Comparison of posttraumatic growth and posttraumatic stress of nurses with physicians and medical students after caring of COVID‑19 patients

Objectives:The present study compared the prevalence and psychosocial factors affecting posttraumatic growth(PTG),posttraumatic stress disorder(PTSD),and psychological distress in nurses,physicians,and medical students.Materials and Methods:In a cross‑sectional study,three groups of medical staff including nurses(n=57),physicians(n=40),and medical students(n=34)who were responsible for the care/treatment of COVID‑19 patients admitted to a general hospital for 4 months responded to Posttraumatic Growth Inventory,Brief Symptom Inventory‑18,Resilience Questionnaire,PTSD Screen,and Social Capital‑Integrated Questionnaire.Results:After the exposure of medical staff to at least 4 months of treatment/care of COVID‑19 patients,PTG prevalence was higher than PTSD(38.2%vs.14.6%),but they experienced some degrees of psychological distress(65.5%).The nurses had 8.33(confidence interval[CI]:2.5–26.7)times higher PTG rate than medical students(P<0.001).Physicists also experienced 5.00(CI:1.4–26.7)times higher PTG than medical students(P<0.001).PTG was aided by age,married status,strong resilience,and high social capital,but gender had no influence.Resilience played an important protective role to prevent the incidence of psychological distress in nurses,medical students,and physicians.Conclusion:Despite the fact that the PTSD and psychological distress were same in the three groups of medical staff,the nurses had a greater rate of PTG than physicians and medical students.

Effects of oxygen therapy on the outcome of patients with acute myocardial infarction:A randomized clinical trial

Objective:To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.Methods:This study was a randomized,double-blind clinical trial.The study population included all patients who were admitted to the emergency room of Ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction.The patients(n=47)were divided into two groups:the case group(with oxygen therapy)and the control group(without oxygen therapy).The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction,mortality caused by any other cause,and re-hospitalization caused by acute myocardial infarction.Results:Out of the 47 patients,27 were male(57.4%).The average age of the patients was(60.9±8.1)years.One month after admission,2 patients(8.7%)in the case group and 2 patients(8.3%)in the control group died due to acute myocardial infarction.A total of 7 patients(14.9%)died three months after admission.There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months.After one month,2 patients(8.7%)in the case group and 1 patient(4.2%)in the control group died of other causes.After three months,4 patients(8.5%)in total died for other causes.There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months.One month after admission,5 patients(21.7%)of the case group and 4 patients(16.7%)of the control group were re-hospitalized due to acute myocardial ischemia.During the next three months,3 patients(13.0%)of the case group and 5 patients(20.8%)of the control group were re-hospitalized.There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months after admission.Conclusions:There is no significant relationship between oxygen therapy and death by acute myocardial ischemia,or any other causes.The relationship between oxygen therapy and the rate of re-hospitalization caused by acute myocardial ischemia is not found within one and three months after admission.The results show that oxygen therapy does not affect patients with acute myocardial ischemia within three months after admission.

Isolation of Stenotrophomonas maltophilia from clinical samples: An investigation of patterns motility and production of melanin pigment

Objectives: To investigate possible sources of Stenotrophomonas maltophilia(S. maltophilia) in the clinical environment.Methods: Different samples were collected from Amol City of Iran. Steps for the identification of S. maltophilia included culturing, biochemical tests, polymerase chain reaction(PCR) of 16 S r RNA gene and 23 S r RNA gene. In addition, production of melanin pigment and patterns of motility of the bacteria, were also investigated.Results: In our study, 20 S. maltophilia strains were isolated from clinical sources,oxygen manometer apparatus of hospitals were 7/110(6.36%), blood was 1/777(0.13%),sputum was 4/40(4%), urine was 1/2 947(0.03%), tap water was 1/240(0.42%) and dental suction was 6/120(5%). The isolated bacteria showed production of melanin pigment with rates of strong, moderate, weak, and lack of pigment. Types of motilities were seen in isolates.Conclusions: The highest percentage of bacteria is isolated of oxygen manometer system and dental suction, yet has not been reported from oxygen manometer system. These bacteria have also been associated with patients who have respiratory problems, so it is essential for staffs of hospitals to draw attention to this source of bacteria.

