Research in Medicine
Year:2008 | Volume:32 | Issue:3|Papers Count:17

Background and Aim: Urinary tract infections (UTI) are common cause of morbidity and mortality especially in young children around the world. Pyelonephritis can lead to scar formation, and subsequent hypertension and renal failure. Interleukins play a major role in renal scar formation following febrile pyelonephritis. The aim of this study was to investigate the level of urinary interleukin-6 (UIL-6) and UIL-8 concentrations during the acute phase of pyelonephritis and after two kinds of treatment. Materials and methods: UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with acute pyelonephritis who were treated with Ceftriaxone plus steroids (case group) and in 20 patients treated with antibiotic alone (control group). Cases and controls were age and sex matched. Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 hours after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated. Results: The differences between the cytokine/creatinine ratios in the initial urine samples and the follow-up samples were significant in the case group (p<0.001), but not for the controls. In addition, combined antibiotic and steroids significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone (p<0.05). Conclusion: We conclude that steroids combined with antibiothics significantly decrease UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This result can suggest that the clinical use of corticosteroids may prevent scar formation following pyelonephritis. 

Background and Aim: Post-mortem structural changes in tissues cause technical difficulties in accurate histo-pathologic interpretation. In the present study, we evaluated the effects of microwave irradiation before tissue fixation on preventing post mortem autolysis and accelerating the process of tissue fixation in the kidneys. Materials and Methods: Twenty-four chickens randomly were divided into 8 groups of 3 each. They were slaughtered and stored at room temperature. At 0, 1, 3, 5, 10, 15, 20 and 25 hours the kidneys were removed from chickens. The right kidneys were used as controls and fixed by conventional method through immersing in 10% buffered formalin; all the left kidneys were first irradiated by microwave (MWI; 30sec/450 watt) and then immersed in 10% buffered formalin. Kidney tissue samples were prepared according to standard routines, sliced into sections measuring 5 microns and stained by hematoxylin and eosin; next, these slides were examined through a light microscope. Results: Morphologic study showed no difference in tissue preservation between the two methods till 20 hours post-mortem; however, at 25 hours, samples that had been fixed according to the standard methods revealed marked post-mortem structural degeneration while samples receiving microwave irradiation before fixation had preserved their original structure to a greater degree. Conclusion: Microwave irradiation before fixation of kidney tissue that has been dead for up to 25 hours results in greater structural preservation as compared to fixation by routine methods. We recommend further studies, preferably by using image analyzing, immunohistopathology and electronic microscopy to scrutinize minute structural changes in detail. 

Background and Aim: Puerperal infection describes any bacterial infection of the genital tract after delivery. It is the cause of 13% of pregnancy related deaths and the fifth leading cause of death. Some studies have addressed the role of meconium-stained amniotic fluid in puerperal infection. The aim of this study was to evaluate the association between meconium-stained amniotic fluid and puerperal infection. Materials and Methods: In this cohort study 300 pregnant women with gestational age≥37 weeks were divided in two groups. In case group amniotic fluid was meconium-stained and in control group amniotic fluid was clear. All patients were delivered by cesarean section and received prophylactic preoperative antibiotics. Patients were checked for puerperal infection within 40 days. All data was analyzed with SPSS. Results: Among 150 patients in case group 2 women (1.3%) developed a fever but none in the control group showed any signs of infection. There was no significant statistical difference between case and control groups (P>0.05). Conclusion: Although this study, revealed no relation between meconium-stained amniotic fluid and puerperal infection, but, since both groups had received antibiotics, further comprehensive studies are needed to elucidate the role of meconium-staining of the amniotic fluid in the occurrence of post-partum sepsis. 

