عفونت ادراری پیچیده با باکتریهای گرم مثبت چیست ؟
Complicated UTI
Complicated UTI is defined as cystitis or pyelonephritis that occurs in individuals with predisposing anatomic, metabolic, or functional risk factors that make UTI more difficult to treat. Complicated UTIs often occur in nosocomial and/or institutional settings, particularly in individuals with structural or functional alterations of the urinary tract (often associated with urinary catheterization), or other underlying renal, metabolic, or immunological disorders ; these populations are at greater risk of Gram-positive and polymicrobial UTI

Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including :

Aerococcus

Corynebacterium

Actinobaculum

Gardnerella Vag


https://t.iss.one/ofooni

آیا شربت پلارژین در بارداری ایمن است ؟

Pregnancy and breast-feeding: There isn't enough reliable information to know if Pelargonium sidoides is safe to use when pregnant or breast-feeding.
👇👇👇👇👇👇
Stay on the safe side and avoid use.

https://t.iss.one/ofooni

توضیح تعریف جدید سپسیس بر اساس جدول SOFA و Sepsis-3 :

گردآوری : دکتر محمدرضا ناظر ; متخصص عفونی و فلوشیپ آموزش پزشکی از مندل و هاریسون 2025 :

اختلال ارگان در پاسخ به عفونت
تعریف Sepsis-3، سپسیس را یک "اختلال ارگان تهدیدکننده حیات ناشی از پاسخ ناهنجار بدن به عفونت" می‌داند، نه صرفاً وجود تب یا لکوسیتوز یا SIRS.

در هر دو تعریف شوک سپتیک :
افت فشار خون مقاوم به مایعات ذکر شده است .‌



توضیح:

در شوک سپتیک، افت فشار خون که با تجویز مایعات اصلاح نمی‌شود و نیاز به وازوپرسور دارد، شاخص اصلی است و نشانه‌ای از نارسایی ارگان‌هاست.

اصلی‌ترین اندام هدف در آسیب اولیه سپسیس


ریه‌ها است .


توضیح:
ریه‌ها معمولاً اولین اندامی هستند که در سپسیس دچار نارسایی می‌شوند (ARDS). علت، نفوذپذیری مویرگی و التهاب شدید در بافت ریه است

معیارهای qSOFA سریع :

GCS زیر ۱۵
فشار سیستولیک کمتر از ۱۰۰
تعداد تنفس بیشتر از ۲۲


توضیح qSOFA :

تغییر سطح هوشیاری،
فشار سیستولیک <100،
تنفس >22
لکوسیتوز از معیارهای SIRS است، نه qSOF

شایع‌ترین ارگانیسم عامل سپسیس در بیماران بستری در ICU Staphylococcus aureus
البته در آمریکا در مندل ۲۰۲۵ این ارگانیسم ذکر شده ولی در ایران هر جایی متفاوت است .


توضیح:
Staph. aureus،
به‌ویژه گونه‌های مقاوم، یکی از شایع‌ترین عوامل سپسیس در بیماران بستری و دارای کاتتر یا زخم‌های باز است .


مهم‌ترین اقدام اولیه در درمان سپسیس شدید تجویز مایعات و آنتی‌بیوتیک وسیع‌الطیف


توضیح:
اقدامات اولیه باید شامل احیای سریع با مایعات و شروع سریع آنتی‌بیوتیک‌های وسیع‌الطیف باشد تا از مرگ‌ومیر جلوگیری کند .


https://t.iss.one/ofooni

آخرین وضعیت بیماریهای حاد تنفسی در کشور


تقدیم شما : حسینی

درمان جدید هیدرآدنیت چرکی در مندل و مقاله

سوال ۳۱۳ این ماه 🌙 :

آیا ضد انعقاد در لخته پا در معتادان تزریقی اندیکاسیون دارد ؟
The management of septic thrombophlebitis?

مونوتراپی با سفازولین ؟ آری یا خیر ؟

Infect Dis. 2025 Sep 24

Evaluation of the Safety of Cefazolin Monotherapy in Outpatient Parenteral Antimicrobial Therapy at a Large Academic Medical Center:

Cefazolin, is commonly prescribed for the treatment of soft tissue, bloodstream, and bone infections, including staphylococcal or streptococcal infections, and is thought to carry few complication risks. The most common adverse events are eosinophilia, leukopenia, and drug hypersensitivity reactions (HSRs) .