Preliminary study on association between toxoplasmosis and breast cancer in Iran

Objective:To investigate the possible association between Toxoplasma gondii(T.gondii)infection and breast cancer by examining the seropositivity and serointensity rate of anti-T gondii antibodies in breast cancer patients and healthy volunteers.Methods:This study was carried out on 66 women with breast cancer which consists of 29 newly diagnosed patients(Group 1) and 37 cases undergoing treatment and regular checkups(Group 2).Also,60 healthy women(Group 3) with no history of cancer confirmed by clinical examination and imaging participated in this study.The participants were tested for T.gondii immunoglobulin G(IgG) and immunoglobulin M(IgM) antibodies by enzyme-linked immunoassays.Results:The mean age of Groups 1.2 and 3 were 43.3±6.8,41.8±5.5 and 42.3±4.9.respectively(P=0.72).Overall.104(82.5%) and 8(6.3%) out of 126 women were positive for anti-T gondii IgG and IgM antibodies,respectively.Higher seropositivity rate of anti-T.gondii antibodies(IgG) was seen in breast cancer patients(86.4%) compared with control group(78.3%)(P=0.24).IgG antibodies were detected in 89.2%of cancer patients under treatment.82.7%of newly diagnosed patients(P=0.18).IgM antibodies were found in 3(10.3%),2(5.4%)and 3(5%) in Groups 1.2 and 3.No significant difference was found between the mean titers of T.gondii IgG antibody among these groups(P=0.87).Conclusions:This study did not find any significant association between toxoplasmosis and breast cancer besides higher rates of seropositivity and serointensity in patients compared with healthy volunteers.

Comparison between SARS, MERS and COVID-19 in diagnostic criteria

Since a lot of people get involved by COVID-19 infection and died and lots of them obliged to stay at home and teleworking due to its unknown contagious pneumonia in February and March 2020 in Iran and the world;and this number is growing,it seems necessary to study the diagnostic criteria of this virus,based on the recently published articles,and then compare them with Severe acute respiratory syndrome(SARS)and Middle East respiratory syndrome(MERS).Corona viruses are the largest known RNA viruses able to infect humans and birds.These viruses can cause more serious respiratory diseases in elderly,or immunocompromised individuals.In this article,by comparing COVID-19,SARS and MERS viruses,we aim to find similarities and differences between these three which are from the same family and by expressing their diagnostic criteria,help care units to find patients faster and have enough time for treating them.

Relationship between CD14-159C/T gene polymorphism and acute brucellosis risk

Objective:To investigate the association between the cluster of differentiation 14(CD14)-I59C/T(rs2569190) gene polymorphism and susceptibility to acute brucellosis in an Iranian population.Methods:The study included 153 Iranian patients with active brucellosis and 128 healthy individuals as the control group.Genotyping of the CD 14 variant was performed using an amplification refractory mutation system-polymerase chain reaction method.Results:The prevalence of CD14-159 TT and CT genotypes were associated with increased risk of brucellosis[odds ratio(OR)=l.993.95%confidence interval(95%CD=1.07-3.71.P=0.03 for CT:OR=3.869.95%CI= 1.91-7.84,P=0.01 for TT genotype.Additionally,the minor allele(T) was significantly more frequently present in brucellosis patients than in controls(61%vs.45%.respectively),and was a risk factor for brucellosis(OR=3.058.95%CI= 1.507-6.315.P=0.01).Condusions:The findings provid suggestive evidence of association of the CDI4-159C/T gene polymorphism with susceptibility to acute brucellosis in the Iranian population.

