Evaluation of interleukin-12 receptor ß1 and interferon gamma receptor 1 deficiency in patients with disseminated BCG infection.

INTRODUCTION: Disseminated BCG infections among other complications of Bacillus Calmette-Guérin (BCG) vaccine are rare and have occurred in children with immunodeficiency disorders such as mendelian susceptibility to mycobacterial disease (MSMD) which could be due to defects in some elements of IL-12/IFN-γ axis. MSMD-causing mutations have been identified in 10 genes during the last two decades. Among them, mutations in the IL12Rß1 and IFNγR1 genes constitute about 80% of recorded cases of MSMD syndrome. The aim of this study was to investigate IL-12Rß1 and IFN-γR1 deficiencies in patients with disseminated BCG infection. METHODS: This study was performed on 31 children with disseminated BCG infections who referred to children's medical center. Whole blood cell culture was performed in presence of BCG, IL-12 and IFN-γ stimulators. The supernatants were assayed for IFN-γ and IL-12p70 by ELISA method. In order to evaluate IL12Rß1 and IFN-γR1 receptors expression, flow cytometry staining was performed on the patients' T-cells stimulated with PHA. RESULTS: Flow cytometry staining of 31 Iranian patients with disseminated BCG infections with the average age of 43 months showed lack of the expression of IL-12Rß1 and IFN-γR1 genes in PHA-T-cells of the nine and one patients, respectively in whom the incomplete production of IFN-γ and IL-12 was reported by ELISA. Among these 10 patients, eight cases had related parents (80%). CONCLUSION: It is recommended that to avoid BCG complications, screening be performed for MSMD before BCG inoculation in individuals with positive family history of primary immunodeficiency diseases and inhabitants of areas with high frequency of consanguinity.

Molecular characteristics and antibiotic resistance profiles of Escherichia coli strains isolated from urinary tract infections in children admitted to children's referral hospital of Qom, Iran.

BACKGROUND: Urinary tract infections (UTIs) are a highly prevalent infection among children and Escherichia coli is one of the most important pathogens causing pediatric UTIs. Production of extended spectrum b-lactamase (ESBL) enzymes is an important factor in the emergence of antibiotic resistance among these bacteria. This study aimed to determine the resistance patterns, the frequency of ESBL-encoding genes and the genetic diversity of E. coli strains isolated from children with UTIs who were admitted to children's referral hospital of Hazrat Masoumeh, Qom, Iran. METHODS: A total of 102 consecutive non-duplicative strains of E.coli that were isolated from children with UTIs were included into the study. Antibiotic susceptibility of the isolates was determined by disk diffusion method according to the CLSI guidelines. The ability of the isolates to produce ESBLs was phenotypically determined by both combined disk test and double disk synergy test. The ESBL encoding genes (bla CTX-M, bla SHV, and bla TEM) in phenotypically confirmed ESBL-positive isolates was detected by PCR method. The genetic relatedness of the isolates was designated by enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR). RESULTS: Eighty-three percent (n=85) of the children were female. Most of the infected boys (88%, n=15) were less than 1 year of age and most of the infected girls (48%, n=41) aged 1 to 6 years old. The highest sensitivity was observed to nitrofurantoin (8%, n=8), followed by amikacin (12%, n=12) and piperacillin-tazobactam (17%, n=17). In contrast, the highest resistance rate was seen to ampicillin (94%, n=96) and cefazolin (93%, n=95). Eighty-eight percent (90 out of 102) of the strains were multidrug-resistant (MDR). Fifty-eight percent (n=59) of the strains were ESBL-positive and results of the combined disk test was in concordance with PCR. The blaCTX-M was the most frequent ESBL encoding gene (88%, n=52), followed by blaTEM (54%, n=32), and blaSHV (15%, n=9). Based on the ERIC-PCR technique, isolates were clustered in 13 different types. There was no relationship between different ERIC types and origin of the isolates (i.e. hospitalized or outpatients), ESBL-producing ability, and antibiotic resistance patterns. CONCLUSIONS: High prevalence of ESBL-positive isolates of E. coli (58%) was found in our study and all of them were MDR. In addition, there were statistically significant differences in the resistance rates of ESBL-producers, and non-producers to some antibiotics, which result in limiting their therapeutic options. Continuous surveillance of the emergence of ESBL-producing isolates and their antibiotic resistance profiles as well as using appropriate typing methods is needed for reducing their spread, selecting appropriate treatment regimens and finding hospital outbreaks.

MHC haplotype diversity in Persian Arabian horses determined using polymorphic microsatellites.

Previous research on the equine major histocompatibility complex (MHC) demonstrated strong correlations between haplotypes defined by polymorphic intra-MHC microsatellites and haplotypes defined using classical serology. Here, we estimated MHC diversity in a sample of 124 Arabian horses from an endangered strain native to Iran (Persian Asil Arabians), using a validated 10-marker microsatellite panel. In a group of 66 horses related as parent-offspring pairs or half-sibling groups, we defined 51 MHC haplotypes, 49 of which were new. In 47 of the remaining 58 unrelated horses, we could assign one previously identified MHC haplotype, and by default, we gave provisional haplotype status to the remaining constellation of microsatellite alleles. In these horses, we found 21 haplotypes that we had previously defined and 31 provisional haplotypes, two of which had been identified in an earlier study. This gave a total of 78 new MHC haplotypes. The final 11 horses were MHC heterozygotes that we could not phase using information from any of the previously validated or provisional haplotypes. However, we could determine that these horses carried a total of 22 different undefined haplotypes. In the overall population sample, we detected three homozygous horses and one maternally inherited recombinant from 21 informative segregations. Virtually all of the horses tested were MHC heterozygotes, and most unrelated horses (98%) were heterozygous for rare microsatellite-defined haplotypes found less than three times in the sampled horses. This is evidence for a very high level of MHC haplotype variation in the Persian Asil Arabian horse.

A novel, cell-permeable, collagen-based membrane promotes fibroblast migration.

BACKGROUND AND OBJECTIVE: Growth factors are frequently incorporated into scaffolds to promote periodontal regeneration but many currently used scaffolds do not encourage cell migration towards the dentogingival junction. We examined the proliferation and migration of human gingival fibroblasts in a novel, physically robust, collagen-Vicryl™ membrane loaded with fibronectin (FN) and/or insulin-like growth factor (IGF-I). Biocompatibility of the membranes was evaluated in rat dorsal skin. MATERIAL AND METHODS: Chemotaxis was examined in Boyden chambers and cell migration by confocal imaging of membranes, which were fabricated from rat tail type I collagen with embedded Vicryl knitted mesh, IGF-I (50, 100 ng/mL) and FN (10 µg/mL). Membranes (Vicryl alone, collagen+Vicryl, collagen+Vicryl+IGF-I, collagen+Vicryl+FN') were implanted subcutaneously in 8 rats and were evaluated by histomorphometry after 7 and 14 days. RESULTS: IGF-I (50 or 100 ng/mL) promoted chemotaxis compared with vehicle controls (P = .02, P = .001, respectively). IGF-I did not affect cell proliferation. Incorporation of FN retarded time-dependent release of IGF-I from collagen gels. Three dimensional confocal microscopy imaging of cell migration through collagen+Vicryl membranes showed enhanced migration in the IGF+FN group compared to all other groups at 8, 10 and 14 days (P < .05). In a rat skin model, implanted membranes were surrounded by thin collagen capsules and mild inflammatory infiltrates. CONCLUSION: Incorporation of FN into IGF-I-loaded collagen+Vicryl membranes reduced IGF release from collagen and increased the migration of human gingival fibroblasts. The new membrane may promote healing and reformation of the dentogingival junction.

