Shahid Rajaee Hospital Research Articles

Intra-operative Risk Factors Affecting Mortality after Heart Transplantation: A Referral Center Experience in Iran.

Heart transplantation is the preferred treatment for end-stage heart failure. This study investigated the intra-operative risk factors affecting post-transplantation mortality. This single-center retrospective cohort study examined 239 heart transplant patients over eight years, from 2011-2019, at the oldest dedicated cardiovascular center, Shahid Rajaee Hospital (Tehran, Iran). The primary evaluated clinical outcomes were rejection, readmission, and mortality one month and one year after transplantation. For data analysis, univariate logistic regression analyses were conducted. In this study, 107 patients (43.2%) were adults, and 132 patients (56.8%) were children. Notably, reoperation due to bleeding was a significant predictor of one-month mortality in both children (OR=7.47, P=0.006) and adults (OR=172.12, P<0.001). Moreover, the need for defibrillation significantly increased the risk of one-month mortality in both groups (children: OR=38.00, P<0.001; adults: OR=172.12, P<0.001). Interestingly, readmission had a protective effect against one-month mortality in both children (OR=0.02, P<0.001) and adults (OR=0.004, P<0.001). Regarding one-year mortality, the use of extracorporeal membrane oxygenation (ECMO) was associated with a higher risk in both children (OR=7.64, P=0.001) and adults (OR=12.10, P<0.001). For children, reoperation due to postoperative hemorrhage also increased the risk (OR=5.14, P=0.020), while defibrillation was a significant risk factor in both children and adults (children: OR=22.00, P<0.001; adults: OR=172.12, P<0.001). The median post-surgery survival was 22 months for children and 24 months for adults. There was no correlation between sex and poorer outcomes. Mortality at one month and one year after transplantation was associated with the following risk factors: the use of ECMO, reoperation for bleeding, defibrillation following cross-clamp removal, and Intensive Care Unit (ICU) stay. Readmission, on the other hand, had a weak protective effect.

Predictions of Adherence to Treatment in Patients Referred to the Heart Failure Clinic of Shahid Rajaee Hospital in Tehran

Predictions of Adherence to Treatment in Patients Referred to the Heart Failure Clinic of Shahid Rajaee Hospital in Tehran

Determinant of antibacterial failure in patients with head and neck infections with odontogenic source.

&lt;b&gt;Introduction:&lt;/b&gt; Odontogenic infections are polymicrobial in origin and can be life-threatening. Antibacterial failure is an important issue in the treatment of odontogenic infections. Aim: This study aimed to determine the factors associated with antibacterial failure in patients with head and neck infections of odontogenic origin.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and method:&lt;/b&gt; This retrospective epidemiological study was performed using data collected from 229 patients with head and neck infections of odontogenic origin who were operated on in Shahid Rajaee hospital from March 2014 to December 2019.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; 123 (53.7%) patients were female and there were 106 (46.3%) males. The mean age SD was 33.01 13.37 years (range 7 to 80). The most common offending teeth were lower molars (81.7%) and lower premolars (5.7%). The most common site of infection was the submandibular area (36.4%) followed by the buccal (20.4%) and pterygomandibular (17.1%) regions. The most common pathogen was Streptococcus haemolyticus. The length of hospitalization was higher (4.66 days) in patients with failure of treatment compared to those without it (6.00 days) (P = 0.002). A combination of penicillin G and metronidazole was prescribed for all patients with failure of treatment compared to 57.6% in patients without failure of treatment (P = 0.002). There was no statistically significant difference between the two groups regarding age, duration of illness before hospitalization, WBC, gender, history of chemotherapy, hypertension, smoking, pregnancy, alcohol consumption, diabetes mellitus, the rate of fever, trismus, dysphagia, malaise, antibiotic before hospitalization, or surgical approach.&lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusion:&lt;/b&gt; Possible determinants in this study were not associated with antibacterial failure. Further studies should be conducted to investigate this relationship.

Quality of life in adult patients with congenital heart disease: Results of a double-center study.

