The intestinal carrier status of Enterococcus spp. in children: clonal diversity and alterations in resistance phenotypes before and after admission to a pediatric intensive care unit.

BACKGROUND: This study aimed to investigate the intestinal carrier status of Enterococcus spp. among children in a pediatric intensive care unit (PICU) and reveal the role of hospitalization in the alteration of resistance phenotypes and clonal diversity of the isolates during admission and discharge periods. METHODS: Two separate stool samples were collected from hospitalized patients in the pediatric intensive care unit at admission and discharge times. The culture was done, and Enterococcus species were tested for antimicrobial susceptibility and carriage of vanA-D gene subtypes. Random Amplified Polymorphic DNA (RAPD)-PCR was used for a phylogenetic study to check the homology of pairs of isolates. RESULTS: The results showed carriage of Enterococci at admission, discharge, and at both time points in 31%, 28.7%, and 40.1% of the cases, respectively. High frequencies of the fecal Enterococcus isolates with vancomycin-resistance (VR, 32.6% and 41.9%), high-level of gentamicin-resistance (HLGR, 25.6% and 27.9%), and multi-drug resistance phenotypes (MDR, 48.8% and 65.1%) were detected at admission and discharge times, respectively. Resistance to vancomycin, ampicillin, and rifampicin was higher among E. faecium, but resistance to ciprofloxacin was higher in E. faecalis isolates. The increased length of hospital stay was correlated with the carriage of resistant strains to vancomycin, ampicillin, and ciprofloxacin. While the homology of the isolates was low among different patients during hospitalization, identical (9%) and similar (21%) RAPD-PCR patterns were detected between pairs of isolates from each patient. CONCLUSIONS: The high rate of intestinal carriage of VR, HLGR-, and MDR-Enterococci at admission and during hospitalization in the PICU, and the impact of increased length of hospital stay on the fecal carriage of the resistant strains show the importance of antibiotic stewardship programs to control their transmission and spread in children.

Quantitative filter forensics: Size distribution and particulate matter concentrations in residential buildings.

We applied filter forensics, the analysis of dust from the heating, ventilation, and air-conditioning (HVAC) filters, to measure particle size distribution in 21 residences in Toronto, Canada over a year. Four filters with different nominal efficiencies (Minimum Efficiency Reporting Value (MERV) 8-14 from ASHRAE Standard 52.2) were deployed in each residence each for three months, while the effective filtration volumes (the product of flow rate, runtime, and in-situ filter efficiency) were characterized over each filter lifetime. Using extraction and laser diffraction, we found that approximately 90% of the volumetric distributions were >10 µm and the volume median diameter (VMD) ranged from 23.4 to 75.1 µm. Using quantitative filter forensics (QFF), total suspended particle (TSP) concentrations ranged from 2.9 to 823.7 µg/m3 (median = 89.8 µg/m3 ) with a moderate correlation with the content of TSP on the filters (in terms of g) and with the TSP effective filtration volume (m3 ) indicating the importance of both filter forensics and HVAC metadata parameters to QFF concentration estimates. There was no strong correlation between PM10 or PM2.5 concentrations and hourly airborne particle number concentrations measured by low-cost sensors suggesting an evaluation of QFF is warranted, particularly for the exploration of smaller particles.

Intraoperative Complications of Cataract Surgery in Tehran Province, Iran.