To that end, OPAT safety lab monitoring for patients treated with cefazolin serves primarily for the early detection of eosinophilia and other findings that may distinguish asymptomatic eosinophilia from HSRs.

RESULTS:
Our study included 420 patients enrolled in OPAT and treated with cefazolin monotherapy (2 g of IV cefazolin every 8 hours with adjustment for renal function).

The median treatment duration was 5.6 weeks. The median age was 61.7 years and the most common indications for treatment were bacteremia and osteomyelitis

we recorded cases where patients were switched from cefazolin to an alternative antimicrobial agent or readmitted to the hospital during the OPAT period.

There were 39 readmissions (9.3%), and 25 antimicrobial changes (6%).

However, only 9 patients who experienced readmission or medication change had a preceding lab abnormality (2.1%).

There were 2 deaths in our cohort over the OPAT period. Chart review revealed that neither was related to complications from OPAT or associated with a detected safety lab abnormality.

Finally, we sought to understand how soon after discharge lab abnormalities were detected through weekly monitoring.

We found that two-thirds of the 18 lab abnormalities in our cohort were detected within the first 2 weeks after discharge, with 4 in the first week (22.2%) and 8 in the second week (44.4%). Of the remaining 6 lab abnormalities, 3 (16.7%) were detected in the last week of treatment.

DISCUSSION:
In this single-center retrospective study evaluating the utility of OPAT safety lab monitoring for patients treated with cefazolin monotherapy, we found that few patients experienced a lab abnormality detected by safety labs (4.3%). Additionally, safety labs coincided with changes in treatment plans in <2% of patients and readmission in <1%, indicating that safety labs contributed to changes in clinical decision-making for few patients.

These findings coincide with previous studies looking at the safety profile of cefazolin that found adverse event rates between 1% and 5%, primarily consisting of eosinophilia, nephrotoxicity, and HSRs .

Further, as our data show, decisions to alter antimicrobial treatment often result from clinical changes, such as the development of a rash, that are evident with or without concomitant lab abnormalities. The low rate of lab abnormalities and the fact that abnormalities typically develop early in the treatment course presents the possibility that weekly monitoring may be unnecessary, especially in the later weeks of therapy.

Our study has several strengths.
First, our study population was larger than most comparable studies investigating the effects of cefazolin monotherapy .

Second, our study focused on adverse events that occurred during OPAT, excluding confounding events that occurred during acute care.

Third, our study included rates of readmission and antimicrobial agent change, allowing us to determine a ceiling on the maximum number of patients for whom safety lab monitoring potentially altered treatment course.

Fourth, our study measured the time to detection of lab abnormalities, which can inform the optimal frequency of laboratory monitoring.


https://t.iss.one/ofooni

اولین و بزرگترین رویداد کشوری در مرکز مردمی
"نفــــس استـان اصفهـان"


↫با احترام و افتخار شما را دعوت
می کنیم به؛

برای نجاتِ کوچک‌ترین جـــ👶ـــانِ جهان،
[ و در پاسداشت اهمیت حمایت
از حیات جنین، گردهم می آییم! ]

✦ به میزبانی حمید مـــــ🧔ــــــرادی
٬٬ و همراه با اجرای تئاتر، گروه سرود و برنامه های متنوع ،،

📆زمان: پنجشنبه | ۲۷ آذرماه ۱۴۰۴ |
ساعت ۸ الی ۱۲
📍مکان: دانشگاه علوم پزشکی اصفهان، تالار دکتر شریعتی

👤 جهت ثبت‌نام و حضور در این مراسم، لطفا از طریق آیدی زیر در پیامرسان ایتا اقدام فرمایید.
@Roydad_Nafas1

