Molecular Epidemiology of OXA-48 and NDM-1 Producing Enterobacterales Species at a University Hospital in Tehran, Iran, Between 2015 and 2016

Carbapenem-resistant Enterobacterales (CRE) is an increasing problem worldwide. Here, we examined the clonal relatedness of 71 non-repetitive CRE isolates collected in a university hospital in Tehran, Iran, between February 2015 and March 2016. Pulsed-field gel electrophoresis (PFGE) and MLST were used for epidemiological analysis. Screening for antibiotic resistance genes, PCR-based replicon typing, conjugation experiments, and optical DNA mapping were also performed. Among all 71 isolates, 47 isolates of Klebsiella pneumoniae (66.2%), eight Escherichia coli (11.2%), five Serratia marcescens (7%), and two Enterobacter cloacae (2.8%) harbored blaNDM–1 and blaOXA–48 genes together or alone. PFGE analysis revealed that most of the OXA-48- and NDM-1-producing K. pneumoniae and all of OXA-48-producing S. marcescens were clonally related, while all eight E. coli and two E. cloacae isolates were clonally unrelated. The predominant clones of carbapenemase-producing K. pneumoniae associated with outbreaks within the hospital were ST147 (n = 13) and ST893 (n = 10). Plasmids carrying blaNDM–1 and blaOXA–48 were successfully transferred to an E. coli K12-recipient strain. The blaOXA–48 gene was located on an IncL/M conjugative plasmid, while the blaNDM–1 gene was located on both IncFII ∼86-kb to ∼140-kb and IncA/C conjugative plasmids. Our findings provide novel epidemiologic data on carbapenemase-producing Enterobacterales (CPE) in Iran and highlight the importance of horizontal gene transfer in the dissemination of blaNDM–1 and blaOXA–48 genes. The occurrence and transmission of distinct K. pneumoniae clones call for improved infection control to prevent further spread of these pathogens in Iran

Molecular characterization of carbapenem-resistant acinetobacter baumannii isolated from pediatric burns patients in an Iranian hospital

Purpose: To survey the molecular characteristics of imipenem-resistant Acinetobacter baumannii obtained from pediatric burns patients in a teaching hospital in Tehran, Iran. Methods: Over a 10-month period, 73 non-duplicate A. baumannii strains were collected from pediatric burns patients admitted to Motahari Burn and Reconstruction Center, Tehran, Iran. The resistance profile of several antimicrobials was determined. Metallo-β-lactamase (MBL)-producing isolates were identified using double-disk synergy and an MBL E-test. Polymerase chain reaction (PCR) was carried out to detect the following β-lactamase-encoding elements: blaVIM, blaIMP, blaSIM, blaSPM, blaGIM, blaNDM, blaAIM, blaDIM, blaKPC, blaOXA-23/24/51, and blaOXA-58. The types of integrons were also identified using PCR. Results: Out of the 73 collected strains, 92.4 and 38.3 of the isolates were multidrug-resistant (MDR) and extensively drug-resistant (XDR), respectively. Colistin was the most effective antibiotic. It was found that 94.5 of the strains were resistant to imipenem, as determined both by disk agar diffusion and MIC E-test methods. Based on double disk synergy and E-test, 78.1 and 83.5 of the isolates, respectively, were MBL producers. The prevalence of blaOXA-23 and blaOXA-24 were 75.4 and 39.1 , respectively. The results also indicate that 62.3, 30.4, and 4.3 of the isolates were positive for blaVIM, blaIMP and blaNDM genes, respectively. Furthermore, 16.4, 76.1, and 7.5 of the isolates carried intI, intII, and intIII genes, respectively. Conclusion: The increased frequency of carbapenem-resistant A. baumannii in burns cases underlines the importance of choosing an appropriate antibacterial regimen based on antibiotic susceptibility profile. Rapid identification of carbapenemase-producing strains would be helpful for selecting suitable antimicrobial therapy and preventing further spread of their encoding genes. © Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin City, 300001 Nigeria

Long-term full-scale intelligent quotient outcomes following pediatric and childhood epilepsy surgery: A systematic review and meta-analysis

