[Comparing clinical manifestations and endoscopic findings between elderly and non- elderly patients with dyspepsia reffered to Rasoul-e-Akram Hospital in 2014]

Background: Frequency of H.pylori infection in the elderly with dyspepsia is unknown in Iran. The aim of this study was to compare manifestations and endoscopic/pathologic findings in elderly and non- elderly population in a teaching hospital

Materials and methods: In this cross sectional study, all patients over 18 years with dyspepsia admitted to our hospital over a period 6 months were studied. All adult patients [below 60 years] and elderly patients [over 60 years] diagnosed with dyspepsia were examined and underwent upper gastrointestinal endoscopy. Analysis was performed using chi square, in order to find correlation between symptoms and endoscopic and pathologic findings of patients with dyspepsia and age

Results: Totally, 500 patients [250 elderly] were studied. The mean [ +/- SD] age of elderly and others were 76 +/- 2.8 years and 41 +/- 3.3 years, respectively. Our results showed that the frequency of H.pylori infection in elderly was 66% in comparison of 34.8% in adults [p<0.005]. In endoscopic findings, frequency of erosive duodonitis [p=0.031] and duodenal deformity [p=0.025] increased with age. In pathologic findings, frequency of dysplasia and metaplasia in the elderly was more than others [p<0.05]

Conclusion: Upper endoscopy screening may be an effective technique for early detection of H.pylori infection and its complications, such as metaplasia and dysplasia, in the elderly

Spread of Efflux Pump Overexpressing-Mediated Fluoroquinolone Resistance and Multidrug Resistance in Pseudomonas aeruginosa by using an Efflux Pump Inhibitor

BACKGROUND: Fluoroquinolone resistance in Pseudomonas aeruginosa may be due to efflux pump overexpression and/or target mutations. We designed this study to investigate the efflux pump mediated fluoroquinolone resistance and check the increasing effectiveness of fluoroquinolones in combination with an efflux pumps inhibitor among P. aeruginosa isolates from burn wounds infections. MATERIALS AND METHODS: A total of 154 consecutive strains of P. aeruginosa were recovered from separate patients hospitalized in a burn hospital, Tehran, Iran. The isolates first were studied by disk diffusion antibiogram for 11 antibiotics and then minimum inhibitory concentration (MIC) experiments were performed to detect synergy between ciprofloxacin and the efflux pump inhibitor, carbonyl cyanide-m-chlorophenyl hydrazone (CCCP). Then to elucidate the inducing of multi drug resistance due to different efflux pumps activation in Fluoroquinolone resistant isolates, synergy experiments were also performed in random ciprofloxacin resistant isolates which have overexpressed efflux pumps phenotypically, using CCCP and selected antibiotics as markers for Beta-lactams and Aminoglycosides. The isolates were also tested by polymerase chain reaction (PCR) for the presence of the MexA, MexC and MexE, which encode the efflux pumps MexAB-OprM, MexCD-OprJ and MexEF-OprN. RESULTS: Most of the isolates were resistant to 3 or more antibiotics tested. More than half of the ciprofloxacin resistant isolates exhibited synergy between ciprofloxacin and CCCP, indicating the efflux pump activity contributed to the ciprofloxacin resistance. Also increased susceptibility of random ciprofloxacin resistant isolates of P. aeruginosa to other selected antibiotics, in presence of CCCP, implied multidrug extrusion by different active efflux pump in fluoroquinolones resistant strains. All of Ciprofloxacin resistant isolates were positive for MexA, MexC and MexE genes simultaneously. CONCLUSION: In this burn hospital, where multidrug resistant P. aeruginosa isolates were prevalent, ciprofloxacin resistance and multidrug resistance due to the overexpression of fluoroquinolones mediated efflux pumps has also now emerged. Early recognition of this resistance mechanism should allow the use of alternative antibiotics and use an efflux pumps inhibitor in combination with antibiotic therapy.

