Saeed Nemati, Hamidreza Najari, Anita Eftekharzadeh, A. Kazemifar, Ali Qandian, Pedram Fattahi, Sepideh Abdi, Elnaz Saeedi, Maedeh Zokaei nikoo, M. Rouhollahi
Background: The coronavirus disease 2019 (COVID-19) pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in reverse-transcriptase-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and ventilators availabilities throughout the COVID-19 outbreak. Objectives: This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different real-time RT-PCR test results during the first three weeks of the outbreak in Qazvin province, Iran. Methods: In this retrospective cohort study, patients with a positive chest computed tomography (CT) scan for COVID-19 who were admitted to all 12 hospitals across Qazvin province, Iran, between February 20 and March 11, 2020, were included and followed up until March 27, 2020. A multivariate logistic regression model was applied to compare the independent associates of death among COVID-19 patients. Then, patients were categorized into six groups based on admission to the intensive care unit (ICU) and rRT-PCR test status (positive, negative, or no test). Also, multilevel logistic regression was used to compare the odds of surviving in each group against the reference group (PCR negative patients not-received ICU) to show if the rational allocation of ICU occurred while its capacity is limited. Results: In this study, we included 998 patients (57% male; median age: 54 years) with positive chest CT scan changes. Among them, 558 patients were examined with rRT-PCR test and 73.8% tested positive. Case fatality rate (CFR) was 20.68 and 7.53% among hospitalized patients with positive and negative tests, respectively. While only 5.2% of patients were admitted to the ICU, CFR outside ICU was 17.70 and 4.65% in patients with positive and negative results not admitted to the ICU, respectively. Conclusions: Total CFR in all hospitalized COVID-19 patients in Qazvin province during the first three weeks of the pandemic was 11.7%. Also, according to the results, the main risk factors included a positive rRT-PCR test, age more than 70 years, and having two or more comorbidities or just immunodeficiency disorders. Hence, the ICU admission criteria or prioritized ICU beds allocation should be considered with more emphasis on rRT-PCR results when the capacity of ICU beds is low.
{"title":"Association Between rRT-PCR Test Results Upon Admission and Outcome in Hospitalized Chest CT-Positive COVID-19 Patients: A Provincial Retrospective Cohort with Active Follow-up","authors":"Saeed Nemati, Hamidreza Najari, Anita Eftekharzadeh, A. Kazemifar, Ali Qandian, Pedram Fattahi, Sepideh Abdi, Elnaz Saeedi, Maedeh Zokaei nikoo, M. Rouhollahi","doi":"10.5812/archcid.111866","DOIUrl":"https://doi.org/10.5812/archcid.111866","url":null,"abstract":"Background: The coronavirus disease 2019 (COVID-19) pandemic imposed the most devastating challenge on healthcare systems worldwide. Iran was among the first countries that had to confront serious shortages in reverse-transcriptase-polymerase chain reaction (RT-PCR) testing for severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and ventilators availabilities throughout the COVID-19 outbreak. Objectives: This study aimed to investigate the clinical course of hospitalized COVID-19 patients with different real-time RT-PCR test results during the first three weeks of the outbreak in Qazvin province, Iran. Methods: In this retrospective cohort study, patients with a positive chest computed tomography (CT) scan for COVID-19 who were admitted to all 12 hospitals across Qazvin province, Iran, between February 20 and March 11, 2020, were included and followed up until March 27, 2020. A multivariate logistic regression model was applied to compare the independent associates of death among COVID-19 patients. Then, patients were categorized into six groups based on admission to the intensive care unit (ICU) and rRT-PCR test status (positive, negative, or no test). Also, multilevel logistic regression was used to compare the odds of surviving in each group against the reference group (PCR negative patients not-received ICU) to show if the rational allocation of ICU occurred while its capacity is limited. Results: In this study, we included 998 patients (57% male; median age: 54 years) with positive chest CT scan changes. Among them, 558 patients were examined with rRT-PCR test and 73.8% tested positive. Case fatality rate (CFR) was 20.68 and 7.53% among hospitalized patients with positive and negative tests, respectively. While only 5.2% of patients were admitted to the ICU, CFR outside ICU was 17.70 and 4.65% in patients with positive and negative results not admitted to the ICU, respectively. Conclusions: Total CFR in all hospitalized COVID-19 patients in Qazvin province during the first three weeks of the pandemic was 11.7%. Also, according to the results, the main risk factors included a positive rRT-PCR test, age more than 70 years, and having two or more comorbidities or just immunodeficiency disorders. Hence, the ICU admission criteria or prioritized ICU beds allocation should be considered with more emphasis on rRT-PCR results when the capacity of ICU beds is low.