Iranian Red Crescent Medical Journal
Year:2014 | Volume:16 | Issue:11|Papers Count:20

Background: B-cell chronic lymphocytic leukemia (B-CLL) is the most common form of leukemia in adults. Some reports showed that expression of ZAP70 gene and chromosomal abnormality are two prognostic factors in management of B-CLL Objectives: In this study, we determined ZAP70 mRNA expression level in the del17p13, del6q21 and del11q13 subgroups of Iranian B-CLL patients to investigate prognostic value of ZAP70 expression.Patients and Methods: In this cross-sectional study, fluorescence in situ hybridization analysis was carried out on 66 Iranian B-CLL patients. Zap70 mRNA expression was evaluated by using Real Time RT-PCR.Results: Molecular analysis showed that ZAP70 expression increased 2.46 fold in the del11q13 subgroup, 2.87 fold in the del17p13 and 1.87 fold in the del6q21, compared to the 15 patients in the control group. Comparison of standard deviation and mean of the ZAP70 expression profile within the subgroups showed more variability among the cases of the del11q13 and del17p13 versus tight clustering for the del6q21. Therefore, there is a relation between del6q21 aberrations; which has good prognosis with normal levels of ZAP70 expression.Conclusions: The results of ANOVA test showed that ZAP70 expression gene was significantly increased in del17p13 and del11q13 subgroups compared to control group. Thus, ZAP70 may play an important role in the prognosis of B-CLL patients.

Background: Ischemic injury of the spinal cord during the surgical repair of thoracoabdominal aortic aneurysms might lead to paraplegia. Although a number of different mechanisms have been proposed, the exact cause of paraplegia has remained unknown, hampering the development of effective pharmacologic or other strategies for prevention of this condition. A number of studies suggested that cyclooxygenases (COX) contribute to neural breakdown; thus, COX inhibitors might reduce injury.Objectives: We aimed to assess the preventive effect of intrathecal (IT) pretreatment with paracetamol on spinal cord injury in a rat model.Materials and Methods: This experimental study was performed in Ataturk University Animal Research Laboratory Center, Erzurum, Turkey. Adult male Wistar rats were randomly allocated to three experimental groups (n=6) to receive IT physiologic saline (controls), 50 mg of paracetamol, or 100 mg paracetamol one hour before induction of spinal cord ischemia. Six other rats were considered as the sham group. For the assessment of ischemic injury, motor functions of the hind limbs and histopathologic changes of the lumbar spinal cord were evaluated. Additional 20 rats were divided into two equal groups for the second part of the study where the survival rates were recorded in controls and in animals receiving 100 μg of paracetamol during the 28-day observation period.Results: Pretreatment with 100 mg of paracetamol resulted in a significant improvement in motor functions and histopathologic findings (P<0.05). Despite a higher rate of survival in 100 mg of paracetamol group (70%) at day 28, the difference was not statistically significant in comparison with controls.Conclusions: Our results suggest a protective effect of pretreatment with IT paracetamol on ischemic spinal cord injury during thoracolumbar aortic aneurysm surgery.

Background: The relation between physical access in emergency department (ED) and the time patients have to wait before being served is unknown.Objectives: Our objective was to discover the associations between the physical access in ED and the time patients had to wait before receiving services.Materials and Methods: In this cross-sectional study, statistical society comprised two portions, namely, public hospitals’ EDs and referred patients to the ward. Data on waiting time for 240 patients in six public and private hospitals were gathered. In addition, physical condition of EDs was inspected by visiting these hospitals. A designed checklist, based on the introduced physical space, was filled for each hospital. Results of the checklist were scored using Likert’s five-points scale and Spearman and Pearson's correlation coefficient were applied to determine the relationship between physical access and waiting time.Results: The correlation between the waiting time beginning from the very moment of stepping into the ward until first examination and physical condition at the triage wards in private (P<0.001) and public hospitals (P>0.05) was not significant. The waiting interval, beginning from the very moment of stepping into the ward until first examination and access to physical space of ED, was significant for private hospitals (P<0.001) and insignificant for public hospitals (P>0.05).Conclusions: According to the results, there was a direct correlation between access to physical space in ED and waiting time. In addition, improving the physical access did not necessarily result in shorter waiting time. Therefore, to improve triage process, improvement of waiting time indices, and modifying forms of work process in ED are recommended.

