Feyz Medical Sciences Journal
Year:2009 | Volume:12 | Issue:4 (SERIAL 48)|Papers Count:20

Background: Diabetes mellitus is known as a major worldwide complication. Despite numerous synthetic medicines presented for treatment of the disease, it still remains a universal health problem. Although Citrullus Colocynthis is traditionally used as an antidiabetic herbal medicine, however, scant studies describe the antidiabetic properties of the fruit. The present study was designed to investigate the probable hypoglycemic effects of this drug in diabetic rats. Materials and Methods : This work was carried out on 15 male (n=7 and n=8 in the control and test groups, respectively) Wistar rats weighed 200 – 250 g. To make the animals diabetic, they were injected by a single dose of streptozotocin. The rats in the test group were treated daily (continued for 40 days) by the herbal medicine (30 mg/kg; dissolved in 0.2 cc distilled water), while those in the control group received distilled water in the same volume. Plasma glucose was measured 10, 20, 40 days following the prescription and 10 days after the termination of treatment. Results: We found a significant decline in the plasma glucose of the drug-treated rats on the 10th day of experiment (P<0.05). In contrast to the control group, the number of diabetic rats decreased in the drug-treated group with passing the time (P<0.018). While the mortality rate decreased in the rats treated with the medicine, it considerably increased in the controls as the experiment proceeded (P<0.05). Conclusion: Citrullus Colocynthis has a moderate hypoglycemic effect in adult diabetic rats. Decreased number of diabetic animals and increased mortality in the test animals indicate that the herbal medicine has a potential effect in treating diabetes.

Background: Post partum hemorrhage (PPH), with a prevalence of 5%, is one of the most important obstetric emergencies. Oxytocin infusion in the third stage of labor is used to control PPH. Some studies indicated that the oxytocin bolus is more effective than its infusion. This study was performed to compare the oxytocin bolus and infusion effects on maternal hemodynamics and also the outcome of the third stage of labor. Materials & Methods: This double-blinded clinical trial was carried out on 200 normal vaginal delivery (NVD) patients of Shabihkhani Hospital in Kashan during 2006-2007. Gestational age≥20 weeks, parity≤5, and Iranian nationality were considered as including factors. Excluding factors were over-distended uterus, previous PPH history, hypertension, previous diseases, placenta previa, abruption, history of instrumental delivery or precipitated labor. Patients were divided into 2 equal groups (n=100): the case group received 10 IU oxytocin bolus post-delivery and the control group received 10 IU oxytocin infusion with a rate of 125 cc/h. Maternal hemodynamics and the outcome of the third stage of labor were compared in both groups. Data were analyzed using t-test, Fisher and Chi-square tests. Results: Both groups were matched in terms of maternal age, gestational age, parity, birth weight and duration of the second stage of delivery. Hemodynamic findings showed no significant difference between the two groups in terms of pulse rate of pre- and 1, 10, 20 min post-delivery, but it was significant for 5 min post-delivery (p=0.02). Systolic and diastolic blood pressures had no significant difference between the two groups and in 1, 5, 10 and 20 min post-delivery, however the different outcome findings indicated a shorter duration of the third stage of delivery in bolus group than in the infusion one (p<0.0001). However, no significant difference was seen in terms of requirement for uterotonic agents, hemoglobin and placental retention. Conclusion: While the oxytocin bolus could not change the maternal hemodynamic status, it reduced the duration of the third stage of labor.

Background: Nowadays faster healing of surgical wounds to decrease wound complications, especially pain, is a matter of challenge for researchers. Synthetic drugs are more effective for the improvement of wound healing. The main objective of the present study was to evaluate the healing effects of ibuprofen, as a non-selective COX-1 and COX-2 inhibitor, on surgical trauma of stomach in rats. Materials and Methods: In this experimental study fifteen Wistar rats were randomly assigned into three groups of five animals. To induce trauma, a gastrotomy incision with a width of 1 cm was made in the grater curvature of rat stomach. Thereafter, it was sutured in 2 layers. After the surgery, the experimental group was treated with daily oral ibuprofen for 15 days in a dose of 30 mg/kg (dissolved in 10 ml/kg of DMSO 5%). The placebo and control groups received DMSO (5%) and saline (10 ml/kg), respectively, in the same manner. Histopathologi cal studies for the evaluation of healing were carried out in experimental rats, which were euthanized 15 days after the experiment using hematoxylin-eosin (H&E) and Masson's trichrome staining methods. Wound healing within the groups was compared with the consideration of more effective agents on wound healing (e.g., proliferation of fibroblasts, angiogenesis , re-epithelialization and collagen synthesis). Significant differences (p<0.05) among the groups were determined by ANOVA followed by Bonferroni correction. Results: The numbers of fibroblasts and capillary buds in ibuprofen treated rats were significantly less than those of the healthy control and DMSO control groups (p<0.05). The epithelial gap in treated rats was more than that in the other groups (p<0.05). There were significant differences in collagen contents of wound healing region between the ibuprofen treated and other experimental groups. Conclusion: The results of this study indicate that ibuprofen has an inhibitory effect on surgical wound healing of stomach. Therefore, it is not recommended as a postoperative analgesic.

