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

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

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

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

Aim: This study evaluated the frequency of C. difficile and CDAD in the ICU of Shahid Bahonhar Hospital, Kerman, Iran., Background: Clostridium difficile ( C. difficile ) is the most important antibiotic associated diarrhea agent in intensive care unit (ICU) patients. Based on its toxin producing ability, C .difficile is divided to toxigenic and non-toxigenic strains., Methods: A total of 233 diarrheal samples were collected from ICU patients. The samples were cultured on Clostridium difficile medium with 5% defibrinated sheep blood containing cycloserine (500 mg/L), cefoxitin (16 mg/L) and lysozyme (5mg/L). The isolates were confirmed as C. difficile by polymerase chain reaction (PCR) of 16s rRNA gene and the presence of toxins genes (tcdA, tcdB, cdtA and cdtB) was also confirmed. Then, the toxin production of isolates was evaluated using ELISA., Results: C. difficile was isolated from 49 (21%) out of 233 samples. The total isolates fell into the A-/B-/CDT- (48.97%), A+/B-/CDT- (28%), A+/B+/CDT- (20.4%) and A+/B+/CDT+ (2%) types. Both types of C.difficile, A-/B-/CDT- and A+/B-/CDT-, which account for 77.5% of all isolates, were unable to produce the toxin (nontoxigenic). On the other hand, A+/B+/CDT+ and A+/B+/CDT- (22.5%), were able to produce toxin or were toxigenic., Conclusion: The frequency of C. difficile was about 21% and only 22.4% of C. difficile isolates were able to produce toxins. It is expected that C. difficile A+/B+/CDT± are toxigenic and related to C. difficile associated diarrhea (CDAD). Additionally, about 4.7% of hospitalized patients in ICU suffered from CDAD, which is higher than the rates reported from industrialized countries. Notably, 28% of isolates were C. difficile A+/B-/CDT- which only carries tcdA genes without toxin production., Competing Interests: The authors declare that they have no conflict of interest.

Aim: The aim was to evaluate the level of interleukin 8 (IL-8), transforming growth factor β1 (TGF β1) and Nitric oxide (NO) in diffuse axonal injury (DAI) and its association to the outcome and clinical status., Material and Methods: This cross-sectional study was conducted on 20 patients with DAI and 20 patients with multiple traumas without head injury and 20 healthy subjects as controls. Blood levels of IL-8, TGF β1 and nitric oxide in the 1st, 2nd, 3rd and 7th days of injury were measured. Glasgow coma scale (GCS) of patients was recorded. The patients' outcome was evaluated by Glasgow Outcome Scale (GOS)., Results: The level of TGF β1 was increasing during the admission and had the maximum level at the 7th day. In the DAI group, there was significant correlation between GOS score and serum IL-8 at 7th day of admission (r=-0.68, p= 0.002). In this group the GCS was found to be significantly correlated with the IL-8 concentration at 7th day of admission (p= 0.026, r=-0.55)., Conclusion: IL-8 has negative correlation with GCS and GOS. TGF β1 could protect the brain from cytotoxics, hypoxia and acidosis so its level comes down in brain injuries as a result of its overuse.