مجله دانشکده پزشکی اصفهان
پیاپی 463 (هفته سوم اسفند 1396)

The selection of incisions for laparotomy depends on a number of factors such as the area that needs to explore, being emergency or elective (non-emergency), and ultimately, surgeon preference. This study aimed to compare the complications of surgical wound in two methods of midline and reverse L. incision in order to recognize the complications and benefits in any circumstances.
This cross-sectional study was performed on 68 patients who underwent laparotomy in Alzahra hospital in Isfahan City, Iran, during the years 2015 and 2016. 34 patients were enrolled in midline incision group, and 34 patients underwent reverse L incision. During the study, the severity of postoperative pain, wound infection, incisional hernia, and dehiscence were compared.
Findings: There was no significant difference between the two groups in terms of incisional hernia, wound infection, and dehiscence (P Due to the similarity of wound complications in the two groups, two different methods can be used in different conditions depending on need.

The most common source of infection in renal transplant patients is urinary tract infection (UTI) that may cause wide ranges of complications in this critical group; thus, finding microbial etiology of urinary tract infection is important. The aim of current study was to define microbiological etiology of urinary tract infection in renal transplant patients with fever using polymerase chain reaction (PCR) technique, due to higher accuracy and less needed time in comparison to culture, for the first time in Iran.
This was census cross-sectional study on 82 renal transplant patients referred to the hospitals affiliated to Isfahan University of Medical Sciences, Iran, during the years 2015-2017. All patients who had undergone renal transplantation and had fever were included. Midstream morning urine was sent for real-time polymerase chain reaction and urine culture to identify Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, and Staphylococcus aureus.
Findings: Urine cultures were positive in 29.3% of patients. Urine polymerase chain reaction was positive in 48.8% of patients, 35% of them for Escherichia coli, 20% for Klebsiella pneumonia, and 45% for Enterococcus faecalis. History of previous infection was statistically related to Enterococcus faecalis positive polymerase chain reaction (P = 0.040). Microorganisms detected by polymerase chain reaction were not in significant association with history of intensive care unit (ICU) admission, or type of immunosuppressant remedy.
Based on findings of our study, using polymerase chain reaction for assessment of urinary tract infection in patients with history of renal transplantation is recommended, due to higher rate of positive results, and less needed time of preparation in comparison to urine culture. Our epidemiological findings showed Enterococcus faecalis as a nosocamial infection as the most prevalent organism detected through real-time polymerase chain reaction panel.

This study aimed to compare the preemptive effect of intravenous ketorolac and ketamine on decreasing the pain of patient in cesarean surgeries.
In a clinical trial study, 150 patients undergoing cesarean surgery were selected and randomly divided into three equal groups of the ketorolac, ketamine, and placebo. A stat dose of 15 mg ketorolac, continuing as 10 mg/hour till end of the surgery, a stat dose of 0.25 mg/kg ketamine continuing as 10 mg/hour till end of the surgery, and the same amount of normal saline was injected in the three groups, respectively. Postoperative pain intensity, analgesic requirement, hemodynamic changes during and after surgery, and adverse effects were compared between the three groups.
Findings: The mean score of postoperative pain in ketorolac group was significantly lower in the return time of motor block, and 4, 12, and 24 hours later than ketamine and at 4, 12, 24 hours than placebo group (P Injection of ketorolac as preemptive treatment could decrease postoperative pain intensity in patients who undergo cesarean surgery. It also has some cardiovascular protective effect and decrease incidence of flushing, shiver, and nausea and vomiting after surgery. So, we recommend preemptive use of ketorolac in cesarean surgeries.

Multiple-drug resistance (MDR) is one of the medical challenges in medicine. The aim of present study was molecular identification of multiple-drug resistant bacterial isolates in wounds of patients in Ahvaz City, Iran, hospitals, and detection of the effect of bee propolis ethanol extract on these bacteria.
120 samples was obtained from bed, burn, and diabetic foot wounds of patients hospitalized in 5 hospitals in Ahwaz City from May to July 2016. Multiple-drug resistant isolates were selected using disk diffusion method and were identified via sequencing 16SrRNA gene. Propolis ethanol extract was prepared using soaking method and its effect as an antibacterial agent was tested on the isolates by well diffusion and microdilution methods.
Findings: 6 multiple-drug resistant isolates including Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis were identified among 25 antibiotic-resistant isolates from different wounds. The concentration of 25 mg/ml of propolis ethanol extract was effective on Gram-positive bacteria in well diffusion method. In microdilution method, the most sensitivity was seen in Staphylococcus aureus with minimum inhibitory concentration (MIC) of 25 mg/ml and minimum bactericidal concentration (MBC) of 50 mg/ml, and then in Enterococcus faecium, and Enterococcus faecalis minimum inhibitory concentration of 100 mg/ml and minimum bactericidal concentration of 200 mg/ml. Gram-negative bacteria were resistant to all concentrations of extract in both methods.
The isolated multiple-drug resistant Gram-positive bacteria which were from problematic agents in treatment of wounds, showed high sensitivity to propolis ethanolic extract.

Vitamin B12 is a water-soluble vitamin shown to have a positive effect on cognition. This study aimed to examine the effect of Vitamin B12 on spatial learning and memory in electrical lesion model of nucleus basalis magnocellularis (NBM) of Alzheimer's disease.
49 adult male Wistar rats were divided into seven groups of control, sham (the electrode was entered into the nucleus basalis magnocellularis with no lesion), lesion (which received bilateral electric lesions of nucleus basalis magnocellularis), vehicle (lesion 0.2 ml saline), and lesion vitamin B12 (5, 10, and 15 mg/kg intraperitoneally). After one week, the rats were trained to perform the Y-maze task for five days. 25 days after training, a retention test was performed to determine long-term memory.
Findings: Bilateral nucleus basalis magnocellularis lesion reduced spatial learning in comparison with control and sham groups (P Our findings indicated that the bilateral nucleus basalis magnocellularis lesion impaired spatial learning in rats, but vitamin B12 improved the learning in them.