مجله دانشگاه علوم پزشکی اراک
سال پانزدهم شماره 7 (پیاپی 66، آذر 1391)

Measurement of service quality is a basic prerequisite for improving quality. Studies show that consumers are in close contact with services quality better than any other group. This study was conducted with the aim of measuring service quality based on patients’ expectations and perceptions teaching hospitals in Arak, Iran.

This cross-sectional study was done on 260 patients at under auspices of Arak University of Medical Sciences. For data collection SERVQUL questionnaire was employed to measure quality of services. The reliability and validity of this questionnaire had already been confirmed by studies both in Iran and other countries.

The results showed that there were significant differences between patients’ expectations and perceptions in all dimensions of quality. The accessibility dimension constituted the most serious problem at hospitals.

The negative scores show that it is necessary to promote all quality services dimensions at hospitals. For reducing the qualitative gap among all dimensions, it is recommended that hospital managers take patients’ needs into account and provide desirable services for them.

Chronic hepatitis B virus (HBV) infection is a multi-factorial disease that is accompanied with serious clinical complications. Host’s genetic background, especially immune–genetic factors, is critical in the pathogenesis of infection. Gamma interferon ((INF-γ) and its receptor have an important role in immune response to the virus and clinical course of the disease. The aim of this study is to investigate the association between single nucleotide polymorphism -611G/A located in promoter of gamma interferon receptor1 gene (INFGR1) and chronic HBV infection. In this Case Control study, genomic DNA from peripheral blood samples of 150 chronically HBV infected patients and 150 healthy controls was extracted by phenol-chloroform method. DNA analysis was performed by PCR-RFLP method and P<0.05 was considered significant. After stages of genotyping and statistical analysis, a significant difference was observed between patient and control group, so that genotype GG was higher in the control group compared to the patient group. The host’s immune-genetic background can play an important role in the pathogenesis of infectious disease. Variations in INFGR1 were related to several diseases. The results showed that the presence of GG allele is accompanied by a decrease in susceptibility to chronic HBV infection.

Nowadays, international concern about the impact of antibiotic residues on the environment increased and their removal has received a lot of consideration. The aim of this study was to investigate the efficiency of Fenton’s advanced oxidation process (H2O2/Fe+2) in sulfadiazine antibiotic removal from aqueous solutions. An experimental-laboratory scale study was done on a synthetic wastewater containing sulfadiazine antibiotic with 0.079, 0.19, and 0.47 mM concentrations under Fenton’s process. Then optimal values of affecting parameters, such as initial antibiotic concentration, molar ratio of reagents, [Fe+2] and [H2O2] concentration, detention time, and pH, were determined. The discharged effluent analyzed by HPLC-UV to identify the antibiotic residues. The results showed that the optimal parameters in the Fenton’s oxidation process to remove the sulfadiazine included antibiotics at pH 3.5, molar ratio of [H2O2] / [Fe +2] equal to 1.5, and contact time of 15 minutes, respectively. In these optimal conditions, the efficiency of removal of antibiotic in concentrations of 0.079, 0.19, and 0.47 mM were 99.82%, 97.97% and 78.23% and the wastewater COD removal degrees were 83.33%, 78.57%, and 78.57%, respectively. The experiments showed the efficient removal of sulfadiazine antibiotic in wastewater by Fenton’s oxidation process. The efficiency of this method can also be considered in eliminating other antibiotics resistant to biological treatment.

Nucleos(t)ide analogues, such as lamivudine and adefovir, are effective drugs for treatment of hepatitis B patients. However, long-term treatment with these drugs leads to the emergence of the nucleos(t)ide analogue resistant strains. The impact of nucleos(t)ide analogues on the emergence of HBsAg escape mutations is not clarified. Hence, the aim of this study was to determine HBsAg escape mutations in chronic hepatitis B patients treated with nucleos(t)ide analogues. A cross-sectional study was performed on 50 patients with chronic hepatitis B under treatment with nucleos(t)ide analogues (lamivudine and/or adefovir) and 50 naive chronic hepatitis B patients. HBV DNA was extracted from plasma and S gene of virus was amplified by Nested-PCR followed by direct sequencing. HBsAg gene sequence of the samples was evaluated for detection of HBsAg escape mutations. Among the 100 patients, the following HBsAg escape mutations were identified: sQ101H, sG119R, sP120S, sP127S, sA128V, sG130N, sG130R, sT131I, sM133I, and sY134N. The frequency of HBsAg escape mutations in patients under treatment of nucleos(t)ide analogues was 16% and in naïve patients was 6% (p=0.2, OR=2.98). According to the obtained results, there seems to be no association between using nucleos(t)ide analogues and emergence of HBsAg escape mutations.

