مجله دانشگاه علوم پزشکی شهرکرد
سال بیست و یکم شماره 2 (پیاپی 101، Mar-Apr 2019)

Staphylococcus aureus is considered as a frequent cause of infections. Therefore, antibacterial agents including β-lactam are normally used to treat these infections while the emergence of antibiotic resistance is one of the major clinical problems in this respect. Accordingly, combination antibacterial therapy is one way to alleviate this problem. As a result, the present study aimed to investigate the combined effects of vancomycin and methicillin on clinical isolates of methicillin-resistant S. aureus (MRSA) and methicillinsensitive S. aureus (MSSA). In addition, a series of follow-up studies were performed to evaluate the antibacterial activity. The current cross-sectional study was conducted on 40 hospitalized patients from various clinical samples such as pus/wound swabs, blood, urine and sputum during a 6-month period in 2017. To this end, the antibacterial activities of vancomycin and methicillin, alone and in combination were investigated against MRSA and MSSA. Eventually, the inhibitory effects of vancomycin and methicillin alone and in combination were studied on the growth profile of MRSA and MSSA, as well as the expression of mecA gene. Based on the results, the significant synergistic and partial synergistic activity with fractional inhibitory concentration (FIC) and fractional bactericidal concentration (FBC) indexes ranged from 0.27-0.938 and 0.313-0.844, respectively, in the combination of vancomycin and methicillin in MRSA and MSSA isolates. Further, the obtained data indicated that the combination of vancomycin and methicillin had a synergistic effect against MRSA isolates (P<0.01). The expression levels of the mecA gene were down-regulated by 5.25- fold in the combination of vancomycin and methicillin in MRSA isolate (P<0.001). In general, these events may reflect the potential uses of vancomycin and methicillin combination against MRSA. However, a greater understanding of the underlying molecular mechanisms of vancomycin and methicillin in combination could contribute to the development of therapeutic strategies.

Ischemic stroke is considered as the second leading cause of death in the world and yet one of the causes of disability in adults. The present study aimed to evaluate the effects of iron oxide nanoparticles and the magnetic field on neural stem cells proliferation after ischemia/reperfusion in the rat model. This experimental study was conducted on a total of 50 male Wistar rats aged 6-7 weeks and weight of 220-250 g weight, which were divided into sham (i.e., ischemia-reperfusion model), control, iron oxide nanoparticles treated-, magnetic field exposed-, and simultaneously iron oxide nanoparticles and magnetic field exposed- groups. The brain ischemia/reperfusion was performed for 20 minutes by blocking the animal carotid arteries. In addition, neural stem cell proliferation was evaluated in the hippocampus of the 5 groups after 4 days by bromodeoxyuridine (BrdU) staining method. Then, the expression of Ki67 gene involved in the cell proliferation was quantitatively studied among the 5 groups by the quantitative real-time polymerase chain reaction (qRT-PCR). The results of BrdU staining revealed that iron oxide nanoparticles and the magnetic field separately increased cell proliferation after ischemia/reperfusion after 4 days in the hippocampus. However, simultaneous treatment with nanoparticles and magnetic field failed to show a significant difference compared to the sham group for 4 days. Conversely, the expression of Ki67 gene increased significantly in the group treated with iron oxide nanoparticles or the group exposed to magnetic field compared to the ischemia-reperfusion model. In general, iron oxide nanoparticles and magnetic field can separately be regarded as 2 effective methods for increasing the neural stem cell proliferation after ischemia/reperfusion.

