Researcher Bulletin of Medical Sciences
Volume:19 Issue: 1, 2014

The Middle East Respiratory Syndrome (MERS) is a novel viral respiratory illness first reported on September 2012 in Jeddah، Saudi Arabia. The etiology of the disease is a novel coronavirus، which belongs to the genus، betacoronavirus. At this stage the origin of this virus is unclear but genetic studies suggest that bat coronaviruses are the nearest relatives. However، it is unlikely that the virus is transmitting directly from bats to humans. Since، human-to-human transmissibility of the virus appears to be rare، many researchers suspect that another animal reservoir for the virus exists and following that they have found antibodies specific to bat coronaviruses in dromedary camels. In general، MERS-CoV is thought to be an animal virus that has sporadically resulted in human infections with subsequent limited transmission between humans. Globally from September 2012 till August 30th 2013 WHO has been informed of a total 130 laboratory-confirmed cases of infection with MERS-CoV including 58% deaths، with Saudi Arabia reporting approximately 80% of cases. Countries where cases acquired infection from an unknown source or through person-to-person transmission are: Jordan، Kingdom of Saudi Arabia، Qatar and the United Arab Emirates. Countries where cases are imported associated with travel or contact with a returned infected travelers are: Germany، France، Tunisia، Italy and The United Kingdom. Exclusively، cases are all linked to a point of origin in the Arabian Peninsula، in particular، the Kingdom of Saudi Arabia. The original source (s)، route (s)، of transmission to humans and the mode (s) of human-to-human transmission have not been determined yet. However، there is growing evidence that like many other respiratory viruses the fine droplets created when people cough or sneeze، they will spread the infection. The incubation period of illness is generally less than one week، but ranges between 2-14 days. MERS-CoV has seen to cause a spectrum of disease from asymptomatic infection to mild illness to life threatening infection leading to death. Common symptoms are acute، serious respiratory illness with fever، cough، and shortness of breath and breathing difficulties. Most patients have had pneumonia. Many have also had gastrointestinal symptoms، including diarrhea. Some patients have had kidney failure. In people with immune deficiencies، the disease may have an atypical presentation. The majority of patients have had at least one comorbid condition، including diabetes، heart disease، hypertension and pulmonary disease. There are several highly sensitive، confirmatory real-time RT-PCR assays for rapid identification of MERS-CoV from patient-derived samples. Respiratory samples including upper respiratory tract viral swabs، nasopharyngeal aspirates، sputum، bronchoalveolar lavage fluid، lung biopsies and post-mortem tissues are suitable for testing for MERS-CoV. Lower respiratory tract specimens should be collected if possible. There is no specific treatment for MERS-CoV infection and patients should be evaluated and treated case by case، which may include using antivirals، antibiotics for preventing secondary bacterial infection or using immunomodulators. Considering our proximity to countries where MERS-CoV is circulating and likelihood of virus entry into our country with pilgrims. Our purpose is to review the symptoms، characteristics، diagnostic approach and management of a patient with suspected infection with MERS-CoV.

Breast fissure is disorder during breastfeeding that causes cessation and failure of breastfeeding. With high prevalence of breast fissures, as well as the existence of evidence in favor of the application of Aloe vera gel as an anti-inflammatory herb, the purpose of this study is to determine the effect of Aloe vera on improving breast fissures. This study is conducted using a clinical trial method on 110 cases. Samples were divided randomly into two groups of 55 women. The women in both groups were homogeneous in obstetrics and demographic characteristics (P>0.05). The women in the Aloe vera gel group applied 0.5 ml of Aloe vera gel and control group applied 4 drops of their own milk on their nipple and areola after each feeding. Then, the two groups were studied on days 10 and 14 postpartum. For intensity of pain, the Visual Analogue Scale and to measure the severity of damage, Amir Scale was applied and the existence or lack of nipple discharge was also recorded. The mean intensity of pain and nipple damage before treatment on day 10 and day 14 after delivery in the control group had a significant difference (P<0.001). In comparison of nipple discharge between the two groups before treatment on day 10 and day 14 after delivery, the case and control groups indicated a significant difference (P<0.001). According to the results of this study, it seems that Aloe vera gel can improve breast fissures.

