Predictors of breastfeeding self-efficacy during the covid-19 pandemic.

Background: Breastfeeding self-efficacy (BSE) is a strong predictor of the duration of breastfeeding. The aim of this study is to determine the predictors of BSE in breastfeeding mothers during the Covid-19 pandemic. Methods: A cross-sectional study was conducted with 300 breastfeeding mothers who breastfed during the Covid-19 pandemic. Convenience sampling was used to recruit participants. A battery of online questionnaires measured sociodemographic and obstetric characteristics, breastfeeding self-efficacy, spouse postpartum social support, perceived social support, anxiety and depression, and fear of Covid-19. Data were analyzed using Pearson correlation coefficients, one-way ANOVA, and multivariable linear regression via stepwise method. The significance level in this study was α = 0.05. Results: The mean BSE score among participants was 58.19 ± 10.48 (out of 70). Spouse postpartum social support (ß = 0.732, p = 0.04), intention to breastfeed (ß = 0.17, p = 0.001), use of formula while breastfeeding (ß = -0.09, p < 0.001), and depression (ß = - 0.11, p < 0.001) were significant predictors of BSE. However, fear of Covid-19 was not significantly correlated with BSE (p = 0.514). Conclusion: The results of the present study showed that fear of Covid-19 was not a significant predictor of BSE, while spouse postpartum social support and having the intention of breastfeeding were positively associated with BSE. Depression and simultaneous use of formula in feeding the infant was negatively associated with BSE during Covid-19. Overall, breastfeeding can be encouraged through counseling to improve receiving spousal support, increasing breastfeeding intent, and reducing depression.

A comparative study of patient safety in the intensive care units.

AIM: This study aimed to assess patient-safety principles in ICUs. DESIGN: This is a descriptive-comparative study. METHODS: The research environment includes ICUs of hospitals affiliated to the two universities of medical sciences in Tehran. Sampling was done by census using Time and Event Sampling methods. Research instrument was "Patient Safety Principles Checklist". Data analysis was performed using SPSS-20 and descriptive-inferential statistics with a significance level of 0.05. RESULTS: There is no significant difference (p-value = .15) in the level of observance of patient-safety principles in two university-affiliated hospitals A (133.26 ± 9.14) and B (128.16 ± 18.01). Evaluation of the mean scores obtained in each dimension and in each of the ICUs was showed that only in dimension No.3 the difference was significant (F[68,2] = 5.20, p-value = .008) and in the AICUs (16.13 ± 1.8) (p-value = .04), it was significantly lower than other ICUs. Identifying risk factors for the patient's immunity reduces the side effects of patient care.

Identification of major sequence types among aminoglycoside resistant Staphylococcus aureus and Staphylococcus epidermidis strains isolated from clinical samples.

Background and Objectives: Aminoglycosides have been widely used for treating severe staphylococcal infections. Production aminoglycoside modifying enzymes (AMEs) is the main mechanism of resistance to this antibiotic. The aim of this study was to determine the prevalence of AME genes and molecular characterization of aminoglycoside-resistant Staphylococcus aureus and Staphylococcus epidermidis strains isolated from clinical specimens in Iran. Materials and Methods: A total of 42 clinical isolates of Gram-positive cocci (20 S. aureus and 22 S. epidermidis) with resistance to gentamicin were tested for antimicrobial resistance and differentiated by multilocus sequence typing (MLST). Results: All 42 isolates were resistant to methicillin, kanamycin, and most of them were also resistant to amikacin (98%), tobramycin (98%) and netilmycin (78.5%). Overall, aac(6')-Ie-aph(2")-Ia was the dominant AME gene found in 100% of isolates, followed by aph(3')IIIa found in 90% of isolates. MLST classified S. aureus and S. epidermidis into 5 and 9 distinct sequence types (ST), respectively. The majority of the strains belonged to ST239 (50%) for S. aureus and ST2 (36%) for S. epidermidis. Conclusion: The resistance to aminoglycosides was mainly due to the presence of the aac(6')-Ie-aph(2")-Ia and aph(3') IIIa genes as well as the ST239 for S. aureus and ST2 for S. epidermidis have become the predominant clones in the selected university hospital of Tehran, Iran. Thus, it is critical that clinicians and healthcare workers are aware of the population of S. aureus and S. epidermidis present in order to make decisions for appropriate treatment and infection control practices.

