مجله فیض
سال هفدهم شماره 2 (پیاپی 69، خرداد و تیر 1392)

Tranexamic acid، as an anti-fibrinolytic agent، has been shown to reduce bleeding، but its use has been limited in the scope of vaginal delivery. The purpose of this study was to examine the effect of tranexamic acid on pregnancy outcome and vaginal post-parturition hemodynamics. In a randomized، double-blind clinical trial، 200 primgravida pregnants were divided into the two groups (case and control). The case group received IV tranexamic acid immediately post-parturition and the control group IV glucose 5%. H emoglobin (Hb) on admission and 24 hours post-parturition were measured and Hb level drop more than 10% was considered as postpartum hemorrhage. The Hb status was evaluated through measuring blood pressure and heart rate. The pregnancy outcome measures (e. g. changes in Hb level، need for the additional uterotonic drugs، blood transfusion and surgery) were evaluated. There was a significant difference between the two groups in Hb level drop within the first 24 hours post-parturition. Moreover، no severe bleeding، blood transfusion and misoprostol administration were reported in the case group، but 4 cases in the control group. Tranexamic acid administration can effectively reduce post-partum bleeding and therefore prevent a further decrease in maternal Hb levels.

Considering the effectiveness of nebulized furosemide in asthma crisis that were non-responsive to the inhalational β-agonists، this study aimed to examine the effect of concomitant administration of furosemide (10 mg) and nebulized salbutamol (2. 5 mg) on spirometry parameters in persistent asthma. In this clinical trial، 53 patients (age، 18-75 years) with a 6-months history of persistent asthma were randomly allocated to two groups، the salbutamol (n=27) and salbutamol + furosemide (n=26) groups. Participants in each group were classified into the mild، moderate and severe persistent asthma on the basis of FEV1. Participants were administered salbutamol or salbutamol + furosemide، and then the spirometry parameters were recorded 15 minutes after the completion of nebulization treatment. Before and after the treatment، mean and standard deviation of the spirometry parameters and their changes were calculated. Results showed no significant difference regarding the mean percentage change for FEV1 in the salbutamol (27. 5%) and salbutamol + furosemide groups (25. 83%) after the treatment (P=0. 72). Moreover، no significant difference was seen between the two groups regarding the mean percentage changes in other parameters after the treatment (FVC، FEV1، PEF، MMEF، FEV1/FVC، P>0. 25). Concomitant administration of furosemide and salbutamol has no advantage over salbutamol in normalizing the spirometry parameters of persistent asthma.

Ischemic heart disease (IHD) is predicted to be the most common cause of death worldwide by 2020. Cardiac rehabilitation (CR) as a secondary preventive measure can reduce the cardiac risk factors، mortality and morbidity، and improve the quality of life in such patients. This study aimed to investigate the effect of an 8-week CR program on clinical and paraclinical findings of patients with IHD. This clinical trial was performed on IHD patients referred to Kashan Shahid Beheshti hospital. Patients were allocated the two groups (rehabilitation and control). The rehabilitation group received an 8-week rehabilitation program; the clinical and paraclinical evaluations were performed before and after the program. This study showed that body weight، BMI، HDL، TG، FBS، resting heart rate and the systolic and diastolic blood pressure، quality of life، exercise capacity، maximal oxygen uptake during exercise and the numbers of recurrent hospitalization were significantly improved in the rehabilitation group (P<0. 001). The rehabilitation program had no effect on the platelet count، frequency and duration of chest pain، total cholesterol، and LDL. Using an 8-week cardiac rehabilitation program can be beneficial in the management of IHD patients and ultimately can reduce the risk factors of the heart diseases، improve the quality of life and reduce the risk of disease exacerbation.

Metformin، a drug widely used for type 2 diabetes، may also have anti-cancer properties. The purpose of this study was to examine the effect of metformin on cisplatin cytotoxicity in the gastric adenocarcinoma cells line (MKN45). In this study، cells viability and apoptosis were measured using the (3- [4، 5-dimethylthiazol-2-yl] -2، 5-diphenyltetrazolium bromide) assay and flow cytometry، respectively. Moreover، the expressions of mammalian target of rapamycin، survivin and AKT genes were evaluated by RT-PCR. All experiments were performed in triplicate. The results showed that each of metformin and cisplatin separately reduced the viability of cancer cell، but in co-administration، metformin reduced the cytotoxicity of cisplatin. In co-administration، the survivin expression was increased followed by a reduction in cisplatin anti-cancer effect. Therefore، the antagonistic effect of drugs can be associated with survivin expression. The results also revealed that the anti-apoptotic effects of metformin co-administrated with cisplatin are associated with increased AKT expression. It seems that in gastric cancers، metformin is not an appropriate choice to make cells sensitive to cisplatin and the antagonistic effects of the two drugs should be considered when they prescribed in combination.

