Avicenna Journal of Clinical Medicine
Year:2007 | Volume:14 | Issue:2 (SN 44)|Papers Count:13

Introduction & Objective: Homocysteine is essential for protein metabolism. On the other hand, hyperhomocysteinemia is recognized as an independent risk factor for cardiovascular diseases, including oxidative stress damage, atherosclerosis, coronary artery disease and myocardial infarction. In spite of different study about the cardiovascular effect of homocysteine, the pathogenic mechanism of homocysteine effect on cardiovascular disease is not fully understood. With regard to this fact, the effect of homocysteine on the isolated heart of rat has been considered in this study.Materials &Methods: Male Wistar rats (n=20) were used in this experimental study. The hearts of animals were isolated according Langendorff method and perfused with Kreb's solution. After 20 min stabilization period, hearts were perfused with Kreb's solution which contained different concentration of homocysteine in three groups (0.5, 0.1 & 0.05 mmol/lit) for 25 min. The different cardiac parameters were measured during different experimental periods and their changes were analyzed in each group with repeated measure ANOVA and were compared between groups with one way ANOVA and Tukey post test.Results: Results showed that the cardiac functional parameters including RPP (Rate Pressure Product) were not significantly affected by different concentration of homocysteine. On the other hand this amino acid resulted in increase of coronary flow. This increase started from 5 min after perfusion with homocysteine in three groups and continued to 25 min with 0.5 mmol/lit and to 10 min with 0.1 mmol/lit. Conclusion: In summary results showed the vasodilator effect of homocysteine on the coronary vessels without any changes in cardiac function.

Introduction & Objective: The aim of this research was to review the constitutional and other risk factors in children with Attention Deficit and Hyperactivity Disorder (ADHD).Materials& Methods: Present research was a descriptive-comparison and subjects were 180 children with ADHD. 210 matched healthy children participated as a control group.Questionnaire was designed by the researcher.Results: Results showed that the rate of temperamental and learning disorder type in children of subject group, and the history of learning disorder, attention deficit and hyperactivity disorder in parents and relatives of subject group were more than control group.Conclusion: On the basis of results it was determined that constitution factors more than environmental factors have great effect in ADHD. These finding support the results of previous researches.

Introduction & Objective: Isolation of cells from different tissues rely on proteolytic enzymes mainly collagenases that selectively digest collagen fibers of extra-cellular matrix. It is important to find new and proper collagenases from plant sources. In the present research actinidin, a cysteine protease abundant in Kiwifruit, was used to isolate and culture of rat hepatocytes.Materials & Methods: Different concentrations of actinidin was used to isolate rat hepatocytes by one or two-step perfusion method. The viability of the separated cells was examined by the trypan blue test. The isolated rat hepatocytes were cultured on collagen coated plates in William's E medium. The morphology of hepatocytes was examined microscopically after staining with the Papanicolaou method.Results: Actinidin in the concentration of 0.4 mg/ml in two-step perfusion method properly isolated hepatocytes from rat liver. The viability of isolated hepatocytes that successfully cultured in collagen coated plates was 90-95 percent.Conclusion: These results showed that actinidin is a proper protease for isolation of hepatocytes. In addition, purification of this enzyme is simpler than the collagenases.

Introduction & Objective: Exchange transfusion is replacement of blood or main part of RBC mass and plasma of a recipient by compatible RBC or plasma from one or more donors. This study was carried out with the aim of evaluation the rate of complications of exchange transfusion in hospitalized neonates during 2002-2005.Materials& Methods: This descriptive cross-sectional study was done on 120 neonates with jaundice who had blood exchange. Medical documents of these neonates were then evaluated for complications of exchange transfusion. Complications after exchange transfusion were included hypocalcaemia, hyperkalemia, thrombocytopenia, necrotizing enterocolitis, cardiac arrest, hypoglycemia, hypothermia, seizure, sepsis and mortality. Data extracted were statistically analyzed by SPSS 10.Results: In 120 evaluated neonates, 64 neonates (53.3%) were boys and 56 cases (46.7%) were girls. The incidence of complications of exchange transfusion was 61.7% (74 cases). The most common complication in these neonates was thrombocytopenia (51.7%). The second common complication was hypocalcaemia (30.8%). Cases of necrotizing enterocolitis were not seen. Mortality rate from exchange transfusion in neonates was 5% (6 cases). The rate of exchange transfusion complications in low birth weight neonates (body weight less than 2500gr) was more than normal weight neonates (p<0.05). The rate of exchange transfusion complications in preterm neonates was also more than term neonates (P<0.05).Conclusion: This study showed the thrombocytopenia is the most common complication of exchange transfusion. The total rate of incidence of complications, mortality and main complications of exchange transfusion (seizure and cardio-pulmonary arrest) were more prevalent in preterm and low birth weight neonates compared to the term and normal weight neonates.

