مجله دانشگاه علوم پزشکی اراک
سال نهم شماره 1 (پیاپی 34، بهار 1385)

In many studies, immunogenicity of Brucella proteins such as P39 in animals is investigated. In this study, we evaluated antigenicity of recombinant P39 from Brucella abortus in patients with Brucellosis. In this experimental study, at first recombinant P39 was produced in Escherichia coli. Sera reactivity of six infected individuals against the recombinant P39 protein was analysed by Western Blot. Data indicated that P39 protein from Brucella abortus was recognized by patients, sera antibodies. Our data showed that recombinant P39 protein can be detected as an antigen by sera in infected human. Therefore, recombinant P39 have same epitopes with natural form of this antigen.

The main goal of treatment and care of chronic patients including those suffering from end stage chronic renal failure is to promote their health and their quality of life (QOL). Various researches have shown that health level, performance status and QOL, especially for hemodialysis patients are often less than expected. So, an attempt to find effective and cost benefit education methods in this area seems to be necessary. This study is done to compare the effects of two educational methods of direct and indirect (multimedia educational package) self-care program on QOL and physical problems of hemodialysis patients. This quasi experimental research was carried out on two groups of hemodialysis patients. Sixty three patients were selected from three main dialysis centers in Tehran and allocated randomly into two groups (group one 32 and group two 31 patients). The first group used the direct educational program and the second group used the indirect educational package (multimedia). Patients were assessed before education using QOL questionnaire (short form SF-36), need assessment questionnaire and checklists. After determining educational needs and status of the patients, a self care educational program was designed based on self care model and the principles of patient education and also through counseling with nephrologists and nutritionists. The educational program was implemented directly on group one (direct education). Also it was recorded and indirectly used for the second group as a multimedia educational package once a week within one month during dialysis. After implementation of the self care educational program, both groups were assessed and measured again by same questionnaires and checklists. Data was analysed using student T, Wilcoxon and Mc Nemar tests. Findings showed that most of studied variables including laboratory tests, blood pressure, weight gain between two dialysis, skin itching, edema and some vascular complications are decreased significantly in each group before and after education. QOL was also significantly improved in each group. But there was no significant difference between the two groups. Since, there was no significant difference between the two groups in terms of efficiency of two methods of direct and indirect (multimedia) educational self care programs and also due to the problems and higher costs of the direct educational program comparing to the indirect method, the indirect method is recommended as an effective, cost benefit, simple and patient-friendly method for hemodialysis patients.

A high prevalence of HCV infection among hemodialysis patients has been reported worldwide. Risk factors such as history of blood transfusion, duration of hemodialysis and recently nosocomial transmission of HCV in hemodialysis units have been identified. In this study the prevalence of Hepatitis C virus antibody and risk factors in hemodialysis patients in Markazi province is investigated. In this cross-sectional analythical study, blood samples were obtained from all 204 hemodialysis patients. Samples were tested for anti-HCV antibodies by using third generation enzyme immunoassay. The reactive samples on ELISA were confirmed by the third generation RIBA. Risk factors were evaluated by a questionnaire. Data was analysed using Chi square and logistic regression. The prevalence of anti-HCV antibody among hemodialysis patients was 4.9%.Duration of hemodialysis was identified as a major risk factor in transmission of HCV (p=0.004). There was a significant relationship between anti-HCV positivity and previous renal transplantation (p=0.032). Female sex was another risk factor for HCV infection (p=0.030). There was no significant relationship between anti-HCV positivity and history of blood transfusion. Nosocomial transmission of HCV within hemodialysis units seems to be a route of infection in patients on hemodialysis in Markazi province. Application of dialysis precautions recommended by CDC can reduce the prevalence of HCV infection among hemodialysis patients in this province.

