Iranian Red Crescent Medical Journal
Year:2020 | Volume:22 | Issue:2|Papers Count:10

Background: In recent years, the prevalence of antibiotic resistance has steadily increased and also the antibiotic-resistant strains producing extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamases have emerged among the Enterobacteriaceae, predominantly in Escherichia coli and Klebsiella pneumoniae species. Objectives: This prospective study aimed at determining the production of ESBL or AmpC, phenotypically and also at the molecular level, in E. coli and K. pneumoniae isolates collected from various clinical specimens. Methods: In total, 78 K. pneumoniae and 92 E. coli isolates were collected from various clinical infectious sources available in different wards of the Imam Reza Hospital, Tabriz, Iran, from July 2017 to December 2018. All isolates were subjected to antimicrobial susceptibility testing. MAST 4-disc test and polymerase chain reaction (PCR) were applied for phenotypic and genotypic detection of ESBLs and plasmid-encoded AmpCs (pAmpCs) among isolates, respectively. Results: Overall, 78 K. pneumoniae and 92 E. coli isolates were evaluated, of which 46 K. pneumoniae (58. 9%) and 51 E. coli (55. 4%) isolates were resistant to cefotaxime/ceftazidime and included in the study. Among the K. pneumoniae and E. coli isolates resistant to cefotaxime/ceftazidime, 40(86. 9%)and40(78. 4%) isolates were ESBL producersand8 (17. 3%)and2 (3. 9%) isolates werepAmpCproducers, respectively. In addition, 40 E. coli (78. 4%) isolates were positive for both CTX-M-14 and CTX-M-15 genes. Regarding K. pneumoniae isolates, 40isolates (86. 9%) were positive for CTX-M-15 geneand 18 isolates (39. 1%) for CTX-M-14 gene. Among51 ceftazidime/cefotaximeresistant E. coli isolates, 32 isolates (62. 7%) were positive for DHA-1 gene and 33 isolates (64. 7%) isolates for CMY-2 gene. Also, among 46 ceftazidime/cefotaxime-resistant K. pneumoniae isolates, 15 isolates (32. 6%) had DHA-1 gene and 27 isolates (58. 7%) had CMY-2 gene in the genome. Conclusions: The high prevalence of ESBL and AmpC production among E. coil and K. pneumoniae isolates was a serious concern in the studied region. Therefore, a simple and rapid PCR-based technique is essential to detect and distinguish various pAmpC and ESBL genes to discriminate other resistance determinants.

Introduction: Hepatic lipomas are rare benign lesions of the liver with characteristic findings on imaging, which differentiate them from other more important tumors of the liver and prevent unessential invasive procedures. Case Presentation: A 62-year-old man with intense acute dyspnea referred to our emergency department in Imam Reza Hospital, Mashhad city, Iran. We performed initial diagnostic tests, Chest X-Ray (CXR), and non-contrast lung CT scan for further evaluation. Laboratory tests were in the normal range, but two well-defined lobulated masses with typical features of lipomas were noted on abdominal sections of plain CT scan in the patient’ s liver. The aim of this report is to define the characteristic appearance of these benign neoplasms on imaging techniques and to help exclude some more prevalent hepatic tumors with similar appearances without invasive procedures. Conclusions: Although there are numerous fat-containing lesions in the liver and some have heterogeneous and atypical features, it is often possible to make a definitive diagnosis of hepatic lipomas based on their typical imaging features, including pure fat density on CT scan, well-defined margins, chemical shift artifact on MRI, etc.

