مجله دانشکده پزشکی اصفهان
پیاپی 252 (هفته دوم آبان 1392)

Rheumatoid arthritis (RA) is a chronic inflammatory disease which can cause articular destruction and disability in patients. Current therapies are relatively effective and sometimes harmful. Royal Jelly with anti-inflammatory and anti-oxidative properties may be used as an adjunct therapy. The aim of this study was to assess the effect of Royal Jelly on Clinical Disease Activity Index (CDAI) and morning stiffness in patients with rheumatoid arthritis. According to American College of Rheumatology (ACR) 1987 classification criteria، 80 patients with RA، who had active disease (CDAI > 2. 8)، were randomly assigned to receive Royal Jelly or placebo beside background treatment for 3 months. Morning stiffness، tender joint count (TJC)، swollen joint count (SJC)، evaluator global assessment (EGA) and patient’s global assessment (PGA) [based on visual analogue scale (VAS)] were determined before and after 3 months of intervention. The changes in aforementioned indexes were analyzed by SPSS software. 65 patients completed the study (35 in Royal Jelly and 30 in placebo group). The sex، age، residence، disease duration and drug consumption had no significant changes (P > 0. 050). In the first group، CDAI (P = 0. 012)، SJC (P = 0. 024)، TJC (P = 0. 027)، and morning stiffness (P = 0. 004) had significant statistical changes; but only changes in morning stiffness were statistically different between the two groups (P < 0. 05). Royal Jelly has good effect on morning stiffness but not on CDAI and may be a suitable adjunct therapy. Further studies may demonstrate more significant results.

Cutaneous leishmaniasis (CL) is a self-healing disease; however، due to some reasons، in a few cases the lesion develops to a non-healing form of disease. The initial encounter of Leishmania with its host’s innate immune system is important in the outcome of infection. Although، tremendous data is available in murine model of leishmaniasis but immunological surrogate marker (s) of healing and protection in human is not yet well-defined. In this study، the level of IL-23 and IL-27 produced by peripheral blood derived macrophages from patients with healing or non-healing form of cutaneous leishmaniasis lesion were determined to explore whether IL-23 or IL-27 plays a protection role in healing process of cutaneous lesions induced by Leishmania major (L. major). 26 six patients resident in Isfahan Province، Iran، with healing or non-healing forms of cutaneous leishmaniasis caused by L. major were selected. In-vitro productions of IL-23 and IL-27 by peripheral blood derived macrophages، before and after stimulation with live L. major (MRHO/IR/75/ER) promastigotes were evaluated in these two groups and control group using the enzyme-linked immunosorbent assay (ELISA) method. The mean difference production of IL-23 and IL-27 from macrophages of patients with healing form of lesion was significantly higher than patients with non-healing form. The levels of IL-23 and IL-27 in culture supernatants before and after stimulation in healing form of disease was significantly higher than non-healing form (P < 0. 001). It seems that IL-12 agonists might play a protection role in human leishmaniasis and further studies are needed to understand the role of these cytokine in cutaneous leishmaniasis.

Nowadays، multidrug resistant (MDR) Acinetobacter baumannii (A. baumannii) strains are as one of the problematic opportunistic pathogens، especially in intensive care units in the world. The purpose of current study was to define the antibiotic susceptibility patterns and detect the prevalence of producing strains of extended-spectrum β-lactamase (ESBL) and the appearance of betalactamase CTX-M-II enzymes in A. baumannii strains.

This study was conducted in 3 major hospitals in Tehran، Iran، on 500 clinical samples during one year. After the identification of isolates in species، test sensitivity was carried out to 4 antibiotics by using the disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines; also minimum inhibitory concentrations (MIC) was determined for cefepime، cefotaxime and ceftazidime; and finally، to identify the producing strains of ESBL، phenotypic method of combined-disk was used and then، isolates were considered for presence of blaCTX-M-II gene by polymerase chain reaction (PCR) assay.

