Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic.

METHODS

The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic.

FINDINGS

Global DALYs increased from 2·63 billion (95% UI 2·44-2·85) in 2010 to 2·88 billion (2·64-3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7-17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8-6·3) in 2020 and 7·2% (4·7-10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0-234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7-198·3]), neonatal disorders (186·3 million [162·3-214·9]), and stroke (160·4 million [148·0-171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3-51·7) and for diarrhoeal diseases decreased by 47·0% (39·9-52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54-1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5-9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0-19·8]), depressive disorders (16·4% [11·9-21·3]), and diabetes (14·0% [10·0-17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7-27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6-63·6) in 2010 to 62·2 years (59·4-64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6-2·9) between 2019 and 2021.

INTERPRETATION

Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades.

FUNDING

Bill & Melinda Gates Foundation.

CARDIOPROTECTIVE EFFECT OF DICHLOROMETHANE VALERIAN (VALERIANA OFFICINALIS) EXTRACT ON ISCHEMIA-REPERFUSION-INDUCED CARDIAC INJURIES IN RATS

Background

Valepotriate is an active ingredient of valerian (Valeriana officinalis) with strong antioxidant activity that is effective for numerous cardiovascular diseases.

Objective

The aim of this study was to investigate the effect of an active ingredient of V. officinalis extract on ischemia-reperfusion-induced cardiac injuries in male rats.

Methods

Thirty-two male rats were subjected to ischemia for 40 minutes and reperfusion for five days. The rats were divided into 4 groups of 8 each; group 1 (control) was given normal saline, and groups 2-4 were gavaged with 0.2, 0.1, 0.05 mg/kg of valepotriate extract, respectively, and received extract (0.2 mg/kg ip) two weeks before ischemia induction.

Results

Dichloromethane V. officinalis (valepotriate) extract exerted a protective effect against ischemia-reperfusion-induced injuries. So that infarct size and number of ventricular arrhythmia and ventricular escape beats decreased compared to the control group. Moreover, ST segment amplitude, QTC interval, and heart rate decreased in the injured hearts and serum levels of antioxidant enzymes glutathione peroxidase, catalase, and superoxide dismutase increased. Biochemical markers malondialdehyde and lactate dehydrogenase also decreased on day 5 after the onset of reperfusion.

Conclusion

V. officinalis extract may have a protective effect against myocardial ischemia-reperfusion by producing antioxidant effects.

Sensitivity of actuation dynamics on normal and lateral Casimir forces: Interaction of phase change and topological insulator materials

We investigated here the influence of the lateral and normal Casimir force on the actuation dynamics between sinusoidal corrugated surfaces undergoing both normal and lateral displacements. The calculations were performed for topological insulators and phase change materials that are of high interest for device applications. The results show that the lateral Casimir force becomes stronger by increasing the material conductivity and the corrugations toward similar sizes producing wider normal separation changes during lateral motion. In a conservative system, bifurcation and Poincaré portrait analysis shows that larger but similar in size corrugations and/or higher material conductivity favor stable motion along the lateral direction. However, in the normal direction, the system shows higher sensitivity on the optical properties for similar in size corrugations leading to reduced stable operation for higher material conductivity. Furthermore, in non-conservative systems, the Melnikov function with the Poincaré portrait analysis was combined to probe the possible occurrence of chaotic motion. During lateral actuation, systems with more conductive materials and/or the same but high corrugations exhibit lower possibility for chaotic motion. By contrast, during normal motion, chaotic behavior leading to stiction of the moving components is more likely to occur for systems with more conductive materials and similar in magnitude corrugations.

Seroprevalence and trends of transfusion transmissible infections among retrospective blood donors in Western Azerbaijan Regional Blood Transfusion Center, Iran: A ten-years evaluation

Transfusion transmissible infections (TTIs) have been a public health challenge for the accessibility, quality and safety of blood transfusion. The present study aimed to consider the prevalence and the trends of hepatitis B virus (HBV), hepatitis C virus (HCV), Human T-cell leukemia virus type 1 (HTLV-1), human immunodeficiency virus (HIV) and syphilis across the ten years among retrospective blood donors. A retrospective investigation of blood donors' data covering the period from 22 May 2009 to 22 May 2019 was done. Data was accumulated and analyzed from Blood Transfusion Center records, pertaining to all donors who were screened for various TTIs using respective immunological techniques. Out of the 682,171 screened donors in the 2009-2019 study period, 2470 (0.36 %) were infected with at least one infectious agent. The overall prevalence of HBV, HCV, HTLV-1, HIV and syphilis were 1700 (0.25 %), 184 (0.027 %), 335 (0.05 %), 4 (0.0.05 %) and 247 (0.036 %), respectively. The study showed male dominated donor pool (96.79 %) with higher prevalence (0.34 %) of TTIs compared to female donors (0.02 %) with 3.21 % population. Despite the low prevalence of TTIs in our study, HBV, HCV, syphilis and HIV have remained a big threat to safe blood transfusion in Iran. Strict adherence to selection criteria, algorithm of donor screening, use of highly sensitive and specific methods for detection of TTIs, regular consultation and health education programs, prevention and sanitization strategies to reduce the risk of TTIs are recommended to reduce the risk of TTIs and ensure the safety of blood transfusion for recipient.

Staphylococcal enterotoxins as good candidates for cancer immunotherapy: a systematic review

BACKGROUND

Cancer is considered as one of the leading causes of death today. The wrong lifestyles have led to an increase in the incidence rate of this deadly disease. There are many complications associated with common treatments of this disease. Immunotherapy is one of the new approaches taken recently. The purpose of this systematic review was to evaluate the studies on Staphylococcus aureus enterotoxins as a treatment of cancer worldwide.

STUDY DESIGN

We conducted a systematic review of articles published in PubMed, Cochrane, Scopus and Google scholar databases from 1995 to 2016 to evaluate the effects of Staphylococci enterotoxins on cancer.

