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AIM: Assess the microbiology and treatment outcomes of post-traumatic osteomyelitis (PTO) patients in Medecins Sans Frontieres (MSF) supported reconstructive surgical facilities in Gaza, pre-October 7, 2023, and identify recurrence risk factors. BACKGROUND: PTO is common among war-wounded in conflict-affected settings in the Middle East. The ongoing war in Gaza since October 2023, has severely disrupted healthcare, increasing suspected and sub-optimally treated PTO, and related literature is scarce. METHODS: Two-centre retrospective cohort study including PTO patients diagnosed by microbiological confirmation via bone biopsy and treated between December 6, 2018 and September 8, 2021, with follow-up until January 31, 2022. Differences between multi-drug resistant (MDR) and non-MDR, polymicrobial and monomicrobial PTO were assessed. Predictors of recurrence were identified using cox proportional hazards multivariate regression. RESULTS: 202 patients with 275 PTO episodes and 441 isolates were included. MDR was present in 53% of episodes; 43% episodes were polymicrobial; recurrence occurred in 26%. Twenty patients (10%) underwent amputation. Staphylococcus aureus was the most prevalent (35%) isolate (62% methicillin-resistant), followed by 13% Enterobacterales (59% extended-spectrum beta-lactamase producers), 10% Pseudomonas aeruginosa and 3% Acinetobacter species. The 6-month survival (recurrence-free) probability was 79% (95% CI: 73-86) decreasing to 56% (95% CI: 47 - 68) by 24 months. Significant risk factors of recurrence included up to 3 procedures, fibula fractures, PTO with Enterobacter cloacae or Staphylococcus aureus. CONCLUSIONS: Managing PTO in Gaza is complex. Rebuilding the healthcare system, strengthening local capacities, ensuring access to necessary resources are essential for the long-term management of PTO in Gaza.

Introduction: Caries happen by the interaction between microorganisms causing caries and carbohydrates on the tooth surface. Studies show the presence of Streptococcus mutans and Lactobacillus acidophilus bacteria in caries lesions. Considering the relative resistance to antibiotics among bacteria and given the antibacterial effect of Citrullus Colocynthis, this study aimed to evaluate the antimicrobial effect of this plant.Materials and Methods: After preparing the extract by the maceration method, serial dilutions of 1:2, in which each concentration contains an active ingredient equal to half of its previous concentration, were prepared from 16384 to 8 µg/ml. Afterward, in each plate, 100 μl of different concentrations of extracts, culture medium (2×), and standard bacterial suspension were added. The plates were incubated in an anaerobic jar at 37°C for 48 h. Following that, minimum inhibitory concentration was determined by observation.Results: Ethanolic extract inhibited the growth of Lactobacillus acidophilus at the concentration of 16384 µg/ml, and the aqueous extract inhibited the growth at the concentrations of 16384 and 8192 µg/ml. The ethanolic and aqueous extracts inhibited Streptococcus mutans growth at the concentrations 16384 and 8192 µg/ml. Conclusion: The inhibitory effect of ethanolic and aqueous extracts of Citrullus colocynthis on Streptococcus mutans was the same, and considering that only very high concentrations have antibacterial effects, none of the extracts had antibacterial effects on this bacterium. Regarding Lactobacillus acidophilus, none of the extracts had antibacterial effects on this bacterium.

Splenic abscess in the setting of salmonella infection is a rare entity, which has been reported during the course of typhoid fever. We describe the presentation of a healthy 11 year-old boy who had abdominal pain, incidental finding of splenic cyst and who developed Salmonella enteritidis gastroenteritis and splenic abscess shortly following laparoscopic removal of the splenic cyst. We review 11 additional cases of nontyphoidal salmonellae splenic abscesses in pediatric patients. Keywords: Salmonella entiritidis, Splenic cyst, Splenic abscess

