Disinfectants and antiseptics inhibit the dissemination of pathogenic organisms in hospitals but often cause disinfectant-resistant microorganisms, an important factor for nosocomial infection. This study aimed to evaluate the correlation between qacΔE efflux pump gene and its resistance to disinfectants among Escherichia coli clinical isolates. A total of 97 E. coli isolates were isolated from patients with urinary tract infections. The minimum inhibition concentration (MIC) value of chlorhexidine and benzalkonium chloride was determined using broth microdilution method. Effect of efflux pumps was assessed by MIC test in the presence of phenylalanine-arginine β-naphthylamide (PAβN), and then the qacΔE efflux pump gene was detected using polymerase chain reaction (PCR). Of the isolates, 85.6% and 61.9% were resistant to chlorhexidine and benzalkonium chloride, respectively. Following the treatment of isolates with the efflux pump's inhibitor, PAβN, the MIC value of chlorhexidine and benzalkonium chloride decreased in 75.2% and 57.7% of the isolates, respectively. A significant correlation was found between PAβN treatment and the change in the resistant strains to susceptible strains (p = 0.021). The qacΔE gene was detected in 84.5% (n = 82) of the isolates, and the presence of the gene amongst disinfectant-resistant strains was also significant (p < 0.001). It is suggested to conduct other studies on other efflux pumps, as well as to periodically monitor the resistance to disinfectants. Substances inhibiting efflux pumps and neutral compounds are effective in the reduction of resistance to disinfectants. New disinfectants and drugs should be designed.

Klebsiella pneumoniae is one of the opportunistic bacteria that cause hospital infections. Various virulence factors are involved in its pathogenesis. The purpose of our study was to investigate the prevalence of virulence factor genes entB, mrkD, magA, kfu, iutA, rmpA, ybtS, and k2 among ESBLs-producing Klebsiella pneumoniae isolated from clinical samples of Khorramabad hospitals in Iran. In this descriptive, analytical study, the extended-spectrum β-lactamases (ESBLs) screening phenotypic test was performed by disc diffusion method, and virulence factor genes were detected by PCR method for Klebsiella pneumoniae isolates. Finally, the obtained data were statistically analyzed by SPSS software (version 21) using the chi-squared test. One hundred and ten K. pneumoniae strains were isolated from urine 69 (62.7%), sputum 16 (14.5%), blood 10 (9.1%), wound 9 (8.2%), tissue 3 (2.7%), body fluids 2 (1.8%), and catheter 1(0.9%). Based on an ESBL screening phenotypic test, 57 (51.8%) K. pneumoniae isolates were ESBLs-producing. Among 57 ESBLs-positive K. pneumoniae, the occurrence of mrkD, entB, ybtS, iutA, kfu, k2, and rmpA genes were 88 (80%), 87 (79.1%), 65 (59.1%), 42 (38.2%), 19 (17.3%), 5 (4.5%), 3 (2.7%), and 2 (1.8%), respectively. The findings of this study revealed, there is no significant association between the occurrence of virulence genes or source of samples with production of ESBLs among K. pneumoniae isolates.

The goal was to explore the value of using radiomics analysis based on multimodal MRI for evaluating the advanced fibrosis in patients with hepatitis B. One hundred and forty-three patients with hepatitis B fibrosis were randomly divided into training and validation cohorts in a 2:1 ratio. In the training cohort, a clinical model was established with logistic regression, a radiomics signature based on multimodal MRI was established with support vector machine (SVM), and a nomogram integrated the radiomics signature and clinical factors. The value of three models was assessed by ROC analysis in the training and validation cohorts. The nomogram demonstrated the largest area under the ROC curve. The nomogram presented good agreement in the prediction probability of advanced liver fibrosis in two cohorts. Radiomics analysis has good diagnostic value for advanced liver fibrosis and the nomogram can enhance the diagnostic value.

The aim was to explore the diagnostic value of serum free light chain (sFLC) and other laboratory indicators for the patients with light chain multiple myeloma (LCMM). We performed a retrospective study including 82 LCMM cases and 43 healthy subjects as the observation and control groups, respectively. The observation group was further divided into two subgroups: κ- and λ-type LCMM. Sixteen quantitative indicators were collected and the difference among groups was compared. We also evaluated the positive detection rate (PDR) of four qualitative indicators for M protein detection. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of sixteen indicators. Fourteen indicators showed statistical differences between the control group and κ- or λ-type LCMM subgroup. The κ and λ sFLC ratio (rFLC) and the difference between κ and λ FLC (dFLC) showed differences among the three groups. Among the four qualitative indicators of M protein detection, rFLC showed the highest PDR for both κ- and λ-type LCMM. Among the three combinations with rFLC or uIFE did not show statistical differences. ROC curve analysis indicated a relatively high diagnostic value of dFLC for both κ- and λ-type LCMM. We should be vigilant about the missed diagnosis by observing the changes of MM-related indicators, particularly dFLC and the six other indicators with high diagnostic value. rFLC can improve the diagnostic ability of LCMM.

