Hospitals In Ahvaz Research Articles

Assessment of Mortality Rate, Need for ICU Admission and Ventilation in COVID-19 Patients with Diabetes Mellitus.

Introduction: Coronavirus disease 2019 (COVID-19) has become a threat to public health. People with chronic diseases, such as diabetes, are at a greater risk of severe diseases and death upon contracting this new disease. Due to the novelty of COVID-19, no specific information is available about the degree of its mortality and risk factors among diabetic patients. Therefore, this study aims to compare diabetic and nondiabetic COVID-19 patients regarding mortality rate, the need for intensive care unit (ICU) admission, invasive and noninvasive ventilation, and the associated risk factors.Methods: This was a cross-sectional study performed on the medical records of 650 adult COVID-19 patients (325 diabetics and 325 nondiabetics) admitted to Razi Hospital in Ahvaz from March 2020 to September 2020.Results: The mean age of the patients was 61.3 years in the diabetic group and 52.3 years in the nondiabetic group. Men comprised 48.3% of the diabetic group and 59.7% of the nondiabetic group. Diabetic patients suffered from significantly more underlying diseases, such as ischemic heart disease (IHD), hypertension (HTN), chronic kidney disease (CKD), and acute renal failure (ARF) compared to the nondiabetic group (p < 0.0001). Also, when compared with the nondiabetic group, the diabetic group had a significantly higher mortality rate (17.5% vs. 12%; p = 0.047, respectively), more ICU admissions (35.4% vs. 27.7%; p = 0.035, respectively), and a greater need for invasive ventilation (17.5% vs. 11.4%; p = 0.026, respectively).Conclusion: In diabetic patients, the mortality rate, need for ICU admission, and need for invasive ventilation were significantly higher than nondiabetic patients. Our logistic regression analysis in diabetic patients with COVID-19 showed that age, CKD, and ARF were the risk factors affecting mortality. In contrast, age and CKD were the risk factors affecting the rate of ICU admission, and CKD and ARF were the risk factors affecting the need for invasive ventilation.

Evaluation of Complications and Effectiveness of Snodgraft Method on the Treatment of Distal Hypospadias or Midshaft.

Objective:Hypospadias is one of the most common diseases of the male reproductive system. Considering the different treatment techniques for this anomaly and important complications such as fistula, meatal/neourethral stenosis, an attempt is made to use a method that has the best result and the least complication for treatment. The aim of this study was to evaluate the snodgraft method in repairing distal or midshaft hypospadias in terms of complications, beauty and effectiveness.Methods:In this retrospective study, conducted Oct 2018 to Oct 2020, 60 boys with distal hypospadias or midshaft who underwent the methods of Snodgraft in Imam Khomeini and Abuzar Hospitals of Ahvaz, southern Iran were enrolled. All patients were followed up and examined for postoperative complications after surgery with intervals of 1 week, 2 weeks, monthly to 6 months and then annually.Results:The mean age of patients was 30.1±11.3 months. No surgical diverticulitis or meatal stenosis was seen after surgery. Urethrocutaneous fistula was seen in 4 patients at initial follow-up, of these 4 patients, 1 spontaneous improvement was seen after 6 months. Urinary status was normal in all patients. Bleeding, hematoma and meatus stenosis were not observed in patients. In all patients, the appearance of meatus was very good and similar to normal people.Conclusion:The snodgraft surgery method in repairing hypospadias is a very simple, appropriate method and with a good appearance of Glans and Meatus, and the complications of this technique are few and acceptable. To confirm our findings, prospective studies with larger sample size of patients are needed.

Frequency of retinopathy of prematurity at a tertiary referral center.

