Razi Journal of Medical Sciences

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Background & Aims: Diabetes Mellitus (DM) is an incurable disorder with various complications that causes damage to various organs. According to reports, 463 million adults worldwide suffer from DM, which is expected to increase to 578 million by 2030 (1).
Hyperglycemia is the most common symptom of diabetes, which is caused by an autoimmune disease of pancreatic cells, ultimately leading to a decrease in insulin secretion in type 1 diabetes (T1DM) or insulin resistance in type 2 diabetes (T2DM). The creation of oxidative stress in diabetic patients and subsequent disruption of vascular endothelial function directly and indirectly affects the function of the human reproductive system (1,2). It has been shown that half of the men with diabetes have poor semen quality and dysfunctional reproductive system. These factors are influenced by various mechanisms such as neuropathy, endocrine disorders and oxidative stress. According to various reports, erectile dysfunction (ED) occurs in 59% of men with diabetes. ED is caused by hyperglycemia because it increases the amount of ROS (reactive oxygen species) and advanced glycation end products (AGEs) and by disrupting the metabolism of eNOS (endothelial nitric oxide synthase), it decreases the synthesis of nitric oxide (NO)(3,4). Nitric oxide is an unstable messenger molecule that plays a role in the regulation of gonadotropin hormones, sperm capacitation, erection and ejaculation (5). Oxytocin, which induces mating behavior in both sexes, induces the release of gonadotropin-releasing hormone (GnRH) through the production of NO. Also, NO controls the mating behavior in men through neural mediators related to ejaculation, so that the inhibition of nitric oxide synthesis reduces the frequency of ejaculation and the duration of ejaculation by reducing the activity of the sympathetic nervous system. Many researches show that testosterone levels decrease in diabetic men (5). A decrease in vascular endothelial growth factor (VEGF) may disrupt the function of vascular endothelial cells, which leads to blockage of small arteries (microcirculation) in the testis, which in turn causes morphological and structural changes (6,7). It is believed that in immature rats, DM can cause gonadal growth retardation, decreased sexual behavior and testosterone synthesis while promoting gonadal atrophy (6,7). In both type 1 and type 2 diabetes animal models, studies have shown a significant decrease in antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) and a significant increase in malondialdehyde (MDA) levels (15,16). Also, studies in type 2 diabetic mice have reported upregulation of pro-apoptotic protein BAX and downregulation of anti-apoptotic protein Bcl-2. Apoptosis is a physiological process that occurs in order to remove damaged cells in testicular tissue and other tissues and plays an important role in tissue compatibility. The process of apoptosis occurs in two internal (mitochondria-dependent) and external (ligand-dependent) pathways. In the internal pathway of apoptosis, the Bcl-2 family includes BAX and Bcl-2 proteins as the upstream regulators of apoptosis. Bcl-2 is one of the apoptosis-inhibiting proteins that prevents the oxidative destruction of the cell and by maintaining the integrity of the mitochondrial membrane by removing H⁺ ions, it binds to the apoptotic protease activation factor and activates caspase 9 (17,18).This decrease in antioxidant capacity and the predominance of oxidant conditions in diabetes cause structural changes in the testicles, decrease in sperm production, decrease in sperm motility and decrease in the number of Leydig cells (testosterone secreting cells) and Sertoli cells (13,19).
 Sedentary lifestyle is one of the causes of type 2 diabetes. Physical activity is the most powerful factor in preventing diseases such as obesity and diabetes. Exercise reduces oxidative stress, increases antioxidant capacity and reduces insulin resistance (27). Physical activity increases the uptake of glucose by muscle tissues and reduces blood glucose (28). It has also been reported that physical exercises protect cells from apoptosis and improve spermatogenesis and increase sex hormones (29). However, according to our knowledge, these new evidences that investigate the effect of physical activity on blood sugar levels, sex hormones, antioxidant enzymes, oxidative stress and apoptosis indicators of testicular tissue of diabetic patients, have not been critically evaluated. Therefore, in this article, we review the published evidence to determine whether physical activity can be used as a therapeutic tool for the sexual health of patients with type 2 diabetes. It is hoped that the information presented will be valuable to physicians, exercise physiologists, and those interested in personal or public health..
Methods: This study was conducted in April and May 2024, focusing on investigating the effects of physical activity on some health and fertility indicators of the reproductive system of diabetic patients. Pub Med, Science Direct, Med Line, SID and Google Scholar databases were used in this study. Also, the keywords "diabetes", "diabetes and sexual diseases", "physical activity and diabetes", "physical activity and sexual health" were used to search for articles. The criteria for selecting articles for this study included the following: 1- Original and scientific-research articles. 2- The studied samples should not have any other disease apart from diabetes. 3- The exercise protocols used in the articles should not be short-term or acute. 4- The articles have only examined the response to sports activity (without the use of various medical drugs). The exclusion criteria for articles from this study included the following: 1- Review articles. 2- In the articles, drugs and blood sugar lowering supplements have been used. The articles used in this study were in the time range between 2015 and 2024. 25 articles were collected from scientific databases, and after reading the articles, 11 articles were included in the present study. Results: The results of the present study showed that regular physical activity reduces blood sugar levels, increases sex hormone levels, antioxidant enzymes and oxidative stress, and apoptotic indices of testicular tissue of diabetic patients. The proposed mechanism for reducing blood sugar, improving antioxidant defense and increasing the levels of sex hormones and reducing apoptotic proteins due to regular exercise can be pointed to the fact that physical activity increases the muscle response to insulin through the expression and increases the activity of proteins involved in carbohydrate metabolism. So that physical activity increases the activity of glycogen synthetase and the expression of glucose transporter 4 (GLUT4) proteins. Also, research results have shown that exercise increases insulin sensitivity in diabetic patients and facilitates the entry of blood sugar into muscle cells, which ultimately leads to a decrease in blood sugar levels.
Conclusion: The results of this study show that regular physical activity can reduce blood sugar, increase the levels of sex hormones, increase the activity of antioxidant enzymes, reduce oxidative stress, increase anti-apoptotic factors and decrease pro-apoptotic factors.

