Showing 161 results for Hami
M Sanati, M Zarghami, M Kashoufi ,
Volume 53, Issue 2 (5-1995)
Abstract
This is a study of depressive features in 51 Iranian combatants suffering from PTSD. DSM III-R considers depressive symptoms as associated clinical features of this condition. DSM III and DSM III-R both accepted the strong evidence that PTSD is a form of anxiety and included it in the anxiety disorders category. It is true that many PTSD sufferers present with anxiety features similar to these present in generalized anxiety disorder (The same authors reported anxiety features in 94% of Iranian combatants 1991), but this similarity is true: For depressive features, 92% was found in present study. The findings are discussed in relation to previous studies of combat-related PTSD, both done in Iran or elsewhere.
S Sh Sadr , Ar Shaban Zadeh , F Ghaem Maghami ,
Volume 54, Issue 1 (30 1996)
Abstract
To evaluate the tolerance and effectiveness of conjugated Estrogen for women with established post-menopausal Osteoporosis and hot flushes, with the use of paired comparison, randomized, we tested during an 10 month period the bone mineral contents and plasma glucose in subjects who afforded by premarin in dosages of 0.625 mg for days 1 to 25 and oral medroxy progesterone acetate for days 15 to 25 of a 29 days cycle. All subjects received supplementation to ensure a minimum of 800 mg calcium per day. 25 subjects completed at least 10 month follow up serum calcium, phosphate, glucose and urinary calcium and phosphatae measurements by colorimetric, method. We compared women with herselves, the median change in biochemical studies showed significant decrease in serum calcium, phosphate an urinary excrition of calcium, but significant increase in urinary excrition of phosphate. Fasting plasma glucose did not change significantly. Decrease serum calcium (9.6 compared with 9.16 P<0.005) decrease, serum phosphate (3.77 compared with 3.39 P<0.005), decrease uri calcium (149.81 compared with 121.46, P<0.005), increase uri phosphate (625.83 compared with 676, P<0.005), FBS (92.03 compared with 91.45, 0.1>P>0.05). Regarding the effects of conjugated Estrogen on plasma and urinary calcium and phosphate levels and amelioration of clinical symptoms, we concluded that conjugated Estrogen treatment in effective in post-menopausal Osteoporosis, but we did not find relation between exogenous Estrogen in post-menopausal women with FBS and hot flush
S Sadr , F Ghaemmaghami , M Mostala ,
Volume 57, Issue 1 (7 1999)
Abstract
To evaluate the effectiveness of conjugated estrogen (Premarin) and progesterone in twenty-one postmenopausal women who had been menopause one year, we tested during a 6-month period the serum lipoprotein levels in subjects who offered by premarin in dosage of 0.625 milligram for days 1 to 25 and oral medroxy progestrone acetste for days 15 to 25 of a 30-day cycle. Twenty-one subjects completed at least 6-month follow-up serum total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, very low density lipoprotein (VLDL) cholesterol and triglycerid (TG) measurements by calorimetric method. The results, six months after treatment, is compared to before treatment. The median change in biochemical studies showed significant decrease in serum total cholesterol (248.85 compared with 229.4, P<0.001) serum LDL-cholesterol (155.7 compared with 130.6, P<0.05), but significant increase in serum HDL-cholesterol (53.46 compared with 61.46, P<0.05) TG and VLDL levels did not occur. We concluded that conjugated estrogen is effective on serum total cholesterol, LDL and HLDL cholesterol in postmenopausal women
F Ghaemmaghami , F Ensani , H Bigdely ,
Volume 57, Issue 1 (7 1999)
Abstract
It this prospective cross sectional study out-patient endometrial biopsy by PIPELLE was compared with diagnostic curretage (D&C) in patients suffering of Abnormal Uterine bleeding (AUB). Diagnostic accuracy, sufficient tissue sampling, intensity of pain and effective factors in biopsy results were the evaluated parameters in this study. In 70 patients with complaint of AUB (20 of them were post-menoupsal age admitted in hospital for D&C) endometrial biopsy was conducted by PIPELLE before operation and the results were compared. 96% of total patients (67) and 91% of patients with post menopause age had tolerance of undergoing out-patient PIPELLE biopsy of endometrium. 79% of these individuals complained of mild pain and 21% of moderate pain. Endometrium biopsy by PIPELLE in 77% of patients had similar accurate diagnostic results as compared to D&C. PIPELLE in 34% of patients (24) could not be conducted with the same accuracy of D&C patients, although in 14 (20%) of them, notissue samples could be collected by D&C. In none of these methods endometrial hyperplasia or endometrial cancer were detected. This study showed that in 77% of the total patients, the extra cost and general anesthetical risk of D&C could have been eliminated, by utilization of out-patient biopsy with PIPELLE
Ghaem Maghami Noori F, , ,
Volume 59, Issue 4 (9 2001)
Abstract
Ovarian cancer is second prevalent cancer among gynecologic malignancies and the most common type of ovarian cancer is epithelial form (85-90 percent). To detect the risk factors for the epithelial ovarian cancer, a case-control study was conducted in Valieasr hospital in 1988. In this study, 118 cases with epithelial ovarian cancer (according histological records) and 240 controls without any gynecological cancer in gynecologic clinic had been interviewed. For data analysis, T-test, Chi2 test and logistic regression have been used at a =0.05 as level of significance. The mean age in cases was 50±13 and in controls was 49.9±12 years, without significant different. The mean number of pregnancies and parity in cases was less than controls, significantly (P<0.03). The mean months of breast feeding in cases was less than controls (54.9±71.2 versus 82.4±62.7) (P<0.001). The cases had a lower mean age of menarch than controls (P=0.03). 58 percent of cases and 21.3 percent of controls hadn't used any contraception methods (P=0.00001). The mean years of contraception was significantly less in cases versus controls (P<0.001). The odds ratio for epithelial ovarian cancer was 0.24 (95 percent CI: 0.13-0.48) in OCP users, 0.47 (95 percent CI: 0.005-0.43) in TL method, and was 0.41 (95 percent CI: 0.22-0.76) in other contraception methods, relative to women who hadn't used any contraception methods. This study reveals that epithelial ovarian cancer risk increases significantly with earlier menarch, decreasing number of pregnancy, deliveries duration of breast feeding and use of contraception methods. Use of contraception pill and tubal ligation method decreases risk of epithelial ovarian cancer.
Ghaem Maghami F, Harirchi I, Moghimi R, Mazaheri H ,
Volume 60, Issue 2 (14 2002)
Abstract
Background: The aim of study was to determine the frequency of delay referring and related factors in patients with advanced breast cancer, in Imam Khomeini Hospital in the 2000.
Materials and Methods: Successively 200 patients were entered the study if they were consentient. A questionnaire was constructed and information was obtained through interviewing.
Results: From the cases, 64 patients (32 percent) referred without delay and 136 patients (68 percent) referred tardily. The patients who were late in comparison with patients who didn’t late, had significantly higher mean age (P=0.004), lower education level (P=0.002), and lower economic status (P=0.001). The frequency rate of single were lower among them (P=0.001), fewer percent were residual of big cities (P=0.01) and they had less rate of available physician (P=0.004). 24.3 percent of delay referring patients and 53.1 percent of patients without delay has a positive family history of breast cancer (P=0.001). 62.5 percent of delay referring patients and 85 percent of patients without delay were aware about importance of Self Breast Examination (S.B.E) (P=0.002) and respectively 84.4 percent and 98.4 percent were award about symptoms of breast cancer (P=0.01). 23.5 percent and 33 percent of patients with and without delay Knew the method of B.S.E respectively. It wasn’t a significant difference.
Conclusion: Lack of awareness about necessity of medical consultation, fear, carelessly, unavailable physician and poverty were the major causes of delay in patients who referred late.