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46812574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Sabzehali, H. Goudarzi, Alireza Salimi Chirani, Mohammad Hossein Yoosefi Izad, M. Goudarzi
Background: The emerging problem of antibiotic resistance in Pseudomonas aeruginosa is a global health concern; hence, revealing innovative therapeutic approaches (such as designing an immunogenic vaccine candidate) is needed. There is no evidence of the availability of an effective vaccine that can combat the infection caused by this microorganism. Objectives: This research was conducted to develop a potential chimeric vaccine against P. aeruginosa using reverse vaccinology approaches. Methods: The present vaccine candidate comprised outer membrane protein F and I (OprF/OprI) and PopB with appropriate linkers. After applying meticulous immune-informatics investigation, the multi-epitope vaccine was created, including helper T lymphocyte (HTL), cytotoxic T lymphocyte (CTL), interferon gamma (IFN-γ), and interleukin 4 (IL-4) epitopes. Then, the physicochemical characteristics, allergenicity, toxicity, and antigenicity were analyzed. After investigating the secondary structure, the tertiary structure (3D) model was generated, refined, and validated via computational methods. Besides, the strong protein-ligand interaction and stability between the vaccine candidate and toll-like receptor 4 (TLR4) were determined via molecular docking and dynamics analyses. Moreover, in silico cloning accompanied by pET-22b (+) was used to achieve high translation efficiency. Results: Our results presumed that the chimeric-designed vaccine was thermostable and contained optimal physicochemical properties. This vaccine candidate was nontoxic and highly soluble and had stable protein and TLR4 interaction, adequately overexpressed in Escherichia coli. Overall, it could induce immune responses and repress this microorganism. Conclusions: Therefore, to inhibit Pseudomonas infections experimentally, the efficacy and safety of the vaccine design need to be validated.
{"title":"Development of Multi-epitope Subunit Vaccine Against Pseudomonas aeruginosa Using OprF/OprI and PopB Proteins","authors":"F. Sabzehali, H. Goudarzi, Alireza Salimi Chirani, Mohammad Hossein Yoosefi Izad, M. Goudarzi","doi":"10.5812/archcid.118243","DOIUrl":"https://doi.org/10.5812/archcid.118243","url":null,"abstract":"Background: The emerging problem of antibiotic resistance in Pseudomonas aeruginosa is a global health concern; hence, revealing innovative therapeutic approaches (such as designing an immunogenic vaccine candidate) is needed. There is no evidence of the availability of an effective vaccine that can combat the infection caused by this microorganism. Objectives: This research was conducted to develop a potential chimeric vaccine against P. aeruginosa using reverse vaccinology approaches. Methods: The present vaccine candidate comprised outer membrane protein F and I (OprF/OprI) and PopB with appropriate linkers. After applying meticulous immune-informatics investigation, the multi-epitope vaccine was created, including helper T lymphocyte (HTL), cytotoxic T lymphocyte (CTL), interferon gamma (IFN-γ), and interleukin 4 (IL-4) epitopes. Then, the physicochemical characteristics, allergenicity, toxicity, and antigenicity were analyzed. After investigating the secondary structure, the tertiary structure (3D) model was generated, refined, and validated via computational methods. Besides, the strong protein-ligand interaction and stability between the vaccine candidate and toll-like receptor 4 (TLR4) were determined via molecular docking and dynamics analyses. Moreover, in silico cloning accompanied by pET-22b (+) was used to achieve high translation efficiency. Results: Our results presumed that the chimeric-designed vaccine was thermostable and contained optimal physicochemical properties. This vaccine candidate was nontoxic and highly soluble and had stable protein and TLR4 interaction, adequately overexpressed in Escherichia coli. Overall, it could induce immune responses and repress this microorganism. Conclusions: Therefore, to inhibit Pseudomonas infections experimentally, the efficacy and safety of the vaccine design need to be validated.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":"192 ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41284742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Salehi, Nasim Khajavirad, I. Alavi Darazam, S. Hashemi, S. Ansari, F. Ghiasvand, Saeidreza Jamalimoghadamsiahkali, A. Izadi, Reyhaneh Sadat Kiyaei, Arash Seifi, Sara Abolghasemi, Firouze Hatami, T. Boekhout, S. D. Dehghan Manshadi, S. Khodavaisy