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Introduction
Septorhinoplasty surgery is a common and popular procedure in Iran, known for its significant impact on improving the quality of life, self-confidence, and overall life satisfaction of patients. This surgical technique is well-established and precise, aiming to enhance both the aesthetic and functional aspects of the nose. However, a common challenge associated with septorhinoplasty is the development of ecchymosis, a condition characterized by swelling and bruising, which can be severe and, in some cases, even fatal. This postoperative complication often leads to patient dissatisfaction.
Recent years have witnessed a growing interest in the potential of PDL (Pulsed Dye Laser) treatment to mitigate ecchymosis following septorhinoplasty. Several studies have explored the efficacy of laser therapy in reducing the severity and duration of ecchymosis in the postoperative period. PDL laser treatment, with its targeted and non-invasive approach, has shown promise in effectively reducing bleeding and accelerating the natural healing process. This positive outcome is likely attributed to its ability to increase blood flow, promote lymph drainage, reduce inflammation, and enhance tissue generation. Consequently, PDL laser treatment appears to expedite the healing process for patients undergoing septorhinoplasty. Furthermore, the precision and controlled nature of laser therapy allow for specific treatment methods, thereby minimizing side effects and optimizing patient comfort. The non-invasive nature of this approach provides a favorable alternative to traditional methods, reducing the risk of further damage to delicate nasal tissues and ultimately facilitating a smoother recovery for patients.
Recovery outcomes vary among different articles due to the duration of the study and individual patient conditions. In future studies that provide more detailed insights, a clearer understanding of the types of lasers and the extent of improvement achievable with each can be obtained. This review aims to examine recent articles in this field to present the results, ultimately aiding in informed decision-making regarding the use of PDL laser therapy after septorhinoplasty.
Method
The process of investigating the role of PDL laser in reducing ecchymosis after septorhinoplasty commenced with a thorough research methodology. Keywords such as "laser," "ecchymosis," and "septorhinoplasty" were employed to search various academic databases, including Pubmed, Google Scholar, and the Cochrane Library, for relevant studies. Specific filters were applied to refine the search, including parameters related to publication date, study design, and subject relevance. Priority was given to peer-reviewed articles, clinical trials, systematic reviews, and comprehensive meta-analyses published within the past decade to ensure that the review encompassed current and relevant research. Additionally, the selection criteria focused on studies that specifically investigated the application of PDL laser therapy to reduce ecchymosis following septorhinoplasty.
The selected articles underwent meticulous evaluation, considering methodology, sample size, study design, and the results of laser treatment in managing ecchymosis. Particular attention was given to the quality of evidence, statistical significance, and the identification of any potential limitations or biases within the studies. Subsequently, a detailed analysis of key findings was conducted, emphasizing the mechanisms of action, efficacy, and potential challenges associated with the utilization of laser therapy to reduce ecchymosis after septorhinoplasty. This analysis aimed to ensure that the clinical outcomes related to the procedure were adequately addressed. By comprehensively analyzing the available information, the objective of this review is to provide an informed perspective on the role of laser therapy in managing ecchymosis after septorhinoplasty surgery, contributing to the advancement of knowledge and the enhancement of patient care in the field of septorhinoplasty.
Results
In the study conducted by Alegre-Sánchez et al., involving 34 patients aged between 28 and 79 years, ecchymosis resulting from various causes, including trauma, surgery, and cosmetic procedures, was investigated. The study aimed to assess the effectiveness of PDL laser treatment with varying parameters. The findings indicated that shorter pulses (0.5 ms) and higher fluences (8 j/cm2) were more effective in treating ecchymosis, particularly in cases of severe ecchymosis. Older, milder, and deeper ecchymoses exhibited a lower response rate.
DeFatta et al. conducted a study to explore the effectiveness of PDL laser (6 j/cm2, 6 ms) in reducing ecchymosis following cosmetic procedures in 20 patients. Their research revealed a 63% improvement in ecchymosis within 48 to 72 hours of laser treatment. Moreover, the rate of healing was higher when laser therapy was administered between days 5 and 10 after the onset of ecchymosis. Two other studies reported that the rate and speed of recovery from ecchymosis following PDL laser treatment were significantly higher than in control groups.
Discussion
Septorhinoplasty is widely recognized as an effective cosmetic procedure both in Iran and across the globe. Consequently, significant efforts have been devoted to addressing the challenges associated with this surgery in recent years. Among these challenges, ecchymosis stands out as a worrisome complication during the early postoperative phase. To mitigate these challenges, this study investigates the potential of laser therapy in rhinoplasty patients.
The application of lasers in this context generally contributes to a faster resolution of ecchymosis, providing a smoother path to recovery for patients. This positive outcome is attributed to the reduction of inflammation, improved blood circulation, and increased lymph drainage. Laser therapy allows for precise treatment methods, minimizing damage to sensitive nasal tissues during the healing process. However, it is important to note that further research is necessary to confirm the long-term efficacy and possible complications associated with laser therapy in this field.
The capability of laser therapy to expedite the resolution of bruising and promote rapid healing significantly enhances patient satisfaction and overall surgical outcomes. Recent studies have demonstrated the effectiveness of low-level laser therapy in various medical conditions, ranging from diabetic foot to androgenic alopecia, post-chemotherapy mucositis, wound healing, and inflammation.
Harsant et al. explored the effects of low-level laser therapy in facial plastic surgery, highlighting its impact on flap survival, wound healing, alopecia, and potential effects on skin aging. They recommended further comprehensive data in this field and considered the use of laser therapy as an adjuvant treatment. Moreover, Alegre Sanchez et al. and Fata et al. indicated the potential of low-level laser therapy in reducing ecchymosis. However, it's important to note that none of these studies were case-control studies. In another meta-analysis, Enwemeka et al. emphasized the highly effective role of laser phototherapy in tissue repair and pain reduction, positively impacting all three stages of tissue repair.
The potential effects of low-level laser therapy, as discussed in previous articles, encompass several key mechanisms: Reducing Edema and Inflammation, Restoring Damaged Tissue, Collagen Synthesis, Increasing Elasticity, Reducing Pain, Increasing Tissue Perfusion and Neovascularization, Increasing Cell Proliferation, and Especially Fibroblasts.
An accepted theory regarding the biological mechanism of photomodulation suggests that it involves the absorption of light by chromophores. These mechanisms, especially the recovery of damaged tissue and neovascularization, can effectively reduce edema and ecchymosis following rhinoplasty.
In a study conducted by Saedi et al., the Visual Analog Scale (VAS) scores in the laser-treated group were reported as better than those in the control group. However, it's worth noting that this difference was not statistically significant. Possible explanations for this inconsistency could include patients experiencing post-surgery stress or focusing on all parts of their face rather than just the area around the eyes. Additionally, if patients do not report a significant difference after laser surgery, the treatment may not fully serve its intended purpose. This discrepancy may also account for the differences in perceptions between the researchers and the patients involved. Nevertheless, the findings of this study demonstrated a positive effect of low-power laser therapy on ecchymosis that persisted for up to one month.
While the precise results may vary across different studies, there is a general consensus that the use of laser therapy is effective in reducing ecchymosis following surgery. Patients who undergo septorhinoplasty and receive laser treatment post-surgery tend to experience a swifter healing process. Moreover, certain studies have highlighted the benefits of laser treatment, such as the reduction of side effects and increased patient comfort compared to traditional treatment methods. The available data strongly support the notion that laser therapy plays a pivotal role in the management of ecchymosis following surgeries, including septorhinoplasty.
However, it's important to acknowledge a limitation of this treatment method, namely its cost, which may pose a barrier to its widespread adoption. Despite the positive results observed in this study, the extensive use of PDL in reducing ecchymosis after surgery necessitates longer-term follow-up and further studies with larger sample sizes and diverse intervention types to comprehensively evaluate its benefits and cost-effectiveness.

