Journal of Kerman University of Medical Sciences
Year:2010 | Volume:17 | Issue:1|Papers Count:14

Background & Aims: The anti TNFa drugs are new line treatment for articular inflammatory diseases which are used systemically, but due to expensiveness and some systemic adverse effects have limited usage. The aims of this study were to investigate the effect of intra-articular (local) injection of Etanercept and Infliximab as two anti TNFa drugs on histopathology and also due to the important role of joint blood flow on joint performance, to investigate the effect of local infusion of these drugs on blood flow of chronically inflamed joints.Method: Forty two NZW rabbits underwent chronic knee joint inflammation by antigen induced arthritis method and then were randomly assigned into histopathology and blood flow groups. Each group was divided into 3 subgroups: vehicle (normal saline), Etanercept and Infliximab. In the first group, 2 weeks after intraarticular injection of antigen either 4 mg Etanercept, 16 mg Infliximab or o.5 ml vehicle was injected into the joint and after 2 weeks microscopic sections of knee joints were assessed for synovial membrane hyperplasia, villus hyperplasia, inflammatory cell infiltration and pannus formation. In the second group, 4 weeks after intraarticular injection of antigen, either 4 mg Etanercept, 16 mg Infliximab or vehicle was locally infused into articular atrery. Systemic blood pressure via carotid artery canulla and joint blood flow (JBF) by Laser Doppler Flowmeter were recorded.Results: Intraarticular injection of Etanercept and Infliximab had no significant effect on histopathological indices of inflammation. Etanercept increased JBF by 63.8±16.1% and decreased JVR by 42.2±4.4%. Infliximab, too, increased JBF by 70.6±16.1.1% and decreased JVR by 38.7 ±6.3%. The drugs had no effect on arterial blood pressure. Conclusion: Although not significantly effective on histopathlogical indices, Etanercept and Infliximab seem to improve prognosis of chronic joint diseases such as rheumatoid arthritis through blood flow enhancement and hypoxia diminution.

Background and aims: Cutaneous leishmaniasis (CL) is still a health problem in the world, including Iran where its cases have significantly increased in recent years. The objective of this study was to assess a new focus of anthroponotic CL in rural communities after the earthquake in Bam district.Method: After the report of the provincial health authorities, this study has been carried out in the summer of 2008 in Dehbakry region, Bam district, Kerman province in southeastern Iran.Results: Overall, 3884 individuals consisting of 1913 females (49.3%) and 1971 males (50.7%) were physically examined for the presence of active lesions or scars. The overall prevalence rate was 5.3%; 6.3% in females and 4. 3% in males with no significant difference. Most of the infection was in age group £10 years (9.3%) and the lowest in 21-30 year group (2.9%). The prevalence rate was significantly (P<0.001) higher in native residents (4.1%) than in non_natives (1.1%). Most of the lesions were on the face (47%), and hands (34%). The majority (78%) had one lesion. Most of the cases had occurred during 2006. PCR technique revealed all 26 examined cases as Leishmania tropica.Conclusion: All the cases have occurred after the earthquake and simultaneously with epidemic condition in the city of Bam. Traveling from endemic areas of Bam to this locality could be the main factor for establishment of this new ACL focus.

Background & Aims: Tuberculosis is one of the most important causes of mortality in the world and if it is not treated, 50 – 65% of patients would die in five years. Chest X-ray has an important role in the diagnosis of TB and early diagnosis and treatment prevent tuberculosis transmission. In this study we evaluated radiologic manifestations of patients with smear positive pulmonary tuberculosis in Zabol.Method: In this cross – sectional study, 325 patients with smear positive pulmonary tuberculosis from March 2004 to March 2005 were evaluated. Radiologic findings were recorded in a questionnaire and analyzed.Results: From 325 patients with smear positive pulmonary tuberculosis, 116(35.7%) were male and 209(64.3%) were female.The most frequent involved site was left upper lobe [175(53.8%)] followed by right upper lobe [134(41.2%)]. The most frequent radiologic finding was bronchopneumonia with 242 cases (74.4%). Patchy consolidation in 99 patients (30.4%), cavitary lesion in 68 ones (20.9%) and pleural effusion in 35 patients (10.7%) were observed. In 8 cases (2.4%) CXRs were normal. After six months treatment and according to CXRs, 90 patients (27.7%) recovered completely, 169 cases (52%) had slight recovery and 66 patients (20.3%) did not have any changes.Conclusion: Pulmonary upper lobes were the most frequent involved sites. Since pulmonary TB has different radiologic manifestations and chest X-ray has an important role in the early diagnosis and preventing transmission, careful attention to radiologic manifestations especially in upper lobes and considering TB as one of the differential diagnosis are highly recommended.

Background & Aims: Plant extracts and plant-derived compounds are valuable sources of new medicinal agents that are commonly used to treat infectious diseases. The purpose of this study was to evaluate, anti- Leishmanial activity of three plant extracts on L.major promastigotes by colorimetric assay as compared to a trivalent antimonial compound (tartar emetic). Methods: Leishmania major promastigotes were cultured at 25±2°C in stationary phases in RPMI-1640 medium supplemented with 10% heat inactivated fetal calf serum (FCS) and antibiotic. Then by using MTT assay, the biological activity of plant extracts in comparison to potassium antimonyl tartrate [Sb (III)] on L.major promastigotes were assessed. The optical density (OD) due to cleavage of the tetrazolium salt MTT [3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide] into a colored product formazan by the parasite was measured using ELISA reader and IC50 values (50% inhibitory concentrations) were determined. All experiments were repeated in duplicate.Results: plant extracts and Tartar emetic inhibited the growth of promastigote forms of L.major in vitro after 72 hours of incubation. IC50 of tartar emetic was 4.7 mg/ml, and IC50 values for Zataria multiflora Boiss, Peganum harmala and Myrtus communis extracts were 7.4, 7.2 and 5.8 mg/ml, respectively. Although tartar emetic was more effective than plant extracts, all extracts had profound effects on promastigotes of L.major.Conclusion: Since, plant extracts of Zataria multiflora Boiss, Peganum harmala and Myrtus communis have anti-Leishmanial effects in vitro, further works are required to evaluate the exact effect of these extracts on Leishmania agents in animal models.

Background & Aims: Iron deficiency anemia is the most common kind of anemia in childhood. Iron supplements that are usually prescribed for the treatment stain teeth. The purpose of this study was an in vitro comparison of the adsorption rate of iron onto incisor primary teeth after exposure to three different Iron drops (Darupakhash, Fer–In– Sol, Shahredaru).Methods: This study was performed on sixty intact primary incisor teeth in two stages with one week interval. In each stage thirty teeth were examined. The teeth in each stage were divided into three groups and each group was exposed to one kind of Iron drop. The rate of Iron adsorption was measured by Atomic Absorption system. ANOVA (Kruskal – wallis)_test was used for statistical analysis. Results: There was a significant difference among three types of Iron drops in adsorption of Iron (P<0.001). Fer–In–Sol had the least and darupakhash had the highest adsorption rate. Conclusion: Although all three Iron drops cause stain on primary incisor teeth, there is a significant difference among them.

Background & Aims: This study aimed to translate Parkinson Disease Quality of Life (PDQL) Questionnaire into Persian and test its reliability and validity in Iranian patients with Parkinson disease.Method: In order to standardize the questionnaire, a standard "Forward-Backward" translation, cognitive debriefing and cultural adaptation procedure were applied and the English version of PDQL was translated into Persian, the official language in Iran. Subjects were 108 patients with Parkinson referred to Motaharri Clinic in Shiraz. Demographic and epidemiological data concerning the disease stage were recorded. The reliability of the questionnaire was assessed by Koronbach`s alpha coefficient. Construct validity was assessed through factor analysis. Convergent and discriminate validity were assessed by spearman's correlation coefficient. Data were analyzed by SPSS 15.Results: In whole, 67 males (62.03%) and 41 females (37.97%) with Parkinson and mean ±SD age of 64.9±11.73 participated in this study. Koronbach`s alpha was 0.95. The range of convergent validity was 0.42-0.83 and that of discriminate validity was 0.15-0.70. The range of factorial analysis load was 0.119- 0.801.Conclusion: The Persian version of the PDQL Questionnaire has a good structure. It is a reliable and valid instrument and can be used for measuring the effect of Parkinson on the quality of life.

