مجله مطالعات علوم پزشکی
سال بیستم شماره 3 (پاییز1388)

Single Stranded Conformational Polymorphism as a molecular PCR based method has been significant for rapidly identification of fungal species. This method was previously used for the other aims including analysis of mutations as well as identification and discrimination between some organisms. In the present study, we tried to use the free digestion method of SSCP for discriminating Aspergilli in the species level considering polymorphism patterns between them. Totally 205 Aspergillus strains were isolated from clinical and environmental specimens being collected in some Iranian approved hospitals and from medical mycology lab - School of Public Health, Tehran University of Medical Sciences. The sample size of this study was based on the prevalence; 1% of Aspergillus infections among total of fungal nosocomial infections. All of the Aspergillus isolates, were identified by using four Aspergilli differential media including, CZA, CYA, CYA20S and MEA, followed by macroscopic and microscopic examinations. In the molecular assay, we extracted DNA manually using Glass beads and Phenol chloroform method, followed by PCR amplification of ITS2 region and then thermal denaturizing DNA to make single stranded DNA. Finally, we compared differentiate patterns of electrophoresis bands. During an 18 month study, we obtained 205 Aspergillus isolates including 11 species, from the hospital and environmental specimens. Hospital sources included clinical (25%) and environmental (75%) isolates. Our findings of SSCP method included: A. nidulans, A. fischeri, A. quadricincta, (A.fumigatus, A. niger) as a category and (A. flavus, A. terreus, A. ochraceus) as the other category. SSCP as a rapid and simple molecular method enabled us to identify most important pathogenic Aspergillus species. The above technique is not commonly used because of the low specificity.

Major depression is a mood disorder and the most common psychological disorder. As consistent findings in the major depressive disorder (MDD) denote for a low plasma folate and elevated plasma homocysteine concentration s; the results of studies are controversary. In addition, there has been no previous investigation on the effects of administration of folic acid on plasma homocysteine levels in patients, so the present study aimed to assess the effect of folate supplementation plasma homocysteine levels in patients with major depressive disorder. This study was a double-blind, placebo-controlled trial of 70 MDD patients that were randomly assigned to receive fluoxetine together with either 1 mg folic acid or an identical looking placebo daily for 8 weeks. All patients met the DSM-IV criteria for major depression and had a baseline Hamilton rating scale score of 20 or more. Baseline and 8-week estimations of plasma folate and homocysteine levels were determined by kits and with radioimmunoassay method and Enzyme Immunoassay method. The statistical analysis was conducted with the software package SPSS 11.5 and by paired t-test, independent t-test, and chi-square. Correlations were performed using Pearson’s correlation coefficient. The results of the present study indicated that after 8 weeks, supplementation plasma homocysteine significantly decreased in women by 32%, (p=0.001) but there was no significant change in men. According to Hamilton rating scale women who received the folic acid supplement, showed a good response as compared to women in placebo group (P<0. 05) but there was no significant difference in treatment response between the men of two groups. According to Hamilton rating scale 88.9 percent of women in case group showed a good response (50% reduction in score) as compared to 59.3% women in placebo group (P<0. 05) but there was no significant difference in treatment response between the men of two groups. These finding suggest that Folic acid supplementation is a simple method for decreasing plasma homocysteine levels.

Vision is an important indicator of health and life quality. The latest estimates of the World Health Organization indicate that there are 161 million visually impaired people worldwide. The most common reason for impaired vision may be refractive error. This research was performed to determine the frequency of refractive error s in ophthalmic patients of Urmia Imam Khomeini Hospital. This cross sectional and descriptive study was performed on 451 patients with refractive error which referred to Imam Khomeini Hospital of Urmia. The samples were selected randomly and the d ata collected by using questioner and the results were analyzed using SPSS software. In this study the frequencies of refractive errors were: Plano 41 eyes (4.5%), Hyperopia 71 eyes (7.9%), Myopia 290 eyes (32.2%), Astigmatism 73 eyes (8.1%) and Mixed 427 eyes (47.3%). Most frequencies in all samples with refractive errors were mixed (268 patients, 59.4%) and the least frequencies in all of samples with refractive errors was Astigmatism (29 patients, 6.4%). There was no significant relationship between the frequencies of refractive errors in men and women (P>0.05). All of refractive errors were within the limits of 0-4 diopter. This research was performed to determine the frequency of refractive errors in low size samples and that is incomparable with other researches that performed to determine the prevalence of refractive errors in high size samples. We suggest the further and future studies to determine the prevalence of refractive errors with high samples size.

