[Frequency of group B capsular serotypes of Streptococcus using the multiplex PCR among the pregnant women in Kashan during 2011-2013]

Group B Streptococcus [GBS] has been described as an important pathogen in newborns and pregnant women. Maternal vaccination against GBS can reduce maternal GBS colonization and enhance antibody transfer to the fetus and also prevent the subsequent infections. Nine serotypes can be identified based on capsular polysaccharide: Ia, Ib, II-VIII. Due to the changes in serotypes' distribution pattern over time and also variation in different geographic areas, production of a universally optimal vaccine is impossible. This study aimed to evaluate the serotype distribution of GBS using the multiplex PCR among the pregnant women. This study was performed on 382 pregnant women. Vaginal swab samples were placed in the LIM selective medium and incubated at 37°C for 24 h. Then the samples were cultured in blood Agar medium and the GBS was identified and confirmed using the standard tests and gene encoding dlts, respectively. Capsular typing was performed using the multiplex PCR method to identify the Ia, Ib, II-VIII serotypes. Thirty-six [9.4%] out of 382 pregnant women were carriers of GBS. The most common types were III [32.14%], V [21.43%], and IV [14.3%], respectively. Types II and VIII were not identified in this study. Considering the high prevalence of III, V and IV serotypes in this study, they are potential sources for the production of multivalent GBS vaccines in near future

Molecular characterization and antibiotic susceptibility pattern of methicillin-resistant S. aureus [MRSA] in tertiary care hospital, Kashan

Methicillin resistant Staphylococcus aureus [MRSA], which is the most common cause of nosocomial infection, has been a major cause of morbidity and mortality around the world. This study was carried out to find out the resistance pattern and staphylococcal cassette chromosome mec [SCCmec] typing among MRSA. This descriptive work was done on 87 Methicillin resistant Staphylococcus aureus isolates which were collected from the patients with infections in a teaching hospital in Kashan, Iran, during the period of 2009. The isolates were tested for antibiotic resistance by the disc-diffusion method, covering 10 antimicrobials. The genotypes of SCCmec subtypes were determined by multiplex PCR. Amomg 87 MRSA isolated tested; the highest resistance was shown against erythromycin, clindamycin, sulfamethoxazole-trimethoprim, and tetracycline respectively. By contrast, the highest sensitivity was shown to amikacin. All of the isolates were resistant to Beta-lactams. All of the isolates were resistant to at least three classes of antibiotics, and all of the isolates were sensitive to vancomycin. Three [3.4%] MRSA strains were SCCmec type I, 12 [13.8%] were type II, 8 [9.2%] were type IV-b, 4 [4.6%] were type IV-d, and 3 [3.4%] were typeV. Overall, 57 [65.5%] MRSA strains could not be typed. The rising trend of multi-resistance to antibiotics poses an alarming threat to treatment of MRSA infections. Our findings show that clinical isolates of MRSA in our hospital carrying various kinds of staphylococcal cassette chromosome mec [SCCmec] types. SCCmec typse II and IV were the predominant strain of MRSA identified

[Comparing the effects of Indomethacin and magnesium-sulfate in the treatment of preterm labor]

The prevalence of preterm labor in Iran is 6-10%, accounting for 80% of neonatal morbidity. The most effective tocolytic agents to delay the preterm labor have not yet been known. Therefore, this study aimed to compare the effects of Indomethacin [ICN] and Magnesium-Sulfate [Mgs] in delaying preterm labor and also to assess the maternal complications associated with the two drugs. This randomized clinical trial study was performed on 24-32 week pregnant women [n=60] at risk for preterm labor referred to Shabih-Khani maternity hospital in Kashan. The women were divided into two equal groups: intravenous Mg sulfate [control] or ICN rectal suppository [intervention] groups. Then, the delaying of preterm labor and also the maternal morbidity were assessed in both groups. No significant difference was seen in maternal and sociodemographic variables between the two groups. The delaying of preterm labor was the same for both groups and no case of preterm labor was seen in women during the first 48 hours of hospitalization. Moreover, there was no significant difference in variables [e.g. the maternal age, the number of gravida, gestational age, symptoms on admission, the number of prior preterm labors and a history of preterm labor] between the two groups. The most common complication in both groups was nausea. There was no case of oligohydramnios in the indomethacin group. Although the delaying of preterm labor was the same in both groups, Mg sulfate administration requires permanent nursing care. It seems that ICN can be used as one of primary tocolytic treatments in preterm labor