Background: APOBEC3G (Apolipoprotein B mRNA Editing enzyme, Catalytic polypeptide-like 3G) is an anti-HIV-1 vif cellular factor that modifies minus strand of viral DNA during reverse transcription. To assess the interaction of this cellular factor with HIV-1 vif, natural non-permissive cells, such as H9 and PBMC cells, are used. Since the transfection of these cells with test DNAs is very inefficient, we are to use non-permissive cells which can stably produce high levels of APOBEC3G. Sort of non-permissive cells for this purpose were 293 T cells. Materials and Methods: 293T cells were used for producing non-permissive cells. This was carried out by transfection of 293T cells using PcDNA-APO3G molecular clone. Then the APOBEC3G expression was checked by western blotting. Also the HIV-1 replication and infectivity were assessed using RT and MAGI assay, respectively. Results: A number of 293T cell lines that express a human antiHIV-1 factor, APOBEC3G, were stablished. Immunoblotting analysis proved that 4 out of 7 examined cell clones readily express APOBEC3G. In particular, two clones (i.e. A3G-C1 and-C4) were found to produce much higher levels of functional APOBEC3G relative to that by pooled cell clones. The transfection efficiency of all cell clones was similar to that of the parental cells, with a potential of producing a comparable level of virions upon transfection of wild type and vif-minus proviral DNA clones. Furthermore, the expression level of APOBEC3G in the best cell line (A3G-C1) was much higher than that of APOBEC3G-positive lymphocyte cell line and peripheral blood mononuclear cells. Finally, the incorporation of APOBEC3G into virions produced in A3G-C1 was monitored. Upon transfection of vif-minus proviral clone, but not of wild type, APOBEC3G was easily detected in progeny viral particles. Conclusion: These Results indicated that our new A3G-C1 cell line is eminently useful for studying various study on the interactions of human APOBEC3G and HIV-1 vif.

Background: Diabetes, especially the gestational diabetes with its special fetal and maternal disorders, is the most common complication of pregnancy. Both gestational and type II diabetes mellitus are along with a disturbances to insulin secretion as well as insulin resistance. Considering the significant role of zinc in insulin function, the deficiency and importance of this element in gestational diabetes is a matter of consideration. Materials and Methods: This clinical trial was carried out on 60 pregnants suffering from gestational diabetes, and needing insulin injection from 32nd week to full-term. The patients were divided into two groups; the case group (n=30), received daily zinc sulfate (25mg or 5cc) plus insulin and control group (n=30) received daily placebo (5 cc as syrup) plus insulin until the time of delivery. The required insulin dose was regulated through monitoring fasting blood sugar and blood sugar, 2 h postprandial, every two weeks in both groups. These groups were compared in terms of required insulin dose and maternal/fetal complications. Data were analyzed using t-test, OR, CI, Fisher Exact test, Kolmogorov-Smirnov and Chi-Square tests. Results: The required dose of insulin had a significant decrease in the case group compared to the control one (p<0.001). However, the mean change in insulin dose in the case and control group compared to the beginning of study was 8.766 (SD: 9.63) and 17.533 (SD: 10.54), respectively. The incidence of macrosomia in the case and control groups was significant (P<0.01). The odds ratio of control group compared to the case group was 7. The preeclampsia prevalence in both groups was not significant. Conclusion: Zinc supplementation in gestational diabetes may lead to the reduction of required insulin dose, incidence of macrosomia and the related complications (e.g., caesarian and delivery dystocia).

