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The article focuses on leptospirosis and dengue fever (DF), the two zoonotic infectious diseases with nearly similar clinical manifestation and high probability of coinfection. It outlines several challenges in diagnosis and care giving of patients suffering from these diseases. It discusses about dengue virus and Leptospira. It also offers recommendation for differentiating between these diseases.

Introduction: Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening hematologic disease segregated into familial (primary) and acquired (secondary) subtypes. Hyperinflammation and HLH occur when the immune system fails to clear activated macrophages and histiocytes. Infections, malignancies, and rheumatologic disorders are the major triggers leading to HLH. Miliary tuberculosis is a serious disease with a lymphohematogenous spread of Mycobacterium tuberculosis, which is known to be one of the causative agents of HLH. Miliary tuberculosis and HLH have atypical presentations which are similar to routine diseases. Hence, physicians may face challenges to diagnose and treat these complications. Case report: We report the case of a 60-year-old man with a history of prolonged fever, shortness of breath, jaundice, altered mental status, undiagnosed lower back pain, and overuse of parenteral betamethasone. Miliary tuberculosis was diagnosed by diffuse, vague random micronodules in both lungs and positive acid-fast bacilli in bronchoalveolar lavage and bone marrow aspiration and biopsy. Moreover, compatible presentation and pancytopenia, hypertriglyceridemia, high serum level of ferritin and fibrinogen-derived products, and evidence of hemophagocytosis on bone marrow aspirate led to the diagnosis of HLH. Unfortunately, despite nearly two months of an anti-tuberculosis regimen (standard and salvage) and eight doses of etoposide, he eventually passed away after clinical improvement. Conclusions: Irrational and indiscriminate use of glucocorticoids can be a devastating cause of the spread of tuberculosis and its rare complications, such as HLH. [ABSTRACT FROM AUTHOR]

Background: Global real-time monitoring of SARS-CoV-2 variants is crucial to controlling the COVID-19 outbreak. The purpose of this study was to set up a Sanger-based platform for massive SARS-CoV-2 variant tracking in laboratories in low-resource settings. Methods: We used nested RT-PCR assay, Sanger sequencing and lineage assignment for 930-bp of the SARS-CoV-2 spike gene, which harbors specific variants of concern (VOCs) mutations. We set up our platform by comparing its results with whole genome sequencing (WGS) data on 137 SARS-CoV-2 positive samples. Then, we applied it on 1028 samples from March-September 2021. Results: In total, 125 out of 137 samples showed 91.24% concordance in mutation detection. In lineage assignment, 123 out of 137 samples demonstrated 89.78% concordance, 65 of which were assigned as VOCs and showed 100% concordance. Of 1028 samples screened by our in-house method, 78 distinct mutations were detected. The most common mutations were: S:D614G (21.91%), S:P681R (12.19%), S:L452R (12.15%), S:T478K (12.15%), S:N501Y (8.91%), S:A570D (8.89%), S:P681H (8.89%), S:T716I (8.74%), S:L699I (3.50%) and S:S477N (0.28%). Of 1028 samples, 980 were attributed as VOCs, which include the Delta (B.1.617.2) and Alpha (B.1.1.7) variants. Conclusion: Our proposed in-house Sanger-based assay for SARS-CoV-2 lineage assignment is an accessible strategy in countries with poor infrastructure facilities. It can be applied in the rapid tracking of SARS-CoV-2 VOCs in the SARS-CoV-2 pandemic. [ABSTRACT FROM AUTHOR]

Background and purpose: Influenza is a respiratory infection that annually affects 5-15% of the global population. Influenza A/H1N1 is the most virulent human pathogens that results in a more severe disease and was first reported in 2009. The aim of this study was to investigate the epidemiology of influenza A/H1N1 in patients referring to several hospitals in North of Iran during 2009-2011. Materials and methods: This descriptive cross-sectional study was done on patients with symptoms of influenza using Real-Time PCR analysis. Results: The patients included 572 (41.97%) male and 791 (58.03%) female. The prevalence of influenza A/H1N1 was seen more in patients aged 21-30 (25%) years. In this study, 205 patients (15.4%) were diagnosed with influenza A/H1N1 including 94 (54.85%) male and 111 (54.15%) female. Influenza A/H1N1-associated death was seen in five patients (2.44%). Conclusion: Influenza A viruses are constantly evolving by mutation or by reassortment. The influenza virus evolves rapidly, and new strains quickly replace the older once, therefore, new vaccines should be developed for immunization against new strains of influenza. [ABSTRACT FROM AUTHOR]

