Designing a Multiplex PCR for Rapid and Accurate Detection of Metallobetalactamases Resistant Genes from Acinetobacter baumaniiIsolates in Tehran City, Iran.

Background & Objective: Acinetobacter baumannii strains harboring Meallobetalactamases (MBL) pose a significant threat in the context of nosocomial infections. The present investigation was undertaken with the objective of devising a Multiplex PCR methodology for the concurrent detection of MBL genes within A. baumannii strains prevalent in Tehran City, Iran. Methods: Between October 2020 and February 2021, 100 strains of A. baumannii were procured from burn specimens of hospitalized patients at Motahhari Hospital in Tehran. The identification of A. baumannii strains involved conventional biochemical techniques, coupled with confirmation of the presence of the bla OXA-51 gene. Antibiotic susceptibility was assessed using the Kirby-Bauer disc diffusion test. MBL-producing strains were characterized through a phenotypic approach employing the combined disk test, alongside Multiplex PCR for the simultaneous identification of bla VIM, bla IMP, bla GIM, and bla NDM genes. Statistical analyses were conducted using the chi-square test, with SPSS version 20.0 employed for data processing. Results: Among 100 strains examined, 96.1% exhibited positivity for MBL, as determined by the combined disk test. The study revealed a predominance of extensively drug-resistant (XDR) strains, with colistin demonstrating the highest level of sensitivity. The genotypic assay unveiled that Multiplex PCR identified bla VIM, bla NDM, and bla IMP in 20 strains, bla VIM and bla NDM in 30 strains, and exclusively the bla NDM gene in 45 strains. Notably, the Multiplex PCR technique exhibited the capacity to concurrently detect MBL genes (bla VIM, bla IMP, bla GIM, bla NDM) in 2 strains. Conclusion: The current investigation underscores prevalence of the bla NDM gene within clinical strains of A. baumannii. Furthermore, Multiplex PCR emerges as a robust and highly sensitive technique for rapid discernment of the MBL genes within in A. baumannii strains.

The Relationship between the Biofilm Genes and Antibiotic Resistance in Stenotrophomonas maltophilia.

Objectives: Today, Stenotrophomonas maltophilia (S. maltophilia) is a major opportunistic pathogen among hospitalized or immunocompromised patients. Antibiotic-resistant clinical isolates are increasing in several parts of the world. Various antibiotic-resistance and biofilm-forming genes are identified in this bacterium. Its capacity to form biofilms is an important virulence factor that may impact antibiotic-resistance patterns. In the current study, we evaluated the biofilm-formation capacity, antibiotic-resistance profile, and prevalence of biofilm-forming genes as well as antibiotic resistance genes among S. maltophilia isolates. Materials and Methods: In this cross-sectional study, 94 clinical S. maltophilia isolates were recovered from four tertiary-care hospitals in Iran between 2021 and 2022. The presence of the selected antibiotic-resistance genes and biofilm-forming genes was examined by polymerase chain reaction (PCR). The ability of biofilm formation was examined by microtiter plate assay. The Kirby-Bauer disc diffusion method was used to evaluate the trimethoprim-sulfamethoxazole (TMP-SMX), levofloxacin, and minocycline resistance. Results: S. maltophilia is mainly isolated from bloodstream infections. Notably, 98.93% of isolates were biofilm producers, of which 19.35%, 60.22%, and 20.43% produced strong, moderate, and weak biofilm, respectively. The frequency of biofilm genes was 100%, 97.88%, 96.80%, and 75.53% for spgM, rmlA, smf-1, and rpfF, respectively. Isolates with the genotype of smf-1+/rmlA+/spgM+/rpfF+ were mostly strong biofilm producers. Among the antibiotic-resistance genes, the Smqnr, L1, and sul1 had the highest prevalence (76.59%, 72.34%, and 64.89), respectively. Antimicrobial susceptibility evaluation showed 1.06%, 3.19%, and 6.3% resistance to minocycline, TMP-SMX, and levofloxacin. Conclusion: The results of the current study demonstrated that S. maltophilia isolates differ in biofilm-forming ability. Moreover, smf-1, rmlA, and spgM genes were presented in all strong biofilm producers. Although the overall resistance rate to the evaluated antibiotics was high, there was no statistically significant relation between antibiotic resistance and the type of biofilm.

An observational study to assess circulating nurses' non-technical skills.

BACKGROUND: Non-technical skills are cognitive and social skills that are necessary for safe and efficient practices in operating theatre. These skills are inseparable parts of circulating nurses' duties and help them have a good performance during surgical processes. Circulating nurses' non-technical skills have not been closely measured, and much uncertainty still exists about the quality of their skills. This study aimed to assess circulating nurses' non-technical skills. METHODS: A cross-sectional study was conducted on 300 circulating nurses who worked in four public hospitals in Iran, during 2020. The data of demographics of the studied population were collected using a demographic questionnaire. Kalantari et al's Circulating Practitioner's List of Non-Technical Skills was used to assess the circulating nurses' non-technical skills. RESULTS: The situational awareness domain had the highest score, while leadership was the domain with the lowest mean score. There was a moderate positive relationship between the mean score of non-technical skills and the number of working years as a circulating nurse. CONCLUSION: Although the circulating nurses had a moderate level of non-technical skills, they had low scores in several behaviours. However, they did well in some other behaviours. Educational interventions and policymaking solutions can help improve circulating nurses' non-technical skills.

Small Bowel Obstruction As a Consequence of Peritoneal Tuberculosis.

Peritoneal tuberculosis (PTB) is a rare subset of extrapulmonary tuberculosis which account for only 0.5-1% of all cases. PTB diagnosis can be challenging due to nonspecific clinical manifestations. We present a known case of pulmonary tuberculosis that admitted to the surgery ward due to the major complaint of abdominal pain since ten days before admission. In imaging studies, positive findings favoring mechanical obstruction were detected. There were also several hypodense lesions in the liver suggestive of visceral tuberculosis. An adhesion was noted during exploratory laparotomy prior to the ileocecal valve responsible for intestinal obstruction, which was released. Pathology reports of excised tissues were consonant with the PTB diagnosis. PTB diagnosis can be challenging because of its presentation. This can delay the treatment of patients and thus increase morbidity and mortality. As a result, physicians should always be aware of the PTB diagnosis in patients with nonspecific abdominal involvement.

Determination of Virulence Factors and Resistance Profile of Methicillin-Resistant Staphylococcus aureus Strains among Different Types of spa, agr, and SCCmec.

In order to restrict the spread of methicillin-resistant S. aureus (MRSA) in hospitals, it is necessary to characterize isolates rapidly and precisely. The objective of this study was to determine virulence factors and resistance profiles of MRSA strains among spa, agr, and SCCmec types. In total, 55 MRSA isolates were collected from clinical specimens. The MRSA isolates were characterized by antimicrobial susceptibility testing, virulence genes, agr typing, spa typing, and SCCmec typing. According to our findings, all MRSA strains were resistant to cefoxitin; 88% and 86.7% of which were resistant to erythromycin and clindamycin, respectively. Type II agr was predominant with 54.54% frequency. Among 27 different spa types, type t030 was most frequently (25.45%). Most MRSA isolates (63.3%) were SCCmec type III. The pvl and tst genes were found in 25.3% and 32.7% of MRSA isolates, respectively. Among the MRSA strains, ermA, ermB, and ermC were present in 50%, 33.3%, and 57.3% of cases, respectively. In addition, 43 of the 55 MRSA strains (78%) harbored aminoglycoside resistance genes. The results of our study revealed that the MRSA rate in our region is dramatically high. Better infection control guidelines in hospitals, as well as ongoing epidemiological surveillance studies, could be strongly suggested for effective prevention of the spread of MRSA to inpatients.

Identification of two major direct repeat unit clusters, 8i and 11ce, among methicillin resistant Staphylococcus aureus strains: the emergence of novel dru types and repeats.

BACKGROUND: The changing epidemiology and decreasing susceptibility to first-line antibiotics, such as vancomycin and linezolid, leave clinicians with few therapeutic options for MRSA infections. This study aimed to conduct an epidemiology study and characterize MRSA isolates. METHODS: A total of 150 MRSA isolates were collected from clinical specimens. Antimicrobial susceptibility was determined using the disk diffusion method. Resistance and major virulence genes were screened using the polymerase chain reaction. The SCCmec and dru typing were used to conduct molecular epidemiology. The BioNumerics tandem-repeat sequence typing plug-in tool was utilized for dru type cluster analysis. We constructed a minimum spanning tree using the similarity matrix of the DSI model. RESULTS: We discovered 24 dru types among the 55 dru sequenced MRSA isolates. Additionally, eight new dru types were discovered and added to the dru typing database. Two dru clusters (8i, 11ce) and nine single dru types were identified in 55 dru sequenced MRSA isolates. The two dru clusters, 8i and 11ce, accounted for 46 MRSA isolates (83.63%). The most common one of the nine singles dru types in this study was dt9bd, which belonged to the SCCmec types of IX. CONCLUSIONS: Given that two clusters account for the majority of strains in our study, we can conclude that the genetic origin of these strains is the same. Therefore, the spread of these strains can be prevented with effective MRSA monitoring in hospitals and communities.

Detection and Evaluation of Macrolide Resistance (Erythromycin) in Mycoplasma hominis Isolated from Endocervical Specimens of Patients Referring to Ibn Sina Infertility Treatment Centre, Tehran, Iran.

Background: Mycoplasma hominis (M. hominis) is an important cause of bacterial infections of the genital tract. Macrolides are the first selective agents used to treat mycoplasma infections. However, widespread use of macrolides has led to a rapid and global emergence of macrolide-resistant strains. We evaluated macrolide resistance in M. hominis isolated from endocervical specimens of patients who referred to Ibn Sina Infertility Centre in Tehran, Iran. Materials and Methods: In this cross-sectional descriptive-analytical study, 160 samples of Dacron endocervix swabs (80 infertile patient samples and 80 healthy controls) were collected and transferred to the laboratory. All samples were cultured in liquid pleuropneumonia-like organisms (PPLO) broth and PPLO agar solid media. After culturing and genome extraction, polymerase chain reaction (PCR) was performed using specific primers. Then, minimum inhibitory concentration (MIC) was obtained using the broth microdilution method. The MIC was recorded and reported for all samples positive for M. hominis against erythromycin. Results: From the 160 endocervical specimens cultured in PPLO agar medium, 19 cases (23.75%) were positive. A total of 35 cases (42.5%) were positive using specific primers of M. hominis species. MIC results from all samples positive for M. hominis were measured against erythromycin. All of the M. hominis samples were resistant to erythromycin. Conclusion: The results of the present study showed that a significant percentage of infertile women were infected with M. hominis. Also, MIC results from the broth microdilution method indicated that all strains positive for M. hominis were also resistant to erythromycin.

The Influence of Analgesic Modalities on Postoperative Cancer Recurrence.

The potential for cancer cells to grow and to metastasize depends on complex interactions between inflammatory signals and pathways, immune cells, and elements of the stromal tissue in which they invade. Related to the nature of many cancers, the probability of recurrence can potentially be quite high for some patients. Immunology, lifestyle modifications, timing of disease, genetics, age, gender, and race are only a handful of ways the likelihood of cancer recurrence can be influenced. The quantity, or density, of certain immunological cells or factors, plays a role in the propagation of cancer cells. Opioids are often used in cancer patients for acute postoperative and chronic pain management. While they can produce significant pain relief, the type of analgesic utilized is important, as it may influence cancer propagation. In this regard, certain opioids have been found to increase T regulatory cells while suppressing NK cell function. Morphine may promote tumor neovascularization and expansion. Fentanyl administration significantly diminishes NK-cells and CD8+ cytotoxic T-cells. In a recent meta-analysis, propofol-based anesthesia improved both cancer-free survival and overall survival. COX inhibitors have also shown promise in persevering cancer immune function, as in literature involving ketorolac and celecoxib. In summary, inhaled anesthesia and opioids may contribute to a pro-tumor metastasis environment also known as cancer propagation; whereas propofol and COX inhibitors may provide a better alternative to reduce cancer recurrence and propagation.

Effect of zinc oxide nanoparticles on physical and antimicrobial properties of resin-modified glass ionomer cement.

BACKGROUND: To improve the limitations, many modifications in the resin-modified glass ionomer (RMGI) composition have been proposed. In this study, we evaluated the effect of different concentrations of zinc oxide (ZnO) nanoparticles incorporated into RMGI cement on its physical and antimicrobial properties. MATERIALS AND METHODS: In this in vitro study, ZnO nanoparticles with 0-4 wt.% concentrations were incorporated into RMGI. The following tests were carried out: (a) Antibacterial activity against Streptococcus mutans tested by disc diffusion method, (b) mechanical behavior assessment by measuring flexural strength (FS) and flexural modulus (FM), (c) micro-shear bond strength (µ-SBS), and (d) fluoride and zinc release. Data were analyzed using the statistical tests of ANOVA, t-test, and Tukey's HSD post hoc in SPSS V22. The level of significancy was 0.05. RESULTS: In the disc diffusion method, specimens with 2 wt.% ZnO nanoparticles showed the highest antimicrobial efficacy (P < 0.05). After 1 month of water storage, no significant difference was observed in FS and FM of the samples (P > 0.05). In 2 wt.% ZnO nanoparticles group, µSBS increased in the first 7 days but decreased by 17% after one month, which showed a significant difference with that of the control group. The fluoride release did no change in the ZnO nanoparticle-containing group compared with the control group at all time intervals. CONCLUSION: Incorporation of 2 wt.% ZnO nanoparticles into the RMGI cement adds antimicrobial activity to the cement without sacrificing FS and fluoride release properties, while decreased µSBS.

Molecular Characterization of Antibiotic Resistance Associated with TEM and CTX-M ESBL in Uropathogenic E. coli Strains Isolated from Outpatients.

BACKGROUND & OBJECTIVE: Escherichia coli (E. coli) is a leading cause of urinary tract infections becoming resistant against beta-lactams and cephalosporins through different mechanisms, including ESBL production due to the presence of ESBL specific genes, including blaCTX-M and blaTEM. The purpose of the present study was to detect the uropathogenic E. coli strains producing the ESBL. METHODS: A total of 100 isolates of uropathogenic E. coli were randomly selected in a period of 6 months and their resistances to a number of antibiotics including amoxicillin, amikacin, gentamicin, ciprofloxacin, ceftazidime, cefotaxime, ceftriaxone, ceftizoxime, nalidixic acid, and nitrofurantoin were determined. Then, DDT test was used to detect the presence of ESBL. Finally, the presence of blaCTX-M and blaTEM resistance genes was analyzed by PCR method. RESULTS: The resistance profile of bacterial isolates to the antibiotics was as follows: amoxicillin: 16.7%, amikacin: 7.8%, gentamicin: 20.3%, ciprofloxacin: 35.5/%, ceftazidime: 35.0%, cefotaxime: 40.0%, ceftriaxone: 41.3%, nalidixic acid: 64.0%, nitrofurantoin: 9.7%, and ceftizoxime: 100%. Of these, 28 isolates (28%) were reported to be resistant to cefotaxime, ceftazidime, and ceftriaxone. In DDT test, 21 ESBL positive cases (21%) were detected. PCR results showed that the presence of blaCTX-M and blaTEM genes in the isolates were 21% and 20%, respectively. CONCLUSION: Regarding the production of ESBL by some E. coli isolates, phenotypic detection of ESBL-producing isolates is routinely suggested in the laboratories. Likewise, the treatment regimen should be selected regarding the ESBL production to avoid treatment failure.

The promising shadow of microbubble over medical sciences: from fighting wide scope of prevalence disease to cancer eradication.

Microbubbles are typically 0.5-10 µm in size. Their size tends to make it easier for medication delivery mechanisms to navigate the body by allowing them to be swallowed more easily. The gas included in the microbubble is surrounded by a membrane that may consist of biocompatible biopolymers, polymers, surfactants, proteins, lipids, or a combination thereof. One of the most effective implementation techniques for tiny bubbles is to apply them as a drug carrier that has the potential to activate ultrasound (US); this allows the drug to be released by US. Microbubbles are often designed to preserve and secure medicines or substances before they have reached a certain area of concern and, finally, US is used to disintegrate microbubbles, triggering site-specific leakage/release of biologically active drugs. They have excellent therapeutic potential in a wide range of common diseases. In this article, we discussed microbubbles and their advantageous medicinal uses in the treatment of certain prevalent disorders, including Parkinson's disease, Alzheimer's disease, cardiovascular disease, diabetic condition, renal defects, and finally, their use in the treatment of various forms of cancer as well as their incorporation with nanoparticles. Using microbubble technology as a novel carrier, the ability to prevent and eradicate prevalent diseases has strengthened the promise of effective care to improve patient well-being and life expectancy.

