Razi Journal of Medical Sciences

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 The purpose of this investigation was to survey the epidemiological and other contributing factors on the establishment of fungal infections among patients visiting Hazrat Rasul-e Akram Hospital in Tehran. Five hundred patients suspected of having fungal skin infections were referred to the mycology lab and the specific fungal etiology was determined by both culture methods as well as slide culture observation.

  We were able to isolate a total of 253 fungi which included 51.4% dermatophytes, 20.1% Erythrasma, 18.6% candidiasis, 8.3% pityriasis versicolor and 1.6% nail Aspergillus.

  Dermatophytes consisted the most common etiologic agent ( Χ ² =185, P<0.001), and the most common loci of infection in both sexes were groin(26.4% in male and 54.7% in females)(P<0.001, Χ ² =29 and Χ ² =178.2 respectively). Epidermophyton flucosum was the most common dermatophyte isolated ( Χ ² =33.7, P<0.001) and its source was either from the pelvic region or the feet.

  There was also a higher prevalence of fungal infections among those above 40 years of age (46.2%) ( Χ ² =164, P<0.001).

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Breast cancer is the most frequent cancer among women. Approximately one third of all cancers in women is breast cancer which has a high mortality rate and is second only to lung cancer in cancer related deaths in women. Unfortunately, during the past 50 years, the prevalence of breast cancer has been raised probably due to life style changes. Recently, the prevalence of this cancer in different areas of world ranges between 8 to 23 in every one hundred women. The prevalence in Iran has not been established yet, but some unpublished data from three academic centers related to Mashhad University have indicated that the prevalence of breast cancer raised in women during reproductive age is different and has not been clearly identified. In addition, the risk factors in different countries are not the same and our country has its specific risk factors that should be identified. The main aim of this research was the assessment of certain breast cancer risk factors during reproductive age. This research was a descriptive-analytic and multi-variant study with two groups of case and control. The total number of participants in this research was 350 persons 170 of them were in case and 180 in control group. Interview forms were used for the assessment of the problem. Results indicated that variables such as age, race(heredity), geographic location of residence, occupation and its duration, history of marriage, the age at first pregnancy, mensturac regularity, nulliparity, history of preterm labor, history of infertility, medical and surgical history, cigarette smoke exposure and x-ray exposure are some significant risk factors associated with breast cancer among premenopausal women living in Mashhad.

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    Background & Aim: Maternal steroids modulate various functions in the brain. However, tamoxifen(TAM) treatment, as an estrogen antagonist, induces cell death in the hippocampus formation of a prenatal and postnatal rat. Estrogen influences cognitive functions, learning process, aging, vasodilation, angiogenesis, neurogenesis and neuroprotection. The present study deals with the effects of tamoxifen on ultrastructure and morphology of developing hippocampus in rats. Material & Method: In this experimental study, we examined twelve bands of rats in three groups of control, experimental and sham. In each group, there were four age ranges: full-term embryo(E22), one-day newborn(P1), seven-day newborn (P7), and three-week newborn(P21). Full-term animals received four doses of tamoxifen in propylene glycol and their brains were removed 6 hours after the last injection. We studied hippocampal regions such as CA1, CA3, D.G. and subiculum through light and electron microscopy. Statistical significance of the differences was assessed by ANOVA and t-test using SPSS program. A value of P<0.05 was considered significant. Results: The obtained findings reveal a decrease in the density of cells in various regions such as CA1 and subiculum. Electron microscopy showed pyknosis, increased nucleus density, chromatin clumping, mitochondrial inflammation and changes in mitochondria crista, mostly in CA1 and subiculum. Conclusion: Maximum changes have been seen in E22 and P1 groups. Considering the effect of estrogen on neurogenesis, tamoxifen injection can bring about changes in hippocampal pyramidal cells. The novel finding of this study is the difference in the density of cells at various stages of development. Also, the results show that tamoxifen effects on full-term embryos and one-day newborns are significantly great.

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  Background & Aim: Streptococcal pneumoneae is the most common etiologic agent of community-acquired pneumonia. Pneumococcal isolation from sputum can only demonstrate the possibility of pnumococcal infection because of the possibility of carrying. Definitive diagnosis is made by isolation of pnumococcus from blood and sterile body fluids. Real percentage of positive blood culture in pnumococcal pneumonia is around 15-30%. If urine pneumococcal antigen detection is added to conventional laboratory methods, pnumococcal diagnosis can be increased by 38.9%. The aim of this survey was determining the prevalence of pnumococcal pneumonia in bacterial pneumonia through isolation of pneumococcal antigen from urine.

  Patients and Method: This descriptive cross-sectional study was performed on patients diagnosed with acute bacterial pneumonia. The subjects were above the age of 18 and admitted to Rasoul-e-Akram Hospital in 2007. Urine samples of patients were tested for antigen detection by immunochromatographic method with Binax NOW Streptococcus pneumoneae test. Blood samples of all patients were cultured. Patients who were admitted for elective surgery and had no infection entered the study as a control group. Quantitative variables were evaluated by using mean and standard deviation and qualitative variables were evaluated by using percentage.

  Results: From the total of 43 patients, 26(60.5%) were men and 17(39.5%) were female. The mean age of the patients was 55.47 ( ± 22.46) years. S.pneumoneae was isolated from 2 (4.65%) patients by culture( blood and pleural culture ) and from five (11.6%) patients by urine antigen test. S.pneumoneae was seen only in spring and winter. Normal leukocyte count was seen in 2 cases and lukocytosis existed in 3 of them. Lobar infiltration was seen in 4 subjects and pleural effusion in 1. In 2 cases of positive pneumococcal culture, urine pneumococcal antigen test was positive. None of the members of the control group had positive urine pneumococcal antigen test.

  Conclusion: Pneumococcal antigen was isolated from the urine of 5 patients. There was no positive urine pneumococcal antigen test in the control group,which reveals pneumococcal carriage in adults is very low in this study. This study shows urine pneumococcal antigen test is a good diagnostic tool in adults and can help establish diagnosis.

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    Background: Acute Renal Failure (ARF) is a common complication in Pediatric Intensive Care Units (PICUs) and its quick diagnosis at the bedside is of utmost importance. Various systems have been introduced for the rapid diagnosis of the condition. One of these systems is RIFLE, which based on Glomerular filteration rate (GFR) and urinary output, ARF patients are divided into 5 categories namely Risk group, Injury group , Failure group,  Loss of function, and End stage renal disease. At present we donot have enough data from our centers. The aim of this study�was�to evaluate the prevalence and risk factors of acute renal failure in PICU.  

Methods: This is a cross sectional study conducted between 2006-2007 on 121 patients admitted to PICU of Mofid Childrens Hospital. We evaluated our patients with demographic data, biochemistry and glomerular filtration rate. Based on patients renal function test and 24 hr urinary output, patient's were placed in one of the 5 groups of the RIFLE system. Prevalence of renal failure and the associated risk factors were evaluated. We also used Regression analysis test, t test, Chi², ANOVA and post hoc test for statistic analysis.

Results: We evaluated 121 pediatric patients 65 cases were males (53.72%) and the rest were females. The prevalence of acute renal failure in our patients was 36.4%. Based upon the RIFLE scoring system 19.8% of our patients were in Risk group, 8.3% were in Injury group and 8.3% were in the other three groups. We found out a significant correlation between patients' Glomerular Filtration Rate(GFR) and diastolic blood pressure, platelet level, pH, PaCo2 and PaO2 and serum bicarbonate (p value 0.038, 0.037, 0.044, 0.008, 0.004, and 0.004, respectively). There wasn’t any correlation between GFR and age, sex and urine output at the time of admission. Therefore there could be a relation between these factors and ARF in Intensive care units.

Conclusion: We conclude that the incidence of Acute renal failure in ICU centers has significantly increased and hypotension, hypoxemia, acidosis and thrombocytopenia are the major risk factors for this disorder.

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  Background: Laboratory tests are used to diagnose diseases, monitor its progress and response to treatment. So the goal of the laboratory medicine is reporting accurate and on time test results. The aim of this study was to evaluate rate and causes of post-analytical errors in the Clinical Laboratory of Children’s Medical Center. We especially focused on 1) delay in reporting test results and 2) inaccuracy of test results.

  Methods: This descriptive study was conducted in Children’s Medical Center in 2008. Any complaint related to accurate reporting and on time test results from inpatients and outpatients, physicians and wards during 3 months period were registered. The reasons were investigated then recorded in predesigned forms data were analysed with SPSS version 15, Chi square and Fischer’s tests.

  Results : A total of 375 of 425 complaints were related to delay in reporting test results. We also recorded 50 cases of erroneous result complaints. Also 72% of delayed reports and 34% of complaints of unaccepted results were caused in post-analytical phase (i.e. after test was performed). “Failure to input the results in computer” was the main reason (37%). “Lost results “(25%) and transcription error (22.6%), “absence of laboratory request form” (9.8%) and “wrong method of filing” (4.2%) were the other observed causes. Microbiology, hematology and clinical chemistry were departments with the highest rate of complaints whereas urine culture, CBC and biochemistry tests were the most frequent problematic tests. The rate of complaints was 1:108 patients or 1:541 tests, and 4.8% of results were not reported in timely manner.

  Conclusion: Our findings revealed that the source of most of the errors related to reporting test results were in post-analytical phases. Therefore along with continuing the educational programme, and improvement of automation, it seems necessary to add periodic evaluation and investigation of errors to benchmarks programmes, especially in reporting test result processes, in order to provide error free service to physician and their patients. Cooperation with the clinicians and the other personnel outside the laboratory is also important for error reduction.

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  Background : Mirror therapy as a neural based rehabilitation technique, produces illusion of two healthy limbs for the brain. The aim of the present study was to determine effects of mirror therapy in restoring hand function in patients with active Range of Motion (ROM) impairments following orthopaedic injuries.

  Methods: In a randomised controlled trial, 30 patients with active ROM impairment (8 men, 22 women mean age: 38 years) were measured. Intervention group received mirror therapy, 30-minute a day, 5 days a week for 3-week, as well, half an hour conventional rehabilitation after each mirror therapy session. Patients in the control group received the same treatment program, but instead of mirror, they directly observed the affected hand. Outcome measures including Total Active Motion (TAM), and Disabilities of Arm, Shoulder and Hand (DASH) questionnaire were given pre, and post treatment, and 3 weeks later. Trial is registered as a randomised controlled trial in Iranian Clinical Trial Registry, number NCT01503762 in http://clinicaltrials.gov/.

  Results: Final analysis was performed on 23 patients. The TAM and DASH scores significantly improved in the post-test in both groups, and improvement continued during the follow-up period however, mirror therapy group exhibited significantly greater changes in the TAM and DASH scores than control (p<0.01), either at the post-test (154º vs. 62º 34 vs. 15), or follow-up session (181º vs. 88º 39 vs. 26).

  Conclusion: Mirror therapy in combination to a conventional rehabilitation program produced more improvement in hand function compared with a control group which might be through activating neural networks inhibited after injury.

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Background: Shoes is the first point of contact between the foot and the ground in walking.Any change in that could affect the balance and postural stability. The risks associated with slipping and falling is related to the materials of footwear, surface condition, and geometric design of the shoe sole. The aim of this study was to measure the effect of different shoe sole tread groove depths on the stability during walking on dry and slippery surfaces.

 

Methods: In this semi-experimental study, 22 healthy young men with average age 24.5±3.43 years wore the oxford standard shoe and walked on two different surfaces (dry and slippery) with three different groove depths (1, 2.5 and 5 mm). In fact, there were six different test conditions. Data was collected by the VICON Motion Analysis system and Force plate set. The Paired T-test was performed to study the effects of groove depth and surface contamination on the Coefficient of Friction (COF) and Fluctuations Rate of Ankle (FRA).

 

Results: The results showed that on slippery and dry surfaces, increase in groove depths leads to increase of COF and decrease of FRA (p<0.05). Also values of COF on slippery surface were less than dry surface significantly (p<0.01).

 

Conclusion: The aim of this study was to find the groove depth which has the optimal stability. In our study, the deepest groove (5 mm) was better for reduction of FRA and increase of COF during walking on slippery and dry surfaces.

 

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Background: Many researches have been conducted inorder to explore the ingredients of joint impairements like muscle spasticity and joint rigidity in which mechanical viscoelastic properties have been quantified during the joint movement. The aim of this study was to explore passive viscose and elastic properties at flexion and extension of the human elbow joint and to determine a mathematical torque-angle relation for the measured torque.

 

Methods: The method of this study was descriptive-analysis. Passive resistant torque was measured for 5 healthy subjects by Continues Passive Motion (CPM) at four different velocities for full range of extension and flexion by an isokinetic dynamometer. To extract viscose and elastic properties of the passive resistant torques of flexion and extension of the elbow, measures were extracted using MATLAB-R2009 software and statistical analyses were done by SPSS version 16.