Background: Aminoglycosides are frequently used in children and adults. Depending on the patient's age and the nature of the disease, the standard dose of aminoglycosides is 2-3 times daily. The aim of the present research was to compare the side effects and the efficacy of gentamycin administered in single and divided doses. This study was carried out on urinary tract infections of patients hospitalized in Paediatrics and Infectious wards of Kashan Shahid Beheshti Hospital. Materials and Methods: This clinical trial study was carried out on 30 patients. The patients were randomly divided equally into two groups (n=15). The case and control groups were treated with single and multiple daily divided doses of gentamycin (total daily doses of 3 mg/kg/day), respectively. The daily data of fever, dysuria, urinary frequency and the laboratory findings were recorded for the comparison of safety and efficacy of the two methods. The nephrotoxicity of the drug was evaluated through the creatinine level. Results: The patients were in an age range of newborn to 15 years with a male/female ratio of 5/6. The average period for the recovery of signs (disappreance of dysuria and urinary frequency) in the gentamycin and control groups was 1.6 and 2.06 days, respectively (P=0.127). The average duration for the elimination of fever in the case and control groups was 1.4 and 1.8 days, respectively. The .average level of creatinine (final day compared to the first day) betwen the two groups was equal. Conclusion: The rate of treatment in both groups was similar with no more nephrotoxicity in single–dose. For routine single-dose administration of gentamycin, more research in broader age ranges is suggested.

Background: Mental health refers to the feeling of well-being, self-confidence, self-trust and competition capacity or having the ability to cope with adversity, intergeneration attachment and fulfilling the emotional and potential abilities. Mental health is something beyond the absence of mental disorders. The present study describes a planned program to promote mental health status among university students using self-esteem and health control beliefs from 2004 to 2007. Materials and Methods: The quasi experimental study was carried out on 144 students of Gonabad and Birjand Medical Universities. They were randomly divided into case (n=71) and control (n=73) groups. Data were collected through demographic questionnaires, multidimensional health locus of control (HLC) scales, Rosenberg's self-esteem and general health questionnaire-28 (GHQ-28). The educational program was based on using the self-concept, self-confidence, health locus of control and self-esteem as a focus group in which discussion method was used for 11 sessions. The questionnaires were collected and evaluated before, immediately after and 3 months after the intervention. Results: The results showed significant differences between selected variables in the case group compared to those in the control one, before and after the intervention (p<0.05).The external components of HLC showed a significant decrease, while the internal HLC and self-esteem revealed a significant increase immediately after the intervention (P<0.0001). Besides, the students' mental health significantly increased three months after the intervention (P<0.0001). Conclusion: The findings emphasized on enforcing, participating and improving the HLC beliefs, self-esteem and the promotion of mental health in the students following the program. 

Background: Renal replacement therapies (RRT) in end stage renal disease consist of different therapeutic methods. In this regard the hemodialysis and renal transplantation are two main methods with their own physical and mental consequences. Despite the controversy in results, it is generally accepted that transplanted patients have a better quality of life. Depression and anxiety which are two main problems of RRT can negatively affect the results of treatment. In the present study both of these problems were evaluated in hemodialyzed and transplanted patients in Kashan during the year 2008. Materials and Methods: This is a cross- sectional study in which all hemodialysis and posttransplantation patients were evaluated using two standard questionnaires for depression and anxiety. The higher scores were representatives of higher degrees of depression and anxiety. The Results were analyzed with Man- Witney, Chi-square and multiple regression statistical methods. Results: In this syudy 63 hemodialysis and 100 transplantation patients were evaluated. The mean age of patients was 40.6±14 and 55.3±14.5 in transplantation and hemodialysis patients, respectively. 55.6% of hemodialysis patients were female, while these women consisted 41% of the transplanted patients. The mean depression score was 21.3±11.5 and 12.1±11.5 in hemodialysis and transplanted patients, respectively (p<0.0001). Also the mean anxiety score was 12.6±8.8 and 9.6±8.2 in hemodialysis and transplanted patients, respectively. In both groups factors such as age, education, marital status and the duration of treatment showed no significant relationship with depression and anxiety. The transplanted women significantly had higher depression (p=0.004) and anxiety scores (p=0.008). In transplanted patients cardiac disease and hypertension had significant relationship with depression and anxiety (p<0.02).Conclusion: Depression and anxiety are among the most prevalent and serious problems of RRT. These problems, especially in hemodialysis patients can result in dangerous consequences, such as poor compliance and self care. It is recommended that in these patients routine depression and anxiety assessment should be a part of treatment program.

