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M Mashayekhi, R Mohammadali Baygi,
Volume 7, Issue 21 (12-2000)
Volume 7, Issue 21 (12-2000)
Abstract
ABSTRACT
Prevalence of diabetes in the families is important. There are difference in prevalence of the disease in different cultures and different areas. We studied prevalence of diabetes in relatives of patients in our country. This study was descriptive and retroespective. Patient selection was convenience. There was 432 records of diabetic patients which were hospitalised in Firooz-Abadi Hospital from 1998 to 1999. From 378 records informations about type of diabetes, sex and history of diabetes in their relative were extracted and analysed with Chi–Square (X2–test). Prevalence of type 2 diabetes was 78.6% and of type 1 was 21.4%, most were female (type 1 63%, type 2 66%). Diabetes in relatives was type 1 47%, type 2 28%. First degree relatives were more involved than other relatives. Parents were more involved than others, specialy mothers (P=0.0006 in type 1 DM and P=0.001 in type 2). In mothers transmitions to daughters was more than sons (type 1 P=0.001, type 2 P=0.00004). Prevalence of diabetes in relative of type 1 diabetes is more than type 2 and females are more involved than males. Diabetes in parents especialy in motheres was than other relatives. Transmition from mothers to daugthers was more than sons (type 1 diabetes P=0.001, type 2 P=0.00004). Genetic transmition in Iranian people is different from other countries and more studies can be done in this area.
M. Mashayekhi, R. Azimi, B. Sadeghian,
Volume 8, Issue 23 (6-2001)
Volume 8, Issue 23 (6-2001)
Abstract
The goal of this study was detection of common predisposing factors for diabetic ketoacidosis, which can be a guide for prevention. Also to know, complications and rate of mortality which can be a guide to know difficulties in treatment. This study was descriptive and sampling was in convennience method. About 50 patients were studied in Firooz Abadi Hospital during 1993-1998. Analysis of informations was with Chi-Square (X2-test) method. Common etiology was related to using drugs 52%, infection 26%, unknown 12% and unawarness of disease 10%. Complication were hyperkalemia 24%, hyperkalemia11%, resistance to insulin 4%, cardiac complications 20%, GI bleeding 8%, hypoglycemia 8%, renal failure 6%, adult respiratory distress syndrom (ARDS) 2% and disseminated intravascular coagulations (DIC) 6%.
Other complications were rare. Mortality was 18% and was significant in older age (P = 0.01), in septicemia and pneumonia as the etiologies of the condition (P = 0.002, P = 0.003 respectively) and in some types of complications (like cardiac complications, DIC, ARDS, renal failure) and also in multiple complications. Therefore most common predisposing factor for diabetic ketoacidosis is incorrect use of drug, specialy discontinuing insulin. Most common complications is hypokalemia and hyperkalemia and cardiac complications. In some complications like cardiac, DIC, ARDS and renal failure, mortality were significant.
