Which items of the modified Barthel Index can predict functional independence at discharge from inpatient rehabilitation? a secondary analysis retrospective cohort study

The modified Barthel Index (mBI) is a well-established patient-centered outcome measure commonly administrated in rehabilitation settings to evaluate the functional status of patients at admission and discharge. This study aimed to detect which mBI items collected on admission can predict the total mBI at discharge from first inpatient rehabilitation in large cohorts of orthopedic (n = 1864) and neurological (n = 1684) patients. Demographic and clinical data (time since the acute event 11.8 ± 17.2 days) at patients' admission and mBI at discharge were collected. Univariate and multiple binary logistic regressions were performed to study the associations between independent and dependent variables for each cohort separately. In neurological patients, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with feeding, personal hygiene, bladder, and transfers were independently associated with higher total mBI at discharge (R2 = 0.636). In orthopedic patients, age, the shorter time between the acute event and rehabilitation admission, shorter length of stay, and being independent with personal hygiene, dressing, and bladder were independently associated with higher total mBI at discharge (R2 = 0.622). Our results showed that different activities in neurological (i.e. feeding, personal hygiene, bladder, and transfer) and orthopedic sample (i.e. personal hygiene, dressing, and bladder) are positively associated with better function (measured by mBI) at the discharge. Clinicians have to take into account these predictors of functionality when they plan an appropriate rehabilitation treatment

Integron-Mediated Antibiotic Resistance in Acinetobacter baumannii Isolated from Intensive Care Unit Patients, Babol, North of Iran

Background. We investigated the integron types and their relation with antibiotic resistance among A. baumannii isolates collected from intensive care unit patients, Babol, north of Iran. Methods. In this cross-sectional study, a total of 73 bronchoalveolar lavage samples were obtained from patients in ICU. Susceptibility testing was performed by disk diffusion method. Types of integrons were identified by an integrase gene PCR. Results. In total, 47.9% A. baumannii isolates were recovered from the BAL samples. All isolates were resistant to ceftazidime. 91.4% and 58.3% of isolates were MDR and XDR, respectively. The rate of colistin resistance with the E-test was 5.7%. Molecular analysis of class I, II, and III integrons showed that 25.7%, 88.6%, and 28.6% of the isolates carried the intI, intII, and intIII genes, respectively. Discussion. Our results show that different classes of integrons are commonly spread among A. baumannii strains and these genomic segments can play an important role in the acquisition of MDR and XDR phenotypes. So monitoring drug resistance in A. baumannii isolates with the use of int gene PCR is very important to plan specific infection control measures to prevent the spread of MDR-AB and XDR-AB in Iran’s hospitals

Metallo�β�lactamase�mediated resistance among clinical carbapenem�resistant Pseudomonas aeruginosa isolates in northern Iran: A potential threat to clinical therapeutics

Objective: Carbapenems are effective agents to treat multidrug�resistant (MDR) strains of bacteria, including Pseudomonas aeruginosa. However, there is a potential threat of emergence of carbapenem�resistant P. aeruginosa (CRPA). The aim of this study was to determine antibiotic susceptibility patterns and metallo�beta�lactamase (MBL)�mediated resistance in clinical P. aeruginosa isolates. Materials and Methods: Different clinical specimens were subjected to conventional culture�based identification of P. aeruginosa. Antimicrobial susceptibility patterns and MBL production were evaluated using the Kirby�Bauer and combined double�disk synergy test methods, respectively. Multiplex polymerase chain reaction was performed to investigate the presence of the blaIMP, blaVIM, blaNDM, blaSPM, and blaSIM genes. Results: A total of 71 clinical P. aeruginosa isolates were recovered, of which 28.17 were identified as CRPA. The most active antibiotics were colistin and polymyxin B (92.96 susceptibility to each). A total of 35 and 50 of CRPA isolates were MDR and extensively drug�resistant (XDR), respectively. MBL activity was shown in 20 of CRPA. A total of 90, 40, and 5 of CRPA isolates harbored the blaIMP, blaVIM, and blaNDM genes, respectively. No correlation was found between the MBL�encoding genes of P. aeruginosa and patient characteristics. Conclusion: Although the prevalence of CRPA in our therapeutic centers was relatively low, this rate of carbapenem resistance reflects a threat limiting treatment choices. A high prevalence of MDR/XDR phenotypes among the MBL�producer isolates suggests the need for continuous assessment of antimicrobial susceptibility and surveillance of antibiotic prescription. In addition, infection control measures are needed to prevent further dissemination of these organisms. © 2018 Tzu Chi Medical Journal | Published by Wolters Kluwer - Medknow

