مجله دانشکده پزشکی اصفهان
پیاپی 85 (تابستان 1386)

Extravagant use of vancomycin as first line treatment of infections caused by this organism, has led to production of vancomycin resistant staphylococci and enterococci, as an important health problem. The goal of this study was determining sensitivity of S.aureus isolated from clinical specimens outside hospital using E-Test in order to find suitable primary therapeutic method and to reduce vancomycin use.This cross-sectional study was performed in 2006 among 60 samples of community- acquired S.aureus Minimal Inhibitory Concentration (MIC) for various antibiotics against organisms was determined by E-test method. Qualitative control was performed by staphylococcus ATCC29213 and statistical analysis was done by SPSS ver 13 and WHONET- 5 softwares.Overall, 60 patients (including 10 women and 50 men) were included in the study. The specimen studied were 47% from blood, 30% from skin ulcer, 11.7% from evacuated abscess and 8.3% from synovial fluid. Sensitivity percentage of organisms based on break point used in CLSI M7A6 (Clinical & Laboratory Standard Institute) for various antibiotics was 88.6% for Co-Amoxiclav, 81.8% for Amikacin, 79.3% for Gentamicin, 82.1% for Cephalothin, 75% for Ciprofloxacin, 75% for Clindamycin, 76.7% for Oxacillin, 90.5% for Rifampin and 77.8% for Vancomycin. Highest resistance was noted against Oxacillin (p<0.01), Clinidomycin (p<0.01) and aminoglycosides (p<0.05) and definite resistance against Vancomycin was present in only one sample.Staphylococcus aureus is among the most prevalent agents of hospital infection which shows increasing resistance and still has acceptable sensitivity to Cephalothin, Oxacillin and other first- line treatment drugs in community-acquired infections and empirical use of Vancomycin is not necessary in these patients.

The lower limb fractures are common in young and elderly people. The goal of treatment is to return the patient to normal function as quickly as possible, with minimal complications. Plate and screw is a popular and successful technique in treatment of these patients. This case-control study was conducted on 108 patients (54 with plate fracture as cases and 54 without plate fracture as controls), who have been admitted in Kashani and St Alzahra hospitals affiliated to Isfahan University of Medical Sciences during 2005.A Check list including age, sex, bone fractured, site of initial fracture, use of external support, distance between plate fracture and plating, infection and etc was completed for each patient; and out coming data was analyzed. The most common site of plate fracture was in diaphysis and the least in epiphysis of bones. In the case group, 87% of patients had used no external support (splint, cast, brace), 3/7% of patients had infected surgery site, 44% of patients had had early weight bearing after plating, the most common bone was femur, most initial fracture lines were comminuted, in 33/3% of patients, bone graft had been used, 9/3% of first injuries had been open fracture and 92/6% close fracture, 92/6% of patients were male and 4/7% female, the mean age of patients was 31.6 ± 15.36 yr, the average time between plating and plate fracture was 5.5 ± 3.4 months, All plates were broken at the empty hole site against initial fracture line, PH in site of plate fractures was alkaline and 2 patients had an underlying disease (chronic renal failure). In this study, site of fracture, use of external support, early weight bearing and type of fracture line were contributing factors in plate failure. We didnt find any relation between plate fracture and fracture type (open or close), PH of fracture site, patient's sex or age.

Surrounding noise, especially in industrial environments, is one of the most common etiologic factors of sensory-neural hearing loss (SNHL), which is not curable, but preventable. By industrialization of communities, the prevalence of the disease and its unfavorable socioeconomic outcome is growing up. Since the preventable defect, early diagnosis has the utmost importance. In recent years, the role of extended high frequency audiometry (EHFA) as a sensitive diagnostic tool for noise induced hearing loss has received much attention. This study deals with the role of EHFA in early diagnosis of this disorder. This was a retrospective cohort study during 2003-4 in Isfahan, Iran. A total number of 30 male labors, aged 20-50 years working in a noisy industrial environment, were compared with an equal number of controls with normal conventional audiometry, and no risk factor for other causes of SNHL according to their history and otoscopic examination. All 60 individuals underwent both types of conventional and extended high-frequency audiometry. Data were analyzed with SPSS software using t-test, paired t-test and correlation tests of Pearson and Spearman. There was no difference between the right and left ears. The exposed subjects had significantly worse hearing than the non exposed group, at all tested frequencies (especially at 16 KHz). The age effect was notable in both groups. The correlation between high frequency threshold and duration of noise-exposure was significant only at 16, 18 and 20 KHz. The higher mean frequency threshold of the cases was predictable; the normal findings of conventional audiometry, reveal that EHFA can be useful in early diagnosis of acoustic injuries.

