Avicenna Journal of Clinical Medicine
Year:2018 | Volume:24 | Issue:4 (SN 86) |Papers Count:13

Background and Objective: Cumulus cells regulate oocyte maturation through bilateral communication during follicular growth. Expression of disintegrin-like and metalloproteinase with thrombospondin type I motifs-1 (ADAMTS-1) is essential for structural remodeling during the follicle growth, to maintain normal granulosa cell layers in the follicles. Since limited studies have been performed on this issue, we aimed to evaluate the expression of ADAMTS-1 in human cumulus cells and the possible correlation between ADAMTS-1 expression and oocyte maturity.Materials and Methods: Fifty infertile women aged 18-40 years undergoing in vitro fertilization (IVF) were recruited. The participants had tubal obstruction and/or their partners were diagnosed with male factor infertility. Cumulus cells were obtained immediately after the isolation of cumulus-oocyte complexes. Adamts-1 and β-actin mRNA expression levels were measured using quantitative real-time polymerase chain reaction (qRT-PCR).Results: PCR results showed expression of ADAMTS-1 in cumulus cells. qRT-PCR demonstrated an increased expression of ADAMTS-1 in cumulus cells of mature oocyte compared to the vesicle-stage (GV) oocyte (P=0.02). It is worth mentioning that 5.14 was considered the cut-off point for determining the false and true negative results. Moreover, sensitivity and specificity of the ADAMTS-1 were 90% and 67%, respectively (an area under the ROC curve of 0.8).Conclusion: ADAMTS-1 expression was remarkably lower in GV oocytes than the mature ones, and it can be considered as a specific biomarker in cumulus cells separated from oocytes for determining the rate of oocyte maturation.

Background and Objective: Correct and early diagnosis of infections contributes to proper treatment and helps prevent unnecessary antibiotic treatment. Thus, we aimed to compare the predictive values of the absolute neutrophil count, band count, and toxic granulation of neutrophils with the serum levels of C-reactive protein (CRP) in bacterial infections.Materials and Methods: In this descriptive cross-sectional study, we enrolled 200 patients who were admitted to the infectious disease ward of Sina Hospital, Hamadan, Iran, for bacterial infections in the first 6 months of 2016. The participants were chosen using the census sampling method. Before initiating the treatment, to carry out complete blood count (CBC) and quantitative CRP, 5 cc blood was obtained from the patients after obtaining their permission, and the percentages of neutrophils, band cells, and toxic granulation were evaluated in peripheral blood smear. This information and demographic data were collected by a checklist and analyzed by using SPSS, version 16.Results: The mean age of the patients was 56.26 years (range: 12 to 103 years), and 60.5% of the participants were male. The most frequent causes of hospitalization were pneumonia, soft tissue infections, sepsis, urinary tract infection, septic arthritis, and dysentery. The means of serum CRP, absolute neutrophil count, and band-cell count were 61.18 mg/L, 815.86 per mm3, and 318.86 per mm3, respectively. The correlation coefficients between quantitative CRP and absolute neutrophil count, band count, and toxic granulation severity were 0.43, 0.47, and 0.47, respectively.Conclusion: The results of the present study shows a linear correlation between CRP and the absolute neutrophil count, band count, and toxic granulation, indicating that these variables can replace CRP in the diagnosis of infections. Also, the predictive values of toxic granulation and band count for replacing CRP are equal and higher than that of absolute neutrophil count.

Background and Objective: AmpC -type beta-lactamases have been implicated in group C of Amber, which includes EBC, CIT, MOX, FOX, DHA, and ACC. The active presence of these plasmid genes in clinical isolates of P. aeruginosa has resulted in resistance to a wide range of antibiotics. Therefore, we aimed to determine the minimum inhibitory concentrations (MIC) of different antibiotic groups in clinical isolates of P. aeruginosa carrying AmpC enzyme and study their relationship pattern.Materials and Methods: In this descriptive study, the MIC of 95 P. aeruginosa isolates was determined using E-test for cefocytosine, cefpodoxime, cefotaxime, ceftazidime, ciprofloxacin, colicitin, aztreonam, and ceftriaxone antibiotics (Liofilchem, Italy). Multiplex polymerase chain reaction was used to amplify and identify plasmid genes. The Chi-squared test was used to determine the relationship between variables.Results: Of the 95 P. aeruginosa isolates, 95 (100%) isolates were resistant to cefoxitin, 79 (83.5%) isolates to cefpodoxime, 2 (2.1%) isolates to ceftazidime, 87 (81.57%) isolates to ceftriaxone, and 22 (23.15%) isolates were resistant to aterranum, but none of the isolates was resistant to colistin. In addition, 21 (22.1%) isolates had FOX gene, 13 (11.57%) isolates had AAC gene, 7 (36.6%) isolates had MOX gene, 4 (21.4%) isolates had CIT gene, 2 (2.1%) isolates had DHA gene, and 1 (1.05%) isolate had EBC gene. It is worth mentioning that there was a significant relationship between the presence of plasmid genes and antibiotic resistance (level of significance: P£0.05).Conclusion: The presence of the genes encoding the AmpC enzyme can provide the ground for resistance to a broad range of antibiotics.

