Bronchoalveolar lavage of ventilator-associated pneumonia patients for antibiotic resistance and susceptibility test.

BACKGROUND AND AIMS: Ventilator-associated pneumonia is highly prevalent nosocomial infection among patients under mechanical ventilation. Bronchoalveolar lavage (BAL) is effective in identifying the type of pathogen involved and determine the course of antibiotic. The aim of this study was to evaluate the prevalence of different pathogens involved in ventilator-associated pneumonia (VAP) and associated antibiotic resistance and sensitivity pattern. METHODS: In this descriptive cross-sectional study, patients admitted to the intensive care unit under mechanical ventilation at Shahid Madani Educational and Medical Center in Karaj during 2018 and 2020 were included. BAL samples were obtained from the patients. Demographic data, duration of hospitalization, duration of mechanical ventilation, and antibiotic susceptibility and resistance tests were recorded for all the patients. RESULTS: Among 335 patients included in the study, 215 (64.2%) were males. The mean age of the patients was 55.06 ± 14.90 years. The most common pathogens reported were Acinetobacter baumannii (40%), Pseudomonas aeruginosa (21.2%), and Staphylococcus aureus (13.4%). The mean age of the patients, gender, duration of mechanical ventilation, and duration of hospitalization were not associated with the type of pathogen, P > .05, respectively. CONCLUSION: BAL of these patients indicated that various pathogens are responsible for VAP, and can vary from patient to patient. Antibiotic resistance and susceptibility pattern of these pathogens vary and therefore is important in determining the course of the treatment.

A retrospective study on the cardiac assessment of isolated sternal fracture patients based on radiographic and clinical outcomes.

OBJECTIVE: Sternal fracture may be associated with major and serious injuries. In this study, the complications associated with isolated sternal fracture in trauma patients are evaluated based on radiographic and cardiac findings. METHODS: This retrospective study was performed on patients with isolated sternal fractures admitted to the emergency department of (XXX) Madani Educational-Medical. Data regarding demographic information, mechanism of trauma, length of hospitalization, electrocardiography (ECG), cardiac enzyme, and chest radiography were recorded in the questionnaire for each patient. RESULTS: The mean age of patients 41.2 + 11.04 years and 63.9% were male. The most common cause of the trauma was car accidents in 41% (25 cases). The mean duration of hospitalization was 1.54 ± 0.90 days. The mechanism of trauma was not associated with x-ray and computed tomography findings, p = 0.53 and p = 0.86, respectively. ECG findings were significantly related to x-ray and computed tomography outcomes, p < 0.001, respectively. CONCLUSION: Patients with isolated sternal fracture with displacement >0.5 cm and hematoma are likely to require cardiac consultation.

Comparing the effect of clomiphene citrate and letrozole on ovulation induction in infertile women with polycystic ovary syndrome.

OBJECTIVE: To compare the effects of letrozole and clomiphene citrate in women with polycystic ovaries. METHODS: The double-blind randomised clinical trial study was conducted from September 22, 2012 to March 20, 2013, at the Islamic Azad University of Medical Sciences, Mashad, Iran, and comprised infertile women with polycystic ovaries. The subjects were classified into two groups. Patients who received letrozole 5mg tablets per night formed group A, and those who received clomiphene citrate 50mg tablets per night formed group B. The medication continued for 3-7 days in each group. On the 13th day, transvaginal sonography with multi-frequency vaginal probe was done to check the number and the size of dominant follicle and endometrial thickness. Human chorionic gonadotrophin 5000 IU ampoule, 10000 IU per night, was administered intramuscularly for ovulation in the case of dominant follicle over 18mm and the insemination was recommended 24-36h after injection. Beta human chorionic gonadotrophin was determined 16 days after the injection by immunoassay technique. The patients were followed up for 12 months. SPSS 16 was used for data analysis. RESULTS: There were 220 patients; 110(50%) in each of the two groups. The mean age of patients in group A was 26.2±3.6 years and that in group B was 27±3.6 years. Endometrial thickness in group A was significantly greater compared to group B (p=0.001). The clinical consequence of drug use (pregnancy) in group A was better than group B (p=0.007). CONCLUSION: Although more clinical studies are needed, letrozole is recommended for women with polycystic ovaries and those resistant to clomiphene citrate.