[Emergence of novel plasmid-mediated beta-lactamase in klebsiella pneumonia]

Antibiotic resistance is a major threat for human health that affects hospitalized patients worldwide; Hence, The World Health Organization [WHO] has chosen antibacterial resistance as its theme in 2011. Klebsiella pneumoniae is a gram-negative opportunistic pathogen and a common cause of nosocomial infections. These bacteria -especially in infants- are the cause of pneumonia, sepsis, meningitis, diarrhea and bacteremia. Increasing emergence of multidrug resistance [MDR] among Klebsiella pneumoniae nosocomial isolates has limited the appropriate therapeutic options for the treatment of infections caused by this pathogen. Beta-Lactamases are major defenses of gram-negative bacteria against antibiotics. Recently, the emergence of new beta-lactamases such as NDM-1 [New Delhi metallo-beta-lactamase-1], OXA-48 [Oxacillinase-48], OXA-181 [oxacillinase-181], KPC [Klebsiella pneumoniae carbapenemase], CTX-M-15 [Cefotaxime-M-15] confer resistance to the most antibiotics such as penicillins, carbapenems, cephalosporins, macrolides, aminoglycosides and sulfamethoxazole. Resistant genes are located on plasmids with different sizes and can be readily transferred between bacteria, from one human to another human, and even from one country to another. In 2011, it has been evaluated that the importance of some of these genes like NDM-1, KPCs is as AIDS, malaria and tuberculosis. These enzymes have emerged as an important threat for hospitalized patients. Some pathogens containing both KPC and NDM-1 may be mistakenly diagnosed as susceptible by conventional laboratory methods and hence they could have an important role in the emergence and spread of more resistant pathogens due to administration of ineffective drugs to patients. No vaccines have been found yet that prevent infections caused by carbapenemase-producing bacteria. Also, there is not enough information about frequency of these plasmid genes and their genetic profiles in Iran. Therefore, it is important to diagnose the Klebsiella pneumoniae strains producing resistant enzymes, especially NDM-1, for better treatment of patients and prevention of the spread of these genes to other bacteria via exact phenotypic and genotypic methods

Reference intervals for serum immunoglobulins IgG, IgA, IgM and complements C3 and C4 in Iranian healthy children

Determination of reference ranges of each serum protein in normal population of each country is required for studies and clinical interpretation. The aim of this study was defining reference range values of immunoglobulins and complement components in Iranian healthy children. This study was conducted from June 2003 to June 2006 in Immunology, Asthma and Allergy Research Institute, Tehran University of Medical Sciences. Serum levels of IgG, IgM, IgA, C3 and C4 in 800 Iranian healthy children from newborn to 18 years of age in four population were measured by nephelometry. Kolmogrov-Smirnov tests and Pearson correlation tests were used for analysis. Our results mainly agree with previous reports, except for some discrepancy that might be due to the ethnic and geographic variety. There was a significant difference between two sexes only with IgA in the group of 1-3 months old, which was higher in male group and IgM in groups of 3-5, 6-8 and 9-11 years old that were higher in female groups. Mean of other serum immunoglobulins and complements was not significantly different between male and female groups. These results can be considered as a local reference for use in laboratories, clinical interpretations, and research for Iranian children

[Antibacterial effect of methanolic extract of camellia Sinensis L. on Pseudomonas aeruginosa strains producing beta-lactamases]

Pseudomonas aeruginosa is one of the important causes of nosocomial infections. Extended spectrum-beta Lactamases [ESBLs] and Metallo-beta Lactamase [MBL] producing strains have become resistant against a wide range of antibiotics. The aim of this study was to determine the effect of Methanol extract of Camellia Sinensis on Pseudomonas aeruginosa producing ESBL isolated from burnt wounds of patients. This descriptive study was done on burnt wounds of 245 hospitalaized patients in Shafa hospital, Kerman, Iran during 2006-07. ESBLs producing strains were detected by phenotypic confirmatory test and also E-test strips were used for MBL detection. P.aeruginosa MIC was determined for Cefotaxime, Ceftazidime, Azteronam, Imipenem, Meropenem and methanol extracts of plant Camellia Sinensis prepared by Maceration method. 120 of burnt wound infected with P.aeruginosa, out of them 41 isolates contained ESBL while lacked MBL. 60% of isolates were resistant to Cefotaxime, 66% to Ceftazidime, 42% to Azteronam, 3% to Imipenem and 5% to Meropenem. Among the extracts, green Tea had the highest antibacterial effect on standard strains and P.aeruginosa producing ESBLs in 1.25mg/ml concentration. This study showed that methanolic extract of green tea has higher antibacterial effect aginst beta-lactamase P.aeruginosa strains than Cefotaxime and Ceftazidime