Background and Objective: Gingivitis is the most common inflammatory gingival disease, which is characterized by redness, swelling, and bleeding and can be induced by local factors, such as dental plaque. The management or prevention of this disease can be accomplished by the aid of teeth scaling, medications (e.g., non-steroidal anti-inflammatory drugs), and health education. Today, the use of medicinal herbs has been considered in the preparation of many drugs. Regarding this, the present study aimed to investigate the effect of a green tea extract mouthwash on plaque-induced gingivitis.Materials and Methods: This double-blind clinical trial was conducted on 50 patients suffering from plaque-induced gingivitis within the age range of 18-60 years. The study population was selected using the table of random numbers, and then divided into two groups of case and control. The case group used green tea mouthwash, while the control group utilized chlorhexidine mouthwash. The plaque index (PI; Loe and Silness), gingival index (GI; O' Leary), and bleeding index (BI) were measured at the baseline, as well as one and two months later. Data analysis was performed in SPSS (version 22) by paired sample t-test and repeated measures test.Results: According to the results, each study group showed a significant difference in terms of the PI, GI, and BI (P<0.001). However, there was no significant difference in the PI and BI in the second month, compared to the first month. Regarding the GI, the case group showed no significant difference in the second month, compared to the first month. Nonetheless, the control group showed a statistically significant difference in terms of GI in the second month, compared to the first month (P=0.023). The two groups showed no significant difference in terms of the PI, GI, and BI.Conclusion: As the findings indicated, similar to the use of chlorhexidine mouthwash, green tea mouthwash, along with hygiene education (including brushing three times a day and using dental floss), can be effective in the treatment of bleeding caused by gingivitis, reduction of plaque, and mitigation of gingival inflammation.

Background and Objective: Preoperative anxiety affects outcomes of anesthesia and surgery. Hypotension is a common and major complication after spinal anesthesia, which may delay post-anesthetic care unit (PACU) discharge, prolong hospital stay, and increase the cost of hospitalization. Thus, we sought to determine the effect of pre- and intraoperative anxiety on hemodynamic changes after spinal anesthesia in cesarean section.Materials and Methods: This descriptive analytical study was carried out among 100 patients admitted to Fatemieh Hospital of Hamadan in 2016. The participants were chosen through convenience sampling method. Spielberger’s questionnaire and Visual Analogue Scale were used for assessing preoperative and intraoperative anxiety, respectively. Spinal anesthesia was performed using hyperbaric bupivacaine 10 mg and fentanyl 25 mg. Blood pressure and heart rate were measured at baseline, during surgery, and in the recovery room. Hypotension was treated by the standardized protocol (fluid bolus and ephedrine). The effects of low, medium, and high levels of anxiety were investigated. The data were analyzed by performing Pearson correlation coefficient, Chi-squared test, and Fisher's exact test in SPSS, version 18.Results: Most of the patients had moderate anxiety level. There were no significant relationships between state and trait anxiety and hypotension and bradycardia (P³0.05). In addition, there were no significant associations between intraoperative anxiety and hypotension (P=0.275) and bradycardia (P=0.404).Conclusion: Pre- and intraoperative anxiety have no effect on hemodynamic changes in patients undergoing spinal anesthesia.

Background and Objective: Domestic violence during pregnancy poses the mothers to physical and mental health problems in the future. The aim of this study was to evaluate the effect of domestic violence on postpartum depression among the women referring to the healthcare centers in Rey city, Iran.Materials and Methods: This descriptive-analytical, cross-sectional study was conducted on 120 females referring to the healthcare centers of Rey city in 2016. The study population was selected through convenience sampling technique. The data were collected using a questionnaire including three parts, including demographic information (10 items), Edinburgh Postnatal Depression Scale, and standard questionnaire of domestic violence. Data analysis was performed in SPSS software (version 22) using t-test and Pearson correlation coefficient.Results: There was a significant positive association between physical violence and postpartum depression (P<0.05). However, postpartum depression showed no significant association with economic and psychological violence (P>0.05).Conclusion: As the findings indicated, physical violence could lead to the enhancement of postpartum depression among the women. Therefore, it is essential to take some measures targeted toward the reduction of physical violence by using appropriate educational and interventional approaches and encouraging the healthcare workers to establish an intimate relationship with the pregnant women.

