مجله دانشکده پزشکی اصفهان
پیاپی 180 (هفته دوم اردیبهشت 1391)

Salmonella enterica serovar enteritidis is currently the most frequent serovar causing salmonellosis in humans. The incidence of gastrointestinal infections caused by S. enteritidis increased during the last decade. The aim of this study was to evaluate the genetic diversity of S. enteritidis isolates from Tehran (Iran) hospitals using ribotyping methods. In a descriptive study from April 2008 to December 2011, clinical samples such as fecal and blood specimens of the cases having symptoms of salmonellae infection were collected from different hospitals in Tehran. Salmonella isolation was carried out by bacteriological and serological methods. The relationship between the strains was determined using ribotyping. Of 68 Salmonella spp. strains, 29 isolates were S. enteritidis. Ribotyping was able to differentiate all isolates. The size of the bands ranged from 1.4 to 16.8 kb in all ribotypes. S. enteritidis isolates were divided into three clusters (1d to 3d). Most strains (20) belonged to the 1d cluster. Our results indicated that S. enteritidis strains circulating in Tehran mainly belong to a limited ribotype.

Knowledge about cystic fibrosis (CF) in Iran is very limited. The objective of this study was to determine the prevalence of CF among a group of high risk children with suggestive clinical features in Tehran Pediatric Medical Center, Tehran, Iran. A total number of 505 patients aged 0-15 years participated in this study. Subjects presented with one or more of the following symptoms were asked to participate in the study: chronic or recurrent respiratory symptoms, gastrointestinal symptoms such as rectal prolapsed, steatorrhea, hepatobiliary disease such as prolonged jaundice, failure to thrive, hyperglycemia and glycosuria, hypochloremic metabolic alkalosis, hypoprothrombinemia, anemia, or edema. Children with positive family history of CF were also included. Patients were screened using pilocarpine iontophoresis to collect sweat. Chemical analysis of sweat chloride content was performed by classic Gibson and Cooke technique. Of 505 patients, 89 (17.6%) had positive sweat chloride screening. In 5 patients (1%), cystic fibrosis transmembrane regulator (CFTR) mutation analysis was required to confirm CF. The study results suggested that CF is more common in Iran than previously anticipated. Larger studies are warranted to identify the incidence, molecular basis, and clinical pattern of CF in the Iranian population.

The purpose of evaluating children with mild head trauma is to identify patients with traumatic brain injury and to prevent brain from deterioration and secondary damage while limiting unnecessary imaging procedures. The present study aimed to investigate the frequency distribution of indications for computed tomography (CT) scan in children under 2 years of age with mild head trauma. In this cross-sectional study, medical files of 100 children under 2 years of age with mild trauma were investigated. Data such as age, sex, mechanism of head injury, level of consciousness before CT scan, repeated vomiting, decreased level of consciousness, craniofacial soft-tissue injuries, distant systemic damages, and the possible existence of brain lesions based on patient's CT findings was collected and evaluated. The mean age of patients, 63 of whom were male, was 18 ± 7.1 years. The most common cause of head injuries was falling from a height (66%). Based on CT scan findings, 55% of patients had abnormal CT findings. Age, sex, and mechanism of trauma were not significantly different between groups. Although repeated vomiting and decreased level of consciousness were more prevalent in patients with abnormal CT findings compared to those with normal results, the difference between the two groups was not significant. The results of the present study revealed that vomiting and decreased level of consciousness in children under 2 years of age with mild head injuries cannot be considered as the sole criteria to suspect brain injury and necessitate CT scanning.

Poisoning with carbamazepine is the third most common reason for status epilepticus seizure in the poisoning ward of Nour Hospital (Isfahan, Iran). No survey has been performed on the frequency of seizure among patients poisoned with carbamazepine. The relationship of such toxicity and other effective variables and treatment outcome have not been studied either. This study aimed to identify factors affecting seizure due to carbamazepine toxicity in order to help physicians make the correct decisions. In a retrospective study, information of every patient with carbamazepine toxicity who had been admitted in Nour Hospital was collected by census sampling method. Patients were then divided into two groups of with and without seizures. The two groups were compared using independent-t and Fisher's exact tests in SPSS15. During 1 year, 114 cases were admitted and 7% of cases experienced seizures. The mean dose of drugs and pH levels were significantly different between the two groups. The frequency of patients who were discharged with a complication or died was higher in the seizure group. Using high doses of carbamazepine increases the risk for seizure among poisoned individuals. In addition, patients with seizure are at higher risk for acidosis, complications, and death.

Many studies have shown spinal anesthesia with sedative drugs to affect bispectral index (BIS). On the other hand, spinal anesthesia, even without sedative drugs, reduces the level of consciousness. It has also been suggested that BIS value decreases in cases of epidural anesthesia. The aim of this study was to compare the effects of spinal and epidural anesthesia on BIS during cesarean section. In a double-blind randomized controlled clinical trial study, a group of pregnant women with American Society of Anesthesiologists (ASA) class I or II who were elective cesarean candidates in Beheshti Hospital (Isfahan, Iran) were evaluated. The patients were divided into two groups to receive either spinal or epidural anesthesia. BIS, heart rate (HR), mean arterial pressure (MAP), signal quality index (SQI), electromyography (EMG), consciousness block level, and central temperature (tympanic) were measured in all subjects. The values were registered immediately after anesthesia and at the 5th, 10th, 15th, 30th, 45th, 60th, 90th, and 120th minutes after spinal and epidural anesthesia. The mean changes were compared and analyzed in SPSS. From the recruited subjects, 65 individuals completed the study in each group and their data was analyzed. There were no significant differences between the two groups in terms of mean age, height, weight, body mass index, MAP, SQI, percent of EMG, central temperature, or recorded BIS values at any point of time. According to our results, BIS values during surgery start to decrease immediately after the injection of the spinal or epidural anesthesia drugs. The greatest reduction compared to baseline BIS values occurred at 30th, 45th, and 60th minutes after induction of anesthesia. However, spinal or epidural anesthesia did not have different effects on BIS values during cesarean section.