Jundishapur Scientific Medical Journal
Year:2007 | Volume:6 | Issue:3 (54)|Papers Count:21

Objective: There are several incremental techniques for placement of posterior composites in class II cavities that were introduced to overcome the clinical failures associated with these restorations. The purpose of this study was to evaluate micro- leakage in class II cavities restored with four different placement techniques.Subjects and Methods: On 40 non-carious freshly extracted human premolars, class II cavities were prepared following a standard pattern in which the mesial cavities had a cervical margin of I mm above the CEJ and for distal cavities 1 mm below the CEJ the specimens were randomly divided into 4 groups. The cavity surface was conditioned with 35% phosphoric acid, rinsed, excess water removed, and a dental bonding agent (PQ1) was used for all the cavities. The teeth were then restored with a fiber reinforced resin based composite (Neulite F) with four different placement techniques: Group 1, metal matrix with wooden wedge; Group 2, transparent matrix with reflective wedge; Group3, metal matrix with wooden wedge and light tip and Group 4, metal matrix with wooden wedge and bio-glass cylinder. Then the restorations were finished and polished, rebounded, thermo-cycled (2000 times, 5°C to 55°C, 30 s dwell time), stained, and viewed under a stereomicroscope (40x) and scored according to the micro-leakage at gingival margins on a 0-4 scale. Data were analyzed using Kruskal- Wallis and Mann- Whitney U tests.Results: Compared with other placement techniques, significantly more micro-leakage was observed with metal matrix with wooden wedge technique. While least micro-leakage was seen with metal matrices using light conducting instruments. There was no significant difference between enamel and dentin gingival margin groups. Conclusion: The findings of this study demonstrated that restoration with metal matrices using light conducting instruments results in significantly less micro-leakage at gingival margins of class II composite resin restorations.

Objective: One of the most common diseases in children is allergic diseases. The prevalence and severity of allergic diseases are widely different worldwide. The aim of the present study was to study the prevalence of asthma, allergic rhinitis and eczema symptoms among school children in 13-14 years old age group in Yazd.Subjects and Methods: The prevalence and severity of asthma, allergic rhinitis and eczema symptoms were determined among 3060 school children aged 13-14 years old. The parameters of measurements were based on International Study of Asthma and Allergies in Childhood (ISAAC).Results: The results showed the prevalence of asthma, allergic rhinitis and eczema symptoms were 20.3, 42.7 and 14.8% respectively. Prevalence of ever wheezing was higher in boys than girls. Eczema symptoms were more prevalent in girls.Conclusion: Prevalence of eczema and allergic rhinitis symptoms in our study are more than other cities of Iran. Education of the children and their parents on the necessary change of life styles may help in decreasing these problems.

Objective: The purpose of this study was evaluation of stressing factors and their relationship with the coping styles among first year students in Ahwaz university of Medical Sciences. Subjects and Methods: Three hundred and three students (232 females, 71 males) were selected by convenient sampling, the subjects were assessed using demographic data questionnaire, students' educational stressors questionnaire, general health questionnaire (GHQ), and coping style questionnaire (CSQ).Results: The results showed, the total score of GHQ for 41.8 % of students was out of the normal range, and students with low interest in their admitted course of study, experienced lower mental health (p<0.008).The most common stressors of students were: ''worried about examination", "high volume of lessons", "dormitory problems", and ''worried about employment in future". Students who live in dormitory, experienced greatest stressors (p<0.001) and the coping styles were combination of logical and emotional strategies. A statistically significant relationship was found between stress, logical coping style and mental health (p<0.003).Conclusion: Findings of this study showed that students had maladaptive coping styles which were related to more stress and low general health. Therefore the results suggest, an implementation of plan that can reduce educational and welfare stressors is necessary. In addition, psychological intervention for maintenance of mental health well-being of coping style, especially among first year students, is necessary.

