Developing the use of quality indicators in sterilization practices.

BACKGROUND: Health-care-associated infections are a major threat to the safety of patient care. Control of such problem is a major criterion for hospital accreditation. This study was aimed to determine the developing use of chemical (class 6 products) and biological indicators in Tabriz district hospitals since 1997 to 2011. METHODS: We conducted this time-trend interventional study with all of the public and private hospitals, which counted to 21 in Tabriz district as a sample. The situations of indicator use were presented for each time in the base of indicator groups. Furthermore, the results were showed in the base of hospital groups. RESULTS: All of district hospital (n=21) with 74 autoclave machine and 22 central sterilization room were studied. The result of second time study in 2008 showed a markedly improvement in the control of sterilization processes. Furthermore, we continued our intervention results 6 month later in 2009 and 2 years later in 2011. The most striking result were use of chemical indicator in 100% of hospitals. However, there are defects in the use of biological indicators (63.65%). CONCLUSION: The most obvious finding was significant improvement in sterilization control especially in development the use of chemical indicators. The finding of this study has a number of important implications for hospital managers and infection control practitioners such as continuous practical training of CSSD personnel in hospitals and mandating of indicator using in all sterilization process with controlling of this subject in evaluation and accreditation of hospital programs.

Comparison of bone scan with carbohydrate antigen 15-3 for evaluation of bone metastasis of brest cancer.

This study aimed at comparing the bone scan and CA15-3 titer in patients with breast cancer for evaluation of bone metastasis. Thirty five patients with definite diagnosis of breast cancer were evaluated in Tabriz Imam Khomeini Hospital from 2007 to 2008. Bone scan (99 mTc-MDP) performed in all patients. The serum CA15-3 was measured by ECLIA method. The increased level was considered as >30 U mL(-1). The serum level of CA15-3 was compared between the patients with and without bone metastasis, as well as its correlation with the extent of bone involvement. Thirty five patients with the mean age of 51.69 +/- 10.77 (34-81) years were enrolled in the study. According to bone scan results, 24 (68.8%) patients revealed bone metastasis. The mean level of serum CA15-3 was significantly higher in patents with bone metastasis than patients without metastasis (26.37 +/- 4.74 U mL(-1) vs. 19.09 +/- 1.99 U mL(-1); p<0.001). There was not significant relation between the serum level of CA15-3 and the extent of bone metastasis (rho = -0.063, p = 0.769). Coordinates of the curve study yielded a cut-off point > 21.8 U mL(-1) for the serum level of CA15-3 in our patients, with a sensitivity and specificity of 91.7 and 91%, respectively. Serum level of CA15-3 is higher in the patients with bone metastatic breast cancer; however, the recommended cut-off point might not be suitable for Iranian patients. Further studies with large sample sizes are recommended.

Intracoronary shunt in off-pump coronary artery bypass graft.

This study was performed to compare the early postoperative results of off Pump Coronary Artery Bypass Graft (OPCABG) with or without using Intra Coronary Shunt (ICS). We randomized 208 patients scheduled for OPCABG into shunt group (group 1, n = 104) and no-shunt group (group 2, n = 104). The two groups were well matched according to the age, gender, angina class, New York Heart Association (NYHA) functional class, or operative priority and disease severity. Peri- and post-operative changes in electrocardiography, wall motion abnormality in echocardiography, rate of myocardial infarction, mortality, morbidity, cardiac enzymes and ICU stay were recorded. There was no significant difference between two groups in changes of electrocardiography, myocardial infarction, left ventricular ejection fraction (LVEF), in hospital mortality and ICU stay but Creatine Kinase Myocardial Band (CK-MB) enzyme was higher in no shunt group, while troponin-I was increased in shunt group. Preoperative LVEF was higher in no-shunt group, but postoperative LVEF was higher in shunt group (p > 0.05). Also, the change of LVEF before and after operation in each group was not significant. Using intracoronary shunt in off pump coronary artery bypass graft leads to less change in cardiac enzymes but had no effect on perioperative and postoperative myocardial infarction, LVEF, mortality and morbidity.

Efficacy of intense pulsed light in hirsutism.

Unwanted hair growth presents a significant problem for many patients and considerable resources are spent to achieve a hair-free appearance. Our aim of this study was to further evaluate the efficacy of this method in hirsutism in our region. Sixty patients with idiopathic hirsutism presenting to Dermatology Clinics of Tabriz University of Medical Sciences from September 2007 to March 2009 were classified in three groups regarding the site of hirsutism (chine, face, or mustache). All patients underwent IPL-therapy every month for six sessions. The changes in number and diameter of regional hairs were recorded at the end of each session. The patients had the mean age of 25.50+/-3.01 years (18-33 year). The disease was in chin in 26 cases (43.3%), face in 18 patients (30%) and mustache in 16 (26.7%). The skin type was III in 49 (81.7%) or IV in 11 (18.3%) patients. The positive therapeutic response after sixth session in total and in chin, face and mustache were 86.43, 88.66, 86.95 and 82.19%, respectively. The therapeutic response was not statistically significant in different body regions. The hair number in all treated regions was decrease significantly in each session in comparison with the first therapeutic session (p<0.05). Also, the hair diameter at the end of last session was decreased significantly in comparison with the first session in all treated regions (p<0.05). Regarding the high efficacy (86.42%) of IPL in treatment of facial hirsutism and absence of side effect, it is recommended as an effective treatment modality in hirsutism.

Features of premature ejaculation in infertile men.

Premature ejaculation (PE) is the most common form of sexual dysfunction and is one of the causes of male factor infertility. The aim of this study was assay of frequency and features of PE in a group of infertile men. This cross-sectional study was carried out since December 2006 to January 2008 on a sequential sample of 300 male patients complaining of infertility referring to the only infertility research center of Tabriz al-Zahra hospital. Data were collected by a designed questionnaire in which there were questions about age, age of marriage, history of sexual transmitted disease, drug use, previous sexual contacts, systemic diseases, masturbation, erectile dysfunction and frequency of intercourse. The mean age of studied patients was 30.39 +/- 5.76 and 43% of patients had PE, that in 74.4% primary PE and in 25.6% secondary PE seen. The most common form of ejaculation latency time was about less than 1 min that was seen in 51.2% of patients with PE. Mean of masturbation times was 5.13 +/- 3.19 times per month, and there is significant relation between the age of patients and type of PE, (p = 0.001) and ejaculation latency time and type of PE (p = 0.035). The high frequency rate of PE in Iranian men with complaint of infertility and also relatively lower age of these patients reflects the necessity of attention and management of this imperative psycho-organic disorder.

Safety margin in excision of basal cell carcinoma.

The aim of this study was to evaluate the intact margin after surgery regarding common method with consideration of 4 mm safe margin. Fifty patients with basal cell carcinoma operated in Tabriz Sina hospital, were chosen randomly and pathological report of these patients after surgery was evaluated with consideration of presence of intact margin. In pathologic report before operation of these patients, Basal cell carcinoma was certified. Also, brief data of these patients history was studied from present cases. Forty eight of 50 (96%) patients had intact margin after surgery and just in two patients (4%), lesion was excised insufficiently and they had involved margin. With brief study of patients' history, most of them had advanced ages and the most common site of tumor presentation was head and neck. The most of these patients had exposure with so much sun light that was accounted an important etiology. With comparison of mentioned statistical results with other reports from other countries, this rate is considered in acceptable range and surgical method is done properly in this hospital and consideration of 4 mm of tumoral margin is enough.