#نفس_نفسی‌برای‌هر‌نفس

افزایش احتمال ایجاد سرطان مثانه بدنبال زگیل تناسلی با بررسی بیش از ۸۰ مقاله
 
✍️جمع آوری : محمدرضا ناظر(عفونی)
The association between human papillomavirus and bladder cancer: Evidence from meta‐analysis and two‐sample mendelian randomization
J Med Virol. 2022 Oct 25;95(1):e28208. doi: 10.1002/jmv.28208.PMC10092419
PMID: 36226344
This study retrieved 80 articles from the four bibliographic databases. Of the total, 27 were case–control studies, and 53 were cross‐sectional studies.
The results showed that the prevalence of HPV was 16% (95% CI: 11%–21%) among the BCa patients, most of which were HPV‐16 (5.99% [95% CI: 3.03%–9.69%]) and HPV‐18 (3.68% [95% CI: 1.72%–6.16%]) subtypes.
However, the study found that the prevalence varied by region, detection method, BCa histological type, and sample source.
A significantly increased risk of BCa was shown for the positivity of overall HPV (odds ratio [OR], 3.35 [95% CI: 1.75–6.43]), which was also influenced by study region, detection method, histological type, and sample source.
وجود زگیل با پیشرفت بیشتر و آشکار سرطان مثانه همراه است :
👇👇👇👇👇👇
In addition, the study found that HPV infection was significantly associated with the progression of BCa (RR, 1.73 [95% CI: 1.39–2.15]).

The two‐sample MR analysis found that both HPV 16 and 18 E7 protein exposure increased the risk of BCa (HPV 16 E7 protein: IVW OR per unit increase in protein level = 1.0004 [95% CI: 1.0002–1.0006]; p = 0.0011; HPV 18 E7 protein: IVW OR per unit increase in protein level = 1.0003 [95% CI: 1.0001–1.0005]; p = 0.0089).

Conclusion:

In conclusion, HPV may play a role in bladder carcinogenesis and contribute to a worse prognosis for patients with BCa.
ضرورت زدن واکسن در پیشگیری از سرطان مثانه
👇👇👇👇👇
Therefore, it is necessary for people, especially men, to get vaccinated for HPV vaccination to prevent bladder cancer.
👇👇👇👇👇👇
Surprisingly, we found that HPV infection was significantly associated with BCa progression (RR = 1.73), especially BCa recurrence (RR = 1.87).
This is highly attributed to the persistent existence of HPV E6 and E7 proteins in the bladder, which can inhibit tumor‐suppressing proteins and lead to carcinogenesis. 
 This result shows the latent prognostic value of HPV infection for BCa.
زگیل تناسلی با خطر ایجاد و پروگنوز بدتر سرطان مثانه همراه است
👇👇👇👇👇
HPV infection is significantly associated with increased risk and worse prognosis of bladder cancer.
👇👇👇👇👇
Therefore, HPV vaccination is necessary to prevent bladder cancer, especially among men.

Future studies should investigate the association between HPV infection and bladder cancer using large‐scale sampling of various populations.

Moreover, the mechanisms behind these phenomena should be elucidated.




https://t.iss.one/ofooni

آیا قرص های AHCC  درمان کننده قطعی  زگیل هستند ؟

گردآوری : محمد رضا ناظر(عفونی)

در مقاله زیر طی شش ماه با دوز ۳ گرم (معادل ۵ قرص ۶۰۰ یا ۵۰۰ میلی گرمی ) حدود ۶۰ درصد اثر بخشی داشته است آنهم با هزینه معادل بیش از هفتاد میلیون تومان .

از طرفی در بخش عفونی هاریسون 2025 ذکر نموده که زگیل تناسلی پس از ۶ تا ۸ ماه خودبخود دچار کلیرانس می گردد که البته احتمال بازگشت در هر دو ذکر شده است.

لذا سوال اینجاست آیا تحمیل این هزینه سنگین به بیمار صحیح است ؟


در مقالات بعدی روش های جدید در کتاب جامع بیماری‌های عفونی ( مندل 2025) و مقالات مرتبط به آن خواهیم پرداخت ...

AHCC® Supplementation to Support Immune Function to Clear Persistent Human Papillomavirus Infections
Objective
PMC9256908  PMID: 35814366
To determine the efficacy, safety, and durability of the use of AHCC supplementation for 6 months to support the host immune system to clear high-risk human papillomavirus (HPV) infections. The AHCC supplement is a proprietary, standardized extract of cultured lentinula edodes mycelia (AHCC®, Amino Up, Ltd., Sapporo, Japan) that has been shown to have unique immune modulatory benefits.

