Conventional- versus high-dose vancomycin regimen in patients with acute bacterial meningitis: a randomized clinical trial

Objective: Efficacy of the conventional- versus high-dose vancomycin regimen in patients with acute bacterial meningitis was compared.

Methods: In a randomized clinical trial 44 patients with acute bacterial meningitis were randomly assigned to the conventional- or high-dose vancomycin groups. Clinical and laboratory parameters were used for evaluation of response to the treatment regimens.

Results: In the high-dose group, leukocytosis and fever resolved significantly faster than those in the conventional group. Furthermore, the length of hospitalization was shorter and Glasgow Coma Scale at the end of 10th day was significantly lower in the high dose compared to the conventional group. Trend of creatinine clearance changes did not differ significantly between the two groups.

Conclusion: In comparison to the conventional-dose regimen, the high-dose vancomycin regimen was associated with significantly more favorable clinical response without increase in the incidence of nephrotoxicity in patients with acute bacterial meningitis.     

Correlation between expression of MMP-9 and MMP-3 in Helicobacter pylori infected patients with different gastroduodenal diseases

Background and study aims

Helicobacter pylori (H. pylori) has been implicated in the pathogenesis of most important gastro-duodenal diseases, such as gastritis, peptic ulcer disease (PUD) and gastric cancer. H. pylori upregulates the expression and activity of several matrix metalloproteinases (MMPs) in the gastric mucosa, but the role of MMP-3 and MMP-9 in infected patients with H. pylori have not been clearly defined yet. We examined mucosal MMP-3 and MMP-9 mRNA levels in gastric mucosa of H. pylori infected patients and evaluated the effects of virulence factors cagA and vacA allelic variants on these levels. We also determined correlation between mucosal MMP-3 and MMP-9 mRNA levels and types of disease.

The influence of the polymerization approach on the catalytic performance of novel porous poly (ionic liquid)s for green synthesis of pharmaceutical spiro-4-thiazolidinones

Although poly (ionic liquids) (PILs) have attracted great research interest owing to their various applications, the performance of nanoporous PILs has been rarely developed in the catalysis field. To this end, a micro–mesoporous PIL with acid–base bifunctional active sites was designed and fabricated by two different polymerization protocols including hydrothermal and classical precipitation polymerization in this paper. Based on our observations, hydrothermal conditions (high temperature and pressure) enabled the proposed sonocatalyst to possess a great porous structure with a high specific surface area (S_BET: 315 m² g⁻¹) and thermal stability (around 450 °C for 45% weight loss) through strengthening cross-linking. In a comparative study, the preferred nanoporous PIL was selected and utilized as the sonocatalyst in a multicomponent reaction of isatins, primary amines, and thioglycolic acid. In the following, a variety of new and known pharmaceutical spiro-4-thiazolidinone derivatives were synthesized at room temperature and obtained excellent yields (>90%) within short reaction times (4–12 min) owing to the substantial synergistic effect between ultrasound irradiation and magnetically separable catalyst.

Sustainable synthesize of a new mesoporous poly (ionic liquid) as acid–base bifunctional catalyst for environmental being preparation of monospiro derivatives has been developed.     

The role of interferon-γ in cardiovascular disease: an update

Inflammation Research - Cardiovascular disease (CVD) is the leading cause of death, globally, and its prevalence is only expected to rise due to the increasing incidence of co-morbidities such as...     

Evaluation of parenteral nutritional support in the surgical and medical wards of a referral teaching hospital

Background and purpose

Malnutrition is a common problem in patients who are hospitalized in surgical and medical wards. Surgical patients, geriatric populations and individuals with severe illness are more vulnerable to malnutrition during their hospitalization course.The purpose of this study was evaluation of parenteral nutrition services in a referral teaching hospital, Tehran, Iran.

Method

Medical records of 72 patients who received parenteral nutrition during one year period in different surgical and medical wards of Imam Khomeini hospital were reviewed retrospectively by clinical pharmacists. Criteria for initiation of parenteral nutrition, selection of appropriate formulation and monitoring parameters were assessed based on the American Society of Parenteral and Enteral Nutrition recommendations.

Results

Based on the patients'' anthropometric parameters and serum albumin levels, 4.2%, 75% and 20.8% of the patients were well-nourished, moderately malnourished and severely malnourished respectively at the hospital admission and before nutritional support. Adequate calorie, protein, carbohydrate and lipid supports were achieved in 21.1%, 32.4%, 23.7% and 10.5% of the patients respectively. About 91% of the patients experienced at least one complication of the nutritional support.

Conclusion

In this evaluation, several errors in assessment, establishing goals, and monitoring of parenteral nutrition regimens have been detected. Approximately all of the patients did not receive to the trace elements supports goals.     

A rapidly enlarging neck mass: the role of the sitting position in fiberoptic bronchoscopy for difficult intubation

Difficult airway management is a dilemma for any anesthesiologist. Although practice guidelines and algorithms may help in such situations, the anesthesiologist's judgment and vigilance remain the primary means to save lives. In the following case, we encountered an acutely enlarging thyroid mass that was compromising the airway. This huge neck mass precluded tracheostomy under local anesthesia, and the patient could breathe only in the sitting position. Therefore, there were few safe strategies for airway management for general anesthesia. We reiterate the role of awake fiberoptic intubation in such circumstances.     

