مجله دانش و تندرستی در علوم پایه پزشکی
سال نوزدهم شماره 2 (تابستان 1403)

This study aims to investigate the necessity of simultaneous cholecystectomy in thalassemia major patients undergoing splenectomy, in light of reports regarding the prevalence of gallstones in these patients and the overall incidence of the disease in Mazandaran.

This study was conducted on all 247 patients with beta-thalassemia major, who underwent splenectomy surgery during 2010-2020 for any indication in medical centers affiliated to Babol University of Medical Sciences (without a history of this procedure). Their percentage was determined and a decision was made regarding simultaneous surgery of cholecystectomy and splenectomy. Sampling was done by census method and all cases were reviewed and patients were followed up by phone and the necessary information was extracted and recorded in the checklist. Data were described using SPSS 22 software and analyzed at a significance level of 0.05.

A total of 247 patients with an average age of 20.13 ± 3.98 years (minimum age 10 and maximum age 29) were included in the study. The frequency of simultaneous cholecystectomy was reported in 33 cases (13.4%). Out of 214 patients who did not need simultaneous cholecystectomy (57.9%), 183 patients underwent cholecystectomy after splenectomy (85.5%).In 28 people (11.3 percent) had normal ultrasound and 3 people (1.3 percent) died. The prevalence of gallstones was reported as 87.4 percent. It is The average time for cholecystectomy compared to splenectomy in 183 patients who underwent cholecystectomy was 13.41±6.94 months (minimum time interval 3 and maximum 28 months) and in the examination of ultrasound findings, 219 patients (88.7%) had stones. They had a gall bladder and normal ultrasound was reported in 28 people (11.3%).

The study results indicate a high prevalence of gallstones in patients with thalassemia major. Therefore, it suggests that simultaneous cholecystectomy and splenectomy should be considered, even in asymptomatic cases.

Although healthcare waste is generated in small quantities, improper management can lead to significant health risks. This study aimed to develop a model for assessing the requirements for effective medical waste management on Qeshm Island.

In this descriptive-analytical study, data were initially collected on the number of centers generating medical waste and the current status of waste management practices at these facilities. Subsequently, the quantitative and qualitative characteristics of waste from various medical waste-producing centers on Qeshm Island were assessed. Finally, the study identified the requirements, equipment, facilities, and machinery needed for effective medical waste management on the island.

The study found that Qeshm Island generates 104 kg of medical waste daily, necessitating a 500-liter autoclave, a van for waste transport, a driver, and 100 square meters of land for operational use, including a storage shed. The study also revealed that the quantity of medical waste generated in different clinical environments was considerably greater than that produced by general doctor's offices. In particular, midwifery offices, non-surgical specialists, surgeons, orthopedics, laboratories, dental offices, and obstetrics specialists generated medical waste at rates 1.19, 1.3, 1.97, 2.81, 7.5, 2.75, and 2.56 times higher than that of a general doctor's office, respectively. Moreover, each medical office is required to pay a minimum of 7,725,706 rials monthly for effective waste management.

Based on this study, the condition for the success and continuity of the medical waste management in this island is the support of the Qeshm free zone organization and Hormozgan university of medical sciences from the activities of investor company.

Candidemia is a major hospital-acquired fungal infection, especially among burn patients. Recognizing the risk factors and the particular organism involved is crucial for effective treatment.

Blood samples from 147 hospitalized burn patients were collected, totaling 534 samples, and cultured in a biphasic medium, then incubated aerobically at 37°C. Candida species were identified using specialized culture media and RFLP-PCR with the MspI restriction enzyme. Descriptive statistics were applied to outline the risk factors, while Student's t-test was employed to compare the variables.

Candidemia was detected in 8 patients (5.44%) among hospitalized burn patients. The mean age was 38.3±21.3 years, with an average hospital stay of 32.7 days, a total body surface area burned of 32.7%, and a mortality rate of 19.7%. Patients with candidemia had higher values for these variables. Major causes of hospitalization included explosions, burns over more than three sites (70.1%), and severe burns (degrees 3-4). Significant associations were found between candidemia and the use of central venous catheters, catheter colonization, corticosteroid use, and intravenous nutrition (P≤0.05). No significant links were noted between candidemia and skin grafts, wound dressings, antibacterial antibiotic use, or fever. The organisms identified were Candida albicans (75%), Candida glabrata (12.5%), and Candida tropicalis (12.5%).

The rapid identification, effective management, and treatment of this infection can significantly decrease complications and mortality rates in patients with burn injuries.

The aim of this study is to investigate the correlation between efflux pump activity and the frequency of pslABD genes in clinical isolates of P. aeruginosa collected from diabetic foot infections.

In this descriptive-analytical study, we obtained 91 isolates of P. aeruginosa from diabetic ulcers through biochemical testing. We assessed the antibiotic resistance patterns and identified ESBL- and AmpC-producing strains using the disc diffusion method. The activity of the efflux pumps was evaluated using the agar cartwheel method. Additionally, we investigated the pslABD locus along with the mexA, oprD, and oprM genes using PCR.

Out of the 91 P. aeruginosa isolates, 68 (74.7%) were identified as ESBL strains, and 53 (58.2%) as AmpC strains. Additionally, 61 isolates (67.1%) formed biofilms, while 30 isolates (32.9%) did not. Furthermore, the presence of the following genes was noted: mexA in 19 isolates (20.8%), pslA in 22 isolates (24.1%), pslB in 27 isolates (29.6%), pslD in 19 isolates (20.8%), oprD in 36 isolates (39.5%), and ompM in 41 isolates (45%). A significant relationship was observed between the presence of pslA (P=0.02), pslB (P=0.019), and pslD (P=0.03) and the frequency distribution of beta-lactamase-producing strains. Moreover, isolates carrying the pslA (P=0.012), pslB (P=0.49), and pslD (P=0.025) genes exhibited significantly increased efflux pump activity.

