Prevalence of beta lactamase producing species of pseudomonas and acinetobacter in pediatric burn patients.

Burn wound infection is a major cause of morbidity and mortality in burn victims. Pseudomonas and Acinetobacter species are among the most common organisms complicating burn wounds. Presence of extended spectrum ß-lactamase (ESBL) and metallo-ß-lactamase (MBL) genes plays an important role in spreading ß-lactam resistant strains of these organisms and is a serious condition in the treatment of the affected patients. As a result, we aimed to determine the prevalence of SHV, TEM, PER and VIM ß-lactamases in Pseudomonas and Acinetobacter species isolates from burn wound swabs of children with burn injury. In this descriptive observational study, 107 Pseudomonas and Acinetobacter isolates collected from burn patients were subjected to PCR assay. Using PCR method and DNA sequencing, the existence of SHV-, TEM-, PER- and VIM-type ß-lactamase encoding genes were determined. Out of the 107 Pseudomonas and Acinetobacter isolates, 66 (77.6%) were ESBL positive, 26.2% were positive for SHV gene, 37.4% were positive for TEM gene, 14% were positive for PER gene and 15.9% of them harbored VIM gene. More than half of the Pseudomonas and Acinetobacter strains in our pediatric burn unit harbor ß-lactamase encoding genes that make them resistant to a wide range of ß-lactam antibiotics. Consequently, it is suggested to choose an appropriate antibiotic regimen based on the antibiogram pattern of the strains.

Les infections cutanées sont une cause majeure de morbidité et de mortalité chez les brûlés. Pseudomonas et Acinetobacter sont parmi les micro-organismes les plus communs chez les brûlés. La présence des gènes codant les ß-lactamases à spectre étendu (BLSE) et métallo-ß-lactamases (MBL) joue un rôle important dans la dissémination des souches résistantes et obère le traitement des patients infectés. Nous avons étudié la prévalence des gènes encodant pour des enzymes des groupes SHV, TEM, PER et VIM dans des isolats de Pseudomonas et Acinetobacter chez les brûlés pédiatriques, grâce à des techniques de PCR. Dans cette étude observationnelle descriptive, 107 isolats de Pseudomonas et Acinetobacter, obtenus chez des patients brûlés ont été étudiés. Plus des 3/4 des souches de Pseudomonas et Acinetobacter expriment une BLSE (26.2% SHV; 37.4% TEM; 14% PER; 15.9% VIM), ce qui les rend résistants à de nombreuses ß-lactamines. Il est donc suggéré de choisir un traitement antibiotique approprié, basé sur l'antibiogramme des souches infectantes.

Efficacy of recruitment maneuver for improving the brain dead marginal lungs to ideal.

BACKGROUND: Because of the shortage of lungs for transplantation, finding the suitable lungs in brain-dead donors is an important issue. Recruitment maneuver is a strategy aimed at re-expanding collapsed and edematous lung tissue. The aim of this study was to assess the efficacy of this maneuver on improving marginal lungs for transplantation. METHODS: From 127 brain-dead potential donor which were evaluated for lung donation in Masih Daneshvari Organ Procurement Unit of Tehran, Iran, 31 (25%) had marginal lungs for transplantation. These donors had normal chest X ray or bilateral infiltration and had PaO2 200-300 mm Hg with FIO2 100%. The recruitment maneuver was performed and arterial blood gas was obtained before and after maneuver. The maneuver lasts for 2 hours with continuous check of O2 saturation and patient's hemodynamic during. Finally, patients with normal bronchoscopy and PaO2/FIO2 >300 mm Hg were considered good candidates for lung transplantation. The frequency (%) and mean ± SD were used for description of variables and the Wilcoxon test was used for comparison between pre- and post-maneuver PaO2 with FIO2 100%. RESULTS: The mean ± SD of PaO2/FIO2 with 100% FIO2 of patients before and after recruitment were 239 ± 62 and 269 ± 91, respectively. Recruitment maneuver could convert 10 marginal lungs (32%) to appropriate ones (PaO2 > 300) and finally 8 lungs were transplanted. CONCLUSIONS: Findings of this study showed that recruitment maneuver could convert inappropriate lungs to appropriate ones in one third of brain-dead patients who had marginal lung condition. So, it is recommended that this maneuver is considered in the assessment protocol of lungs for donation.

Survival of Iranian patients on lung transplant waiting list: is there any difference?

OBJECTIVE: Lung transplantation is the last treatment option for end-stage pulmonary diseases. Reviewing the characteristics of patients on the lung transplant waiting list is a helpful way to evaluate and prioritize the patients in need of special care. Because we have no information about mortality on the lung transplantation waiting list in Iran, the aim of this study was to evaluate the characteristics and survival rates of these patients. METHODS: The file of lung transplant candidates listed between 2005 and 2010 were evaluated for patient demographic data, type of disorder, waiting list time, and outcomes of death, transplantation, or alive. RESULTS: The 131 patients on our list in this period revealed a mean age of 37±14 years with 86 (66%) males. The most common disorder among waiting list patients was pulmonary fibrosis (n=52; 40%). Among the 17 (13%) patients who were transplanted, most (35%) suffered from pulmonary fibrosis. The mean waiting time to transplantation was 17.2±11.8 months. Twenty-two patients (7%) died while on the waiting list. The mortality rate was unexpectedly highest among cystic fibrosis patients and then those with bronchiectasis. The mean survival time for all non-transplant patients based on the Kaplan-Meier method was 27.4 months and their 2-year survival rate was 74% based on life tables. CONCLUSION: Although pulmonary fibrosis patients show the poorest survival on lung transplant waiting lists, in other countries, patients with cystic fibrosis and bronchiectasis displayed the worst survival on the Iranian list probably due to their poor rehabilitation and sputum evacuation. We concluded that it is necessary for every center to evaluate the characteristics of its patient cohort to match the activity according to the needs.

