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Background and Objectives: To explore the prevalence and characteristics of secondary bacterial infections among patients suffering from mucormycosis following COVID-19 infection. Materials and Methods: We conducted a cross-sectional, retrospective analysis from March 2020 to April 2022 at Imam Khomeini Hospital Complex in Tehran. The study included patients with histopathologically confirmed mucormycosis and documented secondary bacterial infections. We extracted and analyzed data from hospital records using SPSS software, version 26. Results: The study comprised 27 patients, with a predominance of females (70.4%) and an average age of 56 years. The majority of these patients (63%) had pre-existing diabetes mellitus. The severity of their COVID-19 infections varied. Treatment regimens included immunosuppressive drugs and antibiotics. Rhinocerebral mucormycosis was the most common form observed. The predominant secondary infections involved the urinary tract, respiratory system, bloodstream (bacteremia), and soft tissues, with resistant strains of Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae being the most frequently identified microorganisms. Notably, cases of bacteremia and pneumonia exhibited a higher mortality rate. Ultimately, 55.6% of patients were discharged, while 44.4% succumbed to their infections. Conclusion: Patients recovering from COVID-19 with mucormycosis are significantly susceptible to secondary bacterial infections, particularly those with diabetes mellitus or those undergoing immunosuppressive therapy. Such infections compound the morbidity and mortality risks in this vulnerable patient cohort.

Key Clinical Message Despite the acceptable results in patients receiving organs from COVID‐19‐positive donors, more extensive studies over a longer period are still needed for more accurate conclusions. Abstract Organ transplantation is a major concern during the current COVID‐19 pandemic worldwide. The use of COVID‐19‐positive organ donors has raised widespread concerns in the field of transplantation. In this study, we characterized the outcome of a heart transplant from an organ donor positive for COVID‐19.

Abstract Background Fusarium species are saprophytic fungi with a worldwide distribution. These fungi cause various infections among immunocompromised patients; however, they can also involve immunocompetent individuals. Case presentation We report a case of a 41-year-old Iranian woman who presented with ulcerative lesions on her lips 10 months ago. She had a long history of anxiety but had no history of classical risk factors such as trauma, cosmetic lip tattoo, burning in her lips, smoking or use of alcohol and opium. A skin biopsy from the lower lip was performed and sent for microbiological examinations. Hyaline septate hyphae were seen on direct microscopy with potassium hydroxide. The clinical specimen was subcultured on sabouraud dextrose agar with chloramphenicol and prepared for antifungal susceptibility testing and molecular identification. Considering the minimum inhibitory concentrations (MIC) for antifungals, itraconazole (100 mg orally twice a day) was started for her, and after 2 months, the lesions were treated. She followed up for 3 months, and no signs of disease recurrence were observed. Conclusions Selecting an appropriate treatment strategy according to the laboratory assessments is essential in clinical practice and the management of rare infections to prevent related mortality and morbidity of opportunistic fungal infections.

Background: Mechanically ventilated patients experience a high level of anxiety due to their therapeutic condition. Anxiety is one of the strongest emotions that patients under mechanical ventilation experience due to their inability to communicate with others. The aim of this study was to investigate the effect of using a communication board on these patients' by assessing serum cortisol level and vital signs. Materials and Methods: This randomized clinical trial study was conducted in 2020. This study included 60 ventilated patients, who had been randomly assigned into two intervention and control groups. After blood sampling and evaluation of cortisol and physiological parameters, patients in the control group received routine communication by nurses, whereas those in the intervention group received communication using a communication board. Subsequently, the serum cortisol level and physiological parameters were measured again. Results: No significant difference was observed between the two groups in terms of demographic characteristics. There was a significant difference in blood cortisol levels before and after in the intervention group (t29 = 15.52, p < 0.001). After the intervention, the intervention group's systolic blood pressure (t58 = −3.78, p < 0.001), diastolic blood pressure (t58 = −3.79, p < 0.001), and heart rate (t58 = −2.09, p = 0.041) were significantly lower than the control group. Conclusions: Communication through a communication board in mechanically ventilated patients leads to decreased cortisol levels and physiological parameters. It is recommended to do more studies about communication boards' content and use this tool for more prolonged periods.

Abstract Background Since the COVID-19 outbreak, pulmonary involvement was one of the most significant concerns in assessing patients. In the current study, we evaluated patient’s signs, symptoms, and laboratory data on the first visit to predict the severity of pulmonary involvement and their outcome regarding their initial findings. Methods All referred patients to the COVID-19 clinic of a tertiary referral university hospital were evaluated from April to August 2020. Four hundred seventy-eight COVID-19 patients with positive real-time reverse-transcriptase-polymerase chain reaction (RT-PCR) or highly suggestive symptoms with computed tomography (CT) imaging results with typical findings of COVID-19 were enrolled in the study. The clinical features, initial laboratory, CT findings, and short-term outcomes (ICU admission, mortality, length of hospitalization, and recovery time) were recorded. In addition, the severity of pulmonary involvement was assessed using a semi-quantitative scoring system (0–25). Results Among 478 participants in this study, 353 (73.6%) were admitted to the hospital, and 42 (8.7%) patients were admitted to the ICU. Myalgia (60.4%), fever (59.4%), and dyspnea (57.9%) were the most common symptoms of participants at the first visit. A review of chest CT scans showed that Ground Glass Opacity (GGO) (58.5%) and consolidation (20.7%) were the most patterns of lung lesions. Among initial clinical and laboratory findings, anosmia (P = 0.01), respiratory rate (RR) with a cut point of 25 (P = 0.001), C-reactive protein (CRP) with a cut point of 90 (P = 0.002), white Blood Cell (WBC) with a cut point of 10,000 (P = 0.009), and SpO2 with a cut point of 93 (P = 0.04) was associated with higher chest CT score. Lung involvement and consolidation lesions on chest CT scans were also associated with a more extended hospitalization and recovery period. Conclusions Initial assessment of COVID-19 patients, including symptoms, vital signs, and routine laboratory tests, can predict the severity of lung involvement and unfavorable outcomes.

Background: The scientific researches on COVID-19 pandemic topics are headed to an explosion of scientific literature. Despite these global efforts, the efficient treatment of patients is an in-progress challenge. Based on a meta-study of published shreds of evidence about compounds and their botanic sources in the last six decades, a novel multiple-indication herbal compound (Saliravira®) has been developed. Based on the antiviral, anti-inflammatory, and immune-enhancing properties of its ingredients, we hypothesized that Saliravira® has the potential to act as an antiviral agent, accelerate treatment, and reduce undesirable effects of COVID-19. Methods: In this randomized, controlled, open-label clinical trial, COVID-19 outpatients were included by RT-PCR test or diagnosis of physicians according to the symptoms. Participants were randomly divided into intervention and control groups to receive Saliravira® package plus routine treatments of COVID-19 or routine treatments of COVID-19 alone, respectively. Saliravira® package includes tablets, nasal-sinuses spray, oral-pharynx spray, and inhaler drops. The treatment was for 10 days and followed up till 23 days after admission. Results: On the 8th day, the “mean reduction rates” of viral load of the patients in the intervention group was 50% lower compared to the control group with a p-value