Fakhr Tabatabaei Sa, Hossein Khan Z, Hamidi S ,
Volume 60, Issue 3 (14 2002)
Abstract
Introduction: As spinal cholinergic receptors exhibit an action against somatic pain, this effect could be potentiated by intrathecal injection of cholinesterase inhibitor-neostigmine. This study was designed to evaluate the role of interathecal neostigmine on local back pain relief after single level lumbar disc surgery.
Methods and Materials: In an interventional-expremental study (Imam Khomeini Hospital, Jun. 2000 to sep. 2001), sixty-six patient with unilateral herniated lumbr disc at one lumber space were randomely allocated into two groups including, control (C) group and Neostigmine (N) group. Both groups underwent fenestration employing same anesthetic techniques. At the end of surgery 2 ml normal saline in groups C and 100 micrograms neostigmine methylsulfate (0.2 ml combined with 1.8 ml normal saline) in group N were injected intrathecally postoperative local back pain was measured with 10 cm chart method using Visual Analogue Scale (VAS) at 1, 4, 8 and 12 hours. Total dosage of morphine, as an analgesic rescue, used during the first 24 hours following surgery and observed complications were recorded.
Results: Mean VAS score postoperatively at 1st and 4th hours were 2.24 (Standard Error Mean, SEM=0.36) and 1.82 (SEM=0.28) in group N and 5.36 (SEM=0.39) and 5.61 (SEM=0.37) in group C respectively. Mean morphine used in the first 24 hours was 0.9 (SEM=0.4) in group N and 4.7 (SEM=0.65) mg in group C. All result were found to be statistically different in the two group (P<0.05). There was no neurologic deficit or CSF leakage in both groups postoperatively. Regarding nausea and vomiting, the difference between two groups C (15 percent) and N (24.2 percent) were not significant statistically.
Conclusion: In this study, we have found that injection of 100 micrograms hyperbaric neostigmine intrathecally is a safe and effective method with minimal complications or side effect for pain relief and curtails postoperative opiate demand.
Rafiei M, Sadre Bafeghi S M, Afkhami Ardakani M, Namaiandeh S M, Orafa A M, Ahmadieh M H, Dehghan Hr, Rafie R, Rahmanian M,
Volume 62, Issue 3 (11 2004)
Abstract
Background: To evaluate the ability of Ankle/Brachial Index (ABI), that is a sensitive and specific test for detection of PAD, to foretell the possibility of ischemic heart diseases in diabetic patients.
Materials and Methods: All of diabetic patients who visited in our diabetes research center between May 2000 and May 2001 and were confirmed diabetics since 2 or more years ago were enrolled in the study. The ABI was calculated for all of the patients and their demographic specifications and ischemic heart disease risk factors were recorded. All of the patients refer to perform an exercise test, but 279 patients were conferred to performing stress test. They were containing: 127 patients with ABI =<1.1(group I) and 47 patients with ABI>=1.4(group III) as case groups and, 105 patients with 1.1 60 years (P = 0.02). 238 patients were in group I (25.1 %), 625 patients in group II (65.9 %) and 85 patients in group III (9 %). 52.8% of 125 patients in Group I, 19.6% of 107 patients in group II, and 44.7% of 47 patients in Group III had positive exercise test. I, II (P 0.00)- II , III (P = 0.05) A total of 108 patients from among the 279 patients had positive exercise test (38%), and most of them were from groups I &III. 72.2% of group I , and 52.5% of group II had high blood pressure (P 0.00). Both hypertensive and normotensive patients with ABI =<1.1 & >=1.4 had positive exercise test significantly more than patients with 1.1=1.4 is an independent predictor of coronary artery diseases in diabetic patients especially in those who are hypertensive.
F Ghaem Maghami , F Ensani , N Behtash , S E Hosseini Nejad ,
Volume 62, Issue 4 (11 2004)
Abstract
Background: The aim of this investigation is to evaluate the histologic results of biopsy in women with atypical squamous cells of undetermined significance (ASCUS) cytologic diagnosis.
