banafshe dormanesh
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خودکشی به معنای پایان دادن به زندگی خود توسط خود شخص است که بسیاری از دلایل روانی، اجتماعی یا شخصی برای آن مطرح است. موضوع اقدام به خودکشی و افکار خودکشی در بین دستیاران پزشکی در سال 1400-1402، یکی از مهم ترین دغدغه های تمامی مسئولین و دست اندرکاران دستگاه های تصمیم ساز حوزه سلامت کشوری بوده است. سازمان نظام پزشکی کشور بدلیل قباحت مضاعف مقوله خودکشی در سطوح بالای فراگیری دانش در محیط های دانشگاهی و در بیمارستان ها اقدام به برگزاری جلسات و تشکیل کارگروه تخصصی با حضور دستگاه های تصمیم گیر و تصمیم ساز از جمله دادستانی کل کشور، پزشکی قانونی، انجمن علمی روانپزشکان، انجمن مددکاری اجتماعی،کمیسیون بهداشت و درمان مجلس شورای اسلامی و دفتر مشاوره و سلامت اجتماعی وزارت بهداشت و گروه جمعیت علمی پیشگیری از خودکشی ایران را در اولویت کاری خود قرار داد. این مقاله گزارشی از اهم اقدامات انجام شده در این راستا می باشد و مشخص گردید معطوف کردن تمامی علل خودکشی دستیاران به فشار اقتصادی موجه نیست و لزوم آسیب شناسی معضل فوق و بررسی وضعیت سلامت روانی دانشجویان و دستیاران پزشکی متعاقب برنامه ملی 10 ساله پیشگیری از خودکشی توسط وزارت بهداشت ضروری است. بنابر مطالعات گروه روانپزشکی پزشکی قانونی وضعیت سلامت روان کشور در سال های اخیر با شیب بسیار تندی نزولی شده و به موازات آن، سلامت روانی دستیاران و پزشکان نیز متاثر گردید. روند خودکشی منجر به مرگ در زنان و مردان در دنیا در 20 سال اخیر کاهشی است و از 14 به 9 در صد هزار رسیده است اما در ایران شاهد روند صعودی بوده و هم اکنون 4/7 در صدهزار است. بنابر گزارش پژوهشکده آینده پژوهی در سلامت، آمار مستندی از ارقام افکار خودکشی در جامعه پزشکی و دستیاران نداریم. در آماری از کشور آمریکا، درگروه پزشکی، زنان %250 بیشتر از جامعه و مردان %70 بیش از جامعه عمومی اقدام به خودکشی می کنند. اگرچه خودکشی منجر به مرگ در زنان و مردان پزشک در آمریکا برابر و جمعا سالانه 300 تا 400 مورد است. در کشورهای توسعه یافته این آمار در دوران دستیاری با جامعه پزشکی تفاوت چندانی ندارد. اگر نسبت جمعیت پزشکان ایران و آمریکا را در نظر بگیریم و فکر کنیم نرخ خودکشی در ایران و آمریکا برابر است انتظار ما ثبت سالانه 25 تا 30 مورد خودکشی منجر به مرگ در جامعه پزشکی ایران است. متاسفانه در دو سال اخیر این آمار بیشتر از حد انتظار بوده است. لذا نیاز به تحقیقات مستند برای بررسی شدت و حدت موضوع می باشد. رشته پزشکی در میان 6 شغل با ریسک بالای میزان خودکشی محسوب می شود و 5/2 برابر میانگین جامعه در این گروه اقدام به خودکشی و تا 7 برابر میانگین جامعه خودکشی منجر به مرگ انجام می گردد. میانگین شیوع افکار خودکشی در دانشجویان پزشکی ایران از میانگین جهانی فراتر رفته و در مقایسه با نرخ جهانی 11/1 درصد به24/4 درصد رسیده است است و پزشکان مرد %40 بیشتر و پزشکان زن %130 بیشتر از جمعیت عمومی در معرض افکار خودکشی بوده اند (رضائیان، متخصص پیشگیری از خودکشی، 2017). در جمع بندی اهم چالش ها و مشکلات دوره دستیاری که توسط ایشان ابرز شده است، می توان به موارد زیر اشاره نمود:الف. مشکلات آموزشی:عدم وجود قانون مصوب رسمی آموزشی - خدمتی دستیاری عدم وجود سقف تعداد ویزیت و پروسیجر (مداخلات درمانی) در هر نوبت کاری (گاها خارج از توان انسانی) شروط غیر قانونی در تعهدات اخذ شده در دوره دستیاری عدم اجرای عملیاتی آیین نامه مصوب دستیاری در بخش ه ها در بیمارستان های آموزشی ب. مشکلات اجرایی:کار زیاد درمانی (70 تا 50 برابر سایر مشاغل) در مراکز آموزشی با تعداد بالای بیماران تعدد کشیک های شبانه و خسته کننده برخورد نامناسب ارباب رجوع و هجمه فیزیکی و عدم حمایت حقوقی برخورد دور از شان پرسنل، اساتید و حتی دستیاران ارشدتر عدم رعایت ضوابط میزان کار، تعداد کشیک ها، مرخصی استحقاقی،... افسردگی، فرسودگی شغلی، خودارزشمندی پایین، عدم درمان مشکلات روانشناختی... مشکلات اخلاقی دستیار (مصرف مواد و الکل، مشکلات زناشویی و ارتباطی،...) دعاوی قصورپزشکی ج. مشکلات اقتصادی و معیشتی:حقوق الزحمه بسیار پایین و غیر قابل قبول برای امرار معاش عدم امید به آینده کاری و شغلی با تجربه وضعیت بسیار نامناسب نیروهای طرحی هزینه ی سنگین انصراف از تحصیلی عدم برخورداری از بیمه