Background and Aim: Colorectal cancer is one of the most common malignancies in worldwide. Because the gene 5, 10-methylene-tetrahydrofolate reductase (MTHFR) plays a key role in methylation, synthesis and repair of DNA, numerous studies have focused on evaluating the correlation between polymorphisms of this gene and sporadic colorectal cancer. This study was carried out to examine the association of MTHFR gene polymorphism, C677T, with non-familial colorectal cancer in an Iranian population.Material and methods: We analyzed peripheral blood samples of 118 cases of colorectal cancer and 189 controls by pyrosequencing method. Controls were subjects who had been referred to our center during the study period and had revealed normal findings on colonoscopy.Results: We found that frequency of CC, CT and TT genotypes among the colorectal cancer patients were 51.7%, 28% and 20.3% respectively. The figures for controls were 47.1%, 27% and 25.9% respectively. Furthermore, allele frequency T in the cases was 34% and allele frequency C was 66% while allele frequency T in controls was 39% and allele frequency C was 61%. Conclusion: Interestingly we observed a reverse association between risk of colon cancer with 677TT genotype. 

Neisseria species are gram negative diplococci; an important characteristic of these bacteria is resistance against crystal violet. This study was done to investigate the effect of crystal violet on the growth of Neisseria, to observe the outcome of adding this substance in culture media for isolating these organisms, and finally to make a specific medium for isolation of the Nisseria species.Materials and Methods: The study was done in 3 phases: 1) Initially urethral discharge from 106 male patients with urethritis was cultured on NYC, chocolate agar and chocolate violet agar with various concentrations of violet from 1:100000 to 1:250000. We also made direct smears for gram stains. 2) Pharyngeal secretions from 230 healthy persons were cultured on chocolate agar, Muller Hinton agar, and Thayer Martin agar with different concentrations of violet between 1:50000 to 1:500000. Also direct smears were made for gram stains. 3) The standard strain of gonococcus (ATCC) were cultured on the three media. Concurrently we added various concentrations of violet from 1:50000 to 1:200000 to the above media and studied the effect of adding crystal violet on the growth of the standard strain. Results: In first step, 69 out of 106 patients with urethritis were suspicious of gonorrhea, with positive culture of gonococcus on NYC medium from 64 patients. On chocolate agar only 54 positive cultures, (with 84% sensitivity against NCY medium), were seen together with a growth of normal flora. Chocolate agar plus violet in concentration 1:150000, showed 58 positive cultures, (with 91% sensitivity against NYC medium), with minimal growth of normal flora. In second step, 228 out of 230 healthy persons had positive culture of Neisseria, these organisms grew in different concentrations of crystal violet between 1:500000 and 1:50000. However, with minimal concentration of violet, there was a dense growth of normal flora and with gradual increase in concentration, normal flora grew sparsely. In direct exam, 228 cases of gram negative Neisseria like diplococci were observed. In third step, result of growth of the standard Neisseria gonorrhea in chocolate agar, Muller-Hinton agar and Thayer-Martin agar with and without different concentrations of crystal violet are as follow: In all media without crystal violet, the growth of the bacteria was perfect and abundant; while in media containing crystal violet, minimum colony count was observed in concentrations of 1:50000 and maximum colony count occurred at concentrations of 1:200000. Conclusion: To isolate pathogenic species of Neisseria, for e.g. gonococcus, we can use a specific chromogen medium like chocolate-violet agar 1:150000, or Thayer-Martin-violet agar or Muller-Hinton-violet agar with a concentration of 1:200000. Although nonpathogenic Neisseria have high resistance to crystal violet and were isolated from cultures with 1:50000 dilutions of this substance, but growth become sparse with higher concentrations. We can make chromogen media of varying strengths by adding different amounts of crystal violet in various media to get the desired results.

Background and Aim: Rubella virus is a potent teratogen. Risk of rubella virus induced multisystem fetal malformation is highly dependent on the gestational age at the time of infection. Because the rubella vaccine is an attenuated live virus, its use is contraindicated during pregnancy. Our objective was to examine whether exposure to rubella vaccine during 1-4 weeks periconceptional period can cause any adverse pregnancy outcome or Congenital Rubella Syndrome (CRS). Materials and Methods: This prospective study was performed in 60 pregnant women who received rubella vaccine inadvertently 1-4 wks pre or post conception. Time of conception was determined by last menstrual period (LMP) and first trimester sonography. In addition to gathering mother's obstetric and demographic information, all neonates were evaluated for CRS signs by systemic physical examination and anti rubella IgG and IgM antibody levels in cord blood samples. Results: Mean maternal age was 21.8±2.9 years and 58.3% of pregnancies were unintended. In 90% of mothers there were no post vaccination side effects. None of the mothers had a history of drug abuse, smoking or teratogenic exposures. Mean neonatal weight was 3108±581 gr and 6.7% of them were premature. There was no increase in the rate of adverse pregnancy outcome, (abortion, preterm labour, post term pregnancy, fetal demise, obstetric hemorrhage, pregnancy related major malformation). No signs of CRS were found in the neonates based on systemic physical exam. Mean value of cord blood anti-rubella IgG level was 143.9±69.5 IU/mL. Cord blood anti-rubella IgM was negative in all of the neonates. Conclusion: It seems that inadvertent rubella vaccination 1-4 weeks before and after conception does not cause CRS in neonate and therapeutic abortion is not indicated; however since in rare instances clinical manifestations of rubella have appeared years after the congenital infection, women planning to get pregnant should not be vaccinated against rubella one month before and throughout pregnancy. 

Background and Aim: Since the first description of Amebiasis, we still do not have a proper answer to the question of why disease and symptoms develop in only 5 to 10% of those infected with E. histolytica. It has been speculated that a spectrum of virulence levels among the E. histolytica strains contribute to the outcome of amebic infection. In this study, beside determination of prevalence rate of E.histolytica and E.dispar in gastrointestinal disorder patients, genetic diversity in non-coding locus 1-2 was investigated to identify genetic differentiation of Entamoeba in positive isolates.Materials and Methods: A total of 1700 stool samples were checked from patients referred to clinical laboratories affiliated with Shahid Beheshti Medical University; samples were examined by direct and formalin detergent methods. Twenty seven cases of E. histolytica/E. dispar were detected and total genomic DNA was extracted from stool samples. E. histolytica/E. dispar complex were determined by PCR with two sets of species-specific primers from locus 1-2 gene. The purified PCR products were sequenced and the results were compared with known E. histolytica and E. dispar sequenced data. Results: PCR for locus 1-2 gene amplified a fragment of about 430 bp in 21 out of 27 samples and was identified as E. dispar. One isolate showed a band of about 340 bp and was identified as E. histolytica. PCR were negative in five samples which were discarded. With PCR and sequencing of the PCR products a reliable genetic diversity in size, number and position of the repeat units were seen among the Iranian E. dispar isolates in locus 1-2 gene. Conclusion: Eight new E. dispar genotypes were found in this study and submitted to the GenBank/EMBL/DDBJ. The only Iranian E. histolytica isolate (NH1 E.h IR) was completely similar with the KU2 (Accession No. AB075706) strain reported from Japan. 

Background and Aim: Colorectal cancer is a common and lethal disease with 5000 new cases reported each year in Iran. This study was done to estimate the 1, 2-3 and 4-5 year point prevalence of colorectal cancer in Iran. Materials and Methods: In this descriptive study we studied the follow-up of 2342 patients with colorectal cancer documented in the cancer registry in Iran during a time period of 4 years from March 2001 to March 2005. One-year, 2-3 year and 4-5 year point prevalence were estimated from incidence rates in different years and proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years after diagnosis. Results: Proportion of cases surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years from diagnosis were 79.2% , 65.08%, 57.36%, 51.76% and 48.87% respectively. Estimation of prevalence at 1, 2-3 and 4-5 years were 4156, 5715 and 4283 cases, respectively. Cumulative 5 year prevalence was 13954 cases. Conclusion: Estimates of prevalence at 1, 2-3 and 4-5 years are necessary for the evaluation of initial treatment, clinical follow-up and point of cure, and also for identification of patients who need further social support or health care. Therefore 1, 2-3 and 4-5 year point prevalence estimation are necessary in health service planning for cancer management. Background and Aim: Colorectal cancer is a common and lethal disease with 5000 new cases reported each year in Iran. This study was done to estimate the 1, 2-3 and 4-5 year point prevalence of colorectal cancer in Iran. Materials and Methods: In this descriptive study we studied the follow-up of 2342 patients with colorectal cancer documented in the cancer registry in Iran during a time period of 4 years from March 2001 to March 2005. One-year, 2-3 year and 4-5 year point prevalence were estimated from incidence rates in different years and proportion of patients surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years after diagnosis. Results: Proportion of cases surviving 0.5, 1.5, 2.5, 3.5 and 4.5 years from diagnosis were 79.2%, 65.08%, 57.36%, 51.76% and 48.87% respectively. Estimation of prevalence at 1, 2-3 and 4-5 years were 4156, 5715 and 4283 cases, respectively. Cumulative 5 year prevalence was 13954 cases. Conclusion: Estimates of prevalence at 1, 2-3 and 4-5 years are necessary for the evaluation of initial treatment, clinical follow-up and point of cure, and also for identification of patients who need further social support or health care. Therefore 1, 2-3 and 4-5 year point prevalence estimation are necessary in health service planning for cancer management. 

