Ampicillin-Sulbactam for the Treatment of Aspiration Pneumonia in Patients with Opioid Overdose: A Randomized Controlled Clinical Trial

Background: Aspiration pneumonia is among overdose complications, requiring timely appropriate treatment. The present study aimed to evaluate the effects of ampicillin-sulbactam, compared to our usual regimen ceftriaxone + clindamycin on aspiration pneumonia in opioid-poisoned patients.Methods: In a randomized-controlled clinical trial, opioid-poisoned patients with aspiration pneumonia were randomly divided into the experimental and control groups to receive ampicillin-sulbactam 3 g Intravenously (IV) every 6 hours (experimental group) and ceftriaxone 1 g IV every 12 hours + clindamycin 600 mg IV every 8 hours (control group) followed by co-amoxiclav 625 mg orally every 8 hours and cefixime 400 mg once daily + clindamycin 600 mg orally every 8 hours in experimental and control groups, respectively, to complete a 7-day course of therapy. White blood cell count and temperature (axillary) at baseline and the third day of the intervention and the treatment outcome on the third day of the intervention, defined as either complete response, partial response, or failure, were evaluated and recorded for all patients.Results: Except for the number of cases of leukocytosis on the third day of the intervention, i.e., lower in the control group (5 patients, 26.30%) than the experimental group (13 patients, 68.40%) (P=0.020), no significant difference was observed between the study groups regarding other outcome variables. Clinical response was similar between the study groups; so that, 10.50% and 63.20% of patients in the experimental group and 21.10% and 47.4% of patients in the control group presented complete and partial responses, respectively (P=0.550). Conclusion: The obtained data suggested that ampicillin-sulbactam is an effective antibiotic for the treatment of aspiration pneumonia in patients with opioid overdose, in which case, it has the same efficacy as the two-drug regimen of ceftriaxone + clindamycin

Is Admission Serum Sodium Concentration a Clinical Predictor for the Outcome of Therapy in Critically Ill Poisoned Patients?

BACKGROUND Disorders of serum sodium concentration are some of the most electrolyte abnormalities in the intensive care unit (ICU) patients. These disorders adversely affect the function of vital organs and are associated with increased hospital mortality. PURPOSE In the present study we aimed to evaluate the effects of serum sodium concentration abnormalities at the time of hospital admission on the clinical outcome of therapy in a cohort of critically ill poisoned patients. METHODS In this cross-sectional study, 184 critically ill poisoned patients aged >18 years and in the first 8 hours of their poisoning, hospitalized in the ICU of a tertiary care university hospital (Isfahan, Iran) between 2010-2012, were evaluated at the admission time and 24 hours later for serum sodium concentration abnormalities and its relationship with age, gender, consciousness status, ingested drugs and clinical outcome of therapy. The clinical outcome was considered as recovery and mortality. Logistic Regression analysis was performed for predictive variables including serum sodium concentration abnormalities in patients' clinical outcome. FINDINGS On admission, 152 patients (82.6%) were eunatremic, 21 patients (11.4%) were hyponatremic and 11 patients (6%) were hypernatremic. In the second day eunatremia, hyponatremia and hypernatremia was observed in 84.4%, 13% and 2.2% respectively. Age (OR=1.92; CI=1.18-3.12) and severity of toxicity (OR=1.32; CI=1.12-2.41) were predicting factors of mortality in ICU poisoning patients. CONCLUSIONS Serum sodium concentration abnormalities are prevalent in critically ill poisoned patient but do not seem to have a predictive value for the clinical outcome of therapy

Comparing the pharmacology knowledge and performance of nurses and nursing students in the use of information resources in pediatrics wards: An observational study

