مجله فیض
سال شانزدهم شماره 3 (پیاپی 63، امرداد و شهریور 1391)

This study aimed to compare the effects of peritoneal and subcutaneous injections of bupivacaine 0.5% on post-appendectomy pain and also the efficacy of local anaesthetic injection for postoperative pain relief in peritoneal inflammation with subcutaneous injection. This randomized-clinical trial was conducted on 126 participants (age range, 15-45 years) underwent appendectomy for acute appendicitis in Kashan Shahid- Beheshti hospital. Participants were divided into three groups: bupivacaine (0.5%, ip), bupivacaine (0.5% s.c), and control (no injection). Pain intensity was evaluated using the visual analogue scale at 6, 12 and 24 hours after surgery. There was no significant difference among the three groups in age, sex, the duration of anesthesia and surgery. Pain intensity (6 h post-surgery) was significantly higher in the subcutaneous group than the peritoneal group, but no significant difference was seen between the two groups at 12 and 24 h post-surgery. Moreover, pain intensity in the peritoneal and subcutaneous groups was significantly lower than the control group at 6 and 12 h post-surgery (P<0.05). There was a significant difference between the peritoneal and subcutaneous groups as well as between the peritoneal and control groups required analgesics, but the difference was not significant between the subcutaneous and control groups. Although both peritoneal and subcutaneous injections of bupivacaine can reduce postoperative pain in patients undergoing appendectomy, the peritoneal injection can significantly reduce the postoperative analgesic consumption.

Interleukin (IL-6) is known to cause pro- and anti-inflammatory effects during different stages of inflammation. The purpose of this study was to elucidate the effects of IL-6 on hyperalgesia, edema and the changes in the spinal mu opioid receptor expression during different stages of complete Freund’s adjuvant (CFA)-induced arthritis (AA) in rats. In this study, AA was induced by a single subcutaneous injection of CFA into rats’ hindpaw. The rats with arthritis were divided into four groups, each consisted of three subgroups (n= 6). Anti-IL-6 was administered either daily or weekly during the 21-day study period. Spinal mu-opioid receptor (mOR) expression was detected by Western blotting. Daily treatment with an anti-IL-6 antibody significantly decreased the paw edema in the AA group compared to the control one (P=0.001), but daily and weekly anti-IL-6 administrations significantly increased the hyperalgesia in the antibody-treated group on the 14th and 21st days post-treatment (P=0.001, P=0.01, respectively). The administration of IL-6 antibody not only increased hyperalgesia in a time-dependent manner, but also caused a significant reduction in the spinal mOR expression on the 14th and 21st days post-CFA injection (P=0.01, P=0.001, respectively). Results can indicate the importance of a time-dependent relationship between the serum IL-6 level and hyperalgesia during the AA. Moreover, the results suggest that the stages of inflammation in AA must be considered for anti-hyperalgesic and anti-inflammatory interventions via anti-IL-6 antibody treatment.

Mastectomic patients experience complications such as edema of the operated hand, shoulder pain and dysfunction. This study was conducted to compare the effects of manual lymph drainage and low pressure bandage on shoulder pain and dysfunction after modified radical mastectomy. In this clinical trial study, 90 women with radical mastectomy referred to the oncology ward of Imam Khomeini hospital (Tehran) were randomly assigned to three groups: the massage, massage+bandage and control groups. Groups were trained how to use manual lymph drainage massage and low pressure bandage. Shoulder pain intensity and dysfunction were measured at 7 and 30 days post-surgery. Edema was measured at 24 hours post-surgery and also 30 days post-intervention. Data were analyzed using descriptive and inferential statistics (one-way ANOVA and Kruskal-Wallis). There was no statistically significant difference among three groups in the means of three measured variables (the arm circumference, shoulder pain intensity and dysfunction) before the intervention. Moreover, the results showed a significant reduction in the means of shoulder pain intensity and dysfunction among the three groups on the 30th intervention day (P=0.001), but the difference was not significant in the mean of arm circumference. Lymphatic drainage massage and low pressure bandage are effective in reducing post-mastectomy complications.

