مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال شصت و نهم شماره 5 (پیاپی 125، امرداد 1390)

Numerous use of Beta Lactame in treatment of bacterial infections resulted in increments of drug resistance of such bacteria. One of difficulties in treatment of hospital infections is Extended Spectrum Beta Lactamase (ESBL) among isolated clinical strains of E.coli. Since some of ESBL strains shows double reaction in drug sensitivity test at in vitro and in vivo condition, therefore it makes difficulties in selection of right treatment. In the last years, CTX-M enzymes have become the most prevalent ESBLs in worldwide. The prevalence of ESBL types largely remains unknown in many parts of the Iran. This study was made to find the prevalence of ESBL-producing E.coli and molecular detection of CTX-M-1 in Tabriz. In the present study, 400 urine samples collected between November 2009 and April 2010, from Tabriz Hospitals were studied. Out of the 400 samples, 188 E.coli isolates were detected by standard biochemical tests. Susceptibility to antimicrobial agents was tested to 10 antibiotics by the disk agar diffusion (DAD) method. ESBL production was screened by phenotypic test that included both separate and combined disk agar diffusion techniques. The screened isolates were investigated by PCR assay to detect CTX-M-1 gene. From the total 188 E.coli isolates, 82 (43.6%) were shown to produce ESBLs by phenotypic test. During the PCR method on the 82 isolates, 69 (84.1%) were confirmed as CTX-M-1 producing group. The present study showed that CTX-M-producing isolates were increasing among E.coli strains and indicated the need for adequate susceptibility tests in laboratories for choosing the appropriate antibiotics for treatment.

Cardiac resynchronization therapy (CRT) has proved as an efficient treatment in patients with end stage Heart failure. Previous studies showed the beneficial long term effects of CRT on the severity of mitral regurgitation (MR). The aim of this study was to evaluate acute effects of CRT on severity of MR. This study was a double blind randomized trial performed from 1387 to 1388 in Imam Khomeini Hospital. Echocardiographic parameters including severity of MR were measured before and after CRT implantation with different echocardiographic methods. Patients had a significant improvement in severity of MR (14% Vs. 11% P<0/05), in increasing ejection fraction (18/04 Vs. 24/42 P<0/05) and in decreasing end systolic diameters (6/14 Vs. 5/98 P<0/05) and end diastolic diameters (7 Vs. 6/8 P<0/05) after CRT implantation. The reduction of MR was significantly correlated with the improvement of ejection fraction (P=0.07). The mechanism of decreasing severity of MR is not yet truly understood and may be different in acute and chronic phases. Correction of left ventricular dyssynchrony might influence the improvement of MR severity. Also, synchronization of papillary muscle and increased transmitral pressure with more forceful mitral valve closure, decreases regurgitation fraction and volumes is proposed for these beneficial effects. If posterior papillary muscle is involved in dyssynchrony, the acute reduction of MR following CRT is expected but if the dyssynchrony is mainly at the lateral parts of left ventricle MR might be improved in longer durations.

In recent years, consumption of whole-blood for the treatment of patients has decreased but use of biological plasma-derived medicines such as albumin, immunoglobulin and coagulation factors have increased instead. Paying attention to albumin molecular structure is important for its isolation from human plasma. Albumin is a single-chain protein consisting of about 585 amino acids and a molecular weight of 66500 Daltons. Albumin is a stable molecule and it is spherical in shape. There are different methods for human albumin preparation. Considering the large consumption of this biological drug in clinical settings, methods with fewer steps in production line are of big advantage in saving time and manufacturing more products. In this project, we prepared human albumin using hollow fiber cartridges in order to omit the rework on fraction V+VI. Human albumin is usually produced by the application of cold ethanol method, where albumin is obtained from fraction V by doing a rework on fraction V+VI to separate fraction V. In the current work, human albumin was prepared from fraction V+VI by the help of hollow fiber cartridges. With a concentration of 20%, the obtained albumin had 96.5% of monomer and 3.5% of polymer and polymer aggregate. Comparing the obtained human albumin with a number of commercial human albumin samples by the use of SDS-page, the results were satisfactory regarding the 3.5 percent polymer and aggregate rate for the prepared albumin.

Scoliosis is one of the most common spinal deformities with subsequent decrease in pulmonary function. The effects of surgical correction on the pulmonary function of patients with adolescent idiopathic scoliosis are controversial. The purpose of the present study was to compare the postoperative pulmonary function changes in different surgical approaches chosen for its correction. Sixty-five patients with adolescent idiopathic scoliosis who had undergone corrective spinal surgery in Shafa Yahyaian Hospital since 1997 to 2007 and had documented preoperative pulmonary function test report, included in our study. The patients had documented preoperative pulmonary function tests and were divided into three groups based on their surgical approach. The first group was comprised of 25 patients who had undergone posterior spinal fusion (PSF), the second group included 29 patients who had anterior and posterior spinal fusion (ASF+PSF), and the third group consisted of 10 patients who had posterior spinal fusion and thoracoplasty (PSF+ thoracoplasty). The preoperative and the final follow-up values of absolute and percent predicted forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were compared and their relations with the undertaken surgical approach were evaluated. There were no significant correlations between the surgical approaches and changes in the pulmonary function tests (P>0.05). FVC and FEV1 values were similar to preoperative values in all groups after a minimum follow-up of two years. There were no significant differences between different surgical approaches for adolescent idiopathic scoliosis regarding the pulmonary function test results after at least two years of follow-up.

Overactive bladder (OAB) is one of the most prevalent diseases of lower urinary system. OAB disease is defined by the Standardization Subcommittee of the International Continence Society as urinary urgency, with or without urge incontinence, usually with frequency and nocturia with no proven infection or other obvious pathology. Treatment with the antimuscarinic agents tolterodine and oxybutynin is the mainstay of therapy for overactive bladder. The study was undertaken to compare the efficacy and side-effects of tolterodine and oxybutynin in a number of Iranian women.

This study consisted of two trials and done in Imam Khomeini Hospital in 2009; in one trial, 50 patients with overactive bladder were randomized to 4 weeks of treatment with 2 mg of twice-daily tolterodine, and in the other to 5 mg of three times a day oxybutynin. Urodynamic investigations, Episodes of urge urinary incontinence and adverse events were also evaluated.

The results showed a good association between the questionnaire and cystometry data but urodynamic studies showed significant differences in efficacy. Tow groups showed significant improvements in all Symptoms, but The results showed that the two drugs had no significant differences in efficacy.

The data obtained by questionnaire indicated that both drugs increased quality of life but there were no significant differences between the two in symptom cure. Dry mouth was the most common side-effect in the two groups but unlike other studies it was higher in the tolterodine group. Therefore, our study did not show any preference between oxybutynin and tolterodine.

Acne vulgaris is a common dermatologic disease. Isotretinoin is one of the medications prescribed in severe cases of acne. Despite its high efficacy, isotretinoin use for acne is associated with some side effects. This study was done to evaluate the effects of isotretinoin on serum levels of creatine phosphokinase (CPK) and musculoskeletal symptoms in patients with acne vulgaris. This study was done on forty 15- to 30-year-old patients with moderate to severe acne vulgaris recruited from Semnan dermatology clinics in 2010. The participants were all candidates for isotretinoin therapy. Serum CPK levels and musculoskeletal physical exam were checked before the treatment and every 2 months for 6 months. Isotretinoin was prescribed 0.5-1 mg/kg/body weight and continued throughout the study period with the same dosage. Thirty-three (82.5%) patients were female. The mean (±Standard Deviation) age of the participants was 22.3±3.4 years. The mean serum CPK levels increased significantly, (P< 0.05), 2, 4 and 6 months after the treatment, but they remained below the upper limit of normal range (45-160 IU/L), except in an 18-year old patient, which it was 162 IU/L. Moreover, they did not exhibit noticeable musculoskeletal symptoms. Musculoskeletal symptoms, such as mild myalgia, were reported in 10% of the patients but they were relieved gradually. It seems that the increase in serum levels of CPK, with or without musculoskeletal symptoms, in patients who are on isotretinoin, is a benign phenomenon. Therefore, we do not recommend measurement of CPK levels in patients with mild myalgia.

Entanglement of the umbilical cord around fetal neck has been reported to be associated with birth asphyxia. On the other hand, current evidence suggests that umbilical arterial pH analysis provides the most sensitive reflection of birth asphyxia. In this study we aimed to evaluate and compare the umbilical arterial hydrogen-ion concentration (pH) and to analyze the blood gases of neonates with or without nuchal cord. In this cohort study, 92 newborns with and 95 without nuchal cords were enrolled at Shahid Akbar Abadi Hospital in Tehran, Iran between the years 2009 and 2010. From each newborn an umbilical arterial blood sample was collected to measure pH, base excess and blood gases. There were no statistically significant differences between newborns with or without nuchal cord regarding maternal age, gestational age, and history of pregnancy. The mean pH in the newborns with nuchal cord (7.21±0.1) was significantly less than the value in the newborns without the cord (7.28±0.1), (P<0.001). In contrast, the mean base excess in the newborns with nuchal cord was more than the ones without the cord (P<0.001). Seven newborns (7.9%) in the group with nuchal cord passed meconium during labor while only one (1%) newborn did so in the other group. Our finding showed that nuchal cord had a significant relationship with acidosis in newborns with nuchal cord. However, this finding needs further investigation to reach a common conclusion.

Prevalence of Abdominal Aortic Aneurysm (AAA), estimated by various studies, ranged from 4.1% to 14.2% in men older than 60 years. Most cases of AAA are asymptomatic and often discovered incidentally. Approximately the initial presentation in 12% of cases of AAA is sudden rupture with subsequent high mortality. This study was performed to evaluate the prevalence and screening necessity of AAA among Iranian men older than 65 years old.

In this cross-sectional study, men older than 65 years, who referred for ultrasound examination to three different centers in Tehran, Iran at the year 2008 were included for evaluation of size of the abdominal aorta and presence of AAA.

A total of 240 men older than 65 years enrolled in this study. AAA was found in 24 of the participants with prevalence rate of 10% in the studied population. Mean diameter of detected aneurysms was 3.931.435 cm. In 4 (1.7%) subjects, aneurysms greater than 5.5 cm in diameter were detected. One of these four subjects had the history of coronary artery disease and one was cigarette smoker. Three out of four had history of hypertension.

Considering the estimated prevalence rate of AAA by the current study and the population of Iranian men older than 65, implementing of mass screening for AAA in this group would detect 986 asymptomatic cases each year. Therefore, the authors recommend further studies about the cost-effectiveness of mass screening for AAA among Iranian men above 65 years.

Vertebrobasilar dolichoectasia is defined as a prominent elongation, dilatation and tortuosity of the vertebral and basilar arteries. Ectatic basilar arteries may cause different neurological symptoms by several mechanisms including compressive effects and embolic or ischemic events. In this report we present a 58-year old female patient who was admitted in Dr. Shariati General Hospital in Tehran, Iran with complaints of dysarthria, vertigo, ataxia and nausea. Neuro-imaging procedures (brain CT scan, CT angiography, and an MRI study of the blood vessels or MRA) were performed. Dilation and elongation, as well as tortuosity of the vertebral and basilar arteries revealed the diagnosis of vertebrobasilar dolichoectasia. The patient was discharged from the hospital following the control of underlying diseases and neurological symptoms related to dolichoectasia without undergoing any invasive procedures. Paying attention to any minor or major neurological symptoms, as well as underlying medical conditions along with the conservative control of symptoms can be most helpful. Invasive interventions in a chronically ill patient can be very risky, therefore, medical management including control of associated or underlying diseases is recommended as the first line of treatment.