Antibiotic resistance pattern of gram-negative bacteria in Gorgan

The excessive use of broad-spectrum | antibiotics will lead to drug resistance of microorganism and i specially nosocomial organisms. Because of high incidence of 1 antibiotic resistance in hospitals, we aimed to study antibiotic resistance to gram negative bacteria. This cross-sectional study was conducted on the data of biological samples [2006-2008], with positive culture result. Using antibiogram, microbial resistance to isolated microorganism was determined, and after culturing the samples, bacteria were identified by using differential media and antiserum. Then, antibiotic resistance was performed by disk diffusion. The most common gram-negative microorganism obtained from all cultures was E.coli with the lowest drug resistance to Nitrofurantoin. Based on the results, antimicrobial resistance pattern is not the same in different places and furthermore it is ever changing. Therefore, further research is needed to be done to have an accurate pattern of antibiotic resistance to provide effective treatment regimens

[Effect of ginger and chamomile capsules on nausea and vomiting in pregnancy]

Nausea and vomiting are the most frequent complications in the first trimester of pregnancy. Herbal medicine is among the traditional effective treatments. Ginger and Chamomile are hypothesized to be useful in decreasing the signs. This study was done to determine the effect of Ginger and Chamomile capsules on nausea and vomiting in pregnancy. This triple-blind randomized placebo-controlled trial was carried out on 105 pregnant women in 6-16 weeks of gestational age with a mild to moderate nausea and vomiting, whome referred to the prenatal care clinic in Dezyani hospital and health centers, Gorgan, Northern Iran during 2009-10. Rhodes index questionnaire had been given to all participants to be completed before bed-time for two weeks. In the first week no intervention was done and prescribing the capsules was started the following week. Subjects randomly divided into 3 groups: In group 1, ginger capsules were consumped twice a day for one week, in group 2; twice daily chamomile capsule and in placebo group, glucose capsule was prescribed. Scores were calculated and all data were entered into the SPSS-16 software, analysis was done using variance analysis, Will-Cockson, paired T and Fisher-exact tests. The mean of Rhodes index before intervention in plasbo, Ginger and Chamomile groups were 12.71 +/- 5.88, 10.42 +/- 0.76 and 11.19 +/- 5.51, respectively. Also, the mean of Rhodes index after intervention in plasbo, Ginger and Chamomile groups were 11.47 +/- 6.43, 7.28 +/- 3.74 and 5.73 +/- 4.32, respectively [P<0.05]. Bonferroni test indicated that there is no difference about scor chang [after and before] between Ginger and Chamomile and Ginger and plasbo, but this difference was significant between Chamomile and plasbo group [P<0.05]. This study showed that Chamomile capsule was more effective on nausea and vomiting during pregnancy compared to Ginger

[Ophthalmic disorder among patients with floater Gorgan, Iran [2009]]

Floater is defined as dark and vague spots and lines, which presents in visual fields of patients. Etiologies are various and life threatening, due to the serious complications resulted from floaters, this study was designed to assess ophthalmic disorder among patients with floater Gorgan, Iran [2009]. This cross-sectional study,was done on 164 patients [105 female, 59 male] with floater or photopsia in Gorgan, North of Iran during 2009. Findings of ophthalmic examination and demographic characteristics were recorded in a questionnaire for each patients. The prevalency of floater was higher among patients over sixty years old. 57.2% women with floater were during monopausal period. Myopia [32.9%] and cataract [32.9%] were the most associated ophthalmic diseases. Posterior vitreous detachment and retinal bleeding in patients with floater was 84.1% and 6.1%, respectively. Retinal detachment was not seen in patients. This study showed that posterior retinal detachment is the most frequent associated ophthalmic disorder in patients with floater. Older age, gender, myopia and cataract are considered to be the related risk factors in floater

Molecular epidemiology of high-risk types of human papillomaviruses [16, 18] in pap-smear, the North East of Iran