[ role of procalcitonin in severity and outcome of patients with sepsis in ICU during treatment]

Nowadays sepsis is one of the major causes of mortality in severely ill patients in ICU. At least part of mortality rate in sepsis is due to fewer number of specific clinical symptoms for prompt diagnosis. Moreover, due to lack of specific marker for detection of this disease, problems occur in differentiation of infectious and non-infectious factors. In recent years, there have been some reports of increase in serum level of procalcitonin in these patients but the correlation between PCT with severity and outcome of disease in patients with sepsis in ICU is not yet known. The aim of this study was to examine the correlation between severity and outcome with procalcitonin [PCT] levels in these patients. This descriptive cross-sectional study was conducted on patients with bacterial infectious diseases in ICU. Sampling was don on day 1 and day 3 and day 7 of admission to ICU. A semi-quantitative PCT-Q test for measurement of procalcitonin was used. After that sepsis severity and outcome of disease were compared with procalcitonin levels. Data were then analyzed by SPSS and the results were compared using Pearson chi-square test. Thirty five patients [22 men and 13 women] had internal criteria for inclusion in this study. Eighteen patients died. There was a direct correlation with severity of disease [p<0.01] but there was not any correlation between high Serum procalcitonin concentrations [>/-10ng/ml] known and mortality. The results of this study indicate that there is a correlation between severity of disease and procalcitonin levels. Therefore, it is recommended that measurement of serum procalcitonin be done to determine the severity and likely outcome of disease in all patients with sepsis admitted to ICU

[Does traumatic uncontrolled blood loss require intensive hydration therapy?]

Hemorrhage in trauma is important and replacement of the blood loss is one of the ways which may reduce the number of mortalities. We decided to study the use of hypersaline serum in comparison with normal saline serum and not prescribing blowing serum in caring animal simulation model of uncontrolled hemorrhagic shock following trauma. The assessment of 3% hyper saline serum application compared with saline normal serum and not prescribing blowing serum in caring animal simulation model of hemorrhagic shock in trauma. The animal lab investigation and the grant of this animal trial was provided by AJA University of medical science. The goats were sedated with Ketamine and Diazepam. The tracheostomy was done on the goat and was ventilated with protable ventilator. Continuous blood pressure and electrocardiogram monitoring was positioned. Animals were cut and blood volume was measured. The bleeding was not being controlled and after 300-350 ml of bleeding, the goats were randomized into 3 groups; those treated with normal saline 20ml/kg [n=10], hypersaline 3% 6ml/kg [n=10] and no fluid resuscitation [n=10]. Data related to the duration of survival, volume of lost blood, blood pressure and metabolic acidosis were gathered and analyzed. Blood volume loss in normal saline group, hypersaline group and no volume resuscitation group was 1139ml, 1551ml, 600ml respectively. The mortality rate significantly increased using hypersaline. Also, blood acidosis increased and hemoglobin decreased significantly while using normal and hypersaline serum vs. no fluid resuscitation. Resuscitation with normal saline or hypersaline can increase blood loss during a hemorrhagic shock and do not improve survival

Establishment of a modified in vitro cultivation of protoscoleces to adult echinococcus granulosus; an important way for new investigations on hydatidosis

