Background and Objective: Although patients with uncontrolled type 2 Diabetes mellitus(DM) despite conventional treatment with oral hypoglycemic agents eventually require insulin to achieve glycemic control, most of them reject use of insulin. To evaluate the efficacy of adding acarbose to full doses of conventional oral hypoglycemic agents on the metabolic control of the patients this study was designed.
Materials and Methods: In this uncontrolled follow-up study, 20 patients with type 2 DM and persistent poor glycemic control despite maximal doses of sulfonylurea and metformin were recruited to receive additional treatment with acarbose. Insulin therapy was rejected by all the patients and 12 weeks of dietary reinforcement and supervision for their diet and exercise programs failed to improve their glycemic control. An active treatment period with acarbose 100 mg thrice daily was fallowed by a 12-week of placebo. Efficacy was assessed by changes in HbA1c, fasting and 2-h postprandial plasma glucose and fasting plasma lipid levels.
Results: Acarbose treatment was associated with significantly greater reductions in HbA1c (-1.3 +/- 0.2% vs. placebo 0.2 +/- 0.1%, P = 0.038), Fasting Plasma Glucose(FPG)(-25.3 +/-10 mg/dl vs. placebo 10 +/- 6mg/dl , p:0.019), 2-h postprandial glucose (-24 +/- 8 mg/dl vs. placebo   15+/- 7.5 mg/dl, P :0.001) and body mass index(BMI) (-0.5 +/- 0.32 kg/m² vs. placebo 0.42 +/- 0.29 kg/ m², P: 0.01). There were no significant changes in plasma lipids levels.
Conclusion: In patients with type 2 DM inadequately controlled on conventional oral agents, acarbose resulted in beneficial effects on glycemic control and mean body weight. Additional use of acarbose can be considered as a useful alternative in such patients if they are reluctant to accept insulin therapy.Background and Objective: Although patients with uncontrolled type 2 Diabetes mellitus(DM) despite conventional treatment with oral hypoglycemic agents eventually require insulin to achieve glycemic control, most of them reject use of insulin. To evaluate the efficacy of adding acarbose to full doses of conventional oral hypoglycemic agents on the metabolic control of the patients this study was designed.
Materials and Methods: In this uncontrolled follow-up study, 20 patients with type 2 DM and persistent poor glycemic control despite maximal doses of sulfonylurea and metformin were recruited to receive additional treatment with acarbose. Insulin therapy was rejected by all the patients and 12 weeks of dietary reinforcement and supervision for their diet and exercise programs failed to improve their glycemic control. An active treatment period with acarbose 100 mg thrice daily was fallowed by a 12-week of placebo. Efficacy was assessed by changes in HbA1c, fasting and 2-h postprandial plasma glucose and fasting plasma lipid levels.
Results: Acarbose treatment was associated with significantly greater reductions in HbA1c (-1.3 +/- 0.2% vs. placebo 0.2 +/- 0.1%, P = 0.038), Fasting Plasma Glucose(FPG)(-25.3 +/-10 mg/dl vs. placebo 10 +/- 6mg/dl , p:0.019), 2-h postprandial glucose (-24 +/- 8 mg/dl vs. placebo   15+/- 7.5 mg/dl, P :0.001) and body mass index(BMI) (-0.5 +/- 0.32 kg/m² vs. placebo 0.42 +/- 0.29 kg/ m², P: 0.01). There were no significant changes in plasma lipids levels.
Conclusion: In patients with type 2 DM inadequately controlled on conventional oral agents, acarbose resulted in beneficial effects on glycemic control and mean body weight. Additional use of acarbose can be considered as a useful alternative in such patients if they are reluctant to accept insulin therapy.

