Fariba Keramat

All age groups are at risk of contracting and dying of Coronavirus disease (COVID-19). However, older people and those with underlying conditions, comorbidities and disability levels are at higher risk of developing a serious illness, especially those living in enclosed spaces such as nursing homes and care centers, are more vulnerable ...

Background: Brucellosis is recognized as one of the most prevalent diseases among humans and animals. This study investigated and followed up brucellosis in seropositive participants in the Famenin (Hamadan province, Iran) cohort of brucellosis and their families by culture and serology methods. Methods: Blood samples were taken from 66 subjects, including 18 subjects in the Famenin brucellosis cohort study with antibody titers≥1:180 and 36 subjects from their families and 12 subjects in the Famenin brucellosis cohort study with antibody titers<1:80. In the serological method, standard tube agglutination test (STAT positive with≥1:80) and 2-mercaptoethanol (2-ME) test (positive with≥1:40) were performed using the patient serum. Finally, 8 cc of the blood of all subjects was used for culture in the BACTEC culture medium. Results: Of the 66 serum samples, 20 (30.3%) samples, including 5, 4, and 10 samples at 1:20, 1:40, and 1:80 dilution, respectively, and 1 sample at 1:160 dilution were positive by the STAT, of which 13 (65%) samples belonged to patients’ family members. Using the 2-ME test, 10 (15.2%) serum samples were positive, of which 5 (50%) cases were related to patients’ family members. Eventually, no growth of Brucella was observed in 66 flasks of the BACTEC culture medium. Conclusion: Considering that a definite diagnostic method is not yet accessible, a combination of methods must be applied to diagnose the disease.

Introduction: The COVID-19 crisis poses a heightened risk to vulnerable populations. Considering factors influencing deterioration, complications, and mortality, it is especially important to pay attention to these groups, including persons with hypertension (HTN) and diabetes. This study aimed to investigate the correlation between the angiotensin II (ANG II) level and the disease severity and clinical course in COVID-19 patients. Methods: A cross-sectional study was conducted on 50 COVID-19 patients (mean age 59.1±20) admitted to Sinai hospital in Hamedan. The blood samples of the patients were taken during hospitalization and discharge, and the plasma ANG II level was measured using an enzyme-linked immunosorbent assay kit. The quantitative comparison was analyzed with paired t test and qualitative comparison with the chi-square test. The correlation of variables was checked with the Pearson test, and P<0.05 was considered statistically significant. Results: Overall, 44%, 16%, and 10% of COVID-19 patients had HTN, cardiovascular disease (CVD), and 10% diabetes, respectively. The oxygen level of 82% of the patients was below 90, of which 68% were intubated, and the lowest oxygen levels were observed in patients with HTN and CVD with 2 deaths. The primary and secondary examination of the ANG II level demonstrated that its level was significantly higher during illness compared to full recovery and decreased during recovery. Conclusion: The ANG II level is related to the severity of the disease in the early stages of 2019- nCoV infection. Therefore, HTN or other diseases that affect the level of ANG II in the blood can increase the severity of the disease.

The present study aimed to evaluate the effects of Nutrition Bio-shield Superfood (NBS) powder on the immune system function and clinical manifestations in patients with COVID-19. We compare the effects of NBS powder on the immune system function and clinical manifestations among two different groups: 1) intervention group receiving standard treatment scheduled according to treatment guidelines plus NBS powder, and 2) control group receiving only the same standard treatment. The serum levels of IL-2, IL-6, IL-17, IFNγ, and TNFα were determined after four weeks of treatment by specific ELISA kits according to the manufacturer’s instructions. Finally, the level of immune system stimulation and inflammatory markers were compared at baseline and after intervention in both groups. Data were analyzed using SPSS (version 22). A p-value of ≤ 0.05 was set as significant. A total of 47 patients with COVID-19 (24 patients in the intervention group and 23 patients in the control group) were included in this study. Results showed that the differences in the mean decrease of IL-2, IL-6, and TNF-α in the intervention group in comparison to the control group were 0.93, 10.28, and 8.11 pg/ml, respectively (P<0.001). On the other hand, there was no difference in IL-17, IFNγ, monocytes, eosinophil, and other inflammatory indices between the intervention and control groups. Although NBS powder was able to significantly decrease the levels of some proinflammatory cytokines in patients with COVID-19, however, it is noteworthy that the course of the disease was to large part unaffected by NBS power and there was a reduction independent of treatment. The present study indicates that NBS powder could provide a beneficial anti-inflammatory effect in patients with COVID-19. Hence, NBS in treating patients with COVID-19 shows promise as an adjuvant to the current standard antiviral treatment of such patients.Clinical Trial Registration: https://www.irct.ir, identifier IRCT20200426047206N1.