Background: With the emergence and spread of coronavirus disease 2019 (COVID-19) globally, health care systems have faced the biggest challenge in recent decades. Objectives: The present study aimed to identify risk factors associated with oropharyngeal candidiasis (OPC) in COVID-19 patients. Methods: The total number of confirmed COVID-19 patients was 218 (105 cases with OPC and 113 controls without OPC). The questionnaire used in this study consisted of demographic data, treatment strategy, clinical and laboratory data, and underlying diseases collected from the onset of clinical OPC until the end of hospitalization. Results: Pseudomembranous candidiasis (77/105, 73.3%) was the most prevalent form of OPC in case patients. The majority of the cases (58.1%) and controls (58.4%) were males. Increasing age (P = 0.03) and hospitalization length (P = 0.016) were significantly associated with OPC in COVID-19 patients. Diabetes (P = 0.003), solid tumor (P = 0.019), and hypertension (P = 0.000) were the most common underlying conditions. The use of dentures (P = 0.003) and poor oral hygiene (P = 0.000) were related to OPC in the case group. Therapy with chloroquine (P = 0.012), IVIG (P = 0.001), diuretics (P = 0.000), and corticosteroid pulse therapy (P = 0.000) were significantly associated with developing OPC in case patients. Conclusions: Old age, hospitalization length, poor oral hygiene, corticosteroids use, diabetes, solid tumor, and hypertension may predispose COVID-19 patients to develop OPC.
{"title":"Risk Factors of Oropharyngeal Candidiasis in COVID-19 Patients: A Case-control Study","authors":"M. Salehi, Nasim Khajavirad, I. Alavi Darazam, S. Hashemi, S. Ansari, F. Ghiasvand, Saeidreza Jamalimoghadamsiahkali, A. Izadi, Reyhaneh Sadat Kiyaei, Arash Seifi, Sara Abolghasemi, Firouze Hatami, T. Boekhout, S. D. Dehghan Manshadi, S. Khodavaisy","doi":"10.5812/archcid.114631","DOIUrl":"https://doi.org/10.5812/archcid.114631","url":null,"abstract":"Background: With the emergence and spread of coronavirus disease 2019 (COVID-19) globally, health care systems have faced the biggest challenge in recent decades. Objectives: The present study aimed to identify risk factors associated with oropharyngeal candidiasis (OPC) in COVID-19 patients. Methods: The total number of confirmed COVID-19 patients was 218 (105 cases with OPC and 113 controls without OPC). The questionnaire used in this study consisted of demographic data, treatment strategy, clinical and laboratory data, and underlying diseases collected from the onset of clinical OPC until the end of hospitalization. Results: Pseudomembranous candidiasis (77/105, 73.3%) was the most prevalent form of OPC in case patients. The majority of the cases (58.1%) and controls (58.4%) were males. Increasing age (P = 0.03) and hospitalization length (P = 0.016) were significantly associated with OPC in COVID-19 patients. Diabetes (P = 0.003), solid tumor (P = 0.019), and hypertension (P = 0.000) were the most common underlying conditions. The use of dentures (P = 0.003) and poor oral hygiene (P = 0.000) were related to OPC in the case group. Therapy with chloroquine (P = 0.012), IVIG (P = 0.001), diuretics (P = 0.000), and corticosteroid pulse therapy (P = 0.000) were significantly associated with developing OPC in case patients. Conclusions: Old age, hospitalization length, poor oral hygiene, corticosteroids use, diabetes, solid tumor, and hypertension may predispose COVID-19 patients to develop OPC.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46395980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Nugroho, A. Wardhana, D. Rachmi, Eka Prasetya Budi Mulia, M. Q. A'yun, Imanita Septianda, I. Maghfirah
