The Effectiveness of Laboratory Parameters in Predicting the in-Hospital Mortality of Iranian Patients with Coronavirus Disease 2019 (COVID-19)

BACKGROUND

The novel coronavirus 2019-nCoV (now SARS-CoV-2) has spread globally and affected healthcare systems worldwide. Due to lack of long-term immunization and effective specific treatments for the COVID-19 disease, there is a need of identifying the patients who are at the risk of a fatal outcome, according to the available epidemiological data and laboratory parameters.

OBJECTIVE

Thus, we aimed to evaluate the prognostic value of epidemiological data and laboratory para-meters for in-hospital case fatality in patients with COVID-19.

MATERIALS AND METHODS

A retrospective cohort of patients with COVID-19 admitted to the Shahid Mostafa Khomeini Hospital of Ilam University of Medical Sciences from February 29 until March 29, 2020 was performed. Epidemiologic data and laboratory results were collected. Univariate and multivariate logistic regression models were performed to evaluate the prognostic value of the laboratory parameters for in-hospital death.

RESULTS

A total of 256 Iranian COVID-19 patients were included in the evaluation; 38 of them died, resulting in a in-hospital case-fatality rate of 14.8%. The univariate analysis showed that advanced age [OR=1.04, 95% CI: 1.02, 1.06, P=0.001], smoking [OR=4.041, 95% CI: 1.546-10.563, P=0.004], white blood cells [OR=0.941, 95% CI: 0.904-0.980, P =0.003] and hematocrit [OR=1.060, 95% CI: 1.009-1.113, P=0.020] were positively associated with the risk of a fatal outcome. Multivariate logistic regression analysis revealed that COVID-19 patients with an elevated white blood cell count and elevated hemoglobin level had 1% and 9% greater risk of an in-hospital death for each elevated unit [OR=1.07; 95 %CI: 1.024-1.088, P =0.002 and OR=1.379; 95% CI 0.064-1.788, P =0.015, respectively].

CONCLUSIONS

An increase in white blood cell count and an increase in hemoglobin level might be indepen-dent risk factors for in-hospital death in Iranian patients with COVID-19. Further studies are necessary in order to conferm the prognostic value of the variables discussed.

Characteristics of Clostridioides difficile colonization in Ilamian children

Background

The increasing colonization with Clostridioides difficile in paediatric hospitalized population is a well known event; however, its prevalence in Iranian children has not effectively been identified yet.

Objective

The objective of this study was to determine the intestinal-carriage rates of C. difficile and molecular characterization of C. difficile in the Ilamian pediatric population from May 22, 2018, until September 22, 2018.

Materials and Methods

Eighty samples were obtained from 40 children aged <5 years, at day 0 of their hospitalization (N=40 samples), to determine community-associated colonization, and then at day 5 days after hospitalization (N=40 samples), to determine healthcare associated colonization. The stool samples were examined for C. difficile, and isolated strains were evaluated for production of Clostridial toxins A/B and molecular characterizations.

Results

The colonization rates of C. difficile and toxigenic C. difficile were 10% (8/80) and 3.75% (3/80), respectively. Based on the age group, the intestinal-carriage rates of C. difficile were 37.5, 50, and 12.5% in children ≤ 1, 1-3, and 3-5 years old, respectively. Our findings have revealed eight distinct ribotypes. Our findings have revealed eight distinct ribotypes of C. difficile isolates. Three out of 8 (37.5%) of C. difficile isolates were considered as community-associated colonization and belonged to ribotypes 7, 8, and 9. Conclusion. Our findings suggest the need of confirmation by further epidemiological studies in Iranian children. Given that the 37.5% of cases observed were community-associated, estimates of the incidence of C. difficile infections, that include only hospitalized children, may largely underestimate the burden of disease in children.

Case series of four pregnant women with COVID-19 in Ilam, Iran

Coronavirus disease 2019 (COVID-19) has quickly become the most important health burden globally as a result of the pandemic. Pregnant women are considered to be in a high-risk group because COVID-19 infection in this group may result in extensive damage. We aimed to describe COVID-19 infections in four pregnant women in Ilam, Iran. All had positive results first by real-time PCR, then by computed tomographic scan. All of these patients were hospitalized, and all of them were treated successfully. This study showed that although pregnant women are at a higher risk of COVID-19 infection, they can be treated successfully. It also demonstrated that receiving care and treatment at the hospital can be a good experience for pregnant women.

