مجله پزشکی بالینی ابن سینا
سال پانزدهم شماره 2 (پیاپی 48، تابستان 1387)

Introduction & High prevalence of vitamin D insufficiency in Iran calls for a reliable assessment of vitamin D status for diagnostic, research as well as public health purposes. Circulating level of 25(OH)D has been generally accepted as a reliable indicator of vitamin D status. HPLC-based analyses are considered as standard methods for 25(OH)D assays. The aim of this study was to set up a precise, reliable and rather simple HPLC-based method to determine serum levels of 25(OH)D using ultra violet detector. Serum proteins were precipitated using ethanol and then methanol: iso-propanol (90:10, v/v). 25(OH)D was then extracted using hexane, which was then evaporated under nitrogen flow. The sediment reconstituted in methanol was further filtered. Finally, 20μL of the filtrate was injected to the column, teknochroma tracer excel 150×4, 3 μm. Chromatography was run with the mobile phase of methanol:water (85:15, v/v) containing 0.01% BHT at the column temperature 40°C. The vitamers 25(OH)D3 and 25(OH)D2 were detected at 265nm. For further evaluation of the method, 90 human serum samples were analyzed for 25(OH)D using HPLC, competitive protein binding assay (CPBA) and radioimmunoassay (RIA). The degree of agreement between those three methods was evaluated using coefficient of correlation and Bland-Altman analysis. Retention times of 25(OH)D3 and 25(OH)D2 were 9.5 and 10.7 min, respectively. Standard curves of both vitamers showed linearity up to 375 nmol/L (D3) and 187.5 nmol/L (D2). Recovery percents for 25(OH)D3 and 25(OH)D2 were found 101±5% and 100.8±5.4%, respectively. Intra- and inter-assay variations for 25(OH)D3 were 8.1% and 12.6%, respectively. The results of RIA and CPBA were significantly higher than those of HPLC (p=0.02). RIA, compared to CPBA, showed more agreement with HPLC. The new HPLC method for serum 25(OH)D determination is reliable and rather fast with the advantage of detecting both 25(OH)D2 and 25(OH)D3.

Introduction & Studies have shown that estrogen has important cardiovascular protective role. Nucleus tractus solitarii (NTS) is the termination point for all afferent of baroreceptor fibers that is important in regulation of heart function and circulation. For recognizing the estrogen mechanisms the role of estrogen through autonomic system in NTS have been evaluated. Hypertension state, estrogen increases baroreflex sensivity in NTS through autonomic system in rats. Present study was an experimental-interventional study performed on 32 male rats. After introduction of anesthesia, ovariectomy and capsulation was happened. After two weeks their femoral artery and vein cannulated to recorded mean arterial blood pressure (MAP) and heart rate(HR), also for infusion of phenylephrin (as a vasoconstrictor).Then NTS by drugs (Propranolol, Atropin, Saline) have injected and? HR and? MAP recorded before & after injection of phenylephrin. For evaluating of baroreceptors sensivity, BRS index (Δ HR/ Δ MAP) was employed. HR and MAP in estrogen received groups, without phenylephrine "rest state", had no significant statistical differences in comparison with control group. Estrogen in acute hypertension state "after injection of phenylephrine" enhanced reflex bradycardia and inhibited rising of MAP.? HR in estrogen received group was less than control group (p<0.05).? MAP in estrogen received group was significantly less than control group, (p<0.01). BRS in estrogen received group was significantly more than control group, (p<0.01). BRS in estrogen received group and control group decrease significantly after the micro-injection of Atropin compared with the microinjection of Saline or Propranolol in female rats. The results demonstrate that estrogen enhanced bradicardial baroreflex sensitivity and decreased mean of arterial pressure. Micro-injection of Atropin decreased significantly BRS compared with Propranolol. Probably parasampatetic system is more invole in control of cardiovascular regulation in NTS and the Muscarin receptor in cardiovascular regulation is more important than beta-adrenergic receptor. It is concluded that estrogen in acute hypertension state in NTS is more effective through parasympatetic system on BRS and this can be useful in HRT/ERT even in male animals.

