Publications by authors named "Amir Emami"

69 Publications

Risk Factors Associated with Long COVID Syndrome: A Retrospective Study.

Iran J Med Sci 2021 11;46(6):428-436

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Recently, people have recognized the post-acute phase symptoms of the COVID-19. We investigated the long-term symptoms associated with COVID-19, (Long COVID Syndrome), and the risk factors associated with it.

Methods: This was a retrospective observational study. All the consecutive adult patients referred to the healthcare facilities anywhere in Fars province from 19 February 2020 until 20 November 2020 were included. All the patients had a confirmed COVID-19 diagnosis. In a phone call to the patients, at least three months after their discharge from the hospital, we obtained their current information. The IBM SPSS Statistics (version 25.0) was used. Pearson Chi square, Fisher's exact test, test, and binary logistic regression analysis model were employed. A P value of less than 0.05 was considered to be significant.

Results: In total, 4,681 patients were studied, 2915 of whom (62.3%) reported symptoms. The most common symptoms of long COVID syndrome were fatigue, exercise intolerance, walking intolerance, muscle pain, and shortness of breath. Women were more likely to experience long-term COVID syndrome than men (Odds Ratio: 1,268; 95% Confidence Interval: 1,122-1,432; P=0.0001), which was significant. Presentation with respiratory problems at the onset of illness was also significantly associated with long COVID syndrome (Odds Ratio: 1.425; 95% Confidence Interval: 1.177-1.724; P=0.0001). A shorter length of hospital stay was inversely associated with long COVID syndrome (Odds Ratio: 0.953; 95% Confidence Interval: 0.941-0.965; P=0.0001).

Conclusion: Long COVID syndrome is a frequent and disabling condition and has significant associations with sex (female), respiratory symptoms at the onset, and the severity of the illness.
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http://dx.doi.org/10.30476/ijms.2021.92080.2326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611223PMC
November 2021

Molecular diversity survey on diarrheagenic isolates among children with gastroenteritis in Fars, Iran.

Future Microbiol 2021 Nov 10;16:1309-1318. Epub 2021 Nov 10.

Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

To differentiate isolates from diarrheal pediatric patients in clinical laboratories. Patients with watery diarrhea were selected for sampling and tested for diarrheagenic  (DEC) by API kit. DEC isolates were tested for phylotyping, pathotyping and presence of determined virulence-encoding genes by specific molecular methods. About 50% of isolates were detected as DECs (>55 and >31% were categorized B2 and D phylotypes respectively). Enterotoxigenic was the most and enteroinvasive was the lowest prevalent pathotypes.  and genes were the most present virulence factors. Typing of isolates from stool specimens will help to determine the diversity of diarrheal pathogens and take proper decisions to reduce the health burden of diarrheal diseases.
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http://dx.doi.org/10.2217/fmb-2020-0151DOI Listing
November 2021

Long COVID syndrome-associated brain fog.

J Med Virol 2021 Oct 21. Epub 2021 Oct 21.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

We investigated the frequency of brain fog in a large cohort of patients with documented coronavirus disease-2019 (COVID-19) who have survived the illness. We also scrutinized the potential risk factors associated with the development of brain fog. Adult patients (18-55 years of age), who were referred to the healthcare facilities anywhere in Fars province from February 19, 2020 to November 20, 2020 were included. All patients had a confirmed COVID-19 diagnosis. In a phone call, at least 3 months after their discharge from the hospital, we obtained their current information. A questionnaire was specifically designed for data collection. In total, 2696 patients had the inclusion criteria; 1680 (62.3%) people reported long COVID syndrome (LCS). LCS-associated brain fog was reported by 194 (7.2%) patients. Female sex (odds ratio [OR]: 1.4), respiratory problems at the onset (OR: 1.9), and intensive care unit (ICU) admission (OR: 1.7) were significantly associated with reporting chronic post-COVID "brain fog" by the patients. In this large population-based study, we report that chronic post-COVID "brain fog" has significant associations with sex (female), respiratory symptoms at the onset, and the severity of the illness (ICU admission).
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http://dx.doi.org/10.1002/jmv.27404DOI Listing
October 2021

Long COVID in children and adolescents.

World J Pediatr 2021 10 3;17(5):495-499. Epub 2021 Sep 3.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: To identify the prevalence and also the full spectrum of symptoms/complaints of children and adolescents who are suffering from long COVID. Furthermore, we investigated the risk factors of long COVID in children and adolescents.

Methods: All consecutive children and adolescents who were referred to the hospitals anywhere in Fars province, Iran, from 19 February 2020 until 20 November 2020 were included. All patients had a confirmed diagnosis of COVID-19. In a phone call to patients/parents, at least 3 months after their discharge from the hospital, we obtained their current status and information if their parents agreed to participate.

Results: In total, 58 children and adolescents fulfilled the inclusion criteria. Twenty-six (44·8%) children/adolescents reported symptoms/complaints of long COVID. These symptoms included fatigue in 12 (21%), shortness of breath in 7 (12%), exercise intolerance in 7 (12%), weakness in 6 (10%), and walking intolerance in 5 (9%) individuals. Older age, muscle pain on admission, and intensive care unit admission were significantly associated with long COVID.

Conclusions: Long COVID is a frequent condition in children and adolescents. The scientific community should investigate and explore the pathophysiology of long COVID to ensure that these patients receive appropriate treatments for their condition.
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http://dx.doi.org/10.1007/s12519-021-00457-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414448PMC
October 2021

A follow-up study of patients with COVID-19 presenting with seizures.

Epilepsy Behav 2021 09 2;122:108207. Epub 2021 Jul 2.

Burn & Wound Healing Research Center, Department of Microbiology, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: We performed a follow-up study of patients with COVID-19 presenting with seizures.

Methods: All consecutive patients with seizures, who were referred to Namazee Hospital, Shiraz, Iran, with a diagnosis of COVID-19, from 10 August 2020 until 20 October 2020 were included in this longitudinal study. The clinical data were collected by the admitting physician. In a follow-up phone call to the discharged patients (after eight weeks or more), we inquired their seizure outcome.

Results: In total, 32 patients were studied; 28 patients were followed. Twelve patients (37.5%) presented with a single tonic-clonic seizure and nine (28.1%) had convulsive status epilepticus; one patient had functional (psychogenic) seizures. Ten patients (31.3%) had pre-existing epilepsy, eight others (25%) had pre-existing CNS problems (without epilepsy), one person (3.1%) had pre-existing functional seizures, and 13 individuals (40.1%) neither had epilepsy nor had other CNS problems. Eight patients (28.6%) reported experiencing seizure(s) after being discharged from the hospital; six of these had pre-existing epilepsy and one had pre-existing functional seizures. One patient, who had a newly developed ischemic brain infarction, reported experiencing recurrent seizures.

Conclusion: Seizures in patients with COVID-19 are either acute symptomatic (in about two-thirds) or an exacerbation of a pre-existing epilepsy/functional seizures (in about one-third). A thorough investigation of the underlying etiology of seizures in patients with COVID-19 is necessary. Seizure outcome in patients, who are hospitalized with COVID-19 and seizures, is generally good.
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http://dx.doi.org/10.1016/j.yebeh.2021.108207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249711PMC
September 2021

The role of comorbidities on mortality of COVID-19 in patients with diabetes.

Obes Med 2021 Aug 15;25:100352. Epub 2021 May 15.

Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: Patients with diabetes are one of the most high-risk group to become infected with SARS-CoV-2 Current study was designed to evaluate the risk of other complications in COVID-19 patients with diabetes.

Methods: In this cross-sectional study (25 February to July 10, 2020), 458 patients with diabetes were enrolled based on their characteristics, symptoms and signs, laboratory data and presence of other underlying diseases. Multiple logistic regression and Chi-square test analysis were used to check the effectiveness of other comorbidities on the mortality outcome among patients with diabetes.

Results: Of 458 patients with diabetes, 306 (67%) had other underlying diseases, such as 200 (65.4%) hypertension, 103 (33.7%) cardiovascular diseases and 29 (9.5%) kidney diseases. The rate of fatality was significantly high in patients with chronic kidney and liver diseases. The odds of mortality were increased 3.1-fold for patients over 55 years as compared to those under 55 years (P = 0.011), and the odds of mortality outcome were more than 5.1-fold for those who had chronic kidney disease (P < 0.001).

Conclusions: The presentation of SARS-CoV-2 in older patients with diabetes with other comorbidities such as chronic kidney and liver diseases is more severe in risk of mortality.
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http://dx.doi.org/10.1016/j.obmed.2021.100352DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8123934PMC
August 2021

COVID-19 in Patients With a Past History of Chemical War Injury: A Cross-Sectional Study in Southern Iran.

Disaster Med Public Health Prep 2021 May 3:1-3. Epub 2021 May 3.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: This study aimed to determine whether COVID-19 is associated with a different presenting clinical picture or a more severe course of illness in people with a past history of chemical war injury.

Methods: This is a multicenter retrospective study in Fars Province, Iran, from August 22 to October 4, 2020. People with a past history of chemical war injury and COVID-19 were studied. Two age- and sex-matched control groups, double the size of the patient group each, from the same database of patients with COVID-19 who were hospitalized at the same time (ie, healthy controls and pseudocontrols).

Results: A total of 46 people with a past history of chemical war injury, 92 healthy controls, and 92 pseudocontrols were studied. People with COVID-19 and a past history of chemical war injury had a significantly higher rate of chest pain compared with others. There were no other clinical differences between the groups. Mortality rate was 17.39%, 15.21%, and 27.17% in people with a past history of chemical war injury, the control group, and the pseudocontrol group, respectively.

Conclusions: A past history of a chemical war injury does not add to the risk of COVID-19 and does not significantly modify its clinical picture either.
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http://dx.doi.org/10.1017/dmp.2021.137DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209438PMC
May 2021

Designing a Multicenter Registry of COVID-19 and Other Respiratory Infections in Fars, Iran.

Disaster Med Public Health Prep 2021 Apr 6:1-4. Epub 2021 Apr 6.

Vice Chancellor for Treatment, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: A year after the emergence of a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as a new crisis in respiratory infections, there remain many uncertainties and unknowns about SARS-CoV-2 and the disease it causes, called coronavirus disease (COVID-19). Although COVID-19 is known as a respiratory disease, some atypical manifestations have been seen, different from those seen in other types of viral respiratory infections. This paper aims to describe designing, launching, and implementing a data collection system for all respiratory diseases, with a focus on SARS-CoV-2 from the onset of this pandemic.

Method: The current registry is designed in compliance with the standard Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, along with the declaration of Helsinki principles.

Results: A respiratory disease registry, with an emphasis on COVID-19 and other co-infections, was developed. Data consisted of demographic, clinical, and supporting information about SARS-CoV-2 and other respiratory viral diseases.

Conclusion: It is hoped that the current data registry will facilitate patient evaluation and improve the outcomes of cases of respiratory infection defined by a particular condition, disease, or exposure. Moreover, the registry can harmonize data about the treatment, outcomes, and well-being of patients who receive care over time, and identify best practices.
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http://dx.doi.org/10.1017/dmp.2021.100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193184PMC
April 2021

The Effect of Metformin on Survival Outcomes of Non-Metastatic Breast Cancer Patients with Type 2 Diabetes.