Clarithromycin vs. gemifloxacin in quadruple therapy regimens for empiric primary treatment of Helicobacter pylori infection: a randomized clinical trial

Eradication of Helicobacter pylori infection plays a crucial role in the treatment of peptic ulcer. Clarithromycin resistance is a major cause of treatment failure. This randomized clinical trial aimed at evaluating the efficacy of a clarithromycin versus gemifloxacin containing quadruple therapy regimen in eradication of H.pylori infection. In this randomized double blind clinical trial [RCT 2012102011054N2], a total of 120 patients were randomized to two groups of 60 patients each. Patients with proven H.pylori infection were consecutively assigned into two groups to receive OBAG or OBAC in gastroenterology clinic in Rasoul-e-Akram General Hospital in Tehran, Iran. The patients in the OBAG group received omeprazole [20 mg] twice daily, bismuth subcitrate [240 mg] twice daily, amoxicillin [1 gr] twice daily, and gemifloxacin [320 mg] once daily, and those in the OBAC group received omeprazole [20 mg] twice daily, 240 mg of bismuth subcitrate twice daily, amoxicillin [1 gr] twice daily, and clarithromycin [500 mg] twice daily for 10 days. Five patients from each group were excluded from the study because of poor compliance, so 110 patients completed the study. The intention-to-treat eradication rate was 61.6% and 66.6% for the OBAC and OBAG groups, respectively. According to the per protocol analysis, the success rates of eradication of H.pylori infection were 67.2% and 72.7% for OBAC and OBAG groups, respectively [p=0.568]. The results of this study suggest that gemifloxacin containing regimen is at least as effective as clarithromycin regimen; hence, this new treatment could be considered as an alternative for the patients who cannot tolerate clarithromycin

Seroprevalence of varicella-zoster virus among pregnant women in two teaching hospitals, Tehran, Iran

Varicella zoster virus [VZV] can cause life-threatening disease in pregnant women. The aim of this study was to identify the VZV immune status in pregnant women and also determine the validity of self-reported history for chickenpox. Serologic testing for VZV was performed for 400 pregnant women attending prenatal care at clinics located in two teaching and referral hospitals in Tehran, Iran. The Enzyme Immunoassay method was used to assess IgG antibodies against VZV. A total of 400 pregnant women, aged 16-43 years [median: 27 years, mean: 27.6 +/- 5.9 years], were examined in which 361 [90.3%] were found to be seropositive. Sensitivity, specificity and positive and negative predictive values of patients' self reported history were 51.8%, 71.7%, 94.4% and 13.8% respectively. Serologic screening for VZV in pregnant women seems crucial. We suggest considering the pregnant women as the target group for future immunization programs in Iran

Comparison of chest X-ray findings in health care workers with and without latent tuberculosis infection in Rasool Akram hospital

Background: Hospitals are hazardous environments for the emergence and transmission of tuberculosis. This study was carried out to evaluate the prevalence of latent tuberculosis infection [LTBI] and chest X-ray findings in health care workers [HCWs] with and without LTBI

Materials and Methods: A cross sectional survey was conducted in Rasool Akram hospital, Tehran, Iran. One hundred HCWs were tuberculin skin tested to measure LTBI and were asked for Chest X-ray to detect any lesions compatible with active or latent tuberculosis in two groups with and without LTBI. Chest x-ray findings were reported as: calcified nodule, fibrotic lesions, hilar adenopathy, tuberculoma, pleural effusion, and miliary. Statistical significances were analyzed by Chi-squared test. The obtained data were analyzed by SPSS version 16 software

Results: A total of 100 HCWs were included in our study. Tuberculin skin test [TST] was positive in 49 [49%] cases. There was no significant difference between sex and positive tuberculin skin test. Abnormal findings in chest radiography were reported in 9 [9%] cases. There was no significant difference between LTBI and gender [P=0.8]. There was no significant difference between chest x-ray findings and LTBI [P=0.5]

Conclusion: Although nearly half of participants had positive tuberculin skin test, chest abnormality was reported only in nine percent. Specific tests and imaging such as QuantiFERON and chest CT scan seems to be more effective for latent tuberculosis diagnosis than TST among HCWs

Identification of bacterial antigens and super antigens in synovial fluid of patients with arthritis: a cross sectional study