Study on relationship between acute gastrointestinal disease and Helicobacter pylori infections

Objective: To assess the relation between acute gastrointestinal disease and Helicobacter pylori (H. pylori) infections. Methods: Over the 18-month period, a total of 323 patients referred to three hospitals in Babol (north of Iran) were enrolled in this cross-sectional study. H. pylori status (rapid urease test), endoscopic findings in the patients, personal habits (smoking or alcohol intake) and administration of drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs) were analyzed using standard Chi-square test and multinomial logistic regression analysis. Results: Results showed that acute gastric ulcer patients had a significant association with alcohol (P=0.001, OR=6.183), opium (P=0.022, OR=2.823), smoking (P=0.016, OR=2.579) and NSAIDs (P=0.046, OR=2.071). However, patients with in acute duodenal ulcer have a significant association with opium (P=0.023, OR=2.326) and alcohol (P=0.003, OR=3.888). As well as, gastric cancer had significant association with alcohol (P<0.05, OR=6.937), smoking (P=0.012, OR=2.738), family history (P=0.005, OR=4.380) and gender (P≤0.05, OR=5.103). Conclusions: Current investigation shows that H. pylori infection, alcoholism, male gender, age and family history have an additive impact on the incidence of gastric cancer. In addition, alcoholism, opium usage, NSAIDs and family history have more impact on the incidence of acute gastric ulcer and acute duodenal ulcer in patients.

Lack of Association between rs4331426 Polymorphism in the Chr18q11.2 Locus and Pulmonary Tuberculosis in an Iranian Population

Objective The effect of rs4331426 polymorphism in the Chr18q11.2 locus on pulmonary tuberculosis（PTB） risk was evaluated.Methods This case-control study included 208 PTB patients and 204 healthy subjects.Genotyping of the rs4331426 variant was conducted using polymerase chain reaction restriction fragment length polymorphism.Results The frequencies of genotypes AA,AG,and GG polymorphisms were 83.1%,15.9%,and 1.0% in the PTB group and 84.3%,15.2%,and 0.5% in the control group,respectively.The frequency of the minor（G） allele was 8.9% in the PTB group and 8.1% in controls.Neither genotype nor allele frequencies of the rs4331426 variant showed statistically significant differences between PTB and controls.In addition,stratification by sex showed no significant association between the rs4331426 variant and PTB risk in males or females.Conclusion In conclusion,the results of this study do not support an association between the rs4331426 polymorphism and risk of PTB in an Iranian population.

Coronavirus disease 2019 (COVID-19), MERS and SARS: Similarity and difference

SARS-CoV-2 is the causative agent of COVID-19.Since its outbreak in December 2019,COVID-19 has swept the globe.By 17 July 2020,the World Health Organization(WHO)had confirmed 13?119?239 cases and 573?752 deaths,and the numbers are still rising.Current evidence shows that COVID-19 is lower than severe acute respiratory syndrome and Middle East respiratory syndrome in terms of severity and mortality risk,although the infections are particularly more severe in patients with underlying medical conditions.The bulk of COVID-19 patients had close contact with confirmed cases,but an exact origin and specific transmission for COVID-19 are still unknown.As there is no approved antiviral treatment for COVID-19 infection,proper prevention and control practices are essential to control the infection.To have an insight view of COVID-19,we summarized and compared the etiology,clinical manifestations,diagnosis,treatment,and prevention measures of COVID-19,severe acute respiratory syndrome,and Middle East respiratory syndrome.

A Nonglycosylated 27 KDa Molecule as Common Antigen between Human Breast Cancer and Echinococcus granulosus Hydatid Cyst Wall

Background: Hydatid cyst, which has anti-cancer activities, is outwardly covered with the cyst wall. It is in close contact with the host tissues and its molecules presented to the immune system. In this work immunological reaction of the sera of breast cancer patients with the hydatid cyst wall antigens has been investigated. Method: For this purpose, sera of patients with breast cancer, hydatid cyst and normal human sera were collected and their reaction with hydatid cyst wall antigens was tested using western immunoblotting technique. Results: All sera of patients with breast cancer, hydatid cyst and also human normal sera reacted with a band in western immunoblotting. However, sera of patients with breast cancer showed reaction with a 27 KDa band. Results of this work also revealed that this band was not glycosylated and may express only in some stages of breast cancer development. Conclusion: Sera of patients with breast cancer cross reacted with a nonglycosylated antigen of hydatid cyst wall. However, more work is recommended to find if this band involves in anticancer activity of the hydatid cyst.