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This research was carried out with the aim of the effect of individual characteristics on the resilience of entrepreneurial behavior with the mediating role of development factors, environmental inhibitors and the moderating role of labor market dynamics in Alborz Technical and Vocational University. The research method of the current study is descriptive and survey type. Questionnaire and Likert scale tools have been used to measure the research indicators. This tool was examined and confirmed using face and convergent validity and Cronbach's alpha and composite reliability. The statistical population of this research is the students who graduated from Technical and Vocational University of Alborz province, who are currently entrepreneurs, and based on the inquiry and investigation of the researcher, their number is about 30 people. The measurement tool has been adapted and used by experts and their views. SPSS22 and Smart PLS3 software were used for data analysis. To check the normality of the data, the Kolmogorov-Smirnov test was used, the confirmatory factor analysis test was used to verify the validity of the questions and to specify the key factors of each component, and structural equation modeling was used to check the fit of the research model with the collected data. Is. The findings show that individual characteristics directly and indirectly through dynamic marketing capabilities play an important role in developing the resilience of entrepreneurial behavior. To contextualize this role, this research shows that market dynamism moderates the mediating relationship between individual characteristics and resilience of entrepreneurial behavior through developmental factors.
 

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Background and Aim: New progress has been made in more than one field of sports science. One of the most important and current topics in the development of this field is the science of practice. In recent years, coping with a sedentary and car-free life is of particular importance to societies today, as doing exercise programs has become an undeniable necessity for disease prevention and quality of life. Noses. According to the design of exercise science, the best type of exercise to record the best record is the exercise that becomes the same sport according to the physiological needs and had the most similarity with its competitive conditions.Therefore, better selection and design in special training for swimming and water polo training needs to be found due to the competitive competition during the working group, which needs to maintain higher physical and motor fitness. In this regard, exercise immunology studies have focused on key components of immune functions such as immune cells, immunoglobulins, glutamines and messenger molecules (cytokines) and the effects of environmental, nutritional and exercise factors. Meanwhile, interleukin10 attracts a lot of attention because on the one hand it is in the post-exercise period that increases insulin release and on the other hand it is associated with obesity and decreased insulin function. There are conflicting findings about the appropriate intensity to reduce inflammatory factors and observe the anti-inflammatory effects of physical activity. Exercise with moderate and high intensity and duration in the training period has a greater effect on inflammatory variables and reduces inflammatory factors, and lower intensities have less effects. Although little research has been done on the relationship between intermittent exercise and changes in interleukin and interleukin10; But mainly in them, only nutritional and medical interventions are emphasized and more on patients. In the present study, the changes of these factors in relation to the adaptations of intense periodic training on water polo athletes without nutritional and pharmacological considerations are investigated. Finally, it seeks to answer the question, what effect does eight weeks of selected training have on the serum levels of Interleukin-10 and TNF-α elite water polo players?
Methods: The aim of this study was to evaluate the effect of eight weeks of selected training on serum levels of IL-10,TNF-α of elite water polo players. For this purpose, 20 male water polo players (with a mean age of 23 years) were randomly divided into two groups of 10 experimental (selected water polo training) and control (traditional water polo training). Selected water polo training was performed for eight weeks and 6 sessions per week. To control the intensity of training, used percentage of maximum heart rate (80-100% MHR); Also, the intensity of training was increased by 5% every week. In this study, To evaluate the serum levels of IL-10,TNF-α 5 cc of venous blood was taken in the pre-and post-test stages and measured by sandwich ELISA method. To compare the measured means,t-test was used at a significant level of P <0.05.
Results: The results showed that eight weeks of selected water polo training caused significant changes in IL-10 levels of elite water polo players (P <0.05), however, there were no significant changes in TNF-α levels.
The results of the present study showed that eight weeks of selected water polo exercises had a significant increase in serum IL-10 level in the experimental group but these results did not show a significant increase in TNF-α serum level in the experimental group. Consistent with our research results, many studies have reported an increase in anti-inflammatory cytokines after a period of exercise (29,30,31). Among the studies that examined the effect of exercise on serum interleukin-10 levels; According to the results of our study, Baldusi et al. (2010) in a study measured the effect of one year of aerobic and resistance training on diabetic patients and observed a significant increase in interleukin 10 in one of their research groups compared to the control group. The results of some studies have also shown that obesity causes the production of TNF-α, leptin and proinflammatory cytokines such as 4-IL and 5-IL in patients with asthma (8). Regarding studies close to the present study, we can refer to Nikzad et al. (2017), who showed that twelve weeks of swimming training (on mice). Has decreased the amount of proinflammatory cytokine 6-IL. Ebrahimpour et al. (2017,) also showed that 8 weeks of endurance swimming training increased the inflammatory effects of breast cancer by increasing interleukin-10 and decreasing interleukin-6 in heart tissue(3). Also, the research of Kapomakio et al. (2011) on the effect of physical exercise on swimmers, an increase in interleukin-6 expression levels and no change in interleukin-6 receptor in the training group compared to the control group was observed. Rihaneh et al. In 2013 achieved almost the same findings, so that in the studies of these researchers, 6-IL was significantly increased as a result of exercise(25). our results showed that eight weeks of selected water polo training caused significant changes in plasma levels of interleukin-10 elite water polo players, however, it could not cause significant changes in plasma levels of TNF-α.
 

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Abstract:
Background: Suicide is a phenomenon which has plagued humans life throughout history from traditional relationships in the past to complex one s in modern life, so it has many consequences in different societies. Studies have shown that people who attempts to commit suicide are suffering deficiencies, emotional disturbance and difficulty in emotion regulation. According to these studies, ineffective emotion regulation strategies such as self-blame, rumination and catastrophizing have a stronger relationship with indicators of emotional problems such as suicide and aggression. As a result, the process of emotion regulation and its management is necessary in different situations. Emotional distress is a natural cognitive phenomenon that all people experience in certain situations of life. There are many evidences for this claim, but the intensity, frequency and controllability of this phenomenon are different in different people. [9]
Emotion regulation refers to an individual’s ability to be aware of and control the emotions they experience. It plays a significant role in preventing suicidal thoughts or actions. People unconsciously employ emotion regulation strategies throughout the day to cope with challenging situations. Many individuals use various strategies to regulate their emotions and adapt to environmental demands. Healthy strategies can moderate intense feelings and enhance understanding of the emotional experiences. Conversely, unhealthy strategies may leave lasting damage. Emotional regulation empowers individuals to better manage their emotional states. Unified transdiagnostic treatment is recognized as a novel psychological intervention with proven effectiveness for various emotional disorders.[14] In this study, we investigated the impact of unified transdiagnostic treatment on emotional dysregulation and difficulties in emotion regulation among patients with a history of suicide attempts. The core of this intervention is awareness, especially emotional and cognitive awareness, and identification and control of different emotions.
The main objective of this study is to examine the effectiveness the outcomes of unified transdiagnostic treatment for emotional disorders with those of emotion-focused transdiagnostic treatment in patients with a history of suicide attempts.
Method: The research method employed was a semi-experimental design with a pretest-posttest control group. For this study, 50 patients aged 18 to 40 years with at least one diagnosis of emotional disorders were purposefully selected from Baharloo and Roozbeh hospitals in the year 2023. During the course of the study, 6 individuals (4 from the experimental group and 2 from the control group) dropped out, resulting in a final sample of 44 participants divided into two groups of 22 each (experimental and control). In addition to standard interventions, the experimental group received an unified transdiagnostic treatment (Barlow et al., 2017) consisting of 8 sessions lasting 90 minutes each, while the control group received routine interventions during the same period. Data were collected using standardized questionnaires assessing emotion regulation difficulties (DERS) and emotional distress (DASS-21). Statistical analysis was performed using SPSS version 26.
Results: In the post-test phase, the unified transdiagnostic treatment group showed improvement in emotional dysregulation scores and difficulty in emotion regulation compared to the control group. Additionally, the analysis of Covariance revealed that the distribution of scores in both emotional dysregulation and difficulty in emotion regulation variables is normal. Furthermore, statistical analyses indicated that there is a significant difference between the post-test mean scores of the experimental and control groups in at least one of the emotional dysregulation and difficulty in emotion regulation variables. The results of the multivariate analysis of Covariance showed that the F value for the emotional dysregulation variable was 188.912, and for the difficulty in emotion regulation variable, it was 207.199, all of which are statistically significant (p < 0.05).
Conclusion: The results indicate that unified transdiagnostic treatment is effective in reducing emotional dysregulation and increasing emotional regulation in patients with a history of repeated suicide attempts referred to Tehran neurology and psychiatric hospitals. Transdiagnostic integrated treatment has been effective in reducing the level of emotional disturbance in patients with a history of suicide attempts. In general, the unified protocol for the transdiagnostic treatment of emotional disorders, using psychological training techniques, emotional awareness training, increasing cognitive flexibility and emotional exposure, deals with emotional disturbance and correcting emotional regulation habits of patients. The unified protocol teaches the nature of emotions and the main components of emotional experiences and helps patients to track their experiences of an emotion, that is, to identify the triggers of emotional experiences, their responses to these emotions and the messages of these responses.[34] This finding is consistent with the studies conducted by Izadi et al. (2019),[33] Ghasemzadeh et al. (2021),[36] Elah Dadian Flavarjani and Gerji (2021),[37] Sauer-Zavala et al. (2021),[27] Galehgirian et al. (2021),[24] and Ehrenreich et al. (2017) [39]. The role of emotion regulation can be highlighted in explaining this finding. The second module of the integrated protocol focuses on psychological education about the nature of emotions and the core components of emotional experiences. It assists patients in tracking their emotional experiences, identifying emotional triggers, their responses to these emotions, and the consequences of these responses. unified transdiagnostic treatment, through emotional awareness and emotion regulation training, helps reduce anxiety, depression, and stress in participants. This intervention fosters improvement in negative emotional experiences.
Furthermore, the results demonstrate that unified transdiagnostic treatment has an effect on reducing and improving emotional disorders and emotion regulation in patients with a history of suicide attempts in the experimental group compared to the control group.This finding is consistent with other studies, including Talkovsky et al. (2017),[42] Davoudi et al. (2018),[47] Fadaei et al. (2018),[48] Sakiris and Berle (2019),[21] To elaborate on this finding, It should be said that one of the mechanisms through which this treatment protocol creates change is emotion regulation. One of the most common emotion regulation strategies is the use of cognitive strategies,[52] the fifth module of the integrated protocol focuses on assessing and modifying cognitive evaluations. It helps patients gain greater awareness of how they interpret and evaluate situations and understand how thoughts impact emotional reactions. The goal of changing cognitive evaluations is to enhance flexibility in evaluative situations. This module assists patients in identifying maladaptive self-appraisals, recognizing the impact of these appraisals on their mood or emotions, and achieving greater flexibility in their thinking patterns.       