High frequency of metronidazole and clarithromycin-resistant Helicobacter pylori in formalin-fixed, paraffin-embedded gastric biopsies.

BACKGROUND: Clarithromycin and metronidazole resistance of Helicobacter pylori is increasing worldwide and has resulted in a loss in the effectiveness of therapeutic regimens. We aimed to evaluate common mutations of resistance genes to clarithromycin (A2143G, A2142G and A2142C) and metronidazole (rdxA and frxA) in H. pylori strains in formalin-fixed, paraffin-embedded gastric biopsies. METHODS: A total of 110 tissue blocks from children suspected of H. pylori infection were included. After DNA extraction, UreC PCR was performed. Specific primers and restriction enzymes by PCR-RFLP were used for analysis of A2143G and A2142G mutations. To detect A2142C and assess frequent mutations of metronidazole resistance, specific primers and PCR method were used. RESULTS: One hundred cases of H. pylori (91%) were by PCR. Of 34 (34%) clarithromycin-resistant isolates 17 (50%), 10 (29%) and 7 (21%) had A2143G, A2142G, A2142C, respectively. Resistance rate to metronidazole was 60% (N = 60). In sequencing rdxA and frxA in the mutated strains, missense mutations were most frequent (60 and 57%, respectively), and there were differences in frameshift and non-sense mutations (p < 0.001). CONCLUSION: Resistance rate to clarithromycin was high and the highest percentage of mutation was of A2143G. PCR-RFLP was used directly with formalin-fixed gastric biopsies, thus, avoiding the requirement for time-consuming culture-based methods. The isolates that developed resistance were mainly associated with mutations of both rdxA and frxA genes.

ASQ-3 scores are sensitive to small differences in age in a Peruvian infant population.

OBJECTIVE: The Ages and Stages Questionnaires Edition 3 (ASQ-3) are a well-validated international screen for developmental delays in young children. However, previous studies demonstrate variable scores between children eligible to take the same ASQ-3 interval. This study aimed to determine a relationship between age and ASQ-3 score for each screening interval. METHODS: This was a baseline exploratory cross-sectional study of infants under 2 years old evaluated for the Peruvian social programme Cuna Más. Participants were included in Cuna Más if they lived in districts with fewer than 2000 inhabitants or 400 homes, indicating a predominantly rural population. The appropriate ASQ-3 screening interval was administered to each subject. Subjects were divided into four 2-week chronological subgroups based on age within each 2-month screening window and aggregated across all 12 screening intervals. Fisher's exact test, analysis of variance and Bonferonni post hoc test were used to compare differences between age subgroups. Linear regression was performed to assess the relationship between ASQ-3 score and both aggregated and disaggregated age subgroup. RESULTS: A total of 5850 Peruvian infants were evaluated in 2013. Mean age was 13 ± 6.6 months, 50.7% were male and mean maternal education was 6.6 ± 4.0 years; 34.8% infants were stunted, 7.8% were underweight, 0.9% were wasted and 2% had age adjusted greater than 35 days for prematurity for ASQ-3 interval assignment. Mean total ASQ-3 was 42.2 ± 8.2. The ASQ-3 allocated 49.6% with suspected delay in one or more developmental areas. Before and after adjusting for wealth quintile, maternal education level, infant nutritional status and prematurity adjustment, age subgroup remained significantly associated with total ASQ-3 score (ß = 1.8, CI: 1.7-2.0, P < 0.001), sectional ASQ-3 score (all P < 0.001) and inversely associated with one or more scores indicating suspected developmental delay (P < 0.001). CONCLUSIONS: The ASQ-3 may underestimate the sensitivity of child development to small differences in age in this population.

The application of soy isoflavones for subjective symptoms and objective signs of vaginal atrophy in menopause: A systematic review of randomised controlled trials.

