مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد
سال پنجاه و نهم شماره 6 (پیاپی 149، بهمن و اسفند 1395)

Pneumocystis pneumonia (PCP) is one of the most serious life threatening infections in patients with human immunodeficiency virus. It can also occur in immunosuppressed patients treated with immunosuppressive drugs.Immunocompetent adults can carryPneumocystis.The aim of this study was to identify Pneumocystis jirovecii in patients with pulmonary disorder.
During 9 months (September 2014 - May 2015), 138 Bronchoalveolar Lavage (BAL) samples obtained from patients undergone bronchoscopy referred to different departments of University Hospitals of Mashhad.
Giemsa stained smear and molecular method performed for each sample. After DNA extraction, amplification of mitochondrial gene coding ribosomal large subunit (mtLSU-rRNA) of P. jirovecii was performed by Nested-PCR. To reconfirm diagnosis and definite identification, gene sequencing was performed. For statistical analysis t-test and chi-square tests were used, by using SPSS version 16.
By direct microscopy, P.jirovecii was diagnosed in only 3(2.2%) samples, but DNA was detected in 17 (12.3%) by nested PCR. P. jirovecii isolated from 10 (25%) immunosuppressed and 7 (7.1%) of immunocompetent individuals. Fever, dyspnea and dry cough were the most common symptoms among patients with P.jirovecii.
P. jirovecii is prevalent in immunodeficient patients compared to immunocompetent individuals. The latter group can act as reservoir of P.jirovecii and can be an important source of infection for patients with pulmonary disorders.

for the importance of nutritional management in CKD patients before dialysis ¡uremic diet was one of the first dietary-therapeutic objectives in the treatment of patients in the pre-dialysis phase of CKD.This study was carriedout for the analyzes of hospitals uremic diet, and evaluation of its macronutrients and minerals in the teaching hospitals of Mashhad University of Medical Sciences .
This study is a clinical audit and was conducted in the winter of 1393 in Mashhad teaching hospitals.In order to analyze the diet meal¡ the meal plan of one week of three teaching hospitals in Mashhad were collected. The analysis of uremic diet was conducted with Nutritionist IV software .The data was entered in to the software daily and sum of the meals , the amount of macronutriets and micronutrient of each day, was calculated for each hospital. The data analysis was performed using Spss 11,then the data were compared whit references guidelines for CKD patients before dialysis . After evaluation of normalization of data, the level of significance was set at p overal Thirty-six meals served to CKD patients were studied, The average protein content was (2.8 g/kg day)¡carbohydrate content was (52%)¡ energy content was (39.5kcal /kg) and fat content was (21%) . The average of protein and energy content exceeded the recommendation levels. But the amount of carbohydrate and fat contents were almost near the recommendation level .The amounts of Mg (492.58 ± 54.04)¡P(2338.76 ±276.78)¡ K (5003.57 ± 623.97)and Na(2627.71 ±479.57) were higher than the recommended level .Na and K levels exceeded the Upper level. Ca content )1422.66 ± 140.80 (was inadequate for the end stage of CKD patient.
The oral hospital diet prepared for patients with CKD was considered unbalanced, and it was not designed for their nutritional needs.

The RhoB gene is one of the genes that are involved in cancers such as gastric cancer. This gene is contributed in cytoskeletal organization and cell trafficking and its expression is decreased in gastric cancer. There are a VNTR polymorphism in the promoter of the RhoB gene and in this study different genotypes of this VNTR was assessed with risk of gastric cancer, for the first time.

In this study, the VNTR polymorphism of the promoter region in 250 controls and 100 patients with gastric cancer, was assessed by PCR and electrophoresis on agarose gel. Then, the result was assessed by regression logistic and X2 tests. Also expression of the RhoB gene in 19 controls with different repeats in promoter region was compared by Real Time RT-PCR.

Our result showed the 1.9 folds increase risk of gastric cancer with 8 and 9 repeats allele in comparison with 10 and 11 repeats (p=0.044 ). But we found no association of number of repeats with expression of RhoB gene (p=0.605).

The VNTR polymorphism of the RhoB genepromoter is associated with risk of gastric cancer and may be used for screening of gastric cancer if was confirmed by other studies.

Pediculosis has been reported as neglected and re-emerged infestation that caused in addition to direct problems in people, social problems, academic failure and depression. This study aimed to determine the demographic and environmental factors associated with patients with head licein Mashhad.
In this cross-sectional study, data of 3767 persons with Pediculosis who refered to health centers of Mashhad in the fall of 2017 collected and were analyzed with the SPSS20 software. data was described by frequency tables, measures of central tendency and dispersion and data analysis was done with Mann-Whitney, Kruskal-Wallis and chi-square test.
Of 3767 patients, 3362 (2/89%) were women, 1810 (48.7%) in the age group was 12.7 years. Middle age of patients at three years less for women than men (10 vs. 13 years, Pv People in ages 7-12 years and girls are more vulnerable to Lice infection. schools were the most probable places of contamination, and contact with infected person were the most common way of contamination was obtained. lower Family education was assosiated to risk of more infected people in the family.

