مجله علوم پزشکی رازی
سال بیست و سوم شماره 6 (پیاپی 147، شهریور 1395)

Some previous studies have shown that in the surgical site infection, sterility of the surgeon’s hands is not so effective, while the other studies have shown the other way. Also some studies believe that most infections come either from pathogens of the patient’s skin or from the pathogens of the environment. This study is designed to compare the pathogens of the surgeon’s hands and surgical site for each patient with the same patient’s pathogens of the wound infection, and recognize the possible infection factor. However, there are some altering factors that make the final conclusion, difficult. Some of these factors are unknown. It is tried to match the conditions for all patients, to reduce the chance of biased results. However, some of them could not be prevented.
Methods and Materials: The current study is designed in the form of prospective cohort. In this study, 122 patients which have undergone cesarean operation in the two hospitals of Rasool Akram and Shahid Akbarabadi in the city of Tehran, are considered for the study. The method of sampling was that after washing the surgeon’s and surgeon assistant’s hands with sterile soap, a culture is taken from the grooves of their hand palms on the sheep blood agar, and after preparation of the operation site and before cutting, a culture is taken from the operation site. After 5 to 7 days, the patients are called by phone to the hospital, and their operation site is investigated. If any sign of infection including stiffness, erythma, and discharge is seen, once more a culture is taken from the operation site, and the type of pathogen of operation site and the surgeon’s and surgeon assistant’s hands and that of the wound site are compared and their relation are investigated. To reduce the chance of biased results, the type of operations are matched and all the known infectious factors, such as immune deficiency, diabetes, history of using immunosuppressor drugs, Corton, and rupture of membrane, are excluded from the study.
In this study, 122 patients have participated, which have undergone cesarean operation in Rasool Akram and Shahid Akbarabadi hospitals in Tehran. From these patients, 57% were from Akbarabadi hospital, 39% were above age of 30, 58% had urgent operation, 57% had repeated cesarean operation, 69% were obese, 9% were illiterate, 14% had hypertension or pre-eclampsy, 12% faced with tearing of operation gloves during operation, for %62 of them povidine iodine is used for washing the surgeon’s hands. The results were that in the 4.9% of cases, the surgeon’s hands culture results were positive, in 16.4% of the cases, the surgical site culture results were positive, and finally, in 6.6% of the cases, the wound infection culture results were positive. For investigation of the relation between the wound infection culture result and the other recorded parameters of the operation, the mean and standard deviation of the different parameters in the presence or absence of the wound infection are measured and compared with each other. Then, the significance of the relation is investigated with the calculation of the P Value, and with the calculation of the Odds Ratio for different parameters, their effects as a risk factor for wound infection positive culture is examined.
This study shows that the wound infection culture result has significant and direct relation with the surgeon’s hand culture result, but it rejects the significant relation between wound infection culture result and the surgical site culture result, that requires more samples and investigations for confirmation, and requires that all the samples are taken from a single hospital to reduce the chance of altering factors. This study also shows that for the wound infection culture result, these are some risk factors: age above 30, being an urgent operation, being a repeated operation, obesity, illiteracy, past medical history, hypertension or pre-eclampsy, type of washing solution (povidine iodine), and surgeon’s hands positive culture result. This study shows, as well, that for the surgeon’s hands positive culture result, being an urgent operation, and type of washing solution (povidine iodine) are some risk factors.

As an inappropriate antibiotic administration, the emergence of drug resistance in pathogens associated with clinical and subclinical urinary duct infections is of great concern worldwide. The present cross-sectional study was conducted on 114 patients affected with urinary duct infections and admitted to Shahid Ghazi Hospital in the first half of 1393, on the aim of the bacteriological evaluation of urine samples and identification of antimicrobial resistance profile of the isolated bacteria. The youngest patient was 9 and the oldest one was 85 years old, and 96% were women and 4% were men. The relative frequency of bacteria isolated from the urine samples in bacterial culture were 74% Escherichia coli, 20% Staphylococcus spp., 3% Streptococcus spp., 2% Klebsiella spp., and 1% Pseudomonas spp. The antibiotic susceptibility profile was investigated by antibiogram test in accordance with NCCL protocol. The standard used antibiotic discs contained sulfamethoxazole, ceftizoxime, tetracycline, amikacin, cephalexin, nalidixic acid, gentamicin, nitrofurantoin, cefotaxime, ciprofloxacin, ampicillin, vancomycin, co-trimoxazole and norfloxacine. The most and the least susceptibility in Escherichia coli were for nitrofurantoin and sulfamethoxazole, respectively. Staphylococcus and Streptococcus isolates had the most resistance to ampicillin and sulfamethoxazole and the most susceptibility to nitrofurantoin and gentamicin. Klebsiella and Pseudomonas had the most antibiotic resistance for tetracycline and co-trimoxazole and the most susceptibility to gentamicin and amikacin, respectively.
Based on the importance of antibiotic resistance emerging and the alteration in antimicrobial resistance pattern of bacteria, antibiogram tests are essential for treatment of urinary tract infections.

The study using national data, assessed relationship between Parent’s educations with child’s Health in Iran and looking for the role of intermediary variables.
In this Ecological study, we collected national data on parental education as predictive variables, Children’s health as response variable and housing condition, Child’s benefit from health services and Mother’s health as intermediary variables in 31 provinces and did exploratory factor analysis in order to detect latent variables. Then we estimated correlation between latent variables and made structural equation models by residual variables.
Findings: Findings showed that both Structural models which consists mother’s ill-health and bad dwelling situation has good fitness. In structural models, 20 to 80 percent of child health variance has explained by low parental education and bad dwelling situation, and 60 to 80 percent of child health variance has explained by low parental education and bad mother’s ill-health. GFI was between 0.74-0.99 in models.
The findings confirm the role of Socio-economic factors of families, especially mother’s literacy and health and housing condition on children’s health, and show the importance of investment on these factors in order to achieve improvement in children’s health.

Recently, with the advances in the medicine of boosting the immune system, high ability of peptides for the treatment of viral diseases has been proved. By now, there is no effective vaccine against HIV-1 infection. Previous studies confirmed the efficiency of capsid and envelope proteins of papilloma, Herpes and Adeno viruses in new vaccines design. The present study was planned to predict T-cells epitopes from P24 protein by bioinformatics tools and study their effects on lymphocyte proliferation.
To this aim, sequences of 22 peptides corresponding to P24 protein were obtained from NIBSC and have been examined using HLAPred, Propred, SVMHC, SYFPEITHI, and IEDB server. In this experiment, the peptides were prepared at concentrations of 10,100,500 and 1,000 µg/ml. At the end, the selected peptides were tested on the Iranian blood lymphocyte cells (PBMC).
The results demonstrated that positive peptides significantly increased lymphocyte proliferation. However the negative peptides did not have any effect on lymphocyte proliferation. Results also showed that p16 and p3 among tested peptides had highest and lowest effects on lymphocytes proliferation respectively.
The results of present study confirmed that epitope predictions tools can be reliable alternatives to experimental work.

Factor XIII deficiency is a bleeding disorder that its prevalence in the general population is about 1 in 2 million people around the world. In Iran, the high rate of consanguineous marriages lead to high rate of disorder with 473 factor XIII deficient patients that is about 12 times higher than the global Prevalence of disorder. The study, is a comprehensive review of all aspects of factor XIII deficiency in Iran. The distribution of the disease in different parts of Iran shows that the province is not only the largest number of patients with factor XIII deficiency in Iran, but also the world's highest incidence of the disease has been reported in this area. In Iranian patients, bleeding from the umbilical cord ,hematoma, prolonged bleeding are the most common clinical presentations. Several disease-causing mutation in Iranian patients with the most common mutation factor XIII deficiency that Trp187Arg southeast of Iran. Traditionally, patients with factor XIII deficiency treated with fresh frozen plasma or cryoprecipitate in Iran until 2009, that factor XIII concentrates for the treatment of patients became available. Several studies on the efficacy and safety of prophylactic regimes in different situations with valuable findings have been evaluated.

Hepatoprotective effects of plants with antioxidant properties have been demonstrated. Considering the importance of drug-induced hepatotoxicity as a major cause of liver damage, present study carried out to investigate the protective and therapeutic effects of Fumaria afficinalis extract against hepatotoxicity induced by acetaminophen in rats. 35 adult male Wistar Albino rats randomly were divided into 7 groups: (1) healthy control, (2) positive control rats [intraperitoneally injection of acetaminophen (150 mg/kg)], (3) hepatotoxic rats treated with silybum marianum (100 mg/kg) once daily, (4) and (5) hepatotoxic rats treated with Fumaria aqueous extract once daily at doses 250 and 500 mg/kg, respectively for 2 weeks at the time of acetaminophen injection, (6) and (7) protective experimental rats that treated with aqueous extract of Fumaria once daily at doses 250 and 500 mg/kg, respectively, before drug injection. For groups 6 and 7, after 2 weeks of oral treatment, acetaminophen was injected and treatment continued for 2 weeks. At the end of treatment period serum level of functional liver markers (ALT, AST, ALP, and LDH), lipid profile, malondialdehyde and total antioxicant capacity were measured. The data was analyzed by one way ANOVA test. Fumaria reduced the elevated liver enzymes levels and also improved lipid profile. Furthermore this plant reduced lipid peroxidation and increased total antioxidant capacity. Protective effects of Fumaria in prevention groups were notable compared with therapeutic groups. Our results demonstrated that Fumaria have protective and therapeutic effect on experimentally acetaminophen-induced hepatotoxicity in rats. This protective effect might be due to various flavonoids in different plants and it should be considered when designing new drugs for liver toxicity treatment.

Beam-hardening artifacts in CT image set of patient with a hip prosthesis cause difference between dose distributions resulted by treatment planning system (TPS) algorithms and actual dose distribution in patient body. In this study, dose distributions of TPS algorithms were compared with the results of Monte Carlo simulations of Titanium and Steal as a hip prosthesis for different photon energy.
Siemens Primus linear accelerator was modeled using the MCNPX code for 6MV and 15MV energy mode. Dose reduction due to Titanium and Steal were calculated by different algorithms of Isogray TPS and compared with the results of Monte Carlo simulations of Titanium and Steal. The accuracy of the algorithms for different depth and energy was evaluated.
In 6MV energy, for Titanium, there was 12.9%, 12.6% and 10.7% and for Steal, there was 14.3%, 14.1% and 12.1% differences between simulation results and TPS algorithms included Superposition, Collapsed cone and FFT Convolution respectively. In 15MV energy, for Titanium, there was 15%, 15.6% and 13.3% and for Steal, there was 21.7%, 22.3% and 20.1% differences between simulation results and TPS algorithms included Superposition, Collapsed cone and FFT Convolution respectively.
There was significant dose reduction due to hip prosthesis whereas the TPS algorithms do not have ability to predict the dose reduction accurately. Thus, use of Monte Carlo based algorithms recommend for dose calculation in patient with high density prosthesis.

Silver nanoparticles have been widely used in various biomedical applications and drug delivery systems. The biosynthesis of nanoparticles has been proposed as a cost effective environmental friendly alternative to chemical and physical methods. In the present study, synthesis of nanoparticles using a novel Nocardiopsis sp. AHA2 has been attempted. We used culture supernatant of Nocardiopsis sp. AHA2 for the biologically synthesis of silver nanoparticles and study of its antimicrobial activity.
marine Sediment samples were collected from depth of 10th centimeter. Serial dilution was mad for screening of marine actinomycetes using SCA medium. After Isolation and characterization of Nocardiopsis sp. AHA2, The reduction of silver ions occurred when silver nitrate solution (0.01 M) was treated with the Nocardiopsis sp. AHA2 culture supernatant at room temperature. nanoparticles were characterized by UV-visible, Zeta potential. Antimicrobial activity of the prepared silver nanoparticles against bacteria and fungi pathogens was assayed using well diffusion assay.
Silver nanoparticles were successfully synthesized in the culture supernatant of Nocardiopsis sp. AHA2. During the experiment, the appearance of a dark brown color indicated the formation of silver nanoparticles. In the UV-visible spectrum, maximum peak was observed between 420 nm, indicating the presence of AgNPs. AgNPs displayed antimicrobial activity against all used pathogenic microorganisms. Nocardiopsis sp. AHA2 can be a good candidate for the synthesis of the AgNPs using silver nitrate.

Due to the low awareness of men in reproductive health and its different aspects, such as sexually transmitted diseases and HIV / AIDS need to explain the educational structure in this context. this subjective perception by recognizing men and informative people, led to the discovery of the structure of subjective views based on their experience.
Material & In this study, a qualitative approach was applied and data was gathered via in-depth interviews. The subjects were selected via purposive sampling in two large cities of Iran including Tehran and Mashhad .Overall, 30 man were enrolled in this study. Participants were selected from public health centers, hospitals and offices. Data were analyzed using conventional qualitative content analysis with MAXqda software.
Two themes were derived from the experiences of participants that can be required in relation to reproductive health. The emergent categories were: "education based on gender empowerment" and "favorable consideration to the characteristics of education".
To improve the educational structure of men, planning to inform and empower men with the desirable features of education in the national and regional level, is essential to prevent risky behaviors. It is possible to gain the support of officials contribute to a responsible and comprehensive implementation of such programs should be the basis of government policies and community education.

Hear rate turbulence, Disturbances in Vagal activity and reduced heart rate variability (HRV) is observed in individuals after coronary artery bypass grafting. Exercise training is recommended to improve these failures. Therefore, the aim of this study was to investigate the effects of interval exercise training on heart rate recovery (HRR) and heart rate variability after coronary artery bypass grafting (CABG).
The subjects of this study were those who had gone under CABGin 501 Artesh Hospital and had passed one month of recovery. The subjects were divided into two groups of training (n=12) and control (n=12) after preliminary evaluations and performing exercise test. The patients underwent 4 weeks of interval exercise training, 3 times a week, in Tehran heart center. T-test was used to evaluate the intra-group differences and independent t-test was used to evaluate the difference between groups (p The result showed that parameters of HRV including TP, HF, LF and Lf/HF had been significantly affected by 4 weeks of interval exercise training. Interval exercise training had also significantly reduced the HRR in 1-3 min after exercise training.
As the two important indicators of mortality (HRV and HRR) had improved after interval exercise training, this type of exercise training can be recommended to the patients who undergo CABG for better recovery.

Nocardia asteroides complex is aerobic actinomycete, partially acid-fast and Gram –positive which rarely cause ocular infections especially in immunodeficient persons.
An 83-year-old man with diabetes presented with nasolacrimal duct obstruction to Labbafinejad Hospital Tehran –Iran. According to the clinical examination and microbial assessment cause of illness was diagnosed as Nocardia asteroides complex.
Diagnosis of Nocardia asteroides complex as a cause of nasolacrimal duct infection for prompt and proper treatment is effective.

Nanotechnology is one of great important part of technology. Nanoparticles can be used in different applications for industrial, medical, military and personal use. The objectives of this study were preparation of chitosan –ZnO nanocomposite films via a simple method and investigation of antibacterial activity of them.
Chitosan –ZnO nanocomposites were prepared via the method of sol – gel transformation. Then this nano- composite was studied by using UV-Vis, FTIR, XRD, SEM, and EDX. Antimicrobial properties of product were investigated on Escherichia coli and Staphylococcus aureus. Antibacterial effect of nanocomposites with 1.5 wt % ZnO on the bandages were investigated on both the bacteria.
The results showed that the ZnO content had an effect on antibacterial properties of nanocomposite films. Nanocomposite films with 1.5 wt % ZnO exhibited high antibacterial activities. Further, nanocomposite film on the bandages with 1.5 wt % ZnO exhibited antibacterial activities on both the bacteria.
It was proved that the chitosan –ZnO nanocomposite film had an excellent antibacterial performance. Typically, the nanocomposite film may be used to biomedical application. Also, used as a surface coating to enhance microbial safety and extend food shelf life.

Clinical Grand Rounds method is a common clinical training in most of university hospitals. Its purpose is to provide an opportunity for students to link their practical realities to theoretical ones. The study purpose was to compare the views of trainees, interns, residents, and teachers about grand rounds method at Iran University Medical Sciences in Iran.
This study is descriptive analytical performed on 237 individuals including trainees, interns assistant, and professors of teaching hospitals affiliated to Iran University of Medical Sciences using census method. The designed questionnaire used Likert type multiple-choice questions. The data were analyzed through SPSS v.21.
The results showed that 29.4% of interns and externs showed assessed Grand Rounds training as very well and good, 36.3 as moderate and 34.3% of poor and very poor. But 62% of professors and residents’ assessment was very good and good, 27.6 moderate and 10.4% of poor and very poor. The quality of Grand Round based on type of participants’ ward was: interior1.89%, surgery 1.87%, pediatrics 1.87%, gynecology 2.1%, and also for their academic levels as interns1.85%, externs 1.82%, residents 1.92%, and for professors as 2.13%
The results showed that undergraduates’ attitude toward medical Grand Round is more negative than residents. The dissatisfaction of medical students of Grand Rounds was mostly due to lack of participation because of large number of students. Strengths of Grand Rounds include strengthen reasoning skills, improving decision making, scientific findings, motivating students in education, ethics and professional communication, and evidence-based medicine.