General Hospitals In Tehran Research Articles

Bipolar Spectrum in Patients with Conversion Disorder

Background: The frequency of bipolar spectrum in patients with conversion disorder is not well known, while it is important to be aware of comorbid bipolarity in the management of conversion disorder. Objectives: The study aimed to identify the frequency of bipolar spectrum disorder among people with conversion disorder and the factors associated with this comorbidity. Methods: The participants were 96 consecutive patients aged 18 - 65 years, referring to the emergency department or admitted to the psychiatric wards of two university general hospitals in Tehran, Iran, in 2019. Patients fulfilled the DSM-IV criteria for conversion disorder based on the structured clinical interview (SCID). The Mood Disorder questionnaire (MDQ) was used to identify bipolar spectrum disorder. Demographic characteristics and other relevant correlated factors were also recorded using a checklist. Data were analyzed using Pearson chi-square/Fisher’s exact test and logistic regression model. Results: The frequency of bipolar spectrum disorder based on the MDQ was 35.4% in patients with conversion disorder. The results of the logistic regression model using the Backward Conditional method showed that only two variables, namely antidepressant-induced mania/hypomania (OR = 39; CI 95%: 4.56 - 333.7) and history of hospitalization in the psychiatric ward (OR = 7.1, CI 95%: 2.05 - 24.65), remained as associated factors after controlling for other variables. Conclusions: Our study showed a higher frequency of bipolar spectrum disorder in patients with conversion disorder than did previous epidemiological studies in Iran and other countries. Such significant comorbidity should discourage potentially harmful off-label use of antidepressants for the treatment of conversion disorder instead of looking for other underlying psychiatric or social problems. Further research is suggested in this area.

Patient Flow Analysis in General Hospitals: How Clinical Disciplines Affect Outpatient Wait Times

Background: Overcrowding is an important problem for outpatient services in healthcare facilities. Patient flow analysis (PFA) is a useful method for identifying inefficiencies in and facilitating patient flow. Objective: PFA was used to estimate patient wait time and determine how different clinical disciplines impact wait times in the studied hospital. Methods: This cross-sectional study investigated a study population comprised of outpatients who referred to clinics at a general hospital in Tehran, Iran. A total of 3836 samples were selected from different stations. Nonrandomized quota sampling was used, and data was gathered using workflow checklists, the content validity of which was proven by experts and hospital authorities. SPSS statistical software was used for data analysis. Results: Total patient stay in the outpatient setting was an estimated 77 minutes (without considering para-clinic units and pharmacy). More than 90% of this time was spent waiting. The wait time of patients at the clinic was greater than that at other stations, and it was less at the cash station than at other stations. Wait times varied at different clinics (P value < 0.001) and were correlated with physician delay (P value < 0.001). Conclusion: The most important result of using PFA in the outpatient setting was managing wait times. This study indicated that a considerable amount of a patient’s total stay in the system was related to waiting for physical examinations. This suggests that the first priority in improving the system should be managing patient wait times for physical examinations.

Lymphovascular and Perineural Invasions Are Independently Associated with Advanced Colorectal Carcinoma

Background: Lymphovascular invasion (LVI) and perineural invasion (PNI) are relatively common in various malignancies including colorectal cancers and have been shown to have prognostic significance. Objectives: The aim of this study was to identify the clinical and pathological variables associated with LVI and PNI in patients with colorectal carcinoma, who have been treated at Milad General Hospital in Tehran, Iran. Methods: The records of the patients with the diagnosis of colorectal carcinoma, who had undergone an operation at Milad General Hospital (Tehran, Iran) between 2012 and 2017, were reviewed. All patients, whose pathology reports and treatment records were available at Milad Hospital, were included. Relevant demographic, pathological, and surgical data, including age, gender, tumor location, maximum tumor size, pathologic Tumor, Node, Metastasis (TNM) stage, and grade and number of removed lymph nodes were extracted from the medical records. Results: In total, 547 patients (374 cases of colon cancer and 173 cases of rectal cancer) enrolled in the study. The prevalence of LVI and PNI was 16.4% and 30.7%, respectively. LVI and PNI were found to be associated with higher tumor grade, higher T-stage, and higher overall stage. Conclusions: Colorectal carcinomas with positive LVI or PNI are more likely to have a higher grade, higher T-stage, and higher overall stage, and PNI is an independent factor for advanced disease.

