Journal of Kerman University of Medical Sciences
Volume:23 Issue: 1, 2016

The production of extended-spectrum-?-lactamases (ESBLs) is the main mechanism of resistance to β-lactam antibiotics. The outbreak of isolates simultaneously possessing several resistance mechanisms to β-lactam antibiotics caused a decrease in sensitivity of the confirmatory tests for ESBL. The aim of this study was the evaluation of the β-lactamase disk test method in the detection of ESBLs in clinical isolates of multidrug-resistant Pseudomonas aeruginosa.
A total of 100 multidrug-resistant P. aeruginosa isolates were recovered from burn patients. The sensitivity of the isolates to different antibiotics was determined using the standard disk diffusion method. ESBL-producing isolates were detected through the combination disk test with clavulanic acid, double disk synergy test, and β-lactamase disk test. Carbapenemase-producing isolates were detected using the Modified Hodge Test (MHT). The ESBLs genes (blaTEM, blaOXA, blaPER, blaSHV, blaCTX-M and blaPSE) were determined through polymerase chain reaction (PCR).
All isolates were multidrug resistant. Only 3 isolates were detected as ESBL-producing isolates through combination disk test. No ESBL-producing isolates were detected through double disk synergy test. Among the 100 studied isolates, 87% were detected as ESBL-producing isolates and 68% as carbpenemase-producing isolates through β-lactamase disk test. The prevalence of blaTEM, blaOXA, and blaPER among isolates were 97%, 61%, and 13%, respectively. All isolates were negative for blaSHV, blaPSE, and blaCTX-M.
According to the results obtained in this study, the β-lactamase disk test is suitable for the detection of ESBLs in multidrug resistant isolates. However, further investigation is required.

The purpose of this study was to evaluate the efficacy of oral selenium in alleviation of oral mucositis induced by radiotherapy in head and neck cancer patients.
In a randomized double blind pilot study, 35 patients under radiotherapy, due to primary tumors localized in the head or neck, who had at least two oral sites were studied. They were randomly divided into the treatment group (oral selenium 400 mcg/day) and placebo group. The intervention started one day before radiotherapy and continued for three weeks after the end of the treatment. Mucosal evaluation was done every week during the course of radiotherapy. NCI-CTC (version 2) grading system and Epstein scoring system were used for the assessment of mucositis. Oral cavity was divided into the 14 anatomical sites and relevant sites were examined weekly. Based on the degree of mucositis, each site was scored using 4-point scale and then mean mucositis score was calculated.
In whole, 35 patients were enrolled into the study. Mean score of mucosistis in selenium group was less than placebo group in the first, second and third weeks (respectively, 0.51 ± 0.28, 1.35 ±0.55 and 1.75 ±0.34 in the selenium group and 1.21 ±0.81, 1.79 ± 0.43, 2.08 ± 0.46 in the placebo group). Repeated measure ANOVA analysis revealed significant increase in mucositis (p=0.019) in the placebo group compared to the selenium group.
Results of this study support the hypothesis that oral selenium can be considered as an effective and well-tolerated medication for the prevention of radiation induced oral mucositis.

Aflatoxin M1 is one of the most important toxins present in milk and the product of aflatoxin B1 metabolism in liver microsomes. The aim of this project was to study the aflatoxin M1 adsorption ability of polystyrene-hydroxyapatite nanocomposite.
First, the probability of aflatoxin M1 adsorption by the nanocomposite was evaluated using the HyperChem simulation software. Then, polystyrene-hydroxyapatite nanocomposite was synthesized and its properties were determined through chemical deposition. Subsequently, serial concentrations of the nanocomposite were prepared and separately incubated with aflatoxin M1 solution at different temperatures and pH. Finally, the adsorption quantity was measured through high performance liquid chromatography (HPLC).
The computer simulation showed that aflatoxin M1 was adsorbed by the nanocomposite. In addition, scanning electron microscope (SEM) images showed that polystyrene and hydroxyapatite nanoparticles were formed and formed a nanocomposite. Image analysis showed that the nanoparticle size distribution was between 50-500 nm. This study revealed that although the adsorption quantity was not affected by temperature, it was affected by pH in all concentrations. The adsorption quantity in a pH of 5 was higher than that in pH of 7 and 9.
In the present study, it was shown for the first time that polystyrene-hydroxyapatite nanocomposite can adsorb aflatoxin M1. This study also demonstrated that although the adsorption was not affected by temperature, pH remarkably affected it.

