Vaccine candidates against nontypeable haemophilus influenzae: a review

Nonencapsulated, nontypeable Hemophilus influenzae [NTHi] remains an important cause of acute otitis and respiratory diseases in children and adults. NTHi bacteria are one of the major causes of respiratory tract infections, including acute otitis media, cystic fibrosis, and community-acquired pneumonia among children, especially in developing countries. The bacteria can also cause chronic diseases such as chronic bronchitis and chronic obstructive pulmonary disease in the lower respiratory tract of adults. Such bacteria express several outer membrane proteins, some of which have been studied as candidates for vaccine development. Due to the lack of effective vaccines as well as the spread and prevalence of NTHi worldwide, there is an urgent need to design and develop effective vaccine candidates against these strains

[Dexamethasone phonophoresis in burn hypertrophic scar]

Background: Hypertrophic scars are one of the complications following a burn injury. Intralesional corticosteroid injection is an invasive method for treatment of this complication. We had design a single blinded randomized control trial to deliver dexamethasone by phonophoresis and evaluate its efficacy on hypertrophic burn scars characteristics

Methods: 56 cases of hypertrophic burn scar due to burn injury allocated randomly to dexamethasone and control group. Individuals in case group received 10 sessions of dexamethasone 0.4% phonophoresis. Patients in control group had placebo phonophoresis [ultrasound with normal routine aquatic gel without any dexamethasone] with the same protocol. At the beginning of study and one week after last session, hypertrophic scar characteristics and pruritus were measured by "Vancouver Scar Scale", and "5-D Pruritus Scale" respectively in both groups

Results: Despite mild improvement in Vancouver Scar Scale score one week after intervention in dexamethasone phonophoresis group in comparison to control subjects, but this difference was not significant [p<0/08]. Pruritus score perceived subjectively were significantly lower one week after intervention in dexamethasone groups in comparison to control subjects [p<0/01]

Conclusion: Dexamethasone phonophoresis is a safe and effective treatment method for burn hypertrophic scar pruritus, but its efficacy for scar characteristics improvement needs to be evaluated by larger studies with long-term follow up period

In vitro effects of four porcelain surface treatment methods on adhesion of lactobacilli acidophilus

Objective: Adhesion of Lactobacillus acidophilus [L. acidophilus] to dental porcelain surface may lead to gingival inflammation and secondary caries. Surface roughness is among the factors affecting this adhesion. The purpose of this study was to evaluate the effects of four different surface treatment methods on adhesion of L. acidophilus to dental porcelain

Methods: Sixty specimens [3x10mm] were fabricated of Noritake porcelain and divided into 4 groups [n=15] treated with one of the following four surface finishing techniques: 1. Auto-glazing; 2. Over-glazing; 3. Polishing with Kenda kit and 4. No surface treatment [non-glazed specimens]. Specimens were inoculated with bacterial suspension containing 1x10[6]colony forming units per milliliter [CFU/mL] and L. acidophilus adhesion to the surfaces was evaluated using a spectrophotometer. Data were analyzed using one-way ANOVA and Tukey's HSD test

Results: The mean bacterial adhesion was 0.1440 [0.00429] to auto-glazed specimens, 0.0750 [0.00256] to over-glazed specimens, 0.1800 [0.00325] to polished specimens and 0.7064 [0.00408] to the non-glazed specimens. The differences in this regard among groups were statistically significant [p<0.001]

Conclusion: Over-glazed specimens caused the lowest and non-glazed specimens caused the highest bacterial adhesion. The glazed surfaces caused less adhesion than the polished surfaces

[ results of high tibial open wedge osteotomy in patients with varus deformity]

