Comparison the effect of Sleep Positioning on Cardiorespiratory Rate in Noninvasive Ventilated Premature Infants

Background: Results of several studies suggest that prone position is beneficial in improving the preterm infants’ cardio-respiratory status. Previous studies showed opposite results, and also there is not any available clear study about the effect of this position on cardio-respiratory rates of Nasal Continuous Positive Airway Pressure (N-CPAP) treating premature infants. Objectives: This study aimed at comparing supine and prone positions on cardio-respiratory rates of premature infants with respiratory distress syndrome (RDS) who were treated using N-CPAP. Patients and Methods: This was a cross over study which was performed in 2010 on 44 hospitalized 29-34 weeks gestation premature infants who were receiving N-CPAP in Neonatal Intensive Care Unit of Al-Zahra Hospital of Tabriz University of Medical Sciences. Infants were randomly assigned into two groups, and the first group was placed in prone at first and then in supine, and the position of second group was at first supine and then prone. Infants’ Heart Rate (HR) and Respiratory Rate (RR) were assessed three times in each position for 30 minutes. The data was recorded in a data-collection form, and demographic data was analyzed using t test, Chi square and Fisher exact test. Also, repeated measurement ANOVA and Tukey post-hoc tests were used. Results: There was a significant difference in HR and RR of premature infants who were similar in gestational age and clinical condition and placed in two positions. Premature infants’ HR and RR became lower at prone position than supine in both groups. So it can be concluded that prone position could decrease infants HR and RR, but supine position might increase them (P < 0.05). Conclusion: Our findings support prone positioning for premature infants. Therefore, it is advisable to NICU staff that if there is no obstacle for changing the infant’s position, prone position in infants with respiratory complications during receiving N-CPAP in NICU can be useful. Regarding the fact that prone position is a risk factor for sudden infant death syndrome , prone position should be only used when the newborn is being supervised carefully

Resistance to QoI Fungicide and Cytochrome b Diversity in the Hungarian Botrytis cinerea Population

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Prevalence of high-level gentamicin-resistant Enterococcus faecalis and Enterococcus faecium in an Iranian hospital

This study was designed to determine the molecular characteristics and antimicrobial resistance of enterococcal strains isolated from patients admitted to an Iranian Hospital. Enterococcal strains were isolated from the burn patients. All strains were screened for genes encoding resistance to aminoglycoside aac(6')-Ie-aph(2'')-Ia, aph (3'), ant (4'), resistance to vancomycin (vanA, vanB), resistance to tetracycline (tetK, tetL, tetM, tetO), and resistance to erythromycin (ermA, ermB, ermC) by PCR and multiplex PCR-based methods. Genetic diversity was evaluated via Random Amplified Polymorphic DNA (RAPD)-PCR. All enterococcal isolates showed complete sensitivity to vancomycin with MIC � 0.5μg/ml. Resistance to gentamicin, tetracycline, erythromycin, ciprofloxacin or quinopristin-dalfopristin was detected, whilst more than 96.2% of isolates were high-level gentamicinresistant (HLGR) and multiple drug resistant. The most prevalent aminoglycoside resistance gene was aac(6')-Ie-aph(2'')-Ia, that was found in 96.2% (26/27) of the isolates. The most prevalent tetracycline resistance genes were tetM, found in 85.1% (23/27) followed by tetL and tetO found in 7.4% (2/27) of the isolates. The ermA and ermB genes were detected in 33.3% (9/27) and 44.4% (12/27) of the isolates respectively. RAPD-PCR analysis yielded 17 distinct profiles among 27 investigated isolates. One cluster of isolates shared the same RAPD pattern, while 16 isolates had unique RAPD pattern. Our study showed that during the examination time period one RAPD genotype was the common type and was disseminated among patients in the burn unit. Interestingly, most of these strains had an identical or very similar antibiotic and gene resistance pattern

Application of lidocaine spray for tracheal intubation in neonates - A clinical trial study