The effectiveness of 8A model death education on the reduction of death depression: A preliminary study.

AimDeath education using the 8A model can reduce death distress and promote mental health. The aim of the present study was to investigate the effectiveness of the 8A model death education programme for reducing death depression among nurses. The hypothesis was that participating in the 8A model death education programme would reduce death depression.DesignA pre‐test–post‐test intervention.MethodsTen nurses were selected randomly from the intensive care units and critical care units wards of the Khatom‐Al‐Anbia General Hospital in Tehran, Iran. They completed the Death Depression Scale before and after intervention. The 8A model was conducted in six workshops weekly, each of 6 hr, for a total of 36 hr.ResultsThere was a significant difference between pre‐test and post‐test on the Death Depression Scale scores.DiscussionThe 8A model appears to be useful for the reduction of death depression and the promotion of mental health in the sample. However, the model should be tested on larger samples and with a control group before concluding that the model is effective in reducing death distress.

Assessment of the belief and attitudes of Iranian healthcare personnel's toward the influenza infection and influenza vaccination.

SummaryIntroductionInfluenza is one of the main public health problems and health care personnels (HCPs) are one of the at-risk groups for this infection. The goal of the current study was to identify the beliefs and attitudes of the Iranian HCPs about influenza and the influenza vaccine.MethodsThis cross-sectional study was performed in a general hospital in Tehran, Iran from January to June 2016. A total of 418 questionnaires were distributed among the HCPs. The Chi2 test, linear regression and one-way ANOVA were used for data analysis, α: 0.05 was considered as a statistically significant level. All analyses were performed using the SPSS19 software.ResultsThe influenza vaccination coverage was 57.7%; the highest vaccine rate belongs to the allied health professionals (68.2%). Two main causes for avoiding the influenza vaccination were; the “fear of vaccine adverse effects” and the “uncertainty about the vaccine effectiveness”. The linear regression analysis identified that the physicians had the highest belief score, followed by the nurses and the allied health professionals (p < 0.001).ConclusionsEducational planning on influenza and influenza vaccination is necessary to improve the vaccination coverage and to reduce the influenza mortality and morbidity in susceptible patients.

Smoking Ban in Psychiatric Inpatient Unit: An Iranian Study on the Views and Attitudes of the Mental Health Staff and Psychiatric Patients.

Although the move to smoke-free mental health inpatient settings is an internationally common and popular trend, these policies are neither implemented nor supported by any national program in Iran. This study investigates the attitude of mental health staff and psychiatric patients toward smoking cessation in 2 psychiatric inpatient units (psychosomatic and adult general psychiatry) in the Taleghani general hospital in Tehran. One hundred and twenty participants of this cross-sectional study consist of 30 mental health staff and 90 psychiatric patients. An eight-item questionnaire was used for collecting information. Both staff and patients expressed a positive attitude towards smoking cessation. Patients favoured the implementation of these policies and expressed a more positive attitude towards the feasibility. Sixty-three percent of patients and 57% of staff were opposed to smoking in the units. Seventy percent of patients reported the smoke-free ban as a feasible policy compared to 45% of staff who did the same. The implementation of the smoke-free policy has more support in both staff and patients than the continuation of smoking in psychiatric units. There is a need for an ongoing education and training for mental health care providers, in order to have a successful implementation of smoke-free policy.