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A report of two cases of tuberculosis Arthritis of shoulder joint with different clinical manifestations. The first case a young worker man with pain and pseudo paralysis of shoulder. The second case was an eldery afghani immigrant with a huge cold abcess on the proximal humerus along the long head of biceps tendon.

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    Background & Objective: Being as one of the common problems in neonatal period especially among preterm infants, jaundice can be found among 60-80% of them. One of the traditional drugs used for newborns’ jaundice is shirkhesht(bot.purgative manna) which has been widely used in Iran & Afghanistan. The purpose of this study is to evaluate the effect of shirkhesht on newborns’ indirect hyperbilirobinemia.

Method: In this prospective double-blind assessment, 104 newborns suffering from indirect hyperbilirobinemia in the newborn intensive care unit of Imam Reza Hospital, Mashhad University of Medical Sciences, were selected and then divided into two groups namely case and control groups including 50 and 54 subjects respectively.

Results: In this study there was no significant statistical difference in bilirobin levels of both groups when they were admitted into the hospital. This difference was also not significant after treatment. The average length of admission and phototherapy for case and control groups was 39.12 hours and 35.11 hours respectively which was not statistically significant(p=0.80).

Conclusion: According to the results of this study, using 6 grams (0.21 ounces) of shirkhesht is not more effective than placebo in the treatment of neonatal jaundice.

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    Background & Aim: Listeria monocytogenes has potentiality to cause serious invasive disease in humans and in more than 40 animal species. L. monocytogenes is transmitted from soft cheese, milk, raw meat and sausages to human. The present study was undertaken to find the frequency of L. monocytogenes in poultry, domestic animals, sausage, cheese, milk, and also to determine ctpA(copper transport) gene among them after doing PCR on gel electrophoresis. Materials & Methods: 180 samples from brain, liver and feces of poultry(industrial hens) from 36 birderies, 166 samples of liver, brain, amniotic fluid and feces of cow, horse, sheep and goat, 80 samples of sausage, and 300 samples of dairy from shops in Karaj city were collected. L. monocytogenes was isolated by cold enrichment and standard Australia/New Zealand method. Chromosomal DNA was prepared and used for PCR amplification of ctpA. Then, PCR products ran on agarose gel electrophoresis for detection of the ctpA band. Results: L. monocytogenes was not isolated from poultry samples. These bacteria were isolated from brain and liver of goat and sheep(12.93%), sausage(2.5%), local cheese(2.9%), and milk(2.5%). By using PCR to identify the homologus DNA in 25 L. monocytogenes isolates, 20% of them contained ctpA determinant. DNA homologus to ctpA was not detected in all isolates. Our results showed that 28.57% of cheese and 20% of domestic animal isolates, contained ctpA gene in chromosome DNA. Conclusion: Since ctpA gene was not existent in all isolated bacteria, this might indicate that all the strains do not have the same virulence. CtpA showed significant similarity to the proteins associated with copper metabolism disorders in humans, Menkes disease and Wilson disease. There might be a relationship between these two diseases and ctpA gene in L. monocytogenes. By producing ctpA protein of Listeria to make vaccines it is possible to prevent above diseases in future.

