مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال بیست و سوم شماره 7 (پیاپی 108، مهر 1394)

Host immune responses are considered as an an important factor concerning the progression of HBV infection. B cells population following Hepatitis B infection has received scant attention. A Poroliferation-Inducing Ligand (APRIL) can be introduced as a stimulator of B cell activities. Therefore، this study intended to investigate the proportion of IgD positive B lymphocytes in liver as well as to determine the level of APRIL serum in relation to the clinical findings in chronic hepatitis B patients. Fifty-seven subjects suffering from chronic hepatitis B (CHB) were selected، who attended the Hepatitis Clinic of Shariati Hospital. APRIL ELISA kit was used in order to measure the APRIL serum concentration. HBV DNA was quantified by RealArtTM HBV LC PCR. Liver biopsy sections were stained with immunohistochemistry in order to indentify IgD. The mean score of liver fibrosis and inflammation was reported 4. 20 according to the modified histologic activity index system. The mean score for patients with liver IgD positive B-cells was 1. 9. Moreover، linear regression analysis showed that increasing the score of intrahepatic IgD positive B cells was propotionate to the increase of HBV DNA amplification، whereas it revealed a negative relationship with the APRIL serum level. The study findings revealed that IgD positive B-cells imply the presence of naïve B cells، more within patients who had higher level of HBV DNA. Moreover، higher score of IgD positive B cells population was negatively related with the serum level of APRIL.

Diabetes, as one of the most common endocrine disorders, has many different complications and outcomes. Some pieces of evidence proposed that garlic can be useful for diabetic patients due to its various compounds. Therefore, this study aimed to assess the effect of garlic tablet supplement on fasting blood sugar (FBS), Glycated hemoglobin A1c(HbA1c) and lipid profile levels in type 2 diabetic patients. This double-blind randomized placebo controlled trial was carried out at Imam Khomeini hospital in Tehran. The study sample consisted of 50 diabetic patients, who were randomly divided into two groups of 25 participants: placebo (PG) and garlic group (GG). The GG took three 400mg-garlic tablets and the PG group took 3 tablets similar to the garlic tablets per day after every main meal for 3 months. Lipid profile, HbA1c and FBS concentrations were measured before and after the intervention. There were not any significant differences in regard with age, gender and disease history between the two groups. After 3 months, the mean of FBS (from 155.23±36.47 to 140.57±44.18 mg/dl,pv=0.05) and HbA1c(from 8.6 %±1.04 to 7.27%±1.21,pv<0.001) decreased significantly in GG in comparison with PG. The mean of HDLc change in GG revealed a significant increase compared to PG (-2.03 vs. 1.76±6.96 mg/dl). Moreover, no other significant differences were observed in regard with other studied variables between the two groups. The findings of the present study revealed that daily consumption of three 400mg-garlic tablets in diabetic patients can lead to a decrease of FBS and HbA1c, in contrary to an increase of HDLc. As a result, garlic tablet supplement seems to be beneficial to complications control as well as treatment of diabetes.

Hypertension contributes significantly to worldwide cardiovascular morbidity and mortality. As a matter of fact, hypertension appears to have a complex association with endothelial dysfunction. Hence, the purpose of this study was to evaluate the effect of 4-week isometric handgrip exercise on changes of flow mediated dilation (FMD) and blood pressure within females suffering from hypertension. The study participants consisted of 14 women aged 30-55, who were selected on the basis of their BMI as well as sort of consumed medicine for their hypertension. All the participants were trained three times per week for 4 weeks. FMD brachial artery and blood pressure were assessed before the exercises beginning and 24 hours after the last exercise session. The study data were analyzed using dependent t-test (pretest-posttest design) at significance level of p=0.05. According to the study results, significant changes were observed in regard with FMD, systolic, and diastolic blood pressure (p= 0.001, p=0.006, and p= 0.001 respectively) in the experimented group. The findings of the present study demonstrated that isometric handgrip exercise, producing a positive effect on the endothelial function, can potentially reverse the endothelial dysfunction in females suffering from hypertension.

Since thrombolytic drugs such as streptokinase could cause reocculsion, anticoagulants like heparin are utilized afterwards. Several nomograms have been recommended due to unpredictable pharmacokinetics of heparin. Therefore, this study aimed to compare two prevalent nomograms of heparin used in patients suffering from acute myocardial infarction (AMI) after recieving streptokinase. In this single-blind randomized clinical trial, 113 patients with AMI were randomly assigned to one of the two nomogram groups four hours after receiving streptokinase. Patients in the group1(n=50), received an initial infusion with rate of 17 U/Kg/hr and a bolus of 80 U/Kg. In Group 2(n=35), the initial rate of heparin (n= 53) was 12 U/Kg/hr with a maximum 900U/hr after a bolus of 60 U/Kg with a maximum of 4000 U. Activated Partial Thromboplastin Time (aPTT) was measured every 6 hours for at least 48 hours and infusion rate was adjusted based on each nomogram in order to maintain aPTT in the therapeutic level of 46-70 s. Patients in the two groups were homogenized in regard with their demographic characteristics. The time needed for aPTT to pass the infusion threshold for groups 1 and 2 were 8.00±3.81 hr and 11.12±5.55 hr, respectively (p=0.00). In the first 12 hours, percentages of patients, whose aPTT was reported in an apporpriate therapeutic range were 56.0% and 30.19% for the two groups, respectively (p=0.00). Moreover, period of time that subjects in group 1 were in the therapeutic range in the first 24 and 48 hours was 14.40 ± 6.42 hrs and 27.48 ± 9.90 hrs, respectively. While these numbers for group 2 were 9.74±3.08 hrs and 21.06 ± 9.42 hrs, respectively (P=0.00, P=0.00). The changes in the heparin rate was reported significantly lower in group 1 compared to group 2. The study findings revealed that nomogram 1 is preferred to nomogram 2, since patients in nomogram 1 reached the therapeutic range faster, stayed in this range for a longer period of time, and needed less change in the heparin rate

Laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding are the most common bariatric surgery procedures. Therefore, this study aims to compare the safety of the newer procedure of Laparoscopic sleeve gastrectomy compared to Laparoscopic Roux-en-Y gastric bypass and Laparoscopic adjustable gastric bonding. A systematic review was conducted on the most important and most relevant search data bases, including Cochrane library, Pubmed, Ovid Medline as well as Iranian sites of Magiran, Iranmedex, SID, not taking the time limit into consideration. The results found in the literature were classified and were then analyzed. Out of 384 articles obtained in the search, 4 randomized clinical trials (RCT) were included in this study. There were no reports of death comparing surgical procedures of Roux-en-Y gastric bypass and sleeve gastrectomy. Moreover, in adjustable gastric banding and Roux-en-Y gastric bypass comparison, one death was observed in each group. Regarding the side effects of Roux-en-Y gastric bypass and sleeve gastrectomy, 10% early complications were reported in the Roux-en-Y gastric bypass group, and 13% were observed in the sleeve gastrectomy group between which no statistically significant difference was revealed. The comparison between adjustable gastric banding and Roux-en-Y gastric bypass demonstrated that the occurrence of early and late complications was reported to be higher in the gastric bypass group, though no statistically significant difference was observed. The present study findings demonstrated no statistically significant difference between these methods in regard with the safety aspect. As a result, selection as well as success of the bariatric surgery procedures depend on the patient's and surgeon's preferences.

A series of biochemical reactions are involved in the endogenous production of estrogens. Their final and rate-limiting step is catalyzed by aromatase belonging to the class XIX of cytochrome P450. CYP19 is a key enzyme for estrogen synthesis in males. It catalyzes the irreversible conversion of androstenedione and testosterone to estrone and estradiol-17β, respectively. Aromatase P450 is present in the endoplasmic reticulum of estrogen-reproducing cells in which it is expressed. The effects of the resulting estrogens are mediated through the estrogen receptor. One of the most important polymorphism, is a C to T variation in exon 7 resulting in an Arg264Cys amino acid exchange, has been shown to be very common in Asia. The purpose of this study was to determine the association of CYP19 gene polymorphism with the prostate cancer risk among the studied population. PCR-RFLP analysis of CYP19 gene was on 100 prostate cancer patients and an equal number of matching controls. The data was analyzed using the computer software SPSS for windows (version 19). The frequency of CT genotype was higher in patients (37%) as compared to controls (21.2%) and this incidence was statistically significant (OR, 2.10; 95 % CI, 1.02-4.34; P=0.044). Stratification of patients according to the risk factors, resulted in a slightly improved OR in individuals carrying CT compared to CC genotype (OR, 2.35 95% CI, 1.11-4.96; P=0.024). The TT genotype was not significantly associated with prostate cancer risk (OR, 0.63; 95% CI, 0.16-2.50; P=0.519). It seems that CT genotype is more associated with cancer prostate compare with other genotypes. It appears to be an increased risk of prostate cancer associated with the Arg264Cys substitution in the CYP19 gene.

