Prevalence and risk assessment of CA-MRSA nasal colonization in patients of loghman hospital Tehran, Iran

Community-associated methicillin-resistant staphylococcus aureus [CA-MRSA] is a serious pathogen and its nasal carriage is a risk factor for subsequent infections. This study aimed to determine the prevalence of and risk factors for CA-MRSA colonization at the time of hospital admission in our community. During 2007, patients admitted to the emergency department of Loghman Hakeem hospital were interviewed and anterior nares cultures were obtained within 24 hours of admission. A cross-sectional study and antibiotic susceptibility tests [E-Test] were performed. A positive culture of MRSA within 24 hours of admission was considered as CA-MRSA. Chi-square test was performed to assess associations between culture results and the studied risk factors, using SPSS version 15. 56 [14%] and 11 [2.7%] of 400 patients had a nare culture positive for staphylococcus aureus and MRSA, respectively. HIV infection [P = .001], nursing home residence [P = .033] and nasal anatomic abnormalities [p= .033] had significant association with CA-MRSA cultures. However, in logistic regression, no statistically significant association was found. 45% of MRSA cultures showed induced resistance to clindamycin on D-test. On tigacyline E-test, based on a 12|microgram/ml cutoff for susceptibility, 6 [54.5%] showed resistance. Our study showed CA-MRSA prevalence to be 2.7% and did not demonstrate any association between recent hospitalization, antibiotic use and IV drug abuse with CA-MRSA carriage status unlike other studies. This may have been a result of CA-MRSA low prevalence and a small sample size. We recommend a study with a larger sample size for appropriate evaluation of risk factors

[Correlation between staging of hepatic fibrosis and biochemical markers in patient with liver fibrosis]

Liver fibrosis is an inevitable result of chronic liver diseases which may ultimately lead into liver cirrhosis. Diagnosis and grading of liver fibrosis is of considerable importance in both treatment strategy, treatment response, prognosis and potential risk factors for the disease complications. Although liver biopsy is the best known technique for evaluation of liver fibrosis, researchers have been searching for a more appropriate alternative to be used instead due to its harsh nature along with several side effects. One of the suggested ones is the use of biochemical markers. Our aim in this study, therefore, was the assessment of some of these biochemical markers. In a retrospective trial, 130 patients [94 men [72.3%] and 36 women [27.7%]] of whom had undergone liver biopsy, were studied. Former biopsy samples were reviewed. Gathered data from their medical file and pathology reports were analyzed by SPSS 11.5. It was revealed that there was a positive correlation between age and severity fibrosis. There was no significant relationship between liver fibrosis and gender. Comparing the patients with liver fibrosis and non-fibrotic ones, we found that the AST/platelet index is an appropriate marker for distinction of these patients. To distinguish the patients without liver fibrosis from ones with moderate liver fibrosis, a cut off point=0.39, PPV=0.7 and NPV=0.54 was obtained, whereas for differentiating them from sever liver fibrosis patients, the cut off point of 0.25, PPV=0.76 and NPV=0.7 was achieved. Distincting the mild and moderate fibrosis, platelet was found to be an appropriate variable, having a cut off point of 158500. Moreover, to set mild and sever fibrosis apart, platelet and albumin were more valuable. In this study cut off point of 151000 for platelet and 3.6 for albumin was obtained, respectively. Similar to other relevant studies we also could not find any appropriate marker for making the distinction between moderate and severe fibrosis. Our study outlines that AST/platelet index has an appropriate cut off point for distinction between non-fibrotic and moderate and sever liver fibrosis. Distinguishing the mild cases from both moderate and sever fibrosis, platelet is a good marker. Furthermore, albumin is another marker for distinction between mild and sever fibrosis. The studied markers are not able to distinct all stages of fibrosis. Due to their limitations, they can not be applied in various clinical situations. In this regard, no definite substitute for liver biopsy has been found yet. Acquiring a test or technique that contains all necessary standards for evaluation of liver fibrosis requires further studies and researches