Background & Aims: Hospitals as the largest and most costly operational units in health care system have special importance. The rate of their efficiency can be used as a criterion for the measurement of performance and productivity of resource consumption in hospitals. The purpose of this study was to determine the technical efficiency of general hospitals of Kerman University of Medical Sciences.Methods: This study is a descriptive - analytic study in which the efficiency of general hospitals in Kerman University of Medical Sciences, including 13 teaching hospitals was determined by using Data Envelopment Analysis (DEA). Data and relevant Statistics were collected from statistics office of the University and Deap2.1 software was used to achieve the objectives of the research. Then the hypotheses of the research were studied by using SPSS software.Results: The average technical efficiency of studied hospitals in 2007 was 0.912, managerial efficiency was 0.993 and mean scale efficiency was 0.918. In regard to technical efficiency, 7 hospitals had the maximum technical efficiency (1), 4 hospitals had 0.8–1 efficiency and 2 hospitals had the technical efficiency of less than 0.8. Conclusion: In hospitals with technical efficiency of less than one, the optimal and initial values for staff differed and had personnel surplus. Therefore these hospitals should decrease their initial values for staff in order to achieve the expected optimal performance.

Background & Aims: The quality of interaction between mother and infant has an important role in the formation of infant's personality, social and cognitive functions, temperament and mental health in future.The quality of this reaction is not predictable and can be improved along the time. Thus, Knowing effective variables in this area can be very beneficial in its improvement.Method: In the present research, 30 infants whose mothers were mentally normal based on General Health Questionnaire were compared with 30 infants of mothers who were not healthy by Infant Behavior Questionnaire. These two groups were compared in negative affectivity, surgency/extraversion and orienting/regulation.Results: After using independent t-test, all three hypotheses of the study were proved with the significant level of a=0.05. The most effect of mother's mental health was on orienting/regulation and then on surgency/extraversion and negative affectivity. In the next stage, comparing all 14 temperament items separately showed that except for items of fear, perceptual sensivity, activity level and duration of orienting, two groups have significant difference in other items.Conclusion: Mother's mental health significantly affects infant temperament. These findings in agreement with past results indicate that mother's mental distress in pregnancy period and after this period can have long lasting effects on child's process of evolution and temperament.

Acquired Megacolon is a rare disease that usually presents in elderly people and there have been only few reported cases in literature. In this article we report a 24-year-old woman who had referred with chronic intermittent epigastric pain from 4-5 years ago and also chronic constipation and distension of upper abdominal part. Clinical examinations and imaging studies (chest x-ray, barium enema) showed dilatation of colon with unknown border. She underwent laparatomy surgery with primary diagnosis of partial colon obstruction. Several biopsies were taken from dilated and collapsed parts. Microscopic findings showed destruction of ganglion cells in dilated areas and normal ganglion cells in collapsed parts. At the second operation dilated parts were resected and end to end anastomosis of collapsed parts was done. The patient was discharged in good general condition. About 77 days after operation, the patient was examined again in order to following up. She was in a very good physical condition and had a weight gain about 20 pounds.

Mal de Meleda is a rare autosomal recessive transgredient keratoderma .Onset is in early childhood, and the development of hyperkeratosis is preceded by erythema. Patches of waxy ivory-yellow hyperkeratosis extend across the whole palms and soles, and on to the dorsal surfaces of hands and feet. Similar lesions of knees and elbows may develop.We describe an 18 year old man with the diagnosis of Mal de Meleda who shows the typical Gloves and Socks presentation, hyperhidrosis and fibrotic bands (Pseudoainhum) in many of the fingers and toes.

The American Heart Association (AHA) has provided new guidelines for infective endocarditis prophylaxis in dentistry. In this paper, written for dentists, major changes in the updated recommendations which dentists should be aware have been discussed. These recommendations address the impact of oral hygiene and type of dental procedures on high-risk patients, risk of adverse reactions of antibiotic therapy, precise administration of antibiotics, underlying cardiac conditions and dental Procedures for which, endocarditis prophylaxis is reasonable for patients.