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

The AgriRover : a reinvented mechatronic platform from space robotics for precision farming

This paper presents an investigation of a novel development of a multi-functional mobile platform for agriculture applications. This is achieved through a reinven-tion process of a mechatronic design by spinning off space robotic technologies in terrestrial applications in the AgriRover project. The AgriRover prototype is the first of its kind in exploiting and applying space robotic technologies in precision farming. To optimize energy consumption of the mobile platform, a new dynamic total cost of transport algorithm is proposed and validated. An autonomous navi-gation system has been developed to enable the AgriRover to operate safely in unstructured farming environments. An object recognition algorithm specific to agriculture- has been investigated and implemented. A novel soil sample collect-ing mechanism has been designed and prototyped for on-board and in-situ soil quality measurement. The design of the whole system has benefited from the use of a mechatronic design process known as the Tiv model through which a plane-tary exploration rover is reinvented into the AgriRover for agricultural applica-tions. The AgriRover system has gone through three sets of field trials in the UK and some of these results are reported

Antitumor activity from antigen-specific CD8 T cells generated in vivo from genetically engineered human hematopoietic stem cells

The goal of cancer immunotherapy is the generation of an effective, stable, and self-renewing antitumor T-cell population. One such approach involves the use of high-affinity cancer-specific T-cell receptors in gene-therapy protocols. Here, we present the generation of functional tumor-specific human T cells in vivo from genetically modified human hematopoietic stem cells (hHSC) using a human/mouse chimera model. Transduced hHSC expressing an HLA-A*0201–restricted melanoma-specific T-cell receptor were introduced into humanized mice, resulting in the generation of a sizeable melanoma-specific naïve CD8^+ T-cell population. Following tumor challenge, these transgenic CD8^+ T cells, in the absence of additional manipulation, limited and cleared human melanoma tumors in vivo. Furthermore, the genetically enhanced T cells underwent proper thymic selection, because we did not observe any responses against non–HLA-matched tumors, and no killing of any kind occurred in the absence of a human thymus. Finally, the transduced hHSC established long-term bone marrow engraftment. These studies present a potential therapeutic approach and an important tool to understand better and to optimize the human immune response to melanoma and, potentially, to other types of cancer

Dry Needling for Spine Related Disorders: a Scoping Review

Introduction/Background: The depth and breadth of research on dry needling (DN) has not been evaluated specifically for symptomatic spine related disorders (SRD) from myofascial trigger points (TrP), disc, nerve and articular structures not due to serious pathologies. Current literature appears to support DN for treatment of TrP. Goals of this review include identifying research published on DN treatment for SRD, sites of treatment and outcomes studied. Methods: A scoping review was conducted following Levac et al.’s five part methodological framework to determine the current state of the literature regarding DN for patients with SRD. Results: Initial and secondary search strategies yielded 55 studies in the cervical (C) region (71.43%) and 22 in the thoracolumbar-pelvic (TLP) region (28.57%). Most were randomized controlled trials (60% in C, 45.45% in TLP) and clinical trials (18.18% in C, 22.78% in TLP). The most commonly treated condition was TrP for both the C and TLP regions. In the C region, DN was provided to 23 different muscles, with the trapezius as treatment site in 41.88% of studies. DN was applied to 31 different structures in the TLP region. In the C region, there was one treatment session in 23 studies (41.82%) and 2–6 treatments in 25 (45.45%%). For the TLP region, one DN treatment was provided in 8 of the 22 total studies (36.36%) and 2–6 in 9 (40.9%). The majority of experimental designs had DN as the sole intervention. For both C and TLP regions, visual analogue scale, pressure pain threshold and range of motion were the most common outcomes. Conclusion: For SRD, DN was primarily applied to myofascial structures for pain or TrP diagnoses. Many outcomes were improved regardless of diagnosis or treatment parameters. Most studies applied just one treatment which may not reflect common clinical practice. Further research is warranted to determine optimal treatment duration and frequency. Most studies looked at DN as the sole intervention. It is unclear whether DN alone or in addition to other treatment procedures would provide superior outcomes. Functional outcome tools best suited to tracking the outcomes of DN for SRD should be explored.https://doi.org/10.1186/s12998-020-00310-