First report of methicillin-resistant Staphylococcus aureus carrying the mecC gene in human samples from Iran: prevalence and molecular characteristics

There is a lack of information concerning mecC clinical methicillin-resistant Staphylococcus aureus (MRSA) strains throughout the world. In the present survey, 345 MRSA strains were characterized by antimicrobial susceptibility testing and staphylococcal cassette chromosome mec element (SCCmec) typing. mecC-positive MRSA isolates were characterized by study of biofilm formability, adhesion and virulence analysis, multilocus sequence typing, accessory gene regulator (agr) typing, S. aureus protein A locus (spa) typing and staphylocoagulase typing. The present study found ten SCCmec types, with the majority being SCCmec type III (38.3%). The presence of mecC was confirmed in three isolates from skin wounds (two isolates) and burn wounds (one isolate). All the mecC-positive isolates carried SCCmec XI and belonged to coa type III. Molecular typing showed that these isolates belonged to clonal complex/ST130-spa type t843-agr type III (two isolates) and clonal complex/ST599-spa type 5930-agr type I. The presence of SCCmec type IV confirms the hypothesis of extensive infiltration from the community to the hospital. Detection of MRSA isolates harbouring the mecC gene highlights the need to perform routine detection methods and molecular investigations in order to identify these emerging strains and limit their transfer in hospitals and communities.

Serological Survey of Avian Influenza (H9N2) in Commercial Ostrich Farms in Iran, 2015

The aim of this study was to determine the seroprevalence of avian influenzaH9N2 subtype in the industrial ostrich farms and its geographical distribution. This cross-sectional study was conducted from January to June 2015. A total of 40 farms were selected from different provinces of Iran, from each of which 11 ostriches (n=440) were sampled. The sera samples were examined using 4 hemagglutination units of H9N2 antigens. A frequency distribution was used to describe the responses to the survey questions. The mean titers between provinces were compared using one-way analysis of variance. According to the results, 21 (47.5%) out of 40 farms and 108 (24.5%) out of 440 ostriches tested positive in the HI-H9N2 test. There were statistically significant differences between the mean titers of samples in different provinces (P<0.001). The current study was conducted on unvaccinated ostriches. The results showed that H9N2 had a high seroprevalence at both farm and bird levels. The findings of this study can be for the further investigation of infection in ostrich farms in order to consider this species in the surveillance programs of the Iranian Veterinary Organization. The detection and isolation of viruses and epidemiological investigation are necessary for the persistent use of H9N2 vaccines in some ostrich farms.

Efficient Synthesis of Sodium Aryloxymethanesulfonates Using Microwave Irradiation

A very simple, efficient and rapid method is described for the synthesis of sodium aryloxymethanesulfonates using microwave irradiation.

Identification of tigecycline- and vancomycin-resistant Staphylococcus aureus strains among patients with urinary tract infection in Iran

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major causes of hospital- and community-acquired infections worldwide. Although S. aureus rarely accounts for urinary tract infections (UTI), untreated UTI can lead to several complications. For decades vancomycin has been used for the treatment of MRSA infections. This study was performed to assess the in vitro activity of vancomycin, tigecycline, linezolid and quinupristin/dalfopristin against MRSA isolates from UTI patients. Thirty MRSA strains from 54 S. aureus isolates were isolated from patients with UTI. The antimicrobial susceptibility patterns of the strains were determined by the Kirby-Bauer disk diffusion and broth microdilution methods. PCR assays were used to detect the vanA gene. The MRSA isolates resistant to vancomycin were confirmed using the broth microdilution method. The results revealed that the MRSA isolates were 100% susceptible to linezolid and quinupristin/dalfopristin but 93.3% susceptible to vancomycin and tigecycline respectively. The broth microdilution method confirmed two MRSA strains (6.6%) to be resistant to vancomycin and tigecycline. The study identified vancomycin resistance among the MRSA isolates from UTI patients. This vancomycin resistance in MRSA isolates poses a challenge in managing S. aureus infections. Our study's results highlight the need to correctly identify patients in whom last-resort therapy such as linezolid and quinupristin/dalfopristin should be administered.

Phenotypic and genotypic study of biofilm formation in Enterococci isolated from urinary tract infections

BACKGROUND

Urinary tract infection (UTI) is one of the most frequent types of nosocomial and community acquired infections in humans. Management of multidrug-resistant Enterococci UTI due to the limited therapeutic options is a great challenge for physicians and clinical microbiologists. The role of bacterial biofilms in recurrent urinary tract infections and antimicrobial resistance has great importance for public health. The aim of this study was to investigate the antibiotic susceptibility pattern as well as the phenotypic and genotypic biofilm formation ability of Enterococci isolates from patients with UTI.

METHODS

A total of 57 isolates of Enterococci were collected from patients with UTI. Enterococcus species were identified using conventional microbiological methods. The antibiotic susceptibility patterns of the isolates were determined by the Kirby-Bauer disk-diffusion. The Modified Congo red agar (MCRA) and Microtiter plate methods used to assess the ability of biofilm formation. All enterococcal isolates were examined for determination of biofilm-related genes, esp, asa1 and ebpR using PCR method.

RESULTS

Of 57 enterococcal isolates, 85.9% were recognized as E. faecalis and 14.1% of them were E. faecium. According to our results, linezolid, chloramphenicol and nitrofurantoin were the most effective agents against Enterococcus species. Overall, 26.5% of E. faecalis and 75% of E. faecium isolates were biofilm producers, respectively. Resistance to some antibiotics including penicillin G, ampicillin, vancomycin, nitrofurantoin and chloramphenicol, and ciprofloxacin was significantly higher among biofilm producers than non-biofilm producers Enterococci. The esp, asa1 and ebpR genes were present in 84.2%, 91.2% and 100% isolates. In this study, there was not a significant relationship between presence of these genes and biofilm formation.

