Antimicrobial susceptibility patterns of the gram-negative bacteria isolated from septicemia in Children?s Medical Center, Tehran, Iran

Introduction. The choice of antimicrobial treatment for septicemia is often empirical and based on the knowledge of local antimicrobial activity patterns of the most common bacteria causing such bloodstream infections. The current study aimed to study the prevalence of bacterial pathogens causing septicemia and their antimicrobial resistant profiles in hospital admitted patients. Methods. This cross sectional study done at Children?s Medical Center, Tehran, Iran. We examined 168 bacterial strains isolated from 186 clinically diagnosed septicemia cases refereed at Children?s Medical Center, Tehran, Iran Over a period of twelve months from July 2010 to 2011 July. 11446 blood samples from patients of clinically suggestive septicemia were evaluated. Results. Bacterial strains were isolated from 910 (7.95%) of blood cultures. Gram-negative bacteria identified were Pseudomonas species (20.5%), Pseudomonas aeruginosa (1.86%), Salmonella spp (1.09%), Acinetobacter naumannii (8.13%), Escherichia coli (4.06%), Klebsiella spp (5.16%). Gram-negative pathogens were more than gram positive in bloodstream infections. Antimicrobial susceptibility testing was done according to Clinical and Labo- ratory Standards Institute (CLSI, USA) guidelines against: amikacin ampicillin, amoxicillin, amoxiclav, cefuroxime, cefotaxime, ceftazidime, cefoperazone tetracycline, chloramphenicol, ciprofloxacin, gentamicin. Resistanc to different antibiotics in the most important isolated bacteria were: 32.1 %, 10.8%, 87.8%, 96%, 39.1%, 35.2, 49.4%, 69%, 80.02%, 22%, 59%, 30.1% respectively, for Pseudomonas spp, 32%, 3.7%, 84.2 %, 83.2%, 80.1%, 75.4%, 44.8%, 45.2%, 33.3%, 19%, 34.1, 11.5% respectively for Acinetobacter species. Discussion. Resistant to majority of the antimicrobial agents for several pathogens implicated in bloodstream infections, particularly in Gram-negative bacteria, can make complication in treatment of infection cause by them

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective

Molecular biology of the blood-brain and the blood-cerebrospinal fluid barriers: similarities and differences

Efficient processing of information by the central nervous system (CNS) represents an important evolutionary advantage. Thus, homeostatic mechanisms have developed that provide appropriate circumstances for neuronal signaling, including a highly controlled and stable microenvironment. To provide such a milieu for neurons, extracellular fluids of the CNS are separated from the changeable environment of blood at three major interfaces: at the brain capillaries by the blood-brain barrier (BBB), which is localized at the level of the endothelial cells and separates brain interstitial fluid (ISF) from blood; at the epithelial layer of four choroid plexuses, the blood-cerebrospinal fluid (CSF) barrier (BCSFB), which separates CSF from the CP ISF, and at the arachnoid barrier. The two barriers that represent the largest interface between blood and brain extracellular fluids, the BBB and the BCSFB, prevent the free paracellular diffusion of polar molecules by complex morphological features, including tight junctions (TJs) that interconnect the endothelial and epithelial cells, respectively. The first part of this review focuses on the molecular biology of TJs and adherens junctions in the brain capillary endothelial cells and in the CP epithelial cells. However, normal function of the CNS depends on a constant supply of essential molecules, like glucose and amino acids from the blood, exchange of electrolytes between brain extracellular fluids and blood, as well as on efficient removal of metabolic waste products and excess neurotransmitters from the brain ISF. Therefore, a number of specific transport proteins are expressed in brain capillary endothelial cells and CP epithelial cells that provide transport of nutrients and ions into the CNS and removal of waste products and ions from the CSF. The second part of this review concentrates on the molecular biology of various solute carrier (SLC) transport proteins at those two barriers and underlines differences in their expression between the two barriers. Also, many blood-borne molecules and xenobiotics can diffuse into brain ISF and then into neuronal membranes due to their physicochemical properties. Entry of these compounds could be detrimental for neural transmission and signalling. Thus, BBB and BCSFB express transport proteins that actively restrict entry of lipophilic and amphipathic substances from blood and/or remove those molecules from the brain extracellular fluids. The third part of this review concentrates on the molecular biology of ATP-binding cassette (ABC)-transporters and those SLC transporters that are involved in efflux transport of xenobiotics, their expression at the BBB and BCSFB and differences in expression in the two major blood-brain interfaces. In addition, transport and diffusion of ions by the BBB and CP epithelium are involved in the formation of fluid, the ISF and CSF, respectively, so the last part of this review discusses molecular biology of ion transporters/exchangers and ion channels in the brain endothelial and CP epithelial cells

Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage

Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use meta-genomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, health and environmental factors, which we use to predict AMR gene abundances in all countries in the world. Our findings suggest that global AMR gene diversity and abundance vary by region, and that improving sanitation and health could potentially limit the global burden of AMR. We propose metagenomic analysis of sewage as an ethically acceptable and economically feasible approach for continuous global surveillance and prediction of AMR.Peer reviewe

Setting a baseline for global urban virome surveillance in sewage

The rapid development of megacities, and their growing connectedness across the world is becoming a distinct driver for emerging disease outbreaks. Early detection of unusual disease emergence and spread should therefore include such cities as part of risk-based surveillance. A catch-all metagenomic sequencing approach of urban sewage could potentially provide an unbiased insight into the dynamics of viral pathogens circulating in a community irrespective of access to care, a potential which already has been proven for the surveillance of poliovirus. Here, we present a detailed characterization of sewage viromes from a snapshot of 81 high density urban areas across the globe, including in-depth assessment of potential biases, as a proof of concept for catch-all viral pathogen surveillance. We show the ability to detect a wide range of viruses and geographical and seasonal differences for specific viral groups. Our findings offer a cross-sectional baseline for further research in viral surveillance from urban sewage samples and place previous studies in a global perspective

Association of CagPAI integrity with severeness of Helicobacter pylori infection in patients with gastritis

Background and aim. - The Helicobacter pylori cag pathogenicity island (cagPAI) is involved in delivery of CagA effector protein and peptidoglycan into host cells and also in IL-8 induction in the human gastric tissue. Diversity of cagPAI may affect disease status and clinical outcome of the infected patients. Our study was aimed to investigate diversity of this island and its intactness in Iranian patients to investigate possible associations between cagPAI integrity and pathological changes of the infected tissue. Material/Patients and methods. - Out of the 75 patients, H. pylori strains were obtained from 30 patients with severe active gastritis (SAG) (n = 11), moderate chronic gastritis (CG) (n = 14) and intestinal metaplasia/dysplasia (IM) (n = 5). Intactness of the cagPAI was determined using 12 sets of primer pairs specific for functionally important loci of cagPAI by polymerase chain reaction (PCR). Results. - The cagPAI positive strains were significantly observed in patients with SAG (52.4) in comparison to those presenting CG (33.3) and IM (14.3). In addition, the presence of intact cagPAI was 87.5 in H. pylori strains isolated from patients with SAG, which was higher than those obtained from patients with CG (12.5) or IM (0). A significant increase in the frequency of caga-cagY and cagW-cagT segments, as exterior proteins of the CagPAI, was illustrated in strains from SAG patients compared with those from patients with CG. Conclusions. - Overall, these results strongly proposed an association between the severity of histopathological changes and intactness of cagPAI in the gastric tissue of patients infected with H. pylori. (C) 2015 Elsevier Masson SAS. All rights reserved

Adding intra-articular growth hormone to platelet rich plasma under ultrasound guidance in knee osteoarthritis: A comparative double-blind clinical trial

Introduction: Intra-articular injections of platelet rich plasma (PRP) for the treatment of knee osteoarthritis have been shown to reduce pain and improve joint function. The aim of this study is to examine the joint function by adding intra-articular growth hormoneto platelet rich plasma. This study was performed on the individuals with knee osteoarthritis and under ultrasound guidance. Methods: Fifty four patients who were scheduled for ultra-sound guided intra-articular injection were enrolled in the study. The patients were randomly allocated to groups P (platelet rich plasma) and PS (platelet rich plasma and Somatropin). Group P and PS were injected with 5 mL of platelet rich plasma, and 4 IU growth hormone (Somatropin) added to platelet rich plasma, respectively. Intra-articular injection was performed in two steps; the onset of study and one month after. Knee joint function based onWestern Ontario and McMaster osteoarthritis index (WOMAC) score at the baseline, 1 and 2 month later, and complications were evaluated. Results: WOMAC score in both groups has been significantly reduced after injections (P = 0.030). WOMAC score reduction in group PS in firstmonthwassignificantly higher thangroupP, but in secondmonth2, the differencebetweentwogroupswasnot significant (P = 0.235). No complication was observed. Conclusions: These results showed that adding growth hormone to platelet rich plasma for intra-articular injection improved function of the osteoarthritic knee joint in short period of time. © 2016, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM)