مجله دانشگاه علوم پزشکی قم
سال ششم شماره 4 (پیاپی 24، زمستان 1391)

Friedreich’s ataxia (FRDA) is an autosomal recessive disorder that is typically associated with dysarthria, muscle weakness, spasticity in the lower limbs, scoliosis, bladder dysfunction, absent lower limb reflexes, and loss of position and vibration sense. Approximately two-thirds of these patients suffer from cardiomyopathy and more than 30% have diabetes mellitus. Individuals with FRDA have identifiable mutations in the FXN gene. The most common type of mutation which is observed on both alleles in more than 98% of patients is an expansion of a GAA triplet-repeat in intron of FXN gene. Approximately 2% of individuals with FRDA are compound heterozygotes, who have a GAA expansion in the disease-causing range in one FXN allele and an inactivating FXN mutation in another allele. Aim of the present study was to investigate exon 1 in FRDA gene in patients with clinical symptoms of Friedreich’s Ataxia that have not GAA triplet-repeat expansion in intron 1 of FXN gene. In this study, exon 1 in 5 patients suspected of FRDA analyzed using PCR and sequencing. An A to G transition at nucleotide number 815284, in exon 1 was observed in all patients. The results of this study showed that disease-causing homozygous mutations could be because of consanguinity marriage in Iran. Therefore, sequencing of all exons of the gene is necessary.

Despite widespread use of electromagnetic field (EMF) generator devices in everyday life, their effects on biological tissues are still controversial. In the present study, the effects of EMF on the mouse liver were studied. Thirty female balb/c mice were randomly divided into three groups: 1- EMF-exposed, 2-Sham, and 3-Control. EMF group was exposed to 50 Hz & 0.5 mT EMF 4 hours daily for 2 months while the animals in sham group were placed in EMF device without exposure. At the end of 2-month period, all animals were anesthetized and their livers were removed. After preparation of microscopic slides, the panoramic view of liver, the number of Kupffer and necrotic cells were determined using ‘Image Tool’ software. The data were statistically analyzed using ANOVA and Dunnett's tests. p<0.05 was considered as statically significant. The comparison of data showed that the mean number of Kupffer cells in EMF group significantly increased compared to sham and control group (p<0.001 for both), while the mean number of Kupffer cells in sham group showed no significant difference compared to control group. The mean number of necrotic cells in experimental groups had no significant increase compared to sham and control groups. There were no significant differences in the mean number of necrotic cells between sham and control groups. Qualitative studies also showed no disorganization in the structure of liver lobules and sinusoids in the exposed group compared to sham and control groups. According to the results of this study, longtime exposure to electromagnetic field could increase Kupffer cells but do not affect the necrosis of liver cells in mice.

Anxiety of mother, as the first personality influencing child’s mental health, is of great importance. Use of anxiety-reducing techniques for pregnant mothers plays an important role in decreasing maternal and child psychological problems. This study aimed to determine the effect of relaxation and attachment behaviors training on anxiety in first-time mothers. The present study was done as a clinical trial on 126 primigravida women (42 subjects as relaxation group, 42 subjects as attachment group and 42 subjects as control group) referred to Hafiz and Shushtari hospitals in Shiraz (2010). Data were collected using personal data form and Spielberger Anxiety Inventory questionnaire. In addition to routine pregnancy care, four 90 minute sessions of attachment behaviors and relaxation training courses were held during 4 weeks (once a week). The control group only received routine pregnancy care. Anxiety score before the intervention and at the end of the intervention were analyzed in all three groups. Data analysis was done using chi-square, Anova and paired t-test analysis, p<0.05 was considered statistically significant. In this study, the mean anxiety scores were not significantly different in the three groups before the intervention, but there were significant differences among three groups after the intervention (p<0.004). There was a decrease in the mean anxiety score in the two experimental groups after the intervention, whereas there was an increase in the control group. The results of this study indicated that relaxation and attachment behaviors training could reduce anxiety in pregnant mothers.

Among different water treatment methods, photocatalytic process is applied as a new efficient technology with appropriate potential to remove inorganic, organic and microbial contaminants from water. This study aimed to evaluate photocatalytic removal of Escherichia coli and Streptococcus faecalis bacteria as microbial indicators of drinking water using immobilized ZnO nanoparticles on glass plates. In this study, at first characteristics of ZnO nanoparticles were determined using scanning electron microscope (SEM) equipped with EDX system and X-ray diffraction (XRD), then ZnO nanoparticles were immobilized on glass plates using thermal method. The water samples containing the studied bacteria were irradiated by different intensities of UV-A and the effects of intensity and duration of irradiation, number of bacteria, number of immobilized ZnO nanoparticles layers, and reactor flow on the photocatalytic removal of the bacteria were evaluated. The optimal photocatalytic removal for both Escherichia coli and Streptococcus faecalis bacteria using one layer of immobilized ZnO nanoparticles, under 360 µWs/cm2 UV-A radiation for 2-40 and 2-50 minutes was 10-1000 CFU/100 ml. Photocatalytic process efficiency was promoted by increasing the duration and intensity of radiation intensity up to 360µWs/cm2 and was decreased by increasing the numbers of bacteria. In addition, Streptococcus faecalis bacteria were more resistant to photocatalytic process than Escherichia coli. photocatalytic removal of bacterial contaminations using immobilized ZnO nanoparticles on glass plates is a novel technology and effective process that could be considered for water disinfection.

Adverse effect of children's epilepsy on family members, especially mothers, is an issue that has been less considered. One of these effects is anxiety increase in mothers. This study has been done with the purpose of determining frequency of worry and anxiety in epileptic children's mothers and recognizing the factors affecting it. This descriptive cross-sectional study has been done with the participation of epileptic children's mothers referred to Mofid Neurology Clinic of Medical Training and Therapy Center of Children. Anxiety level was determined by the State Trait Anxiety Inventory (STAI) standard questionnaire. The data was analyzed using t-test, Mann-Whitney test and one-way ANOVA and in all cases, p<0.05 considered as significant. In this study, 206 mothers were surveyed. The mean anxiety scores of mothers was 45±9.5. 84 subjects (40.7%) had mild anxiety, 71 (34.5%) had moderate anxiety and 51 (24.8%) had severe anxiety. Anxiety of mothers was significantly higher in cases such as education of child in special school (p=0.018), the high number of antiepileptic drugs (AEDs) consumed for controlling epilepsy (p=0.011), worry of death (p<0.001), permanent brain damage (p=0.036), drug side effects (p<0.01) and paralysis of child (p=0.030). Mothers who had been previously trained about epilepsy in center, had lower anxiety (p<0.001).‍ This study showed that the majority of epileptic children's mothers had moderate and severe anxiety. This phenomenon will be higher in cases like child’s education in special school, multi medication therapy and worries of side effects of epilepsy and will be lower by increasing mothers’ awareness.

Severe preeclampsia and eclampsia are responsible for 25% of maternal mortality, especially in developing countries. Considering the importance of this complication, the present study aimed to compare between effects of labetalol and hydralazine on control of hypertension and the maternal and neonatal outcomes in severe preeclamptic patients.

This clinical trial study was conducted on 190 severe preeclamptic patients classified into two groups (95 subjects in each group). Two groups were randomly received hydralazine (5 mg intravenously,, every 20 minutes, up to a maximum of five doses) or labetalol (at first 20 mg intravenously, and if not effective, 40, 80, 80, 80 mg respectively, every 20 minutes, up to a maximum of five doses). In both groups, blood pressure and heart rate were recorded 20 minutes after drug administration. Blood pressure control, as well as the maternal and neonatal outcomes, compared between two groups. Maternal and neonatal outcomes were compared using chi-square, Fisher's exact, Mann-Whitney, and t tests. All significant differences were at p<0.05.

