Tehran University Medical Journal

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Neutropenic state with fever is exactly regarded as a medical emergency, with high mortality and morbidity rate, unless treated urgently and correctly. Every attempt should be made to find and establish the offending organism, but postponing treatment until obtaining culture results is not advised. Controversy exist on which antibiotic regimen to be used while waiting for culture results. Many antibiotic regiments both monotherapy or combination treatments have been used with varying result. The objective of this study is to compare the efficacy of cefriaxon monothenapy with ceftazidim. Plus Amikacin as initial empiric antibiotic therapy in febrile neutropenic patients.
Materials and Methods: We performed a randomized, single blind clinical trial in 57 adult (age>12 years), neutropenic (PMN<1000) patients with fever (Temperature, oral >38.5c) in Hematology ward, Imam khomeini hospital. After careful physical exam and obtaining blood & urine samples for culture, the patients were randomized to each of the two arms: Cefriaxon 2 grams daily, intravenously (arm A) and Ceftazidim 2g thrice daily plus amikacin 500 mg twice daily (arm B). Patients with shock, organ failure or previous antibiotic intake (during 48 hour before fever) were excluded. If needed, dose adjustment of drugs were allowed. Effervescence in 3 days following initiation of treatment, lasting 48 hours or more, were regarded as effective (positive result).
Results: During a twelve months period of study, a total of 57 patients (17female, 40male) were included. They were randomly selected to each arm of empirical treatment. Of 28 pts in arm A, 19 (67 percent), the treatment was effective, compared to 15 of 29 (51.7 percent) in groups B. The duration of fever after initiation of treatment was 37.9 ± 17 hours in arm A and 40. 1 ± 20 h in arm B. Blood and / or urine culture was equally positive in two arms (25 percent in arm A and 27.6 percent in arm B).
Conclusion: Cefriaxon monotherapy is at least equally effective in low risk neutropenic patients with fever compared to combination of ceftazidim plus amikacin at a decreased cost and probably (expected) less adverse side effects in our patients.

 

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Normal 0 false false false EN-GB X-NONE AR-SA MicrosoftInternetExplorer4 Background: Tuberculosis is an important cause of death in some countries. The world health organization estimates that if stronger measures are not taken up to control the prevalence of this disease, from 2000 to 2020 a billion people will be infected by the bacterium. According to time consuming of common detection methods of Mycobact-erium tuberculosis such as culture, it is necessary to evaluate a rapid detection tests such as PCR. Rapid diagnosis of tuberculosis may have profound effects in patients' care According to importance of rapid detection and treatment of tuberculosis and for determine of sensitivity, specificity, positive predictive value and negative predictive value of PCR by using IS6110 this study was done in Kashan university of medical science.
Methods: A total of 248 sputum samples from patients suspected of mycobacterial diseases were studied. DNA was extracted by boiling method. IS6110 PCR method by a specific pair of primers designed to amplify 123bp and 245bp sequences of the insertion sequence, 6110, in the M. tuberculosis genome was used to analyze sputum samples.
Results: 32 out of 248 (12.9%) of samples had positive culture. PCR yielded a sensitivity of 93.8% and specificity of 99.1% for the diagnosis of TB patients with TB confirmed by culture. There were two out of 32 (6.3%) PCR-positive cases among the patients with non-TB disease.
Conclusion: The findings of the present study indicate that Multiplex PCR may provide a faster method of detecting tuberculosis, thus enhancing diagnostic procedures and we conclude that the performance of an IS6110 PCR assay is valuable in the rapid diagnosis of tuberculosis.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Many studies have demonstrated that pre-term neonates gained more weight over the 10 days stimulation period. This research has been conducted to determine the effects of five days Tactile- Kinesthetic stimulation (TKS) on weight gaining of pre-term infants hospitalized in Fatemiye neonatal intensive care unit.
Methods: Fifty one babies who graduated from the NICU to the intermediate care nursery were randomly allocated into test and control groups (24 and 27 neonate respectively). TKS was provided for three 20 minute periods per day for five consecutive days to the test group, with the massages consisting of moderate pressure strokes in left and right lateral position and kinesthetic exercises consisting of flexion and extension of the limbs. They were observed for changes in physiologic parameters and weight gaining during five days stimulation in hospital.
Results: Over the five days TKS an increase in weight was seen in the test group (p=0.018, 43.1 vs 5.4). Infants in both the test and control groups were matched for mean weight before study and days in which they received antibiotics and photo therapy. Mean temperature and O² saturation had no meaningful difference, but an increase in respiratory rate (p=0.047, 32.9 vs 32.5) and heart rate (p<0.001, 148 vs 145.7) (within physiologic range) was seen in the test group during stimulation, so that no one excluded from study.
Conclusion: Tactile- Kinesthetic stimulation has no adverse effects on physiologic parameters, meanwhile has a beneficial effect on weight gaining in pre-term neonates, So touch and massage therapy which are both beneficial and cost effective could be placed in policy of care programs in nurseries in Iran.