Diabetes is one of the most prevalent diseases in the world. Today there are 100 milion diabetics around the world and in Iran it is about 1.5 milion. The prevalence of symptomatic neuropathy is 15% but with NCV it will increase to 50%. Regarding the suffer produced by neuropathy and that there is no effective treatment for that, this is necessary to investigate new treatment options. This is a clinical trial study, done during a 3 months period in vali-e-asr hospital in year 2004. 100 diabetic patients were selected randomly and divided into two equal groups. A complete sensorimotor assessment was performed and a questionnaire consisting history and clinical symptoms including limb pain, murmur and paresthesia and examinations such as pin prink test, position and vibration assessment, was completed. NCV was also done and blood sugar and HbA1c was measured. In case group 2000 micrograms vit B12 was prescribed twice weekly and in control group 10mg nortiptiline every night was prescribed. After 3 months patients were assessed again. Data was analysed using mean and standard deviation and Chi square, K-S, Leven, T and Mann Whitney tests. Based on visual analage scale the difference between pain number before and after treatment was decreased 3.66 (3.66-4.25) in case and 0.48 (0.54-1.13) in control group (P<0.001). Also the difference between paresthesia number before and after treatment was decreased 2.98 (2.51-3.44) in case and 1.06 (064-1.47) in control group (P<0.001). The difference between murmur number before and after treatmat was decreased 3.48 (2.93-4.02) in case and 3.48(2.93-4.02) in control group (P<0.001). There was no significaut difference between NCV, vibration, position and pin prink test results. Changes in clinical symptoms in case group in comparison to those in control group was significant, but changes in physical assessment findings (pin prink, Position, vibration and NCV) was not significamt.

Diagnosing parturients in risk of cesarean section early in the beginning of active phase of labor, is very important. This may let take necessary action to accelernate labor (delivery) and prevent maternal mortality and morbidity due to late cesarean section. During a period of 8 months from July 2004 to March 2005, 216 primiparous women, with term pregnancy and cephalic single fetus, referred to Imam Reza hospital in (during) active phase of labor, were studied. Changes of cervical dilatation and descent of the conceptus were observed. Parturients were devided to two groups, vaginal delivery and cesurean section. Protraction or arrest disorders were the indications of cesarean deliveries. Findings were analysed through using T-Test, unilateral variance and Chi square test. The more changes in cervical dilatation in the first 2 hours of active phase of labor, the less possibility of cesarean delivery (p<0.001). Also the more rate of the conceptus descent in the first 2 hours of active phase of labor, the less rate of cesarean section (p<0.001). There was no significant statistical relationship between condition of membranes at the onset of active labor and method of delivery, however there was a significant relationship between oxytocin augmentation and method of delivery (p<0.001). In primiparous women with term pregnancy, vaginal delivery would be fairly predictable by observing changes of cervical dilatation and conceptus descent during the first 2 hours of active phase of labor.

Estimation of fetal weight is very important in preventing delivery complications and also in selecting delivery method. This is specially important in potential macrosomia, IUGR and also preterm labor. The objective of this study is to compare the accuracy of ultrasonic, clinical and mother, fetal weight estimation in pregnant women in Kerman. In this cross sectional study 246 women with singleton, term pregnancies admitted for cesarean section within the following week, were studied. Estimation of fetal weight (EFW) was done using sonography and then by two obstetricians and one senior resident who were unaware of the other clinical and ultrasonic results. Mother's estimation of their baby weight was also asked. Statistical analysis was done by paired T and Chi square tests. We also used ROC (Radar Operating Characteristics) curve to compare the accuracy of different tests. Fetal birth weight was 3339±443 gr. In the 2500-4000 gr birth weight the sensitivity of predicting clinical birth weight was 11.8% with 99.6% specificity and for sonographic EFW was 12.6% with 92.1% specificity. Clinical estimation of birth weight in term pregnancies is as accurate as routine ultrasonic estimation obtained in the preceding week of delivery.

