نشریه پژوهش در پزشکی
سال سی و ششم شماره 2 (پیاپی 142، تابستان 1391)

Bone tissue is a type of dense connective tissue with rich networks of blood vessels and nerves. Bone is constantly being torn down and replaced in a remodeling process. Nutrition also plays an important role in bone health and strong bones need an appropriate diet. The aim of this study was to evaluate the effects of selective nutrients such as calcium, (Ca) vitamin D, Boron, (B) and fluoride, (F) on mechanical strength of bone tissue in rat. Thirty-one adult Albino Wistar rats were divided into five groups as below: group 1 (control), group 2 (F), group 3 (F+B), group 4 (F+Ca+D), group 5 (F+B+Ca+D). The animals were given free access to food for 8 weeks: experimental groups received a daily dose of 1mg boron, 55 IU vitamin D, 210 mg calcium and/or 0.7 mg fluoride according to their grouping category. Mechanical strength of femoral neck bending test and mechanical strength of the fifth lumbar vertebra with a axial compression test was evaluated in different groups. The data of all groups were analyzed by nonparametric tests. Our results showed significant differences in the mean stiffness of neck of femur in group F+B in comparison to the control group, group F and group F+B+Ca+D. Mean value of Fmax in group F+B and group F+B+Ca+D compared to control group was significantly increased. Mean deformation to Fmax of fifth lumbar vertebrae in all groups particularly in group F+B+Ca+D significantly increased when compared to control group. Significant difference was detected in this parameter between group F, group F+B and group F+Ca+D. Fluoride and boron have more positive effects on bone strength and stiffness than calcium and vitamin D.

Clostridium difficile infection (CDI) has been a major growing problem in hospitals in recent years. Detection of the source of Clostridium difficile strains is of importance for the control of the nosocomial spread of this microorganism. This study was done to identify C.difficile isolates by polymerase chain reaction, (PCR), ribotyping. The descriptive study was done during a period of 12 month. Seventeen C.difficile isolates were collected from patients hospitalized with suspected CDI in different wards of a general hospital. All samples were treated with alcohol and yeast extract broth. The treated samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA) supplemented with 5% sheep blood and incubated in anaerobic conditions, at 37 °C for 5 days. Prevalence and confidence intervals were calculated. Cdd-3, tcdA and tcdB genes were identified using PCR assay. PCR ribotyping was performed on C.difficile isolates. Out of 108 isolates 17(15.7%) were C.difficile. The prevalence of A+B+, A+ B- and A- B+ strains were 12(70.59%), 1(5.9%) and 4(23.9%) respectively. PCR ribotyping of 17 isolates showed different ribotype patterns The pattern of PCR ribotypes of isolates showed that the strains circulating in different wards of the hospital were different and may have been be endogenous or community acquired.

This study was done to define the role of Graded Prognostic Assessment (GPA) score for predicting overall survival in patients diagnosed with brain metastases undergoing Gamma-knife radiosurgery.

Patients diagnosed with brain metastases who were candidates for Gamma-knife radiosurgery entered this cross sectional study between 2003 and 2011. Clinical and radiological parameters were evaluated, and the GPA score were determined. Kaplan–Meier, log-rank, was used to assess prognostic value of the GPA score.

Two hundred and twenty patients were eligible to enter the study during the course of the study. Patients were aged 54 ± 12.7 years (19 to 82 years) and were followed for an average of 7 (range 1-25) months after treatment with Gamma-knife. Median survival times according to GPA were: GPA 0–1=4±0.4 months; GPA 1.5–2.5=6±0.7 months; GPA 3= 9±0.9 months; and GPA 3.5–4.0= 12±1.8 months; Mean overall survival was 7±0.6 months. The level of statistical significance between GPA groups was p < 0.0001.

It seems that the preoperative GPA is able to predict Gamma-knife radiosurgery results in patients with brain metastases. The results will need to be confirmed with further Clinical trials.

Quantitative Electroencephalography (QEEG) is an effective modality in the study of brain functions in various conditions such as sleep, unconsciousness, seizures and hypnosis. The purpose of the study was to compare sensitivity and specificity of this new analytical procedure (QEEG) in the diagnosis of stroke. QEEG was performed on 17 healthy persons and 12 patients and two scaled exponents were extracted from EEG; EEGs of stroke patients were recorded in closed eyes state and then analyzed; this was compared with recordings obtained from healthy persons by multifractoral detrended fluctuation analysis method with the order (q=2.37) in Matlab software. Two factors ‎() were revealed for separating patients from healthy persons. The positive predictive value and negative predictive value of the scaling exponents obtained from the EEGs was calculated. Analysis of information derived from electroencephalogram of 29 persons, showed that the negative and positive predictive values were 100%. This approach provides rapid diagnostic of stroke based on EEG without need for complex and time consuming calculations such as Fourier transform and special software. Thus, this method can be used for diagnosis of stroke on the base of EEG information and can help in medical centers when a specialist is not available.

