Long-term rheumatoid manifestations as a consequence of COVID-19 and/or vaccination: A case report after a 2-year follow-up.

COVID-19 is now established as a multi-organ involvement disease with a broad range of manifestations. Identification of post-acute COVID-19 incidence is critical according to increasing number of late symptoms reports. Hereby, we report a case with a past history of COVID-19 who presented different manifestations including osteoarticular and neurological involvement within a long-term follow-up. The organs involvement initiated lately after primary vaccinations (with inactivated vaccine) and lasted few months without any pre-existing medical condition. However, upon the completion of the vaccine schedule and receiving a protein subunit vaccine, PastoCovac Plus, as a booster, the symptoms improved substantially and resolved, though in the reinfection episode partial, reoccurrence was recorded. This presentation can be a challenging issue owing to the fact that the majority of global population are vaccinated and also experience COVID-19 in this era and sometimes differentiation between consequences of the virus as post COVID-19 or the vaccination side effects is difficult.

A landscape on disorders following different COVID-19 vaccination: a systematic review of Iranian case reports.

There have been massive studies to develop an effective vaccine against SARS-CoV-2 which fortunately led to manage the recent pandemic, COVID-19. According to the quite rapidly developed vaccines in a fast window time, large investigations to assess the probable vaccine-related adverse events are crucially required. COVID-19 vaccines are available of different platforms and the primary clinical trials results presented acceptable safety profile of the approved vaccines. Nevertheless, the long-term assessment of the adverse events or rare conditions need to be investigated. The present systematic review, aimed at classification of probable vaccine-related unsolicited adverse events in Iranian population through the data collection of the published case report studies.The related published case reports were explored via PubMed, Web of Science and Google scholar according to the available published data up to 14th Dec, 2022 using PRISMA guideline. Out of 437 explored studies, the relevant data were fully investigated which totally led to 40 studies, including 64 case reports with a new onset of a problem post-vaccination. The cases were then classified according to the various items, such as the type of adverse event and COVID-19 vaccines.The reported COVID-19 vaccines in the studied cases included BBIBP-CorV, ChAdOx1-S, Sputnik V and COVAXIN. The results showed that the adverse events presented in 8 different categories, including cutaneous involvements in 43.7% (n = 28), neurologic problems (n = 16), blood/vessel involvement (n = 6), cardiovascular involvement (n = 5), ocular disorders (n = 4), liver disorder/failure (n = 2), graft rejection (n = 2) and one metabolic disorder. Notably, almost 60% of the cases had no comorbidities. Moreover, the obtained data revealed nearly half of the incidences occurred after the first dose of injection and the median duration of improvement after the symptom was 10 days (range: 2-120). In addition, 73% of all the cases were either significantly improved or fully recovered. Liver failure following ChAdOx1-S vaccination was the most serious vaccine adverse event which led to death in two individuals with no related medical history.Although the advantages of COVID-19 vaccination is undoubtedly significant, individuals including with a history of serious disease, comorbidities and immunodeficiency conditions should be vaccinated with the utmost caution. This study provides a comprehensive overview and clinical implications of possible vaccine-related adverse events which should be considered in further vaccination strategies. Nevertheless, there might be a bias regarding potential under-reporting and missing data of the case reports included in the present study. Although the reported data are not proven to be the direct vaccination outcomes and could be a possible immune response over stimulation, the people the population with a medium/high risk should be monitored after getting vaccinated against COVID-19 of any platforms. This could be achieved by a carefull attention to the subjects ' medical history and also through consulting with healthcare providers before vaccination.

Characterization of long COVID-19 manifestations and its associated factors: A prospective cohort study from Iran.

The prevalence and variety complaints of COVID-19 cases in a long term have been investigated in recent studies. The symptoms over the time are various and unpredictable which may persist several weeks after full recovery. The importance of long-COVID-19 manifestations includes its effect on the recovered cases which requires a rational management based on an accurate guideline to handle post-acute COVID-19 state. The aim of this study was to evaluate the incidence of post-acute COVID-19 syndrome and to identify the associated risk factors as well as to compare new and persistent symptoms at different post-acute phases. Totally 254 individuals from Pasteur Institute of Iran (or/and their relatives) were investigated who had a previously confirmed COVID-19 PCR test. The long-term manifestations of the virus were categorized through a time window as acute, ongoing, post-COVID and persistent phases and the individuals were assessed by the face-to-face or the phone call interview according to their complaints. The data were then statistically analyzed to determine the frequency of the symptoms and also the associated factors in which a p value < 0.05 was considered significant. Except a small asymptotic group of five, 249 cases progressed the symptoms to acute phase among which 64.1% reported at least one symptom in post-acute phase. Neurological sequelae were found as the most frequent symptom (91.6%). Furthermore, there was a significant association between the underlying diseases, age and acute phase symptoms to the post-acute phase syndrome susceptibility (p < 0.05). In conclusion, the increasing number of the reports and studies on long COVID-19 which can hugely affect the life quality should be more investigated and explored in terms of the pathophysiology to achieve appropriate treatments in time. The clusters of symptoms, specially a combination of neurological signs, presenting over months after the recovery impose a huge difficulty to the recovered population.