Study Design
This was a randomized, double-blind, placebo-controlled study (CTN: NCT02405533) in 50 women over 30 years of age with confirmed persistent high-risk HPV infections for greater than 2 years.

Patients were randomized to placebo once daily for 12 months (N = 25) or AHCC 3-g supplementation by mouth once daily on empty stomach for 6 months followed by 6 months of placebo (N = 25).

Every 3 months, patients were evaluated with HPV DNA and HPV RNA testing as well as a blood sample collected to evaluate a panel of immune markers including interferon-alpha, interferon-beta (IFN-β), interferon-gamma (IFN-γ), IgG1, T lymphocytes, and natural killer (NK) cell levels.

At the completion of the 12-month study period, patients on the placebo arm were given the option to continue on the study to receive AHCC supplementation unblinded for 6 months with the same follow-up appointments and testing as the intervention arm.


Results:
Fifty women with high-risk HPV were enrolled, and 41 completed the study. Fourteen (63.6%) of the 22 patients in the AHCC supplementation arm were HPV RNA/HPV DNA negative after 6 months, with 64.3% (9/14) achieving a durable response defined as being HPV RNA/HPV DNA negative 6 months off supplementation.

On the placebo arm, two (10.5%) of 19 patients were HPV negative at 12 months.

In the twelve placebo arm patients who elected to continue on the unblinded study, 50% (n = 6) were HPV RNA/HPV DNA negative after 6 months of AHCC supplementation.

At the time of completion of the study, there were a total of 34 patients (22 blinded and 12 unblinded) who had received AHCC supplementation with an overall response rate of 58.8% that cleared HPV persistent infections.

At the time of enrollment, the mean IFN-β level was 60.5 ± 37.6 pg/ml in women with confirmed persistent HPV infections.

Suppression of IFN-β to less than 20 pg/ml correlated with an increase in T lymphocytes and IFN-γ and durable clearance of HPV infections in women who received AHCC supplementation.

Conclusion:
Results from this phase II study demonstrated that AHCC 3 g once daily was effective to support the host immune system to eliminate persistent HPV infections and was well tolerated with no significant adverse side effects reported.
The duration of AHCC supplementation required beyond the first negative result needs more evaluation to optimize success for durable outcomes.
The suppression of the IFN-β level to less than 20 pg/ml correlated with clearance of HPV infections and merits further evaluation as a clinical tool for monitoring patients with HPV infections.




https://t.iss.one/ofooni

اثر بخشی ضعیف سفتازیدیم، سفپیم در مننژیت آسینتوباکتر حتی وقتی حساس باشد

محمد رضا ناظر

سفتازیدیم ، سفپیم نامناسب برای مننژیت آسینتوباکتر
البته روشهای دوز بالا و آنفوزیون طولانی و آرام طی ۴ ساعت کمی بهتر بوده است :

از آخر مقاله شروع می کنیم :
In summary, pharmacodynamic considerations would suggest that ceftazidime or cefepime would be poor choices for therapy of acinetobacter meningitis even against susceptible strains.😔
👇👇👇
The potential efficacy of the antibiotic may be improved if an alternative dosing strategy is used (eg, use of higher daily doses administered as a continuous infusion). Nau and colleagues73 have suggested that the daily dose of ceftazidime should be increased to 12 g/day for Gram-negative meningitis when the blood–CSF barrier is minimally impaired. It is important to note that doubling the daily dose will only increase T>MIC by one halflife, which is typically 1–2 h. Whereas an additional halflife will extend the T>MIC by roughly 12–25% for an 8 h dosing interval (intermittent dosing), its effect on the pharmacodynamic probability of target attainment profile is minimal. Even with administration of 12 g of ceftazidime as a continuous infusion, the probability of achieving 50% and 100% T>MIC was greater than 80% for MIC equal or below 1.0 μg/mL but was less then 70% for MIC values of 2.0 μg/mL or more. We are not aware of any clinical reports in which such dosing has been given.


https://t.iss.one/ofooni

حتی در مقالات قدیمی تر نیز
فقط دو درصد آسینتو باکتر با دوز ایدسا به سفتازیدیم حساس بوده است .