Leptospirosis is a zoonotic disease in nearly all parts of the world, especially in tropical and subtropical areas and is prevalent in hot and humid areas. Particularly in the northern provinces of Caspian Sea in Iran by having mild and wet weather conditions, this disease is more spread to other parts of the country. Today, with evolution of the Leptospira, disease from traditional village that enhance its prevalence among farmers and fishing, modified to epidemics in urban communities that do not have good health. Thus the purpose of this review is epidemiology, prevention, diagnosis and treatment of leptospirosis. Prevalence of the disease in each zone depends on climate, geography, population, domestic and wild animals, and the abundance of surface water. Laboratory diagnosis of leptospirosis important and Micro Agglutination Test (MAT) in the diagnosis of disease is Valuable. Molecular tests such as PCR can be used in early detection of disease particularly when there are no specific antibodies. ELISA tests are also important in early screening. Disease prevention will be Possible by increasing awareness of the people at risk, regional health systems employees, and prevention from human contact with contaminated materials and vaccination of livestock and animals. [ABSTRACT FROM AUTHOR]

Background and purpose: Psychiatric disorders as a chronic illness lead to the exacerbation of physical symptoms and controlling them is very difficult. Respiratory chemical damaged veterans have many different psychiatric problems and low health-related quality of life. In this study, we evaluated the relations of spirometry parameters and health- related quality of life with mental health. Material and methods: This was a descriptive- co relational study done on 41 respiratory chemical veterans (Iran-Iraq war) selected with randomized available sampling in Tehran City. We used Spirometry test, St. George's Respiratory Questionnaire (SGRQ) & General Health Questionnaire (GHQ) for assessing the patients and Pearson's correlation matrix for analyzing the data. Results: There were significant negative correlations between the total score of GHQ and depression subscale with FVC & FEV1. There were significant positive correlations between the total score of GHQ and depression & anxiety subscales with total score of SGRQ. There were significant positive correlations between the total score of GHQ and depression & anxiety subscales with "symptoms" score of SGRQ. There were significant positive correlations between the total score of GHQ and depression & anxiety subscales with "impacts" score of SGRQ. Conclusion: Poor mental health condition with increased level of depression & anxiety leads to the decrease in FVC & FEV1 in spirometry and health-related quality of life, and increase in respiratory symptoms such as cough, breathless and sneezing. Totally, there were significant correlations between spirometry and health-related quality of life with mental health. It seems that in rehabilitation programs for mustard gas exposed veterans with chronic respiratory diseases, the psychological and psychiatric interventions should be considered. [ABSTRACT FROM AUTHOR]

Background and purpose: Hyponatremia is the most common electrolyte disorder in hospitalized patients and different report exists about its prevalence. This study aimed at determining the frequency of hyponatremia and its associated factors in hospitalized tuberculosis (TB) patients in Razi hospital, Iran. Materials and methods: This cross-sectional study was done using the existing data and the study population included all TB patients admitted in Razi Hospital during 2006 to 2011. TB was diagnosed based on clinical symptoms, positive sputum culture, positive radiographic finding and anti TB treatment. Variables included level of Na, age, sex, and drug regimen (standard / second line). Hyponatremia were sodium levels less than 135 in two consecutive tests. The data was analyzed by SPSS and Chi-square test. Results: The cases were 200 TB patients including 115 (57.5%) male. The mean age of patients was 51.2 ± 20.8 years. Hyponatremia was seen in 36(18%) patients (CI 95%: 12.6% -23.4%). Distribution of mortality was not significantly different in patients with and without hyponatremia (P>0.05). No significant difference was seen in frequency of hyponatremia according to the type of tuberculosis. Conclusion: Hyponatremia was considerably higher in patients with TB which should receive more attention for proper management and follow up. [ABSTRACT FROM AUTHOR]