With advances in medical facilities and increased survival of premature infants, the prevalence of retinopathy of prematurity (ROP) has increased. This study aimed to determine the frequency of ROP and its associated risk factors. This descriptive-analytical, retrospective study included all premature infants with a birth weight (BW) ≤ 2,500 g and/or gestational age (GA) ≤ 35 weeks who were referred to Imam Khomeini Hospital in Ahvaz, Iran, for ROP screening over a 7-year period from April 2013 to April 2020. Demographic criteria, associated risk factors, and findings of eye examinations were collected and analyzed. Of the 812 at-risk infants screened, 807 met the inclusion criteria. ROP was observed in 316 (39.0%) of the 807 premature infants, with types I and II in 142 (45.0%) and 174 (55.0%) infants, respectively. The mean (SD) GA (29.6 [2.5] weeks versus 30.7 [2.5] weeks) and BW (1,203.6 [382.8] g versus 1,333.5 [386.5] g) were significantly lower in infants with ROP than in those without ROP (both P < 0.001). GA (r = 0.80; P < 0.001) and BW (r = 0.85; P < 0.001) had a strong positive correlation with ROP, and the correlation increased as GA and BW decreased (all P < 0.001). Associated risk factors in infants with ROP, in order of frequency, were oxygen therapy (22.8%), respiratory distress (16.1%), phototherapy (14.6%), blood transfusion (5.7%), apnea (4.1%), mechanical ventilation (1.6%), and intraventricular hemorrhage (0.9%). Multivariate regression analyses showed low GA and BW (both P < 0.05) as independent predictors of ROP. The frequency of ROP in premature infants was slightly higher than the average range reported for domestic and foreign statistics. Low BW and GA were independent predictors of ROP.

Mothers' involvement in assessing feeding skills of premature infants

ObjectiveAmong the problems faced by premature infants after birth are weakness in oral-motor skills and an inability to achieve oral feeding independence. The Early Feeding Skills (EFS) Assessment is a tool for identifying infant's feeding ability level and determining the levels at which an infant requires support for safe and efficient feeding. Given the effective role of mothers and their involvement in taking care of premature infants and the importance of examining the psychometric properties of tools used for assessing infant's feeding, this study aimed at evaluating inter-rater reliability (between mother and rater) using the EFS Instrument. MethodsThis is a cross-sectional study. Participants in this study included 30 mothers with premature infants admitted to the NICU ward of Imam Khomeini Hospital in Ahvaz, Iran. To evaluate the inter-rater reliability of the “Early Feeding Skills (EFS) Assessment Instrument”, feeding skills of the infants were evaluated by the mother and a rater. Statistical analysis was carried out using Intraclass Correlation Coefficients (ICC) in SPSS software (Ver. 22). ResultsThe inter-rater reliability of the total score for each section of the EFS Instrument was good (ICC >0.75). ICC values for inter-rater agreement in assessing Oral Feeding Readiness, Ability to Maintain Engagement in Feeding, Ability to Organize Oral-Motor Functioning, Ability to Coordinate Swallowing, Ability to Maintain Physiologic Stability, and Oral Feeding Recovery were 0.87, 0.94, 0.91, 0.85, 0.95 and, 0.80, respectively. ConclusionIf mothers are appropriately trained on the EFS assessment, they can actively participate with the health care professionals providing care to their children. Furthermore, remote participation is possible. The findings of this study revealed significant inter-rater reliability.

Occurrence of plasmid-mediated quinolone resistance genes in Pseudomonas aeruginosa strains isolated from clinical specimens in southwest Iran: a multicentral study

This study aimed to assess the presence of qnrA, qnrB, qnrC, qnrD, qnrS, qepA, and aac(6′)-Ib-cr determinants as well as quinolone resistance pattern of clinical isolates of P. aeruginosa in Ahvaz, southwest Iran. A total of 185 clinical isolates of P. aeruginosa were collected from 5 university-affiliated hospitals in Ahvaz, southwest Iran. The disk diffusion method was applied to assess the quinolone resistance pattern. The presence of qnrA, qnrB, qnrC, qnrD, qnrS, qepA, and aac(6′)-Ib-cr genes was investigated by the polymerase chain reaction (PCR) method. Overall, 120 (64.9%) isolates were non-susceptible to quinolones. The most and the less quinolone resistance rates were observed against ciprofloxacin (59.4%) and ofloxacin (45.9%), respectively. The prevalence rates of qnr genes were as follows: qnrA (25.8%), qnrB (29.2%), and qnrS (20.8%). The qnrB gene was the most common type of qnr genes. The qnr genes were occurred in 37.5% (n = 45/120) of quinolne-resistant isolates, simultaneously. The qnrC, qnrD, qepA, and aac(6′)-Ib-cr genes were not recognized in any isolates. In conclusion, the ofloxacin was the most effective quinolone. This study was the first to shed light on the prevalence of PMQR genes among P. aeruginosa isolates in southwest Iran.

Explaining the Psychological Distress of Women with High-Risk Pregnancies in Iran: A Qualitative Study.