Sub-minimum inhibitory concentrations of biocides induced biofilm formation in Pseudomonas aeruginosa

It is clear that biofilm formation causes many serious health-care problems. Interestingly, sub minimum inhibitory concentrations (sub-MICs) of some biocides can induce biofilm formation in bacteria. We investigated whether sub-MICs of Savlon, chlorhexidine and deconex®, as biocidal products, can induce biofilm formation in clinical isolates of Pseudomonas aeruginosa. To determine MICs and biofilm formation, we performed microtitre plate assays. All three biocides induced biofilm formation at sub-MICs; Savlon was the most successful antiseptic agent to induce biofilm formation among P. aeruginosa isolates. Deconex had the best inhibition effect on planktonic cultures of P. aeruginosa isolates. We concluded that sub-MICs of Savlon and deconex could significantly induce biofilm formation.

Report of five nurses infected with severe acute respiratory syndrome coronavirus 2 during patient care: case series

The high prevalence of coronavirus disease 2019 (COVID-19) has received much attention all over the world. Nurses are in the first line of defence against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and are placed in a high-risk situation. This study aimed to report on infection with SARS-CoV-2 during patient care among nures in the Mostafa Khomini Hospital, Ilam, Iran. In this hospital 125 nurses were enrolled in the COVID-19 centre. Five out of 125 nurses (4%) who enrolled in the COVID-19 infection centre, developed COVID-19. They were first positive by real-time PCR but the CT scan was positive for only one of them. None of the infected nurses were hospitalized and all of them preferred to quarantine at home and receive the necessary care and treatment (oseltamivir, azithromycin and lopinavir/ritonavir). This study showed that, regardless of self caring, the nurses were exposed to the virus, because at the start of the SARS-CoV-2 outbreak in Iran, there was no special protection against this infection, so the nurses were placed at risk. This study also reported that receiving the necessary care and treatment at home was a good experience for nurses and can be used in some cases.

Asymptomatic carriers of Neisseria meningitidis and Moraxella catarrhalis in healthy children

There is a close correlation between asymptomatic oropharyngeal colonization by bacterial pathogens and paediatric respiratory diseases. Evaluation of the frequency of asymptomatic carriers of Neisseria meningitidis and Moraxella catarrhalis in healthy children was the main aim of the current study. In this cross-sectional study, 123 oropharyngeal swabs were collected from children between 2 and 6 years old in kindergartens of Ilam, Iran. Moraxella catarrhalis and N. meningitidis were identified using phenotypic and genotypic assays. In addition, the occurrence of the virulence factors (ctrA and uspA1) and iron uptake (tbpA) genes was evaluated by PCR. Results showed that 21 M. catarrhalis isolates and 17 N. meningitidis isolates were identified by conventional microbiological and biochemical methods, but the RT-PCR assay detected that 18 and 8 isolates were positive for M. catarrhalis and N. meningitidis, respectively. The tbpA gene was positive in all N. meningitidis and M. catarrhalis isolates. Seven isolates were positive for the ctrA gene in N. meningitidis and seven isolates were positive for the uspA1 gene in M. catarrhalis. These pathogenic bacteria often occurred as asymptomatic carriage of N. meningitidis in children from large families with low economic status, which reflects the importance of the environment and socio-economic level of families in the distribution of these potentially pathogenic bacteria in the oropharynx of children. Monitoring for the carriage of potential pathogenic bacteria in the nasopharynx of healthy children is important as this can predispose to infectious diseases; common exposure to human respiratory bacterial pathogens is a further risk factor.

Rapid and direct molecular detection of Streptococcus pneumoniae and Haemophilus influenzae isolated in oropharynx and nasal cavity of children

