Detection of Legionella pneumophila in the bronchoalveolar lavage samples by real time PCR in patients with ventilator-associated pneumonia in ICU

زمینه و هدف: لژیونلا پنوموفیلا به خاطر توانایی آن در ایجاد پنومونی ناشی از ونتیلاسیون مکانیکی مورد توجه مراکز درمانی است. هدف از این مطالعه ردیابی گونه های لژیونلا پنوموفیلا در نمونه های بدست آمده از برونکوآلوئولار لاواژ با روشReal Time PCR در بیماران بستری در بخش مراقبت های ویژه ی بیمارستان الزهرا(س) اصفهان می باشد. روش بررسی: در یک مطالعه توصیفی تحلیلی سی و نه نمونه برونکوآلوئولار لاواژ در بیماران مبتلا به پنومونی همراه با ونتیلاتور بستری در بخش مراقبت های ویژه (ICU) بیمارستان الزهرای اصفهان در سال 1390 گرفته و تا زمان آزمایش در 20- درجه سانتیگراد نگهداری شد. DNA به روش فنل کلروفرم استخراج و آزمایش Real Time PCR در 45 چرخه شامل oC95 برای 4 ثانیه و oC58 برای 30 ثانیه انجام شد. در حالی که پروب به روش Taq Man عمل می کرد. یافته ها: نتیجه برای حضور باکتری لژیونلا پنوموفیلا در همه نمونه ها منفی شد. حداقل سن افراد در مطالعه 20 و حداکثر 86 سال بوده است. مدت زمان بستری افراد مورد مطالعه در ICU حداقل 2 روز و حداکثر 65 روز است. مدت زمان ونتیلاسیون افراد مورد مطالعه حداقل 2 روز و حداکثر 65 روز بود. نتیجه گیری: این مطالعه عدم حضور لژیونلا پنوموفیلا در بیماران دچار پنومونی وابسته به ونتیلاتور در ICU بیمارستان الزهرای اصفهان رادریک مقطع زمانی نشان می دهد؛ لذا بر اساس مطالعه فوق، شناخت الگوی میکروبیولوژیک لژیونلا پنوموفیلا در سایر مراکز درمانی نیز امری منطقی به نظر می رسد

Report a Novel Mutation in Human Prostacyclin Receptor Gene in patient affected with Migraine

Objective: The human prostacyclin receptor gene (PTGIR) encodes the human prostacyclin (PGI2) receptor. PTGIR is a part of vasodilator system during the migraine attacks and probably has an important role in the mechanism of this disease. Materials and Methods: We used direct PCR and sequencing to determine the any variants in PTGIR gene. A blood sample was collected from the patients and genomic DNA was extracted. Polymerase chain reaction was carried out on extracted DNA. The PCR products were then sequenced using a cycle sequencing kit, on an automated DNA sequencing machine. Results: In reviewing of familial and clinopathological of these two patients, both patients have migraines with visual aura and their mothers also are suffering from migraines. Their parents had been married strangers. Direct sequencing analysis of exon 2 of the PTGIR gene showing the presence of two mutations in two patients. These mutations were heterozygote that made the following changes; g.1626T>A, c.754T>A, cDNA.867T>A, and p.S252T for the first mutation and c.753C>T, cDNA866C>T, g.1625C>T, p.C251C for the second mutation. The first mutation alters the amino acid and is a novel mutation. The second change is a conservative mutation that have already been reported. Conclusion: The prediction results predicted the variant would negatively affect the protein’s function and seems to be disease causing. Although functional analysis is required to confirm the association between the variant and the disease