M. Mashayekhi, H. Alizadeh, F. Davoudi,
Volume 9, Issue 32 (3-2003)
Volume 9, Issue 32 (3-2003)
Abstract
Goiter (diffused or focal enlargement of thyroid), is one of the most frequent complaints referred to endocrinologists. Goiter is evaluated for thyroid function & anatomical from of the gland. Understanding distribution of patients among different groups, & their signs & symptoms will help to choose a better diagnostic & therapeutic approach. Possible differences of patients characteristics in different geographic regions, & lack of sources related to our country were causes to design the study bellow. A retrospective, observational, cross-sectional study was conducted to assess the function & anatomical form of thyroid in patients with goiter. 1000 patients were selected through systematic randomization from those categorized as goiter in institute of endocrinology & Metabolism. All data about age, sex, state of thyroid function & anatomical forms, in addition to sign & symptoms were collected & analyzed with SPSS 9.50 (α-0.05, POWER=90%, CI=0.95). Mean, SD, Chi ^ 2 & One Way ANOVA were used in statistical analysis. Total mean age was 26.95±0.72. 88.9% were females & 11.1% were males 78.21% of patients were Euthyroids, 20.68 were hyperthyroids & 1.1% hypothyroids. There was a significant difference in mean of age among different groups according to TFT (P=0.0000). 60.74% of patients presented with simple goiter, 11.84 with multinodular nontoxic goiter, 13.95% with diffused toxic goiter, 3.71% with toxic multinodular goiter, 5,62% with a cold nodule & 2.51% with a hot nodule. There was a significant difference in mean of age among different groups according to goiter form (p=0.0000). 91.01% of euthyroid patients, 81.95% hyperthyroids & 100% of hypothyroids were female & the other members of each group were males. 80.2% of females were euthyroids, 18.55% hyperthyroids & 1.2% hypothyroids. 65.2% of males were euthyroids & 34.5% were hyperthyroids. There was a significant difference for sex among different groups according to TFT (p=0.002) & goiter form (p=0.0000). There was no significant difference for staging of goiter among different groups according to TFT (p=0.153) & goiter form (p=0.212) (power=90%). Palpitation was the most frequent sign among euthyroids (25.16%) & hyperthyroids (59.2%). Weakness was the most frequent sign among hypothyroids. There was a significant difference for sign & symptoms among different groups according to TFT (p=p.pppp). The majority of patients were euthyroids then hyperthyroids & hypothyroids. Simple diffused goiter, then diffused toxic goiter & non-toxic multinodular goiter were the most frequent forms of goiter. Low mean of age & higher prevalence of heperthyroidism compared to hypothyroidism is due to endemic Iodine deficiency. Higher hyperthyroidism ratio in men compared to women & the higher prevalence of multinoduar goiters need more studies to find the underling cause. Since euthyroidism is the most goiters need more studies to find the underling cause. Since euthyroidism is the most prevalent state of functions & there is a significant difference for sign & symptoms among different groups it is recommended to pay more attentions to clinical signs of patients before requesting TFTs. So that waste of money & laboratory sources is avoided.
L Haghighi, A.r Akbarian, M Mashayekhi,
Volume 11, Issue 42 (12-2004)
Volume 11, Issue 42 (12-2004)
Abstract
The role of Nitric oxide in myometrial function is known and Nitric oxide donors are used for prevention of preterm delivery during recent years. This research was conducted as RCT during 14 months in Shahid Akbar Abadi Hospital. 150 pregnant women with live and singletone pregnancies in the 34-37th week of gestation and with preterm uterine contractions were randomly divided into two groups: case(isosorbide dinitrate) and control(no medication) group. Age, gestational age, parity, cervical dilatation and effacement were the same in both groups. Based on the obtained results it was found out that isosorbide dinitrate(ISD) was effective for prevention of preterm delivery at least for 48 hours(P<0.0001). ISD had no adverse effect on 1 and 5 minute Apgar score. The mean time from initiation of ISD to suppression of uterine contractions was 3.291±1 hours. Side effects of ISD were hypotension(7.4%), headache(4.9%) and tachycardia(2.5%). On the basis of these findings, it can be concluded that ISD is a good choice for prevention of preterm delivery because of its low cost and side effects as well as its easy usage.
M Mashayekhian, S Abbasi, D Farsi, M Jafarinadushan, H Saeedi, M Zare,
Volume 17, Issue 77 (11-2010)
Volume 17, Issue 77 (11-2010)
Abstract
Background: Pneumothorax may be associated with penetrating or blunt chest traumas' that need early diagnosis and treatment. Today the diagnosis modalities are CXR and CT-Scan that are not suitable for unstable patients. Chest sonography can be a fast diagnostic method at patient bedside. The purpose of this study was to evaluate the accuracy of bedside ultrasonography in diagnosis of pneumothorax.
Methods: In this prospective study, 60 cases suspicious of pneumothorax were included in study. Bedside ultrasonography was performed for all the cases. Sonography site was between parasternal and midclavicular lines in 2nd to 4th intercostals spaces of both thoracic sites and performed between 5-10 respiratory cycles. Gold standard results for definite diagnosis were: positive results of chest X ray, chest CT scan and/or air leak after needle or tube thoracostomy. In suspicious results, CT scan was done. Data were analyzed accordingly with statistic tests of “Chi-Square” and “Fisher’s Exact Test”. SPSS V.12 was also used.
Results: Trauma mechanism in 5 cases (8.3%) was stab wound, and in 53 cases(88.3%) multiple trauma there was 1 case of tuberculosis and 1 case of blunt chest trauma as well. Eleven out of the 12 pneumothorax cases (proven by chest Xray or CT scan) were diagnosed by bedside sonography. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of bedside ultrasonography for diagnosis of pneumothorax were 91.6%, 100%, 100%, 97.9% and 98.6%, respectively.
Conclusion: With respect to the results of this study and previous studies, bedside ultrasonography is a good method for diagnosis of pneumothorax.
Leyla Bahadorizadeh, Sara Minaeian, Reyhaneh Taheri Tinjani, Fatemeh Shamlou Mahmoudi, Fatemeh Khazaie, Laleh Alidoust, Farzaneh Mashayekhi, Yousef Alimohamadi,
Volume 28, Issue 4 (7-2021)
Volume 28, Issue 4 (7-2021)
Abstract
1. Pourkazemi A, Farashbandi H, Balu H. Epidemiological study of nosocomial infections and antibiotic resistance patterns In Guilan. Yafteh. 2019;21(1).
2. Darvishi M, Forootan M, Nazer MR, Karimi E, Noori M. Nosocomial Infections, Challenges and Threats:A Review Article. Iran J Med Microbiol. 2020;14(2):162-81.
3. Khan HA, Baig FK, Mehboob R. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pac J Trop Biomed. 2017 May 1;7(5):478-82.
4. Tolera M, Abate D, Dheresa M, Marami D. Bacterial nosocomial infections and antimicrobial susceptibility pattern among patients admitted at hiwot fana specialized university hospital, Eastern Ethiopia. Adv Med. 2018 Dec 4;2018.
5. Despotovic A, Milosevic B, Milosevic I, Mitrovic N, Cirkovic A, Jovanovic S, et al. Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, andrisk factors for acquisition and mortality. Am J Infect Control. 2020.
6. Puchter L, Chaberny IF, Schwab F, Vonberg R-P, Bange F-C, Ebadi E. Economic burden of
nosocomial infections caused by vancomycin-resistant enterococci. Antimicrob Resist Infect Control. 2018;7(1):1-7.
7. Metersky ML, Kalil AC. New guidelines for nosocomial pneumonia. Curr Opin Pulmonary Med. 2017 May 1;23(3):211-7.
8. Stiller A, Schröder C, Gropmann A, Schwab F, Behnke M, Geffers C, Sunder W, Holzhausen J, Gastmeier P. ICU ward design and nosocomial infection rates: a cross-sectional study in Germany. J Hosp Infect. 2017 Jan 1;95(1):71-5.
9. Ang H, Sun X. Risk factors for multidrug‐resistant Gram‐negative bacteria infection in intensive care units: A meta‐analysis. Int J Nurs Pract. 2018;24(4):e12644.
10. Chia PY, Sengupta S, Kukreja A, Ponnampalavanar SSL, Ng OT, Marimuthu K. The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms. Antimicrob Resist Infect Control. 2020;9(1):29.
11. Siwakoti S, Subedi A, Sharma A, Baral R, Bhattarai NR, Khanal B. Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal-a prospective cohort study. Antimicrob Resist Infect Control. 2018;7(1):114.
12. Zeinali Aghdam S, Minaeian S, Sadeghpour Karimi M, Tabatabaee Bafroee AS. The antibacterial effects of the mixture of silver nanoparticles with the shallot and nettle alcoholic extracts. J Appl Biotechnol Rep. 2019 Dec 5;6(4):158-64.
13. Lepape A, Jean A, De Waele J, Friggeri A, Savey A, Vanhems P, et al. European intensive care physicians’ experience of infections due to antibiotic-resistant bacteria. Antimicrob Resist Infect Control. 2020;9(1):1-11.
