Background: Coronavirus disease 2019 (COVID-19) is difficult to treat in pregnant women due to pregnancy itself and the lack of standard treatment for the disease. As of August 2021, the etiotropic drug remdesivir has been added to the prescription list for women during gestation. There are few publications in the global scientific community regarding the use of this antiviral drug in pregnant women. Moreover, there are only sporadic scientific studies in Kazakhstan, so the question remains open. Objectives: This study aimed to evaluate the efficacy of remdesivir in pregnant women with probable or confirmed COVID-19. Methods: The study comprehensively examined 120 pregnant women with severe to very severe COVID-19, who were divided into two groups of patients. The study group consisted of women who received remdesivir and standard therapy. The control group included patients who received standard therapy per the protocol. Results: Statistically significant age differences were observed between the main and control groups (P = 0.019). The differences detected were due to a higher frequency in the age group of 33 and 42 years in patients taking remdesivir than in the control group (P = 0.036). Women in the main group (Median = 9.00; Q1 - Q3 = 8.00 - 11.0) had longer hospital stays than the control group (Me = 8.00; Q1 - Q3 = 7.00 - 10.0). This was due to the more severe condition of the patients in this group. There were statistically significant differences in amniotic fluid changes according to ultrasound between the control and main groups (P = 0.013). When comparing the groups in pairs, amniotic fluid was more common in women who received remdesivir (P = 0.316) than in the control group. Our study found that a decrease in temperature to normal levels occurred earlier in the control group (68%) than in the main group. Further SpO2 increases of more than 95% were seen on days 3 - 4 in the main group (71%) and days 1 - 2 in the control group (43%). After three days, there was an improvement in respiratory rate (41.6%) and a reduction in subjective dyspnea (66.6%) in the main group. Conclusions: The study found that repeat mothers have a more severe course of COVID-19. The older age group and the third trimester of pregnancy are risk factors for progression to severe disease.

Context: Community-acquired pneumonia (CAP) refers to pneumonia attained outside the hospital or less than 48 hours before admission, which is a significant cause of mortality and morbidity, especially in major comorbidities and older age. Several microorganisms contribute to developing CAP, primarily Streptococcus pneumonia, Haemophilus influenza, Moraxella catarrhalis, and atypical pathogens, e.g., Mycoplasma pneumonia. The incidence of these microorganisms depends on outpatient or inpatient settings. Administering appropriate treatment among available antibiotics is a critical issue affecting patient survival. Methods: With a multidisciplinary panel expert, this document offers evidence-based recommendations for managing CAP in Iran. Results: The document evaluated the availability of antimicrobial agents and local antibiotic resistance patterns based on 94 relevant published studies from Google Scholar, Scopus, PubMed, Scientific Information Database (SID), Iran Medex, Iran doc, Mag Iran, PubMed, and expert opinions. Conclusions: The panel addressed two main parts of rational recommendations for managing outpatients or hospitalized patients with CAP.

Background: Healthcare workers (HCWs) are considered at higher risk for hepatitis B virus infection compared to the general population, due to their potential contact with blood or body fluids and possible needle stick injuries. In turn, infected HCWs may be a risk for patients. Hepatitis B vaccination programs represent a strategic approach to control the infection. Objectives: In this study, we aimed to evaluate the serological status of HCWs employed at the teaching hospital of Rome Tor Vergata and their risk of occupational injuries after the adoption of directive 2010/32/EU. Methods: Medical records of 539 HCWs were evaluated during their occupational medical examination at the Tor Vergata teaching hospital (PTV). All subjects were screened for specific viral markers: Hepatitis B surface antibodies (anti-HBs IgG), antibodies to hepatitis core antigen (anti-HBc IgG), and hepatitis B surface antigen (HBsAg). Data regarding needlestick injuries were collected by the prevention service team during the same year. Results: In this sample population, we found five subjects (0.9%) positive to the HBsAg, and most of them (four) were born in foreign countries. Moreover, seven subjects (1.3% of our population) were HBsAg-positive and anti-HBc-positive. A protective anti-HBs titer was found in 462 out of 527 (85.7%) subjects. The risk of being serologically unprotected was higher in males and subjects aged 40 years or older. The nurses were more protected than other healthcare professionals considering the anti-hepatitis B surface antibody titer. In 2018, 16 needlestick injuries were reported among our population of HCWs, with a global risk of 2.9% per year. Conclusions: Although hepatitis B virus (HBV) infection rate among HCWs was similar to that of the general population, the risk of HBV transmission in HCWs was likely to be high due to suboptimal vaccination coverage.