Background and Objective: Sulfur mustard is a potent chemical vesicant warfare agent that remains a significant military and civilian threat. Inhalation of sulfur mustard gas causes inflammation and injury to airways and bronchioles. Mast cells promote allergic reactions when exposed to some chemical compounds such as HD. Hexamethylenetetramine has been shown to protect human lung cells against HD toxicity and has also been shown to be effective against the chemical warfare agent phosgene in vivo. The aim of this study was to evaluate the effects of HMT on the number of mast cells in the lamina propria of visceral layer of pleura in male rats after exposure to sulfur mustard. Materials and Methods: Twenty seven Albino Wister male rats weighting 200±20 gr were randomly divided into 5 groups (Normal Saline (N.S), HMT, HD, Pre-exposure and Post-exposure). HD, Pre-exposure and Post-exposure groups received sulfur-mustard and N.S group received Normal Saline as a solvent by intratracheal catheter. HMT, Pre-exp and Post-exp groups received HMT via intra-peritoneal for 14 days. After the day 14, body weight changes, the rate of lung tissue injury and the number of mast cells measured in the pleura's visceral layer of the rats' lungs. Results: Histological examination and mast cells count showed no significant difference when compared among NS, HMT, Pre-exposure and Post-exposure groups. However, significant reduction was seen in the number of mast cells in HMT and NS groups in comparison with the HD group (p < 0/001). The number of mast cells in the Pre-exposure and Post-exposure groups was also significantly lower than that of the HD group (p < 0/001). Conclusions: From the results of this study it can be concluded that HMT may have a positive protective and therapeutic effect on lung tissue in rats. Key words: Sulfur mustard, Lung, Mast cell, Hexamethylenetetramine, Rat

Background and Objective: Environmental pollutions that affect human health are one of the important worries related to heavy metals production. Our objective of this study was to investigate the blood lead levels in workers of Zinc melting factory of Dandi Zanjan and to compare its level with healthy men who were living around the factory. Materials and Methods: This study was carried out on 40 workers as case group and 40 healthy non-worker male individuals who where living around the mentioned factory in Dandi region of Zanjan as control group. Blood lead concentrations was measured by graphite furnace atomic absorption spectrophotometer (GFAAS). The data were analyzed using T-test and ANOVA. Results: The mean of blood lead levels in case and control groups were 16.06 and 10.47 μg/dL respectively (P = 0.0001). There was also a significant difference between workers lead levels in different parts of the factory (P = 0.04). Conclusion: Blood lead levels in factory workers were higher than in control group, although blood lead levels were in reference limit in workers on the basis of OSHA standards. Since the major way of lead pollution is respiratory tracts, therefore it is necessary to use appropriate air conditioner systems in such factories.

Intracranial Tuberculoma is a rare form of Tuberculosis (Tb) with presentation of multiple space occupying lesions. Clinical manifestations of intracranial Tuberculoma are dependent to the site of involvement. MRI, positive smear and the evidences of other organs infection can help us to diagnose intracranial Tb. We should consider tuberculosis in patients with unusual presentations even when presents with normal CXR. A 24 years old man was admitted to the infectious ward. He presented with a decreased consciousness level and weakness in four limbs during the past 7 days. He complained of a productive cough since 3months ago and knee arthralgia from 5 months ago. He was febrile and ill appearance. Breathing sound was decreased at the base of the right lung among with Cracle sound. Patient was quadriplegic without deep tendon reflex. Laboratory tests showed the rise of liver transaminases and elevation in the serum ESR and CRP. Gastric fluid smear was positive for AFB. In brain MRI, multiple hyperdense heterogen lesions were reported. The patient was treated with anti tuberculosis drugs and prednisolon. He discharged from the hospital with good general appearance after 21 days.

The term aplasia cutis is used to describe congenital localized defects of the skin. The most common site is scalp. The preauricular location is a rare form of aplasia cutis. The presented patient in this paper had skin tag and atrophy in preauricular region from after birth. Skin biopsy was performed, but surgical wound site was not healed. The results of precise investigation, deep biopsy and existence of localized skin atrophy guided to aplasia cutis diagnosis. Aplasia cutis could be recommended in every patient with skin atrophy. The treatments include protection, excision and skin graft or flap.

Background and Objective: Poly D,L-lactic-co-glycolic acid (PLGA) is known as biodegradable and biocompatible polymer. These polymers have recently received much attention in tissue engineering. The aim of this study was to investigate the biological behavior of the bone marrow stromal cells (BMSCs) in culturing with PLGA nanofibers coated with poly-L-lysine or gelatin. Materials and Methods: In this study, the electrospinning of PLGA nanofibers was performed with hexafluoro-2-propanol (HFIP) as solvent and coated with gelatin and poly-L-lysine, separately. The properties of polymers were investigated with scanning electron microscopy (SEM) analysis and contact angles were studied. After culturing BMSCs and reaching passage two, cells in the four groups of nanofibers, nanofibers PLGA, PLGA nanofibers coated with poly-L-lysine, and PLGA nanofibers coated with gelatin, were grown. Cell proliferation during the second, fourth and sixth days were examined by Acridin Orange and morphology of the cells seeded on nanofibers were investigated via SEM. Results: The mean diameter of PLGA nanofibers were between 270 - 700 nm. The average contact angles were 107.66° for PLGA, 64.58 for PLGA coated with gelatin and 40.12 for poly-L-lysine-coated PLGA, respectively. The results showed significant reduction in cell proliferation in PLGA nanofibers alone (P <0.05). But this number increased in groups of nanofibers coated with poly-L-lysine and gelatin. Conclusion: Culture of Schwann cells with PLGA nanofibers coated with gelatin and particularly coated with poly-L-lysine provide a biodegradable scaffold associated with Schwann cells.

Background and Objective: Klebsiella pneumoniae is one of the most important causative agents both in form of hospital acquired and community-acquired infections. This bacterium is one of the most prevalent pathogens that is isolated from hospitals and is associated with high mortality rates. The uprising trend of multi drug resistance among Klebsiella pneumoniae has limited the treatment options. The objective of this study was to detect Metallo-beta-Lactamases, Extended-spectrum beta-lactamases (ESBLs) and outer membrane porins among Klebsiella pneumoniae strains isolated from hospitalized patients in Taleghani and Mofid hospitals. Materials and Methods: This cross-sectional study was performed on 100 Klebsiella pneumoniae isolates from 2012 to 2013. Antibiotic susceptibility tests were performed via Kirby-Bauer disc diffusion and Broth Microdilution methods according to CLSI guidelines. Metallo-beta-Lactamases, Extended-spectrum beta-lactamases (ESBLs) producing strains were detected by phenotypic confirmatory test and Combination Disk Diffusion Test (CDDT), respectively. The blaAIM, blaSPM, blaDIM, blaIMP, blaVIM ، blaTEM، blaSHV and blaCTX-M genes were detected using PCR and sequencing method. The outer membrane porins including OmpK35 and OmpK36 were analysed throughSDS-PAGE, PCR and sequencing methods. Results: Out of 100 K. pneumoniae isolates, 48 (48%) and 3(3%) were ESBL and MBL positive, respectively. The presence of blaTEM-1, blaSHV and blaCTX-M-15 was detected in 24 (50%), 30(62.5%) and 28 (58.33%) isolates respectively, while other genes were not detected. Outer Membrane Porins, OmpK35, was detected among 30 (62.5%) of 48 ESBL-producing isolates while OmpK36 was found in 35(72.91%) of 48 ESBL-producing isolates. In this study, Fosfomycin and Tigecycline were more effective than other antibiotics. Conclusion: The high prevalence of ESBL-producing K. pneumoniae detected in this study is of great concern which requires infection control measures including antibacterial management and rapid detection of beta-lactamases-producing isolates. References 1- Amraei S, Eslami G, Taherpour A, Goudarzi H, Hashemi A. Detection of FOXMOX, and ACT genes in ESBL- producing Klebsiella Pneumoniae strains. J Mazandaran Univ Med Sci. 2014 24: 11-20. 2- Fallah F, Taherpour A, Vala MH, Hashemi A. Global spread of new delhi metalo-beta-lactamase-1 (NDM-1). Arch Clin Infect Dis. 2012 6: 171-7. 3- Fallah F, Vala MH, Goudarzi H, et al. Identification of extended-spectrum-beta-lactamases (ESBLs), metallo-beta-lactamases (MBLs), Amp-C and KPC ß-lactamases among Klebsiella pneumoniae isolated from adults and pediatric patients in Iran. Afr J Microbiol Res. 2013 7: 3254-61. 4- Fallah F, Borhan RS, Hashemi A. Detection of bla (IMP) and bla (VIM) metallo-beta-lactamases genes among Pseudomonas aeruginosa strains. Int J Burns Trauma. 2013 3: 122-4 5- Hakemi Vala M, Hallajzadeh M , Hashemi A , et al. Detection of ambler class A, B and D β-lactamases among Pseudomonas aeruginosa and Acinetobacter baumannii clinical isolated from burn patients. Ann Burns Fire Disasters. 2014 27: 8-13. 6- Fallah F, Taherpour A, Borhan R, Hashemi A, Habibi M, Nia RS. Evaluation of Zataria MultiFlora Boiss and Carum copticum antibacterial activity on IMP-type metallo-beta-lactamase-producing Pseudomonas aeruginosa. Ann Burns Fire Disasters. 2013 26: 193. 7- Taherpour A, Hashemi A. Detection of OqxAB efflux pumps, OmpK35 and OmpK36 porins in ex-tended- spectrum-β- lactamase- producing Klebsiella pneumoniae isolates from Iran. Hippokratia. 2013 17: 355-8. 8- Hashemi A, Fallah F, Erfanimanesh S, Hamedani P, Alimehr S. Detection of β-lactamases and outer membrane porins among Klebsiella pneumoniae strains isolated in Iran. Scientifica. 2014 2014: 726179. 9- Tsai Y-K, Fung C-P, Lin J-C, et al. Klebsiella pneumoniae outer membrane porins OmpK35 and OmpK36 play roles in both antimicrobial resistance and virulence. Antimicrob Agents Chemother. 2011 55: 1485-93. 10- Landman D, Bratu S, Quale J. Contribution of OmpK36 to carbapenem susceptibility in KPC-producing Klebsiella pneumoniae. J Med Microbiol. 2009 58: 1303-8. 11- Hashemi A, Shams S, Kalantar D, Taherpour A, Barati M. Antibacterial effect of Methanolic extract of Camellia Sinensis L. on Pseudomonas aeruginosa strains producing β-lactamases. J Gorgan Uni Med Sci. 2012 14: 136-42. 12- Hashemi A, Shams S, Barati M, Samedani A. Antibacterial effects of methanolic extracts of Zataria multiflora, Myrtus communis and Peganum harmala on Pseudomonas aeruginosa producing ESBL. Arak Med Univ J. 2011 14: 104-12. 13- Shakibaei M, Shah CF, Hashemi A, ADELI N. Detection of TEM, SHV and PER type extended-spectrum β-lactamase gene among clinical strains of Pseudomonas aeruginosa isolated from burnt patients at Sbafa-Hospital, Kerman, Iran. Iran J Basic Med Sci. 2008 2: 104-111. 14- Jafari M, Fallah F, Borhan RS, et al. The first report of CMY, aac (6′)-Ib and 16S rRNA methylase genes among Pseudomonas aeruginosa isolates from Iran. Arch Pediatr Infect Dis. 2013 2: 109-12. 15- Vala MH, Nowroozi J, Ghazi F, Tabatabai PN, Haghighi S. Comparing invasive and non-invasive of isolated Shigella flexneri by electron microscopy of cell culture, SDS-Page and congo red method. Iran Biomed J. 2007 11: 47-52. 16- Mansouri S, Kalantar D, Asadollahi P, Taherikalani M, Emaneini M. Characterization of Klebsiella pneumoniae strains producing extended spectrum beta-lactamases and AMPC type beta-lactamases isolated from hospitalized patients in Kerman, Iran. Roum Arch Microbiol Immunol. 2012 71: 81-6. 17- Ghafourian S, Bin Sekawi Z, Sadeghifard N, et al. The prevalence of ESBLs producing Klebsiella pneumoniae isolates in some major hospitals, Iran. Open Microbiol J. 2011 5: 91-5. 18- Feizabadi MM, Delfani S, Raji N, et al. Distribution of bla TEM, bla SHV, bla CTX-M genes among clinical isolates of Klebsiella pneumoniae at Labbafinejad hospital, Tehran, Iran. Microb Drug Resist. 2010 16: 53-49. 19- Goudarzi H, Aghamohammad S, Hashemi A, Nikmanesh B, Noori M. Distribution of blaTEM, blaSHV and bla CTX-M genes among Escherichia coli isolates causing urinary tract infection in children. Arch Clin Infect Dis. 2013 8: e1b207. 20- Keramati N, Zeighami H, Haghi F. Frequency of class I and II integrons in metalobetalactamase producing clinical isolates of Pseudomonas Aeruginosa. J Zanjan Univ Med Sci. 2014 22: 111-9. 21- Hemmati F, Soroori Zanjani R, Haghi F, Zeighami H. Determination of Antibiotic Resistance Profile and Frequency of Metallo-Beta- Lactamases in Pseudomonas Aeruginosa Isolates. 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Background and Objective: Previous studies have distinctly illustrated the decreasing effects of lemon and garlic extracts on blood glucose and cholesterol. In the present study, the anti-diabetic, anti-atherosclerotic and antioxidant effects of combined lemon and garlic extract were evaluated in diabetic rats fed with high cholesterol diet.

Materials and Methods: The experiment was performed in five groups of rats (N=40); control, diabetic, diabetic plus high-cholesterol, diabetic plus extract and diabetic plus high-cholesterol plus extract. Diabetes was induced by an intravenous injection of streptozotocin (37mg/kg). High-cholesterol diet was prepared by adding 4% cholesterol and 1% colic acid to standard food. Treated groups received lemon and garlic extract orally (1ml, twice a day) for 60 days. At the end, the heart malondialdehyde (MDA) and histopathological changes of aorta were assessed.

Results: Blood glucose significantly increased in diabetic groups (>200mg/dl) and blood cholesterol significantly increased in diabetic plus high-cholesterol rats (187±15mg/dl). Combined extract significantly decreased the blood glucose of diabetic plus extract group (147±7mg/dl) compared to diabetic group (P<0.05). Also, this extract meaningfully decreased the blood cholesterol of diabetic plus high-cholesterol plus extract group (102±10mg/dl) compared to diabetic plus high-cholesterol group (P<0.05). The MDA content of the heart were high in diabetic and diabetic plus high-cholesterol groups plus combined extract decreased the level of MDA in both treated groups. Finally, damage to aorta and atherosclerosis was only observed in diabetic& high- cholesterol group.

Conclusion: Based on our findings, combined extract of lemon and garlic was able to prevent atherosclerosis formation and damage of aorta probably by reduction of tissue oxidative stress, blood glucose and cholesterol in diabetic rats fed with high cholesterol diet.

Background and Objective: Eccentric exercises and taping have been claimed to be an efficient method to improve the symptoms of tennis elbow. The objective of this study was to compare the effect of the implementation of a six-week-eccentric training program with and without taping on grip strength, wrist and middle finger extension in female athletes with tennis elbow.