An accurate and prompt diagnosis of bacterial arthritis is essential for earlier treatment and a good outcome. Superantigens produced by Staph. Aureus are among the most lethal toxins. The paper objective was Identification of common bacterial antigens and S. aureus superantigens in synovial fluid [SF] of children with negative culture and direct smear for other bacteria except for S. aureus. In this cross-sectional study a total of 62 patients with a mean age of 11 +/- 3.8 years [range: 5 months-16 years] with acute arthritis in pediatric and orthopedic wards of Rasoul Hospital [2008-2010] were studied. Three common bacterial antigens [e.g. S.pneumonia, H.influenza, N. meningitis] using LPA [latex particle antigen] and Staphylococcal superantigens [TSSTl; Enterotoxin A; B; C] using ELISA method [ABcam; USA] were identified in 60 adequate SF samples with negative culture and negative direct smears [for other bacteria except for S. aureus. Staphylococcal superantigens were compared with S. aureus infection [positive culture or direct smear]. Positive bacterial antigens [LPA test] were found in 4 cases including two S. Pneumonia, one N. meningitis, and one H.influenza. S.aureus was diagnosed in 7 cases including 4 positive cultures and 3 positive smears. Staphylococcal superantigens [toxins] were found in 73% of SF samples. Some cases had 2 or 3 types of toxins. S. aureus toxins were reported in 47% of culture negative SF samples. Positive TSSTl, Enterotoxin B, Enterotoxin A, and Enterotoxin C were found in 47% [n= 28], 18% [n= 10], 39% [n= 22], and 39% [n=21] of cases respectively. The most common type of superantigens was TSSTl; and Enterotoxin A was the less common type. Except for Enterotoxin A, no relation between positive S. aureus culture and positive tests for superantigens in SF was found. S. aureus has a prominent role in septic arthritis. S.aureus toxins might have a prominent role in arthritis with negative SF culture. Rapid identification of bacterial antigens [LPA] or S.aureus superantigens [toxins] are valuable for diagnosis in cases with negative cultures. We recommend usage of complementary methods [e.g. antigen detection tests] in children. Those tests are cheaper and easier in comparison with PCR as a complex and time-taking method. Identification of S. aureus superantigens in SF of all cases with negative culture, or treatment with antagonist drugs needs further clinical trial studies

[Risk factors and antimicrobial susceptibility in ventilator associated pneumonia: a brief report]

Ventilator associated pneumonia [VAP] is one of the serious complications of ventilatory support, occurring in ICUs. The aim of this study was to determine various risk factors associated with the acquisition of Acinetobacter infection and its antimicrobial susceptibility pattern. This cross-sectional study was performed in the ICUs of Rasoul-e-Akram Hospital in Tehran, Iran during the year 2011. A total of 51 endobronchial aspirates from intubated patients who had been clinically diagnosed to have VAP were studied bacteriologically. The in vitro susceptibility was determined by disk-diffusion and broth microdilution MIC methods. Out of 51 patients with VAP, 35 [66.66%] had positive cultures for Acinetobacter species. In vitro susceptibility test revealed that a high percentage of isolates were resistant to imipenem, piperacillin-tazobactam, third generation cephalosporines, and aminoglycosides. The antimicrobial resistance of gram negative bacteria, particularly Acinetobacter species, is increasing and preventive measures need to be taken as a matter of urgency.

Investigation of class I, II and III integrons among acinetobacter strains isolated from ventilator-associated pneumonia patients in intensive care unit of Rasoul Akram Hospital in Tehran, Iran

Multi-drug resistant strains of Acinetobacter spp. have created therapeutic problems worldwide. The objective of this study was to detect integrons in Acinetobacter spp. isolates from Ventilator-Associated Pneumonia patients using PCR method. A total 51 Bronchoalveolar lavage samples were obtained from patients in ICU and examined for Acinetobacter spp. infection by biochemical and PCR methods using blaOXA51-like primers. Antimicrobial susceptibility testing was performed using disk diffusion and MIC methods. Among 51 patients with VAP [62.7% males, 35.2% females, mean age 53 year], 50 [98%] were positive, with a high prevalence of gram-negative bacteria, mainly Acinetobacter spp. [70%], from which A. baumani was detected in 34 [68%] and A. lwoffii in 1 [2%] of isolates. More than 90% of isolates were resistant to imipenem, piperacillin+tazobactam, third generation cephalosporins and gentamicin, while the most effective antibiotic was colistin [100%]. The correlation coefficient between disk diffusion and MIC was 0.808 [p = 0.001]. Three Acinetobacter isolates [8%] harbored integrase /gene but none of isolates contained Class II or III integrons. The results showed that colistin was an effective antibiotic and can be used for treatment of patients in ICU. Due to the high number of MDR isolates lacking Integrons it can be concluded that although class I integrons are important among clinical isolates of A. baumannii, they have no significant role in dissemination of antibiotic resistance genes in Rasoul Akram Hospital in Tehran, Iran. The presence of IntI in A. Iwoffii may be related to transfer of integron to A. baumannii which can be considered as an important threat for hospitalized patients

