Journal of Kerman University of Medical Sciences
Volume:14 Issue: 3, 2007

Increasing rate of candidiasis prevalence and consequently use of antifungal drugs as prophylactic and curative agents has led to the widespread emergence of resistant strains. Therefore this study was designed to evaluate the in vitro antifungal activity of an aqueous extract of garlic and the synergic effect of garlic extract with fluconazole against common clinical isolates of Candida species from patients with candidiasis. The antifungal activity of aqueous garlic extract was investigated in an in vitro system using standard broth microdilution method against five common clinically isolates of Candida species including C. albicans, C. tropicalis, C. glabrata (T.glabrata), C. parapsilosis, C. krusei and 3 standard strains of Candida. The synergic antifungal effect of garlic extract in combination with fluconazole was also determined. The strongest activity of garlic extract was seen against Candida tropicalis (MIC=0.78mg/ml), C. glabrata (MIC=1.56mg/ml), and C. albicans (MIC=3.12mg/ml) respectively. C. krusei was the most resistant species against garlic extract (MIC 6.25mg/ml). The minimum inhibition concentration of fluconazole was reduced eight folds against C. tropicalis, 4 folds against C. albicans and C. glabrata, and 2 folds for other Candida species in the presence of 3.12 mg/ml garlic extract. In comparing means, the isolated colonies (CFU) in wells without garlic extract and CFU in other wells showed statistical significant differences for C. tropicals (P=0.0001), C. glabrata (P=0.001) and C. albicans (P=0.002). Candida species particularly resistant species such as Candida tropicalis and Candida glabrata are sensitive to aqueous extract of garlic, and combination of garlic extract with fluconazole in topical use could increase the efficacy rate of fluconazole.

Anal fissures are small tears in the lining skin of the anus presenting with typical symptoms of pain and bleeding during defecation. Several new forms of medicines such as glyceryle trinitrate (GTN) ointments and diltiazem, a calcium channel-blocking agent, have been recently used for the treatment of these fissures. Diltiazem relaxes the muscle of anal sphincter and consequently increases blood flow to promote healing. It does not have GTN side effects like headache, anal burning and hypotension. The objective of this study was to formulate a suitable topical gel from diltiazem and then to investigate its physicochemical stability and also the drug release profiles from the bases. Various formulations of gel base including Guar 1.25%, Tragacanth 1.5%, HPMC 1%, and HPMC 1.5% were prepared and in vitro release and penetration characteristics of diltiazem from each preparation were studied through a hydrophilic dora pore diffusion barrier and membrane excised rat skin using Franz cell over a period of 5 hours. The amount of drug released from topical preparations was determined spectrophotometrically at? max=236 nm. Stability studies and shelf life assessments were performed too. Gel formulations containing HPMC, Guar and Tragacanth presented both good chemical and physical stabilities. The rates of cumulative drug release from HPMC 1%, HPMC 1.5%, Guar 1.25% and Tragacanth 1.5% bases using synthetic membrane were 89.7%, 76.7%, 94.9% and 66.1% respectively. For excised rat skin test, the cumulative percent of penetrated drug at the end of each experiment were 52.7 %, 50.9%, 64.6% and 42.6% for HPMC 1%, HPMC 1.5%, Guar 1.25% and Tragacanth 1.5% bases respectively. The comparative study showed that the percent of drug release from synthetic membrane was more than the percent of penetrated drug through excised rat skin for all bases (P<0.05). It was concluded that the kinetics of diltiazem release in vitro was not affected by the kind of gel forming agent and for all of the formulations, Higuchi’s kinetic model was suitable to explain their kinetics.

