مجله دانشکده پزشکی اصفهان
پیاپی 158 (هفته دوم آذر 1390)

Cutaneous leishmaniasis is an infection caused by protozoan genus leishmania the incidence rate of which has been estimated as 0.28 in every 1000 individuals in Iran. Although glucantime is commonly used to treat leishmaniasis, it has some side effects including increased liver enzymes and electrocardiogram changes. In addition, the drug is expensive, the injection is painful, and research shows that glucantime resistance of parasite is growing in different parts. Therefore, scientists are paying more attention to new drugs such as nanosilver solution. The present study tried to evaluate the in-vivo topical effects of different concentrations of nanosilver solution. Colloidal particles were used in this study. Female Balb/c rats aged 6-8 weeks were studied in groups of 10. Different concentrations [60, 80, 120, 130, and 2000 particles per million (ppm)] of nanosilver 4000 were prepared (Nano Alvand, Arad Co., Iran). Rats were subcutaneously injected at the base of the tail with 0.1 ml of solution containing the parasite. Clinical control of the infection trends was conducted weekly for 6 weeks by measuring lesion diameter at the base of the tail. Data was analyzed by paired t-test, analysis of variance (ANOVA), and Tukey test. The significance level was considered as P < 0.05. Mean lesion diameter before and after the treatment did not significantly differ between different groups (P > 0.05). Likewise, a significant difference in splenic parasite load was not observed between different treatment groups. Based on our results, different concentrations of nanosilver are ineffective in reducing mean sizes of lesions. However, nanosilver can be used in treating secondary infections in patients with cutaneous leishmaniasis.

Candida albicans is a pathogenic yeast that causes oral, vaginal and systemic infections. Oral candidiasis is treated with antifungal agents, particularly triazoles such as fluconazole. However, the overuse of fluconazole has resulted in the emergence of azole-resistant strains of Candida. This study tried to evaluate the sensitivity to fluconazole in strains of C. albicans clinical isolates from oral candidiasis of AIDS patients by broth microdilution and disk diffusion methods. The study included 66 C. albicans isolated from oral candidiasis of AIDS patients. C. albicans ATCC10231 was used as sensitive control and C. albicans ATCC76615 as resistant control. The minimum inhibitory concentrations (MICs) of fluconazole for all isolates were determined by broth microdilution assays for yeasts according to the clinical and laboratory standards institute (CLSI) guidelines. The MICs were evaluated after 48h of incubation at 35°C. The disk diffusion test was performed according to the procedure outlined in CLSI M44-S2 document. Mueller-Hinton agar supplemented with 2% glucose and 0.5 μg/ml of methylene blue was used and the results were read after 24h incubation at 35°C. Significant differences were not observed between broth microdilution and disk diffusion methods for evaluating the sensitivity of isolates to fluconazole. However, while broth microdilution is a difficult, time consuming technique, disk diffusion test is a quick and simple method for determining the sensitivity of yeasts to fluconazole.

The aim of this study was to evaluate the frequency distribution and associated factors of burnout syndrome among nurses in Alzahra Hospital, Isfahan, Iran. This was a cross-sectional study conducted on 100 selected nurses in Alzahra Hospital in 2010, Iran. The subjects filled maslach burnout inventory (MBI). The data was analyzed by Student's t-test and analysis of variance (ANOVA) in SPSS18 software. The mean age of nurses was 37.35 ± 12.13 years. Our results showed significant differences in burnout scores between nurses in different departments, i.e. the scores of nurses in ICU and emergency departments were significantly higher than those in dialysis and orthopedic departments (P = 0.01). Student's t-test revealed the scores of women to be significantly higher than men (P = 0.0001). In addition, ANOVA showed a work experience lower than 10 years to be associated with lower burnout scores. Based on our results and previous studies, sex, work experience and site of working in the hospital are important factors affecting burnout syndrome in nurses.

Culture media are often essential for diagnosis of metabolism and antigenic properties of leishmania promastigotes and laboratory studies. Fetal calf serum (FCS) has long been used as a supplement in leishmania culture media. There are many technical problems in FCS processing such as sterilization (especially viral contamination removal) and high cost. In this study growth stimulating effects of brain heart infusion broth (BHIB) on L.major promastigotes culture was assessed. The possibility of FCS replacement with BHIB as an appropriate supplement in single phase media and also as an enhancer for mass culture of L.major promastigotes in biphasic media was also evaluated. n this study, "RPMI 1640" and "agar and blood agar" were used as single-phase and biphasic medium, respectively. They were supplemented with different concentrations of BHIB for leishmania promastigotes culture. RPMI 1640 containing 10% FCS was used as control medium. Biphasic medium containing normal saline was used to culture parasite promastigotes. The numbers of proliferated promastigotes were determined at definite time intervals and the average numbers of promastigotes in each media were compared with the control medium. The average number of L.major promastigotes in presence of BHIB 10% in RPMI 1640 was 22.7 × 106 /ml which was significantly higher compared to the controls (P = 0.012). The average numbers of L.major promastigotes in the presence of BHIB 4% in agar and blood agar media were 275 × 106 /ml and 367 × 106 /ml, respectively. These numbers were also significantly higher compared to the control medium (P = 0.025). These results indicated that different concentrations of BHIB have a promoting effect on the proliferation of L.major promastigotes. Therefore, BHIB may be an appropriate substitute for FCS in single-phase media and biphasic media for mass culture.

The montreal cognitive assessment (MoCA) is a screening tool for evaluating mild cognitive impairments. The purpose of this research was to study the psychometric properties of the MoCA in Parkinson's disease patients in Isfahan, Iran. Thirty-five patients with Parkinson’s disease who satisfied all the inclusion criteria were referred to the researchers by a neurologist. They answered the MoCA, and the mini mental status examination (mmse) and demographic questionnaires. In addition, 40 healthy subjects with all the inclusion criteria except Parkinson's disease were randomly selected. They also completed the scales. Cronbach's alpha, Pearson correlation, and discriminant analysis were respectively used for computing reliability, concurrent validity, and diagnostic validity of the test. A Cronbach's alpha of 0.77, concurrent validity of 0.79, sensitivity of 0.85 and specificity of 0.90 were found. ROC table revealed 24 as the best cut-off point for MoCA. MoCA can be a valid and reliable instrument for assessing cognitive deficits in Iranian Parkinson's disease patients.