In P. aeruginosa from diabetic foot, the psl locus is crucial in enhancing the activity of efflux pumps and influencing the distribution of AmpC and ESBL-producing strains.

A febrile seizure is a convulsion in a child that's caused by a fever. Disruptions in the balance of serum electrolytes significantly contribute to the onset of these issues. This study aimed to investigate serum electrolyte abnormalities in hospitalized children experiencing fever and seizures.

In this cross-sectional study, a census was conducted to examine all children hospitalized with fever and convulsions at Taleghani Hospital in Gorgan during the years 2013 and 2014. Demographic information, seizure type, recurrence, and test results of patients were gathered using a checklist developed from the data available in the patients' inpatient records and the hospital's information system. Spearman and Mann-Whitney correlation tests were performed using software for statistical analysis.

The study's results indicated that the average age of the patients was 22.6 ± 13.9 months, with 117 of them (54.7%) being boys. Fever and convulsions were classified as simple in 163 patients (76.2%), while 28 patients (13.1%) experienced recurrent convulsions. The findings revealed an inverse and significant relationship between age and serum levels of potassium, calcium, and magnesium; however, no such relationship was found between age and sodium serum levels. Additionally, there was no correlation between gender, type of fever and seizures, or the recurrence of seizures with serum levels of sodium, potassium, calcium, and magnesium.

It appears that measuring serum electrolytes in children with fever and convulsions should be conducted on a case-by-case basis, guided by a physician's assessment.

Dengue is a globally prevalent mosquito-borne disease that has been endemic in Malaysia since the 1980s. Despite significant government efforts, dengue cases continue to rise. To combat this trend, fostering positive perceptions, attitudes, and practices is essential. This study aims to assess the perceptions and attitudes of undergraduate medical students in Malaysia regarding dengue prevention activities and their responses to early warnings.

Participants were given online questionnaires constructed in English. Statistical tests (Unpaired t-test and chi square test) were done using Epi Info software (version 7.2.2.6).

Almost 100% of the students are aware of dengue fever, and 96.2% believe that it can cause mortality. Additionally, 79.5% reported having sufficient knowledge to prevent dengue infection. Furthermore, 99.4% think that an early warning system is a useful tool for the community to take preventive measures to avoid potential infection in a timely manner. However, only 23.7% of the participants checked the current dengue hotspot in their area. Regarding early warning about dengue, 95.6% reported that they would help convey this information to others, 81.4% reported that they would avoid outdoor activities, and 82.7% reported that chemical fogging is necessary.

Most participants demonstrated a positive perception, attitude, and response regarding dengue infection and early warning systems. The study found a significant association between the participants' phases of study and their perceptions of dengue. Overall, medical students showed a favorable outlook toward dengue infection, a positive attitude toward the early warning system, and an appropriate response to it.

CoNS, as opportunists, are responsible for severe nosocomial and health-care related infections. This study aimed to investigate the prevalence and distribution of aminoglycoside resistance genes encoding aminoglycoside-modifying enzymes (AMEs) and to simultaneously address the SCCmec types in CoNS isolated from patients and healthcare workers.

A total of 130 isolates including 80 clinical isolates and 50 healthcare worker isolates (HCWs), were collected from two hospitals examined for their susceptibility to gentamicin, tobramycin and amikacin using disc diffusion. AME genes and SCCmec types were detected by the Multiplex PCR assay.

The resistance rate to gentamicin, tobramycin and amikacin was 67.5%, 56.3%, and 40% respectively. In addition, resistance to gentamicin was predominant among both patients and healthcare workers isolates. Also, aac(6`)-aph(2”)-Ia gene was the most prevalent, occurring in 56.3% of isolates, followed by ant(4`)-Ia gene at 18.8%. In contrast, 23.8% isolates lacked any AMEs genes. SCCmec types I, II, III, IV, and V were identified in 62.5%, 1.6%, 29.7%, 1.6%, and 6.3% of isolates, respectively. The combinations of types I + III and III + V were found in 18.8% and 4.7% of isolates, respectively, while 21.9% of isolates were non-typeable.

In this study, the emergence of aminoglycoside resistant strains was observed among clinical and health care workers isolates. Furthermore, SCCmecI was the most abundant type detected, demonstrating that there are different types among the isolates in different regions.

The occurrence of a true umbilical cord knot is a rare event in the fetal umbilical cord that can lead to fetal death and stillbirth. The primary reason for fetal death associated with the presence of a true knot is the decrease in blood flow between the placenta and the umbilical cord, which reduces the delivery of sufficient oxygen and nutrients needed by the fetus. Therefore, it is very important to identify true umbilical cord knots.

Case report:

The patient is a 33-year-old G2P1 woman with a history of stillbirth in a previous pregnancy due to the presence of a true knot in the umbilical cord. At the 32nd week of her second pregnancy, she began monitoring her fetal health, and to avoid stillbirth, her delivery was scheduled for the 37th week of pregnancy. The fetus was born with an Apgar score of 9 and two true knots along the umbilical cord.

Considering the occurrence of true knots during two consecutive pregnancies, it seems that heredity plays an important role in the frequent occurrence of this event in this individual. Therefore, a careful examination of the history of previous pregnancies is necessary to prevent recurrence and mitigate the negative consequences from prior pregnancies in subsequent ones.