CONCLUSION

Our findings reinforce the role of biofilm formation in resistance to antimicrobial agents. Quinupristin/dalfopristin, tetracycline and rifampin may be used as an effective treatment for UTI caused by biofilm producers Enterococci. Our results suggest that biofilm formation is complex and depends on various factors but not just esp, asa1 and ebpR genes in Enterococcus strains.

New Pd(ii) complexes of sulfur ylides; synthesis, X-ray characterization, a theoretical study and catalytic activity toward the Mizoroki–Heck reaction

The reaction of sulfur ylides SMe₂C(H)C(O)R (R = 4-nitrophenyl, phenyl, and 3-nitrophenyl) with [PdCl₂(cod)] gives the new Pd(ii) complexes of type cis- and trans-[PdCl₂(SMe₂C(H)C(O)R)₂] (R = phenyl (1), 3-nitrophenyl (2), and 4-nitrophenyl (3)).

Incidence and Trend of Childhood and Adolescent Cancers in Yazd, Iran

BACKGROUND

Data on childhood and adolescent malignant tumors incidence are skimp in developing countries. In this study, we analyzed the incidence and trend of childhood and adolescent cancers in Yazd city, center of Iran between Jan 2004 and Dec 2013.

MATERIAL AND METHODS

The various types of malignant tumors were grouped pursuant to the International Classification for Cancer in Children. To analyze the data, descriptive and illative statistical methods were used.

RESULTS

Two hundred twenty-two patients with a malignancy aged less than 18 years were studied with a male to female ratio of 1.36.The mean age of patients was 9.88 (±5.7) years. Leukemia with the frequency of 84 (37.8%) and after that lymphoid malignancies with the frequency of 49 (22.1%) were the most common cancers. There was a low range of oscillation in the incidence rate of malignancies during this period of time (P value= 0.081). Malignancies were mostly in males (P value=0.057) but the whole process of malignancy incidence had gone toward the higher rate of incidence in females. Incidence rate of cancers types was steady. Malignancy incidence was 3-7 cases in hundred of thousands except a year of which this incidence rate was estimated 13.4.

CONCLUSION

Leukemias and lymphomas were the main cancers in the center of Iran. Childhood and adolescent malignancies may be considerably under-recorded in our province .A childhood and adolescent cancer registry is necessary for exact analysis of these types of malignancies.

Hematological Indices in Children with Non-organic Failure to Thrive: a Case-Control Study

BACKGROUND

Non-organic failure to thrive (NFTT) is the most common cause of failure to thrive (FTT) which is attributed to inadequate nutrition due to economic factors or parental neglect . NFTT can lead to a vicious cycle of poor and inadequate eating and severity of anemia. The aim of this study was to determine the hematological indices in children with NFTT.

MATERIALS AND METHODS

In a cross sectional case control study, iron status and blood indices of forty five aged 6-60 months children with NFTT were evaluated and compared with 45 healthy control children (with matching of age and sex).

RESULTS

In this study, the prevalence of anemia was 48.9% in NFTT compared to 11.4% in the control group (p<0.001). Microcytic anemia was significantly more prevalent among the subjects than the controls (77.8% versus 27.3%; p<0. 001). The serum iron level was 73.2 and 62.8 mcg/dl for the case and control groups (P=0.29). The ferritin level in the study group was 29.8 versus 35.47 ng/ml in the control group (p=0.227). The prevalence of iron deficiency anemia among children with mild, moderate, and severe underweight was 44.4%, 45.5%, and 48%, respectively. The highest prevalence of iron-deficiency anemia was seen between age group of 12 and 24 months (p<0.05).

CONCLUSION

Based on the results of this study, a correlation between malnutrition and anemia was found. However, further studies are needed to assess and confirm the current outcomes.

Nanotechnology and Pediatric Cancer: Prevention, Diagnosis and Treatment

Despite development of new approaches for the treatment of cancer disease, it is the second cause of mortality in world. Annually, 30000 persons die in Iran due to cancer diseases. Eighty percent of cancer patients are children which about 50% children lead to death. Given the high rate of cancer-related death, the new approaches for prevention, control, early diagnosis, and treatment of this disease seem necessary. Investigation of new strategies is the major challenge for scientists at recent century. Nanotechnology as a new scientific field with novel and small compounds utilized different fields over the past ten years especially in medicine. This science has come to the forefront in the areas of medical diagnostics, imaging, and therapeutic scheduls. Therefore, it has the potential applications for cancer detection and therapy. This review will discuss the therapeutic applications of different nano-materials in diagnosis, imaging, and delivery of therapeutic agents for the treatment of cancer with a major focus on their applications for the treatment of cancer and cancer- related diseases in children. The advancements in established nanoparticle technologies such as liposomes, polymer micelles, and functionalization regarding tumor targeting and controlled release strategies as well as drug delivery were discussed. It will also review the blood toxicity of used nanostructures.