Olanzapine (OLZ) is a commonly prescribed drug for the treatment of schizophrenia and related disorders. However, OLZ use is associated with several adverse effects, including decreased locomotor activity and increased body weight. While the majority of studies have directed their focus towards managing the metabolic side effects of OLZ, there has been limited attention given to the effects on locomotor activity. This study aimed to investigate the potential therapeutic effect of hyperbaric oxygen therapy (HBOT) in alleviating OLZ-induced locomotor impairment in female Sprague Dawley rats. Subjects were divided into four groups: control rats (CR), HBOT, OLZ, and HBOT + OLZ. In addition to behavioral effects, we also evaluated the total antioxidant capacity (TAC) of rats’ brain tissue to demonstrate the maintenance of OLZ effectiveness in improving antioxidant status during the intervention using a rotarod device to measure locomotor activity and coordination. Results showed that HBOT effectively counteracted the hypolocomotion produced after OLZ administration. Moreover, HBOT did not result in a decrease in TAC in brain tissue, which is linked to OLZ treatment effectiveness. Therefore, our results suggest that HBOT may represent a promising non-pharmacological approach to improving locomotor and motor coordination impairments associated with OLZ treatment.

Background: Cockroaches play a role in the mechanical transmission of microbial pathogens. This study was designed to determine the isolated bacteria and their susceptibility to conventional antibiotics from brown-banded cockroach, Supella longipalpa, in Qom province, central Iran. Methods: In this cross-sectional study, brown-banded cockroaches were bred in an insectary and caught from hospitals of Qom. The samples were taken from the surface and alimentary canal and then cultured on microbial culture media; next, grown specimens were identified using differential culture media. Finally, after performing diagnostic tests and identifying the bacteria species, their susceptibility to various antibiotics was evaluated. Results: A total of 120 adult cockroaches from the insectary and hospitals were included in the study. Ten bacterial genera were found; nine were Gram-negative and one was Gram-positive. The genus Klebsiella, Enterobacter, Staphy­lococcus, Citrobacter and Hafnia were isolated only from the hospital strain. On the other hand, Pseudomonas and Escherichia from both groups and other species such as Salmonella, Proteus and Shigella were isolated only from la­boratory strains. The highest antibiotic resistance among Gram-positive cocci and Gram-negative bacilli were 100.0% and 98.1% for ampicillin and Ceftazidime, respectively. Conclusion: The results of this study showed that various pathogenic bacteria harbored by brown-banded cockroaches. Moreover, it was found that most of these bacteria belong to the Enterobacteriaceae family, which can be pathogenic and thus threaten human health.

Abstract Background Immigration is considered as a risk factor of tuberculosis (TB). Qom province receives millions of pilgrims and significant numbers of immigrants each year. Most of the immigrants to Qom, arrive from neighboring TB-endemic countries. This study aimed to identify the current circulating Mycobacterium tuberculosis genotypes in Qom province using 24-locus MIRU-VNTR genotyping. Methods Eighty six M. tuberculosis isolates were collected during 2018–2022 from patients referring to Qom TB reference laboratory. The DNA of isolates was extracted and followed by 24 loci MIRU-VNTR genotyping which performed using the web tools available on MIRU-VNTRplus. Results Of 86 isolates, 39 (45.3%) were of Delhi/CAS genotype, 24 (27.9%) of NEW-1, 6 (7%) of LAM, 6 (7%) of Beijing, 2 (2.3%) of UgandaII, 2 (2.3%) of EAI, 1 of S (1.2%) and 6 (7%) did not match with profiles present in MIRUVNTRplus database. Conclusions About half of the isolates belong to Afghan immigrants; which warns health policy makers about the future situation of TB in Qom. Also, the similarity of Afghan and Iranian genotypes provides evidence that immigrants partake in the circulation of M. tuberculosis. This study underpin the studies about the circulating M. tuberculosis genotypes, their geographical distribution, the association of TB risk factors with these genotypes and the impact of immigration on the situation of TB in Qom province.

Abstract The presence and reactivation of oral lesions such as herpetic gingivostomatitis, erythema multiforme, and candidiasis in a COVID‐19 recovered patient could be related to COVID‐19s profound role in immune dysregulation or related therapies.

