Avicenna Journal of Clinical Medicine
Year:2018 | Volume:25 | Issue:2 (SN88) |Papers Count:12

Background and Objective: Bleeding is one of the most common problem during nasal surgeries, including the functional and aesthetic surgeries. One of the methods to reduce intraoperative hemorrhage is the administration of anti-fibrinolytic agents, such as tranexamic acid. Regarding this, the present study aimed to determine the effect of intravenous transaxamic acid on bleeding volume and operative field quality during nasal surgery. Materials and Methods: This clinical trial was conducted on 70 patients within the age range of 18-65 years referring to Besat Hospital in Hamadan, Iran, for nasal surgery. The participants were assigned into two groups of case (n=35) and control (n=35) using the table of random numbers. The case group was administered a mixture of 500 mg tranexamic acid and 500 ml ringer serum infused with a maximum rate of 15 mg/min at a concentration of 1 mg/ml. However, the control group just received ringer serum infusion. Results: The mean age of the patients was 34. 64± 15. 43 years and 61. 4% of them were male. There was no statistically significant difference between the two groups in terms of age, gender, and weight (P>0. 05). The mean scores of surgeon satisfaction were obtained as 73. 6 and 51. 4 in the case and control groups, respectively, which were significantly different between the two groups (P=0. 000). The mean volumes of blood in suction were 208± 97. 64 and 273. 71± 147. 72 ml in the case and control groups, respectively, which showed a significant difference between the groups (P=0. 032). Furthermore, the mean surgery durations were estimated as 119. 2± 34. 58 and 139. 71± 38. 46 min in the case and control groups, respectively, and this difference was statistically significant (P=0. 02). Additionally, the mean volumes of infused fluid were 1057. 14± 217. 31 and 1260± 497. 168 ml in the case and control groups, respectively, which were significantly different between the two groups (P=0. 030). The mean difference of hematocrit level between the pre-and post-surgical stages were obtained as 1. 67% and 3. 13% in the case and control groups, respectively, which were significantly different between the study groups (P=0. 001). No tranexamic acid side effects were observed in the patients. Conclusion: According to our study, the intravenous infusion of tranexamic acid could reduce hemorrhage and improve the quality of nasal surgery field without any significant side effects.

Background and Objective: Pain is one of the most common complaints in emergency departments of trauma centers. Opioid and Non-steroidal (NSAIDs) drugs are the most widely used medications for pain control in the emergency unit. This study was aimed to compare the analgesic effects of Ibuprofen and ketorolac in patients with radius fracture. Materials and Methods: This study was a randomized clinical trial evaluating 150 patients with distal radius fractures referring to emergency department of Besat hospital in Hamadan between 2016 and 2017. Patients were randomly placed in two intervention groups. The first group received IV ibuprofen 400 mg and the other group received IV ketorolac 30 mg which were infused for 30 min in both groups. The severity of pain was recorded ten min before the injection and every 30 min until 1 h after injection. Patients pain score and side effects were recorded in the data sheath and data were analyzed using statistical tests and SPSS (version 16). Results: A total of 97 males and 53 females with the mean age of 35. 72 years were included in the study. There was no significant difference in the average pain scores measured by Numeric rating scale (NRS) before prescribing medications. The reduction in pain was more significant in the ketorolac group 30 min after injection (P<0. 05). Conclusion: IV ketorolac 30 mg infusion is a safer and more effective method than IV ibuprofen 400 mg infusion for pain control in distal radius fracture following trauma.

Background and Objective: Due to the emergence and development of antimicrobial resistance in coagulase-negative Staphylococci (CoNS), which is mainly a normal flora of the skin surface and mucous membrane of humans, and the limitation of therapeutic options, this study was aimed to investigate the antibiotic resistance pattern in CoNS strains isolated from clinical specimens. Materials and Methods: In this cross-sectional descriptive study, a total of 44 isolates of coagulase-negative staphylococci were examined from clinical specimens of the patients using standard biochemical methods. Disc diffusion test was utilized to detect resistance to common antibiotics. Multiplex polymerase chain reaction (PCR) was employed to determine the frequency of resistance genes, namely mecA and vanA. Results: The results of disc diffusion test showed that the isolates had the highest resistance rate to erythromycin as 88. 64%; while the lowest resistance rate to meropenem was observed 4. 55%. A molecular analysis indicated the presence of 18. 18% of the mecA gene in the isolates; however no isolates containing vanA gene were observed. Conclusion: Considering the frequency of mecA gene, results of antibiotic resistance pattern among coagulase-negative Staphylococci strains, and lack of any resistance observations to vancomycin by PCR, it is necessary to conduct more precise laboratory methods for the detection of antibiotic resistance to prevent resistance spread in this bacterium.