Evaluation of the efficacy and safety of plasma exeresis in periorbital rejuvenation using the Reviscometer®.

BACKGROUND: Periorbital rejuvenation is performed through various methods. Recently, plasma exeresis has been suggested for the treatment of dermatochalasis and periorbital wrinkles. AIMS: To evaluate the clinical efficacy and safety of plasma exeresis in periorbital rejuvenation and palpebral laxity and assess its effectiveness using the Reviscometer® . PATIENTS/METHODS: Fifty-six women with mild-to-severe dermatochalasis and periorbital wrinkles volunteered to participate in this clinical trial. They received plasma exeresis thrice at one-month intervals. The efficacy of the intervention was evaluated according to the Cutaneous Resonance Running Time (CRRT) value changes, photographic changes, patients' satisfaction, and clinical side effects. RESULTS: This study showed significant clinical improvements in dermatochalasis and palpebral laxity after treatment compared with the baseline (p < 0.001). Most of the participants had relative satisfaction, and no significant or permanent side effects were observed. CONCLUSION: The findings of this study suggest that plasma exeresis is a safe and effective nonsurgical method for periorbital rejuvenation. Furthermore, the procedure has no serious adverse effects if performed correctly and for the right patient.

Tetracycline resistance mediated by tet efflux pumps in clinical isolates of Acinetobacter baumannii.

Acinetobacter baumannii is one of the most frequent nosocomial pathogen capable of acquiring resistance to different antimicrobials. The aim of this study was to investigate the activity of tetracycline, doxycycline and minocycline, the prevalence of tet(A) and tet(B) determinants, and the role of efflux pump in tetracycline resistance among the A. baumannii clinical isolates. Susceptibility of 98 A. baumannii isolates to tetracyclines was evaluated by disk diffusion method. The presence of active efflux pump was investigated by determination of the minimum inhibitory concentration (MIC) of tetracycline using the carbonyl cyanide 3-chlorophenylhydrazone (CCCP). Polymerase chain reaction (PCR) was performed to investigate the presence of tet(A) and tet(B) determinants in tetracycline-resistant isolates. The rate of resistance to tetracycline, doxycycline and minocycline was 47.95%, 0%, and 30.61%, respectively. Among the 47 tetracycline-resistant isolates, 29.79% were originated from burned patients and showed MIC ranging from 128-256 µg/mL with both MIC 50 and MIC90 values of 256 µg/mL, while 70.21% were from ventilator-associated pneumonia (VAP) patients and had MIC values ranging from 32-1024 µg/mL, with MIC50 and MIC90 of 512 µg/mL and 1024 µg/mL, respectively. The tet(B) gene was found in 61.7% of tetracycline-resistant isolates, while none of the isolates carried the tet(A) gene. CCCP led to 2-128-fold reduction in tetracycline MIC of the tested isolates. The results showed that doxycycline and minocycline are promising agents for the treatment of A. baumannii infections. This study has also revealed the role of efflux activity in the resistance to tetracycline of A. baumannii isolates. The emergence of resistance to these agents is likely due to the spread of clones presenting with a higher prevalence of resistance determinants.

Does a ketogenic diet have beneficial effects on quality of life, physical activity or biomarkers in patients with breast cancer: a randomized controlled clinical trial.