Nausea, vomiting and retching, commonly experienced by women in early pregnancy, have considerable physical and psychological effects on pregnants. This study aimed to examine the effect of acupressure on nausea and vomiting during pregnancy. This single-blind clinical trial was performed on 150 pregnant women (<16 weeks of gestation) referred to Naghavi prenatal clinic for seven days and at two research stages during 2010-11. They were randomly divided into three groups: the acupressure, placebo acupressure and control groups. At first stage, women received no treatment during the first 3 days and on next 4 days a continuous pressure was applied on the P6 point at both wrists using a sea-band in the acupressure and placebo groups. The control group did not receive any intervention. Data were collected by the self-trained women themselves using Rhodes index which then were analyzed statistically. There was no statistically significant difference among three groups in age, marriage age, gestational age, occupation and satisfaction with spouse. Although the mean change in Rhodes index was not significantly different between the acupressure and placebo groups, the difference was significant between the control and the other two groups. Acupressure using sea-band is considered as a noninvasive, inexpensive, safe, and effective treatment for the nausea and vomiting during pregnancy.

Multiple sclerosis and its murine model, experimental autoimmune encephalomyelitis (EAE), are chronic inflammatory demyelinating diseases of CNS. This study aimed to examine the effects of IL-27coding plasmid on disease status and certain immunological parameters in EAE-affected C57BL/6 mice. IL-27 gene was subcloned in P240 plasmid. The recombinant P240-mIL27 and P240 plasmids were injected two times, each time 200 micrograms, to test and control EAE mice, respectively. The clinical signs of the treated mice were evaluated daily and scored according to a standard method. One week after the last injection, all mice were sacrificed. The ELISA and MTT tests were performed to evaluate the production of IL-4, IFN-γ and IL-17 from and proliferative response of splenocytes against specific antigen challenge, respectively. Furthermore, to demonstrate the immune cells infiltration, histopathological exam was performed on the brainstem of mice. The P240-mIL27 plasmid could significantly improve clinical course of EAE in the test group. Also in this group, the level of IL-4 was greater than that in the control group, while the levels of IFN-γ and IL-17 were lower than those of the control group. In MTT test, the splenocytes of the test group showed a significantly less proliferative response than the control group. Finally, less infiltration of immune cells was seen in the brainstem of EAE mice treated with P240-mIL27 plasmid. IL-27 by shifting the immune responses from inflammatory Th1/Th17 towards anti-inflammatory Th2-type responses could be a suitable candidate for the treatment of inflammatory diseases such as MS.

Neonatal sepsis is one of the common causes of neonatal mortality and morbidity. This study was aimed to evaluate the plasma interleukin-6 (IL-6) level as an early marker of neonatal sepsis. This study was conducted on 142 term neonates admitted to the neonatal intensive care unit of Kashan Shahid Beheshti hospital during 2010-11. The plasma IL-6 level of cases was determined using the electrochemiluminescence method. Ten icteric neonates with no signs or symptoms of sepsis were treated with phototherapy. Bactec blood culture was performed in 132 cases of suspected sepsis. Ten cases had positive blood culture and 122 negative blood culture with symptoms of sepsis. Then the levels of IL-6, in10 positive blood culture, 10 negative blood culture and another 10 cases with no symptoms of sepsis, were compared using Kruskal-Wallis test. Seventy-four cases were male and 68 were female. The incidence of neonatal sepsis was 7%. The most common bacterial agents were group B Streptococcus and Staphylococcus epidermidis. Tachypnea (35.9%) was the most common sign among the admitted neonates. The mean IL-6 level in the first (suspected sepsis with a positive blood culture), the second (suspected sepsis with a negative blood culture) and the control group (icteric neonates) were 1545.65, 14.79 and 11.04 ρg/dl, respectively (P=0.001). The plasma IL-6 level can be a good predictor of early neonatal sepsis.

