Hospitals In Shiraz Research Articles

Association of oral manifestations with severity of the disease in ulcerative colitis patients

ObjectiveInflammatory bowel diseases (IBD), such as Crohn’s disease (CD) and ulcerative colitis (UC), are chronic conditions primarily affecting the intestines. This study aims to identify the nature and frequency of oral symptoms and signs in patients with ulcerative colitis and to explore the connection between these complications and the activity of the disease.MethodsThis descriptive-analytical study involved ulcerative colitis patients who visited the gastroenterology clinic at Shahid Sayad Shirazi Hospital in Gorgan, along with an equal number of healthy companions as a control group in 2019. A gastroenterology internist assessed the disease severity through clinical examination and a simple clinical disease activity index for colitis patients. The collected data were then analyzed statistically using SPSS version 19.ResultsThe average age of patients in the case group was 41.84 ± 11.66 years, while in the control group it was 40.43 ± 12.67 years. There was a significant correlation between difficulty swallowing, burning sensation in the mouth, vomiting, acidic taste, the presence of oral ulcers, and a coated tongue with the severity of disease activity (p < 0.05). However, no significant relationship was found between other variables and the severity of disease activity (p > 0.05).ConclusionThe results of this study confirm that as the severity of ulcerative colitis increases, the occurrence of oral lesions also rises, particularly during severe disease activity. Among oral symptoms, dry mouth had the highest incidence, followed by bad breath and changes in taste. The most common oral lesions observed were a coated tongue, grooved tongue, and oral ulcers, respectively.

Epidemiology and characteristics of unintentional self-inflicted penetrating ocular injuries in children less than 6 years-old

IntroductionPediatric ocular injuries, notably unintentional self-inflicted penetrating ocular injuries in children under 6, pose a substantial public health concern, leading to visual impairment and psychological distress. With global prevalence indicating severe visual impairment or blindness in 2–14% of affected children, these injuries necessitate multiple surgeries and extended monitoring. Our study aims to analyze the epidemiology and characteristics of such injuries, emphasizing preventive measures, parental supervision, and timely medical intervention to mitigate their impact on young lives.MethodConducted at Khalili Hospital in Shiraz, Iran, our retrospective study included 141 cases admitted between April 2018 and April 2023. Ethical principles guided data collection from medical records, encompassing demographic details, causative objects, ocular laceration specifics, surgical procedures, complications, and visual acuity assessments.ResultsThe mean age of the participants in this study was 47.18 ± 16.48 months (ranging from 10 to 71 months), and the male to female ratio was 1.76:1 (90 vs. 51). Objects of injury mostly included knives (34.8%), wood (12.1%), and glass (10.6%), and the most common initial manifestation of injury was iris prolapse (56.7%), followed by traumatic cataract (46.8%) and limbus laceration (34.0%). Fifteen (10.6%) patients had a visual acuity better than LogMAR 0.5, 24 (17.1%) had finger count vision, 37 (26.2%) had hand motion, 7 (0.5%) had light perception, and 58 (41.1%) were uncooperative. Type of laceration and season of injury were associated with retinal detachment, and a longer time-to-visit was correlated with a higher risk of developing retinal detachment or endophthalmitis.ConclusionOur study highlights the significant burden of unintentional self-inflicted penetrating ocular injuries in children under 6. Emphasizing preventive measures, parental supervision, and timely medical intervention, our findings underscore the potential psychological and visual consequences. This research advocates for parental education and safety measures to reduce the occurrence and severity of such injuries in this vulnerable population, promoting a healthier and safer environment for children.

Comparison of depression, anxiety, perceived stress, and resilience in parents faced with abortion in Iran: a longitudinal study

