Impact of the Iranian Registry of Infective Endocarditis (IRIE) and multidisciplinary team approach on patient management.

BACKGROUNDS: The last 30 years have witnessed major improvements in understanding of all aspects of infective endocarditis (IE). The Iranian Registry of Infective Endocarditis (IRIE) was formed to address epidemiological aspects of IE vis-à-vis its main pathogens and underlying heart diseases over a 12-year period. Indeed, a multidisciplinary team (MDT) for IE was developed alongside. METHODS: In a longitudinal observational study, data of adult patients with definite or possible IE based on modified Duke criteria were collected from 2007 to 2016 in our tertiary centre, Iran. From 2016 until 2019, we run a prospective observational study using formation of an IE MDT to provide better patient management and compared data before and after this. RESULTS: Totally, 645 patients with mean age of 48 ± 17 years were enrolled. Data of 445 and 200 patients were compared before and after IRIE and MDT formation, respectively. We found significantly reduced type and number of applied antibiotics (p = 0.04) and higher rate of positive blood culture (p = 0.001). Hospital length of stay increased significantly after formation of the IRIE and IE MDT (p = 0.02). The rate of heart failure, new abscess formation and cerebral emboli were significantly decreased after IRIE and IE MDT (p < 0.001) and consequently in-hospital mortality reduced significantly (p = 0.05). CONCLUSION: Developing national registries and MDTs has potential to enhance patient management and reduce IE burden. Our results demonstrated that establishment of the Iranian IRIE and IE MDT conferred better diagnoses, standardised treatments and significantly reduced cardiac and extra cardiac morbidity.

Combined Aortic Root Replacement and Heart Transplantation in a Patient with Dilated Cardiomyopathy and Aortic Root Aneurysm.

Concomitant replacement of the ascending aorta and heart transplantation are an infrequent procedure. This procedure was most often performed in patients with Marfan syndrome, however, it has its own technical difficulties. Hereby, we report on combined heart transplantation and aortic root replacement using donor's ascending aorta in a 25-year-old man diagnosed with dilated cardiomyopathy and ascending aorta aneurysm. This procedure was successful and beneficial to patients with aortopathy who are candidates for heart transplantation.

Association analysis of rs1049255 and rs4673 transitions in p22phox gene with coronary artery disease: A case-control study and a computational analysis.

BACKGROUND: The p22phox gene encodes the main subunit of NADH/NADPH-oxidase. This enzyme is expressed in smooth muscle cells of arteries, and it produces the reactive oxygen species. On the other hand, oxidative stress plays a main role in the pathogenesis of coronary artery disease (CAD). AIM: The aim of this study is to evaluate the association between rs4673 and rs1049255 polymorphisms of p22phox gene with CAD in an Iranian population which was followed with a computational analysis approach. METHODS: In a cross-sectional study, we collected blood samples of 302 Iranian Caucasian including 143 patients and 159 healthy controls. Genotype of the polymorphisms was detected through PCR-RFLP method. A computational analysis was also performed using SNAP, Polyphen-2, Chou-Fasman, RNAsnp, and miRNA SNP databases. RESULTS: Data of case control study demonstrated that CT genotype (R = 1.84, 95% CI = 1.13-3.00, p = 0.014) and T allele (OR = 1.53, 95% CI = 1.09-2.15, p = 0.013) of rs4673 polymorphism, have a significant association with enhanced risk of CAD. But rs1049255 analysis demonstrated the absence of such an association with CAD. Indeed, in silico data analysis demonstrated that rs4673 transition could impact on function of p22phox protein (SNAP score 56, expected accuracy 75%; Polyphen-2 score 0.99, sensitivity 0.09, specificity 0.99). Data derived from miRNA SNP database demonstrated that rs1049255 polymorphism increases the affinity of attachment between has-miR-3689a-3b with 3'-UTR of p22phox gene. CONCLUSION: Our data demonstrated that rs4673 transition may be involved in susceptibility to CAD and could be applied as a potential biomarker for this disease.

Double-chimera proteins to enhance recruitment of endothelial cells and their progenitor cells.

BACKGROUND: Enhanced attraction of selective vascular reparative cells is of great importance in order to increase vascular patency after endovascular treatments. We aimed to evaluate efficient attachment of endothelial cells and their progenitors on surfaces coated with mixture of specific antibodies, L-selectin and VE-cadherin, with prohibited platelet attachment. METHODS: The most efficient conditions for coating of L-selectin-Fc chimera and VE-cadherin-Fc chimera proteins were first determined by protein coating on ELISA plates. The whole processes were repeated on titanium substrates, which are commonly used to coat stents. Endothelial progenitor cells (EPCs) and human umbilical vein endothelial cells (HUVECs) were isolated and characterized by flow cytometry. Cell attachment, growth, proliferation, viability and surface cytotoxicity were evaluated using nuclear staining and MTT assay. Platelet and cell attachment were evaluated using scanning electron microscopy. RESULTS: Optimal concentration of each protein for surface coating was 50 ng/ml. The efficacy of protein coating was both heat and pH independent. Calcium ions had significant impact on simultaneous dual-protein coating (P<0.05). Coating stability data revealed more than one year stability for these coated proteins at 4°C. L-selectin and VE-cadherin (ratio of 50:50) coated surface showed highest EPC and HUVEC attachment, viability and proliferation compared to single protein coated and non-coated titanium surfaces (P<0.05). This double coated surface did not show any cytotoxic effect. CONCLUSIONS: Surfaces coated with L-selectin and VE-cadherin are friendly surface for EPC and endothelial cell attachment with less platelet attachment. These desirable factors make the L-selectin and VE-cadherin coated surfaces perfect candidate endovascular device.