Background: Due to the increasing number of women suffering from breast cancer worldwide, promoting the empowerment of these patients is an important factor affecting their survival.Objectives: Few studies have investigated the empowerment needs of the breast cancer women, especially in Iran. Therefore, this study was performed to explain the empowerment needs of women with breast cancer in Iran.Patients and Methods: In this qualitative study, 19 women with breast cancer were interviewed regarding their empowerment needs using the individual open-ended and, in-depth interviews and then the qualitative data were analyzed through content analysis.Results: Three main categories of empowerment needs from the participants’ perspectives were as follows: 1- information: the initial empowerment plans (timely and comprehensive information, coordination and continuity of information, easy and full-time access to information), 2- beliefs: the approval of the empowerment plans for execution (actuality, trust and hope and new beliefs), and 3- skills: efficient execution of the empowerment plans (communication skills, expression the needs, emotions, questions and use of the internet).Conclusions: It seems that promoting the empowerment of women with breast cancer is essential. Factors found in this study and also in similar studies, in which empowerment needs are explained in-depth through the experiences of the patients, should be considered and used in the treatment, educational and counseling programs to promote the empowerment of women with breast cancer.

Introduction: Gorham's disease is a rare disorder characterized by osteolysis and abnormal vascular growth within bones. Diagnosis of Gorham's disease is often delayed and for accurate and early diagnosis high clinical suspicion is crucial. No specific treatment is available. Management options include surgery, radiation therapy and medical therapy. We aimed to present the first case of Gorham’s disease with chest wall involvement in Iran. By review of the literature we discussed important issues of this rare disease including clinical findings, diagnosis and treatment options.Case Presentation: We present a 48-year-old man with a history of dyspnea following a blunt chest trauma who was admitted to our clinic several times due to reaccumulation of pleural fluid and chylothorax. Gorham's disease was finally established according to clinical manifestations and radiological findings including massive osteolysis in his left ribs and also histological examination.Discussion: According to review of the literature and considering all treatment modalities the patients was successfully treated with a combination of radiotherapy, pamidronate and thalidomide. We suggest that this disease should be considered among differential diagnoses of patients with chest pain, pleural effusion and/or chylothorax with an unknown reason and more importantly history of chest trauma. In suspected cases, it is essential to examine biopsy specimens of the bone adjacent to the inflammated tissues in order to confirm diagnosis.

Background: Dyspepsia is a common disorder that can present many clinical dilemmas in patient management. Although not usually life-threatening, its symptoms such as abdominal pain, heartburn, early satiety and postprandial fullness can have a significant negative impact on patients' quality of life.Objectives: The aim of this study was to determine the prevalence of dyspepsia and its associated factors among the adult population in Kerman in 2010.Patients and Methods: This cross-sectional study was performed on 2210 patients with the mean age of 43.4 years in Kerman, a city in southeast of Iran. Demographic factors, lifestyle data and gastrointestinal symptoms were collected for each patient.Results: The prevalence of dyspepsia was 16.1% (95% confidence interval: 14.3-18.1). The prevalence in patients with abdominal obesity (7.3%) was lower in comparison with those with low physical activity (13.8%). Out of other psycho-behavioral risk factors, anxiety after controlling for other variables increased the risk of functional dyspepsia more than 65 percent (P=0.004) and depressive disorders also increased that risk about 2.13 percent (P<0.0001). Patients with dyspepsia symptoms were more likely to restrict their diet, take herbal medicine, use over-the-counter drugs and consult with physicians.Conclusions: Results of this study reveal the moderate prevalence of dyspepsia among the adult population in Kerman like in other parts of the country and this prevalence is associated with several demographic factors, lifestyle and health-seeking behaviors.