OBJECTIVE: Cognitive measures are an important primary outcome of pediatric, adolescents, and childhood epilepsy surgery. The purpose of this systematic review and meta-analysis is to assess whether there are long-term alterations (≥ 5 years) in the Full-Scale Intelligence Quotient (FSIQ) of pediatric patients undergoing epilepsy surgery. METHODS: Electronic databases (EMBASE, MEDLINE, and Scopus) were searched for English articles from inception to October 2022 that examined intelligence outcomes in pediatric epilepsy surgery patients. Inclusion criteria were defined as the patient sample size of ≥ 5, average follow- up of ≥5 years, and surgeries performed on individuals ≤ 18 years old at the time of surgery. Exclusion criteria consisted of palliative surgery, animal studies, and studies not reporting surgical or FSIQ outcomes. Publication bias was assessed using a funnel plot and the Quality in Prognosis Studies (QUIPS) toolset was used for quality appraisal of the selected articles. A random-effects network meta-analysis was performed to compare FSIQ between surgical patients at baseline and follow-up and Mean Difference (MD) was used to calculate the effect size of each study. Point estimates for effects and 95% confidence intervals for moderation analysis were performed on variables putatively associated with the effect size. RESULTS: 21,408 studies were screened for abstract and title. Of these, 797 fit our inclusion and exclusion criteria and proceeded to full-text screening. Overall, seven studies met our requirements and were selected. Quantitative analysis was performed on these studies (N = 330). The mean long-term difference between pre- and post- operative FSIQ scores across all studies was noted at 3.36 [95% CI: (0.14, 6.57), p = 0.04, I2 = 0%] and heterogeneity was low. CONCLUSION: To our knowledge, this is the first meta-analysis to measure the long-term impacts of FSIQ in pediatric and adolescent epilepsy patients. Our overall results in this meta-analysis indicate that while most studies do not show long-term FSIQ deterioration in pediatric patients who underwent epilepsy surgery, there was an increase of 3.36 FSIQ points, however, the observed changes were not clinically significant. Moreover, at the individual patient level analysis, while most children did not show long-term FSIQ deterioration, few had significant decline. These findings indicate the importance of surgery as a viable option for pediatric patients with medically refractory epilepsy

Effect of logging wounds on diameter growth of beech (Fagus orientalis Lipsky) trees following selection cutting in Caspian forests of Iran

Background Logging damage to residual trees during selection cutting may lead to serious economic losses in terms of both timber quality and diameter growth reduction. In this study, we investigated the effect of logging operations on residual tree damage and the consequence of injuries on diameter growth in an uneven-aged mixed forest dominated by beech (Fagus orientalis Lipsky)

Modified Biopolymer Adsorbents for Column Treatment of Sulfate Species in Saline Aquifers

In the present study, variable forms of pelletized chitosan adsorbents were prepared and their sulfate uptake properties in aqueous solution was studied in a fixed-bed column system. Unmodified chitosan pellets (CP), cross-linked chitosan pellets with glutaraldehyde (CL–CP), and calcium-doped forms of these pellets (Ca–CP, Ca–CL–CP) were prepared, where the removal efficiencies and breakthrough curves were studied. Dynamic adsorption experiments were conducted at pH 4.5 and 6.5 with a specific flow rate of 3 mL/min, fixed-bed height of 200 mm, and an initial sulfate concentration of 1000 mg/L. Breakthrough parameters demonstrated that Ca–CP had the best sulfate removal among the adsorbents, where the following adsorption parameters were obtained: breakthrough time (75 min), exhaust time (300 min), maximum sulfate adsorption capacity (qmax; 46.6 mg/g), and sulfate removal (57%) at pH 4.5. Two well-known kinetic adsorption models, Thomas and Yoon-Nelson, were fitted to the experimental kinetic data to characterize the breakthrough curves. The fixed-bed column experimental results were well-fitted by both models and the maximum adsorption capacity (46.9 mg/g) obtained was for the Ca–CP adsorbent. A regeneration study over four adsorption-desorption cycles suggested that Ca–CP is a promising adsorbent for sulfate removal in a fixed-bed column system

A Fixed-Bed Column with an Agro-Waste Biomass Composite for Controlled Separation of Sulfate from Aqueous Media