Osteoarticular manifestations of human brucellosis:A review

Brucellosis is a common global zoonotic disease, which is responsible for a range of clinical manifestations. Fever, sweating and musculoskeletal pains are observed in most patients. The most frequent complication of brucellosis is osteoarticular involvement, with 10% to 85% of patients affected. The sacroiliac(up to 80%) and spinal joints(up to 54%) are the most common affected sites.Spondylitis and spondylodiscitis are the most frequent complications of brucellar spinal involvement. Peripheral arthritis, osteomyelitis, discitis, bursitis and tenosynovitis are other osteoarticular manifestations, but with a lower prevalence. Spinal brucellosis has two forms: focal and diffuse. Epidural abscess is a rare complication of spinal brucellosis but can lead to permanent neurological deficits or even death if not treated promptly. Spondylodiscitis is the most severe form of osteoarticular involvement by brucellosis, and can have single-or multifocal involvement. Early and appropriate diagnosis and treatment of the disease is important in order to have a successful management of the patients with osteoarticular brucellosis. Brucellosis should be considered as a differential diagnosis for sciatic and back pain, especially in endemic regions. Patients with septic arthritis living in endemic areas also need to be evaluated in terms of brucellosis. Physical examination, laboratory tests and imaging techniques are needed to diagnose the disease. Radiography, computed tomography, magnetic resonance imaging(MRI) and bone scintigraphy are imaging techniques for the diagnosis of osteoarticular brucellosis. MRI is helpful to differentiate between pyogenic spondylitis and brucellar spondylitis. Drug medications(antibiotics)and surgery are the only two options for the treatment and cure of osteoarticular brucellosis.

Twelve vegetables used for prevention and treatment of hemorrhoids in Persian Medicine

OBJECTIVE: To review the role of vegetables to prevent and treat hemorrhoids in Persian Medicine(PM).METHODS: We search main Persian Medicine manuscripts, including the books of Liber Continens,Canon of Medicine, Great Elixir, Akbarie’s Medicine,Storehouse of Medicaments and Present for the faithful. Also, it was considered by searching in reference books and published papers with the help of PubMed, Scopus, Google scholar databases.RESULTS: Twelve vegetables, relating to 8 plant families, have been found in PM that their effectiveness involved in laxative, anti-inflammation, antimicrobial, analgesic and wound healing.CONCLUSION: Our findings suggest that 12 Persian Medicine vegetables can be used to prevent and treat hemorrhoids.

Antibacterial resistance patterns of Acinetobacter baumannii complex:The results of Isfahan Antimicrobial Resistance Surveillance-1 Program

Objective: To determine the antibiotic resistance patterns of the Acinetobacter(A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source(hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS.Results: From 254 patients who had confirmed A. baumannii complex infection, 158(62.20%) cases were male, 27(10.63%) were less than 20 years old, 172(67.72%) had healthcare-associated infections and 96(37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections(111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics(more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline(20, 44.44%) and colistin(0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance(MDR) were significantly different between males and females. In patients with healthcare associated infection(HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses.Conclusions: In our study, a high level of antibiotic resistance was detected in both community-acquired and healthcare-associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.

Toll-like Receptor 1 Polymorphisms Increased the Risk of Pulmonary Tuberculosis in an Iranian Population Sample

A case-control study was carried out that involved 203 individuals diagnosed with pulmonary tuberculosis （PTB） and 203 healthy subjects. Genotyping of TLR1 rs5743551 and rs5743618 polymorphisms was done using polymerase chain reaction-restriction fragments length polymorphism assay. We found that TLR1 rs5743551 variant affected the risk of PTB in the codominant （OR=3.28, 95% C1=1.98-5.45, P〈0.0001, GA vs. GG; OR=1.86, 95% C1=1.05-3.28, P=0.033, AA vs. GG） and dominant （OR=2.69, 95% C1=1.67-4.34, P〈0.0001, GA＋AA vs. GG） inheritance models tested. The A allele was associated with a higher risk of PTB than the G allele （OR=1.33, 95% C1=1.01-1.75, P=0.049）. The TG genotype of the rs5743618 variant significantly increased the risk of PTB compared to the risk associated with the TT genotype （0R=3.29, 95% C1=1.82-5.97, P〈0.0001）. The G allele was associated with a higher risk of PTB than the T allele （OR=3.00, 95% C1=1.69-5.31, P=0.0001）. Our findings revealed that TLR1 rs5743551 and rs5743618 polymorphisms affected the risk of PTB in an Iranian population sample. Additional studies with larger sample sizes and involving subjects of different ethnicities are required to validate our present findings.

Antimicrobial resistance pattern in ventilator-associated pneumonia in an intensive care unit of Babol, northern Iran

Objective:To investigate antibiotic resistance pattern of ventilator-assiated pneumonia (VAP) generating microorganisms,and quantitative culture and determining antibiotic sensitivity.Methods:This cross sectional study was performed on 50 patients suffering from VAP in intensive care unit of Ayatollah Rouhani Hospital,Babol,Iran during 2014-2015.VAP was probable for them based on clinical signs and the criteria of Clinical Pulmonary Infection Score standards.Lower respiratory samples were given under bronchoalveolar lavage and quantitative culture was done on them.Afterwards by microdilution method,minimal inhibitory concentration based on respective microorganisms,considering clinical pulmonary infection score were determined.Results:From 50 investigated samples in this study,the most common microorganisms were Acinetobacter baumannii (A.baumannii) (70%) then Pseudomonas aeruginosa (12%),Staphylococcus aureus (8%) and Klebsiella pneumonia (3%).In our study A.baummannii showed approximate 100% resistance to all antibiotics,in a way that A.baumannii resistance to imipenem and meropenem and piperacillin/tazobactam each was 97.1%.The most resistance of Pseudomonas aeruginosa was 66.7% to each cefepime and ceftazidime and clavulanate/ticarcillin.Staphylococcus aureus showed 75% resistance to nafcillin,cloxacillin and resistance in case of vancomycin was not seen.Conclusion:In current study,A.baumannii had the most prevalence among VAP and this species is resistant to most of antibiotics.Using ceftazidime,cefepime and clavulanate/ticarcillin,in treatment of the patients suffering VAP is not reasonable.

Gastropericardial fistula: a case report

Rationale: Gastropericardial fistula is a rare condition in which the patient presented with chest pain, dyspnea, tachycardia, pneumo/hydropericardium, or pericarditis. Alcohol intake or previous history of gastroesophageal surgery made the patient susceptible to fistula formation. Patient concerns: An 80-year-old male complained of sudden onset of dyspnea and respiratory distress. Nausea, hematemesis, and constipation were noted on clinical examination. Diagnosis: Herniation of the gastric fundus and massive pneumopericardium due to formation of fistula in the lesser curvature. Interventions: Urgent surgery was performed. Outcomes: The patient was discharged without any complication. Lessons: Although the lethal form of this condition is rare, gastroepicardial fistula should be included in the differential diagnosis workup of cases with stomach cardia and fundus ulceration.

Acute pancreatitis with cytomegalovirus infection in a kidney transplant recipient: A case report

Cytomegalovirus (CMV) can cause significant inflammation. Besides, it is an important cause of pancreatitis in organ transplantations. We report a case of CMV pancreatitis in a 48-year-old male kidney transplant recipient who was admitted with elevated amylase (3337 U/L) and lipase (1160 U/L) enzymes, and abdominal pain. CMV infection was tested by reverse transcription polymerase chain reaction and the result was positive. CMV viremia was successfully cleared with ganciclovir. Then the absence of some of more noticeable clinical symptoms of pancreatitis may not be a decisive reason not to rule out the disease in transplanted cases.

