Routine versus selective chest and abdominopelvic CT-scan in conscious blunt trauma patients: a randomized controlled study.

PURPOSE: CT-scan is increasingly used in blunt trauma, but the real impact on patient outcome is still unclear. This study was conducted to assess the effect of performing routine (versus selective) chest and abdominopelvic CT-scan on patient admission time and outcome in blunt trauma. METHODS: Conscious and hemodynamically stable high-energy trauma patients were included (n = 140). Routine chest and abdominopelvic CT-scan was requested in addition to the conventional radiography and ultrasound for the intervention group and selective CT-scan according to clinical presentation was done for the control group. Patient admission times in the emergency room and surgery ward, complications, and performed surgical procedures were assessed. "Unsuspected injuries" defined as additional findings on CT-scan, which were not expected before CT-scan, were evaluated. RESULTS: Admission time in the emergency ward and admission time in hospital were significantly shorter in the intervention group. Complications were similar in both groups. Abdominopelvic CT-scan in the intervention group revealed nine (7.8%) unsuspected injuries. All of these nine patients had also a positive clinical examination and injuries in other body regions. Chest CT-scan in the intervention group led to additional diagnoses in 17 patients (24.28%) leading to tube thoracostomy in 13 patients (18.57%). CONCLUSION: Routine chest and abdominopelvic CT-scan in conscious blunt trauma patients decreases the hospitalization time, but has no impact on patient outcome and probably might lead to overtreatment of occult injuries. The option of using a selective approach should be further evaluated to decrease radiation exposure and facility overuse.

Identification and characterization of probiotic lactic acid bacteria isolated from traditional persian pickled vegetables.

Background: The pickle, a traditional fermented product, is popular among Iranians. Much research has been conducted worldwide on this food group. Due to a lack of related data in Iran, this study was conducted to isolate and identify dominant lactic acid bacteria (LAB) in pickles and salted pickles. Materials and methods: Seventy samples were collected from different regions of Iran. The isolated bacteria were identified as LAB by Gram staining and catalase by using MRS agar. Then, those strains were identified at the species level by physiological tests (e.g., gas production from glucose, arginine hydrolysis, CO2 production from glucose in MRS broth, carbohydrate fermentation) and growth at temperatures of 15°C, 30°C, and 45°C in MRS broth for 3 days. The probiotic characteristics of these bacteria were studied using acid and bile tolerance. The corresponding results were verified using PCR analyses of the 16S rDNA region. Results: 114 presumptive lactic acid bacteria (LAB) with Gram-positive and catalase-negative properties were obtained from the samples. The results revealed that all isolated bacteria were identfied as Lactobacillus (L.) plantarum, L. brevis, L. pentosus, L. casei, L. paracasei and Leuconostoc mesenteroides. The predominant LAB in these pickles was L. plantarum, which was isolated from most of the samples. Among the 114 LAB, 7 isolated species have probiotic potential. Six out of seven were recognized as L. plantarum and one remained unidentifiable by biochemical testing. PCR analysis and sequencing of the 16S rDNA region using 27f and 1522r primers showed that all of the probiotic strains were L. plantarum. Conclusion: The results of this study showed that the dominant LAB in traditional Persian pickled vegetables are L. plantarum, L. brevis, L. pentosus, L. casei, L. paracasei, and Leuconostoc mesenteroides. Moreover, L. plantarum was recognized as a probiotic species in pickled vegetables. The raw data obtained from this study can be used in the pickling industry to improve the nutritional value of products.

Effect of reinforced audit and feedback intervention on physician behaviour: a multifaceted strategy for targeting medical record documentation.

We investigated the effects of reinforced audit and feedback on the medical record documentation (MRD) of 35 surgical residents at a tertiary university hospital. In three phases (pre-intervention, 3 and 9-month post-intervention), 525 medical records were assessed. An educational guideline assisting residents to record more accurate MRD was developed. The MRD rate in the pre-intervention and immediate post-intervention phases had changed significantly. The MRD rate in the pre-intervention and 9 months after cessation of intervention was not statistically significant. Reinforced audit and feedback had only a short term effect on MRD. To achieve long lasting change, we suggest residents' MRD behaviour must be integrated in their periodic clinical performance evaluation and reinforced through positive feedback including incentive mechanisms.

Inhibitory effect of Lactobacillus plantarum and Lb. fermentum isolated from the faeces of healthy infants against nonfermentative bacteria causing nosocomial infections.

Nosocomial infection constitutes a major public health problem worldwide. Increasing antibiotic resistance of pathogens associated with nosocomial infections has also become a major therapeutic challenge for physicians. Thus, development of alternative treatment protocols, such as the use of probiotics, matters. The aim of this research was to determine the antagonistic properties of Lactobacillus plantarum and Lb. fermentum isolated from the faeces of healthy infants against nonfermentative bacteria causing nosocomial infections. One hundred five samples of nosocomial infections were collected and processed for bacterial isolation and antimicrobial susceptibility testing following standard bacteriologic techniques. The antibiotic susceptibility test was performed by the disk diffusion method, and antagonistic effect of Lactobacillus strains was investigated by well diffusion method. Of 105 samples, a total of 29 bacterial strains were identified as nonfermentative bacteria, including 17 Acinetobacter baumannii and 12 Pseudomonas aeruginosa. A. baumannii showed high resistance to tested antibiotics except ampicillin/sulbactam, and P. aeruginosa showed resistance to ampicillin/sulbactam and gentamicin and sensitive to amikacin and meropenem. Lb. plantarum had antagonistic properties against both A. baumannii and P. aeruginosa strains. Lb. plantarum had considerable effects on preventing the growth of A. baumannii and P. aeruginosa strains. However, further research is needed to better understanding of these effects on P. aeruginosa.