Cervical Cancer is one of the most important and commonly diagnosed types of cancer in females. There are different causes of cervical cancer, amongst which recurrent and persistent infection with HPV types 16 and 18 are the most renowned ones. These genotypes are the main factors in 99% of cases in developed countries and 70% in developing ones. Due to the importance of these viruses in cervical cancer, molecular detection of HPV and its high risk genotypes in Gorgan was designed. Pap smears and swabs specimens were taken from 308 women. Papanicola staining method and cytology were used. Nucleic acid was extracted by proteinase K phenol-chloroform standard method and then assessed by using beta-globin primer. Polymerase Chain Reaction [PCR] was then performed for papilomaviruses on all patients and positive cases from both types, including HPV 16 and 18 genotypes, were detected. Three hundred and eight women [15-75 years old] with mean age of 37.54 +/- 10.6 were recruited. Seventy six cases [20.1%] of whom were infected with HPV and 48.6% with HPV16 or 18 positive. Normal cytology was seen in 226 cases and 41 patients [18.1%] were HPV positive. Amongst those 152 cases with inflammation or abnormal cytology, 35 cases [23%] were HPV positive. No significant relation was reported between different variables and HPV infections. Due to high rate of HPV infection, as well as its high risk genotypes in different studies, more careful screening of women by Pap smear is recommended

Serum level of lactate dehydrogenase, homocystein, hemoglobin and platelet in preeclampsia

Pre-eclampsia affects approximately 5-8% of pregnant women. The aim of this study was to compare the serum level of Lactate dehydrogenase [LDH], Homocystein, Hemoglubin and platelet in pregnant women diagnosed as pre-eclampsia and a normal group in Gorgan city, Northeastern Iran from 2007-2008. In this case control study, 50 cases of pre-eclampsia were compared with the control group women hospitalized in Dezyani hospital. Pre-eclampsia criteria were: Blood pressure more than or equal to 140/ 90 mm hg and Proteinuria greater or equal to 300 mg/ 24 hours urine sample in the third trimester. Hemoglobin, platelet, LDH and hemocystein were measured. Data were analyzed by the mean of SPSS-14 program and Chi-2 or t-student were used. The difference of BMI and family incomes was significant between two groups [P-value<0.01]. LDH level was not statistically different between healthy and pre-eclamptic individuals. Six cases [12%] in controls and 9 cases [18%] in pre-eclamptic group had thrombocytopenia [P-value>0.01]. Hemocystein level was more than normal range in five patients with pre-eclampsia [P-value<0.001]. In this study, hemocystein level was significantly higher in pre-eclampsia patients but LDH, hemoglobin and platelet level had no significant difference

[Tissue trans-glutaminase antibody in inflammatory bowel disease in golestan province, Northern Iran [2005-08]]

Celiac is a hereditary disease presented with chronic inflammation of small intestine. Several studies supposed a relationship between Celiac disease and Inflammatory Bowel Disease [IBD]. Tissue trans-glutaminase antibody is one of the best serological markers in Celiac disease. This study was designed to evaluate the association of Celiac and IBD using tissue trans-glutaminase antibody. In this descriptive study 127 confirmed IBD patients who were referred by gastroentrologists 2005-08 enrolled into the study. A questionnaire was completed and tissue trans-glutaminase antibody was evaluated with ELISA method with a Cut-off=12 U/ml. Among 127 referred patients, serum samples of 102 patients were collected. Mean +/- SD of age was 36.17 +/- 15.2 years and 48% were males. Ulcerative colitis, Crohn's disease and other colitis were observed in 76 [74.5%], 7 [6.9%] and 19 [18.6%] of patients, respectively. Tissue trans-glutaminase antibody was positive [19.8 U/L] in one 46-years-old male patient with ulcerative colitis. Tissue trans-glutaminase antibody titer was not significantly different between IBD patients and controls, thus it seems not appropriate to suggest as one of the routine tests in IBD patients

[Distribution of hepatitis C virus genotype among HCV infected patients in Golestan province, Iran]