PURPOSE: To determine the prevalence and types of intraoperative complications of cataract surgery and examine potential risk factors. METHODS: Data were obtained from the 2011 Iranian Cataract Surgery Survey in which information about cataract surgeries throughout the nation was collected. In the Province of Tehran, 55 centers and 1 week per season per center were randomly selected for sampling. In each center, the charts of all patients who underwent cataract surgery during the selected weeks (total of 20 weeks per center) were reviewed for data extraction. The prevalence of different types of intraoperative cataract surgery complications were determined, and their relationships with age, sex, surgical method, surgeon, and hospitalization time were examined. RESULTS: The prevalence of intraoperative complications of cataract surgery was 4.15% (95% confidence interval, 0.94 to 7.36). The prevalence of posterior capsular rupture with vitreous loss, posterior capsular rupture without vitreous loss, retrobulbar hemorrhage, suprachoroidal effusion/hemorrhage, intraocular lens drop, and nucleus drop was 2.86, 0.69, 0.06, 0.39, 0.03, and 0.11%, respectively. The prevalence of cataract surgery complications decreased from 6.95% in 2006 to 3.07% in 2010. The results of multiple logistic regression showed that surgery by residents, nonphacoemulsification methods of surgery, and patient age less than 10 years and more than 70 years were the risk factors for complications. CONCLUSIONS: This study evaluated the prevalence of intraoperative complications of cataract surgery for the first time in Tehran Province. The prevalence of complications was high in this study. To achieve the goals of the Vision 2020 Initiative and improve surgical quality, it is necessary to minimize complication rates. Factors to note for decreasing complication rates include type of surgery, surgeon experience, and patient age.

Particle loading time and humidity effects on the efficiency of an N95 filtering facepiece respirator model under constant and inhalation cyclic flows.

It is necessary to investigate the efficiencies of filtering facepiece respirators (FFRs) exposed to ultrafine particles (UFPs) for long periods of time, since the particle loading time may potentially affect the efficiency of FFRs. This article aims to investigate the filtration efficiency for a model of electrostatic N95 FFRs with constant and 'inhalation-only' cyclic flows, in terms of particle loading time effect, using different humidity conditions. Filters were exposed to generated polydisperse NaCl particles. Experiments were performed mimicking an 'inhalation-only' scenario with a cyclic flow of 85 l min(-1) as the minute volume [or 170 l min(-1) as mean inhalation flow (MIF)] and for two constant flows of 85 and 170 l min(-1), under three relative humidity (RH) levels of 10, 50, and 80%. Each test was performed for loading time periods of 6h and the particle penetration (10-205.4nm in electrical mobility diameter) was measured once every 2h. For a 10% RH, the penetration of smaller size particles (<80nm), including the most penetrating particle size (MPPS), decreased over time for both constant and cyclic flows. For 50 and 80% RH levels, the changes in penetration were typically observed in an opposite direction with less magnitude. The penetrations at MPPS increased with respect to loading time under constant flow conditions (85 and 170 l min(-1)): it did not substantially increase under cyclic flows. The comparison of the cyclic flow (85 l min(-1) as minute volume) and constant flow equal to the cyclic flow minute volume indicated that, for all conditions the penetration was significantly less for the constant flow than that of cyclic flow. The comparison between the cyclic (170 l min(-1) as MIF) and constant flow equal to cyclic flow MIF indicated that, for the initial stage of loading, the penetrations were almost equal, but they were different for the final stages of the loading time. For a 10% RH, the penetration of a wide range of sizes was observed to be higher with the cyclic flow (170 as MIF) than with the equivalent constant flow (170 l min(-1)). For 50 and 80% RH levels, the penetrations were usually greater with a constant flow (170 l min(-1)) than with a cyclic flow (170 l min(-1) as MIF). It is concluded that, for the tested electrostatic N95 filters, the change in penetration as a function of the loading time does not necessarily take place with the same rate under constant (MIF) and cyclic flow. Moreover, for all tested flow rates, the penetration is not only affected by the loading time but also by the RH level. Lower RH levels (10%) have decreasing penetration rates in terms of loading time, while higher RH levels (50 and 80%) have increasing penetration rates. Also, the loading of the filter is normally accompanied with a shift of MPPS towards larger sizes.

Distribution of cataract surgical rate and its economic inequality in Iran.

PURPOSE: To determine the distribution of the cataract surgical number per million population per year (CSR), the CSR in the population older than 50 years (CSR 50+) in the provinces of Iran, and their economic inequality in 2010. METHODS: As part of the cross-sectional 2011 CSR survey, the provincial CSR and CSR 50+ were calculated as the total number of surgeries in major and minor centers divided by the total population and the population older than 50 years in each province. Economic inequality was determined using the average province income, the average urban and rural household incomes, and the percentage of urban and rural population in each province. RESULTS: Tehran and Ilam provinces had the highest and lowest CSR (12,465 vs. 359), respectively. Fars and Ilam provinces had the highest and lowest CSR 50+ (71,381 vs. 2481), respectively. Low CSR (<3000) was detected in 9 provinces where 2.4 to 735.7% increase is needed to reach the minimum required. High CSR (>5000) was observed in 14 provinces (45.2%) where rates were 0.6 to 59.9% higher than the global target. Cataract surgical rate increased at higher economic quintiles. Differences between the first, second, and fifth (poorest) quintiles were statistically significant. The CSR concentration index was 0.1964 (95% confidence interval, 0.0964 to 0.2964). CONCLUSIONS: In line with the goals of the Vision 2020 initiative to eliminate cataract blindness, more than 70% of geographic areas in Iran have achieved the minimum CSR of 3000 or more. However, a large gap still exists in less than 30% of areas, mainly attributed to the economic status.

Contribution of breathing frequency and inhalation flow rate on performance of N95 filtering facepiece respirators.

The investigation of particle penetration through filtering facepiece respirators under cyclic flows is very necessary because cyclic flows represent actual breathing flow patterns. This article reports the development of a procedure to investigate the individual impact of breathing frequency and flow rate on the performance of N95 filtering facepiece respirators. Experiments were performed for two peak inhalation flows (PIFs; 135 and 360 l min(-1)) and two breathing frequencies [24 and 42 breaths per minute (BPM)] for a total of four cyclic flows (Flow A: 135 l min(-1) and 24 BPM; Flow B: 135 l min(-1) and 42 BPM; Flow C: 360 l min(-1) and 24 BPM; and Flow D: 360 l min(-1) and 42 BPM). Each experiment was performed using two different set-ups: the first set-up included both inhalations and exhalations through the filter media and test chamber, while with the second set-up, only inhalation flows were considered. The results showed that, for the most penetrating particle size range, an increase in both PIF and breathing frequency could potentially enhance the penetration with both set-ups; however, the effect of PIF was observed to be much more pronounced than that of frequency. The results indicated that with both set-ups, when the PIF was increased from 135 to 360 l min(-1) (for the given frequency: 24 or 42 BPM), an increase of up to 139-152% in penetration was observed. On the other hand, only a 10-16% increase in penetration occurred when the frequency was changed from 24 to 42 BPM (for a given PIF: 135 or 360 l min(-1)). This suggests that, from low to high respiratory efforts, a huge portion of penetration enhancement is due to PIF variations and only a small portion is contributed by frequency variations.

Cataract surgical rate in Iran: 2006 to 2010.

PURPOSE: To determine the cataract surgical rate (CSR) between 2006 and 2010 in Iran. METHODS: In this cross-sectional study, sampling was done from surgical centers throughout Iran. Centers throughout all of Iran with more than 3000 surgeries per year were grouped as major centers and the rest were grouped as minor centers. All major centers and a percentage of minor centers were selected from each province. For each center, we determined the number of cataract surgeries in a random week of each season. RESULTS: Of the 237 eligible surgical centers, 124 were selected and 106 were enrolled in the study; 80 were major centers and 26 were minor centers. The number of surgeries has increased from 335,948 in 2006 to 475,526 in 2010. Cataract surgical rate has increased from 4723 (95% confidence interval, 4707 to 4739) per million population in 2006 to 6328 (95% confidence interval, 6309 to 6346) per million population in 2010. In the 50 and older population, CSR was 38,450 per million population in 2010. Average annual number of cataract surgeries per surgeon was 263 in 2006 and 339 in 2010. CONCLUSIONS: Compared with previous studies, the 2006 to 2010 CSR in Iran is on an ascending trend. Also, our numbers are higher than the minimum recommended by the World Health Organization, although lower than that in Western countries. Considering the aging population of the country, the observed rate is not sufficient for all cases of cataract in the future, and there is a need to increase CSR throughout the nation.

Evaluation of N95 filtering facepiece respirator efficiency with cyclic and constant flows.

An increasing demand for protecting workers against harmful inhalable ultrafine particles (UFPs), by means of filtering facepiece respirators (FFRs), necessitates assessing the efficiency of FFRs. This article evaluates the penetration of particles, mostly in the ultrafine range, through one model of N95 FFRs exposed to cyclic and constant flows, simulating breathing for moderate to heavy work loads. The generated particles were poly-dispersed NaCl, within the range of 10-205.4 nm. The tests were performed for several cyclic flows, with mean inhalation flows (MIFs) ranging from 42 to 360 L/min, and constant flows with the same range. The measurements were based on filter penetration and did not consider particle leakage. With the penetrations recorded for the selected constant and cyclic flows, the worst-case scenario penetrations at the most penetrating particle size (MPPS) were obtained. The MPPS penetrations measured with the cyclic and constant flows equivalent to minute volume, MIF and peak inhalation flow (PIF) of the cyclic flows were then compared. It was indicated that the constant flows equivalent to the minute volume or PIF of the cyclic flow could not accurately represent the penetration of the corresponding cyclic flow: the constant flow equal to the minute volume of the cyclic flow significantly underestimated the MPPS penetration of the corresponding cyclic flow, while the constant flow equal to the PIF of the cyclic flow overestimated it. On the other hand, for the constant flow equal to the MIF of the cyclic flow, the MPPS penetrations were almost equal for both the constant and cyclic flows, for the lower flow rates (42 to 170 L/min). For higher flow rates (230 to 360 L/min), however, the MPPS penetration was exceeded under the constant flows, compared with the corresponding cyclic flows. It was therefore concluded that the constant flow equal to the MIF of the cyclic flow could better predict the results of corresponding cyclic flow, since it could provide the MPPS penetrations (worst-case scenario) equal to or greater than the MPPS penetrations of the cyclic flow.

Timely referral to health centers for the prevention of cardiovascular diseases: IraPEN national program.

Introduction: The IraPEN program is an adapted version of the WHO-PEN program designed to prevent four major non-communicable diseases in Iran. This study aimed to determine the rate of compliance and related factors among individuals participating in the IraPEN program for the prevention of cardiovascular disease. Method: In this study, compliance was defined as timely referral to the health center as scheduled, and the researchers approached four pilot sites of IraPEN from March 2016 to March 2018. Sex-stratified logistic regressions were applied to investigate factors related to compliance. However, it is important to note that in this study, compliance was defined as compliance to revisit, not compliance to taking prescribed medications or behavioral lifestyle changes. Results: The total compliance rate, including timely compliance and early and late compliance, was 16.5% in men and 23.3% in women. The study found that cardiovascular risk factors such as diabetes, hypertension, hypercholesterolemia, and being underweight were associated with lower compliance. The higher calculated risk of CVD was associated with higher compliance, but after adjusting for cardiovascular risk factors, high-risk individuals showed lower compliance. There was negligible interaction between sex and other factors for compliance. Conclusion: The compliance rate with scheduled programs for cardiovascular preventive strategies was very low, and high-risk individuals were less compliant, regardless of their high level of risk factors. The study recommends further training to increase awareness and knowledge regarding the IraPEN program and the prevention of non-communicable diseases among high-risk populations.

HVAC filtration of particles and trace metals: Airborne measurements and the evaluation of quantitative filter forensics.

Filters installed in the heating, ventilation, and air-conditioning (HVAC) systems can serve as air-cleaning and sampling devices for indoor particles. The purpose of this article is to evaluate these dual roles. An occupied home with a central HVAC system equipped with a Minimum Efficiency Reporting Value (MERV, from ASHRAE Standard 52.2) 11 filter was monitored for six weeks. Weekly airborne gravimetric and real-time sampling was performed to measure the particle size distribution and the concentration of total suspended particles (TSP), PM10, PM2.5, PM1, and 12 trace metals. The weekly system runtimes were intentionally changed to provide a wide range of weekly filtration volumes. The quantitative filter forensics (QFF) concentrations of particulate matter (PM) and trace metals were calculated using the analysis of the dust collected on the HVAC filter, the filtration volume, and filter in-situ efficiency. The results indicated that filtration was not influential to remove PM and trace metals as the concentrations during the weeks with continuous HVAC operation were not consistently lower than those during the other weeks. This suggests the dominance of other particle and trace metal source and loss mechanisms weakens the influence of filtration in this home. The QFF evaluation results indicated that the concentration of TSP and over half of the tested trace metals (e.g., Pb, Cd, Ni, V, Sb, K, and Sr) could be estimated by QFF within a factor of two when compared to airborne sampling results. PM10, PM2.5, and PM1 concentrations were significantly underestimated by QFF potentially due to the limitations of size distribution analysis by a laser diffraction particle sizer (LDPS) for the detection of <1 µm particles. Overall, while QFF was promising for TSP and some trace metals, improvement in size distribution analysis could extend the application of QFF for airborne sampling.

How to improve Iranians' vision health: on the national policy of preventing Iranians' blindness.

AIM: To review vision health situation of Iranian community, analyze its determinants, and discuss the adopted improvement strategies by the Iran Ministry of Health and Medical Education (MOHME). METHODS: This was a rapid situation analysis with a qualitative approach in three parts of recognition, orientation and implementation. The data were gathered via review of upstream documents, national and international experiences, and experts and stakeholders' opinions. RESULTS: Eradicating trachoma, increasing human resources, increasing educational and research centers and promotion of ophthalmic technologies were important achievements in the field of vision health in Iran. Through these achievements, it seemed that the pattern of causes of blindness and low vision was similar to that of the developed countries. However, the review of Iranians' vision health indicators showed that a considerable percent of the blindness and low vision was avoidable through a national program demanding 3 types of interventions in social determinants of health (SDH), community education, and increasing the access to health care services by integrating the necessary services in primary health care system. CONCLUSION: Managing the issue requires attentions from a national committee for preventing blindness with participation of all stakeholders, implementing a national survey on vision health, preparation of the primary level health centers including employment and education of community health workers (Behvarzes), optometrists and general practitioners, fair distribution of specialized human resources and establishing at least one specialized center in each province for referring patients from the primary levels.

Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults.

OBJECTIVE: The aim of this study was to estimate the prevalence and risk factors of prehypertension (Pre-HTN) and hypertension (HTN) among the adult population of Iran. METHODS: A nationwide cross-sectional survey was conducted from December 2004 to February 2005. The selection was conducted by stratified probability cluster sampling through household family members in Iran. Blood pressure (BP) and associated risk factors of 35 048 men and 34 674 women aged 25-65 years (mean 44.1 years) were measured. RESULTS: The prevalence of Pre-HTN was 59.6% in men and 44.5% in women; and 19.8% of men and 26.9% of women were hypertensive, according to Joint National Committee 7 criteria. Pre-HTN was more common among men whereas HTN was more common among women. Multivariate analysis revealed that age, overweight, obesity, abdominal obesity and high cholesterol were strongly associated with Pre-HTN in both genders. In women, low educational attainment, residence in an urban area and high blood glucose were also associated with Pre-HTN. Age, low educational attainment, overweight, obesity, abdominal obesity and high cholesterol and blood glucose were strongly associated with HTN in both genders. CONCLUSION: Pre-HTN and HTN appear to be quiet common in Iran and were associated with obesity. More men than women present with Pre-HTN, whereas more women than men present with HTN. Prevention and treatment strategies are urgently needed to address the health burden of Pre-HTN and HTN and to prevent prehypertensive people from developing HTN and cardiovascular disease.

Association of body mass index and abdominal obesity with marital status in adults.

