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Background: Colistin and carbapenem-resistant Klebsiella pneumoniae (Col-CRKP) represent a significant and constantly growing threat to global public health. We report here an outbreak of Col-CRKP infections during the fifth wave of COVID-19 pandemic. Methods: The outbreak occurred in an intensive care unit with 22 beds at a teaching university hospital, Isfahan, Iran. We collected eight Col-CRKP strains from seven patients and characterized these strains for their antimicrobial susceptibility, determination of hypermucoviscous phenotype, capsular serotyping, molecular detection of virulence and resistance genes. Clonal relatedness of the isolates was performed using MLST. Results: The COVID-19 patients were aged 24–75 years with at least 50% pulmonary involvement and were admitted to the intensive care unit. They all had superinfection caused by Col-CRKP, and poor responses to antibiotic treatment and died. With the exception of one isolate that belonged to the ST11, all seven representative Col-CRKP strains belonged to the ST16. Of these eight isolates, one ST16 isolate carried the iucA and ybtS genes was identified as serotype K20 hypervirulent Col-CRKP. The blaSHV and blaNDM-1 genes were the most prevalent resistance genes, followed by blaOXA-48 and blaCTX-M-15 and blaTEM genes. Mobilized colistin-resistance genes were not detected in the isolates. Conclusions: The continual emergence of ST16 Col-CRKP strains is a major threat to public health worldwide due to multidrug-resistant and highly transmissible characteristics. It seems that the potential dissemination of these clones highlights the importance of appropriate monitoring and strict infection control measures to prevent the spread of resistant bacteria in hospitals. [ABSTRACT FROM AUTHOR]

Objective. Evaluation of the pruritus features in children with end-stage renal disease (ESRD) who underwent dialysis at an academic tertiary pediatric dialysis center. Methods. This cross-sectional study was conducted at an academic tertiary pediatric dialysis center, Isfahan, Iran. The reviewed medical records of the children included their characteristics, dialysis properties, and laboratory parameters. The 4-item itch questionnaire was utilized to assess distribution, severity, frequency, and associated sleeping disorders. Results. Thirty ESRD patients with pruritus, including 23 males (76.7%) with a mean age of 11.7 ± 3.64 years, were recruited. The most common cause of CKD was nephronophthisis (23.3%). The median total score of pruritus was 5 (range: 3-15). The distribution score of pruritus was directly correlated with the age (Spearman's rho = 0.42, P = 0.02) and serum level of parathyroid hormone (PTH) (Spearman's rho = 0.42 , P = 0.04). In the reduced multiple logistic regression model, the increasing level of serum calcium was associated with increased odds of having total pruritus score ≥ 5 (OR (odds ratio): 4.5; 95% CI 1.12 to 18.05). In addition, an increase in age for one year was found to be associated with 50% higher odds of having total pruritus score ≥ 5 (OR: 1.5; 95% CI 1.03 to 2.18). Conclusion. Increased level of serum Ca and higher age were associated with increased odds of having more severe pruritus score in children. [ABSTRACT FROM AUTHOR]

This study aimed to compare the efficacy of rituximab versus Cyclophosphamide on active secondary progressive multiple sclerosis (SPMS). The randomized clinical trial was performed from 2015 to 2017 in multiple sclerosis (MS) clinics affiliated to Isfahan MS society (IMSS). Patients were randomized to two groups, and one of them received Rituximab that was repeated every six months in case of medical indication. The other one received a monthly pulse of methylprednisolone plus cyclophosphamide (Endoxan, Baxter, UK) until two years. Expanded disabilities status scale (EDSS), clinical, and MRI findings were assessed every six months. Statistical analysis was performed using SPSS software. 39 patients in the Rituximab group and 30 in the Cyclophosphamide group with similar age and gender distribution were entered for analysis. At baseline, the mean number of attacks in the Rituximab group was significantly more than the Cyclophosphamide group (P=0.0001). After 6, 12, and 18 months of treatment, the rate of attacks was similar between groups although it increased significantly in the Rituximab group (P=0.030) after 24 months of treatment. EDSS was increased in the Rituximab group more than the other group at the end of the study. Both drugs were well-tolerated by patients. The EDSS was increased in the Rituximab group but the disability score did not worsen in the Cyclophosphamide group. Both therapies were associated with a reduction in disease attacks and improvement in radiologic findings in a two-year period of follow-up. [ABSTRACT FROM AUTHOR]