و عدم محاسبه سابقه فعالیت دستیاری به عنوان سابقه کار تاخیر یا عدم پرداخت کارانه ها ماحصل برگزاری این جلسات ارائه پیشنهادات زیر مطرح گردید:- تصویب قانون رسمی و تبدیل دستیاری به شغل و مشمولیت قانون کار (اعمال بیمه و پرداخت حقوق مناسب و...) - حذف جریمه انصراف از دستیاری (با استناد بر رای هیات عمومی دیوان عدالت اداری به شماره 2134 مورخ 20/7/1400 - مبنی بر ابطال اخذ تضامین و وثایق از دستیاران) - ایجاد راهکاری جهت داشتن ضمانت اجرایی آیین نامه دستیاری و بخشنامه ها - ایجاد راهکاری مناسب با ضمانت اجرایی برای جلوگیری از رفتارهای دور از شان دستیاران - تامین امکانات اقامتی به خصوص برای دستیاران متاهل در مجاورت مراکز آموزشی- درمانی به قید فوریت - تشکیل کمیته سلامت روان دستیاران و پزشکان طرحی - ترغیب به ورود پزشکان به رشته های مورد نیاز کشور از جمله بیهوشی - اطفال - داخلی - طب اورژانس _ جراحی و... - به کارگیری روند یکنواخت در پرداخت کارانه به دستیاران و ضرورت انجام بیمه تامین اجتماعی. - تقویت برنامه حمایت روانی و تقویت ارتباط با دستیاران (مجازی و حضوری) و انجام غربالگری های اختیاری - تلاش جهت بهبود دیدگاه جامعه از جامعه پزشکی در فضای رسانه ای کشور - نظارت بیشتر در ارزیابی سلامت روان اعضای هیات علمی در زمان جذب در راستای پیاده سازی پیشنهادات فوق برنامه عملیاتی در سازمان نظام پزشکی نوشته شده و امید است با پیاده سازی آن بتوانیم شاهد کاهش آمار خودکشی باشیم.
کلید واژگان: خودکشی, دستیار پزشکی, سازمان نظام پزشکیSuicide means ending one's life by the person himself, for which there are many psychological, social or personal reasons. The subject of medical students’ suicidal thoughts is one of the most important concerns of all decision-making bodies of the country's health. It is not justified to attribute all the causes of suicide of medical assistants to economic pressure, and it is necessary to analyze the pathology of the above problem and examine the mental health status of medical students and medical assistants. In this article Medical Council of Iran has an approach to the causes of this social-cultural problem with other National organizations and responsible bodies, to make suggestions, which led to the design of an action plan to prevent suicide of medical students.
Keywords: Suicide, Medial Assisstant, Medical Coucil -
Background and Aim
Studies on the prevalence of kidney stones in Iranian children are limited. Children with nephrolithiasis have a high risk of recurrent stones; therefore, a thorough evaluation is warranted. Due to the paucity of data on Iranian children, this study aims to investigate the prevalence of kidney stones in this population.
MethodsThis cross-sectional study examined the prevalence of kidney stones among outpatients and inpatients at various university centers in Iran from March to December 2019. Twenty-six pediatric nephrologists from 13 centers participated and completed a questionnaire on the total number of inpatients and outpatients and the number of patients with kidney stones. The diagnosis was based on radiological results.
ResultsA total of 97 912 patients were included, with 20327 hospitalized and 77585 outpatients. Of all patients, 2.86% had kidney stones, the prevalence of which was 1.5% in inpatients and 3.2% in outpatients. This figure is about 1% more than Iran’s past reports. Inpatient stones in Kerman City, Iran (3.65%) and outpatients in Zahedan City, Iran (16.4%)
Keywords: Pediatrics, Urolithiasis, Prevalence, Multicenter studiesAkhavan Sepahi M, et al. Kidney Calculi in Iranian Children. J Ped Nephrol. 2023, 11(1):31-36 -
Background
Obesity has become one of the most important health problems worldwide. Body Mass Index (BMI) is a clinical assessment of overweight and obesity in children, although Mid-Upper Arm Circumference (MUAC) assessment is more straightforward, especially for parents.
