نشریه پژوهش در پزشکی
سال چهلم شماره 1 (پیاپی 157، بهار 1395)

The World Health Organization (WHO) has recommended the cell culture based rabies vaccines that have no significant side effects. Vero is a type of cell culture based vaccine which is used for human rabies vaccination in Iran. Because Vero is produced by a single source provider other cell-culture derived vaccines, PCEC, has recently been used for vaccination.
In this double blind clinical trial study 1449 people bitten by animals (279 females) were recruited from 4 different cities of Iran and randomly assigned to receive Vero and PCEC vaccine in 5-dose regimen. The local and systemic adverse reactions to both of two vaccines were reported by the patients and confirmed by a physician.
The most common local adverse reaction in both groups was pain at the injection site (4%). Most of the reported systemic adverse reaction was headache (2.5%) and fever (1.9%) in PCEC and VERO group, respectively. The percentage of subjects had itching after vaccination was fewer In PCEC group than VERO group (0.1% vs. 1%) (p The result of the present study indicated that PCEC administered to people bitten by animals associated with fewer itching at the injection site. There was no significant difference between PCEC and VERO vaccine considering local and systemic adverse reaction. Therefore the PCEC vaccine can be administered instead of Vero, when the country encounters serious challenges in Vero vaccine supply.

Diebetes is frequently along with hyperlipidemia. Glycemic control could improve this condition and including statins and fibrates is the best option to aciliate this amelioration. Noting the importance of diabetes in terms of its multiple complications and the load of its huge cost on the sghoulders of the health system of our contry, this study aimed to to compare the efficacy of fenofibrate and gemfibrozil in improving lipid profile in patients with diabetes type II.
Methods and materials: In this case-cotrol setting, a total of 60 diabetic patients with serum low-density lipoprotein (LDL) in the target range but with increased srum triglyceride were randomized in to 30-patient groups, receving either fenofibrate (200 mg/day) or gemfibrozil (450 mg/day) for 3 consecutive months. Lipid profile changes at the endpoint were compared between the two groups.
Although there were no significant differences between the two groups as to the percent changes in serum total cholesterol, triglyceride, high-density lipoprotein (HDL), Non-HDL, and LDL levels, the improvement was bettwe in fenofibrate receivers. No significant complications were documented in both groups.
The efficacy of fenofibrate in improving serum lipid profile in diabetic patients is marginally better that that of gemfibrozil.

given the high prevalence of bacterial infections, particularly the E.coli in the semen of infertile men compared to fertile men and according to the controversial reports on the association of E.coli with male infertility, herein, the prevalence of this bacterium in the semen of infertile men and its possible association with parameters determining sperm fertility was evaluated.
In this case-control study and in a convenient sampling manner in 2014, semen specimens were collected from infertile and fertile men and were cultured on eosin methylene blue medium, and then, gram staining and biochemical tests were used to identify the E.coli bacteria. Sperm morphology and motility and other related parameters such as; fast, slow and non-progress motility was investigated according to the World Health Organization protocol. Finally, the sperm characteristics were compared between fertile and infertile E.coli-positive groups.
the prevalence of E.coli in the semen of the infertile group was significantly higher than that in the fertile group (P despite the high prevalence of E.coli bacteria in the semen of the infertile compared to the fertile men, it seems that this bacterium is not responsible for alterations in morphology and motility properties of sperm. However, it suggested that in individuals with E.coli infection, along with increasing the age, the association between this bacterium and sperm quality becomes much more tangible.

Students are the main clients for educational system and their opinions can improve service quality. Thus determination of educational gap based on their viewpoints can trigger quality promotion programs. This project was performed to evaluate educational service quality based on Mashhad medical student's viewpoints.
This cross-sectional study was carried out on 216 medical students of Mashhad University of Medical Sciences in 2015. Multi stage random sampling method was used to gather post third grade students. The evaluation tool was the standardized SERVQUAL questionnaire which had demographic (4 questions) and 27 paired question for measuring service quality in 5 dimensions: Assurance, Accountability, Empathy, Confidence and Physical with 5 point Likert scale. SPSS 22 with p Mean age was 22.7±2.9 years. Sixty four percent (139) were female. There were significant differences between desired and existing situation in all items and dimensions. Total service gap was -0.98±0.50 out of which accountability had the highest (-1.22±0.74) and physical had the lowest (-0.79±0.62) educational gap. Gender, educational level and student's situation were not related to educational gap.
Negative gap in all dimensions of educational services shows that student's expectations are not met. Some of these gaps can be easily disappeared by proper management and reconstruction of presenting services.