Background and Objective: Despite the speed and accuracy of cell counting devices in the analysis of blood samples, several confounding factors may influence their outcomes. This study was performed to assess the effect of hyperlipidemia patterns on the results of complete blood cell count (CBC).Materials and Methods: This analytical study (case-control) was performed among 306 non-diabetic and non-anemic patients, who were divided into five groups: 1) cholesterol above 200 mg/dl, 2) cholesterol above 200 mg/dl and low-density lipoprotein (LDL) over 130 mg/dl, 3) cholesterol 200 mg/dl and normal LDL, 4) triglycerides above 150 mg/dl, and 5) cholesterol above 200 mg/dl and triglycerides above 150 mg/dl. The blood cell count and indices were compared with the control group. After obtaining samples from the participants, the level of blood lipids and complete blood cell count were measured. Finally, statistical analysis and comparison between the two groups were performed with SPSS, version 20.Results: Comparison between the case and control groups separately in each of the five groups showed the following results: 1- White blood cell (WBC) and platelet count (PLT) in the group with high cholesterol level were significantly higher than the control group (P<0.05).2- WBC and PLT in the group with high cholesterol and LDL levels were significantly higher than the control group (P<0.05).3- WBC in the group with high cholesterol and normal LDL levels was significantly higher than the control group (P<0.05).4- Red blood cell (RBC), mean corpuscular volume, and mean corpuscular hemoglobin concentration in the group with high triglycerides were significantly higher than the control group (P<0.05).5- RBC, WBC, and PLT in patients with high cholesterol and triglyceride levels were higher than the control group (P<0.05).Conclusion: Our study showed that hyperlipidemia patterns clearly increased blood cell count and indices. Therefore, hyperlipidemia patterns should be considered as a confounding factor in the interpretation of complete blood cell count.

Background and Objective: Trichomoniasis is one of the most common non-viral sexually transmitted infections worldwide. Thus, we aimed to determine the prevalence of this infection among women in Bahar city, Iran, and evaluate drug susceptibility of the isolated parasites.Materials and Methods: This cross-sectional study was conducted on 850 females visiting the health centers of Bahar city, during 2016. The diagnosis of Trichomonas vaginalis infection was carried out by using wet mount and Dorset culture medium. In the next step, the obtained parasites were transferred to Diamond Medium and after the preparation of their pure cultures, they were placed under laboratory and aerobic conditions to test their drug sensitivity.Results: Four (0.5%) isolates of T. vaginalis were obtained from the participants. Drug sensitivity of the isolates after 48 h ranged between 1.6 and 25 mg/ml, with the mean and standard deviation of 12.6±8.26 mg/ml.Conclusion: We found that the prevalence of trichomoniasis in the studied women in this region is lower than most parts of Iran. Due to the importance of this infection, this prevalence rate is significant and needs proper diagnosis and treament.

Background and Objective: Diabetic peripheral neuropathy (DPN) is a common sequela of diabetes. Late diagnosis of DPN may result in ulcer and amputation of the lower limbs. Electrodiagnostic (EDX) testing is the golden standard for DPN assessment. However, due to the limitations of EDX testing, the estimation of EDX indices using a regression model is of utmost importance. Herein, we sought to determine the correlation between compound muscle action potential (CMAP) amplitude of extensor digitorum brevis muscle following peroneal nerve stimulation and HbA1C in type-II diabetic patients.Materials and Methods: From among 730 diabetic females, we enrolled 33 patients with the mean age, weight, height, body mass index (BMI), fasting blood sugar (FBS), and HbA1C of 48.30±7.36 years, 69.68±8.38 kg, 1.59±0.07 m, 27.32±3.24 kg/m2, 180.94±52.09 mg/dl, and 8.65±0.28%, respectively. Using EMG/NCV 4000S system, the amplitude of CMAP of extensor digitorum brevis (EDB) muscle following the stimulation of peroneal nerve was quantified. Then, using HbA1C and BMI as predictor variables, stepwise multiple regression analysis was performed in SPSS 22 to estimate CMAP amplitude. P-value less than 0.05 was considered statistically significant.Results: Only HbA1C was entered into the equation. The regression equation was=9.354+ (-0.638) * HbA1C. Multiple adjusted R2 showed that HbA1C could explain 34% of the variations in CMAP amplitude of EDB. g¢ Conclusion: HbA1C variable can predict EDX indices. Timely diagnosis of DPN by regression equations in physician’s office can reduce diabetes complications through early initiation of treatment.