INTRODUCTION: Despite recent interest in the use of ketogenic diets (KDs) for cancer, evidence of beneficial effects is lacking. This study examined the impact of a randomly assigned KD on quality of life, physical activity and biomarkers in patients with breast cancer. METHOD: A total of 80 patients with locally advanced or metastatic breast cancer and without a history of renal disease or diabetes were randomly assigned to either a KD or a control group for this 12-week trial. Concurrent with the first, third, and fifth chemotherapy sessions, quality of life, physical activity, and biomarkers (thyroid function tests, electrolytes, albumin, ammonia, ALP, lactate and serum ketones) were assessed. Dietary intake was also recorded on admission and the end of the treatment. RESULTS: No significant differences were seen in quality of life or physical activity scores between the two groups after 12 weeks; however, the KD group showed higher global quality of life and physical activity scores compared to the control group at 6 weeks (P = 0.02 P = 0.01). Also, serum lactate and ALP levels decreased significantly in the KD group compared to the control group at the end of the intervention (10.7 ± 3 vs 13.3 ± 4, 149 ± 71 vs 240 ± 164, P = 0.02 and P = 0.007, respectively). A significant inverse association was observed between total carbohydrate intake and serum beta-hydroxybutyrate at 12 weeks (r = - 0.77 P < 0.001). No significant differences between groups were observed in thyroid hormones, electrolytes, albumin, LDH or ammonia. Compliance among KD subjects ranged from 66.7 to 79.2% as assessed by dietary intake and serum ketones levels of > 0.5. CONCLUSION: According to our results, besides a higher global quality of life and physical activity scores compared to the control group at 6 weeks, KD diet combined to chemotherapy in patients with breast cancer does not bring additional benefit about quality of life and physical activity at 12 weeks. However, decreases seen in levels of lactate and ALP in the KD group suggest that a KD may benefit patients with breast cancer. TRIAL REGISTRATION: This trial has been registered on Iranian Registry of Clinical Trials (IRCT) under the identification code: IRCT20171105037259N2 https://www.irct.ir/trial/30755.

Molecular characterization, antibiotic resistance pattern and capsular types of invasive Streptococcus pneumoniae isolated from clinical samples in Tehran, Iran.

BACKGROUND: Streptococcus pneumoniae causes serious infections worldwide. The aim of this study was to determine the molecular characteristic, antibiotic resistance pattern and capsular types of invasive S. pneumoniae in Tehran, Iran. RESULTS: Of the 44 pneumococcal invasive isolates, 39 (89%) were isolated from children and 5 (11%) from adults. The results show that all pneumococcal isolates were susceptible to linezolid but had varying resistance to trimethoprim-sulfamethoxazole (86%), erythromycin (73%), tetracycline (66%), clindamycin (43%), penicillin (16%), chloramphenicol (14%) and levofloxacin (2%). The range of erythromycin, tetracycline and penicillin MICs were 2 - ≥ 256 µg/mL, 4 - ≥ 48 µg/mL, and 0.047 - ≥ 256 respectively. All of the penicillin resistant isolates were multidrug resistant (MDR) and in addition to penicillin were resistant to tetracycline, erythromycin and trimethoprim-sulfamethoxazole. The most common capsular types detected in 64% of the pneumococcal isolates was 6A/B, 19A, 15A, 23F. The multilocus sequence typing (MLST) of 10 pneumococcal isolates revealed 9 different sequence types (STs), including ST 15139 (capsular type 19A) and ST 15140 (capsular type 23F), which have not previously been reported. CONCLUSIONS: The study revealed that the S. pneumoniae isolates belonged to diverse capsular types and clones with high rate of resistance to erythromycin, tetracycline, and penicillin.

Relationship between infiltration, sewer rehabilitation, and groundwater flooding in coastal urban areas.

The aging of sewer networks is a serious issue in urban areas because of the reduced functionality of the system that can have negative impact on the urban environment. Aging pipes are not water-tight anymore and they can leak untreated sewage or allow infiltration of groundwater. In the latter case, more frequent combined sewer overflows (CSOs) may occur. Generally, prompt intervention to repair damaged conduits is envisaged. However, in low-lying coastal regions, sewer systems may provide an unplanned drainage that controls the groundwater table from flooding the urban ground. Here, a study is presented to investigate the influence of the repair of damaged sewer on the water table of an urban shallow aquifer. Sewer and groundwater models were built to describe the effect of sewer replacement. Based on a real dataset, simulations were run for a city located along an estuary. Results show that the presence of infiltration into the sewer system increases the frequency of CSOs, which trigger the discharge of untreated sewage after a minor precipitation or even in dry weather conditions. As the sewer is repaired, CSO spills diminish occurring only upon significant precipitation. However, the water table rises and eventually, during the high tide, the groundwater floods the low-lying part of the city. Overall, this work highlights the susceptibility of shallow aquifers in coastal urban areas and suggests that they should be regarded in flooding predictions.

Assessing the Prevalence and Treatment of Malnutrition in Hospitalized Children in Mofid Children's Hospital During 2015-2016.

BACKGROUND: Malnutrition in hospitalized patients causes problems in treatment and increases hospitalization duration. The aim of this research was to determine the prevalence of malnutrition in hospitalized children. METHODS: Children aged 1 month to 18 years (n = 1186) who were admitted to medical and surgery wards of Mofid children's hospital from November 2015 to February 2016, entered the study. We measured different anthropometric variables in patients with malnutrition. Also, nutritional counseling was performed and three months follow-up was done. RESULTS: Patient data were registered in questionnaires particularly for children 2 years old and less. 597 children under 2 years of age and 607 children over two years entered the study. The data analysis was done by SPSS version 22.0 (Chicago, IL, USA). The t test inferential method was used in comparing variables. P values less than 0.05 were considered statistically significant. Based on the body mass index (BMI) Z score, and in accordance with the World Health Organization (WHO) cut-off, among children over 2 years, 9% were diagnosed as overweight or obese, 54% were within the normal range and 37% were underweight at time of admission. In the underweight group, 43% were mildly, 21.2% were moderately and 35.8% were severely underweight. Based on the weight for length Z score in patients less than 2 years of age at time of admission, 6% were overweight, 60% were in normal range and 34% were underweight. Among children with malnutrition, 21% had mild, 3.0% had moderate and 10% had severe malnutrition. No significant meaningful relation was found between prevalence of malnutrition and severity of illness. In the moderate to severe undernutrition group, nutritionist counseling was done. Comparison of BMI and weight, before and after admission (the baseline and the follow up visits), was done by means of repeated measurements. Comparison of the patient's weight at time of admission with weight at 1, 2 and 3 months after the first nutritional consultation showed statistically meaningful difference (P value < 0.05). CONCLUSION: Growth indices need to be evaluated in every hospitalized child. Nutritional consultation is useful in children with malnutrition. The main purpose of early diagnosis of malnutrition is to prevent its progression, and also to design a useful, applicable and cost-effective nutritional intervention for malnutrition treatment.

Effects of Micro RNAs and their Targets in Periodontal Diseases.

RNA interference (RNAi) or Post-Transcriptional Gene Silencing is a strong mechanism of gene silencing which is moderated by MicroRNAs (miRNAs), underlying many fields of eukaryotic biology. The miRNAs are small noncoding RNAs and a gene regulation expression system which showing a tissue-specific expression pattern, and inhibits protein synthesis. For the first time, miRNA has been seen in Caenorhabditis elegans. They play an important role in signaling pathways of various diseases especially periodontal disease during periodontal inflammation and oral cancers. The most important miRNAs in periodontal diseases and oral squamous cell carcinoma are miR-142-3p, miR-146a, miR-155, miR-203, and miR- 223. One of the most important diseases in association with gingival infectious is periodontal diseases which if left untreated, would lead to tooth loss. Hence, the aim of the present study is to focus the effects of miRNAs and their targets in diseases which are mentioned above.

Oral Colonization by Nosocomial Pathogens During Hospitalization in Intensive Care Unit and Prevention Strategies.