Deliberated hypotension and administration of vasoconstrictive drugs such as epinephrine during ear microsurgery are of the most important aids for reducing blood loss and improving the surgical field. One of the important challenges in selecting the appropriate method of deliberated hypotension is to easily reach to desired blood pressure and to have the least interaction to anesthetic drugs and the function of vital organs. This study aimed to assess the efficacy of magnesium sulphate for deliberated hypotension during ear microsurgery. In this clinical trial, 55 patients candidate for mastoidectomy surgery, and aged 15-65 yrs, were randomly assigned to receive placebo (n=27) or magnesium sulphate (n=28) infuse 60 mg/Kg over 15 minute followed by a maintenance dose of 10 mg/Kg/h until 30 minutes prior to the end of surgery. Intra-operative bleeding, the surgery duration, surgeon satisfaction, serum magnesium level, recovery time, anesthetic drug requirements (atracurium-halothane), and vasodilator (TNG) were measured in both groups and then compared with independent t and Mann-Whitney statistical tests. Patients receiving magnesium sulphate had less blood loss than controls (59.46±27.19 vs. 97.57±31.41 ml, respectively, p

Using Glutamate antagonists such as topiramate has been suggested on the basis of glutamate hypothesis for schizophrenia; as its properties encourage its exploration and possible development as a medication for the treatment of schizophrenia. A randomized, double-blind, placebo controlled clinical trial was performed on 18-45 years old schizophrenic patients. Baseline information including vital signs, height, weight, smoking status, demographic characteristics, (past) psychiatric history, medication history and medication-related adverse effects was collected. Patients were randomly assigned to topiramate or placebo group. Efficacy was assessed by administering positive and negative syndrome scale (PANSS), and tolerability was recorded in both groups on days 0 (baseline), 28, and 56. Total PANSS score in topiramate group was 96.87 (85.37-108.37), 85.68 (74.67-96.70) and 76.87 (66.06-87.69) compared with 101.87 (90.37-113.37), 100.31 (89.29-111.32) and 100.56 (89.74-111.37) in placebo group in baseline, 28th and 56th days, respectively (95% confidence interval). General linear Model for repeated measure analysis showed that topiramate has lowered PANSS score significantly (p)

Nephropathy is one of the serious adverse effects in administration of contrast media in percutaneous coronary intervention (PCI). This study was designed in order to evaluate the effect of ACEI and diuretics on contrast- induced nephropathy. This randomized clinical trial was conducted in Isfahan University of Medical Sciences in 2006. Overall, 60 persons were randomly assigned for each group. Groups A and B were treated by angiotensin converting enzyme inhibitors (ACEI) and groups C and D were treated by diuretics. In group A, ACEI was discontinued from 36 hours before PCI and in group C diuretics were discontinued as well. The post-intervention and the amount of increase in the serum creatinin (Cr) level were compared by ANOVA between groups. The increase in Cr level was not significantly different between groups A and B (0.07±0.22 vs.,0.06±0.13 mg/dL, respectively, p=0.7). Similarly, this difference was not significant between groups C and D (0.08±0.17vs. 0.05±0.14mg/dL, respectively, p=0.2). Regarding to non- significant difference of Cr level between the groups either continuing or discontinuing ACEI and diuretics,in the presence of normal kidney function, these drugss,have no side effect in patients undergoing PCI.