One of the common problems in people with obsessive-compulsive disorder and substance abuse is emotion regulation difficult. The aim of this study was to compare emotion regulation strategies in people with obsessive-compulsive disorder, substance abuse and normal people. This study was conducted with historical cohort method. 40 patients with OCD, 40 substance abusers by purposive sampling, and 40 healthy people by available sampling, were selected as a control group. Structured Clinical Interview for DSM-IV axis I disorders (SCID-I), Yale Brown obsessive-compulsive scale (Y-BOCS), difficulties in emotion regulation scale (DERS), Emotion Regulation Questionnaire (ERQ) were performed. There was a significant difference (P=0.001) among three groups in all items of emotional difficulties and emotion regulation strategies except suppression. According to the results of binary comparisons there was a significant difference (P=0.001) in all items except suppression between obsessive-compulsive group and normal people. In impulse control difficulties (P=0.004) and limited access to emotion regulation strategies (P=0.001) there was a significant difference between substance abusers and normal people. There was a significant difference in nonacceptance of emotional responses (P=0.001), difficulties engaging in goal- directed behavior when distressed (P=0.009), limited access to emotion regulation strategies (P=0.006) between obsessive-compulsive group and substance abusers. ‍ It seems that considering emotion-focused interventions for substance abuse group and all of the emotion regulation subfactors including cognitive methods for patient with obsessive-compulsive disorder be effective in their treatment interventions.

Domestic violence is a global problem that led to many maternal and neonatal complications. Among the factors associated with domestic violence, social determinants of health are the most controversial issues in health policy domain. According to the WHO conceptual framework of Commission on Social Determinants affecting on health this study has been designed to investigate the articles that have been published on its prevalence and related factors in Iran. This descriptive study reviews the Iranian articles published in four data bases (PubMed, SID, Iran Medex, Magiran) between 2000-2013, by searching violence, abuse, pregnancy in title, abstract and keywords of the articles. Overall, 38 articles, 5 English and 33 Persian, were selected according to inclusion criteria and assess. 35 articles were descriptive (longitudinal and cross-sectional) and 3 were analytic (cohort and case-control). Prevalence of domestic violence in pregnancy was reported between 19.3% to 94.5%. Among domestic violence related factors, the most prevalent factors in structural determinant were maternal education and in intermediary determinant were material circumstance: housing, psychosocial circumstance: unwanted pregnancy, behavioral factors: partner substance abuse and health system: lack of prenatal care. ‍ The prevalence of domestic violence during pregnancy in Iran is a matter of concern and can be reduced by identifying high risk groups. Since many social determinants may affect domestic violence, performing etiological investigations is recommended.

Regards to limitations to the use of embryonic stem cells, scientists created embryonic-like stem cells using reprogramming somatic cells by over expression of OCT4, klf-4, c-Myc and SOX2- genes (reprogramming markers). Considering the benefits of mesenchymal stem cells derived bone marrow and adipose tissue are mentioned today, the present study was proposed to comparison of expression of reprogramming genes of induced pluripotent stem (ips) cells and mesenchymal stem cells derived bone marrow and adipose tissue. After preparation, isolation and culture of human mesenchymal stem cells derived bone marrow and adipose tissue and iPS cells, their reprogramming genes OCT4, klf-4, c-Myc and SOX2- were assessed by real time PCR in third passage. Oncogene c-Myc expression in adipose derives stem cells was the highest compare to the other group. Also Oncogene c-Myc expression in iPS cells was higher than bone marrow stem cells. Bone marrow stem cells were the lowest to klf4 expression. Expression of this gene in adipose stem cells was the same as described by iPS cells and there was no significant difference between them. Bone marrow stem cells showed the highest expression of OCT4. There was no significant difference between bone marrow and adipose stem cells. SOX-2 gene expression in bone marrow stems cells was significantly higher than the other groups. Bone marrow stem cells in terms of OCT and c-Myc expression genes are the best source compare to adipose and iPS cells.

