Journal of Advances in Medical and Biomedical Research
Volume:27 Issue: 120, Jan-Feb 2019

Quinolones are the antibiotics used to treat infections. Several reports have indicated the increased resistance to quinolone in K. pneumoniae strains all over the world. The aim of this study is to investigate amino acid substitutions in GyrA and ParC proteins among quinolone-resistant isolates of K. pneumoniae in Borujerd )west of Iran( hospitals.

Totally, 100 isolates of K. pneumoniae were collected. After validating the isolates by conventional laboratory methods, an antimicrobial susceptibility test was carried out for some antibiotics from the quinolones family. Quinolone resistance and Minimum Inhibitory Concentration (MIC) of Ciprofloxacin were detected by disk diffusion and E-test methods, respectively. The amplification of gyrA and parC genes in quinolone-resistant strains was performed by PCR using specific primers. PCR products were sequenced in order to detect the mutations in gyrA and parC genes.

Generally, 38% of all the collected isolates were resistant to Nalidixic acid and Ciprofloxacin, 18% were resistant to Ofloxacin, and 15% were resistant to Norfloxacin. Concurrent resistance to Nalidixic acid, Ciprofloxacin, Ofloxacin, and Norfloxacin was determined in 15% of the cases. In 86% (n=20) of Ciprofloxacin-resistant strains, MIC was measured 128 μg/mL. The mutation rate was 40% (n=9) in gyrA gene in quinolone-resistant strains and 35% (n=8) in parC gene.

Briefly, our research findings reveal that relatively high resistance to quinolones as well as fluoroquinolone was observed among K. pneumoniae isolates in Brojurd hospitals. It is likely that mutation occurrence in certain positions of gyrA and parC genes has a significant effect on developing high-level resistance to quinolone in K. pneumoniae.

Parkinson is a neurodegenerative disease that leads to incurable and debilitating conditions. Herbal extracts can afford protection against neurodegenerative diseases due to their bioactive compounds. In the present study, we investigated the effect of hydro-alcoholic extract of B. carduchrum on catalepsy and brain oxidative stress in rat’s model of Parkinson’s disease.
Rats were randomly divided into five groups of eight animals. The control group was left intact. Parkinsonian group received an injection of 6-hydroxydopamine (6-OHDA) in the right anterior mid-brain. Extract treated groups received hydro-alcoholic extract of B. carduchrum at doses of 100, 200 and 400mg/kg by gavage seven days after 6-OHDA injection. 14 days after treatment, bar test was performed and lipid peroxide levels of different brain regions were determined. Data were analyzed by ANOVA followed by Tukey's test using SPSS software and P<0.05 was considered statistically significant.
In 6-OHDA-lesioned group, bar time was increased significantly (P<0.05) when compared with the control group (122.50±90.12 versus 0.00±0.00). B. carduchrum at doses of 200 and 400mg/kg significantly reduced 6-OHDA induced catalepsy (P<0.0.5). 6-OHDA treatment leads to significant increases in lipid peroxide levels of cerebellum, cortex, hippocampus and striatum (P<0.05). Administration of B. carduchrum extract at different doses caused significant reduction in the lipid peroxide levels of different brain regions (P<0.05).
B. carduchrum extract ameliorated 6-OHDA -induced catalepsy and lipid peroxide level of brain in rat’s model of Parkinson’s disease.

Several studies have shown that topical and intravenous Dexmedetomidine and Lidocaine can decrease pain and reduce consumption of analgesic drugs. However, Lidocaine may be accompanied with several side effects such as respiratory suppression, seizure, and cardiac arrhythmias. On the other hand, Dexmedetomidine has favorable properties such as low risk of apnea, analgesia, sympatholysis, and sedation. Therefore, the aim of this study was to compare the effects of nebulized Dexmedetomidine and nebulized Lidocaine on hemodynamic characteristics of the patients undergoing bronchoscopy.
In the present randomized, double-blind study; 75 children (1-6 years old) undergoing fiber-optic bronchoscopy were allocated to three groups. Group 1 received nebulized solution containing 2 µg/kg of Dexmedetomidine. Group 2 received nebulized solution containing 4 mg/kg of Lidocaine 1%. Group 3 received nebulized solution containing 0.9% of normal saline as the control group. Heart rate, mean arterial blood pressure and SpO2, Bispectral Index (BIS) were measured and compared. BIS, indicating the depth of anesthesia was considered as a confounding factor. Statistical analysis was performed using SPSS software.
The mean of arterial blood pressure and heart rate was significantly lower in group 1 compared to groups 2 and 3 during bronchoscopy (P< 0.05). Blood oxygen saturation and sedation scores were significantly higher in group 1 compared to the other groups during bronchoscopy (P< 0.05). Furthermore, the hemodynamic parameters were more stable in group 1 compared to the other groups during recovery.
Premedication with nebulized Dexmedetomidine was significantly associated with more stable hemodynamic parameters and lower risk of side effects compared to nebulized Lidocaine in children undergoing fiberoptic bronchoscopy.

Metabolic syndrome is defined as a cluster of metabolic disorders, which may lead to type II diabetes and cardiovascular diseases. The aim of this study was to investigate the effect of 8 weeks of aerobic training and Nigella sativa supplements on insulin resistance, lipid profiles, and plasma levels of HbA1c in Type 2 diabetic rats.
35 male Wistar rats were divided into five groups. Diabetes was induced by intraperitoneal injection of streptozotocin. The training program included 8 weeks of aerobic training on a treadmill. The supplement group consumed N. Sativa supplement at the end of each training session at the dose of 400mg/kg/day. After 8 weeks of aerobic training and N.Sativa consumption, the plasma levels of HbA1C, insulin resistance and lipid profiles were measured.
The results showed that blood glucose level in all three groups was significantly lower than the baseline (P=0.0001). Cholesterol, triglyceride and LDL showed the most significant decrease in aerobic and combination training groups (P=0.0001). In HDL index, aerobic and combined exercise groups showed a significant increase (P=0.0001). Hemoglobin A1c index and insulin resistance in the combination group showed a significant decrease compared to the other groups (P=0.0001).
The results show that exercise along with N. Sativa supplement is more effective than N. sativa supplement or exercise alone in the status of rats with type 2 diabetes. This kind of combination therapy may also be applicable to diabetic patients.

Epidemiology and predisposing factors of spondylodiscitis or vertebral osteomyelitis are different in different populations. This study was conducted to delineate the epidemiology and microbiological status of in Hamedan, Iran.
In this retrospective study, all patients with definite diagnosis of spondylodiscitis (changing of intervertebral disc and adjacent vertebral MRI signal) hospitalized in Besat and Farshchian Hospitals of Hamedan between 2006 and 2015 (during 10 years) were enrolled by convenience sampling. Data on age, gender, underlying disease, constitutional symptoms, place of acquiring infection, leukocytosis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), surgical intervention, vertebral biopsy culture, anemia, abscess, place of vertebral involvement, positive brucellosis test, and blood culture results were obtained from the patients’ medical files and recorded in a questionnaire.
A total of 71 patients with spondylodiscitis (mean age: 49.56 years) were enrolled. Brucella (n: 27, 38%) was the leading cause of the disease followed by tuberculosis (n: 11, 15.5%). Although 34 patients had positive serologic test for Brucella, other agents were causes of the disease according to course of treatment and vertebral biopsy in 7 of them. In 21 cases, the cause of the disease was unknown. The most common place of involvement was lumbosacral region (78.9%).
Unlike Infectious Diseases Society of America (IDSA) guideline that do not recommend to perform age-guided aspiration biopsy in suspected cases of spondylodiscitis when Brucella is endemic and whereby people have strong positive serology, our results demonstrated that, even in case of positive Brucella test, other factors are likely to contribute to acquiring spondylodiscitis, and vertebral biopsy is recommended for definite diagnosis. Early diagnosis is necessary to select appropriate antibiotic and treat spondylodiscitis early.