14. Khoshfetrat M, Keykha A, Sedaghatkia M, Farahmandrad R. Determination of Antibiotic Resistance Pattern of Organisms Isolated from Endotracheal Tube Cultures of Patients Admitted to Intensive Care Unit. Arch Anesthes Crit Care. 2020 Aug 18.
15. Hemmati A, Nikoonejad AR, Lotfollahi L, Jahed S, Nejad Rahim R, Nabizadeh E. Antibacterial resistance pattern of microorganisms isolated from posetive blood cultures at ICUs of Imam Koeinihospital. J Urmia Univ Med Sci. 2016;27(6):533-40.
16. Khashei R, Navabi Z, Mohebi S, Samadi N. Antibiotic Resistance Among Escherichia coli,Pseudomonas aeruginosa and Acinetobacter baumannii Isolates Obtained From Shiraz Nemazi Hospital ICU Wards. Iran J Med Microbiol. 2018;12(4):294-300.
17. Salehifar E, Abedi S, Mirzaei E, Kalhor S, Eslami G, Ala S, et al. Profile of Microorganisms Involved in Nosocomial Pneumonia and Their Antimicrobial Resistance Pattern in Intensive Care Units of Imam Khomeini Hospital, Sari, 2011-2012. J Mazandaran Univ Med Sci. 2013.
18. Bayani M, Siadati S, Rajabnia R, Taher AA. Drug resistance of Pseudomonas aeruginosa and Enterobacter cloacae isolated from ICU, Babol, Northern Iran. Int J Mol Cell Med. 2013;2(4):204.
19. Molazade A, Gholami MS, Shahi A, Najafipour S, Mobasheri F, Ashraf Mansuri J, Jafari S. Evaluation of Antibiotic Resistance Pattern of Isolated Gram-Negative Bacteria from Urine Culture of Hospitalized patients in Different Wards of Vali-Asr Hospital in Fasa During the Years 2012 and 2013. J Fasa Univ Med Sci. 2014 Sep 1;4(3).
20. Xie J, Roberts JA, Lipman J, Cai Y, Wang H, Zhao N, et al. Pharmacokinetic/pharmacodynamic adequacy of polymyxin B against extensively drug-resistant Gram-negative bacteria in critically ill, general ward and cystic fibrosis patient populations. Int J Antimicrob Agents. 2020 Jun;55(6):105943.
21. Jeannot K, Bolard A, Plesiat P. Resistance to polymyxins in Gram-negative organisms. Int J Antimicrob Agents. 2017;49(5):526-35.
22. Velkov T, Dai C, Ciccotosto GD, Cappai R, Hoyer D, Li J. Polymyxins for CNS infections: pharmacology and neurotoxicity. Pharmacol Ther. 2018;181:85-90.
Ali Hosseininasab, Mojgan Pouramini, Hossein Ghaedamini, Habibeh Ahmadipour, Niloofar Kalantarinejad, Salman Farahbakhsh, Narges Mashayekhi,
Volume 30, Issue 2 (4-2023)
Volume 30, Issue 2 (4-2023)
Abstract
Background & Aims: Sepsis is the principal cause of death in the first months of life and leads to 30-50% of infant mortality in developing countries (1). The prevalence of sepsis is reported differently in many countries. In developed countries, the prevalence of sepsis is 1-4 per 1,000 live births, while in poor and developing countries it is almost ten times higher (2). Neonatal sepsis leads to 25.2% of all neonatal deaths in Iran (3). The clinical signs of neonatal sepsis are nonspecific and may be mixed with non-infectious disorders such as aspiration syndrome and respiratory distress syndrome (4,5). The most important factor in reducing infant mortality from sepsis is appropriate and quick treatment (6).
On the other hand, the clinical signs of affected infants, including decreased neonatal reflexes, bradycardia, hypo/hyperthermia, respiratory distress, seizures, weakness and lethargy, apnea, and abdominal distension, are not sensitive enough to definitively diagnose sepsis. Blood tests and immunological tests also have less sensitive and specific compared to blood culture (7). Since sepsis is one of the most important causes of mortality and disability in the neonatal stage, with early diagnosis and treatment of the disease and improving the quality of care during delivery, neonatal survival can be increased, the clinical signs, predisposing factors, laboratory findings, treatment and outcome of neonates with the diagnosis of sepsis who admitted to Afzalipour hospital in Kerman were evaluated.
Methods: This was a descriptive and cross-sectional study. The statistical population was all infants admitted to Afzalipour Hospital in Kerman from 2015 to 2017.The sample size was determined with the census method (sample size = 200 infants). Infants with Complete Blood Count (CBC), arterial gas measurement, C Reactive Protein (CRP), blood and urine cultures, and Cerebrospinal fluid (CSF) were included in the present study. All neonates with a diagnosis other than sepsis were excluded from the study. Based on clinical and laboratory findings, neonates were classified into three groups:
On the other hand, the clinical signs of affected infants, including decreased neonatal reflexes, bradycardia, hypo/hyperthermia, respiratory distress, seizures, weakness and lethargy, apnea, and abdominal distension, are not sensitive enough to definitively diagnose sepsis. Blood tests and immunological tests also have less sensitive and specific compared to blood culture (7). Since sepsis is one of the most important causes of mortality and disability in the neonatal stage, with early diagnosis and treatment of the disease and improving the quality of care during delivery, neonatal survival can be increased, the clinical signs, predisposing factors, laboratory findings, treatment and outcome of neonates with the diagnosis of sepsis who admitted to Afzalipour hospital in Kerman were evaluated.
Methods: This was a descriptive and cross-sectional study. The statistical population was all infants admitted to Afzalipour Hospital in Kerman from 2015 to 2017.The sample size was determined with the census method (sample size = 200 infants). Infants with Complete Blood Count (CBC), arterial gas measurement, C Reactive Protein (CRP), blood and urine cultures, and Cerebrospinal fluid (CSF) were included in the present study. All neonates with a diagnosis other than sepsis were excluded from the study. Based on clinical and laboratory findings, neonates were classified into three groups:
- Infants who had positive blood culture sepsis in addition to clinical and laboratory findings.
- Neonates who had only laboratory and clinical findings of sepsis but their blood culture was negative.
- Infants who had clinical signs of sepsis but were negative for laboratory findings and blood culture.
All infants were treated with antibiotics immediately after the tests. Clinical and laboratory findings as well as the type of antibiotic and maternal and neonatal risk factors were collected using a checklist. Outcomes of treatment were expressed as improvement and discharge, complications, and death. The collected data were analyzed using SPSS software version 25 (version 25, SPSS Inc., Chicago, IL). Quantitative data were presented as Mean ± SD (standard deviation) and frequency and percentage.
Results: The highest age of infants was related to the birth group (91%). 59.5% of infants were male and 40.5% were female. The mean duration of admission was 9.76. 1.05 days. The most common clinical signs were tachypnea (74%), poor nutrition (36%), apnea (32%), and hypo/hyperthermia (25%) respectively. The results showed that 91.5% of participants used ampicillin, 93% of them gentamicin, 84% of them used vancomycin, 52% of them used meropenem, 18.5% of them used metronidazole, 19.5% of them used amikacin, 18 % of them took cefotaxime, 19% of them used fluconazole, 1% of them used clindamycin and 1.5% of them used ceftazidime
Regarding the frequency distribution of risk factors, the results showed that 23.5% of participants had PROM (Premature rupture of Membrane), 11 % had maternal urinary tract infection, 12 % had maternal fever and 91.5% had low birth weight. The results showed that the mortality rate for participants was 78% and the rate of discharge and recovery was 22%. The results showed that the mean number of white blood cells was 16.468 ± 0.103 × 103 و and the mean CRP of the participants was 22.6 ± 2.8. The results of this study also showed that 14.5% of participants had positive blood cultures and 85.5% of them had negative blood cultures.
Conclusion: Systemic and local infections are very common in infants. Sepsis is a systemic response to infection and is divided into early, late and nosocomial types (17).
