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Saeed Khoshnood,1,2 Mohammad Savari,1,2 Effat Abbasi Montazeri,1,2 Ahmad Farajzadeh Sheikh1,2 1Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IranCorrespondence: Ahmad Farajzadeh SheikhInfectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Khuzestan 61357-15794, IranTel +98 9161133491Fax +98 61 3333 2036Email farajzadehah@gmail.comIntroduction: Acinetobacter baumannii is an opportunistic pathogen responsible for nosocomial infections. The emergence of colistin-resistant A. baumannii is a significant threat to public health. The aim of this study was to investigate the molecular characterization and genotyping of clinical A. baumannii isolates in Southwestern Iran.Methods: A total of 70 A. baumannii isolates were collected from patients admitted to Imam Khomeini Hospital in Ahvaz, Southwestern Iran. Minimum inhibitory concentration test was conducted by using Vitek 2 system. The presence of biofilm-forming genes and colistin resistance-related genes were evaluated by PCR. The isolates were also examined for their biofilm formation ability and the expression of pmrA and pmrB genes. Finally, multilocus sequence typing (MLST) and PCR-based sequence group were used to determine the genetic relationships of the isolates.Results: Overall, 61 (87.1%) and 9 (12.8%) isolates were multidrug-resistant (MDR) and extensively drug-resistant (XDR), respectively. Colistin and tigecycline with 2 (2.8%) and 32 (45.7%) resistance rates had the highest effect. Among all the isolates, 55 (78.5%), 7 (10%), and 3 (4.3%) were strong, moderate, and weak biofilm producers, respectively. The frequency rates of biofilm-related genes were 64 (91.4%), 70 (100%), 56 (80%), and 22 (31.42%) for bap, ompA, csuE, and blaPER1, respectively. Overexpression of pmrA and pmrB genes was observed in two colistin-resistance isolates, but the expression of these genes did not change in colistin-sensitive isolates. Additionally, 37 (52.8%) and 8 (11.4%) isolates belonged to groups 1 (ICII) and 2 (IC I), respectively. MLST analysis revealed a total of nine different sequence types that six isolates belonged to clonal complex 92 (corresponding to ST801, ST118, ST138, ST 421, and ST735). Other isolates were belonging to ST133 and ST216, and two colistin-resistant (Ab4 and Ab41) isolates were belonging to ST387 and ST1812.Conclusion: The present study revealed the presence of MDR and XDR A. baumannii isolates harboring biofilm genes and emergence of colistin-resistant isolates in Southwestern Iran. These isolates had high diversity, which was affirmed by typing techniques. The control measures and regular surveillance are urgently needed to preclude the spread of these isolates.Keywords: Acinetobacter baumannii, drug resistance, colistin, MLST, clonal complex

Aghil Bahramian,1,2 Saeed Khoshnood,3,4 Aref Shariati,5 Farahnoosh Doustdar,2 Alireza Salimi Chirani2 Mohsen Heidary5,6 1Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 2Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 3Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 4Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 5Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran; 6Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran Introduction: Pseudomonas aeruginosa is the most common opportunistic pathogen associated with a broad range of infections, including cystic fibrosis, ocular, otitis media, and burn infections. The aim of this study was to show the frequency of the pilS2 gene, and its association with P. aeruginosa plasmid pKLC102 and PAPI-1 pathogenicity island among P. aeruginosa strains.Methods: The samples were collected from patients with cystic fibrosis, ocular, otitis media, and burn infections between January 2016 and November 2017. DNA was extracted using the DNA extraction kit and was used for PCR assay. PCR with 4 primer-pairs including 976 F/PAPI-1R, 4542 F/intF, SojR/4541 F, and intF/sojR was performed to identify PAPI-1. pKLC102 was detected using three other primer-pairs including cp10F/ cp10R, cp44F/cp44R, and cp97F/cp97R.Results: A total of 112 P. aeruginosa isolates were collected from patients with cystic fibrosis (36), burn (20), otitis media (26), and ocular (30) infections. The results of PCR showed that pilS2 gene was identified in 96 (85%) strains. PAPI-1–attB integration was detected among 38 (33.9%) isolates and the circular form of PAPI-1 detected among 17 (14%) isolates. In addition, 79 (70.5%) strains were found to be positive for pKLC102.Conclusion: We found that the majority of the isolates may be susceptible to transfer this significant island and the related element pKLC102 into recipient isolates lacking the island owing to high association of the PilS2 pilus with the islands in the studied strains. It is anticipated that strains isolated from burn and eye with the highest rate of PilS2, PAPI-1, and pKLC102 association have a high level of antibiotic resistance. Keywords: Pseudomonas aeruginosa, pilS2, cystic fibrosis, pKLC102, PAPI-1