Helicobacter pylori in diabetic and non-diabetic patients with dyspepsia

Helicobacter pylori [H. pylori] is one of the most common chronic infections in patients with gastrointestinal disorders. Recent reports suggested that H. pylori might have high prevalence among patients with diabetes. The aim of this cross-sectional study was to assess the prevalence of H. pylori infection in diabetes mellitus and to study the relationship between histological findings and H. pylori infection in diabetic patients. Eighty patients with dyspepsia that were referred to our gastrointestinal department between May 2007 and May 2008 were included in our study. We checked fasting blood sugar for all of the study samples. All of patients underwent upper endoscopy and biopsy specimens were obtained from the antrum and the corpus. The specimens for the presence of H. pylori were colored by Giemsa stains. A single pathologist evaluated the histology slides. We found that prevalence of H. pylori infection was significantly higher in diabetics than in non-diabetics [P=0.001]. Indeed, the prevalence of gastritis did differ significantly between the two groups [P=0.001]. According to our results diabetes mellitus is one of the risk factor that must be considered in evaluation of H. pylori infection in diabetic patients with dyspepsia

[Determination of STREM-1 level in synovial fluid for diagnosis of septic arthritis in children]

Triggering receptors expressed on myeloid cells i.e soluble triggering expressed on myeloid cells-1 [STREM-1] is inducible on monocyte/macrophages and neutrophils and accelerates tissue destruction by propagating inflammatory responses in disease related to bacterial infections. The aim of this study was to investigate the role of STREM-1 in the synovial fluid to identify septic arthritis from aseptic ones. A cross sectional study [2007-2009] was conducted in the Pediatric and Orthopedic wards of Hazrat-e-Rasool Akram hospital, Tehran . Synovial fluid was aspirated in 53 cases with arthitis and searched for diagnosis of bacterial arthritis by conventional diagnostic tests. About 0.5-3cc of synovial fluid was stored at -70°C, and quantification of STREM-1 was done in 53 synovial fluid samples [Quantikine, R and D systems, USA] by EIA; results were compared between septic and aseptic arthritis. Septic arthritis was detected in 49% [26/53] and aseptic arthritis in 51%[27/53]. Positive synovial fluid culture was detected in 20.3%, and positive latex particle agglutination for bacteria was found in 8.5%. Positve direct smear was obtained in 10.5% of the cases. Cut off level 825 pg/ml for SF-STREM-1 yielded 50% sensitivity, 70% specificity, 64% Positive Predictive Value [PPV], and 64%, Negative Predictive Value [NPV]. Poor agreement was seen between SF -STREM-1 levels and positive culture [p value: 0.037; Kappa=0.28]. The area under the ROC curve for discriminating between septic and aseptic arthitis was 0.603 [95% CI; 0.757-0.448, p = 0.1]. SF-STREM-1 level with cutoff 825pg/ml had 50% sensitivity, and 70% specifity in discriminating between proved cases with septic arthitis from aseptic ones. Searching for bacterial antigens in synovial fluid [Latex Particle Aagglutination test] and synovial fluid -STREM-1 level could potentially assist clinicians in better diagnosis of septic arthitis if added to the conventional tests including smear and routine analysis of synovial fluid. It might prevent unnecessary empiric antibiotic theray in children with arthritis. In clinical decision making; randomized studies on the potential synovial fluid - STREM-1 -level guided antimicrobial therapy in bacterial arthritis would be useful.

[Comparing pulmonary tuberculosis between elderly patients and young adults]

Atypical clinical manifestations and radiologic images of pulmonary tuberculosis are common in elderly. To investigate the differences in the clinical, radiologic and laboratory features of pulmonary and pleural tuberculosis in older patients, as compared to younger patients. The medical records of patients with documented pulmonary tuberculosis in Rasoul-e-Akram hospital from 2005 through 2010 were analyzed. Data included sex, age, medical comorbidities, symptoms and signs, laboratory data, radiographic findings, tuberculin skin test [TST] and sputum smears and bronchoalveolar lavage [BAL] for AFB results. Statistical significances were analyzed by student t test and chi2 test. Among 285 patients with documented tuberculosis, 126 were 65 years of age and older, and 159 under 65 years of age. A lower prevalence of fever, night sweating, hemoptysis, anorexia, pleuritic chest pain, cavitary lesion in upper lobes, positive TST and positive acid fast bacilli in sputum and BAL were detected among older patients [p<0.05]. In addition, the older patients had a greater prevalence of dyspnea [p<0.001] and some comorbidities, such as diabetes mellitus, COPD, and renal failure [p<0.05]. This study showed the main differences of pulmonary tuberculosis in the elderly, compared to young patients that should be considered during the diagnostic assessment