Objectives: The Bruton tyrosine kinase (BTK), an important element for the production of several inflammatory cytokines, may play a role in the pathogenesis of COVID-19. The aim of this study was to investigate the level of BTK gene expression in COVID-19 cases based on the severity and the outcome of the disease., Methods: In this study, 33 hospitalized patients with COVID-19 were recruited and were divided into two groups based on the severity of the disease: "mild to moderate" and "severe to critical". A blood sample was taken from each patient, peripheral blood mononuclear cells (PBMCs) were extracted, and BTK gene expression was measured. The level of BTK gene expression was compared based on the demographic data, laboratory results, and the severity and outcome of the disease., Results: Among 33 patients, 22 (66.7%) were male. Nearly half of the cases had at least one underlying disease. According to the severity of the disease, 12 patients were in the "mild to moderate" group, and 21 were in the "severe to critical" group; eight (24.2%) eventually died. Age, weight, and BMI had no significant relationship with BTK expression. BTK expression was significantly lower in "severe to critical" and ICU-admitted cases and in subjects with low O2 saturation. There was no significant difference in BTK expression between cured and dead patients (p=0.117)., Conclusion: BTK gene expression in PBMCs had an inverse relationship with the severity of the disease of COVID-19. However, no correlation between BTK expression and disease outcome was observed., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: Coronavirus disease 2019 (COVID-19), an acute, sometimes severe respiratory illness caused by a novel coronavirus has led to a vast pandemic with an astonishing spread rate. Its treatment is unknown, its mortality is significant, and its socioeconomic complications are uncontrollable. Although there is still little known about the pathogenesis of the disease, severe cases of COVID-19 are usually associated with cytokine release syndrome and high serum levels of inflammatory cytokines, which are believed to be a major cause of mortality in these patients. Different pathways cause inflammation and the release of cytokines. One of these pathways is the Bruton tyrosine kinase (BTK) pathway, which is essential for the production of several anti-inflammatory cytokines. Theoretically, the inhibition of BTK signaling can reduce cytokine levels and subsequent anti-inflammatory effects., Objective: This review aims to investigate the role of the BTK pathway in the pathogenesis of COVID-19 and the possible effects of its inhibition in the treatment of this disease., Methods: This narrative review provides information regarding the use of BTK inhibitors in patients with COVID-19 and discusses whether clinicians should consider these medications while managing their patients based on the literature. Data were gathered using the PubMed, Scopus, and Web of Science databases., Results: Some data support the use of BTK inhibitors for treating COVID-19., Conclusions: It is recommended that patients continue their medications in this class if they develop COVID-19 and were receiving these agents before the disease developed. The use of BTK inhibitors might enable patients to experience less severe immune responses to the COVID-19. Well-designed studies are needed to evaluate the effectiveness of BTKis in the management of COVID-19. (Curr Ther Res Clin Exp. 2022; 82:XXX-XXX) © 2022 Elsevier HS Journals., Competing Interests: The authors have indicated that they have no conflicts of interest regarding the content of this article., (© 2021 The Authors.)

Considering the increasing prevalence and burden of coronavirus disease 2019 (COVID-19) disease and false-negative results in routine reverse transcription-polymerase chain reaction (RT-PCR) tests, additional diagnostic methods are needed to diagnose active cases of this disease. This prospective study was conducted on patients, in whom clinical and radiological symptoms/signs were in favor of COVID-19 while their first PCR test was negative. Later on, a second RT-PCR was performed and serological evaluation was carried out and results were compared with each other. Out of 707 patients who had been referred to the hospital and were clinically and radiologically suspicious of disease, 137 patients with negative RT-PCR tests entered the study. RT-PCR assay became positive for the second time in 45 (32.8%). Anti-COVID-19 IgM and IgG antibodies were positive in 83 (60.6%) and 86 (62.8%) patients, respectively. Finally, it was determined that serological test was diagnostic in 73% of patients and the diagnostic yield of serology was significantly higher after the first week of illness (54.8% in the first week and 88% after that). Taking advantage of both serological tests and RT-PCR helps in diagnosing 83.9% of cases. Based on the present study, the serology may be useful as a complementary test and in parallel to RT-PCR assay for diagnosis of COVID-19 among admitted symptomatic cases.