SARS-CoV-2 re-infection rate in Iranian COVID-19 cases within one-year follow-up.

Since the COVID-19 pandemic initiation, the possibility of re-infection has been unclearly present. Although herd immunity has a potential reliance through natural infection, human corona viruses has the ability to subvert immunity and re-infection happens for seasonal corona viruses. Currently, the frequency of SARS-CoV-2 re-infection incidence is not exactly defined. In this study we aimed at determination of SARS-CoV-2 re-infection rate in Iranian population. In a total of 5696 COVID-19 suspicious individuals, RT-PCR was applied to diagnose the infection. The confirmed patients were followed for 12 months and serology tests were applied to measure the specific antibodies. Among 1492 confirmed COVID-19 cases, five individuals experienced the subsequent infection. The re-infection/reactivation incidence rate was totally 0.33% after one year of follow-up. The interval ranged from 63 to 156 days. All the cases had viral mutations in the second episode of the infection. All of them were symptomatic cases with moderate severity. The estimated rate of SARS-CoV-2 in Persian population is therefore rare and natural infection seems to induce good protection against re-infection which clarifies that mass vaccination can hugely affect the society.

Effect of Oral Midazolam in Pain Relief of Patients Need Nasogastric Tube Insertion: A Clinical Trial Study.

OBJECTIVE: Due to the presence of pain during nasogastric tube (NGT) insertion and related complications and lack of positive clinical response of nasopharyngeal anesthesia with lidocaine and the related side effects and limitations in ketamine and intravenous midazolam, this study aims to determine the efficacy of oral midazolam in relieving pain in the patients requiring NGT insertion. METHODS: A randomized, triple-blind clinical trial was performed on the patients in the Emergency Department of Zanjan Valiasr and Mousavi Hospitals in Iran, who were nominated for NGT. In each group, 100 patients were examined. Two milligram syrups of midazolam and placebo were administered 20 min before the procedure. In two groups, the pain based on the Visual Analog Scale and satisfaction rate of patients during the NGT insertion were compared. The data were analyzed through the SPSS software version 16.0. FINDINGS: There was no statistically significant difference in the demographic characteristics of two groups. Despite the effects of potential confounding variables, the cause of the referral and indication of NGT, as well as the use of midazolam syrup, had a significant relationship with the outcome, so that midazolam group experienced less pain. The mean and standard deviation of the examined outcomes (feeling of pain and satisfaction with NGT insertion) was statistically significantly different in the midazolam group as compared to the placebo group (P = 0.001). CONCLUSION: Midazolam was effective in decreasing pain and increasing the satisfaction of patients after NGT insertion. This manuscript is registered in Irct. com with code IRCT20110629006922N4.

No evidence of occult HBV infection in population born after mass vaccination.

Despite access to efficient hepatitis B virus (HBV) vaccine and universal immunization schedules, HBV infection remains a global health concern. HBV infection has decreased by this program. Nevertheless, breakthrough infections occur due to generation of occult HBV infection (OBI) and surface gene mutants in the immunized population. We aimed to determine the presence of OBI in a population born after initiation of nationwide HBV vaccination in Tehran, Iran. A HBV mass vaccination schedule was launched in Iran in 1993. For this study, we enrolled 1120 cases younger than 24 years. ELISA was applied to evaluate the presence of HBsAg, anti-HBs and anti-HBc. HBV-DNA presence was determined in all HBsAg-negative cases using nested polymerase chain reaction. The prevalence of HBsAg, anti-HBc and anti-HBs was 0.1, 0.54 and 39.9% respectively. Out of 6 anti-HBc-positive individuals, 4 cases also had anti-HBs. One case revealed HBsAg co-existence and the other one showed isolated anti-HBc. HBV-DNA was not detected in HBsAg-negative specimens. A very low prevalence of HBsAg and isolated anti-HBc was observed and no occult HBV infection was detected. It seems that evasion mutants are not a potential threat for HBV universal immunization efficacy in the vaccinated population.

