Medical Journal Of the Islamic Republic of Iran
Volume:26 Issue: 2, Summer 2012

Candida species are among the most common causes of opportunistic fungal diseases. Among Candida species, Candida albicans is responsible for most infections. Having many strains, C. albicans is very polymorph. C. dubliniensis is very similar to albicans species both morphologically and physiologically. For an infection to occur, cell wall proteins play an important role as they enable yeast to adhere to host cells and begin pathogenesis. Therefore, we decided to extract these proteins and examine them through common molecular methods of protein analysis including SDS-PAGE. Initially cell wall proteins of two C. albicans strains (CBS 562 and PTCC6027) and one C. dubliniensis strain (CBS7987) were extracted by using a solution of beta-mercaptoethanol and ammonium carbonate. After dialysis against Tris-HCL buffer, SDS gel electrophoresis was performed on the proteins extract. Bands were then visualized by using three different staining methods among which one method provided improved detection. By using Coomassie Brilliant Blue staining method, proteins with molecular weight of 42, 66.2 and 200 kDa were detected. By using Silver staining method, proteins with molecular weight of 21.5, 28.5 and 37 kDa were detected. However, using combined Coomassie Brilliant Blue & Sliver staining method visualized more bands resulting in improved detection. To answer many existing questions about fungal diseases, fungi cell wall proteins are necessary to be examined. To commence such examinations, a simple step may be an SDS-PAGE performance on as many strains as possible. A combined staining method can enhance bands detection.

The aim of this study was to investigate the ability of Iranian medical and dental students in thinking critically and to assess their ability in using definite components of critical thinking (CT). Multistage cluster sampling was utilized to recruit 125 preclinical (1st, 2nd and 3rd year of study) students in Yazd Shaheed Sadoughi University of Medical Sciences in Yazd, Iran. The Watson-Glaser Critical Thinking Appraisal (WGCTA) was applied to collect data. The statistical analysis of the data included One-way analysis of variance (ANOVA), t-test and bivariate correlations. The mean total score for this sample was 45.33±5.4. Significant differences were found in total critical thinking score by gender (p= 0.022), residency (p= 0.026) and the year of education (p= 0.01). A significant correlation was found between the total CT score and the student’s number of passed credits (r= 0.297, p= 0.003). Also, a significant difference was found in the students’ scores on the WGCTA evaluation subtest by passing any research method courses (p= 0.04). The CT ability in medical and dental students in the present study was weak overall. Medical educators and clinical instructors should try to develop the ability of CT by teaching methods and techniques like purposeful planning and problem-based teaching to promote the components of CT in their students. The improving of CT in medical students has implications for medical education and promotion of medical profession.

The ministry of health and medical education of Iran and many other countries advice physicians to use this guideline for diagnosis and treatment of acute otitis media (AOM), but there is not any evaluation of effectiveness and obedience of this guideline, so the aim of this study was to evaluate the attitude of pediatricians, the most important group that interfere with these patients in treatment of acute otitis media. A total of 120 anonymous surveys were mailed to 120 pediatrician in Tehran (Iran) to evaluate pattern of diagnosis and treatment of AOM in these physicians. Age, gender, place of work, attitude of diagnosis and treatment were asked by anonymous survey. Sixty-two completed surveys were received, for a response rate of 51%. There was no significant difference between responders in these survey and scenarios, according to sex, age, practice setting, graduation year or the number of AOM patients visiting each month. Our study seems to add new insights to the previous literature on management of AOM according to guideline. We can assess the impact of guidelines on the usual practice of practitioners in evidencedbased management of AOM.

The role of uric acid as a risk factor for vascular disease and acute stroke is controversial and there is little information about it. In this study, we determined serum uric acid levels in patients with acute stroke and assessed its relationship with cerebrovascular risk factors. In this cross sectional study, we assessed patients with acute stroke who were admitted in Firoozgar Hospital from September 2010 to March 2011. Clinical records of patients and their serum uric acid level was investigated. Finally, collected data were analyzed using SPSS software Ver.16. Fifty five patients with acute stroke were evaluated who 25 of these patients (45.5%) were female and 30 of them (54.5%) were male. The mean age of patients was 67±14 years. Mean serum uric acid levels in the patients studied 5.94±1.70 mg/dl, and about half of the patients (47.3%) were hyperuricemic. There was a significant negative correlation between age of patients and their serum uric acid level (p=0.04, R =-0.27). Uric acid level was significantly higher in men than women (p=0.03). Hyperuricemia was associated with increased amounts of triglycerides and Low-density lipoprotein (LDL) cholesterol (p=0.03, p=0.02). In patients with acute stroke, there was no significant association between serum uric acid level and diabetes mellitus, hypertension, history of ischemic heart disease, smoking, prescription rTPA, and type of stroke. Due to the high prevalence of hyperuricemia in patients with acute stroke, and its accompanying increase in triglyceride and LDL cholesterol levels, it can be considered as a risk factor for acute stroke.