130 Acinetobacter species were isolated from the patients. The majority of isolates was from blood specimens and revealed the highest resistance to cefepime and ceftriaxone. The MIC of cefepime in 91%، for ceftazidime in 84%، and for cefotaxime in 80% of the studied isolates was more than 128 μg/ml. The results of the combined-disk test demonstrated that 20% of samples were ESBL positive. The PCR results showed that 19% of our isolates had bla CTX-M-II gene.

Multidrug resistant (MDR) A. baumannii is widespread in Iran and is considered as hazard risk for hospitalized patients; also by virtue of the results of this survey، there are more significant mechanisms than ESBL bacteria such as secretory pumps and changes in purine resistance which causes more resistance، too، and should be consider.

Acute poisoning is one of the most threatening health problems around the world. The purpose of this study was to evaluate the prevalence of intentional and unintentional poisoning in vulnerable groups in order to assist in planning and implementation of preventive measures. This cross-sectional study included 786 patients in vulnerable groups (children، women of reproductive ages and the elderly) with acute poisoning who attended the Emergency Department of Noor Hospital in Isfahan، Iran، during 2012. In 89. 5% of cases، poisoning was intentional and 20. 1% of these patients had a history of previous suicide attempts. Women at the age 19-44 were the most suicidal cases (95. 1%). The most common medications were psychiatric drugs (51. 9%). No significant difference was found between sexes، ingested drugs، and outcome between intentional and poisoning group compared to unintentional poisoning. Majority of patients recovered and the mortality rate was 0. 5%. Our results showed that the women of reproductive ages were the most vulnerable groups at risk of intentional poisoning in our society that commit suicide by using drugs especially with psychiatric drugs. More attention and support for this vulnerable group is suggested.

Metabolic syndrome is a cluster of metabolic risk factors that come together in a single individual. These metabolic factors include insulin resistance، hypertension (high blood pressure)، dyslipidemia، and an increased risk for clotting. Patients are most often overweight or obese. The development of nonalcoholic fatty liver disease (NAFLD) is strongly associated with the metabolic syndrome as reflected by the fact that most of the patients with NAFLD have more than one feature of metabolic syndrome. The aim of this review was to summarize the current knowledge on the epidemiology and pathophysiology of both NAFLD and metabolic syndrome and the findings about the effects nutrient content or specific food components (such as ω3 fatty acids). We searched Pubmed، ISI web of science، and EMBASE databases by using “Metabolic syndrome’، ‘Nonalcoholic fatty liver”، “Metabolic syndrome & diet”، “Metabolic syndrome & nonalcoholic fatty liver”، ‘Nonalcoholic fatty liver & diet”، “Nonalcoholic fatty liver & nutrition”، and “Metabolic syndrome & nutrition” from 2008 until 2013. The global increase in the prevalence of obesity is associated with NAFLD. NAFLD is also commonly associated with an increased risk of Type 2 diabetes mellitus development. Although there are no ideal options available for NAFLD treatment، dietary modification has a major role. Dietary patterns highly in fruit and vegetable content were generally found to be associated with lower prevalence of metabolic syndrome. High meat intake was associated with components of metabolic syndrome، especially impaired glucose tolerance. Intake of trans fatty acids from hydrogenated oils found to increase inflammatory markers. A low carbohydrate and saturated fat and high fiber and ω3 fatty acid diet is likely to be beneficial. The higher intake of soft drinks is associated with an increased risk of NAFLD. It is recommended to limit the intake of high-fructose foods and beverages in the NAFLD population. Findings showed negative correlation between coffee consumption and metabolic syndrome، because of the lower prevalence of hypertriglyceridemia، and data suggested coffee intake can reduce the risk of NAFLD. A gradual weight reduction and physical activity program is still the gold standard of NAFLD treatment. Regular consumption of fruit and vegetables is recommended to reduce the risk of developing metabolic syndrome.