An agro-waste composite with a pelletized form was prepared and characterized via IR and 13C solids NMR spectroscopy. Thermal gravimetry analysis (TGA) was used to study the weight loss profiles, while SEM images provided insight on the biocomposite morphology, along with characterization of the sulfate adsorption properties under equilibrium and dynamic conditions. The sulfate monolayer adsorption capacity (qe = 23 mg/g) of the prepared agro-waste pellets was estimated from the adsorption isotherm results by employing the Langmuir model, and comparable fitting results were obtained by the Freundlich model. The dynamic adsorption properties were investigated via adsorption studies with a fixed bed column at pH 5.2. The effects of various parameters, including flow rate, bed height and initial concentrations of sulfate, were evaluated to estimate the optimal conditions for the separation of sulfate. The experimental data of the breakthrough curves were analyzed using the Thomas and Yoon–Nelson models, which provided satisfactory best-fits for the fixed bed kinetic adsorption results. The predicted adsorption capacities for all samples according to the Thomas model concur with the experimental values. The optimum conditions reported herein afford the highest dynamic adsorption capacity (30 mg/g) as follows: 1100 mg/L initial sulfate concentration, 30 cm bed height and 5 mL/min flow rate. The breakthrough time was measured to be 550 min. This study contributes to a strategy for controlled separation of sulfate using a sustainable biocomposite material that is suitable for fixed-bed column point-of-use water treatment systems

Amino acid mutation in Plasmodium vivax dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) genes in Hormozgan Province, southern Iran

Molecular analysis of antifolate resistance-associated genes - dihydrofolate reductase (dhfr) and dihydropteroate synthetase (dhps) of Plasmodium vivax is important in predicting the emergence of drug resistance to sulphadoxine-pyrimethamine (SP). The present study aimed to determine the polymorphism of dhfr and dhps genes in P. vivax field isolates. Samples from 80 microscopically diagnosed vivax malaria cases were collected from endemic areas of malaria in Hormozgan Province of Iran, from June 2010 to November 2015. The two sets of codons at position 33, 57, 58, 117, 173 of dhfr and 382, 383, and 553 of dhps genes were analysed by direct sequencing of PCR products. The majority of the isolates (70) harboured a wild-type allele for P. vivax dhfr (Pvdhfr) and P. vivax dhps (Pvdhps). Mutations were detected in three codons of Pvdhfr (P33L, S58R and S117N) and single codon in Pvdhps (A383G). Novel mutations that have not been identified previously at codon 459 (D459A) of Pvdhps were also observed. The high prevalence of point mutation as well as the rising triple mutation of Pvdhfr and Pvdhps genotypes necessitate change in programmes and guidelines to eliminate P. vivax in future. © 2019 Journal of Vector Borne Diseases. All rights reserved

Donor-derived peripheral mononuclear cell DNA is associated with stable kidney allograft function: A randomized controlled trial

A large body of literature has documented an inconsistent relationship of peripheral donor cell chimerism with alloimmune tolerance following kidney transplantation. We revisit this association with assays capable of quantifying cellular microchimerism with 150–1500-fold greater sensitivity than previously utilized allo-antibody based flow cytometric approaches. Forty renal transplant patients, 20 with concurrent donor bone marrow infusion (DBMI) and 20 control participants without infusion were prospectively monitored for peripheral blood microchimerism using donor polymorphism-specific quantitative real-time PCR. Thirty-eight patients were evaluated for microchimerism, 19 in each group. The frequency of testing positive for (95% vs. 58%, p = 0.02) and mean concentrations of microchimerism (115 ± 66 vs. 13 ± 3 donor genomes/million recipient genomes, p = 0.007), respectively, were higher in infused patients compared with controls. Thirty-one patients maintained stable graft function; 17 in the DBMI group vs. 14 in controls. Patients with stable graft function in the DBMI group compared with control patients harbored microchimerism more frequently (94 vs. 50%, p = 0.01) and at higher concentrations (123 ± 67 vs. 11 ± 4, p = 0.007), respectively. Significant correlation between dose of infused cells and microchimerism levels was found post-transplant (p = 0.01). Using very sensitive assays, our findings demonstrate associations between the presence and quantity of microchimerism with stable graft function in infused patients