Evaluation of antibiotics resistance in Southern Iran in light of COVID-19 pandemic: A retrospective observational study

Background and Aims

Antimicrobial resistance (AMR) was taken as one of the high-priority long-lasting public health issues, although it might have been underrated in terms of COVID-19 pandemic emergence. Regarding limited data on assessing the pandemic effect on AMR trend in Iran, this study aimed to describe the epidemiology of antibiotics resistance during the COVID pandemic in southern Iran.

Methods

This descriptive study was conducted on 2675 patients' samples collected and processed in a referral COVID-19 center hospital in southern Iran from March 21, 2019, to February 18, 2020 (prepandemic), and February 19, 2020, to March 21, 2021 (pandemic). Susceptibility test results in sensitivity and resistance levels were compared in prepandemic and pandemic periods.

Results

Compared to prepandemic, the inpatient number has increased almost three times. On the other hand, there are around four times fewer outpatients now. More than 85% of the specimens were found in urine samples. In all, 92.22% of all bacteria samples were Gram-negative isolates, with Escherichia coli accounting for 59.19% of them. The change rate of Gram-negative bacteria resistance to antimicrobials is an average of 7.74% (p < 0.001). On the other hand, the average change rate of Gram-positive bacteria resistant to antibiotics has decreased by 19.3% (p = 008). As a forerunner among other Gram-negative bacteria, the average change rate for Pseudomonas aeruginosa and Klebsiella pneumonia resistance to monitored antibiotics was 89% and 66.3%, respectively (p < 0.001).

Conclusion

During the Covid-19 pandemic, the increase in AMR among Gram-negative bacteria, particularly P. aeruginosa and K. pneumonia, was observed compared to the prepandemic. This further limits treatment options, and endangers global public health.

Toxoplasma gondii, HBV, and HCV co-infection and their correlation with CD4 cells among Iranian HIV-positive patients

INTRODUCTION

Human immunodeficiency virus (HIV/AIDS) infected patients have a higher risk of opportunistic infections (OIs) depending on their immunological status, especially CD4 + cell count. Toxoplasma gondii, hepatitis C virus (HCV), and hepatitis B virus (HBV) are important OIs among Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) patients. However, little is known about co-infection of these pathogens among HIV-infected individuals and their correlation with the patient's CD4 + cell count. Hence, this study aimed to investigate the serological and molecular status of T. gondii infection among HIV-infected individuals who had co-infection with HBV and HCV infections.

METHODS

A total of 100 HIV/AIDS patients in two cities in the southwest of Iran was tested for T. gondii Immunoglobulin G (IgG) and Immunoglobulin M (IgM) antibodies as well as DNA detection by polymerase chain reaction (PCR) targeting the RE gene. HBV and HCV were detected by hepatitis B surface antigen (HBsAg) test, hepatitis C antibody (HCV Ab) test, and Real-Time PCR. The number of CD4 + cell counts was determined by Flow cytometry.

RESULTS

Anti-T. gondii IgG was positive in 22% of the patients, but anti-T. gondii IgM and PCR were negative in all samples. HBV and HCV were positive in 8% and 33% of the patients, respectively. Co-infections were as followed: HIV + HCV (16%), HIV + HCV + T. gondii (11%), HIV + T. gondii (5%), HIV + HBV (1%), HIV + HBV + T. gondii (1%), HIV + HBV + HCV (1%), and HIV + HBV + HCV + T. gondii (5%). A significant decline in CD4 + cell counts was found in such co-infection groups (HIV + T. gondii, HIV + HCV + T. gondii, and HIV + HBV + HCV + T. gondii) compared with the HIV mono-infection group.

CONCLUSIONS

Our study showed that co-infections of T. gondii, HCV, and HBV were common among HIV-infected patients and co-infections had a negative correlation with CD4 + cell counts of the patients.

Enhancing the Rational Use of Albumin and Intra-venous Pantoprazole in Hospitals by Implementing Pharmaceutical Guidelines in Hospitals: A Quasi-experimental study

Background: Irrational use of drugs is a serious global problem, especially in developing countries. Scientific evidence has announced albumin and intravenous pantoprazole as expensive drugs, i.e., relatively irrationally applied in hospitals without following the guidelines.  Objectives: Considering health cost management policy in Iran, this study aimed to evaluate the effects of implementing pharmaceutical guidelines to rationalize and reduce the use of albumin and intravenous pantoprazole and the related inappropriate costs. Methods: This quasi-experimental study was conducted from January 2016 to October 2018 in two teaching Hospitals in Jahrom City, Iran. Pharmaceutical guidelines were implemented throughout the physical training as well as a pharmacist-led intervention and supervising. All inpatient prescriptions of the studied medicines were evaluated.  Results: Before conducting the intervention (June 2016), an average of 357 albumin vials were monthly used; after performing the interventions, 166 and 167 vials were used in 2017 and 2018, respectively. Reduced albumin use rate equaled 48%, i.e., significant (P=0.002). Annual cost-saving was estimated to be 25000 USD. In comparison to the previous year, there were 46% and 70% reductions in the mean number of pantoprazole vials prescribed in 2017 and 2018, respectively (P=0.005).Consuming pantoprazole was measured to be 1457 vials per month in 2017 and 795 in 2018, i.e., significant (P=0.002). Cost-Saving in intravenous pantoprazole was estimated to be 16000 USD in 2017 and 25000 USD in 2018.  Conclusion: Prescription strategies, such as pharmaceutical guidelines with educational measures, pharmacist-led intervention, monitoring the prescribing drug, and feedback to prescribers can significantly decrease the inappropriate use of expensive drugs and their costs.

