Awareness of Academic Staff Physicians with Principles of Evidence-Based Medicine and its Application in Daily Practice

Introduction: The purpose of this study was to evaluate familiarity of academic staff physicians with EBM and its application in daily practice. Methods: This cross-sectional study was conducted in 2022 with the participation of academic staff physicians of Hamadan University of Medical Sciences in Iran. Data were collected using CEBM questionnaire and were analyzed with SPSS 20 software, using T-test and Spearman correlation statistical tests. Results: Out of 156 academic physicians, 97 (62.2%) completed the questionnaire, 62 (63.9%) were male, and 33 (34%) had participated in EBM workshops. Mean score of knowledge and attitude questions were 14.7± 3.9 and 3.8± 0.5 respectively. There was no significant difference between males and females in knowledge and attitudes (P >0.05). Physicians who participated in EBM workshops had higher scores in knowledge (P <0.05) but not in attitude (P= 0.06). Positive and significant correlation between age (r = 0.32, P = 0.001) and teaching experience (r = 0.28, P = 0.005) was observed with knowledge and attitude about EBM. 69.1% of participants used very little or not at all EBM in their daily practice. The most important obstacles were lack of time (49.5%) and specific information (22.7%). More than 65% of physicians tended to use EBM in their daily practice. Conclusion: The academic staff physicians of Hamadan, Iran had a positive attitude towards evidence-based medicine, but did not have enough information in this regard. Accordingly, its application in daily clinical work was relatively low. Holding EBM workshops is essential to increase awareness about EBM

Comparison Of Chloral Hydrate Solution, Hydroxyzine Syrup And Lidocaine/Prilocaine Cream As Premedication For Lumbar Puncture In Children, A Double Blind Study

  ObjectivesThis study aimed to compare the clinical effectiveness of oral hydroxyzine and chloral hydrate to topical lidocaine/prilocaine 2.5% cream as premedication in pediatric leukemia patients. Material & Methods This double-blind clinical trial study was conducted on 70 leukemic and non-leukemic patients aged 3-11 years old. The patients were divided into 4 groups as follow: in the group A, choral hydrate solution was given in 18 patients, in group B hydroxyzine syrup was used in the same number of patients, in group C, chloral hydrate solution and Lidocaine/Prilocaine cream were used in 17 patients, and in group D hydroxyzine syrup and Lidocaine/Prilocaine cream were given in the same number of patients. These groups were assessed and judged based on visual analog scale (VAS). Side effects of the drugs were also recorded. Results In this study, 54.3% (38) of cases were girls and 45.7% (32) were boys. Patients’ selection was included as follow: ALL in 77%, AML in 7.2% and non-leukemic cases in 15.8% of cases. The VAS test showed no difference in these four groups. Non-Traumatic lumbar puncture (RBC<50) were seen in 97.1% of cases. Conclusion Although the use of pre-medications for lumbar puncture with hydroxyzine syrup and chloral hydrate solution was not statistically effective, it did lead to increased patient and parent satisfaction. Also, adding  the Lidocaine/Prilocane cream does not improve the effectiveness of the drugs. &nbsp

A Comparative Analysis of Clinical Characteristics and Laboratory Findings of COVID-19 between Intensive Care Unit and Non-Intensive Care Unit Pediatric Patients: A Multicenter, Retrospective, Observational Study from Iranian Network for Research in Viral

Introduction: To date, little is known about the clinical features of pediatric COVID-19 patients admitted to intensive care units (ICUs). Objective: Herein, we aimed to describe the differences in demographic characteristics, laboratory findings, clinical presentations, and outcomes of Iranian pediatric COVID-19 patients admitted to ICU versus those in non-ICU settings. Methods: This multicenter investigation involved 15 general and pediatrics hospitals and included cases with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection based on positive real-time reverse transcription polymerase chain reaction (RT-PCR) admitted to these centers between March and May 2020, during the initial peak of the COVID-19 pandemic in Iran. Results: Overall, 166 patients were included, 61 (36.7%) of whom required ICU admission. The highest number of admitted cases to ICU were in the age group of 1–5 years old. Malignancy and heart diseases were the most frequent underlying conditions. Dyspnea was the major symptom for ICU-admitted patients. There were significant decreases in PH, HCO3 and base excess, as well as increases in creatinine, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), and potassium levels between ICU-admitted and non-ICU patients. Acute respiratory distress syndrome (ARDS), shock, and acute cardiac injury were the most common features among ICU-admitted patients. The mortality rate in the ICU-admitted patients was substantially higher than non-ICU cases (45.9% vs. 1.9%, respectively; p<0.001). Conclusions: Underlying diseases were the major risk factors for the increased ICU admissions and mortality rates in pediatric COVID-19 patients. There were few paraclinical parameters that could differentiate between pediatrics in terms of prognosis and serious outcomes of COVID-19. Healthcare providers should consider children as a high-risk group, especially those with underlying medical conditions