Variants in Human Prostacyclin Receptor Gene in Patients with Migraine Headache

Objective: Prostaglandin I2 receptor plays a major physiologic role in the relaxation of arterial smooth muscle and vasodilation and possibly during migraine attacks. Therefore, in this study, the coding and noncoding exons and exon-intron boundaries of Prostaglandin I2 receptor  gene were examined in patients with migraine headache and healthy controls and the potential effects of identified single nucleotide variations were evaluated using direct PCR-sequencing and in silico analysis. Method: In this study, the peripheral blood samples of 50 patients and 50 controls were examined to find any mutation in coding and noncoding exons and exon-intron boundaries of PTGIR gene. DNA was extracted and all the samples were amplified by polymerase chain reaction (PCR) and sequenced. Results: In this study, the patients had a mean age of 35.235 ± 10.99 years (range, 9–60 yrs.), and female to male ratio was 4:1 in this group. The controls had a mean age of 35.058 ± 11.116 years (range, 8–59 yrs.), and female to male ratio was 3.7:1.3 in this group. Two patients had mutations in exon 2. The first mutation was located in exon 2 (at amino acid position 251) of PTGIR gene at nucleotide position c.866A > T, a synonymous variant described previously in the database. The second mutation was located in exon 2 c.867G > A, which is a missense variant. Sequence analysis revealed high occurrence of previously reported intronic variants mostly in a homozygous statue. Conclusion: The data supported the hypothesis that mutations in PTGIR gene, particularly the mutation we described, should be considered even in cases of migraine. The presence of this mutation in patients with family history raises important issues regarding genetic counselling.

Assessment of electromyograghic findings in peroneus tertius, tibialis posterior and dorsal interoseous pedis muscles in patients with axonal polyneuropathy

Background: Axonal polyneuropathy (APN) is a common kind of neurologic disorders, which is normally diagnosed by electrodiagnostic methods. Different muscles were studied to find a muscle, which can be considered as a reliable site for early diagnosis of mild APN; this muscle should be easily activated by patient, has the highest sensitivity to EMG changes of APN, and has the lowest rate of false positive results in normal subjects. Materials and Methods: Based on the inclusion and exclusion criteria, 32 patients were recruited, and all of them underwent needle EMG of 3 different muscles including Peroneus tertius (PT), tibialis posterior (TP), and dorsal interoseous pedis (DIP). EMG Findings of different muscles [Motor Unite Action Potential (MUAP) duration, MUAP amplitude, polyphasic MUAP, fibrillation potential (FP), and the ability of subjects to contract special muscle] were recorded and compared. Results: Mean of MUAP amplitude was significantly different between all 3 muscles (P-values < 0.001). PT showed a significantly higher frequency of polyphasic MUAP than others (P-value: 0.001). The frequency of FP was significantly lower in TP than PT and DIP (P-values: 0.03 and 0.001, respectively). DIP showed significantly shorter MUAP duration than PT and TP (P-values 0.002 and 0.003, respectively). All cases were able to activate TP and PT voluntarily though only 20 patients could activate DIP (P-value < 0.0001). Conclusion: The higher frequency of polyphasic MUAP, the higher frequency of FP, and finally, the ability of all patients in activation of PT voluntarily, all support the usefulness of PT for EMG studies in APN patients

Relationship Between Triple Managerial Skills and The Occupational Creativity of The Physical Education Teachers In Isfahan

Background: This research was done with the aim of studying the relation among management&apos;s triple skills with the vocational innovation among physical education instructors in Isfahan province.2012Objective: The research method is of correlativedescriptive way, which was done in surveying method. The statistical population of this paper included the physical education instructors in Isfahan province in 2012 among 1637 persons in which 305 persons were selected as the sample in random method according to Cochran &amp; sharp table. To collect information, two questionnaires about management&apos;s triple skills (Mohammad Nadi-2005) and vocational innovation (Jazani &amp; colleaques-2003) were used. After confirming nominal validity of the questionnaires by the experts, the questions constancy was studied through Kronbatch Alpha. This coefficient was estimated at 0.95 in the first questionnaire and as 0.85 in the second questionnaire. The findings of this paper were analyzed through T-tests and one-way variance and Pearson coefficient of correlation test, and multi-variances Regression test in progressive method in order .The meaningful level for testing the theories was considered (p 0.05). Results: The results of the paper showed that the rate of technical, human, conceptual skills and vocational innovation of physical education instructors was estimated more than middle level. There is a positive meaningful relation between the management&apos;s triple skills and the vocational innovations. According to the demographic specifications in the conceptual skills level and innovation as per sexuality and also technical skills level as per sexuality, age group, and type of employment, there was a meaningful difference. Conclusion: The prediction relation among the components of the management triple skills with vocational innovation was a positive meaningful relation