Latent adenocarcinoma of prostate refers to cases who present no obvious sign or symptom during their life spans and the tumor is incidentally found at postmortem examination. Its frequency can be very important in epidemiologic investigations, prevention and treatment. No previous study has been done in this regard in Iran and the studies performed in other countries show various results. The aim of present study is to determine the frequency of latent prostate carcinoma by studying the corpora of men above 50 years old referred to forensic medicine organization in Tehran in 2008 and 2009. In this study, 149 men aged above 50 who had died of different reasons and undergone autopsy were examined. Their prostates were excised and the slides were studied for the presence of adenocarcioma and prostatic intraepithelial neoplasia (PIN). In each case, age, weight of prostate, location of lesion, and grading according to Gleason's system were determined and the results were analyzed by SPSS software (version 16). Out of 149 cases, 34(22.8%) had low grade PIN, 26(17.4%) high grade PIN, and 14(9.4%) invasive adenocarcinoma. Most of the tumors were located in posterior lobe of prostate and they were more frequent in older cases (>65 years of age) and heavier prostates (p value <0.05). All invasive adenocarciomas were accompanied by PIN. Worldwide studies show lower prevalence of latent carcinoma of prostate in Asian men than white European ones. Considering the absence of such studies in Iran, a larger study to compare and find out the precise rate of this kind of carcinoma, is recommended.

Hypoglycaemia is a well recognized complication of falciparum malaria in children but its diagnosis may be overlooked because all the clinical features may be mimicked by severe malaria. To determine the prevalence of hypoglycaemia at the point of hospital admission of under-fives with falciparum malaria and identify its risk factors in patients seen in a Nigerian secondary-health-care institution. During a 12-month period and at the point of hospital admission, venous blood sample was collected into an appropriate sample bottle (fluoride-oxalate bottle) from 502 children who were below 5 years of age with positive falciparum malaria parasitaemia. The blood sample was analysed using the glucose-oxidase method. The duration of illness, degree of parasitaemia and time of last meal were noted for each child. Ninety two (18.3%) out of 502 children below five years old with falciparum malaria had hypoglycaemia (blood glucose below 2.6 mmol/L or 50 mg/dl) at the point of hospital admission. Twenty three percent (78 out of 339) of children below 36 months old were hypoglycaemic compared to 8.6% (14 out of 163) children aged 36 months and above; (p=0.01). Prevalence of hypoglycaemia was higher in girls (20.7%) than boys (16.3%) [Odd ratio, OR = 0.75 (95% Confidence Interval, CI = 0.48-1.18)]. Forty (13.1%) out of 305 children whose time of last meal was 12 hours and below had hypoglycaemia compared to 52(26.4%) out of 197 whose time of last meal was greater than 12 hours; (p=0.02). Hypoglycaemia at admission point was associated with a significant increase in mortality rate; (p=0.00). The duration of illness and the degree of parasitaemia did not have significant difference with the prevalence of hypoglycaemia. In falciparum malaria, a greater interval (between 2 meals) than 12 hours in children below 36 months old predisposed them to hypoglycaemia. Routine monitoring of blood glucose at the admission point is suggested in malaria endemic region.

Shivering is one of the common problems in spinal anesthesia. The objective of the present study was to evaluate the effect of intrathecal fentanyl (25 μg) on incidence and severity of intraoperative and postoperative shivering. A double-blind randomized controlled study was conducted in eighty healthy women (ASA Physical status I) scheduled for elective cesarean section under spinal anesthesia. Subjects were randomly divided into two equal groups. The patients received 12.5 mg (2.5ml) of 0.5% hyperbaric bupivacaine combined with 25 μg (0.5 ml) fentanyl in Group F as a study group and 12.5 mg (2.5ml) of 0.5 % hyperbaric bupivacaine combined with 0.5 ml normal saline in Group S as a control group. Incidence of shivering during 30 and 60 minutes of surgery and recovery and complications were evaluated. The total incidence of shivering in Group F was significantly lower than Group S (10% in group F; 75% in group S, p< 0.0001). Almost all patients started shivering in the first hour after spinal anesthesia and the rate of shivering especially in second 30 minutes was higher than first 30 minutes in both groups. None in Group F but 22 patients (55%) in Group S had shivering during recovery and all of them reported shivering at the first 30 minute at recovery. The severity of shivering in Group F was significantly lower than Group S (p <0.0001). Intrathecal bupivacaine combined with fentanyl is associated with a lower incidence and severity of shivering.

The most common laryngeal mass in children is recurrent respiratory papillomatosis (RRP). Studies have attempted to correlate viral typing and its aggressiveness. 29 patients with histologically confirmed RRP enrolled in adjuvant therapies. Patients underwent several surgical interventions. HPV genotyping demonstrated 45% HPV-6 and 55% HPV-11. The mean age at the first surgical intervention was 52.39 months (SD=102.28) (range from 4 months to 426 months). The mean number of surgical intervention was 10.39 (SD=7.76) (range from 2 to 30). The mean time of surgical intervals was 4.63 months (SD=4.02) (range from 2 to 24 months). In fourteen patients (48%) tracheotomy was done. All patients who had tracheotomy received alpha-interferon. One of our cases was a male who had pulmonary extension with HPV-6. A review of patients with RRP was regarding to HPV genotyping and need for adjuvant therapy and tracheostomy. Mean number of surgical procedure was 10/40 and nearly fourteen patients (48%) need to tracheotomy. The clinical differences between HPV6 and HPV11 disease may not be accurately predictable. Patients with less age and with HPV-11 seemed to have more severe problems, but these differences were not statistically significant which needs much more investigations for reasonable starting point of evaluation for these differences.

This case is a rare aspect of left inguinal hernia. The patient was a 60-years old man with left scrotal mass since childhood. In the operating room, the hernia sac was opened which included cecum and appendix that is called left Amyand`s hernia. The patient underwent herniorrhaphy with Lichtenstein repair.