Background and Objective: According to the high incidence of Klebsiella pneumoniae nosocomial infections in different wards of health care units and the emergence of high levels of antibiotic resistance, evaluating the frequency of multi-drug resistant strains and recognizing the virulence factors may help treat the related infections.Materials and Methods: In this descriptive cross-sectional study, by presenting to the laboratories of Rouhani and Shahid Beheshti hospitals of Babol (Iran) during six months, Klebsiella pneumoniae strains were isolated from clinical specimens and transferred to the microbiology laboratory of Babol University of Medical Sciences for confirmation. Afterwards, the antibiotic resistance pattern was identified by disc diffusion method for the following antibiotics: a moxicillin, erythromycin, cefotaxime, gentamicin, ciprofloxacin, piperacillin, cefixime, amikacin, and imipenem. Finally, after DNA purification by using a commercial kit, mrkD and Kpn genes were evaluated by PCR molecular test.Results: Sixty Klebsiella pneumoniae strains were isolated from different clinical specimens during six months. By using disc diffusion method, the highest (95.4%) and lowest (0%) resistance rates pertained to amoxicillin and imipenem, respectively. The frequencies of mrkD and Kpn genes were 71% and 63%, respectively.Conclusion: Due to the high prevalence of antibiotic resistance among Klebsiella pneumoniae strains and considering that this is the first report of the mentioned genes in Babol, it is necessary to adopt appropriate therapeutic regimens to reduce antibiotic resistance.

Background and Objective: Today, due to the occurrence of drug resistance and the ability of bacteria to develop acute infections, investigating the antimicrobial effects of herbs has been proposed. Therefore, we aimed to examine the effects of Hypericum perforatum extract and microemulsion and Aloe vera extract on Brucella bacteria.Materials and Methods: This experimental study was carried out with the help of a hood in a biosafety level 2 laboratory. Fifty blood serum samples were cultured in BACTEC for brucellosis, and if grown, they were transferred to Brucella Agar in an anaerojar containing 10-5% CO2 for 48-72 h. Biochemical validation tests were carried out on the grown samples. Extraction was performed by a reflux (distillation) apparatus in a 1 liter balloon and a 40 cm spiral arm. Microemulsion structure was prepared by emulsifiers from the extract. Afterwards, 1, 8.4, and 2 mg/L dilutions of the aqueous extracts of Hypericum perforatum and Aloe vera were prepared, and the antimicrobial properties of these extracts were evaluated by disc diffusion, pour plate, and extraction methods on pure culture of Brucella isolated from patients.Results: Evaluation of antimicrobial effects on the isolated Brucella strains showed that the mean diameters of the zones of inhibition in the studied strains for the of 8-1 mg/l concentrations of Hypericum perforatum extract were 36.6±2 and 18±3 mm, respectively, and for Aloe vera they were respectively 30.7±3 and 18±1 mm. None of the strains formed an inhibition zone at the 0.5 mg/l concentration. Evaluation of the effect of the extract in the well diffusion method also yielded similar results, but in the pour plate method, the effect of the extractes on the bacteria was not observed. Micoemulsion of the Hypericum perforatum extract did not have any effect because of over dilution.Conclusion: The disk diffusion method under biosafety level 2 laboratory was highly effective, and the extract of Hypericum perforatum had the highest effect on Brucella; therefore, it is recommended for clinical studies.

Background and Objective: There are critical areas in the mandible that should be considered during implant placement such as inferior alveolar canal, mental foramen, and the root of the adjacent tooth. Two-dimensional images obtained from periapical, panoramic, and conventional tomography are considered in the evaluation of implant placement and bone quality. Cone-beam computed tomography (CBCT) is a new imaging technique, which is superior to other methods from different aspects. Thus, we aimed to compare the accuracy of two different CBCT systems (i.e., Promax 3D and Newtom 3G) in measuring the anatomic distances in the mandible.Materials and Methods: In this experimental study, six dry mandibles were used for measuring the width and height of mandible in six areas. Also, caliper was used as the gold standard and the distances were marked by barium sulfate as a radiopaque material. Then, the mandibles were scanned with the two CBCT systems, and the distances were measured by two observers (oral and maxillofacial radiologists) under homogenous conditions by using their respective software. The obtained results were evaluated by multivariate ANOVA and compared with the gold standard.Results: The accuracy of both CBCT systems (in all the three FOVs) was close to that of collies in measuring the height of mandible. The accuracy of Promax 3D was closer to collies in evaluating bacco-lingual width, and it was more accurate than Newtom 3G (in all the three FOVs; P<0.001). Thus, the accuracy of Promax system is close to the gold standard in the evaluation of the mandible height and bacco-lingual width.Conclusion: The results of this study showed that Promax 3D and Newtom 3G techniques (in all the three FOVs) have millimeter precision and are capable of measuring the lengths and widths needed to establish the treatment plan.