Exposure assessment of nitrate and phenol derivatives in Tehran's water distribution system.

The presence of organic and inorganic contaminants in drinking water is a global concern. Nitrate and phenol derivatives are examples of pollutants that could be of anthropogenic origin. They are associated with numerous health risks, underscoring the importance of monitoring their presence in drinking water. This study aimed to measure nitrate and phenol derivatives, including 2,4-Dichlorophenol (2,4-DCP), Pentachlorophenol (PCP), 2,4,5-Trichlorophenol (2,4,5-TCP), 2-Chlorophenol (2-CP), 4-Chlorophenol (4-CP), and phenol, in Tehran's water distribution system (WDS). The pollutants in Tehran's WDS were significantly and positively correlated with precipitation. The Hazard Quotient (HQ) and the Excess Lifetime Cancer Risk (ELCR) of the detected pollutants were estimated. The results showed that the regional mean of nitrate and PCP in Tehran's WDS were 35.58±8.71mg L-1 and 76.14±16.93 ng L-1 lower than the guideline values of 50 mg L-1 and 1000 ng L-1, respectively. Some districts exhibited nitrate concentration exceeding the allowable limit by a factor of 1.2 to 2.3. Consequently, the nitrate intake in some districts constituted approximately 50% of the reference dose. While PCP as a phenol derivative with more health concerns was identified in Tehran's WDS, the likelihood of its health effects was determined to be negligible.

Human biomonitoring and reference values of urinary 1-hydroxypyrene among Iranian adults population.

Polycyclic aromatic hydrocarbons (PAHs) are one of the most important environmental pollutants. Urinary concentrations of 1-hydropyren metabolites of PAHs have been used as biomarkers of these chemicals' exposure in humans. This cross-sectional study was conducted on 468 healthy Iranian adults over 25 years old and non-smokers in six provinces who were selected based on the clustering method. Fasting urine sampling and body composition and demographic measurements were performed. Urine samples were analyzed by GC-MS. The analysis included descriptive statistics and analytical statistics using multiple linear regression by Python software. 1-Hydroxypyrene was found in 100% of samples, and the mean (Reference Value 95%) concentration of 1-hydroxypyrene was 6.12 (RV 95%: 20) µg/L and 5.95 (21) µg/gcrt. There was a direct relationship between the amount of body composition (body fat, visceral fat), BMI, and age with the urinary concentrations of 1-hydropyren metabolites, and this relationship was significant for BMI with urinary concentrations of 1-hydropyren metabolites (P = 0.045). The amount of 1-hydroxypyrene in healthy Iranian adults has been higher than in similar studies in other countries. These results provide helpful information regarding the exposure of Iranian adults to 1-hydroxypyrene, and these data can be used to supplement the national reference values of human biomonitoring for the interpretation of biomonitoring results.

In Commemoration of Dr. Bijan Sadrizadeh, a Prominent Physician and Expert in the Field of Public Health in Iran and Around the World.

In line with the commemoration of the scientists who played a significant role in advancing knowledge and providing services to the country, it is imperative to publish their biographies so that their lives and achievements are recorded in the history of the country and serve as an example for future generations. Dr. Bijan Sadrizadeh, a physician and a public health specialist, undertook many valuable activities, particularly in the field of public health in Iran and the world during more than 60 years of great services, including the promotion of public health in the Islamic Republic of Iran, the development of I.R. Iran's international collaborations in the field of public health, and the development of research programs in the field of neglected tropical diseases and the eradication of polio in the world. He served the country in many high-level executive capacities, including three periods as deputy Minister of Health. In addition to several years of full-time employment in the World Health Organization (WHO), Dr. Sadrizadeh also served on the WHO Executive Board and was a member of numerous scientific and advisory committees. In reviewing his life, great determination, devotion, believing in primary health care and universal health coverage and a deep sense of responsibility are visible and can be an inspiration and a model for all.

Photocatalytic degradation of bisphenol a from aqueous solution using bismuth ferric magnetic nanoparticle: synthesis, characterization and response surface methodology-central composite design modeling.