BACKGROUND: Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with current marital status among the adult population of Iran. METHODS: A nation-wide cross-sectional survey was conducted from December 2004 through February 2005.The subjects were selected by stratified probability cluster sampling through household family members in Iran. Weight, height, waist circumference, and marital status of 89,404 men and women aged 15 - 65 (mean: 39.2) years were recorded. Four classes of body mass index, i.e., <18.5, 18.5 - 24.9, 25 - 29.9, and > or =30 kg/cm2, and three marital status, i.e., currently-, formerly-, and never-married were used. Abdominal obesity was defined as waist circumference > or =102 cm in men and > or =88 cm in women. RESULTS: The prevalence of overweight was twofold higher in married men (OR: 2.24; 95% CI: 2.08 - 2.41) and women (OR: 2.36; 95% CI: 2.20 - 2.53) than never-married men and women, even when age, educational level, leisure time physical activity, smoking habits, and place of residence were controlled. The multivariate OR of obesity was increased about threefold in married men (2.82; 95% CI: 2.51 - 3.18) and women (3.64; 95% CI: 3.31 - 3.99). The prevalence of abdominal obesity was twofold higher among married men (2.02; 95% CI: 1.79 - 2.29) and about threefold higher among married women (2.87; 95% CI: 2.69 - 3.06). CONCLUSION: The marital status appears to influence the likelihood of developing overweight, obesity, and abdominal obesity in both men and women in Iran.

Validation of the influencing factors associated with traffic violations and crashes on freeways of developing countries: A case study of Iran.

Among the rural roads, freeways have the maximum allowable speed limit. This subject increases the tendency of drivers to use these kinds of roads, and despite its positive effects, it has caused numerous problems. One of them is the increase in the rate of traffic violations and crashes. The amount of crashes per kilometer in Iran's freeways is almost twice the other rural roads. Hence, finding a solution to this problem is of particular importance. This research intends to validate some of the influencing factors which cause traffic violations and crashes in freeways and determine their amount of influence through statistical models. For this purpose, the authors considered violations and crashes for 36 road segments as dependent variables and other factors as independent ones. Since dependent variables were count, discrete, and non-zero, the proposed models were Poisson and Zero-truncated Poisson. The processing of the models indicated that the amounts of Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) indices for the Zero-truncated Poisson model are less than those of the Poisson model and the result of the Pseudo-R2 test for this model is within the acceptable range. Moreover, the result of Chi-square test which shows the proximity of expected and observed amounts was better for Zero-truncated Poisson model. Thus, this model has a considerable advantage against Poisson model. Final models indicated that the average speed has a positive correlation with the number of violations and crashes and as it increases, they increase too. Besides, peripheral landscapes, number of interchanges, number of passing lanes, and exemption from paying toll have an opposite relationship with violations and crashes.

Intranasal Premedication Effect of Dexmedetomidine Versus Midazolam on the Behavior of 2-6-Year-Old Uncooperative Children in Dental Clinic.

OBJECTIVES: The aim of this study was to compare the intranasal premedication effect of newly introduced dexmedetomidine (DEX) versus midazolam on the behavior of uncooperative children in the dental clinic. MATERIALS AND METHODS: This crossover double-blind clinical trial was conducted on 20 uncooperative children aged 2-6 years who required at least two similar dental treatment visits. The subjects were randomly given 1 µg/kg of DEX and 0.5 mg/kg of midazolam via the intranasal route. For the sedation protocol in the two groups, 0.25 mg/kg of atropine in combination with 0.5 mg/kg of midazolam added to 1-2 mg/kg of ketamine were used 30 minutes after premedication and transferring the patient to the operating room. Dental treatments were carried out by a pediatric dentist blinded to the type of the administered premedication. The sedative efficacy (overall success rate) of the agents was assessed by two independent pediatric dentists based on the Houpt scale. Data analyses were carried out according to Wilcoxon signed-rank test and paired t-test. RESULTS: There were no significant differences in the premedication efficacy of intranasal DEX and midazolam according to the Houpt scale (P>0.05). CONCLUSIONS: Intranasal midazolam and DEX are satisfactory and effective premedication regimens for uncooperative children.

Phthalates and organophosphates in settled dust and HVAC filter dust of U.S. low-income homes: Association with season, building characteristics, and childhood asthma.

