مجله مطالعات علوم پزشکی
سال سی و چهارم شماره 9 (آذر 1402)

New hypervirulent strains of Klebsiella pneumoniae have emerged in recent years and have led to life-threatening infections in young and healthy people. The aim of the present study was to determine the hypervirulence of Klebsiella Pneumoniae strains producing carbapenemase and Extended-Spectrum Beta-Lactamase (ESBLs) isolated from hospitals of Rasht, Iran.

This cross-sectional study was conducted on clinical samples isolated from inpatients in Razi, Poursina, Rasoul Akram, Golsar and Al-Zahra hospitals in Rasht. Standard microbiology and molecular methods were used to confirm the identity of Klebsiella pneumoniae isolates. String test was used to identify hypervirulent strains. CDT test was used to phenotypically determine ESBL producing strains. Then, determining the presence of the gene encoding carbapenemase (NDM-1) as well as typing of hypervirulent strains was done by PCR method.

In this study, 158 Klebsiella pneumoniae strains isolated from different samples were collected and analyzed. In total, 55 isolates (34.8%) had positive string test and were identified as hypervirulent. Among 55 Klebsiella pneumoniae isolated strains, 16 (29.1%) were determined phenotypically as ESBL producers. The results showed that only 2 isolates (3.6%) had NDM-1 gene. Also, the frequency of common sequence types in hypervirulent isolates were 9.1% for ST258, 9.1% for ST86 and 3.6% for ST23; ST65 was observed in none of the isolates.

The present study showed significantly high prevalence of hypervirulent Klebsiella pneumonia strains with the ability to produce ESBLs and carbapenemase. Undoubtedly, the emergence of high-risk strains in the region in the future is a serious threat to the health system.

Letter to the Editor
The Association of Medical Education of Europe (AMEE), which is the European regional association of the World Federation for Medical Education and one of the six members of the executive council of this federation, was established in 1972 in Copenhagen to facilitate communication between medical science teachers and promote the national medical education associations of countries in Europe. Every year, this association organizes international conferences on various topics of medical science education hosted by one of the European countries. This year the international conference also held in Glasgow, Scotland (1). With the efforts of the Ministry of Health, Treatment and Medical Education of Iran, and especially, the Smart University of Medical Sciences, this international conference was broadcast online from August 28 to 30, 1402 in 15 universities of medical sciences in Iran, including Urmia University of Medical Sciences. In this article, we will reflect this event.
Reflection is described as a group of effective intellectual activities in which people explore their experiences to gain new understanding. Reflection is a process of learning from experience (experiential learning) whereby new understanding and knowledge are developed through action (2). The reflection of any occurrence and experience can be written in the form of a reflection paper (3). This universal conference, which was held both online and in person, included various educational programs in the field of medical education. In its online broadcast, we saw the active participation of faculty members at Urmia University of Medical Sciences. In terms of access to conference content and programs, it was possible to use online broadcastings of symposiums and plenary plans. Programs were executed and displayed on the platform of Swapcard software.
Although it was not possible to interact directly with the conference venue, However, the topics presented in the conference were explained and explained to the academic staff members participating in the conference during the breaks and opportunities during the programs by medical education specialists, and at the same time as the conference, they answered the professors' questions and clarified the subjects.
Based on the reflection and criticism of this educational event, as well as the survey conducted by the participating faculty members, it seems that this conference has had beneficial achievements, despite the limitations, especially in accessing the content. Among them, this need was felt by the faculty members present at the conference that they should empower themselves more in terms of educational aspects and the science of medical education as well as in terms of English language skills. Another critical issue is the need to establish scientific communication and interactions with the world. Even if this communication is limited and virtual, it will still show positive and effective results. Simultaneously, by rethinking this educational event, we realize that educational problems exist everywhere in the world; even in many cases, these problems are similar and therefore it is necessary to examine and evaluate them in order to think of solutions for them.
Another issue that emerges from reflection of this event is that in conferences and similar events, the importance of interaction and communication is much stronger and more mandatory from the learning aspect. Although learning is a principle, learning how to communicate with the world, observing the way of behavior and educational and moral patterns, the interest of faculty members in education, and observing the way of presenting content and the skills of expressing the content are all subjects that are unconscious and tacit knowledge that is learned. The important points of holding this educational event can be used as a model for holding other similar events at Urmia University of Medical Sciences.
Another effective and informative outcome of this conference was understanding the necessity and methods of documenting events and experiences. At this conference, all the executive and scientific activities and processes in the university were documented and recorded, and in a way, it became an exercise for the future. The documents included photos and videos from the venue of the conference in the university, survey forms, attendance and interview forms with the participants, correspondence, letters and emails, etc., all of which were recorded.
The experience of this international educational event showed how much the science of medical education requires expertise, interest, and deepening. While there are educational challenges everywhere, the solution is not to give up on them contrary to strive and become more aware. Establishing communication is a vital principle in learning, whether it is the connection at the classroom level between a teacher and a student or at an international level during a conference. For this reason, it is necessary to extend and generalize the lessons of the conference to more and other levels consequently that we can finally ensure the quality of our education, which will subsequently lead to the improvement of health and the quality of patient care, which is the ultimate goal of medical education.