The H9N2 avian influenza subtype is endemic in many parts of Iran and has the ability to transmit from bird to human. In the present study, the risk of this subtype for humans was assessed by determination of the viral titer and shedding time in bird.
The experiment was done on fifteen male budgerigars at 4 months of age. The birds were inoculated intranasally with allantoic fluid containing 106 EID50/ml of H9N2 virus. At days 1,3,5 and 7 post inoculation, viral presence and titer in the pharynx and cloacal were determined using TaqMan-real time-PCR.
The study showed that following infection of companion birds, viral shedding from pharyngeal and cloacal secretions can start one day after infection continued up to 7 days. In the early days, the viral titer in pharyngeal secretions is very high and reduces over time, while in the dropping of affected bird, it is low in the early days and increases, over time. Maximum viral shedding in the pharyngeal and fecal exertion was seen on days 3 and 5, respectively.
The results of the present study showed that the H9N2 subtype sheds from pharyngeal and cloacal secretions and releases in the environment. Due to the zoonotic nature of the influenza disease and the increasing tendency of people to keep birds, informing the public about the disease, duration of shedding, risk for human and strategies of disease prevention is necessary.

Nocardia are gram-positive, aerobic, relative acid-fast, and opportunistic bacteria, and one of the causes of systematic infection around the world. The natural habitats of these bacteria are soil and dust. Hospitalized patients with immune deficiency are at high risk of transmission of opportunistic infection. Due to these facts and the complexities that exist in the isolation and identification of these bacteria, the identification and controlling of the environmental resources of Nocardia in order to prevent opportunistic diseases are essential in controlling such infections. The objective of this study was to determine an appropriate method for the isolation and identification of Nocardia from environmental sources in hospitals.
A total of 30 soil samples were collected from hospitals in Isfahan, Iran, and studied using dilution serial method, paraffin baiting (McClung's carbon free broth with paraffin bait), and slip-buried method. Samples were incubated at 28 °C in all three methods. Then, polymerase chain reaction (PCR) which recognized a 596-bp fragment of the 16S rRNA gene was used to confirm the genus Nocardia.
From a total of 30 soil samples from hospitals in Isfahan Province, 11 Nocardia isolates (36%) were isolated through dilution serial method, 7 Nocardia isolates (23%) through paraffin baiting method, and 6 Nocardia isolates (20%) through slip-buried method.
This study showed that there are some limitations in the use of paraffin baiting method due to the use of paraffin by some soil bacteria such as Pseudomonas and the competition between these bacteria and Nocardia, and lack of use of paraffin by all Nocardia species. Moreover, the slip-buried method was not suitable in this respect due to the sensitivity of some Nocardia species to the antibiotics used. Thus, since these two methods were not able to identify all Nocardia species in samples, the dilution serial method was identified as an appropriate method. Furthermore, due to the inactivity of some species of Nocardia and the long duration of other methods, molecular and phenotypic methods, as rapid methods, are of high importance in the detection and confirmation of these species.

