مجله دانشکده پزشکی اصفهان
پیاپی 367 (هفته سوم اسفند 1394)

Acinetobacter infections are of nosocomial infections with a significant increase in antibiotic resistance in recent years. Since the infection in hospitalized patients, especially patients hospitalized in intensive care units and patients with secondary immune deficiency can be associated with high morbidity and mortality rates. Hence, the aim of this study was to determine the prevalence and patterns of antibiotic resistance in Acinetobacter species isolated from patients hospitalized in the Alzahra hospital, Isfahan, Iran.
In a cross-sectional study, hospital records of all patients with Acinetobacter nosocomial infection who were hospitalized in Alzahra hospital during 2012 to 2013 were studied. The pattern of antibiotic resistance was determined in all the patients and isolated Acinetobacter were analyzed based on clinical and demographic characteristic.
Findings: 495 cases with nosocomial infection of Acinetobacter were studied. The most antibiotic resistance was seen for ampicillin-sulbactam (21.1%) and amikacin (13.1%). In addition, the frequency of resistance to ciprofloxacin, cefoxitin, cefotaxime, and meropenem were 5.4, 4.8, 2.0, 1.7 and 1.3 percent, respectively. All the samples were sensitive to cefazolin, cefepime, ceftazidime, gentamicin, nitrofurantoin and tazocin and co-trimoxazole. Resistance to amikacin was different based on the sex, hospitalization, ward and source of sampling; resistance to ampicillin was different based on the source of sampling; resistance to ampicillin-sulbactam was different based on the sex; resistance to cefoxitin was different based on the sex; and finally, resistance to ciprofloxacin was different based on the source of sampling.
According to our study, Acinetobacter infection is one of the most prevalent nosocomial infections but a considerable part of samples are sensitive to general antibiotics. High sensitivity to general antibiotics probably is due to the source of infection. In the other hand, contamination with staff’s hands is the most common way for infection transition. Thus, programming for prevention and control of infection transfer must be done in all hospitals.

The symmetricity of even organs of body may help clinicians in the early detection of diseases. So, we estimated the cup-to-disk ratio (CDR) in left and right eyes and checked the symmetricity between the two eyes using the data of optical coherence tomography (OCT).
In this study, data from 40 normal subjects were used. This data was taken from the 3D-OCT1000 Tapcon model. For estimating CDR in each B-scan, at first the internal limiting membrane (ILM) and retinal pigment epithelium (RPE) layers were extracted; then using the end-point of RPE layer and the depth of cup, the boundary of disk and cup were determined. Finally, CDR of each B-scan was compared point-by-point and the symmetricity parameters were evaluated.
Findings: CDRs in the left and right eyes of 40 normal data were investigated locally. We divided optic disk area into three regions named upper, middle and lower. Then, CDR of each region was calculated for left and right eyes of each patient. The local CDR were 0.433 ± 0.0548, 0.432 ± 0.061, and 0.432 ± 0.0635 for the right eyes and 0.441 ± 0.0635, 0.443 ± 0.0731, and 0.417 ± 0.675 for the left eyes in upper, middle and lower regions, respectively. The differences between local CDRs in different regions of the two eyes were 0.0483± 0.042, 0.0420 ± 0.039, and 0.067 ± 0.045, respectively.
The results of local comparison of CDRs between the left and right eyes indicated that the level of asymmetricity in the lower region of disk was higher than upper and middle regions, and the middle region has the most symmetricity. In addition, in point-by-point symmetricity evaluation of CDRs, the highest level of symmetricity is seen in the second B-scan, near the center of optic disk.

Diabetic autonomic neuropathy is a serious and common complication of diabetes. There is a need to develop a simple instrument to measure autonomic symptoms in patients with neuropathy and to test the validity of the instrument. Using the survey of autonomic symptoms (SAS) questionnaire for screening diabetic autonomic neuropathy is a new procedure. Sympathetic skin response (SSR) is a method for the study of autonomic nervous system. Given the importance of diabetes and its autonomic complications, in this study, data obtained from the SAS questionnaire was compared with the SSR to know whether it can be used for these patients.
In this cross-sectional study, the patients with a diagnosis of diabetes with at least one symptom of autonomic dysfunction, referred to the clinic of Neurology and Clinical Endocrinology, after obtaining written informed consent were enrolled. For each patient, the SAS questionnaire was completed and SSR was assessed via electromyography (EMG) recording. The SAS questionnaire consists of 11 items in women and 12 in men. Each item is rated by an impact score ranging from 1 (least severe) to 5 (most severe).
Findings: The SAS was tested in 135 patients with neuropathy and diabetes. The mean score of SAS was 16.82 ± 12.62, that was not significantly related to age and gender. 60 patients (44.4%) had positive and 75 patients (55.6%) had a negative SSR response. Independent t-test showed a significant association between the response of SSR and the score of SAS (P The SAS is a new, valid, and easily administered instrument to measure autonomic symptoms in early diabetic neuropathy and would be of value in assessing neuropathic autonomic symptoms in clinical trials and epidemiologic studies.