[ study on the variations of temperature, moisture, pH and carbon to nitrogen ratio in producing compost by stack method]

Background: Considering the importance of chemical and physical parameters such as temperature, moisture, pH and carbon to nitrogen [C:N] ratio in producing compost, the purpose of this study was to evaluate these parameters in producing compost by stack method

Materials and Methods: This descriptive study was carried out on municipal solid waste generated in Kashan during a 63-day period from Oct 3 to Dec 4, 2010. Compost samples were taken from the top one-third, the center and also the bottom of the compost pile and mixed; the compost pile was aerated [if necessary]. Thereafter, samples were analyzed for carbon and nitrogen content using Fourti method

Results: The initial temperature of the compost pile was 38[degree]C and then increased to 65[degree]C at the 9[th] day, and reached to 26[degree]C at the last day of composting. The moisture at the beginning of the process was 67.5%, increased to 73% at the 5[th] day and decreased to 38% at the last day. The initial pH of the compost was 5.5, increased during the compost process, and reached an optimal value of 7.7 at the end of the process. The C:N ratio at the beginning of the process was 35:1 and in mature compost decreased to 12.5:1

Conclusion: Presence of actinomycetes and the dark-brown color of the prepared compost on the 63rd day of composting indicate that the compost meets the required standards. Consequently, the implementation of this method is suitable for tropical cities like Kashan

[Job stress among the nursing staff of Kashan hospitals]

Background: Job stress, the most important factor in reducing organizational productivity and the cause of psychosomatic disorders, today is more prevalent among the healthcare staff. Therefore, the aim of the present study was to assess the level of job stress among the nursing staff of Kashan hospitals during 2009

Materials and Methods: This descriptive cross-sectional study was performed on 190 nurses of Kashan hospitals using the Osipow questionnaire consisted of two parts: demographic data and six stress-inducing work roles [role overload, role insufficiency, role ambiguity, role boundary, responsibility and physical environment]. In addition, job stress was divided into four [subnormal, normal, moderate and severe] levels

Results: Results indicated that the 95.3% of nursing staff were found to have a normal level of job stress. No significant relationship was seen between the job stress and gender; however, there was a significant relation between the role insufficiency, role boundary, responsibility and physical environment and gender. Moreover, no significant relationship was found between the job stress and some factors [e.g. age, education, marital status, income and type of hospital]. The most frequent job stressors among the men and women were responsibility [90.2%] and role ambiguity [40.9%], respectively

Conclusion: Role ambiguity, responsibility and workload are the major sources of stress among the nursing staff

[Accordance between serum beta-hCG and vaginal ultrasonography in confirming a complete abortion]

Considering that there is no general agreement on use of misoprostol as the best method for the termination of pregnancy in first trimester, this study aimed to compare the vaginal ultrasonography and serum beta-hCG in the confirming of a complete abortion. This study was performed on 133 patients with a missed abortion or the blighted ovum diagnosed by vaginal ultrasonography, and a 12 week gestational sac admitted to Shabih-Khani hospital of Kashan in 2010. The patients' serum beta-hCG levels were measured. They were assessed for the tissue discharge [abortion] after taking one or two doses of vaginal misoprostol suppositories and the oral contraceptive pills prescribed after confirming the abortion. Then vaginal ultrasonography and the serum beta-hCG measurement were performed to diagnose the complete abortion in the second and fourth weeks of pregnancy. Among 133 patients, a complete abortion was diagnosed for 116 [87.2%] and 80 cases [60.15%] based on beta-hCG level and vaginal ultrasonography, respectively in the second week of pregnancy. In other cases, a complete abortion was diagnosed using both beta-hCG level and vaginal ultrasonography in the fourth week. Therefore, beta-hCG level was more effective [98.75%] than the vaginal ultrasonography to diagnose a complete abortion in the second week of pregnancy. The accordance between the two methods was 0.327 at the end of the second week of pregnancy. The measurement of beta-hCG level and vaginal ultrasonography are equally effective to confirm a complete abortion. Hence, to diagnose the complete abortion, determining the beta-hCG level followed by clinical examination is recommended