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    Background & Aim: Enterococci comprise an important and diverse group of bacteria that cause disease in human and animals. They reside in the gastrointestinal tract of human and animal, soil, water, foods, and can persist in elevated salt contents and various pH values. They can readily acquire antibiotic resistance and various other virulence factors. In this study, the prevalence of various virulence factors among different clinical isolates versus those isolated from healthy individuals was compared. Material & Methods: In this analytic cross-sectional study, enterococcal strains isolated from clinical and healthy cases were tested for various virulence related properties such as hemolysin, gelatinase, hemoglutinin, DNase, and fremone(aggregative substance) production. T-test and chi-square test were used for analysis of the data and their antibiotic resistance patterns were also determined. The ability to exchange resident plasmids via conjugation was tested by two different mating protocols. Results: The frequency of gelatinase, aggregation substance, and hemolysin production was higher in E.faecalis relative to those in E.faecium. However, no statistically significant difference was detected in the other trains. Fremone-responsive plasmids were common in most isolates and had the ability to transfer between strains with high frequency(10-4-10-7). Most isolates contained one or more plasmids in the 3-98 MDa range. Two isolates showed total resistance to all of the antibiotics tested. Antibiotic resistance genes had the ability for conjugational inter-strain transfer. The prevalence of aggregative substance in the strains isolated from clinical cases was much higher than those obtained from the control group(P<0.001). Conclusion: Since no known protein ecotoxin was identified in enterococci, their pathogenic potential may be attributed to a variety of extracellular enzymes, antibiotic resistance, aggregative substance, and other factors. Their importance in medicine is related to their ability to acquire antibiotic resistance and cause nosocomial infections in hospitalized and debilitated patients. The statistically significant higher proportion of aggregative substance in enterococci spp, isolated from sick people in comparison with those obtained from healthy cases, points to the pivotal role conjugational gene transfer may play in the acquisition of pathogenic potential.

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    Background & Aim: Molecular epidemiology is the using of molecular techniques (e.g. Spoligotyping, RFLP VNTR) in order to study bacterial distribution in human populations. The aim of this study was to investigate the prevalence of all genotypes in M. tuberculosis strains typed by spoligotyping and to determine the associated risk factors in patients with different nationalities residing in Iran. Patients & Methods: In this analytic cross-sectional study a total number of 439 patients who referred to NRITLD (a referral tuberculosis center in Iran) were registered during March 21st 2003 to March 21st 2004. The isolated Mycobacterium tuberculosis strains were characterized by performing susceptibility tests against four first-line antituberculosis drugs and were then subjected to spoligotyping characterization. T-test and ch-square test were used for analysis of the data. Results: Spoligotyping of M. tuberculosis strains resulted in 140 different patterns divided into three evolutionary groups(I, II, III). 122(87.1%) of these spoligotype isolates were unique and reported for the first time. The remaining 18(12.8%) spoligotype patterns were previously reported from other geographical regions of the world. Haarlem family was more prevalent than other genotypes. Interestingly, 6.3% of the strains belonged to the Beijing family. MDR(multi drug resistance), double and triple resistance were seen in group I of evolutionary scenario. Antibiotic resistance was higher in those isolated from Afghan patients(P<0.001). Other risk factors such as sex and age were also contributing factors to the disease state. Conclusion: Results showed that multi-drug-resistance was more prevalent in bacteria isolated from Afghan TB patients residing in Iran. In addition, the spread of M. tuberculosis strains belonging to Beijing family among Iranian patients has to be considered seriously. It is also important to undertake studies to identify which factors are the most significant to consider in tuberculosis control program.

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    Background & Aim: Chlamydia trachomatis is one of the most prevalent causative agents of sexually transmitted diseases. It causes a variety of genital tract complications such as urethritis, cervicitis, endometritis, epididymitis and lymphogranuloma venereum. The prevalence rate of chlamydia induced cervicitis varies in different societies. In a recent study, the prevalnce of chlamydia cervicitis in sexually active American women was in the range of 5-15% and in pregnant women was 1.2%. The purpose of this study was to evaluate the prevalence of different detection techniques, such as ELISA, MIF, DIMA rapid test and direct microscopy after Gimenez staining. Patients and Methods: A total 137 women with cervicitis(diagnosed according to stablished gynecological protocols) who referred to Rasool Akram hospital and Nilo private clincial laboratory were admitted for this study. Two endocervical swabs were obtained. One of them was used for the rapid Dima test and the other swab was subjected to Gimenez staining. Blood samples were also obtained for serological tests. Results: ELISA tests indicated that 18 patients had positive IgG antibody levels in their blood and 4 of them had IgM antibodies against Chlamydia trachomatis. Ten patients had significant IgG levels and 3 of them had anti-Chlamydia IgM according to the MIF test results. Dima rapid detection test was able to show positive results for only 5 patients. We were not able to detect any Chlamydia inclusion bodies with direct microscopy after Gimenez staining. Conclusion: According to the results obtained with MIF technique which is generally considered to be the "Gold standard" serological detection method, the prevalence of chlamydia induced cervicitis was shown to be 7.2%. There was no statistically significant difference in IgM titers detected by ELISA and MIF methods. But there was statistically different IgG titer rates between ELISA and MIF techniques. Therefore, it is suggested that any ELISA positive IgG titer samples to be rechecked and reconfirmed by MIF method. Due to the lack of chlamydia inclusion body detection by direct microscopy, Gimenez staining is not recommended as a diagnostic tool.

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    Background & Aim: Preterm infants born at less than 34 weeks postconceptional age are not as neurologically mature as their term counterparts and thus have difficulty coordinating sucking, swallowing and breathing. As a result, they are traditionally gavage fed until they are able to oral feed successfully. The aim of study was to evaluate comparative effect of orogastric and breast feeding on oxygen saturation in very low birth weight infant(<1500gm). Patients and Methods: In this clinical trial all babies admitted in the Neonatal Research Center of Imamreza Hospital, Mashhad during a 4 months period were elected. Criteria for entrance to study included birth weight ≤ 1500 grams, exclusive breastfeeding, having no special problem after 48 hours, receivinge only routine care and intake of milk was 100cc/kg/day. Each neonate received two rounds of orogastric and breast feeding in the morning and in the afternoon, during which mean oxygen saturation was measured by pulse-oxymetry. During the study the heart rate and temperature of the neonates were monitored, and in case of hypothermia, bradycardia(less than 100 per minute) or apnea the feeding was discontinued and the study was repeated the following day. Data analysis was carried out using SPSS and EPI. For comparison & averages of qualitative and quantitative data one-way variance test and for studying the relation between qualitative data Chi Square test was used. Results: Fifty neonates were studied. The average birth weight was 1267.20±165.42 grams and average gestational age was 31.81±1.92 and female/male ratio was 1.2. There was no significant statistical difference in arterial oxygen saturation in orogastric and breast feeding in the morning and in the afternoon.(p=0.16 in the morning and p=0.6 in the afternoon). There was no complication of apnea, hypothermia or bradycardia. Conclusion: There was no significant statistical difference between the two methods in arterial oxygen saturation. It seems that oral feeding(which is a natural route) and skin contact between the mother and neonate causes a strong emotional bonding between the two and brings about better social adaptation for the neonate. Also shorter period of stay in hospital is more preferred, and breast feeding should be started at the earliest possible time after birth.

