Epidemiologic study of poisonings in patients reffering to emergency ward of Shahid Mohammadi university hospital in Bandar Abbas

Poisoning is a major health problem worldwide and one of the most common reasons for visiting emergency departments [EDs]. The object of this study was to determine the epidemiological characteristics of poisoned patients referred to emergency department of Bandar Abbas Shahid-Mohammadi hospital in 2011-2012. In a cross-sectional study between March 2011 and February 2012 all the paitents admitted through ED for further evaluation and treatment were investigated. Data were gathered from direct interviewing and patient's medical files by using a checklist and analyzed by SPSS version 16 using descriptive statistical tests, Chi-Square and t-test. Poisonings comprised 3.6% of emergency department patients. During the study period, 493 patients with drug or chemical exposure were admitted. Of them, 52.1% were male and 47.9% were female. 75.7% were between the ages of 14-29 years. Benzodiazepines [23.1%] followed by Tramadol [20.1%] were the most common cause of poisonings. Intentional poisonings constituted the majority of cases [67%]. The mean age of suicidal cases was lower [23.3 vs 30.3]. The majority of patients were single [52.9%], unemployed [58.4%] and living in urban centers [75.3%]. 26% of patients had a diagnosed psychiatric disease, 13% had previous suicidal self-poisoning and 32.3% were addicted. 2.2% of patients were died during hospital stay. In this study, poisonings most commonly occur as intentional and mostly by pharmaceutical agents. The prevalence was higher in younger individuals than other groups. According to these findings, the authorities have to prevent its further occurance by screening of psychiatric diseases in poisoning cases and early treatment of them, as well as limiting easy availability of drugs

Investigation of violence against emergency nurses in a referral university hospital in Southern Iran

Today, the incidence of violence such as verbal violence physical violence, including battering, sexual harassment is defined conflicts, especially in work environments around the world. The aim of this study was to investigate violence against emergency department nurses of Shahid Mohammadi hospital in Bandar Abbas. This study was a cross - sectional descriptive study which was conducted in 2012-2013, the population of nurses in the emergency department of shahid Mohammadi hospital, with at least one year of work experience ranging from formal contracts and are recruiting in all of them [88 women and 13 men] were enrolled in this study. The researcher made questionnaire including open and closed questions was used for data collection. By using SPSS software, Chi-Square test was used for statisrical analysis. Verbal abuse, threat and physical violence had the highest prevalence of violence. Night shift work, lack of police intervention, long-term care services, the main risk factors for violence are the most violent patients, and the shift is 7 nights to 12 nights. In the majority of cases [94%], nurses were not well trained on how deal with violence and also report an incident. In this study, the prevalence of violence over a period of one year, which is higher than the foreign studies of the consideration and study. Hence a proper and comprehensive research, prevention programs, such as raising the general culture, involvement of nurses with higher responsibility and high-speed action in emergencies, the sensitizing concerned authroties with the aim of reducing violence, is necessary

Dental curriculum revision in Iran: dentists' perspective on achievement of essential competencies through national curriculum

Based on the current emphasis on competency-based education, as a part of need assessment phase of dental curriculum revision in Iran, in the present study the dental graduates' perspective concerning the minimum competency requirements for an Iranian general dentist has been investigated. Based on the three available major competency documents in the literature a questionnaire was developed in which the participants were asked to indicate their opinion about the necessity of each of the 142 stated competencies for an Iranian general dentist [Yes/No], and to state the degree to which they believed the current curriculum covers each competency [Completely, Partially, Not at all]. In an annual meeting in June 2008, the provincial chief dental managers were asked to distribute the questionnaires among general dentists in their province [10 questionnaires in each province]. The managers posted back the completed questionnaires to the researchers. Of 300 questionnaires distributed in the 30 provinces of the country, 250 questionnaires [83%] were returned. While most of the participants considered the competencies as necessary for an Iranian dentist, less than 40% of the respondents believed that the graduates acquire the most required competencies of the profession during the current educational program. A necessity exists for curriculum revision. In addition to clinical skills, in this revision more emphasis also should be placed on the non-clinical part of the curriculum