Psychological Distress (PD) is one of the most common mental disorders during pregnancy and involves stress, anxiety, and depression. According to the literature, High-Risk Pregnancy' (HRP) is a major physiological risk factor associated with PD during pregnancy. The main purpose of this study was to explore the perception and experience of women with HRP who, based on standard questionnaires, had moderate-to-severe stress and anxiety scores. This qualitative study was conducted using conventional content analysis from December 2020 to June 2021. To this aim, 16 women with HRP were purposefully selected from Imam Khomeini Hospital in Ahvaz, Iran, with maximum diversity. In-depth, semi-structured, individual interviews were conducted to collect the data. The MAXQDA software was used for data analysis. Data analysis led to the extraction of two main categories and nine subcategories. "Disrupted peace" and "inefficient adaptation to the situation" were the two extracted categories. The former included the five subcategories of concerns about pregnancy complications, concerns about the parenting process, concerns about the couple's relationship, fear of Covid-19, and occupation-related stress. The latter included the three subcategories of unpleasant feelings, current pregnancy experiences, and previous pregnancy experiences. This study highlighted a wide range of psychosocial factors involved in the PD of women with HRP. These findings can be used to design appropriate prevention strategies to manage the mental health problems of these women in order to turn their pregnancy into a pleasurable experience.

Measurement of Lead Concentration in the Blood of Patients Undergoing Appendectomy and Cholecystectomy

Background and Objectives Lead poisoning is a life-threatening condition due to its acute and chronic effects.Therefore, preventive methods are very important to prevent the multiple toxic effects of this metal.Due to the lethal effects of lead and its increasing concentration in the environment, this study was designed and performed to measure the concentration of lead in the blood and tissue of patients undergoing appendectomy and cholecystectomy. Methods In a cross-sectional study that was performed on patients with appendectomy or cholecystectomy in Razi Hospital in Ahvaz during a period of twelve months from May 2019 to May 2020. We examined 120 patients in three groups of appendectomy (n=40), cholecystectomy (n=40) and control (n=40).Blood samples were taken from all three groups. Then, after the operation, a pathology sample was taken from the appendix or gallbladder from patients in two groups who underwent appendectomy and cholecystectomy. X-ray Imaging was used to check for lead. Results Our results show well the mean blood lead concentration in the appendectomy group. In the cholecystectomy group and in the control group, the difference between the three groups was statistically significant (P&lt;0.001). Also, lead was found in 21 samples (52.5%) from the appendectomy group and lead in 23 samples(57.5%) from the cholecystectomy group, but this difference was not statistically significant. (P= 0.175). Conclusion Based on the results of this study, it can be said that chronic exposure and lead poisoning may play a role in the occurrence and change of gallstones and appendicitis.

Drug Utilization Evaluation of Colistin: A Retrospective Study

Background: Colistin, is used as the last treatment line for infections concluded from multiple drug-resistant gram-negative microorganisms. Increased consumption of colistin leads to resistance to this antibiotic in many countries. This study investigated the usage pattern of colistin administration in a selected hospital in Iran. Methods: This study was conducted in a selected hospital in Ahvaz. Inclusion criteria were all patients who received colistin during this time according to the health information system. Patients who were received less than three doses of colistin were excluded from the study. Prescription of colistin in all patients was evaluated according to the protocol extracted from the last version of Lexicomp written by Wolters Kluwer. The descriptive and analytical statistics were carried out by the R software. Results: Among 27 patients who received colistin, pneumonia (30%) was the main diagnoses. Colistin administration was based on the microbiological culture data in 70% of cases. Considering the involved microorganism, most cases were Acinetobacter spp., followed by Klebsiella spp. Loading dose was prescribed for seven (26%) patients. In only five (19%) cases, colistin dosing, including loading dose, maintenance dose, and the interval of colistin administration, was appropriate during the study time. Increasing in serum creatinine was seen in two (7.4%) patients. In 29.4% of patients, the combination of colistin and carbapenems was observed. Conclusion: Given the lack of appropriate dose adjustment of colistin that may lead to incidence of resistance and adverse effect, applying of the specialist clinical pharmacist will be suggested.

The effect of different doses of vitamin D on the prognosis of patients undergoing carpal tunnel syndrome surgery.