The Prevalence of 23S rRNA Mutations in ML-Resistant M. pneumoniae Isolates to Clarithromycin in Patients with Respiratory Infections.

BACKGROUND: Mycoplasma pneumoniae is one of the widespread causes of community-acquired pneumonia (CAP). Over recent years, the widespread use of macrolides has led to the emergence of macrolide-resistant M.pneumoniae (MRMP) resulted from mutations at specific positions of domain V of the 23S rRNA gene. METHODS: We collected 100 samples of throat swabs from patients with respiratory infections. After extraction of DNA from bacterial cell cultured in PPLO broth media using Roche kit (Germany), the PCR was performed on specific samples of M. pneumoniae using specific primers for 23S rRNA gene.Afterwards, for positive samples, minimum inhibitory concentration (MIC) was determined using the broth microdilution with Clarithromycin. Finally, the PCR product was sequenced to detect mutations related to macrolide resistance in domain V of 23S rRNA . RESULTS: According to the analysis of the sequenced PCR product of M. pneumoniae 23S rRNA gene using Clustalw2 online software, one of the samples were shown to have a mutation at A2431G and G2491A positions. The MIC measurement also revealed that all isolates were sensitive to Clarithromycin, and there was no macrolide resistance to Clarithromycin in all isolates. CONCLUSION: Sequence analysis of the 23S rRNA gene in M. pneumoniae , revealed no macrolide resistance of M. pneumoniae to Clarithromycin. Thus, the use of these antibiotics should be restricted to prevent the development of macrolide-resistant M. pneumoniae in Iran.

Molecular Detection and Evaluation of MLـ Resistance M. Pneumoniae Associated with Mutation in 23S RNA Gene among Iranian Patients with Respiratory Infections.

BACKGROUND: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. The global increased resistance of M. pneumoniae strains to macrolide (ML) has become a worrisome health problem. The widespread use of these medications has led to increased rate of reported ML-resistant M. pneumoniae (MRMP) throughout the world. This study was aimed to evaluate the resistance of M. pneumoniae against erythromycin due to mutations in the 23S rRNA gene of patients with respiratory infections in Iran. METHODS: In this study, 100 samples of throat swab from a patient with respiratory problems were collected. After the cultured of all samples in M. pneumonia-specific PPLO medium, PCR technique was performed with specific primers. Afterwards, the broth micro-dilution MIC assay was employed. Finally, the PCR product of the 23S rRNA gene was sequenced to detect mutations of domain V in 23S rRNA gene of MRMP. RESULTS: It was found that 17 cases (17%) were positive for mycoplasma genus and six cases (6%) positive for M. pneumoniae species. Also, analysis of the sequence of 23S rRNA gene, revealed that one of the samples had mutations at positions A2431G and G2491A. All positive samples M. pneumoniae with 23S rRNA gene were sensitive to erythromycin. CONCLUSION: These use of these antibiotics should be limited to prevent the emergence of MRMP in Iran.

Antibiotic resistance assessment of Acinetobacter baumannii isolates from Tehran hospitals due to the presence of efflux pumps encoding genes (adeA and adeS genes) by molecular method.

OBJECTIVE: Acinetobacter baumannii (A. baumannii) has caused many problems in nosocomial infections. Efflux pumps are considered as one of the most important mechanisms of resistance in this bacterium and have the ability to excrete toxic substances such as antibiotics out of the cell. RESULTS: In this study, 60 isolates of A. baumannii were collected from patients in several hospitals in Tehran, Iran. After diagnosis using standard biochemical methods, the pattern of antibiotic susceptibility was determined using the disk diffusion method according to CLSI guidelines. The adeA and adeS genes were identified by PCR method. The highest resistance to Piperacillin and the lowest resistance to Gentamicin were observed (100% compared to 48.4%). 6.6% of the isolates had only adeA gene and adeS gene was observed in 8.4% of isolates and both genes were detected in 73.4% of the samples. Despite the high resistance of t A. baumannii o antibiotics and due to the high frequency of genes of adeA and adeS efflux pumps in A. baumannii isolates, it can be concluded that these efflux pumps may play an important role in resistance of this bacterium. By determining the pattern of antibiotic the resistance before treatment, the resistance of this pathogen can be prevented in societies.

