Integron-Mediated Antibiotic Resistance in Acinetobacter baumannii Isolated from Intensive Care Unit Patients, Babol, North of Iran

Background. We investigated the integron types and their relation with antibiotic resistance among A. baumannii isolates collected from intensive care unit patients, Babol, north of Iran. Methods. In this cross-sectional study, a total of 73 bronchoalveolar lavage samples were obtained from patients in ICU. Susceptibility testing was performed by disk diffusion method. Types of integrons were identified by an integrase gene PCR. Results. In total, 47.9% A. baumannii isolates were recovered from the BAL samples. All isolates were resistant to ceftazidime. 91.4% and 58.3% of isolates were MDR and XDR, respectively. The rate of colistin resistance with the E-test was 5.7%. Molecular analysis of class I, II, and III integrons showed that 25.7%, 88.6%, and 28.6% of the isolates carried the intI, intII, and intIII genes, respectively. Discussion. Our results show that different classes of integrons are commonly spread among A. baumannii strains and these genomic segments can play an important role in the acquisition of MDR and XDR phenotypes. So monitoring drug resistance in A. baumannii isolates with the use of int gene PCR is very important to plan specific infection control measures to prevent the spread of MDR-AB and XDR-AB in Iran’s hospitals

Prevalence, and virulence determination of listeria monocytogenes strains isolated from clinical and non-clinical samples by multiplex polymerase chain reaction

Introduction: This study aimed to determine the prevalence, and virulence factors of Listeria monocytogenes isolated from various samples by multiplex polymerase chain reaction (MPCR). Methods: A total of 617 isolates were obtained and MPCR was employed for detection of the inlA, inlC, and inlJ genes. Results: L. monocytogenes was detected in 46 (7.45) of the 617 specimens. inlA, inlC, and inlJ were detected in 100, 76.26, and 71 isolates, respectively. Conclusions: This study validated MPCR in the analysis and rapid detection of L. monocytogenes. The role of the genes in pathogenesis of the strains can also be affirmed. © 2016, Sociedade Brasileira de Medicina Tropical. All rights reserved

Serological diagnosis of Helicobacter pylori infection in patients with a polycystic ovary syndrome

Background: Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in 4 - 6 of women in the reproductive age and is a common cause of infertility. Even though the number of investigations is scarce, studies show that Helicobacter pylori infection may influence reproduction. Objectives: The purpose of this study was to determine and compare the levels of H. pylori specific antibodies IgA, IgG and anti-CagA at both PCOS and non-PCOS women with their spouses using the serological test. Patients and Methods: In this cross-sectional study, 127 women with their spouses (age range, 30 - 60 years) were selected. These patient were referred to infertility center of Shariati Hospital in Tehran, Iran, with a diagnostic criteria of PCOS based on Androgen Excess Society (AES). The specific antibodies of IgA, IgG and anti-CagA were measured using the commercial Enzyme-Linked Immunosorbent Assay (ELISA) kit. Results: The positive titers of H. pylori antibodies IgA, IgG and anti-CagA in the PCOS group were 45 (35), 79 (62) and 77 (60.5), respectively, while in non-PCOS group were 38 (30), 76 (60) and 50 (39.5), respectively. The sera positive for IgA, IgG and anti-CagA antibodies in spouses of the non-PCOS group were 38 (30), 84 (66) and 79 (62) respectively, but in spouses of the PCOS group were 51 (40), 83 (66) and 48 (38), respectively. The results showed that H. pylori infection probably did not affect infertility or reproduction. Conclusions: Findings of this study demonstrate no significant difference between levels of H. pylori specific antibodies of IgA, IgG, anti-CagA and the presence of PCOS disorders, and also indicate that serologic testing is a sensitive method for the detection of H. pylori antibodies. The high prevalence of H. pylori positive antibody levels in both PCOS and non-PCOS patients can be probably associated with the high frequency of H. pylori infection. © 2015, Infectious Diseases and Tropical Medicine Research Center

