Detection of vim- and ipm-type metallo-beta-lactamases in Pseudomonas aeruginosa clinical isolates

BACKGROUND: Pseudomonas aeruginosa is the most important bacterium isolated from burn wounds, and its resistance to imipenem due to metallo-beta-lactamases is increasing. This study was designed to detect vim1, vim2, ipm1 and ipm2 metallo-beta-lactamases genes between Pseudomonas aeruginosa isolates isolated from Shahid Motahari Burns Hospital, Iran. METHODS: To that end, we isolated 483 nonduplicate consecutive isolates of P. aeruginosa from burn infections; and after biochemical confirmation, we examined the imipenem susceptibility via the Kirby-Bauer method. All the imipenem-resistant and imipenem-intermediate isolates were screened for vim1, vim2, ipm1 and ipm2 genes through the PCR method. RESULTS: From the 483 isolates, 272 (56) and 63 (13) isolates had resistant and intermediate zones in their imipenem antibiogram pattern, respectively. Fifty-four (16.1), 7 (2.1), 22 (6.6), and 11 (3.3) of the resistant and intermediate isolates had vim1, vim2, ipm1 and ipm2 genes in their PCR results, respectively. CONCLUSION: MBL-mediated imipenem resistance in P. aeruginosa is a cause for concern in the treatment of infective burn patients. The rate of imipenem resistance due to MBL was increased dramatically and newer versions of MBL families were detected for the first time. These results suggest that an effective method should be provided to fight MBL production in clinical isolates

Pathogenicity locus determinants and toxinotyping of Clostridioides difficile isolates recovered from Iranian patients

Little is known about the toxin profiles, toxinotypes and variations of toxin Clostridioides difficile C (tcdC) in Iranian C. difficile isolates. A total of 818 stool specimens were obtained from outpatients (n = 45) and hospitalized patients (n = 773) in Tehran, Iran, from 2011 to 2017. The 44 C. difficile isolates were subjected to PCR of toxin C. difficile A (tcdA), toxin C. difficile B (tcdB), tcdA 3�-end deletion, toxinotyping and sequencing of the tcdC gene. Thirty-eight isolates (86.36) were identified as tcdA and tcdB positive, and the remaining six isolates (13.63) were nontoxigenic. All tcdA- and tcdB-positive isolates yielded an amplicon of 2535 bp by PCR for the tcdA 3� end. Fourteen (36.84), seventeen (44.73) and seven (18.43) isolates belonged to wild-type, toxin C. difficile C subclone3 (tcdC-sc3) and tcdC-A genotype of tcdC, respectively. Thirty-one isolates (81.57) belonged to toxinotype 0, and seven isolates (18.42) were classified as toxinotype V. This study provides evidence for the circulation of historical and hypervirulent isolates in the healthcare and community settings. Furthermore, it was also demonstrated that the tcdC-A genotype and toxinotype V are not uncommon among Iranian C. difficile isolates. © 201

Factors Associated with Anxiety in Premature Coronary Artery Disease Patients : THC-PAC Study

Anxiety may negatively affect the course of coronary artery disease (CAD). The aim of this study was to assess which factors are associated with anxiety in young adults with CAD. A cohort of individuals with premature coronary artery disease was formed between 2004-2011, as the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Patients (men 6445-year-old, and women 6455-year-old) were visited between March 2013 and February 2014. All participants were examined, and their demographic, clinical, and laboratory data were collected. Then, all participants filled in the Beck Anxiety Inventory. Logistic regression models were used to identifying factors related to anxiety in both sexes. During the study, 708 patients (mean [SD] age: 45.3 [5.8] y, men:48.2%) were visited. Anxiety was present in 53.0% of participants (66.0% of women and 39.0% of men). The logistic regressions model showed that the associated factors for anxiety in men were opium usage (OR=1.89, 95% CI: 1.09-3.27), positive family history (OR=1.49, 95% CI:0.94-2.35), and creatinine serum level (OR=1.17, 95% CI:1.05-1.303); and in women were major adverse cardiac events (MACE) during follow-up (OR=2.30, 95% CI:1.25-4.23), hypertension (OR=1.71, 95% CI:1.07-2.73) and the duration of CAD (OR=0.99, 95% CI:0.98-1.00). In premature CAD patients, the determinants of anxiety seem to be different in each sex. Opium usage, positive family history of CAD, and creatinine serum levels in men, and MACE, hypertension, and duration of CAD in women appear the relevant factors in this regard

