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Background: Pneumonia is one of the common infectious diseases in the community and hospital, which can cause complications and death if not treated. Correct treatment of this disease is important. Therefore, in this study, we aimed to evaluate antibiotic stewardship for pneumonia with the American Thoracic Society (ATS) guidelines in Loghman Hakim Hospital in 2021. Materials and Methods: In this descriptive study, all patients admitted to Loghman Hakim Hospital in 2021 with pneumonia were evaluated. Age, gender, type of pneumonia (healthcare-associated pneumonia, community-acquired pneumonia, community-acquired aspiration pneumonia, early-onset and late-onset hospital-acquired pneumonia, ventilator-associated pneumonia, and hospital-acquired aspiration pneumonia), antibiotic type and dose, and renal dose adjustment of antibiotics were recorded. Then, the antibiotic prescription protocol in patients with pneumonia was compared with the ATS guidelines. Results: 72 people were included in the study; 11 (15.28%) had healthcare-associated pneumonia (HCAP), 24(33.33%) community-acquired pneumonia (CAP), 20(27.78%) community-acquired aspiration pneumonia (CAAP), 7(9.72%) hospital-acquired pneumonia (HAP), 4(5.56%) hospital-acquired aspiration pneumonia (HAAP), and 6 (8.33%) patients had ventilator-associated pneumonia (VAP). 31.94% did not receive antibiotics according to the protocol. 13.88% of patients received antibiotics correctly, but with the wrong dose, and in 18.06% of patients, the type of antibiotic was wrong (P-value=0.102). Conclusion: Monitoring antibiotic stewardship in the hospital for patients with pneumonia is necessary.

Background: Imaging and PCR each have a role in detecting and implementing precautionary measures in isolating individuals with a history of close contact, which helps limit the COVID-19 pandemic. Due to developing countries' difficulties, PCR is limited in Iran. This study seeks to determine the feasibility of early low-dose chest computed tomography (CT) scans substitution with PCR. Materials and Methods: Asymptomatic participants with a history of close contact with a confirmed case of COVID-19 were enrolled and followed for one week, receiving 2 PCR tests within one week. Initially, a chest CT scan was performed. The second CT scan was performed within one week on two participants. Participants with an initially negative CT scan and participants with a first CT scan compatible with COVID-19 who became symptomatic. Results: All Participants had an RT-PCR and at least one CT scan. Positive RT-PCR results were reported in 6 and 9 participants initially and within one week, respectively. Chest CT scans favoring COVID-19 infection were initially reported in 4 and 6 participants within one week, respectively. Seventeen participants showed neither symptoms nor positive RT-PCR or chested CT scans favoring COVID-19. Thirteen participants either had positive RT-PCR, a COVID-19 chest CT scan or became symptomatic. Conclusion: Rapid detection of COVID-19 and subsequent quarantining is crucial in the global fight against this pandemic. Our results showed lower sensitivity for chest CT scans compared to COVID-19 PCR, suggesting that chest CT scans are unsuitable for COVID-19 PCR tests.

