مجله علمی دانشگاه علوم پزشکی کردستان
سال سیزدهم شماره 4 (پیاپی 50، زمستان1387)

Nosocomial infections are common with known complications and high mortality and morbidity rate. There are several efficient and quick-acting antiseptic alcohol solutions such as Sterillium that require no scrubbing. The aim of this study was to compare the efficacy of betadin and Sterillium hand rubs for hand disinfection in a before-after trial according to prEN12054 prEN 1500.

We compared Betadin and Sterillium hand rubbing for hand disinfection in a before-after study. The study was done with 72 healthy ICU staff, whose hand microbial flora were measured before and after 30 seconds Hands washing with Betadin and Sterillium. Sampling was achieved according to the stratified randomization. Samples cultured on BA and EMB media and the frequency of microorganisms and the efficacy of two agents were determined. Then we compared results of Betadin and Sterillium by using Chi square and Fisher,s Exact and McNemar tests.

The most frequent pathogens were staph epidermidis (32), aerobacter aerogenosa (4), staph saprofiticus (3), pseudomona (1), klebsiella (1), acintobacter (1), and E.coli (1). The percentage of organism reduction following the usage of antibacterial agents was 94% for betadin and 87% for Sterillium (P=0.8). This reduction was significant statistically. We did not find significant difference about sex, ward, shift and job before and after washing with regard to Betadin, but in Sterillum we found significant difference(P=0.04) only after rubbing. The rate of negative culture about Betadin was more than Sterillium but was not statistically significant.

Since skin is a routine source of infections transmission, and with respect to the satisfactory results, we advise the usage of this agent for ICU staff for hand disinfection.

To evaluate the effect of propofol and remifentanil on pain and hemodynamic in patients under phacoemulsification with topical anesthesia.

After Ethic’s committee approval in a clinical trial study, 100 consecutive patients scheduled for phacoemulsification were randomized to 2 groups in a prospective manner. Each group received intravenous infusion 3 mg/kg/h propofol or 3 µ/kg/h remifentanil. Phaco time, blood pressure and heart rate before and after surgery, number of patients with respiratory depression (O2 sat<90%) and vomiting, pain scores, ophthalmologist satisfaction and demographic data were recorded.

Mean age, sex and phaco time were equal in the two groups. Systolic and diastolic blood pressure and heart rate were decreased significantly (p<0.05) in propofol group but this difference in remifentanil was not significant. Patients had more pain in propofol group (p=0.001) and the surgeon satisfaction was higher in remifentanil group (p=0.01). Two patients in the remifentanil group had respiratory depression but the difference was not statistically significant (p>0.05). Perioperative vomiting was not found in any groups.

With the doses used in this study, It was shown that remifentanil was more effective than propofol in minimizing pain and hemodynamic stability without producing excessive, respiratory depression or perioperative nausea and vomiting.

In skeletal muscle, carnitine plays an essential role in the translocation of long-chain fatty-acids into the mitochondrial matrix for subsequent beta-oxidation. Despite an abundance of literature describing the basic mechanisms of action of L-carnitine metabolism, there remains some uncertainty regarding the effects of oral L-carnitine supplementation on metabolism and exercise performance in normal subjects. This study examined the effects of chronic L-carnitine supplementation on glucose and lactate concentration, heart rate and aerobic capacity during submaximal cycling. Thirty healthy and male students cycled for 20 min at 70% VO2 max before and after 3 weeks (3g daily) L-carnitine (experimental) and placebo (control) supplementation. Blood samples were taken immediately after each exercise for the purpose of calculation plasma glucose and Lactate concentration, lactate dehydrogenase activity (LDH). A two-way repeated measure ANOVA was used to determine significant differences between the two groups (p<0.05). The finding of our study showed that L-carnitine supplementation had no influence on plasma glucose and lactate. Also rest and rest heart rate, VO2 max and LDH activity was equal in pre and posttests (p<0.05). All variables were unaffected in the control trial. Three weeks L-carnitine supplementation had no effect on substrate and carbohydrate metabolism. Also, L-carnitine supplementation would be unlikely to be associated with the enhanced exercise performance.