METHODS

Eligible studies were evaluated qualitatively based on a checklist prepared by two independent reviewers, and they were subsequently matched.

RESULTS

Our review identified 97 records through searching PubMed and Cochrane database and 1306 records through searching Google scholar and Scopus. Forty six studies were excluded from PubMed and Cochrane database and 1281 studies were excluded from Google scholar and Scopus after screening abstracts and titles. Therefore, our systematic review was based on 51 publications on PubMed and Cochrane, and 25 publications on Google scholar and Scopus, which met our criteria. Staphylococcal enterotoxin A was the most commonly used toxin in these studies. The side effects of using this toxin in immunotherapy have been reported to be low and all studies have identified this toxin as a suitable option for immunotherapy.

CONCLUSIONS

The data obtained from these studies showed that due to the low rates of complications, Staphylococcal enterotoxins have the potential to induce immune system against various cancers as super-antigens. Therefore, they can be considered as a suitable candidate for immunotherapy of cancer.

Chaotic motion due to lateral Casimir forces during nonlinear actuation dynamics

We investigated here the influence of the lateral Casimir force on the dynamical actuation of devices with interacting materials covering a broad range of optical properties ranging from poor to good conductors, such as, for example, nitrogen doped SiC and Au, respectively. The conservative actuating system shows a central heteroclinic orbit surrounded by a finite number of homoclinic orbits, because at higher periods, an increased lateral Casimir force will be necessary to counterbalance the restoring force. As a result, the conservative system reaches stable operation sooner for the higher conductivity materials (Au-Au), indicating the significant impact of the material optical properties on the lateral Casimir force. Furthermore, for the non-conservative driven systems, the decrement of the Melnikov parameter α leads to a faster disappearance of the satellite homoclinic orbits in the Poincaré portraits, followed by a strong shrinkage of the central heteroclinic orbit toward unstable chaotic motion. The latter is more pronounced for the lower conductivity materials since comparison shows the Au-Au system to be significantly more stable than the SiC-SiC system. Therefore, in actuating systems where the lateral Casimir force could play a significant role, the higher conductivity materials appear to be a better choice to ensure stable operation against a chaotic motion.

Sensitivity of nonequilibrium Casimir forces on low frequency optical properties toward chaotic motion of microsystems: Drude vs plasma model

Here, we investigate the sensitivity of nonequilibrium Casimir forces to optical properties at low frequencies via the Drude and plasma models and the associated effects on the actuation of microelectromechanical systems. The stability and chaotic motion for both autonomous conservative and nonconservative driven systems were explored assuming good, e.g., Au, and poor, e.g., doped SiC, interacting conductors having large static conductivity differences. For both material systems, we used the Drude and plasma methods to model the optical properties at low frequencies, where measurements are not feasible. In fact, for the conservative actuating system, bifurcation and phase space analysis show that the system motion is strongly influenced by the thermal nonequilibrium effects depending on the modeling of the optical properties at low frequencies, where also the presence of residual electrostatic forces can also drastically alter the actuating state of the system, depending strongly on the material conductivity. For nonconservative systems, the Melnikov function approach is used to explore the presence of chaotic motion rendering predictions of stable actuation or malfunction due to stiction on a long-term time scale rather impossible. In fact, the thermal effects produce the opposite effect for the emerging chaotic behavior for the Au-Au and SiC-SiC systems if the Drude model is used to model the low optical frequencies. However, using the plasma model, only for the poor conducting SiC-SiC system, the chance of chaotic motion is enhanced, while for the good conducting Au-Au system, the chaotic behavior will remain unaffected at relatively short separations (<2 μm).

Sensitivity of chaotic behavior to low optical frequencies of a double-beam torsional actuator

We investigate here how the optical properties at low frequencies affect the actuation dynamics and emerging chaotic behavior in a double-beam torsion actuator at nanoscale separations (<200nm), where the Casimir forces and torques play a major role. In fact, we take into account differences of the Casimir force due to alternative modeling of optical properties at low frequencies, where measurements are not feasible, via the Drude and plasma models, and repercussions by different material preparation conditions. For conservative autonomous actuation, bifurcation and phase portrait analysis indicate that both factors affect the stability of an actuating device in such a way that stronger Casimir forces and torques will favor increased unstable behavior. The latter will be enhanced by unbalanced application of electrostatic voltages in double-beam actuating systems. For the case of a time-periodic driving force, we use a Melnikov function and a phase plane analysis to study the emerging chaotic behavior with respect to the Drude and plasma modeling and material preparation conditions. We find indications that any factor that leads to stronger Casimir interactions will aid chaotic behavior and prevent long term prediction of the actuating dynamics. Moreover, in a double-beam actuator chaoticity will be amplified by the application of unbalanced electrostatic voltages. Therefore, the details of modeling of optical properties and the material preparations conditions must be carefully considered in the design of actuating devices at nanoscale because here Casimir forces are omnipresent and broadband type interactions.

Dependence of non-equilibrium Casimir forces on material optical properties toward chaotic motion during device actuation

The sensitivity of nonequilibrium Casimir forces on material optical properties can have strong impact on the actuation of devices. For this purpose, we considered nonequilibrium Casimir interactions between good and poor conductors, for example, gold (Au) and highly doped silicon carbide (SiC), respectively. Indeed, for autonomous conservative systems, the bifurcation and phase portrait analysis have shown that the nonequilibrium Casimir forces can have significant impact on the stable and unstable operating regimes depending on the material optical properties. At a few micrometer separations, for systems with high conductivity materials, an increasing temperature difference between the actuating components can enhance the stable operation range due to the reduction of the Casimir force, while for the poor conductive materials, the opposite takes place. For periodically driven dissipative systems, the Melnikov function and Poincare portrait analysis have shown that for poor conductive systems, the nonequilibrium Casimir forces lead to an increased possibility for chaotic behavior and stiction with an increasing temperature difference between the actuating components. However, for good conducting systems, the thermal contribution to Casimir forces reduces the possibility for chaotic behavior with increasing temperature, as comparison with systems without thermal fluctuations shows. Nevertheless, the positive benefit of good conductors toward increased actuation stability and reduced the chaotic behavior under nonequilibrium conditions can be easily compromised by any voltage application. Therefore, thermal, nonequilibrium Casimir forces can influence the actuation of devices toward unstable and chaotic behavior in strong correlation with their optical properties, and associated conduction state, as well as applied electrostatic potentials.

