Background:Treatment of the nosocomial infections is complicated especially in children due to an increase in the antibiotic-resistant bacteria.Objectives:The aim of this study was to survey the nosocomial infections in children and determine the antibiotic susceptibility of their causative organisms in teaching hospitals in the north of Iran.Patients and Methods:The investigation was designed as a retrospective cross-sectional study. The study population consisted of patients under 12 years old, which were hospitalized in three teaching hospitals in the north of Iran and had symptoms of nosocomial infections in 2012. The required data of patients were extracted and entered in the information forms. The collected data were analyzed using SPSS (ver. 16). Descriptive statistics and Fisher’s exact tests (Monte Carlo) were used.Results:Out of the total number of 34556 hospitalized patients in three teaching hospitals, 61 (0.17%) patients were children under 12 years old age with nosocomial infection from which 50.81% were girls and 49.18% were boys. Most of these patients (55.73%) were admitted to the burn unit. The most common type of nosocomial infection (49.18%) was wound infection. Pseudomonas spp. (36.84%) and Acinetobacter spp. (28.02%) were the most common bacteria isolated from the clinical specimens. All the Acinetobacter spp. were multidrug-resistant. All the gram negative and gram positive bacterial species in our study showed high resistance to antibiotics.Conclusions:The rate of nosocomial infections was low in our study because the detection of nosocomial infection was based on the clinical grounds in most cases and laboratory reports might contain false-negative results. These results provide useful information for future large scale surveillance in the context of prevention programs.

Purpose: Given the coronavirus disease 2019 (COVID-19) pandemic, there is a global urgency to discover an effective treatment for patients withthis disease. This study aimed to evaluate the effects of the widely used antiparasitic drug ivermectin on outcomes in patients with COVID-19.Methods: In this randomized, double-blind clinical trial, patients with COVID-19 admitted to 2 referral tertiary hospitals in Mazandaran, Iran, were randomly divided into 2 groups: intervention and control. In addition to standard treatment for COVID-19, the intervention group received a single weight-based dose (0.2 mg/kg) of ivermectin; the control group received the standard of care. Demographic, clinical, laboratory, and imaging data from participants were recorded at baseline. Patients were assessed daily for symptoms and disease progression. The primary clinical outcome measures were the durations of hospital stay, fever, dyspnea, and cough; and overall clinical improvement.Findings: Sixty-nine patients were enrolled (mean [SD] ages: ivermectin, 47. 63 [22.20] years; control, 45.18 [23.11] years; P = 0.65). Eighteen patients (51.4%) in the ivermectin group and 18 (52.9%) in control group were male ( P = 0.90). The mean durations of dyspnea were 2.6 (0.4) days in the ivermectin group and 3.8 (0.4) days in the control group ( P = 0.048). Also, persistent cough lasted for 3.1 (0.4) days in the ivermectin group compared to 4.8 (0.4) days in control group (P P = 0.019). The mean durations of hospital stay were 7.1 (0.5) days versus 8.4 (0.6) days in the ivermectin and control groups, respectively ( P = 0.016). Also, the frequency of lymphopenia decreased to 14.3% in the ivermectin group and did not change in the control group ( P = 0.007).Implications: A single dose of ivermectin was well-tolerated in symptomatic patients with COVID-19, and important clinical features of COVID-19 were improved with ivermectin use, including dyspnea, cough, and lymphopenia. Further studies with larger sample sizes, different drug dosages, dosing intervals and durations, especially in different stages of the disease, may be useful in understanding the potential clinical benefits ivermectin. Iranian Registry of Clinical Trials identifier: IRCT20111224008507N3.

Background:Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens.Objectives:The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014.Methods:In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used.Results:Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR).Conclusions:We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and ESBL bacteria is increasing in our region.

Statins can help COVID-19 patients’ treatment because of their involvement in angiotensin-converting enzyme-2. The main objective of this study is to evaluate the impact of statins on COVID-19 severity for people who have been taking statins before COVID-19 infection. The examined research patients include people that had taken three types of statins consisting of Atorvastatin, Simvastatin, and Rosuvastatin. The case study includes 561 patients admitted to the Razi Hospital in Ghaemshahr, Iran, during February and March 2020. The illness severity was encoded based on the respiratory rate, oxygen saturation, systolic pressure, and diastolic pressure in five categories: mild, medium, severe, critical, and death. Since 69.23% of participants were in mild severity condition, the results showed the positive effect of Simvastatin on COVID-19 severity for people that take Simvastatin before being infected by the COVID-19 virus. Also, systolic pressure for this case study is 137.31, which is higher than that of the total patients. Another result of this study is that Simvastatin takers have an average of 95.77 mmHg O2Sat; however, the O2Sat is 92.42, which is medium severity for evaluating the entire case study. In the rest of this paper, we used machine learning approaches to diagnose COVID-19 patients’ severity based on clinical features. Results indicated that the decision tree method could predict patients’ illness severity with 87.9% accuracy. Other methods, including the K -nearest neighbors (KNN) algorithm, support vector machine (SVM), Naïve Bayes classifier, and discriminant analysis, showed accuracy levels of 80%, 68.8%, 61.1%, and 85.1%, respectively.