حتی با انفوزیون پیوسته
👇👇👇👇👇👇

Unfortunately, just 2% of acinetobacter isolates have ceftazidime MICs equal or below 0.5 μg/mL.88–95

Therefore, these data would suggest that ceftazidime dosed at 2 g every 8 h (the dose recommended by IDSA guidelines for meningitis), even as a continuous or extended infusion, would be insufficient for the vast majority of cases of acinetobacter meningitis .
منبع :

Contemporary in vitro spectrum of activity summary for antimicrobial agents tested against 18569 strains non-fermentative gram-negative bacilli isolated in the SENTRY antimicrobial surveillance program (1997–2001) Int J Antimicrob Agents. 2003;22:551–56. doi: 10.1016/s0924-8579(03)00245-0.


https://t.iss.one/ofooni

تزریق داخل بطنی و داخل نخاعی اساس درمان مننژیت آسینتوباکتر است

محمد رضا ناظر
Intraventricular antibiotics appear to have an important role in therapy of acinetobacter meningitis since MICs of antibiotics commonly used intravenously for meningitis are typically high. Thus, adequate CSF concentrations may not be attained when these antibiotics are administered intravenously. It is vital that any agent given intraventricularly be made up in a preservative-free medium to prevent toxicity.

https://t.iss.one/ofooni

انشاء الله درست باشه برای بیماران مستضعف

سلام عزیزان. جهت پیشگیری از آسیب کلیویAKI در عفونتهای شدید بخصوص در بیماران دیابتی داروی زیر توصیه شده :
البته خودتان هم سرچ کنید
Finerenone is used to treat adults with chronic kidney disease (damage to the kidneys which may worsen over time and may cause the kidneys to stop working) due to type 2 diabetes.


https://t.iss.one/ofooni

مقاله زیر که خلاصه آن گذاشته شد که قرص  فاینرنون می تواند از نارسایی کلیه بدلیل AKI پیشگیری کند .

تقدیم شما : محمد رضا ناظر

Nonsteroidal Mineralocorticoid Receptor Antagonist Finerenone Protects Against Acute Kidney Injury–Mediated Chronic Kidney Disease: Role of Oxidative Stress

MR blockade by finerenone is effective not only for preventing the acute consequences of ischemic AKI but also to limit the progression of AKI to CKD. Four months after IR, rats displayed characteristics of CKD such as proteinuria, kidney dysfunction, increased renal vascular resistance, and structural alterations. Short-term prophylactic MR antagonism (2 days) with finerenone fully prevented the progression from AKI to CKD.
In experimental models, the targeting of renal hemodynamics and oxygenation by RAS blockade, epigenetic changes and cell cycle arrest, has shown to have potential for targeting the progression of AKI to CKD.6,40–42

 However, the ADQI XVIII work group acknowledged that in the current clinical practice, there are no therapeutic interventions to avoid the AKI to CKD progression.7


Altogether, our data show that in a rat model of AKI to CKD, the novel nonsteroidal MR antagonist finerenone is able to prevent acute injury induced by IR and the chronic and progressive deterioration of kidney function and structure. The underlying mechanism relies on prevention of oxidative stress and its consequence on the ET-B receptor. These preclinical data warrant further studies using nonsteroidal MR antagonists in clinical trials, to target kidney injury associated to IR.




https://t.iss.one/ofooni

غذا و داروی آمریکا به داروی دیگری برای درمان بیماران بستری کووید-۱۹ برای شروع در فاصله ۴۸ ساعت از آغاز تهویه مکانیکی یا ECMO مجوز مصرف اضطراری داد. این دارو با نام Gohibic یا vilobelimab، یک آنتی بادی مونوکلونال است که منجر به کاهش C5a از اجزای سیستم کمپلمان می‌شود که در شروع یک آبشار التهابی و‌پیشرفت بیماری کووید موثر است. مطالعه مربوطه کاهش ریسک مرگ تا روز ۲۸ و ۶۰ بعد از استفاده از این دارو را در مقابل پلاسبو نشان داده است.
بعد از رمدسیویر، توسیلیزومب (اکتمرا) و باریسیتینیب، این چهارمین دارویی است که برای بیماران بستری کووید-۱۹ مجوز می‌گیرد.



https://t.iss.one/ofooni