High tibial open wedg osteotomy is one of the most important modality for treatment of varus deformity in order to correct deformity and improving signs and symptoms of patients with primary degenerative osteoarthritis. The aim of this study was to investigate the results of high tibial open wedge osteotomy in patients with varus deformities. This retrospective study conducted on twenty nine patients [36 knees] undergone proximal tibial osteotomy operation in Shafa Yahyaian University Hospital from2004 to 2010. Inclusion criteria were: age less than 60 years, high physical activity, varus deformity and involvement of medical compartment of knee. Patients with obesity, smoking, patelofemoral pain, lateral compartment lesion, deformity degree more than20 degree, extension limitation and range of motion less than 90 degree were excluded. The clinical and radiologic characteristics were measured before and after operation. Fourteen patients were females. All of them were younger than 50 years, with mean [ +/- SD] 27.64 [ +/- 10.88]. The mean [ +/- SD] of follow up time was 4.33 [ +/- 1.7]. All the patients were satisfied with the results of operation. Tenderness and pain decreased in all of them. In all patients autologus bone graft were used, in15 cases [42.5%] casting and in the rest T. Buttress plate were used for fixation of fractures. In both groups of primary and double varus the International knee documentation committee [IKDC] and modified Larson indices were improved after operation, but there was no significant difference between two groups. High tibial open wedge osteotomy can have satisfying results in clinical signs and symptoms of patients with primary medial joint degenerative osteoarthritis. This procedure also may correct the deformity and improves the radiologic parameters of the patients.

[ prevalence of nosocomial infections caused by Enterobacter cloacae and antibiotic resistant patterns in samples isolated from patients in two hospitals in Tehran]

The increasing use of beta-lactam antibiotics in clinics for the treatment of different bacterial infections since early 1980s has led to increased rates of resistant bacteria isolated from patients. One of the problems in the treatment of nosocomial infections is related to resistant bacteria such as Enterobacter cloacae due to cross resistance through extended-spectrum beta-lactamase production. The aim of this study was to determine the prevalence of extended-spectrum beta-lactamase producing E. cloacae from different clinical specimens collected from hospitalized patients. In the present study, 101 E. cloacae confirmed by standard specific microbiologic tests were collected from different specimens in Milad and Motahri hospitals in Tehran, Iran during February 2010 and September 2011. Antibiotic susceptibility tests were conducted according to the process recommended by the Clinical and Laboratory Standards Institute for 13 antibiotics of choice. Extended-spectrum beta-lactamase producing strains were screened for by combined disk method as a phenotypic diagnostic test. From a total of 101 E. cloacae, 33 [33%] were shown to produce extended-spectrum beta-lactamase by phenotypic tests; 5% of the bacteria were resistant to imipenem too. This study clearly showed the high prevalence of resistance to broad-spectrum beta-lactam antibiotics in the isolated E. cloacae among which 5% were multi drug resistant. All the isolated E. cloacae were susceptible to Colistin. These results can be alarming for physicians treating resistant E. cloacae infections, especially extended-spectrum beta-lactamase producing species

[Congenital dislocation of knee: results of the treatment in 29 cases between 1970 and 2010 years at Shafa Yahyaian Hospital in Tehran]

There are not many reports regarding the treatment approaches of congenital dislocation of the knee in the literature. Therefore, the preferred method of treatment of this rare congenital disease is still controversial. Hereby, we report the treatment outcome of 29 patients admitted in Shafa Yahyaian Hospital during 40 years. In this retrospective study done in Shafa Yahyaian Hospital in Tehran, Iran during 2010, we retrospectively reviewed the medical records of 29 patients treated conservatively or surgically for congenital dislocation of the knee. Patients had been evaluated for an average follow-up of 8.5 years. Overall, 54 knee dislocations had been treated surgically [58%] or conservatively [42%]. Range of knee motion, persistent recurvatum, instability, valgus deformity after treatment and limping were the more important factors reported in the two surgically or conservatively treated groups. Knee function was satisfactory in patients with conservative treatment. Despite 80% of instability in the operated knees, patients could ambulate with or without braces and had a range of motion equal to 80 degrees. Knee function was also good after quadricepsplasty with transarticular pins in selected cases. We recommend a conservative approach to the disease, regardless of the patient's age at the time of treatment and subsequent surgery in patients with dissatisfactory recovery. Quadricepsplasty with transarticular fixation is recommended as a good option in treating these patients. Posterior capsulorrhaphy for patients with CDK and ligamentous laxity is also recommended

[Assessment of clinical and radiologic manifestations of Larsen syndrome]

