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

Assessment of health-related quality of life among patients with tuberculosis in Hamadan, western Iran

Tuberculosis is one of the oldest infections known to affect humans. The aim of the study was to assess the quality of life including physiological, general health perception and social role functioning among patients with tuberculosis in Hamadan, Western Iran. A cross sectional analytical study was conducted between December 2009 and March 2011, the quality of life scores of 64 tuberculosis cases were measured by SF-36 questionnaire before treatment, after the initial phase and at the end of treatment and were compared with those of 120 controls. The association of the quality of life with age, type of tuberculosis, sputum smear, duration of disease, and the stage of treatment were assessed among the patients. Before treatment, all scores of tuberculosis patients were lower than those of the controls [p<0.05]. The patients' score increased signififificantly after two months of treatment [p=0.01], but the difference was not significant between two and six months after treatment [p=0.07]. The lowest score in tuberculosis patients was related to physical functioning and energy [45 +/- 42, 44 +/- 24, respectively]. According to the results, tuberculosis patients still have a low quality of life in spite of receiving new care strategies. Therefore, enhancement in quality of life may improve adherence to anti-tuberculosis treatment, functioning and well-being of patients with tuberculosis.

[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

relationship between clinicobiochemical markers and depression in women with polycystic ovary syndrome

Previous studies have demonstrated that clinical features of 16TPolycystic ovary syndrome16T [PCOS] are associated with a lower degree of health, self, and sex satisfaction. Our study aimed to investigate possible associations between depression and different clinicobiochemical markers of PCOS. In a cross-sectional analytic study, 120 PCOS women aged 18-45 yr, were enrolled. Beck Depression Inventory was used to assess depression. Also, all participants underwent biochemical studies. Individuals with 15 points and more in Beck test were referred to a psychiatrist to participate in a complementary interview for the diagnosis of depression based on Diagnostic and Statistical Manual of Mental Disorders IV [DSMIV-TR] criteria. Among the study participants, 82 women [68.3%] were non-depressed, and 38 patients [31.7%] had some degrees of depression. According to the psychiatric interview, 10 patients [8.3%] had major depression, 22 patients [18.3%] had minor depression and 6 patients [5%] had dysthymia. We failed to show any significant difference in body mass index, hirsutism, infertility, serum total testosterone, lipid profile, and the homeostasis model assessment of insulin resistance [HOMA-IR] between depressed and non-depressed subjects [p>0.05]. Using Spearman correlation, we did not find a positive correlation between BDI scores and clinicobiochemical markers for all PCOS subjects [-0.139 0.05]. In spite of high rate of depression in women with PCOS, there was no significant association between Clinicobiochemical Markers and depression

Fibrinolytic therapy in CCU instead of emergency ward: how it affects door to needle time?

The door-to-needle-time [DNT] is considered a standard time for scheduling thrombolysis for acute ST-segment elevation of myocardial infarction and this time can be reduced by minimizing the delay in starting thrombolytic treatment once the patient has reached to the hospital. This study was carried out on a sample of Iranian patients with acute myocardial infarction to determine the DNT in those after changing schedule of thrombolysis during 8 years from emergency to coronary care unit [CCU]. A descriptive cross-sectional study was carried out on all consecutive patients with a confirmed diagnosis of acute myocardial infarction admitted to the emergency ward of Ekbatan Hospital in Hamadan, Iran, within 2011 and had an indication of fibrinolytic therapy, which 47 patients were finally indicated to receive streptokinase in the part of CCU. The mean time interval between arrival at the hospital and electrocardiogram [ECG] assessment was 6.30 min, taking ECG and patient's admission was 21.6 min and transferring the patient from admission to CCU ward was 31.9. The time between transferring the patients to CCU ward and fibrinolytic administration order and the time between its ordering and infusion was 31.2 min and 14.0 min respectively. In sum, the DNT was estimated 84.48 +/- 53.00 min ranged 30-325 min that was significantly more than standard DNT [P<0.01]. Furthermore, DNT mean in this study is significantly more than a study conducted 8 years ago in the same hospital [P<0.01]. The DNT is higher than the standard level and higher than the estimated level in the past. This shows that DNT was longer after transferring to CCU

prevalence of antibiotic resistance of Enterobacteriaceae strains isolated in community- and hospital-acquired infections in teaching hospitals of Hamadan, west of Iran

