Detection of Legionella pneumophila in the bronchoalveolar lavage samples by real time PCR in patients with ventilator-associated pneumonia in ICU

زمینه و هدف: لژیونلا پنوموفیلا به خاطر توانایی آن در ایجاد پنومونی ناشی از ونتیلاسیون مکانیکی مورد توجه مراکز درمانی است. هدف از این مطالعه ردیابی گونه های لژیونلا پنوموفیلا در نمونه های بدست آمده از برونکوآلوئولار لاواژ با روشReal Time PCR در بیماران بستری در بخش مراقبت های ویژه ی بیمارستان الزهرا(س) اصفهان می باشد. روش بررسی: در یک مطالعه توصیفی تحلیلی سی و نه نمونه برونکوآلوئولار لاواژ در بیماران مبتلا به پنومونی همراه با ونتیلاتور بستری در بخش مراقبت های ویژه (ICU) بیمارستان الزهرای اصفهان در سال 1390 گرفته و تا زمان آزمایش در 20- درجه سانتیگراد نگهداری شد. DNA به روش فنل کلروفرم استخراج و آزمایش Real Time PCR در 45 چرخه شامل oC95 برای 4 ثانیه و oC58 برای 30 ثانیه انجام شد. در حالی که پروب به روش Taq Man عمل می کرد. یافته ها: نتیجه برای حضور باکتری لژیونلا پنوموفیلا در همه نمونه ها منفی شد. حداقل سن افراد در مطالعه 20 و حداکثر 86 سال بوده است. مدت زمان بستری افراد مورد مطالعه در ICU حداقل 2 روز و حداکثر 65 روز است. مدت زمان ونتیلاسیون افراد مورد مطالعه حداقل 2 روز و حداکثر 65 روز بود. نتیجه گیری: این مطالعه عدم حضور لژیونلا پنوموفیلا در بیماران دچار پنومونی وابسته به ونتیلاتور در ICU بیمارستان الزهرای اصفهان رادریک مقطع زمانی نشان می دهد؛ لذا بر اساس مطالعه فوق، شناخت الگوی میکروبیولوژیک لژیونلا پنوموفیلا در سایر مراکز درمانی نیز امری منطقی به نظر می رسد

Bionomics and phylo-molecular analysis of Leishmania species isolated from human lesions using ITS1 genes in north-east of Iran

Leishmaniasis is a zoonotic infectious disease caused by Leishmania species. The identification of parasite species and the type of disease is beneficial for treatment and preventive modalities. Leishmania tropica and L. major have been reported as the main etiological agents of cutaneous leishmaniasis (CL) in Iran. The incidence of zoonotic CL has increased and different in distinct loci of Iran. Hence, we perused the Leishmania species and its genetic traits in the North East of Iran. The investigation was conducted on 200 positive smears prepared from patients’ lesions suffering from CL referred to the health care centers of northeastern provinces in Iran from 2013 to 2019. The obtained positive microscopy samples were divided to score the ranges from + 1 to + 6, of them 40 smears exhibited low-parasitemia. Leishmania species analyzed using PCR–RFLP, genetic diversity indices evaluation, phylogenetic analysis, and sequencing comparison with other species in the GeneBank based on ITS1 gene. The isolated L. major strains were similar to other Iranian isolates in this region. Pairwise fixation index (FST) index was statistically significant in different L. major populations and showed the genetic differences in pairwise population of different geographical locations of Iran. The current study confirmed an old pattern endemicity of zoonotic CL in North-east of Iran. Therefore, in order to assess the hybrid formation, more epidemiological, ecological, and gene polymorphism studies are needed to understand the pathogenic role of Leishmania species in Iran.acceptedVersionPeer reviewe

Nursing Care and Documentation Assistant with an Electronic Nursing Management System in Neonatal Intensive Care Unit

Background: All nursing cares require decision-making, and the ability to make the best decisions impact upon the quality of nursing care. Moreover, authenticity and accuracy of the best cares may be questioned if not recorded and reported properly and in a standard manner. We aimed to design and implement an electronic nursing managementsystem and then evaluate satisfaction of nurses with the designed electronic system.Methods: This technical action research was conducted in four phases of a) designing an electronic nursing process decision support system, b) designing an electronic nursing care documentation system, c) integrating these two systems and developing an electronic nursing information management system, and d) implementing the system and system satisfaction evaluation using quantitative methods (satisfaction questionnaire).Results: The results of this project led to design and development of an electronic nursing information management system for neonatal intensive care units, which enables nurses to carry out standard care and documentation with high level of nursing satisfaction.Conclusion: In order for an electronic system to support nurses in their care process, it must be accepted by nurses. If nurses are satisfied with the performance and nature of this system, they are much less likely to develop workaround solutions and much more likely to spend their efforts focusing on the professional aspects of nursing care

