Application of knee MRI in forensic age estimation: A retrospective cohort.

INTRODUCTION: Forensic age estimation is performed via clinical examination and utilizing various imaging modalities. Currently, radiography and CT are used. In this study we aim to evaluate if magnetic resonance imaging (MRI) can be used to determine stages of fusion in the epiphysis of the tibia and femur, and if these stages are significantly different regarding the mean age of subjects classified in each one. METHODS: A total of 193 subjects were included in the study. Knee MR imaging was performed on all of the patients, and the patients were categorized based on imaging findings of the tibial and femoral epiphysis. Tukey multiple comparison test and analysis of variance were used to assess if the difference in the mean age of the groups were significantly different. RESULTS: Analysis of variance revealed that the mean of the five groups, both in tibia and femur imaging were significantly different. Analysis of variance showed that in most of the cases, the groups mean age significantly differed from the other groups. Tukey multiple comparison tests showed that although the differences between stages I-III could not be regarded as significant, MR imaging was suitable in distinguishing stages IV-V from stages I-III. CONCLUSION: MR imaging of the knee may be a suitable imaging modality to assess an individual's age, does not involve ionizing radiation, and that with imaging a single anatomical location, at least two epiphyses could be used to determine the age. IMPLICATIONS FOR PRACTICE: Utilization of knee MRI by clinicians as a safe and practical age estimation method.

Radiation exposure levels according to vascular access sites during PCI : A prospective controlled study.

BACKGROUND: We previously showed that using the radial artery access site as opposed to the femoral artery site decreases the radiation exposure of patients during coronary artery interventions. The objective of this study was to compare radiation exposure levels of the operating physician during coronary interventions when incorporating both radial and femoral artery approaches. METHODS: The study assessed all coronary angioplasties performed in a major metropolitan general hospital. The study design was prospective and observational, in which we measured the radiation exposure of the patient and the operator. Measurements of radiation levels were made using an electronic personal dosimeter (Diamentor® E2-DAP) at the radial and at the femoral artery access sites. An interventional cardiologist operator performed all the percutaneous coronary interventions (PCI) using a single-plane angiography unit via both femoral and radial artery approaches. RESULTS: Data from 252 PCIs were recorded. The mean physician radiation exposure levels from the femoral access site and the right radial access site were 40.5 ± 20.2 µSv and 47.5 ± 26.5 µSv, respectively (p < 0.02). There was a strong correlation between physician and patient radiation exposure levels. However, there was no correlation between patient body mass index and radiation exposure levels. CONCLUSION: We found significantly higher physician radiation exposure levels with the radial artery than with the femoral artery access site.

Study of rs1137101 polymorphism of leptin receptor gene with serum levels of selenium and copper in the patients of non-ST-segment elevation myocardial infarction (NSTEMI) in an Iranian population.

OBJECTIVE: NSTEMI is a type of myocardial infarction (MI) causing partial but progressive occlusion of cardiac coronary vessels. The aim of this study was to investigate rs1137101 polymorphism of soluble leptin receptor (sLEPR) as well as circulatory selenium and copper levels in NSTEMI patients and their usefulness in analyzing susceptibility to NSTEMI. METHODS: We collected sera and whole blood of 80 NSTEMI patients and 80 healthy individuals using cTnI levels plus electrocardiography as the "gold standard". Polymorphism analysis was done after DNA extraction by high-resolution melt PCR, selenium and copper levels by atomic absorption spectrophotometry, and sLEPR by ELISA. RESULTS AND DISCUTION: There was Hardy-Weinberg (HWE) equilibrium for both patient and control loci (χ2 = 0.368434509 and 0.341447368, respectively). The frequencies of A/A, A/G, and G/G genotypes were 18 (22%), 37 (46%), and 25 (31%) for patients, and 30 (38%), 36 (45%), and 14 (18%) for healthy controls, respectively. The frequencies of A and G alleles were 73 (46%) and 87 (54%) for patients and 96 (60%) and 64 (40%) for control groups. There was correlation between allele G and sLEPR level and Body Mass Index (BMI). Selenium levels were lower in patient group than control group (66.307 ±â€¯11.013 against 87.488 ±â€¯11.839 µg/L; p < 0.001) but copper concentrations were higher (1.8105 ±â€¯0.358 against 1.366 ±â€¯0.454 mg/L; p < 0.001). sLEPR levels were also higher in patient than control group (30.568 ±â€¯3.290 against 23.740 ±â€¯5.457 ng/dL; p < .001). Low selenium and high copper concentration had positive diagnostic value for disease. CONCLUSION: We find for the first time that there is a significant association between rs1137101 polymorphism and susceptibility to NSTEMI. There is also statistically meaningful association between decrease in serum selenium and increase in serum copper levels with susceptibility to NSTEMI.