BackgroundAbortion could impact the mental well-being of parents. Resilience also has a significant effect on the mental health of the family as a factor in coping with abortion. This study aimed to compare depression, anxiety, perceived stress, and resilience in parents after abortion.MethodsThe present longitudinal study was performed on 200 hospitalized women and their spouses in the post-partum department of Shiraz hospitals in 2023. The instruments used in this study included questionnaires of fertility and demographic characteristics, hospital depression and anxiety (HADS), Connor’s resilience, and Cohen’s perceived stress. Data analysis was performed using SPSS 25.ResultsThe mean age of the fathers was 35.37 ± 4.99 and that of mothers was 31.35 ± 6.23. The scores of parents’ anxiety, depression, and perceived stress in the first 24 h after facing abortion were in the highest possible state and decreased in 12 weeks, and their resilience also increased. In all three time periods, the mean scores of the fathers’ anxiety, depression, and perceived stress were lower than those of the mothers, but the mean score of resilience was always higher in fathers. Fathers´ age and mothers’ age, mothers’ age at the time of marriage, fathers’ job, number of children, gender of the last child (boy or girl), and unwanted pregnancy were among the predicting variables of anxiety, depression, perceived stress, and resilience of both parents faced with abortion.ConclusionAlthough mental disorders in fathers were fewer than mothers compared to post-abortion resilience, identifying and managing these issues promptly is crucial for enhancing post-abortion mental well-being in both parents. How parents navigate the challenges of pregnancy, childbirth, and abortion can significantly impact the couple’s health.

The frequency, risk factors, onset time, and outcome of acute kidney injury induced by vancomycin, colistin, and liposomal amphotericin B in hospitalized patients

Introduction: Medications are among the major causes of acute kidney injury (AKI) in hospitalized patients. Objectives: This study aimed to explore the frequency, characteristics, risk factors, and clinical outcomes of AKI induced by vancomycin, colistin, and liposomal amphotericin B (L-AmB) in hospitalized patients across various wards of two educational hospitals in Shiraz, Iran. Patients and Methods: From October 2022 to May 2023, an observational cross-sectional study was conducted in both intensive care unit (ICU) and non-ICU wards of Namazi and Shahid Faghihi hospitals, Shiraz, Iran. Patients aged 18 and older, without a documented history of AKI or chronic kidney disease, scheduled to receive treatment with vancomycin, colistin, or L-AmB for at least one week, were considered eligible. Relevant data, including demographic, clinical, and laboratory findings, were collected. Results: AKI was observed in 36 (34.3%) out of 105 patients during treatment. The incidence rates of AKI were 29%, 55%, and 31.1% in vancomycin, colistin, and L-AmB recipients, respectively. The mean ± SD time to AKI onset was 5.44 ± 2.04 days (range; 3 to 13 days). Dehydration at admission significantly increased the risk of antibiotic-induced AKI (odds ratio [OR] = 3.686, 95% confidence interval [CI] = 1.226–11.081, P = 0.020). Co-administration of aminoglycosides (OR = 8.422, 95% CI = 1.846 – 38.426, P = 0.006), diuretics (OR = 3.763, 95% CI = 1.092–12.965, P = 0.036), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (OR = 7.149, 95% CI = 1.534–33.308, P = 0.012) were also identified as independent risk factors. The in-hospital mortality rate was significantly higher in patients with AKI than in those without AKI (8.6% vs. 6.7%; P &lt; 0.044). Conclusion: AKI induced by vancomycin, colistin, and L-AmB occurred in about one-third of our study population, primarily within five days of initiating treatment. Dehydration and co-administration of nephrotoxic medications were significantly associated with AKI. Clinicians should explicitly address these factors in preventive strategies to reduce antibiotic-induced AKI in hospitalized patients.

Anatomical and functional outcomes of rectal prolapse treatment with laparoscopic pelvic organ prolapse suspension versus laparoscopic ventral mesh rectopexy

AbstractAimVery few studies have compared laparoscopic pelvic organ prolapse suspension (POPS) and laparoscopic ventral mesh rectopexy (LVMR) in the treatment of rectal prolapse, particularly regarding the comparison of improvement rates in obstructed defecation syndrome (ODS). This study aimed to compare the anatomical and functional outcomes of these two methods over a long‐term follow‐up period.Patients and methodsThis retrospective study was conducted on 120 female patients diagnosed with rectal prolapse who underwent surgery at the Colorectal Surgery Department of Shahid Faqihi Hospital in Shiraz, Iran, between October 2015 and October 2022. The patients were categorised into two groups based on their surgical procedures: 58 underwent LVMR in the first group, and 62 underwent POPS in the second group.ResultsRecurrence of prolapse occurred in 7 (12.1%) patients in the LVMR group and 5 (8.1%) patients in the POPS group (P = .550). The mean operation time, mean length of hospital stay, Visual Analogue Scale score, early and late post‐operative complications, Cleveland Clinic Incontinence Score, ODS symptoms, and Wexner Constipation Scores did not differ significantly between the two groups.ConclusionBoth laparoscopic POPS and LVMR techniques significantly improved the anatomical and functional outcomes in the treatment of rectal prolapse and obstructed defecation. LVMR and POPS can each be considered first‐line treatment options for rectal prolapse, depending on the specific case.

