Investigation of Carbapenem-Resistant AcinetobacterBaumannii Resistance Rate in Clinical Specimens of Newborns at Imam Khomeini Hospital in Tehran

Background: Carbapenem-resistant Acinetobacter Baumannii (CRAB) hospital infection poses a serious threat to the health of the newborns in neonatal intensive care units (NICU). The present study was conducted to evaluate the prevalence and resistance of hospital infections in the NICU ward at Imam Khomeini hospital in Tehran.Materials and Methods: The blaOXA-51 like gene was investigated with polymerase chain reaction (PCR). Then, sensitivity of isolates to different antibiotics was assessed using disc diffusion method and broth micro dilutions to determine the minimum inhibitory concentrations (MICs). Pulsed field gel electrophoresis (PFGE) was used for typing of randomly collected CRAB infection at different wards of this hospital. Results: A total of 10 CRAB infections were isolatedduringthe6-month study period, and it was found that 100% of them were positive forblaOXA-51-like gene in PCR assay.  All  isolates were resistant to all tested antibiotics, except colistin, polymyxin B, and tigecycline. CRAB isolates had a high MIC values for imipenem, cefotaxim, and amikacin, showing multidrug resistant (MDR) phenotype. According to PFGE analysis,3palsotypes including clone A (7%), clone B (2%), and clone D (1%) were seen in the 10 CRAB isolates. Clone A was a dominant clone and spread in different wards of the hospital, especially in other ICUs and the emergency ward. Moreover, the similarity between the palsotypes showed the ability of transferring CRAB infection from different wards of the hospital to the NICU.Conclusions: Based on the results of this study, CRAB infection, with a high resistance rate, has the ability to enter into important wards such as NICU, and thus it is highly important to control the presence of these isolates in different parts of the hospital

The association of serum levels of folic acid and homocysteine in pregnant women with Pre-Eclampsia

Introduction: Pre-eclampsia is one of the main cause of death in pregnant mothers and their babies, but its cause is still unknown. Studies have shown that increased maternal homocysteine in the blood is associated with various diseases such as pre-eclampsia. For inhibition from serum homocysteine elevation, high dose folic acid can be prescribed in these cases. This study aimed to assess the association of serum levels of folic acid and homocysteine with pre-eclampsia. Methods: This case-control study was conducted on 125 women with pre-eclampsia and 125 healthy pregnant women referred to Hajar hospital of Shahrekord, Iran during 2011-2012. 5 ml of blood sample was taken and serum levels of folic acid and homocysteine were measured. Data were analyzed using SPSS software version 20 and t-test, chi-square, two-way ANOVA and correlation regresion. P value less than 0.05 was considered significant. Results: Mean levels of homocysteine were elevated in cases with pre-eclampsia compared to control group (p=0.01) (11.27±4.8 vs. 9.9±3.9 μmol/l) and mean level of folic acid were significantly lower in cases with pre-eclampsia (p=0.002) (9.96±4.3 vs. 8.39±3.6 ng/ml). BMI, age, gestational age and neonatal weight have been shown to be different statistically in two groups (p<0.001) and other variables such as education level revealed no significant differences between two groups (p=0.257). Conclusion: Mothers with high serum levels of homocysteine and folic acid and high age and BMI are more at risk of pre-eclampsia. It seems that upper dose of folic acid can prevent or decrease the risk of pre-eclampsia

Effective Factors in Hospitalization Costs of the Public Hospitals: A Qualitative Study

Introduction:Hospitals are the most expensive health care organizations. In this study, identifying factors influencing hospitalization costs based on the three aspects of the health system including patients, health care providers, and insurance organizations were considered. Methods:This was a qualitative and phenomenological study. In this study, 12 experts in the field of management and controlling hospital’s costs were selected through purposive and snowball sampling method. Data were collected using focused group discussion. Framework analysis was used for data analysis. Results:The factors affecting hospitalization costs were classified into three codes including patients, health care providers, and insurance organizations. Lack of knowledge and awareness and neglecting self-care were the main patient-related factors, and weak management and supervision, lack of medical guidelines, long-term recovery period, lack of implementation of family physician and weak commitments and structural problems of insurance organizations were the main factors related to the health care providers and insurance organizations. Conclusion:The results showed that by increasing and improving self- care programs, providing health-oriented services, implementation of family physician program, specializing the hospital management, improving the quantity and quality of supervisions and reforming expert structure of insurance organizations, the hospitalization costs can be managed. Key¬words:Hospitalization Costs, Patients, Health Care Providers, Insurance Organizations, Public Hospital, Qualitative Study. Citation:Jafari M, Lashkari M,Mahmoudi F, Dehnavi R, NooriHekmat S, Izadi A.Effective Factors in Hospitalization Costs of the Public Hospitals: A Qualitative Study. Journal of Health Based Research 2016; 2(1): 39-54

High prevalence of OXA-type carbapenemases among Acinetobacter baumannii strains in a teaching hospital of Tehran

Nosocomial infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has created a public health concern all around the world. In this study, 100 isolates of CRAB from hospitalized patients during 2015–2016 at Imam Khomeini Hospital were investigated to determine the rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains using Kirby–Bauer disk diffusion method. The minimum inhibitory concentrations (MICs) of six antibiotics were determined by broth microdilution method. Multiplex polymerase chain reaction (PCR) was performed to detect blaOXA-51 like and blaOXA-58 like, blaOXA-23 like, and blaOXA-24 like that are encoding resistance to carbapenems. All CRAB isolates were MDR and XDR and 2% of them were pandrug-resistant (PDR), whereas colistin, polymyxin B, and tigecycline were the most effective agents. All isolates were positive for blaOXA-51 like by PCR. The frequency of blaOXA-23 like and blaOXA-24 like was 81% and 22%, respectively. Findings of this study showed that very few therapeutic options remained for the treatment of CRAB infections and blaOXA-23 like is a dominant resistance gene in CRAB at this hospital

The Accreditation of Human Resources and Physical Space of the Iranian Heart Centre: Comparison to the national and international standards

Objective: Standardization of hospital resources and physical space can be an important strategy to increase productivity and effectiveness of services. The study was conducted with the aim of comparative accreditation of human resources and physical space in Mazandaran heart centre compared with the standards. Method: This comparative descriptive study was carried out in Sari city (centre of Mazandaran province) during 2016-2017. The data collection tool consists of two checklists for investigating the physical space and human resources of the hospital. To evaluate the quality of the content, a checklist was distributed to 5 experts from Mazandaran University of Medical Sciences. After corrections the checklist was applied. Data were analyzed by SPSS software version 16 and descriptive statistics. Findings: The total number of nurses in this hospital was 288 and the total number of beds was 171. The human resources in the nursing, nutrition, operating room, anaesthesia departments were not standard. The ratio of total human resource to the number of beds was also estimated as 4.04. Results showed that the physical conditions in the hospital were moderately standard. The physical conditions of the hospital in most dimensions based on checklist, except the physical location of hospital and the features of its doors, were in accordance with the standard requirements. Conclusion: Considering the inappropriate distribution of human resource in the hospital and the non-standard design of physical space for providing services with better quality and increasing patients' satisfaction, it is recommended that experts control more carefully standard requirements

Association of serum immunoglobulin G level with peritonitis in patients undergoing peritoneal dialysis: An analytical study

Introduction: Peritonitis is one of the most common complications of peritoneal dialysis. On the other hand, reduced levels of immunoglobulins (Igs), mainly IgG, can increase the risk of infection in various pathologic conditions. Here, we aimed to determine the association of severity and frequency of peritonitis with serum IgG levels in peritoneal dialysis patients. Methods: 100 patients with chronic renal failure referred to Imam Reza Hospital, Tabriz, Iran, for peritoneal dialysis were included in the study. Serum IgG levels were measured in all of these patients at the beginning of the study and after six months of follow-up. In case of peritonitis, serum IgG levels were also measured, and samples were sent to Imam Reza Hospital laboratory for analysis. Results: 40 cases (40%) were women, and 60 cases (60%) were men with a mean age of 47 years. 24 cases (24.0%) had at least one episode of peritonitis during the study. Among those with peritonitis, 14 cases (60.9%) had at least one more peritonitis episode in the 6-month follow up. The mean serum IgG levels were 1079 mg/dl and 429 mg/dl at the beginning and after six months of follow up, respectively. The difference was shown to be statistically significant (P = 0.006). There was no correlation between serum IgG level reduction and peritonitis in these patients (P > 0.999). Conclusion: This study found reduced levels of serum IgG in patients undergoing peritoneal dialysis. However, it was not associated with increased risk of peritonitis in these patients

The effect of repeated preheating of dimethacrylate and silorane-based composite resins on marginal gap of class V restorations

Background. One of the problems with composite resin restorations is gap formation at resin‒tooth interface. The present study evaluated the effect of preheating cycles of silorane- and dimethacrylate-based composite resins on gap formation at the gingival margins of Class V restorations. Methods. In this in vitro study, standard Class V cavities were prepared on the buccal surfaces of 48 bovine incisors. For restorative procedure, the samples were randomly divided into 2 groups based on the type of composite resin (group 1: di-methacrylate composite [Filtek Z250]; group 2: silorane composite [Filtek P90]) and each group was randomly divided into 2 subgroups based on the composite temperature (A: room temperature; B: after 40 preheating cycles up to 55°C). Marginal gaps were measured using a stereomicroscope at ×40 and analyzed with two-way ANOVA. Inter- and intra-group comparisons were analyzed with post-hoc Tukey tests. Significance level was defined at P < 0.05. Results. The maximum and minimum gaps were detected in groups 1-A and 2-B, respectively. The effects of composite resin type, preheating and interactive effect of these variables on gap formation were significant (P<0.001). Post-hoc Tukey tests showed greater gap in dimethacrylate compared to silorane composite resins (P< 0.001). In each group, gap values were greater in composite resins at room temperature compared to composite resins after 40 preheating cycles (P<0.001). Conclusion. Gap formation at the gingival margins of Class V cavities decreased due to preheating of both composite re-sins. Preheating of silorane-based composites can result in the best marginal adaptation