Metallo�β�lactamase�mediated resistance among clinical carbapenem�resistant Pseudomonas aeruginosa isolates in northern Iran: A potential threat to clinical therapeutics

Objective: Carbapenems are effective agents to treat multidrug�resistant (MDR) strains of bacteria, including Pseudomonas aeruginosa. However, there is a potential threat of emergence of carbapenem�resistant P. aeruginosa (CRPA). The aim of this study was to determine antibiotic susceptibility patterns and metallo�beta�lactamase (MBL)�mediated resistance in clinical P. aeruginosa isolates. Materials and Methods: Different clinical specimens were subjected to conventional culture�based identification of P. aeruginosa. Antimicrobial susceptibility patterns and MBL production were evaluated using the Kirby�Bauer and combined double�disk synergy test methods, respectively. Multiplex polymerase chain reaction was performed to investigate the presence of the blaIMP, blaVIM, blaNDM, blaSPM, and blaSIM genes. Results: A total of 71 clinical P. aeruginosa isolates were recovered, of which 28.17 were identified as CRPA. The most active antibiotics were colistin and polymyxin B (92.96 susceptibility to each). A total of 35 and 50 of CRPA isolates were MDR and extensively drug�resistant (XDR), respectively. MBL activity was shown in 20 of CRPA. A total of 90, 40, and 5 of CRPA isolates harbored the blaIMP, blaVIM, and blaNDM genes, respectively. No correlation was found between the MBL�encoding genes of P. aeruginosa and patient characteristics. Conclusion: Although the prevalence of CRPA in our therapeutic centers was relatively low, this rate of carbapenem resistance reflects a threat limiting treatment choices. A high prevalence of MDR/XDR phenotypes among the MBL�producer isolates suggests the need for continuous assessment of antimicrobial susceptibility and surveillance of antibiotic prescription. In addition, infection control measures are needed to prevent further dissemination of these organisms. © 2018 Tzu Chi Medical Journal | Published by Wolters Kluwer - Medknow

Evaluation of polymyxin b susceptibility profile and detection of drug resistance genes among Acinetobacter baumannii clinical isolates in tehran, iran during 2015-2016

Acinetobacter baumannii is an important opportunistic pathogen, responsible for approximately 10 of all gram-negative nosocomial infection. The aim of this study was to determine aminoglycoside and quinolone resistance genes and their antimicrobial susceptibility profile in the clinically A. baumannii. In this cross-sectional study, a total of 100 nonduplicative A. baumannii isolates were collected from different clinical samples. Antimicrobial susceptibility test was performed by disk diffusion method. QnrA, anrB, qnrS, aac(3)-IIa, and aac(6')-Ib genes were identified using PCR method. The results of antibiotic susceptibility test showed that polymyxin B was the most effective antimicrobial against A. baumannii. 97, 95 and 82 of isolates were resistant to cefepime, ceftriaxone, and amikacin, respectively. The molecular distribution of aac(3)-IIa, aac(6')-Ib, and qnrA genes were 45, 50, and 50 of isolates, respectively. However, qnrB and qnrS genes could not be detected in any strain. This study showed that polymyxin B was the best drug against A. baumannii clinical isolates. This data is also valid for polymyxin E (colistin), which is mostly used in clinics. There is a high level of resistance genes among clinical A. baumannii isolates. This high prevalence rate highlights the necessity for the development of rapid diagnostic assays and continuous monitoring of antibiotic resistance. © 2018, Mediterranean Journal of Hematology and Infectious Diseases

Barriers to sEMG assessment during overground robot-assisted gait training in subacute stroke patients

