Original Article

Background: Infectious diseases continue to be one of the biggest health challenges around the world, followed by problems caused by antibiotic resistance and excessive use of antibiotics. In general, Enterococcus faecalis is the main cause of nosocomial infections and is the most common cause of surgical ulcer infections. This study examines how a vancomycin nanomedicine attaches to poly lactic-co-glycolic acid (PLGA) nanoparticle. Determining the role of vancomycin nanomedicine on reducing the drug resistance of vancomycin in E. faecalis (clinical hospital isolates) and determining the cytotoxicity effects of nanomedicine.

Materials and Methods: In this method, first, attachment made through chemical processes such as emulsion between vancomycin antibiotic and a PLGA nanoparticle, and resultant antibiotic tested on vancomycin resistant E. faecalis.

Results: The results of this study indicate that the method of nanomedicine attachment to antibiotics was an effective method and it was determined by X-ray Diffraction that the attachment was precisely performed. In the antibiogram method, the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) of the nanomedicine increased in respect to vancomycin antibiotic.

Conclusion: The results showed that produced Nano-antibiotics had a better effect than resistant antibiotics.

CRISPR-Cas9 Mediated Capsule Gene Silencing in Escherichia coli

Mojgan Bandehpour, Tina Nafarieh, Fatemeh Zahedipour, Afsaneh Tavasoli, Bahram Kazemi

Novelty in Biomedicine, Vol. 6 No. 4 (2018), 31 October 2018 , Page 162-166

Background: Genomic engineering of Escherichia coli is applied to design and produce recombinant proteins as the new drugs. The aim of this study was to CRISPR-Cas9 mediated capsule gene silencing in E. coli.

Materials and Methods: We suppressed genes involved in capsule expression of E.coli by CRISPR cas9 process. The constructed E.coli was confirmed by microscopic smear, transmission electron microscopy and T7 phage influence assay.

Results: The results were shown that the inhibition of capsule production was carried out successfully and there was not any capsule layer around the bacteria.

Conclusion: E. coli without any capsule around may proper for replacement of it with other molecules in future.

Prevalence of Gram-negative Bacteria Isolated from Patients with Ventilator-Associated Pneumonia in Intensive Care Units of Imam Khomeini Hospital, Ahwaz, Iran

Seyed Hamid Borsi, Maryam Haddadzadeh Shoushtari, Hanieh Raji, Faramarz Ghalavand

Novelty in Biomedicine, Vol. 6 No. 4 (2018), 31 October 2018 , Page 167-173

Background: Ventilator-associated pneumonia (VAP) is a common nosocomial infection among hospitalized patients who have undergone intubation and mechanical ventilation for more than 48 hours. Patients admitted to the intensive care unit (ICU) are at risk of developing life-threatening VAP due to specific conditions, especially with Gram-negative pathogens with advanced drug resistance. Hereby, the control of these agents and its monitoring is of particular importance. In this study, the pattern of antibiotic resistance of Gram-negative bacteria isolated from tracheal culture of patients with VAP investigated in ICU of Imam Khomeini Hospital of Ahwaz.

Materials and Methods: In this cross-sectional study, tracheal samples were collected during April 2016 to April 2017 from patients who were on mechanical ventilation in ICU of Imam Khomeini Hospital in Ahwaz, Khuzestan province, southwest of Iran. After isolation, bacterial strains were identified using biochemical tests. Then, antimicrobial resistance pattern of these isolates investigated using standard disc diffusion according to clinical and laboratory standards institute 2016 (CLSI 2016) guidelines.

Results: A total of 111 bacterial isolates were identified which were as following; Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Stenotrophomonas maltophilia, and Serratia marcescens, with prevalence of 54%, 19.8%, 14.4%, 6.4%, 4.5%, and 0.9%, respectively. Antibiotic susceptibility test of isolates showed that almost all isolates had high resistance to treatment antibiotics and were multi-drug resistance (MDR). The A. baumannii isolates were resistant to ciprofloxacin and piperacillin-tazobactam, but ampicillin-tazobactam had a good effect.

Conclusion: The results of this study showed that patients admitted to ICU due to their conditions of treatment are more likely to develop VAP by Gram-negative pathogens. The empirical treatment of VAP due to predominant bacterial causes and emerging drug resistance has become more challenging. It requires to use of multidrug regimens for routine clinical practice. It should be noted that in order to appropriate antimicrobial therapy, precise and correct diagnosis is very important.

Background: The present study aims to assess the ability of the acute physiology, chronic health evaluation IV (APACHE IV) scoring system to predict in-hospital mortality of intensive care unit (ICU) patients with acute poisoning.

Materials and Methods: Using data from 622 consecutive ICU admitted poisoned patients, Loghman-e-Hakim Hospital, Tehran, during May 2015-April 2016. Various statistical tools used to assess the correlation, significance, and predictability.

Results: Overall APACHE IV scoring system was statistically significant (P=.001). Death rate prediction, increased from 79.4% to 86.8 % by model, with SMR =0.83%. A meaningful association between APACHE-IV score and the risk of mortality with good discrimination and, calibration (p value of 0.978) was evident.

Conclusion: The present study demonstrates that the APACHE IV system performs acceptably in our patients with acute poisoning and can be utilized as a performance assessment tool in poisoning centers.

