Increasing antibiotic resistance among uropathogens isolated during years 2006-2009: impact on the empirical management.

UNLABELLED: Urinary tract infections (UTI) are one of the most common infections with an increasing resistance to antimicrobial agents. PURPOSE: Empirical initial antibiotic treatment of UTI must rely on susceptible data from local studies. MATERIALS AND METHODS: Retrospective analysis of isolated bacteria from children with UTIs was performed at the university hospital during years 2006-2009. The findings were compared with data collected in a similar study carried out in 2002-2003. RESULTS: A total of 1439 uropathogens were isolated. Escherichia coli (E.coli) was the leading cause, followed by Enterobacter, and other gram negative bacilli. It was observed resistance of E.coli to ceftriaxone, cefexime, amikacin, gentamycin, and nalidixic acid; Enterobacter to cefexime; and the resistance of gram negative bacilli to gentamicin and cefexime increased significantly. The highest effective antibiotic was Imipenem, ciprofloxacin, and amikacin with 96.7%, 95% and 91% sensitivity rates, respectively, followed by ceftriaxone 77.2%, gentamicin 77%, nitrofurantoin 76.4%, nalidixic acid 74.3% and cefexime with 70%. CONCLUSION: The use of nitrofurantoin or nalidixic acid as initial empirical antibacterial therapy for cystitis seems appropriate. For cases of simple febrile UTI, the use of initial parenteral therapies with amikacin or ceftriaxone followed by an oral third generation cephalosporin also seemed appropriated, and in cases of severely ill patients or complicated UTI, imipenem as monotherapy or, a combination of Ceftriaxone with an aminoglycoside, are recommended.

A novel epigenetic biomarker, plasma miR-138-5p gene promoter-methylated DNA, for colorectal cancer diagnosis.

Aim: The miR-138-5p promoter-methylated DNA level, miR-138-5p and PDL1 expression were investigated in colorectal cancer (CRC) patients. Materials & methods: miR-138-5p promoter methylation status and miR-138-5p expression were investigated using the MethyLight and qPCR method, respectively. For measuring PDL-1, we applied the Bioassay Technology Elisa kit. Results: The percentage of methylated reference values of plasma and tissue samples from patients was higher than control groups. The area under curve presented a sensitivity of 55% and a specificity of 82.5% for plasma samples. Compared with the control groups, lower expression of miR-138-5p and higher concentration of PDL1 protein were observed in the patients group. Conclusion: CRC may be detected early by identifying miR-138-5p methylated DNA in plasma as a diagnostic biomarker.

Unfortunately, most patients with colorectal cancer (CRC) are diagnosed late in advanced stages. Genetic alterations due to a person's behavior or environment, such as miRNA dysregulation and methylation, occur in the initial phases of tumorigenesis. This study investigated the disease causing role of methylation of the miR-138-5p gene and its target protein, PDL1, in CRC as well as their potential ability to be used in the early diagnosis of this cancer. Using molecular techniques, higher methylated miR-138-5p as well as a higher PDL1 concentration were found in patients. This suggested a link between PDL1 protein and hyper methylation of the miR-138-5p gene. On the other hand, the hypermethylation of miR-138-5p happened before the increase of PDL1 protein, which resulted in decreased miR-138-5p and as a result decreased PDL1 protein. Compared with other biomarkers, miR-138-5p methylation and PDL1 had high diagnostic accuracy (acceptable sensitivity and specificity). Thus, the methylated miR-138-5p and PDL1 are proposed as diagnostic biomarkers for CRC.

Measles-mumps-rubella revaccination; 18 months vs. 4-6 years of age: potential impacts of schedule changes.

OBJECTIVE: The policy of administering the second dose of measles-mumps-rubella (MMR) vaccine (MMR(2)) has recently changed in Iran, at age 1.5 years instead of 4-6 years previously. The effects of such a change on the immune status of the individual are evaluated in this study. METHODS: Totally 249 and 228 children aged 18 months and 4- to 6-year-olds, respectively, with a documented receipt of primary MMR vaccine at the age of ≥ 1 year were enrolled. Before, and 4-6 weeks after MMR(2) administration, anti-MMR IgG antibody levels were measured using ELISA method. IgM antibody levels were also assessed in measles-rubella seronegative children that responded to MMR(2). Collected data for each component from both age groups were compared by using Fischer's exact probability and chi-square tests. RESULTS: Before revaccination, measles seroimmunity rate was similar between the two groups, but rates to mumps and rubella were significantly higher in younger children-measles: 74 vs. 78.3%; mumps: 82.3 vs. 68.4% and rubella: 75% vs. 67%, respectively. After administration of MMR(2), all seroimmune subjects were IgG boosted. Except for rubella, older seronegative children showed significantly higher seroconvertion rate to MMR(2) and seroprevalence rates increased in vaccinees--measles: 98.2 vs. 94%, mumps: 97 vs. 94.4% and rubella: 87 vs. 92.4%, respectively. Only few measles-rubella seronegative children showed IgM response to MMR(2). CONCLUSION: This study showed that the majority of younger children were susceptible to MMR infection before revaccination. Earlier age policy provides more protection against MMR in preschool-aged children. Rubella strain seems to be less potent than reported.

Long-term Protection Against the Hepatitis B Virus Detected Through an Early Response to a Booster Dose Injection.

OBJECTIVE: To determine the duration of protection conferred by the hepatitis B (HB) vaccination and the necessity of a booster dose. METHODS: Immediately after the initial blood sampling, 252 youths (aged 18.8-20.5 years, 52% females) with a history of neonatal HB vaccination with one dose of the HB vaccine received a booster. Serum concentrations of antibodies against the HB surface antigen were assessed in samples collected before and 10-14 days after the booster. Seroconversion from concentrations <10 to ≥10 IU/L were defined as a positive immune response. RESULTS: Of the 252 participants, 131 were sero-susceptible and 114 responded. CONCLUSION: Nearly 90% of young people preserved their long-term protection; the results of this study do not support the use of an HB booster vaccination.

The Relationship Between Stressors and Anxiety Levels After CABG in Sari, Iran.

BACKGROUND: Hospitalization and surgery are crucial adverse life events that lead to considerable anxiety in patients. OBJECTIVES: The present study aimed to investigate stressors after coronary artery bypass graft surgery and identify stressors that predict anxiety. PATIENTS AND METHODS: This is a descriptive-analytical study that uses a non-random convenience sampling method on patients undergoing coronary artery bypass graft surgery at the cardiac surgery intensive care unit of Fatemeh Zahra Cardiac center in Sari, Iran. A total of 186 patients completed the post-surgical stressors questionnaire and the Spielberger State-Trait Anxiety Inventory on postoperative days 2 or 3 in the cardiac surgery intensive care unit. Data were analyzed using descriptive statistics including frequencies, means, and standard deviations. The Mann-Whitney U test was used to determine the relationship between the observed variables, and the logistic regression model was used to identify the relationship between stressors and anxiety after-surgery. RESULTS: Post-surgical anxiety predictors included insufficient sleep during hospitalization (Odds ratio [OR]: 5.42; 95% confidence interval [CI]: 1.46 - 20.00; P = 0.010), treatment not explained to the patient by the nurse (OR: 4.83; 95% CI: 1.82 - 12.84; P = 0.002), being away from family members (OR: 3.88; 95% CI: 1.46 - 10.26; P = 0.006), presence of a chest tube (OR: 3.27; 95% CI: 1.83 - 5.84; P = 0.000), and pain in any part of the body (OR: 1.95; 95% CI: 1.06 - 3.58; P = 0.031). CONCLUSIONS: Physical or physiological and psychological stressors impose greater stress and are predictors of anxiety. When preparing their nursing care plan, nurses should consider these stressors that affect anxiety levels in patients undergoing CABG surgery and those hospitalized in intensive care units.

Study of attitudes and practice of physicians regarding consultation-liaison psychiatry in teaching hospitals of mazandaran, iran.

OBJECTIVE: Consultation-liaison (CL) psychiatry interfaces between psychiatry and other medical disciplines to promote integrated care of patients. The purpose of this study is evaluation of attitudes and practice of Mazandaran University of Medical Sciences physicians of teaching hospitals regarding CL psychiatry. METHODS: In this descriptive study, all of the general practitioners, specialist and subspecialist physicians and assistants working in teaching hospitals of Mazandaran University of Medical Sciences were requested to fill in a questionnaire which was designed based on previous studies and observations to assess their attitudes and practice. Data were analysed by SPSS-16 software, using chi square. RESULTS: One hundred and forty nine (62.6%) physicians had very positive attitudes and 89 cases (37.4%) had positive attitudes; 234 physicians (98.3%) had acceptable practice, and 4 cases (1.7%) had unacceptable practice. There were no significant differences between physicians with positive and very positive attitudes and between physicians with acceptable and unacceptable practice regarding gender, age, education, specialty and place of work (hospital). The most common reasons of physicians for not requesting psychiatric consultation were lack of time, forgetfulness, lack of access to psychiatrist, and lack of belief in the need for psychiatric consultation respectively. CONCLUSION: The findings of this study indicate the successful psychiatric educations and psychiatrists practice in formation of positive attitudes and acceptable practice regarding CL Psychiatry in these university hospitals. No significant differences between different specialties and work place hospitals indicate that they are similarly affected.

Long-term T-cell-mediated immunologic memory to hepatitis B vaccine in young adults following neonatal vaccination.

BACKGROUND: The long-term duration of cell-mediated immunity induced by neonatal hepatitis B virus (HBV) vaccination is unknown. OBJECTIVES: Study was designed to determine the cellular immunity memory status among young adults twenty years after infantile HB immunization. PATIENTS AND METHODS: Study subjects were party selected from a recent seroepidemiologic study in young adults, who had been vaccinated against HBV twenty years earlier. Just before and ten to 14 days after one dose of HBV vaccine booster injection, blood samples were obtained and sera concentration of cytokines (interleukin 2 and interferon) was measured. More than twofold increase after boosting was considered positive immune response. With regard to the serum level of antibody against HBV surface antigen (HBsAb) before boosting, the subjects were divided into four groups as follow: GI, HBsAb titer < 2; GII, titer 2 to 9.9; GIII, titer 10 to 99; and GIV, titers ≥ 100 IU/L. Mean concentration level (MCL) of each cytokines for each group at preboosting and postboosting and the proportion of responders in each groups were determined. Paired descriptive statistical analysis method (t test) was used to compare the MCL of each cytokines in each and between groups and the frequency of responders in each group. RESULTS: Before boosting, among 176 boosted individuals, 75 (42.6%) had HBsAb 10 IU/L and were considered seroprotected. Among 101 serosusceptible persons, more than 80% of boosted individuals showed more than twofold increase in cytokines concentration, which meant positive HBsAg-specific cell-mediated immunity. MCL of both cytokines after boosting in GIV were decreased more than twofold, possibly because of recent natural boosting. CONCLUSIONS: Findings showed that neonatal HBV immunization was efficacious in inducing long-term immunity and cell-mediated immune memory for up to two decades, and booster vaccination are not required. Further monitoring of vaccinated subjects for HBV infections are recommended.

The Cytotoxic T Lymphocyte Antigen-4 +49A/G Single Nucleotide Polymorphism Association With Visceral Leishmaniasis.

BACKGROUND: Several lines of evidence approve that innate and adaptive immunity play key roles in the defense against visceral leishmaniasis (VL). The polymorphism within the cytotoxic T lymphocyte antigen 4 (CTLA-4) gene alters its expression. OBJECTIVES: The main aim of this study was to evaluate the polymorphism within the +49 position of the CTLA-4 gene of Iranian patients with VL in comparison with healthy controls. MATERIALS AND METHODS: In this cross-sectional study, 88 patients with clinical presentations of VL, who were seropositive for Leishmania (group 1), 86 patients without clinical presentations but seropositive (group 2), and 115 healthy controls (group 3) were assessed with respect to the CTLA-4 +49A/G polymorphism, using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The anti-Leishmania antibody titration was evaluated using an immunofluorescence method. RESULTS: Our results indicated that both CTLA-4 +49A/G polymorphisms were significantly associated with VL. CONCLUSIONS: According to the results, the polymorphisms within the +49 position of CTLA-4 can be associated with VL and may be considered as risk factors for the disease.

Prevalence of hepatitis B virus seromarkers in young adults vaccinated at birth; impact on the epidemiology of hepatitis B infection in iran.

BACKGROUND: The epidemiological impact and the duration of protection provided by infant hepatitis B (HB) vaccination are unknown. OBJECTIVES: This study was designed to determine the hepatitis B virus (HBV) infection seromarkers in young adults who have been vaccinated against HBV as the first group of Iranian neonates during 1993 and 1994. PATIENTS AND METHODS: We recruited 510 young adults with a history of complete HB vaccination at birth. HBV seromarkers (HB surface antigen (HBs Ag), antibody against HBs Ag (Anti-HBs), and antibody against HB core antigen (Anti-HBc) were measured using ELISA method. Anti-HBs titers ≥ 10 IU/L were considered protective and titers more than 300 IU/L were indicative of a natural boosting. Positive results for Anti-HBc and HBs Ag were considered as breakthrough infection and possible vaccine failure, respectively. The history of acute symptomatic clinical hepatitis was also investigated. RESULTS: Anti-HBs seropositivity rate was detected in 224 of 510 [95% CI: 39-47] young adults. Breakthrough infection (positive sera for Anti-HBc without chronic infection) was observed in 18 [95% CI: 2.5-3.5] subjects. There were neither HBs Ag positive results nor symptomatic hepatitis cases. CONCLUSIONS: The study results indicated that the neonatal HBV immunization induced a long-term protection against HBV and was very efficacious in reducing chronic HBV infection rate in vaccinated young adults in Iran.

Path analysis of the risk of low birth weight for multipara.

BACKGROUND: LBW rate is one of the most important health indices in every society. It reveals mothers and their new-born infants' health. OBJECTIVES: Our aim, in the present paper, was to present a new statistical framework for analysis based on path analysis techniques. PATIENTS AND METHODS: A prospective study was conducted in two maternity wards, (privet & governmental hospital) in Sari, Iran. In this research a check-list containing 25 questions about mother's demographic information and her new-born infant was prepared. Every new born infant who was born weighing less than 2500 g was entered in our study and just next the newborn infant who was normal all of his/her information use to be taken too, (n = 190). Path analysis, an extension of the regression model, was used in this study. RESULTS: Obviously exactly half of the infants were LBW, and the remainder were normal. There were 97 boys and 93 girls. The percentage of IUGR among mothers who had preterm delivery was 19, while this percentage for mothers who had term delivery was 11.5 (P value = 0.167). LBW infants were 36.7% unexpected, while this percent for normal infants was 15.5 (P value < 0.001). Preterm delivery has a significant and direct effect on LBW (p value < 0.001), and its positive sign of path coefficient shows that if it occurs, the probability of LBW will increase, the second important was IUGR, the results showed unexpected pregnancy had direct effect on LBW but this wasn't significant (P value = 0.292). CONCLUSIONS: By preventing unnecessary termination of pregnancy and keeping fit, the chances of LBW can be reduced.

Age-specific seroprevalence of anti-hepatitis a antibody among 1-30 years old population of savadkuh, mazandaran, iran with literature review.

BACKGROUND: To determine age-specific seroprevalence rates of hepatitis A virus (HAV) immunoglobulin G (IgG) antibody in Savadkuh district, Mazandaran province, north of Iran, as well as to compare the collected data with earlier seroprevalence studies in the region and Iran in order to draw a proper epidemiological pattern for HAV infection in the country. OBJECTIVES: This study aimed to assess an age-specific HAV seroprevalence among 1- to 30-yearold people in Savadkuh, a less developed district of Mazandaran province, north of Iran. PATIENTS AND METHODS: The study participants were 984 subjects who aged from one to 30 years and were residents of rural and urban areas of Savadkuh. They were selected using cluster sampling method and divided into five age groups: 1-2.9 (316 cases), 3-6.9 (254 cases), 7-10.9 (201 cases), 11-17.9 (115 cases), and 18-30 (98 cases). Anti-HAV antibody was measured by ELISA method. Seroprevalence rates among different age groups and their relationship to residency, educational levels of parents, water supply, and waste water disposal system was analyzed using chi-squared test. RESULTS: Overall seroprevalence rate was 19.20 % with no significant difference between rural and urban residents. The seroprevalence rates increased significantly with age: from 5.7 % in age group 1-2.9 year to 34.8 % in adolescents, and to 68.4 % among young adults (P < 0.0001); regardless of significant differences in educational levels among parents of residents in two areas it did not affect seroprevalence rates. Findings of this study and reviewing other reports from the region and the country suggest an epidemiological shift towards lower rates of anti-HAV antibody seroprevalence. CONCLUSIONS: It appears that anti-HAV antibody seroprevalence rate has been declining among Iranians and thereby more children would be susceptible to this infection. This would necessitate revising current strategies of preventative measures in Mazandaran and Iran.

Bordetella pertussis IgG and IgA antibodies seroprevalence among 1-35 y-old population: the role of subclinical pertussis infection.

OBJECTIVE: To determine age-dependent pertussis specific IgG and IgA antibodies seroprevalence in apparently healthy subjects. METHODS: A total of 595 healthy 1-35-y-old individuals divided into 5 different age groups were selected from Sari district. Antipertussis IgG and IgA antibodies levels were measured quantitatively by ELISA method. Positive sera for IgA and also IgG titer ≥150 were considered for recent pertussis infection. RESULTS: High seroprevelence levels (72% and 71%) were observed among preschool (<7 y) children. After decreasing the seroprevelence rates significally to lowest level (54.4%) among school aged (7-11 y), the rates increased again to the highest levels of 60% and 73% at adulthood (P = 0.03 and P = 0.003). In total, 1.55% of study subjects were IgA positive, and 5.7% showed high IgG titers. CONCLUSIONS: The present study reveals, vaccine induced immunity has decreased among school-aged children and natural pertussis infection is common among adolescent and young adults. Also, asymptomatic/sub-clinical recent pertussis infection was prevalent among studied population. These findings necessitate developing new strategies to reduce and control pertussis infection in Iran.

Low back pain in 1,100 Iranian pregnant women: prevalence and risk factors.

BACKGROUND: Low back pain (LBP) is a common and costly problem in pregnancy. It is one of the main reasons for disability, absence from work, and responsible for huge direct and indirect economical impact. PURPOSE: The purpose of this study was to determine the prevalence and risk factors of LBP during pregnancy. STUDY DESIGN: A cross-sectional study was carried out on Iranian pregnant women. PATIENT SAMPLE: Eleven hundred randomly selected pregnant women. OUTCOME MEASURES: A structured questionnaire including demographic, lifestyle, as well as prevalence and characteristics of LBP was used. Visual Analog Scale and Oswestry low back disability questionnaires were also used to assess the pain intensity and functional disability, respectively. METHODS: After ethical approval from Medical Ethics Board at the Mazandaran University of Medical Sciences and Health Services, a cross-sectional study was conducted on 1,100 pregnant women from 18 health centers in Sari district, at northern Iran. RESULTS: Point, last-month, last 6-month, last-year, and lifetime prevalence of LBP were 40.2%, 55.9%, 59.4%, 76.2%, and 84.1%, respectively. Prolonged standing and rest were found to be the most significant aggravating and relieving factors (76.3% and 87.7%, respectively). LBP was significantly correlated with history of previous LBP and LBP in previous pregnancy (p=.000 in both cases). CONCLUSION: The prevalence of LBP in pregnant women appears to be high and future research should focus on different preventive strategies during pregnancy.