abbas taher

Coronaviruses are important pathogens in humans and animals. Two years ago, a new coronavirus was identified as the cause of pneumonia and adult respiratory distress syndrome. These viruses have many clinical features, and new features are created daily. Bell’s palsy is sporadic facial nerve palsy. The main reason of Bell’s palsy is not recognized. Many viruses, such as herpes simplex or herpes zosters, have been previously identified as Bell’s palsy. This case report seeks to explain the occurrence of Bell’s palsy in a patient infected with coronavirus. The polymerase chain reaction test of a 60‑year‑old woman was positive for SARS‑CoV‑2. Bell’s palsy happened on the 2nd day of admission to intensive care unit and recovered by the 12th day. After ruling out other etiologies of Bell’s palsy, coronavirus appears to be one of the new etiologies of Bell’s palsy.

Antibiotic prophylaxis is often used by surgeons to prevent surgical site infection (SSI) following operations. Despite the availability of several national guidelines for proper antibiotic prophylaxis, adherence to guideline recommendations, especially in developing countries, is still sub-optimal. This study aimed to assess adherence to the American Society of Health-System Pharmacists (ASHP) guidelines for prophylactic antibiotic use among surgeons in a referral hospital in western Iran.

This prospective cross-sectional study was conducted in surgery wards of a tertiary hospital affiliated with Hamadan University of Medical Sciences, Hamadan, Iran, for six consecutive months from February 1 to July 31, 2019. The records of 264 patients who were randomly chosen from patients admitted to surgery wards were reviewed. The appropriateness of parameters of surgical antibiotic prophylaxis, including indication, antibiotic choice, dose, timing of the first dose, and duration of prophylaxis, was assessed against ASHP guidelines.

A total of 248 patients (93.94%) received antibiotic prophylaxis. Only in 32.2% of the procedures, full adherence to all parameters of the AHSP guidelines was achieved. In a significant percentage of procedures, prophylactic antibiotics were administered inappropriately for more than 24 hours (59.21%). Regarding the antibiotic selection (92.1%), dose (88.6%), and timing of administration (89.9%), the rate of adherence to guidelines recommendations was relatively satisfactory in our hospital.

Our survey demonstrated that the adherence of surgeons to antibiotic prophylaxis guidelines was inadequate in our hospital, and there is still considerable room for improvement, especially in the process of discontinuation of antimicrobial prophylaxis.

Primary endodontic infections are caused by necrotic colonization of the pulp tissues by microorganisms. The success of endodontic treatment depends on complete debridement and disinfection of the root canal space. Maximum antibacterial effects, maximum dissolving effects on necrotic tissues, and minimum toxic effects on the periapical tissues are essential characteristics of ideal root-canal irrigants. Recently, researchers have become further interested in medicinal plants as herbal medicines due to their good antimicrobial activities and natural origins.

This study aimed to compare the antimicrobial properties of chlorhexidine solution alone and mixed with two herbal solutions in root dentine and optimize factors affecting the disinfection of primary tooth root canals.

Teeth infected with pure Enterococcus faecalis suspensions were treated with chlorhexidine solution alone and mixed with chamomile and Satureja khuzestanica. After selecting the most efficient solution, factors possibly affecting the disinfection process were optimized using a central composite design. These factors were the CHX concentration, chamomile concentration, and contact time.

The microbial colony count showed that the minimum colony count belonged to 1% chamomile essence and 1% CHX solution, while the maximum colony count belonged to 1% S. khuzestanica and 1% CHX solution, with significant differences. In the optimization process, the best chlorhexidine concentration, chamomile concentration, and contact time were 1.13%, 1.39%, and 11.33 min, respectively.

A combination of chlorhexidine and chamomile provided protection against oral microbial pathogens for endodontic infections. However, further comprehensive in vivo studies seem necessary.

Drug interactions are one of the problems caused by the irrational administration of drugs and one of the common causes of morbidity and mortality in patients. Since drug interactions are usually predictable, they are therefore avoidable and manageable. This study aimed to evaluate the frequency of drug interactions and their related factors in hospitalized patients of the intensive care unit in the Hamadan Besat hospital, Iran.

 This cross-sectional study was performed on the clinical records of patients admitted to the intensive care unit (2019-2020) of Besat Hospital in Hamadan, Iran. Data were analyzed to determine the type of drug interactions based on the interactions available on the Up To Date and RxList databases. Other information was obtained from the patientschr('39') clinical records. Completion of information was recorded in the Pre-Design checklist. Finally, the data was analyzed using SPSS software version 22 and appropriate descriptive-analytical methods.

 The mean number of total drug interactions per prescription was 5.94 ± 4.91. Most interactions were type C (63.89%), Moderate (67.66%), Fair (70.96%) and Significant (44.76%).

According to the results, prolonged stay in an intensive care unit, the elderly, and polypharmacy are the main important factors associated with the occurrence of drug-drug interactions. These results indicate the importance of paying more attention to the monitoring and control of prescribed drugs in these patients.

Acinetobacter infection is one of the most common nosocomial infections that its antibiotic resistance has increased in recent years.This study aimed to evaluate drug resistance to colistin in nosocomial infections with multidrug-resistant (MDR) Acinetobacterbaumannii.

This cross-sectional study was performed on 45 blood or body fluid culture samples collected from hospitalized patients at Sina Hospital, Hamadan, Iran, within 2018-2019.The Minimum Inhibitory Concentration (MIC) was determined using E-test trips and disk diffusion method to evaluate the resistance of Acinetobacterbaumannii to the antibiotic colistin according to the guidelines of the Clinical and Laboratory Standards Institute.The collected data were analyzed in SPSS software (version 16).

In this study, out of 45 patients, 24 (53.3%) and 21 (46.7%) of the subjects were male and female, respectively.The mean age of patients was estimated at 68.0±15.9 years. The antibiotic-resistance of samples was determined using the disk diffusion method. Accordingly, all samples were 100% resistant to ceftriaxone, ceftazidime, ciprofloxacin, cefepime, imipenem, meropenem, ampicillin sulbactam.Out of 45 culture samples examined with MIC, 39 (86.7%) and 6 (13.3%) of samples were sensitive and resistant to colistin, respectively.Based on the results of the disk diffusion method, 21 (46.7%), 19 (42.2%), and 5 (11.1%) of samples were sensitive, intermediate, and resistant to colistin

Based on the findings, colistin was effective against multidrug-resistant Acinetobacterbaumannii and is suggested to be used in cases of Acinetobacter MDR as an effective treatment in combination with other antibiotics.

In this study which was conducted in Besat hospital (Hamadan, Iran), the therapeutic drug monitoring (TDM) of vancomycin (VAN) was carried out based on the quantification of VAN trough in intensive care unit (ICU) patients.

The study population was selected from ICU patients treated by intravenous VAN. To determine VAN trough, blood samples were taken from patients before the fourth dose. Then, trough concentrations were determined by newly developed high-performance liquid chromatography (HPLC) and compared with the conventional method of immunoassay. Twenty patients were included based on the aim of the study.

The mean value of the trough for the studied patients was 26.31±18.05 μg/mL. For 16 (80%) patients, trough levels were found to be less than 10 μg/mL. For 12 (60%) patients, creatinine clearance was less than 90 mL/min and more than 120 mL/min. The mean value of creatinine clearance for the studied patients was 95.49± 25.74 mL/min. Based on the results, there was a significant relationship between VAN trough concentration and creatinine clearance (P=0.045).

In general, the HPLC method is more sensitive than immunoassay for the determination of VAN in plasma samples. However, VAN dosing based on creatinine clearance is not enough for achieving the goal trough level but measuring the creatinine clearance and trough concentration are considered as vital aspects for the TDM of VAN.

Ventilator-associated pneumonia (VAP) is a common and very serious problem which its early diagnosis and treatment can save the lives of patients. The purpose of the present study was to determine the gold standard for the diagnosis of VAP in centers without the possibility of conducting bronchoscopy.

In this cross-sectional study, 85 patients hospitalized in the Intensive Care Unit (ICU) of Besat Hospital in Hamadan whom met the inclusion criteria were recruited. The sensitivity and specificity of components and the two criteria of the Clinical Pulmonary Infection Score (CPIS) (pulmonary infiltration, body temperature, white blood cell count, tracheal and blood cultures, and arterial partial fraction of oxygen) and the Serum Procalcitonin Level (SPCL) higher than 0.5ng/ml were calculated as the gold standard.

According to the findings of this study, 72.94% of the patients were male with an age average of 46.94 ± 18.91 years. The frequency of VAP diagnosis was 75.3% by using CPIS, and 56.47% by using SPCL. Considering the combination of the two mentioned criteria as the golden standard, the sensitivity and specificity of the CPIS criteria in the diagnosis of VAP was 97.7% and 95.1%, respectively.  The Youden test index was calculated to be 0.889.

To conclude, findings reveal that the introduced golden standard in this study is a reliable method for the diagnosis of VAP in centers without the possibility of performing bronchoscopy.