Temporal lobe and tonic-clonic seizures are the most common types of epilepsy. It is a disease that disrupts the regulation of the hypothalamic pituitary adrenal (HPA) axis. The disturbance in the regulation of this axis affects the secretion of hormones from the anterior pituitary. Due to the different origins of these 2 types of epilepsy listed above, this study aimed to examine their differences in the level of anterior pituitary hormones. This cross-sectional study was conducted in Al-Zahra hospital of Isfahan, Iran, from 2014 to 2016. A total of 36 patients with the idiopathic first seizure were selected for the examination including 20 patients with tonic-clonic seizure and 16 patients with temporal lobe seizure. The diagnosis of epilepsy was confirmed by a neurologist along with electroencephalogram (EEG) findings. The levels of anterior pituitary hormones including thyroid-stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH), GH (growth hormone), follicle-stimulating hormone (FSH), luteinizing hormone (LH) and PRL (prolactin) were measured and compared using ELISA method in both groups. The results indicated that all the anterior pituitary hormones except TSH and ACTH had higher means in the temporal lobe epilepsy than in the tonic-clonic epilepsy, but a significant difference (mean ± SD) was reported only in GH (4.59±2.95) (2.55±1.87) (P<0.005) and FSH (19.4±14.06) (4.34±2.37) (P<0.033) respectively in the temporal lobe and tonic-clonic seizures. Meanwhile, there was a significant relationship between seizure, regardless of its type, and the level of growth hormone and FSH. In the future, hormonal changes may be used as an adjunct to diagnose the type of epilepsy. More studies are required to confirm the findings.

Breast cancer is one of the main causes of death in women, the early diagnosis of which is made by physical examination, mammography, ultrasound, and biopsy of breast masses. The aim of this study was to assess the diagnostic accuracy of fine needle aspiration (FNA) compared to core needle biopsy (CNB) in breast masses. The current descriptive study was conducted in Kashani and Hajar hospitals in 2015. And a total of 200 patients diagnosed with breast masses participated in this study. First, patients referred to the clinic, received local anesthesia in the area, and then underwent FNA using 10 cc syringes and 23G needles, and simultaneously CNB specimens were taken by a special needle for diagnosis. FNA and CNB specimens were transferred to the Pathology Department with a few day interval for cytological interpretation. The sensitivity and specificity of FNA compared to CNB in the diagnosis of malignant breast masses were 83.9% and 89.9%, respectively. Moreover, the positive and negative predictive values of FNA for breast masses were 78.8% and 92.5%, respectively. The accuracy of FNA test for breast masses was also 0.88%. According to the results of this study, FNA test had a high sensitivity, specificity, and predictive value in the diagnosis of breast masses. Therefore, it could be used as an appropriate diagnostic tool, and could obviously save many costs as well.

Klebsiella is an opportunistic organism that is the cause of severe diseases such as pneumonia, septicemia, and urinary tract infections (UTIs). In addition, high antibiotic resistance has challenged the treatment of this bacterium. However, carbapenem antibiotics are considered as the therapeutic agents for selecting the treatment of penicillin- and cephalosporin-resistant gram-negative bacterial infections. The present study aimed to determine the resistance and minimum inhibitory concentration (MIC) of meropenem and imipenem. A total of 80 Klebsiella spp isolated from UTIs were collected in various educational wards (i.e., urology, obstetrics, and gynecology, as well as the units of infectious diseases, internal medicine, and intensive care) in different hospitals of Shahrekord. The isolates were then identified by using biochemical tests. Further, disc diffusion method was employed to determine the antibiotic resistance. Furthermore, MIC was estimated by the Epsilon-test strip. Moreover, P=Q=0.50, an error of 0.05, and an accuracy of 0.11 were considered for determining the sample size (n=80). Based on the results of disc diffusion method, 24 strains were resistant to meropenem and imipenem. Additionally, the MIC was 24 (30%) by the E-test. In addition, 24 isolates had a MIC of ≥4 μg/mL for meropenem and imipenem and thus were resistant while 18 isolates were found to have a MIC of 1≤ MIC<4 μg/mL and therefore, were considered semi-sensitive (P<0.001). In general, Klebsiella strains were found to be resistant to meropenem and imipenem. Therefore, rapid and accurate identification of these strains and the selection of appropriate antibiotics can help quickly eradicate the infections caused by these bacteria. Accordingly, a waste of time, the consumption of medication, or even an increased resistance are prevented.