ObjectivesThis study aimed to investigate the relationship between MUAC and BMI in children aged 6 - 12 years.
MethodsThis cross-sectional study was performed on 455 elementary school children aged 6 - 12, including 278 girls and 177 boys with a mean age of 8.8 ± 1.8 years selected using the census method. Our researcher was trained for anthropometric data collection. Data were analyzed by SPSS version 25 software using Mann-Whitney, Kolmogorov-Smirnov, and Kruskal-Wallis tests.
ResultsThe mean age was 9.19 ± 1.8 years, the mean height was 135 ± 12 cm, the mean weight was 31.85 ± 11 kg, the mean MUAC was 21 ± 3.1 cm, and the mean BMI was 17 ± 3.6 kg/m2. There was a significant correlation between MUAC and BMI in both sexes, but it was stronger in girls than in boys (P-value < 0.05). The MUAC cutoff point was 23.75 cm (77% sensitivity and 80% specificity) and 24.75 cm (93% sensitivity and 88% specificity) for overweigh and obesity in girls, respectively. Also, it was 23.25 cm (88% sensitivity and 83% specificity) and 25.25 cm (87% sensitivity and 90% specificity) for overweigh and obesity in boys, respectively.
ConclusionsWe recommend MUAC as a predictor of early diagnosis of overweight and obesity.
Keywords: Obesity, Mid-Upper Arm Circumstance (MUAC), Body Mass Index (BMI) -
مقدمهاهدای عضو، نوعی کنش اجتماعی است که بر اساس تصمیم فرد در زمان حیات و یا رضایت خانواده او در زمان مرگ مغزی صورت می گیرد. هدف از مطالعه بررسی عوامل موثر بر گرایش به اهدای عضو در یک دانشگاه نظامی بود.مواد و روش هااین مطالعه توصیفی- مقطعی بر روی 330 نفر از کارکنان یک دانشگاه نظامی با روش پیمایش در سال 1396 انجام شد. داده ها توسط پرسشنامه و مصاحبه حضوری با دو گروه از افراد دارای کارت و فاقد کارت اهدا جمع آوری و با نرم افزارSPSS 18 و با روش های آمار توصیفی و استنباطی تجزیه و تحلیل گردید.یافته هابر اساس آزمون های تی تست و کای دو، آمادگی عملی برای اهدای عضو با دو متغیر سن و تحصیلات رابطه معناداری دارد(0001/0 = P). حدود 75% کارکنان ارتش نگرش مثبتی نسبت به اهدای عضو دارند و سهم افراد دارای کارت اهدا از این میزان بیشتر از افراد فاقد کارت اهدا است. نتایج تحلیل رگرسیونی نشان داد که بینش و آگاهی مذهبی بالاترین اثر (46%) را در تبیین تغییرات نگرش به اهدای عضو دارد که با افزایش عقل گرایی، اخلاق گرایی، مطلع بودن از ویژگی ها و شرایط اهدا عضو و در نهایت استفاده از رسانه های ارتباط جمعی در مجموع شانس یا احتمال آن که فرد در گروه دارندگان کارت اهدا عضو قرار گیرد، افزایش می یابد.بحث و نتیجه گیریپژوهش حاضر نشان می دهد که عوامل اجتماعی و فرهنگی سهم بسزایی در امر اهدا و پیوند دارند و در راستای هموار کردن مسیر اهدای عضو نگاهی شایان توجه به این عوامل می تواند مثمرثمر باشد.کلید واژگان: کنش اجتماعی, عقل گرایی, اخلاق گرایی, اعتماد, عام گرایی, آگاهی, اهدا و پیوند عضوIntroductionOrgan donation is a social action that is based on the individuals decision in time of life or Family consent at the time of brain death. The present study aimed to investigate the Factors Affecting Tendency to Body Organ Donation.
Methods and Materials: This descriptive cross-sectional study was conducted on 330 employees of a military university in 2017. Data were collected through questionnaire and face to face interview with two groups of donation cardholders including those who had a donation card or did not have. Data were analyzed using descriptive and inferential statistics by SPSS version 18.ResultsAccording to Chi-square and t-test, there was a significant relationship between the organ donation and two variables of age and education (P = 0.0001). Results demonstrate that most of the people has positive attitude to organ donation (about 75 percent). Moreover, most of these people are those who have donation card. The results of the regression analysis indicate that religious awareness has the highest effect of changes in attitude toward organ donation (46%). In addition, the growth of rationalism, ethics, awareness of the condition and characteristics of organ donation, and the usage of mass media increase the chance or probability that a person volunteers for a donation card.