The present study aimed to evaluate the effect of resveratrol on fetal heart tissue changes as well as to investigate the serum level of alanine aminotransferase (SGOT) and aspartate aminotransferase (SGPT) enzymes in pregnant rats after preeclampsia. In this experimental study, 36 pregnant female Sprague-Dawley rats were divided into 4 equal groups. The normal and L-name groups received respectively, normal saline and 70 mg/kg L-name intra peritoneally (IP). Two other groups named L-Res10 and L-Res20 groups received L-name 70 mg/kg plus 10 and 20 mg/kg of resveratrol, respectively. Injections were given for all groups from 9th to 20th days of the pregnancy. The fetal heart tissue changes as well as the serum level of SGOT and SGPT enzymes of the pregnant rats were measured on the 20th day of the pregnancy. Moreover, the study data were statistically analyzed using one-way ANOVA and Tukey post-hoc tests. The mean thickness of left ventricle in the L-res20 was reduced significantly compared to the L-name rats (P<0.05). The mean thickness of endocardium and epicardium was increased in rats which received resveratrol compared to the L-name group, though the difference was not proved to be significant. The mean serum levels of alanine aminotransferase and aspartate aminotransferase did not reveal to be significant between the groups. The results of the current study proposed that the resveratrol can have protective effects on fetal heart tissue and liver enzyme normal range in a rat model of preeclampsia.

Antibiotics are regarded as one of the most widely consumed drugs, which have abundantly contributed to the treatment of diseases, though their incorrect prescription as well as indiscriminate use can cause such complications as drug resistance and failure in patients’ treatment. Therefore, this study aimed to evaluate the pattern of prescribing antibiotics in surgical wards of Shahid Rahnemon Hospital compared to standard Methods. This is an analytical study conducted on 154 patients undergoing surgey in 4 surgery wards (General surgery, urology, neurosurgery and orthopedics) of Shahid Rahnemon hospital in Yazd in 2015. In order to glean the study data, a researcher-made data collection form was applied. The collected data were analyzed using SPSS software (ver-19) applying descriptive statistics (frequency and perrentage) and Chi-square test. 24% of patients had consumed Ceftriaxone, 72.1 % Keflin and 3.9% had recievd Cefazolin. The prescribed dose results showed 87% of compatibility with the guidelines. Regarding the prescription method, 86.4% compatiblity was reported with the guidelines. In total, 68.8% of the prescribed antibiotics were matched with managed care instruction of number (8) in terms of their type. The present study findings revealed that in 68.8% of the operations, the prescribed antibiotics were compatible with the guidelines in all the cases. Hence, taking antibiogram bacteria isolated from patients into account, developing standard treatment guidelines, and possibly providing oral forms of antibiotics can be effective in rationalizing the use of injectable antibiotics.

Malignant pleural effusion is recognized as the second most common cause of exudative pleural effusion. Thoracentesis and cytological examinations are regarded as simple procedures that can be performed easier than biopsy presenting less pain and danger. Hence, this study aimed to compare the results of malignant pleural fluidcytology and pathology of effusions in order to determine an appropriate method for malignant pleural effusion dignosis. The design of this study was a cross-sectional analytical survey of all pleural puncture samples (obtained from 1383-1393) which were diagnosed malignant via cytologic or pathologic analysis in the pathology department of Shahid Sadoughi hospital. After the required data were collected by a questionnaire, SPSS software(ver. 19) was applied via Chi- square and fisher’ s exact tests in order to analyze the study data. Out of 61 malignant pleural effusion cases, 31 (50.8%) were males and 30 (49.2%) were females. 39 cases (63.9%) were reported to have positive cytology results and 56 cases were reported to have positive (91.8%) pleuralneedle biopsies. Biopsy and cytology (55.7% of cases) were matched in regard with malignancy diagnosis. However,within 27 cases this correspondence was not observed between cytology and pathology results. In general, 22 (36.1%) biopsies and 5 (8.2%) cytologies were reported to be positive. The study results revealed that pleural fluid cytology can be considened as a noninvasive and rapid diagnostic method in order to diagnose malignant pleural effusions. The diagnostic efficiency of this method can be improved via repeating pleural fluid cytology.

Sleep is regarded as one of the basic needs of human. Several factors can cause sleep disturbances in hospitalized inpatients, among which noise and light can be taken into account in Coronary Care Unit(CCU). Therefore, this study intended to investigate the effect of eyemasks and earplugs use on sleep quality of patients suffering from Myocardial Infarction in CCU. In this randomized clinical trial, a sample size of 90 patients admitted in CCU was selected. The samples were randomly divided into three groups on the first night of stay: patients with an eye mask and ear plug, patients with only an eye mask and patients in the control group. The intervention was performed from the first night of admission until discharge and sleep quality was assessed by Visual Analog Scale. Moreover, the study data were analyzed via SPSS software (ver,18) using ANOVA, paired t-test, independent t-test and post hoc Don. The mean score of sleep quality showed a significant difference after the intervention between the two experimental groups with the control group (p<0/05), whereas no significant difference was observed between the two experimental groups after the intervention (p>0/05). The study findings revealed that using eyemasks and earplugs as low-cost and uncomplicated devices can improve sleep quality in patients in CCU.