Medical Laboratory Journal

Prevalence and antibiotic resistance patterns of carbapenemase-producing organisms in burn and wound infections

Sarah Ahmed Hasan

Background: Carbapenems are broad-spectrum β-lactam antibiotics, often reserved as last-line treatment for infections caused by multidrug-resistant (MDR) Gram-negative bacteria. Carbapenemase producing organisms (CPOs) pose a serious public health threat, contributing to severe healthcare-associated infections and increased mortality rates. This study aimed to determine the prevalence of CPOs and their antibiotic resistance patterns in isolates from burn and wound infections.
Methods: A total of 250 clinical samples (140 wound swabs and 110 burn swabs) were collected from hospitalized patients in Kirkuk and Sulaimaniyah hospitals between January and July 2023. Specimens were cultured on MacConkey agar and cetrimide agar and incubated at 37°C for 18–24 hours. Bacterial identification and antimicrobial susceptibility testing were performed using the BD Phoenix™ M50 system, while carbapenemase production was confirmed using the BD RAPIDEC® CARBA NP assay.
Results: Among the isolates, 27 (38.02%) were confirmed as carbapenemase-producing and exhibited multidrug resistance. The distribution was as follows: Pseudomonas aeruginosa (44.44%, 12 isolates), Escherichia coli (33.33%, 9 isolates), Enterobacter cloacae (18.51%, 5 isolates), and Klebsiella pneumoniae (3.7%, 1 isolate). Notably, CP-P. aeruginosa and CP-K. pneumoniae showed the highest resistance, being resistant to 15 antibiotics across seven different classes.
Conclusion: This study reveals a high prevalence of MDR CPOs in burn and wound infections, likely due to antibiotic misuse or overuse. The findings highlight the urgent need for novel therapeutic strategies to combat carbapenem-resistant pathogens, which are associated with increased global morbidity and mortality.

Prevalence and trends of hepatitis B infection among blood donors

Yashica Gowda R

Background: The significance of blood transfusion is best captured by the phrase, "It's not just blood-it's liquid life." However, without proper safety measures, transfusion carries serious risks, including the transmission of highly infectious diseases. Among these, hepatitis B virus infection poses a major public health threat due to its high infectivity, potential for chronic infection, and severe complications. Despite the availability of an effective vaccine, hepatitis B virus remains a persistent challenge in transfusion medicine, underscoring the need for stringent screening and preventive strategies. This study aimed to determine the trend of hepatitis B surface antigen (HBsAg) seropositivity among the blood donor population over five years and its prevalence among voluntary and replacement donors.
Methods: This study was conducted at a licensed blood center of a tertiary care hospital. A retrospective review of blood donor data over five years was extracted. All donated blood was screened for the presence of HBsAg using commercially available ELISA kits. All repeatedly reactive samples were labelled seropositive. The data were analyzed for trends in the prevalence of HBsAg over the study period.
Results: A total of 18,139 healthy donors were screened during the study period. Among them, 11,517 were replacement donors and 6,622 were voluntary donors. The overall prevalence of HBsAg seropositivity was 0.66%, which was higher in replacement blood donors (0.46%). A decline in the incidence of HBsAg among donors was also observed over the five-year study duration.
Conclusion: Promoting and encouraging voluntary blood donation is a simple and effective way to reduce the prevalence of all transfusion-transmitted infections.

Plasma parathyroid hormone levels and bone-associated biomarkers in postmenopausal women: Insights into osteoporosis risk assessment

Atere Adedeji David

Background: Menopause, characterized by the cessation of menstrual periods, often leads to bone diseases due to hormonal changes, particularly affecting calcium metabolism. This study aimed to evaluate bone-associated biomarkers and their correlation with parathyroid hormone (PTH) levels in postmenopausal women, shedding light on potential osteoporosis risks.
Methods: Sixty postmenopausal (PMP) women, along with 20 premenopausal (PRM) and 20 reproductive-age (RWA) women as controls, were included in this cross-sectional study. Blood samples were analyzed for PTH, vitamin D, uric acid, calcium, phosphorus, alkaline phosphatase (ALP), and estradiol levels.
Results: Statistical analysis revealed significantly higher levels of ALP and phosphorus, and lower levels of calcium, PTH, vitamin D, uric acid, and estradiol in PMP and PRM groups compared to RWA (p <0.05). Moreover, PTH had a significant negative correlation with ALP, and phosphorus; however, it had a positive correlation with calcium, vitamin D, and estradiol in PMP women. ALP demonstrated a superior area under the receiver operating characteristic curve (AUC-ROC) compared to other bone-associated markers.
Conclusion: These findings highlight the reduced bone-associated biomarker levels in postmenopausal women, potentially increasing the risk of bone loss and osteoporosis.

Burkholderia cepacia complex: An outbreak in the neonatal intensive care unit of a tertiary care hospital in central India

Shayosree Sarkar

Background: Burkholderia cepacia complex (BCC) is an opportunistic nosocomial pathogen known to cause severe infections in neonates, including those affecting the respiratory and urinary tracts, as well as bloodstream infections. Consequently, BCC has the potential to instigate outbreaks originating from various sources. This study was undertaken to facilitate the early detection and effective control of a BCC-related outbreak.
Methods: A cross-sectional study, conducted in July 2023 at a tertiary care hospital, investigated bacterial isolates from neonates. Over a one-month period, eleven neonates' blood cultures grew motile, oxidase-positive, non-fermenting gram-negative bacilli. These isolates were presumptively identified as BCC based on conventional biochemical tests and their antimicrobial susceptibility profiles. The recurring isolation of an identical bacterial strain within the neonatal intensive care unit (NICU) strongly suggested an ongoing outbreak. Consequently, active surveillance was initiated to identify the source of the infection and implement containment measures. The identity of the isolated strains was subsequently confirmed using the VITEK 2 Compact microbiology analyser (BioMérieux, France).
Results: Surveillance identified the BCC sources for all 11 affected neonates. The investigation traced the infection origins to several environmental factors within the healthcare setting, including intravenous (IV) catheters and neonatal cradles, operating theatre (OT) beds, and instrument trolleys in the labour room where the deliveries occurred. Furthermore, all environmental BCC isolates demonstrated genetic relatedness to the clinical isolates concurrently exhibiting a similar antibiotic susceptibility pattern. Timely interventions were instrumental in controlling the outbreak.
Conclusion: This study highlights the critical role of the hospital infection control team in effectively managing a BCC outbreak among neonates.

Comparative study of microwave tissue processing versus conventional tissue processing

SreeRekha Jinkala

Background: Conventional Tissue Processing (CTP) is the gold standard method for tissue processing; however, the method is relatively time-consuming. Microwave Tissue Processing (MTP) reduces the turnaround time and gives comparable histomorphology to CTP. The objective was to compare the Laboratory-grade Microwave Processing (LMP) and Domestic Microwave tissue Processing (DMP) with CTP in terms of histomorphology and immunohistochemistry (IHC) staining.
Methods: Three tissue bits from 89 formalin-fixed resection specimens received in the histopathology laboratory were processed by CTP, LMP, and DMP processing methods. The specimens were fixed in 10% neutral buffered formalin for 24 hours. The sections were stained with Hematoxylin and Eosin (H and E) stain. In subgroup analysis, IHC was done on 17 relevant cases using two antibodies, Ki67 (Nuclear) and Pancytokeratin (Membranous and cytoplasmic). Parameters such as the clarity of section, cytoplasmic details, nuclear details, color intensity, and interface of epithelium and connective tissue were studied. Parameters like color intensity, localization of antigen, background staining, and crispness of staining were studied on IHC. The results were analyzed using Kappa statistics.
Results: There was a fair to moderate agreement between CTP and LMP. There was a slight to fair agreement between CTP to DMP and LMP to DMP.
Conclusion: Microwave tissue processing reduced the turnaround time. The overall quality of LMP tissue was better than DMP and was equally good as that of CTP.

