[Evaluation of a short-time exercise on serum leptin levels in type 2 diabetic patients]

Research evidences showed that adipocytokines secreted by adipose tissue play an importance role in the development of obesity-related diseases such as type 2 diabetes. The objective of this study was to determine the effects of a single bout of exercise on serum leptin levels and insulin resistance in adult males with type 2 diabetes. Fifteen adult obese men with diabetic aged 38-50 years participated in this semi-experimental study. Concentrations of glucose, triglyceride, serum leptin and insulin, as well as insulin resistance were measured before and immediately after a short single bout exercise on a fixed bicycle in studied patients. Statistical analysis was performed using t-test. Statistical significance was considered at p<0.05. In this study, exercise protocol did not cause any changes in the mentioned variables, except glucose concentration. In other word, blood glucose concentration significantly decreased after exercise test [p<0.03]. The finding of this study showed that a short single bout exercise has no acute effect on leptin levels and insulin resistance in type 2 diabetic patients. It seems that serum leptin is decreased in response to long time exercise with high energy expenditure and negative energy balance

[Clinical evaluation of drug induced acute angle closure glaucoma]

To evaluate all cases of drug induced angle closure glaucoma cases who presented to Feiz Hospital, Isfahan during 2008-2010. In this retrospective case series, we present 7 cases of drug induced angle closure glaucoma after administration of Topiramate. All patients were female. The average age of patients was 33.28 years old [ranging from 19 to 44]. With sufficient corneal clarity, mean BCVA was 20/400 and mean refractive error was -6.50 [rang -3.00 to-12.00] diopters. Mean intraocular pressure was 44.71 [rang 34 to 60] mmHg. Mean time normalization of intraocular pressure was 12.30 [rang 8 to 23] hours. Acute myopia and acute angle closure glaucoma are serious adverse effects of Topiramate, both of which are reversible with immediate discontinuation of the drug. So, taking a complete drug history and thinking about culprit drugs is critical in the evaluation of such cases

HIV/HBV Co-infections: epidemiology, natural history, and treatment: a review article

Hepatitis B virus [HBV] infection, one of the major health priorities, accounts approximately for 350 million chronic cases and a global total of 33 million people were living with human immunodeficiency virus [HIV] in the world. Co-infection with HIV and the HBV presents a significant challenge to health care providers, with different prevalence rates in different parts of the world. It is important to screen all HIV infected individuals for HBV infection and reverse. Infection with HBV becomes more violent in patients co-infected with human immunodeficiency syndrome. HIV/HBV co-infected individuals are at increased risk of chronic hepatitis, cirrhosis, and hepatocellular carcinoma, and of experiencing HAART toxicity. In this review, the latest statistics on epidemiology of HIV, HBV and their co-infection has been presented along with prominent characteristics of HBV. Transmission routes which are the common between HBV and HIV are described and the most important ones are described according to the regional and age features. Also, there is a series of actions being performed once HBV infections occur to prevent HIV or to diagnose if the HBV-infected individuals are also infected with HIV. As in treatment case, some of the frequent treatment methods including applying interferon and using nucleoside and nucleotide analogues have been discussed. Finally, we would explain the new recommendations for treating patients who were co-infected with HBV and HIV, including staging HBV and HIV treatment, based on the stage of each disease. It also outlines the optimal treatment options, whether the patient is treated for HBV first, HIV first, or HIV and HBV together

Specific PCR assay for rapid and direct detection of Neisseria meningitidis in cerebrospinal fluid specimens

Neisseria meninigitidis is one of the most frequently encountered microorganisms associated with central nervous system infections. The aim of this study was to evaluate a PCR-based assay for specific and rapid detection of N. meninigitidis in CSF specimens. Since April 2002 to July 2006, 130 CSF specimens were collected from patients suspected of having baterial meningitis. Bacterial isolation and identification was carried out according to the standard bacteriological methods. The PCR was used to amplify a 101bp fragment of capsular transport gene A [ctr A] of N. meningitidis. PCR yielded an amplified product with the expected size of 101 base pair fragment. Sensitivity test proved 500 mg of N. meningitidis DNA as the final detection limit and specificity test revealed no cross-reaction for a wide range of respiratory pathogenic organisms. The PCR assay was more sensitive than the bacterial culturing. It might be possible to apply this procedure for rapid diagnosis of meningococci in clinical samples

[ effect of chronic L-carnitne supplementation on plasma glucose and lactate during exercise]

