Amirreza Keyvanfar

Solid organ transplant (SOT) recipients receive immunosuppressive drugs that predispose them to opportunistic infections, including cytomegalovirus (CMV) infection. In these patients, CMV infection can lead to life-threatening consequences, such as transplant rejection. This systematic review and meta-analysis investigated the role of CMV infection in the development of acute rejection in SOT recipients. PubMed, Embase, Scopus, and Web of Science databases were systematically searched for eligible publications until Jan 31, 2025. English-language studies reporting the association between CMV infection and acute rejection in adult SOT recipients were included. Baseline characteristics, transplanted organs, and CMV infection and acute rejection status in SOT recipients were independently extracted by two reviewers. The pooled odds ratio (ORs) with a 95% confidence interval (CI) was calculated using the random effect model. Overall, 27 studies with 6308 SOT recipients entered the meta-analysis. Acute rejection was significantly higher in SOT recipients with CMV infection than those without CMV infection (OR = 2.02, 95%CI 1.64–2.49, I2 = 40.44%). Acute rejection was significantly higher in recipients of liver (OR = 4.43, 95%CI 2.20–8.92, I2 = 0.00%), kidney (OR = 2.22, 95%CI 1.70–2.89, I2 = 48.72%), and lung (OR = 1.38, 95%CI 1.01–1.90, I2 = 0.00%), if they were infected with CMV. While acute rejection was not significantly associated with CMV infection in heart transplant recipients (OR = 1.49, 95%CI 0.54–4.12, I2 = 18.83%). Furthermore, Egger’s test did not indicate any evidence of publication bias (P = 0.7440). CMV infection approximately doubles the risk of acute rejection in SOT recipients. This association differs between various organs, with liver transplants indicating the highest risk, followed by kidney and lung transplants.

Dengue fever is a serious public health concern caused by the dengue virus (DENV). The first documented case of dengue fever in Iran occurred in 2008; however, only a few cases have been reported since then, all linked to imported infections. In 2024, Iran faced a dengue fever outbreak, though limited data are available on its scope and impact. Therefore, our study aimed to analyze the epidemiological patterns and clinical/paraclinical characteristics of patients affected by the 2024 dengue fever outbreak in Iran. This cross-sectional study documented epidemiological characteristics, clinical manifestations, and disease outcomes of dengue fever patients. Healthcare providers collected data through interviews, adhering to the national guideline checklist. The diagnosis of dengue fever was established using rapid diagnostic tests, followed by further confirmatory tests. Throughout the illness, healthcare providers monitored patients, and their outcomes were documented in their medical records. A total of 1057 patients with a mean age of 34.83 ± 15.40 years were identified, with 64.7% male and 35.3% female. Of the cases, 853 were locally transmitted, while 196 were imported from other countries. Most cases were reported from Sistan and Baluchestan (85.4%), Fars (9.9%), and Hormozgan (3.2%) provinces. Additionally, a few sporadic cases were recorded in other provinces. The first case of dengue fever in this outbreak was reported on May 2, 2024. The number of cases reported in the fall (75.6%) was higher than those reported in the spring (14.0%) and summer (10.4%). Patients primarily experienced fever (98.1%), myalgia (94.9%), and headache (94.0%). Ultimately, the vast majority of patients recovered after symptomatic treatment, with only one death reported. Understanding epidemiology and clinical manifestations of dengue fever, along with diagnostic laboratory tests, is crucial for its timely detection. Clinicians in endemic regions should be particularly attentive to these factors to facilitate rapid diagnosis and treatment, thereby preventing the spread of the disease. Additionally, health policymakers should prioritize preventive measures, such as implementing screening at border crossings and improving the environment to reduce mosquito populations.