Asian Pac J Cancer Prev 2021 Feb 1;22(2):611-616. Epub 2021 Feb 1.

Department of Hematology-Oncology, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.

Background: There are still inconsistencies about the role of metformin on breast cancer. This study was designed to assess metformin's effect on the prognosis of female breast cancer patients with type II diabetes.

Methods: The present research was carried out as a retrospective cohort study between 2003 and 2014. Breast cancer patients with pre-existing type II diabetes mellitus were included. Overall survival (OS) and relapse-free survival (RFS) were measured as the main endpoints. Kaplan-Meier estimate was used to calculate survival rates.

Results: 217 patients were included with a mean age of 53.32±11.10 years. 148 (68.2%) patients were prescribed metformin and 69 (31.8%) took other antidiabetic drugs (non-metformin group). Five-year OS and RFS rates for all patients were 82.5% (95% CI: 76.0%-87.4%) and 71.1% (95% CI: 64.2%-77.0%) respectively. Log-rank test showed that the metformin group had a significant advantage over the non-metformin group in terms of both OS and RFS rates (p.
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http://dx.doi.org/10.31557/APJCP.2021.22.2.611DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190344PMC
February 2021

Investigation of genetic variation: Neuraminidase gene of influenza A virus H1N1/pdm09, Shiraz, Iran (2015-2016).

J Med Virol 2021 08 13;93(8):4763-4772. Epub 2021 Apr 13.

Department of Bacteriology and Virology, Shiraz University of Medical Sciences, Shiraz, Iran.

Oseltamivir and antiviral agents are frequently used for the prevention and treatment of influenza infection. However, resistance to oseltamivir has been reported globally due to a mutation in the Influenza virus neuraminidase gene. Such resistance will be detected by genotyping and phenotyping studies of viral isolates. The recent study aimed to determine the genetic mutation of neuraminidase gene in influenza A (H1N1) viruses isolated from children referred to Shiraz tertiary hospitals during 1 year (2015-2016) with influenza-like symptoms. A total of 300 patients were registered and throat samples were taken. The throat swabs were used for viral RNA extraction. Detection of influenza A (H1N1) was performed using the one-step real-time polymerase chain reaction (qRT-PCR) method. From positive isolates for H1N1, 51 random samples were evaluated for neuraminidase gene mutation with the nested PCR-sequencing method. Of 300 cases, 102 (34%) isolates were detected as influenza A (H1N1) pdm09. Based on sequencing results, 2 of the 44 sequenced isolates exhibited H275Y substitution, which presented oseltamivir resistance. In comparison with reference strain, the phylogenetic analysis of sequenced isolates was classified in genogroup 6B. While this result is the first report of emerging oseltamivir-resistant in the southwest of Iran, it is highly recommended to perform these evaluations on the different geographical regions in any prevalence area to plan treatment strategies for influenza.
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http://dx.doi.org/10.1002/jmv.26894DOI Listing
August 2021

COVID-19 presentations and outcome in patients with epilepsy.

Acta Neurol Scand 2021 Jun 16;143(6):624-628. Epub 2021 Feb 16.

Burn & Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: To determine whether patients with epilepsy (PWE) are particularly over-represented in a very large cohort of patients with COVID-19. We also investigated whether COVID-19 is associated with a different clinical picture or a more severe course of illness in PWE (compared with others).

Methods: All consecutive patients who referred to and admitted at healthcare facilities anywhere in Fars province (located in the south of Iran with a population of 4,851,000 people) from February 19, 2020 until November 20, 2020 were included.

Results: A total of 37,968 patients were studied. Eighty-two patients (0.2%) had pre-existing epilepsy. Seizures were significantly more frequent among PWE as a presenting manifestation of COVID-19 compared with that in people without epilepsy (Odds Ratio = 27; p = 0.0001). Furthermore, PWE less often reported cough (significantly) and more often had gastrointestinal symptoms (vomiting and anorexia; as trends) compared with those in people without epilepsy. Patients with epilepsy were not differently likely to be intubated or admitted at ICUs. Case fatality rates were not different between the two groups [9.8% in PWE and 8.5% in people without epilepsy; p = 0.690].

Conclusion: Patients with epilepsy are not susceptible to contracting COVID-19 more than other individuals. Furthermore, COVID-19 in PWE is not associated with a more severe illness or a poorer prognosis. However, PWE and COVID-19 may present somewhat differently than others with such an illness. Why PWE less often present with cough and more often present with gastrointestinal symptoms is not clear yet and should be investigated and clarified in the future studies.
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http://dx.doi.org/10.1111/ane.13404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014655PMC
June 2021

COVID-19 in patients with Down syndrome.

Neurol Sci 2021 May 1;42(5):1649-1652. Epub 2021 Feb 1.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Purpose: The aim of the current study was to determine whether COVID-19 is associated with a different presenting clinical picture or a more severe course of illness in people with Down syndrome (DS).

Methods: All consecutive patients who were admitted at healthcare facilities anywhere in Fars province (located in the south of Iran with a population of 4,851,000 people) from 19 February 2020 to 20 November 2020 were included. For every patient with DS, three age- and sex-matched patients with COVID-19 and without any underlying medical conditions were selected as controls.

Results: During the study period, 37,968 patients were hospitalized with a diagnosis of COVID-19. Eighteen patients had DS. Patients with DS were significantly more likely to be intubated [7 patients (39%)] compared with those without DS [3 patients (6%)]; p = 0.002. Patients with DS significantly more often died of COVID-19 compared with the controls [8 (44.4%) vs. 1 (1.9%); odds ratio: 24.37; 95% confidence interval 2.39-247.94; p = 0.007].