The current study aimed to investigate the role of catastrophizing as mediator variable in the relationship of neuroticism and extraversion with fear of movement and pain intensity in patients with musculoskeletal pain.
This study was conducted on 200 subjects who were selected through purposive sampling from among the clients of Shohada, Emam Hossein, and Sina Hospitals in Tehran, Iran, and the Pain Clinic in Tabriz, Iran. The subjects completed the Five-Factor Inventory (NEO-FFI), Pain Catastrophizing Scale (PCS), Tampa Scale for Kinesiophobia (TSK), and Visual analog scale (VAS). The data were analyzed using LISREL software through path analysis method.
Among the personality traits, neuroticism had a positive impact on catastrophizing, and thus, caused fear of movement and pain intensity in patients with chronic pain. However, extraversion and openness to experience with a negative impact on catastrophizing caused a reduction in fear of movement and pain intensity.
Based on the results of this study, neuroticism, through decreasing the pain threshold, causes catastrophizing and results in higher degrees of fear of movement and pain intensity. Nevertheless, extraversion (through increasing the pain threshold, and thus, decreases sensitivity to physical and sensory stimuli) and openness to experiences (due to high flexibility in the face of new experiences) have negative effects on catastrophizing.

Breast cancer is the most prevalent cancer and the leading cause of death due to cancer in woman. The presence of a breast cancer patient in the family not only increases the risk of this cancer among family members, but can also increase their stress level. Moreover, increased stress level can be proposed as a trigger for breast cancer. The aim of the present study was to evaluate the effect of stress management group counseling on stress levels of women with a family history of breast cancer.
This was a quasi-experimental study with control group. In this study, 97 women whose mothers, sisters, or daughters had breast cancer in the past 5 years were selected and randomly divided into control and experimental groups. The stress management intervention was designed in the form of group counseling and implemented in 6 sessions lasting 90 minutes. The data collection tool consisted of a 2-part questionnaire including a demographic questionnaire and the Harry’s stress questionnaire. The questionnaire was completed by both group participants before and after the intervention. Data were analyzed using independent t-test in SPSS software.
Before the intervention, no significant statistical difference was observed between the two groups in terms of the mean stress score. However, after the intervention, independent t-test showed a statistically significant difference between the control and experiment groups in terms of the mean stress management score (P Stress management group counseling is effective on the stress level of women with a family history of breast cancer. Thus, this intervention is recommended as an appropriate mental health plan in this group of women.

The purpose of the present study was to compare feeding problems, infant eating behavior, and feeding styles between infants with and without feeding problems according to their mothers’ narratives.
In this casual-comparative study, 50 mother-infant dyads were selected using convenient sampling. The infants’ ages ranged between 6 to 12 months. After matching, the infants were classified into two separate groups of infants with and without feeding problems according to their mothers’ narratives. The Feeding Problem, Child Eating Behavior (CEBQ), and Infant Feeding Style (IFSQ) questionnaires were used for data collection. Data were analyzed using MANOVA.
Infants with feeding problems had less desire for and enjoyment in food, slower feeding rate, and more emotion-dependent eating. Moreover, mothers of infants with feeding problems had less responsible feeding styles and more negligent beliefs and behaviors toward feeding their children, and applied more force and pressure in feeding their infants.
The findings of this study could be considered by specialists in preventive and therapeutic programs for eating problems in infants.

The most common problem of unsatisfied couples is failure in communication skills and the ability to control emotions. Psychological well-being is one of the most important success factors in marital life. The aim of this study was to compare communication skills, psychological well-being, and alexithymia between female applicants and non-applicants of divorce in Tabriz, Iran.
This was a causal–comparative study. The study population consisted of all 18-30-year-old married women who had applied for a divorce and all 18-30-year-old married women of Tabriz. For this purpose, 200 women (2 groups of 100 applicants and non-applicants of divorce) were selected through multistage random and convenience sampling. Data were collected using Barton’s Communication Skills Questionnaire, Ryff’s Psychological Well-being Scale, and the Toronto Alexithymia Scale. Data were analyzed using descriptive statistics and multivariate analysis of variance test.
There was a significant difference between the two groups of women in terms of communication skills, psychological well-being, and alexithymia. This means that communication skills and psychological well-being was lower and alexithymia was higher among the applicants for divorce.
The results showed that in order to strengthen couples’ relationships and the foundation of families, and thus, to prevent the phenomenon of divorce and its consequences, the promotion of premarital counseling and providing families with appropriate information is essential.