Background: The relationship between hepatic disorders and Transfusion transmitted virus (TTV) and the significance of parenteral transmission of TTV are controversial. The aim of this study was to compare the prevalence of TTV in injection drug users (IDUs), hemodialysis patients, and healthy blood donors, in Isfahan, Iran, at the year of 2010. Methods: In a case-control study, 108 subjects included 36 hemodialysis patients, 36 IDUs, and 36 healthy blood donors (as control group) were studied. Five-mL blood sample was taken from each subject on EDTA-containing tubes. Then DNA extraction was implemented using DNA extraction kit, and DNA reproduction was done using specific primers and probe by Rotor-Gene 6000 real-time PCR instrument. Findings: The mean of age in subjects was 38.7 ± 14.7 and 71 (66%) were male. Of 108 cases, 30 (27.8%) were TTV positive and 78 (72.2%) were TTV negative. The prevalence of TTV in IDUs 21 (58%) and hemodialysis patients 6 (17%) was higher than healthy blood donors 3 (8%) that was statistically significant (P < 0.0001). Conclusion: The prevalence of TTV in IDUs and hemodialysis patients is significantly higher than the general population in Isfahan, Iran. It seems necessary to make plans and policies to reduce the risk of TTV transmission to families of hemodialysis patient and IDUs, individuals who have close contact with them and health care workers. [ABSTRACT FROM AUTHOR]

Objective: Multiple sclerosis (MS) is an inflammatory demyelinating disease of central nervous system. Environmental factors such as different viruses have proposed to be involved in the pathogenesis of multiple sclerosis (MS). This study was aimed to evaluate Cytomegalovirus (CMV) seropositivity in Iranian patients suffering from MS compared to controls. Methodology: This case control study was conducted in Isfahan. Using ELISA method, IgM and IgG antibodies to Cytomegalovirus (CMV) in MS patients and age and sex matched controls were detected. CMV IgM titer higher than 25 and CMV IgG titer higher than 0.6 were regarded as seropositive according to laboratory Kit. Results: Total 82 MS patients (64 females and 18 males) and 38 controls (29 females and 9 males) were included (P>0.05). The median [IQR] titer of CMV IgM in MS group was 3.25[2.97- 5.1] versus 3.5[2.5-5.7] in control group (p=0.66); likewise, the median [IQR] titer of CMV IgG in MS patients was 15.15 [8.1-22.5] versus 7.75[5.3-22] in control group (p=0.011). According clinical course median of IgG was 14.94[7.3-24] in RRMS and 20.0[9.8-22] in SPMS and median of IgM was 4.0[2.9-6.5] and 3.0[2.7-4.0] respectively. Conclusion: Seropositivity of CMV was higher in MS patients than controls, therefore, it may have a possible role in MS pathogenesis, but further studies are needed to evaluate this result. [ABSTRACT FROM AUTHOR]

Background: Stroke is one of the commonest neurological diseases. However, no study has been designed to compare urban and rural stroke risk factors in Iran. Therefore, this study aimed to evaluate epidemiologic characteristics of stroke risk factors among rural and urban population. Methods: In this prospective cross-sectional study, 590 consecutive patients were evaluated in departments of neurology at two university hospitals (associated with Isfahan University of Medical Sciences, Isfahan, Iran). Patients above 16 years of age with confirmed stroke by a neurologist were included. Stroke risk factors such as hypertension (HTN), diabetes, dyslipidemia, atrial fibrillation, myocardial infarction, valvular diseases, smoking and addiction, ischemic heart disease (IHD), history of previous stroke and seasons of the year were registered. The patients were also asked if they lived in the rural or urban areas. Findings Urban and rural patients respectively constituted 78.6% (n = 464) and 21.4% (n = 126) of the 590 participants. According to the performed analyses, HTN, IHD and diabetes were the commonest risk factors in both urban and rural patients. In addition, no significant differences were found in stroke risk factors between rural-urban patients. Conclusion: Similar to previous researches, this study indicated urban population to have a higher probability of having HTN, IHD and diabetes. However, no significant differences were observed in such complications between rural-urban patients. [ABSTRACT FROM AUTHOR]