Larsen syndrome has complex clinical manifestations accompanying different congenital joint dislocations. Therefore, early diagnosis, correct treatment and prevention of complications are essential. This study was performed on 10 cases of Larsen syndrome and their clinical / radiological aspects were assessed. In our review, there were 6 male [cases 1 to 6] and 4 female patients. The youngest and oldest patients at the time of referral were 3 and 51 years old, respectively. An interesting aspect is that hypertelorism and nose widening were detected in all cases. In spine, six patients had Spina bifida, whereas hip dislocation was also detected in eight cases. The significant points were high riding DDH in a 46- year old female patient and bilateral femoral head subluxation in a 51- year old male patient. Knee dislocation was seen in 9 patients. The above two cases had neglected knee dislocation, but acceptable knee function was reported. In upper extremities of eight patients, radial head posterior dislocation was seen. A 5- year old male patient had distal humerus physical deformity. All patients had 2nd metacarpal base deformity [double epiphysis in 2nd metacarpal bone]. Concerning multiple joints involvement in the syndrome, accurate physical examination is essential. Prioritization and staged management of the involvements is recommended.

Qnr prevalence in extended spectrum beta-lactamases [ESBLs] and none-ESBLs producing escherichia coli isolated from urinary tract infections in central of Iran

Extensive use of quinolones has been associated with raising level of resistance, in the current, we focused on assessing the prevalence of Escherichia coli resistance to quinolones and frequency of qnrA, qnrB and qnrS in non ESBLs [extended spectrum beta-lactamases] and ESBLs producing E. coli with blaSHV and blaTEM. One hundred and fifty E. coli isolates were identified during Mar. 2007 to Apr. 2008 in Milad [Tehran] hospital. They were tested for ESBLs production as well as quinolone resistance. PCR was performed for detection of blaSHV and blaTEM as well as qnrA, B and S. Of 150 isolates, forty-two [28%] ESBLs producing and one hundred and eight [72%] non-ESBLs producing E. coli were identified. 64.2% [n= 24] of E. coli producing ESBLs and 4.62% [n= 5] of non-ESBLs E. coli were resistance to ciprofloxacin. 95.2% [n= 40] and 26.1% [n= 11] of the isolates harbored blaTEM and blaSHV, respectively. 23.8% [n= 10] had both genes. 37.5% [n= 9] and 20.8% [n= 4] of ESBLs producing E. coli were positive for qnrA and qnrB respectively. qnrS was not identified in any isolate. Our study showed high frequency of ESBLs producing E. coli as well as quinolone resistance genes [qnrA, qnrB] in Milad hospital

cholera outbreak associated with drinking contaminated well water

Cholera has been a significant public health challenge in many communities. An outbreak of acute diarrheal illness occurred among participants in a wedding ceremony in a village in Qazvin, Iran, in 2008. We conducted an epidemiological, environmental and microbiological investigation to determine the causative agent, source and extent of this outbreak. Clinical and environmental samples were collected and analyzed for the presence of diarrhea-causing bacterial organisms, which included Vibrio cholera. The relationship between the strains was determined using enterobacterial repetitive intergenic consensus poly-merase chain reaction [ERIC-PCR]. The attack rate was 21.8%. Clinical and environmental samples were positive for V. cholerae serotype Inaba. All tested isolates had a similar ERIC-PCR pattern, which indicated that a single clone of V. cholerae was responsible for this outbreak. Our findings demonstrated that well water was the source of this outbreak

Occurrence of class 2 integrons among multi-drug resistant Shigella sonnei isolated from Tehran, Iran in 2005

Shigellosis is one of the major causes of morbidity in children with diarrhea in Iran. Integrons play an important role in the evolution and dissemination of multidrug resistance in gram-negative bacteria. The occurrence of integrons among Shigella spp. is frequently reported throughout the world. The aim of this study was to assess the occurrence of class 2 integrons among the multi drug resistant S. sonnei isolated from Iranian children in 2005. The study was conducted in two major pediatric hospitals in Tehran, Iran. Fecal specimens and rectal swab collected from patients were cultured and identified as Shigella by the conventional methods. Antimicrobial susceptibility test was performed according to the standard CLSI guideline. Multi-drug resistant isolates of S. sonnei were further examined for the presence of class 2 integron by PCR using specific primers. Amplicons were confirmed by restriction endonuclease analysis. A total of 83 multi-drug resistant S. sonnei strains were isolated. Of these, 45 [54%] exhibited a class 2 integron of 2.1 kbp, and 34 [41%] a class 2 integron of 1.3 kbp. Class 2 integrons were not detected in four isolates. The results showed an increased occurrence of class 2 integron carrying S. sonnei isolated from children in Tehran in 2005

