سید علیرضا فهیم زاد

Acinetobacter is a pathogen that could cause nosocomial infections. The present study aimed at determining Acinetobacter cases in clinical cultures of patients hospitalized in Tabriz Imam Reza Hospital to determine the frequency of the most common oxa genes causing drug resistance in these specimens.

In this descriptive cross-sectional study, clinical specimens including the blood, urine, tracheal secretions, ulcers, and throat specimens were collected from July to October 2017. The bacteria were isolated and identified using standard bacteriological methods. The Clinical and Laboratory Standards Institute (CLSI, 2016) guideline was used to determine bacterial susceptibility and resistance. Bacterial DNA extraction was done and the OXA genes (23, 24, 48, 58) were identified using specific primers and PCR method.

We identified 66 (72.52) multiple drug-resistant (MDR) Acinetobacter strains. These isolates showed 100% resistance to cefepime, cefotaxime, piperacillin-tazobactam, and meropenem. In 100% of the samples, sensitivity to colistin was observed. According to findings, there was a significant relationship between the presence of oxa24 gene and resistance to tobramycin and amikacin (P= 0.005).

This study showed high rate of MDR Acinetobacter strains, so, nosocomial infection control is highly necessary. Strategies such as identifying infected patients, detecting bacterial colonization, sterilizing equipment and units, and controlling antibiotic use in the hospital are recommended to prevent the development of multidrug-resistant bacteria and to control nosocomial infections.

Pediatrics assistants should have the same training program. Shahid Beheshti University of medical sciences has seven training hospital, however, there are no similar specialized departments in all of these hospitals. Therefore, it is necessary to develop identical rotational style in order to train assistants according curriculum. The aim of this study was to investigate and compare the pediatrics assistants' skills scores in clinic, before and after the executive rotational style.

This descriptive cross-sectional study was carried out in two successive steps in Shahid Beheshti University of Medical Sciences. In the first step, the rotational guideline was developed by the specialists and used for pediatrics assistants since 2015. The second step was carried out in 2017. In this phase, the effect of the implementation of the guideline was investigated by a researcher-made questionnaire. Eighty-four questionnaires were distributed among the pediatrics assistants of Shahid Beheshti University of Medical Sciences. Sixty-nine assistants fulfilled the questionnaires. Thirty-eight assistants have been trained by the rotational program and, 31 assistants have been trained by the old one. Data were collected from questionnaires, and analyzed using Spss software version 16. 0.

The mean and standard deviation of the clinical skills scores were higher in rotational group of assistants, camper with the others especially in wards of neonatal, nephrology, emergency, infectious, gastroenterology, lung, heart, rheumatology, hematology, and oncology. The rotational group assistants earned lower clinical skills scores than the others in endocrinology (3. 7±1. 5) and asthma and allergy (4. 3±2. 1) departments.

the findings indicated that the implementation of rotational style in Shahid Beheshti University of medical sciences had a positive effect on the pediatrics assistants' clinical skills improvement.

True approach and appropriate behavior to the child with loss of consciousness whom referred to emergency room is one of the important skills of every physician. If there is defined diagnostic and therapeutic algorithm in the emergency room for managing these children, it help physicians not to be confused and save golden time for survival of the patients. After describing the history taking, physical and neurologic exams’ skills in children with loss of consciousness, this article explain the etiological factors which are classified into traumatic and nontraumatic agents. Infectious encephalopathies and applied classification of them are more evaluated and emphasized in our paper.

The signs and symptoms of neonatal sepsis are often non-specific and can make the diagnosis of infection more difficult. This leads to treat majority of neonates with antibiotics without bacterial infections. The aim of this study was to determine the incidence of positive bacterial cultures and isolating the etiologic agents from neonates with suspected sepsis. This cross-sectional study was conducted on 120 neonates with suspected bacterial sepsis admitted in Mahdieh hospital, Tehran, Iran. Blood culture was performed by BACTEC 9120 system, as a more sensitive method compared to current blood culture techniques. Sepsis was classified as definite, probable, or possible based on clinical findings of sepsis, hematologic data, blood culture and CRP. Among 120 neonates, 11 cases had positive blood culture. Seven of them were positive by staphylococcus epidermidis and the rest by entrococcus, lactobacillus, diphtheroid and gram positive bacillus. Definite, probable, and possible sepsis was found in 1.7%, 9.2% and 89.1% of neonates, respectively. Early onset sepsis was determined in 90.8% of patients. The most common clinical manifestations were respiratory distress and apnea. It is beneficial to use an automated blood culture system such as BACTEC which is a sensitive method and lead to earlier detection of bacterial growth.