مجله پزشکی بالینی ابن سینا
سال هفدهم شماره 3 (پیاپی 57، پاییز 1389)

Introduction & Zoonotic parasites are large groups of zoonoses among which the most important are hydatid cyst، liver trematodes and sarcocystis. These zoonoses are of considerable importance regarding both human health and economy. The objective of this study was to determine the prevalence of tissue zoonotic parasites and their epidemiologic status in Hamadan and to estimate the health and medical burden they impose on the society. In this cross sectional study، viscera (including liver، lung، kidney، heart،…) and muscles of 2590 sheep، 420 cattle، and 490 goats were macroscopically inspected for hydatid cysts، liver flukes، cysticercus، and microscopically (for Sarcocystis) in the Hamadan abattoir. The data were presented by descriptive tables and analyzed by c2 statistical test The infection rate for hydatid cyst، Fasciola، Dicrocoelium and Sarcocystis were found 12. 3%، 4. 9%، 6. 5%، and 5. 5% respectively. The high infection rates for hydatid cyst and Fasciola were found in cattle (16. 2% and 9. 5%) and for Dicrocoelium and Sarcocystis were found in sheep (6. 9%). Infection rate of lungs was higher (41. 2%) than liver (36. 6%) and liver and lung simultaneously were 22. 2% in the infected animals. Infection to Sarcocystis and Cysticercus were not found in the cattle. This study indicated that infection rate of tissue zoonotic parasites are relatively high in the domestic animals of Hamadan، however، the rate is lower in comparison to the previous studies. These parasites had imposed considerable economic burden on the society through reduction in the dairy production and increased the risk of infection in the population as well.

Introduction & Gastric Cancer (GC) is one of the most common causes of death in the world. The most important cause of high death rate related to GC is late diagnosis of the disease. The main treatment of gastric cancer in its primary stage of is surgery، and radiotherapy and chemotherapy are supplementary treatments. There are some factors that affect survival after surgery. This study aimed to assess the survival of patients with GC under surgery and to determine the risk factors of this cancer. A total of 262 patients with GC under surgery were followed and included in the study from 21st of March 2003 to 21st of March 2007 in the cancer institute of Tehran، Imam Khomeini Hospital،. The staging of the disease before the surgery was based on CT-Scan and endosonography and after the surgery was based on the pathologic reports. The survival of the patients was determined by their periodical referrals and our telephone contacts with their relatives. The survival times were considered as the time from the diagnosis up to the death or the end of the study. The effect of the various risk factors including gender، age at diagnosis، tumor site، pathologic stage of the disease، type of treatment، metastases and relapse were evaluated. Kaplan-Miere approach was used to estimate survival and Log-rank test and proportional Cox model to evaluate the related factors. Data were analyzed using Spss16 statistical software. 75. 2% of patients were men and 34. 4% cases of patients experienced death. The mean follow-up time was 19. 3±17. 4. The mean age at diagnosis was 58±11. 5 and survival mean and median were 49 and 27 months respectively. The one، three and five year survival of the patients were 0. 85، 0. 41 and 0. 3 respectively. Gender، pathologic stage، age at diagnosis and weight-loss were significantly related to the survival in multivariate analysis. The diagnosis of the cancer in primary stages causes timely treatment and this in turn decreases the unpleasant outcomes of delayed diagnosis

Introduction & This study was performed to compare the visual and refractive outcomes of photorefractive keratectomy (PRK) in eyes with medium-high astigmatism by WF-guided method using Visx system and cross-cylinder method using Nidek EC-5000 excimer laser system. Although there are many studies about efficacy and safety of Wave front guided and Cross Cylinder Photorefractive Keratectomy، there are few studies on moderate to high astigmatism. In a descriptive comparative study، WF-PRK was performed on 50 eyes of 25 patients with compound myopic astigmatism. Each patient underwent PRK by WF-guided approach. Then the results were compared with the cross-cylinder PRK previously performed on 48 eyes of 24 patients. After 6 months، 100% of the eyes in the WF group had uncorrected visual acuity of 20/25 or better compared to 79. 2% in the cross-cylinder group. Mean refractive astigmatism had decreased by 1. 57± 0. 53 in the WF group and 1. 67±0. 52 in the cross-cylinder group (P=0. 75). Mean postoperative absolute change in total root-mean-square higher order aberrations in the WF group and cross-cylinder group were 0. 05± 0. 22 µm and 0. 17±0. 20µm، respectively (P<0. 001). Both methods of PRK using the Nidek EC-5000 and visx excimer laser systems are effective for correcting medium-high astigmatism. WF approach is more successful in improving the refractive results.

Introduction &

Enterococci have emerged as the leading nosocomial pathogens. In addition to natural resistance to many agents، enterococci have also developed plasmid- and transposon-mediated resistance to high concentrations of aminoglycosides. High-level gentamicin resistance (HLGR) of enterococci results in the failure of drug synergism with an aminoglycoside plus cell-wall-active agents. HLGR (MIC=500μg/ml) strains is usually due to the presence of the aac (6'') Ie-aph (2″) Ia gene.

In the present experimental study 142 enterococci were isolated from the patients’ species. Identification was done by using standard methods and antimicrobial susceptibility test was performed by disc diffusion technique. MIC of Gentamicin was determined by a broth micro dilution method (NCCLS). PCR was performed to detect the aac (6'') Ie-aph (2″) Ia gene. Presence of the gene aac (6'') -Ie-aph (2″) -Ia was confirmed by digest with Sca1 enzyme. A PCR product was sequenced and BLAST analyzed at the NCBI database to be confirmed.

62 (43. 7%) out of the 142 isolates، were found to exhibit HLGR phenotype. MIC ranging from 512 to >1024 μg/ml in 55 HLGR isolates. All resistant isolates except one، were found to harbor the aac (6'') Ie-aph (2″) Ia gene. In our strain collection، 42% of E. faecalis and 44% of E. faecium were HLGR. In the HLGR isolates the prevalence of resistance to other antibiotics and Multi Drug Resistance (MDR) was higher than non–HLGR. This prevalence in E. faecium was higher than E. faecalis. The sequence was compared with a published sequence and confirmed.

Our results indicate that high prevalence of MDR and HLGR enterococcal colonization is an important problem in our medical centers. Spread of the aac (6'') -Ie-aph (2″) -Ia gene was responsible for HLGR among enterococci isolated from the patients in Tehran.

Introduction & Etiological researches suggest that biopsychosocial dimensions are responsible for coronary heart disease (CHD). The main goal of the present research was to compare stressful life events and stress coping strategies in coronary heart patients (Acute Myocardial Infarction) and non-patients. In this cross sectional research 102 patients (all males) suffering from acute myocardial infarction and 162 non-patient individuals after matching were studied and compared with regard to psychosocial life events and stress coping strategies through coping response inventory (Moos، 1993)، scaling of life Events (paykel، 1971) and researcher made questionnaire. The result established that myocardial infarction patients experienced more stress than the control group during one year before heart- attack and they used more inadequate stress coping strategies comparing with the control individuals. This study showed that stress and inadequate coping strategies are important variables for the development of coronary heart diseases.

Introduction & Nowadays، students’ mental health is very important in the overall mental health of the society. Because adolescence is the most critical period of life، providing mental health services through heath service school are fundamental for promotion of students mental health. Whereas adolescence is a most crisis of life periods. Adolescence encounter with many stressors، therefore; they are probably susceptible for mental disorder. The aim of this study was determined the mental health status in high school students in Hamadan city. This investigation is a descriptive study. The sample size of this study was 600 students that selected by cluster method between primary، second and third degrees of high school students. Data collected by GHQ-28 questionnaire and analyzed by SPSS10. In total scale to allow for diagnosis score 23 and higher and subscale score 7 and higher. Results of this study show that 60. 2% of total scale had score 23 and higher and in subscales social dysfunction 36. 7% of somatic symptoms، 46. 5% of anxiety،49. 5% of social and 45. 8 of depression had score 7 and higher. In present study we show that mental health correlated with course، level and age (P<0. 05). With regard to this result، major students are susceptible to mental disorder that are social function disorder، anxiety، depression and hypochondriasis، respectively. So it is highly recommended that authorities pay special attention to this group.

Introduction & Toxoplasmosis is one of the most widespread parasitic infections in humans that can cause abortion in pregnant women or serious damage to their fetuses. To determine the seroprevalence of toxoplasmosis in pregnant women of Khorram-Abad،a city in the west of Iran، a cross sectional study was performed by random cluster sampling of pregnant women admitted to rural and urban health centers of Khorram-Abad during 2006 to 2007. After recording 390 volunteers’ information in the questionnaires and preparation of the samples، prevalence of current/recent toxoplasmosis was evaluated by an enzyme-linked immunosorbent assay (ELISA) technique for the detection of toxoplasma-specific IgM، and previous history of infection by IgG. This study revealed that the IgG seroprevalence of toxoplasmosis in urban and rural pregnant women of Khorram-Abad was 30. 8% and 31. 4%، respectively; and that of IgM seroprevalence was 7. 2% and 7. 9%، respectively. However، IgG antibody levels increased with age (P<0. 001). Education level of women was associated with the level of both antibodies (P<0. 01). No statistically significant differences were observed in the levels of antibodies in relation to other study variables. According to this study، 69% of the pregnant women were seronegative and consequently are susceptible to acute toxoplasmosis and subsequent injury to their fetuses. So because of the importance of toxoplasmosis in pregnant women، public health education is necessary for prevention of this serious opportunistic infection.

Introduction &

Hepatocellular carcinoma (HCC, also called malignant hepatoma) is a primary malignancy (cancer) of the liver. Most cases of HCC are secondary to either a viral hepatitic infection (hepatitis B or C) or cirrhosis (alcoholism being the most common cause of hepatic cirrhosis. Recently, the biological activities of zingiber officieale plants have been reported as possessing antitumor, antibacterial, anti ulcer, antifungal, and insecticidal properties. However, the antitumor effects havent been studied in cancer cell lines. The aim of this study was to investigate the antitumor effect of zingiber officieale on hepatocellular carcinoma cell lines.

Hepatocellular carcinoma (HEPG2) cell lines and normal connective tissue cell line (L929) were cultured in DMEM medium. Zingiber officinale was extracted and different concentration of zingiber extract (5000 to 78 µg) was added to cell culture. Cell viability was quantitated by MTT assay after 24,48 and 72 hours.

The effects of zingiber officieale on cell viability was observed after 48 hours on cell lines. Ginger doses in concentration 2500 µg inhibited 50% cell growth (IC50) in (HEPG2) cell lines after 48 hours of incubation, respectively.

Our study shows that fresh ginger extract has cytotoxic effects on tumor cells but it doesn’t have any cytotoxic effect on normal cells. It seems that ginger can be considered as a promising chemotherapeutic agent in cancer treatment.

Introduction & Nowadays، families of patients with bipolar disorders are actively participating in the care of their relatives. Successful management of bipolar disorder in the community relies significantly on family caregivers. The needs and experiences of such caregivers have been little studied with respect to bipolar disorder. The aim of the study was to identify the family caregivers’ needs of patients with bipolar disorder. This study is a qualitative research of phenomenological methodology in which the caregivers taking care family members with bipolar disorder in Farshchian psychiatric hospital in Hamadan were selected through purposive sampling. In order to reach data saturation،we interviewd 12 persons. Data were gathered through in-semi unstructured interviews and analyzed by «Colaizzi” method. Five groups were identified in this study analysis: illness management، counselling، economical needs، persistent care، and social attention & perception. Identification of the needs of caregivers taking care of family members with bipolar disorder let the health providers choose the specific caring interventions that are effective in sustaining family care giving cycle.

Introduction & Many factors such as retirement، work disability، being isolated from the society، physical illness… affect the general health of the aged، one factor among many، is the role of psychological variables. The purpose of this study has been the investigation of the effect of positive and negative perfectionism and type D personality on general health of the aged. In this descriptive-correlational study، 80 subjects (47 males and 33 females) were selected through available sampling method among the aged in nursing homes in Hamadan and Malayer. Then the positive and negative perfectionism questionnaire of Terry- Short et al، that of type D personality and Goldberg and Hiller''s general health questionnaire were administered to them. Positive perfectionism (r=-0. 30) and type D personality (r=0. 32) had significant correlations with general health. Multiple regression analysis also revealed that positive perfectionism and type D could explain at least 49 percent of the variance of general health. The females’ mean was higher than that of males concerning the variables of depression-anxiety، speech inhibition and irritability and in positive perfectionism، general health and social function variables the males’ mean was higher than that of females. Creating optimistic attitudes and enhancing social functions، positive perfectionism may cause the mental disorder to be decreased in old age and type D personality; however، positive perfectionism makes the aged apt to physical illness and mental disorder.