مجله علوم پزشکی رازی
سال بیست و ششم شماره 2 (پیاپی 179، اردیبهشت 1398)

Ventilator associated pneumonia(VAP) is one of the serious complications of ventilator support, occurring in ICUs. The aim of this study was to determine the susceptibility pattern of Acinetobacter baumannii isolated from patients with VAP by two disk diffusion and E.Test. This descriptive-cross sectional study was conducted in the four ICUs of Rasoul-e-Akram hospital in Tehran, from Mehr 1395 to Aban 1396. A total of 58 endobronchial aspirates from intubated patients who had been clinically diagnosed to have VAP by Acinetobacter baumannii Were studied. The in vitro susceptibility was determined by disk-diffusion and broth microdilution MIC methods. The results used in chi 2 assay to express a meaningful relationship, p<0.05 was considered statistically significant. With the E.test method high percentage of isolates were resistant to levofloxacin (100%), carbapenems(meropenem: 93.10%, imipenem 70.69%), piperacillin-tazobactam(50%) and aminoglycosides(gentamicin41.38%), the most sensitive antibiotic was colistin. The antimicrobial resistance of Acinetobacter baumannii In ICUs is increasing, and the findings of the study have shown that colistin is the only drug with relative efficacy.

Insulin is essential for type 1 and advanced type 2 of diabetes to maintain blood glucose levels and increase the patient’s longevity. Frequent subcutaneous insulin injections are usually associated with pain, local tissue necrosis, infection and nerve damage. Recently, a number of new delivery methods such as oral insulin delivery have been developed to overcome these limitations and increase patient’s satisfaction. Oral delivery of insulin and other therapeutic peptides/ proteins are associated with poor intestinal absorption and enzymatic degradation in the gastrointestinal tract. However, cell penetrating (CPPs) and transytosing peptides have exhibited promising potential as carriers that conjugated to insulin and capable to across the intestinal epithelium. Numerous studies have shown that after conjugation of insulin with CPPs and transytosis peptides these biomolecules can retain their biological activity and also are stable and resistant to proteolytic degradation. In this review, following the introduction of different types of CPPs and also transytosis peptides, we have focused on the studies that they use these peptides as a powerful technology for oral insulin delivery. Based on the results of these studies, oral insulin will not only be a good candidate for painful injections in diabetic patients, but also mimics the physiology of endogenous insulin secreted by pancreas.

Vitamin D deficiency is a common disorder in elderly, previously suggested to be associated with cognitive impairment. This study was aimed to determine the association between 25(OH) vitamin D and cognitive impairment in the elderly. In this case-control study, 35 individuals who met criteria of cognitive impairment were examined against 35 individuals who did not have cognitive impairment. Serum 25(OH) vitamin D levels were measured in both fasting groups by ELISA kits. Data were collected using a checklist containing demographic data and serum vitamin D levels in two groups and analyzed using SPSS 16 software. The mean age of the control group was 67.91±4.78 years and of the case group was 68.91±3.63 years (p=0.328). The mean serum level of 25(OH) vitamin D in the control and case groups was 37.28 ng/ml and 23.06 ng/ml, respectively. The observed difference was statistically significant (p=0.003). 20 (57.1%) of control group and 10 (28.6%) of case group had sufficientlevels of vitamin D (p=0.01). The odds ratio of cognitive impairment in the case group was 3.3 times higher than control group, which was also statistically significant (p=0.001). Elderly people with cognitive impairment have lower levels of vitamin D than healthy ones with same age, which may be related to their cognitive impairment. However, confirmation of the results of this study requires further studies with a larger sample sizes.

