Original Article

Background: Escherichia coli (E. coli) is the most frequent infecting organism in acute infection. So, knowledge about the frequency and distribution of urinary tract infection (UTI) is important to improve infection control measures. The aim of this research was to determine the prevalence of bacteria isolated from urinary tract infection (UTI) in patients and determination of the antibiotic susceptibility patterns of the gram negative bacteria.

Materials and Methods: This descriptive study was performed in Imam Reza hospital, Tabriz (northwest of Iran) during March 2012 to February 2013. We surveyed 8153 patients, who had clinical manifestations of UTI. 5093 (62.47%) of them were female and 3060 (37.53%) of them male. Urine specimens were cultured for isolation of the microbial agents of UTI. The isolated bacteria were identified using biochemical tests. Disk diffusion susceptibility test was used to determine antimicrobial susceptibility.

Results: E. coli (55.38%) was the most common isolated pathogen, followed by Enterobacter spp. (29.61%), Pseudomonas spp. (4.9%), S. aureus (3.21%), Enterococcus spp. (2.3%),  fungi (1.5%) and Klebsiella (0.48%). The sensitivity rates of isolated gram negative bacteria were for Amikacin (95.7%), Nitrofurantoin (91.5%), Gentamicin (64.1%), Ceftizoxim (56.8%), Ciprofloxacin (37.6%), Cotrimoxazole (31.4%) and Nalidixic acid (23.5%).

Conclusion: This study showed that the frequency of E. coli and  Enterobacter spp. increases the probability of urinary tract infection. Also this survey indicates the emergence of antibiotic resistant infections in the studied hospital. So, there is a need to improve the effectiveness of integrated infection control programs to control and manage nosocomial infections caused by highly resistant organisms.

Diagnostic Performance of F-18 FDG PET/CT in Patients with Cancer of Unknown Primary: Additional Benefit over CT-Based Conventional Work up

Mehrdad Bakhshayeshkaram, Mohsen Ghobadi, Maryam Hassanzad, Abtin Doroudinia, Hamidreza Jamaati, Farahnaz Aghahosseini

Novelty in Biomedicine, Vol. 4 No. 1 (2016), 18 January 2016, Page 5-12

Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary (CUP) as an appropriate imaging tool in early phase of initial standard work up.

Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated.

Results: Sixty-two patients with mean age of 62 (30 men, 32 women), PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway.

Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation.

Intravenous Acetaminophen Effect on Postoperative Narcotic Analgesic Demand after Elective Cesarean Section

Mahshid Ghasemi, Maryam Vosoughian, Mastaneh Dahi-Taleghani, Mehrnaz Sohrabi, Seyed Amir Mohajerani

Novelty in Biomedicine, Vol. 4 No. 1 (2016), 18 January 2016, Page 13-17

Background: Opioid analgesics are the mainstay of the treatment of postoperative pain. Appropriate monitoring of patients receiving opioid analgesics is essential to detect those with side effects such as respiratory depression. The discovery of Acetaminophen as a COX-3 variant may represent a primary central mechanism by which acetaminophen decrease pain. The aim of this study was to assess the effect of intravenous acetaminophen on morphine requirement in post-operation pain after elective cesarean section.

Materials and Methods: In a randomized clinical trial, patients’ candidate for elective cesarean section. In experiment group, intravenous acetaminophen (1000 mg/6 hour) was administered and normal saline to control group. Visual analogue scale (VAS) was measured at 1, 3, 6, 12, and 24 hours post-operation. Besides, Morphine dose requirement were measured during next 24 hours.

Results: 83 patients were enrolled in the study; which 44 patients assigned in placebo group and 39 in Acetaminophen. Mean Age of placebo group was 29.64±5.55 and Acetaminophen was 30.33±5.50 which was not significantly different (p=0.568). Only at 1 and 3 hours, there was a significant difference between two groups of study. Total dose of morphine requirement was 5.73±2.78 mg/24 h in placebo group and 3.64±2.42 in Acetaminophen group which was significantly different (p=0.001).

Conclusion: Intravenous Acetaminophen could decrease post cesarean pain and decrease post operation total morphine requirement particularly at first 3 hours post operation.

