[HeLa-cell adherence patterns of shiga toxin- producing Escherichia coli [STEC] serotypes isolated from faecal samples]

Shiga toxin-producing Escherichia coli [STEC] has been recognized as an important cause of diarrheal diseases. The ability to colonize the human intestine is an essential part of the infection. To determine the importance of the adherence among non-O157 STEC serotypes isolated from diarrheal and asymptomatic healthy persons, HeLa cell adherence pattern was studied. Polymerase chain reaction-restriction fragment length polymorphism [PCR-RFLP] analysis of the flagellin gene [fliC] was performed in 35 strains of STECO serogroups for determining their flagellar antigen [H] status. The entire coding sequence of fliC was amplified by PCR, the amplicon was restricted with HhaI, and the restriction fragment pattern was examined after gel electrophoresis. The adherence property of 35 Shiga toxin-producing Escherichia coli [STEC] not belonged to O157:H7 serotype was checked on HeLa cell adherence pottern. Three to five individual colonies from each case were assessed. These strains were isolated from patients with bloody, non-bloody diarrhea and healthy cases. Of the 35 STEC colonies, 2 strains [5.7%] were isolated from bloody diarrheal cases, 25 strains [71.5%] from non-bloody diarrheal and 8 strains [22.8%] from healthy persons. None of the strains belonged to O157: H7 serotype but 22 strains belonged to O126 and O128, O26 and O111 serogroups. Out of 27 strains isolated from bloody and non-bloody diarrheal cases 3 strains [11.1%] were non-adherent [NA] and 24 strains [88.9%] were adherent. However, aggregative adherence [AA] was observed in 10 serotypes [O128: H2, O128: H9, O125: H12 and O125: H15] and diffuse adherence [DA] and localized adherence [LA] were exhibited by 1 serotype, respectively. The remaining 12 strains showed non-specific adherence [NSA]. Among adherence patterns, LA and AA were found to be significantly associated with diarrhea [p < 0.001]. Human pathogenicity of E. coli strains belonging to STEC group varied according to serotypes, virulence attribute and adherence patterns. Based on the observation obtained in this study, it can be concluded that STEC strains with adherence property are more virulent than the non-adherence ones and further detail studies on adherence factors and their mechanisms of pathogenesis are needed

Missed injuries in patients with multiple traumas in Shohada hospital

Delayed diagnosis of musculoskeletal injury in multitrauma patients may potentially cause functional or cosmetic sequelae remaining for the rest of survivors life. Identification of factors which hide injuries from early diagnosis in multitrauma patients will decrease their occurrence and prevent many functional disabilities and cosmetic sequelae. We planned this study to assess the reasons for injury concealment in multitrauma patients and provide resolutions to reduce them. This cross-sectional study on 487 patients was carried out in Tabriz Shohada Hospital from February 2004 to February 2005. After collection of needed data, a questionnaire was filled for every multitrauma patient who had a missed injury. The relative frequency of multitrauma was 18.51% among all studied trauma patients [487 cases], but 7.6% of included patients [28 from 367 trauma cases] had missed injury [ies]. 32 missed injuries were found in 28 patients. Most injuries were musculoskeletal, involving the distal part of the limbs [feet, hands, wrists and ankles]. Fracture was the most common type of musculoskeletal injury [19 out of 32 missed injuries]. Causes that lead to concealment of injuries were founded to be inadequate physical and / or, radiographic examinations, commonly after severe penetrating injuries which are mostly due to motorcycle accident. Most of the missed injuries have been ultimately diagnosed upon the patient's complaints in hospital wards, within 1 to 30 days after trauma. We can prevent missing of injuries by complete and accurate physical examination and perfect radiographic evaluation according to the standard protocols. Repetitive serial examinations during admissions and after discharge can reveal missed injuries