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Inadequate knowledge and negative attitudes are the major hindrances to prevent the spread of the human immunodeficiency virus. This study aims to assess the knowledge and attitude toward the human immunodeficiency virus and acquired immune deficiency syndrome among youths in Iran. We conducted a systematic review, searching online databases until July 2018, focusing on knowledge and attitudes about the human immunodeficiency virus and acquired immune deficiency syndrome in Iranian youths. We included the studies that aimed to determine the knowledge and attitudes of people from Iran and were conducted in the last 18 years. In total, 14 eligible papers (out of 300) were entered into the analysis, and the overall knowledge of Iranian youth toward the acquired immune deficiency syndrome was 57.6% (95% CI: 56.7%-58.5%). Also, the results of Cochran's test showed the heterogeneity of the studies (Q=1578.2, df=13, I2=79.4%, p<0.001). We concluded that our results would guide the development of population-focused knowledge and attitude about the human immunodeficiency virus and acquired immune deficiency syndrome in Iran, which is lacking among the general public and healthcare staff.
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Síndrome de Inmunodeficiencia Adquirida/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Conducta del Adolescente , Femenino , Humanos , Irán/epidemiología , Masculino , Asunción de RiesgosRESUMEN
OBJECTIVE: To evaluate the feasibility and results of using serosal patch of small bowel for repair and replacement of inferior vena cava (IVC) after resection of a part of infra-renal IVC in an animal model, as it may be encountered in extensive tumors of retroperitoneal and trauma patients. METHODS: Five healthy sheep of both sexes were prepared. After general anesthesia and laparotomy, a defect with 1 cm width and 4cm length was made on anterior aspect of infra-renal IVC, and then an adjacent loop of small bowel was brought and sutured continuously to cover the defect of IVC as a patch graft. The observation period was two months. RESULTS: Three of five IVCs were macroscopically patent without stenosis and thrombosis. Pathologic assay revealed complete endothelialization of serosal surface of the patch of small bowel loop. One of IVCs was completely occluded in gross evaluation and fibrous formation in pathologist review. The sheep had no sign of venous hypertension and edema of limbs. One sheep died at the night of first operation due to internal bleeding. CONCLUSION: Serosal patch of small bowel is an accessible and feasible alternative in repair and reconstruction of IVC especially when there is restriction for use of prosthetic material in a contaminated space of abdomen.
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The present study was done to scrutinize the possible relation between infective genes and antimicrobial resistance in Enterococcus faecalis and Enterococcus faecium. Considering the fact that the presence of recognized infective determinants among clinical isolates may promote the emergence of infections and persistence of Enterococci in hospital settings, which can lead to an increase in antimicrobial resistance. 175 E. faecalis and 67 E. faecium isolated from clinical specimens were used. The isolates were identified, and then antibiotic susceptibility testing was performed. The MIC of vancomycin and teicoplanin were determined by broth microdilution method. The presence of infective genes esp, hyl and asa1 was scrutinized using PCR. Of the 280 enterococcal isolates, 175 (62.5%) isolates were identified as E. faecalis, 67 (24%) as E. faecium and 38 (13.5%) as Enterococcus spp. The results of the antibiotic susceptibility testing showed resistance rates of 5% and 73% to vancomycin and teicoplanin in E. faecalis and E. faecium isolates, respectively. The statistical analysis showed that the esp infective gene has significant associations with ciprofloxacin, erythromycin and tetracycline in E. faecium and with chloramphenicol in E. faecalis strains; the hyl with teicoplanin and vancomycin in E. faecium strains; and also asa1 with vancomycin in E. faecium and with ampicillin and chloramphenicol in E. faecalis strains. Regarding the relationships between virulence genes and antibiotic resistance in strains of E. faecalis and E. faecium, detection of infective factors associated with invasive diseases has become a major issue of concern.
