Clinical features and antimicrobial resistance of bacterial agents of ventilator-associated tracheobronchitis in Hamedan, Iran

Objectives: Ventilator-associated tracheobronchitis [VAT] is a common cause of mortality and morbidity in patients admitted to intensive care units [ICUs]. This study was conducted to evaluate the clinical course, etiology, and antimicrobial resistance of bacterial agents of VAT in ICUs in Hamedan, Iran

Methods: During a 12-month period, all patients with VAT in a medical and a surgical ICU were included. The criteria for the diagnosis of VAT were fever, mucus production, a positive culture of tracheal secretions, and the absence of lung infiltration. Clinical course, including changes in temperature and tracheal secretions, and outcomes were followed. The endotracheal aspirates were cultured on blood agar and chocolate agar, and antimicrobial susceptibility testing of isolates were performed using the disk diffusion method

Results: Of the 1 070 ICU patients, 69 [6.4%] were diagnosed with VAT. The mean interval between the patient's intubation and the onset of symptoms was 4.7+/-8.5 days. The mean duration of response to treatment was 4.9+/-4.7 days. A total of 23 patients [33.3%] progressed to ventilator-associated pneumonia [VAP], and 38 patients [55.0%] died. The most prevalent bacterial isolates included Acinetobacter baumannii [24.6%], Pseudomonas aeruginosa [20.2%], and Enterobacter [13.0%]. P. aeruginosa and Enterobacter were the most prevalent bacteria in surgical ICU, and A. baumannii and K. pneumoniae were the most common in the medical ICU. All A. baumannii and Citrobacter species were multidrug-resistant [MDR]. MDR pathogens were more prevalent in medical ICU compared to surgical ICU [p < 0.001]

Conclusions: VAT increases the rates of progression to VAP, the need for tracheostomy, and the incidence of mortality in ICUs. Most bacterial agents of VAT are MDR. Preventive policies for VAP, including the use of ventilator care bundle, and appropriate empirical antibiotic therapy for VAT may reduce the incidence of VAP

[Endometrial morphology following repeated ovarian stimulation in mouse]

Gonadotropins are commonly used for superovulation in human and animals to retrieve more oocyte and increase chance of pregnancy. Ovarian stimulation in assisted reproduction technology produces lower implantation rates per embryo transferred than natural and ovum donation cycles, suggesting suboptimal endometrial development due to the hormones used to recruit more oocytes. Due to the frequent use of gonadotropins in the treatment of infertility in successive periods, the aim of this study was to determine the endometrial changes in response to repeated ovarian stimulation. This experimental interventional study has done in research center of Hamadan university of medical sciences in 2012. NMIRI female mice six weeks old were used in this study and divided into 7 groups [5 each]. The mice in group 1, 2, 3 and 4 received 1, 2, 3 and 4 times pregnant mare serum gonadotropin [PMSG] and 48 hours later 7.5 IU human chorionic gonadotrophin [hCG] respectively. For each group were considered a control group which received on time gonadortropin injection. The mouses were killed 13-16 hours after hCG injection and middle part of uterine horn cut for histological study using Hematoxylin and Eosin staining. The parameters that studied were surface epithelium of endometrium, glandular epithelium, and endometrial height and axis of uterine gland. Our results showed that there are no significant differences in glandular epithelium, axis of glands and height of endometrium in experimental groups [P>0.05]. The height of surface epithelium showed significant increases after ovarian stimulation in experiment group [P0.03]. Our results showed that there are no significant differences in glandular epithelium, axis of glands, height of endometrium and height of surface epithelium between control groups and also it's experimental group [P>0.05]. Conclusion Changes in the height of surface epithelium could be one of the reasons for decrease implantation rates with repeated ovarian stimulation

immunohistochemical survey to evaluate the expression of cd105 and cd34 in ameloblastoma and odontogenic keratocyst

Statement of the Problem: Ameloblastoma is the most common odontogenic tumor which is slow-growing, locally invasive and exhibit specific biologic behavior and high recurrence rate. Likewise, odontogenic keratocyst is a developmental odontogenic cyst that has a high recurrence rate and aggressive behavior. There are limited studies considering the relationship between the angiogenesis factors and the biologic behavior of these lesions