Objective: Idiopathic thrombocytopenic purpura is a common disease in childhood.Management of thrombocytopenia includes corticosteroids, IV immunoglobulin (IVIG), Rhogam and many other interventions. In this article we study the therapeutic effects of these methods and their complications.Subjects and Methods: This is a study on 32 chronic and acute ITP casesin childs who visited Dr Sheikh hospital from Jun 2004 to March 2005. Inclusion criteria were Rh+, and negative Combs test. The patients were allocated to receive one of the treatment protocols: Prednisolone (dose/time), IVIG (dose/time), or Rhogam (dose/time). The following end points were assessed: duration of treatment, the effectiveness of treatment and the side effects.Results: Mean age was 8.35±4.5 years and male and female had similar prevalence. Petechia and purpura was the significant clinical sign found in 90.6 % of patients.Prednisolone, IVIG and Rhogam were administered to 43.8, 25, and 31 % of patients respectively. Although the initial platelet count was higher in prednisolone group, at the end of treatment all groups had similar platelet count. Compared to other treatment protocols, the Rhogam-treated group had a significantly shorter hospitalization period, more frequent complete therapeutic response, without any recurrence over the period of study, and lack of side effects such as acute hemolysis and hepatotoxicity.Conclusion: The results of the study suggest that Rhogam produces more rapid remission of symptoms and is a safe, effective, easy to use and cost effective. Therefore we recommend it for treatment of ITP in Rh+, and Combs negative children.

Objective: Useful effects of many medicinal plants are reported in the literature, among which antibacterial, antiviral and antifungal effects are the most important. In the present study, antifungal affects of essential oil of clove tree flower (eugenol) was examined.Subjects and Methods: Serial dilution antibiotic susceptibility tests were performed to determine minimum inhibitory concentration (MIC) and minimum fungicial concentration (MFC) against different fungal species (Aspergillus niger, Aspergillus fumigatus, Penicillium sp., Mucor sp., Alternaria sp., Fusarium sp., Candida albicans and Candida sp.) at two different pHs (5.5 and 6.5).Results: MIC value for A. fumigatus, A. niger, Penicillium sp., Candida sp., and Mucor sp. was found to be 0.39 mg/ml. However, a MIC of 0.78 mg/ml was found for Alternaria sp., Fusarium sp., and Candida albicans. MFC value for Mucor sp., Alternaria sp., and Candida albicans was 0.78 mg/ml. This value was found to be twice greater for other Fungi (1.56 mg/ml). Generally, no difference was shown between MIC and MFC values at pH 5.5 or 6.5. Conclusion: The Fungi tested under these experimental conditions showed almost similar sensitivities to eugenol.

Objective: Prevalence of colonization of group B Streptococci in genital or lower GI system of pregnant women varies from 5 to 40 %. Race, age, geographical location, socioeconomic and marriage status are causes of this variability. Penicillin is the drug of choice and ampicillin is an acceptable regimen for the treatment of mother-to-be and fetus streptococcal infection. The goal of this study was to study its epidemiological prevalence among pregnant women of 35 to 37 weeks of gestation and sensitivity.Subjects and Methods: In this study 250 pregnant women between 35-37 weeks of gestation who visited our prenantal care unit were evaluated. Two samples from vagina and rectom were taken. The samples were assessed moicrobiologically for b-Streptococcus and an antibiogram for evlaution of sensitivity to ceftizoxim, cephazolin, penicillin and ampicillin.Results: From 250 cases, 33 patients (13.2%) had positive streptococcal culture in vagina or rectom. Mode of previous delivery, history of corioamnionitis, PROM, preterm labor in previous pregnancy, age and gravity had no significant correlation with incidence of streptococcal colonization. Antibiotic sensitivity of 97%, 93%, 56% and 50%of cases were sensitive to ceftizoxim, cephazolin, penicillin and ampicillin respectively.Conclusion: The prevalence of streptococcal colonization is as same as other studies.However, unlike other study that recommends penicillin or ampicillin as the first line therapy, in our study suggests that cephalosporins are the drug of choice for treatment.