Purpose: Vancomycin is a narrow therapeutic window glycopeptide antibiotic that acts against Gram-positive bacteria. As it is renally eliminated, therapeutic drug monitoring is recommended for vancomycin, especially in case of kidney function alteration. Augmented renal clearance (ARC), defined as a creatinine clearance of more than 130 ml/min, is a risk factor for sub-therapeutic concentrations of vancomycin. This study aimed to evaluate the vancomycin pharmacokinetics following the administration of two different regimens in ARC patients.Methods: A randomized clinical trial (IRCT20180802040665N1) was conducted on patients in need of vancomycin therapy. Eight hours of urine was collected and 56 patients divided into two groups with creatinine clearance of more than 130 ml/min were included in the study. The first group received 15 mg/kg of vancomycin every 12 h and the second group 15 mg/kg every 8 h. After four doses, the peak and trough concentrations were measured from two blood samples. The primary outcome was the percentage of patients who attainted AUC more than 400. The occurrence of acute kidney injury also was evaluated after seven days.Results: The mean age of patients in the every 12 h and every 8 h groups was 44.04 ± 16.55 and 42.86 ± 11.83 years, respectively. While neurosurgical issues were the most common causes of hospitalization, central nervous infections were the most common indications for vancomycin initiation. Urinary creatinine clearance was 166.94 ± 41.32 ml/min in the every 12 h group and 171.78 ± 48.56 ml/min in the every 8 h group. 46.42% of patients in the every 12 h group and 82.14% of patients in the every 8 h group attained AUC/MIC of more than 400 mg × hr/L. None of the patients in the every 12 h group reached more than 15 mcg/ml concentration. At the 7-day follow-up, 10.7% patients in the BD group and 28.6% patients in the TDS group developed acute kidney injury (p = 0.089).Conclusion: Administration of vancomycin at a dose of 15 mg/kg every 8 h is associated with higher pharmacokinetic attainment in ARC patients. The occurrence of acute kidney injury also was not significantly higher in this therapeutic regimen. AUC/MIC monitoring is necessary in this population.

Abstract Serotonin syndrome is a potentially life‐threatening adverse drug reaction typically caused by a single or combination of two or more medications with serotonergic properties due to increased serotonin release. Our case is a 60‐year‐old drug‐addict man who was admitted to the poisoning department of Loghman hospital with methadone poisoning. On the fifth day of hospitalization and after initiating the linezolid treatment for VAP, the patient began to run a fever with agitation, tremor, spontaneous clonus movement in the hands, and tachycardia. Due to patients' manifestations and after ruling out other diagnoses, serotonin syndrome was confirmed with the possibility of concomitant use of linezolid and methadone. Linezolid administration was promptly discontinued, and vancomycin therapy was initiated (1000 mg twice a day intravenously). Supportive therapies were performed. Finally, tremor, rigidity, and clonus movement disappeared within 48 h.

Abstract Datura spp. is a potentially poisonous plant that is widely spread and is simply accessible, which can yield poisoning with a central and peripheral anticholinergic effect. We reported cases of family poisoning caused by the herbal tea with refreshing effects that were identified as Datura spp.

Abstract Here, a case of Sputnik‐V vaccine‐induced panniculitis was reported. The patient developed erythema, induration, and local tenderness at the injection site after 13 days of the injection. Ultra‐sonography imaging showed inflammation in subcutaneous layers including fat tissue compatible with panniculitis. She received ibuprofen and warm compress, and all symptoms resolved.

Background: Due to uncontrolled lymphocyte reaction, the overproduction of cytokines in COVID-19 patients can cause sepsis-like symptoms, suggesting sepsis, cytokine release syndrome (CRS), and secondary hemophagocytic lymphohistiocytosis (sHLH). Since different therapeutic approaches are used for each diagnosis, differentiation is essential. This study aims to use H-score as a possible prognostic tool in COVID-19 patients. Methods: A sample of 64 moderate and severe COVID-19 patients was enrolled in this study. Clinical and laboratory findings were assessed. H-score was initially calculated and reevaluated among severe cases 72 hours later and among moderate cases showing severe features of COVID-19. Results: Mortality of 31.3% was reported. Laboratory findings, including triglycerides (TG), ferritin, and aspartate aminotransferase (AST) showed significantly higher initial and follow-up laboratory assessment levels in severe cases than in moderate cases. Moreover, fibrinogen was significantly higher among severe cases than moderate cases at the initial assessment, but no significant difference was reported in the second fibrinogen assessment. Conclusion: In this study, H-score was useful as a predictive tool for the initial evaluation of severe cases of COVID-19. H-score is much lower in these patients than in non-COVID-19 HLH patients may be due to the different underlying immunologic pathophysiology of COVID-19; thus, each H-score criterion must be evaluated for sensitivity and specificity in COVID-19 patients. The H-score cut-offs, H-score may be useful for diagnosing immune overreaction and determining the need for more exclusive immunomodulatory treatments.