One of the most common causes of Epiphora or abnormal tearing or recurrent infection is Dacryocystitis. The Dacryocystorhinostomy involves fistulization of the lacrimal sac into the nasal cavity which may alleviate the symptoms. This research was performed to study three year results of the DCR with silicone tube in patients who had Dacryocystitis in Urmia Imam Khomeini Hospital, during 2004-2006. This cross sectional and descriptive study was performed on 189 patients who referred to Imam Khomeini Hospital of Urmia. All patients who underwent DCR in three years during 2004-2006 were studied. The d ata were collected using a questioner including age, sex, form of the affection, the affected eye, complete recovery or a relative one, etc, then the results were analyzed in SPSS software using descriptive, Chi-square and Fisher tests. In this study, 194 eyes of 189 patients (50 males, 139 females) were studied. The average age of the patients was 46.22 years old (rang 30 - 60 years). Common presentations were epiphora and purelant discharge (56.1 %). Five of them had (2.7 %) bilateral involving and 184 (97.3%) had unilateral one. From 189 patients, 102 (20 male & 82 female) were followed up as they collaborated. The surgeries were successful in 84 cases (82.4 %). This study showed that the patients over 60 years old were more successful than the others. The rate of recovery among unilateral groups was more than bilateral ones. The rate of recovery is high at over 60 year old groups, so it is recommended that the patients of this group undertake a therapy with DCR.

Antidepressants are very common therapeutic agents in medicine. Design and using new antidepressants have built a new scope for depression treatment. Bupropion is an atypical antidepressant but it is used as an anti-smoke agent widely due to its smoke cessation. Its effectiveness in producing smoking cessation seems independent of its antidepressant effects. The study of synaptic effects of bupropion can reveal its mechanism for nicotine dependence cessation. This study has tested the effects of bupropion on evoked responses of rat hippocampal slices. 16 hippocampal slices from 18-25 old age rat pops were tested. The hippocampal slices have been prepared according to standard techniques. Bupropion was perfused in ACSF (2 mmol) for 30 minutes. The amplitude of population spikes (PS) amplitude of Stratum Radiatum was measured before and after bupropion perfusion. Amplitude of PS before bupropion perfusion fitted as 100% for baseline. Bupropion (2 mmol) abolished PS of all slices for different periods. PS disappeared in 37.5% of slices for 1 hour, 25% for 1.5 hour, 12.5 % for 2 hour, and 25% for 4 hour or more. Bupropion disappeared PS 5-15 minutes after perfusion. Bupropion abolished or decreased PS amplitude. The results have showed that bupropion can decreases LTP or synaptic plasticity and alters the synaptic behavior in drug dependence.

Annually from one billion gastroenteritis patients 3-5 million children die world wide. Etiologic agent in developed countries is viral in 15-60% of cases, while in developing countries bacteria and parasites are frequently reported as etiologic factors. Neurologic signs including convulsion are seen in some cases with diarrhea, which may be accompanied with or without fever and may have electrolyte imbalance. Convulsion with gastroenteritis is mostly benign, usually without changes in EEG or cerebrospinal fluid. Tabriz Children Hospital is a center for complicated cases of gastroenteritis including convulsion. This study aimed to investigate the etiology, risk factors and short term prognosis of gastroenteritis with convulsion. This descriptive-cross sectional study was done during three years in Tabriz Children Hospital and 50 children at the range of two months to seven years old having gastroenteritis with convulsion were enrolled into the case group. Equal number of children at the same range of age having gastroenteritis without convulsion were included in the control group. The case and control groups were matched considering age, sex, and duration of the study. Body temperature (BT), severity and type of dehydration, stool exams, cultures, history of convulsion in subjects and first degree relatives, electrolyte imbalances, and short term prognosis were studied. There was no significant difference between the groups regarding age, sex, and weight, while the fever at the time of admission, history of convulsion in first degree relatives and severity of dehydration were significantly higher in the case group (P<0.001). The BT of the case group at time of admission was higher than the control group (39.01±0.80 vs. 37.52±0.67 o C). Also the frequency of history of convulsion in the patients, shigellosis and antibiotic usage were significantly higher in the case group (P=0.025, P=0.014, and P=0.001 respectively). Convulsion mostly common in mild gastroenteritis accompanied with high fever and positive history of convulsion in the first degree relatives. The history of convulsion in the patients and shigellosis were causes of the relative increased occurrence of convulsion in patients with gastroenteritis. Electrolyte imbalance did not play a significant role in the development of convulsion.

The aims of this study were to represent the efficiency of Endoscopic Ultra Sonography in determining the place of insulinoma and assessment communication between tumor size and careful diagnosis of this method. Endoscopic ultra sonography is a method for determining the place of pancreatic tumor before a surgery. Suspected insulinoma patients based on clinical and laboratory entered in this study; all of them underwent Endoscopic ultra sonography investigations before operation. In 16 patients, (9 men and 7 women) with an average age of 52.5 years, sonography and then surgery was done. In all the patients CT scan as a supplementary recognition method was done. Sensitivity and specifity of endoscopic ultra sonography for identifying insulinoma was 70.58 and 60.6 percent and for tumor of head and body of pancreas was 83.3 and 66.6 percent Endoscopic ultra sonography is an accurate method in order to identify insulinoma; the accuracy of the method depends on the tumor site and is greater in tumors that locate in the head of pancreas

