مجله دانشگاه علوم پزشکی رفسنجان
سال پنجم شماره 2 (پیاپی 19، تابستان 1385)

Organ transplantation is revolutionized since production of cyclosporine. Considering the increased incidence of cytomegalovirus (CMV) infection in patients with transplantation, this study is designed to evaluate the relationship between cyclosporine blood level in patients undergone kidney's transplantation and the rate of CMV infection. This retrospective descriptive study evaluated 511 kidny's transplanted patients for cyclosporine blood level and rate of CMV infection during 100 postoperative days in Labbafinejad hospital (2001-2003). 57 (11%) out of 511 developed CMV infection. The minimum interval between surgery and infection was 20 days, the maximum interval was 99 days with a mean of 56 days. Mean blood cyclosporine levels in infected and non-infected patients were 383.3 and 310 ng/ml respectively. This difference was statistically significant (p<0.05). We conclude that CMV infection is closely related to cyclosporine blood level. In order to obtain more efficacy and less cytomegalovirus infections, careful cyclosporine blood level monitoring (<300 ng/ml) is recommended.

Cardiac complications are the major cause of morbidity and mortality in patients with Beta Thalassemia Major (BTM). Increased left ventricular mass index is due to ventricular hypertrophy after iron overload. The purpose of this study was to assess the relationship between left ventricular mass index (LVMI) and diastolic function and early diagnosis of cardiac involvement by echocardiography. This cross-sectional study was conducted on 44 patients with BMT and a healthy control group (matched based on age and sex) in Ali-Asghar hospital of Zahedan from September 2002 to December 2003. After physical examination, complete M-Mode, 2D and Doppler echocardiography studies were performed and left ventricular diastolic and left ventricular mass index were assessed and these data were compared with those of the control group. From 44 patients 24 were male. The mean age was 14.3+2.9 years. The mean weight, height and body surface area (BSA) were 34.5±7.4, 142.2±12.3, 1.16±0.17 respectively. Compared to the control group, the mean weight, height and BSA in cases were decreased, the mean heart rate increased and systolic and diastolic blood pressures decreased significantly. LVMI increased significantly (50% compared with that of the control group) too. Cardiac output stroke volume and also heart rate increased significantly due to increased left chamber size. Systolic function was in acceptable range in all subjects excluding 5 patients. Diastolic dysfunction was more common and isovolumic relaxation time (IVRT) was the most frequent abnormal diastolic index which increased significantly with increment of LVMI. The results of this study showed that prolonged IVRT and LVMI had a significant correlation. Therefore the assessment of LVMI and diastolic function is a must that leads to early diagnosis of cardiac dysfunction.

Neonates have complete insight into the pain. Pain not only causes physiologic and emotional alteration in neonates but also has long-term detrimental effects. Circumcision using dorsal penis nerve block is one of the most common surgical procedures in male neonates. Despite this method is effective, it has few complications. For instance, there is the risk of injecting lidocain in the vein and also there is the possibility of formation of hematoma on the injection site. However, lidocain spray does not cause these complications. The present study is conducted to compare the effect of these two methods on the level of pain after circumcision. This randomized clinical trail study was conducted on 54 neonates who were circumcised. Of these, 25 neonates were anaesthetized using lidocain spray 10%. The remaining (n=29) were received dorsal penis nerve block for the local anesthesia. The severity of pain was measured using Neonatal Infant Pain Scale (NIPS) in three different occasions when the circumcision procedure was being condacted (time 0), and 15 and 30 minutes after circumcision. Mann Whitney U test and t-test were used for comparing the severity of pain in the two groups. In both groups severity of pain was decreasing over the time. The severity of pain among those who received dorsal penis nerve block was less than that of neonates in the other group in both occasions during circumcision (time 0) and 15 minutes after circumcision. However, there was no significant difference of pain severity between the two groups 30 minutes after circumcision. During circumaision and 15 minutes after the procedure, the effect of lidocain spray on the pain of circumcision was less than the effect of dorsal penis nerve block. However, 30 minutes after circumcision the effect of lidocain spray on the pain was comparable with the effect of dorsal penis nerve block method. It can be concluded that regarding the physiological and emotional responses after circumcision, in comparison with lidocain spray, dorsal penis nerve block can be a more effective method for relieving the pain caused by circumcision. However, more investigations are needed to study the side effects of this method.

The role of ascorbic acid (AA) in plasma lead reduction under lead exposure conditions, has been investigated in both human and animal studies for several decades. These studies had contradictory results, especially concerning lead toxicokinetics. This investigation has been performed to study the effects of ascorbic acid supplementation on plasma lead levels of workers who were occupationally exposed to lead. In a randomized, double-blind, placebo- controlled clinical trial, a total of 24 men were randomly divided into two similar groups. Each group received one of the following daily supplements for two weeks 1000mg AA in cases and placebo (starch) in controls. At baseline, at the end of the 2 week supplementation, and also 4 weeks after the end of the supplementation, plasma and total blood�ascorbic-acid levels as well as plasma lead�levels were measured. The differences between the ascorbic acid, blood lead as well as plasma lead levels in 2 groups and also in different stages were assessed. Results indicated that at the end of a 2 week supplementation, lead plasma levels in cases significantly decreased compared to those of the controls (p<0.05) and also to baseline levels (p<0.01). In addition, 4 weeks after the end of the supplementation, plasma levels of lead decreased significantly in case group compared to those of the controls (p<0.05) and also to baseline levels (p<0.05) Using AA supplementation can be considered as a useful harmless, economical and convenient prophylactic agent for lead-exposed population.

The genus of sarcocystis, zonotic parasites, have two hosts in their life cycle. They have also special importance in industrial veterinary. The serological tests are the best methods for detection of the parasite. This research was planned for isolation of sheep sarcocystis specific protein for using in serological laboratory tests. The infected muscles of sheep carcass were collected from Tehran slaughter house and transferred to our laboratory. The sarcocystis were isolated from the infected muscles and crude antigen was prepared. The crude antigen was fragmented by serial dilution of ammonium sulfate solution and followed by size exclusion chromatography. Crude antigen was electrophoresed by SDS-PAGE and its protein bands were detected by commassi brilliant blue staining. We used different concentrations of ammonium sulfate for precipitation and after by size exclusion chromatography, a 35kDa protein band was separated and observed by SDS-PAGE. The protein band of sheep sarcocystis which can be used as antigen in serological methods was parified and detected.

Poor educated people in some parts of Iran use burned mantles as a wound healing powder to prevent the bleeding and infections caused by injuries. Some lantern mantles contain low levels of radioactive thorium for maximizing the light output, while non-radioactive mantles contain yttrium. Although radioactive lantern mantles may cause a minimal radiation health hazard, it is generally believed that it would be dangerous when inhaled or ingested. This study was conducted to evaluate the effect of burned radioactive lantern mantles on wound healing. Twenty rats were divided randomly into two groups of 10 animals each. After inducing general anesthesia, full thickness excision wound (314±31.4 mm2) was made on the dorsal neck in all animals. The 1st group received topical burned radioactive lantern mantle powder at 1st-3rd day after wound excision. The presence of radioactivity in the mantle was detected using a Monitor-4 survey meter. The 2nd group received non-radioactive lantern mantle powder at the same days. Accurate blind surface measurement of the wounds was performed by transparency tracing to assess the wound healing at 1st, 3rd, 7th, 10th and 15th days after excision. A progressive reduction in the wound area of both groups was observed. However, for thorium treated group, the rate of recovery was significantly enhanced compared to that of the control group. Although this value in the thorium group was not significantly different from that of the control group at the 3rd and 5th days after wounding, a statistically significant difference was observed between these two groups at the day7, day10 and day 15. The mean wound surface in thorium and control groups were 150.20±15.87 and 186.37±12.68 mm2 at day7 (p<0.001), 92.90±15.97 and 134.12±14.19 mm2 at day 10 (p<0.001), 1.40±0.41 and 8.56±2.04 mm2 at day15 after wounding, respectively (p<0.01). These findings suggest that low-level radioactive burned mantle accelerates wound healing in rats. However, as thorium oxide is a known human carcinogen, more research is needed to clarify if low levels of radioactive burned mantle can be utilized for enhancing wound healing.

