مجله دانشکده پزشکی اصفهان
پیاپی 341 (هفته اول شهریور 1394)

Cutaneous leishmaniasis is a self-limited disease that does not cause a major problem in terms of death and disability compared to other diseases. However، permanent disfiguring scar، long-term period of wound healing، secondary infection، drug side effects، treatment duration and secondary effects caused by the drugs increase the impact of the burden of this disease. This study was designed to investigate the status of cutaneous leishmaniasis reinfection in patients referred to Skin Disease and Leishmaniasis Research Center (SDLRC)، Isfahan، Iran. Demographic information such as age، sex، number and place of lesion، migration to endemic areas، nationality، and occupation of the patients with cutaneous leishmaniasis referred to Skin Disease and Leishmaniasis Research Center parasitology laboratory in the years of 2012 and 2013 was collected. Of 1087 patients diagnosed as having cutaneous leishmaniasis، 75 patients (6. 8%) had reinfection. Mean age of these patients was 34. 73 ± 20. 91 years (ranging 1-75). Women (41، 54. 7%) were affected more than the men (34، 45. 3%) with no statistically significant difference. Some patients with the history of cutaneous leishmaniasis may suffer reinfection after several years of recovery. Less than 10% of patients had this problem in the our study population. Several factors such as genotype or strain variations and immune deficiency due to chronic backgrounds may be involved in the process of reinfection. Further researches are warranted to explore the underlying pathophysiology.

Most of the Escherichia coli strains can cause intestinal and extra-intestinal diseases. Enterohemorragic Escherichia coli (EHEC) O157: H7 diseases have increased in developed countries، and today is the third cause of diarrhea. The purpose of this study was to investigate the eaeA، hly، and flich7 virulence genes in Escherichia coli isolated from diarrheal stool samples. After collecting 55 samples of human diarrhea in Tehran city hospitals، Iran، chemical and microbial tests for Escherichia coli strains were done، the bacteria were isolated and DNA was extracted using multiplex polymerase chain reaction (multiplex PCR) method. Of 55 human samples، 34 (61. 8%) were of the flich7 gene، 11 (20. 0%) were of the hly gene and 4 (7. 2%) were of the eaeA gene. The controversy of the results of this study and other studies may be due to age، sample type، geographical location، type of diet، methods of detection and isolation، individual health status and even seasons of the year.

Prevention and control of shivering after surgery is of significant importance and different methods are used for this purpose. In this study، three drugs of dexamethason، petidine and hyoscine were compared in the prevention of postoperative shivering. In a clinical trial study، 90 patients who were candidates for laparascopic cholesistectomia were selected and randomly divided in three equal groups. The first group received 0. 5 mg/kg pethidine، the second group 0. 1 mg/kg dexamethason and the third group 0. 15 mg/kg hyoscine. The prevalence of postoperative shivering was compared between the three groups. The data was analyzed using SPSS software. In three groups of pethidine، hyoscine and dexamethason، 60%، 43. 3% and 54. 4% had no postoperative shivering، respectively. In these groups، 20. 0%، 13. 3% and 23. 3% had mild shivering، 16. 7%، 33. 3% and 6. 7% had moderate shivering and 3. 3. %، 10. 0% and 10. 0% had sever postoperative shivering، respectively، and no statistically difference were seen between the three groups (P = 0. 16). Pain was lower in pethidine group than the other groups. In addition، dexamethasone and hyoscine had positive effects of postoperative nausea and methoclopramide consumption. Three drugs of pethidine، hyoscine and dexamethason have not different effects of prevention of postoperative shivering but the complications such were different. We recommend that in future studies، the combined effect of these drugs on postoperative complications in patients undergoing surgical procedures could be studied.

Some of studies showed that Hepatitis C Virus (HCV)، Human Immunodeficiency Virus (HIV) and related drugs not only have effect on liver and immunity systems but also have effect on musculoskeletal and bone mass density and led to increase of fractures risk; investigations about these effects are limited. The aim of this study was determining the frequency distribution of fractures among HCV- or HIV-positive patients referred to hospital orthopedic surgery wards. In a cross-sectional study during 2012-2014، 132 HCV- or HIV-positive patients hospitalized to Kashani and Alzahra hospitals (Isfahan، Iran) due to fractures were studied. Fracture status، improvement time and complications due to fracture were investigated. Of 132 studied patients، 87 (65. 9%) were HCV-positive، 21 (15. 9%) HIV-positive، 17 (12. 9%) HCV- and HIV-positive and 7 (5. 3%) were HCV-positive with cancer. The most prevalent of damage was femur fracture that happened in 69 (52. 3%) patients. Kind of damage was related to background diseases and frequency distribution of femur fracture (as the most frequent fracture) in HCV-، HIV-، HCV- and HIV- and HCV-positive with cancer patients was 48. 3، 28. 6، 88. 2 and 85. 7 percent، respectively. In addition، the frequency distribution of complications was different based on the kind of background diseases (P = 0. 001). According to the results of this study، prevalence of bone fracture in HCV- or HIV-positive patients was high and probably، was related to lock of bone mass density and increase of bone fracture risk. In addition، post-treatment complications such as infection and un-union were prevalent in these patients. Hence، prevention activities and routine surveillances such as bone densitometry and musculoskeletal surveillance mast be done in these patients.

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) initiated and mediated by autoreactive T-helper1 cells directed against myelin antigens. One of the T-cell surface receptors is T-cell immunoglobulin and mucin domain (TIM) family. There are several single nucleotide polymorphisms (SNPs) in their sequences witch had associated with susceptibility to different autoimmune diseases. The aim of this study was to investigate the susceptibility of patients with multiple sclerosis in Isfahan population، Iran، with polymorphism +4259A>C in TIM-3 gene. Blood samples were collected. DNA was extracted from the blood samples using Genomic DNA Extraction Kit. Polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) was performed. TIM-3 gene was amplified using PCR. Then، the products were digested with restriction enzyme، PstI. Electrophoresis was performed for separating the digested products. Genotype and allele carrier frequency between patient and healthy groups were statistically significant (P = 0. 029). The odds ratio of susceptibility to multiple sclerosis for whom carrying C allele of TIM-3، compared with those who do not carry، was about 2 (P = 0. 010). +4259A>C polymorphism in TIM-3 gene is associated with multiple sclerosis in Isfahan population، measuring the expression level of the genes carrying such polymorphisms and their relevant protein functional and/or structural analysis could be helpful.