Background: Currently, vaginal examination is the gold standard for assessment of labor progress. The World Health Organization emphasizes that the number of vaginal examinations should be limited where it is necessary.Objectives: Therefore, this study aimed to determine the diagnostic accuracy of purple line in the prediction of labor progress.Patients and Methods: In this cross-sectional study, 350 women with a single pregnancy in vertex presentation and gestational age of 38-42 weeks without any medical disorder, admitted to government hospitals of Mashhad, were selected using convenience sampling. Vaginal examination and observation of the line each hour in the active phase of labor were measured. Abnormal progress of labor was defined as cervical dilatation less than 1 centimeter/hour in the active phase for two consecutive hours and fetal head descend less than 1cm/h or duration of more than two hours for nulliparous and one hour for multiparous In the second stage of labor. Data was analyzed by SPSS version 16 using chi -square test.Results: The purple line appeared in 75.3% of women during the active phase of labor. Appearance of the purple line in the prediction of labor progress had 90.2% sensitivity, 45.3% specificity, 88.1% positive predictive value, 51.0% negative predictive value in the first stage of labor and had 87.6% sensitivity, 52.4% specificity, 96.5% positive predictive value, 22.0% negative predictive value in the second stage of labor and has 68.57% sensitivity, 42.66% specificity, 85.32% positive predictive value, and 43.85% negative predictive value for the total labor.Conclusions: According to the appearance of the purple line in most of the cases and its high sensitivity and specificity, we can use it as a non-invasive complementary method for clinical assessment of labor progress.

Background: Tuberculosis has been announced as a global emergency by World Health Organization and the second infectious agent of mortality worldwide. The general policy in the development of new vaccines is to develop some vaccines with higher efficiency not only for infants but also for adults compared with the Bacillus Calmette-Guerin vaccine. Recently, cytochrome P450 cyp141 has been introduced as a new target for detecting Mycobacterium tuberculosis from clinical samples.Objectives: The aim of this study was to clone this gene in order to pave the way for more evaluation.Materials and Methods: M. tuberculosis H37Rv DNA was extracted by a standard phenol-chlorophorm protocol. After designing the specific primers, P450 cyp141 gene was replicated by PCR. The purified PCR products were then subcloned into the pTZ57R/T plasmid vector. After extraction, enzyme digestion, and recombinant pTZ57R/T-cyp141 plasmid vector sequencing, the aforementioned products were cloned into a pET-26b plasmid vector. Then, the recombinant pET26b-cyp141 plasmid molecules were transformed to Escherichia coli strain BL21 (DE3) using the transformation method. Next, the recombinant pET26b-cyp141 plasmids were purified and evaluated by the enzyme digestion analysis.Results: The cloning of P450 cyp141 gene was confirmed by the enzyme digestion and sequencing of the recombinant pTZ57R/T-cyp141 and pET26b-cyp141 plasmid vectors.Conclusions: The results of this study demonstrated that the P450 cyp141 gene was successfully cloned into a pET26b plasmid vector as an expression vector. In this paper, for the first time in Iran, this gene was cloned for more purposes, including the expression and purification of the recombinant cytochrome P450 cyp141 protein.

Introduction: Pelvic pain results from many causes such as primary dysmenorrhea, uterine anomalies, menstrual outflow obstruction, endometriosis, myoma and adenomyosis. This study reports on a rare case of non-communicating functional rudimentary horn.Case Presentations: A 15-year-old nulligravida young woman with a history of severe intermittent pelvic pain presented a 4-5 centimeter mass. A surgical procedure for appendicitis was previously performed on this patient. Per-operative diagnosis was myoma and suspicion of leismus sarcoma. Laparotomy revealed left rudimentary horn, non-communication was confirmed by postoperative hysterosalpingogram (HSG) and magnetic resonance imaging (MRI). Resection of mass and left fallopian tube was done during the second surgery.Conclusions: Rudimentary horn should be considered in differentiation of pelvic pain and mass in young females. Early diagnosis and horn resection prevents emergency surgery and reliefs pain.

