مجله دانشکده پزشکی اصفهان
پیاپی 647 (هفته سوم دی 1400)

In patients under mechanical ventilation, the patient's position is one of the factors affecting the efficiency of respiratory gas exchange. The aim of this study was to compare the level of arterial blood gas pressure and the percentage of arterial oxygen saturation in the supine position with the lateral position in patients with ventilator-associated pneumonia.

In a clinical trial study with a sample size of 50 patients with ischemic stroke under mechanical ventilation admitted to the intensive care unit of Kashani hospital affiliated to Shahrekord University of Medical Sciences, Shahrekord, Iran, in 2019 were selected using convenience sampling method. Oxygen saturation percentage was measured by a pulse oximeter in patients lying on their backs and then, on their sides for two hours; arterial blood pressure and carbon dioxide levels were measured with arterial blood sample by laboratory device, and recorded in the relevant checklist as well.

In both supine and lateral positions, the mean arterial oxygen pressure and the percentage of hemoglobin oxygen saturation were not significantly different (P > 0.050); while the arterial carbon dioxide pressure in the lateral position was significantly lower than the supine position (P = 0.008).

The lateral position has no significant effect on the improvement of arterial blood gases and oxygen saturation in patients with pneumonia due to mechanical ventilation; but has significantly reduce the pressure of carbon dioxide.

Klebsiella pneumoniae (K. pneumonia) is an opportunistic pathogen and one of the most common causes of nosocomial infections, some of which are now resistant to antibiotics and make infection difficult to treat. The main purpose of this study was to use multiplex polymerase chain reaction (PCR) to detect tetracycline-resistance genes in clinical isolates of K. pneumonia.

After collecting clinical samples from hospitals in Mashhad City, Iran, in 2021, K. pneumoniae was isolated and identified by biochemical and molecular methods (Kp16S rRNA specific primer). Antibioticresistance pattern was determined for 30 isolates by disk diffusion method. After designing primer and its blast, detection of tet genes was optimized by PCR. Finally, multiplex PCR was set up using three pairs of primers and positive control.

The highest and lowest antibiotic resistance of the isolates was for ampicillin (90%) and ceftriaxone (26.66%), respectively, and 53.33% of Klebsiella isolates were phenotypically resistant to tetracycline. Multiplex PCR was set up by annealing temperature of 55°C. Simultaneously with detection of Kp16S rRNA gene, tetA and tetB genes were detected in 87.5% and 68.75% of tetracycline-resistant Klebsiella isolates, respectively. 56.25% of the isolates carried both tetA and tetB genes, simultaneously, and 12.5% of the isolates transferred one of the tetA or tetB genes.

The results show that the multiplex PCR technique designed in this study is a fast, accurate, and sensitive method for identifying antibiotic-resistant K. pneumoniae that can be used for clinical samples or in epidemiological studies.

Scabies is one of the most important infectious skin diseases caused by the arthropod mite Sarcoptes scabiei var Homonis. Crusted scabies is a rare form of scabies that multiplies rapidly and extensively in the skin of an infected person, usually in immunocompromised patients, and is accompanied by a severe allergic reaction. Here, we report an 85-year-old man, a resident of the village, who had been severely itchy for two months.

An 85-year-old man with severe skin symptoms was referred to the Parasitology Department of Isfahan University of Medical Sciences, Isfahan, Iran, for diagnosis of skin parasitic disease. A sample of skin lesions was prepared by scraping method and observed under microscope. Under microscopic examination, by observing the mite and its eggs, scabies was diagnosed and the diagnosis of crusted scabies was confirmed according to the clinical signs.

This form of the disease occurs in people with defective immune systems, but according to the case reported here, it seems that it can also occur in people with healthy immunity.