Discussion andConclusionThe present study reveals that social and cultural factors have a significant role in the donation and transplantation. A good look at these factors can be beneficial to pave the path of donation.Keywords: Social action, Rationalism, Ethicism, Trust, Knowledge, awareness, Universalism, Organ donation, transplantation -
BackgroundProliferative diabetic retinopathy (PDR) is one of the most important microvascular complications among the patients with diabetes. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) agent enacts a key role in PDR. Some studies have dealt with the systemic exposure to these agents after intravitreal administration. However, renal dysfunction following this therapy has scarcely been reported. Hence, this study aimed to determine the effect of intravitreal bevacizumab treatment on the deterioration of renal function and proteinuria.Materials and MethodsThis present prospective observational study was performed on 40 patients with diabetic nephropathy and PDR and/or significant diabetic macular edema as the candidates for receiving intravitreal injection of bevacizumab. To evaluate renal function, changes in the urinary albumin-to-creatinine ratio (UACR), serum creatinine (SCr), and estimated glomerular filtration rate (eGFR) one month after injection were measured. Also, changes in systolic and diastolic blood pressures (BPs), plasma VEGF level, platelet, white blood cell (WBC) counts, and hemoglobin (Hb) level were measured at the baseline and one month after treatment.ResultsThe mean age of the patients was 60.3 ± 9.2 years, and 33 patients were female. The decrease in the plasma VEGF level and platelet count, as well as the increase in diastolic BP, and Hb level were significant. However, systolic BP and WBC count remained unchanged. There were no significant changes in UACR, SCr, and eGFR after the injection as compared to baseline (P>0.05).ConclusionOur study indicated that intravitreal bevacizumab injection was not associated with renal dysfunction and proteinuria in patients with diabetic nephropathy. Nevertheless, diastolic BP and Hb level could increase after one month.Keywords: Anti-VEGF, Bevacizumab, Diabetic Nephropathy, Diabetic Retinopathy, Glomerular Filtration Rate, Renal Dysfunction, Proteinuria
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Objective(s)Silver nanostructures have gathered remarkable attention due to their applications in diverse fields. Researchers have recently demonstrated that bacterial spores are capable of reducing silver ions to elemental silver leading to formation of nanoparticles.Materials And MethodsIn this study, spores of Bacillus subtilis and Geobacillus stearothermophilus were employed to produce silver nanoparticles (SNPs) from silver nitrate (AgNO3) through a green synthesis method. The production of SNPs by spores, heat inactivated spores (microcapsule) and spore extracts was monitored and compared at wavelengths between 300 to 700 nm. The biosynthesized SNPs by spore extracts
were characterized and confirmed by XRD and TEM analyses.ResultsUV-Visible spectroscopy showed that the spore extracts were able to synthesize more SNPs than the other forms. The XRD pattern also revealed that the silver nanometals have crystalline structure with various topologies. The TEM micrographs showed polydispersed nanocrystal with dimensions ranging from 30 to 90 nm and 15 to 50 nm produced by spore extracts of B. subtilis and G. stearothermophilus, respectively.
Moreover, these biologically synthesized nanoparticles exhibited antimicrobial activity against different opportunistic pathogens.ConclusionThis study suggests the bacterial spore extract as a safe, efficient, cost effective and eco-friendly material for biosynthesis of SNPs.Keywords: Bacillus subtilis, Geobacillus stearothermophilus, Silver nanoparticles, Spore extract -
Background And ObjectivesObesity is a major public health problem worldwide and it has been reported that the prevalence of overweightness and dyslipidemia increases in military personnel. This study was designed to evaluate the independent or combined effect of calcium and vitamin D supplementation on blood lipid profile and body weight in overweight military male personnel.MethodsOverall, 120 overweight males were allocated to 4 groups, including 1, Calcium supplementation (2 tablets per day; each containing 500 mg of calcium carbonate); 2, vitamin D supplementation (2 tablets per day; each containing 200 IU of vitamin D3); 3, Ca Vit D supplementation (2 tablets per day; each containing 500 mg calcium carbonate plus 200 IU vitamin D3); and 4, Placebo (2 tablets per day, containing micro-cellulose). In all groups, blood lipid, body weight, and anthropometric indices were measured at baseline and after 6 weeks. Changes of lipid profile and body weight following intervention were calculated as before minus after the intervention. Data was analyzed by one-way analysis of variance (ANOVA) followed by Tukeys post hoc test.ResultsSerum triglycerides and total cholesterol significantly decreased in the calcium-treated group more than the other groups (PConclusionsIt seems that Ca or Ca plus Vit D supplements decrease triglycerides, total Cholesterol, LDL, and body weight in overweight patients.Keywords: Calcium, Vitamin D, Lipid Profile, Body Weight, Military Personnel, Overweight Men
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BackgroundHemoglobin levels measured after hemodialysis, as compared to hemoglobin levels measured before hemodialysis, are suggested to be a more accurate reflection of the hemoglobin levels between hemodialysis sessions, and to be a better reference point for adjusting erythropoietin dosing..ObjectivesThe aim of this study was to compare the hemoglobin levels before and after hemodialysis, to calculate the required erythropoietin doses based on these levels, and to develop a model to predict effective erythropoietin dosing..