There is a direct correlation between asymptomatic oropharyngeal colonization by pathogenic bacteria and the prevalence of paediatric respiratory infections. Streptococcus pneumoniae and Haemophilus influenzae are common cause of serious bacterial infections such as meningitis in children. This study aimed to monitor healthy children to detect asymptomatic carriers of S. pneumoniae and H. influenzae. In the present cross-sectional study, real-time PCR assay was developed and evaluated in comparison with culture for direct detection of S. pneumoniae and H. influenzae in 123 oropharynx and nasal cavity specimens from healthy children in Ilam, Iran. In addition, virulence factor (ply and hpd) and iron uptake (tbpA and piuA) genes were evaluated by PCR. Our results demonstrated that among all isolates only 14 S. pneumoniae and eight H. influenzae were identified by phenotypic methods, whereas 37 and 21 S. pneumoniae and H. influenzae were identified, respectively, by real-time PCR assay. All S. pneumoniae and H. influenzae isolates possessed tbpA and piuA genes. Also, 81% (30/37) of S. pneumoniae isolates were positive for ply gene, which encoded pneumolysin, as well as 90% (19/21) of H. influenzae isolates were positive for hpd gene. Simultaneous colonization of S. pneumoniae and H. influenzae could indicate the importance of monitoring of healthy children to identification of carriers.

The rationale behind antibiotic resistance pattern in Klebsiella pneumoniae

Presently, there is an increase in antibiotic resistance in bacteria, due to relax prescription of antibiotics, especially in Iran. Undoubtedly, in toxin antitoxin (TA) system, a toxin neutralized by antitoxin, which known as a potent antimicrobial target; but there is no extensive survey on the prevalence of TA loci in large scale of Klebsiella pneumoniae. Therefore, this study aims to determine the prevalence of different TA loci in clinical and environmental K. pneumoniae isolates. For this reason, 48 K. pneumoniae clinical isolates and 49 K. pneumoniae environmental isolates were subjected for evaluation of different TA loci. The results of current study indicated that there is no association between antibiotic resistances and presence of TA loci in clinical and environmental K. pneumoniae. The role of TA loci as a potent target in antibiotic resistant K. pneumoniae has been complicated. Therefore, more studies should be performed to explain why TA loci are presented in K. pneumoniae and what is the rationale behind antibiotic resistant K. pneumoniae?

Enterococcus faecalis as multidrug resistance strains in clinical isolates in Imam Reza Hospital in Kermanshah, Iran

The current study aimed to investigate the prevalence of vancomycin-resistant Enterococcus in E. faecalis and E. faecium and antimicrobial susceptibility patterns, then dominant genes responsible for vancomycin resistance were determined. For this propose, 180 clinical isolates of Enterococcus were subjected for identification and antibiotic susceptibility assay. Then, the gene responsible vancomycin resistant strains were determined. The results demonstrated the E. faecalis as a dominant Enterococcus. Resistance to erythromycin was dominant and multidrug resistance strains observed in E. faecalis. vanA was responsible for vancomycin resistance. In conclusion, a high rate of resistance to antibiotics in Enterococcus is clearly problematic, and a novel strategy is needed to decrease resistance in Enterococcus.

Vitiligo: symptoms, pathogenesis and treatment

Vitiligo is an acquired cutaneous disorder of pigmentation, with an incidence of 0.5&#x0025; to 2&#x0025; worldwide. There are three major hypotheses for the pathogenesis of vitiligo that are not exclusive of each other: biochemical/cytotoxic, neural and autoimmune. Recent data provide strong evidence supporting an autoimmune pathogenesis of vitiligo. As vitiligo can have a major effect on quality of life, treatment can be considered and should preferably begin early when then disease is active. Current treatment modalities are directed towards stopping progression of the disease and achieving repigmentation. Therapies include corticosteroids, topical immunomodulators, photo(chemo)therapy, surgery, combination therapies and depigmentation of normally pigmented skin. It seems that traditional Chinese medicine could be more effective than the current treatment for vitligo.

Cloning and Overexpression of Extracellular Elastase from Pseudomonas Aeruginosa

This study was an attempt to overexpress the extracellular elastase from Pseuodomonas aeruginosa in Escherichia coli and characterize the level of purified enzymes of recombinant bacterium. The gene encoding an elastase natively produced by Pseudomonas aeruginosa was cloned and overexpressed in Escherichia coli using pET-32a system and the resultant recombinant elastase was purified and compared with the native elastase gene. The 1497 bp gene was amplified and subcloned in pET-32a and subsequently transformed into E. coli BL21. The media assay, SDS-PAGE and Western blotting were carried out to analyze the results, and the extracellular enzyme was purified to detect enzyme activity of recombinant E. coli. Nucleotide sequencing of the DNA insert from the clone revealed that the protease activity corresponded to an open reading frame consisting of 1497 bp coding for a 53.69-kDa protein. The clear zones around the recombinant colonies on skim milk agar as well as sharp band on 53-kD size on SDS-PAGE and Western blotting confirm the correct expression of elastase enzyme. Bacterial culture containing pET-32a-lasB showed high enzyme activity around 670 μg elastase ml−1. The results showed that elastase has potential to be produced industrially and be applied in medicine, food, etc. divisions.