Prevalence of congenital heart disease (CHD) has increased in recent years, and patients with CHD have to deal with sequelae of the multiple medical and surgical treatments that can affect different aspects of their life which could be reflected in their quality of life (QoL). In Iran, to the best of our knowledge, QoL of adult patients with CHD has not been investigated, so this study aimed to investigate the QoL of adult patients with CHD referred to two Iranian outpatient settings. In 2022, a double center, cross-sectional study was performed on adult patients with CHD receiving out-patient care at Besat Clinic in Kerman, Iran, and Clinic of Shahid Rajaee Hospital in Tehran, Iran. Inclusion criteria were documented diagnosis of CHD based on guidelines, ejection fraction of above 45% and age of 18-55 years. We recruited a sample of 120 individuals using a simple random sampling method. At the day of referring to the adult congenital heart diseases clinic, after ensuring their written consent to participate in the study, we asked patients to fill in two questionnaires of demographic questionnaire and Persian version of the Ferrans and Powers Quality of Life Index. Data were analyzed using descriptive statistics and chi square via SPSS-22. A total of 101 patients with a mean age of 31.05 years participated in the study. Demographic and socio-economic factors had no significant relationship with the patients' QoL. But factors related to the disease were significantly different among QoL groups (P-value > 0.05). Adults with CHD had a low QoL, which is not related to their demographic and socio-economic factors. That is, the existence of the disease alone and its accompanying complications can affect the QoL of these people. Hence, the mental health of adult patients with CHD should be monitored during their routine cardiac care.

Predictions of Adherence to Treatment in Patients Referred to the Heart Failure Clinic of Shahid Rajaee Hospital in Tehran

Background: The objective of this study was to identify the level of treatment adherence and also sought to explore several demographic, clinical, comorbidities, and self-care behavior factors that may affect adherence among patients with heart failure (HF). Materials and Methods: This single-center cross-sectional, questionnaire-based study was conducted on 500 adult HF patients referred to the clinic of Rajaie Cardiovascular, Medical, and Research Center, in Tehran, Iran, from February to July 2022. The level of treatment adherence was assessment through Modanloo’s questionnaire. An unadjusted and adjusted binary logistic regression model was used to check the effect of different factors on the patients’ adherence level. Results: Among 474 responders, 51.7% had “good” adherence to treatment. According to the results, age &gt;54 years (odds ratio [OR]: 0.967, 95% confidence interval [CI]: 0.946–0.988, P = 0.002), mitral valve regurgitation (OR: 0.597, 95% CI: 0.362–0.982, P = 0.042) and HF duration (OR: 0.486, 95% CI: 0.274–0.862, P = 0.014) were found as independent variables associated with “poor” treatment adherence. However, higher educational level (OR: 3.313, 95% CI: 2.632–4.067, P &lt; 0.001), New York Heart Association class I (OR: 3.231, 95% CI: 1.587–4.661, P = 0.002), ejection fraction (EF) &gt;40% (OR: 1.023, 95% CI: 1.005–1.041, P = 0.013), HF with preserved EF (OR: 2.728, 95% CI: 1.387–5.365, P = 0.004), familiar with social media (OR: 3.792, 95% CI: 1.777–4.268, P &lt; 0.001) and high awareness of HF (OR: 2.385, 95% CI: 1.072–3.044, P = 0.006) were significant positive predictors for good adherence to treatment. Conclusion: Adherence to the treatment regimen has improved compared to previous studies, but is still suboptimal, particularly with respect to awareness of HF. Therefore, improving the awareness of patients as well as encouraging and supporting them for self-care behaviors can have a positive effect on treatment adherence.

