مجله دانشکده پزشکی اصفهان
پیاپی 249 (هفته سوم مهر 1392)

Mesenchymal stem cells (MSCs) by having immunomodulatory and neuroprotectivity properties could be a suitable candidate for the treatment of inflammatory and neurodegenerative diseases. Furthermore، by genetical manipulation، it is possible to potentiate the therapeutic characteristics of these cells. The aim of this study was to investigate the effect of IL-27-transfected MSCs in a mouse model of experimental autoimmune encephalomyelitis (EAE). MSCs were isolated from the bone marrow of C57BL/6 mice and were trnasfected with mouse IL-27 gene by using a lentiviral vector system. On days 15 and 22 post EAE induction، one million of these cells were injected to EAE-affected mice. Finally، all the mice were sacrificed; and histological and immunological assays were performed to investigate the myelin status and infiltration rate of immune cells into the central nervous system (CNS) tissues and measure certain cytokines، respectively. IL-27-transfected MSCs could ameliorate disease in the EAE-affected mice. Besides، they could diminish the infiltration rate of immune cells into the CNS، and inhibited the myelin destruction. Moreover، IL-27- transfected MSCs could enhance IL-4 and IL-10، and reduce IL-17 production from the EAE mice splenocytes. IL-27-transfected MSCs could be considered as a therapeutic tool for the treatment of inflammatory diseases including multiple sclerosis (MS). Changing dose and rout of administration، however، would be suggested to achieve better results.

ß-lactamase enzymes are the most important factor for antimicrobial resistance in Gram-negative rods. This study aimed to determine the antimicrobial susceptibility pattern and the occurrence of AmpC ß-lactamase genes in clinical isolates of Klebsiella pneumoniae (K. pneumonia). A total of 100 K. pneumonia isolates was collected from clinical specimens obtained in the Vali-Asr hospital، Arak، Iran. The isolates were identified on the basis of standard biochemical tests. Antimicrobial susceptibility pattern was defined by the standard disk diffusion method according to CLSI (Clinical and Laboratory Standards Institute) guidelines. Plasmid-mediated AmpC β-lactamases genes were detected by using polymerase chain reaction (PCR) method. Of the 100 isolates tested، 19 (19%) were demonstrated to harbor AmpC β-lactamases by multiplex PCR; eight isolates carried β-lactamases genes of the CIT group، seven isolates carried genes belonging to the MOX group، three and one isolates carried genes belonging to the EBC and DHA groups، respectively. ACC and FOX groups were not found in our isolates. This study is the first report of MOX group of AmpC β-lactamases in K. pneumoniae in Iran. High prevalence of plasmid-mediated AmpC in the central hospital of Arak، indicating the antibiotic resistant، is a major concern; hence، antibiotic prescription policy should be revised and infection control measure is necessary to be improved.

Pediatric supracondylar humeral fractures can be associated with infectious، vascular، and neurological complications. There is debate about emergency or elective treatment methods of this fracture. The aim of this study was to evaluate the passing of time in the treatment of pediatric elbow supracondylar fractures. In this study، 60 patients underwent early surgery (before 8 hours) and 60 patients with delayed arrival underwent delayed treatment (after 8 hours). After data collection by observation and checklist they were analyzed by means of SPSS software and X2، Fisher’s exact test، t-test، and Mann-Whitney statistical test. P values of > 0. 05 were considered significant. There was no significant difference between the two groups regarding neurovascular injury، infection، myositis ossificans، and varus deformity. Moreover، there was no compartment syndrome in the two groups (P > 0. 05). We were unable to identify any significant differences regarding complications such as neurovascular injury، infection، myositis ossificans، and varus deformity between early and delayed treatment groups of pediatric supracondylar humeral fractures. Therefore، the choice between early or delayed operative treatment depends on the surgeon’s preference and judgment.

One of the most common visceral cancers among men in the world is prostate cancer. Screening for early detection has a positive effect on patients’ survival time. Measurement of serum level of total PSA and free PSA is abundantly used for screening and diagnosis of prostate cancer. However، no study has been done to determine the relation between serum level of total PSA and free PSA/total PSA ratio with malignancy degree on biopsy samples. The aim of this study was to determine the relation of serum level of total PSA and free PSA/total PSA ratio، with malignancy degree. This is a cross-sectional study done in Alzahra Hospital during 2012-2013. We selected 85 patients with prostate cancer whose disease was detected in the pathology ward. Serum level of total PSA and free PSA were measured، and the degree of malignancy was determined by pathology ward based on the Gleason scoring system. All data was recorded in the questionnaire and entered into the computer and analyzed by SPSS software. The results of this study showed that there is 38% correlation between Gleason score and free PSA/total PSA ratio. Based on the Pearson correlation، this relation was statistically significant (P = 0. 037). Moreover، there is a 37% relation between serum level of total PSA and the Gleason score; this relation was statistically significant (P < 0. 001). Prostate cancer is usually detected late and biopsy is rarely accepted by patients. Moreover، serum level of total PSA and total PSA/free PSA ratio has a relation with degree of malignancy. Therefore، serum level of PSA can help patients and physicians in early detection and treatment of prostate cancer.

Several studies have shown that gender concordance between patient and physician led to a better relationship between them. Moreover، lack of gender concordance may lead to decrease in quality of this relationship، and finally to the lack of contribution of patients in diagnosis and treatment of the diseases. Gender concordance is very important in the several aspects such as medicine، psychology، religion، culture، and society. Lack of concordance can cause different aspects of the disease to remain hidden and dissatisfaction of the patient. Thus، the aim of this study was to compare male and female patients’ satisfaction of physicians. This is a cross-sectional study conducted in general and specialized medical centers of Isfahan، Iran، during 2012-2013. The target population was patients who referred to the above centers. The sample of this study was selected by sequential method from general، specialized، and highly specialized patient centers affiliated to Isfahan University of Medical Sciences. Patient satisfaction was measured by the patient contribution questionnaire (PICS). After collection، the data were analyzed by SPSS software and applying of Student t-test and chi-square. 423 patients were studied، among 231 (54%) of which gender concordance existed. 83% of male and 70% of female patients were referred to male physicians، and there was a statistical difference between males and females in physician gender selection (P < 0. 001). Total patients satisfaction is low، but it was higher among patients with gender concordance; no statistical difference was observed between concordance and non-concordance groups (P = 0. 26). According to results of this study، gender concordance between patients and physician is not at a suitable level in Isfahan medical centers. In addition، there is not enough contribution between patient and physician. This problem led to a decrease in patient satisfaction and information transferred between doctor and patient. As a result، their diagnosis and treatment encountered some problems. Thus، suitable decisions and programs may be needed for medical staff distribution in different areas and the dissemination of the culture of equality of male and female doctors’ capability.