Neurophysiological and Clinical Effects of Upper Limb Robot-Assisted Rehabilitation on Motor Recovery in Patients with Subacute Stroke: A Multicenter Randomized Controlled Trial Study Protocol

Background: The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific and high-intensity exercises are key points in facilitating motor re-learning in neurorehabilitation since RAT can provide an assisted-as-needed approach. This study aims to investigate the clinical effects of an exoskeleton robotic system for UL rehabilitation compared with conventional therapy (CT) in people with subacute stroke. As a secondary aim, we seek to identify patients’ characteristics, which can predict better recovery after UL-RAT and detects whether it could elicit greater brain stimulation. Methods: A total of 84 subacute stroke patients will be recruited from 7 Italian rehabilitation centers over 3 years. The patients will be randomly allocated to either CT (control group, CG) or CT plus UL-RT through an Armeo®Power (Hocoma AG, CH, Volketswil, Switzerland) exoskeleton (experimental group, EG). A sample stratification based on distance since onset, DSO (DSO ≤ 30; DSO > 30), and Fugl–Meyer Assessment (FM)-UL (FM-UL ≤ 22; 22 < FM-UL ≤ 44) will be considered for the randomization. The outcomes will be recorded at baseline (T0), after 25 + 3 sessions of intervention (T1), and at 6 months post-stroke (T2). The motor functioning assessed by the FM-UL (0–66) will be considered the primary outcome. The clinical assessments will be set based on the International Classification of Function, Disability and Health (ICF). A patient satisfaction questionnaire will be evaluated in the EG at T1. A subgroup of patients will be evaluated at T0 and T1 via electroencephalography. Their brain electrical activity will be recorded during rest conditions with their eyes closed and open (5 min each). Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early UL-RAT through a whole arm exoskeleton and how it may relate to the neural plasticity process. The trial was registered at ClinicalTrial.gov with the registration identifier NCT04697368

Barriers to sEMG assessment during overground robot-assisted gait training in subacute stroke patients

Background: The limitation to the use of ElectroMyoGraphy (sEMG) in rehabilitation services is in contrast with its potential diagnostic capacity for rational planning and monitoring of the rehabilitation treatments, especially the overground Robot-Assisted Gait Training (o-RAGT). Objective: To assess the barriers to the implementation of a sEMG-based assessment protocol in a clinical context for evaluating the effects of o-RAGT in subacute stroke patients. Methods: Anobservationalstudywasconductedinarehabilitationhospital.Theprimary outcome was the success rate of the implementation of the sEMG-based assessment. The number of dropouts and the motivations have been registered. A detailed report on difficulties in implementing the sEMG protocol has been edited for each patient. The educational level and the working status of the staff have been registered.Each member of staff completed a brief survey indicating their level of knowledge of sEMG, using a five-point Likert scale. Results: The sEMG protocol was carried out by a multidisciplinary team composed of Physical Therapists (PTs) and Biomedical Engineers (BEs). Indeed, the educational level andtheexpertiseofthemembersofstaffinfluencedthefulfillmentoftheimplementation of the study.ThePTsinvolved in the study did not receive any for maleducationonsEMG during their course of study. The low success rate (22.7%) of the protocol was caused by several factors which could be grouped in: patient-related barriers; cultural barriers; technical barriers; and administrative barriers. Conclusions: Since a series of barriers limited the use of sEMG in the clinical rehabilitative environment, concrete actions are needed for disseminating sEMG in rehabilitation services. The sEMG assessment should be included in health systems regulations and specific education should be part of the rehabilitation professionals’ curriculum. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03395717

Efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in Parkinson's disease: a multicenter randomized controlled trial

BACKGROUND: The implementation of regular prolonged, and effective rehabilitation in people with Parkinson's disease is essential for ensuring a good quality of life. However, the continuity of rehabilitation care may find barriers related to economic, geographic, and social issues. In these scenarios, telerehabilitation could be a possible solution to guarantee the continuity of care. AIM: To investigate the efficacy of non-immersive virtual reality-based telerehabilitation on postural stability in people with Parkinson's disease, compared to at-home self-administered structured conventional motor activities. DESIGN: Multicenter randomized controlled trial. SETTING: Five rehabilitation hospitals of the Italian Neuroscience and Rehabilitation Network. POPULATION: Individuals diagnosed with Parkinson's disease. METHODS: Ninety-seven participants were randomized into two groups: 49 in the telerehabilitation group (non-immersive virtual reality-based telerehabilitation) and 48 in the control group (at-home self-administered structured conventional motor activities). Both treatments lasted 30 sessions (3-5 days/week for, 6-10 weeks). Static and dynamic balance, gait, and functional motor outcomes were registered before and after the treatments. RESULTS: All participants improved the outcomes at the end of the treatments. The primary outcome (mini-Balance Evaluation Systems Test) registered a greater significant improvement in the telerehabilitation group than in the control group. The gait and endurance significantly improved in the telerehabilitation group only, with significant within-group and between-group differences. CONCLUSIONS: Our results showed that non-immersive virtual reality-based telerehabilitation is feasible, improves static and dynamic balance, and is a reasonably valuable alternative for reducing postural instability in people with Parkinson's disease. CLINICAL REHABILITATION IMPACT: Non-immersive virtual reality-based telerehabilitation is an effective and well-tolerated modality of rehabilitation which may help to improve access and scale up rehabilitation services as suggested by the World Health Organization's Rehabilitation 2030 agenda

Molecular characterization of carbapenem-resistant acinetobacter baumannii isolated from pediatric burns patients in an Iranian hospital

Purpose: To survey the molecular characteristics of imipenem-resistant Acinetobacter baumannii obtained from pediatric burns patients in a teaching hospital in Tehran, Iran. Methods: Over a 10-month period, 73 non-duplicate A. baumannii strains were collected from pediatric burns patients admitted to Motahari Burn and Reconstruction Center, Tehran, Iran. The resistance profile of several antimicrobials was determined. Metallo-β-lactamase (MBL)-producing isolates were identified using double-disk synergy and an MBL E-test. Polymerase chain reaction (PCR) was carried out to detect the following β-lactamase-encoding elements: blaVIM, blaIMP, blaSIM, blaSPM, blaGIM, blaNDM, blaAIM, blaDIM, blaKPC, blaOXA-23/24/51, and blaOXA-58. The types of integrons were also identified using PCR. Results: Out of the 73 collected strains, 92.4 and 38.3 of the isolates were multidrug-resistant (MDR) and extensively drug-resistant (XDR), respectively. Colistin was the most effective antibiotic. It was found that 94.5 of the strains were resistant to imipenem, as determined both by disk agar diffusion and MIC E-test methods. Based on double disk synergy and E-test, 78.1 and 83.5 of the isolates, respectively, were MBL producers. The prevalence of blaOXA-23 and blaOXA-24 were 75.4 and 39.1 , respectively. The results also indicate that 62.3, 30.4, and 4.3 of the isolates were positive for blaVIM, blaIMP and blaNDM genes, respectively. Furthermore, 16.4, 76.1, and 7.5 of the isolates carried intI, intII, and intIII genes, respectively. Conclusion: The increased frequency of carbapenem-resistant A. baumannii in burns cases underlines the importance of choosing an appropriate antibacterial regimen based on antibiotic susceptibility profile. Rapid identification of carbapenemase-producing strains would be helpful for selecting suitable antimicrobial therapy and preventing further spread of their encoding genes. © Pharmacotherapy Group, Faculty of Pharmacy, University of Benin, Benin City, 300001 Nigeria