Introduction & There are some reports about influence of the rare nutrients such as copper and zinc on immune system. Serum concentrations of copper alter in patients with brucellosis. Brucellosis is a common and endemic disease and a health problem in Iran. We compared serum concentrations of copper in patients with brucellosis and healthy individuals. In a cross sectional study, serum concentrations of copper was measured in patients with brucellosis and control group. Eighty six subjects were enrolled in the study, including 43 patients with brucellosis (34 men and 9 women) and 43 healthy individuals. Serum concentrations of copper was measured by automatic absorptive spectrophotometer in patients with brucellosis and compared with control group. We employed a non parametrical test, kolmogrov – smirnov, to determine if data distribution was normal or not. Mean age of patients with brucellosis was 40.14±15.10 years with the range of 14-60 years. The most frequent symptoms were arthralgia (86%). Serum concentrations of copper in patients with brucellosis were significantly higher than healthy subjects (160.84±54.61, 101.74±27.37 mg/dl respectively, p<0.001). Serum concentrations of copper in patients with brucellosis showed significant alterations in comparison with healthy subjects. So, we recommend using serum copper concentrations in patients with brucellosis as a marker in brucellosis diagnosis. Also we recommend another study for detection of serum copper concentrations before and during treatment.

Introduction &

UTI is one of the most common bacterial infections and Ecoli is known as an important cause of UTIs. Since bacterial resistances of antibiotics are increasing, reliable methods of antimicrobial resistance detection are of paramount importance in treatment and management of UTIs. The objective of the present study is to compare and to evaluate the performance of disk diffusion agar (Iranian and Italian) and E.test (Epsilometer test) (Sweden) for antimicrobial susceptibility testing of Ecoli isolated from UTI.

This study was done on 250 Isolates of Ecoli from patients with UTI in Shariati Hospital, Tehran University of Medical Sciences during 2004. Antibiotic susceptibility testing was performed by disk diffusion method using Iranian and Italian disk for Trimetoprim sulfamethoxazole, Gentamysin, Ceftazidim, Nitrofurantoin and Ciprofluxacin and Minimum Inhibitory concentration (MIC) determination was performed by E.test for the same set of antimicrobial. All tests were performed on muller hinton agar.

Comparison of E.test and Iranian disk diffusion agar showed that paramount differences in antibiotic agreement (Max 37.8 %) those differences in case of Ceftazidim and Gentamysin were respectively 76.8% and 62.2% whereas comparison of E.test and Italian disk diffusion agar showed less difference of antibiotics agreement (Max 11.2%).

The results of this study showed that Iranian disk diffusion agar may be used as a preliminary screen for antibiotic susceptibility testing of E.coli and is less sensitive than Italian disk diffusion and E.test. Comparison of 3 mentioned methods have showed that E.test is the most sensitive and shows the effective dose of antibiotic for treatment and prevention of antibiotic resistance.

Introduction & Sexual dysfunction is called to inability to get or keep a successful sexual intercourse. The term “sexual dysfunction” may also be used to describe other problems that interfere with sexual intercourse, such as inability to achieve erection and problems with ejaculation or orgasm. Damage to nerves, arteries, smooth muscles and fibrous tissues, often as a result of a disease, are the most common cause of erectile dysfunction. The aim of the present study was to evaluate the frequency of sexual dysfunction in patients referred to Fatemieh infertility clinic, Hamadan. In this cross-sectional study all males referred to Fatemieh infertility center in 2005, were entered the study. All patients were clinically examined and their medical histories were obtained. Data such as age, accusation, education, history of smoking and opioid abusing, sexual dysfunction, inability to achieve orgasm, premature ejaculation and the frequency of intercourse were entered in the questionnaires. Data was analyzed using SPSS 13 and c2 statistical test. The mean age of patients studied was 32.3±7.4 years (20-65 years). From 245 cases, 135 (55.1%) had sexual dysfunction. The most common sexual dysfunction was premature ejaculation(38.8%). Other sexual dysfunctions were impotence with 16.3%, lack of sexual desire with 12.2% and orgasm disorder with 10.6% respectively. 65.9% patients were uneducated or had elementary education, 27.4% had diploma, and 6.7% had academic education. 23.7% of patients had addiction and 34.1% were smoker. This study showed that most common etiology of sexual dysfunction was premature ejaculation. Other sexual dysfunctions were: impotence, sexual desire disorder and orgasm disorder respectively.