Cloning and Expression of N-terminal Region of IpaD from Shigella dysenteriae in E. coli

Genus Shigella is one of the important members of the family Enterobacteriaceae. There are numerous antigens in Shigella carrying by a 220 kb plasmid. Among them, IpaD is the key virulence factor of S. flexneri. Apart from having effectors function that is essential for host cell invasion and intracellular survival, this protein also controls the secretion and translocation of other effector proteins into eukaryotic host cells. In the present study, we have cloned and expressed the ipaD in E. coli. The ipaD gene was amplified by PCR. Prokaryote expression vector pET-28a [+] - ipaD was constructed, and used to transform E. coli BL21DE3 plySs. The expression of recombinant protein induced by IPTG was examined by SDS-PAGE. Western blot were used to determine immunoreactivity of IpaD-His by a rabbit monoclonal antibodies against his-tag. SDS-PAGE demonstrated that the constructed prokaryotic expression efficiently produced IpaD at the 1 mmol/L of IPTG. IpaD protein was able to react with the rabbit monoclonal antibody against His-tag. IpaD is essential for Shigella spp invasion. N-terminal region is most significant functional fragment of IpaD. Purification of IpaD from the wild type of Shigella is difficult furthermore profound study on a specific domain on the N-terminal of IpaD by using the wild type of purified IpaD is not feasible

Fatality due to shigellosis with special reference to molecular analysis vi Shigella sonnet strains isolated from the fatal cases

Shigellosis as a global human health problem is more severe than other forms of gastroenteritis and causes over a million deaths in developing countries worldwide annually. Fatality due to shigellosis is usually due to dehydration and two-third of fatalities are seen among children. The aim of current study was to describe fatal cases of shigellosis due to infection with Shigella sonnei and S.flexneri. We investigated the fatal cases of shigellosis among all children with acute diarrhea admitted to Children's Medical Center, Tehran, Iran. Bacterial isolation and identification was achieved according to standard bacteriological methods. Antibiotic susceptibility tests, plasmid profiling and ribotyping were performed to investigate the clonal relationship among the isolates. Among 1200 children with acute diarrhea, 140 [12.7%] cases had shigellosis. Of these, three patients died. No signs of severe dehydration were observed among the fatal cases. The symptoms were not improved following antibiotic therapy and all three cases died after 24 h of hospitalization despite receiving intensive treatments. Stool cultures yielded S.flexneri and S. sonnei for one and two cases, respectively. The isolates were resistant to streptomycin, ampicillin, and sulfamethoxazole-trimethoprim. 5. sonnei strains were further studied and showed a single pattern of antibiotic susceptibility and ribotyping. Mortality due to species other than 5. dysenteriae is rare, however, in current study we found S. sonnei and S.flexneri as the cause of fatality among pediatric patients during the study

Sensitivity pattern of methicillin resistant and methicillin sensitive Staphylococcus aureus isolates, against several antibiotics including tigecycline in Iran: a hospital based study

Methicillin resistant Staphylococcus aureus [MRSA] is a major nosocomial pathogen causing significant morbidity and mortality. The aim of this study was to evaluate in vitro activity of tigecycline and other new agents against MRSA, isolated from surgical wound and soft tissue infections in an Iranian 1000-bed tertiary hospital. In vitro activity of tigecycline and other antibiotics were tested against 102 strains of Staphylococcus aureus isolated from different patients hospitalized at Milad hospital from May 2008 to June 2008. All strains were identified according to routine bacteriological methods. Susceptibility testing was performed by disk diffusion methods as recommended by Clinical Laboratory Standards Institute [CLSI]. Cefoxitin [30 micri g] disk used for detection of methicillin resistant strains of S.aureus. One hundred two strains of S.aureus were isolated from patients admitted to our hospital. The majority of patients was from surgical wards including open heart, orthopedic ward and had post operation wound infections. Of 102 strains 36[35.3%] isolates were MRSA. All isolates including MRSA strains were susceptible to tigecyline, linozolide and vancmycin. Of 102 isolated strains 96 [94.1%] were susceptible to teicoplanine and six stains [5.9%] were intermediate. Resistant rate to other antibiotics including clindamycinm erythromycin pencillin, co-trimoxazole, rifampicin and ciprofloxacin were 35.3%, 27.7%, 97.7%, 26.5%, 16.7%and 33.7% respectively. All strains of S.aureus, isolated from wound and soft tissue in our hospital were susceptible to tigecyline, linozolide and vancomycin