Content analysis of advertisements related to oral health in children: a systematic review and meta-analysis.

OBJECTIVES: The evidence about the content of TV advertisements broadcast during children's viewing times with an emphasis on the number of food advertisements and the number of cariogenic food advertisements was systematically reviewed and meta-analyzed. STUDY DESIGN: A systematic review and meta-analysis. METHODS: Articles published up until October 2017 in PubMed, Scopus, Embase, Web of Science, Cochrane Library, and Persian databases such as Magiran, IranDoc, and Iranmedex with the keywords that were related to advertising and oral health in children were searched and screened by two reviewers independently, and the outcomes of interest were extracted. Meta-analysis was performed using the Comprehensive Meta-Analysis, version 2.0. RESULTS: A total of 480 titles were retrieved and reduced to 256 eligible studies after deletion of duplicates, and finally, after closer assessment of titles and abstracts, five articles were selected for systematic review and meta-analysis. Of the included studies, three were conducted in the UK, one in India, and one in Greece. About 38.0% (95% confidence interval: 19.6-60.6, P = 0.296) of advertisements were related to food and also about 70.6% (95% confidence interval: 53.7-83.3, P < 0.019) of food advertisements were related to cariogenic foods. CONCLUSIONS: Food advertising during children's programs is dominated by food items that are potentially harmful to oral health. Moreover, the advertisements shifted toward food items that appeared healthy but contain a large amount of hidden sugar.

Operator radiation exposure during transradial coronary angiography : Effect of single vs. double catheters.

BACKGROUND: The right radial artery has gained popularity as the preferred access site for coronary angiography. To save time and limit the radiation exposure of operators and patients, newly designed catheters can be used to access both the right and left coronary arteries. The aim of this study was to compare operator radiation exposure between single-catheter (SCA) and two-catheter approaches (TCA). METHODS: In all, 256 patients undergoing diagnostic coronary angiography via the right radial artery in a high-volume medical center were randomized to either the SCA or TCA group. The dose of radiation exposure of the operators was measured by an electronic dosimeter attached to the breast pocket of the operator's apron. The dose-area product and air kerma were used as indices of patient exposure to radiation. The duration of fluoroscopy "beam-on" time, acquisition time, and total duration of the procedure were measured and analyzed for the two groups. RESULTS: Operator radiation exposure was 21.6 ± 11.4 µSv in the SCA group, which was significantly less than 28.0 ± 14.9 µSv in the TCA group. The duration of fluoroscopy was significantly shorter in the SCA group than in the TCA group (152 ± 83 vs. 203 ± 121 s; p < 0.001). Moreover, the total duration of the diagnostic procedure was also shorter in the SCA group compared with the TCA group (9.5 ± 3.2 vs. 11.4 ± 4.0 min; p < 0.001). CONCLUSION: The use of SCA is advantageous over TCA in reducing the exposure of operators to radiation. The shorter duration of fluoroscopy beam-on time and total procedure time may contribute to the lower exposure of operators to radiation.

Decreased circulatory microRNA-4478 as a specific biomarker for diagnosing non-ST-segment elevation myocardial infarction (NSTEMI) and its association with soluble leptin receptor.

OBJECTIVE: This study aimed to assess the usefulness of circulatory microRNA-4478 (miR-4478) and soluble leptin receptor (sLEPR) in prognosis and diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) and to introduce miR-4478 as a new biomarker for NSTEMI disease. This study aimed also to examine correlation between miR-4478 and soluble leptin receptor and effects of miR-4478 on leptin receptor concentration. BACKGROUND: MicroRNAs could be used as predictive biomarkers for diseases. METHODS: We collected sera of 80 angiographically confirmed NSTEMI patients and 80 healthy individuals and performed RNA extraction, cDNA synthesis, measurement of microRNAs, sLEPR and other chemistries. Statistical analyses were done using excel, XLSAT, and SPSS. Quality control analysis was done triplicated for 7 serial dilution of stock cDNA solution. RESULTS: The patients with NSTEMI had higher serum levels of miR-4478, sLEPR, cTnI, CKMB, Urea, creatinine, glucose, cholesterol, TG, and ALP but lower levels of ALT compared with the normal healthy individuals. We detected decrease in expression of miR-4478 (2^-∆∆Cq = 0.161 ± 0.211) along with increase in sLEPR levels (F = 3.645, p < 0.001) in the NSTEMI group compared with normal individuals. Pearson's correlation tests indicated positive correlation of miR-4478 and sLEPR (p < 0.001, R² = 0.698). There was sensitivity and specificity of 87.5% and 98.8% for miR-4478 and 92.5% and 87.5% for sLEPR. CONCLUSION: Circulatory miR-4478 and sLEPR may be used as predictors of NSTEMI. miR-4478 may also be used as a new biomarker for NSTEMI disease (Tab. 3, Fig. 6, Ref. 30).

Follicular fluid PlGF/sFlt-1 ratio and soluble receptor for advanced glycation end-products correlate with ovarian sensitivity index in women undergoing A.R.T.

PURPOSE: Considering potential roles of soluble receptor for advanced glycation end products (sRAGE) and placental growth factor (PlGF) in ovarian function and embryo implantation, in the present study we have evaluated the association of these factors and also PlGF/sFlt-1 ratio with the ovarian response and implantation rate by dividing patients according to the OSI. METHODS: In a cross-sectional study, 90 infertile women who were undergoing ICSI cycle using long protocol were recruited. The patients were divided according to ovarian sensitivity index (OSI). ICSI cycle outcomes were evaluated for each patient and PlGF, sFlt-1 and sRAGE levels of follicular fluid were assayed using commercial ELISA kits. RESULTS: Follicular fluid (FF) sRAGE levels and PlGF/sFlt-1 ratio were statistically greater in high-responder women than other responders (p < 0.05). Positive correlations were obtained between sRAGE level with the number of oocytes, follicles and OSI level. sRAGE levels with cutoff value of 4.83 (ng/ml) for evaluating the pregnancy outcome showed 81.8 % sensitivity and 60.7 % specificity. Furthermore, there were positive associations between PlGF/sFlt-1 ratio with the number of oocytes, embryos and OSI level. CONCLUSION: In conclusion, the results of current study supported that good ovarian response is independent of pregnancy outcome. Our results showed that FF levels of sRAGE and PlGF/sFlt-1 ratio could be used as markers for determining the high-responder women. Also, FF sRAGE levels could be a good predictor for ART outcome.

Comparative study of vaginal danazol vs diphereline (a synthetic GnRH agonist) in the control of bleeding during hysteroscopic myomectomy in women with abnormal uterine bleeding: a randomized controlled clinical trial.

OBJECTIVE: To compare the usefulness of vaginal danazol and diphereline in the management of intra-operative bleeding during hysteroscopy. DESIGN: Randomized controlled clinical trial. SETTING: University hospital. PATIENTS: One hundred and ninety participants of reproductive age were enrolled for operative hysteroscopy. Thirty women were excluded from the study. INTERVENTIONS: One hundred and sixty participants with submucous myomas were allocated at random to receive either vaginal danazol (200mg BID, 30 days before surgery) or intramuscular diphereline (twice with a 28-day interval). MAIN OUTCOME MEASURES: Severity of intra-operative bleeding, clarity of the visual field, volume of media, operative time, success rate for completion of operation and postoperative complications. RESULTS: Overall, 145 patients completed the study. In the danazol group, 78.1% of patients experienced no intra-operative uterine bleeding, and 21.9% experienced mild bleeding. In the diphereline group, 19.4% of patients experienced no intra-operative uterine bleeding, but mild, moderate and severe bleeding was observed in 31.9%, 45.8% and 2.8% of patients, respectively. The difference between the groups was significant (p<0.001). A clear visual field was reported more frequently in the danazol group compared with the diphereline group (98.6% vs 29.2%, p<0.001). The mean operative time was 10.9 min and 10.6 min in the danazol and diphereline groups, respectively (p=0.79). The mean volume of infused media was 2.0L in both groups (p=0.99). The success rate was 100% for both groups with no intra-operative complications. CONCLUSION: Both vaginal danazol and diphereline were effective in controlling uterine bleeding during operative hysteroscopy. However, vaginal danazol provided a clearer visual field.