Copper and zinc play a key role in oxidative reactions and in vivo studies have shown their different effects. In this study we examined the influence of exposure to copper and zinc on catalase and superoxide dismutase (SOD) activities in erythrocytes, total serum antioxidant capacity and malondiadehyde (MDA) production of copper industry workers. In the present study, 70 workers in a Copper Industry and 70 healthy controls with the age range of 35-55 years were studied. The catalase assay and SOD activity in RBC lysate and total antioxidant were measured by spectrophotometric methods. Using thiobarbitoric acid reaction, MDA concentration was determined. The results showed a higher copper and zinc concentration in serum of worker group (113.8±2.2 & 148.3±3.2 μg/L respectively, P<0.001) in comparison with the control group (104.5±1.5 & 107.7±2μg/L respectively). Serum catalase and SOD activities in RBC were higher in workers (7621.7±199.3 & 1489.5±12.3 μ/l) than in the control group (7049.1±157.4 & 1421.7±11.1 μ/l respectively, P<0.05, for SOD only). Serum total antioxidant was significantly higher in workers than controls (1.6±0.03 vs. 1.4±0.01) and it was the same for MDA concentration (245.5±3.7nmol/gHb in the worker group compared to 205±3.2nmol/gHb in the control group). No correlation were found between copper and zinc concentrations and the other factors (P>0.05). These results suggest that occupational exposure to copper and zinc induces oxidative stress followed by anti oxidative defense system

It has been approved that in most tissues NO production increases during acute inflammation and Angiotensin II has a role in production of reactive oxygen species (ROS). As regulation of joint blood flow (JBF) is important in this situation, this study was performed to investigate the interaction of local Ang II and ROS production and the modulatory role of NO on regulation of JBF during acute inflammation. The study was performed on 24 Newzealand white rabbits divided into three experimental and one control groups. Acute knee joint inflammation was produced by intraarticular injection of 0.5 ml of a 2% solution of carrageenan in knee joint. In the first group after 24 hours animals were anesthetized by thiopental sodium and carotid artery, jugular vein and saphenous artery were cannulated for recording blood pressure, injection of L-NAME and local injection of AngII and losartan respectively. Blood flow was recorded by laser Doppler flow meter. Joint vascular resistance (JVR) was calculated by dividing arterial blood pressure (ABP) by JBF. In the second group, knee joint tissue was used for homogenization and ROS measurement. In the third group, Losartan (10mg/kg) was administrated orally 2 hours before induction of inflammation. L-NAME increased JVR significantly. JVR in response to AngII was significantly increased. This response was significantly potentiated by L-NAME (P<0.01). Losartan completely blocked the effect of AngII on JVR. Data showed that total amount of antioxidant and catalase activity nonsignificantly increased in inflamed group. Losartan significantly returned the catalase activity of the inflamed joint to the control level (P<0.01). NO plays a role in the regulation of joint vascular tone and modulates theAT1receptor response to AngII in acutely inflamed joints. Ang II increased the production of ROS and as a result the amount of antioxidants in acutely inflamed joints and this is via angiotensin II and through AT1 receptors.

Age estimation is one of the important issues for treatment planning and determination of patient’s rights in forensic medicine. In spite of various methods which have been introduced for age estimation, there is still no specific practical, non-invasive, and rapid method of age estimation for Iranian population. The aim of this study was to find a precise criteria for age estimation in Iranian native population based on the development of the maxillary and the mandibular third molar teeth.

In this study 750 panoramic radiographs which were taken from 1993 to 2006 and belonged to healthy persons between 5.5-25 years old were collected in 5 different cities. Our criteria for selection of the cities was based on racial and geographic distribution and access to high amount of the cases. The cities were Isfahan, Ahvaz, Mashhad, Kerman and Tabriz. One hundred and fifty radiographs were collected from each city. The radiographs were randomly divided between two radiologists who independently evaluated the development of the mandibular and the maxillary third molar teeth based on Demergian calcification criteria. Statistical analysis was performed by Spearman and Pearson coefficient of correlations.

From 750 paranormic radiographs 535 (70%) and 215 (30%) belonged to females and males respecively. According to the results, in both genders, there is a significant difference between the upper and lower jaws regarding to the tooth development of the third maxillary molar (P<0.05). So that, upper third molars in male people were calcified faster in all Dermirgian phases in comparison with female ones.

Demirgian formation stages is applicable for age estimation in Iranian population. The age of calcification was not similar in male and females that shows the role of gender on teeth calcification stage.