Background: Identifying the potential risk factors of the length of stay in hospital (LOSH) in COVID-19 patients could help the health system meet future demand for hospital beds. Objectives: This study aimed to determine the factors affecting the length of stay in hospital in COVID-19 patients in Hamadan, the west of Iran. Methods: This cross-sectional study recruited 512 hospitalized COVID-19 patients in Hamadan city. Demographic, clinical, and medical laboratory characteristics of the patients and their survival status were assessed by a checklist. Univariate and multiple negative binomial regressions were used by Stata 12. Results: The median hospitalization length for COVID-19 patients was five days (range: 0 to 47). In the discharged patients, the adjusted incidence rate ratios (95% CI) of LOSH for females, rural residents, patients with a history of diabetes and cardiovascular disease, SPO2 less than 88%, prothrombin time higher than 13 s, platelet count lower than 130 × 1000 µL, blood sugar higher than 105 mg/dL, and intensive care unit experience were 1.16 (1.03, 1.44), 1.22 (1.03, 1.44), 1.43 (1.07, 1.92), 1.41 (1.23, 1.61), 0.82 (0.71, 0.93), 1.32 (1.11, 1.56), 1.18 (1.03, 1.36), and 1.85 (1.59, 2.17) compared to their references, respectively. Conclusions: Our study added new insight into LOSH determining factors that could be used for future planning in combating the need for hospital beds. The present study revealed that some demographic, social, and clinical variables could increase the IRR of a more extended hospital stay.

SARS-CoV-2 genome surveillance projects provide a good measure of transmission and monitor the circulating SARS-CoV-2 variants at regional and global scales. Iran is one of the most affected countries still involved with the virus circulating in at least five significant disease waves, as of September 2021. Complete genome sequencing of 50 viral isolates in an early phase of outbreak in Iran, shed light on the origins and circulating lineages at that time. As part of a genomic surveillance program, we provided an additional 319 complete genomes from October 2020 onwards. The current study is the report of complete SARS-CoV-2 genome sequences of Iran in the March 2020-May 2021 time interval. We aimed to characterize the genetic diversity of SARS-CoV-2 in Iran over one year. Overall, 35 different lineages and 8 clades were detected. Temporal dynamics of the prominent SARS-CoV-2 clades/lineages circulating in Iran is comparable to the global perspective and introduces the 19A clade (B.4) dominating the first disease wave, followed by 20A (B.1.36), 20B (B.1.1.413), 20I (B.1.1.7) clades, dominating second, third and fourth disease waves, respectively. We observed a mixture of circulating 20A (B.1.36), 20B (B.1.1.413), 20I (B.1.1.7) clades in winter 2021, paralleled in a diminishing manner for 20A/20B and a growing rise for 20I, eventually prompting the 4 ^th outbreak peak. Furthermore, our study provides evidence on the entry of the Delta variant in April 2021, leading to the 5 ^th disease wave in summer 2021. Three lineages are highlighted as hallmarks of SARS-CoV-2 outbreak in Iran; B4, dominating early periods of the epidemic, B.1.1.413 (specific B.1.1 lineage carrying a combination of [D138Y-S477N-D614G] spike mutations) in October 2020-February 2021, and the co-occurrence of [I100T-L699I] spike mutations in half of B.1.1.7 sequences mediating the fourth peak. Continuous monthly monitoring of SARS-CoV-2 genome mutations led to the detection of 1577 distinct nucleotide mutations, in which the top recurrent mutations were D614G, P323L, R203K/G204R, 3037C>T, and 241C>T; the renowned combination of mutations in G and GH clades. The most frequent spike mutation is D614G followed by 13 other frequent mutations based on the prominent circulating lineages; B.1.1.7 (H69_V70del, Y144del, N501Y, A570D, P681H, T716I, S982A, D1118H, I100T, and L699I), B.1.1.413 (D138Y, S477N) and B.1.36 (I210del). In brief, mutation surveillance in this study provided a real-time comprehensive picture of the SARS-CoV-2 mutation profile in Iran, which is beneficial for evaluating the magnitude of the epidemic and assessment of vaccine and therapeutic efficiency in this population.

