Comparing the Effects of Active and Passive Intradialytic Pedaling Exercises on Dialysis Efficacy, Electrolytes, Hemoglobin, Hematocrit, Blood Pressure and Health-Related Quality of Life

Background: The effect of exercise during hemodialysis has been a controversial issue, however, there are just few studies about the effect of active exercise during hemodialysis. Objectives: This study aimed to compare the effects of passive and active intradialytic pedaling exercises on dialysis efficacy, electrolytes, hemoglobin, hematocrit, blood pressure and health-related quality of life in hemodialysis patients. Patients and Methods: This quasi-experimental study was conducted on 16 hemodialysis patients in Akhavan hemodialysis center in Kashan from April to November 2013. Active or passive intradialytic pedaling exercise was performed using a Mini-Bike for 30 minutes during the first two hours of the dialysis sessions. The quality of life (QOL) was assessed before and after the intervention. Blood pressure was examined at the beginning and then hourly during the dialysis sessions. Dialysis efficacy, levels of phosphorus, calcium, sodium, potassium and Blood urea nitrogen (BUN) were measured at the end of the intervention. Kolmogorov-Smirnov test, paired t test, Wilcoxon signed rank and Friedman tests and repeated measure analysis of variancewere used to analyze the data. Results: No significant changes were observed in serum potassium, phosphorus and calcium levels at the end of the passive exercise program compared to the baseline. However, phosphorus levels were significantly decreased in the active exercise program (P < 0.05). Moreover, the mean diastolic blood pressure was significantly decreased after the passive exercise (P = 0.039). Passive exercise did not significantly change the dialysis efficacy, urea reduction rate, hemoglobin and calcium levels. The mean overall QOL was 63.78 ± 21.15 at the beginning of the study, which was increased to 77.07 ± 21.14 at the end of eight weeks of the intradialytic exercise (P = 0.007). Conclusions: The passive intradialytic exercise had a positive effect on blood pressure. The active exercise could decrease the serum phosphorus and potassium levels. Moreover, both exercise programs could significantly improve the QOL. Both active and passive intradialytic exercises can have some beneficial effects

High prevalence of extended-spectrum β-lactamase (blaCTX-M-15) and New Delhi metallo-β-lactamase-1 (NDM-1) genes among high-level carbapenem resistance Klebsiella pneumonia: an alarm for our health system

Background: The extended-spectrum β-lactamase (ESBL) carbapenems-resistant Klebsiella isolates are considered one of the most significant challenging in the treatment of patients in hospitals. The aim of this study was to determine the prevalence of important carbapenem resistance genes ESBL subtypes and between K. pneumoniae from patients at hospital in Tehran, Iran.Methods: Fifty-four isolates of K. pneumoniae were isolated from Shariatee Hospital in Tehran from February 2013 to July 2016. Antibiotic testing was done by using the standard disk diffusion method and E-test MIC. The confirmation of carbapenemase activity was performed using an MHT and a new method called the carbapenem inactivation method test (CIM). Finally, a polymerase chain reaction (PCR) and sequencing of related genes was performed.Results: Our PCR data demonstrate that blaCTX-M group’s 40 (81.4%) genes were the most prevalent in our hospital followed by group genes blaCTX-M-3 (18.51%) and blaCTX-M-2 (20.38%). The distribution of the CTX-M group revealed that blaCTX-M-15 23 (42.6%) was the dominant subtype. The coexistence of multiple genes included blaTEM, CTX-M and blaSHV, and CTX-M The presence of blaNDM1, blaOXA-48, and blaKPC were identified in the carbapenem-resistant isolates, 22 (40.7%), 10 (18.5%), and 7 (12.9%) respectively.Conclusion: Our research showed that a CIM test for the first time in Iran is possible and has a high facility for the fast identification of carbapenem-resistant Klebsiella (CRK). We are encountered with the emergence of CTX-M, OXA-48, KPC, and NDM1 harboring CRK strains in our hospitals. Therefore, the treatment of patients infected with these isolates will be an important future concern in our clinical settings.Running Head: Resistance genes among carbapenem-resistant Klebsiella pneumoniaKeywords: New Delhi metallo-beta-lactamase-1, Klebsiella pneumoniae, Carbapenem, Extended-spectrum ß-lactamas