Introduction: Cerebrovascular incidents are considered uncommon but important complications of vaccination against coronavirus disease-2019 (COVID-19). Subarachnoid hemorrhages (SAH) usually occur due to an underlying cerebral aneurysm. In this study, we have reported a subarachnoid hemorrhage incidence in a patient shortly after receiving the COVID-19 vaccine (ChAdOx1-AstraZeneca). Case Presentation: A 69-year-old male with no remarkable risk factors referred to the emergency room with complaints of headache, nausea, and vomiting. The patient had received his first dose of vaccine against COVID-19 four days before symptoms started. An aggravated headache, nausea, elevated blood pressure (180/100), and drowsiness occurred on the second day of admission. Imaging implied on acute hydrocephalus and increased intracranial pressure (ICP) caused by subarachnoid hemorrhage. The condition was treated by inserting an external ventricular drain (EVD). We found no underlying vascular abnormality in primary and follow-up cerebral angiographies. Conclusions: Reported cerebral haemorrhages caused by COVID-19 vaccination are mostly intra-parench. Our study observed a type of cerebrovascular event that has not been reported frequently. Vaccine-associated cerebrovascular events, however rarely, are critical. It is important to demonstrate possible risks and complications, as vaccination programs against COVID-19 have become an essential part of health care in most countries.

Background: Cervical cancer (CC) is linked to human papillomavirus (HPV). Globally, the prevalence and genotype distribution differ significantly. Objectives: The goal of this study was to find HPV 14, 16, 18, and 45 genotypes in urogenital swabs by using a real-time PCR amplification test for quantitative genotyping of HPV DNA types 16, 18, and 45 and for simultaneous quantitative detection of HPV DNA types 31, 33, 35, 39, 51, 52, 56, 58, 59, 66, and 68, for a total of 14 HPV genotypes. Methods: This case-control study included 86 cervical swabs from Iraqi women referred by the Al-Yarmook teaching hospital in Baghdad, Iraq. The ages of cases varied from 23 to 70 years and specimens were obtained between March 2020 and March 2021. The DNA was extracted for molecular assay. Fourteen HPV genotypes were detected using real-time PCR (16, 18, 45, 31, 33, 35, 39, 51, 52, 56, 58, 59, 66, and 68). The detection protocol was based on the commercial Kit V31-100/F FRT as follows. For each sample reaction, 10х(N+1) μL of PCR-mix-1-FRT HPV 14 was added into a new tube. Then, 5.0х(N+1) μL of PCR-mix-2 buffer and 0.5х(N+1) μL of TaqF DNA polymerase were added. The tubes were vortexed. Finally, the prepared tubes added 10 μL of DNA samples from test or control samples. The statistical analysis was conducted using the statistical package for SPSS and Excel 2016 software. Results: Genotype 16 had the highest frequency, followed by genotypes 45 (22%), 18 (14%), 35 and 59 (6%), 52 and 58 (4%), and 31 (2%), while genotypes 33, 39, 51, 56, 66, and 68 had the lowest frequency (1%). Conclusions: The real-time PCR was efficient for detecting and genotyping HPV-DNA and could help in earlier detection and clinical care of HPV-infected patients by reducing costs and workload.

Background: Despite the clinical and epidemiological importance of Mycobacterium simiae worldwide, including in Iran, there is no clear and effective treatment regimen for M. simiae and its different subtypes. Objectives: Concerning the superiority of molecular approaches, this study aims to identify the common M. simiae subtypes submitted to the National Reference Tuberculosis (TB) Laboratory of Iran and study the presence of drug resistance by molecular detection methods. Methods: We included sputum samples with M. simiae confirmation submitted to the National Reference TB Laboratory of Iran from May 2014 to May 2016. The polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) assay was used for drug susceptibility testing (DST). Results: Among 7200 TB suspected patients, a total of 60 M. simiae cases belonging to subtype I were identified. All the included clinical isolates met the American Thoracic Society (ATS) and Infectious Diseases Society of America (IDSA) diagnostic criteria and were considered the disease’s causative pathogen. Males (58.33%), elderly (68.54%), and patients with a history of TB (51.42%) were shown to be more prone to infection with the disease. All clinical isolates of M. simiae were resistant to rifampin (RIF) and isoniazid (INH). Amikacin/kanamycin (AMK/KAN) and ciprofloxacin (CIP) susceptibility was found to be 91.66% and 88.33%, respectively. Conclusions: Subtype I was exclusively identified among M. simiae patients in Iran. Molecular detection of drug resistance suggests that amikacin/kanamycin and ciprofloxacin could be used to treat patients infected with M. simiae subtype I.

