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Brucellosis is a chronic and debilitating disease in humans, causing great economic losses in the livestock industry. Making an effective vaccine is one of the most important concerns for this disease. The new mRNA vaccine technology due to its accuracy and high efficiency has given promising results in various diseases. The objective of this research was to create a novel mRNA vaccine with multiple epitopes targeting Brucella melitensis . Seventeen antigenic proteins and their appropriate epitopes were selected with immunoinformatic tools and surveyed in terms of toxicity, allergenicity, and homology. Then, their presentation and identification by MHC cells and other immune cells were checked with valid tools such as molecular docking, and a multi-epitope protein was modeled, and after optimization, mRNA was analyzed in terms of structure and stability. Ultimately, the immune system's reaction to this novel vaccine was evaluated and the results disclosed that the designed mRNA construct can be an effective and promising vaccine that requires laboratory and clinical trials., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: The ability of bacteria to form biofilm is an essential strategy for creating stable infections. This issue is more critical in Acinetobacter bauamannii as a hospital pathogen. Today, the control of biofilm formation and solutions to prevent or remove biofilm is being developed. Carvacrol has been considered an anti-biofilm compound in significant bacteria. This study investigated the anti-biofilm effect of Carvacrol on biofilm formation in clinical colistin heteroresistant isolates of A. baumannii ., Methods: 22 clinical strains of A. baumannii were collected from Motahari Hospital in Tehran, Iran, in 2019. Biochemical and genotypic methods confirmed these isolates. Colistin heteroresistance was determined by the Standard PAP method. Carvacrol's antibacterial and anti-biofilm activity was determined according to the standard protocol., Results: About 12 isolates were considered strong biofilm producers and were used for analysis. Six isolates had hetero-resistance to colistin. Carvacrol at a 512 g/ml concentration showed the best antibacterial activity against all isolates. The sub-MIC of Carvacrol (256 g/ml) reduced the biofilm formation capacity, which was statistically significant (p < 0.05)., Conclusion: The results of this study showed that sub-MIC of Carvacrol has anti-biofilm effects in clinical A.baumannii colistin hetero-resistance isolates., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

The rising issue of antibiotic resistance has made treating Pseudomonas aeruginosa infections increasingly challenging. Therefore, vaccines have emerged as a viable alternative to antibiotics for preventing P. aeruginosa infections in susceptible individuals. With its superior accuracy, high efficiency in stimulating cellular and humoral immune responses, and low cost, mRNA vaccine technology is quickly replacing traditional methods. This study aimed to design a novel mRNA vaccine by using in silico approaches against P. aeruginosa. The research team identified five surface and antigenic proteins and selected their appropriate epitopes with immunoinformatic tools. These epitopes were then examined for toxicity, allergenicity and homology. The researchers also checked their presentation and identification by major histocompatibility complex cells and other immune cells through valuable tools like molecular docking. They subsequently modeled a multi-epitope protein and optimized it. The mRNA was analyzed in terms of structure and stability, after which the immune system's response against the new vaccine was simulated. The results indicated that the designed mRNA construct could be an effective and promising vaccine that requires laboratory and clinical trials., (© The Author(s) 2024. Published by Oxford University Press.)

Dental caries is a multi-factorial infectious disease. The primary cause is dental plaque, a complex of biofilm. It was postulated that the ethanolic extract of fruite wall of acorn may represent a new substance to prevent caries. Hence, the study was performed to evaluate the effect of ethanolic extract of fruite wall of acorn against biofilm formation by Streptococcus mutans , which is associated with dental plaque. The cytotoxicity of the ethanolic extract was determined against Vero cells resulting in an inhibitory concentration of 50 (IC 50 ) of 55 µg/ml. After bacterial collection, different concentrations under the IC 50 from the extract were evaluated against biofilm formation of S. mutans . 3 µg/ml of the extract inhibited the biofilm formation of S. mutans , and 1 to 3 µg/ml caused a decrease in gtfB and brpA biofilm-production genes. This study showed the potency of the ethanolic extract of fruite wall of acorn against biofilm formation by S. mutans ., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2023 Chavak et al.)

Purpose: This study was conducted to evaluate the effect of alcohol consumption on breast cancer, adjusting for alcohol consumption misclassification bias and confounders., Methods: This was a case-control study of 932 women with breast cancer and 1000 healthy control. Using probabilistic bias analysis method, the association between alcohol consumption and breast cancer was adjusted for the misclassification bias of alcohol consumption as well as a minimally sufficient set of adjustment of confounders derived from a causal directed acyclic graph. Population attributable fraction was estimated using the Miettinen's Formula., Results: Based on the conventional logistic regression model, the odds ratio estimate between alcohol consumption and breast cancer was 1.05 (95% CI: 0.57, 1.91). However, the adjusted estimates of odds ratio based on the probabilistic bias analysis ranged from 1.82 to 2.29 for non-differential and from 1.93 to 5.67 for differential misclassification. Population attributable fraction ranged from 1.51 to 2.57% using non-differential bias analysis and 1.54-3.56% based on differential bias analysis., Conclusion: A marked measurement error was in self-reported alcohol consumption so after correcting misclassification bias, no evidence against independence between alcohol consumption and breast cancer changed to a substantial positive association., (© 2023. The Author(s).)

Aim: Persistence cells comprise a subpopulation of bacteria that is resistant to treatment. In this study, the role of the toxin-antitoxin (TA) system in the formation of persistence cells of Acinetobacter baumannii isolates was investigated. Methods: After confirming all isolates, TA systems abkBA, mqsRA and higBA were identified. Persister cells were confirmed using the standard method. Real-time PCR was used to compare the expression of TA systems in isolates in persistence and normal states. Results: The abkAB system was present in all isolates; 4% of isolates formed persister cells. The expression level of the  abkB gene in persistent isolates showed a sevenfold increase compared with nonpersistent isolates. Conclusion:  The abkBA system is proposed as an antipersistence target in A. baumannii isolates.

Aim: To determine the age- and sex-standardized prevalence and risk factors of depression, anxiety, and stress symptoms in the city of Ilam., Method: In this population-based cross-sectional study, 1,350 people were invited using a multi-stage stratified cluster random sampling method. Depression, anxiety, and stress symptoms were measured using the DASS-21 standard questionnaire. For data analysis, multiple ordinal logistic regression was used in Stata version 12 software. A significance level of 5% was considered., Results: The data of 1,431 people were analyzed. The age- and sex-standardized prevalence (95% CI) of severe depression, anxiety, and stress symptoms was 19.90% (17.64 to 22.16), 25.95% (23.48 to 28.43), and 15.75% (13.69 to 17.81), respectively. There was a positive association among depression symptoms with female sex (OR: 1.52; p  < 0.003), Kurdish ethnicity (OR: 2.15; p  < 0.004), low educational level (OR: 1.37; p  < 0.031), job losing history (OR: 1.64; p  < 0.001), mental disorders history (OR: 2.17; p  < 0.001), hopelessness for the future (OR: 5.38; p  < 0.001), and history of other diseases (OR: 1.67; p  < 0.001). There was a positive association among anxiety symptoms with female sex (OR: 1.72; p  < 0.001), job losing history (OR: 1.53; p  < 0.003), mental disorders history (OR: 2.11; p  < 0.001), hopelessness to future (OR: 3.33; p  < 0.001) and history of other diseases (OR: 1.97; p  < 0.001). Hopelessness for the future and a history of other diseases were the most effective variables for anxiety symptoms and stress symptoms., Conclusion: A significant proportion of Ilam's urban population suffers from mental disorders. Increasing people's awareness, establishing counseling centers, and improving infrastructure should be considered by mental health policymakers who work in the province., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kakaei, Maleki, Biderafsh, Valizadeh, Mansournia, Pakzad and Pakzad.)

Introduction: The possibility of surface transmission in hospitals with high density of COVID- 19 patients is unneglectable. The aim of this study is to determine the extent of surface contamination in coronavirus central hospital of Ilam province in western Iran., Materials and Methods: In this experimental study, 205 samples were taken from environmental surfaces in hospital. SARS-CoV-2 RNA detected by Real-time RT-PCR., Results: 121 out of 205 (50.02%) samples were positive. The most contaminated objects were toilet sites (5/5,100% ICU; 5/5, 100% isolation wards)., Conclusion: High surface contamination with SARS-CoV-2 proposes the surface as a potential route of transmission.

