مجله دانشکده پزشکی اصفهان
پیاپی 169 (هفته اول اسفند 1390)

Pentavalent antimonial compounds are the main treatment option for cutaneous leishmaniasis. However, their clinical use has limitations such as lack of efficacy by oral route, long-term treatment period, emergence of drug resistance in about 10-15% of cases, cardiac toxicity, and reversible renal insufficiency. Curcumins are phenolic derivatives extracted from turmeric rhizome which have anti-leishmania effects. Intraperitoneal injection of licochalcone A, extracted from licorice root, prevents ulcer in BALB/c mice infected by L. major. As a part of screening of Iranian herbs with potential antileishmanial activity, the effects of total extract of turmeric and licorice on L. major culture were assessed in this study.

Serial concentrations of 0.4, 0.5, 1, 2.5, 5 and 10 mg/ml were prepared from the dried plant extract. Moreover, 400 microliters of the parasite suspension was added to all test tubes except for the negative control in which only the culture media was added. Amphotericin B 0.1 mg/ml was used as the positive control. The average numbers of promastigotes of all three series of test tubes were calculated. For each concentration, percent of alive parasites at different times were recorded. The results were expressed as IC50 of each extract.

The 2 mg/ml concentration of turmeric extracts resulted in rapid death of promastigotes compared to 0.2 mg/ml concentration which killed them after 88 hours of exposure. The effects of licorice total extract were similar to negative control at lower concentrations (0.5 and 1 mg/ml). Increasing the concentration up to 16 mg/ml killed more promastigotes.

The results of this study showed that both turmeric and licorice total extracts have antileishmanial effects in-vitro. However, the overall activity of licorice on promastigotes is much less than turmeric. It also kills parasites at higher doses.

Bone marrow mesenchymal stem cells (BM-MSCs) have been shown to be highly immunosuppressive. In some studies, MSCs were found to suppress T cell proliferation and cytokine production. Most researchers reported this effect to be mediated by soluble factors including IL-10, TGF-β1, nitric oxide, indoleamine 2,3-dioxygenase (IDO), and prostaglandin (PG) E2. Others however claim that cell-to-cell contact is necessary. Since the exact mechanism is still uncertain, this study tried to determine the mechanism underlying the immunoregulatory properties of human BM-MSCs and their ability to inhibit T-cell proliferation. In addition, role of cell-cell contact and dose-dependent immunomodulatory activities of these cell were explored. In this study, both mitogen- and alloantigen-activated T cells were cultured in the presence of different numbers of BM-MSCs. In some co-cultures, activated T cells were in direct contact to BM-MSC and in other co-cultures, they were separated from BM-MSCs by a permeable membrane. The proliferation of T lymphocytes was assayed with a cell proliferation enzyme-linked immunosorbent assay (ELISA) (Brdu). Although proliferation index of unstimulated T cells did not significantly differ in the presence or absence of BM-MSCs, the index was inversely related with BM-MSC presence in stimulated cells. Generally, the presence of BM-MSC resulted in a statistically significant decrease in PHA/alloantigen-induced proliferation of T lymphocytes. In addition, proliferation was significantly lower in transwell cultures than in stimulated lymphocytes without BM-MSCs (P < 0.05). The present study showed that BM-MSC suppressed T cells proliferation triggered by allogeneic PBMCs and mitogen (PHA). This effect is dose dependent and BM-MSCs do not necessarily require the cell-to-cell contact (direct contact) of MSC and lymphocytes. However, the suppression is reduced to some extent by the physical separation of MSCs and immune cells (indirect contact).

Chronic neck pain is one of the most common problems among computer users. The aim of this research was to evaluate the effects of an eight-week selected therapeutic exercises course and self-treatment with pamphlet programs on the rate of chronic neck pain and disability among computer users. Out of a total number of 196 bank staff members, 66 men with chronic neck pain (mean age: 39.19 ±3.1 years) voluntarily recruited in this study. they were randomly allocated into three groups of selected exercise therapy (N = 18), self treatment with pamphlet (N = 23) and control (N = 25). Chronic neck pain and disability were measured by the Neck Pain and Disability Scale. For analyzing data, pretest-posttest measures were calculated. Then, analysis of variance (ANOVA) and Scheffe post hoc test were used to analyze the obtained data. Pearson's correlation coefficient test was used to determine the relationship between work experience and neck pain and disability rate of subjects. The results of this study revealed 42.85% of the subjects to be suffering from chronic neck pain. There were significant differences between decreased values of neck pain and disability between the three groups (P < 0.01). There was no significant relationships between neck pain, disability and work experience (P =0.086; r = 0.21). Generally, it can be concluded that compared to self- treatment by pamphlet program, the selected therapeutic exercises course under supervision of a trainer was beneficial in reducing chronic neck pain and disability.