Background: Prenatal maternal lipopolysaccharide (LPS) exposure causes behavioral deficits in adulthood. LPS-exposure cause oxidative damage and cytokines production. In contrast, astaxanthin (Ast) is a carotenoid antioxidant that shows protective effects through its antioxidant capacity. Objectives: This study investigates the effect of prenatal treatment with astaxanthin on the behavioral deficit (including sexual, depressive and anxiety-like behavior) caused by prenatal maternal LPS in adult male offspring. Methods: Pregnant mice were randomly divided into 4 groups: (1) control, (2) LPS: injecting with LPS (20  g/kg, sc. ) on gestation day 11, (3) Ast: receiving astaxanthin (4 mg/kg for 3 days, i. p. ) on 11-13th gestation day, (4) LPS+Ast: injecting with LPS (20  g/kg, sc. ) on gestation day 11 and receiving astaxanthin (4 mg/kg for 3 days, i. p. ) on 11-13th gestation day. Then in each group, 23 day old male offspring (3 and 12 male children from each mother and group, respectively) were separated from mothers and then the sexual, depressive and anxiety-like behaviors were examined in adult male mice. Results: Findings showed that prenatal LPS-exposed mice had more anxiety and spent less time in open arms of the elevated plusmaze test (P < 0. 05). In addition, it decreased sexual behaviors, the amount of which was significant in the number of sniffing, following behaviors (P < 0. 01). Also, there was no significant difference between different groups in the forced swimming test (P < 0. 05). Onthe other hand, prenatal treatment with astaxanthin significantly elevated the percentage of openarmtime and openarm entry, without altering in locomotor activity (P < 0. 05). Also, it significantly increased sexual behavior in Ast and LPS+Ast groups (P < 0. 01). Conclusions: The obtained results suggest that prenatal maternal exposure to LPS impaired several aspects of male sexual behavior and resulted in behavioral deficits in adulthood, while astaxanthin has an antianxiety effect and improves the deficits of sexual behavior presumably via its antioxidant property.

Background: Herbal medicines are preferred over chemical medications for a wide range of mental disorders such as depression. “ Monzej-e soda” is a polyherbal combination that has been used in Iranian traditional medicine for several years to cure different mood disorders with similar signs to depression. Traditional formulations should be reformulated to reach pharmacopoeial standards as modern medicines. Objectives: In this study, “ Monzej-e soda” was reformulated and its quality control and antidepressant evaluations were performed to present a standard and efficacious formulation. Methods: The aqueous extract of the mixture of Echium amoenum, Lavandula angustifolia, Melissa officinalis, Foeniculum vulgare, Ziziphus jujuba, Cordia myxa, Glycyrrhiza glabra, Fumaria parviflora, Adiantum capillus-veneris, and Alhagi spp. was dried with the spray drying method. Dried extract and various ingredients at different ratios were used to produce 13 experimental tablet formulations and several pre-and post-formulation tests were performed to select the best formulation. The formulation was evaluated physicochemically. The accelerated stability test was performed on the tablets, as well. Moreover, the antidepressant effect of tablets was evaluated by the forced swimming test. The serum levels of serotonin (5-HT), noradrenaline (NA), and brain-derived neurotropic factor (BDNF) were measured in rats. Finally, histopathological examinations were performed on the liver, kidney, and spleen. Results: Among different formulations, the best one was a combination of dried extract (490 mg), maltodextrin (189 mg), colloidal silicon dioxide (21 mg), and croscarmellose sodium (2%). The hardness, weight, friability, disintegration time, dissolution percentage, and total phenolic content were 6. 98 kg/cm2, 715. 76 mg, 0. 7%, 12. 0 min, 97. 46% in one hour, and 31. 4 mg/tab, respectively. No significant changes were seen in the product in the accelerated stability test. The polyherbal tablet produced significant antidepressant effects through the decrease in immobility time, which was mediated via an increase in NA and 5-HT levels. It had no effect on the BDNF level. In addition, tablets had no toxic effects on the liver, kidney, and spleen. Conclusions: “ Monzej-e soda” tablet can be considered a suitable antidepressant drug and used in patients after passing clinical trial tests.

Background: Temporomandibular disorder (TMD) is a frequently occurring and common oral and maxillofacial disease with relevant clinical issues (such as pain, clicking sound, and difficulty in opening the mouth). Kinesio taping (KT) is a typical soft tissue taping technique that plays a role in relieving pain, relaxing muscles, and increasing proprioception. Objectives: The study aimed to investigate the function of the KT technique in the rehabilitation of TMD. Methods: In this prospective study, 60 TMD patients (group I disorders, muscle disorders) were recruited from the outpatients of the Department of Rehabilitation Medicine of Shanghai First People’ s Hospital, China, between June 2016 and September 2016 based on the inclusion/exclusion criteria. They were randomly divided into the control, short wave, and taping groups using a random number table, with 20 cases in each group. Different rehabilitation methods were applied according to the grouping. The course of treatment was six days. The estimations of the Fricton craniomandibular index (CMI), Self-Rating Anxiety scale (SAS), and Self-Rating Depression scale (SDS) were conducted in pretherapy and post-treatment by a physician who was blinded to the patients’ groups. Results: No significant differences were observed between patients in the three groups (P > 0. 05) in pretherapy in the temporomandibular joint dysfunction index (DI), muscle palpation index (PI), CMI, SAS, and SDS. In post-treatment, the CMI in the shortwave and taping groups was significantly improved compared to the control group (P < 0. 05). The SAS in the taping group improved significantly compared to the control and short wave groups (P < 0. 05). The SDS in the short wave group improved significantly compared to the control and taping groups (P < 0. 05). Conclusions: Taken together, KT effectively improved the dysfunctionandmoodof TMDpatients with the group I disorders, thereby necessitating further investigation for widespread application.

