فهرست مطالب nooshin abdollahpour

Intensive care units (ICU) still face a high risk of primary and nosocomial infection. Pathogens in ICU are generally becoming more resistant to antimicrobial drugs, but there are differences between countries, possibly moving to different antibiotic usage patterns. It seems necessary to have adequate knowledge about local microbes and their sensitivity patterns in order to prepare an effective experimental treatment protocol in the ICU. In this study, the bacteriological profile and antibiogram of cultures performed in the ICU are investigated.

The cross-sectional study examined all culture samples obtained from patients in four intensive care units at Imam Reza Hospital, Mashhad, Iran, during 2016 to 2019. Culture and antibiogram information was extracted from the HIS system and compared with patient files whenever necessary. In order to analyze the data, SPSS software was used along with the Chi Square test.

In total, 1569 samples were examined, and 674 (42.95%) were positive for microbial culture. As the most commonly isolated bacteria, Acinetobacter accounted for 32.9% of the cases in 222 cases. Candida accounted for 85 cases (12.6%), Staphylococcus aureus 81 cases (12%), and Klebsiella 59 cases (7.8%). Colistin, the most effective antibiotic against Acinetobacter, showed a resistance rate of 0.9%, whereas carbapenems were not effective against over 95% of these bacteria.

Acinetobacter was the most common Gram-negative bacillus in intensive care units, accounting for more than half of infections. In addition, most of the tested antibiotics, except colistin, were resistant to these strains. Since these microorganisms are multidrug resistant, it is crucial that infection control processes in intensive care units are reviewed and standard antibiotics are prescribed.

This review study aimed to investigate the role of PCT in the prognosis of mortality among patients admitted to the intensive care units (ICU). Procalcitonin (PCT) is a polypeptide and prohormone of calcitonin. This prohormone is secreted by thyroid gland C cells in response to hypercalcemia, and Its elevated level indicates infection, especially bacterial infections, in which there is a systematic response to infection.

This narrative review study was performed based on Cochrane collaboration recommendations for reviews. We reviewed all the titles and abstracts of published research articles with the following inclusion criteria studies aimed to confirm the function of a prognostic model in predicting mortality or survival, (b) mortality or survival of a specific endpoint (for example, 30 days), (c) patients admitted to intensive care units, and d) the articles written in English. The exclusion criteria of the current review included: (a) articles whose data were not specifically focused on prognosis of patients in ICU, (b) articles that did not provide sufficient information on the cause of death of patients in ICU, and (c) articles focusing on the treatment of comorbid patients with infections in ICU. The search was conducted on Google Scholar, PubMed, Magiran, ScienceDirect, and SID. Also, to search Iranian databases, including SID and Magiran, the same terms and expressions were searched.

Based on the findings of this review, serum levels of PCT were reported within the range of at least 5 to more than 16 ng/ml in patients admitted to ICU. The mortality rate was estimated at 5.7% to 79% in these patients. Moreover, the incidence of sepsis was reported from 13% to 77.6%.

Serum levels of PCT as a prognostic factor may help early detection, and better classification of the poor prognoses sepsis patients and more invasive treatment of patients admitted to ICU and are at risk for mortality.

Sepsis and acute respiratory distress syndrome are the most important causes of death. Sepsis accounts for 20% of deaths worldwide and is one of the most common causes of acute respiratory distress syndrome (ARDS) with a prevalence of 23%. Sepsis-induced ARDS occurs among 10% of ICU patients. Today, mesenchymal stem cells (MSCs) therapy has been studied as a new treatment in the management of sepsis and as a promising treatment for ARDS. The aim of the present study was to systematically review studies on the use of MSCs for treatment of sepsis and ARDS.

The results of the search strategy include eight studies: one meta-analysis, three systematic reviews, one clinical trial, one cohort study, one combined cohort study, and a double-blind clinical trial, and one case report with a sample size of animal models from two meta-analyzes, and one systematic review of 1266 and 1326 animal models and 1,085 patients in human studies. The results of most studies indicated a significant relationship between mesenchymal stem cell (MSCs) therapy and reduced mortality of sepsis syndrome and ARDS. The results of systematic studies also supported the efficacy and health of MSCs in the treatment of sepsis and ARDS. Patients tolerated high doses of intravenous or intrathecal therapy.

Multi-potency MSCs have an extraordinary ability to respond and manage the immune system and have been studied in animal and human studies as an immune regulatory tool in improving acute disease conditions such as sepsis and respiratory distress syndrome. Results of studies showed that these stem cells can be used clinically, but the need for more extensive studies, especially human studies in the future, is still recommended.

Burn remains a globally significant life-threatening problem, especially in developing countries, and infection is considered as a major complication among burn patients. The rate of antibiotic-resistant bacteria isolated from burn patients has demonstrated a significant increase. In this regard, this study aimed to determine the antibiotic resistance pattern in Staphylococcus aureus isolated from patients’ burn wound infections.

All available wound cultures of burn patients admitted to the burn unit of Emam-Reza hospital/ Mashhad, northeast Iran from March 2012 to March 2017 were included in this retrospective study. Then, the resistance of isolated S. aureus strains against 25 different antibiotic disks was studied based on the aim of the study.

