High frequency of vancomycin resistant Enterococcus faecalis in children: an alarming concern

Introduction: Enterococcus spp. is considered as important etiological agents of nosocomial infections. However, a little is known about the epidemiology of vancomycin resistant Enterococcus faecalis (VREF). The aim of this study was to investigate the frequency of  VREF and detecting of two prevalent resistance genes (vanA, vanB) in pediatric population in an Iranian referral pediatric Hospital.Material and methods: During January 2013 to December 2013, 180 E. faecalis was isolated from clinical samples of hospitalized children at Children Medical Center Hospital, tertiary care and teaching hospital in Tehran, Iran. Antimicrobial testing was performed by Kirby-Bauer disk diffusion and E-test method according to Clinical Laboratories Standards Institute (CLSI). Two prevalent resistance genes (vanA, vanB) were investigated in VREF isolates.Results: Cephalosporin resistance was found in majority of E. faecalis isolates. There were no linezolid-resistant E. faecalis among all isolates. Teicoplanin resistance was observed in 13.8% of E. faecalis (n=25). MIC ≥32 µg/ml for vancomycin was found in 29 isolates (16%) and vanA gene was detected in 21 (72%) VREF strains, while vanB gene was not detected in any of these isolates. The mortality rate of all cases was 3.4% and 10% of patients with VREF infection died.Conclusion: This study reveals high rate of multidrug-resistant as well as vancomycin resistance in E. faecalis strains. Thus periodic surveillance of antibacterial susceptibilities is recommended to detect emerging resistance.

Detection of Toxoplasma gondii in Acute and Chronic Phases of Infection in Immunocompromised Patients and Pregnant Women with Real-time PCR Assay Using TaqMan Fluorescent Probe

Background: Toxoplasma gondii, cause severe medical complications in infants and immune-compromised individuals. As using early, sensitive and rapid technique has major in diagnosis of toxoplasmosis, the present study was aimed to detect parasite by using from repetitive element (RE) and B1genes, in blood samples of seropositive immunocompromised patients and pregnant women. Methods: A total of 110 peripheral blood samples were collected from seropositive cases with anti-T. gondii antibodies, including immunocompromised patients and pregnant women. DNA was extracted by a commercial kit and subjected to TaqMan probe-based real-time PCR assay by using primers and probes specific for RE and B1 genes, separately. The data were analyzed by Kappa test and SPSS-22 software. Results: In the pregnant women, 17 (68%) and 14 (56%) samples from 25 IgM+/ IgG+ cases and, 7 (25%) and 6 (21.4%) samples from 28 IgG+/IgM- cases were positive by RE and B1 real time PCR, respectively. Likewise, in immunocompromised group, 20 (66.6%) and 17 (56.6%) samples from 30 IgM+/ IgG+ cases and 2 (7.4%) and 2 (7.4%) samples from 27 IgG+/ IgM- cases were positive by RE and B1 real time PCR, respectively. Conclusion: Probe-based real time PCR assay is a quantitative approach for early diagnosis of T. gondii infection in clinical samples. Moreover, this method can be more appropriate in diagnosis of acute and reactivated toxoplasmosis. In addition our results indicated that RE gene is more sensitive than B1 gene

Safety Evaluation of Nano-Liposomal Formulation of Amphotericin B (SinaAmpholeish) in Animal Model as a Candidate for Treatment of Cutaneous Leishmaniasis

Background: Development of a topical treatment for cutaneous leishmaniasis (CL) is an important step in the im­provement of lesion management. Amphotericin B (AmB) is effective against Leishmania species but it is toxic, a Nano-liposomal form of AmB with a size of about 100nm (Lip-AmB) was developed and showed to be effective against Leishmania major, and Leishmania tropica in vitro and against L. major in vivo in animal model. This study was designed to check the irritancy Draize test in rabbits and was completed in the Center for Research and Training in Skin Diseases and Leprosy, TUMS, in 2012. Methods: Twenty rabbits in 3 steps were housed individually with artificial lighting (12/12h light/dark). SinaAm­pholeish cream or empty liposomes (prepared under GMP condition at Minoo Company, Tehran, Iran), was applied on a gauze patch and the patches were placed on the designated sites of the skin in the back of the rabbits. At 48 and 72h later, the erythema and oedema were checked, scored and recorded. Results: The erythema score in rabbits was 0.83+0.41 for the SinaAmpholeish and 0.5+0.55 for empty liposomes (P= 0.16). The average score for oedema was 0.67+0.52 for SinaAmpholeish and 0.33+0.52 for empty liposomes (P= 0.16). Conclusion: Based on skin irritancy reactions the topical formulation of SinaAmpholeish is safe and could be further checked in human trials

