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Background: Data gathering and bioinformatics play a significant role in the management and treatment of patients, especially of critically ill patients. This study assesses the feasibility and design of a registration system for nosocomial infections and sepsis in the intensive care unit of Alzahra university hospital in Isfahan. Methods: The members of the registration system consisting of physicians and nurses of the ICU, infectious disease and pulmonary specialists, microbiologists, infection control supervisors, and librarians. The data collection tool was a researcher-made checklist. To design the framework of the tool, researchers investigated various tools and indices in references and databases such as PubMed, Scopus, Web of Science, and national databases regarding ICU infection and disease registration systems. Essential items in this field were selected and a preliminary draft was prepared to record the data of patients with ICU-related infections. After applying experts' opinions, the checklist was reviewed, and the final approval of the checklist was obtained. Results: The final version of the checklist is prepared in three parts consisting of demographic data, principle variables (data required for registration of a patient), and the extended variables including details of the principle variables, and the data used to diagnose and treat. Conclusion: The ICU infection registration system can predict the prevalence of infection, monitor services and treatment of patients, analyze survival, assess clinical care outcomes, and investigate drug-related interventions. Reducing hospitalization costs by stratifying patients, providing a database for research studies, assessing the cost-effectiveness of interventions, are other advantages that resulted from the design of this system.

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BACKGROUND AND AIMS: To evaluate the effect of a one-week LactoCare® oral probiotic supplementation on prognostic scores (APACHE II: acute physiology and chronic health evaluation II; SAPS II: simplified acute physiology score II; SOFA: sequential organ failure assessment), C-reactive protein (CRP) levels, and other outcomes in multiple trauma (MT) patients requiring intensive care compared to placebo. MATERIAL AND METHODS: A randomized, double-blind, placebo-controlled clinical trial. The population included MT patients admitted to ICUs of two referral centers in Isfahan, Iran, from December 2021 to November 2022 (registered under IRCT. ir identifier no. IRCT20211006052684N1). LactoCare® and placebo were administered twice daily for one week. Prognostic scores and CRP levels were calculated/measured before and after the dedicated intervention. RESULTS: There was not a significant difference in APACHE II (p-value = 0.62), SAPS II (p-value = 0.70), SOFA (p-value = 0.71) scores, CRP levels (p-value = 0.25), median hospital days [LactoCare® vs. placebo] (28.00 vs. 22.50, p-value = 0.06), median ICU days (21.00 vs. 18.00, p-value = 0.16), and median days under mechanical ventilation (14.00 vs. 14.50, p-value = 0.74) between the LactoCare® and placebo groups. Also, 28-day mortality and time to discharge did not significantly differ between the two groups. CONCLUSION: Evidence from this trial does not support the use of oral probiotic supplementation for MT patients who are admitted to the ICU.

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To affirm the short-term safety of the BBIBP-CorV (Sinopharm) COVID-19 vaccine among people with multiple sclerosis (pwMS), 517 vaccinated and 174 unvaccinated pwMS were interviewed. 16.2% of the vaccinated pwMS reported at least one neurological symptom in their respective vaccine-related at-risk periods (ARP) - a period from the first dose until two weeks after the second dose of the vaccine. In a multivariable logistic regression model, the presence of comorbidities (P = 0.01), use of natalizumab (P = 0.03), and experiencing post-vaccination myalgia (P < 0.01) predicted the development of post-vaccination neurological symptoms. One MS relapse, one COVID-19 contraction, and one ulcerative colitis flare after the first dose, and four MS relapses after the second dose of the vaccine were the only reported serious adverse events during the ARPs. To show if the vaccine provoked MS relapses, we compared the relapse rate of vaccinated pwMS in the vaccine-related ARP with the annualized relapse rate of unvaccinated pwMS in the prior year-a measure of baseline MS relapsing activity in the respective time-using a multivariable Poisson regression model accounting for possible confounders, which failed to show any statistically significant increase (P = 0.78). Hence, subject to replication-as the vaccinated and unvaccinated pwMS differed in baseline characteristics-the BBIBP-CorV vaccine does not seem to affect short-term MS activity. Furthermore, as 83.33% of the unvaccinated pwMS reported fear of possible adverse events to be the reason of their vaccination hesitancy, provision of evidence-based consultations to pwMS is encouraged. Limitations of our study briefly included lack of data for self-controlled analysis of relapse rates, possible presence of recall bias, and lack of on-site validations regarding the clinical outcomes due to the remote nature.