Radiographers' professional knowledge regarding parameters and safety issues in plain radiography: a questionnaire survey.

OBJECTIVE: To review the knowledge of radiographers and examine the possible sociodemographic and situational contributors to this knowledge. METHODS: A questionnaire survey was devised and distributed to a cohort of 120 radiographers. Each questionnaire contained two sections. In the first section, background data, including sex, age, highest academic level, grade point average (GPA), length of time from graduation, work experience as a radiographer and the status of previous refresher course(s), were collected. The second section contained 17 multiple-choice questions concerning radiographic imaging parameters and safety issues. RESULTS: The response rate was 63.8%. In univariate analytic model, higher academic degree (p < 0.001), higher GPA (r(2) = 0.11; p = 0.001), academic workplace (p = 0.04) and taking previous refresher course(s) (p = 0.01) were significantly associated with higher knowledge score. In multivariate analytic model, however, higher academic degree (B = 1.62; p = 0.01), higher GPA (B = 0.50; p = 0.01) and taking previous refresher course(s) (B = -1.26; p = 0.03) were independently associated with higher level of knowledge. Age, sex, length of time from graduation and work experience were not associated with the respondents' knowledge score. CONCLUSION: Academic background is a robust indicator of a radiographer's professional knowledge. Refresher courses and regular knowledge assessments are highly recommended. ADVANCES IN KNOWLEDGE: This is the first study in the literature that examines professional knowledge of radiographers in terms of technical and safety issues in plain radiography. Academic degree, GPA and refresher courses are independent predictors of this knowledge. Regular radiographer professional knowledge checks may be recommended.

'Anteroposterior placenta': a novel, simple sonographic feature indicating benign vaginal bleeding in early pregnancy.

This study proposes a sonographic feature of the placenta in association with benign vaginal bleeding. A total of 286 normal singleton pregnancies were examined for 'anteroposterior, AP, placenta', which was reported when the placenta was attached to both anterior and posterior walls of the uterus in sagittal transabdominal ultrasound scans. Pregnancies were followed up by week 20. AP placenta, vaginal bleeding and spontaneous abortion were documented in 61 (21.3%), 44 (15.4%) and 2 (0.7%) pregnant women, respectively. AP placenta was significantly more common in the group with vaginal bleeding (54.5% vs 1.3%, p < 0.001, odds ratio = 6.65 with a 0.95 confidence interval of 3.34-13.24). Abortions occurred only in patients with vaginal bleeding and no AP placenta (10% vs 0%; p = 0.20). In a normal clinical pregnancy with no known risk of miscarriage, the presence of an AP placenta usually forecasts a benign vaginal bleeding/spotting in first 20 weeks of gestation.

Can child temperament be related to early childhood caries?

