مجله علمی دانشگاه علوم پزشکی کردستان
سال شانزدهم شماره 3 (پیاپی 61، پاییز 1390)

Brucellosis is a major cause of zoonosis and is endemic in Kurdistan Province in Iran. The purpose of this study was to isolate Brucella species from brucellosis patients and identify different species of this bacterium in order to determine the prevalence of these species in Kurdistan Province. 60 blood samples were obtained from brucellosis patients with clinical symptoms of the disease in Tohid Hospital in Sanandaj. The samples were cultured in BACTEC medium and incubated at 35 0C for 5 days. Then, the samples were cultured on Brucella agar for 3 days. For detection of the bacteria we used catalase, oxidase and urease tests, PCR, Gram stain and media with various dilutions of Thionin and Fuschin dyes. Also we used agglutination test for identification of Brucella species. 18 Brucella strains were isolated from 60 blood samples of the patients. PCR and biochemical methods revealed that all the 18 isolated bacteria were Brucella melitensis.The results of agglutination test showed that 14 bacteria belonged to biovar 1 and 4 bacteria to biovar 3. This study showed a high prevalence of brucellosis due to Brucella melitensis in Kurdistan Province and efforts in this region should be aimed at the eradication of this bacterium.

Peripheral nerve lesions are a challenge for neurosurgeons and different surgical repairing methods are applied for the treatment of this problem. This study was conducted to evaluate the poled polyvinelidene fluoride (PVDF) tube filled with nerve growth factor (NGF) and collagen gel as a substitute for nerve autograft.

In this experimental study the left sciatic nerve was manipulated in 50 male Wistar rats and then the animals were divided randomly into five groups. In the epineural group the injured nerves were repaired by end to end suture. In the rats with autograft a 10 mm piece of sciatic nerve was rotated through 180° and sutured in the nerve gap. In the nerve guidance channel group (NGC), polarized piezoelectric PVDF tube containing NGF and collagen gel was replaced in the gap and in the axotomy group two nerve ends were hidden among muscles. The left sciatic nerve was exposed but not transected in the sham group. After two months L4-L6 segment neurons of spinal cord were studied histologically and by immunohistochemical and axonal DiI tracing. The collected data were analyzed by one way ANOVA, LSD and paired t- test.

The mean number of Bax positive cells and labeled motor neurons increased significantly in axotomy and sham group respectively, compared to the other groups (P<0.05). Also, the mean number of labeled motor neurons increased significantly in epinural group in comparison to the autograft and the NGC groups (P<0.05). There was no significant difference in the mean number of the labeled neurons between the autograft and nerve guidance channel groups. The mean number of motor neurons in the left side showed a significant decrease in comparison to that of the right side (p<0.01).

The PVDF tube together with other therapies provided a favorable environment for nerve regeneration and could be used as a substitute for autograft in nerve injuries.

Legionella pneumophila is the cause of legionellosis disease that can be fatal. Yet, no vaccine has been available for this infection. Also antigens of these bacteria can stimulate the immune system. The purpose of this study was to compare the immunogenic effect of lipopolysaccharide fraction with that of protein fraction of Legionella pneumophila in challenging with lethal dose of these bacteria in mice.

After preparation of bacterial biomass, LPS and protein fractions were separated by hot phenol method and precipitated by enzyme digestion. LPS and protein fraction electrophoresis on poly acrylamide gel was performed. For preparation of vaccines from LPS and protein fractions, 10µg of each antigen was solved in 0.5 ml of normal saline and used for injection. Six groups of female BALB/c mice (each group consisted of 15 mice) were selected. Four groups of mice were vaccinated by intraperitoneal (i.p) injections at fortnightly intervals for three times. The two control groups of mice received normal saline injections. Two weeks after the last immunization, two groups of vaccinated mice and one control group were challenged with LD100 of the virulent strain of L. pneumophila. Also six weeks after the last immunization the other three groups (2 vaccinated and one control groups) were challenged.