Purpose: Bisphenol A (BPA), as endocrine-disrupting compound (EDC), is extensively used as an important chemical in the synthesis of polycarbonate polymers and epoxy resins. BPA absorption into the body can result in the development of metabolic disorders such as low sex-specific neurodevelopment, immune toxicity, neurotoxicity and interference of cellular pathway. Therefore, the presence of BPA in the body and the environment can create hazards that must reach standards before being discharged into the environment. Methods: In this study, bismuth ferric nanomagnetic (BFO NMPs) were successfully synthesized via sol-gel method and developed as photocatalysts for BPA removal under visible light irradiation. FE-SEM, TEM, PL, XRD, UV-Vis DRS, VSM, EDX, and FTIR were used to characterize the BFO NMPs. Results: RSM model (R2 = 0.9745) showed a good correlation between experimental and predicted removal efficiency of BPA. The investigation of four independent variables indicated that pH had the most significant positive effect on the degradation of BPA. Under optimal conditions (pH = 4.042, catalyst dose = 7.617 mg, contact time = 122.742 min and BPA concentration = 15.065 mg/L), maximum degradation was calculated to be 98.7%. After five recycles, the removal of BPA remained >82%, which indicated the proper ability to reuse the catalyst. Conclusion: In conclusion, it can be stated like BPA, the prepared BFO NMPs is a promising photocatalyst for practical application in organic pollutant decomposition.

Quantitative microbial risk assessment of enteroviruses in raw-eatable vegetables irrigated by wastewater: examining different scenarios of washing.

Due to the increasing water crisis, the reuse of wastewater deserves attention as a method to reduce the pressure of the water crisis, especially in developing countries. The application of health risk assessment models is a way to estimate disease burdens associated with crop irrigation by wastewater effluents. In this study, a quantitative microbial risk assessment (QMRA) with probabilistic Monte-Carlo simulation was used to estimate the annual risk of enteroviruses (EVs) infection and disease burden for consumers of effluent-irrigated raw vegetables in Tehran, the capital of Iran. Wastewater effluent samples were collected over two seasons: summer and winter. EVs were analyzed in three stages, concentration and separation, cell culture, and real-time PCR (RT-PCR). A questionnaire was used to determine the dominant patterns of vegetable washing by consumers. There were 4 vegetable washing steps: wiping away mud (A), rinsing (B), using detergents (C), using disinfectants (D). 5 patterns of washing were examined in the laboratory and the concentration of enteroviruses was measured in every pattern. pattern 1: just wiping away mud (A), pattern 2: wiping away mud and rinsing (AB), pattern 3: wiping away mud by using detergents and rinsing (ABCB), pattern 4: wiping away mud by using disinfectants and rinsing (ABDB), and pattern 5: wiping away mud by using detergents and disinfectants and rinsing (ABCBDB). For washing pattern 1, pattern 2, and pattern 3, the estimated annual infection risk of EVs was estimated to be 5.6 × 10-1, 3.6 × 10-1, 1.7 × 10-1 (risk/per.day), and burden of disease was calculated as 3 × 10-2, 2 × 10-2, and 9 × 10-3 (burden/year), respectively. The results showed that if vegetables are washed according to method 5, the microbial risk will be minimized and the excess prevalence of viral infections will be eliminated.

Fluoride removal from aqueous solution via environmentally friendly adsorbent derived from seashell.

Nowadays, the presence of excessive ions in water resources is of utmost concern and has attracted increasing attention; therefore, excessive amounts of these ions such as fluoride should be removed from drinking water. Conventional water treatment processes are shown to be incapable of the complete removal of redundant fluoride from aqueous water bodies, whereas adsorption is a promising, effective, cost-benefit, and simple method for this purpose. This study aimed to synthesize effective adsorbents from bivalve shells and evaluate the adsorption function of bivalve shells in removing fluoride from aqueous solutions. In this study, the oyster shell was collected from the Persian Gulf's seaside and were crushed by manual mortar and blender, and graded with standard sieves with 70 mesh size. The prepared bivalve shell was characterized by SEM and FTIR. To investigate and optimize various variables on fluoride removal percentage a response surface methodology based on central composite design (RSM-CCD) was used. Under optimal conditions (pH: 5.5, adsorbent dose: 0.3 g/L, contact time: 85 min and fluoride concentration: 3 mg/L) the maximum removal efficiency was 97.26%. Results showed that the adsorption equilibrium and kinetic data were matched with the isotherm Langmuir Model (R2 = 0.98) with qmax = 27.31 mg/g and pseudo-second-order reaction (R2 = 0.99). Also, a thermodynamic study exhibited that the adsorption process of fluoride into bivalve shells was an exothermic reaction and could not be a spontaneous adsorption process. Based on the results, the bivalve shell was found as an appropriate adsorbent to remove fluoride from aqueous solutions.