Conclusion: Patients with DS are among the high-risk populations with respect to severe COVID-19 and should receive the vaccine as soon as possible. Furthermore, they should receive more intensive care if they get hospitalized with the illness.
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http://dx.doi.org/10.1007/s10072-021-05091-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848039PMC
May 2021

Management of colon and rectal cancers during COVID-19 pandemic: A clinical guideline (TUMS-CRC-CoV19 Guideline).

Med J Islam Repub Iran 2020 29;34:128. Epub 2020 Sep 29.

Division of Colorectal Surgery, Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.

In a resource-demanding COVID-19 pandemic, guidelines can free up health care resources needed for providing better care to those with COVID-19 and other patients. This study was performed to design a guideline to manage patients with colorectal cancers during the COVID-19pandemic. To design this guideline, major topics and headings of colon and rectal cancers (CRC) were selected and included. Based on the extent of COVID-19 infection in the community and availability of hospital resources, the guideline has been designed for 2 major COVID-19 phases. Several multidisciplinary discussion sessions were held to review the comments of experts, finalize the data, and write the guideline. This guideline has been prepared in 2 main COVID-19 phases of the community/hospital. Phase A refers to the condition where a large number of COVID-19 patients are admitted to the hospital, but limited surgical ICU beds and facilities are still accessible. In phase B, many people are affected by COVID-19, and all hospital resources are allocated for COVID 19 patients. In phase A, 4 major groups are discussed, including malignant and suspicious colorectal polyps, colon cancers, rectal cancers, and recurrent cancers. The approach to emergent cases, including obstruction, bleeding, and perforation, will be presented in phase B. This guideline is a comprehensive instruction on the approach to colorectal cancers during the COVID-19 pandemic that covers the major topics of colon and rectal cancers in detail.
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http://dx.doi.org/10.34171/mjiri.34.128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787015PMC
September 2020

SARS-CoV-2 antibody seroprevalence in the general population and high-risk occupational groups across 18 cities in Iran: a population-based cross-sectional study.

Lancet Infect Dis 2021 04 15;21(4):473-481. Epub 2020 Dec 15.

Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Background: Rapid increases in cases of COVID-19 were observed in multiple cities in Iran towards the start of the pandemic. However, the true infection rate remains unknown. We aimed to assess the seroprevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 18 cities of Iran as an indicator of the infection rate.

Methods: In this population-based cross-sectional study, we randomly selected and invited study participants from the general population (from lists of people registered with the Iranian electronic health record system or health-care centres) and a high-risk population of individuals likely to have close social contact with SARS-CoV-2-infected individuals through their occupation (from employee lists provided by relevant agencies or companies, such as supermarket chains) across 18 cities in 17 Iranian provinces. Participants were asked questions on their demographic characteristics, medical history, recent COVID-19-related symptoms, and COVID-19-related exposures. Iran Food and Drug Administration-approved Pishtaz Teb SARS-CoV-2 ELISA kits were used to detect SARS-CoV-2-specific IgG and IgM antibodies in blood samples from participants. Seroprevalence was estimated on the basis of ELISA test results and adjusted for population weighting (by age, sex, and city population size) and test performance (according to our independent validation of sensitivity and specificity).

Findings: From 9181 individuals who were initially contacted between April 17 and June 2, 2020, 243 individuals refused to provide blood samples and 36 did not provide demographic information and were excluded from the analysis. Among the 8902 individuals included in the analysis, 5372 had occupations with a high risk of exposure to SARS-CoV-2 and 3530 were recruited from the general population. The overall population weight-adjusted and test performance-adjusted prevalence of antibody seropositivity in the general population was 17·1% (95% CI 14·6-19·5), implying that 4 265 542 (95% CI 3 659 043-4 887 078) individuals from the 18 cities included were infected by the end of April, 2020. The adjusted seroprevalence of SARS-CoV-2-specific antibodies varied greatly by city, with the highest estimates found in Rasht (72·6% [53·9-92·8]) and Qom (58·5% [37·2-83·9]). The overall population weight-adjusted and test performance-adjusted seroprevalence in the high-risk population was 20·0% (18·5-21·7) and showed little variation between the occupations included.

Interpretations: Seroprevalence is likely to be much higher than the reported prevalence of COVID-19 based on confirmed COVID-19 cases in Iran. Despite high seroprevalence in a few cities, a large proportion of the population is still uninfected. The potential shortcomings of current public health policies should therefore be identified to prevent future epidemic waves in Iran.

Funding: Iranian Ministry of Health and Medical Education.

Translation: For the Farsi translation of the abstract see Supplementary Materials section.
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http://dx.doi.org/10.1016/S1473-3099(20)30858-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833828PMC
April 2021

Cutaneous Vesicular of COVID-19 in Two Burn Patients.

World J Plast Surg 2020 Sep;9(3):331-338

Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Despite the whole world's effort for controlling an ongoing global outbreak caused by new corona virus; it is still a major public health issue. Any hospitalized patient or outpatient in burn departments should be considered as a potential infectious source of COVID-19, which may cause an overwhelming of disease. However, there are no previous experiences about COVID-19 in burn patients all over the world, and here we reported two burn cases at Amir-al-Momenin Burn Hospital Affiliated to Shiraz University of Medical Sciences, Shiraz, Iran with skin manifestations, which were detected as a rarely COVID-19 symptom. A 13-year-old girl [total body surface area (TBSA): 18%] and a 37-year-old woman (TBSA: 30%) who had burn injuries by gas explosion and car accident, respectively were enrolled. After admission, some vesicular injuries were visible in burn area. To confirm, skin biopsy specimens were either sent for histopathology examination or for real time polymerase chain reaction (PCR) as follow: Herpes Simplex Virus (HSV), chicken pox, and potassium hydroxide (KOH) for fungal infections. All test results were negative. Although they had no symptoms of COVID-19, two swabs from nasopharyngeal and oropharyngeal samplings were taken, the result was negative either. Specimens were obtained from vesicular lesions for qRT-PCR assay of COVID-19. According to the molecular results for vesicular samples, all the results were positive for COVID-19. Unlike all other COVID-19 patients who have respiratory symptoms, SARS-COV-2 appeared by cutaneous vesicular and blisters in two burn cases.
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http://dx.doi.org/10.29252/wjps.9.3.331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734937PMC
September 2020

Prevalence of underlying diseases in died cases of COVID-19: A systematic review and meta-analysis.