Overall, 1973 patients were admitted, out of whom 4758 swab samples were taken from them. Out of 3188 micro-organisms isolated from burn wound cultures, 185 (5.8%) cases were S. aureus. Based on the results, the highest susceptibility rates were related to vancomycin (98.8%), cefazolin (72%), ciprofloxacin (75%), and gentamicin (74.6%).

In general, vancomycin, cefazolin, and ciprofloxacin appeared to be the most effective agents among all tested antibiotics for S. aureus. The extensive use of antibiotics in treating infections has resulted in the emergence of resistant strains. Routine microbiological surveillance and careful in vitro testing before antibiotic use may help in the prevention of the ever-increasing antibiotic-resistant pathogens in burn infections

The present study aimed to determine the mean blood glucose during the first 24 h post-surgery and its relation with the source of calorie intake. The data of the current observational retrospective study was collected from hospital medical records. A total of 45 neonates suffering from atresia in different parts of the gastrointestinal tract, who were candidates for open abdominal surgery from September to October 2016 were selected. Blood glucose within 24 h after the surgery were taken four times using a glucometer. Moreover, the mean blood glucose during this period was calculated. Independent Student's t-test, chi-square test, and logistic regression model were performed to assess the association of post-operative blood glucose with calorie and macronutrient intakes. In one third of neonates, the mean blood glucose of the samples during the first day after the surgery was ≥180 mg/dl and the rest of them had mean blood glucose of 40-179 mg/dl. There was a significant relationship between blood glucose BG≥180 mg/dl and calorie (P=0.001), macronutrient (carbohydrate (P<0.001), and fat (P=0.04)) intakes. After adjustment of confounding variables, carbohydrate intake was found as an independent factor in increasing BG≥180 mg/dl during the first 24 h after the surgery (P=0.01). In addition, fat intake was observed as an effective factor in decreasing BG≥180 mg/dl during this time (P=0.04). The present study revealed that there was a significant relationship between mean blood glucose during the first 24 h after the surgery and intake of macronutrients (carbohydrate and fat).

Congenital diaphragmatic hernia (CDH) is associated with high mortality due to pulmonary hypoplasia, pulmonary hypertension, and concomitant anomalies. This condition is identified by the presence of an orifice in the diaphragm (mostly to the left and posterolateral), leading to the herniation of the abdominal contents into the thorax. Morgagni hernia is a less common CDH, accounting for only 5-10% of CDH cases. It is an uncommon congenital herniation of the abdominal content through the triangular parasternal gaps of the anterior diaphragm. This condition usually affects the right side, and the patients are usually asymptomatic. Herein, we presented the case of a 15-month-old male infant with large Morgagni hernia resulting in poor weight gain. The presentation was unique due to its huge orifice, its accompaniment with gastrointestinal obstruction, and also its unremarkable radiologic findings. The patient was monitored by the follow-up team for 12 months. The follow-up revealed no recurrence, and the patient had favorable weight gain without any gastrointestinal symptoms.

  Regarding adverse effects of postpartum depression on maternal mental health and the reduction of mother-infant attachment, there is a need to comprehensively understand Edinburgh Postnatal Depression Scale (EPDS). We aimed to review the validity and reliability of the EPDS in Iranian population to provide comprehensive information for the health providers. The search procedure was fulfilled on the databases of Medline (via PubMed), Scopus, Cochran Library and Web of Science from inception to April 2018. The quality of studies was assessed by COSMIN checklist. Search keywords include (Edinburgh Postnatal Depression Scale) AND (Psychometric Properties). Three studies identified a two-factor structure and one study found a three-factor structure. Discriminant validity of the EPDS was able to differentiate three groups (minor depression, major depression, and healthy women); but failed to distinguish between women with caesarean section, and women with normal delivery. Internal consistency was reported by four studies. Cronbach’s alpha ranged from 0.7 to 0.79 for total EPDS score. Test-retest reliability was reported only in a study with Intraclass Correlation Coefficient (ICC) > 0.80. In terms of convergent validity, the EPDS was significantly positively correlated with General Health Questionnaire (GHQ) (r=0.76; p<0.001), and Hamilton Depression Rating Scale (HDRS) (r=0.62, p<0.001), and negatively with Short Form Health Survey (SF-36). Sensitivity was almost 0.74%, and specificity ranged from 0.80% to 0.93% at the cut-off point of Evidence to support the validity and reliability of the EPDS in Iranian population is sufficient as a screening tool for postnatal depressionto decrease damage to the mother and the baby.

