Journal of

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Introduction: Everyday, millions of people around the world go through phlebotomy, either to donate blood or for therapeutic intention. The most important worrisome adverse effects are hemodynamic alterations. In this study, hemodynamic changes following blood donation were assessed. Methods & Materials: Three hundred laborers who donated blood voluntarily were enrolled in this study. Blood pressure (BP) and pulse rate were measured before the procedure, ten minutes afterwards, and one week following phlebotomy. Hemoglobin (Hgb) and hematocrit (Hct) were also determined prior to and one week after phlebotomy. Finally, results before and after donation were compared with each other. Results: 242 volunteers had normal BP and 58 were hypertensive. The mean systolic blood pressures (SBP) before phlebotomy, ten minutes after the procedure, and one week later were 120, 117, and 122 mmHg, respectively. During the same periods of time, the mean of diastolic blood pressures (DBP) were 77 , 78 and 78 mmHg , in order , while pulse rates on average were 80 , 82 and 76 beats/minute . None of the aforementioned changes were clinically significant. After one week, Hgb decreased by about 0.3 g/dl (P<0.001) and Hct declined on average of 1.7 (P<0.001). Forty six individuals had high DBP and one week after donation, their DBP was reduced by 7 mmHg. Age, body mass index and smoking did not have any significant effect on hemodynamic status. Conclusion: Hemodynamic changes in healthy blood donors were not clinically significant. It seems that DBP drops desirably in hypertensive individuals. This needs to be evaluated more carefully in future studies.

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Introduction: Previous studies have shown that various factors such as emotional stress can trigger of MI in susceptible persons. More studies are needed to evaluate the characteristics of patients regarding to emotional stress, heavy work, routine activity, infection or rest before occurrence of MI. Methods: We studied 608 consecutive hospitalized in CCUs from May 2000 to October 2001. For patients, questionnaires including demographic, clinical and paraclinical characteristics were completed and data analyzed. Results: In this study rest (33.4%) and ordinary activity (32.4%) were more prevalent among the MI situations and infection had the lowest prevalence (0.7%). In patients higher than 45 years we had similar results, but in age group younger than 45 year ordinary activity (30.6%) and after heavy work (20.8%) had the highest prevalence before occurring of MI. In Diabetic patients, MI developed in sleep situation more frequently.(17.8%),(P=0.03) 52.5% of MI mortality occurred in rest situation.(P=0.009) Conclusion: Rest had the highest prevalence of MI compared to other situations but in age group younger than 45 years MI after heavy work had the highest prevalence. Autonomic neuropathy may be one of the reason of higher prevalence of MI in sleep situation.

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Introduction: Several studies have evaluated the association of admission blood glucose levels and short and long term mortality after myocardial infarction and have had different results. The aim of this study was evaluation of association between admission blood glucose levels and in-hospital and one year mortality in non-diabetic patients with AMI. Methods: In this study, demographic, clinical and Para clinical data of 120 non-diabetic patients with AMI on admission was collected and analyzed. The patients were followed for one year. Blood glucose level ≥ 140 mg/dl was defined as hyperglycemia. Results: 78% of patients were men. The mean age and admission blood glucose level was 63+13 years and 146+76mg/dl, respectively. Death due to cardio vascular causes was seen in 20% of patients in hospital and 9.8% during the one year follow up. The mean admission blood glucose level in patients who died in hospital was significantly more than live patients and also had an influence on the in-hospital outcome. Every 100mg/dl increase in blood glucose level was associated with 11% increase in in-hospital mortality risk in non-diabetic patients. Conclusion: Our results demonstrate that admission blood glucose level is a good marker for diagnosing patients with worse prognosis after AMI. We suggest that later studies should focus on optimal control of hyperglycemia with insulin in patients with AMI.

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Introduction: The Clinical and Paraclinical Characteristics of patients with congestive heart failure (CHF) have been described by a number of previous studies, but very little information is available on this issue in Iran. This study aimed to delineate the clinical and paraclinical characteristics of Iranian patients hospitalized with CHF. Methods: During an observational, analytical, descriptive, cross-sectional study, 258 consecutive patients were interviewed and examined at 5 hospitals in Yazd, Iran from January to December 1999.Questionnaire comprised of information regarding etiology, signs, symptoms, paraclinical data, etc. Results were analyzed by SPSS9.01 and EPI6 programs using ANOVA, Chi-Square and T-TEST and reported as Mean ± SD. Results: The study population had a high mean age (67.59 ± 0.73), 0.8% were less than 35 years old and 70.80% were older than 65 years. Mortality rate due to heart failure was 7.5%. Major causes of CHF were ischemia (65.1%), valvular lesions (5.8%), cardiomyopathy (5%) and hypertensive heart diseases (4.6%). Mean number of hospitalizations per year was 2.2 ± 0.1, while mean hospitalization time was 7.25 ± 3.8 days and mean cost was 1122439 ± 89874.8 rials. Conclusion: Even though many background and aggravating factors of heart failure are preventable, this disease incurs a lot of expenditure on our country’s health system. Therefore, there is a requirement for programming and research in the fields of education, treatment and prevention of this disease for all members of the community.

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Introduction: Hepatitis E is a kind of viral infectious disease that involves the liver and can vary from a simple and asymptomatic disease to a fulminant and lethal disease. Considering the importance of HEV prevalence and history of epidemics in neighborhood provinces, this study was performed to evaluate the seroprevalence of HEV in Khorrmabad city in 2009. Methods: This is a cross sectional research which was done in 2009. A total of 400 people who had referred to the health centers of Khorrmabad city were selected as the subjects of study using multiphase sampling method. After getting informed consents from all cases as well as 5 milliliters of blood from each case, the intended demographic data was collected by a questionnaire. Then, ELISA test was performed for evaluation of the samples. Results: In this study, the result was positive in 31 cases that showed 7.8% seroprevalence of HEV in Khorramabad city. The mean age of all cases was 36 years positive cases:49.7 years negative cases : 34.8 years and highest prevalence was in the 40-59 years age group(61.2%). There was no significant relationship between sex, blood transfusion and HEV positive test. Conclusion: Considering the prevalence rate of 7.8%, Khorramabad city is endemic for HEV and probably, this prevalence is higher at the mean age of 49.7% years and in the 40-59 years age group. We suggest that hepatic patients should be evaluated for HEV routinely in Lorestan province paying special attention to pregnant women.

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Introduction: Group B Strepococcus(GBS) is one of the most important causes of neonatal infections including septicemia and meningitis. It also plays an important role in maternal infections such as chorioamnionitis, pyelonephritis, metritis and post partum infection. The present study was carried out to find the prevalence of GBS in pregnant women with 28 to 38 weeks gestational age. Methods: In this study, 100 pregnant women referring to the obstetrical clinic of Asalian Hospital in Khorramabad city in the third trimester of pregnancy (after explaining the study, getting informed consent and demographic informations) were tested for GBS by taking a vaginal sample. The sample was taken by sterile cotton swab. The swabs were placed in transport media, transported to the central Lab, and were inoculated in blood agar. Then all samples were analyzed for the presence of GBS. Results: In this study, the prevalence of positive vaginal GBS culture in pregnant women was 14% (CI: 7.2-20.8%). No significant correlation were found between this positive culture and maternal age, gestational age, abortion status, diabetes mellitus and pregnancy induced hypertension, while a significant correlation was found between positive cultures and parity. Conclusion: As the colonization rate of GBS in pregnant women of Khorramabad is high, routine culture-based screening is recommended for all pregnant women in third trimester of pregnancy.

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Introduction: Food-borne pathogens are causes of poisoning and gastrointestinal infections. In recent years, it is recommended to use natural materials like plant extracts and essences instead of chemical preservatives in food industry. Therefore, the aim of this study was to identify the phenolic compounds of ethanolic walnut kernel and its antimicrobial effect on some food-borne pathogens. Methods: In this experimental study, after collection of walnut kernel, its ethanolic extract was prepared. Then its antimicrobial activity on salmonella typhimurium, shigella disentriae, listeria monocytogenes was examined as Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) using microdilution method. Chloramphenicol (30µg) was used as the reference antimicrobial agent. Total phenols, flavonoids and flavonols were also determined by colorimetric method. Results: The results showed that MIC was between 0.625 and 1.25 mg/ml and MBC was between 1.25 and 2.5mg/ml for ethanolic extract. Total phenols were 365±14.71mg/g gallic acid equivalent, and total flavonoids and flavonols were 285±12.25 and 132± 1.63mg/g rutin equivalent, respectively. Conclusion: These findings showed that walnut kernel has antibacterial effects on three aforementioned bacteria and can substitute for chemical preservatives. More studies, such as examinations in food models are needed to unravel the antimicrobial effects of this plant.

