In vitro investigation of relationship between quorum-sensing system genes, biofilm forming ability, and drug resistance in clinical isolates of Pseudomonas aeruginosa.

BACKGROUND: Pseudomonas aeruginosa is an opportunistic pathogen in the health-care systems and one of the primary causative agents with high mortality in hospitalized patients, particularly immunocompromised. The limitation of effective antibiotic administration in multidrug-resistant and extensively drug-resistant P. aeruginosa isolates leads to the development of nosocomial infections and health problems. Quorum sensing system contributes to biofilm formation, expression of bacterial virulence factors, and development of drug resistance, causing prolonged patient infections. Therefore, due to the significance of the quorum sensing system in increasing the pathogenicity of P. aeruginosa, the primary objective of our study was to investigate the frequency of quorum sensing genes, as well as the biofilm formation and antibiotic resistance pattern among P. aeruginosa strains. METHODS: A total of 120 P. aeruginosa isolates were collected from different clinical specimens. The disk diffusion method was applied to detect the antibiotic resistance pattern of P. aeruginosa strains. Also, the microtiter plate method was carried out to evaluate the biofilm-forming ability of isolates. Finally, the frequency of rhlI, rhlR, lasI, and lasR genes was examined by the polymerase chain reaction method. RESULTS: In total, 88.3% P. aeruginosa isolates were found to be multidrug-resistant, of which 30.1% had extensively drug-resistant pattern. The highest and lowest resistance rates were found against ceftazidime (75.0%) and ciprofloxacin (46.6%), respectively. Also, 95.8% of isolates were able to produce biofilm, of which 42.5%, 33.3%, and 20.0% had strong, moderate, and weak biofilm patterns, respectively. The frequency of quorum sensing genes among all examined strains was as follows: rhlI (81.6%), rhlR (90.8%), lasI (89.1%), and lasR (78.3%). The most common type of quorum sensing genes among multidrug-resistant isolates were related to rhlR and lasI genes with 94.3%. Furthermore, rhlI, rhlR, and lasI genes were positive for all extensively drug-resistant isolates. However, the lasR gene had the lowest frequency among both multidrug-resistant (83.0%) and extensively drug-resistant (90.6%) isolates. Moreover, rhlR (94.7%) and lasR (81.7%) genes had the highest and lowest prevalence among biofilm-forming isolates, respectively. CONCLUSION: Our findings disclosed the significantly high prevalence of drug resistance among P. aeruginosa isolates. Also, the quorum sensing system had a significant correlation with biofilm formation and drug resistance, indicating the essential role of this system in the emergence of nosocomial infections caused by P. aeruginosa.

Numerical and experimental investigation of the deviation of microparticles inside the microchannel using the vortices caused by the ICEK phenomenon.

One field of study in microfluidics is the control, trapping, and separation of microparticles suspended in fluid. Some of its applications are related to cell handling, virus detection, and so on. One of the new methods in this field is using ICEK phenomena and dielectrophoresis forces. In the present study, considering the ICEK phenomena, the microparticles inside the fluid are deviated in the desired ratio using a novel ICEK microchip. The deviation is such that after the microparticles reach the floating electrode, they are trapped in the ICEK flow vortex and deviated through a secondary channel that was placed crosswise and noncoplanar above the main channel. For simulation verification, an experimental test is done. The method used for making two noncoplanar channels and separating the particles in the desired ratio with a simple ICEK microchip is an innovation of the present study. Moreover, the adjustment of the percentage of separation of microparticles by adjusting the parameters of the applied voltage and fluid inlet velocity is one of the other innovations of the present experimental study. We observed that for input velocities of 150-1200 µm/s with applied voltages of 10-33 V, 100% of the particles can be directed toward the secondary-channel.

Effects of 3D electrodes arrangement in a novel AC electroosmotic micropump: Numerical modeling and experimental validation.

To date, a comprehensive systematic optimization framework, capable of accurately predicting an efficient electrode geometry, is not available. Here, different geometries, including 3D step electrodes, have been designed in order to fabricate AC electroosmosis micropumps. It is essential to optimize both geometrical parameters of electrode, such as width and height of steps on each base electrode and their location in one pair, the size of each base electrode (symmetric or asymmetric), the gap of electrode pairs, and nongeometrical parameters such as fluid flow in a channel and electrical characteristics (e.g., frequency and voltage). The governing equations comprising of electric domain and fluid domain have been coupled using finite element method. The developed model was employed to investigate the effect of electrode geometric parameters on electroosmotic slip velocity and its subsequent effect on pressure and flow rate. Numerical simulation indicates that the optimal performance can be achieved using a design with varying step height and displacement, at a given voltage (2.5 V) and frequency (1 kHz). Finally, in order to validate the numerical simulation, the optimal microchip was fabricated using a combination of photolithography, electroplating, and a polydimethylsiloxane microchannel. Our results indicate that our micropump is capable of generating a pressure, velocity, and flow rate of 74.2 Pa, 1.76 mm/s, and 14.8 µl/min, respectively. This result reveals that our proposed geometry outperforms the state-of-the-art micropumps previously reported in the literature by improving the fluid velocity by 32%, with 80% less electrodes per unit length, and whereas the channel length is ∼80% shorter.