 Regarding the physiological and immunological changes of the human body following the acute exhaustive activity and the evidence in traditional medicine of the effects of barberry on the strengthening of the immune system, and since saffron is a valuable and rich carotenoids spice and has been used in traditional medicine for a variety of uses, the aim of this study was Evaluation of the Effect short-term Barberry Juice Supplementation On the response of immunoglobulin A, G, M and cortisol in active girls following exhaustive exercise activity. In this clinical trial study, 20 healthy young girls (23.92 ± 1.28 years, weight 55.69 ± 5.71 kg) were randomly divided into two experimental group (Consumption of 250 ml Barberry Juice and exhausting activity) and control group (Consumption of 250 ml placebo and exhausting activity). After the two-week supplementation, both groups performed exercise activity until they were of exhaustion on the treadmill. In this research, the nutritional value of Barberry Juice was extracted and the subjects' nutrition was analyzed. Blood samples were measured to measure the humoral immune variables in similar conditions in three stages of pre-test, after two weeks of supplementation and after the exhaustive test and using Independent T-test, ANOVA with repeated measure and Bonferron's post hoc test were analyzed at p≤0.05. The results showed that in the experimental group, the levels of immunoglobulin A (p=0.026), G (p=0.013) and M (p=0.017) after acute exhaustive activity were significantly higher than the control group, whereas in the experimental group cortisol values (p = 0.018) were significantly lower than the control group. It seems that, Consumption of Barberry Juice for two weeks with increased immune function, Reduces the effects of acute exhausting activity on the immune system in active girls.

Operating room technologists are constantly exposed to sleep disturbances due to their occupationally sensitive nature and these disorders lead to physical and psychological complications. Job stress is one of the important factors of physical and mental complications, as well as reduction of efficiency in operating room technologists. In this descriptive-analytical study, the sample size was 134, which was calculated using the sample size formula and included the operating room technologists working in educational hospitals of Iran University of Medical Sciences who were available and the questionnaires were given to them. The questionnaires included the following items: 1) Demographic information such as age, sex, work record, marital status and educational level, 2) Pittsburgh Sleep Quality Index (PSQI) 3) Kahen et al. job stress questionnaire. The quality of sleep and job stress did not have a significant relationship with any of the demographic variables. there is no significant difference in mean of sleep quality and occupational stress among single and married people. Nursing managers are aware of the results of this study by properly communicating with the operating room technologists and supporting them and creating the right environment for the continuing professional activity of technologists to reduce occupational stress, as well as for operating room technology technologists, classes and workshops to increase Sleep patterns and stress management are organized periodically.

Vitamin D plays critical role in the development and bone stability, cell proliferation and differentiation. The aim of this study was to determine the serum levels of vitamin D and its affecting factors in infants aged 2 to 6 years in Kermanshah. This cross-sectional descriptive study was performed in 32 health centers of Kermanshah on 389 children from 2 to 6 age, between 2014-2015. The questionnaires were distributed by verbal and written consent from parents of children and characteristics of them and type of their nutrition were recorded. The height and weight of infants were measured and recorded using the Sika scales with minimal coverage. The serum vitamin D levels were analyzed by ELISA method and the data were analyzed using SPSS v. 20 software. In this study, from 389 children 180 (46.3%) were female and 209 (53.17%) male. The results showed, 8.7% of infants had severe deficiency and 49.1% and 42.2% had insufficient and normal levels of vitamin D respectively. The highest mean serum vitamin D level was reported in summer, and there was a significant relationship between serum vitamin D levels with age, height, weight, and exposure to sunlight (p<0.05). In this study, due to the high deficiency of vitamin D and its importance in children's growth and health, parents should be notifyed about the importance of this vitamin and also the necessity of enrichment of food in the health program.

Malaria is one of the most important tropical diseases that is prevalent in some of regions of Iran and the world. The malaria agent is resistant to different chemical drugs which have several side effects. So, the use of various medicinal plants, especially different species of Artemisia herb which have artemisinin as its active ingredient, is significantly important. Therefore, the aim of this study was to evaluate the effect of alcoholic extract of Artemisia fragrance herb as compared with chloroquine in laboratory albino mice exposed to Plasmodium berghei (P.berghei). In this experimental study, twenty-five mice were divided into five groups (n=25 mice/group) placed in separate cages: four groups were infected with P.berghei. Two groups were treated with different concentrations (25 and 75 mg/kg) of alcoholic extract of Artemisia fragrance and one group was treated with chloroquine current drug. The fourth group was a placebo group without receiving any drugs. The data were analysed using SPSS software and paired and student T-test. In groups treated with 25 and 75 mg of the extract, parasitemia decreased significantly on days 5 and 8 compared to placebo groups (p<0.001). Mean while, the parasitemia rate decreased in the 75 mg group than in the group receiving 25 mg on day 5 (p<0.005). The life span of the mice in the group treated with chloroquine and 75 mg of the extract had a statistically significant difference with other groups (p<0.05). This study showed that alcoholic extract of Artemisia fragrance in 75 mg/kg mice weight concentration has a significant effect on P.berghei parasite.