Echinococcus granulosus, a zoonotic cestode parasite, causative agent of hydatid cyst is endemic in many parts of the world including the Middle East. Study on different aspects of this parasite is very important and valuable. However, working with adult worms which their habitat situated in the small intestine of canids, is dangerous and risky. Achieving such risky situation needs a controlled condition which is cultivation of the organisms in the laboratory. In this regard, cultivation of E. granulosus protoscoleces leading to adult worms was established in the laboratory for the first time in Iran. Under aseptic conditions a number of protoscoleces were cultivated in diphasic S.10E.H medium using CO2 incubator to produce adult worms. Different forms of parasites including pre-segmentation stages [PS1 - PS4] and segmentation stages [S5-S8] and developing stages in segmented worms [S10-S11] were observed and evaluated in these medium. Finally adult worms contained four proglottids with a large and distinct genital pore were observed 50-55 days post cultivation. These parasites do not produce fertile eggs and conclusively do not have risk of hydatid disease transmission to the researchers. The mentioned method for producing E. granulosus adult worms can open a new window for researches and facilitate working on different aspects of hydatidosis especially for diagnosis, protection and treatment studies

[Effects of pretreatment with pentoxyfilline and N-acetylcysteine on renal injury following induction of liver ischemia-reperfusion]

Background and Aims: Liver ischemia-reperfusion [IR] is one of the common consequences of liver surgery, especially during liver transplantation which results in organ dysfunction. Acute hepatic injury causes systematic inflammatory responses which may finally lead to functional disturbances in remote organs such as heart, lungs and kidneys. In this study, the effects of a potent inhibitor of inflammatory cytokines [pentoxyfilline, PTX] and a well known antioxidant, [N-acetylcysteine, NAC], was evaluated on renal functional damage and oxidative stress following liver IR

Method: Five groups of six male rats were used. Group one was sham operated. In group 2, 90 min liver partial ischemia was conducted by a clamp around hepatic artery and portal vein and followed by 4 hours of reperfusion. In group 3 and 4, PTX or NAC was injected intraperitoneally before the ischemia, while in group 5 both drugs were co-administered. The levels of ALT, AST, ALP, BUN and creatinine in serum as well as MDA and GSH levels in renal tissues were measured

Results: Significant increase in the serum levels of ALT, AST in IR group is indicative of liver functional damages comparing to sham operated rats. Elevated BUN levels and increased renal tissue MDA and decreased GSH levels in IR group demonstrates a significant kidney functional damage and oxidative stress comparing to sham group. Administration of PTX alone and PTX+NAC prevented the IR-induced increase in renal MDA levels. Administration of both drugs and their co-administration prevented the reduction in renal GSH levels

Conclusion: Pretreatment with PTX and NAC before liver IR induction may prevent renal oxidative stress by protection of cellular GSH concentration and a reduction in MDA levels

[Comparison of the effect of four non-metal posts on fracture resistance of endodontically treated teeth restored with composite]

Statement of problem: The fracture resistance of the root canal is mainly associated to the kind of the post used for treatment, and studies indicate that there are still different opinions about the fracture resistance of root canals when Non-Metal posts are used

Purpose: The purpose of this study was to compare the fracture resistance of four adhesive non-metal posts with different MOEs against compressive load in endodontically treated teeth

Materials and Method: In this In-vitro experimental study, a total of 40 recently extracted mandibular premolars were selected, sectioned adjacent to the CEJ, and endodontically treated. The specimens were randomly assigned to four groups [n=10]. Post spaces were prepared and the fiber D.T. Light posts, D.T. Composi post, D.T. white posts and Cosmopost were cemented. Composite resin [Lumiglass] cores were built up. After simulating the PDL, the specimens were embedded in acrylic resin, and then secured in a Universal Testing Machine. A compressive load was applied at a 45[degree sign] angle to the long axis of the tooth until fracture, at a crosshead speed of 1mm/min. The data were analyzed, using one-way ANOVA and Tukey's test [ p <0.05]

Results: The teeth restored with D.T. white fiber posts exhibited significantly higher resistance to fracture. Those restored with the other 3 groups were statistically similar [ p >0.05]. Fractures observed in the fiber groups would allow further restorations of the tooth, whereas unrestorable, catastrophic fractures were observed in the Zirconia [Composi] group