Background: Nasal colonization of Staphylococcus aureus increases the risk of nosocom-ial infections. Therefore, medications that can decolonize this pathogen can help prevent such infec-tions. Objective: Our study aimed to compare the efficacy of povidone-iodine solution with intranasal mupi-rocin ointment in decolonizing S. aureus from the nasal cavity of healthcare workers. Methods: This single-blinded randomized controlled trial was conducted on healthcare workers car-rying S. aureus nasally. After confirming nasal colonization through culture tests, participants were assigned to intervention groups A and B with an allocation ratio of 1:1. Group A received intranasal mupirocin ointment twice daily for five days, while group B received intranasal povidone-iodine so-lution twice daily for five days. After the decolonization period, samples were taken to compare the efficacy of both interventions in decolonizing S. aureus. Results: In this study, 54 healthcare workers with a mean age of 39.37±7.80 years were included, 42.6% and 57.4% of whom were male and female, respectively. They were randomly assigned to each of the intervention groups. After the intervention, individuals who received povidone-iodine had significantly more positive cultures than those who received mupirocin (37.0% vs. 11.1%, P = 0.026). Additionally, factors such as age, gender, wards, and employment duration may affect the efficacy of mupirocin and povidone-iodine in decolonizing S. aureus from the nasal cavity. Conclusion: The study findings revealed that both mupirocin and povidone-iodine were effective in decolonizing S. aureus from nasal carriers. However, mupirocin was more effective compared with povidone-iodine.

Tissue infarction is a rare but serious life-threatening complication of brucellosis. In this systematic review, we investigated manifestations, diagnostic and therapeutic measures, and causes of tissue infarction in patients with brucellosis. Pubmed/Medline, Embase, Scopus, and Web of Science were systematically searched for case reports or case series that detail tissue infarction secondary to brucellosis up to October 20, 2024. Baseline characteristics, clinical and paraclinical findings, infarcted tissue details, treatments, and outcomes of the patients were independently extracted by two reviewers. A total of 34 articles were included, reporting on 36 brucellosis patients with tissue infarction in the central nervous system (CNS) (n = 24), spleen (n = 6), heart (n = 3), kidney (n = 1), bowel (n = 1), and three organs–spleen-bowel-kidney– (n = 1). These patients primarily presented with flu-like symptoms and organ-specific manifestations resulting from tissue infarction. Laboratory findings were predominantly suggestive of brucellosis. Furthermore, tissue infarctions were confirmed by imaging in all cases. Most patients indicated improvement with medications and surgical interventions. Tissue infarction in patients with brucellosis can impact various organs, particularly the brain, spleen, and heart, with symptoms differing based on the specific organ involved. As patients with brucellosis exhibit symptoms of tissue infarction, healthcare providers should be aware of this complication. Prompt diagnosis can be achieved through laboratory and imaging investigations. Appropriate medical and surgical treatments should be provided for these cases. The study protocol was registered in the international prospective registry of systematic reviews known as PROSPERO (Protocol number: CRD42024595263).

Background: Thiamine (vitamin B1) has the potential to influence the severity of various diseases by enhancing immune function. However, its role in the manifestations of coronavirus disease 2019 (COVID-19) remains inadequately understood. Objectives: This study aimed to investigate the efficacy of thiamine in alleviating symptoms of post-acute COVID-19 syndrome. Methods: In this open-label, randomized, controlled trial, 66 recovered COVID-19 patients experiencing post-acute COVID-19 syndrome were enrolled. Participants were randomly assigned to two groups: An intervention group receiving vitamin B1 alongside supportive therapy and a control group receiving supportive therapy alone. Symptom frequency and severity were monitored weekly over a nine-week period as study outcomes. Data were analyzed using SPSS. Results: The mean age of participants was 49.35 ± 13.83 years. Findings showed that vitamin B1 administration significantly shortened the duration for symptom improvement compared to the control group, with effects observed within two weeks (P < 0.0001). Unlike the control group, many symptoms—including myalgia, anosmia, ageusia, fatigue, and sleep disturbances—showed improvement after five weeks of vitamin B1 supplementation (P < 0.05). From the seventh week onwards, the recovery rate in the vitamin B1 group was twice that of the control group. Conclusions: Our findings indicate that vitamin B1 administration can significantly reduce the duration of post-acute COVID-19 syndrome. For post-acute COVID-19 patients, vitamin B1 supplementation along with appropriate supportive therapy is recommended to enhance recovery rates.