Silver- and fluoride-containing mesoporous bioactive glasses versus commonly used antibiotics: Activity against multidrug-resistant bacterial strains isolated from patients with burns

The wound healing process is frequently associated with a number of major clinical challenges, due to the failure of commonly used antibiotics as a remedy for wounds. There have always been fascinating questions about the novel applications of bioactive glasses (BGs) and it is expected that in the next few years these types of materials may play an important role in many aspects of soft tissue regeneration. This research focuses on the feasibility of using silver- and fluoride-containing BGs against multidrug-resistant bacterial strains isolated from patients with burns. According to the results obtained, fluoride did not exhibit antibacterial activity against the tested bacteria, while both 1% and 2% silver-containing BGs inhibited the bacterial growth. It is an important finding that 1% silver-containing BGs showed a potential antibacterial activity without any toxicity against fibroblasts, suggesting that this class of BGs could play a key role in the prevention of infection, reduction of pain, and removal of excessive exudates.

The effective differentiation of Salmonella isolates using four PCR-based typing methods

AIMS

Discrimination of Salmonella strains below the species level is very important to trace the source of outbreaks. To this end molecular typing methods can be successfully applied to routine analysis in nonspecialized laboratories due to their simplicity and speed. Here, the discriminatory ability of four molecular typing methods was investigated in 74 Salmonella enterica isolates.

METHODS AND RESULTS

Salmonella strains isolated from human stool, blood, bone marrow, synovial fluid, ascites and urine sources in Iran during the years 2012 and 2013 were differentiated by random amplification of polymorphic DNA (RAPD), enterobacterial repetitive intergenic consensus (ERIC), repetitive extragenic palindromic (REP) and BOX repeat-based (BOXAIR) PCR methods. A total of 74 isolates were obtained, with 67 isolates belonging to eight serotypes/serogroups, while seven were nontypeable. The 74 strains produced 32 fingerprints with OPS-11 primers, 44 RAPD fingerprints using OPP-16 primers and 54 fingerprints with P1254 primers; their discriminatory index (DI) was 0·942, 0·978, and 0·984 respectively. BOXAIR fingerprinting produced 49 patterns (DI 0·985), while REP resulted in 55 patterns (DI 0·991) and ERIC in 48 fingerprints (DI 0·983). The discrimination of Salmonella isolates was improved when methods were combined. The combination of ERIC, REP and BOXAIR as well as the combination of BOXAIR with ERIC or REP could differentiate all 74 investigated Salmonella strains.

CONCLUSIONS

The combined use of RAPD and ERIC fingerprinting offers an excellent means of differentiating Salmonella strains.

SIGNIFICANCE AND IMPACT OF THE STUDY

The discrimination power of Salmonella molecular typing by combination of ERIC, REP and BOXAIR methods, or by combination of BOXAIR with ERIC or REP, is sufficient to determine genetic relationships for epidemiological purposes.

Comparison of hematological aspects among children with Malaria and healthy children

BACKGROUND

Malaria is an acute and chronic illness characterized by paroxysms of fever, chills, sweating, fatigue, anemia, and splenomegaly. Most malarial deaths occur in infants and young children.Anemia in malaria has diverse pathophysiologic mechanisms such as direct invasion of Red cells, In the following, we presented comparison of hematological aspects: children with Malaria and healthy children.

MATERIALS AND METHODS

This was a lab trial study. Patients were referred and admitted to the pathobiology laboratory along with physical examination. Then, they underwent a complete blood count and the result of complete blood count was compared with healthy person in the same age. Out of 30 patients, with equally falciparum, vivax, and healthy .The hematological examination was performed. Finally, the data was analyzed using SPSS version 19 software.

RESULTS

The levels of HGB (P=0.001), HCT (P=0.001), MCV (P= 0.001), MCH (P=0.001), WBC (P=0.001), and Plt (P= 0.02) decreased significantly in children with falciparum and vivax malaria compared to healthy controls. The levels of RBC (P=0.49) increased significantly in children with falciparum and vivax malaria compared to controls. Blood culture at two times. To investigate malaria; blood smears taken after microscopic study of Plasmodium falciparum ring was observed.

CONCLUSION

Malaria is a multisystem disorder which can lead to many diseases. Physicians, especially those in endemic areas, should be aware of the varied manifestations and maintain in a high index of suspicion for the disease in order to that diagnose and treat timely and, morbidity and mortality.

Composition controlled synthesis of PCL-PEG Janus nanoparticles: magnetite nanoparticles prepared from one-pot photo-click reaction

The aim of this study is to investigate the effect of polymer nature on the morphology of synthesized nanoparticles. Super paramagnetic iron oxide nanoparticles (SPIONs) were prepared by co-precipitation method and then reacted with (3-mercaptopropyl) trimethoxysilane to obtain thiol-decorated SPIONs. Acrylated poly(caprolactone) and methoxy poly(ethylene glycol) were prepared, and then "thiol-ene click" reaction was performed under UV irradiation to attach two types of polymers on the surface of magnetite nanoparticles via the "photo-click" reaction method. Computational modelling was used for the prediction of the self-assembly of polymers on the surface of SPIONs, which determines the morphology of polymer coated nanoparticles.

Seroprevalence of Hepatitis B, Hepatitis C and Human Immunodeficiency Viruses among Thalassemia Patients in West North of Iran

BACKGROUND

Thalassemia patients that are conventionally treated by a regular transfusion regimen are exposed to blood born viral infections.The aim of this study was to investigate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human Immunodeficiency virus (HIV) among all multitransfused thalassemia patients in west north of Iran.

MATERIAL AND METHODS

A retrospective study was conducted in February 2014, on 32 patients in Urmia, suffering from transfusion dependent thalassemia were admitted to Motahari and Emam Khomeini hospitals. Patients' medical records were studied for HBs antigen and seropositivity for HCV, and HIV antibodies.

