Shiraz E-Medical Journal
Year:2021 | Volume:22 | Issue:1|Papers Count:8

Background: Pneumonia has high rates of morbidity and mortality in Indonesia. Infections caused by multidrug-resistant (MDR) pathogens are not only found in patients with nosocomial pneumonia but are also reported in patients with community-acquired pneumonia (CAP). Only a few studies have analyzed the factors associated with MDR pathogenic infections, especially in developing countries such as Indonesia. Therefore, the identifi cation of such factors can help to predict the infections caused by MDR pathogens in CAP patients. Objectives: This study aimed to determine factors associated with MDR pathogenic infections in CAP patients admitted to Hasan Sadikin General Hospital, Bandung, West Java Province, Indonesia. Methods: This is an observational analytic study which compared 85 patients with MDR pneumonia and 70 patients with pneumonia caused by non-MDR pathogens from March to May 2018. Sputum of all adults patient > 18 years old with CAP who had the Murray and Washington’ s criteria was collected. In vitro test was performed based on the Kirby-Bauer method with Clinical and Laboratory Standards Institute (CLSI) 2018 protocols. This study was ethically approved by the Ethics Committee of the Hasan Sadikin Hospital. Results: One hundred and fi fty fi ve patients with positive sputum culture were investigated. Overall, 85 (54%) patients had MDR pathogens in their cultures. Klebsiella pneumoniae was the most common pathogen found in the CAP patients (37/155; 23. 9%), while Acinetobacter baumannii accounted for the highest proportion of MDR pathogens (18/85; 21. 2%). Multivariate logistic regression analysis showed that the immobilization status was the only associated factor for MDR pathogenic infections in CAP patients (adjusted prevalence ratio = 1. 862 [1. 432-2. 420]; P < 0. 001). Conclusions: This study highlighted the need for early risk assessment of infections caused by MDR pathogens, especially immobilization status in CAP patients. Also, the local pathogen pattern should be considered to prescribed antibiotics for CAP patients. The fi ndings showed that antibiotics against MDR pathogens should be prescribed for CAP patients with immobilization.

Background: Children with developmental delays are at higher risk of poor health, and lower educational attainment and wellbeing than the normal ones. Objectives: As previous studies had contradictory results regarding the association between socioeconomic status (SES) and child development, the current study aimed at determining this association at the age of 60 months. Methods: The current prospective cohort study was conducted in Shiraz, Iran, from summer 2011 to the end of 2016. The study was conducted on 640 mothers registered in the Fars Birth Cohort study. A checklist comprised of social and economic parts was employed. The children’ s communication development was also assessed using the ages and stages questionnaire for 60-month-old children. In addition, SES was determined using 25 variables. Data analysis was performed using SPSS version 19. 0 and partitioning around medoid (PAM) clustering in R 3. 5. 0 software; P value < 0. 05 was considered as the level of signifi cance. Results: The majority of the subjects (79. 1%) were categorized as the moderate level of SES; 106 (16. 56%) children had a delay in at least one developmental domain. The current study results showed that the education level of parents and the occupational status of mothers were signifi cantly associated with delayed communication skills in children (P < 0. 05). Delay in communication skills was signifi cantly more prevalent among children whose parents had a low education level (P < 0. 05). After controlling other confounders, the relative risk of delay in communication skills was 3. 7 times higher among children in the moderate level of SES and almost 10 times higher among the ones in the low level of SES. Conclusions: Children brought up in families with low SES had the highest level of delay in communication skills, followed by the ones in families with moderate SES. Considering the importance of communication skills in children socialization, more attention should be paid to SES of the families with preschool kids. It seems quite reasonable if health policymakers put more emphasis on the communication skills of preschool children.