Background: Tracheal intubation is extremely distressing, painful, and may influence heart rate and blood pressure. Sedatives, analgesics, and muscle relaxants are not commonly used for intubation in neonates. Objectives: This study aimed to evaluate the effects of lidocaine spray as a non-intravenous drug before neonatal intubation on blood pressure, heart rate, oxygen saturation and time of intubation. Patients and Methods: In a randomized, controlled study each neonate was randomly assigned to one of the two study groups by staffs who were not involved in the infant's care. The allocation concealment was kept in an opaque sealed envelope, and the investigators, the patient care team, and the assessors were blinded to the treatment allocation. The selected setting was NICU unit of a teaching hospital in Ilam city, Iran and participants were 60 neonates with indication of tracheal intubation with gestational age >30 weeks. Patients in the treatment group received lidocaine spray and the placebo group received spray of normal saline prior to intubation. Main outcome measurements were the mean rates of blood pressure, heart rate, oxygen saturation, intubation time and lidocaine side effects were measured before and after intubation. Results: Totally 60 newborns including 31 boys and 29 girls were entered into the study (drug group n = 30; placebo group n = 30). Boy/girl ratio in treatment and placebo groups were 1.3 and 0.88, respectively. Mean age ± SD of participants was 34.1 ± 24.8 hours (treatment: 35.3 ± 25.7; placebo: 32.9 ± 24.3; P < 0.0001). Mean weight ± SD of neonates was 2012.5 ± 969 g. Application of lidocaine spray caused a significant reduction of mean intubation time among treatment group compared with placebo group (treatment: 15.03 ± 2.2 seconds; placebo: 18.3 ± 2.3 seconds; P < 0.0001). Mean blood pressure, heart rate and oxygen saturation rate, among neonates in treatment group was reduced after intubation compared with their relevant figures before intubation; however, their differences were not statistically significant except for mean oxygen saturation rate that was reduced significantly in placebo group. No side effects were observed during study. Conclusions: Though the current study revealed some promising results in the application of lidocaine spray during neonatal intubation without any considerable side effects; however, the current investigation could only be considered as a pilot study for further attempts in different locations with higher sample sizes and in different situations. © 2015, Growth & Development Research Center

Numerical Investigation of Optimization of Injection Angle Effects on Fluidic Thrust Vectoring

A computational investigation was conducted to optimize the fluidic injection angle effects on thrust vectoring. Numerical simulation of fluidic injection for shock vector control, with a convergent-divergent nozzle concept was performed, using URANS approach with Spalart-Allmaras turbulence model. The fluidic injection angles from 60º to 120º were investigated at different aerodynamic and geometric conditions. The current investigation demonstrated that secondary injection angle is an essential parameter in fluidic thrust vectoring. Computational results indicated that, optimizing secondary injection angle would have positive impact on thrust vectoring performance. Furthermore, in most cases, decreasing expansion ratio of the nozzle with increasing NPR has negative impact on pitch thrust vector angle and thrust vectoring efficiency. That is, the highest pitch thrust vector angle is obtained by decreasing nozzle expansion ratio with increasing SPR in smaller fluidic injection angles. In addition, the current investigation attempted to initiate a database of optimized injection angles with different essential parameter effects on thrust vectoring, in order to guide the design and development of an efficient propulsion system

Phenotypic and genotypic characteristics of tetracycline resistant Acinetobacter baumannii isolates from nosocomial infections at Tehran hospitals

Objective(s): To date, the most important genes responsible for tetracycline resistance among Acinetobacter baumannii isolates have been identified as tet A and tet B. This study was carried out to determine the rate of resistance to tetracycline and related antibiotics, and mechanisms of resistance. Materials and Methods: During the years 2010 and 2011, a total of 100 A. baumannii isolates were recovered from patients in different hospitals of Tehran, Iran. Antimicrobial susceptibility to tetracycline, minocycline, doxicycline and tigecycline was evaluated by E-test. Polymerase chain reaction (PCR) of the tet A and tet B genes was performed using specific primers, after which the isolates were subjected to Repetitive Extragenic Palindromic-PCR (PCR) to identify the major genotypes. Results: Of all isolates, 89 were resistant to tetracycline (MIC50 = 32 mu g/ml, MIC90 = 512 mu g/ml). Minocycline with the resistant rate of 35 (MIC50 = 16 mu g/ml, MIC90 = 32 mu g/ml) and doxicycline with the resistant rate of 25 (MIC50 = 16 mu g/ml, MIC90= 32 mu g/ml) have a good activity against A. baumannii isolates. All isolates were sensitive to tigecycline. Frequencies of tet B and tet A genes and coexistence of tet A and tet B among the isolates resistant to tetracycline, were 87.6, 2.2 and 1.1, respectively. Distribution of REP-types among A. baumannii isolates was types A (40), B (30), C (10), D (5) and E (5). Conclusion: It seems that tet A and tet B genes play an important role in the induction of resistance towards tetracyclines used in this study. It is suggested that further studies focus on other antimicrobial drugs and combinations in order to achieve a successful therapy against multi drug resistance (MDR) A. baumannii strains in Iran