PLoS One 2020 23;15(10):e0241265. Epub 2020 Oct 23.

Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: Underlying disease have a critical role in vulnerability of populations for a greater morbidity and mortality when they suffer from COVID-19. The aim of current study is evaluating the prevalence of underlying disease in died people with COVID-19.

Methods: The current study have been conducted according to PRISMA guideline. International database including PubMed, Scopus, Web of Science, Cochrane and google scholar were searched for relevant studies up to 1 June. All relevant articles that reported underlying disease in died cases of COVID-19 were included in the analysis.

Results: After screening and excluding duplicated and irrelevant studies, 32 articles included in the analysis. The most prevalent comorbidities were hypertension, diabetes, cardiovascular disease, liver disease, lung disease, malignancy, cerebrovascular disease, COPD and asthma. Among all reported underlying disease, highest and lowest prevalence was related to hypertension and asthma which were estimated 46% (37% - 55%) and 3% (2%- 6%), respectively.

Conclusion: In summary, underlying disease have a critical role in poor outcomes, severity of disease and high mortality rate of COVID-19 cases. Patients with hypertension, cardiovascular disease and diabetes should be carefully monitored and be aware of health protocols.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241265PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584167PMC
November 2020

Seizure in patients with COVID-19.

Neurol Sci 2020 Nov 19;41(11):3057-3061. Epub 2020 Sep 19.

Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

Objective: The purpose of the current study was to collect the data on the occurrence of seizures in patients with COVID-19 and to clarify the circumstances of the occurrence of seizures in these patients.

Methods: All consecutive patients who referred to healthcare facilities anywhere in Fars province (located in South Iran with a population of 4.851 million people) from February 19 until June 2, 2020, and had confirmed COVID-19 by positive result on polymerase chain reaction testing and seizure were included.

Results: During the study period, 6,147 people had confirmed COVID-19 in Fars province, Iran; 110 people died from the illness (case fatality rate 1.79%). During this time period, five people had seizures (seizure rate 0.08%). In four patients, seizure was one of the presenting manifestations, and in one person, it happened during the course of hospital admission. Two patients had status epilepticus. All patients experienced hypoxemia and four of them needed respirator. Two patients had related metabolic derangements and one had cerebrospinal fluid (CSF) lymphocytic pleocytosis. Brain imaging was abnormal in three patients. Four patients died.

Conclusion: New-onset seizures in critically ill patients with COVID-19 should be considered as acute symptomatic seizures and the treating physician should try to determine the etiology of the seizure and manage the cause immediately and appropriately. Detailed clinical, neurological, imaging, and electrophysiological investigations and attempts to isolate SARS-CoV-2 from CSF may clarify the role played by this virus in causing seizures in these patients.
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http://dx.doi.org/10.1007/s10072-020-04731-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501768PMC
November 2020

Characteristics of deceased patients with CoVID-19 after the first peak of the epidemic in Fars province, Iran.

Infect Ecol Epidemiol 2020 Jun 17;10(1):1781330. Epub 2020 Jun 17.

Vice Chancellor for Treatment, Shiraz University of Medical Sciences, Shiraz, Iran.

Emergence of a new coronavirus causes a serious concern whether this can be stopped at all. The ongoing coronavirus disease created a substantial variation in the fatality rate over the world. The current report brought an explore about the epidemiological characteristics of deceased patients and the fatality rate after the first peak in Fars province which is the fourth most populous and large province in Iran. Of the 3702 confirmed cases with coVID-19, 87 patients passed away and so the fatality rate estimated 2.35. Also, it was derived that male sex, old age and underlying diseases especially diabetes were common characteristics of these victims.
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http://dx.doi.org/10.1080/20008686.2020.1781330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7480469PMC
June 2020

Immunity to Hepatitis-A virus: A nationwide population-based seroprevalence study from Iran.

Vaccine 2020 10 9;38(45):7100-7107. Epub 2020 Sep 9.

Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.

Background: The mortality rate of acute Hepatitis A increases from 0.1% in the children to 1.2%, in the adults. Hepatitis A is efficiently prevented by HAV-vaccine, but the strategy for distributing this vaccine among countries is dependent on their level of immunity to HAV. This study aimed to detect the level of immunity to HAV in Iran.

Methods: In this population-based seroprevalence study, 5419 participants from 12 of provinces of Iran, including 57 urban and 120 rural areas were chosen through a multi-stage cluster random sampling. Participants were interviewed by filling checklists and 3 cc of blood sample was obtained from each of them. IBM SPSS statistics V.21 software was used for univariable and multivariable analysis of data.

Results: Mean of age of Interviewees was 26.4 ± 16 years, ranging from 1 to 94 years with a male to female ratio 1.02. Overall, 3603 (66.5%) of subjects were seropositive for HAV-IgG. Among the age groups, 41.1% of children by the age 15 years and 82.6% of adults around 30 years old were immune to HAV. The Mid-point age of population immunity was 21 years. Residents of the borders of the country, people who had less access to the safe water or sanitary toilet, individuals with low socioeconomic status and persons who were a member of dense families had the most probability of seropositivity.