Differentiation of Brucella abortus and B. melitensis biovars using PCR-RFLP and REP-PCR

Brucellosis is one of the most common zoonotic diseases of animal and human beings. This study aimed to differentiate the Brucella spp. and determines the patterns of biovars by using repetitive element palindromic (REP)-PCR and PCR restriction fragment length polymorphism (RFLP) methods. A total of 100 blood specimens suspected of harbouring brucellosis were collected. Conventional culture methods and multiplex PCR were used for the detection of Brucella genus and species; and REP-PCR was used for Brucella spp. differentiation and polymorphisms sequence analysis. In addition, to identify the biovar patterns of REP-PCR, PCR-RFLP was used. Eighty-three samples were identified as harbouring Brucella spp. by the implementation of multiplex PCR, 72 of which were detected as Brucella melitensis and 11 as B. abortus. Also, through analysing the results of PCR-RFLP, it was found that of 72 B. melitensis samples, 69 were B. melitensis biovar 1 and three species were from other biovars. In addition, the obtained patterns for all of the B. abortus samples were from biovars 3, 5, 6 and 9. This study also optimized a test for the detection of Brucella biovar with the REP-PCR method such that Brucella spp. and biovars could be separated in the shortest possible time.

Therapeutic bacteria to combat cancer; current advances, challenges, and opportunities

Successful treatment of cancer remains a challenge, due to the unique pathophysiology of solid tumors, and the predictable emergence of resistance. Traditional methods for cancer therapy including radiotherapy, chemotherapy, and immunotherapy all have their own limitations. A novel approach is bacteriotherapy, either used alone, or in combination with conventional methods, has shown a positive effect on regression of tumors and inhibition of metastasis. Bacteria-assisted tumor-targeted therapy used as therapeutic/gene/drug delivery vehicles has great promise in the treatment of tumors. The use of bacteria only, or in combination with conventional methods was found to be effective in some experimental models of cancer (tumor regression and increased survival rate). In this article, we reviewed the major advantages, challenges, and prospective directions for combinations of bacteria with conventional methods for tumor therapy.

Prevalence of extended-spectrum beta-lactamase genes in Acinetobacter baumannii strains isolated from nosocomial infections in Tehran, Iran

Background and objectives:bla_SHV, bla_TEM and bla_VEB are a group of Extended-Spectrum Beta-Lactamase enzymes (ESBLs) which are able to hydrolyze Penicillins and some cephalosporin antibiotics. The present study evaluated the frequency of ESBL genes bla_SHV, bla_TEM and bla_VEB in Acinetobacter baumannii strains isolated from nosocomial infections to outline the importance of these genes in antibiotic resistance.

Methods: One hundred Acinetobacter baumannii strains were isolated from different nosocomial infections. After antibiotic resistance evaluation with the Kirby-Bauer disc-diffusion method, the Minimum Inhibitory Concentration (MIC) of Ciprofloxacin was measured using the E-test method. Then, the ESBL producing strains were identified employing Combined Disk Methods. Finally, all isolates were evaluated with the Polymerase Chain Reaction (PCR) technique to detect the ESBL genes of interest.

Results: Out of 100 Acinetobacter baumannii isolates, 59% were ESBL positive according to the phenotypic method. The PCR assay could not detect the bla_SHV and bla_VEB genes in the studied isolates, but the presence of bla_TEM gene was demonstrated in 42% of the strains.

Conclusion: The high resistance to most antibiotics, the high prevalence of ESBLs-producing strains and also a high prevalence of bla_TEM gene in A. baumannii strains found in the current study gives cause for major concern about nosocomial infections in Iran because of the treatment complexity of these strains. Our results highlight the need for infection control measures to prevent the spread of resistant isolates, especially in hospitals.

Fosfomycin: mechanisms and the increasing prevalence of resistance

There are challenges regarding increased global rates of microbial resistance and the emergence of new mechanisms that result in microorganisms becoming resistant to antimicrobial drugs. Fosfomycin is a broad-spectrum bactericidal antibiotic effective against Gram-negative and certain Gram-positive bacteria, such as Staphylococci, that interfere with cell wall synthesis. During the last 40 years, fosfomycin has been evaluated in a wide range of applications and fields. Although numerous studies have been done in this area, there remains limited information regarding the prevalence of resistance. Therefore, in this review, we focus on the available data concerning the mechanisms and increasing resistance regarding fosfomycin.

Dependence of chaotic behavior on optical properties and electrostatic effects in double-beam torsional Casimir actuation

We investigate the influence of Casimir and electrostatic torques on double-beam torsional microelectromechanical systems with materials covering a broad range of conductivities of more than three orders of magnitude. For the frictionless autonomous systems, bifurcation and phase space analysis shows a significant difference between stable and unstable operating regimes for equal and unequal applied voltages on both sides of the double torsional system giving rise to heteroclinic and homoclinic orbits, respectively. For equal applied voltages, only the position of a symmetric unstable saddle equilibrium point is dependent on the material optical properties and electrostatic effects, while in any other case stable and unstable equilibrium points are dependent on both factors. For the periodically driven system, a Melnikov function approach is used to show the presence of chaotic motion rendering predictions of whether stiction or stable actuation will take place over long times impossible. Chaotic behavior introduces significant risk for stiction, and it is more likely to occur for the more conductive systems that experience stronger Casimir forces and torques. Indeed, when unequal voltages are applied, the sensitive dependence of chaotic motion on electrostatics is more pronounced for the highest conductivity systems.