The results showed that 59.5% of the participants who had early sepsis were male and 40.5% of them were female, which is consistent with the results of Khalili et al. (13). While in the textbooks, the incidence of male infants is twice as high as female infants (18). In the study of Arab Mohammadi et al., 60% of patients were boys and 40% were girls. In this study, the most common clinical symptoms were tachypnea (74%), hypo/hyperthermia (25%), and tachycardia (5%), respectively, which is consistent with the results of Hengst et al. (10) while it is not similar to the results of Khalili et al. (13), Santana et al. (9) and Vergnano et al. (14). In other textbooks, the most common clinical symptoms are fever, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, and cyanosis (19). In the study of Shiva et al. (20), a total of three symptoms of tachycardia, tachypnea, hypothermia had a sensitivity of 53.6% and a specificity of 100% in identifying sepsis with positive blood culture. In the study of Arab Mohammadi et al. (21), hyperthermia, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, lethargy, and cyanosis were reported as the most common symptoms of sepsis.
Investigation of 500 infants suspected of sepsis, temperature instability, and respiratory symptoms were the most common symptoms. The results showed that 14.5% of the participants had positive blood cultures and 85.5% of them had negative blood cultures. This rate (positive blood culture) was 15.4% for the study of Khan et al (22). This rate was 14% in the study of Manucha et al. (23) in India. The reason for the lack of positive blood culture is neonatal SEPSIS is one of the diseases in which the actual number of cases is much less than the number of suspected cases and laboratory-related problems also play an important role in this results (24). The prevalence of sepsis with positive blood culture has been reported in the study of Shiva et al. 25% (20), Samaei et al. 41% (25), and Hosseini et al. The results showed that the mean CRP of the participants in our study was 22.6. 2.8. According to textbooks, if CRP is performed in combination with other tests, it is effective in screening for sepsis, but if used alone as a primary test to look for infection, it helps in less than 10% of definite diagnoses (26, 27). CRP sensitivity has been reported from 46 to 74% in various studies (28). In the meta-analyzes about this subject, the first time CRP sensitivity was 39%, CPR specificity was 92.5%, positive predictive value was 53.2% and negative predictive value was 93.6%. Therefore, it seems that the serum level of CRP for the first time at the time of admission in infants suspected of early neonatal sepsis in the neonatal intensive care unit (NICU) has no value in determining sensitivity (29). In the study by Zecca et al, the negative predictive value of CRP was 100% (30 %). A study by Cetinkaya et al on 100 infants suspected of having early neonatal sepsis showed that the diagnostic power of CRP increased over time and peaked 24 to 48 hours after the onset of sepsis, which is consistent with our study (31). Therefore, if serum CRP levels remain negative 24 hours after the onset of clinical symptoms, the high negative predictive value is 99%, and antibiotic therapy can be discontinued in the absence of strong clinical suspicion of sepsis (32).
Results: The highest age of infants was related to the birth group (91%). 59.5% of infants were male and 40.5% were female. The mean duration of admission was 9.76. 1.05 days. The most common clinical signs were tachypnea (74%), poor nutrition (36%), apnea (32%), and hypo/hyperthermia (25%) respectively. The results showed that 91.5% of participants used ampicillin, 93% of them gentamicin, 84% of them used vancomycin, 52% of them used meropenem, 18.5% of them used metronidazole, 19.5% of them used amikacin, 18 % of them took cefotaxime, 19% of them used fluconazole, 1% of them used clindamycin and 1.5% of them used ceftazidime
Regarding the frequency distribution of risk factors, the results showed that 23.5% of participants had PROM (Premature rupture of Membrane), 11 % had maternal urinary tract infection, 12 % had maternal fever and 91.5% had low birth weight. The results showed that the mortality rate for participants was 78% and the rate of discharge and recovery was 22%. The results showed that the mean number of white blood cells was 16.468 ± 0.103 × 103 و and the mean CRP of the participants was 22.6 ± 2.8. The results of this study also showed that 14.5% of participants had positive blood cultures and 85.5% of them had negative blood cultures.
Conclusion: Systemic and local infections are very common in infants. Sepsis is a systemic response to infection and is divided into early, late and nosocomial types (17).