Vitamin D accelerates myelin repair and recovery after nerve damage. This study aimed to evaluate the effect of vitamin D on the prognosis of patients with carpal tunnel syndrome (CTS). A randomized clinical trial was conducted in the orthopedic ward of Golestan and Imam Khomeini hospitals in Ahvaz for 2 years (from October 2018 to October 2020). Patients were divided into three groups: the first group received 1,000 units of vitamin D daily, the second group received 4,000 units of vitamin D per week for the first 4-6 weeks and then 2,000 units per month, and the third group received no vitamin D supplementation. The results were compared before and after 6 months between the study groups. A total of 105 patients were included in the study, who were divided into three groups. The mean age of the patients was 39.24 ± 7.01 years (25-52 years). The mean level of the vitamin D in the control group was 25.40 ± 8.37 ng/mL, the group receiving 1,000 units/day was 26.71 ± 8.70 ng/mL, and the group receiving 50,000 units per week was 26.17 ± 8.63 ng/mL. The mean values of preoperative pain intensity, symptom severity, and functional status were almost the same in the three groups. These values were reduced after surgery in the two groups receiving the drug compared to the control group. The findings of the study showed that the administration of vitamin D supplementation in patients with CTS can significantly improve the postoperative symptoms of patients who underwent tendon release surgery and further improve the severity of symptoms and dysfunction of patients.

Analysis the Effect of Job Strain on Nurses' Quality of Work-Life: A Mediating and Moderating Model.

One of the most important issues in all organizations is to improve performance of human resources to achieve goals. Therefore, it is necessary plans and solutions to reduce Job Strain (JS) and then increase Organizational Citizenship Behaviors (OCB), and Quality of Work-Life (QWL). The purpose of this study is to investigate the effect of JS on QWL with mediating role of OCB and moderator of employment status. This cross-sectional study was conducted on 300 nurses who were non-randomly voluntary selected among nurses working in seven educational hospitals in Ahvaz, Iran. Data were collected using demographic and occupational characteristics questionnaire and JS questionnaire with 12 items, OCB with 16 items & QWL with 26 items in the 5-point Likert scale. Data analysis was performed in SPSS22 using descriptive and inferential statistics, and structural equation modeling with SmartPLS3. The results indicated the mean (SD) score of 49.56 (6.68) for JS (more than normal) and 58.84 (5.94) and 49.88 (7.69) for QWL and OCB, respectively. Spearman correlation coefficients show that JS has a negative relationship with QWL (r = -0.69, p < 0.001) and OCB (r = -0.54, p = 0.008). Also, nurses' employment status (Formal and Contractual) moderates the relationship between JS, QWL, and OCB. According to the results, job stress in nurses of Ahvaz hospitals was high and QWL was moderate (or less). Therefore, increased job stress leads to reduced QWL and OCBs of nurses. Also the employment Status and job security that it provides can modify this impact.

Investigating the effect of magnesium supplement in patients with major depressive disorder under selective serotonin reuptake inhibitor treatment.

Major depression disorder (MDD) is a mental disorder that affects millions of people worldwide. This disease has negative impacts on quality of life and psychological-related functions. This is a multifactorial disorder; both genetic background and environmental factors have their role. Antidepressants are prescribed as the first line of treatment for patients with depressive disorders. Selective serotonin reuptake inhibitor (SSRI) antidepressants are used to treat MDD and anxiety; however, some patients do not respond to them. Regarding that, magnesium plays a major role in mood regulation; therefore, this study aimed to investigate the role of magnesium supplement in patients with MDD and under an SSRI treatment regimen. In this randomized, double-blind controlled trial, 60 patients with major depressive disorders based on the DSM-V diagnosis referred to Golestan Hospital in Ahvaz, Iran, were included. The eligible patients were categorized randomly into two thirty-people groups receiving magnesium (intervention) and placebo (control) along with SSRI for 6 weeks. To evaluate the depression status, the Beck II test was applied. Subjects were examined before and after the intervention. There was no statistically significant difference between the two groups in terms of demographic characteristics (P > 0.05). The mean Beck scores at the beginning of the study and the second week after the intervention were not different between the two groups (P = 0.97, P = 0.56), whereas the mean Beck scores were lower in the intervention group than in the control group in the fourth and sixth weeks after the intervention (P = 0.02 and P = 0.001, respectively). Administration of Mg supplement for at least 6 weeks might improve depression symptoms. It can also be considered as a potential adjunct treatment option for MDD patients who are under SSRI treatment.