Implementation of the surgical safety checklist in hospitals of Iran; operating room personnel’s attitude, awareness and acceptance

PurposeThe WHO Surgical Safety Checklist (SSC) has improved patient safety effectively. Despite the known benefits of applying the checklist before surgery, its implementation is less than universal in practice. The purpose of this paper is to determine the operating room personnel’s attitude, their awareness and knowledge of the SSC, and to evaluate staff acceptance of the SSC (including personal beliefs).Design/methodology/approachThis cross-sectional study was conducted in eight tertiary general hospitals in Tehran, Iran. Some 145 operating room personnel (surgeons, anaesthetists and nurses) were selected for the study. Data collection was carried out via a validated questionnaire in three parts which included socio-demographic, attitude, awareness and acceptance. Data were then analysed using the Kruskal–Wallis and χ2 statistical test.FindingsOut of the 145 participants in the study, 92 per cent were aware of the existence of the SSC and 73.9 per cent of them were aware of the objectives of SSC. Overall, the attitude to SSC was positive. The attitude of surgeons was positive towards the impact of the SSC on safety and teamwork. Surgeons were significantly more sensitive to the barriers of SSC application compared to nurses and anaesthetists (p=0.046). Among the three groups, nurses had the highest level of support for SSC (p=0.001).Practical implicationsDespite high acceptance of the checklist among staff, there is still a gap in knowledge about when exactly the checklist should be used. Therefore, involvement of all surgical team members to complete the checklist process, support of senior managers, on-going education and training and consideration of the barriers to its implementation are all key areas that need to be taken into account.Originality/valueThis is the first research to examine the operating room personnel’s attitude, awareness and acceptance about SSC in Iranian hospitals. The outcomes of this study provide documentation and possible justification for effective establishment of SSC in Iran and other countries.

Effective and organ doses from common CT examinations in one general hospital in Tehran, Iran

Abstract Purpose: It is well known that the main portion of artificial sources of ionizing radiation to human results from X-ray imaging techniques. However, reports carried out in various countries have indicated that most of their cumulative doses from artificial sources are due to CT examinations. Hence assessing doses resulted from CT examinations is highly recommended by national and international radiation protection agencies. The aim of this research has been to estimate the effective and organ doses in an average human according to 103 and 60 ICRP tissue weighting factor for six common protocols of Multi-Detector CT (MDCT) machine in a comprehensive training general hospital in Tehran/Iran. Methods: To calculate the patients' effective dose, the CT-Expo2.2 software was used. Organs/tissues and effective doses were determined for about 20 patients (totally 122 patients) for every one of six typical CT protocols of the head, neck, chest, abdomen-pelvis, pelvis and spine exams. In addition, the CT dosimetry index (CTDI) was measured in the standard 16 and 32 cm phantoms by using a calibrated pencil ionization chamber for the six protocols and by taking the average value of CT scan parameters used in the hospital compared with the CTDI values displayed on the console device of the machine. Results: The values of the effective dose based on the ICRP 103 tissue weighting factor were: 0.6, 2.0, 3.2, 4.2, 2.8, and 3.9 mSv and based on the ICRP 60 tissue weighting factor were: 0.9, 1.4, 3, 7.9, 4.8 and 5.1 mSv for the head, neck, chest, abdomen-pelvis, pelvis, spine CT exams respectively. Relative differences between those values were -22, 21, 23, -6, -31 and 16 percent for the head, neck, chest, abdomen-pelvis, pelvis, spine CT exams, respectively. The average value of CTDIv calculated for each protocol was: 27.32 ± 0.9, 18.08 ± 2.0, 7.36 ± 2.6, 8.84 ± 1.7, 9.13 ± 1.5, 10.42 ± 0.8 mGy for the head, neck, chest, abdomen-pelvis and spine CT exams, respectively. Conclusions: The highest organ doses delivered by various CT exams were received by brain (15.5 mSv), thyroid (19.00 mSv), lungs (9.3 mSv) and bladder (9.9 mSv), bladder (10.4 mSv), stomach (10.9 mSv) in the head, neck, chest, and the abdomen-pelvis, pelvis, and spine respectively. Except the neck and spine CT exams showing a higher effective dose compared to that reported in Netherlands, other exams indicated lower values compared to those reported by any other country.

Association between Managers’ Competency and Technical Efficiency in General Hospitals in Iran

Introduction: Inefficient management of hospitals leads to the substantial waste of resources. Therefore, hospital efficiency has recently been a major concern among researchers. The present study aimed to evaluate the association of the management competency and technical efficiency in the general hospitals of Tehran, Iran. Materials and Methods: This descriptive-analytical, cross-sectional study was conducted in 28 general hospitals in Tehran, Iran in 2015. In the first step, a survey was performed among 224 managers at different levels in the hospitals using a researcher-made management competency self-assessment questionnaire. In the second step, technical efficiency in the selected hospitals was measured by the Data Envelopment Analysis (DEA). Data analysis was performed using SPSS, Enterprise Management Software (EMS), and Deap1, 2. Results:The average of competency was relatively high among the hospitals managers. However, more than half of the hospital performances were observed to be inefficient. Moreover, the results indicated that the competency of hospital managers was significantly correlated with their field of education, participation in training courses, and managerial experience. Also, a significant, direct association was observed between the competency of managers and technical efficiency in the studied hospitals. Conclusion: According to the results, although the level of technical efficiency was favorable in the studied hospitals, the hospital managers with high competency should further develop and improve their performance and efficiency in these hospitals.

Relative frequency of human papillomavirus genotypes and related sociodemographic characteristics in women referred to a general hospital in Tehran, 2014- 2015: A cross-sectional study

Human papilloma virus (HPV) is one of the major public health problems and the main causes of cervical cancer. The prevalence HPV infection in developing countries with low financial resources is high. This study aimed to determine the relative frequency of HPV genotypes and its sociodemographic characteristics in women referred to a general hospital in Tehran, Iran from 2014-2015. This cross-sectional study was performed in 400 women with Pap smear samples, referring to to a general hospital in Tehran, Iran from 2014-2015. The detection of 28 HPV genotypes was performed by using the Multiplex PCR technique. The sociodemographic survey was conducted for each HPV positive woman. HPV-positive infection was detected in 155 (38.75%) women aged 17-85 years. HPV 16 (19.1%) was the most prevalent type, followed by HPV 39 (12.5%) and HPV 18 (8.9%). The highest rate of HPV infection was observed at the age of 36 years (7.7%). The level of education and economic situation of each woman were showed most of HPV-positive women had a high school diploma (34.6%) and average economic situation (67,9%). 60.9% of these women were a housewife, and 67.3% lived in the capital . Determination of HPV genotype and risk factor related to HPV infection in each geographical region can lead to the production of effective vaccines against the HPV virus. It can also be useful for disease management and high sensitivity diagnosis of cervical intraepithelial neoplasia.

Contamination of Senior Medical Students’ Cell Phones by Nosocomial Infections: A Survey in a University-Affiliated Hospital in Tehran

Background and Purpose: Nosocomial infections are a growing problem in many health centers. Cell phones used by the medical staff can act as a vector for nosocomial transmission of microorganisms. This study aimed to investigate the role of cell phones of senior medical students in the spread of nosocomial bacterial infections in Amir-al-Momenin general hospital in Tehran in September 2015. Methods: Thirty medical students were enrolled using convenience sampling method. Demographic data, perspectives, attitudes, phone type, and frequency of cleaning of mobile phones were collected by questionnaires. Samples were taken from the phones using a sterile swab moistened with a nutritive medium in order to assess the possibility of bacterial growth. Results: A total of 53.3 percent of mobile phones were infected. Isolated bacteria were: Staphylococcus epidermidis (26.7%), Non-albicans Candida (16.7%), Bacillus PSP (13.3%), Micrococcus PSP (10%), non-hemolytic Streptococcus and Enterococcus (each 6.7%), and Klebsiella and Staphylococcus aureus (each 3.3%). Conclusions: Mobile phones can act as potential carriers of nosocomial infections which are significantly higher in male students’ phones and in smartphones. So, some restrictions should be applied to their use in sensitive areas of hospitals. Also, due to the significant impact of cleaning mobile phones in reducing the frequency of bacterial contamination, attention to their regular cleaning should be considered.

Elements of healthy death: a thematic analysis.

Background: Death is a natural and frightening phenomenon, which is inevitable. Previous studies on death, which presented a negative and tedious image of this process, are now being revised and directed towards acceptable death and good death. One of the proposed terms about death and dying is "healthy death", which encourages dealing with death positively and leading a lively and happy life until the last moment. This study aimed to explain the views of Iranians about the elements of healthy death. Methods: This qualitative study was conducted for 12 months in two general hospitals in Tehran (capital of Iran), using the thematic analysis method. After conducting 23 in-depth interviews with 21 participants, transcription of content, and data immersion and analysis, themes, as the smallest meaningful units were extracted, encoded and classified. Results: One main category of healthy death with 10 subthemes, including dying at the right time, dying without hassle, dying without cost, dying without dependency and control, peaceful death, not having difficulty at dying, not dying alone and dying at home, inspired death, preplanned death, and presence of a clergyman or a priest, were extracted as the elements of healthy death from the perspective of the participants in this study. Conclusion: The study findings well explained the elements of healthy death. Paying attention to the conditions and factors causing healthy death by professionals and providing and facilitating quality services for patients in the end stage of life make it possible for patients to experience a healthy death.

Detection of pbp2b Gene and Antimicrobial Susceptibility Pattern of Streptococcus Pneumoniae Isolates in Tehran Hospitals, Iran

Background: Streptococcus pneumoniae is the major cause associated with otitis, sinusitis, bronchitis, and pneumonia, as well as an outstanding cause of meningitis, bacteremia, and many other infections. Throughout the world, an increase in antibiotic resistance S.pneumoniae has become a serious problem in the recent years in many different countries. Penicillin resistance in S. pneumoniae cause of altered on the penicillin target position, the penicillin-binding proteins (PBPs). Objectives: In the present study, we describe the prevalence and antimicrobial susceptibility pattern and identification of the pbp2b gene of S. pneumoniae isolates at specimens of several general hospitals in Tehran, the capital of Iran. Methods: A total of 73 S. pneumoniae were obtained from various clinical specimens from hospitals in Tehran from September 2012 to July 2015. Antibiotic susceptibility of isolates was determined by the broth microdilution method. The genes pbp2b in penicillin-resistant streptococcus pneumoniae (PRSP) were detected using polymerase chain reaction (PCR). Results: In total, 73 isolates were collected and diagnosed as S. pneumoniae. Isolates were susceptible to ofloxacin 95.9%, vancomycin 93%, penicillin 78%, trimethoprim-sulfamethoxazole 61.6%, ceftriaxone 53.5%, meropenem 52%, cefotaxime 46.5%, and erythromycin 8.2%. Of the 15 PRSP isolates, the pbp2b gene was identified in 12 (80%). In 1 penicillin-intermediate S. pneumoniae isolate the pbp2b was detected. Conclusions: These results in comparison with same studies in other parts of the world showed us an increase in resistant S. pneumoniae isolates to conventional drugs in the treatment of the acute infections caused by this bacteria. In the present study, PRSP possess the pbp2b gene were the most frequently found, which means they have a high level of resistance of S. pneumoniae. For decreasing the mortality and morbidity of patients, it is suggested to determine the antibiotic susceptibility pattern of the isolates in each hospital for doing necessary medical interventions.

Prevalence of Substance Abuse/Alcohol Consumption and their Predictors among Patients Admitted in Operating Rooms of a General Educational Hospital, Tehran, Iran

Substance/alcohol abuse is an important public health threat in most countries. Social stigmatization and legal restrictions prevent accurate and direct estimate of prevalence of substance/alcohol abuse in Iran. This study aimed to estimate of the prevalence of alcohol and substance use among Iranian patients who were admitted to operating rooms of a general hospital in Tehran and identified risk factors that may predict alcohol and substance use. This cross-sectional study was conducted among all consecutive patients who were admitted to 16 operating rooms in Vali-e-Asr General Educational Hospital (Tehran, Iran) during March 2014 to September 2015. Data were derived from a medical history form prior to operation by trained nurses who were working in the operating rooms. Among 1136 patients admitted to operating rooms, 105 (28.7%) men and 21 (2.7%) women were substance/alcohol users. The main substance of abuse was opium (57.3%) followed by alcohol consumption (25.6%) and water pipe smoking (14.8%). Cigarette smoking was reported by 110 (30.1%) men and 21 (2.7%) women. Sex, cigarette smoking and family history of alcohol and substance abuse predicted 42.3% of the variance in substance abuse/alcohol consumption. Substance use, especially opium, alcohol, water pipe tobacco and cigarette smoking were found to be significantly high particularly among male patients. Being a man, current cigarette smoking and having a first-degree family member who had abused substances should be considered when planning preventive or therapeutic programs.