Background: The prolonged persistence of viral ribonucleic acid (RNA) in coronavirus disease 2019 (COVID-19) patients and the difficulty in differentiating between infectious virus and noninfectious viral RNA have impeded the use of current molecular diagnostic tests as a decision tool in quarantine termination. The performance of new methods to detect surrogate viability markers, such as subgenomic RNAs (sgRNAs), has been discussed, and numerous important questions are still needed to be addressed before broad implementation. Objectives: This study aimed to primarily evaluate the performance of SYBR green quantitative reverse transcription-polymerase chain reaction (RT-qPCR) targeting N and E sgRNAs as a surrogate of viability markers. Methods: This pilot study was carried out to detect genomic RNAs (gRNAs) and sgRNAs using RT-qPCR in cell culture infected with severe acute respiratory syndrome coronavirus 2 and nasopharyngeal swabbing samples from COVID-19 patients, and the results were compared to viral culture as a gold standard method for infectious virus detection. The diagnostic parameters and Cohen’s Kappa correlation index were then analyzed. Results: E subgenomic RNA detection was the most reliable predictor for actively replicating the virus as it showed the highest value of all diagnostic parameters with a good correlation with viral cultivation. The lowest cycle threshold value of gRNAs and sgN detection become undetectable by sgE within the range of 23 - 26. Conclusion: Using a suitable sgRNA type was important for test accuracy. The findings suggested E sgRNA detection as a promising surrogate approach to indicate a truly active viral infection, and when performed with a low-cost molecular test of SYBR green-based assay, it could support huge demands for routine analysis.

Background: The COVID-19 pandemic, caused by SARS-Cov-2, has affected the care of patients with hemophilia, indicating the necessity of their vaccination. Nevertheless, there are concerns about using anti-SARS-Cov-2 virus vaccines for hemophilic patients, particularly concerning bleeding adverse events. Methods: Following a cross-sectional design, all adult hemophilic patients who received two doses of Sinopharm anti-SARS-Cov-2 virus vaccine in Afzalipour Hospital, Kerman, Iran, during May and June 2021 were recruited. The participants were followed for two weeks after receiving each dose of vaccine. Results: Fifty-one patients with a mean age of 37.07 ± 11.45 years were included, of whom 27 (61.4 %) patients experienced at least one adverse reaction. Pain was the most frequent local adverse event (occurred in 20 (39.2%) and 15 (29.4%) cases after 1st and 2nd doses, respectively). Menometrorrhagia and epistaxis were reported by two and one patients, respectively. Conclusions: Overall Sinopharm anti-SARS-Cov-2 virus vaccine seems to be safe for patients with hemophilia in the short term.

Background: Coronavirus is one of the major pathogens of the human respiratory system and a major threat to the human health. Objectives: This modeling study aimed to project the epidemics trend of coronavirus disease 2019 (COVID-19) in Qom, Iran Methods: This study projected the COVID-19 outbreak in Qom using a modified susceptible-exposed-infectious-recovered (SEIR) compartmental model by the end of December 2020. The model was calibrated based on COVID-19 epidemic trend in Qom from 1 January to 11 July. The number of infected, hospitalized, and death cases were projected by 31 December. A Monte Carlo uncertainty analysis was applied to obtain 95% uncertainty interval (UI) around the estimates. Results: According to the results, the reduced contact rate and increased isolation rate were effective in reducing the size of the epidemic in all scenarios. By reducing the contact rate from eight to six, the number of new cases on the peak day, as well as the total number of cases admitted to the hospital by the end of the period (31 December), decreased. For example, in Scenario A, compared to Scenario E, with a decrease in contact rate from eight to six, the number of new cases on peak days decreased from 15,700 to 1,100. The largest decrease in the number of new cases on peak days was related to Scenario F with 270 cases. Also, the total number of cases decreased from 948,000 to 222,000 between the scenarios, and the largest decrease in this regard was related to Scenario F, with 188,000 cases. Conclusions: The parameters of contact rate and isolation rate can reduce the number of infected cases and prevent the outbreak, or at least delay the onset of the peak. This can help health policymakers and community leaders to upgrade their health care systems.