Cutaneous leishmaniasis is a common parasitic disease and one of the health problems world wide. The pentavalent antimonial drugs (e.g. pentostam and Glucantime) are the first line treatment for leishmaniasis, and resistance to these drugs is a serious problem. Using PCR method, this study was carried out to identify the mutation for sodium stibogluconate resistance gene in cutaneous leishmaniasis cases referred to different health centers during 2006-8. This descriptive study was conducted on 150 isolates of leishmania major and leishmania tropica to identify the mutation in drug resistance gene. Promastigote clones were cultured in enriched RPMI 1640 medium and then the genomic DNA was isolated and using a pair of primers, a 400 bp of the gene was amplified. Finally, the PCR products were screened by conformation sensitive gel electrophoresis (CSGE) method and then the mutation was confirmed using RFLP with Sdu1 enzyme. Screening using CSGE and RFLP methods showed that 6.3% of the samples carried a mutation for drug resistance gene. Results showed a resistance for cutaneous leishmania against sodium stibogluconate. Further studies are required to determine the biochemical mechanism of this resistance.

An increase in the prevalence of metabolic syndrome (MetS) and type 2 diabetes (T2D) among the obese children is associated with such complications as the early cardiovascular diseases. This study was undertaken to evaluate the frequency of MetS and T2D among the obese children and adolescents in Kashan. This cross-sectional study was carried out on 450 obese children aged 4-18 years in Kashan. Demographic data were recorded for each case and the 12-hour fasting blood samples were collected to determine the total cholesterol, HDL, triglyceride, and plasma glucose levels. MetS was defined as the presence of at least three of the following five criteria: (1) BMI≥95th percentile for age and gender, (2) triglyceride level >95th percentile for age and gender, (3) HDL level<5th percentile for age and gender, (4) impaired fasting glucose≥100 mg/dL, and (5) systolic or diastolic blood pressure≥95th percentile for age and height. Among 450 children, 227 (50.4%) cases were male and 223 (49.6%) female. The mean age of children was 10.3±3.18 years. One hundred fifty-four cases (34.22%) had MetS and 7 cases (1.3%) met 5 criteria for MetS. Moreover, three cases (0.7%) had T2D. Significantly high frequency of the metabolic syndrome in obese children and adolescents in this city can signal a wide range of adverse health effects.

Relapse in leukemic patients is considered as a major cause of treatment failure and a decrease in patient survival rate. This study was conducted to determine the survival rate of patients with acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) based on their relapse status. This retrospective cohort study was performed on a total of 243 cases of leukemia aged less than 15 years in Shiraz Shahid Faghihi hospital. Data were analyzed using Kaplan-Meier method, log-rank test and Cox regression model. The 1- and 5-year survival rates for patients without relapsed leukemia were 96.9 and 76.9% and for relapsed leukemia were 82.4 and 28.6%, respectively. Therefore, there was a significant relationship between the relapse occurrence and survival rate among the patients (P=0.001). The relapse occurrence is one of the main effective factors in survival rate of leukemic patients; a five-year survival rate in the patients is less than 30 percent in this center.

Fasciolosis is one of the most important parasitic disease common among both humans and livestock. Considering the health and economic importance of the disease, an understanding of the epidemiology of Fasciolosis is highly crucial. This study aimed to evaluate the prevalence and severity of Fasciola infection in animals from different geographical regions of Iran during 2009-10. In this descriptive study, 11100 livers taken from slaughtered sheep and cattle were carefully examined for Fasciola parasites at the six industrial slaughterhouses of East Azerbaijan, Khorasan-Razavi, Khuzestan, Fars, Mazandaran and Markazi provinces. All Fasciola parasites isolated from the livers of infected animals were transferred to the laboratory, and then the parasite species were identified and counted. Finally, the frequency distribution and the severity of infection were analyzed. In this study, 1.10% of the total sheep and cattle slaughtered in six industrial slaughterhouses were found positive for Fasciolosis. The severity of Fasciola in sheep and cattle livers was 7.77±0.42 and 15.24±1.78, respectively. Khorasan Razavi and Fars provinces had the highest (14.54±3.16) and lowest (7.75±0.79) severity of infection, respectively. Results of the study show a reduction in the prevalence and severity of Fasciolosis in sheep and cattle. But considering the importance of the disease and its endemicity, the preventive measures should be taken against the animal and human Fasciolosis in Iran.

