An Assessment of Changes in the Magnesium Level During Gynecological Abdominal Surgeries

Background: Magnesium (Mg) is the fourth most common cation in the human body and the second most intracellular cation after potassium. It has a fundamental role in several vital functions. As this essential ion is not measured in routine chemistry panels, little is known about its alterations during intraoperative time.Aim: The present study was designed to determine the negative eff ects of postoperative hypomagnesemia during and after surgeries.Subject and Methods: This study was a descriptive interventional study involving 74 patients. All patients underwent gynecological abdominal surgeries, and anesthesia protocols were standardized to comprise general and spinal anesthesia. All the patients were aged between 25 and 45 years, with ASA class I and II. Their total serum Mg level was measured 1 h before and 2 h after the surgery. The total serum Mg, calcium, and albumin level were measured by photometric methods. Data were analyzed using SPSS version 16.0 (Chicago Illinois, (USA). Inferential statistic was done using Vilksonnon-parametric and Pearson’s correlation test. P<0.05 were considered as significant.Results: The mean serum Mg levels were 1.87 (0.32) mg/dl before and 1.55 (0.34) mg/dl after the surgeries (The normal range: = 1.7-2.5 mg/dl). Results illustrated a significant hypomagnesemia after operations. Conclusion: Clinical impact of hypomagnesemia during surgeries needs to be studied further. Moreover, surgeons should be warned about the severity of probable electrolyte imbalances induced by perioperative events to decrease associated morbidities. Keywords: ASA, cation, gynecologic surgeries, magnesium, magnesium level, photometric method, standardized anesthesia, surgerie

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

Genetically Determined Platelet Count and Risk of Cardiovascular Disease.

Objective- Cardiovascular disease, including coronary artery disease (CAD) and ischemic stroke, is the leading cause of death worldwide. This Mendelian randomization study uses genetic variants as instruments to investigate whether there is a causal effect of genetically determined platelet count on CAD and ischemic stroke risk. Approach and Results- A genome-wide association study of 166 066 subjects was used to identify instruments and genetic association estimates for platelet count. Genetic association estimates for CAD and ischemic stroke were obtained from genome-wide association studies, including 60 801 CAD cases and 123 504 controls, and 60 341 ischemic stroke cases and 454 450 controls, respectively. The inverse-variance weighted meta-analysis of ratio method Mendelian randomization estimates was the main method used to obtain estimates for the causal effect of genetically determined platelet count on risk of cardiovascular outcomes. We found no significant Mendelian randomization effect of genetically determined platelet count on risk of CAD (odds ratio of CAD per SD unit increase in genetically determined platelet count, 1.01; 95% CI, 0.98-1.04; P=0.60). However, higher genetically determined platelet count was causally associated with an increased risk of ischemic stroke (odds ratio, 1.07; 95% CI, 1.04-1.11; P<1×10-5), including all major ischemic stroke subtypes. Similar results were obtained in sensitivity analyses more robust to the inclusion of pleiotropic genetic variants. Conclusions- This Mendelian randomization study found evidence that higher genetically determined platelet count is causally associated with higher risk of ischemic stroke

Impact damage characteristics of carbon fibre metal laminates : experiments and simulation

In this work, the impact response of carbon fibre metal laminates (FMLs) was experimentally and numerically studied with an improved design of the fibre composite lay-up for optimal mechanical properties and damage resistance. Two different stacking sequences (Carall 3–3/2–0.5 and Carall 5–3/2–0.5) were designed and characterised. Damage at relatively low energy impact energies (≤30 J) was investigated using Ultrasonic C-scanning and X–ray Computed Tomography (X-RCT). A 3D finite element model was developed to simulate the impact induced damage in both metal and composite layers using Abaqus/Explicit. Cohesive zone elements were introduced to capture delamination occurring between carbon fibre/epoxy plies and debonding at the interfaces between aluminium and the composite layers. Carall 5–3/2–0.5 was found to absorb more energy elastically, which indicates better resistance to damage. A good agreement is obtained between the numerically predicted results and experimental measurements in terms of force and absorbed energy during impact where the damage modes such as delamination was well simulated when compared to non-destructive techniques (NDT)

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

Breast imaging technology: Recent advances in imaging endogenous or transferred gene expression utilizing radionuclide technologies in living subjects - applications to breast cancer

A variety of imaging technologies is being investigated as tools for studying gene expression in living subjects. Two technologies that use radiolabeled isotopes are single photon emission computed tomography (SPECT) and positron emission tomography (PET). A relatively high sensitivity, a full quantitative tomographic capability, and the ability to extend small animal imaging assays directly into human applications characterize radionuclide approaches. Various radiolabeled probes (tracers) can be synthesized to target specific molecules present in breast cancer cells. These include antibodies or ligands to target cell surface receptors, substrates for intracellular enzymes, antisense oligodeoxynucleotide probes for targeting mRNA, probes for targeting intracellular receptors, and probes for genes transferred into the cell. We briefly discuss each of these imaging approaches and focus in detail on imaging reporter genes. In a PET reporter gene system for in vivo reporter gene imaging, the protein products of the reporter genes sequester positron emitting reporter probes. PET subsequently measures the PET reporter gene dependent sequestration of the PET reporter probe in living animals. We describe and review reporter gene approaches using the herpes simplex type 1 virus thymidine kinase and the dopamine type 2 receptor genes. Application of the reporter gene approach to animal models for breast cancer is discussed. Prospects for future applications of the transgene imaging technology in human gene therapy are also discussed. Both SPECT and PET provide unique opportunities to study animal models of breast cancer with direct application to human imaging. Continued development of new technology, probes and assays should help in the better understanding of basic breast cancer biology and in the improved management of breast cancer patients

Switching on the Lights for Gene Therapy

Strategies for non-invasive and quantitative imaging of gene expression in vivo have been developed over the past decade. Non-invasive assessment of the dynamics of gene regulation is of interest for the detection of endogenous disease-specific biological alterations (e.g., signal transduction) and for monitoring the induction and regulation of therapeutic genes (e.g., gene therapy). To demonstrate that non-invasive imaging of regulated expression of any type of gene after in vivo transduction by versatile vectors is feasible, we generated regulatable herpes simplex virus type 1 (HSV-1) amplicon vectors carrying hormone (mifepristone) or antibiotic (tetracycline) regulated promoters driving the proportional co-expression of two marker genes. Regulated gene expression was monitored by fluorescence microscopy in culture and by positron emission tomography (PET) or bioluminescence (BLI) in vivo. The induction levels evaluated in glioma models varied depending on the dose of inductor. With fluorescence microscopy and BLI being the tools for assessing gene expression in culture and animal models, and with PET being the technology for possible application in humans, the generated vectors may serve to non-invasively monitor the dynamics of any gene of interest which is proportionally co-expressed with the respective imaging marker gene in research applications aiming towards translation into clinical application

Frequency and severity of myocardial perfusion abnormalities using Tc-99m MIBI SPECT in cardiac syndrome X

BACKGROUND: Cardiac syndrome X is defined by a typical angina pectoris with normal or near normal (stenosis <40%) coronary angiogram with or without electrocardiogram (ECG) change or atypical angina pectoris with normal or near normal coronary angiogram plus a positive none-invasive test (exercise tolerance test or myocardial perfusion scan) with or without ECG change. Studies with myocardial perfusion imaging on this syndrome have indicated some abnormal perfusion scan. We evaluated the role of myocardial perfusion imaging (MPI) and also the severity and extent of perfusion abnormality using Tc-99m MIBI Single Photon Emission Computed Tomography (SPECT) in these patients. METHODS: The study group consisted of 36 patients with cardiac syndrome X. The semiquantitative perfusion analysis was performed using exercise Tc-99m MIBI SPECT. The MPI results were analyzed by the number, location and severity of perfusion defects. RESULTS: Abnormal perfusion defects were detected in 13 (36.10%) cases, while the remaining 23 (63.90%) had normal cardiac imaging. Five of 13 (38.4%) abnormal studies showed multiple perfusion defects. The defects were localized in the apex in 3, apical segments in 4, midventricular segments in 12 and basal segments in 6 cases. Fourteen (56%) of all abnormal segments revealed mild, 7(28%) moderate and 4 (16%) severe reduction of tracer uptake. No fixed defects were identified. The vessel territories were approximately the same in all subjects. The Exercise treadmill test (ETT) was positive in 25(69%) and negative in 11(30%) patients. There was no consistent pattern as related to the extent of MPI defects or exercise test results. CONCLUSION: Our study suggests that multiple perfusion abnormalities with different levels of severity are common in cardiac syndrome X, with more than 30 % of these patients having at least one abnormal perfusion segment. Our findings suggest that in these patients microvascular angina is probably more common than is generally believed