Incidence of Oculocardiac Reflex in Pediatric Population Undergoing Corrective Strabismus Surgery: Comparison between Sevoflurane and Total Intravenous Anesthesia

Fatemeh Roodneshin, Mahtab Poor Zamany Nejat Kermany, Pooya Rostami, Omid Niksan

Novelty in Biomedicine, Vol. 6 No. 4 (2018), 31 October 2018 , Page 180-184

Background: Oculocardiac reflex (OCR) is a life threatening, possible complication of corrective strabismus surgery and is more common among the pediatric patients. Sevoflurane and Propofol are the most commonly used agents in pediatric surgery. This study aimed to compare the effect of these two agents on oculocardiac reflex during corrective strabismus surgery in pediatrics patients.

Materials and Methods: A total of 89 children were divided in two groups and no significant demographic data difference was between the two groups. Group 1 (n=45) received sevoflurane 6-8% as induction agent followed by 2-3% for maintenance, group 2 (n=44) was injected with propofol 3mg/kg as induction agent followed by 200µg/kg/min infusion as the maintenance dose, bispectral index (BIS) was kept 40-60 in both groups. Oculocardiac reflex was compared between the two groups.

Results: Incidence of OCR of group 1was showed a significant decrease.

Conclusion: Sevoflurane reduced the incidence of OCR. Sevoflurane may be the agent of choice in corrective strabismus surgery, compared to propofol.

Effectiveness of Narrative Exposure Therapy on the Severity of Posttraumatic Stress and the Co-Morbid Symptoms of Iranian Survivors of Mina Disaster

Elahe Haghighat Manesh, Seyed Ali Mar'ashi, Seyed Ali Mar'ashi, Taher Doroudi, Taher Doroudi, Mohsen Saberi, Mohsen Saberi, Seyed Hossein Modjtahedi, Seyed Hossein Modjtahedi, Pirhossein Kolivand, Pirhossein Kolivand, Abbas Masjedi Arani, Abbas Masjedi Arani

Novelty in Biomedicine, Vol. 6 No. 4 (2018), 31 October 2018 , Page 185-195

Background: Mass gathering has not received much attention of researches as one of the potentially traumatic events in the field of psychological studies. Mina (Mecca, Saudi Arabia) disaster during 2015 hajj occurred in this context. Individuals may be at risk for posttraumatic stress disorder (PTSD), depression and somatic symptoms following traumatic events. Narrative exposure therapy (NET (has been known as a therapeutic protocol for PTSD and trauma-related disorders. The present study was carried out aimed to investigate the effectiveness of narrative exposure therapy on the severity of posttraumatic stress symptoms and the co-morbid symptoms of Iranian survivors of Mina disaster.

Materials and Methods: The present study is based on single-case experimental design (SCED) with baseline. Eight Survivors of Mina disaster who met the criteria for posttraumatic stress disorder and completed inclusion criteria were randomly divided into two groups NET and control. The experimental group participant received twelve NET sessions individually. Data collection tool included PTSD Checklist for DSM-5 (PCL-5) and Beck depression inventory-II (BDI-II), patient health questionnaire 15 (PHQ-15). Data was analyzed using the cut-off point, percentage improvement index, RCI and the Hedges' g effect size.

Results: Total percentage improvement of participant receiving NET for PTSD, was 68.25%, depression 63.25%, and somatic symptoms was 53.75%. All changes in the participant receiving NET were clinically significant in severity of PTSD, depression and somatic symptoms (RCI≥1.96).

Conclusion: According to the results of this study, NET has a significant effect on the reduction of PTSD symptoms and its co-morbid symptoms.

Case Report

Varicella Pneumonia: a Case Report in an Immunocompetent Patient

Mahshid Heidari, AmirHossein Moghtader Mojdehi, Sahar Babaali

Novelty in Biomedicine, Vol. 6 No. 4 (2018), 31 October 2018 , Page 196-198

Background: Varicella  (chicken  pox)  is  a  highly  contagious  disease  caused  by  the  Varicella-Zoster  Virus. Varicella pneumonia is a rare presentation of pneumonia, which is seen in immunocompromised adults.

Cases Report: Here we reported a 13-year-old immunocompetent boy who was admitted with fever and acute respiratory symptoms.

Conclusion: Varicella pneumonia occurring particularly in immunocompromised patients; however, it should not be misdiagnosed in immunocompetent patients.

Airway management in a case of expanding neck hematoma after carotid endarterectomy

Masih Ebrahimy Dehkordy, Faranak - Behnaz, Shayesteh Khorasanizadeh, Homeyra kouzekanani, Naeimeh Gholizadeh

Novelty in Biomedicine, Vol. 6 No. 4 (2018), 31 October 2018 , Page 199-201

Background: Respiratory obstruction is a fatal complication following carotid endarterectomy, which caused direct compression of trachea secondary to venous and lymphatic congestion.

Cases Report: In this study, we report a complicated case of carotid endarterectomy   that required emergency intubation in difficult circumstance due to progressing hematoma and soft tissue edema.

Conclusion: we report a case of hematoma and edema causing compromised airway following carotid endarterectomy (CEA), in which quick action to decompress the hematoma and prepare a secure airway lead to successful outcome.