Tehran University Medical Journal

Background and Aim: With daily improvement of diagnostic modalities, accurate knowledge of anatomy and microanatomy is necessary and important, for better diagnosis of pathologic problems from normal variations. One of this very important anatomical sites is sella and suprasellar zones, where sensitive elements is noted. CT and MRI is very helpful in diagnosis and management of diseases as well as for differentiating of pathology from normal variation. A study was designed for evaluation of normal variation of this zones in normal men achieved.

Materials and Methods: 200 referral patients to CT center with headache and 200 referral patients to MRI center with headache which had normal imaging findings were chosen. We grouped the sella and suprasellar cistern on the basis of shapes, dimensions and normal variation.

Results: Different normal variations of soft tissues and bony elements in sella and suprasellar zones noted. Different shapes of sella turcica and suprasellar cistern and optic chiasma is noted.

Conclusion: Advanced imaging systems allows us to diagnosis of different formal sella and suprasellar cistern, so that accurate anatomic patterns were diagnosed for better evaluation of pathology and differentiation from normal variations. different CT patterns of sella and suprasellar regions are due to anatomic and technical variations. CT scaning with thin slices is necessary. Both CT and MRI are highly reliable in diagnosis of sella and suprasellar cistern lesions.

Background: The clinical importance of yeast infections has increased in recent decades. There are 10-15 pathogenic Candida species. The current morphological and physiological methods for identification of Candida species are generally not easy to interpret and may be expensive or time-consuming. In the present study, we introduce and use a new approach for the identification and differentiation of medically important yeast species of Candida. In this method, size polymorphism of the internal transcribed spacer regions, ITS1 and ITS2, of the ribosomal DNA in various Candida species is used as the basis of species recognition.

Methods: The genomic DNA of 31 standard strains and 60 clinical isolates was extracted and PCR-amplified using two primer pairs (ITS1-ITS2 and ITS3-ITS4) separately. Both PCR products were mixed and analyzed after standard agarose gel electrophoresis. The species of the tested yeasts were identified by the electrophoretic patterns of the mixed PCR products of each sample, comparing the data obtained from the sequence analyses of ITS1 and ITS2 molecules.

Results: By this method, with the exception of C. albicans and C. dubliniensis, we were able to clearly differentiate nearly all common pathogenic Candida species, including C. albicans, C. glabrata, C. gulliermondii, C. parapsilosis, C. tropicalis,      C. krusei, C. kefyr, C. lusinaniae and C. rugosa. All standard and clinical strains were identified correctly, without expensive methods such as sequencing and capillary electrophoresis.

Conclusion: It seems that the PCR-FSP method introduced in this study is the easiest molecular approach for the identification of a wide range of pathogenic Candida species and is applicable for diagnostic and epidemiological purposes in reference laboratories.

Background: The effects of growth hormone (GH) on bone density in healthy adults is controversial. This study was performed to evaluate the effects of GH administration on bone density under controlled conditions in healthy adult rabbits.

Methods: Twenty healthy adult New Zealand white rabbits of both sexes were included in the study. The rabbits were divided into two groups. The experiment group received human GH and the controls placebo for three months. The density of femur and humerus were measured at proximal epiphysis, mid shaft and distal epiphysis by radiography, aluminum step-wedge and appropriate software. Measurements were performed in five stages, once before and four times after the administration of GH or placebo, with 3-week intervals.

Results: The mean concentration of serum insulin-like growth factor I (IGF-I) increased significantly after GH administration (P<0.05) in the experiment group. Bone density generally increased in all regions except the distal epiphysis of femur in the test group, but significant difference were only seen in the midshaft of femur in comparison to the controls (P<0.05). In the second stage, bone density decreased slightly in all regions except distal epiphysis of femur, but it increased in the next stages.

Conclusion: GH can increase bone density (mostly cortical bone) in adult rabbits. According to the similarities seen between growth hormone effects in rabbit and humans, this study suggests rabbits as a model for studying GH effects on bone density in acromegaly, growth hormone deficiency and even in healthy adult humans.