For the prevention of nosocomial infections, hand hygiene is very important. One of the best ways to destroy microorganisms is using alcohol-based hand hygiene gel. The purpose of this study is was to evaluate the effectiveness of hand hygiene gel when encountering different concentrations of bacteria.
For this study we chose a common hand hygiene gel used in our hospital. Initially, serial dilutions of Staphylococcus aureus were prepared using 1 McFarland turbidity standard suspension in eight tubes. Then different concentrations of bacteria were encountered with the hand hygiene gel. After four different encounter duration a sample was obtained and cultured on blood agar medium and bacterial growth was examined.
Hand hygiene gel was not effective when encountered with the highest concentration of bacteria in all four time-tested, and the entire surfaces of the plates were coated with bacteria, and with decreasing concentrations of bacteria and increasing the encounter duration, the number of bacteria reduced.
This study showed that basic hand hygiene gel was only effective when the number of bacteria was lower than CFU per milliliter and the exposure time was at least 40 seconds. Accordingly, as the average numbers of bacteria on hands are far less than this threshold the routine use of hand hygiene gel is recommended, and in case of high pollution hands should be washed first.

Vitamin C is one of the life necessary soluble vitamins of body composition that its role has been shown in collagen synthesis, immunity, cancer prevention and a lots of enzyme activity. Thyroid function effects of vitamin C supplementation has proposed in some human and experimental studies. The aim of present study was to evaluate the effect of simultaneous consumption of vitamin C and levothyroxine on thyroid function of patients with primary hypothyroidism.
Subjects and In this before-after clinical trial, 73 patients with primary hypothyroidism of both sexes were treated with one brand of levothyroxine sodium (OSVEH Company). Fasting serum levels of T3, T4, and TSH were measured before and 8 weeks after treatment. Then, vitamin C tablet 500mg was added to levothyroxine treatment of the same patients for another 8 weeks. Again, thyroid function was measured at the end of this period. The results considered significant if P value was ≤ 0.05.
With vitamin C, the mean levothyroxine need reduced in 83.6 percent of patients. (P=0.001). The results of present study showed significant difference between mean TSH levels, before and after adding vitamin C. (P=0.001).
Consumption of Vitamin C with levothyroxine, improves primary hypothyroidism control.

Despite the importance of the journal club in eduction, but problems threaten the quality of journal clubs. This study aimed to evaluate the quality of journal clubs in clinical groups in Mashhad University of Medical Sciences from the perspective of residents and faculty members.
Subjects& This cross-sectional study was conducted in 2016 in the Medical School. The sapmle was all the third and fourth year residents and faculty members with more than two years experience
A total of 372 subjects were enrolled which 201 were faculty members (45%) and 163 were assistants (55 %)
The average score given to the conduct of the Journal club in Mashhad University of Medical Sciences was15.3±3.20.The highest score from the perspective of faculty members belonged to the Department of Nuclear Medicine (19) and from the perspective of residents belonged to the Department of Occupational Medicine (18). Average scores in residents and faculties was not significantly different in most groups. However, in orthopedic, ENT, pediatrics, pathology, dermatology and anesthesia, assistants rated the Journal club significantly less than faculty members.
It is suggested that with reforming the journal club, make this training tool more productive.

Ventricular tachycardia attacks are one of the main causes of cardiac death. Ventricular tachycardia attacks can be treated using implantable cardioverter defibrillator (ICD) and this device prevents death due to Ventricular tachycardia attacks. For optimal use of this treatment method, it is better that individuals initially be selected based on clinical or laboratory criteria. This study aimed to evaluate clinical findings predictive of recurrence of heart attacks in patients undergoing ICD therapy.
Subjects & In this retrospective cohort study, all patients referring to Ghaem Hospital in Mashhad from the beginning of 2005 until the end of September 2008 and underwent ICD for various clinical reasons, were included. Data analysis was conducted using R software. The frailty model was used to investigate the effect of factors, including age, gender, family history, ICD manufacturer, QTC and QRS time on receiving appropriate shocks.
Findings: The mean age of patients was 46/63±15.51 years. A total of 30 patients (69.8%) were male and 38 patients (88.4%) do not have a family history of heart disease. In these patients, the mean and standard deviation of QTC and QRS duration were 467.4± 62.87 ms and 110.063± 31.64 ms, respectively. According to the results of frailty model fitting , QRS was the only variable affecting the appropriate shock. (P= 0.0016)
Patients with longer QRS receive more appropriate shocks that are due to recurrent ventricular tachycardia

crohn disease(CD) is a disorder of uncertain etiology that is characterized by transmural inflammation of the gastrointestinal tract. CD may involved the entire gastrointestinal tract from mouth to the perianal area.
Case Report: Fifty years old man in with generalized edema, severe weakness, musculoskeletal disorder, scattered abdominal pain, dyspnea, psychotic state and pallor with history 20 years of crohn.
Physical examination: there were tachycardia, blood pressure= and general edema. In lab test anemia and hypo albuminia reported.
Imaging findings: In abdominal X-Ray in lie position the probability of the presence of air in right subdiphramatic area was reported ,which in chest X-Ray in lie position was not clear. In sonography and CT scan there was some fluid with local collection containing debrides which on aspiration pus collection was seen.
Laparatomy: copious pus collection with fibrin and adhesion without any fistulas or free perforation were observed.
penetration of the bowel most often present as an indolent process and not as acute of down part. For diagnosis of this complication, in addition to clinical manifestation use of all diagnostic methods is needed.