مجله دانشگاه علوم پزشکی اردبیل
پیاپی 37 (پاییز 1389)

Detection of TEM and SHV genes in ESBL producing Pseudomonas aeruginosa and their antimicrobial resistance pattern can provide useful information about the epidemiology and risk factors of associated infections. In this study we determined the antimicrobial susceptibility pattern and prevalence of ESBLs in clinical isolates of Pseudomonas aeruginosa by phenotypic and genotypic methods. In this analytic-descriptive study, 110 Pseudomonas aeruginosa strains isolated from different clinical specimens were used. The pattern of antimicrobial resistance was determined by disk diffusion (Kirby-buer) method. The ESBL production was determined by combination disk method using disks containing ceftazidim and cefotaxim alone and in combination with Clavulanic acid. SHV and TEM types of ESBL producing genes was detected by PCR. In this study Co-trimoxazole and Amoxicilin with 96.4% and 92.7% and Amikacin with 17.3% showed the highest and lowest resistance against isolates respectively. According to PCR results 37.5% and 12.5% of isolate were carried SHV and TEM genes respectively and 12.5% of isolate were carried both the SHV and TEM genes. According to the results most of the isolates are drug resistant and among the ESBL producing strains the frequency of SHV type is higher than TEM. The isolate ceftazidim resistance was contains SHV (37.5%) and TEM gene (12.5%), that showed SHV and TEM genes play more important role in create of ceftazidim resistance than cefotaxim resistance.

This study was conducted to compare the clinical efficacy of two-drug regimen of glucosamine and prednisolone with one-drug regimen of glucosamine in treatment of knee osteoarthritis. In this randomized clinical trial, 30 patients received glucosamine and prednisolone (case group) and 25 cases underwent treatment by only glucosamine (control group) for 12 weeks. For considering pain and disability, WOMAC (Western Ontario and McMaster Universities) was used. Mean value of WOMAC index in the case group was 2.81 at the beginning, 1.53 in week 6, and 1.49 in week 12. In the control group, this value was 3.15 at the beginning, 2.39 in week 6, and 2.35 in week 12. In week 6 and 12, mean value of WOMAC index was significantly lower in the case group compared to the control group (P < 0.05). In patients younger than 65 years old, females, and body mass index of equal or less than 30 a significant difference was seen in both week 6 and 12 between the case and control groups (P < 0.05). Two-drug regimen of glucosamine and prednisolone in a 12-week period had a better clinical efficacy than one-drug regimen of glucosamine in lowering the pain and improving joint function of patients with knee osteoarthritis, especially females with body mass index less than 30 and younger than 65 years of age.

Abuse of psychostimulant amphetamine (Ecstasy and Crystal meth or n-methyl-1- phenyl-propan-2- amine) has increased dramatically within recent years in Iran. It is known that these substances have toxic effects on the cardiovascular and immune system. Since so far the effects of chronic Ecstasy and Crystal meth exposure on the blood cells count and serum cholesterol level have not been examined comparatively, this study was aimed to investigate the above mentioned parameters. In this experimental study 21 male adult rats were used. The rats were divided into three groups; normal control group, Ecstasy-treated group and Crystal meth-treated group. Ecstasy and Crystal meth were used at a dose of 10 mg/kg/day, intraperitoneally for 15 days. On the fifteenth day, the blood samples were taken from rats and analyzed for red and white blood cells, platelets, cholesterol, triglyceride, LDL and HDL. The Instat statistical software was used for analyzing data. All data were analyzed by one-way analysis of variance (ANOVA) and the differences were considered to be significant at the p< 0.05 level. The count of red and white blood cells, and platelets in Ecstasy group were significantly decreased in comparison with control group (p< 0.05). Hemoglobin and hematocrit levels were significantly decreased in ecstasy group in comparison with control group (p< 0.01). The level of cholesterol in the Crystal meth and ecstasy group was not changed significantly. The level of triglyceride in Crystal meth group was markedly increased in comparison with control group (p< 0.05). The level of HDL in Crystal and Ecstasy groups did not show significant differences, but the level of LDL in Crystal group showed significant reduction in comparison with control group. Our data showed that Ecstasy is able to induce anemia by decreasing the total red blood cells, hemoglobin and hematocrit. Increasing the level of blood triglyceride following crystal meth abusing, may augment the probability of arteriosclerosis.

Three major semen parameters that involves on male infertility are sperm count, motility and morphology. In 50% of couples referring to physicians, because of infertility, male factor, solely or accompanying with female factor is responsible of infertility. Some of drugs are used to improve the semen parameters. The goal of this study was to study the effect of pentoxifylline on semen parameters (count, motility, morphology, volume of semen). Sixty one patients with impairment in semen parameters were selected and semen samples requested from each participant for analysis before treatment. Then patients were treated with pentoxifyllin, 400 mg three times a day, for three months. After that we took semen specimens again and analyzed them. Mean total sperm count in case group before treatment with PF was (17 millions) and after treatment with PF reached to (21 millions). In 68.9% of patient, Sperm count increased (p< 0.001) Mean motile sperm percent in case group before treatment with PF was 19.42% and After treatment with PF reached to 28.78% and 88.52% of patient this parameter increased (p< 0.001). Parameter motility showed the most important after treatment. Mean normal morphology of sperm percent in case group before treatment with PF was 24%and after treatment with PF reached to 26.39% and in 32.8% of patient this parameter increased (p< 0.001).Mean semen volume in this group before treament with PF was 1.95ml and after treament with PF reached to 1.93 ml. There was no significant variation in semen volume after treament with PF. (p= 0.321) Results show that Pentoxifylline has significant efficacy for increasing sperm count, motility and morphology correction (specially for sperm motility). Considering that oral PF is safe and cheap, with easy application, we can use it for improving semen parameter's quality before performance ART.

Lipopolysaccharide (LPS) is the main antigenic structure expressed on the surface of smooth strains of Brucella. It has been shown that Outer membrane vesicle (OMV) of Neisseria meningitidis efficiently promote IgG and IgM response against the administrated antigen as an adjuvant. In this study The aim of this study is to evaluate the effect of LPS-OMV noncovalent complex in producing of T helper 1 cytokine (IFN-γ) and T helper 2 cytokines (IL-4 and IL-10) in mice. LPS extracted by an optimized method based on hot phenol-water extraction. Groups of six BALB/c mice were injected subcutaneously with LPS alone, LPS with Freund adjuvant and LPS-OMV complex on 0, 14 and 28 days. Levels of IFN-γ, IL-4 and IL-10 were evaluated in spleen cell suspension supernatant by ELISA. Immunization with B. abortus LPS significantly induced high level of IFN-γ in comparison to the other groups immunized with LPS-OMV and LPS+ adjuvant (P< 0.05). In contrast, lower levels of IL-4 and IL-10 were elicited by LPS in the rest groups. Immunization with the non-covalent complex of B. abortus LPS-N.meningitidis serogroup B OMV caused a significant increase of IL-4 and IL-10 compared with the mice immunized with B. abortus LPS (p< 0.05),while the titer of IFN-γ is still significantly higher than IL-4 and IL-10 (p< 0.05). The raise of IFN-γ following the immunization with all of the compounds (LPS, LPS-OMV non-covalent complex and LPS+adjuvant) indicates the activation of Th1 population that would be correlated to the clearance of the organism due to the amplification of anti-microbial activity of Polymorphonuclear cells. Low levels of IL-4 and IL-10 following the immunization with all compounds would be a sign of Th1 responses dominancy or inhibition of Th2 population proliferation and activity. Such a cytokine pattern would be a sign of the efficiency of brucellosis subunit vaccine because Th2 responses basically have no role in the immune responses against Brucella and may lead to the persistence of intracellular infection.

Because of diminished inflammatory responses to microbial invasion, the identification and diagnosis of diabetic foot infections remains a complex problem. The aim of this study was to determine the bacterial agents of diabetic foot infection and their antimicrobial susceptibility pattern. Additionally the percent of infections that were lead to amputation was determined. This retrospective study was conducted on a cross sectional basis at two teaching hospitals. Documents belonging to patients with diabetic foot infections in stages III and IV were studied. All demographic information, clinical manifestations, culture results, outcome of infection and other necessary data were recorded in special data sheets. The SPSS 13 statistical software was used for analyzing data. Statistical significance was assayed by Student's t-test and chi2. The differences were considered to be significant at the p< 0.05 level. Fifty two patients were selected, 36 patients (69.2%) were male. The mean age of patients was 60±12.8 years, and the mean duration of diabetes was 17±10.6 years. Amputation was done in 29 patients, and a significant correlation was found between duration of diabetes and amputation (p= 0.04). The most frequently isolated pathogens were Staphylococcus aureus (38.46%) E. coli (15.4%), coagulase negative staphylococci (13.5%), and proteus spp (13.5%). Antimicrobial susceptibility results showed that 55% of Staphylococcus aureus isolates were resistant to methicillin. All the Staphylococcus aureus and coagulase negative Staphylococci isolates were sensitive to vancomycin. 100% and 87.5% of E. coli isolates were resistant to ceftriaxone and ceftazidime respectively. All Pseudomonas aeruginosa isolates were sensitive to ceftazidime. More than half of patients with diabetic foot infection were under amputation and there was significant correlation between amputation and duration of diabetes, so prevention of foot ulcer is very important in those patients. The results showed that the most isolates were resistance against common antibiotics and antibiogram is the best way to choose appropriate therapy in these patients.