Patients andMethodsIn this cross-sectional study, the hemoglobin levels of 52 patients with end-stage renal disease were measured before and after hemodialysis. The required erythropoietin doses and the differences in cost were calculated based on the hemoglobin levels before and after hemodialysis. A model to predict the adjusted erythropoietin dosages based on post-hemodialysis hemoglobin levels was proposed..ResultsHemoglobin levels measured after hemodialysis were significantly higher than the hemoglobin levels before hemodialysis (11.1 ± 1.1 vs. 11.9 ± 1.2 g/dL, PConclusionsUsing post-hemodialysis hemoglobin levels as a reference point for erythropoietin dosing can result in significant dose and cost reduction, and can protect hemodialysis patients from hemoconcentration. The prediction of the erythropoietin adjusted dosage based on post-hemodialysis Hb may also help in avoiding overdosage..Keywords: Hemoglobin, Hemodialysis, Erythropoietin, Cost -
Shiga Toxigenic Escherichia coli in Iranian Pediatric Patients With and Without Diarrhea: O-Serogroups, Virulence Factors and Antimicrobial Resistance PropertiesBackgroundShiga-toxigenic Escherichia coli is an important human pathogen cause of diarrhea, hemorrhagic colitis, hemolytic uremic syndrome and thrombotic thrombocytopenic purpura in humans is a significant public health..ObjectivesThe aim of this study was to determine the molecular characteristics and antimicrobial resistance properties of Shiga toxigenic Escherichia coli (STEC) strains with respect to their seasonal, age and geographical distributions in Iranian pediatric patients with and without diarrhea..Patients andMethodsFour hundred and eighty swab samples were taken from pediatric patients with and without diarrhea of four major provinces of Iran. Swab samples were immediately cultured and the positive culture samples were analyzed by the polymerase chain reaction (PCR) method. Finally, antimicrobial susceptibility testing was performed using the disk diffusion method in Mueller-Hinton agar..ResultsIn total, 118 out of 200 diarrheic stool samples (59%) and 77 out of 280 non-diarrheic stool samples (27.5%) were positive for E. coli. Samples taken from one to ten months old cases (73.33%) and those from Shiraz province (81.13%) were the most commonly infected. Samples taken in the summer season (91.66%) were the most commonly infected. A significant difference was shown between AEEC and EHEC strains of E. coli. The genes encoding Shiga toxins and intimin protein were the most commonly detected in all strains. O26 (33.33%), O111 (18.18%) and O91 (12.12%) serogroups had the highest incidence in patients with and without diarrhea. Prevalence of the genes that encode resistance against ampicillin (CITM), gentamicin (aac(3)-IV) and tetracycline (tetA) were 80.30%, 75.75% and 65.15%, respectively. The STEC strains harbored the highest levels of resistance against ampicillin (84.84%), gentamycin (78.78%), tetracycline (50%) and sulfamethoxazole (40.90%) antibiotics. We found that 55.08% of diarrheic and 1.29% of non-diarrheic E. coli isolates were resistant to more than six antibiotics..ConclusionsAccurate control programs should be organized for antibiotic prescription especially during warmer seasons in Iran. Primary treatment of diarrheic patients with co-trimoxazole, cefotaxime and ceftriaxone is effective.Keywords: Microbial Sensitivity Tests, Virulence Factors, Iran, Shiga Toxigenic Escherichia coli
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BackgroundRenal ischemia/reperfusion injury (IRI) is a major problem in renal transplantation, which occurs during the process of organ retrieval and storage, and is closely associated with acute rejection episodes and late allograft failure. Recent studies have revealed a new phenomenon called “chemical preconditioning” that can induce tolerance against the ischemic stress via a variety of proposed pathways especially nitric oxide (NO) system. Propylthiouracil (PTU) is suggested to modulate the intracellular NO signaling..ObjectivesIn this study, we investigated the preconditioning properties of chronic pretreatment with PTU in preventing renal IRI. In addition, we evaluated the involvement of NO pathway..Materials And MethodsSixty adult male Wistar rats were allocated into six groups. All groups underwent right nephrectomy 15 days before intervention. In groups 1 (Chronic PTU + L-NG-nitro arginine methyl ester [L-NAME]) and 2 (Chronic PTU) oral PTU (500 mg/L in water) treatment was started 15 days before right nephrectomy to achieve the therapeutic plasma level of PTU. Fourteen days after nephrectomy, animals received either L-NAME (10 mg/kg) or its vehicle and renal IRI was induced 45 minutes later. Groups 3 and 4 (Control) received respectively L-NAME (10 mg/kg) and its vehicle 45 minutes before IRI. The last two groups were normal sham operated rats and PTU + sham. Rats were killed 24 hours after IRI. The blood samples were collected and assessed for serum blood urea nitrogen (BUN) and creatinine (Cr) level, and tissue samples were fixed in formalin for histopathologic scoring of tubular damage (H-score)..ResultsThe mean BUN, Cr, and H-score of control group were 176.66 ± 12.24 mmol/L, 4.45 ± 0.44 μmol/L, and 83.5% ± 3.5%, respectively. Chronic pretreatment with PTU significantly improved BUN (40.4 ± 6.1 mmol/L), Cr (0.96 ± 0.068 μmol/L), and H-score (7.83% ± 4.02%) in IRI animals in comparison to those that were not treated with chronic PTU (P < 0.001) and L-NAME; however, it did not completely reversed the chronic PTU-induced protection (BUN, 93.33 ± 12.22 mmol/L; Cr, 2.7 ± 1.15 μmol/L, and H-score, 24.83% ± 3.5%). There was no significant difference between rats that were treated with L-NAME alone (group 5) and the control group..ConclusionsOur study demonstrates that preconditioning of kidney with chronic PTU administration protects renal tissue against IRI and this phenomenon was mediated through NO system. The results suggest a potential indication for using PTU to protect the kidney before transplantations and to reduce the risk of tissue rejection afterwards..Keywords: Ischemia, Reperfusion, Rat, Renal, Transplantation
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BackgroundRenal and urological complications are the main causes of mortality and morbidity associated with spinal cord injury (SCI). Besides clinical risk factors, there are environmental predisposing factors making a patient prone to develop any complications.ObjectivesThe present study aimed to evaluate the risk factors of developing nephrolithiasis, urinary tract infection, hydronephrosis and renal failure, as the main renal and urological complications in the SCI patients.Materials And MethodsThe database of SCI patients of State Welfare Organization of Iran (SWOI) was used for data gathering. The data were collected between 2008 and 2010 by 222 separate teams consisting of 6 mobile rehabilitation team members. The independent risk factors of developing nephrolithiasis, urinary tract infection, hydronephrosis and renal failure were recognized by controlling the confounders after entering all biologically plausible variables in multivariate regression models.ResultsComplete information was available for 5901 (72.59%) of the patients. Urologic and renal complications were reported in 2358 (40%) of the patients among which 286 (4.8%) had chronic renal failure, 127 (2.2%) from hydronephrosis, 307 (5.2%) from nephrolithiasis and 2138 (36.2%) from urinary tract infection. Generally, renal and urological complications associated with old age, and more time since SCI; however, lumbar level of injury and living in rural area negatively correlated with renal and urological complications.ConclusionsSCI patients with and without renal and urological complications are different regarding demographic and environmental factors; hence, it is necessary to determine the modifiable risk factors in patients'' life-style to design preventive programs.Keywords: Spinal Cord Injuries, Kidney Diseases, Urologic Diseases
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BackgroundUropathogenic Escherichia coli O- Serogroups with their virulence factors are the most prevalent causes of UTIs..ObjectivesThe present investigation was performed to study the virulence factors and O-Serogroups profiles of UPEC isolated from Iranian pediatric patients..Patients andMethodsThis cross sectional investigation was performed on 100 urine samples collected from hospitalized pediatrics of Baqiyatallah Hospital, Tehran, Iran. Midstream urine was collected to decrease potential bacterial, cellular and artifactual contamination. All samples were cultured and those with positive results were subjected to polymerase chain reactions to detect pap, cnf1, afa, sfa and hlyA genes and various O- Serogroups..ResultsWe found that 37.5% of boys and 75% of girls had positive results for Escherichia coli. We also found that O1 (19.33%), O2 (13.33%), O6 (13.33%), O4 (11.66%), and O18 (11.66 %) were the most commonly detected Serogroups. Totally, the serogroup of 5% of all strains were not detected. In addition, all of these O- Serogroups were pap+, cnf1+, hlyA+, and afa+. Totally, pap (70 %), cnf1 (56.66 %), and hlyA (43.33 %) were the most commonly detected virulence genes in the both studied groups of children. The sfa (30 %) and afa (26.66 %) genes had the lowest incidence rates..ConclusionsSpecial health care should be performed on UTIs management in Iranian pediatric patients. Extended researches should be performed to evaluate relation between other O-Serogroups and virulent genes..Keywords: Uropathogenic Escherichia Coli, Pediatrics, Iran
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زمینه و اهدافسروگروپ ها و فاکتور های حدت اشریشیا کلی نقش مهمی را در بروز علائم عفونت ادراری کودکان بازی می کنند. هدف از بررسی حاضر تعیین همزمان فراوانی فاکتور های حدت، سروگروپ ها و خصوصیات مقاومت پادزیستی باکتری اشریشیا کلی یوروپاتوژنیک جداسازی شده از کودکان مبتلا به پیلونفریت و التهاب مثانه بود.مواد و روش کاردر این مطالعه که در طی سال های 92-1391 انجام گرفت، 121 سویه اشریشیا کلی از نمونه های ادرار افراد مبتلا به پیلونفریت و التهاب مثانه، بستری شده در بیمارستان بقیه الله (عج) تهران، جمع آوری شد. مقاومت پادزیستی سویه ها علیه 10 پادزیست رایج با استفاده از روش دیسک گذاری ساده ارزیابی شد. در نهایت با استفاده از پرایمرهای اختصاصی فاکتور های حدت، سروگروپ ها و ژن های کد کننده مقاومت پادزیستی، ارزیابی شدند.یافته هادر جامعه نمونه ها، 09/45% پسران و 71/55% دختران بودند. بیش ترین فراوانی باکتری در پسران زیر 1 سال (42/71 %) و دختران 12-5 ساله (75%) دیده شد. فراوانی اشریشیا کلی در کودکان مبتلا به ترتیب 55/55% و 89/44%، بود. سروگروپ های اصلی ردیابی شده در کودکان مبتلا به پیلونفریت، O1، O2، O4، O7 و O25 و سروگروپ های اصلی ردیابی شده در کودکان مبتلا به التهاب مثانه، O16، O18، O75 و O22 بودند. فاکتور های حدت در موارد پیلونفریت، pap (100%)، afa (5/97%)، sfa (95%)، hly 95% و cnf-1 5/92% و در موارد التهاب مثانه، fim (100%)، pap (7/72%)، afa 6/63% و hly 4/45%، بودند. ژن های کد کننده مقاومت پادزیستی علیه جنتامایسین (7/96%)، بتا لاکتام ها (به ترتیب 3/90 و 7/88%) و تتراسیکلین (2/82%)، بیش ترین فراوانی را در جدایه های باکتری داشتند. جدایه های اشریشیا کلی بیش ترین مقاومت پادزیستی را علیه پادزیست جنتامایسین (1/95%) و آمپی سیلین (9/91%)، داشتند.نتیجه گیریدر بررسی حاضر تنها 4/6% از جدایه ها به پادزیست ایمی پنم مقاوم بودند. در نتیجه این پادزیست می تواند انتخاب مناسبی برای درمان موارد مبتلا به عفونت های ادراری ناشی از اشریشیا کلی باشد.
کلید واژگان: اشریشیا کلی یوروپاتوژنیک, سروگروپ ها, فاکتور های حدت, خصوصیات مقاومت آنتی بیوتیکی, عفونت های ادراری, کودکان, ایرانBackgroundA lot of children suffer from urinary infections which can lead to pyelonephritis and cystitis. The main cause of these infections is uropathogenic strains of Escherichia coli. Serogroups and virulence factors of this bacterium play an important role in occurrence of infection’s symptoms. Unfortunately, due to the occurrence of antibiotic resistances, common treatments are ineffective and costly. The aim of this study was to study the distribution of virulence factors, serogroups and antibiotic resistance properties of uropathogenic Escherichia coli isolated from pediatrics with pyelonephritis and cystitis.Material And MethodsIn this study which was conducted during the year 2012 to 2013, 121 Escherichia coli strains were isolated from boys (51 samples) and girls (70 samples) with pyelonephritis and cystitis impatient in Baqiat-alah Hospital, Tehran. Antibiotic resistance of the isolates against commonly used antibiotics in the cases of urinary infections was investigated using disk diffusion method. Finally, PCR reactions using specific primers were done in order to detect virulence factors, serogroups and antibiotic resistance genes.ResultsTotally, 45.09% of boys and 55.71% of girls were positive for presence of uropathogenic Escherichia coli. The highest distribution of bacterium was seen in less than one year old boys (71.42%) and 5-12 years old girls (75%). Results showed that the distribution of Escherichia coli in children with pyelonephritis and cystitis were 55.55% and 44.89%, respectively. The most commonly detected serogroups in children with pyelonephritis were O1, O2, O4 and O7 