Journal of Advances in Medical and Biomedical Research
Year:2019 | Volume:27 | Issue:123|Papers Count:8

Background & Objective: Nosocomial infection is one of the most daunting challenges to the global health care system. The current study aimed to compare the antimicrobial resistance pattern in hospital versus community-acquired infections in pediatric patients in Besat Hospital, Hamadan, Iran. Materials & Methods: The current study was carried out on all patients with a hospital-acquired infection (HAI) who were hospitalized in Besat Hospital, Hamadan, Iran, for 48 hours. Moreover, patients with community-acquired infections (who had an infection before hospitalization) were also included in the current study. E-test and Kirby-Bauer disk diffusion test were utilized to determine antimicrobial susceptibility patterns according to the report test/CLSI M100/S27 guidelines. Antibiotic resistance patterns in both patients with hospital and community-acquired infections were separately recorded. Subsequently, the obtained data were analyzed by SPSS software (version 16). Results: A number of 43 and 68 patients showed HAI and CAI, respectively. The most common HAI and CAI were blood-stream infection and urinary tract infection (UTI) with a prevalence of 69. 8%, and 73. 5%, respectively. The most frequent organisms isolated from CA and HA-infections were E. coli and Staphylococcus aureus with a prevalence of 67. 9%, and 30. 2%, respectively. The highest level of resistance in Gram-negative bacteria was observed against cotrimoxazole and ceftriaxone. Furthermore, the highest resistance in Gram-positive organisms was against clindamycin. The prevalence rates of MRSA isolates in HAI and CAI were reported as 46. 2% and 36. 9%, respectively. Conclusion: The obtained results indicated the high resistance to several antibiotics that can be used as promising choices in the treatment of both CA and HA-infections. It is recommended that region-specific monitoring studies be carried out in order to assist the clinician to select the accurate empirical therapy.

Background & Objective: Stress contributes to sleep-wake behavior in all animals. It seems that factors such as learning and memory processes can improve sleep disorders. Therefore, the present study was conducted to determine the effects of stress and learning (spatial memory) on total post-stress REM, NREM and waking time in rats. Materials & Methods: Adult rats (n=21) were divided into 3 groups; group 1 received only immobilization stress; group 2 was subjected only to the learning process (Barnes maze); and group 3 underwent both the stress and learning conditions. For each rat, sleep signals were recorded for 2 hours for 3 consecutive days. After recording of sleep or awakening signals, animal subjected to immobilization stress for 2 hours in each day. Then, post-stress and post-learning signals were recorded for another 2 hours. Results: Immobilization stress resulted in significant decrease in total REM sleep time. However, total time of NREM increased following stress. Performing the learning task resulted in a significant increase in post-learning REM time (p<0. 05). Moreover, total NREM time did not change markedly following the learning process. Interestingly, the learning process significantly (p<0. 05) decreased total time of awakening when compared with pre-learning condition. However, learning process could increase REM sleep significantly (p<0. 05) after the stress condition has been administered. Conclusion: Our data suggested that immobilization stress could not prevent REM sleep after a learning process has been administered. However, the completion of a learning process increased post-stress REM time. It seems that learning helps to prevent the inhibitory effects of stress on REM sleep.

Background & Objective: Securigera securidaca is a medicinal plant used in Persian folk medicine to decrease blood sugar. Nevertheless, there is some controversy about its effects. The current study investigated the hypoglycemic activity of the aqueous seed extract of Securigera securidaca. Materials & Methods: Sixty mature male Charles-River rats were categorized and divided randomly into 10 groups with two timeframes (7 and 14 days). To induce diabetes, rats were injected intraperitoneally with 7 mg/0. 5 ml streptozotocin in normal saline per 100 g body weight. The aqueous seed extract of Securigera securidaca was given orally to rats daily (80 mg/0. 5 ml in distilled water per 100 g of rat body weight). The blood sugar of rats was measured on the 7th and 14th days. Blood lipid indices and ALT, AST, and ALP plasma levels were measured after 14 days of treatment. Results: The findings showed that the Securigera securidaca aqueous seed extract had a significant effect on the blood sugar of rats after 7 and 14 days compared with the diabetic group. After 14 days, there was a significant difference in the weight of treated rats between the Securigera securidaca aqueous seed extract and diabetic groups. The Securigera securidaca aqueous seed extract had no significant effect on the blood lipid profiles of the treated rats. The AST enzyme levels were significantly higher in rats exposed to the seed extract than in the diabetic group. REM sleep significantly (p<0. 05) after the stress condition has been administered. Conclusion: Based on the results, Securigera securidaca seed extract had a significant effect in reducing the blood sugar of diabetic rats with no significant changes in lipid profiles. More studies are needed to explore in more detail the mechanism of this hypoglycemic effect.

Background & Objective: The production of plasmid-mediated AmpC beta-lactamases (PMABLs) among urinary Klebsiella pneumoniae isolates causes a severe problem to the successful treatment of urinary tract infections (UTIs). This study was designed to evaluate antimicrobial resistance, the presence of AmpC beta-lactamase genes, and the genetic relatedness among K. pneumoniae strains separated from patients with UTI. Materials & Methods: In this cross-sectional descriptive study, a total of 100 K. pneumoniae isolates were collected from UTI cases in Milad Hospital, Tehran, Iran. The sensitivity of the isolates to 12 antibiotics was tested using the Kirby-Bauer disk diffusion method. AmpC production was determined using a boronic acid combined-disk test. Polymerase chain reaction (PCR) was carried out to screen all isolates with family-specific PMABL genes. The genetic relatedness of AmpC-producing isolates was determined by an enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR). Results: Over a period of 11 months, PMABLs were detected in 49 isolates (49%) of K. pneumoniae. Resistance to at least three classes of antimicrobials was detected in 30 (61. 2%) PMABL producers. Among AmpC producers, 34 isolates harbored only one AmpC gene group, including MOX (n=11), EBC (n=8), ACC (n=7), CIT (n=4), FOX (n=2), and DHA (n=2). Multiple AmpC gene groups were detected in 15 isolates. The ERIC-PCR showed the polyclonal distribution of AmpC-producing isolates. Conclusion: In our study, a high frequency of AmpC-producing K. pneumoniae was observed. This is the first report of ACC type AmpC beta-lactamase in Iran. Strategies to minimize the spread of AmpC beta-lactamase-producing isolates should be implemented.

Background & Objective: Nowadays, conventional analgesic agents that are usually used for pain killing after cesarean sections do not provide enough analgesia with infrequent serious side effects. Lidocaine has been suggested as an adjuvant analgesic agent for postoperative pain relief. We designed this randomized double-blind, placebo-controlled study to evaluate the analgesic efficacy of intravenous lidocaine in patients undergoing a cesarean section under spinal anesthesia. Materials & Methods: Eighty patients undergoing elective cesarean section under spinal anesthesia were randomly divided into two groups to receive intravenous 1. 5 mg/kg of lidocaine 2% bolus 15 minutes prior to spinal anesthesia followed by an intravenous infusion of 1. 5 mg/kg/h for 60 minutes (L group) or 0. 9% sodium chloride (C group) in a double-blind fashion. The time until the first request for an analgesic, the duration of sensory and motor blockade, hemodynamic variables and adverse events were recorded. Results: The difference in sensory (95% CI 10. 18 to 18. 01; P≤ 0. 001) and motor (95% CI 35. 50 to 50. 19; P≤ 0. 001) blockade durations between groups L and C were significant. Similarly, the mean time until the first analgesic request was longer in group L (175. 37± 21. 43) than in group C (157. 12± 15. 25); the difference between the two groups was significant (95% CI9. 95 to 26. 54; P<0. 001). Conclusion: Intravenous lidocaine given as a supplementary agent in patients undergoing cesarean section under spinal anesthesia prolonged the duration of the sensory and motor blockade of spinal anesthesia and delayed the first analgesic request by patients without hemodynamic disturbance, respiratory depression and compromising the fetus.

Background & Objective: FLT3-ITD mutation detection has been an integral part of diagnostic work ups focused on acute myeloid leukemia. However, some studies have indicated that the mutation is unstable during the various stages of the disease. The purpose of this study was to evaluate the stability of this marker in paired diagnosis-relapse samples using Delta-PCR method. Materials & Methods: In this retrospective study, paired diagnosis-relapse bone marrow or peripheral blood samples from 180 adult AML patients were analyzed for FLT3-ITD mutations using conventional fragment analysis and Delta-PCR methods. A dilutional experiment of DNA derived from a FLT3-ITD mutated patient in normal peripheral blood was performed in order to evaluate the sensitivity of each method. Results: All samples were analyzed using both conventional fragment analysis and Delta-PCR methods. FLT3-ITD mutations were detected in 24 diagnostic samples (13. 3%) and 28 relapse samples (15. 5 %) through conventional fragment analysis. Three out of four patients who were FLT3-ITD positive in the relapse samples had a mutation in the diagnostic samples using the Delta-PCR method. On the other hand, at the time of diagnosis and relapse, the mutation test results were incompatible in only 3. 6% of patients based on the results of the Delta-PCR method compared to 14. 2 based on conventional fragment analysis. Our findings revealed that the sensitivity of Delta-PCR as related to FLT3-ITD detection was 0. 2 %. Compared to the conventional fragment analysis, with a sensitivity of 2%, Delta-PCR shows greater sensitivity and specificity. Conclusion: The conventional testing of the FLT3-ITD mutation by fragment analysis did not detect a significant proportion (11%) of FLT3-ITD positive samples in AML patients. Delta PCR increased the sensitivity and specificity relative to the conventional method. The detection of FLT3-ITD mutation through Delta PCR is important in order to detect minor clones at diagnosis or during the monitoring of AML patients.

Achieving adequate coverage of soft tissue defects located on the lower third of the legs and feet is challenging for reconstructive surgeons. Fasciocutaneous flaps can be used to meet this challenge. Two common fasciocutaneous flaps used in this context are the reverse sural flap and lateral supramalleolar flap (LSMF). Plastic and reconstructive surgeons are relatively unfamiliar with the second flap. In this article, we introduce a patient with an extensive soft-tissue defect on the dorsum and lateral side of her foot and ankle.

Acroangiodermatitis (AAD), also known as Pseudo-Kaposi’ s sarcoma, is a rare benign angioproliferative disease associated with chronic venous insufficiency (CVI) or other vascular disorders. We present an 81-year-old male with plaque-like cutaneous lesions, which had progressive erythematous margins, severe pain, and intense pruritus, as well as bilateral swollen and painful feet. It was around five months that he had these problems. Based on the pathology of skin lesion biopsy specimens and the immunohistochemical staining results (which indicated the positivity of CD34), the diagnosis of pseudo-Kaposi’ s sarcoma was confirmed.