Cardiac tamponade is a life-threatening condition requiring prompt diagnosis and therapeutic intervention. Diagnosis and management of cardiac tamponade in patients with human immunodeficiency virus (HIV) infection pose a major challenge for clinicians. This study aimed to investigate clinical characteristics, paraclinical findings, therapeutic options, patient outcomes, and etiologies of cardiac tamponade in people living with HIV. Pubmed, Embase, Scopus, and Web of Science databases were systematically searched for case reports or case series reporting HIV-infected patients with cardiac tamponade up to February 29, 2024. Baseline characteristics, clinical manifestations, paraclinical findings, therapeutic options, patient outcomes, and etiologies of cardiac tamponade were independently extracted by two reviewers. A total of 37 articles reporting 40 HIV-positive patients with cardiac tamponade were included. These patients mainly experienced dyspnea, fever, chest pain, and cough. They were mostly presented with abnormal vital signs, such as tachypnea, tachycardia, fever, and hypotension. Physical examination predominantly revealed elevated Jugular venous pressure (JVP), muffled heart sounds, and palsus paradoxus. Echocardiography mostly indicated pericardial effusion, right ventricular collapse, and right atrial collapse. Most patients underwent pericardiocentesis, while others underwent thoracotomy, pericardiotomy, and pericardiostomy. Furthermore, infections and malignancies were the most common etiologies of cardiac tamponade in HIV-positive patients, respectively. Eventually, 80.55% of the patients survived, while the rest expired. Infections and malignancies are the most common causes of cardiac tamponade in HIV-positive patients. If these patients demonstrate clinical manifestations of cardiac tamponade, clinicians should conduct echocardiography to diagnose it promptly. They should also undergo pericardial fluid drainage and receive additional therapy, depending on the etiology, to reduce the mortality rate.

Background: Providencia species are opportunistic pathogens that can rarely cause nosocomial infections. They possess numerous virulence characteristics, such as intrinsic antibiotic resistance, which enable them to cause lethal outbreaks. The emergence of pan-drug resistant (PDR) isolates amplifies the threat of Providencia spp. to human health. Objectives: We described an outbreak caused by PDR Providencia spp. in the intensive care unit (ICU) of our medical center. Methods: This outbreak occurred at Imam Hossein Hospital in Tehran, Iran, between 20 June and 28 July 2023. The majority of the 14 patients experienced ventilator-associated pneumonia (VAP); however, two others had surgical site infections (SSI) and peritoneal abscesses. Samples were subcultured on Blood agar, Chocolate agar, and MacConkey agar, as well as differential gallery mediums. Additionally, susceptibility to antimicrobial agents was determined by the disk diffusion protocol using Mueller-Hinton (MH) agar. Results: The rapid diagnosis of the outbreak and practical measures recommended by the infection prevention and control (IPC) committee (e.g., sampling from other patients, hands of healthcare workers, and the environment to identify further cases and the source of the infection, contact isolation, disinfection of the ICU with 1% chlorine solution, and combined antibiotic therapy) assisted us in managing it. Nevertheless, the outbreak resulted in the mortality of eight patients, despite these preventive and therapeutic measures. Conclusions: Clinicians should be aware of nosocomial infections caused by opportunistic pathogens such as Providencia spp., especially in ICU-admitted patients with prolonged hospitalizations and broad-spectrum antibiotic administration. Strong clinical suspicion and timely detection of outbreaks, investigation of further cases, contact isolation of infected patients, disinfection of the environment, treatment with combined antibiotic regimens, and re-sampling of patients and the environment are the cornerstones of managing outbreaks caused by Providencia spp.