Background: Poor sleep quality is one of the most common difficulties of old adults. With the advancing age, some changes occur in sleep quality, structure and circadian rhythm. These changes result in sleep disorders and frequent complaints in elderly people. The present study was conducted to assess the quality of sleep and its related factors in the hospitalized elderly patients in Kashan hospitals in 2007. Materials and methods: A cross-sectional study was carried out on 390 cases (age over 65 years) of hospitalized elderly patients in Kashan hospitals through sequential sampling. A two-part questionnaire was used for data gathering. The first part consisted of 19 questions on personal data and the second part the questions of Pittsburgh Sleep Quality Index (PSQI). An overall score of "6" or higher was an indicator of "poor" quality of sleep. Student t-test, ANOVA and X² were applied for statistical analysis. Result: About half of the samples (55.4%) were female and the rest were male. The mean age of samples was 71.8±5.9 years. Of the total samples, 89.5% were married and 70.8% illiterate. The patients of surgical wards had a better quality of sleep than the medical wards (95%, CI=1.72-4.4). There was a significant association between the quality of sleep and education (p<0.01). The total quality of sleep was poor in hospitalized elderly patients, but somehow better for men (6.22±4.9) than women (8.32±4.33). A significant difference was identified in all aspects of sleep except the sleep duration and efficiency for both sexes. Dyspnea (9.3±4.56), change in sleep habits (8.77±4.35) and light stimulators (10.1±4.74) were among the most important factors affecting the quality of sleep. In addition, the quality of sleep had a significant relationship with the latency of falling sleep (p=0.0001), respiratory and blood disorders. Conclusions: The quality of sleep was poor in the elderly hospitalized patients. Some modifications in ward facilities and routines can help the elderly patients to have a better sleep quality during the hospitalization.

Background: Acinetobacter species are non-fermentative, aerobic, gram-negative coccobacilli, widely distributed in hospitals considered as an important opportunistic pathogen responsible for a variety of nosocomial infections. Multiple drug resistant (MDR) strains of Acinetobacter have created therapeutic problems worldwide. Antibiotic resistance in Acinetobacter species is a new emerging problem in Iran. The aim of the present study was to determine the antimicrobial susceptibility of Acinetobacter species isolated from clinical specimens in educational hospital, in Kashan university of medical sciences. Materials and Methods: This descriptive study was carried out on sixty Acinetobacte species isolated from patients in Beheshti hospital. At the species level conventional biochemical tests were used for the identification of isolates. The strains were isolated from blood (58.3%), urine (13.3%), cerebrospinal fluids (8.3%), trachea (8.3%), sputum (8.3%), and pleural fluid (3.3%). For determination of susceptibility, Acinetobacter baumannii ATCC 19606 (11B) and Acinetobacter lwoffli ATCC (13A) strains were used as quality controls. Antimicrobial susceptibility testing was performed on all 60 isolates according to the standard method established by the CLSI (formerly NCCLS). In this analysis, MDR was defined as presence of resistance to three or more classes of antibiotics. PCR was used for the detection and amplification of antibiotic resistance genes. PCR products were resolved on agarose gel (2.0%), stained with ethidium bromide, and then photographed by UV. A 100 bp DNA ladder was used to assess PCR product. Results: Forty-eight isolates of Acinetobacter baumannii, six isolates of Acinetobacter lwoffli and six isolates of other Acinetobacter species were isolated from patients. Thirty-five (58.3%) men and 25 (41.7%) women with the mean age (±SD) of 39.27 (±19.20) years enrolled in the study. Acinetobacter species demonstrated the highest resistance to amikacin, tobramicin, ceftazidime, ciprofloxacin, piperacillin/tazobactam, doxycycline, SXT/TMP, minocyclin, levofloxacin, imipenem and sulbactam/ampicilln, respectively. MDR rate was 66.7%. The positive rate of the resistance genes for aphA 6, aacC1, ADC-7, OXA SET C, aadA 1 and aadB were 39 (65%), 38 (63.3%), 34 (56.7%), 32 (53.3%), 32 (53.3%), 25 (41.7%), and 2 (3.3%), respectively. Conclusion: In the present study, A cinetobacter baumannii was the most common isolate among the patients. Acinetobacter species demonstrated the highest resistance rate to amikacin, tobramicin and ceftazidime. The genetic analysis revealed the presence of aphA6, aacC1 and ADC-7 genes in all of the strains and aphA6 in resistance to amikacin, gentamicin, kanamycin, and neomycin. Another gene aacC1 suggests the resistance to gentamicin and Bla ADC including seven genes encoding B- lactamase (bla -ADC-1, bla-ADC-2, bla-ADC-3, bla-ADC-4, bla-ADC-5, bla-ADC-6, bla-ADC-7). Because of nosocomial spread and resistance to more groups of antibacterial agents, Acinetobacter species pose a threat for hospitalized patients.