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    Background & Aim: Patients with congenital renal abnormality are more prone to calculus formation and have less chance of spontaneous stone passage. Percutaneous treatment of patients with calculi in an abnormal kidney can be challenging due to the altered anatomical relationship in the retroperitoneum. Therefore, we performed a review to assess the safety and efficacy of this minimally invasive technique in patients with congenital renal abnormality. Patients and Methods: We performed percutaneous nephrolithotomy(PCNL) in 15 patients with calculi in anomalous kidneys. Mean age was 34.8 years and 53.3% of the patients were males. The type of anomaly, size of stone, tract site, number of tracts, stone-free rate, transfusion and complication rate and need for secondary intervention were evaluated. Results: Majority of patients had horseshoe kidney(46.7%), 2 cases had ectopic pelvic kidney and 6 others had malrotated and miniaturized kidney. Renal access was obtained through upper pole calyx in 53.3% of the cases, a lower calyx in 33.3% and a middle calyx in 13.3%. Only two cases needed 2 tracts and re-PCNL was performed in 3 cases. Pleural injury occurred in 2 patients and was managed conservatively. There was no need for transfusion. Meanwhile 13(87%) were completely and 2(13%) were relatively stone-free after first or second look procedures. Conclusion: Percutaneous treatment of patients with renal calculi in an anomalous kidney is technically challenging, usually requiring upper pole access. The high stone-free rate and a relatively low incidence of major complications suggest that this minimally invasive method is an effective means of stone management in this complex patient population.

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    Background & Aim: Nalidixic acid is a quinolone antibiotic with excellent in vitro and in vivo activity against salmonella. It is often the first choice for treating drug resistance salmonella infections. Nalidixic acid resistance can often lead to resistance to fluoroquinolones such as ciprofloxacin. In this survey the extent of salmonella infections, the salmonella strains involved, antibiotic susceptibility patterns, and the MIC values towards nalidixic acid were investigated. Patients and Methods: During one year period(2005-2006), a total of 1333 diarrheal stool samples were collected from hospitalized patients. Stool cultures were performed on differential and selective media for salmonella isolation. A total of 45 salmonella spp.(species) were isolated(3.4%). Species identification were achieved by agglutination with species-specific antisera. Antibiotic susceptibilities were determined by disk-diffusion method(Kirby-Baure). The minimal inhibitory concentration(MIC) of drug-resistance salmonella isolates was performed by E.test. The study was a descriptive work. Data was analyzed by SPSS sftware. Based on difference ratio hypothesis there were no significant differences between the two methods. Results: A total of 45 salmonella spp.(3.4%) were isolated from 1333 stool samples. Agglutination tests with specific antisera indicated that 9 of them belonged to S. enteritids(20.0%), 6 S. typhimurium(13.3%), 4 S. montevideo(8.9%), 3 S. paratyphi C(6.7%), 2 S. paratyphi B(4.4%), 1 S. muenchen(2.2%), 1 S. derby(2.2%), 1 S. schwarzengrund(2.2%), 1 S. arizonea(2.2%) and 13(28.9%) untypable strains. All of the isolates were agglutinated with only anti O-antisera and non showed any reactions with anti-H antisera. Of the 13 untypable strains, 10(22.2%) belonged to the salmonella serogroup C and the remaining 3(6.7%) were serogroup B. Antibiogram tests indicated that 11(24.4%) of the salmonella isolates were resistant to Nalidixic acid in the disk diffusion agar method. However, determination of MIC values with E.test indicated that only 9(20.0%) of these strains showed MIC values within resistant range. Conclusion: The highest rate of nalidixic acid resistance was seen within the non-typhoidal salmonella strains. These strains are widely distributed within our environment and are the major etiological agents of human salmonellosis. Eleven strains were nalidixic acid resistant in the disk-diffusion method whereas, only 9 showed resistant trait with E.test. The MIC of the resistant isolates to nalidixic acid was ≥ 32µg//ml. Despite its high cost, it is therefore concluded that E.test gives a better and more accurate identification of drug-resistance trait as compared to disk diffusion agar method.