The application of the loop-mediated isothermal amplification method for rapid detection of methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) is an important problem associated with significant mortality and morbidity and well known as a predominant bacterial pathogen. The aim of this study was to identify MRSA strains. In this study (June 2018 to June 2019) isolates of S. aureus were obtained from patients referred to teaching hospitals of Ahvaz, Iran. All isolates were confirmed by conventional microbiological methods. In following, antimicrobial susceptibility testing (AST), MRSA screening, PCR detection of MRSA and LAMP assay were performed. Out of a total of 156 staphylococcal isolates, 126 isolates were identified as MRSA. Seventy-two (57.1%) MRSA isolates were recovered from wound. All MRSA isolates were sensitive to vancomycin, linezolid, teicoplanin, quinupristin-dalfopristin, and tigecycline. The results of LAMP showed 100% agreement with PCR. Sensitivity and specificity of the LAMP assays for the mecA genes were 100% and 100%, respectively. The LAMP assay is a rapid and simple method for the identifications of MRSA. Because of its performance without the need for specific instrumentation, this method can be easily employed in medical centers for the detection of mecA.

Surgical early complications of the laparoscopic insertion of peritoneal dialysis catheter: A cross-sectional descriptive two-center study in Ahvaz, southwest of Iran

Objectives: This study aimed to investigate the surgical complications of this technique of peritoneal dialysis catheter insertion in Imam Khomeini and Golestan hospitals in Ahvaz, southwest of Iran, in the period between 2007 and 2019. Methods: In this retrospective cross-sectional analytic-descriptive study, we examined end-stage renal disease (ESRD) patients who underwent laparoscopic peritoneal dialysis catheter insertion between 2007 and 2019. Patients' records and follow-up information recorded in the hospital dialysis unit were reviewed and early infectious and mechanical complications of peritoneal dialysis catheter insertion were analyzed. Results: In this study, 290 patients (144 males and 138 females) with ESRD who have a mean age of 46±19.7 years (1-90 years) were recruited, of whom 8 patients were excluded due to incomplete information in their records, and 68 patients (24.1%) had an early complication of surgery. Surgical complications included: Catheter exit-site infections in 20 patients (7.1%), peritonitis in 18 patients (6.4%), catheter exit-site leakage in 17 patients (6%), catheter occlusion without migration in 16 patients (5.7%), catheter migration in 7 patients (2.5%), and hemoperitoneum in 7 patients (2.5%). Conclusions: Due to the low complications of laparoscopic surgery in the insertion of a peritoneal dialysis catheter, this technique is recommended as a safe surgical procedure with low complications.

The Effect of a Training Program Based on Roy’s Adaptation Model on the Adaptation of Patients Undergoing Coronary Artery Bypass Graft in Intensive Care Units

Background: One of the effective nursing measures for enhancing the quality of life (QOL) and adaptation of patients undergoing coronary artery bypass graft (CABG) is the use of Roy’s adaptation model (RAM). Objectives: This study aimed to determine the effect of a training program based on Roy’s adaptation model on the adaptation of patients undergoing CABG. Methods: This quasi-experimental study was performed on 60 patients admitted to the intensive care units (ICUs) of Imam Khomeini Hospital and Golestan Hospital in Ahvaz, southwest of Iran, in 2020. Patients were selected based on inclusion criteria and randomly assigned into intervention and control groups. A four-session training program based on RAM was held for the intervention group. Data were analyzed using SPSS ver. 22. Results: The mean scores of physiological, self-concept, role function, and independence and interdependence dimensions in the experimental group before the intervention were 48.76 (6.36), 23.76 (4.10), 19.60 (2.93), and 25.60 (3.54), respectively. After the intervention, the mean scores in the mentioned dimensions were 101.26 (5.23), 50.80 (3.82), 39.10 (4.15), and 25.47 (3.99), respectively, indicating an upward trend (P &lt; 0.05). Also, the mean score of total adaptation before the intervention was 117.73 (12.00), which rose to 216.63 (7.88) after the intervention (P &lt; 0.05). Conclusions: The results showed that RAM plays an important role in the adaptation of patients undergoing CABG surgery. Thus, this model can provide a suitable framework for examining and providing care for patients undergoing CABG in ICUs.