Diabetes mellitus (DM) is one of the most common metabolic disorders that cause a high annual cost of patients care and health services in a society.  Given the fact that DM management is very important, the present study aims to investigate the effect of combined therapy with fenugreek and nutrition training based on Iranian traditional medicine on FBS, HgA1c, BMI, and waist circumference in type 2 diabetic patients.
This randomized double blinded clinical trial was conducted on patients with type 2 diabetes in Tehran (Iran) during 2017. Patients were randomly divided into four groups, including: G1 [fenugreek powder (10g/two times per day) with nutrition training), G2 [wheat flour (placebo) with nutrition training), G3 [fenugreek powder (10g/two times per day) without nutrition training], and G4 [wheat flour (placebo) without nutrition training]. 
This study was done on 125 patients (43% male and 57% female). There was no significant difference in demographic characteristics of all groups. The mean of FBS in G1, G2, G3 and G4 significantly decreased by 62, 12, and 23 units, respectively (P<0.001). The mean of HbA1c in groups G1, G2, and G3 declined by 0.77, 0.31 and 0.5 units, respectively. The mean of BMI in groups G1, G2, and G3 decreased by 1.38, 0.82 and 0.89 units, respectively. Furthermore, waist circumference reduced in all of three groups by 7.11, 3.8 and 3.18 units, respectively. There was no significant change in mean value of these parameters in G4 group.  
Given the positive effect of fenugreek and nutrition training on FBS, HbA1c, BMI, and waist circumference, it can be suggested for blood glucose control in diabetic patients. Interestingly, combined therapy with fenugreek and nutrition training was more effective in reducing blood glucose, indicating the importance of this combined therapy for blood glucose control in DM patients.

Esophageal cancer (EC) has been identified as one of the most common cancers in the northeastern regions of Iran.  In our study, parametric non-mixture cure rate model was applied to evaluate the effects of risk factors on the long-term survival of patients with EC in East Azarbaijan, Northeastern Iran.
This retrospective cohort study of 127 patients with EC registered at Iran National Cancer Registry office in the period 2009-2010. These patients were followed up for 5 years in East Azarbaijan, Iran until 2015. The best parametric cure rate model was identified and the risk factors of survival in patients with EC were measured by Akaike Information Criteria and parametric non-mixture cure rate model, respectively.
The survival time of EC patients ranged 0.10-69.03 months. Male sex (Odds Ratio (OR) =0.08, 95% confidence interval (CI):0.02-0.32, p-value<0.001), patients who underwent esophagectomy surgery (OR=6.11, 95%CI: 1.46-25.55, p-value=0.013) had a significant effect on the survival and the cure fraction of EC patients. Population cure rate was 0.11 (95%CI: 0.07-0.19) and cure fraction was estimated 4.9%.
The Weibull non- mixture cure rate model was the most appropriate statistical tool to identify potential risk factors that affect both survival and cure fraction of EC patients. It is a recommended tool for analyzing the long-term survival of patients with EC.

A 32-year-old man with dyspepsia and rectorrhagia dating back 3 weeks underwent endoscopy and colonoscopy. Upper GI endoscopy revealed a 2×2cm submucosal lesion at the gastric body. Endoscopic ultrasonography confirmed GIST and surgery was recommended. Colonoscopy diagnosed left side inflammatory bowel disease (IBD) (ulcerative colitis). Abdominal CT scan and sonography had no apparent abnormality. The pathology report confirmed low grade, spindle type gastrointestinal stromal tumor (GIST). Treatment was started with oral Mesalazine and Asacol enema. As the abdominal and pelvic CT showed no metastasis, a complete surgical resection of the tumor was performed and in a 6-month follow up, the patient had no problem.

IBD patients are at an increased risk of malignancy due to chronic inflammatory state and the use of immunomodulator agents. Thus, the risk of malignancies at the beginning of the disease is low and its occurrence is rare.  The most common cancer in such patients is adenocarcinoma and GIST is somehow rare, with a small number reported in literature. Since the presence of GIST is not related to disease activity, it should be considered in differential diagnosis in patients with controlled IBD who are still symptomatic.