Reinfection risk of novel coronavirus (COVID-19): A systematic ‎review of current evidence

BACKGROUNDThere is recently a concern regarding the reinfection and reactivation of previously reCoVered coronavirus disease 2019 (CoVID-19) patients.AIMTo summarize the recent findings and reports of CoVID-19 reinfection in patients previously reCoVered from the disease.METHODSThis study was a systematic review of current evidence conducted in August 2020. The authors studied the probable reinfection risk of novel coronavirus (CoVID-19). We performed a systematic search using the keywords in online databases. The investigation adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist to ensure the reliability and validity of this study and results.RESULTSWe reviewed 31 studies. Eight studies described reCoVered patients with reinfection. Only one study reported reinfected patients who died. In 26 studies, there was no information about the status of the patients. Several studies indicated that reinfection is not probable and that post-infection immunity is at least temporary and short.CONCLUSIONBased on our review, we concluded that a positive polymerase chain reaction retest could be due to several reasons and should not always be considered as reinfection or reactivation of the disease. Most relevant studies in positive retest patients have shown relative and probably temporary immunity after the reCoVery of the disease.     

Thyroid-associated ophthalmopathy in Iranian patients

We determined the frequency of clinical thyroid ophthalmopathy in Iranian patients. This cross-sectional study was performed at the Endocrinology Institute of Tehran University of Medical Sciences. All patients with documented thyroid disorders from September 2003 to July 2005 were recruited. Eye examinations included evaluation of soft tissue changes, measurement of proptosis, lid width, lagophthalmos, evaluation of eye muscle function, and determination of visual acuity. The activity of ophthalmopathy was scored according to the NOSPECS scale. Among 851 visited patients, 303 cases had thyroid eye disease (TED). The nature of the ophthalmopathy breaks down as follows: 53.4% were hypothyroid (9.3% Hashimoto disease), 5.5% euthyroid and 41.1% had Graves' disease. The prevalence of TED in males was 60% which was nearly 2 times the prevalence of TED in females. There was a significant relationship between presentation of TED and active smoking of the patients (P<0.0001) while no significant relationship with passive smoking was obtained (P=0.181). The most common clinical sign of TED in descending order respectively were proptosis with 63.4%, soft tissue involvement (40.9%), extraocular muscle involvement (22.1%), corneal involvement (12.9%) and optic nerve dysfunction (6.3%). Myasthenia gravis occurred in only 2 patients. In the logistic regression, occurrence of TED was influenced by cardiovascular disease (OR=5.346), Graves' disease (OR=47.507), radioiodine therapy (OR=2.590), and anti-thyroid medications (OR=0.650). Thyroid ophtalmopathy (orbitopathy) is a matter of important health concern among patients with thyroid disorder. Since TED occurred with a high prevalence in all thyroid states, a close collaboration between endocrinologists and ophthalmologists along with timely referrals of patients with any eye complaint is deemed necessary. Also smoking was the most important risk factor for developing TED. Therefore, it is advisable to raise awareness and to strongly encourage smokers with thyroid disorders to quit smoking.     

Seroprevalence of toxoplasmosis in HIV(+)/AIDS patients in Iran

Toxoplasma gondii has arisen as an important opportunistic agent especially in the central nervous system and in advanced HIV disease can cause significant morbidity and mortality. This study was carried out to determine the seroprevalence of toxoplasmosis among HIV-positive patients in Iran. Blood samples were collected from 201 HIV-positive patients and anti-toxoplasma antibodies were detected by using conventional ELISA. An antibody titer of >3 IU/ml was considered positive. The majority of studied patients were male (male to female ratio: 5 to 1) with the mean age of 36 ± 1 yrs. The seroprevalence of toxoplasmosis in HIV-positive patients was 49.75%. The mean CD4 count in HIV patients with positive toxoplasma serology was 332.5 ± 22.4 cells/μl. Only 1% of the patients had IgM anti-toxoplasma antibodies and 10% of the patients had clinical toxoplasma encephalitis. The mean CD4 count in this group was 66.4 ± 15.5 cells/μl and there was a significant association between CD4 count and rate of toxoplasma encephalitis (P<0.001). Previous reports suggested that toxoplasma encephalitis could be prevented by appropriate chemoprophylaxis. In view of the relatively high prevalence of toxoplasma infection found among the HIV-infected patients in our study, we suggest that routine screening for toxoplasma should be undertaken for all HIV-infected patients in Iran.     

