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The current pandemic made scientists create new platforms of vaccines to fight against SARS-CoV-2. Without a doubt, the new forms of present vaccines could develop a diversity of unknown complications. Sputnik V vaccine with two different adenovirus vectors (Ad26 priming and Ad5 boost) was first announced safe and effective by Russia. However, there are controversies surrounding this vaccine such as the possible decline of its immunogenicity and diminished neutralizing capacity against some Covid-19 variants. In addition, its impression on serum biomarkers is not clearly surveyed. The present study aimed to evaluate the frequency of Sputnik V vaccine-related complications and its impression on inflammatory and hematologic biomarkers.An observational cohort study was performed to evaluate the side effects and serum biomarkers changes in healthcare workers receiving Sputnik V vaccine. The vaccine adverse events were recorded daily within 60 days. The blood samples were obtained before vaccination, and on the10th day after each dose of vaccination. The prevalence of all complications and inflammatory biomarkers levels were compared between two doses. All analyses were performed using SPSS software version 22.0.Totally, 126 participants completed the study. The mean age was 37.19 ​± ​7.73 years. The prevalence of all complications was higher following the first dose than the second dose. The most common side effects were pain at the injection site, body pain, fever, headache, weakness, vertigo, sore throat and sleep disorder. The hematocrit, mean corpuscular volume of red blood cells and neutrophils count declined following vaccination significantly (P-value; 0.04, 0.039, 0.000 respectively).It seems the side effects of Sputnik-V vaccine are mild and decrease significantly after the second dose. The decreasing level of hematocrit, MCV and neutrophil count was found significant following vaccination.

Background: The combination of sofosbuvir (SOF) and daclatasvir (DCV) has shown preliminary efficacy for patients with COVID-19 in five open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir and daclatasvir to standard care improved clinical endpoints in hospitalized patients with moderate or severe COVID-19. Methods: This was a placebo-controlled, randomized clinical trial in adults with moderate or severe COVID-19 admitted to 19 hospitals in Iran. Patients were randomized to SOF/DCV 400/60mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O 2 saturation

Achieving high COVID-19 vaccination coverage rates is essential as soon as a vaccine is available to deal with and end this pandemic. Due to the different amounts of COVID-19 vaccine acceptance rates in different regions, the pooled estimation of this rate is essential. Therefore, we conducted a systematic review and meta-analysis to investigate worldwide COVID-19 vaccine acceptance rates.International databases (including, Web of sciences, PubMed, and Scopus) were searched to identify related studies. The heterogeneity among studies was assessed using the IThe overall pooled estimate of COVID-19 vaccine acceptance rate was 65.1 (95% CI 60.1-70.1;COVID-19 vaccine acceptance rate among HCWs is lower than the general population. More studies are recommended to identify related factors to the COVID-19 vaccine acceptance rate.

Aim: In this study our aim was to elucidate whether advanced cancer patients benefit from antibiotic treatment in the last days of life in addition to reviewing the relevant costs and effects.Materials and methods: We reviewed medical records from 100 end-stage cancer patients that treated with antibiotics during the hospitalization in Imam Khomeini hospital. Patient's medical records were analyzed retrospectively for cause and periodicity of infections, fever, increase in acute phase proteins, cultures, type and cost of antibiotic. Results: Microorganisms were found in only 29 patients (29%) and the most microorganism among the patients was E.coli (6%). About 78% of the patients had clinical symptoms. The highest dose of antibiotics was related to Ceftriaxone (40.2%) and in the second place was Metronidazole (34.7%) and the lowest dose was related to Levofloxacin, Gentamycine and Colistine (1.4%). Fifty-one patients (71%) did not have any side effects due to antibiotics. The most common side effect of antibiotics among patients was skin rash (12.5%). The average estimated cost for antibiotic use was 7935540 Rials (24.4 dollars).Conclusion: Regardless of not prescribing antibiotics or the type of antibiotics used, it was ineffective in treating advanced cancer patients. The cost of using antibiotics during hospitalization is very high, and physicians should consider the risk of developing resistant hospital strains. Antibiotic side effects also occur in patients, causing more harm to the patient at the end of life.