In skeletal muscle, carnitine plays an essential role in the translocation of long-chain fatty-acids into the mitochondrial matrix for subsequent beta-oxidation. Despite an abundance of literature describing the basic mechanisms of action of L-carnitine metabolism, there remains some uncertainty regarding the effects of oral L-carnitine supplementation on metabolism and exercise performance in normal subjects. This study examined the effects of chronic L-carnitine supplementation on glucose and lactate concentration, heart rate and aerobic capacity during submaximal cycling. Thirty healthy and male students cycled for 20 min at 70% VO2 max before and after 3 weeks [3g daily] L-carnitine [experimental] and placebo [control] supplementation. Blood samples were taken immediately after each exercise for the purpose of calculation plasma glucose and Lactate concentration, lactate dehydrogenase activity [LDH]. A two-way repeated measure ANOVA was used to determine significant differences between the two groups [p < 0.05]. The finding of our study showed that L-carnitine supplementation had no influence on plasma glucose and lactate. Also rest and rest heart rate, VO2 max and LDH activity was equal in pre and posttests [p < 0.05]. All variables were unaffected in the control trial. Three weeks L-carnitine supplementation had no effect on substrate and carbohydrate metabolism. Also, L-carnitine supplementation would be unlikely to be associated with the enhanced exercise performance

Clinical manifestations of Hirschsprung's disease: a six year course review of admitted patients in Gilan, northern Iran

Hirschsprung's disease [HD] is a congenital disease in which intestinal ganglionic cells are absent, leading to intestinal obstruction. The disease has various clinical manifestations and different lengths of bowel may be involved. Our aim was to study Hirschsprung's clinical presentations and its rate of intestinal involvement in hospitalized patients in a six year course study in Gilan, a northern province of Iran. We studied patients diagnosed with HD who were referred to the Gilan Surgery Referral Center in Poursina Hospital from 1995 until 2001. In this cross sectional descriptive-analytical study, all data were collected from patients' files and questionnaires. Data included demographics, clinical presentations, diagnostic methods, involved intestinal segments, type of surgical procedure, and surgical complications. There were 58 cases of HD during this six year period that underwent surgery. Of these, 19 patients were female and 39 were male whose ages ranged from one day to 18 years old. A variety of clinical findings such as: constipation, abdominal distension, failure to pass meconium, diarrhea, and other less common manifestations were present. We found three different pathological types: rectosigmoid, ultra short segment and total colonic involved segment. No differences between disease presentations were discovered among these three types. The following surgical procedures were performed: Swenson, Soave-Boley, and Lynn. Early complications, which occurred during the first month following surgery, were anastomotic leakage, wound infection, hemorrhage and anastomosis stenosis. Late complications, occurring at least one month after surgery, comprised the following: long-term con-stipation, enterocolitis, incontinence, and obstruction due to adhesion. No significant difference between the complications of these surgical procedures and any accompanying anomalies were found. Most patients had chronic constipation and abdominal distension regardless of the types of involvement, age or clinical presentations. There were few associated anomalies amongst the patients. In some cases, surgical complications were less than those seen in other studies; therefore, it seemed that the performed procedures had fewer complications or may have been performed at the appropriate time

Effects of an exercise-oriented rehabilitation program on mechanical efficiency and aerobic capacity in children with spastic cerebral palsy

Children suffering from Cerebral Palsy [CP], exhibit movement limitations and physiological abnormalities as compared to normal individuals. The objective of this study was to assess mechanical efficiency and certain cardiovascular indices before and after an exercise-rehabilitation program in children with dipelegia spastic cerebral palsy [experimental group] in comparison with able-bodied children [controls]. In this study, 15 spastic cerebral palsy [dipelegic] children participated in an exercise-rehabilitation program, three days a week for three months with an average 144bpm of heart rate. The mechanical efficiency [net, gross], rest and submaximal heart rate and maximal oxygen consumption [VO[2max]] were measured before [pretest] and after [posttest] exercise program on the cycle ergometer according to the Macmaster ergometer protocol. Then control group, of 18 normal children underwent the exercise program and were assessed, following which results of the 2 groups were compared using SPSS for statistical analysis [P<0.05]. Mechanical efficiency [net, gross] increased significantly in CP patients after the exercise-rehabilitation program; results did not alter significantly for the controls. Rest and submaximal heart rate in CP patients decreased significantly after exercise program. Maximal oxygen consumption, which remained unchanged in patients following the exercise program, was similar in patients and controls after the program. Cerebral palsy patients, because of their high muscle tone, severe degree of spasticity, and involuntary movements are physically more incapacitated and need more energy than normal able-bodied individuals. Rehabilitation and aerobic exercise can be effective in improving their cardiovascular fitness and muscle function and increasing their mechanical efficiency