Materials and Methods: We reviewed a series of cases with ASCUS pap smears from March 1999 to Feb 2002 in Imam Khomeini Hospital (n= 104), Who had cervical biopsy indirected colposcopy (103) and in Onec endocervical biopsy obtained without colposcopy. In 60 patients before colposcopy and biopsy repeat pap smear was tabled.
Results: Biopsy revealed 28.8% SIL (14 LSIL and 16 HSIL), 1 invasive carcinoma and 1 endometrial carcinoma. Pap smear repeated for 60 women before colposcopy examination, which 7 (11.7%) of them were normal. ASCUS persisted in 45 cases (75%) and 8 cases (13.3%) turned out to be SIL (6 LSIL, 2 HSIL) of 7 normal repeat smear, 2 marked as LSIL by biopsy. In colposcopic examination 22 of 103 (21.4%) had normal view which one of them was LSIL histologically.
Conclusion: Based on these findings, it seems immediate colposcopy and directed biopsy are appropriate procedures for management of ASCUS and to detect underlying SIL.
M.h Baradaranfar, M Afkhami , A Mahmmodi,
Volume 64, Issue 2 (30 2006)
Abstract
Background and Aim: It seems that diabetes mellitus affects hearing system by several mechanisms including microangiopathy ,sorbitol deposition and glycosilation ,dealing to progressive bilateral sensorineural hearing loss which is related duration of diabetes.
Materials and Methods: This is a descriptive cross-sectional study performed on 300 patients with type 2 diabetes mellitus aged 30 to 50 years and a control group of 300 persons matched regarding age and gender .The cases were selected randomly and they were assessed by a quastionaire before performing audiogram. The exclusion criteria were conductive hearing loss sensorineural hearing loss with any other cause and other metabolic diseases .Audiometric test battery consisting of pure tone audiogram (PTA) and impedance were perfumed on both case and control groups.
Reasults: In this study the hearing threshold in low and high frequencies in case group was higher than control group. In different age groups, the mean high and low frequencies hearing threshold in case group was higher than control groups. Based on duration of diabetes , the mean hearing threshold in the group with 8 to 18 years duration of diabetes was higher than the other two groups with 1 to 3 years and 4 to 7 years diabetes duration. The hearing level of hypertensive and normotensive diabetic patients were not significantly different. The mean hearing threshold was not significantly different between male and female diabetic patients.
Conclusion: In general, diabetic patients have a poorer hearing compared with normal population and there is a significant relationship between duration of diabetes and incidence of sensorineural learning loss.
F. Ghaemmaghami, A. Mousavi, Z.b. Ale Mohammad,
Volume 64, Issue 5 (1 2006)
Abstract
Background: Cervical cancer is one of the most common cancers in women.Conization of the cervix is one of the best diagnostic and therapeutic modality in preinvasive lesion of the cervix.
Methods: In this retrospective study we have evaluated the indications,complications, cytopathologic results, diagnostic and therapeutic value of 44 patients who underwent cervical conization.
Results: Age of the study group ranged from 18 to 75 (mean=43.18, SD=±11.4), and their parity ranged from 0 to 10 (mean 4-5, SD=±2-3). Ten cases (22.7%) were menopauses. The main indication was inability to visualize the entire T.zone (19 cases/43.2%) that was more prevalent in menopauses (50%/5cases in menopauses and 41.2% /14 cases in premenopauses). Bleeding occurred in 2 cases (4.5%) and urinary infection in 1 case (2.3%). The most common histologic result after conization was mild dysplasia in 23 cases (52.3%). The most common colposcopic biopsy result was moderate dysplasia in 16 cases (36.4%).The most common pap smear result was HSIL in 16 cases (36.4%). Two cases (4.5%) had invasive cancer in colposcopic- biopsy: one of them had ASCUS in the pap and another one had HSIL. Four cases (9.1%) had invasive cancer in histologic report: one of which had ASCUS on the pap and the others had HSIL.
Conclusion: Pap smear in screening of cervical cancer are not reliable and colposcopy is more acceptable in LSIL and ASCUS. Gynecologists should develop the skill to perform an accurate knife conization because the classical indications for conization continue to be valid and it has a low complication rate.
Haji Abdolbaghi M, Makarem J, Rasoolinejad M, Afahami Sh, Fazeli Ms, Unesian M, Adili F, Alavi S. Sh,
Volume 64, Issue 8 (13 2006)
Abstract
Background: Surgical wound infection surveillance is an important facet of hospital infection control processes. There are several surveillance methods for surgical site infections. The objective of this study is to evaluate the accuracy of two different surgical site infection surveillance methods.
Methods: In this prospective cross sectional study 3020 undergoing surgey in general surgical wards of Imam Khomeini hospital were included. Surveillance methods consisted of review of medical records for postoperative fever and review of nursing daily note for prescription of antibiotics postoperatively and during patient’s discharge. Review of patient’s history and daily records and interview with patient’s surgeon and the head-nurse of the ward considered as a gold standard for surveillance.
Results: The postoperative antibiotic consumption especially when considering its duration is a proper method for surgical wound infection surveillance. Accomplishments of a prospective study with postdischarge follow up until 30 days after surgery is recommended.
Conclusion: The result of this study showed that postoperative antibiotic surveillance method specially with consideration of the antibiotic usage duration is a proper method for surgical site infection surveillance in general surgery wards. Accomplishments of a prospective study with post discharge follow up until 30 days after surgery is recommended.
Pajand O, Ziyaeyan M, Mousavi A, Hojabri Z, Kazemi B, Bahador A, Hamidian M, Mousavi A, Hashemi F B,
Volume 64, Issue 11 (7 2006)
Abstract
Background: Human Cytomegalovirus (HCMV) infections are a significant challenge in patients with Hematopoietic Cell Transplant (HCT). Acute Graft vs. Host (GVHD) is recognized as a predisposing factor for increased incidence of HCMV reactivation. Availability of rapid and accurate tests for HCMV detection in HCT recipients is of foremost importance in developing countries, such as Iran.
Methods: A total of 201 peripheral blood leukocyte (PBL) and plasma specimens from 26 allogeneic HCT recipients were examined for HCMV DNA by polymerase chain reaction (PCR) assay. Densitometric analysis of 257bp PCR products from clinical samples and 101-106 "cloned plasmid" per µg DNA containing a HCMV specific fragment were analyzed using LabWorks software (v3.0.02). Optical density of amplicons was plotted, and calculated HCMV viral loads were compared with the patients' antigenemia results.
Results: HCMV viral loads ranged between <102 to 1.35×102 copies per µg DNA among 7 HCT patients. In addition, 14 episodes of positive antigenemia assay in 7 patients in which peak HCMV load were compared with GVHD grade II-IV patients. Significant correlation was also detected between HCMV DNA load in PBL and plasma samples, as well as HCMV DNA load in PBL samples and antigenemia results. Receiver–Operating Characteristic analysis determined that 2,200 HCMV copies in PBL samples as the threshold value for initiation of Ganciclovir therapy.
Conclusion: This report shows that rapid and sensitive assays, like quantitative PCR, are extremely valuable for detection of active HCMV infection, and life-threatening HCMV disease in HCT recipients during the post transplant period. Furthermore, high HCMV DNA load among GVHD grade II-IV patients confirms the high risk of HCMV reactivation among these HCT recipients. Tests such as quantitative PCR also helps physicians initiate timely preemptive therapy and for a shorter period, which may lead to better clinical outcome in HCMV-infected transplant patients.
Modarres M, Mosavi A, Mohammadifar M, Behtash N, Ghaemmaghami F, Soltanpour F,
Volume 64, Issue 11 (7 2006)
Abstract
Background: Access to a safe and efficient chemotherapy regimen for improving the survival and live quality is a goal in ovarian carcinoma. Despite surgery is the base treatment of ovarian cancer, but in most patients chemotherapy is used due to progression of their disease. This study designed to compare two important chemotherapy regimens.