RESULTS

Out of 32transfusion dependent thalassemia patients aged between 5-17years, 18 (56.25%) and14 (43.75%) were male and female, respectively. All of them were found seronegative for HBs antigen, HCV, and HIV antibodies.

CONCLUSION

It seems that screening of blood products is efficient in Urmia, capital of West Azarbaijan, Iran for prevention of blood born viral infections.

Mouth-rinses for the prevention of chemotherapy induced oral mucositis in children: a systematic review

BACKGROUND

The purpose of this review was to evaluate studies in basic oral care interventions to update evidence based practice guidelines for preventing oral mucositis (OM) in cancer patients undergoing chemotherapy.

MATERIAL & METHODS

Pub Med database and Google Scholar were searched for all papers published between 2000 and December 2014 in English that were conducted using the search terms including ''mocusitis, chemotherapy, mouth-rinses, oral care, oral care protocol, dental care,dental cleaning, oral decontamination, oral hygiene", and the combined phrases in order to obtain all relevant studies.

RESULTS

The initial search concluded 151 published papers representing both research and clinical work. Review articles, clinical case reports, literature reviews, and other nonresearch articles were excluded from the review. Following this process, 30 papers remained.

CONCLUSION

Among these, chlorhexidine, normal saline, sodium bicarbonate, iseganan, benzydamine, sucralfate and Granulocyte macrophage colony-stimulating factor have been used in the form of mouth-rinse for prevention of chemotherapy induced mucositis. However, none of these mouthrinses have been shown to be definitely effective in preventing chemotherapy induced oral mucositis.

Cardiac and Hepatic T2*-Weighted Magnetic Resonance Imaging in Transfusion Dependent Hemoglobinopathy in North West of Iran

BACKGROUND

Iron overload is the main transfusion related side effects in patients with transfusion dependent hemoglobinopathies. Severe iron deposition in tissues leads to organ dysfunction. Many organs can be affected such as heart, liver, and endocrine organs. Cardiac failure and liver fibrosis are the consequent of Iron overload in transfusion dependent hemoglobinopathy. Magnetic Resonance Imaging (MRI) is a safe, noninvasive, and accurate method for the assessment of iron deposition in different tissues. This study assessed iron levels in liver and heart of the patients with transfusion dependent hemoglobinopathies.

MATERIALS AND METHODS

The studied population consisted of 12 patients (7 male and 5 female) with transfusion dependent hemoglobinopathies, aged between 10-18 years old. Then, Cardiac and liver T2*- weighted magnetic resonance imaging (MRI) were obtained.

RESULTS

In current study, 1patient (8.33%) had severe, 2 patients (16.66%) had moderate and 2(16.66%) had mild cardiac iron deposition. Out of 12 patients, 1 had severe iron deposition in liver (8.33%), 5(41.66%) and 4(33.33%) had moderate and mild hepatic iron deposition, respectively. Differences between Hepatic and cardiac iron levels were not significant between males and females (p>0.05).

CONCLUSION

Since cardiac and liver iron levels were higher than normal in most of the study group, checking ferritin level and liver function test and also echocardiography in shorter intervals (each 3 months) in involved group is suggested instead of checking routinely in 6 month intervals in patients with transfusion dependent hemoglobinopathies.

Clinical and laboratory features of pertussis in hospitalized infants with confirmed versus probable pertussis cases

BACKGROUND

The clinical presentations of pertussis infection have considerable variation. Many infections and illnesses can cause prolonged repetitive paroxysmal cough that could be confused with Bordetella pertussis infection.

AIM

This retrospective study was designed to compare the clinico-laboratory findings between two groups of hospitalized infants with confirmed, and those who have clinical pertussis disease; to identify the possible additional diagnostic clues "for the diagnosis of confirmed pertussis disease".

SUBJECTS AND METHODS

The study population consisted of infants ≤12 months of age with clinical diagnosis of pertussis that fulfilled the World Health Organization definition for pertussis or those diagnosed by physicians. Clinico-laboratory findings were compared between two groups of patients (confirmed vs. clinical cases).

RESULTS

From a total of 118 infants admitted with a clinical diagnosis of pertussis, 16% (19/118) were confirmed by laboratory to have confirmed pertussis. Twelve of 19 (63%) and 71.99% of confirmed and clinical cases were younger than 6 months of age, respectively. For most patients, the duration of symptoms before hospitalization was <14 days. There were no significant differences between two groups of patients for paroxysmal cough and facial discoloration. However, whoop and apnea were more common among confirmed pertussis cases: P = 0.01, and P = 0.02, respectively. Leukocytosis (≥16,000/ml) (P = 0.01) and lymphocytosis (≥11,000) (P = 0.02) were reported significantly more frequently in confirmed pertussis cases.

CONCLUSION

Given the unavailability of a highly sensitive diagnostic test, in every afebrile patient with paroxysmal cough lasting for ≥7 days associated with whoop and/or apnea, particularly if accompanied by leukocytosis/lymphocytosis, pertussis disease should be considered. In this situation, prompt administration of empiric treatment for cases, and providing control measures to prevent infection transmission to contacts are recommended.

A novel use of amniotic membrane for fingertip injuries

OBJECTIVE

Fingertip injuries, which are the most common hand injury, represent management challenges for hand surgeons. Full thickness skin grafts are routinely used to cover the fingertip site, but has significant donor site morbidity. As amniotic membranes (AM) are used as a dressing substitute in burns, we decided to evaluate the efficacy of AM as a biologic wound dressing material for coverage of these injuries.

