Identification of a Novel Cassette Array in Integronbearing Helicobacter Pylori Strains Isolated from Iranian Patients.

Helicobacter pylori as the second most common cause of gastric cancer in the world infects approximately half of the developed countries population and 80% of the population living in developing countries. Integrons as genetic reservoirs play major roles in dissemination of antimicrobial resistance genes. To the best of our knowledge, this is the first study to report carriage of class 1 and 2 integrons and associated gene cassettes in H. pylori isolates from Iran. This crosssectional study was conducted in Tehran among 110 patients with H. pylori infection. Antimicrobial susceptibility testing (AST) for H. pylori strains were assessed by the micro broth dilution method. Class 1 and 2 integrons were detected using PCR. In order to determine gene cassettes, amplified fragments were subjected to DNA sequencing of both amplicon strands. The prevalence of resistance to clarithromycin, metronidazole, clarithromycin, tetracycline, amoxicillin, rifampin, and levofloxacin were 68.2% (n=75), 25.5% (n=28), 24.5% (n=27), 19.1% (n=21), 18.2% (n=20) and 16.4% (n=18), respectively. Frequency of multidrug resistance among H. pylori isolates was 12.7%. Class 2 integron was detected in 50 (45.5%) and class 1 integron in 10 (9.1%) H. pylori isolates. The most predominant gene cassette arrays in class 2 integron bearing H. pylori were included sateraaadA1, dfrA1sat2aadA1, blaoxa2 and, aadB whereas common gene cassette arrays in class 1 integron were aadBaadA1cmlA6, aacA4, blaoxa2, and catB3. The high frequency of class 2 integron and multidrug resistance in the present study should be considered as a warning for clinicians that continuous surveillance is necessary to prevent the further spread of resistant isolates.

Psychogenic unilateral pseudoptosis.

Conversion disorders are among common psychological problems. Pseudoptosis is an uncommon presentation of this category of disorders. Herein, the authors report 2 cases of psychogenic pseudoptosis. The first case is a 21-year-old man who presented with sudden onset of ptosis in his OS 2 weeks previous. The patient reported episodes of left upper eyelid drooping during the last 7 months. The second case is a 10-year-old girl with ptosis onset 6 months previously, after a viral conjunctivitis. In both patients, specific presentations in favor of nonorganic ptosis were observed; all neurological and paraclinical evaluations were normal, and considerable familial or social stressors were found. Both patients received psychological treatment, and no recurrence was observed afterward.

Pregabalin and gabapentin for post-photorefractive keratectomy pain: a randomized controlled trial.

PURPOSE: To evaluate the efficacy of pregabalin and gabapentin for reducing post-photorefractive keratectomy (PRK) pain. METHODS: In this randomized clinical trial, 150 subjects undergoing PRK were allocated into 3 groups. In addition to the routine regimen, pregabalin 75 mg, gabapentin 300 mg, and placebo were administered 3 times daily for 3 days, in groups 1, 2, and 3, respectively. Subjects could take acetaminophen-codeine 300/10 mg tablets every 4 hours as needed. Patients completed a pain assessment survey (visual analogue scale ranging from 0 = no pain to 10 = most severe pain) 7 times in the first 3 days following PRK and also recorded the number of consumed acetaminophen-codeine tablets. RESULTS: Age, sex, refractive error, ablation depth, and mitomycin-C (MMC) application were similar in the 3 study groups (all p values>0.05). Overall pain scores in the placebo group were 0.9 and 1 unit higher than the pregabalin (p=0.029) and gabapentin (p=0.023) groups, respectively. Severe pain (score >7) was more frequent in the placebo group on the morning of the first postoperative day (p=0.043). The difference in the number of consumed acetaminophen-codeine tablets was statistically borderline (p=0.061) and less in the pregabalin (7.9 ± 5.2) and gabapentin (9.0 ± 4.1) groups in comparison to the placebo group (10.3 ± 5.6). CONCLUSIONS: Pregabalin and gabapentin seem to be helpful in alleviating post-PRK pain when combined with other measures. Depending on availability, either compound can be used as an adjuvant for pain control in this setting.

Effect of corneal thickness on the agreement between ultrasound and Orbscan II pachymetry.

PURPOSE: To study the agreement between ultrasound (US) and Orbscan II (Bausch & Lomb) measurements with different ranges of central thickness in normal corneas. SETTING: Noor Ophthalmology Research Center, Tehran, Iran. METHODS: The central corneal thickness was measured first by the Orbscan II and then with a US pachymeter in 177 right eyes. Data were compared in 3 thickness groups: less than 500 microm, 500 to 600 microm, and more than 600 microm. In all cases, uncorrected Orbscan II data were used. For each range, a correction factor was calculated through regression analysis, which was then used in a new set of analyses. To study the agreement between the 2 methods, the 95% limits of agreement (LoA) and intraclass correlations coefficients (ICC) were determined. RESULTS: The mean interdevice difference was 2.7 +/- 16.9 (SD) in the less than 500 microm group (P = .365), 21.3 +/- 3.1 in the 500 to 600 microm group (P = .0001), and 27.2 +/- 20.9 in the more than 600 microm group (P = .0001). No clinically acceptable LoA were found in any group. The application of regression equations to the Orbscan II readings improved the agreement in the less than 500 microm group better than the other 2 groups. The ICC was 0.76, 0.61, and 0.43 in the less than 500 microm, 500 to 600 microm, and more than 600 microm groups, respectively. CONCLUSIONS: The Orbscan corneal thickness readings had relatively lower validity than US measurements. The 2 devices should not be used interchangeably, especially when the validity of the measurement is vital. In patient screening for corneal surgery, it is advisable to recheck corneal thickness with a US pachymeter.