Objectives: One of the major duties of nurses is proper medication administration while maintaining patient safety, which requires sufficient knowledge and practice. Any gaps in knowledge used by nurses can lead to irreversible injury or death of the patient. This study is aimed to determine and compare the pharmacology knowledge and performance of nurses and nursing students in using the information resources in pediatrics wards. Method: This descriptive observational study was performed on 300 nurses and nursing students. Sources of knowledge and performance of nurses and nursing students were analyzed with researcher-made tools to determine their pharmaceutical knowledge, sources of knowledge, and attitudes by independent t-test, chi-square, one-way analysis of variance, Pearson, and Spearman tests. Result: Three hundred questionnaires were examined. The clinical experience of nurses and students was their most important source of information in drug challenges for 33.7% of the participants. About 24.6% of nurses obtained the required information from specialized books on pediatric medicine. About 17.1% of the participants attained their knowledge from multiple sources (e.g. various available sources such as the Internet, pharmacy books, software, and their experiences and colleagues), while electronic sources and the Internet were the sources of knowledge for 15.5% and 7.7% of the nurses, respectively. Concerning nursing students, 6.3% used books, 41.7% considered colleagues (clinical experiences), 20.8% employed electronic resources, 22.8% used the Internet, and 9.1% relied on multiple sources. There were significant differences in the knowledge and performance of the nurses based on their source of pharmacological knowledge (P < 0.05). Conclusion: Most of the resources used in the hospital are not up-to-date and evidence-base, and the majority of nurses tend to rely on their clinical experience or their collegues information for medication administration rather than reading books or searching for up-to-date approaches and information. Nursing students also trust nurses’ clinical experiences more than other sources provided for them including books and Internet. Some action should be taken by the managers for boosting the nurses’ tendency for using up-to-date information resources

Fruit and vegetables intake among elderly Iranians: a theory-based interventional study using the five-a-day program

Abstract Background The benefit of FV intake in old age is well documented. However, there is evidence that old people do not consume enough FV. The purpose of this study was to evaluate the effectiveness of a tailored nutrition intervention that aimed to increase the FV intake among elderly Iranians aged 60 and over. Methods This quasi-experimental study was performed among a community-based sample of elderly in Tehran, Iran in year 2008 to 2009. Data were collected at baseline and 4 weeks follow-up. At baseline face-to-face interviews were conducted using a structured questionnaire including items on demographic information, stages of change, self-efficacy, decisional balance, daily servings of FV intake. Follow-up data were collected after implementing the intervention. Results In all 400 elderly were entered into the study (200 individuals in intervention group and 200 in control group). The mean age of participants was 64.06 ± 4.48 years and overall two-third of participants were female. At baseline total FV intake was not differed between two groups but it was significantly increased in the intervention group at posttest assessment (mean serving/day in intervention group 3.08 ± 1.35 vs. 1.79 ± 1.08 in control group; P = 0.001). Further analysis also indicated that elderly in intervention group had higher FV intake, perceived benefits and self-efficacy, and lower perceived barriers. Compared with control group, greater proportions of elderly in intervention group moved from pre-contemplation to contemplation/preparation and action/maintenance stages (P Conclusion This study suggests that the Transtheoretical Model is a useful model that can be applied to dietary behavior change, more specifically FV consumption among elderly population in Iran and perhaps elsewhere with similar conditions.</p

Bacterial safety of commercial and handmade enteral feeds in an Iranian teaching hospital

Background: This study aimed to investigate and compare the bacterial safety of handmade and commercial ready-to-use enteral feeding formulas used in an Iranian teaching hospital. Methods: In this experimental study, a total number of 70 samples (21 handmade formulas sampled at two sampling times, i.e. the time of preparation and 18 h after preparation, and 28 commercial ready-to-use formulas) were studied. Total count of viable microorganisms, coliform count and Staphylococcus aureus count for all samples were conducted. Results: Out of 42 handmade samples, 16 samples (76%) had total viable counts greater than 10 3 CFU/g in the first sampling time and 17 samples (81%) had total viable counts greater than 10 3 CFU/g in the second sampling time. Also, 11 (52%) had coliform contamination in the first sampling time which reached 76% (16 samples) in the second sampling time. Regarding contamination with S. aureus, 5 samples (24%) were contaminated in the first- and 13 samples (62%) were contaminated in the second-sampling time. Out of 28 commercial formulas, 27 samples (96%) had total viable counts greater than 10 3 CFU/g. Also, 24 samples (86%) were contaminated with S. aureus and 27 samples (96%) were contaminated with coliforms. In order to compare these two formulas, the results of Mann-Whitney test showed that contamination of ready-to-use formulas in all three microbiological samples was significantly more than that for handmade samples. Conclusions: The results of the present study indicate that the microbial safety of enteral feeding solutions in this hospital is much lower than standard values, demonstrating that the development of protocols for clean techniques in the preparation, handling and storage of both commercial and handmade enteral feeds is necessary

Polymerase chain reaction amplification of a GC rich region by adding 1,2 propanediol

Background : Apolipoprotein E (ApoE) is one of the most important carriers of lipids in mammalians. The gene for this lipoprotein (ApoE) is located on chromosome 19 which is related with the pathogenesis of some nervous system disease. ApoE gene is identified as a high guanine-cytosine (GC) content fragment. Detection and amplification of these templates are extensively laborious and baffling. The aim of this study was to find a practical and feasible method for the amplification of the number of GC rich genes such as ApoE. Materials and Methods: We experimented with simple polymerase chain reaction (PCR), nested PCR and PCR with 1-2 propanediol, dimethylsulfoxide (DMSO), and ethyleneglicol as additive substances to enhance the amplification ApoE gene and used the 40 samples of the human whole blood were collected in test tubes with a pre-treatment of ethylene diaminetetraacetic acid. Results: According to our observations, presence of 1-2 propanediol, DMSO, and ethyleneglicol as additive substances resulted to enhanced amplification of ApoE gene. Addition of 1-2 propanediol showed the best results, caused optimization and revealed more specific and sharp bands. Conclusion: According to our findings 1-2 propanediol are the best organic reagent for improving the amplification of ApoE gene. Optimization procedure for each GC rich sequence is recommended to be performed separately in order to identify which of the additive agent is more efficient and applicable for a particular target

Bacterial contamination of hospital-prepared enteral tube feeding formulas in Isfahan, Iran

&lt;ul&gt;&lt;li&gt;&lt;strong&gt;BACKGROUND&lt;/strong&gt;: Hospital-prepared tube feedings from three intensive care units of two hospitals in Isfahan, Iran were analyzed for microbial contamination.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;METHODS&lt;/strong&gt;: A total number of 152 samples (76 samples each at the time of preparation and 18 hours following preparation) were collected. Standard plate count, coliform count and Staphylococcus aureus count for all samples were conducted. Samples were analyzed also for the presence of Salmonella spp. and Listeria spp.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;RESULTS&lt;/strong&gt;: At the time of food preparation, out of 76 samples, 53 samples (70%) had coliform contamination and 87% of these contaminated samples had counts greater than 101 cfu/g. Also, 68&amp;nbsp; amples (90%) had S. aureus contamination greater than 101 cfu/g. In standard plate count, 74 samples (97%) had counts greater than 103 cfu/g, while 54 samples (71%) had counts greater than 104 cfu/g. In second sampling occasion, out of 76 samples, 68 samples (90%) had coliform contamination and 84% of these contaminated samples had counts greater than 101 cfu/g. Also, 72 samples (95%) had S. aureus contamination, 98.6% of these contaminated samples had counts greater than 102 cfu/g. In standard plate count, 74 samples (97%) had counts greater than 104 cfu/g. No Salmonella or Listeria was detected from samples.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;CONCLUSION&lt;/strong&gt;: The results indicated that a majority of the blenderized enteral tube feedings in those hospitals are not safe. In comparison to the standard limits, these enteral tube feedings are highly&amp;nbsp; ontaminated and posed substantial risk for developing a foodborne disease or nosocomial infection.&lt;/li&gt;&lt;li&gt;&lt;strong&gt;KEYWORDS&lt;/strong&gt;: Enteral Feeding, Microbial Contamination, Nosocomial Infection, Standard Plate Count, Coliform.&lt;/li&gt;&lt;/ul&gt