The clinical and paraclinical effectiveness of four-hour infusion vs. half-hour infusion of high-dose ampicillin-sulbactam in treatment of critically ill patients with sepsis or septic shock: An assessor-blinded randomized clinical trial

PurposeThis study was conducted to determine whether critically ill patients admitted to the intensive care unit (ICU) with sepsis and septic shock may benefit from extended infusion of ampicillin/sulbactam compared with those receiving intermittent infusion. Material and methodsThis randomized assessor-blinded clinical trial was conducted in the ICUs of Nemazee and Shahid Rajaee hospital, Shiraz, Iran, from August 2019 to August 2021. The participants randomly received 9 g Ampicillin/Sulbactam every 8 h by either extended (infused over 4 h) or intermittent (infused over 30 min) intravenous infusion if their estimated glomerular filtration rate based on Cockrorft-Gault formula was higher than 60 ml/min. ResultsTotally, 136 patients were enrolled and allocated to the intervention and control groups, each with 68 patients. Clinical cure was significantly higher in the extended group (P = 0.039), but ICU and hospital length of stay did not differ between the groups (P = 0.87 and 0.83, respectively). The ICU (P = 0.031) and hospital (P = 0.037) mortality rates in the extended infusion group were significantly lower than those in the intermittent infusion group. ConclusionThese data should be replicated in larger clinical trials before providing any recommendation in favor of this method of administration in clinical practice.

Suicide attempts and related factors in patients referred to Gachsaran Hospital, Iran

BackgroundSuicide is considered as an important, widespread phenomenon in the world, causing numerous deaths annually. This study is going to investigate how suicidal attempts are affected by several demographic and other underlying factors. ObjectiveThe present study was designed to investigate suicide attempts and its related factors in patients referred to Gachsaran Hospital, Iran. Materials and methodsThis cross-sectional study was conducted on 348 people who had attempted suicide (Please note that 348 was the number of suicidal attempts not the number of suicidal deaths). The data were collected by consent of Shiraz University of Medical Sciences and necessary coordination with the Emergency Management Statistics Center of Shahid Rajaee Hospital in Gachsaran city. The data analysis was performed through the logistic regression test using SPSS software version 19. The significance level was considered 0.05. ResultsA total of 348 individuals with a mean age of 23.9 ± 8.1 had attempted suicide in Gachsaran. Of these, 185 were female (53.2%) and 163 were male (46.8%). The results of multivariate regression showed that, after controlling the effect of probable confounding variables, the following variables had a significant relationship with suicide attempts in the individuals who had attempted to suicide: male gender, unemployment, and love problems. ConclusionConsidering the high rate of suicide attempts among unemployed male individuals during one year, counseling centers in Gachsaran city should pay special attention to this group of people. Measures such as creating jobs for young people can help prevent this social dilemma.

Development and Validation of the Rhinoplasty Outcomes Evaluation (ROE) Questionnaire: An Analytical Study.

BACKGROUND:Rhinoplasty Outcome Evaluation (ROE) is an easy-to-use questionnaire that allows comprehensive assessment of rhinoplasty-related patient satisfaction. However, the normal values for this questionnaire are not known. Therefore, we aim to validate the ROE questionnaire adapted to Iranian culture.METHOD:In this cross-sectional descriptive study, the statistical population consisted of applicants for cosmetic surgery referred to Shahid Rajaee Hospital, Shiraz, Iran, in the autumn and winter of 2017. Two hundred individuals participated in this research by a convenience sampling method. The questionnaire (ROE) was translated to Persian and backward translated to English by independent medical extern Persian speakers with complete English proficiency. The data were analyzed using SPSS software version 23 using exploratory factor analysis. RESULTS:The findings showed that the Cronbach’s Alpha of composite reliability (CR) and average variance extracted (AVE); overall, values above 0.4 were favorable in this measure. In addition, the AVE ranged from 0.50 to 0.59, which confirmed convergent validity. The AVEs of each factor was higher than the squared correlations and confirmed discriminant validity within the constructs. In the presence of significant factor loadings and composite reliability greater than 0.70, convergence validity was confirmed. Furthermore, the higher AVEs for each factor were compared to the squared correlations to confirm discriminant validity.CONCLUSION:The Iranian version of ROE is a valid instrument to assess results in rhinoplasty patients.