Comparison of gut microbiota in adult patients with type 2 diabetes and healthy individuals

Recent studies indicate that inflammatory reactions leading to the development of type 2 diabetes mellitus (T2DM) may also contribute to variations in the composition of the intestinal microbiota, suggesting a relation between T2DM and bacterial residents in the intestinal tract. This case-control study was designed to evaluate the composition of the gut microbiota dominant bacterial groups in patients with T2DM compared to the healthy people. A total of 36 adult subjects (18 patients diagnosed with T2DM and 18 healthy persons) were included in the study. The intestinal microbiota composition was investigated by quantitative real-time polymerase chain reaction (qPCR) method using bacterial 16S rRNA gene. The quantities of two groups of bacteria were meaningfully different among T2DM patients and healthy individuals. While, the level of Lactobacillus was significantly higher in the patients with T2DM (P value < 0.001), Bifidobacterium was significantly more frequent in the healthy people (P value < 0.001). The quantities of Prevotella (P value = 0.0.08) and Fusobacterium (P value = 0.99) genera in faecal samples were not significantly different between the two groups. The significant alterations in dominant faecal bacterial genera found in T2DM patients participating in the current study highlight the link between T2DM disease and compositional variation in intestinal flora. These findings may be valuable for developing approaches to control T2DM by modifying the gut microbiota. More investigations with focus on various taxonomic levels (family, genus and species) of bacteria are necessary to clarify the exact relevance of changes in the gut microbial communities with the progression of T2DM disorder.

Drug-resistant gram-negative uropathogens: A review

Urinary tract infection(UTI) caused by Gram-negative bacteria is the second most common infectious presentation in community medical practice. Approximately 150 million people are diagnosed with UTI each year worldwide. Drug resistance in Gram-negative uropathogens is a major global concern which can lead to poor clinical outcomes including treatment failure, development of bacteremia, requirement for intravenous therapy, hospitalization, and extended length of hospital stay. The mechanisms of drug resistance in these bacteria are important due to they are often not identified by routine susceptibility tests and have an exceptional potential for outbreaks. Treatment of UTIs depends on the access to effective drugs, which is now threatened by antibiotic resistant Gram-negative uropathogens. Although several effective antibiotics with activity against highly resistant Gram-negatives are available, there is not a unique antibiotic with activity against the high variety of resistance. Therefore, antimicrobial susceptibility tests, correlation between clinicians and laboratories, development of more rapid diagnostic methods, and continuous monitoring of drug resistance are urgent priorities. In this review, we will discuss about the current global status of drug-resistant Gram-negative uropathogens and their mechanisms of drug resistance to provide new insights into their treatment options.

Molecular detection of β-lactamase and integron genes in clinical strains of Klebsiella pneumoniae by multiplex polymerase chain reaction

INTRODUCTION:

Infections caused by β-lactamase-producing gram-negative bacteria, such as Klebsiella pneumoniae, are increasing globally with high morbidity and mortality. The aim of the current study was to determine antimicrobial susceptibility patterns and the prevalence of antibiotic resistance genes (β-lactamase and integron genes) using multiplex PCR.

METHODS

One-hundred K. pneumoniae isolates were collected from different clinical samples. Antibiotic susceptibility testing was performed with thirteen different antibiotics. Multiplex-PCR was used to detect β-lactamase (bla TEM, bla CTX-M, bla SHV , bla VEB, bla PER, bla GES, bla VIM, bla IMP, bla OXA, and bla KPC) and integron genes (int I, int II, and int III).

RESULTS:

The highest and lowest rate of resistance was exhibited against amikacin (93%) and imipenem (8%), respectively. The frequency of β-lactamase-positive K. pneumoniae was 37%, and the prevalence of the bla TEM, bla CTX-M, bla SHV , bla VEB, bla PER, bla GES, bla VIM, bla IMP, bla OXA, and bla KPC genes was 38%, 24%, 19%, 12%, 6%, 11%, 33%, 0%, 28%, and 23%, respectively. Of the 100 isolates, eight (8%) were positive for class I integrons; however, class II and III integrons were not detected in any of the strains.

CONCLUSIONS:

These results indicate co-carriage of a number of β-lactamase genes and antibiotic resistance integrons on the same plasmids harboring multi-drug resistance genes. It seems that these properties help to decrease treatment complications due to resistant bacterial infections by rapid detection, infection-control programs and prevention of transmission of drug resistance.

The association of type II diabetes with gut microbiota composition

It is known that type 2 diabetes (T2D) in humans could be linked to the composition of gut microbiota. The aim of this study was to evaluate three faecal bacterial species, including Bacteroides fragilis, Bifidobacterium longum and Faecalibacterium prausnitzii in patients with T2D. This case control study included 18 patients with T2D and 18 matched persons without diabetes. The concentrations of B. fragilis, B. longum and F. prausnitzii were determined by quantitative Real-Time PCR. Quantitative PCR analysis revealed that the gut bacterial composition in patients with T2D was partially different from that in the healthy individuals. Faecalibacterium prausnitzii was significantly lower in patients with T2D (P-value = 0.038). Bacteroides fragilis was under-represented in the microbiota of the group with diabetes, but its difference between two groups was not significant (P-value = 0.38). No difference was observed for B. longum community between the both groups (P-value = 0.99). Characterization of specific species of intestinal microbiota shows some compositional changes in patients with T2D. The results may be valuable for developing strategies to control type 2 diabetes by modifying the intestinal microbiota. Long-term studies with emphasis on other bacterial groups are suggested to clarify the association of T2D with gut microbiota.