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AIM: The aims of the present study were to determine the antibiotic susceptibility profils with particular emphasis on susceptible or resistant strains to macrolides and lincosamids antibiotics and to determine possible antibiotic resistance mechanisms occurring in group B streptococci (GBS) strains using PCR assay and disk diffusion method. METHODS: A total of 62 clinical GBS strains were investigated. Antibacterial susceptibility testing was performed using the disk diffusion method and inducible resistance test for clindamycin by standard double disk diffusion or D-zone test for all isolates to differentiate macrolide resistance phenotype (M), constitutive macrolide-lincosamide-streptogramin B phenotype (cMLSB) and induced macrolide-lincosamide-streptogramin B phenotype (iMLSB). In addition, minimum inhibitory concentrations (MIC) of penicillin were determined for all isolates. Finally, possible existence of antibiotic resistance genes for erythromycin (ermTR, ermB and mefA/E) and for clindamycin (linB) were examined among isolates using PCR assay. RESULTS: All 62 isolates were susceptible to penicillin, ampicillin, linezolid, cefazoline and vancomycin. However, 93.5% (n=58) of isolates showed an increased MIC to penicillin. The overall rate of erythromycin resistance was 35.5% (n=22). All erythromycin-resistant isolates displayed the M phenotype (100%, n=22). All three erythromycin resistance genes (i.e. ermTR, ermB and mefA/E) were found in erythromycin-resistant isolates. CONCLUSION: It was concluded that prescribing antibiotic without antibacterial susceptibility tests should be prevented because of the high prevalence of erythromycin-resistant GBS strains and the fact that erythromycin-resistant GBS strains has shown an increased MIC to penicillin, as the drug of choice for treating GBS infections.
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BACKGROUND: The aim of this study was to determine the occurrence of virulence determinants and vancomycin-resistant genes among Enterococcus faecalis and E. faecium obtained from various clinical sources. METHODS: The study was performed on the 280 enterococcal isolated from clinical specimens in Hamadan hospitals, western Iran in 2012-14. Antibiotic susceptibility testing was performed using disk diffusion and Minimal Inhibitory Concentration (MIC) methods. The presence of vancomycin-resistant genes and virulence genes was investigated using PCR. RESULTS: Totally 280 enterococcal isolates were identified as follows: E. faecalis (62.5%), E. faecium (24%) and Enterococcus spp (13.5%). The results of antibiotic susceptibility testing showed that resistance rates to vancomycin and teicoplanin in E. faecalis and E. faecium isolates were 5% and 73%, respectively. Of Sixty vancomycin-resistant Enterococci strains, fifty-one isolates were identified as E. faecium (VREfm) and nine as E. faecalis (VREfs). Prevalence of esp, hyl, and asa1 genes were determined as 82%, 71.6%, and 100%, respectively in E. faecium strains; and 78%, 56/6%, and 97%, respectively in E. faecalis strains. CONCLUSION: The increased frequency of VREF, as seen with rapid rise in the number of vanA isolates should be considered in infection control practices.
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Streptococcus agalactiae is acommensalorganism, but it may cause infection in susceptible hosts. The aim of this study was to evaluate PCR assay compared with conventional culture method for direct detection of Streptococcus agalactiae. Total of 203 paired low vaginal swabs were collected from women at 35-37 weeks of pregnancy from June 2013 through February 2014 for detection of Streptococcus agalactiae using PCR assay targeting 16S rRNA, cfb, scpB, and atr genes and culture method following broth enrichment. The results were recorded and evaluated for determining of sensitivity, specificity, positive and negative predictive values of PCR assaycompared with culture method. Prevalence of Streptococcus agalactiae was determined as 7.39% (n=15) using culture method; 19.70% (n=40) by PCR targeting 16S rRNA gene; 18.23% (n=37) by targeting atr gene; 17.24% (n=35) by cfb gene; and 8.87% (n=18) by scpB gene. Generally, a total of 49 specimens were considered true positive (27 samples by PCR assay using the four genes in sum, 4 samples only by atr gene PCR, 3 samples only by cfb gene PCR, 2 samples only by culture method, and 13 samples by PCR assay and culture method in common) and prevalence of Streptococcus agalactiae determined 24.14% in Hamadan. The current data demonstrated that performing only culture method for detecting GBS from pregnant women leads to missed false negative carrier individuals. Thus, it is recommended that both the PCR assay and conventional culture method to be performed in order to detect Streptococcus agalactiae.