Crack is a solid salt processed with sodium bicarbonate from cocaine. Methamphetamine is a derivative of methylamphetamine, which is highly addictive. The current study aims to investigate the effect of intraperitoneal injection of crack cocaine and methamphetamin over the parameters of blood creatinine, urea, sodium, and potassium as indicators of kidney failure in male rats.

This experimental study was carried out over seven groups of 6 male rats, including a control group, three crack-cocaine experimental groups, and three methamphetamine experimental groups, each of them receiving concentrations of 5, 10, and 15 mg/kg of crack-cocaine or methamphetamine respectively for 7 days (once a day). After the drug injection, blood was taken from the hearts of the rats and the parameters of urea, sodium, potassium, and creatinine were measured and analyzed from the blood samples taken. Statistical analysis of the data was done with the one-way analysis of variance and Tukey's post hoc test via SPSS.

The injection of low and medium concentrations of two drugs, crack cocaine and methamphetamine, had no significant effect on the mentioned parameters (P > 0.05), and only the medium concentration of methamphetamine caused the amount of blood potassium to increase compared to the control group (P < 0.05). Injection of 15 mg/kg concentration of both drugs significantly increased the amount of blood creatinine in the respective groups (P < 0.05).

The increase in plasma creatinine due to the administration of methamphetamine and crack-cocaine may be caused by acute renal failure, rhabdomyolysis, or the induction of acute interstitial nephritis.

Different surfaces have different effects on body mechanics during walking. The aim of this study was to evaluate ankle joint co-contraction in individuals with healthy and supinated feet during walking on artificial turf and stable ground.

This study was a semi-experimental and laboratory one. The statistical population included 10 individuals with supinated feet (mean age of 22.1± 2.2 years) and 10 individuals with healthy feet (mean age of 24.2± 3.3 years). The electrical activity of selected lower limb muscles was recorded using electromyography system during walking. Two ways ANOVA with repeated measure test was used for statistical analysis using SPSS 20 software at significant level of 0.05.

Results showed that the main effect of surface (P=0.035) and group (P=0.000) on general ankle co-contraction was significant during loading phase. General ankle co-contraction during loading phase while walking on artificial turf was greater than walking on the ground. Differences between other directional and general co-contraction components in other phases during walking on artificial turf and stable ground were not significant (P<0.05).

General co-contraction values of muscles during walking on artificial turf were greater than walking on the stable ground. Increased general co-contraction may be associated with instability of the surface. Nevertheless, to prove this as well as possible, it is necessary to conduct more research in the future with larger statistical populations.

Romiplastim is a fusion protein that has the same function as thrombopoietin in the body and thereby, stimulates bone marrow to produce more platelets. Thrombopoietin is a hormone that controls the production of platelets. Romiplastim is used in the treatment of thrombocytopenia in patients with chronic immune thrombocytopenia (ITP) when other drugs like corticosteroids and immunoglobulins or splenectomy have not treated them. The aim of this study was cloning and optimization of gene expression conditions and purification of recombinant Romiplastim peptibody in Escherichia coli bacteria.

In this practical study, the independent variables used included the amount of ODs (0.4, 0.8 and 1.2) at a wavelength of 600 nm, IPTG concentration (0.5, 1 and 1.5 mM) and the type of culture medium (LB, TB, M9). The Response Surface Methodology (RSM) was used in the form of central composite design with Design-Expert 12 software to predict independent variables on the amount of romiplastim production.