Background: Coronary artery diseases are the most frequent cause of mortality in industrialized countries as well as Iran. Coronary artery disease affects patient’s quality of life (QoL) and produces some degrees of anxiety and depression. Although self-management programs have shown significant impact on chronic diseases, there is limited evidence in Iran regarding the effectiveness of these interventions, particularly in patients with coronary artery disease.Objectives: This study aimed to evaluate the effects of angina plan on QoL, anxiety, and depression in post coronary angioplasty patients referred to selected hospitals in Shiraz.Patients and Methods: This parallel randomized, controlled trial was conducted in selected hospitals in Shiraz, Iran. We enrolled 80 post coronary angioplasty eligible patients in the study. After acquisition of the informed consent, eligible patients were randomly divided into two groups: control and experimental. Pretest data were obtained by using a demographic data form and two valid and reliable questionnaires for QoL, anxiety, and depression. Blood pressure, weight, and height (to calculate body mass index) were measured too. Patient’s history of smoking, diabetes, hypercholesterolemia, hypertension, and coronary vascular involvement (with grade and severity) were obtained from their medical records. A 12-week angina plan intervention consisted of a 30 to 40 minutes of counseling interview and telephone follow up at the end of 1, 4, 8, and 12 weeks were performed for experimental group. Post-test data were obtained three months after the pretest using the same questionnaires as pretest. QoL data were analyzed by analysis of co-variance (ANCOVA). The results (before and after intervention) regarding anxiety and depression were analyzed by independent t-tests or their equivalent nonparametric Mann-Whitney test using SPSS v.11.5.Results: There was no statistically significant difference in demographic variables between two groups. Baseline mean scores for QoL, anxiety, and depression did not differ between the two groups. There was a significant difference between the experimental and control groups in terms of changes in perception of QoL before and after the intervention. Adjusted mean±SD of perception of QoL for the control group was 38.48±13.38 and for the experimental one was 56.30±13.38, with a P value of less than 0.001. The mean difference of anxiety scores (before and after intervention) in experimental and control groups were 1.15±1.99 and.0.07±2.22, respectively with a P value of less than 0.01. The mean difference of depression scores (before and after intervention) in experimental and control groups were 0.4±2.89 and 0.13±2.76, respectively (P>0.05).Conclusions: Our results show that the self-management angina plan was effective in improving perception of QoL and reducing anxiety. Further studies with a larger sample size and a longer follow-up period are recommended to better understand the effectiveness of this plan.

Background: Different levels of pharmacological sedation ranging from minimal to general anesthesia are often used to increase patient tolerance for a successful colonoscopy. However, sedation increases the risk of respiratory depression and cardiovascular complications during colonoscopy.Objectives: We aimed to compare the propofol and midazolam/meperidine sedation methods for colonoscopy procedures with respect to cardiopulmonary safety, procedure-related times, and patient satisfaction.Patients and Methods: This was a prospective, randomized, double-blinded study, in which 124 consecutive patients undergoing elective outpatient diagnostic colonoscopies were divided into propofol and midazolam/meperidine sedation groups (n: 62, m/f ratio: 26/36, mean age: 46±15 for the propofol group; n: 62, m/f ratio: 28/34, mean age: 49±15 for the midazolam/meperidine group) by computer-generated randomization. The frequency of cardiopulmonary events (hypotension, bradycardia, hypoxemia), procedure-related times (duration of colonoscopy, time to cecal intubation, time to ileal intubation, awakening time, and time to hospital discharge) and patients’ evaluation results (pain assessment, quality of sedation, and recollection of procedure) were compared between the groups.Results: There were no statistically significant differences between the two groups with respect to demographic and clinical characteristics of the patients, the frequency of hypotension, hypoxemia or bradycardia, cecal and ileal intubation times, and the duration of colonoscopy. The logistic regression analysis indicated that the development of cardiopulmonary events was not associated with the sedative agent used or the characteristics of the patients. The time required for the patient to be fully awake and the time to hospital discharge was significantly longer in the propofol group (11±8 and 37±11 minutes, respectively) than the midazolam/meperidine group (8±6 and 29±12 minutes, respectively) (P=0.009 and P<0.001, respectively).The patient satisfaction rates were not significantly different between the groups; however, patients in the propofol group experienced more pain than patients in the midazolam/meperidine group (VAS score: 0.31±0.76 vs.0±0; P=0.002).Conclusions: Midazolam/meperidine and propofol sedation for colonoscopy have similar cardiopulmonary safety profiles and patient satisfaction levels. Midazolam/meperidine can be preferred to propofol sedation due to a shorter hospital length of stay and better analgesic activity.