Hyperglycemia is an independent risk factor for mortality in neonatal intensive care units (NICU). Herein, we aimed to investigate the relationship of hyperglycemia duration with mortality and ventilator dependence in infants admitted to NICU.
In this original retrospective study, data was collected between October 2015 and December 2015 from NICU of Dr. Sheikh Children’s Hospital in Mashhad, Iran. The studied samples (n=112) were 0-3 month old infants who were admitted to this hospital and were followed up until discharge. Information related to blood sugar was collected based on the samples routinely taken using a glucometer every six hours and were recorded in each patient's blood sugar chart.
Of the subjects, 46.4% (n=52) had blood sugar ≥ 126 mg/dl and 53.6% (n 60) had blood sugar ≤ 40-125 mg/dl. Mann-Whitney and logistic regression tests were used to analyze the data. In this study, we controlled the effect of confounding variables; a significant association was observed between mortality and duration of hyperglycemia (P=0.002). In addition, a significant association was observed between duration of hyperglycemia and ventilator dependence (P=0.02).
Our study showed that the duration of hyperglycemia is positively associated with mortality and ventilator dependence in infants admitted to NICU.

Despite recent pharmaceutical advancements in the production of new antibiotics, antibiotic resistance is increasing at an alarming rate in mammals; given the high prevalence of infectious diseases.

The current study aimed to determine the epidemiology of different infections in patients admitted to the infectious disease ward of Imam Reza hospital in Mashhad, North-East of Iran.

This cross-sectional study was conducted on 1681 patients referred to Imam Reza hospital of Mashhad during 2006 - 2008. Prepared checklists were used to collect the required data, including age, gender, employment status, place of residence, length of hospitalization and season of admission in patients diagnosed with infectious diseases.

In the current study, prevalence of tuberculosis, septicemia, skin and soft tissue infections, urinary tract infections (UTIs), febrile neutropenia, myocarditis, and gastrointestinal infections were estimated at 8.4%, 8.3%, 7.1%, 5.4%, 4.9%, 3.9%, and 3.8%, respectively. Also, major respiratory infections were reported in 5.8% of the studied patients. Among the female patients in the study, 20.9% and 10.56% were diagnosed with pneumonia and tuberculosis, respectively. As for the male patients, 16.1%, 10.7%, and 7.1% were diagnosed with pneumonia, nervous system infections and tuberculosis, respectively.

According to the results of the study, the most common causes of hospital admission were respiratory infections (e.g. pneumonia), nervous system infections, tuberculosis, septicemia, skin and soft tissue infections and UTIs. Considering the diversity of infections, epidemiological evaluation of these diseases is essential, especially in regions with high prevalence of infectious diseases. Furthermore, etiological diagnosis is considered imperative for clinicians before initiating therapy in patients with infectious diseases

The purpose of this study is to determine the frequency of hyperglycemia in nondiabetic critically ill children and to investigate its relationship withmechanical ventilation, length of stay andmortality.

In this original retrospective study, data was (were) collected between 2013 and 2014 from the pediatric intensive care unit data base of Sheikh’s Children Hospital inMashhad, Iran (one hundred admitted children).

From among 97 subjects, 49 subjects (50.5%) were hospitalized for more than 10 days, and the mean length of stay wa 14 days. The overall mortality rate was 16 subjects (16.5%) and frequency of hyperglycemia was 24 subjects (24.7%). The median fo blood glucose measurements was 100 mg/dl. Seventy three subjects (75.3%) had a mean blood glucose level in the normal range Overall, 18 subjects (18.6%) had at least one blood glucosemeasurement of 180mg/dL or higher. There was a significant association between hyperglycemia and mortality (P < 0.001). Linear regression analysis showed positive correlation between blood glucose level, length of stay and length of ventilation (P  0.001). The maximum serum glucose concentration positively correlated with duration of mechanical ventilation and length of stay (P < 0.001).

Our study found thatmaximumserumglucose concentration positively correlatedwith the duration of mechanica ventilation, length of stay, andmortality.

The most important change in medical education is a shift from didactic teacher-centered and subject-based teaching to the use of interactive, problem-based, student-centered learning. Student-centered approach is a teaching approach t that encompasses replacing lectures with active learning, integrating self-paced learning programs and cooperative group situations, ultimately holding the student responsible for his own advances in education. This study aimed to determine the attitudes of students towards learning method based on problem solving as a student-centered and their satisfaction from the student-centered learning method in the medical students of Mashhad University of Medical Science. this was a descriptive cross-sectional study. In total, 47 M.Sc. students of health (11 male and 36 female) was selected to participate in this study. We used convenience and purposeful sampling strategies. Data collection tools included an 8-items questionnaire to evaluate the student-centered approach in the course of disease in children. The questions were on a 5-point Likert scale ranging from never to more times. in total,eleventh male and 36 female participation in this study. The results of this study showed that there was a significant difference in the score of participation in the course of pediatric (t=8.86) (p<0.0001), the knowledge of the participants of this course in the other university (t=4.5) (p<0.0001), the conference is presented by students (t=9.14) (p<0.0001), the suitability of student-centered approach (t=5.65) (p<0.0001). However, there was no significant difference in the score of usefulness of the student-centered approach (t=0.58) (p=0.56). Also there was a significant difference in the score of interest in teaching by using student-centered approach (t=2.31) (p=0.025). The other results showed that the students preference the teacher-centered ten the student-centered approach (t=2.54) (p=0.014). Most studies comparing didactic teacher-centered and subject-based teaching showed that the majority of students interested to the traditional method of teaching. However, there is Evidence of increasing use of student-centered teaching style.