METHOD

In this clinical study, 30 patients with full-thickness zone 1 fingertip skin loss were included. The patients were divided into 2 groups using the block randomisation method. In the first group, a skin graft was used for coverage and in the second group, AM was used. All patients were operated on by the same hand surgeon between February 2012 to October 2012. The minimum follow-up period was 6 months. Two point discrimination (T.P.D), light touch, healing time, days lost from work and infection rate were evaluated and recorded.

RESULTS

This study recruited 30 patients with full-thickness zone 1 fingertip skin loss (age range 13-47 years). Fingertips in both groups were assessed. T.P.D, light touch and days lost from work were significantly lower in the AM group than in the skin graft group. Healing time was lower in the skin graft group. In the both groups, no infection was detected. Patients of both groups were satisfied of their treatment and healing progress.

CONCLUSION

Our results showed the effectiveness and safety of AM for the treatment of fingertip amputation, which can produce better sensation and functional outcomes than skin graft transplantations.

Detection of Ambler class A, B and D ß-lactamases among Pseudomonas aeruginosa and Acinetobacter baumannii clinical isolates from burn patients

In this study, we evaluated the existence of classes A, B and D ß-lactamases among Pseudomonas aeruginosa (P.aeruginosa) and Acinetobacter baumannii (A.baumannii) strains isolated from burn patients in Tehran during the years 2012 and 2013. From these strains, the frequency of MBL (metallo-beta-lactamase) and ESBL (extended-spectrum beta-lactamase) producers were evaluated using CDDT (Combined Disk Diffusion Tests). The prevalence of some related genes, including blaIMP, blaVIM, blaSPM, blaKPC, blaGIM, blaDIM, blaBIC, blaOXA-48, blaCTX-M-15 and blaNDM genes, was evaluated using PCR and sequencing methods. Of the 75 non-fermenter isolates, 47 P.aeruginosa and 28 A.baumannii were isolated and identified. A high rate of resistance to common antibiotics was detected among A.baumannii isolates in particular, showing 100% resistance to 9 tested antibiotics. CDDT showed that 21 (28%) and 25 (34.25%) of the non-fermenter isolates were ESBL and MBL producers respectively. The prevalence of blaCTX-M-15 and blaIMP genes among the 75 non-fermenter isolates was 7 (9.3%) and 1 (1.3%), respectively. Fortunately, no other genes were detected in either of the non-fermenters. The mortality rate due to MBL-producing isolates was 5 (20%). This study showed specific resistance genes exist among some MBL and ESBL gram-negative non-fermenters which were isolated from burn patients in Tehran.

Clinicopathologic characteristics and outcome of childhood and adolescent Ewing's sarcoma in center of Iran

BACKGROUND

Ewing's sarcoma family is a group of small round cells tumors. The aim of this study is to evaluate clinicopathologic characteristics and outcome of Ewing's sarcoma in children and adolescents in Yazd, Iran.

MATERIALS AND METHODS

All patients under 19 years with documented pathology of Ewing's sarcoma family tumor who referred to Shahid Ramazanzadeh Radiotherapy center between 2002 to 2010 were enrolled in this retrospective study. Overall survival and disease free survival and prognostic factors were evaluated.

RESULTS

Among approximately 80,000 patients who referred to Shahid Sadoughi pathology department, over an 8-year period, the total number of patients with Ewing sarcoma was 32, of which, 18 cases were under the age 19 . The mean age was 13.72 years. Five patients (27.8%) had metastatic disease at the time of diagnosis. Complete response had been achieved in 8 (44.4%) of the patients. Local recurrence occurred in 4 (22.2%) of the patients. During the follow up 13 (72.2%) of the patients showed metastases. The mean overall survival was 34.79 months (95% CI: 22.27-47.32) .One, two, four and five year survival was 72%, 39%, 25% and 17% respectively. Complete remission occurred in 10 patients (63.6%). A trend of better overall survival was found in these patients (p=0. 55). When the brain and bone metastases occurred, the overall survival decreased significantly (p=0. 003 ).

CONCLUSIONS

The overall survival rate of Ewing's sarcoma is very low in comparison with other parts of the world.

Mosaic and partial monosomy of chromosome 21 in a case with low platelets count

BACKGROUND

Monosomy is defined as the presence of only one chromosome instead of two in humans. Partial monosomy occurs when only a portion of the chromosome is present in a single copy, while the rest has two copies. It can occur in unbalanced translocations or deletions.

CASE REPORT

In this report, a 6 years old girl was presented who was referred to the Pediatric Dep, Shahid Sadoughi Hospital,Yazd, Iran, due to multiple congenital anomalies such as: frontal bossing, horizontal palpebral fissure, small deepest eyes, aplastic nasal bridge, broad philtrum, low set ears, large prominent ears, short neck, microcephaly, pectus excavatum, mental retardation, and dislocation of the hip. In peripheral blood smear, platelets were decreased but other hematological levels were normal. The karyotype result indicated a mosaic monosomy and partial monosomy of chromosome 21.

CONCLUSION

According to this and other case reports of monosomy of chromosome 21, this disease had very low prevalence rate among live infants or children. The present case had some congenital anomalies that present with abnormal medical condition. Therefore these patients must be evaluated for chromosomal studies.

