Ventilator-associated pneumonia in a teaching hospital in Tehran and use of the Iranian Nosocomial Infections Surveillance software

Ventilator-associated pneumonia is the most common health-care-associated infection in the intensive care unit [ICU] and computer-assisted diagnosis and surveillance is called for. The frequency of ventilator-associated pneumonia was assessed prospectively during a 6-month period in the ICUs of a teaching hospital in Tehran, Islamic Republic of Iran. To determine the accuracy of the Iranian Nosocomial Infections Surveillance [INIS] system, patient data were input to the software and compared with physicians'judgement. The frequency of ventilator-associated pneumonia was 21.6%, or 9.96 episodes per1000 ventilator days. The duration of admission to the ICU, duration of mechanical ventilator and number of re-intubations were significantly higher in patients who developed pneumonia. The INIS system identified 100% of cases, with no false-positive or false-negative results. Compared with developed countries, the frequency of ventilator-associated pneumonia was high in our ICUs, and INIS software was accurate in diagnosing nosocomial infection

[Detection of intracytoplasmic Th1/Th2 cytokine profiles in patients with sepsis and severe sepsis]

Sepsis is the leading cause of death in critically ill patients throughout the world. The incidence is increasing despite the major advances in the development of antimicrobial agents and other supportive treatments. Based on multiple studies, it has been shown that patient outcome depends on Th1 and Th2 cytokine response. Moreover, whenever the Th2 response is predominant, the sepsis is more severe. The aim of this study was to evaluate the correlation between cytokine levels and the severity of sepsis in patients. A cross-sectional study on the cellular levels of several pro-inflammatory cytokines was carried out in patients with sepsis and severe sepsis. The study included 37 patients [24 men and 13 women], 26 of them had sepsis and 11 had the severe form of sepsis Thirty-seven healthy volunteers served as controls. The average age of the patients was 57 years [ +/- 23.3 years], with a range of 21 to 92 years. From the whole blood of the subjects, we separated the monocytes and leukocytes, which were then cultured. Using an ELISA method, we measured levels and IL-12 [associated with Th1], and IL-4 and IL-10 [associated with gamma of IFN- Th2] in the cultured cells with and without cell stimulation. No gamma production in the cells of patients with sepsis gamma correlation was found for IFN- and severe sepsis, regardless of whether the patients had died or survived. However, IL-12 levels were significantly decreased in severe sepsis compared with those of sepsis patients [P=0.048]. Furthermore, the cells of expired patients also had significantly decreased IL-12 levels compared with those of, IL-4, and surviving patients [P=0.028]. We also found that the levels of IFN- IL-10 were decreased in patients compared with those of controls, which correlated to their production. However, there was no correlation for IL-12 production between the cells of the patients compared with those of the controls. There was also no correlation for cytokine production between men and women with sepsis and in adults compared with that of elderly patients [>55 years old]. We have shown that the predominating T helper cell subset in patients with severe sepsis, as well as expired patients, is Th2. In conclusion, the correlation of Th1 cytokine production and progression of sepsis was demonstrated. Most probably IL-12 levels would be significantly lower in patients with severe sepsis and those who expired

Frequency of hypothyroidism and factors affecting it in HIV-infected patients in Tehran, Iran [2004]

A wide spectrum of endocrine abnormalities including thyroid dysfunction has been observed in HIV-infected patients with different results. This study was conducted to determine the frequency of thyroid dysfunction and to identify factors affecting the development of hypothyroidism in HIV-infected patients. Free T4, FT3, TSH, and thyroglobulin levels of 88 HIV-infected patients receiving care at UT counseling center for Behavioral Disorders in Tehran, an out patient referral center, were measured and data on their age, sex, body weight, BMI, history of opium and injection addictions, duration of HIV infection, disease stage, history of opportunistic infection or malignancy, CD4 cell count, antiretroviral treatment with antiretroviral drugs [HAART], receipt of other drugs [TMP-SMX, antituberculosis drugs, and steroids], and hepatitis C virus Co-infection were collected. Inclusion of the subjects was simply random. 17% of subjects had hypothyroidism; 1.1% had overt hypothyroidism; 2.3% subclinical hypothyroidism and 13.6% had low FT4 levels. The multivariate analysis showed that none of the studied factors were associated with the development of hypothyroidism. As none of the above-mentioned factors are not associated with the development of hypothyroidism, hypothyroidism should be considered in HIV-infected patients

[Infectious diseases and traveling]

As international travels have become increasingly common for both business and tourism, physicians are confronted with innumerable travelers suffering from unknown syndromes and infectious diseases, thus it is necessary for physicians to maintain familiarity with current guidelines and recommendations about travel medicine and prevention of related infectious diseases. Fever, travelers' diarrhea, skin eruptions, respiratory and CNS involvement are diseases seen among travelers on return which make them visit the physicians. Consultation and a checkup prior to traveling with the aim of immunization, recommendations about traveler's diarrhea, malaria and diseases transmitted by blood or sexual contacts are steps that could be taken by the physicians before travel. Knowledge about the epidemiology and etiology of traveler's diseases, destination and immunization status of travelers can prevent complications, morbidity and mortality attributed to infectious diseases in travelers