[ effect of prenatal care group education on pregnant mothers' knowledge, attitude and practice]

Effective prenatal education may play an important role in decreasing diseases and morbidity and therefore promoting mother's health. The aim of this study was to examine the effect of group education [by a standard teaching model] on knowledge, attitude and practice of pregnant mothers. This study was a field trial which was performed on 60 pregnant women in their 6[th] to 8[th] gesta-tional age. Samples were divided into two groups randomly. The experiment group was instructed using the standard protocol developed by maternal health unit of Isfahan Provincial Health Center and the control group received the routine prenatal instructions. In the standard protocol, the educational needs during the first, second and third trimesters of pregnancy were determined and 14 training sessions with prepared lesson plans were designed. The data were gathered by a questionnaire. Mother's knowledge in second and third trimester was significantly higher in intervention group compared to the control group. Also, it was almost significant in the first trimester. But, the educational program had no effect on mothers' attitude and no difference between the attitude of the two groups of intervention and control was observed. In contrast, the education had a positive effect on mothers' practice and a significant difference was revealed between the practices of the two groups. Considering the special features of this educational model, implementing this program as a continuous intervention in all health care centers could improve the quality of prenatal care

Advatages of rapid diagnosis of bacterial meningitis by PCR in compare with direct microscopy and culture

Acute bacterial meningitis has remained an important cause of death and neurological damages among survivors. Rapid diagnosis of bacterial meningitis is crucial for the early targeting of antimicrobial therapy. The aim of this study was to develop and apply a PCR assay for rapid diagnosis of meningitidis and to compare the results with those obtained by conventional bacteriology. We assessed 150 cerebrospinal fluid [CSF] specimens from suspected patients by PCR targeting 16S rRNA gene with specefic primers for Neisseria meningitidis, Sterptococcus pneumonia and Heamophilus influenza. All speciemns were also examined by conventional bacteriology. The rapidity of diagnosis increased when bacteriological methods were combined with PCR. Of 150 speciemens tested, 10 were positive for Neisseria meningitidis in PCR. Direct microscopy and bacterial culture found 5 and 8 cases infected with this organism respectively. PCR was more sensitive than direct microscopy and culture for detection of Neisseria meningitidis. However, direct microscopy may provide evidences for the quality of specimens and presence of other organisms in the samples. Wet- mount direct microscopy showed morphology and arrangements of the observed organisms that may be helpful in presumptive identification of certain bacteria such as gram negative bacilli and cocci. Moreover, the observed organisms may be useful in correct selection of culture media in the laboratory and prescription of appropriate therapy by physicians in a quickest time

Antimicrobial susceptibility and AP-PCR typing of acinetobacter Spp. strains

Acinetobacter spp., as important opportunistic pathogens, have been found to be responsible for an increasing number of nosocomial infections. This study was undertaken to investigate the antimicrobial susceptibility and molecular typing of Iranian isolates of A. baumannii. The study was conducted over a period of 19 months in three hospitals in Tehran, Iran. Acinetobacter spp. Were isolated from different clinical specimens using standard bacteriological methods. Antimicrobial susceptibility test was performed according to the standard CLSI guideline using 17 antibiotic disks. The AP-PCR fingerprinting was carried out using ARB11 primer. The PCR product was run and visualized in 2% agarose gels and stained with ethidium bromide. The AP-PCR profiles were grouped depending on the patterns of the amplified bands. Sixty seven strains of Acinetobacter spp. [including 21 A. baumannii and 46 non- A. baumannii] were isolated. The sources of these isolates were blood, urine, wound, and respiratory tract. A. baumannii isolates were further studied. Results showed that all A. baumannii isolates were resistant to at least 11 antibiotics tested. AP-PCR analysis of A. baumannii strains resulted in 7 different patterns. The dominant AP-PCR pattern was E [57.1%]. Acinetobacter spp. are still important nosocomial pathogens in the region studied and most of isolates were multi-drug resistant. Our results also indicate that the AP-PCR technique represents a rapid and simple means for typing of A. baumannii

[ investigation of the effect of rehabilitation program on the spastic diplegia patients' oxygen pulse and aerobic capacity]

Despite the voluminous amount of studies in the field of exercise sciences over the past three decades, there remains a paucity of information on the activity patterns and physiological responses to exercise in people with disability. The aim of this study was to investigate the effect of an exercise-rehabilitation aerobic program on the cardiovascular fitness, maximal oxygen uptake [VO[2 max]] and oxygen pulse for children with spastic cerebral palsy [Diplegia] and their comparison with healthy children. The experimental group for this semiexperimental study comprised of 18 [10-14 years old] diplegic spastic cerebral palsy children [CP] with average height [131 +/- 6.34 cm] and weight [29.83 +/- 5.64 Kg] selected with the consent of their parents as well as specialist physician. Eighteen normal children were randomly designated as the control group. The variables of the experimental group were measured before and after the exercise-rehabilitation program according to Mac Master protocol on cycle ergometer at the laboratory conditions. Then these values were compaired with those of the control group. The experimental group performed exercise program for a period of three months, three times a week with intensity average 144 bpm of heart rate. Each session lasted 20-25 minutes for each subject. The exercise-rehabilitation program led to enhancement of the maximal oxygen uptake [VO[2 max]] at the patient group. The oxygen pulse [VO[2]/HR] of the patient group was significantly lower than that of the normal group and the exercise program improved this variable [p<0.05]. This study indicated that in the spastic patients the lack of activity and being sedentary for a long time increases spasticity, the involuntary movements lead to a decrease in cardiovascular fitness and aerobic capasity and an increase in energy cost during exercise or daily activity as compared with normal people. The Rehabilitation program and exercise, even for short time or at low intensity leads to an improvement in the variables under study and enhances cardiovascular efficiency in these patients

Frequency of hypothyroidism and factors affecting it in HIV-infected patients in Tehran, Iran [2004]

A wide spectrum of endocrine abnormalities including thyroid dysfunction has been observed in HIV-infected patients with different results. This study was conducted to determine the frequency of thyroid dysfunction and to identify factors affecting the development of hypothyroidism in HIV-infected patients. Free T4, FT3, TSH, and thyroglobulin levels of 88 HIV-infected patients receiving care at UT counseling center for Behavioral Disorders in Tehran, an out patient referral center, were measured and data on their age, sex, body weight, BMI, history of opium and injection addictions, duration of HIV infection, disease stage, history of opportunistic infection or malignancy, CD4 cell count, antiretroviral treatment with antiretroviral drugs [HAART], receipt of other drugs [TMP-SMX, antituberculosis drugs, and steroids], and hepatitis C virus Co-infection were collected. Inclusion of the subjects was simply random. 17% of subjects had hypothyroidism; 1.1% had overt hypothyroidism; 2.3% subclinical hypothyroidism and 13.6% had low FT4 levels. The multivariate analysis showed that none of the studied factors were associated with the development of hypothyroidism. As none of the above-mentioned factors are not associated with the development of hypothyroidism, hypothyroidism should be considered in HIV-infected patients

effect of sub-maximal exercise rehabilitation program on cardio respiratory endurance indexes and oxygen pulse in patients with spastic cerebral palsy

Physical or cardio-respiratory fitness are of the best important physiological variables in children with cerebral palsy [CP], but the researches on exercise response of individuals with CP are limited. Our aim was to determine the effect of sub-maximal rehabilitation program [aerobic exercise] on maximal oxygen uptake, oxygen pulse and cardiorespiratory physiological variables of children with moderate to severe spastic cerebral palsy diplegia and compare with able-bodied children. In a controlled clinical trial study, 15 children with diplegia spastic cerebral palsy, were recruited on a voluntarily basis [experimental group] and 18 subjects without neurological impairments selected as control group. In CP group, aerobic exercise program performed on the average of exercise intensity [144 beat per minute of heart rate], 3 times a week for 3 months. The time of each exercise session was 20-25 minutes. Dependent variables were measured in before [pretest] and after [post test] of rehabilitation program through Mac Master Protocol on Tantories cycle ergometer in CP group and compared with the control group. The oxygen pulse [VO[2]/HR] during ergometery protocol was significantly lower in CP group than normal group [P<0.05]. No significant statistical difference in maximal oxygen uptake [VO[2] max] was found between groups. The rehabilitation program leads to little increase of this variable in CP group. After sub-maximal exercise in pretest and post test, the heart rate of patient group was greater than control group, and aerobic exercise leads to significant decrease in heart rate in CP patients[P<0.05]. The patients with spastic cerebral palsy, because of high muscle tone, severe spasticity and involuntarily movements have higher energy cost and lower aerobic fitness than normal people. The rehabilitation exercise program can improve physiological function of muscle and cardio-respiratory endurance in these patients

[Brucellosis arthritis: infection or inflammation of joint?]