Stressor marrow response in the case of neonatal sepsis – Significance of nRBCs in peripheral smears

Neema Tiwari

Background: Nucleated red blood cells (nRBCs) are immature erythrocytes whose production is thought to be driven primarily by the interplay of hypoxia and erythropoietin synthesis. Neonatal sepsis is classified as early-onset (occurring within the first 24 hours of life) or late-onset (Occurring after 48-72 hours). The aim of this study was to analyze the cause for the presence of nRBCs in the peripheral blood of neonates sent for routine workup in the Hematology Laboratory of the Department of Pathology, SMSR, Sharda University.
Methods: Retrospective analysis of 27 complete blood counts and peripheral blood smears of neonates was conducted over one month. Smears had been prepared and stored for examination, and reports had been dispatched. Clinical details (As available from clinicians), parameters for neonatal sepsis (NLR, PLR, IG), platelet counts, and nRBC counts were recorded and tabulated. For result tabulation, neonatal samples were divided into two groups: 0-1 day and 2-30 days.
Results: The neonates included 17 males and 9 females. Assessment of NLR, PLR, and IG indicated higher values in the 2-30-day group compared to the 0-1-day group. Moreover, nRBCs were also elevated in the 2-30-day group.
Conclusion: The presence of nRBCs in peripheral blood smears is an important indicator of neonatal stress, including sepsis, jaundice, and hypoxic sepsis.

Red blood cell alloantibodies in patients with thalassemia major referred to the blood transfusion center of Golestan province, Iran

Seyed Sadegh Baniaghil

Background: One of the major complications in thalassemia patients is alloimmunization, which occurs when the patient produces antibodies against transfused Red Blood Cells (RBCs). In the present study, the frequency of alloantibodies was investigated in patients with thalassemia major.
Methods: This cross-sectional retrospective study was performed on 99 multi-transfused patients with thalassemia major. An antibody screening test was carried out using a three-cell panel. Positive patients were followed up for antibody identification using an 11-cell panel. The information was finally analyzed using SPSS software version 16.0.
Results: Out of ninety-nine cases, 53 were female (53.53 %) and 46 were male (46.46 %). The patient’s mean age was 29.22±10.46 years with an age range of 2 to 61 years. Only 5.05% (n=5) had developed alloantibodies. The most common alloantibodies were anti-D, anti-E, anti-c, and anti-K. No significant correlation was seen between the presence of alloantibody and age, sex, blood type, and spleen condition.
Conclusion: Antibody production against RBC antigens is a common problem in multi-transfused thalassemia patients. Compatibility between antigens of the Kell and Rh blood group systems in donors and recipients can be one of the useful ways to prevent alloimmunization of blood recipients and the formation of unexpected antibodies against the donor’s red blood cells.

Effect of a period of intense functional training on IL-10, Dectin-1, and IL-1Ra in prediabetic obese women

Hajar Abbaszadeh

Background: Obesity and prediabetes are associated with chronic low-grade inflammation, and macrophage-related markers such as IL-10, Dectin-1, and IL-1Ra play a key role in modulating inflammatory responses. The purpose of this study was to investigate the effect of a period of high-intensity functional training (HIFT) on IL-10, Dectin-1, and IL-1Ra in prediabetic obese women to assess the impact of this exercise modality on M2 macrophage markers.
Methods: Thirty eligible female volunteers aged 35-40 years were selected and homogeneously divided into two groups: 1) control (n=15) and 2) training (n=15). The training group underwent a 16-week HIFT program based on CrossFit protocols, incorporating squats, deadlifts, barbell/dumbbell exercises, kettlebell swings, and aerobic/weight-bearing movements in a Workout of the Day format (60 min/session). The control group maintained their daily routines without structured exercise. Serum levels of Dectin-1, IL-10, and IL-1Ra were measured via ELISA. Descriptive statistics (Mean, standard deviation) were used for data analysis.
Results: After 16 weeks, HIFT significantly reduced Dectin-1 (P = 0.048) and increased IL-10 (P < 0.0001) and IL-1Ra (P < 0.0001) levels in prediabetic obese women.
Conclusion: These findings suggest that 16 weeks of HIFT may enhance anti-inflammatory markers (IL-10, IL-1Ra) and modulate Dectin-1, potentially mitigating obesity-related inflammatory complications in prediabetic women.

