Avicenna Journal of Clinical Medicine
Year:2010 | Volume:17 | Issue:2 (SN 56)|Papers Count:15

Introduction & Objective: Heart failure that is a major health problem with increasing incidence with the aging of the population often occurs as a result of ischemia and coronary artery disease. Allopurinol can protect the ischemic heart muscle and improve the use of energy during myocardial -ischemia. The aim of the present study was to evaluate the effects of allopurinol on the left ventricular function in patients with heart failure.Materials & Methods: In this clinical trial study eighty-two patients randomized to receive either allopurinol or placebo, in addition to the standard treatment. Echocardiography evaluation was performed. before the treatment and 6 months after the treatmentResults: At the end of the study, the rate of change in LVEF compared to the baseline was also significantly greater in the allopurinol-treated patients than the control. Improved New York Also Heart Association class (NYHA class) occurred more in the patients receiving allopurinol compared to the controls.Conclusion: In the patients with heart failure, long-term administration of allopurinol in addition to improving left ventricular function, has beneficial effects on their quality of life.

Introduction & Objective: Metabolic control in adolescents with type 1 DM who are in pubertal period will be impaired, thus finding a therapeutic strategy such as adding metformin to insulin to reduce insulin resistance will be useful in blood glucose control and metabolic state improvement.Materials & Methods: This was a randomized double blind placebo controlled 3-month trial metformin therapy in 32 adolescents with type 1 DM. These patients were divided in two groups of metformin and placebo and treated with metformin and placebo for 3-months. Their HbA1C, FBS, Insulin dosage, TG, Cholesterol, and LDL were measured at the initiation and end of the treatment.Results: After the study there was a significant improvement of FBS and TG in metformin group versus placebo group (P=0.02 and P=0.028 in order). But, there was not significant difference in other variables such as BMI, insulin dosage, HbA1C, Cholesterol and LDL between the two groups.Conclusion: Metformin treatment in teenagers with type1 DM who are in pubertal period will improve the control of FBS and lowers TG but has not any significant effect on HbA1C, BMI, insulin dosage, Cholesterol and LDL.

Introduction & Objective: Percutaneous Dilatational Tratheostomy (PDT) is an elective procedure increasingly performed at bedside in intensive care unit (ICU). With this technique the complications during transferring to the operating room, duration between one patient candidate for PDT to perform it and cost decreased compared to the standard technique. In our study we compared the duration and complications of tracheostomy in percutaneous tracheostomy with surgical tracheostomy.Materials & Methods: In this clinical trial 18 patients candidating PDT underwent PDT with Griggs method in the ICU (Group I) and simultaneously compared with 18 patients that underwent surgical tracheostomy (group 2).Results: The two groups based on characteristics such as age, sex, hemodynamic variables (systolic blood pressure, diastolic blood pressure, heart rate), pulmonary function, and oxygenation measured by pulse oximetry were similar. The duration of stay in ICU was also similar between the two groups. Mean delay time among the candidates to perform tracheostomy in group I was 1.38±0.6 (1-3) days and in group 2 was 4.55±2.33 (2-10) days respectively, (p<0.001).Mean duration of tracheostomy in the both groups was 11±2.93 (8-30) minutes and 13.77±6.19 (7-30) minutes respectively, (p<0.05). The bleeding occurred in one case (5.6%) in the PDT group and 5 patients (27.8%) in the group 2, (p=0.17).The two groups were similar with respect to infection on site of tracheostomy, trauma to the posterior wall of trachea, subcutaneous emphysema, morbidity and mortality due to tracheostomy, and other complications.Conclusion: PDT technique with regard to delay time to perform tracheostomy, duration of this procedure, and bleeding is preferred to the standard surgical technique. Moreover, PDT is safer and more cost-effective than the standard technique. Other complications and mortality were similar in the two groups.

Introduction & Objective: Sodium arsenite as an environmental pollutant being found in the air, water, and earth crust threats the human beings' health. The aim of this study was to investigate the effect of sodium arsenite on viability and morphology of mesenchymal stem cells in rat bone marrow.Materials & Methods: In this exprimental study the cells were extracted in DMEM containing 15% FBS and Pen/Strep until the 3rd passage then treated with 0, 0.1, 0.5, 2.5, 12.5 and 20 mM of sodium arsenite for 12, 24, 36 and 48 hrs. Viability of the cells was carried out with trypan blue and MTT staining, then 0.1 mM and 36 hrs treatment was selected for further investigations. Morphology of the cells was studied using fluorescent dye (Hochest, propidium iodide and acridine orange as well as protein profile of the cells were studied using SDS-PAGE. Data was analyzed using one and two way ANOVA.Results: Based on the two way ANOV A, cumulative effect of treatment time and used dosage caused highly significant reduction (p<0.001) in viability of rat bone marrow mesenchymal stem cells. One way ANOVA indicated that the viability of the cells reduced significantly (p<0.05) from 0.1 mM of sodium arsenite on wards in all the treatment time. Morphological changes including condensation and deformation of the nuclei, membrane disruption, and shrinkage of cytoplasm were also observed.Conclusion: Sodium arsenite toxicity caused morphological and protein profile changes as well as dose and time dependent reduction in viability of rat bone marrow mesenchymal stem cells.

