مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و ششم شماره 6 (پیاپی 114، بهمن و اسفند 1393)

Multidrug-Resistant Tuberculosis (MDR-TB) has been lead to complexity in succesfull treatment of Tuberculosis (TB). The aim of this study was to determine the pattern of first and second line drug resistance on pulmonary TB pateints and study their demografic and clinical links. In a cross-sectional study in 2011-2012, 105 Mycobacterium Tuberculosis (M.TB) pateints were collected randomly from east azerbayjan province of Iran. After full clinical history and physical evaluation, standard proportion method was performed for detection of drug resistance in M.TB pateints. Frequency distribution of the M.TB in various parts of the city was significantly different. The total prevalence of resistance to any drug was 8.57% (6.1% in new cases and 33.3% in previously treated cases). Two (1.9%) patients were MDR-TB and a case was Extensively Drug-Resistant (XDR). In the multiple logistic regrassion analysis, odds of resistance to one or more TB drug was significantly more in retreatment group than newly diagnosed group (OR=7.7). Frequency of resistance to Streptomycin (5.7%) was the highest and resistance to Etambutol was the lowest (0.95%). Sputum (88.3%) and coughing (86.4%) were the most common symptoms. Monitoring of drug resistance status by rapid teqnniques is necessary and crucial on patients with previous history of TB. Unexpected distribution of the disease in different parts of the city indicates the need for other studies.

In situ gel formation of Glycerol Monooleate (GMO) has been utilized to release many drugs. The aim of this research was to optimize, and in-vitro characterization of the controlled release and formulation of the matrices containing Olanzapine (OZ), GMO and Polyethylene glycol (PEG 300). Methods and Materials: Response surface methodology (RSM) is a combination of mathematical and statistical techniques. In this study, Design-Expert® software with Box-Behnken response surface methodology has been used to determine the relationships between variables and responses. GMO/water weight ratio (w/w) different and PEG 300/GMO (w/w) were in the range of 2-4% and 2-6% respectively. Percentage of loading; and release at 12th and 168th hr were calculated. In-vitro release studies of OZ from prepared gels were conducted in PBS (pH 6.8) and then analyzed by spectrophotometer at 265 nm. The optimum formulation was obtained at weight ratio of water/GMO (w/w) and PEG (300)/GMO (w/w) at 0.28 and 0.2 respectively, and percentage of OZ was at 4%. The observed and predicted values for EE % were 86.8 %, 90.31% respectively those parameters for release at 12th hr were 16.1% and 15% and for release at 168th hr, were 59.8 % and 63.56% respectively. In this study we performed kinetic release profile of OZ with several models, from which Higuchi model showed the best fitting and correlation.

Multiple Sclerosis (MS) is a progressive neurologic disorder characterized by wide clinical features. Some voice features and signs of these patients are used by speech therapists for differential diagnosis for its speech disorders. The aim of present study was to compare some vocal and respiratory indices of MS patients with normal subjects in Ahvaz city. In this cross-sectional analytic study, 30 patients with Multiple Sclerosis and 30 normal subjects (aged between 21 to 50 years) were compared based on Fundamental frequency (F0) and Maximum Phonation Time (MPT). Dr.Speech software was used for speech analysis and SPSS program was applied for data analysis. Mean of fundamental frequency in male and female patients was 130.53±68.11 and 194.91±33.12 Hz, respectively; and also mean of maximum phonation time in male and female patients was 11.25±2.71 and 9.21±2.32 seconds, respectively. Also, mean of fundamental frequency in male and female was 135.62±46.25 and 217.16±17.21 Hz, respectively; and mean of maximum phonation time in normal subjects was 23.73±3.62 and 19.30±3.44 seconds, respectively. Patients with MS had lower scores and significant differences than the control group in all the studied variables (p<0.001). It seems that variations of F0 and MPT are two respiro-vocal features that could be used for speech features differential diagnosis of MS patients from normal subjects.

There is limited available data about the effects of antioxidant supplements on changes of hematological parameters after exercise. This study was carried out to investigate the effect of short-term CoenzymeQ10 supplementation on white blood cells, hemoglobin and red blood cell indices in non-athlete men after relatively intense running. Twenty healthy inactive men (25±3 years, fat 13±2. % and VO2max 41±2 ml/kg/min) in a randomized and double-blind design were allocated in two equal groups: supplement (2.5 mg/kg/day Coenzyme Q10) and placebo (2.5 mg/kg/day dextrose) groups. After the 14-day supplementation therapy, all subjects were participated in an aerobic exercise with 75% VO2max on the treadmill for 30 minutes. Blood samples obtained before the Q10 supplementation along with before and after the exercise protocol. Ingestion 14-day coenzymQ10 supplementation on indexs (RBC, Hg, MCV, MCH, MCHC, Hct, WBC,PLT, lanphosit percentages, notrophils and other blood cells) had no significant effect (P>0.05) on basal parameters. Moreover, aerobic exercise causes lower red blood cells counts, hemoglobin and hematocrit and increase White blood cells and platelete (P<0.05), However, the rang of lower red blood cells, hemoglobin, hematocrit and increase white blood cells in supplementation group after aerobic exercise low was that placebo group (P<0.05). Tngestion 14-day coenzymQ10 supplementation (with 2/5 g/kg/day) in effective on withe blood cells, hemoglobin and red blood cell indices after that aerobic exercise.