Background: The aim of the present meta-analysis is to estimate the prevalence of colistin resistance among the Enterobacteriaceae family., Methods: Articles from various databases (Medline, Scopus, Web of Science, and Embase) examining colistin resistance among Enterobacteriaceae in human, animal, and environmental specimens were searched from 2016 to 2021 using related keywords. The Cochran's Q-test and I2 were applied to evaluate heterogeneity and a random-effects model was used to assess the pooled prevalence. The meta-regression method was applied to determine heterogeneity among the studies., Results: Of 5,145 articles, 60 articles with a sample size of 404,856 was included. The pooled estimate for prevalence of bacterial resistance were 9.13% (95% CI: 6.96 to 11.56; I-squared = 99.4%) in total, 8.34% (95% CI: 5.87 to 11.16; I-squared = 99.3%) for Klebsiella spp. subgroup and 3.44% (95% CI: 2.46 to 4.57; I-squared = 98.4%) for E. coli subgroup. The pooled prevalence for human and animal settings were 9.07% (95% CI: 6.77 to 11.67; I-squared = 99.3%) and 9.73% (95% CI: 484 to 16.02; I-squared = 99.4%), respectively. The continent (coefficient: 3.51; 95% CI: 0.08 to 6.94, p: 0.045) and bacterial type (coefficient: 0.03; 95% CI: 0.01 to 0.05 p: 0.042) had significant effects on heterogeneity among studies., Conclusion: The results of this study showed that the prevalence of colistin resistance in Enterobacteriaceae was similar between animals and humans, with the highest colistin resistance found in Klebsiella strains.

Aims: Chitosan, like docosahexaenoic acid (DHA) and mesenchymal stem cells (MSCs), is used in medicine as a wound healing accelerator. Thus, in this study, chitosan-alginate (CA) membranes containing DHA and MSCs were produced, and their antibacterial and antibiofilm activities against burn infections caused by Pseudomonas aeruginosa were investigated. Methods: Physicochemical properties were assessed by SEM, Fourier transform infrared (FTIR), and X-ray diffraction (XRD). Porosity, cytocompatibility, and antibacterial and antibiofilm activities were evaluated both in vitro and in vivo. The viability and apoptosis of MSCs were studied using flow cytometry. Wound healing effects were analyzed based on histopathological features, the wound contraction rate (WCR) ratio, and bacterial clearance. Results: The CA membranes showed antibiofilm activity both in vivo and in vitro, accompanied by reduced lasI and rhlI expressions and pyocyanin production. The membranes were highly porous and biocompatible and showed favorable physicochemical properties. Docosahexaenoic acid incorporation to CA membranes improved their antibacterial and antibiofilm activities, as well as MSCs' viability by reducing crystallinity and increasing porosity ( p = .008 ). Treatment with CA-DHA-MSC accelerated burn wound healing (with complete healing being observed after 14 days, WCR = 85%) and augmented antibacterial and antibiofilm activities in vivo compared to CA-DHA and CA-MSC. The CA-DHA-MSC group delivered a significantly higher WCR and lower inflammation than the CA-MSC group ( p = .0001). Conclusion: In combination with DHA-loaded CA membranes, MSCs reduced the healing time of burn wounds, offering a viable option for designing effective wound dressings.

Background: Staphylococcus aureus is a human pathogen causing nosocomial infections and increased hospitalization and mortality among human communities. Methicillin-resistant S. aureus strains are considered a severe threat in nosocomial infections and cause complications in the remedy process of bacterial infections. In this study, 137 samples were collected from different departments, staff, and patients in Ilam hospital., Methods: Eighty-eight samples of these strains were examined to test antibiotic resistance and diffusion. MIC (minimum inhibitory concentration) and PCR (polymerase chain reaction) were performed on the samples resistant to oxacillin. 36 (40.9%) strains were MRSA, and 52 (59.1%) isolates were MSSA. 44.4% of MRSA strains with IV SCCmec type., Results: Fourteen different spa types were found using spa typing, of which the most abundant types were t037, t030, and t701, and three new types, including t15471, t15474, and t17470, were identified among the strains. The molecular analysis by MLST showed that the strains are classified into 11 different sequence types. Sequence type 239 and clonal complexes of 329 and 22 were dominant. ST239- spat037-SCCmec III was also identified as the most frequent clone of MRSA. The most identified clones were MRSA ST239-spa t037-SCCmec III., Conclusion: The results show the spa-type distribution between samples of patients, personnel, and surfaces, demonstrating MRSA circulation between patients and the environment. The results show the need to control environmental health., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Reports show that other ordinary childhood infections like measles or influenza are likely to reemerge. The re-emergence of infectious diseases may happen due to the direct impact of the pandemic on the community because of decreased access to health and medical services, interrupted transport systems, weaknesses in the supply chain, flight restrictions, closings of the border, and international trade problems. The most prevalent cause (60.9%) for low vaccine uptake and coverage during the current pandemic was fear of exposure to the COVID-19 virus outside the home. The expectation and hope that the pattern of reduction in transmission and number of influenza cases will continue over the next flu season depend on continued adherence to nonpharmaceutical interventions and their long-term application. But there is always the fear and threat of increasing the spread of influenza by reducing the movement restrictions and low adherence to protective health measures due to vaccination. So far, not much information has been published about the interaction between different infectious diseases in the background of the coronavirus pandemic and related interventions. The purpose of this article is to examine the general effects of the COVID-19 vaccination on the spread of influenza in the coming seasons., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: One of the major problems with Brucella infections is its tendency to become chronic and recurrent, providing a hindrance to the management of this infection. It has been proposed that chronicity is greatly affected by a phenomenon called persistence in bacteria. Several mechanisms are involved in bacterial persistence, including the type II toxin-antitoxin system, the SOS and oxidative and stringent responses., Methods: In this in silico study, these persistence mechanisms in Brucella spp. were investigated., Results: The structure and the interactions between modules involved in these systems were designed, and novel peptides that can interfere with some of these important mechanisms were developed., Conclusion: Since peptide-based therapeutics are a new and evolving field due to their ease of production, we hope that peptides developed in this study, as well as the information about the structure and interactions of modules of persistence mechanisms, can further be used to design drugs against Brucella persister cells in the hope of restraining the chronic nature of Brucellosis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

In this study, a systematic investigation was performed to estimate the prevalence of head lice infestation, and to determine the factors affecting the prevalence of heterogeneity among primary school-aged children in Iran. A comprehensive search was fulfilled in international databases, including MEDLINE, Scopus, Web of Science, and Embase, to identify the articles on the prevalence of pediculosis. So, all the cross-sectional epidemiological studies evaluating the prevalence of pediculosis were covered without any restrictions. A random-effects model was used to assess the pooled prevalence. A meta-regression method was applied to determine the factors affecting the heterogeneity among the studied population. An analysis was performed on 67 studies with a total sample size of 358,053. The total pooled estimate for the prevalence of pediculosis in boys and girls was 7.52% (95% CI: 6.15-9.03), 1.99% (95% CI: 1.25-2.89), and 8.97% (95% CI: 721-10.91), respectively. The highest and lowest pooled prevalence was in Hormozgan (southern Iran) (29.21%; 95% CI: 8.89-55.34) and Isfahan (Central Iran) (0.69%; 95% CI: 0.59-0.80), respectively. Based on the results of the univariate meta-regression, gender and father's job showed a significant direct association with the prevalence of pediculosis, but the sample size had significant inverse relations with the prevalence of pediculosis. This study demonstrated that pediculosis is a common public health problem affecting school-aged children with a relatively high prevalence in Iran, especially among girls., (© The Author(s) 2022. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Pulmonary diseases are amongst the most common causes of premature death and distressing disorders worldwide. This study aimed to detect the fastidious and routine infectious agents, and their drug resistance patterns in bronchoalveolar lavage (BAL) samples., Methods: A total of 44 BAL samples were collected by bronchoscopy from patients with respiratory disorders hospitalized at 2 teaching hospitals in Ilam, Iran. The samples were cultured on routine bacterial culture media to identify the bacterial agents and calculate the colony count. Antibiotic susceptibility was determined by disk diffusion method according to the CLSI protocol. PCR was used to detect the fastidious bacteria Mycoplasma pneumoniae and Chlamydia pneumoniae using the 16srRNA specific primers and Legionella pneumophila using the mip specific primers., Results: Overall, 100 bacterial isolates were isolated by culture from the 44 BAL samples including: Staphylococcus aureus (24, 31.2%), Streptococcus pyogenes (18, 23.4%), Enterococcus spp. (11, 14.3%), Acinetobacter baumannii (11, 14.3%), Pseudomonas aeruginosa (11, 14.3%), Enterococcus spp. (10, 13%), Micrococcus spp. (5, 6.5%), Staphylococcus epidermidis (5, 6.5%) and Klebsiella pneumoniae (5, 6.5%). PCR detected 4 positive samples (9.1%) for Chlamydia pneumoniae but no positive cases for Mycoplasma pneumoniae and Legionella pneumophila . Acinetobacter baumannii showed the highest resistance rate (81.8%) to aztreonam and ceftazidime. Seventy-five percent of the Staphylococcus aureus isolates were resistant to cefoxitin (MRSA) and 83.3% had the mecA gene. Vancomycin resistance was observed in 27.3% of the Enterococcus species (VRE). Resistance to piperacillin, cefotaxime, ciprofloxacin and imipenem was observed in 54.5%, 45.5%, and 36.4% of the Pseudomonas aeruginosa isolates, respectively. The frequency of organisms isolated from the ICU was higher (46%) than from other wards., Conclusions: The presence of MRSA, cephalosporins-resistant Enterobacteriaceae as well as Pseudomonas aeruginosa and Acinetobacter baumannii resistant against piperacillin, imipenem, cefotaxime, aztreonam and ciprofloxacin amongst different wards, especially the ICU ward of the surveyed hospitals, is a major healthcare concern and it is necessary to wisely scrutinize the preventive strategies for antibiotic resistant infections., Competing Interests: Conflicts of interest: All authors – none to declare., (GERMS.)