Epidemiology of multidrug-resistant Acinetobacter baumannii strains in Iran: a systematic review and meta-analysis

Acinetobacter baumannii is an important opportunistic pathogen that causes major public health concern especially in hospitalized patients due to the acquisition of multidrug resistance (MDR). The aim of this study was to systematically review published data about the prevalence rate of MDR-A. baumannii (MDR-AB) from different parts of Iran and provide an overall relative frequency (RF) using meta-analysis. All available national and international databanks were searched to find published studies up to June 2016. Quality of studies was assessed by STROB and PRISMA forms. Because of the significant heterogeneity observed, random effects model was used to combine the results. STATA SE version 11.2 was used for statistical analysis. Out of the 9646 results, 37 suitable articles were extracted according to inclusion and exlusion criteria. The pooled prevalence of MDR-AB was estimated 72% annually. Relative frequency of MDR-AB in different studies varied from 22.8 to 100%. Since the prevalence of MDR-AB is higher than many other countries, measures should be taken to keep the emergence and transmission of these strains to a minimum.

Molecular investigation of virulence factors of Brucella melitensis and Brucella abortus strains isolated from clinical and non-clinical samples

Brucella is zoonotic pathogen that induces abortion and sterility in domestic mammals and chronic infections in humans called Malta fever. It is a facultative intracellular potential pathogen with high infectivity. The virulence of Brucella is dependent upon its potential virulence factors such as enzymes and cell envelope associated virulence genes. The aim of this study was to investigate the Brucella virulence factors among strains isolated from humans and animals in different parts of Iran. Seventy eight strains of Brucella species isolated from suspected human and animal cases from several provinces of Iran during 2015-2016 and identified by phenotypic and molecular methods. The multiplex-PCR (M-PCR) assay was performed in order to detect the ure, wbkA, omp19, mviN, manA and perA genes by using gene specific primers. Out of 78 isolates of Brucella spp., 57 (73%) and 21 (27%) isolates were detected as B. melitensis and B. abortus, respectively, by molecular method. The relative frequency of virulence genes ure, wbkA, omp19, mviN, manA and perA were 74.4%, 89.7%, 93.6%, 94.9%, 100% and 92.3%, respectively. Our results indicate that the most of Brucella strains isolated from this region possess high percent of virulence factor genes (ure, wbkA, omp19, mviN, manA and perA) in their genome. So, each step of infection can be mediated by a number of virulence factors and each strain may have a unique combination of these factors that affected the rate of bacterial pathogenesis.

Prevalence of hepatitis E infection in the general population of Iran: a systematic review and meta-analysis

Aim: Hepatitis E is a form of acute viral hepatitis, which is caused by hepatitis E virus (HEV). The study objective was to evaluate the prevalence of HEV to provide an overall relative frequency in Iran. Methods: In this study, databases such as PubMed and Scopus were searched using the following keywords according to MeSH, “Hepatitis E virus”, “Epidemiology”, “Enzyme-linked immunosorbent assay (ELISA)” and “Iran”. Then studies which had reported prevalence of HEV were selected. Results: We selected 36 researches out of 9246 for our study. From all the samples, the pooled estimated prevalence of HEV positive was 9.7%. It should be noted that HEV infection's relative frequency varied from 1.1% in Tehran to 46.1% in Ahvaz. Conclusion: HEV is common in Iran, although comparing to some neighboring countries, its prevalence is lower.

High pressure gas flow, storage, and displacement in fractured rock-Experimental setup development and application

This paper presents the design, development, and application of a laboratory setup for the experimental investigations of gas flow and reactions in a fractured rock. The laboratory facility comprises (i) a high pressure manometric sorption apparatus, where equilibrium and kinetic phenomena of adsorption and desorption can be examined, (ii) a high pressure triaxial core flooding system where the chemical reactive transport properties or processes can be explored, and (iii) an ancillary system including pure and mixed gas supply and analysis units. Underground conditions, in terms of pore pressure, confining pressure, and temperature, can be replicated using the triaxial core flooding system developed for depths up to 2 km. Core flooding experiments can be conducted under a range of gas injection pressures up to 20 MPa and temperatures up to 338 K. Details of the design considerations and the specification for the critical measuring instruments are described. The newly developed laboratory facility has been applied to study the adsorption of N₂, CH₄, and CO₂ relevant to applications in carbon sequestration in coal and enhanced coalbed methane recovery. Under a wide range of pressures, the flow of helium in a core sample was studied and the evolution of absolute permeability at different effective stress conditions has been investigated. A comprehensive set of high resolution data has been produced on anthracite coal samples from the South Wales coalfield, using the developed apparatus. The results of the applications provide improved insight into the high pressure flow and reaction of various gas species in the coal samples from the South Wales coalfield.

Prevalence, and virulence determination of Listeria monocytogenes strains isolated from clinical and non-clinical samples by multiplex polymerase chain reaction

INTRODUCTION:

This study aimed to determine the prevalence, and virulence factors of Listeria monocytogenes isolated from various samples by multiplex polymerase chain reaction (MPCR).

METHODS:

A total of 617 isolates were obtained and MPCR was employed for detection of the inlA, inlC, and inlJ genes.

RESULTS:

L. monocytogenes was detected in 46 (7.45%) of the 617 specimens. inlA, inlC, and inlJ were detected in 100%, 76.26%, and 71% isolates, respectively.

CONCLUSIONS:

This study validated MPCR in the analysis and rapid detection of L. monocytogenes. The role of the genes in pathogenesis of the strains can also be affirmed.

Capillary-force measurement on SiC surfaces

Capillary forces have been measured by atomic force microscopy in the sphere-plate geometry, in a controlled humidity environment, between smooth silicon carbide and borosilicate glass spheres. The force measurements were performed as a function of the rms surface roughness ∼4-14 nm mainly due to sphere morphology, the relative humidity (RH) ∼0%-40%, the applied load on the cantilever, and the contact time. The pull-off force was found to decrease by nearly two orders of magnitude with increasing rms roughness from 8 to 14 nm due to formation of a few capillary menisci for the roughest surfaces, while it remained unchanged for rms roughness <8 nm implying fully wetted surface features leading to a single meniscus. The latter reached a steady state in less than 5 s for the smoothest surfaces, as force measurements versus contact time indicated for increased RH∼40%. Finally, the pull-off force increases and reaches a maximum with applied load, which is associated with plastic deformation of surface asperities, and decreases at higher loads.

Phylogenetic Analysis of Prevalent Tuberculosis and Non-Tuberculosis Mycobacteria in Isfahan, Iran, Based on a 360 bp Sequence of the rpoB Gene

Background

Taxonomic and phylogenetic studies of Mycobacterium species have been based around the 16sRNA gene for many years. However, due to the high strain similarity between species in the Mycobacterium genus (94.3% - 100%), defining a valid phylogenetic tree is difficult; consequently, its use in estimating the boundaries between species is limited. The sequence of the rpoB gene makes it an appropriate gene for phylogenetic analysis, especially in bacteria with limited variation.

Objectives

In the present study, a 360bp sequence of rpoB was used for precise classification of Mycobacterium strains isolated in Isfahan, Iran.

Materials and Methods

From February to October 2013, 57 clinical and environmental isolates were collected, subcultured, and identified by phenotypic methods. After DNA extraction, a 360bp fragment was PCR-amplified and sequenced. The phylogenetic tree was constructed based on consensus sequence data, using MEGA5 software.

Results

Slow and fast-growing groups of the Mycobacterium strains were clearly differentiated based on the constructed tree of 56 common Mycobacterium isolates. Each species with a unique title in the tree was identified; in total, 13 nods with a bootstrap value of over 50% were supported. Among the slow-growing group was Mycobacterium kansasii, with M. tuberculosis in a cluster with a bootstrap value of 98% and M. gordonae in another cluster with a bootstrap value of 90%. In the fast-growing group, one cluster with a bootstrap value of 89% was defined, including all fast-growing members present in this study.

Conclusions

The results suggest that only the application of the rpoB gene sequence is sufficient for taxonomic categorization and definition of a new Mycobacterium species, due to its high resolution power and proper variation in its sequence (85% - 100%); the resulting tree has high validity.

Epidemiology of Multidrug Resistant Uropathogenic Escherichia coli in Iran: a Systematic Review and Meta-Analysis

Urinary tract infection (UTI) is one of the most common infections in humans. It is primarily caused by uropathogenic Escherichia coli (UPEC), which has a high multidrug resistance (MDR). In consideration of the prevalence of MDR-UPEC strains, the aims of the present study were to systematically review the published data about the prevalence rate of MDR-UPEC from different parts of Iran and to establish the overall relative frequency (RF) of these strains in Iran. We searched several databases including PubMed, ISI Web of Science, Scopus, Google Scholar, IranMedex, and Iranian Scientific Information Database by using the following keywords: "Escherichia coli", "multidrug resistant", "MDR", "urinary tract infections", "UTI", "uropathogenic". and "Iran". Articles or abstracts that reported the prevalence of MDR-UPEC were included in this review. We found 15 articles suitable for inclusion in this study. A pooled estimation of 10,247 UPEC strains showed that 49.4% (95% confidence interval = 48.0-50.7%) of the stranis were MDR positive. The RF of MDR-UPEC in different studies varied from 10.5% to 79.2% in the Kashan and Hamedan provinces, respectively. According to the results of the present study, the RF of MDR-UPEC in Iran is high. Thus, measures should be taken to keep the emergence and transmission of these strains to a minimum.

High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran

BACKGROUND AND OBJECTIVES

Urinary tract infection (UTI) is one of the most frequent infectious diseases and can occur in all age groups. Escherichia coli is the main cause of this infection. Multiple resistances to antimicrobial agents are increasing quickly in E. coli isolates and may complicate therapeutic strategies for UTI. The aim of this study was to determine the antibiotic resistance pattern and the multidrug-resistance (MDR) phenotypes in uropathogenic E. coli (UPEC).

MATERIALS AND METHODS

A total of 135 UPEC isolates were collected from both outpatients (91 isolates) and inpatients (44 isolates) between September, 2012 and February, 2013. In order to determine the MDR among UPEC isolates, we have tested 15 antimicrobial agents and antibiotic susceptibility was done by Kirby-Bauer disk diffusion method.

RESULTS

The percentage of MDR isolates (resistant to at least three drug classes such as aminoglycosides, fluoroquinolones, penicillins, cephalosporins, or carbapenems) was 68% in the inpatients and 61% in the outpatients. Antibiotic resistance to ampicillin, ceftazidim, nalidixic acid, and trimethoprim/sulfamethoxazole were higher than 50%. Amikacin, nitrofurantoin, and gentamicin showed markedly greater activity (89.1%, 85.9%, and 82.4% sensitivity, respectively) than other antimicrobial agents. Resistance to meropenem did show either in outpatients or in inpatients.

INTERPRETATION AND CONCLUSIONS

The high prevalence of drug resistance among UTI patients calls for continuous monitoring of the incidence of drug resistance for appropriate empiric selection of antibiotic therapy. Empirical treatment of UTIs should be relied on susceptibility patterns from local studies.

In silico analysis and molecular modeling of RNA polymerase, sigma S (RpoS) protein in Pseudomonas aeruginosa PAO1

BACKGROUND

Sigma factors are proteins that regulate transcription in bacteria. Sigma factors can be activated in response to different environmental conditions. The rpoS (RNA polymerase, sigma S) gene encodes sigma-38 (σ38, or RpoS), a 37.8 kDa protein in Pseudomonas aeruginosa (P. aeruginosa) strains. RpoS is a central regulator of the general stress response and operates in both retroactive and proactive manners; not only does it allow the cell to survive environmental challenges; it also prepares the cell for subsequent stresses (cross-protection).

