Evaluation of antibiotic resistance changes in Acinetobacter baumannii in the era of COVID-19 in Northern Iran.

Background and Objectives: During the coronavirus pandemic, the overuse of antibiotics to reduce coinfections and mortality may be contributing to the rise of antimicrobial resistance. In this study, we aim to investigate the antibiotic resistance changes of Acinetobacter baumannii post-COVID-19 pandemic in Northern Iran. Materials and Methods: The current study is a cross-sectional study. Between 2022 and 2023, 2190 clinical samples were collected from patients with healthcare-associated infections (HAIs) at four hospitals in Sari, which served as corona centers after the COVID-19 pandemic. Antimicrobial sensitivity was determined using standard broth macro-dilution, and resistance genes were detected using multiplex PCR. Results: Based on the results co-amoxiclav had a resistance rate of 100%, while piperacillin/tazobactam showed the least resistance rate of 29.82%. In terms of GM MIC values, colistin was the most potent against multi-drug resistant isolates. The frequency of bla OXA-51 , ampC, aphA6, and bla NDM genes were 100%, 99.12%, 90.35%, and 69.30% respectively. Conclusion: Our study revealed high multi-drug resistance rates. Piperacillin/tazobactam recommended for treating multi-drug resistant Acinetobacter baumannii infections in Northern Iran.

Effect of collagen hydrogel containing Lavandula officinalis essential oil nanoemulsion in wound healing of infectious burn.

Background and Objectives: The main cause of mortality in burn patients is infection from burns. Drug-resistant bacteria are the main causes of wound infection, so alternative antibiotic therapies hold significant importance. The objective of this study was to examine the impact of a collagen hydrogel that contains a nanoemulsion of Lavandula essential oil on the healing process of infected burn wounds. Materials and Methods: In this experimental study, 20 rats were randomly divided after applying burns with a 10 mm diameter hot plate and infecting the wounds with multidrug-resistant Pseudomonas aeruginosa into four groups, including a positive control, a negative control, the first experiment (collagen hydrogel), and the second experiment (collagen hydrogel containing Lavandula essential oil nanoemulsion). On the 4th, 11th, and 18th days, tissue samples were taken for pathology studies. The important parameters in burn wound healing with hematoxylin and eosin and Masson's trichrome staining methods were investigated and scored according to Abramov's method. Results: Based on the pathology findings, experimental groups 1 and 2 compared to the negative and positive control groups were effective in rat infection wound healing. The hydrogel scaffold in the experimental groups increased fibroblasts and angiogenesis compared to the control groups. Epithelization was noticed only in the hydrogel group containing nanoemulsion. Conclusion: The study findings suggest that the use of collagen hydrogel with Lavandula essential oil nanoemulsion has potential as a wound dressing. This is because it has the potential to effectively promote healing and act as an antibacterial agent to prevent infections.

Cytoplasmic CCR7 (CCR7c) Immunoexpression Is Associated with Tumor Invasion in Gastric Cancer.

Background : This study investigates the CCR7 chemokine receptor's prognostic value in gastric cancer and its relationship to metastasis. Materials and Methods : Normal and adjacent tumor cells in 70 patients with gastric cancer were evaluated for CCR7 expression using immunohistochemical staining. The prognostic values of high and low levels of expression of CCR7 were also evaluated by multivariate and univariate analyses. Results : Analysis indicated high expression of CCR7 in 52.9% of tumor tissue. Moreover, high expression of CCR7 was significantly related to metastasis of lymph nodes (p = 0.00). In addition, high expression of CCR7 had a positive correlation to the disease stage (p = 0.00), age of ≥50 years (p = 0.019), male gender (p = 0.024), vascular involvement (p = 0.009), histology of tumor adenocarcinoma (p = 0.00), and poor tumor differentiation (p = 0.00). However, the high expression of the CCR7 marker was not related to the tumor size. Conclusion : Based on our results, CCR7 expression in gastric cancer can be considered a clinical prognostic indicator in patients with gastric cancer.

Membranous fat necrosis of gall bladder, a case report and literature review.

INTRODUCTION AND IMPORTANCE: Membranous fat necrosis is a rare histological finding. Despite its low incidence and lack of clinical significance, it can involve various organs. Majority of membranous fat necrosis cases are diagnosed in breast lumps and skin in comparison to intra-abdominal lesions. There has been only one reported case of membranous fat necrosis of gall bladder in literature. CASE PRESENTATION: A 56-year-old female patient with previous history of diabetes mellitus and hypertension was administered due to abdominal pain and fever. Based on her physical exam, lab data, and ultrasonography, she was diagnosed by cholangitis. After primary care, she went under cholecystectomy. The histological finding of gall bladder revealed crenulated fatty membranes phagocytized by macrophages in Hematoxylin and Eosin (H&E) staining. Moreover, necrosis and giant cells were seen on Sudan black staining. Hence, the diagnosis of membranous fat necrosis in gall bladder was made. CLINICAL DISCUSSION: Membranous fat necrosis occurs when peripheral blood circulation is compromised. Ischemia of fat tissue cause fatty membranous material accumulation acting as foreign bodies. Hence, it can attract inflammatory response. Regarding pathology, phagocyted membranous by macrophages and giant cells is diagnostic. Sudan black, Luxol fast blue (LFB), long Ziehl-Neelsen, and D-PAS are positive in membranous fat necrosis. CONCLUSION: Membranous fat necrosis of gall bladder is a rare entity. This is the second reported case of such diagnosis. Nonetheless, further pathological investigations are necessary.

