Invasive Fungal Sinusitis in Immunocompromised Patients: A Multicenter, University Hospital Experience in Shiraz

Objective: It is to determine the causes of invasive fungal sinusitis in patients of Shiraz University hospitals, Iran. Methods: This cross-sectional study was conducted during 18 months (from 21 March 2009 till 22 September 2010) in three Shiraz University Hospitals. Thirty-six patients with sings of invasive fungal sinusitis were enrolled, and tissue samples were investigated for histopathology, culture and antifungal susceptibility test. The laboratory results with host factor and sinus computed tomography scan were evaluated for classification of patients as proven, probable and possible invasive fungal sinusitis. Results: Thirty-five patients have involved with at least one risk factor (immune compromised disease, diabetes mellitus, or use of immune suppressed drugs). Radiological findings of parasinus invasion or necrosis were present in 20 patients. By histopathology, 21 patients were considered as proven, from these, 17 samples had positive growth. The culture aetiology agents were 4 Candida, 8 Aspergillus, and 5 Mucor. All positive culture samples were matched with histopathology findings. Significant associations were considered for radiologic finding and histopathology and culture (p 0.05). From 8 patients with mucormycosis histopathology, 6 suffered from diabetes mellitus. None of the antifungal agents were effective on these three types of infections. Conclusion: DM is the most common predisposing factor for IFS followed by ALL and AML. The most common aetiology of IFS was found to be Aspergillus fumigant followed by Mucormycosis and Candida. None of antifungal agents could successfully cover all the species.

Nonlinear wave dispersion in monoatomic chains with lumped and distributed masses:discrete and continuum models

The main objective of this paper is to investigate the influence of inertia of nonlinear springs on the dispersion behavior of discrete monoatomic chains with lumped and distributed masses.The developed model can represent the wave propagation problem in a non-homogeneous material consisting of heavy inclusions embedded in a matrix.The inclusions are idealized by lumped masses,and the matrix between adjacent inclusions is modeled by a nonlinear spring with distributed masses.Additionally,the model is capable of depicting the wave propagation in bi-material bars,wherein the first material is represented by a rigid particle and the second one is represented by a nonlinear spring with distributed masses.The discrete model of the nonlinear monoatomic chain with lumped and distributed masses is first considered,and a closed-form expression of the dispersion relation is obtained by the second-order Lindstedt-Poincare method(LPM).Next,a continuum model for the nonlinear monoatomic chain is derived directly from its discrete lattice model by a suitable continualization technique.The subsequent use of the second-order method of multiple scales(MMS)facilitates the derivation of the corresponding nonlinear dispersion relation in a closed form.The novelties of the present study consist of(i)considering the inertia of nonlinear springs on the dispersion behavior of the discrete mass-spring chains;(ii)developing the second-order LPM for the wave propagation in the discrete chains;and(iii)deriving a continuum model for the nonlinear monoatomic chains with lumped and distributed masses.Finally,a parametric study is conducted to examine the effects of the design parameters and the distributed spring mass on the nonlinear dispersion relations and phase velocities obtained from both the discrete and continuum models.These parameters include the ratio of the spring mass to the lumped mass,the nonlinear stiffness coefficient of the spring,and the wave amplitude.

Protective effect of co-enzyme Q10 on testicular tissue and sperm parameters in adult male rats treated with Sunset Yellow FCF

Objective:To determine the protective effect of co-enzyme Q10(CoQ10)on testicular tissue and sperm parameters in male rats treated with SunsetYellow FCF.Methods:Sixty male Sprague-Dawley rats were randomly divided into 6 groups of the control,CoQ10(10 mg/kg/day),low dose of Sunset Yellow(2.5 mg/kg),high dose of Sunset Yellow(70 mg/kg),low dose of Sunset Yellow(2.5 mg/kg)plus CoQ10,and high dose of Sunset Yellow(70 mg/kg)plus CoQ10.The drugs were administered via daily oral gavages for 6 weeks.At the end of the experiment,sperm analysis,stereological and histological assessments of the testis were carried out.Results:The normal morphology(by 41.1%)and progressive spermatozoa(by 74.8%),testicle volume(by 33.4%),lumen volume(by 38.3%),interstitial tissue volume(by 44.7%),seminiferous tubule volume(by 40.7%),and number of spermatogonia(by 53.9%)and Leydig cells(by 70.7%)reduced in the rats that received high doses of Sunset Yellow in comparison to the control group.Nonetheless,all these alterations were recovered by CoQ10 treatment in the CoQ10 plus high dose of Sunset Yellow group.Furthermore,low doses of Sunset Yellow did not affect different parameters of the testis and sperm.Conclusions:CoQ10 could,to some extent,prevent structural changes of the testis induced by the high dose of SunsetYellow.

