Journal of Isfahan Medical School
Year:2011 | Volume:28 | Issue:119|Papers Count:19

Background: Vitamin D has immunomodulatory function. Polymorphisms of the gene encoding the vitamin D receptor detected by BsmI may be source of diversity in its action. An association between vitamin D receptor gene BsmI polymorphisms and lupus nephritis has been reported. This study was performed to evaluate vitamin D receptor gene BsmI polymorphisms in lupus nephritis.Methods: Twenty nine patients with lupus nephritis enrolled in this study. Vitamin D receptor gene typing was performed based on polymerase chain reaction-restriction fragment length polymorphism.Finding: Vitamin D receptor genotyping of BsmI polymorphisms was 20.6% for BB, 51.7% for Bb, and 27.5% for bb without statistically significant difference (P=0.090). In 21 patients that renal biopsy was done, the Bb genotype was the most (42.8%). There was not any correlation between renal histology and vitamin D receptor gene BsmI polymorphisms (P=0.068).Conclusion: There was no relationship between vitamin D receptor gene BsmI polymorphisms and lupus nephritis.

Background: Many of the epileptic patients although are treated by multiple antiepileptic drugs but have recurrent multiple seizures. Surgery may be useful in these patients. Video-electroencephalic monitoring (VEM) is useful for finding epileptic focus or differentiating pseudoseizure from true seizure. This study was done in epilepsy centre of Kashani Hospital in Isfahan University of Medical Sciences to assess the clinical and paraclinical findigs of patients with intractable epilepsy.Methods: This cross-sectional study was done in epilepsy ward in Kashani hospital in 2009. Total data of admitted patients such as sex, age, type of seizure, type of medications, family history, duration of disease, and EEG findings were gathered in questionnaire forms. Data were analyzed by SPSS13 software.Finding: 101 patients were admitted in epilepsy ward of Kashani hospital in 2009. Mean age of patients was 26.8 and 50.5% (51 patients) were women.26.7% (27 patients) had pseudoseizure and 5.9% (6 patients) had focal epileptic lesion and were candidated for surgery.Conclusion: Video-electroencephalic monitoring is necessary in patients with intractable epilepsy for confirming diagnosis and selecting the patients that surgery could help them.

Background: Health system research improves health system processes. This study was designed to define health system research priority setting for sub-secretaries of Shahid Beheshti University of Medical Sciences. These could be lead to purposeful researches and better resource allocation.Methods: Through a health system research, stakeholders of each sub-secretary were defined and analyzed. Those who had the base score were selected to be asked. Research fields were listed through brain storming and finalized by Delphi technique. Research fields were prioritized through a questionnaire in which weighted criteria used for scoring. Final score calculated by multiplication of mean of each criterion’s weigh by research field mean score.Finding: Totally 89 sub-secretary were selected in 15 research fields. The top priority for sub-secretary of research was providing the University research map and priority setting, for sub-secretary of students was psychological problems in students, for sub-secretary of resources was criteria for workforce planning, for sub-secretary of food and drug was automation of services, for sub-secretary of treatment was hospital infections and for sub-secretary of health was needs assessment and situational analysis in the field of Shahid Beheshti University of Medical Sciences.Conclusion: Health system research committees in Shahid Beheshti University of Medical Sciences should be considered as an opportunity. Announcing the health system research priorities shows the way to promote community health based on its need. It also provides a tool for better resource allocation when there is resource shortage.

Background: Allergic rhinitis, one of the rhinitis syndromes, is associated with a symptom complex characterized by paroxysms of sneezing, rhinorrhea, nasal obstruction, and itching of the eyes, nose, and palate. Allergic rhinitis is associated with significant morbidity. Affected individuals have a quality of life significantly worse than otherwise healthy ones. The main goal of this study was to determine the sensitivity and the specificity of these tests and the relationship between clinical manifestation severity and the tests results.Methods: This cross-sectional study with forward direction was performed in allergy clinic of Alzahra hospital in Isfahan. The sampling was done in consecutive nonrandomized mode. The tool of gathering the data was a questionnaires asking about age, sex, family history, smoking, pet contact, allergic rhinitis type, severity and frequency of clinical presentation; also total serum IgE, nasal eosinophil count and Prick skin test results noted in questionnaires. The gathered data were analyzed by SPSS software.Finding: There were significant differences in patients Prick skin test results as the gold standard test depend on their family history and place of life; also total serum IgE titer and nasal eosinophil count in patients with positive skin test was significantly more than patients with negative skin test. For the other analyzed factors, there were no significant differences in patient Prick skin test result as the gold standard test. There was no significant relation between total serum IgE titer and clinical presentation severity and frequency; a same result was seen about nasal eosinophil count too. Based on Spearman’s correlation coefficient test, there was no significant correlation between total serum IgE titer and nasal eosinophil count; however this correlation coefficient would be raised ever the clinical presentation severity raises. The calculated cut off point for total serum IgE titer in this study was 61 IU/mL with 75% specificity and 80% sensitivity. The calculated cut off point for nasal eosinophil percentage in this study was 5% with 100% specificity and 72.7% sensitivity.Conclusion: Noticing the obtained results, it seems the physicians should concern family history and place of life in history taking as an important clue to allergic rhinitis diagnosis. This study clarified that total serum IgE titer and nasal eosinophil count can be acceptable paraclinic tests to allergic rhinitis diagnosis; but they should not be used to determine or guess how much the disease severity is.

Background: Bone diseases and injuries, including bone fractures during accidents and trauma, in all communities are prevalent and in most cases, crushed bone is not able to repair; various treatment ways including tissue graft from an allograft or autograft have risks and lead to problems. One method for treatment of bone fractures is using outologous osteoblasts with culturing on suitable scaffolds and then implant of cells to defect region. In this study, we cultured osteoblast cells on monolayer and calcium phosphate hydroxyapatite (HA-TC) scaffolds and the behavior of these two types of cells in different cultures were analyzed.Methods: During the craniotomy operation in Alzahra hospital in five individual, bone samples were obtained and in sterile condition were sent to the laboratory. Each sample after washing with PBS was cut into small pieces and plates containing the medium culture were transferred to the incubator. After 10-12 days, the cells have started to leave the bones covering the floor plate and after using the enzyme Trypsin-EDTA isolated from plate divided into two groups. One group was cultured in HA-TC scaffold and other as monolayer culture. Van kossa staining, flow cytometry, alkaline phosphatase assay and MTT method were used to investigate the characteristics of osteoblasts.Finding: Osteoblasts in monolayer culture were observed as fibroblast- like cells. Van kossa staining determined the mineral deposits in the two groups. The cell proliferation increased in cellular scaffolding HA-TC more than monolayer (P<0.001). Results of MTT showed more activity items on living cells in scaffold HA-TC than monolayer (P<0.001). In alkaline phosphatase staining, blue granules were observed; in the flow cytometry, 57 percent of primary cultured cells and 5 percent in the third passage cells showed alkaline phosphatase marker.Conclusion: According to the results of this study, the hydroxyapatite scaffold is better than monolayer culture for osteoblast cells. This could be because of having more calcium and similar elements to bone matrix that facilitate feeding cultured cells.

Background: One of the reasons that the power of intraocular lens (IOL) after Photorefractive keratectomy (PRK) report lower than the actual amount is an error of measurement of refractive power of cornea by corneal topography system and keratometers. There are Different devices with different accuracy for postoperative keratometry. It is necessary to use a more accuare device. This study aimed to compare IoL-Master keratometer with Zhaval keratometer.Methods: This clinical trial was a prospective study on patients referred for PRK. 35 patients aged 20 to 30, were randomly chosen. Keratometery was done by Zhaval (, china GM300) and the IOL Master system. Three months after PRK another keratometry was done for all of the patients with both devices by an 5 minutes interval. The differences between postoperative clinical history method with IOL Master keratometry and Zhaval keratometry was calculated. SPSS version 16 was used for data analysis and paired t-test and student t-test were performed.Finding: 70 eyes of 35 patients included 10 males and 25 females were studied. The mean age of patients was 23.45±1.55 years. The difference between postoperative keratometry using IOL Master with keratometry from CHM compared with the difference between Zhaval keratometer from CHM was statistically significant. There was a Significant direct relationship between IOL master keratometry and CHM method (0.86 but Zhaval keratometry had not a significant correlaton with CHM.Conclusion: The result of this study showed that the method obtained by IOL Master are much closer to the CHM, therfor is recommended that for postoperative PRK keratometry IOL Master device should be used.

Background: The six-minute walk test is a good index of physical function and therapeutic response in patients with chronic lung disease. The aim of present study was comparison Six-minute walking test with spirometry variables in patients who were candidates for thoracotomy.Methods: In this Descriptive–Analytic study, 65 patients who were candidates for thoracotomy recruited from Al-Zahra Hospital in Isfahan by simple nonrandom sampling. At the beginning of the study spirometry then the six-minute walk test (6MWT) was performed in the patients. Also measurements of oxygen saturation and pulse rate during exercise and distance walked during six minutes. Three patients were unable to performed six-minute walk test and excluded. Data were collected and analyzed for 65 patients.Finding: The mean age of patients was 44.8±14.2 years. Mean distance walked during six minutes was 427.27±98. There was significant association between mean of distance walked during six minutes with FEV1 dosage (r=0.5, P-value=0.043). There was no significant association between mean of distance walked during six minutes with age (r=-0.15, P-value=0.5).Conclusion: The results of this study demonstrated that there is significant association between mean of 6MWT with FEV1 but more studies need to assay the relations among 6MWT with spirometry variables.

Background: Insulin like growth factor I (IGF-I) is a member of large single-chain polypeptides, similar to proinsulin protein. This gene increases cell growth. The purpose of this study was to investigate polymorphism of Adenosine-Cytosine (CA) in IGF-I gene promoter among breast cancer patients and healthy individuals and its relation to risk of breast cancer.Methods: This study was a case-control study on 100 patients and 100 controls women. DNA was extracted from the blood of study subjects, the sequence were amplified by the technique of Polymerase Chain Reaction (PCR). Thereafter the number and sequence of CA was measured by gel electrophoresis on Polyacrilamid.Finding: The results of this study shown that IGF-I gene allele distribution in Isfahan population varies between 11 and 23 repeats and (CA)19 was the most common allele between patients and controls. Women with sequences larger than 19 were in a greater risk of breast cancer.Conclusion: These findings indicate a direct relationship between the numbers of repetitive sequences of IGF-I gene promoter and increased risk of breast cancer. In other words, increasing the number of CA repeat (greater than 19) located in the promoter gene, increases the risk of breast cancer in women.

Background: Nosocomial infections are amongst important complications of cardiac surgical operations. The principal types of these infections appear as surgical site or respiratory infections. The rate of surgical site infections after cardiac surgery has been reported between 1 and 9 percent and the rate of respiratory infections has been up to twice this range. Various studies have attempted to make use of methods to prevent post-operative infections in addition to routine measures of preparation before surgery. Topical application of bacitracin or gentamicin ointment, intranasal mupirocin ointment, oral rinse and intranasal application of chlorhexidine solution are among these methods. The current study aimed to investigate the impact of mouth and nose disinfection with chlorhexidine solution on reduction of surgical site as well as respiratory infections after cardiac surgical operations.Methods: This study was conducted in the cardiac surgery ward, Sina Hospital, Isfahan from 1388 to 1389 as a randomized clinical trial. Patients undergoing open heart surgery entered the study. Patients were randomly assigned to two groups, whereby in one group preparation for operating room was implemented by routine methods and in the other group, mouth and nose disinfection with 0.2% chlorhexidine solution was performed every 6 hours from one day before to one day after surgery, in addition to routine hospital measures. Each patient was followed for signs of infection up to one month after surgery.Finding: From 180 patients were recruited too this study, Chlorhexidine solution was used in 88 patients and 92 other patients who comprised the control group. The age of patients ranged from 43 to 77 years. Mean age was 61.8 years in case group and 61.5 years in control group. Total number of infections in case (intervention) group was 6 (7%) including 2 surgical site infections and 4 respiratory infections. A total of 13 patients (14%) in the control group were diagnosed with infections including 7 surgical site and 6 respiratory infections. There was no statistical difference I using chlorhexidine (P=0.232). In the case group 4 infections (66%) occurred in patients suffering from underlying diseases specially diabetes and 9 infections (69%) in the control group occurred in patients with underlying diseases .1 patient in the control group died from acute heart failure during a second hospitalization, who also had fever and wound infection.Conclusion: Despite lower number of infections in the case (intervention) group, there was no significant difference. Some studies have attained similar results not considering nasal S. aureus carrier state. But some studies on S. aureus carrier patients have found meaningful reductions in postsurgical.

Background: ERCP is very useful Method in diagnose and treatment of jaundice and obscure abdominal pain. In this study patients who had hospitalised due to jaundice and obscure abdominal pain and very different examination had been performed for them, were studied for terminal diagnose using ERCP.Methods: Patients’ records of 100 patients who ERCP had been done for them during 1382-1389 were investigated. All available information including history, lab data and physical exams as well as paraclinical findings at the time of ERCP were collected.Finding: Our findings indicates that 47% were diagnosed as stone, 27% as normal, 9% as cholangiocarcinoma, 4% as adenocarcinoma of papilla, 6% cancer of head of pancreas and 7% as other. Among those who primary diagnosis was cholestatic jaundice, 51% stone, 15.8% cholangiocarcinoma, 12.2% normal, 5.2% adenocarcinoma of papilla, b.7% cancer of head of pancreas and 7% others were diagnosed using ERCP. This figures for patient with primary diagnosis of right upper quadrane pain was 66.7% normal, 25% stone and 8.3% pancreatic cancer.Conclusion: It seems that stone is the most common cause of jaundice and obscure abdominal pain. The most prevalent final diagnosis for those with primary diagnosis of cholestatic jaundice was stone and cholangiocarcinoma afterwards.

