مجله دانشگاه علوم پزشکی اراک
سال پانزدهم شماره 6 (پیاپی 65، آبان 1391)

Cutaneous leishmaniasis is a health problem in many areas of Iran. Cutaneous leishmaniasisis reported mostly in the central county of Qom province، including Ghanavat and Qomrood villages. This study was done to identify parasite species in human and rodents in order to illustrate the epidemiologic picture of the disease and provide an appropriate control program in 2010 This cross-sectional study was done on microscopic smears of 45 human samples and rodents samples hunted around Ghanavat and Qomrood villages in the central county of Qom province in 2010. In total،15 human samples and one hunted rodent sample were positive. In this study،the DNA of the parasites were extracted from the slides and analyzed by Leishmania specific premiers using ITS1 PCR-amplification (Internal Transcribed Spacer1). PCR (PolymeraseChain Reaction) products were digested by Haelll enzyme. Overall، 15 human samples and one rodent sample from Merioneslibycus species were evaluated by PCR-RFLP (Restriction Fragment Length Polymorphism). After electrophoresis، it was demonstrated that the parasite was Leishmaniamajor in both human and rodent species. PCR-RFLP technique is an effective method to determine Leishmania parasite species in Geimsa stained slides from human and rodent reservoirs. One of the advantages of this technique is that it is possible to recognize the pathogen species of Leishmania parasite without gene sequencing. Besides، PCR-RFLP technique is a method of quite high sensitivity and specificity which can identify parasite species in addition to the diagnosis of leishmaniasis within 24 hours.

Enterococcus is known as an important pathogen in Iran like all around the world. The increasing use of vancomycin makes vancomycin-resistant enterococci (VRE) an important nosocomial pathogen. Vancomycin in combination with an aminoglycoside can provide effective treatment for severe enterococcus infections، while resistance to vancomycin antibiotic is increasing in enterococci. In this study، the pattern of antibiotic resistance and prevalence of vancomycin resistance enterococci have been explored. In this experimental study، after isolating and identifying 150 strains of enterococci from clinical specimens، the antibiotic resistance pattern of these strains to erythromycin، teicoplanin، vancomycin، ciprofloxacin، tetracycline، gentamicin، co-trimoxazole and linezolid was examined. The MIC test by using micro dilution broth method was performed for the vancomycin resistance enterococci specimens with the vancomycin and teicoplanin antibiotics. Antibiotic susceptibility test showed 14% and 5. 3% of the samples were resistant to vancomycin and teicoplanin respectively. Resistant to erythromycin، co-trimoxazole، ciprofloxacin، tetracycline، linezolid and gentamicin were 64، 40، 38. 6، 6. 6، 0، 38. 76 percent respectively. Fourteen samples had high resistance to vancomycin which MIC were ≥ 256 µg/ml. Based on the results of present study، there are vancomycin-resistant enterococci in Arak as well as other parts of the world. The percentage of vancomycin resistance enterococci is high in Arak and appropriate treatment of infections caused by enterococcus is essential

Multiple sclerosis is a chronic and degenerative disease of the central nervous systemthat due to such reasons as its chronic nature، no prognosis، and absence of a definitive treatment causes stress in patients. Thus، this study was designed to examine the impact of peer educational program on stress in patients with multiple sclerosis in 2011. In this clinical trial، 110 patients with multiple sclerosis were randomly allocated to test and control groups (each group including 55 patients). After preparing 5 multiple sclerosis patients as the peer group، six training sessions forthe test group were held by the peer group over two months. Data collection tool was DASS 21 questionnaire that assessed patients’ stress before and after 4 months which was completed by both groups. In order to analyze the results، SPSS software 16 was used. The results showed that before intervention، there was not astatistically significant difference between the two groups in stress score (p=0. 24) while a statistically significant difference was seen between the two groups after intervention (p=0. 001). Also، stress score in test group was statistically significant (p=0. 001) but there was not a statistically significant difference between the stress scores of the patients in the control groups (p=0. 39). Peer group educational program caused stress reduction in patients with multiple sclerosis. Hence، it is recommended that peer groups be used for education of multiple sclerosis.