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    Background & Aim: Brucella is one of the most important zoonotic diseases and is caused by the members of Brucella genus especially B. melitensis. The bacteria begin to synthesize heat shock proteins(hsp) when facing elevated temperatures. In this investigation, clinical isolates of B. melitensis were subjected to heat shocks and the hsps produced were surveyed by SDS-PAGE electrophoresis. The immunogenicity of hsp-60 was then investigated in both sick and healthy sera by Western blot. Material and Method: In this analytical descriptive study, five B. melitensis isolated from sick people were cultured. The bacterial isolates were subjected to 39, 40, and 42˚C heat shocks and after lysing the cells by lysozome, cell proteins were extracted by SDS(sodium dodecyl sulfate). The extracted proteins were exposed to electrophoresis in SDS-PAGE followed by staining with Coomasie Blue. Finally, antibodies against hsp-60 in control as well as sick sera were surveyed by Western blot. Results: SDS-PAGE gels revealed protein bands mainly in the range of 10-100 KDa. The major protein groups were in the range of 45-75, 20-30, and 14-20 KDa. The amount of 60 KDa protein band(hsp-60) was significantly enhanced following heat shock in comparison to unheated cells. The sera from Brucellosis patients reacted with several of these cell-derived protein bands in Western blots, none of which were reactive with the sera from healthy individuals. These reactive proteins were in the range of 10, 60, and 100 KDa. The 60 KDa band was the most significant one and showed strong reactions with all Brucellosis serum samples. Significant differences in protein bands were detected by the electrophoresis of the cells subjected to 39 and 40˚C heat shocks in comparison to unheated bacteria. Conclusion: The SDS-PAGE results indicated that Brucella melitensis begins to synthesize heat shock proteins when facing elevated temperatures. The Western blot protein bands of the heat shocked bacteria incubated with sera from sick and healthy individuals showed striking differences. This observation points to the immunogenic properties of hsps, especially the overwhelming response to hsp-60. Therefore, hsp-60 can be a good antigen candidate for ELISA test development as well as for engineering subunit vaccine against Brucella.

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Background & Aim:

clinical cases especially from hospitalized patients. Recently multiple drug resistant

isolated from clinical cases. Resistances were seen against drugs belonging to different antibiotic families. In this

survey, drug resistance in clinical isolates was studied with special reference to extended spectrum beta

lactamases.

Escherichia coli is one of the most important and prevalent bacteria isolated fromE.coli strains have been

Patients and Method:

for drug resistance by disc diffusion method. The minimal inhibitory concentration (MIC) of isolates resistant to

different antibiotics was determined by E-test. Beta lactamases production was tested with nitrocephin disc and

extended spectrum beta lactamases assays were performed with double disc synergy tests. Finally, Chi-square

and t-tests were used to analyze the data.

A total of 113 E. coli strains isolated from hospitalized patients were initially surveyed

Results:

these MDR strains were positive in nitrocephin test, indicating beta lactamases production. Double disc synergy

tests results showed production of extended spectrum beta lactamases in all MDR isolates.

From the total of 113 E.coli isolates tested, 47 (41.5%) showed multi drug resistant trait. All of

Conclusion:

Detection of 41.5% MDR trait, especially extended spectrum beta lactamases, in the clinical

E.coli

cephalosporins. It also necessitates conduction of a wider study to determine the extent of MDR

isolates points to the potential dangers posed by the widespread usage of extended spectrumE.coli

occurrence at national level.

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    Background & Aim: Mycoplasmas are the smallest bacteria capable of independent growth in artificial media. Mycoplasma hominis is associated with pre-mature birth, rupture of amniotic membranes and post-delivery fever. Ureaplasma urealyticum is similarly associated with chorioamnionitis and low-birth weight infants. Both of these bacteria can easily get transferred into newborns during childbirth leading to pneumonia, meningitis, cerebral abscesses and other complications. This study was conducted in order to survey the prevalence of these two micro organisms in women suffering from genital infections.

Patients and Methods: The study was adescriptive. Endocervical swabs were collected from a total of 205 women with genital tract infections who referred to various hospitals affiliated to Iran University of Medical Sciences in

Tehran. The swabs were placed in PPLO broth transport media and immediately sent to laboratory. Following filtration through 0.45

mm pore-size disposable filters, the filtrates were cultured into Arginine broth and Urea broth. In cases of color change, the broth media were sub-cultured into PPLO agar plates. All media were incubated at 35°C under elevated Co₂ atmosphere.

Results: From the total of 205 endocervical swabs, 64 samples (31.18%) were positive for Ureaplasma urealyticum and 16 samples (7.76%) were positive for Mycoplasma hominis. The highest prevalence of positive cases was among the 29-39 years of age group (34 patients) and belonged to women diagnosed with vaginitis (36 patients).

Conclusion: The results of this survey indicate that the prevalence rate of Mycoplasma hominis and Ureaplasma urealyticum infections among symptomatic Iranian women is in the intermediate range. Due to fact that the prevalence rates of these infections are probably on the rise, more attention needs to be paid to their role as an important etiologic factor of urogenital infections. Its prompt culture in routine clinical laboratories and immediate treatment should be considered as a health care priority.

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    Background and Aim:�Staphylococcus aureus (S.aureus) is one of the most prevalent causes of nosocomial infections. It is also involved in community acquired infections. The resistance of this bacterium towards methicillin which has been reported since 1961, made Vancomycin the last choice for treatment of Staphylococcal infections.

Considering the reduced sensitivity or resistance to vancomycin which has been observed since 1996, this study was conducted with the aim of evaluating the vancomycin MIC values (Minimun Inhibitory Concentration) of S. aureus cells isolated from hospitalized patients and compared with those recovered from outpatients.

Materials and Methods: A cross sectional – analytic survey was conducted from 2006 till 2007. A total of 200 S.aureus strains were isolated from various clinical sources including blood, sputum,

urine and sinus secretions. Their susceptibilities to vancomycin were initially surveyed by disk diffusion method. Subsequently, the MIC values of each

individual strain towards vancomycin were determined by E-test strips, and the obtained data was analyzed by SPSS (V. 11) software. For statistical analysis, t-test was used.

Results: In 125 S. aureus strains isolated from hospitalized patients, the growth inhibition zones were 14-18 mm and the MIC values were 1-2mg/ml. In 75 S. aureus strains isolated from outpatients, the growth inhibition zones were 16-20 mm and the MIC values were 0.75-1.5 mg/ml.

Conclusion: The result of this survey shows increased MIC values for vancomycin in hospitalized patients as compared to outpatients.