Dermatologic manifestations in end-stage renal disease

End-stage renal disease (ESRD) is a rapidly growing global health problem within the past decades due to increased life expectancy, diabetes mellitus, hypertension, and vascular diseases. Since ESRD is not curable definitively, patients suffering from ESRD have a very low quality of life; therefore, symptomatic management is the cornerstone of medical treatment. Uremia affects almost all body organs, such as skin, through different mechanisms including biochemical, vascular, neurologic, immunologic, hematologic, endocrine, and electrolyte and volume balance disturbances. Some of these conditions are associated with significant morbidity, and patients with ESRD commonly present with a spectrum of dermatologic disorders. Each one has its own unique presentation and treatment approaches. In this review article, we discuss the clinical presentation, pathophysiology, and treatment of the most common skin disorders associated with ESRD. © 2015, Iranian Society of Nephrology. All rights reserved

Iranian Medical Universities in SCIE: Evaluation of address variation

Applying different institutional addresses in the scientific production of a same university has underestimated the scientific production of Iranian universities and consequently lowered their position in the international academic rankings for a long time. The present study evaluated the scientific production of Iranian medical universities according to their institutional addresses registered in the papers indexed by Science Citation Index Expanded (SCIE). By conducting a descriptive research we retrieved total SCIE indexed of top Iranian medical universities and their respective hospitals and research centers from the beginning of 1986 to the end of 2007. Then different variations of the institutional addresses of each university in the author affiliation of papers were assessed. Finally the universities were ranked according to observing a uniformed format for more registered addresses in SCIE. The findings showed unexpected diversity in the institutional affiliation of each university in their SCIE indexed papers. Although "Tehran University of Medical Sciences" showed the most variation in registering institutional addresses but ranked first according to observing unification for more addresses in the SCIE indexed papers comparing to the other universities. The problem of applying different institutional affiliations in the scientific production of the universities should be valued enough by the whole scientific community. Observing a uniformed format in registering institutional addresses of Iranian medical universities would affect their scientific credibility and international ranks through representing their real scientific productivity. © 2010 Akadémiai Kiadó, Budapest, Hungary

Supplementary Material for: Evidence of Interruption of the comM Gene in a Large Series of Clinical Isolates of Multidrug-Resistant Acinetobacter baumannii

<p>Recent studies have recognized the ATPase-encoding <i>comM</i> gene as a hot spot for the integration of <i>Acinetobacter baumannii</i> resistance islands (RIs). Despite the circulation of high numbers of multidrug-resistant <i>A. baumannii </i>(MDR-AB) isolates in Middle East countries, no information is available about the interruption of <i>comM</i> and subsequent transposition into <i>comM</i> in isolates belonging to the global clones (GC) GC1, GC2, or GC3. In this study 401 <i>A. baumannii</i> isolates from hospitals in Tehran, Iran, were included. The resistance profile was determined by disc diffusion against 22 antibiotics. PCR was used to assess the GC type, presence of the <i>comM</i> gene, and the boundary junctions (J1 and J2) of RIs. Most of the MDR-AB isolates (384 of 388; 98%) and more than half of the susceptible <i>A. baumannii </i>isolates (9 of 13; 69%) had interrupted <i>comM</i> gene-carrying integrative elements. Among the isolates tested, 57 belonged to GC1, 86 to GC2, and 8 to GC3. A set of 250 isolates showed distinct patterns of allele-specific PCR for <i>ompA</i>, <i>csuE</i>, and <i>bla</i>_OXA-51-like genes. All but 2 of the GC1 isolates and 2 of the GC2 isolates contained interrupted <i>comM</i> genes. Four <i>A. baumannii</i> isolates harbored intact <i>comM</i>, but were multiply resistant to antibiotics. This study demonstrated that the <i>comM</i> gene is targeted by transposons in Iranian MDR-AB isolates belonging to different GCs. The data also showed that the carriage of interrupted <i>comM</i> is not exclusive to MDR isolates of <i>A. baumannii</i>.</p

Clinical outcomes of percutaneous coronary intervention with drug eluting stents in diabetic patients

Background: Several randomized controlled trials have demonstrated the safety and efficacy of drug eluting stents (DES) in selected groups of patients with less complicated diabetes. We conducted this study to determine how an unselected group of diabetic patients in Iran fare following DES implantation. Methods: Data were collected on 147 consecutive diabetic patients who underwent percutaneous coronary intervention (PCI) with the implantation of at least one DES at the Tehran Heart Center from June 2003 to September 2005. Clinical follow-up was performed by timely scheduled visits at one, four and nine months following DES implantation. Nine months of follow-up was completed for 94.5% of the patients. The primary endpoint was the occurrence of major adverse cardiac events (MACE), which include cardiac death, myocardial infarction and target vessel revascularization (TVR). In-hospital complications were the secondary endpoint.Results: A total of 158 coronary artery lesions were treated with DES in 147 diabetic patients (mean age = 56.4&amp;plusmn;8.92 years, 57.1% were men). During the nine-month follow-up, MACE occurred in 3.4% of patients, with a myocardial infarction rate of 1.4% and TVR rate of 1.4%. Considering one patient who underwent TVR due to acute stent thrombosis following angioplasty (during hospitalization) the total number of TVR reached 3 (2%). Only one patient (0.7%) died of cardiac death, which occurred after the procedure and before discharge. In-hospital complications occurred in six patients (4.1%); five patients suffered from myocardial infarction. Conclusions: PCI with DES seems to be safe and effective in diabetic patients. However, more studies with larger study populations and longer follow-up are required to confirm this issue