Recove® burn ointment for managing acute radiodermatitis in patients with breast cancer: A double blind randomized controlled trial

Background:Radiodermatitis is the most common complication of radiotherapy. There is no gold standard for managing the radiodermatitis. This study aimed to evaluate the effect of topical Recove® burn ointment; basically compounded of sesame oil, camphor, and zinc oxide; in preventing acute radiodermatitis.Methods:This double blind RCT (IRCT No.: 201204047136N2) was performed on 71 patients that referred for radiotherapy after mastectomy to Shahid Rajaee Hospital (Babolsar-Iran) during 2013-2017. Patients were allocated into 2 groups; 34 in control group and 37 in Recove® group. Patients applied the ointment 2 times a day, before every radiation therapy session for 5 weeks. The radiation oncologist assessed the severity of dermatitis weekly for 5 weeks and graded it from 0 to 4 according to the RTOG criteria.Results:Baseline characteristics including age, and BMI had no significant difference between groups. The Recover group patients experienced significantly less severe dermatitis compared to the controls (p<0.001). None of the patients in Recove® group encountered more than grade 2 of RTOG criteria, however, in the control group, 4 (12.9%) patients experienced grade 3 of RTOG and 3 (9.7%) patients developed grade 4 of RTOG at the end of the 5th week.Conclusion:Our results indicate that Recove® ointment significantly reduces the severity of acute radiodermatitis.

Recove® burn ointment for managing acute radiodermatitis in patients with breast cancer: A double blind randomized controlled trial.

Radiodermatitis is the most common complication of radiotherapy. There is no gold standard for managing the radiodermatitis. This study aimed to evaluate the effect of topical Recove® burn ointment; basically compounded of sesame oil, camphor, and zinc oxide; in preventing acute radiodermatitis.This double blind RCT (IRCT No.: 201204047136N2) was performed on 71 patients that referred for radiotherapy after mastectomy to Shahid Rajaee Hospital (Babolsar-Iran) during 2013-2017. Patients were allocated into 2 groups; 34 in control group and 37 in Recove® group. Patients applied the ointment 2 times a day, before every radiation therapy session for 5 weeks. The radiation oncologist assessed the severity of dermatitis weekly for 5 weeks and graded it from 0 to 4 according to the RTOG criteria.Baseline characteristics including age, and BMI had no significant difference between groups. The Recover group patients experienced significantly less severe dermatitis compared to the controls (p<0.001). None of the patients in Recove® group encountered more than grade 2 of RTOG criteria, however, in the control group, 4 (12.9%) patients experienced grade 3 of RTOG and 3 (9.7%) patients developed grade 4 of RTOG at the end of the 5th week.Our results indicate that Recove® ointment significantly reduces the severity of acute radiodermatitis.

Evaluating Medical Staff's Burnout and its Related Factor during the COVID-19 Pandemic: A Cross-Sectional Study of Daran Shahid Rajaee Hospital

Evaluating Medical Staff's Burnout and its Related Factor during the COVID-19 Pandemic: A Cross-Sectional Study of Daran Shahid Rajaee Hospital

The evaluation of alveolar fractures of trauma patients in Iran

BackgroundAlveolar bone plays a vital role in mastication and supporting the teeth. The alveolar process is one of the most challenging regions of facial bone to reconstruct due to the deformity involves both hard and soft tissues. However, the etiology, gender, and age distribution vary between different regions, cultures, and countries. This study aims to investigate the prevalence of alveolar trauma in Shahid Rajaee Hospital, Shiraz, Iran, for three years.MethodsIn a retrospective cross-sectional study, patients with alveolar fractures referred to Shahid Rajaei Hospital in Shiraz were included in the study. Age, sex, site of alveolar fractures, and etiology factors of trauma explored. The collected data was analyzed by SPSS software. Mean pm SD calculated for the inferential statistics, and the data compared using Chi-square and Exact Fisher. A p-value of < 0.05 was considered statistically significant with a 95% reliability.ResultsA total of 165 patients had alveolar fractures in this study. We found that the most common cause of alveolar fracture was road accidents (32.3%) and the lowest reason was violence (9%). Most people with alveolar trauma were male and in the 21–30 years. The prevalence of mandibular and maxillary alveolar fractures was 17.61 and 17.01%, respectively, with the most anterior area of injury.ConclusionAlveolar trauma is one of the most common injuries among trauma patients. Early diagnosis and treatment plans are necessary to reduce the complications of facial trauma. Early training for a young adult is essential to prevent the severity of trauma.

