Investigation of Carbapenem-Resistant AcinetobacterBaumannii Resistance Rate in Clinical Specimens of Newborns at Imam Khomeini Hospital in Tehran

Background: Carbapenem-resistant Acinetobacter Baumannii (CRAB) hospital infection poses a serious threat to the health of the newborns in neonatal intensive care units (NICU). The present study was conducted to evaluate the prevalence and resistance of hospital infections in the NICU ward at Imam Khomeini hospital in Tehran.Materials and Methods: The blaOXA-51 like gene was investigated with polymerase chain reaction (PCR). Then, sensitivity of isolates to different antibiotics was assessed using disc diffusion method and broth micro dilutions to determine the minimum inhibitory concentrations (MICs). Pulsed field gel electrophoresis (PFGE) was used for typing of randomly collected CRAB infection at different wards of this hospital. Results: A total of 10 CRAB infections were isolatedduringthe6-month study period, and it was found that 100% of them were positive forblaOXA-51-like gene in PCR assay.  All  isolates were resistant to all tested antibiotics, except colistin, polymyxin B, and tigecycline. CRAB isolates had a high MIC values for imipenem, cefotaxim, and amikacin, showing multidrug resistant (MDR) phenotype. According to PFGE analysis,3palsotypes including clone A (7%), clone B (2%), and clone D (1%) were seen in the 10 CRAB isolates. Clone A was a dominant clone and spread in different wards of the hospital, especially in other ICUs and the emergency ward. Moreover, the similarity between the palsotypes showed the ability of transferring CRAB infection from different wards of the hospital to the NICU.Conclusions: Based on the results of this study, CRAB infection, with a high resistance rate, has the ability to enter into important wards such as NICU, and thus it is highly important to control the presence of these isolates in different parts of the hospital

Effects of vitamin D supplementation on the bone specific biomarkers in HIV infected individuals under treatment with efavirenz

BACKGROUND: It was reported that antiretroviral drugs such as efavirenz can increase the catabolism of vitamin D in HIV infected individuals. We have not found any study that evaluated effects of vitamin D supplementation on the bone specific biomarkers in HIV positive patients under treatment with antiretroviral regimen containing efavirenz. FINDINGS: Vitamin D deficiency was detected in 88.4 % of included patients. Baseline osteocalcin, but not collagen telopeptidase, serum levels were lower than normal range in all of these individuals. Both bone biomarkers’ concentrations increased significantly (p < 0.001 for both of them) after supplementation of vitamin D and it was more predominant for osteocalcin. CONCLUSION: In the HIV-infected patients under treatment with efavirenz, vitamin D deficiency is prevalent. After supplementation with single dose of 300,000 IU vitamin D in this population, the activation of osteoblasts and osteoclasts stimulates bone formation and resorption respectively with favorable bone formation without any adverse event. Significant percent of HIV infected individuals are vitamin d deficient that could benefit from vitamin D supplementation

High prevalence of OXA-type carbapenemases among Acinetobacter baumannii strains in a teaching hospital of Tehran

Nosocomial infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has created a public health concern all around the world. In this study, 100 isolates of CRAB from hospitalized patients during 2015–2016 at Imam Khomeini Hospital were investigated to determine the rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains using Kirby–Bauer disk diffusion method. The minimum inhibitory concentrations (MICs) of six antibiotics were determined by broth microdilution method. Multiplex polymerase chain reaction (PCR) was performed to detect blaOXA-51 like and blaOXA-58 like, blaOXA-23 like, and blaOXA-24 like that are encoding resistance to carbapenems. All CRAB isolates were MDR and XDR and 2% of them were pandrug-resistant (PDR), whereas colistin, polymyxin B, and tigecycline were the most effective agents. All isolates were positive for blaOXA-51 like by PCR. The frequency of blaOXA-23 like and blaOXA-24 like was 81% and 22%, respectively. Findings of this study showed that very few therapeutic options remained for the treatment of CRAB infections and blaOXA-23 like is a dominant resistance gene in CRAB at this hospital

Cyproheptadine for Prevention of Neuropsychiatric Adverse Effects of Efavirenz: A Randomized Clinical Trial

Cyproheptadine prevention of the neuropsychiatric adverse effects of an antiretroviral regimen including efavirenz has been evaluated in a randomized clinical trial. Twenty-five patients (16 males and 9 females with mean – SD ages of 36 – 9 years) in a cyproheptadine group, and 26 patients (17 males and 9 females with mean – SD ages of 34 – 7 years) in a control group completed the trial. Sexual contact and injection drug use were the main routs of HIV infection in both groups. The patients’ neuropsychiatric adverse effects were evaluated based on the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation, and Somatization Subscale of Symptom Checklist 90 at baseline and 4 weeks after treatment. Cyproheptadine significantly decreased the scores of Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Positive and Negative Syndrome Scale, Beck Depression Scale, Pittsburgh Sleep Quality Inventory, Positive and Negative Suicide Ideation of the patients after 4 weeks in comparison with control group. All of the scores increased in control group following antiretroviral therapy. Although short duration of the patients’ follow-up was a major limitation of the study, the results of the study showed that cyprohepradine is effective in prevention of depression, anxiety, hallucination, aggressive behaviors, emotional withdrawal, poor rapport, poor impulse control, active social avoidance, suicidal ideation, and improved sleep quality of HIV-positive patients after initiation of antiretroviral therapy including efavirenz

