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The emergence and dissemination of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates and their involvement in several nosocomial outbreaks are of high concern. This study was conducted to investigate the genetic relatedness and molecular determinants of carbapenem resistance in 100 CRKP isolates. Susceptibility to carbapenems as well as other antibiotics was determined by using disk diffusion method. The Modified Hodge test was performed for detection of carbapenemase production. The minimum inhibitory concentrations of selected antibiotics were determined by broth microdilution method. The presence of blaOXA-48, blaKPC, blaNDM, and blaVIM carbapenemase genes was examined by PCR, and clonal relatedness of CRKP isolates was investigated by pulsed-field gel electrophoresis (PFGE) analysis. blaOXA-48 was the most frequent carbapenemase gene (72%), followed by blaNDM (31%). None of the isolates harbored blaKPC and blaVIM genes. PFGE separated the majority of isolates into 10 clusters, including the major clusters A and B, carrying blaOXA-48, and clusters C and D, carrying blaNDM, and 4 isolates had a unique PFGE pattern. An increased rate of colistin resistance (50%) was detected among the isolates. Tigecycline was found to be the most active agent against CRKP isolates. Our results revealed that high prevalence of blaOXA-48 and blaNDM carbapenamses and resistance to colistin are alarming threats, necessitating an immediate action to prevent the spread of carbapenem-colistin-resistant K. pneumoniae isolates in Iran.

Reproductive history and obesity are among the well-recognized risk factors in the development of breast cancer, which are partially mediated by the increased exposure of breast tissues to estrogens. However, only a few studies have investigated the link between these risk factors and the pattern of methylation signatures in the breast tissue of healthy women. The role of the estrogen receptor 1 (ESR1) gene hypermethylation is reportedly important in the development of breast cancer. Thus, it is speculated that such ESR1 epigenetic changes may be influenced or shaped by obesity and reproductive history-related factors before and during breast carcinogenesis.Breast samples were collected from 120 cancer-free women who had undergone cosmetic mammoplasty. DNA was extracted from the breast tissues and, then, the methylation levels at the promoter and exon 1 regions of the ESR1 gene CpG island were determined by using the methylated DNA immunoprecipitation-quantitative PCR assay.The methylation level of the ESR1 promoter observed in women with a body mass index (BMI) ≥30 kg/mThese findings provide new hints about the relationship between epigenetic changes within the ESR1 gene CpG island and postmenopausal obesity and aging in cancer-free women. In terms of lifestyle intervention opportunities, this study also highlights the significance and feasibility of such interventions for BMI as a modifiable risk factor.

Obesity is a rapidly progressing pandemic and a central feature of the metabolic syndrome. There is no solid evidence on the recent trends of obesity in Iran. In this study we present the secular trends of overweight and obesity among Iranian adults (25-64 years old) within an 8-year period (1999-2007).The analyses were performed on the datasets of three cross-sectional national surveys: The National Health Survey-1999 (n = 21,576), National Surveys of Risk Factors for Non-Communicable Diseases (SuRFNCD)-2005 (n = 70,945), and SuRFNCD-2007 (n = 4,186).The overall prevalence of obesity increased from 13.6% in 1999 to 19.6% in 2005 and 22.3% in 2007 [odds ratio (OR) = 1.08 per year; P0.001]. For overweight subjects, the rates were, respectively, 32.2%, 35.8% and 36.3% (OR = 1.02 per year; P0.001). During these years, the mean body mass index (BMI) (kg/m(2)) increased from 25.03 in 1999, to 26.14 in 2005, and 26.47 and 2007 (P0.001). The increase in prevalence of obesity was seen in both males (OR = 1.09 per year; P0.001) and females (OR = 1.07 per year; P0.001) and both urban (OR = 1.07 per year; P0.001) and rural (OR = 1.10 per year; P0.001) residents.In conclusion, the present study highlighted the rapid growth of obesity during recent years in Iran. Our findings indicate the crucial necessity of primary prevention programs to counteract this undesired condition.

Stimulation of patient's immune response and therefore increasing inflammatory indices in patients who underwent invasive treatment methods for kidney stone removing can be predictable. In the present study, we tried to evaluate the differences of inflammatory indices in percutaneous nephrolithotomy (PCNL) and compared them with open stone surgery in patients with kidney stones.In a clinical trial study, 15 adult patients that scheduled to undergo PCNL and 15 patients who were candidate for open stone surgery matched for sex and age were included. Body temperature and concentrations of white blood cell, hemoglobin, C-reactive protein, interleukin-6, 24-hour urine cortisol levels, fibrinogen, TNF-alpha, and total antioxidant status (TAS) were measured. Pain severity was also measured on the basis of verbal rating scale (VRS). All measurements were recorded immediately before and 24 hours after operation.Patients that underwent open surgery had more severe pain than PCNL group (P = 0.001). Postoperative fever in the first group was more prevalent than other group (P = 0.020). Also, surgery time (P0.001), and total length of stay in hospital (P0.001) were higher in open surgery group. Differences rate of white blood cell (P = 0.003), C-reactive protein (P = 0.005), 24-hour urine cortisol level at 24 and 48 hours after open surgery were significantly more than PCNL (P = 0.02, P = 0.048, respectively).According to the higher postoperative complications and patient's inflammatory response in open stone surgery in comparison with PCNL, stone removing by PCNL has lower impact in terms of stress response in comparison to open surgery to the treatment of kidney stones.

To assess the outcome and safety of the totally tubeless percutaneous nephrolithotomy in renal anomalies.During a prospective clinical trial from December 2002 to November 2006, 60 patients with renal anomalies and nephrolithiasis were included in our study. The anomalies consisted of the horseshoe kidney, rotational anomalies of pyelocalyceal system, and ectopic kidney. The patients were randomly divided in two groups: the "totally tubeless" procedures performed in 30 patients (the nephrostomy tube and internal stent were not used in any patient), and 30 patients underwent standard percutaneous nephrolithotomy (PCNL; using both nephrostomy tube and ureteral stent). The incidence of complications, hospital stay, transfusion requirements, and stone-free rates were compared in the two groups.In the group of patients that underwent totally tubeless PCNL for the stone extraction, the mean stone burden was 2.54 cm(2) (standard deviation [SD] = 0.96). Patients' stay in the hospital averaged 1.3 (SD = 0.43) days. The average analgesics requirement was 4.5 (SD = 1.6) mg of morphine. The patients returned to normal activity in 10 (SD = 3.2) days. The postoperative complications were blood transfusion in one patient (3.3%) and fever in one patient (3.3%). An 83.3% stone-free rate was achieved. For the standard PCNL group, the mean stone size was 2.83 (SD = 0.76) cm(2), and the mean length of hospitalization was 2.6 (SD = 0.65) days. The average analgesics requirement was 10.4 (SD = 3.2) mg of morphine, and the time to return normal activity was 15.5 (SD = 3.2) days. Only 2 (6.7%) patients required a transfusion, and 1 (3.3%) patient had postoperative complications (penumothorax). Of the 30 patients, 86.7% became stone free. The differences between operation time, transfusion rates, complications, retreatment, and overall stone-free rate were not statistically significant in the two groups but days of hospitalization (P0.001), analgesics requirement (P0.001), and time of return tonormal activity (P0.001) were statistically significant.Totally tubeless percutaneous renal surgery is a safe and effective procedure in renal anomalies and can be performed in patients even with a moderate to large stone burden.