مجله دانشکده پزشکی اصفهان
پیاپی 450 (هفته دوم آذر 1396)

Candiduria is one of the most common infections in hospitalized patients, which is created by the administration of long-term antibiotic, disseminated candidiasis, urinary tract problems, and having long-term urine catheter. Prevalence of the candiduria in women is more than men. The aim of present study was to determine the frequency of the Candida species of candiduria in hospitalized patients in nephrology department, Labbafinejad hospital, Tehran, Iran.
This study was carried out on 53 patients. The early identification of species was done using CHROMagar Candida medium. The genomic DNA was extracted using boiling method. Polymerase chain reaction (PCR) was used to amplify ITS1-5.8s-ITS2 region. The polymerase chain reaction products were then digested with MspI restriction enzyme. Polymerase chain reaction and restriction fragment length polymorphism (RFLP) products were revealed on 1.5% and 2% agarose gel electrophoresis, respectively, to identify the yeast.
Findings: Among 53 patients, 14 were diagnosed with candiduria. In our study, the frequency of candiduria was 26.4%. Separately, 5 patients (35.7%) were men and 9 (64.3%) were women. Candida glabrata (C. glabrata) had the highest frequency (42.8%). Other identified Candida species were C. albicans (21.4%), C. krusei (21.4%), C. tropicalis (7.2%), and C. parapsilosis (7.2%).
Increase in non-albicans species, due to resistance to antifungal drugs and increased use of immunosuppressive drugs, have resulted in many problems for candiduria treatment. Therefore, identification and appropriate treatment of these elements, especially in nephrology ward of hospitals, seems to be necessary.

Legionella pneumophila is considered as one of the most important etiologies of respiratory infection in immunocompromised patients, which causes high morbidity and mortality. The aim of this study was to evaluate the epidemiology of Legionella pneumophila in febrile neutropenic patients.
This cross-sectional study was performed on 36 patients with neutropenia admitted to Seyedoshohada hospital, Isfahan, Iran, during 2014-2015. All patients underwent throat sampling with a sterile swab. All samples were analyzed via quantitative real-time multiplex polymerase chain reaction (PCR) covering Legionella pneumophila. The prevalence of Legionella pneumophila in febrile neutropenic patients was then assessed.
Findings: Mean age of the patients (including 22 men and 14 women) was 54.8 ± 7.6 years. Most of the patients had acute myeloid leukemia (AML) (33.3%) and non-Hodgkin lymphoma (NHL) (19.4%). From 36 examined throat samples obtained from the patients with confirmed neutropenia, no positive result of Legionella pneumophila was detected via polymerase chain reaction.
Our study does not support the hypothesis that Legionella pneumophila plays an important role in the development of neutropenic fever. Thus, more studies and using additional diagnostic methods to detect Legionella pneumophila in atypical pneumonia are recommended.

The aim of our study was to evaluate the prevalence of accidental extracardiac findings in multidetector computed tomography (MDCT) angiography of coronary arteries.
Patients with suspected coronary artery disease were evaluated with multidetector computed tomography during injection of contrast material. Images were reviewed for extracardiac findings which were classified as therapy needed, further workup needed, follow-up needed, and no further action needed.
Findings: Extracardiac findings were detected in 24.30% of patients. The frequency of the findings classified as needed therapy, needed workup, needed follow-up, and no further action needed was 1.94%, 8.02%, 10.94%, and 3.40%, respectively.
The prevalence of noncardiac findings on cardiac multidetector computed tomography was noticeable. To avoid missing clinically important findings, all the fields of cardiac multidetector computed tomography should be evaluated carefully.

The aim of this study was to evaluate the magnitude and axis orientation of anterior, posterior, and total corneal astigmatism (ACA, PCA, and TCA, respectively).
In this retrospective study, pentacam topographical maps of 226 eyes (113 patients) with 1.0 to 6.0 diopters (D) of astigmatism were analyzed. Topographical anterior and posterior corneal surface astigmatism was determined. The magnitude and axis orientation of the anterior, posterior and total corneal astigmatism were compared.
Findings: The mean age of the study population was 33.00 ± 6.74 years. The mean magnitude was 2.02 ± 0.99, 0.44 ± 0.20, and 1.98 ± 1.01 diopters for anterior, posterior, and total corneal astigmatism, respectively. Most eyes had with-the-rule (WTR) anterior astigmatism and against-the-rule (ATR) posterior astigmatism. With-the-rule astigmatism had a higher mean magnitude compared to against-the-rule and oblique astigmatism in anterior and posterior corneal astigmatism groups. Posterior corneal astigmatism magnitude exceeded 0.75 diopters in only 8% of the subjects. Anterior corneal astigmatism had a significant positive correlation with posterior and total corneal astigmatism (P The provided information of this study may be helpful in obtaining optimum results in astigmatism correction in refractive surgery or designing new intraocular lenses.

The aim of this study was to evaluate the effects of platelet-rich plasma (PRP) gel on the diabetic wound in order to find a new safe and effective treatment method.
In this randomized clinical trial, 50 patients with diabetic wound were selected and randomly allocated into two groups. In the intervention group, 1 ml of platelet-rich plasma was administered topically at the wound edges, 3 times with one-week interval. The control group received routine treatment. Quality of life, pain score, wound extent, and incidence of infection were evaluated for all the patients within the first 3 months.
Findings: The mean score of quality of life after the first month in both groups was similar. However, the mean score of quality of life in the control group was lower than the intervention group after 2 and 3 months (31.88 ± 2.8 vs. 39.13 ± 1.35, respectively, P Platelet-rich plasma gel seems to be effective in the treatment of diabetic foot. It is likely that this combination can be used as a treatment option in addition to standard treatment to be effective in controlling the wound and infection in short term. Considering the limitations of this study including small sample size, more studies are recommended.

Deep sedation is essential during endoscopic retrograde cholangiopancreatography (ERCP) in order to achieve therapeutic goals and avoid complication. Therefore, providing a suitable sedation is critical for the patients. The most common sedation protocol includes an intravenous (IV) benzodiazepine along with an intravenous narcotic. For the difficult-to-sedate patients, like addicted patients, general anesthesia should be considered as an alternative. Meperidine is commonly used because of the traditional belief that other narcotic agents may be associated with contraction of Oddi. However, it seems that using morphine for addicted patients may cause deeper sedation without Oddi sphincter contraction.
This was a clinical trial study on 88 ERCP-candidate addicted patients assigned into two groups. The case group received morphine before starting ERCP and the control group only received the routine sedation regimen. The degree of sedation, patient movements, and the status of the sphincter of Oddi were evaluated during procedure time.
Findings: The data about 44 patients of the case and 40 patients of control groups were analyzed. The mean age was 58.52 ± 1.11 years. Evaluating the degree of sedation every 15 minutes during ERCP showed significant differences between the case and control group. In case group, the degree of sedation was significantly deeper. Furthermore, Oddi sphincter showed a significantly increased contraction in case group. However, only in one patient procedure failed.
Administration of morphine in addicted patients can make deeper sedation during ERCP, without any significant problem related to contraction of the sphincter of Oddi.

Inadequate pain control has a significant role in maternal and neonatal health in the early postpartum period. It interferes with breastfeeding and has a negative influence on child normal growth. This study aimed to evaluate the preemptive effect of intraincisional infiltration magnesium sulfate on postoperative pain control.
This was a double-blind randomized prospective clinical trial study involving 64 pregnant women underwent cesarean section, from 2015 to 2016, in Shahid Beheshti and Alzahra hospitals, Isfahan, Iran. Patients were randomly assigned to two equal groups. Patients in the case group received 1 mg of magnesium sulfate in the incisional site. Pethidine was a pain reliever in the follow-up examination. The obtained data, including mean pain intensity, nausea and vomiting, pethidine consumption, blood pressure, heart rate, sedation score, and patient satisfaction were collected and analyzed using repeated measures ANOVA and Man-Whitney tests.
Findings: Mean pethidine consumption was not statistically different between two groups (P = 0.850). Mean pain intensity was significantly different only 12 (P = 0.024) and 24 (P = 0.007) hours after the surgery and it was not significant at other time points (P = 0.130). Other parameters were also not statistically significant.
It seems that preemptive intraincisional infiltration of magnesium sulfate could not have a significant effect on postoperative pain and reduction of pethidine use in cesarean section.