Vaginal atrophy is a common complaint among many women in their menopause, presenting with a cluster of symptoms including dryness, itching, burning/soreness, discharge, irritation and painful intercourse. We searched for existing pertinent data in three chief registries. Specified time brackets included 1996-2013 for Medline, 1990-2013 for Scopus and 2013 for Cochrane Central Register of Controlled Trials (issue 1). Of 110 potentially relevant publications, 17 and 9 trials (7 on maturation value and 2 on vaginal dryness) were selected for qualitative and quantitative analysis, respectively. In general, soy isoflavones seem to improve vaginal symptoms as opposed to control arms. Soy isoflavones were also shown to be more efficacious in quantitative analysis, though this was statistically non-significant. Standardised difference in means of maturation value change was 0.072 (95% confidence interval [CI]: - 0.42 to 0.57), p = 0.777; heterogeneity P = 0.00; I(2) = 85.15%. Difference in means of vaginal dryness was - 0.204 (95% CI: - 0.28 to - 0.126), p < 0.001; heterogeneity P = 0.423; I(2) = 0.00. Soy isoflavones may relieve vaginal symptoms during menopause; nevertheless beneficial effects still remain uncertain due to possible publication bias or vast heterogeneity of the selected studies. Further studies with consistency in design as well as statistics are warranted.

Red clover for treatment of hot flashes and menopausal symptoms: A systematic review and meta-analysis.

This study evaluated the efficacy of red clover to relieve hot flashes and menopausal symptoms in peri/postmenopausal women. Electronic databases (MEDLINE, Scopus and the Cochrane Library) were searched. The mean frequency of hot flashes in red clover groups was lower compared with that in the control groups (close to statistical significance). Difference in means (MD) of hot flashes frequency was - 1.99 (- 4.12-0.139; p = 0.067; heterogeneity P > 0.01; I(2) = 94.93%; Random effect model). Subjective (vaginal dryness) and objective (maturation value) symptoms of vaginal atrophy showed a significant improvement with 80-mg dose of red clover. Red clover showed less therapeutic effect on psychology status, sexual problems and sleeping disorders. Red clover consumption may decrease frequency of hot flashes, especially in women with severe hot flashes (≥ 5 per day). Red clover may reduce other menopausal symptoms. Further trials are needed to confirm the current systematic review findings.

Investigation of ERG11 gene expression among fluconazole-resistant Candida albicans: first report from an Iranian referral paediatric hospital.

The multiplicity of mechanisms of resistance to azole antifungal agents has been described. As fluconazole-resistant clinical Candida albicans isolates that constitutively over-express ERG11 have been identified in previous studies, the aim of this study is to investigate this molecular mechanism involved in fluconazole resistance of C. albicans clinical isolates. Fluconazole susceptibility testing was carried out on clinical isolates of Candida spp. obtained from hospitalised children in an Iranian referral children's hospital. A polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) technique was used to differentiate Candida spp. The resistant C. albicans isolates were subjected to RT-qPCR using primers that identify ERG11 gene expression. Of the 142 Candida spp. isolates studied, C. albicans was the most predominant isolate, occurring in 68.3% (97/142) of the patients. According to the CLSI method, the majority of the C. albicans isolates (91.7%, 89/97), categorised as susceptible (minimum inhibitory concentration [MIC] ≤8 µg/mL), five isolates were considered resistant (MIC ≤64 µg/mL) and three had dose-dependent susceptibility (MIC = 8.16-32 µg/mL). The ERG11 gene in the five fluconazole-resistant C. albicans isolates was upregulated 4.15-5.84-fold relative to the ATCC 10231 control strain. In this study, the expression of ERG11 was upregulated in all the fluconazole-resistant C. albicans isolates. There are limited data on the antifungal susceptibility of Candida spp. as well as the molecular mechanism of azole resistance in Iran, especially for isolates causing infections in children. Therefore, the surveillance of antifungal resistance patterns and investigation of other mechanisms of azole resistance in all Candida spp. isolates is recommended.

Emergence of community-acquired methicillin-resistant Staphylococcus aureus in an Iranian referral paediatric hospital.

