فصلنامه کومش
سال پانزدهم شماره 2 (پیاپی 50، زمستان 1392)

Use of informed medical consent prior to therapy is not a new concept and has been performed for a long time. Yet in recent years it has acquired a critical importance due to the widely increased complexity of medical procedures. Informing the patient about his chances of benefiting from a given therapeutic procedure and the likelihood of its antecedent risks and side effects is an inseparable and essential component of standard patient management. An informed consent will be meaningless without such data. Informed consent plays key roles in both medical ethics and patient rights، and its proper application prior to diagnostic or therapeutic procedures typically will yield better results. It is therefore imperative that the patient or his legal guardian or surrogate fully understand and approve the therapy under consideration. Understanding and approving are equally important in this process and when properly applied in an ethical manner، can hasten the process of patient recovery. Medical personnel are thus obliged to fully reveal the patients all information about their illness as well as the therapeutic options available to them. Failure to do so will encumber legal ramifications

Using Boston questionnaire (BQ) is common to evaluate the severity and functional ability in patients with carpal tunnel syndrome (CTS). This study aimed to translate and adapt the Persian version of BQ for the assessment of the severity and investigation of its validity and reliability. BQ has two parts: first part with 11 questions evaluates the severity of symptoms (BQ-SS) and the other part with 8 questions evaluates the functional status (BQ-FS) of patients. After translation and preparing the Persian version of BQ by two translators، it has been re-translated to English and matched to the original. For content and construct validity evaluation، the opinions of 15 patients with CTS and 20 specialist medical doctors were used. They were asked to complete the final Persian version of BQ. To investigate the reliability، 45 CTS patients (age ranged 20-60 years old، 86 affected wrists) in two groups; low-literate and literate، completed Persian BQ in two different sessions with at least 2 weeks interval for each affected hand. Using Cronbach''s alpha، showed excellent internal consistency for both literate (BQ-SS= 0. 88، BQ-FS= 0. 90) and low-literate (BQ-SS= 0. 90، BQ-FS= 0. 90) subjects. The intraclass correlation oefficients were also excellent in both literate (BQ-SS= 0. 834، P<0. 01 and BQ-FS= 0. 91، P<0. 001) and low-literate (BQ-SS= 0. 90، P<0. 001 and BQ-FS= 0. 89، P<0. 001) subjects Pearson’s correlation coefficient of BQ-SS and BQ-FS were 0. 84 and 0. 90 for literate and 0. 90 and 0. 89 for low-literate subjects. The results showed that the Persian version of BQ is a reliable tool in both literate and low-literate Iranian CTS patients. However، it is necessary to investigate its reliability in CTS patients over 60 years old.

Currently، the recording and digitalization of EEG is possible due to development of electrophysiological instruments. Increased in repeated patterns in EEG as a time series indicates occurrence of neuronal hyper-synchronization and epilepsy. The occurrence of this phenomenon can be evaluated by self-similarity exponents. In this research، epilepsy was detected and efficacy of its medication by attention the patient sex was studied with help of these exponents. Self-similarity exponents α1، α2 and η and ν factors were calculated by detrended fluctuation analysis method for two minute resting EEG recording from 16 healthy persons (8 men and 8 women) and 21 generalized epileptic patients (8 men and 13 women) that received different anti-seizure medications. Body mass index and waist to hip ratio of all participation was measured. The metabolic indexes have not any significant difference between groups. Only self similarity exponent α2 was shown significant (p<0. 05) difference between male epileptic patients and healthy persons. The η and ν exponents of epileptic patients was shown a significant (p<0. 05) difference with healthy ones without consideration of its gender. The male epileptic patients ν factor have significant difference (p<0. 05) with healthy one. These exponents and factors have diagnostic potency for detection of healthy persons from epileptic patients even after treatment with anti-seizure drugs. Also، the results indicate that anti-epileptic drugs can cause effective suppression of EEG hypersynchronization in women than men

