مجله دانشگاه علوم پزشکی قم
سال دهم شماره 1 (پیاپی 48، فروردین 1395)

Activation of AT1 receptor (type 1 angiotensin II receptor) has an important role in the pathogenesis of renal ischemia-reperfusion injuries. In the present study, the effect of losartan on the level of reactive nitrogen species (RNS) and renal function in renal ischemia-reperfusion injuries, was assessed in rat.
Eighteen male Wistar rats were randomly divided into three groups of sham, control ischemic, and ischemic treated. Ischemia was induced by occlusion of renal arteries for 60 min. Losartan (10mg/kg) were injected intraperitoneally one hour before ischemia, and also 24, 48, and 72 hours after ischemia. Blood samples were collected for measuring creatinine before and 72 hours after ischemia. Finally, NOx concentration and histopathological changes were assessed 72 hours after ischemia.
The mean of creatinine concentration in the animals in sham and control ischemic groups at the beginning of experiment were 0.37±0.21 and 0.27±0.14mg/dl, respectively. Induction of ischemia significantly increased creatinine concentration (2.75±2.26mg/dl) in the control ischemic group (p=0.020). The NOx concentration significantly increased in control ischemic group (29.49±5.93nmol/mg protein) compared to sham group (1.00±0.23nmol/mg protein), (p>0.001). Losartan significantly decreased the concentration of creatinine (0.68±0.52mg/dl) in the ischemic treated group (p=0.044), and considerably decreased the NOx level in ischemic treated animals along with histhopathological altrations (53%).
The use of losartan can effectively prevent renal ischemia-reperfusion injuries through reduction of RNS and improve the function of the ischemic kidney.

Dysthymia is one of the categories of mood disorders, which is defined by depressed mood at most times of the day. The aim of the present research was comparison of the effect of rational-emotional and mindfulness-based treatment methods on symptoms of dysthymia disorder in women.
In this quasi-experimental study that was performed as pretest-posttest with control group, 20 women with dysthymia disorder were selected randomly from treatment centers under the supervision of wellbeing organization and assigned to two groups of experimental and specific. Beck depression questionnaire and clinical interview were used for diagnosis and pretest-posttest. Data were analyzed using dependent and independent t- and chi-square tests.
In this study, both rational-emotional and mindfulness-based methods of had significant effect on the reduction of dysthymia symptoms (p The results of this study indicated that mindfulness-based and rational-emotional treatments are effective cognitive treatment methods in reducing symptoms of dysthymia in women, of which mindfulness-based treatment method is more effective.

Low back pain is one of the areas of body and mind interaction. Treatment of chronic low back pain by active rehabilitation included training of social-psychological skills along with therapeutic experiences, which has been increasingly supported in recent years. The aim of the present research was to determine the effect of active rehabilitation on the functional ability and quality of life in patient with chronic low back pain.
This study is experimental with a pretest-posttest design with a control group. The statistical population was all patients with chronic low back pain who were referred to physiotherapy clinics of Ardabil city in 2012. Thirteen subjects with chronic low back pain were selected conveniently and assigned randomly to two groups of experimental and control (each n=15). Data collection was performed using pain coping inventory, physical activity indicator, Quality of Life questionnaire of the World Health Organization, and musculoskeletal complaints indicator. The intervention method in this research was active rehabilitation treatment, which was implemented in 10-30 sessions of 30 minutes each. The research data were analyzed using multivariable analysis of variance (MANOVA) on the differences between the scores of pretest and posttest variables.
In this study, active rehabilitation was effective in the improvement of physical activity, quality of life, increase in cognitive-behavior strategies, and decrease in pain symptoms.
The findings of this research indicate that active rehabilitation is effective in functional ability and quality of life of patients with chronic low back pain.

Escherichia coli (E.coli) is an opportunistic Gram-negative bacterium, which causes common nosocomial infections, including pneumonia, septicemia, meningitis, diarrhea, bacteremia, etc. Antibiotic resistance is a serious problem for human health, so that the World Health Organization in called the year 2011 as the year of antibiotic resistance. One of the reasons of these resistances is production of broad-spectrum β-lactamases (ESBLs), which are able to hydrolyze broad-spectrum β-lactam antibiotics. This study was performed aiming at determining the prevalence of cefotaxime-resistant strains and evaluating the ESBL genes (bla TEM, bla SHV and blaCTX-M) in E. coli isolates.
In this cross-sectional study during a 5-month period (April to September 2014), specimens sent to the laboratory of Ali-Ibne Abi Talib Hospital of Qom, such as blood, urine, wound, etc., were examined. After identification and isolation of E.coli strains, their antibiotic resistance and ESBL production were determined by disk diffusion method, MIC, and combination disk method according to CLSI guidline. Then, detection of blaCTX-M, SHV, and TEM genes was performed using PCR.
Of 160 isolated E. coli and based on the results of disk diffusion and MIC, 31 (19%) isolates were resistant to cefotaxime. Also, based on the phenotypic results, 24 (77%) cefotaxime-resistant ESBL-producing strains, were idetified. The blaCTX-M, blaTEM, and blaSHV genes were determined in 90%, 42%, and 3% of the strains, respectively.
The results revealed that prevalence of ESBL-producing E .coli is high. Therefore, there is a need to manage the use of antibiotics and identify the source and distribution of β-lactamase-producing isolates.

Backgrounds and High-quality health care depends on comprehensive information of medical record, and high-quality care is very difficult without accurate information. Given the importance of the observance of principles of diagnosis recording in clinical records and their educational, therapeutic, research, legal, and statistical application and given lack of knowledge about the existing situation, this research was conducted to determine the rate of observance of principles of diagnosis recording in the clinical records in the hospitals affiliated to Qom University of Medical Sciences.
This research was conducted as a descriptive-analytical study on medical records of the patients of hospitals affiliated to Qom University of Medical Sciences (including 6 centers) in 2014. The number of statistical sample was estimated to be 398. Data were gathered using a checklist. Data were analyzed by Fisher's exact test and independent t-test.
In this study, assessment of the observance rate of principles of diagnosis recording in medical records, showed that the highest observance was for the observance rate of diagnosis recording principles with 58%. Then, recording principles of medical measures with 50%, and external causes of events with 5.5%, were respectively in the second and third levels.
According to the findings of this study, it seems that more attention and effort of authorities, physicians, and experts of medical records to this issue in the hospitals affiliated to Qom University of Medical Sciences and holding educational classes for physicians, and admission staff and nurses, are necessary.

One of the most common problems in hospitals is infections caused by Pseudomonas aeruginosa that is an opportunistic pathogen for humans. Five important enzymes, including exotoxin A, Y, T, U, S are major virulence factors in this bacterium. The purpose of this study was to determine the frequency of these enzymes in the samples isolated from hospitals of Qom city and to determine their antibiogram pattern against third-generation cephalosporins using CLSI standards.
In this cross-sectional analytical study, 120 strains of P. aeruginosa isolated from various clinical specimens from hospitals of Qom city, were examined. At first, bacteria were identified using biochemical tests, and then their antibiogram pattern against thirdgeneration cephalosporins was obtained according to CLSI standards.
After genome extraction (extraction kit of Sinaclon Co.), primers design and evaluation were performed through NCBI website, and PCR reaction was conducted to evaluate each gene. After electrophoresis, the bands’ results obtained from PCR reaction, was
observed in gel doc system.
The frequency of the isolates in the samples of skin, blood, lung, and urine was, respectively, 63.2, 16.1, 16.1/, and 4.1%. The frequency of exotoxins A, T, U, S, and exoenzyme Y were respectively obtained to be 100, 37.9, 26.4, 39.1, and 29.9%.
According to the results of this study, drug resistance and presence of virulence factors, such as exotoxins can be a serious warning to treatment centers in terms of control of disease caused by this bacterium.

Cutaneous fungal infections are common infections, which involve keratinized tissue (skin, hair, and nail). Dermatophytes are important and abundant cutaneous fungal agents. The aim of this study is to assess the epidemiology of dermatophytes and the prevalence of various type of tinea in Tehran province for better identification and treatment of patients.
Five hundred and eight patients suspected to have dermatophyte infections, after clinical examination, were referred to mycology laboratory of Razi Hospital in Tehran city for definite diagnosis, and then using direct examination and slide culture technique, and finally molecular examinations, the causative fungus of infection was diagnosed. Data were analyzed by chi-square statistical test at the significance level of (p£0.05).
Of 161 obtained positive samples, 73 (45.3%) patients were female and 88 cases (54.7%) were male. The mean age of patients was 42 years. The most and least common types of tinea were tinea pedis with 71 cases (44.1%) and tinea faciei with one case (0.6%), respectively. Trichophyton mentagrophytes was the the most isolated species and the least was Microsporum ferrugineum.
According to the results of this study, dermatophyte infections in different parts of the body, especially foot and groin, are considered as an important health problem in Tehran city. It seems that design and implementation of training programs with the purpose of primary and secondary prevention, especially for age group over 20 years, are necessary for reduction of cases of dermatophytosis.

High prevalence of drug abuse in the Society and its associated health-social problems presents a significant and important challenge to health care systems and large communities. This study aimed to assess risk factors of drug abuse in the students of second course of high school in Shahroud city.
The present study was performed as a descriptive cross-sectional study on 460 students of second course of high school in Shahroud city (2013-2014 school years). Schools were selected randomly and samples were selected using systematic random sampling from each school. Data collection was carried out using valid and reliable questionnaires of risk and protective factors for adolescent drug abuse and also national-level standardized questionnaire of prevalence of risky behaviors. Data were analyzed by Chi-square test.
In this study, of 12 studied risk factors, students were assigned to high risk group in terms of 2 risk factors; medium risk group in terms of 5 risk factors; and low risk group in terms of other factors. There was significant relationship between gender and some risk factors, including sensitivity to anxiety, lack of parental supervision, perceived social disorder, impulsivity, and lack of social skills.
According to the results of this study, prevention programs for drug addiction in adolescent, should be based on the status of the risk factors in each part of the community and also gender differences in terms of vulnerability to various risk factors.

Infertility problem has involved different communities around the world. Psychosocial consequences of infertility affect both infertile men and women. The current study was conducted with the aim of providing required information for health system planners in the health sector and infertility treatment.
In a meta-analysis study and by use of random-effects models, all Persian and English articles were searched using valid keywords (epidemiology of infertility, infertility, prevalence of infertility). In initial search, 84 articles was available. After reviewing full-text articles, finally 52 articles were selected for analysis. Data were combined using meta-analysis (random effects model).
Based on the studied articles, the total mean of infertility was 10% (95% confidence interval: 8-12). The lowest and highest prevalences of infertility have been reported in Australia and Africa, respectively. Meta-regression scatter plot of infertility prevalence showed that prevalence of infertility increases with increasing the year of research, but this difference was not statistically significant (p=0.602).
Based on the results of this study, about one-tenth of the world's population suffer from infertility, and infertility trend has been increasing in recent years in most parts of the world.

Pseudomembranous colitis is an advanced form of infection with clostridium difficile, which damage epithelial cells following colonization in the intestine and production of toxins A and B. Diarrhea is the most common clinical manifestation caused by C. difficile, which in these cases, blood is never observed macroscopically in the stool. Antibiotic exposure is the main risk factor for this infection and is especially associated with ampicillin, clindamycine, and 2nd and 3rd generation cephalosporins, such as ceftriaxone, cefotaxime, and ceftazidime. To confirm the diagnosis of infection, assessment of the microorganism toxins in the stool by PCR as well as observation of pseudomembrane in colonoscopy, was performed. In this article, a case of an old patient with diarrhea (pseudomembranous colitis) was presented in this article.
Case Report: The patient is an 85-year-old man with signs of weakness, fatigue, fever and chills, and non-productive cough and diagnosis of pneumonia underwent antibiotic therapy, and in the course of treatment, he demonstrated massive watery diarrhea. Laboratory colonoscopy findings was indicative of infection with C. difficile.