---

Background and purpose: Wild rats are considered as an important spreading factor of contamination in urban areas. During recent years, the wild rats were extensively distributed in Tehran. Therefore, it is important to investigate the antibiotic resistance of enteric bacteria isolated from rats, because of the possibility of antibiotic resistance transmission to human. The aim of this study was to investigate the antibiotic resistance rate of Ënterobacteriaceae among wild rats living in densely populated areas of Tehran city.
Materials and methods: Forty wild rats were trapped in the North, South, Ëast, West and Çentral areas of Tehran and transferred to the laboratory alive. Çecum was obtained and its contents were cultured aseptically. Ântibiotic susceptibility of isolated was determined by disk diffusion method.
Results: Ëscherichia coli (10 isolates), Salmonella typhimurium (7 isolates), Shigella sonnei (1 isolate), Proteus mirabilis (3 isolates), Çitrobacter freundii (17 isolates), and Ënterobacter (4 isolates) were isolated from rats. Ântibiotic resistance was very high in all isolated species of Ënterobacteriaceae.
Çonclusion: The results showed that the rats from the study areas of Tehran city harbored antibiotic resistant pathogenic bacteria such as Salmonella and Shigella in their cecal contents. These organisms may be important reservoirs for transmission of drug-resistant bacteria to human. Therefore, it is very important to control the rat populations and to improve sewage management systems.

---

Background and purpose: Hyperglycemia leads to some complications in traumatic patients and its control could improve the patient's prognosis. In this study the prevalence of hyperglycemia and its effects were investigated in patients with multiple traumas. Materials and methods: In this cross-sectional study the blood glucose levels of 472 multiple trauma patients attending emergency department at Imam Hossein Hospital were measured in June-Oct 2010. Diabetic patients were excluded. SPSS ver.16 was applied to analyze the data. Results: The incidence of posttraumatic hyperglycemia in multiple trauma victims was 20%. There was a significant relationship between posttraumatic hyperglycemia and presence of fracture (FX). However, no significant correlation was observed between hyperglycemia and age, sex, mechanism of trauma, and site of trauma. Moreover, this study found a significant correlation between hyperglycemia and intracranial bleeding. Conclusion: Considering high rate of posttraumatic hyperglycemia and previous findings on controlling and improving the patient’s prognosis, we recommend checking the blood glucose level of trauma patients` on arrival, particularly among those suspected of having FX. However, further studies are needed to investigate this issue in other traumas.

---

Visceral leishmaniasis (VL) or kala-azar is a parasitic disease caused by Leishmania donovani complex. Evidence suggests that visceral leishmaniasis is prevalent in some areas of Mazandaran and Golestan provinces. This study aimed to investigate the cases and also determining the causative agents of VL in these provinces. In this study, seven VL patients (mean age 1.5 years) admitted to the pediatric departments in Sari Booali Sina and Gorgan Taleghani hospitals, 2013–2016, were examined. The most common clinical and laboratory findings included prolonged fever, hepatosplenomegaly, anemia, pancytopenia, and hypergammaglobulinemia. Blood and bone marrow (B.M) samples were taken. Direct agglutination test (DAT) and rapid rK39 strip test were used as serologic tests and B.M microscopic slides were checked by species-specific PCR to identify the parasite species. All patients had positive rK39 and DAT tests. Examination of bone marrow smears demonstrated amastigotes of Leishmania (Leishman bodies) in the samples. The species of Leishmania in all B.M smears was Leishmania infantum. According to the identification of L. infantum as the major agent of VL in Mazandaran and Golestan provinces, increasing physician awareness (especially pediatric specialists) of the disease and conducting control programs in these areas are recommended.

---

Background and purpose: Hepatitis B virus (HBV) is considered to be one of the most important etiological factors of liver complication around the world. Interactions of host immune responses with HBV have a crucial role in the outcome of the infection. IL12 is an important pro-inflammatory cytokine that stimulates natural killer cells and T-lymphocytes to produce IFN-γ, promotes T-helper 1 responses, and expands CD8+cytotoxic T-cell activity. These unique properties of IL12 indicate that it might play an important role in control and clearance of HBV. In addition, single nucleotide polymorphisms (SNPs) are presumed to be linked to differential production of cytokines levels. This study investigated the association of IL12B rs6887695 G/C polymorphism with chronic HBV infection.
Materials and methods: Genotypes distribution of IL12B rs6887695 was determined in 120 chronic HBV infected patients and 120 healthy controls using polymerase chain restriction fragment length polymorphism (PCR-RFLP) method between 2013 and 2015.
Results: The frequencies of rs6887695 GG, GC and CC genotypes in the patients with chronic infection were 56.7%, 36.7% and 6.6%, respectively and in healthy controls were 51.7%, 42.5%, and 5.8%, respectively. No statistically significant difference was detected in IL12B rs6887695 genotypes between the patients and controls (P =0.65).
Conclusion: IL12 plays an essential role in immune response against HBV infection; however, present findings suggest that IL12B rs6887695 SNP was not associated with chronic HBV in the Iranian population studied.

---

Background and purpose: There are various clinical forms of cutaneous leishmaniasis (CL) and there is lack of access to diagnostic local laboratories especially in endemic regions. The present study aimed to conduct molecular examination of the typical and atypical clinical forms of CL in endemic area of Bam, Iran.
Materials and methods: This cross-sectional study was carried out between 2013 and 2014. The diagnosis was performed by direct smears from skin lesions, Giemsa staining, and microscopic examination. Total DNA was extracted from positive and negative direct smears. PCR method was used to determine the genus and species of Leishmania. 
Results: In this study, 353 suspected cases of CL in Bam Health Center were investigated of whom 278 (78.7%) were positive by microscopic examination. Forty skin smears from typical lesions were positive by both PCR and microscopic examinations, but out of 40 skin smears from atypical lesions which were negative by microscopic observation, Leishmania DNA was detected in 6 (15%) samples. Leishmania tropica was identified in all positive samples.
Conclusion: In current study, microscopy method was not found reliable enough for diagnosis of CL. Therefore, for early diagnosis of the disease PCR is recommended in negative smears of patients suspected of CL.
 

---

Background and purpose: Postoperative pain management would result in increased patient’s satisfaction and decreases their problems. This survey was performed to determine the efficacy of premedication with dextromethorphan and gabapentin alone or in combination, for postoperative pain management in anterior cruciate ligament and posterior cruciate ligament knee arthroscopy with general anesthesia.
Materials and methods: In a randomized clinical trial, 114 patients under anterior cruciate ligament and posterior cruciate ligament knee arthroscopy with general anesthesia were randomly assigned to receive either dextromethorphan or gabapentin alone or in combination. The intensity of pain was assessed by numeric rating scale (NRS). Analgesic use and Ramsay score were compared among the three groups.
Results: In this study, the pain (P=0.0001) and analgesic use (P=0.004) were significantly lower in patients who had received the combination of dextromethorphan and gabapentin.
Conclusion: According to current study, premedication with combination of dextromethorphan and gabapentin is superior to each one alone for postoperative pain management in anterior cruciate ligament and posterior cruciate ligament knee arthroscopy with general anesthesia.
 
(Clinical Trials Registry Number: IRCT20141127020112N9)

---

Background and purpose: Methicillin resistant Staphylococcus aureus (MRSA) have recently emerged as major causes of urinary tract infection (UTI). The aims of this study were to determine antibiotic susceptibility of S. aureus isolated from UTI and to detect the presence of mecA (causing resistance to methicillin) and SCCmec types.
Materials and methods: In this cross sectional study, 44 S. aureus isolates were collected in autumn 2017 from patients with UTI in two hospitals in Sanandaj, west of Iran. Susceptibility rates to nine antibiotics and vancomycin were determined by disk diffusion method and E test, respectively. The mecA and SCCmec types were detected by polymerase chain reaction (PCR). Descriptive statistics were used to evaluate the data.
Results: Vancomycin, linezolid, and trimethoprim-sulfamethoxazole showed the highest susceptibility rates (more than 90%), followed by gentamicin (86.4%), cefoxitin (79.5%), tetracycline (77.3%), clindamycin (75%), ciprofloxacin (70.4%), erythromycin (52.3%), and penicillin (6.8%). The isolates from inpatients were more susceptible to antibiotics compared to those from outpatients. Of the 44 isolates, 9 (20.5%) were MRSA, of which 6 were isolated from outpatients. Five of 9 MRSA isolates carried the mecA gene, and of these, two isolates harbored SCCmec V while three were nontypeable.
Conclusion: Our study suggests that trimethoprim-sulfamethoxazole, vancomycin or linezolid would be suitable agents in treatment of UTI caused by MRSA. Identification of an MRSA isolate in urine is a serious concern and highlights the need for monitoring drug resistance in S. aureus.
 

---

Background and purpose: Delirium is a disruption of consciousness and cognitive function that frequently occurs in the postoperative period. The incidence of delirium following open-heart surgery has been reported to exceed 90%, potentially leading to delays in extubation among patients admitted to the intensive care unit (ICU). Ketamine, an anesthetic agent with distinct pharmacological properties, may influence the prevention or management of postoperative delirium. However, its precise role in this setting remains unclear and warrants further investigation.
Materials and Methods: This narrative review aimed to investigate delirium and extubation time in patients undergoing coronary artery bypass grafting (CABG) surgery. A systematic search was conducted across databases including Scopus, Web of Science, PubMed, Cochrane Library, and Google Scholar, using MeSH terms and relevant keywords covering the past decade. Inclusion criteria consisted of randomized clinical trials, cohort studies, and meta-analyses that addressed postoperative delirium and/or extubation time in CABG patients.
Results: This review analyzed 11 key domains, including: the definition of delirium, its epidemiology, and pathophysiology; risk factors for delirium following cardiac surgery; the relationship between postoperative pain control and delirium; the association between sedation levels and delirium after cardiac surgery; complications arising from postoperative delirium; optimal dosing and timing of ketamine administration during cardiac surgery; the effect of ketamine on extubation time; the association between extubation time and postoperative complications; and factors influencing extubation timing.
Conclusion: Evidence suggests that ketamine may offer benefits in reducing postoperative delirium following cardiac surgery, particularly due to its anti-inflammatory properties. However, it does not appear to significantly influence extubation time. The heterogeneity among existing studies and the absence of standardized protocols limit the generalizability of these findings. Future research should focus on randomized, controlled trials with standardized methodologies to better evaluate ketamine's role in this context.