Lung donation and causes behind its failure: a single-center experience.

INTRODUCTION: Brain-dead patients are almost the only source of organs for lung transplantation, and lungs fall within the area of the least harvested organs. As a result, maintaining the highest possible harvest rate is a must for the lung transplantation system. In the present study, the harvest rate of lungs and also the causes of failure to donate the lungs is reported for brain-dead patients in our organ procurement unit. MATERIALS AND METHODS: After going through the brain-death database at our organ procurement unit between 2004 and 2008, we included all 93 brain deaths in this hospital. The lung donation rate was reviewed to examined the causes for failure to donate lungs. RESULTS: From the total brain-dead patients registered in the database, only 4 (4.6%) patients donated their lungs. The causes of failure to donate a lung were not suitable lungs among 78 (83.8%) because they had an unacceptable oxygen challenge test results (<300 mm Hg). Another 11 patients had acceptable oxygen challenge test results, but donation failed in their case as well due to most frequently to pulmonary aspiration. CONCLUSION: In this center, only a small percentage of lungs are appropriate for harvest in brain-dead patients, because many patients' lungs do not meet the criteria with unacceptable oxygen challenge test results. Patients with proper test results may fail to donate lungs due to pulmonary aspiration. More aggressive care of the patients may have an important role in keeping them in good condition and helping to preserve the organs for harvest. For this purpose, further training of intensive care unit staff and physicians are among the suggested steps to enhance the quality of care, which in turn can maximize the lung harvest rate.

Eight years of lung transplantation: experience of the National Research Institute of Tuberculosis and Lung Diseases.

BACKGROUND: Lung transplantation has evolved from an experimental procedure to a viable therapeutic option in many countries. In Iran, the first single-lung transplantation was performed in the year 2000, more than 3 decades after the first successful procedure in the world, and the first double-lung transplantation was performed in the year 2006. OBJECTIVE: To describe our 8-year experience in lung transplantation. PATIENTS AND METHODS: During 8 years, we performed 24 lung transplantation procedures. Underlying lung diseases were pulmonary fibrosis in 16 patients (66.6%); chronic obstructive pulmonary disease in 2 (8.3%); bronchiectasis in 5, including 2 patients with cystic fibrosis (20.8%), and alveolar microlithiasis in 1 (4.16%). Data for all patients were collected and analyzed. Procedures were carried out using standardized methods. The induction suppression regimen consisted of cyclosporine and methylprednisolone. Maintenance immunosuppression drugs were cyclosporine and mycophenolate mofetil, and tapering dosage of prednisolone. Patients were followed up with physical examinations, 3 times a week, as well as and cycle ergometry 3 times a week and spirometry and laboratory tests once a week and chest radiography per needed for up to 3 months posttransplantation. RESULTS: The longest survival time was 7.2 years, in a 60-year-old patient with idiopathic pulmonary fibrosis. Fourteen patients died, 8 as a result of hemodynamic instability and/or hemorrhage, 1 as a result of bone and fat emboli, 3 after cessation of drug and 2 of them after infection. CONCLUSION: Although lung transplantation is a complex procedure it can be performed in developing countries such as Iran.

Ozone oxidation of pharmaceuticals, endocrine disruptors and pesticides during drinking water treatment.

This study investigates the oxidation of pharmaceuticals, endocrine disrupting compounds and pesticides during ozonation applied in drinking water treatment. In the first step, second-order rate constants for the reactions of selected compounds with molecular ozone (k(O3)) were determined in bench-scale experiments at pH 8.10: caffeine (650+/-22M(-1)s(-1)), progesterone (601+/-9M(-1)s(-1)), medroxyprogesterone (558+/-9M(-1)s(-1)), norethindrone (2215+/-76M(-1)s(-1)) and levonorgestrel (1427+/-62M(-1)s(-1)). Compared to phenolic estrogens (estrone, 17beta-estradiol, estriol and 17alpha-ethinylestradiol), the selected progestogen endocrine disruptors reacted far slower with ozone. In the second part of the study, bench-scale experiments were conducted with surface waters spiked with 16 target compounds to assess their oxidative removal using ozone and determine if bench-scale results would accurately predict full-scale removal data. Overall, the data provided evidence that ozone is effective for removing trace organic contaminants from water with ozone doses typically applied in drinking water treatment. Ozonation removed over 80% of caffeine, pharmaceuticals and endocrine disruptors within the CT value of about 2 mg min L(-1). As expected, pesticides were found to be the most recalcitrant compounds to oxidize. Caffeine can be used as an indicator compound to gauge the efficacy of ozone treatment.

Pharyngeal traumatic neuromas and traumatic neuromas with mature ganglion cells (pseudoganglioneuromas).

Over a period of 4 years, 14 cases of traumatic neuroma were detected in laryngoscopic biopsy specimens. The approximate incidence was 10% of biopsy specimens from this area. The most frequent symptoms in descending order of frequency, were hoarseness, dysphagia, choking spells, intermittent aphonia, and cough. Six (43%) of the 14 lesions contained mature ganglion cells. These lesions have not been reported in the pharyngeal region, and I suspect that in the past a few similar conditions have been diagnosed as ganglioneuromas. Because the lesion appears to be the cause of the symptoms and is a reactive, nonneoplastic process, accurate diagnosis and commensurate management are important.

Terminal branch of anterior interosseous nerve as source of wrist pain.

The terminal branch of the anterior interosseous nerve is described anatomically and demonstrated histologically. Injury to this nerve can be the source of persistent, dull aching volar wrist pain. Suitability for partial volar wrist denervation is determined by functional testing before and after a diagnostic nerve block. Experience with twelve patients with this problem is presented.