JOURNAL OF BABOL UNIVERSITY OF MEDICAL SCIENCES (JBUMS)
Year:2011 | Volume:13 | Issue:6 (63)|Papers Count:16

BACKGROUND AND OBJECTIVE: Klebsiella pneumoniae is one of the most important agents of nosocomial infections and drug resistance. Integrons are genetic elements that carry genetic determinants for antimicrobial drug resistance. The role of class I integron genes is very important to transfer of antibiotic resistance. The aim of the present study is isolation of Klebsiella pneumoniae from the environment and equipments in intensive care unit (ICU), investigation of class I integron genes in these strains and determine their susceptibility or resistance to antibiotics.METHODS: The descriptive and analytical study was carried out on 30 Klebsiella pneumoniae isolatesd from ICU of Shahid Beheshti hospital in Babol, Iran in 2010. Sampling of environment and equipments in ICU was carried out. After isolation and extraction of DNA, class I integron gene was investigated by PCR and specific primers. Also for the sensitivity test to antibiotics of Ciprofloxacin, Cefazolin, Ceftriaxone, Ceftizoxime, Cefotaxime, Amikacin, Ofloxazin, Imipenem, Cefepim, Ticarcilin and Gentamicin was performed by disk diffusion method.FINDINGS: From 30 Klebsiella pneumoniae isolates, 36.6 percent (11 samples) have had class I integron gene. After sensitivity test, from 9 of the 26 resistant isolates to Cefazolin, 10 of 25 resistant isolates to Ceftriaxone, 11 of 27 resistant isolates to Ceftizoxime, Cefotaxime and Cefepim, 9 of 18 resistant isolates to Ciprofloxacin and Imipenem, 11 of 26 resistant isolates to Ticarcilin, 5 of 17 resistant isolates to Ofloxazin, 5 of 11 resistant isolates to Amikacin and 8 of 26 resistant isolates to Gentamicin had class I integron gene.CONCLUSION: The results of this study show contamination of environment and equipments in ICU was increased. The class I integron gene frequency in these strains is high; that can have important and basic role in occurrence and transfer of antibiotic resistance. The antibiotic resistance of Klebsiella pneumoniae, isolated from the environment and ICU equipments, is very high; that it can be due to the irregular use of antibiotics. Measures should be thought to prevent occurrence and dissemination of antibiotic resistance elements.

BACKGROUND AND OBJECTIVE: There are no pharmacokinetic data on CC isomers zuclomiphene (Zu) and enclomiphene (En) in patients receiving the drug, mainly women with polycystic ovary disease (PCOS). Thus, the main purpose of this study was to characterize the pharmacokinetics of Zu and En isomers and their intersubject variability, for the first time, in anovular patients with PCOS after a single oral administration of CC.METHODS: Nine women with infertility and PCOS who referred to the infertility clinic were included in this study. After getting consent of patients and ethical approval from the University ethics committee, they received clomiphene citrate 50 mg on the first day of their menstrual cycle. LH, FSH and prolactin levels were measured before and after medication. Plasma concentrations of Zu and En were measured in the patients from the second day of their menstrual cycle (day 1 of dosing) up to 21 days.FINDINGS: The mean (± coefficient of variation) of Cmax, tmax, and AUC of Zu was 15±41 ng/mL, 7±87 h, and 1289±34 ng/mL.h (AUC0-456 h), and that of En was 15±18 ng/mL, 3±68 h, and 65±35 ng/ml.h (AUC0-72 h), respectively.CONCLUSION: These parameters appeared to be different for Zu from those reported previously in healthy participant; the pharmacokinetic parameters of En in patients with polycystic ovary syndrome were not generally different from the healthy subjects.

BACKGROUND AND OBJECTIVE: Caries is a multifactorial disease with a microbial nature. Thus, more concentration on its operative treatment will lead to failure in annihilating its origin. On the other hand, because of known side effects of antibiotics and world attraction to traditional treatment and importance of drug extraction of natural material and plants, this study was done to compare the antibacterial effect of hydroalcoholic extract of Salvia officinalis, Pimpinella anisum, Mentha longifolia and Achillea millefolium against Streptococcus mutans, Lactobacillus rhamnosus and Actinomyces viscosus with two in vitro methods.METHODS: In this experimental study, hydroalcoholic extracts have been prepared from Salvia officinalis, Pimpinella anisum, Mentha longifolia and Achillea millefolium with maceration method. Their antibacterial activity against Streptococcus mutans, Lactobacillus rhamnosus and Actinomyces viscosus have been evaluated with Broth macrodilution (the method in which amounts of antimicrobial agents is diluted in broth environment serially) (0.18-200 mg/ml) and Agar diffusion (the method in which antimicrobial effect is assessed in solid environment) (0.78-400 mg/ml) methods.FINDINGS: In Broth macrodilution method MIC (Minimum Inhibitory Concentration) for Pimpinella anisum, Salvia officinalis, Mentha longifolia and Achillea millefolium for Streptococcus mutans were respectively 12.5, 6.25, 12.5 and 50 mg/ml, for Lactobacillus rhamnosus 12.5, 1.56, 3.12 and 12.5 mg/ml and for Actinomyces viscosus 50, 12.5, 100 and 50 mg/ml. In Agar diffusion method Pimpinella anisum and Salvia officinalis against Streptococcus mutans, Pimpinella anisum against Lactobacillus rhamnosus and Mentha longifolia against Actinomyces viscosus had antibacterial effect.CONCLUSION: According to the results of this study, four extracts had growth inhibitory effect on all three bacteria. Salvia officinalis had greater effect on inhibition of growth of all three bacteria. All of the extracts had bactericidal effect in the range of concentration.

BACKGROUND AND OBJECTIVE: Genistein is a soya phytoestrogen having estrogenic effects. Phytoestrogen has been introduced as one of the elements of unproductively in some animals, but previous studies on genistein role in male reproductive system have shown contradictory results. Since no similar study has taken place in Iran, the present study has been designed for evaluation of genistein effects on male reproductive system.METHODS: In this experimental study, 30 male rats with 13 weeks of age and limited weight of 220 to 250 grams were selected. They were divided into six groups of 5, and different genistein doses (0, 0.5, 1, 2, 4 mg/kg) were injected subcutaneously on 14 consecutive days to male rats. After 24 hours animal were killed and then their blood testosterone, FSH (follicle-stimulating hormone), and (LH Luteinizing hormone) were measured via ELAISA method. Sperm count and viability were measured through WHO protocols.FINDINGS: There was a significant reduction in FSH plasma levels among groups that were injected low doses of genistein while by increasing the genistein dose the inhibitory effect of reducing became slower (p<0.05). There were not any significant differences between other indicators.CONCLUSION: Based on our findings, genistein has an effect on FSH level of plasma and the functioning of male reproductive system.

BACKGROUND AND OBJECTIVE: Cytokines are mainly released during immune responses to antigens. In some circumstances such as toxic shock during super-antigen stimulation, high level of cytokines are released which it may have a dramatic impact on cardiovascular system. Therefore, in the present study the effects of supernatant of Phytohemaglotinin (PHA) - stimulated lymphocytes on isolated heart in rat have been evaluated.METHODS: This is an interventional study which was arranged on 20 male Wistar rats weighed 200-250g. The animals were randomly divided in two groups of control and test. The isolated heart in control group received the cell culture medium with PHA, while in test group the supernatants of PHA stimulated lymphocytes were introduced to isolated hearts. Three dilutions of supernatants (1/800, 1/400 and 1/200) on isolated rat hearts were used. Each concentration was infused to the heart for 10 minutes and the heart rate and the intraventricular pressure were recorded for 40 minutes. The peripheral blood mononuclear cells from healthy volunteers were isolated and stimulated by PHA in vitro for three days and then the supernatants were harvested.FINDINGS: The highest dilution, 1/800, reduced the heart rate 1 and 2 minute after infusion significantly (p<0.05). This effect was significant 10 minutes after infusion for 1/400 and 1/200 dilutions as well. However, the effect of supernatant on the Max dp/dt, Min dp/dt, Max LV and Min LV were not significant.CONCLUSION: In general the data in the present study shows that cytokine pattern of PHA stimulated lymphocyte had a marked negative impact on heart rate which might be due to the effect of these cytokines on stimulatory and conductivity (chronotropy) of cardiac muscle. On the other hand, there was not any significant effect on contractility.

