نشریه پژوهش در پزشکی
سال سی و سوم شماره 3 (پیاپی 131، پاییز 1388)

Backgraound: It is recommended to use BIS (BISpectral) to determine anesthesia levels. Currently, due to low capacity in Iran, anesthesiologists use cardiac indices, such as pulse rates and blood pressure to detect anesthesia levels. This study was designed to assess association of cardiac parameters with anesthesia levels measured by brain function.

In this descriptive study, 14 patients candidate for operation in Milad hospital were studied. Patients’ information, including systolic blood pressure, pulse rate and BIS (BISpectral) index were simultaneously registered by Rugloop software using Datex-ohmeda S5. Cut-off of 75 percent by Delphi method was considered as agreement, and percent of disagreement of 3 cardiac parameters, including blood pressure, pulse rate and both blood pressure and pulse rate were assessed.

14 patients with mean age (± standard deviation) of 43.3±12.6 years were studied. All patients experienced moderate (BIS 35-65) and mild (65-85) level of anesthesia during operation. Percent agreement of BIS with systolic blood pressure, pulse rate and both systolic blood pressure and pulse rate was 7.1%, 21.4% and 14.3%, respectively. Mean percent agreement of BIS with systolic blood pressure, pulse rate and both systolic blood pressure and pulse rate was 51.4%, 58.2% and 60.6%, respectively.

It seems that cardiac parameters are not able to determine anesthesia levels. So, it is better to use BIS tools and processors of brain signals.

CD5B1 lymphocytes are the major cell subpopulation for defense found in many organs including peritoneum and splenic follicles. They can produce natural antibodies with poly specific reaction with an important Ligand: Lipopolysaccaride (LPS). The aim of this study was isolation and purification of this unique population from cellular content of peritoneum, spleen and blood and determining their functional activity in producing IgM antibody in response to stimulants in cell culture under experimental conditions.

With direct heart puncture, splenic puncture, and peritoneal lavage from inbred Balb/C mice, cells were collected and purified through Ficole density gradient and nylon wool column for purification of B lymphocytes. In complete tissue culture medium (Bwool), cells were harvested and divided into 2 Groups, experimental and control. LPS stimulation was performed on the experimental group for different durations: 24, 48 and 72 hours. Finally culture supernatants were assayed for IgM concentration with ELISA Technique. The proliferation rate was defined by M.T.T assessment. Immunophenotyping studies for confirmation of cellular purity were carried out by CD3 and CD5 markers.

Lymphocytes from spleen and peritoneum organs had significantly higher levels of IgM secretory activity in 24 hours, as compared to the control groups. In Immuno-phenotyping studies, purified B lymphocytes from peritoneum showed highest levels of CD5 marker.

The findings of this research indicate that Cells collected from splenic puncture and peritoneal fluid are excellent source for IgM antibody with polyspecific properties against LPS in the laboratory and extremely useful for research purposes.

Rheumatoid Arthritis, (RA) is a chronic inflammatory autoimmune disease with a progressive course requiring early diagnosis and treatment. The value of anti-cyclic citrullinated peptide antibodies (Anti-CCP) in the diagnosis of RA has been shown in several studies. The present study was designed to determine and compare the diagnostic value of Anti-CCP and rheumatoid factor (RF) for RA.

207 females and 48 males with RA, diagnosed by clinical criteria, with the mean age of 50±13.8 years and 290 non-RA controls with the mean age of 47±14 years were enrolled in the study. Serum samples were taken for assessment of Anti-CCP and RF from all participants. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio(LR+), and negative likelihood ratio (LR-)and their 95% confidence interval (95%CI) were estimated by comparison of patients with controls.

In patients with RA, Anti-CCP was positive in 79.2% and RF was positive in 72.1% and both antibodies were positive in 64.7%, and both negative in 13.3%. 47.8% of seronegative RA were Anti-CCP positive and 7.8% of anti-CCP negative were RF positive.. Sensitivity, specificity, PPV, NPV, LR+ and LR- for Anti-CCP in diagnosis of RA were: 79.2%, 94.8%. 93.08%, 83.8%, 13.46 and 0.19 respectively for RF the respective values were 72.1%, 90.6%, 87.2 %, 78.7%, 6.81, and 0.26. For both Anti-CCP and RF the values were 64.7%, 97.5%, 95.9 %, 75.8%, 26.8and 0.36. Anti-CCP was more diagnostic than RF and both antibodies had more diagnostic values than either of them alone. Anti-CCP yielded a specificity of 89.6% and PPV of 85% for diagnosis of seronegative RA.

The findings of this study indicate that anti-CCP has a higher diagnostic performance than RF. It is highly useful in the diagnosis of seronegative RA. In addition, presence of both antibodies is more diagnostic than either of them alone.

Improvement in health policies has led to changing diseases pattern and increasing rapidly population of elderly people in developing countries such as Iran. Therefore, improvement of quality of life and health status of elderly people demands increased attention. This study was conducted to identify tools that are commonly used to measure health status and quality of life in elderly people.

A systematic review was conducted in the websites of Medline, World Health Organization and other sources based on keywords of quality of life and health status of elderly people without limitation for the publishing year. Authors of these papers had reported the most common techniques used for measurement of health status and quality of life in the elderly.

5186 articles were obtained based on search keywords. 91 articles were related to tools that measure health status and quality of life of elderly people. Most commonly used techniques were Short Form 36(49%), Short Form 12(7%), Nottingham Health Profile (6%), Sickness Impact Profile (4%), and Health Status Questionnaire 12(4%).