Assessment of burden of disease induced by exposure to heavy metals through drinking water at national and subnational levels in Iran, 2019.

The burden of disease attributable to exposure to heavy metals via drinking water in Iran (2019) was assessed at the national and regional levels. The non-carcinogenic risk, carcinogenic risk, and attributable burden of disease of heavy metals in drinking water were estimated in terms of hazard quotient (HQ), incremental lifetime cancer risk (ILCR), and disability-adjusted life year (DALY), respectively. The average drinking water concentrations of arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), and nickel (Ni) in Iran were determined to be 2.3, 0.4, 12.1, 2.5, 0.7, and 19.7 µg/L, respectively, which were much lower than the standard values. The total average HQs of heavy metals in drinking water in the entire country, rural, and urban communities were 0.48, 0.65 and 0.45, respectively. At the national level, the average ILCRs of heavy metal in the entire country were in the following order: 1.06 × 10-4 for As, 5.89 × 10-5 for Cd, 2.05 × 10-5 for Cr, and 3.76 × 10-7 for Pb. The cancer cases, deaths, death rate (per 100,000 people), DALYs, and DALY rate (per 100,000 people) attributed to exposure to heavy metals in drinking water at the national level were estimated to be 213 (95% uncertainty interval: 180 to 254), 87 (73-104), 0.11 (0.09-0.13), 4642 (3793-5489), and 5.81 (4.75-6.87), respectively. The contributions of exposure to As, Cd, Cr, and Pb in the attributable burden of disease were 14.7%, 65.7%, 19.3%, and 0.2%, respectively. The regional distribution of the total attributable DALY rate for all heavy metals was as follows: Region 5> Region 4> Region 1> Region 3> Region 2. The investigation and improvement of relatively high exceedance of As levels in drinking water from the standard value, especially in Regions 5 and 3 as well as biomonitoring of heavy metals throughout the country were recommended.

Comparison of the Toxic Effects of Pristine and Photocatalytically Used TiO2 Nanoparticles in Mice.

TiO2 nanoparticles used in the photocatalytic degradation of pollutants in water treatment processes undergo physiochemical changes; therefore, their toxicological effects may be potentially different from those of the pristine nanoparticles. This study compared the toxic effects of exposure to pristine and photocatalytically used TiO2 nanoparticles in mice. To obtain used TiO2, the nanoparticles were used for photocatalytic degradation of a model pollutant under UV irradiation several times. Two groups of mice were exposed to pristine (PT group) and photocatalytically used TiO2 (UT group) at three different concentrations (5-20 mg/m3) using whole-body exposure chambers (2 h/day, 5 days/weeks, 4 weeks). Exposure to both pristine and used TiO2 increased the levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphate (ALP), lactate dehydrogenase (LDH), C-reactive protein (CRP), and creatine kinase (CK-MB) significantly. Both exposed groups showed higher levels of WBC, lymphocytes, platelets, hematocrits, hemoglobin, and mean corpuscular volume (MCV) and lower levels of RBC and mean corpuscular hemoglobin concentration (MCHC) in a concentration-dependent manner. In all analyses, there were small non-significant differences between the PT and UT groups. More pathological changes were observed in the lung, kidney, and brain of the UT group, while the PT group showed more pathological effects in the liver and heart. The histological observations indicated that damage was mostly in the form of vascular endothelial injury. These two types of TiO2 may activate different pathways to promote adverse effects. Further studies are required to evaluate and distinguish the mechanisms through which pristine and used TiO2 induce toxicity.

Effect of dilution factor on the isolation of Helicobacter pylori from municipal wastewater using culture technique.