BACKGROUND AND OBJECTIVE: According to high prevalence and mortality of ischemic heart disease, mention to treatment is important. Glucose-insulin-potassium (GIK) as an adjunctive treatment of ST segment elevation myocardial infarction (STEMI) has been suggested but its effects are controversial. Whereas C-reactive protein (CRP) has prognostic value, we aimed to evaluate the effect of GIK on Plasma concentrations of C-reactive protein in STEMI patients.METHODS: This randomized clinical trial enrolled 72 patients who had STEMI that were referred to Vaseie hospital of Sabzevar, Iran. Patients were categorized to two groups by block randomization and were treated with a high dose of GIK (25% glucose, 50 IU of soluble insulin per liter, and 80 m mol of potassium chloride per liter at 1 ml/kg/hour) (GIK group) or normal saline (control group) as adjunct to thrombolytic therapy. We analyzed Plasma concentrations of high-sensitivity C-reactive protein (CRP) at baseline and sequentially for 48 hours.FINDINGS: Baseline CRP (GIK=5.6±5.9, control=4.0±4.3mg/L, p=0.35) were significantly increased to 3-fold at 48 hours in each group (GIK=16.8±2.2, control=15.5±3.2mg/L, p=0.17). There was no difference in plasma concentrations of CRP between GIK and control patients (p=0.24). Mean glucose level over 6 hours was higher in GIK group (212±13 mg/dL) than control group (142±46 mg/dL, p=0.006).CONCLUSION: In patients with acute myocardial infarction treated with streptokinase, glucose-insulin-potassium therapy offers no anti-inflammatory effect.

BACKGROUND AND OBJECTIVE: HELLP syndrome is a serious presentation of pre-eclampsia and eclampsia during pregnancy and its diagnosis is difficult because of lack of specific features. This syndrome is associated with prenatal and neonatal morbidity and mortality. The aim of the present study was to compare the maternal and neonatal outcomes of HELLP syndrome with preeclampsia in Yahyanejad hospital (Babol, Iran) in the past ten years.METHODS: This cross-sectional study was performed on all patients with pre-eclampcia/eclampcia who were hospitalized in Yahyanejad hospital during 10 years. Primary data, clinical and laboratory data, prenatal and maternal complications included (cesarean section, placental abruption, need to blood transfusion, liver hematoma, pulmonary edema, acute renal failure, DIC, brain hematoma and infection, intra-abdominal hemorrhage, ARDS and maternal mortality) and neonatal complications included (preterm neonates, IUGR, NICU admission and neonate mortality) were compared.FINDINGS: In this study, from 445 patients who were evaluated, 361 patients (81.3%) with mild preeclampsia, 83 patients (18.7%) with severe pre eclampsia and 1 (%0.2) with eclampsia were hospitalized in primary diagnosis, that 12 patients (2.7%) had HELLP syndrome symptoms. Cases of placental abruption, liver hematoma, pulmonary edema, need to blood transfusion, acute renal failure, DIC and maternal mortality in patients with HELLP syndrome was significant in compared to preeclampsia (p<0.05). Neonatal complications included preterm neonates, IUGR, NICU admission in patients with HELLP syndrome were significant in compared to preeclampsia (p<0.05). Also no case of brain hemorrhage and infection, ARDS, intra-abdominal hemorrhage, IUFD and neonatal mortality was reported.CONCLUSION: According to the results of this study, maternal and fetal complications in patients with HELLP syndrome can be prevented and this could be result of early diagnosis and appropriate management.

Depressive symptoms are common among post myocardial infarction (MI) patients and may cause negative impacts on cardiac prognosis. The studies supported that depression is an independent risk factor for poor prognosis in post MI patients.The various articles about the plausible mechanisms between post-MI depression and adverse outcomes were found and studied. The plausible pathways involved in this link were described.The study of the results of these articles showed that the different behavioral, neuroendocrinological, and immunological, arrhythmias mechanisms and increased thrombosis are likely the pathways by which depression may cause increased risk for adverse outcomes and mortality. It seems that particularly increased thrombosis and arrhythmias may cause increased risk for mortality in depressed patients with heart disease. This review showed important role of psychological and biological pathways for increasing risk of mortality and adverse consequences among patients with post MI depression.

