Efficacy of plasmapheresis in neutropenic patients suffering from cytokine storm because of severe COVID-19 infection

Background@#With the emergence of the coronavirus disease 2019 (COVID-19) and inability of healthcare systems to control the disease, various therapeutic theories with controversial responses have been proposed. Plasmapheresis was administered as a medication.However, the knowledge of its efficacy and indications is inadequate. This study evaluated the use of plasmapheresis in critically ill patients with cancer. @*Methods@#This randomized clinical trial was conducted on 86 patients with malignancies, including a control group (N=41) and an intervention group (N=45) with severe COVID-19 during 2020-21. Both groups were treated with routine medications for COVID-19 management according to national guidelines, and plasmapheresis was applied to the intervention group. C-reactive protein (CRP), D-dimer, ferritin, lactate dehydrogenase, hemoglobin, and white blood cell, polymorphonuclear, lymphocyte, and platelet levels were measured at admission and at the end of plasmapheresis. Other variables included neutrophil recovery, intensive care unit admission, intubation requirements, length of hospital stay, and hospitalization outcomes. @*Results@#CRP (P ＜0.001), D-dimer (P ＜0.001), ferritin (P =0.039), and hemoglobin (P =0.006) levels were significantly different between the groups after the intervention. Neutrophil recovery was remarkably higher in the case than in the control group (P ＜0.001). However, plasmapheresis did not affect the length of hospital stay (P =0.076), which could have significantly increased survival rates (P ＜0.001). @*Conclusion@#Based on the study findings, plasmapheresis led to a significant improvement in laboratory markers and survival rate in patients with severe COVID-19. These findings reinforce the value of plasmapheresis in cancer patients as a critical population suffering from neutropenia and insufficient immune responses.

Relationship between knowledge, attitude and tendency to care of HIV/AIDS patients among nurses and midwives, working in general hospitals and health care centers of Isfahan University of Medical Sciences, 2013

Knowledge and attitude of the nurses and midwives towards HIV/AIDS patients could affect the quality of care provision. Thus, this study aimed to determine the relationship between knowledge, attitude, and tendency of nurses and midwives towards caring for HIV/AIDS patients. This cross-sectional study was conducted on 303 nurses and midwives at healthcare centers, affiliated to Isfahan University of Medical Sciences, using stratified sampling in 2013. All participants completed a four-section questionnaire including demographic data, knowledge about HIV/AIDS, attitude towards HIV/AIDS, and tendency to care for HIV/AIDS patients. For data analysis, Pearson's correlation coefficient, t-test, and one-way ANOVA were performed, using SPSS version 16 As to the findings, 57% of the participants had insufficient knowledge, 98% had negative attitudes, and 86% had a moderate tendency to care for HIV/AIDS patients. A negative correlation was seen between HIV knowledge and attitude towards HIV patients [P=0.042, r=-0.58]. Also a significant relationship was observed between attitudes towards HIV/AIDS and tendency to provide care for these patients [P=0.011, r=0.78]. As the knowledge, attitude, and tendency to care for HIV/AIDS patients were not desirable among nurses and midwives, it is recommended that comprehensive courses be organized in order to change caregivers' knowledge, attitudes, and tendencies towards care provision for HIV/AIDS patients

Efficacy of mupirocin and rifampin used with standard treatment in the management of acne vulgaris

The multiple etiologic factors involved in acne make the use of various medications necessary to treat the condition. This study aimed to determine the efficacy of mupirocin and rifampin used with standard treatment in the management of acne vulgaris. In a multicenter, randomized controlled, triple-blinded study, a total of 105 acne patients, with a clinical diagnosis of moderate to severe acne, were randomized divided into three groups [35 per group], for treatment of acne. The first group was treated with standard treatment alone, the second group received mupirocin plus standard treatment and the third group received rifampin plus standard treatment. There were three study visits according to Global Acne Grading System [GAGS]: at baseline and weeks 6 and 12. The absolute changes of GAGS score from baseline to week 6 and 12 demonstrated a reduction in the mean score of GAGS in the three treatment groups [p < 0.001]. Due to the difference between GAGS score at the baseline of study, the data were adjusted using the general linear model. The findings showed that all of the treatments significantly improved acne lesions. Nevertheless, none of the treatments was shown to be more effective than the others [p = 0.9]. The three treatments were well tolerated, and no serious adverse events were reported. These findings provide evidence on the efficacy of combining mupirocin and rifampin with standard treatment in the management of acne vulgaris, although none of the treatments had superior efficacy compared with the others