Background: In addition to antibiotic resistance, the entry of Helicobacter pylori into the persistence phase leads to recurrent and chronic infections, as well as the development of antibiotic resistance in persister cells., Methods: In this study, after genetic confirmation of H. pylori in 20 biopsy specimens, the prevalence of the type II TA systems mazEF, relEB, yafQ/dinJ was investigated. Also, the most common system observed in the study in terms of structure, evolution, and molecular interaction was evaluated by bioinformatics tools., Results: The results of the PCR test on 20 biopsy samples were positive for ureA and glmM genes. Moreover, yafQ/ dinJ was the only module positive in half of the samples (10 samples) in the PCR technique. The toxin residues and their interactions with the cognate antitoxin residues are revealed by docking analysis results. Furthermore, the multiple sequence alignment (MSA) of the YafQ toxin showed that this toxin has a low polymorphism among H. pylori species. The evolutionary study showed that the yafQ toxin had the highest sequence similarity among the bacteria Helicobacter cetorm (60% similarity) and Muricauda olearia (57.35 % similarity)., Conclusions: Collectively, the data of the present study indicate that the YafQ/DinJ is the dominant type II TA system and has the highest frequency among the studied systems in H. pylori, and further studies are required to elucidate its exact role in this bacterium.

Background: Nowadays, novel antimicrobial strategies are being developed which focus on debilitating, rather than killing the microorganisms. In this regard, anti-biofilm therapy is one of the important ways to combat bacterial infections. Therefore, the aim of the current study was to evaluate the anti-biofilm activity of Carvacrol against E. faecalis by means of its effects on biofilm formation as well as on the gene expression levels of the two biofilm related genes, Epa and Esp., Methods: A total of 40 clinical strains of E. faecalis were collected from three hospitals in Tehran, Iran during 2020. These isolates were confirmed by biochemical and genotypic methods. Antibacterial and anti-biofilm activity of Carvacrol essence were determined according the standard protocol. Finally, expression level of the biofilm related genes (Epa and Esp) were evaluated before and after the treatment with Carvacrol., Results: A total of 14 isolates were considered as strong biofilm producers and were used for analysis. Carvacrol essence showed the best antibacterial activity at 2,500 μg/mL concentration against all the isolates, the biofilm formation capacity was decreased by Carvacrol essence, and it was statistically significant (p < 0.05). Expression levels of the Esp gene were decreased in 5 isolates while increased in 3 isolates following the Carvacrol treatment. Ex-pression levels of the EpaI gene was significantly decreased (p < 0.05) in 4 isolates following the Carvacrol treatment., Conclusions: In conclusion, the results presented in this study suggest that carvacrol extract exhibits significant antimicrobial and anti-biofilm properties against E. faecalis, even against vancomycin resistant isolates.

Bacterial vaginosis is a condition caused by changes in the vaginal microbial ecosystem and increases the risk of preterm delivery, premature rupture of membranes, endometritis, and weight loss of the baby. This study aimed to evaluate the frequency of gonococcal and non-gonococcal genital infections in women referred to clinics in Ilam, Iran. Two swab samples were taken from each patient using a sterile swab, one swab was placed in a THB medium for the culture of Streptococcus agalactiae and the other in PBS buffer for PCR. PCR method was conducted for the identification of the other bacterial agents such as Neisseria gonorrhoeae , Chlamydia trachomatis , Mycoplasma genitalium , Mycoplasma hominis , Ureaplasma urealyticum , and also S. agalactiae . Sampling was performed on 169 women with symptomatic vaginosis. The frequency of S. agalactiae by culture and PCR methods was 4.7% (8 samples) and 13.6% (23 samples) respectively. Also, 6.5% (11 samples), 3.5% (6 samples), 4.1% (7 samples), 1.2% (2 samples), and 0% of the samples were positive for N. gonorrhoeae , M. genitalium , M. hominis , U. urealyticum and C. trachomatis by PCR method. Except for a significant association between S. agalactiae colonization and abortion, there was no significant correlation between the prevalence of these bacteria and the patient's age, age of marriage, number of deliveries, and number of abortions. Overall, the prevalence of gonococcal and non-gonococcal infection in women referred to clinics in Ilam is similar to the other parts of Iran., Competing Interests: Conflict interest All of the authors declare that there are no any potentially conflicting interests related to the submitted manuscript., (Copyright © 2016 - 2022 InfezMed.)

Considering the widespread occurrence of antibiotic resistance, the need for new therapeutic strategies is inevitable. Bacterial proteases are a broad set of enzymes that play a vital role in cell survival, stress response, and pathogenicity. This in silico study was aimed to focus on the crucial role of Lon protease in the regulation of toxin-antitoxin systems in E. coli and to design inhibitory peptides against the action of this protease. With the help of relevant servers and softwares, the communication network, the evolutionary history, and the interaction of Lon with the corresponding antitoxins were examined, following which the inhibitory peptides were designed against these interactions. The results showed that Lon protease plays a central role in the control of these systems and is a conserved protein, especially among the Enterobacteriaceae family. The docking results of the designed peptides with the Lon protease were significant. This study showed that Lon protease may have the characteristics of a new therapeutic target., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: Biofilm makes bacteria resistant to antimicrobial agents and facilitates the transmission of infectious diseases in hospitals. Disinfectant compounds are frequently used to control surface contamination. This study was designed to investigate the effect of chlorhexidine (CHX) and hydrogen peroxide (H2O2) on biofilm formation of Enterococcus faecalis., Methods: This study was performed on 40 E. faecalis clinical isolates. After the determination of MIC, the effect of different concentrations of CHX and H2O2 on the biofilm formation was evaluated. Also, the relative expression level of the studied biofilm genes, following exposure to sublethal concentration of CHX and H2O2, was assessed using quantitative reverse transcription PCR (qRT-PCR)., Results: The frequency of the asa1, efaA, epaI, and esp biofilm genes were 80%, 92.5%, 100%, and 75%, respectively. Various concentrations of CHX increased the biofilm mass in E. faecalis. Also, the combination of CHX and H2O2 at sub-minimal inhibitory concentrations, significantly elevated the expression of asa1, epaI, and esp genes., Conclusions: The results of this study showed that the improper use of disinfectants can increase the ability of biofilm formation in E. faecalis and may cause selective pressure leading to the emergence of biocide-resistant microorganisms.

Microbial coinfections can increase the morbidity and mortality rates of viral respiratory diseases. Therefore, this study aimed to determine the pooled prevalence of fungal coinfections in coronavirus disease 2019 (COVID-19) patients. Web of Science, Medline, Scopus, and Embase were searched without language restrictions to identify the related research on COVID-19 patients with fungal coinfections from December 1, 2019, to December 30, 2020. A random-effects model was used for analysis. The sample size included 2,246 patients from 8 studies. The pooled prevalence of fungal coinfections was 12.60%. The frequency of fungal subtype coinfections was 3.71% for Aspergillus, 2.39% for Candida, and 0.39% for other. The World Health Organization's Regional Office for Europe and Regional Office for Southeast Asia had the highest (23.28%) and lowest (4.53%) estimated prevalence of fungal coinfection, respectively. Our findings showed a high prevalence of fungal coinfections in COVID-19 cases, which is a likely contributor to mortality in COVID-19 patients. Early identification of fungal pathogens in the laboratory for COVID-19 patients can lead to timely treatment and prevention of further damage by this hidden infection.

Background: Phenotypic resistance is considered as a serious therapeutic challenge for which a definitive remedy has not been discovered yet. Biofilm and persister cell formation are two well-studied phenotypic resistance phenomena, leading to the recalcitrance and relapse of different types of chronic infections. The presence of persister cells in biofilm structures seems to be one of the main factors contributing to the relapse of infections and treatment failure. Given the dormant and inert nature of persister cells, they can be easy targets for the immune system factors. Biofilm formation can be a survival strategy for the defenseless persister cells. Thus, this study was aimed to evaluate the expression of biofilm-associated genes in Enterococcus faecalis persister and non-persister cells., Methods: Vancomycin susceptibility and biofilm formation ability were investigated among 95 E. faecalis clinical isolates using microtiter broth dilution and microtiter plate assays, respectively. PCR was used to determine the presence of biofilm-related genes (gelE, esp, and agg) among the vancomycin-susceptible, biofilm producer E. faecalis isolates (91 isolates). Minimum bactericidal concentration for biofilms (MBCB) were determined for vancomycin using the MTP assay. Bacterial persister assay was performed using an enzymatic lysis assay. Finally, the expression of biofilm-related genes was compared between the persister and non-persister isolates of E. faecalis using real-time qPCR., Results: E. faecalis isolates showed a high level of susceptibility (95.8%) to vancomycin (MIC < 1 µg/mL). The gelE, esp, and agg genes were found in 91 (100%), 72 (79.12), and 74 (81.32) of the isolates, respectively. All the E. faecalis isolates were tolerant to vancomycin in the biofilm condition, showing a MBCB of > 2500 µg/mL. Based on the enzymatic lysis assay, only 3 isolates, out of the 91, had the ability to form persister cells. The expression of biofilm-associated genes was higher among the persister compared to non-persister E. faecalis isolates., Conclusions: Biofilm-associated persister cells indicated a high vancomycin tolerance compared to non-persister cells. Moreover, persister isolates showed a higher tendency for biofilm formation and a higher expression level of the biofilm-associated genes, compared to non-persister isolates., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

The world is still faced with widespread dissemination and many unanswered questions related to Coronavirus disease (COVID-19). Several candidate vaccines have been introduced against COVID-19, mostly requiring the injection of two doses and some with nearly 90-95% efficacy. All strategies against the spread of infection have focused on breaking the chain of virus transmission through protective public health measures and mass vaccination. The current situation emphasizes the global need for carefully designed policies to maximize vaccine access and uptake. The risk compensation theory (Peltzman Effect) states that the decrease in perceived risk through access to preventive measures may lead to increasing frequency of risky behaviors. The current pandemic has exposed people to the sense of risk compensation and behavior change in response to the perceived risk. Risk compensation phenomenon may significantly reverse the benefits of COVID-19 vaccination, especially if the vaccine is not sufficiently effective in real life or among high-risk populations. Recognition and awareness of Peltzman risk compensation are of high importance in counteracting and neutralizing the false complacency of the community, which also lends more weight to public health efforts. The public health messages and practices should be clearly expressed, straightforward, reliable and applicable. It is important to encourage mass vaccination of the population, and other NPIs must be re-established and implemented to ensure education to live with COVID-19 in parallel with daily activities and job tasks., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background: To provide information about pathogens' coinfection prevalence with SARS-CoV-2 could be a real help to save patients' lives. This study aims to evaluate the pathogens' coinfection prevalence among COVID-19 patients., Method: In order to find all of the relevant articles, we used systematic search approach. Research-based databases including PubMed, Web of Science, Embase, and Scopus, without language restrictions, were searched to identify the relevant bacterial, fungal, and viral coinfections among COVID-19 cases from December 1, 2019, to August 23, 2021. In order to dig deeper, other scientific repositories such as Medrxiv were probed., Results: A total of 13,023 studies were found through systematic search. After thorough analysis, only 64 studies with 61,547 patients were included in the study. The most common causative agents of coinfection among COVID-19 patients were bacteria (pooled prevalence: 20.97%; 95% CI: 15.95-26.46; I 2 : 99.9%) and less frequent were virus coinfections (pooled prevalence: 12.58%; 95% CI: 7.31-18.96; I 2 : 98.7%). The pooled prevalence of fungal coinfections was also 12.60% (95% CI: 7.84-17.36; I 2 : 98.3%). Meta-regression analysis showed that the age sample size and WHO geographic region did not influenced heterogeneity., Conclusion: We identified a high prevalence of pathogenic microorganism coinfection among COVID-19 patients. Because of this rate of coinfection empirical use of antibacterial, antifungal, and antiviral treatment are advisable specifically at the early stage of COVID-19 infection. We also suggest running simultaneously diagnostic tests to identify other microbiological agents' coinfection with SARS-CoV-2., (© 2021 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.)

Background: There are reports of ocular tropism due to respiratory viruses such as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Various studies have shown ocular manifestation in coronavirus disease-2019 (COVID-19) patients. We aimed to identify ophthalmic manifestations in COVID-19 patients and establish an association between ocular symptoms and SARS-CoV-2 infection., Methods: A systematic search of Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted for publications from December 2019 to April 2021. The search included MeSH terms such as SARS-CoV-2 and ocular manifestations. The pooled prevalence estimate (PPE) with 95% confidence interval (CI) was calculated using binomial distribution and random effects. The meta-regression method was used to examine factors affecting heterogeneity between studies., Results: Of the 412 retrieved articles, 23 studies with a total of 3,650 COVID-19 patients were analyzed. The PPE for any ocular manifestations was 23.77% (95% CI: 15.73-31.81). The most prevalent symptom was dry eyes with a PPE of 13.66% (95% CI: 5.01-25.51). The PPE with 95% CI for conjunctival hyperemia, conjunctival congestion/conjunctivitis, and ocular pain was 13.41% (4.65-25.51), 9.14% (6.13-12.15), and 10.34% (4.90-15.78), respectively. Only two studies reported ocular discomfort and diplopia. The results of meta-regression analysis showed that age and sample size had no significant effect on the prevalence of any ocular manifestations. There was no significant publication bias in our meta-analysis., Conclusion: There is a high prevalence of ocular manifestations in COVID-19 patients. The most common symptoms are dry eyes, conjunctival hyperemia, conjunctival congestion/conjunctivitis, ocular pain, irritation/itching/burning sensation, and foreign body sensation., (Copyright: © Iranian Journal of Medical Sciences.)

Gestational diabetes mellitus (GDM) can have adverse effects on pregnancy. GDM is associated with changes in the lipid profile of pregnant women. Finding out the early ways to diagnose GDM can prevent the adverse outcomes. This meta-analysis study aimed to determine the effect of GDM on lipid profile. PubMed, ProQuest, Web of Science, Scopus, Science Direct, Google Scholar, and ClinicalTrial were systematically searched for published articles relating to GDM until 2021 according to PRISMA guidelines. Newcastle Ottawa scale was used to assess the quality of the studies. Thirty-three studies with a sample size of 23,792 met the criteria for entering the meta-analysis. Pooled standardized mean difference (SMD) for total cholesterol (TC) and triglyceride (TG) was 0.23 mg/dL (95% CI: 0.11-0.34) and 1.14 mg/dL (95% CI: 0.91-1.38), respectively. The mean of TC and TG in people with GDM was higher than that in normal pregnant women. A similar pattern was observed for the very low-density lipoprotein (VLDL) and TG/high-density lipoprotein (HDL) ratio, with pooled SMD of 0.99 mg (95% CI: 0.71-1.27) and 0.65 mg (95% CI: 0.36-0.94), respectively. Pooled SMD for HDL was -0.35 mg/dL (95% CI: -0.54 to -0.16), women with GDM had a mean HDL lower than normal pregnant women. Although pooled SMD was higher for low-density lipoprotein (LDL) in the GDM group, this difference was not significant (0.14 [95% CI: -0.04 to 0.32]). Of all the lipid profiles, the largest difference between the GDM and control groups was observed in TG (SMD: 1.14). Elevated serum TG had the strongest effect on GDM. Higher levels of TC, LDL, VLDL, and TG/HDL ratio, and lower level of HDL were exhibited in GDM group. So, these markers can be considered as a reliable marker in the diagnosis of GDM., Competing Interests: Conflict of interest: The authors declare no conflict of interest., (© 2022 Fatemeh Alsadat Rahnemaei et al., published by De Gruyter.)

Background: Foodborne diseases, especially those transmitted by milk and its products, are worldwide problem. Milk is not only a complete food but also a unique medium for activating various bacteria such as Listeria monocytogenes, Staphylococcus aureus and Salmonella typhi. In recent years, numerous bacteria with multiple drug resistance patterns have appeared, and there have been many problems in infection control. Today, ranchers use antibiotics for control of the animal disease, and humans are constantly using animal products containing antibiotics., Objective: The purpose of this study was to evaluate the contamination status of raw and pasteurised milk as well as local cheese and to find a rapid Multiplex PCR method for investigation of contamination. Determination of antibiotic resistant isolates is also desirable., Materials and Methods: One hundred samples were collected from livestock and retail outlets using culture and molecular methods to identify S. aureus, L. monocytogenes and S. typhi. The antibiotic resistance pattern was determined for the isolates., Results: In this study, culture results for 100 samples showed 10% S. aureus isolates while no cases of S. typhi and L. monocytogenes were detected. In real-time qPCR, S. aureus was isolated in 60% (n = 60) of samples, S. typhi in 53% (n = 53) and L. monocytogenes in 2% (n = 2). The results of sensitivity and specificity of Multiplex PCR for the three studied bacteria indicated general specificity of 72% and sensitivity of 80%., Conclusion: Based on the results of this study, it can be concluded that S. typhi, L. monocytogenes and S. aureus are more likely to be detected by real-time qPCR because of the high sensitivity of this test to culture. Multiplex method was not reliable in this study and cannot be suggested for rapid diagnosis., (© 2021 The Authors. Veterinary Medicine and Science published by John Wiley & Sons Ltd.)

Background: Coinfections have a potential role in increased morbidity and mortality rates during pandemics. Our investigation is aimed at evaluating the viral coinfection prevalence in COVID-19 patients., Methods: We systematically searched scientific databases, including Medline, Scopus, WOS, and Embase, from December 1, 2019, to December 30, 2020. Preprint servers such as medRxiv were also scanned to find other related preprint papers. All types of studies evaluating the viral coinfection prevalence in COVID-19 patients were considered. We applied the random effects model to pool all of the related studies., Results: Thirty-three studies including 10484 patients were identified. The viral coinfection estimated pooled prevalence was 12.58%; 95% CI: 7.31 to 18.96). Blood viruses (pooled prevalence: 12.48%; 95% CI: 8.57 to 16.93) had the most frequent viral coinfection, and respiratory viruses (pooled prevalence: 4.32%; 95% CI: 2.78 to 6.15) had less frequent viral coinfection. The herpesvirus pooled prevalence was 11.71% (95% CI: 3.02 to 24.80). Also, the maximum and minimum of viral coinfection pooled prevalence were in AMRO and EMRO with 15.63% (95% CI: 3.78 to 33.31) and 7.05% (95% CI: 3.84 to 11.07), respectively., Conclusion: The lowest rate of coinfection belonged to respiratory viruses. Blood-borne viruses had the highest coinfection rate. Our results provide important data about the prevalence of blood-borne viruses among COVID-19 patients which can be critical when it comes to their treatment procedure., Competing Interests: The authors have no conflicts of interest to declare., (Copyright © 2021 Pooneh Malekifar et al.)

The pandemic of severe acute respiratory syndrome coronavirus 2 raised the attention towards bacterial coinfection and its role in coronavirus disease 2019 (COVID-19) disease. This study aims to systematically review and identify the pooled prevalence of bacterial coinfection in the related articles. A comprehensive search was conducted in international databases, including MEDLINE, Scopus, Web of Science, and Embase, to identify the articles on the prevalence of bacterial coinfections in COIVD-19 patients from 1 December 2019 until 30 December 2020. All observational epidemiological studies that evaluated the prevalence of bacterial coinfections in patients with COVID-19 were included without any restriction. Forty-two studies including a total sample size of 54,695 were included in the analysis. The pooled estimate for the prevalence of bacterial coinfections was 20.97% (95% CI: 15.95-26.46), and the pooled prevalence of bacterial coinfections was 5.20% (95% CI: 2.39-8.91) for respiratory subtype and 4.79% (95% CI: 0.11-14.61) for the gastrointestinal subtype. The pooled prevalence for Eastern Mediterranean Regional Office and South-East Asia Regional Office was 100% (95% CI: 82.35-100.00) and 2.61% (95% CI: 1.74-3.62). This rate of coinfection poses a great danger towards patients, especially those in critical condition. Although there are multiple complications and adverse effects related to extensive use of antibiotics to treat patients with COVID-19, it seems there is no other option except applying them, and it needs to be done carefully., (© 2021 The Authors.)

Background: Diarrhea remains a major threat to children in low- and middle-income countries, which is the second cause of death among children in the world. The aim of the present study was to develop and evaluate a multiplex-PCR assay for direct detection of common bacterial enteropathogens in fecal specimens., Methods: One hundred and three stool specimens were collected from children under 5 years of age with gastroenteritis during a six-month period in Ilam, Iran. The multiplex PCR assay simultaneously detected Shigella spp., Campylobacter jejuni, Enteropathogenic Escherichia coli (EPEC), Enterotoxigenic Escherichia coli (ETEC), and Salmonella enterica in stool samples., Results: Our results demonstrated that the prevalence of Shigella spp. Campylobacter jejuni, EPEC, ETEC, and Salmonella enterica were 21.35%, 10.67%, 1.94%, 0.97% and 0%, respectively. In addition, Shigella spp. with Campylobacter jejuni and EPEC with Campylobacter jejuni coinfection were observed in sample 11 (10.67%). The analytical sensitivity of the multiplex PCR assay was estimated to be 0.01 ng/µL of genomic DNA from culture. The analytical specificity was determined to be 100% by using common and standard enteropathogenic bacterial strains., Conclusions: The molecular method developed in the study was rapid, sensitive, and specific for detection of common bacterial enteropathogens.

The ongoing pandemic of Coronavirus disease 2019 (COVID-19) has infected more than 27 million confirmed cases and 8,90,000 deaths all around the world. Verity of viral infections can infect the nervous system; these viral infections can present a wide range of manifestation. The aim of the current study was to systematically review the COVID-19 associated central nervous system manifestations, mental and neurological symptoms. For that we conducted a comprehensive systematic literature review of four online databases, including Web of Science, PubMed, Scopus and Embase. All relevant articles that reported psychiatric/psychological symptoms or disorders in COVID-19 without considering time and language restrictions were assessed. All the study procedures were performed based on the PRISMA criteria. Due to the screening, 14 studies were included. The current study result indicated that, the pooled prevalence of CNS or mental associated disorders with 95% CI was 50.68% (6.68-93.88). The most prevalence symptoms were hyposmia/anosmia/olfactory dysfunction (number of study: 10) with 36.20% (14.99-60.51). Only one study reported numbness/paresthesia and dysphonia. Pooled prevalence of numbness/paresthesia and dysphonia was 5.83% (2.17-12.25) and 2.39% (10.75-14.22). The pooled prevalence of depression and anxiety was 3.52% (2.62-4.54) and 13.92% (9.44-19.08). Our findings demonstrate that COVID-19 has a certain relation with neurological symptoms. The hypsomia, anosmia or olfactory dysfunction was most frequent symptom. Other symptoms were headache or dizziness, dysgeusia or ageusia, dysphonia and fatigue. Depression, anxiety, and confusion were less frequent symptoms., (© 2020 Walter de Gruyter GmbH, Berlin/Boston.)

Background: Toxin-antitoxin systems (TAs) are two-component elements, which are extensive in the bacterial genome and have a regulatory role in many cellular activities including, growth arrest, survival, biofilm formation, and bacterial persistence., Objective: TAs have not well studied in Brucella spp., Methods: We evaluated the presence of different toxin-antitoxin systems, including relE- rhhlike, Fic- Phd, Cog- Rhh, and cogT- cogAT in 40 clinical Brucella melitensis isolates using PCRbased sequencing assay., Results: Our results showed the high presence of relE-rhh-like, Fic-Phd, Cog-rhh, and cogTcogAT s TAs genes in B. melitensis isolates that were 96.25%, 92.5%, 96.25%, and 95%, respectively., Conclusion: A high presence of TAs genes in clinical B. melitensis isolates revealed that the TA system could be an antibacterial target in B. melitensis but more investigation is necessitated to elucidate the exact roles of these genes., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Introduction: Mycobacterium tuberculosis (MTB), the causative agent of tuberculosis (TB), is a significant global public health threat. Besides extensive multidrug resistance, MTB possesses several properties for long-term viability in the host as well as stress adaptation and resistance in harsh conditions. The role of toxin-antitoxin (TA) systems in disseminating and maintaining antimicrobial resistance in bacterial populations has also been demonstrated. This study aimed to evaluate differences in expression of MazEF (a well-known TA system) related genes (mazE3, mazF3, mazE6, and mazF6) amongst drug-susceptible and resistant MTB isolates in Iran., Material and Methods: A total of 20 confirmed clinical isolates of MTB including 10 drug-susceptible and 10 drug-resistant (nine MDR, and one XDR) species were included in this study. M. tuberculosis H37Rv was used as the standard strain. RNA extraction, cDNA synthesis, and relative quantitative real-time PCR were performed according to the standard procedures., Results: Our analysis indicated significant enhanced expression of the mazE6 antitoxin gene in drug-susceptible isolates compared to drug-resistant isolates and the standard strain. The expression of the mazF6 toxin gene was also increased in drug-susceptible isolates compared with the standard strain. In drug-resistant isolates, the expression levels of mazF3 and mazF6 genes were significantly higher than that in the susceptible isolates and the standard strain., Conclusions: In this study, there was significant overexpression of mazE6 in drug-susceptible isolates. As well, mazF3 and F6 were overexpressed in drug-resistant isolates when compared with the standard strain. The changes in expression levels of MazEF6 associated genes were greater than that of MazEF3 in both groups of isolates.

On December 31, 2019, the novel human coronavirus (COVID-19) was identified in Wuhan, China and swiftly spread in all nations and territories around the globe. There is much debate about the major route of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmissions. So, more evidence is required to determine the potential pathway of transmission of SARS-CoV-2 including airborne transmission. Therefore, we examined the potential aerosol transmission of the virus through hospital wards indoor air by confirmed COVID-19 patients on May 7, 2020. In order to capture airborne SARS-CoV-2, the liquid impinger biosampler was used to take fourteen air samples in different wards of the indoor air of the hospital. The specific primer and probe real-time reverse transcriptase-polymerase chain reaction (RT-PCR) were applied to detect viral genomes of the SARS-CoV-2 virus in positive air samples. Accordingly, we found two positive air samples (in the ICU) out of 14 ones taken from different wards with confirmed COVID-19 patients. The results revealed the possibility of airborne transmission of SARS-CoV-2 though more studies are required to determine the role of actual mechanisms such as cough, sneeze, normal breathing and speaking in the emission of airborne size carrier aerosols. Likewise, more quantitative analyses are needed to estimate airborne viability of SARS-CoV-2 in the carrier aerosols., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

It is clear that biofilm formation causes many serious health-care problems. Interestingly, sub minimum inhibitory concentrations (sub-MICs) of some biocides can induce biofilm formation in bacteria. We investigated whether sub-MICs of Savlon, chlorhexidine and deconex®, as biocidal products, can induce biofilm formation in clinical isolates of Pseudomonas aeruginosa . To determine MICs and biofilm formation, we performed microtitre plate assays. All three biocides induced biofilm formation at sub-MICs; Savlon was the most successful antiseptic agent to induce biofilm formation among P. aeruginosa isolates. Deconex had the best inhibition effect on planktonic cultures of P. aeruginosa isolates. We concluded that sub-MICs of Savlon and deconex could significantly induce biofilm formation., (© 2020 The Authors.)

Background: Brucellosis is considered a main health concern in humans and animals. Neither familiar molecular methods nor the classical biotyping techniques are acceptable for subtyping Brucella spp. Loci containing variable number tandem repeats (VNTRs) have recently demonstrated their practicality in typing isolates from human and animal origin despite the excessive genetic homogeneity in the genus Brucella., Methods: The genotypic characteristics of sixty-six Brucella melitensis and thirty-four Brucella abortus isolates from veterinary samples and human brucellosis cases in Iran during 2014 - 2018. They were analyzed using multiple-locus variable-number tandem-repeat analysis (MLVA) which consisted of sixteen primer pairs and designed and classified as belonging to one of the three panels: panel 1 (MLVA-8: eight loci including Bruce06, Bruce08, Bruce11, Bruce12, Bruce42, Bruce43, Bruce45, and Bruce55), panel 2A (three loci including Bruce18, Bruce19, and Bruce21), and panel 2B (five loci including Bruce04, Bruce07, Bruce09, Bruce16, and Bruce30); MLVA-11 (panels 1 and 2A), and MLVA-16 (panels 1, 2A, and 2B) using BioNumerics software (Version 7.6)., Results: Using panel 1, 2A, and 2B (MLVA-16), 59 genotypes with a genetic similarity coefficient ranging from 91 to 100% were obtained from the 100 Brucella spp. isolates. For all isolates, only genotype 36 and genotype 26 were obtained using panels 1 and 2A, respectively. The B. abortus isolates showed variations at 9 different genotypes, while B. melitensis isolates have been dispersed in 50 different genotypes. Bruce16 and Bruce4 showed the highest discriminatory power., Conclusions: The MLVA-16 assay appeared to be a useful and important molecular genotyping tool that is capable of proving epidemiological linkages in outbreak and trace-back investigations and is helpful in improving the effectiveness of brucellosis control programs.

The high incidence of bacterial respiratory infections has led to a focus on evaluating the human respiratory microbiome. Studies based on culture-based and molecular methods have shown an increase in the bacterial community that includes the bacterial phyla Firmicutes, Bacteroidetes, Actinobacteria, and Proteobacteria in the oropharynx of healthy individuals. Therefore, recognizing this microbial compound and subsequently identifying those carriers of specific pathogens can be of great help in predicting future infections and their control. In this prospective study, we sought to characterize the bacterial communities of the respiratory microbiome in healthy children aged between 3 and 6 years old by combining both cultural techniques and sequencing of the 16S rRNA gene. Seventy-seven oropharynx samples using Dacron swabs were collected from 77 healthy children in the kindergartens of Ilam, Iran. Bacterial identification was performed by phenotypic methods and in house developed PCR-based sequencing (the V1-V9 hypervariable region of the bacterial 16S ribosomal RNA gene). In total, 346 bacterial isolates were characterized based on phenotypic and sequencing-based molecular methods. The 3 most predominant phyla were Firmicutes (74%), Proteobacteria (22%), and Actinobacteria (4%). At the level of the genus, Staphylococci (coagulase-positive and coagulase-negative) and Streptococci were dominant. Also, the most commonly identified potentially pathogenic colonisers were S. aureus (75%), Enterobacteriaceae spp. (40.1%), and A. baumannii (15.6%). The present study identified 3 phyla and 9 family of bacteria in the oropharyngeal microbiome. Remarkably, the presence of potential pathogenic bacteria in the nasopharynx of healthy children can predispose them to infectious diseases, and also frequent exposure to human respiratory bacterial pathogens are further risk factors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

There is a close correlation between asymptomatic oropharyngeal colonization by bacterial pathogens and paediatric respiratory diseases. Evaluation of the frequency of asymptomatic carriers of Neisseria meningitidis and Moraxella catarrhalis in healthy children was the main aim of the current study. In this cross-sectional study, 123 oropharyngeal swabs were collected from children between 2 and 6 years old in kindergartens of Ilam, Iran. Moraxella catarrhalis and N. meningitidis were identified using phenotypic and genotypic assays. In addition, the occurrence of the virulence factors ( ctrA and uspA1 ) and iron uptake ( tbpA ) genes was evaluated by PCR. Results showed that 21 M. catarrhalis isolates and 17 N. meningitidis isolates were identified by conventional microbiological and biochemical methods, but the RT-PCR assay detected that 18 and 8 isolates were positive for M. catarrhalis and N. meningitidis , respectively. The tbpA gene was positive in all N. meningitidis and M. catarrhalis isolates. Seven isolates were positive for the ctrA gene in N. meningitidis and seven isolates were positive for the uspA1 gene in M. catarrhalis . These pathogenic bacteria often occurred as asymptomatic carriage of N. meningitidis in children from large families with low economic status, which reflects the importance of the environment and socio-economic level of families in the distribution of these potentially pathogenic bacteria in the oropharynx of children. Monitoring for the carriage of potential pathogenic bacteria in the nasopharynx of healthy children is important as this can predispose to infectious diseases; common exposure to human respiratory bacterial pathogens is a further risk factor., (© 2020 The Authors.)