OD equal to 0.8, IPTG concentration equal to 1 mM and LB culture medium were optimized for the production of recombinant Romiplast peptibody.

Since the optimal production of peptibody was desired, cloning and optimization of conditions of gene expression and purification of Romiplastim peptibody in BL21 strain of Escherichia coli bacteria were done with the most optimal conditions which were done by RSM. Also, for correct folding of the protein, the refolding step was used at the beginning of the purification. Medicinal proteins play an important role in modern molecular medicine treatments.

The importance of "publish or perish" in academic contexts, especially for faculties and graduate students, is an undeniable problem because of its role in determining university achievement around the world. To deal with such problems, academic writers must be fluent in language repertoires (e.g., lexical bundles), which are an essential component of scholarly writing and necessary for creating publishable research articles (RAs).

Hence, the present study reviews 85 empirical RAs that have been done to extract highly frequent 4-word lexical bundles (LBs) published between 2008 and 2021 in ISI and Scopus-indexed journals across various hard sciences disciplines including medical sciences. Additionally, it offers a list of the general academic four-word LBs in the various sections of hard sciences RAs that can be used as a reference list of general LBs for scholarly writing in hard sciences.

The review revealed that in each discipline, the experts use discipline-specific bundles. The findings also revealed that academic writing structurally relies heavily on phrasal bundles and functionally on referential bundles.

The current study concludes that it is essential to explore disciplinary linguistic features such as LBs in academic writing to enhance academic success and RA literacy. The results may also be useful in developing appropriate educational materials and activities on LBs for academic writing in hard sciences such as medical sciences.

Caffeine, a natural substance found in coffee and tea, can have anticancer effects by reducing cell proliferation and inducing apoptosis. On the other hand, nanocarriers can be used as a suitable method for properly delivering drugs at the tumor site, protecting drugs, targeting specific organs, and high durability. This study aimed to produce caffeine nanoemulsions and evaluate its anticancer effects on leukemia cells.

In this experimental study after producing caffeine nanoemulsion and evaluating its physicochemical properties, K562 cancer cells were treated with different concentrations of these caffeine nanoemulsions and free caffeine, and then, the viability of cancer cells was determined using Neutral Red and Trypan Blue methods. The AO/PI test was also used to evaluate the rate of apoptosis and necrosis. Data were analyzed by one-way ANOVA and Tukey's test using SPSS v.16 software.

The results showed that the decrease in the viability of cells treated with different concentrations of caffeine nanoemulsion and free caffeine was both concentration- and time-dependent, and caffeine nanoemulsion has more cytotoxic effects on cancer cells than free caffeine. The results also showed that caffeine nanoemulsion caused more apoptosis-type cell death in treated cancer cells.

The present study indicated a decrease in the viability and induction of apoptosis in K562 cells as a chronic myeloid leukemia cancer cell line after exposure to caffeine nanoemulsion, and caffeine nanoemulsion can be suggested as an adjuvant therapy along with other treatments for the treatment of chronic myeloid leukemia cancer.

Diphtheria is an acute vaccine-controlled respiratory disease caused by the gram-positive bacterium Corynebacterium diphtheria. Since the preparation, purification, and detoxification of the vaccine against this disease involves many and complex steps, the present study aimed reduction of time of various stages of toxoid purification.

For this purpose, three factors were first optimized for the concentration of iron in the culture medium, incubation temperature and rotation speed to produce more toxins. In each case, the experiment was carried out in triplicate and Lf and Kf values were tested to evaluate toxin production. After toxin inactivation and production of the toxoid, step reductions were performed to purify the toxoid. For this, ultrafiltration, precipitation, dialysis and chromatography with Sephadex G-25 column are used. In step reduction conditions, dialysis, chromatography or both of them were removed in the first, second and third cases, respectively. The results of each method were evaluated by SDS-PAGE and the quantitative data was analyzed using Minitab 18 (p‹0.05).

The results for optimizing the culture medium showed that highest amounts of toxin were produced at an iron concentration of 1 mg/l, a temperature of 35 °C, and a rotation speed of 200 rpm(p‹0.05). In the reduction experiments related to toxoid purification steps, the best results were obtained in a series of purified samples with ultrafiltration, precipitation and column chromatography steps.

Since time and cost are two key factors in industrial production, toxoid production for the diphtheria vaccine can be produced at a lower cost and in less time by eliminating the two-week dialysis phase.