Familial Congenital Hepatic Fibrosis: Report of a Family with Three Affected Children

Congenital hepatic fibrosis (CHF) is a developmental disorder of the biliary system, characterized by defective remodeling of the ductal plate. Herein a family of three children, from consanguineous parents, with minor thalassemia is presented who suffered from congenital hepatic fibrosis (CHF). Prompt diagnosis and appropriate treatment are necessary to avoid further complications in the affected patients

Investigation on the oxygen transport mechanisms in the Sarcheshmeh waste rock dumps

Introduction Pyrite oxidation and acid mine drainage (AMD) are the serious environmental problems associated with the mining activities in sulphide ores. The rate of pyrite oxidation is governed by the availability of oxygen (Borden, 2003). Therefore, the identifying oxygen supplying mechanism is one of the most important issues related to the environmental assessment of waste rock dumps (Cathles and Apps, 1975; Jaynes et al., 1984; Davis and Ritchie, 1986). Although comprehensive researches were performed on the mathematical description of oxygen transport processes using the numerical modeling (Morin et al., 1988; Blowes et al., 1991; Wunderly et al., 1986; Elberling et al., 1994; Jannesar Malakooti et al., 2014), so far, the interactions between these processes and geochemical and mineralogical characteristics has not been studied especially in waste rock dumps. Therefore the main objective of this study is to identify the evidences for knowing the oxygen transport mechanisms in the waste dumps and also, its role in intensity of pyrite oxidation. It is expected that such these structural studies could be useful for better understanding of dominant processes in numerical modeling and also providing environmental management strategies in the study area and other sites by similar characteristics. Materials and Methods In this study, thirty solid samples were collected from six excavated trenches in the waste rock dumps No. 19 and 31 of the Sarcheshmeh porphyry copper mine. Collected samples were studied using several methods such as XRD, ASTM-D2492, paste pH and grain size distribution. The results obtained from these methods were used with the field observations in order to characterize some detail information about oxygen supplying mechanisms for oxidation reactions in the waste rock dumps. Result The main minerals found by the XRD analysis were quartz and muscovite which were present in all samples. Pyrite, orthose, albite, and chlorite were also present in some samples. The carbonate content as the major neutralizing agent was zero in all samples. Due to the presence of sulfide minerals, mainly as pyrite, and also lack of any carbonate minerals, the AMD generation from the Sarcheshmeh waste rocks during the weathering reactions is predictable. At the Sarcheshmeh mine waste, several secondary minerals such as butlerite, jarosite and gypsum were detected by XRD at some depths. Moreover, amorphous iron oxyhydroxide minerals visually observed in waste dumps were not detected by XRD due to being negligible and low level of crystallinity. Hence, they were measured in terms of (Feo-h) by ASTM standard test method. The ASTM-D2492 standard test showed that pyrite, sulphate and iron oxyhydroxide minerals (Feo-h) are present in all samples. Against the XRD method, the test even detected the negligible content of the minerals. The paste pH tests showed that 15 samples were acid-producing because they had pH lower than 4. On the basis of moisture content results, the samples by name A6, A7, B1 and B2 showed high level of moisture which can be sign of the particular status in them. Discussion According to the field observations, channels with a strong flow of warm and humid air were detected in the depth of 3 to 5 meters of the investigated waste rock dumps. High content of humidity (8.25 and 13.43 percent) and sulfate (4.5 and 7.02 percent) were observed together with low content of pyrite (1.5 and 6.23 percent) and acidic paste pH values (3.13 and 2.88) around these channels. Therefore, from the relation of these occurrences, it can be inferred that the air convection is important for supply oxygen to pyrite oxidation in the waste dumps of Sarcheshmeh. The results also indicate that, two main factors including grain size distribution and formation of hardpan layer on top of old weathered rocks are responsible for the decreasing of oxygen transformation rate via the molecular diffusion mechanism through the waste rock dumps. Considering the presence of coarse grain and poorly graded material as a proper media for air convection and also hardpan layer as a confining factor in molecular diffusion of oxygen, it can be deduced that the air convection is the main important mechanism to supply oxygen for weathering and oxidation reactions in the waste rock dumps. The abundance of oxygen and high temperatures in such conditions are also favorable for bacterial activities, which can then accelerate the pyrite oxidation in lower depth of dump. It is expected that the results of this study could be useful as a basis for providing the remediation strategies to control acidic drainage. So that knowing the domination of air convection and presence of hardpan justify controlling the flux of oxygen from the coarse material in bottom of waste dump. Therefore, it would be wrong to construct the impermeable layer on the surface of waste dump for arresting the oxygen diffusion as a traditional method in the remediation. Acknowledgement The authors appreciate the cooperation of the Research and Development Division of the Sarcheshmeh Copper Complex for financial support and access to sampling and analysis facilities. Reference Blowes, D.W., Reardon, E.J., Jambor, J.L. and Cherry, J.A., 1991. The formation and potential importance of cemented layers in inactive sulfide mine tailings. Geochimica et Cosmochimica Acta, 55(4): 965-978. Borden, R.K., 2003. Environmental geochemistry of the Bingham Canyon porphyry copper deposit, Utah. Environmental Geology, 43(7): 752-758. Cathles, L.M. and Apps, J.A., 1975. A model of the dump leaching process that incorporates oxygen balance, heat balance, and air convection. Metallurgical Transactions B, 6(4): 617-624. Davis, G.B. and Ritchie A.I.M., 1986. A model of oxidation in pyritic mine wastes: part 1: Equations and approximate solution. Applied Mathematical Modeling, 10(5): 314-322. Elberling, B., Nicholson, R.V., Reardon, E.J. and Tibble, R., 1994. Evaluation of sulphide oxidation rates: a laboratory study comparing oxygen fluxes and rates of oxidation product release. Canadian Geotechnical Journal, 31(3): 375-383. Jannesar Malakooti, S., Shafaei Tonkaboni, S.Z., Noaparast, M., Ardejani, F.D. and Naseh, R., 2014. Characterisation of the Sarcheshmeh copper mine tailings, Kerman province, southeast of Iran. Environmental Earth Sciences, 71(5): 2267-2291. Jaynes, D.B., Rogowski, A.S. and Pionke, H.B., 1984. Acid mine drainage from reclaimed coal strip mines 1. Model description. Water Resources Research, 20(2): 233-242. Morin, K.A., Cherry, J.A., Dave, N.K., Lim, T.P. and Vivyurka, A.J., 1988. Migration of acidic groundwater seepage from uranium-tailings impoundments, 1. Field study and conceptual hydrogeochemical model. Journal of Contaminant Hydrology, 2(4): 271-303. Wunderly, M.D., Blowes, D.W., Frind, E.O. and Ptacek, C.J., 1986. Sulfide mineral oxidation and subsequent reactive transport of oxidation products in mine tailings impoundments: A numerical model. Water Resources Research, 32(10): 3173-3187. <br

