Antimicrobial-resistance pattern of Shigella species in children: a six-year study in an Iranian referral Hospital.

BACKGROUND: Shigella species are a frequent cause of shigellosis and shigellosis is considered as one of the most common causes of diarrhea in children. This disease is endemic in many developing countries such as Iran. This study was carried out to determine the prevalence and pattern of antimicrobial resistance of Shigella species among pediatric patients with acute diarrhea in Children Medical Center (CMC) Hospital, with a diagnosis of acute diarrhea to CMC Hospital from March 2011 through March 2016. Isolation and identification techniques, as well as the susceptibility tests are described in detail. RESULTS: Of the 46,795 stool specimens that were sent to the microbiology laboratory of the CMC Hospital for culture and susceptibility testing, 573 (1.2%) were positive for Shigella species. The most common species of Shigella were S. sonnei (n= 335, 58.4%) and S. flexneri (n=229, 40%), followed by S. boydii (n=8, 1.4%) and S. dysenteriae (n=1, 0.2%). S. flexneri was most sensitive to gentamicin (n=17/19, 89%) and amikacin (n=15/18, 83%), while high frequency of resistance to trimethoprim- sulfamethoxazole (n=204/224, 91%) and ampicillin (n=216/228, 95%) was seen. S. boydii was most sensitive to ampicillin (n=5 out of 7, 71%) and cefotaxime (n=6/7, 86%) and the high frequency of resistance was seen against trimethoprim-sulfamethoxazole (n=5/7, 71%). For S. sonnei, the highest sensitivity was reported against amikacin and gentamicin (87% and 80%, respectively), while the highest resistance to trimethoprim- sulfamethoxazole (n=325/331, 98%) and ciprofloxacin (n= 66 out of 76, 87%) was reported. Ciprofloxacin was examined on 115 out of 573 isolates and 84 isolates were resistant (73%). Multidrug-resistance (MDR), (i.e. resistance to three or more classes of antimicrobial agents) was classified into 11 distinct patterns. CONCLUSIONS: In this study, S. sonnei was the predominant Shigella species. High frequency of resistance to common antimicrobials such as trimethoprim-sulfamethoxazole and ampicillin limits the empirical therapy for the management of shigellosis in Iran. On the other hand, it should be noted that third-generation cephalosporins can be convenient replacing drugs.

Sleep disturbances in patients with rheumatoid arthritis.

BACKGROUND: Sleep problems are frequent in chronic diseases like rheumatoid arthritis (RA). The present study was conducted to determine frequency of sleep disturbances and their relations with disease severity. METHODS: The present case-control study was performed on 100 rheumatoid patients who were referred to the rheumatology clinic at the Avicenna hospital. A hundred age- and sex-matched healthy individuals were recruited in the study as a control group. Pittsburgh Sleep, 1Quality questionnaire, Insomnia Severity Index questionnaire and Epworth Sleepiness Scale were used. The disease activity was caIculated with the disease activity score 28. The collected data were analyzed using SPSS version 19. RESULTS: Mean scores of the sleep quality were 6.2 +/- 4.3 in patients and 4.6 +/- 2.5 in control group. 28% of the patients had good sleep quality whereas 72% had poor sleep quality. Daytime sleepiness was present in 24.8% of the patients and 15% of the control group. Multiple logistic regressions showed that insomnia, pain and disease intensity were the most important factors that determine patients' sleep quality. CONCLUSION: The present study showed that sleep disturbances are frequent in patients with RA and may contribute to disease severity. It is recommended that rheumatoid patients be evaluated for sleep disturbances during routine examinations.

Correlation between BIS and GCS in patients suffering from head injury.

OBJECTIVES AND BACKGROUND: Glasgow coma scale (GCS) is considered an important parameter to predict the clinical outcome in head injury; however, in some cases such as the use of sedative drugs the estimate of GCS would not be precise. Bispectral index (BIS) is an electrophysiological parameter to determine the clinical state of anesthesia. The aim of the present study is to evaluate correlation between GCS and BIS in patients suffering from head injury and to see if we can use BIS values as a prognostic factor in head trauma. METHODS: In this analytic study 61 consecutive patients with traumatic head injury admitted to the intensive care unit from January till June 2010 were examined. In each case the GCS and BIS values were measured and compared regarding different degrees of head injuries. RESULTS: Mean BIS in mild injury group was 96.20 ± 3.27 and in moderate injury group was 45.57 ± 1.28 and in severe injury group was 31.37 ± 2.08. There was a significant correlation between GCS and mean BIS (r = 0.88; P < 0.05). Mean BIS values were significantly different between mild, moderate and severe head injuries (96.2 ± 3.2, 45.5 ± 1.2, and 31.3 ± 2.08, respectively; P < 0.05). CONCLUSION: We found significant correlation between GCS and BIS in patients with traumatic head injury, so BIS can be used in addition to GCS for prediction of outcome in these patients specially in patients who are sedated or are intubated or in other case in whom GCS values cannot be determined accurately.

Pattern of factor VIII inhibitors in patients with hemophilia A in the north east of Iran.

This survey was conducted to evaluate coagulation factor VIII:C inhibitors among 102 hemophilia A patients from different cities of Khorasan province in north east of Iran in order to identify and characterize the pattern of inhibitor formation in these patients population. For this purpose, we randomly obtained plasma samples of 102 hemophilia A patients (44 patients with severe, 28 patients with intermediate and 30 patients with mild hemophilia A) and studied them using two tests: the APTT mix and Bethesda test were performed. In the whole group 20 patients (19.6%) factor VIII inhibitors were detected. These were in 11 patients with severe, five patients with intermediate and four patients with mild hemophilia A. None of patients with hemophilia A had previously been studied for the presence of an inhibitor, so there was no existing history of inhibitor evaluation.