Efficacy of tadalafil on improvement of men with erectile dysfunction caused by COVID-19:A randomized placebo-controlled trial

Objective: According to the high prevalence of COVID-19 and the subsequent risk of men's sexual health, we decided to investigate the efficacy of tadalafil on improvement of men with erectile dysfunction caused by COVID-19.Methods: In this study, 70 outpatients who were recovered from COVID-19 without acute respiratory distress syndrome with negative polymerase chain reaction test and a complaint of erectile dysfunction were divided into two groups: 35 patients who received tadalafil 5 mg daily and 35 who received placebo. For each patient, basic assessment of sexual function was performed using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Then, treatment was started from 2 months after complete recovery of COVID-19 with negative polymerase chain reaction test for 3 months. At the end of the treatments, the patients were re-evaluated for sexual function using the complete version of IIEF questionnaire. Finally, the results before and after treatment in the intervention group were compared with those of the control group.Results: Treatment with both tadalafil and placebo improved the patients' sexual function criteria compared to the baseline. However, this improvement was significantly higher in the intervention group with tadalafil than the control group with placebo (p<0.05).Conclusion: Daily administration of tadalafil 5 mg seems to be effective and safe for improvement of erectile dysfunction caused by COVID-19.

Evaluation of the seismic behavior of reinforced concrete structures with flat slab-column gravity frame and shear walls through nonlinear analysis methods

This paper presents an investigation of the seismic behavior of reinforced concrete(RC)structures in which shear walls are the main lateral load-resisting elements and the participation of flat slab floor systems is not considered in the seismic design procedure.In this regard,the behavior of six prototype structures(with different heights and plan layouts)is investigated through nonlinear static and time history analyses,implemented in the OpenSees platform.The results of the analyses are presented in terms of the behavior of the slab-column connections and their mode of failure at different loading stages.Moreover,the global response of the buildings is discussed in terms of some parameters,such as lateral overstrength due to the gravity flat slab-column frames.According to the nonlinear static analyses,in structures in which the slab-column connections were designed only for gravity loads,the slab-column connections exhibited a punching mode of failure even in the early stages of loading.However,the punching failure was eliminated in structures in which a minimum transverse reinforcement recommended in ACI 318(2019)was provided in the slabs at joint regions.Furthermore,despite neglecting the contribution of gravity flat slab-column frames in the lateral load resistance of the structures,a relatively significant overstrength was imposed on the structures by the gravity frames.

Sacrificial piles as a countermeasure against local scour around underwater pipelines

Local scour around pipelines crossing rivers or in marine environments is a significant concern.It can lead to failure of the pipelines resulting in environmental side effects and economic losses.This study developed an experimental method to reduce local scour around pipelines with a steady flow of clear water by installing cylindrical and cubical sacrificial piles.Three sizes of sacrificial piles were examined in a linear arrangement.Sacrificial piles were installed on the upstream side of the pipeline at three distances.Maximum scour depth reduction rates below the pipeline were computed.The results showed that sacrificial piles could protect a pipeline from local scour.A portion of scoured sediment around the sacrificial piles was deposited beneath the pipeline.This sediment accumulation reduced the scour depth beneath the pipeline.Analysis of the experimental results demonstrated that the size of piles(d),the spacing between piles,and the distance between the pipe and piles(Xp)were the variables that reduced the maximum scour beneath the pipeline with a diameter of D.For the piles with d=0.40D and 0.64D,X_(p)=4OD was the optimal distance to install a group of piles,and cubical piles could mitigate scour more effectively than cylindrical piles under similar conditions.For the piles with d=D,the greatest reduction in scour depth was achieved at X_(p)=50D with any desired spacings between piles,and cylindrical piles in this dimension could protect the pipeline against scour more effectively than cubical piles.