Age-related macular degeneration is the most common cause of irreversible central visual loss in individuals over 50 years old. The aim of this study was to assess visual loss due to age-related macular degeneration and some of its associated risk factors. This case-control study was conducted on 150 patients with age-related macular degeneration and 150 controls، both aged over 50. A questionnaire on demographic and medical information was completed for each participant and an ophthalmological examination was performed. The results were recorded andthe data were analyzed using SPSS software version 16. Mean age of the subjects in the case and control groups was 78. 38 and 79. 28 years، respectively. In a multivariable model، hypertension (p=0. 003)، diabetes (p=0. 006)، light iris color (p=0. 05)، hypercholesterolemia (p=0. 036)، lens opacity (p=0. 029)، and previous cataract surgery (p=0. 029) were significantly associated with age-related macular degeneration. There was not a significant relationship between body mass index (p=0. 11) and refractory errors (p=0. 94) andage-related macular degeneration. Age-related macular degeneration is associated with hypertension، diabetes، hypercholesterolemia، light iris color، lens opacity، and previous cataract surgery.

Tuberculosis is an old problem that is currently considered a great challenge. Noticing Iran’s borders with Afghanistan and Pakistan، which are among the 22 high burden countries around the world، the present study was conducted to analyze the current molecular epidemiology of TB and survey genetic diversity of Mycobacterium tuberculosis strains in Markazi province، Iran. In this experimental study، 57 sputum specimens from smear positive patients admitted to health centers in Markazi province were cultured on specific mycobacterial culture media. Genomic DNA was extracted by standard protocols of WHO and digested separately by PvuII and AluI. Electrophoresis was performed and DNA fragments were transferred to positively charged nylon membrane by southern blotting method and hybridization by PGRS probe. The hybridized strains were subsequently detected by enzymatic reaction and analyzed. Genotyping of the isolates by PGRS-RFLP with Pvu II and AluI displayed a wide range of genetic diversity so that 50 and 45 genotypes were identified، respectively. Noticing the great diversity of PGRS in the Mycobacterium tuberculosis strains، it can be concluded that in the study population، the majority of the patients hadtuberculosis with different etiologies. Therefore، it seems that reactivation of latent infection has had the main role in the spread of tuberculosis

Considering the lack of a standardized and validated questionnaire on oral health care for pregnant women based on a specific behavioral pattern، the aim ofthis study was development and psychometric assessment of an oral health instrument based on Health Belief Model in pregnant women. This cross-sectional study was carried out on 340 pregnant women in Arak city. After reviewing the related literature، the instrument was designed and its content validity ratio، content validity index، face validity، and exploratory factor analysis were measured. For measuring the reliability of the scales، three methods، including test-retest، internal consistency، and agreement، were used. Data analysis was done using SPSS software. The reliability of the 61 items was evaluated with impact score of 1. 5 and the content validity index of 0. 79 and based on exploratory factor analysis were classified into seven categories. The overall reliability measured through Cronbach alpha was 0. 84. The reliability of the questionnaire was 0. 88، perceived susceptibility was 0. 73، severity was 0. 70، perceived benefits was 0. 75، perceived barriers was 0. 71، the cues to action was 0. 72، and self-efficacy was 0. 76. Kappa coefficients were determined with a high performance for checklists. This study provided good evidence of the strength factor structure and reliability of Health Belief Model structures about oral health behaviors in the vulnerable group of pregnant women، according to the study of psychometrics process.

Urogenital atrophy is a common problem after menopause and quality of life in post-menopauseis seriously affected by the symptoms associated with vaginal atrophy. The aim of this study was to compare the effectiveness of the vaginal suppository of hyaluronic acid and vitamin E in atrophic vaginitis treatment. This randomized double-blind clinical trialwas carried out in Ahvaz (Iran) from August to December 2010. Forty postmenopausal women with symptoms of vaginal atrophy were randomly allocatedto two groups to take vaginal suppositories of either 5 mg hyaluronic acid sodium salt (n=20) or 1 mg vitamin E (n=20) for 8 weeks. The symptoms of vaginal atrophy were evaluated by a self-assessed 4-point scaleand the composite score was determined asnone، mild، moderate، and severe in four periods. The results showed that the symptoms were relieved significantly in both groups (P<0. 001). The relief of symptoms was significantly superior in the hyaluronic acid group compared with the vitamin E group (P<0. 05). Although both hyaluronic acid and vitamin E relieved the vaginal symptoms، improvements were greater in the hyaluronic acid group. Therefore،hyaluronic acid vaginal suppository is suggested for women with vaginal atrophy who do not want to or cannot take local estrogen treatment.