Demographic characteristics and blood pressure control were similar in both groups, only five women in the hydralazine group and four women in labetalol group had persistent severe hypertension after maximum of five doses. Hypotension was not observed in both groups. Maternal tachycardia was similar in two groups. Others maternal and neonatal outcomes had no significant differences between two groups.

According to the results of this study, the effect of labetalol and hydralazin is similar in the control of hypertension in severe preeclamptic patients and there isn’t significant different in maternal and neonatal outcome in two groups.

Research evidences showed that adipocytokines secreted by adipose tissue play an importance role in the development of obesity-related diseases such as type 2 diabetes. The objective of this study was to determine the effects of a single bout of exercise on serum leptin levels and insulin resistance in adult males with type 2 diabetes. Fifteen adult obese men with diabetic aged 38-50 years participated in this semi-experimental study. Concentrations of glucose, triglyceride, serum leptin and insulin, as well as insulin resistance were measured before and immediately after a short single bout exercise on a fixed bicycle in studied patients. Statistical analysis was performed using t-test. Statistical significance was considered at p<0.05. In this study, exercise protocol did not cause any changes in the mentioned variables, except glucose concentration. In other word, blood glucose concentration significantly decreased after exercise test (p<0.03). The finding of this study showed that a short single bout exercise has no acute effect on leptin levels and insulin resistance in type 2 diabetic patients. It seems that serum leptin is decreased in response to long time exercise with high energy expenditure and negative energy balance.

Results of many studies suggest that prone position is effective in improving oxygenation. This study aims at comparing supine and prone positions on oxygenation of premature infants with respiratory distress syndrome who are under N-CPAP treatment. This study was conducted as a cross-sectional study on 44 premature infants of 29-34 weeks gestation who were under N-CPAP treatment in NICU of Tabriz Alzahra Hospital, 2010. The infants were randomly divided into 2 groups. The position of the first group was at first, prone and then supine, and for the second group was vice versa. arterial oxygen saturation (SatO2) and fraction of inspired oxygen (FiO2) were assessed in each position for 30 minutes and were recorded in a questionnaire. The data was analyzed by one-way ANOVA and repeated measures ANOVA. Statistical significance was considered at p<0.05. This study showed that there was a significant statistical difference between SatO2 and FiO2 in both groups in each two positions (p<0.05) and the results of variance analysis were significant (p=0.000), So that satO2 increased and FiO2 decreased when the position changed from supine to prone. This study showed that in premature infants under N-CPAP treatment, SatO2 increased and consequently, FiO2 decreased in prone position compared to supine position. Therefore, if there is no limitation for changing infants’ position, prone position can be used to improve oxygenation during N-CPAP treatment.

Sleep problems negatively impact on quality of life. In this study, sleep quality, sleep disorders, daytime sleepiness and their associated factors were evaluated in systolic heart failure patients. This cross-sectional study was conducted on 100 male patients with systolic heart failure. Simple sampling method was used for data collection. Data were collected using Epworth sleepiness scale questionnaire, sleep disorder index, and the Pittsburgh sleep quality index (PSQI). Data were analyzed by descriptive statistics, t-test, one-way ANOVA, and Pearson correlation coefficient using SPSS software, significance level was considered as p<0.05. In this study, the mean PSQI score was 13.24 ±3.14 and 100% of patients had PSQI score>6. 53% had mild daytime sleepiness. The most common sleep problems were insomnia and sleep apnea. There were statistically significant relationships between sleep quality and age (p=0.030), education (p=0.004), smoking (p=0.048) and between sleep disorders and income (p=0.012), body mass index (p=0.028), education (p=0.019), smoking (p=0.050), chronic obstructive pulmonary disease (p=0.035), consumption of angiotensin converting enzyme inhibitors (p=0.009), and angiotensin receptor blockers (p=0.016). The results of this study showed that sleep problems are common in heart failure patients. Weight loss, smoking cessation, control and treatment of chronic diseases, and control of drugs side effects could help to decrease sleep problems in heart failure patients.