Background: Hepatitis C virus [HCV] is one of the main causative factors of liver disease which can lead to chronic hepatitis C infection in 80% of cases. HCV genotypes have a special worldwide geographic distribution. The goal of the present study was to detect HCV genotypes in patients with anti-HCV positive titers in Golestan Province, Iran

Materials and Methods: In this cross-sectional study, 95 positive HCV samples as detected by RIBA were evaluated. Viral RNA was extracted with a Roche extraction kit and the Fermentase cDNA kit Random hexamer primers was used for viral genomic cDNA synthesis. PCR was performed on all samples by a general pair of primers. Second-step PCR was done with specific primers, and the results were obtained following electrophoresis in 1.5% agarose gel and ethidium bromide staining in documentation gel

Results: General primer PCR revealed 91 positive samples. Assessment of 77 samples determined that the following genotypes were present: 1 and 3 [1a [19.5%], 1b [19.5%], 3a [15.6%], 3b [24.7%]], 2a [2.6%], 4 [7.8%]. The remaining samples were a mixture of genotypes 1 and 3 [6.5%]

Conclusion: The ingmost prevalent genotypes found were types 1 and 3 in Golestan Province. This distribution pattern differed from other areas in Iran, however genotype 4 was in accordance with other studies. Genotype 2 was only reported in this study and a study in Tehran. Thus, additional, larger studies of HCV genotypes should be performed for further analysis of genotypic distribution patterns

[Polyethylene glycol versus lactulose in chronic pediatric constipation]

Introduction: Constipation is one of the most prevalent causes of abdominal pain in pediatrics, with no underlying pathology. It is defined as functional constipation in 95% of cases evaluated. This study was designed to compare the therapeutic effect of polyethylene glycol [PEG] and lactulose in treating chronic functional constipation in children

Materials and Methods: In this randomized, double blind clinical trial, patients were classified into two groups: lactulose [n=65] and PEG [n=63]. During an eight week period, patients were either treated with an average of 3.5 g/day [PEG] or 7 g/day [lactulose]. Successful treatment was defined as defecation [painless and soft, or normal] three times or more per week. Analysis was performed by calculation and comparison of the success rate in both groups, followed by reporting the relative risk and number needed to treat [NNT]

Results: Response to treatment in the second week was significantly higher in the PEG group when compared with the lactulose group [P<0.0001]. There was a significant difference in the response rate between both groups in the 4th and 6th weeks [P<0.0001]. In the 8th week all patients in the PEG group were treated successfully, whereas there were five [7.7%] cases who did not respond in the lactulose group

Conclusion: These results have shown that a four week treatment period with PEG [3 g/day] lead to a response rate of 87% in children, in comparison with lactulose [7 g/day] which needed at least eight weeks of treatment

[Wild lettuce toxicity: case - series]

Wild lettuce [Lactuca virosa] is a famous herb in the world but is unknown in Iran. It has many dangers when used randomized or over dosage. Wild lettuce grows in the North of Iran and some natives consume it unaware of its adverse side effects. Here, we presented 8 patients with manifestations of wild lettuce toxicity, admitted to a general hospital affiliated to Golestan University of Medical Sciences. All patients recovered [except for an ICU admission] and no chronic complications were reported. Toxicity happened because wild lettuce was fresh and out of the time of harvest. Clinical suspicious to toxicity and history taking are the basis of diagnosis. It should be suggested to avoid using any suspicious substance like herbal materials, except when aware of its complications and effects

[Nitrate and nitrite level of drinking water and the risk of upper gastrointestinal cancers in urban areas of Golestan province, northeast of Iran]

Esophageal and gastric cancers are among prevalent cancers in the world and it is believed that nitrate and nitrite contaminations of drinking water are important factors in increasing the risk of these cancers. This study was designed to determine the correlations between these factors and upper gastrointestinal cancers. In this ecologic study, mean concentrations of nitrite and nitrate of drinking waters in Golestan urban areas were obtained during 2004-2005. All patients with esophageal and gastric cancers during this period who resided in urban areas were recruited to estimate the incidence rate and Age Standardized Rate [ASR] of these cancers. The province was divided into three regions of low, intermediate and high incidence based on 33% and 66% quartiles of both cancers. Spearman Correlation Coefficient and regression line were used to analyze data