Seroprovalence of herpes simplex1, 2 IgG antibodies in patients with beta thalassemia in a major tertiary care hospital located in Yazd, Iran

BACKGROUND

Patients with beta thalassemia suffer from increased susceptibility to infections and putridity plays a major role in the patient's morbidity and mortality. The risk of transfusion-transmitted viral infection is well known in these patients. However, there is dearth of information about the seroprevalence of herpes simplex virus (HSV) infection in patients with beta thalassemia in literature. This study analyzes the prevalence of anti-HSV1, 2 IgG antibodies in patients with beta thalassemia in a major tertiary care hospital located in Yazd,Iran.

MATERIAL AND METHODS

In this case control study, we undertook a serological study of HSV1,2 IgG antibodies among 45 patients with beta thalassemia and 45 healthy individuals as control group by ELISA method. A p.value <0.05 was considered statistically significant. Statistical analyses were performed using SPSS.20.

RESULTS

The prevalence of HSV 1,2 IgG antibodies were estimated 88.8% among patients with beta thalassemia and 77.7% in control group. Regarding p.value=0.64, it showed no significant difference in these two groups.

CONCLUSION

Although infectious diseases still represent a major challenge in patients with beta thalassemia, HSV past infection rate was not increased in these patients in our study. More studies are required to clarify this matter.

Evaluation of Zataria MultiFlora Boiss and Carum copticum antibacterial activity on IMP-type metallo-beta-lactamase-producing Pseudomonas aeruginosa

Carbapenem resistance due to acquired metallo-beta-lactamases (MBLs) is considered to be more serious than other resistance mechanisms. The aim of this study was to evaluate the antibacterial activity of Zataria multiflora Boiss and Carum copticum plants on IMP-producing P.aeruginosa strains. This experimental study was carried out on hospitalized burn patients during 2011 and 2012. Antibiotics and extracts susceptibility tests were performed by disc diffusion and broth microdilution methods. MBL detection was performed by Combination Disk Diffusion Test (CDDT). The bla(VIM) and bla(IMP) genes were detected by PCR and sequencing methods. Using Combination Disk Diffusion test method, it was found that among 83 imipenem resistant P.aeruginosa strains, 48 (57.9%) were MBL producers. PCR and sequencing methods proved that these isolates were positive for blaIMP-1 genes, whereas none were positive for bla(VIM) genes. The mortality rate of hospitalized patients with MBL-producing Pseudomonas infection was 4/48 (8.3%). It was shown that Zataria multiflora and Carum copticum extracts had a high antibacterial effect on regular and IMP-producing P. aeruginosa strains in 6.25 mg/ml concentration. The incidence of MBL-producing P. aeruginosa in burn patients is very high. In our study, all MBL-producing isolates carry the blaIMP-1 gene. Therefore, detection of MBL-producing isolates is of great importance in identifying drug resistance patterns in P. aeruginosa, and in prevention and control of infections. In this study, it was shown that extracts of Z. multiflora and C. copticum have high antibacterial effects on ß-lactamase producing P. aeruginosa strains.

Detection of OqxAB efflux pumps, OmpK35 and OmpK36 porins in extended-spectrum-β-lactamase-producing Klebsiella pneumoniae isolates from Iran

BACKGROUND & AIM

The aim of this study was the detection of OqxAB efflux pumps, OmpK35 and OmpK36 porins among extended-spectrum-β-lactamase-producing Klebsiella pneumoniae isolates from Iran.

MATERIALS AND METHODS

This study was conducted with 83 K. pneumoniae isolates from two hospitals in Tehran, Iran. Antibiotic susceptibility tests were performed by Kirby-Bauer disc diffusion and Broth Microdilution methods according to CLSI guidelines. The OqxAB , blaTEM, blaSHV and blaCTX-M genes were detected by PCR and sequencing methods.The outer membrane porins OmpK35 and OmpK36 were analyzed by SDS-PAGE, PCR and sequencing methods.

RESULTS

Among the 83 K. pneumoniae strains, 48 (57.5%) were ESBL positive. The existence of blaTEM, blaSHV and blaCTX-M was detected in 24 (50%), 30 (62.5%) and 28 (58.33%) ESBL-producing isolates respectively. The prevalence of both oqxA and oqxB detected in K. pneumoniae was high: 50 (60.2%) and 50 (60.2%), respectively. OmpK35 was detected in 30 (62.5%) while OmpK36 was found in 35 (72.91%) out of 48 ESBL-producing isolates. In this study, fosfomycin and tigecycline were more active than other antibiotics.

CONCLUSIONS

The prevalence of beta-lactamase-producing K. pneumoniae detected in this study is of great concern and highlights the need of infection control measures including antibacterial management and prompt identification of beta-lactamase-producing isolates.

Comparing Electrolytes in Prestorage Leukocyte-Reduced Packed Cell versus Unfiltered Packed Cell

BACKGROUND

Blood transfusion is associated with side effects caused by residual leukocytes in blood and blood components. Using leukodepleted blood components can decrease some of these adverse effects. Among the various methods to remove leukocytes in blood components, prestorage leukoreduction has been most efficient, but the evidence of clinical side effects awaits further studies. We evaluated changes of electrolytes in prestorage leukocyte-reduced red blood cells.

MATERIALS AND METHODS

In this case-control study, one hundred twenty eight packed cells were studied: 64 unfiltered packed cells and 64 prestorage filtered packed cell. Two groups were matched as sex and age. Electrolytes such as Calcium, Sodium, and Potassium of two groups were measured, and compared during preparation.

RESULTS

In this study, mean of Calcium in unfiltered and filtered group were 6.16±1.09 mg/dl and 5.57±2.21 mg/dl, respectively (P-value<0.055). Mean of Sodium in unfiltered group also was 155.91+/-9.51meq/l and in filtered group, 153.05+/-13.21meq/l (P-value<0.163), and mean of Potassium in unfiltered group was 5.01+/-1.72 meq/l and in filtered group, 7.42+/-2.45meq/l (P-value<0.001).