Inter- and intra-observer reliability of the Ergonomic Screening and Prioritization Tool to assess the risk level of work-related musculoskeletal disorders in nurses

Introduction: Musculoskeletal Disorders (MSDs) are among the most common occupational diseases, and ergonomics and occupational health engineering specialists need reliable and valid methods for assessing high-risk activities and the factors contributing to their occurrence. Materials and Methods: In this cross-sectional study, 100 nurses employed at Namazi Hospital in Shiraz were randomly selected. Data was collected using a demographic/occupational questionnaire, Hierarchical Task Analysis (HTA), and the Ergonomics Screening and Prioritizing Tool (ESPT). Three observers simultaneously assessed the risk of developing MSDs for each job duty. After a six-month interval, the same observers re-evaluated the same group of nurses in the same work Postures. To assess the reliability of ESPT between and within observers, the Intra-class Correlation Coefficient (ICC) and the Kappa Multi-rater Fleiss method were used. Data analysis was conducted using SPSS software version 26. Results: The results of the study showed a high agreement between each observer as well as between the three observers before and after six months. The ICC for observers 1, 2, and 3 were respectively 0.951, 0.947, and 0.927, and also between each of the three observers for the first and second time respectively 0.955 and 0.941. Conclusion: The ESPT has been shown to possess high reliability for assessing the risk of developing MSDs among nurses, and it can be used for this purpose.

Investigating depression, anxiety, perceived stress and resilience in fathers faced with their spouse’s abortion in Iran: a longitudinal study

BackgroundAbortion is a stressful event that can often affect the mental health of both parents. It seems that resilient people can adapt to stressful situations. The mental health of fathers plays an important role in improving the mental health of the family, but few studies have been conducted in this regard. Therefore, this study aimed to investigate depression, anxiety, perceived stress and resilience of fathers faced with their spouse’s abortion.MethodsThis longitudinal study was conducted on 125 spouses of women hospitalized in the post-partum department of Shiraz hospitals in 2023. Data collection tools included questionnaires of demographic and fertility characteristics, hospital depression and anxiety (HADS), Cohen’s perceived stress, and Connor’s resilience. The data were analyzed through Spss24 software using Friedman’s tests and post hoc tests, Adjusted Bonferroni, Kruskal-Wallis and Mann-Whitney tests.ResultsThe mean age of the fathers was 35.02 ± 6.22. The scores of the father’s anxiety, depression, and perceived stress from 24 h to 12 weeks after abortion were decreased significantly. However, their resilience score increased significantly. Also, there was a significant relationship between the fathers’ age, education, job, duration of marriage, type of abortion, number and history of abortion, unwanted pregnancy, number of children and economic status with the mean score of anxiety, depression, perceived stress, and resilience in fathers over time.ConclusionThis research pointed out the effect of abortion on depression, anxiety, and perceived stress in fathers; also, resilience as a coping factor could affect these disorders and improve the fathers’ mental health. Therefore, screening and managing mental disorders in them are important to improve family health.

Relationship Between the Atmosphere of Psychiatric Wards and the Motivation, Attitude, and Perception of Patients Hospitalized in Shiraz and Bushehr University Hospitals-2019