Background and Objective: Acceptable control of blood glucose is one of the most important goals of treatment management in diabetic children. An insulin therapy regimen with multiple daily injection or continuous subcutaneous insulin infusion has been admitted as a desirable therapeutic approach in children with diabetes mellitus type 1. This study was designed to evaluate the effect of intensive insulin therapy on HbA1c as an alternative for the conventional two-injection insulin therapy. Materials and Methods: This descriptive-cross sectional study was conducted on 100 children and adolescents with diabetes mellitus type 1 at Pediatric Endocrinology Outpatient Clinic of Besat Hospital, Hamadan, Iran in 2017. The present study was conducted on the patients that were previously treated with twice-daily NPH and regular insulin, and then with four injections of insulin Aspart per day before each meal and insulin Glargine at bedtime. Demographic data included: age of onset of diabetes, weight, height, body mass index, duration of diabetes, number of hypoglycemic events, number of episodes of diabetic ketoacidosis (a year before and after the change of insulin regimen), number of insulin injections, type of insulin, injection device, and mean of HbA1c (a year before and after the change of insulin regimen). The data were analyzed using SPSS software (version 16) and appropriate statistical tests. Results: The mean age of the patients was 11. 41 years. Out of 100 subjects, 60 cases (60%) were female and 75% were male. In addition, 75% and 25% of the cases were urban and rural, respectively. The average body mass index was 19. 65. The average number of visits to the clinic and measurement of HbA1c were 3. 33 times a year. The mean of HbA1c before and after four injections per day was 8. 4 and 8. 1, respectively. There was a statistically significant difference (P= 0. 03). The mean reduction was significant (P= 0. 001) in subjects that were referred to the clinic and performed HbA1c more than three times a year. The frequency of reported hypoglycemia was 1. 4 each year and the difference was not statically significant. There were no differences in terms of hypoglycemia events before and after four injections per day. Conclusion: The findings of this study confirmed that multiple daily injection of insulin is associated with improved metabolic control of blood glucose. However, HbA1c levels were not in the range of good control.

Background and Objective: Hydatidosis is one the most important zoonotic infections that is a critical issue of health economics in endemic areas. The aim of this study was to estimate the prevalence level of hydatidosis and parasitic disease encounters in Hamadan. Materials and Methods: This cross sectional study was conducted on 1000 individuals referring to health centers in Hamadan in 2017. The samples and demographic data had been collected before the serum samples were subjected to anti-Echinococcus IgG antibody detection by ELISA method. Data were analyzed using SPSS and Fisher's exact test. Results: Out of the total participants, four subjects (two males and two females, 0. 4%) were considered positive for anti-Echinococcus antibody. Two of the seropositive individuals were residing in rural and the other two subjects were living in urban areas. In addition, about ninety nine percent of the cases had no knowledge of hydatid cyst disease. Three of the seropositive subjects had a history of contact with dog (29. 3%). Moreover, they used water for washing raw vegetables (36. 2%). Conclusion: The prevalence level of hydatidosis in this area is lower than that of other regions in Iran. However, it is a must to implement management and prevention programs to control and reduce the infection levels in the country due to the endemicity and health economics importance of this issue. Background and Objective: Hydatidosis is one the most important zoonotic infections that is a critical issue of health economics in endemic areas. The aim of this study was to estimate the prevalence level of hydatidosis and parasitic disease encounters in Hamadan. Materials and Methods: This cross sectional study was conducted on 1000 individuals referring to health centers in Hamadan in 2017. The samples and demographic data had been collected before the serum samples were subjected to anti-Echinococcus IgG antibody detection by ELISA method. Data were analyzed using SPSS and Fisher's exact test. Results: Out of the total participants, four subjects (two males and two females, 0. 4%) were considered positive for anti-Echinococcus antibody. Two of the seropositive individuals were residing in rural and the other two subjects were living in urban areas. In addition, about ninety nine percent of the cases had no knowledge of hydatid cyst disease. Three of the seropositive subjects had a history of contact with dog (29. 3%). Moreover, they used water for washing raw vegetables (36. 2%). Conclusion: The prevalence level of hydatidosis in this area is lower than that of other regions in Iran. However, it is a must to implement management and prevention programs to control and reduce the infection levels in the country due to the endemicity and health economics importance of this issue.