Introduction & Exposure to the environmental Tobacco smoke is associated with detrimental effects on pulmonary function in the children. This study investigated the relation between airway complications in children receiving general anesthesia with the passive inhalation of smoke and those who were not. 223 children scheduled to receive general anesthesia care were enrolled in this case-control study. The anesthesiologist and the residents, unaware of the smoke exposure history, recorded the occurrence of airway complications. A history of passive smoking was assessed by measuring the numbers of cigarettes smoked by their parents per day. The data was analyzed by c2statistical test. Respiratory complications occurred in 54.3% of the patients who were exposed to smoke and 32.4% of those who were not and the difference was statistically significant. Respiratory complications in daughters exposed to tobacco smoke was seen in 57.5% and in boys 51.2% (P=0.012). Respiratory events in children exposed to tobacco smoke was seen in 76.7% children with mother without education, 46.5% children of mothers with low educated level, and 12.5% children of mother with high educational level (P=0.002). This correlation was seen between respiratory events and educational level of fathers (P=0.006). Moreover, our study showed positive correlation between the number of cigarettes smoked per day with respiratory complications during general anesthesia (P<0.05). There is a strong association between passive inhalation of tobacco smoke and respiratory complications in children receiving general anesthesia. The relationship was greatest for the daughters and those whose parents had a lower level of education. Passive smoking should be regarded as a risk factor for the children undergoing general anesthesia.

Introduction & The influence of genetic, biological, psychological, social and cultural factors on drug dependency and high rate comorbidity of this phenomenon with psychiatric disorders for example anxiety, depression and characteristics and personality disorders is emphasized. The aim of this study was the comparative investigation of mental disorders and personality traits in persons with drug dependent and non drug dependent in Hamadan city in 2001-2003. Present research was a descriptive comparison and subjects were 100 drug dependent persons and 100 non drug dependent individuals. Case group was chosen through available sampling among persons who call on psychiatrist and control group was chosen through randomly simple sampling from general population. Measurement and diagnostic tools includes questionnaire for examining demographic characteristics, designed by researchers and MMPI, SCL90-R tests and DSM IV criteria diagnostic and also T test that was used for analyzing data. Between two groups in clinical and validity scales of MMPI test expect for hypochondriasis and hysteria and scales of SCL 90-R test expect somatization and interpersonal sensitivity differences were statistically significant (P<0.05). We can conclude that persons with drug dependent display more signs of psychopathology and mental disorders in comparison with non drug dependent people and Major depressive disorder and personality disorder were frequent among drug dependent groups. Depression and personal disorders were frequent in non drug dependent persons too. Our results support the results of previous studies.

Introduction & Multiple sclerosis (MS) is an autoimmune disease with unknown cause. MS is one of the disabling neurologic diseases in adult especially young range that myelin part of central nervous system (CNS) is destructed. The aim of this study was assessment of types A and B personality and internal and external locus of control in multiple sclerosis (MS) patients and comparison of the results with control group. In a case-control study, 30 patients with MS and 30 normal persons as control group evaluated with neurological examination, Rotter locus of control test and Friedman-Rosenman questionnaire for detection of types A and B personality. We employed to analyze the results. 43 percent and 57 percent of MS patients had internal and external locus of control respectively. 63 percent and 37 percent of MS patients had type A and B personality respectively. 60 percent and 40 percent of control group had internal and external locus of control respectively. 20 percent and 80 percent of control group had type A and B personality respectively. Difference between personality type in two groups was significant (P<0.01). In this study, MS patients had more type A personality in comparison to control group.