Background: Treatment of psychiatric patients is a challenging issue that requires special attention due to their unique nature and conditions. Identifying the factors that influence treatment acceptance among these patients can aid in disease management and health promotion. The environment in which individuals reside can significantly impact their behaviors. Objectives: The present study aimed to determine the correlation between ward atmosphere and the motivation, perception, and attitude of patients towards continuing the treatment process in psychiatric wards of certain university hospitals in Shiraz and Bushehr in 2019. Methods: The present cross-sectional study included 299 patients admitted to the psychiatric wards of hospitals in Bushehr and Shiraz, Iran. A convenience sampling method was employed. Data collection tools included a demographic characteristics form, a short-form psychiatric ward questionnaire, and patient attitude, motivation, and treatment perception questionnaires. Data were analyzed using SPSS 19 with Pearson or Spearman correlation tests, independent t-test, one-way analysis of variance, and linear regression. The significance level was set at less than 0.05 in all cases. Results: The mean score of ward atmosphere was lower than average (18.37 ± 2.99) from the patients' point of view. Among the subscales of ward atmosphere, the "support" subscale correlated with patients' attitudes towards continuing the treatment process (P = 0.042). Patients exhibited a more positive attitude towards treatment at higher levels of support. Two subscales, "support" (P = 0.048) and "programme clarity" (P &lt; 0.001), correlated with patients' perceptions of the treatment continuation. In other words, patients' perception of the treatment process was higher at elevated levels of these two subscales. None of the ward atmosphere subscales correlated with the patient's motivation to continue the treatment process from the patient's point of view. Conclusions: Given the correlation between certain subscales of ward atmosphere and patients' attitudes and perceptions about continuing the treatment process, it is recommended to design programs to optimize the ward atmosphere. This could improve patients' attitudes and perceptions regarding continuing their treatment. Additionally, it is suggested to study other factors affecting treatment in psychiatric patients.

Investigating the knowledge, attitude, and performance of the staff of the therapeutic educational center in Gorgan city about the factors related to hand hygiene according to the PRECEDE Model: A cross-sectional study

Introduction: Hospital-acquired infections pose a significant risk to patients who are hospitalized and have become a major global concern. These infections are associated with an increasing number of complications, morbidity, and mortality rates, and result in considerable costs for patients during their hospital stay. Objectives: This study aimed to investigate the knowledge, attitude, and practice of the staff of Shahid Sayad Shirazi Hospital in Gorgan regarding the factors related to hand hygiene based on the PRECEDE model, 2020. To improve the observance of hand hygiene in personnel, it is necessary to study the factors related to their behaviors. Patients and Methods: This was a cross-sectional study with a descriptive-analytical approach. The statistical population was the administrative and medical personnel working in Shahid Sayad Shirazi Hospital, who were selected by random sampling. An author-made questionnaire was used, which included questions on knowledge, attitude, and performance. The questionnaire was based on Najafi Ghezeljeh et al’s study questionnaire and had 6 sections: demographic, knowledge, attitude, and enabling, where content validity was confirmed by determining CVR=0.78 and CVI=0.84. The questionnaire’s reliability was Cronbach’s alpha=0.84. The data collected were analyzed using SPSS version 16, and descriptive statistics and inferential statistics parametric tests ANOVA, t test, and Pearson’s correlation coefficient were used at the error level (0.05). Results: The results showed that the score of all areas was above average. The domain of enabling factors was affected by four variables: gender, degree of education, grade of education, and type of employment. The knowledge was affected by three demographic variables: age, work experience, and marital status. The performance is affected by the variable of work experience. Conclusion: To observe hand hygiene according to the instructions, it is required to create resources on a proper basis and provide basic knowledge, attitude, and practice training to the staff based on the PRECEDE model.

Four-Year Bacteriological Profile and Antibiotic Resistance Rate of Neonatal Blood Cultures in a Major Neonatal Intensive Care Unit (NICU) in Shiraz, Southwest Iran

Background: Bacterial infections are the leading cause of death in newborns. The growing resistance of bacteria to antibiotics is a major concern. In this study, we identified isolates from blood cultures in the neonatal intensive care unit (NICU) of a major referral hospital in Shiraz in southwest Iran and determined antibiotic resistance patterns. Methods: All newborns admitted to the NICU were evaluated in a four-year study. The blood samples were cultured using a BACTEC system. From May 2015 to March 2020, 5937 blood culture samples were analyzed. The antibacterial sensitivity test was conducted using the disk diffusion method, following the guidelines of Clinical &amp; Laboratory Standards Institute (CLSI) 2018. Results: In this study, 507 isolates were obtained from 5937 specimens. The most commonly isolated gram-negative bacteria were Acinetobacter (8.7%), Escherichia coli (5.7%), Klebsiella (1.6%), Enterobacter (1.4%), and Pseudomonas (0.9%). Among the gram-positive bacteria, coagulase-positive staphylococci (51.1%), coagulase-negative staphylococci (15.4%), Staphylococcus epidermidis (10.2%), non-hemolytic streptococci (2.4%), alpha-hemolytic streptococci (1.4%), and Streptococcus pneumonia (1.3%) were the most frequently isolated bacteria. Of the 318 Staphylococcus aureus isolates, 88.5% were resistant to methicillin. Conclusion: Staphylococcus, with a high frequency in the NICU, can be an alarm for medical centers. Also, in dead infants, the most observed bacterial infection was Acinetobacter infection, which requires the serious attention of the hospital infection control unit.

