Shiraz Emedical Journal
Volume:18 Issue: 5, May 2017

Bradycardia may result in the exacerbation of myocardial dysfunction in elderly patients.
In this retrospective cohort study, ephedrine and atropine were compared for the treatment of symptomatic bradycardia.
In this study, patients (above 65 years) with symptomatic bradycardia during skin tumor resection were evaluated. Symptomatic bradycardia was defined as heart rate below 49 beats per minute and systolic blood pressure below 85 mmHg. According to the anesthesiologist''s decision, 1 group of patients (atropine group) received atropine (0.5 mg) as the first-line drug, while the other group (ephedrine group) received ephedrine (10 mg) as the first-line drug to restore hemodynamic parameters. If the initial treatment had no effects on the management of the symptoms, ephedrine (10 mg) was administered to the patients in both groups. The number of patients, who received treatment with a single drug to normalize their hemodynamic parameters, was compared with those who required a second drug.
Among 194 subjects with symptomatic bradycardia, 86 and 108 patients were allocated to the atropine and ephedrine groups, respectively. Based on the findings, 35 patients in the atropine group required the second drug for bradycardia management; therefore, 51 patients were treated with only atropine (efficacy: 51/86, 59.30%). Moreover, 21 patients in the ephedrine group required the second dose of ephedrine for the management of bradycardia; consequently, 87 patients were treated with only ephedrine (efficacy: 87/108, 80.55%). There was a statistically significant difference between the 2 groups (P = 0.001).
Ephedrine is more effective than atropine in the management of symptomatic bradycardia in elderly patients.

Communication has a fundamental role in marital life and lack of effective communication is a common compliant of married couples attending counseling and treatment centers.
This study was conducted to examine the effect of communication skills on marital satisfaction of couples attending premarriage counseling centers.
This parallel interventional study was conducted on 60 couples who attended a premarriage counseling center (Shahid Rast Ravesh) affiliated to Alborz University of Medical Sciences. A simple sampling method was used and samples were allocated into the intervention and control groups using blocks randomization. The intervention group, in addition to the routine trainings, received training on communication skills and sexual relation. The Enrich’s marital satisfaction questionnaire was completed by the participants in both groups before, after and two months after the intervention.
The mean age of the couples was 24.9 ± 4.7 years in the intervention group and 25.8 ± 4.1 in the control group. Twenty participants (66.7%) in the intervention group and 19 participants (63.3%) in the control group had diploma. Also, 13 persons (43.3%) in the intervention group and 12 persons (40%) in the control group were self-employed. There was no statistically significant difference between the two groups in socio-economic traits of the couples. The results of repeated measures showed that marital satisfaction has changed over time (P Considering the effect of communication skills on marital satisfaction of the couples, it would be suggested to include the content of communication skills in the premarriage education class.

Females encounter various stresses during life. Different courses of female’s life, namely menstruation, pregnancy, and childbirth, cause particular physical and mental changes that make them more vulnerable.
The purpose of this study was to investigate the effect of group counseling based on cognitive-behavioral approach on pregnancy-specific stress and anxiety
This randomized trial recruited 62 qualified pregnant females during year 2016. The participants were selected through convenience sampling and divided to 2 groups, the intervention and the control group, based on randomized blocks of 4. The control group received routine prenatal care and an instructional package for dealing with stresses during pregnancy. The intervention group received counseling for 6 sessions of 90 minutes besides routine prenatal care. Both groups were evaluated at baseline and at the end of the study using pregnancy-specific stress and anxiety questionnaire. The collected data were analyzed using the SPSS16 software.
Based on the results of this study, the 2 groups did not significantly differ in terms of age, educational level, occupation, ethnicity, and housing. The score of stress during pregnancy was not significantly different at baseline either. However, mean score of stress after the intervention was significantly lower in the intervention group than the control group (P = 0.001).
Cognitive-behavioral counseling can be used as an optional method for reducing the pregnancy-specific stress and anxiety, and improving the pregnant female’s mental health.

Prevalence of plasmid mediated quinolone resistance in Escherichia coli clinical isolates is a serious problem in developing countries.
The aim of this study was to investigate quinolone resistance determinants among Extended-Spectrum Β-Lactamases (ESBL)-producing E. coli recovered from patients with nosocomial urinary tract infection.
A total of 290 E. coli isolates, obtained from patients with UTI, were included in this study. The phenotypic confirmatory test for ESBL production was performed by double disc synergy test and combined disk diffusion test. Kirby-Bauer Disk diffusion method was performed to test susceptibilities of ESBL-producing E. coli isolates to 15 antimicrobial agents. Isolates were screened for the presence of ESBL and plasmid-mediated quinolone resistance genes by polymerase chain reaction (PCR).
In the present study, 290 (71.7%) E. coli strains were recovered from 410 hospitalized patients with UTI, 51.7% of which were found to have ESBL positive results. In vitro, the susceptibilities of ESBL-producing E. coli strains showed that all isolates were resistant to amoxicillin and penicillin and resistance rates to other of antibiotics differed from 40% to 96%. Among the 150 ESBL positive isolates, frequencies of aac(6’)-Ib, oqxA, oqxB, qnrA, qnrB, qnrS, and qepA were 74.7%, 8%, 4%, 3.3%, 1.3%, 2%, and 2.7%, respectively. Coexistence of bla CTX-M, bla TEM, bla CTX-M, and aac(6’)-Ib were the most widely distributed resistance genotypes.
The data of the present study revealed the high prevalence of plasmid-mediated quinolone resistance genes among ESBL-producing E. coli in the hospitals. The bla CTX-M genes were found to be the dominant ESBL-encoding gene.