Introduction & Hexavalent chromium, Cr+6, is a very harmful pollutant and a relatively unstable compound that is present in many industries. It is a known human respiratory carcinogen and occupational exposure to this chemical is associated with different health hazards. The purpose of this study was to evaluate the effects of four parameters including: type of sampling head, sampling height from the surface of electroplating solution, sampling duration, and sample storage duration on Cr+6 mist monitoring. To evaluate the influence of the main parameters as an experimental study, the 24 factorial design was applied at constant electroplating condition. A chromium electroplating bath with the ability to produce homogenous mist was used to create Cr+6 mist in laboratory setting. The National Institute for Occupational Safety and Health (NIOSH) method 7600 was used to determine the Cr+6 concentration. The results of 48 Cr+6 mist samples showed that Cr+6 concentration was higher: (1) for sampling by closed-face filter cassettes than for sampling by open-face filter cassettes (P<0.001); (2) for samples collected at 35 cm above the electroplating solution surface than for samples collected at 50 cm (P <0.001); (3) for sampling duration of 30 minutes than for sampling duration of 180 minutes (P <0.001); and, (4) for samples extracted immediately after sampling than for samples with delayed extraction (24 hours after sampling) (P <0.001). It is concluded that the accuracy of Cr+6 mist sampling in electroplating shops will be enhanced when: (1) a closed-face filter cassette is used to prevent liquid splash contamination; (2) the sampling height is suitable as determined by further research; (3) the sampling duration is short (approximately 30 minutes); and, (4) the extraction of the Cr+6 sample is performed as soon as the sampling is completed.

Introduction & The practice of eliminating pathogenic microorganisms in water dates back to ancient times. The most common methods for water disinfection are using chemicals, Ozonation, Ultra Violet ray, Membrane Processes and etc. There has been considerable interest in disinfection of water by using electrochemical methods in recent years. The main purpose of this study is to conduct experimental investigation of water disinfection by using the electrolysis method. Inactivation and killing Coliform in polluted waters was investigated by different voltage, electrodes (Al, St and Cu) and distance between electrodes. The polluted water was prepared by adding a colony of coliform growth on EMB in raw water. Experiments were done similarly via the same electrolyzes time, electrodes distance and voltage intensity for all types of combinations of electrodes respectively. The experimental results show that the removal efficiency depends on the voltage and electrodes material. From the experiments carried out at 10 V. and at current intensity of 135 mA, it was found that five-minute period was sufficient for disinfecting water using Stainless Steel electrodes. Due to the results, the electrochemical methods can be proposed as a promising cleaning and purifying method for water disinfection.

Introduction & Pulmonary Langerhans Cell Histiocytosis (PLCH) is an uncommon (5% ILD) interstitial tissue disorder with significant importance. It occurs predominantly in adult smokers. The organs involved in LCH include skin, bone, pituitary gland, thyroid, lymph node, and lungs. In this descriptive study all patients admitted to the Masih Daneshvari Hospital in Tehran from 1996 to 2007 diagnosed with LCH (recognized by clinical features, laboratory investigations, radiological manifestations, BAL and biopsy) were evaluated. A total of 20 patients were studied; mean age was 27.8 yrs.; 40% were smokers; 80% had pulmonary involvement while in 20% other organs were affected. On spirometry, a mixed pattern (50%) was the most common and on chest radiography (CXR) 77% of lung cysts were visible. The most frequent finding on CT- scan was diffuse lung cysts (80%). It is notable that ground glass opacity and consolidation occur in the early stages of disease. Since most of the patients refer with features of advanced disease, it is essential for the physicians to consider the early signs during the diagnostic stage. Also bronchoscopy and bronchial lavage are recommended in selected cases.

Jarcho- Levin syndrome and caudal regression syndrome are rare syndromes with clinical and radiologic findings of cervical and thoracic vertebral anomalies with rib deformities (jarcho-levin syndrome) and sacrococcygeal agenesis, lower extremity anomalies, truncated spinal cord and neurogenic bladder (caudal regression syndrome). There are only one report of simultaneous existence of these two syndromes in a dead fetus in literature.Case Report: The case was a 5 year old girl who had history of bilateral hip dysplasia and spastic dipleigia of lower limbs who presented with recurrent urinary tract infections. X - Ray findings was extensive vertebral anomalies such as hemivertebrae, butterfly vertebrae, coccygeal agenesis and rib deformities. MRI findings was termination of spinal cord at low thoracic level, cystic mass of sacral area. This case is a rare simultaneous occurrence of Jarcho-levin and Cauda regression syndrome in a patient and to our best knowledge is reported for the first time in Iran.