Evaluation of QT prolongation in children with cirrhosis and its association with the severity of liver diseases

Summary: Introduction: Prolongation of the QT interval in an electrocardiogram (ECG) is seen in more than 60% of adults with advanced cirrhosis. According to careful research, people with cirrhosis who have their QT intervals prolonged had worse survival rates, more severe disease symptoms, and faster development of their condition. Considering the importance of predicting complications of liver cirrhosis in children and the limited number of studies related to the relationship between prolonged QT and the severity of liver disease in children, in this study, prolonged QT in children with liver cirrhosis and its relationship with the severity of liver disease was investigated. Methods: In the present study, children under 18 years of age with liver cirrhosis were evaluated in the list of liver transplants referred to Abu Ali Sina Organ Transplantation Hospital in Shiraz between 2019 and 2021. QT was calculated based on two pediatric cardiologists‘ 12-lead ECG from liver transplant surgery. Results: In this study, 130 patients with liver cirrhosis with an average age of 7.05±5.34 years were evaluated. The average length of the QT segment was reported as 397±31milliseconds. Only 4 (3%) had a long QT segment in all the studied patients. The comparison of the Meld/ Peld criterion and Child criterion in the two groups of regular QT and prolonged QT showed that the mean of both criteria was signifi cantly longer in the standard QT group (P = 0.018, P = 0.038). Also, prolonged QT showed a signifi cant relationship with the cause of liver cirrhosis (P = 0.003). Conclusion: Our study is one of the fi rst to examine the relationship between QT and severity of cirrhosis in children. Based on the results of this study, prolonged QT is associated with severity of liver disease. Key words: liver – cirrhosis – children – long QT – fi brosis

Study of MIC of silver and zinc oxide nanoparticles, strong and cost-effective antibacterial against biofilm-producing Acinetobacter baumannii in Shiraz, Southwest of Iran

BackgroundAcinetobacter baumannii resistant strains lead to increased mortality, treatment costs, and an increase in the length of hospitalization. Nowadays, nanoparticles are considered a substitute for antibiotics. This study aimed to determine the MIC of Silver (Ag) and Zinc Oxide (ZnO) Nanoparticles (NPs) on Biofilm-Producing Acinetobacter baumannii and determine the relationship between MIC and frequency of efflux pump genes in cutaneous specimens in Shiraz, Southwest Iran in 2021–2022.MethodsIn this study, specimens were collected from April 2021 to June 2022 at Namazi and Faqihi Hospitals in Shiraz. Investigation of biofilm production in multidrug resistance (MDR) isolates was done by the microtiter plate method. Synthesized nanoparticles were characterized by UV–vis spectrum, X-ray diffraction (XRD), and electron microscopy. The MIC of AgNPs and ZnONPs for isolates was done using the method described in the CLSI guideline (2018). The antibacterial effect of MIC of NPs on inanimate objects was done by colony counts. The prevalence of efflux pump genes (adeR, adeC, adeA, abeM, adeK, adeI) was also investigated by PCR technique.ResultsThe highest ceftriaxone resistance (68%) and lowest colistin resistance (7%) were identified. 57% of isolates were MDR. In addition, 71.9% could produce biofilm and 28.1% of isolates could not produce biofilm. The average size of AgNPs and ZnONPs in the present study is 48 and < 70 nm, respectively. The nanoparticles were spherical. The MIC and the MBC of the ZnONPs were in the range of 125 to 250 µg/mL respectively. Also, for AgNPs, the MIC and the MBC were in the range of 62.5 to 250 µg/ml, respectively. AbeM gene had the highest frequency and the AdeK gene had the lowest frequency. Statistical analysis showed that there is a relationship between the frequency of adeA, adeC, and adeM genes with the MIC of AgNPs and ZnONPs.ConclusionAccording to the results of the present study, inanimate objects such as scalpels in contact with AgNPs (6000 µg/ml for 240 min) or ZnONPs (5000 µg/ml for 120 min) can be free of biofilm producing Acinetobacter baumannii with efflux pump genes.

Evaluation of various types of maxillofacial fractures in motorcyclists with and without helmets reffered to Shahid Rajaei Hospital in Shiraz

Evaluation of various types of maxillofacial fractures in motorcyclists with and without helmets reffered to Shahid Rajaei Hospital in Shiraz

The Frequency of Celiac Disease and Its Association with Infertility in Women Attending Infertility Clinics: A Case-Control Study in Southern Iran

Background: Celiac disease (CD) is a multifactorial systemic disease that causes enteropathy and can lead to a wide spectrum of disorders related to infertility. Objectives: This case-control study aimed to evaluate the frequency of celiac disease (CD) and its association with infertility in women. Methods: This study was conducted on women referred to Ghadir Mother and Child Hospital in Shiraz. Women with infertility served as the case group, while fertile women comprised the control group. Blood samples were collected from participants, and tissue anti-transglutaminase (Anti-TTG Ab) levels were measured. Patients with elevated Anti-TTG Ab levels were referred for duodenal biopsy. Results: One hundred subjects were enrolled in the case group and 200 in the control group. Eight patients in the case group tested positive for serology, and four of these had duodenal biopsies confirming CD. In the control group, one individual tested positive for serology, but the duodenal biopsy was negative (P for between-group differences: 0.001 for serology and 0.012 for biopsy results). There was a significant association between high levels of Anti-TTG Ab and infertility (odds ratio = 17.30, 95 % CI: 2.13 - 140.39), which remained even after adjusting for age and body mass index (odds ratio = 9.92, 95 % CI: 1.17 - 84.21). Conclusions: The frequency of CD was higher among infertile women compared to fertile women. Increased levels of Anti-TTG Ab were independently associated with infertility.

Molecular epidemiology and multilocus genotyping of Giardia duodenalis in individuals attending major public hospitals in Shiraz, southwestern Iran: A public health concern

Giardia duodenalis is one of the most common causes of waterborne disease worldwide, and is often associated with outbreaks of diarrhea in areas with poor sanitation and hygiene. This study aimed to assess the prevalence and genetic diversity of G. duodenalis assemblages in individuals attending major public hospitals in Shiraz, southwestern Iran. From August 2022 to May 2023, a total of 614 stool samples from individuals were collected and initially examined for G. duodenalis cysts using parasitological techniques, sucrose flotation, and microscopy. Microscopy-positive samples were validated by SSU-PCR amplification of the parasite DNA. A multilocus genotyping (MLG) scheme, which focused on the triose phosphate isomerase (tpi) and the glutamate dehydrogenase (gdh) genes, was employed for genotyping purposes. G. duodenalis cysts were found in 7.5% (46/614) and 8.5% (52/614) of samples through microscopy and SSU-PCR, respectively. Successful amplification and sequencing results were obtained for 77.3% (17/22) and 45.5% (10/22) of the infected samples at the tpi and gdh loci, respectively. MLG data for the two loci were available for only five samples. Out of the 22 samples genotyped at any loci, 54.5% (12/22) were identified as assemblage A, while 45.5% (10/22) were identified as assemblage B. AII was the most predominant sub-assemblage identified [54.5% (12/22)], followed by BIII [27% (6/22)], discordant BIII/BIV [13.6% (3/22)], and BIV [4.5% (1/22)]. In the present study, no assemblages suited for non-human animal hosts (e.g., CF) were detected. This suggests that the transmission of human giardiasis in Shiraz is primarily anthroponotic. Further molecular-based analyses are necessary to confirm and expand upon these findings. These analyses will also help determine the presence and public health importance of the parasite in environmental samples, such as drinking water.