Background & Objective: Verapamil, nifedipine and diltiazem are calcium channel blockers widely used as a variety of cardiovascular ailment in humans. A number of studies have shown that calcium channel blockers have anticonvulsant effect in a range of animal seizure models (but not all animals). The aim of this study was to investigate the effects of verapamil, nifedipine and diltiazem on pentylenetetrazole-induced seizure threshold and to compare these effects in mice.Materials & Methods: In this experimental study, mice were pretreated intraperitoneally with vehicle or calcium channel blockers (0.5, 1, 2.5, 5, 10 and 20 mg/kg) before intravenously the determination of the pentylenetetrazole-induced seizure threshold.Results: Our results showed that the pentylenetetrazole-induced seizure threshold was 33.4±0.42 mg/kg in control group. In animals pretreated with verapamil, nifedipine and diltiazem the pentylenetetrazole-induced seizure threshold dose dependently increased.Compare between calcium channel blockers showed that diltiazem and verapamil had greatest and least effects, respectively.Conclusion: Our results suggest that the Ca2+ channel blockers possess anticonvulsant activity probably via an antagonism effect on voltage-gated Ca2+channels.

Introduction & Objective: Complication of cesarean incision such as infection and disruption can involve the life quality of the patients and also can lead to recurrent physician visit, usually re-hospitalization and re-operation. This study designed to compare the wound disruption between three methods: closure of subcutaneous with polyglycolic, plain and nonclosure after cesarean section.Materials & Methods: This study was a clinicaltrial on 690 women underwent cesarean section at Fatemieh hospital, Hamadan during 2004-2005. Inclusion criteria were: women with subcutaneous thickness more than 2cm and singleton pregnancy who underwent cesarean section in any cause. Women with risk factors for wound disruption such as PROM (more than 18 hours), time of surgery longer than 90 minutes, vertical incision, administration of corticosteroid and immunosuppressive agents, having chronic systemic diseases including diabetes mellitus and immunodeficiency were excluded. The patients were randomly divided into 3groups: closure of subcutaneous with plain, polyglycolic sutures, and non-closure of subcutaneous. All patients received three doses of prophylactic antibiotic (cephazolin). The patients were evaluated for the wound infection and disruption during hospitalization and first week after surgery. Data such as age, parity, gestational age, duration of surgery were extracted from medical records.Results: The wound disruption were 7%, 2.6% and 0.9% in plain, polygylcolicand non-closure groups respectively, and the differences were statistically significant (P<0.05). Wound infection was found in 2 patients who belonged to plain closure group. Differences of wound infection statistically were not significant between three groups (P>0.05).Conclusion: This study showed that subcutaneous closure in patients underwent cesarean section will not increase the rate of wound disruption, where as subcutaneous closure with plain suture increase the rate of wound dehiscence versus closure with polyglycolic suture and non-closure of subcutaneous.

Introduction & Objectives: Low back pain (LBP) is one of common medical problems with several accepted medical modalities such as drugs, physiotherapy, surgery, etc. We studied the efficacy of tricyclic antidepressant (TCA), and tricyclic antidepressant plus non steroidal anti inflammatory drugs (TCA + NSAID) in 200 patients with chronic LBP.Materials & Methods: In an experimental clinical trial study on patients with chronic low back pain without organic findings, patients were divided in two groups of 100 cases. At certain times the response to treatment protocols were collected and compared using VAS system. Patient's data including age, sex, smoking and response to treatment were recorded and analyzed using chi-square, t-tests, ANOVA and SPSS software.Results: 83 (41.5%) of patients were males and 117 (58.5%) were females. The age range was 21 to 75 (mean age 43.1±14.1y) there was no meaning full statistical difference in demographic characteristics such as age, sex (respectively p=0.66, p=0.78) the ultimate pain was less (p<0.05) in patients receiving TCA+NSAID compared to the other group. Two methods of quantization of pain had not any meaning full statistical difference (p>0.05).Conclusion: TCA prescription is an efficient method of treatment of low back pain with or without NSAIDS. But using NSAID+TCA will be almost more powerful and efficient method in the long term period.