Background: The limitation to the use of ElectroMyoGraphy (sEMG) in rehabilitation services is in contrast with its potential diagnostic capacity for rational planning and monitoring of the rehabilitation treatments, especially the overground Robot-Assisted Gait Training (o-RAGT). Objective: To assess the barriers to the implementation of a sEMG-based assessment protocol in a clinical context for evaluating the effects of o-RAGT in subacute stroke patients. Methods: Anobservationalstudywasconductedinarehabilitationhospital.Theprimary outcome was the success rate of the implementation of the sEMG-based assessment. The number of dropouts and the motivations have been registered. A detailed report on difficulties in implementing the sEMG protocol has been edited for each patient. The educational level and the working status of the staff have been registered.Each member of staff completed a brief survey indicating their level of knowledge of sEMG, using a five-point Likert scale. Results: The sEMG protocol was carried out by a multidisciplinary team composed of Physical Therapists (PTs) and Biomedical Engineers (BEs). Indeed, the educational level andtheexpertiseofthemembersofstaffinfluencedthefulfillmentoftheimplementation of the study.ThePTsinvolved in the study did not receive any for maleducationonsEMG during their course of study. The low success rate (22.7%) of the protocol was caused by several factors which could be grouped in: patient-related barriers; cultural barriers; technical barriers; and administrative barriers. Conclusions: Since a series of barriers limited the use of sEMG in the clinical rehabilitative environment, concrete actions are needed for disseminating sEMG in rehabilitation services. The sEMG assessment should be included in health systems regulations and specific education should be part of the rehabilitation professionals’ curriculum. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03395717

Neurophysiological and Clinical Effects of Upper Limb Robot-Assisted Rehabilitation on Motor Recovery in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial Study Protocol

Background: The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific and high-intensity exercises are key points in facilitating motor re-learning in neurorehabilitation since RAT can provide an assisted-as-needed approach. This study aims to investigate the clinical effects of an exoskeleton robotic system for UL rehabilitation compared with conventional therapy (CT) in people with subacute stroke. As a secondary aim, we seek to identify patients’ characteristics, which can predict better recovery after UL-RAT and detects whether it could elicit greater brain stimulation. Methods: A total of 84 subacute stroke patients will be recruited from 7 Italian rehabilitation centers over 3 years. The patients will be randomly allocated to either CT (control group, CG) or CT plus UL-RT through an Armeo®Power (Hocoma AG, CH, Volketswil, Switzerland) exoskeleton (experimental group, EG). A sample stratification based on distance since onset, DSO (DSO ≤ 30; DSO > 30), and Fugl–Meyer Assessment (FM)-UL (FM-UL ≤ 22; 22 < FM-UL ≤ 44) will be considered for the randomization. The outcomes will be recorded at baseline (T0), after 25 + 3 sessions of intervention (T1), and at 6 months post-stroke (T2). The motor functioning assessed by the FM-UL (0–66) will be considered the primary outcome. The clinical assessments will be set based on the International Classification of Function, Disability and Health (ICF). A patient satisfaction questionnaire will be evaluated in the EG at T1. A subgroup of patients will be evaluated at T0 and T1 via electroencephalography. Their brain electrical activity will be recorded during rest conditions with their eyes closed and open (5 min each). Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early UL-RAT through a whole arm exoskeleton and how it may relate to the neural plasticity process. The trial was registered at ClinicalTrial.gov with the registration identifier NCT04697368

Comparison of loop-mediated isothermal amplification and conventional PCR tests for diagnosis of common Brucella species

Objective: Rapid, reliable, and affordable detection of Brucella species via the molecular methods remains a challenge. In recent years, loop-mediated isothermal amplification (LAMP) is a functional nucleic acid amplification technique offering a substitute to polymerase chain reaction (PCR). So, we compared the LAMP assay with the conventional PCR for the identification of common Brucella species in Iran. In this study, LAMP assay was comprehensively evaluated against the common PCR method. A group of specific LAMP primers were used to amplify a highly specific fragment from the sequence of the Brucella abortus, bcsp31 gene. Sensitivity and specificity values of tests were done with a set of 78 (50 Brucella and 28 non-Brucella) strains. Results: A dilution series of B. abortus DNA indicated that the LAMP reaction could reliably detect 10 (fg/µl) DNA target copies per reaction within 36 min, which is 10 times greater than the PCR assay. In summary, we conclude that LAMP assay provide accurate and fast test results to identify of common Brucella species in low-complexity labs, mainly in low and lower middle income countries. © 2020, The Author(s)