CONCLUSION

Releasing of Potassium during preparation of prestorage leukoreduction can cause increased Potassium level and hemoglobin concentration changes in prestorage filtered packed cell.

Thrombocytopenia and Associated Factors in Neonates Admitted to NICU during Years 2010_2011

BACKGROUND

Thrombocytopenia is the most common hematological abnormality which is encountered in the neonatal intensive care unit (NICU). The incidence in neonates varies greatly, depending upon the population studies. According to the frequency of thrombocytopenia and its complications and because of lack of such research in Iran, this study was performed on neonates admitted to Shahid Sadughi NICU during years 2011-2012.

MATERIALS AND METHODS

In a retrospective study, 350 neonates who were admitted to NICU were enrolled in the study. They were categorized to three groups regarding platelet count: mild, moderate and severe thrombocytopenia. Incidence of thrombocytopenia was determined and contribution of variables such as sex, gestational age, intrauterine growth retardation, asphyxia, sepsis, necrotizing enterocolitis, blood group, placental insufficiency in Gestational Diabetes Mellitus (GDM) and hypertension (HTN) were analyzed.

RESULTS

Neonatal thrombocytopenia was found in 100(28.5%) of 350 subjects, consisted of 75.3% early onset and 24.7% late onset, which most of them (96.5%) had mild and moderate thrombocytopenia, and just 3.5% had developed severe thrombocytopenia. Thrombocytopenia was associated with sepsis, intrauterine growth retardation sepsis, asphyxia, GDM, maternal hypertension and prematurity. There was no relation between occurrence of thrombocytopenia and gender.

CONCLUSION

 The incidence of neonatal thrombocytopenia was 28.5 %. Significant maternal risk factors that lead to thrombocytopenia were HTN and preeclampsia, while risk factors of neonates were asphyxia, sepsis and Intera Uterus Growth Retardation.

Effect of two Different Concentrations of Propofol and Ketamine Combinations (Ketofol) in Pediatric Patients under Lumbar Puncture or Bone Marrow Aspiration

BACKGROUND

Ketamine is an anesthetic drug that is importantly analgesic without respiratory depression. Ketamine increases blood pressure and heart rate. Propofol is an anesthetic drug with good sedation, rapid recovery, but it causes respiratory depression, low heart rate and low blood pressure. Combination of Ketamine and Propofol provides sedation, analgesia and rapid recovery with hemodynamic stability and minimal respiratory depression. The aim of this study was to compare two different combinations of these two drugs to reach necessary sedation scale for the Lp or BMA in pediatric with ALL.

MATERIALS AND METHODS

This randomized, double blinded study was designed to compare the quality of sedation and side effects of intravenous Ketofol on 60 patients of both gender. Patients received titrated injection of a solution containing combination of one part of Ketamine and two parts of Propofol (1:2) (group I) or one part of Ketamine and three parts of Propofol (1:3) (group II) to reach almost near 5 sedation level (using Ramsay Sedation Scale). Respiratory and hemodynamic profiles, amount of drug injected and side effects were recorded.

RESULTS

These drug combinations were used on 60 children with a median age of 6.2 years. In this study, recovery time and hallucination was significantly high in group I, but in both groups hemodynamic were stable, amnesia was enough, and there was no respiratory depression.

CONCLUSION

Lower doses of Ketamine in these combinations have lower psycho mimetic side effects, and shorter recovery time.

The effect of granulocyte colony stimulating factor administration on preterm infant with neutropenia and clinical sepsis: a randomized clinical trial

BACKGROUND

This study was conducted to evaluate the clinical effect of Granulocyte Colony Stimulating Factor (GCSF) on prognosis of neonatal sepsis.

MATERIALS AND METHODS

Present study is a double- blinded randomized clinical trial, conducted on 46 preterm infants with neutropenia (Absolute Neutrophil Count (ANC) ≤ 5000 / μL) and clinical sepsis. Infants were randomly allocated into two groups. In the first group (treatment group), infants were treated with GCSF for up to 5 consecutive days with 10 μg/ kg in addition to standard treatment protocols, and in other group, infants received normal saline as the placebo. Each infant was monitored for 14 days. Primary outcome was mortality during 14 days after entering the study, and secondary outcome was the incidence of positive blood culture, weight gain on the fourteenth day, the duration of hospitalization and medication side effects.

RESULTS

In the treated group, only one death was observed (P-value=1.00). However, no positive results for cultures were reported. Only one case in the treatment group and 3 patients in the control group showed feeding intolerance and needed respiratory support (P-value= 0.608). Length of hospitalization was 25 ± 6 days for the treatment group and 30 ± 7 days for the control group which was statistically significant (P-value=0.042).

CONCLUSION

The results of this study demonstrated that GCSF could reduce the hospital stay, but no significant effect was observed on mortality rate, respiratory or feeding status.

Comparing the efficacy of ceftazidime and meropenem in treatment of febrile neutropenia in pediatric patients with cancer

BACKGROUND

In cancer patients, various infections were developed due to severe neutropenia resulted from chemotherapy. Ceftazidime is commonly used as monotherapy of cancer patients with fever and neutropenia. Meropenem is a new carbapenem with more extended antibacterial spectrum including anaerobes. It provides better coverage against gram positives. This trial compared the efficacy and safety of meropenem with ceftazidime as empirical monotherapy for febrile neutropenia in pediatric patients with cancer.