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BACKGROUND: With the spread of COVID-19, treatment of diseases such as multiple sclerosis (MS) should be resumed with caution due to the disease-modifying therapies (DMTs) used in this subset of patients and the immunoregulatory effects of these drugs. We aim to assess the outcome of COVID-19 infection in MS patients receiving DMTs. MATERIALS AND METHODS: This is a cross-sectional study involving 45 COVID-19-infected patients previously diagnosed with MS. The data regarding their MS status and the type of DMT taken by the patients were extracted from the Isfahan MS Institute registry and were summarized. Diagnosis of MS was based on the 2017 McDonald Criteria, and the diagnosis of COVID-19 was based on computed tomography scan and polymerase chain reaction of nasopharyngeal swabs. RESULTS: Out of the 45 MS patients infected with COVID-19, 5 had unfavorable outcomes. Two patients deceased and the other three had persistent respiratory complications on the 4-week follow-up visit. Hypertension, diabetes, seizures, and rheumatoid arthritis were among the comorbidities that the patients reported. Both patients who died received rituximab as part of their MS treatment. All other patients recovered completely. CONCLUSION: Each different drug category may possess a distinct risk for infection, therefore until robust evidence are available, the safest drug should be utilized or the therapy should be postponed, if possible, to minimize patient risk. Disease-modifying therapy use in MS patients should be cautiously applied as their effect on COVID-19 infection prognosis is not yet studied.

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Cytokine release syndrome with rituximab has been reported in certain diseases, however, it is rarely reported in MS patients treated with rituximab. The treating physician should suspect the syndrome when typical signs and symptoms appear.

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BACKGROUND: Differentiation of the demyelinating disorders of the CNS seems challenging in practice. Conus medullaris, the cone-shaped end of the spinal cord, is more involved in anti-MOG patients based on preliminary studies, a possibly helpful detail in its differentiation. Nevertheless, the evidence is still limited and the underlying cause is unclear and undiscussed in previous studies. OBJECTIVE: To contribute to preliminary studies by comparing conus involvement among patients with MS, anti-AQP4, and anti-MOG diseases using larger sample size. METHODS: More than a thousand MS, anti-AQP4, and anti-MOG patients were followed up for a maximum of five years, scanned for conus medullaris involvement. Data regarding each cohort were then analyzed and compared using statistical methods. RESULTS: The rate of conus medullaris involvement was significantly higher in anti-MOG patietns (OR = 27.109, P < 0.001), followed by anti-AQP4 (OR = 4.944, P = 0.004), and MS patients (OR = reference). Survival analysis showed higher pace and cumulative incidence of conus attacks in anti-MOG patients. Conus-involved patients, showed no significant difference regarding age, sex, concurrent brain lesions, and their partial recovery. Predictive values show that the probability of being diagnosed with anti-MOG is roughly 13 times higher in conus-involved patients (25.93% vs. 1.97%), although this probability was still higher for MS, as it has a much higher incidence. CONCLUSION: Despite minor differences, the results were in line with previous studies, confirming the higher rate of conus medullaris involvement among anti-MOG patients. Potential underlying causes are proposed and remain to be investigated in future studies.

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With the progress of COVID-19 vaccination programs worldwide, some new adverse events associated with the available vaccines may unfold, especially in subpopulations, representatives of whom were not included in phase I, II, and III clinical trials of these vaccines, such as patients with autoimmune diseases, including multiple sclerosis (MS). A 34-year-old woman presented with severe right hemiplegia and ataxia. She was diagnosed with relapsing-remitting MS (RRMS) 13 years ago and treated with rituximab (an anti-CD20 monoclonal antibody) during the last 15 months. She had received her first dose of adenovirus-vectored COVID-19 vaccine Gam-COVID-Vac (Sputnik V) three months after her last infusion of rituximab and three days before experiencing her latest MS relapse episode, preceded by mild symptoms (fatigue, myalgia, generalized weakness, etc.). Magnetic resonance imaging revealed several new periventricular, juxtacortical, brainstem, and cerebellar peduncle lesions. She received corticosteroid therapy for five consecutive days, and her neurological deficits slightly improved. Twenty-one days after receiving the first dose of the vaccine, her anti-SARS-CoV-2 antibodies were below the lower detection limit. However, a decision was made to adhere to the vaccination schedule and not risk the patient's safety against an unfortunate COVID-19 contraction, and thus, she was advised to receive the second Gam-COVID-Vac dose after discontinuation of oral steroid taper. The safety of adenovirus-based vaccines in patients with autoimmune diseases requires further investigation. Meanwhile, clinicians should raise awareness among their patients regarding the potentially limited efficacy of COVID-19 vaccination in those treated with anti-CD20 treatments. After careful, individualized risk-benefit assessments, planning a delay/pause in such treatments to create a time window for patients to receive the vaccine and develop anti-SARS-CoV-2 immunity may be recommended.

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