Introduction & Objective: Because of widespread use of Functional Endoscopic Sinus Surgery (FESS) technique and basic role of coronal CT- Scan in understanding of normal drainage route of Para-nasal sinuses, identifying the major patterns of inflammatory sinonasal disease and accompanied anatomical variations is crucial for appropriate preoperative surgical planning. The purpose of this study was to determine the incidence of major inflammatory patterns and accompanied anatomical variations in patients with chronic inflammatory sinonasal disease that underwent FESS in different hospitals of Hamadan during 2000- 2004.Materials and Methods: This prospective descriptive study was carried out on coronal CT- Scans of 385 patients with chronic inflammatory sinonasal disease that underwent FESS. Patients with clinical signs of chromic rhinosinusitis were diagnosed by otolaryngologist and after 3- 6 weeks of medical therapy if appropriate clinical response were not achieved, coronal and if needed axial CT-Scan were taken from them. CT-Scans were taken mainly in bone and intermediate windows and if soft tissue masses except than polyposis were suspected soft tissue windows were taken too. CT-Scans were reported by radiologist and inflammatory patterns and accompanied anatomical variations with clinical and demographic information were analyzed. Results: In 385 cases major inflammatory pattern included: infundibular 11.1%, osteomeatal unit 37.6%, sphenoethmidal recess 21.2%, sinonasal polyposis 18.9% and sporadic 24.4%. These patterns were seen solely or as a combinations and so total percent was more than 100%. Three major obstructive patterns were seen in 70.1% of cases. In 73.2% of cases accompanied anatomical variation including septal deviation (50.6%), concha bullosa (28.5%), extensive pneumatization of sphenoid sinus (17.9%), paradoxic middle turbinate (16.1%), Haller cell (15.5%), giant bulla ethmoidalis (10.3%), athelectatic uncinate process (8.8%), Agger nasi cell (8.3%) and Onodi cell (3.1%) were seen.Conclusion: Because of study on surgical cases, higher incidence of more severe patterns and anatomical variations in our study was predictable, but some delay in patient's presentation due to socioeconomic problems in our society should be considered too.

Background & Objective: Nowadays, the most common cause of mortality in Iran is coronary artery diseases. The most serious fact that threat patients is acute myocardial infarction and its complications. First day, especially the first hours after acute myocardial infarction is the most important time for the patient life saving. Our goal in this study is evaluation of the time interval between the beginning of acute chest pain occurrence in the patients with AMI and Admission of these patients at coronary care unit and the factors which affect it.Materials & Methods: This study was a cross-sectional analytic study that was done on 164 patients with definite diagnosis of acute myocardial infarction who were admitted at CCU, Ekbatan Hospital Hamadan. At this study, patients were selected from both sexes. Data were entered the questionnaire and then analyzed by SPSS software and Hest.Results: The mean time interval between the beginning of chest pain and admission of these patients at CCU was 282 minutes. The mean time interval between the beginning of chest pain and transfer of the patient to a primary medical center, between entrance to the primary medical and transfer to the emergency ward, and between entrance to the emergency ward and admission at CCU were 207,73 and 28 minutes respectively. Sex, education level, distance between patient's living location and medical center, chest pain location and chest pain form were the most important factors which affect this delay considerably.Conclusion: In this study, we showed that time delay between the beginning of the chest pain and CCU admission is categorized into three stages. Multi center study, defining of the problems and collecting the data can reduce the mortality rate, complications and cost.