Background: Teenage pregnancy is known as a high risk pregnancy. However, some study show that good prenatal care can decrease the rate of complications. This study was done to evaluate the frequency of preterm labor, still birth, premature rupture of membranes, cesarean section, eclampsia, low birth weight and interest of mother's about the type of delivery. Methods: This study was conducted from October 2009 to November 2010 in Isfahan University of Medical Sciences, Isfahan, Iran. Five hundred mothers were followed during their pregnancy and were divided into two groups, under 20 years (teenagers) and-over 20 years. The complications and outcome of pregnancy were evaluated and the collected data was analyzed by SPSS16. Findings: Five hundred pregnant women were evaluated during their pregnancy. The mean age of teenage women was 18.12 ± 1.11 years and the mean age of over 20-years mothers was 26.53 ± 3.08 years. 15(6%) teenage women have experienced eclampsia, while only 4(1.6%) women over 20 years old had eclampsia (P = 0.01). Conclusion: This study showed that teenage pregnancy has more complications than older age, and more education is needed to reduce this type of pregnancy. [ABSTRACT FROM AUTHOR]

Background: The P53 tumor suppressor gene plays important roles in genomic stability. G-to-C at codon 72 in the P53 gene has been associated with increased risk for lung, oral, prostate, breast, colorectal cancers and may be a marker for risk of skin cancer. This project studied the effect of P53 polymorphism on risk of nonmelanoma skin cancers (Squamous and basal cell carcinoma). Methods: This case-control study undertook for study of twenty basal cell carcinoma (BCC), twenty squamous cell carcinoma (SCC) and twenty specimens as controls for each cancer specimen in the city of Isfahan, Iran. Different P53 codon 72 genotypes were identified using polymerase chain reaction. Findings: In control samples, the frequency of Arg/Arg genotype showed 25% and in BCC specimens showed 60%. The differences in this genotype group between the cases and controls were statistically significant (P = 0.048). The differences in the frequency of heterozygot Arg/Pro and also in the frequency of Pro/Pro genotype between the cases and controls were not statistically significant. OR = 4.5 in BCC cases show that the risk for this disease in persons who have Arg/Arg genotype is about 4.5 times more than normal people. The results of χ2 test showed that in this study there is not statistically significant differences between the SCC specimens and controls for frequency of different genotypes. Conclusion: The present study indicate that P53 codon 72 polymorphism is a genetic predisposing factor for risk of nonmelanoma skin cancers (of BCC type) in Isfahan. However, further studies are needed in order to elucidate the role of P53 codon 72 polymorphism in skin cancer development. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to assess the prevalence of Hepatitis C virus (HCV), Hepatitis B virus (HBV) and Human Immunodeficiency virus (HIV) among hemophilia and thalassemia patients. Methods: This cross-sectional study was conducted from October 2008 to December 2010 in Isfahan, Iran. 1160 adult multi-transfused patients suffering from beta-thalassemia (n = 545) and hemophilia (n = 615) were enrolled in the study. Blood samples were obtained from the patients and were tested for HBs Ag, Anti-HCV Ab and Anti- HIV Ab. Patients with HCV positive underwent genotype determination. Findings: 822 males and 338 females (mean age 22.7 ± 11.5 years, range 1-76 years) were investigated in this study.312 males (57.2%) and 233 (42.8%) females had thalassemia. 511 (83%) males and 104 (17%) females were in hemophilia group. Of the 505 (82.1%) persons with chronic hepatitis in hemophilia patients, 495 (98%) patients were HCV antibody positive and 10 (2%) patients had HBs positive. There were 56 (11%) patients with chronic hepatitis in patients with thalassemia. Of them, 50 (89.2%) patients were HCV antibody positive and 6 (10.8%) patients had HBs positive. None of the thalassemia and hemophilia patients was positive for HIV Ab. HCV genotype 1 was the major genotype among patients. Conclusion: HCV is a major virus of concern in the multi-transfused patients. The strategies for prevention of HBV and safety of blood products in this respect have indeed been successful. Family History of hepatitis is the major risk factors among patients. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis is an inflammatory and degenerative disease of central nerves, in which myelin appears as several large and small plaques in cerebrospinal white matter. The aim of this study was investigate the familial prevalence of Multiple Sclerosis. Methods: This cross- sectional study was performed from the beginning to the end of 2007 on 539 MS patients in Isfahan, Iran. The patients were selected among all of the MS people who referred to the MS clinics of Isfahan University of Medical Sciences by the simple random sampling. Finally 593 patients were studied; their disease was proved based on the McDonald values by 2 neurologists. Findings: The average of patients' age was 33.44 ± 0.9. 493 patients (83.1%) were female. 85% had partial disability and 83.3%of them had Relapsing Remitting kind of this disease. 53.5% of them had 2 or more hospitalizations. 119 of them (20.1%) had familial history of MS which among them in 47 (40.5%) patients it was in first degree relatives, in 26 (22.6%) was in second degree relatives and in 46 (36%) was in third degree. Conclusion: According to the achieved results it seems the familial prevalence of MS in Isfahan, Iran is more than other regions, so it is recommended to do more etiologic studies based on the genetic and environmental factors. [ABSTRACT FROM AUTHOR]