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals has been changed in recent years due to the arrival of community-associated MRSA (CA-MRSA) strains into healthcare settings. The aim of this study is to investigate the distribution of staphylococcal cassette chromosome mec (SCCmec) type V as well as SCCmec IV subtypes, which have been associated with community-acquired infection among healthcare-associated MRSA (HA-MRSA) isolates. Antimicrobial susceptibility, SCCmec type, spa type and the presence of Panton-Valentine leukocidin (PVL) genes were determined for all HA-MRSA isolates in an Iranian referral hospital. In this study of 48 HA-MRSA isolates, 13 (27%), three (6.2%), five (10.4%) and one (2%) belonged to SCCmec subtypes IVa, IVb, IVc and IVd, respectively. Only two isolates (4.2%) belonged to SCCmec types V Notably, one isolate was found to harbour concurrent SCCmec subtypes IVb and IVd. MRSA containing SCCmec subtype IVb, IVc and IVd as well as type V isolates were all susceptible to chloramphenicol, clindamycin and rifampicin, while the sensitivity to these antibiotics was lower among MRSA containing SCCmec subtype IVa. The most frequently observed spa ttype was t037, accounting for 88% (22/25). Three other spa type was t002, t1816 and t4478. Large reservoirs of MRSA containing type IV subtypes and type V now exist in patients in this Iranian hospital. Therefore, effective infection control management in order to control the spread of CA-MRSA is highly recommended.

Topical administration of isoflavones for treatment of vaginal symptoms in postmenopausal women: A systematic review of randomised controlled trials.

Current systematic review evaluated the efficacy of topical isoflavones to relieve vaginal symptoms in menopausal women. MEDLINE (1966 to January 2014), Scopus (1990 to January 2014), and the Cochrane Central Register of Controlled Trials (The Cochrane Library issue 1, 2013) were searched using keywords 'isoflavone and vagina'. Relevant studies were reviewed by two independent reviewers. Only randomised controlled trials (RCTs) were included in the systematic review. Out of 115 potentially relevant publications, four studies met the inclusion criteria. Topical isoflavones showed beneficial effects on dyspareunia, vaginal dryness and maturation value. Based on only one trial, the result of conjugated equine oestrogen cream (0.3 mg/day) was similar to use of isoflavone vaginal gel and superior to that of placebo gel. However, drawing any definite conclusion was difficult because of the limited number of RCTs, the small sample sizes, weak methodology and considerable heterogeneity of the included studies.

Effects of short-term metformin therapy associated with levothyroxine dose decrement on TSH and thyroid hormone levels in patients with thyroid cancer.

AIM: Suppressive therapy with levothyroxine is the main step in treatment of differentiated thyroid cancer (DTC). However, subclinical hyperthyroidism is associated with deleterious effects on cardiovascular and skeletal systems. Metformin may have a suppressive effect on TSH level. METHODS: We performed a single blind randomized controlled trial on the effect of short term Metformin therapy on 50 non-diabetic patients with DTC (mean age of 39.68 ±8.7 years) under suppressive therapy with levothyroxine. Metformin (500 mg) or placebo was added to the drug regimen of the patients and levothyroxine dose decreased by 33%. TSH and thyroid hormone values were measured at the beginning of the study and 3 months after treatment. RESULTS: Forty-six patients had papillary and 4 had follicular carcinoma. The mean dose of levothyroxine was 2.2±0.48 µg/kg. The mean TSH level at the beginning of the study was 0.05±.04 mIU/L. The mean age, weight and baseline TSH level was not significantly different between metformin and placebo groups (P>0.2). In the metformin group, the mean (±SD) TSH level was significantly increased from 0.03±0.04 to 3.1±5.7 mIU/L after 3 months of intervention (P=0.01) and the mean thyroid hormone levels were significantly decreased (P<0.001). In the placebo group, the mean TSH level increased from 0.04±0.04 to 3.1±4.7 mIU/L after 3 months (P=0.003). Delta TSH was 3.0±5.6 mIU/L and 3.1±4.7 mIU/L in metformin and placebo groups, respectively (P=0.9). CONCLUSION: Adding 500 mg of metformin to drug regimen was not useful to compensate for 33% of levothyroxine dose reduction in patients with DTC.