Context: COVID-19 severe manifestations must be detected as soon as possible. One of the essential poor characteristics is the involvement of coagulopathy. Simple coagulation parameters, including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and platelet, are widely accessible in many health centers. Objectives: This meta-analysis aimed to determine the association between simple coagulation profiles and COVID-19 in-hospital mortality. Method: We systematically searched five databases for studies measuring simple coagulation parameters in COVID-19 on admission. The random-effects and inverse-variance weighting were used in the study, which used a standardized-mean difference of coagulation profile values. The odds ratios were computed using the Mantel-Haenszel formula for dichotomous variables. Results: This meta-analysis comprised a total of 30 studies (9,175 patients). In our meta-analysis, we found that non-survivors had a lower platelet count [SMD = -0.56 (95% CI: -0.79 to -0.33), P < 0.01; OR = 3.00 (95% CI: 1.66 to 5.41), P < 0.01], prolonged PT [SMD = 1.22 (95%CI: 0.71 to 1.72), P < 0.01; OR = 1.86 (95%CI: 1.43 to 2.43), P < 0.01], prolonged aPTT [SMD = 0.24 (95%CI: -0.04 to 0.52), P = 0.99], and increased INR [SMD = 2.21 (95%CI: 0.10 to 4.31), P = 0.04] than survivors. Conclusions: In COVID-19 patients, abnormal simple coagulation parameters on admission, such as platelet, PT, and INR, were associated with mortality outcomes.
{"title":"Simple Coagulation Profile as Predictor of Mortality in Adults Admitted with COVID-19: A Meta-Analysis","authors":"J. Nugroho, A. Wardhana, D. Rachmi, Eka Prasetya Budi Mulia, M. Q. A'yun, Imanita Septianda, I. Maghfirah","doi":"10.5812/archcid.115442","DOIUrl":"https://doi.org/10.5812/archcid.115442","url":null,"abstract":"Context: COVID-19 severe manifestations must be detected as soon as possible. One of the essential poor characteristics is the involvement of coagulopathy. Simple coagulation parameters, including prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and platelet, are widely accessible in many health centers. Objectives: This meta-analysis aimed to determine the association between simple coagulation profiles and COVID-19 in-hospital mortality. Method: We systematically searched five databases for studies measuring simple coagulation parameters in COVID-19 on admission. The random-effects and inverse-variance weighting were used in the study, which used a standardized-mean difference of coagulation profile values. The odds ratios were computed using the Mantel-Haenszel formula for dichotomous variables. Results: This meta-analysis comprised a total of 30 studies (9,175 patients). In our meta-analysis, we found that non-survivors had a lower platelet count [SMD = -0.56 (95% CI: -0.79 to -0.33), P < 0.01; OR = 3.00 (95% CI: 1.66 to 5.41), P < 0.01], prolonged PT [SMD = 1.22 (95%CI: 0.71 to 1.72), P < 0.01; OR = 1.86 (95%CI: 1.43 to 2.43), P < 0.01], prolonged aPTT [SMD = 0.24 (95%CI: -0.04 to 0.52), P = 0.99], and increased INR [SMD = 2.21 (95%CI: 0.10 to 4.31), P = 0.04] than survivors. Conclusions: In COVID-19 patients, abnormal simple coagulation parameters on admission, such as platelet, PT, and INR, were associated with mortality outcomes.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48216843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is the Reduced Incidence of Crimean-Congo Hemorrhagic Fever Related to the Preventive Measures of COVID-19?","authors":"J. Nejati, A. Saghafipour","doi":"10.5812/archcid.109182","DOIUrl":"https://doi.org/10.5812/archcid.109182","url":null,"abstract":"<jats:p />","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48307320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Acquired immune deficiency syndrome (AIDS) inflicts severe damage to the immune system. It transmits from one person to another through blood transfusions and vertical and sexual transmission. It should be noted that almost all papers reporting AIDS emphasized that HIV led to immune deficiency. However, this study reported the first HIV-1 seropositive woman who had an active viral load of HIV-1 without any signs or CD4 lymphocyte count depletion. Case Presentation: This study, for the first time, reported a 46-year-old HIV-1 seropositive woman without any signs and symptoms diagnosed 31 years ago by laboratory tests. Also, it is noteworthy that the patient had not received regular therapeutics during the infection period. Our serologic tests showed an active seropositive patient without any CD4 depletion. The viral load of HIV-1 was 132967.2 u/L, which was quantified by a real-time PCR assay. Also, a CBC test was performed and showed no abnormal results. Conclusions: An untreated HIV-1 positive patient without immunodeficiency is a rare condition, and we found no report of it in the literature. This article reported an HIV-1 positive patient in whom the infection was confirmed several times using the real-time PCR method.