A 10-year review and epidemiology of animal bite cases in Gerash city, south of Iran: A retrospective cross-sectional study

Objective:To determine the temporal trend and epidemiology of animal bite cases in Gerash City,Iran.Methods:This retrospective cross-sectional study analyzed 630 cases of people with animal bites between 2011 and 2021 in Gerash City.The collected data were analyzed using Chi-square test.Results:The mean age of victims was(30.9±17.5)years.80.54%Of victims were male,39.70%were self-employed,and 64.60%were adults(≥18 years).Most cases of bites occurred in 2019(91 cases),2020(74 cases)and 2021(87 cases),and most of the bites were related to the upper limbs(62.70%).Most of the wounds were superficial(78%),most of the biting animals were domestic animals(91.74%),and most of the victims had Iranian nationality(97.62%).Conclusions:Given the increasing trend of animal bites in Gerash City,health authorities should carry out basic measures such as education and awareness among the public,especially at-risk groups such as adult males.Additionally,since most cases of bites are due to dogs,it seems necessary to plan for vaccination of dogs,especially those with owners.

Spatial analysis of animal bites in Iran(2015-2020):A cross-sectional study

Objective:To investigate the distribution pattern of animal bites in Mirjaveh,Iran from 2015 to 2020.Methods:The data on animal bites were collected from the Department of Infectious Diseases,the provincial health center.Monthly climatic data on precipitation and temperature during the study period were also collected.The correlation between incidence and temperature,precipitation rate,land type,and altitude was also analyzed.Results:The results showed that men were more affected by animal bites than women(76.4%,P<0.001),and the highest incidence rate occurred in the age group of 5-19 years.The incidence rate of animal bites was found to be correlated with temperature and altitude.An increase in temperature was associated with a rise in the incidence rate of animal bites.The number of animal bites increased until 2019,possibly due to an increase in the number of dogs in the area.Conclusions:Targeted interventions should be implemented to reduce the incidence of animal bites,particularly among children,housewives,and students.Improving access to appropriate treatments,increasing public awareness of the hazards of animal bites,and increasing the number of vaccinated dogs in the area are essential strategies to be considered.

Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States:An analysis of geographical distribution,academic,leadership,and demographic characteristics

BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.

Application of Stork Optimization Algorithm for Solving Sustainable Lot Size Optimization

The efficiency of businesses is often hindered by the challenges encountered in traditional Supply Chain Manage-ment(SCM),which is characterized by elevated risks due to inadequate accountability and transparency.To address these challenges and improve operations in green manufacturing,optimization algorithms play a crucial role in supporting decision-making processes.In this study,we propose a solution to the green lot size optimization issue by leveraging bio-inspired algorithms,notably the Stork Optimization Algorithm(SOA).The SOA draws inspiration from the hunting and winter migration strategies employed by storks in nature.The theoretical framework of SOA is elaborated and mathematically modeled through two distinct phases:exploration,based on migration simulation,and exploitation,based on hunting strategy simulation.To tackle the green lot size optimization issue,our methodology involved gathering real-world data,which was then transformed into a simplified function with multiple constraints aimed at optimizing total costs and minimizing CO_(2) emissions.This function served as input for the SOA model.Subsequently,the SOA model was applied to identify the optimal lot size that strikes a balance between cost-effectiveness and sustainability.Through extensive experimentation,we compared the performance of SOA with twelve established metaheuristic algorithms,consistently demonstrating that SOA outperformed the others.This study’s contribution lies in providing an effective solution to the sustainable lot-size optimization dilemma,thereby reducing environmental impact and enhancing supply chain efficiency.The simulation findings underscore that SOA consistently achieves superior outcomes compared to existing optimization methodologies,making it a promising approach for green manufacturing and sustainable supply chain management.

