First report of class 1 and class 2 integrons in multidrug-resistant Klebsiella pneumoniae isolates from northwest Iran

We investigated the prevalence of multidrug resistance, production of extended-spectrum β-lactamases (ESBLs), and presence of class 1 and 2 integrons in 150 clinical isolates of Klebsiella pneumoniae from northwest Iran by performing phenotypic confirmatory tests and polymerase chain reaction (PCR) analysis. Of the 150 isolates, 149 (99.3%) were multidrug resistant (MDR). Of the MDR isolates, 124 (83.2%) were ESBL positive. The results of the PCR analysis showed that 117 (78.5%) and 20 (13.4%) MDR K. pneumoniae isolates carried intI1 and intI2, respectively, and 16 (10.7%) MDR K. pneumoniae isolates contained the integrase genes of both class 1 and class 2. Resistance of the isolates to gentamicin, tetracycline, ceftazidime, cephalothin, chloramphenicol, and nalidixic acid was observed to be significantly associated with the presence of class 1 integrons; however, the resistance to tetracycline was observed to be associated with the presence of class 2 integrons alone. This study showed that integrons are widely prevalent in the clinical isolates of K. pneumoniae from northwest Iran, and that they may be playing an important role in attributing multidrug resistance to the clinical K. pneumoniae isolates. To the best of our knowledge, this is the first report showing the presence of class 1 and class 2 integrons in MDR K. pneumoniae isolates from clinical settings in northwest Iran.     

Role of Toll-Like Receptor 13 in Innate Immune Recognition of Group B Streptococci

Murine Toll-like receptor 13 (TLR13), an endosomal receptor that is not present in humans, is activated by an unmethylated motif present in the large ribosomal subunit of bacterial RNA (23S rRNA). Little is known, however, of the impact of TLR13 on antibacterial host defenses. Here we examined the role of this receptor in the context of infection induced by the model pathogen group B streptococcus (GBS). To this end, we used bacterial strains masked from TLR13 recognition by virtue of constitutive expression of the ErmC methyltransferase, which results in dimethylation of the 23S rRNA motif at a critical adenine residue. We found that TLR13-mediated rRNA recognition was required for optimal induction of tumor necrosis factor alpha and nitrous oxide in dendritic cell and macrophage cultures stimulated with heat-killed bacteria or purified bacterial RNA. However, TLR13-dependent recognition was redundant when live bacteria were used as a stimulus. Moreover, masking bacterial rRNA from TLR13 recognition did not increase the ability of GBS to avoid host defenses and replicate in vivo. In contrast, increased susceptibility to infection was observed under conditions in which signaling by all endosomal TLRs was abolished, i.e., in mice with a loss-of-function mutation in the chaperone protein UNC93B1. Our data lend support to the conclusion that TLR13 participates in GBS recognition, although blockade of the function of this receptor can be compensated for by other endosomal TLRs. Lack of selective pressure by bacterial infections might explain the evolutionary loss of TLR13 in humans. However, further studies using different bacterial species are needed to prove this hypothesis.     

Future Prospects for Human Tissue Engineered Urethra Transplantation: Decellularization and Recellularization-Based Urethra Regeneration

To evaluate the histological characteristics of decellularized human urethra after transplantation into the rat omentum and compare in vivo cell seeding with perfusion-based and cell sheet urethral regeneration. Eight adult human male urethras accompanied with the surrounding corpus spongiosum were obtained. The tissues were decellularized with detergent-based method. The efficacy of decellularization and extracellular matrix preservation was evaluated by several techniques. Decellularized scaffolds were transplanted into the omentum of 12 male rats and located into the scrotum. Biopsies were taken 1, 3, and 6 months postoperatively to assess the natural recellularization. Mesenchymal stem cells obtained from preputial tissue were seeded with perfusion-based and cell sheet techniques as well. Immunohistochemical staining with α-actin, cytokeratin AE1/AE3, synaptophysin, and CD31 antibodies were performed. Removal of nuclear components and preservation of biomechanical properties was confirmed. In-vivo recellularization revealed promising results in progressive angiogenesis and cell seeding of epithelium-like cells in the lining of the urethra as well as smooth muscle cells in the wall structure. In-vitro urethral regeneration revealed that cell sheet engineering was the technique of choice compared to perfusion-based technique. This study may paw the road for clinical application of acellular urethral matrix with the surrounding corpus spongiosum in urological reconstructive surgery.     

Multiple Sclerosis Presenting as a Delirium: A Case Report

Objective

To report a case of multiple sclerosis (MS) with delirium as the first presentation.

Clinical Presentation and Intervention

A 34-year-old female was referred to our department with an acute onset of drowsiness, withdrawal from routine activities and aggression, followed by neurologic deficits after a couple of days. Clinical and radiographic examinations were performed, leading to the initial diagnosis of MS. A vast range of differential diagnoses was excluded to confirm the diagnosis of MS.

Conclusion

Neurological examination and appropriate imaging enabled the diagnosis of MS with delirium in this patient followed by the appropriate treatment.Key Words: Multiple sclerosis, Delirium, Plasmapheresis     

N-Substituted pyrimidinethione and acetophenone derivatives as a new therapeutic approach in diabetes

In this study, compounds with 4-hydroxybutyl, 4-phenyl, 5-carboxylate, and pyrimidine moieties were determined as α-glycosidase inhibitors. N-Substituted pyrimidinethione and acetophenone derivatives ( A1 – A5 , B1 – B11 , and C1 – C11 ) were good inhibitors of the α-glycosidase enzyme, with K_i values in the range of 104.27 ± 15.75 to 1,004.25 ± 100.43 nM. Among them, compound B7 was recorded as the best inhibitor, with a K_i of 104.27 ± 15.75 nM against α-glycosidase. In silico studies were carried out to clarify the binding affinity and interaction mode of the compounds with the best inhibition score against α-glycosidase from Saccharomyces cerevisiae. Compounds B7 (S) and B11 (R) exhibited a good binding affinity with docking scores of −8.608 and 8.582 kcal/mol, respectively. The docking results also showed that the 4-hydroxybutyl and pyrimidinethione moieties play a key role in S. cerevisiae and human α-glycosidase inhibition.     

Ovarian vein thrombosis after coronavirus disease (COVID-19) infection in a pregnant woman: case report

Corona virus outbreak started in December 2019, and the disease has been defined by the World Health Organization as a public health emergency. Coronavirus is a source of deep venous thrombosis (DVT) due to complications such as over-coagulation, blood stasis, and endothelial damage. In this study, we report a 26-year-old pregnant woman with coronavirus who was hospitalized with a right ovarian vein thrombosis at Besat Hospital in Sanandaj. Risk classification for deep vein thrombosis (DVT) disease is of crucial importance for the forecast of coronavirus.