JOURNAL OF BABOL UNIVERSITY OF MEDICAL SCIENCES (JBUMS)
Year:2016 | Volume:18 | Issue:10|Papers Count:16

BACKGROUND AND OBJECTIVE: Airway obstruction is a lethal complication of anterior cervical discectomy and prevertebral soft tissue swelling after surgery is one the important causes of this complication. The aim of this study is to investigate the effect of local steroid injection on prevertebral soft tissue swelling after anterior cervical discectomy and fusion (ACDF).METHODS: This randomized clinical trial was conducted on 40 patients hospitalized in Qazvin educational & clinical Rajaee hospital who were candidates for ACDF in one to three segments because of myelopathy or radiculopathy. Patients were randomly divided into case and control groups. In case group (20 patients), 80 mg methylprednisolone was injected locally on the site of the operation. No injection was performed in control group (20 patients). Lateral neck radiography was performed one day before surgery and on the second and tenth day after surgery. The ratio of prevertebral soft tissue thickness to mid anteroposterior vertebral body (S/V) was calculated for C3-C7. In addition, pain and dysphagia after surgery were recorded on the second and tenth day after surgery (IRCT: 201507212327N1).FINDINGS: S/V ratio in C3-C7 revealed no significant difference in both groups. On the second day after surgery, increase in S/V ratio in all cervical vertebrae revealed a significant difference between the two groups compared with the day before surgery (p<0.001). However, this level of increase on the tenth day was only significant in C5 (control group=0.10±0.07, case group=0.02±0.08) and C7 (control group=0.11±0.05, case group=0.02±0.1) (p=0.004 and p=0.002, respectively). There was also a significant difference between the two groups on the second and tenth day regarding intensity of pain and dysphagia after surgery (p=0.001).CONCLUSION: Based on the results of this study, local methylprednisolone injection reduces prevertebral soft tissue swelling, pain and dysphagia after surgery.

BACKGROUND AND OBJECTIVE: Stress urinary incontinence (SUI) occurs in 35% of women and about 30% of them will require a second surgery. This illness has negative effects on patients’ quality of life. Since TVT (Tensionfree vaginal tape) bladder neck suspension is a minimally invasive procedure for curing patients with stress urinary incontinence, the present study was conducted to investigate the effect of TVT bladder neck suspension on quality of life in these patients.METHODS: This analytical study was conducted to assess the quality of life in 50 patients with stress urinary incontinence, using Kings Health Questionnaire in various fields, before TVT surgery, one month after surgery, and six month after that. This questionnaire has a 4-point grading system. Each field is graded from 0 (best) to 100 (worst). Decline in scores indicates increase in quality of life. FINDINGS: Every field that influenced the quality of life in women with stress urinary incontinence was improved significantly, one and six month after TVT surgery compared with the situation before the surgery (p<0.05). Intensity of symptoms increased from 14.10±3.77, before the surgery to 8.16±2.35, one month and 8.26±2.3, six month after the surgery (p<0.001). After TVT surgery, 14 patients (28%) experienced fever, 5 patients (10%) experienced urinary retention, 3 patients (6%) experienced urinary infection and 1 patient (2%) experienced bleeding.CONCLUSION: Results of the study demonstrated that TVT bladder neck suspension improves the quality of life in patients with stress urinary incontinence.

BACKGROUND AND OBJECTIVE: Recurrent oral aphthous ulcers (Recurrent Aphthous Stomatitis = RAS) is a common mucosal lesions occur in 20% of the population and majority of the current treatments for recurrent aphthous stomatitis (ras) are aimed to minimizing pain. The aim of this study was to determine whether laser co2 has this analgesic effect.METHODS: A randomized single blind trial was conducted in 43 patents with ras. The subjects were divided into 3 groups: namely, co2 laser group, group with conventional treatment and placebo group. The co2 laser device was operated 3 w power in continuous mode for 5-8 seconds. To measure the pain, VAS scale was used and patients were evaluated for pain and size of the ulcers within before treatment, and days of 1, 4, and 7. FINDINGS: The average intensity of pain was 5.94±2.41, before the intervention and reached to 0.39±1.28 on the seventh day. The pain reduction in co2 laser treatment group is more than the placebo group and conventional therapy group (p=0.001). The average size of the ulcers was 4.41±2.21 mm before the intervention and decreased to 0.6±1.19 on the seventh day, but there were no statistically significant differences in the size of ulcers between groups (p>0.05).CONCLUSION: It seems that the use of laser CO2 has favorable results in reducing pain in patients with RAS.

BACKGROUND AND OBJECTIVE: Copper is a metal element which plays a pivotal role in the pathology of various neurological disorders including cognitive disorders. Previous studies have shown different relationships between serum levels of copper and cognitive impairment. This study aimed to investigate the relationship between serum levels of copper and cognitive disorders in the elderly in Amirkola.METHODS: This cross-sectional study is a part of Amirkola Health and Ageing Project performed on all the population is 60 years and older. According to the Mini-Mental State Examination (MMSE), people were divided into two groups with impaired cognitive status (N=347) and normal (N=657). People with cognitive impairment were classified in mild, moderate, severe subgroups. In this test, point more than or equal to 25 (30-25) was considered as natural and score less than 25 as a person with cognitive impairment. Serum copper level was measured in venous blood samples and was compared between two groups.FINDINGS: In this study, of 1616 elderly people, 1004 people in the age group 60-90 years were examined. 518 men and 486 women were existed with a significant difference in serum level of copper between the sexes (p<0.0001). The average serum level of copper in people without cognitive impairment (129.43±54.83) was different from an average copper level in patients with cognitive impairment (135.06±57.38), but was not statistically significant. There was a significant difference in serum levels of copper in the MMSE subgroups (p=0.009).CONCLUSION: The results showed that cognitive impairment is associated with serum levels of copper.

BACKGROUND AND OBJECTIVE: Premature rupture of membranes (PROM) is a serious complication during pregnancy, which is accompanied by prenatal, neonatal and maternal complications including premature delivery, infection and fetal death. The Purpose of this research is to study the frequency of maternal risk factors and neonatal complications of premature rupture of membranes.METHODS: This cross-sectional study was conducted on 309 infants with premature rupture of membranes (more than 18 hours before delivery) from 2009 to 2015. After confirming premature rupture of membranes based on history and speculum examination, a questionnaire containing pregnancy information, delivery information and infant profile was completed and assessed.FINDINGS: Maternal risk factors included diabetes (23 cases, 12.7%), hypertension (17 cases, 9.5%), smoking (16 cases, 8.9%), history of premature rupture of membrane (16 cases, 8.9%), urinary tract infection (13 cases, 7.2%), thyroid disorders (9 cases, 5%), previous premature birth (8 cases, 4.4%) and cerclage (7 cases, 3.8%). Delivery complications included cesarean (117 cases, 38.1%), oligohydramnios (61 cases, 33.9%), chorioamnionitis (14 cases, 11.6% placental abruption (17 cases, 9.5%), fetal distress (6 cases, 3.3%), intrapartum fever (6 cases, 3.3%) and placenta praevia (5 cases, 2.8%). Neonatal complications included immaturity (165 cases, 73%), jaundice (108 cases, 59%), neonatal infection (94 cases, 52%), respiratory distress syndrome (65 case, 30.4%) and asphyxia (52 cases, 17%). There was a significant difference between infants with infection and without infection in terms of first and fifth minute Apgar scores, erythrocyte sedimentation, platelet and gestational age (p=0.000).CONCLUSION: Results of the study demonstrated that diabetes and hypertension are the most frequent maternal risk factors of premature rupture of membranes. Immaturity, respiratory disorders, asphyxia and infection are the most serious associated problems. It may be possible to reduce neonatal problems with proper measures and management.

BACKGROUND AND OBJECTIVE: Gastroenteritis caused by salmonella is common in humans and is regarded as a global public health issue. The aim of this study is to identify agfA and mgtC genes in salmonella typhimurium strains isolated from stool samples using multiplex PCR method and to determine the resistance patterns of these strains.METHODS: This cross-sectional study was conducted on salmonella typhimurium isolated from children with gastroenteritis admitted to Children's Hospital Medical Center in Tehran. Frequency of agfA and mgtC genes was evaluated using multiplex PCR method. In addition, antibiotic susceptibility of these isolates was studied using gel diffusion method and according to CLSI guidelines.FINDINGS: Of total 200 stool samples, 60 salmonella typhimurium isolates were obtained. Molecular analysis showed that 24 isolates contained both agfA and mgtC genes at the same time, while 52 isolates contained mgtC gene and 40 isolates carried agfA gene. All strains (100%) were susceptible to ciprofloxacin and 85% of strains were resistant to nitrofurantoin.CONCLUSION: Results of the study demonstrated that most frequent virulence gene in these strains was mgtC (86.6%) and the least frequent virulence gene was agfA (66.6%). Moreover, it was concluded that these isolates were 100% susceptible to ciprofloxacin and were the most resistant to nitrofurantoin (85%).

BACKGROUND AND OBJECTIVE: Mupirocin is a secretory antibiotic and a bacterial Isoleucine- tRNA synthetase enzyme inhibitor which is used against impetigo. Mupirocin specifically binds to Isoleucine-tRNA synthetase enzyme and inhibits protein synthesis. The aim of this study was to prepare standard strains of Staphylococcus aureus with a designated and approved molecular genetic map from iles-1 gene using AluI enzyme.METHODS: In this cross-sectional study, 150 clinical strains of Staphylococcus aureus isolated from skin samples of patients and staff in three hospital of Qom, from transfer medium (BHI) (Merck, Germany) on blood agar medium (Merck, Germany) using streak plate method and cultured for 24 to 48 hours and were incubated at 37oC. Using biochemical and PCR methods, srRNA 16 area was validated. Presence of Iles-1 gene was considered using PCR and mapping of AluI enzymatic digestion was carried out. Also 5ug mupirocin disk was used to investigate bacterial resistance.FINDINGS: The results showed that from 150 samples, 7 samples are mupirocin resistant strains. The rate of infection with resistant strains in women was 42.58% and men 57.14%, respectively. 100% of resistant isolates to mupirocin had a positive PCR for iles-1 gene of resistant to chromosomal mupirocin.CONCLUSION: It is concluded that mupirocin resistant strains of Staphylococcus aureus is few.