Measurement of health status and quality of life in the elderly requires tools specifically designed to address issues in that age group.

Inactivation of tumor suppressor genes can cause irreversible uncontrolled growth. PTEN is a tumor suppressor gene and its polymorphism (IVS4) role in breast cancer was investigated in this study.

Forty nine female subjects with confirmed breast cancer comprised the case group and 43 healthy women participated as a control group in this study. The PTEN polymorphism was genotyped by amplification of genomic DNA and then digestion by restriction of endonuclease and finally RFLP analysis.

The frequencies of mutant allele (M) were 0.37 and 0.27, respectively in the case and control groups. The genotype frequency distributions were in Hardy-Weinberg equilibrium in both groups.

The mutant allele frequency in case group was 10% higher than control group it is possible that PTEN IVS4 polymorphism has a role in Breast Cancer.

Backgraound: Sodium disturbances are among the most common electrolyte disturbance in Intensive Care Unit (ICU) patients. The aim of the present study was to determine the frequency of hypernatremia, hyponatremia and their comparison in relation to their mortality impact on patients admitted to a general ICU.

In a cross sectional fashion we studied 273 patients hospitalized in an ICU of a large teaching hospital in Tehran, Iran between 2004 and 2006. Age, sex, reasons for hospitalization, hyponatremia (serum sodium < 135 mEq/L) and hypernatremia (serum sodium > 145 mEq/L) during ICU stay were recorded and their effects on ICU mortality of the patients were assessed.

We observed hypernatremia in 39.5% and hyponatremia in 60.5% of our patients. The mean age of patients with serum sodium imbalance was significantly higher as compared to those without it 52±21 vs. 44±20 years for hyponatremics and 56±20 vs. 49±22 years for hypernatremics respectively. Hyponatremia occurred more frequently in surgical patients than those with medical causes, 72% vs. 22% respectively. Mortality of patients with hyponatremia (34% vs. 15% with odds ratio of 5.7 and 95% CI from 2.9 to 11.30) and hypernatremia (55.2% vs. 17.8% with odds ratio of 2.8 and 95%CI from 1.4 to 5.5) were significantly higher than patients without sodium imbalance. 55%with hypernatremia died vs. 34% with hyponatremia, (95% CI from 7.7% to 33.9%, p value = 0.0034).

Serum sodium imbalances are frequent in ICU patients, occurring more frequently in older individuals and are associated with an unacceptably high mortality. Mortality was significantly higher in patients with hypernatremia compared to those with hyponatremia.

Vulvovaginal candidiasis is a fungal disease with itching, and thick white vaginal discharge. 70-75% of normal healthy adult women report having had at least one episode in their life Candida albicans is identified as the most common cause. The objective of this study was to identify the different candida species in the vaginal swabs of patients with vulvo-vaginitis.

175 vaginal swab specimens, from patients admitted in the Gynecology Department of Mahdieh Hospital with recurrent and non-recurrent vulvovaginitis, were cultured on SDA medium. The isolates were subcultured onto CHROM agar Candida medium and incubated at 37˚C for 48h.

In 89.7% of cases, single candida species and in 10.3%, multiple candida species were isolated. Frequency of different isolates was as follows: C. albicans (65.1%), C. glabrata (13.1%), C. tropicalis (6.2%), C. krusei (4%), C. guilliermondii (0.6%), C. parapsilosis (0.6%), C. glabrata and C. albicans (5.7%), C. albicans and C.parapsilosis (1.1%), C. glabrata and C. tropicalis (0.6%), C. krusei and C. tropicalis (0.6%), C. albicans and C. tropicalis (0.6%), C. krusei and C. albicans (0.6%), C. glabrata and C. krusei (0.6%), and C. glabrata and C. krusei and C. albicans (0.6%).

Our findings suggest that, the common cause of both recurrent and non-recurrent vulvovaginal candidiasis was C. albicans, followed by C. glabrata.

The annual Hajj pilgrimage to Holy Mecca, brings over two million people together in a small confined area through the world. Respiratory illnesses are the most common afflictions during this ceremony presenting as various clinical syndromes. Several microbiologic, Sero-epidemiologic and Immunologic studies have revealed that most of these syndromes are caused by viral infections. Assessment of Gamma Interferon level and neutrophilic function with Nitrobluetetrazolium Reduction Test can confirm or exclude the role of the infections indirectly. The main objective of this study is the assessment of Neutrophilic phagocytosis and also the measurement of the Gamma INF, (A potent phagocytic activator cytokine) among the pilgrims.

In an Observational & Longitudinal study, blood samples of 130 pilgrims were taken before and 3 weeks after return from the pilgrimage and tested for NBT and Gamma INF levels. For the Nitroblue Tetrazolium Reduction Test (NBT), changes were assayed with Chemiluminescence, and Gamma IFN with ELISA. All volunteers were followed during the trip and the particulars of pilgrims who developed respiratory complaints recorded. For data analysis, we used the SPSS software.

Results showed, that serum Gamma IFN levels were 4.8±6 before starting on the journey and rose to 5.2±5.8 pg/ml. after the pilgrimage, (non-significant) NBT percentage before and after the pilgrimage were 90.4±4.3 and 87.7±4.3 respectively, (p=0.001).

Significant changes in NBT, and increased serum Gamma IFN level indicate the occurrence of an infectious process during the pilgrimage.