مجله پزشکی بالینی ابن سینا
سال شانزدهم شماره 3 (پیاپی 53، پاییز 1388)

Introduction & Leishmaniasis is a major worldwide health problem throughout the world and in Iran as well. Skin lesions are mostly healing but nonhealing cases have also increased recently. T-helper type1 (Th1) responses induction helps the patients to resist against the disease while T-helper type2 (Th2) responses cause susceptibility to disease. With the assessment of IL-5, IL-10, IL-12, and IL-18 cytokines secreted from peripheral blood mononuclear cells (PBMC) in leishmaniasis healing and nonhealing patients, their role in curing leishmaniasis was surveyed. Cytokines secreted from PBMCs of 60 healing and nonhealing patients and also control group referred to Ab-o-Bargh number1 clinic and Mashhad Qaem hospital during 2007 were evaluated Elisa commercial kits after stimulation by leishmania antigen and mitogen in vitro. Healing patients PBMCs secreted IL-12 (236.55±38.00 pg/ml) more than non healing patients (p<0.05) while in nonhealing patients IL-5 (52.14±65.21 pg/ml) and IL-10 (30.19±18.73 pg/ml) secreted more than healing patients (p<0.005). Also IL-18 secreted significantly higher in nonhealing patients compared with healing patients (p=0.003). According to the results It can be concluded that IL-12 is secreted more in healing patients than nonhealing patients but IL-18, which causes the increase of IL-12 secretion and the activation of Th1 cells during IL-12 secretion decrease, secrets more in nonhealing patients, induces Th2 responses and results in disease progression.

Introduction & Vitamin D receptor (VDR), which is involved in regulating cell growth and proliferation, may contribute to the development of colorectal cancer. Polymorphisms in the VDR gene may influence the expression or function of the VDR protein. The purpose of this study was to examine the association between the polymorphism and colorectal cancer. In this case-control study, the association between VDR polymorphism and colorectal cancer in 130 patients and 130 controls was evaluated. PCR-RFLP technique was used to determine the genotypes. The frequencies of the CC, CT, and TT genotypes were 10%, 31.5%, 58.5% in healthy controls and 15.4%, 37.7% and 65.8% in colorectal cancer patients, respectively. We observed the T allele in 60.7%, 65.8%, and the C allele in 39.3% and 34.2% of the control group and colorectal cancer patients. We could find significant association between the CT genotype and colorectal cancer (P=0.005 CI=95% 0.257-0.783 OD=0.449) while there was not any association between the CC genotype and colorectal cancer P=0.992, CI=95% 0.433-2.289, OD=0.996. Based on our finding, interestingly we could detect a reverse association between genotype 61968T>C and colorectal cancer. But we could not find any significant association between CC genotype and colorectal cancer. Our study corroborates the findings of the previous studies regarding lack of association between the CC genotype and colorectal cancer.

Introduction & Genetic agents play important roles in developing of cancers. Mutations and polymorphism affects on p53 protein function in suppressing tumor. We aimed to investigate the intron 3 polymorphism of p53 in Isfahanian breast invasive ductal carcinoma. We undertook a case–control study on 192 controls and 192 patients with breast invasive ductal carcinoma from Isfahan. p53 intron 3 genotypes were identified using allele-specific PCR. The c2-test was used to assess the statistical significance of the data. In control samples, the genotype distribution for p53 intron 3 polymorphisms was 57.3% and 42.7% for the A1/A2 and A1/A1 genotypes, respectively. In the cancer group, 85.4% of the cases were A1/A2 and 14.6% were A1/A1. The differences in the distribution of the p53 intron 3 polymorphism between the cases and controls were statistically significant (P<0.001). Our findings indicated that p53 intron 3 polymorphism probably is a genetic predisposing factor for breast invasive ductal carcinoma development in Isfahanian specimens.

Introduction & Postoperative acute pain is a complex reaction to tissue injury, visceral distention or a disease that causes harmful physiologic effects on several organs. It seems that with more epidemiologic and pathologic knowledge of postoperative pain, patients can be relieved more and hospital expenses reduced. One of the methods to reduce postoperative analgesics requirement is the preemptive analgesia. Many drugs like NSAIDs and narcotics have been used. The aim of this article was to study the effect of a single dose Indomethacin suppository given before operating colles fracture to reduce postoperative analgesics requirement. In this clinical study patients were divided into two groups randomly. The case group (55 people) received 100 mg indomethacin thirty minutes before anesthesia, while the control group (45 people) received nothing. All had the same kind of anesthesia, which lasted less than an hour for all. After operation they received NSAIDs or narcotics according to the Flacc pain scale. The average NSAID received after the operation in the case group was 16.8±23.1 mg, and 30.5±33.6 mg in the control group. Studying these values with t- test illustrates that using preoperative indomethacin causes less postoperative NSAID requirement (P<0.05). The average opioid equivalent dose given in the case group was 1.3 ±2.9 mg and 6.2±8.3 mg in the control group, demonstrating less opioid requirement in the case group(P<0.05). Prescribing a single dose indomethacin suppository before colles fracture operation has preemptive analgesic effect and reduces postoperative analgesic requirement.

Introduction & Hydatiform mole is one of the emergency and high risk situations during pregnancy and is defined as swelling and hyperplasia of the placental chorionic villosities. It is histologically characterized by abnormal changes in placental villi including trophoblastic proliferation and stromal edema of villi. Its incidence in different regions of the world is different and various risk factors have been mentioned in different studies. The aim of the present study is determination of frequency of hydatiform mole and some relative factors in Motazedi hospital, Kermanshah. In this descriptive analytic study, medical records of 200 women with the diagnosis of hydatiform mole who were admitted in Motazedi hospital during a 10 year period (1998-2008) were retrospectively reviewed. Also, records of 400 healthy pregnant women who were admitted for delivery were reviewed as control group. The data were analyzed using SPSS software and statistical test including U. mann withney, kelmogrof esmereinof, fischer exact and chi square. In this study frequency of hydatiform mole was 3.1/1000 live birth frequency of complete and incomplete mole were 2.07/1000and 1.04/1000 live birth, respectively. Mean age of patients was 26.33 years. Sixty percent of patients were multipar. History of previous molar pregnancy and irregular menstruation, were significantly effective on frequency of molar pregnancy. (p=0.004,p=0.01 respectively). Molar pregnancy is an emergency situation. There is a high incidence and a high recurrence rate of hydatiform mole in our country. Hydatiform mole should be considered as one of the probable diagnoses women in their reproductive age who refer with bleeding.

Introduction & Myocardial infarction (MI) is one of the most important causes of mortality in human communities today. MI can disable patients, and moreover it imposes financial burden on society. Therefore, regarding to the effect of some variables in the trend of the disease, we tried to determine a 5 year survival rate for patients with MI and assess the effect of some factors on it in Bushehr port. In this retrospective cohort study, 197 patients suffering from myocardial infarction for the first time and admitted in Bushehr hospitals during "1997-2001" were evaluated. The patients were followed up for 5 years and the relationship between their survival rate and factors such as patient's age at the time of MI, their sex and what time MI happened was evaluated. The mean 5 year survival time for the patients after the first myocardial infarction was approximately 53.7 months (53.5 for men, 54.4 for women; p>0.05). In this study, only age of the patients had a significant relationship with their survival rate (P=0.018). The study showed that mortality rate in hospitalized patients in the first 28 days, one year and 5 years after myocardial infarction were 1%, 8.6% and 13.7% respectively. MI in Bushehr port mostly occurred in fall and summer respectively. The study indicated that MI mostly happened in the early morning In this study, the 5 year survival rate of patients (86.3%) was higher than that of patients in other studies.

Introduction & Rivers are one of the main water supply resources for various uses such as agricultural, industrial and drinking purposes. As population and consumption increase, monitoring of rivers water quality becomes an important function of environmental management field. Because Darreh-Morad Beyg river of Hamadan is a water supply for different purposes and many pollutants are discharged in it, its water quality assessment seems necessary. Zoning of pollution and depicting a detailed image of surface water resources quality using geographic information system (GIS) are the key factors for the better management of these resources. This research is a cross sectional- descriptive study and river water samples were taken for 7 months from 6 sampling stations on the length of the river. Biochemical oxygen demand (BOD), electrical conductivity, dissolved oxygen (D.O.), pH, fecal coli form, nitrate, temperature, phosphate and total solids were determined in the samples. Obtained data were analyzed by national sanitation foundation water quality index (NSFWQI) and the river was zoned using GIS software. Results of the analyses by NSFWQI showed the best water quality for station 1 and the worst water quality for station 6 with scores of 62.78 and 27.49, respectively. The NSFWQI is a suitable index for zoning of Darreh-Morad Beyg river. Monitoring of physical, chemical, bacteriological quality parameters and using water quality index in various sampling stations are used in the assessment of water pollution. It also helps the officials to correctly decide about the water uses for different purposes.

Introduction & Brucellosis is an important zoonosis considered a serious hazard to public health. Human brucellosis is caused by one of the four species of the brucella genus: B. melitensis is principally found in goats and sheep, B. abortus in cattle, B. suis in swine and B. canis in dogs. Vaccination of young animals, is a strategy to decrease the incidence rate of brucellosis in humans. The objective of this study is to give an estimate of vaccination coverage in animals (sheep or goats and cattles) and its effect on human brucellosis incidence rate. In this cross-sectional study, the data on reported human cases of brucellosis originated from Hamadan health deputy and the data on animal vaccination was collected from provincial veterinary of Hamadan. The relationship between the animals vaccination coverage with the incidence of human brucellosis was assessed with the SPSS software. Pearson correlation coefficient was used to evaluate the correlation between animal vaccination and human brucellosis. According to provincial veterinary of Hamadan reports, animal vaccination coverage (percentage) from 2002 to 2008 was between 17.5% in 2002 and increased to 60% in 2008 in young sheep and goats, and vaccination coverage against brucellosis in young cattles was 5.6% in 2002 and increased to 38% in 2008. According to Hamadan health deputy human brucellosis incidence rate was 86 per 100000 persons in 2002 and reduced to 44.7 per 100000 persons in 2008. Statistical analysis showed that Pearson correlation coefficient of cattle vaccination and human brucellosis(r = -0.78), sheep's vaccination and human incidence rate (r = - 0.38) are negative but incomplete. Vaccination of young animals was effective in reducing the incidence rate of human brucellosis. Our findings emphasize the importance of the combination of health education and animal vaccination programs for controlling such zoonosis diseases and highlight the need for cooperation between public health officials and veterinary officers.

Mature teratoma is the most common germ cell tumor(and the most common tumor) of the ovary,composing more than 20% of all ovarian neoplasms. Super infection of dermoid ovarian cyst is very rare.Case Report: A 72 year-old woman was admitted to the gynecological outpatient clinic because of lower abdominal pain and fever. Gynecological examination and ultrasonography revealed a heterogeneous cystic mass in the right ovary. Abdominopelvic CT scan revealed a right ovarian mass (15×15 cm) thought to be a dermoid cyst. Right adnexectomy was performed. The pathological evaluation suggested infected benign ovarian dermoid. They are the most common ovarian neoplasm found in adolescence and during pregnancy. Mature cystic teratoma may be complicated by torsion, rupture, and malignant change infection of a mature teratoma is a relatively uncommon event. However, based on our case and other cases, superinfection with abscess formation should be considered in the differential diagnosis whenever a patient with a documented pelvic mass and fever refers to gynecologists.

VZV is an exclusively human pathogen. The primary infection typically occurs during childhood and causes varicella. As with other members of the herpes viruses’ family, VZV is noninfectious in its latent form but can reactivate at a later time to form intact virions in the involved sensory neurons. These virions then migrate to the skin through axons, spread from cell to cell, and penetrate the epidermis.Case Report: In this case a 72 years old woman with history of diabetes mellitus and hypertension is reported hospitalized because of urinary retention, weakness and parestesia in the right leg, complicated with vesiculoulcerative lesions in sacral area with distribution to the right buttock and vagina. L.P was done to confirm inflammatory radicopathy that showed aseptic meningitis and therapy started with acyclovir and prednisolone. Patient got well and discharged from the hospital. Motor weakness in noncranial nerve is one of the zoster complications known as zoster paresis. Weakness begins suddenly 2-3 weeks after rash and progresses to extremities. In this case 3 weeks after rash, nerve complications were observed. We recommend to do paresthesia examination of skin for eruption in all patients presented with paresis.