Prevalence of Parvovirus B19 Infection by Serology and PCR in Pregnant Women Referring to Obstetrics and Gynecology Clinic.

OBJECTIVE: Infection by Primate erythroparvovirus 1, generally known Parvovirus B19, is highly prevalent worldwide. Although infection by this virus will not be clinically problematic in most cases, new infections during pregnancy could result in serious repercussions in the fetus. Serologic and PCR-based methods are among the available approaches for diagnosis of Parvovirus B19 infection. In this regard, the present study is aimed to investigate the frequency of Parvovirus B19 infection by these two techniques in pregnant women of Zanjan. MATERIALS AND METHODS: In this cross sectional-descriptive study, 110 pregnant women referring to Mousavi hospital in Zanjan during one year were evaluated in terms of serologic and Real-Time PCR test results in search for Parvovirus B19 infection. The rate of positive IgG and IgM were determined in women and the Real-Time PCR results were reported. RESULTS: Overall, 18.2% of participants were above 35 years old and 4.5% of them were younger than 18 years old. 41 (44.1%) and 2 (1.8%) cases had positive anti-Parvovirus B19 IgG and IgM, respectively. Real-Time PCR results were negative in all the studied samples. CONCLUSION: Based on the findings of this study, prevalence of acute Parvovirus B19 infection was 0 and 2% based on Real-Time PCR and IgM tests, respectively. About 40% of pregnant women had experienced infection with this virus before.

Prevalence of Toxoplasma gondii Antibodies and DNA in Iranian HIV Patients.

BACKGROUND & OBJECTIVE: Toxoplasma gondii infection has public health importance and can lead to serious diseases in immunosuppressed patients, such as HIV cases. Appropriate control of T. gondii infection in HIV patients requires information about the prevalence of T. gondii antibodies and DNA in different population. In this study, we aimed to determine the prevalence of Toxoplasma gondii antibodies and DNA in HIV patients in Tehran, Iran. METHODS: A total of 149 HIV patients from the Iranian Research Center for HIV/AIDS, Tehran, Iran were enrolled in the study. Anti-Toxoplasma IgG and IgM were detected by ELISA and T. gondii DNA was evaluated by PCR and quantita- tive real-time PCR. IgG positive samples were also assessed for their avidity. RESULTS: Anti-Toxoplasma IgG and IgM were positive in 46.3% and 2.7% of cases respectively. 92.7% of our patients showed past infection and 4.3% revealed recently acquired toxoplasmosis based on their IgG avidity test. T. gondii DNA was not detected by PCR but real-time PCR results showed DNA in 4.7% of total patients and 13.1% of the IgG seropositive cases. CONCLUSION: Our findings indicated that latent toxoplasmosis was relatively prevalent in our study population, but new T. gondii infection had low prevalence. Almost half of our patients were IgG negative and at risk of acquiring toxoplasma infection. Low copy numbers of DNA were detected in 4.7% of the cases without any clinical manifestation. Therefore, detection and monitoring of anti-Toxoplasma antibodies and DNA in HIV patients is substantial to estimate the risk of reactivation and new infection.

No Role of Herpes Simplex Virus Type 2 (HSV-2) Infection on HIV Progression in Naïve HIV Patients

Background: Herpes simplex virus type 2 (HSV-2) is a common infection in human immunodeficiency virus (HIV) patients and may accelerate HIV progression by rising HIV viral load and decreasing CD4 count. However, the available data regarding the influence of HSV-2 seropositivity on HIV progression in HIV individuals are inconclusive. Therefore, we aimed to determine HSV-2 seroprevalence in naïve HIV patients and normal controls and also investigate the relation of HIV viral load and CD4 count with HSV-2 seropositivity. Subsequently, we investigated the association of HSV-2 serostatus with changing in CD4 count and HIV viral load in our subjects, after one year follow-up. Methods: In this study, 116 naïve HIV patients and 85 healthy controls from Tehran, Iran were enrolled. HSV-2 IgG antibody was detected by ELISA. CD4 count was determined by flowcytometry, and serum HIV RNA copy numbers were determined using real-time PCR. Results: The prevalence of HSV-2 IgG was 18.1% in naïve HIV patients and 0% in the control group (P=0.000). HSV-2 seroconversion was observed in 2.43% of HIV patients after one year. There was no significant difference regarding HSV-2 serostatus with CD4 count and HIV RNA viral load in our study cohort at baseline and after one year. Conclusion: Our results revealed that the prevalence and incidence of HSV-2 infection are low in our HIV cases, and it is negligible in control group. However, it seems that HIV/HSV2 co-infection has no role on HIV infection acceleration.