Carbapenem resistance in gram-negative bacilli isolates in an Iranian 1000-bed tertiary hospital

Carbapenems are beta-lactamase antibiotics, presently considered as most potent agents for treatment of infections caused by Gram-negative bacilli. The aim of this study was to determine resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumonniae as prevalent nosocomial agents to commonly used antibiotics including carbapenems such as imipenem and meropenem. A total of 202 gram-negative bacilli including K. pneumoniae, P aeruginosa and A. baumannii isolated from hospitalized patients in Milad hospital of Tehran were subject for susceptibility testing. Susceptibility testing was performed by disk diffusion and MIC methods as recommended by Clinical Laboratory Standards Institute [CLSI]. All isolates of K. pneumonia were susceptible to imipenem and meropenem. Resistance in non-fermenting gram-negative bacilli [NFGB] was prevalent. P. aeruginosa isolates exhibited 7.5% and 40.2% resistance to imipenem and meropenem respectively. The majority isolates of Acinetobacter baumannii were multi-drug resistant and resistance of this organism to imipenem and meropenem was 27.7% and 38.5% respectively. Our study revealed that in spite of resistance of K. pneumoniae to commonly used antibiotics, all isolates were susceptible to imipenem and meropeem. More than 80% isolates of A. bammanni were resistant to commonly used antibiotics. About 40.2% isolates of P. aeruginosa and [38.5%] isolates of A. baumannii were resistant to meropenem respectively

Value of gastric lavage for diagnosis of pulmonary tuberculosis

To evaluate the sensitivity of gastric lavage specimen for observation of acid fast bacilli and isolation of mycobacterium in patients proved to be suffering from pulmonary tuberculosis. A total number of 886 hospitalized patients in different hospitals of Urmia City were tested for pulmonary tuberculosis. Fifty-three patients were eventually enrolled in the study and one gastric lavage specimen was taken from each patient. Among these fifty three, 44 had positive gastric lavage results and 43 were positive on culture, while both positive results of smear and culture were matched in all patients proved to be suffering from pulmonary tuberculosis. The highest positive rate was in 20 to 49 and 20 to 29 years for the culture and smear respectively but the lowest culture positive rate was in those patients who were in children and those over 60 years of age. Gastric lavage can be a valuable alternative specimen instead of sputum for diagnosis of tuberculosis in children and elderly patients if both smear and culture results are applied

Comparison of different laboratory methods for detection of methicillin resistant staphylococcus aureus

The aim of this study was to compare four different laboratory methods for detection of methicillin resistant Staphylococcus aureus [MRSA]. The clinical specimens including urine, blood, wound and tracheal tube aspirates were processed for isolation of S .aureus. The samples were obtained from patients admitted in Milad hospital in Tehran, Iran. 95 strains of S.aureus were tested with four different methods i.e. disk diffusion, oxacillin screen agar E-test and latex agglutination for methicillin resistantance. Of 95 tested S. aureus; E-test revealed that 51 isolates were MRSA. Oxacillin screen agar showed two false positive MRSA. The sensitivity and specificity of oxacillin screen agar method was 96% and 95% respectively. The MRSA -Screen latex agglutination showed 54[three false positive] MRSA. The sensitivity and specificity for this method was 94% and 93% respectively. Results of susceptibility testing by disk diffusion methods in comparison with other methods were conflicting. Oxacillin screen agar test is a reliable alternative for detection of MRSA in clinical laboratory where MIC detection or molecular methods are not available. Also MRSA latex agglutination kit offers an interesting new approach to early detection of MRSA