Estimation of Increasing the Surge Capacity of Shaheed Rajaei Trauma Hospital in Shiraz City, Iran

Background: The present study aimed to evaluate the surge capability of Shahid Rajaee Trauma Hospital in Shiraz City, Iran, in response to a mass causality incident. Materials and Methods: This descriptive study was conducted in Shahid Rajaee Hospital in Shiraz in 2017. The Delphi technique was used in this study. Three checklists were used for the Emergency Department, Operating Room, and Intensive Care Unit. The surge capacity was calculated for each unit based on the formulas derived from different studies. Results: The surge capacities of the Emergency Department, Intensive Care Unit, and Operating Room were obtained 36%, 20%, and 17.5%, respectively. Shahid Rajaee Hospital of Shiraz can quickly increase its capacity by 27% based on the scenario defined in this study. However, if an accident leads to more causalities, it will likely face several limiting factors for increasing the surge capacity. Conclusion: Due to the critical role of hospitals in the crisis, it seems that the studied hospital should look for ways to increase its surge capacity to cope with unexpected accidents as soon as possible.

Which criteria is a better predictor of ICU admission in trauma patients? An artificial neural network approach

PurposeOne of the most critical concerns in the intensive care unit (ICU) section is identifying the best criteria for entering patients to this part. This study aimed to predict the best compatible criteria for entering trauma patients in the ICU section. MethodThe present study was a historical cohort study. The data were collected from 2448 trauma patients referring to Shahid Rajaee Hospital between January 2015 and January 2017 in Shiraz, Iran. The artificial neural network (ANN) models with cross-validation and logistic regression (LR) with a backward method was used for data analysis. The final analysis was performed on a total of 958 patients who were transferred to the ICU section. ResultsBased on the present results, the motor component of the GCS score at each cutoff point had the highest importance. The results also showed better performance for the AUC and accuracy rate for ANN compared with LR. ConclusionThe most critical indicators in predicting the optimal use of ICU services in this study were the Motor component of the GCS. Results revealed that the ANN had a better performance than the LR in predicting the main outcomes of the traumatic patients in both the accuracy and AUC index. Trauma section surgeons and ICU specialists will benefit from this study's results and can assist them in making decisions to predict the patient outcomes before entering the ICU.

Translation and Psychometric Assessment of the Postoperative Handover Assessment Tool

PurposeThe objective of the present study was to translate and validate the Postoperative Handover Assessment Tool (PoHAT) in the Persian language. DesignThe study used a descriptive, mixed-method design. MethodsThe present descriptive, mixed-method study was conducted in 2018 at Shahid Rajaee Hospital and Shiraz Nursing and Midwifery School, Shiraz University of Medical Sciences (Shiraz, Iran), to evaluate the psychometric properties of the Persian version of the PoHAT. The original version of PoHAT was translated into the Persian language and then back-translated for comparison. The face validity (qualitative), content validity (qualitative and quantitative), construct validity (experimental intervention method), and reliability (inter-rater reliability, internal consistency) of the Persian version of the PoHAT were assessed. Data were analyzed using SPSS software, version 22. P values less than 0.05 were considered statistically significant. FindingsThe content validity ratio of all the 34 items of the Persian version of the PoHAT ranged between 0.66 and 1. The content validity index for all items was within the acceptable range (between 0.92 and 1). The result of construct validity, using the experimental intervention method, showed a significant difference between before and after intervention (P < .05). The correlation coefficient for inter-rater reliability of all subscales (information, tasks, teamwork) and the total checklist was 0.89, 0.80, 0.94, and 0.85, respectively; the coefficient was significant for all subscales (P < .001). ConclusionsThe validity and reliability of the 34-item Persian version of the PoHAT were confirmed. The application of the PoHAT to assess the process and quality of postoperative handover in Iran and other Persian-speaking countries is recommended.

