efficacy of Glasgow coma scale [GCS] score and acute physiology and chronic health evaluation [APACHE] II for predicting hospital mortality of ICU patients with acute traumatic brain injury

Objective: To compare the efficacy and functional outcome of Glasgow Coma Scale [GCS] score with that of Acute Physiology and Chronic Health Evaluation Score II [APACHE II] in patients with multiple trauma admitted to the ICU

Methods: This cross-sectional study included 125 patients with traumatic brain injury associated with systemic trauma admitted to the ICU of Shahid Kamyab Hospital, Mashhad, between September 2015 and December 2016. On the day of admission, data were collected from each patient to calculate GCS and APACHE II scores. Sensitivity, specificity, and correct outcome prediction was compared between GCS and APACHE II

Results: Positive predictive value [PPV] at the cut-off points was higher in APACHE II [80.6%] compared with GCS [69.2%]. However, negative predictive value [NPV] of GCS was slightly higher in comparison with APACHE II. Moreover, the area under the receiver operating characteristic [ROC] curve for sensitivity and specificity of GCS and APACHE II showed no significant difference [0.81+/-0.04 vs. 0.83+/-0.04; p=0.278 respectively]

Conclusion: Our study suggested that there was no considerable difference between GCS and APACHE II scores for predicting mortality in head injury patients. Both scales showed acceptable PPV, while APACHE II showed better results. However, the utilization of GCS in the initial assessment is recommended over APACHE II as the former provides higher time- and cost-efficiency

Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

Introduction: Regarding to the recent advances in assisted reproductive techniques [ART], twin and multiple pregnancies have increased during past years

Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy

Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group [n=96] and ART group [n=31]. Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications [preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation [IUGR], postpartum hemorrhage], neonatal outcomes [weight, first and fifth minuteP PApgar score, Neonatal Intensive Care Unit [NICU] admission, mortality, respiratory distress, and icterus] were recorded using a questionnaire

Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death [IUFD] were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes [weight, 1PstP and 5PthP min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus]

Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART

[Long term clinical outcome of small intestinal atresia in children, a single center experiences]

Prognosis of small intestine Artesia, the most common agents causing intestinal obstruction in neonates, has improved in last decades. Some variable such as weight change, type of feeding, post operation oral feeding starting time, and adequacy of energy and protein intake can change patients clinical outcomes. We performed a retrospective study to evaluate all neonates with small intestinal Artesia who were admitted to pediatric intensive care unit [PICU], during 2002-2010 and followed-up their clinical outcomes over an 8-year period. We reviewed medical records of all patients with small intestinal atresia treated at Dr. Sheikh hospital in the between 2002 and 2010. Information of all patients were recorded, including demographic data, type and location of atresia, other problem or anomalies, being term or preterm, term of stay and length of hospitalization, weight change, type of feeding, post operation oral feeding starting time, and adequacy of energy and protein intake. 65 neonates presented with small intestinal atresia treated at Dr. Sheikh hospital during 2002-2010 entered our study. The age of neonates at admission time was median 3 days [1 day - 2 month]. The median weight at reception was 2.32 +/- 0.6 kg [ranged 0.75-3.85 kg]. The median of hospitalization period was 15 days. The mean amount of delivered calorie- protein and energy intake was significantly lower than the guidelines of the American Society for Parenteral and Enteral Nutrition [p<0.001]. We recommend full investigation of congenital anomalies and possible prevention of infections and its resultant sepsis in all infants with intestinal atresia, in order to reduce the risk of mortality in these infants

High-level vancomycin-resistant Staphylococcus aureus [VRSA] in Iran: a systematic review

Staphylococcus aureus is a major human pathogen worldwide. Vancomycin has been used for decades to treat multidrug resistant S. aureus. Ten years has passed since the first report of vancomycin resistant S. aureus [VRSA]. The objective of this systematic review was to determine the total number of VRSA isolates that have been reported from Iran. Search terms reflected [Iran], [vancomycin] and [SI aureus] were searched in the ISI web of knowledge, PubMed, SciVerse, and Google scholar. Also two Persian scientific databases and 13 recent national congresses were investigated. Articles / abstracts working on S. aureus in Iran, evaluating vancomycin MIC and / or PCR of vanA/B were included in this systematic review. Out of the 3484 records found in mentioned resources, 13 related studies were included in the final analysis. The result showed that at least 24 VRSA isolates which have been reported from Iran up to September 2012. It seems that many Iranian researchers did not follow a spe-cific guideline for reporting and confirming VRSA. Establishing an Iranian reference center where studies on VRSA can be registered, evaluat-ed and confirmed is strongly recommended