Prevalence of blaCTX-M gene in multi-resistant Escherichia coli isolated from Urinary Tract Infections, Tehran, Iran

Background:The emergence and increase in the incidence of Extended-spectrum beta lactamase (ESBL) producing Escherichia coli has become an emerging challenge especially in hospitalized patients with UTI. The aim of the present study was to survey the frequency of bla CTX-M genotype in ESBL producing E. coli isolated from hospitalized patients with UTI and determination of their antibiotic resistance pattern.Material and methodsA total of 135 E. coli isolates were collected from isolated from patients with UTI. The isolates were subjected to confirmatory phenotype tests for the presence of ESBL. 75 E. coli isolates were confirmed as ESBL-positive by means of the Double disc synergy test. In vitro susceptibility of ESBL isolates to 15 antimicrobial agents amoxicillin, penicillin, ceftazidime, cefotaxime, cefoxitin, ceftriaxone, cefixime, cephalexin, co-trimoxazole, gentamicin, nalidixic acid, ciprofloxacin, nitrofourantoin, amikacin and imipenem was performed by Kirby-Bauer’s Disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI, 2012) guideline. PCR method was used to identify bla CTX-M gene in 75 ESBL positive strains.Results:PCR and sequence analysis showed that 75 (55.5%) isolates produced bla CTX-M genes. In vitro susceptibility of ESBL producing E. coli showed that all of them were resistant to amoxicillin and penicillin and The rates of resistance to the majority of tested antibiotics varied between 61% to 100 %, with the exception of amikacin (14.7%) and imipenem (2.7%). Our results showed that the frequency of bla CTX-M was strikingly high (93.3%).Conclusion:These data confirmed that the frequency of bla CTX-M genes were high among E. coli isolated from patients with UTI. The trend of multidrug-resistant profile has been associated with bla CTX-M gene is alarming. Therefore, it is very important to establish a routine screening of ESBL in clinical isolates to prevent dissemination of resistant isolates in health care settings

Characterization of coagulase-negative staphylococci isolated from hospitalized patients in Tehran, Iran

     Coagulase-negative staphylococci (CNS) are a main cause of nosocomial infection. The main purpose of this study was to determination of frequency of CNS isolates in in hospitalized patients and their susceptibility pattern to antimicrobial agents. During 11 month study, 65 CNS clinical isolates were recovered from hospitalized patients in different wards of hospital. In vitro susceptibility of isolates to 12 antimicrobial agents Penicillin; Ampicilin; Cephalothin; Cefoxitin; linezolid; Nitofurantoin; Erythromycin; Norfloxacin; Gentamicin; Vancomycin; Chloramphenicol and Oxacillin was performed by Kirby-Bauer’s Disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) criteria. Out of 1875 samples of hospitalized patients 65(3.47%) patients were infected with CNS. Twenty one (32.3 %) were isolated from the urine samples, 17(26.1%) from sputum, 15(23.1%) from pus samples, 8(12.3 %) from ear swabs, 3(4.7%) from fluid and 1(1.5%) from blood sample. All of CNS isolates were sensitive to nitrofurantoin. The rates of resistance to the majority of antibiotics tested varied between 4.5% and 100 %. The rate of resistance to beta lactam antibiotics, Chloramphenicol, erythromycin, gentamycin was high (more than 70%). The most of isolates remained susceptible to linezolid, and nitofurantoin. All of isolates were susceptible to vancomycin. Multi-drug resistant CNS with reduced susceptibility to linezolid and nitrofurantoin are emerging pathogens of clinical concern. Monitoring of antibiotic resistance with attention to multi-resistant profile and aware to practitioners in the field is necessary

Safety Outcomes of Intrastromal Injection of Sodium Hypochlorite in the Normal Rabbit Cornea

Purpose: To investigate side effects of intrastromal sodium hypochlorite (NaOCl) injection in normal rabbit corneas and to investigate its possible use in treatment of fungal corneal infections.Methods: We conducted a prospective, non-randomized study in a healthy cornea rabbit model. Intrastromal injection of one hundred µl of NaOCl 5 % in one eye and NaOCl 10 % in the other eye was performed in 5 rabbits. Clinical examinations including the study of conjunctival injection, corneal edema, corneal opacity or melting, and limbal ischemia were performed on days 1, 7, 14 and 21after injection.  Specular microscopy and pathological studies were also performed three weeks after corneal injections in enucleated eyes. Results: NaOCl 5 % injection was associated with normal endothelial morphology and cell count in specular microscopy. Some irregularities and drop out was associated with NaOCl 10 % injection.  Conclusion: Intrastromal injection of NaOCl 5 % could be a safe method to treat fungal corneal infections

Experimental and Computational Study on the Microfluidic Control of Micellar Nanocarrier Properties

Microfluidic-based synthesis is a powerful technique to prepare well-defined homogenous nanoparticles (NPs). However, the mechanisms defining NP properties, especially size evolution in a microchannel, are not fully understood. Herein, microfluidic and bulk syntheses of riboflavin (RF)-targeted poly(lactic-co-glycolic acid)-poly(ethylene glycol) (PLGA-PEG-RF) micelles were evaluated experimentally and computationally. Using molecular dynamics (MD), a conventional "random"model for bulk self-assembly of PLGA-PEG-RF was simulated and a conceptual "interface"mechanism was proposed for the microfluidic self-assembly at an atomic scale. The simulation results were in agreement with the observed experimental outcomes. NPs produced by microfluidics were smaller than those prepared by the bulk method. The computational approach suggested that the size-determining factor in microfluidics is the boundary of solvents in the entrance region of the microchannel, explaining the size difference between the two experimental methods. Therefore, this computational approach can be a powerful tool to gain a deeper understanding and optimize NP synthesis. © 2021 The Authors. Published by American Chemical Society

Early administration of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in patients with acute coronary syndrome: a systematic review and meta-analysis

Abstract Background High-intensity statin therapy is currently recommended initial guideline therapy in ACS treatment. However, only a minority of patients are achieving LDL-C attainment goal at 6 months. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are on recommended guideline therapy post-ACS if LDL-C goal attainment is not achieved after high-intensity statin (4–6 weeks) and after the addition of ezetimibe if guideline goal attainment is not achieved after an additional 4–6 weeks. Thus, it has been recommended that PCSK9 inhibitors be considered earlier post-ACS. However, the efficacy of early PCSK9 inhibitors initiation in ACS patients remains uncertain. Methods This systematic review and meta-analysis was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) and observational studies involving ACS patients who received PCSK9 inhibitors within 48 h of hospitalization were included. Common and random effects models were used to evaluate the pooled effect of early PCSK9 inhibitor administration. Nine RCTs and three cohort studies were included. Results Early PCSK9 inhibitor administration reduced the incidence of MI, ACS hospitalization, and revascularization at 6–18 months post-ACS. Although there was a drift towards reduced stroke, all-cause mortality, and cardiovascular death, no statistically significant reduction was observed. Additionally, PCSK9 inhibitors significantly enhanced lipid control at 4–12 weeks after index hospitalization. Conclusion Early PCSK9 inhibitors initiation in ACS patients reduces MACE and improves lipid profiles. While the results propose promising benefits in terms of stroke and mortality, further research with longer follow-up is required for more decisive evidence