Background and Objectives: Isolating Helicobacter pylori (H. pylori) from wastewater and culturing it using a conventional method has always been a controversial issue because the bacterium converts into a coccoid form when exposed to an unfavourable environment like wastewater. To clarify the cultivability behaviour of the bacterium in fresh wastewater samples, the effect of municipal wastewater dilation on the cultivation of the bacterium using a conventional method was examined. Materials and Methods: Several dilutions of wastewater samples were inoculated with fresh H. pylori suspension (with McFarland's dilution 0.5) to examine the dilution effect of wastewater on the bacterium isolation. Results: The H. pylori growth was found to be possible for a dilution factor from 1/106 to 1/107 of raw wastewater. In higher dilution factors the growth of fungi was dominant and could prevent the isolation of the bacterium. Conclusion: The optimized technique could be applied in future studies for increasing the chance of H. pylori isolation from fresh wastewater environments.

Paramedical staff's knowledge, attitude, and performance about nosocomial infection controls at hospitals: A cross-sectional survey in Iran.

BACKGROUND: Nosocomial infections usually occur 48 hours after admission to the hospital or up to 72 hours after discharge from the hospital. They lead to an increase in mortality and health costs. The purpose of this study is to measure the knowledge, attitude, and performance of paramedical staff about nosocomial infection control. MATERIALS AND METHODS: This cross-sectional study was conducted in Tehran hospitals in 2019. A valid and reliable questionnaire was used to collect data. The questionnaires were distributed among 405 randomly selected paramedical staff at 25 hospitals in Tehran. The data were analyzed using SPSS18. RESULTS: The mean scores of paramedical staff's knowledge, attitude, and performance in terms of nosocomial infection control were 11.2 ± 2.2 (good), 21.7 ± 3.7 (good), and 49.2 ± 9.4 (good) respectively. A statistically significant relationship was obtained between paramedical staff's work experience and type of hospital and their knowledge, attitude, and performance in terms of nosocomial infection control (P <0.05). In addition, a statistically significant relationship was found between gender, age, education, and, employment type and nosocomial infection control performance (P <0.05). CONCLUSIONS: The knowledge, attitude, and performance of paramedical staff about nosocomial infections in Tehran hospitals were good. Education, continuous supervision, and provision of the necessary equipment are needed for improving the paramedical staff's knowledge, attitude, and performance in terms of nosocomial infections.

Correction to: Evaluation of iron and manganese removal effectiveness by treatment plant modules based on water pollution index; a comprehensive approach.

[This corrects the article DOI: 10.1007/s40201-021-00665-2.].

Isolation, identification and reviewing the health effect of HPC bacteria in household point-of-use (PoU) water treatment devices: a case study, Ahvaz, Iran.

In Ahwaz, a city in west southern Iran, the majority of households are using Point of Use (PoU) water treatment units. The heterotrophic plate count (HPC) bacteria were isolated from these units while they were mounted on water distribution system in order to determine the variations in HPC and diversity of the bacterial population using polymerase chain reaction (PCR). Results showed that bacterial population regrowth in PoU units could increase HPC exceeding the limit of the 500 CFU/mL in outlet water. In around 70% of the input water samples, the HPC was less than 500 CFU/ml with a mean of 226.7 (CI 95%: 28.1-425.3). HPC in output treated water samples had an increasing trend from the start of the unit operation with a mean of 2416.4 (CI 95%: 1074.9-3757.9). Out of 49 detected bacterial strains, 20 strains were Gram-negative and 29 Gram-positive. Bacillus was the most frequent genes detected in inlet and outlet water samples. Most of the identified bacterial strains were opportunistic pathogens potentially dangerous for immunocompromised population. HPC population in PoU units significantly can be increased during a one-month period of operation, so replacement of the filters must be done regularly.

Evaluation of iron and manganese removal effectiveness by treatment plant modules based on water pollution index; a comprehensive approach.

