نشریه پژوهش در پزشکی
سال سی و چهارم شماره 1 (پیاپی 133، بهار 1389)

Abstract MS14 is an Herbal-marine preparation that has been used in experimental studies for the management of Multiple sclerosis, (MS). In this study the effect of MS14 on body weight, spleen index and the histological picture of various organs was evaluated. Female Balb/C mice of 6-8 weeks age were divided into control and test groups. MS14 was orally administrated at a dose of 100 mg/kg for five days to the experimental group and normal saline given to the control group. After euthanasia on day six, the body weight was measured, spleen index was calculated and representative pieces of tissues including kidney, liver, spleen, lung, lymph node and bone marrow were collected in 10% formalin solution and processed through a standard paraffin embedding method. Sections of 5 micrometer thickness were cut and stained with hematoxylin and eosin. MS14 at 100 mg/kg did not affect body weight and spleen index, but in the test group, at least 50% of spleen and 90% of lymph node micro sections showed lymphoid hyperplasia: no reactive changes were observed in controls. In both groups, histological evaluation of kidney, liver, spleen, lung, lymph node and bone marrow micro sections showed no significant histological alterations in the normal architecture. According to result of this study, it seems that although MS14 has no effect on body weight and spleen index, it may induce hyperplastic changes in spleen & lymph nodes, thus signaling activation of the immune system. Keywords: MS14, "body weight", spleen index, spleen, lymph nodes, histology.

Abstract The aim of this study was comparison of sedation and analgesia between two drug combinations i.e. propofol+ fentanyl and ketamine+fentanyl, in patients with End stage renal disease, (ESRD) who were candidates for insertion of ‘Perm Cath’ catheter for the purpose of hemodialysis. Fifty one candidates for ‘perm cath’ catheter insertion were enrolled in this study. They were divided into three groups: Propofol+fentanyl; ketamine+fentanyl, and placebo. Systolic and diastolic blood pressure, heart rate and respiratory rate were measured before the procedure and then every 5 minute until the end of the procedure. Xylocaine was infiltrated at the site of insertion in all groups. Propofol1mg/kg with fentanyl 1micgr/kg were injected in propofol group, and ketamine 0.5mg/kg with fentanyl 1micgr/kg in the ketamine group. Pain was measured with Ambesh score in the beginning of catheter insertion and sedation was measured with Ramsay score at the beginning of procedure and at insertion of catheter in the heart. Patient satisfaction was measured qualitatively in the PACU. Comparative evaluation of mean heart rate, mean systolic and diastolic blood pressure and mean respiratory rate were different among the three groups, (P<0.05).Frequency distribution of pain was different among groups in the beginning of the procedures (P=0.001); also sedation score was different in the beginning of the procedures and when the catheter entered the heart among the three groups (P<0.001). Patients satisfaction score was higher in propofol group, (P=0.001). Local infiltration of Xylocaine at Perm Cath insertion is insufficient to produce sedation and analgesia, and it is necessary to use sedative drugs in combination. Both methods of sedation: propofol+fentanyl and ketamine+fentanyl provide sedation and analgesia effectively. Propofol appears to be superior in providing stability of vital signs, sedation and patient satisfaction. KEYWORDS: Perm Cath, ESRD, Sedation, Propofol, Ketamine, Monitoring anesthesia care.

Abstract Factor VII, is a coagulant protease; it begins the proteolytic cascade reactions and produces thrombin. The use of recombinant human factor VII, (rhFVII) is effective for the treatment of patients with hemophilia A or B. It is a target for gene therapy. This study was done to clone factor VII from HepG2 cell line. RNA was extracted from the hepatoma, (HepG2), cell line. On reverse transcription FVII cDNA was amplified by RT-PCR. PCR product was cloned into the pTZ57R/T vector and transported into the E-coli cells. By amplification of the FVII gene, the PCR band was observed and cloning into the vector was confirmed by restriction analysis. In this paper we report the cloning of factor VII from HepG2 cell line.

Abstract Most animal studies have shown that trans-10 and cis-12 isomers of Conjugated linoleic Acid, (CLA) tend to increase insulin resistance. But the effect of equal isomers of CLA (50:50 ratios of cis-9, trans-11: trans-10, cis-12 isomers) on lipid profiles, glucose, and insulin resistance and sensitivity in postmenopausal women is not clear. In the present study, we performed a randomized, double blind, placebo-controlled trial to examine the changes in lipid profiles, glucose, and insulin concentration following 4 CLAG80 capsules containing 3.2g CLA (50:50 ratios of cis-9,trans-11: trans-10, cis-12 isomers) or 4 placebo capsules supplementation for 12 weeks in post-menopausal women. Seventy six healthy post-menopausal women were randomized to receive placebo or 3.2 g CLA for 12 weeks. Anthropometric measurements were done. Blood samples were collected after 12-14 hours fasting before and after intervention. Insulin resistance and insulin sensitivity were estimated based on the homeostasis (HOMA) and QUIKI models. In weeks 0, 6 and 12 during the trial, subjects completed 3d dietary records. These dietary records were coded by the same dietitian, and analyzed with the Food Processor program. There were no significant effect on serum lipids, insulin, glucose, insulin resistance and insulin sensitivity over 12 weeks in postmenopausal women. Mixed isomer CLA supplementation had no effect on serum insulin, lipids profile, glucose and insulin resistance/sensitivity during 12 weeks of intervention in postmenopausal women.

Abstract Backgraound: In view of the increasing prevalence of diabetes, and the absence of a previous survey in the study population, the present study was done to assess the quality of life in diabetic patients. Two groups of diabetic (n=101) and healthy (n=123) subjects matched according to age, gender, educational status, social class, occupation and marital status were recruited for this historical cohort study. The level of quality of life was measured using SF-36 scale. Data was collected by a trained expert through face-to-face interview carried out in uninterrupted and peaceful surroundings. Parametric (t-test) and non-parametric (Mann-Whitney U) tests were used to compare groups. The cohort under study consisting of 224 people in two different groups of patients and healthy people was statistically similar in the baseline variables including age, gender, educational status, social class, occupation and marital status. Proportion of people with undesirable quality of life among the patients group was significantly greater than controls. Relative risk for reporting undesirable quality of life was significantly increased, (7.1 times, 95%CI= 3.8-13.4) in diabetic patients as compared to healthy subjects. Our findings show that diabetes has an adverse effect on the quality of life. These findings underscore the need for goal-directed interventions to improve the quality of life in diabetic patients.

Abstract Complete regional anesthesia of larynx accompanied by sedation is used for microlaryngeal procedures performed in the vicinity of airway system. In this study we have compared the sedative effects of two combinations of sedative drugs during microlaryngoscopic surgery. 40 patients who were candidates for microlaryngoscopic surgeries were selected for this study. All patients were in ASA class I-II. At first Laryngeal anesthesia was given by using Lidocaine as superior Laryngeal block and scattering lidocaine as spray on the tongue and pharynx. Intratracheal block was done for all patients. All 40 patients received 0.5 mg/kg of propofol intravenously as bolus, followed by 50 µg/kg/min as an IV infusion. Patients were then randomly divided into two groups. Group I received 0.03 mg/kg of midazolam intravenously and group II received fentanyl 2 µg/kg intravenously. Blood pressure, heart rate and oxygen saturation of arterial blood was checked in all patients after induction of sedation, one minute after initiating Laryngoscopy and one minute after relieving the Laryngoscope stimulation. Time of complete awareness and recovery and also side effects, such as shivering, nausea and vomiting were evaluated. Induction using Fentanyl and propofol was accompanied by a greater degree of bradycardia as compared to the midazolam group, (p<0.02). In addition, decrease in the level of oxygen saturation during laryngoscopy was more marked in the fentanyl group (P <0.05). During the entire procedure, blood pressure showed fluctuation in both groups but reverted to normal faster after eliminating the stimulation in the midazolam group. (P <0.01) Eye opening and complete awareness were faster in the midazolam group. (P <0.01) Nausea occurred in 2 patients of fentanyl group. Recall about the procedure was present in 50% of fentanyl group and 10% of midazolam group (P < 0.01). Sedating patients by midazolam accompanied by Laryngeal block has faster recovery and less recall and also fewer episodes of arterial oxygen desaturation during micro-laryngoscopic surgical procedures.

Abstract Few studies have evaluated association of Helicobacter pylori with benign and malignant laryngeal lesions. The aim of this study was to evaluate the coexistence of Helicobacter pylori with laryngeal lesions in patients with laryngeal growths, admitted in Taleghani hospital. In this cross-sectional study, all patients referred to ENT ward of Taleghani hospital for direct laryngoscopy and biopsy were evaluated. Biopsied specimens were sent for histologic evaluation and PCR (Polymerase Chain Reaction) to the Research Center for Gastroenterology and Liver diseases. PCR was used to detect Helicobacter pylori in biopsied specimens. Fifty-nine patients with a mean age of 46.1±18.3 years were evaluated. 27 patients had malignant laryngeal lesions and 32 had benign laryngeal lesions. The frequency of Helicobacter pylori in the malignant and benign group was 29.6 and 15.6 percent, respectively; the difference was statistically non-significant. However, a correlation was found between malignant laryngeal tumors with male gender, alcohol consumption, smoking and opioid usage. Findings of this study failed to find an association between the presence of Helicobacter Pylori and laryngeal cancers.

Abstract Despite the high prevalence and recurrence of bladder cancer, researches about the role of trace elements such as iron, copper and zinc in bladder cancer are limited in number. In the present study the concentration of Iron, Copper and Zinc, (Fe, Cu and Zn) were determined in the serum of patients with bladder cancer and compared with the level of these trace elements in healthy subjects. This case control study was conducted on 51 patients with bladder cancer and 58 healthy volunteers after matching for age, sex and smoking habits. After a written consent sample were collected and the concentrations of Fe, Cu and Zn were measured. Comparisons were made using student t test. There was a significant decrease in mean Fe and Zn serum level in bladder cancer patients as compared to the control group (p <0.001). In contrast serum Cu level were significantly higher in patients having bladder cancer than in the control group (p <0.001). More over patients with bladder cancer had significantly higher Cu/Zn ratio than controls. The present study showed that the mean serum cu level was higher and the mean serum Zn and Fe level were lower in patients with bladder cancer than the control group. Further studies are required to demonstrate a possible cause-and effect relationship between these elements and bladder cancer.

The aim of this study was to identify multidrug resistant isolates of Escherichia coli and K. pneumoniae causing urinary tract infections (UTI) in children and the occurrence of class 1, 2 and 3 integrons in the antibiotic resistant isolates..

A total of 200 urine samples were processed. Urine culture was done using conventional microbiological techniques. Biochemical testing was used to identify the organisms. Susceptibility of 200 isolates to 13 antibiotics was determined and the frequency of multi-drug resistance and their association with intergron was assessed by PCR –RFLP.

171 isolates out of 200 were multi-drug resistant. Existence of intergrons was confirmed in 20.5% of these isolates. Association of multi-drug resistance to Gentamicin, Norfloxacin, Cephalotin and Nalidixic Acid with the presence of integrons was statistically significant, (p <0.002, <0.001, <0.005, and <0.004, respectively). Imipenem and Amikacin were the most effective antibiotics against resistant isolates.

Multi-drug resistance suggests that strategy for treatment of patients with Escherichia coli and K. pneumonia infections needs to be revised. The possibility of transmission of resistance genes by integrons would be decreased by treatment of patients with the appropriate antibiotics. Keywords: Escherichia coli, Kelebsiella, Urinary tract infections, PCR –RFLP.

The Baldrige Criteria for Performance Excellence provide a systems perspective for understanding performance management. They reflect management practices against which an organization can measure itself. The Criteria have been accepted internationally as the model for performance excellence. This descriptive cross-sectional study was performed at Hasheminejad hospital, a training hospital of Iran University of Medical Science And Health Services, in Tehran. Members of the study team interviewed the Hospital administrator and senior managers according to the standard global Malcolm Baldrige questionnaire and documented the data. 7 criteria were used for performance assessment. This hospital got 426 points from a maximum of 1000 (42.6%). Of 426 point, 46 (37% of maximum point) was for leadership criteria, 38 (44%) for strategic planning, 41 (50%) for focus on patients and other costumers, 40 (44%) for criteria of data assessment, analysis and management, 43 (51%) for focus on personnel, 33 (39%) for process management and 185 (41%) for function of organization. Baldrige model can be used as comprehensive model for assessing the performance of training hospitals. By using this model, managers can find strengths and weaknesses of organizations and then use this model for performance improvement. Keywords: performance assessment, Malcolm Baldrige, training hospital. Hasheminejad, Excellence model.

Conversion disorder is a type of disturbance in physical functions that does not conform to anatomical and physiological functions of central or peripheral nervous system. Being more common among adolescents, this disorder occurs following stress and results in disturbed organic functioning. Despite the high prevalence of its classic picture, this disorder also creates various uncommon clinical pictures and is often associated with the diagnosis of mood disorders, anxiety disorders and schizophrenia. Case Report: The reported case was an example of conversion disorder associated with mood disorder presenting with severe elbow and finger contractions of the left side that occurred following trauma to the same hand and was associated with mood swings, aggression and suicidal ideas. All symptoms improved following electroconvulsive therapy.

In patients with physical symptoms and signs, looking for personal and social factors is very important. Moreover, evaluation of other concurrent psychiatric disorders and their treatment is worthwhile.