A systematic overview of electrode configuration in electric-driven micropumps.

Accurate manipulation of fluids in microfluidic devices is an important factor affecting their functions. Since the emergence of microfluidic technology to transport fluids in microchannels, the electric field has been utilized as an effective dynamic pumping mechanism. This review attempts to provide a fundamental insight of the various electric-driven flows in microchannels and their working mechanisms as micropumps for microfluidic devices. Different electrokinetic mechanisms implemented in electrohydrodynamic-, electroosmosis-, electrothermal, and dielectrophoresis-based micropumps are discussed. A detailed description of different mechanisms is presented to provide a comprehensive overview on the key parameters used in electric micropumps. Furthermore, electrode configurations and their shapes in different micropumps are explored and categorized to provide conclusive information for the selection of efficient, simple, and affordable strategies to transport fluids in microfluidic devices. In this paper, recent theoretical, numerical and experimental investigations are covered to provide a better insight both on the operational mechanisms and strategies for lab-on-chip applications.

Emergence of carbapenem resistant Acinetobacter baumannii clonal complexes CC2 and CC10 among fecal carriages in an educational hospital.

Carbapenem-resistant Acinetobacter baumannii strains are increasing worldwide. In this study, samples were collected from hospital environments, extra hospital environments, and fecal carriages. 76% (89/117) of bacterial isolates were detected as A. baumannii strains. The imipenem resistance in the hospital environment, fecal carriages, extra hospital environments, and clinical isolates was 37.7% (17/45), 100% (9/9), 0% (0/45), and 92.9% (92/99), respectively. The blaVIM and blaOXA-23 were detected in 6.6% (3/45) and 2.2% (1/45) of strains isolated from hospital environments. Interestingly, strains isolated from fecal carriages had blaVIM, blaOXA-23, and blaIMP genes which resembled carbapenem resistance genes in clinical strains. The structure of clonal relatedness among all non-clinical isolates was as follows: CC2, 37% (33/89); CC1, 22.4% (20/89); CC3, 12.3% (11/89); CC25, 7.8% (7/89); CC10, 4.4% (4/89) and CC15, 2.2% (2/89). Comparison of clonal relatedness among clinical and non-clinical isolates indicated that widespread clones including CC2, CC3, and CC10 were common clonal complexes between two categories.

New putative vaccine candidates against Acinetobacter baumannii using the reverse vaccinology method.

Infections caused by multi-drug resistance Acinetobacter baumannii are increasing worldwide. Discovery of the vaccine against this bacterium as a cost-effective and preventive strategy seems necessary. This study has introduced 11 new putative vaccine candidates against A. baumannii using the reverse vaccinology method. We considered 33 genomes of A. baumannii strains and selected the outer membrane and secreted proteins as putative vaccine candidates using Vaxign web tool. Finally, 11 proteins were confirmed as promising vaccine candidates. These targets belonged to proteins involved in cell division (NlpD), fimbria or pili assembly (FimA, PapC, and PapC associated with usher system), iron acquisition (FhuA, BfnH, FatA-like protein, and IutA), DcaP-like protein and two novel hypothetical proteins (HP-1 and HP-2). The analysis of linear and conformational B-cell epitopes showed that the outer membrane proteins including DcaP-like protein and HP-2 had high conserved surface-exposed epitopes that they can consider as excellent putative vaccine targets in the upcoming immunological assays.

Droplet size prediction in a microfluidic flow focusing device using an adaptive network based fuzzy inference system.

Microfluidics has wide applications in different technologies such as biomedical engineering, chemistry engineering, and medicine. Generating droplets with desired size for special applications needs costly and time-consuming iterations due to the nonlinear behavior of multiphase flow in a microfluidic device and the effect of several parameters on it. Hence, designing a flexible way to predict the droplet size is necessary. In this paper, we use the Adaptive Neural Fuzzy Inference System (ANFIS), by mixing the artificial neural network (ANN) and fuzzy inference system (FIS), to study the parameters which have effects on droplet size. The four main dimensionless parameters, i.e. the Capillary number, the Reynolds number, the flow ratio and the viscosity ratio are regarded as the inputs and the droplet diameter as the output of the ANFIS. Using dimensionless groups cause to extract more comprehensive results and avoiding more experimental tests. With the ANFIS, droplet sizes could be predicted with the coefficient of determination of 0.92.

In vitro evaluation of biofilm phenotypic and genotypic characteristics among clinical isolates of Pseudomonas aeruginosa in Hamadan, West of Iran.

Due to high antimicrobial resistance and biofilm-forming ability, Pseudomonas aeruginosa is one of the seriously life-threatening agents causing chronic and nosocomial infections. This study was performed to determine the antibiotic resistance pattern, biofilm formation, and frequency of biofilm-related genes in P. aeruginosa strains. In total, 123 P. aeruginosa isolates were collected from different clinical sources. Antimicrobial susceptibility testing (AST) was performed to detect multidrug-resistant P. aeruginosa (MDRPA) isolates. To evaluate the biofilm-forming isolates, the microtiter plate (MTP) method was carried out. Also, the prevalence of biofilm genotype patterns, including pslA, pslD, pelA, pelF, and algD genes, was detected by polymerases chain reaction (PCR). According to our findings, the highest resistance and susceptibility rates were found in ceftazidime with 74.7% (n = 92) and ciprofloxacin with 42.2% (n = 52), respectively. In our study, the highest level of antibiotic resistance belonged to wound isolates which meropenem had the most antibacterial activity against them. In total, 86.1% (n = 106) P. aeruginosa isolates were determined as MDRPA, of which 61.3% (n = 65) were able to form strong biofilm. The highest and lowest frequency of biofilm-related genes among biofilm producer isolates belonged to pelF with 82.1% (n = 101) and algD with 55.2% (n = 68), respectively. The findings of the conducted study indicate a significant relationship between MDRPA and biofilm genotypic/phenotypic patterns, suggesting the necessity of a careful surveillance program in hospital settings.

Novel therapeutic strategy for obesity through the gut microbiota-brain axis: A review article.

Background: The interaction between commensal bacteria and the host is essential for health and the gut microbiota-brain axis plays a vital role in this regard. Obesity as a medical problem not only affect the health of the individuals, but also the economic and social aspects of communities. The presence of any dysbiosis in the composition of the gut microbiota disrupts in the gut microbiota-brain axis, which in turn leads to an increase in appetite and then obesity. Because common treatments for obesity have several drawbacks, the use of microbiota-based therapy in addition to treatment and prevention of obesity can have other numerous benefits for the individual. In this review, we intend to investigate the relationship between obesity and the gut microbiota-brain axis as well as novel treatment strategies based on this axis with an emphasis on gut microbiota.

Relationship between antibiotic resistance with class 1 integron and SmeDEF efflux pump encoding genes in clinical isolates of Stenotrophomonas maltophilia.

Stenotrophomonas maltophilia is an emerging multidrug-resistant organism with an increasing frequency of hospital-acquired infections predominantly in developing countries. The purpose of this study was to determine the antibiotic resistance and frequency of the smeD, class 1 integron, and sul1 genes in clinical isolates of S. maltophilia in two Iranian provinces. From January 2020 to September 2021, 38 clinical isolates of S. maltophilia were collected from patients in hospitals in Tabriz and Sanandaj provinces of Iran. S. maltophilia isolates were confirmed by standard bacteriological tests and 16S rRNA gene PCR. Disk diffusion and the MIC test strip methods were used to determine the antibiotic resistance patterns. PCR was performed to investigate the presence of smeD, class 1 integron, and sul1 genes. The antimicrobial test for the isolated S. maltophilia showed a high level of sensitivity against most of the antibiotics used. Maximum sensitivity was recorded for ciprofloxacin (100% (38/38)) and levofloxacin 100% (38/38), followed by ceftazidime (97.36% (37/38)), trimethoprim-sulfamethoxazole (81.57% (31/38)), ticarcillin-clavulanate (60.52% (23/38)), and piperacillin-tazobactam (55.26% (21/38)). We observed a high prevalence of smeD (100% (38/38)) and class 1 integron (94.73% (36/38)) genes in the isolates, and none of the isolates carried the sul1 gene. The findings from this study indicate that resistance to trimethoprim-sulfamethoxazole was not observed, and still, trimethoprim-sulfamethoxazole is the best drug with desirable antimicrobial effect in the treatment of nosocomial infections caused by S. maltophilia strains. Despite the observation of a high number of class 1 integron, the sul1 gene was not observed, which indicates the role of this gene in high-level trimethoprim-sulfamethoxazole resistance and not having a role in low-level resistance. Based on our results, clinical microbiology laboratories need continuous surveillance of resistance rates to trimethoprim-sulfamethoxazole, because of the possibility of S. maltophilia acquiring trimethoprim-sulfamethoxazole-resistance by mobile gen elements.

Investigation of the biofilm formation in extra-intestinal pathogenic Escherichia coli ST131 strains and its correlation with the presence of fimH, afa, and kpsMSTII genes.

Escherichia coli sequence type 131 (ST131) is a multidrug-resistant strain with the global dissemination. Biofilm formation-related factors include the most important virulence factors in extra-intestinal pathogenic E. coli (ExPEC) ST131 strains causing infections with treatment-limited subjects. This study aims to investigate the biofilm formation ability and its correlation with the presence of fimH, afa, and kpsMSTII genes in clinical isolates of ExPEC ST131. In this regard, the prevalence and characteristics of these strains collected and evaluated. The results revealed strong, moderate, and weak attachment abilities related to biofilm formation attributes in 45%, 20%, and 35% of strains, respectively. In the meantime, the frequency of the fimH, afa, and kpsMSTII genes among the isolates was observed as follows: fimH positive: 65%; afa positive: 55%; and kpsMSTII positive: 85%. The results convey a significant different of biofilm formation ability between clinical E. coli ST131 and non-ST131 isolates. Furthermore, while 45% of ST131 isolates produced strong biofilms, only 2% of non-ST131 isolates showed the ability to form strong biofilms. The attending of fimH, afa, and kpsMSTII genes in the majority of ST131 strains demonstrated a key role leading to biofilm formation. These findings suggested the application of fimH, afa, and kpsMSTII gene suppressors for treating biofilm infections caused by drug-resistant ST131 strains.

Examining the Effect of the Training Program by Using the Health Belief Model in Performing Self-Care Behaviors of Rural Patients Having High Blood Pressure.

BACKGROUND: High blood pressure effects on patients' life. One of the problems in controlling blood pressure is lack of self-care. As a primary form of care, self-care is under patients' control and the patient's belief plays an important role in self-care behaviors. Using the Health Belief Model, this study aimed to determine the effect of educational program on self-care behaviors of rural patients afflicted with hypertension in Toyserkan city. METHODS: This study was a quasi-experimental research. It studied 100 hypertensive patients in four health centers in rural areas in Toyserkan city in 2019. The samples were simple random sampling among those people referred to the four health centers. Participants in the intervention group attended three training sessions, but the control group did not take part in any training program. The assessment was conducted in both groups before and after the intervention through personal interviews with patients. The questionnaire including the Health Belief Model and self-care behavior constructs was administered. RESULTS: Perceived susceptibility, perceived severity, self-efficacy and self-care behavior constructs did not have significant statistical differences in terms of mean scores before intervention between the two groups, but after intervention, there were statistically significant differences between the two groups. Examining the model factor in predicting self-care in the intervention group showed that the perceived severity and self-efficacy constructs had the highest predictive power. CONCLUSION: The results showed that planning and intervention based on HBM, as the models that were used in education and health promotion could be effective in achieving better performance and attitude of patients suffering from hypertension and their self-care. Also, special mention is needed to health care providers to improve self-care training in patients with high blood pressure.

Pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 symptoms in Iran.

Aim: We report two cases of pediatric patients diagnosed and treated for pediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) symptoms. Materials & methods: Two previously healthy 3- and 4-year-old boys were referred to the hospital after 5 days of 39°C fever, with symptoms such as erythema multiform in the lower extremities, irritability, refusal to eat, restlessness, lymphadenopathy, conjunctivitis and abnormal echocardiography. Results: After 8 days of hospitalization, the patients showed normal laboratory tests, improvement of clinical condition and were discharged from the hospital. Conclusion: This study raised several issues for physicians about SARS-CoV-2, its complications, diagnosis and treatment. Based on our results, pediatrics with PIMS-TS should be first screened for SARS-CoV-2, then treated with a combination of antivirals, anti-inflammatories, antibiotics and intravenous immune globulin.

Lack of correlation between plasma neuropeptide Y and typical and atypical febrile seizures.

It is known that neuropeptide Y which is widely distributed throughout the central nervous system is able to prevent seizures in animals. There are limited studies about the role of neuropeptide Y in febrile seizures. This study was conducted to evaluate the association between plasma neuropeptide Y level and febrile seizures in children. Seventy six patients with typical and atypical febrile seizures (each group 38 patients) and 38 sex and age matched control subjects were enrolled. The mean plasma levels of neuropeptide Y in typical and atypical febrile seizures were 90.60±28.01 and 97.34±41.27 pmol/l respectively. This value in control group was 88.94±32.66 pmol/l. There was no significant differences between groups regarding plasma neuropeptide Y level (P=0.532). Also, there was no significant difference in comparison with case groups (P=0.40). This study revealed that there is no association between plasma neuropeptide Y and febrile seizures.