Utility of blood as the clinical specimen for the diagnosis of ocular toxoplasmosis using uracil DNA glycosylase-supplemented loop-mediated isothermal amplification and real-time polymerase chain reaction assays based on REP-529 sequence and B1 gene

Background: Ocular infection with Toxoplasma gondii is a major preventable cause of blindness, especially in young people. The aim of the present study was to assess detection rate of T. gondii DNA in blood samples of clinically diagnosed of ocular toxoplasmosis using uracil DNA glycosylase-supplemented loop-mediated isothermal amplification (UDG-LAMP) and real-time quantitative PCR (qPCR) based on REP-529 and B1. Methods: One hundred and seventeen patients with clinically diagnosed ocular toxoplasmosis (OT) were participated in the study as well as 200 control patients. Peripheral blood samples were assessed using UDG-LAMP and qPCR techniques targeting REP-529 and B1. Results: Detection limits of qPCR using REP-529 and B1 were estimated as 0.1 and 1 fg of T. gondii genomic DNA, respectively. The limits of detection for UDG-LAMP using REP-529 and B1 were 1 and 100 fg, respectively. In this study, 18 and 16 patients were positive in qPCR using REP-529 and B1, respectively. Based on the results of UDG-LAMP, 15 and 14 patients were positive using REP-529 and B1, respectively. Results of the study on patients with active ocular lesion showed that sensitivity of REP-529 and BI targets included 64 and 63%, respectively using qPCR. Sensitivity of 62 and 61%, were concluded from UDG-LAMP using REP-529 and B1 in the blood cases of active ocular lesion. qPCR was more sensitive than UDG-LAMP for the detection of Toxoplasma gondii DNA in peripheral blood samples of patients with clinically diagnosed toxoplasmic chorioretinitis. Furthermore, the REP-529 included a better detection rate for the diagnosis of ocular toxoplasmosis in blood samples, compared to that the B1 gene did. Moreover, the qPCR and UDG-LAMP specificity assessments have demonstrated no amplifications of DNAs extracted from other microorganisms based on REP-529 and B1. Conclusions: Data from the current study suggest that qPCR and UDG-LAMP based on the REP-529 are promising diagnostic methods for the diagnosis of ocular toxoplasmosis in blood samples of patients with active chorioretinal lesions

Studies of the Host Response and the Induction of Immunosuppression in Murine Malaria

211 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1983.Various fractions were separated from Plasmodium berghei infected erythrocytes and tested for suppression of the immune response to SRBC. Membranes containing fractions Peak I (C), Peak I (G), and the sodium deoxycholate void volume all act as a vaccine against Plasmodium infection and are all without immunosuppressive activity as assayed by the plaque technique. Immunosuppressive activity was found in association with the sedimented parasite fragments (E), detergent-insoluble components (N), and Sephadex G-200 eluate fractions (H(,1), D(,1)).The daily injection of suppressor factor derived from P. berghei infected erythrocytes was found to suppress the immune response to Plasmodium berghei infection in mice. One, two, or three injections of this factor did not suppress the immune response.Suppressor factor-free partially purified fractions were used in combination with suppressor factor and without suppressor factor to study the effect of suppressor factor during vaccination. One injection of Peak I (G) and sodium deoxycholate void volume sediment without any adjuvant were very effective against P. berghei challenge. Three injections of Peak I, II, III, and IV from the 6 M guanidine column did not have a significant effect on the patency or mortality rate of mice following P. berghei challenge. However, daily injection of Peak III gave significantly more protected animals as compared to the controls.Immunosuppressive activity was observed with unfiltered supernatant from PRBC-stimulated spleen cells and with supernatant of PRBC alone in medium (no spleen cells). Filtration of these two supernatants fluids removed the immunosuppressive activity. The supernatant from unstimulated spleen cells was not immunosuppressive.The effects of PABA, methionine, threonine, and protein dietary levels on the immune system of mice infected with P. berghei were also studied. Methionine had no effect on the parasitemia levels of mice infected with P. berghei. The protein dietary level seems not to be as important to the immune response as is the ratio of supplemental methionine to the threonine.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Diagnostic Value of Spectral Doppler Ultrasound in Detecting Breast Malignancies: An Original Article