An elevated homocysteine level is a serious risk factor among the cardiovascular risk factors. The purpose of this study was to examine the effect of an eight-week aerobic exercise on the homocysteine level and VO2max and also to determine the correlation between the homocysteine level and VO2max. In this quasi-experimental study، 28 male students from Iran University of Science and Technology، who passed the primary physical training course، were randomly divided into the experimental and control groups (age= 19. 14±1. 24، weight= 70. 13±11. 76 kg، height= 175. 42±5. 86 cm، body fat percentage= 19. 11±5. 98). Blood samples were taken from each participant in both groups and the experimental group performed the Bruce test (VO2max) and an eight-week aerobic exercise program three times a week with the intensity near 60-75 percent of maximum heart rate. Results of this study showed no significant difference between the experimental and control groups in the homocysteine level in posttest (P=0. 75)، but a significant difference was seen between the two groups in VO2max (P=0. 0001). However، no significant correlation was seen between the homocysteine level and VO2max (P=0. 40، r=0. 16). Although an eight-week aerobic exercise program in young non-athlete men has no significant effect on the homocysteine level، it can increase the Vo2max.

Phosphorus (in a concentration range of 0. 005-0. 05 mg/L-P) is enough for eutrophication of water bodies; therefore، phosphorus removal from effluents is necessary. The electrochemical process is one of the methods used for phosphorus removal. Thus، this study aimed to examine the effect of the electrochemical process on phosphorus removal from filtered effluent of activated sludge.

This bench-scale experimental study was carried out on the samples of filtered effluent of activated sludge in a batch system. Phosphorus concentrations for 210 samples were measured through stannous-chloride method (The Standard Method، 4500 P-D.). Data were analyzed using Green house Geisser، one-way ANOVA and the Tukey’s post- hoc tests.

The average phosphorus concentration before the electrochemical process in the filtered samples and the maximum efficiency of phosphorus removal were 1. 93±0. 86 mg/L-P and 98%، respectively. The residual phosphorus concentrations (electrical current ≥0. 3A، reaction time ≥10min) in all samples were decreased to less than 1mg/L-P.

Results showed that the electrochemical process can decrease the residual phosphorus to less than the standard limit (1mg/L-P) in Iran. The plot for the average residual phosphorus concentrations versus reaction time is a straight line (R²=0. 837). Phosphorus removal from the samples of filtered effluent of activated sludge is considered as a second-order reaction and the fitted model can be formulated as y= -0. 001x2 + 0. 133x + 0. 875 (R²=0. 925).

Patients with thalassemia major are clinically dependent on red blood cell (RBC) transfusions. Performing multiple transfusions increase the risk of transfusion-related complications including blood-borne infections، iron overload and also RBC alloimmunization.

This cross-sectional descriptive study was conducted on 70 thalassemia cases with regular blood transfusions. The serum samples were screened for the detection of the unexpected antibodies and the positive samples were subjected to antibody identification.

Among 70 cases، 6 (8. 6%) were identified as unexpected alloantibody; three cases as Anti-K، one as Anti-E and another one as Anti-D. Coincidence of Anti D and Anti-E was detected in one case. Eighteen patients (25. 7%) were splenectomized. No significant correlation was seen between the presence of alloantibody and age، sex، the time of first transfusion and spleen condition.

Considering that the most prevalent unexpected antibodies (8. 6%) identified in this study were against the Kell and Rh system antigens، the evaluation of compatibility for antigens found can be recommended before the performing of transfusion. Therefore، this strategy may decrease the possibility of recipient immunization and production of the unexpected antibodies against donor RBCs.

Group B Streptococcus (GBS) has been described as an important pathogen in newborns and pregnant women. Maternal vaccination against GBS can reduce maternal GBS colonization and enhance antibody transfer to the fetus and also prevent the subsequent infections. Nine serotypes can be identified based on capsular polysaccharide: Ia، Ib، II-VIII. Due to the changes in serotypes'' distribution pattern over time and also variation in different geographic areas، production of a universally optimal vaccine is impossible. This study aimed to evaluate the serotype distribution of GBS using the multiplex PCR among the pregnant women. This study was performed on 382 pregnant women. Vaginal swab samples were placed in the LIM selective medium and incubated at 37°C for 24 h. Then the samples were cultured in blood Agar medium and the GBS was identified and confirmed using the standard tests and gene encoding dlts، respectively. Capsular typing was perform ed using the multiplex PCR method to identify the Ia،Ib،II-VIII serotypes. Thirty-six (9. 4 %) out of 382 pregnant women were carriers of GBS. The most common types were III (32. 14%)، V (21. 43%)، and IV (14. 3%)، respectively. Types II and VIII were not identified in this study. Considering the high prevalence of III، V and IV serotypes in this study، they are potential sources for the production of multivalent GBS vaccines in near future.