while, the most commonly detected serogroups in children with cystitis were O1, O2, O6 and O16. The most frequent virulence factors in the cases of pyelonephritis were pap (100%), afa (97.5%), sfa (95%), hly (95%) and cnf-1 (92.5%) and their most frequent in the cases of cystitis were fim (100%), pap (72.7%), afa (63.6%) and hly (45.4%). The genes which encode antibiotic resistance against gentamicin (aac(3)-IV) (96.7%), beta-lactams (blaSHV and CITM) (90.3% and 88.7%, respectively), tetracycline (tetA) (82.2%), had the highest incidence in the bacterial isolates. Escherichia coli isolates had the highest antibiotic resistance against gentamicin (95.1%), ampicillin (91.9%), amikacin (85.4%) and ciprofloxacin (83.8%).DiscussionDetermination of the antibiotic resistance pattern in uropathogenic Escherichia coli isolated from children with urinary infections is important in each area or in hospital. Imipenem, due to its low antibiotic resistance, can be an effective drug for treatments of children with pyelonephritis and cystitis.Keywords: Uropathogenic Escherichia coli, Antibiotic resistance, Urinary infections -
سابقه و هدفدر دنیای مدرن و ماشینی امروزی، انسان در معرض طیف وسیعی از بیماری ها و آسیب های بافت استخوانی قرار دارد. اغلب این آسیب ها با روش های رایج پزشکی قابل درمان هستند ولی برخی از آنها غیرقابل درمان و یا ناعلاج تلقی می شوند.اینها اغلب ضایعاتی هستند که در آنها بخش وسیعی از بافت استخوان از بین رفته و مکانیسم های طبیعی بدن قادر به بازسازی بافت صدمه دیده نیست. درمان چنین آسیب هایی به عهده شاخه ای از علوم پزشکی موسوم به طب ترمیمی است. یکی از ابزارهای طب ترمیمی پیوند سازه های شبه استخوانی ساخته شده به روش مهندسی بافت است.مواد و روش هامهندسی بافت استخوان از سه جز اصلی سلول، داربست و فاکتور رشد بهره می گیرد. به کارگیری سلول بنیادی مزانشیمی به عنوان عامل سلولی در طراحی داربست مهندسی، فرآیند ساخت سازه استخوانی را به مقدار زیادی تسهیل وحوزه مهندسی بافت استخوان را متحول کرده است. این تاثیرات سلول بنیادی مزانشیمی مرهون توان خودنوزایی، پتانسیل بالای تمایز به استخوان و عدم تحریک سیستم ایمنی است. کشت سلول های استخوان زا روی داربست متخلخل می تواند یک راه حل جدید برای پیوند استخوان با استفاده از سلول های مزانشیمی خود شخص باشد.
بحث و نتیجه گیریتحقیقات درون تنی و نتایج بالینی حاصله نیز نشان داد که درمان ضایعات با این استراتژی کاملا قابل اعتماد است. دانشمندان بر این تلاش اند تا با توسعه این استراتژی و انجام ابتکارهای جدید همچون استفاده از نانو ذرات یا داربست های نانوساختار به روش های درمانی نوینی برای درمان انواع صدمات و ضایعات بافت اسکلتی بدن درآینده ای نزدیک دست پیدا کنند. واژه های کلیدی:کلید واژگان: مهندسی بافت استخون, سلول های بنیادی, داربست, ضایعات ارتوپدیBackgroundIn today’s modern and mechanical world، humans are exposed to a wide range of bone tissue diseases and injuries. Most of these injuries can be treated using conventional medical methods، but some are considered incurable or refractory. These injuries are often those in which large parts of bone tissue have been destroyed and natural body mechanisms are not able to rebuild the damaged tissue. A branch of medical sciences called the regenerative medicine is responsible for treating such injuries. One of the tools of regenerative medicine is the transplantation of bone-like structures made by tissue engineering method.ResultsBone tissue engineering is benefitted from three main parts including the cell، the scaffold and the growth factor. The use of mesenchymal stem cells as the cell factor in the design of engineering scaffold، has been greatly facilitated the construction process of bone structures and revolutionized the field of bone tissue engineering. Such effects of mesenchymal stem cells are due to their self-renewal ability and high potential to differentiate into bones while not stimulating the immune system. The culture of osteoblasts on porous scaffolds can be a new solution for bone transplantation using the person’s own mesenchymal cells.ConclusionsIn-vivo studies and the obtained clinical results also showed that treating injuries using this strategy is completely reliable. Scientists try to attain modern treatment methods to treat different kinds of skeletal tissue injuries of the body in the near future through developing this strategy and employing new innovations such as the use of nanoparticles or nanostructured scaffolds.Keywords: Tissue Engineering, Bone, Bones Stem Cells, Tissue Scaffold, Orthopedics, Wounds, Injuries
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