[ comparison between advanced O3/UV and H2O2/UV oxidation processes for the treatment of municipal solid waste leachate]

The solid-waste leachate is a type of wastewater with high concentration of mineral and organic compounds. There is little information about the effect of the advanced oxidation processes for the treatment of municipal solid-waste leachate. Thus, this study aimed to evaluate the effectiveness of processing advanced oxidation method as a biological pre-treatment for municipal solid waste. This bench-scale experimental study was conducted in a closed batch system on leachate samples of Kahrizak landfill [Tehran]. After obtaining the optimal conditions for the O3/UV and H2O2/UV processes, the effect of each process on 20 leachate samples was assessed and for each sample, 4 different reaction times were studied for the removal of BOD5, COD, TS and color. The results were compared using the mixed-design ANOVA model. The BOD5, COD and TS in raw leachate were 2500, 21910 and 29347 mg/l, respectively. The O3/UV and H2O2/UV processes removed 87% and 73% of COD, respectively. The BOD5/COD ratio in the O3/UV and H2O2/UV processes increased from 0.11 to 0.33 and 0.11 to 0.12, respectively. Moreover, the color in the O3/UV and H2O2/UV processes decreased from 82 to 67.25% and 81.65%, respectively. The O3/UV process can be used as a biological pre-treatment. The optimum pH for this process is 8.5, the optimum ozone concentration is 60.1 g/kg of decreased COD and the best reaction time which increases the BOD5/COD ratio more than 0.25 and less expensive than other reaction times, is 10 minutes

[Identification of mutation for drug resistance gene in cutaneous leishmaniasis]

Cutaneous leishmaniasis is a common parasitic disease and one of the health problems world wide. The pentavalent antimonial drugs [e.g. pentostam and Glucantime] are the first line treatment for leishmaniasis, and resistance to these drugs is a serious problem. Using PCR method, this study was carried out to identify the mutation for sodium stibogluconate resistance gene in cutaneous leishmaniasis cases referred to different health centers during 2006-8. This descriptive study was conducted on 150 isolates of leishmania major and leishmania tropica to identify the mutation in drug resistance gene. Promastigote clones were cultured in enriched RPMI 1640 medium and then the genomic DNA was isolated and using a pair of primers, a 400 bp of the gene was amplified. Finally, the PCR products were screened by conformation sensitive gel electrophoresis [CSGE] method and then the mutation was confirmed using RFLP with Sdu1 enzyme. Screening using CSGE and RFLP methods showed that 6.3% of the samples carried a mutation for drug resistance gene. Results showed a resistance for cutaneous leishmania against sodium stibogluconate. Further studies are required to determine the biochemical mechanism of this resistance

[Prevalence of postpartum depression and its relation to some psychosocial factors in mothers referred to health centers of Kashan during 2007-8]

Postpartum depression is a serious problem that may have negative effects on mother and family mental health. Considering that several theories have been proposed to explain the epidemiologic and demographic factors associated with the postpartum depression, the aim of this study was to identify the factors related to postpartum depression in Kashan. In this cross-sectional study, 50% of all health centers in Kashan were randomly selected during 2007-8. All of 204 mothers referred during 2-3 months of postpartum with minimum literacy [primary education] showed willingness to complete the questionnaire which included two parts: demographic and psychosocial questions and BDI [Beck Depression Inventory]. Data were analyzed using Chi-square test, CI, OR, and logistic regression. Seventy-seven [37.7%] out of 204 mothers referred to Kashan health centers experienced postpartum depression [0.31-0.44]. There was a statistically significant relationship between seven demographic and psychosocial factors and postpartum depression, in logistic regression [P<0.001], three factors [husband's appropriate behavior, intimate relationship with family, and no prior history of depression] were remained in the model. The findings indicated that the mentioned factors can reduce the incidence of postpartum depression. According to the results, factors including husband's appropriate behavior, intimate relationship with family and no prior history of depression may reduce the incidence of postpartum depression