Beyond the biological risk factors of early childhood caries (ECC) is child temperament. This study aimed to investigate the relationship of ECC to different traits of child temperament, directly and indirectly through the nutritional and oral hygiene habits. Through a multi-stage sampling, 373 kindergarten children aged 18-36 months participated in this study. The primary caregivers filled in the Early Childhood Behaviour Questionnaire (ECBQ) and a checklist containing demographic data and the dietary and oral hygiene habits of the children. Children were examined for dental caries. The frequency of ECC was 41.14%. With 18 aspects of a child's temperament under consideration, attentional shifting, fear, frustration, low-intensity pleasure, sadness and shyness were significantly higher in the ECC group. Cuddliness, perceptual sensitivity, positive anticipation and soothability were significantly higher in caries-free children. Attentional shifting (p = 0.02), frustration (p = 0.02) and shyness (p = 0.03) were risk factors and cuddliness (p < 0.001) was a protecting factor for ECC. In the multiple regression model regarding nutritional and oral hygiene habits, easily soothable children were 0.69 times less likely to use sweetened liquids frequently [odds ratio (OR) 0.69, 95% confidence interval (CI) 0.49-0.97, p = 0.03], while sad children were 0.58 times less likely to brush (OR 0.58, 95% CI 0.36-0.94, p = 0.02). Considering temperament traits along with socioeconomic status, positive anticipation was the most significant determinant of ECC (OR 1.57, 95% CI 1.13-2.19, p = 0.007). However, considering temperament, socioeconomic measures and child habits among ECC risk factors, the most significant was the initiation of brushing habits (OR 5.41, 95% CI 2.81-12.98, p = 0.002).

Concha bullosa, nasal septal deviation and paranasal sinusitis; a computed tomographic evaluation.

PROBLEMS/OBJECTIVES: Although concha bullosa, nasal septal deviation (NSD) and paranasal sinusitis are apparently three independent entities, some studies suggest that they are interconnected. Computed tomography (CT) is a useful and accurate imaging modality for examining this interconnection. The objective of this study is to use CT imaging to investigate the possible association between concha bullosa, NSD and paranasal sinusitis. METHODOLOGY: We reviewed 206 nasal and paranasal CT images of individuals with sinonasal symptoms/cosmetic issues and investigated the association between the presence of concha bullosa and NSD with paranasal sinusitis. RESULTS: There was no significant relation between the presence of concha bullosa and paranasal sinusitis. The mean NSD was significantly higher in the cases with frontal, maxillary, ethmoid and sphenoid sinusitis than in unaffected subjects. Similar findings were found in the patients with any involved paranasal sinus and the controls (6.49 +/- 3.060 vs. 3.31 +/- 1.99 degrees; p<0.001). An NSD > or =3.5% differentiated between the presence and absence of paranasal sinusitis, with a sensitivity and specificity of 77.8% and 76.5%, respectively. A significant positive correlation was found between NSD and the number of involved sinuses (Pearson's r=0.58, p<0.001). The laterality of sinusitis was not associated with NSD or concha bullosa. CONCLUSIONS: Nasal septal deviation, but possibly not concha bullosa, is associated with paranasal sinusitis and its extent. An NSD > or = 3.5 degrees is a useful predictor of paranasal sinusitis.

Effect of delaying toothbrushing during bleaching on enamel surface roughness: an in vitro study.

This study aimed to evaluate the effect of toothbrushing on enamel surface roughness at three different intervals after daily bleaching treatment. Eighty enamel slabs were initially evaluated for surface roughness and then randomly divided into four groups. The bleaching procedure was carried out for 21 days, six hours daily. In the control group (group 1), the specimens were not brushed after bleaching, but in groups 2-4, they were brushed with toothpaste immediately, one hour, or two hours after bleaching, respectively. Then the specimens were stored in artificial saliva. Enamel surface roughness was reevaluated at the end of the period. Kruskal-Wallis and Mann-Whitney U tests showed statistically significant differences in the means of surface roughness values between the immediately brushed group and the three other groups (p<0.001). Daily toothbrushing immediately after bleaching increased enamel surface roughness; however, postponing the procedure for one or two hours after daily bleaching and exposing the specimens to artificial saliva during the study period resulted in enamel surface roughness comparable to that of the control group.

Comparison of pedicled buccal fat pad flap with buccal flap for closure of oro-antral communication.