Materials and Methods: Forty-five female athletes with tennis elbow in age range of 35 to 50 years participated in this study. After the measurement of grip strength by dynamometer (Yagummy), extension strength of middle finger and wrist with handheld dynamometer (Lafayette) were measured. Subjects were assigned to two groups of practice (N=15) and control (N=15[L1] ). Eccentric exercises mainly were performed by Flexbar (Thraband product). Elbow diamond taping technique was used. The collected data was analyzed using SPSS 21 and significance level of 0.05 (P=0.05) was considered in the analysis of the collected data.

Results: The study showed differences between pre-test and post-test scores of grip strength (P=0.001). However, there was not any significant differences between pre-test and post-test results in wrist extension strength (P=0.504) and the middle finger extension variables (P=0.96). Bonferroni test results also showed that there was no statistically significant difference between the effects of eccentric exercises with or without taping (P=0.818).

Conclusion: The eccentric exercises and combined exercises (eccentric exercises and taping) can possibly enhance strength and increase performance in rehabilitation of patients with tennis elbow.

Background and Objective: Efflux pumps are one of the major resistance mechanisms in Pseudomonas aeruginosa that inhibit the accumulation of antibiotics in bacterial cells. The aim of this study was determining the effect of carbonyl cyanide 3-chlorophenyl hydrazone (CCCP) and detecting the overexpression of pump MexCD-oprJ in P. aeruginosa isolated from burn patients in Shahid Motahari hospital during 2014 and 2015.

Materials and Methods: This descriptive study was performed on 100 P. aeruginosa isolates from burn patients in Shahid Motahari hospital. Antibiotic susceptibility tests were performed by Kirby-Bauer disc diffusion and broth microdilution methods according to the CLSI guidelines. The effect of CCCP was determined using the broth microdilution method. The expression levels of MexD-oprJ (an efflux pump) was evaluated by Real-Time PCR and finally detection of nfxB mutations was carried out by PCR and sequencing techniques. 

Results: Antibiogram for 100 P. aeruginosa showed maximum susceptibility and resistance to colistin (100%) and ticarcilin (98%), respectively. The inhibitory effect of CCCP was apparently seen in 16 isolates. Real-time PCR results for these strains showed overexpression in range of 0.26-15.34 (mean: 4/1). The PCR and sequencing techniques showed mutations that converts lucin to prolin in position 14 of the protein sequence.

Conclusion: The increase in expression level of efflux pump MexCD-oprJ shows the prevalence of nfxB mutants in burn wound infections. Therefore, use of carbonyl cyanide 3-chlorophenyl hydrazone (CCCP) can help disrupt the function of efflux pumps and improve the effects of antibiotics.

Background and Objective: People with functional ankle instability face various complications which entail quick actions via multifaceted and combined exercises. Therefore, the main objective of this semi-experimental research was to determine the effectiveness of the comprehensive combined programs on functional strength of ankle in active men with functional ankle instability.
Materials and Methods: The subjects of this research were active university men with functional ankle instability (with a mean age and standard deviation of 20.00 ± 3.72 year and mean height of 185.85 ± 8.55 cm), of whom  30 were selected and randomly assigned to experimental and control groups (15 in the control group and 15 in the experimental group ). The experimental group performed eight weeks of combined exercises, mostly neuro-muscular and strength training exercises (using red Tera band), for eight weeks and three sessions per week for one hour. The research variable was the functional strength of the ankle muscles. The instruments for collecting research data were isokinetic biodex system3, and foot ankle inability index questionnaire. To figure out the normality of inputs, Kolmogorov-Smirnov test was used and to compare groups, Covariance test was run and to attain differences within groups, paired t-test was used.
Results: Results showed significant differences before and after the exercise program in the experimental group. However, in the control group these changes were not statistically significant.
Conclusion: The results of the current research showed that combined program can be effective and reliable in improving functional strength of agonist and antagonist muscles.