MATERIALS AND METHODS

A prospective, double-blind, randomized clinical trial was conducted at Departments of Pediatric Haematology/Oncology, University Hospitals, Yazd, Iran, during the years 2012 to 2013. A total of 48 cancer patients participated in the trial.

RESULT

In this study, 26 patients (54.16%) were treated by ceftazidime and 22 patients (45.84%) by meropenem. Mean duration of fever in those who responded to treatment in ceftazidime group was 19.43+/-31.04 hours, and in meropenem group was 16.53+/-28.77 hours (P-value = 0.965).

CONCLUSION

Finding of this study indicate that ceftazidime and meropenem have similar efficacy in treatment of fever and sever neutropenia. Due to more availability and lower cost of ceftazidime than meropenem, ceftazidime is suggested as a first line treatment in fever and neutropenia.

Investigation of the Effect of Folic Acid Based Iron Oxide Nanoparticles on Human Leukemic CCRF-CEM Cell Line

BACKGROUND

Nanoparticulate drug delivery systems have attracted significant attention in the field of cancer nanotechnology. This study determines the effect of folate-based Fe2O3 nanoparticles. This study aimed to decorate nanoparticles with folate (FA), a molecular ligand for 'active' targeting of cancerous cells and the application of modified-nanoparticles in cancer treatment.

MATERIALS AND METHODS

The nanoparticles were prepared by a solvent evaporation and emulsification cross-linking method and anticancer activity of agent was evaluated on CCRF CEM cells, derived from human blood cancer samples.

RESULTS

The physicochemical properties of the nanoparticles were characterized by various techniques, and uniform nanoparticles with an average particle size of 110±15 nm were obtained. Cytotoxicity tests showed that the SPIO-FA had higher cell toxicity, and confocal microscopy analysis confirmed excellent cellular uptake efficiency.

CONCLUSION

These results indicate that FA based SPIO-NPs have potential uses as anticancer drug carriers and also have an enhanced anticancer effect.

Infantile fibrosarcoma in a child: a case report

BACKGROUND

Infantile Fibrosarcoma is a rare soft tissue tumor in infants and children mostly located in extremities. An infantile and adult form has similar histopathological patterns but survival prognosis is much better in infantile form. Recurrence of infantile fibrosarcoma is common but the rates of metastasis are less than 10 percent in children younger than five Years and 50 percent in children more than 10 years old.

CASE PRESENTATION

In this case report, we presented a nine years girl with a relapsing mass in her left hand. The pathologic findings showed sheets of spindle-shaped cells with suggested diagnose of infantile fibrosarcoma. She was successfully treated with combination of surgery and chemotherapy with a good outcome.

CONCLUSION

Infantile fibrosarcoma is a differential diagnose of soft tissue mass in infants and children. It has a good prognosis and distant metastasis is uncommon. Choice of treatment is surgery but chemotherapy and radiotherapy were useful in decrease metastasis.

Optimization of transfection methods for Huh-7 and Vero cells: A comparative study

Availability of an efficient transfection protocol is the first determinant in success of gene transferring studies in mammalian cells which is accomplished experimentally for every single cell type. Herein, we provide data of a comparative study on optimization of transfection condition by electroporation and chemical methods for Huh-7 and Vero cells. Different cell confluencies, DNA/reagent ratios and total transfection volumes were optimized for two chemical reagents including jetPEI™ and Lipofectamine™ 2000. Besides, the effects of electric field strength and pulse length were investigated to improve electroporation efficiency. Transfection of cells by pEGFP-N1 vector and tracking the expression of GFP by FACS and Fluorescence Microscopy analysis were the employed methods to evaluate transfection efficiencies. Optimized electroporation protocols yielded 63.73 ± 2.36 and 73.9 ± 1.6% of transfection in Huh-7 and Vero cells respectively, while maximum achieved level of transfection by jetPEI™ was 14.2 ± 0.69 and 28 ± 1.11% Huh-7 and Vero cells, respectively. Post transfectional chilling of the cells did not improve electrotransfection efficiency of Huh-7 cells. Compared to chemical based reagents, electroporation showed superior levels of transfection in both cell lines. The presented protocols should satisfy most of the experimental applications requiring high transfection efficiencies of these two cell lines.

Optimization of transfection methods for Huh-7 and Vero cells: comparative study

Availability of an efficient transfection protocol is the first determinant in success of gene transferring studies in mammalian cells which is accomplished experimentally for every single cell type. Herein, we provide data of a comparative study on optimization of transfection condition by electroporation and chemical methods for Huh-7 and Vero cells. Different cell confluencies, DNA/reagent ratios and total transfection volumes were optimized for two chemical reagents including jetPEI and Lipofectamine 2000. Besides, the effects of electric field strength and pulse length were investigated to improve electroporation efficiency. Transfection of cells by pEGFP-N1 vector and tracking the expression of GFP by FACS and Fluorescence Microscopy analysis were the employed methods to evaluate transfection efficiencies. Optimized electroporation protocols yielded 63.73 +/- 2.36 and 73.9 +/- 1.6% of transfection in Huh-7 and Vero cells respectively, while maximum achieved level of transfection by jetPEI was respectively 14.2 +/- 0.69 and 28 +/- 1.11% for the same cells. Post transfectional chilling of the cells did not improve electrotransfection efficiency of Huh-7 cells. Compared to chemical based reagents, electroporation showed the superior levels of transfection in both cell lines. The presented protocols should satisfy most of the experimental applications requiring high transfection efficiencies of these two cell lines.