Purpose: the aim of this study was to evaluate the mean density of vessels in odontogenic keratocysts and ameloblastoma and investigate its possible relationship with biological behavior of these lesions

Materials and Method: In this descriptive-analytic cross-sectional study, 40 cases, comprising 10 odontogenic keratocysts and 30 ameloblastomas [10 plexiform, 10 follicular, and 10 unicystic type] were selected and were stained immuno-histochemically with CD34 and CD105. The micro vessel density was assessed and compared in all groups. T- test for the independent samples' One- way Anova, Wilcoxon test and Tukey tests were adopted for statistical analysis

Results: A statistically significant difference was observed in mean vascular density [MVD] between the odontogenic keratocyst and ameloblastoma groups concerning the CD105 and CD34 markers [p= 0.005, p= 0.000, respectively]. The MVD was significantly higher in ameloblastomas than odontogenic keratocyst. MVD with CD34 was significantly higher than MVD with CD105 in ameloblastomas [p= 0.00]

Conclusion: It can be suggested that angiogenesis might be one of the mechanisms that is more possible to contribute the aggressive biological behaviors in ameloblastoma rather than odontogenic keratocyst

Comparison of vitamin D[3] serum levels in new diagnosed patients with multiple sclerosis versus their healthy relatives

Multiple risk factors are introduced for Multiple Sclerosis [MS]. Recent studies have suggested a possible correlation between vitamin D deficiency and an increase risk of MS. This study was therefore undertaken to compare vitamin D levels in new cases of MS and their relatives as healthy controls. Seventy five new diagnosed MS patients and 100 matched healthy controls among their relatives were enrolled in this study. Two groups were matched for gender, age, season in which serum level of vitamin D was checked and region and diet. Serum levels of 25-hydroxy vitamin D was measured, recorded and analyzed. Seventy five patients [57 female and 18 male] and 100 healthy subjects [75 female and 25 male] were enrolled in this study. The mean serum levels of 25-hydroxy vitamin D in case and control groups were 11.31 and 17.9 ng/ml, respectively [P=0.003]. Compared to the healthy subject, serum levels of vitamin D were significantly lower in patients with MS. This difference was only significant in women. Observed difference of vitamin D levels of both groups were significant in summer. This study continues to support the role of vitamin D deficiency in MS

[Semi-quantitative analysis of endometrial HOXA10 and BTEB1 mRNA expressions in the implantation window of patients with endometriosis and myoma]

The techniques used in assisted reproductive technologies have progressed considerably, but many embryos do not implant after transfer upon the use of these techniques. One of the causes of infertility is repeated implantation failure due to decreased endometrial receptivity. Furthermore, in clinical conditions such as endometriosis and myoma, implantation decreases after embryo transfer. In this case-control study the expression patterns of HOXA-10 and BTEB1 mRNAs were evaluated at the time of implantation in patients with myoma and endometriosis. In this study performed in Hamadan University of Medical Sciences during 1389, the cases included 16 patients with endometriosis and myoma [8 in each group] and the control group consisted of 8 fertile women. Endometrial sampling was performed at mid-secretory phase. Later, the expression patterns of HOXA-10 and BTEB1 mRNAs were evaluated using a semi-quantitative RT-PCR method. The optimal PCR cycles determined were 30, 32 and 26 for HOXA10, BTEB1 and beta-actin, respectively. Endometrial HOXA-10 and BTEB1 mRNA expression levels [normalized to beta-actin expression] at the time of implantation were significantly decreased in the endometrium of infertile patients with endometriosis compared with that of healthy fertile controls [P<0.05]. A similar pattern was seen in patients with myomas for both HOXA10 and BTEB1 genes, [P<0.05]. It seems that lower expression of HOXA-10 and BTEB1 mRNAs in the implantation window of endometrium that increase normally, could account for some aspects of infertility in patients with endometriosis and myoma

Primary bilateral intrapelvic hydatid cyst presenting with adnexal cystic mass: a case report

Hydatid disease, caused by Echinococcusgranulosus, is a common parasitic infection of the liver. Disseminated intra-abdominal hydatid disease may occur with the rupture of the hydatid cyst into the peritoneal cavity, producing secondary echinococcosis. But primary hydatid cyst in the pelvis is rare. We report a case of bilateral hydatid cyst of the pelvis in a 53years old woman presented with adnexal cystic mass