Background: Malaria is the most important parasitological disease which infected annually 300-500 millions people and caused more than one million people. Eradication process has began since 1950 and Isfahan province was under protection too. In 2003 WHO, put Isfahan in sixth rank after Sistan & Balochestan, Hormozgan, Kerman, Fars and Tehran. Therefore epidemiological study of regional malaria has a special importance. Methods: This study was a cross-sectional study. The study population was all of the patients with malaria who refers to health centers since 2004 to 2009. Sampling method has been unaccidental simple assay. Findings: Totally 726 patients were investigated, 679 patients (93.5%) are male and 47 patients (6.5%) are female. The mean age of studied population was 25.9 ± 9.9 years. Plasmodium vivax was the high prevalent parasite (94.6%). The most prevalence of Malaria was seen in 2005 with 243 patients (23.5%) and during june (11.8%). Afgan immigrants are 91% and Iranian patients were only 2.8% of all patints. After the treatment, 348 patients (47.9%) are fully recovered, 39 patients (5.4%) were remained under treatment and we didn't have any information from 339 patients (46.7%). Conclusion: Isfahan climate, existence of species of anophel masquito (macolypenis, superpictues and sakharovi) and uncontrolled immigration of Afghans, can lead Isfahan to be a new center for growing malaria epidemics. Therefore we can prevent the distribution of malaria by controlling of entrance, prevent of immigration and effective treatment. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate the association between clinical symptoms and endoscopic findings among patients with duodenal ulcer. Methods: This cross-sectional study was performed in endoscopic center of Al-Zahra Hospital in Isfahan. We selected 200 patients older than 18 year who had Dyspepsia by simple nonrandom sampling. Finally Endoscopic findings and clinical symptoms data were collected and analyzed for 114 patients with active peptic duodenal ulcer. Finding: The mean age of the study sample was 46.5 ± 10.4 years. There were 44 females (38.6%) and 70 males (61.4%). The average of BMI was 27.2 ± 4.3. There was a significant association between endoscopic findings (site, size and quantity of ulcer) with clinical symptoms (weight loss and heartburn) and there was no association between other endoscopic findings and clinical symptoms. Conclusion: The results of present study showed that weight loss and heartburn can use as marker to determine site, size and quantity of duodenal ulcer. But these findings can not be enough and more study need to be done to determine the association between endoscopic findings and clinical symptoms. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections are amongst important complications of cardiac surgical operations. The principal types of these infections appear as surgical site or respiratory infections. The rate of surgical site infections after cardiac surgery has been reported between 1 and 9 percent and the rate of respiratory infections has been up to twice this range. Various studies have attempted to make use of methods to prevent post-operative infections in addition to routine measures of preparation before surgery. Topical application of bacitracin or gentamicin ointment, intranasal mupirocin ointment, oral rinse and intranasal application of chlorhexidine solution are among these methods. The current study aimed to investigate the impact of mouth and nose disinfection with chlorhexidine solution on reduction of surgical site as well as respiratory infections after cardiac surgical operations. Methods: This study was conducted in the cardiac surgery ward, Sina Hospital, Isfahan from 1388 to 1389 as a randomized clinical trial. Patients undergoing open heart surgery entered the study. Patients were randomly assigned to two groups, whereby in one group preparation for operating room was implemented by routine methods and in the other group, mouth and nose disinfection with 0.2% chlorhexidine solution was performed every 6 hours from one day before to one day after surgery, in addition to routine hospital measures. Each patient was followed for signs of infection up to one month after surgery. Finding: From 180 patients were recruited too this study, Chlorhexidine solution was used in 88 patients and 92 other patients who comprised the control group,. The age of patients ranged from 43 to 77 years. Mean age was 61.8 years in case group and 61.5 years in control group. Total number of infections in case (intervention) group was 6 (7%) including 2 surgical site infections and 4 respiratory infections. A total of 13 patients (14%) in the control group were diagnosed with infections including 7 surgical site and 6 respiratory infections. There was no statistical difference I using chlorhexidine (P=0.232). In the case group 4 infections (66%) occurred in patients suffering from underlying diseases specially diabetes and 9 infections (69%) in the control group occurred in patients with underlying diseases. 1 patient in the control group died from acute heart failure during a second hospitalization, who also had fever and wound infection. Conclusion: Despite lower number of infections in the case (intervention) group, there was no significant difference. Some studies have attained similar results not considering nasal S. aureus carrier state. But some studies on S. aureus carrier patients have found meaningful reductions in postsurgical. [ABSTRACT FROM AUTHOR]