Helicobacter pylori is a gram-negative bacterium inhabits the gastric mucosa and may remains there for a long period. It causes gastritis and ulcer. Recently, antibiotics are widely used to treat the infections caused by Helicobacter pylori but other means of treatment such as Probiotic (using live organisms such as Lactobacilli) can be considered. Therefore in this study antagonistic effects of two species of Lactobacillus against Helicobacter pylori under the laboratory condition are investigated. In this study a gel stabilized system was used. This system consisted of two phases solid layer (10 ml peptone yeast extract salt solution plus 1.5% agar and 2% glucose) at the bottom and a semi layer (10 ml PYES plus 0.75% agar and 1.5 × 107 washed bacterial cell /ml) at the top in 30 ml screw test tubes. Lactobacilli and Helicobacter pylori were used as pure and mixed in the upper phase of the above system. After incubation at 37 ºC for different time intervals, samples were withdrawn from the semisolid layer using sterilized steel corkscrew and sectioned. The bacterial population, optical density, pH and glucose concentration of the medium were measured at the various depths. All bacteria had a condensed band of growth in the special places of semisolid. Growth appearance (growth band) viable count, optical density, pH in the mixed culture of Lactobacillus plantarum and Helicobacter pylori were like the pure culture of Lactobacillus plantarum. However, mixed culture of Lactobacillus casei and Helicobacter pylori was similar to that of pure culture of Helicobacter pylori. Regarding the results of this study Lactobacillus plantarum inhibited the growth of Helicobacter pylori in the mixed culture. This may be due to possible production of organic acids like lactic acid and bacteriocins, but Lactobacillus casei could not inhibit the Helicobacter pylori’s growth. Therefore, Lactobacillus plantarum has antagonistic effect against Helicobacter pylori under in vitro condition and it can be a good choice for the probiotic purposes against Helicobacter pylori infections for in vivo investigations.

An excitatory pathway is reported to link the pretibial muscles to quadriceps motoneurones. It has been suggested that the interneurones in this reflex pathway relay the supraspinal inputs to quadriceps motoneurones. This may suggest an important role of this neural pathway in the motor control of knee during activities such as walking. In this regard, the pattern of modulation of this short latency reflex was investigated in normal subjects during walking in order to find its role in the motor control of quadriceps muscles. The reflex was elicited in 12 subjects by stimuli applied to common peroneal nerve at several points of gait cycle during walking on treadmill. The reflex magnitude and the intensity of the contraction were calculated from the surface EMG recorded in vastus medialis, rectus femoris and tibialis anterior and was normalized as the percentage of the maximum voluntary contraction in related muscles. The reflex showed the significant correlation with the intensity of contraction in quadriceps, mainly during the early stance phase. The correlation was weak during transition period from stance to swing, where rectus femoris showed a small peak of activity in half of the subjects and it was not accompanied by any reflex. The average peak activity in tibialis anterior was 69 ms preceded that of quadriceps. The precedence of activity in anterior tibial muscle and the strong presence of the reflex during the early stance phase may indicate a positive feed-forward effect from ankle dorsiflexor afferents to quadriceps muscle. Stimulation and activation of this neural connection may have clinical application in the improvement of the motor control of quadriceps muscles as an antigravity muscle in patients with gait disorders.