The results of the first challenge showed the immunogenic efficiency gains of 86.66% and 73.33% for protein fraction and LPS respectively, and after six weeks of the last immunization the immunogenic efficiency gains were 60% for LPS and 86.66% for protein fractions.

This study showed that the protein fraction and LPS of L.pneumophila have high immunogenic activity and can be proper candidates for vaccine studies.

Frequency and morbidity of hot flushes has led to development of multiple hormonal and non hormonal treatments in the recent years. Fluoxetine and citalopram with limited side effects and high tolerability by most women with hot flushes have attracted the researcher's attention but there are plenty of rooms for disagreement on their effectiveness. In this study the effects of fluoxetine, citalopram, hormone therapy and placebo on perimenopausal flushes, were compared with one another. This study was a randomized clinical trial (RCT). The study population included 46 to 55 year old women with hot flush who had lack of menstruation and reached menopause for at least 1 year. Sampling method was blocked randomization and the patients were divided into four groups including fluoxetine, citalopram, hormone therapy and placebo groups. The collected data were introduced into the SPSS software and analyzed by chi- square, ANOVA and Kruskal-Wallis tests. There were no significant differences between the groups in the mean duration of menopause, history of any chronic disease, drug use and frequency of hypertension before intervention (p<0.05). But there was significant differences between the values of the mean age of the groups before intervention (P=0.03). The mean frequency of hot flushes decreased by 57%, 74.7%, 81.8% and 80% after intervention in estrogen + progesterone, fluoxetine, citalopram and placebo groups respectively (P<0.001). Considering the high rate of success of the treatment of the hot flushes with citalopram and fluoxetine and few side effects of these drugs, they can be regarded as good alternatives to hormone therapy and for thoese who are not willing to take estrogen.

Enteroaggregative Escherichia coli (EAEC) strains have been implicated as causative agents of acute, chronic and persistent diarrhea in children. EAEC have special aggregative adherence pattern for HEp-2 or HeLa cells. PCR methods based on the presence of essential virulence factors would facilitate the diagnosis of EAEC strains. The aim of this study was to assess the usefulness of the PCR assay targeting the pCVD432gene for the detection of EAEC strains and the presence of aggR, agg, aafA, aap and astA genes which can be used for the differentiation of typical and atypical EAEC strains. One hundred and forty faecal samples were collected from children of less than 12 years of age with diarrhea at the Besat Hospital, in Hamadan, between July 2007 and May 2008. The faecal samples were plated onto MacConkey agar and incubated at 37 oC for 18 hours. E.coli colonies were identified by biochemical tests. EAEC strains were identified by ues of pCVD432 primer which is specific for EAEC strains. Then their virulence factors were evaluated by use of specific primers of aggR, aggA, aafA, aap and astA genes. Strains of E. coli harboring the pCVD432 gene were found in the faecal samples from 15 (10.8%) patients. The aggR gene was present in 11(73.3) strains. The aggA gene was found in 3 isolates and 4 strains had the aafA gene. The aap and astA genes were found in 9 and 7 strains, respectively. Several different combinations of the genetic markers were found among the EAEC strains. The most prevalent combinations were aggR/aap, found in 8 (53.3%) and aggR/aafA detected in 4(26.7%) strains. The results of this study showed that EAEC strains were one of the most prevalent enteric pathogens in children in this region. The pCVD432 gene PCR assay is the most common method for detection of EAEC strains. Typical EAEC strains with aggR gene had a high prevalence in this region and considering the pattern of virulence factors, they were heterogenous.

Methyl-tributylether (MTBE) is a volatile organic compound which has detrimental effects on the environment, surface water and groundwater resources and it can change the taste of drinking water. The aim of this research was to determine the efficiency of activated sludge reactor with fixed bed in biological removal of methyl-tri-butyl ether from synthetic wastewater. This was an intervention-applicable study. The applied reactor was made of plexiglas and after transfer of activated sludge to it; the system ran for 4 weeks discontinuously. During a period of one month, concentration of glucose of the solution reduced and that of MTBE increased. 32 days after running the system, the whole COD input was provided through MTBE. COD, TSS, MLSS, SVI, temperature, PH, and dissolved oxygen parameters were analyzed in duplicate forms by excel software. The results of this research indicated that by increasing the organic input load, the efficiency of the reactor decreased to some extent. The mean values of efficiency of COD removal during hydraulic remains of 4, 6, 8 and 10 hours were 82.7, 92.45, 95.97 and 96.1%, respectively. The results of this study showed with organic loadings up to 3 and 4/5 kg COD/m 3.d, the combined activated sludge reactor with fixed bed is capable of meeting the standards of household and industrial wastewater according to the standards of Environmental Protection Organization of Iran as to effluent wastewater COD for discharge in accepting water resources. Therefore we can conclude that the activated sludge reactor with fixed bed is an efficient, reliable and applicable technology for the treatment of strong wastewater.

Cardiovascular diseases are one of the most common causes of death and also major health problems in the world. The classical methods such as Cox regression are used in most medical studies on survival distribution, while this model assumes a linear relationship between log hazard ratio and risk factors which is not useful in many cases. The present study was performed to use the method of penalized splines to analyze the survival rate of the patients who had acute myocardial infraction.

This research was a prospective descriptive-analytical study of longitudinal type which included 650 patients with acute myocardial infarction. Patients were followed for one year from the moment of diagnosis of MI, for survival analysis. The collected data were recorded in a check-list for every patient. Two different multivariate methods, proportional hazard regression and Cox model with penalized splines were used. Data analysis was carried out using R version 2.12 software and significant levels were considered 0.05.

The mortality rate of the patients in a period of one year was 10.3% (67patients). History of smoking, hypertension, diabetes, hyperlipidemia, arrhythmia and heart block were detected in 48%, 33.4%, 17.7%, 15.3%, 30% and 10.3% of the patient respectively. Based on Cox model with penalized splines the factors affecting survival rate were age, ejection fraction and use of streptokinase.

Knowledge of the survival rate and factors affecting survival in the patients with acute MI can be used to provide the patients with valuable services, and to take measures to control and reduce mortality rate which can lead to increased life expectancy of these patients.

Heavy metals pollution represents a serious problem for human health and for life in general and bacterial biofilms are able to adsorb heavy metals from dilute aqueous solutions and accumulate them within their cell structure. The aim of this study was to investigate the ability of Escherichia coli biofilm (an effective agent for metal adsorption) supported on clinoptilolite for the removal of cadmium from aqueous solutions. Adsorption experiments were carried out in a laboratory-scale batch model with clinoptilolite alone and clinoptilolite covered by a bacterial biofilm. The effects of initial heavy metal concentrations, pH, and agitation time on the removal efficiency were studied. Finally, experimental results were analyzed using isotherm equations. The results of this study revealed that cadmium adsorption to clinoptilolite was lower than that of clinoptilolite covered by biofilm and adsorption of the cadmium was influenced by several parameters such as initial concentration of cadmium, biosorption time and solution pH. The uptake values for clinoptilolite and for clinoptilolite covered by biofilm were 6.8 mg/g and 9.6 mg/g respectively in the batch model, for initial cadmium concentrations of 25 and 100 mg/L. It was also observed that as the initial cadmium concentration increased, the uptake increased, but the removal rate decreased. Maximum adsorption efficiency was achieved at pH value of 6. The biosorption equilibrium for cadmium was best described by the Freundlich and Longmuir models. It is concluded that the presence of biofilm increased the uptake efficiency of clinoptilolite and the biofilm tested in our study seems very promising for the removal of cadmium from aqueous solution.

Passing the medical abortion law in 2006 brought about, a major change in dealing with cases of therapeutic abortion. This study was performed to investigate the causes of therapeutic abortion request made by pregnant women who had referred to the Legal Medicine Organization in Sanandaj, from July 2004 to July 2008. This was a descriptive cross sectional study and included all the files of therapeutic abortion (58 files) in the Forensic Medicine Organization in Sanandaj from 2004 to 2008. Sampling method was census. The collected data were analyzed by using SPSS statistical software and frequency tables were prepared. Most requests for therapeutic abortion were made in 2008 and included 18 cases (31%) and the least number of requests was in 2004 with six cases (10.3%). 16 patients between 30 and 35 years of age had the highest rate of abortion (27.6%). The lowest rate of abortion belonged to those with less than 18 years of age with one case (1.7%). The mean gestational age was 11.8± 4.1 (range 5-19 week). The approved cases of therapeutic abortion included 34 patients (58.6%).The prevalence rates of requests for abortion license due to fetal and maternal causes were 22 (37.9%) and 36 (62.1%), respectively. Among the confirmed cases of therapeutic abortion 18 (52.9%) had fetal causes and 16 (47.1%) had maternal causes. The most common fetal causes for therapeutic abortion permit was anencephaly with 7 cases (20.6%) and thalassemia with 3 cases (8.8%) and the most common maternal cause was cardiovascular diseases with 10 cases (29.4%). The results of this study indicated that after passing the medical abortion law, the numbers of requests for therapeutic abortion due to fetal causes are on the rise. Further interventions to promote knowledge in the field of therapeutic abortion among the medical staff and in the society and encourage use of certain methods of contraception by women with advanced cardiovascular disease are recommended.

Both endogenous cannabinoids and opiate substances have high levels of expression in the brain and may have important neuromodulatory functions. The present study evaluated the possible role of cannabinoid system of the dorsal hippocampus in morphine induced amnesia and morphine state-dependent memory in adult male mice. In this experimental study 255 adult male NMRI mice were anaesthetized and put into a stereotaxic device and cannula were implanted bilaterally in the CA1 regions of their dorsal hippocampus. Seven days after recovery from surgery, the behavioral testing was started by use of inhibitory avoidance task. In this study morphine and WIN55, 212-2 was used as opioid receptor agonist and cannabinoid receptor agonist respectively. Intra peritoneal (i.p.) administration of morphine immediately after training, decreased memory formation in a dose-dependent way (P<0.01). Amnesia induced by post-training morphine injection was reversed by pre-test administration of the same dose of morphine that is due to a state-dependent effect (P<0.001). Pre-test intra-CA1 administration of WIN55 212-2 after training, reversed amnesia induced by morphine and restored normal memory state (P<0.001). The results of this study suggested that cannabinoid receptors of the dorsal hippocampal CA1 regions might play an important role in morphine-induced amnesia and morphine state-dependent memory.

People, patients, governments and third party payers seek in-depth accurate assessment of health care quality world wide. To meet this aim, countries have different approaches to improving quality and standards, which licensure, certification and accreditation are some of these systems developed for this purpose. Because of maximum and challenging standards, accreditation is distinguished as the most powerful method. The aim of this study was to perform a systematic review of advantages and disadvantages of accreditation models to select and use as the reference model to develop a national accreditation model. In this study, a systematic review was conducted in SID, Ovid Medline and PubMed databases using key words of accreditation, hospital, medical practice, clinic, accreditation models and health care in both English and Persian languages. Considering defined inclusion and exclusion criteria, 2379 articles were identified. After that, based on the advantages and disadvantages of accreditation models, titles, abstracts and content of selected articles were studied step by step and finally 83 articles were selected and analyzed. Then the findings were extracted and summarized in the summary tables. Finally, based on 25 selected items the best accreditation models in the world were compared with one another in order to develop a national model. The accreditation models which were of much debate were JCAHO from USA and CCHSA from Canada, and the accreditation models of UK, Australia and France were in the next places. The results of this study were compatible with those of previous studies. According to the comparative items the accreditation models of JCAHO and CCHSA had the most advantages and the least disadvantages respectively. Based on the defined items, the JCAHO accreditation model and then CCHSA model are the models which can be best applied and other important accreditation models such as ACHS of Australia, ANAES of France, QHNZ of New Zealand and UK accreditation models are almost as the same level as JCAHO and CCHSA models. Therefore it seems that the Joint Commission accreditation model (JCAHO) is the best model which can be used as a benchmark to design a national accreditation model.