Antibiotic Susceptibility Evaluation of Group A Streptococcus Isolated from Children with Pharyngitis: A Study from Iran / 감염과화학요법

BACKGROUND: The aim of this study was to evaluate the antibiotic susceptibility of Group A streptococcus (GAS) to antibiotics usually used in Iran for treatment of GAS pharyngitis in children. MATERIALS AND METHODS: From 2011 to 2013, children 3-15 years of age with acute tonsillopharyngitis who attended Mofid Children's Hospital clinics and emergency ward and did not meet the exclusion criteria were enrolled in a prospective study in a sequential manner. The isolates strains from throat culture were identified as GAS by colony morphology, gram staining, beta hemolysis on blood agar, sensitivity to bacitracin, a positive pyrrolidonyl aminopeptidase (PYR) test result, and the presence of Lancefield A antigen determined by agglutination test. Antimicrobial susceptibility was identified by both disk diffusion and broth dilution methods. RESULTS: From 200 children enrolled in this study, 59 (30%) cases were culture positive for GAS. All isolates were sensitive to penicillin G. The prevalence of erythromycin, azithromycin, and clarithromycin resistance by broth dilution method was 33.9%, 57.6%, and 33.9%, respectively. Surprisingly, 8.4% of GAS strains were resistant to rifampin. In this study, 13.5% and 32.2% of the strains were resistant to clindamycin and ofloxacin, respectively. CONCLUSION: The high rate of resistance of GAS to some antibiotics in this study should warn physicians, especially in Iran, to use antibiotics restrictedly and logically to prevent the rising of resistance rates in future. It also seems that continuous local surveillance is necessary to achieve the best therapeutic option for GAS treatment.

Physiologic effects of intra-nasal sedation with midazolam and ketamine in 3-6 years old uncooperative children

Objective: Several medications have been used for sedation in children in dentistry and intra-nasal route has been reported to be an efficient way regarding patient cooperation. The aim of the present study was to compare the changes in physiologic parameters following intra-nasal midazolam and ketamine administration

Methods: In this randomized cross-over double-blind trial, 17 uncooperative 3-6 years old children requiring at least two dental treatments were selected randomly and received intra-nasal ketamine [0.5 mg/kg] and midazolam [0.2 mg/kg] prior to the treatment using the other drug in the next visit. Physiologic parameters including blood pressure, heart rate, respiratory rate and O[2] saturation were measured and compared during the different time intervals using two way repeated measure ANOVA

Results: The patients showed higher blood pressure and heart rate following ketamine administration compared to midazolam [p<0.001]. No significant difference was found between the drugs at different time intervals regarding respiratory rate and O[2] saturation. [p>0.05]

Conclusion: In spite of significant differences between midazolam and ketamine regarding heart rate and blood pressure, both drugs can b e used as effective sedative medications without treatment interruption in children

Comparison of oral and buccal midazolam for pediatric dental sedation: a randomized, cross-over, clinical trial for efficacy, acceptance and safety

Objective: Providing a safe and efficient dental treatment for a young patient is a challenge for the dentist and the child. The purpose of this study was to investigate the effectiveness, safety and acceptability of buccal midazolam in dental pediatric patients and to compare it with oral Midazolam

Methods: Eighteen uncooperative healthy children aged 2.5-6 years were randomized to each of buccal midazolam [0.3mg/kg] or oral midazolam [0.5mg/kg] at the first visit, the alternative has been used at the second visit in a cross-over manner. The study took place at pediatric dentistry clinic of Shahed University, Tehran, from November 2011 to June 2012. The patients' vital signs and behavioral scores were recorded. The patient, the operator and the observer were blinded to the applied medication. Post operatively, patients' and parents' satisfaction were assessed by Visual Analogue Score and a questionnaire respectively. The P-value was set at 0.05 for significance level

Findings: There were no significant differences in physiologic factors in the medication groups at time 0, 10, 20, 30 minutes and discharge. There was also no significant difference between the two groups in behavioral parameters. The majority of parents rated both sedative agents as "effective" or "very effective" and their children mostly were without anxiety or with minor anxiety

Conclusion: Buccal midazolam may be safely and efficiently used in sedation of pediatric dental patients

[ effect of various amounts of nanohydroxyapatite on the mechanical properties and remineralization of a fissure sealant]

The main reason for failure in application of fissure sealant is its loss of bond to tooth and development of secondary decays. Nanoparticles of hydroxyapatite have convenient biologic properties and we can try to benefit from these characteristics by adding them to repair materials. The present study was performed with the aim to assess the effect of addition of various amount nanoparticles of hydroxyapatite on mechanical properties such as microshear bond strength and physical properties like curing depth and degree of conversion as well as evaluation of teeth enamel remineralization. In the present laboratory experimental study different weight percentages comprising 0% [control], 1%, 3%, 5%, 10% and 15% of nanoparticles of hydroxyapatite with 50 nm dimensions were separately added to fissure sealant. Then degree of conversion test by Fourier Transform Infrared Spectroscopy [FTIR] and curing depth according to ISO 4049 standard were performed on prepared samples. For the microshearbond strength test 35 premolar teeth without caries were used. The substance properties measurement device [Zwick] was used to do the test. Remineralization of permanent teeth enamel was assessed by Scanning Electron Microscopy [SEM]. Raw data obtained were statistically analyzed by normal distribution test [Kolmogorov-Smirnov], one way ANOVA and Tukey Post Hoc. Results showed that microshear bond strength and degree of conversion had no significant difference in various concentrations of fissure sealant containing hydroxyapatite nanoparticles [P>0/05]. Between microshear bond strength and degree of conversion means of 3M commercial fissure sealant and usual fissure sealant there was no significant difference [P>0/05]. Curing depth in concentrations of 10% [P=0] and 15% [P=0] statistically significantly decreased compared to previous groups [P<0/05]. Curing depth of 3M commercial fissure sealant group was lower compared to conventional fissure sealant group [P=0] and the difference was statistically significant [P<0/05]. A remineralized region on the surface between the fissure sealant and tooth enamel was observed by SEM. This region was more remarkable in higher concentrations. Fissure sealant containing hydroxyapatite nanoparticles with effect on remineralization on the surface of tooth enamel can lead to reduction of micro-leakages and prevention of development of secondary caries while mechanical properties do not decline