Researcher Bulletin of Medical Sciences
Volume:17 Issue: 1, 2012

Crimean-Congo Hemorrhagic Fever (CCHF) is an acute viral hemorrhagic disease which is transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected animal or human. CCHF was first recognized in the Crimean peninsula in the mid-1940s, and the same virus was isolated from a patient in Democratic Republic of Congo, in 1956. Person-to-person transmission of CCHF virus occurs through direct exposure to blood or other secretions; in addition, nosocomial transmission is well-documented with case fatality rates ranging from 30 70%. Tick bite is one of the most important risk factors for CCHF acquisition and Hyalomma tick is its main reservoir in the nature, but many domestic animals including cattle, sheep, goats, hare, buffalo, and even ostrich can be infected by this virus. Disease in animals is subclinical and they are infected only for one week. During the viremia phase, direct exposure to blood or other secretions can infect human. Hyalomma ticks favor dry climates and arid-type vegetation, and are abundant in European countries bordering the Mediterranean Sea; numerous animals may act as CCHF virus hosts. In recent years, a number of cases have been reported from Africa, Eastern Europe and Asia. Healthcare workers are also at risk of infection through unprotected contact with infected blood and other body fluids. Incubation phase is about 3 to 4 days after tick bite and 3-14 days when the patient is exposed to infected blood and other body fluids. Typical CCHF progresses rapidly with high fever, malaise, severe headache, myalgia, and gastrointestinal symptoms like abdominal pain and nausea. CCHF is confirmed either by detection of specific immunoglobulin M antibodies or a four-fold increase of immunoglobulin G titers using enzyme-linked immunoassays, indirect immunofluorescent assays, or through RT-PCR. Supportive therapy is an essential part of the case management. Intensive monitoring of fluid volume and blood component replacement is recommended. Oral ribavirin is the therapy of choice in the clinical practice. If the patient meets the criteria for probable CCHF, treatment with ribavirin protocol needs to be started immediately. Interferon and Immunoglobulin have significant antiviral activity in vitro against CCHF. Recently, we face many cases of CCHF in several provinces of Iran. The aim of this article is to review clinical manifestations, treatment and prevention of this disease.

In skeletal muscle, carnitine plays an essential role in translocation of long-chain fatty-acids for subsequent beta-oxidation; in addition, coenzyme Q10 (ubiquinone, CoQ10) is a component of the mitochondrial electron transport chain and also an important antioxidant. Despite abundant literature describing the basic mechanism of L-carnitine and CoQ10 metabolism, there remains some uncertainty regarding the effect of oral L-carnitine and CoQ10 supplementation. The aim of this study was to investigate effect of CoQ10 and L-carnitine supplementation on aerobic and anaerobic exercise performance in healthy inactive collegiate men. In a randomized double-blind placebo-controlled trial, 40 subjects (age: 23.01±2.97 y, weight: 72.9±11.71 kg and height: 176.80±5.36 cm) participated in two test sessions separated by 10 days. Subjects were randomly allocated into parallel groups to receive either CoQ10 (3 mg/kg/day), L-carnitin (30 mg/kg/day), both of them, or placebo, for 10 days. A 30-second Wingate anaerobic capacity test for determination of fatigue index (FI), and a maximal cardiopulmonary graded exercise test (modified Bruce protocol), for direct determination of VO2max by gas analyzer, were performed on the day before and after supplementation period. Data was analyzed using repeated measures ANOVA and paired sample T test. Results showed that co-supplementation with L-carnitine and CoQ10 had a significant incremental effect on VO2max (p< 0.05). In the L-carnitine group, VO2max showed a tendency to increase but it was not significant (p=0.096). FI decreased by 7.7% with L-carnitine + CoQ10, compared with 4.9% increase in placebo group; however this difference was not statistically significant (p=0.099). Only supplementation with L-carnitine could significantly improve the fatigue index (p<0.05). ‍ Short term co-supplementation with L-carnitine and CoQ10 may improve aerobic and anaerobic exercise performance in inactive collegiate men.

