مجله مطالعات علوم پزشکی
سال بیست و ششم شماره 8 (آبان 1394)

In recent years, the emergence of multi drug resistant Klebsiella pneumonia is responsible for many therapeutic problems all over the world. Nowadays carbapenems are often considered as the final options for antibiotic treatment of infections caused by most Gram-negative bacilli. The aim of this study was to determine antibiotic resistance pattern (with focus on carbapenems) of K. pneumoniaeisolates from clinical specimens of in-patients and out-patients admitted to Urmia University of Medical Sciences teaching hospitals. In this descriptive-analytical study, 182 isolates of K. pneumonia were investigated. All bacterial isolates were identified as K. pneumoniae by using standard microbiological tests. Antimicrobial susceptibility testing of confirmed isolates was carried out by disk diffusion method proposed by (Kirby-Bauer) against 12 different antibiotics. The minimum inhibitory concentration (MIC) of imipenem for each isolate was determined using E-test method. Accordingly, 43 isolates (23.6%) were resistant to imipenem, and 45 isolates (24.7%) belonged to multiple drug resistant (MDR) phenotypes. These isolates demonstrated high resistance to imipenem and meropenem. The MIC of imipenem for resistant isolates was ≥32 µg/ml. Considering the high prevalence of resistance to imipenem, especially in Klebsiella pneumonia isolates from patients admitted to ICU wards in the present study and various reports from other countries, precaution should be taken in the administration of these drugs. Also determination of bacterial susceptibility prior to prescription of antimicrobial agents is crucial for proper treatment and preventing the dissemination of antimicrobial resistance.

The present study aims to investigate the prevalence and severity of fluorosis and decayed, missing, and filled teeth (DMFT) in students aged 7-14 in villages of Maku. The present research was carried out on 240 school children that were divided into two groups according to clustering random sampling. Group one included villages with average fluoride concentration of drinking water of 7mg/l, and group two included villages with average fluoride concentration of drinking water 0.45 mg/l. Then, Chi-square test and Mann-Whitney tests were applied. It was revealed that the percentage of fluorosis in groups 1 and 2 were 3.7 and 0.046, respectively. There was statistically significant relation between fluorosis and fluoride concentration of drinking water. According to Deans criteria, high percentage of students in group 1 had dental fluorosis (grades 2 to 5) (p<0.001), while the second group had healthy teeth. The mean DMFT score in group 1 was D= 0.95, M=0.025 and F=0.01; and in group 2 was D=0.4, M=0.025 and F= 0. It is deduced that high prevalence of dental fluorosis is connected with high concentration of fluoride drinking water and it is suggested to control its level to eliminate the excessive fluoride from drinking water.

Nowadays, infertility is a stressful problem and has an undesirable influence on psychological states of the couples. This research aims to determine efficiency of training courses of anger control on their mental health This research is a semi-experimental method under pre and post tests. 90 infertile women referred to Sarem Clinic in Tehran and filled up Spielberger anger expression scale questionnaire, among them 32 candidates obtained the highest score. They also were selected according to voluntary sampling method and were divided into experimental and control groups, randomly. Subsequently, experimental group participated in training course of anger management held upon cognitive- behavioral approach within 10 sessions (each session was 90 min.), the control group did not receive any instruction. General health questionnaire (28 questions) was used in two stages of pre and post tests. Covariance and Khido tests were applied for the data analysis to determine the frequency of infertility. The results showed that training of anger control upon cognitive- behavioral approach caused to increase the mental health among individuals in the experimental group. It was indicated that training course has a significant effect on increasing mental health. Therefore, such trainings are advised beside other medical instruction as a part of treatment.

It has been proposed that uric acid (UA) and FetuinA (FA) are independent risk factor for the development of cardiovascular disease (CAD). UA is the end-product of purine metabolism and is considered an endogenous antioxidant. FA is a protein secreted by the liver; acting as an inhibitor of coronary artery calcification. The aim of the present investigation was to survey the association between severity of CAD and sera UA or FA. Subjects (n=83) undergoing coronary angiography were enrolled. According to angiographic results, the subjects were divided into: Control (CTL; n=21; age 55±8.9 years), one vessel obstruction (1VD; n=20; 57±10.1 years) and multi-vessel obstruction (Multi VD; n=42; 65.4±9.7 years). FA level were determined by ELISA. Clinical biochemical parameters were assayed by routine laboratory methods. Statistical analyses were performed using SPSS package (version 22). Serum UA levels in multi VD and 1VD were higher than that of CTL group (P=0.05). FA levels slightly declined with the severity of CAD (P=0.23). Multi-regression analysis revealed that age, BMI, HDL-C, glucose and Hb were associated with the severity of CAD. It was also found that UA is independent for the prevalence of CAD. Considering the small sampling size, this study demonstrates that increasing UA levels is associated with the severity of CAD and is an independent risk factor for the occurrence of CAD. Regarding the impact of FA on the severity of CAD, further studies with larger sample size and the implementation of a scoring system for degree of artery calcification are deemed necessary.

Water microbial quality in hemodyalsis centers is particularly important in medicine. The aim of this study was to investigate cultivable bacteria present in outlet of water treatment systems in hemodialysis centers affiliated to Tabriz University of Medical Sciences.This cross-sectional descriptive study was performed in three hemodialysis wards at the hospitals in 2014. Twenty four samples were obtained from the inlet and outlet of the water treatment systems. Bacterial quality of samples were determined with total and fecal coliform bacteria test, heterotrophic plate count (HPC) by membrane filteration technique on blood agar medium and gram-negative bacteria by membrane filtration technique on EMB agar medium. Isolated colonies were identified using standard biochemical tests. Average of pH, temperature and residual chlorine in outlet samples were obtained 6.9, 14.5 °C and zero mg/l, respectively. Total and feacal coliformbacteria were negative at inlet sample, but was postive in one of the outlet samples. HPC at oultel samples from two centers were higher than standart limits of Association for the Advancement of Medical Instrumentation (AAMI). Gram negative bacteria were the frequent species at all samples. Pseodomonaces spp. and Entrobacter spp. were isolated from most samples. The results demonstrates that water treatment devices at hemodialysis centers at hospitals do not provide enough efficiency for water supply according to the microbial quality standards.

The changes of brain waves eventually sub-bands power incidence in the form of clinical protests. Regarding the use of multi-walled carbon nanotubes in neuroscience, the alpha/ theta power ratio is a reliable scale to measure the disorders associated with learning. The present study aimed to examine the effect of this substance examined on brain waves and investigated its possible effect on learning through analysis of brain waves sub-bands. In this experimental study, 10 male Wistar rats (300-280 g, 4 to 6 months) were investigated in one group receiving nanotube. In order to record brain waves, electrodes were implanted in the frontal and the occipital cortex. Brain signals were recorded 15 minutes before and 15 minutes after injection of 1mg / kg carbon nanotube suspension. After suspension injection, the power of gamma and theta sub-bands and the power ratio of theta to alpha sub-bands showed a significant reduction in the after injection intervals compared to baseline (control) (P >0/001). No significant change was observed in the alpha and beta sub-bands (P> 0/05). The results of this study showed that multi-walled carbon nanotubes reduce the power of gamma and theta sub-bands and the power ratio of theta to alpha sub-bands and possibly can lead to disorders associated with learning and memory.

Many areas of Iran are suitable habitat for the snakes. Annually, 4500 to 7000 snakebites occur in the country. Although many books and articles have been published about the snakebite in Iran, but no clinical guideline is available freely for clinicians in Persian language. This paper aimed to present a comprehensive overview of the snakebite in Iran. A detailed search was performed in medical electronic databases and libraries of Urmia University of Medical Sciences. More than fifty scientific papers, textbooks, clinical guides and pharmaceutical brochure were accurately studied and useful details of each reference were recorded. Then the initial draft of the current guideline was prepared and reviewed. Finally, in a focus group with presence of experts from different medical specialties, the final version of current clinical guideline was developed. This clinical guideline contains useful information about the geographical distribution of snakes in the world, general characteristics and identification of snakes, snake venom, clinical presentations, principles of diagnosis, severity grading and details of snakebite management, antivenom administration, prognosis and snakebites in specific groups (women and children) and some recommendations for prevention of snakebite. Despite previous references which have been offered only certain aspects of snakebite, accurate and practical tips required for comprehensive management of snakebite are presented in this article.

The present study was aimed to investigate the effect of stress management on reducing blood sugar through cognitive-behavioral method among type 2 diabetic patients. This research used an experimental design with pre-test, post-test and control group. The samples included 30 patients selected through simple randomization from among the members of diabetes community. Harry’s stress questionnaire and a Glocometer were used for data collection. The pre-test and post-test questionnaires were filled out by the patients. Fasting blood suger (FBS) was measured by the researcher before and after the experiment. Cognitive-behavioral therapy was received by the experimental group over 10 sessions of one hour half. The control group did not receive a treatment. The data were analyzed using a covariance analysis. The results revealed a statistically significant reduction in the mean scores of life quality, blood sugar and stress. Stress management through cognitive-behavioral therapy could be beneficial as an effective part of comprehensive diabetes care.

Epilepsy is a chronic disease of the brain occurring in the form of loss of consciousness, abnormal movements, and emotional disturbances. This disorder may be recurrent and have lifelong durability that requires regular and natural cares. In order to help the sick, the present study compared the theory of mind among tonic-clonic epilepsy, juvenile myoclonic epilepsy and healthy people. This causal-comparative study was conducted on 134 individuals (60 healthy people and 74 patients with epilepsy) who referred to health centers of Urmia city. Baron Cohen’s Reading Mind from Eyes Test (RMET) was used as a study tool. T-tests for independent samples and ANOVA and Scheffe post hoc test were used. Accordingly, the theory of mind in epileptic patients and healthy subjects has a significant difference, and this defect in juvenile myoclonic epilepsy is more than tonic-clonic epileptic patients and normal subjects. The deficit of theory of mind in epileptic patients is affected by same neurological base, drugs and the clinical characteristics, and personality and status of patients. Thus, the evaluation of this theory can explain some of the behavioral and psychological problems for planning effective non-pharmacologic therapy.

Cardiovascular diseases are the most common cause of death in the world and a major cause of coronary artery obstruction. Myocardial infarction is the most fatal form of coronary heart disease that is increasing in developing countrie. This study aimed to investigate the prevalence and distribution of age, sex, type of stroke, premature mortality and risk factors of type in patients with diagnosis of myocardial infarction in Western Azerbaijan province hospitals. This descriptive study was conducted using the medical records of 2337 patients extracted from Ministry of Health data in 2012 and 2013 in Western Azerbaijan province hospitals. The occurrence of myocardial infarction in patients during hospitalization with ECG changes and elevated cardiac enzymes (CK-MB و Troponin) were verified. The data were analyzed using SPSS software and descriptive statistics. The study poulation were 72. 9% male and 27. 1% female with the mean age of 13±60 years, and 45 years of age had the highest distribution. The most important risk factors were smoking (45%) and hypertension (35%), respectively. Lower infarction with 34. 7% had the highest rate and hospital mortality rate was 2. 1% Hypertension is more common in men than in women, the greatest risk factor for myocardial infarction in this study is a history of smoking and hypertension. The location of myocardial infarction was associated with lower heart.