There is a direct correlation between asymptomatic oropharyngeal colonization by pathogenic bacteria and the prevalence of paediatric respiratory infections. Streptococcus pneumoniae and Haemophilus influenzae are common cause of serious bacterial infections such as meningitis in children. T his study aimed to monitor healthy children to detect asymptomatic carriers of S. pneumoniae and H. influenzae . In the present cross-sectional study, real-time PCR assay was developed and evaluated in comparison with culture for direct detection of S. pneumoniae and H. influenzae in 123 oropharynx and nasal cavity specimens from healthy children in Ilam, Iran. In addition, virulence factor ( ply and hpd ) and iron uptake ( tbpA and piuA ) genes were evaluated by PCR. Our results demonstrated that among all isolates only 14 S. pneumoniae and eight H. influenzae were identified by phenotypic methods, whereas 37 and 21 S. pneumoniae and H. influenzae were identified, respectively, by real-time PCR assay. All S. pneumoniae and H. influenzae isolates possessed tbpA and piuA genes. Also, 81% (30/37) of S. pneumoniae isolates were positive for ply gene, which encoded pneumolysin, as well as 90% (19/21) of H. influenzae isolates were positive for hpd gene. Simultaneous colonization of S. pneumoniae and H. influenzae could indicate the importance of monitoring of healthy children to identification of carriers., (© 2019 Published by Elsevier Ltd.)

Brucellosis is the most common bacterial zoonotic infection. This pathogen may survive and sustain in host. The aim of this study is to define relationship between long noncoding (lnc) RNA-IFNG-AS1 and interferon gamma (IFN-γ) in different groups of patients with brucellosis compared to control group. In this study, associations of lncRNA IFNG-AS1 expression with secretion of IFN-γ level in Sixty patients with brucellosis, which were divided into 3 groups (acute, chronic and relapse groups), as a case group were compared with 20 subjects with negative serological tests and brucellosis clinical manifestation as a control group. In this regard, RNA were extracted from isolated peripheral blood mononuclear cells (PBMCs). LncRNA IFNG-AS1, T-box transcription factor (T-bet) and IFN-γ expressions were detected using quantitative polymerase chain reaction (qPCR). Serum level IFN-γ was assessed using enzyme linked immunosorbent assay (ELISA). The results showed that expression level of LncRNA IFNG-AS1, T-bet and IFN-γ increased significantly in all patient groups in compared to healthy subjects (P < 0.0001, P < 0.01, P < 0.001). However, there was no significant difference in T-bet expression between chronic and healthy groups (P = 0.98). Additionally, further analysis revealed that the serum level of IFN-γ in acute and relapsed groups were higher than control group (P < 0.0001, P < 0.001). The effective role of IFNG-AS1 in many protective actions, including enhancing the expression of INF-γ in the immune response of brucellosis patients, revealed new potential marker, LncRNA IFNG-AS1 in screening, diagnosis or treatment of brucellosis.

Background: Urinary tract infection (UTI) is one of the most common infectious diseases ranking next to upper respiratory tract infections. UTIs are often significantly associated with morbidity and mortality. The inappropriate administration of antibiotics to treat these infections increased infection resistance to antibiotics. The aim of this study is to determine the frequency of antibiotic resistance pattern in UTIs., Methods: We searched several databases including PubMed, Web of Science, Scopus, Google Scholar, Iran Medex, Magiran, IranDoc, MedLib, and Scientific Information Database to identify the studies addressing antibacterial resistance patterns of the most common uropathogenic bacteria in UTIs in Iran. A total of 90 reports published from different regions of Iran from 1992 to May 2015 were involved in this study., Results: It is shown that the most common pathogen causing UTIs is Escherichia coli with 62%. The resistance among the isolates of E. coli was as follows: ampicillin (86%), amoxicillin (76%), tetracycline (71%), trimethoprim-sulfamethoxazole (64%), cephalexin (61%), and cefalothin (60%). The highest sensitivity among isolates of E. coli was as follows: imipenem (86%), nitrofurantoin (82%), amikacin (79%), chloramphenicol (72%), and ciprofloxacin (72%)., Conclusions: The results of this study showed that the most common resistance are antibiotics that are commonly used. The most effective antibiotics for E. coli were imipenem, nitrofurantoin, amikacin, chloramphenicol, and ciprofloxacin. Considering this study, it had better, use less gentamicin, second-generation cephalosporins, and nalidixic acid in the initial treatment of infections caused by E. coli , and no use penicillins, tetracyclines, cotrimoxazole, and first-generation cephalosporins., Competing Interests: There are no conflicts of interest., (Copyright: © 2019 International Journal of Preventive Medicine.)

Objectives: The emergence of resistant bacteria is being increasingly reported around the world, potentially threatening millions of lives. Amongst resistant bacteria, methicillin-resistant Staphylococcus aureus (MRSA) is the most challenging to treat. This is due to emergent MRSA strains and less effective traditional antibiotic therapies to Staphylococcal infections. The use of bacteriophages (phages) against MRSA is a new, potential alternate therapy. In this study, morphology, genetic and protein structure of lytic phages against MRSA have been analysed., Methods: Isolation of livestock and sewage bacteriophages were performed using 0.4 μm membrane filters. Plaque assays were used to determine phage quantification by double layer agar method. Pure plaques were then amplified for further characterization. Sulfate-polyacrylamide gel electrophoresis and random amplification of polymorphic DNA were run for protein evaluation, and genotyping respectively. Transmission electron microscope was also used to detect the structure and taxonomic classification of phage visually., Results: Head and tail morphology of bacteriophages against MRSA were identified by transmission electron microscopy and assigned to the Siphoviridae family and the Caudovirales order., Conclusion: Bacteriophages are the most abundant microorganism on Earth and coexist with the bacterial population. They can destroy bacterial cells successfully and effectively. They cannot enter mammalian cells which saves the eukaryotic cells from lytic phage activity. In conclusion, phage therapy may have many potential applications in microbiology and human medicine with no side effect on eukaryotic cells., Competing Interests: Conflicts of Interest The authors have declared no conflicts of interest.

Objectives: Drug resistance among gram-negative bacteria is a worldwide challenge. Due to the importance of drug-resistant Klebsiella pneumoniae and Escherichia coli strains in hospital-acquired infections, we aimed to determine the phenotypic and genotypic characteristics of ESBL-, AmpC-, and carbapenemase-producing isolates obtained from hospitalized patients in Tehran and Ilam (Iran)., Materials and Methods: In total, 90 K. pneumoniae isolates and 65 E. coli isolates were collected from various infections. Phenotypic identification of bacterial isolates was performed using standard methods. Phenotypic screening of ESBL, AmpC, and carbapenemase enzymes was carried out. Detection of ESBL, AmpC, and carbapenemase genes was also performed by the PCR method., Results: Phenotypic detection tests showed that 36 (40%) K. pneumoniae and 23 (35.4%) E. coli isolates were ESBL producers. Moreover, 18 (20%) and 6 (9.2%) K. pneumoniae and E. coli isolates were AmpC producers, respectively. Modified Hodge test results indicated that 39 (43.3%) K. pneumoniae and 18 (27.7%) E. coli isolates produced carbapenemase. Molecular tests showed that 40% of K. pneumoniae and 36.9% of E. coli isolates were ESBL positive. AmpC was detected in 24.4 and 13.8% of K. pneumoniae and E. coli isolates. Carbapenemase was detected in 34 (37.8%) K. pneumoniae and 13 (20%) E. coli isolates. -Conclusion: In this study, 3 K. pneumoniae isolates simultaneously carried ESBL, AmpC, and carbapenemase genes. Up-to-date strategies such as combination therapy or utilization of new antimicrobial agents might help to combat such drug-resistant organisms., (© 2019 The Author(s) Published by S. Karger AG, Basel.)

Objectives: The ability of bacteria to produce biofilm and adhesion makes them more resistant to antibiotics. The current study aims to evaluate the biofilm formation by Staphylococcus aureus and to determine the prevalence of adhesion genes, also their correlation with drug resistance., Materials and Methods: A total of 96 MRSA were collected from hospitals of Iran's western provinces during 2012 to 2013. The presence of ica A, B, C, D, clfA, cna, fnbA, mecA genes were determined by PCR technique. Biofilm formation was studied by microtiter plate assay, the clonal relations of the strains were examined by SCCmec and Spa typing., Results: The results demonstrated that 96 % of isolates were biofilm producers. The distributions of biofilm formation between isolates were 4.2%, 54.2%, 35.4% as high, moderate and weak, respectivelly. The highest biofilm production was observed from blood culture isolates. All virulent genes icaA,B, C, D, clfA, cna, fnbA were observed in moderate and weak biofilm formation isolates. Among high biofilm formation isolates, icaB and cna genes were not seen. Statistical analysis showed that there was a significant correlation between ica , fnbA and the biofilm production, but there was not a significant correlation between the type of samples and drug resistance, spa type and SCCmec type with biofilm production ( P >0.05). Frequency of All virulent genes in type III SCCmec was higher than other types., Conclusion: The majority of MRSA isolates were biofilm producers and blood isolates ranked as the great biofilm producer. In these isolates ica D and fnbA genes are correlated with biofilm production.

Objective: To investigate the distribution and trends associated with brucellosis incidence rates in Iran from 2011 to 2014., Methods: The reported incidence rates of brucellosis for the years 2011-2014 were collected and entered into GIS 10.1. The Cochran-Armitage test for linear trends, choropleth maps, hot-spot analysis, and high-low clustering analysis were used to investigate patterns of the disease over the study period and by season, and to identify high-risk areas and any clustering of the disease. The significance level was set at p<0.05., Results: A total of 68493 cases of brucellosis were reported during the study period, giving an average brucellosis incidence rate for this period of 38.67/100000. In 2011, the highest rate of brucellosis was observed in Koohrang County of Chaharmahal-Bakhtiari Province, with 317/100 000. In the subsequent years, 2012-2014, Charuymaq County of East-Azerbaijan Province had incidence rates of 384, 534, and 583/100000, respectively. However, the incidence rate of the disease did not follow a linear trend (p<0.001). The maximum and minimum incidence rates of the disease occurred in mid-summer and mid-winter, respectively. The results of the hot-spot analysis showed that the distribution of the disease was highest in the mountainous areas of Iran, particularly along the Zagros mountain range and in most cities near the Zagros Mountains (p<0.01). In addition, the cluster analysis showed a clustering pattern in these high incidence areas (p<0.01)., Conclusions: There were significant differences in the geographic distribution of brucellosis, with the incidence rates being highest in most of the cities in the west and north-west of the country. The incidence of this disease also increased during the summer. It is important to take these patterns into account when allocating resources to combat this disease and to ensure that health programs and other interventions focus on the areas of greatest need., (Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Because of the unknown situation of antibiotic resistance pattern in the main hospital in Ilam, Iran, we aimed to evaluate the antibiotic resistance pattern of uropathogenic bacteria obtained from referred patients to Imam Khomaini Hospital, Ilam, Iran. So, 114 bacteria were collected during 9-month period and evaluated for their antibiotic resistance patterns., Results: Our results demonstrated that Escherichia coli as the dominant responsible for urinary tract infection. Our results demonstrated that 61.4 % (n = 70) of isolates were positive for E.coli, while lowest prevalence was observed for Staphylococcus aureus and Acinetobacter baumannii. The results also showed that 6.4% (n = 7) were metallo beta lactamase (MBL) producers. Our findings showed only 4 gram positive bacteria were obtained from patients with urinary tract infections including one methicillin resistant S. aureus (MRSA) and 2 vancomycin resistant Enterococcus faecalis (VRE)., Conclusion: In conclusion, we strongly recommended to perform a perfect study among all hospitals in Iran to evaluate the situation of antibiotic resistance and make a real panel to control this issue., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Background: Neisseria meningitidis is considered as a dangerous pathogen threatening human health. Nowadays, the new drug target is focused. Toxin antitoxin (TA) system is recently identified as an antimicrobial drug target. Also, in N. meningitidis, iron-uptake system could be an interesting target for drug discovery., Methods: In this study, fbpA and mazE genes were chosen as new antimicrobial targets and treated with antisense peptide nucleic acid (PNA). Firstly, they were evaluated by bioinformatics and then analyzed by experimental procedures. Secondly, the functionality was evaluated by stress conditions., Results: Our results interestingly demonstrated that when fbpA and mazE loci of N. meningitidis were targeted by antisense PNA, 8 µM concentration of fbpA-PNA as well as 30 µM concentration of mazE-PNA inhibited the growth of N. meningitides and were found to be bacteriostatic, whereas 10 μM concentration of fbpA-PNA showed bacteriocidal activity., Conclusion: Our findings demonstrated the bactriocidal activity of fbpA-PNA and bacteriostatic activity of mazEPNA. Therefore, mazE and fbpA genes should be potent antimicrobial targets but further analysis including in vivo analysis should be performed., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.)

Toxin antitoxin system is a regulatory system that antitoxin inhibits the toxin. We aimed to determine the role of TA loci in biofilm formation in K. pneumoniae clinical and environmental isolates; also inhibition of biofilm formation by Peganum harmala. So, 40 K. pneumoniae clinical and environmental isolates were subjected for PCR to determine the frequency of mazEF, relEB, and mqsRA TA loci. Biofilm formation assay subjected for all isolates. Then, P. harmala was tested against positive biofilm formation strains. Our results demonstrated that relBE TA loci were dominant TA loci; whereas mqsRA TA loci were negative in all isolates. The most environmental isolates showed weak and no biofilm formation while strong and moderate biofilm formation observed in clinical isolates. Biofilm formations by K. pneumoniae in 9 ug/ml concentration were inhibited by P. harmala. In vivo study suggested to be performed to introduce Peganum harmala as anti-biofilm formation in K. pneumoniae., Competing Interests: Conflict of Interest: There is no conflict of interest., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Resistance to Acinetobacter baumannii is dramatically on the rise in Iran. Therefore, it is important to study resistance pattern among Acinetobacter isolates which is a common cause of nosocomial infections., Aim: To investigate antibiotic resistance patterns and the role of resistant genes and biofilm formation in the induction of resistance among Acinetobacter baumannii isolated from burn wound and ventilator associated pneumonia infections., Materials and Methods: Total 103 isolates such as 33 burn samples from Rasool Akram Hospital and 70 isolates from ventilated patients in Shahid Motahhari Hospital were identified with A . baumannii using biochemical method, and then identified to species level with PCR of gyrB and bla OXA-51 gene. Antibiotic sensitivity pattern for β-lactam and carbapenem antibiotics was assessed using Agar disc diffusion test and E-test. The presence of different carbapenemase and metalo-β-lactamase ( bla OXA-51-like , gyrB , bla OXA-23-like , bla OXA-24-like , bla OXA-58 , bla VEB , bla PER , bla GIM , bla SIM , bla IMP , bla VIM ), extended-spectrum β-lactamases ( bla TEM , bla SHV ) and two insertion sequences genes ( IS aba1 , IS 1113 ) was assessed. Biofilm formation of all isolates was then assessed. Chi-square analysis or Fisher's-exact tests were used for statistical analysis. A p-value <0.05 was considered statistically significant., Results: Colistin was the most effective antimicrobial agents, although 10.7% (11/103) of the isolates were resistant. The high rate of resistance to meropenem (93.2%) and imipenem (90.3%) was determined. Also, with exception of ampicillin-sulbactam, surprisingly the resistant rate was 28.2%, the resistance to β-lactam antibiotic was dramatically increased. Co-existence of two and three blaOXA genes was also determined. The blaOXA-58 was detected in only one isolate. The blaTEM and blaOXA-23 was the most prevalent Extended-Spectrum β-Lactamases (ESBL) gene. All isolates were biofilm producers., Conclusion: Antibiotic resistance is increasing among A. baumannii isolates which is due to excessive use of antibiotics and also acquired resistant genes and biofilm production. Resistance to nearly all antimicrobial agents especially colistin as end choice for treatment of multiple drug resistance A. baumannii is a big concern.