Competing Interests: Conflict of Interest The authors declared that they have no conflict of interest.

Background: A surgical site infection (SSI) is the most common nosocomial infection after surgery and is the third most common infection in hospitalized patients. The aim of this study was to asses minimum inhibitory concentration (MIC) of the causing agents of SSI and antimicrobial susceptibility patterns., Methods: This cross-sectional study was done in three referral hospitals in North of Iran during 2011-2012. The samples were taken one month after orthopedic, abdominal, cesarean section surgery and coronary artery bypass graft (CABG) in patients with scores compatible to SSIs criteria. The sample was sent for bacteriologic culture and MIC determination for positive cases by broth microdilution method. The data were collected and analyzed., Results: From 103 positive cases S. aureus, E.coli and coagulase negative staphylococci were the most common isolated agents as 29.12%, 23.3% and 21.3%, respectively. S. aureus was sensitive to vancomycin (70%), amikacin (70%) and teicoplanin (76.6%) and cogulase negative staphylococci was sensitive to vancomycin (68.1%) and teicoplanin (72.6%) and E.coli to amikacin (95.83%) and imipenem and meropenem (66.66%). P.aeroginosa showed no sensitivity to cefepime and was sensitive to imipenem (93.75%) and meropenem (81.25%)., Conclusion: The most important point is worrisome problem of the increased MIC of S. aureus to vancomycin that causes difficult use in the treatment of staphylococcal SSIs. In spite of resistance of micro-organisms to cephalosporins, gram negative organisms had low MIC to carbapenemes especially P.aeroginosa although the rate of its MIC is increasing.

Nosocomial, or hospital-acquired, infections are considered the most common complications affecting hospitalized patients. According to results obtained from studies conducted in the Children Medical Center Hospital, a teaching children's hospital and a tertiary care referral unit in Tehran, Iran, improvements in infection control practices in our hospital seem necessary. The aim of this study was to identify risk management and review potential hospital hazards that may pose a threat to the health as well as safety and welfare of patients in an Iranian referral hospital. Barriers to compliance and poor design of facilities, impractical guidelines and policies, lack of a framework for risk management, failure to apply behavioral-change theory, and insufficient obligation and enforcement by infection control personnel highlight the need of management systems in infection control in our hospital. In addition, surveillance and early reporting of infections, evaluation of risk-based interventions, and production of evidence-based guidelines in our country are recommended.

Background: Planning, organizing, staffing, leading and monitoring are the basic functional component of management. In present article, we aim to define the project monitoring and evaluation in health research system (HRS) considering its success and challenges based on our national experience., Methods: IN THIS STUDY BASED ON THE INFORMATION OF ANNUAL MEDICAL SCIENCE UNIVERSITIES EVALUATION DURING THE LAST DECADE THE HRS INDICATORS HAVE BEEN SCORED IN THREE AXES BASED ON HRS FUNCTIONS: Stewardship, capacity building and knowledge production. In this article, we will focus on the results of HRS evaluation from 2002 to 2010, also on its success and challenges., Results: In an overall view, the main results are the experiences of the designing and implantation of such process after pre-project preparation, all parts followed under the whole supervision of the aims of the HRS evaluation. Project management light the way of practical application of knowledge, skills, tools and techniques for better HRS evaluation and management., Conclusions: We concluded that; although monitoring and evaluation as an essential part of HRS Management light the improvement ahead way but we still need to advantage of the new project management advances.