Resistance index of penicillin-resistant bacteria to various physicochemical agents.

Widespread use of various antimicrobial agents resulted in the emergence of bacterial resistance. Mechanisms like direct efflux, formation, and sequestration of metals and drugs in complexes and antiporter pumps are some examples. This investigation aims to investigate the resistance pattern of penicillin-resistant bacterial strains to some physicochemical agents. Sensitivity/resistance pattern of common bacterial strains to antimicrobial agents were evaluated by disk diffusion assay. Broth and agar dilution method were used for determination of minimum inhibitory concentration and minimal bactericidal concentration. The impact of UV ray on the bacterial growth under laminar flow hood was measured using photonmeter. Our data demonstrates that the most prevalent metal resistance was against arsenate (95.92%), followed by cadmium (52.04%) and mercury (36.73%). There was significant difference between cetrimide resistances among studied microbial strains especially for P. aeruginosa (P < 0.05). High rate of pathogen resistance to various antibacterial agents in our study supports previously published data. This great rate of bacterial resistance is attributed to the emergence of defense mechanisms developed in pathogens. The higher general bacterial resistance rate among Staphylococcus strains rather than E. coli and P. aeruginosa strains draws attention towards focusing on designing newer therapeutic compounds for Staphylococcus strains.

Antimicrobial susceptibility pattern of microorganisms involved in the pathogenesis of surgical site infection (SSI); A 1 year of surveillance.

The aim of this study is to identify the antibiotic sensitivity pattern of pathogens involved in the process of surgical site infection, in surgical wards. Changes made in the pattern of antibiotic use will result in different microorganism susceptibility patterns, which needs correct determination for precise empiric antibiotic therapy. One thousand patients (62% men and 38% women, 18- 74-years-old, with mean age 43 +/- 8)) who underwent surgical treatment, in Alzahra University Hospital, Isfahan University of Medicine, Isfahan, Iran, were studied from 2005 to 2006. Surgical wound infections, based on the reported criteria, were aspirated for culturing within 1 plus gram staining of prepared smears. Minimum Inhibitory Concentrations (MICs) were determined for samples and all derived data were compared by SPSS 13 and WHO net 5 software. The prevalence of SSI was 13.3% with 150 positive cultures, totally. Of 150 bacteria, isolated from surgical site infections Staphylococcus aureus had most frequency (43%). Resistance of isolated organisms was 41.7% in amikacin, 65 and 78.6% in ceftazidime, 85.7% in ceftriaxone, 61.5% in ciprofloxacin, 78.8% in gentamicine, 6.4% in imipenem, 13% in meropenem and 70.6% in trimethoprim/sulfamethoxazole, respectively. 78.9% of Staphylococcus aureus isolates were MRSA and vancomycine was the most effective antibiotic without any resistance. Among 10 isolates of coagulase negative Staphylococcus, no vancomycine resistance was seen, but in contrast all cases were resistant to oxacillin. The most common gram negative organism was Klebsiella (18 isolates) in which 100 and 80% were sensitive to imipenem and meropenem, respectively. Seventeen cases were E. coli, in which the most sensitivity was to meropenem (80%) and imipenem (77.8%). Thirteen cases of Pseudomonas were detected, in which 16.7% were resistant to imipenem and 8.3% to meropenem. Our results demonstrated that the total antibiotic resistance is increasing among SSIs, with an up sloping pattern, which will contact with a constant empiric antibiotic therapy. So, precise up to date antibiogram tantalize us toward balancing the rate of total antibiotic resistance to SSIs.

The changes of metabolic profile and weight during Ramadan fasting.

INTRODUCTION: Ramadan is the holiest month in the Islamic calendar and Muslims fast during this month. We designed this study to evaluate the effect of Ramadan fasting on plasma lipids and lipoproteins. METHODS: This cohort study was performed during Ramadan in December 2002 (Islamic year 1423). The subjects were 81 students of Tehran University of Medical Sciences. We evaluated weight, body mass index (BMI), glucose, triglyceride (TG), cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL), and very low density lipoprotein (VLDL), before and after Ramadan. RESULTS: Body weight and BMI both decreased during Ramadan fasting in both genders. Glucose and HDL decreased and LDL increased significantly during fasting in Ramadan, but there was no significant change in total cholesterol, TG and VLDL. We did not find any association between TG, cholesterol, LDL, VLDL, HDL and the following variables: sex, body weight changes, and two or three instances of meals before Ramadan. Triglyceride level also increased in students with normal BMI while it decreased in overweight subjects. CONCLUSION: This study indicated that Ramadan fasting led to a decrease in glucose and weight. Although there was a significant reduction in meal frequency, a significant increase in LDL and decrease in HDL was noted during Ramadan. It seems that the effect of Ramadan fasting on serum lipid levels may be closely related to the nutritional diet or biochemical response to starvation.

Acute glomerulonephritis in children.

Acute glomerulonephritis (AGN) remains fairly common in the developing world although its frequency has declined in the industrial countries. The pattern of AGN was studied in one hundred hospitalised children. We recorded an increased prevalence in school age, i.e., 6-15 years (75%) and the occurrence of a streptococcal infection (90%), most often a pharyngeal infection (86%), one to three weeks preceding the illness. The problems that needed specific management during the acute phase were hypertension (39%), encephalopathy (5%) and ARF with hyperkalemia, 2% of the patients needing haemodialysis. Most of our patients (98%) recovered with 2% progressing to RPGN. The excellent prognosis of AGN with proper management emphasises the need for optimal care during the acute phase in the hospitalised children.