[Inoperable esophageal cancer and outcome of palliative care in Golestan province, Iran]

Dysphagia is the most distressing problem in patients with advanced inoperable esophageal cancer. Palliative interventions like balloon dilation and stenting are used to improve quality of life and make patients enable to eat more comfortably. This study was designed to determine the outcome of palliative care in esophageal cancer patients referred to Gorgan and Gonbad gastrointestinal clinics, northeast Iran. This cross-sectional study was performed on inoperable esophageal cancer cases during 2005-2006. Demographic data were collected during the procedure and cases were followed every month for six months. Improvement proportion was calculated with 95% confidence interval, to determine the rate of improvement. Survival analysis and Kaplan-Meier methods were used to estimate the duration of palliative care effectiveness. We recruited 39 cases into the study. Male to female ratio was 1.6 to 1 and mean age was 67.5 +/- 13.7 years. Twenty two patients had grade 3 dysphagia and other 17 had grade 4 at the begining of the study. Dilation was the most preferred method [89.7%] and stenting was performed in 4 [10/3%] cases. Decreasing dysphagia score was not related to palliation method used or pathologic type of carcinoma but it was showed to be related to the age of the patients significantly. Mean survival was significantly different between 2 groups [with and without dysphagia improvement in first month of follow-up]. Results of this study showed a lower survival rate after palliative care in advanced esophageal cancer cases, although dysphagia scores showed some improvement

effect of active education on knowledge of health care workers of Golestan university of medical sciences about avian influenza

The main goal of medical education is preparing experts in health care fields. Medical education should answer the population needs and develop in accordance with technology changes. The aim of this study was to evaluate the effect of active education on knowledge of health care workers of Golestan University of Medical Sciences about avian influenza. In 2005-2006, this semi experimental study was conducted through before-after design. At the beginning, knowledge of the samples regarding to avian influenza was evaluated with self-administered questionnaire. After intervention [active participation in lectures and group workshops] the questionnaires were distributed once again. Data were analysed by non-parametric tests [Wilcoxon, Mann- Whitney, Kruskal-Wallis] to evaluate the effect of active education on knowledge about Avian Influenza. The mean score of knowledge increased significantly after educational intervention [P-value < 0.001]. Previous information was significantly related to pretest scores. The mean score of knowledge was not significantly related to gender and age. Educational workshops are effective in increasing knowledge of healthcare workers about avian influanza. While educational programs of the mass media are effective knowledge, it doesn't meet the special educational needs in the field of health

Study of the P53 gene expression by immunohistochemistry in patients with gastric cancer at 5th azar hospital in Gorgan, Iran

Background and Purpose: P53 gene is a tumor suppressive gene and its product, P53 protein, is a protective factor against tumor formation that inhibits the extension of genetically damaged cells. P53 aggregation in tumoral cell nucleus is related with p53 gene mutations, which can be detected by immunohistochemical methods. This study was designed to investigate the protein aggregation in patients with gastric cancer in Gorgan, Iran

Methods and materials: All paraffin-embedded blocks of gastric cancer cases during the years 2000 to 2004 in the pathology ward of the 5th Azar Hospital in Gorgan, Iran [111 cases altogether] were evaluated and stained, for detecting microtome cutting. The obtained data were entered into SPSS and chisquare was used for analysis

Results: 111 cases with gastric cancer were investigated. The most frequent type of gastric tumor was adenocarcinoma [66.7%]. In 59.5% of the affected cases, P53 protein was detected. No significant relationship was observed between P53 expression and factors such as age, gender, and histological type of the tumor

Conclusions: In this study, P53 protein rate was high but it showed no significant relationship with other variables. We suggest further studies to discover the relationship between protein aggregation in tumor cells and other variables in affected cases