Background and Objectives: Cutaneous leishmaniasis is one of the common diseases between humans and animals that is considered a health problem in Iran and many countries around the world. Currently, glucantime is used to treat cutaneous leishmaniasis. Due to its high side effects and resistance, the use of alternative therapies, especially plants and natural compounds, has been highly recommended by researchers. The aim of this study is to investigate the effect of the methanolic extract of dandelion root (Taraxacum officinale) on Leishmania major in vitro techniques. Methods: In this experimental study, the extract was prepared by the Soxhlet method and to evaluate the effect of methanolic extract of dandelion root on L. major parasite at concentrations of 300-1200 mg/ml. Amphotericin B and distilled water were considered as positive and negative controls, respectively. Then, 106 live parasites were added to all tubes, and all groups were kept at 25 ±1 °C. At 24, 48, and 72 hours, the number of live parasites was counted by Trypan Blue using a neobar slide and light microscope (Hemocytometer method). Then Half-maximal inhibitory concentration (IC50) value for the above extract was calculated using SigmaPlot™ 13 software. All steps of the experiment were done in triplicate and the results were considered as average. Results: The IC50 content of methanolic extract of dandelion roots after 24, 48, and 72 hours on L. major were calculated to be 1.04, 0.9, and 0.68 µg/ml. The highest growth inhibition (100%) was observed at a concentration of 1200 μg/ml after 72 hours of exposure. There was a significant difference between the IC50 extract and amphotericin B drug after 24, 48 and 72 hours (P

Introduction: Olanzapine (OLZ) is one of the second-generation antipsychotics drugs (APDs) used to treat several psychiatric illnesses. Olanzapine treatment is often associated with many metabolic side effects in a dose dependent manner such as obesity, dyslipidemia and insulin resistance, induction of type II diabetes and acute pancreatitis in some patients.Methods: Hyperbaric Oxygen therapy (HBOT) was investigated as a tool to mitigate olanzapine metabolic side effects in rats. Thirty-six female Sprague Dawley (SD) rats were divided into 4 groups; rats on olanzapine treatment either exposed to hyperbaric oxygen therapy (HBOOLZ) or left without exposure (OLZ) then non-treated rats that either exposed to hyperbaric oxygen therapy or left without exposure (control). Rats received Hyperbaric Oxygen therapy for 35 days at 2.4 atmospheres absolute (ATA) for 2.5 h daily followed by intraperitoneal injection of olanzapine at 10 mg/kg or placebo.Results: Rats on either hyperbaric oxygen therapy or olanzapine had a significant loss in body weight. Olanzapine treatment showed a decrease in serum insulin level, triglyceride, highdensity lipoprotein (HDL) cholesterol, and lipase level but an increase in fasting blood sugar (FBS), insulin resistance index (HOMA-IR) and amylase, while rats’ exposure to hyperbaric oxygen therapy reversed these effects. The Pancreatic Langerhans islets were up-regulated in both hyperbaric oxygen therapy and olanzapine treatments but the combination (HBOOLZ) doubled these islets number.Discussion: This study advocated that hyperbaric oxygen therapy can be an alternative approach to control or reverse many metabolic disorders (MDs) associatedwith olanzapine treatment. In addition, it seems that hyperbaric oxygen therapy positively affect the pancreatic Langerhans cells activity and architecture.

Background and Objectives: Efflux pumps are among the main mechanisms for antibiotic resistance in Escherichia coli (E.coli) strains. The present study aimed to investigate the relationship between 5 efflux pump genes; acrA, acrB, emrA, emrB, and mdtk and fluoroquinolone resistance in E.coli isolated from patients with urinary tract infections. Methods: In this descriptive cross-sectional study, clinical samples were collected from several medical centers in Qom City, Iran, from June 2017 to September 2017. After the detection and primary identification of E.coli isolations using culture and biochemical tests, the antimicrobial susceptibility strains to the fluoroquinolones, such as Ciprofloxacin, Norfloxacin, Ofloxacin, and Levofloxacin were determined by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Identifying the genes encoding efflux pumps was performed in sensitive and resistant strains by Polymerase Chain Reaction (PCR) technique. Results: Of the collected 170 clinical samples, 100 strains of E.coli were isolated and identified based on phenotypic characteristics. Evaluating antibiotic susceptibility of the strains demonstrated that 63(63%) isolates presented resistance to fluoroquinolones. PCR assay demonstrated that the prevalence of acr- AB, emrAB, and mdtk genes among fluoroquinolones resistant isolates were equal to 100%, 98%, and 94%, respectively. Furthermore, the frequency of the mentioned genes in fluoroquinolone-sensitive isolates was measured to be 34.2%, 27.02%, and 13.5%, respectively. Conclusion: The present research results revealed that the presence of acrAB, emrAB, and mdtk efflux pumps genes is potentially a factor in resistance to fluoroquinolone antibiotics. The presence of these genes in sensitive strains may indicate that the genes are not transcribed or translated. According to the high resistance of E.coli strains to fluoroquinolone antibiotics, it is recommended that antibiotic susceptibility testing be performed before starting treatment.