Evaluating the effect of intracoronary n-acetylcysteine on platelet activation markers after primary percutaneous coronary intervention in patients with st-elevation myocardial infarction

During percutaneous coronary intervention (PCI), trauma occurs in the arterial endothelium, resulting in platelet activation and aggregation. As platelet aggregation may lead to coronary thrombosis, antiplatelet agents are essential adjunctive therapies in patients undergoing PCI. The aim of this study was to determine the effect of the intracoronary administration of high-dose N-acetylcysteine (NAC) for the evaluation of its antiplatelet effects in human subjects. In this triple-blind trial, 147 patients undergoing primary PCI were enrolled. Finally, 100 patients were randomized to receive high-dose intracoronary NAC (100 mg/kg bolus, followed by 10 mgkg21h21 intracoronary continued intravenously for 12 hours) (n 5 50) or dextrose solution (n 5 50). Platelet activation biomarkers were measured before and 24 hours after the procedure. Secondary end points, comprising all-cause death, reinfarction, and target-vessel revascularization, were assessed at 30 days and 2 years. In comparison with the placebo, NAC could not reduce the level of platelet activation biomarkers within a 24-hour period after its prescription. Major adverse clinical events at 30 days and 2 years were infrequent and not statistically different between the 2 groups. Our results revealed that NAC, compared with the placebo, did not provide an additional clinical benefit as an effective antiplatelet agent after PCI. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

Outcomes of fasciotomy in patients with crush-induced acute kidney injury after Bam earthquake

Introduction. Fasciotomy may increase the morbidity and mortality in patients with crush-induced acute kidney injury (AKI), by creating an open wound, increasing the risk of bleeding, coagulopathy, and potentially fatal sepsis. This study evaluates the outcomes of fasciotomy in these patients after Bam earthquake in Iran. Materials and Methods. We reviewed medical records of victims of Bam earthquake complicated with crush-induced AKI. Demographic, biochemical, and clinical data of patients who underwent fasciotomy were evaluated and compared with other patients with AKI. Results. Fasciotomy was performed for 70 of 200 patients with crush-induced AKI (35.0). There were no significant differences regarding sex, age, time under the rubble, and muscle enzymes level between these patients and those without fasciotomy. They did not experience higher rates of disseminated intravascular coagulopathy, sepsis, adult respiratory distress syndrome, amputation, and dialysis session. Neither did they have a longer hospitalization period or higher death rate. Conclusions. This study showed that fasciotomy did not have any deteriorating effect on morbidity and mortality of patients with crush-induced AKI after Bam earthquake

Characterization of Clostridioides difficile isolates recovered from hospitalized patients and the hospitals environment and air: A multicenter study

In healthcare settings, contamination of environment with toxigenic and hypervirulent Clostridioides difficile strains is a serious concern. Here, we assessed whether patients with C. difficile have a role to play in the dissemination of C. difficile in our settings or other sources are implicated in its circulation. A total of 700 fecal specimens and 1435 environmental samples from surfaces, equipment and air of rooms occupied by patients suspected of C. difficile infection were taken from 4 tertiary hospitals in Tehran, Iran between April 2016 and August 2017. Antibiotic susceptibility testing and detection of resistance genes were performed for the environmental isolates. The clinical and environmental isolates of C. difficile were subjected to Pulsed Field Gel Electrophoresis (PFGE) analysis.Forty three (6.14%) and 2 (0.13%) isolates of C. difficile were recovered from the clinical and environmental samples, respectively. In the clinical settings, 2 patients were suspected of recurrent C. difficile infection. Thirty distinct pulsotypes were found among the C. difficile isolates including 28 singletons and 2 common types. One of the two environmental isolates was isolated from floor in the Medical ward, of pulsotype/ribotype/toxinotype PT10/New ribotype/toxinotype V, harbored cdtA/B and tcdC-A, and resistant to ciprofloxacin. The other one was isolated from air of a room in ICU, assigned to PT11/RT001/toxinotype 0, belonged to tcdC-sc3 genotypes and resistant to metronidazole. The environmental isolates did not generate amplicons in PCR assays targeting vanA and nim genes.This study provided evidence for dissemination of genetically diverse strains of C. difficile in hospitalized patients, presence of C. difficile in hospital air, existence of binary toxin positive/antibiotic-resistant isolate on the floor and intra-hospital dissemination of this pathogen. (C) 2019 Elsevier Ltd. All rights reserved.Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc