مجله دانشکده پزشکی اصفهان
پیاپی 447 (هفته سوم آبان 1396)

Pulmonary thromboembolism (PTE) is one of the serious and lethal cardiopulmonary diseases. Rapid diagnosis and therapy is of paramount importance. In recent years, various factors including white blood cell count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) have been used as prognostic factors in acute pulmonary embolism. This study aimed to evaluate the correlation between neutrophil-to-lymphocyte ratio and mortality rate in patients with pulmonary thromboembolism treated with thrombolytic drugs.
A total of 40 patients hospitalized whit diagnosis of pulmonary embolism and treated with thrombolytic drugs were enrolled. Clinical data, admission complete blood count (CBC) parameters, and neutrophil-to-lymphocyte ratio were all recorded. The clinical outcomes of study subjects were determined using hospital-reported mortality data.
Findings: The mean age was 59.90 ± 13.82 years, and 13 patients were women (32.5%). The mean white blood cell (WBC) count was 9673.25 ± 2885.37. The mean neutrophil-to-lymphocyte ratio was 4.80 ± 2.41; 7 patients (17.5%) died during hospital course. The mean neutrophil-to-lymphocyte ratio level was significantly higher among patients who died compared to those who survived (7.10 ± 1.37 vs. 4.31 ± 2.31; P This study showed a correlation between neutrophil-to-lymphocyte ratio and hospital mortality rate in patients with acute pulmonary thromboembolism treated with thrombolysis.

Uterus myometrium contractions play crucial role in break or successful embryo implantation. Furthermore, efficient myometrial angiogenesis is important event for supplying endometrium blood. Recently, many studies were performed for investigating the effects of sildenafil citrate (SC) on female fertility. This study aimed was to assess the changes in myometrial thickness and associated angiogenesis after injections of sildenafil citrate in superovulated mice.
Thirty adult female mice and ten adult male mice were purchased. The female mice were divided into three equal groups of control without any intervention, gonadotropin receiving human menopausal gonadotropin (HMG) and human chorionic gonadotropin (HCG), and gonadotropin and sildenafil citrate receiving human menopausal gonadotropin, and human chorionic gonadotropin and sildenafil citrate administration. After mating, animals were deeply anesthetized and the uterus was rapidly removed for histology and immunohistochemistry process to identify cluster of differentiation 31 (CD31).
Findings: In gonadotropin sildenafil citrate group, the thickness of myometrium was significantly thicker than control and gonadotropin groups (P 0.05).
It may finally conclude that administration of sildenafil citrate does not cause remarkable alterations in myometrial angiogenesis; but increases the thickness of myometrium. Although for realistic decision about the sildenafil citrate effects on aforementioned parameters, more molecular investigations and longer drug consumption periods are necessary.

Bacteria, fungi, and viruses have the ability to colonize in burned lesions. Due to the wide use of antibacterial drugs, this colonization is increasing.These drugs induce impairment of immune system in burn patients, destruction of blood vessels, and presence of fungal agents in environment and body normal flora, colonization of fungi tends to induction of infection. The most common fungi in burn patients are Candida spp., Aspergillus spp., and other molds such as Mucorals. Nowadays, antifungals drugs cause resistance increasing in non-albicans spp., uncommon molds, and yeasts. This study aimed to determine fungal infections in burn patients.
From 111 hospitalized burn patients at Isfahan burn center, Iran, during February 2016 to April 2017, sampling was performed via pus swabs and skin scraping. Each sample divided into two parts; one for direct exam by 10% potassium hydroxide (KOH) and Giemsa staining. The second part cultured on Sabouraud dextrose agar with chloramphenicol (SC); then, incubated at 30°C for 24-48 hours, and after amplification, the polymerase chain reaction (PCR) product was purified and sent for DNA sequencing.
Findings: Out of 111 patients, only one specimen was positive in direct exam, culture criteria, and DNA sequencing, in which, Neurospora sitophila isolated and identified. In the present study, the frequency of fungal species was 0.9%.
Due to the consideration of antifungals at the early phase after burn injury, the low positive rate of fungal cultures is reasonable. This prophylaxis protocol is recommended to be considered in other burn centers.

