Background: Chronic ulcers are one of the challenges of treatment today and cost a lot to the health system. The present study was conducted to investigate the effect of Lucilia sericata maggot therapy in chronic wound treatment. Materials and Methods: This study was conducted as a clinical trial study with 90 eligible patients. Patients were randomly assigned to two equal intervention and control groups. Both groups received routine treatments for chronic ulcers. Patients in the intervention group received maggot therapy with larvae of Lucilia sericata. For all patients, a smear and culture of wound discharges were acquired. The condition of wound healing, the type of infection, and the reduction of microorganisms were compared between the two groups. Results: Staphylococcus aureus was present in 68.9% of the patients and was the most abundant infection among all patients. Results of culturing after larval treatment at different times revealed a decrease in the number of all bacteria, especially Pseudomonas aeruginosa, Escherichia coli, and S. aureus, but the response rate for Enterococcus was the lowest. Also, the wound healing rate and reduction in necrotic tissue at the end of the second week (p=0.041) and the third week (p=0.012) was significantly higher in the intervention group. Conclusion: Larvae of L. sericata have the highest effects on P. aeruginosa and had the least effect on the growth of Enterococcus. Also, our results showed larvae of L. sericata therapy can significantly improve wound healing rate.

s u m m a r yBackground: Non-alcoholic fatty liver disease is one of the most common chronic liver diseases. Due to the lack of definitive documentation for the effect of folic acid on fatty liver, this study was conducted to determine the relationship between serum folate levels and fatty liver in patients referred to Imam Hossain Hospital in Shahroud, in 2016. Methods: This caseecontrol study was performed on 150 patients. The case group was fatty liver patients whose disease was diagnosed based on laboratory and ultrasound findings and a control group of patients without fatty liver. After liver ultrasonography, blood samples were taken from all patients and folic acid levels were measured. Results: Of the 150 patients examined, mean BMI of patients was (25.3 ± 6.1 kg/m2 in case group and 24.8 ± 7.2 kg/m2 in control group), which was significantly higher in case group (p < 0.035). The mean fasting blood glucose level in patients was (137.5 ± 53.5 mg/dl in case group and 124.5 ± 62.5 mg/dl in control group), which was significantly higher in case group (p < 0.01). The mean LDL of the patients was (175.3 ± 65.5 mg/dl in case group and 125.5 ± 42.5 mg/dl in control group), which was significantly higher (P < 0.003) in patients with fatty liver. The mean of folic acid in patients was (3.7 ± 5.3 ng/ml in case group and 5.3 ± 4.1 ng/

Introduction: Enterococcus faecium is a major cause of community and hospital-acquired infections. Due to limited options for infection with fluoroquinolones-resistant Enterococci, novel therapeutics are urgently needed. Efflux pumps are contributed to fluoroquinolones resistance phenotype in this bacterium and novel inhibitors that target these efflux pumps could be effective in patients. In this research, the possible synergistic effect of an efflux pump inhibitor (EPI), thioridazine, with ciprofloxacin was investigated against clinical isolates of E. faecium. Methodology: A total of 88 isolates of E. faecium from clinical specimens were studied from August 2017 to September 2018. Conventional phenotypic and molecular methods characterized all the isolates. Standard susceptibility tests and molecular assays determined the antibiotic resistance profiles and the frequency of efflux pump genes. Minimum inhibitory concentrations (MICs) to ciprofloxacin (CIP) in the presence and absence of thioridazine were measured by the micro-broth dilution method. Results: The highest antibiotic resistance rate among E. faecium isolates was related to ciprofloxacin (96.8%), levofloxacin (94.3%), and imipenem (90.9%), respectively. The highest frequency of efflux pump determinants was related to efmA (60, 68%), followed by emeA (48, 54.5%), and efrA and/or efrB genes (45, 51%). The efflux pump inhibitor showed ≥ 2-fold decrease in the MIC value of ciprofloxacin in 48.2% of the isolates. Conclusions: Efflux pump inhibitor genes efrAB, efmA, and emeA are common among the E. faecium clinical isolates. Our results supported the administration of thioridazine, as an efflux pump inhibitor, in fluoroquinolone-resistant E. faecium infections due to its synergistic effect with CIP.

Background: Urinary tract infection (UTI) is a common clinical problem during pregnancy that can have serious consequences for the mother and fetus. Some studies have suggested that UTI can trigger or aggravate preeclampsia. The present study aimed to investigate the association between urinary tract infection in the first trimester and the risk of preeclampsia in pregnant women referring to Bahar hospital of Shahroud. Patients and Methods: In this case-control study, 92 pregnant women with a diagnosis of preeclampsia were selected as cases, and for comparison 92 pregnant women were selected as control. History of previous UTI in the first trimester was assessed as a risk factor. Data were analyzed using SPSS 16 software and related statistical tests such as mean and standard deviation, chi-square, and independent t-test. Results: In this study, the mean age of the patients was 28.6 ± 6.9 years that no significant differences were found between the two groups. It was also found that 37 (40.2%) patients in the case group and 29 (31.5%) patients in the control group had a UTI which was significantly (p<0.043) higher in the case group. Also, in the multivariate regression model, UTI was significantly associated with preeclampsia (p<0.048), so that UTI increases the risk of preeclampsia (OR=1.86). Conclusion: The results of this study showed UTI during the first trimester of pregnancy is associated with the risk of preeclampsia. Therefore, controlling and treatment of urinary infections can reduce the risk of preeclampsia in the later months.

Key Clinical MessageSCARF syndrome is a very rare syndrome that so far only two cases have been reported in the papers. In this article, a 3-month-old female who exhibited SCARF syndrome presented with multiple congenital abnormalities and problems at Imam Hossein hospital of Shahroud.