Introduction & Objective: Since the elimination of poliomyelitis from Iran, Guillain-Barre Syndrome (GBS) has been the leading cause of acute flaccid paralysis. There are a few studies concerning clinical and epidemiologic features of Guillain-Barre syndrome in our country, therefore we evaluated ten years clinical and epidemiologic features of GBS in Sina hospital, Hamadan, Iran.Materials & Methods: In a retrospective descriptive study, we reviewed 80 records of patients with GBS who were hospitalized in Sina Hospital (Hamadan, Iran) during 1993-2003. Because of incomplete data we excluded 29 patients from the study. We evaluated clinical and epidemiologic features, risk factors, lab data and management protocols. Complete remission defined as complete improved patient four weeks after the GBS treatment and partial remission as the continuation of the symptom after that time. All the data extracted manually and analyzed with SPSS software.Results: From 51 patients, 36 (70.59%) were men and 15 (29.41%) women, with a proportion of 2.4 men to 1 woman. The age ranged from 3 to 85 years. The highest frequency was observed in patients aged 11 to 20 (35.28%). 13 patients were student, 11 were house keeper, 11 were farmer, 7 were worker. 29 patients (56.84%) had risk factors like respiratory and gastrointestinal track infection, surgery and fever before the disease onset. Complete and partial remission occurred in 17 and 28 patients respectively and 5 patients did not improve. Management failure occurred in 3 (8.83%), 2 (22.23%) and 5 (62.5%) patients who underwent IVIG, plasmapheresis and corticosteroids respectively.Conclusion: Our data was not similar to other studies in term of male to female proportion, age distribution and management protocols, therefore geographical pattern of the disease should be concerned for better patients' management.

Introduction & Objective: Cerebral infarction is a sudden dysfunction of brain tissue secondary to circulatory accidents. There are two types of ischemic and hemorrhagic accidents; the former is the most common type. It is the third cause of mortality and morbidity in United States. Many studies have postulated neuroprotective effects for potassium and magnesium. These two elements are also involved in blood pressure, hyperlipidemia, and cardiovascular diseases which themselves are risk factors for cerebrovascular accidents (CVA). In this research we studied the relationship between CVA and serum potassium and magnesium levels.Materials & Methods: In this case control study 130 CVA patients were compared to 130 matched patients without CVA who admitted to Kashan University hospitals. Serum potassium and magnesium levels were measured in all patients and control group and the results analyzed statistically using t-test.Results: In both groups there were 68 male and 62 females. Mean (±SD) of age in case and control groups were 73.8 ±9.7 and 73.7±9.5 years respectively. Mean (±SD) of serum potassium and magnesium levels in case group was 4.67±0.46, and 1.98±0.28 meq/l respectively, and for control group it was 3.83 ±0.38, and 1.44±0.32meq/l respectively. It was lower in case group and the difference was statistically significant (P< 0.0005).Conclusion: Serum potassium and magnesium levels of patients with CVA were lower than their matched counterparts. This may be an indicator for a metabolic or nutritional derangement, correction of which may be helpful in prevention and/or better management of cerebrovascular accident patients.

Introduction & Objective: DMFT Index is the best epidemiologic caries index in dentistry and can show the state of oral and dental hygiene in one society. By considering this index we can design suitable preventive and treatment program for total population of a society. The aim of this descriptive analytical study was evaluation of DMF6 index in 12 years old children in Hamadan city.Materials & Methods: Using explorer and mirror under natural light, 4 permanent first molars of 480 twelve years old students were examined from the aspect of decay, missing and filling; then DMF6 was accounted for each subject. The statistical analysis was done by SPSS 12 and Pearson, Chi- square test.Results: The mean of DMF6 was 2.17±1.39. DMF6 in girls (2.22) was more than boys (2.12) but this difference was not statistically significant. 72.9% of girls and 72.5% of boys had carries in their first permanent molars. 1.3% of girls and 2.5% of boys had one missing first molar. The difference between girls and boys in missing and decayed teeth was not statistically significant. 22.5% of girls and 11.7% of boys had filling teeth and only this difference was statistically significant.26% of population had no sound teeth and only 18.8% of them had 4 sound first permanent molors. 72.7% of population had caries and 1.9% had missing and 17.1% had filled teeth.Conclusion: Analysis of DMF6 showed that untreated caries is the most important problem in 12 years old children in Hamadan.

Introduction: Evaluation and treatment of foreign bodies in rectum involves careful history and physical examination. The cases of forced introduction of the objects most commonly are sexual assault, self - introduced for anal eroticism and accidental insertion.Case Report: We describe a case of a patient with rectal impaction following self administration of a plastic bottle for anal sexual gratification. A 49 years old man was admitted in the emergency department with the history of self introduced a bottle into his rectum physical examination and abdominal X-Ray diagnosed the case as impacted foreign body in rectosigmoid. An attempt was made to deliver the bottle through the rectum but because of high lying big bottle in the sigmoid laporotomy was performed and the bottle was removed though a longitudinal incision on sigmoid colon.Conclusion: Retained rectosigmoid foreign bodies have been encountered more frequently and present a dilemma for management and rarely laporotomy for extraction of foreign bodies was performed.