Acute myopericarditis is a well-recognized but rare complication of numerous viral infections. Here we report a case of fulminant myopericarditis presenting with acute heart failure and a state of shock in a previously healthy young woman. H1N1 influenza A virus sequences were identified in throat and pericardial fluid, suggesting a viral source of the infection.

Background A protective effect of vitamin D against COVID-19 infection is under investigation. We aimed to analyze the effect of vitamin D sufficiency on the clinical outcomes of patients infected with COVID-19. Methods In this cross-sectional study we analyzed the vitamin D levels of COVID-19 patients who were admitted to Razi Hospital (an infectious disease referral center in Mazandaran province in northern Iran) from February to March 2020. Overall, a cutoff point of 30 ng/mL was used for the definition of vitamin D sufficiency. Results One hundred fifty-three patients were analyzed in this study who had laboratory documentation of a 25(OH) D level at the time of hospitalization. The vitamin D levels of the patients were 27.19 ± 20.17 ng/mL. In total, 62.7% (n = 96) of the patients had a 25(OH) D level of less than 30 ng/mL and 37.25% (n = 57) had a 25(OH) D level of more than 30 ng/mL. In total, 49% (n = 75) of the patients suffered from at least one underlying disease. The univariate and multivariable regression showed that vitamin D sufficiency was not associated with a statistically significant lower risk of adverse clinical outcomes of COVID-19 such as duration of hospitalization and severity of infection (P > 0.05). Conclusions Sufficient vitamin D levels were not found to be protective against adverse clinical outcomes in patients infected with COVID-19. Chronic disorders in COVID-19 patients were found to have greater relevance than vitamin D levels in determining the adverse outcomes of the infection. Further studies are needed to determine the role of vitamin D level in predicting the outcomes of COVID-19 infection.

Background: Brucellosis is a zoonosis with diverse clinical manifestations. This study investigated the epidemiological, laboratory, and clinical features of brucellosis. Methods: In a cross-sectional survey, we evaluated brucellosis patients who referred to Razi hospital, a referral center for infectious diseases in Mazandaran province (north of Iran), from 21 March 2009 to 20 March 2014. Factors such as age, sex, clinical signs, and laboratory findings were extracted from their medical records. Results: 219 patients with a mean age of 41.6 ± 16.9 years were enrolled including 86 women (39.27%) and 133 men (60.73%). 191 participants (87.2%) had used local dairy products. 174 (79.4%) were suffering from non-focal brucellosis and 45 patients (20.6%) from focal brucellosis. The rates of referral per season were 23.7, 33.8, 23.3, and 19.2 percent in the spring, summer, autumn, and winter, respectively (P = 0.006). In terms of job, 76 patients (34.7%) were in business/market-related jobs, 64 (29.2%) were homemakers, and 49 (22.4%) were in dairy jobs. The relationship between jobs and disease was significant (P = 0.003). The most common chief complaint of patients was fever and chills (31.1%). Conclusions: Based on the findings, factors such as fever, chills, back pain, myalgia, anemia, and abnormal ESR were associated with brucellosis.

Background A protective effect of vitamin D against COVID-19 is under investigation. We aimed to analyze the effect of vitamin D sufficiency on clinical outcomes of patients with COVID-19 infection. Methods In this retrospective study we analyzed the vitamin D levels of COVID-19 patients who were admitted to Razi Hospital (an infectious disease referral center in Mazandaran province in north of Iran) from February to March 2020. Overall, a cutoff point of 30 ng/mL was used for the definition of vitamin D sufficiency. Results 153 patients were analyzed in this study who had laboratory documentation of a 25(OH) D level at the time of hospitalization. In total, 62.7% (n-=96) of the patients had a 25(OH) D level of less than 30 ng/mL and 37.25% (n = 57) had a 25(OH) D level of more than 30 ng/mL. In total, 49% (n = 75) of the patients suffered from at least one underlying disease. Vitamin D sufficiency was not associated with a statistically significant lower risk of adverse clinical outcomes of COVID-19 such as duration of hospitalization, lung involvement, intensive care unit (ICU) admission, invasive and non-invasive ventilation, the severity of disease or death. Conclusions Sufficient vitamin D levels were not found to be protective against adverse clinical outcomes in patients infected with COVID-19.