مجله دانشکده پزشکی اصفهان
پیاپی 98 (مهر 1388)

Leishmania is an obligate interacellular protozoa and sand fly, as a vector, transmits infectious forms of the parasite to vertebrate host. In this way it is important to find candidate antigens which could tend to prevent the disease.

The gene coding mannose 1 phosphate guanyl transferase enzyme was amplified from genomic DNA isolated from the Iranian strain of L. major (MRHO/IR/75/ER) as a template. The Polymerase Chain Reaction (PCR) product was ligated into the pTZ57R plasmid and the recombinant gene was digested using restriction enzymes, BamHI and EcoRI. The fragment was ligated into the pET32a plasmid, as an expression vector. The cloned pET32a-GDP mannose was confirmed using restriction enzyme digestion method and the DNA fragment was sequenced.

Electrophoresis method confirmed the PCR product is related to the enzyme mannose 1 phosphate guanyl transferase. After the ligation of the product into the pTZ57R and pET32a, and the restriction enzyme digestion by BamHI and EcoRI, the correct frame of cloned gene in vectors was confirmed.

There was 92 percent homology between the cloned gene coding enzyme mannose 1 phosphate guanyl transferase in this study and the ones present in gene bank. It is suggested that the gene encoding mannose 1 phosphate guanyl transferase enzyme is conserved among different genera of Leishmania.

Considering different effective factors in age of menarche in different geographical areas and the necessity of determining a reliable and up-to - date reference in this field, the aim of this study was to determine the mean age of menarche in 11 - 18 years old school-girls of Shahrekord. This was a descriptive cross-sectional study among 778 school girls aged 11 - 18 years of Shahrekord which were selected by clustering method among 8163 students. Data was collected using a questionnaire about demographic characteristics, age of menarche, weight of birth, and socioeconomic and family educational status. From 778 students, menarche was occurred in 351 (45.12%). The mean age of menarche was 12.7 ± 15 years and lowest and highest ages of menarche were 8 years and 2 months and 15 years and 5 months, respectively. Age of precoious and delayed menarche was 10 years and 5 months (in 1.99%) and 15 years (in 4.5%), respectively. There was not any significant relationship between age of menarche and weight of birth but there was a significant relationship for mothers’ carrier, families’ socioeconomic condition, and dimension of the families. Likewise other parts of Iran, a reduction in the mean age of menarche was found in Shahrekord, too; which was due to improvement of socioeconomic, nutritional and health condition. However the findings of this study could be considered as a reference for future studies in this field and for assessment of menarche age variation trends in this region.

Myocardial Infarction is a common and lethal disease, especially in first hours. Rapid and correct decision is essential for priority of advance therapies and this study follows the accuracy of a scoring system for this triage. The aim was to assess the correlation of Thrombolysis in Myocardial Infarction Risk score and Angio score in patients with ST Elevation Myocardial Infarction. In this cross sectional study, 240 patients with ST elevation myocardial infarction from CCU of universal hospitals participated in the study. Thrombolysis in myocardial infarction risk score was calculated and during 2 month they underwent angiography and follow up. Mean age was 60.02 and 79 patients were female. Correlation between thrombolysis in myocardial infarction risk and angio score was significant (P < 0.001). Correlation between ejection fraction and thrombolysis in myocardial infarction risk score (P < 0.001) and angio score with age (P < 0.001) was significant too. There was no significant correlation between Angio score and recurrent angina (P = 0.143), rehospitalization (P = 0.524) and death (P = 0.179). Pearson's correlation showed significant relation between thrombolysis in myocardial infarction risk score and angio score (P < 0.001, r = 0.556). This correlation shows that thrombolysis in myocardial infarction risk score probably can be used for evaluating angiographic extent of coronary artery disease. Simple clinical use of this score at bedside if confirms with a prospective cohort study, makes this score a method to stratify patients in high and low risk groups and accordingly diagnostic– therapeutic strategies.

