مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و نهم شماره 1 (پیاپی 144، فروردی ن و اردی بشهت 1395)

Acinetobacter baumannii, an opportunistic gram negative bacteria, is a threat in hospital infections, especially in ICU wards due to the high survival ability and talent to get different antibiotic resistance. So far, there are few reports about sensitivity patterns of multi-drug resistant Acinetobacter baumannii (MDR), especially carbapenem resistance from various hospitals in Mashhad, Iran.
In this study 54 strains of MDR from referral burn unit of Imam Reza hospital in Mashhad were collected during October to March 2013. Sensitivity pattern to antibiotics was determined by Kirby-Bauer method for each isolate. Frequency of various genes responsible for resistance to carbapenem was studied for each isolte by PCR method.
The rate of resistance to tested antibiotics was more than 95%. In addition, this study showed the high prevalence of blaVIM, blaIMP, blaTEM, blaADC, OXA-Like23, OXA-Like24, OXA-Like51, OXA-Like58 and ISAba1 genes, that mediated resistance to betalactam antibiotics.
These results indicate that all isolates were resistant to betalactam antibiotics. These results suggest more study on rational usage of carbapenems for treatment of infections by Acinetobacter baumannii.

One of the advantages of intravenous regional anesthesia is rapid return of normal sensation and power of movement at the end of the surgery. The aim of the present study was to compare the effect of different doses of granisetron in combination with lidocaine in intravenous regional anesthesia.
In this double blind clinical trial, from May 2014 to July 2015, ninety patients who were candidate for forearm Orthopedic surgeries entered the study. Patients in the first group received 0.5% lidocaine (3 mg/kg), one mg granisetron in the second group, and also 2 mg granisetron in the third group in combination with 0.5% lidocaine (3 mg/kg). Pain during surgery and after it was assessed using visual analog scale.
The results showed that mean pain of patients immediately after the inflation of tourniquet and at minutes 15, 30 and 45 in the third group was significantly lower than the other two groups (p=0.0001) and also the difference between granisetron groups (second & third groups) and first group was significant. The average time of onset of tourniquet pain was 33.50±7.56 minutes in the first group, 41.33±4.96 minutes in the second, and 44.70±4.39 minutes in the third group and this time in both granisetron groups (second & third groups) was significantly higher than the first group (p=0.0001).
It seems that using granisetron can significantly reduce the pain during and after forearm surgery.

Health information seeking and knowledge acquisition can play an important role in the management of chronic diseases such as diabetes. This research was carried out in order to study how diabetic patients that referred to Mashhad diabetic center acquired health knowledge.
This descriptive analytical cross-sectional study was carried out on 185 patients with diabetes in Mashhad in 2015. Data were collected by using questionnaire that its validity was confirmed by two medical informatics experts and reliability was confirmed by test-retest. Data were analyzed using descriptive statistics and analytic statistics such as Chi-squared test by applying SPSS 22 software.
The average age of the patients was 61 and 63% of them were women. About 62% of diabetic patients had not acquired any knowledge about their disease after diagnosis of diabetes. Overall 38% of the patients did not relay on the acquired information and %23 of them stated inaccessibility to appropriate information resources such as internet, physician and diabete centers, as the reasons for not acquiring knowledge about their illness. From the view point of the patients (62.5%), the best resources for knowledge acquisition were physicians and the diabetes specialized centers.
Lack of knowledge acquisition and awareness about chronic disease such as diabetes are common problems among diabetic patients. This can lead to serious complications in patients and can impose high costs on health care system. Therefore, it is essential that health professionals use the effective methods for transferring information to this group of patients.

The most important factor in resistance to beta-lactam antibiotics in Acinetobacter family is extended-spectrum beta-lactamases (ESBLs) and OXA is one of the most common ESBL enzymes. The aim of this study was to determine the frequency of bla-OXA-2 and bla-OXA-10 resistance genes among Acinetobacter strains isolated from patients referred to teaching hospitals of Zahedan city, Iran.
This cross-sectional descriptive study was carried out on 100 Acinetobacter isolated from patients referred to teaching hospitals of Zahedan, Iran in 2013-2014. The isolates were identified using standard biochemical and microbiological tests. ESBL production was determined in isolates by Combined Disc test. The presence of bla-OXA-10 and bla-OXA-2 in clinical isolates were investigated by PCR technique.
The results of antimicrobial sensitivity tests revealed that the highest resistance was against ampicillin (100%), oxacillin (100%), cefotaxime and cefexime (99%), whereas the highest susceptibility was observed for colistin (93%). PCR results showed that among the 24 isolates of ESBL positive, OXA-2 gene in 5 cases (20.8%) and OXA-10 in 4 cases (16.66%) were positive.
The results of this study showed the presence of OXA-2 and OXA-10 type ESBLs among drug resistant Acinetobacter strains that reminded the necessity of preventive measures for inhibiting dissemination of these resistant isolates.

Subclinical hypothyroidism is a relatively common disease with different etiologies. zinc deficiency that is common in Iran is suggested as a potential cause of subclinical hypothyroidism .The aim of this study was the evaluation of the role of plasma zinc in subclinical hypothyroidism.
This cross-sectional study was performed in Mashhad in Khorasan Province between 2009-2010.Atotal of Fifty- seven patients with subclinical hypothyroidism as case group and 57 patients with age- and sex-matched , normal thyroid function were enrolled. Zinc and TSH in controls and TSH, Anti-thyroid peroxidase, free T4 or free T4 index in case group were measured. Results were analyzed with SPSS version 11.5. Based on distribution of variables, parametric and non-parametric tests for comparing means and evaluation of correlation were used.P value less than 0.05 was considered significant.
Mean of plasma zinc was 83 μg/dl in case group and 90 μg/dl in control group and difference between them was statistically significant ( p=0.022) .Frequency of zinc deficiency was 10.5% in case and 14% in control group. There was no statistically significant correlation between plasma zinc level and TSH and Anti-TPO in case group.
There was a negative correlation between zinc level and TSH in patients with subclinical hypothyroidism but this correlation was not statistically significant. So this study does not support the role of plasma zinc in subclinical hypothyroidism.

Retinal vein occlusion causes sudden visual loss and macular edema.Visual improvement after intravitreal Bevacizumab in recent years is argued in this study. To define the Bevacizumab effect on visual outome in retinal vein occlusion.
All attendants who had a diagnosis of retinal vein occlusion after ophthalmic examination enrolled in this study. The logarithm of the vision set, before 1.25 mg Bevacizumab injected intravitrealy was compared with postoperative visual acuity of log Mar of 1, 3 and 6 months after injection. The possible side effects of intravitreal injection of Bevacizumab ,after 1, 3 and 6 months were recorded. The Cross Kalvalys ,Wilcoxon and Friedman rank correlation coefficients of α≤0.05 were assessed in study.
The mean age of 39 patients was 60.70 ± 10.9 years. The mean disease duration was 2.29 ± 2.72 months. There was statistically significant difference in mean Log Mar visual acuity regarding the duration of time. Mean visual acuity before injection was 1.58 ± 0.81, a month after the injection 0.93 ± 0.77, three months after the injection 1.16 ± 0.97, and six months after injection, 1.27 ± 1.
The Bevacizumab has significant role in improving vision in patients with retinal vein occlusion, although ocular complications after intraocular injection of Bevacizumab are far less than other similar approaches but few no responding occur which develop neovascular glaucoma.

Obsessive-compulsive disorder (OCD) is a prevalent psychiatric disorder among adolescences that leads to functional impairment so it is necessary that the researchers assess the appropriate treatment methods. In addition to routine medications, cognitive-behavioral therapy and neurofeedback are applied for treatment. The present study aimed to compare the efficacy of cognitive-behavioral therapy (CBT) and neurofeedback on symptoms of adolescence obsessive-compulsive disorder.
This clinical trial conducted in 2011-12 and its statistical community was the OCD adolescents who referred to a private clinic in Mashhad, Iran.Over all 24 adolescents (12-18 years) who received the score >70 in Wechsler IQ test and the diagnosis of OCD according to the clinical interview by a child and adolescents psychiatrist and DSM-IV criteria were selected through available sampling method and they were divided into CBT and neurofeedback groups randomly. The participants fulfilled the Yale-Brown Scale before and after intervention (10 weekly sessions). Data analyzed by descriptive statistics, variance analysis, T test, and SPSS software version 16.
The two groups were matched in variables of sex and education. The scores of Yale-Brown Scale were not significantly different in pre-test (p=0.421). These scores were reduced significantly after intervention in CBT group (p=0.001) and neurofeedback group (p=0.000) but the effect of neurofeedback was more compared to CBT (P=0.014).
Based on the results, both cognitive-behavioral therapy and neurofeedback have significant effects on reduction of symptoms of obsessive-compulsive disorder among adolescents but the effect of neurofeedback was more significantly compared to cognitive behavioral therapy.

Given the high prevalence of Type 2 diabetes and it’s psychological, social and economic negative effects, nowadays empowerment approaches to type 2 diabetic care have been extended. This study intented to investigate the status of empowerment index and its related factors in type 2 diabetis Patients of Sirjan city.
This cross sectional study was performed on 160 type 2 diabetic patients referred to health centers in Sirjan. Patient's empowerment was measured by DES (Diabetes Empowerment Scale) self-report scale. Collected data were analyzed using SPSS software (version 18) and descriptive and analytical statistics.
Respondents aged in range of 35 to 81. Mean duration of diabetes was 3.2±2.4 years. The mean score of Diabetes Empowerment Scale among respondents was 101.5±12.5. Setting and achieving diabetes goal was considered as the most important domain in measuring diabetes self-management. 35% of participants had optimal control according to World Health Organization criteria. Diabetes empowerment index showed a significant and positive relation with educational level and duration of diabetes (pThe study showed that efforts to improve the ability of diabetics can result in better control of the disease. Empowering can be achieved only if the patients receive the necessary information and are actively informed and educated about their health condition.