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Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use metagenomics analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross- selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socioeconomic, health and environmental factors, which we use to predict AMR gene abundances in all countries in the world. Our findings suggest that global AMR gene diversity and abundance vary by region, and that improving sanitation and health could potentially limit the global burden of AMR. We propose metagenomic analysis of sewage as an ethically acceptable and economically feasible approach for continuous global surveillance and prediction of AMR.

Aim: The purpose of this study was to investigate the prevalence of enteropathogenic Escherichia coli (EPEC) and shiga toxin producing E. coli (STEC) strains in healthy broilers in Iran. Background: STEC and EPEC strains as diarrheagenic E. coli are among the most prevalent causative agents in acute diarrhea. Domestic animals, mainly cattle and sheep, have been implicated as the principal reservoirs of these pathotypes; however their prevalence among the broilers is varied among different countries. Patients and methods: A total of 500 cloacal swab samples from broilers of five different poultry houses (A-E) were collected to investigate the presence of stx1, stx2, hly, eae, and bfp virulence genes among the E. coli isolates by polymerase chain reaction. The shiga toxin encoding strains were evaluated serologically to detect their interaction with a commercial antiserum against O157 antigen. Results: Out of the 500 collected samples, 444 E. coli strains were isolated. Three strains (0.67%) presented at least one of the studied virulence genes (stx2, hly and eae), two strains were identified as STEC (stx2+, O157:nonH7) and one as an atypical EPEC strains (eae+ bfp-). Conclusion: The study established the presence of STEC and atypical EPEC in healthy broilers in Iran. Poultry might serve as vectors for transmission of pathogenic E. coli to human populations.

Aim: Since, contradictory data have been reported about the effect of diverse variants of H. pylori virulence factors on IL-8 induction, we aimed to analyze the effect of this diversity on levels of IL-8 secretion in AGS cell line. Background: Helicobacter pylori colonizes the human stomach and induces the activation of inflammatory cytokines, including interleukin (IL)-8, in the gastric mucosa. This induction promotes neutrophil and monocyte recruitment that causes gastric tissue damage. Methods: To determine whether different strains of H. pylori and their CagA variants have possible roles on IL-8 induction, polarized AGS cell line was infected with CagA+ H. pylori strains carrying different EPIYA motifs (ABCCC and ABC) and CagA- strain for 24 hours. Difference in stimulation of IL-8 was measured by ELISA. Results: IL-8 secretion was elevated in the treated cells with CagA encoding strains compared with the negative one. Furthermore, a noticeably increased level of IL-8 induction was measured by the CagA-EPIYA type ABCCC encoding strain in compare to that carried EPIYA type ABC Conclusion: Results of this study provide new evidence about different effects of H. pylori strains and possible roles of their CagA variants on IL-8 induction. It seems that not only carriage of cagA and its expression, but also diversity in EPIYA motif be involved in IL-8 induction in the gastric epithelial cells.

Background: Opiate is used in patient-controlled intravenous analgesia pumps (PCIA) for controlling pain in post-surgical patients. Other drugs are remarkably added to opioid pumps to enhance quality, lengthen analgesia, and reduce side effects. Lidocaine, a local anesthetic which inhibits sodium channels, has anesthetic and analgesic effects when injected locally or intravenously. The objective of this study is to evaluate the analgesic effects of adding lidocaine 1% to different doses of morphine via IV pump to patient-controlled analgesia (PCA) after orthopedic surgeries. Materials and Methods: In a randomized clinical trial, 60 patients who had undergone orthopedic surgery of lower extremities were divided into three equal groups to control postoperative pain. Intravenous pump with 5 ml/h flow rate was used as the analgesic method. The solution consisted of lidocaine 1% plus 20 mg morphine for the first group, lidocaine 1% plus 10 mg morphine for the second group, and only 20 mg morphine for the third group (control group). Patients were checked every 12 h, and Visual Analog Scale (VAS), extra opioid doses, nausea/vomiting, and sedation scale were examined. Results: Pain score was lower in the first group compared to the other two groups. Mean VAS was 2.15 ± 0.2, 2.75 ± 0.2, and 2 ± 0.25 on the first day and 1.88 ± 0.1, 2.74 ± 0.3, and 2.40 ± 0.3 on the second day, respectively, in the three groups and the difference was statistically significant (P < 0.01 and