Many progresses has been made in the field of digital replantation which is based on progresses in microsurgery and surgeons skills in hand trauma. In this study, procedure and results of 97 digital replantatios are investigated. In this descriptive study 66 patients with 97 amputated fingers, who underwent replantation were studied. Only completely amputated fingers were studied and fingers with even the least connection to the proximal stump by a skin bridge were omitted from the study. Amputations were at the level or distal to the MCP joint. Success rate of replantation was %57.7 which is 56 fingers from the total of 97 fingers. 58 patients were male and 8 female. Patients age was between 9-52 years. The total hospitalization period was 3-5 days for unsuccessful and 12-16 days for successful replantations. After the operation, Aspirin was used as the anticoagulant and heparin was used only after reexploration or in severe crushing injuries or in cases with vein graft use. Type of surgery and postoperative care was the same in all patients. Based on the results, it seems some reasons of lower success rate in our study in comparison to other countries are wrong transportation method of the amputed fingers and delay in patient transportation. Also surgeons, skill in plastic surgery seems to be effective.

Free radical-mediated peroxidation of biological molecules, such as lipids, is implicated in the pathogenesis of multiple sclerosis and it's animal model experimental allergic encephalomyelitis(EAE). Low concentration of antioxidant vitamin E has been observed in serum of multiple sclerosis. However, it is not known whether vitamin E has protective effect in EAE. Vitamin E may inhibit EAE by effect on the level of uric acid and Nitric Oxide (NO) production. In this experimental study some male C57BL/6 mice were placed in two therapeutic groups (n=8 per group) with age and weight-matched as follow: 1)Vitamin E-treated EAE mice (10mg/kg/every two days of vitamin E given i.p from day-3 until day+19 after disease induction, 2) Non-treated EAE mice (EAE control) received vehicle alone with same schedule. In addition, 5 age and weight-matched male C57BL/6 mice served as normal (non-EAE) controls. Clinical score of disease, uric acid and NO levels of the groups were analysed. Results showed that vitamin E-treated mice had significantly less clinical score of EAE (4±0.8) than non-treated EAE induced mice (5.3±0.44), (p<0.01). Also, there was difference at the onset day of the disease between vitamin E-treated and non-treated EAE-induced mice (day 13±1 and day 11±1, respectively), although was not significant. Concentration of uric acid in vitamin E treated mice were significantly lower than EAE control (p<0.001). There was no difference at the level of NO between the groups. Vitamin E had no effect on NO level, but decreased serum uric acid level. It suggests that vitamin E can reduce or delay the onset of EAE by increasing uric acid consumption.

Renal cell carcinoma can be presented with extension of thrombosis to renal vein and inferior vena cava. Management of these patients consists of radical nephrectomy and thrombectomy. In this study we reviewed approach to these patients. This is a case series report. During 1379 to 1384, 148 patients diagnosed with renal cell carcinoma (RCC) limited to Gerota’s fascia (stage T3 or less) were admitted to Hasheminejad hospital. Fourteen patients had inferior vena cava (IVC) involvement. Radical nephrectomy as well as thrombectomy was performed in 8 patients. This investigation is done on these 8 patients. Patient's average age was 51.4 years. Six patients were male (75%) and 2 female (25%). The most common symptoms were flank pain (75%), gross hematuria (62.5%) and structural symptoms (50%). All patients had tumors limited to Gerota’s fascia without any distant metastasis. Infrahepatic involvement of IVC was seen in 6 patients and in 2 patients thrombosis extended above the hepatic vein (infrahepatic). No perioperative mortality was seen. Postoperative complications were atelectasia in 2 patients and deep vein thrombosis in one which was treated with conservative management. By skillful surgical approach in patients with RCC and IVC involvement, thrombosis can be completely excised without increasing the rate of complications and longterm survival could be expected.

Intruduction: Testicular feminization syndrome is a disorder with the prevalence of 1 in 20000 to 64000 male births. It,s characteristics are female phenotype, male caryotype (64XY) and normal to increased testosterone and LH levels. In this article a case of testicular feminization is reported. Case: The patient was a 16 years-old woman with primary amenorrhea and without secondary sexual characteristics. The patient had normal female external genitalia, absent axillary and pubic hair, immature breast, and repaired bilateral inguinal hernia with pathology report of immature testicular tissue. FSH and LH levels were elevated. Testosteroe level was normal. Sonography and CT scan of pelvis did not show uterus and adnex. Karyotype was 46XY. It is recommended that due to the risk of neoplasia, the existing testes must be removed. Also hormone therapy must be done for the patient.