Background and Objectives: According to hazardous infection possibility in patients with a weakened immune system, old adults, and children, microbial contamination in the waterlines of dental units has become a recent concern. The aim of the present study was to evaluate the microbial contamination in dental unit waterlines in the School of Dentistry, Qom University of Medical Sciences, Qom, Iran. Methods: This descriptive-analytical study investigated 94 water samples collected from three parts of each unit, including air/water syringe, turbine headpiece, and cup filler, in the School of Dentistry in 2019. The water samples were taken on Saturday and Wednesday before and 60 sec after flushing on the same unit. The samples were transported in closed sterile containers to the Microbiology Laboratory. All the samples were incubated on nutrient agar plates using the Spread plate technique. Subsequently, bacterial contaminations were counted and reported based on CFU/ml for every plate. The data were analyzed using the Kruskal-Wallis test and Wilcoxon signed-rank test by SPSS software version 25. Results: The total mean of the bacterial counts was reported as 16,457 CFU/ml. The pre-clinic and periodontics were reported with the highest and lowest bacterial counts, respectively. The mean of bacterial counts after flushing was significantly lower than that reported before flushing on the same unit (P

Introduction: Cryptococcus neoformans is an encapsulated fungal pathogen that causes life-threatening meningoencephalitis in immunocompromised patients. This yeast secretes several potent immunogenic proteins by secretory vesicular mechanisms, such as HSP70 chaperone. Methods: The PCR-amplified HSP70 gene was cloned into a PET-28a(+) expression vector. The purified recombinant HSP70 (rHSP70) was evaluated by western blotting using an anti-His Tag-HRP antibody and then used for immunization of a rabbit. The serum of the immunized rabbit was tested against the whole lysate of C. neoformans in ELISA. Results: The antibodies in the rabbit’s serum recognized lysate of C. neoformans yeast. The highest antibody levels were achieved after the third booster injection. Conclusion: The rHSP70 showed to be a reliable candidate for the designing and development of an ELISA kit for early detection of cryptococcosis, and to screen a large number of specimens.

Background and Aim: Middle East respiratory syndrome coronavirus (MERS-CoV) has rapidly spread throughout the Middle East since its discovery in 2012. The virus poses a significant global public health threat with potentially devastating effects. In this study, a recombinant adenoviral-based vaccine encoding the spike 1 (S1) subunit of the MERS-CoV genome was constructed, and its humoral, and cellular immune responses were evaluated in mice. Materials and Methods: Mice were immunized initially by intramuscular injection and boosted 3 weeks later by intranasal application. Expression of the S1 protein in the lungs and kidneys was detected using conventional polymerase chain reaction (PCR) and immunohistochemistry (IHC) targeting specific regions within the S1 subunit at weeks 3, 4, 5, and 6 after the first vaccination. Antigen-specific humoral and cellular immune responses were evaluated in serum and in cell culture following in vitro stimulation with a specific 9-mer epitope within the S1 protein (CYSSLILDY). Results: S1 protein expression was only detected by IHC in the kidneys of the Ad-MERS-S1 group at week 6 from first immunization, and in both lungs and kidneys of Ad-MERS-S1 group by conventional PCR at weeks 3 and 5 post-prime. The vaccine elicited a specific S1-immunoglobulin G antibody response, which was detected in the sera of the vaccinated mice at weeks 4 and 6 from the onset of the first immunization. There was a significant increase in the amount of Th1-related cytokines (interferon-γ and interleukin [IL] 12), and a significant decrease in the Th2-related cytokine IL-4 in splenocyte cell culture of the vaccinated group compared with the control groups. Conclusion: The results of this study suggest that this recombinant adenovirus vaccine encoding the S1 subunit of MERS-CoV elicits potentially protective antigen-specific humoral and cellular immune responses in mice. This study demonstrates a promising vaccine for the control and/or prevention of MERS-CoV infection in humans.