Groundwater is a viable alternative when access to surface water resources is limited. Iron and manganese are known ions in soil and naturally in groundwater sources. However, human activities also are responsible. To identifying the best module for removing manganese and iron in the water treatment plant (WTP) of Mazandaran, 516 samples were taken from raw and treated water. The concentration of manganese, iron, was measured by atomic absorption spectrophotometry, and turbidity was used with the nephelometry method. The water pollution index (WPI) was applied for categorizing the status of pollution in treated water. The effect of seasonal temperature and backwashing (At flow rates of 3.5, 9.2, and 15.3 m h-1) on the sand filter efficiency was also investigated. The highest concentrations of manganese, iron, and turbidity in raw water were 0.744, 6.70 mg L-1, and 41.8 NTU, and in treated water were 0.67, 1.09 mg L-1, and 5.58 NTU, respectively. The mean concentration of manganese and iron in raw and treated water were 0.24 ± 0.1, 0.93 ± 0.91, 0.105 ± 0.06 and 0.18 ± 0.14 mg L-1 respectively. The WPI statuses in drinking water were excellent for manganese and iron in 95.74 and 53.88 % of the samples and very poor in 1.16 and 12.01 % of the samples, respectively, and its classification for drinking water for manganese and iron was excellent ˃ good ˃ extremely polluted ˃ polluted and the concentration of iron was more than manganese in treated water. The study of temperature's effect on sand filters showed that the removal efficiency in warm seasons was higher than in cold seasons. Also, the turbulence in the backwash with the 9.2 m h- 1 rates, is lesser than other speeds, and in this flow, after 270 s, the turbidity decreases to less than 10 NTU. Spearman correlation comparison showed that the parameters amounts after filtration decreased significantly (p ≤ 0.0001) in comparison to raw water. The results showed that module #1 that used open-aeration and chlorine as oxidations, was most effective in removing iron and manganese. In the end, the WTP couldn't diminish the parameters completely and need subsidiary units.

A systematic review and meta-analysis of human biomonitoring studies on exposure to environmental pollutants in Iran.

Population exposure to environmental contaminants can be precisely observed through human biomonitoring studies. The present study aimed to systematically review all the biomonitoring studies conducted in Iran on some selected carcinogen environmental pollutants. In this systematic review study, 11 carcinogen agents were selected including arsenic, cadmium, chromium, nickel, lindane, benzene, trichloroethylene (TCE), pentachlorophenol (PCP), radon-222, radium-224, - 226, - 228, and tobacco smoke. The Web of Science, PubMed, and Scopus databases were searched for peer-reviewed articles published in English. After several screening steps, data were extracted from the studies. Meta-analyses (a random-effect model using the DerSimonian-Laired method) were performed only for the biomarkers with more than three eligible articles, including cadmium in blood and breast milk, and arsenic in breast milk. Methodological quality of the studies was assessed using the Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. Of the 610 articles found in the database search, 30 studies were eligible for qualitative review, and 13 were included in the meta-analysis (cadmium in blood (n = 3), cadmium in breast milk (n = 6), and arsenic in breast milk (n = 4)). The overall pooled average concentrations (95% CI) of cadmium in blood, cadmium in breast milk, and arsenic in breast milk were 0.11 (95% CI: 0.08, 0.14), 5.38 (95% CI: 3.60, 6.96), and 1.42 (95% CI: 1.02, 1.81) µg/L, respectively. These values were compared with the biomarker concentrations in other countries and health-based guideline values. This study showed that there is a need for comprehensive action plans to reduce the exposure of general population to these environmental contaminants.

Iranian population exposures to heavy metals, PAHs, and pesticides and their intake routes: a study protocol of a national population health survey.

Cancer is the second leading cause of death in the world and the third leading cause of death in Iran. It has been proven that numerous cancer cases are caused by exposure to environmental pollutants. There is a public health concern regarding an increase in exposure to carcinogens across Iran through different sources (air, food, and water) and a lack of research to address this issue. This study aims to gather data on exposure to heavy metals, polycyclic aromatic hydrocarbons (PAHs), and pesticides and their intake routes during the implementation of a national population health survey. This is a cross-sectional study of environmental pollutants in Iran, with a stratified multi-stage random sampling method, which led to 660 nationally representative samples in 132 clusters in three sequential parts. The first will be questionnaires to obtain demographics, assets, food records, air quality, and food frequency. The second will be physical measurements, including anthropometric and body composition. The third will be lab assessments that measure 26 types of environmental pollutants (7 heavy metals, 16 PAHs, and 3 pesticides) in urine, inhaled air, and consumed food and water of the population under study using ICP-MS and GS-MS devices. The results of this study will inform policymakers and the general population regarding the level of threat and will provide evidence for the development of interventional and observatory plans on the reduction of exposures to these pollutants. It could also be used to develop local standards to control contaminants through the three exposure routes. This study protocol will obtain data needed for policymakers to set surveillance systems for these pollutants at the national and provincial level to address the public concerns regarding the contamination of food, air, and water.