This research has been established with the aim of the comparison of psychological risk factors such az depression، anxiety، psychosocial stress، type D personality، mindfulness among patients with and without myocardial infarction relapse. In this quasi-experimental study، 60 heart patients were selected amoung the patients admitted to the H. Zahra hospital in Sari city (Iran). The patient divided into two groups: 30 patients with one myocardial infarction and 30 patients with two or more myocardial infraction. Psychological risk factors such as type D personality، depression، anxiety، psycho-social stress، mindfulness were evaluated by the questionnaires including Denollet type D personality، anxiety، depression and stress Lovibond & Lovibond and Brawn & Ryan’s mindfulness scales. No significant differences were found between two groups regarding to blood pressure، heredical problem، diet، kidney stone، cholesterol (LDL)، smoking، and diabetes (P> 0. 05). Anxiety with a direct effect (P=0. 017) and type D personality with an indirect effect (P = 0. 011) could predict relapse of myocardial infraction (p<0. 05)، but depression and psychosocial stress and mindfulness could not have any effect on the prediction of myocardial infraction relapse (P> 0. 05). Given the role of anxiety and type D personality in myocardial infraction، it is suggested for the sufficient training to reduce anxiety and inhibition of expression of negative excitement and social dissuasion to prevention of relapse myocardial infraction

Viral hepatitis is one of the major problems for health of the communities. Despite remarkable advances in diagnosis، screening and controlling methods of these diseases، still the virus transmit by blood products is one of the important challenges in blood transfusion centers. The purpose of this study was determination of prevalence of the hepatitis B and hepatitis C in blood donors at Semnan province. In this cross-sectional study، the data of questioners and lab analysis results of the blood donors who referred to Semnan (Iran) Blood Transfusion Organization from 2008 until the middle of 2011 were surveyed. Demographic characteristics and prevalence of hepatitis B and hepatitis C in blood donors were studied during these years. A total of 124704 blood donors were surveyed. From 329 persons who were suffering from hepatitis، 297 cases were positive for HBV and 32 cases for HCV. The prevalence of HBV and HCV contamination among the donors were 0. 24% and 0. 026%، respectively. The prevalence of HBsAg and HCVAb were higher among the first-time، male and married donors. The prevalence of hepatitis infection in Semnan province is lower than of many other parts of the world and Iran that is very promising. Furthermore، due to the very low prevalence viral infection in regular blood donors، it seems that for approach to a safe blood supply، using of the regular donors has priority.

Regulation of endotracheal tube cuff pressure is a caring challenge in patients with mechanical ventilation. There are different methods for regulation of cuff pressure. The aim of this study was to investigate the effects of regulation of cuff pressure with minimal occlusion volume (MOV) method on incidence of ventilator associated pneumonia (VAP). In this pilot and quasi-experimental study، 40 patients in intensive care units were selected purpose fully with specific criteria and randomly allocated in two groups (estimated and MOV). In the estimated group، one of experienced nurses estimated cuff pressure and in the MOV group، cuff pressure regulated with no leakage in peak of inspiratory pressure. Cuff pressure and score of clinical pneumonia was measured in four days. Findings showed that mean of cuff pressure in estimated group was 50. 35±9. 5 cmH2O and in MOV was 20. 78±1. 4 cmH2O. Patients in two groups were similar in VAP related factors (P>0. 05). In pneumonia scores two groups were not significantly different (P=0. 968). Findings showed that regulation of cuff pressure with MOV in patients under mechanical ventilation can cause seal endotracheal tube and prevented pneumonia without over-inflation and tracheal injury.

Aflatoxin M1 is a hydroxylated metabolite of Aflatoxin B1. It has toxic and carcinogenic effects. So monitoring of its concentration in milk is a very important health concern. The purpose of this study was to determine the concentration of aflatoxin M1 in raw milk produced in the cites of Semnan province، Iran. This descriptive–analytical study was done during the 2009-2010، and a total of 311 samples were collected from raw milk collection centers and analyzed by HPLC-fluorescence detection after immunoaffinity purification. The mean concentration and standard deviation of aflatoxin M1 in the raw milk samples was 55. 1±80. 1 (ng/kg). The lowest and the highest levels of Aflatoxin M1 were zero (undetectable) and 743ng/kg، respectively. Also، the average concentration and standard deviation of aflatoxin M1 in the raw milks produced in Damghan، Shahrood، Semnan and Garmsar (cities of the province) were 25. 8±17. 1، 47. 5±36. 5، 62. 2±106. 3 and 79. 4±62. 5 ng/kg، respectively. In overall، 15. 8% of the raw milk samples had the aflatoxin M1 concentration higher than the 100 ng/kg (Iranian standard). The differences of aflatoxin M1 levels between the cities were statistically significant (P<0. 001).

