Potential role of serum vitamin D as a risk factor in pediatric acute lymphoblastic leukemia.

Vitamin D deficiency/insufficiency (VDD, VDI) is common in children yet limited experience exists on the association of VDD and hematologic malignancies amongst this population. Therefore, this study aimed to compare serum vitamin D levels in children with acute lymphoblastic leukemia (ALL) and controls. Moreover, vitamin D levels is compared in subjects with and without relapse and evaluated as a prognostic factor for relapse-free survival (RFS). Children with newly diagnosed ALL were recruited as case group. Data on demographic variables as well as the dietary habits were collected by interview. In addition, serum 25(OH)D3 was measured. The case group was followed up for 36 months to assess RFS. Overall, 358 subjects were included in the study (n = 169 cases, n = 189 controls). The mean levels of 25(OH)D3 were 28.05 ± 18.87 and 28.76 ± 12.99 in cases and controls, respectively (p = .68). VDD was found in 15.4% (n = 26) and 4.2% (n = 8) of the case and control groups, respectively (p < .001). Relapse was seen in 18.34% of patients and vitamin D levels of 20 ng/mL or above were associated with longer RFS (p = .044 by log-rank test). In this study, VDD and VDI amongst children with ALL were significantly higher than controls. In addition, lower levels of Vitamin D were associated with increased risk of relapse.

Environmental Risk Factors for Pediatric Acute Leukemia: Methodology and Early Findings.

Background: Acute leukemia is the most common type of malignancy in children, and no major environmental risk factors have been identified relating to its pathogenesis. This study has been conducted with the aim for identifying risk factors associated with this disease. Methods: This study was conducted in 2016-2020 among children aged <15 years residing in Isfahan Province, Iran. Children with newly diagnosed Acute lymphoblastic leukemia, including Acute myeloid leukemia (ALL and AML) were considered a case group. The control group was selected among children hospitalized in orthopedic and surgery wards in the same region. Demographic data, parental occupational exposures and educational level, maternal obstetric history, type of feeding during infancy and parental smoking habits, exposure to pesticides, and hydrocarbons besides dietary habits (using a food frequency questionnaire) were evaluated. Results: Overall, 497 children (195 cases and 302 controls) completed the survey. In the initial analysis, there was no significant difference between case and control groups about type of milk feeding (P = 0.34) or parental age (P = 0.56); however, an association between mothers' education and increased risk for ALL was observed (P = 0.02). Conclusions: The results of this study can be helpful in better understanding the environmental risk factors involved in the incidence of acute leukemia. Future publications based on the analysis of the database created in the present study can lead to recognizing these factors. In addition, evaluating the effect of these factors on treatment outcomes is an important step in reducing the burden of the disease.

Microbiology and antimicrobial sensitivity of ventriculo-peritoneal shunt infections in a referral paediatric neurosurgery ward during a period of 7 years.

OBJECTIVES: This study aims to evaluate the aetiology and antibiotic susceptibility pattern in children with ventriculo-peritoneal (VP) shunt infections. METHODS: A retrospective investigation was conducted from March 2011 to March 2018 among 163 children, who were admitted because of VP shunt infections in a referral educational hospital in Isfahan, Iran. RESULTS: Coagulase negative staphylococcus (CoNS) was the most common organism (49.0%), followed by Acinetobacter baumannii (10.4%) and Staphylococcus aureus (8.9%). Susceptibility of Gram-positive organisms to a different class of antibiotics was as follows: glycopeptides (82, 96%), carbapenems (78.38%), aminoglycosides (57.81%), fluoroquinolones (50.00%) and trimethoprim-sulfamethoxazole (50%). Gram-negative isolates were more susceptible to aminoglycosides (56.52%) and fluoroquinolones (52.78%), respectively. Sensitivity of Gram-negative bacteria to fluoroquinolones was significantly higher in infections that occurred in the first month of the shunt implantations compared to infections that were detected afterward (78.95% vs. 23.53%, respectively, P = 0.001). CONCLUSION: The highest sensitivity of Gram-positive bacteria was to glycopeptides and carbapenems. In addition, Gram-negative organisms had the best susceptibility to aminoglycosides and fluoroquinolones. A high level of resistance to studied antibiotics among Gram-negative isolates underscores the necessity of including new antibiotics such as colistin, fosfomycin, ceftazidime/avibactam, ceftolozane/tazobactam and tigecycline in susceptibility testing and empiric antibiotic therapy for VP shunt infections.

Fatal disseminated infection due to Sarocladium kiliense in a diabetic patient with COVID-19.

Sarocladium kiliense is a soil saprophytic mold with worldwide distribution, which can infect humans and other mammals, sporadically. The clinical manifestations include mycetoma, onychomycosis, keratomycosis, pneumonia, and arthritis. Here, we present a disseminated infection due to S. kiliense in a diabetic patient infected to coronavirus disease 2019 (COVID-19) from Isfahan, Iran.

Antimicrobial Resistance in Hospitalized Patients with Community Acquired Urinary Tract Infection in Isfahan, Iran.

BACKGROUND: Antibiotic resistance against uro-pathogens is a worldwide health concern. The aim of this study was to determine the causative bacteria and antibiotic susceptibility patterns among hospitalized patients with community acquired urinary tract infection (UTI). METHODS: This cross-sectional study was performed in 2016-2018 in Isfahan, Iran. Urine samples were examined for strain identification and antimicrobial resistance pattern using standard tests. Stratification was done based on gender and age (<20 and >20 years) groups. Chi-square and Fisher exact tests were applied to assess differences in etiology and susceptibility rates between groups. RESULTS: Among 1180 patients, Escherichia coli was the commonest pathogen (68.1%) followed by Enterococcus spp. (8.8%) and Klebsiella pneumonia (8.0 %). Non-E. coli pathogens were more frequent among males (41.8% versus 24.8% in females, P<0.01) and in those aged under 20 years (61.0% versus 22.2% in older than 20 years, P<0.01). Isolated bacteria revealed high susceptibility to imipenem (94.9%), meropenem (92.2%), and amikacin (91.9%); moderate sensitivity to gentamicin (64.4%), cefepime (52.6%) and ceftazidime (47.2%); and low susceptibility to ceftriaxone (41.8%), cefotaxime (40.0%), ciprofloxacin (38.6%) and trimethoprim-sulfamethoxazol (31.3%). The sensitivity of isolates to ceftriaxone, ceftazidime, cefepime, imipenem, meropenem, amikacin and ciprofloxacin was significantly higher in females. Compared to the older age group, uro-pathogens were more susceptible to ciprofloxacin, ceftazidime and gentamicin in patients aged under 20 years. CONCLUSION: We found that imipenem, meropenem and amikacin were good choices for empiric therapy of complicated or severe hospitalized patients with community acquired UTI; and gentamicin, cefepime and ceftazidime were acceptable as initial choices in non-severe infections in the area.

Cross-Sectional Study of Candidemia from Isfahan, Iran: Etiologic Agents, Predisposing Factors, and Antifungal Susceptibility Testing.

BACKGROUND: Candidemia is a fatal invasive fungal infection that involves thousands of patients annually and is associated with high mortality rate and economic burden. The incidence of candidemia is increasing due to the use of invasive medical instruments and immunosuppressive drugs. The treatment of infection is problematic because of the increased resistance of clinical strains to antifungal drugs. The aim of the present study was to identify Candida species isolated from candidemia and determination of antifungal susceptibility patterns of clinical isolates. MATERIALS AND METHODS: Three thousand eight hundred BACTEC bottles suspected to candidemia were evaluated from April 2019 to June 2020. For primary identification, a positive blood culture was subcultured onto the sabouraud glucose agar and CHROMagar™ Candida. For molecular identification, ITS1-5.8SrDNA-ITS2 region was amplified by ITS1 and ITS4 primers and MspI restriction enzyme was applied to digest polymerase chain reaction amplicons. Minimum inhibitory concentration of seven antifungals was determined against clinical isolates by broth microdilution method in accordance with the Clinical and Laboratory Standards Institute M27-A3 and M27-S4 documents. RESULTS: Forty-six out of 3800 suspected specimens were positive for candidemia (1.2%). The age range of the patients was between 11 days and 89 years, with a median age of 34.8 years. Candida albicans was found to be the most Candida species (58.7%), followed by C. parapsilosis complex (19.6%), C. glabrata complex (8.7%), C. krusei (6.5%), C. famata (4.3%), and C. tropicalis (2.2%). Resistance to amphotericin B, fluconazole, itraconazole, and voriconazole was detected in 13.6%, 11.3%, 6.8%, and 4.5% of clinical isolates, respectively. CONCLUSION: The incidence of non-albicans Candida species is increasing that must be highlighted. Since resistant Candida strains are found repeatedly, consecutive tracing of the species distribution and in vitro antifungal susceptibility of clinical isolates is recommended for better management of infections.