مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال شصت و هشتم شماره 10 (پیاپی 118، دی 1389)

Pseudomonas aeruginosa is an important opportunistic pathogen causes clinical infections among burn patients. Metallo-β-lactamases (MBLs) are important mechanisms of Carbapenem (drug of choice) resistance among Pseudomonas aeruginosa isolates. The aims of this study were to determine the antibiotic susceptibility pattern and to detect the prevalence of MBLs among Pseudomonas aeruginosa isolates using two phenotypic and genotypic methods. Initially, the antibiotic resistance patterns of 170 clinical strains isolated from burn patients in Motahari Hospital in Tehran, Iran were determined by Kirby-Bauer disc diffusion method. All of the clinical Pseudomonas aeruginosa isolates resistant to Imipenem were screened for production of MBL by E test with Imipenem / Imipenem plus EDTA (E test MBL). PCR assay was performed for detection of blaVIM genes. Based on the study results, the percentage of resistance was as below: Imipenem (10 μg) 52.9%, Amikacin (30 μg) 81.7%, Carbenicilin (100 μg) 74.7%, Polymixine B (300 unit) 10%, Ticarcilin (75 μg) 84.7%, Tobramycin (10 μg) 88.2%, Colisitin (10 μg) 34.1, Colisitin (25 μg) 28.3%. Of 90 Carbapenem resistant isolates, 10(11/1%) isolates were positive by E test, all were sensitive to Colisitin and Polymixine B. All of the Imipenem resistant Pseudomonas aeruginosa isolates were examined by PCR for the presence of the blaVIM genes. All MBL-producing isolates carried blaVIM-1 genes. Considering the high prevalence and clinical importance of MBL-producing isolates, rapid identification of them and use of the appropriate infection control measures are necessary to prevent further spread of infections by these organisms.

Numerous evidences indicate that various environmental stresses during pregnancy affect physiological behavior of the offspring. This experimental study was designed to investigate the effect of noise stress during prenatal period of rats on spatial learning and memory and plasma corticostrone level in postnatal life. Three groups of pregnant rats were given daily noise stress with durations of two and/ or four hours in last week of pregnancy period. The fourth group was left unstressed. The male offspring from the unstressed and different stressed groups were assigned as controls and stressed groups. The animals were introduced to a spatial task in Morris water maze 4 trials/day for five consecutive days. The probe test was performed on the 5th day of the experiment. The delay in findings and the distance passed to locate the target platform were assessed as the spatial learning. Our results showed that prenatal exposure to noise stress for two and/ or four hours a day, leads to impaired acquisition of spatial learning in the postnatal animals. The plasma level of corticostrone in the two stressed groups of rats markedly matched with their behavioral function. Prenatal exposure to 1- hour noise stress revealed no effects on the offspring's behavior and plasma corticostrone level. Based on our study results, it seems that applied range of stress which is executed through the noise stress could increase the plasma corticostrone level and could decrease spatial learning and memory of adult male offspring.

Alprazolam belongs to benzodiazepine family and is increasingly used these days by pregnant women. It should be noticed that alprazolam exposure during pregnancy may have teratogenic effects on the fetus. Till now, limited studies have been conducted on the teratogenic effect of alprazolam. In this study, teratogenicity of alprazolam intake during pregnancy and its effects on fetus development was investigated.

About 20 virgin rats of known age and weight were selected. After being pregnant, they were divided into four groups which contained five animals in each group: Negative and positive control groups. The case group exposed to 1 to 6 mg/kg/day alprazolam. The fetuses were first studied macroscopically regarding anomalies, and then histologically and histochemically to inspect the defects of tissue organogenesis.

Our results show that there was significant difference especially at the dose 6 mg/kg weight and length of the cases compared to the control group. It appeared that at the dose of 6 mg/kg/day, cleft lip and palates were seen in the animals. The highest anomalies of limbs were also seen at the dose of 6 mg/kg/day. The statistical results indicate that alprazolam intake during the second half of pregnancy can lead to irreversible anomalies.

Our results indicate that alprazolam in doses higher than 4 mg/kg/day might cause teratogenic effect. It seems that benzodiazepine therapy among pregnant woman would be better to avoid during the first trimester and multidrug regimens.

