مجله دانشکده پزشکی اصفهان
پیاپی 686 (هفته دوم آبان 1401)

The surge in antibiotic resistance, especially to colistin in multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) is one of the important factors of mortality in wound infections in burn patients. The aim of this study was to investigate the prevalence of resistance to colistin as a last line treatment in MDR P. aeruginosa isolates from the wounds of hospitalized patients and for the detection mcr-1 gene.

Seventy-two P. aeruginosa isolates were obtained from Imam Musa Kazem Hospitals’ laboratories and confirmed using standard microbiological techniques. Antibiotic sensitivity was evaluated by the standard disk diffusion method against 8 antibiotics and minimum inhibitory concentration (MIC) of colistin was determined. The presence of mcr-1 gene was detected using specific primers by Polymerase chain reaction (PCR) test.

Out of 72 isolates, 50 (69.44%) were identified as MDR P. aeruginosa, with the highest resistance to Levofloxacin (98%) and Ciprofloxacin (92%) and the lowest. Resistance was to piperacillin tazobactam (40%). Only 2% of isolates showed complete resistance to all antibiotics. Colistin resistance was detected in 14% and mcr-1 gene in 2% of the isolates.

The resistance of P. aeruginosa to colistin (14%) among the isolates from burn infections in Isfahan and the prevalence of mcr-1 gene (2%) in this study, shows the importance of early detection of colistin resistance, following antibiotic resistance genes and avoid recommending this drug unnecessarily to control hospital infections.

The clinical features of early repolarization in children are important to prevent cardiac complications and sudden death. The aim of this study was to investigate the characteristics, clinical manifestations and frequency of early repolarization and the frequency of ventricular and atrial arrhythmias in children.

The present retrospective, cross-sectional study took in to account the files of 78 children between the ages of 5 and 18 with atrial or ventricular arrhythmia. Based on the ST segment pattern, the early repolarization was divided into malignant and benign categories, and according to the involvement of the lower and lateral leads, it was divided into three categories of low, medium and high risk.

Among the 78 investigated cases, the frequency of early repolarization was 21.8% (95% CI: 13-32) and 56.25% of the patients were in the benign group. Around 75% of the children with early repolarization had clinical symptoms, the most common symptom being palpitations (12.78%). The most common arrhythmias were ventricular tachycardia and ventricular fibrillation amounted to 87.21% and 25.6%. The most common arrhythmias with atrial origin were supraventricular tachycardia (50%), atrial flutter (37.9%), atrial tachycardia (25.6 %) and atrial fibrillation (12.3%) respectively. There was a significant relationship between the type of arrhythmias and repolarization.

The presence of early repolarization in children's ECG should be taken into consideration for the occurrence of atrial and ventricular arrhythmias. Also, in patients with palpitations, it can be important to check early repolarization even with a benign pattern.

Hemoglobinopathies are a group of qualitative hemoglobin disorders which also happen to be very common in Iran. Some of these cases have severe clinical symptoms and others have none. Specific hemoglobinopathies are seen in certain ethnicities and can also lead to misdiagnosis and misinterpretation by similar electrophoretic motion to other hemoglobin variants.

Case Report:

 In this article, three patients with rare hemoglobinopathies named Hb Arya, Hb Q-Iran, Setif and two cases of Hb Constant Spring who were referred to Kermanshah Reference Laboratory have been studied and discussed. These hemoglobinopathies are caused by mutations in the alpha chain of hemoglobin, and in addition, Arya and Q-Iran hemoglobinopahies-can interfere with the interpretation of other clinically significant hemoglobinopathies. Hemoglobin Setif can move on electrophoresis similar to hemoglobin S, and its sickling test is a false positive. Finally, hemoglobin Cs could cause more severe hemoglobin H disease if it combines with deletional alpha thalassemia.

Therefore, accurate evaluation of these hemoglobinopathies can prevent further problems.