[Epidemiological study of cutaneous leishmaniasis in Aran and Bidgol city from April to September 2009]

Leishmaniasis caused by leishmania protozoa can be considered as a zoonotic disease. This disease caused major health problems in some parts of Iran. Aran and Bidgol city [Isfahan province, Iran] is considered as one of the endemic foci of cutaneous leishmaniasis [Salak]. For success in controlling the disease and to provide the necessary training for high-risk groups, the epidemiological data of disease in the region is required. This cross-sectional study was carried out on 94 patients admitted to the health center of Aran and Bidgol from April to September 2009. The demographic and epidemiologic data were collected and analyzed. Thirty percent [30.8%] of patients were in the age group of 1-9 years. The number of patients in urban areas was more than that of rural areas and in men more than women. Most of these cases were seen in Aran and Bidgol city [52.1%] and then in Abuzeydabad city [22.3%], respectively. Moreover, most cases of disease were found in July [37.2%] and 54.3% and 45.7% of cases were dry and wet cutaneous sores, respectively. It seems that the high incidence of disease in age group of 1-9 years is due to the susceptibility of this age group to leishmaniasis. Therefore, regulating the control training programs in this group is suggested

[Amount of baking soda and salt in bakeries of Mehrdasht city [Najafabad] during 2009-10]

Bread is a valuable source of proteins, minerals and calories. Baking soda prevents the absorption of bread and more salt used in the production of bread causes different diseases. This study aimed to determine the amount of soda and salt used in bakeries of Mehrdasht. This cross-sectional descriptive study was performed on 50 bakeries of Mehrdasht city during 2009-10. A total number of 400 samples were randomly collected from all bakeries in four steps [two loaves from first batch]. The measurement of PH and salt was done in accordance with the standard method of Institute of Standard and Industrial Research of Iran [ISIRI, 1999]. The PH less than 6.2 was seen in 91.5% of samples and the most PH values above 6.2 were in Lavash bread [12.5%]. In 64.5% of samples, the amount of salt was more than the standard. A significant difference was seen between the amount of baking soda and the season while no significant difference was seen between the type of bread and the salt consumption [P=0.042].The amount of baking soda used in the bakeries of this city is not high; either bakers had no enough knowledge about the amount of salt used for production of bread or had more other reasons to use more or less salt than the standard. Therefore, drastic measures to control the amounts of baking soda and salt in bakeries are recommended

[Protective effect of N-acetylcysteine on blocking potentiation of noise induced hearing loss by carbon monoxide in rabbits]

Noise induced hearing loss [NIHL] is one of the most important occupational diseases worldwide. NIHL has been found to be potentiated by simultaneous carbon monoxide [CO] exposure. This study was performed to evaluate the protective effect of Nacetylcysteine [NAC] administration on potentiating effect of CO on NIHL in rabbits. In this experimental study forty-two male adult white rabbits were divided into seven groups [n=6 for each group]. Group 1, as control [no exposure to noise or CO and no injection]; Group 2, noise exposure [100 dB for 40 h]; Group 3, noise+CO exposure; Group 4, noise exposure+NAC administration [325 mg/kg]; Group 5, noise+CO exposure+NAC administration, Group 6, NAC administration alone and Group 7, CO exposure [700 ppm for 40h]. Audiometric test of rabbits was assessed by Auditory Brain stem Response [ABR] test in three stages: before exposure, 1 hour and 14 days post exposure at 1, 2, 4 and 8 kHz frequency. The administration of NAC attenuated temporary and permanent ABR threshold shift caused by noise exposure and simultaneous exposure to noise plus CO. NAC administration blocked the potentiating of temporary threshold shift by CO at 1, 2, and 4 KHz frequency and also blocked potentiating of permanent threshold shift by CO at all frequencies. NAC as an antioxidant agent can attenuate temporary and permanent noise induced ABR threshold shifts and provides protective effect against potentiating of NIHL by CO in rabbits

