مجله دانشکده پزشکی اصفهان
پیاپی 82 (پاییز 1385)

Early diagnosis of neonatal sepsis is essential for successful treatment. Blood culture is a gold standard for diagnosis but the final results are not available until 48-72 hours after culture. Interleukin-6 (IL-6) as a marker plays a critical role in the induction of C-reactive protein (CRP) synthesis in the liver. It has been hypothesized that this cytokine could be detected in blood earlier than CRP during the course of neonatal sepsis. Blood samples were collected upon admission from 50 neonates with suspected sepsis, and 10 healthy neonates. The patients were assigned to two groups according to bacteriological and laboratory results. Group І consisted of 19 newborns with positive blood cultures and clinical signs of sepsis. Group ІІ included 31 neonates with negative blood cultures, but with two or three clinical signs of sepsis. The control group (group III) included 10 healthy neonates with no clinical or biological data of infection. Serum CRP was determined by using the nephelometry method and IL-6 was determined by ELISA method. Mean CRP level in the group with proven sepsis was 22.18 mg/l which was higher than in other groups (P=0.005). The sensitivity and specificity of CRP were 57% and 100%, respectively. Mean level of IL-6 was 117.49 pg/ml in group І, which was higher than in other groups (P=0.001), exhibiting a sensitivity of 78% and a specificity of 95%. Based on our results, measurement of IL-6 is more useful than CRP for early diagnosis of neonatal sepsis, especially within the 24 hours before the onset of sepsis. We conclude that IL-6 measurement combined with CRP measurement can be the ideal tests for diagnosis of neonatal sepsis.

Cutaneous leishmaniasis (CL) is one of the most important zoonotic diseases in Iran. According to the reports of the Center for Disease Management and Control, among the 20,000 cases infected with various types of leishmaniasis annually, 80% are zoonotic cutaneous leishmaniasis (ZCL). This descriptive and retrospective study was performed to determine the most recent status of ZCL in Iran, from 2001 to 2005. Data were collected from patients presenting to Primary Health Care Centers. Identification of the parasite was carried out by observation of amastigotes in direct smear after staining with Giemsa. The prevalence of infection in 2005 (29824) showed an increasing rate of 105.6% in comparison with 2001 (14050). In the last year of our study, the overall incidence rate per 100,000 was 30. Although among the 11 endemic provinces, the most cases were observed in Khorasan, Fars and Isfahan, respectively, the highest incidence rates were found in Yazd Province (203.2) in 2004 and Boshehr Province (139.6) in 2005. Surprisingly, during the past five years, the cases of ZCL have increased. This might be partly due to resettlement programs in countryside, reconstruction and destruction of the rodent vector’s habitats, the migration of infected persons from Afghanistan to the borderline provinces and relaxation of preventative measures.

Hemoglobin (Hb) levels in fetus increase with progression of pregnancy, reaching highest levels in life. Hb serves as iron reserve in fetus and is needed for the infant to adapt with anemia. Many factors can decrease Hb levels at birth and lead to accelerated physiological anemia. Hence, the infant would require earlier administration of iron drops. Identification of these factors and immediate management is essential to child health. This study was performed to compare mean Hb levels in cord blood of neonate subjects with corresponding levels cited in Nelson's Textbook of Pediatrics and their relationship with maternal Hb and delivery pattern. In this cross-sectional study, cord blood samples taken from 502 newborns in six months were evaluated. Simple sampling method was used. Premature neonates and those with low birth weight and high-risk deliveries were excluded. Data were analyzed with t-test using SPSS. The mean Hb level of the studied group was 13.24±1.77 g/dl, which was significantly lower than corresponding parameters cited Nelson's Textbook of Pediatrics (P value=0. 000). Also, there was a significant and direct correlation between Hb of umbilical cord blood, and maternal Hb and pattern of delivery. Hb levels in the umbilical cord blood of newborns delivered by cesarean section were lower than Hb levels of those with normal delivery. The results of this study show that Hb levels of cord blood in the studied population are lower than values cited in Nelson's Textbook of Pediatrics; this is in direct relationship with low levels of maternal Hb which we studied for comparison with values cited in Nelson's Textbook of Pediatrics (11.7 g/dl vs. 14 g/dl). Thus, newborn infants in our study (especially cesarean section newborns) are at greater risk of early and accelerated physiological anemia. Therefore we recommend further efforts to improve maternal nutrition before and during the gestational period, prescription of iron tablets, encouraging normal vaginal delivery, and early initiation of iron drops in the first few months of infancy.