Background: Allergic rhinitis, one of the rhinitis syndromes, is associated with a symptom complex characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, and itching of the eyes, nose, and palate. Allergic rhinitis is associated with significant morbidity. Affected individuals have a quality of life significantly worse than otherwise healthy ones. The main goal of this study was to determine the sensitivity and the specificity of these tests and the relationship between clinical manifestation severity and the tests results. Methods: This cross-sectional study with forward direction was performed in allergy clinic of Alzahra hospital in Isfahan. The sampling was done in consecutive nonrandomized mode. The tool of gathering the data was a questionnaires asking about age, sex, family history, smoking, pet contact, allergic rhinitis type, severity and frequency of clinical presentation; also total serum IgE, nasal eosinophil count and Prick skin test results noted in questionnaires. The gathered data were analyzed by SPSS software. Finding: There were significant differences in patients Prick skin test results as the gold standard test depend on their family history and place of life; also total serum IgE titer and nasal eosinophil count in patients with positive skin test was significantly more than patients with negative skin test. For the other analyzed factors, there were no significant differences in patient Prick skin test result as the gold standard test. There was no significant relation between total serum IgE titer and clinical presentation severity and frequency; a same result was seen about nasal eosinophil count too. Based on Spearman's correlation coefficient test, there was no significant correlation between total serum IgE titer and nasal eosinophil count; however this correlation coefficient would be raised ever the clinical presentation severity raises. The calculated cut off point for total serum IgE titer in this study was 61 IU/mL with 75% specificity and 80% sensitivity. The calculated cut off point for nasal eosinophil percentage in this study was 5% with 100% specificity and 72.7% sensitivity. Conclusion: Noticing the obtained results, it seems the physicians should concern family history and place of life in history taking as an important clue to allergic rhinitis diagnosis. This study clarified that total serum IgE titer and nasal eosinophil count can be acceptable paraclinic tests to allergic rhinitis diagnosis; but they should not be used to determine or guess how much the disease severity is. [ABSTRACT FROM AUTHOR]