Monitoring of serum vancomycin concentrations in pediatric patients with normal renal function

Vancomycin is a a glycopeptide antibiotic with bacetiocidal effects on gram positive bacteria by interfering with cell wall synthesis. The necessity for monitoring of serum vancomycin concentrations (SVCs) has been recently noticed at many institutions because of concerns for its nephrotoxicity. We aimed to describe the SVCs monitoring in pediatric patients, in an effort to determine subtherapeutic or toxic levels. The medical records were reviewed for all patients older than 60 days of age admitted to the general or subspecialty services who received intravenous vancomycin at Children's Medical Hospital in Tehran, Iran between July 2003 and December 2005. Because pharmacokinetic parameters for children with cancer may be different, this group was evaluated separately. During the study, 167 infants and children without cancer and 42 patients with cancer; aged between 3 months to 17.5 years were treated with vancomycin for various infections. In children without cancer, peak SVCs were in an adequate therapeutic range for 93% of patients (8-55 microg/ml). For children with cancer, peak SVCs was lower than 10 microg/ml (10%), and trough values were lower than 5 microg/ml (21%). In conclusion, according to the results of this research, due to different pharmacokinetics of vancomycin in cancerous patients, the monitoring of vancomycin plasma concentrations is necessary for the best therapeutic antibacterial activities with a fewer occurrence of serious adverse effects.     

The effects of mindfulness-based stress reduction (MBSR) program in Iranian HIV/AIDS patients: a pilot study

Psychological or behavioral interventions that attenuate the effects of stress may be useful in promoting immunocompetence and delaying HIV disease progression and CD4 count level. Mindfulness-Based Stress Reduction (MBSR) is a behavioral intervention that has as its foundation the practice of insight-oriented (or mindfulness) meditation. In this study, we examined the effects of MBSR upon psychological, physical status and CD4 count of HIV/AIDS infected patients registered at the Positive Club of Imam Khomeini Hospital in 2007. Using a pilot study, we evaluated the effectiveness of a psychological intervention (8-week) that was based on training in mindfulness at the Positive Club of Imam Khomeini Hospital in 2007. Eight 2-hour sessions weekly and a day-long retreat were planned for a group of 10 participants with HIV. We investigated the long-term effects of this approach on psychological and physical status of patients by SCL-90-R and MSCL questionnaires and CD4 count after MBSR and in 3, 6, 9 and 12-month follow-ups. We studied six HIV positive patients. The mean age was 35 +/- 7.7 yrs. There was no significant difference in MSCL scores after MBSR and in 3, 6, 9 and 12 months compared to those before MBSR (P>0.05). There was a significant difference in SCL-90-R score after MBSR compared with before (P=0.05). Nevertheless, in 3, 6, 9 and 12 months no significant differences were seen in SCL-90-R scores relative to those before MBSR (P>0.05). The means of CD4 count, before and after MBSR, and in 3, 6, 9 and 12 months were 549 +/- 173.6, 640.2 +/- 189.4, 655.3 +/- 183.4, 638 +/- 167.4, 619.3 +/- 163.2, and 595.2 +/- 165.6, respectively. There was a significant difference in CD4 counts in comparison with those before MBSR (P<0.05). In our study, MBSR had positive effects on psychological status and CD4 count. However, more studies with large sample size are necessary.     