Alternaria alternata acts on human Monocyte-derived Dendritic cells to mediate Th2/Th17 polarisation

INTRODUCTION

Although the mechanism of asthma is not precisely understood in humans, clinical and epidemiological studies have offered a potential relationship between exposure to environmental fungi, such as Alternaria alternata (A. alternata) and the development and exacerbation of asthma. The aim of this project is to investigate the mechanisms of Th2 responses by A. alternata as a clinically relevant model for the environmental exposure.

MATERIALS AND METHODS

Plastic adherent monocytes were cultured with granulocyte macrophage colony stimulating factor (GM-CSF) and interleukin-4 (IL-4) to convert these cells into Monocyte-derived Dendritic cells (MoDc) and then matured in the presence of Monocyte-Conditioned Medium (MCM) as the control group and MCM+ A. alternata extract as the inductive groups.

RESULTS

The results indicated that the expression of CD14 decreased and CD83 and anti-human leukocyte antigen-DR (HLA-DR) increased in the inductive groups in comparison with the control group. More importantly, A. alternata inhibited IL-12 production by activated dendritic cells (DCs), and the DCs exposed to A. alternata enhanced the Th2 polarisation of CD4⁺ T cells. The production amount of IL-10 overcame IL-12 as well as Il-23 increased significantly, and hand in T cells the production of cytokines Interferon-γ (IFN-γ) decreased. However, both IL-17 and IL-4 increased (p<0.05). Phagocytic activity in the inductive groups decreased significantly compared with the control group.

CONCLUSION

The asthma-related environmental fungus A. alternata, with an effect on dendritic cells profile mediates TH2/TH17. Such immunodysregulation properties of causative environmental fungi may explain their strong relationship with human asthma and allergic diseases.

WITHDRAWN: Seroepidemiology of hepatitis E virus in Western Iran

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.bbr.2011.03.031. The duplicate article has therefore been withdrawn.

Ventricular dilatation in experimental intraventricular hemorrhage in pigs. Characterization of cerebrospinal fluid dynamics and the effects of fibrinolytic treatment

BACKGROUND AND PURPOSE

Hemorrhagic ventricular dilatation (HVD) is a prominent feature of human intraventricular hemorrhage (IVH) and a strong indicator for poor outcome. We developed an IVH model to define the mechanisms responsible for HVD and to test the efficacy of intraventricular administration of tissue plasminogen activator (TPA) in the treatment of HVD.

METHODS

Isolated IVH was produced in pigs by injecting 10 mL of blood simultaneously with thrombin into the right lateral ventricle. The treatment group received 1.5 mg of TPA after induction of IVH. Intraventricular blood volume and the volume of the lateral ventricles were assessed by CT after 90 minutes, 7 days, and 42 days. Intracranial pressure, the pressure-volume index, and the resistance to outflow of cerebrospinal fluid (R(out)) were measured 30 minutes and 7 days after IVH.

RESULTS

After IVH, the volume of the lateral ventricles increased from 1.98 +/- 0.69 to 6.43 +/- 1.23 mL (P < .001). There was a linear relationship between ventricular and clot volume (P = .014). Initially, R(out) increased from 24.34 +/- 7.13 to 63.56 +/- 64.91 mm Hg/mL per minute (P < .001). After 7 days, restoration of normal cerebrospinal fluid circulation occurred, but the ventricles were still significantly enlarged (5.24 +/- 1.76 mL, P < .001) and filled with blood. Within 6 weeks, ventricular volume had returned to normal values, paralleled by complete clot resolution. Intraventricular administration of TPA significantly accelerated clot clearance and restoration of normal ventricle volume.

CONCLUSIONS

These results suggest that intraventricular bleeding may cause impairment of cerebrospinal fluid circulation but that the mass effect of clots distending the ventricle walls is the most important mechanism responsible for HVD. This model closely imitates several prominent features of human IVH and may therefore be a useful tool for preclinical assessment of the efficacy and safety of treatment with TPA.

PET-study of intracranial meningiomas: correlation with histopathology, cellularity and proliferation rate

The glucose metabolism of 62 meningiomas was measured by fluorine -18-2-fluorodeoxyglucose (FDG) PET and correlated with proliferation rate (Ki-67 index) and tumor cellularity. The mean metabolic rate (MRGlu) for meningiomas was 0.26 +/- 0.13 mikromol/g/min (range 0.08-0.62 mikromol/g/min). The relative tumor FDG-uptake (Q-MRGlu) (tumor/contralateral cortex) of all meningiomas was calculated with 0.73 +/- 0.37 (0.24-1.79). Differences of Q-MRGlu were significant between the groups with high vs. low cellularity (p < 0.01), increased vs. normal proliferation rate (p < 0.025) and low (WHO grade I) vs. higher (WHO grades II, III) graded tumors. In recurrent meningiomas (14 tumors) the glucose metabolism was not increased. The data show that 18 FDG-PET is suitable to serve as non-invasive predictor of tumor growth characteristics in meningiomas.