Metritis is one of the causes of maternal morbidity and there are many risk factors for it. Because of the importance of possible association of meconium-stained amniotic fluid and maternal metritis the present study was done to determine whether meconium stained amniotic fluid (MSAF) is associated with puerperal infection. In this case-control study 150 women with MSAF and 150 women with clear amniotic fluid (gestational age > 37 weeks) were compared for puerperal metritis. Subjects’ educational level, gestational age, gravida, mean vaginal exams, route of delivery and mean neonatal weight were not significantly different between the two groups. But mean maternal age and neonatal Apgar were significantly different in the two groups. That is, post partum metritis in women with clear amniotic fluid occured less than women with MSAF (2.7% vs 10%, P<0.014). Since meconium stained amniotic fluid is associated with metritis, special care in this regard is recommended.

Percutaneously inserted double-lumen central venous hemodialysis catheters provide the nephrologist with an excellent temporary access for an immediate hemodialysis treatment and preserve the peripheral veins for the future creation of a permanent arteriovenous vascular access. Unfortunately catheter-related infections are usually common. In this study, the impact of intra luminal vancomycin administration on catheter-related infections in a group of hemodialyzed patients has been investigated. A total of 100 patients with renal failure requiring hemodialysis by way of double-lumen central venous catheters inserted into the internal jugular or subclavian vein in 6 months period, were randomly divided into two groups of receiving a single intravenous dose of 1000 mg of vancomycin during catheter insertion and no antibiotics. The rate of infection, in situ duration of the initial catheter, number of dialysis sessions per week, site of catheter, length of the catheter which was outside of the skin, catheter tip cultures and the presence of systemic infections related to the catheter, were recorded for every patient. The study period was terminated when the initial catheter was changed or removed for any reason. Catheter-related infection was observed in 6 patients: 2 patients (4%) in the first group who received vancomycin and 4 patients (8%) in the second group who received no antibiotic (P= 0.05). In regard to infection, 33.3% of the infections occurred in the first week after catheter insertion, 16.7% in the second week and 50% in the third week and there was no association between the duration of catheter fixation and infection (P= 0.7). The type of the catheter (jugular or subclavian) and the length of the catheter which was outside of the skin had not any effect on the catheter infection (P= 0.5 and P= 0.6 respectively). In all cases infection was due to staphylococcus. It can be concluded that in uremic patients, a single intravenous dose of vancomycin during the insertion of a double-lumen hemodialysis catheter into the internal jugular or subclavian vein has no effect on prevention of catheter-related infections.

Physical symptoms associated with depression and common psychiatric disorders sometimes lead to the misdiagnosis of depressive disorders. The aim of this study was to determine the frequency distribution of different chief complaints in patients with major depressive disorder referring to psychiatric clinics according to their demographic characteristics and source of referral.

The study was done on 246 depressed patients (191 females & 55 males) visited by three psychiatrists in Kerman. Patients’ chief complaints, duration of presenting symptoms, their demographic characteristics and source of referral were recorded and data were analyzed by chi-square.

Pain was more prevalent in women, while somatic complaints other than pain and psychiatric complaints were more prevalent in men. Higher educational level and age were significantly associated with higher rate of presenting psychiatric complaints (P<0.001, P<0.01 respectively). Marital status and duration of symptoms had no significant correlation with the type of somatic complaints. In patients with psychiatric complaints sources of referral were respectively patient’s own referring, general practitioners and specialists other than psychiatrists (P<0.001). In patients with pain complaint sources of referral were respectively patient’s own referring, specialists other than psychiatrists and general practitioners.

Somatic complaints are frequently present in depressed patients. Cultural differences in presenting complaints, stigma in referring to psychiatrists, general practitioners’ and specialists’ attitudes and knowledge toward psychiatric disorders affect appropriate and early diagnosis of major depressive disorder. Improving the knowledge of general practitioners about depressive disorders decreases mortality rate, social functioning disturbances, unnecessary expenses and the risk of unnecessary clinical procedures in these patients.

Leiomyoma of the female urethra is a rare condition and there have been only 35-40 reported cases in literature. We report a 20-year-old woman who had referred with a painless mass in her vaginal vestibule, dysparonia, dysuria and previouse history of urine retention for two times. After clinical examination, imaging studies (US, MRI) and cystoscopy a mass in urethra protruding to vagina and bladder was diagnosed. She underwent biopsy and complete surgical resection. Histopathological study revealed urethral leiomyoma and after operation all symptoms disappeared.