One of the main problems in patients undergoing spinal anesthesia for surgical operations especially cesarean section is the post spinal headache. This study was done to assess the effects of early ambulation in such patients on the prevalence of headache. In a randomized clinical trial, after taking informed written consent, 80 patients undergoing cesarean section under spinal anesthesia were divided in to 2 groups (40 in each group). Patients in the 1st group were ambulated 9 hours after surgery and patients in the 2nd group were ambulated after18 hours. The two groups were compared regarding prevalence and severity of headache, and the type of analgesic methods used for them. SPSS version 11 was used for data entry and analysis. No difference was found between groups regarding prevalence and severity of headache, (p=0.1). Also, there was no difference between the 2 groups regarding the use of analgesia, (p=0.3). Early ambulation, though possibly beneficial for the pregnant mothers, is not effective regarding headache alleviation after spinal anesthesia for cesarean section.

Thrombocytopenia is common in ICU patients. The objective of this study was to evaluate possible links between platelet counts and survival in ICU patients. All patients who were admitted to the Imam Hossein Medical Center ICU for at least 2 days and were 18 years or older with absence of thrombocytopenia at the time of admission were included in this retrospective study. A multivariate logistic regression model was used to examine thrombocytopenia and ICU mortality as the outcome variable. From 565 patients admitted in that ICU during the study period, 394 matched the inclusion criteria. The incidence of thrombocytopenia was 57.5% and mortality was 61.4%. Mortality rate was 28.5 % in thrombocytic patients vs. 9.2% in non-thrombocytic patients (p‹0.001). Patients with ICU acquired thrombocytopenia had statistically significant lower baseline, minimum and 4th day platelet counts. Female sex, longer ICU stay, admission platelet counts, and albumin levels were significantly associated with occurrence of thrombocytopenia. Higher platelet counts on admission were associated with significantly reduced risk of thrombocytopenia (P=0.00). On multivariate regression analysis age, ICU acquired thrombocytopenia, higher INR, higher mean APACHE II score, renal replacement therapy, and mechanical ventilation were significantly associated with mortality. The incidence of thrombocytopenia and subsequent mortality in ICUs is considerably high and is a real medical concern. In patients, who spend ≥ 2 days in the ICU and have normal platelet counts at ICU admission, a decline in platelet counts to less than 150,000/mL is an indicator of poor prognosis.

Cryptosporidium, a protozoa coccidian, has recently been recognized as an important cause of acute and chronic diarrhea leading to dehydration. Since there was no survey about clinical symptoms of this parasite in adult patients in Chahar-mahal and Bakhtiari province, this study was carried out to define the clinical manifestation of Cryptosporidiosis in these areas. In this cross-sectional and descriptive study, 156 patients hospitalized in the Infectious Diseases ward of Shahre-kord Hajar Hospital from May 2009 to April 2010 due to diarrhea were enrolled. Clinical information was documented; stool samples were collected from participants and tested by commercial ELISA kit to detect Cryptosporidium Surface Antigen (CSA). Data were analyzed by SPSS version 13. One hundred and fifty-six samples were collected; 10 samples were excluded due to insufficient amount or incomplete clinical information. Out of 146 stool samples tested for the presence of Cryptosporidium Surface Antigen, 5 samples (3.5%) were infected with Cryptosporidium (including 3 men and 2 women). There was a statistically significant association between Cryptosporidiosis and dehydration, and also between chronic diarrhea and keeping animals at home. However no significant difference was seen between infection with the parasite and the place of living, previous hospitalization in the last 3 months, history of previous diarrhea in the past 3 months, sex and occupation. The frequency of Cryptosporidium in adult patients in this survey was similar to other studies around Iran and the world. We found a significant association between Cryptosporidiosis and dehydration with more cases of dehydration in patients infected with Cryptosporidium.

Scientific cooperation is one of the main features of the research system that is growing rapidly and research collaboration is the most effective way to share scientific knowledge and technology; co-authorship and collaboration in writing articles is one of the indicators that examine credit for scientific articles. Due to the lack of information regarding the participation of authors in the “Journal of Research in Medical Sciences” this study aims to determine the collaborative coefficient of authors of articles in issues of this journal published from 2007 to 2011. The present study was cross-sectional. The society of research included all papers published in the “Journal of Research in Medical Sciences” from 2007 to 2011. Collaborative coefficient between the authors was examined in 250 articles; number of authors, average number of authors, and gender of authors were analyzed. To collect data main articles and Excel software was used for data entry. Data analysis was performed by descriptive statistics. Two hundred and fifty articles were written by 1020 authors. The average number of authors for each article was 4.08±1.94. Gender share of women was 35.39 percent. The average Collaborative Coefficient was 0.71. It seems that authors in “Journal of Research in Medical Sciences” have a high tendency to cooperate. This cooperation has increased during the recent years.

Harlequin ichthyosis is a fatal and extremely rare disorder; it is an inborn error of epidermal keratinisation with autosomal recessive inheritance. In most cases, neonates die within a few days after birth. We describe a male term infant born from a 32 years old woman with odd looking, clown like face. The skin was composed of rigid fixed plaques separated by deep red fissures; ears and eyes were not developed. Despite vigorous attempts at resuscitation he died within a few minutes. As ichthyosis is autosomal recessive, genetic counseling and prenatal screening is important.