Detection of Legionella pneumophila in the bronchoalveolar lavage samples by real time PCR in patients with ventilator-associated pneumonia in ICU

زمینه و هدف: لژیونلا پنوموفیلا به خاطر توانایی آن در ایجاد پنومونی ناشی از ونتیلاسیون مکانیکی مورد توجه مراکز درمانی است. هدف از این مطالعه ردیابی گونه های لژیونلا پنوموفیلا در نمونه های بدست آمده از برونکوآلوئولار لاواژ با روشReal Time PCR در بیماران بستری در بخش مراقبت های ویژه ی بیمارستان الزهرا(س) اصفهان می باشد. روش بررسی: در یک مطالعه توصیفی تحلیلی سی و نه نمونه برونکوآلوئولار لاواژ در بیماران مبتلا به پنومونی همراه با ونتیلاتور بستری در بخش مراقبت های ویژه (ICU) بیمارستان الزهرای اصفهان در سال 1390 گرفته و تا زمان آزمایش در 20- درجه سانتیگراد نگهداری شد. DNA به روش فنل کلروفرم استخراج و آزمایش Real Time PCR در 45 چرخه شامل oC95 برای 4 ثانیه و oC58 برای 30 ثانیه انجام شد. در حالی که پروب به روش Taq Man عمل می کرد. یافته ها: نتیجه برای حضور باکتری لژیونلا پنوموفیلا در همه نمونه ها منفی شد. حداقل سن افراد در مطالعه 20 و حداکثر 86 سال بوده است. مدت زمان بستری افراد مورد مطالعه در ICU حداقل 2 روز و حداکثر 65 روز است. مدت زمان ونتیلاسیون افراد مورد مطالعه حداقل 2 روز و حداکثر 65 روز بود. نتیجه گیری: این مطالعه عدم حضور لژیونلا پنوموفیلا در بیماران دچار پنومونی وابسته به ونتیلاتور در ICU بیمارستان الزهرای اصفهان رادریک مقطع زمانی نشان می دهد؛ لذا بر اساس مطالعه فوق، شناخت الگوی میکروبیولوژیک لژیونلا پنوموفیلا در سایر مراکز درمانی نیز امری منطقی به نظر می رسد

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Study of different Concentrations HgCl2 effects on ovary tissue in the Caspian roach ( Rutilus rutilus ) in vitro conditions

A series of specific toxicological effects including bioaccumulation of the pollutant, histological changes and influences on ovary tissue were examined in the Rutilus rutilus after the exposure to graded sublethal concentrations (10 , 30 , 50 μg Hg/L) of mercury chloride (MC). Histopathological changes, such as telangiectasis, and degenerative, can clearly be observed in the slices from the ovary exposed Roach. A batch of Roach with the mean values of 5 cm in length and 5.5 g in mass were pre-raised in a static system, which was supplied with dechlorinated tap water and constantly aerated. The water qualities were controlled as follows: pH, 7.45; oxygen concentration, 7 mg/L; the water temperature, 21–22 ◦C. All fish were fed twice a day with a commercial ration of biomar. Reagents Appropriate amount of mercury chloride (MC, AR 98%, Merck-Schuchardt) was dissolved in a stock solution of 0.676g HgCl2/L. Based on the 24 h LC50 value (70 ppb) obtained from the acute exposure test, a graded series (10 , 30 , 50 μg Hg/L) of mercury chloride (MC) were administered to Roach fish (Rutilus rutilus) with 48 fish per group. The chemical exposure experiments lasted for 48 , 96 and 144 hours. These designed exposure levels were sublethal, and could induce obvious alteration of tissues abnormalities and disease at the same time

Serum ferritin has correlation with HbA1c in type 2 diabetic patients.

BACKGROUND Serum C-reactive protein (CRP) and ferritin are two acute phase reactants. CRP may be related to metabolic syndrome and ferritin which in turn could cause resistance to insulin and dysfunction of b cells of pancreases. The aim of the study was the evaluation of the relationship of these two acute phase reactants with some indices of diabetic control. MATERIALS AND METHODS In a quasi-experimental study, 67 patients with type 2 diabetes, serum CRP, ferritin, Fasting Blood Sugar (FBS), post prandial BS, Hemoglobin A1c (HbA1c), triglyceride, Low Density Lipoprotein Cholesterol (LDL) and High Density Lipoprotein cholesterol (HDL) were checked before and 3 months after the control of hyperglycemia and hyperlipidemia. RESULTS The mean age of the patients was 56.5 ± 9.7 (30 to 82) years. There was no significant difference between CRP before and after study; however, serum ferritin significantly decreased after study with control of hyperglycemia. FBS, 2 hours post-prandial blood sugar (2hppBS), HbA1c and triglyceride of patients decreased significantly after control of hyperglycemia and hyperlipidemia (P 0.05). CONCLUSION Based on our results, serum ferritin decreased after decline of patients' blood sugar, so might be we used it as one of the diabetes control indices for diabetic patients

Effect of the Nurse-directed Weaning Readiness Assessment on the Duration of Mechanical Ventilation: A Randomized Clinical Trial

Background and Objectives: Aassessment of patient readiness for weaning from mechanical ventilation is an important of phase in the weaning process. The aim of this study was to determine the effect of the nurse-directed patient readiness assessment for weaning on duration of mechanical ventilation in the intensive care unit. Methods: In this clinical trial study, 50 intensive care units patients who needed mechanical ventilation for more than 48 hours were selected using convenient sampling method, and randomly divided into two 25-person groups. Burn’s weaning readiness assessment questionnaire were used for intervention group, and the control group were weaned from the system according to routine method of the unit. The findings were analyzed with the aid of descriptive statistical methods, independent t-tests, chi-square and Pearson’s correlation. Significance level was considered to be 0.05.Results: The mean duration of mechanical ventilation in the intervention group was significantly lower than that of the control group (p<0.03). Also, there was a significant inverse relationship between Burn’s checklist scores and the duration of mechanical ventilation (p<0.04, r=-0.263). Conclusion: The results of this study showed that assessment of the patient’s readiness for weaning from mechanical ventilation by nurse is a safe method in day time and shortens the duration of mechanical ventilation in intensive care units compared to the routine method

The role of socio-demographic factors associated with water pipe smoking among male adolescents, in western Iran: A cross-sectional study

Aim and objective Water pipe (WP) smoking is a significant leisure activity among young people in Iran that is on the rise. The purpose of this study was to identify the role of socio-demographic factors associated with WP smoking among male adolescents in Iran. Methods The study used a cross-sectional design. It included 730 high school male students (grades 10-12)recruited through multi-stage random sampling conducted in 2017 in the Hamadan city of western Iran. The self-administered questionnaires included information on demographic variables and behavioral risk factors related to WP smoking. Statistical analyses were executed using SPSS version 22 summarizing descriptive statistics and conducting inferential statistics through multi nominal logistic regression modeling. Results The mean (SD) ages of the students and at WP smoking initiation were 16.41(0.84) and 13.31 (2.43), respectively. The distribution of never, ever and current WP smoking were 37.3 %, 35.3% and 27.4%, respectively. We found that ever cigarette smoking (OR=5.34; 95% CI [2.66, 10.73]) and WP smoking family (OR=2.41; 95% CI [1.32, 4.40]) were significantly associated with ever WP smoking. WP smoking friends (OR= 0.50; 95% CI [0.35, 0.72]) had protective role on ever WP smoking. Also, the variables18 years of age, studying in technical fields, ever and current smoking of cigarettes and family usage of WP smoking were significantly associated with the current usage of WP smoking. Conclusion The results indicated that the prevalence of ever and current WP smoking were high in Hamadan city. Thus, designing and implementing interventions for increasing students’, friends' and family's awareness regarding the harms of WP smoking and cigarette smoking facilitating behavior change in this direction is necessary. Funding This study was supported by Hamadan University of Medical Sciences, Hamadan, Iran

Silica chemically bonded N-propyl kriptofix 21 and 22 with immobilized palladium nanoparticles for solid phase extraction and preconcentration of some metal ions

Silica gel chemically bonded N-propyl kriptofix 21 (SBNPK 21) and N-propyl kriptofix 22 (SBNPK 22) and subsequently immobilized with palladium nanoparticles (PNP-SBNPK 21 and PNP-SBNPK 22) to produce two new complexing lipophilic materials. Then these novel sorbents were applied for the enrichment of some metal ions and their subsequent determination by flame atomic absorption spectroscopy (FAAS). The influences of the variables including pH, amount of solid phase, sample flow rate, eluent conditions and sample volume on the metal ion recoveries were investigated. The detection limit of proposed method was in the interval 2.1-2.3 and 1.7-2.8 ng mL(-1) for PNP-SBNPK 21 and PNP-SBNPK 22 respectively, while the preconcentration factor was 80 for two sorbents. The relative standard deviations of recoveries were between 1.23-1.31 and 1.28-1.49 for PNP-SBNPK 21 and PNP-SBNPK 22 respectively. The method has high sorption-preconcentration efficiency even in the presence of various interfering ions. Due to the reasonable selectivity of proposed method, the relative standard deviation of recoveries of all understudied metal ions in some complicated matrices was less than 3.0%. (c) 2013 Elsevier B.V. All rights reserved