Emergence of cefepime resistance in gram-negative induced nosocomial infections

The rapid emergence of antibiotic resistance, especially broad-spectrum antibiotics, resulted in the avid use of new potent antibiotics. Ceftriaxone and ceftazidime, two third-generation cephalosporin, are usually used to manage complicated and uncomplicated infections. The use of cefepime in resistant infections is increasing gradually, which put this potent antibiotic at risk of resistance. During an 18-month period, a total of 220 gram-negative bacteria including Pseudomonas spp, Serratia spp, Acinetobacter spp, Proteus spp, E-coli and Kiebsiella spp. have been isolated by standard microbiological methods from nosocomial surgical site, abscess, blood stream and urinary tract infections. MIC of antibiotics on isolated bacteria was determined by gradient concentration method. Totally, 29.4%, 19.5% and 23.3% of isolated bacteria with MIC /= 256micro g/ml to cefepime, cefiriaxone and ceftazidime was also observed in 47.1%, 70.8% and 62.5% of cases, respectively [p<0.05]. High level resistance to cefepime were more commonly observed for pseudomonas [73.1%] and Klebsiella spp. [73.5%], respectively [p<0.05]. According to CLSI criteria, 47.1% of isolated bacteria in this study showed high level of resistance [MIC >/= 256micro g/ml] to cefepime. Therefore application of cefepime, as a drug of choice, for gram-negative organisms is not reasonable. Our result demonstrated that this potent antibiotic should not be used as a choice for empiric antibiotic therapy, in the cases of nosocomial infections caused by gram-negative organisms

Prevalence of vancomycin resistant enterococci colonization in gastrointestinal tract of hospitalized patients

Vancomycin-resistant Enterococci [VRE] are the most common nosocomial pathogen worldwide. Colonization with VRE can lead to serious infection, some of which e.g. VRE sepsis can be fatal. Because VRE are dangerous important pathogens, we aimed to determine the prevalence of VRE among patients admitted in infectious, ICU and surgery wards in a referral teaching hospital in Isfahan, Iran. A total of 100 patients from infectious, ICU and surgery [post- operative patients] wards were selected by simple sampling method. Stool specimens were taken from the patients and cultured in VRE selective media [bile- esculin agar plate with 6 micro g/ml of vancomycin] and gram positive cocci from black colonies were inoculated to the tryptase soya broth plus 6.5% NaCl and again gram positive cocci were inoculated to bile-esculin and finally MIC [minimal inhibitory concentration] evaluated by E-Test for detection of VRE. Totally 58 out of 100 patients had positive cultures for enterococci. Among them 16 out of 58 were female [27.6%] and 42 [72.4%] were male. Of 58 positive cultures, 17 [29.3%] were highly resistant to vancomycin. There was significant relation between previous antibiotic therapy especially vancomycin and VRE in this study [P=0.02]. Most of the patients [74.1%] with negative cultures for Enterococci had GI surgery. Most of culture positive patients [46%] were from infectious ward. There was no significant relation between VRE and sex, GI surgery and admission ward in this study. Results of this study suggest that previous antibiotic therapy especially vancomycin and B-lactam is a major risk factor for colonization with VRE. Prevalence of VRE in our study was high. This problem is very important in epidemiology of hospital infections. Considering the feet that there is no substitute agent for vancomycin in our country, it is necessary to determine guidelines regarding treatment with antibiotics specially vancomycin