Comparison of loop-mediated isothermal amplification and conventional PCR tests for diagnosis of common Brucella species

Objective: Rapid, reliable, and affordable detection of Brucella species via the molecular methods remains a challenge. In recent years, loop-mediated isothermal amplification (LAMP) is a functional nucleic acid amplification technique offering a substitute to polymerase chain reaction (PCR). So, we compared the LAMP assay with the conventional PCR for the identification of common Brucella species in Iran. In this study, LAMP assay was comprehensively evaluated against the common PCR method. A group of specific LAMP primers were used to amplify a highly specific fragment from the sequence of the Brucella abortus, bcsp31 gene. Sensitivity and specificity values of tests were done with a set of 78 (50 Brucella and 28 non-Brucella) strains. Results: A dilution series of B. abortus DNA indicated that the LAMP reaction could reliably detect 10 (fg/µl) DNA target copies per reaction within 36 min, which is 10 times greater than the PCR assay. In summary, we conclude that LAMP assay provide accurate and fast test results to identify of common Brucella species in low-complexity labs, mainly in low and lower middle income countries. © 2020, The Author(s)

Investigative of the Relationship between job Stress and General Health among staffs of Ilam University of Medical Sciences in 2015

Background and aims: One of the major problems facing human societies in recent decades is the stress phenomenon, especially in the workplace. Job stress is the harmful responses that result from a mismatch between one's abilities and knowledge with job pressures and demands. Stress is one of the most important and effective factors in disturbing people's health, that makes a person unable to perform his or her individual, family and social duties and commitments optimally. Public health means complete physical, mental and social welfare (Not just lack of illness and disability). One of the most common disorders in general and occupational groups is mental disorders. The most important signs and symptoms of mental health include self-reliance, independence, the ability to cope with others, the ability to accept responsibility and the duty, to express love and affection, the ability to o endure failure, and so on. Manpower is one of the most important resources and the most significant asset of any organization; also, staffs health is one of the key Scales of effectiveness of any organization. Today, university staff are exposed to workplace stress, their health has been harmed. In addition, it is essential for lecturers and staff to be healthy individuals to ensure that those who educate and deliver the community have adequate health and expertise. The aim of this study was to determine the relationship between public health and occupational stressors and its influencing factors among staffs of Ilam University of Medical Sciences. Methods: This descriptive-analytic and correlation ty pe study was conducted on 153 staffs (employees and faculty members) of Ilam University of Medical Sciences. The samples were selected using Cochran statistical formula and simple random sampling. Data collection tools were Goldberg and Hiller General Health Questionnaire, Philippe L. Rice Job Stress Questionnaire and Demographic Questionnaire. The GHQ questionnaire was designed by Goldberg and Hiller and localized by Taghavi in Iran. The questionnaire consisted of 28 questions and 4 subscales of seven questions, including somatic symptoms, anxiety and insomnia, social dysfunction and severe depression, in which general health and its dimensions are divided into four domains: none or least, mild disorder, moderate disorder and severe disorder. In this study, 4-point Likert scale, from 0 to 3, was used to score GHQ-28 questionnaires; also, cut-off point 6 was used for each subscale and cut-off poin nt 22 for overall score. The Philip L. Rice Job Stress Questionnaire is one of the validated job stress questionnaires approved by the American Institute of Mental Health (NIMH). This questionnaire was designed by Philip L. Rice and localized by Hatami in Iran. The Philip L. Rice Job Stress Questionnaire contains 57 questions and three subscales of interpersonal relationships (26 questions), workplace physical conditions (22 questions) and job interests (9 questions) that job stress and each of its subscales are divided into three levels of low, moderate and