Background: Cryptosporidium is a worldwide protozoan parasite and one of the most common causes of infection and diarrhea in humans and cattle. The aim of the present study was determina­tion of subtypes of Cryptosporidium among children with diarrhea in Tehran by se­quence analysis of the highly polymorphic 60-kDa glycoprotein (GP60) gene.Methods: Fecal samples were collected from 794 diarrheic children. Initial identification of Crypto­spo­ridium was carried out on stool samples by Ziehl-Neelsen acid-fast staining method. DNA was extracted from positive microscopically samples and Cryptosporidium genotypes and subtypes were determined, accordingly."nResults: Out of 794 collected samples, 19 (2.40 %) were positive for Cryptosporidium oocysts. Sequences analysis of GP60 gene showed that 17 (89.47 %) of the positive isolates were Crypto­spori­dium parvum and 2 (10.52 %) were C. hominis. All subtypes of C. parvum isolates belonged to allele families IIa (6/17) and IId (11/17). The most common allele in all 17 isolates belonged to IId A20G1a (41.18%). A22G1 (IF) subtype was detected in two C. hominis isolates of the chil­dren."nConclusion: The predominancy of C. parvum species (specially, IId A20G1a sub­type) in current study underlines the importance of zoonotic Cryptosporidium transmission in Iran.

Human mesenchymal stem cell (MSC) can be isolated from bone marrow (BM) and differentiated into multiple lineages. These properties make them promising tools in cell and gene therapy. Up to now, no definite therapeutic intervention for late stages of multiple sclerosis (MS) has been found. We decided to inject MS patients with autologous expanded MSC."nFive patients participated in this ongoing study. Patients were injected intrathecally with the culture expanded BM MSCs. Patients were followed monthly for their clinical status and every 3 months re¬garding their magnetic resonance imaging."nDuring 7 months follow up, one patient improved 1.5 EDSS, two patients improved by 1 and 2 scores, and two others remained unchanged till now. The first MRI findings of patients showed no change. We can claim that the injection of expanded MSC is a safe procedure. Three patients showed some de¬gree of improvement and the other two had no progression. Patients should be followed for at least one year and a larger sample is required in order to draw a definite conclusion.

An immunosuppressed man was admitted to hospital with diarrhea and a history of urinary tract infection. He was subjected to treatment with antibiotics. The patient died of putative severe sepsis. The etiological agent was a carbapenemase producing isolate of Bacillus circulans with resistance to all prescribed antimicrobial agents.

Background: Induction Chemotherapy for Acute Lymphoblastic Leukemia achieves complete remis¬sion in over 90% of children. It is apparent therefore that many patients in clinical remission and with¬out residual disease detectable by conventional light microscopy of peripheral blood or bone marrow films still harbor viable cells of the original disease MRD analysis does have a useful role to play in the risk directed treatment of childhood ALL and this is currently being investigated in large prospective studies."nMethods: We have investigated MRD in bone marrow samples by three color flowcytometry approach in 63 pediatric B-precursor ALL patients treated according to BFM ALL 95 protocol. Bone marrow samples were collected from children at three different times including: Day 28th, At the beginning of intensified therapy and at the end of therapy .Cells with leukemia associated Immunophenotype were investigated by DNA analysis for evaluation of DNA content."nResults: Among 63 children with diagnosis of B-lineage ALL and quantified for post induction residual disease study .We observed that the mean number of blast cells have significant differences among these groups. The mean number of Leukemic blasts counted on day 28 was 2.7± 0.4, at the beginning of intensified therapy 1.7±0.4, and at the end of treatment 0.5±.2. These patients were in complete re¬mission in light microscopy examination. Relapse of ALL was demonstrated in six of 63 children (9.5%) whose MRD were more than one blast in 10-2 cells .Comparing this to light microscopic exami¬nation dill of these patients had 4-5% blasts vs. 1% for those who did not relapse. Conclusion: MRD analysis does have a useful role in the risk directed treatment of child hood ALL and the investigation of levels and the dynamics of MRD by sensitive and quantitative flowcytometry and PCR methods reduce false negative results. However a good morphology is also valuable.