{"title":"An HIV-1 Positive Woman Without Usual Immunodeficiency","authors":"Bagher Moradi, Saeed Keshvari","doi":"10.5812/archcid.119029","DOIUrl":"https://doi.org/10.5812/archcid.119029","url":null,"abstract":"Introduction: Acquired immune deficiency syndrome (AIDS) inflicts severe damage to the immune system. It transmits from one person to another through blood transfusions and vertical and sexual transmission. It should be noted that almost all papers reporting AIDS emphasized that HIV led to immune deficiency. However, this study reported the first HIV-1 seropositive woman who had an active viral load of HIV-1 without any signs or CD4 lymphocyte count depletion. Case Presentation: This study, for the first time, reported a 46-year-old HIV-1 seropositive woman without any signs and symptoms diagnosed 31 years ago by laboratory tests. Also, it is noteworthy that the patient had not received regular therapeutics during the infection period. Our serologic tests showed an active seropositive patient without any CD4 depletion. The viral load of HIV-1 was 132967.2 u/L, which was quantified by a real-time PCR assay. Also, a CBC test was performed and showed no abnormal results. Conclusions: An untreated HIV-1 positive patient without immunodeficiency is a rare condition, and we found no report of it in the literature. This article reported an HIV-1 positive patient in whom the infection was confirmed several times using the real-time PCR method.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41756150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: COVID-19 infection causes a wide spectrum of macrovascular thrombosis, which has contributed significantly to morbidity and mortality in the elderly. Guidelines have recommended extended prophylaxis following discharge from the hospital for variable periods. The risk of thrombosis and the optimal duration of extended anticoagulation remain uncertain. Objectives: This study aimed at determining the overall incidence and timing of macrovascular thrombosis in post-COVID-19 elderly patients. It also aimed at finding out the predictive value of clinical severity, in-hospital anticoagulation, and discharge D-dimer values for the incidence of macrovascular thrombosis and overall mortality within 13 weeks following clinical recovery from acute COVID-19 infection in the elderly. Methods: In this study, 288 elderly patients with symptomatic acute COVID-19 infection discharged between August 1, 2020, and November 30, 2020, were enrolled. Details regarding the incidence of macrovascular thrombosis were collected through a telephone interview after 90 days. Data were tabulated and analyzed with IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp.) Results: The number of macrovascular thrombotic events was significantly higher in group C (critical illness) than in the other two groups (17.9 vs. 1.8 and 1.1%, respectively) (P = 0.0005). Three (10.7%) patients died within 13 weeks of discharge in group C, versus one (0.6%) patient in group M (mild to moderate illness) and none in group S (severe illness) (P = 0.0005). There were two macrovascular thrombotic events in the elevated D-dimer group versus one in the reduced D-dimer group (P = 0.135). The number of deaths was high in the elevated D-dimer group [2 (8.3%) vs. 0 (0), P = 0.053]. The cumulative incidence rate of macrovascular events in the post-COVID-19 elderly cohort 13 weeks after discharge was 3.12%. Conclusions: Elderly patients with a critical illness during hospitalization due to COVID-19 and elevated D-dimer values at discharge have the maximum risk of developing macrovascular thrombosis in the post-COVID-19 period. It is reasonable to recommend extended thromboprophylaxis for at least eight weeks in the post-COVID-19 elderly.