Demographic, Clinical, and Radiological Characteristics of Patients With Hydatid Cyst Refereed to Ahvaz Hospitals During 2017-2019

Background and Objectives Hydatid cyst is a worldwide zoonotic disease caused by the larval stages of Echinococcus granulosus. The aim of this study was to investigate the demographic, clinical and radiological characteristics of hydatidosis patients undergoing surgery in hospitals in Ahvaz during Subjects and Methods This study is a retrospective descriptive cross-sectional study based on the information recorded in the patients' files. Data were analyzed using SPSS software, descriptive statistics and Chi-square test. Results Of the 107 patients with a mean age of 36.78 years, 42.1% were male and 57.9% were female. The highest frequency was related to the age group of 31-40 and the lowest was related to the patients under 10 years old. 52.3% lived in the rural areas and 47.7% lived in the urban areas. In 70.1% of the patients, liver was involved and recurrence was reported in 14%. In 59.8% of the patients, only one cyst was reported and in 40.2% more than one cyst was reported. The cysts size was 10 to 180 mm and about 50% of the patients had CE2 cysts. The diagnostic method of all patients was imaging techniques and drainage method was the most common method used. Conclusion This study showed that hydatid cyst in Khuzestan Province is still one of the important health problems that raise the need for educational programs based on the prevention and control of parasitic infections, especially parasites transmitted by dogs. Observation of 14% recurrence also raises the importance of choosing the appropriate surgical method by surgeons.

The Effect of Behavior Simulation Behavior with Addicted Person on Moral Sensitivity of Iranians Working in Bustan Psychiatric Hospital in Ahvaz

The Effect of Behavior Simulation Behavior with Addicted Person on Moral Sensitivity of Iranians Working in Bustan Psychiatric Hospital in Ahvaz

Determining the Frequency of Hearing Loss and Its Risk Factors in Neonates Admitted to the Neonatal Unit: A Hospital Study

Background and Objectives The prevalence of hearing loss in infants with a risk factor is higher than in infants without a risk factor. The aim of this work is determine the prevalence of hearing loss and identify the most significant risk factors for hearing impairment in neonates hospitalized at neonates unit. Subjects and Methods A total of 450 infants admitted to the neonatal unit of Abuzar hospital in Ahvaz were evaluated for hearing in October 2020 to April 2020. The hearing screening tests performed were Transient Evoked Otoacoustic Emissions (TEOAES) and the automated auditory brain stem response (AABR). Risk factors include birth weight less than 1500g, prematurity, family history of hearing loss, consanguineous marriage, hyperbilirubinemia, mechanical ventilation for more than 5 days, asphyxia, autotoxic drugs, sepsis, hypoglycemia and Apgar less than 5 were in one minute after birth. Results twenty neonates (4.4%) had different type of hearing loss. Mechanical Ventilation more than 5 days, sepsis, asphyxia, hyperbilirubinemia and Apgar&lt;5 were considered risk factors of hearing loss. Conclusion The prevalence of hearing loss in neonate with risk factor is significant that raises the need for hearing screening using TEOAE and AABR simultaneously. It is recommended that children with hearing loss risk factors be evaluated for hearing periodically.

Evaluation of Blood and CSF Isolated Bacteria and Their Antimicrobial Resistance in Hospitalized Patients in Ahvaz Golestan Hospital in 2020

Background and Objectives: Infection of the blood and cerebrospinal fluid can have irreparable consequences and even death. In the present study, the prevalence of bacteria causing blood and cerebrospinal fluid infection and their antibiotic resistance in hospitalized patients was investigated. Subjects and Methods: In this present descriptive-cross-sectional study, the results of all blood and cerebrospinal fluid samples were sent for culture from the hospitalized patients of Golestan Hospital in Ahvaz in the first six months of 2019 were examined. Relevant information was extracted from patients’ medical records. Results: In this study, 12.17% of blood culture were positive and 7.6% of cerebrospinal fluid culture were positive. The most common bacteria causing blood infections were Staphylococcus Coagulase Negative (32.5%), Klebsiella (24.1%) and Pseudomonas (21.7%), and the most common bacteria causing cerebrospinal fluid infection were Klebsiella (30.9%), Streptococcus. group D (Enterococcus) (20.6%) and pseudomonas (15.5%). The highest bacterial resistance was observed for Ampicillin, Ceftriaxone, Cefazolin, Cefixime and Cefotaxime antibiotics, and the highest sensitivity was observed for Meropenem, Colistin, and Levofloxacin antibiotics. Conclusion: Since the bacterial resistance pattern is always changing, it is suggested that before starting any empirical treatment in infectious diseases, sensitive antibiotics for common bacterial agents are recommended for a more efficient treatment.