 

Results: The results showed 3 total slopes of the passive torque curves by increasing the velocity of movement and also greater slope at the beginning and the end range of passive torque curves appeared in both extension and flexion. I It seemed to be a nonlinear relation and depending on elastic and viscose properties on angular movement and velocity at the passive torques.

 

Conclusions: Viscose and elastic properties were dependent on velocity and movement of muscle-tendon unit. Finally it was concluded from this study the possibility of evaluation and analysis the mechanical function of spanning tissues using a simple torque-angle relation for the passive torques with assumption of linear dependency on elastic and viscose properties and independency of viscose properties on angular movement. 

 

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  Background : There is always difficulty and inaccuracy in measurement of blood pressure by conventional method in children. Technical errors, human errors, and incompliance of child during measurements are the main disadvantage. Nowadays, 24- hour ambulatory blood pressure measurements (ABPM) are introduced to apply for children. The aim of this review is to update our understanding on the accuracy, validity and application in children.

  Methods: All original articles from 2009 to 2014 in EBSCO, Scholar.google, Pubmed, Cochrane were searched. Review articles, pharmaceutical clinical trials, case reports, and those articles related to adults were deleted.

  Results: According to literature studies, ABPM has correlation with the severity of end organ damage, morbidity and mortality. The accuracy and reproducibility of it has been assessed frequently. It is very important and useful to detect hypertension especially in children suffering from chronic disease such as diabetes mellitus, reflux nephropathy, renal transplantation. It helps to discriminate among true hypertension, white coat hypertension and masked hypertension and to detect those with non- dipper statues.

  Conclusion: All children with underlying renal disease, diabetes, heart disease, children with history of stroke, myocardial infarction or hypertension in their family members, high office blood pressure, on hypertensive medication and those of dialysis will benefit from regularly assessment by ABPM.

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Background: Regarding the consequences of aging and the elderly, we can refer to gait speed reduction, functional disorder and power reduction. The current study aimed to investigate the effectiveness of eight weeks of muscular endurance trainings on the orderly's gait kinematic parameters.
Methods: In the current semi-experimental study, two elderly groups consisting of 18 male participants were divided into control group (average and standard deviation age of: 63.33±1.33 years, height: 1.69±5.83 and weight: 80.26±6.41 kilograms) and experimental group (average age deviation: 64.57±2.88, height: 168±4.26 and weight: 73.84±6.17 kilograms). The experimental group took part in training sessions for eight weeks (two sessions a week) while the control group did not take any treatment. Using Vicon 460, both experimental and control groups were tested based on the parameters before and after the training session. Relatively, the depended and independent sample t tests were used to assess and compare changes within and between groups, at the level of 0.05.
Results: There was a significant increase of the step length and gait speed in the experimental group. However, except for the step length, both experimental and control groups showed no significant difference in other parameters.
Conclusion: Regarding the obtained results, muscular endurance trainings can be used to improve the elderly's step length and gait speed. This improvement maybe is resulted from the muscular improvement and balance leading to longer steps and more speed.
 
 

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Background and aims: Diabetes mellitus is a group of metabolic disorders resulting in increased level of blood sugar. Type 1 Diabetes (T1D), Type 2 Diabetes (T2D) and monogenic diabetes are there major groups of diabetes. Maturity-onset diabetes of the young (MODY) is a monogenic diabetes that is frequently mistaken for T1D or T2D and it has 14 different subgroups. The aim of this study was to diagnose MODY and determine the frequency of its 2 major subgroups in Isfahan diabetic population.
 
Methods: In this descriptive-experimental study with the aim of determining type and the frequency of mutations in GCK and HNF1A genes in 26 families with MODY from Isfahan using genetic linkage analysis method and select of 4 markers for each gene. Linkage results was confirmed by fragment analysis and then all the exons of genes were sequenced in any linked families.
 
Results: In this study from 26 families, 4 families were linked to markers of GCK gene and 3 families were linked to HNF1A gene. After sequencing of all exons of these 2 genes in the related families, variants were analyzed and their effects on diabetes were surveyed. There was no pathogenic mutation but some polymorphisms with increasing effects on susceptibility to diabetes were found.
 
Conclusion: in this study despite of the fact that some families were linked to markers of these 2 gene, and the results of other studies that mutations in these 2 genes are the frequent reasons of MODY, there were any pathogenic variant in any of the patients. So it seems that the genetic profile of this population is different from other studied populations.
 
Keywords: Maturity Onset Diabetes of the Youngs (MODY), Genetic linkage, STR marker, GCK gene, HNF1A gene.