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Proteínas Bacterianas/genética , Complicaciones Infecciosas del Embarazo/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus agalactiae/genética , Adhesinas Bacterianas/análisis , Adhesinas Bacterianas/genética , Adulto , Proteínas de la Ataxia Telangiectasia Mutada/análisis , Proteínas de la Ataxia Telangiectasia Mutada/genética , Proteínas Bacterianas/análisis , Endopeptidasas/análisis , Endopeptidasas/genética , Femenino , Proteínas Hemolisinas/análisis , Proteínas Hemolisinas/genética , Humanos , Neuropéptidos/análisis , Neuropéptidos/genética , Reacción en Cadena de la Polimerasa/métodos , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Tercer Trimestre del Embarazo , ARN Ribosómico 16S/análisis , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Infecciones Estreptocócicas/microbiología , Vagina/microbiología , Adulto JovenRESUMEN
Sepsis is a leading cause of morbidity and mortality in hospitalized patients worldwide and based on studies, 30-40% of all cases of severe sepsis and septic shock results from the blood stream infections (BSIs). Identifying of the disease, performing laboratory tests, and consequently treatment are factors that required for optimum management of BSIs. In addition, applying precise and immediate identification of the etiologic agent is a prerequisite for specific antibiotic therapy of pathogen and thereby decreasing mortality rates. The diagnosis of sepsis is difficult because clinical signs of sepsis often overlap with other noninfectious cases of systemic inflammation. BSIs are usually diagnosed by performing a series of techniques such as blood cultures, polymerase chain reaction-based methods, and biomarkers of sepsis. Extremely time-consuming even to take up to several days is a major limitation of conventional methods. In addition, yielding false-negative results due to fastidious and slow-growing microorganisms and also in case of antibiotic pretreated samples are other limitations. In comparison, molecular methods are capable of examining a blood sample obtained from suspicious patient with BSI and gave the all required information to prescribing antimicrobial therapy for detected bacterial or fungal infections immediately. Because of an emergency of sepsis, new methods are being developed. In this review, we discussed about the most important sepsis diagnostic methods and numbered the advantage and disadvantage of the methods in detail.
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BACKGROUND: Pseudomonas aeruginosa is one of the most common nosocomial pathogens with high mortality rates. Organisms such as Pseudomonas aeruginosa have the ability to develop high level MDR (Multi drug resistance). The MexAB-OprM system is one of the largest multi-drug resistant efflux pumps with high levels of expression and the first finding of the RND (Resistance-nodulation-division) family in P. aeruginosa. AIM: For better understanding of the antibiotic resistance mechanism in P. aeruginosa, this study was conducted to determine the expression of the genes encoding these efflux pumps in 100 strains of P. aeruginosa isolated from patients admitted to various hospitals in Hamadan using quantitative Real-Time PCR (qRT-PCR). METHODS: This study examined 100 strains of P. aeruginosa isolated from patients admitted to various hospitals in Hamadan. Then, 31 samples were selected based on collected specimen type and their antibiotic susceptibility pattern; i.e., the samples with reduced susceptibility to antibiotics, particularly carbapenems. Antibiotic disk diffusion method was performed for aminoglycoside, quinolone and carbapenem. Furthermore, MIC method was performed for ciprofloxacin, gentamicin and imipenem. Finally, qRT-PCR was used for determining the efflux pump genes expression. RESULTS: Among eight selected antibiotics, the greatest resistance was to levofloxacin (61.2%, n = 19) and the lowest one to imipenem (9.6%, n = 3). All isolates (100%, n = 31) exhibited efflux pump MexAB-OprM genes but different expression was observed in different strains. The result of gene expression indicated that significant differences in expression of MexR (P value = 0.003), OprD (P value < 0.001), and MexB (P value = 0.026) genes. In addition, there was high level of MexR gene expression in bacteria that leads to reduced expression of MexA, MexB, and OprM. The OprD gene was presented in all strains but different expression has been observed. CONCLUSION: Identifying the bacterial resistance mechanisms is very complicated. Although efflux pump MexAB-OprM plays an important role in antibiotic resistance in P. aeruginosa, because of acting the efflux pumps on antibiotics in a non-specific manner, it is elusive to consider or describe an antibiotic resistance based on the presence or absence of an efflux pump.