Human herpesvirus 6 infection in febrile children: frequency in an Iranian referral hospital.

Polymerase chain reaction (PCR) tests for virus in blood and saliva are frequently positive in persons with past infection, re-infection with new strains or latency with or without repeated reactivation of human herpesvirus 6 (HHV6). The aim of this study is to determine the frequency of HHV6 infections in children aged two years or under with an initial diagnosis of fever during an evaluation in the paediatric emergency department of the Children's Medical Center, an Iranian referral hospital, using PCR methodology. In all children, the clinical characteristics noted at the initial evaluation as well as demographic and laboratory findings were obtained. Among 150 patients (91 male, 59 female) admitted to the paediatric emergency department, HHV6 was found in 49 (33%; 14 female [29%] and 35 male [71%]). Rash was seen in 14/49 (29%) of HHV6-positive cases, while 35 cases without rash had a positive PCR test (71%). Seizures were found in 78/150 (52%) patients. There was no significant association between seizures and positive HHV6 results (43% in patients without seizure; 57% in cases that developed seizure). Although standard PCR on samples including blood cannot discriminate between latent and active HHV6 infection, nearly a third of patients (mainly children less than one year old) had HHV6 infection.

Concordance between peri-areolar blue dye and peri-incisional radiotracer injections for sentinel node mapping in patients with a history of primary breast cancer excisonal biopsy.

BACKGROUND: We evaluated the concordance between peri-areolar blue dye and peri-incisional radiotracer injections for axillary sentinel node mapping of patients with the history of previous breast lesion excisional biopsy. METHODS: 80 patients with the history of previous excisional biopsy of the breast lesions were included. All patients received two injections of 99mTc-antimony sulfide colloid in both ends of incision line in an intradermal fashion. 2 mL patient blue V dye was injection to all patients in the peri-areolar area of the index quadrant after induction of anesthesia. All blue or hot nodes were harvested as sentinel lymph nodes. RESULTS: At least one sentinel node could be detected during surgery in 79 patients. In total 94 sentinel nodes were detected. All detected sentinel nodes were hot. In three patients sentinel nodes were detected by gamma probe but not blue dye. The tumor location in all of these patients was in the upper lateral quadrant and the incision line was extended into the axillary tail of the breast in all of them. 91 out of 94 sentinel nodes were stained blue, which amounts to 95.8% concordance between blue dye and radiotracer on a per node analysis. CONCLUSIONS: Single peri-areolar injection in the index quadrant would suffice for sentinel node mapping of patients with history of excisional biopsy. Care should be taken in patients with large excisional biopsy in the extreme proximity to axilla.

Sentinel node biopsy in endometrial cancer: systematic review and meta-analysis of the literature.

PURPOSE: Sentinel lymph node biopsy is a fairly new approach for staging of gynecological malignancies. In the current study, the authors comprehensively reviewed the available reports on sentinel node biopsy of endometrial cancer. MATERIALS AND METHODS: The authors searched Medline, SCOPUS, ISI web of knowledge, Science Direct, Springer, OVID SP, and Google Scholar with the following search terms: "endometrium OR endometrial OR uterine OR uterus AND sentinel". The outcomes of interest were detection rate and sensitivity. RESULTS: Overall, 35 studies had enough information for false negative rate evaluation and 51 studies (including the sub-groups of individual studies) for detection rate evaluation (2,071 patients overall). Pooled detection rate was 77.8% (95% CI: 73.5-81.5%) and pooled sensitivity was 89% (95% CI: 83-93%). Cervical injection, as well as using both blue dye and radiotracer, results in higher detection rate and sensitivity. New techniques such as fluorescent dye injection and robotic-assisted surgery showed high detection rate and sensitivity. CONCLUSION: Sentinel node mapping is feasible in endometrial cancer. Using both blue dye and radiotracer and cervical injection of the mapping material can optimize the sensitivity and detection rate of this technique. Larger studies are still needed to evaluate the false negative rate and the factors influencing the sensitivity before considering this method safe.

Pseudomonas aeruginosa infection among cystic fibrosis and ICU patients in the referral children medical hospital in Tehran, Iran.

INTRODUCTION: Pseudomonas aeruginosa is one of the important causes of hospital-acquired infections in Intensive Care Unit (ICU) and considered as a major determinant of morbidity and mortality in patients affected by cystic fibrosis (CF). The aim of this study was to investigate clonal diversity among randomly picked P. aeruginosa isolates of CF and the other hospitalized patients in ICU. METHODS: Cultivation, identification, and antimicrobial susceptibility testing of P. aeruginosa isolates were performed using standard techniques. The genetic similarity of the strains was investigated by amplification of the Enterobacterial Repetitive Intergenic Consensus-polymerase chain reaction (ERIC-PCR) sequence. RESULTS AND DISCUSSION: Among 49 isolates, sixteen were isolated from 11 patients affected by CF and 33 came from an epidemiological investigation of 25 P. aeruginosa infected patients of ICU. Five clusters were generated for all isolates analyzed through ERIC-PCR genotyping. Two major clusters (B and C) were discovered in P. aeruginosa isolates of ICU and CF patients during the whole period of this study. Fifteen unique antibiogram patterns obtained from all isolates and multi-resistant P. aeruginosa (MRPA) were identified in 23 isolates (47%). MRPA isolates were detected in all clusters (except A) while pan-resistant isolates were recovered only in cluster C. The high prevalence of related or identical isolates in CF and non-CF patients can be due to transmission of particular dominant clones in ICU ward. Therefore, enhanced infection-control may become necessary to prevent further spread of clonal strains.

Healthcare information management and operational cost performance: empirical evidence.

Healthcare knowledge management systems can mitigate hospitals' operational inefficiency. As a healthcare information technology, the electronic health record (EHR) receives much attention from medical institutions due to its considerable impact on operational cost performance. This paper focuses on EHR systems to address operational inefficiency by which patients pay more for health care services, and many U.S. hospitals are filing for bankruptcy. From the theoretical perspective of the practice-based view, this paper introduces a path to implement EHR systems for improving cost performance. The empirical investigation is archival data of 200 hospitals collected from the U.S. healthcare agencies. Findings contribute to prior work by hypothesizing moderating and mediating roles in EHR systems implementation. This paper introduces absorptive capacity and monitoring mechanisms as enablers of implementing EHR systems. The results showed that hospital monitoring strengthens the relationship between absorptive capacity and electronic health record systems implementation, which results in better operational cost performance. Theoretically, this study supports the long-term potential benefits of EHR adoption, and its findings are consistent with optimizing efficiency through data standardization and interoperability. From a practical perspective, this study supports hospitals' investments in evolving healthcare information technology systems through the development of a knowledge-based system employing EHR, particularly when hospitals are merging or need a financial strategic plan to control expenses.

Genotyping of Staphylococcus aureus strains among healthcare workers and patients in the tertiary referral Children's Medical Hospital in Tehran, Iran.

Nasal carriage among hospital personnel is an important source of nosocomial staphylococcal infection. Therefore, this study aims to evaluate Staphylococcus aureus nasal colonisation among healthcare workers (HCWs) and its association with infection in children through analysis of antibiotic susceptibility profiles and genetic similarity. Nasal swabs were taken from the anterior nares of HCWs and also a total of 130 strains that had been isolated from various clinical samples were examined. Antibiotic susceptibility profiles of the strains were determined using the disc-diffusion technique and genotyping was performed by amplification of the enterobacterial repetitive intergenic consensus sequences (ERIC-PCR). Approximately 48% of clinical strains obtained were methicillin-resistant S. aureus (MRSA), whereas only 24.7% of strains from HCWs were MRSA. Among isolates from HCWs, cephalothin, cefazolin, chloramphenicol, rifampicin and vancomycin were most effective, with susceptibility rates of 100%. In this study, the ERIC-PCR profiles did not reveal any genetic similarity among the S. aureus strains from HCWs and the clinical samples. In contrast, MRSA strains showed clonal dissemination, with clones D and A2 predominant among patients and HCWs, respectively. No association was observed between the MRSA nasal carriers and infections in patients. These findings suggest that MRSA nasal carriage among HCWs may not be the source of related infections in the group studied.

Genotypic characteristics of Pseudomonas aeruginosa strains circulating in the tertiary referral Children's Medical Hospital in Tehran, Iran.

Pseudomonas aeruginosa is an important pathogen with the ability to cause infection in all departments of the hospital, especially in intensive care units (ICUs). The aim of this study is to analyse the epidemiological relationships among clinical P. aeruginosa strains isolated from different wards of the Children's Medical Center Hospital (Tehran, Iran). These isolates were identified by standard laboratory procedures and tested for antimicrobial resistance to several antibiotic agents. The genetic similarity of the strains was investigated by amplification of the enterobacterial repetitive intergenic consensus sequence (ERIC-PCR). During the study period, 87 non-duplicate patients were colonised or infected with P. aeruginosa. Among the isolates, resistance to piperacillin/tazobactam was low (27%), followed by amikacin (31%), gentamicin (33%), imipenem (33%), ciprofloxacin (36%) and meropenem (39%). Thirty-five patients (40.2%) were either colonised or infected with a multidrug-resistant P. aeruginosa strain (MDRP) over a one-year period, and 17 isolates were non-susceptible to all the tested antibiotics. One predominant profile (D) was identified in 59 strains. This profile first appeared in the paediatric intensive care unit (PICU) and infection ward in June 2010, and circulated around all wards up to the end of the study period. Of the 35 MDRP, 22 (62.8%) were found to be profile D. Molecular typing of the isolates suggests considerable cross-transmission of P. aeruginosa not only between patients in one ward but also between patients from different wards. This can be explained partly by the high number of patients transferred between different wards of the hospital.

Effect of prewarming and/or delayed light activation on resin-modified glass ionomer bond strength to tooth structures.

INTRODUCTION: Recent research shows that the acid-base reaction and light-activated polymerization in resin-modified glass ionomers (RMGI) compete with and inhibit one another. In addition, extrinsic energy would improve some properties of RMGI. This in vitro study evaluated the effect of prewarming and/or delayed light activation on bond strength of RMGI to tooth structure. MATERIALS AND METHODS: Ninety-six flat enamel and dentin surfaces of human molars were ground with sequentially finer abrasives to 600-grit silicon carbide paper. Each surface was treated with a cavity conditioner for 10 seconds, rinsed, and gently air-dried (n=12). RMGI was applied to tooth substrates according to the following protocols: group 1) according to manufacturer's instructions; group 2) a delay of two minutes in light activation; group 3) prewarming of the encapsulated material (90 seconds, 40°C); group 4) prewarming plus a delay of two minutes in light activation. After 24 hours of storage at 37°C and 500 rounds of thermocycling, the samples were tested for shear bond strength and analyzed using two-way analysis of variance and Tukey HSD test (α=0.05). RESULTS: Significant differences were observed between study groups (p<0.05). The highest enamel bond strength was recorded in group 2. Regarding dentin groups, the highest bond strength was recorded in group 1. CONCLUSION: Within the limitations of the present study, delaying light activation might improve bond strength of RMGI to enamel; however, the standard procedure recommended by the manufacturer is the best procedure for bonding of RMGI to dentin. More investigations are necessary.