Abstract

Background and Objective: Bacterial infections are of the leading causes of morbidity and mortality in ICU patients with underlying immunodeficiency. This study aimed to determine the frequency of microorganisms in patients admitted to the ICU of Panje Azar Hospital in Gorgan.

Material and Methods: This cross-sectional study was conducted on the patients admitted in three wards, each having at least 48, of ICU in Panje Azar Hospital in Gorgan. All microbial cultures requested by patients' physician were recorded.

Results: In ICU positive cultures were 53.9%.  The number was 16 for Staphylococcus coagulase negative,  15 for  Enterococci  , 11 for Yeast, 11 for E.Coli, 9 for Enterobacter  , 8 for streptococcus, 5 for staphylococcus aureus. The highest  percentage was related to coagulase-negative staphylococci (16.5%) and the lowest to Alcaligenes, Diphtheroids, Acremo bacteria , Serratia with one positive case.

Conclusions:  the incidence of bacterial contamination in ICU patients compared to other parts of country is not different significant.  While it is far from world standard, it is essential that many efforts be done to reduce the level of infection.

Keywords: ICU; Microorganisms; Panje Azar Hospital.

ABSTRACT

        Background and Objective: One of the main tasks of clinical microbiology laboratories is to determine antibiotic resistance profiles in common pathogens and ensure the selection of effective antibiotics for certain infections. The aim of this study was to compare the methods of disk diffusion, broth microdilution and modified Hodge test in Escherichia coli isolates from urinary tract infection and diarrhea for susceptibility testing against beta-lactam antibiotics in Kerman, Iran.

        Methods: In this study, 432 E. coli isolates were collected from diarrhea (216 isolates) and urinary tract infection samples (216 isolates). The antibiotic susceptibility testing methods of disk diffusion, broth microdilution and modified Hodge test were performed according to the Clinical and Laboratory Standards Institute guidelines.

      Results: The findings of disk diffusion method showed that resistance to cefotaxime, ceftazidime, aztreonam, cefepime and imipenem was 51.15%, 30.55%, 24.30%, 15.27% and 1.85%, respectively. In the disk diffusion test, 51.15% of the isolates were resistant to at least one antibiotic, all of which were later evaluated by the broth microdilution method. Moreover, 52.94%, 17.19%, 13.12% and 0.90% of the isolates were resistant to cefotaxime, ceftazidime, cefepime and imipenem, respectively. All of the isolates were evaluated for the production of carbapenemase enzyme by the modified Hodge test and none of the isolates were found as positive.

       Conclusion: This study shows that performing carbapenem tests is very challenging, and laboratories are recommended to use secondary and independent antibiotic susceptibility tests such as modified Hodge test to confirm the carbapenem-resistant results.

ABSTRACT

       Background and Objective: Esophageal cancer is the third most common type of cancer in Iran. Studies on water, soil, grains, waste and sediments in Golestan Province have shown that the environmental concentrations of antimony and strontium are increased in areas with high incidence rate for cancer. The carcinogenic effects of strontium have been reported, but carcinogenicity of antimony is still unclear. Since there is not enough information regarding the relationship between the concentration of strontium and antimony and prevalence of esophageal cancer in the province, this study aimed to evaluate serum levels of these elements in patients with esophageal cancer using atomic absorption spectroscopy.

       Methods: This study was performed on 30 patients with esophageal squamous cell carcinoma and 30 healthy matched controls. After sampling, concentrations of strontium and antimony were measured using atomic absorption spectroscopy.

       Results: Half of the esophageal cancer patients and control participants were male. The mean age of patients and controls was 66 ± 13 and 64 ± 8 years, respectively. The mean serum concentration of strontium in patients and controls was 24.18 ± 1.62 and 24.08 ± 1.46 μg/L, respectively. The mean serum concentration of antimony in patients and controls was 18.61 ± 1.48 and 18.98 ± 1.93 μg/L, respectively. No statistically significant difference was observed between the serum concentrations of the two elements in patients and controls.

        Conclusion: There is no difference between serum levels of strontium and antimony in cancer patients and healthy controls, which could be due to tissue accumulation.

          Keywords: Antimony, Strontium, Esophageal Neoplasms.