Context: The occurrence of intradialytic hypotension (IDH) during hemodialysis (HD) continues to be a main problem in patients with ESRD (end-stage kidney disease). It also negatively affects health-related quality of life. We aimed to determine vasopressin effect in decreasing IDH.Evidence Acquisition: We reviewed clinical and experimental literature in a variety of sources, including PubMed, Current Content, Scopus, Embase, and Iranmedex regarding the possible effect of vasopressin administration in prevention of hypotension during HD to clarify its mechanism, efficacy, and safety.Results: Although arginine vasopressin is widely recognized for its anti-diuretic properties, it is also a well-recognized vasoconstrictor. It has been shown that the vasopressin release (as it would normally be expected) does not increase in the majority of HD patients with recurrent dialysis hypotension. In addition, it has also been reported that vasopressin secretion (due to the osmotic stimulation) is the most important mechanism in blood pressure control in ESRD patients receiving hypertonic solution for IDH. Therefore, it is suggested that vasopressin administration may improve hemodynamic stability among ESRD patients during HD. There are few clinical trials about this issue, suggesting that administration of exogenous vasopressin may be significantly associated with a decreased incidence of IDH as well as cardiovascular stability in ESRD patients in need of volume removal during HD.Conclusions: Vasopressin insufficiency may have an important role in the pathogenesis of hemodynamic instability during HD and administration of exogenous vasopressin is significantly associated with a lower incidence of IDH.

Background: Diabetes is associated with an increased generation of reactive oxygen species (ROS), which plays an important role in the development of oxidative stress and anemia.Objectives: The main purpose of this study was to investigate whether patients with diabetes undergoing hemodialysis (HD) were susceptible to oxidative stress and whether resulting damages affect the structure of hemoglobin (Hb) and plasma proteins.Patients and Methods: Twenty patients with diabetes undergoing HD, 20 patients with diabetes and normal renal function, and 20 age- and sex-matched healthy subjects were included in this study. Methaemoglobin (Met-Hb), hemichrome and conformational changes of Hb were analyzed as oxidative markers in erythrocytes. Ferric reducing ability of plasma (FRAP) and protein carbonyl content (PCO) were determined as plasma oxidative biomarkers. Also triglyceride, cholesterol, albumin, blood urea nitrogen (BUN), creatinine, glucose and uric acid were assayed as biochemical parameters of plasma.Results: Patients with diabetes undergoing hemodialysis had significantly lower levels of PCO and albumin (P<0.05), but significantly higher levels of FRAP, BUN, creatinine and uric acid (P<0.05) as compared to patients with diabetes and normal renal function. Linear regression analysis showed significant negative correlations between PCO and FRAP (r=-0.53), oxy-Hb (r=-0.88) and Hb absorbance at 340 nm (r=-0.79), 420 nm (r=-0.85) and 577 nm (r=-0.68) in patients with diabetes undergoing hemodialysis. Also PCO was significantly and positively correlated with Hb absorbance at 275 nm (r=0.63) and 560 nm (r=0.61) which confirmed the oxidative damage to erythrocytes in control subjects.Conclusions: Hemodialysis exacerbates oxidative stress and conformational changes of Hb in patients with diabetes on hemodialysis. The FRAP value can be used as a positive determinant, while PCO and Hb derivatives can be used as negative determinants of oxidative stress in patients with diabetes.

Background: Patients with early stage breast cancer with same treatment strategy can have markedly different outcomes. Human epidermal growth factor receptor 2 (HER2/nue) gene amplification or the subsequent overexpression of protein has been proved to be associated with patient's outcome and response to anthracyclins-based regimens.Objectives: This study assessed prognostic value of HER2/nue marker in patients with early stage breast cancer who received adjuvant chemotherapy with anthracyclins-based regimens.Materials and Methods: Fifty tissue samples from patients with primary breast cancer of moderate risk receiving sequential adjuvant chemotherapy with anthracyclins-based regimens were assessed to evaluate HER2/nue gene status (quantified by Immunohistochemistry and fluorescence in situ hybridization) retrospectively. Besides, correlation of HER2/neu with patients' characteristics and outcome was studied.Results: HER2/neu amplification was identified in 19 (38%) of 50 patients. No significant difference regarding HER2/neu status was seen in clinic pathological characteristics of patients. Although Progression Free Survival (PFS) was shorter in HER2 overexpressed group, but uni/multivariate analysis adjusted for HER2 overexpression, nodal involvement, hormone receptor status, age and tumor size revealed no significant predictive and/or prognostic value for HER2 regarding PFS.Conclusions: This study on a limited number of patients treated with adjutant anthracyclins-based regimens, revealed that HER2/neu is not a unique strong predictor for outcome, thus according to combination of HER2/neu status and other clinical factors, it is necessary to distinguish patients at high risk of recurrence.