Background: Proteinuria has independent deleterious effects on the progression of chronic renal disease. The aim of this study was to determine effect of pioglitazone on proteinuria in patients with non-diabetic renal disease. Methods: This was a self-controlled clinical trial study conducted in Al-Zahara Hospital and few private clinics of nephrology in Isfahan. Forty four non-diabetic patients aged 18 and over, who had renal disease and stable proteinuria over 0.5 g in 24 h and body mass index (BMI) lower than 30 kg/m2, were enrolled in the study. Patients were treated by 15 mg of pioglitazone for 4 months. The primary end point was urine protein excretion, measured prior to the study, at the end of 2 and 4 months during treatment as well as 2 months after cessation of pioglitazone. Secondary end points included systolic blood pressure, creatinine, ALT, AST, FBS, BUN and GFR levels. Findings: Mean urine protein excretion was 1088.6 ± 775.6 mg/24 h before treatment; therefore mean urine protein excretion at the end of 4th month was 433.9 ± 406.2 mg/24 h (P<0.001, CI95%: 0.49-0.82). There was no significant trend for systolic blood pressure, creatinine, ALT, AST, FBS, BUN and GFR levels to increase or decrease during the follow-up period (P> 0.01). Conclusion: Considering complications of proteinuria followed by gradual kidney malfunction based on findings of present study, pioglitazone could significantly decrease proteinuria in patients with nondiabetic kidney diseases. [ABSTRACT FROM AUTHOR]

Background: The etiology of multiple sclerosis (MS) is still not fully understood. Infectious agents are believed to play a role in the development of this multifactorial disease. The aim of this study was comparison of HBsAg and HBsAb in multiple sclerosis patients and control group. Methods: We conducted a case-control study within the Multiple Sclerosis Database in Isfahan. Forty multiple sclerosis patients and forty people of their neighbors (as control group) were include in the study. We evaluate the plasma levels of HBsAg and HBsAb in both groups. Statistical analysis was performed by SPSS16 using Independent sample t-test and chi-square test. We considered P < 0.05 as significance. Findings: Plasma levels of HBsAb were positive in 25% of all multiple sclerosis subjects vs 15% of subjects in control group (P > 0.05). Conclusion: The findings indicate no association between plasma levels of HBsAg and multiple sclerosis. [ABSTRACT FROM AUTHOR]

To date, there are no reports studying the rate of amyotrophic lateral sclerosis (ALS) in relatives of multiple sclerosis (MS) patients and vice versa. This study was designed to look into this issue using two population-based databases of MS and ALS in Isfahan province of Iran. We have searched for any first, second or third degree familial kinship between the Isfahan MS Society database and Isfahan ALS population. We compared the rate of ALS among the population of first degree relatives of MS patients, with the crude prevalence of ALS in the general population of Isfahan. On the other hand, a reverse analysis was carried out to compare the prevalence of MS in Isfahan with its rate amongst the first degree relatives of ALS patients. We found 10 families among which five had first degree kinship. The rate of the diseases was significantly higher in both comparisons among the family members (p < 0.00001) and an odds ratios of more than 67 in both calculations showed a several-fold increase of ALS occurrence in the first degree relatives of MS patients and vice versa. In our study relatives of MS patients were significantly more prone to ALS and vice versa. This could give clues about the common features that the two disease share. Both diseases have an environmental and genetic component and these results mostly point toward genetic similarities. [ABSTRACT FROM AUTHOR]