Prevalence of Chlamydia trachomatis and Mycoplasma genitalium in Patients with Benign and Malignant Ovarian Cancer by Nested PCR Method

Masoud Dadashi, Gita Eslami, Zohreh Ghalavand, Hossein Goudarzi, Fatemeh Fallah, Parviz Owlia, Zahra Zahirnia, Najmeh Ardeshiri

Novelty in Biomedicine, Vol. 4 No. 1 (2016), 18 January 2016, Page 18-23

Background: Chlamydia trachomatis (C. trachomatis) and Mycoplasma genitalium (M. genitalium) are considered factors in cervical and ovarian cancer and are associated with flaky cell carcinoma of the cervix. The role of steady infection, leading to chronic inflammation, in the of ovarian cancer has received very little consideration, although a background of pelvic inflammatory disease (PID) is in a case-control study associate to higher risk for ovarian cancer. C. trachomatis, the most common and important cause of PID in the developed world is the genital and cervical infectious agent. The aim of this study was prevalence of C. trachomatis and M. genitalium in patients with ovarian cancer who referred to Imam Hossein Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Materials and Methods: In this descriptive study that was conducted from January 2014 to April 2015, 124 samples were studied which obtained from patients with ovarian cancer who referred to medical centers of Shahid Beheshti University of Medical Sciences. After obtaining samples from ovarian cancer tissue by the pathologist, for extraction DNA, samples were transferred to the laboratory of university. To confirm the presence of C. trachomatis in samples of ovarian cancer, specific primers for the Major Outer Membrane Protein (MOMP) genes of C. trachomais, were designed and used Nested PCR method for detection of M. genitalium. Sequencing was performed on the PCR and Nested PCR product to confirm the presence of C. trachomatis and M. genitalium.

Results: Out of 124 samples of ovarian cancer, 62 (50%) samples were malignant cancer and 62 (50%) were benign cancer as control group. From 65 malignant samples 14 (22.5%) were Chlamydia trachomatis positive. None of the tissue samples of benign cancer of ovary were positive for C. trachomatis. Notably, none of the 124 ovarian samples were positive in the M. genitalium standard PCR assay.

Conclusion: The results suggest that the spread of C. trachomatis in the female with ovarian cancer may be common. This finding reflects a possible role of C. trachomatis in the carcinogenesis of ovarian tumors. C. trachomatis infection may play a relative role in the pathogenesis of ovarian carcinomas or it could facilitate its progression.

The Prevalence of Pediculus Capitis among Primary Schools of Shahriar County, Tehran province, Iran, 2014

Moniba Alborzi, Reza Shekarriz-Foumani, Vahideh Moin vaziri

Novelty in Biomedicine, Vol. 4 No. 1 (2016), 18 January 2016, Page 24-27

Background: Pediculosis capitis is a common parasitic infection of children, which has been neglected in many areas as well in Shahriar County, Tehran province. This study was conducted to determine the prevalence of pediculosis capitis among pupils in primary schools of Shahriar County.

Materials and Methods: This descriptive-analytical study was conducted in Shahriar for the period of 2012 to 2013. Data were collected by questionnaires and direct head inspection. The prevalence rate was determined in three primary schools and 750 girls participated, which were selected by a randomized cluster method. Data were analyzed using Statistical Package for Social Sciences (SPSS16) and Chi-square test.

Results: Among the 750 girls who were examined, head pediculosis was observed in 36 cases (4.8%). There was a significant relationship between head lice infestation and two factors, father’s job and using private tools in hair salon.

Conclusion: The results showed that pediculosis capitis could be a potentially health threatening problem for school children. It is necessary to give health education to families in order to prevent pediculosis in the study areas.

Epidemiological, Clinical and Paraclinical Study of Hydatid Cysts in Three Educational Medical Centers in 10 Years

Simindokht Shoaee, Mohammad Rezvanizadeh, Mehrdad Haghighi, Hooman Yousefi

Novelty in Biomedicine, Vol. 4 No. 1 (2016), 18 January 2016, Page 28-33

Background: Echinococcosis or hydatidosis, caused by the larval stage of Echinococcus granulosus (E. granulosus), is an important public health problem in many areas of the world  and  Iran is a country of endemic situation for hydatidosis In the present study, we evaluated epidemiological, complications and clinical characteristics of hydatidosis at three University Medical Centers in Tehran over a 10-year period.