Background: The present study was conducted to investigate the diagnostic value of spectral Doppler ultrasound in determining malignant potential of breast masses. Methods: The dedicate dB-mode and Doppler (including color and spectral) breast ultrasound examinations were performed on 100 consecutive women with breast mass (mean age = 45.02 years). The findings were compared between benign (n = 65) and malignant (n = 35) groups, regarding the histopathologic results. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off point for each spectral Doppler index. Results: On B-mode ultrasound, malignant breast masses tended to have bigger size, irregular and ill-defined border, cystic components, and mixed echogenicity (P < 0.001 for all characteristics). On color Doppler study, detectable flow was more common in malignant tumors compared to benign lesions (74.1 vs. 21.9, P < 0.0001). All spectral Doppler indices, including mean peak systolic velocity (PSV), resistive index (RI), and pulsatility index (PI) were significantly higher in malignant tumors. All of these indices had high diagnostic accuracy for differentiating malignant tumors from benign lesions with area under the curve (AUC) equals to 0.79, 0.78, and 0.90 for PSV, RI, and PI, respectively. The optimal cut-off points were PSV = 12.5 cm/s (sensitivity: 75, specificity: 71.4), RI = 0.68 (sensitivity = 85, specificity = 74), and PI = 0.93 (sensitivity = 90, specificity = 85.7). Conclusions: Doppler examination has a significant role in the evaluation of breast masses and adds value to the B-mode ultrasound for distinguishing malignant tumors from benign lesions

A Planning Model for Expansion and Stagnation of Higher Education in Iran

Iran universities of medical sciences have experienced a period of expansion in past decades. Now previous concerns are alleviated, and the former quantity-based policy has given a way to a more quality-seeking attitude. In this study, we developed a planning model for expansion and stagnation of higher education in Iranian universities of medical sciences based on workforce requirements of the country and capabilities of the universities. The plan provided an objectively documented base for the authorities to decide on developmental limits of universities. We devised guidelines for justifying existing programs within universities, assigning new undergraduate and postgraduate programs to universities, voluntary request of universities to cancel a program, and their request to offer new programs for the first time in the country, based on three factors: university educational status, each university-program educational status and the nation's need for each discipline. Related councils of the Ministry of Health and Medical Education legitimately approved the plan and guidelines. In this article, we introduced the methodology of developing the plan, described it and its related guidelines and discussed challenges and limitations we encountered in design and application phases

Periodontal status following orthodontic mini‐screw insertion: A prospective clinical split‐mouth study

Abstract Background Anchorage control is one of the most important determinants of orthodontic treatments. Mini‐screws are used to achieve the desired anchorage. Despite all their advantages, there is a possibility that treatment will not be successful due to conditions related to their interaction with the periodontal tissue. Objective To evaluate the status of the periodontal tissue at the sites adjacent to the orthodontic mini‐implants. Methods A total of 34 teeth (17 case and 17 control) in 17 orthodontic patients requiring a mini‐screw in the buccal area to proceed with their treatment were included in the study. Oral health instruction was provided to the patients prior to the intervention. In addition, scaling and root planing of the root surface were done using manual instruments and ultrasonic instruments if needed. For tooth anchorage, a mini‐screw with Elastic Chain or Coil Spring was used. The following periodontal indices were examined in the mini‐screw receiving tooth and the contralateral tooth: plaque index, pocket probing depth, attached gingiva level (AG), and gingival index. Measurements were made before the placement of the mini‐screws and 1, 2, and 3 months following that. Results The results revealed a significant difference only in the amount of AG between the tooth with mini‐screw and the control tooth (p = 0.028); for other periodontal indices, there were no significant differences between the two groups. Conclusion This study showed that periodontal indices in adjacent teeth of the mini‐screws do not change significantly compared to other teeth and mini‐screws can be used as a suitable anchorage without posing a threat to the periodontal health. Using mini‐screws is a safe intervention for orthodontic treatments

Isolation and molecular characterization of Toxoplasma gondii strains from different hosts in Iran.

Toxoplasma gondii is one of the most prevalent protozoan parasites in Iran. This study was aimed to isolate T. gondii from a variety of hosts and to genetically analyze the parasite isolates. The prevalence of T. gondii in different animal hosts was assessed in two provinces of Iran, Tehran and Mazandaran in the central and northern parts, respectively. The latex agglutination (LA) test was carried out, and antibodies were found in 24 out of 105 sheep, 5 out of 35 goats, 23 out of 45 free-ranging chickens (Gallus domesticus), 2 out of 13 ducks (Anas spp.), and two of four stray cats (Felis domesticus). T. gondii was isolated by bioassay in mice from four sheep, six chickens, one duck, two cats, and three human samples. Genotyping of these 16 isolates was performed using Multiplex PCR for five microsatellite markers and GRA6 gene sequence analysis. The results indicated that the studied isolates consisted of only two genotypes, II and III, with no evidence of type 1 or mixed genotypes