Deciphering resistancemechanisms and novel strategies to overcome drug resistance in ovarian cancer:a comprehensive review

Ovarian cancer is among the most lethal gynecological cancers,primarily due to the lack of specific symptoms leading to an advanced-stage diagnosis and resistance to chemotherapy.Drug resistance(DR)poses the most significant challenge in treating patients with existing drugs.The Food and Drug Administration(FDA)has recently approved three new therapeutic drugs,including two poly(ADP-ribose)polymerase(PARP)inhibitors(olaparib and niraparib)and one vascular endothelial growth factor(VEGF)inhibitor(bevacizumab)for maintenance therapy.However,resistance to these new drugs has emerged.Therefore,understanding the mechanisms of DR and exploring new approaches to overcome them is crucial for effective management.In this review,we summarize the major molecular mechanisms of DR and discuss novel strategies to combat DR.

Magnificent Frigatebird Optimization: A New Bio-Inspired Metaheuristic Approach for Solving Optimization Problems

This paper introduces a groundbreaking metaheuristic algorithm named Magnificent Frigatebird Optimization(MFO),inspired by the unique behaviors observed in magnificent frigatebirds in their natural habitats.The foundation of MFO is based on the kleptoparasitic behavior of these birds,where they steal prey from other seabirds.In this process,a magnificent frigatebird targets a food-carrying seabird,aggressively pecking at it until the seabird drops its prey.The frigatebird then swiftly dives to capture the abandoned prey before it falls into the water.The theoretical framework of MFO is thoroughly detailed and mathematically represented,mimicking the frigatebird’s kleptoparasitic behavior in two distinct phases:exploration and exploitation.During the exploration phase,the algorithm searches for new potential solutions across a broad area,akin to the frigatebird scouting for vulnerable seabirds.In the exploitation phase,the algorithm fine-tunes the solutions,similar to the frigatebird focusing on a single target to secure its meal.To evaluate MFO’s performance,the algorithm is tested on twenty-three standard benchmark functions,including unimodal,high-dimensional multimodal,and fixed-dimensional multimodal types.The results from these evaluations highlight MFO’s proficiency in balancing exploration and exploitation throughout the optimization process.Comparative studies with twelve well-known metaheuristic algo-rithms demonstrate that MFO consistently achieves superior optimization results,outperforming its competitors across various metrics.In addition,the implementation of MFO on four engineering design problems shows the effectiveness of the proposed approach in handling real-world applications,thereby validating its practical utility and robustness.

Security and Privacy Challenges in SDN-Enabled IoT Systems: Causes, Proposed Solutions,and Future Directions

Software-Defined Networking(SDN)represents a significant paradigm shift in network architecture,separating network logic from the underlying forwarding devices to enhance flexibility and centralize deployment.Concur-rently,the Internet of Things(IoT)connects numerous devices to the Internet,enabling autonomous interactions with minimal human intervention.However,implementing and managing an SDN-IoT system is inherently complex,particularly for those with limited resources,as the dynamic and distributed nature of IoT infrastructures creates security and privacy challenges during SDN integration.The findings of this study underscore the primary security and privacy challenges across application,control,and data planes.A comprehensive review evaluates the root causes of these challenges and the defense techniques employed in prior works to establish sufficient secrecy and privacy protection.Recent investigations have explored cutting-edge methods,such as leveraging blockchain for transaction recording to enhance security and privacy,along with applying machine learning and deep learning approaches to identify and mitigate the impacts of Denial of Service(DoS)and Distributed DoS(DDoS)attacks.Moreover,the analysis indicates that encryption and hashing techniques are prevalent in the data plane,whereas access control and certificate authorization are prominently considered in the control plane,and authentication is commonly employed within the application plane.Additionally,this paper outlines future directions,offering insights into potential strategies and technological advancements aimed at fostering a more secure and privacy-conscious SDN-based IoT ecosystem.