BACKGROUND AND OBJECTIVE: Stenotrophomonas maltophilia is known as an emerging bacterium in the world, associated with a wide range of diseases. The aim of this study was to investigate the virulence factors of these bacteria including extracellular enzymes, ability to form biofilm and rpfF gene involved in quorum sensing.METHODS: This cross-sectional study was conducted using urine samples, blood and sputum samples, swab samples of oxygen manometer system and tap-water of hospitals as well as dental suction. Bacteria identification was done using culture methods and biochemical tests and to confirm the existence of bacteria, presence of 23S rRNA gene was assessed using real-time PCR method. Isolates were studied in terms of gelatinase, hemolysin, hyaluronidase ,lecithinase, lipase and protease enzymes using phenotypic method and biofilm formation using microplate method. Moreover, existence of rpfF gene in isolates was investigated using PCR method.FINDINGS: 100% of isolates contained rpfF gene. Most isolates contained gelatinase (90%), hemolysin (85%), protease (75%), lecithinase (90%), lipase (75%) and hyaluronidase (100%) enzymes. Biofilm formation was not observed in 15% of isolates; 45% of isolates had weak power of biofilm formation; 40% of isolates had moderate power of biofilm formation and none of the isolates had strong power of biofilm formation. Correlation between hemolysin and lipase, hemolysin and lecithinase, and lecithinase and lipase variables was significant.CONCLUSION: Results of the study demonstrated that bacteria isolates contained various virulence factors including rpfF gene that produce diffusion signal factor which is essential for quorum sensing and were highly capable of producing extracellular enzymes and forming biofilm.

BACKGROUND AND OBJECTIVE: Hereditary metabolic diseases are individually rare disorders, early diagnosis and treatment are very important which can prevent from permanent damage to the nervous system and mental retardation and other irreparable injury and even death in these patients. This study was done to evaluate the prevalence of hereditary metabolic diseases in children admitted to Amirkola children hospital 1384-94.METHODS: In this cross-sectional study, medical records of patients with hereditary metabolism disorders from 1384 to 1394 were studied. Related information to age, gender, family relationship, family history, disorder type, diagnostic criteria and disease outcome were extracted and analyzed.FINDINGS: In this study, 65 children were diagnosed with different types of metabolic disease research. The common disorders were maple syrup urine disease 14 patients (21.5%), methylmalonic acidemia 10 (15.3%), mitochondrial 8 (12.3%) galactosemia 6 (2.9%), respectively. Among children, 36 cases (55.4%) were male and positive family history of metabolic disorders was observed in 15 children (23.1%). Mortality of metabolic disorders was in 26 children (40%) and the rest of the 19 children (54.2%) had developmental delay.CONCLUSION: In this study 19 different types of hereditary metabolic diseases were detected that more than 25% of patients had a positive family history of this disorder.

BACKGROUND AND OBJECTIVE: Ogilvie Syndrome is an acute, non-organic pseudo obstruction of the colon due to neurological dysfunction of the bowel, that can be happened after pelvic & gynecologic surgery Perforation of the colon and peritonitis can be occur due to perfusion impairment of the colon wall, because of increased intraluminal pressure of the bowel. We here reported a case of this rare syndrome as it may have high mortality and morbidity if any delay be occurred.CASE REPORT: A 33 years old Female patient, presented with abdominal distention and obstipation and constipation 48 hours after her 2nd cesarean section delivery that accompanied with abdominal pain, fever and tachycardia and abdominal tenderness, regard less to conservative management. So she Underwent laparotomy with impression of peritonitis. Severe dilation of the cecum and ascending colon with perforation of the cecal wall was found known as Ogilvie syndrome. Right hemicolectomy and ileocolic anastomosis was done. The patient was house arrested for 5 days in ICU of surgery. During this period, patient was treated with broad spectrum antibiotics, optimal hydration and nutritional support as PPN were performed. On the fifth day after surgery, a liquid diet was started for patient and bowel movement was established. After 10th day of surgery, the patient was discharged with good general appearance. In three months follow-up after surgery, there was no specific complication.CONCLUSION: Proper and on-time diagnosis and management of the Ogilvie Syndrome, decreases the rate of mortality and morbidity of this emergent condition. It is important for the healthcare provider to know this critical condition and to have high clinical suspicion when deal with a patient with bowel obstruction symptoms after pelvic & gynecologic surgery.