Background and aims: Coronavirus disease 2019 (COVID-19) has spread widely throughout the world and become a pandemic disease. In this study, we decided to investigate the chest computed tomography (CT) findings in COVID-19 patients in Hamadan, west of Iran. Methods: This cross-sectional study was conducted on 101 patients with confirmed COVID-19 infection from February to March 2020. Demographic, clinical, laboratory, and chest CT findings of identified COVID-19 patients were assessed. Results: The mean age of the patients was 55.21 ± 14.08 years, and 54 (53.47%) of them were male. With regard to clinical manifestations, 82.18%, 72.28% and 54.46% of COVID-19 patients had dry cough, dyspnea, and fever, respectively. The right lower lobe was the most commonly and severely involved lope (69%), followed by left lower lobe, right middle lobe, and lingual segment; however, the anterior segment of upper lobes showed the least involvement with abnormality in the late course of the disease. The most common pattern was ground glass opacity (GGO), but atypical patterns such as round pneumonia, moderate to severe pleural effusion, and segmental lobar consolidation were seen without evidence of mediastinal adenopathy, cavitation, or nodular lesion. Chest X-ray (CXR) was not a sensitive method as the first-line imaging method because 34.65% of them were normal. Conclusion: CXR is not a sensitive method as the first-line imaging method (34.65% normal first CXR), but chest CT is a very sensitive and nonspecific modality for diagnosis of COVID-19. The lower lobe and posterior basal segments of the lungs are the most involved sites in most cases. About 12% showed atypical chest CT findings.

Background: Brucellosis is a common zoonotic disease with protean clinical manifestations. Osteoarticular involvement is the most common complication of the disease. This study aimed to compare the clinical and para-clinical manifestations of brucellosis among the patients with and without spondylodiscitis. Methods: In this comparative and cross-sectional study, 135 patients having brucellosis with and without spondylodiscitis and admitted to Sina hospital in Hamadan, Iran from March 2009 to March 2014 were included. Clinical and para-clinical data of the patients were obtained from their medical records in the hospital based on a designed checklist. Results: Thirty-five patients having brucellar spondylodiscitis (BS) with the mean age of 55.60±14.31 years, and 100 patients having brucellosis without BS with the mean age of 43.27±18.35 years were examined. A significant difference was found between the mean age of the patients with spondylodiscitis and that of those without spondylodiscitis (P<0.001). All patients with spondylodiscitis complained of back pain and vertebral tenderness, while 60% of the patients without BS suffered from back pain but experienced no vertebral tenderness (P=0.003). The most common vertebral involvement in spinal MRI of the patients with BS was L4-L5 (45.7%). Patients with spondylodiscitis had more increased ESR and CRP than those without spondylodiscitis (P<0.001). Conclusion: It is recommended that Brucellar spondylodiscitis be considered in the differential diagnosis of the patients with prolonged fever, back pain, and vertebrae tenderness in the endemic areas.

Prompt and adequate treatment of human brucellosis continues to be the most important strategy in its management, as eradication of animal brucellosis is not possible so far, and there is no adequate vaccine for humans. The goal of antibrucellar treatment is to alleviate and shorten the symptomatic period and reduce complications, relapses, and chronicity. Contemporary trends in the treatment of human brucellosis are postulated on the ability of Brucellae to persist in host macrophages through the inhibition of phagolysosome fusion and to survive for prolonged periods intracellularly without restricting basic cellular functions. As a result of this and despite satisfactory antibiotic treatment, relapses and therapeutical failures are inevitable to a certain degree. The current principles for the treatment of brucellosis advocate for a long enough treatment duration combined with antimicrobial regimens that possess activity in the intracellular acidic environment. In the future, other antimicrobial agents, immunomodulation, decrease in the intracellular acidic environment, or development of agents that would act on well-defined molecular bacterial targets, might be incorporated to improve the therapeutical effects.