Overexpression of Recombinant Lipase from Burkholderia Cepacia in Escherichia Coli

This study attempts to clone and express the extracellular lipase from Burkholderia cepacia in Escherichia coli using pET system as well as to determine the enzyme activity of recombinant lipase. The extracted DNA from B. cepacia was used as a template for amplifying lipase gene, and then the lipase gene was subcloned into pET-32a and subsequently transformed into E. coli BL21. Media assay and SDS-PAGE were carried out to analyse the results. Nucleotide sequencing of the DNA insert from the clone revealed that the lipase activity corresponded to an open reading frame consisting of 1092 bp coding for a 37.5-kDa protein. The successful expression of lipase was confirmed by obtaining blue color colonies on Nile Blue Sulphate Agar and big band at 37.5-kD size on SDS-PAGE. The enzyme activity assay also showed the high lipase activity around 590 μg lipase ml−1 culture 30 min−1 of recombinant E. coli BL21. The specific lipolytic activity of the recombinant lipase was 185 U/mL which is around 35-fold higher than the native baseline. The findings suggest that the crude recombinant lipase has potential application in digestion of lipids and fatty acids. In conclusion, the results of the current study showed a lipase gene encoding an enzyme with non-specific hydrolysis activity, which could be applied as lipase biosensor for digestion of lipids in food and medicine as well as oil-contamination treatment.

Extended-Spectrum Beta-Lactamases Producing Klebsiella Species Isolated from Several Major Hospitals in Iran

Klebsiella pneumoniae is a common hospital-acquired pathogen, causing urinary tract infections, nosocomial pneumoniae, and intra-abdominal infections. K.pneumoniae is also a potential community acquired pathogen. The aims of this study are to determine epidemiology of ESBL-producing K.pneumoniae and Koxytoca in Iran during different seasons, to determine the prevalence of blaTEM, SHV and CTX-M responsible for ESBL production among ESBL-producing K.pneumoniae and Koxytoca in the different wards and hospitals in Iraa Klebsiella spp producing ESBLs were identified by phenotypic and genotyping methods. The findings in this study revealed that 36.5%, 51.7% and 45.6% of K.pneumoniae were producing ESBLs in Ham, Milad and Emam Reza hospitals, respectively. The results revealed blaSHV was responsible for ESBLs production. The analysis showed significant difference of ESBLs production by K.pneumoniae in winter (53%) in comparison to the other seasons P≤ 0.01. The results also showed a significant difference in blaSHV that was the dominant gene responsible for ESBL production P≤ 0.049 but no significant difference was observed between blaTEM and blaSHV. The results showed that the highest ESBL production was found in Koxytoca isolated from patients in Emam Reza Hospital and the lowest frequency of ESBL production was found among Koxytoca in Ham hospital. BlaSHV was found as dominant gene responsible for ESBLs production by K.pneumoniae and Koxytoca, followed by blaCTX-M.

Effect of tannin extract against Pseudomonas aeruginosa producing metallo beta-lactamase

Carbapenems are the most potent beta-lactam agents with a broad-spectrum activity against Gram-negative and Gram-positive bacteria. They are stable in the presence of penicillinases and cephalosporinases. This study was focused on frequency of metallo beta- lactamase (MBL) among Pesudomonas aeruginosa strains isolated in patients with urinary tract infection, effect of tannin against PA positive strains which produced blaVIM or blaIMP and both of these genes (Species). Detection of MBL was performed by phonotypic and genotypic methods. Tannin extract was tested against P. aeruginosa producing MBL. During the study period, 240 P. aeruginosa isolates were identified. Among them 64 (26.6 percent) isolates were imipenem non-susceptible and confirmed by imipenem/EDTA. Our results revealed that the growth of blaVIM positive P. aeruginosa inhibited at 15 microg/ml concentration. The experiment repeated for blaIMP-positive P. aeruginosa and P. aeruginosa which harbored blaIMP and blaVIM, the results showed 35 microg/ml was the best concentration for inhibition of P. aeruginosa-positive blaIMP and also P. aeruginosa blaIMP and blaVIM. In conclusion, tannin was effective against P. aeruginosa producing blaVIM and blaIMP and both of them so it can be substituted with common antibiotics. The result showed significantly P. aeruginosa-harbored blaIMP was more responsible for imipenem resistance than P. aeruginosa-positive blaVIM. Interestingly, tannin was more effective against MBL-P. aeruginosa in comparison with current antibiotics.