Methods: This historical cohort study compared two chemotherapy regimen cisplatin (75mg/m2)+ cyclophosphamide (750mg/m2), versus taxol (175mg/m2)+ carboplatinium (GFR+25)AUC between 1998-2005 in valiasr hospital. In this study toxicities of two regimes were compared. The survival function in these two groups were analysed with Kaplan-Meire curve.
Results: Gastrointestinal and mucosal toxicity were significantly higher in CP group compared TC group (p=0.02). Also there were no significant relation between decrease of serum CA125 and patient remission length in CP group but in other group with decrease of CA125 in lower than three cycle we had an increase in patient remission period. (P=0.02). Disease free interval in cisplatin group was longer versus taxol group (p<0.05), there was no significant difference in overall survival in two group.
Conclusion: This study revealed that cisplatin plus cyclophosphamide regimen can yet be used as a chemotherapy treatment in ovarian cancer. In this study there was no significant benefit in taxol regimen compared CP. In the adjuvant therapy of epithelial ovarian carcinoma.
Hamid N,
Volume 64, Issue 12 (6 2006)
Abstract
Background: Job stressors in managers are progressively affecting and destroying their immune systems. The relationship between hardiness, stress and immune system is important for mental health. This study was designed to determine the resources in managers against stress, resources herein designated as “hardiness” and “social support". Also in this research, the correlation between hardiness, defined collectively as feelings of challenge, commitment and control, as a resource against stress and the immune system of high school managers in Khozestan Province were studied.
Methods: The study sample was comprised of 340 managers (male and female), selected by the cluster sampling method. Each subject completed the personal view survey scale and social support questionnaire. Then the individuals were divided into four groups (n= 35 in each group) of high and low hardiness and social support as follows: high hardiness / high social support, high hardiness / low social support, low hardiness / high social support and low hardiness / low social support. Subjects who suffered from disorders that affect the immune system were excluded. The number of T-helper cells (CD4), T-suppressor cytotoxic cells (CD8), natural killer cells (CD56+ CD16), complement system (C3, C4, CH50), immunoglobulin M and G (IgM and IgG), cortisol hormone, eosinophils, neutrophils and lymphocytes were measured for each subject.
Results: The results revealed that, there was a significant positive correlation between hardiness and CD4, CD4/CD8, CD56, CD16, CH50, IgM and neutrophil levels. Also, there was a significant negative correlation between hardiness and CD8, cortisol and eosinophil levels. There was a significant difference between the four groups of in CD4, CD8, CD4/CD8, cortisol, C3, C4, CH50 and lymphocyte levels. Also, there was a significant positive correlation between social support and CD4, CD4/CD8, CD56, CD16, CH50, IgM, C3 and neutrophil levels.
Conclusions: The results revealed that the performance of the immune system in managers with high hardiness and high social support is significantly better than that of managers with low hardiness and low social support. Furthermore, high hardiness and high social support act as resources and moderating factors against stress.
Shamimi K, Aminian A, Moazami F, Jalali M,
Volume 64, Issue 12 (6 2006)
Abstract
Background: Abdominal compartment syndrome (ACS) is a clinical entity that develops from progressive, acute increases in intra-abdominal pressure (IAP) and adversely affects all vital organ systems In this study, the development of intra-abdominal hypertension (IAH) and ACS in a surgical ICU population is described and examined.
Methods: Over a one-year period (2004), urinary bladder pressure (UBP) was measured prospectively in all surgical patients with abdominal problems admitted to the ICU of the Imam Hospital complex. UBP of >20 cm H2O indicated IAH. ACS was defined as the development of multiple organ dysfunction including peak airway pressure (PAP) >50 cm H2O, Horowitz quotient <150 torr or urine output <0.5 ml/kg/hr in the setting of IAH. Data were gathered on all patients with IAH and ACS.