One of the important issues that bereaved students are faced with is the symptoms that they experience after the death of their loved one. Consequently, this can reduce their performance in various aspects of life, including education. The present study aimed to investigate the effectiveness of group trauma management therapy (GTMT) in reducing the traumatic bereavement symptoms of bereaved female students. This study was an experimental research with pretest-posttest control group design. The statistical population of the present study included all the bereaved senior high school female students of Iranshahr in the school year of 2016-2017. Forty subjects were selected among the whole population using the simple random sampling method. After conducting a clinical interview, to confirm the symptoms of bereavement, the selected individuals were randomly assigned to two experimental group (n=20) and control group (n=20). The Hogan Grief Reaction Checklist (HGRC) was used to collect the data. To analyze the obtained data, the descriptive statistics and multivariate analysis of covariance (MANCOVA) tests were applied using SPSS software. The results indicated the effectiveness of trauma management therapy (TMT) in decreasing despair (P<0.001), panic (P<0.001), anger and blame (P<0.001), detachment (P<0.001), disorganization (P<0.001), and personal growth (P<0.001). Considering the effect of GTMT on the reduction of traumatic bereavement symptoms among bereaved students, this method can be used as an effective treatment for relieving and reducing the traumatic bereavement symptoms.

The present study aimed to determine the effect of acceptance and commitment therapy on perceived stress, resilience, and the quality of life in thalassemia major patients in Lordegan during 2015-2016. This semi-experimental study used the pre-test and post-test designs with a control group and period. The samples included 40 patients with thalassemia major who referred to Lordegan Shohada hospital, were selected by the purposeful sampling technique based on the inclusion and exclusion criteria, and were randomly assigned to experimental and control groups. The experimental group received eight-week sessions of the acceptance and commitment-based therapy, while the control group received no intervention until the end of the study. The data were collected by the perceived stress questionnaire (Cohen et al), Researcher Conner and Davison Resilience Scale, and the World Health Organization Quality of Life (SF-26). Finally, the obtained data were analyzed using the SPSS software, repeated measure, and covariance tests The results showed that there was a significant difference between the experimental and control groups in terms of the perceived stress, resilience, and the quality of life (P<0.001). In addition, based on the results, 66% of the changes in the perceived stress scores, 81% of the difference in the resiliency scores, and 75% of the difference in the quality of life scores were related to the impact of therapy based on the acceptance and group commitment. Further, the results of the analysis variance of the internal group revealed that the effect of therapy based on the acceptance and commitment on the perceived stress, resilience, and the quality of life had a significant difference in pretest, posttest, and follow-up stages. In general, the therapy based on the acceptance and commitment is found to be a useful practice in reducing the perceived stress while increasing the resilience and improving the quality of life in patients with thalassemia major.

Mucorales are fungi belonging to the category of Zygomycetes, found much in nature. Culture-based methods for clinical samples are often negative, difficult and time-consuming and mainly identify isolates to the genus level, and sometimes only as Mucorales. Therefore, applying fast and accurate diagnosis methods such as molecular approaches seems necessary. This study aims at isolating Mucorales for determination of Rhizopus genus between the isolates using molecular methods. In this descriptive observational study, a total of 500 samples were collected from air and different surfaces and inoculated on Sabouraud Dextrose Agar supplemented with chloramphenicol. Then, the fungi belonging to Mucorales were identified and their pure culture was provided. DNA extraction was done using extraction kit and the chloroform method. After amplification, the samples belonging to Mucorales were identified by observing 830 bp bands. For enzymatic digestion, enzyme BmgB1 was applied for identification of Rhizopus species by formation of 593 and 235 bp segments. One hundred pure colonies belonging to Mucorales were identified using molecular methods and after enzymatic digestion, 21 isolates were determined as Rhizopus species. The sequencing of PCR products and macroscopic and microscopic studies confirmed the existence of R. stolonifera, R. oryzae and R. caespitosus in the samples. Generally, developing a reliable method for determining Zygomycete species can be a useful tool for better understanding of the epidemiology of mucoromycosis.