Profiling of Virulence-associated Factors in Shigella Species Isolated from Acute Pediatric Diarrheal Samples in Tehran, Iran

OBJECTIVES: The genus Shigella comprises the most infectious and diarrheagenic bacteria causing severe diseases, mostly in children under five years of age. This study aimed to detect nine virulence genes (ipaBCD, VirA, sen, set1A, set1B, ial, ipaH, stx, and sat) in Shigella species (spp.) using multiplex polymerase chain reaction (MPCR) and to determine the relation of Shigella spp. from pediatric diarrheal samples with hospitalization and bloody diarrhea in Tehran, Iran. METHODS: Shigella spp. were isolated and identified using standard microbiological and serological methods. The virulence genes were detected using MPCR. RESULTS: Seventy-five Shigella spp. (40 S. sonnei, 33 S. flexneri, 1 S. dysenteriae, and 1 S. boydii) were isolated in this study. The prevalence of ial, sen, sat, set1A, and set1B was 74.7%, 45.4%, 28%, 24%, and 24%, respectively. All S. flexneri isolates, while no S. sonnei, S. dysenteriae, or S. boydii isolates, contained sat, set1A, and set1B. All isolates were positive for ipaH, ipaBCD, and virA, while one (1.4%) of the isolates contained stx. The highest prevalence of virulence determinants was found in S. flexneri serotype IIa. Nineteen (57.6%) of 33 S. flexneri isolates were positive for ipaBCD, ipaH, virA, ial, and sat. The sen determinants were found to be statistically significantly associated with hospitalization and bloody diarrhea (p = 0.001). CONCLUSION: This study revealed a high prevalence of enterotoxin genes in S. flexneri, especially in serotype 2a, and has presented relations between a few clinical features of shigellosis and numerous virulence determinants of clinical isolates of Shigella spp.

Identifying weaknesses in undergraduate programs within the context input process product model framework in view of faculty and library staff in 2014 / 한국의학교육

PURPOSE: Objective of this research is to find out weaknesses of undergraduate programs in terms of personnel and financial, organizational management and facilities in view of faculty and library staff, and determining factors that may facilitate program quality-improvement. METHODS: This is a descriptive analytical survey research and from purpose aspect is an application evaluation study that undergraduate groups of selected faculties (Public Health, Nursing and Midwifery, Allied Medical Sciences and Rehabilitation) at Tehran University of Medical Sciences (TUMS) have been surveyed using context input process product model in 2014. Statistical population were consist of three subgroups including department head (n=10), faculty members (n=61), and library staff (n=10) with total population of 81 people. Data collected through three researcher-made questionnaires which were based on Likert scale. The data were then analyzed using descriptive and inferential statistics. RESULTS: Results showed desirable and relatively desirable situation for factors in context, input, process, and product fields except for factors of administration and financial; and research and educational spaces and equipment which were in undesirable situation. CONCLUSION: Based on results, researcher highlighted weaknesses in the undergraduate programs of TUMS in terms of research and educational spaces and facilities, educational curriculum, administration and financial; and recommended some steps in terms of financial, organizational management and communication with graduates in order to improve the quality of this system.

Analyzing Gensini score as a semi-continuous outcome

Background: Investigators frequently encounter continuous outcomes with plenty of values clumped at zero called semi-continuous outcomes. The Gensini score, one of the most widely used scoring systems for expressing coronary angiographic results, is of this type. The aim of this study was to apply two statistical approaches based on the categorization and original scale of the Gensini score to simultaneously assess the association between covariates and the presence and severity of coronary artery disease [CAD]

Methods: We considered the data on 1594 individuals admitted to Tehran Heart Center with CAD symptoms from July 2004 to February 2008. The participants' baseline demographic and clinical characteristics were collected, and their coronary angiographic results were expressed through the Gensini score. The generalized ordinal threshold and two-part models were applied for the statistical analyses

Results: Totally, 320 [20.1%] individuals had a Gensini score of zero. The results of neither the two-part model nor the generalized ordinal threshold model showed a significant association between Factor V Leiden and the occurrence of CAD. However, based on the two-part model, Factor V Leiden was associated with the severity of CAD, such that the Gensini score increased by moving from a wild genotype to a heterozygote [beta = 0.44; 95% CI: 0.20-0.69 in logarithm scale] or a homozygote mutant [beta = 0.70; 95% CI: 0.28- 1.12 in logarithm scale]. The proportional odds assumption was not met in our data [= 54.26; p value < 0.001]; however, a trend toward severe CAD was also observed at each category of the Gensini score using the generalized ordinal threshold model

Conclusion: We conclude that besides loss of information by sorting a semi-continuous outcome, violation from the proportional odds assumption complicates the final decision, especially for clinicians. Therefore, more straightforward models such as the two-part model should receive more attention while analyzing such outcomes

In-vitro activity of 10 antifungal agents against 320 dermatophyte strains using microdilution method in Tehran

Dermatophyte fungi are the etiologic agents of skin infections commonly referred to as ringworm. These infections are not dangerous but as a chronic cutaneous infections they may be difficult to treat and can also cause physical discomfort for patients. They are considered important as a public health problem as well. No information is available regarding the efficacy of antifungal agents against dermatophytes in Tehran. Therefore, in this study we evaluated the efficacy of 10 systemic and topical antifungal medications using CLSI broth microdilution method [M38-A]. The antifungal agents used included griseofulvin, terbinafine, itraconazole, ketoconazole, fluconazole, voriconazole, clotrimazole, ciclopiroxolamine, amorolfine and naftifine.Fifteen different species of dermatophytes which were mostly clinical isolates were used as follows; T. mentagrophytes, T. rubrum, E. floccosum, M. canis, T. verrucosum, T. tonsurans,M. gypseum, T. violaceum, M. ferruginum,M. fulvum, T. schoenleinii, M. racemosum, T. erinacei,T.eriotriphon and Arthrodermabenhamiae. The mean number of fungi particles [conidia] inoculated was 1.25 x 10[4] CFU/mL. Results were read after 7 days of incubation at 28 °C. According to the obtained results,itraconazole and terbinafine showed the lowest and fluconazole had the greatest MIC values for the most fungi tested. Based on the results, it is necessary to do more research and design a reliable standard method for determination of antifungal susceptibility to choose proper antibiotics with fewer side effects and decrease antifungal resistance and risk of treatment failure

Excess mortality during heat waves, Tehran Iran: an ecological time-series study

In the past three decades, Tehran, capital of Iran, has experienced warmer summers so we need to determine heat-related mortality to establish appropriate public health activities during hot summers. The aim of this study was to detect heat waves during the last decades and then determine excess mortality in immediate and lagged times. An ecological study based on time-series model was conducted in Tehran for re-cent decade using generalized linear lagged model [GLLM] with Poisson regression in 2001-2011. Maximum daily temperature was heat exposure for death outcome on the same day [lag 0], 3 [lag 01] and also 7 [lag 02] day moving average. Relative risk with 95% confidence was reported to quantify for increasing of daily mortalities for 1[degree sign]C risen exposure. Air pollutants considered as confounders in final model. Total excess mortality during 17 heat waves was 1069 [8.9 deaths/Heat wave days]. All non-external cause of death increased significantly during heat waves [3%-9%] with [RR= 1.03, 95% CI: 1.01, 1.05 and RR=1.09, 95% CI: 1.07, 1.09] and after adjusting for ozone and PM10 raised. Cause-specific deaths [especially circulatory disease] and death among elderly increased during heat waves [especially in the hottest wave]. The largest positive lagged effect of hot temperature although seen during hottest waves for all mortalities. Three waves had the most harvest effect for all categories of mortalities. This study showed excess mortalities resulted from hot temperatures and exacerbated with air pollutants in Tehran in the context of climate change. Forward displacement mortality and lagged mortalities were seen, but our results were not conclusive about the displacement pattern of mortalities

Recurrence in breast cancer. analysis with frailty model

To determine the value of known prognostic factors for metastasis in breast cancer by accounting for patient-specific effect of patients who received surgical treatment followed by adjuvant treatment using the frailty model. One hundred seventeen women with breast cancer who underwent surgery followed by adjuvant therapy at 3 hospitals in Tehran, Iran between 1995 and 2003 were enrolled in this study. Women with defined breast cancer with no distant metastases at time of diagnosis that have undergone modified radical mastectomy or breast-conserving surgery were enrolled. Tumors were classified according to the Tumor, Node, Metastasis [TNM] system of the American Joint Committee on cancer. Grading was performed according to Scarff-Bloom-Richardson method. Estrogen receptor [ER] was measured by immunohistochemistry method. The patients have been followed regularly by routine clinical laboratory profile, serologic markers [CEA, CA15-3] and para-clinical examinations; furthermore, we have followed missing materials by other access ways such as calling. Median follow up time for patients was 26 months after surgery. During the follow up time 44 [38%] patients developed metastasis and 20 [45%] of these 44 patients experienced the second metastasis. The median disease-free survival for patients in the study was 49.6 month. The median time to experience second metastasis after the first one was 22.5 months. Risk of occurrence of a metastasis in the first year after surgery was 12%. Risk of experience a metastasis up to the second year was 32% and up to fifth years was 69%. Result of fitting a frailty model to data showed that size of tumor, number of positive lymph nodes and histologic grade had a significant effect on the risk of metastasis [p<0.05]. Patients with tumor size larger than 5 cm were in higher risk of metastasis compared with others. Increase in the number of positive lymph nodes to more than 10, increased risk of metastasis. Patients with moderate or undifferentiated histologic grade were in higher risk of metastasis to well differentiated patients. Age, family history, lymph node stage, and ER had no significant effect. It was found that there was heterogeneity between patients after adjusting for other covariates because variance of frailty was 0.315. It means that based on the variance of the distribution of frailty, the relative risk of high-risk patients to low-risk patients was 7.2, wherein high-risk group is defined as a cluster at the 95th percentile and low-risk to a cluster of 5th percentile of the frailty distribution. Known risk factors describe the risk of metastasis partly and other unknown or unmeasured factors, such as genetics or environmental factors are important to describe the risk of metastasis in breast cancer

[Pharmacokinetic comparison between regular insulin and oral insulin based on superporous hydrogel polymers in healthy volunteers]

All contemporary methods of insulin administration are non-physiological. Insulin is not absorbed from the gastrointestinal tract because of its peptide nature. The aim of the present study was to examine the absorption of oral insulin from gastrointestinal tract, using novel oral formulation- adding a delivery agent superporouse hydrogel [SPH] and SPH composite [SPHC] in combination with insulin. Capsules containing insulin and SPH and SPHC were administered orally, to 15 non-diabetic subjects in order to assess its biological effects and safety. Plasma glucose, insulin and c - peptide serum levels were determined, at timed intervals up to 4 h. In the present study, we showed that AUC of exogenous insulin in polymer -insulin group was higher than sub-cutaneous regular insulin group. It means that addition of SPHC polymer caused increase in insulin absorbtion.In addition, Insulin Tmax in polymer group was longer than sub-cotaneaus insulin group. Blood glucose AUC in sub-cotaneaus group was higher than polymer group.AUC C-peptide serum level in polymer group was higher than sub-cutaneous group. Insulin in combination with a novel delivery agent, SPH and SPHC, given orally is absorbed through the GI tract in a biologically active form. This was demonstrated by suppression of endogenous insulin secretion