Background: Family-centered empowerment of drug and stimulant users is an effective program for a better response to treatment, prevention of treatment adverse effects, and promotion quality of life (QoL) and lifestyle in the process of discontinuing drug abuse.Objectives: This study aimed to determine the effects of educational intervention, based on family-centered empowerment and Pender's health promotion models, on health-promoting lifestyle and health-related QoL among methamphetamine users and their families.Patients and Methods: In a randomized clinical trial, methamphetamine users, who were admitted to Tehran University of Medical Sciences Substance Abuse Treatment Centers, were randomly allocated to three groups: a group for training of methamphetamine users who were in recovery phase (intervention group 1; 95 subjects); a group for training of a family member of methamphetamine users who were in recovery phase (intervention group 2; 95 subjects); and a control group (95 subjects). A demographic checklist and a standard questionnaire covering health-promoting lifestyle, health-related QoL, self-efficacy, perceived affect, perceived social support, and perceived barriers dimensions were used to gather required data. Independent-samples t test, paired-samples t-test, and ANCOVA were used to analyze the data.Results: Analysis of covariance showed that after adjusting for effects of pretest scores, the difference between mean post-test scores of health-promoting lifestyle scale, health-related QoL scale, and all constructs of Pender's health promotion model (self-efficacy, perceived affect, perceived social support, and perceived barriers) in the intervention group 1 and control group were significant (P<0.0001). In addition, changes in mean scores of lifestyle scale (42.4±13.6), QoL scale (29.1±14.2), self-efficacy (16.1±2.6), perceived affect (16.1±8), social support (35.4±12.4), and barriers (17.2±15.8) before and after intervention were significant in the intervention group 2 (P<0.0001).Conclusions: Application of family-centered empowerment model among methamphetamine users and their families is practically feasible and can result in enhancement and improvement of their QoL, lifestyle, and health promotion model constructs.

Background: Helicobacter pylori is known to be a causative agent of chronic active gastritis, peptic ulcer and gastric cancer in human. Diverse genotypes of H. pylori strains have different virulence potency and geographic distribution.Objectives: The purpose of this study was to investigate the association between the cytotoxin-associated gene (cagA), and the various vacuolating cytotoxin (vacA) genotypes of H. pylori strains and clinical outcomes in patients referred to Shahid-Beheshti Hospital in Hamadan, Iran.Patients and Methods: In this cross-sectional study, biopsy samples were collected consecutively from 153 patients with gastric cancer (GC), peptic ulcer dyspepsia (PUD) and non-ulcer dyspepsia (NUD) in the gastroenterology department of Shahid-Beheshti Hospital in Hamadan province, the west of Iran. H. pylori infection was confirmed in 83 patients (3 with GC, 27 with PUD, and 53 with NUD) by histology, rapid urease test (RUT) and culture. Genomic DNA was extracted from the bacterial isolate and was further confirmed with 16S rRNA gene sequencing as H. pylori, and characterized based on cagA and vacA genotyping using the polymerase chain reaction (PCR) method.Results: In this study, vacA genotypes s1/m2, s1/m1, s2/m2 and s2/m1 were determined in 43.4%, 19.3%, 13.2% and 6% of the isolated H. pylori, respectively. The vacAs1 genotype was detected in 52 (62.6%) isolates, of which the vacAs1a genotype was detected in 45.2, 40.7, and 66.6% of the isolates from patients with NUD, PUD, and GC, respectively. The cagA-positive genotype was determined in 73 (87.9%) isolates and 10 (12.1%) were negative. The frequency rates of cagA gene were 84.9, 92.6 and 100% in isolates of patients with NUD, PUD, and GC, respectively. The cagA-positive genotype is strongly associated with s1a/m2 and s1a/m1 vacA genotypes.Conclusions: The most predominant VacA genotypes in our areas were s1/m2 and s1/m1, which regard as the genotypes with more virulence intensity. The H. pylori vacAs1a, cagA genotypes have a significant relationship with the presence of PUD and GC in Iranian patients with dyspepsia.