Due to widespread use of saffron (Crocus sativus L) as food colorant and flavor, and its reputation in folk medicine as a drug, recent studies revealed that main components of saffron are the carotenoids: crocin, crocetin, picrocrocin and safranal which have a large number of physiological effects on different biological systems. Our objective was to assess the efficacy of Crocus sativus on serum proteins pattern in the male mice. Five groups including eight adult male Balb/C mice were used in this study. Normal saline administered as placebo to control group and saffron extract in doses of 25 mg/Kg/48hr, 50 mg/Kg/48hr, 100 mg/Kg/48hr and 200 mg/Kg/48hr were injected intra peritoneally for 20 days to experimental groups. The levels of Albumin, Alpha-1, Alpha-2, Beta and Gamma globulins were separated electrophoretically and A/G ratio was calculated from the pattern of electrophoretogram. The result indicated that the levels of Albumin increased significantly in two experimental groups that had received 50 mg/Kg/48h and 100 mg/Kg/48h extract of Saffron as compared to the control group, the levels of Alpha-1 didnt have any remarkable changes in any group. The injection of 50 mg/Kg/48h, 100 mg/Kg/48h and 200 mg/Kg/48hr extract of saffron decreased (p<0.05) the Alpha-2 level in plasma as compared to the control group and levels of Beta globulins increased significantly in these three groups. The levels of Gamma globulins increased significantly in 100 and 200 mg/kg-treated groups as compared to the placebo controlled group. A/G ratio (Albumin/Globulin ratio) were significantly (p<0.05) lower than control group in any groups that received saffron extract in a dose-dependent manner. Albumin were significantly increased in two groups and A/G ratio was decreased in any groups. This can be interpreted that in the absence of antigen stimulation, serum globulins did alter markedly by extract of saffron. The study shows that since albumin synthesis occurs in the liver cells‚ thus administration of saffron may improve the status of liver function significantly.

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In the present time, analgesic and anti-inflammatory drugs such as nonseroidal anti-inflammatory drugs and opioid compounds are used for the releif of pain, but due to their side effects and economical issues, the significance of research on finding analgesic drugs with less side effects and their ability to substitute these synthetic drugs and substituting newer analgesic compounds is obvious. There is very little information about physiologic effects of Artemisia herba alba, one of species of Herba alba family. In the present study the possible analgesic effects of hydroalcoholic extract of this plant were investigated in chemical and thermal models of nociception in rats.

In this experimental study, percolation method was used for extraction. Specified amounts of dried extract were dissolved in twin to produce desired concentration. The extract were used orally or injected intraperitoneally and analgesic activity was assessed with two methods, Tail flick and Formalin test. In addition, anti nociceptive effect of this plant was compared with sodium salicylate as standard drug.

The plant extract significantly increased tail flick latency in tail flick test and decreased significantly pain perception in both phases of formalin test. The anti-nociception effect of herba alba was dose dependent.

These data confirm peripheral and central antianalgesic effect of this plant.

The thalassemia is belived to be the most prevalent of all human genetic diseases and caused by mutations of the synthesis of hemoglobin.Regular blood transfusions are necessary in major thalassemia patients. The combination of transfusion and chelation therpy has dramatically extended the life expectancy of thalassemic patients but an important complication is iron overload in different organs of the body. Despite improved hematologic care in recent years, in these patients primary hypothyroidism and other endocrine disorders due to iron overload are still common complication and affect the patient's quality of life. The aim of this study was to identify the prevalence of thyroid dysfunction and to determine its correlation with ferritin plasma level, amount of blood transfused and liver function in thalassemic patients. In this cross sectional study, fourty patients with beta thalassemia (20 males and 20 females; mean age, 12.7 ± 5.8 yrs) were evaluated. Serum ferritin levels, SGOT, SGPT were evaluated by ELISA method and TSH were evaluated byIRMA. Hypothyroid index was defined according to the criteria of Kronberg et al. Normal thyroid hormone values were found in 34 patients (85%) and 6 (15%) had subclinical hypothyroidism. Mean ferritin levels in hypothyroid and normal patients were2220 ± 1056 mg/l and 2028 ± 1548 mg/l respectively, (p= 0.2). Thyroid dysfunction could not be correlated with amount of blood transfused, liver function or ferritin plasma level. The high rate of thyroid dysfunction may be the result of poor disease control and manegment in early life when irreversible tissue damage ocuures due to iron overload and chronic hypoxia, and indicates the importance of regular follow-up of beta thalassemia patients for early detection and manegment of associated complications.