背景：新冠肺炎感染可导致广泛的大血管血栓形成，这对老年人的发病率和死亡率有重要影响。指南建议在不同时期出院后延长预防期。血栓形成的风险和延长抗凝治疗的最佳持续时间仍不确定。目的：本研究旨在确定COVID-19后老年患者大血管血栓形成的总体发病率和时间。它还旨在找出临床严重程度、住院抗凝和出院D-二聚体值对老年人急性新冠肺炎感染临床康复后13周内大血管血栓形成发生率和总死亡率的预测价值。方法：在本研究中，纳入了在2020年8月1日至2020年11月30日期间出院的288名有症状的急性新冠肺炎感染的老年患者。90天后通过电话采访收集大血管血栓形成发生率的详细信息。将数据制成表格，并使用IBM SPSS Statistics for Windows 23.0版进行分析。（纽约州Armonk：IBM Corp.）结果：C组（危重症）大血管血栓性事件的发生率显著高于其他两组（分别为17.9%、1.8%和1.1%）（P=0.0005）。C组有3名（10.7%）患者在出院13周内死亡，相比之下，M组（轻度至中度疾病）有一名（0.6%）患者，S组（重度疾病）没有一名（P=0.0005）。D-二聚体升高组发生两起大血管血栓事件，而D-二聚物降低组发生一起（P=0.0135）出院13周后的COVID-19后老年队列为3.12%。建议COVID-19后老年人延长血栓预防至少八周是合理的。
{"title":"Incidence, Risk Factors, and Timing of Macrovascular Thrombosis in the Post-COVID-19 Elderly and Assessing the Need and Duration of Extended Thromboprophylaxis: A Prospective Study","authors":"S. P., Sudha Madhavan, Viswanathan Pandurangan","doi":"10.5812/archcid.119593","DOIUrl":"https://doi.org/10.5812/archcid.119593","url":null,"abstract":"Background: COVID-19 infection causes a wide spectrum of macrovascular thrombosis, which has contributed significantly to morbidity and mortality in the elderly. Guidelines have recommended extended prophylaxis following discharge from the hospital for variable periods. The risk of thrombosis and the optimal duration of extended anticoagulation remain uncertain. Objectives: This study aimed at determining the overall incidence and timing of macrovascular thrombosis in post-COVID-19 elderly patients. It also aimed at finding out the predictive value of clinical severity, in-hospital anticoagulation, and discharge D-dimer values for the incidence of macrovascular thrombosis and overall mortality within 13 weeks following clinical recovery from acute COVID-19 infection in the elderly. Methods: In this study, 288 elderly patients with symptomatic acute COVID-19 infection discharged between August 1, 2020, and November 30, 2020, were enrolled. Details regarding the incidence of macrovascular thrombosis were collected through a telephone interview after 90 days. Data were tabulated and analyzed with IBM SPSS Statistics for Windows, Version 23.0. (Armonk, NY: IBM Corp.) Results: The number of macrovascular thrombotic events was significantly higher in group C (critical illness) than in the other two groups (17.9 vs. 1.8 and 1.1%, respectively) (P = 0.0005). Three (10.7%) patients died within 13 weeks of discharge in group C, versus one (0.6%) patient in group M (mild to moderate illness) and none in group S (severe illness) (P = 0.0005). There were two macrovascular thrombotic events in the elevated D-dimer group versus one in the reduced D-dimer group (P = 0.135). The number of deaths was high in the elevated D-dimer group [2 (8.3%) vs. 0 (0), P = 0.053]. The cumulative incidence rate of macrovascular events in the post-COVID-19 elderly cohort 13 weeks after discharge was 3.12%. Conclusions: Elderly patients with a critical illness during hospitalization due to COVID-19 and elevated D-dimer values at discharge have the maximum risk of developing macrovascular thrombosis in the post-COVID-19 period. It is reasonable to recommend extended thromboprophylaxis for at least eight weeks in the post-COVID-19 elderly.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42347713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Retapamulin is one of the antibiotics recently developed semi-synthetically to inhibit protein synthesis in a specific manner different from other antibiotics. This pleuromutilin derivative shows magnificent anti-bacterial activity in Gram-positive pathogens, especially Staphylococcus aureus and Streptococcus pyogenes, and now it is available in ointment formulations (1%) for clinical use with negligible side effects. Despite the low potential for resistance development, antimicrobial susceptibility rates are significantly high. This is especially important when the prevalence of mupirocin-resistant strains is increasing, and the need for new alternatives is urgent. Unfortunately, due to its oxidation by cytochrome p450, this drug cannot be used systemically. However, another pleuromutilin derivative with systemic use, lefamulin, was approved in August 2019 by the US Food and Drug Administration. In addition to pharmacokinetic features, financial issues are also barriers to consider in the progress of new antimicrobials. In this review, we attempt to take a brief look at the derivatives usable in humans and explore their structures, action mode, metabolism, possible ways of resistance, resistance rates, and their clinical use to explain and highlight the valuable points of these antibiotics.