Procalcitonin in diagnosing the diabetic foot infection

Diabetic foot infection is a debilitating disease that requires prompt diagnosis and treatment. In this study, we assessed inflammatory markers; serum Procalcitonin [PCT], c-reactive protein [CRP], erythrocyte sedimentation rate [ESR] and leukocyte counts in two groups of patients with infected and non-infected diabetic foot ulcer. A descriptive cross-sectional study was carried out on diabetic patients during 18 months in Firoozgar Hospital. Patients were divided in two groups according to Infectious Disease Society of America [IDSA] guideline for diagnosis and treatment of diabetic foot infections. Blood samples were drawn from venous lines for measurement of complete blood count [CBC], ESR, CRP, and PCT. Diagnostic values of serum PCT Levels were determined by immunoluminometric assay. SPSS version 15.0 software was used for analysis. Sixty adult patients were considered for this study. Thirty patients with infected ulcer with mean age of 57.5 +/- 2.09 years and 30 with non- infected ulcers with mean age of 61.1 +/- 1.9 years were evaluated. Patients with infected ulcers had significantly elevated levels of CRP, ESR and leukocyte counts in comparison with the non- infected ulcers. Serum PCT levels did not differ between the two groups. Our study suggests CRP, ESR and Leukocyte counts can be used to diagnose of infected ulcers. The role of PCT in localized infections should be determined in further studies

Ten-year experience of rhinocerebral zygomycosis in a teaching hospital in Tehran

Rhinocerebral zygomycosis is a rare, rapidly progressive and often fatal fungal infection occurring in several immunocompromised states. Prior investigators have reported an increasing incidence among Iranian population; therefore, we decided to present the clinical features and treatment outcome of a group of patients with rhinocerebral zygomycosis. Medical records of all cases with the diagnosis of rhinocerebral zygomycosis attending Rasoule- Akram Hospital, Tehran, Iran, were retrospectively reviewed from 1997 to 2007. Age, gender, predisposing illness, surgical procedures, and treatment outcomes were reviewed. Totally, 30 patients [17 males and 13 females] were reviewed with a mean age of 49.4 +/- 20.3 years. The lag time between onset of symptoms referable to zygomycosis and commencement of amphotericin B was 1 to 90 days with median of 10 days. An association between delayed treatment and mortality was found [p=0.01]. Visual loss was observed in 53.3%. The ethmoid [86.6%] and maxillary sinuses [66.6%] were most commonly involved. Eighteen patients had underlying diabetes mellitus [60%]. All patients received medical treatment, while 28 [93.3%] underwent surgical intervention. Twenty three patients [76.7%] had orbital involvement with a mortality rate of 43.5%. The overall mortality rate was 40% [12 cases]. Patients with higher doses of amphotericin B and multiple surgical intervention had lower mortality rate [p=0.00 and p=0.01, respectively]. Factors such as age, gender, predisposing diseases, orbital involvement, multi-sinus involvement, and white blood cell count had no impact on survival rate. Institution of aggressive surgical debridement of devitalized tissue and the timely initiation of systemic medical therapy is critical for good outcome

Comparing community acquired pneumonia between elderly population and others

To evaluate the manifestations and outcome of community acquired pneumonia in elderly population and compare it with other adults in two teaching hospitals. A prospective study including all patients over 14 years of age admitted to our hospitals with community acquired pneumonia, was carried out over a period of 12 months. All adult patients and over 65 years old [elderly patients] diagnosed with pneumonia were examined and followed by two of the authors distinctly. Analysis was performed, using chi square, in order to find correlations between signs and symptoms of pneumonia and age. Totally, 183 patients [103 elderly] were studied. The mean age of the participants [ +/- SD] was 59 +/- 24 years. The main manifestations of pneumonia in elderly patients were as follow: tachypnea [64%], cough [62%], and fever [34%], respectively. Our results showed that the frequency of fever [p=0.04], chest pain [p=0.001], and pleuritic pain [p=0.001] decrease with aging, however, mental status changes [p=0.015], and CHF [p=0.02] increase with aging. Thirty one patients [17%] died, of whom 29 were over 65 years of age [p=0.01]. The clinical presentations of pneumonia in the elderly population can be different from those in younger patients, therefore, it is important to be familiar with these differences to avoid unnecessary delays in prompt diagnosis

