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This study evaluated the effects of Mg administration on carotid intima–media thickness (CIMT), glycaemic control and markers of cardio-metabolic risk in diabetic haemodialysis (HD) patients. This randomised, double-blind, placebo-controlled clinical trial was conducted in fifty-four diabetic HD patients. Participants were randomly divided into two groups to take either 250 mg/d Mg as magnesium oxide (n 27) or placebo (n 27) for 24 weeks. Mg supplementation resulted in a significant reduction in mean (P<0·001) and maximum levels of left CIMT (P=0·02) and mean levels of right CIMT (P=0·004) compared with the placebo. In addition, taking Mg supplements significantly reduced serum insulin levels (β=–9·42 pmol/l; 95% CI –14·94, –3·90; P=0·001), homoeostasis model of assessment-insulin resistance (β=–0·56; 95 % CI –0·89, –0·24; P=0·001) and HbA1c (β=–0·74 %; 95 % CI –1·10, –0·39; P<0·001) and significantly increased the quantitative insulin sensitivity check index (β=0·008; 95 % CI 0·002, 0·01; P=0·002) compared with the placebo. In addition, Mg administration led to a significant reduction in serum total cholesterol (β=–0·30 mmol/l; 95% CI –0·56, –0·04; P=0·02), LDL-cholesterol (β=–0·29 mmol/l; 95% CI –0·52, –0·05; P=0·01), high-sensitivity C-reactive protein (hs-CRP) (P<0·001) and plasma malondialdehyde (MDA) (P=0·04) and a significant rise in plasma total antioxidant capacity (TAC) levels (P<0·001) compared with the placebo. Overall, we found that taking Mg for 24 weeks by diabetic HD patients significantly improved mean and maximum levels of left and mean levels of right CIMT, insulin metabolism, HbA1c, total cholesterol and LDL-cholesterol, hs-CRP, TAC and MDA levels.

BACKGROUND: Acinetobacter baumannii is an important opportunistic nosocomial pathogen. Class 1 integrons in A. baumannii plays a significant role in antibiotic resistance. Therefore, this study aimed to investigate the prevalence of integrons and antibiotic resistance pattern in A. baumannii isolated from clinical samples of Iranian patients. METHODS: The Medical Subject Headings (MeSH) and the keywords with the help of Boolean operators ("AND" or "OR") were used alone or in combination to conduct the search. The searching process was conducted in the Web of Science, PubMed, Cochrane Library, Scopus, and Google Scholar databases and, also Iranian databases. The search was restricted to relevant English and Persian cross-sectional publications reporting the prevalence of Int1 in A. baumannii isolated from clinical samples from 1 January 2000 to 31 December 2018. The data were analyzed using Comprehensive Meta-Analysis software. Regarding the heterogeneity of studies, the random effects model was used. Cochrane Q and I 2 tests was used to evaluate statistical heterogeneity between the studies. RESULTS: Fifteen studies were included in the analysis. The combined prevalence of class 1 integrons in A. baumannii was 55.2% (95% CI: 44.8-65.1). The pooled prevalence of MDR A. baumannii isolates was 68.1%. The highest resistance belonged to Aztreonam, followed by Ciprofloxacin, and Ceftazidime with a resistance rate of 97.6%, 92.8%, and 91.6%, respectively. Tobramycin was reported as an effective antibiotic. CONCLUSIONS: The present study reported an alarmingly high prevalence of class 1 Integrons, and MDR isolates of A. baumannii recovered from clinical samples that should be considered.

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Background The role of integrons has been shown in the horizontal transmission of antibiotic resistance genes among bacterial isolates especially Gram-negative microorganisms in clinical settings. Objectives The aim of this study was to systematically review the prevalence of class 1 integrons and antibiotic resistance in Pseudomonas aeruginosa isolates of clinical samples of Iranian patients. Methods The Web of Science, PubMed, Scopus, and Science Direct databases were searched using preferred keywords based on the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. The cross-sectional studies addressing the frequency of class 1 integrons and antibiotic‑resistance in P. aeruginosa isolates from clinical samples of Iranian patients published from 1 January 2000 until 31 December 2018 were included. Meta-analysis was performed using Comprehensive Meta-Analysis¬ (CMA) software. The random effects model was used for meta-analysis. The Cochran’s Q and I2 tests were applied for statistical analyses. Publication bias was assessed using Funnel plot and Egger’s linear regression test. Results Out of 911 studies retrieved in the initial search, 17 articles met the eligibility standards for being included in the meta-analysis. The Egger’s linear regression test indicated no publication bias (P = 0.95). The combined prevalence of class 1 integrons in P. aeruginosa isolates was obtained as 58.9% (95% CI: 46.3–70.4%). The highest rate of combined antibiotic resistance was related to Carbenicillin with a resistance rate of 79.9%. On the other side, the most effective antibiotic against P. aeruginosa was Polymyxin B with the resistance rate of 0%. The pooled prevalence of multi-drug resistant (MDR) P. aeruginosa isolates was 55% (¬95% CI: 33.8-75.3%). Conclusions Our findings indicated the high prevalence of class 1 integrons and antibiotic resistance among P. aeruginosa isolates of Iranian patients’ clinical samples. Also, the prevalence of MDR P. aeruginosa isolates was noticeable requiring prompt action.