A challenging case of carbapenem resistant Klebsiella pneumoniae-related pyogenic liver abscess with capsular polysaccharide hyperproduction: a case report

BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) infections are a major public health problem, necessitating the administration of polymyxin E (colistin) as a last-line antibiotic. Meanwhile, the mortality rate associated with colistin-resistant K. pneumoniae infections is seriously increasing. On the other hand, importance of administration of carbapenems in promoting colistin resistance in K. pneumoniae is unknown.Case presentationWe report a case of K. pneumoniae-related pyogenic liver abscess in which susceptible K. pneumoniae transformed into carbapenem- and colistin-resistant K. pneumoniae during treatment with imipenem. The case of pyogenic liver abscess was a 50-year-old man with diabetes and liver transplant who was admitted to Abu Ali Sina Hospital in Shiraz. The K. pneumoniae isolate responsible for community-acquired pyogenic liver abscess was isolated and identified. The K. pneumoniae isolate was sensitive to all tested antibiotics except ampicillin in the antimicrobial susceptibility test and was identified as a non-K1/K2 classical K. pneumoniae (cKp) strain. Multilocus sequence typing (MLST) identified the isolate as sequence type 54 (ST54). Based on the patient’s request, he was discharged to continue treatment at another center. After two months, he was readmitted due to fever and progressive constitutional symptoms. During treatment with imipenem, the strain acquired blaOXA−48 and showed resistance to carbapenems and was identified as a multidrug resistant (MDR) strain. The minimum inhibitory concentration (MIC) test for colistin was performed by broth microdilution method and the strain was sensitive to colistin (MIC < 2 µg/mL). Meanwhile, on blood agar, the colonies had a sticky consistency and adhered to the culture medium (sticky mucoviscous colonies). Quantitative real-time PCR and biofilm formation assay revealed that the CRKP strain increased capsule wzi gene expression and produced slime in response to imipenem. Finally, K. pneumoniae-related pyogenic liver abscess with resistance to a wide range of antibiotics, including the last-line antibiotics colistin and tigecycline, led to sepsis and death.ConclusionsBased on this information, can we have a theoretical hypothesis that imipenem is a promoter of resistance to carbapenems and colistin in K. pneumoniae? This needs more attention.

Nursing labor supply in Iran: a survey in Shiraz public hospitals in 2022

Background The labor supply of nurses, as one of the main healthcare workers, is an important issue in health human resources planning in all health systems. Finding the factors affecting it, could help policymakers to solve the shortage of nursing work supply. The present study aimed to investigating the quantity and factors affecting the nurses' labor supply in Iran.MethodIn this cross-sectional study, a sample of 598 nurses working in public hospitals of Shiraz (Iran) were selected via proportionate stratified random sampling method. The required data was collected using a structured questionnaire which asked working hours and other related factors. To analyze the data, descriptive statistics, univariate analysis and multivariate linear regression were performed using STATA 15. The multivariate labor supply model was estimated separately for married and single nurses. ResultsThe average weekly working hours of nurses was 54.65 h in all medical centers and 50.28 h in the main hospital. The regression results showed that the labor supply of nurses with work experience (β = − 0.368, P = 0.014), satisfaction with work shift arrangement (β = − 2.473, P = 0.001), income between 60-89 million rial (β = − 14.046, P = 0.002), income between 90-119 million rial(β = − 12.073, P = 0.012), and working in the emergency department (β = − 5.043, P = 0.017) had negative and significant relationship; But there was a positive and significant relationship with satisfaction of the work environment (β = 1.86, P = 0.011), workload at work (β = 1.951, P = 0.023) and employment status (contractual employees) (β = 4.704, P = 0.004).ConclusionThe labor supply function of nurses is affected by demographic, economic and non-economic factors. The most contributing factors were related to non-economic variables. It seems that the non-financial cost and benefits related to the job as well as internal factors have more important role on the nurses' labor supply.

Association between Toxoplasma gondii and gestational diabetes with regard to serum leptin and tumor necrosis factor alpha, a preliminary study

