Shiraz E-Medical Journal
Year:2020 | Volume:21 | Issue:3|Papers Count:8

Background: The emergence and spread of plasmid-mediated quinolone resistance (PMQR) among extended-spectrum betalactamase (ESBL)-producing isolates have become a serious threat to global public health. Objectives: The purpose of this study was to determine the presence of PMQR determinants in ESBL-producing Klebsiella pneumoniae isolates from hospitalized patients. Methods: We collected 100 strains of K. pneumoniae from patients admitted to Milad Hospital. Antimicrobial susceptibility and ESBL production were tested based on the Clinical and Laboratory Standards Institute (CLSI) guidelines. Polymerase chain reaction (PCR) was used to determine the presence of ESBL and PMQR genes. The genetic relatedness among the strains was evaluated by enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR). Results: We found 51% (n = 51) of the isolates as ESBL producers. Among them, the highest resistance rates were to cefepime (76. 5%), amikacin (74. 5%), ciprofloxacin and levofloxacin (both 70. 6%), and the lowest resistance rate was to ticarcillin (96%). Among the 51 ESBL-positive isolates, blaTEM (94. 1%) was the most frequent gene, followed by blaSHV (66. 7%) and blaCTXM (59. 9%). The frequencies of aac(6’ )-Ib, qnrS, qnrD, qnrB, qnrA, and qnrC were 35. 3%, 33. 3%, 31. 4%, 29. 4%, 13. 7%, and 5. 9%, respectively. Coexistence of ESBL and PMQR genes was observed in 44 (86. 2%) isolates. ERIC-PCR analysis revealed that ESBL producers were genetically divergent. Conclusions: Our findings indicate that PMQR genes are highly prevalent in ESBL-producing strains of K. pneumoniae in Iran. Regular detection of ESBL strains and monitoring of their antibiotic resistance patternsmay help reduce the spread of these strains in hospitals.

Background: Achieving professional identity is one of the research priorities, and considering the importance of professional attitude among student nurses, it is necessary to identify a scale that is able to measure their achievement in professional attitude. Objectives: The present study was conducted with the aim of translation and psychometrics of instrument of professional attitude for student nurses (IPASN) scale. Methods: In this cross-sectional study, the translation and psychometrics of “ instrument of professional attitude for student nurses scale” was performed based on the model of Wild et al. The third to eighth semester nursing students of Ilam University of Medical Sciences comprised the research population who were 300 students. After translation and retranslation, the editorial comments of the scale designer were applied. Then, content validity, face validity, confirmatory factor analysis, internal consistency, and testretest reliability of the Persian version were calculated. Data were analyzed using SPSS software version 20 and EQS6. 1. Results: The confirmatory factor analysis of the 28-item scale with its 8 sub-scales was confirmed by deleting the statement 7 and moving the items 10, 15, and 18. The reliability of the internal consistency was calculated to be = 0. 89 for the total scale, and (0. 89), (0. 45), (0. 67), (0. 69), (0. 69), (0. 73), (0. 70), and (0. 93) for the sub-scales, respectively. Pearson’ s correlation coefficient was r = 0. 79 for test-retest reliability (P < 0. 005). Conclusions: This study shows that the modified Persian version of the instrument of professional attitude for student nurses scale with 27 statements is valid and reliable, and can be used to assess the nursing students towards their professional life.

Context: Several studies declared a significant correlation between academic achievement as a behavioral index and happiness among Iranian students. Objectives: The present studyaimedto explore the relationshipbetween happinessandacademic achievement in students through a systematic review and meta-analysis approach. We also aimed to categorize the influencing factors based on their type and study fields. Evidence Acquisition: Based on a systematic review and meta-analysis approach, we retrieved articles published in PubMed, Scopus, Web of Science, and Google Scholar databases using keywords including correlation, happiness, academic achievement, and students. We also searched the Persian equivalents of the keywords in a Persian database (i. e. SID) from 2013 to 2017. The Q statistic and I2 index were utilized for seeking heterogeneity between studies. The statistical analyses were conducted by STATA 11. 1 software. Results: Assessing the correlation coefficient between academic achievement and happiness scores led to z = 0. 25 (95% CI: 0-7. 56, I2 = 98. 7%) and r = 0. 24 (95% CI: 0-50) in university students. Conclusions: Happiness improves the student’ s academic achievement. Thus, this factor should be considered for improving the students’ performance.

