Novelty in Biomedicine

Background: Pneumonia is one of the common infectious diseases in the community and hospital, which can cause complications and death if not treated. Correct treatment of this disease is important. Therefore, in this study, we aimed to evaluate antibiotic stewardship for pneumonia with the American Thoracic Society (ATS) guidelines in Loghman Hakim Hospital in 2021.
Materials and Methods: In this descriptive study, all patients admitted to Loghman Hakim Hospital in 2021 with pneumonia were evaluated. Age, gender, type of pneumonia (healthcare-associated pneumonia, community-acquired pneumonia, community-acquired aspiration pneumonia, early-onset and late-onset hospital-acquired pneumonia, ventilator-associated pneumonia, and hospital-acquired aspiration pneumonia), antibiotic type and dose, and renal dose adjustment of antibiotics were recorded. Then, the antibiotic prescription protocol in patients with pneumonia was compared with the ATS guidelines.
Results: 72 people were included in the study; 11 (15.28%) had healthcare-associated pneumonia (HCAP), 24(33.33%) community-acquired pneumonia (CAP), 20(27.78%) community-acquired aspiration pneumonia (CAAP), 7(9.72%) hospital-acquired pneumonia (HAP), 4(5.56%) hospital-acquired aspiration pneumonia (HAAP), and 6 (8.33%) patients had ventilator-associated pneumonia (VAP). 31.94% did not receive antibiotics according to the protocol. 13.88% of patients received antibiotics correctly, but with the wrong dose, and in 18.06% of patients, the type of antibiotic was wrong (P-value=0.102).
Conclusion: Monitoring antibiotic stewardship in the hospital for patients with pneumonia is necessary.

Background: The emergence of resistant Enterobacteriaceae and the abundance of antibiotic-resistant genes is one of the major problems of the global health system. The present study aimed to determine the phenotypic and genotypic expression levels of metallobetalactamase coding genes (blaVIM, blaNDM, blaIMP, blaSIM, blaSPM, and blaGIM) in Enterobacteriaceae isolates (Escherichia, Enterobacter, Citrobacter, Klebsiella, and Serratia) from patients referred to the clinical centers in Isfahan city and typing of these isolates.
Materials and Methods: Enterobacteriaceae isolates were identified and isolated after sample collection. Antibiotic sensitivity pattern was investigated by disk diffusion method. MIC was performed in carbapenem-resistant isolates by the E-test method, and the frequency of strains with multidrug resistance was determined. The presence of metallobetalactamase genes was investigated phenotypically using a combined disk test and modified Hodge test. The genotypic identification of the above genes was done by PCR and sequencing techniques. Finally, PCR based on the sequence of repetitive elements was performed for molecular typing of metallobetalactamase-producing Enterobacteriaceae.
Results: In the present study, 580 isolates of Enterobacteriaceae were isolated by examining 3500 samples. Klebsiella and Escherichia were the most common isolates, and the frequency of MDR was 60% in Klebsiella and 59.53% in Escherichia. Moreover, MIC results showed that 33.7% Klebsiella, 4.1% Escherichia, 5.7% Enterobacter, 3.5% Citrobacter, and 5.5% Serratia were resistant to carbapenems. Frequency of isolates with multidrug resistance in Escherichia (MDR 59.53% and XDR 1.5%), Klebsiella (MDR 60%, XDR% 3 and PDR 0.8%), Enterobacter (MDR 44%), Citrobacter (MDR 53.5%) and Serratia (MDR 55.5%) were reported. Metallobetalactamase production was confirmed by phenotypic analysis in Escherichia (1.8%) and Klebsiella (10.4%). Genotypic tests showed that blaSIM, blaSPM, and blaGIM genes were absent in any Enterobacteriaceae isolates. The presence of blaVIM, blaIMP, and blaNDM genes was confirmed in 6.2% of Klebsiella isolates and 1.3% of Escherichia isolates. The frequency of detected metallobetalactamase genes in Klebsiella and Escherichia isolates was 4.58% and 1.39% for blaVIM, 0.83% and 1.39% for blaIMP and 0.83% and 1.39% for blaNDM. The rep-PCR results showed that 11 metallobetalactamase-producing Klebsiella isolates are in 4 main groups, and 9 Escherichia isolates and 4 Enterobacter isolates are classified in two main clusters.
Conclusion: The present study shows the prevalence of Klebsiella and Escherichia isolates and their resistance to metallobetalactamase-producing Enterobacteriaceae. These genes in the horizontal transfer of antibiotic resistance identification of metallobetalactamase-producing isolates in clinical environments are essential to reduce the spread of antibiotic resistance. The high homology of resistant isolates of Enterobacteriaceae inclinical samples indicates the high power of these genotypes in causing infection in hospitalized patients, which can play an important role in increasing antibiotic resistance.