The prevalence of antimicrobial resistance among Enterobacteriaceae is increasing worldwide. Identification of pathogens and their resistance to antimicrobials is mandatory for successful empiric antibiotic treatment. The aim of this study was to investigate the prevalence of antimicrobial resistance of Enterobacteriaceae isolated from hospital-acquired and community-acquired infections. In a descriptive-comparative study, during 2010, all clinical isolates of Enterobacteriaceae and their antibiograms from laboratories of Sina and Bessat Hospitals, Hamadan, west of Iran were included. Hospital-acquired infections were identified by records from infection-control units. A questionnaire containing information about demographic characteristics, source of specimen, kind of En-terobacteriaceae and their antimicrobial resistance was filled for each patient. Data were analysed using SPSS. A total of 574 samples were collected, out of which the most prevalent pathogens were Escherichia coli and Klebsiella pneumoniae. Almost all isolates of Enterobacteriaceae were resistant to ampicillin [98.8%], and the least resistance was to piperacillin [3.7%]. In addition, most isolates were resistant to cefazolin, cefixime, and co-trimoxazole. Among third generation cephalosporins, the highest resistance to ceftriaxone and the least resistance to ceftizoxime were observed. 19.3% of isolates were resistant to imipenem. In terms of fluroquinolones, nosocomial infections and community acquired infections were resisitant to ciprofloxacin 33% and 4.1% respectively. The rate of resistance in nosocomial infections was higher than that of community-acquired infections. The prevalence of multidrug resistant Enterobacteriaceae is increasing both in community-acquired and hospital-acquired infections. Because of propable increasing resistance to fluoro-quinolones and newer betalactams, reassessment of resistance of Enterobacteriaceae must continue in future years

Effect of intramural myomectomy on endometrial HOXA10 and HOXA11 mRNA expression at the time of implantation window

HOXA11 and HOXA10 are expressed in endometrium throughout the menstrual cycle and show a dramatic increase during the mid-luteal phase at the time of implantation. The expression of these genes is decreased in women with myomas. To determine whether myomectomy would reverse HOXA11 and HOXA10 expression, we evaluated the transcript levels of these genes in the endometria of patients before and after myomectomy. Expression of HOXA11 and HOXA10 were examined prospectively during the midluteal phase in endometrium obtained from infertile women [n=12] with myoma before and three months after myomectomy. Endometrial HOXA11 and HOXA10 expression were evaluated using quantitative real-time reverse transcriptase-polymerase chain reaction [RT-PCR]. Endometrial HOXA11 and HOXA10 mRNAs expression levels [normalized to 18SrRNA] were increased insignificantly in endometrium of patients after myomectomy [p=0.7 and p=0.15 respectively]. The results suggest that the alteration in expression pattern of these genes could not account for some aspects of fertility after myomectomy

[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

[ retrospective evaluation of epidemiological, clinical and laboratory features of brucellosis in 230 patients in Hamadan, Iran: a brief report]

Brucellosis is one of the most common infectious diseases in Iran with very different clinical manifestations. In this retrospective descriptive study, all patients with brucellosis, who were admitted in Farshchian Hospital in Hamadan, Iran in 2005 to 2010, were enrolled in the study. The data were collected from the patients' medical records and were entered in forms for analysis. A total of 230 patients with brucellosis, including 130 [56.5%] male and 100 [43.5%] female patients with a mean age of 40.84 +/- 20.29 years, who mostly [72.2%] lived in rural areas were enrolled in the study. Outbreaks were most common in spring and summer and the main route of transmission was consumption of contaminated dairy products [60.3%]. The most common symptoms were fever [77.4%], arthralgia [70%], sweating [47%], malaise and fatigue [46.5%]. Arthritis and epididymo- orchitis were seen in 121 [52.9%] and 48 [8.20%] patients, respectively. CBC analysis showed leukocytosis in 20.8% of the participants. ESR rise was noted in 59.5% of the patients and 52.9% had positive CRP. Given to various clinical presentations, brucellosis should be considered in the differential diagnosis of individuals with chronic fever with or without other organ abnormalities