The Association of Menstrual Migraine with Iron Deficiency and Its Induced Anemia

Background: Menstrual Migraine (MM) is a subgroup of migraine headache that affect the quality of life of patients in menstrual age. Iron Deficiency Anemia (IDA) is the most common cause of anemia, especially in women of reproductive age. Objectives: To determine the association of iron deficiency anemia with menstrual migraine. Materials and Methods: This descriptive-analytic study was conducted on women with migraine visiting neurology clinics affiliated to Isfahan University of Medical Sciences in late 2015 and early 2016. The demographic data and characteristics of migraine headache were registered in a designed questionnaire. The patients underwent laboratory tests for iron deficiency and anemia. Data were analyzed in SPSS-20 using Chi-square test and independent t-test. Significance level was considered at p<0.05. Results: Of the 93 migraine patients, 47.3% had Pure MM (31.9% with premenstrual migraine and 15.4% with true menstrual migraine), 40.6% had Menstrual-Related Migraines, and 12.1% had non-menstrual migraines. The frequency of iron deficiency anemia was 51.1%, 40.5% and36.4% in PMM, MRM and non-menstrual migraines (p=0.18). Total frequency of iron deficiency anemia in PMM and MRM groups was 46.2%, which was not significantly different from non-menstrual migraine group (p=0.82). Iron deficiency anemia was significantly higher in migraine patients with aura compared to those without aura (53% vs. 43.2%) (p=0.04). Conclusion: Although iron deficiency anemia was more prevalent among patients with menstrual migraine, but it is not associated menstrual migraine

The Effect of Pregabalin and Metformin on Subacute and Chronic Radiculopathy

Background: Radicular pain is one of the most common forms of chronic pain in the world, which has challenges about effective medical therapy. The aim of this study was to evaluate the effect of pregabalin (PGB) and metformin (Met) on subacute and chronic radiculopathy. Materials and Methods: This double-blind prospective clinical trial was performed on 71 patients with subacute and chronic cervical and lumbosacral radiculopathy. Group A was treated with PGB 75 mg daily while Group B was treated with PGB 75 mg daily and Met 500 mg daily for 3 months. Finally, the pain score in both groups was evaluated based on visual analog scale (VAS) and numerical scale pain. Results: The results showed a significant reduction in VAS and pain severity in both groups but this reduction in the terms of VAS (47.79% vs. 46.48%, P = 0.125) and pain severity (47.1% vs. 39.2%, P = 0.264) was more in treated patients with PGB and Met as compared to PGB group while total pain experience (53.5% vs. 49.1%, P = 0.464) and interference with daily function (57.1% vs. 50.61%, P = 0.726) were more in patients treated with PGB alone. Conclusion: Our results showed that PGB and PGB + Met reduced pain intensity and interference with daily function while we did not observe significant differences between two groups. PGB alone would have the potentiality to become a simple and economic means to decrease radicular pain