Locus coeruleus is one of important involved sites in morphine withdrawal signs, contains high densities of Angiotensin II receptor binding sites. In this study the effect of microinjection of Angiotensin II and captopril to the Locus coeruleus on morphine withdrawal signs was evaluated. Male wistar rats were anesthetized and stainless style cannula implanted in the locus coeruleus and allowed to recover from surgery. Morphine was injected 3 times in each day for 4 days to induce morphine dependence. The animals divided into 3 groups; control group received saline and case groups received Angiotensin II (1 nanomole) or captopril (30 µg) before naloxone injection. After naloxone injection, morphine withdrawal signs were assessed and compared between groups. In Angiotensin group, some of withdrawal signs such as wet dog shakes was significantly higher than saline group (P < 0.05). Expression of some of withdrawal signs such as jumping in Angiotensin group was decreased more than saline group (P < 0.01). Also, in captopril group some of withdrawal signs such as wet dog shakes was significantly higher than those of saline group (P < 0.05. Expression of some of withdrawal signs such as writhing posture, teeth chattering, grooming, genital grooming and head shakes were decreased in captopril group more than saline group (P < 0.05). We suggest that Angiotensin II have some roles in opioid withdrawal through locus coeruleus nucleous which contains considerable receptors for it.

The residual scar of cutaneous leishmaniasis (CL), an endemic disease in Iran, could tend to a major psychologic problem for the patients. Based on the efficacy of trichloroacetic acid (TCA) in the treatment of some dermatologic scars, this study was designed to assess the efficacy of combined intralesional Meglumin Antimuan (MA) and TCA compared to MA alone for treatment of CL lesions and its remnant scar. 200 patients with confirmed CL referring to Skin Disease and Leishmaniasis Research Center were randomized into two treatment groups. Both groups were treated with intralesional injection of MA twice a week until complete healing of the lesion or up to 8 weeks. In combination therapy group, TCA was applied to the lesions fortnightly up to week 8. Data were analyzed using SPSS11 software. There was no significant difference in lesion area change between two groups after treatment but a significant difference in time to complete cure with accelerated healing rate in the combination therapy group (P < 0.05). Combination therapy of intralesional MA and TCA-50% could accelerate healing of CL lesions. Topical TCA could be suggested as an adjuvant therapy to decrease the healing time of the lesions in CL patients. Although there was not any side effect due to TCA in the treated patients of this study, because of some complications of topical TCA (such as hyperpigmentationa and scarring) further studies with longer follow up needed to evaluate the final effect of TCA in the CL lesions treatment.

Finding risk factors for asthma is important for the prevention and treatment of it in children. The aim of the present study was to evaluate the relationship of asthma and body mass index (BMI) in children. In this cross-sectional study, 138 children with asthma and 138 children without asthma were evaluated during 8 months period (2005-2006). For case group, children were selected consecutively from the clinic of respiratory diseases, Al-Zahra Hospital, Isfahan, and for control group, children were selected randomly from those without any respiratory symptoms referred to Ebn-Sina Health Center, Isfahan. Weight and height of children were measured and body mass index was and was classified according to standard growth charts. There was no difference between the two groups in age or gender (P > 0.05). Mean weight of case group (38.6 ± 13 kg) was significantly lower than that of control group (53.2 ± 15.2 kg) (P < 0.001). According to body mass index, children with asthma were more in normal weight group, in contrast to children without asthma who were more in over weight group. In children with asthma, body mass index was not correlated with gender, FEV1, or severity of asthma (P > 0.05). In contrast to most of previous studies, in our study population, asthma was not associated with higher body mass index. Also, body mass index was not correlated with severity of asthma. Prospective and preventive studies are recommended to clarify this issue.

Intratympanic steroid injection is an effective method in treatment of sudden sensorineural hearing loss in cases resisted to systemic therapy. The purpose of this study was to determine the efficacy of intratympanic injection.

This case-series study was carried out on fifteen patients with sudden sensorineural hearing loss that had failed systemic therapy. Audiometric evaluation (PTA) performed before and after treatment and intratympanic dexametasone injection performed and the amount of improvement evaluated. Data Analysis was done using SPSS11.

In male patients, 33.3% partial and 33.3% complete improvement and in female patients, 18.6% partial and 50% complete improvement was reported. In cases with lower degrees of hearing loss, total improvement was 66.7%; also earlier time of treatment had better results.

Intratympanic injection of steroid is one effective modality in treatment of sudden sensorineural hearing loss in cases with no response to standard systemic therapy. It can improve the hearing level of patients while its complication rate is low and as degree of hearing loss increases the results decrease earlier treatment have a better results.

A case with scaphoid osteochondroma (exostosis) with wrist pain and tender mass. In this case, mass resection was performed with excellent outcome.