مجله علوم پزشکی رازی
سال هجدهم شماره 11 (پیاپی 92، بهمن 1390)

Triggering receptors expressed on myeloid cells i.e soluble triggering expressed on myeloid cells-1 (STREM-1) is inducible on monocyte/macrophages and neutrophils and accelerates tissue destruction by propagating inflammatory responses in disease related to bacterial infections. The aim of this study was to investigate the role of STREM-1 in the synovial fluid to identify septic arthritis from aseptic ones. A cross sectional study (2007-2009) was conducted in the Pediatric & Orthopedic wards of Hazrat-e-Rasool Akram hospital, Tehran. Synovial fluid was aspirated in 53 cases with arthitis and searched for diagnosis of bacterial arthritis by conventional diagnostic tests. About 0.5-3cc of synovial fluid was stored at -70 °C, and quantification of STREM-1 was done in 53 synovial fluid samples (Quantikine, R&D systems, USA) by EIA; results were compared between septic and aseptic arthritis. Septic arthritis was detected in 49% (26/53) and aseptic arthritis in 51%(27/53). Positive synovial fluid culture was detected in 20.3%, and positive latex particle agglutination for bacteria was found in 8.5%. Positve direct smear was obtained in 10.5% of the cases.Cut off level 825 pg/ml for SF-STREM-1 yielded 50% sensitivity, 70% specificity, 64% Positive Predictive Value (PPV), and 64%, Negative Predictive Value (NPV). Poor agreement was seen between SF -STREM-1 levels and positive culture (p value: 0.037; Kappa=0.28). The area under the ROC curve for discriminating between septic and aseptic arthitis was 0.603 (95% CI; 0.757–0.448, p = 0.1). SF-STREM-1 level with cutoff 825pg/ml had 50% sensitivity, and 70 % specifity in discriminating between proved cases with septic arthitis from aseptic ones. Searching for bacterial antigens in synovial fluid (Latex Particle Aagglutination test) and synovial fluid -STREM-1 level could potentially assist clinicians in better diagnosis of septic arthitis if added to the conventional tests including smear and routine analysis of synovial fluid. It might prevent unnecessary empiric antibiotic theray in children with arthritis. In clinical decision making; randomized studies on the potential synovial fluid - STREM-1 -level guided antimicrobial therapy in bacterial arthritis would be useful.

Saprophytes are one of the agents causing nail dystrophy. Saprophytes can invade healthy nail or may invade nails previously damaged in the course of other diseases and grow with suitable conditions. The reported incidence of saprophytic nails is between 1.43-17.6%. Saprophytes preferably invade the nails on the big toes, especially in individuals above 60 years. The most etiologic agents of saprophyte nail are Aspergillus spp, Acremonium spp, Scopulariopsis spp, Penicillium spp, and fusarium. The purpose of this study was to determine the prevalence agents of saprophytic nails in patient that had referred to Razi hospital. This was a cross sectional study and nail samples were analyzed by direct microscopy and culture. Microscopic examination of these specimens was carried out in potassium hydroxide solution (20%). These specimens were cultured on two media of sabourad dextrose Agar (S). Czapek-Dox Agar [CZA] medium was used for identification of Aspergillus species. For investigation of relevance between the variables, Chi-square test and Fisher exact tests were used. In this study, 34 cases were positive by both direct microscopy and culture. Of those, 17 patients were females and 17 patients were males. The most frequently isolated saprophytes from nails was Aspergilus flavous (35.3%). Meanwhile 58.8% of saprophytes were isolated from toe nails. In this study the distal subungual onychomycosis was the most frequent (% 64.7%). The age group 50-59 years (29.4%) had the highest prevalence of saprophytic nail infections.In this study the prevalence of saprophytic nails infections was 17.2%. A proper diagnosis, consisting of both clinical and mycological examinations, may aid the clinician in selecting the most appropriate therapy. Knowledge of epidemiology and mycology characteristics of nail infections has been noted by many authors as being an important tool for control of these fungal infections.

Studies have shown that patients with Spinal Cord Injury (SCI) are susceptible to various diseases including dislipidemia and Cardiovascular Disease (CVD). In this study for the first time, we evaluated the relationship between dietary intake and metabolic variables of 162 patients. This cross sectional study was done in Tehran University of Medical Sciences. All of the consumed food items and the variables were measured. Independent-sample t-test was used for comparison of dietary intake and serum profile. Multiple regression analysis was used to estimate predicting variables of serum variables. Men as compared to women had higher triglycerides (TG) levels and lower HDL-C levels (p<0.05). Patients with paraplegia compared to those with tetraplegia had significantly higher total cholesterol and LDL-C levels (p<0.001). In regard to serum profile, there is a positive correlation between LDL-C levels and age (p<0.05). Dietary intake of saturated fat showed positive correlation with FBS (p<0.05). Moreover, there is a significant negative correlation between LDL-C levels and dietary intake of PUFA (p<0.05). Body Mass Intake (BMI), cholesterol intake and level of trauma were positive predictors for serum cholesterol. Waist circumference, level of injury and cholesterol intake were positive predictors for serum LDL. Moreover, PUFA intake and education level were negative predictor for serum LDL. Despite low intake of saturated fat and cholesterol in older participants, serum LDL level was high. Male group had higher levels of TG. So, attention to dietary intake of patients with SCI and encouraging healthy dietary habits may have important effects on their health.