Background and Objectives: Staphylococcus aureus is one of the important causes of nosocomial infections. Resistance to various antibiotics, such as beta-lactams, aminoglycosides, and macrolides is one of the major problems in treatment and prevention of infections caused by this bacterium. Therefore, accurate determination of antibiotic susceptibility pattern of organisms isolated from patients can be beneficial in treatment and prevention of dangerous infections. The objective of this study was to isolate S. aureus bacterium and to determine the antibiotic susceptibility pattern of the isolated strains in patients referred to some treatment centers of Qom city. Methods: In this descriptive cross-sectional study, 340 clinical samples, were collected from September 2016 to July 2017. After isolation and primary identification of S. aureus isolates (using standard bacteriology methods), the isolated strains were confirmed by PCR technique and amplification of femA gene as a molecular diagnostic marker of S. aureus. Finally, antibiotic susceptibility pattern of the strains, was determined by disk diffusion method according to CLSI guideline. Results: Out of 340 clinical samples, 86 S. aureus strains were isolated and identified based on phenotypic characteristics. The femA gene was observed only in 45 strains (52.32%) based on molecular analysis. The results of the antibiotic susceptibility test showed that the highest resistance was to penicillin (86.04%) and the lowest resistance was to chloramphenicol (0%). Conclusion: The results of this study indicated that femA gene cannot by itself identify all the S. aureus strains. Also, with regard to the results of antibiogram test, it seems that antibiotic susceptibility test is necessary for S. aureus strains isolated from patients.

Background and Objectives: Bioremediation is a process to reduce toxic heavy-metals, such as arsenic, in the environment using microorganisms. This study aimed to isolate arsenic remediating microbial strains from garbage leachates and to evaluate the effects of several factors on bioremediation by isolated strains. Materials and Methods: After isolating arsenic-resistant bacteria from garbage leachates and determining their MIC values, Taguchi design of experiments was used to evaluate the effect of arsenic concentration, pH solution, temperature, and contact time on arsenic bioremediation by isolated bacteria. Results: The results revealed that 3 arsenic-resistant strains of genus Bacillus characterized as KL1, KL4, and KL6 had arsenic bioremediation activity. Based on the results, the highest bioremediation of arsenic by Bacillus sp. KL1 was obtained as 77% after 24 hours at 40°C, pH 5, and 150 ppm concentration. However, the maximum bioremediation of arsenic by KL4 (91.66%) and KL6 (88%) was achieved after 24 hours at 40°C, pH 5, and 60 ppm concentration and at 35°C, 90 ppm concentration, pH 5 after 36 hours, respectively. Conclusion: The results presented here may facilitate improvements in the eliminating arsenic from contaminated sites and reducing environmental pollutions.

Background and Objectives: Cutaneous fungal infections are common infections, which involve keratinized tissue (skin, hair, and nail). Dermatophytes are important and abundant cutaneous fungal agents. The aim of this study is to assess the epidemiology of dermatophytes and the prevalence of various type of tinea in Tehran province for better identification and treatment of patients. Methods: Five hundred and eight patients suspected to have dermatophyte infections, after clinical examination, were referred to mycology laboratory of Razi Hospital in Tehran city for definite diagnosis, and then using direct examination and slide culture technique, and finally molecular examinations, the causative fungus of infection was diagnosed. Data were analyzed by chi-square statistical test at the significance level of (p£0.05). Results: Of 161 obtained positive samples, 73 (45.3%) patients were female and 88 cases (54.7%) were male. The mean age of patients was 42 years. The most and least common types of tinea were tinea pedis with 71 cases (44.1%) and tinea faciei with one case (0.6%), respectively. Trichophyton mentagrophytes was the the most isolated species and the least was Microsporum ferrugineum. Conclusion: According to the results of this study, dermatophyte infections in different parts of the body, especially foot and groin, are considered as an important health problem in Tehran city. It seems that design and implementation of training programs with the purpose of primary and secondary prevention, especially for age group over 20 years, are necessary for reduction of cases of dermatophytosis.