Ahmad Farajzadeh Sheikh,1,2 Mojtaba Moosavian,1,2 Mahtab Abdi,2 Mohsen Heidary,3,4 Fatemeh Shahi,2 Nabi Jomehzadeh,5 Sakineh Seyed-Mohammadi,1,2,6 Morteza Saki,1,2,6 Saeed Khoshnood1,2,6 1Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 2Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 3Department of Microbiology, Faculty of Medicine, Iran University of Medical Sciences,Tehran, Iran; 4Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran; 5Abadan School of Medical Sciences, Abadan, Iran; 6Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Introduction: Shigellosis is a significant global human health problem, and Shigella is in charge of almost 165 million cases of this disease annually, of whom 163 million cases are in developing countries and 1.5 million cases are in developed countries. The main aims of the current survey were to identify Shigella spp. isolated from diarrheal patients by conventional biochemical tests, determine the antimicrobial susceptibility profiles by disk diffusion method, and detect the ipaH gene using the PCR assay.Methods: The bacterial isolates were identified as Shigella spp. by microbiological tests and were serogrouped by the slide agglutination test. Antimicrobial susceptibility testing was performed using the disk diffusion method. PCR was performed to detect the ipaH gene.Results: The Shigella strains were isolated from 522 patients with various diarrhea, including bloody diarrhea (3%), mucoid plus bloody diarrhea (1.9%), mucoid diarrhea (3.2%), and watery diarrhea (3.2%). Overall, 69 (13.2%) isolates were positive for Shigella spp., of which 34 (49.3%) serotypes were identified as Shigella flexneri, 22 (31.9%) serotypes were identified as Shigella sonnei, 9 (13%) serotypes were identified as Shigella boydii, and 4 (5.8%) serotypes were identified as Shigella dysenteriae. Antibiotic susceptibility tests revealed that the highest resistance percentage was related to ampicillin (82%) and trimethoprim-sulfamethoxazole (77%), and ciprofloxacin and ceftriaxone were the best antibiotics against Shigella isolates.Conclusion: We concluded that Shigella spp. can be considered as an etiological agent of diarrhea in southwest Iran. Since the drug resistance pattern of Shigella differs geographically and over time within a country, continuous and regular surveillance program is necessary. Keywords: Shigella, diarrhea, resistance, Iran

Introduction: Helicobacter pylori ( H. pylori ) induces gastritis by stimulating Th17 cells and related cytokines. The aim of our study was to investigate the synergistic effect of metformin with amoxicillin as an antibiotic in inhibiting H. pylori and modulating the immune response in a rat model., Methods: Forty-five male Sprague-Dawley rats were divided into seven groups and infected with H. pylori . Over the course of 14 days, all animals were treated with metformin and amoxicillin alone and in combination. The antibacterial activity of metformin was evaluated by growth curves and colony counts. The immunoregulatory effect on Treg/Th17 balance was assessed by flow cytometry, and the cytokine profile of IL-17A, IL-1 β , IL-6, IL-8, TGF- β , and IL-10 was determined by ELISA. The effect of metformin on gene expression of cagA and IL-8 was investigated by RT-PCR. Pathological changes were assessed by hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining., Results: Metformin showed weak antibacterial activity against clinically isolated H. pylori . However, the combination of metformin and amoxicillin (AMX) showed strong synergistic antibacterial activity ( Σ FIC = 0.24). Compared with AMX, metformin reduced inflammation and tissue damage but resulted in increased bacterial growth. During metformin administration, both TGF- β levels and Treg cells increased dramatically ( P = 0.002). In synergy with AMX, metformin decreased the effective dose of antibiotic to eradicate H. pylori ., Conclusions: The combination of metformin with potential antibiotics such as AMX had a positive effect on the relief of H. pylori -related inflammation by inducing Treg cells while successfully eliminating H. pylori ., Competing Interests: No conflict of interest was reported by the authors., (Copyright © 2023 Hassan Valadbeigi et al.)

Scenarios for monitoring land cover on a large scale, involving large volumes of data, are becoming more prevalent in remote sensing applications. The accuracy of algorithms is important for environmental monitoring and assessments. Because they performed equally well throughout the various research regions and required little human involvement during the categorization process, they appear to be resilient and accurate for automated, big area change monitoring. Malekshahi City is one of the important and at the same time critical areas in terms of land use change and forest area reduction in Ilam Province. Therefore, this study aimed to compare the accuracy of nine different methods for identifying land use types in Malekshahi City located in Western Iran. Results revealed that the artificial neural network (ANN) algorithm with back-propagation algorithms could reach the highest accuracy and efficiency among the other methods with kappa coefficient and overall accuracy of approximately 0.94 and 96.5, respectively. Then, with an overall accuracy of about 91.35 and 90.0, respectively, the methods of Mahalanobis distance (MD) and minimum distance to mean (MDM) were introduced as the next priority to categorize land use. Further investigation of the classified land use showed that good results can be provided about the area of the land use classes of the region by applying the ANN algorithm due to high accuracy. According to those results, it can be concluded that this method is the best algorithm to extract land use maps in Malekshahi City because of high accuracy., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Early diagnosis of tuberculosis (TB), followed by effective treatment, is the cornerstone of global TB control efforts. An estimated 3 million cases of TB remain undetected each year. Early detection and effective management of TB can prevent severe disease and reduce mortality and transmission. Intrinsic and acquired drug resistance of Mycobacterium tuberculosis (MTB) severely restricted the anti-TB therapeutic options, and public health policies are required to preserve the new medications to treat TB. In addition, TB and HIV frequently accelerate the progression of each other, and one disease can enhance the other effect. Overall, TB-HIV co-infections show an adverse bidirectional interaction. For HIV-infected patients, the risk of developing TB disease is approximately 22 times higher than for persons with a protective immune response. Analysis of the current TB challenges is critical to meet the goals of the end TB strategy and can go a long way in eradicating the disease. It provides opportunities for global TB control and demonstrates the efforts required to accelerate eliminating TB. This review will discuss the main challenges of the TB era, including resistance, co-infection, diagnosis, and treatment.