No Evidence of Human Herpesvirus 8 among Iranian Patients Infected with HIV.

BACKGROUND: Kaposi's sarcoma is a vascular malignancy, which frequently occurs among immunocompromised individuals such as transplant recipients and patients with acquired immunodeficiency syndrome. Human herpesvirus 8 (HHV-8) is considered the etiological agent of all forms of Kaposi's sarcoma. Though some seroepidemiological studies conducted on the prevalence of HHV-8 in Iran, there are insufficient data on the prevalence of HHV-8 viremia in HIV infected patients. We therefore, aimed to determine the prevalence of HHV-8 viremia in general population and HIV infected patients without Kaposi's sarcoma in Tehran, Iran. METHODS: We conducted a cross sectional survey on 99 patients with HIV infection referred to Iranian Research Center for HIV/AIDS and 40 healthy controls in Tehran, Iran from January to April 2014. The presence of HHV-8 DNA was detected in buffy coat samples of enrolled subjects using nested PCR assay. RESULTS: A total of 99 HIV infected patients with mean age of 37.9±10 yr and 40 healthy controls with mean age of 39±11.5 yr were enrolled in the study. The mean CD4 count was 410.3± 211.4 cells/mm(3). HHV-8 DNA was not detected in both healthy control and HIV patient groups. CONCLUSION: This survey showed low rate of HHV-8 DNA in healthy controls and HIV patients. Considering our findings HHV-8 infection does not seem to be widespread in our population. Further studies focusing on different regions of Iran appear to be required to have a more accurate estimation.

Occult hepatitis B virus infection and S gene escape mutants in HIV-infected patients after hepatitis B virus vaccination.

Hepatitis B virus (HBV) vaccination is recommended for HIV patients. Despite the relative success of HBV vaccination, breakthrough infections can occur infrequently in patients, and it can be due to occult HBV infection, vaccine unresponsiveness and/or emergence of escape mutants. This study assessed the presence of occult HBV infection and S gene escape mutants in HIV-positive patients after HBV vaccination. Ninety-two HIV-positive patients were enrolled in this study, including 52 responders to HBV vaccine and 40 non-responders. All of the cases received HBV vaccine according to routine HBV vaccination protocols. The presence of HBV-DNA was determined by real-time polymerase chain reaction (PCR). In HBV-DNA positive samples, the most conserved regions of S gene sequences were amplified by nested PCR and PCR products were sequenced. Occult HBV infection was detected in two cases. Glycine to arginine mutation at residue 145 (G145R) within the 'a' region of the S gene was detected in one of the occult HBV infection cases who was in the non-responder group. This study showed that the prevalence of occult HBV infection and vaccine escape mutants was low in our HBV-vaccinated HIV-positive patients in both responder and non-responder groups, so there was no alarming evidence indicating breakthrough HBV infection in our vaccinated HIV-positive cases.

Effectiveness of nursing interventions based on family needs on family satisfaction in the neurosurgery intensive care unit.

BACKGROUND: Since the family is a social system, the impairment in each of its component members may disrupt the entire family system. One of the stress sources for families is accidents leading to hospitalization particularly in the intensive care unit (ICU). In many cases, the families' needs in patient care are not met that cause dissatisfaction. Since the nurses spend a lot of time with patients and their families, they are in a good position to assess their needs and perform appropriate interventions. Therefore, this study was conducted to determine the effectiveness of nursing interventions based on family needs on family satisfaction level of hospitalized patients in the neurosurgery ICU. MATERIALS AND METHODS: This clinical trial was conducted in the neurosurgery ICU of Al-Zahra Hospital, Isfahan, Iran in 2010. Sixty four families were selected by simple sampling method and were randomly placed in two groups (test and control) using envelopes. In the test group, some interventions were performed to meet their needs. In the control group, the routine actions were only carried out. The satisfaction questionnaire was completed by both groups two days after admission and again on the fourth day. FINDINGS: Both of the intervention and control groups were compared in terms of the mean satisfaction scores before and after intervention. There was no significant difference in mean satisfaction scores between test and control groups before the intervention. The mean satisfaction score significantly increased after the intervention compared to the control group. CONCLUSIONS: Nursing interventions based on family needs of hospitalized patients in the ICU increase their satisfaction. Attention to family nursing should be planned especially in the ICUs.