Background: The high risk of recurrence of ovarian endometrioma after laparoscopy is a major challenge. Objectives: In this study, we measured recurrence of endometriosis six months after laparoscopic surgery and evaluated its risk factors in these patients. Methods: In this cross-sectional study, patients with endometrioma (based on the pathologic report) who underwent laparoscopic cystectomy in Rasool-Akram Hospital, Tehran, from April 2015 to August 2016, were evaluated by ultrasonography six months after the surgery. Endometriosis surgery was done by a team of expert surgeons. The demographic information of patients, number, size, and location of cysts, disease stage, and medical treatment taken after the surgery were recorded in the study checklist. The pre-operative endometriosis-related symptoms, including pelvic pain, dysmenorrhea, dyspareunia, dyschezia, and dysuria were recorded by visual analogue scale and compared with related symptoms six months after the surgery. Results: Seventy-nine patients completed the study with the mean age of 31. 38  5. 98 years. The mean cysts’ size was 69. 2  2. 76 mm: 44. 3% had multiple cysts and 39. 2% bilateral endometrioma. In 53. 1% deep infiltrative endometriosis (DIE) was recorded. After six months, 13. 9% had a recurrence with the mean size of 37. 2  13. 3 mm. There was a statistically significant correlation between recurrence and a previous surgery (P = 0. 001) and infertility (P = 0. 02). All endometriosis-related symptoms significantly decreased six months after the surgery. Conclusions: The recurrence rate, compared to the previous report, indicated that patients with a previous surgery and infertility should be closely monitored for the risk of recurrence. Possibly, damages in the previous surgery and cellular and molecular abnormalities that encountered more deeply in endometriosis-associated infertility predispose the patients to more recurrence rate, which can be further investigated.

Background: Iron deficiency anemia (IDA), as one of the most common problems of the elderly, is preventable and treatable. Objectives: The current study aimed at determining the prevalence of IDA and its related factors in older females and comparing it between community-dwelling individuals and nursing home residents in the Southwest of Iran. Methods: The current cross sectional study was conducted on 365 community-dwelling and nursing home residents in Bushehr Province, Iran. Data were collected in 2017. Blood samples were taken from all participants to measure hemoglobin and ferritin levels. Hemoglobin values less than 12 g/dL were considered as diagnostic criteria for anemia. Simple logistic regression was used to compare normal subjects with the ones with anemia, and after adjusting the marital status and age, the odds ratio (OR) was obtained. Furthermore, independent variables affecting them and ORs and their associated confidence intervals (CIs) were obtained, which were significant. Data were analyzed using SPSS software and the significant level was less than 0. 05. Results: The mean SD age of participants was 82. 00 5. 79 years, and the means of hemoglobin and ferritin levels were 12. 6 1. 04 g/dL and 15. 00 5. 11  g/dL, respectively. Based on the hemoglobin rate, 30% of the elderly females had anemia, and the prevalence of IDA in the elderly living in the community and nursing homes was 27% and 39%, respectively. Conclusions: The prevalence of IDA in elderly females was high in Southwest of Bushehr. The crude and adapted ORs indicated that living in the nursing home was a risk factor for anemia. Therefore, this ailment requires a national screening, diagnosis, and early intervention.

Background: Mastalgia is the most common breast problem. Objectives: This study aimed to assess the relationship between physical activity and cyclic mastalgia in women. Methods: This study was a cross-sectional study that was conducted on 322 healthywomen45-18 years old referred to health centers of Tabriz, Iran through purposeful sampling. Questionnaires including socio-demographic characteristics, nominal day breast pain (NDBP) and International Physical Activity questionnaire (IPAQ) were applied to collect the data. Analysis of covariance test was used to determine the impact of the independent variables (physical activity and socio-demographic characteristics) on the dependent variable (severity and duration of breast pain). Results: According to the Pearson correlation test, a statistically significant association was observed between mastalgia severity and length of physical activity (P < 0. 001). Based on analysis of covariance test, physical activity was a predictor of severity and duration of mastalgia. Conclusions: According to the results of this study, physical activity is an effective factor on cyclic mastalgia. Therefore, a regular exercise program should be included in the treatment protocol of women with cyclic mastalgia.

Background: Absence of a screening tool for domestic violence seriously influences clinical practice and research in Iran. Objectives: In this study, a four-item Hurt-Insult-Threaten-Scream (HITS) screening tool was translated into Persian and evaluated in the Iranian women. Methods: The HITS was translated into Persian, evaluated, and finalized by a panel of experts, with acceptable face and content validity. Married women who referred to Psychiatry Clinic and family practice offices of Tabriz and Kermanshah Universities of Medical Sciences first answered Farsi HITS and then underwent a psychiatric interview. The results of these two evaluations were compared. The participants were invited to answer HITS four weeks later again to evaluate the reliability. Results: A total of 269 participants (Azeri, Kurdish and Fars ethnicity) were included with a mean age standard deviation of 34. 96  9. 83 years. Based on reports of the psychiatric interview, 58 women (21. 5%) were victimized by domestic violence. The ROC curve analysis, reported the best cut-off point for the Persian version of HITS to be 9, giving a sensitivity of 91. 4% and a specificity of 94. 3%. About 75% showed up for the second time, and Cronbach’ s alpha coefficients for testing the consistency of answers for all questions of Farsi HITS showed acceptable reliability. Conclusions: The Persian version of HITS is now available as a valid tool for screening domestic violence in Iranian women with acceptable validity and reliability.

Objectives: This study aimed to investigate the effect of assisted reproductive technology (ART) on both maternal and neonatal outcomes in monochorionic (MC) and dichorionic (DC) twin pregnancies. Methods: This retrospective cohort study was conducted on women with twin pregnancies who delivered at Hafez and Hazrat Zeinab hospitals (affiliated to the Shiraz University of Medical Sciences) from March 2013 to May 2018. Results: In this study, 651 twin pregnancies (122 MC and 529 DC) were analyzed. Among MC twin pregnancies, the adverse maternal and neonatal outcomes were similar between the ART and the spontaneous pregnancies, except for lower 1-minute and 5-minute Apgar scores (5. 3 vs. 7. 2; P = 0. 036 and 6. 4 vs. 8. 5; P = 0. 039, respectively) and a higher fetal death rate in ART group (19% vs. 3. 5%, P = 0. 001). Among the DC twin pregnancies, the risks for pregnancy-related hypertensive disorders, gestational diabetes mellitus, emergency cesarean section and antenatal corticosteroid exposure significantly increased in the ART group (P < 0. 001, P = 0. 002, P = 0. 014, and P = 0. 001, respectively). Furthermore, DC twins showed significantly higher rates of deliveries before the 34 weeks of gestation (44. 8% vs. 31. 0%, P = 0. 002), extremely low birth weight (11. 9% vs. 4. 0%, P < 0. 001), intrauterine fetal growth restriction (29. 3% vs. 13. 5%, P < 0. 001), lower 1-minute (P = 0. 009 for fetus A and P = 0. 003 for fetus B, respectively) and 5-minute (P < 0. 001 for fetus A and P < 0. 001 for fetus B, respectively) Apgar scores, perinatal mortality (14. 4% vs. 6. 9%, P < 0. 001) and congenital anomaly (8. 3% vs. 2. 3%, P = 0. 001) after ART treatment. These results were confirmed by multivariate analysis after adjusting for the baseline variables. Conclusions: Despite the controversial perinatal outcomes in the literature, we found that ART is associated with an increased risk of perinatal morbidity and mortality, particularly in DC twin pregnancies. Therefore, ART twin pregnancies management requires closer surveillance and advanced facilities at tertiary care centers.