Penile Improvement Protocol in Postoperative Management of Patients Undergoing Metoidioplasty.

To introduce a postoperative protocol to optimize the final size of the penis in patients undergoing metoidioplasty. Fourteen patients with the mean age of 29.3years (8-40±11.7), ten female transsexuals (46 xx karyotype) and four with 5-alpha-reductase deficiency syndrome (5ARDS) who had undergone extensive metoidioplasty entered a penile improvement protocol (PIP) between 2007 and 2015 at a specialized clinic in a general hospital in Tehran, Iran. Subjects were thoroughly instructed, rehearsed on the protocol and closely followed for 24weeks. Written informed consent was obtained from all participants. We adapted a popular device, the so-called penile traction device, to accommodate the size of the neo-penis. All patients achieved an increase in their penile length with a mean of 28.42mm (21-47±6.86). Two subjects developed penile bruises and edema during the protocol implementation. No significant procedural complications were detected in the remaining 12 participants. PIP can be an effective step in increasing the size of the neo-penis in patients who have undergone metoidioplasty. We suggest this procedure to be seriously considered in postoperative management of well-informed and motivated patients to improve the final penile length and function in this population. Larger studies are needed to further validate this protocol. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Extensive Metoidioplasty as a Technique Capable of Creating a Compatible Analogue to a Natural Penis in Female Transsexuals.

To introduce the operative technique of "extensive metoidioplasty" (EM) in female transsexual surgery, for achieving an effective reconstruction of a male-appearing, normally functioning, fully sensate and erectile external genitalia. Ten female transsexuals (46 xx karyotype) between the ages of 20 and 40 years underwent EM as their sex reassignment surgical procedure with the mean operative time of 171 min (45-211, SD 19.55 min) between 2007 and 2014 in a general hospital in Tehran, Iran. Subjects were closely followed for the mean time of 68.4 months. All participants were thoroughly rehearsed about the nature of their surgical procedure and an informed written consent was obtained before surgery. We extensively detached the native clitoris to the point of a nearly complete detachment from its attachments to the pubic arch and approximated the originally divergent corporal bodies to each other. We were also able to increase the penile size by the application of PEP, a procedure which is in practice at our clinic. Postoperatively all ten patients achieved a mean penile length of 8.7 (6-12) cm and 7/10 (70 %) were capable of obtaining erection, rigid enough for intromission. We did not observe any significant postoperative complications. EM in association with the application of PEP could result in a natural-looking, erotically fully sensate and functional penis in majority of female transsexuals undergoing this procedure. This operative technique should be given serious considerations in well-informed female transsexual. Larger studies may be needed to validate this technique further. This journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

The Value of ABCD2F Scoring System (ABCD2 Combined with Atrial Fibrillation) to Predict 90-Day Recurrent Brain Stroke.

Background. The ABCD2 score is now identified as a useful clinical prediction rule to determine the risk for stroke in the days following brain ischemic attacks. Aim. The present study aimed to introduce a new scoring system named “ABCD2F” and compare its value with the previous ABCD2 system to predict recurrent ischemic stroke within 90 days of the initial cerebrovascular accident (CVA). Methods. 138 consecutive patients with the final diagnosis of ischemic CVA or TIAs who referred to emergency ward of Rasoul-e-Akram general hospital in Tehran from September 2012 to December 2013 were eligible. By adding a new score in the presence of atrial fibrillation to ABCD2 system, the new scoring system as ABCD2F was introduced and the risk stratification was done again on this new system. Results. The area under the curve for ABCD2 was 0.434 and for ABCD2F it was 0.452 indicating low value of both systems for assessing recurrence of stroke within 90 days of primary event. Multivariable logistic regression analysis showed that none of the baseline factors could predict 90-day recurrent stroke. Conclusion. ABCD2 and/or atrial fibrillation are not good scoring candidates for assessing the risk of recurrent stroke within first 90 days.