Metabolic syndrome is considered as one of the risk factor for Cardio Vascular Disease (CVD). Correlation between this syndrom and white and red blood cell counts is unknown whereas the relationship between insulin resistance and hamatologic factors is indicated in some published articles. The purpose of this study was to assess the correlation between hematologic parameters and metabolic syndrome. In a descriptive study 11974 over 19 years old participants in Isfahan, Najaf-Abad and Arak in rural and urban areas was evaluated as part of Isfahan Healthy Heart Program (IHHP) study. At first these participant's demographic data (age, sex, past history and drug consumption) were collected then trained physicians measured their blood pressure and waist circumference. Blood pressure in two separate occasions was recorded and mean of these measures was used in this study. In all participants, laboratory examinations (RBC, WBC, HDL-C, FBS, TG) were done after a 12 hour fasting. Participants were evaluated for metabolic syndrome according to ATP-III criteria. Data were entered in to SPSS-11 and analyzed by t-test and Spearmen correlation. Overall 6132(51%) females and 5842(49%) males with mean age of 35.6±3.8 and 35.9±32 year were studied respectively. The prevalence of metabolic syndrome in male and female participants were 10.6% and 35% respectively and 23/1% in overall. WBC and RBC counts were higher in patients with metabolic syndrome compared to those of normal subjects. Correlation between metabolic syndrome and RBC and WBC counts was significant excluding the case of hypertension. The most powerful correlation was obsereved between count RBC and HDL-C (r: -0.245, p<0.001), WBC and TG (r: 0.195, p<0.001). We observed increased RBC and WBC counts in patients with metabolic syndrome. In this regard a widespread study may help us use these hematologic parameters even in normal values as indicators for evaluation of high risk patients.

Fasting improves both spiritual and physical aspects of individual's performance. In other words, fasting has many advantages in improving human health and elimination of abnormal behavior. In general, the advantages of fasting include psychological, physical and spiritual benefits. In this study, the effect of Ramadan fasting on psychological health and depression among university students has been evaluated. Three hundred and sixty one students were randomly selected and their demographic information was collected. Psychological health and depression scores were examined by Ferrell 12-item scale and standard Beck depression test, respectively. The data were collected in two different occasions 10 days before and 10 days after Ramadan. Mean scores of psychological health and depression of students in these two occasions were compared. The mean score of psychological health of participants before Ramadan was 33.94±8.55 (Mean±SE) that increased to 34.5±8.2 after Ramadan. Mean score of depression before Ramadan was 14.45±10.33 that decreased to 11.88±10.38 after Ramadan. These differences were statistically significant. Our findings confirmed that Ramadan fasting could be an important factor for improving mental health and elimination of depression in university students.

Cutaneous Leishmaniasis (CL) is an important public health problem in many parts of the world, especially in tropical and sub-tropical countries including Iran. The incidence of new cases is about 105 million, globally. CL in Iran presents two epidemiological forms Anthroponotic CL (ACL) that is caused by Leishmania tropica and Zoonotic CL (ZCL) that is caused by L. major. The district of Bam, one of the oldest foci for CL, 185 km far from the capital of Kerman province, is located in the south- eastern part of Iran. The population of Bam was 242, 234 in 2003. The objective of the present study was to compare the new cases one year after the earthquake with those occurred during the four years before the earthquake. Data for this descriptive-analytical study were collected by means of a questionnaire. Most of the CL cases were referred to the center for disease control after diagnosis by direct smear. The total incidence rate showed no significant difference between 1999 and 2003, although the number of cases increased considerably between December 2002, and March 2003 one year after the earthquake (p<0.005) compared with the corresponding months during the four years before the earthquake. The mean age at incidence, increased during 1999 to 2003, while this difference was considerable in females and there were no significant differences based on the year of contraction, location of sore, number of sores, place of living and nationality. The results of this study indicated that although CL has been endemic in Bam district, there was no significant difference in the number of cases during the five years, four years before the earthquake and one year after the disaster, in spite of the earthquake and the proper condition for propagation of CL organism. It seems that control measures performed during the earthquake prevented the occurrence of any CL epidemics.

Birth injuries are due to difficult labors. Dislocation of elbow as a consequence of birth trauma has not been reported yet. Case report: A two days newborn was referred to Imam Reza hospital because of restlessness and limitation of movement in upper arm. Double dislocation of left elbow was observed in radiographic evaluation. In any newborn with difficult labor and limitation of movement in upper arm in addition to more common conditions dislocation of elbow should be considered. Key words: