مجله دانشکده پزشکی اصفهان
پیاپی 173 (هفته چهارم اسفند 1390)

Zoonotic diseases have always threatened humans. They are common between human and many animals. Large numbers of dogs, especially stray dogs, are born every year. In addition, they inhabit around the cities and people's residences. Therefore, they have always been considered as threats for human health and environment. Identification of parasites in stray dogs around Isfahan, Iran would have economic, medical, veterinary, and particularly zoonosis benefits. In this study, 96 killed stray dogs were collected from several regions of Isfahan. After autopsy in place, the two ends of animal's bowel were closed and the intestines were moved to the laboratory. The intestines were opened longitudinally, washed with water, and examined for the presence of worms. The worms isolated from water were then transferred to a 10% formaldehyde solution. After temporary and permanent staining and transparency of isolates, the appropriate isolates were mounted and prepared for taxonomic study. The shapes of all samples were drawn by a drawing tube. They were then identified by diagnostic keys such as length of large hook, shape of proglottid, and characteristics of mature worms like cirrus sucks and the positions of testis. Nematode body length, the cuticle, cephalic and caudal fins, number of lips, morphology of esophagus, and position of rectum and vagina were also evaluated as crucial properties in taxonomic study. All isolates were identified at genus and species levels. In this study, 96 dogs were examined. Overall, 60.4% intestinal samples of stray dogs were infected with at least one isolated worm. The isolates included a total of seven species of cestodes and three species of nematodes. The identified cestodes consisted of 24% Taenia ovis, 13.54% T. hydatigena, 5.21% T. pisiformis, 5.21% T. multiceps, 27.1% Echinococcus granulosus, 22.92% Dipylidium caninum, 5.21% Mesocestoides lineatus. The nematodes were categorized as 21.9% Toxascaris leonina, 6.25% Toxocara canis, 3.13% Rictularia affini Taenia pisiformis was reported for the first time in the province of Isfahan. Our findings reveal the role of parasites in medical and veterinary aspects. Pet dogs and sheepdogs are thus required to be treated properly. On the other hand, stray dogs should be killed and the infected bodies need to be destroyed.

Breast cancer is the most common cancer in women. It jeopardizes different aspects of individual health including mental health. The aim of the study was to evaluate mental health among women who had survived breast cancer and also among the general population In a case-control design, we recruited 60 participants in two groups. The first group had survived breast cancer and had undergone mastectomy while the other group was selected from the general population. Mental health status of participants was measured by General Health Questionnaire (GHQ-28). For analyzing the data, Student t-test and logistic regression were used. Data analyses did not reveal any significant differences in mental health scores between the two groups. Although the risk of psychological distress increased 44% in breast cancer patients, there were not any statistically significant differences between the two groups. Iranian women survived from breast cancer are not significantly different with the general population in terms of mental health.

Polycystic ovary syndrome (PCOS) is among the most common endocrine disorders in women of reproductive age and affects 7% of this population. PCOS is identified as a reproductive disorder characterized by an ovulation, hyperandrogenism and insulin resistance. PCOS increases the risk for type 2 diabetes mellitus and metabolic syndrome, a constellation of cardiovascular risk factors associated with insulin resistance. The aim of our study was to investigate and compare insulin resistance reduction and chemical changes during the application of insulin sensitizers from two different groups (metformin and pioglitazone). This randomized clinical trial lasted for 3 months and was conducted in Avicenna Hospital, Qazvin, Iran. Overall, 56 women with PCOS were randomly divided into two groups. Group 1 received 500 mg metformin three times daily and group 2 was treated with pioglitazone 30 mg per day. Serum levels of insulin, fasting blood sugar (FBS), and lipid metabolism parameters including triglyceride (TG), cholesterol (Chol), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) were measured before the treatment and in the 3rd month. Homeostasis model assessment of insulin resistance (HOMA-IR) was used. Body mass index (BMI) was also calculated at baseline and at the end of therapy. Before the treatment, the two groups matched for age, weight, and BMI (P > 0.05). Before the treatment, there were no statistically significant differences in FBS, HDL, LDL, TG, Chol and serum levels of insulin between the two groups. Three months after treatment, mean serum levels of FBS, TG, Chol, LDL and insulin decreased significantly in both groups. Moreover, the treatment significantly increased HDL levels in both groups (P < 0.01). In metformin group, mean values of BMI before and after treatment were 26.1 and 25.5 (P < 0.05). The corresponding values in pioglitazone group were 25.9 and 25.2 (P > 0.05). Our findings showed that in women with PCOS, treatment with metformin and pioglitazone for 3 months resulted in similar beneficial effects on laboratory parameters of insulin sensitization. However, there is no evidence that pioglitazone improves BMI when compared to metformin. Further research is needed to investigate whether treatment with insulin sensitizers in women with PCOS can also reduce cardiovascular risk factors.