Viral hepatitis in patients hospitalized in two teaching hospitals, Tehran, Iran

Viral hepatitis is a systemic infection affecting the liver predominantly. Almost all cases of acute viral hepatitis are caused by one of five viral agents: HAV, HBV, HCV, HDV and HEV. The present study aimed to find out the frequency of various forms of viral hepatitis [HAY, HBV, and HCV], route of transmission, the history of vaccination against hepatitis B, and clinical findings in 252 hepatic patients referring to 2 teaching hospitals. In this descriptive study, 252 patients with viral hepatitis hospitalized in two university hospitals were included. Based on medical files, the initial data and laboratory indices including HBS-Ag, HBS-Ab, anti- HBC Ab, anti-HCV Ab [ELISA generation II], anti-HAV Ab [IgG, Ig M], and anti-HIV Ab were gathered. The mean age of patients [ +/- standard deviation] was 40.3 +/- 16.3 years. Of 252 cases, 37 [14.5%] suffered from acute viral hepatitis, while 215 [85.5%] were chronically infected. Finally, the frequency of various forms of viral hepatitis was as follows: hepatitis A 5.2%, hepatitis B 54.8%, hepatitis C 34.9%, and hepatitis B and C co-infection 5.2%. With respect to the hazardous complications of hepatitis B and C and the reality that most of the patients are in their reproductive ages, suitable strategic planning for controlling and preventing the disease is of utmost importance

[Accuracy of urea breath test to detect Helicobacter pylori infection among patients with chronic renal failure candidate for renal transplantation]

There are few studies to evaluate diagnostic accuracy of urea breath test [UBT] in patients with chronic renal failure [CRF]. In this study, accuracy of urea breath test to detect Helicobacter pylori [H. pylori] infection among patients with chronic renal failure candidate for renal transplantation was studied. In this descriptive-analytic study, 40 patients with CRF were studied. Upper GI endoscopy and UBT were requested for all patients. Clinical data and histologic findings and UBT results were analyzed by chi-square using SPSS ver.12 software. P< 0.05 was considered statistically significant. Forty patients with mean age of 33.56 +/- 11.22, including 20 male and 20 female, were studied. Both sensitivity and specificity of UBT were 80 percent, but with cut-off point of 5, its specificity increased to 100 percent. Positive and negative predictive values of UBT were 92.30 percent and 57.14 percent, respectively, but with cut-off point of 5, they increased to 100 percent and 71.42 percent, respectively. In according to relatively low sensitivity of UBT in CRF patients and higher risk of peptic ulcer and its bleeding, it is suggested that histologic examination must be done for all patients with negative UBT. Furthermore, diagnostic accuracy for H. pylori detection could be improved by assessing the UBT with a cut-off value of 5

Serum zinc level in children with febrile convulsion and its comparison with that of control group

Febrile convulsion is the most common disorder in childhood with good prognosis. There are different hypotheses about neurotransmitters and trace element [such as zinc] changes in cerebrospinal fluid and serum, which can have a role in pathogenesis of febrile convulsion. The aim of the present prospective analytical case-control study was to determine whether there was any changes in serum zinc level in children with febrile convulsion during seizure. Ninety-two children aged 6 months to 5 years were divided into three groups: group A, 34 children with febrile convulsion, group B, 40 children having fever without convulsion, and group C, and 18 children with non-febrile convulsion. Serum zinc levels for the three groups were estimated by atomic absorption spectrophotometry [AAS]. Data were analyzed to compare zinc level among the three groups using appropriate statistical tools employing SPSS 13. Serum zinc levels of groups A, B, and C had a mean value of 76.82 +/- 24.36mg/1, 90.12 +/- 14.63 mg/1 and 94.53 +/- 17.39 mg/l, respectively. Serum zinc level of group A was lower than those of the other two groups [P < 0.006]. It was also lower in group B than in group C [P < 0.006]. These findings revealed that serum zinc level decreases during infection; this decrease was more significant in patients with febrile convulsion

