مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و هشتم شماره 9 (پیاپی 142، آذر و دی 1394)

Depression is the most prevalent psychological problem among HD patients, associated with higher mortality in these patients. Inflammatory factors have been reported to play an important role in the pathogenesis of depression. It has been also found that Associated depression has been correlated with inflammatory status in these patients.
Sertraline, an antidepressant with selective inhibition of serotonin reuptake, decreases serum level of inflammatory factors in patients with depression.
This study was designed to assess the effect of sertraline on serum concentration of CRP, Hb & Albumin of depressed hemodialysis (HD) patients.
During a clinical trail, 35 depressed HD patient with CRP>5 allocated to receive sertraline for 12 weeks. Patients’ depression was assessed using Beck Depression inventory second edition (BDI-II). Biochemical parameters (hemoglobin, serum albumin, etc.) and CRP levels were measured at baseline and at weeks 4 and 8 and 12 of study.
BDI-II score evaluated before and after 12 Weeks of treatment with sertraline.
Sertraline significantly improved depression symptoms in HD patients.
At the end of the study, BDI-II scores have significantly changed from baseline
(P value=0.001) and Serum level of CRP has Significantly decreased at week 12 comparing with level at initiation of the study. (P=0.001)
Not significantly change in Hemoglobin and serum albumin concentration and weight has been observed (P=0.995 and P=0.328)
Sertraline has significantly decreased CRP level and could be a promising strategy to reduce the systemic inflammation and to treat depression in HD patients.
Sertraline has significantly decreased CRP level and could be a promising strategy to reduce the systemic inflammation and to treat depression in HD patients.

ERCP as a diagnostic and therapeutic tool for biliary tract and pancreatic diseases is associated with many complications such as pancreatitis, bleeding, perforation , and cardiovascular consequences. A recent survey showed that the use of non- steroid anti-inflammatory drugs before ERCP could reduce risk of pancreatitis after ERCP. In this study we attempted to investigate the preventive effects of non- steroid anti-inflammatory drugs (Diclofenac) on pancreatitis and bleeding after ERCP in patient with CBD stone.
The study was double-blind randomized clinical trial of 160 patients who had ERCP due to common duct stones. Two 80-person groups were randomly allocated . The control group received Acetaminophen suppository and study group received Diclofenac suppository before ERCP. Based on clinical and laboratory findings of pancreatitis and bleeding, their occurrence were studied after ERCP.
In study group 9 patients had mild pancreatitis and severe pancreatitis was not found in any of them. In control group 11 patients had mild pancreatits and two cases had severe acute pancreatitis.
In control group the mean hemoglobin level before ERCP was 12.65 ±1.68 , 24 hour after ERCP was12.69 ± 1.53 and one week after was 12.68 ± 1.53 . In Study group the mean hemoglobin level before ERCP was 12.06 ± 1.73 , in 24 houre after ERCP was 12.15 ± 1.63 and one week after ERCP was 12.36 ±1.5 . The mean of hemoglobin level in one week after ERCP in Tow group did not differ statistically ( p-value = 0.176; Z= 1.355).
Although in study group any severe pancreatitis after ERCP was not observed , but no statistically significant difference between the two groups in the incidence of pancreatitis wasnot seen. Diclofenac administered after ERCP had no effect on the incidence of bleeding complications

One of the most important inflammatory cytokines that may be involved in the pathogenesis of cardiovascular disease is resistin. The aim of this study was to investigate the effect of eight weeks aerobic training on Resistin levels and cardio respiratory fitness in sedentary middle-aged women.
21 healthy elderly women were selected by convenience sampling method and were randomly assigned to control (n=11) and experimental (n=10). The program training include: 60 min per session, 3 times per week for 8 weeks participate in aerobic exercise with 50-70 HRR%. Pre and post of aerobic exercise, resistin levels and cardio respiratory fitness evaluated. The average and standard deviation of data were calculated after checking the noremal distribution using Kolmogorov-Smirnov test and Homogeneity of variance method and then examined by comparison of means within and between means groups Paired-Samples and Independent t-test was used respectively. Statistical significance was assigned at P Eight weeks aerobic exercise lead to reduce of resistin levels in elderly women. Amount of cardio respiratory fitness increased significantly. The variations of between groups in weight, BMI and Vo2max have differences.
Eight weeks of aerobic training resulted in improved levels of resistin and cardio respiratory fitness in middle-aged women and it can help to reduce the risk of cardiovascular disease

Kidney transplantation is the best replacement therapy for patients with end stage renal disease at present. Cardiovascular disease is the most important cause of mortality among these patients. Also chronic allograft nephropathy is to some extent a manifestation of cardiovascular pathology. Diabetes mellitus is the most influencing factor both in cardiovascular disease and chronic allograft nephropathy. Prediction and timely detection of new onset diabetes after kidney transplant can help therapies in appropriate management and manipulation of modifiable risk factors of this phenomenon.
The present study has been performed upon 66 chronic renal failure patients undergone kidney transplantation during a 4 months period at Imam Reza (p.b.u.h) university hospital of Mashhad –IRAN. On day 5 and at month 6 post transplantation, fasting blood glucose measured and a 75 g , glucose tolerance test performed. Another fasting blood glucose recorded at week 12. The immunosuppression regimen was the same for all. Exclusion criteria were: History of Diabetes mellitus, Graft rejection, Hepatitis C, Infection and need for immunosuppressive drug modification. Sensitivity and specificity analysis test used to evaluate the ability of day 5-post transplantation fasting blood glucose and glucose tolerance test to predict the occurrence of post transplantation diabetes mellitus. (PTDM)
6 out of 66(9.3%) patients had day 5 fasting blood glucose > 126 mg/dl while the remaining 60 had values 126 mg/dl six months post transplantation and indeed developed PTDM. Therefore sensitivity and specifity of 5th day fasting blood glucose as a predictor Of PTDM equals one (100% ) based on our results. The results were similar for glucose tolerance test .
Day 5 post transplantation fasting blood glucose is a good predictor of PTDM and can be used as a modifier to individualize the management of kidney transplant recipients.

parasite called Leishmania. The three clinical forms are: cutaneous, mucocutaneous and visceral. Cutaneous Leishmaniasis (CL). The purpose of this study was to investigate on present status of CL and the effect of Bio-climate factors on the prevalence of the disease in Mashhad during past twenty years(1995 – 2014). Therefor if a factor be effective, we can exploit precautionary measures.
in this epidemiological study, the raw data of confirmed cases with CL obtained from 5 health centers of Mashhad University of Medical Sciences. Environmental maters were also obtained from Meteorology office. The collected data were analyzed using excel software and Pierson test.
During 20 years (1995 – 2014), 68958 cases of CL were diagnosed at health centers. The results showed that the highest rate of the CL observed among the patients who had referred during cool seasons of each year. No significant relation was observed between sunlight rate, wind speed & CL, but there was a remarkable correlation between the rate on rainfall, seasonal temperature, humidity & frequency of CL. It means that with increase of this three factors, increase of CL also occurred. The highest rate of CL infection was observed during years 2000_2001. Regarding the annual histogram of CL prevalence during past 20 years, it shows that frequency distribution of the disease corresponds with ACL form.
Mashhad is an endemic city for ACL. Despite in reduction of CL relation to several past years, occurrence of about 2000 patients in one year in mashhad city is so remarkable, and rather healthy and precautionary measures must be use, especially in years that the rate on rainfall, seasonal temperature and humidity is high.

Infective endocarditis is a disorder with high mortality and morbidity in children specially in whom with Congenital Heart Disease(CHD) .The target of our study is a description of the factors affecting pediatric Infective endocarditis particularly in whom with CHD in Mashhad.
this cross-sectional study includes 19 patients less than 18 years old with endocarditis hospitalized in the Department of Pediatric Cardiology( University of Mashhad Medical Sciences) between 1381 to1391.Clinical symptoms, risk factors, underlying heart disease ,laboratory- echocardiogeraphic results were studied. Finally data were analyzed by using SPSS 16 software.
Endocarditis were seen in 21.1% of children with previous underlying infectious disease. According to results of blood cultures Staphylococcus aurous was the most common crime ( 21%).Each of Coagulase-negative staphylococci, Staphylococcus epidermidis and gram-negative cocci were seen in just one patient.10.6% of children had Umbilical /vein catheter history. The most common underlying factor was congenital heart disease (47.7%). Having history of surgery in 7(36.8%) patients due to CHD before endocarditis were detected .Vegetation were resected in 2 (10.5%)children as a treatment after endocarditis .There was no significant difference between time of surgery and microbial crime(p-value= 0.069). Cardiac vegetation was seen in 18 children(94.7%).One child (5.2%) died.
According to irrecoverable effects of infectious endocarditis in children, it seems that strong clinical suspicion also considering of underlying causes and negative results of blood cultures , especially in children with congenital heart disease can be crucial in reducing mortality and complications of infectious endocarditis.

Background & Brucellosis is a transmissible disease between humans and animals that is transmitted through infected animals and their products. Razavi Khorasan which is classified as a high incidence province, considered as one of the notable areas for controlling the disease. The aim of this study is to identify epidemiological characteristics of the disease in Razavi Khorasan.
Data on 5743 cases in Razavi Khorasan (affiliated to Mashhad Medical University) during 5 years were analyzed.
The incidence of the disease in the province is 26 out of 100,000 people which the incidence rate in Daregaz,Takhtjolge and Roshtkhar was much higher. In the first 3 years of study the disease incidence was ascending and in last 2 years it was descending and from May to August the prevalence was more than other months.85% of patients were rural and 15% were urban. 56.9% were male and 43.1% female. Household and farmer-rancher were the most common jobs. Average age of patients was 33.4 ±18.1 year. 77.2% had consumption of unpasteurized dairy products which milk (91.4%) and cheese (21.4%) had the highest consumption. The most common symptoms were fever (79%) and anorexia (47.5%). A significant relationship between location and both livestock vaccination history and also family history, was found.
Because of higher incidence rate of the disease in Daregaz, Takhtjolge and Roshtkhar, and also young people aged 10 to 30 years and villagers, It’s need to control the disease in these groups.

The aim of this study was to find out the prevalence and risk factors of varicose veins in hospital staffs.
This cross sectional study was performed in Qaem and Emam Reza hospitals. 240 hospital staffs were selected by random sampling method. Inclusion criteria were work experience more than3 years and satisfaction for participation in the study. All staffs underwent physical examination and history taking. Data were analyzed with SPSS version 16 .
From 240 hospital staffs 132 persons (55%) had varicose veins of lower limb. Incidence of varicose veins was significantly higher in clinical ward workers (p=0/001). Female sex was one of the most important risk factor of varicose veins occurrence. Odds ratio of varicose vein in clinical personnel was 3/7 . In clinical personnel group the risk of greater grade of varicose veins was more in nurse's aides group (OR =3/4).Between grade of varicose vein and shift working was significant correlation (p=0/018).
This study show that occupational factors such as prolong standing ; shift work and lifting have significant role in development of varicose veins in lower limbs.