The coagulation system is more complicated in younger infants because the hemostatic system is not completely mature before 6 months. There is confusion among pediatricians to choose conventional coagulation tests and thromboelastography (TEG) to evaluate coagulation function for infants in major surgery. This study was undertaken to perform a comparison between the two methods for pediatric patients who underwent cardio-pulmonary bypass (CPB) surgery. Infant patients who underwent CPB surgery were divided into two groups - younger group (age < 6 months old, n = 72) and older group (age from 6 months old to 12 years old, n = 76). Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (Fib) of conventional coagulation tests and reaction time (R-time), speed of fibrin building up (ɑ-Angle), clot conformation time (K-time), maximum colt amplitude (MA) of TEG results before and after CPB, as well as increasing or decreasing rate of all the values after CPB, were compared between the two groups. Postoperative transfusion details were summarized. PT, APTT, R-time, and K-time markedly increased (p < 0.05) and Fib, ɑ-Angle, and MA decreased (p < 0.05) after CPB in both groups. The younger group had a much higher rate of postoperative transfusion with suspended red cells (54.17% vs. 17.11%), fresh frozen plasma (29.17% vs. 9.21%), cryoprecipitate (9.72% vs. 1.32%), and apheresis platelet (5.56% vs. 0) than the older group. Increasing rate of R-time and K-time and decreasing rate of ɑ-Angle and MA after CPB in the younger group were significantly higher than that in the older group (p < 0.01), whereas no significant differences were observed in conventional coagulation tests (p > 0.2). TEG was more sensitive than conventional coagulation tests in response to variation of coagulation function for younger infants after major surgery.

The aim of this study is to determine the in vitro activity of ceftazidime-avibactam (CZA) on Entero-bacteriaceae and P. aeruginosa strains isolated in the bacteriology-virology laboratory of the Ibn Rochd University of Casablanca. This is a prospective descriptive longitudinal study conducted from May 28 through June 25, 2022, on Enterobacteriaceae and P. aeruginosa isolated from diagnostic samples received at the Bacteriology-Virology and Hospital Hygiene Laboratory of the Ibn Rochd University Hospital of Casablanca. The isolation and identification of the strains were carried out using standard bacteriological techniques. The study of sensitivity to ceftazidime-avibactam was done by diffusion susceptibility testing on agar medium according to EUCAST 2022 recommendations. During the study period, 271 strains of Enterobacteriaceae were isolated. The sensitivity rate to ceftazidime-avibactam was 91% vs. 74% for ceftazidime alone. R. terrigena was the most resistant strain to CZA with a rate of 69%, followed by E. cloacae (14%), then K. pneumoniae (6%), and finally E. coli (5%). Among the strains isolated, 24% (n = 66) produced ESBL, of which 29% (n = 19) were resistant to CZA, and 10.7% (n = 29) were re-sistant to imipenem, including 44, 8% (n = 13) that were resistant to imipenem and CZA. Regarding P. aeruginosa, 92 strains were isolated. The CZA resistance rate was 33.6% (n = 31). Among the strains isolated, 30.4% (n = 29) were resistant to imipenem, of which 82.7% (n = 24) were resistant to CZA. The in vitro evaluation of the ceftazidime-avibactam activity on the strains isolated, mainly: E. Coli, K. Pneumoniae, and E. Cloacae, showed a good inhibitory activity of this molecule which can constitute a therapeutic alternative for the treatment of infections due to these microorganisms.

The study investigates the prognostic impact of D-dimer levels in patients with cardiogenic shock (CS). Although D-dimer levels were found to be associated with prognosis in various clinical settings such as heart failure or acute myocardial infarction (AMI), the prognostic role of D-dimer levels in CS patients has not yet been clarified. Consecutive CS patients with and without concomitant AMI were prospectively included from 2019 to 2021. The prognostic impact of D-dimer levels was tested for 30-day all-cause mortality within the entire study cohort and stratified by the presence or absence of AMI. Statistical analyses included C-statistics, Kaplan-Meier, and multivariate Cox regression analyses. One hundred and twenty-three consecutive CS patients were included with an overall all-cause mortality at 30 days of 55%. The median D-dimer level on admission was 8.44 mg/L, whereas D-dimer levels were higher in 30-day non-survivors compared to survivors (median 13.0 vs. 5.2 mg/L; p = 0.011). D-dimer levels above the median were associated with an increased risk of 30-day all-cause mortality compared to patients with lower D-dimer levels (66% vs. 54%, log rank p = 0.050; HR = 1.594; 95% CI 0.979 - 2.594; p = 0.061), especially in patients with non-AMI-related CS (65% vs. 30%, log rank p = 0.010). The prognostic value of D-dimer levels was still demonstrated after multivariate adjustment (HR = 1.024; 95% CI 1.004 - 1.045; p = 0.020). D-dimer measurement may be a reliable biomarker to predict the risk of 30-day mortality in CS patients, especially in patients with non-AMI related CS.

