مجله دانشکده پزشکی اصفهان
پیاپی 476 (هفته چهارم خرداد 1397)

Migraine is a common neurodegenerative disorder, and the loss of the function of several genes in the serotonergic system is involved in the susceptibility to this disease. In this study, the association of the functional polymorphism of A1438G single nucleotide in the promoter of the 5-HT2A receptor gene with migraine susceptibility was studied.
Genomic DNA was extracted from blood samples of 109 patients with migraine and 107 healthy individuals. Then, the fragment of the promoter of the HTR2A gene, which contained A1438G polymorphism, was amplified using polymerase chain reaction (PCR) technique. To determine the genotype of each individual, the product of polymerase chain reaction was digested with MspI enzyme.
Findings: Genotype AA increased the risk of migraine disease by two folds (P = 0.03). Moreover, allele A increased the risk of migraine significantly (P = 0.01).
Based on the results of this study, it is suggested that the genotype AA in the A1438G single nucleotide of the HTR2A receptor gene can increase the risk of migraine disease, which may be due to the effect of allele A on enhancement of promoter activity, receptor expression, and consequently, the effect of it on the contraction of the vessels that is present in migraine headaches.

Chronic ankle instability due to ankle sprain is a common injury among athletes. Theraband exercises and the use of external stabilization devices for nerve-muscle controlling in the injured ankle are among rehabilitation and prevention methods for ankle sprain. This study aimed to compare the effect of eight weeks of Theraband exercises or using kinesiotape on performance, balance, and range of motion among the athletes with chronic ankle instability.
In a clinical trial study, 30 athletes from the city of Kazeroun, Iran, who had ankle sprain at least twice during the last six month before the study were selected and randomly divided into two groups of Theraband and kinesiotape. The 8-week training program was performed 3 sessions a week. Performance measurement [Figure of 8 HopTest (FH)], balance [Star Excursion Balance Test (SEBT)], and range of motion (goniometer) were evaluated. The data were analyzed using dependent and independent t statistical tests.
Findings: The kinesiotape group were better significantly in performance compared Theraband group (P = 0.001); Theraband group were better significantly in anterior (P = 0.001), right (P = 0.16), and left (P = 0.02) balance, as well as dorsiflexion (P = 0.001) and plantar flexion (P = 0.010) range of motion.
Theraband exercises and kinesiotape both significantly improved performance, balance, and range of motion among the athletes. Theraband exercises were more effective in balance and range of motion, and kinesiotape was more effective in athletic performance.

Sensorineural hearing loss is a radiotherapy complication in patients with brain tumors.The auditory system of patients with brain tumors often is placed inside of radiation field and receives a significant amount of radiation dose resulting in hearing loss.The purpose of this study was to compare contouring and delivery dose to cochlea and inner ear in two techniques of 3D conformal radiotherapy vs 2D conventional radiotherapy in patients with brain tumors.
Methods and materials:Computerized tomography (CT) scan of43 patients(23male and20 female) were used.Patients were treated for brain tumor at the radiotherapy unit of Isfahan Milad Hospital 2016.Contouring of cochlea and inner ear were done on patients CT.by Radiation oncologist.using TiGRTtreatment planning system.Dose volume histograms (DVHs) for methods of 2D (two parallel and opposite fields) and 3D (two parallel and opposite field and a vertex field using wedge and Multileaf collimators(MLC)) were compared.
The mean dose in 2D technique for the cochlea was 2624 ± 338.7and for the inner ear was 2718.3 ± 341.3,and in 3D radiotherapy technique for the cochlea 2507±294.6,and for inner ear was 2581± 295.6.The mean dose of inner ear and cochlea in 3D was 5.3% and 4.6%lower than 2D,respectively.
The study of dosimetric parameters of the auditory system in treatment planning of two methods of radiation therapy showed that there was no significant difference between the doses of cochlea and inner ear in 2D and 3D methods (Pvalues=0.86,0.85).Therefore in treatment planning of these two radiotherapy techniques, contour of cochlea can be replaced by inner ear.

Effective antibiotics on the translation pathway, such as mupirocin, may cause gene mutations in methicillin-resistant Staphylococcus aureus in long-term. Using high-sensitivity methods plays an important role in identifying these bacteria. Our goal was to identify these mutations using high-resolution melting (HRM) curve of DNA analysis.
Resistance to mupirocin was identified using disc microdilution plate method in according to the Clinical and Laboratory Standards Institute (CLSI) guideline. mupA gene amplification in the isolates of methicillin-resistant Staphylococcus aureus was done using polymerase chain reaction (PCR). Then, analysis was performed using StepOne Software and HRM software. Sequencing was used as gold-standard method for confirming of the results.
Findings: Out of 162 Staphylococcus aureus isolates, 83 (51.32%) were methicillin resistant. Among methicillin-resistant Staphylococcus aureus isolates, 47 (52.80 %) showed high level resistance to mupirocin carrying mupA. The most and lowest resistance was observed for penicillin (79.62%) and ceftazidime (6.17%), respectively. Moreover, all of multi-drug resistant (MDR) isolates were mupirucin resistant, too. Among mupirocin-resistant Staphylococcus aureus, wound samples were the most prevalent. Besides, isolates obtained from wound and blood demonstrated the highest mutation in A and G bases. Meaningful association was observed between the type of clinical sample and mutation rate, and resistance to mupirocin and methicillin (P Mupirocin-derived gene mutations provide multi-drug resistance in methicillin-resistant Staphylococcus aureus.

Osteoarthritis (OA) is one of the main causes of chronic pain in worldwide. Intra-articular corticosteroid injection has been routinely used for symptom control in patients with osteoarthritis. Some possible complications have limited its repeated application. Recently, intra-articular injection of nonsteroidal anti-inflammatory drugs (NSAIDs), namely ketorolac, has drawn major attention which should be further assessed.
In this double-blind clinical trial study, 38 patients randomly assigned into two equal groups of case with single intra-articular injection of 30 mg ketorolac and control with single intra-articular injection of 40 mg triamcinolone. Required data were gathered via visual analogue scale (VAS), and validated Persian translations of the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Lequesne questionnaires.
Findings: In one and three months follow up, triamcinolone was effective in pain reduction, joint stiffness, function, and walking ability. Ketorolac was effective only in the pain domain of questionnaires. In One month, triamcinolone showed a considerably better pain reduction effect than ketorolac (P = 0.008). However, after 3 months, both methods were equally effective in pain reduction (P = 0.712).
Ketorolac can cause significant pain reduction in knee osteoarthritis, but considering its minimal effects on patients’ functional status, its application should be limited to cases with contraindications or patient refusal to corticosteroid injection.