The aim of this study was to compare the clinical results of pedicled buccal fat pad flap (PBFPF) with the standard buccal flap in the closure of oro-antral fistula (OAF). Twenty-two patients aged 25-56 years with oro-antral communication were randomly divided into two groups using Rand List 1.2 software. In group 1, OAF was treated with the classic buccal sliding flap and in group 2 a pedicled buccal fat pad was used. All patients were visited 48 h, 1 week and 1 month after surgery for assessment of primary (success of surgery) and secondary outcomes (pain, swelling, maximum mouth opening (MMO) reduction). Both methods were equally successful for the closure of OAF. The pain score was statistically greater in the experimental group (U=9, P=0.001). MMO was statistically less in the experimental group 2 and 7 days after surgery (P<0.001). 1 month after surgery, no statistically significant difference was found in MMO between the two groups (P=0.09). In general, the PBFPF group had more pronounced swelling than the control group. Despite the statistical evidence, none of the patients complained of pain and swelling following the PBFPF procedure.

In vitro evaluation of the effect of delaying toothbrushing with toothpaste on enamel microhardness subsequent to bleaching the teeth with 15% carbamide peroxide.

Changes in enamel surface microhardness as a result of bleaching with carbamide peroxide in various in vitro conditions have been reported. The present study evaluated the effect of oral hygiene procedures on enamel microhardness at three time intervals following bleaching with 15% carbamide peroxide. Although this was an in vitro study, the purpose was to address whether or not a patient's toothbrushing following at-home bleaching might affect surface changes in tooth enamel. Eighty enamel slabs were prepared from impacted human third molars that had been extracted surgically. Subsequent to placing the specimens in acrylic resin, their surfaces were smoothed, and they were randomly divided into four equal groups. The specimens were initially evaluated for microhardness by Vickers test. The bleaching procedure was carried out for 21 days for 6 hours daily. In each group, the surfaces of specimens were brushed with toothpaste immediately, 1 hour, and 2 hours after bleaching except for the control group. The specimens were stored in artificial saliva. Enamel microhardness was again measured at the end of the bleaching period. Then the differences in enamel microhardness between the two periods were calculated. Data were analyzed with a nonparametric Kruskal-Wallis test at a significance level of p<0.05. The differences in the microhardness values before and after intervention between the groups were not significant (p=0.59). Daily oral hygiene procedures either immediately or 1 or 2 hours after daily bleaching procedures and exposing the specimens to artificial saliva during the study period produced no significant differences in enamel microhardness values.

Comparison of ketamine and fentanyl for postoperative pain relief in children following adenotonsillectomy.

Adenotonsillectomy has a high incidence of postoperative pain. Therefore, the purpose of this study was to evaluate the effectiveness and safety of either ketamine or fentanyl for postoperative pain relief in children following adenotonsillectomy. Sixty children aged 3-12 years, scheduled for adenotonsillectomy, were enrolled in this randomized, double-blind study. Patients were divided into two groups of 30 cases and received intravenous ketamine (0.5 mg kg(-1)) or fentanyl (1 microg kg(-1)). Modified Hannallah pain scale or Observational Pain Scores (OPS), nausea, vomiting, bleeding, rescue analgesia, sedation and post-anesthesia recovery scores were recorded both at first and 15th minute postoperatively. Moreover, patients receiving ketamine (group 1) or fentanyl (group 2) had comparable OPS and sedation score both on arrival and at 15th minute in the recovery room (p > 0.05). Although rescue analgesics were similarly required in both groups (p > 0.05), the time to reach rescue analgesia was shorter in group 1 (p = 0.001). Only one patient in fentanyl group had nausea and vomiting in the first 15 min that needed antiemetic in the recovery room. In conclusion, intravenous fentanyl (1 microg kg(-1)) compared with intravenous ketamine (0.5 mg kg(-1)) might provide extended time to first analgesic in children undergoing adenotonsillectomy. Interestingly, fentanyl and ketamine did not differ in post-operative vomiting.

Effect of uterine contraction and amniotomy on fetal cardiotocograph.