One-pot, four-component synthesis of novel cytotoxic agents 1-(5-aryl-1,3,4-oxadiazol-2-yl)-1-(1H-pyrrol-2-yl)methanamines

A series of N-benzyl-1-(5-aryl-1,3,4-oxadiazol-2-yl)-1-(1H-pyrrol-2-yl)methanamines were synthesized via one-pot reaction of appropriate benzylamine, pyrrole-2-carbaldehyde, (N-isocyanimino)triphenylphosphorane, and a carboxylic acid. The anti-tumor potential of title compounds was tested against several cancer cell lines by using MTT assay. Some tested compounds including 5e, 5p and 5q exhibited comparable or better cytotoxic activity against A549, HT29 or HT1080 cells in comparison to the reference drug doxorubicin. Also, the cytotoxic activity of compounds 5d and 5n against MCF-7 was better than that of doxorubicin. Compound 5n with IC50 value of 4.3 mM was 4-fold more potent than doxorubicin. The structureeactivity relationship study revealed that the introduction of halogen atoms on both 5-phenyl ring and N-benzyl part improved the cytotoxic activity against all tested cell lines

Green Synthesis of Silver Nanoparticles Using Avena sativa L. Extract

Objective(s): Nowadays, nanoparticles bio production, considering their performance in medicine and biological science, is increasing. Green synthesis of metal nanoparticles using organisms has emerged as a nontoxic and ecofriendly method for synthesis of metal nanoparticles The objectives of this study were the production of silver nanoparticles using Avena sativa L. extract and optimization of the biosynthesis process. The effects of quantity of substrate (silver nitrate (AgNo3)) and temperature on the formation of silver nanoparticles are studied. Methods: In this work, silver nanoparticles were synthesized from an extract of Avena sativa L. at different temperatures (30° C, 60° C, 90° C )  and AgNo3 concentrations( 1 mM, 2mM, 4mM) . The morphology and size of the nanoparticles were determined using Scanning Electron Microscope (SEM) and Dynamic Light Scattering (DLS). Results: SEM images showed that by increasing temperature nanoparticles size were decreased and by increasing concentrations of AgNo3 the number of nanoparticles was increased. Conclusions: The results indicated that by increasing the reaction temperature, the size of the nanoparticles would decrease. Also by increasing the concentrations of AgNo3, the amount of produced nanoparticles would be increased, but won't have a significant effect on its size. The preparation of nano- structured silver particles using Avena sativa L. extract provides an environmentally friendly option as compared to currently available chemical/ physical methods

Analytical evaluation of hydrodynamic pressure distribution produced by dam-reservoir interaction

Because of the dam's importance, it is critical to pay close attention to its seismic stability while building a dam, especially in seismically active locations, because a dam's failure could inflict catastrophic damage downstream. In order to generate a dynamic interaction between the dam and the water reservoir, the influence of the reservoir's presence and the boundary conditions associated to it must be considered for the dam's dynamic analysis. The hydrodynamic pressure created by the interaction between the dam and the reservoir is one of the effective aspects in optimal dam design for seismic zones. Predicting the behavior of concrete dams during an earthquake is one of the most difficult structural dynamics problems. Furthermore, the strong forces generated endanger the dam. The dynamic behavior and solution of the dynamic equations governing dam motion and hydrodynamic pressure are coupled and not independent of the fluid environment. The percentage of calculation errors is reduced when pressure equations are solved using accurate and analytical methods. Navirastokes equations, continuity, and the relationship between velocity and velocity potential function are used to derive the Helmholtz equation. Among the important assumptions considered in this article are the solidity of the tank bottom regardless of surface waves and the fluid's non-viscous nature. Helmholtz's equation becomes Laplace's equation when the fluid is assumed to be incompressible and Euler's method is used. Meanwhile, if the aforementioned properties are not properly checked and applied in accordance with the conditions of the desired model, the nature of the problem will change and numerous errors will be generated. The obtained results are the required length for complete depreciation of the pressure wave propagation and the appropriate location for the range cutoff, which were simulated using MATLAB software and the results were extracted.</p