Evaluation of antimicrobial effectiveness of ophthalmic drops according to the pharmacopeial tests criteria

In this study antimicrobial effectiveness test was performed on eye-drops which had high microbial contaminations in hospital practice to find out whether their antimicrobial efficacies affect the magnitude of microbial contamination during their uses. Artificial tear, atropine sulfate, betamethasone, homatropine hydrobromide, phenylephrine hydrochloride, phenylephrine zinc, pilocarpine hydrochloride, tetracaine hydrochloride and tropicamide eye-drops were subjected to the United States Pharmacopeia [USP] and British Pharmacopeia [BP] antimicrobial preservative effectiveness tests. The results of this study showed that eight out of the nine products met the BP 'B' and USP criteria. The preservative employed in phenylephrine zinc eye-drop did not possess adequate antimicrobial activity against P. aeruginosa. Other eye-drops showed appropriate reductions in bacterial viability after 6 hrs, 24 hrs and 7 days, but showed a very low bacterial recovery after 28 days which didn't comply with the no recovery [NR] term of BP 'A' criteria. Since viable microbial counts were usually determined by plate count method, it seems that the term of NR should define an acceptable range. The results indicated that there is not a clear correlation between antimicrobial efficacy testing of eye-drops and the rate of their microbial contamination while are being used. Other factors such as hygienic practices of eye-drops, proper bottle design and training of patients could influence their microbial contaminations. Regulation of in-use efficacy testing of eye-drops which is influenced by the environment, the frequency and technique of use, might be essential

Conductive arterioveous fistula: Comparison of patency rates, complications and outcome with upper arm and elbow [non-conductive] fistulas in a randomized clinical trial

A 18 month single-blinded randomized clinical trial was undertaken to compare the patency rate complications and outcome of Conductive arterio-venous creation, a group of techniques using mediancubital and perforating veins for elbow and brachial fistulas, with Non-Conductive [brachiocephalic/brachiobasilic] fistulas in referred patients to SINA hospital for vascular access creation. From may 2001 to December 2002, vascular access procedures were performed for 260 patients.144 patients were followed for patency rate, complications and outcome. Mean age was 53.4 + 16.7 years and 55.5% were male, patency rate was 81% in a 3 month follow up in Conductive and Non-Conductive group. Infection and neuro-muscular complications were not significantly different between groups. 3 venous hypertension and 2 steal syndrome developed in non-conductive group. The major complications, venous hypertension and steal syndrome, were treated by conversion to conductive fistula. In 16 [43%] patients, referred for synthetic graft,conductive fistula was created. Conductive AV fistula is a reasonable alternative for maintenance of hemodialysis access, particularly when other types of brachial and elbow fistula has failed or in cases of major complications. In addition, performing conductive fistula in patients referred for synthetic graft would decrease costs. At the end, further multi-centeral randomized clinical trails are recommended

[Conductive arteriovenus fistula: comparison of patency rates, complications and outcome with upper arm and elbow [non-conductive] fistulas in a randomized clinical trial]

Background: A 18 month single-blinded randomized clinical trial was undertaken to compare the patency rate, complications and outcome of Conductive arterio-venous creation, a group of techniques using mediancubital and perforating veins for elbow and brachial fistulas, with Non-Conductive [brahiocephalic/brachiobasilic] fistulas in referred patients to SINA hospital for vascular access creation

Materials and methods: From May 2001 to December 2002, vascular access procedures were performed for 260 patients. 144 patients were followed for patency rate, complications and outcome

Results: Mean age was 53.4 + 16.7 years and 55.5% were male, patency rate was 81% in a 3 month follow up in Conductive and Non-Conductive group. Infection and neuro-muscular complications were not significantly different between groups. 3 venous hypertension and 2 steal syndrome developed in nonconductive group. The major complications, venous hypertension and steal syndrome, were treated by conversion to conductive fistula. In 16 [43%] patients, referred for synthetic graft, conductive fistula was created

Conclusions: Conductive AV fistula is a reasonable alternative for maintenance of hemodialysis access, particularly when other types of brachial and elbow fistula has failed or in cases of major complications. In addition, performing conductive fistula in patients referred for synthetic graft would decrease costs. At the end, further multi-central randomized clinical trails are recommended

evaluation of the performance assessment of APACHE III scoring system in patients admitted in the ICUs of TUMS with Sina designed APACHE scoring model

Performance assessment of intensive care units may not be possible unless there are objective criteria. This performance eventually determines patients' outcome and is the most reliable outcome measure for intensive care in hospital mortality. Scoring systems have been proposed for individual patient outcome prediction, for evaluating the performance of ICUs and for therapeutic trials. Despite a reasonable accuracy of scoring systems for predicting mortality, probability of defined ICU populations in developed countries, the healthcare delivery systems and patient characteristics in developing countries might influence the correlation between a given scoring instrument and the probability of death. Accordingly, intensive care physicians in developing countries should verify the accuracy of the available severity scoring systems in their specific settings by an objective validation process. This study tries to evaluate validity of APACHE III model in patients admitted to ICUs of Tehran University Medical Sciences intensive care units based on assessing calibration and discrimination. In the study, 1312 patients were analyzed. The mean age was 48.7 and median of length of stay at ICU and hospital was 4 and 9 days, respectively. Mean APACHE III score was 60 at first day of admission. Customized APACHE III [APACHE IIIc] model had poor calibration [P<0.0001], but good discrimination [area under ROC curve =0.88].In comparison, Sina-designed APACHE III [APACHE Ills] model had appropriate calibration [P value =0.4] and good discrimination [area under ROC curve =0.87]. Although APACHE Ills model sensitivity was about 70%, acceptable specificity [86.1%] plus corrected classification percent as%79, it is being introduced as an acceptable model in intensive care units of Tehran University of Medical Sciences; however extended use of this model needs more comprehensive studies