Both uterine contractions and artificial rupture of fetal membranes (amniotomy) are important events during delivery phase, this study was planned to determine possible effects of both events on fetal heart rate using nonstress test method. Sixty term pregnant women admitted for termination of pregnancy were selected. Primary nonstress test was performed, then nonstress test was done after active uterine contractions. After the amniotomy the last test was done. All results were statistically analyzed. Out of 60 term pregnant women, 51 (85%) patients reported acceleration for primary nonstress test. After uterine contractions, acceleration was seen in 46 (76.7%) patients, this happened in 40 (66.7%) cases after amniotomy. There was no deceleration after primary nonstress test. However, deceleration reported after uterine contractions and amniotomy in five (8.3%) and two (3.3%) cases, respectively. The 56 (93.3%) patients showed variability in primary nonstress test; variability following the uterine contractions and amniotomy was seen in 58 (96.7%) and 56 (93.3%) of subjects, respectively. None of them were statistically significant (p > 0.05). Mean fetal heart rate baseline in primary Nonstress test was (141.00 +/- 9.35), this was (140.50 +/-10.51) following uterine contractions and (143.08 +/- 11.97) after amniotomy. Baseline fetal heart rate reduction, statistically significant, was seen following uterine contractions (r = +0.28, p = 0.02). This means reductions in lower baseline fetal heart rates will be more outstanding. Uterine contractions and amniotomy had no correlation with presence or absence of variability, acceleration and deceleration.

Class 1 integron and Imipenem Resistance in Clinical Isolates of Pseudomonas aeruginosa: Prevalence and Antibiotic Susceptibility.

BACKGROUND AND OBJECTIVES: Pseudomonas aeruginosa is one of the most important causative agents of nosocomial infections especially in ICU and burn units. P. aeruginosa infections are normally difficult to eradicate due to acquired resistance to many antibiotics. Recent appearance of carbapenem resistant P. aeruginosa isolates is considered a major healthcare problem. The present study was conducted to detect class 1 integron and antibiotic susceptibility profiles of imipenem-sensitive and resistant clinical isolates of P. aeruginosa. MATERIALS AND METHODS: Antibiotic susceptibility profiles and minimum inhibitory concentration against imipenem was studied in 160 clinical isolates of P. aeruginosa by disk agar diffusion method and Etest, respectively. Detection of class 1 integron was performed by the PCR method. Demographic and microbiological data were compared between imipenem susceptible and non-susceptible isolates by the SPSS software. RESULTS: PCR results showed that 90 (56.3%) of P. aeruginosa isolates carried class 1 integron. Antibiotic susceptibility results revealed that 93 (58.1%) were susceptible and 67 (41.9%) were non-susceptible to imipenem. Comparison of antibiotic susceptibility patterns showed high level of drug resistance among imipenem non-susceptible isolates. We found that MDR phenotype, presence of class 1 integron and hospitalization in ICU and burn units were significantly associated with imipenem non-susceptible isolates. CONCLUSION: The high frequency of imipenem resistance was seen among our P. aeruginosa isolates. Since carbapenems are considered as the last drugs used for treatment of P. aeruginosa infections, it is crucial to screen imipenem non-susceptible isolates in infection control and optimal therapy.

Upper gastrointestinal bleeding during the first month after renal transplantation in the mycophenolate mofetil era.

Upper gastrointestinal (GI) bleeding remains a significant cause of mortality and morbidity among renal transplant recipients. We retrospectively analyzed the records of patients who received renal transplantations between January 2001 and July 2007 using mycophenolate mofetil (MMF) in their immunosuppressive regimens. The following data were recorded for those subjects with upper GI bleeding during the first month after transplantation (group B, cases): age, sex, acute rejection episodes, pretransplant upper GI endoscopic findings, Helicobacter positivity, and cytomegalovirus (CMV) seropositivity. The same parameters were studied among a group of patients, who did not have a history of upper GI bleeding (group A, controls). A statistical analysis was performed to ascertain potential risk factors. Among 523 patients (311 females, 212 males) of age range 7 to 58 years, 27 (5.2%) had upper GI bleeding: 13 males and 14 females of mean age 44 +/- 12 years. The most frequent endoscopic finding was erosive gastritis (n = 13; 48.1%) followed by duodenal ulcers. Binary logistic regression analysis comparing the 2 groups showed that acute rejection episodes (P = .015) and active CMV infection (P = .046) were the most prominent risk factors for upper GI bleeding during the first month after renal transplantation.