Seroepidemiological Study of Epstein-Barr Virus in Patients with Head and Neck Tumors at Shahid Rajaee Hospital in Babolsar, Iran

Background: Epstein-Barr virus (EBV) is a herpes virus, which is the cause of infectious mononucleosis. Seroepidemiological studies show that more than 95% of adults in the world are infected with this virus. This virus is a modifying virus that is associated with some malignancies such as Burkitt lymphoma, tumors in HIV-infected patients, Hodgkin's lymphoma, head and neck tumors, and T-cell lymphoma. Objectives: This study aimed to determine the prevalence of EBV and its relation to the type of cancer in patients with head and neck tumors, which were treated in the years 2015 to 2016 at Shahid Rajaee Radiation Hospital in Babolsar. Methods: During one year, all patients with head and neck tumors were monitored, and finally, a total of 37 patients who had pathologically confirmed diagnoses were entered into the study after obtaining written informed consent. In this descriptive study, specific anti-EBV viral capsid antigen (VCA) immunoglobulin M (IgM) and IgG antibodies were evaluated using enzyme-linked immunosorbent assay (ELISA). Also, other patients' information was obtained from their records. Results: The mean age of the patients was 59 years, and the number of men (70.23%) was higher than that of women (29.77%). Regarding the histopathology information and the frequency of tumors, most of the patients had squamous cell carcinoma (SCC) (73%) in the sites of the nasopharynx (27.02%) and pharynx (18.91%). The results of the ELISA test showed that IgG antibodies were positive in most of the patients (86.5 %). About the relation between the sites of the tumors and the IgG antibody, all patients (100%) with nasopharyngeal, tongue, and lips cancers were positive while they were the least in pharyngeal cancer (5.4%). Conclusions: This study showed that a significant number of patients with head and neck tumors (86.5%) were infected with this virus, which indicates that EBV as a carcinogenic agent in head and neck tumors has a high prevalence in our society and requires preventive and therapeutic actions.

Comparison of anger control and its relationship with mental health in trauma patients after incident

Introduction: Anger, as a major factor in traffic accidents and beatings, plays an important role in the mortality of the people. According to the statistics from the World Health Organization, beatings and traffic accidents are predominant causes of trauma incidents. An increase in violence, as a risk factor, is effective in traumatic and mental health injuries and has an important role in creating incidents. This study aimed to compare anger control and its relationship with mental health in trauma patients after incidents. Method: This cross-sectional study was conducted in Shahid Rajaee Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, on 214 patients who were selected based on systematic randomization using the available sampling method. Novaco's Anger Control Questionnaire, as a standard questionnaire, and General Mental Health Questionnaire were used for comparing the anger control and assessing the mental health, respectively. The collected data were analyzed in SPSS software (Version. 18) using the independent t-test and Pearson correlation coefficient. A p-value less than 0.05 was considered statistically significant. Results: According to the results of demographic characteristics, the mean age of the patients was 32.65±8.318 years. Out of 214 patients who participated in this study, 120 and 94 cases were injured by beatings and traffic accidents, respectively. The results of statistical analysis indicated a significant relationship between mental health and anger control in these subjects. Conclusion: The injury caused by an increase in violence in traffic accidents and beatings is a dangerous risk factor lurking in the population, which leads to irreparable damages to the country's economy. These findings showed a significant relationship between anger control and mental health in the two groups of traffic accidents and beatings. Therefore, the development of anger control training packages can reduce damages caused by anger in people.