This Study estimated the prevalence of specific language impairment (SLI) in five-year old children. SLI is applied to children who exhibit a significant deficit in language ability yet display normal hearing، age-appropriate scores on tests of nonverbal intelligence، and no obvious signs of neurological damage. In this epidemiological study، 436 children at five years old، 221 boys and 215 girls were selected from all public and private preschool centers in the city of Semnan (Iran). The impairment was diagnosed during two phases. The focus of the phase one was the screening of children suspected to SLI by the relevant data gathered through a questionnaire specified for parents، in regard to motor، speech and language development adding family history of language or learning difficulties. In phase two، 19 Children who failed the screening and similar number of controls nominated for more investigating of some of their language properties by sampling of descriptive and conversational speech. The data obtained from the second phase provided a basis for diagnosis of SLI with 15 out of 19 suspected SLI children. The findings provided an estimated overall prevalence rate of 3. 44 percent. The prevalence estimate for boys was 3. 61% and for girls 3. 25%. The prevalence of SLI fell under some of the estimates in the studies of English speakers. However، it was within the identified range of DSM IV. Also، this condition was almost the same between the two sexes. These results might be a consequence of Persian language morphosyntactic features، the reliance on parents report for the screening، social characteristics of the region.

There are growing evidences showing protective effects of fruit and vegetables with lower risk of asthma. The aim of this study was to investigate the association between fresh fruits and vegetables consumption in dietary pattern and the risk of developing childhood asthma.

A case - control study was performed among children at 2 - 8 years. Subjects were children aged between 2-8 years old. Cases were asthmatic children diagnosed based on GINA criteria (n=207) and controls were children without asthma symptoms (n=414). Cases and controls were matched for age and gender. Information related to fruits، vegetables intakes and other effected factors were collected using ISSAC phase three questionnaire which completed by interviewing with parents. The association of dietary patterns with risk of asthma was analyzed by multiple logistic regressions using STATA 10 software.

Asthmatic patients had lower intake of fresh fruits، vegetables and potatoes in comparison with control group. Protective effects were found for consumption of fruits، vegetables، potato for 3 or more times a week (OR frutis: 0. 36، 95% CI: 0. 19-0. 68، P = 0. 002، OR vegetables: 0. 74، 95% CI: 0. 51-1. 07، P = 0. 11).

Our findings indicate that three or more intake of fruits and vegetables have a protectiveeffect in the risk of childhood asthma at 2-8 years.

The risky multidrug resistance phenotypes could be spread among strains of Escherichia coli (E. coli). The resistance against β-lactam drugs could emerge through the production of different enzymes with different spectrum of activities. This study was planned to determine the activity of β-lactamases extracted from different clinical isolates of E. coli and their relatedness with resistance phenotype and plasmid patterns. Antimicrobial susceptibility of E. coli isolates from different clinical samples to 10 β-lactam antibiotics were studied by disk diffusion method and minimal inhibitory concentration (MIC) of the resistant isolates were determined against cefotaxime by agar dilution method. Iodometry assay was used to detect β-lactamase activity of periplasmic fractions of the protein extracts in the presence of cefotaxime. Plasmid transmissibility of the resistance phenotype into E. coli HB101was finally studied by CaCl2 transformation method. Results of this research showed existence of high plenty of multidrug resistance phenotypes (21%) among these isolates. The study-generated antibiogram showed that the lowest percent resistance antibiotics for all the isolates were imipenem (11%) and ceftazidime (15. 52%). This resistance phenotype was transferable by plasmids in strain E. coli HB101. Analysis of the β-lactamase activities showed a variation among them in ranges of 0،007 upto 0،065 units. No significant relationship was observed between the level of MIC (<4 to 1024 µg/ml) and the amounts of enzyme activities. These results indicated that type of the produced enzymes and also their specificities for β-lactam drugs، but not the amount of their total enzyme activities، do determine the level of their resistance phenotypes and MIC levels. Presence of the high levels of MIC in some isolates with very low enzyme activities suggested the existence of other mechanisms of drug resistance among them. Identification of antibiotics with higher affinity for these β-lactamases will provide valuable information about fighting against these bacteria in severe infections