Background: Studies have shown that Mindfulness Based Stress Reduction (MBSR) has positive effect on physical and psychological dimensions of chronic illnesses. In this study for the first time we examine the effect of this new technique on quality of life and pulmonary function in chemically pulmonary injured veterans who have chronic pulmonary problem, psychological problems and low quality of life., Methods: Forty male pulmonary injured veterans were randomly replaced in two groups with 20 participants (MBSR and control Wait List (WL)). Then MBSR group received 8-weekly sessions intervention. We evaluate quality of life (used SF-36 questionnaire) and Spirometry parameters two times; before and after intervention in two group. We used "mixed factorial analyses of variance" test for analyzing data in each dependent variables. Then if we have significant interactional effect, we used -paired- sample t-test" for comparing before and after intervention data of each group, and "Independent-Sample t-test" for comparing after intervention data of two groups., Results: The MBSR compare to WL group improved SF-36 total score, (F (1, 38) =12.09, P=0.001), "Role limitations due to physical problems"(F(1,38)= 6.92, P=0.01), "Role limitations due to emotional problems"(F(1,38)= 7.75, P=0.008), "Social functioning"(F(1,38)= 9.89, P=0.003), "Mental health"(F(1,38)= 15.93, P=0), "Vitality"(F(1,38)= 40.03, P≤0.001), and "Pain"(F(1,38)= 27.60, P≤0.001). MBSR had no significant effect on "FEV1" (F (1, 38) = 0.03, P=0.85),"FVC" (F (1, 38) = 0.16, P=0.69) and "FEV1/FVC" (F (1, 38) = 2.21, P=0.14)., Conclusion: MBSR can improve individual's quality of life but not lung function in chemically pulmonary injured veterans.

Objective: The aim of this study was to compare problem solving strategies between peoples with high and low emotional intelligence (EI)., Methods: This study is a cross sectional descriptive study.The sample groups include senior BS& BA between 20-30 years old into two with high and low emotional intelligence, each group had 30 subjects.Data was analyzed with non-parametric chi square test for main dependent variable (problem solving strategies) and accessory dependent variables(manner of starting and fulfillmentof the test).The Independent two group T-test was used for analyzing other accessory dependent variables(Number of errors and total time used for fulfillment of the test)., Results: There was a significant difference between two groups in "number of errors" (t=-3.67,p=0) and "total time used for fulfillment of the test"(-6.17,p=0) and there was significant relation between EI and "problem solving strategies" (χ2=25.71, p<0.01) and (Cramer's v = 0.65, p<0.01) .Also there was significant relation between EI and "fulfillment of test" (χ2=20.31, p<0.01) and (φ=0.58, p<0.01). But the relation between EI and "manner of starting the test" was not significant (χ2=1.11, p=0.29). Subjects with high EI used more "insightful" strategy and subjects with low EI used more "trial- error" strategy. The first group completed the test more rapidlyand with fewer errors, compared with the second group. In addition the first group was more successful in performing the test than the second one., Conclusion: People with high EI significantly solve problems better than people with lowEI.

Background: The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data., Methods: All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period., Results: There were 24959 procedures performed: 19663 (78.8%) isolated coronary artery bypass grafting surgeries (CABGs); 1492 (6.0%) isolated valve surgeries; 1437 (5.8%) CABGs concomitant with other procedures; 832 (3.3%) CABGs combined with valve surgeries; 722 (2.9%) valve surgeries concomitant with other procedures; 545 (2.2%) surgeries other than CABG or valve surgery; and 267 (1.1%) CABGs concomitant with valve and other types of surgery. The overall mortality was 205 (1.04%), with the lowest mortality rate (0.47%) in the isolated CABGs and the highest (4.49%) in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males (1.90% vs. 0.74%, respectively)., Conclusion: Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD.

Objective: Emotional intelligence (EI) is a set of competencies that enable us to engage in sophisticated information processing of emotions and emotion-relevant stimuli and to use this information as a guide for thinking and behavior. Prefrontal cortexes (PFC) of brain and related regions have an important role in emotion and emotional regulation. Accordingly, we conducted a study to investigate the relation between EI and performance in Wisconsin Card Sorting Test (WCST) (a neuropsychological test, used to evaluate some of the frontal lobe functions)., Methods: In this quasi-experimental study, 250 volunteers from BS and BA students of universities of Tehran were recruited using available sampling method. Bar-on EI, general health questionnaire (GHQ-28) and Raven's Progressive Matrices were completed by the participants. They were categorized into two groups; each group contained 40 students with high and low EI, whose performance in WCST were evaluated thereafter individually. Data was analyzed by MANOVA., Results: Our results showed that the high EI group had a better performance in WCST than the low EI group., Conclusion: It can be concluded that people with better EI may have better PFC functions.