Objective: One of the most important principles in dental local anesthesia is aspiration before injection which can prevent a lot of emergencies in dentistry. The purpose of this study was to compare three techniques of mandibular local anesthesia in terns of blood aspiration pro bability.Subjects and Methods: A full trained oral and maxillofacial surgeon performed 424 injections on 236 patients (88 males and 148 females, average age 26) using one standard aspirable syringe system and one type of needle with 34 mm length and 27 gauge. Patients who had systemic diseases were omitted; for the other patients one or more of three techniques of local anesthesia was performed which consisted of direct or indirect techniques inferior alveolar nerve block and mandibular nerve block by Gow-Gates technique. Frequency of injections in each group included: direct technique 180 injections, indirect technique 123 injections and Gow-Gates technique 121 injections. Aspiration was performed at the start of each type of injection. In each block the age and sex of patients were recorded, along with anesthetic technique and blood aspiration (either positive or negative). The X2 test was used to analyze the variables and data.Results: In this study we found that: the positive aspiration rate was 8.3, 7.3 and 7.4 % by direct, indirect and Gow-Gates techniques respectively. No significant differences were observed among the anesthetic techniques performed.Conclusion: The findings of this study demonstrated no significant differences among all the techniques of nerve blocks and all these techniques are equally effective in performing this procedure.

Objective: Chemotherapy-induced neutropenia is a life threatening and common side effect in treatment of acute lemphoblastic leukemia (ALL). It predisposes to serious infections, fever and prolonged hospitalization. The aim of the present study was to assess the effectiveness of G-CSF in combination with antibiotics in shortening the periods of hospitalization, fever and chemotherapy-induced neutropenia Subjects and Methods: The was prospective randomized clinical study carried out on 140 patients with acute lymphoblastic leukemia (ALL) who received a standard intensification dose with prednisolon, adriamycin, cytosar, MTX, 6TG and VCR. These patients were referred to our pediatric ward of Shafa hospital, Ahwaz University of Medical Sciences, over three years (2001 to 2003) due to (fever >38°C), neutropenia (ANC<500/mm3) and with no obvious sings of infection (pneumonia, sepsis or diarrhea). A random group of 68 patients were assigned to receive G-CSF (10 mg/Kg/day) for at least 3 days with a combination of antibiotic and 72 patient received only standard antibiotic therapy. When the patients became afebrile with ANC> 1500 were discharged from hospitalResults: Patients randomized to G-CSF had a shorter hospitalization (median 7.6.v 8.8 days; p<0.001), and shortening of neutropenia period (median 6.7 v 8.0 days p<0.001). However, difference in the period of fever between both groups was observed (mean 3.2 days). G-CSF treated patients also had more rapid neutrophil recovery and higher neutrophil levels at the time of discharge (1600 v 2020 ANC, p<0.001)Conclusion: Adding G-CSF therapy to antibiotic treatment shortens the duration of neutropenia and hospitalization periods in the patients with fever and neutropenia. However, this combination had no effect on the mortality rate and duration of fever. Larger studies on the cost effectiveness of this trial need to be assessed independently.

Objectives: Viral hepatitis is an important causative agent resulting in acute and chronic hepatitis, cirrhosis and hepatocellular carcinoma. Because of frequent transfusions, thalassemic patients are at a greater risk of developing this disease. Therefore, knowledge on the HB immune status of these patients is impotents. The aim of this study was to determine the immune status of HB-vaccinated Major b-thalassemic children by measuring the serum anti-HBS antibody level.Subjects and Methods: This study carried out on 215 thalassemic children who received three standard intramuscular recombinant HBV vaccines. Their age range was 1 - 4.5 years (mean 3.37 years). Serum anti-HB antibodies measurements were recorded on three occasions and based on the time lapsed since the last injection. The results were categorized into three groups: good, low responders and non responders.Results: The mean of anti-HBS level in the above three groups were as 205.34, 128.8 and 54.25 lu/lit respectively (p<0.001). In the girls the mean of antibody level was 104.2 and in boys it was 95.8 Iu/Lit (p>0.05). The distribution of immune response in these three groups was as following: the first group: good responders 29, low responders 6, non responders 1, the second group: good responders 31, low responders 16and non responders 13; the third group: good responders 15, low responders 43 and non responders 61 (p<0.001). In other words the anti-HBS Ab level had declined by time of last vaccination. Overall from 215 selected individuals 75 had good response, 65 low response and 75 non responses. Conclusion: The results from this study suggest that standard HBV vaccination in thalassemic children results in 65% immune responses. In order to maintain the immune status among these patients, it is recommended that anti-HBS Ab level be measured after 45 months of last HBV and a booster dose of the vaccine be administered when necessary.