[Efficacy of stool antigen test for the non-invasive diagnosis of helicobacter pylori infection in dyspeptic patients referred to GI clinic of Kashan Shahid Beheshti hospital during 2007-8]

Dyspepsia is one of the most common ailments today and Helicobacter pylori infection is known as one of the common causes of dyspepsia in adults and children. Histopathologic diagnosis of Helicobacter pylori is a standard method and biopsy samples can be obtained by invasive endoscopy method. The current study was designed to evaluate the diagnostic value of stool antigen test of Helicobacter pylori as a non-invasive method. In this study all dyspeptic patients referred to GI clinic of Kashan Shahid Beheshti Hospital from 2007 to 2008 were involved in this study. In upper gastrointestinal endoscopy, mucosal biopsy was taken from antrum and corpus; simultaneous examination of the stool antigen sample for diagnosing of Helicobacter pylori was evaluated using ELISA method [positive titer>1/1]. Data were collected and analyzed for sensitivity, specificity, positive predictive value and negative predictive value. Among the 100 dyspeptic patients 50 were men and the remaining 50 women with a mean age of 43.3 +/- 17.13. The sensitivity, specificity, positive predictive value and negative predictive value in stool antigen test were%83.3,%79.4, 88.7% and 71.7%, respectively. There was a direct correlation between the severity of Helicobacter pylori infection and stool antigen titer in biopsy samples. The stool antigen test as a noninvasive method of diagnosing Helicobacter pylori can be regarded as an affordable alternative to the invasive biopsy procedure

[ correlation between neonatal phototherapy and risk of childhood asthma in children referred to pediatric clinic of Kashan Shahid Beheshti hospital during 2009-10]

Asthma is the most common chronic disease in childhood. Several factors have been considered as the disease risk factors. The neonatal phototherapy has recently been recognized as the main childhood risk factor. The aim of this study was to evaluate the relationship between the neonatal phototherapy and childhood asthma. This analytical case-control study was conducted on the asthmatic children with a history of neonatal icterus as the case group and those with no history of neonatal icterus as the control group with similar characteristics [age, gender, type of delivery and birth weight]. Twenty-eight out of 200 subjects in the case and 34 in the control group had the inclusion criteria. Phototherapy and its duration were compared in the case and control groups. Data were analyzed using chi-square and t-test. Twenty-six [92.8%] subjects in the case group and 20 [58.8%] subjects in the control group had a past history of phototherapy [P=0.002]. The mean number of days for neonatal phototherapy in the case and control groups was 4.9 and 3.2, respectively [P=0.001]. This study shows that neonatal phototherapy, as well as its duration, is an effective factor affecting childhood asthma. So, the phototherapy must be avoided except in rare situations with the least duration

[ quality of hospital services in Kashan educational hospitals during 2008-9: the patients' viewpoint]

The main mission of any hospital in a health care system is to promote care quality for patients and to meet their needs and expectations. The aim of this study was to evaluate the quality of hospital services from the viewpoint of patients admitted to Kashan educational hospitals. In this cross-sectional study, 390 patients admitted to Kashan educational hospitals were selected based on the stratified sampling and their points of view were evaluated using SERVQUAL questionnaire during 2008-9. The quality attributes of the questionnaire consisted of seven dimensions [e.g. physician's empathy, physician's availability, the reliability of physician performance, nurse's responsibility, nurse's empathy, drugs management and tangibility of services]. Validity and reliability of the questionnaire were confirmed using content validity and Cronbach's alpha coefficient [0.93], respectively. The data were analyzed using the Kruskal-Wallis and Mann-Whitney tests. The mean age of the respondents was 45.72 +/- 18.36 years and 54.1% of subjects were men. There was a significant difference among the mean of seven dimension scores and the total quality dimension. Moreover, a significant difference was observed in the quality score mean of different dimensions among hospitals. The highest and lowest means of quality score were for physician's empathy [3.97 +/- 0.75] and tangibility of the services [3.76 +/- 0.58], respectively. From the patients' viewpoint, educational hospitals have made good progress in providing hospital services; however, different quality scores among quality dimensions in any hospital signify that the health care administrators should pay more attention on the quality improvement programs to improve patients' satisfaction

[Prevalence of musculoskeletal disorders and work-related risk factors among the employees of an automobile factory in Tehran during 2009-10]

Work-related musculoskeletal disorders are considered as one of the most common occupational diseases and injuries. The high prevalence of the disorders has been reported in automobile industries due to numerous risk factors. This study was conducted to determine the prevalence of musculoskeletal disorders and the work-related risk factors in an automobile factory in Tehran. This cross-sectional study was performed on 145 workers in an automobile factory in Tehran during 2009-10. The prevalence of disorders was evaluated with standard Nordic questionnaire and work-related risk factors with KIM index. Data analyzed using chi-square test. Musculoskeletal disorders were most commonly seen in tire installing [92.8%] and exhaust storage installing [88.4%] units. It was least common in door installing [43.7%] unit. Awkward posture, load lifting, back bending and torsional movements were the most important work-related risk factors for the disorders. A significant relationship was observed between prevalence of musculoskeletal disorders and occupational risk level [P<0.05]. Ergonomics programs and specific ergonomic interventions are necessary to correct work-related problems in the work stations of this industry

[Molecular characterization and SCCmec typing in meticillin-resistant staphylococcus aureus isolated from clinical samples]

Methicillin-resistant Staphylococcus aureus [MRSA] is the main cause of hospital infection. The aim of present study was to investigate the molecular characteristics of Staphylococcus aureus [SA], to detect mecA gene, and to type SCCmec in the strains isolated from patients at Kashan Shahid Beheshti Hospital. This descriptive study was carried out on SA isolates [n=150] collected from the clinical samples at Kashan Shahid Beheshti Hospital, Iran during 2009. The identification of all tested isolates were confirmed using Gram's stain, coagulase, DNase and manitol salt agar. In addition, the genotypes of SCCmec in the MRSA isolates were determined by multiplex PCR. Eighty seven [58%] out of 150 SA isolates were confirmed as MRSA harboring mecA gene detected by PCR. Thirty four out of 87 [39.1%] were HA-MRSA and the remainig 53 [60.9%] were CA-MRSA. The multiplex PCR assay for SCCmec complex of MRSA strains [n=87] showed that 3[3.4%] samples were SCCmec type I, 12[13.8%] SCCmec type II, 8[9.2]% SCCmec type IVb, 4[4.6%] SCCmec type IVd and 3[3.4%] SCCmec type V. More than 50% of SA strains were positive for mecA gene and more than 60% of them were CA-MRSA. Moreover, SCCmec type II was the predominant strain of the identified MRSA

Do infants using baby walkers suffer developmental delays in acquisition of motor skills?

Development is a complex process, completed over a specific period of time, through the maturation of the nervous system. It is affected by genetic, ethnic, nutritional, social, and economic factors; one of the environmental factors affecting the acquisition of motor skills in infants is the use of baby walkers. Since this device is very commonly used for infants in our country, we conducted this study to evaluate its effects on the acquisition of motor skills in this age group of children. This longitudinal study was conducted in 2005 on 300 infants referring to the Primary Health Care Centers of Kashan district in 1384; the infants were divided into two groups of 150 babies each, with the case group using baby walkers, while the other 150, the controls, did not. All babies were followed for two years, and the ages for acquisition of motor skills were documented during face-to face or telephone interviews with the parents. Data were analyzed using the T-test and the Chi Square test. Of the study population, 175 babies [58.33%] were male. The mean age of acquisition of motor skills including rolling, crawling, moving on hands and feet, sitting without and with help, standing and walking dependently and independently were found to be delayed in infants using baby walkers, a difference between the two groups of walker users and non- walker users that was statistically significant [P<0.001]. Considering the adverse effects that walkers have on the acquisition of motor skills in infants, as demonstrated by the results of this study, we do not recommend the use of baby walkers in infants

Survival after in -hospital cardiopulmonary resuscitation

During recent years, cardiopulmonary resuscitation [CPR] in hospital has received much attention. However, the survival rate of CPR in Iran's hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival