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Background & objectives: Methicillin-resistant Staphylococcus aureus is one of the most common causes of nosocomial infections.  The polysaccharide adhesion mechanism encoded by the ica operon generates a direct role in biofilm formation and infection of the bacteria. The aim of this study was to evaluate the frequency of icaA gene in Staphylococcus aureus isolates isolated from clinical specimens of patients admitted to some clinical centers of Rasht.
Methods: This descriptive, cross-sectional study was performed on 100 Staphylococcus aureus isolates from some clinical centers of Rasht in 2019 and confirmatory tests were performed to identify the bacteria. icaA gene identification and its frequency were investigated using molecular methods . The antibiotic resistance pattern against 10 antibiotics and biofilm-forming ability of the isolates were determined using the disk diffusion method and Congo red method respectively.
Results: In the present study, among the 100 studied isolates, the highest drug resistance was related to penicillin, and the lowest antibiotic resistance was belonged to ciprofloxacin. 81 isolates (81%) were resistant to methicillin and 37 isolates (37%) had multiple resistance. Of 37 isolates with multiple resistances, 32 isolates (86.48%) had icaA gene and 24 isolates (64.9%) ،had the ability to produce strong biofilms.
Conclusion: According to the findings of this study, the prevalence of Staphylococcus aureus isolates carrying icaA gene with strong biofilm forming ability and resistance to methicillin, were high. This necessitates the need for serious management of antibiotic administration.

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Background & objectives: Endoscopy is an invasive and painful procedure. The use of sedatives, especially in children, is expanding. The aim of this study was to compare the sedative effects of ketofol and the combination of midazolam-ketamine in upper endoscopy in children aged 1 to 14 years who referred to Taleghani Hospital in Gorgan.
Methods: In this study, 55 children entered the study 1 to 14 years after obtaining parental consent. They were then divided into two groups, ketamine-propofol (KP) and ketamine-midazolam (KM), by simple randomization. At all stages of the work, patients underwent cardiac and respiratory monitoring. All hemodynamic parameters and ramsy sedation score (RSS) were recorded for all participants in the 5 time periods before, during and after endoscopy. ANOVA test and bonferroni tracking test were used in spss software to analyze and compare data.
Results: 54.5% were male patients. The ANOVA test showed that the scores of the two groups at the time of the study had a statistically significant difference (p=0.02). In the KM group, the mean blood pressure and heart rate of patients increased at all times compared to before the intervention (p=0.005). Blood pressure in the KP group had a steady trend over time (p<0.001).
Conclusion: There was a statistically significant difference between the scores of the two groups and the group (KM) had higher scores, but the use of two drug regimens Propofol-Ketamine and Ketamine-Midazolam caused a good sedation in pediatric endoscopy. The propofol-ketamine compound resulted in greater hemodynamic stability in cardiovascular parameters during and after endoscopy

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Neuroarthropathy occurs following the loss of pain sensation in a joint. Martin Charcot was the first researcher who explained this strange, non-infectious destruction of bone and joints. This disease mostly affects the lower extremity of patients, especially their feet and ankle. In this paper, we present a rare case of simultaneous neuroarthropathy in the wrist and ankle of a 39-year-old man with no history of diabetes. Simultaneous neuroarthropathy of two joints and its occurrence in uncommon parts of the body like the wrist is quite rare and might lead to misdiagnosis and incorrect treatment.
 

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Background & Objective: Bleeding is a common complication during heart surgery, and management of heparin and protamine consumption during operation affects hemeostasis. The dosage of protamine sulfate is variable based on the amount of heparin used and studies have reported different results. The aim of this study was to evaluate the effect of protamine sulfate administration after cardiac surgery on the drainage of the patient's blood secretions.
Methods: In this retrospective cross- sectional study, required data from 120 medical records patients, from 2011 to 2020 undergoing heart surgery, for example CABG, was extracted and examined. Patients were grouped (60 people in each group) and compared based on protamine sulfate intake and not receiving it, in the intensive care unit and body mass index, age, sex, ACT values ​​and blood drainage rate.
Results: 76 (63.37%) patients were male and 44 (36.66%) patients were female. Most patients were in the age range of 50-70 years and most patients were overweight. Blood drainage in the protamine group was significantly lower than the control group. There was no statistically significant difference between the two groups in terms of ACT values. Blood drainage in the protamine group was significantly lower in normal BMI and overweight individuals than in the control group. The amount of blood drained in the protamine group in women and in people over 70 years was significantly lower than the control group.
Conclusion: despite previous studies, our study showed a reduction in the amount of postoperative bleeding following re-prescribing of protamine sulfate in the intensive care unit, which eliminated the effect of heparin and the coagulation disorder caused by heparin. The limitations of the present study included patients under 12 years of age, patients weighing more than 120 kg, and patients requiring hypothermia treatment less than 28 Cº.