Frequency of significant virulence genes in gastric biopsies of Helicobacter pylori-positive patients with gastritis.

Helicobacter pylori is one of the most common bacteria affecting human societies worldwide, and is mainly associated with gastrointestinal complications due to different virulence factors. This study aimed to investigate some virulence genes of H. pylori in gastric biopsies of patients with gastritis in Sari city, North of Iran. Informed consent forms were obtained from the studied patients, and those who needed endoscopy were included in the study. To evaluate the prevalence of cagA, iceA1, iceA2, vacA, dupA, and oipA genes, gastric biopsies with positive or negative rapid urease test were collected from 50 patients (25 in each group) with gastro-duodenal diseases. The bacterial DNAs were extracted by a specific kit, and the presence of the genes was analyzed by PCR using specific primers. Eighteen (72%) biopsies from 25 H. pylori-positive samples were cagA-positive, while 17 (68%) biopsies contained the vacA gene, and 11 (44%) samples had both vacA and cagA genes. However, 16 (64%), 12 (48%), 13 (52%), and 14 (56%) biopsies contained dupA, iceA1, iceA2, and oipA genes, respectively. Due to the significant role of the studied virulence factors in the pathogenicity of H. pylori, the high prevalence of these factors in biopsies of patients with gastritis is a concern needing to the management in this region.

Fatal vanishing bile duct syndrome in Iranian patient with Hodgkin's lymphoma.

Vanishing bile duct syndrome (VBDS) has been postulated that may be related to Hodgkin's lymphoma (HL). In the present study, we present a 75-year-old male patient with HL who received chemotherapy but has not received any radiotherapy. The patient's condition worsened in further days, and he died with the diagnosis of cirrhosis and hepatic failure.

Utero-ovarian low grade endometrial stromal sarcoma, a case report.

INTRODUCTION: Endometrial stromal sarcoma (ESS) is a rare malignancy of uterine in middle aged women. There are numerous subtypes for ESS which share the same clinical picture of uterine bleeding and pelvic pain. Consequently, diagnosis and treatment modalities of LG-ESS with metastasis are challenging. However, both molecular and immunological study of samples can be useful. CASE PRESENTATION: In this case study, we report a 52-year-old woman presenting with the chief complaint of unusual uterine bleeding. There was no specific finding in her past medical history. The CT study revealed enlarged bilateral ovary with a significantly large left ovarian mass and suspicious mass in uterus. By the diagnosis of ovarian mass, patient went under total abdominal hysterectomy with bilateral salpingo-oophorectomy (BSO), greater omentectomy, and appendectomy followed by post-op hormone therapy. Her follow-up was uneventful. The IHC and pathological study of samples revealed incidental LG-ESS uterus mass with metastasis to ovaries despite her primary diagnosis. DISCUSSION: LG-ESS has low metastasis rate. Surgical modalities and neoadjuvant therapies are recommended base on the stage of ESS. In the following study, we represent a case of incidental LG-ESS with bilateral ovarian invasion who was initially diagnosed as an ovarian mass. CONCLUSION: Our patient was successfully managed by surgical intervention. Despite scarcity of LG-ESS, it is advised to consider LG-ESS as a differential diagnosis in management of patients with a uterus mass with bilateral ovarian involvement.

Dermatofibrosarcoma protuberans challenges: a case series and review of the literature.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is a rare variant of skin sarcoma which is characterized by proliferation of spindle cells in a storiform pattern. Although it is mostly benign in its primary stages, it can cause a high burden of morbidity unless it is thoroughly excised. CASE PRESENTATION: Here, we review six cases of DFSP which were characterized by skin lesions in various parts of the body. Patients were from 26 to 51 years old; four were Asian men and two were Asian women. Wide surgical excision was performed for all these patients and no extra treatment was considered. Samples were studied by hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) tests. Only one of our patients experienced recurrence after the initial surgery. CONCLUSION: Determining the best surgical method is still a dilemma in the treatment of DFSP lesions. There are numerous studies to prove the efficacy of various surgical interventions. Although DFSP is not commonly known as a malignant skin lesion, delay in treatment will have a catastrophic impact on patients' lives. Thus, applying an in-time surgical method (wide local excision in our cases) in treating DFSP is crucial in preventing recurrence as well as decreasing the morbidity burden of DFSP.

Prenatal chest wall mesenchymal hamartoma: a case report and review of the literature.