Clinico-epidemiological profile of VRE enterococcus faecium in Shariati hospital in Tehran

Background: Owing to restricted treatment options, Vancomycin-resistant Enterococci (VRE) was considered a prominent cause of nosocomial infections. This study was undertaken to evaluate the presence of Van-type and virulence determinants in the clinical isolates of E. faecium (Ent. faecium) in Shariati Hospital. Materials and Methods: A total of 150 Enterococcal isolates were surveyed. Antimicrobial susceptibility testing was performed by disc diffusion and E-test as well as the genotypic method. The presence of virulence factors, including hyaluronidase (hyl), gelatinase (gelE), aggregation substance (asa1), and Enterococci surface protein (ESP) were identified by Polymerase chain reaction (PCR). Results: Overall, 66.67 percent (80/120) of VRE Ent. faecium strains were confirmed by the PCR method. The maximum number of isolates was from urine specimens (p μg/ml) and carried a VanA phenotype (p < 0.05). In all the isolates, asa1, gelE, and ESP genes were identified in 14 (17/5), 26/3 (21/80), and 45 (36/80), respectively. E. Ent. faecium carried ESP at a significantly higher frequency presented in VRE strains (p < 0.001). The prevalence of hly determinants in the E. faecium was 20 (16) (P < 0.001). Conclusion: We, in our hospital, are faced with a high rate of VRE Ent. faecium isolates with a VanA-positive phenotype. With increasing resistance of the VRE strains to linezolid, we will encounter a serious challenge in treating VRE patients in future years. An interesting finding from the present study is that the spreading rates of ESP and hly among Ent. faecium isolates are higher. © 2019 Online Journal of Health and Allied Sciences

The risk of nosocomial infection with multidrug-resistant corynebacterium urealyticum after prostate cancer surgery

Corynebacterium urealyticum is a Gram-positive, lipophilic, multidrug resistant, and urease positive microorganism with diph-theroid morphology. C. urealyticum causes several diseases such as urinary tract infection, chronic urological disease, urinary tract infections, and bacteremia in immunocompromised individuals. This study reports a rare case with nosocomial infection and hematuria caused by multidrug-resistant C. urealyticum after prostate cancer surgery. © 2019, Archives of Clinical Infectious Diseases

Noninvasive, Transient and Selective Blood-Brain Barrier Opening in Non-Human Primates In Vivo

The blood-brain barrier (BBB) is a specialized vascular system that impedes entry of all large and the vast majority of small molecules including the most potent central nervous system (CNS) disease therapeutic agents from entering from the lumen into the brain parenchyma. Microbubble-enhanced, focused ultrasound (ME-FUS) has been previously shown to disrupt noninvasively, selectively, and transiently the BBB in small animals in vivo. For the first time, the feasibility of transcranial ME-FUS BBB opening in non-human primates is demonstrated with subsequent BBB recovery. Sonications were combined with two different types of microbubbles (customized 4–5 µm and Definity®). 3T MRI was used to confirm the BBB disruption and to assess brain damage

Closed-loop control of product properties in metal forming

Metal forming processes operate in conditions of uncertainty due to parameter variation and imperfect understanding. This uncertainty leads to a degradation of product properties from customer specifications, which can be reduced by the use of closed-loop control. A framework of analysis is presented for understanding closed-loop control in metal forming, allowing an assessment of current and future developments in actuators, sensors and models. This leads to a survey of current and emerging applications across a broad spectrum of metal forming processes, and a discussion of likely developments.Engineering and Physical Sciences Research Council (Grant ID: EP/K018108/1)This is the final version of the article. It first appeared from Elsevier via https://doi.org/10.1016/j.cirp.2016.06.00

Normalized Bernstein polynomials in solving space-time fractional diffusion equation

Abstract In this paper, we solve a time-space fractional diffusion equation. Our methods are based on normalized Bernstein polynomials. For the space domain, we use a set of normalized Bernstein polynomials and for the time domain, which is a semi-infinite domain, we offer an algebraic map to make the rational normalized Bernstein functions. This study uses Galerkin and collocation methods. The integrals in the Galerkin method are established with Chebyshev interpolation. We implemented the proposed methods for some examples that are presented to demonstrate the theoretical results. To confirm the accuracy, error analysis is carried out