Optimization of Freestream Flow Effects on Thrust Shock Vector Control Nozzle

The present study attempted to utilize a computational investigation to optimize the external freestream flow influence on thrust-vector control. The external flow with different Mach numbers from 0.05 to 1.1 and with optimum injection angles from 60˚ to 120˚ were studied at variable flow conditions. Simulation of a converging-diverging nozzle with shock-vector control method was performed, using the unsteady Reynolds- averaged Navier-Stokes approach with Spalart-Allmaras turbulence model. This research established that freestream flow and fluidic-injection angle are the significant parameters on shock-vector control performance. Computational results indicate that, increasing freestream Mach number would decline the thrust vectoring effectiveness. Also, optimizing injection angle would reduce the negative effect of external freestream flow on thrust-vector control. Moreover, increasing secondary to primary total pressure ratios and decreasing nozzle pressure ratios at different freestream Mach number would decrease dynamic response of starting thrust-vector control. Additionally, to lead the improvement of the next generation of jet engine concepts, the current study aimed to originate a database of variable external flow with effective aerodynamic parameters, which have influence on fluidic thrust-vector control

Phenotypic and genotypic evaluation of fluoroquinolone resistance in clinical isolates of Staphylococcus aureus in Tehran

Background: Fluoroquinolones are broad-spectrum antibiotics widely used in the treatment of bacterial infections such as Staphylococcus aureus isolates. Resistance to these antibiotics is increasing. Material/Methods: The occurrence of mutations in the grlA and gyrA loci were evaluated in 69 fluoroquinolone-resistant S. aureus isolates from 2 teaching hospitals of Tehran University of Medical Sciences. Results: Out of the 165 S. aureus isolates, 87 (52.7) were resistant to methicillin and 69 (41.8) were resistant to fluoroquinolone. Fluoroquinolone-resistant S. atoms isolates had a mutation at codon 80 in the grlA gene and different mutational combinations in the gyrA gene. These mutational combinations included 45 isolates at codons 84 and 86,23 isolates at codons 84,86 and 106 and 1 isolate at codons 84, 86 and 90. Fluoroquinolone-resistant S. aureus isolates were clustered into 33 PFGE types. Conclusions: The findings of this study show that the fluoroquinolone-resistant S. aureus strains isolated in the teaching hospitals in Tehran had multiple mutations in the QRDRs region of both grlA and gyrA genes

Hyponatremia and hospital outcomes among patients with pneumonia: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Community-acquired (CAP) and nosocomial pneumonias contribute substantially to morbidity and hospital resource utilization. Hyponatremia, occurring in >1/4 of patients with CAP, is associated with greater disease severity and worsened outcomes.</p> <p>Methods</p> <p>To explore how hyponatremia is associated with outcomes in hospitalized patients with pneumonia, we analyzed a large administrative database with laboratory component from January 2004 to December 2005. Hyponatremia was defined as at least two [Na⁺] < 135 mEq/L within 24 hours of admission value.</p> <p>Results</p> <p>Of 7,965 patients with pneumonia, 649 (8.1%) with hyponatremia were older (72.4 ± 15.7 vs. 68.0 ± 22.0, p < 0.01), had a higher mean Deyo-Charlson Comorbidity Index Score (1.7 ± 1.7 vs. 1.6 ± 1.6, p = 0.02), and higher rates of ICU (10.0% vs. 6.3%, p < 0.001) and MV (3.9% vs. 2.3%, p = 0.01) in the first 48 hours of hospitalization than patients with normal sodium. Hyponatremia was associated with an increased ICU (6.3 ± 5.6 vs. 5.3 ± 5.1 days, p = 0.07) and hospital lengths of stay (LOS, 7.6 ± 5.3 vs. 7.0 ± 5.2 days, p < 0.001) and a trend toward increased hospital mortality (5.4% vs. 4.0%, p = 0.1). After adjusting for confounders, hyponatremia was associated with an increased risk of ICU (OR 1.58, 95% CI 1.20–2.08), MV (OR 1.75 95% CI 1.13–2.69), and hospital death (OR 1.3, 95% CI 0.90–1.87) and with increases of 0.8 day to ICU and 0.3 day to hospital LOS, and over $1,300 to total hospital costs.</p> <p>Conclusion</p> <p>Hyponatremia is common among hospitalized patients with pneumonia and is associated with worsened clinical and economic outcomes. Studies in this large population are needed to explore whether prompt correction of [Na⁺] may impact these outcomes.</p