Conclusions: This study showed that Iran is among HAV low endemic countries and vaccination against HAV is recommended only in the high-risk population, including patients with chronic liver diseases, patients with coagulopathy, travelers to the high endemic areas, and homosexuals. Establishment of national HAV surveillance system, concerning of health system about the occurrence of the HAV outbreaks, implementation of harm reduction strategies, improving economic indices and sanitation and access to the safe water in the deprived regions is recommended.
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http://dx.doi.org/10.1016/j.vaccine.2020.08.071DOI Listing
October 2020

Survival rate in hypertensive patients with COVID-19.

Clin Exp Hypertens 2021 Jan 24;43(1):77-80. Epub 2020 Aug 24.

Vice Chancellor for Treatment, Shiraz University of Medical Sciences , Shiraz, Iran.

Introduction: A life-threatening respiratory disease, coronavirus 2019 (COVID-19), has spread across the globe since December 2019. Many prognostic factors have already been put forward to predict the risk of death and other outcomes. The current study is evaluating the survival rate between hypertensive and non-hypertensive infected patients.

Methods: Patients who were included in this study were admitted between 20 February to 1 March 2020 in Fars (southwest of Iran) province hospitals. Data were collected from the electronic base registry which contained demographic information, medical symptoms, and signs, underlying diseases, CT scan results, and final outcome.

Results: Of all 1239 positive cases, 159 (12.83%) had known with hypertension ant this group was significantly older than non-hypertensive patients (66.1 years Vs 48.95 years, < .001). According to Kaplan-Meier survival curve and log-rank test, it was seen hypertensive patients deteriorated more rapidly than non-hypertensive group ( = .032). Moreover, HIV, cardiovascular, and kidney disease were diagnosed as factors that increase the risk of death in hypertensive patients.

Conclusion: The current study about the survival rate of COVID-19 patients had shown hypertensive patents are in danger of disease severity, although it may be related to their age. Moreover, the probability of other complications like diabetes, smoking, asthma, kidney, and cardiovascular diseases, and either some other infections such as HIV can make the condition complicated and need more consideration to prevent noxious outcomes.
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http://dx.doi.org/10.1080/10641963.2020.1812624DOI Listing
January 2021

Glucantime-loaded electrospun core-shell nanofibers composed of poly(ethylene oxide)/gelatin-poly(vinyl alcohol)/chitosan as dressing for cutaneous leishmaniasis.

Int J Biol Macromol 2020 Nov 28;163:288-297. Epub 2020 Jun 28.

School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Basic Sciences in Infectious Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address:

Leishmaniasis, one of the main concerns of the World Health Organization, is a parasitic disease caused by Leishmania species. The main objective of this study was to prepare a topical drug delivery system that can deliver glucantime to the site of cutaneous Leishmania wounds. Using the electrospinning method, a core-shell nanofibrous mat composed of macromolecules including polyethylene oxide, gelatin, poly (vinyl alcohol) and chitosan was prepared. The prepared nanofibers were characterized by scanning electron microscopy (SEM), transmission electron microscopy, Fourier transform infrared spectroscopy (FT-IR), tensile test and in vitro drug release test. The anti-Leishmania activities of drug-loaded nanofibers against Leishmania promastigotes and its cytotoxicity on fibroblasts were determined respectively by flow-cytometry and indirect MTT methods. Results of morphological studies showed that uniform nanofibers were prepared without any bead with average diameter of 404 nm. The TEM investigation confirmed the core-shell structure of the fibers. The in-vitro drug release assay was executed using Franz diffusion cell, which indicted 84% of glucantime was released during the first 9 h. The results indicated that 4 and 6 cm of nanofibers mat were significantly killed promatigotes up to 78%. Moreover, the MTT assay also showed that the fabricated nanofibers do not possess any cytotoxicity towards fibroblast cells.
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http://dx.doi.org/10.1016/j.ijbiomac.2020.06.240DOI Listing
November 2020

Three Year Study of Infection Profile and Antimicrobial Resistance Pattern from Burn Patients in Southwest Iran.

Infect Drug Resist 2020 20;13:1499-1506. Epub 2020 May 20.

Burn Research Center, Surgery Department, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Burn wound infections, as one of the most important risk factors, cause serious complications in burns. Hence, the focus of medical care should be preventing infections and resistant isolates. The current study investigates the prevalence of infectious agents and antimicrobial resistance patterns during three years.

Materials And Methods: A total of 960 isolates were collected from different sample kinds cultured for 615 burn patients who were hospitalized during January 2016 to December 2018 in Amir-Al-Momenin Burn Center. The type of microorganism and their antibiotic resistance patterns were identified by microbiological tests and the standard disk-diffusion method according to the introduced standard techniques.

Results: Incidence of positive growth was seen more in males than in females. Most of the burns encountered were due to flame injuries (35.4%). Based on the diversity of bacterial isolates, was the most frequent pathogen (49.9%), followed by sp. (9.7%), sp. (7.2%) and (6.5%). The trend of resistance of meropenem was declining in  isolates. sp. as the second most prevalent agent showed a high level of resistance to the studied antibiotics. The antibiogram results for isolates showed an increasing trend in MRSA isolates.

Conclusion: By evaluating the infectious agent, it was found that although frequencies of microorganisms and resistant isolates were a little high, performing a multidisciplinary approach controls the trend during the study period. These achievements have been gained due to a strict politicized infection control and stewardship program in the appointed burn center.
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http://dx.doi.org/10.2147/IDR.S249160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246306PMC
May 2020

Hidden threat lurking behind the alcohol sanitizers in COVID-19 outbreak.

Dermatol Ther 2020 Jul 7;33(4):e13627. Epub 2020 Jun 7.

Microbiology Department, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.

The ongoing COVID-19 pandemic has made various challenges for communications all over the world. Nowadays hand hygiene practices with alcohol sanitizers are an unavoidable reality for many people, which cause skin dryness and flaking. The current short communication has been explained about monitoring the quality control of alcohol concentrations and hand rub formulation, which needs more attention and should consider meticulous in this crisis.
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http://dx.doi.org/10.1111/dth.13627DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280687PMC
July 2020

Antibiotic resistant profile of asymptomatic bacteriuria in pregnant women: a systematic review and meta-analysis.

Expert Rev Anti Infect Ther 2020 08 4;18(8):807-815. Epub 2020 May 4.

Burn & Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences , Shiraz, Iran.

Objectives: Different microorganisms contribute in the pregnancy bacteriuria, which resistance microorganisms limited the therapeutic options for the treatment and increasing the related risks to pregnant women and their pregnancy. Based on this, asymptomatic bacteriuria and the use of inappropriate empirical antibiotics are dangerous in the emergence of pregnancy complications and the incidence of drug resistant.

Methods: A comprehensive systematic search was performed on all international databases including Scopus, PubMed, Web of Science, Medline, Cochrane library during 2000 - June 2019. This meta-analysis, which was registered by a pre-defined protocol in PROSPRO, carried out in accordance with PRISMA guideline. Relevant articles were included in the analysis if reported the susceptibility pattern of antimicrobial resistance related to asymptomatic bacteria in pregnant women with no acute diseases. Overall prevalence and related 95% confidence interval for resistance in different asymptomatic infections were estimated by inverse variance method. The random effect model was used in case of considerable heterogeneity.

Results: Results of this analysis demonstrated different resistance rate against studied classes of antibiotics. Nitrofurantoin resistance in . coli, Klebsiella sp, P. aeruginosa, and isolates were estimated 0.22 (95%CI: 0.15-0.30), 0.40 (95%CI: 0.26-0.54), 0.81 (95%CI: 0.59-0.97), 0.34 (0.11-0.63), respectively. Subgroups analysis showed highest resistance in isolates, in Asia and Africa against Cefotaxime and Ampicillin, respectively.

Conclusion: In summary, increasing resistance rate in urinary tract infection (UTI)-related agents is a risk factor that endangers both mother and fetus. Health care providers should consider screening as the radical part of infection control strategies. Due to low resistance rate to Nitrofurantoin, this drug can be a good choice for UTI treatment in pregnancies, but it should use with caution.
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http://dx.doi.org/10.1080/14787210.2020.1759420DOI Listing
August 2020

Prevalence of Underlying Diseases in Hospitalized Patients with COVID-19: a Systematic Review and Meta-Analysis.

Arch Acad Emerg Med 2020 24;8(1):e35. Epub 2020 Mar 24.

Department of Anesthesiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.

Introduction: In the beginning of 2020, an unexpected outbreak due to a new corona virus made the headlines all over the world. Exponential growth in the number of those affected makes this virus such a threat. The current meta-analysis aimed to estimate the prevalence of underlying disorders in hospitalized COVID-19 patients.

Methods: A comprehensive systematic search was performed on PubMed, Scopus, Web of science, and Google scholar, to find articles published until 15 February 2020. All relevant articles that reported clinical characteristics and epidemiological information of hospitalized COVID-19 patients were included in the analysis.

Results: The data of 76993 patients presented in 10 articles were included in this study. According to the meta-analysis, the pooled prevalence of hypertension, cardiovascular disease, smoking history and diabetes in people infected with SARS-CoV-2 were estimated as 16.37% (95%CI: 10.15%-23.65%), 12.11% (95%CI 4.40%-22.75%), 7.63% (95%CI 3.83%-12.43%) and 7.87% (95%CI 6.57%-9.28%), respectively.

Conclusion: According to the findings of the present study, hypertension, cardiovascular diseases, diabetes mellitus, smoking, chronic obstructive pulmonary disease (COPD), malignancy, and chronic kidney disease were among the most prevalent underlying diseases among hospitalized COVID-19 patients, respectively.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096724PMC
March 2020

Evaluating the Saliva of Burn ICU Patients for Resistant Infections Harbor Metallo-β-Lactamase Genes.

J Burn Care Res 2020 05;41(3):647-651

Burn & Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Shiraz, Iran.

Pseudomonas aeruginosa and Acinetobacter baumannii are the bacteria which increasingly account for nosocomial infections. Due to high virulence, the rate of Multi-Drug Resistance (MDR) and limited availability of new agents, these infections create significant clinical burdens, making it important to identify the possible sources of their occurrence. The aim of this study was to assess non-lactose fermenting bacteria and their metallo-β-lactamase (MBLs) genes expression in the Burn Intensive Care Unit (BICU) patients' saliva samples. This cross-sectional study was conducted from 2017 to 2018 on 124 saliva samples of BICU patients. Identified isolates were evaluated for drug susceptibility by disc diffusion method. MBLs production isolates were detected by Modified Hodge test and Imipenem-EDTA Combined disk. MBLs related genes were evaluated by polymerase chain reaction (PCR). A total of 86 Gram negative non-lactose fermenting bacteria (38; A. baumannii) and (48; P. aeruginosa), were detected. All of the A. baumannii isolates were resistant to Carbapenems, while more than 90% of them were sensitive to Colistin. However, the highest sensitivity in P. aeruginosa isolates was related to Carbapenems and Colistin. More than 95% of A. baumannii and 32% of P. aeruginosa were detected MDR. MBLs production was confirmed in 9 (33.33%) P. aeruginosa and 18 (66.67%) A. baumannii isolates. The blaVIM was the most prevalent gene, while this gene was detected in all of MBLs positive strains. This study confirmed the prevalence of carbapenemase producer Gram-negative bacilli in the saliva of BICU patients. The results of the present study provide a new data set about saliva infection source that could lead to the proper antibiotic regimen and better control of drug resistance.
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http://dx.doi.org/10.1093/jbcr/iraa007DOI Listing
May 2020

Cardioprotective effects of dapsone against doxorubicin-induced cardiotoxicity in rats.