 Unit of p65 is one of the subunit of NF-κB and its phosphorylation by stress oxidative causes activation of NF-κB. The aim of present study was to investigate the effects of adenosine injection after of brain ischemia reperfusion injury on gene expression of NF-κB /p65 and ROS in male Wistar rats. 40 male wistar rats were randomly divided into four groups, healthy control (n=10), ischemia reperfusion (n=10), ischemia reperfusion + adenosine dose of 0.1 mg/kg (n=10) and ischemia reperfusion + adenosine dose of 0.4 mg/kg  (n=10). The animals were subjected to ischemia by the ligation of common carotid arteries for 45 min. Intraperitoneal injection of adenosine was done after 24 h ischemia in rats. The gene expression of NF-κB /P65 and ROS activity were examined by Real time-PCR and Spectroflourimeter, respectively. One-way ANOVA and Bonferroni post hoc test were used to analysis the data. The significant level was set at p<0.05.   The results showed that ischemia induced significant increase in gene expression of NF-κB /p65 and ROS activity compared to control group (p<0.05). Also, both dose of adenosine resulted in significant decrease in gene expression of NF-κB /p65 and ROS activity compared to ischemia group(p<0.05). Brain ischemia reperfusion causes the stress oxidative. It appears that injection of adenosine is effective in reduction of stress oxidative and inflammation due to brain ischemia reperfusion.

 The transition from communicable to non-communicable diseases has occurred over many years in all countries of the world, even in developing countries. Diabetes and its ischemic heart complication are among the most important second groupe diseases. In recent years, discussions about the role of obesity and weight gain have risen again as a risk factor for both diseases. Our objective of this study was to determine the relationship between body mass index and prevalence of ischemic heart disease in type 2 diabetic patients in Iran. This study was conducted in 1397 in 666 patients with type II diabetic patients registered in the Family physician system in Malard county. Data were gathered through medical records and then was analyzed by SPSS software using Chi-square method.

Of these, 177 were male and 489 were female. The findings showed that 73 type 2 diabetic patients (10.96%) had ischemic heart disease (51 women and 22 men). In terms of body mass index, 2.7% were in the under-weight group, 21.9% in the normal weight group, 37% in the overweight group, 27.4% in the grade1 obesity group, 8.2% in the grade 2 obesity group, and 2.7% were in the grade 3 obesity group.

According to our findings, although the prevalence of type 2 diabetes in overweight and grade1 obesity people is higher than normal or underweight individuals, but prevalence of ischemic heart complication in type2 diabetic patients is not consistent with this trend, and not only ischemic heart disease is not low in normal weight subjects, but also is slightly lower from grade 1 obesity and is higher than grade 2 and 3 obesities. Also, the distribution of ischemic heart disease in type 2 diabetic women and men is different among groups with different BMIs and prevalence of ischemic heart disease in females more than males in normal weight group.

This study was done to evaluate the spinal alignment to verify the prevalence of spinal malailgments such as FHP⃰, thoracic hyper kyphosis, lumbar hyper lordosis and scoliosis in 7-9 year-old students in south of Tehran 2017. In this cross-sectional study, 2114 healthy students with mean age of 7.99±0.81 years old, including 1059 girls and 1055 boys were screened. A sociodemographic questionnaire used to gathering personal information and visual spinal assessment from side of body to determine any derailment toward plumb line and FBT⃰ for detecting scoliosis. Data analysis was done using descriptive and regression methods on SPSS software version 21. The prevalence of FHP was 68.4%, hyper lordosis 69.1%, hyper kyphosis 68.6% and scoliosis 15.7%. There was significant association among FHP with gender and age, also between hyper kyphosis with BMI⃰, among hyper lordosis with gender and BMI and finally among scoliosis with age and BMI. Hyper kyphosis, hyper lordosis and Scoliosis were more frequent in girls but FHP in boys. Another interesting result was susceptibility among underweight children with hyper kyphosis, hyper lordosis and scoliosis. There wasn’t any significant association among FHP, hyper kyphosis, hyper lordosis and scoliosis with habit of school bag carriage. According to the high prevalence of spinal malailgments at this age, it seems necessary to implement screening programs in schools to find problems exactly, then made perfect plan and finally perform the planning to decrease progressions of malaignments at the right time.

BMI⃰= Body Mass Index
FBT⃰= Forward Bending Test
FHP⃰= Forward Head Posture