Background: Alpha-1 antitrypsin (AAT) defi ciency is a common genetic cause of childhood liver disorders. Its prevalence is highly variable around the world. Although this genetic defi ciency is the main cause of neonatal jaundice, few studies have investigated AAT in Iran. Objectives: The current study aimed to investigate the association between specifi c alleles of AAT with idiopathic neonatal jaundice disease in patients with idiopathic jaundice. Methods: In this study, 30 neonates with a defi nitive diagnosis of neonatal cholestasis referred to Ghaem, and Dr. Sheikh hospitals in Mashhad (Iran) are included. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was performed on the extracted DNA from their blood samples. In the lack of commonly mutated alleles detected, the whole gene exons were DNA sequenced. Results: In the molecular test, we found no case of PiS or PiZ allele. The mutated alleles of PiS and PiZ were not appeared in patients with neonatal jaundice using the PCR-RFLP method. DNA sequencing was performed in 30 patients. Other rare missense variations were detected in the form of heterozygous (for Glu400Asp in 8 patients and Val237Ala in 2 patients), homozygous (for Glu400Asp in 1 patient), and compound heterozygous (for Glu400Asp/Val237Ala in 3 patients and Val237Ala/Asp280Val in 1 patient). Conclusions: The AAT defi ciency caused by PiZ and PiS allelic variants was noted among infants with neonatal cholestasis in the Khorasan province of Iran. Other rare variants in the PiM might be caused by AAT defi ciency and presenting the neonatal cholestasis. The possible functional study should be considered for the mutations identifi ed.

Background: Acetaminophen (APAP) hepatotoxicity is a highly prevalent drug used for the treatment of pain. Allium hooshidaryae is widely used as herbal medicine in western Iran. Objectives: In this study, we investigated the protective eff ects of A. hooshidaryae methanolic extract (AhME) on liver damage induced by APAP. Methods: Rats were divided into six groups. Groups 1 (negative control) and 2 (positive control) received normal saline; groups 3 received 200 mg/kg of AhME, and groups 4-6 received AhME at the doses of 50, 100, and 200 mg/kg once daily, by gavage, respectively. After the 14 days, except for groups 1 and 3, the other groups received 2 g/kg of APAP. After 48 hours, hepatic tissue and blood sample were taken for histopathology and biochemical experiments. Results: APAP induced a notable increase in serum levels of aspartate transaminase (AST, P < 0. 001), alanine transaminase (ALT, P < 0. 001), alkaline phosphatase (ALP, P < 0. 001), lactate dehydrogenase (LDH, P < 0. 01), nitric oxide (NO, P < 0. 001), and lipid peroxidation (LPO, P < 0. 001) levels in hepatic tissue. It also signifi cantly reduced the level of total antioxidant capacity (TAC), total thiol groups (TTGs) as well as glutathione contents (GSH) in hepatic tissue (For all P < 0. 001). Following the use of AhME, a noteworthy improvement was observed in hepatic serum enzymes and oxidant/antioxidant parameters in liver tissue. Conclusions: This study demonstrated that AhME prevents APAP-induced hepatotoxicity through improvement in the hepatic antioxidant status.

Background: The evolution of fertility treatment methods such as laparoscopic surgery and assisted reproductive technology (ART) leads to an increased chance for conception in women with endometriosis. However, it is still not clear which treatment is more likely to result in endometriosis recurrence. Objectives: The current study aimed at assessing the recurrence rate of endometriosis and its main determinants following fertility treatment with surgery or ART. Methods: The current historical cohort study was conducted on 51 consecutive women with endometriosis undergoing fertilization procedures, including laparoscopic surgery (n = 42) and ART (n = 9) in Tehran from 2006 to 2016. All patients with complete hospital records were enrolled in the study. The patients in the two groups were followed up for fi ve years for endometriosis recurrence. Results: Within the follow-up time, the rate of endometriosis recurrence in patients of the surgery and ART groups was 28. 6% and 44. 4%, respectively, indicating no signifi cant diff erence between the groups (P = 0. 436). In this regard, the 1-, 2-, and 3-year recurrencefree survival rate in the ART group was 87. 5%, 50. 0%, and 50. 0%, and in the surgery group was 96. 9%, 90. 6%, and 70. 5%, respectively. Using the Cox proportional hazard modeling adjusted for baseline variables, the method of fertilization (ART or surgery) could not aff ect the rate of long-term recurrence of endometriosis (odds ratio = 1. 428, 95% confi dence interval: 0. 177-9. 900, P = 0. 784). Conclusions: The method of fertilization treatment-e g, surgery, and ART-may not aff ect the rate of endometriosis recurrence in women with subfertility caused by endometriosis.

