مجله دانشکده پزشکی اصفهان
پیاپی 405 (هفته اول دی 1395)

Carbapenem antibiotics are often used as the last line of treatment for infections caused by resistant Gram-negative bacteria (GNB). The most important mechanism of resistance to carbapenems is production of carbapenemase. The prevalence of carbapenem-resistant Gram-negative bacteria is on the rise worldwide, posing a major public health threat. The aim of this study was to determine the antibiotic resistance patterns and to detect carbapenemase producing Gram-negative bacteria in clinical isolates.
In this study, a total of 134 clinical isolates of Gram-negative bacteria were collected in Tehran city, Iran, during 2012-2013. Antimicrobial susceptibility testing was performed and resistance genes were characterized using polymerase chain reaction (PCR) amplification and sequencing. The modified Hodge test (MHT) and ethylenediaminetetraacetic acid (EDTA) double-disk diffusion test (DDST) were performed for the screening carbapenemases.
Findings: The number and frequency of isolated bacteria were as Escherichia coli 57 (42.5%), Klebsiella pneumonia 26 (19.4%), Acinetobacter spp 21 (15.6%), Pseudomonas aeruginosa 17 (12.6%), Citrobacter spp 8 (5.9%), Proteus spp 3 (2.2%), and Enterobacter spp 2 (1.4%). These organisms showed the highest resistance to ertapenem, cefotaxime, aztreonam, ceftazidime, amikacin and kanamaycin (100%). Confirmatory tests showed that 44 isolates (32.8%) were DDST positive and 17 isolates (12.6%) were MHT positive. Most of MHT-positive (41.17%) and DDST-positive (39.13%) isolates were Acinetobacter spp. The PCR based screening revealed the presence of the blaIMP-1 gene in 4 isolates.
Owing to the presentation of blaIMP-1 gene in Klebsiella, Citrobacter, Acinetobacter and Escherichia coli and feasibility of horizontal gene transfer among bacteria, changing in antibiotic prescription policies is required. Due to the importance of Metallo beta lactamase producting strains in hospital, early identification could play an effective role in prevention and treatment of these isolates.

This study aimed to compare the weaning rate in three mechanical ventilation methods, automatic tube compensation and pressure support ventilation with airway pressure of five and eight centimeters of water.
In a clinical trial study, 105 patients admitted to the intensive care unit who needed ventilation distributed randomly in three groups of 35 individuals, under ventilation with automatic compensation tube mode (group 1), and under ventilation with pressure support ventilation with airway pressure of five (group 2) or eight (group 3) centimeters of water. The patients were placed in isolation and the rate and the time of success weaning from the device were compared between the three groups.
Findings: The rate of success in weaning from the ventilator in was 88.6, 57.1 and 85.7 percent in groups 1, 2, and 3, respectively; and the difference between the groups was statistically significant (P = 0.002). Mean (± SD) time of weaning in the three groups was 6.9 ± 3.7, 8.9 ± 6.4 and 7.1 ± 10.6 days, respectively; and there was not any significant difference between the three groups (P = 0.490).
The rate of success in weaning from the device in patients undergoing mechanical ventilation under automatic tube compensation mode was higher and therefore, selecting this mode in these patients is better. In addition, morbidity and mortality rates and hospital costs would decrease in this method and bed capacity in intensive care units which is now a major problem for hospitals and health centers would increase.

Chronic myelogenous leukemia (CML) is a type of blood cancers that usually occur in adults. The first step for diagnosis of leukemia is blood test and counting cells. Diagnosis and counting cells from blood smear are done by pathologist using optical microscope. This is a time-consuming and costly process and needs experience and expert in this field. Besides, other factors such as fatigue and working conditions can negatively affect the diagnostic evaluation. Thus, an aid tool for pathologists to help in the diagnostic process can be so useful. This research proposed a novel software tool to diagnose and classify of chronic myeloid leukemia cells.
In the proposed method, after accurate manual segmentation, various geometric features of cell and nucleus were extracted from neutrophils cells using image processing techniques. Then, applying these features by a new designed tree classifier, cells were categorized in to six groups.
Findings: The proposed method was evaluated on 120 blood smear microscopic images including 714 white blood cells (WBCs). An accuracy of over 97%, specificity of over 98% and sensitivity of over 91% for all of six groups were achieved.
In this study, a semi-automatic method was proposed for detection and classification of effective cells in diagnosis of chronic myeloid leukemia in microscopic images utilizing image processing methods.

Rheumatoid arthritis is a chronic, progressive inflammatory disease that causes pain, stiffness, swelling and destruction of the articular tissues. This study aimed to evaluate the relationship between serum levels of vitamin D and disease severity in patients with rheumatoid arthritis.
In this descriptive-analytic-sectional study was conducted in the city of Qom, Iran, 120 patients were enrolled based on the evaluation and consideration of inclusion and exclusion criteria using convenience sampling method. The activity or severity of disease was determined based on the disease activity score 28 (DAS28) criteria.
Findings: 92 patients (76.7%) were women and the mean age of the patients was 48.26 ± 13.28 years. The serum vitamin D level was lower than normal in 19 patients (15.8%). The severity of the disease was reported as severe in 54 patients (45%), average in 51 patients (42.5%) and minor in 15 patients (12.5%). There was no significant relationship between the disease activity based on criteria and serum level of vitamin D (P > 0.05).
According to the frequency and importance and effects of rheumatoid arthritis, more and more accurate and complete studies should be done in this area; then, the health departments can conclude details of preventive and curative approach in the context of the relationship between vitamin D and disease activity in patients with rheumatoid arthritis.

Cutaneous leishmaniasis is endemic in 97 countries. If there is no remission with Glucantim as a choice of drug, other treatments such as cryotherapy and thermotherapy methods are used or other drugs such as allopurinol, pentamidine and amphotericin are prescribed. The use of trichloroacetic acid (TCA) 50% solution is another effective treatment.
Case Report: We report three cases (two women and one man) of cutaneous leishmaniasis resistant to Glucantim treated with combination therapy of allopurinol and TCA 50%.
According to the results, the use of combination therapy of allopurinol and TCA 50% could be used as one of the alternative treatments in Glucantim™-resistant cutaneous leishmaniasis.