The Effect of a Single dose Dantrolene in Patients with Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Background: Cerebral vasospasm is a prolonged, occasionally severe, but reversible narrowing of the cerebral arteries that begins 3 to 5 days after the hemorrhage becomes maximal at 14 days. This study is designed to evaluate the effect of dantrolene on the reduction of vasospasm following aneurysmal subarachnoid hemorrhage (SAH). Materials and Methods: This randomized controlled clinical trial was conducted on 32 patients with proven aneurysms in AL-Zahra hospital during 2011-2013. They were randomly divided into two groups. In all patients, daily transcranial Doppler sonography was performed and as soon as the diagnosis of vasospasm onset in the first group, in addition to conventional treatment of vasospasm 2.5 mg/kg Dantrolene infusion within 60 minutes and while the blood pressure and heart rate of patient monitored, and arterial flow velocity changes such as PSV and MFV were measured by transcranial Doppler sonography in 45, 90 and 135 minutes. Data was analyzed by SPSS 22 and Chi-square, Student t, Mann-Whitney and ANOVA tests with repeated observations. Results: There was no significant difference in the site of the aneurysm in the two groups. The mean of PSV index prior to treatment and the 45th minute was not different but at 90th and 135th minutes it was significantly lower in the Dantrolene receiving group (P < 0.05). The mean of MFV index prior to intervention and in the 45th minute was not different between two groups, but at 90th and 135th minutes was significantly lower in the target group Conclusion: Using dantrolene in patients with artery vasospasm significantly reduced artery spasm and increased the patient recovery

Evaluation of Clinical Symptoms in Patients with Different Severities of Carpal Tunnel Syndrome

Background: The carpal tunnel syndrome (CTS) is a common neuropathy caused by the entrapment of the median nerve in the carpal tunnel. It causes pain and paresthesia in the hand. Objectives: To evaluate the role of clinical symptoms of CTS to determine the severity of this disorder. Materials and Methods: This descriptive cross-sectional study examined 75 hands of 40 patients were referred with CTS symptoms to Kashani and Alzahra hospitals in Isfahan, Iran, with signs of CTS from 2014 to 2015. The definitive diagnosis and severity of the disease were determined using electromyography and nerve conduction study (EMG-NCS). The correlation of the severity of CTS with clinical symptoms was examined using Spearman’s correlation coefficient and Man-Whitney test. Results: A total of 75 hands with CTS in 40 patients with mean age of 49.73 ± 12.53 years were examined (24% males, 76% female). The severity of CTS directly and significantly correlated with age, physical activities done with the involved hand, shaking or ringing the hands, weakness or atrophy of the thenar eminence, positive Phalen's test, and positive reverse Phalen’s test (p0.05). Conclusion: It is concluded that the different severities of the disease cannot be differentiated only through evaluation of clinical symptoms although they played the main role in diagnosis of the disease. Thus, electrodiagnostic evidence is still required for determining its severity and planning the treatment

Migraine and Irritable Bowel Syndrome: an Epidemiological Study

Background: Migraine and irritable bowel syndrome (IBS) are chronic conditions that seem to share common pathophysiological aspects. Objectives: Our study aimed to estimate the prevalence of IBS in an Iranian migraine population, investigate its association with headache's characteristics and depression. Materials and Methods: This cross-sectional study was done in a tertiary hospital clinic in Iran. Of patients referring for headache, migraineurs were diagnosed using international classification of headache disorder second edition (ICHD-II) by an experienced neurologist. Then, they were asked to answer to IBS section of SEPAHAN (The study on the epidemiology of psychological, alimentary health and nutrition) questionnaire, Persian version of Rome III questionnaire, to identify IBS and its subtypes in patients. Depression was evaluated by using Persian version of Beck-Depression Inventory second edition (BDI-II). The data were analyzed in SPSS software version 20 using the Chi-square test, the independent t-test and the Mann-Whitney U test. Results: Of 215 participants, 84% were female. Their mean age was 34±10.5 years. The frequency of IBS was 13.5% among migraineurs. The most common type of IBS was undifferentiated (58.6%). IBS was more common among patients with migraine with aura (p=0.03). A significant association was observed between constipation dominant IBS and migraine (p=0.04). IBS patients were significantly depressed than non-IBS ones (p=0.01). Conclusion: IBS prevalence is high in migraine patients. Therefore, its diagnosis and treatment should be regarded in their management to improve their quality of life