OBJECTIVE: To compare the clinical and paraclinical features and outcomes of pregnant and nonpregnant women with COVID-19. METHODS: A multicenter retrospective cohort study of pregnant and nonpregnant women of reproductive age hospitalized between March and October 2020 in Tehran, Iran. Medical records were reviewed and women who tested positive for SARS-CoV-2 on RT-PCR were included. Extracted data were compared and logistic regression performed. RESULTS: A total of 110 pregnant and 234 nonpregnant COVID-19-positive women were included. Frequency of severe disease was higher in nonpregnant women than pregnant women (29% vs 11.8%; P

BACKGROUND AND OBJECTIVES: A notable proportion of COVID-19 patients need statins for their co-existing conditions. Statins possess several anti-inflammatory properties. We have attempted to describe potential association of exposure to statins and severity of COVID symtpoms in a historical study in hospitalized COVID-19 patients. METHODS: This single-center, historical cohort study was performed in Baharloo hospital as a referral hospital for COVID-19 patients in Tehran. Patients were divided into two groups; 163 statins users and 547 non-users. Mortality rate, intensive care unit (ICU) admission and length of hospitalization were compared between studied groups. In addition, during the investigation, pre-existing conditions were evaluated for groups. If a significant difference was observed between groups, the feature was considered in the adjustment of the odds ratio. RESULTS: At the beginning, statistical analysis study showed that statins users had significantly (p

Background: The current study aimed to identify effective factors on the death among COVID-19 patients. Methods: All articles published in the period Jan 1, 2020, to Mar 23, 2020, written in English and reporting factors associated with COVID-19 mortality were reviewed. The random-effects model with 95% CI was used to calculate the pooled Odds Ratio (OR) and Hazard Ratio (HR). Data were analyzed using Stata ver.11.0. Results: The older age OR: 1.21(1.10-1.33) and male gender OR: 1.41(1.04-1.89) were most prone to death due to COVID-19. The Comorbidity with some chronic diseases such as Diabetes type2 OR: 2.42(1.06-5.52), Hypertension OR: 2.54(1.21-5.32), Kidney disorder OR: 2.61(1.22-5.60), Respiratory disorder 3.09 (1.39-6.88) and Heart diseases OR: 4.37 (1.13-16.90) can increase the risk of COVID19 mortality. Conclusion: Infection with COVID-19 is associated with substantial mortality mainly in older patients with comorbidities. We found the significant effect of age, gender and comorbidities such as Diabetes Mellitus, Hypertension, Kidney disorders and Heart diseases on the risk of death in patients with COVID-19. The factors associated with mortality found in this research can help to recognize patients with COVID-19 who are at higher risk of a poor prognosis. Monitoring these factors can serve to give early warning for the appropriate interventions.

Cerebrovascular accident is the second most common cause of death in the world. Herpes zoster (HZ) is reported to be a major trigger of the stroke syndrome. Considering the high prevalence of stroke in Iran, we carried out a study to assess the correlation between stroke and HZ. This is one of the very few studies carried out on this correlation in Asian nations. One hundred and five cases and 105 controls were included in this study. The cases had been diagnosed with stroke by a neurologist and confirmed by brain imaging. The controls had never had any type of stroke. Both groups were between 30 and 90 years of age. We looked for the HZ infection in both groups. Logistic regression analysis was used to evaluate the association between stroke and HZ. The mean age of the cases was 63.95 ± 12.24 years and the man age of the controls was 66.99 ± 14.58 years. There was a significant difference in the HZ infection between the cases and the controls (P < .0001). Head zoster (including ophthalmic zoster) was significantly higher in the case group than the control group (P < .0001). The risk of stroke was the highest 2-4 weeks after the onset of HZ and the incidences of ischemic stroke were higher than those of hemorrhagic stroke (P < .0001). In an analysis adjusted for the age, sex, and hypertension, HZ was found to be associated with an increased risk of stroke (odds ratio, 5.84; 95% confidence interval, 1.98-8.23). Close monitoring is suggested for cerebrovascular diseases in patients who have had the head zoster, especially in the first month after the infection.

