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Background and Aim: Tocilizumab is a monoclonal antibody against the Interleukin-6 (IL6) receptor, but its effect on improving the clinical condition of coronavirus disease of 2019 (COVID-19) patients is debated. Accordingly, this study investigated the impact of Tocilizumab as an alternative treatment on the outcomes of COVID-19 patients. Materials and Methods: In this retrospective case-control study, 300 COVID-19 patients in Afzalipour Hospital in Kerman, Iran, from November 2021 to January 2022 diagnosed by Real Time-PCR test with severe pneumonia were classified into two groups: 150 patients in the control group, treated with standard treatment, and 150 patients in the case group, that treated with intravenous Tocilizumab in addition to those treatments. Prognostic factors such as the hospitalization period, need for mechanical ventilation, and the patient's discharge condition were investigated. Results: Effect of Tocilizumab on outcomes of COVID-19 patients, like demanding mechanical ventilation, and length of hospitalization in the case group, despite the presence of poor biological symptoms such as severe lymphopenia in admission, show a significant difference in comparison to the control group. Tocilizumab does not affect the patient's discharge condition and the mortality rate. Conclusion: The results of this study showed that Tocilizumab, despite the lack of an apparent effect on the outcome of the COVID-19 disease (recovery or death), reduced length of hospitalization and the necessity for mechanical ventilation and can be used as an alternative therapy with other treatments. [ABSTRACT FROM AUTHOR]

Materials and Methods: In this descriptive study, 417 diarrheal stool samples were taken from hospitalized patients of educational hospitals of Kerman City from 2018 to 2020. The samples were cultured on cycloserine-cefoxitin fructose agar (CCFA), and suspected C. difficile colonies were isolated. Identification of the cdd-3 gene for definitive diagnosis of C. difficile was performed. Antibiotic resistance test was conducted by the disk-diffusion method using vancomycin, metronidazole, rifampin, amoxicillin-clavulanic acid, erythromycin, imipenem, ciprofloxacin, and clindamycin disks. The results were reported as numbers and percentages. Results: A total of 68 (16.3%) isolates of C. difficile were taken from the samples. Most C. difficile strains were susceptible to vancomycin and metronidazole, while the highest rate of resistance was related to ciprofloxacin and clindamycin. The prevalence of multi-drug resistant (MDR) strains was 77.9%. Conclusion: The results of this study showed that vancomycin is still the best antibiotic for treating CDI. Also, the frequency of the isolates resistant to CDI-inducing antibiotics (erythromycin, clindamycin, ciprofloxacin) and MDR isolates was high. Therefore, the spread of resistant strains of C. difficile can be prevented by appropriate antibiotic prescription. [ABSTRACT FROM AUTHOR]

Background and Objectives: Antibiotics prescribed for infections have diverse effects on microbiota and the pathogen Clostridium difficile (C. difficile) as the most important antibiotic-associated diarrhea. This study aims to determine the gene expression of toxins A and B at the transcription level in the sub-MIC of vancomycin (VAN), clindamycin (CLI), and ceftazidime (CAZ) alone and in combination. Materials and Methods: The MIC and fractional inhibitory concentration (FIC) of two C. difficile samples (a clinical isolate and ATCC 9689) were determined by microdilution and checkerboard microdilution methods, respectively. The total RNA was extracted from the medium inoculated with ~106 CFU/mL of fresh bacteria in the pre-reduced medium containing ½ MIC of antibiotics alone and ½ FIC of antibiotics in combination. Real-time PCR was performed by sybrGreen methods in triplicate, and the data were analyzed by the comparative CT method. Results: All antibiotics except CAZ (alone and in combination) decreased the gene expression of toxins A and B within 24 hours. VAN and CLI reduced toxin gene expression within 24 and 48 hours. However, CAZ alone and in combination with VAN as well as CLI increased the gene expression of toxins A and B. Conclusion: The results confirmed toxin gene transcription and toxin production are associated with the type of isolates and antibiotics, as well as the combined form of antibiotics. This could be the reason which can explain the occurrence of C. difficile infection among patients who were treated with the third generation of cephalosporins alone and in combination with another antibiotic in the form of combinational therapy. [ABSTRACT FROM AUTHOR]

Aim: This study evaluated the frequency of C. difficile and CDAD in the ICU of Shahid Bahonhar Hospital, Kerman, Iran. Background: Clostridium difficile (C. difficile) is the most important antibiotic associated diarrhea agent in intensive care unit (ICU) patients. Based on its toxin producing ability, C .difficile is divided to toxigenic and non-toxigenic strains. Methods: A total of 233 diarrheal samples were collected from ICU patients. The samples were cultured on Clostridium difficile medium with 5% defibrinated sheep blood containing cycloserine (500 mg/L), cefoxitin (16 mg/L) and lysozyme (5mg/L). The isolates were confirmed as C. difficile by polymerase chain reaction (PCR) of 16s rRNA gene and the presence of toxins genes (tcdA, tcdB, cdtA and cdtB) was also confirmed. Then, the toxin production of isolates was evaluated using ELISA. Results: C. difficile was isolated from 49 (21%) out of 233 samples. The total isolates fell into the A-/B-/CDT- (48.97%), A+/B-/CDT- (28%), A+/B+/CDT- (20.4%) and A+/B+/CDT+ (2%) types. Both types of C.difficile, A-/B-/CDT- and A+/B-/CDT-, which account for 77.5% of all isolates, were unable to produce the toxin (nontoxigenic). On the other hand, A+/B+/CDT+ and A+/B+/CDT- (22.5%), were able to produce toxin or were toxigenic. Conclusion: The frequency of C. difficile was about 21% and only 22.4% of C. difficile isolates were able to produce toxins. It is expected that C. difficile A+/B+/CDT± are toxigenic and related to C. difficile associated diarrhea (CDAD). Additionally, about 4.7% of hospitalized patients in ICU suffered from CDAD, which is higher than the rates reported from industrialized countries. Notably, 28% of isolates were C. difficile A+/B-/CDT- which only carries tcdA genes without toxin production. [ABSTRACT FROM AUTHOR]

Background: Clinical interprofessional education (IPE) can promote mutual understanding of other health professions and respectful behaviors among health-care professionals. The aims of this study were to evaluate the effects of IPE on the attitudes of medical and pharmacy students in an inpatient hospital setting and, in particular, the influence of pharmacy students on the attitudes of medical students. Methods: The 6th year doctor of pharmacy students and medical students were enrolled in a prospective cohort study. They were paired and each pair was responsible for three beds and all the patients occupying these mentioned beds over the 2-week course. The Readiness for Interprofessional Learning Scale (RIPLS) questionnaire was used to assess the students' attitudes before and after the course. Results: The attitudes of the medical students changed positively after the IPE course based on RIPLS teamwork and collaboration and professional identity subscales. Changes in the attitudes of the pharmacy students were not statistically significant based on the mentioned scale and subscales. Discussion: IPE could improve the attitudes of the medical students regarding interprofessional teamwork, communication, and sharing learning experience. Based on the current investigation, IPE did not have an effect on pharmacy students. [ABSTRACT FROM AUTHOR]

Introduction: The failure in eradication of Helicobacter pylori (H.pylori) using standard treatments is a common concern all over the world. Limited data have shown efficacy of melatonin against H.pylori in vitro. We hypothesise that, melatonin as adjuvant to quadruple therapy may improve H.pylori eradication rate. Aim: To evaluate additive effects of melatonin combined with a quadruple therapy for the eradication of H.pylori. Materials and Methods: This was a double-blind, placebocontrolled, randomized clinical trial. The trial comprised a 14- days, quadruple eradication regimen (omeprazole 20 mg twice daily; bismuth subsalicylate 525 mg four times daily; amoxicillin 1000 mg twice daily; and metronidazole 500 mg twice daily) supplemented with melatonin 3 mg/d (MEL group) or a comparable placebo (placebo group) without melatonin. The data were analysed using the SPSS version 19 and p-values less than 0.05 was considered statistically significant. Results: Eradication rates of intention-to-treat analysis (ITT; n = 118) were 73% in the MEL group and 65% in the placebo group. Eradication rates of per protocol analysis (PP; n = 98) were 80% and 79% in the MEL and placebo groups, respectively. There was no significant difference between the two groups either by ITT or PP analysis (p = 0.74 and p = 0.91, respectively). Conclusion: According to the result of the trial, MEL 3 mg/d does not have an additive effect on the eradication of H.pylori infection. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the prevalence of anti-microbial resistance in intubated patients in intensive care unit (ICU) of Bahonar hospital in Kerman province, Iran during the year 2008. Tracheal samples were obtained from 111 intubated patients in the ICU by broncoalveolar lavage method. Amikacin, Ceftazidim and Imipenem were used to evaluate antibiotic susceptibility. For detecting anti-microbial susceptibility, minimum inhibitory concentration method were used. Colony counts equal or more than 104 microorganisms/mL were considered resistant. Overall we obtained positive tracheal cultures from 32 patients (29%) out of 111 intubated ones. The most common micro organisms isolated were Klebsiella (90.6%), Acinetobacter (28.1%) and Pseudomonas (21.9%). The results showed that the most common resistance was against to ceftazidim. The susceptibility of Klebsiella in tracheal cultures to the antibiotics was only 5%. E. coli in both sexes was 100% resistant to the tested antibiotics. In the ICU, There was a very big problem concerning antibiotic resistance. Most of the isolated microorganisms were resistant to both the old and the new antibiotics. It may be related to the inappropriate use of antibiotics, bacterial contamination of enteral feeding and infection transmission by medical staff or instruments. [ABSTRACT FROM AUTHOR]