  Drug interactions (DIs) are one of the problems caused by irrational drug use and includes the effects of drug, food, or anything that changes the pharmacokinetics or pharmacodynamics of a given drug. In this regard, DI is one of the causes of morbidity and mortality in patients. However, this problem is usually predictable and hence is required to be properly managed. The aim of the present study was to assess DIs in the patients hospitalized in the intensive care units and infectious ward of Sina hospital, Hamadan, Iran. This cross-sectional study was conducted on the medical records of 500 patients hospitalized in ICUs and infectious ward of Sina hospital in Hamadan from March 2014 to February 2015. The inclusion criterion was the presence of at least one DI in the patients hospitalized in the intensive care units (ICUs) and infectious ward of the hospital for at least 24 hours. The potential DIs were classified based on the type and severity. Medical and demographic characteristics of the patients, including age, sex, duration of hospitalization, inpatient ward, and treatment results (death or advances in treatment) were collected using a checklist. Data were analyzed using SPSS software version 16.0. A total of 514 DIs were identified from which 5.05% were major and 41.82% were moderate interactions. The mean of DI per patient was 2.81 in the range of 1 and 23. The frequency of antibiotic/ antibiotic and antibiotic/other drugs interactions were 7.97% and 28.98%, respectively. The average length of stay in hospital was 12.07 days, and 26.22% and 25.13% of the studied patients were hospitalized in general and infectious ICUs, respectively. The mean of DIs per patient was significantly higher in infectious ICU rather than other studied wards. To sum up, although the percentage of major DIs were low, the prevalence of total DIs was high in the studied patients. Based on the results of this study, it seems that physicians must be aware of the presence of potential and harmful DIs. Moreover, working under the careful supervision of a clinical pharmacist in hospitals and continuous training around DIs and training the pharmacological care to physicians can be effective in the prevention of DIs

Traumatic brain injury (TBI) is one of the important causes of morbidity and mortality throughout the world, especially in young people. In recent years normobaric hyperoxia has become an important and useful step for recovery and improvement of outcome in TBI.

The purpose of this study was to evaluate the effects of normobaric hyperoxia on clinical neurological outcomes of patients with severe traumatic brain injuries. We used the Glasgow outcome scale (GOS), barthel index, and modified rankin scale (mRS) to measure the outcomes of patients with TBI.

Sixty-eight consecutive patients with severe TBI (mean Glasgow coma scale [GCS] score: 7.4) who met the inclusion criteria were entered in this randomized controlled clinical trial. The patients were randomized into two groups, as follows: 1) experimental: received 80% oxygen via mechanical ventilator in the first 6 hours of admission, 2) control: received 50% oxygen by mechanical ventilator in the first 6 hours of admission and then standard medical care. We measured the GOS, Barthel Index, and mRS at the time of discharge from hospital and reassessed these measurements at the 6-month follow-up after injury.

According to our study, there were no significant sex or age differences between the two groups (P = 0.595 and 0.074). The number of days in the intensive care unit (ICU) in the control group and experimental group were 11.4 and 9.4 days, respectively (P = 0.28), while the numbers of days of general ward admission were 13.9 and 11.4 days (P = 0.137) respectively. The status of GOS at time of discharge were severe = 13 and 10, moderate = 16 and 19, and low = 5 and 5 in the control and experimental groups, respectively (P = 0.723); 6 months after injury, the scores were as follows: moderate = 16 and 9, low = 15 and 25, and severe = 3 and 0 (P = 0.024). The Barthel index scores in the control and experimental groups were 59.7 and 63.9 at time of discharge (P = 0.369) and 82.7 and 91.3 at 6 months after injury (P = 0.018), respectively. The mRS results were 2.6 and 2.3 at time of discharge (P = 0.320) and 1.6 and 0.7 at 6 months after injury (P = 0.006) for the control and experimental groups, respectively.

According to the results of this study, oxygen therapy by mechanical ventilator in the first 6 hours after injury in patients with severe TBI can improve the final GOS, Barthel index, and mRS scores. It could also improve long-term outcomes and enhance rehabilitation and the quality of life.

Oxygen therapy might increase damaged tissue oxygenation, turn on the aerobic pathway, and save neurons from death and could improve clinical outcome of the patients with stroke and head trauma. Hyperbaric oxygen therapy is accompanied by some unfavorable effects. Results of normobaric oxygen therapy on clinical outcomes of patients with stroke were controversial up till now. This study was therefore designed to evaluate effects of normobaric hyperoxia on clinical outcomes of patients with severe acute stroke. A total of 52 consecutive patients with stroke who meet the inclusion criteria of the study were entered into this randomized controlled clinical trial. The patients in the case group underwent oxygen therapy with Venturi mask for first 12 hours of admission. The patients were examined for neurologic defects at the time of discharge and after six months using both Barthel and modified Rankin Scale (mRS) neurologic disability scoring systems. There was no significant sex difference between the two groups (P=0.5). There was no statistically significant difference between ischemic-hemorrhagic stroke constitutions of two groups (P=0.2). There were no significant difference in Barthel index scores of both groups at the time of discharge as well as the follow-up examination (P=0.7) According to the mRS scoring system, there was no difference between the patients of both groups at the time of admission (P= 0.8), however after treatment there was a significant difference between mRS scores of the treated group compared to the controls (P=0.04). According to the results of this study, normobaric oxygen therapy in the first 12 hours of accident could improve long time outcome of the patients with either ischemic or hemorrhagic stroke.