Effect of green tea consumption in treatment of mild to moderate depression in Iranian patients living with HIV: A double-blind randomized clinical trial

Objective: Depression affects people living with HIV(PLWH) compliance leading to poor control infection.Previous observational studies showed an anti-depression effect of green tea extract(GTE). The therapeutic effect of GTE on depression were investigated in PLWH receiving antiretroviral therapy(ART).Methods: Fifty PLWH on ART with diagnose of mild to moderate of depression, participated in a doubleblind, placebo-controlled trial and underwent 12 weeks of treatment with either 400 mg GTE capsules or placebo twice daily. The Hamilton depression scale of patients was measured before, 6 weeks and 12 weeks after treatment in two groups. The primary outcome measure was performed to evaluate the efficacy of GTE in improving depressive symptoms.Results: The mean of Hamilton score showed a significant difference between the two groups after 12 weeks(P = 0.035). Repeated measures ANOVA test showed a significant effect for time ? treatment interaction on the Hamilton mean score between the two groups(P = 0.000).Conclusion: It seems the use of GTE capsules in PLWH on ART is safe and could lead to greater and more rapid improvement in depressive symptoms than placebo. Thus it can be considered as an alternative therapy for mild to moderate depression. Further studies with higher sample size and longer followup and comparisons with other antidepressive drugs are warranted.     

Incidence of isolation of Mycobacterium tuberculosis from blood samples in tuberculosis patients in Imam Khomeini Hospital, Tehran, Iran

It is estimated that one third of the world's population is latently infected with tuberculosis (TB). The HIV epidemic fuels the TB epidemic by increasing the risk of reactivation of latent TB infection and by facilitating a more rapid progression of TB disease. Although the incidence of TB is constant or decreasing in many regions of the world, rates remain high in developing countries as a consequence of the HIV epidemic. This study was conducted as a collaboration of the Infectious Diseases department of Imam Khomeini Hospital with the Microbiology department of Tehran University of Medical Sciences. The hospital dataset of 94 patients admitted with TB during 2003-2005 was reviewed. We aimed to study factors correlating with positive blood culture including age, sex, immune deficiency status, HIV serology and SIRS (Systemic Inflammatory Response Syndrome) status. In this study, we found that positive blood cultures are more frequent in patients less than 45 years old. Positive blood cultures were also more frequent in HIV infected patients and there was a significant correlation between blood culture and SIRS status. Therefore, we recommend that we obtain blood cultures from these high-risk groups in order to increase early detection of TB.     

Pleural and pericardial effusions: rare presentations of brucellosis, Iran

We report a rare case of brucellosis presenting with pleural and pericardial effusions in a 35 year-old male rancher in Iran with fever and dyspnea. Such findings should prompt inclusion of brucellosis in the differential diagnosis in endemic areas.     

Hepatitis-C and hepatitis-B co-infections in patients with human immunodeficiency virus in Tehran, Iran

We carried out a study to determine the seroprevalence of HBV and HCV infections in HIV positive patients at a main referral center for HIV/AIDS in Iran. Serum samples from 201 HIV positive patients referring to a referral center for HIV/AIDS were analyzed for the presence of some hepatitis B (HBsAg, anti-HBc, anti-HBs) and Hepatitis C (anti-HCV) markers, during 2004- 2005. HBsAg was positive in 27 patients (13.4%), anti-HBc was positive in 60 patients (29.8%) and anti-HBs in 23 patients (11.4%). Anti-HCV Ab was positive in 135 of 201 (67.2%). HBV and HCV coinfection was observed in 73 of 201 (36.3%). The maximum prevalence of HBV-HIV and HCV-HIV coinfections were seen in intravenous drug users; 61.2% and 85.1%, respectively (P<0.0001). The minimum prevalence of HBV-HIV and HCV-HIV were seen in HIV patients' wife (HIV(+) patients who were infected by monogamous sexual contact with their HIV positive husband) both of them were 8% (P<0.0001). This study showed that HBV-HIV and HCV-HIV coinfections are significant in patients with HIV/AIDS in Iran. A greater relevance was observed in the association between HCV and HIV. This study suggests that it is necessary to investigate risk factors and risk groups for these infections in Iran.