Background: Engaged nurses have high levels of energy and are enthusiastic about their work which impacts quality of health care services. However, in the context of Iran, due to observed burnout, work engagement among nurses necessitates immediate exploration.Objectives: This investigation aimed to identify a suitable work engagement model in nursing profession in hospitals according to the hypothesized model and to determine antecedents and consequences related to work engagement among nurses.Patients and Methods: In this cross-sectional study, a questionnaire was given to 279 randomly-selected nurses working in two general teaching hospitals of Shiraz University of Medical Sciences (Shiraz, Iran) to measure antecedents and consequences of work engagement using the Saks’s (2005) model. Structural Equation Modeling was used to examine the model fitness.Results: Two paths were added using LISREL software. The resulting model showed good fitness indices (c2=23.62, AGFI=0.93, CFI=0.97, RMSEA=0.07) and all the coefficients of the paths were significant (t³2, t£-2). A significant correlation was found between work engagement and model variables.Conclusions: Paying adequate attention to the antecedents of work engagement can enhance the quality of performance among nurses. Additionally, rewards, organizational and supervisory supports, and job characteristics should be taken into consideration to establish work engagement among nurses. Further researches are required to identify other probable antecedents and consequences of nursing work engagement, which might be related to specific cultural settings.

Background: Staphylococcus aurous is a major pathogen, causing variety of diseases and death in Iran and in the world. Despite the use of a spectrum of new antibiotics, this organism has caused severe infections in burns as well as in different parts of the body, due to acquired drug resistance. Widespread inappropriate use of antibiotics in treating bacterial infections has led to the selection and circulation of resistant strains and the growing risk of transferring resistant genes to sensitive bacteria. One of the causes of antibiotic resistance in S. aurous strains is the gain of resistance genes including integrase and qac/sul1.Objectives: The purpose of this study was to investigate the presence of class 1 integron in S. aurous strains isolated from clinical samples for the first time in Iran.Materials and Methods: This descriptive study was performed on 200 strains of S. aurous isolated from patients admitted to Baqiyatallah Hospital in Tehran in 2013. These strains were confirmed using biochemical and serological tests and the presence of class 1 integron was determined by polymerase chain reaction (PCR).Results: Among the 200 samples, 1% of the strains (two isolates) contained the class 1 integron gene. The results of this study showed that the highest frequency of the obtained samples belonged to males and the isolates occurred mostly in individuals aged 51-60 years old. The highest number of strains was found in wound samples. The strains were most frequently isolated from the emergency ward and the intensive care unit (ICU).Conclusions: Findings of this study showed that integron can have a limited frequency in S. aurous isolated from clinical sample in Tehran.

Background: Interleukin (IL) -2 plays a central role in T cell-dependent immune responses.Objectives: We conducted this study to determine and compare IL-2 expression in lupoid and usual types of Old World Cutaneous Leishmaniasis (OWCL), using immunohistochemistry.Patients and Methods: Thirteen paraffin-embedded specimens of lupoid and 12 specimens of usual types of OWCL were used. A mouse monoclonal anti IL-2 antibody was used for staining by the envision technique.Results: There were strongly stained discrete foci of staining through inflammatory infiltrates of dermis and also in basal layers of epidermis and adnexal structures, with a distinctive pattern of hot spot activity foci (mean of 9.31±6.4 versus 8.17±6.9 foci per HPF for lupoid and usual types, respectively). The expression of IL-2 had no correlation with the pattern of granulomatous inflammation (tuberculoid, sarcoidal or mixed suppurative).Conclusions: Interleukin-2 takes part in the immunological response of the granulomatous reaction of OWCL and is not statistically different between lupoid and usual types (P=0.674).

Introduction: Zolpidem is a short acting inducer of sleep and thought to lack benzodiazepine properties such as anxiolysis, anticonvulsion, muscle relaxation and side effects such as dependency. Recently, some cases of Zolpidem abuse and dependency have been reported. In review of literature, we found that the lowest reported dosage of Zolpidem, which caused dependency, was 160 mg daily.Case Presentation: We reported a 30-year-old unmarried Iranian woman with dysthymic disorder and chronic insomnia treated with Zolpidem irregularly. She started to use Zolpidem with 5mg per day irregularly since a year ago but augmented its daily dosage gradually to 100 to 150 mg per day in divided doses. After a period of 16 hours without taking Zolpidem she developed a withdrawal syndrome, with generalized tonic-clonic seizures for two times. She was managed with supportive care and recovered completely.Conclusions: Zolpidem dependency and withdrawal seizure can occur with a dosage under last reported doses. Therefore, possibility of mentioned problems cannot be excluded at any dosage and physicians should pay more attention to potential of Zolpidem to create these adverse effects.