Preterm delivery is a relevant public health problem. The aim of this study was to evaluate the association between spontaneous preterm delivery (SPTD) before 35 and 37 weeks of gestational age and the measurement of the cervix length, cervical funneling and Cervical Gland Area (CGA), in high risk pregnant population. A prospective cohort of 200 women carrying high risk pregnancies was evaluated by transvaginal sonography between 14th and 28th gestational weeks. The data were analyzed using statistical methods. A multiple linear regression model was estimated in order to examine the relationship between the gestational age at delivery and the cervical markers. A multiple logistic regression was estimated in order to analyze the factors associated to spontaneous preterm delivery and the transvaginal sonographic markers. Cervical length less than 18 mm and the presence of cervical funneling presented a statistically significant association with spontaneous preterm delivery before 35 weeks. The nondetection of Cervical Gland Area demonstrated a strong association with spontaneous preterm delivery before (p=0.0001, OR=169.1, CI=2.6-3.1) and 35th and 37th gestational week (p=0.001, OR=115, CI=2.12-3.5). The multiple logistic regression analysis suggested the non-detection of CGA as the only variable to reveal statistically significance association with spontaneous preterm delivery. Based on results of present study the absence of cervical gland area (CGA) can be a new and important ultrasound marker for predicting spontaneous preterm delivery and needs to confirm with future multicenter investigations.

Epilepsy is a common disease in the pediatric neurology. There are frequent anti-epileptic drugs which are used in management of epilepsy. Anti-epileptic drugs may have some complications on bone and vitamin-D metabolism. In this study we aimed to evaluate vitamin-D metabolism in epileptic children.

The study was a prospective and cross sectional one. A total 89 epileptic children who were taking anti-epileptic drugs for longer than six months with no underlying disorder in Imam Khomeini and Bahrami Hospitals in Tehran, Iran were enrolled in our study.

Forty nine boys and 40 girls were enrolled in this study; mean age of the patients was 7.8±2.1 years. Mean duration of anti-epileptic drug therapy was 2.3 years (SD=0.4), 70 of patients were under monotherapy and 19 were under polytherapy. None of the patients had signs of rickets. Serum calcium and phosphor levels were within normal ranges. Serum alkaline phosphates levels were increased more than two times in 43%. 42% had vitamin-D deficiency (25-OH Vit D<10 ng/ml) and another 33% had vitamin-D insufficiency (10<25-oh Vit D<20 ng/ml). 29 patients (32%) were taking prophylactic supplemental Vit D (200-400 IU/day). There was significant difference between patients taking supplemental vitamin-D as prophylaxis and patients who did not (p=0.04). There was no significant difference in vitamin-D levels between patients according to age, gender or different drugs.

Periodic measurement of 25-hydroxy vitamin-D is recommended in epileptic children taking anti-epileptic dugs. Supplemental vitamin-D administration in such patients may be helpful.

Cervical ripening usually begins prior to the labor when there is an unripe cervix. Complications will increase significantly when the cervix is not ripped. Misoprostol is a pharmacologic agent available for cervical ripening and labor induction. The aim of this study was to compare the efficacy and safety of administration of a single dose of 25 mg vaginal Misoprostol (A) with 100 mg Misoprostol (B) for cervical ripening. Sixty subjects with pregnancies of at least 40 gestation weeks, and an unfavorable cervix (Bishop Score <6) were randomly assigned to receive one dose oral misoprostol 100 mg or 25 mg vaginal misoprostol. The main dependent variables were mode of delivery, time interval from induction to cervical ripening, need for additional oxytocin, perinatal results and maternal side effects. The mean time from the indication of induction to cervical ripening was the same in the two groups (3.63 h in oral group and 3.9 h in vaginal group). Two groups did not differ statistically in the percent of patients who were delivered vaginally or with cesarean section during 24 hours (20% in group A versus 10% in group B). Based on the results of our study, Misoprostol is an effective drug for the cervical ripening and labor induction in the term pregnancies. 25 mg vaginal tablet of Misoprostol is as effective as 100 mg oral misoprostol for cervical ripening.

Common Variable Immunodeficiency (CVID) is a primary immunodeficiency disease, characterized by hypogammaglobulinemia and heterogeneous clinical manifestations. This study was performed to evaluate the clinical and immunological features of pediatric patients with CVID.

We reviewed the records of 69 children diagnosed under age of 16 years with CVID (35 males and 34 females).

By the year 2008, 15 patients (21%) had died. The total follow-up period was 333 patient-years. The mean diagnostic time between onset and diagnosis in our patient group was 4.40 years. The overall rate of consanguineous marriages was 58%. 10 patients had a positive family history of immunodeficiency. At the time of diagnosis, the mean levels of serum immunoglobulin G (IgG), IgM, and IgA levels were 286.86, 39.92, and 18.39 mg/dl, respectively which were below the normal levels for age. All of the patients presented with infectious diseases at the time of onset, the most common of which were pneumonia, diarrhea and sinusitis. Acute and recurrent infections were also found in almost all of the patients, particularly involving respiratory and gastrointestinal systems. The most common infections during follow-up period were pneumonia (31.9%), acute diarrhea (18.8%), acute sinusitis (18.8%), and otitis media (14.5%). Post-diagnosis survival was estimated to be 79% during the first five years. The survival rate was not shown to be influenced by delayed diagnosis, serum levels of IgG and B-lymphocyte count at the time of diagnosis.

Any child with a history of recurrent infections, decreased levels of serum immunoglobulin isotypes and consanguineous parents should be considered as a CVID patient.

Tuberculosis with high prevalence in HIV/AIDS patients is the main reason for morbidity and mortality in these patients. About one-third of patients with HIV infection have concomitant tuberculosis. Lack of appropriate infection control on many social and economic communities will impose. Comprehensive study on the effects of anti-tuberculosis drugs in patients with HIV infecting less done, also due to the importance of reducing morbidity and mortality, reduce the cost of disease, identifying drug pharmacokinetics, the importance of completing treatment tuberculosis, this study was performed to evaluate the effects of anti- tuberculosis drugs on HIV infection and to identify the drug pharmacokinetics and so more complete tuberculosis treatment. A historical cohort study was performed on patients referring to the research center for HIV/AIDS, consultation center, department of infection diseases of Imam Khomeini Hospital in Tehran, Iran. A total number of 75 cases with HIV negative versus HIV positive patients with pulmonary tuberculosis and positive sputum smear in accordance with inclusion and exclusion criteria were selected. In this study, the frequency of peripheral neuropathy 27(73%), arthralgia 31(83.8%), vomiting 18(48.6%), headache 26(70.3%), dizziness 20(54.1%), renal toxicity 4(10.8%) and of skin rash 10(27%) in patients with HIV virus infection were significantly more than HIV- negative patients. Hepatotoxicity, fever and anemia were not significantly more common in patients who infected with HIV virus. The HIV patients, who have not received antiretroviral drugs during tuberculosis treatment, may show higher incidence of anti-tuberculosis drugs complications.

The role of reactive oxygen species (ROS) in the pathogenesis of different cardiac diseases has been documented. Recently, effect of allopurinol in decreasing the production of ROS and improving cardiovascular pathogenesis has come into scientific interest. Animal studies have documented the benefit of allopurinol in improving left ventricular dilatation, hypertrophy and fibrosis, and myocardial contractility and in the prevention of systemic vasoconstriction. The aim of this study was to evaluate the effect of allopurinol in improving diastolic dysfunction in ESRD patients with hyperuricemia.

This was an interventional study on 28 patients (19 males and 9 females) with ESRD and hyperuricemia. At the end of a one-month course of allopurinol therapy (100 mg daily), echocardiographic indices of diastolic dysfunction were measured and compared to the baseline indices.

The mean level of uric acid was 7.5±0.96 mg/dl. The mean EF before and after the study were %44.28±%9.8 and %44.64±%9.7, (no significant difference), Respectively. The two indices of IVCT and A reversal were shown to have significant improvement after therapy (p=0.028 and 0.012, respectively). The grading of diastolic dysfunction didn’t improve significantly after treatment with allopurinol.

Significant improvement in some of studied indices, reproduced only in male subgroup of patients that might be related to a better response of males to allopurinol, however, a longer course of treatment may result in more favorable responses. Better patient selection in terms of “EF”s with normal distribution and repeating the study in non-dialysis hyperuricemic patients may result in more accurate information.

Osteochondroma is a common tumor of the skeletal bone and is a common benign tumor of the bone constitutes 10-15% of all and 20-50% of the benign bone tumors. The lesion is an exophytic bony protrusion covered by a cartilaginous cap. It is most commonly found in long bones, and especially at the epiphysis. Nearly 40% of cases are seen around the knee joint. Osteochondroma rarely affect skull bones, occurrence of an intracranial osteochondroma is a rarity in the neurosurgical literature and only anecdotal reports are available in the literature. To our knowledge no case arising from foramen magnum has been reported. We present a 73 years old male with gait problem and limb paresis. Imaging investigation showed a bony mass in the foramen magnum, that compresses neural elements. The patient also complained of persistent headache in his occipitocervical region. There was no history of previous trauma. The patient underwent surgery and histopathological examination confirmed the lesion to be osteochondroma. Many types of lesion may be seen in foramen magnum area, and in differential diagnosis of such lesion rare, osseous tumors such as osteochondroma should be considered.