Background: There are many risk factors for childhood tinnitus such as hearing loss, exposure to high pitch sound, and passive smoking. Cotinine (C) is one of the metabolites of nicotine and is an important biochemical marker that reveals the objective and numerical indication of smoking exposure. Although there is a study investigating the role of urinary C levels in the etiology of tinnitus (T), the role of salivary C levels has not yet been elucidated. Objectives: Therefore, this study aimed to investigate the risk factors of idiopathic subjective T in children in terms of passive smoking and whether the salivary C level can be used as a novel marker for monitoring and follow-up of T. Methods: We retrospectively studied 1, 245 children aged 7-15 years with T. We excluded 830 patients (66. 5%) whose total tinnitus diagnosis was confirmed due to organic causes such as middle ear pathology and hearing loss. The remaining 415 (33. 5%) patients with subjective T and 200 healthy individuals constituted the study and control groups. Complete blood counts, routine biochemical tests, and salivary C levels of children with T and controls were measured and their parents were also evaluated. Results: In univariate analysis, parents’ C, children’ s C, ALP, and erythrocyte levels were significantly associated with T (P < 0. 001 in all). Regarding laboratory values, erythrocyte and serum ALP levels were significantly associated with T (P < 0. 001 in both) in univariate analysis (OR, 0. 99; 95% CI, 0. 98 to 0. 99 for erythrocyte and OR, 157. 04; 95% CI, 44. 7 to 551. 6 for serum ALP level). No significant relationships were found between other parameters. These four parameters that were found to be significant in the univariate analysis showed meaningful associations with T in multivariate analysis (P < 0. 01 for parents C and P < 0. 001 for other parameters). It was also observed that as the C levels increased in the parents, the C level also increased in children. Conclusions: There is a significant correlation between salivary C levels and parental salivary C levels in children. This suggests that the salivary C be used for evaluating the etiology of T in children and monitoring children with T exposed to cigarette smoke.

Introduction: Elizabethkingia meningoseptica (EM) is a non-fermenting Gram-negative bacterium that is a conditional pathogen and easily causes infection in neonates and immunocompromised patients. The infection of the bacterium is prone to develop multi-drug resistance, difficult to treat, and associated with a high mortality rate. Case Presentation: A 28-year-old female was admitted to the intensive care unit (ICU) of our hospital due to fulminantmyocarditis, cardiogenic shock, acute heart failure, and multiple organ dysfunction syndrome (MODS) on 24 April 2019. The patient developed a lung infection and sepsis after admission. Two sputum culture tests on 27 April and 4 May showed infection with Pseudomonas aeruginosa and multi-drug resistance. The minimum inhibitory concentration (MIC) for imipenem was 4 mg/L and 8 mg/L, respectively. Four blood cultures on 9 May suggested anEMinfection and multi-drug resistance, the MIC for imipenem was 16 mg/L. Due to the serious condition of the patient, imipenem-resistant lung infection, and typical sepsis manifestations, we initiated a regimen of polymyxin B combined with meropenem between 3 and 12 May. The infection was well-controlled and the patient was discharged on 14 May. Conclusions: A polymyxin B-based combinational regimen is effective in the treatment of sepsis due to EM and play an important role in controlling EM-associated mixed infections.