Background: surgical resection without preoperative angioembolization is an appropriate treatment for carotid body tumor but may lead to unwanted complications. The aim of present study is to define characteristics, complications, and outcomes of patients with carotid body tumor treated without embolization and by subadvantitial tumor resection.Methods: this cross sectional study was performed in Al Zahra hospital during 2004-2009 among patients candidate for carotid body tumor resection. Demographic data as well as complications attributed to operation were collected. Data were analyzed by SPSS software.Finding: 32 patients and 36 operations were enrolled. Mean age was 51.4±13.62 years.12.5 % of subjects were male and 87.5% were female. All tumors were diagnosed as paraganglioma by histopathology examination. Mean size of tumors was 3.4±0.91 cm. Cervical lymphadenopathy was the most common complication and orthostatic hypotension was tge second one.Conclusion: the rate of complications among our series of patients operated without preoperative angioembolization via subadvantisial dissection were overall acceptable.

Background: Acute phase proteins disorders are common problems in dialysis patients. According to previous studies, carnitine can increase blood albumin levels in these patients. In this study the effect of carnitine on serum albumin level of hemodialysis patients was investigated.Methods: In this blinded placebo controlled randomized clinical trial, 51 hemodialysis patients (16, 17 and 18 patients in the drug (carnitine), placebo and control groups, respectively) aged more than 21 years, were enrolled. L-carnitine (250 mg) and placebo pills were prescribed daily in three divided doses orally for 6 months. The control group received no drug. Serum albumin level in studied patients was measured before the study and every month after intervention.Findings: The mean serum albumin level at baseline in carnitine, placebo, and control groups was 3.87±0.26, 3.88±0.35, and 3.96±0.45 g/dl, respectively. The mean serum albumin level at the end of the study in carnitine, placebo and control groups was 4.39±0.54, 4.44±0.78, and 3.84±0.45, respectively. The mean serum albumin changes in three studied groups were significantly different before and after intervention (P< 0.05) due to the difference of control group with placebo and carnitine groups. There was no significant difference regarding side effects and mortality in carnitine and placebo groups (P>0.05).Conclusion: Carnitine had not significant effect in serum albumin level. But considering the improvement was observed in carnitine and placebo groups comparing with control group, it could be suggested that it may be attributed to placebo effect and improvement of patients’ mood. Similar studies with higher doses of carnitine are recommended.

Background: Renal transplantation is the end of renal failure treatment in ESRD patients. It is a well-known model of renal eplacement therapy for end-stage renal disease patients in developed and developing countries. This model of treatment has widely been used in our country in recent years. The present study was undertaken to investigate the long tome complications and survival time of transplanted kidney in Al Zahra Isfahan hospital.Methods: In a cross sectional study long time complications of kidney transplantation such as infection, cardial and renal were studied. This retrospective study reviewed patient population in terms of age, sex, etiology of transplantation reject, using corticosteroid drugs and survival time for new kidney. The data recorded in special questionnaire and entered to computer and analyzed by SPSS soft ware, The chi square, T paired student and Kaplan Meyer tests were used for data analysis.Finding: 130 patients (42 females, 88 males) who had been under kidney transplantation were studied between Jan. 1382 and Jan. 1385. The patients mean age was 46.3±14.5 years. The frequency distribution of long time complications of transplantation include renal, cardiac and infection was 10%, 3.1% and 36.9% respectively.Conclusion: Kidney transplantation is a method of choice for treating of ESRD patients. The most common cause for discontinuing renal efficacy is long time complication specially infection in transplantation site.

Background: Inguinal herniotomy is the most common operation in pediatric surgery. The aim of this study was comparison of two methods of herniotomy with and without opening of external oblique muscle fascia.Methods: 49 patients with inguinal hernia was surveyed in two groups. 25 PT was operated without opening and 24 PT with opening of facia from 2006 lun-2007 lun. Data of age sex post operative complications (score of pain and firmness of wound) Time of surgery and anesthesia were analyzed with T-Test and X2 and P<0.05 was meaningful.Finding: No meaningful different was about age and sex between the two groups but score of post operative pain and firmness, mean of operative and anesthetic times were loss significantly in without opening fascia group (P=0.000). No recurrence of hernia was observed as follow as one year.Conclusion: Inguinal herniotomy without opening of fascia was effective as another procedure with more less complications and duration of operation and anesthesia.