Phenotypic screening of extended-spectrum ß-lactamase and metallo-ß-lactamase in multidrug-resistant Pseudomonas aeruginosa from infected burns.

Pseudomonas aeruginosa is an important opportunistic pathogen causing nosocomial infections, especially in immunocompromised patients such as burn patients. Pseudomonas aeruginosa is potentially resistant to different broad-spectrum antibiotics due to its ability to produce extended-spectrum ß-lactamase (ESBL) and metallo-ß-lactamase (MBL). In the present 6 month study, 220 strains of multidrug-resistant (MDR) Pseudomonas aeruginosa were isolated from male and female burn patients who had been hospitalized for at least one week in Motahari Hospital in Tehran. These strains were screened by the disc diffusion and double disc methods to determine the capacity of producing ESBL and MBL. Of all strains, 18% were ESBL-positive, resulting in a significant inhibition zone (≥5 mm) with cefotaxime and ceftazidime plus clavulanic acid discs when compared to the plain cefotaxime or ceftazidime discs. 38% of the strains were MBL-positive, showing at least 7 mm difference between the inhibition zone around the imipenem discs alone in comparison with imipenem plus EDTA discs, and at least 5 mm difference between the inhibition zone around imipenem plus EDTA discs and EDTA discs alone. In the light of our results, the rapidly spreading resistance among bacterial populations due to the extensive use of antibiotics is a matter of concern for the optimal treatment of patients, particularly in burn wards, and the determination of ESBL and MBL production of MDR Pseudomonas aeruginosa strains is essential.

Anxiety and depression in breast cancer patients before and after participation in a cancer support group.

A prospective study was conducted to assess the long-term impact of attending a support group on the prevalence of psychological morbidity in patients with breast cancer before and after 1-year participation in the Iranian breast cancer support group. Psychological morbidity was measured using the hospital anxiety and depression scale (HADS). In addition, qualitative data were collected to throw some lights on the topic. All current members of the three Iranian breast cancer support groups (n=56) were interviewed. The mean age of patients was 45.4 (S.D.=9.2) years, most were married (n=46, 82%), and 54% of patients (n=30) were diagnosed as having breast cancer from 1 to 5 years ago. While at baseline 16 patients (29%) scored high on the anxiety sub-scale and eight patients (14%) scored high on the depression sub-scale, at follow-up only two patients (2%) were likely experiencing severe anxiety symptoms and there were no patients with probable severely depressed mood. Comparing anxiety and depression at baseline and follow-up, there was a statistically significant difference between baseline and follow-up anxiety (P=0.03) and depression (P=0.008) scores. Analysis of the qualitative data indicated that the group involvement was the most important factor that contributed to the patients' improved psychological well-being. The findings of this prospective study suggest that participation in cancer support groups could have a long-term effect in reducing anxiety and depression in breast cancer survivors.

The EORTC breast cancer-specific quality of life questionnaire (EORTC QLQ-BR23): translation and validation study of the Iranian version.

The objective of this study was to test the reliability and validity of the Iranian version of the European Organization for Research and Treatment of Cancer (EORTC) Breast Cancer-Specific Quality of Life Questionnaire (QLQ-BR23). The English-language version of the questionnaire was translated into Persian (Iranian language) and its final form was approved by the EORTC Study Group on Quality of Life and then it was used in this study. The questionnaire was administered at two points in time to a consecutive sample of 168 newly diagnosed breast cancer patients and almost all of them (99%) found the questions easy to understand and acceptable. Cronbach's alpha coefficient for multi-item scales (to test reliability) ranged from 0.63 to 0.95 at baseline and from 0.75 to 0.92 at follow-up administration of the questionnaire. Validity analysis was performed using known-groups' comparison analysis. The results showed that all functional and symptom scales discriminated between sub-groups of patients differing in clinical status as defined by their performance status and disease stage. In addition, all functional and symptoms scales detected change over time, as a function of changes in patients' performance status. In general, the findings of this study indicated that the Iranian version of the EORTC QLQ-BR23 is a reliable and valid supplementary measure of the quality of life in breast cancer patients and can be used in clinical trials and studies of outcome research in oncology.

Anxiety and depression in Iranian breast cancer patients before and after diagnosis.

A prospective study was conducted to measure anxiety and depression in Iranian breast cancer patients before and after diagnosis using the Hospital Anxiety and Depression Scale (HADS). The HADS was administered at two points in time: before diagnosis and 3 months after. In all, 168 breast cancer patients were interviewed. While 48% of patients had severe symptoms of anxiety at both baseline and follow-up, more than 60% of patients had no symptoms of depressive illness at pre-and post-diagnosis assessments. Comparing anxiety and depression before diagnosis and after 3 months, there were no significant differences between patients' scores on anxiety (P = 0.42) and depression (P = 0.98) subscales. The results showed that patients with advanced disease and a lower performance status were more anxious and experienced more depression. The study findings suggest that severe symptoms of anxiety are the most frequent symptoms in Iranian breast cancer patients. It seems that during the process of diagnosis and 3 months after psychological morbidity persists in patients who suffer from breast cancer.

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): translation and validation study of the Iranian version.

The objective of this study was to test the reliability and validity of the Iranian version of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30). The English-language version of the questionnaire was translated into Persian (Iranian language), and its final form was approved by the EORTC Study Group on Quality of Life before it was used in this study. The questionnaire was administered at two time points to a consecutive sample of 168 newly diagnosed breast cancer patients, and almost all of them (99%) found the questions easy to understand and acceptable. Crohnbach's alpha coefficient for multi-item scales (to test reliability) ranged from 0.48 to 0.95 at baseline and from 0.52 to 0.98 at follow-up administration of the questionnaire. Validity was checked using two methods: inter-scale correlation and known-groups comparison. Almost all inter-scale correlations were statistically significant in the expected direction. Known-groups comparison analysis showed that all functioning and symptom scales discriminated between subgroups of patients differing in clinical status as defined by their performance status and disease stage. In general, the findings of this study indicate that the Iranian version of the EORTC QLQ-C30 is a reliable and valid measure of quality of life in cancer patients and can be used in clinical trials and studies of outcome research in oncology.

Evaluation of a national breast cancer information service: the Iranian experience.

This descriptive study evaluates a newly established national breast cancer information service in Iran and reports data on the impact of contacting the service. Two instruments were used to collect data: a "call record form" and a "user survey" questionnaire. The call record was filled in after each inquiry, and during 1 year 1,000 forms were completed. The questionnaire was filled in 1 week after each inquiry and was completed for a random sample of 400 callers. Thus, the results are presented in two parts. Analysis of the call record forms (part one) showed that 95% of the callers were female, mostly married (82%) and with secondary or higher education (80%). Most callers reported that they had heard about the service through the mass media (69%). Benign breast diseases, mastalgia and breast masses were the most common subjects of the inquiries (28%, 27%, and 18%, respectively). The majority of callers (77%) said that the main reason for contacting the service was that they wanted more information about breast diseases. Examination of the questionnaires (part two) revealed that 97% of respondents described the service as "useful" or "very useful". The vast majority (80%) perceived the information given as "easy" or "very easy" to understand. When respondents were asked to compare their feelings before and after contacting the service, 86% said that they felt "much more" or "a little more cheerful" and 81% said that they felt "much less" or "a little less worried". Practically all (99%) were satisfied with the overall service provided. The findings indicate that the service is effective in providing information and support for patients, relatives and the general public. The real challenge is how to make the service more widely available, especially to breast cancer patients.