{"title":"Retapamulin: Current Status and Future Perspectives","authors":"M. Goudarzi, Amin Khoshbayan, F. Taheri","doi":"10.5812/archcid.114970","DOIUrl":"https://doi.org/10.5812/archcid.114970","url":null,"abstract":": Retapamulin is one of the antibiotics recently developed semi-synthetically to inhibit protein synthesis in a specific manner different from other antibiotics. This pleuromutilin derivative shows magnificent anti-bacterial activity in Gram-positive pathogens, especially Staphylococcus aureus and Streptococcus pyogenes, and now it is available in ointment formulations (1%) for clinical use with negligible side effects. Despite the low potential for resistance development, antimicrobial susceptibility rates are significantly high. This is especially important when the prevalence of mupirocin-resistant strains is increasing, and the need for new alternatives is urgent. Unfortunately, due to its oxidation by cytochrome p450, this drug cannot be used systemically. However, another pleuromutilin derivative with systemic use, lefamulin, was approved in August 2019 by the US Food and Drug Administration. In addition to pharmacokinetic features, financial issues are also barriers to consider in the progress of new antimicrobials. In this review, we attempt to take a brief look at the derivatives usable in humans and explore their structures, action mode, metabolism, possible ways of resistance, resistance rates, and their clinical use to explain and highlight the valuable points of these antibiotics.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41673126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Candida albicans is the predominant yeast reported from human infection. Non-albicans Candida species have been recently developed as medically vital fungi. Therefore, it is essential to detect and identify the pathogens at the species level to prescribe appropriate treatment. Methods: This study assessed two complementary methods, including real-time polymerase chain reaction-high resolution melt (PCR-HRM) and polymerase chain reaction-restriction fragment length morphism (PCR-RFLP) with standard PCR and Sanger sequencing as the benchmark. Results: In total, 66 samples were tested, and two newly-advanced assays were more effective and displayed comprehensive concordance (66/66, 100%) with Sanger sequencing outcomes. Moreover, accurate and economical tests were positively advanced by real-time PCR-HRM for C. albicans and C. parapsilosis complexes. Conclusions: Given the number of studies performed on the comparison of sensitivity and specificity of phenotypic and genotypic methods to diagnose and identify invasive fungal pathogens and the findings of this study, it could be stated that the correlative PCR-HRM and PCR-RFLP methods were effectively advanced as substitutes for conventional Sanger sequencing for the reasonable identification. However, supplementary evaluations and confirming studies should be carried out with a broad range of samples to standardize this method for routine application in medical laboratories.