[Effects of an active multifaceted educational intervention on dispensing time in the pharmacies of Gorgan]

Introduction: The pharmaceutical care framework requires an active client-pharmacist partnership, particulary with respect to consultation about medication [dispensing process]. The educational intervention can imply to improve rational use of drugs

Objectives: In this study the effect of active group discussion and dispenser feedback in increasing the patient care indicator [dispensing time] in the pharmacies of Gorgan were examined

Materials and Methods: An interventional, semi-experimental study was designed. The study was conducted in Gorgan, thirty pharmacies and 750 pharmacy client, were randomly selected in each step [before and after intervention]. A structural questionnaire was used to interview clients. Data were collected from patients and by interviewing immediately after patient-dispenser encounter. Focused group discussion, audit feedback and distribution of educational bucklet were designed and conducted, after two months. All data were collected and analyzed with SPSS-11.5 software and were shown as mean +/- SE

Results: Data from 750 prescriptions before intervention showed that the average drug dispensing time was 19.43 +/- 5.83 seconds and the average waiting time was 4.91 +/- 1.2 minutes. In the post-intervention period, we had significant increase in the aformention indicators. Patients' satisfaction and knowledge of adverse effects and dosage information significantly increased after intervention

Conclusion: The study shows the impact of active educational intervention in improving WHO patient care indicator [dispensing time]

[Gastrointestinal and abdominal Tuberculosis in Golestan-Iran: a 5-years report]

15-20% of TB cases are extra pulmonary tuberculosis [EPTB]. Abdominal TB is the most common type of extra intestinal TB. Signs and symptoms of abdominal TB are unspecific. In this study, we identified all GITB cases in Golestan province [Iran] between 1999 and 2003 and determined their demographic characteristics. We reviewed all new cases of TB reported during 1999-2003 from TB centers of Golestan province.Then EPTB and especially GI and abdominal TB cases were selected. We completed a questionnaire containing demographic information for each of them. The information entered the computer in SPSS-13 was used to analyze the data. 30 patients had been treated for GI and abdominal TB, most of them were females [22 cases, 73.3%]. Mean age of the patients was 32.03 +/- 13.73 with higher incidence in age before 40 years old [70%]. Most common complaints of the patients were fatigue, weight loss, anorexia, fever and abdominal pain, respectively. In 66.7% of patients the diagnosis was pathologically documented. Our data suggest that 38.46% of all TB cases in Golestan province were EPTB, and this scale is higher than other studies. In this study, 5.27% of EPTB cases were GI and abdominal TB, higher than the world reports [3%]

[Seroepidemiology of celiac disease among blood donor in Golestan province]

Celiac is a digestive disease. In this disease, small bowel is damaged and the absorption of nutrients are adversely affected. These patients do not absorb gluten. There is probably a correlation between esophagus cancer and celiac. The aim of this research was to study the seroepidemiology celiac disease in this area with high prevalency of esophagus cancer. This research was a descriptive study, which was performed on blood donors in Golestan province during the year 2005-06. blood samples were taken from 2547 subjects. tTG-IgA determination were carried out using ElISA technique, the titre<4U/ml, 4-10U/ml and >10Um/l were considered to be as negative, weakly positive and positive respectively. EMA antibody assessment were carried out on all sample population with more than 4U/ml, using IFA method. 28 subjects [1.1%] had tTG-Ab positive test, out of this number 18 subjects [0.7%] were weakly positive and 10 persons [0.4%] were considered to be positive. EMA test were positive in 70% of subjects with tTG positive results. There was not any significant meaning between positive tTG test and ethnicity from weakly positive tTG, 15 subjects [83.3%] and 3 subjects [16.7%] were male and female respectively. The entire tTG positive were male subjects. In regard to high prevalency of esophagus cancer in the region and the relation of celiac disease with above cancer, it seems necessary to look more seriously at the celiac disease

[Factors associated with esophageal cancer in the southeast part of the Caspian Sea]

