Prevalence of non-tuberculous mycobactera isolated from patients referring to tuberculosis center of Kashan University of Medical Sciences

Background and Aim: Nowadays, the importance of pathogenicity of non-tuberculosis mycobacteria is well known. Generally, this group, in addition to the respiratory system can cause lymph nodes, skin, soft tissue and bone disorders. Identification of Mycobacterium by culture and biochemical tests may take several weeks and may not be useful for definitive diagnosis. PCR-RFLP [PRA] technique of the hsp65 gene using Haelll and BstEII enzymes is a precise method for species differentiation, in comparison to phenotypic methods. It is a quick and inexpensive method for detection of mycobacterial species

This study aimed to assess the prevalence of non-tuberculous mycobacteria isolated from the patients referring to tuberculosis center [TB] of Kashan University of Medical Sciences

Material and Method: The study included 106 patients who had been referring to TB Center of Kashan University of Medical Sciences, from 1391 to 1394. The samples were tested by biochemical diagnostic tests. At the same time identification of the strains was made by use of PRA

Amplification of 441-bp fragment was performed by PRA for detection ofhsp65 gene

The PCR products were digested with Haelll and Bstell enzymes and analysis was performed on the basis of electrophoresis

Results: Molecular analysis showed non-tuberculosis mycobacteria in 4[8.3%] sputum samples,i.e. one positive sample [0.9 %] for every one of the following strains: M abscessus, M. senegalense, M.fortuitum and M.kansasii

Conclusion: The results of this study showed that some cases of tuberculosis in Kashan are due to non-tuberculosis mycobacteria. Also use of PRA analysis of hsp65 gene for clinical specimens is a rapid and useful tool for identification of species of mycobacterium which is helpful for early diagnosis, treatment and control of tuberculosis

[Frequency of group B capsular serotypes of Streptococcus using the multiplex PCR among the pregnant women in Kashan during 2011-2013]

Group B Streptococcus [GBS] has been described as an important pathogen in newborns and pregnant women. Maternal vaccination against GBS can reduce maternal GBS colonization and enhance antibody transfer to the fetus and also prevent the subsequent infections. Nine serotypes can be identified based on capsular polysaccharide: Ia, Ib, II-VIII. Due to the changes in serotypes' distribution pattern over time and also variation in different geographic areas, production of a universally optimal vaccine is impossible. This study aimed to evaluate the serotype distribution of GBS using the multiplex PCR among the pregnant women. This study was performed on 382 pregnant women. Vaginal swab samples were placed in the LIM selective medium and incubated at 37°C for 24 h. Then the samples were cultured in blood Agar medium and the GBS was identified and confirmed using the standard tests and gene encoding dlts, respectively. Capsular typing was performed using the multiplex PCR method to identify the Ia, Ib, II-VIII serotypes. Thirty-six [9.4%] out of 382 pregnant women were carriers of GBS. The most common types were III [32.14%], V [21.43%], and IV [14.3%], respectively. Types II and VIII were not identified in this study. Considering the high prevalence of III, V and IV serotypes in this study, they are potential sources for the production of multivalent GBS vaccines in near future

Molecular characterization and antibiotic susceptibility pattern of methicillin-resistant S. aureus [MRSA] in tertiary care hospital, Kashan

Methicillin resistant Staphylococcus aureus [MRSA], which is the most common cause of nosocomial infection, has been a major cause of morbidity and mortality around the world. This study was carried out to find out the resistance pattern and staphylococcal cassette chromosome mec [SCCmec] typing among MRSA. This descriptive work was done on 87 Methicillin resistant Staphylococcus aureus isolates which were collected from the patients with infections in a teaching hospital in Kashan, Iran, during the period of 2009. The isolates were tested for antibiotic resistance by the disc-diffusion method, covering 10 antimicrobials. The genotypes of SCCmec subtypes were determined by multiplex PCR. Amomg 87 MRSA isolated tested; the highest resistance was shown against erythromycin, clindamycin, sulfamethoxazole-trimethoprim, and tetracycline respectively. By contrast, the highest sensitivity was shown to amikacin. All of the isolates were resistant to Beta-lactams. All of the isolates were resistant to at least three classes of antibiotics, and all of the isolates were sensitive to vancomycin. Three [3.4%] MRSA strains were SCCmec type I, 12 [13.8%] were type II, 8 [9.2%] were type IV-b, 4 [4.6%] were type IV-d, and 3 [3.4%] were typeV. Overall, 57 [65.5%] MRSA strains could not be typed. The rising trend of multi-resistance to antibiotics poses an alarming threat to treatment of MRSA infections. Our findings show that clinical isolates of MRSA in our hospital carrying various kinds of staphylococcal cassette chromosome mec [SCCmec] types. SCCmec typse II and IV were the predominant strain of MRSA identified