Experimental study and FEM analysis of forward hot dieless spinning

In this study, the forward hot dieless spinning method is employed in order to fabricate conical tubes using thick aluminum. The process is first examined numerically and then verified by an experimental work. In the numerical study, a 3-D dynamic explicit model is used to solve a common problem in the modeling of the spinning process, the tube is fixed and the roller rotates around the tube. The strain distribution in the tube at various forming passes is studied. The numerical results show that the circumferential strain distribution in different positions of the tube has a negative value whose value increases toward the free end of the tube. Besides, the results indicate that the hardness of the sample increases by about 18% due to the hot dieless spinning process and such a hardness augmentation is obvious along the thickness of the formed tube

Nasal carriage of methicillin resistant Staphylococcus aureus and their antibiotic susceptibility patterns in children attending day-care centers

Nasal colonization with community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is being increasingly reported, especially in places where people are in close contact and in reduced hygiene, such as day-care centers. In this study we investigated the frequency of MRSA colonization and their antibiotic susceptibility patterns in 1–6 years old children of day-care centers in Hamadan, West of Iran.Five hundred nasal swabs were collected from children of 27 day-care centers that had no risk factors for colonization by S. aureus. The specimens were cultured for isolation of S. aureus by standard methods. Antimicrobial susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. For evaluation of the frequency of erythromycin induced clindamycin resistance, disk approximation test (D-test) was applied.Totally, 148 (29.6%) children were colonized by S. aureus. Out of 260 male, 94 (36.2%) and of 240 female, 54 (22.5%) cases were nasal carriers of S. aureus (P value = 0.001). Six (4.1%) of the 148 S. aureus isolated from children were MRSA strains. None of MRSA and methicillin susceptible S. aureus (MSSA) was resistant to vancomycin and clindamycin. Three of the 6 strains of MRSA and 7 (4.9%) of the 142 MSSA strains were resistant to erythromycin, and D-test was positive in all of them.We conclude that the rate of colonization by S. aureus is high in children attending day-care centers but colonization with MRSA is not common in our areas. Clindamycin or trimethoprim-sulfamethoxazol could be used in mild to moderataly severe diseases caused by CA-MRSA. However, if the CA-MRSA isolates are erythromycin resistant, D-test should be carried out for detection of inducible clindamycin resistance

Can Children Enhance Their Family’s Health Knowledge? An Infectious Disease Prevention Program

Objective: The purpose of this study is to propose an innovative method of knowledge transfer that aims to improve health literacy about pediatric infectious diseases prevention in families. Children have an appreciable role in this scheme. Methods: This study is a before and after trial that has been conducted in Hamedan in 2009. After changing seven infectious disease topics into childish poems, we selected five kindergartens randomly and taught these poetries to the children. Teaching process held after a pretest containing 24 questions that examined 103 of parents about mentioned topics. The same post-test was given after 4 months of teaching process. Findings: The mean of correct answers to the pretest was 59.22% comparable with 81.00% for post-test (P<0.00). Gender and knowledge degree could not change the results significantly. Assuming one’s correct answers to the questions as his/her Knowledge Mark, the mean of this variable increased to 5.32 by this method. Conclusion: This cost-effective and joyful method had successful results in promoting health knowledge. Children are able to play an active role in family’s health situation. Learning within family atmosphere without any obligations makes our scheme a solution for paving the knowledge transferring way

Virulence Factors and Antibiotic Resistance in Uropathogenic and Commensal Escherichia coli Isolates

Background: Urinary Tract Infections (UTIs), including cystitis and pyelonephritis, are the most common infectious diseases in childhood. Aim and Objectives: Escherichia coli (E. coli) account for as much as 90% of the community-acquired and also 50% of nosocomial UTIs. Therefore, the identification of E. coli strains and antibiotic resistance patterns is important for both clinical and epidemiological implications. Material and Methods: To characterize uropathogenic strains E. coli, we studied 100 strains recovered from both urine samples of children aged less than 7 years with community-acquired UTIs and stool samples of healthy children, respectively. Results: We assessed Virulence Factors (VFs) and drug sensitivities of E. coli isolates. Drug sensitivities of the isolates were 94% (amikacin), 90% (nitrofurantoin), 66% (gentamicin), 56% (cefixime), 40% (nalidixic acid) and 28% (cotrimoxazol). Laboratory tests showed that the prevalence of virulence factors ranged from 18% for hemolysin and P-fimbriae to 2% for type1-fimbriae. Most drug resistance was cotrimoxazole and amikacin was the lowest. P-fimbriae and hemolysin in uropathogenic E. coli were more frequent than non-pathogen type of E. coli. Conclusion: Although amikacin appeared to be the first choice for UTI in children, but nitrofurantoin seems to be practical and could be considered as the selective choice for uncomplicated lower UTIs

Incidence of diarrhoeagenic Escherichia coli isolated from young children with diarrhoea in the west of Iran

Diarrhoeagenic Escherichia coli (DEC) represents a main group of enteric pathogens that cause human diarrhoea. Because it is not simply distinguished from normal flora by simple laboratory methods, modern molecular diagnostic assays are necessary. Although it is neither necessary nor applicable to perform PCR for all patients, it is of many advantages to verify the prevalence of DEC in different areas by this method. Knowing the prevalence of DEC in an area, we can focus on few pathogens and narrow our antimicrobial treatment. The aim of this study is to evaluate the contribution of the different DEC categories in children diarrhoea in the west of Iran.The stool specimens of 251 children with diarrhoea were collected from June to September 2007. Polymerase chain reaction (PCR) was performed to determine the presence of enteropathogenic (EPEC), enterotoxigenic (ETEC), entero-invasive (EIEC), Shiga toxin-producing (STEC) and entero-aggregative (EAEC) strains. ETEC strains were isolated from 13 and EAEC strains from 16 children. STEC was detected in 7 children, and no EIEC was isolated. Finally, EPEC strains were isolated in 41 cases. EAEC and EPEC are the most frequent DECs in children less than 10 years of age in West of Iran

Patterns of Antiepileptic Drug Reactions in Children: A Multicenter Study: Antiepileptic Drug Reactions in Children

ObjectivesAntiepileptic drugs are among the most common triggers of cutaneous adverse reactions. About 5–17% of epileptic patients develop idiosyncratic skin reactions at some point during their treatment course, most of which occur within the first two months of drug initiation. This study aimed to investigate the pattern of cutaneous drug reactions associated with anticonvulsant use among the pediatric population in Iran to identify high-risk individuals. Materials &amp; MethodsIn this retrospective descriptive study, medical records of children aged two months to 14 years, who were diagnosed with drug reactions due to anticonvulsant drugs between April 2007 and March 2018, were reviewed, and relevant information were extracted. This multicenter study was conducted in several provinces of Iran.ResultsA total of 186 cases with a final diagnosis of the antiepileptic druginducederuption were evaluated. The median age of participants was36 months (range: 2-168), and 56% were male. In approximately70% of the children, phenobarbital was the culprit. The median timeinterval between initiation of the causative drug and development ofrash and fever was 10 and 7 days, respectively. The most commonrash type was maculopapular rash (69%). Overall, 33% of the patientsonly received antihistamines after discontinuation of the causativedrug. ConclusionSimilar to previously published studies in Iran, phenobarbital wasthe main cause of cutaneous drug reactions to antiepileptic drugs,indicating the necessity of paying more attention when prescribingphenobarbital for Iranian pediatrics