Background and Objective: Cardiovascular patients are susceptible to drug interactions due to the simultaneous use of several drug types. The purpose of this descriptive-analytic study was to evaluate the potential drug interactions and the related factors in subjects admitted to the Cardiology Department of Farshchian heart hospital of Hamadan, Iran. Materials and Methods: This descriptive cross-sectional study was conducted on 900 subjects. The data, including drugs, sex, type of illness, and length of hospitalization were extracted from files of the patients referred to Farshchian hospital in 2014 and 2015. Drug interactions were evaluated by the Micromedex 1630. The results were analyzed using SPSS software (version 16). Results: Of the 900 cases, 424 (47. 1%) were male and 476 (52. 9%) were female. A total of 4318 cases of interference were detected, 1610 (37. 3%) of which were strongly interfered and 2708 (62. 7%) were moderately interfered. The mean ages of males and females were 61. 00 and 60. 50 years, respectively (P=0. 602). It was reported that 815 (90. 6%) cases had at least one interaction. Based on the results, 389 male patients (91. 3%) and 426 (90. 6%) female patients had a drug interaction (P= 0. 258). The differences of mean age, number of drugs, and length of hospitalization were statistically significant between the groups with and without interactions (P=0. 001). The highest frequency of drug-drug interaction was detected with moderate severity in atrovastatin and clopidogrel with 464 repetition times. Furthermore, aspirin and clopidogrel with major severity and 485 repetitions were reported the most interfering drugs. Conclusion: Based on the results of this study, the amount of drug intake, length of hospitalization, and sex affect the incidence of drug interactions.

Background and Objective: Secreted toxins of the burn wounds caused by Pseudomonas aeruginosa play an important role in spreading infection. The antibiotic resistance pattern may have an effect on the increased toxicity of this bacterium. Therefore, the aim of this study was to determine the relationship between the presence of P. aeruginosa toxins isolated from burn wounds and the antibiotic resistance pattern. Materials and Methods: In this cross sectional-descriptive study, P. aeruginosa isolates were first isolated from the burn wound samples by using biochemical tests. The next step dealt with the investigation of antibiotic resistance pattern based on CLSI (Clinical and Laboratory Standards Institute). The process of identifying the genes responsible for producing toxin was performed by polymerase chain reaction method. Data analysis was performed in SPSS (version 16) using the Chi-square test. Results: Out of 250 strains isolated from burn wounds, 63 isolates (25. 2%) were obtained from P. aeruginosa. With regard to resistance, the obtained results revealed that Doripenem, Ertapenem, and Meropenem antibiotics had the highest frequency, whereas, the antibiotics of Piperacillin/Tazobactam and Piperacillin had the lowest frequency. Moreover, resistance to imipenem was observed to be semi-sensitive regarding the minimum inhibitory concentration in three isolates (76. 4%). The exoS, toxA, exoT, exoY, and pvdA genes were observed in 40 (63. 49%), 31(49. 2%), 39 (61. 9%), 56 (88. 88%), and 50 (79. 36%) isolates, respectively. In addition, there was a significant correlation between the antibiotic resistance pattern and distribution of toxin genes (P <0. 05). Conclusion: According to the obtained results, it can be concluded that the antimicrobial resistance pattern could play an important role in the distribution of P. aeruginosa toxin genes isolated from burn wounds.

Background and Objective: Klebsiella pneumoniae is known as one of the opportunistic pathogens. The prevalence of antibiotic resistance, emergence of multidrug resistant strains, and multiple virulence factors contribute to the development of various infections. In this regard, the aim of this study was to evaluate the frequency of fimH, magA, and rmpA genes among Klebsiella pneumoniae isolates in hospitalized patients from Babol, Iran. Materials and Methods: In this descriptive cross-sectional study, 65 Klebsiella pneumoniae strains were collected. In the present study, antibiotic resistance pattern was performed using disc diffusion method. After DNA extraction by a commercial kit, the frequency of magA, fimH, and rmpA genes was evaluated by polymerase chain reaction. Results: A total of 65 strains was collected from Rouhani (n=42) and Shahid Beheshti (n=23) Hospitals. Based on the antibiogram pattern, the highest resistance rate belonged to erythromycin (61. 5%) and cefotaxime (60%) and the lowest resistance rates belonged to imipenem (0%) and ofloxacin (16. 9%). Furthermore, in the molecular method, the frequency of fimH and rmpA genes was reported 86. 1% and 10. 8%, respectively. It should be noted that none of the strains harbored the magA gene. Conclusion: Based on the results of the present study, antibiotic resistance and multidrug resistance strains among Klebsiella pneumoniae strains are increasing. On the other hand, the presence of some virulence factors can play a significant role in the development of resistant strains.