[Frequency of extended-spectrum beta-lactamase [ESBL] multidrugresistance produced by Pseudomonas aeruginosa isolated from clinical and environmental specimens in Kashan Shahid Beheshti hospital during 2010-11]

Pseudomonas aeruginosa is among the most important nosocomial bacterial infections with innate resistance to many antibiotics. This study was designed to evaluate the frequency of extended-spectrum beta-lactamase [ESBL] multidrug-resistance produced by P. aeruginosa isolated from clinical and environmental specimens in Kashan Shahid Beheshti hospital. This descriptive study was conducted on clinical isolates [n=76] of P. aeruginosa from Kashan Shahid Beheshti hospital during 2010-11. Antibiotic susceptibility testing for eight antimicrobial agents was carried out according to the clinical and laboratory standards institute [CLSI] guidelines and ESBL-producing strains were confirmed using double-disk diffusion test. MDR-isolates were defined as those resistant to three or more classes of antibiotics. Among all P. aeruginosa isolates, the highest resistance was seen for piperacillin, imipenem, cefotaxime, ceftriaxone, gentamicin, ceftazidime, aztreonam and ciprofloxacin, respectively. Seven strains [9.2%] were ESBL-positive. Twenty-seven percent of the isolates were resistant to at least three classes of antibiotics; 8 out of 14 tracheal discharges; 4 out of 9 wound and 2 out of 3 blood samples were MDR. The study emphasizes the high frequency of MDR-P. aeruginosa in clinical and environmental specimens isolated from this hospital. Imipenem resistance in MDR-P.aeruginosa isolates is also high in this study. This calls for strict infection control measures to prevent further microbial spread

Effect of coronary artery bypass graft on qt interval dispersion: a measure of inhomogeneity in ventricular repolarization

The QT interval dispersion [QTd] has been described as the maximum minus minimum QT intervals in simultaneously 12-lead electrocardiographic recording which reflect inhomogeneity in myocardial repolarization. Increased QTd has been illustrated in patients with a variety of cardiac diseases such as myocardial infarction and left ventricular dysfunction and was suggested as a risk factor for development of ventricular arrhythmias and sudden death. QTd may also be a prognostic factor in patients undergoing Coronary Artery Bypass Grafting [CABG]. The purpose of this study was to evaluate the influence of CABG on QTd in patients with coronary artery disease. In this retrospective study we evaluated the effect of CABG on QTd in 79 consecutive patients with coronary artery disease. Measurement of QTd was performed on ECGs taken before and 24 hours after operation. There was no significant QTd changes in post CABG patients compared with baseline QTd [0.06 +/- 0.04 vs. 0.06 +/- 0.03, P=0.18]. In subgroups analysis, decrease in QTd was observed following CABG only in those with two-vessel coronary involvement compared with baseline [0.05 +/- 0.04 SD seconds versus 0.07 +/- 0.02SD seconds, P<0.05]. The present study showed that CABG does not affect QTd except in few patients with two-vessel coronary involvement

Molecular epidemiology of aminoglycosides resistance in Acinetobacter SPP. with emergence of multidrug-resistant strains

Acinetobacter spp. is characterized as an important nosocomial pathogen and increasing antimicrobial resistance. Our aim was to evaluate antimicrobial susceptibility and aminoglycosides resistance genes of Acinetobacter spp. isolated from hospitalized patients. Sixty isolates were identified as Acinetobacter species. The isolates were tested for antibiotic resistance by disc diffusion method for 12 antimicrobials. The presence of aphA6, aacC1 aadA1, and aadB genes were detected using PCR. From the isolated Acinetobacter spp. the highest resistance rate showed against amikacin, tobramycin, and ceftazidim, respectively; while isolated bacteria were more sensitive to ampicillic/subactam. More than 66% of the isolates were resistant to at least three classes of antibiotics, and 27.5% of MDR strains were resistant to all seven tested classes of antimicrobials. The higher MDR rate presented in bacteria isolated from the ICU and blood samples. More than 60% of the MDR bacteria were resistance to amikacin, ceftazidim, ciprofloxacin, piperacillin/tazobactam, doxycycline, tobramycin and levofloxacin. Also, more than 60% of the isolates contained phosphotransferase aphA6, and acetyltransferase genes aacC1, but adenylyltransferase genes aadA1 [41.7%], and aadB [3.3%] were less prominent. 21.7% of the strains contain three aminoglycoside resistance genes [aphA6, aacC1 and aadA1]. The rising trend of resistance to aminoglycosides poses an alarming threat to treatment of such infections. The findings showed that clinical isolates of Acinetobacter spp. in our hospital carrying various kinds of aminoglycoside resistance genes