Antimicrobial Susceptibility Pattern of Enterococci Isolated From Patients in Tehran

Background: Enterococci are one of the most common nosocomial pathogens and the emergence of multidrug-resistant strains has been increasing. Objectives: We studied the antimicrobial susceptibility of enterococci isolated from different clinical specimens of patients in Tehran. Materials and Methods: From the beginning of April 2013 to the end of June 2013, a total of 146 enterococci were isolated from the Pars General Hospital in Tehran. The antimicrobial susceptibility pattern of the isolates against ampicillin, clindamaycin, ciprofloxacin, erythromycin, levofloxacin, linezolid, nitrofurantoin, tetracycline, and vancomycin was determined using the disk diffusion method according to the guidelines of clinical laboratory standards institute (CLSI). Results: The rates of resistance were high to clindamycin, tetracycline, and erythromycin (97.2%, 89%, and 74.5%, respectively); moderate to ciprofloxacilin and levofloxacilin (40.6% and 36.4%, respectively); and low to ampicillin and nitrofurantoin (13.8% and 3.5%, respectively). All isolates were linezolid sensitive. Vancomycin-resistant enterococci (VRE) accounted for 9.6% of the isolates. Conclusions: VRE and a high rate of resistance to some of antimicrobial agents were found among the enterococci isolated from patients in Tehran. These findings highlight the importance of regular supervision of antimicrobial susceptibilities.

Neurological symptoms in psoriasis patients under treatment with infliximab

ObjectiveTo study the neurological symptoms of psoriasis patients who used infliximab. MethodsWe studied psoriasis patients who used infliximab in two referral general hospitals in Tehran from January 2013 to January 2014. We completed neurological symptoms checklists by questioning the patients. ResultsSixty patients with psoriasis were included in this study. Among them, 3 patients had sensory symptoms as side effect and one patient showed motor symptoms as side effect. There was no statistically significant difference between age, gender, and session count with the sensory and motor side effects (P > 0.05). ConclusionsNeurological symptoms can be detected among 6% of patients under treatment with infliximab and there is no significant association between symptoms and gender, duration of drug use as well as age.

Physicians' attitudes toward integrating consultation-liaison psychiatric services in four major general hospitals in Tehran

ObjectiveOur objective was to validate a scale for the evaluation of attitudes of physicians toward integrating consultation-liaison psychiatric services and then apply it among the nonpsychiatrist attending physicians of four major general hospitals in Tehran. MethodThe eight-item Doctors' Attitudes toward Collaborative Care for Mental Health (DACC-MH) Scale was translated to Persian and back-translated to English by nonphysician translators and was presented for expert opinion to four psychiatrists for assessment of face validity. The validated questionnaires were presented to nonpsychiatrist attending physicians of four major general university-affiliated hospitals with consultant-liaison psychiatric services in Tehran, and the returned questionnaires were analyzed using the 21st version of SPSS software. The score for each physician was generated by counting positive responses of the eight items questioned. ResultsOf the 300 questionnaires presented, 193 (64.3%) were returned. The mean score of the respondents was 6.62 (±1.33) for the Farsi version of the DACC-MH which was significantly higher than the assumed mean score of 4, according to the independent-sample t test (P<.001). The mean score of the respondents for the first four items of the DACC-MH was 3.49, which was significantly higher than that of the second four items of the scale which was 3.13 (P<.01) according to the Wilcoxon test. ConclusionThe respondents have an above-average positive attitude toward integrating consultation-liaison psychiatric services for the management of psychiatric disorders among inpatients. They had a more positive attitude toward requesting psychiatric consultations than managing the patients' psychiatric disorders themselves.