مجله طب جنوب
سال هفتم شماره 2 (اسفند 1383)

Entamoeba histolytica and Entamoeba dispar can not be differentiated with each other in microscopic examination of stool but isoenzyme electrophoresis is the gold standard technique. Isolated Entamoeba histolytica and Entamoeba dispar from stool samples of patients who referred to clinical laboratories in the south parts of Iran were collected. These samples were cultivated in Robinson's medium and after mass cultivation and separation of their enzymes isoenzyme electrophoresis for four enzymes (Malic Enzyme, Glucose Phosphate Isomerase, Phospho Gluco Mutase, and Hexokinase) was done. A total of 23 positive samples were collected, six samples (16%) were diagnosed as Entamoeba histolytica and 17 samples (74%) as Entamoeba dispar. Zymodemes of Entamoeba histolytica were II and XIV and, zymodemes of Entamoeba dispar were I, XVI, XVII and XVIII. In conclusion, isoenzyme electrophoresis showed that the most reported samples as Entamoeba histolytica were Entamoeba dispar.

There is scant information about biological effects of the venoms of scorpions on different organs. Sixteen healthy native dogs aged about 2 years with average body weight of 18.5 kg of both sexes were selected for this study. Dogs were divided randomly into four equal groups (4 dogs in each group). Clinical signs are recorded and electrocardiogram was obtained for each dog prior to injection of venom. In the control group 1 ml of saline solution was injected and the amount of equal to 0.1, 0.05 and 0.01 mg of venom powder per kg bwt were dissolved in 1 ml saline solution and injected intradermal in the abdominal region or hind limb of each dog in the second, third, and four groups, respectively. Clinical signs and electorcardiogram of each dog were recorded at different time intervals (5, 15, 30, 60, 90, 120, 180, 360 and 24 hours after injection of venom). The results of ECGs, in group 1 and 2 indicated advanced sinus arrhythmia, sinus arrest, sinoatrial standstill, sever bradycardia and tachycardia, first and second degree heart block, premature ventricular contraction, sinus bradycardia and ventricular fibrillation. In group 3, partial sinus arrhythmia, sinus tachycardia, sinus arrest, advanced sinus arrhythmia and tachycardia were observed. In conclusion, the venom of the scorpion Odonthobuthus produces very changes in electrocardiogram by its effects on autonomic system and adrenal gland.

Down syndrome is the most common autosomal abnormality and occurs in approximately 1 per 700 live births. Down syndrome accounts for about one third of all moderate and sever mental handicaps in school-aged children. To reveal genetic epidemiology of Down syndrome, 545 karyotypes of referred cases to the author were evaluated. The frequencies of three cytogenetic variants of Down syndrome were trisomy 21 (77.5%), mosaicism (18%) and chromosomal translocation (4.5%). Male to female ratio was 1.34. The mean age of their mothers and fathers were 29.03 years (median=27 years) and 34.6 years (median=33 years), respectively. Therefore, mean age of Iranian mothers with Down syndrome is six years less than those in the western countries.

Chlamydia pneumonia is a common etiologic agent of community-acquired pneumonia. In a prospective study, the frequency of Chlamydia pneumonia was investigated in 95 admitted subjects in a university hospital in Bushehr port during autumn and spring of 2005. Age range of the patients was 16 to 95 years. The acute and convalescent sera for IgG titer were examined by ELISA method. A four-fold rising in antibody or >=1/1200 titer was defined acute infection with Chlamydia pneumonia and a titer of >=1/100 was also defined as seroprevalence of the organism. The prevalence of acute infection and seroprevalence of Chlamydia pneumonia were 25 and 71 percent, respectively. The prevalence of acute infection with the organism was 28.6 and 11.8 percent in COPD and asthma groups, respectively. In conclusion, Chlamydia pneumonia is a prevalent etiologic agent.

Nosocomial infection is an increasing problem. The global problem of antimicrobial resistance is particularly pressing in developing countries, where the infectious disease burden is high and cost constraints prevent the widespread application of newer, more expensive agents. In a prospective study, 203 consecutive cases with hospital-acquired infection in a university hospital in Bushehr port were evaluated. The most common hospital-acquired infection was urinary (76 cases), conjunctivitis (16 cases), bacteremia (8 cases), meningitis (5 cases), wound (3 cases), empyema (2 cases) and peritonitis (1 case). The patients with hospital-acquired infection were from surgical and internal medicine I.C.Us (53.2% & 15.6%, respectively). The most frequent isolated organisms were Pseudomonas aeruginosa (25.6%), Acinetobacter baumannii (19.7%), E. coli (13.3%), Klebsiella pneumoniae (11.3%), Staphylococcus aureus (8.4%), Staphylococcus epidermidis (7.9%), Enterobacter species (7%), Streptococcus species (6.4%), and Proteus mirabilis (0.5%). The most resistant organisms to antimicrobial agents were Acinetobacter baumannii and Pseudomonas aeruginosa 97 & 93.3% of these bacteria were resistant to third generation cephalosporins. The isolated Staphylococcal species were resistant to amikacin (94%). In conclusion, gram negative bacteria were the most common etiologic agent of hospital-acquired infection and had a high level of resistance to amikacin and third generation cephalosporins. Therefore, new therapeutic strategies should be designed to combat these microorganisms.

Urinary tract infection (UTI) is a common problem in patients with spinal cord injury (SCI). UTI is an important cause of morbidity and mortality among these patients. In a cross-sectional study, 957 cases with SCI were evaluated for UTI. The mean of age of the subjects (35 females & 62 males) was 26.74 years and the mean duration of SCI was 8.5 years. The prevalence of UTI was 63.9 percent. The most frequent isolated bacteria was E. coli (71.7%) and had susceptibility to ceftizoxime and a high level of resistance to nitrofurantoin. The most common locus of SCI was in lumbosacral area (70.1%). The lumbosacral area was the most prevalent lesion in patients with SCI and UTI. In conclusion, there is a high prevalence of UTI in patients with SCI, therefore intermittent catheterization and the other strategies including using local disinfectants are recommended.

A.I.D.S as a worldwide crisis continues to spread in Iran too. The number of afflicted patients has reached 5780 subjects most of them are between 20 to 40 years of age. Prevention is one of the most effective methods to combat this human hazard. Promotion of general knowledge is thought to be the preliminary measure in this regard. Although, schools have turned to be the most favorable environment for health education, the issue of the group to afford training has remained controversial in our country yet. The aim of this research is a comparison between the effect of training performed by teachers or health staff on the knowledge of students of the first high school grade in Bushehr/ Iran. A total of 684 male and female students of the first high school grade were selected according to cluster random sampling. The selected students were divided into two groups and training for A.I.D.S using the same contents was done by their teachers and health staff separately. Before intervention, the mean knowledge scores of female & male students about A.I.D.S were 16.68 and 15.52, respectively. There was no significant difference in female students in two groups but teacher trained male students showed an increment score of 4.17 while in health staff ones, the score increment was 2.22 (P<0.01). In conclusion, the level of knowledge about A.I.D.S was not satisfactory in the high school students in Bushehr and for education in this group their sex in conjunction to different training methods should be considered.

Metabolic syndrome comprises insulin resistance, abdominal fat distribution, dyslipidemia, and hypertension. The metabolic syndrome is expected to be diagnosed in millions of subjects in the near future worldwide. There are very few data in literature clearly documenting that subjects with metabolic syndrome have an increased cardiovascular risk. In a cross-sectional study, we used National Cholesterol Education Program (NCEP)-Adult Treatment Panel (ATP)-III criteria and Minnesota Code of a 12-lead resting electrocardiogram (ECG) to assess in 3723 subjects, aged 25 years and over, selected by cluster random sampling in three Iranian ports in the northern Persian Gulf. Electrocardiogram with evidence of IHD (IHD ECG) was defined as myocardial infarction (Codes 1.1 and 1.2) and ischemia (Codes 1.3, 4.1-4.4, 5.1-5.3 and 7.1) together. An estimated 49.08% (52.04% of males and 46.34% of females) were identified as fulfilling NCEP-ATP III criteria for diagnosing the metabolic syndrome. Prevalence of EKG with evidence of ischemic heart disease (IHD ECG) was 12.7% (10.4% for men and 14.7% for women p<0.0001). In multiple logistic regression analysis, metabolic syndrome was found to have a significant association with IHD ECG [OR=1.35, C.I (1.09-1.66) p=0.005] after adjusting for sex and age. The association of metabolic syndrome and IHD ECG in the study population increased monotonically with increasing number of metabolic syndrome components. In conclusion, the metabolic syndrome, which occurs very frequently in the general population, has a significant association with nonfatal ischemic heart disease by electrocardiogram criteria.

Recurrent abdominal pain (RAP) is a common problem in children and adolescence. The functional abdominal pain is the most common cause of RAP. The conceptual models of RAP are multivariate and acknowledge the contributions of a variety of biological, psychological, and social factors. Among the 6-7 year-old population of Bushehr port, 485 (50.1% male, 49.9%female) children starting primary school were randomly selected. Questionnaires were completed by direct interview during the National Program of Health Surveillance of Schoolchildren in 2000. According to Apley's criteria, 49 children had RAP (9.1% male and 11.2% female). Abdominal pain pattern such as frequency, duration, location, radiation, associated symptoms was relatively similar to other investigations. The signs of environmental reinforcement of pain behavior such as specific attention and medication at time of pain were commonly observed (32.6% and 71.4%, respectively). Prolonged duration of involvement (73.5%, more than one year) and frequent referral to physician (30.6%, at least three referral) were detected. Some psychosocial stress such as father unemployment and history of irritable bowel syndrome (IBS) in parents were significantly more frequent in RAP group (p values= 0.038 and 0.01, respectively). History of RAP in siblings and appendectomy, peptic disease and migraine were mildly more frequent in RAP group. Separation of one of the parents, change of address, parent education and mother employment, sibling number and order and weight and height had not significant differences between two groups. Among 22 patients, giardia cyst was detected in the stool of 4 patients (18.2 %). In conclusion, RAP is a common problem in Bushehr port and its pattern was relatively similar to other regions. The father unemployment and the history of IBS in parents, two psychosocial stresses, were associated with RAP.

Responses to recent incidents involving radiation indicate that most general practitioners are uncertain about the health consequences of exposure to ionizing radiation and the medical management of exposed patients. Acute radiation syndrome is an acute illness caused by irradiation of the entire body by a high dose of penetrating radiation in a very short period of time. In order to assess the level of knowledge of physicians in Bushehr province about preparedness and response for nuclear emergency, we used a questionnaire based on IAEA-WHO protocol. A total of 233 doctors (47 of specialist and 186 of general practitioners) participated in a cross-sectional study. The mean of score for doctors was 3.99 (from 13) 3.7 score for general practitioners and 4.28 scores for specialists. Overall, the doctors did not gain the acceptable scores in subjects like physics of radiation, diagnosis and management of acute radiation syndrome, triage and management of nuclear accidents. In conclusion, the level of doctors’ knowledge in Bushehr province about preparedness and response to nuclear or radiological emergency is deficient. Therefore, medical education and postgraduate training programs for doctors should be designed.

Human Development has been defined as enlarging people's choices in a way which enables them to lead longer, healthier and fuller lives, in a democratized society. Human Development Index (HDI) has been measured and compared by three indices. A long and healthy life is measured by life expectancy at birth, knowledge by the adult literacy rate and the combined gross enrollment ratio for primary, secondary and tertiary schools and a decent standard of living is measured by GDP per capita or purchasing power parity.The above mentioned indices, which are components of Human Development Index, are summed up and divided to three. According to Human Development Reports, Iran Index has increased from 56% in 1975 to 73% in 2002.Meanwhile world average index was 0.729% in 2002. Among 177 UN members, the ranking for Iran was 106 in 2001 and 101 in 2002. Although, the HDI has an ascending trend in Iran, the three indices may be increased, while the HDI is decreased, because the value or longevity, knowledge and living level are determined by the highest and the least values of specific countries and it shows the rank of each country in comparison to the other countries. Health care managers and health staff have a key role in enhancing the health indices, and accordingly they have a great share in Human Development and improving Iran in the world rankings.