Despite the use of exercise therapy in patients with respiratory disease such as asthma, some researchers have emphasized on taking supplementation as a therapeutic approach. The aim of this research was to investigate the effect of a course of aerobic exercise and consumption of vitamin D supplementation (1000 IU) on respiratory indicators of patients with asthma.

This study was designed as a quasi-experimental investigation on a total of 32 female asthmatic patients with a mean age of 20-30 years. Subjects were classified into four eight-person groups: 1- (AT+S) group which had both aerobic training and supplementation consumption; 2- Aerobic training (AT) group that only participated in exercise training; 3- Group (S) that only consumed vitamin D supplementation; 4- Control (C) Group that had neither aerobic training nor supplementation consumption. Statistical analysis was performed by ANOVA and Bonferroni post-hoc test. Significant difference considered as p<0.05.

In this study, there was a significant difference in post test (p<0.001) between groups in case of maximum voluntary ventilation (MVV), peak expiratory flow rate (PEF) and maximum expiratory flow at 75% vital capacity (FEF75%) and Maximum expiratory flow between 25% to 75% vital capacity (FEF25%-75%). These indices increased in group AT and AT+S, whereas, they showed decrease in group S and C.

Our results indicated that aerobic exercise together with consumption of vitamin D supplementation for 8 weeks could improve the pulmonary function and level of aerobic performance of asthmatic patients and could be considered as a part of pulmonary rehabilitation programs for asthmatic patients.

Backgrounds and diabetes is the most common metabolic disorder and is a major public health problem in the world. Patient participation in treatment of disease is one of the most effective factors in the control of disease. The present study aimed to determine Self Care Behaviors of Diabetic Patients. In this descriptive cross-sectional study, 250 patients who referred to the diabetes association of Qom in the age range of 17-75 years after at least one year from their diabetes diagnosis were selected using a simple sampling method. Data was collected by means of SDSCA (summary of diabetes self care activities) questionnaire as in-person interview. The questionnaire consists of two parts of demographic characteristics and self care behaviors questions. Data analysis performed using t-test and Pearson correlation test, p<0.05 was considered as statistically significant. Among studied patients, 96.4% had type 2 diabetes. The mean score of self-care behavior in patients with diabetes was 46.53±10.61. There was a significant relationship between fasting blood glucose and self care (p=0.008), physical activity and fasting blood glucose (p=0.001) level of education and self care (p=0.02). Considering the result of this study, diabetes is one of the most important and complicated diseases that annually imposes heavy costs on patients. Therefore, necessary planning should be performed to continue education about self-care behavior of diabetes, its complications and ways of coping.

Despite science and technology development and their application in various industries, accidents continue to occur in many workplaces. This study was designed and carried out with the aim of epidemiological survey of accident among workers of a tunneling industry.

This study was conducted on 144 out of a total of 440 employees of a tunneling project who were at risk of occupational accidents. 48 workers with a history of occupational accident over the past two years were selected as case group and 96 workers of the same project were selected as control group. The data were collected through a designed checklist and analyzed using logistic regression, chi-square and independent t tests.

A significant association was observed between accident rate and different age groups (p<0.05). There was a significant relationship (p=0.016) in the case of sport activities between case and control groups, and significant relationships were observed between two groups regarding education (p=0.057) and smoking (p=0.06), but there was no significant relationships between accident occurrence with marital status, residence in workplace, job related education, job experience, chronic diseases and obesity.

The results of this study clarify the necessity of the use of epidemiological data in preventive and control measures in workplaces. Therefore, Developing programs for determination of physical and mental capacity of workers are essential to employ them in jobs commensurate with their abilities, especially in older workers.