Background: Disease patterns have changed from communicable to non-communicable diseases, which are the leading causes of mortality around the globe. Health-promoting behaviors (HPBs) could be effective in the prevention of disease and the development of metabolic syndrome. Objectives: The objectives of the current study are (1) determination of the level of the HPBs and; (2) understand the predictive role of the HPBs of the metabolic indicators in the employees of the Red Crescent Society (RCS) based in Shiraz in Iran. Methods: This is a descriptive and analytical study, in which all 402 employees of the RCS participated. This study used a Census method and was done in 2018. The validation of this HPBs model was confirmed by confirmatory factor analysis (CFA) model. Relationships between the HPBs dimensions and metabolic indicators were obtained with Pearson correlation. Data analyzed with the SPSS and Amos software. Results: We found that the goodness of fit of the HPBs model was acceptable, which is indicated by the value of equal to 1. 22 and the RMSEA value equal to 0. 025. In addition, the standard estimated effect of physical activity on the levels of triglyceride, cholesterol, body mass index, and hypertension was significant (P < 0. 01). Regarding the aspects of the HPBs, the health responsibility had a higher mean score (24. 92  5. 23), than the other parameters. In this study, physical activity had the strongest role in the HPBs model. Conclusions: We can suggest interventions regarding lifestyle, especially physical activity to improve the employees’ health.

Background: Hepatitis B is a problematic condition which can affect both patients and health systems. The fetus health effect, transmissibility of infection, disease screening during pregnancy and confronting the disease during pregnancy as a new diagnosis case havemadethis disease close to the reproductive health domain. A health need assessment is a first step in designing an equality health service, the aim of this study was the development and validation of the health need questionnaire of hepatitis B affected women in the reproductive health domain. Methods: Based on the specific design, this study had two phases. At the first step to develop the instrument, we conducted some qualitative interviews with hepatitis B affected women and reproductive health care providers. After analyzing, we developed a health need questionnaire, the psychometric characteristics of which were determined in the second phase. Results: After analyzing the data, we received 88 codes and 186 items. The research team removed 9 items during the face and content validity based on the cut off point of Impact Score, CVR and CVI. To elucidate, the questionnaire with 79 items developed in the psychometric evaluation phase. Internal consistency of the total scale was good with Cronbach alpha coefficient 0. 87, and Spearman correlation coefficient of 0. 84 that indicated good stability. In the construct validity by exploratory factor analysis, the Kaiser-Meyer-Olkin (KMO) index was higher than 0. 90 and also the Bartlett test of sphericity was significant (P < 0. 001). Concerning the cumulative percentage of the variance, the 4 factors determined 54. 99% of the total variance. Conclusions: This study lead to development and validation of a questionnaire to evaluate the health needs of hepatitis B affected women in the reproductive health domain.

Background: Cancer is currently the second leading cause of death worldwide that is originated from cell growth and proliferation without control. Acute lymphoblastic leukemia (ALL) is one of the types of leukemia that affects lymphocyte maturation and it is common among children. Silver nanoparticles are considered one of the targeted chemotherapy methods by creating cytotoxicity. Objectives: In this research, a comparative study of cytotoxic effect of silver nanoparticles was evaluated on human lymphocytes and HPB-ALL cell line as an in vitro study. Methods: In this experimental study, lymphocytes and HPB-ALL cell line were exposed to silver nanoparticles at RPMI 1640 medium culture in order to assess toxicity for 24 hours. To this aim, MTT assay was used to evaluate the toxicity of the silver nanoparticles. DNA fragmentation and apoptosis were evaluated by Gel Electrophoresis and Flow Cytometry, respectively. Moreover, quantitative PCR was performed on bax, bcl-2, and caspase-9 genes. Results: The results of MTT assay showed IC50 values of silver nanoparticles were 5. 87 and 2. 68  g/mL for lymphocytes and HPBALL cell line, respectively. The results showed that silver nanoparticles could split DNA of the HPB-ALL cell line more than DNA of the lymphocytes during DNA fragmentation. Flow Cytometry results indicated that the early apoptosis was 6. 04% and 22. 75% in lymphocytes and HPB-ALL cell line, respectively. Moreover, Q-PCR results showed a significant up-regulation of caspase-9 and bax genes and downregulation of bcl-2 gene in comparison to the control group. Conclusions: The silver nanoparticles had cytotoxic effects on the lymphocytes and HPB-ALL cell line. The results showed that the silver nanoparticle had a significant cytotoxic effect on HPB-ALL cell line.