Evaluation of Chronic Hepatitis B Infection in Patients with Seronegative HbsAg

BACKGROUND

It is estimated that about 370 million people are chronic carriers of HBV worldwide. Apparently 3% of Iranian populations are chronic carriers of this virus. We aimed to evaluate the viral DNA in biological fluids of chronic hepatitis patients compared to a control group.

METHODS

The current case-control study was designed to evaluate the viral DNA in biological fluids of 70 chronic hepatitis patients compared to a control group using ELISA, PCR and Real Time.

RESULTS

All individuals (100%) in case group were HBsAg positive while in control group only 2 individuals (2.8%) were HBsAg positive. Three individuals, in control group were positive using PCR and Real Time PCR indicating that about 7% of those in control group were chronic carriers of HBV. The interesting point was the copy of viral DNA; (5.49 ×10(4), 2.162×10(3) and 7.26×10(6)) for 3 chronic carriers using sera while it was about (5.71×10(3), 1.45×10(2) and 2.56×10(5)) using ear cerumen confirming the necessity of investigating for the carriers of HBV in different biological fluid and by different methods.

CONCLUSION

It can be concluded chronic carriers of hepatitis B are much more than what is diagnosed by routine diagnostic tests. On the other hand ELISA alone can not be relied on as a complete test for screening of chronic carriers in hepatitis B. PCR and Real Time PCR are more reliable tests for this purpose.

An outbreak of gastroenteritis of unknown origin in Tehran, July 2003

Aim of this study was to determine the causative agent and source of a large gastroenteritis outbreak occurred in a national financial center (CBIRI) in July 2003. A patient definition was defined staff were interviewed in the clinic of the Bank and their information were collected by means of a standardized questionnaire. A total of 110 fecal specimens were collected within 48 h of symptom onset from 100 patients with symptoms of gastroenteritis and 10 restaurant staff. The specimens were processed within 12 h to detect ova and parasites by direct microscopy and common bacteria by standard methods. The outbreak started on 22 July 2003 lasted 4 days. From a total of 1300 staff. 535 persons experienced a severe gastrointestinal illness. None but one of tested fecal samples were positive for bacterial enteric pathogens. S. paratyphi B was isolated from the positive case. Definitive association between illness and isolated S. paratyphi B remained to be determined since it was isolated only from one case. There is a need, however, for increased awareness among both professionals and the public to implement appropriate prevention measures and monitoring of food and water.

Antimicrobial susceptibility patterns and distribution of blaOXA genes among Acinetobacter spp. Isolated from patients at Tehran hospitals

Multiple drug-resistant strains of Acinetobacter have created therapeutic problems worldwide. This study was conducted to determine the antimicrobial susceptibility patterns and prevalence of bla(OXA-type) carbapenemases among isolates of Acinetobacter spp. obtained from Iranian patients. Here, 128 Acinetobacter isolates were identified at the species level, and their susceptibilities to different antibiotics were determined using disk agar diffusion testing. Isolates were then subjected to multiplex-PCR targeting bla(OXA) genes. More than 50% of the isolates showed multidrug resistance to different antibiotics. The rates of susceptibility to imipenem, meropenem, piperacillin-tazobactam, and amikacin were 50.7, 50, 42.1, and 38.2%, respectively. The MICs of carbapenems for the resistant isolates ranged from 64 to > or = 256 microg/ml. All strains of Acinetobacter baumannii possessed a bla(OXA-51-like) gene. The co-existence of bla(OXA-51-like)/bla(OXA-23-like) and bla(OXA-51-like)/bla(OXA-24-like) was detected in 25% (n=32) and 17.9% (n=23) of the isolates, respectively. Over 70% of carbapenem-resistant strains contained at least two genes encoding OXA-type carbapenemase. Resistance to carbapenems in the population of Acinetobacter strains in Iran is high, with the majority of isolates showing multidrug resistance. A wide diversity of OXA genes exists among the strains of A. baumannii in Iran. Detection of bla(OXA-51-like) can be used as a simple and reliable method to differentiate A. baumannii strains from other species.