In a near future, stroke will be the second leading cause of death and disability in many regions of the world. To reduce the overall burden of the disease on society, the development and the establishment of an organized approach for acute stroke care is postulated. The identification of predictors for death and poor outcome might contribute to reduce mortality and morbidity rates after stroke by enhancing the application of specific therapeutic and management strategies to patients at high risk. However, only limited information is available in this regard. Leukocytosis and increased erythrocyte sedimentation rate (ESR) during the early phases of acute ischemic stroke has been proposed to be related with poor prognosis. This study aimed at evaluating these two parameters in patients with ischemic stroke. In an analytic study, 150 patients with confirmed ischemic stroke hospitalized at Tabriz Imam Hospital were reviewed during a 13-month period. The white blood cell (WBC) count and ESR were determined on admitting and 3 days after. Any history of diabetes mellitus (DM), hypertension (HTN), heart disease (HD), hyperlipidemia (HLP), smoking, CT findings, Level of consciousness, and the condition of patient on admission and discharge (according to Rankin's scale) was assessed. The patients categorized into three groups: expired during hospital stay, discharged in good situation (Rankin's scale of 0-2), discharged in poor situation (Rankin's scale of 3-5). One hundred fifty patients, 75 males and 75 females, with the mean age of 67.3±8.2 (48-88) years enrolled in this study. There were 32 (21.3%) expired cases, 26 (17.3%) cases discharged in good condition and 92 (61.3%) cases discharged in poor condition. Leukocytosis on day one was significantly more prevalent in patients passed away during hospitalization or discharged in not-so-well condition. High WBC and ESR levels, altered consciousness, diffused lesions in CT scan, and imperfect neurological condition on day one, as well as positive history of DM and HTN were significantly related with higher in-hospital death rate and/or poor condition at discharge. In a multivariate study, all the mentioned parameters except a positive history of DM were independent predictors of short mortality and morbidity in the patients (p<0.05). This study showed that the raised WBC count and ESR just after an ischemic stroke attack might be related with a poor prognosis and necessitate immediate and meticulous monitoring and therapies.

Shiga toxin- producing Escherichia coli (STEC) has been recognized as an important cause of diarrheal diseases. The ability to colonize the human intestine is an essential part of the infection. To determine the importance of the adherence among non-O157 STEC serotypes isolated from diarrheal and asymptomatic healthy persons, HeLa cell adherence pattern was studied. Polymerase chain reaction- restriction fragment length polymorphism (PCR-RFLP) analysis of the flagellin gene (fliC) was performed in 35 strains of STECO serogroups for determining their flagellar antigen (H) status. The entire coding sequence of fliC was amplified by PCR, the amplicon was restricted with HhaI, and the restriction fragment pattern was examined after gel electrophoresis. The adherence property of 35 Shiga toxin- producing Escherichia coli (STEC) not belonged to O157:H7 serotype was checked on HeLa cell adherence pottern. Three to five individual colonies from each case were assessed. These strains were isolated from patients with bloody, non-bloody diarrhea and healthy cases. Of the 35 STEC colonies, 2 strains (5.7%) were isolated from bloody diarrheal cases, 25 strains (71.5%) from non-bloody diarrheal and 8 strains (22.8%) from healthy persons. None of the strains belonged to O157: H7 serotype but 22 strains belonged to O126 and O128, O26 and O111 serogroups. Out of 27 strains isolated from bloody and non-bloody diarrheal cases 3 strains (11.1%) were non- adherent (NA) and 24 strains (88.9 %) were adherent. However, aggregative adherence (AA) was observed in 10 serotypes (O128: H2, O128: H9, O125: H12 and O125: H15) and diffuse adherence (DA) and localized adherence (LA) were exhibited by 1 serotype, respectively. The remaining 12 strains showed non-specific adherence (NSA). Among adherence patterns, LA and AA were found to be significantly associated with diarrhea (p<0.001). Human pathogenicity of E. coli strains belonging to STEC group varied according to serotypes, virulence attribute and adherence patterns. Based on the observation obtained in this study, it can be concluded that STEC strains with adherence property are more virulent than the non-adherence ones and further detail studies on adherence factors and their mechanisms of pathogenesis are needed.