This study was conducted to investigate the effect of a four-week aerobic physical activity in water on the extent of clinical improvement and amount of neuregulin-1 (NRG1) protein in the brain tissue of animal model of multiple sclerosis (MS) via inducing experimental autoimmune encephalomyelitis (EAE).
To this end, a total number of 80 female Syrian mice from the race of C57BL/6, aging 10 to 12 weeks and weighing 20 ± 2 gram were divided into eight groups of 10, namely, control, swimming, MS, MS swimming, MS interferon beta (INF-β), MS solvent, and MS solvent swimming environment. For induction of EAE, 300 μg (35-55) myelin oligodendrocyte glycoprotein (MOG) was first mixed in 100 μl phosphate buffered saline (PBS) with complete Freund's adjuvant (CFA) and injected subcutaneously (SC). At the time of injection and after 48 hours, 300 ng pertussis toxin was diluted in PBS and injected intraperitoneally (IP). During a week after the treatment, mice recieving the drug in form of intraperitoneal received 150 IU/g of the drug per day. Clinical symptoms and the mice's weights were recorded every day. Physical activity group did the aerobic activities for four weeks, five sessions a week, 30 minutes each session. Standard scoring system was used for clinical check and enzyme-linked immunosorbent assay (ELISA) was applied to measure NRG1 protein. Data analysis was done using one-way ANOVA.
Findings: The effect of physical activity in water on treatment of multiple sclerosis was the same as that of interferon. The amount of rise in NRG1 protein in swimming group was more than that of the interferon group.
Aerobic swimming exercises could probably help remyelination by increasing the amount of NRG1 protein and lowering the speed of myelin destruction, hence, helping the clinical improvement in patients with multiple sclerosis.

Major depressive disorder (MDD) is a prevalent and devastating psychiatric disorder worldwide that needs multidimensional interventions. Metacognitive treatment is a new psychotherapeutic approach of some psychiatric disorders. This study was conducted to comparatively evaluate the impact of citalopram and metacognitive interventions on major depressive disorder.
This was a clinical trial study with a pretest/posttest design. After selection of objects, the eligible patients were randomly assigned into three groups of citalopram (n = 12), metacognitive intervention (n = 16), and waiting list (n = 8). One experimental group received ten 1-houre sessions of metacognitive therapy; 10-40 mg citalopram was administered to other group; and third group did not receive any interventions and placed on waiting list. Outcome measures were done using Beck Depression Inventory (BDI), Metacognitions Questionnaire-30 (MCQ30), and Cognitive Emotion Regulation Questionnaire (CERQ) before and after interventions. Data analysis was performed using ANOVA and post hoc tests.
Findings: There was significant difference between the groups in terms of symptom of depression, metacognition, and emotion regulation before and after intervention. In term of metacognition, only metacognitive therapy was useful (P = 0.010). Symptom of depression were improved significantly with metacognitive therapy (P = 0.007); but in pharmacotherapy, despite clinical improvement, there was not any statistically significant improvement (P = 0.070). In addition, emotion regulation was improved with metacognitive therapy (P = 0.020).
Metacognitive therapy could be used in major depressive disorder. In addition, this intervention could lead to higher level of cognitive emotion regulation.

Vasoplegia or vasoplegic syndrome is a type of vasodilator shock that occurs in a large number of patients after cardiac surgery under a cardiac pulmonary pump, which can increase the incidence of complications and mortality in patients. Therefore, it is necessary to find a way to treat this disease. So, the aim of this study was to evaluate the effect of two doses of alpha-agonist midodrine on the prevention of vasoplegic syndrome induced by cardiopulmonary bypass.
This study was performed on 135 patients undergoing cardiac surgery (45 cases in midodrine 5 mg, 45 cases in midodrine 10 mg, and 45 cases in control group) in Chamran hospital, Isfahan, Iran, in 2016. Patients were randomly assigned into three groups, the drugs were prescribed one hour before surgery, and the vital sign and complications were recorded in patients. Chi-square and ANOVA tests were used to compare the data.
Findings: The mean blood pressure during the pump was higher in the midodrine 10 mg group than the other groups (5 mg midodrine and control) (P = 0.021); and the mean ephedrine administration in this group (15.33 mg) was also less than 5 mg midodrine (21.55 mg) and control (29.77 mg) groups (P = 0.012).
Considering the high incidence of vasoplegic syndrome after cardiac surgery, administrating 10 mg of midodrine can improve clinical symptoms during the pump and reduce the need for vasopressor drugs, which can make better surgical results.

Coagulopathy is a common complication in patients hospitalized in intensive care units that leads to increase mortality rate, hospitalization, and hospital costs. This study aimed to detect the prevalence of coagulopathy and its related risk factors in patients with trauma hospitalized in intensive care units of Alzahra hospital, Isfahan, Iran, during 2013-2016.
In a cross-sectional study, medical reports of 400 traumatic patients admitted in intensive care unit of Alzahra hospital from 2013-2016 were studied and the prevalence of coagulopathy was determined.
Findings: Thrombocytopenia was seen in 20 percent of patients. In addition, 16.5, 12.8, and 30.0 percent revealed prolonged prothrombin time (PT), prolonged partial thromboplastin time (PTT), and prolonged international normalized ratio (INR), respectively.
Prevalence of coagulopathy in patients with trauma hospitalized in intensive care units is high and probably is related to some factors such as blood transfusion, drug consumption, level of consciousness, body temperature, acid-base status, and the site of trauma.