BACKGROUND AND OBJECTIVE: Acute post ERCP pancreatitis (PEP) is still the most common complication of endoscopic retrograde cholangiopancreatography (ERCP), and the reported incidence ranges between 5% and 20%. This difference reflects variety of patient populations, indications, definition of pancreatitis, endoscopic expertise and data collection methods. This study was designed to examine the incidents of post ERCP pancreatitis and hyperamylasemia and related risk factors from a tertiary academic medical center of North of IranMETHODS: This retrospective study was performed on all patients who underwent ERCP in Shahid Beheshti hospital (Babol; Iran) during 2005-2009. Patients presented with acute pancreatitis and history of endoscopic sphincterotomy were excluded. Age, gender, CBD diameter, type of sphincterotomy, opium consumption and liver enzyme were the main variable for final analysis.FINDINGS: The overall incidence of PEP was 8.2% (43 of 525 patients) and post ERCP hypramilasemia developed in 34% of patients. In multivariate analysis, independent risk factors for PEP were: age less than 40 (OR=3/2, p<0.001) and needle knife Sphincterotomy (NKS) (OR=2/2 p<0.015). The independent risk factor of PERCP hyperamylasemia were age less than 40 (OR=1.8, p<0.04) and intact gallbladder without stone (OR=1.6, p<0.01).CONCLUSION: The results of this study show that young age is independently associated with post ERCP pancreatitis and hyperamylasemia. NKS increase PEP and intact gallbellader is predictor of post ERCP hyperamylasemia.

BACKGROUND AND OBJECTIVE: Diagnosis and treatment of renal stone are very important especially according to non-special symptoms and risk of complication in children. According to invasive surgical methods for treatment of these patients, this study was done to evaluate oral potassium citrate solution efficacy in children with urolithiasis.METHODS: This quasi experimental study was done on 150 children who referred to nephrology department or clinic with renal stone and without urinary obstruction (2002-2010). All children were treated with potassium citrate solution initially 1 ml/kg/day and then it was increased till urine PH reached to above 6.5-7. Urinary ultrasonography was done every 3 months and response to treatment was evaluated according to the stone size, age and duration of treatment.FINDINGS: The age of children was 25 days to 15 years (Mean 36.7±37.4 month). Eighty five cases (56.6%) were male and 65 (43.4%) were female. The rate of complete response to drug (absence of stone) was 78.7% during one year. Mean of follow up was 15.9±14.6 months and the risk of relapse (recurrence of stone) was 12.4%. There weren't significant difference between response to treatment and stone size, age and children sex.CONCLUSION: Potassium citrate has been found to be significantly effective in treatment of renal stone, so we suggest using this drug for treatment of renal stone in all children without urinary obstruction.

BACKGROUND AND OBJECTIVE: Cloning is one of the achievements in the field of experimental science in contemporary time, which is associated with many questions, serious challenges and sensitivity for experts, jurists, and ethics scholars that each of them has adopted different positions against it. The aim of this study was to survey the cloning from the perspective of theology and jurisprudence.METHODS: In this study, research on religious texts, book and tradition and also jurists' votes and statements is the base of this study from the perspective of theology and jurisprudence in cloning sciences. In any jurisprudential debate, its related texts are considered as a document.FINDINGS: Cloning is not manipulation in the creation system and can not destroy the distinctions. Such individuals have dignity, worth and honor, and familial, environmental and educational factors can be effective in their personality structure. Cloning cannot be a factor to cancel a marriage and in many cases, parents' provision for cloned individuals is applicable. Ambiguity in the issue of inheritance is also resolvable. In the context of the Holy Quran, we cannot find a compulsory commandment that natural reproduction is the only way for human beings to procreate and also there is no commandment for prohibition of cloning.CONCLUSION: While there is no strong reason to prohibit the cloning, it cannot be adjudged decisively about prohibition of cloning and it needs further investigation and discussion.

BACKGROUND AND OBJECTIVE: Chiari 1 malformation is a congenital anomaly defined as downward displacement of cerebellar tonsils through the foramen magnum. Various surgical procedures have been presented for this malformation with diverse results. In this study, clinical outcome in these patients was reviewed.METHODS: lhis retrospective study was performed on 26 cases of Chiari 1 malformation operated at Imam Khomeini hospital in Orumieh, Iran. Symptoms and signs that have been evaluated included: suboccipital pain, weakness, spasticity, numbness, nystagmus, vertigo, atrophy and dissociated sensory loss. Each patient was analyzed separately to clarify if there was a benefit from surgery.FINDINGS: Suboccipital pain improved in 3 patients. Weakness in 2 patients resolved. Nystagmus in 5 patients and vertigo in 4 patients improved. Spasticity, numbness, atrophy and dissociated sensory loss remained unchanged.CONCLUSION: Results of this study clarifies that the main benefit of surgery in patients with chiari 1 malformation (with or without syringomyelia) is to stop the progression of the disease.