[Presenting the course of community dentistry as problem based learning workshop and comparing it to learning through lecture]

Nowadays, the attitudinal aspect of community dentistry course and the way in which this course is taught is critically important. The aim of this study is to compare the presentation of theoretical community dentistry course through workshops using PBL method with that of contemporary method of lecture. In this quasi experimental study, 64 dental students of Tehran University of Medical Sciences who took the course of community dentistry in second semester of academic year of 2006-2007 were entered into the survey through census. They were randomly allocated into two groups of experiment and control each including thirty two. The course of community dentistry was taught to control group through traditional method in 17 lecturing sessions; meanwhile this course was instructed to experiment group through problem based learning method. A questionnaire was used for gathering data. Data was analyzed by SPSS software using descriptive statistics and Chi[2]. The improvement in attitude of PBL group was significant in contrast with that of traditional method group. In post-test, the mean score of knowledge and attitude of the group attending in workshop was higher than that of traditional group but the difference was not statistically significant. The mean score of satisfaction and transferring educational concepts was significantly higher in the group attending in workshop. Eighty one percent of the workshop attendees were satisfied with the method employed in the course. The new method of education has been successful in its achievements as forming a positive attitude in students and making them eager for community dentistry issues

Detection of s315t mutation in the katg gene associated with isoniazid resistance in mycobacterium tuberculosis isolated from isfahan and tehran by PCR-RFLP

Drug resistance to tuberculosis is increasing continuously and is a significant threat to tuberculosis control programs because there arc few drugs effective against Mycobacterium tuberculosis. Although isoniazid is most efficient in killing the tuberculosis bacilli, resistance to this drug also develops most readily. Mutations in katG, in particular the Ser 315 Thr substitution, are responsible for isoniazid resistance in a large proportion of tuberculosis cases. However, the frequency of the katG Ser 315 Thr substitution varies with population samples. This study provided the first molecular characterization of isoniazid resistance of M. tuberculosis strains and extended our knowledge of molecular basis of M. tuberculosis drug resistance that are widely applicable for rapid drug resistance detection. Using 1% proportional method, the sensitivity of 126 strains collected from Isfahan and Tehran to isoniazid was determined. The katG mutations in codon 315 associated with isoniazid resistance among isoniazid resistant isolates were determined by PCR-RFLP. In this way, 355 bp PCR products were digested by Mspl of 126 isolates of M. tuberculosis, 32 [25.4%] strains were determined as INH resistant. Resistance rate was 22.6% [19 strains] in Isfahan and 31% [13 strains] in Tehran. In total, 72% of isoniazid-resistant isolates could be identified by analysis of just katG 315 loci. The PCR-RFLP with Mspl that detect katG Ser315Thr substitution identified more isoniazid-resistant strains with mutations at codon 315 in the katG. Elucidation of the molecular basis of isoniazid resistance in M. tuberculosis has led to the development of different genotypic approaches for the rapid detection of isoniazid resistance in clinical isolates

[Measurement of endotoxin levels in blood of hemodialysis patients by 'LAL' test and comparision of its efficacy with blood culture]

Presently, bacteremia is the principal cause of morbidity in patients undergoing hemodialysis. Gram-negative bacteria account for approximately 50 percent of documented infections. Endotoxins released during lysis of gram negative bacteremia result in inflammatory and defense response by the body and if not treated promptly result in septic shock and ultimately death of the patient. This study describes the detection of endotoxins in blood of patients with bacteremia due to gram-negative bacteria by LAL test. Blood samples of 278 hemodialysis patients were analyzed in this study and pathogens were isolated from blood culture samples. Then, their antibiotic sensitivity was determined. In patients with positive blood culture, endotoxin levels were measured by LAL-test. Frequency of bacteremia in patients was 13.6%. The prevalence of gram-negative bacteremia was 44.7%. E coli were the major pathogens, while staphylococcus aureus was the most common gram positive bacterium. Endotoxin was detected in 15 patients [3.8 +/- 1.08 EU/ml]. The sensitivity and specificity of endotoxins for gram-negative bacteremia were 88% and 95%, respectively. The results indicate that the LAL method is a fast, sensitive and simple method. There was no significant difference between the results of blood culture and LAL-test [P>0.05]