Background: The basal levels of androgens in women decline gradually with age. These changes may reduce muscle strength and bone density leading to fatigue and psychological problems. Thus, the aim of this study was to compare the effects of resistance and endurance exercises on androgens, cortisol and lactate concentrations in elderly women.

Methods: In this study, 10 elderly women with a mean age of 54.3±3.74 years and a BMI of 24.88±2.07 kg/m2 completed an endurance exercise session (ES), a resistance exercise session (RS), and a control session (CS) in a randomized, cross-balanced design. The RS consisted of three sets of 10 repetitions of eight exercises with 80% 1RM (one repetition maximum) over of 45 minutes and the ES consisted of cycling at 60%-70% of maximum oxygen consumption for 45 minutes. During the CS, subjects performed no exercise. Before and immediately after exercises, and after 15 minutes of recovery, and also during CS blood samples were obtained an analyzed for serum testosterone, dehydroepiandrosterone sulfate, cortisol and lactate.

Results: There was a significant increase in testosterone levels following resistance and endurance exercise sessions (P<0.05). Dehydroepiandrosterone sulfate demonstrated a significant increase after resistance exercise (P<0.05). While differences in cortisol levels were not significant within groups, but they were significant (P<0.05) between groups.

Conclusion: A session of resistance exercise in elderly women can increase concentrations of androgens that are essential for their health and well-being.

Background: Over the last two decades invasive candidiasis has become an increasing problem in neonatal intensive care units (NICUs). Colonization of skin and mucous membranes with Candida spp. is important factor in the pathogenesis of neonatal infection and several colonized sites are major risk factors evoking higher frequencies of progression to invasive candidiasis. The aim of this study was to detect Candida colonization in NICU patients.

Methods: This cross-sectional study was conducted on 93 neonates in NICUs at Imam Khomeini and Children Medical Center Hospitals in Tehran. Cutaneous and mucous membrane samples obtained at first, third, and seventh days of patients’ stay in NICUs during nine months from August 2013 to May 2014. The samples were primarily cultured on CHROMagar Candida medium. The cultured media were incubated at 35°C for 48h and evaluated based on colony color produced on CHROMagar Candida. In addition, isolated colonies were cultured on Corn Meal Agar medium supplemented with tween 80 for identification of Candida spp. based on their morphology. Finally, polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was performed for definite identification of isolated species.

Results: Colonization by Candida spp. was occurred in 20.43% of neonates. Fifteen and four patients colonized with one and two different Candida spp., respectively. Isolated Candida spp. identified as; C. parapsilosis (n: 10), C. albicans (n: 7), C. tropicalis (n: 3), C. guilliermondii (n: 2), and C. krusei (n: 1). In present study non-albicans Candia species were dominant (69.56%) and C. parapsilosis was the most frequent isolate (43.47%). Using Fisher's exact test, the correlation between fungal colonization with low birth weight, low gestational age, and duration of hospital stay was found to be statistically significant (P=0.003).

Conclusion: The results of this study imply to the candida species colonization of neonates. Neonates in NICU are at the highest risk for severe infection with Candida parapsilosis. Therefore, isolation of C. parapsilosis as the most common species (43.47%) in present study was noteworthy.

Background: Fungal infections especially Candida species are frequent cause of mortality and morbidity in very low-birth-weight (VLBW) infants receiving intensive care; Candida infections are tissue invasive. This infection increases the risks of adverse neurodevelopmental sequelae. Prevention and treatment of fungal infection is so important in very VLBW infants. The aim of this study was to determine the prophylactic effect of fluconazole in decreasing the mortality and morbidity in VLBW infants (less than 1500gr) admitted in NICU.

Methods: This prospective case control study were conducted among 102 Infants (weighing less than 1500gr at birth at born) admitted in NICU department of Ali Asghar University Hospital from 2012 to 2013, Tehran, Iran. Weigh of birth in cases and groups were less than 1500 gr and both were culture negative. Cases received oral fluconazole 3 mg/kg in 3 days in 1^st and 2^nd weeks, alternate day in 3^rd and 4^th weeks, daily in 5^th and 6^th weeks. Control groups had not received fluconazole. Mortality and morbidity and hospital stay were compared between cases and controls groups.

