Background Nosocomial infections and persistence of multidrug resistant biofilm forming Acinetobacter baumannii in hospitals has made it as a serious problem in healthcare settings worldwide. Methods A total of 100 A. baumannii clinical isolates from immunocompromised patients hospitalized in ICU were investigated for biofilm formation, the presence of biofilm related genes ( bap, ompA, csuE, fimH, epsA, bla PER-1 , bfmS, ptk, pgaB, csgA, kpsMII ), integron characterization and molecular typing based on REP-PCR. Results All isolates were resistant to three or more categories of antibiotics and considered as multidrug resistant (MDR). A total of 32 isolates were resistant to all tested antibiotics and 91% were extensively drug-resistance (XDR). All isolates were able to produce biofilm and 58% of isolates showed strong ability to biofilm formation. All strong biofilm forming A. baumannii isolates were XDR. All A. baumannii isolates carried at least one biofilm related gene. The most prevalent gene was csuE (100%), followed by pgaB (98%), epsA and ptk (95%), bfmS (92%) and ompA (81%). 98% of isolates carried more than 4 biofilm related genes, simultaneously. Class I integron (67%) was more frequent in comparison with class II (10%) ( P < 0.05). The REP-PCR patterns were classified as 8 types (A-H) and 21 subtypes. The A1 (23%) and C1 (15%) clusters were the most prevalent among A. baumannii isolates ( P < 0.05). According to the REP-PCR patterns, 23% of all isolates had a clonal relatedness. Conclusion Our study revealed the high frequency of biofilm forming XDR A. baumannii in ICU patients, with a high prevalence of biofilm related genes of csuE and pgaB. It seems that the appropriate surveillance and control measures are essential to prevent the emergence and transmission of XDR A. baumannii in our country.

Background Respiratory failure and hypoxemia are the known complications of anesthesia and surgery. As a major surgery mainly at advanced ages, the coronary artery bypass graft (CABG) surgery could lead to hypoxemia in the early post-operative phase. Currently, the fraction of partial pressure of arterial oxygen to the fraction of inspired oxygen (PiO 2 /FiO 2 ) is used to determine the severity of the respiratory assault. Objectives This study aimed to find the effect of hypoxemia measured by PaO 2 /FiO 2 at the first hour following CABG in the determination of short-term prognosis of CABG. Methods Being approved by a local ethics committee, this observational cross-sectional study was conducted in 212 patients undergoing CABG on the cardiopulmonary pump, with no concurrent surgery or other cardiac pathologies. Factors like age, sex, weight, height, the duration of pump and cross-clamp, as well as other medical conditions including chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), opioid use, ejection fraction (EF), and creatinine clearance (CrCl) before the surgery were brought into consideration as possible confounders. The ratio of PiO 2 /FiO 2 in the first hour after the surgery was measured, and its effect on intubation time and intensive care unit (ICU) length of stay was evaluated as the primary outcomes. The t -test and chi-squared were used to compare quantitative and qualitative variables, respectively. The repeated measures ANOVA test was used to compare the means. Results There was no significant relationship between hypoxemia measured as the ratio of PaO 2 /FiO 2 and the duration of ICU length of stay (P value = 0.220) and the total intubation time (P value = 0.661). Among the qualitative variables, just opium addiction in patients with PaO 2 /FiO 2 > 300 was associated with significantly longer intubation time (P value = 0.016). Furthermore, in the quantitative variables, longer intubation time was associated with higher cross-clamp time (P value = 0.035) in hypoxemia in the range of ARDS patients. Conclusions Hypoxemia after the CABG surgery is common and does not affect the short-term prognosis of CABG patients.

Purpose: Parkinson's Disease (PD) is a neuro-degenerative interminable issue causing dynamic loss of dopamine-creating synapses, which is one of the most far reaching ailments after Alzheimer's infection. In this paper, a system for the classification of Parkinson’s disease tremor using noninvasive measurement and frequency domain features is represented. Materials and Methods: Tremor time-series of Parkinson's disease patients were recorded via a smartphone’s accelerometer sensor. Short-Time Fourier Transform (STFT) was applied to transform the time-domain signal into the frequency domain with high time-frequency resolution. Several frequency features, including mean, max of power spectral density and side frequency have been extracted and by using the FDR algorithm combinations of features carried enough information to reliably assess the severity of tremor in Parkinson patients were determined. Results: Four different classifiers were implemented to estimate the severity of tremors based on the Unified Parkinson's Disease Rating Scale (UPDRS) in Parkinson's disease patients. Conclusion: Classifiers’ estimation was compared to clinical scores derived via neurologist UPDRS annotation on Parkinson's disease patients’ tremor. The best accuracy achieved was 95.91±1.51.

Background: Occult hepatitis B infection (OBI) is defined as the lack of detectable HBsAg in serum, despite the presence of intrahepatic viral DNA, and low levels of covalently closed circular DNA (cccDNA). Since the hemodialysis patients are at a greater disadvantage if they are a carrier of Hep B, as it can lead to OBI this study was designed to determine the prevalence of OBI in hemodialysis patients residing in Zanjan, Iran. Methods: We conducted an anti-HBc test (ELISA) on 166 HBsAg negative hemodialysis patient samples. OBI was evaluated using seropositive (anti-HBc and/or anti-HBs) and seronegative (anti-HBc and anti-HBs) using nested PCR. Results: Out of the total hemodialysis patients sampled, the study consisted of 58.4% male and 41.6% female participants. The age of the study group ranged from 58.89±15.49, and had received approximately 28.27±27.43 years of dialysis. Additionally, 5.4% of patients had a history of blood transfusions, while 58.4% were vaccinated against the hepatitis B virus (HBV). Moreover, 23.5% patients were anti-HBc positive, while 76.5% patients tested negative. Lastly, 66.3% of the patients were positive for anti-HBs, whereas 33.7% were negative for anti-HBs. Overall, the study revealed that the prevalence of OBI was 6%, and HBV DNA was detected in 2.1% of individuals who were vaccinated against hepatitis B (p < 0.01). Conclusions: Though no significant difference between the prevalence of OBI to the patients' age, sex, duration of dialysis, or history of blood transfusion was identified, however, a strong correlation between the prevalence of OBI to HBV vaccination was found.

Background: Acute hypoxemia is the main characteristic of acute respiratory distress syndrome (ARDS), which is one of the most critical complications of coronary artery bypass grafting (CABG). Given the dearth of data on acute hypoxemia, we sought to determine its prevalence and risk factors among post-CABG patients. Methods: This cross-sectional study was conducted on on-pump CABG patients in Tehran Heart Center in 2 consecutive months in 2012. The effects of arterial blood gas variables, age, gender, the duration of the pump and cross-clamping, the ejection fraction, the creatinine level, and the body mass index on the prevalence of hypoxemia at the cutoff points of ARDS and acute lung injury were assessed. Results: Out of a total of 232 patients who remained in the study, 174 (75.0%) cases were male. The mean age was 60.60±9.42 years, and the mean body mass index was 27.15±3.93 kg/m2. None of the patients expired during the current admission. The ratio of partial pressure arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) 1 hour after admission to the intensive care unit (ICU), before extubation, and at 4 hours after extubation was less than 300 mmHg in 66.6%, 72.2%, and 86.6% of the patients and less than 200 mmHg in 20.8% 17.7%, and 30.2% of the patients, respectively. Among the different variables, only a heavier weight was associated with a PaO2/FiO2 ratio of less than 300 mmHg at 1 hour after ICU admission and at 4 hours after extubation (P=0.001). A rise in the cross-clamp time showed a significant association with the risk of a PaO2/FiO2 ratio of less than 200 mmHg at 4 hours after extubation (P=0.014). Conclusion: This study shows that hypoxemia following CABG is very common in the first 48 postoperative hours, although it is a benign and transient event. The high prevalence may affect the accuracy of the ARDS criteria and their positive or negative predictive value.   J Teh Univ Heart Ctr 2019;14(2):74-80   This paper should be cited as: Yousefshahi F, Samadi E, Paknejad O, Movafegh A, Barkhordari K, Bastan Hagh E, Dehestani B. Prevalence and Risk Factors of Hypoxemia after Coronary Artery Bypass Grafting: The Time to Change Our Conceptions. J Teh Univ Heart Ctr 2019;14(2):74-80.