Adenotonsillar hypertrophy (ATH) is the most prevalent cause of chronic upper airway obstruction and sleep-disordered breathing. It is also associated with growth delay in children. Adenotonsillectomy is the most common surgical treatment of sleep disordered breathing in children. This study evaluated the effects of adenotonsillectomy on weight, height, and body mass index (BMI) changes in children with ATH. In this randomized clinical trial study, 96 children (48 healthy and 48 ATH patients) aged 3-10 years old were enrolled. Weight, height, and BMI were measured before, and 6 and 9 months after surgery. Both groups were similar in age and sex dispensation. Height and weight significantly increased in both groups (P < 0.001). Increase in BMI was only significant in ATH patients. Mean values of weight and BMI were higher among ATH patients than the healthy group 6 and 9 months after the operation (P < 0.001). Mean height was similar in both groups but was a little more in the control group (P = 0.8). Adenotonsillectomy increases weight and BMI in children with ATH.

Stress urinary incontinence (SUI) is very prevalent in middle-aged women. Minimal invasive anti-incontinence surgery is the most common surgery for treating the problem. The purpose of this study was to compare the therapeutic results and complications of minimally invasive anti-incontinence operative procedures for middle-aged women with SUI. We prospectively evaluated 146 women with SUI, who underwent suprapubic arc (SPARC) or transobturator (TOT) sling by the same surgeon. Concurrent anterior prolepses repair was performed in 43 (59.7%) and 29 (39.2%) patients in the SPARC and TOT groups, respectively. Objective cure rate was 90% and 93% respectively in the SPARC and TOT groups. Voiding difficulties were observed in 8 (11.1%) cases of the SPARC group and 13 (17.6%) patients of the TOT group. Urethrolysis and complete mesh removal were necessitated in 2 cases of the SPARC group. Regional and pelvic pains were observed in 3 (4.2%) and 10 (13.5%) patients of the SPARC and TOT groups, respectively. Vaginal erosion occurred in 8 (11.1%) and zero individuals of the SPARC and TOT groups, respectively The short-term anti-incontinence effects of SPARC and TOT were much similar. However, chronic pelvic and groin pain (with movement) occurred in 13.5% of women in the TOT group which implies the need for further study to determine the best technique in active women.

Due to some problems of serological assays in diagnosis of patients infected with HIV-1 and HCV, the use of molecular assay has become widely accepted. However, molecular assays have a major drawback of high cost and dependency to expensive thermocycler instruments. This research described the development of a multiplex nucleic acid sequence-based amplification (NASBA) assay for the simultaneous or single detection of HIV-1 and HCV genomes in plasma samples. The sensitivity and specificity of this assay has been evaluated using several clinical samples. The results showed that the primers used in this assay did not have any interactions with each other or with other possible interfering agents. The analytical sensitivity of this assay for both HIV-1 and HCV was calculated as 1000 copies/ml. The clinical sensitivity and specificity of the assay were considered as 90% and 100%, respectively. The developed multiplex NASBA assay can be used for simultaneous or single detection of HIV-1 and HCV viruses with a suitable sensitivity and specificity. Due to easy application, multiplexity, and no need to thermocycler instruments, this assay can be used as a low cost method in laboratories with limited instruments.