Comparative analysis of antibacterial activity and chemical composition of essential oils from Salix aegyptiaca male inflorescences and leaves

Mojtaba Raeisi

Background: Due to the growing problem of antibiotic-resistant bacteria and rising consumer preference for natural food preservatives, there is an increased interest in plant-based antimicrobial agents. While Salix aegyptiaca (S. aegyptiaca), also known as Musk Willow, is a promising source of bioactive compounds, its antibacterial properties have not been extensively studied. Therefore, this research investigates the chemical composition and antibacterial effectiveness of essential oils extracted from the leaves and male inflorescences of S. aegyptiaca against important foodborne pathogens like Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Listeria monocytogenes (L. monocytogenes), and Salmonella enteritidis (S. enteritidis).
Methods: Essential oils were extracted from the leaves and male inflorescences of S. aegyptiaca through hydrodistillation. The chemical composition of these oils was then determined by gas chromatography-mass spectrometry (GC-MS) to identify their bioactive constituents. The antibacterial efficacy of the extracted oils was assessed using several methods, including the determination of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC), as well as diffusion assays (Agar disk and agar well diffusion).
Results: GC-MS analysis revealed that the leaf oil was predominantly composed of 1,4-dimethoxybenzene, citronellol, and eugenol, whereas carvone was the main constituent of the male inflorescence oil. The leaf oil demonstrated superior antimicrobial activity, particularly against S. aureus, for which the MIC was determined to be 1250 µg/mL. Both oils indicated limited efficacy against Gram-negative bacteria. Of the strains tested, S. aureus proved to be the most susceptible, while E. coli exhibited the highest resistance.
Conclusion: The essential oils extracted from S. aegyptiaca, especially from its leaves, have shown significant antibacterial effects against common foodborne pathogens. This suggests they could be used as natural food preservatives, offering a viable alternative to synthetic additives. Additional research is necessary to investigate their use in food products and to establish their toxicological safety.

Antibiotic resistance genes in helicobacter pylori isolates from gastric biopsies of patients with gastrointestinal diseases in Golestan province, Iran

Ailar Jamalli

Background: Antibiotic resistance in Helicobacter pylori infections can lead to treatment failure. This study aims to evaluate the antibiotic resistance to metronidazole, clarithromycin, and fluoroquinolone in H. pylori strains isolated from gastric biopsy specimens.
Methods: This study was conducted between 2016 and 2017 on 80 biopsy specimens obtained from Golestan province. Resistance to metronidazole (rdxA) and fluoroquinolones (gyrA) was determined using PCR. Mutations in the loci of the 23S rRNA gene associated with clarithromycin resistance were analyzed using PCR-RFLP with the BsaI and BbsI enzymes.
Results: In this study, 25% of H. pylori strains showed resistance to clarithromycin. Mutations in the A2143G locus (65%) and the A2142G locus (35%) were detected in these strains. Resistance to fluoroquinolones (27.5%) was observed, with the most common mutations being at the 91 amino acid position of aspartate (63.63%) and the 87 amino acid position of asparagine (36.36%). Resistance to metronidazole was not observed in any of the strains of this study, and concomitant resistance to clarithromycin and fluoroquinolones was observed in 13.75% of H. pylori strains.
Conclusion: According to our study, in Iran, the resistance of H. pylori to clarithromycin is increasing, which may lead to treatment failure. The mechanism of clarithromycin resistance is related to mutations in the A2143G and A2142G positions, and a mutation in the gyrA gene causes resistance to fluoroquinolones, which often occurs in the 91 amino acid position.