مجله دانشگاه علوم پزشکی رفسنجان
سال چهارم شماره 5 (پیاپی 17، زمستان 1384)

Accurate pathology reporting is important for treatment of malignancies including breast cancer. The aim of this study was to determine the concordance of the current reporting system with international cancer reporting guidelines. Pathology reports of 112 consecutive cases of invasive breast cancer who were treated by modified radical mastectomy and axillary lymph node dissection in different hospitals of Kerman city during 2001 to 2004 were studied. Adherence to the international guidelines for macroscopic and microscopic items were determined. Pathology reports were collected from pathology centers of Kerman University of Medical Sciences, social security organization and private laboratories. Rosai check list was considered as our standard reporting proforma. One hundred twelve cases met the inclusion criteria. The results of reporting of the prognostic criteria were as follow: Histologic type (100%), lymph node status (96.4%), tumor size (93.7%), tumor location (91.2%), histologic grade (87.5%), vascular invasion (85.7%), perineural invasion (83.9%), status of surgical margins (82.3%), calcification (75%), necrosis (74.1%), presence of insitu component (39.3%), tumor multicentricity (38.4%), extent of lymph node involvement (33%), extent of insitu component (23.2%) and level of lymph node involvement (0.8%). In most reports the presence and extent of carcinoma insitu, level and extent of lymph node metastasis and tumor multicentricity have been ignored. Considering the pivotal role of these factors using a standard reporting protocol is suggested.

Bacground and A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The topical anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of EMLA cream with that of orally administered glucose during venipuncture in newborns. A randomized controlled, double-blind study including 220 newborns undergoing venipuncture for clinical purposes was performed. One hundered and six newborns received EMLA on the skin and orally administered placebo (sterilized) and 114 received glucos- 30% orally and placebo (Vit A+D) on the skin. Symptoms associated with pain at venipuncture were measured with the Neonatal/ Infant Pain Scale (NIPS). Crying time was recorded. The results showed that the NIPS scores were significantly lower in the glucose group (mean: 1.89) compared to the EMLA group (mean: 2.81). The duration of crying in the first 2 minutes was significantly lower in the glucose group (median=2 seconds) than in the EMLA group (median=9 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defind as NIPS scores above 3), 12.3% compared with 29.2% in the EMLA group. We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns. Our results showed that glucose is more effective than the local anesthetic cream EMLA.

Coronary heart diseases, specially myocardial ischemias due to atherosclerosis, are among the major causes of mortality in industrialized societies. Oxidative stress occurs during ischemia. This finding has been confirmed by in vitro studies which have shown some changes in antioxidant concentration during ischemia. However, antioxidant system status and its relation to ceruloplasmin as a risk factor have not been studied in patients with ischemic heart disease (IHD). This study was conducted to evaluate this status. This case-control study carried out on 99 men, aged 35-55 years. Two groups including 29 patients with IHD due to coronary artery stenosis above 70 percent, confirmed by angiography and exercise tests, and 70 healthy men without heart disease, diabetes and hypertension background were studied. Blood samples were collected from all subjects early in the morning. Then catalase and superoxide dismutase (SOD) activities, total antioxidant of serum (TAS), ceruloplasmin and malondialdehyde (MDA) concentrations were measured by a spectrophotometric method. TAS, SOD and catalase levels were 0.9 ± 0.04 mmol/L, 1224 ± 21.40 U/g Hb and 5657 ± 290.60 U/g Hb respectively in patients which were significantly lower than those of controls 1.6 ± 0.02 mmol/L, 1488 ± 13.03 U/g Hb and 7546 ± 176.80 U/g Hb (p<0.05). MDA and ceruloplasmin concentrations were 36 ± 0.92 mg/dl, 277 ± 6.90 nmol/g Hb) respectively in cases and 29 ± 0.60 mg/dl and 247 ± 4.20 nmol/g Hb in controls which showed a significant difference (p<0.05). There was no statistical correlation between antioxidants and ceruloplasmin level in these groups. In patients with IHD, antioxidant system capacity was lower than that of controls which can explain higher lipid peroxidation in these patients. Also we can not predict lipid peroxidation severity by measuring ceruloplasmin level because no association was found between these two factors.

Diabetes, is an important risk factor for crebrovascular lesions. Studies obviously demonstrate a higher prevalence, worse prognosis, more relapses and complications and higher mortality rate due to stroke in diabetic patients. This risk is independent from other risk factors, and various studies such as topography of stroke lesions conducted on diabetic patients showed controversial results. This study was conducted to compare the prevalence of location and the number of thrombotic stroke lesions in diabetic and nondiabetic patients in Rafsanjan, Iran. This cross - sectional study was conducted on patients suffering from thrombotic stroke, through the convenience nonrandom sampling. Sixty diabetic cases and 60 nondiabetic controls matched for demographic factors and risk factors of stroke, the MRI images of study participants were analyzed by using EPI6 software. 56.7% of samples were female and the average age of patients was 67.5 years. The majortly of samples (66.7%) had history of hypertension. All together 99 vascular lesions in diabetic patients and 118 vascular lesions in nondiabetic patients were observed. The number of lesions had been increased by increasing patient's age significantly. In diabetic patients parietal lobe, occipital lobe and brain stem and in nondiabetic patients parietal, frontal and temporal lobes were the most frequent location of lesions respectively. The majority of these patients (70%) had more than two vascular lesions. The number and the site of cerebrovascular lesions showed no significant difference between diabetic and nondiabetic patients. There was no significant difference between diabetic and nondiabetic patients concerning the number and site of cerebrovascular lesions. However, trombotic stroke in diabetic patients with hypertension had a specific clinical pattern, with a low progress but a sudden appearance and high rate of morbidity and mortality. It can be concluded that stroke in these patients should be diagnosed and treated rapidly.

Proteases are among the most important industrial enzymes. Alkaline proteases are used primarily as cleansing additives. As alkaline pH and temperature stability are two main important factors of enzyms for their addtion to detergent's formula, it is desirable to search for new proteases with novel properties from different sources. The purpose of this study was to isolate an alkalophilic bacillus sp. with possibility of alkaline protease production and then purification of the produced alkaline protease. Isolation and purification of proper colonies from soil samples were performed. After characterization of taxonomic and biochemical specifications of colonies, they were cultivated in a specific liquid culture medium (alkaline pH) and then selected bacillus 2-5 was cultivated in a proper culture medium. The enzyme was isolated and purified as fallows: 1- Ammonium sulfate precipitation (saturation percentage, 55%) 2- Ultra filtration 3- Cation exchange chromatography (CM- cellulose). Alkaline protease activity was checked by determination of equal concentration of tyrosine as a product at λ=275 nm after alkaline hydrolysis of casein as a substrate. Bacillus 2-5 was selected because only it had growth and alkaline protease activity. It had both amylolitic and proteolytic activities at alkaline pHs but no gelatinolytic activity was found. Purification progression was demonstrated by gel electrophoresis (PAGE). Molecular weight of alkaline protease by SDS-PAGE and was measured by using protein standard solutions this was 24700 Dal. The yield of purification was 24% and parification, was 50 times gain factor, as found by other researchers. The purified enzyme was monomer because electrophoretic mobility at PAGE was the same as SDS-PAGE.

Imported mineral Trioxide Aggregate (MTA) as a root –end filling material has many applications in root repairing and bone healing including direct pulp capping, repair of root and furcation perforation, and apexification. By introducing a similar material, made in Iran, namely Root MTA, primary tests such as cytotoxicity test should be performed. The purpose of this study was to compare the 24h and 48h cytotoxicity effect of Root MTA on peripheral blood mononuclear cells using MTT Assay. In this study, after blood sampling, peripheral blood mononuclear cells were isolated on a gradient of ficole hypac. After several washing phases, cells were cultured in RPMI with 10% FCS in 96 well U shape microtiterplates in a 5% Co2 incubator. Serial dilution of MTA and Root MTA were added to the wells. Cell cytotoxicity was determined, 24 and 48 hours after treatment by MTT Assay. Cytotoxicity of Root MTA was less than that of MTA (ProRoot). At 24 hours after culture there was significant difference between cell viability affected by Root MTA and MTA in the three different dilutions 20 λ, 50 λ, and 100 λ (p<0.05). At 48 hours, there was also a significant difference between cell viability after using Root MTA and MTA in two dilutions 50 λ, 100 λ (p<0.05). Root MTA could be considered as a proper alternative for MTA. For ther studies such as clinical trials should also be performed.

Injuries due to accidents have been known as one of the most important cause of disability and death in human communities. Of these, accidents in construction industry are in particular important. This study is conducted to determine factors related to occopational accidents of construction industry and to recognise the outcomes of these accidents in Rafsanjan. Our population comprised all cases who were working in construction industry and were registered as having an occupational accident during 2000 to 2002 based on vecords obtained from the central office of labor and social affairs in Rafsanjan. Information about age, gender, the latest educational qualification, marifal status, type of activity, experience, cause of accidents, sites of injury, and the outcome of accident were collected. Parametric tests (z-test, t-test, correlation test) and non-parametric tests (Chi-Square, Fisher Exact) were used to compare groups. Mean age was 35.8±11.1 years (n=70, min=11 yrs, max=55 yrs). A vast were male (98.6%, n=69) and 83% (n=58) were married. In 36% (n=25) and %30 (n=21) of cases, the accident was due to carelessness and inadequate usage of protective equipment, respectively. The biggest proportion of cases (23%, n=16) were employed in welding activities and the least proportion of injured people were electric workers (7.9%, n=5). A big proportion (45%, n=31) of cases had an experience of less than 5 years. About 18% (n=12) of cases were died due to accidents and 30% (n=21) of cases had a long-term outcome of disability for the rest of their lives. Conclussion: It can is concluded that occopational health education programs specially for younger employees with a short work experience are strongly suggested. Protective equipment should be available and workers should be persuaded to use these equipment.

Nicotine is the most abused drug in the world Experiments have shown that repeated administration of nicotine may increase the responsibility to the drug, whereas small amounts of nicotine may increase behavioral responses including locomotor activity. The aim of the present study was to investigate the role of nitric oxide and possible dopamine mediation in nicotine-induced behavioral sensitization. Since, it is hypothesized that dopaminergic pathways within the brain are responsible for sensitization, apomorphine has been used. Apomorphine was also used to evaluate the interactions between nitric oxide and brain dopaminergic pathways. In the present study, the effects of L-arginine (a nitirc oxide precursor) and L-NAME (a nitric oxide synthase inhibitor) on the acquisition and expression of nicotine-induced behavioral sensitization in female N-MARI mice (body weight 20-25 g n=7/group) were investigated. Animal activities were recorded by an infrared activity meter. In order to evaluate the effetcs of the drugs on animal locomotor activity, animals were received different doses of nicotine (0.25, 0.5, 0.75, 1 and 1.5 mg/kg), L-arginine (5, 10, 20 and 50 mg/kg), L-NAME (5, 10 and 20 mg/kg) apomorphine (0.125, 0.5 and 2 mg/kg). L-arginine and/or L-NAME were injected to the animals either 20 min before each nicotine or apomorphine administration during the sensitization phase (acquisition) or 20 min before nicotine or apomorphine challenge dose (expression). Results showed that administration of nicotine (1 mg/kg) caused significantly reduced, while apomorphine (0.125 mg/kg) significantly increased in animal's locomotor activity. While L-arginine administration did not change the animal's activities, injection of L-NAME (10 and 20 mg/kg) significantly reduced animals activities. Administration of L-arginine (5-50 mg/kg) before nicotine injection did not affect the nicotine-induced behavioral sensitization but did inhibit apomorphine-induced behavioral senitization. Injection of L-arginine (5-50 mgkg) reduced the expression of behavioral sensitization in nicotine and apomorphine senstized mice. L-NAME (5, 10 and 20 mg/kg) injection reduced both acquisition and expression of nicotine and apomorphine-induced behavioral sensitization. It could be concluded that inhibition of nitric oxide synthesis caused the inhibition of behavioral sensitization to nicotine and apomorphine. Considering these findings, it seems that nitric oxide inhibits nicotine-induced behavioral sensitization via brain dopaminergic pathways.

Acinetobacters are opportunistic pathogens. Nowadays these bacteria are are among the pathogens causing nosocomial infections, so the aim of this study was to identify of acinetobacter in surgical Intensive Care Unit (ICU) in Rasoul Akram hospital and to assess the possibility of transferring antibiotic resistance by conjugation method. In this study 100 samples were collected from respiratory tubes, respiratory secretion, intensive care unit room, food trays, bed's wheels, serum tubes and bed sheets of patients in hospitalized at Rasoul Akram hospital. Bacteria were isolated and identified by using standard bacteriological methods. After identification, antibiogram tests were done performed to determine the antibiotic sensitivity. After this phas, conjugation were done between donor and recipient strains in BHI broth medium. From all 100 collected samples, 21 samples acinetobacter was isolated. Isolated acinetobacters showed 100% resistance to rifampin, penicillin, erythromycin and tetracycline, 95/2% resistance to gentamicin, nalidicsicacid, amikacin, seftizokcim, streptomycin, sephazolin, and cloroamphenicol, 90/5% resistance to seftazidim and cyprofelocsazin. They showed maximum sensitivity 28/6% to sulfumetoxasol. Isolation of acinetobacter from surgical intensive care unit showed the contamination of this unit with this opportunistic pathogen bacteria. So more care for sterilization of this unit and tools that are used are suggested. Suitable use of antibiotics for prevention of producing multiresistant bacteria and nosocomial infections are necessary too.

Type 2 diabetes is the most common form of diabetes and accounts for 90% of all cases. The number of diabetic patients in IR Iran is estimated to be about 1.5 million. Identification of diabetes risk factors and trying to remove them, can prevent or delay it. The relationship between type 2 diabetes and genetic factors is stronger than the relationship in type 1 diabetes. The concordance of type 2 diabetes in identical twins is 70-90%. Obesity particularly visceral is very common in type 2 diabetes. The risk of diabetes increases with increasing age. Prevalence rates of diabetes are strongly different among different ethnic groups. Women with a history of gestational diabetes have a 50% risk of eventually developing diabetes in the next 20 years of their lives. High blood pressure (=>140/90mm hg) could be an early sign of underlying insulin resistance, related to central adiposity. Risk of diabetes in persons with high blood pressure is twice the normal persons. Low birth weight is often followed by accelerated postnatal growth and this may be important for assessing the risk of diabetes. Impaired glucose tolerance (IGT) test is typically characterized by hyperglycemia and insulin resistance. Persons with IGT without changing their lifestyles develop type 2 diabetes in 10 years. Insulin resistance has been observed in women with polycystic ovary (PCO) syndrom. It is estimated that 35-50% of women with PCO have impaired glucose tolerance test. Stress stimulates the release of various hormons, which may cause elevated blood glucose levels. Smoking is not a well-documented risk factor for type 2 diabetes. In spite of this diabetes and CHD have many common causal factors. Large-scale prospective studies have shown that smoking is associated with the development of type 2 diabetes. However larger scale and long-term studies are needed to clarify the role of smoking as a risk factor of diabetes.