Stroke is the third cause of death in developed countries and is the commonest neurologic disease resulting in disability. This study was designed to evaluate epidemiologic characteristics and seasonal distribution of stroke among patients with first and recurrent stroke. This cross-sectional study was conducted during 2010-2011 in the departments of neurology at two hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Overall, 590 ninety patients above 16 years old with confirmed stroke diagnosis enrolled in this study. Hypertension (HTN), diabetes, dyslipidemia, atrial fibrillation (AF), myocardial infarction, valvular diseases (VD), smoking and addiction, ischemic heart disease, history of prior stroke and seasons of the year were registered. Among the 590 patients, 287 (48.6%) were females and 303 (51.4%) were males. Moreover, 94 patients (15.9%), 89 (15.1%), 110 (18.6%), 162 (27.5%), 124 (21%) and 11 (1.9%) were < 50, 50-59, 60-69, 70-79, 80-89 and ≥ 90 years old, respectively (P = 0.01). HTN, AF and VD were the commonest risk factors in patients with prior history of stroke compared to those with first strokes (P = 0.01, P = 0.01, and P = 0.02, respectively). This study indicated no difference in the prevalence of stroke between seasons. HTN, AF, and VD were the commonest risk factors in patients with prior history of stroke.

Although sporadic studies have expressed an association between croup and childhood asthma, the relationship is still ambiguous. So far, no studies have been performed to evaluate the relationship between severe croup and adolescent asthma, especially in Iran. The purpose of this study was to find any relation between moderate and severe croup and future asthma. In 2010-2011, a historical cohort analysis was performed on 164 adolescents who had been admitted to hospitals in Isfahan, Iran due to croup during their childhood (case group). A control group with the same age range and gender was also selected by convenient sampling method from secondary schools in the province. Both groups were called upon to perform spirometry. Spirometric results in the two groups were compared with chi-square test. In this study, 164 adolescents aged 13.7 ± 2.2 years with a history of croup (mean age at diagnosis 2.9 ± 1.3 years) were evaluated as the case group. The same number of adolescents without a history of croup were considered as the control group. Spirometry before and after 15 minutes of exercise revealed 30 cases (18.3%) and 17 controls (10.4) to have asthma (decreased FEV1/FVC or FEF25-75) (P = 0.01). The reductions in FEV1/FVC were more than 15% in 9 patients (5.5%) in the case and 7 (4.2%) in the control groups (P < 0.05). Moreover, FEF25-75 reductions more than 15% were observed in 21 cases (12.8%) and 10 controls (6.1%) (P = 0.001). The prevalence of croup was higher in boys than girls (P = 0.02). It seems that the inflammation caused by moderate and severe childhood croup might result in a series of inflammatory processes in the airways, especially the small airways and the individuals will be prone to asthma and decreased FEV1/FVC and FEF25-75 in adolescence.

Psychosomatic medicine is a field of medical sciences concentrated on the effects of social, psychological and behavioral factors on human body. The relationship between some gastrointestinal (GI) diseases and psychiatric disorders has been previously investigated. However, little research has been conducted on the relation between GI symptoms of psychosomatic diseases and psychiatric disorders.

In this retrospective study, 1802 cases with GI diseases who referred to the psychosomatic clinic (Isfahan, Iran) during 2005-2010 were evaluated. An attempt was made to find correlations between GI symptoms of psychosomatic diseases and psychiatric disorders.

No significant relationships were found between GI symptoms and gender, educational level, and marital status. However, age and nausea were significantly correlated (P = 0.002). Anxiety was the most common psychiatric symptom with a frequency of 814. In addition, mood disorders were the most common disease in patients with GI symptoms. Moreover, the most prevalent mood disorder was major depression. On the other hand, abdominal pain was found to be significantly related with psychiatric disorders (P = 0.039).

Our results showed mood disorders to be the most common disorder in patients with GI diseases who referred to the psychosomatic clinic. Therefore, patients with medically unexplained GI symptoms are required to be evaluated for mood disorders, especially major depressive disorder.

Nowadays, high prevalence of obesity and its consequences is considered as a major health complication worldwide. Overweight increases risk of diseases such as hypertension, cardiovascular diseases, type 2 diabetes, certain types of cancer, gallstone, and osteoarthritis. Obesity is defined as growth of visceral white adipose tissue. On the other hand, in order to supply for metabolic needs of adipose tissue, depends on appropriate growth of blood vessels, either in number and/or in size (angiogenesis/arteriogenesis). Moreover, the very close interconnection between adipogenesis and angiogenesis has been considered in recent years. Therapeutic interventions for treating obesity by targeting vessels of adipose tissue illustrate a promising future. In this review, we discussed adipose tissue, important roles and functions of vessels in adipose tissue, obesity, and angiogenesis. We finally presented suggestions on how to use anti-angiogenesis agents for treatment of obesity as a novel approach.