BACKGROUND: Critically ill patients are very susceptible to a variety of disorders and infections during hospitalization in Intensive Care Units [ICU]. Among these problems, nosocomial infections are major causes of morbidity and mortality. METHODS: Nosocomial pneumonias, specifically ventilator associated pneumonias have become a major health care issue. The implication of oral care in hospital presents challenges that can prevent or reduce the risk of nosocomial pneumonias in ICU. In this review article, we reviewed the most important nosocomial pathogens which colonize the oral cavity and causes severe infections during hospitalization in ICU. CONCLUSION: Finally, we discuss that the prevention strategies against oral colonization of nosocomial pathogens include classical methods and novel methods such as Photodynamic therapy, NO based therapy, anti-virulence therapy and other new under investigation antimicrobial strategies.

Association between mutations in gyrA and parC genes of Acinetobacter baumannii clinical isolates and ciprofloxacin resistance.

OBJECTIVES: We investigated the contribution of gyrA and parC mutational mechanism in decreased ciprofloxacin susceptibility of Acinetobacter baumannii isolated from burn wound infections. MATERIALS AND METHODS: Ciprofloxacin susceptibility of 50 A. baumannii isolates was evaluated by disk diffusion and agar dilution methods. PCR and sequencing were performed for detection of mutation in gyrA and parC genes. RESULTS: The 44 and 4 isolates of A. baumannii exhibited full and intermediate-resistant to ciprofloxacin, respectively. Overall, the 42 isolates with double mutations of gyrA and parC genes showed a higher level of ciprofloxacin resistance than the 3 isolates with single mutations of gyrA or parC. CONCLUSION: Simultaneous mutations in gyrA and parC genes are expected to play a major role in high-level fluoroquinolone resistance in A. baumannii; albeit a single mutation in DNA topoisomerase IV could occasionally be associated with intermediate-resistance to these antimicrobials.

Detection of AdeABC efflux pump genes in tetracycline-resistant Acinetobacter baumannii isolates from burn and ventilator-associated pneumonia patients.

PURPOSE: Acinetobacter baumannii is the most prevalent nosocomial pathogen which have been emerged in the past three decades worldwide. The aim of this study was to assess the distribution of the AdeABC efflux pump genes, associated with tetracycline resistance in Acinetobacter baumannii isolates collected from burn infection and Ventilator Associated Pneumonia (VAP). MATERIALS AND METHODS: Ninety-eight A. baumannii isolates were collected from two different hospitals in Tehran, Iran. Tetracycline susceptibility testing was performed by disk diffusion and agar dilution methods according to the CLSI guidelines. The presence of adeSR, adeB, drug efflux system genes in resistant isolates was assessed by polymerase chain reaction (PCR). Carbonyl cyanide 3-chlorophenylhydrazone (CCCP) was used as a chemical inhibitor agent to assess the contribution of AdeABC efflux pump in tetracycline resistance isolates. RESULTS: Approximately 48% (47 out of 98) of isolates showed resistance to tetracycline which 14 (14.2%) isolates were corresponded to burn infection and the remaining 33 (33.8%) strains were isolated from VAP. All tetracycline resistant isolates have AdeABC in PCR assay. The reduction of tetracycline MICs by using 50 µg/ml CCCP were as follows: in 18 isolates 2-4 fold reduction in MICs, 26 isolates showed 8 fold reduction,1 isolate showed 16 fold, 1 isolate showed 32 fold and the remaining 1 isolate showed 128 fold reduction in MICs. CONCLUSION: The results showed significant correlation between tetracycline resistance and AdeABC efflux pump genes in resistant A. baumannii isolates.

Low Glycemic Index Treatment in pediatric refractory epilepsy: the first Middle East report.