Abstract Background Vitamin C is an essential water-soluble nutrient that functions as a key antioxidant and has been proven to be effective for boosting immunity. In this study, we aimed to assess the efficacy of adding high-dose intravenous vitamin C (HDIVC) to the regimens for patients with severe COVID-19 disease. Methods An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received HDIVC (6 g daily) added to the same regimen. Results There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. The mean body temperature was significantly lower in the case group on the 3rd day of hospitalization (p = 0.001). Peripheral capillary oxygen saturations (SpO2) measured at the 3rd day of hospitalization was also higher in the case group receiving HDIVC (p = 0.014). The median length of hospitalization in the case group was significantly longer than the control group (8.5 days vs. 6.5 days) (p = 0.028). There was no significant difference in SpO2 levels at discharge time, the length of intensive care unit (ICU) stay, and mortality between the two groups. Conclusions We did not find significantly better outcomes in the group who were treated with HDIVC in addition to the main treatment regimen at discharge. Trial registration irct.ir (IRCT20200411047025N1), April 14, 2020

Background and purpose: The use of vancomycin, as a key therapeutic choice for treatment of hazardous infections, may be associated with nephrotoxicity. The proposed mechanism is the indirect production of reactive oxygen species and oxidative stress. The purpose of this study was to investigate the effect of vitamin E asan antioxidant agent in the prevention of vancomycin-induced nephrotoxicity. Experimental approach: In a matched-groups interventional study, patients who received vancomycin for any indication were assigned to vitamin E (n = 30) and control (n = 60) groups. The patients in experimental group received 400 units of oral vitamin E per day for 10 days started concurrently with vancomycin, while the patients in control group received vancomycin alone. Serum level of creatinine, blood urea nitrogen (BUN), creatinine clearance (CrCl), and 24-h urine output were determined and recorded before the start of interventions, every other day during therapy, and 12 h after the last dose of vancomycin in 10[th] day of therapy for all patients. Also, the rate of acute kidney injury (AKI) in the two groups was recorded. Finally, the mean values of the measured parameters were compared between the groups. Findings / Results: Treatment with vitamin E for 10 days resulted in a significant reduction of BUN (from 17.5 ± 7.8 mg/dL at baseline to 11.4 ± 4.8mg/dL at the end; P < 0.001) along with slightly non-significant increase of CrCl (from 84.7 ± 18.9 mL/min at baseline to 91.3 ± 19.5 mL/min at the end; P = 0.301) in comparison to the control group. However, CrCl decreased significantly in the control group. Vitamin E had no significant effect on24-h urine output. Regarding vancomycin-induced AKI, 12 cases were observed in the control group, while no case was reported in experimental group (P = 0.041). Conclusion and implications: This study showed the beneficial effect of add-on therapy of vitamin E besides vancomycin in reducing AKI, which could be considered as a new potential prophylactic therapy for vancomycin-induced nephrotoxicity.

Introduction: Influenza is a viral disease which is self-limited in immunocompetent patients but it can be dangerous in immunocompromised patients. In these patients it may lead to sever viral and/or bacterial infection that often may lead to death. Therefor prevention of influenza in immunocompromised patients is very important and thus health care workers’ belief is important too. This study is evaluation of knowledge, attitude and practices of health care workers in oncology, hemodialysis and transplantation wards in hospitals of Isfahan in 2017. Methods: In this descriptive cross-sectional study selected health care workers filled a questionnaire which has 2 sections. In first section we asked about demographic characterization of them and in second section we asked the questions about their knowledge, attitude and practices. At the end we evaluate and analyze the data by SPSS software. Results: We evaluate 110 units and they were 72 (65.5%) female and 38 (34.5%) were male. Mean age of individuals was 32.7±7 years and mean time of their working acquaintance was 8.49±6.8 years. Attitude of the health care workers was well but only 58 units from 110 (52.7%) had been vaccinated. Conclusion: By attention to the knowledge and attitude of the participants and low proportion of vaccination in them it seems that we should have program for improving the vaccination in health care workers in our country. We should take modeling from the countries which have better vaccination coverage in their health care workers.

Introduction: For any medical student, bedside training plays a pivotal role that could integrate his clinical skills and theoretical knowledge. Every efficient educational system requires regular evaluation and medical education is not an exception. The purpose of this study was to assess major clinical training fields from the perspective of medical students in Isfahan School of Medicine. Methods: This descriptive, cross-sectional study assessed the clinical training fields (training round and outpatient training) of the surgery, internal medicine, gynecology, and pediatrics departments of teaching hospitals affiliated with Isfahan University of Medical Sciences from the perspective of medical students in the first semester of the academic year 2015-16. The study was conducted in the first week of the program on 61 groups of medical students selected by means of census method including 21 groups of internal medicine, 20 groups of surgery, 7 groups of gynecology, and 13 groups of pediatrics medical students. Data were collected by the notebook of clinical training monitoring to record the number of medical students attended, hours attended, hours of training by teachers, and the number of visited patients per day for a week categorized by the training fields. The data were analyzed in Excel using mean and standard deviation. Results: Daily training hours of the medical students (training rounds and outpatient training) were 2.5±0.53 (internal medicine), 2.75±0.32 (surgery), 2.04±0.3 (gynecology), and 2.17±0.24 (pediatrics) hours in the wards and 2.75±0.25 in the clinics. The medical students visited an average number of 5.54±1.55 inpatients and outpatients (internal medicine), 8.25±1.25 (surgery), 3±0.6 inpatients and 22.2±5.02 outpatients (gynecology), and 5.7±1.02 inpatients and 15.9±5.14 outpatients (pediatrics) per day. Conclusion: The information obtained in relation to the average number of medical students, interns and residents, the number of visited patients per day, and the hours of medical students’ attendance and training by teachers in the wards can show a realistic picture of the conditions of training fields and help program planners.

Objective: Recent studies have shown that serum cystatin C (Cys C) is a better marker for measuring the glomerular filtration rate and may rise more quickly with acute kidney injury (AKI). The purpose of this study was to evaluate the clinical application of serum Cys C to predict colistin-induced nephrotoxicity in comparison with serum creatinine (SCr). Methods: Thirty-two adult patients with no history of acute or chronic kidney injury having been planned to receive intravenous colistin for an anticipated duration of at least 1 week for any indication were recruited. At baseline and 5 days after colistin treatment, serum Cys C as well as creatinine levels were measured. The incidence of colistin-induced acute renal failure was defined according to the AKIN criteria for SCr. Rise in concentration of Cys C by more than 10% from baseline considered as AKI. Findings: Colistin-induced nephrotoxicity (defined as SCr ≥0.3 mg/dl) occurred in 6 patients (18.8%). A Cys C increase concentration ≥10% after 5 days of colistin treatment was detected in 15 patients (46.9%). There was a poor agreement between the presence and absence of any SCr-AKI and Cys C-AKI (κ = 0.28, P = 0.04). Conclusion: Serum Cys C is a better marker of renal function in early stages of AKI and predictive of persistent AKI on colistin treatment.