Predictors of postretention stability of mandibular dental arch dimensions in patients treated with a lip bumper during mixed dentition followed by fixed appliances

Objective:To identify which dental and/or cephalometric variables were predictors of postretention mandibular dental arch stability in patients who underwent treatment with transpalatal arch and lip bumper during mixed dentition followed by full fixed appliances in the permanent dentition.Materials and Methods:Thirty-one patients were divided into stable and relapse groups based on the postretention presence or absence of relapse. Intercuspid, interpremolar, and intermolar widths; arch length and perimeter; crowding; and lower incisor proclination were evaluated before treatment (T0), after lip bumper treatment (T1), after fixed appliance treatment (T2), and a minimum of 3 years after removal of the full fixed appliance (T3). Logistic regression analyses were performed to evaluate the effect of changes between T0 and T1, as predictive variables, on the occurrence of relapse at T3.Results:The model explained 53.5 % of the variance in treatment stability and correctly classified 80.6 % of the sample. Of the seven prediction variables, intermolar and interpremolar changes between T0 and T1 (P = .024 and P = .034, respectively) were statistically significant. For every millimeter of increase in intermolar and interpremolar widths there was a 1.52 and 2.70 times increase, respectively, in the odds of having stability. There was also weak evidence for the effect of sex (P = .047).Conclusions:The best predictors of an average 4-year postretention mandibular dental arch stability after treatment with a lip bumper followed by full fixed appliances were intermolar and interpremolar width increases during lip bumper therapy. The amount of relapse in this crowding could be considered clinically irrelevant.     

Effect of cryoanalgesia on post-thoracotomy pain

We prepared this study to determine the effect of cryoanalgesia on post-thoracotomy pain. In this double-blinded randomized clinical trial, 60 patients who underwent thoracotomy were divided into two groups (control and cryoanalgesia). Visual Analogue Scale (VAS, 0-10) was used for the measurement of severity of post-thoracotomy pain. It was classified into three categories: 0-1 (mild), 2-3 (moderate), and 4-10 (severe). Pethidine (0.5-1 mg/kg) was administered in case of need for both groups. Patients were visited at the hospital a week later, and were contacted by phone at the first, second, and third months post-operatively. Intensity of pain in the control group was higher than the cryoanalgesia group in all visits the follow-up period. On the second day, the frequencies of severe pain (4-10) were 33.3% and 0 in the control and cryoanalgesia groups, respectively. The mild pain on the seventh day was 13.3% and 83.3% in the control and cryoanalgesia groups, respectively (P < 0.01). Pethidine consumption was 151.6 ± 27 mg in the control group and 87.5 ±48 mg in the cryoanalgesia group on the first day post-operation (P < 0.001). Cryoanalgesia is a useful technique with not serious side effects in order to alleviate post-thoracotomy pain and reduce the need for opiate consumption.     

Interactive effects of Salicylic acid and nitric oxide in alleviating zinc toxicity of Safflower (<Emphasis Type="Italic">Carthamus tinctorius</Emphasis> L.)

The purpose of this study was to assess the possible protective role of exogenous salicylic acid (SA), sodium nitroprusside (SNP), a donor of nitric oxide, and their combination on 21-day-old safflower (Carthamus tinctorius L.) seedlings grown under zinc (Zn) stress. The results revealed that exposure to 500?µM ZnSO₄.7H₂O for 10 days markedly reduced the root and shoot dry weights in Zn-treated plants, while the application of SA, SNP and specially SA?+?SNP significantly increased the root and shoot dry weights in seedlings subjected to Zn stress. Addition of SA, SNP and SA?+?SNP interestingly reduced root-to-shoot translocation of zinc and increased significantly the level of glutathione (GSH) and ascorbate (ASC) in leaves of Zn-stressed plants. The Zn-treated plants supplemented with SA and SNP revealed an improved activity of ascorbate-glutathione cycle enzymes and those enzymes which are involved in glyoxalase system as compared to the plants treated with Zn only. However, no significant relationship was found between SA or SNP supplementation and glutathione S-transferase activity in Zn-stressed plants. These findings demonstrate that exogenous application of SA or SNP could ameliorate the negative effects of Zn on safflower plants probably by stimulation of antioxidant defense and glyoxalase systems.     

Drug utilization evaluation of albumin in a teaching hospital of Mashhad,Iran: an interventional pre–post design study

Background Albumin is a protein colloidal solution with limited availability and high cost. It should be used in such approved indications as paracentesis, extensive burn, spontaneous bacterial peritonitis, and nephrotic syndrome. Objectives The aim of this study was to evaluate and compare the appropriateness of albumin usage before and after an evidence-based guideline. Setting Four wards of Imam Reza Hospital, Mashhad, Iran. Method An interventional pre–post design study was performed on 2 groups of patients; in gGroup 1 as a preparation phase group in 6 months from February 2015 to July 2015 and Group 2 as an interventional group from September 2015 to February 2016. A guideline for proper indications of albumin, designed and finalized based on the physicians’ comments, was implemented in Group 2. Main outcome measure The pattern of albumin consumption. Results Fifty patients were evaluated in each group. The implementation of the guideline resulted in reduction of improper albumin use from 62 to 57.5%, which was not statistically significant; however., it reduced inappropriate dose and duration of albumin therapy (55.5–16.7%), the number of consumed albumin vial, and the average cost for each patient (317.78 ± 3.15–149.81 ± 1.91 USD) significantly, as well. Conclusion This study illustrated that in this hospital in most cases, albumin was used inappropriately and at an alarming rate. This improved after the introduction of an evidence-based guideline. Moreover, guideline implementation resulted in significant cost reduction.