Employee satisfaction is an important issue that can have a powerful effect on motivation levels. This study aimed at determining the level of satisfaction in family physicians and health care team members and factors influencing it in Shahroud University of Medical Sciences. This applied study was conducted in a cross sectional frame in 2011. Sample size included all physicians (25) and all health care providers (224) who were working in health centers involved in family medicine projects. Separate self-questionnaire was filled by physician, assistances and other health care providers. Data was analyzed with SPSS software using Independent-samples t test, Chi square, One-way ANOVA and Pearson correlation coefficient. Post hoc multiple comparisons test was Tukey. Family physicians covered about 96464 people. Mean of general satisfaction score in physicians was 97.2±15.5 that indicated medium satisfaction. There was no significant relation between physicians’ general satisfaction and age, gender, marriage, acquaintance in family medicine and number of people that they covered. However, there was significant relation between family physicians satisfaction and the number of rotation during the project period, satisfaction of knowledge and skill, and cooperation of health care provider. In addition, there was significant difference among different professions and distance of health center from center of town. As family physicians are leaders of health care provider teams and considering their medium level of satisfaction, it is essential to give this group full attention in order to promote their motivation. In addition, it is crucial to consider coordination and staff problems and their instruction.

Inadequate folate intake could be associated with increased breast cancer risk. The aim of the present study was to assess the folate intake by designed Food Frequency Questionnaire (FFQ) using plasma folate concentration. This analytic cross-sectional study was conducted to evaluate the validity of the semi-quantitative FFQ (136 items) in 152 women with confirmed breast malignancy aged between 35 - 85 years old.. Folate plasma level was assessed by means of automated electrochemiluminescence. The Pearson and partial correlation coefficients were performed between the plasma level of folate and crude, total and energy-adjusted (residual) folate intakes. Area under ROC curve (AUC), sensitivity, specificity, positive and negative predictive values and odds ratio were fulfilled in two models in order to achieve validity assessment. The folate plasma level was significantly correlated with total intake of vegetables, bread and cereal groups (p=0.001) and also with total intake of fruits (p=0.001) and dairy products (p=0.026). After adjusting for confounders, the folate plasma levels were correlated significantly with daily (β=0.39), and residual (β=0.41) folate intake levels (p=0.001). The area under ROC curves in model I (folate plasma level <5.9 ng/ml) was 0.74 (95%CI=0.63-0.85) and for model II (folate plasma level <10.0 ng/ml) was estimated as 0.61(95%CI= 0.51- 0.71). Model I indicated more appropriate predictive value (p=0.001) of folate intake assessment via FFQ. The results of this study showed that FFQ described in this study could be a valid and appropriate tool for assessing folate intake status in dietary content of breast cancer patients and also could be representative and valid for assessing the folate rich-food intake status.

Hearing is one the most important senses of human. Hearing loss is one of the greatest chronic disabilities. Noise induced hearing loss (NIHL) is a common occupational disorder and several factors affect its intensity. One of these factors is individual differences. The aim of present study is the assessment of dyslipidemia’s effect on NIHL. This study was conducted to evaluate association between dyslipidemia and noise induced hearing loss.

This was an analytic-descriptive study which was conducted in 2010. The factory workers of Rasht industrial city with the following inclusion criteria were selected: environmental noise above 85dB, age below 55 years, no otologic disease or surgery, and no history of usage of ototoxic drugs. A total of 298 workers were assessed. After physical examination and audiometry, we measured the level of serum cholesterol, triglyceride, high and low density lipoprotein of participants. The results were analyzed with the SPSS version 17.0. The p value < 0.05 is considered significant statistically.

In this study, 250 men and 48 women were assessed. The mean age of participants was 35.8 years. The participants had high noise exposure of 11 years on average (1-26years). Ninty five of them had NIHL (31.8%). The frequency of serum cholesterol, triglyceride, high and low density of this group were 31.5%, 10.8%, 53.2% and 14.3%, respectively. These levels in the group without NIHL (203 workers) were 38.9%, 12.6%, 58.9% and 21.1%, respectively. There was no statistical significance between these levels in the two groups. By backward logistic regression method, we observed that the duration of employment and gender increased the hearing threshold of 4 KHz frequency in the NIHL group. The odd ratio of hearing loss in male gender was 3.36 (95% confidence interval: 1.61-8.95, p= 0.004). The other effective factors on the hearing threshold of 4 KHz frequency had statistical, but no clinical significant difference in two groups.

We observed no statistical significance of dyslipidemia frequency between two groups. In addition to duration of employment, male gender was the other observed related factor with hearing loss in the two groups. This effect may be due to protective effect of estrogen on the hearing level. Studies with more sensitive approaches on a larger sample is advised.