Although renal transplantation from cadaver is common, living donors continue to be an important source of transplanted kidneys. Recipients of living-donor kidneys demonstrate improved graft survival. In this study, we evaluated the outcomes of renal transplantation from cadaver, related donors and unrelated donors in Isfahan.

We evaluated all of the patients who underwent kidney transplantation in hospitals affiliated to Isfahan University of Medical Sciences in 2002. We assessed complications including hypertension, urinary tract infection, fever, transplant rejection, urinary leak, renal failure, renal vessels thrombosis and urinary tract obstruction. Donors (living related, living unrelated, cadaver) were registered and complications were compared in the three groups. Chi-square and Fisher exact tests were used for statistical analysis.

One-hundred patients were evaluated (22 had received kidneys from cadaver, 10 from living related donors, and 68 from living unrelated donors). Transplant rejection was most common in recipients of kidneys from living unrelated donors (49.7%, P=0.02). Renal failure was most common in recipients of kidneys from cadaver (68%, P=0.02), urinary infection was most common in recipients of kidneys from living unrelated donors (26%, P=0.04). Overall, complications were most common in patients who had received kidneys from cadaver (81%, P=0.04).

Given the high transplant rejection rate in recipients of kidneys from living unrelated donors, and the complications observed in recipients of kidneys from cadaver, kidney transplant from living related donors seems to be the most favorable option.

Candidiasis as an opportunistic infection is created by some species of Candida. Here the role of Candida albicans is more noticeable than other species. Candida can cause an extended spectrum of symptoms. Due to the increasing consumption of immunosuppressants including corticosteroids and diseases like diabetes, candidiasis has drawn more attention than before. Considering the side-effects of antifungal chemical drugs and their high cost, we used the essential oil of Boswellia serrata against the isolates of Candida which are sensitive and resistant to fluconazole. Of 50 samples used in this study, twenty-five were sensitive and twenty-five were resistant to the fluconazole. Different concentrations of Boswellia serrata essential oil were prepared in microplates. One-thousand Candida albicans yeast cells were added to each well and after 24 hours of incubation, the number of Candida cells in each well was counted. In the group of sensitive isolates, 3, 7, 7, and 8 did not grow up to dilutions of 1/32nd, 1/64 th, 1/128th, and 1/256 th, respectively. In group of resistant isolates, 1, 6, 8, and 10 isolates did not grow up to dilutions of 1/32nd, 1/64th,, 1/128th, and 1/256th., respectively. The essential oil of Boswellia serrata displayed an inhibiting effect on all Candida albicans isolates in-vitro; hence we recommend the investigation of its antifungal properties in vivo.

Exercise is associated with an increase in cortisol - the most important hormone in fat metabolism. Cortisol levels vary during a day. This study was conducted in view of the lack of any documents on cortisol levels in endurance athletics in Iran. In a cross-sectional study, 25 male endurance runners age 18-25 years and 25 non-athlete men were selected. The cortisole and TG levels were analyzed using ELISA in the morning and evening. T-test was used for statistical analysis and P

Vitiligo is an acquired pigmentary disorder of the skin and has significant harmful effects on the appearance and consequently social functions of the patients. There is no universally effective treatment for this disease, but topical steroids and levamisole have been used. This study evaluates the effects of levamisole and clobetasol with that of clobetasol in the treatment of vitiligo. Through a randomized clinical trial, 73 adult patients with vitiligo were divided into two groups. The first group consisted of 37 patients and received levamisole 150 mg daily for 2 consecutive days per week, and topical clobetasol ointment 0.05% daily. The second group consisted of 36 patients and received topical clobetasol ointment 0.05% daily. Treatment was continued for 4 months and 35 patients in each group completed the study. Of seventy patients who completed the study, 32 were males and 38 were females aged between 18 and 55 years. In the first group, 37.1% showed no response, another 37.1% had partial response and 25.8% showed complete response to treatment. In the second group, these 3 types of responses were observed in 25.7%, 54.3% and 20% of subjects, respectively. There was no statistically significant difference between the responses of the two groups. It seems that addition of levamisole to clobetasol is not helpful in the treatment of vitiligo.

Hippocampus is a well-defined brain region involved in learning and memory. In spite of the existing reports on hippocampal-dependent memory impairment due to noise stress, to our knowledge, there is no study on the effect of noise stress on the size of hippocampus. The present study aimed to investigate the likely effects of chronic noise exposure on learning and the size of rat hippocampus. Twenty adult male Wistar rats were randomly divided into two equal groups. Animals in the experimental group were exposed to noise with intensity of 40 dB for 20 minutes 3 times per day for a period of 3 months. The control animals were kept in the same laboratory conditions without being exposed to noise. Learning function was assessed according to passive avoidance test. Animals were then anesthetized and transcardially perfused with fixative solution. The brains were removed. The right hemispheres were selected; 25-μm thick sections were cut along the entire extent of the hippocampus. Using systematic uniformly random sampling, one section from every twenty sections was analyzed. Volume estimation was performed using Cavalieri principle. A decreased latency to enter the dark compartment was observed in noise-exposed animals, suggesting decreased learning function. This study also showed that the noise-exposed rats had smaller hippocampal formation than controls. Reduced volume of hippocampus most probably reflects alterations in its neuronal circuits. These changes may be relevant to the learning and memory disturbances in human and animals following noise stress.

Carhart's Notch (CN) is a major audiometric criterion for diagnosis of otosclerosis; it is an abnormal audiometric pattern due to fixation of stapes and relative reduction in perilymphatic motion. 130 patients (146 diseased ears) were evaluated in this study. Audiometric tests were performed for each patient 2 weeks before and 6 month after surgery, and the average decline in bone conduction threshold was measured in frequencies of 500, 1000, 2000, and 4000 Hz. The average correction in CN in frequencies of 500, 1000, 2000, and 4000 Hz was 3, 5.4, 10.4 and 3 db, respectively after stapedectomy, and 4, 5.8, 9.6 and 4.2 db, respectively after stapedotomy. Mean correction of CN in the above frequencies was 3.8, 5.7, 9.8 and 3.8 db, respectively, measuring 5.7 db on the average. There was a significant correlation between CN correction and stapes surgery. The highest correction was seen in 200 Hz (9.8 db) and the lowest in 500 Hz (3.8 db). The correlation between the type of surgery and specific changes in CN was not significant.

This study was conducted to evaluate the involvement of body organs such as the lungs in systemic lupus erythematosus (SLE). Little information exists on lung involvement in lupus patients without respiratory symptoms; we aimed to evaluate the characteristics of lung gas transfer in female SLE patients using carbon monoxide diffusion capacity (DLCO) in comparison with a control group. DLCO and lung volume parameters were prospectively measured and analyzed in 76 sequential SLE patients with active disease in our Rheumatology Department in 2005. The measured transfer factor was lower in female patients with lupus than in the control group (P≤0.001). A similar reduction was observed in volume-corrected transfer factor with stronger statistical significance (P≤0.001). Residual volume and total lung capacity were greater in patients than in the control group (P≤0.001). Reduction of lung transfer factor is a frequent observation in patients with SLE who had no clinical respiratory symptoms. This finding is in favor of alveolocapillary membrane involvement in patients with lupus. Increased residual volume and total lung capacity may be due to subclinical bronchiolitis.

Atherosclerosis is a disease which begins during childhood. Oxidation of lipoproteins is an important factor implicated in atherosclerosis. Vitamin C decreases blood serum lipids and may inhibit atherosclerosis. This study was designed to observe the effect of ascorbic acid on blood serum lipids in male rabbits fed high-cholesterol diet. Twenty white male rabbits were weighed (mean weight = 950 g) and blood serum samples were taken for analysis of serum cholesterol, LDL, HDL, TG, and VLDL. They were randomly divided into two groups. For 40 days, group 1 (n=10) was given high-cholesterol (1%) diet, and group 2 (n=10) was fed high-cholesterol diet with ascorbic acid (100 mg/kg). Both groups were then weighed and blood samples were taken for analysis of serum cholesterol, LDL, HDL, TG, and VLDL. Significant differences in cholesterol, LDL, HDL, TG, and VLDL were seen between the two groups (P)