METHODS

The significance of RpoS for stress resistance and protein expression in stationary-phase P. aeruginosa cells was assessed. The goal of the current study was to characterize RpoS of P. aeruginosa PAO1 using bioinformatics tools.

RESULTS

The results showed that RpoS is an unstable protein that belongs to the sigma-70 factor family. Secondary structure analysis predicted that random coil is the predominant structure followed by extended alpha helix. The three-dimensional (3D) structure was modeled using SWISS-MODEL Workspace.

CONCLUSION

Determination of sequence, function, structure, and predicted epitopes of RpoS is important for modeling of inhibitors that will help in the design of new drugs to combat multi-drug-resistant (MDR) strains. Such information may aid in the development of new diagnostic tools, drugs, and vaccines for treatment in endemic regions.

In silico analysis and modeling of ACP-MIP-PilQ chimeric antigen from Neisseria meningitidis serogroup B

BACKGROUND

Neisseria meningitidis, a life-threatening human pathogen with the potential to cause large epidemics, can be isolated from the nasopharynx of 5-15% of adults. The aim of the current study was to evaluate biophysical and biochemical properties and immunological aspects of chimeric acyl-carrier protein-macrophage infectivity potentiator protein-type IV pilus biogenesis protein antigen (ACP-MIP-PilQ) from N. meningitidis serogroup B strain.

METHODS

Biochemical properties and multiple alignments were predicted by appropriate web servers. Secondary molecular structures were predicted based on Chou and Fasman, Garnier-Osguthorpe-Robson, and Neural Network methods. Tertiary modeling elucidated conformational properties of the chimeric protein. Proteasome cleavage and transporter associated with antigen processing (TAP) binding sites, and T- and B-cell antigenic epitopes, were predicted using bioinformatic web servers.

RESULTS

Based on our in silico and immunoinformatics analyses, the ACP-MIP-PilQ protein (AMP) can induce high-level cross-strain bactericidal activity. In addition, several immune proteasomal cleavage sites were detected. The 22 epitopes associated with MHC class I and class II (DR) alleles were confirmed in the AMP. Thirty linear B-cell epitopes as antigenic regions were predicted from the full-length protein.

CONCLUSION

All predicted properties of the AMP indicate it could be a good candidate for further immunological in vitro and in vivo studies.

Antibiotic Resistance Patterns and Genetic Diversity in Clinical Isolates of Pseudomonas aeruginosa Isolated From Patients of a Referral Hospital, Isfahan, Iran

Background:

Pseudomonas aeruginosa is a well-known opportunistic pathogen, which affects hospitalized patients in different wards due to its natural resistance to drugs.

Objectives:

The purpose of the current study was to determine the antibiotic susceptibility profiles and genetic relatedness in P. aeruginosa isolated from patients admitted to a referral hospital in Isfahan, Iran.

Materials and Methods:

Out of 150 analyzed samples, 54 P. aeruginosa isolates were recovered and were subjected to antibiotic resistance patterns and genetic diversity determination by Kirby-Bauer’s disk diffusion method and RAPD-PCR, respectively.

Results:

The highest percentage of resistance was observed against ceftazidime and imipenem with 30 (55.6%) isolates; meanwhile all isolates were sensitive to polymyxin B. Twenty-eight (51.8%) isolates revealed resistance to all applied antibiotics. RAPD-PCR (Random Amplified Polymorphic DNA- Polymerase Chain Reaction) results showed 54 unique genotypes, which were divided into 39 clusters.

Conclusions:

Although different source of P. aeruginosa may involve in patient colonization, genetically related strains were isolated from different wards and or the same ward of the hospital. Our results pointed to the restriction of currently used antibiotics in studied hospital. We hope that our results cast light on the control and transmission of the infection in the investigated hospital.

Influence of materials' optical response on actuation dynamics by Casimir forces

The dependence of the Casimir force on the frequency-dependent dielectric functions of interacting materials makes it possible to tailor the actuation dynamics of microactuators. The Casimir force is largest for metallic interacting systems due to the high absorption of conduction electrons in the far-infrared range. For less conductive systems, such as phase change materials or conductive silicon carbide, the reduced force offers the advantage of increased stable operation of MEMS devices against pull-in instabilities that lead to unwanted stiction. Bifurcation analysis with phase portraits has been used to compare the sensitivity of a model actuator when the optical properties are altered.

Molecular detection of metallo-β-lactamase gene blaVIM-1 in imipenem-resistant Pseudomonas aeruginosa strains isolated from hospitalized patients in the hospitals of Isfahan

BACKGROUND

Pseudomonas aeruginosa is an opportunistic human pathogen that causes serious problems, especially in people, who have immunodeficiency. In recent times, metallo-β-lactamase (MBLs) resistance in this bacterium has led to some difficulties in treating bacterial infections. The metallo-beta-lactamase family of genes, including blaVIM-1, is being reported with increasing frequency worldwide. The aim of this study is the detection of the metallo-β-lactamase gene blaVIM-1 in imipenem-resistant P. aeruginosa (IRPA) strains isolated from hospitalized patients.

MATERIALS AND METHODS

In this study, 106 P. aeruginosa samples were isolated from various nosocomial infections. The isolates were identified, tested for susceptibility to various antimicrobial agents by the Kirby-Bauer disk diffusion method, and all the imipenem-resistant isolates were screened for the presence of MBLs by using the combined disk (IMP-EDTA). The minimal inhibitory concentration (MIC) of imipenem was determined by E-test on the Mueller-Hinton agar. To detect the blaVIM-1 gene, the isolates were subjected to a polymerase chain reaction (PCR).

