مجله پزشکی بالینی ابن سینا
سال بیست و سوم شماره 2 (پیاپی 80، تابستان 1395)

Introduction & MS is the most common disabling neurological disorder. Identifying new active MS plaques at the onset and clinical status and faster onset of treatment as well as evaluating the response to treatment is important and MRI with contrast is the best indicator for these measures.
This study was cross-sectional including 62 patients with diagnosed MS. Whose clinical symptoms suggested the recurrence of MS. They were referred to the radiology department to undergo brain MRI with injection for the diagnosis of active plaques by a neurologist,The Data were analyzed using statistical tests and SPSS 21 software.
Based on the sequences of post contrast T1, pre contrast MTC and post contrast MTC 74, 272 and 271 plaques were respectively discovered. Detection of active MS plaques on T1 sequences after injection were in poor accordance and had significant difference with MTC before and after injection. Moreover, detection of active MS plaques on MTC sequences before injection were in good accordance and did not show significant difference with MTC sequences after injection.
Based on these results, it seems that the purpose of MRI in MS patients is determining the amount of active plaques. Sequences of pre contrast and post contrast MTC are significantly more than sequences of post contrast T1. Therefore, using sequences of MTC can be helpful in MRI.

Introduction & Vacuolar proteinase is an aspartic enzyme in Candida albicans (C. albicans) that is expressed by VAP gene and plays an important role in the development of systemic candidiasis. The aim of this study was to evaluate VAP gene expression in C. albicans strains isolated from patients with systemic candidiasis.
The evaluation of VAP gene expression was performed using reverse transcriptase-polymerase chain reaction (RT-PCR) method and samples were electrophoresed in 1.5% agarose gels. In addition, a total of 48 female Balb/c mice (six-weeks old and weight of 25 g) were experimentally infected by various C. albicans strains and the level of VAP gene expression was assessed in yeasts obtained from the blood of infected mice.
The level of VAP gene expression in non-Iranian strains was significantly higher than those of Iranian strains (P VAP gene as producer proteinase can act as an important gene in the development of systemic candidiasis caused by C. albicans.

Introduction & In the context effect of metformin in patients with acute coronary syndrome, available evidence supports cardiac effect. Yet, there is doubt about continuation or discontinuation of metformin before major surgery. The aim of the present study is to determine the efficacy of continuing metformin in plasma glucose, renal function index, arterial PH in type II diabetic patients after coronary artery bypass graft surgery.
In this clinical-experimental study, 90 type II diabetic patients with ASA class II admitted for CABG surgery in Hamadan Ekbatan Hospital were enrolled in the study in 2014 and were randomly assigned to two groups , one group treated with insulin and continued metformin and the other group treated with insulin and discontinued metformin.In the beginning indicators such as age, sex, body mass index (BMI) were compared which were not significantly different in the two groups. Then, other parameters such as blood glucose, BUN, Cr, arterial blood PH, cardiac arrhythmia and need for inotrope were compared. Used inotropes in this study included dopamine, dobutamine, epinephrine, norepinephrine, milrinon to achieve systolic blood presser pressure over 100mmHg.
Average plasma BUN after surgery and one day after surgery in the group who discontinued metformin significantly were higher compared with the metformin group, but no differences were observed in average plasma BUN in the 2nd and 3rd days after surgery in the two groups. During 3 days after surgery, average plasma creatinine was significantly lower in metformin group compared to non- metformin group. Although there was no difference between the two groups in pH parameter before surgery but in the metformin group, average pH was lower than non-metformin group after surgery. Before and 3 days after surgery mean blood glucose level was not significantly different between the two groups. During surgery, average need for inotrope in metformin group equaled 1.57 person and in non- metformin group equaled 1.05 person showing no significant difference in demography. In the both groups, not only before surgery, but also after surgery there was no cardiac arrhythmia. Also, the need for inotrope duration and tracheal intubation duration in ICU were not significantly different.
Although serum glucose level of patients did not change, continuation and discontinuation of metformin in patients with CABG surgery was concomitant with elevated BUN and Cr. Level and decrease of pH on the 1st and 2nd days after surgery. Noticeably, BUN and Cr. Fluctuation in patients who continued metformin, were significantly lower, but in the two groups these values were reversible and return to normal range in pending several days after surgery. Prescription of this drug did not increase the need for cardiac inotrope and risk of incidence of arrhythmia after surgery.

Introduction & Fluoroquinolones are essential antimicrobial agents used to treat UTIs. Clinical experiences have shown a high rate of antibiotic resistance among uropathogens. These resistance are usually the consequence of mutations involving genes encoding gyrA and parC. The aim of this study was to determine antimicrobial resistance pattern and the presence of mutations in regions that code for quinolone resistance in the genes gyrA and parC in clinical isolates of E. coli from a hospital in Isfahan, Iran.
A total of 135 isolates of E.coli (from urine) were collected from September to February 2013 from Alzahra Hospital (Isfahan, Iran). Bacterial susceptibility to antimicrobial agents was determined using disk diffusion method. PCR was performed to detect genes gyrA and parC. Then, 13 isolates were randomly chosen for genetic characterization of the quinolone-determining region (QRDR) of the parC and gyrA genes.
Among 135 E. coli isolates, 61 isolates ( 45 % ) were resistant to fluoroquinolones. From 13 isolates, 11 isolates showed two mutations (Ser83Leu/ Asp87Asn) and 2 isolates showed a single mutation (Ser83Leu) in gyrA gene. Also, five different mutations were detected in parC gene in the E. coli isolates, encoding Ser80Ile, Ser80Val, Ser80Arg, Glu84Val, Gly78Ser.
More research on the molecular basis of FQ resistance is required to develop new therapeutic strategies for FQ-resistant E. coli. To overcome antibiotic resistance antibiotic therapy should be limited and based on the susceptibility patterns of microorganisms.

Introduction & Nicotine could directly act as a cancer promoter. The purpose of this study was to evaluate effects of nicotine on mitotic index in esophagus epithelium.
In the present study 30 adult male mice were used. Animals were randomly divided into three groups. Group A or the control group received vehicle, groups B and C received nicotine intraperitoneally at doses of 0.2 and 0.4 mg/kg once daily for 14 days, respectively. Evaluations were made using kI-67 immunohistochemistry and Hematoxilin& Eosin for proliferative activity and morphometric study on esophagus mucosa, respectively.
Administration of nicotine in group C, showed a significant increase (P This study indicates nicotine at dose of 0.4 mg/kg increases mitotic activity in basal cells in esophagus epithelium.

Introduction & Cryptosporidiosis caused by Cryptosporidium, which is a protozoan parasite, has a worldwide distribution. The infection is through fecal-oral route, direct or indirect contact, food or water. The treatment of cryptosporidiosis is difficult and the anti-parasitic agents are not effective. The purpose of this study was encapsulation of nitazoxanide in solid lipid nano-particles (SLN) and investigation of its anti-Cryptosporidium effect and its comparison with free drug in the neonatal rat.
Nitazoxanide was encapsulated by HPH method with 2 mg/Kg concentration in SLN nanoparticles. The oocysts were collected from calves and purified by sucrose floatation. A total of 72 Wistar neonatal rats were categorized in 6 groups of 12 rats including four infected groups treated by free drug, encapsulated nano drug, colloidal carriers without drug (SLN) and olive oil; an infected control group and a healthy control group that received PBS. 5 × 105 of oocyts inoculated orally into the sample groups. Finally, intestine of each rat was homogenized in PBS by rotor and the homogenized material was passed through a sieve. Then, floated oocysts in sucrose solution were counted by hemocytometer.
Treatment by nitazoxanide significantly decreased the number of parasites in the treatment groups. This decrease at day 6 was more than day 3. Nano nitazoxanide had more effects on parasites than free drug. This difference at day 3 of treatment was not significant (p= 0.182) but at day 6 was statistically significant (P Using nano-nitazoxanide could be a more effective way in the treatment of Cryptosporidium infections.

Introduction & The most common site of involvement in TB is the lungs. TB involves different parts of the lungs and has variable radiologic features. The aim of this study was to compare radiologic sequels between smear positive and smear negative pulmonary tuberculosis patients (PTPs).
In an analytic cross-sectional study, 63 pulmonary tuberculosis patients who referred to Farshchian hospital and Health center in Hamadan from March 2012 to September 2014 were enrolled. Demographic data, clinical manifestations of the patients (smear positive and smear negative), sputum smear results and imaging reports were gathered. In additional, clinical manifestations and radiological findings of the patients were evaluated at the end of the treatment. Thirty two patients remained until the end of the study.
Sixty three patients with mean age 56.85±24.20 were enrolled among that 68.25% of the patients were men and 31.75% were women. Forty four (69.84%) of the patients were smear positive and 19 (30.16%) of them were smear negative. Sputum was seen in smear positive patients more than smear negative patients. At the beginning of the treatment, the most common pulmonary involvements in imaging among the smear positive patients were reported to be nodular infiltration and fibrotic changes, but at the end of the treatment it was found to be atelectasis. However,in the smear negative patients the involvements were alveolar consolidation, nodular infiltration, pleural effusion, ground glass patterns and lymphadenopathy, and at the end of the treatment, fibrotic changes and reduction of pulmonary volume were seen. At the end of the treatment, 54.5% of smear negative patients and 85.7% of smear positive patients had abnormal imaging.
At the end of the treatment, abnormal findings on diagnostic imaging were observed in both smear positive and negative patients (more than 50%). Knowledge of common and various imaging findings in smear positive and smear negative patients can be helpful for early diagnosis of pulmonary tuberculosis.

Introduction & Heavy metals are major pollutants that can spread in the atmosphere with particulate matter and dust and because of the toxic and carcinogenic effects, their measurement and control is very important. Therefore, this study was conducted to assess Co, Cr and Mn concentration in the atmospheric dry deposition collected from Hamadan city in 2014.
After collection of 12 dust samples from 3 sampling stations and their laboratory preparation, metals concentrations were determined using ICP–OES. All statistical analyses were performed using the SPSS statistical package.
The results showed that the minimum and maximum mean concentrations of Co were 0.19 and 0.29 mg/kg for high and low traffic intensity sampling stations, respectively. The min and max mean concentrations of Cr were 0.65and 1.02 mg/kg for high traffic intensity and suburb sampling stations, respectively and the min and max mean concentrations of Mn were 7.23and 8.82 mg/kg for high and low traffic intensity sampling stations , respectively. Also comparing the mean concentrations of assessed metals with WHO permissible limits showed a significant difference (P Although the mean concentrations of Co, Cr and Mn are lower than the standard levels, lack of continuous monitoring of heavy metals concentrations in the dust and particulate matters in the air can lead to the entrance of various types of toxic pollutants such as heavy metals into the air and result in adverse health effects.

Introduction & After urinary tract infection and prostatic disorders , the urine stones are the third common genitourinary diseases. Demographic, environmental and genetic factors affect urine stone formation. The aim of our study is to survey epidemiologic factors in patients with urinary stones referring to educational hospitals of Hamadan during 2010-2013.
In this analytic-cross-sectional study, we studied 500 cases of urinary stones referring to educational hospitals of Hamadan. The data were collected from electronic patient records system of laboratory. The results were registered in a check list and analyzed by spss16 and descriptive statistical indicators.
The patients were between 0.5-84 years. The average age of them was 40.36 years. In our study of 500 cases, 348 cases were male (69.6%) and 152 cases were female (30.4%). The male to female ratio was 2.3 to 1. Urinary stones were more prevalent in 25- 45 year old men and 30-50 year old women. Among 500 patients, 466 cases had only one type of renal stones and 34 cases had 2 types. The calcium oxalate was the most common stone (386 cases, 72.5%). The other common stone types were uric acid (130 cases, 24.3 %), cystine (14 cases,2.6 %) ,calcium carbonate (3 cases,0.5 %) and calcium phosphate (1 case,0.1 %)
Urinary stones are twice as common in men as in women. Most patients are between 38-42 years old. The most common stone in both sexes and all ages was calcium oxalate.

Introduction & Pharmacists usually encounter requests for over the counter drugs. How a pharmacist performs in evaluating patient's signs and symptoms, treating them, and moreover his or her approach in prescribing over the counter (OTC) medications were the main goals of this study.
In this cross- sectional study, the scenarios of cough, diarrhea and common cold were obtained from questionnaires. These scenarios were then designed by determining key questions. From the overall pharmacies in Hamadan, for each of the three scenarios, 46 pharmacies were randomly selected and analyzed. Performance of pharmacists, including their interventions on over the counter counseling, asking key questions, explaining drug's side effects and interactions, and their approach of prescribing medications, were measured. Moreover, the influence of pharmacist's gender and type of the pharmacy were determined.
In 41 out of 179 visits, pharmacists were not present in the pharmacy (22.9%), mostly in suburban pharmacies. The pharmacist's performances in explaining drug interactions were significantly better in urban pharmacies in comparison with suburban ones. Moreover, suburban pharmacies and male pharmacists, in comparison with urban pharmacies and female pharmacists, prescribed more drugs.
This study shows that despite the pharmacists asking the key questions ,the majority of pharmacists made weak recommendations. In order to improve pharmacists performances, modification of educational system for pharmacy students in addition to the continuous and effective supervision of authorities on pharmacist's performance in OTC drugs is suggested.

Introduction & Nowadays,herbal extracts are used to treat diseases, especially infectious ones. Candida albicans is the most common causes of oral opportunistic infections.In this study, antifungal effects of two herbal extracts were evaluated on an oral pathogen i.e. Candida albicans.
In this descriptive- analytic study, the Department of Prosthodontics, ,Tehran University of Medical Sciences, school of Dentistry the oral samples of 25 patients with denture stomatitis were collected using sterile swabs. Then the isolated candida albicans and standard candida albicans PTCC 5027 were cultured. The antifungal effect was evaluated with disk plate method. Nystatin and methanol were used as positive and negative control groups, respectively. The power of antifungal activity was evaluated with the inhibition zone diameter of each of the extracts. At the end, the data were analyzed by ANOVA and Friedman statistical tests.
Results showed that extracts of Querques infectoria had great antifungal effects. There was not statistically significant difference between nystatine and Querques infectoria extract (P>0.05) however , Querques infectoria was statistically more effective than lavender extract and nystatin showed the highest antifungal activity (P This study showed that plant extracts had positive effects on Candida albicans as compared to nystatin. Thus, we hope to find new herbal medicines and compounds to treat candidiasis in the future.

Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs commonly prescribed in dental practice for the management of pain and swelling. But, rarely hypersensitivity reactions are reported.
Case Report: A 28 year old woman underwent periodontal plastic surgery (gingival graft). Postoperative analgesics (400 mg Gelofen ,oral) and antibiotics were administrated for the patient. Three hours after discharge of patient, she complained of redness, itching , rapid swelling of her eyes in 10 minutes, and watery eye discharge 1 hour after taking the drugs. She was treated with 8mg/2ml mg Dexamethasone IM at the dental department and with Hydrocortisone 100mg/ml IM and antihistamine drugs at the hospital.
There are no published protocols and sensitivity and specifity of skin pick testing and patch testing for Gelofen. So avoidance of re-exposure is the best management strategy. The use of Cox-2 specific medications would be a proper alternative for pain relief.