Staphylococcus aureus is a fastidious pathogen of global concern. S. aureus can not only cause a wide range of serious infections, but can also colonize healthy individuals. Nosocomial- associated S. aureus infection is a major concern for healthcare facilities. Recent increases in antibiotic resistance and community-acquired infection highlight the need for improved understanding for prevention and treatment of this pathogen. This study aimed to determine the antibiotic susceptibility pattern of Staphylococcus aureus (SA). This cross sectional study was performed during April 2013-April 2015 among 62 samples of community acquired S. aureus minimal inhibitory concentration (MIC) for various antibiotics against organisms was determined by E-test method and statistical analysis was done by SPSS ver 13. Overall, 62 patients (including 25 women and 37 men) were included in the study. Sensitivity percentage of organisms based on break point used in CLSI M7A6 (Clinical & Laboratory Standard Institute) for various antibiotics. Highest sensitivity was noted to Linezolid (100%) and highest re4sistance was noted against Oxacillin ( 96.1 %). Keywords: MRSA, VISA ,VRSA , E-test, Staphylococcus aureus, Antibiotic resistance

Immunoglobulin G (IgG) is the most abundant antibody in serum and extracellular fluids. The amount of serum IgG is associated to severity of some diseases like immunodeficiency, infections and autoimmunity. Therefore IgG has a high diagnostic value. Immunoinformatic is a branch of immunology which helps in solving of immunologic problems, well understanding of immune responses and precise diagnosis of diseases using the computational biology. The aim of this study is epitope mapping of human IgG by immunoinformatic approaches.
Methods of study : The amino acid sequence and third structure of reference human IgG was found in PDB database. The second IgG structure was determined by Phyre 2 software. IgG linear epitopes were determined by Ellipro and IEDB softwares.
Linear epitopes are located in 160 - 175 and in 350 – 360 amino acid sequence of light and heavy chains respectively as was determined by IEDB software. 11 linear epitopes in constant domains of human IgG, one in fragment of antigen binding (Fab) and others in fragment of crystalizable (Fc) region (equally distributed in the second and third domains of IgG heavy chain constant region (CH2 and CH3) were determined by Ellipro. 5 main epitope are located in CH3 domain.
In this study a lot of linear epitopes located on human IgG were determined by two softwares and the results of previous experimental studies confirm our results. These epitopes are useful tools for producing specific monoclonal anti IgG antibodies, epitope mapping of human IgG and phylogenic studies.

The duration of infantile hepatitis B vaccination-induced immunity is still unknown. We assessed antibody persistence and immunological memory to hepatitis B 18 years after vaccination during infancy in Iranian young adults at risk of hepatitis B virus infection due to behavioral or occupational exposures.
This study was conducted on 395 freshman students of with a history of 3 times infant HB vaccination (10 µg recombinant HBV vaccine) 18 years ego (in accordance with the national vaccination program). Antibody against HBs Ag (anti-HBs) was measured and participants who had a serum protection (anti-HBs ≥ 10 mIu/mL) excluded. The others (anti-HBs Anti-HBs seropositivity rate was 79.2% (n=313). 42 of 82 seronegative participants received a booster dose and anamnestic response observed in 92.9% (n=39). After the booster dose geometric mean (GMCs) and range of anti-HBs antibodies were 216.8 and 1084.3 respectively (n=42). The mean antibody concentration was significantly different after the boost than before (3.07±1.37 vs. 517.97±435.75, p=0.000).
These findings show that the infantile HBV immunization induced a long-term protection in our group and immunological memory retained for at least 18 years.

The increasing emergence of antimicrobial resistance among gram negative bacteria especially Enterobacteriaceae has become a global problem. Klebsiella pneumoniae is an opportunistic pathogen, which recently due to causing broad spectrum of disease and antibiotic resistance has been lionized. Efflux pumps are one of the antibiotic resistance mechanisms, which were introduced in this bacteria. Therefore, the aims of this study were detection of oqxA, oqxB, acrA and acrB genes, evaluation of expression level of oqxA and acrA genes and determination of antibiotic resistance patterns among Klebsiella pneumoniae isolated at Tehran hospitals.
In this descriptive study 83 Klebsiella pneumoniae were collected from patients attending to three hospitals in Tehran. Antibiotic susceptibility test was performed by disk diffusion method. The presence of oqxA, oqxB, acrA and acrB resistance genes was detected by PCR. The CCCP was used as efflux pump inhibitor and the oqxA, acrA genes expression level was analyzed by using real-time PCR.
The most of strains showed to have OqxAB (96%) and AcrAB (97%) pumps. The use of efflux pump inhibitor showed different results for ciprofloxacin MIC. Real-time PCR assay showed higher expression level of OqxAB (2.3 folds) and AcrAB (4 folds) pumps in resistant strains.
The existence of antibiotic resistance genes, increasing of Klebsiella pneumoniae strains, which become resistant to common antibiotics and nosocomial infections, highlights the need for particular detection, prevention and control of spread of resistant bacteria.