Neisseria meningitidis (N. meningitidis) is a pathogen which colonizes in the nasopharynx without any clinical manifestations. Among the 13 different serological groups، only the serogroups A، B، C، W135، Y، X play a major role in disease development. This study aimed to determine N. meningitidis cases carrying these serological groups using the multiplex PCR method in the nasopharynx of students in Kashan schools. This cross-sectional study was conducted on 1289 students in Kashan during 2011-2012. Samples were collected from the students'' nasopharynx using a sterile swab and cultured on a selective medium. Strains were identified through biochemical tests. Then the serological groups were determined using the multiplex PCR method. One-hundred and fifteen (8. 9%) out of 1289 students were N. meningitidis carriers; 75 (65. 2%) male and 40 (34. 8%) female. There was a significant difference between gender and the rate of carriers (P=0. 032). The highest rate of carriers (12. 3%) was in the 15 to 19 year age group. There was a significant relationship between the rate of carriers and increase in the number of family members (P<0. 001). In this study، only the serological groups B (8 cases) and C (107 cases) were detected. Since the serological group C is involved in the outbreak and there is no vaccine currently available for the serological group B to prevent the infection، detection of these serological groups can be important.

Shiga toxin-producing Escherichia coli (STEC)، as one of the most important food-borne pathogen، in human may lead to deadly syndromes، like hemolytic–uremic syndrome (HUS). Occurrence of HUS following urinary tract infection (UTI) has been previously reported. The aim of this study was to identify stx1، stx2 and eaeA genes in E. coli strains isolated from urine samples in Alashtar (Lorestan، Iran)

A total number of 144 bacterial isolates were collected from three hospitals in Alashtar during a six-month period. One-hundred E. coli isolates were identified using the standard biochemical tests as well as the selective and differential media. The multiplex PCR method was used to evaluate the presence of stx1، stx2 and eaeA genes.

Two out of 100 E. coli isolates carried both stx2 and eaeA genes and one isolate (1%) only sxt1gene. Moreover، the three genes were not found in any of the isolates tested.

Detection of Shiga toxin-producing E. coli (e. g. O157: H7 and non-O157: H7 serotypes)، which may lead to life-threatening syndromes such as HUS، from urine samples is of great importance. Further research in this field using the fast and precise molecular methods is recommended.

Irritable bowel syndrome (IBS) is a functional gastrointestinal (GI) disorder that is characterized by abdominal pain, diarrhea or constipation. The severity of IBS is associated with mental health and quality of life. Thus, the present study aimed to compare the mental health and the quality of life in IBS patients and healthy subjects in Kashan, Iran. In this analytical cross-sectional study, 71 patients with IBS meeting the diagnostic criteria of Rom- III and 69 healthy subjects were selected through convenience sampling. Data were collected using the demographic questionnaire, general health questionnaire (GHQ-28) and quality of life questionnaire (QOL-34) and then analyzed. Results showed that the mean scores for quality of life (101.21) and its sub-scales in IBS patients were lower than those in healthy subjects (47.31), but the mean scores for mental health (30.11) and its sub-scales were higher than those in healthy subjects (19.57). Moreover, the signs, anxiety and depression in IBS patients were more severe than healthy subjects. It seems that mental health and the quality of life are lower for IBS patients compared to healthy subjects in this city.

Mice as a reservoir and potential source of some zoonotic disease play an important role in transferring and spreading of infectious diseases. Considering the important role of mice in transmitting diseases to human، this study aimed to evaluate the geographic distribution of mouse and mouse-borne diseases. This review article was carried out using keywords: rodents، Yersinia، Tularemia، Salmonellosis and the terms for other diseases caused by mouse. Ovid، PubMed، Web of Science، Medline، Systematic Review، SID، Scirus and Google scholar databases were searched to find the relevant articles. A total number of 600 articles were retrieved and their titles and abstracts were reviewed. The irrelevant articles were excluded and the eligible ones selected and finally the results were analyzed. Findings of this study indicated a new geographical distribution for mouse and mouse-borne diseases in Iran. Moreover، the results of this study clearly showed the types of disease transmission and distribution by mice in Iran. Such places can be labeled as high-risk areas in order to use the effective control methods. Results show that mice are the important reservoirs of diseases in Iran. Important foci of the diseases in almost all areas of Iran are dispersed. Therefore، reliable methods to control mice are important.

Renal cell carcinoma (RCC) is responsible for 90-95% of malignant renal neoplasms. Peak incidence is between the 5th and 7th decades of life. Metastatic RCC to the breast is extremely rare. Case Report: A 55-year-old woman presented with a mass in her right breast. Mammography demonstrated a 22×32 mm mass with increased density associated with spiculation and microcalcification areas. Biopsy of the mass reported an invasive ductal carcinoma. During the evaluation of metastasis and staging، another mass (38×33×27 mm) was detected in the inferior pole of the right kidney with heterogeneous appearance. Nephrectomy was performed and the pathological evaluation of the kidney mass reported a clear cell renal carcinoma. Breast mass was vimentin-positive carcinoma that was consistent with metastasis from RCC. Breast metastasis from RCC was diagnosed and the patient treated with immunotherapy (Interferon alfa). It can be concluded that the breast tissue can be a site for RCC metastasis. Therefore، after detecting a malignant breast mass، a comprehensive evaluation is necessary to differentiate between the primary and metastatic breast cancers.