[HIV positive patients and utilization of dental health services]

To determine the level of dental health services utilization by HIV-positive patients. In this study we used a proportional random sampling method to select 230 HIV-positive patients from three HIV counseling centers. An anonymous questionnaire was completed for each patient. The total demand for dental services was 165. The rate of demand was 47.9% and the rate of utilization was estimated 75.9%. Most patients [56%] did not have insurance. Only 60% of these individuals notified the health workers of their HIV status. The most common reason for not demanding services was high cost, and the most common reason of non-utilization was the refusal by health workers to provide services. The main reason for not reporting the HIV-positive status was fear of rejection by the dentist. Inadequate insurance coverage and poverty might result in decreased access to dental health in HIV-positive individuals. In addition there is need to improve knowledge of HIV in dentists and change their attitudes and practices in order to increase utilization of dental services by HIV-positive patients

[Frequency, clinical findings and outcome of foreign bodies in the upper gastrointestinal tract]

Foreign body ingestion is a potentially serious problem in children. Most of ingested foreign bodies pass through the gastrointestinal tract spontaneously, but some of them [20%] need endoscopic or surgical removal. Sharp foreign object may cause serious complications and need an emergency intervention. The aim of this study was to characterize the clinical features associated with foreign bodies in the upper gastrointestinal tract and to determine the clinical factors for their successful removal by endoscopic techniques. We analyzed retrospectively 120 cases of foreign bodies in the upper gastrointestinal tract at Children's Medical Center, Tehran. Depending on the type of the swallowed foreign body and its site obtained by routine neck and chest x-ray as well as existing symptoms, we decided to fulfill an emergency endoscopy or to wait. Of 120 patients with a mean age of 4 years, 75 [62.5%] were males and 45 [37.5%] females. There was a history of parents' presence as a witness in 93.3% of cases. Common sites of foreign bodies were stomach [66.6%], esophagus [25%], and duodenum [2.5%]; a coin was the most common foreign body [30%]. Other foreign bodies were disc battery [12.5%], and sharp foreign bodies [10%]. Most of patients were brought in the first 24 hours after ingestion of the foreign body. In only 8 patients, complications occurred. Foreign body ingestion in children is a serious problem which may need an emergency procedure. Still the best way is its prevention; children should not be allowed to play with coins, metallic objects, safety pins etc

Study of spontaneous bacterial peritonitis etiologic agents and determination of their antibiotic resistance pattern

Spontaneous bacterial peritonitis [SBP] is a frequent and often fatal complication of ascites without a demonstrable intra abdominal cause. In adults, the organisms of SBP are usually gram-negative bacteria, but they may differ in children. Since these organisms are resistant to most antibiotics, identification of active antimicrobial agents and determination of resistance pattern are essential. The aim of the present study was also to determine the causative agents of SBP in children with liver disease and ascites, referred to pediatrics ward of Imam Khomeini hospital during 1384-85. In this study, ascites samples were taken from 85 patients with liver disease and ascites of Emam Khomeini Hospital, pediatrics ward, and they were examined by direct test, culture on different media and biochemistry tests. Antibiogram tests by disk diffusion were done on each positive sample. Of 85 examined samples, 32 bacterial and 2 yeast agents were isolated. Of bacterial cases, Escherichia coli [31.25%] and coagulase negative Staphylococci [18.75%] were the most isolated agents and the rest, included Streptococci and Enterobacteriaceae. Moreover, antibiogram tests identify that most of coagulase negative Staphylococci isolates as resistant to cotrimoxazol, amoxicillin, penicillin and cephalosporin [first generation]. The most of gram negative isolated bacteria were resistant to amikacin, vancomycin and gentamicin. Since the spontaneous bacterial peritonitis is not detectable by clinical signs, ascites samples should be examined in order to determine the etiologic agents. In general spontaneous bacterial peritonitis agents are mostly composed of normal flora bacteria, in our study most isolated bacteria were Escherichia coli and coagulase negative Staphylococci, two major normal flora of gastrointestinal tract and skin. The isolated bacteria showed a high antibiotic resistance against common drugs in our study. In general, this study showed that the major agents of spontaneous bacterial peritonitis should be identified by ascites examination and antibiogram test to establish a perfect treatment pattern in order to treat the patients rapidly