The results showed that 59.5% of the participants who had early sepsis were male and 40.5% of them were female, which is consistent with the results of Khalili et al. (13). While in the textbooks, the incidence of male infants is twice as high as female infants (18). In the study of Arab Mohammadi et al., 60% of patients were boys and 40% were girls. In this study, the most common clinical symptoms were tachypnea (74%), hypo/hyperthermia (25%), and tachycardia (5%), respectively, which is consistent with the results of Hengst et al. (10) while it is not similar to the results of Khalili et al. (13), Santana et al. (9) and Vergnano et al. (14). In other textbooks, the most common clinical symptoms are fever, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, and cyanosis (19). In the study of Shiva et al. (20), a total of three symptoms of tachycardia, tachypnea, hypothermia had a sensitivity of 53.6% and a specificity of 100% in identifying sepsis with positive blood culture. In the study of Arab Mohammadi et al. (21), hyperthermia, jaundice, respiratory distress, hepatomegaly, anorexia, vomiting, lethargy, and cyanosis were reported as the most common symptoms of sepsis.
Investigation of 500 infants suspected of sepsis, temperature instability, and respiratory symptoms were the most common symptoms. The results showed that 14.5% of the participants had positive blood cultures and 85.5% of them had negative blood cultures. This rate (positive blood culture) was 15.4% for the study of Khan et al (22). This rate was 14% in the study of Manucha et al. (23) in India. The reason for the lack of positive blood culture is neonatal SEPSIS is one of the diseases in which the actual number of cases is much less than the number of suspected cases and laboratory-related problems also play an important role in this results (24). The prevalence of sepsis with positive blood culture has been reported in the study of Shiva et al. 25% (20), Samaei et al. 41% (25), and Hosseini et al. The results showed that the mean CRP of the participants in our study was 22.6. 2.8. According to textbooks, if CRP is performed in combination with other tests, it is effective in screening for sepsis, but if used alone as a primary test to look for infection, it helps in less than 10% of definite diagnoses (26, 27). CRP sensitivity has been reported from 46 to 74% in various studies (28). In the meta-analyzes about this subject, the first time CRP sensitivity was 39%, CPR specificity was 92.5%, positive predictive value was 53.2% and negative predictive value was 93.6%. Therefore, it seems that the serum level of CRP for the first time at the time of admission in infants suspected of early neonatal sepsis in the neonatal intensive care unit (NICU) has no value in determining sensitivity (29). In the study by Zecca et al, the negative predictive value of CRP was 100% (30 %). A study by Cetinkaya et al on 100 infants suspected of having early neonatal sepsis showed that the diagnostic power of CRP increased over time and peaked 24 to 48 hours after the onset of sepsis, which is consistent with our study (31). Therefore, if serum CRP levels remain negative 24 hours after the onset of clinical symptoms, the high negative predictive value is 99%, and antibiotic therapy can be discontinued in the absence of strong clinical suspicion of sepsis (32).
Mohsen Jafari, Maryam Mashayekh, Arslan Khan Mohammadi Otaqhsara,
Volume 30, Issue 7 (10-2023)
Volume 30, Issue 7 (10-2023)
Abstract
Background & Aims: In today's world, attention-deficit/hyperactivity disorder can be considered one of the most numerous and unknown childhood disorders, which has three characteristics impulsivity, attention deficit, and hyperactivity. The purpose of this research was to compare the effectiveness of cognitive rehabilitation and sensory integration training on the attention and impulsivity of hyperactive students referring to educational and clinical centers in District 5 of Isfahan City. Therefore, due to the high prevalence of these behaviors in children and adolescents and the lack of comprehensive understanding of these behaviors in Iranian culture and the current generation's Western treatment and disproportion with our culture, it is necessary to provide an effective and low-cost intervention. Considering that few efforts have been made in this field in Iran and most of the efforts remain limited to superficial and untested techniques; therefore, it is necessary to improve the behavioral and cognitive characteristics of hyperactive students with the use of interventions based on new and tested approaches to achieve educational goals. Given that a wide range of cognitive and psychiatric research has been conducted to investigate the effectiveness of Various treatments that have been used to improve the symptoms of this disorder and conflicting findings have been obtained in this field; It is necessary to carry out research to determine which of the treatment methods can be considered more effective for the treatment of people with hyperactivity disorder in the scope of current scientific developments.