Comparison of limulus amebocyte lysate assay for detection of endotoxin with blood culture in patients undergoing chronic hemodialysis

Infection is a common complication in patients undergoing hemodialysis. Despite the improvement of dialysis techniques, infection especially by bacteria remains the primary cause of death in these patients. Laboratory diagnosis is made by blood culture, the result of which may not be available for several days and during this period endotoxemia may lead to septic shock. Therefore, attempts at developing simple and rapid diagnostic tests are underway. In the present study, the Limulus Amebocyte Lysate [LAL] assay was used to detect endotoxin and compare its results with that of blood culture in hemodialysis patients. This study involved 278 chronic hemodialysis patients. LAL assay and blood culture were performed and the results were compared. 38 blood cultures were positive and the types of bacteria were determined with biotyping and serotyping methods. LAL assay was used to determine the presence of endotoxin in positive blood cultures. Endotoxin was detected in 15 patients. The sensitivity and specificity of LAL assay for Gram-negative bacteria were 88% and 95%, respectively. The frequency of bacteremia in patients was 13.6%. The prevalence of Gram-negative bacteremia [GNB] was 44.7%. Escherichia coli accounted for the majority of pathogenic microorganisms and Staphylococcus aureus was the most commonly encountered Gram-positive bacterium. Results of present study demonstrated that LAL assay is a rapid, sensitive and simple method. An excellent correlation was found between results of LAL assay and the presence of GNB. Gram-negative bacteria accounted for approximately 50% of documented infections. Endotoxin originating from Gram-negative bacteria was found to contribute to the inflammatory responses of patients with sepsis

Penicillin susceptibility testing of streptococcus pneumoniae by oxacillin disk screening method and standard broth microdilution method

Despite the widespread use of new antibiotics, Streptococcus pneumoniae still remains a significant cause of infection-caused morbidity and mortality across all age groups the world over. Isolates of Pneumococci that are resistant to Penicillin and other antibiotics are being found with increasing frequency. Rapid recognition of Penicillin-resistant strains in the laboratory is therefore critical to proper selection of antimicrobial therapy. The present study, carried out on clinical specimens, compared the Oxacillin disk screening test with the standard broth microdilution method in order to determine antibiotic susceptibility of Penicillin-resistant strains of Streptococcus pneumoniae. For the purposes of this study, 327 clinical samples were collected and Pneumococci strains were isolated from various parts of human body including blood, sputum, CSF etc. The minimal inhibitory concentration [MIC] of Penicillin G was determined using the standard broth microdilution method. The diffusion method [Kirby and Bauer] with 1 microg Oxacillin disk was used for first screening of Penicillin-resistant Pneumococci. A total of 61 S. pneumoniae strains were isolated from the clinical samples. The disk diffusion method classified 85% of the isolates as highly Penicillin-resistant and 15% as susceptible, while the microdilution method identified 19.6% susceptible to Penicillin, 16.2% moderately susceptible, and 18.1% highly resistant to Penicillin. Comparison of the two methods applied showed that the Oxacillin disk screen test was false-positive in 25% of the cases but the susceptibility of the strains to Penicillin as detected by the two methods did not show significant differences [p>0.05]. The high percentage of Pneumococci resistance to P-lactam antibiotics, particularly to Penicillin, necessitates the application of Oxacillin disk screening test as a cost-effecfive and rapid test and as an essential tool for initial diagnosis of resistant strains. The test is regarded as very sensitive but of low specificity because it does not distinguish between isolates highly resistant to Penicillin and those with intermediate resistance. It is, therefore, advisable that the standard microdilution test should be used for serious infections like meningitis or bacteriome

[Diagnosis of legionella pneumophila by direct fluorescent antibody [DFA] technique in bronchoalveolar specimens of pneumonia patients referring to medical centers in Isfahan, 2002]

Wide and universal distribution of Legionnaires' disease, abundance of reports about its prevalence and Pontiac fever from different countries, unresponsiveness to conventional antibiotic therapy in a number of pneumonia patients and the lack of any report about it in Iran directed us to perform this project. Legionnaires' disease is seen in sporadic and epidemic form and the most prevalent cause is legionella pnuemophilia which produces a severe disease in vulnerable individuals with a high fatality rate [50-80%]. It is also considered as one of the most fatal nasocomial infections. In the present research for isolating and detecting of L. pneumophila, bronchoalveolar specimens of patients were examined using culture and DFA methods. After 3-5 days of incubation at 37[degree]C, and humidity [about 95%], thin, convex and round colonies with blue-gray to blue-green appearance developed. Slides were prepared from these colonies and stained with Gram and Gimenez methods which displayed Gram -negative, small successive coccobacilli. Statistical analysis were performed by a software [SPSS, v10] using Fisher exact and McNemar Tests. From among the 96 bronchoscopic specimens, 4 strains of Gram negative bacilli were isolated. Further investigations by means of biochemical tests and specific DFA revealed that they were L.pneumophila. In vitro drug resistance and sensitivity tests of Legionella showed that these bacteria were sensitive to Erythromycin, Riphampicin, Gentamycin, Doxycycline and Tubramicin, the sensitivity being more pronounced against Erythromycin than others. The above-mentioned organisms were resistant to Tetracycline and Ampicillin. The Fisher exact Test revealed that there is no correlation between frequency of L.pneumophila and the sex of patients [P value= 0.72]. McNemar Test was performed and the results revealed that there is no significant difference between the results obtained by culture and DFA tests [P value= 1]. L.pneumophila has no correlation with the sex of patients. According to the results obtained by McNemar test, DFA method can be used for rapid detection of L.pneumophila, although further studies with larger quantity of specimens need to be performed to substantiate results

Detection of icaAD gene and biofilm formation in staphylococcus aureus isolates from wound infections

Wound infections are a common cause of staphylococcal infections. An ability of S.aureus is to adhere and form biofilm on host surfaces. Biofilm is an exopolysaccharide, a slime matrix around multiple layers of cells and is mediated by expression of the icaADBC operon. The present study evaluated the biofilm forming capacity and the presence of icaAD gene among S.aureus isolated from wound infections. Slime production assay was performed by cultivation on Congo Red Agar plate. In addition, Quantitative biofilm formation determined by microtiter plate assay PCR method used for detection of icaAD gene. Fifty strains were identified, 54% of the isolates produced black colonies on CRA plate, 52% were positive biofilm forming, and all strains carried the icaAD gene. Regarding the ability of S.aureus to form biofilms helps the bacterium to survive hostile environments within the host, suggests that biofilm production is a risk factor for infection. It is important in rapid diagnosis and treatment biofilm forming strains, because biofilm formation may lead to increased antimicrobial resistance and create a significant impediment to wound healing

Chlorine residual efficiency in inactivating bacteria from secondary contamination in Isfahan, 2002

To investigate the inactivation of potential pathogens, we evaluated survival rates for Escherichia coli, Enterococcus faecalis, Aeromonas hydrophila and Salmonella typhi in samples taken from the Isfahan drinking water system. Chlorine residual, pH, temperature and total organic carbon levels were measured. The organism most sensitive to chlorine was A. hydrophila. It was inactived in < 100 minutes at chlorine levels of 0.11 mg/L to 0.90 mg/L. The other 3 organisms showed higher resistance. E. coli tolerated 0.30 mg/L chlorine for > 1000 minutes while Ent. faecalis and S. typhi survived at total chlorine concentration of 0.50 mg/L for 100 minutes. We concluded that total chlorine levels of less than 0.71 mg/L in water supply systems cannot provide the recommended safety levels