Executive function define as ability to maintain a suitable and gool directed condition for problem solving. The results of previous studies on Tourette syndrome (TS) were contradiction, but the impairment of visual-spatial performance, working memory and reaction time were shown. In children with Attention Defiat Hyperactivity Disorder (ADHD) impairment of set shifting, motor inhibition and planning are present. This study aimed to evaluate executive function in children and adolescent's with Tourette syndrome with and without attention deficit hyperactive disorder. This descriptive-analytic (case-control) study was performed in children and adolescents presenting to the Psychiatry Clinic of Rozbeh Hospital during 1381-1383. By means of clinical psychiatric evaluation, K-SADS and DSM-IV criteria, 26 children and adolescents age 7-17 years diagnosed with ADHD with Tourette, and Tourette were enrolled in the study. Also 15 healthy matched subjects were enrolled as a control group. In each group, Tower of London Test, and Yale and Conners Behavior Rating Scales were used. There isnt significant differences between tourette syndrome and control group in field of move planning ad subsequent (P>0.05). But in group with combined ADHD and TS there is a significant differences (P=0.048, P=0.02, P=0.03). Comparison of the 3 groups showed impairment of attention, planning, and working memory impulsivity (executive function) in children and adolescents with Tourette and ADHD.

Lipid-based anesthetic agents such as propofol support rapid microbial growth at room temperature. Many reports of systemic infections have been traced to the injection of contaminated propofol. The results of these studies are different according to the magnitude and the mechanisms of infections. The aim of this study was to evaluate the development of bacterial infection in syringes and vials containing propofol in relation to duration and the location of storage. In this experimental study, 2 vials of propofol (50 ml) were selected. Under sterile conditions, 20 ml of each vial was aspirated into a sterile syringe and the others were kept in operation room. During one week, the four samples were obtained and aerobic and anaerobic culture were performed. Twenty-four and 48 hours after culture, we evaluated the cultures media for detection of bacteria and colony count. There was no evidence of bacterial growth in any of the samples. With the increasing use of lipid-based medications such as propofol, which support rapid bacterial growth at room temperature, strict aseptic techniques are essential during the handling to prevent extrinsic contamination. We remain concerned that anesthesiologists will endanger patients and assume increased medicolegal risk if they do not follow the manufacturer’s ASA and CDC recommended procedure.

Otomycosis is a common infection of the external ear that is seen in the tropical and subtropical areas of the world. We performed mycologic analysis by obtaining samples from the external auditory canal in patients clinically diagnosed with otomycosis. 174 patients with clinical suspicion of otomycosis referred to the Otolaryngology Clinic of Al-Zahra and Kashani Hospitals were studied from 2001 to 2003. First, samples were obtained from the external auditory canal of patients suspected of otomycosis. The samples were cultured in three dish plates and prepared for smear and direct microscopic examination. Then the fungi were identified in culture dish plates by a fungologist The patients had a mean age of 35.18 years. Eighty-eight patients were women and 86 were men. Housekeeping was the most common profession of subjects. Itching of the external canal was the most common symptom (88.5%). The most common cultured fungi were Asperfillus species (overall 60%). Aspergillus flavus was cultured in 27.6% of cases, Aspergillus niger in 25.3%, Aspergillus fumigatus in 3.4%, and Aspergillus nidus in 2.6%. Candida was cultured in 5% of cases. Predisposing factors included trauma and manipulation of the external canal (47.27%), diabetes (6.9%), and swimming (13.8%). External Itching was the most common symptom of otomycosis (88.5%). Aspergillus is an important pathogen for fungal external otitis in our environment. Although candida was not a significant pathogen for otomycosis in our study, its role in other geographic areas is remarkable.

Forestier disease - an unusual cause of dysphagia is a common presenting complaint in otolaryngology, internal medicine, and neurology practice, which has many known causes. Forestier disease or DISH is a rare but curable cause of dysphagia. DISH (diffuse idiopathic skeletal hyperostosis) is a rheumatic abnormality characterized by exuberant proliferation of bone at osseous sites of ligamentous and tendinous attachments throughout the body. A higher prevalence is found among diabetics and males. The incidence of DISH increases with aging. Presenting features include dysphagia, dyspnea, hoarseness, aspiration pneumonia, myelopathy, and entrapment neuropathy. A sixty-year-old man with complaint of progressive dysphagia to solid food for 6 years underwent barium swallow examination and cervical x-ray showed diffuse ligament calcification and osteophytes protrusion and compression of the esophagus. The patient underwent conservative treatment with non-steroidal anti-inflammatory drugs (NSAIDS) but was then referred for surgical intervention because no favorable clinical response was seen.