{"title":"Comparison of Direct Sequencing with Real-time PCR High Resolution Melt and PCR Restriction Fragment Length Polymorphism Analysis to Identify Clinically Important Candida Species","authors":"Zeynab Yassin, Fariba Shirvani, M. Fattahi","doi":"10.5812/archcid.110202","DOIUrl":"https://doi.org/10.5812/archcid.110202","url":null,"abstract":"Background: Candida albicans is the predominant yeast reported from human infection. Non-albicans Candida species have been recently developed as medically vital fungi. Therefore, it is essential to detect and identify the pathogens at the species level to prescribe appropriate treatment. Methods: This study assessed two complementary methods, including real-time polymerase chain reaction-high resolution melt (PCR-HRM) and polymerase chain reaction-restriction fragment length morphism (PCR-RFLP) with standard PCR and Sanger sequencing as the benchmark. Results: In total, 66 samples were tested, and two newly-advanced assays were more effective and displayed comprehensive concordance (66/66, 100%) with Sanger sequencing outcomes. Moreover, accurate and economical tests were positively advanced by real-time PCR-HRM for C. albicans and C. parapsilosis complexes. Conclusions: Given the number of studies performed on the comparison of sensitivity and specificity of phenotypic and genotypic methods to diagnose and identify invasive fungal pathogens and the findings of this study, it could be stated that the correlative PCR-HRM and PCR-RFLP methods were effectively advanced as substitutes for conventional Sanger sequencing for the reasonable identification. However, supplementary evaluations and confirming studies should be carried out with a broad range of samples to standardize this method for routine application in medical laboratories.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42172249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Bakhshipour, Narjes Sargolzaie, Raheleh Rafaiee
Background: Recently, epidemiological studies on hepatitis A virus (HAV) infection showed the seroprevalence has been changing due to changes in lifestyle. To the best of our knowledge, there have been no published data on the seropositivity of HAV in Zahedan, southeastern Iran. Objectives: This study aimed to investigate the seroprevalence of HAV immunoglobulin G (IgG) antibody in Zahedan, southeastern Iran, to provide the required information for better planning in preventive strategies. Methods: In this cross-sectional study, using the available sampling method, a total of 250 serum samples (18 years and above) in both the urban and rural areas of Zahedan were evaluated for anti-HAV IgG by enzyme-linked immunosorbent assay. Results: Based on the results, it was observed that 228 out of 250 (91.2%) serum samples were positive for HAV IgG antibody. Male gender, family size, parents’ education, mother’s occupation, and history of jaundice before the age of 12 years were associated with positive HAV antibody (P < 0.001). The seroprevalence HAV rates were not statistically different between the residents of urban and rural regions. Conclusions: The seropositivity of HAV is high in both the urban and rural areas of Zahedan, Iran. Therefore, the HAV vaccination of the general population is not necessary. It is recommended to monitor HAV seroprevalence in the general population to determine high-risk groups, including anti-HAV seronegative individuals, for HAV vaccination in the residents of the southeast border.
{"title":"Status of Immunity Against the Hepatitis A Virus in Healthy Population: A Report From Southeastern Iran","authors":"A. Bakhshipour, Narjes Sargolzaie, Raheleh Rafaiee","doi":"10.5812/archcid.118869","DOIUrl":"https://doi.org/10.5812/archcid.118869","url":null,"abstract":"Background: Recently, epidemiological studies on hepatitis A virus (HAV) infection showed the seroprevalence has been changing due to changes in lifestyle. To the best of our knowledge, there have been no published data on the seropositivity of HAV in Zahedan, southeastern Iran. Objectives: This study aimed to investigate the seroprevalence of HAV immunoglobulin G (IgG) antibody in Zahedan, southeastern Iran, to provide the required information for better planning in preventive strategies. Methods: In this cross-sectional study, using the available sampling method, a total of 250 serum samples (18 years and above) in both the urban and rural areas of Zahedan were evaluated for anti-HAV IgG by enzyme-linked immunosorbent assay. Results: Based on the results, it was observed that 228 out of 250 (91.2%) serum samples were positive for HAV IgG antibody. Male gender, family size, parents’ education, mother’s occupation, and history of jaundice before the age of 12 years were associated with positive HAV antibody (P < 0.001). The seroprevalence HAV rates were not statistically different between the residents of urban and rural regions. Conclusions: The seropositivity of HAV is high in both the urban and rural areas of Zahedan, Iran. Therefore, the HAV vaccination of the general population is not necessary. It is recommended to monitor HAV seroprevalence in the general population to determine high-risk groups, including anti-HAV seronegative individuals, for HAV vaccination in the residents of the southeast border.","PeriodicalId":51793,"journal":{"name":"Archives of Clinical Infectious Diseases","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2021-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42165250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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