Acinetobacter baumannii produce biofilm and efflux pumps. This systematic review study aimed to provide new strategies to inhibit the efflux pumps and biofilm in A. baumannii using nanoparticles. In this research, analyses from 2000 to February 24, 2022, were performed by the Statement of Preferred Reporting Items for Systematic Reviews (PRISMA). Keywords include Acinetobacter baumannii (A. baumannii) AND (biofilm) AND (anti-biofilm activity) AND (nanoparticles) AND (solid lipid NPS) AND (lipid nanocarriers), and in other searches include Acinetobacter baumannii (A. baumanni) AND (efflux pumps) AND (nanoparticles) AND (solid lipid NPS) AND (lipid nanocarriers). Searches were conducted in English databases, including Science Direct, PubMed, Scopus, Ovid, and Cochrane. At first, 136 studies were extracted, but after removing duplicates, 116 cases remained for further analysis. After evaluating the title and abstract of each study, 95 unrelated studies were excluded. The remaining 25 studies were reviewed based on full texts. Considering the inclusion/exclusion criteria, 19 studies were selected. In this study, metal nanoparticles were the most used nanoparticles for anti-biofilm and efflux pump purposes, and among these nanoparticles, silver nanoparticles (AgNPs) contributed the most. The present study shows that nanoparticles have potential and significant effects in inhibiting biofilm and efflux pumps in A. baumannii isolates, which researchers can consider in light of the increasing prevalence of antibiotic resistance.

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can be diagnosed using rapid real-time PCR, real-time reverse transcription PCR (rRT-PCR), or rapid antigen testing. Among these, rRT-PCR is considered the gold standard assay. The Xpert Xpress SARS-CoV-2 assay is a rapid real-time PCR test, approved by the Korean Disease Control and Prevention Agency in 2020. The overall concordance and positive concordance rates of the Xpert assay with the STANDARD M nCoV Real-Time Detection kit were determined. All samples with positive or inconclusive Xpert test results from July 2021 to February 2023 that underwent confirmatory testing using the reference rRT-PCR assay were included in the analysis. Samples from 224 patients (93 men and 131 women) with a median age of 59 years (range 15 - 90 years) were included. Of 212 samples that tested positive using Xpert, 112 (52.8%) were true positves and 100 (47.2%) were false positives on rRT-PCR testing. The overall concordance and positive concordance rates were 52.8% (112/212) and 54.5% (112/224), respectively. In the Xpert positive group, the samples had a lower Ct value for the E gene than the N2 gene. The Ct values for the E and N2 genes were significantly lower in the positive group than in the inconclusive group. Positive or inconclusive Xpert results should be confirmed by the gold standard rRT-PCR for early control of this disease. Furthermore, Korea's policy should be reconsidered given the high false-positive rate of the rapid real-time PCR Xpert Xpress SARS-CoV-2 assay.

Matrix-assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) is one of the preferred detection techniques for identification of clinical microorganisms and it has the characteristics of rapid identification, simple operation, low cost, and updatable databases. For laboratory medicine undergraduates, clinical internship is an important stage for the connection of basic theoretical knowledge and clinical practice. Internship teaching choosing MALDI-TOF MS as the content will greatly increase the popularity and applicability of the new technology in the clinical microbiology laboratory. With the help of electronic databases on the network, we conducted a systematic review. According to the purpose of research, we singled out forty papers. Latest studies on history, basic principles, clinical features, and applications of MALDI-TOF MS and the internship teaching contents introducing new technologies are summarized and focused on. In internship teaching, firstly we explain the historical development, basic principle and widespread applications of MALDI-TOF MS in the identification of clinical pathogenic microorganisms and the detection of antibiotic resistance. Subsequently, we instruct the students to perform the experimental operations, analyze the common problems, and find solutions. Finally, we highlight quality control and laboratory biosafety. Most of the reviews published previously report the clinical features and applications of MALDI-TOF MS and the internship teaching contents choosing other new technologies. It is the first study selecting MALDI-TOF MS technology as an internship teaching content creatively. Primary outcome is that the students understand the theoretical knowledge in detail, master the operation skills of MALDI-TOF MS quickly, and obtain excellent internship performances in the clinical internship through the internship teaching. Secondary outcome is that it is a help to cultivate medical students' train of thought for scientific research and to understand the application of the new technology in clinical testing and scientific research. Laboratory medicine undergraduates should cherish the opportunity to learn the new technology during the internship period and should master basic principle and operation. As internship teachers, it is necessary to introduce the new technology to students during the internship and encourage undergraduates to cultivate creative and innovative thinking of scientific research.