Mesenchymal hamartoma of the chest wall (MHCW) is a rare but benign tumor of childhood. Its clinical presentation varies from nonsymptomatic to respiratory distress. It is rarely detected in prenatal period and usually is diagnosed after birth. We discuss a male-fetus with MHCW detected by ultrasound during pregnancy. He was managed surgically due to scoliosis and multiple rib involvement also respiratory symptoms.

Is gastric mapping needed in the endoscopy of dyspeptic patients?

AIM: Our study aimed to determine the prevalence of intestinal metaplasia in dyspeptic patients who underwent upper GI endoscopy. BACKGROUND: Intestinal metaplasia, which is defined as the replacement of normal gastric mucosa by metaplastic intestinal epithelium, has been described as a premalignant gastric lesion. METHODS: Six hundred two consecutive patients with dyspeptic symptoms who had undergone upper GI endoscopy were included in the study. For all patients, gastric mapping was performed to determine the presence of intestinal metaplasia. All histologic samples were reported according to the updated Sydney classification. RESULTS: Total of 61.3% of the patients were female. The mean age of the patients was 46±15 years. The overall prevalence of intestinal metaplasia was 22%. The distribution of intestinal metaplasia in the stomach was 15.1% in the antrum, 4.3% in the body, and 2.6% in the antrum and body together. Also, the prevalence of intestinal metaplasia in the age group of under 40 years was 9.5% and in patients over 40 years it was 29.5%.. CONCLUSION: The results of this study have shown that more than one-fifth of the patients with dyspepsia have intestinal metaplasia. This indicates that gastric mapping in patients with dyspepsia may lead to the detection of precancerous lesions especially after the age of 40.

The role of immunohistochemistry expression of COX-2 in differentiating pigmented benign and malignant skin neoplasms.

Background: Skin cancer is one of the most common types of cancer and its annual mortality rate is increasing. The induction enzyme of cyclooxygenase COX-2 causes biosynthesis of prostaglandin and thromboxane during inflammation of the body. Increasing the expression of COX-2 has an important role in the development and progression of malignant epithelial cancers and other types of cancers. Considering the diagnostic status of the marker, this study aimed to evaluate the expression of COX-2 for diagnosis and differentiation of benign skin pigmented neoplastic lesions from malignant melanoma types. Methods: In this diagnostic study, the immunohistochemistry of COX-2 maker in 82 paraffin blocks of pigmented benign and malignant skin neoplasms of patients (49 men; 33 women) and its association with clinicopathological features of the tumor was evaluated. Data were analyzed using chi-squared and t test in SPSS18. Significance level was set at less than 5%. Results: The findings showed that 20 patients (24.3%) had malignant melanoma and 13 had significant COX-2 (3+ High), while COX-2 marker was not detected in other benign and malignant pigmented skin neoplasms (p<0.001). A significant association was found between COX-2 marker and grade (p<0.001), but there was no significant correlation with other clinicopathological tumor criteria. Sensitivity, specificity, PPV and NPV value of the COX-2 marker were 65%, 100%, 89.9%, and 100%, respectively. Conclusion: Because of the high level of COX-2 in malignant melanoma skin marker, it can be used to distinguish benign and malignant neoplastic lesions (SCC and BCC) from melanoma and to provide effective therapeutic strategies through specific COX-2 enzyme inhibitors.

Immunohistochemical Expression of Nanog and Its Relation with Clinicopathologic Characteristics in Breast Ductal Carcinoma

Background: Cancer stem cells (CSCs) are a group of tumor cells with self-renewal property and differentiation potential. CSCs play a crucial role in malignant progression of several types of tumors. However, what is still controversial is the clinicopathological relationship between the Nanog marker and its prognostic value in the patients with breast cancer. The expression of Nanog in the patients with breast cancer and its correlation with clinicopathological prognostic factors was explored in the present study. Methods: A sample of 120 breast cancer tissues was obtained from the patients who referred to Imam Khomeini Hospital in Sari City, Iran during January 2012 and December 2016. The associations between Nanog expression and clinicopathological factors were analyzed based on immunohistochemical analysis. Results: The expression of Nanog was detected in 67 (55.8%) patients with a high expression rate in 24 (36%) cases (staining index ≥3). Moreover, there was a statistically significant relationship between Nanog expression and clinicopathological factors, including tumor grade (p = 0.001), lymph node metastasis (p = 0.01), and the stage of the disease (p = 0.003). Conclusion: Findings of the study indicate that Nanog may act as a biomarker for prognostic prediction in patients with breast cancer.

Primary tonsillar tuberculosis: a forgotten clinical identity.

Primary tonsillar tuberculosis is an uncommon entity and a diagnostic challenge. Misdiagnosis can be prevented with early professional para-clinical finding. The true diagnosis is often delayed and infection management depends on recognizing disease patterns and early laboratory documentation. This rare clinical caseation granuloma with positive clinical symptoms, negative results of radiology/laboratory and alone based on histopathological finding without any Mycobacterium particle indicates the role of an accurate laboratory/pathology finding for urgent medical intervention treatment and lifesaving of patients, particularly in immunocompromised group.