Most antibiotics not only inhibit microbial growth, but also can increase the growth of livestock. Although enrofloxacin is one of the most commonly used antibiotics, it has high toxicity on the kidney, liver, and brain. The aim of this study was to synthesize nanocellulose conjugated with aminobenzyl purin and to study its enrofloxacin adsorption capability.
Nanocellulose was first synthesized and conjugated with aminobenzyl purin in the presence of a crosslinker. Then, serial concentrations of conjugated nanocellulose (125, 250, 500, 1000, and 2000 µg/ml) were incubated with enrofloxacin solution of 1000 µg/ml concentration at different temperatures, incubation times, and pH. At the end of incubation, all tubes were centrifuged at the speed of 5000 RPM for 5 minutes and the optical density of the upper layer of solution was obtained using a spectrophotometer with 340 nm wavelength. Finally, the percentage of absorption was calculated.
The adsorption tests showed that the variation in concentration of conjugated nanocellulose, and incubation temperature and time did not affect the adsorption, but the variation in pH caused a significant difference in the amount of adsorption. The maximum adsorption was 82.5 % and was observed in acidic conditions for the concentration of 1000 µg/ml.
Nanocellulose conjugated with aminobenzyl purin is an efficient adsorbent of enrofluxacin, and could possibly be used in food to adsorb this antibiotic.

Patellofemoral pain syndrome (PFPS) is one of the most common musculoskeletal disorders with various conservative therapeutic methods for its management. The aim of this study was to investigate national research regarding the effects of conservative treatment methods of PFPS.
The review process was performed using the keywords of anterior knee pain, PFPS, quadriceps strengthening exercises, hip muscle strengthening exercises, taping, bracing, orthoses, exercise therapy, manual therapy, and physiotherapy. The search engines used included Islamic World Science Citation Center (ISC), IranMedex, Google Scholar, MedLib, Magiran, Scientific Information Database (SID), and PubMed. Only 15 articles had the study inclusion criteria. The findings related to the effects of conservative therapeutic methods on pain intensity, balance, function and physical ability, and knee joint proprioception in patients with PFPS were extracted from the selected articles.
The majority of articles focused on exercise therapy as an important part of the rehabilitation program. They had reported improvement in patients with PFPS in terms of pain intensity, disability, and proprioception as a result of exercise therapy. Although, other therapeutic methods also had positive effects on these patients, they were not as effective as therapeutic exercise.
Current literature supports the continued use of exercise therapy as an efficient treatment in patients with PFPS. However, designing and implementation of new therapeutic interventions encompassing other treatment methods and evaluation of their long term effects through follow-up assessments is essential.

Tranexamic acid has been used to decrease blood loss volumes and the subsequent need for blood transfusion in the orthopedic, spinal and cardiac surgeries.
In this prospective controlled randomized clinical trial study, 24 candidates for orthognathic surgeries received tranexamic acid (20 mg/kg) intravenously just before the surgery while matched control patients received normal saline. The patients underwent the surgeries according to the standard protocol. Patients’ blood hemoglobin and hematocrit levels were calculated before and after the surgeries and blood loss volumes were calculated using these criteria.
The blood loss was estimated as 693.65 ± 81.24 and 1024.00 ± 75.41 ml regarding blood hemoglobin values before and after the surgery in intervention and control groups, respectively; while it was estimated as 660.93 ± 62.78 and 1052.00 ± 48.54 ml concerning patients’ blood hematocrit levels before and after the surgery in those groups, respectively. Significant differences were noted between the intervention and control patients regarding blood loss volumes determined via the two methods (both: P As suggested by the results, the intravenous injection of tranexamic acid (20 mg/kg) just before the orthognathic surgeries was associated with the significant decreased blood loss volumes compared to the control patients.