The description of Brucellosis arthritis feature with other findings in the main goal of this study. This is a 2 years descriptive and prospective study, which includes 20 patients who diagnosed as brucellosis and join involvement. In this study, arthritis involvements were as follow: Sacroilitis [70%], Peripheral arthritis [15%], Sacroilitis and arthritis [12/5%] and Spondylitis [2/5%]. The other finding of this study include: Range of age between 15-30 [80%], male to female ratio [5:1], rural to urban ratio [2:1], fever more than 38 degree of Centigrade [60%], Normal CBC [90%], relative lymphocytosis [70%], ESR more than 25 mm/ 1st hour [100%], Wright titer 1:320, and 2ME titer 1:160. With beginning of standard anti brucellosis regimen and supportive care, there was a 100% cure rate and no any sequel of arthritis. There was no relapse in next few months follow up of them. This study confirms previous findings, which indicate, Brucellosis arthritis have a good prognosis and outcome, without any sequel. So it seems that Brucellosis arthritis are rather inflammations than infection of joint [Septic arthritis]

[Clinical manifestations of Hirschsprung's disease: a 6-year course review in Rasht]

Hirschsprung's disease [H.D] is a congenital disease in which intestinal ganglionic cells are absent and can cause intestinal obstruction. The disease has various clinical manifestations and different length of bowel may be involved. Our aim was to study Hirschsprung's clinical presentations and its rate of intestinal involvement in hospitalized patients in a 6-year course study in Rasht. The capital city of Gillan province in north of Iran. We studied the Hirschsprung's patients referred to Poursina Referal Hospital between 1995-2001. A cross sectional descriptive- analytic study whose data was collected from patient's files and questionnaires including demographic data, disease presentations, diagnostic methods, involved segment, surgical procedure types, surgical complications. Finally, the data was analyzed in SPSS10 software. We detected 58 H.D in these 6 years, whom underwent surgery. There were 19 females and 39 males. Age of patients differed from one day to 18 year. Clinical findings were variable as follow: constipation [79.31%], abdominal distention [67.24%], inability to pass mecunium [17.24%], diarrhea [5.17%] and other less common manifestations. Pathologically, we divided our patients into 3 kinds: rectosigmoid, ultra short - segment, total - colonic. Surgeries were performed in three ways as follow Swenson - Soave - Lynn. Early complications, which come within one month after operation, contain anastomotic leakage [10.2%], prolonged constipation [10.2%]. There were not any significant differences between these three types of surgical procedures. Majority of patients presented with a chronic course of constipation and abdominal distention. There wasn't any difference between kinds of involvement and age and type of presentations. There are few associated anomalies in our patients. In some cases, surgical complications were less than other studies; so, it is probable that our procedures had fewer complications or they had performed in appropriate time

[ validity of single-tube Widal test in diagnosis of typhoid fever]

Background: the Widal test is widely used for the serological diagnosis of typhoid fever in areas of endemically , such as Iran, but the results of a single Widal test, are virtually un-interpretable unless the sensitivity and specificity of the test for the specific laboratory and patient population are known, so we have evaluated the validity of a single acute-phase Widal result for the diagnosis of typhoid fever in Iran and calculated the likelihood ratio at each titers of the Widal test

Methods and Material: the study was performed at the Bu-Ali Hospital in Zahedan, in the region of southeast Iran. Patients were grouped into two categories: 149 blood and or bone marrow culture-positive typhoid cases, and 226 nontyphoidal febrile cases. The results of two groups were analyzed by the test performance, namely, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratio for positive and negative results

Results: widal test was negative in 4 7% of typhoid patients and 83% of non-typhoid patients. The ratio for H agglutinin was 19 and 65%, respectively. Mean interval for patients was 13 and in non-typhoid patients it was 14.2 days. Sensitivity of O agglutinin was low even with titters of l: 80 [49%], but its specificity was high [90%]. H agglutinin had a higher sensitivity and a lower specificity. Likelihood ratio of positive O agglutinin with different titters was relatively good. H agglutinin with titters higher than 1 /80 had good likelihood ratio, but likelihood ratio for negative results of titters 1 /40 and l /80 of H agglutinin was desirable and it was not desirable for other titters

Conclusions: in hospital conditions, positive results of Widal test highly increase post-test probability, but negative results do not decrease the possibility of typhoid significantly