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Introduction: Garlic has been demonstrated to have anticancer activity in some studies however its effect on fibrosarcoma is not evident. This study intends to examine the preventive and curative effects of fresh garlic extract and its aerial parts on the growth of WEHI-164 fibrosarcoma cells in Balb/c mice. Methods: In this preclinical study, 48 female inbred Balb/c mice(6 to 7 weeks old) were divided in to 6 groups of 8 each. A single aliquot of WEHI-164 cells(5 × 106 cells/100 μl) was injected subcutaneously in the chest of animal. Two weeks before or three weeks after cell injection, 0.2 cc of normal saline or 20 mg/kg extract of garlic or its aerial parts were injected intraperitoneally(IP) to the Balb/c mice. The tumors sizes were compared with each other, using ANOVA test. The antioxidant potential and total phenolic compounds of the extracts were also assessed. Results: The mean sizes of tumor growth in groups which received fresh garlic extract or its aerial parts were smaller than that of control group. However this difference was significant on the 21st day only in garlic extract group(p<0.05). The antioxidant power of fresh garlic involved 35.6%, whereas for its aerial parts it was 15.3%. Moreover, the general amount of phenol in fresh garlic was 12.61 mg/g and in its aerial parts was 2.44 mg/g. Conclusion: Garlic consumption might have a crucial role in prevention and control of fibrosarcoma growth. Furthermore, the phenolic compounds and antioxidant activity of garlic aerial parts are less in comparison to garlic itself, however, higher doses might have anticancer activity

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Introduction: Tuberculosis is a widespread disease which is more common in developing countries .Musculoskeletal tuberculosis constitutes10-15% of cases in underdeveloped countries. The most common site of involvement is vertebrae. Clinical manifestations, location of vertebral involvement and therapy approaches vary between geographic areas. Recognition of specific features of the disease, predominant signs and consequences of common therapies in the region can be useful for physicians and can reduce its complications. Methods: This cross-sectional descriptive case series study included all spinal tuberculosis cases who have been diagnosed in Yazd city between 2001 and 2008. A questionnaire was applied to collect the data about demographic, clinical signs and symptoms, imaging features, medical or surgical therapeutic approaches, complications and outcome of treatment were collected by questionnaire. Analysis was done by SPSS(version 10.5) and p value< 0.05 was taken as significant. Results: Fifty patients were evaluated in this study, the most frequent age group of patients the 40-60 year group, and the least frequent was the group< 20years old. The most common clinical finding in decreasing order was local pain in involved vertebrae, weight loss, sweating and loss of appetite. Location of involved vertebrae was lumbar, thoracic, thoraco-lumbar and cervical. All patients were treated medically and 16 patients required surgical intervention. The study results revealed cure for 42(84%) without any complications. Conclusion: Considering occurrence of this disease in middle age, the most common symptoms and local vertebral pain are influential in earlier diagnosis. They prevent the complications and surgical intervention of spinal tuberculosis.

