مجله دانشگاه علوم پزشکی بابل
سال نوزدهم شماره 2 (پیاپی 113، بهمن 1395)

Nowadays, anti-phospholipase A2 receptor (PLA2R) antibody is recognized as a diagnostic biomarker for idiopathic membranous nephropathy (iMN) and is also used to assess disease progression. Considering the differences in the prevalence of this antibody in various geographic regions, this study aims to evaluate the level of anti-PLA2R antibody in different types of glomerulonephritis and its relationship with proteinuria and creatinine clearance.
This cross-sectional study was conducted among 115 patients with diagnosis of glomerulonephritis and nephrotic syndrome. The patients were divided into three categories of iMN (34 patients), secondary membranous nephropathy (9 patients) and other types of glomerulonephritis (72 patients) based on their clinical history and test results. Demographic data, latest creatinine level, volume, protein and the 24-hour urine creatinine were recorded and the creatinine clearance was calculated. The serum level of anti-PLA2R antibody was measured and the level of antibody ≥ 20 RU/ml was considered positive. The level of antibody was compared between the three groups and the relationship between antibody levels and creatinine clearance and proteinuria was assessed in patients with iMN.
FINDINGS: The mean age of the patients was 38±13 years. 81 patients (70%) were female. The mean (SD) antibody level in iMN patients was significantly higher than secondary membranous nephropathy and other types of glomerulopathy (129.9±190.1, 2.6±1.7, 2.0±1.6, respectively, P Results of the present study demonstrated that the presence of anti-PLA2R antibody specifically indicates idiopathic membranous glomerulonephritis. However, antibody level is not associated with disease severity

Urinary incontinence is a common health problem among elderly population, particularly elderly women, and it is necessary to identify the different risk factors that cause urinary incontinence. The present study was designed to assess this problem among elderly women in Babol and the risk factors associated with it.
In this cross-sectional study, 590 elderly women over 60 years old in Amirkola were studied using census method. The required data were collected using standard checklists and questionnaires. Any form of involuntary withdrawal of urine, wetting the pad or underwear was considered urinary incontinence.
FINDINGS: In this study, the mean age of subjects was 68.2 ± 6.8 years and 194 out of 590 women (32.9%) had urinary incontinence. The marital status (OR: 0.64 (CI-95% =0.42-0.98), p=0.04), constipation history (OR: 1.63 (CI-95% =0.11-2.39), p=0.01) and use of corticosteroid drugs (OR: 1.7 (CI-95% =1.01-2.95), p=0.05) were directly related to urinary incontinence after matching with other risk factors. However, urinary incontinence in elderly women was not related to factors such as age, obesity, education, number of children, chronic diseases like diabetes, blood pressure and respiratory disorders.
According to the results of this study, one third of elderly women in Babol suffer from urinary incontinence and unmarriedness, constipation history, and use of corticosteroid drugs increase the possibility of this condition, which necessitates the need for more attention to this problem and its risk factors that have significant emotional effects on elderly women.

Whooping cough is an acute contagious human respiratory disease especially in infants and children and is one of the ten major causes of death from infectious diseases. Despite reducing the risk due to vaccination with killed bacteria pathogen (Bordetella pertussis), increased disease emerged in recent decades indicates re-emerging due caused by genetic diversity of bacteria and the insufficiency of current vaccines. Therefore, the design of new and effective vaccines based on common strains of the population is essential. In this study the prevalent strain Iranian B.pertussis strains has been selected for gene amplification of pertussis toxin (PTX), the most important antigen of bacteria. The toxicity of the PTX related to its enzymatic activity therefore by site directed mutagenesis, the effective residues in the active site of the enzyme has been changed and the inactive and safe recombinant was produced.
Bacterial strain used in this study to determine the genome and gene amplification was selected from pathogenic strains isolated from Iranian patients from the pertussis reference laboratory of Microbiology of the Pasteur Institute of Iran. Genomic DNA was extracted by kit, ptx- s1(the enzymatic fragment of PTX) fragments amplified and inserted in pUC18. Site directed mutagenic primers were used for substitution of Arg 9 by Lys and Glu129 by Gly. The confirmed mutant ptx- s1 (mptx-s1) was sub-cloned into expression vector pET15b. The expression of recombinant protein in E.coli BL21 was induced by 0.5mM IPTG. The expression was analyzed by SDS-PAGE and immuno-blotting. The protein was puifird by Ni-NTA affinity chromatography under denature condition.
FINDINGS: Sequencing data and restriction enzyme analysis confirmed the gene constructing and mutations. The presence of a 28 kDa band in SDS-PAGE and immunoblot showed the expression of mutant PTX. The concentration of recombinant protein was 0.36 mg/ml.
The Recombinant protein which was obtained in this study provided the possibility of designing acellular vaccines on the basis of important antigens of prevalent strain of B.pertussis in Iran.

Human error and timeless in conventional techniques to identify species Enterococcus faecium and Enterococcus faecalis are two species of the pathogenic species in humans, more accurate techniques is essential. The aim of this study is to design a method of quickly and accurately using DNA melting by Real Time PCR technique to identify and separate the two species in clinical isolates.
In this experimental study, the bacterial isolates in the Department of Microbiology Bank of Hamadan University of Medical Sciences was used. Design of primers was done by proprietary software and selecting DivIVA gene for Enterococcus faecalis and alanine racemase for Enterococcus faecium was performed. Isolates identification was evaluated by using Real Time PCR test and melting curve temperature of DNA.
FINDINGS: Susceptibility of primers designed in divIVA gene (specific for E. faecalis) and alanine-racemase gene (specific for E. faecium) was 15CFU/ml per reaction. Specificity of designed primers by using DNA melting curve analysis was 76.6 for E. faecalis and 80.93 for E. faecium which showed considerable different in comparison with another microorganism.
Using the results obtained in this study, primers designed were sensitivity and specificity for diagnosis and differentiation of Enterococcus faecium and Enterococcus faecalis species in clinical isolates.

Training the patients and their follow-up after discharge from coronary care units (CCU) play a significant role in their rehabilitation. This study aims to evaluate the effect of telephone follow-up programs after hospital discharge on hope and the quality of life in patients admitted to the coronary care unit (CCU) in Social Security Hospitals in Mazandaran Province, North of Iran.
In this case-control study, 60 patients (30 patients in control group and 30 patients in case group) were randomly selected among patients admitted to the coronary care unit (CCU) in Social Security Hospitals in Mazandaran. Data collection was done using Hope Miller questionnaire containing 48 questions and World Health Organization Quality of Life questionnaire containing 26 questions. All patients were provided with the required training before discharge while the case group received an additional one-month telephone follow-up. Finally, the two groups were compared in terms of hope and quality of life, one month after discharge.
FINDINGS: At the time of discharge, the two groups were almost identical in terms of hope and quality of life. However, after one month, hope (155±33 in case group and 138±25 in control group) and quality of life (87±15 in case group and 75±11 in control group) improved significantly in case group (p=0.025 and p=0.001, respectively).
Results of the study demonstrated that telephone follow-up for patients discharged from CCU significantly improves their hope and quality of life. Therefore, telephone follow-up needs to be considered as an accessible and low-cost method to improve the quality of life and hope in patients with heart disease.

Teucrium polium plant from Lamiaceae family and evolvable in a range of climate types and used in traditional medicine to treat diseases and also has antimicrobial effects is significant. This paper was done to compare the antimicrobial effects T. polium plants grown in Iran with the around of the world.
In this review study using keywords Essential oil, Medicinal Plants and Teucrium searching was done in the databases Pubmed, Science Direct, Elsevier, SID, Magiran, Google Scholar, Food and Agriculture Organization of the United Nations (FAO) and World Health Organization (WHO).
FINDINGS: A total of 269 articles were identified with the desired subject of who 86 were selected for further investigation. Failure to select other articles, was away from the goal the finding of this study showed that the α-Pinene¡ β-Pinene¡ Spathulenol, Verbenene, β-Myrcene were the main components of T. polium essential oil was grown in Iran. Amount of MIC, MBC value against pathogenic bacteria and inhibition diameter of T. polium was grown in Iran In comparison with the elsewhere in the world was not significant.
T. polium plant can be used as an effective antimicrobial compounds. The dose should be determined in various experiments and controlled manner taking the risk of toxicity occurs.

Vitamin D-dependent rickets type II (VDDR2) is a rare genetic disorder caused by mutations in vitamin D receptor (VDR) and leads to resistance to biological effects of calcitriol. Based on the type of mutation, this disease is resistant to calcitriol even at high doses of calcitriol and successful treatment of these patients requires hypocalcemic modification through administration of high doses of calcium and bypassing the intestinal defect in VDR signaling. In addition to the need for frequent hospitalization and high costs, intravenous administration of calcium is associated with complications and problems such as arrhythmia and sepsis, venous catheter infection and hypercalciuria. This study aims to report the positive treatment effects of high doses of oral calcium in 4 patients with vitamin D-dependent rickets type II.
CASE REPORT: In this study, 4 patients with vitamin D-dependent rickets type II, diagnosed based on clinical and biochemical symptoms of rickets with alopecia, underwent therapy using high doses of oral calcium (300 mg/kg/day) in pediatric endocrinology and metabolism center of Imam Reza hospital. After a short period, increased growth rate in height, strength and elasticity of muscles was observed in addition to biochemical improvements without serious side effects and even one patient started walking independently within the first week of therapy for the first time. Patients were regularly followed up in terms of height and weight, growth rate and biochemical factors including calcium, phosphorus and alkaline phosphatase every 3 months for one year.
Regardless of the type of mutation in vitamin D receptor, it is suggested that a 3-6 months trial of high dose oral calcium be started in each patient with vitamin D-dependent rickets type II, particularly for patients whose disease was diagnosed at lower ages.

Genetics, hormone profiles and other physiologic factors can cause hair loss. Medication induced hair loss is an occasional side effect of many psychopharmaceuticals. It can reduce medication compliance if not discovered and treated. We present a 18 year old female with migraine headache who developed hair loss after 3 months of receiving topiramate treatment.
CASE REPORT: 18 year old female had been suffering from headache visited in psychiatric clinic. She agreed to a treatment with topiramate (50mg per day) for Migraine headache. 3 months later, the patient complained of significant hair loss. Topiramate tapered to 25 mg/day and stopped. Hair loss stopped after topiramate withdrawal. Two weeks after reintroduction of topiramate, hair loss developed again. The medication was stopped and hair loss stopped again.
Topiramate can cause hair loss. Although the condition is not life-threatening, a decrease in medication compliance can cause recurrence of the underlying disease. It is necessary to ask the patient at visits about it.