A comprehensive systematic review of photocatalytic degradation of pesticides using nano TiO2.

This study has systematically reviewed all of the research articles about the photocatalytic degradation of pesticides using titanium dioxide (TiO2) nanoparticles (NPs) and ultraviolet (UV) irradiation. Online databases were searched for peer-reviewed research articles and conference proceedings published during 2009-2019, and ultimately 112 eligible articles were included in the review. Fifty-three active ingredients of pesticides and one mixture had been investigated, most of them were organophosphorus (22%), followed by triazine derivatives (11%), chloropyridines (9%), and organochlorines (9%). Sixteen types of TiO2 with an average photodegradation efficiency of 71% were determined. Based on the type of pesticide and experimental conditions such as irradiation time, the complete photodegradation had been observed. The removal of each group of pesticides has been sufficiently discussed in the article. Effect of experimental conditions on photocatalytic activity has been investigated using linear and polynomial regressions. The strategies to reduce the required energy for this process, doping TiO2 with metal and non-metal agents, innovative reactor designs, etc., were also discussed. In conclusion, TiO2 NPs have been successful for degradation of pesticides. Future direction for research incorporates developing and application of heterogeneous doped and immobilized titania having optimized characteristics such as surface area, reactive centers, recombination rate, and phase, and capable to photo-degrade low levels of pesticides residues under solar light in an efficient full-scale size.

Subnational exposure to secondhand smoke in Iran from 1990 to 2013: a systematic review.

Every year, almost eight million people die from tobacco-related diseases, among which around 1.2 million die from secondhand smoke (SHS) exposure. Generally, it is estimated that SHS constituents generated in the interval between puffs are approximately 3 times more toxic than those produced at the moment of puffing. There is no risk-free level of SHS exposure, and even brief exposure can be harmful to health. The aim of this study was to assess SHS exposure and its trend in the different provinces of Iran from 1990 to 2013. To collect available data on SHS exposure, a systematic review was performed. We searched international and national databases using a combination of Medical Subject Headings (MeSH) and relevant text words in the titles, abstracts, and/or keywords. Also, the data in national surveys were gathered. The frequency of exposure in different provinces as well as age, sex, and rural/urban areas were extracted. Afterwards, modeling was done to estimate SHS exposure from the smoking data. According to our findings, SHS exposure was more prevalent among young people. Moreover, this exposure was greater in rural areas as compared to urban areas. A national study on 13-15-year-old individuals showed the highest exposure occurred outdoors. In addition, a declining trend was observed on SHS exposure over time. It seems that attention to the importance of SHS exposure in researches in Iran dates back to 2001, and gradually, especially in recent years, further studies have been conducted on SHS exposure.

Tehran environmental and neurodevelopmental disorders (TEND) cohort study: Phase I, feasibility assessment.

PURPOSE: To advance knowledge about childhood neurodevelopmental disorders and study their environmental determinants, we conducted a study in Tehran, Iran to assess the feasibility of prospective birth cohort study. METHODS: We evaluated participation of pregnant women, feasibility of sampling biological material, and health care services availability in Tehran in four steps: (1) first trimester of pregnancy; (2) third trimester of pregnancy; (3) at delivery; and (4) two to three months after delivery. We collected related data through questionnaires, also various biological samples were obtained from mothers (blood, urine, milk and nails-hands and feet) and newborns (umbilical cord blood, meconium, and urine samples) from February 2016 to October 2017. RESULTS: overall 838 eligible pregnant women were approached. The participation rate was 206(25%) in our study and about 185(90%) of subjects were recruited in hospitals. Out of 206 participants in the first trimester, blood, urine, hand nail, and foot nail samples were collected from 206(100%),193(93%), 205(99%), and 205(99%), respectively. These values dropped to 65(54%), 83(69%), 84(70%), and 84(70%) for the remaining participants 120(58%) in the third trimester, respectively. Also, we gathered milk samples from 125(60%) of mothers at two to three months after delivery. CONCLUSION: Our findings suggest that hospitals were better places for recruitment of subjects in a birth cohort in Tehran. We further concluded that birth cohort study recruitment can be improved by choosing appropriate gestational ages. Obtaining the newborn's urine, meconium, and umbilical cord blood were challenging procedures and require good collaboration between hospital staff and researchers.