Context: Constipation is a prevalent symptom of gastrointestinal disorders, which has an annoying impact on health and quality of life. On the other hand, refl exology is a popular type of complementary and alternative medicine in medical practices. Objectives: The present study aimed to assess the eff ect of foot refl exology on constipation symptoms. Methods: Nine databases were systematically searched to detect relevant Randomized Clinical Trials. The current used the Cochrane Risk of Bias tool to evaluate the methodological quality of the included articles. The primary outcome was the improvement of constipation symptoms. The Standardized Mean Diff erence (SMD) was measured, and random eff ects were reported instead of the fi xed eff ects due to the high heterogeneity. Results: Out of the 693 articles retrieved from the databases and eight additional records identifi ed through other sources, 496 titles, 48 abstracts, and 16 full-texts were reviewed, and 11 articles were included in this study, out of which nine articles entered the meta-analysis. The fi ndings of the meta-analysis indicated that foot refl exology had a signifi cant eff ect on the constipation score (SMD:-0. 82; 95% CI:-1. 47 to-0. 17; P value = 0. 0001; I = 93%) Conclusions: Foot refl exology can eff ectively improve constipation symptoms; however, clinical trials with better designs are recommended.

Introduction: The Wiedemann-Rautenstrauch syndrome (WRS) is a rare progeroid syndrome with an autosomal recessive pattern of inheritance. The main clinical features include severe intrauterine and postnatal growth failure, distinctive facial appearance, hydrocephaly, prominent scalp veins, absence of subcutaneous fat, sparse hair of the scalp, eyebrows, and eyelashes, generalized lipoatrophy, psychomotor delay, progressive neurological deterioration, and short life expectancy. Natal teeth and micrognathia are reported as the oral manifestations of this syndrome. Case Presentation: Here is the report of a 6. 5-year-old female patient with clinical signs of WRS referred to the Department of Periodontology of Shiraz School of Dentistry with the chief complaint of toothache and gingival hyperplasia. Carious teeth were extracted, and excess gingival tissue was removed through a surgical procedure under general anesthesia. The patient was the fi rst case with a concomitant severe anterior open bite. Conclusions: Therapies for WRS are symptomatic, requiring the coordinated eff orts of a team of specialists. Dentists and oral surgeons can be recruited by pediatricians and family physicians to improve the quality of life of such patients.

Background: Thyroid is a gland that controls body key functions. Since thyroid hormones are responsible for controlling metabolism, the thyroid glands are one of the major organs in the body. Disruption of the glands causes thyroid disease, which is one of the most common endocrine diseases worldwide. Early diagnosis of thyroid disease is diffi cult since early symptoms are easily confused with those of other illnesses. In recent years, the employment of computer techniques to utilize data mining and intelligent algorithms accelerates the early diagnosis of the disease. Objectives: The current study aimed at evaluating the role of the new automatic method according to a multilayer perceptron (MLP) in the diagnosis of thyroid disease. Methods: The study aimed at comparing the particle swarm optimization (PSO) with the genetic algorithms (GA) as training for MLP technique used to diagnose thyroid functional disease. The data were collected for three classes: 150 cases of euthyroidism, 30 cases of hypothyroidism, and 35 cases of hyperthyroidism. MLP was used to elucidate the pattern in the data and species responsible for separating the classes. Furthermore, improved PSO and GAs were used to train the system, and the sensitivity and specifi city of the model were studied in terms of accuracy, sensitivity, and specifi city. All analyses were performed using MATLAB software. Results: For the proposed model, the simulations results showed that the GA algorithm had a higher performance than the PSO algorithm in the diagnosis of functional thyroid disease, and the means of classifi cation accuracy, sensitivity, and specifi city were 95%, 96%, and 96%, respectively. Conclusions: The results of real data indicated that the GA-MLP can be used with high diagnostic accuracy as an eff ective tool to clinically diagnose thyroid functional disease. The current study was a step towards prototype system development of the classifi cation of knowledge in this area with a much lower computational cost.