Objectives: Viral hepatitis is an important causative agent resulting in acute and chronic hepatitis, cirrhosis and hepatocellular carcinoma. Because of frequent transfusions, thalassemic patients are at a greater risk of developing this disease. Therefore, knowledge on the HB immune status of these patients is impotents. The aim of this study was to determine the immune status of HB-vaccinated Major b-thalassemic children by measuring the serum anti-HBS antibody level.Subjects and Methods: This study carried out on 215 thalassemic children who received three standard intramuscular recombinant HBV vaccines. Their age range was 1 - 4.5 years (mean 3.37 years). Serum anti-HB antibodies measurements were recorded on three occasions and based on the time lapsed since the last injection. The results were categorized into three groups: good, low responders and non responders.Results: The mean of anti-HBS level in the above three groups were as 205.34, 128.8 and 54.25 Iu/lit respectively (p<0.001). In the girls the mean of antibody level was 104.2 and in boys it was 95.8 Iu/Lit (p>0.05). The distribution of immune response in these three groups was as following: the first group: good responders 29, low responders 6, non responders 1, the second group: good responders 31, low responders 16and non responders 13; the third group: good responders 15, low responders 43 and non responders 61 (p<0.001). In other words the anti-HBS Ab level had declined by time of last vaccination. Overall from 215 selected individuals 75 had good response, 65 low response and 75 non responses. Conclusion: The results from this study suggest that standard HBV vaccination in thalassemic children results in 65% immune responses. In order to maintain the immune status among these patients, it is recommended that anti-HBS Ab level be measured after 45 months of last HBV and a booster dose of the vaccine be administered when necessary.

Objective: Bacterial meningitis is one the most severe and complicated pediatric diseases with high mortality and morbidity. The aim of the present study was to study the prevalence treatment outcome and to identify type the bacteria involved.Subjects and Methods: in this retrospective study 123 hospitalized patients with suspected bacterial meningitis in ten years (1393-2003) were studied. Based on clinical and laboratory data, finally 85 patients recognized as bacterial meningitis. All the laboratory works including measurement of CSF sugar, protein and 'differential cell count, gram-stain of CSF, blood and cerebrospinal fluid cultures was done.Results: The results showed that the implicated bacteria in 40 cases with Streptococcus pneumoniae (47.1%), Haemophilus influenzae type b in 22 cases (25.9%), Neisseria meningitides in 13 cases (15.3%), Escherichia coli in 4 cases (4.7%),(, Klebsiella species in 3 cases (3.5%), Enterobacter , group B Streptococci and Streptococci viridians in one case each (3.5%).Complications and mortality in young infants under two months of age was high .The neurological complications in children above two months, in descending order, were: hearing loss, hydrocephaly, seizures, mental retardation, ataxia and hemiparesis. Conclusions: In patients under 2 months of age Gram-negative bacilli was the leading cause of bacterial meningitis, above this age streptococcus pneumoniae was more frequent. The neurological complications were decreased after passing of time, therefore early diagnosis and treatment yield better outcome in our patients.

Objective: Incidence of femoral artery mycotic aneurysm is increasing due to rising rate of drug abusers. There are multiple surgical procedures for mycotic aneurysm with different complications. Surgical treatments include extensive debridement and revascularization with autogen or synthetic grafts, primary or delayed and ligation of femoral artery without any revascularization. The aim of this study was to evaluate the outcome of femoral artery ligation in treatment of mycotic aneurysm without revascularization among IV drug abusers.Subjects and Methods: This is a retrospective, descriptive study in 44 drug abusers who suffered from femoral mycotic aneurysm who were referred to imam Khomeini and Razi Hospital during 2001-2004. All patients, operated on by just by femoral artery ligation and debridement without revascularization. Limb salvage and disability followed up for two years after operation.Results: In 2 cases (out of a total 44 cases) amputation was performed after femoral artery ligation (95% limb salvage). Intermittent claudication occurred in 5 cases (11.9%) and two (40 %) out of these 5 cases had delayed revascularization by synthetic graft prosthesis Paresthesia occurred in 2 cases.Conclusion: There are high complications with low success rate for primary revascularization in these patients either anatomical or extra anatomical due to extensive infection and sepsis.According to excellent surgical outcomes among our patients (95% limb salvage), we recommended that femoral artery ligation and debridement without any revascularization procedures be used. This method is safe, fast and effective in limb saving treatment for femoral mycotic aneurysm in IV drug abusers.

Objective: Diabetic patients are more sensitive to some infection. Oral Candidacies is one of the most common opportunistic infection in diabetic and immunocompromised patients. Several reports indicate increase of oral Candidiasis species in oral cavity of diabetic subjects rather than non - diabetic subjects, Almost half of diabetic subjects are carriers of Candida species specially Candida albicans. The aim of this research was to compare the pH and the prevalence of different Candida species in diabetic and non-diabetic saliva. Subjects and Methods: This research was a case-control study this study was done in Ahwaz Golestan hospital in 1381-82. A total of 140 patients were recruited, and divided in two groups of diabetic and non-diabetic (70 persons in each). They were trained an oral hygiene procedure. After two weeks cotton-swab samples were taken from their saliva. The swabs were cultured in chromagar media. The pH of their saliva was measured using a pH paper. For statistical analysis of the data, Chi-squired, non-parametric and T- tests were used.Results: The age of population in both groups Vas between 25 to 65 years old. The results showed a significantly higher presence of Candida species in diabetic saliva than in nondiabetic patients. Candida albicans was the most common Candida in the saliva of both groups. The salivary pH in diabetic patients was significantly (p<0.05) lower than nondiabetic patients. Conclusion: These research shows that Candida species, especially Candida albicans in the mouth of diabetic patients have significant presence and these patients are at a greater risk of developing oral caondidiasis. It is recommended that oral hygiene, control of blood sugar and, when infected, early use of local anti fungal is necessary.

Objective: Oleic acid (OA) (Omega 9) is an essential constituent of neuronal membrane. This fatty acid is transferred across the placenta and is accumulated in the brain during fetal development. It induces neuronal differentiation during rat brain development and behaves as a neurotrophic factor for neurons, promotes axonal growth, neuronal clustering. However, it role in adulthood has not been finny established. The aim of this study was, therefore, to test the effects of this fatty on spatial learning in adult rats.Subjects and Methods: Wister adult male rats were selected and divided randomly, into five groups (n=9). The control group was fed with an ordinary diet and the remaining four groups were fed with a diet containing 10 % OA for 1, 2, 3 and 4 weeks, respectively. The rats were tested for spatial learning task using T-maze over for 9 days based on standard method.Results: The result showed that the rats fed with 10 % OA in their diet for 4 weeks had a significant increase in special learning relative to other groups (p<0.01).Conclusion: It seems this unsaturated fatty acid increases spatial learning in adulthood and this action may be mediated by increase in the fluidity of membrane nerve cell especially in hippocampus area.