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Introduction: Entropion and ectropion with involutional changes are the most common eyelid malpositions. Entropion is a condition in which the eyelid margin turns inwards against the globe and ectropion is a malposition in which the lid turns outwards or is pulled away its normal position from the globe. Knowledge of eyelid problems and their abnormalities is a key to plan a successful surgical procedure. Methods: This descriptive study lasted from Sep. 2008 to March 2009. We evaluated 78 patients with eyelid malpositions who referred to educational hospitals of Yazd. The patients were examined by an eye specialist. Each patient’s demographic data, type of eyelid malposition, specific treatment results and 6-month follow up of each patient were recorded by the questioners and then were analyzed statistically by SPSS13 software, chi-square and fisher exact test. Results: Among 78 cases, entropion was observed in 41 cases(52.6%), trichiasis in 31 cases(39.7%), ectropion in 27 cases(34.6%) and distichiasis in 3 cases (3.8%). The Wies procedure proved to be influential in entropion treatment and lateral tarsal strip canthoplasty surgery also reported acceptable results in ectropion. Conclusion: The involutional changes were the most common causing factors for eyelid malpositions. Entropion appears most prevalently specially in right upper eyelid. The Wies and lateral tarsal strip canthoplasty procedures were thoroughly successful in treatment of entropion and ectropion of either upper or lower eyelids

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Introduction: Since thrombolytic drugs such as streptokinase could cause reocculsion, anticoagulants like heparin are utilized afterwards. Several nomograms have been recommended due to unpredictable pharmacokinetics of heparin. Therefore, this study aimed to compare two prevalent nomograms of   heparin used in patients suffering from acute myocardial infarction (AMI) after recieving streptokinase.

Methods: In this single-blind randomized clinical trial, 113 patients with AMI were randomly assigned to one of the two nomogram groups four hours after receiving streptokinase. Patients in the group1(n=50), received an initial infusion with  rate of 17 U/Kg/hr and a bolus of 80 U/Kg. In Group 2(n=35), the initial rate of heparin (n= 53) was 12 U/Kg/hr with a maximum 900U/hr after a bolus of 60 U/Kg with a maximum of 4000 U. Activated Partial Thromboplastin Time (aPTT) was measured every 6 hours for at least 48 hours and infusion rate was adjusted  based on each nomogram in order to maintain aPTT in the therapeutic level of 46-70 s.

Results: Patients in the two groups were homogenized in regard with their demographic characteristics. The time needed for aPTT to pass the infusion threshold for groups 1 and 2 were 8.00±3.81 hr and 11.12±5.55 hr, respectively (p=0.00). In the first 12 hours, percentages of patients, whose aPTT was reported in an apporpriate therapeutic range were 56.0% and 30.19% for the two groups, respectively (p=0.00). Moreover, period of time that subjects in group 1 were in the therapeutic range in the first 24 and 48 hours was 14.40 ± 6.42 hrs and 27.48 ± 9.90 hrs, respectively. While these numbers for group 2 were 9.74±3.08 hrs and 21.06 ± 9.42 hrs, respectively (P=0.00, P=0.00). The changes in the heparin rate was reported significantly lower in  group 1 compared to  group 2.

Conclusion: The study findings revealed that nomogram 1 is preferred to nomogram 2, since patients in nomogram 1 reached the therapeutic range faster, stayed in this range for a longer period of time, and needed less change in the heparin rate

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Introduction: Salmonella is one of the most important causes of gastroenteritis in humans. Salmonella enterica Serovar Typhimurium has many hosts in addition to humans, and its prevalence in the community is high. The aim of the study was comparing the genetic diversity of Salmonella enterica serovar Typhimurium isolated from human fecal samples by both of ERIC-PCR and BOX-PCR method.
Methods: In this cross-sectional study, 60 Salmonella enterica serovar Typhimurium were obtained from the human fecal samples. These strains were identified by standard microbiological and biochemical tests. Then, ERIC-PCR and BOX-PCR were carried out for determination of molecular relatedness of Salmonella enterica serovar Typhimurium using specific primers.
Results: The results showed that all 60 Salmonella enterica serovar Typhimurium were separable using ERIC 1, ERIC 2 and BOXAIR. In electrophoresis, 2-11 bands with 20-3200bp for ERIC-PCR and 2-10 bands with 200-1500bp for BOX-PCR were observed. Therefore, 13 different clusters (C1-C13) in ERIC-PCR and 21 different clusters (C1-C21) in BOX-PCR were identified.
Conclusion: The results showed that Salmonella enterica serovar Typhimurium strains were non-homolog. Therefore, ERIC-PCR and BOX-PCR methods are appropriate methods for molecular typing of Salmonella strains and determine the original infection source for the epidemiological survey as well as infection prevention program.

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