PURPOSE: Intractable epilepsy is a challenging aspects of pediatric epilepsy. This study was conducted to determine the efficacy and tolerability of Low Glycemic Index Treatment (LGIT) in pediatric patients referred to a Children's Hospital in Iran with intractable epilepsy. METHODS: We studied 42 children with refractory epilepsy aged between 1.5 and 17 years of age, from October 2009 to April 2011 in the pediatric neurology department of Mofid Children's Hospital. Patient information on clinical status, seizure type, and baseline frequency, blood and urine biochemistry, neuro-imaging and the EEG were collected. LGIT was initiated on an outpatient basis and the diet was composed of 65% fat, 25% protein and 10% carbohydrate (40-60 g), and the glycemic index of foods was limited to below 50. RESULTS: 84% of patients were categorized as having more than one seizure per day at study entry, with the remaining children as experiencing over one seizure per week. A greater than 50% seizure reduction was observed in 71.4% of the patients after the second week, in 73.8% at the end of the first month and in 77.8% at the end of the second month. In 30% of the patients a mild increase in blood urea nitrogen (BUN) was detected. The most important reasons for discontinuation of LGIT were restrictiveness, lack of satiation and excessive meat in this diet. No significant complications were observed during the administration of the diet. CONCLUSION: LGIT is a safe and effective adjuvant antiepileptic therapy and may be used as an alternative to the ketogenic diet in conditions when this diet cannot be used.

Effect of Surface Treatment with Carbon Dioxide (CO2) Laser on Bond Strength between Cement Resin and Zirconia.

INTRODUCTION: Since it is not possible to form an adequate micromechanical bond between resin cement and zirconia ceramics using common surface treatment techniques, laser pretreatment has been suggested for zirconia ceramic surfaces. The aim of this study was to evaluate the effect of Carbon Dioxide (CO2) Laser treatment on shear bond strength (SBS) of resin cement to zirconia ceramic. METHODS: In this in vitro study thirty discs of zirconia with a diameter of 6 mm and a thickness of 2 mm were randomly divided into two groups of 15. In the test group the zirconia disc surfaces were irradiated by CO2 laser with an output power of 3 W and energy density of 265.39 j/cm(2). Composite resin discs were fabricated by plastic molds, measuring 3 mm in diameter and 2 mm in thickness and were cemented on zirconia disk surfaces with Panavia F2.0 resin cement (Kuraray Co. Ltd, Osaka, Japan). Shear bond strength was measured by a universal testing machine at a crosshead speed of 0.5 mm/min. The fracture type was assessed under a stereomicroscope at ×40. Surface morphologies of two specimens of the test group were evaluated under SEM before and after laser pretreatment. Data was analyzed by paired t-test (p value < 0.05). RESULTS: The mean SBS values of the laser and control groups were 12.12 ± 3.02 and 5.97 ± 1.14 MPa, respectively. Surface treatment with CO2 laser significantly increased SBS between resin cement and zirconia ceramic (p value = 0.001). CONCLUSION: Under the limitations of this study, surface treatment with CO2 laser increased the SBS between resin cement and the zirconia ceramic.

Optimization of the Expression of Genes Encoding Poly (3-hydroxyalkanoate) Synthase from Pseudomonas aeruginosa PTCC 1310 in Escherichia coli.

Over the years, the use of plastics has complicated the problem of disposal of solid wastes. One strategy to reduce plastic waste is the use of biodegradable plastics. A group of these plastics are polyhydroxyalkanoates (PHAs). To date more than 250 different microorganisms are known to synthesize and accumulate PHA. Most Pseudomonas strains are able to accumulate mcl-PHA. In previous studies, the phaC1 and phaC2 genes were identified in Pseudomonas aeruginosa (P.aeruginosa) PTCC 1310 and were cloned. The aim of this study was to express these genes and optimize the conditions for their expression. The inserts obtained from vectors pTZPHAC1 and pTZPHAC2 were subcloned into pET15b expression vector. After transformation of competent Escherichia coli (E.coli) BL21 (DE3) cells with recombinant plasmids, expression was induced using IPTG. By changing expression conditions such as IPTG concentration, time and temperature of incubation with IPTG, the expression conditions for these enzymes were optimized, and the obtained results were compared using proper statistical analysis. The PHA synthase genes were induced with IPTG and the expressed 62 kDa protein was observed and purified. By changing expression conditions, 1 mM IPTG, 37 °C and a 2 hr incubation provided the highest level of protein production in E.coli cells. These results suggest that induction condition of PhaC genes can influence expression of PHA synthase enzymes.