Comparison of Intercostal Nerve Block with Ropivacaine and Ropivacaine-Dexmedetomidine for Postoperative Pain Control in Patients Undergoing Thoracotomy: A Randomized Clinical Trial.

BackgroundThoracotomy is one of the most painful surgeries, and failure to alleviate patients' pain can have dangerous consequences. ObjectivesThis study aimed to evaluate the addition of dexmedetomidine to ropivacaine in the intercostal block for postoperative pain control in patients undergoing thoracotomy.MethodsIn this randomized clinical trial, 74 patients aged 18 to 60 years with ASA class I or II, BMI less than 40, and no severe systemic problems referred to a teaching hospital in Ahvaz to undergo thoracotomy were included in the study and randomly divided into two groups. After surgery, an ultrasound-guided intercostal block was done with ropivacaine (5 cc of 0.25% solution; group R) or ropivacaine (5 cc of 0.25% solution) plus dexmedetomidine (0.5 µg/kg; group RD) per dermatome. Two dermatomes above and two dermatomes below the level of surgical incision were used. Pain, total opioid consumption, length of ICU stays, time to first rescue analgesic, and time to get out of bed were compared between the two groups.ResultsThe intercostal block significantly reduced pain in both groups (P < 0.0001). The pain was lower in the RD group than in the R group from six hours after the intervention up to 24 hours after (P < 0.001). The number of patients who needed rescue analgesia at 12 hours was significantly lower in the RD group (P < 0.05). The RD group also had lower total opioid consumption and a longer time to receive the first rescue analgesia (P < 0.01). There was no significant difference between the two groups in the length of hospitalization and the time to get out of bed.ConclusionsDexmedetomidine is an effective and safe choice to be used as an adjunct to ropivacaine in ICB, and it extends the duration of analgesia in combination with ropivacaine after thoracotomy.

Detection of OqxAB Efflux Pumps, a Multidrug-Resistant Agent in Bacterial Infection in Patients Referring to Teaching Hospitals in Ahvaz, Southwest of Iran.

Antibiotic resistance mechanisms in Enterobacteriaceae are causative agents of global health problems. Bacterial infections due to multidrug resistance (MDR) may be mediated by the overexpression of efflux pumps. In this study, we investigated the prevalence of oqxA and oqxB genes as two encoding agents of efflux pumps and the determination of antibiotic resistance rate in clinical isolates of Enterobacteriaceae. In this study, 100 Enterobacteriaceae isolates collected from different clinical specimens of infectious patients, such as wounds, urine, blood, discharge, and abscesses except stool, were examined. Identification of the isolates was performed using standard biochemical tests such as TSI, citrate, urea, lysine, SIM, MR-VP, and gas production. The antimicrobial susceptibility test was carried out by the Kirby–Bauer disk diffusion method according to CLSI guidelines, and finally, the oqxA and oqxB genes were detected by the PCR method. Among 100 Enterobacteriaceae isolates, Escherichia coli and Enterobacter gergoviae were the most common isolates with 71% and 20%, respectively. Also, the lowest isolates belonged to Enterobacter cloacae (3%) and Klebsiella pneumoniae (1%). Out of 100 Enterobacteriaceae isolates, 37 isolates (37%) were positive for at least one of oqxA or oqxB genes, while both of these genes were detected among 12% of them. oqxAB genes were detected in 8 cases of 20 (40%) Enterobacter gergoviae and 4 cases of 71 (5.7%) E. coli isolates. The antimicrobial susceptibility test showed that all isolates (100%) were susceptible to imipenem, while the maximum resistance to piperacillin, ceftriaxone, and cefotaxime were 69%, 55%, and 55%, respectively. Also, the results of this study showed that antibiotic resistance in Enterobacteriaceae isolates caused by oqxAB genes is increasing among patients in Iran. Therefore, identification of resistant isolates and antibiotic monitoring programs are essential to prevent the spread of MDR isolates.