Reports on microsporidia infections are increasing and some species, such as Enterocytozoon bieneusi and Encephalitozoon intestinalis, have become important causes of chronic malabsorptive diarrhea, especially in HIV infected patients. In this study, Modified Trichrome-Blue (MTS) and Acid-Fast Trichrome (AFT) staining methods as well as PCR technique were used for detecting microsporidia in stool specimens.

In this experimental study, a total of 71 stool specimens from AIDS patients with chronic diarrhea were collected and sent to laboratory. Two slides were prepared for each stool specimen. The slides were fixed with methanol, stained with MTS and AFT stain, and read by at least three individuals. In addition, PCR with primers directed to a conserved region of the 16s rRNA of intestinal microsporidian spores was used.

Totally of 71 patients, 13 patients (18.30%) were positive for microsporidia by MTS and AFT stain methods. In addition, 9 patients (12.67%) were positive for cryptosporidium by AFT stain and 4 (5.63%) of them were positive for microsporidia. Furthermore, 16 patients (22.53%) were positive for intestinal microsporidiosis by PCR technique. Notably, all cases that were positive for microsporidia by staining methods were also positive for PCR technique as well

PCR technique was more sensitive than staining methods. Also, MTS and AFT stain methods were equally useful in the diagnosis of microsporidiosis.

Transient hip tenosynovitis is one of the common causes of pain and limping in children and includes 0.4% to 0.9% of admissions in emergency wards. The aim of this study is to evaluate this disease in terms of clinical presentations, age and sex distribution, and six-month recurrence. In this cross-sectional study, 51 children with diagnosis of transient hip tenosynovitis were investigated. Inclusion criteria were physician's clinical suspicion of acute tenosynovitis according to clinical presentations, physical exam, and age range of 3 to 8 years. Among the 51 children with tenosynovitis, 34 patients were male with age of 61.70±19.1 months and 17 patients were female with mean age of 48.35±20.49 months that presented a significant statistical difference (p=0.026). The most common complaint was hip pain and the most commonly involved joint was the hip. Also, most of the patients had the history of viral diseases. Transient hip tenosynovitis is more common in boys. The right hip is the most involved joint and the majority of patients have the history of recent viral diseases.

Vibrio cholera is an important agent causing cholera in human. The expression of Flagellum and the movement of the bacterium are critical in the colonization and virulence of Vibrio cholera. FlaA gene is one the five genes encoding Flagellin which plays an important role in the activity and movement of the bacterium and its colonization which has a significant role in its immunogenicity. The aim of this study was to express and produce the recombinant FlaA protein in E.coli using Western blot method.

In this experimental study, FlaA gene was proliferated by PCR method using the specific primers and cloned with BamHI and Xhol in pTz57R/T. Then it was proliferated and sequenced in DH5a vector of E.coli. The cloned FlaA gene was inserted into pGEX-4T-1 vector. The cloned vector was transformed to BL21-DE3 of E. coli and successfully expressed by induction of IPTG. The expressed protein was purified by GST affinity resin. For preparation of the primary antibody, the purified recombinant protein was injected to rats. Western blot assay method was used for determining the antigenicity of the recombinant FlaA.

Determination of gene sequencing showed that this gene has been proliferated properly and the antibody used in Western blot verified the production of the recombinant protein.

The results of this study demonstrate that FlaA protein is immunogenic and can be evaluated in vaccine designing and as a diagnostic tool for detection of cholera infection.

Vibrio cholerae is a gram-negative bacterial pathogen that causes diarrheal disease cholera. One of the most pathogenic factors of Vibrio cholera is pili. Pili plays an important role in colonization and persistence of bacteria in small intestine.

In this study, pili A (tcpA) gene was amplified by Polymerase chain reaction (PCR) method and sub-cloned into expression vectors such as pGEX4T-1. Escherichia coli competent cells were transformed by recombinant plasmids and the expression of protein with IPTG. The recombinant proteins were purified by affinity chromatography (GST) and immunoblot analysis was used for evaluation of new recombinant proteins antigenicity. The concentration of recombinant proteins was measured according to Bradford assay.