Neuroblastoma is the most common malignant tumor in infancy and childhood after the CNS malignancies. Diseases originated and spread of the neural crest cells that differentiated adrenal and sympathetic nerve network. The aim of this study was to investigate the prevalence and stages disease in patients of Tabriz Children's Teaching Hospital. In this descriptive study, 80 children under 14 years since March 2003 to March 2008 (6 years) with a diagnosis of neuroblastoma that have been hospitalized in Tabriz Children Hospital were investigated. Information were extracted from the hospitals records. Of the 80 investigated patients, 33 cases were male and 47 were female. The mean patient age was 37.80 ± 31.86 month. Out of 80 patients, stage II in 9 patients (% 11.2), stage III in 19 cases (23.8%) and stage IV was seen in 52 patients (65%). The primary source of neuroblastoma in 26 cases (32.5%) was from the right adrenal and in 31 cases (38.8%) was the left adrenal, in 3 cases (3.8%) was from the mediastinum, in 3 cases (3.8%) from liver, in 3 cases (3.8%) was from hip and in 14 cases (17.5%) was from the paravertebral. Paraneoplastic symptoms were positive in 13 patients (16.25%). Neurological symptoms were positive in 13 patients (16.25%). Weight loss was found in 44 patients (55%). Fever was found in 43 patients (53.8%). Hematuria was found in 25 patients (31.2%). In terms of platelet count, thrombocytopenia was seen in 33 patients (41.25%). Mean systolic blood pressure was 86.94 ± 13.34 and mean diastolic blood pressure in evaluated patients was 54.88 ± 8.45 mmHg. Mean serum LDH level in patients was 1665.4 ± 1532.51. The serum LDH levels showed a significant correlation with patient's condition at discharge with P = 0.04. Clinical symptoms, paraneoplastic symptoms, weight loss and fever were the most prominent finding in patients with neuroblastoma. The most common region for evaluation in terms of primary source for neuroblastoma was left adrenal. There was a significant correlation between serum LDH level and patient’s outcome

Diarrhea is one of the most common complications of antibiotic usage. And clostridium difficile is the most common cause of Antibiotic-Associated Diarrhea (AAD). This study was aimed to investigate the infection with Clostridium Difficile Toxin (CDT) and Clostridium Difficile-Associated Diarrhea (CDAD) among hospitalized patients. This cross-sectional descriptive study was conducted on 195 patients admitted to different wards of Valiasr Hospital in Arak, Iran in the summer of 2013, by simple random sampling and considering inclusion and exclusion criteria. Demographic and clinical information of the patients was recorded using questionnaires. Among 195 patients, the prevalence positive toxin and CDAD were calculated as 14.4% and 4.1%, respectively. Incidence of CDAD had a significant relationship with antibiotic consumption history (p<0.05). Though the prevalence of positive toxin cases was more in female patients (p=0.001) and having significant relationship with diarrhea (p=0.036), no other significant relationship was found between the age, the type of hospital wards, the reason for hospitalization and antibiotic use with the results of CDT test. The CDT infection and CDAD were highly frequent in the hospital under our study. Therefore, it is suggested to implement care programs to decrease prevalence of the toxin of this organism in the patients admitted to hospitals and the related CDAD.

Prevention of pulmonary complications after coronary artery bypass graft is an important fact. The aim of this study was to evaluate the role of pulmonary rehabilitation prior to the surgery for reducing the risk of pulmonary complications after surgery. In a randomized clinical trial, 60 patients undergoing heart surgery randomly were divided into two groups (Group A and B). In group A Patients was performed physiotherapy before and after chest physiotherapy surgery, but on patients in group B were done only chest physiotherapy after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using Spirometry, arterial blood gas (ABG), Visual Analog Scale (VAS) and 6 Minutes Walking Test (6MWT). Thirty Nine males (65%) and 21 females (35%) patients with a mean age of 56.9 ± 10.8 was been analyzed. Pneumonia after surgery was observed lower in the group A in compared with group B (0% VS. 40%). The mean difference in PCO2 and HCO3 indices (of ABG parameters), mean oxygen saturation (Spo2) (of 6MWT parameters) and VAS index were significantly different in the A and B groups (respectively; P =.008 and P =.001, P <.0001 and P <.0001). The pulmonary rehabilitation program before surgery is recommended to reduce complications of heart surgery.

There are few regional researches which have been done about psychological dimensions of cancer especially in Iran. The aim of the current study was to investigate emotional intelligence and coping style and the evaluating of relationship in patients were diagnosed with cancer. In this co- relational descriptive study, four hundred patients in Imam Hossein hospital and Clinic of Dr. Payam Azadeh in Tehran were considered for the present study. The patients answered to the Emotional Intelligence questionnaire (Schutte), coping with stressful condition questionnaire (ciss). There was no significant relationship between task-oriented in two groups of women (patients and healthy subjects). The Pearson correlation coefficient showed that there was a positive relationship between emotional intelligence and its components and problem-oriented coping style. In addition, there was a positive relationship between emotional intelligence and its subscales and avoidance-oriented coping style. Having psychological interventions in the field of emotional intelligence patient diagnosed with cancer can be a big help for patients diagnosed with cancer inorder to improve their mental status, increase their resistance capacity, and also to accelerate the process of their medical treatment.

Radical Nephrectomy (RN) is a standard treatment modality for localized Renal Cell Carcinoma (RCC), and recently laparoscopic RN is coming popular for RCC treatment. The advantages of retroperitoneal laparoscopy to the intraperitoneal approach include less visceral and vascular injury, easier access to renal vessels and no peritoneal seeding. Accordingly that in our country intraperitoneal approach is known as a common option, we decided to report our experience in retroperitoneal laparoscopic RN in these patients. In this retrospective study, 12 patients (6 male and 6 female) with 3-11 cm renal masses who were hospitalized from 2008 to 2012, underwent the retroperitoneal laparoscopic RN with hand assisted intact kidney removal by Gibson incision, assessed for local recurrence, perioperative hemorrhage and other postoperative complications. Mean operation time was 193 ± 32 min with during operation blood loss of 162 ± 48 ml. Post operation hospital stay was 2-5 days. Conversion to open surgery was not required. There was no blood transfusion during and post operation. No major complication occurred. At mean 47.5 ± 18 months fallow up local recurrence was not seen. Retroperitoneal laparoscopic RN has become safe, simplified and effective although not easy. Complications, blood loss, hospital stay and convalescence times are low, therefore this approach is a good option for selected case of renal mass.

Two clinical forms of leishmaniasis exist in Iran: cutaneous and visceral. According to the sporadic reports of new cases of Visceral Leishmaniasis (VL) in Lorestan province, real status of VL is not clear, so this study aimed to describe the seroprevalence of VL in Delphan city. In this descriptive analytic study, blood samples were collected from children ≤ 12 years and 10% of adults by a multi-stage randomized cluster sampling from January 2012 to September 2012. The sero-prevalence evaluation was done by Direct Agglutination Test (DAT). Based on different studies in Iran, the 1/800 and 1/1600 titers were considered as the infection with L. infantum and the of titers ≥ 1/3200 accompanied with clinical symptoms was considered as VL disease. 800 collected serum samples, 21(2.62%) showed anti-Leishmania antibodies at titers of 1/800 and 1/1600, whereas 5(0.62%) showed anti-Leishmania antibodies at titers of ≥1/3200. But just one of them showed clinical symptoms (anemia and large abdominal) which is under treatment with miltefosine. A new focus of VL with low endemicity is going to be formed in our region, which showed that further studies on vector and reservoirs is necessary in the region and other parts of Lorestan province.

ʺGhaze-yaghiʺ with scientific name of Falcaria Vulgaris Bernh has different uses in Iranian traditional medicine such as treatment of skin trauma, gastric and liver disorders. In this study, antibacterial effects of different extract of Falcaria Vulgaris fruits were investigated. Methanolic extraction of the fruits of was fractionated using different solvents including petroleum ether, dichloromethane and ethyl acetate. After drying and concentrating minimum inhibitory concentration (MIC) of crude extract was determined using agar dilution method. Disk diffusion method was used to study antibacterial effects of fractions against 8 standard bacterial strains. Constituent compounds of the most effective fraction were separated on silica gel chromatography plates, using thin layer chromatography (TLC) method. Then chromatograms were analyzed using immersion bioautography. According to disk diffusion method, ethyl acetate fraction was the most effective extract. In bioautography of this fraction, antibacterial effect against Staphylococcus aureus, Staphylococcus epidermidis, Klebsiella pneumonia and Pseudomonas aeroginosa was appeared in Rf: 0.9. In addition, S. aureus and S. epidermidis dishes did not show any growth in the site of fraction loading. Some components in ethyl acetate fraction of Falcaria Vulgaris Bernh have synergism effects against gram positive bacteria (S.aureus, S.epidermidis), while they show antagonistic effects against gram negative ones (K.pneumonia, P.aeroginosa).

Several studies have showed that high levels of CRP and homocysteine increase the risk of coronary artery diseases. This study was aimed to investigate the effects of combined exercises on homocysteine, CRP and lipid profile in middle-aged inactive men. In this semi-empirical study, 24 subjects were selected by convenience sampling method. The cases were randomly assigned into two groups [experimental (n=12) and control (n=12)]. The aerobic training method included: 3 times a week, 20 minutes per session, with intensity of 60-70 percent of heart rate reserve. Also the resistance training program conducted by intensity of 70% one repetition maximum. The levels of serum homocysteine and CRP after combined exercises were decreased significantly (P=0.001 and P=0.003, respectively). Although, TC, TG, HDL-C and LDL-C levels between both groups did not differed significantly. As well as, maximum oxygen consumption has increased significantly (P=0.008). It seems that combined exercise (aerobic and resistance) with reduction of homocysteine and CRP levels can used as a non-pharmacological methods to prevent the development of atherosclerosis.