Evaluation of the immune-modulatory, anti-oxidant, proliferative, and anti-apoptotic effects of nano-silymarin on mesenchymal stem cells isolated from multiple sclerosis patients' adipose tissue sources

Silymarin (SL) has a long history of use for the treatment of a variety of diseases, but several limitations, such as poor bioavailability and negligible solubility, have restricted its successful translation in a clinical setting. However, the nano-micelle delivery system is a highly reproducible method which capable of improving poor-water solubility and bioavailability of free-SL. Mesenchymal stem cells (MSCs) are multipotent cells proficient in tissue renewal and regeneration. MSCs have similar properties to SL including immunomodulatory, antioxidant, and neuroprotective effects. Here, we show that nano-SL (1 and 2.5) increased AD-MSCs proliferation and protected from apoptosis. Our findings indicated that the levels of anti-inflammatory agents including IL-10, IL-4, FOXp3 and TGF-B mRNA expression were significantly upregulated in nano-SL-treated MSCs along with downregulated mRNA expression of pro-inflammatory cytokines (IL-6, IL-17). We identified that nano-SL elevated the T-regulatory (Treg) population (1 and 2.5 µM) and superoxide dismutase activity (2.5 µM) while decreasing nitrite oxide content. Conclusively, combinatorial therapy by nano-SL and MSCs may be useful for MS patients who are receiving MSCs for treatment

A Course on "Health Management in Crises" for Medical Students: A Delphi Study

Background: General physicians play a significant role in the health management of crises. In order to enhance the knowledge and skills of medical students on how to address health-related issues in crises and to promote their ability to manage and deal with such crises after graduation, appropriate training is necessary. Methods: Applying the Delphi method, 103 experts with field experience in health management and crises were invited to participate in the study. The Delphi study provided aggregation of the opinions and extracted the topics. Conventional content analysis was used to make sense of qualitative data gathered during the study. Results: Among the feedback (n = 66) obtained in the first round, a primary list was extracted including 27 topics and 97 single items. Nineteen major topics, encompassing 97 items, were finally determined in the subsequent rounds. The participants agreed to teach this course at the beginning the internship period via different methods of instruction. Conclusion: This study indicated that health management in crises is important and must be taught in medicine. This study provided a blueprint and an educational rationale as well as contents and structure of a course on health management in crisis to be delivered in undergraduate medical education

Identification of the Origin and Behaviour of Arsenic in Mine Waste Dumps Using Correlation Analysis: A Case Study Sarcheshmeh Copper Mine