Background and Aim: In the turbulent healthcare marketplace, performance is often of the highest importance; as a result, performance evaluations are critical to the long-term success of the organization. Among different performance appraisal systems, one current method is appraisal by The Excellence Model (EFQM). The underlying philosophy of the EFQM Model is that of continuous quality improvement based on an integrated framework that attempts to describe the relationships between processes, people and results, all of which are relevant to the provision and delivery of healthcare. This study aimed to assess the Performance in different hospitals of Isfahan University of Medical Sciences and Healthcare Services by using The Excellence Model.Methods: This cross-sectional study was carried out in 2007. The research population included managers in hospitals belong to Isfahan University of Medical Sciences and Healthcare Services. Data were collected by a questionnaire that had been used in past studies. This questionnaire of 50 items was completed by managers. Results: The mean scores for self-assessment in different fields were as follows: The mean score in leadership performance: 56/100; policy and strategy: 40/80; workforce 51/90; partnerships and resources: 50/90; processes: 71/140; customer results: 103/200; workforce results: 42/90; society results: 28/60; function key results: 74/150. Total mean scores of performance self-assessment was 516/1000. Conclusion: Culture of self-assessment is important to evaluate performance accurately. Findings of this study underscore the need for improvement in the areas pertaining to workforce and customer satisfaction.

Background and Aim: The use of medicinal plants has increased greatly mainly due to their easy availability, fewer side effects and lack of toxicity. The present study was carried out to investigate the antidiabetic effect of the extract of aerial parts of salvia nemorosa in normal and streptozotocin- induced diabetic male rats. Materials and Methods: After collection and taxonomic identification of plant, the ethanolic extract of Salvia nemorosa was prepared by the soxhlet apparatus. The animals were made diabetic by using 70 mg/kg streptozotocin injected intraperitoneally. The plant extract was administrated orally in doses of 0.01, 0.1, 0.2 and 0.4 g/kg to the normal and diabetic rats for 14 days. Two groups of normal and diabetic rats, which served as sham group, were administered distilled water. Blood samples were obtained from the hearts of all experimental animals after 14 days. Serum glucose and insulin were measured by glucose oxidase and radio immunoassay methods, respectively. Results: Oral administration of the alcoholic extract of Salvia nemorosa significantly decreased serumic glucose (p<0.001) and increased serumic insulin levels (p<0.01) in rats with streptozotocin-induced diabetes, but not in healthy rats. Furthermore, it increased weight in diabetic rats (p<0.01). Conclusion: The present data indicate that extract of Salvia nemorosa has hypoglycemic effect in diabetic rats. This plant should be considered as a therapeutic option in future experimental researches for the management of Diabetes Mellitus in human. 