Microbial fuel cell (MFC) used for electricity generation and wastewater treatment, simultaneously. In MFC, microorganisms act as a catalyst to convert chemical energy stored in organic materials into electrical energy. This study was performed with the aim of electricity generation from synthetic wastewater treatment in microbial fuel cell.

A dual chambered microbial fuel cell was operated in continuous flow for 720 hours at temperature 20±4ºC at different organic loading rates and hydraulic retention times.

Organic loading rate and hydraulic retention time were effective factors for the power production and removal of organic loading rate. Maximum COD removal efficiency was observed as 49% for a period of 1.5 to 2.5 hours that this range of time can be used as optimum retention time for operation of microbial fuel cell reactor. Maximum voltage and power production were obtained 700 mV and 1700 mW/m2, respectively.

Considering the advantages such as direct electricity generation from wastewater and considerable removal efficiency of organic loading rate, wastewater treatment in a microbial fuel cell, application of industrial scale microbial fuel cell for wastewater treatment is recommended after complementary studies and economic assessment.

Antibiotic resistance is a major threat for human health that affects hospitalized patients worldwide; Hence, The World Health Organization (WHO) has chosen antibacterial resistance as its theme in 2011. Klebsiella pneumoniae is a gram-negative opportunistic pathogen and a common cause of nosocomial infections. These bacteria -especially in infants- are the cause of pneumonia, sepsis, meningitis, diarrhea and bacteremia. Increasing emergence of multidrug resistance (MDR) among Klebsiella pneumoniae nosocomial isolates has limited the appropriate therapeutic options for the treatment of infections caused by this pathogen. Beta-Lactamases are major defenses of gram-negative bacteria against antibiotics. Recently, the emergence of new β-lactamases such as NDM-1 (New Delhi metallo-β-lactamase-1), OXA-48 (Oxacillinase-48), OXA-181 (oxacillinase-181), KPC (Klebsiella pneumoniae carbapenemase), CTX-M-15 (Cefotaxime-M-15) confer resistance to the most antibiotics such as penicillins, carbapenems, cephalosporins, macrolides, aminoglycosides and sulfamethoxazole. Resistant genes are located on plasmids with different sizes and can be readily transferred between bacteria, from one human to another human, and even from one country to another. In 2011, it has been evaluated that the importance of some of these genes like NDM-1, KPCs is as AIDS, malaria and tuberculosis. These enzymes have emerged as an important threat for hospitalized patients. Some pathogens containing both KPC and NDM-1 may be mistakenly diagnosed as susceptible by conventional laboratory methods and hence they could have an important role in the emergence and spread of more resistant pathogens due to administration of ineffective drugs to patients. No vaccines have been found yet that prevent infections caused by carbapenemase-producing bacteria. Also, there is not enough information about frequency of these plasmid genes and their genetic profiles in Iran. Therefore, it is important to diagnose the Klebsiella pneumoniae strains producing resistant enzymes, especially NDM-1, for better treatment of patients and prevention of the spread of these genes to other bacteria via exact phenotypic and genotypic methods.

HELLP syndrome was described in 1982 by Weinstein as a triad of hemolysis, elevated liver enzymes and thrombocytopenia. This syndrome develops antepartum in 70% and postpartum in 30% of cases. HELLP syndrome occurs in 0.5 to 0.9% of all pregnancies and is accompanied by disseminated intravascular coagulation (DIC) in 38% of patients. Maternal mortality rate is reported to be 1.1%. Although thrombotic thrombocytopenic purpura (TTP) is rare, it is one of the most important differential diagnoses for HELLP syndrome, which may be lethal without appropriate treatment. Plasmapheresis is one of the recommended treatments in complicated and/or resistant to treatment cases. Case Report: In this article we introduce a 22 years old primiparous woman with a term pregnancy that developed HELLP syndrome and DIC after delivery. Due to the lack of improvement, an accompany of TTP was diagnosed. So, she underwent plasmapheresis treatment and was discharged with full recovery after 22 sessions of treatments.