severe stress. Occupational Stress Questionnaire scores were scored on a 5-point Likert scale from one (never) to five (always). In the present study, in interpreting occupational stress (total), a score less than 120.96 indicates low stress, a score between 120.96 - 183.54 moderate stress and a score above 183.54 indicates severe stress. Finally, the data were analyzed using SPSS software version 22 and t-test, chi-square, ANOVA, Pearson correlation and regression tests. Results: The total mean score of general health and occupational stress in the study population was 25.09 (14.81) and 25.152 (31.29), respectively. Also, 50.3 of the studied subjects had no or least impairment in scope of general health and 68.6 of the study participants had moderate level of job stress. In the survey of general health dimensions, the highest score belonged to social dysfunction with mean score of 7.49 (3.58) and also mean score of all three subscales of occupational stress was in average level, althou h, the highest score among the subscales belonged to the subscale of interpersonal relationships. Pearson correlation test showed a significant and direct correlation between job stress and general health (p0.05). Also, subscales of interpersonal relationships and physical conditions of workplace with 22.3 and 5.5 respectively are able to predict changes in public health. According to the results of this test, only the interpersonal relationship subscale predicted 20.9 of the changes in the severe depression subscale. T-test showed a significant difference between the mean score of the components of somatic symptoms, interpersonal relationships and job stress with marital status (p0.05). According to the results of analysis of variance (ANOVA), there was a significant difference between subscales of interpersonal relationships and age groups (p0.05). Conclusion: The staff of Ilam University of Medical Sciences were in the range of unhealthy (mild disorder) and moderate level of general health and job stress, respectively. Marital status and age were identified as the most important factors affecting job stress and general health, and interpersonal relationships and somatic symptoms were determined as the most important subscales among job stress and general health subscales. To improve general health and reduce job stress, such as developing a comprehensive stress management program, avoiding the use of high-stress and with little experience people in high-stress and high-risk jobs, prioritized to married people and men when to operate in sensitive and stressful jobs, providing consulting services to staffs within the organization, as well as regular and periodic physical and psychological staff monitoring are recommended.. © 2020 Iran University of Medical Sciences. All rights reserved

The Vertical Transmission in the Covid-19 Pandemic. Are Neonates at Risk? A Case Report in Iran

Introduction: Although there was no evidence of vertical transmission at the beginning of the pandemic, this hypothesis has been strengthened over time and there is evidence to support it. In the present article, we present a case of Covid-19 in a newborn from a mother with a recent Covid-19 infection. Case presentation: The female neonate was born from Normal Vaginal Delivery (N.V.D) in a primiparous 30-year-old woman. Her mother was presented at 36 weeks and complained of fever and cough symptoms. The mother was admitted in Taleghani hospital with labor pain without clinical signs of Covid-19 when she had 39 weeks of G.A. All stages of labor progressed normally based on Friedman Curve and a female neonate with meconium-stained was born. The neonate Apgar score dropped gradually and central cyanosis and tachycardia appeared about 20 minutes after birth. Immediately, laboratory tests, cardiac counseling, and transformation to the Neonatal Intensive Care Unit (NICU) NICU were done. Both moderate to severe Tricuspid Regurgitation (T.R) and positive Reverse Transcription Polymerase Chain Reaction (RT-PCR) Covid-19 were reported. A set of antibiotic, antiviral, and blood product replacement treatments was prescribed based on clinical signs and laboratory results. On the 28 th day of the birth, the neonate was discharged in good general condition, while his RT-PCR Covid-19 result was negative. Conclusion: The vertical transmission of Covid-19 in neonates is possible. Therefore, the health care providers should consider the important points in caring for these neonates