International Consortium on Mammographic Density:methodology and population diversity captured across 22 countries

Mammographic density (MD) is a quantitative trait, measurable in all women, and is among the strongest markers of breast cancer risk. The population-based epidemiology of MD has revealed genetic, lifestyle and societal/environmental determinants, but studies have largely been conducted in women with similar westernized lifestyles living in countries with high breast cancer incidence rates. To benefit from the heterogeneity in risk factors and their combinations worldwide, we created an International Consortium on Mammographic Density (ICMD) to pool individual-level epidemiological and MD data from general population studies worldwide. ICMD aims to characterize determinants of MD more precisely, and to evaluate whether they are consistent across populations worldwide. We included 11755 women, from 27 studies in 22 countries, on whom individual-level risk factor data were pooled and original mammographic images were re-read for ICMD to obtain standardized comparable MD data. In the present article, we present (i) the rationale for this consortium; (ii) characteristics of the studies and women included; and (iii) study methodology to obtain comparable MD data from original re-read films. We also highlight the risk factor heterogeneity captured by such an effort and, thus, the unique insight the pooled study promises to offer through wider exposure ranges, different confounding structures and enhanced power for sub-group analyses

Chronic Bacterial Prostatitis due to Staphylococcus haemolyticus; Case Report

Prostatitis causes up to 25% of male genitourinary complaint. However, due to technical restrictions in sampling, only in 10% of cases pathogens were identified. In this paper, a patient with chronic prostatitis due to Staphylococcus hemolyticus is described. A 48-year-old man was referred with longstanding (approximately for 18 months) complaint of increased genitourinary symptoms and pain in perineum. In evaluation, moderate growth of methicillin-resistant Staphylococcus hemolyticus (MRSH) in post-prostatic massage voided urine and expressed prostatic secretion (EPS) was positive. Culture of urethral urine (urine or voided bladder 1; VB1), midstream urine (VB2) and post-ejaculation urine specimens were negative. Leukocyte count values in EPS and post-prostatic massage voided urine were 14 and 8 per oil immersion field respectively. PCR of urine samples was positive for Ureaplasma urealyticum and confirmed by repeated analysis. Based on the antimicrobial susceptibility results patient was treated with teicoplanin 400 mg intramuscularly every 12 hours for three doses followed by the daily maintenance dose of 400 mg.  In addition, doxycycline 100 mg twice daily was added to cover Ureaplasma urealyticum. Treatment course completed in 6 weeks. Alleviation of patient’s symptoms begun within the first week of treatment and this trend continued until the end of the treatment

Frequncy and etiology of lymphadenopathy in Iranian HIV/AIDS patients

Objective: To estimate and outline the frequency and etiology of lymphadenopathy in HIV/AIDS patients. Methods: This study was conducted on 178 consecutive HIV/AIDS patient files for etiologies (categorized into three sub-groups: definite, probable and possible) and associated factors of local and generalized lymphadenopathy. Results: Seventy-two (40.45%) patients including 63 male patients (87.5%) developed lymphadenopathy. HIV in lymphadenopathy(+) patients was most commonly transmitted intravenously (n=49). Generalized and localized lymphadenopathy respectively occurred in 27 (37.50%) and 45 (62.50%) patients, mainly in the cervical region (28.9% for local and 63% for generalized lymphadenopathy). The most common causes of lymphadenopathy were tuberculosis (n=24, 33.3%) and lymphoma (n=12, 16.6%). The frequency of lymphadenopathy was non-significantly higher in patients with AIDS (CD4 count 200 cell/µL). Conclusions: Lymphadenopathy in HIV/AIDS patients may reflect a serious condition, most likely tuberculosis and lymphoma. Since patients might underestimate lymphadenopathy, physicians would rather list these entities for diagnosis

A large intracardiac hydatid cyst with concomitant cervical and hepatic involvement: A case report

Key Clinical Message Cardiac hydatidosis is a relatively rare complication of echinococcosis. Understanding the atypical manifestations, potential associated risk factors, and epidemiology leads to optimal and timely management. Abstract Cardiac hydatidosis is a relatively rare complication of echinococcosis, with a potentially life‐threatening condition. Here, we reported a large interventricular septal hydatid cyst bulging in the left ventricle accompanied by a huge cervical lamp with recurrent hepatic cysts that underwent cardiac surgery to excise the cyst uneventfully