Because of heavy metals toxicity for the environmental، heavy metals are considered as environmental pollutants. The hexavalent chromium is one of the heavy metals that toxic and soluble in water. This study to remove of hexavalent chromium from aqueous solution by pomegranate seed powder has been done. This study was performed in laboratory scale and experimental. The adsorbent prepared in laboratory scale and pulverized by standard ASTM sieves (40-100 mesh). In this research، the effect of pH (2، 3، 4، 6)، adsorbent dose (0. 2 to 0. 6 g/100 ml)، contact time (15 to 180 min) at initial Cr (VI) concentrations of 2 and 10 mg/L، was studied. The results of adsorption equilibrium were analyzed to Langmuir and Freundlich isotherm models. The unknown Concentration of Hexavalent Chromium by spectrophotometer set (UV/VisibleSP-3000 Plus-Japan) at 540 nm based on standard methods for testing water and wastewater book determined. The results showed that increasing the adsorbent dose and contact time led to increasing of the removal efficiency and increasing pH and initial chromium concentration led to reducing of removal efficiency. According to the results، the best removal efficiency occurred at acidic pH and adsorption equilibrium time was 120 min. In the absorbed dose of 0. 6gr/100ml، pH = 2 and hexavalent chromium concentration 2 mg/l، the removal efficiency was achieved equal to 99. 5%. In this study، chromium ions adsorption by pomegranate seed powder is follows Freundlich isotherm model. The obtained results showed that pomegranate seed powder is suitable natural adsorbent for the removal of chromium (VI).

In recent years، the idea of being able to replace the destruction of insulin-producing beta cells of the pancreas by introducing new cells to repairthe damaged areas has become an accepted potential treatment for Diabetes mellitus. The idea to generate pluripotent stem (iPS) cells specific from diabetic patient and differentiate to insulin-producing cells has opened a new window to using of iPS cells as new source for cell therapy of diabetes without being worried about the immunologica rejection or ethical issues. In the present study، iPS cells were directly generated from the human conjunctive-stromal cells and they were subjected to embryoid body formation for 5 days and differntiatied to definitive endoderm cells usingActivin A and Wnt3a. Differentiated cells were subjected to qRT-PCR using primers for FoxA2 and Sox17 genes as marker of definitive endoderm. To confirm the result in the level of protein the immucocytochemistry will be undertaken. In conclusionthe result of this study can clarify the effect of Activein A and Wnt3a in definitve endoderm derivation of iPS and will utilize these cells as precursors for cell therapy for hepatic and diabetics disease

Gentamicin (GD) is an aminoglycoside antibiotic that is used to treat infections with gram-negative bacteria. Due to side effects such as nephrotoxicity، its use is limited. The aim of this study was to evaluate the therapeutic effects of methanolic extract extract of Urtica dioica (UD) on GD-induced nephrotoxicity. 32 male Wistar rats weighting between 200-250 g were randomly divided into 4 groups (n = 8 in each group): 1- control group received no drug orgentamicin، 2- treatment group with GD (100 mg/kg/d) intraperitoneally for 8 days and distilled water (4 ml/kg) by gavage for two days، 3-treatment group with saline intraperitoneally for 8 days and UD extract (200 mg/kg) for two days، and 4 - treatment group with GD (100 mg/kg/d) intraperitoneally for 8 days and UD extract (200 mg/kg) for two days. On the tenth day، after the last administration، the animals were placed in metabolic cages and urine volume was measured gravimetrically. Following this، the animals were anesthetized، and blood pressure and renal artery blood flow were measured. After that، blood sampls were taken from aorta، and the levels of urea، creatinine، sodium، potassium and osmolality were determined in plasma and also urine samples. Finally، the left kidney was maintained in 10% formalin for histological examination and the right kidney was kept in -20oC for biochemical examination of malondialdehyde (MDA) and the ferric reducing ability of plasma (FRAP) (markers of oxidative stress). UD extract significantly inhibited GM-induced enhancement of plasma creatinine، BUN، absolute excretion of sodium، fractional excretion of sodium and potassium، and MDA levels. UD extract also restored GM-induced derecment in creatinine clearance، urine osmolarity، renal blood flow and FRAP levels. This study showed that UD extract likely via the reduction of oxidative stress and anti inflammatory and vasodilatory effects could improve nephrotoxicity induced by gentamicin