[Molecular characterization and SCCmec typing in meticillin-resistant staphylococcus aureus isolated from clinical samples]

Methicillin-resistant Staphylococcus aureus [MRSA] is the main cause of hospital infection. The aim of present study was to investigate the molecular characteristics of Staphylococcus aureus [SA], to detect mecA gene, and to type SCCmec in the strains isolated from patients at Kashan Shahid Beheshti Hospital. This descriptive study was carried out on SA isolates [n=150] collected from the clinical samples at Kashan Shahid Beheshti Hospital, Iran during 2009. The identification of all tested isolates were confirmed using Gram's stain, coagulase, DNase and manitol salt agar. In addition, the genotypes of SCCmec in the MRSA isolates were determined by multiplex PCR. Eighty seven [58%] out of 150 SA isolates were confirmed as MRSA harboring mecA gene detected by PCR. Thirty four out of 87 [39.1%] were HA-MRSA and the remainig 53 [60.9%] were CA-MRSA. The multiplex PCR assay for SCCmec complex of MRSA strains [n=87] showed that 3[3.4%] samples were SCCmec type I, 12[13.8%] SCCmec type II, 8[9.2]% SCCmec type IVb, 4[4.6%] SCCmec type IVd and 3[3.4%] SCCmec type V. More than 50% of SA strains were positive for mecA gene and more than 60% of them were CA-MRSA. Moreover, SCCmec type II was the predominant strain of the identified MRSA

[Dimensional accuracy of three polyvinyl siloxane putty-wash impression techniques]

There is much controversy with regard to the effect of the impression technique on accuracy of cast restorations. The aim of this study was to evaluate the accuracy of 3 putty - wash impression techniques using polyvinyl siloxane material. Three putty-wash impression techniques were used for this experimental in vitro study. [1] two-step with 1mm relief [using prefabricated copings for wash space], [2] two-step technique with a polyethylene spacer and [3] one-step. For each-technique, 15 impressions were made of a maxillary edentulous model that contained 4 ITI analogue abutments [one with undercut]. The impressions were made by standard trays with same, space and poured with type IV dental stone. The stone die measurements were made on digital photographs by a computer software. The percentage of dimensional changes of intra abutment [diameter and height] and inter abutment were analyzed by ANOVA, Turkey HSD and t - student tests [a=0.05]. One way analysis of variance showed statistically significant differences among the 3 putty- wash impression techniques, for all measurements[P<0.05]. The dimensional changes of technique 1 were significantly less than another two techniques. There were significant differences between height and diameter of the dies with undercut in techniques 2 and 3 .The diameter of the die was increased in technique 1 and decreased in the other techniques. The height of the dies decreased and the intra abutment spaces increased in all impression techniques. The polyvinyl siloxane 2-step with 1 mm relief putty-wash impression technique was the most accurate for fabricating cast restoration

[ survey on prevalence and risk factors for antibiotic-resistant Staphylococcus aureus isolated from samples in Kashan hospitals]

Methicillin-resistant Staphylococcus Aureus [MRSA] is a serious problem in hospitals. The purpose of this study was to determine the prevalence and related risk factors of methicillin resistance S. aureus isolated from clinical specimens in Kashan hospitals. This descriptive study was carried out on 100 S .aureus strains isolated from patients admitted to Kashan hospitals in 2006- 2007. Strains were inoculated on blood agar containing 5% sheep blood and 7.5% mannitol salt agar media, and were incubated at 35°C for 24 hours. The isolated S. aureus strains were identified using gram staining, catalase test, coagulase tube test, growth on chrome agar and the DNAse test. The antibiotic sensitivity test was determined by disk diffusion method. Variables including age, sex, previous hospitalization, duration of hospitalization, previous antibiotic therapy, and type of the disease, were recorded in questionarres. Data were analyzed statistically by the Chi-square and Fischer's exact tests. Penicillin and Ciprofloxacin revealed the highest and lowest resistance rates respectively [99%, vs 11%]. Meticillin resistance was 22% and an intermediate resistance to Vancomycin was detected in 7% of isolates. A significant correlation was established among the presence of resistant staphylococci with age of more than 46 years old [P<0.040], previous hospitalization [P<0.000], hospitalization for more than 1 week [P<0.000], previous antibiotic therapy [P<0.004], and administration of antibiotics for more than 1 week [P<0.002]. Awareness about the prevalence of antibiotic resistant S. aureus and identification of risk factors for infection with resistant isolates is essential to help clinicians, choosing appropriate antibiotic regimen

[Frequency of beijing genotype in mycobacterium tuberculosis strains isolated from tuberculosis patients in city of Mashhad]

The Beijing genotype is one of the most important strains of Mycobacterium tuberculosis involving outbreaks of tuberculosis in various parts of the world. Unsought regarding Beijing genotype in Iran, is the reason this study is undertaken in order to evaluate the frequency of this genotype in Mashhad. This descriptive study was carried out on 113 M.tuberculosis Specimens isolated from patient with pulmonary tuberculosis in hygienic centers, located at Ghaem and Imam Reza hospitals in the City of Mashhad. In this study, Beijing genotypes were detected with PCR-based method, and spoligotyping. Results were processed with descriptive statistics and CI was evaluated. Beijing genotype was detected in 8 specimens of all the 113 isolated M.tuberculosis strains [7.1%, CI 95%, 2.36-11.84]. Out of 8 isolated specimens, 5 isolates belonged to Afghan patients and 3 specimens were isolated from Iranian patients. Out of 8 patients that were infected with Beijing genotype, 2 patients were male and 6 patients were female. Although the rate of Beijing family is low in Iran, in comparison to other Asian countries, however, one needs to adopt a suitable policy in order to prevent its spread

Bacterial culture of neonatal sepsis

Neonatal bacterial sepsis is one of the major cause of morbidity and mortality in neonates. This retrospective study was performed to determine the incidence of bacterial sepsis with focus on Gram negative organisms in neonates admitted at Beheshti Hospital in Kashan, during a 3-yr period, from September 2002 to September 2005. Blood culture was performed on all neonates with risk factors or signs of suggestive sepsis. Blood samples were cultured using brain heart infusion [BHI] broth according to standard method. From the 1680 neonates 36% had positive blood culture for Pseudomans aerugi-nosa, 20.7% for Coagulase negative Staphylococci, and 17% for Klebsiella spp. Gram-negative organisms accounted for 72.1% of all positive cultures. The overall mortality rate was 19.8% [22/111] of whom 63.6% [14/22] were preterm. Pseudomona aeruginosa and Klebsiella spp. showed a high degree of resistance to commonly used antibiotics [ampicillin, gentamicin] as well as third generation cephalosporins. Continued local surveillance studies are urged to monitor emerging antimicrobial resistance and to guide interventions to minimize its occurrence

Increasing trend of antimicrobial drug-resistance in Pseudomonas aeruguiosa causing septicemia

The emergence of multi-drug resistant strains of Pseudomonas aeruginosa has complicated treatment decision and may lead to treatment failures. In this study, we describe the trends of drug-resistant P. aeruginosa isolated in blood cultures from patients detected in a tertiary teaching hospital and evaluated the prevalence of resistance to amikacin, ampicillin, carbeni- cillin, cefixime, cefotaxime, ceftazidime, ceftizoxime, ceftriaxone, gentamicin, imipenem, and trimethoprim/ sulfameth- oxazole in sixty-nine strains of P. aeruginosa isolated from neonates with septicemia in Kashan, Iran, from April, 2000 to June 2004. In assessment of the current breadth of multi-drug resistance in P. aeruginosa isolated from neonates with septicemia, 4.3% were susceptible to all studied agents, 10.1% were resistant to a single agent. Multi-drug resistance [MDR] isolates accounted for 73.9% of isolates. The majority of MDR isolates [41.2%] were resistant to three antimicrobial agents, which accounted for 30.4% of all isolates. Nineteen MDR isolates from fifty-one [37.3%] were resistant to four agents [19 out of 69; 27.5% of all isolates] and 21.6% to five agents [15.9% of all isolates]. Statistical analysis confirmed that there were no significant differences between multi-drug resistance phenotypes of isolates with age, gender, gestational age, outcome of septicemia, and application of respirator in neonates. Continued local surveillance studies are urged to monitor emerging antimicrobial resistance and to guide interventions to minimize its occurrence

Seroprevalence, of cytomegaovirus, hepatitis C and human immunodeficiency virus antibodies among volunteer blood donors

The transfusion transmitted infections are potentially dangerous complications of transfusion therapy in immunocompromised patients. The aim of this study was to determine the prevalence of transmissible infections in blood donor population in Kashan, Iran. A total of 600 consecutive sera were tested for CMV-IgM antibody, HBsAg, hepatitis B core [HBc] antibody, hepatitis C [HCV] antibody, and HIV antibody with st and ard methods. Of the sera tested, 14 specimens [2.3%] were CMV-IgM positive. The frequency of seropositive revealed no significant differences between male and female donors. The frequency rates of CMV-IgM seropositive tests tend to decline with increasing the age. There was no relation between the frequency rates of CMV-IgM seropositive with the educational level, socioeconomic status, marital status, urban dweller and rural resident patients. The prevalence of HBV, HCV, and HIV antibody was 0.5%, 0.5%, and 0%, respectively. These findings implied important clinical applications because detection of CMV positive sera may reduce the risk for transmission of CMV in blood transfusion and thereby decrease the risk on CMV-induced complications