Molecular characterization of carbapenem-resistant acinetobacter baumannii isolated from pediatric burns patients in an Iranian hospital

Purpose: To survey the molecular characteristics of imipenem-resistant Acinetobacter baumannii obtained from pediatric burns patients in a teaching hospital in Tehran, Iran. Methods: Over a 10-month period, 73 non-duplicate A. baumannii strains were collected from pediatric burns patients admitted to Motahari Burn and Reconstruction Center, Tehran, Iran. The resistance profile of several antimicrobials was determined. Metallo-β-lactamase (MBL)-producing isolates were identified using double-disk synergy and an MBL E-test. Polymerase chain reaction (PCR) was carried out to detect the following β-lactamase-encoding elements: blaVIM, blaIMP, blaSIM, blaSPM, blaGIM, blaNDM, blaAIM, blaDIM, blaKPC, blaOXA-23/24/51, and blaOXA-58. The types of integrons were also identified using PCR. Results: Out of the 73 collected strains, 92.4 and 38.3 of the isolates were multidrug-resistant (MDR) and extensively drug-resistant (XDR), respectively. Colistin was the most effective antibiotic. It was found that 94.5 of the strains were resistant to imipenem, as determined both by disk agar diffusion and MIC E-test methods. Based on double disk synergy and E-test, 78.1 and 83.5 of the isolates, respectively, were MBL producers. The prevalence of blaOXA-23 and blaOXA-24 were 75.4 and 39.1 , respectively. The results also indicate that 62.3, 30.4, and 4.3 of the isolates were positive for blaVIM, blaIMP and blaNDM genes, respectively. Furthermore, 16.4, 76.1, and 7.5 of the isolates carried intI, intII, and intIII genes, respectively. Conclusion: The increased frequency of carbapenem-resistant A. baumannii in burns cases underlines the importance of choosing an appropriate antibacterial regimen based on antibiotic susceptibility profile. Rapid identification of carbapenemase-producing strains would be helpful for selecting suitable antimicrobial therapy and preventing further spread of their encoding genes. © Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin City, 300001 Nigeria

Occupational fatigue and sleep quality: A comparison between nurses working in various wards of public hospitals

Background & Objective: Fatigue is defined as a feeling of disability and weakness that leads to a reduction in the capacity of individuals to do their job and daily activities. Sleep disorders are one of the most important causes of fatigue in nurses. The present study aimed to determine the level of occupational fatigue and sleep quality among nurses working in various wards of public hospitals. Materials & Methods: This cross-sectional study was conducted on 234 nurses working in diverse wards of the two public hospitals affiliated to Ilam University of Medical Sciences, Iran selected by the convenience sampling method. The data were collected using a demographic questionnaire, Occupational Fatigue Exhaustion Recovery scale, and Pittsburgh Sleep Quality Index. Finally, the data were analyzed by descriptive statistics, independent t-test, and one-way analysis of variance using the SPSS software version 21. Results: The mean sleep quality index of the nurses working in the nursing station was at the appropriate level (3.83±2.32), whereas the nurses working in other wards had an unsuitable level of sleep quality index. Moreover, the mean score of occupational fatigue was high among the nurses of female Post-cardiac Care Unit (post-CCU) (58.12±12.24) and moderate among the nurses of other hospital wards. The results of t-test indicated significantly lower mean scores of sleep latency, taking sleeping medications, and acute fatigue in nurses with a second job, compared to nurses with a single job (P<0.05). Conclusion: Sleep problems and occupational fatigue in nurses of the female Post-CCU and nursing stations were higher and lower than the nurses working in the other hospital wards, respectively. Furthermore, the second job variable was found to be important and influential. © 2020, Journal of Advances in Medical and Biomedical Research. All rights reserved