Background: Using hospital databases to retrieve information, doing epidemiologic researches and making administrative decisions extremely depend on an accurate classification based on clinical coding. The researchers aim was to determine the validity of diagnostic coding based on ICD10. Materials and Methods: 370 medical records were selected from KAUMS teaching hospitals in 2008. We abstracted and recoded the first-sequenced diagnostic codes based on ICD10. The validity was determined by the agreement between original codes and recodes as gold standard. The coding errors were classified into major and minor. The major code errors were those happened in nature and topography. Others were considered as minor. Possible determinants were studied through a checklist and observation methods. The data were analyzed through X2, fisher test, OR, and CI 95% for OR. Results: Diagnostic codes accuracy was 77.3%. There were 84 (22.7%) errors in diagnostic codes so that 28 (33.3%) of them were major and 56 (66.7%) were minor. Using coding book and not using abbreviation reduced errors significantly. Complete records review reduced errors. Documenting more information especially diseases etiology increased errors. In addition, the relationship between readability of records and code accuracy was not significant. Conclusion: Majority of diagnostic codes were accurate. to reduce current errors, Coders’ factors such as more attention to available information and better documentation (e.g. not using abbreviation) can increase the quality of diagnostic coding and its databases.

Background: Intestinal parasitic infection is one of the major health problems in the world, especially in developing countries. The prevalence of infection in Iran varies among different social groups. As the geriatric are high risk group, the present study was carried out in order to determine the prevalence of intestinal parasites in geriatric and disabled residents of Kashan Golabchi Center, during 2006-2007. Materials & Methods: In this cross-sectional study a total of 297 stool samples (obtained from 243 geriatric and disabled and 54 office personnels) were randomly collected and examined by both direct, and formalin ether concentration methods. The demographic data (i.e. sex and age) and confidence interval were recorded for the study. X2 test was used for statistical analysis.Results: One hundred ninety one (78.6%) out of 243 geriatric and disabled were infected with pathogen and nonpathogenic intestinal parasites (CI=78.6±5.16). The prevalence of pathogenic intestinal parasites was 42.9%. Infection rate in the male disabled was higher than that in the female (P=0.001). The prevalence of pathogenic protozoa was as follows: Blastocystis hominis, 33.3%; Entamoeba histolytica/ E.dispar, 16.5 %; Giardia lamblia, 4.5% and Dientamoeba fragilis, 1.6%. Also the prevalence of nonpathogenic protozoa was: Entamoeba coli, 49.4%; Chilomastix mesnili, 23.5%; Entamoeba hartmanni, 23.9%; Endolimax nana, 11.5% and Iodamoeba butschlli, 6.6%. The prevalence of helminthes infections was as follows: Taenia, 1.6%; Hymenolepis nana, 0.8%; Strongyloides stercoralis, 0.4%; and Enterobius vermicularis, 1.6%. Infection rate in the office personnel was 49.3%. The prevalence of Blastocystis hominis, Entamoeba coli and Enterobius vermicularis was 31.5%, 20.4% and 8.5%, respectively. Regarding the severity of infection, 42.8% were infected with one parasite, 24% with two parasites, 18.2% with three parasites and 15% with more than four parasites.Conclusion: Infection with intestinal parasites, especially pathogenic parasites, was higher than what was expected. Considering the importance of parasitic infection in geriatric and disabled people and the susceptibility of these groups to risk factors (i.e., overcrowding and immunosuppressive predisposition of these group), it seems that controlling and treating the infection is important.

Background: Myelolipoma is one of the rare benign tumors of adrenal gland containing lipid and hematopoietic tissues. While the tumor is often detected incidentally, recently it can be diagnosed by modern radiological methods.Case report: The present study is the report of a 58year old man suffering from mild hypertension who had been referred to an endocrine clinic for the investigation of his right adrenal gland mass. The adrenal mass was detected incidentally through abdominal sonography when he was investigated for his chief complaint of epigastric pain. In adrenal CT scan, it was shown that a fat density mass between superior pole of right kidney and liver was attached to the internal side of right adrenal gland.Conclusion: Since adrenal myelolipoma is a nonfunctional mass with no hormonal secretion, it could be diagnosed efficiently through radiology rather than the conventional endocrine tests.