Background: Pre-diabetes is a level before diabetes involvement. Pre-diabetes is prevalent, and if the blood
glucose parameters of pre-diabetic patients do not reduce, patients will be involved with type 2 diabetes. In this
study, we aimed to investigate the value of hemoglobin A1c (HbA1c) level for predicting diabetes and
retinopathy involvement in pre-diabetics.
Materials and Methods: This prospective study was performed on pre-diabetics referred to the endocrinology
clinic of Loghman Hakim Hospital (Tehran-Iran) from 2020-20211. The patients were assessed on age, sex,
familial history of diabetes, systolic and diastolic blood pressure, and laboratory studies, including fasting blood
sugar (FBS), oral glucose tolerance test (OGTT), HbA1c, lipid profile, aspartate aminotransferase (AST), and
alanine transaminase (ALT). All participants underwent ocular examination by an expert ophthalmologist for
retinopathy assessment. After one year, all participants were again assessed for all mentioned factors.
Results: Pre-diabetics are five-fold more likely to be involved with diabetes after one year than patients with
normal HbA1c. We found that patients with pre-diabetes HbA1c are 7.94 fold more at risk of retinopathy
involvement than pre-diabetic patients with normal HbA1c (all p-values<0.05).
Conclusion: A high level of HbA1c in pre-diabetics increases the risks of retinopathy and diabetes involvement.

Background: This descriptive study aimed to assess preoperative pulmonary function test (PFT) results and pulse oximetry readings in patients recovered from COVID-19 who were candidates for elective surgery.
Materials and Methods: This is a descriptive study. A total of 110 patients (men = 51) with a mean age of 52.6 years were enrolled in the study. The study protocol was presented to the ethics committee and received approval. Participants included patients with a positive SARS-CoV-2 PCR test history, with a recovery period of at least 6-8 weeks for symptomatic patients and four weeks for asymptomatic patients. Data collection involved a random selection, obtaining informed consent, and conducting a history and physical examination. Pulmonary function capacity and oxygen saturation were assessed, and frailty was evaluated using the Edmonton Frail Scale. Echocardiography and electrocardiography were performed on all patients.
Results: The study participants mainly underwent trans-ureteral lithotripsy (TUL), laparoscopic cholecystectomy (LC), and percutaneous nephrolithotomy (PCNL). Symptomatic patients exhibited lower pulse oximetry readings than asymptomatic patients (91.18% vs. 96.13%, p-value = 0.005). Although the average ejection fraction was slightly lower in symptomatic patients (44.25%) compared to asymptomatic patients (48.18%), the difference was insignificant. Symptomatic patients also had higher rates of abnormalities in chest X-rays, electrocardiograms, pulmonary function tests, and fasting blood sugar levels, as well as a higher rate of ICU admission.
Conclusion: Comprehensive preoperative evaluations, including pulmonary function and oxygenation assessment, are crucial for COVID-19 survivors undergoing elective surgery. Symptomatic patients showed lower pulse oximetry readings and higher respiratory and cardiovascular abnormalities rates. These findings emphasize the importance of optimizing perioperative management and minimizing complications by thoroughly assessing patients' preoperative health status.

Background: Infertility treatment methods that are used today have a limited (or little) success rate, and patients bear a lot of financial and emotional burden to get pregnant. Recently, artificial intelligence has been proposed to evaluate gametes better and choose the best embryo for transfer to the uterus. This study investigated the financial benefit of using artificial intelligence for infertility treatment.
Materials and Methods: We aim to evaluate the effectiveness of AI in IVF, comparing AI model performance with standard methods and introducing a novel method to measure financial benefits in healthcare resource allocation.
Results: Achieving 75% accuracy, AI significantly outperformed standard methods, reducing the likelihood of discarding viable embryos. This technology streamlines the IVF process, leading to shorter treatment cycles and a cost reduction of 1500 dollars per cycle.
Conclusion: The integration of AI in IVF represents a paradigm shift, improving success rates, cost-efficiency, and patient experiences. Further research and adoption of AI-driven embryo selection can revolutionize infertility treatments, benefiting both patients and healthcare systems.

Background: Hepatic spontaneous sub-capsular hematoma is uncommon. This is a life-threatening condition because the rupture of this hematoma is accompanied by uncontrolled intra-abdominal hemorrhage.
Cases Report: We presented a 71-year-old man with a huge hepatic sub-capsular hematoma without any history of trauma or coagulopathy. The patient received heparin due to a neglected myocardial infarction. Blood pressure and hemoglobin levels decreased. The drug was discontinued, an abdominal computed tomography (CT) scan was done for him, and a huge hepatic sub-capsular hematoma was detected.
Conclusion: Spontaneous liver subcapsular hematoma may be found in patients with a history of surgery on the liver site and those with a history of COVID-19. In these patients, hemodynamic instability should increase the doubt of physicians about a rupture of hepatic hematoma.

Abstract

Nowadays, an estimated 15% of couples are having trouble conceiving. Infertility is not only a reproductive health problem, but also a social problem that affects family and other interpersonal relationships. Infertility involves psychological problems for both partners. There is a correlation between psychological factors and infertility. It seems that the main cause of infertility can be psychological rather than biological factors. Anxiety, depression, stress associated with infertility and antidepressants used in these patient can impact in the treatment of infertility and their outcomes. Persistent fertility problem will have several negative influences on a couple's life and may cause relationship breakdown. Therefore, more research should be conducted on the reasons of infertility as a way to find the factors related to infertility and reduce its impact.