Frilled Lizard Optimization: A Novel Bio-Inspired Optimizer for Solving Engineering Applications

This research presents a novel nature-inspired metaheuristic algorithm called Frilled Lizard Optimization(FLO),which emulates the unique hunting behavior of frilled lizards in their natural habitat.FLO draws its inspiration from the sit-and-wait hunting strategy of these lizards.The algorithm’s core principles are meticulously detailed and mathematically structured into two distinct phases:(i)an exploration phase,which mimics the lizard’s sudden attack on its prey,and(ii)an exploitation phase,which simulates the lizard’s retreat to the treetops after feeding.To assess FLO’s efficacy in addressing optimization problems,its performance is rigorously tested on fifty-two standard benchmark functions.These functions include unimodal,high-dimensional multimodal,and fixed-dimensional multimodal functions,as well as the challenging CEC 2017 test suite.FLO’s performance is benchmarked against twelve established metaheuristic algorithms,providing a comprehensive comparative analysis.The simulation results demonstrate that FLO excels in both exploration and exploitation,effectively balancing these two critical aspects throughout the search process.This balanced approach enables FLO to outperform several competing algorithms in numerous test cases.Additionally,FLO is applied to twenty-two constrained optimization problems from the CEC 2011 test suite and four complex engineering design problems,further validating its robustness and versatility in solving real-world optimization challenges.Overall,the study highlights FLO’s superior performance and its potential as a powerful tool for tackling a wide range of optimization problems.

Correlation between critical thinking and emotional intelligence:a national crosssectional study on operating room nursing students in Iran

Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after surgery by having or acquiring this skill in health care.Also,Emotional intelligence is introduced as an impor tant and effective factor on the professional performance and mental health of healthcare professionals.Thus,the present study was designed and implemented to determine the relationship between emotional intelligence and critical thinking among operating room nursing students of medical sciences universities in Iran.Methods:This cross-sectional study was done on 420 operating room students in 10 top medical sciences universities of Iran in 2022.The sampling method in this research was multistage sampling.The data collection instruments included demographic characteristics,Rickett's critical thinking,and Bradberry-Greaves'emotional intelligence questionnaires.After receiving the ethics code,data collection was done for 2 months.For data analysis,descriptive and inferential analyses including independent t-tests,analysis of variance,and Pearson correlation were used.The collected data were analyzed by SPSS 18(IBM Corporation,Armonk,New York,United States).P-value<0.05 was considered significant.Results:The mean age of the students participating in this study was 23.02±3.70 years,with women constituting 67.4%of them.The results of data analysis indicated that the mean total score of critical thinking and emotional intelligence was 124.10±37.52 and 114.12±43.63,respectively.A direct significant correlation between critical thinking and emotional intelligence(r=0.459,P-value<0.001)and a significant relationship between gender and emotional intelligence(P-value=0.028)were found.Conclusions:Based on the present study results,educational managers in the Ministry of Health are suggested to consider suitable educational programs for improving critical thinking and emotional intelligence to enhance the quality of care provided by students in operating rooms.

Necessary prerequisites for evidence-based practice:results of investigating nurses'informatics competency and information literacy skills

This study aimed to evaluate the correlation between nursing informatics(NI)competency and information literacy skills for evidencebased practice(EBP)among intensive care nurses.This cross-sectional study was conducted on 184 nurses working in intensive care units(ICUs).The study data were collected through demographic information,Nursing Informatics Competency Assessment Tool(NICAT),and information literacy skills for EBP questionnaires.The intensive care nurses received competent and low-moderate levels for the total scores of NI competency and information literacy skills,respectively.They received a moderate score for the use of different information resources but a low score for information searching skills,different search features,and knowledge about search operators,and only 31.5%of the nurses selected the most appropriate statement.NI competency and related subscales had a significant direct bidirectional correlation with information literacy skills for EBP and its subscales(P<0.05).Nurses require a high level of NI competency and information literacy for EBP to obtain up-to-date information and provide better care and decision-making.Health planners and policymakers should develop interventions to enhance NI competency and information literacy skills among nurses and motivate them to use EBP in clinical settings.

Risk factors of gastroesophageal reflux disease in Shiraz,southern Iran

AIM: To determine the prevalence and symptoms of gastroesophageal reflux disease (GERD) in a healthy general population in relation to demographic,lifestyle and health-seeking behaviors in Shiraz,southern Iran. METHODS: A total of 1978 subjects aged > 35 years who referred to Gastroenterohepatology Research Center and who completed a questionnaire consisting of 27 questions for GERD in relation to demographic,lifestyle and health-seeking behaviors were included in this study for a period of five months. The validity and reliability of the questionnaire were determined. RESULTS: The prevalence of GERD was 15.4%,which was higher in females (17.3%),in rural areas (19.8%),and in illiterate subjects (21.5%) and those with a mean age of 50.25 years. The prevalence was significantly lower in subjects having fried food (14.8%),and fruit and vegetables (14.6%). More symptoms were noticed in subjects consuming pickles (22.1%),taking aspirin (21%) and in subjects with psychological distresses (27.2%) and headaches (22%). The correlation was statistically significant between GERD and halitosis (18.3%),dyspepsia (30.6%),anxiety (19.5%),nightmares (23.9%) and restlessness (18.5%). Their health seeking behavior showed that there was a significant restriction of diet (20%),consumption of herbal medicine (19%),using over-the-counter drugs (29.9%) and consulting with physicians (24.8%). Presence of GERD symptoms was also significantly related to a previous family history of the disease (22.3%).CONCLUSION: GERD is more common in females,rural and illiterate subjects and correlated with consumption of pickles,occurrence of headache,psychological distress,dyspepsia,halitosis,anxiety,nightmare and restlessness,and a family history of GERD and aspirin intake,but the correlation was negative with consumption of fat and fiber intake.

Discernment scheme for paraquat poisoning: A five-year experience in Shiraz, Iran

AIM To evaluate various schemes for paraquat poisoning and different variables that influence the outcome of acute paraquat poisoning.METHODS In a cross-sectional study, the information about all cases of acute paraquat poisoning who were admitted to teaching hospitals affiliated to Shiraz University of Medical Sciences, in a five year period(September 2010 to September 2015) were evaluated. The variables included: Demographic data, medical assessment, therapeutic options, laboratory findings, and the outcomes. Data were analyzed using SPSS, version 22. Significant difference between groups was tested using t-test for continues outcomes and χ~2 test for categorical. The significance level was considered to be P < 0.05. RESULTS A total of 104 patients(66.3% male) were evaluated. The mean age of the female patients was 22.81 ± 9.87 years and the male patients' was 27.21 ± 11.06 years. Ninety seven(93.3%) of all the cases were suicide attempts with mortality rate of 43.2%. Despite the necessity for emergency hemodialysis during the first 6 h of intoxication, none of the patients had dialysis during this time. Immunosuppressive and corticosteroid medications were not administrated in adequate dosage in 31.1% and 60% of the patients, respectively. Ingestion of more than22.5 cc of paraquat and increase in creatinine level were the most important predictors of mortality.CONCLUSION Treatment should start immediately for these patients.Moreover, creating a clinical guideline according to the findings can have an impact on the treatment procedure which seems to be necessary.

Antimicrobial susceptibility of Helicobacter pylori strains isolated from patients in Shiraz, Southern Iran

AIM: To improve our understanding of Iranian regional variation in Helicobacter pylori (H. pylori ) antibiotic resistance rates to find the best antibiotic therapy for eradication of H. pylori infections.METHODS: A total of 266 patients undergoing endoscopy in Shiraz, Southern Iran, were included in this study. H. pylori strains were isolated from antral biopsies by culture and confirmed by the rapid urease-test and gram staining. Antibiotic susceptibility of H. pylori isolates was determined by E-test.RESULTS: A total of 121 H. pylori strains were isolated, 50 from male and 71 from female patients. Data showed that 44% (n = 53), 20% (n = 24), 5% (n = 6), and 3% (n = 4) of all strains were resistant to the antibiotics metronidazole, amoxicillin, clarithromycin, and tetracycline, respectively. When the antibiotics were considered together we found 11 sensitivity patterns for the strains. Resistance to metronidazole was significantly higher in female than in male patients (P < 0.05). In about 71% of the metronidazole-resistant isolates, the minimum inhibitory concentrations (MICs) exceeded 256 μg/mL.CONCLUSION: We found a moderate rate of primary resistance to metronidazole. However, a high MIC (> 256 mg/L) which was found in 71% of the isolates is considerable. In the case of amoxicillin, an increased resistance rate of 20% is worrying. Resistance to clarithromycin and tetracycline is also emerging among the H. pylori strains in our region.