Urinary tract infection is one of the most common infections and its treatment is complicated by the emergence of antibiotic resistance. Resistance patterns of organisms differ between community-acquired and hospital-associated urinary tract infections.The aim of this study was to determine the most effective antibiotics against uropathogens and if antibiotic resistance differed by setting (inpatient versus outpatient).This 2016-2017 cross-sectional study examined 300 midstream clean-catch urine samples with positive culture (150 outpatient and 150 inpatient samples) for the uropathogens isolated and the resistance of these pathogens to different antibiotics. Samples were obtained from the laboratory of Baharloo hospital, Tehran. The differences in antibiotic resistance between inpatient and outpatient uropathogens were analysed using the chi-squared test.Escherichia coli (72.0% of the 300 samples) and Klebsiella spp (13.0%) were the most common uropathogens isolated. A greater proportion of inpatient samples showed resistance to ceftriaxone, cefixime, sulfamethoxazole-trimethoprim, ciprofloxacin and nalidixic acid than the outpatient samples (P0.05). The most effective antibiotics for Gram-negative uropathogens were imipenem (only 6.0% of these uropathogens overall were antibiotic-resistant), amikacin (6.3%) and nitrofurantoin (10.3%).Uropathogen resistant rates in inpatients were higher than outpatient rates. The use of imipenem and amikacin instead of traditional first-line empirical therapy (fluoroquinolone and sulfamethoxazole-trimethoprim) is advised for hospitalized patients with urinary tract infections.مقاومة المضادات الحيوية: مقارنة بين مُْرضات الجهاز البولي التي تصيب المرضى الداخليين والمرضى الخارجيين، جمهورية إيران الإسلامية.حامد اخوی زاد جان، حدیثه هوسمی رودسری، هدایت اله بیروتی، سمانه اکبرپور.تُعدُّ عدوى الجهاز البولي من أكثر أنواع العدوى شيوعاً، ويتعقد علاجها بسبب ظهور مقاومة المضادات الحيوية. وتختلف أنماط مقاومة الكائنات الحية فيما بين عدوى الجهاز البولي المكتسبة مجتمعياً والعدوى المرتبطة بالمستشفيات.هدفت هذه الدراسة إلى تحديد أكثر المضادات الحيوية فعالية ضد مُْرضات الجهاز البولي في أحد مستشفيات جمهورية إيران الإسلامية، وما إذا كانت مقاومة المضادات الحيوية تختلف باختلاف المكان (المرضى الداخليين في مقابل المرضى الخارجيين).فحصت هذه الدراسة المقطعية التي أُجريت خلال الفترة 2017 – 2016 300 عينة نظيفة من وسط جريان البول جاءت نتائج زرعها إيجابية (150 عينة من المرضى الخارجيين و 150 عينة من المرضى الداخليين) للكشف عن مُْرضات الجهاز البولي وعزلها والكشف عن مقاومتها للمضادات الحيوية المختلفة. وتم الحصول على عينات من مختبر مستشفى بهارلو في طهران. وحُلِّلت الاختلافات في مقاومة المضادات الحيوية بين مُْرضات الجهاز البوليفي صفوف المرضى الداخليين والمرضى الخارجيين باستخدام اختبار مربع كاي.كانت الإشريكية القولونية (72.0٪) من العينات البالغ عددها 300 عينة) والكليبسيلة بأنواعها (13.0٪) أكثر مُْرضات الجهاز البولي المعزولة شيوعاً. وأظهرت نسبة أكبر من عينات المرضى الداخليين مقاومة لسيفترياكسون، وسيفيكسيم، وسلفاميثوكسازول - تريميثوبريم، وسيبروفلوكساسين، وحمض ناليديكسيك، مقارنة بعينات المرضى الخارجيين (0.05P) وكانت المضادات الحيوية الأكثر فعالية مع مُْرضات الجهاز البولي سالبة الجرام هي الإيميبينيم (6.0٪) وحسب من مُْرضات الجهاز البولي إجمالاً كانت مقاومة للمضادات الحيوية)، والأميكاسين (6.3٪)، والنيتروفورانتوين (10.3٪).كانت معدلات مقاومة مُْرضات الجهاز البولي في صفوف المرضى الداخليين أعلى من نظيرتها في صفوف المرضى الخارجيين. ويُنصح باستخدام الإيميبينيم والأميكاسين بدلاً من علاج الخط الأول التجريبي التقليدي (الفلوروكوينولون وسلفاميثوكسازول - تريميثوبريم) للمرضى الذين يدخلون المستشفى لوجود عدوى بالجهاز البولي.Résistance aux antibiotiques : comparaison entre les agents uropathogènes associés aux soins hospitaliers et ambulatoires.L’infection urinaire est l’une des infections les plus fréquentes et son traitement est compliqué à cause de l’apparition d’une résistance aux antibiotiques. Les schémas de résistance des organismes diffèrent entre les infections des voies urinaires acquises dans la communauté et les infections hospitalières.Le but de la présente étude était de déterminer les antibiotiques les plus efficaces contre les agents uropathogènes et si la résistance aux antibiotiques différait selon le contexte (patient hospitalisé ou ambulatoire).La présente étude transversale réalisée en 2016-2017 a examiné 300 échantillons d’urine de capture propre à mi-jet avec culture positive (150 échantillons pour les patients ambulatoires et 150 échantillons pour les patients hospitalisés) pour détecter les uropathogènes isolés et la résistance de ces agents pathogènes à différents antibiotiques. Les échantillons ont été obtenus au laboratoire de l’hôpital Baharloo, à Téhéran. Les différences en matière de résistance aux antibiotiques entre les agents uropathogènes associés aux soins hospitaliers et ambulatoires ont été analysées à l’aide du test du khi carré.Escherichia coli (72,0 % des 300 échantillons) et Klebsiella spp (13,0 %) étaient les uropathogènes les plus fréquemment isolés. Une plus grande proportion d'échantillons ambulatoires que d’échantillons hospitaliers ont montré une résistance à la ceftriaxone, à la céfixime, au sulfaméthoxazole-triméthoprime, à la ciprofloxacine et à l'acide nalidixique (p0,05). Les antibiotiques les plus efficaces pour les agents uropathogènes à Gram négatif étaient l'imipénem (seulement 6,0 % de ces uropathogènes étaient résistants aux antibiotiques), l'amikacine (6,3 %) et la nitrofurantoïne (10,3 %).Les taux de résistance des uropathogènes étaient plus élevés chez les patients hospitalisés que chez les patients ambulatoires. L’utilisation de l’imipénem et de l’amikacine au lieu d’un traitement empirique de première intention traditionnel (fluoroquinolone et sulfaméthoxazole-triméthoprime) est recommandée pour les patients hospitalisés souffrant d’infections des voies urinaires.

• Presented here is a rare case of ophthalmic zoster that caused cortical blindness and deafness after central nervous system involvement.

Cerebrovascular accident is the second most common cause of death in the world. Herpes zoster (HZ) is reported to be a major trigger of the stroke syndrome. Considering the high prevalence of stroke in Iran, we carried out a study to assess the correlation between stroke and HZ. This is one of the very few studies carried out on this correlation in Asian nations. One hundred and five cases and 105 controls were included in this study. The cases had been diagnosed with stroke by a neurologist and confirmed by brain imaging. The controls had never had any type of stroke. Both groups were between 30 and 90 years of age. We looked for the HZ infection in both groups. Logistic regression analysis was used to evaluate the association between stroke and HZ. The mean age of the cases was 63.95 ± 12.24 years and the man age of the controls was 66.99 ± 14.58 years. There was a significant difference in the HZ infection between the cases and the controls (P .0001). Head zoster (including ophthalmic zoster) was significantly higher in the case group than the control group (P .0001). The risk of stroke was the highest 2-4 weeks after the onset of HZ and the incidences of ischemic stroke were higher than those of hemorrhagic stroke (P .0001). In an analysis adjusted for the age, sex, and hypertension, HZ was found to be associated with an increased risk of stroke (odds ratio, 5.84; 95% confidence interval, 1.98-8.23). Close monitoring is suggested for cerebrovascular diseases in patients who have had the head zoster, especially in the first month after the infection.

Disseminated Mycobacterium avium complex (MAC) infections occur in late stage of AIDS. Highly active antiretroviral therapy (HAART) decreases the incidence of MAC infection, but patients with low CD4 counts who have no access to HAART, are remained at risk. The intestine is involved in disseminated MAC which causes gastrointestinal tract symptoms. Spontaneous perforation of small bowel, only ileum by disseminated MAC is documented in one case report. We present a rare case of disseminated MAC infection that led to the multiple spontaneous perforation of small intestine in ileum and cecum. The patient deceased, despite immediate surgical intervention. Mycobacterium avium complex is an important cause of multiple, spontaneous small bowel perforation. We recommend administrating MAC prophylaxis in HIV positive patients who do not have access to HAART therapy.

Introduction: Tuberculous meningitis (TBM) is the most fatal form of tuberculosis. Despite adequate treatment, its mortality and morbidity is high. Clinical, laboratory, and radiologic findings help in diagnosis of TBM, although analysis of cerebrospinal fluid (CFS) might sometimes delay and mislead the rapid diagnosis. Case Presentation: We present a 14- year- old Afghan immigrant male, with uncommon laboratory results of advanced TBM, who referred to Baharloo hospial in Tehran, Iran, in September 2016. He experienced headache and anxiety one month prior to referring to the hospital; he had fever, severe headache, vomiting and showed bizarre behavior 7 days before admission. Suspecting meningoencephalitis, the physician advised empirical treatment. The first CSF revealed polymorphonuclear (PMN) predominance with low glucose, which was repeated in the second and third CSF analysis. This pattern indicates early phase of TB meningitis. In day 4, antituberculous treatment with corticosteroid was administered empirically. Unfortunately, he succumbed to disease in day 36. Polymerase chain reaction (PCR) for mycobacterium tuberculosis (MTB) in CSF was positive. The patient’s presentation (lethargic to coma) and brain computed tomography (CT) scan indicated advanced stage of disease. Conclusions: All physicians should consider TB meningitis in any patient with low glucose even with serial PMN predominance in CSF.

Introduction: Iran is amongst endemic countries for Fasciola hepatica. Individuals can become infected by consumption of contaminated uncooked green vegetables. In the chronic cases, symptoms are fever, vague abdominal pain with eosinophilia. Patients sometimes have symptoms and signs of hepatobiliary involvements such as cholangitis and cholecystitis. Case Presentation: Here we present a unique case of chronic cholecystitis due to Fasciola Hepatica. Conclusions: Fascioliasis should be considered in any hepatobiliary system involvement, especially in endemic areas.

Introduction: Epidemic curves are a type of time series data consisting of the number of events that occur over a period of time. The time unit in this data can be a day, a week, or a month, etc. Methods: In the current letter, the authors tried to explain the growth factor and its effect on epidemic curves by using some literature. Results: In the outbreaks setting, the number of cases can increase with different patterns. When the number of cases is increasing exponentially, it means that the number of cases is increasing at a certain speed, which is determined by a factor called an exponential growth factor. When this factor is greater than one, it means that the cases are increasing exponentially, and when this coefficient is equal to 1, it means that we have reached an inflection point that we will face a change in the growth rate of the cases. Conclusion: Some factors such as reducing the contact between infected and healthy people, run the social distancing program, and so on can have an effective role in decreasing epidemic growth factor and controlling the epidemic. © 2021 Tehran University of Medical Sciences.