Protein-energy malnutrition is regarded as one of the public health problems in developing countries as a result of poor feeding due to poverty. This study was conducted to compare protein quality of two samples of commercial weaning food، Cerelac (based on dry milk، wheat and banana containing probiotic Bifidobactriumlactis) and Ghoncheh (based on dry milk، wheat، and honey)، in rats.

This experimental study was conducted on 64 male rats aged 23 days in 8 groups under 8 diets، including 2 test diets (Cerelaccontaining probiotic Bifidobactriumlactis and Ghoncheh)، 1 standard diet (casein)، 1 basal diet (protein free) for true protein digestibility and apparent digestibility study، 2 test diets، 1 standard diet، and 1 basal diet for net protein ratio، protein efficiency ratio، and food efficiency ratio study.

The contents of true protein digestibility for casein، Cerelac، and Ghoncheh were 93. 77، 84. 23 and 89. 82، respectively and the results were significant in all of the groups (p<0. 001). The content of net protein ratio for casein، Cerelac، and Ghoncheh was 4. 38، 4. 1 and 3. 17، respectively and the results were significantin all of the groups (p=0. 009). The contents of protein efficiency ratio for casein، Cerelac، and Ghoncheh were 3. 05، 2. 59، and 2. 01، respectively and the results were significant in all of the groups (p<0. 001).

The findings of this study indicated that the protein value of Cerelaccontaining Bifidobactriumlactis was higher than Ghoncheh.

Multiple sclerosis، an immune-mediated demyelinating disorder، is one of the most common diseases of the central nervous system. Two-thirds of patients with multiple sclerosis are women in their child bearing age، 20s and 30s. Multiple sclerosis is followed by neurological disability in young people. The purpose of this study was to determine pregnancy outcomes in patients with multiple sclerosis and compare them with healthy pregnant women. In this cohort study،37 pregnant women with multiple sclerosis and 73 healthy pregnant women were compared in terms of pregnancy، child birth، and infant variables. Patient information was collected through questionnaires and evaluated using independent t-test، Chi-square، and Mann-Whitney test. The results showed that pregnancy complications like preeclampsia and gestational symptoms in women with multiple sclerosis were higher than the control group (p=0. 001). Instrumental delivery was more in women with multiple sclerosis (p=0. 05) and there was not a significant difference between the two groups in terms of neonatal outcomes. The resultsof this study show that some of the complications of pregnancy are higher in women with multiple sclerosis. Also، normal delivery and instrumental vaginal delivery were more in women with multiple sclerosis that couldbe due to fatigue in this population. Hence، these findings should be taken into consideration in planning andmanaging pregnant patients.

The use of propofol alone for insertion of supraglottic devices can lead to undesirable events such as cough، gagging، and laryngeal spasm. Narcotic drugs are used to improve the insertion of these devices. In this study، the effect of two narcotics، remifentanyl and sufentanyl، on ease of insertion of two types of supraglottic airway devices were evaluated.

In this clinical trial، 200 patients undergoing general anesthesia were divided into four groups through blocked randomization. Induction of anesthesia was performed using propofol 2. 5 mg/kg. Then the first group received remifentanyl and laryngeal mask، the second group remifentanyl and SLIPA، the third group sufentanyl and laryngeal mask، and the fourth group sufentanyl and SLIPA. The amount of jaw opening، ease of insertion of supraglottic devices، cough، laryngospasm، gag reflex، heart rate، and arterial blood pressure were recorded one، three، and five minutes after insertion of supraglottic devices.

No significant differences were observed in the amount of jaw opening، ease of insertion of supraglottic devices، cough، laryngospasm، gag reflex، and hemodynamic parameters between the four groups.

The results of our study indicated that for controlling airways using supraglottic devices، use of laryngeal mask or SLIPA in the presence of remifentanyl or sufentanyl have no priority over each other and do not lead to hemodynamicimpairement