Objective: There are many restorative designs for root canal treated maxillary premolars. One of these treatments is overlay composite with fiber-reinforced composite. The aim of the present study was to compare the fracture resistance of endodontically-treated maxillary permolars with MOD cavities restored using fiber-reinforced composite and posterior packable composite (3M-P60).Subjects and Methods: Seventy-two sound maxillary permolars with the same size were chosen and randomly divided into six groups of 12. Group I: intact teeth; Group2: Root canal treated teeth with MOD cavity; Groups 3 and group 4: Root canal treated teeth with MOD cavity preparation for direct fiber-reinforced (Nulite F) composite Onlay using Nulite F2 linear (group 3: at 90° degree of force, group 4 :at 45° degree of force) Groups 5 and 6: these groups were prepared in the same way as groups 3 and 4, differing in that these specimens were restored by 3M-P60 composite instead of Nu lite F. (group 5: at 90° degree of force, group 6: at 45° degree of force). ANOVA and Comparison multiple tests were used for statistical analysis.Results: The mean fracture resistance obtained was: Group 1:2.092 KN; Group 2:0.862 KN Group3: 1.639KN; Group 4:0.806 KN; Group 5: 1.314KN; Group 6: 0.615 KN. Except for groups 4 and 6, the p-value showed significant difference among the others.Conclusion: The destructive effects of oblique (shear) forces are more than vertical forces. Cavity form and existence of marginal ridge are other factors that are effective on fracture resistance.Endodontically-treated maxillary premolars with MOD cavities could be successfully restored by fiber-reinforced composite, but this is not recommended for persons with para-functional inhibitions.

Objective: Hemophilic arthropathy due to repeated intraarticular bleeding leads to reduction of quality of life in hemophiliacs. There are variety of methods in prevention and treatment of joints complications in patients, which intraarticular rifampin injection is the cheapest, less complicating and more beneficial one.Subjects and Methods: Among patients referring to hemophilic clinic of Ahwaz shafa hospital, we selected patients that had target joints or chronic synovitis. Pre and post treatment (3 to 6 months later) clinical examination (by world federation of hemophilia guideline) and MRI of involved joints were performed. In knee rifampin 500mg lidocaine, weekly for 10 weeks and in elbow, ankle and shoulder joints 250mg rifampin lidocoine, for 5 weeks injected intraarticularly. The factor patients levels reached to 50-80 percent in the day of injection and the following days.Results: intraarticular injections were performed for 9 hemophilic patients with 11 affected hemophilic joints clinical signs and MRI showed dramatic improvement in 6 patients, but out come was not favorable in 3 patients due to advanced disease and joint destruction.Conclusion: Intraarticular rifampin injection is a suitable method for prevention of bleeding, improvement of clinical signs and quality of life in hemophiliacs.MRI is more helpful in reviewing the therapeutic results and Joint chonges after treatment. Hyperplasia and hypertrophy of synovium, bone cystsjoint cartilage loss, precipitation of hemosiderin and osteonecrosis are evaluated with MRI better and precisely than plain radiography or clinical examination, pre and post treatment.

Hypothyroidism rarely presents only by hoarseness. Hoarseness is induced by various etiological factors including CNS nucleus involvement, crycothyroid muscle edema, TVC edema, and at least commonly due to laryngeal polyp. In this report, we present a case of a 50 year-old women with laryngeal polyp with hypothyroidism. She was presented with a 1 year history of hoarseness without any improvement to various medical treatments and with no sign or symptom denoting hypothyroidism. Laryngeal examination revealed a giant polyp.Para-clinical assessment showed subclinical hypothyroidism and histopathology was compatible with hypothyroidism deposition (hyaluronic acid collection). Hypothyroidism and Hashimato thyroiditis was proven by clinical and paraclinical assessment in 6 months follow up. Hypothyroidism had predisposed laryngeal polyp formation. Laryngeal polyp is an irreversible stage of hypothyroidism induced hoarseness and caused by mucopolysacarides and hyaluronic acid collection. As regards the high incidence of hypothyroidism especially in premenopose women, it is important to consider thyroid abnormality in the face of hoarseness in such patients and perform thyroid function tests.