Clinical outcome and determinants of amputation in a large cohort of Iranian patients with diabetic foot ulcers.

OBJECTIVE: Determining the predictive factors of diabetes foot ulcer (DFU) development and lower extremity amputations (LEA) in patients with diabetes mellitus (DM) is of great importance to compose risk stratification models. The aim of this study is to investigate the outcome and predictors of LEA in patients with DFU in large sample of Iranian patients. METHODS: This prospective cohort study was conducted during a 2-year period from 2014 to 2016, in Shiraz, southern Iran. All the patients with type 1 and 2 DM and DFU were included in the cohort and were followed for 2 years at least. They were visited in the clinic on a monthly basis and development of new DFU and LEA were recorded. The two-year free-DFU survival and predictors of the DFU development and LEA were recorded. Multivariate regression models were used to determine the factors. RESULTS: A total number of 432 patients with mean age of 56.8 ± 13.3 years were included. The two-year DFU-free survival rate was 0.826. The two-year DFU-free survival was associated with male gender (p = 0.005), foot deformity (p = 0.002), history of prior DFU (p < 0.001), cigarette smoking (p = 0.032), nephropathy (p = 0.005), retinopathy (p = 0.007), ischemic heart disease (p = 0.043), and neuropathy (p < 0.001). CONCLUSION: Development of new DFU is associated with higher age, longer duration of disease, and type I diabetes. LEA was associated with increased white blood cell (WBC), Creatinine and ulcer history for major amputation and ulcer history, fasting blood sugar (FBS), infection, revascularization history, and foot deformity, for minor amputation.

Antibacterial activity of a glass ionomer containing silver nanoparticles against Streptococcus mutans and Streptococcus sanguinis.

AIM: Nano-sized metal particles exhibit special biological, chemical, and physical properties. The aim of this study was to evaluate the effect of incorporating silver nanoparticles into a resin-modified glass ionomer (GI) on its antimicrobial property. MATERIALS AND METHODS: Antibacterial action of GI samples containing 0, 40, 80 ppm silver nanoparticles against standard strains of Streptococcus sanguinis and Streptococcus mutans were assessed by agar diffusion and direct contact tests. Data were analyzed using analysis of variance and Duncan test (P < 0.05). RESULTS: Agar diffusion test showed no bacterial inhibition zone, but direct contact test exhibited significant antimicrobial activity against S. sanguinis and S. mutans in resin containing 80 ppm of nanosilver. CONCLUSION: Incorporation of a certain amount of silver nanoparticles into GI can increase its antimicrobial activity compared to the original material.

Molecular Detection of Adefg Efflux Pump Genes and their Contribution to Antibiotic Resistance in Acinetobacter baumannii Clinical Isolates.

BACKGROUND: Acinetobacter baumannii (A. baumannii) is one of the most important bacteria causing nosocomial infections worldwide. Over the past few years, several strains of A. baumannii have shown antibiotic resistance, which may be due to the activity of efflux pumps. This study was aimed to detect AdeFG efflux pump genes and their contribution to antibiotic resistance in A. baumannii clinical isolates. METHODS: A total of 200 A. baumannii clinical isolates were collected from clinical specimens of ulcers, pus, sputum, and blood. All isolates were identified using standard biochemical tests. After identifying and cleaving the genome by boiling, PCR was performed on samples using specific primers. The antimicrobial susceptibility patterns were determined by disk diffusion, with and without CCCP efflux pump inhibitor were determined according to CLSI guidelines. RESULTS: We identified 60 clinical isolates of A. baumannii using biochemical differential tests. Identification of all A. baumannii isolates was confirmed by blaOXA-51-like PCR. According to the results of our study, 98.37% of A. baumannii isolates were resistant to ciprofloxacin, norfloxacin, and levofloxacin. PCR results indicated that all 60 A. baumannii isolates contained the AdeF and 76.66% contained AdeG. CONCLUSION: the results of this study demonstrated that most of the A. baumannii isolates contained AdeF and AdeG efflux pump genes, and more than 98% of the isolates were resistant to ciprofloxacin, norfloxacin, and levofloxacin. This reflected the significant contribution of efflux pumps to the development of resistance to these antibiotics.

A Comparative Study of Injury Severity Scales as Predictors of Mortality in Trauma Patients: Which Scale Is the Best?

OBJECTIVE: To compare the injury severity scales as predictors of mortality in trauma patients to search for the best scale. METHODS: In a prospective cohort study and systematical random sampling conducted from March to September 2017, trauma patients over the age of 13 years were enrolled. The investigated variables were age, gender, systolic blood pressure, heart rate, respiratory rate, injured body region, Glasgow Coma Scale (GCS), injury severity score (ISS), revised trauma score (RTS), trauma injury severity score (TRISS) and the outcome. RESULTS: Totally, 1410 trauma patients were followed up, out of which 68.5% were male. The participants' mean age was 43.5±20.88 years. After adjusting the confounding effects, age over 60 years (OR=7.38, CI [3.91-13.93]), GCS<8 (OR=6.5, CI [2.38-18.16]), RTS<7.6 (OR=6.04, CI [2-13.7]), and TRISS<0.9 (OR=3.09, CI [1.39-6.88]) were determined as the most significant predictor variables for in-hospital mortality. The results of Receiver Operating Characteristic (ROC) curve revealed that TRISS had the highest area under the curve in comparison to other tests that were evaluated. Furthermore, TRISS had the highest sensitivity and specificity for scores higher than 96.15. By contrast, the sensitivity and specificity of GCS decreased for scores higher than 5.5. CONCLUSION: Our results showed that TRISS, RTS, GCS, and ISS were all very effective approaches for evaluating prognosis, mortality and probable complications in trauma patients; thus, these systems of injury evaluation and scoring are recommended to facilitate treatment. TRISS, RTS, and ISS had almost the same sensitivity that was higher than GCS, but GCS had the most specificity. Finally, TRISS was selected as the most efficient scale for predicting mortality.

Electroconvulsive Therapy for a Patient with Suicide by Drinking Bleach During Treatment of COVID-19: A Case Report.

Electroconvulsive therapy (ECT) was first experienced in 1938 and had been conducting without anesthesia for 30 years. In this study, the most common indication for ECT was mood disorder (major depressive disorder and bipolar I disorder). We introduce a patient with a history of COVID-19 and suicide who required emergency ECT. Electroconvulsive therapy can be life-saving in patients with suicide history or catatonic schizophrenia. Health workers are at the front line of the COVID-19 outbreak control and must follow health instructions. Aerosol-producing procedures such as suction in anesthesia for ECT may facilitate the transmission of infectious diseases such as COVID-19. When performing aerosol-producing procedures during the pandemic of novel coronavirus, every patient should be considered suspicious.

Frequency of Antimicrobial Resistance and Class 1 and 2 Integrons in Escherichia Coli Strains Isolated from Urinary Tract Infections.

Resistance to antimicrobial compounds in E. coli strains is increasing. Integrons are mobile genetic elements that lead to the spread and transfer of antibiotic resistance genes in bacteria. The aim of the present study was to determine the frequency of class 1 and 2 integrons as well as the antimicrobial resistance in E.coli strains isolated from urinary tract infections (UTIs). A total of 100 clinical isolates of uropathogenic E. coli (UPEC) were collected from patients having UTIs. These strains were identified using biochemical tests. The antibiotic susceptibility patterns of the isolated bacteria were determined in accordance with the standard method recommended by the clinical and laboratory standards institute (CLSI). The presence of class 1 and 2 integrons was determined by PCR method. The most frequent antibiotic resistance was observed to ampicillin (72%), co-trimoxazole (66%), and nalidixic acid (62%). The highest sensitivity was seen to amikacine (11%) and gentamicin (20%). The multi-drug resistance (MDR) was observed in 80% of E. coli isolates. 70% and 3% of E. coli isolate possessed class 1 and 2 integrons, respectively. Our data suggest that the antimicrobial resistance to some antibiotics as well as the frequency of class 1 and 2 integrons is very high in E. coli strains. Moreover, class 1 integrons are correlated with resistance to ampicillin, gentamicin, ciprofloxacin, co-trimoxazole, and nalidixic acid. Therefore, it is very important to monitor integron-induced drug resistance, especially class 1 integron, in order to control the urinary tract infections causing by MDR E.coli strains.