Pregnancy accompanies with physical and psychological alternation during woman's life. These changes effluence the overall dimensions of couple's life especially sexual relation. The aim of this study was to investigate the women's attitude and sexual function during pregnancy. This descriptive-analytical study was conducted among 329 healthy pregnant women aged 15-45 years. The attitude and sexual function of the cases were studied based on their gestational age (the last fourth weeks of each pregnancy trimester) in three groups. Data were collected using an instrument. The instrument has three parts including demographic characteristics, attitude assessment and Arizona Sexual Scale Experience (ASEX). One way ANOVA, Post hoc, chi square and Spearman correlation were used for data analysis and the differences were considered to be significant at the p< 0.05 level. The results showed that the score of sexual dysfunction, sexual desire disorder and orgasmic disorder increase with gestational age development. Statistical analysis demonstrated a significant relation between total score of sexual function disorder and decrease of sexual attraction in all three trimesters (p=0.01, p=0.04, p=0.03 respectively) and fear of prematurity in the second trimester (p=0.01). According to the results sexual function disorder has a high frequency in pregnancy. The findings emphasize the need for educational programs to improve the Sexual functions during prenatal care.

Gastric cancer is the most incident disease in Iran that leads to death. This study was designed to evaluate the oxidative and antioxidative status in patients with gastric cancer by detecting paraoxonase 1 and arylesterase activities together with the level of malondialdehyde. The purpose of the present investigation was determination of Paraoxonase /Arylesterase activity and malondialdehyde (MDA) levels in the serum of patients with Gastric cancer. In a case-control study, 20 subjects who diagnosed as gastric cancer individuals that referred to Ardabil Aras Clinic were selected from 2008 up to 2009. The case groups were matched with control group (30 subjects). Arylesterase and paraoxonase activities of paraoxonase-1 (PON-1), MDA levels and lipid profile were determined spectrophotometrically in serum of subjects. Upon matching of case and control groups, paraoxonase and arylesterase activities in patients with gastric cancer showed to be significantly lower than healthy subjects (190 ± 68.95 IU/L vs 258 ± 68.59 IU/L, 30.5 ± 28.4 U/L vs 284.23 ± 163.2 U/L respectively, P ≤ 0.001). Standardized activities of paraoxonase and arylesterase of case group were lower than controls (P ≤ 0.001). MDA levels have revealed significant increasing in cases than controls. In present study, HDL cholesterol and triglyceride levels were found to decrease in patient sera too, but the levels of total cholesterol and LDL cholesterol didnt show to be different between two groups. It was concluded that in patients with gastric cancer, oxidative stress was raised by attenuation of antioxidant system and oxidant levels rising.

Arsenic is the third element of 5th Group of the periodic table and it is the twentieth rarest element in the earth's crust. This material has application in agriculture, livestock, medicine, electronics and metallurgy. It enters the environment from natural phenomena and human activities, causing pollution in it. Arsenic is a substance that is poisonous, cumulative, and an inhibitor of SH group enzymes. Several studies have identified significant correlation between high levels of Arsenic in drinking water and cancer in liver, nasal cavity, lungs, skin, bladder and kidney in men and women, and prostate in men. The present study was aimed to determin the impact of parameters affecting reverse osmosis membrane performance in Arsenic removal from drinking water. In this research, Arsenic removal was surveyed and tested through reverse osmosis membrane with spiral-wound module (model: 2521 TE, made in CSM Co. Korea). The used solution was prepared synthetically in the laboratory using sodium arsenate, and system performance was investigated under the influence of parameters such as arsenic concentration, pressure, pH and temperature of the input solution. In each case, the flux rate passing through the membrane and transverse velocity was measured. For each mode, after 30 minutes, desired samples were picked up, and then were tested with silver diethyldithiocarbamate method (Test No. 3500-As B, standard method). The results of experiments and measurements showed that the parameters of concentration, pH, temperature and pressure in input solution are effective in reverse osmosis membrane performance (model TE 2521), and the increase or decrease in each parameter leads to changes in the system's efficiency and performance. The optimal conditions and performance of membrane under the influence of these parameters were defined as follows: pressure 190-210 psi, concentration 0.2-0.5 mg/L, temperature 25-30 0C, and pH = 6-8. Arsenic removal efficiency at the optimum system performance was determined at about 99-95 percent. According to the results and the high efficiency and acceptable performance, this approach is effective and can be applied as a method for Arsenic removal in areas with contaminated water.

The OHS is characterized by hypersomnolence, hypoxia, polycytemia, headache and edema. Polysomnography is the gold standard diagnostic test. Overnight oximetry with significant oxyhemoglobin desaturation is reasonable to begin treatment. Weight reduction and Non invasive positive pressure ventilation (NIPPV) has evolved as the mainstay of treatment.Obesity is a risk factor for deep vein thrombosis (DVT). Heparin and warfarin are the drugs that used for treatment of DVT. HIT typically appears as a 50% or greater reduction in the platelet count after the first exposure to heparin. This case is a obese man with extreme DVT that diagnosed by duplex sonography and symptoms of obesity hypoventilation syndrom.In overnight pulseoximetry oxyhemoglobin desaturation was occurred more than 15 times per hours and treatment begins with NIPPV. Patients thrombosis were treated with heparin and warfarin. Heparin induced thrombocytopenia (HIT) and cutaneous necrosis was occurred and drug therapy withdrawn. After healing of cutaneous necrosis low dose warfarin was started.NIPPV promote airway occlusion and improve hypercapnia.hypoxia and quality of life and reduced cardiovascular complications