Pregnant ladies always have the stress of the delivery. One of the methods to reduce the stress and pain of pregnant mothers is the body stretch along with music. We have done the following study in order to reduce the stress and pain of delivery. The study was done on 20 pregnant women. The light melody of iguana dance was selected. The music was played at the active phase of labor. We compared results with Fisher test and T-test. The results showed that listening to music reducing the stress and pain of delivery. We considered the stress of delivery; there was no obvious difference between the two groups before delivery. The hidden stress and comparison of pain after delivery was compared in both groups after delivery, which showed increase in the control group (P= 0.009) but no significant difference was in the study group (P= 0.002). There are different ideas how the music effects the pain centers, through psychological or nerve endings effects. From psychological point of view music has calming down effect through the enhancing, of positive condition, which results in well being and causes release of pain. We suggest that more attention should be paid to patients in gynecology and also other medical wards.

Dimethoate as an organophosphorus compound is commonly used for crop production which is neurotoxic in human. Pseudomonas family harbor organophosphate degrading plasmids have been known as tools for cleaning environmental pollutions. Pseudomonas Putida was isolated from contaminated soil being identified and optimally cultured in mineral medium and was enriched with dimethoate. Bacterial utilization of dimethoate was determined by acetylcholine esterase inhibition (toxicity). The degrading plasmids for hydrolytic enzymes were deleted by acridine orange and transferred from resistance to sensitive strain. Dimethoate was optimally utilized at 0.8 g/L concentration in mineral solution. The maximum dimethoate concentration tolerate by this bacterium was up 4.0 g/L in nutrient broth. The bacterial growth increased more than 2 folds in medium containing dimethoate in comparison with inorganic phosphate. Total proteins’ content that increased up to 357 mg/L was used as a known neuro-toxicity marker. Acetylcholine esterase activity was decreased by dimethoate in concentrations of 0.2 - 2.0 g/L in linear order but the inhibitory effect of dimethoate residue decreased 50-95% in P. Putida culture containing 2.0 g/L dimethoate after 48 - 96 hrs respectively. The resistance strain was lost degrading plasmids by acridine orange. The resistance plasmids were also transferred to sensitive strains. The mentioned plasmids express organophosphorus degrading enzymes and are supposed as effective techniques for cleaning of organophosphorus compounds as anti-nerve poisons and may be applicator of adverse effects of organophosphoruse compounds by modern technologies.

Arteriovenous Malformation(AVM) is one of the most common etiologies of subarachnoid hemorrhage. In the past, conventional angiography was the only way for the diagnosis of AVM but nowadays, using noninvasive devices such as MRA and recently TCD, the diagnosis of AVM is revaluated. This patient is a 19 year old man who was admitted for a severe headache and convulsion after its onset. Despite of overt signs of meningeal irritation, the axial brain CT scan was normal so lumbar puncture was performed and the diagnosis of subarachnoid hemorrhage was documented. First with the diagnosis of Aneurysmal subarachnoid hemorrhage, TCD sonography was done but surprisingly blood flow indices were indicating the presence of an AVM in the territory of right MCA and MRA established it. TCD not only can anticipate the risk of vasospasm in the patient with subarachnoid hemorrhage, but also it can reveal AVM as the second etiology of subarachnoid hemorrhage. So it is recommended that blood flow indices should be noticed in any patient with the diagnosis of subarachnoid hemorrhage for early recognition of AVM.

Shared psychotic disorder is a type of disorder in which two or more individuals develop a psychotic disorder. The primary case usually has a major psychotic disorder and other individuals (secondary case) who are passive and suggestible, accept the psychotic symptoms of primary case and become psychotic. This disorder is rare, and the previous references consist almost entirely of case reports. In this literature a case of shared psychotic disorder has been reported. A seventeen year old girl -Miss A - had a three year history of psychotic disorder. During observation from her family members it has been specified that her mother, sister and brother also had same psychotic symptoms, for example: persecutory delusion and auditory hallucination. This family had an isolation condition from society. Miss A’s family lives in isolation from social community. In these situations the family members are in exposure of a great number of psychiatric problems. As a principle of mental health policies the families must been encouraged to have relationship with other families in a moral and lawful basis.

The sciatic nerve, posterior cutaneus nerve of thigh, and inferior gluteal nerve are branches of sacral plexus. They leave the pelvis via greater sciatic foramen and arises in gluteal region in infra piriformis fossa. The sciatic nerve usually divides at the upper angle of the popliteal fossa to common peroneal and tibial nerves. There are different variations in course of these nerves. Here common peroneal part of sciatic nerve, part of posterior cutaneous nerve of the thigh and inferior gluteal nerve leave the pelvis above and tibial part of sciatic nerve and part of posterior cutaneous nerve of thigh pass inferior to the piriformis muscle to enter the gluteal region. Variations in these three nerves are rare and are of clinical and surgical importance