Phthalates and organophosphates are ubiquitous indoor semi-volatile organic contaminants (SVOCs) that have been widely used as plasticizers and flame retardants in consumer products. Although many studies have assessed their levels in house dust, only a few used dust samples captured by filters of building heating, ventilation, and air conditioning (HVAC) systems. HVAC filters collect particles from large volumes of air over a long period of time (potentially known) and thus provide a spatially and temporally integrated concentration. This study measured concentrations of phthalates and organophosphates in HVAC filter dust and settled floor dust collected from low-income homes in Texas, United States, in both the summer and winter seasons. The most frequently detected compounds were benzyl butyl phthalate (BBzP), di-(2-ethylhexyl) phthalate (DEHP), di-n-octyl phthalate (DnOP), tris (1-chloro-2-propyl) phosphate (TCIPP), triphenyl phosphate (TPHP), and tris (1,3-dichloroisopropyl) phosphate (TDCIPP). The median level of TCIPP in settled dust was 3- to 180-times higher than levels reported in other studies of residential homes. Significantly higher concentrations were observed in HVAC filter dust as compared to settled dust for most of the frequently detected compounds in both seasons, except for several phthalates in the winter. SVOC concentrations in settled dust in winter were generally higher than in summer, while different seasonality patterns were found for HVAC filter dust. Settled dust samples from homes with vinyl flooring contained significantly higher levels of BBzP and DEHP as compared to homes with other types of floor material. The concentration of DEHP and TDCIPP in settled dust also significantly associated with the presence of carpet in homes. Cleaning activities to remove dust from furniture actually increased the levels of certain compounds in HVAC filter dust, while frequent vacuuming of carpet helped to decrease the concentrations of some compounds in settled dust. Additionally, the size and age of a given house also correlated with the levels of some pollutants in dust. A statistically significant association between DEHP concentration in HVAC filter dust in summer and the severity of asthma in children was observed. These results suggest that HVAC filter dust represents a useful sampling medium to monitor indoor SVOC concentrations with high sensitivity; in contrast, when using settled dust, in addition to consideration of seasonal influences, it is critical to know the sampling location because the type and level of SVOCs may be related to local materials used there.

Comparison of the Peak Inspiratory Pressure and Lung Dynamic Compliance between a Classic Laryngeal Mask Airway and an Endotracheal Tube in Children Under Mechanical Ventilation.

BACKGROUND: The present study was performed with the aim of comparing the peak inspiratory pressure and lung dynamic compliance between a classic laryngeal mask airway (LMA) and an endotracheal tube in children under mechanical ventilation. MATERIALS AND METHODS: In this study, 30 children aged 1 to 7 years with a physical condition of ASA I-II who were admitted for operations to repair inguinal hernias, hydroceles, or hypospadias were randomly enrolled. After induction of anesthesia, the appropriate laryngeal mask was used for each patient and they were placed under pressure-controlled mechanical ventilation. The peak inspiratory pressure was adjusted and recorded to obtain an appropriate tidal volume, then the laryngeal mask was removed and the appropriate size uncuffed endotracheal tube was inserted and the patient was placed again under controlled mechanical ventilation. The required settings were adjusted and peak inspiratory pressure and tidal volume were measured and recorded by the ventilator. Dynamic compliance was also calculated in both cases using the appropriate formula. RESULTS: The results showed that peak inspiratory pressure (PIP) with the use of LMA in children under mechanical ventilation was less than the PIP with the use of an endotracheal tube (p<0.05). Also, the pulmonary dynamic compliance with a laryngeal mask was greater than the use of an endotracheal tube (p<0.05). CONCLUSION: A laryngeal mask airway due to its low airway resistance and high dynamic compliance is an acceptable alternative to a tracheal tube during mechanical ventilation and it can be a good alternative to the endotracheal tube, especially during mechanical ventilation of children, in whom avoidance of barotrauma is desirable.

Impact of parental presence during induction of anesthesia on anxiety level among pediatric patients and their parents: a randomized clinical trial.

INTRODUCTION: Anesthesia induction is a stressful event for children and their parents, and may have potentially harmful consequences on the patient's physiological and mental situation. Stressful anesthesia induction has psychological adverse effects that recur with repeated anesthesia, can lead to increased pediatric discomfort during the recovery period, and may even induce reactionary postoperative behavior. A randomized controlled trial was performed to assess the impact of parental presence during induction of anesthesia (PPIA) on preoperative anxiety of pediatric patients and their parents at three different times, cooperation of child with anesthesiologist at induction of anesthesia, and parental satisfaction. PATIENTS AND METHODS: A total of 96 pediatric patients undergoing elective minor surgery (ASA 1-2) were randomly divided into two groups. Both groups received oral midazolam (0.5 mg/kg) at least 20 minutes before surgery, but in the PPIA group, the parents were also present in the operating room until loss of consciousness of child at anesthesia induction. Anxiety in the patients (as measured by the modified Yale Preoperative Anxiety Scale [mYPAS]) and parents (as measured by the State and Trait Anxiety Inventory [STAI]), the Induction Compliance Checklist (ICC), and parental satisfaction (as measured by visual analog scale) were assessed. RESULTS: There was no significant difference in the mean anxiety scores (mYPAS) of participants in the control and PPIA groups at ward T0 and upon arrival to operating room T1 (P>0.05). However, between the PPIA and control groups, mean mYPAS score was different at the time of induction of anesthesia T2 (35.5±16.6 vs 59.8±22.4; P<0.001). The ICC scores showed that perfect score was significantly different in the PPIA and control groups (66.6% vs 6.3%; P<0.01). The STAI scores of the parents in the two groups did not differ in T0, T1, and T2. The mean parental satisfaction score was higher in the PPIA group than in the control group (7.6±7.0 vs 5.8±6.1; P<0.01). CONCLUSION: PPIA may reduce preoperative state anxiety of pediatric patients and improve quality of anesthesia induction based on ICC scores and higher parental satisfaction, but it does not impact on parental state anxiety.

Incidence of Ventilator-Associated Pneumonia in Critically Ill Children Undergoing Mechanical Ventilation in Pediatric Intensive Care Unit.

BACKGROUND: Among hospital-acquired infections (HAIs) in children, ventilator-associated pneumonia (VAP) is the most common after blood stream infection (BSI). VAP can prolong length of ventilation and hospitalization, increase mortality rate, and directly change a patient's outcome in Pediatric Intensive Care Units (PICU). OBJECTIVES: The research on VAP in children is limited, especially in Iran; therefore, the identification of VAP incidence and mortality rate will be important for both clinical and epidemiological implications. MATERIALS AND METHODS: Mechanically ventilated pediatric patients were assessed for development of VAP during hospital course on the basis of clinical, laboratory and imaging criteria. We matched VAP group with control group for assessment of VAP related mortality in the critically ill ventilated children. RESULTS: VAP developed in 22.9% of critically ill children undergoing mechanical ventilation. Early VAP and late VAP were found in 19.3% and 8.4% of VAP cases, respectively. Among the known VAP risk factors that were investigated, immunodeficiency was significantly greater in the VAP group (p = 0.014). No significant differences were found between the two groups regarding use of corticosteroids, antibiotics, PH (potential of hydrogen) modifying agents (such as ranitidine or pantoprazole), presence of nasogastric tube and total or partial parenteral nutrition administration. A substantial number of patients in the VAP group had more than four risk factors for development of VAP, compared to those without VAP (p = 0.087). Mortality rate was not statistically different between the VAP and control groups (p = 0.477). CONCLUSION: VAP is still one of the major causes of mortality in PICUs. It is found that altered immune status is a significant risk factor for acquiring VAP. Also, occurrence of VAP was high in the first week after admission in PICU.

Abdominal Mass Secondary to Human Toxocariasis.

Toxocariasis is an extensive helminthic infection that leads to visceral larva migrans in humans. A 2.5-year-old girl referred for abdominal mass. She had history of pharyngitis for two weeks. There were no other symptoms. Abdominal examination revealed an irregular solid mass in right lower quadrant (RLQ). Abdominal ultrasonography revealed an echohetrogenic large mass in RLQ, liver, and retroperitoneal area. Abdominal CT scan showed a huge mass. At laparotomy a large retroperitoneal mass that involved right liver lobe, bladder, ileocecal valve, small and large intestines was found. At histopathology diagnosis of toxocariasis was made.