Depression is one of the most common psychological states in type 2 diabetes that contributes to adverse health outcomes. This study aimed to investigate the risk factors for the incidence of depression in type 2 diabetic patients. In this descriptive cross-sectional study, 254 type 2 diabetic patients were selected through convenience sampling among diabetes outpatient clinics of Tehran university of medical sciences and also Iranian diabetes society during 2010-11. Data were collected using demographic and disease characteristic questionnaire, patient health questionnaire, social support scale and diabetes self-management scale (DSMS) and then analyzed using Chi square, t-test and binary logistic regression. Increased pain and functional disability (OR=11.725), decreased social support (OR=3.086), decreased performance for diabetes self-care (OR=4.088), longer duration of diabetes (OR=1.328), diabetes complications (OR=2.324), the need for insulin therapy (OR=2.431), HbA1c>9% (OR=21.575), BMI>25kg/m2 (OR=2.251) and major life events (OR=14.043) were significantly different between the diabetic patients with and without depression (P=0.001). There was no significant difference in age, sex and socio-economic status between the two groups. The regression model correctly was fitted in 95.3% of the cases. Pain and functional disability, poor social support, weaker diabetes self-care, longer duration of diabetes, diabetes complications, the need for insulin therapy, HbA1c>9%, BMI>25kg/m2 and the experience of major life events all together contribute to the incidence of depression in type 2 diabetic patients. The results of the study have implications for the prevention of depression in diabetic patients.

Nowadays, 1.1 billion people in the world do not have access to a safe and adequate water supply. So, seeking more efficient water treatment methods are a critical need. This study designed to compare the effects of the electrochemical process (EP) and Alum coagulation on turbidity and coliform bacteria removal from the synthetic wastewater (SW). This experimental study was conducted on five SW samples in a batch system. First, the optimum Alum dosage and pH were determined by Jar-test. Thereafter, samples were subjected to coagulation and 10 samples were taken before and after the process. The EP was accomplished on each five SW samples. In each run, a 600 mA DC was applied on 1700 ml of SW using aluminum electrodes for 1 hour and one sample was taken every 10 minutes (35 samples). The turbidity and most probably numbers of total coliforms were confirmed and the fecal coliforms as well as the heterotrophic plate count (HPC) were determined for all samples according to the standard methods book instructions (21st edition). The optimum Alum dosage and pH range for coagulation were 16mg/L and 7 pH units, respectively. Using coagulation, the removal efficiencies for the total, confirmed and fecal coliforms were 80.57%, 48.89%, and 65.59%, respectively. Moreover, the removal efficiencies for HPC and turbidity were 89.92% and 91.11%, respectively. The EP not only removed 100% of the coliforms, but also reduced both HPC and turbidity to 91.05% and 96.31%, respectively. The EP is more effective than Alum coagulation in the removal of turbidity and bacteriological indicators from the synthetic wastewater.

Deep neck infections are relatively common and appear in the vicinity of the great vessels, organs and mediastinum. The aim of this study was to determine the epidemiology of deep neck infections among the hospitalized patients in Kashan Matini hospital. This cross-sectional study was carried out on patients hospitalized with the diagnosis of deep neck infections in Kashan Matini hospital from Sep 2006 to August 2007. Demographic data of the participants and the history and clinical findings of the disease were recorded using a questionnaire. Then to provide the smear, culture and antibiogram, the samples were taken from the infected area. Finally, the findings and treatment measures were recorded. Among the 66 participants (mean age: 34.48 ± 17.71), 27 (40.9%) were male and 39 female. The most common problems on admission were fever (70%), pain (67%), tenderness and dysphasia (52%), respectively. Regarding the etiology of the disease, the most common bacteria were mixed bacteria (39.39 %), anaerobic (33.33 %) and aerobic ones. Approximately two thirds of the patients underwent surgery had shorter lengths of hospital stay than the other patients (P=0.0002). Pritonsilar and submandible abscess, the most common infections among the patients in this hospital, are mostly associated with the early stages of tonsil and pharynx infections as well as the improperly performed dental procedures.