The genitourinary system is one of he most common sites of infection in non-pulmonary tuberculosis (TB). The clinical symptoms and radiologic findings of urinary TB are nonspecific. Current diagnostic tests are of low sensitivity and labor-intensive. Therefore, this study was aimed to evaluate diagnostic value of urine PCR in genitourinary tuberculosis (GNTB). This was a descriptive study on 33 patients with confirmed genitourinary TB. Demographic data, clinical symptoms, laboratory and radiologic findings were collected. For each patient, three consecutive early morning urine specimens were examined by PCR. The diagnostic value of PCR in mycobacterium tuberculosis (MTB) in comparison with standard microbiological methods was assessed. There were 33 patients with a mean age of 47.27 16.1 years. The most common presenting symptoms were irritative voiding symptoms (51.5%), flanks pain (27.2%), gross hematuria (9%) and suprapubic pain (9%). Laboratory findings in U/A were hematuria (75.8%) and pyuria (60.6%). IVU was abnormal in 61.5% of patients. Most common abnormalities were pyelocalyceal dilation (44%), ureteral stricture and hydroureter (37%) and multiple small calyceal deformities (25%). Of the 33 patients PCR for MTB was positive in 16 cases (48.5%). In patients with abnormal IVU, PCR was positive in 62.5%. A high index of clinical suspicion is necessary for diagnosis of GUTB. PCR is recommended for instant diagnosis and screening before further examination, it cannot be the only method in identification of GUTB.

Human brucellosis is a common bacterial zoonosis in I.R.of Iran, and with current therapy has significant relapse rate and side effects. However, the optimal duration of therapy has not been determined and side effects cause poor compliance. This study focused on comparison between effects and complications of two therapeutic regimens. In this single-blind randomized trial, 78 uncomplicated brucellosis patients were recruited and allocated into two tails of study by fixed block allocation method. Patients of doxycycline tail were treated with streptomycin, doxycyline plus rifampin (streptomycin plus doxycycline for first month; and, doxycycline plus rifampin for second and third months). Patients of ofloxacin tail were treated with streptomycin, ofloxacin plus rifampin (streptomycin plus ofloxacin for first month and ofloxacin plus rifampin for second and third months) for three months.Therapeutic outcome was evaluated by measuring efficacy, relapse rate and drug's GI and skin side -effects. Active brucellosis diagnosed by serology (Wright and 2 ME tests) at the start, 3 and 6 month after drug therapy. The data were analyzed by stata 8.0 soft ware. The proportions were compared by fisher exact test. Significance level was 0.05. The results were reports as proportion (standard error). At the end of the study, the curative results were similar in doxycycline and ofloxacin tail (100%). The complication rate had Significant difference in doxycycline and ofloxacin tails, 48.6±8.3% versus 13.2±5.5%, respectively (p)

Although cardiovascular diseases get top position in burden of disease list, the role of risk factors in extent and severity of atherosclerosis in coronary artery disease (CAD) remain controversial. To study the determinants of severity and extent of coronary artery disease in consecutive patients with major risk factors of CAD undergoing clinically indicated coronary angiography. In this cross sectional study, coronary angiograms of 325 men and 235 women patients were analyzed quantitatively. Then systolic and diastolic blood pressure, body weight, height, fasting blood sugar, serum lipids and smoking habit were collected in a questionnaire. Relationship of angiographic scores, reflecting severity and extent of CAD were comparing with potential risk factors using logistic and multiple linear regression analysis. We found significant differences between age and fasting blood glucose in patients with positive coronary angiogram versus patients with negative coronary angiogram (P

Solitary Pulmonary Nodule (SPN) is one of the most common diagnostic problems in chest radiology because differentiation between benign and malignant nature of the lesions based on radiologic pictures may be difficult and sometimes impossible. Nowadays, CT scan is the most accurate imaging modality for diagnosis and characterization of pulmonary nodules. In this study, 131 patients were included in whom Preliminary chest x-ray revealed SPN, chest CT scan was the next imaging investigation in these patients. Chest CT Scan confirmed SPN in 103 patients. Of these patients, Fine Needle Aspiration (FNA) and surgical resection of the nodule were taken place in 69 and 27 patients respectively. Pathological results compared with CT scan findings. Considering CT characteristics of the lesions, results were in favor of malignancy in 27 patients and in other 61 patients, CT scan findings were consistent with benign process. Mentioned data disclosed sensitivity and specificity of CT scan in prediction of malignant SPN 81/8% and 86/3% respectively. CT scan as used in this study could be useful for determining benign or malignant nature of solitary pulmonary nodules. Rate of enhancement in the lesions following IV administration of contrast agent is the most important criterion to differentiate benign and malignant lesions.