Results: We studied 49 very low-birth-weight infants with negative culture as cases (received fluconazole prophylaxis), 46 VLBW infants without fluconazole profilaxy (controls). No significant difference in gestational age (P=0.2), and mean weights (P=0.4) were observed between cases and controls. The mortality rate 8.7% (n=4) in controls (without prophylactic fluconazole) observed vs 2% (n=1) mortality rate in VLBW cases (with prophylactic fluconazole). Although the mortality rate in controls was 4 times higher than cases, but without significant differences (P=0.1). Indeed, mean duration of hospital stay in controls was longer than cases (28.41±9.93 vs 19.85±6.19 days, P=0.00001).

Conclusion: Although prophylactic fluconazole in VLBW could decrease the mortality of cases (control the fungal infection) 4 fold in compare with controls (no treatment), it was not significant. The prophylactic effect of fluconazole might decrease the length of hospital stay of VLBW neonates in NICU. Due to limited number of cases and control. For further decision about prophylactic use of fluconazole, prospective RCT studies with larger cases and control would be helpful in future.

Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.

Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.

Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.

Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.

Background: Bacterial sepsis is a main cause of mortality and morbidity especially in preterm newborns. The aim of this study was to search the bacterial etiologies of neonatal sepsis in NICU admitted preterm neonates.

Methods: A descriptive cross-sectional study had done in NICU of Ali Asghar Hospital, Tehran, Iran from March 2007 to March 2009. Seventy septicemic preterm newborns (<37 weeks) were studied. At admission day, for blood culture, 1-2 ml of venous blood was drawn after swabbing the venipuncture site with alcohol. After centrifugation of blood samples, deposits were cultured on sheep blood agar and incubated in a candle jar at 37 °C for 48 h and followed by subcultured. Isolates were identified using standard techniques (Nima pouyesh, Iran). Type of isolated bacterial organisms determined. Its correlation with gestational age, birth weight, premature rupture of membranes (PROM) and other variables determined we used the nonparametric two independent sample test, Mann-Whitney U test. Chi-square values (CI 95%, P< 0.05) were calculated for all categorical variables. P-value less than 0.05 considered statistically significant.

Results: Of 70 studied septicemic preterm cases, 17 (10.6%) cases had positive blood culture. Overall gram-negative organisms were more frequent than gram-positive organisms, Klebsiella (K.) pneumoniae, Escherichia (E.) coli and Staphylococcus (S.) aureus organisms were the 3 common causes of bacterial sepsis in studied cases. Early onset sepsis produced by K. pneumonia (40%), E. coli (20%) and S. aureus (20%). K. pneumonia, E. coli, S. aureus had equal incidence in late onset sepsis (26.8%). K. pneumonia was more frequent in early onset sepsis (P= 0.05), and in low birth weight (< 1500 g) neonates (P= 0.005, and PROM (P= 0.05).

Background: Patient satisfaction is an important indicator of healthcare quality and effectiveness. Quality management as an organizational strategy enhances the quality of hospital services through continuously improving hospital structures and processes. This study aimed to examine the impact of quality management on patient satisfaction.

Methods: A participatory action research was conducted in respiratory intensive care unit, at Labafinejad hospital, Tehran, Iran, in 2013. A quality improvement team was established. Operational processes were improved using a quality management model. The quality improvement team standardized processes, identified quality goals for the processes and improved them until achieved quality goals. Patients’ satisfaction data was collected before and after the intervention using a valid and reliable questionnaire.

Results: Patients’ satisfaction was 75 percent at the beginning of the study. Patients were mostly dissatisfied with the nutrition services, amenities, lack of attention to their personal needs and lack of involving them in their treatment processes. An action plan was developed for improving patient satisfaction. After the quality management intervention, patient satisfaction reached to 81 percent at the end of this study. The quality management model improved the quality of services by 54.5 percent and consequently increased patient satisfaction by 7.2 percent. Almost half of the patients at the beginning of this study were definitely willing to recommend the hospital to their friends and relatives. This figure increased to 76 percent. The rest of patients stated that they may recommend the hospital to others.