Axillary vein thrombosis after physical activities of upper limbs or Paget-Von Schroetter syndrome is a rare disease with potentially lethal complications, which occurs mainly in athletes without any systemic predisposing factors after repetitive, vigorous activities of upper limbs. Axillary vein can be compressed at various places along its route, most importantly in the costoclavicular space (space between clavicle and the first rib). Compression usually occurs when the patient hyperextends the neck and hyperabducts the arm concurrently (as in bench press), or when the patient takes a military brace posture with a backward movement of the shoulders. Most patients with effort-related upper extremity deep vein thrombosis have an underlying venous thoracic outlet syndrome. Presentation: A 50‐year‐old male presented with acute onset of right arm swelling, heaviness and range of motion impairment after weight training. The arm was cyanotic. The pulses were intact. He initially diagnosed with cellulitis and received oral antibiotics, which were ineffective. Doppler sonography examination confirmed the diagnosis of axillary vein thrombosis. He was started on intravenous and then six-month oral anticoagulation therapy. His symptoms resolved and he was without thrombosis at four-year follow‐up. He did not have any systemic predisposing factors for thrombosis such as thrombophilia or malignancy. The potentially life threatening complications (such as pulmonary emboli) and unusual presentations of the disease, makes its correct diagnosis more important.

Speech recognition software is the facilitator tool for data entry into the EHR. Utilizing this software in the healthcare field requires definition of specialized database. The aim of this study was to establish the specialized database to speech recognition software in reconstructive hand surgery and likewise, practical test of this technology at the hospital. In the first phase, exploratory method for designing database was used and secondly the experimental procedure was performed to determine system performance. This includes typing of 1863 operation report sheet and typing in the first 3-month period in 15-Khordad Hospital in 2012. After performing the required analysis, hand reconstructive surgery text database was created and loaded into the Nevisa system. In the second stage to determine the accuracy of the software, system was tested and evaluated in the operating room. The design of the database consists of three steps: creating electronic texts, eliciting language model and vocabulary from these texts. Created database contains a large vocabulary of over 1000 words for use in the hand surgical unit of the relevant hospitals. After testing the software in the operating room, the system accuracy for the trained user 7.83%, and the not-trained user 8.77% was obtained. This project resulted in the creation of the software in the medical field fitting with the country’s situations and the possibility to create a complete electronic documentation. The system accuracy is associated with background voices; training system with the user’s voice and microphone’s type to improve each of the above mentioned cases at the time of examination would increase accuracy of the system.

Food borne diseases are an important public health problem in different countries. Food handlers with poor personal hygiene working in food establishments can have an important role in the transmission of these diseases. This study was undertaken to determine the prevalence of bacteria (Salmonella, Shigella) and intestinal parasites among food handlers in the city of Kerman. This cross-sectional study in years 2011-12 was conducted. 450-food handlers were employed in the kitchen preparing food centers. We recourse to food centers and stool sample were taken in three different time from each person and samples were studied by direct observation and formalin-ether concentration method for intestinal parasites and culture for detected bacteria (Salmonella and Shigella). At the same time, a questionnaire were with variables such sex, age, education, use gloves and form, restroom and health cart filled. The data analyzed by statistical software SPSS. Among 450 food handlers, included females 40.4% and male 59.6%. The prevalence of intestinal parasites is 14.7% that 13.8% were infected with 1 parasite and 0.9% showed infection to 2 parasites. The highest prevalence is related to Giardia lamblia 7.3%, Entamoba coli 3.6%, Heminolopis nana 1.6%. There was no significant effect between age and sex with parasitic infection (Ρ=0.087 and Ρ=0.054, repectively). Whereas, using the protective facilities (gloves and uniforms) and having health cart, both significantly reduced the parasitic infection (P=0.016 and P<0.001, respectively). The Shigella isolated from 3 (0.7%) cultures and Salmonella isolated from 1 (0.2%) culture. The results show that the prevalence of intestinal parasitic infections are relatively high, especially pathogenic protozoa in food handler. Therefore, health controls should be increased and screening with concentration method should be done. It is natural in this context, the continuation and expansion of health education has a crucial role.