Increased intracranial pressure (ICP) can be life-threatening and is associated with poor prognosis. In these patients, mortality rate and life expectancy would increase by reducing the intracranial pressure. Finding appropriate way to reduce pressure without specific changes in blood electrolytes and blood pressure is essential. This study aimed to evaluate the effect of rehydration with hypertonic saline 5% on intraoperative complications and prognosis in patients with high intracranial pressure.
This study was performed on 90 patients with high intracranial pressure undergone surgery. After skin incision, hypertonic saline 5% was injected intravenously. Electrolytes and vital signs of patients at baseline and at 24 and 48 hours after the surgery were compared. The data were analyzed using ANOVA with repeated measures test.
Findings: 54 patients (60%) were men and 36 (40%) were women, with the mean age of 48.1 ± 9.8 years. Administration of hypertonic saline significantly increased sodium level (137.5 to 144.9 mmol/l), potassium level (3.8 to 4.96 mmol/l), the amount of output (1.43 to 3.94 l), systolic blood pressure (104.6 to 127.32 mmHg), diastolic blood pressure (61.58 to 85.13 mmHg) and anion gap (9.34 to 18.8) (P This study showed that the use of hypertonic saline 5% serum in patients with high intracranial pressure who need surgery, improve the electrolyte and vital signs, especially blood pressure, which increases the quality of treatment and consequently reduces mortality rate of the patients.

One of the most common ophthalmic diseases is glaucoma that may lead to some of serious complications such as blindness and damage to eye tissue. Glaucoma and be treated by using several methods that one of the most common ones is trabeculectomy. In the other hand, some studies showed that using mitomycin C probably can help the treatment of glaucoma and decrease complications. So, the aim of this study was determining the success rate and postoperative complications of trabeculectomy with and without rubbing mitomycin C in the local operation among the patients with glaucoma.
In a prospective cohort study, 70 patients who were candidates for trabeculectomy were divided in two equal groups. In the first group, mitomycin C was contacted with operation site during surgery and in the second group, only trabeculectomy was done. Intraocular pressure was measured before, one week and one, three and six months after the surgery. In addition, postoperative complications were evaluated until six months after the surgery. The collected data were compared between the two groups.
Findings: According to six-month follow-up, the surgery was completely successful in 22 (63.9%) and 28 (80%) patients, relatively successful in 5 (14.3%) and 6 (17.1%) patients and unsuccessful in 8 (22.9%) and 1 (2.9%) patients in control and intervention groups, respectively; The success rate was significantly better in intervention group (P = 0.048).
According to results of this study, rubbing mitomycin C in operation site during trabeculectomy increased the success rate and decreased the number of used drugs. So, it is suggested to be used by ophthalmologists.

Real-time quantitative reverse transcriptase- polymerase chain reaction (qRT-PCR), is a fast, sensitive and reliable method of gene expression comparison that is prone to a lot of technical errors. On the other hand, historical reference (housekeeping) genes are not suitable for all tissues. Herein, we have tried to identify and evaluate the best reference gene for testis tissues for further qRT-PCR experiments.
Testis tissues of 15 men with non-obstructive (NOA) and 15 men with obstructive (OA) azoospermia (as control individuals) were collected. Primer designing and verification of four candidate reference genes including glyceraldehyde 3-phosphate dehydrogenase (GAPDH), ribosomal protein L37 (RPL37), ring finger protein 1 (RING1) and eukaryotic translation elongation factor 2 (eEF2) were performed using Beacon designer 8.1 software. PCR pre-optimization for reverse transcriptase input RNA and best primer concentration were included. Melt curve analysis was drawn and values of quantitation cycle (Cq) were extracted. Mean Cq analysis was calculated using BestKeeper v1 software and suitable reference genes were selected afterward.
Findings: Comparing the mean Cq values between the NOA and OA groups declared that RPL37 and GAPDH showed the lowest standard deviations of 1.39 and 1.67 among the other candidates. GAPDH and RPL37 were selected as the best reference genes in testis tissues with their r values of 0.959 and 0.927, respectively.
The results of this study show that the best reference genes for normalization of qRT-PCR data of testis tissues are GAPDH and RPL37.

Each year, on November 14, the World Diabetes Day (WDD) is celebrated. WDD is a campaign led by the International Diabetes Federation (IDF) and its member associations throughout the world. It was created in 1991 by IDF and World Health Organization (WHO) in response to increasing concerns about the intensifying threat of diabetes worldwide. The WDD 2014 campaign marked the first of a three-year (2014-16) emphasis on “Act today to change tomorrow“. These activities and materials in these years will particularly concentrate the topic of healthy eating and its importance both in the prevention of type II diabetes and the applicable management of diabetes to prevent the complications.