Introduction: Esophageal cancer is the 8th prevalent cancer [4% of all] around the world and the sixth leading cause of death from cancers .The Northeastern parts of Iran [Caspian littoral areas] are one of the most prevalent areas of esophageal cancers in the world

Objective: In this study, we examined relationship between esophageal cancer tumor histology and variables like age and sex, in pathologically confirmed cases in the Northeastern of Iran [Caspian littoral margins]

Materials and Methods: This descriptive cross-sectional study was conducted in the health care services and pathologic centers in Golestan Province. All pathologically confirmed esophageal cases were enrolled in the study and demographic data were listed. Data were analysed with SPSS-10 software. Variables were compared with one-way ANOVA and Mann-Whitney tests for continuous variables and chi-square for nominal/categorical variables. Level of significance was set at p-value less than 0.05

Results: Four hundred and ninety one pathologically confirmed esophageal cancer cases from 1996 through 2000 were included in this study. Squamous cell carcinoma was the dominant tumor histology in this study and it was more common in females. We found that tumor histology is highly related to gender and this association is independent of age factor. Our finding revealed that this association is only applicable to older age groups [older than 50]

Conclusion: Results from this study suggested that demographic factors might be different in esophageal cancer cases in different geographic areas. Our finding can be a reflection of distinctive etiology for esophageal cancer in the Caspian littoral areas

[Evaluation of mental disorders' symptoms in students of Golestan University of Medical Sciences by SCL-90-R questionnaire]

Nowadays epidemiologic paterns of the diseases are verifying rapidly; noncontagious diseases like mental disorders are replacing contagious one. Several people, unaware of their psychiatric problems seek medical advise and treating. College students are susceptible to mental disorders because of their conditions. This research was done to evaluate mental health state in students of Golestan University of Medical Sciences. 218 students of Golestan University took part in this research. SCL-90-R was the test for evaluation, after collecting the questionnaires and entering into SPSS-10 software, data were analyzed with chi-square and Fisher-exact test. The momental prevalence was estimated 72%. 157 persons had disorder, at least in one dimension, and 16 persons [7.34%] had severe disorder at least in one. Marriage and psychosis, paranoid and anxiety had meaningful relations [P<0.05], residential site and paranoid had meaningful relations [P<0.05], higher levels of father's education and interpersonal sensitivity had meaningful relation [P<0.05], Family history of mental disorders, moderate interest in education, field of study and phobia had meaningful relationships [P<0.05], females had higher scores in depression [P<0.05]. According to this high prevelence of mental disorders it seems that mental health's problem is critically high in this region, much more attention should be paid to prevent further complications

effect of active training in reducing severe drug interactions

Background: medication errors are among the most important medical errors. Considering the current trend of poly-pharmacy and a high average number of drugs in prescriptions, drug interactions are of great significance

Purpose: to evaluate the effect of educational interventions including face-to-face, audit feedback and educational notes, among Gorgan physicians

Methods: with an initial estimation of 8% severe drug interactions [95% confidence level, 7% accuracy], the sample size was calculated to include at least 5600 prescriptions. After classifying the observed interactions and identifying the physicians, a questionnaire was prepared and completed attending their offices. Training was provided using face-to-face conversation, audit feedback and educational notes. After training on the severe interactions, physicians' prescriptions were reviewed again after three months and the number of interactions was compared with that observed at baseline, to evaluate the effect of training. Data were classified, computerized and analyzed with SPSS-10 using Chi-square and McNemar tests. The interactions' clinical importance was also evaluated using relative test

Results: overall prevalence of drug interactions was 8.93%, of which 6.55% were major, 65.58% moderate and 27.87% minor. Interactions were mostly seen among male doctors. The physicians with an average drug number of more than 4 had significantly more interactions in their prescriptions. The majority of physicians with major drug interactions did not know their clinical significance. After training, there was a significant reduction in major drug interactions, but none in moderate and minor interactions for which no education was provided

Conclusion: drug interactions are common medical errors in Gorgan province and training can decrease their rate