ABSTRACT

       Background and Objective: This study was conducted to evaluate epidemiology of risk factors for hepatitis C virus (HCV) transmission, and determine the association of its genotypes with viral load and response to treatment in patients referred to the Infectious Disease Clinic of Khorramabad.

        Methods: The study included patients infected with hepatitis C referred to the Infectious Disease Clinic of Khorramabad during 2011-14. Those who met the inclusion criteria were referred to counseling centers for risky behaviors. After collecting demographic and epidemiologic data on the modes of transmission, blood samples were collected for more accurate testing. The erum of patients with hepatitis C was evaluated in terms of HCV genotype and viral load using PCR.

        Results: Among 120 patients studied, 102 (85%) were male and 18 (15%) were female. The most prevalent genotypes were 3a (63.8%), 1a (25%), 1a/1b (5.2%) and 2 (1.7%). Intravenous drug abuse was the main route of transmission of hepatitis C in the study.  The genotypes 3a and 1a had a clear correlation with intravenous drug abuse and history of blood transfusion (P<0.05). It was also found that the patients with genotype 3a show a better initial response to treatment with interferon.

       Conclusion: The study shows that intravenous drug abuse is the main route of transmission, which highlights the need for intervention and education in this group of patients to prevent disease transmission.

         Keywords: Hepatitis C, Genotype, Intravenous Drug Abuse, HIV, Interferon.

ABSTRACT
        Background and Objectives: Biofilm is a population of bacteria growing on a surface and enclosed in an exopolysaccharides matrix, which increases resistance to antimicrobial agents and immune response. Uropathogenic Escherichia coli (UPEC) are biofilm-forming bacteria and the most common cause of urinary tract infections (UTIs). This study evaluated the effect of different concentrations of glucose, NaCl, blood, serum and urine on biofilm formation and antigen 43 (Ag43) gene expression, as a main gene involved in biofilm formation.
        Methods: Among E. coli isolates from patients with UTI, four extended-spectrum beta-lactamase (ESBL) and non-ESBL strains, and a standard UPEC strain were selected. Biofilm formation of the strains in brain heart infusion (BHI) broth with different concentrations of glucose, NaCl, sheep blood, serum and human urine was evaluated using microplate method and crystal violet staining. Ag43 gene expression was investigated using Real-Time polymerase chain reaction, SYBR Green dye, and specific primers.
           Results: Presence of glucose at all concentrations reduced biofilm formation. Presence of 1% NaCl, 1% sheep blood, 10% bovine serum, and 5% urine significantly increased biofilm formation. Expression of Ag43 by the strains grown under 1% glucose, 1% NaCl, 1% sheep blood, 10% bovine serum and 5% urine decreased.
         Conclusion: All environmental factors other than glucose may increase biofilm formation of E. coli at different concentrations. This is not affected by factors such as isolation from inpatient or outpatients and type of strains (ESBL or non-ESBL). Contrary to our expectations, Ag43 expression is independent of environmental factors and decreases even under the most suitable concentrations.
          Keywords: Biofilms, Uropathogenic Escherichia coli, UTI, Antigen 43, Real-Time PCR.

ABSTRACT
       Background and Objective: Toxoplasmosis is a common parasitic infection worldwide. The infection can be caused via consumption of contaminated meat and mother-to-child (congenital) transmission, causing changes in central nervous system tissue, eye irritation and sometimes death. The human form of the disease is often asymptomatic and may be accompanied with general discomfort and swelling of the lymph nodes when associated with chorioretinitis. Acute infection in immunocompromised individuals could lead to mortality. The purpose of this study was to determine the prevalence of anti-Toxoplasma gondii antibodies in serum of patients with multiple sclerosis (MS) referred to the MS Center in city of Ahvaz, southeastern Iran.
        Methods: Blood samples were taken from 100 patients with MS and 100 healthy control participants. After separating the serum, presence of anti-Toxoplasma antibodies (IgG, IgM) was evaluated by enzyme-linked immunosorbent assay.
        Results: Frequency of anti-Toxoplasma IgG was 38% and 21% in the patients and controls, respectively. Toxoplasma IgM antibodies were not detected in any of the study groups. Pearson correlation coefficient showed a significant association between Toxoplasma antibodies and MS.
       Conclusion: Due to high prevalence of toxoplasmosis in MS patients, it is recommended to measure serum titers of the patients regularly, and placed them under antiparasitic therapy when necessary.
      Keywords: Toxoplasma, Multiple sclerosis, MS, Ahvaz.

ABSTRACT
         Background and Objectives: Capparis spinosa has been used in traditional medicine for various applications including treatment of liver disorders and cancer. We studied the effects of this plant on cell proliferation and morphological characteristics of PLC/PRF/5 liver cancer cell line.
        Methods: After preparing ethanolic extract of the plant, the inhibitory effect of the extract was assessed using MTT assay, and morphological changes were assessed by an inverted microscope.
       Results: C. spinosa ethanolic extract exhibited anti-cancer effects in a concentration-dependent manner. Half-maximal inhibitory concentration of the extract was 1051±4.21 mg/mL. Morphological changes including cell shrinkage, reduction of cell volume and nuclear condensation confirmed the inhibitory effect of C. spinosa on PLC/PRF/5 cells.
        Conclusion: According to the results of this study, extract of C. spinosa seems to be suitable for prevention and treatment of liver cancer. Further studies on animal models could verify the efficiency of the extract against cancer cells.

KEYWORDS: Plants, Medicinal, Capparis spinosa, Liver Neoplasms.       

ABSTRACT
         Background and Objectives: Breast cancer is one of the most common cancers among women. Cardiovascular disease is one of the most important complications of breast cancer. The aim of this study was to investigate the effects of six weeks of swimming on malondialdehyde (MDA) and superoxide dismutase (SOD) levels in the heart tissue of mice with breast cancer.
         Method: Breast cancer was induced in 30 female Balb/c mice (6-8 weeks old, weighing 150-200 g) by tumor transplantation. The tumor site was examined every day for the formation or absence of tumor. After becoming familiar with the laboratory environment and swimming pool, the subjects were randomly divided into three equal groups: 1. healthy control, 2. cancer control, and 3. swimming-cancer. The swimming group performed swimming training 60 minutes/day, five days a week, for six weeks. After the intervention, the levels of SOD and MDA in the heart tissue samples were evaluated by enzyme-linked immunosorbent assay. Data were analyzed in SPSS (version 16) using independent t-test at significance of 0.05.
         Results: The results showed that induction of breast cancer was accompanied by a significant increase in MDA and a significant decrease in SOD in the heart tissue of mice. Participation in the six-week swimming significantly reversed these effects.
         Conclusion: Swimming could have beneficial effects in improving oxidative factors in breast cancer patients.
         Keywords: Breast Neoplasms, Heart, Malondialdehyde, Superoxide Dismutase, Swimming.

ABSTRACT
          Colorectal cancer remains a leading cause of morbidity and mortality worldwide. Most colorectal cancers begin as a growth of tissue called a polyp, some types of which can change into cancer over the course of several years. Angiogenesis, the formation of new blood vessels, is known to play a key role in the initiation, growth and progression of polyp and colorectal cancer. In this review, we discuss the mechanisms involved in colorectal cancer and polyp angiogenesis.

ABSTRACT
            Background and Objectives: Implementing quality management system (QMS) in medical laboratories improves quality of procedures and enhances the staff’s skill development. It prevents frequent inaccuracies in both clinical and laboratory procedures caused by lack of regulatory compliance, safety precautions and inadequate facilities. The purpose of this study is to evaluate effect of implementing QMS based on essential standards NABH (MLP) and NABL (ISO 15189:2012) in a medical laboratory on quality of services.
            Methods: Important quality indicators such as external quality assurance services (EQAS), rework, turnaround time (TAT) and feedback were monitored for four months, following implementing the QMS standards in a medical laboratory.
            Results: We found that implementation of the QMS program improved the tested indicators of quality. Overall percentage of rework reduced significantly.
Conclusion: Implementation of QMS improves overall quality of laboratory procedures. It significantly reduces laboratory errors and progressively improves quality, efficiency, and outcomes, thus enabling delivery of timely and accurate services for patients.
            Keywords: ISO 15189, Quality Assurance, Quality Improvement, Accreditation, Clinical Chemistry, India.

ABSTRACT
            Background and Objectives: Nowadays, infections with antibiotic-resistant bacteria are among the most important causes of mortality worldwide. This has attracted the attention of researchers to seek suitable alternatives for antibiotics. The venom of many toxic species such as arthropods has antibacterial properties. In this study, we investigated antibacterial effects of crude venom of Latrodectus dahli on Escherichia coli, Staphylococcus aureus, and Bacillus subtilis.
            Methods: Lyophilized crude venom of L. dahli was dissolved in 50 mM Tris-HCl buffer. Protein concentration was determined by the Bradford assay. Then, the bacteria were exposed to different concentrations (31.25-250 ng/mL) of the crude venom. Inhibitory activity of the venom against the bacteria was determined by MTT assay and determining minimum inhibitory concentration (MIC).
            Results: Results of the MTT assay showed that the crude venom significantly inhibited the growth of E. coli (31.25 and 62.5 ng/mL), S. aureus (at 250 ng/mL) and B. subtilis (at 125 and 250 ng/mL). In the MIC experiment, the crude venom significantly inhibited the growth of E. coli (at concentrations of 31.25 and 62.5ng/mL), S. aureus (at concentrations of 31.25-250 ng/mL) and B. subtilis (at concentrations of 31.25-250ng/mL).
            Conclusion: The crude venom of L. dahli and its components showed relatively strong antibacterial effects.
            Keywords: Spider venoms, Black Widow Spider, Antibacterial agent, Drug-resistance.

          Background and Objectives: Staphylococcus aureus is a common cause of nosocomial infections. The ability of S. aureus to form biofilm and acquire antimicrobial resistance has made this organism a major health problem. In this study, we investigate the biofilm-forming ability of S. aureus isolates from clinical samples.
          Methods: Sixty S. aureus isolates from clinical specimens were collected from the 5th Azar Hospital of Gorgan (Iran) in 2018. The isolates were identified using conventional methods including Gram staining and biochemical tests (catalase and coagulase). Biofilm formation by S. aureus isolates was evaluated using a microplate-based method.
          Results: Of 60 S. aureus isolates, 47 (78.3%) strains were identified as biofilm-forming and 13 (21.7%) strains were non-biofilm-forming.
          Conclusion: The high prevalence of biofilm-producing S. aureus isolates in the 5^th Azar hospital of Gorgan could pose a major health challenge with serious consequences for hospitalized patients. Therefore, it is crucial to disinfect and sterilize hospital surfaces and equipment effectively to minimize the risk of contamination and spread of bacteria in the hospital settings.
          Keywords: Biofilms, Staphylococcus aureus, sample.

ABSTRACT
             Background and objectives: Matrix metalloproteinase-13 (MMP-13) and activin receptor-like kinase 5 (ALK5) are considered as important factors contributing to knee osteoarthritis (OA) pathogenesis. Here, we compared therapeutic effects of mesenchymal stem cells (MSCs), ozone and exercise training alone and combined on expression of MMP-13 and ALK5 in rats with knee OA.
            Methods: Knee OA was induced by a surgical method. Rats with OA were then randomly divided into several groups, including model, MSCs, ozone, exercise, MSCs + ozone, MSCs + exercise, ozone + exercise and MSCs + ozone + exercise groups. Expression of MMP-13 and ALK5 genes was evaluated using RT-PCR. Data were analyzed using SPSS software at significance of 0.05. 
            Results: Expression of MMP-13 and ALK5 differed significantly between the study groups (P<0.0001). Knee OA was significantly associated with overexpression of MMP-13 and ALK5 in the cartilage tissue of rats with knee OA. Combined therapy with MSCs, ozone and exercise significantly decreased the expression of MMP-13 and ALK5 in the cartilage of rats with OA (P<0.001). Although MSCs, ozone and exercise training were effective to mitigate expression of MMP-13 and ALK5 genes, ozone therapy was more effective compared to the other two therapies.
            Conclusion: Although ozone, MSCs and exercise training alone could decrease the expression of MMP-13 and ALK5 genes, combined therapy with MSC, ozone and exercise is more effective.  
            Keywords: Osteoarthritis, O3, MSCs, exercise, MMP-13, ALK5.