Isolation and characterization of a multidrug-resistant Clostridioides difficile toxinotype V from municipal wastewater treatment plant.

PURPOSE: Wastewater treatment plant (WWTP) is regarded as a potential source for transmission of Clostridioides difficile from urban areas into the surface water, through feces of human and animals. The aim of this study was to screen and characterize the C. difficile bacteria in inlet and outlet wastewater of different WWTPs in Tehran, Iran. METHODS: Totally, 72 samples were collected from three different WWTPs (inlet site and outlet sites) during a year. C. difficile was isolated and characterized in terms of toxins, toxinotype, resistance profile and genes, and colonization factors using PCR. RESULTS: One C. difficile toxinotype V was isolated from the outlet samples. The isolate was susceptible to vancomycin but resistant to metronidazole, tetracycline, ciprofloxacin, and moxifloxacin using MIC Test Strips. The isolated C. difficile was toxigenic (tcdA, tcdB, cdtA, cdtB positive and CPE positive) and had tcdC-A genotype. No mutations were found in fliC and fliD. The slpA sequence type was 078 - 01. The C. difficile was positive for tetM, int, but negative for vanA, nim, and tndX genes. Mutations were not observed in gyrA and gyrB genes. CONCLUSIONS: This study provided evidence of presence of a multidrug-resistant C. difficile toxinotype V in one of the municipal WWTP. The transmission of such isolate to the environment and reuse of treated wastewater by human pose a threat to human health and dissemination of antibiotic resistant bacteria which are untreatable.

High prevalence of Clostridiodes diffiicle PCR ribotypes 001 and 126 in Iran.

Clostridium difficile is a leading causative agent of hospital-acquired and community-acquired diarrhea in human. This study aims to characterize the predominant C. difficile strains, RT001 and 126, circulating in Iranian hospitals in relation to resistant phenotypes, the antibiotic resistance genes, and their genetic relatedness. A total number of 735 faecal specimens were collected from patients suspected of CDI in Tehran hospitals. Typing and subtyping of the strains were performed using CE-PCR ribotyping and MLVA, respectively, followed by PCR assays for ARGs and indicators of Tns. Minimum inhibitory concentrations (MICs) of five antibiotics were determined by MIC Test Strips. Among 65 strains recovered from CDI patients, RT001 (32.3%) and RT126 (9.2%) were found as the most frequent ribotypes, and 64 MLVA types were identified. Using MLVA, RT001 and RT126 were subtyped into 6 and 4 groups, respectively. The vanA, nim, tetM, gyrA, gyrB genes were detected in 24.6%, 0%, 89.2%, 95.3%, and 92.3% of the strains, respectively. The indicators of Tns including vanHAX, tndX, and int were found in 0%, 3% and 29.2% of the strains, respectively. The most common amino acid (AA) alterations of GyrA and GyrB were related to substitutions of Thr82 → Val and Ser366 → Val, respectively. Resistance rate to metronidazole, vancomycin, tetracycline, ciprofloxacin, and moxifloxacin was 81.5%, 30.7%, 85%, 79%, and 74%, respectively. This study, for the first time revealed the subtypes of circulating RT001 and RT126 in Iran. It is of importance that the majority of the strains belonging to RT001 were multidrug resistant (MDR). This study also pointed to the intra-hospital dissemination of the strains belonging to RT001 and RT126 for short and long periods, respectively, using MLVA. The most important resistance phenotypes observed in this study was vancomycin-resistant phenotypes. Resistance to metronidazole was also high and highlights the need to determine its resistance mechanisms in the future studies.