Gestational diabetes (GDM), the onset of any degree of glucose intolerance during pregnancy, increases a wide range of adverse health outcomes for both the mother and the fetus. The aim of the present study was to evaluate the association of Toxoplasma gondii infection with GDM in a case-control study with regard to the levels of leptin and tumor necrosis factor alpha (TNF-α) as two inflammatory biomarkers. Fifty-one pregnant diabetic cases and 109 controls were selected from a prenatal care clinic of a general hospital in Shiraz, southern Iran during July–November 2020. Cases and controls were similar in age, gestational age and number of parturitions. The presence of IgG antibodies against T. gondii, and serum concentrations of leptin and TNF-α were determined by ELISA. Anti-Toxoplasma antibodies were detected in 25 subjects (15.6 %, 95 % CI: 9.9–21.3). Nine (18 %) diabetic cases were infected with Toxoplasma compared to 16 (15 %) healthy controls (P = 0.63). Level of leptin was higher (P = 0.07) while TNF-α was lower in diabetic cases compared to healthy controls (P = 0.08). When subjects were classified according to the combination of GDM and T. gondii, leptin was significantly lower in healthy (non-diabetic, non-infected) subjects compared to diabetics (P = 0.026), and TNF-α was higher in healthy subjects compared to Toxoplasma-infected diabetics (P = 0.032). These findings can be interpreted as both comorbidities being individually associated with increasing serum leptin and decreasing TNF-α concentrations, with modifying effects on each other. The present study opens a new perspective on GDM and its complex pathophysiological mechanism. Future research in this area is needed to better understand the underlying pathway for the development of GDM and the role of T. gondii and inflammatory biomarkers.

Development of New PCR Protocols to Detect Genetic Diversity in the Metronidazole Metabolism Genes in Susceptible and Refractory Clinical Samples of Giardia duodenalis.

Investigating the genetic variation in thioredoxin reductase (TrxR) and nitroreductase (NR) genes in both treatment-resistant and -sensitive Giardia duodenalis isolates can provide valuable information in identifying potential markers of resistance to metronidazole. The rapid increase in metronidazole treatment failures suggests the presence of genetic resistance mechanisms. By analyzing these genes, researchers can gain insights into the efficacy of metronidazole against G. duodenalis and potentially develop alternative treatment strategies. In this regard, four G. duodenalis isolates (two clinically sensitive and two clinically resistant to metronidazole) were collected from various hospitals of Shiraz, southwestern Iran. Parasitological methods including sucrose flotation and microscopy were employed for the primary confirmation of G. duodenalis cysts in stool samples. Microscopy-positive samples were approved by SSU-PCR amplification of the parasite DNA. All four positive G. duodenalis specimens at SSU-PCR were afterward analyzed utilizing designed primers based on important metronidazole metabolism genes including TrxR, NR1, and NR2. Unlike TrxR gene, the results of NR1 and NR2 genes showed that there are non-synonymous variations between sequences of treatment-sensitive and -resistant samples compared to reference sequences. Furthermore, the outcomes of molecular docking revealed that there is an interaction between the protein sequence and spatial shape of treatment-resistant samples and metronidazole in the position of serine amino acid based on the NR1 gene. This issue can be one of the possible factors involved in the resistance of Giardia parasites to metronidazole. To reach more accurate results, a large sample size along with simulation and advanced molecular dynamics investigations are needed.

The effect of vitamin D levels on clinical outcomes after pediatric open-heart surgery

Objectives: Congenital heart disease is a massive structural abnormality in the heart or large vessels inside the chest that is potentially important. Vitamin D is essential for the recovery of organs. This study aimed to evaluate the effect of serum vitamin D levels on clinical outcomes after pediatric open-heart surgery. Recent studies in infants have shown that vitamin D deficiency and hypocalcemia are associated with heart shock.&#x0D; Methods: The following descriptive cross-sectional study was conducted in the Cardiology Unit of Shahid Faghihi Hospital in Shiraz from April 2021 to October 2022, involving 115 patients aged one to seven years old. Serum levels of vitamin D were measured to evaluate the correlation between vitamin D levels and postoperative clinical outcomes. Data was gathered using SPSS.v16 software and analyzed through statistical tests.&#x0D; Results: The mean age of the patients in this study was 29.20± 53.10 months. The average vitamin D level of the patients was 24.52± 10.3 ng/ml. The study's findings indicated that infants eligible for heart surgery with normal vitamin D levels had significantly shorter durations of Inotropes, ventilators, chest tubes, and Intensive Care Unit (ICU) stay (P&lt;0.001).&#x0D; Conclusions: Decreased vitamin D levels in children with abnormal vitamin D can delay the improvement of heart and myocardial function and increase the use of inotropes, ventilators, and chest tubes. It also increases the number of days hospitalized in the ICU after Cardio Pulmonary Bypass (CPB) surgery.