Oral lichen planus (OLP) is a common chronic inflammatory disease affecting the oral mucosa. The pathogenesis of OLP is incompletely understood but is thought to be related to the immune system. As the oral cavity is a major reservoir and transmission gateway for bacteria, viruses, and fungi, the microbial composition of the oral cavity could play a role in the pathogenesis of OLP. However, limited by analytic technology and knowledge of the microbial community in the oral cavity, it is not yet clear which pathogens are associated with OLP. Next generation sequencing (NGS) is a powerful tool to identify pathogens for many infectious diseases. In this study, we compared the host cell gene expression profiles and the microbial profiles between OLP patients and matched healthy individuals. We identified the activation of the hepatocyte nuclear factor alpha (HNF4A) network in OLP patients and potential pathogens, including Corynebacterium matruchotii, Fusobacterium periodonticum, Streptococcus intermedius, Streptococcus oralis, and Prevotella denticola. Prevotella denticola is capable of activating the HNF4A gene network. Our findings shed light on the previously elusive association of OLP with various diseases like hepatitis, and indicate that OLP is a T-helper type 17 (Th17) mediated mucosal inflammatory process. The identified molecular pathways and microbes could be used to inform future investigations into OLP pathogenesis and to develop novel therapeutics for OLP treatment.

Background and Objectives: Invasive and non-invasive techniques are used to diagnose H. pylori infection. Some factors influence the choice of a diagnostic test, such as the sensitivity and specificity of the tests, the clinical circumstances and the cost-effectiveness of the testing strategy. The aim of this study was to reveal the relationship between different H. pylori infection diagnosis methods, and clarify the application scope of each diagnosis method. Materials and Methods: 91 patients were included in the study, and specimens including biopsies, blood and stool were taken. Biopsies were evaluated by hematoxylin and eosin, and Giemsa staining. A sequence of 294 bp in the ureC (glmM) gene was amplified. The rapid urease test (RUT) was performed using a non-commercial validated test. Stool samples were analyzed using a polyclonal ELISA stool antigen test. A serological assay for IgG antibodies was performed by a commercial Helicobacter pylori IgG ELISA kit. Results: According to the predefined criteria, a total of 46 (50.5%) patients tested were positive by at least 2 of the 3 biopsy- based methods. The best sensitivity (95.6%) belonged to histology and RUT. The sensitivities of other tests including PCR, serology and stool antigen test were 93.5%, 91.3% and 73.9%, respectively. RUT showed the best specificity (100%), and the specificities of the other tests, including PCR, stool antigen test, histology and serology, were 95.6%, 86.7%, 77.8% and 55.6%, respectively. Conclusion: In view of the better results obtained for invasive vs. non-invasive tests, for a more accurate diagnosis, it is advisable not to solely rely on non-invasive methods of H. Pylori diagnosis.

Background and objectives: Pyrococcus woesei is a hyperthermophilic archaea and produces a heat stable polymerase(Pwo polymerase) that has proofreading activity. Materials and Methods: In this study, this microorganism was cultured, its DNA was extracted and the pwo gene polymerase was cloned, expressed and purified. The DNA sequence of the cloned gene was verified by sequencing. The pwo polymerase gene consists of 2,328 bps (775 amino acids with about 90 kD molecular weight). Cloning was done by GATEWAY™ Cloning System and for purification of recombinant protein; His6x-Tag was added to the C-terminus of the recombinant protein. Results and Conclusion: We could purify Pwo polymerase enzyme by Ni-NTA resin. PCR assay showed that Pwo polymerase activity is comparable to a commercial Pfu polymerase activity.