Symptomatic nosocomial urinary tract infection in ICU patients: identification of antimicrobial resistance pattern

Nosocomial infections are generally occurring 72 hours after admittance and are not present or incubating prior to admittance. The most common nosocomial infection is urinary tract infection [UTI]. Scanty data are available regarding the nosocomial infections in Iranian teaching hospitals. The aim of the present study was to determine the frequency of symptomatic nosocomial UTI, identify the etiologic organisms, and determine their antimicrobial susceptibility pattern. This cross sectional study was conducted on ICU patients of Firoozgar hospital affiliated to Iran University of Medical Sciences from September 2003 to September 2005. Antimicrobial susceptibility pattern was achieved by disk-agar diffusion and E. test methods. Totally, 306 patients were admitted to ICU, of whom 28 [9.2%] suffered from symptomatic UTI. The most common isolated organism was Klebsiella [13 cases, 46%] followed by E. coli, Pseudomonas and Enterobacter spp. A high level of resistance was observed for third generation cephalosporins [Pseudomonas 100%, Klebsiella 92%, E. coli 71% and Enterobacter 25%], however, microorganisms were less resistant to imipenem and cefepime. Based on observed results, carbapenems and cefepime are the drugs of choice for empiric antibiotic therapy of nosocomial UTIs in Firoozgar hospital

Bacteriological profile and antimicrobial resistance of blood culture isolates

Bloodstream infection [BSI] is an important cause of mortality and morbidity and among the most common health-care associated infections. In this study we described the frequency of occurrence and antimicrobial susceptibility patterns of nosocomial and community-acquired BSI isolates from a teaching hospital in Tehran, Iran. his cross-sectional study was conducted in 850-bed Rasul Akram university hospital from April 2006 to April 2007. All patients with a positive blood culture were enrolled. Antimicrobial susceptibility testing was performed with disk diffusion and E-test MIC. During the study period, 456 isolates were obtained from blood cultures, from a total of 8818 collected sets, among which 291 were felt to represent true bacteremia and 98 were nosocomial. Acinetobacter spp. were the most frequently isolated agents in the hospital and community acquired BSIs [32%], followed by Escherichia coli [13.7%] and Klebsiella spp. [12%]. The most effective antibiotics for gram-negative and gram-positive bacteria were ciprofloxacin [13% resistance rate] and vancomycin and oxacillin [with 13% resistance rate], respectively. Analysis of antibiotic resistance pattern showed that 20.43% of Acinetobacter spp. and 15.4% of Pseudomonas aeruginosa were multi drug resistant [MDR], while 48.7% of Kiebsiella spp were ESBL-producing isolates and 15% of Staphylococcus aureus were oxacillin-resistant. We did not observe any vancomycin-resistant strains among isolates of S. aureus. Rifampin and ciprofloxacin showed good activity against most of gram-positive and gram-negative organisms, respectively. Carbapenems [imipenem and meropenem] were highly active against strains of Enterobacteriaceae [E. coli, Klebsiella] that showed resistance to third generation of cephalosporines

Evaluation of diabetes mellitus in patients with sepsis

Diabetes mellitus is a prevalent disease worldwide and infection is a major problem in diabetics. This study investigated the frequency of diabetes mellitus and its associated factors in patients with sepsis. This is a descriptive cross-sectional study including 300 randomly selected cases admitted to Rasoul-e-Akram Hospital with the diagnosis of sepsis between March 2003 and February 2006. Of 300 septic patients, 158 [52.7%] had diabetes mellitus with the mean age [ +/- standard deviation] of 52.7 +/- 28.4 years. The most common site of infection was respiratory tract. Evaluation of the outcome of patients in two diabetic and non-diabetic groups demonstrated a statistical difference [p=0.001]. Mortality rate increased with aging, delay in therapy commencement and the number of SIRS criteria [p=0.001]. Evaluation of the mortality rate in 3 diabetic groups [blood glucose> 250, 180-250 and <180 mg/dl] demonstrated a statistical difference [P= 0.001]. Aging can increase the rate of sepsis and its associated mortality in both diabetic and non-diabetic patients. Mortality of sepsis is more in diabetics when compared with non-diabetics. Severity of disease [further SIRS criteria] increases mortality and tight control of blood glucose may be associated with better prognosis