Diabetes mellitus in long term accompanies with enhanced oxidative stress and decreased activity of antioxidant defense system. Due to antidiabetic and antioxidant activity of effective constituent of turmeric, curcumin, the effect of this component on serum level of aspartate and alanine aminotransferase and cardiac level of some oxidative stress markers were determined. In this experimental study, rats were divided into 5 groups, i.e. control, curcumin-treated control (50 mg/kg), diabetic, and curcumin-treated diabetic groups (10 and 50 mg/kg). Curcumin was administered 7 days after streptozotocin injection for 5 weeks. Serum level of aspartate and alanine aminotransferase and heart tissue level of malondialdehyde (MDA) and nitrite and activity of Superoxide dismutase (SOD) were measured. Diabetic rats showed a significant increase in serum level of aspartate and alanine aminotransferase (p<0.01-0.05), while high-dose curcumin significantly reduced serum level of these enzymes (p<0.05). In addition, diabetes was followed by increased level of MDA and nitrite in heart tissue (p<0.05-0.01) and non-significant decrease of SOD activity, whlie high-dose curcumin treatment significantly reduced MDA and nitrite level (p<0.05) and did not significantly change activity of SOD. ‍ Chronic treatment with curcumin could improve serum level of alanine and aspartate aminotransferase and some oxidative stress markers in cardiac tissue of diabetic rats.

Appearance is an important part of individual identity and social situations; thus, the importance of this personality structure is very obvious. This study compared psychological disorders in applicants of cosmetic surgery with controls. Applicants of cosmetic surgery were 62 patients who were selected using convenience sampling; 62 controls were selected among the relatives of the cases and were matched for age, gender, and education level. The applicants of cosmetic surgery were those who were visited in cosmetic surgery centers of Urmia during a three months period. Data were collected through SCL-90-R questionnaire. The results were analyzed by software SPSS 16; using descriptive statistics and multivariate analysis of variance (MANOVA). Among nine dimensions of psychological disorders, applicants of cosmetic surgery and controls had significant differences in all aspects except in paranoia and psychosis. ‍ Based on this study, applicants of cosmetic surgery have significant vulnerability in psychological aspects.

Legionella is one of the leading causes of nosocomial diseases. This bacterium can reproduce and survive under different temperatures, pH, nutrients and oxygen; while hot water of distribution systems provides an ideal environment for its growths. This study was carried out to identify Legionella in water distribution systems of Taleghani Hospital and to assess environmental factors affecting its growth. In this descriptive-cross sectional study which was run in summer 2011, 32 samples of cold and hot water systems of Taleghani Hospital were obtained. Samples with 1 to 1.5 liters volume were gathered and immediately concentrated using 0.45 µ membrane filter systems. BCYE culture along with GVPC, CCVC, L-Cystein and pyrophosphate Ferric supplementaries were made according to the protocol. In order to eliminate interference of other bacteia, GVPC, CCVC, and acid care for inhibition of growth were used. Then the samples were cultured and the colonies were recognized using morphology and biochemical characteristics. From 32 samples, 11 were contaminated with Legionella (34%). The residual chlorine of samples were 0.4-1.4 (mean: 0.909 mg/L) and their pH were 4.5-8.2 (mean: 7.36). Most of the positive cases were reported from hot water samples and also samples with residual chlorine of less than 1 mg/L. The positive samples were reported mostly from men oncology ward, storage tanks and newborn ward. Data analysis showed that there are significant correlations between legionella pneumophila growth and temperature (OR=1.676, (1.08-2.599); p-value <0.02) and also residual chlorine ((OR= 0.006, (0.0005-0.703); p-value <0.035); while no correlation was seen between other variables such as turbidity and pH. ‍ In spite of the fact that the hospital uses treated water of urban distribution system, 34% of samples were contaminated with legionella pneumophila; most of them were found in samples with residual chlorine concentrations of less than 0.9 mg/L. This shows that Legionella pneumophila is resistant against antiseptic factors and hard conditions of the environment, since most of the positive cases were related to hot water samples.

Assessing use of physician visits by people is fundamental as this is the main theme and starting point in medical services. The aim of this study was to evaluate fluctuations in public demand for GP and specialist's services (those who had contract with social security organization (SSO)) with regard to tariffs, access and rates of patient's cost-sharing. This study is descriptive and analytical. Analysis was performed throughout the country, based on time series data of institutes in contract with SSO. After data collection, GP and specialist services market were studied, both from the perspective of demand and supply, regarding both government and private tariffs. Then the role of the amount of patient out-of-pocket in service utilization was analyzed. During 1998-2008, patient out-of-pocket percentage has increased from 30 to 67% for SSO GP services while it has increased from 30 to 75% for SSO specialists. The average SSO GP visits per person has decreased from 1.13 in 1998 to 0.88 in 2008; meanwhile, the average SSO specialist visits per person has increased from 0.65 to 0.76. ‍ It seems that decreased average GP visit is due to increased patient out-of-pocket in institution under contract with SSO, which cause patients to seek these services from cheaper providers. However, specialist visits are more inelastic and there is no proper substitute for their services; thus, despite increased patient out-of-pocket, patients have to receive services from SSO specialists.

To study the predictive value of Japanese orthopaedic association (JOA) score in patients diagnosed with Lumbar disc herniation undergoing discectomy in many hospitals during 2008-2011. Patients diagnosed with lumbar disc herniation who were candidate for discectomy entered this cross sectional study. The Finneson and preoperative JOA scores were determined. Patients were recalled at least three months after surgery, and the result of discectomy were recorded based on DJOA (the difference between pre and postoperative JOA score); in addition, patients’ satisfaction were measured. Then the correlation coefficient and the linear relationship between the JOA score before surgery and the DJOA were found. Finally in a pilot study on 10 patients, the linear equation was evaluated. 117 patients were eligible to enter the study during the two years course of the study. Patients’ mean age was 45±11 (18-82 y) and were followed for at least three months. The difference between pre and postoperative JOA score (18 ± 5.2) was statistically significant (P<0.0001). The correlation coefficient between the preoperative JOA score and DJOA was r=0.82. The linear relationship between preoperative JOA and DJOA was as follows: DJOA= -1.036 × preoperative JOA + 23.635. In a pilot study to estimate discectomy outcome, the correlation coefficient between the actual amount of DJOA and the estimated DJOA was r=0.88. ‍ It seems that the preoperative JOA is able to predict discectomy results in patients with lumbar disc herniation. A Longitudinal study in this area is recommended.

In recent years, the concept of sense of coherence (SOC) has helped our understanding about factors that influence health and disease; it has also attracted attention as a health model. Remarkable applications of SOC in research and clinics indicate necessity of research on its psychometric properties. This study was run to assess the psychometric characteristics of the SOC (29 questions) in university students.

This study aimed at investigating psychometric characteristics of the SOC questionnaire and assessing the correlation between variables; thus, is a correlational study. For this purpose, 400 students (200 female, 200 male) were chosen using multistage sampling. After data collection, data were analyzed by exploratory factor analysis and Cronbach's alpha coefficients to assess questionnaire validity and reliability.

Factor analysis showed that this questionnaire has only one factor that explained 76.5% of the variance and all items are loaded in this factor; thus, internal consistency of the SOC questionnaire was equal to α=0/.969. This indicates good reliability of this questionnaire.

It seems that the 29-question SOC questionnaire has acceptable validity and reliability in Iranian students and can be used by researchers and specialists in the area of health psychology, behavioral medicine, mental health, preventive mental health and other fields.