Hypervirulent Klebsiella pneumoniae (hvKp) pathotype is emerging worldwide in pyogenic liver abscesses (PLAs). However, the role of virulence factors in pathogenicity remains unclear. On the other hand, the epidemiology of PLAs in Iran is unknown. From July 2020 to April 2022, bacterial species were isolated and identified from the drainage samples of 54 patients with PLAs. K. pneumoniae as the most common pathogen of pyogenic liver abscesses was identified in 20 (37%) of the 54 patients. We analyzed the clinical and microbiological characteristics of K. pneumoniae-related pyogenic liver abscesses. Antibiotic susceptibility testes and string test were performed. 16S rRNA, antibiotic resistance, and virulence genes were determined by polymerase chain reaction amplification. Clonal relatedness of isolates was identified by multilocus sequence typing. Virulence levels were assessed in the Galleria mellonella larval infection model. Four hvKp isolates (K1/K2) were found to be responsible for cryptogenic PLAs, and 16 classical K. pneumoniae isolates (non-K1/K2) were associated with non-cryptogenic PLAs. Three capsular serotype K1 strains belonged to sequence type 23 (ST23) and one K2 strain to ST65. Meanwhile, the non-K1/K2 strains belonged to other STs. ST231 was the most common strain among the classical K. pneumoniae strains. Compared with the non-K1/K2 strains, capsular serotypes K1/K2 strains were less resistant to antibiotics, had positive string test results, and had more virulence genes. In Galleria mellonella, a concentration of 106 colony-forming units of the K1 hvKp strain resulted in 100% death at 24 hours, confirming the higher virulence of the hvKp strain compared with cKp. K. pneumoniae isolates represented that the acquisition of any plasmid or chromosomal virulence genes contributes to pathogenicity and high prevalence in PLAs. Meanwhile, hvKp isolates with a specific genetic background were detected in cryptogenic PLAs.

Portraying a robust working-team model in the practice of neuro-oncology requires continued interdisciplinary efforts. The Neuro-Oncology Scientific Club (NOSC) initiative is an interdisciplinary clinical forum promoting the connect-approach across involved disciplines in the management of CNS malignancies. With its provincial founding-panels and national steering board; NOSC has been operational in Iran since 2011. This initiative has pursued its mission through interval strategic meetings, tumor-boards, case-discussions as well as publishing neuro-oncology updates, case study periodicals and newsletters. A provincial meeting of NOSC in Shiraz, put together insights from international practice guidelines, emerging evidence and expert opinions to draw a position statement on high-grade glioma management in adults. The present report summarizes key highlights from the above clinical forum.

: Otorrhagia is not a common manifestation of petrous internal carotid artery (ICA) aneurysm. Besides idiopathic cases, different etiologies, including trauma, infection, and radiation, have been suggested for petrous ICA aneurysms/pseudoaneurysms. However, there is limited experience in the management of this rare aneurysm/pseudoaneurysm with coil embolization. A 58-year-old man, who was a known case of chronic otitis media, was referred from the otorhinolaryngology ward with intractable bleeding from the right ear. A pseudoaneurysmal lesion (7 mm × 5 mm) was detected in the petrous segment of the internal carotid artery. The patient underwent coil embolization with no complications. To the best of our knowledge, this is the first case of petrous ICA pseudoaneurysm, presenting with only intractable otorrhagia. The patient was successfully treated with coil embolization, with no need for further interventions. Besides, a review of petrous ICA aneurysms or pseudoaneurysms presenting with otorrhagia was performed.

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Background: Transradial approach (TRA) is widely used all around the world in coronary angiography and percutaneous coronary interventions. Ulnar artery (UA) access can be used as an alternative to TRA in coronary catheterization. Transulnar approach (TUA) is as effective and safe as TRA in coronary angiography and angioplasty. Objectives: The aim of the present study was to evaluate the effects of unilateral reciprocal compression of radial artery (RA) and ulnar artery (UA) on arterial diameter, flow velocity, and volume flow in healthy individuals. Patients and Methods: A total of 210 extremity arteries of 105 consecutive cases were evaluated using Doppler ultrasonography. At the wrist level, UA and RA were sequentially compressed for 60 seconds. The diameter, peak systolic velocity (PSV), and volume flow (VF) were evaluated during UA and RA compressions.