Age- related cataract is the main cause of blindness and visual impairment worldwide. Surgery is the only treatment currently available for lens opacity. It is the most frequently performed procedure in ophthalmology. There are many different advantage and disadvantages. Today, ultrasound phaco-emulsification is the most performed method for surgery. One of alternative energy forms is laser photolysis. The aim of this study was to evaluate the mean energy delivery to eye using Dodick laser photolysis for phaco-emulsification. 76 eyes from 76 patients at Aban Eye Clinic in Esfahan were introduced to study. Cataract density was rated preoperatively using lens opacity classification system III (LOCS III) on 0 to +4 density scale. Lenses with +4 nuclear density scales were excluded. Finally 67 eyes were operated with ARC Dodick laser photolysis system throw 2.8 mm clear corneal incision. Delivered energy was recorded. Of 67 patients, 39 (58.2%) were male and 28 (41.8%) were female, and had a mean age of 58.3+12.8 (14-84 years). There was no statistically significant difference between age of male patients (56.5+12.8) and female patients (60.7+11.9) (p=0.18). Mean delivered energy to eyes was 4.5+2.6 joules for nucleuses with density of +1, +2 and +3 mean delivered energy was calculated as 3.32+2.60, 3.7+2.59 and 5.7+2.23 joules respectively. Finally it was reverted that there was a direct relationship between delivered energy and nuclear density (p=0.00001, r=0.57). In spite of the lower amount of energy used, as the preoperative hardness of lens nucleus or lengthening of operation cannot be predicted before surgery, this technique is not well- accepted; hopefully with resolving of technical problems in the future, it can be used more properly.

Re-intubation of the trachea is one of the complications of the patients encounter with critical illness in the intensive care unit. The incidence of this complication has reported between 2% and 25%. Many risk factors contribute with this phenomenon; such as female sex, aging, narcotic and sedative drugs, etc. Re-intubation increases the duration of hospitalization, as well as pulmonary complications and mortality rate. The aim of this study was to evaluate the risk factors of re-intubation in the intensive care units (ICU). This study was a retrospective cross- sectional study and was conducted in 2004 among the data documented 210 medical records. These records were obtained from three ICUs of AL-Zahra medical Center. Incomplete medical records were. All data was extracted and filled in specially-designed questionnaires. Obtained data was analyzed with SPSS software by using Chi-square and t-tests. From the 210 medical records studied, 15 patients (7.1%) were re-intubated. There was a positive correlation between re-intubation and hemoglobin when it was lees than 12 gr/dL or more than 15 gr/dL.

Efficacy of xanthine oxidase inhibitors on the improvement of cardiac performance is not clearly defined. This study was designed to study the efficacy of allopurinol on the improvement of left ventricular ejection fraction (LVEF) in patients with chronic heart failure. A randomized, double blind, placebo controlled clinical trial was performed on two groups of patients suffered from class II to III heart failure of New York Heart Association classification. 16 cases were in intervention group who intake allopurinol (100 mg/day in the first three days, 200 mg/day in the second three days and 300 mg/day for one month); 15 cases were in control group and intaked placebo like case group. Left ventricular ejection fraction was measured by echocardiography with Simpson's method and compared before and after the intervention. The mean of LVEF before and after intervention, in case group were 38.8±9.9 and 41.9±9.7 respectively (p0.05). In intervention group EF was increased 3.1% from base level. Allopurinol can be effective in improvement of cardiac performance. However its clinical use for heart failure patients needs to be approved by more trials, in various situations and longer periods.