Conclusion: Since Zirconia post should be used catiously due to the unfavorable and unrestorable fractures created, fiber posts are indicated, in endodontically treated teeth

modified conductance and micro-fluidic technique for cell counting

This study reports the development of a new micro-machine based flow cytometer with impedance spectroscopy capable of processing cell counting using micro-fluidic technologies and conductivity possible for detection of a single cell level. Micro-scale hydrodynamic focusing is employed to place single cell passing along the center plane of the flow cytometer. By applying AC electrical field, suspended cells are polarized membrane capacitance Cm. cytoplasm conductivity sigma c and cytoplasm permittivity epsilon[c] will vary as a function of frequency. Electrical pulses with frequencies of 3 MHz are fed into the fluidic cell via a pair of silver electrodes. Tracing back the monitored current the number of individual cell species can be evaluated. The changes in the potential difference between the electrodes due to passage of biological cells are measured by a digital storage oscilloscope. Passage of the cells between the electrodes causes change in current frequencies. Frequency shift due to cell passage are measured by calculating Fast Fourier transform of the current signal without and with the cell crossing the gap between the silver electrodes. At a constant flow rate, it was found that the frequency shift is directly proportional to the number of cells. This technique used for the cell counting of human red blood cells [RBC's]. A suspension of RBC's is prepared by taking I ml of the cells and 9 ml of the sucrose buffer [dilution 1:10]. The present cell counting technique is compared with the standard cell counting in order to assess which method was the most feasible and efticient in the laboratory for the counting of red blood cell

Comparison of free hand and stereotatic cranial biopsy

Computerized tomography assisted Stereotactic and Free hand needle biopsies for both supra and infra tentorial lesions are accepted diagnostic techniques. This paper describes the experience of both techniques, 25 and 23 procedures were performed respectively by the above methods over the last one year. Primary and secondary tumours, tuberculoma, abscess, haematoma and colloid cyst were diagnosed. The diagnostic yield was 86% for free hand and 100% for Stereotactic procedures. A comparison of diagnostic yield, morbidity and mortality has shown significant difference between the two groups. Stereotactic biopsy is the method of choice for lesions which are deep, small and in multiple areas of the brain. This has less morbidity but is more expensive and special skill is required to use the frame

Xeroderma pigmentosum: report of 6 cases from two families

This is a report of six cases of xeroderma pigmentosum from two families. Four patients are from the first family, one of whom has died and three are alive, and the other family contains two affected cases, one boy and his aunt. Although basal cell carcinoma is usually the earliest malignancy that appears in the skin of these patients[5,6] in one case squamous cell carcinoma of the cornea happened to be the first malignant presentation. Three different skin cancers were found to simultaneously exist in one case

Treatment with biosynthetic growth hormone in patients with classic growth hormone deficiency

7 cases of classic growth hormone deficiency who were previously untreated, were treated with biosynthetic growth hormone. Their mean chronological age was 10.67 +/- 2.93 with height age of 5.51 +/- 3.53, bone age of 6.14 +/- 3.86 and with bone age lag of 48.85%. Mean pretreatment heigth velocity of these cases was 2.97 +/- 093cm/year. Biosynthetic hGH [Norditmpin and Genotropin] was administered in a dose of 12 units/m2/week at night time. After 1 year their mean height velocity had increased to 8.46 +/- 2.71 cm/year. Maximum increase in height was seen during second trimester of therapy

Pattern of neonatal mortality in Military Hospital, Rawalpindi

The study was undertaken to determine neonatal mortality rate [NMR] and pattern of diseases in our set up of Military Hospital [MH], Rawalpindi. Cohort study of all the newborns delivered in maternity ward of MH, over a period of 6 months was carried out. Follow up was done over a period of one month. IMMR in our study population was 27 per thousand live births, 12% of all the babies were low birth weight and 5.9% were premature. Major causes of mortality were birth asphyxia, infections, respiratory distress and congenital infections. The results were comparable with other regional studies. The incidence of mortality, low birth weight and prematurity along with other complications is still high in our region of the world cost effective and simple measures should be adopted as a remedy