Cardiovascular disease is one of the most common causes of death in today's world. Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) is considered as a treatment for ischemic heart diseases. One of the conflicting points during CPB is maintaining optimum mean blood pressure. This study aimed to examine the impact of two different ranges of mean arterial pressure during CPB on intra- and post-operative clinical and paraclinical variables. In this randomized clinical trial study, two groups of 54 patients undergoing CABG surgery with CPB were enrolled. During CPB, blood pressure was maintained at about 50-70 mmHg in one group and 70-90 mmHg in the other group by administration of ephedrine and nitroglycerin. The patients were studied for blood gas, urine output, pace maker and inotrope requirements, arrhythmia, blood urea nitrogen (BUN), creatinine (Cr), cognition before, during and after the surgery, and also duration of intensive care unit (ICU) stay and intubation. In this study, two groups of 54 patients were enrolled. Overall, 92 (85%) subjects were male and 16 (15%) were female. Mean age of patients was 61.3 ± 9.3 years. Results showed that mean values of bicarbonate (Hco3), BE, arterial pressure of carbon dioxide (PCO2), arterial pressure of oxygen (PO2), BUN, Cr, duration of ICU stay, urine output, duration of intubation, level of cognition, pace maker and inotrope requirements and incidence of arrhythmia had significant relationships with blood pressure before, during, and after surgery. Meanwhile, pH did not have any significant relationships with blood pressure Overall results showed that prognosis in patients with controlled blood pressure at about 70-90 mmHg during CABG surgery was better compared to the group with a blood pressure of 50-70 mmHg. However, more studies seem necessary.

Burns are among the most important accidents related to human health. They receive great attention due to severe complications and high mortality rate. Epidemiologic studies have demonstrated accidents one of the most important health-related problems among which burns are the most common. They impose different physical, psychological, economical and social damages to patients, as well as their family and society. In this research, the epidemiologic characteristics of children with burns were studied to find effective policies to reduce and prevent burns. This retrospective, descriptive, cross-sectional study was performed during 2 years (from April 2010 to March 2011) on 303 children with burns. All children aged under 15 years and were admitted to Imam Musa Kazem Hospital. Data was extracted from patient documents via a valid and reliable checklist. All principles of confidentiality and patient's rights were respected. The data was analyzed using descriptive statistics in SPSS. Most cases of burns (56.9%) were 1-3 year–old children (mean age: 3.71). In addition, 69% of children were male and 31% were female. The majority of burns were caused by boiling water (59.7%). Urban children constituted 57.4% of the cases. The average hospitalization period was 10.8 days (range: 1-60 days). Most children had grade 2 injury (49.2%) and a burn surface area of 11-20% (34%). The highest average burn surface areas were seen in natural gas explosion cases (31.2%) and milk burns (29.2%). In most children, the trunk was injured (66.4%). Findings of this research showed the high risk age groups and the risk factors of burns in children in Isfahan, Iran. The most common causes of burns were boiling water and flame. In this study, we saw an increase in gas explosion burns compared to a previous study in Isfahan in 2000. Preventive programs are required to train parents of high risk children regarding safety issues. Officials and policymakers should adapt precautionary and safety policies in preparing gas tanks and gas-burning equipments. They must also allocate adequate human and financial resources to pay more attention to physical and psychological needs of injured children.

Total knee replacement is an effective and common surgical procedure to relieve advanced knee osteoarthritis. The objective of this study was to assess quality of life after total joint replacement in 60-70 year-old patients with advanced knee osteoarthritis. This nonrandomized clinical trial included 56 patients with advanced knee osteoarthritis who were scheduled for total knee replacement. The quality of life among patients was assessed using the short form health survey (SF-36) during a one-year follow-up period. Additionally, pain score in patients was measured by a visual analogue scale (VAS). Since 3 patients died and 3 refused to participate, 50 patients were evaluated. Mean age of patients was 66.36 ± 3.21 years and 68% were female. Mean SF-36 score significantly improved after surgery compared with before surgery (53.61 ± 6.85 vs. 56.21 ± 5.71; P = 0.041). In six dimensions (physical functioning, limitations due to physical health, limitations due to emotional problems, fatigue, pain and general health), SF-36 scores significantly improved after surgery (P < 0.05). However, the improvements in two dimensions (emotional well-being and social functioning) were not statistically significant (P > 0.05). Pain was also significantly reduced after surgery (P < 0.0001).. The present study showed that quality of life and pain improved after total knee replacement in patients with advanced knee osteoarthritis in a 12-month follow-up period.

Hepatitis B is one of the common liver diseases. It also affects mental and social aspects of life. In this cross- sectional study, patients affected with chronic hepatitis B who referred to Infectious Diseases and Tropical Medicine Research Center, Isfahan, Iran were studied. After filling a validated questionnaire including demographics and information related to depression and anxiety, the data was analyzed. Among 107 patients with chronic hepatitis B (78 males and 29 females with mean age of 39 ± 13 years), none had depression and only 2.8% suffered from anxiety. This study demonstrated that patients with chronic hepatitis B do not have depression. One of the causes might be inadequate information about the disease. Such lack of information needs to be taken care of by physicians and authorities.

Childhood masturbation is defined as self-stimulation of the genitalia in a prepubescent child. It seems to be related with some behavioral and sleep disorders. No previous Iranian study has assessed the effects of this disorder on the formation of other disorders (such as sleep disorders). Therefore, we evaluated the sleep status of 3-7 year-old children suffered from masturbation. This analytic, case-control study included fifteen 3-7 year-old children with masturbation and fifteen age- and sex-matched children as the control group. Data was collected by a researcher-made questionnaire, the Children's Sleep Habits Questionnaire (CSHQ), and an actigraphy device. Child isolation and nightmare were related with masturbation. In addition, lower actual sleep time and higher number of wake bouts were observed in girls with masturbation compared to those without masturbation. Sleep latency (bedtime until start of sleep) in boys with masturbation was more than boys without the problem In this study, we found some sleep disorders to be more frequent in children with masturbation. Reduction of such complications needs the attention of parents and physicians.

Leishmaniasis is a parasitic infectious disease caused by a protozoan parasite from trypanosomatidae family with a wide spectrum in tropical and subtropical areas. The purpose of the study was to characterize various species of Leishmania isolates from Isfahan, Iran with negative direct smears.

This study used culture methods and PCR-RFLP to detect cutaneous leishmaniasis (CL) in patients who referred to the Center for Research in Skin Disease and Leishmaniasis, Isfahan University of Medical Sciences, Isfahan Iran, with negative direct smears. Samples taken from the lesions of patients were cultured on NNN and RPMI1640 mediums. Out of 100 smear negative samples, 50 turned positive for leishmania promastigotes whose DNA was extracted. The amplified ITS1 region of DNA was then analyzed through PCR-RFLP. After digesting the isolates by HaeIII enzyme, the species were determined according to standard strains.

Among 50 isolates from Isfahan region, 46 isolates were identified as L. major and 4 as L. tropica.

The present research showed that PCR-RFLP is an accurate method for specifying agent species of CL. It was also found that L. major and L. tropica were the main two species responsible for various kinds of skin involvement in the region.

Rheumatoid arthritis (RA) is commonly associated with abnormalities in plasma lipoprotein levels, especially a significantly low level of high density lipoprotein (HDL). Most treatments for RA, particularly biological drugs, decrease atherogenic index. Improvement in lipoprotein profile has been found to be associated with decrease in inflammation in RA patients. This study was designed to survey the relationship between lipid profile and RA activity index. This cross-sectional study included a total of 200 randomly selected RA patients. After blood sampling, plasma levels of triglyceride (TG), cholesterol, low density lipoprotein (LDL), HDL were measured. The correlations between these indices and disease activity index were then evaluated using disease activity score calculator (DAS28). The collected data was statistically analyzed by SPSS18. Pierson and Spearman correlation coefficients were applied for data analysis. Multiple regression test and factorial model were used to control bias.. Examination of the relation between LDL levels and RA criteria revealed a direct significant association of 0.13. A significant association of 0.17 was also found between pain intensity (based on visual analogue scale) and LDL levels. Moreover, LDL and tender joints were significantly associated (0.16). There were no statistically significant associations between LDL, joint swelling and erythrocyte sedimentation rate (ESR). HDL levels did not show significant relations with ESR, pain intensity and tender joints (P > 0.05). However, there was a significant reverse association between HDL levels and joint swelling (0.16). This study showed that lipid profile and RA were significantly related in many aspects. This finding was in accordance with the results of other similar studies. Therefore, it seems advisable to check the lipid profile of patients with chronic inflammatory diseases, especially RA, on a regular basis.