RESULTS

Of all the P. aeruginosa isolates, 62 (58.5%) were found to be imipenem-resistant P. aeruginosa (MIC ≥32 μg/ml). Twenty-six (42%) of the imipenem-resistant isolates were MBL positive. None of these isolates carried the blaVIM-1 gene using the PCR assay.

CONCLUSION

The results demonstrated the serious therapeutic threat of the MBL-producing P. aeruginosa populations. The rate of imipenem resistance due to MBL was increased dramatically. Early detection and infection-control practices are the best antimicrobial strategies for this organism. None of MBL-producing isolates in this study carry the blaVIM-1 gene; therefore, another gene in the MBL family should be investigated.

Epidemiology of VIM-1-imipenem resistant Pseudomonas aeruginosa in Iran: A systematic review and meta-analysis

BACKGROUND

Pseudomonas aeruginosa is an opportunistic human pathogen which causes serious problems, especially in people who have immunodeficiency. Metallo beta-lactamase (MBL) resistance in this bacterium has led some difficulties in treating bacterial infections. MBLs are being reported with increasing frequency worldwide. The aim of the present systematic review and meta-analysis was to collect data about the relative frequency (RF) of VIM-1-imipenem resistant P. aeruginosa (VIM-1-IRPA) in different regions of Iran and report an overall prevalence if possible.

MATERIALS AND METHODS

PubMed, ISI web of science, Scopus and Google Scholar were searched using following key terms: "P. aeruginosa," "imipenem," "VIM-1" and "Iran" were. Articles/abstracts, which used clinical specimens and had done polymerase chain reaction to detect the VIM-1 gene of MBL genes, were included in this review. STATA SE version 11.2 (StataCorp, College Station, TX, USA) was used for statistical analysis.

RESULTS

Out of 5457 results found, 10 articles were eligible to be included in our systematic review and meta-analysis. These studies were carried out in Tehran, Isfahan, Kurdistan, Ahvaz, Markazi and Northwest of Iran (Orumieh and Tabriz). Pooled estimation of 1972 P. aeruginosa samples showed that 13% (95% confidence interval = 10.5-16.5%]) of strains were VIM-1 positive. VIM-1-IRPA RF in different studies varied from 0% to 19.5% in Isfahan and Markazi provinces, respectively. We found a moderate heterogeneity (Chochran Q-test, P = 0.032, I-squared = 50.7%) of VIM-1-IRPA RF among studies.

CONCLUSION

According to the results of this study VIM-1-IRPA RF in Iran is in low-level Prevention strategies to reduce the prevalence rates of VIM-1 positive strains in Iran are needed.

Comparison of three phenotypic and deoxyribonucleic acid extraction methods for isolation and Identification of Nocardia spp

BACKGROUND

The aerobic Actinomycetes are a large group of soil-indwelling bacteria that are distributed in world-wide. These Gram-positive bacteria are most commonly associated with opportunistic infections in both immunocompromised and immunocompetent hosts.

MATERIALS AND METHODS

In this study, three phenotypic and deoxyribonucleic acid (DNA) extraction methods for isolation and identification of Nocardia genus were compared. Samples were taken in five different locations of Isfahan's suburb from hospitals area, parks, agricultural lands, gardens, arid lands with different soil temperature and pH.

RESULTS

In this study, showed that slip-buried-method was better than two other phenotypic methods; 14 out of 70 soil samples (20%) were positive for Nocardia spp. DNA of positive samples were extracted with three techniques and DNA extraction by microwave technique was better than others. This technique was confirmed with observation of DNA bands on 1% agarose gel.

CONCLUSIONS

These bacteria are important in immune deficient patients such as cancer patients, transplant recipients, tuberculosis; acquired immunodeficiency syndrome etc., Their affluence is unsteady in different zones of the world. In this study, among the three phenotypic methods for the isolation of Nocardia slip-buried method was better than other methods. Among DNA extraction techniques, DNA extraction by microwave method would be selective method for DNA extraction of Nocardia spp. compared with others techniques.

Involvement of ligninolytic enzymes of Phanerochaete chrysosporium in treating the textile effluent containing Astrazon Red FBL in a packed-bed bioreactor

The effect of Tween80, Mn(II) and veratryl alcohol (VA) on the production of ligninolytic enzymes of Phanerochaete chrysosporium in a packed-bed bioreactor using small pieces of Kissiris as carrier, was investigated. The results of the enzyme activities were noticeable in terms of decolorization and COD removal of the textile effluent containing an azo dye (Astrazon Red FBL). No dilution was made on the tested textile effluent and it was not sterilized, also. Maximum decolorization of the dye (87%) and COD removal (42%), both occurred when only Tween80 (0.05%, w/v) was added to the effluent. The maximum activities of lignin peroxidase (LiP) and manganese peroxidase (MnP) were (U/l): 17 and 52, respectively. The role of MnP was pronounced in the dye decolorization process, while the influence of LiP was noticeable on COD removal. The reusability of the original biomass was examined by replacing undiluted textile effluent (i.e., five times). The cellular performance of the original biomass in repeated-batch operations was promising.

Prevalence of Mental Health Patient Hospitalized in Medical Wards in Beheshti Hospital in 2007

Mental disorders are one of the most problems in the world and influence on medical disease thus this study investigated the prevalence of mental disorders in medical wards of Beheshti hospital.

Method and materials:

This study was a descriptive research in 260 patients hospitalized in medical wards of Beheshti hospital. Data was collected in two groups:

1.

Result:

54.2% suffered from mental disorder include: mood disorder (34.2%), anxiety disorder (9.6%), somatoform disorder (1.5%) and psychosis (0.4%). The rate of illness in female was 56.9% versus 42.7% in male. Prevalence of psychotic disorder is more than findings of Higashi and Yashiro (27 to 39%) and Koeng in Duke university (36.5% MDD).

Conclusion:

Mental disorders are common in general hospital and consult with psychiatrist and liasion psychiatry is very important.