Knowledge of the probable origin and behaviour of arsenic certainly gives valuable insights into the potential for transfer in the environment and of the risks involved in mining sites. Sequential extraction analyses are common experiments often used to study the origin and behaviour of potentially toxic elements. The method, however, presents some deficiencies, including labor-intensive procedure, interferences of phases, being impractical for testing large number of samples in heterogeneous environment as well as inability for determining the individual minerals as source or sink terms for toxic elements. This study attempts to determine the origin and behaviour of arsenic in waste dump using correlation analysis approach. To this end, sixty samples were collected from two waste dumps at the Sarcheshmeh Copper Mine in Kerman Province, Iran. The statistical results along with previous experimental investigations and also sequential extraction experiment revealed that adsorption on muscovite is the main source, and that oxy hydroxides of iron and manganese are the main adsorbent minerals which control the concentrations of arsenic in the waste dumps of the Sarcheshmeh copper mine

Application of Pt@ZIF-8 nanocomposite-based electrochemical biosensor for sensitive diagnosis of tau protein in Alzheimer’s disease patients

Abstract Alzheimer’s disease (AD) is a progressive brain disorder characterized by the ongoing decline of brain functions. Studies have revealed the detrimental effects of hyperphosphorylated tau (p-tau) protein fibrils in AD pathogenesis, highlighting the importance of this factor in the early-stage detection of AD conditions. We designed an electrochemical immunosensor for quantitative detection of the cis conformation of the p-tau protein (cis-p-tau) employing platinum nanoparticles (Pt NPs) supported on zeolitic imidazolate frameworks (ZIF) for modifying the glassy carbon electrode (GCE) surface. Under optimum conditions, the immunosensor selectively and sensitively detected cis-p-tau within the broad linear range of 1 fg mL−1 to 10 ng mL−1 and the low limit of detection (LOD) of 1 fg mL−1 with desired reproducibility and stability. Furthermore, the fabricated immunosensor's performance was examined for the cis-p-tau analysis in the serum of AD patients, indicating its accuracy and feasibility for real-sample analysis. Notably, this is the first application of Pt@ZIF-8 nanocomposite in fabricating a valid immunosensor for selective cis-p-tau detection, even in the presence of trans-p-tau. It is worth mentioning that the enzyme-linked immunosorbent assay (ELISA) reference technique is not able to evaluate pico- or femtomolar concentrations of cis-p-tau, making the fabricated immunosensor superior for early-stage measurement and screening of AD

The Relationship between Lung and Heart Two-Dimensional Parameters and Three-Dimensional Dose-Volume Data in Adjuvant Radiotherapy for Breast Cancer

Background: Two-dimensional (2D) radiographic parameters have been used to estimate the amount of heart and lung irradiated for minimizing heart and lung complications in breast cancer patients. The aim of this study was to investigate the correlation between traditionally used 2D radiographic and dose-volume parameters during adjuvant radiotherapy of breast cancer. Methods: In this cross-sectional study, we analyzed 121 female patients treated with breast-conserving surgery (BCS) or modified radical mastectomy (MRM) and 3D conformal radiotherapy (3DCRT) using two-field radiotherapy (2FRT) or three-field radiotherapy (3FRT) technique. All patients underwent computed tomography (CT)-planning. Two-D parameters, including central lung distance (CLD), maximum lung depth (MLD), maximum heart length (MHL), maximum heart distance (MHD), and chest wall separation (CWS), were measured using digitally reconstructed radiographs (DRR) and CT images. DVHs for lung, heart, and target were created. The Pearson correlation test was used to evaluate the correlation between 2D radiographic and dose-volume parameters. Results: There was a correlation between CLD and ipsilateral lung V5-20Gy and Dmean and between MLD and ipsilateral lung V5-20Gy. In 2FRT, only moderate correlation between CLD and ipsilateral lung V20Gy (r = 0.453, P = 0.003) and between MLD and ipsilateral lung V20Gy (r = 0.593, P <0.001) were observed. Poor correlation of MHL and heart V25Gy (r = 0.409, P = 0.007) was seen only in 3FRT. There was a correlation between MHD and heart dose-volume data, with a strong correlation between MHD and heart V5-25Gy and Dmean (r = 0.875-0.934, P<0.001) in the 2FRT group. No correlation between CWS and breast Dmax was found. Conclusion: There was a correlation between 2D parameters (i.e., CLD, MLD, and MHD) and the heart and lung dose-volume parameters during adjuvant breast radiotherapy. Although CLD was correlated to ipsilateral lung V5-20Gy and Dmean, the correlation between CLD and ipsilateral lung V20Gy was greater than other dose-volume parameters. MHD provided a close estimation of heart dose-volume parameters