مجله دانشکده پزشکی اصفهان
پیاپی 278 (هفته سوم اردیبهشت 1393)

Carbapenem antibiotics are a subtype of beta-lactam antibiotics, which can play an important role in the treatment of severe infections and multi-drug resistant bacteria. The most important mechanism of resistance to carbapenems is carbapenemase production. Since these enzymes are located on mobile genetic elements such as plasmids, they can rapidly spread among gram-negative bacteria.

A total of 500 Enterobacteriaceae clinical isolates were collected in Hamadan city, Iran, during October 2012 to June 2013. The isolates detected by biochemical tests and confirmed by polymerase chain reaction (PCR) method. Antimicrobial susceptibility patterns were determined using the agar diffusion method for 14 antibiotics. Modified Hodge test (MHT) was used for carbapenemase production in the resistant isolates to carbapenem antibiotics.

Among the family members of Enterobacteriaceae, Escherichia coli (66.8%), Klebsiella spp. (21.2%) and Proteus spp. (6.8%) showed the highest role in infections, respectively. These organisms showed the highest resistance to cefotaxime (64.2%), aztreonam (59.3%) and cotrimoxazole (58.6%). Out of 40 isolates which were intermediate or non-susceptible for carbapenems, 29 (72.5%) were positive for carbapenemase production by Modified Hodge test.

Over the past decade, carbapenem-resistant Enterobacteriaceae have emerged and spread throughout the world. Widespread emergence of carbapenem-resistant isolates has been increasing concerned in recent years; because the Carbapenem antibiotics are often used as the last line of treatment for severe infections caused by resistant Gram-negative bacilli including Enterobacteriaceae family. Modified Hodge test can be used as a simple method for the identification of carbapenemase-producing strains in gram-negative strains.

Physical activity without appropriate recovery causes structural damage to the muscles. The aim of this study was to investigate the effect of cold water immersion and passive recovery after anaerobic performance on muscle damage indices and blood cell count.

The participants were ten trained female swimmers from Isfahan University of Technology with the mean age of 17.8 ± 2.2 years. First, they did the 100 meters front crawl in two separate days with 1-week distance. Then, they participated in one of the two methods of recovery intervention including 15 minute sitting beside the pool (passive or PAS) or cold water immersion (CWI) in 23ᵒC. Afterwards, both methods were followed by 45 minutes sitting beside the pool. Leukocyte profile and venous blood markers of muscle damage including creatine kinase (CK) and lactate dehydrogenase (LDH) were also measured pre-exercise and 1 and 24 hours post-exercise. Repeated measure and LSD were used for data analysis.

One hour after CWI, the mean level of CK significantly decreased and it was not any change in leukocytes, neutrophils and monocytes compared to PAS. One hour after CWI, LDH significantly increased comparing pre-exercise. All of these factors except CK, recovered to base measures after 24 hours.

It seems that after anaerobic performance, CWI can reduce damage and leukocytes count and improve recovery conditions.

Ciclesonide is a lung-activated inhaled corticosteroid that provides effective control of persistent asthma. This study aimed to evaluate the safety and effectiveness of this drug compared to commonly used drugs including fluticasone, budesonide or beclomethasone.

The major medical electronic databases including Scopus, Web of Science, CINHAL, Cochrane Library and PubMed were searched in November 2012.

567 articles were found. After exclusion of duplicates and irrelevant articles, 11 randomized controlled trials (RCTs) and 5 systematic reviews were included. No significant difference was found between ciclesonide (CIC) with fluticasone propionate (FP), budesonide (BUD) and beclomethasone dipropionate (BDP) in lung function [forced expiratory volume in 1 second (FEV1) and am and pm peak expiratory flow (PEF)], asthma symptoms score, using rescue medicine and asthma exacerbation requiring use of systemic steroids. In addition, no significant difference was found in adverse events such as pharyngitis, rhinitis, upper respiratory infection, and withdrawal from the study due to adverse events or lack of efficacy. The quality of life score favored ciclesonide versus fluticasone. Candidiasis was less frequent with ciclesonide versus fluticasone. Change in the morning PEF between ciclesonide and beclomethasone dipropionate/budesonide was not clinically significant.

Ciclesonide and budesonide and beclomethasone gave similar results in safety and effectiveness. Ciclesonide improved the quality of life and reduced the oral candidacies compared to fluticasone. There was limited evidence when comparing ciclesonide with beclometasone.