Background: Legionella pneumophila is considered as one of the most important etiologies of respiratory infection in immunocompromised patients, which causes high morbidity and mortality. The aim of this study was to evaluate the epidemiology of Legionella pneumophila in febrile neutropenic patients. Methods: This cross-sectional study was performed on 36 patients with neutropenia admitted to Seyedoshohada hospital, Isfahan, Iran, during 2014-2015. All patients underwent throat sampling with a sterile swab. All samples were analyzed via quantitative real-time multiplex polymerase chain reaction (PCR) covering Legionella pneumophila. The prevalence of Legionella pneumophila in febrile neutropenic patients was then assessed. Findings: Mean age of the patients (including 22 men and 14 women) was 54.8 ± 7.6 years. Most of the patients had acute myeloid leukemia (AML) (33.3%) and non-Hodgkin lymphoma (NHL) (19.4%). From 36 examined throat samples obtained from the patients with confirmed neutropenia, no positive result of Legionella pneumophila was detected via polymerase chain reaction. Conclusion: Our study does not support the hypothesis that Legionella pneumophila plays an important role in the development of neutropenic fever. Thus, more studies and using additional diagnostic methods to detect Legionella pneumophila in atypical pneumonia are recommended.

Background Recurrent vulvovaginal candidiasis (RVVC) is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell-mediated immunity defect in response to candida antigen in RVVC cases. Materials and Methods Our cross-sectional study was performed in 3 groups of RVVC patients (cases), healthy individuals (control I) and known cases of chronic mucocutaneous candidiasis (CMC) (control II). Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. Peripheral blood mononuclear cells were isolated and labeled with CFSE and proliferation rate was measured in exposure to candida antigen via flow cytometry. Results T lymphocyte proliferation in response to candida was significantly lower in RVVC cases (n=24) and CMC patients (n=7) compared to healthy individuals (n=20, P < 0.001), but no statistically significant difference was seen between cases and control II group (P > 0.05). Family history of primary immunodeficiency diseases (PID) differed significantly among groups (P=0.01), RVVC patients has family history of PID more than control I (29.2 vs. 0%, P=0.008) but not statistically different from CMC patients (29.2 vs. 42.9%, P > 0.05). Prevalence of atopy was greater in RVVC cases compared to healthy individuals (41.3 vs. 15%, P=0.054). Lymphoproliferative activity and vaginal symptoms were significantly different among RVVC cases with and without allergy (P=0.01, P=0.02). Conclusion Our findings revealed that T cells do not actively proliferate in response to Candida antigen in some RVVC cases. So it is concluded that patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. Nonetheless, some other cases of RVVC showed normal function of T cells. Further evaluations showed that these patients suffer from atopy. It is hypothesized that higher frequency of VVC in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components.

Background: Rhinocerebral mucormycosis is a fatal infection typically affecting diabetic or immunosuppressed patients. In most cases, infection is caused by inhalation of fungal spores. Mortality rate of patients is very high (40-85%). Case Presentation: In this study, three diabetic patients with rhinocerebral mucormycosis were presented. The etiologic agents of mucormycosis in two patients were isolated and identified by sequence analysis and data were registered in Gene bank database. Conclusion: In patients with mucormeosis, early detection, surgical excision and appropriate debridement, suitable antifungal therapy, and control of risk factors like diabetes mellitus are the main parameters of successful management of this lethal infection.

مقدمه: سندروم منونوکلئوز عفونی، یک بیماری حاد است که اغلب در اثر عفونت اولیه با ویروس اپشتین‌بار ایجاد می‌شود. با توجه به شیوع بالا وگسترش جهانی این سندروم و طیف وسیع علایم بالینی و آزمایشگاهی آن و نیز محدود بودن مطالعات مربوط به آن در كشور، مطالعه‌ی حاضر در سال 1392 در بیمارستان الزهرای (س) اصفهان انجام شد. روش‌ها: این مطالعه، یک مطالعه‌ی توصیفی بود که در سال 1392 در بیمارستان الزهرای (س) اصفهان به انجام رسید. جامعه‌ی آماری مورد مطالعه، بیماران با تشخیص نهایی بالینی و سرولوژیک سندروم منونوکلئوز عفونی بستری شده در بخش‌های عفونی اطفال و بزرگسالان این مرکز طی سال‌های 91-1380 بودند. كلیه‌ی بیمارانی که در طی این مدت در این بیمارستان بستری شده بودند، از نظر علایم بالینی، آزمایشگاهی و عوارض بررسی شدند. اطلاعات بیماران به وسیله نرم‌افزار SPSS مورد تجزیه و تحلیل قرار گرفت. یافته‌ها: در مجموع 49 بیمار، 25 نفر (51 درصد) مرد و 24 نفر (49 درصد) زن با میانگین سنی 6/9 ±2/21 سال و دامنه‌ی 44-3 سال، مورد بررسی قرار گرفتند. عموم علایم و نشانه‌های مشاهده شده در این بیماران بر حسب گروه‌های سنی اختلاف معنی‌دار نداشت. تب (8/89 درصد)، گلودرد (6/81 درصد)، بلع دردناک (1/55 درصد) و لرز (9/42 درصد) شایع ترین علایم و فارنژیت اگزوداتیو (9/93 درصد)، لنفادنوپاتی موضعی (3/63 درصد) و اسپلنومگالی (7/34 درصد) شایع‌ترین نشانه‌ها در این بیماران بود. نتیجه‌گیری: بر اساس این مطالعه، به نظر می‌رسد که شیوع علایم، نشانه‌ها و یافته‌های آزمایشگاهی در بیماران مبتلا به سندروم منونوكلئوز عفونی در بیمارستان آموزشی الزهرای (س) اصفهان، مشابه آمارهای جهانی است. اما با توجه به نقایص این مطالعه و عدم وجود مطالعه‌ی مشابه در سطح کشور جهت مقایسه و نیز با توجه به محدود بودن این مطالعه به یک مرکز، لازم است جهت تعیین دقیق‌تر اپیدمیولوژی این سندروم، مطالعات وسیع‌تر در سایر مراکز کشور انجام گیرد.

Background: Some evidence has shown a relationship between human cytomegalovirus (CMV) infection and pregnancy loss. However, whether recurrent or latent CMV infection or altered immune response to CMV is related to recurrent pregnancy loss (RPL) is unclear. We evaluated CMV infection and avidity of antibodies to CMV in women with RPL. Materials and Methods: This case-control study was conducted on 43 women with RPL referred to a clinical immunology out-patient clinic in Isfahan (Iran), and 43 age-matched multiparous women without history of abortion as control subjects. Patients and controls were evaluated for anti-CMV IgG and IgM antibodies and IgG avidity index (AI) using the enzyme linked immunosorbent assay method. Student′s t-test and Chi-square test were used to analyze the data. Results: One case (2.3%) of positive anti-CMV IgM was detected in each group. Anti-CMV IgG positivity was more frequent in patients than in controls (90.6% vs. 69.8%, P = 0.014), but there was no difference between the two groups in anti-CMV IgG AI (79.4 ± 11.4 vs. 80.1 ± 10.2, P = 0.781). IgG titer was significantly higher in seropositive cases with RPL than seropositive controls (5.18 ± 1.99 vs. 2.00 ± 0.81, P < 0.001). Conclusion: We found that previous exposure to CMV was significantly higher in patients with RPL than the control group. However, no association was found between IgG AI and RPL. Further investigations are needed to find whether latent CMV infection starts an indirect process of autoimmune etiology in RPL or women with RPL have recurrent or reactivation of CMV infection.

Background: Infection, especially pulmonary infection and pneumonia, is a major cause of morbidity and mortality in patients with cancer treated with chemotherapy. Chest X-ray (CXR) is an initial guide, quick, inexpensive, available and low-radiation dose widely performed when pneumonia is suspected. According to various studies, the role of routine CXR in the diagnostic evaluation of febrile neutropenic patients without pulmonary symptoms is unclear. The purpose of this study was to evaluate the diagnostic yield of routine CXR in asymptomatic pulmonary neutropenic patients. Methods: 118 neutropenic patients (59 men and 59 women) with the age of more than 18 years were studied. History, physical examination, complete blood count (CBC), blood culture, urine analysis (U/A), and urine culture (U/C) were checked. In both, symptomatic and asymptomatic patients, 2 CXRs [Posterior-Anterior (PA) and lateral] were obtained and one radiologist studied CXRs without knowing about the physical examination. Findings: The incidence of pneumonia in was 17.8% in the entire population and 6.8% in asymptomatic pulmonary group. The incidence of pneumonia was significantly higher in men than in women (P = 0.04); the incidence of pneumonia significantly increased with age increasing (P = 0.01). Conclusion: Comparing our findings to similar studies, routine CXR in febrile neutropenic men with the age of more than 50 years is recommended.

Background: Balantidiasis is a disease can be manifested with acute clinical presentations which mimic lymphoma. In this article, we have been reported balantidiasis in a young immunocompetent person suspicious to lymphoma. This may be the first reported case of balantidiasis in an immunocompetent person in Iran. Case Report: In an 18-years-old man, the disease was initiated with abdominal pain and weight loss. His abdominal pain was associated with fever, chills, dysentery and tenesmus. Bone marrow aspiration and biopsy was done with suspicion to lymphoma. There was not any presentation of malignancy in his aspiration and biopsy. With these findings, he became candidate for diagnostic laparatomy and biopsy of affected tissues. Balantidiasis was considered according to the pathologic report of parasitic granulomatosis infection and his dramatic response to doxycycline. Conclusion: This case, and the same, previously reported cases, suggest that parasitic granulomatosis infection-like balantidiasis should be considered as other differential diagnosis particularly in patients with complaint of fever, hepatosplenomegaly, weight loss and lymphadenopathy.

Background: Aerobic Actinomycetes, especially Nocardia are of the most common pathogens of systemic infections in worldwide. It is seen from skin infections caused by trauma in normal-immune system host to severe lung diseases or diseases of the central nervous system in patients with immune deficiency. Nocardia species (spp.) are soil-indwelling bacteria. This study aimed to compare three phenotypic methods for isolation and identification of Nocardia spp. Methods: In this study, 60 soil samples were collected from areas of agricultural lands, gardens and around some of the hospitals with different soil temperature and pH in Isfahan, Iran. In order to isolation of Nocardia spp. from soil, three different methods were studied: Paraffin baiting method (McClung's carbon free broth with paraffin bait), Paraffin coated slides, and Slip-burid method. Findings: Paraffin baiting method was surveyed on 10 soil samples and no results were gained. Paraffin coated slides was surveyed on 4 soil samples (same soil samples) but no results were attained. So, slip-burid method of isolation was tested. In this method, 15 out of 60 soil samples (25%) were positive for Nocardia spp. and colonies were suspected to Nocardia spp. Conclusion: In this study, slip-burid method found to be more effective for Nocardia spp. Isolation.

Background: Neutropenia with fever is a common syndrome in patients with hematologic malignancies who have a high risk of infectious diseases. As early diagnosis of infection in such patients is really important, the aim of this study was to investigate the sensitivity and specificity of procalcitonin (PCT) and C-reactive protein (CRP) in the diagnosis of sepsis in febrile neutropenic patients in a referral malignant care center of Isfahan in 2010-2011. Materials and Methods: In this analytical cross-sectional study, all the febrile neutropenic patients who were admitted in the referral malignant care center in 2010-2011 were evaluated. The data from every individual, including sex, age, admission time, and duration of fever before taking antibiotics were collected. Sixty-four subjects were involved in the study. Blood samples of the subjects were obtained and the levels of PCT, CRP, Absolute neutrophil count (ANC), and white blood cell count were measured, and blood cultures were obtained. According to the test results, the 64 subjects were divided into two groups including patients with sepsis and without sepsis. Results: Mean value of PCT in the sepsis group was 28.65 ± 2.68 and in the non-sepsis group was 2.48 ± 0.66, with a P value of 0.000. In case of CRP, the sepsis group had a mean of 159.48 ± 9.73 and the non-sepsis group had a mean of 126.17 ± 10.63 (P = 0.015). Sensitivity and specificity were analyzed by using receiver operating characteristic (ROC) curve and were found to be 92.5% and 97.3%, respectively, for PCT and 70.5% and 42.1%, respectively, for CRP. Conclusion: PCT can be considered as a predictive factor and a diagnostic marker for the diagnosis of sepsis in febrile neutropenic patients.

Disseminated mucormycosis is a rare entity most frequently seen in neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy. We report a 64-year-old immunocompetent male with an acute pneumonia and a generalized jaundice who died within 24 h. In the autopsy, extensive perforations of spleen and multiple hemorrhage foci on the pancreas were two significant findings. Histopathological study of tissue sections revealed typical zygomycetes hyphae in the left lung, pancreas, spleen and brain. Involvement of pancreas in this patient was one of the rare features of mucormycosis reported occasionally in the literature. Our case implies an unusual clinical presentation of disseminated mucormycosis and highlights that disseminated mucormycosis should be regarded even in the immunocompetent patients.

Introduction: Given the importance and impact of test resources on medical student’ learning, this study aimed to assess the time devoted to study books and notes during the semester and exam time. Methods: This descriptive-analytic study was conducted on all medical students (120) who were passing internship period at Isfahan University of medical sciences in 2011. Devoted time to study books and notes was determined. Data analysis was done using t test. Results: The mean and standard deviation of time devoted to study book for students who their mean score were above average (15.89±0.96) was 34.61±4.08. This was 23.12±5.30 for students who their mean score were less than average. It had significant difference. Conclusion: The results of this study showed that, students with lower mean score were more interested in studying notes during the semester and test time. Therefore, it is suggested to conduct further studies to investigate the study sources of students in different academic degree levels.

Objective: The prevalence of anemia in HIV infected patients has not been well characterized in Iran. This study aimed to describe the prevalence of anemia and related factors in HIV positive patients. Materials and Methods: In a cross-sectional study, anemia prevalence and risk factors of 212 HIV positive patients were assessed, at the behavioral disease consulting center in Isfahan. The relationship between anemia, demographic variables, and clinical histories were analyzed. Mild to moderate anemia was defined as hemoglobin 8-13 g/dL for men and 8-12 g/dL for women. Severe anemia was defined as hemoglobin, 8 g/dL. Results: A total of 212 HIV positive patients with a mean±SD age of 36.1 ± 9.1 years were assessed. We found that hemoglobin levels were between 4.7 and 16.5 gr/dL. In this study, the overall prevalence of anemia was 71%, with the majority of patients having mild to moderate anemia. Mild to moderate anemia and severe anemia occurred in 67% and 4% of patients, respectively. The mean absolute CD4 count was 348 ± 267.8 cells/cubic mm. Sixty one of 212 patients were at late stage of HIV infection (males=51 and female=10). Of the 212 HIV positive patients enrolled, 17 (8%) had a positive history of tuberculosis. We found a strong association between anemia and death. Conclusion: Normocytic anemia with decreased reticulocyte count was the most common type of anemia in overall. Prevalence of anemia in this study is relatively higher than other similar studies. Such a high prevalence of anemia needs close monitoring of patients on a zidovudine-based regimen. Better screening for anemia and infectious diseases, and modified harm reduction strategy (HRS) for injection drug users are primary needs in HIV seropositive patients.

Background: Actinomycosis is an indolent, slowly progressive infection caused by non acid fast, gram positive, anaerobic or microaerophilic bacteria. The most common site of actinomycosis infection is cervicofacial region. Bacteriologic identification from infected site or detection of sulfur granules confirms the diagnosis. We report a rare case of simultaneous infection of larynx and lungs actinomycosis with various radiologic manifestations including diffuse right lung cavitation as a very rare finding. Case report: A 77-year-old man was admitted with complaints of fever and productive cough and weight loss, for one month, from the time he had been undergone open heart surgery.On that time, after surgery, he had been intubated for a long time because of decreased level of o2 saturation. Respiratory failure reason was not determined, so laryngeal CT scan was done with suspicious to a pathological lesion; it showed a mass in the larynx. Pathological findings of the laryngeal biopsy showed sulfur granule formation of actinomyces. Lung spiral CT scan revealed speculated margin pulmonary nodules with fibrotic changes and cavitary lesion. Pathology of lung biopsy showed; multiple granuloma consist of epithelioid and mononuclear cells with fibrosis, there were no sign of caseous necrosis or fungal infection in PAS staining and no acid fast bacilli were seen. Cytological evaluation for malignancy was also negative. He was treated with high dose of penicillin and in his follow up, he clinically and paraclinically got better. Conclusion: Although pulmonary and laryngeal actinomycosis is rare, but should be considered in recurrent and persistent infections specially in patients with history of long stay hospitalization. It is in differential diagnosis with the all chronic lung infections and malignancies. Because of good response to appropriate antibiotic therapy and preventable complications, early diagnosis is mandatory.

• Background: The risk of increasing active tuberculosis is a significant health problem among patients receiving hemodialysis. Also prophylactic therapy against tuberculin in these patients is important to have a successful transplantation. The tuberculin skin test (TST) is used to detect tuberculosis infection, but uremia in these patients may lead to coetaneous anergy that decrease the accuracy of the test. The aim of study was to identify the TST reactivity and frequency of booster phenomenon in 3-step TST in under hemodialysis patients. • Methods: A total of 74 patients in Alzahra and Zahraye Marziye hemodialysis center in Isfahan were prospectively tested. To determine the frequency of booster effect, patients with less than 10 mm indurations were given additional TST one and four weeks after the initial test. • Finding: Totally, 12 (16.2%) of 74 patients showed a positive tuberculin reaction (≥ 10 mm) on the initial test. Positive TST in 8 patients (10.8%) was added after the second test and in 6 patients (8.1%) after the third test. The booster phenomenon was detected in 18.9% of the patients. There was a significant correlation between TST positivity and anemia. There was no influence of age, gender, serum albumin level, urea reduction ratio and KT/V (P > 0.05). • Conclusion: According to the results and the necessity of diagnosis of tuberculin in hemodialysis patients, our study support 3-step tuberculin skin testing in hemodialysis patients. As TST is easy and inexpensive, it seems to be useful for kidney transplant candidates. • Keywords: Hemodialysis, Booster effect, Tuberculin skin test, Tuberculosis.

Background: Infection is a major problem in intravenous drug users (IVDUs). Skeletal infections, especially osteomyelitis and septic arthritis are common causes for admitting these patients. In addition to antibiotic therapy, surgical intervention for diagnosis or treatment is often needed. The aim of this survey was to determine the frequency of location, type of microorganisms and surgical intervention in intravenous drug users with skeletal infection. Methods: In a cross-sectional survey, all intravenous drug users with skeletal infections admitted in infections ward and orthopedic ward of Al-Zahra hospital in Isfahan, Iran were enrolled in this study. Data were collected by questionnaire and were analyzed by descriptive statistics. Finding: Thirty three patients were admitted during this period; among them 6 patients (18.2%) were diagnosed as osteomyelitis and 27 (81.8%) as septic arthritis. Knee was the most foci of infection. Staphilococus aurous was the most etiologic agent. Seven patients with septic arthritis and one with osteomyelitis went under surgical operation. Conclusion: Skeletal infections are common among intravenous drug users. Skeletal infections always should be considered especially if the patient has soft tissue infections to prevent more complications. Key words: Osteomyelitis, Septic arthritis, Intravenous drug user.

Background: Paranasal sinus aspergilloma is a rare disease of sinus which is sometimes considered as mycetoma. In this condition, there is gathering of fungal mycelium in sinus cavity without bone or vessels invasion. It presented as a chronic sinusitis with headache, nasal discharge and obstruction. Diagnosis of aspergillosis infection has often dependent on clinical judgment combined with radiologic evaluation and demonstration of the fungus in tissue specimens obtained from the presumed site of infection. Case Report: A 53-year-old man with uncontrolled insulin dependent diabetes mellitus presented with six month history of headache. He had used various drug prescribed by different physicians in the past six months without any effect. Because of progressive headache, he was admitted in the department of otolaringology and surgical debridement was done. Histopathological examination was suggestive of maxillary sinusitis with fungal ball of aspergilluma. The patient treated with itraconazole and after 6 months, he felt better with no clinical and paraclinical signs. Conclusion: Since fungal sinusitis presentation is similar to chronic sinusitis and in the other hand, the incidence of aspergillosis is increasing, the early diagnosis and treatment is important especially when the clinical and paraclinical signs are suggestive.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease of unknown cause. In this study, we report a case of SLE that was presented with persistent vomiting and liver involvement. To our knowledge, this is the first description of a patient with hepatic necrosis as the initial presentation of SLE in a previously healthy woman without any significant past medical history. In the literature, we found few cases of SLE with liver necrosis. In addition, all the cases found had a past medical history of a missed abortion or other complications of the disease. Therefore, if a young woman presents hepatic necrosis with a background of a previously missed abortion, it is better to perform anti-nuclear antibody (ANA) and anticardiolipin antibody tests as a preventive method for early diagnosis and early treatment.

Background: During August 2009, novel H1N1 influenza virus began causing illness in Isfahan. Since rates of hospitalization and mortality due to the disease have varied widely in different countries, we described the clinical, radiologic, and demographic features of H1N1 hospitalized patients in a hospital in Isfahan. Methods: This cross-sectional study was conducted in Alzahra Hospital during September 2009 to February 2010. Totally, 216 patients with confirmed, probable, or suspected cases of 2009 influenza A (H1N1) were admitted. Results: Most patients were women (50.5%). Mean age of patients was 26.6 ± 19.5 years. The most common complains on admission were respiratory symptoms (91.6%, n= 198), fever (88.4%, n = 191), myalgia (65.7%, n = 142). In addition, 120 patients (56%) had at least one underlying medical disorder. Thirty-six patients (16.7%) died. Mortality was higher in children under 5 years old (10/36, 10%) and female cases (63.9% of died patients). Predicting variables affecting mortality were intensive care unit (ICU) admission and procalcitonin (PCT) > 0.5. Antiviral treatment was prescribed for 200 (92.5%) of the 216 patients. Conclusions: Based on the findings of the present study, novel H1N1 influenza is highly prevalent among the youth. Moreover, it causes a relatively high morbidity rate. Therefore, people need to be encouraged to have vaccination against 2009 H1N1. Early diagnosis and treatment is related to less admission and shorter duration of hospitalization.

Background: Pandemic 2009 H1N1 influenza A virus arrived at Isfahan in August 2009. The virus is still circulating in the world. The abnormal thoracic computerized tomographic (CT) scan findings vary widely among the studies of 2009 H1N1 influenza. We evaluated the thoracic CT findings in patients with 2009 H1N1 virus infection to describe findings compared to previously reported findings, and to suggest patterns that may be suggestive for 2009 influenza A (H1N1) in an appropriate clinical setting. Methods: Retrospectively, the archive of all patients with a diagnosis of 2009 H1N1 influenza A were reviewed, in Al-Zahra Hospital in Isfahan, central Iran, between September 23 rd 2009 to February 20 th 2010. Out of 216 patients with confirmed 2009 influenza A (H1N1) virus, 26 cases with abnormal CT were enrolled in the study. Radiologic findings were characterized by the type and pattern of opacities and zonal distribution. Results: Patchy infiltration (34.6%), lobar consolidation (30.8%), and interstitial infiltration (26.9%) with airbronchogram (38.5%) were the predominant findings in our patients. Bilateral distribution was seen in 80.8% of the patients. Only one patient (3.8%) showed ground-glass opacity, predominant radiographic finding in the previous reports and severe acute respiratory syndrome (SARS). Conclusions: The most common thoracic CT findings in pandemic H1N1 were patchy infiltration, lobar consolidation, and interstitial infiltration with airbronchogram and bilateral distribution. While these findings can be associated with other infections; they may be suggestive to 2009 influenza A (H1N1) in the appropriate clinical setting. Various radiographic patterns can be seen in thoracic CT scans of the influenza patients. Imaging findings are nonspecific.

Background: Immunodeficiency is a heterogenous group of diseases affecting different components of the immune system. Patterns of infection, etiology and organ involvement are not similar in this risky population. This study was conducted to determine the prevalence of congenital and acquiring immunodeficiencies and also recognizing the most common infections and affected organs. Materials and Methods: In a retrospective, cross-sectional survey, during 2006-2012, we reviewed all hospital records with any kind of immunodeficiency admitted in, all departments of university referral hospital, Isfahan, Iran. Results: Various immunodeficiencies, sorted by prevalence, were as below: Primary immunodeficiency diseases (PIDs) 122 (27.4%), lymphohematogenous malignancy (LHM) 105 (23.5%), solid cancer 56 (12.6%), human immunodeficiency virus/acquired immunodeficiency syndrome 64 (14.5%), non-cytotoxic immunosuppresion 94 (21%), and splenectomy 5 (1.2%). Common sources of infection were blood, lungs and buccal cavity. Conclusion: The most frequent type of immunodeficiency was PIDs and LHM. Infection continues to be a major problem in all variety of immunodeficiency.

Orf, also known as contagious pustular dermatitis, is an exanthemous disease caused by a parapox virus. It is usually a benign locally self-limiting illness; it can have systemic complication or progressive infected locations can include the finger, hand, arm, and face. Development of erythema multiforme following Orf infection is very rare. In Islamic populations such as those of Iran, Orf can be observed in individuals who are not occupationally involved, but may be in contact with sheep or goats after the Islamic worship as an "Eid ul-Adha." Here we report an erythema multiforme associated with multiple lesion of Orf disease following the "Eid ul-Adha" in Iranian housewives.

Background: Respiratory infections are a frequent cause of fever in neutropenic patients, whereas respiratory viral infections are not frequently considered as a diagnosis, which causes high morbidity and mortality in these patients. Materials and Methods: This prospective study was performed on 36 patients with neutropenia who admitted to hospital were eligible for inclusion with fever (single temperature of >38.3°C or a sustained temperature of >38°C for more than 1 h), upper and lower respiratory symptoms. Sampling was performed from the throat of the patient by the sterile swab. All materials were analyzed by quantitative real-time multiplex polymerase chain reaction covering the following viruses; influenza, parainfluenza virus (PIV), rhinovirus (RV), human metapneumovirus, and respiratory syncytial virus (RSV). Results: RV was the most frequently detected virus and then RSV was the most. PIV was not present in any of the tested samples. Furthermore, no substantial differences in the distribution of specific viral species were observed based on age, sex, neutropenia duration, hematological disorder, and respiratory tract symptoms and signs (P > 0.05). Conclusion: Our prospective study supports the hypothesis that respiratory viruses play an important role in the development of neutropenic fever, and thus has the potential to individualize infection treatment and to reduce the extensive use of antibiotics in immunocompromised patients with neutropenia.

Background: Increasing use of different chemotherapy regimens, organ transplants, etc., has led to the increasing number of neutropenic patients. Overall, 10% of patients affected by cancer who are under treatment with anticancer drugs, regardless of the tumor type, are susceptible to febrile neutropenia. The study was performed to evaluate the frequency of bloodstream fungal infections in pediatric patients with febrile neutropenia in Sayed Al-Shohada Hospital (Cancer Referral Center in Isfahan) in 2010–2012. Materials and Methods: This cross-sectional study was performed on pediatric patients with febrile neutropenia who were referred to Sayed Al-Shohada Hospital (Cancer Referral Center in Isfahan) in 2010–2012. Blood samples were obtained from all the patients and were loaded into Bactec 9050 blood culture instruments (Bectone Dickinson, Baltimore, Md., USA), and organisms responsible for causing fever were detected. Results: Sixty-seven patients (51.3 males, 48.7 females) with a mean age of 12.3 ± 15.8 years were included. The blood cultures of 48 patients (71.6%) were negative. Seven samples of the isolates (10.4%) were fungi, and twelve of them (18%) were bacteria. Thus, the prevalence of fungal infection was 10.4%. Conclusion: Due to the high relative prevalence of fungal infections in our study, it is necessary to take precautions for fungal infection prevention and choose the best way management to obtain optimal results in these patients.

Background: Pneumonia is one of the most common hospital-acquired infections among bedridden patients in Intensive Care Units (ICUs). Colonization of mouth and pharynx by pathogenic bacteria and their aspiration into the lower respiratory tract is an important step in pathogenesis of hospital-acquired pneumonia. The purpose of this study was to compare the effects of chlorhexidine and potassium permanganate mouthwashes in preventing incidence of hospital-acquired pneumonia in hospitalized patients in the ICU. Methods: This study is a clinical trial, conducted on 150 patients on ventilator in ICU. Patients were divided into three groups: Chlorhexidine group, potassium permanganate group, and control group. Mouthwashing three times a day, each time 5 min for 1 week by sterile gas with 10 cc solution of chlorhexidine, potassium permanganate, or placebo, was performed. Finally, pneumonia incidence was recorded, according to the Center for Disease Control and Prevention criteria. The data were analyzed by SPSS software version 20. Results: In the present study, 28 cases of pneumonia among 150 patients on ventilator were investigated. There were 15 (30%), 6 (12%), and 7 (14%) incidences of pneumonia in control, chlorhexidine, and permanganate group, respectively. Pneumonia incidence in these groups differed significantly (P = 0.041). Conclusions: The use of common mouthwashes, especially chlorhexidine solution, for washing oropharynx of ICU patients, can decrease pneumonia incidence, especially in patients under ventilation. Thus, washing and sterilizing mouth of patients with mouthwashes is recommended due to the high risk of hospital-acquired pneumonia in these patients.

Abstract Background: Mucormycosis is a life threatening angioinvasive fungal infection that causes thrombosis and tissue necrosis, it often affects diabetic and immune compromised patients. Ophthalmic artery, cavernus sinus and internal carotid artery involvement have been reported. Treatment includes wide surgical debridement and antifungal agents that the newest of witch is posaconazole. Case Report: In this article we report a diabetic man with sino-orbital mucormycosis whose treatment switched to posaconazole for 8 weeks because of renal failure due to amphotricine B and after clinical and radiological improvement he was discharged; but 2 weeks later, he was admitted again because of severe headache and involvement of temporal artery with mucormycosis established by biopsy. Key words: Mucormycosis, sinusitis, posaconazole, temporal artery, amphotricine B

BACKGROUND: Sub-acute left-sided bacterial endocarditis is a serious condition that may present with variable clinical manifestations. Its symptoms include both sterile and infected emboli, and various immunological phenomena. CASE REPORT: This report presents a 55 year old man with frequency and dysuria after a lithotripsy and several admissions with urosepsis. Due to the suspicion of infective endocarditis echocardiography was done which confirmed streptococcus group B endocarditis. CONCLUSION: Streptococci group B is one of the rare causes of infective endocarditis, but it was observed after various producers such as lithotripsy. Keywords: Group B Streptococci, Infective Endocarditis, Lithotripsy

Liver inflammatory pseudotumor (IPT) is considered a benign inflammatory lesion mostly presented as a solitary solid mass in the right hepatic lobe. It may clinically and radiologically mimic a malignant liver tumor or an abscess. Accordingly, diagnoses of most of the reported cases have been established after surgical resection. In this report, we describe a 52-year-old woman with a 1-year history of fever of unknown origin. In the following investigation, abdominal computed tomography (CT) scan showed infiltrative lesion in the right hepatic lobe. The patient underwent a CT-guided needle biopsy of the hepatic lesion. Histopathologic study of biopsy specimen revealed the features of IPT. The patient was discharged and followedup for 6 months. After 6 months she had no complaint of fever and control liver ultrasonography disclosed no lesion. As liver IPT has favorable response to conservative therapy and may also resolve spontaneously, precise recognition of this condition with the help of fine-needle biopsy may help to avoid unnecessary surgery.

Introduction: Hepatitis B virus (HBV) infection and its complications are major public health problems. As it is hard to treat and control the chronic state, control of disease depends on the prevention especially by vaccination. There is an impaired immune response to vaccinations including HBV in patients with some malignancies. The aim of this study is to assess the response rate of patients undergoing chemotherapy to HBV vaccination. Materials and Methods: All patients from two hematology/oncology clinics in Isfahan, Iran with the history of at least 1 month chemotherapy who had the inclusion criteria were enrolled in a case control study. Also a sex- and age-matched control group from healthy population was selected. They were vaccinated in a schedule of 0, 1, and 6 months and were examined for antibody titers 1 month after the last dose. The titers more than 10 mIU/ml were determined as positive response to vaccination. Results: In this study, 50 patients and 50 healthy subjects were enrolled. The two groups were age and sex matched (P > 0.05). Frequency of negative responses to HBV vaccination in case and control groups were 9 (18%) and 1 (2%), respectively (OR = 10.75, CI = 1.30–88.47, P = 0.027). Of 50 patients, 54%, 12%, 22%, and 12% had breast cancer, lymphoma, gastrointestinal, and genitourinary cancers, respectively, and frequency of negative responses were 3 (11%), 1 (16%), 4 (36.4%), and 1 (16%), respectively (P = 0.167). Conclusion: According to our results, malignancy and chemotherapy will have an important effect on the immune system and cause negative response to HBV vaccination. Our results revealed the importance of passive immunity and screening for HBV infection in patients undergoing chemotherapy. Also more studies for better vaccination schedules in this group of patients are recommended.

Comments on ''Detection of galactomannan in the bronchoalveolar lavage of high-risk patients with invasive aspergillosis admitted at the intensive care unit'' by Khodavaisy et al. AWT-SEP AWT-SEP AWT-SEP AWT-SEP AWT-SEP AWT-SEP Galactomannan in bronchoalveolar lavage for diagnosis of invasive aspergillosis We read with interest the prospective study by Khodavaisy et al on” Detection of galactomannan(GM) in bronchoalveolar lavage(BAL) of the intensive care unit patients at risk for invasive aspergillosis (IA) “.In this study authors reported that there are no available data on GM detection in BAL samples among ICU patients in the Middle East. A study that was performed in ICU patients with underlying predisposing conditions for IA between August 2010 and September 2011 that GM was measured using the Platellia Aspergillus EIA test kit. The conclusion was that the galactomannan level in BAL fluid is more sensitive for diagnosis. (1)

Background: The aim of this study was to investigate the sensitivity and specificity of procalcitonin and C-reactive protein in the diagnosis of febrile neutropenic patients in Seyed-Alshohada Hospital (Isfahan, Iran) during 2010-11. Methods: This analytic cross-sectional study included all febrile neutropenic patients (n = 64) who were admitted in Seyed-Alshohada Hospital during 2010-11. Sex, age, admission time, and duration of fever before taking antibiotics were collected. Patients were then divided to groups with and without severe infection. Findings: The mean levels of procalcitonin in the groups with and without severe infection were 28.65 ± 2.68 and 2.48 ± 0.66 ng/ml, respectively (P < 0.001). The mean levels of C-reactive protein in the groups with and without severe infection were 159.48 ± 9.73 and 126.17 ± 10.63 mg/L, respectively (P = 0.015). Using receiver operating characteristic (ROC) curves, sensitivity and specificity of procalcitonin were determined as 92.5% and 97.3%, respectively. The corresponding values for C-reactive protein were 70.5% and 42.1%. Conclusion: Procalcitonin can be considered as a predictor and diagnostic marker for diagnosis of severe infectious disease. It can also differentiate severe and non-severe disease in febrile neutropenic patients. Nevertheless, clinical signs and symptoms of the disease should also be considered. Keywords: Neutropenia, Fever, Procalcitonin, C-reactive protein

Background: Hepatitis B virus infection (HBV) and its complications is one of the most serious problems of the health system in many parts of the world. In the present study, we will assess chronic and occult HBV and isolated anti-Hepatitis B core antigen whose screening and evaluation is not routine in different populations. Materials and Methods: This descriptive analytical study was conducted on 213 patients undergoing chemotherapy - radiotherapy referred to the hematology - oncology clinics of Isfahan, Iran in 2012. In order to determine the serum levels of hepatitis B surface antigen (HbSAg), Hepatitis B Antigen and Antibody (HBCAb), aspartate aminotransferase (AST), alanine transaminase (ALT) and Alkaline phosphatase (ALK.P), venous blood samples were obtained. If the HBCAb sample was positive, another sample of the serum was sent to the laboratory to perform polymerase chain reaction and to determine viral load. Results: The mean age of the patients was 47.7 ± 9 years, with an age range of 27 -73 years; 98 (46%) and 115 (54%) cases were male and female, respectively, with mean age of 51.9 ± 8.3 and 44.1 ± 8.1 years, and there was no significant difference (P < 0.001). The mean level of liver enzymes including AST, ALT and ALK.P were 34.2 ± 36.02, 38.9 ± 47.1 and 252.1 ± 234.7, respectively. Two cases were HbSAg positive (0.9%) and six cases were HBCAb positive (2.8%) and HbSAg negative. Three cases had a high viral load at the rate of starting treatment among positive anti-HBC patients. Conclusion: Because occult hepatitis is investigated less commonly in routine studies, it seems that screening and evaluating its prevalence is useful in the management of patients.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infections. The changing epidemiology of MRSA became evident in the 1990s when CA-MRSA cases were first reported. Nasal carriage of CA-MRSA is associated with an increased risk for development of infections in various populations. Materials and Methods: Anterior nares culture for the presence of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA was taken from 345 children attending kindergartens, who didn't have any known risk factor for MRSA colonization. Also, children demographic variables were recorded. Identification of SA and community-acquired methicillin-resistant Staphylococcus aureus ( CA-MRSA) with standard microbiological test was performed. Finally, the susceptibility of isolated to various antibiotics determined. The data were analyzed with Whonet 5.6 software. Results: Of 345 children, 20 children (5.8%) were colonized with CA-MRSA, 86 children (24.9%) with MSSA and 239 cases (69.3%) didn't have SA colonization. The highest rate of MSSA and MRSA colonization was obtained at the age of 6 years. The frequency distribution of SA (MSSA and MRSA) colonization prevalence didn't have any significant differences based on age, gender and the admission time (P > 0.05); but it was significantly different in the urban areas (P < 0.001). The lowest resistance rate of CA-MRSA isolates, with a frequency of 10%, was detected with gentamicin, rifampin, and trimethoprim-sulfamethoxazole. Conclusions: In summary, CA-MRSA colonization was observed in child care centers remarkably. Therefore, by facing various infections due to SA especially in areas of low socio-economic status, it must be considered. Based on antibiogram test, empirical treatment with rifampin, gentamicin and ciprofloxacin is recommended during CA-MRSA infections.

Background: One of the major risk factors of foot ulcer is uncontrolled diabetes mellitus (DM) or in fact uncontrolled HbA1C. The aim of this study was to evaluate the relationship between controlling HbA1C and foot ulcer. Methods: This analytic case-control study was conducted in Alzahra Hospital, Isfahan, Iran during 2010-2011. The case group included 65 male non-smoker patients who had suffered DM for more than 10 years. They were not hypertensive, did not have a history of a previous foot ulcer and were diagnosed with foot ulcer at the time of the study. The control group included 65 male patients with the same background but without foot ulcer. HbA1C levels in both groups 6 months before the study and at the time of study were evaluated. The collected data was analyzed in SPSS18. Findings: Mean time of having DM in the control group was lower than the case group (13.30 vs. 15.49 years). HbA1C < 7% was found in 7.69% of the case group and 52.31% of the control group. Conclusion: The results of this study showed uncontrolled HbA1C as the major factor to create foot ulcer. Therefore, constant measurement of HbA1C, controlling DM and modification of the treatment method if necessary can prevent this life threatening complication. Keywords: HbA1C, Diabetes mellitus, Foot ulcer.

Background: Oral mucositis is a debilitating side effect of cancer treatment for which there is not much successful treatments at yet. We evaluated the effectiveness of topical morphine compared with a routine mouthwash in managing cancer treatment-induced mucositis. Materials and Methods: Thirty head and neck cancer patients with severe mucositis (World Health Organization Grade III or IV) were randomized into the morphine and magic mouthwash groups. Patients received morphine sulfate 2% or magic solution (contained magnesium aluminum hydroxide, viscous lidocaine, and diphenhydramine), 10 ml for every 3 h, six times a day, for 6 days. Both groups received same dietary and oral hygiene instructions and care. Mucositis was graded at baseline and every 3 days after treatment. Patients′ satisfaction and drug effect maintenance were also evaluated. Results: Twenty-eight patients (mean age of 49.5 ± 13.2 years, 63.3% female) completed the trial; 15 in the morphine group and 13 in the magic group. There was a decrease in mucositis severity in both of the morphine (P < 0.001) and magic (P = 0.049) groups. However, at the 6 th day, more reduction was observed in mucositis severity in the morphine compared with magic group (P = 0.045). Drug effect maintenance was similar between the two groups, but patients in the morphine group were more satisfied by their treatments than those in the magic group (P = 0.008). Conclusions: Topical morphine is more effective and more satisfactory to patients than the magic mouthwash in reducing severity of cancer treatment-induced oral mucositis. More studies with larger sample size and longer follow-up are required in this regard.

Background: Rheumatoid arthritis (RA) is a common disease in the community, with various complications. An appropriate solution is immunosuppressive drugs, which may lead to weakening of the cellular immune system and body unresponsiveness to tuberculosis (TB). As TB sensitivity is determined by the amount of induration created in the Purified Protein Derivative (PPD) test, this study aims to evaluate the immune response to the PPD test and its booster in RA patients. Materials and Methods: This cross-sectional study was performed on rheumatoid arthritis patients referred to Alzahra Hospital, Isfahan, treated with ‹20 mg glucocorticoid daily or 7.5 mg Methotrexate (MTX) weekly. The sampling method was simple and accessible. The PPD test was performed in patients using the Mantoux method after 72 hours, and seven days later, the results were interpreted in 72 hours after the PPD booster injection. Induration ≥5 mm was considered to be positive. The data was analyzed using the SPSS software. Results: Nineteen patients had positive results in the initial and reminder tests and 81 patients had negative results in both tests. Six patients (6.9%) with negative results in the initial test changed to positive in the reminder test. There was no positive result in the initial test and negative result in the reminder one. The frequency distribution of the reminder test, based on the initial test was significant (P < 0.001). Also, the McNemar test showed that the changes in the reminder test based on the initial test had a significant difference (P = 0.031). Conclusion: It seems that in the endemic and developing areas, the PPD booster is applicable for diagnosing latent tuberculosis in patients with rheumatoid arthritis.