Expression analysis of drug-resistant gene (blaOXA-51) in carbapenemases producing Acinetobacter baumannii treated with imipenem/sulbactam combination

Drug-resistant Acinetobacter baumannii is a frightening reality. The aim of this study is to examine the expression profiles of blaOXA-51 gene in carbapenemases producing A. baumannii treated with imipenem/sulbactam combination. Carbapenemases producing A. baumannii was identified among clinical isolates of A. baumannii obtained from patients at Shahid Rajaee hospital, Gachsaran, Iran, from January to June 2018. Synergism testing of imipenem/sulbactam on carbapenemases producing A. baumannii was carried out by broth microdilution method. Eventually, the expression of blaOXA-51 gene was carried out to investigate the inhibitory properties of imipenem/sulbactam combination against carbapenemases producing A. baumannii using quantitative real time RT-PCR. Among A. baumannii isolates, 24% were carbapenemases producing A. baumannii. Imipenem/sulbactam combination revealed synergistic and partial synergistic effect for all tested isolates (FIC= 0.313-0.75). Finally, imipenem/sulbactam combination displayed significant down-regulation of blaOXA-51 gene in carbapenemases producing A. baumannii. Imipenem synergizes with sulbactam against carbapenemases producing A. baumannii by targeting of the blaOXA-51 gene.

Differential expression of blaCTX-M-33 with vancomycin/trimethoprim combination in Escherichia coli-producing extended-spectrum β-lactamase isolated from intensive care unit-acquired urinary tract infection

Aim: The aim of this study was to develop combination approach for the treatment of Escherichia coli-producing extended-spectrum β-lactamases (ESBLs) isolated from intensive care unit (ICU)-acquired urinary tract infections (UTIs). Materials and Methods: The observational study was conducted between January 5, 2018- June 5, 2019 to isolate and detect E. coli from UTI patients admitted to ICUs in Shahid Rajaee hospital, Gachsaran, Iran. Morphological, biochemical and molecular methods were conducted to identify E. coli isolates. Phenotypic confirmation of E. coli producing ESBL was performed using ESBL disc diffusion test according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The combination index assay set-up was based on CLSI guidelines to investigate antibacterial susceptibilities to vancomycin alone and in combination with trimethoprim and interpreted with the fractional inhibitory concentration (FIC) index. Eventually, the expression levels of blaCTX-M-33 gene were determined by real-time quantitative reverse transcription–polymerase chain reaction. Results: A total of 90 ICU-acquired UTIs occurred among 255 patients. The combination index assay results showed that vancomycin/trimethoprim combination would be reduced its minimal inhibitory concentration90 value. The vancomycin/trimethoprim combination revealed partial synergistic and indifferent effects (FIC = 0.52–1.50) in the isolates of E. coli-producing ESBL. The results of gene expression analysis indicated that vancomycin/trimethoprim combination caused downregulation of blaCTX-M-33 gene at negligible levels by 55.56–58.82-fold and stopped drug resistant. Conclusion: Vancomycin/trimethoprim combination may diminish resistance in the E. coli-producing ESBL isolated from ICU-acquired UTI patients.

Identifying Challenges of Providing Care for Trauma Patients; A Concurrent Mixed Methods Study

Background: Caregiving for trauma patients has many challenges. Inadequate knowledge of these challenges can affect the patients and worsen their conditions. Objectives: We aimed to explore the caregivers’ experiences about these challenges and problems of caring for patients with trauma emergencies. Methods: The study adopted a concurrent triangulation mixed-method and was conducted in Shahid Rajaee Hospital, southern Iran, in 2019. Semi-structured interviews, focus groups, observation and ward document assessments were conducted with focusing on the challenges experienced by the caregivers. A checklist was used to assess the performance of caregivers and measure the indices related to the care process. Statistical results and qualitative data on the main categories were compared and integrated for data analysis. Results: In total,307 codes were extracted by analyzing the content of the interviews and available evidence. The codes were summarized in 20 subcategories, and six main categories were extracted as follows: lack of professional capability, uncoordinated team response, deficits in managerial commitments, inadequate work motivation, complex nature of trauma emergency, and lack of clinical communication. The quantitative results indicated that caregivers’ performance was considerably far from the expected scores and also many indices indicated a waste of time in responding to the patient needs. Conclusion: Various dimensions of trauma care challenges indicate that professional capability, team coordination and communication, managerial commitments and work motivation considering the complex nature of trauma emergency wards are crucial to enhance patients' access to optimum quality care. Caregivers’ performance and quality of indices also affect the care process. Future studies are required for compiling strategies and protocols for the quality of care for trauma patients.