The reduction of dopamine level caused by neurodegenerative diseases such as Parkinson''s disease (PD) may reduce the production of new neurons in dentate gyrus (DG) of the hippocampus. In addition، there is a direct link between the reduction of neurons in the hippocampus and memory impairment. In this study، the effect of carnosic acid (CA) on the hippocampal neurogenesis was evaluated after 6-OHDA injury. Male Wistar rats were randomly divided into six groups. First group was injected by bilateral intra-nigral of 6-OHDA at a dose of 6µg (injury). Groups 2-5 were injured rats which received orally Rosemary extract containing 40% CA at doses of 25، 50 and100 mg/kg (treated) and distilled water (control)، once daily in a period of 14 days before and after injury. The sixth group (sham) was injected with saline instead of neurotoxin. After treatment، the brains were removed and fixed with 4% paraformaldehyde، dehydrated، embedded in paraffin and cut into 10μm thick slices. Sections were stained with cresyl fast violet and cell counting of hippocampal regions was done. The loss of dopaminergic neurons in the 6-hydroxydopamine-lesioned rats، compared to sham-operated rats، was verified by tyrosine hydroxylase immunohistochemistry. Immunostaining analysis revealed a high density of TH+ cells in sham compared to injured group. The number of DG granular and CA1 pyramidal cells were decreased significantly in both control and injured groups compared to sham (P<0. 05). The number of granular and CA1pyramidal cells were increased significantly in CA (25، 50،100) and CA (50،100) treated groups respectively، compared to control and injured rats (P<0. 05). The number of CA3 pyramidal cells was not increased significantly in treated groups compared to control and injured rats. CA plays an important role in protecting hippocampal neurons from further damage in response to 6-OHDA. Then it is the effective herbal drug with treatment potential to improve memory impairment in PD which caused by neurons degeneration in the hippocampus

Nitric oxide synthase enzyme has been detected in the Nucleus accumbens، which is the targetareas of the mesolimbic dopamine pathways. In the present study، the effect of intra-NAc administration of the nitric oxide precursor was investigated on nicotine’s effects in ethanol state-dependent learning. Rats were anesthetized with intra-peritoneal injection of ketamine hydrochloride، plus xylazine and two stainless-steel cannuale were placed 2 mm above nucleus accumbens of them. One week later، the animals were trained in a step-through type inhibitory avoidance task. On the test day step-through latency was measured for the assessment of memory in male Wistar rats. Pre-training injection of ethanol induced amnesia (P<0. 001). The amnesia induced by pre-training ethanol restores with pre-test administration of same dose of ethanol (P<0. 001). This phenomenon، referred to as ethanol state-dependent learning. Pre-test injection of nicotine by itself had no effect on inhibitory avoidance memory (P>0. 05). However، restored amnesia was induced by ethanol (P<0. 001). In contrast، pre-test intra-NAc injection of L-arginine which had no effect alone (P>0. 05) prevented the nicotine reversal effect on ethanol memory impairment (P<0. 001). Our data indicated that nitric oxide precursor can inhibit the improving effect of nicotine on the ethanol-induced amnesia.

The method of platelet preparation is one of the factors which affect the quality and yield of platelet during its storage. Previous studies have shown that the use of high and low centrifugal speed during preparation of platelet concentrates can change platelet aggregation activity. In this research، effect of high and low centrifugation speed on platelet aggregation activity in responding to various agonists and platelet yield were studied.

Firstly، for determination of yield in platelet rich plasma، 11 units of whole blood were centrifuged at 2160 g (method I) and also 11 units were centrifuged at 2050 g (method II) for 4. 0 min and the mean platelet yield of two methods were determined. Again for evaluation platelet aggregation، at the second step، 8 units of whole blood were centrifugedat 2160 g and another 8 units were centrifuged at 2050xg similar to above conditions and for these 16 samples، aggregation tests were performed at the presence of ADP، arachidonic acid، collagen and ristocetin agonists.

the mean platelet yield of first and second method was found 52% and 69%، respectively. Percentage of the mean platelet aggregation activity of platelet rich plasma samples with responding to ADP، arachidonic acid، collagen and ristocetin agonists in the first method were found 42. 2، 26. 9، 28. 4 and 72. 2، whereas at the second method were observed 66. 6، 85. 6، 83. 3 and 84. 4، respectively.

The results showed that the use of low speed at 2050 g in comparison with high speed at 2160xg can significantly increase platelet yield and platelet aggregation activity with responding to ADP، arachidonic acid، collagen and ristocetin agonists and thus it can improve quality of platelet rich plasma preparation.

Psychological problems exist in at least half of patients with irritable bowel syndrome (IBS)، and there is one of the common causes that related to this disorder. This study aimed to determine the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on psychological symptoms in patients with IBS. The method research of current study was experimental (pre-test-post-test-follow up with control group). This research was conducted on fourteen women with IBS that randomly selected، and then randomly replaced in MBCT and control groups. Rome-III diagnostic criteria were used for the diagnosis of irritable bowel syndrome and Brief Symptoms Inventory (Dura et al، 2006) to assessing the psychological symptoms. Data were analyzed using the analysis of variance with repeated measure. Results showed that the mean scores of psychological symptoms has decreased in MBCT group in post-test and follow up. The Results supported the effectiveness of MBCT on psychological symptoms in patients with IBS and have important implications in attention to MBCT in reducing the psychological symptoms in patients with irritable bowel syndrome.

Bilateral ectopic pregnancy is rare، with an estimated incidence of 1 in 725 to 1 in 1580 ectopic pregnancies. They are usually found after using of assisted reproductive techniques. Spontaneous ectopic pregnancy is the rastest from of ectopic pregnany. Early diagnosis is essential for the prevention of significant maternal morbidity and mortality. Case report: A 33-year-old patient، gravidity 3، parity 1 with history of ectopic pregnancy in her first pregnancy was admitted with vaginal bleeding، 48 days after her last menstruation. There was no intrauterine gestational sac in transvaginal sonography، but serial BHCG titer reach to 5000 unit/ml during 7 days admission in hospital. So، the patient was underwent laparotomy and bilateral unruptured tubal pregnancy was noted during surgery، left tube salpingectomy and right tube salpingostomy was performed. This is a rare case of spontaneous bilateral tubal pregnancy in a patient with history of ectopic pregnancy in her first pregnancy

Granulose cell tumors are rare type of ovarian tumors and they are non epithelial cell tumors. Theses tumors usually present in adult age group and the peak of incidence are 50 to 55 years old. The mean size of tumors is 13 cm in most of studies and their size are variable from millimeters to 20cm. These tumors usually diagnosed in early stages but they may recur after years. These tumors secrete inhibin and usually surgery alone is enough for treatment. Case report: A 76 years old woman presented with complaint of abdominal pain، vaginal bleeding and progressive distention of abdomen. Radiologic work up showed that there was huge abdominal mass and high serum CA125 level. The patient was under went laparatomy and there was a huge Right ovarian tumor about 30cm with ascitis in pelvic cavity. Total abdominal hystrectomy and bilateral salping-oophrectomy with surgical staging was done. The result of pathology was granulosa cell tumor of ovary stage IC. The patient was referred to oncologist for further treatment. The Granulosa cell tumor of ovary may be present in advanced age with huge size and ascitis without involvements of others organ. So، in post menopause age if there is pelvic or abdominal tumor with high serum level of CA125 granulosa cell tumor of ovary should be considered and it is necessary to have long term follow-up because late recurrence of theses tumors