Results: We evaluated some 353 patients, consisting of 165 elective laparatomies and 188 emergency cases, including 28 trauma patients. The incidence of IAH and ACS was 2 and 1 per cent (7 and 3 patients, respectively). The mean IAP of these seven patients was 29.8 cm H2O. No elevated IAP was observed after elective laparotomy (165 patients), nor in emergency cases with temporary abdominal wall closure (29 patients). APACHE II score, PAP and worst base deficit were significantly higher in patients with elevated IAP. None of the three patients with ACS underwent decompressive laparotomy. The mortality rate for patients with elevated IAP was 85%, significantly higher than the total study population.
Conclusion: IAH is a rare disease of the rarity of IAH, routine measurement of IAP is necessary only in high-risk patients. Prophylactic temporary abdominal wall closure may prevent IAH and ACS in high-risk patients. Patients with elevated IAP have dismal outcomes. Critical care practitioners should become familiar with different aspects of IAH and ACS, including decompressive laparotomy.
Mirsalehian.a, Nakhjavani.f, Peymani.a, Jabalameli.f, Mirafshar.s M, Hamidian.m,
Volume 65, Issue 1 (5 2008)
Abstract
Background: The incidence of ESBL producing species have been steadily increased in
recent years, resulting in limitation of infection control issues and therapeutic
options.The purpose of this study was to evaluate prevalence of Enterobacteriaceae and
also assess epidemiology ESBL producing strains isolated from patients admitted in
ICUs.
Methods: A total of one hundred fifty isolates were collected from urine, sputum, blood,
wound and other clinical samples from patient admitted in ICU and then were identified
by biochemical tests .All of the samples were screened by DAD method according to The
NCCLS Guideline. The species that met NCCLS screening criteria was further tested for
Clavulanic Acid effect by confirmatory method.
Results: A total of one hundred fifty isolates,133(89.3%) were found to be resistant at
least on of the indicators cephalosporin tested according to NCCLS Guideline.
121(80.6%) of the isolates were resistant to all the indicators tested .89(59.3) isolateds
were confirmed as ESBL producers. The number of isolates ESBL producing was as
follow: Klebsiella pneumoniae 33 (76.74%), E.coli 20 (60.60%), Enterobacter cloacae 8
(47.05%), Citrobacter diversus 6 (54.54%), Enterobacter aerogenes 7 (53.84%),
Citrobacter freundii 4 (40%), Klebsiella oxytoca 6 (62.5%), Proteus mirabilis 4 (50%),
Serratia marcescens 2 (40%), Proteus Volgaris 0%.All of the isolates sensitive to
imipenem.
Conclusion: The present study shows high prevalence of ESBL producing
Enterobacteriaceae from patients admitted in ICU .The increased rate of these species in
most cases due to the administration of inadequate and irrational antimicrobial therapy
.To overcome this problem, it needs to develop new antimicrobial agents, limiting the
Unnecessary Use of antimicrobial and increasing compliance with infection control
issues.
Ahmadinejad Z, Mobaen A.r, Kariminia A, Afhami Sh, Hatmi Zn, Torkabadi E, Yalda A,
Volume 65, Issue 2 (8 2008)
Abstract
Background: Sepsis is the leading cause of death in critically ill patients throughout the world. The incidence is increasing despite the major advances in the development of antimicrobial agents and other supportive treatments. Based on multiple studies, it has been shown that patient outcome depends on Th1 and Th2 cytokine response. Moreover, whenever the Th2 response is predominant, the sepsis is more severe. The aim of this study was to evaluate the correlation between cytokine levels and the severity of sepsis in patients.
Methods: A cross-sectional study on the cellular levels of several pro-inflammatory cytokines was carried out in patients with sepsis and severe sepsis. The study included 37 patients (24 men and 13 women), 26 of them had sepsis and 11 had the severe form of sepsis Thirty-seven healthy volunteers served as controls. The average age of the patients was 57 years (±23.3 years), with a range of 21 to 92 years. From the whole blood of the subjects, we separated the monocytes and leukocytes, which were then cultured. Using an ELISA method, we measured levels of IFN- and IL-12 (associated with Th1), and IL-4 and IL-10 (associated with Th2) in the cultured cells with and without cell stimulation.