The results of this study indicated that recombinant proteins were expressed successfully in competent cell of E. coli, such as E. coli BL21 (DH3). The recombinant protein was purified by affinity chromatography (GST). The immunoreactivity pattern of anti-Tcp antibody with recombinant proteins of TcPA showed that the recombinant proteins had antigenic properties.

Because these recombinant proteins are antigenic, these proteins may be considered as tentative candidates for designing cholera vaccine.

Deaths due to cancer have been increasing in many countries in recent years. Probiotics are live microorganisms that have beneficial effects on consumer’s health. The aim of this study was to investigate antimutagenic and anticancer effects of Lactobacilli strains isolated from Tarkhineh in order to select potential probiotic strains.

In this experimental study, 25 strains of Lactobacillus that had previously been isolated from Tarkhineh were used. Antimutagenicity test was performed based on proposed method of Ames. The results of the test were individuated after comparison between samples (suspensions of Lactobacilli) and positive (sodium azide) and negative (distilled water) controls. SPSS version 16 was used for statistical analysis.

Antimutagenic activity was observed only in four strains of Lactobacilli. The inhibitory percentage in the four strains of Lactobacilli, in its highest level was equal to 60.38 and in its lowest percentage equal to 39.37%. Also, the inhibitory percentage of mutation among the four strains in the presence of microsome were significantly different (P<0.05) than the absence of microsome. Adding the microsome of rat liver (S9) proved the anticancer effects of four Lactobacilli strains.

Of the 25 strains of Lactobacilli, 4 strains which had the highest antimutagenicity effects were chosen as the potential probiotic strains.

In recent decades, with the increasing use of devices generating electromagnetic fields in modern industrial societies, the study of biological effect of these waves on the many organisms development has been considered by government and scientific organizations all over the world. Many people in all hours of their life are exposed to boarding electromagnetic fields of devices in their life and work places, with different intensities and frequencies. This presence of a significant relationship between the increase of some diseases and genetic aberrations and electromagnetic fields is one of the most important issues for researchers that has created many concerns regarding the adverse effects of electromagnetic fields. The findings of some studies indicate that this field does not have enough energy to damage biological molecules, while other researchers believe that electromagnetic fields by affecting cellular stress response and other protective mechanisms cause genetic cell damage. Some studies express that the electromagnetic field are safe alone, but they enhance the genotoxic function of physical and chemical environmental pollutants.

Noticing the side effects associated with chemical drugs, using natural medicinal plants has gained more prominence recently. Physalis alkekengi extract is a medicinal plant belonging to Solanaceae family which similar to most drugs used in traditional medicine, despite possessing a multitude of medicinal properties, has not received sufficient attention. The aim of the present study was to briefly review the effects of Physalis alkekengi extract on the concentration of thyroid hormones, blood cholesterol, some plasma biochemical factors, liver function, immune system, and sexual hormones. Due to the extensive usage of Physalis alkekengi extract in traditional medicine, determining its advantages and possible side effects is of great physiologic and pharmacologic significance. Physalis alkekengi extract due to the presence of such effective substances as alkaloids, lycopene, glucocorticoids, alcoholic agents, and a large amount of vitamin C as well as antioxidant properties can play a significant role in changes in body homeostasis. This study dealt with the function and effect of Physalis alkekengi extract on different body organs through using proper keywords and extensive online search through electronic databases and credible sources. The results of this mini-review showed that Physalis alkekengi extract can bring about various significant changes in different body organs that have not been properly recognized. Therefore, further and more extensive studies should be done on this plant.

Cerebral venous sinus thrombosis is a rare form of brain stroke caused by thrombosis in venous sinuses of Dura. This study reports on a patient with venous sinus thrombosis and brucellosis who presented with uncontrolled seizure. Case: A 33-year-old woman with past history of controlled complex partial seizure who presented with headache, asthenia, and uncontrolled seizure for one month is described in this study. She was febrile and in brain CT scan hemorrhagic focus in left posterioparietal and temporal lobe was reported. MRI and MRV proved venous sinus thrombosis in left transverse sinus. In laboratory assessment, brucellosis was confirmed as well. The patient treated with anticoagulant, anti-brucellosis, and antiepileptic agents and discharged in good condition with medication orders. Clinical suspicion and accurate evaluation is the most important clue in the diagnosis and treatment of brucellosis and venous sinus thrombosis, especially in uncontrolled seizure in patients who had previously been under control.