Materials and Methods: This is a descriptive cross-sectional study performed in patients with hydatid cysts. Information about age, gender, number of cysts, organ involvement, morbidity and mortality and relapse were collected from medical records of hydatid patients. Paraclinic information such as CT Scan, MRI, ultrasound, complete blood count, pathological diagnosis and complication of disease were collected.

Results: Overall, 81 patients, 35 (43.2%) male and 46 (56.8%) female, who were diagnosed as having hydatid cyst by clinical and radiological findings, with pathologic documentation were studied in three university medical center registries over a 10-year period (2003- 2012) in Tehran. Fourteen patients (17% of cases) had complications resulting from this disease. Patients' age ranged from 5 to 86 years, and the peak prevalence of the disease was between 20 and 40 (34% of cases).

Conclusion: Iran  is a country of endemic situation for hydatidosis. Prevalence rate of hydatidosis in Iran was reported to be 0.61-2 in 100000 populations. The highest  rate of infection and complications were in patients of 20-40 years age. Clinical examination revealed that abdominal pain was the most common complaint and was present in 51.7% of the cases. Other most common complain were cough, abdominal mass, dyspnea, icterus, chest pain, dyspepsia, back pain and seizure; and it was result of occupying effect of cysts in organs. This is similar with previous studies in Iran

Comparison between Epidural Block vs. High Intensity Laser Therapy for Controlling Chronic Low Back Pain

Badiozaman Radpay, Mahtab Poorzamany Nejat Kermany, Mastneh Dahi-Taleghani

Novelty in Biomedicine, Vol. 4 No. 1 (2016), 18 January 2016, Page 34-40

Background: Chronic low back pain is among a wide spread musculoskeletal conditions that is related to disability with high economy cost. There are several treatment modalities for controlling chronic low back pain (CLBP), among them high intensity laser therapy (HILT) and epidural blocks (EB) use more commonly. This study aimed to evaluate the benefits and hazards of each of these two methods.

Materials and Methods: We designed a randomized controlled double blind study during 24 months.101 patients divided in 2 groups (52 in EB and 49 in HILT group). Pain intensity was assessed by using faces pain scales (FPS) and LINKERT questionaries' before procedure and during one, four, 12, and 24 weeks after beginning the procedures.

Results: There were no differences between two groups in FPS lumber tenderness, straight leg rising test (SLRT), paresthesia, deep tendon reflex (DTR), and imaging changes. Motor problems seem was less in HILT group comparing EB.

Conclusion: This study showed both EB and HILT approaches can control the pain intensity and motor activities in CLBP patients. Future studies will clarify the precise importance of each these methods.

Case Report

Peg-Interferon Alfa 2-b Related Cellulitis in a 40 Years Man

Shahnaaz Sali, Sahar Vakili Tabatabaee, Hooman Yousefi

Novelty in Biomedicine, Vol. 4 No. 1 (2016), 18 January 2016, Page 41-44

Background: Pegylated interferon and ribavirin are currently one of the accepted treatment for chronic Hepatitis C. Dermatologic complications of interferon have been reported, but to date a few cases of bacterial cellulitis; a rare and severe complication, have been published. Cellulitis is a common infectious process affecting the skin and subcutaneous tissues which results in significant morbidity and holds considerable healthcare costs.

Cases Report: Herein, we report a case of chronic hepatitis C genotype 1a who was on medication since 8 weeks prior to developing leg cellulitis, an uncommon pegylated interferon injection site. Considering no other possible risk factors were found to be in favor of bacterial cellulitis, our case is unique in its kind. Some reports reveal necrotizing vasculitis as basis for cutaneous lesions, which could be due to the high concentrations of drug at the injection site, a toxic effect of the diluents, or an immunological reaction.

Conclusion: According to the latter mechanism patients could develop bacterial cellulitis in their different organs. Conclusively, we propose the hypothesis of a possible association between cellulitis to occur at any site as the complication of pegylated interferon Alfa 2b and would highlight the role of a careful skin examination that could be an asset in preventing local skin infections.