A case of human acute otoacariasis caused by Rhizoglyphus sp, the first report from Iran

Otoacariasis is the presence of ticks and mites in the auditory canal.A 50-year-old Iranian man was subjected at the an ear,nose,and throat clinic at Rouhani Hospital in Babol with complaint of left ear pain.Otoscopic examination showed mite infestation in the left auditory canal.The infestation was eradicated with the 2% H2O2 solution.Treatment began by applying oral ciprofloxacin (500 mg/day) twice daily for 7 d.We report the rare case of an ear canal infestation with the Rhizoglyphus and their eradication with 2% H2O2 solution.

Gastric ultrasound-assisted diagnosis of undifferentiated shock:A case report

Rationale:Peptic ulcer disease and variceal bleeding are two of the most common causes of gastrointestinal(GI)bleeding.GI bleeding can present with symptoms of hemodynamic instability such as tachycardia and shock.Patient’s Concern:A 33-year-old man with confusion and hypotension(blood pressure:70/40 mmHg and pulse rate:140/min)was brought by emergency medical services from home to the emergency department without any companion.The patient was in undifferentiated shock.His hypotension was assessed with inferior vena cava(IVC)size and collapsibility,and rapid ultrasound in shock and hypotension(RUSH)protocol was used to investigate the cause of his shock.Following the RUSH protocol when scanning the IVC,parts of the stomach were seen in its vicinity and suspended heterogeneous particles were observed in the fluid.After seeing these particles,we suspected GI bleeding.Diagnosis:Endoscopy confirmed GI bleeding.Interventions:After placing an orogastric tube and suction,about 2 L of coffee-ground fluid with clots was removed.We started intravenous proton-pump inhibitors 80 mg bolus,followed by a continuous infusion of 8 mg/h.The patient received about 2 L of normal saline and 2 units of packed red blood cells to correct his hypotension.Outcomes:After being admitted to the GI ward and treated for three days,the patient was discharged from the hospital with a hemoglobin level of 11 g/dL and continued to have an outpatient follow-up at the clinic.Lessons:The use of gastric ultrasound in conjunction with the RUSH protocol can help to diagnose undifferentiated hypotensive shock.The components of the RUSH exam are the heart(H),IVC(I),Morrison’s/FAST abdominal views with the aorta(MA),and pulmonary and pipes scanning(P),and can be memorized with the mnemonic:HI-MAP.We would like to introduce a new mnemonic:Hi-MAPS,adding stomach(S)to the RUSH protocol in undifferentiated hypotension and shock to evaluate upper GI bleeding.

Unusual form of strongyloidiasis with gastric involvements: A case report

Rationale: Strongyloides stercoralis (S. stercoralis) is an intestinal nematode with a complicated life cycle that can involve the gastrointestinal system. Infected patients are generally asymptomatic;but if symptomatic, the symptoms will include skin rash, respiratory and gastrointestinal symptoms like abdominal pain, diarrhea, nausea and vomiting. Patient concerns: A 77-year old man presented with edema of the lower extremities and insignificant tenderness in the epigastric region. Diagnosis: The histopathology of gastric tissue showed severe inflammation and multiple ulcers in the cardia, antrum and proximal duodenum. A large number of rhabditiform larvae of S. stercoralis along with tissue hyperemia and infiltration of lymphoplasma cells, eosinophils, and neutrophils were found. Intervention: Treatment with albendazole. Outcome: Despite the albendazole treatment, the patient's condition deteriorated and eventually died because of a sepsis-like syndrome. Lesson: Physicians should remain alert to the urgency due to threadworm, especially among the elderly people and immunosuppressed cases;and should ensure accurate diagnosis, suitable treatment and careful follow-up of these cases.