Results: No correlation was found for IFN- production in the cells of patients with sepsis and severe sepsis, regardless of whether the patients had died or survived. However, IL-12 levels were significantly decreased in severe sepsis compared with those of sepsis patients (P=0.048). Furthermore, the cells of expired patients also had significantly decreased IL-12 levels compared with those of surviving patients (P=0.028). We also found that the levels of IFN-, IL-4, and IL-10 were decreased in patients compared with those of controls, which correlated to their production. However, there was no correlation for IL-12 production between the cells of the patients compared with those of the controls. There was also no correlation for cytokine production between men and women with sepsis and in adults compared with that of elderly patients (>55 years old).
Conclusion: We have shown that the predominating T helper cell subset in patients with severe sepsis, as well as expired patients, is Th2. In conclusion, the correlation of Th1 cytokine production and progression of sepsis was demonstrated. Most probably IL-12 levels would be significantly lower in patients with severe sepsis and those who expired.
Mous0avi A.s, Behtash N, Karimi Zarchi M, Modarres Gilani M, Ghaemmaghami F,
Volume 65, Issue 2 (8 2008)
Abstract
Background: Although endometrial cancer is primarily a disease of the postmenopausal female, 25% of patients are premenopausal, with 3-5% in women 40 years old or younger. The younger group of women with endometrial carcinoma are frequently nulligravid with a history of infertility, and a strong desire to preserve fertility. This may pose a therapeutic dilemma for both patients and treating physician.
Case report: We reported 3 young patients with atypical complex hyperplasia or early stage endometrial cancer that treated with conservative hormonal therapy.
Conclusion: Medical treatment of young patients with endometrial carcinoma and complex atypical hyperplasia who wish to preserve fertility is a reasonable and appealing option. A comprehensive evaluation prior to counseling the patient should include
A complete history and physical examination. A formal D&C with review of history with an experienced gyn-onc pathologist. Evaluation of the pelvic and abdomen preferably with contrast-enhanced MRI or transvaginal ultrasound. In patients found to have a clinical stage I grade I tumor and who want to preserve fertility , thorough counseling include risks and benefits, and explanation that the data is partial and incomplete due to the lack of appropriate controlled studies is mandatory. In patients considered for medical treatment, a high dose progestin regimen should be started with endometrial sampling every 3 months until complete regression of the tumor is documented. Although most responses are long standing, there is a small risk of progression during or after cessation of progestin therapy.
Ghaemmaghami F, Hasanzadeh M, Modarresgilanimadani M, Behtash N, Mousavi As, Ramezanzadeh F,
Volume 65, Issue 4 (3 2007)
Abstract
Background: The aim of this study was to compare the outcome of treatment for ovarian cancer patients who have been treated by gynecologist oncologists and patients who have been treated by general gynecologists or general surgeons.
Methods: We enrolled in this cohort retrospective study all patients diagnosed with primary ovarian cancer in Vali-e-Asr Hospital, Tehran, Iran, between April 1999 and January 2005. A total 157 consecutive patients with ovarian cancer were available for analysis. Of these, 60 patients were treated by gynecologist oncologists and 95 by general gynecologists, and two patients were treated by general surgeons.
Results: The number of patients who underwent optimal cytoreductive surgery (residual tumor <1 cm) was higher in the gynecologist oncologist group, than in the general gynecologist group (P<0.001). Repeated surgeries were required for a majority of patients in the general gynecologist group, while only a few patients in the gynecologist oncologist group needed a second operation (P<0.0001). The interval between the initial surgery and the beginning of chemotherapy was significantly longer in the gynecologist oncologist group compared to that of the general oncologist group (P=0.001). Overall survival and disease-free survival was considerably greater in the gynecologist oncologist group. Optimal cytoreductive surgery and stage of disease are prognostic factors in patients with ovarian cancer. We can therefore conclude that patients with ovarian cancer who are treated by gynecologist oncologists have a better outcome.
Conclusions: We suggest that patients requiring cytoreductive surgery for ovarian cancer be referred to a gynecologist oncologist rather than having a less specialized physician care for such cases.