The problem of casein digestion is seen in some cases specially, among infants. In this study, it is attempted to consider the hydrolysis of cow's milk casein by means of Ficin enzyme in green Fig extract. Cow's milk casein intolerance occurs in a considerable number of infants and without early diagnosis and food replacement can lead to complications like malnutrition and growth retardation. Hydrolysis of cow's milk casein by chemical and enzymatical reactions is one of the main strategies for production of hydrolyzed milk for allergic infants. In this study there has been an effort to use green fig proteases for cow's milk hydrolysis as a new and cheap source.

The aqueous extract was prepared from green fruit of F. carica using phosphate buffered saline. To evaluate the degree of hydrolysis, different concentrations of extract were added to casein and incubated for 1, 3 and 6 hours at various conditions including four buffering system including tris-HCl (pH 8.5) phosphate (pH 7), citrate (pH 5.5) and acetate (pH 4.5) buffers. Hydrolysis of casein was assessed by SDS-PAGE and band densitometry estimated using Scion lab soft ware.

The results indicated that fig extract could hydrolyze pure casein completely at ratio 1/100 (enzyme to substrate) for one or three hours and at 1/500 hydrolyzed casein partially at 6 hours at phosphate buffer. Therefore, phosphate buffer system is more suitable than other buffer systems for casein hydrolysis.

The results of this study showed that ficin can be used as a potential protease for the hydrolysis of milk casein which is used for nutritional targets.

rotavirus is the common cause of acute diarrhea in infants and young children. Hence it is required to investigate rotavirus infection in diarrheal samples in order to determine the prevalence and predominant genotypes for controlling the misusage of antibiotics and vaccination. To determine the prevalence and predominant genotypes of rotavirus in children under five years of age with acute diarrhea in Tabriz. rotaviruses were detected by ELISA in stool samples collected during one year (2005-2006) from children under five years old, admitted to Pediatric Center, in Tabriz. Positive samples in standard condition transferred in our laboratory (RCGLD) and RT-PCR were used for genotyping. In total of 213 samples, 113 samples were positive for group A rotavirus. Prevalence of rotavirus infection was 54%. Samples were typed as follows: G1 (21.4%), G2(3.1%), G4(42.9%), G2+G4(5.1%), G1+G4(17.3%) and G1+G2+G4(3.1%). Genotype G9+G4 was detected in one sample (1%). P [8] was found in 68.4% of samples, P [4+8] 12.2%, P [4] 12.2%, P [6] 2%. The major finding of our study was that the main cause of infectious gastroenteritis in Tabriz occurs by rotavirus. The most prevalent genotyping were G4 P[8], vaccination may be the best way to control rotavirus.

Gender identity disorder consists of the patient’s consistent desire to identify with the opposite sex and feels significant discomfort or the inability to deal with this condition. In patients resistant to treatment (Individual Psychotherapy, Psychoanalysis …) operational procedure has been utilized and has been authorized in Iran through a religious decree issued by the country’s late leader, Ayatollah Khomeini since 1964. A study into the instances of surgery procedures in the country has proven positive results. The procedure consists of cross-sectional study in small scale on 12 transsexual individuals consisting of 9 men and 3 women. All of the participants had sexual reassignment surgery at an average of six years prior to the study. They all were from middle class families and held an average age of 25. The participants were subjected to MMPI-1 questionnaire, (MF) MMPI-2, The Bem Sex-Role inventory and the Bem Gender Traits Test. The study showed that the patients have responded positively to the treatment in psycho –social dimension and had obtained a normal grade at the MMPI- 1 test. According to the results of the Bem and MF tests they have also accepted their new identity and role. Results of Semi structural interview included all of sample agreed with their decision. Neither of the patients has expressed regret of undertaking the surgery Multiple factors include economic status of the patients, satisfying interpersonal relationships, efficient support system, sexual partners and satisfactory sexual life, suitable familial reactions and possibility of extra surgery have prominent role to adjust them with their new identity and role in the society.