Background and Aim: Intra-abdominal pressure, (IAP), is the pressure inside the abdominal cavity. Its normal value has not been defined clearly, but it may range from sub-atmospheric to about 7 mmHg. Intra-abdominal hypertension, defined as IAP greater than 12 mmHg, has been reported in critically ill patients and is associated with cardio-respiratory and renal co-morbidities. The effect of borderline values of IAP on the peri-operative morbidities has not been investigated in previous studies. This study was designed to investigate the effect of high normal values of IAP on anesthesia-related peri-operative complications.Materials and Methods: Intra-abdominal pressure was measured before induction of general anesthesia in 60 adult non-obese patients scheduled for elective orthopedic surgery. Patients were observed throughout the operative and recovery period for any evidence of anesthesia-related complications viz. oxygen desaturation, hypertension, dysrhythmia etc. Patients were categorized into two group, those with >2 episodes of complications, and those with≤2 episodes. Results: Thirty-three patients experienced >2 episodes of complications. The mean IAP was 8.21±2.1 mmHg in this group and was significantly different from the group with fewer complications in whom the mean IAP was 4.2±1.51 mmHg, (p<0.05). Binary logistic regression analysis showed that IAP was an independent predictor for development of anesthesia-related complications with an Odds ratio of 1.4 (1.17-1.81, p=0.015). Conclusion: The result of this study shows that high normal values of IAP are an independent predictor for the development of peri-operative anesthesia-related complications. 

Background and Aim: Injections are one of the most common health care procedures. Each year some 16 thousand million injections are administered in developing and transitional countries. Due to unsafe injection practices 26 million years of life are lost each year. Objective: To define the knowledge of health care providers about safe injection practice in children according to WHO standards. Materials and Methods: We prepared a cross sectional study and included health care personnel in two university affiliated medical centers. Data about the knowledge of safe injection practices, as recommended by the World Health Organization, was collected using a previously designed questionnaire. Statistical analysis was performed by using SPSS 13.0. Results: 150 personnel answered the questions. Percentage of incorrect answers were as follows: use of gloves 92%, need to disinfect single dose vials 80%, disinfecting site of muscular injections 86.7%, safe needle disposal 70.7%, recapping the needle 56%, and the optimal site for intramuscular injections in young children 12.7%. 72.7% were not familiar with auto-disable syringes. There was no significant difference in the belief that injection is better than oral medication between doctors and nurses (p>0.05). Almost 80% of doctors and more than 50% of nurses believed that parents preferred injection prescriptions for their children. Conclusion: Our findings revealed a serious lack of knowledge about safe injection practices among health care providers albeit doctors or nurses. We recommend that instructions about safe injection practices should be included in the medical and nursing curriculum. Moreover, improving communication skills between health care providers and their patients would prevent the misuse of all drugs including injections. 

Background and Aim: Query (Q) fever is caused by hard ticks infected by Coxiella burnetii. It belongs to a group of diseases, classified as zoonosis, that are common between human-beings and animals. This study was conducted with the objective of defining the prevalence of Coxiella burnetii in humans, animal hosts and hard ticks in the western part of the Mazandaran province. Materials and Methods: Blood samples were collected from subjects randomly selected from individuals working in professions that brought them in close contact with animals. We also obtained blood samples from randomly selected farm animals, and a limited number of samples from stray dogs in the community. Hard ticks were collected from the bodies of farm animals and also from the shrubs around the farms. The ticks were identified by genus, species and developmental stage. All blood samples were tested by PCR. With the aid of two pairs of primers especially designed 16S rRNA for Coxiella burnetii, PCR and then Nested–PCR was done on each sample. Results: A total of 2417 hard ticks were removed from: animal bodies (1644) and from the shrubbery (773). The hard tick species were identified as follow: Ixodes ricinus (72%), Hyalomma anatolicum anatolicum (15%), Boophilus annulatus (9%), Haemaphysalis sulcata (3%), Dermacentor marginatus (1%) No positive case of Coxiella burnetii was observed in 1052 investigated samples in this study (120 humans, 135 sheeps, 102 cows, 60 goats, 20 dogs, 10 hedgehogs and 605 hard ticks). Conclusion: This study did not find any evidence of contamination with Coxiella burnetii in the samples collected from the rural areas of Western Mazandaran. To define the prevalence of this microorganism in different parts of northern Iran further epidemiological studies are necessary.