Ventilator-associated pneumonia among ICU patients receiving mechanical ventilation and prophylaxis of gastrointestinal bleeding

Pneumonia in ventilated intensive care unit [ICU] patients is one of the most serious nosocomial infections with a frequently fatal outcome. Retrograde colonization of the oropharynx from the stomach by micro-aspiration of gastric fluid was shown to be associated with pneumonia. The purpose of the present study was to compare the frequency of ventilator-associated pneumonia [VAP] between two groups of ICU patients taking gastrointestinal bleeding prophylaxis including ranitidine or omeprazole. This double-blind randomized clinical trial was achieved on 129 subjects receiving at least 48 hours mechanical ventilation. They were assigned in 2 groups of ranitidine and omeprazole as the prophylactic regimen of stress-related gastrointestinal bleeding. In ranitidine group, 6 patients [9.7%] developed VAP compared to 8 subjects [13.1%] in the other group, however, chi square analysis failed to show a significant difference [P=0.4]. The incidence of VAP in ICU patients receiving either ranitidine or omeprazole did not differ significantly, however, further studies with greater sample size are required to draw a firm decision

[ frequency of vitamin D receptor gene polymorphisms in pulmonary tuberculosis [TB] patients and its relation with susceptibility to TB]

Many genetic studies on predisposing factors for active tuberculosis have been conducted. Study on human leukocyte antigens [HLA], vitamin D receptor [VDR], NRAMP1, mannose binding lectin [MBL], and tumor necrotizing factor [TNF] are the most studies in this field. This study was planned to identify any relationship between VDR polymorphisms [Apa I, Bsm I, Fok I and Taq I] and susceptibility to TB. This case-control study was performed on blood samples from tuberculosis cases [n=164] and controls [n=50]. DNA was extracted from white blood cells and the sequences were amplified by PCR followed by restriction digestion [PCR-RFLP technique] using specific primers and enzymes for each polymorphism. VDR polymorphisms were evaluated for two mentioned groups. Two genotypes of AbfT and AabbFfTT were the only statistically significant genotypes which had adfferent frequency between the study and control groups. Results of this study showed that genotypes of AbfT and AabbFfTT are protective factors against TB in our patients. We could not find any genotype as a predisposing factor for TB in our study group. However, other studies with larger group of samples are needed to find such a relationship

[Investigation of validity and reliability of Persian version of the "St. George Respiratory Questionaire"]

Health related quality of life [HRQL] questionnaires allow clinicians to measure daily the impact of disease on a patients daily life and is valuable in clinical trial designed to assess benefits and costs of management. We describe the adaptation into Persian version of the St.George Respiratory Questionnaires [SGRQ]; a recognized valid self administered questionnaire for chronic obstructive pulomnary diseases. In order to adapt the face validity, the forward and back- translation method was used. Then this questionnaire was edited by researchers and a single pulmonologist as an internist. The content of tests evaluated for feasibility and comprehension by 15 educated COPD patients. In following, the professional committee of researcher assessed the content validity. At last, 55 COPD patients with wide range of disease severity fulfilled the Persian version of the SGRQ. Internal consistency were measured by Cronbach's alpha coefficient test. The test coefficiency for reliability was 0.74 in part I of questionnaire; "symptoms". Factor analysis indicated that if latest question of part 1 was eliminated ["If you wheeze, is it become worse in the morning?"] Cronbach's alpha would be elevated to 0.78. Cronbach's alpha was 0.95 in Part II [Activity and impact] and for overall scale, the result was found to be 0.93. Data from this study revealed that Persian version of SGRQ, as a research tool, is of good validity and sufficient reliablity. The present study suggest the feasibility of adapting a specific instrument of health related quality of life in patients with respiratory disease to be used in different settings from where the instrument has been originally developed