Methods: The current research was a semi-experimental study with a pre-test and post-test design with a control group with three stages of evaluation (pre-test, post-test, and follow-up). The statistical community of all students referring to the educational and clinical centers of Isfahan city in the third quarter of 1400, 200 people who met the entry criteria, responded to the Connors parent questionnaire (hyperactivity). 45 people out of 60 people qualified to enter the study were selected as a sample and were randomly placed in three groups, during three stages of evaluation, Connors Parent Questionnaire, Continuous Performance Test (CPT), Wisconsin Card Classification Test (WCST), Barat impulsivity scale and numeric span subscale of Wechsler IQ scale for children-revised form answered. In this plan, after selecting the subjects, they were randomly replaced into three groups, experimental group (1), experimental group (2), and control group. Then, before the implementation of the independent variable (1) (cognitive rehabilitation), and the independent variable (2) (sensory integration method), the subjects selected in all three groups were measured using a pre-test (attention, impulsivity). Experimental group 1 was exposed to the independent variable (cognitive rehabilitation) experimental group 2 was exposed to the independent variable (sensory integration method) and independent variables (cognitive rehabilitation and sensory integration) were not implemented in the control group. In the end, dependent variables (attention, impulsivity) were measured in all three groups using a post-test. One month later, all three groups were re-evaluated.
Results: The results of descriptive statistics and inferential statistics (multivariate covariance analysis, covariance analysis with repeated measures) with the help of spss-26 statistical software showed that the average age of the students participating in the research in the cognitive rehabilitation groups 10.33, sensory integration 9.86 and control 10.46 years old. Also, the results showed that there is a difference between the effectiveness of cognitive rehabilitation and sensory integration training on attention, and impulsivity, in three groups (the effectiveness of cognitive rehabilitation training, sensory integration, and control group) in the post-test and follow-up of hyperactive students. There is a significant difference between the intervention groups and the control group, but there is no difference between the intervention groups (cognitive rehabilitation training and sensory integration) post-test and follow-up in terms of the effect on attention.
Conclusion: Students with hyperactivity/attention deficit often face problems with attention and impulsivity. The treatment of sensory integration and cognitive rehabilitation by involving different senses, paying attention reducing impulsivity, and performing game-type activities causes coherence and organization in the central nervous system of the brain and controls and regulates the processing of senses and behavior management. The results have shown that there is a significant difference in the impulsivity variable and its components, i.e., cognitive impulsivity, motor impulsivity in the post-test phase and the follow-up phase. After examining and comparing the two groups using the Bonferroni test, the results have shown that the null hypothesis is confirmed and the negative hypothesis is rejected. Also, the results show that there is no significant difference between the two groups of cognitive rehabilitation and sensory integration in the post-test and follow-up stages in cognitive impulsivity, movement, and lack of planning. In other words, according to what has been mentioned in the explanation of these findings, it can be said that taking into account that in the cognitive rehabilitation approach, attention is paid to the compensation and repair of cognitive damage, it can be expected that children with hyperactivity due to lack of Concentrating on one subject and scattering the senses around different axes of aggression occurs, so it is expected that children cannot focus their attention. Therefore, in cognitive rehabilitation training, by repairing the mentioned damages and compensating them as a result of changes in habits and environment, these changes lead to improvement of impulsivity levels in children. Also, the approach of sensory integration helps to improve cognitive and perceptual problems in children with hyperactivity by focusing children's senses retrieving information in different ways, and helping children to organize information received from different senses. In other words, it can be expected that both of the proposed approaches can control the neurological level and perceptual damage, cause more concentration in hyperactive children, and reduce impulsivity in these children. Reducing cognitive impulsivity through sensory integration and increasing concentration, as well as reducing hyperactive activities, leads to a decrease in motor impulsivity, and thus leads to better planning in these vulnerable children.
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