Cancer Chemother Pharmacol 2020 03 8;85(3):563-571. Epub 2020 Jan 8.

Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.

Purpose: It has been supposed that cardiac toxicity of doxorubicin is due to its production of free radicals and inflammatory cytokines. Dapsone, an antibiotic drug which is the principal in a multidrug regimen for the treatment of leprosy, is a sulfone with anti-inflammatory and antioxidant immunosuppressive properties. Therefore, we designed this study to investigate the possible effects of dapsone on doxorubicin-induced cardiotoxicity.

Methods: Male rats were administrated doxorubicin (2.5 mg/kg) and dapsone (1, 3, 10 mg/kg) intraperitoneally six times in 2 weeks. Then electrocardiographic (ECG) parameters (QRS complexes, RR and QT intervals) alternation, papillary muscle contraction and excitation, and histopathological changes were assessed. Also, the heart tissue levels of malondialdehyde (MDA) as oxidant factor and superoxide dismutase (SOD) as antioxidant enzyme, tumor necrosis factor-alpha (TNF-α) and serum level of CK-MB were analyzed.

Results: Administration of dapsone with doxorubicin significantly reversed alterations induced by doxorubicin in serum levels of CK-MB, ECG parameters, papillary muscle contractility and excitation. Furthermore, the measurement of MDA, SOD and TNF-α tissue level indicated that dapsone significantly reduced oxidative stress and inflammation. These findings were consistent with histopathological analysis.

Conclusion: Dapsone exerts cardioprotective effects on doxorubicin-induced cardiotoxicity through its anti-inflammatory and antioxidant mechanism.
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http://dx.doi.org/10.1007/s00280-019-04019-6DOI Listing
March 2020

Integron-Related Resistance in New Emerged Staphylococcus lugdunensis Infection in Burn Patients.

J Burn Care Res 2020 05;41(3):598-603

Burn and Wound Healing Research Center, Microbiology Department, Shiraz University of Medical Sciences, Iran.

Staphylococcus lugdunensis is a coagulase-negative Staphylococcus species that may cause various infections with unusual severity. In spite of the administration of various antibiotics, infections caused by such bacteria are become resistant significantly. Transmission of antibiotic resistance genes, especially by Integron structures, exacerbates the prevalence of resistant strains. To investigate the antibiotic susceptibility pattern of S. lugdunensis as a new emergence in burns, the presence of integron classes (I, II, III) was performed in recent study. Sampling for this study was carried out over a period of 13 months (January 2017 to February 2018) from Amir-Al-Momenin burn center of southwest of Iran, affiliated with Shiraz University of Medical Sciences. Twenty-eight isolates of S. lugdunensis were confirmed by phenotypic tests. The presence of integron classes was evaluated by PCR technique and specific primers. The majority of studied infectious agents were seen in ICU with 28.57%. The prevalence of class I and II integrons was 7 (25.00%) and 2 (7.14%), respectively, in S. lugdunensis isolates, whereas no integron III was found. No significant association was seen between antibiotic resistance and the present integrons (P > .05). Since the prevalence of S. lugdunensis strains as a new emergence infection is increasing in clinical settings especially burns, preventing drug resistance in these isolates is inevitable. So knowing the epidemiology pattern of new emerging infections and their resistant pattern is very helpful in infection control and save hospitalized patients life.
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http://dx.doi.org/10.1093/jbcr/irz211DOI Listing
May 2020

Possibility of BKV-Associated Nephropathy in Hospitalized Burn Patients.

J Burn Care Res 2020 05;41(3):593-597

Microbiology Department, Burn & Wound Healing Research Center, Shiraz University of Medical Sciences, Iran.

Although renal failure in burn patients results from some defined reasons, there are various causes which are still unclear. BK virus is a human polyomavirus, which, in case of reactivation, can cause late-onset renal dysfunction and cystitis among immunodeficient patients such as transplant, pregnant, diabetic, and HIV patients. Regarding the related challenges, Polyomavirus BK (BKV), as a ubiquitous virus, is considered as one of the potential threats in the occurrence of Polyomavirus-associated nephropathy (PAN). Hypovolemia, occurring due to the weakness of the immune system, may be regarded as the major reason for the possibility of PAN as a risk factor in burn patients. Accordingly, this study was designed to evaluate the reactivation of BKV as a probable risk factor for renal failure or a problem in the future life of burn patients. This case-control study was conducted from October 2014 to September 2016, during which 270 patients were admitted to the burn unit. The patients were divided into two groups of case and control according to the inclusion criteria, and 20 patients were assigned to each group. The serum samples were first assessed for BKV-IgG and then were quantified by specific quantitative real-time polymerase chain reaction for BKV load. Positive samples were assessed for changes in noncoding regulatory region (NCRR) compared to Archetype strain by PCR sequencing method. Amplified sequences were analyzed for NCRR arrangement while the reactivation was assessed through these changes in NCRR. In both groups, patients were seropositive for BKV-IgG. Eight patients (40%) in the case group and two patients (10%) in the control group were found to be positive for BKV DNA with a load of ≥1000 and ≥100 copies/ml, respectively. There was a significant association between BKV DNA and kidney injury in the case group. The NCRR of DNA-positive samples had a large rearrangement compared to standard strain, but they showed relatively high similarity. Compared with other patients, burn patients are among the most susceptible ones to PAN, which can be considered as a major risk factor in the treatment of burn patients and optimizing their therapy.
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http://dx.doi.org/10.1093/jbcr/irz209DOI Listing
May 2020
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