Introduction & Objective: The success of root canal therapy depends on the ability to establish and maintain an apical seal, therefore, it is important, that post space preparation do not disrupt the integrity of the apical seal. The purpose of this study was to compare the effect of immediate versus delayed post space preparation on the apical seal using AH26 and Dorifil sealers.Materials & Methods: In this experimental study forty six extracted premolars intact, single canal, and caries free were used. Teeth were randomly assigned to 2 groups and three teeth assigned to each positive and negative control group. Teeth were prepared with step back method and filled with gutta-percha and sealer by lateral condensation. In groups 1 and 2 AH26 sealer and Dorifil sealer were used respectively. Post spaces were made until 5mm of the apex after placing the teeth in incubator for one week. The teeth were attached to bacterial leakage assay system. Staphilococus epidermidis was placed every 48 hours into the root canal of the teeth. Duration of study was 60 days. The data was statistically analysed with chi square and t-test.Results: In AH26 group 19 samples and in Dorifil group 18 samples were leaked. The mean time of leakage in AH26 group and Dorifil group were 22.58±11.37 and 25.94±1058, respectively. The results showed that there were no significant differences in incidence and mean time of leakage between AH26 and Dorifil groups (P=0.54 and P=0.35), respectively.Conclusion: Under the condition of this study, teeth will be contaminated after post space preparation if access cavity are open. No significant differences were found in the AH26 and Dorifil sealers groups.

Introduction & Objective: Prenatal hydronephrosis is increasingly reported because of more extensive application of prenatal sonography in the recent decades. Determination of causes of prenatal hydronephrosis could help in better recognition of natural course of disease and designing proper treatment protocol. On the other hand, severity of renal pelvic dilatation in the first sonography after birth could be related to underlying cause of prenatal hydronephrosis and may be important in diagnostic approach to these patients. This study was performed in order to investigate the causes of prenatal hydronephrosis and it's relation to severity of renal pelvic dilatation in neonates.Materials & Methods: This is a descriptive cross sectional study of 60 neonates with prenatal hydronephrosis reffered to Hamadan pediatric nephrology clinics of Be'sat and Ekbatan hospitals in Hamadan, Iran. Case records were thoroughly reviewed for the degree of renal pelvic dilatation in the first postnatal sonography after 3 days of life and the causes of hydronephrosis detected in the follow up workup. The patients were classified according to anteroposterior diameter of renal pelvis to mild dilatation (5-9.9 mm), moderate (10-14.9 mm) and severe (³15 mm). Voiding cystoureterography and renal isotope scan (DTPA) were performed in all the patients for diagnosis of vesicoureteral reflux and obstructive uropathy.Results: 44 Ollt of 60 patients (73%) were male and 16 (27%) were female. Causes of hydronephrosis were obstructive in 32 patients (53.3%) and non-obstructive in 28 patients (46.7%). There was mild pelvic dilatation in 31 patients, among which 7 (22.6%) had obstructive causes and 24 (77.4%) had non - obstructive causes. Moderate pelvic dilatation was detected in 24 patients, among which 17 (70.8%) had obstructive lesions and 7 (29.2%) had non obstructive causes. Severe dilatation in 5 patients was due to obstructive causes in 4 (80%) and non - obstructive causes in 1 (20%) patient.Conclusion: Obstructive lesions were the causes of hydronephrosis in about 50% of the neonates. In this study the most common cause of prenatal hydronephrosis was ureteropelvic junction stenosis and after that idiopathic and vesicoureteral reflux were more common. Severity of renal pelvic dilatation has a direct relationship to the probability of obstructive causes of hydronephrosis (P<0.05) and can be used as a guidance to select further diagnostic workups.

Introduction & Objective: This belief that overfilling the bladder after anterior colporrhaphy might have a negative influence on surgical outcome, causes routine catheterization after operation. This study was done to compare short term (24h) with long term (72h) catheterization after anterior colporrhaphy.Materials & Methods: This randomized clinical trial was carried out at Kosar Hospital, Qazvin (Iran) in 2005-2006. One hundred cases candidating for anterior colporrhaphy, were divided in two equal groups. In the first group foley catheter was removed 24 hours and in the second group 72 hours after the operation. Before removing catheter, urine sample was obtained for culture. After removal and urination, residual volume was determinded. If the volume exceeded 200 ml or retention occured, the catheter would be fixed for more 72 hours. Need for recatheterization, urinary retention, positive urine culture, and hospital stay were surveyed. The data was analyzed using T and Fisher tests.Results: Residual volume exceeding 200 ml and the need for recatheterization occurred in one case (2%) in the short term group but in the long term group none of the subjects needed recatheterization (P=1). Retention was not seen. In the both groups, one case (2%) had positive urine culture with no statistically significant difference (P=1). Mean hospital stay was short in the first group (P=0.00).Conclusion: Short term catheterization after anterior colporrhaphy does not cause urinary retention and decreases hospital stay.

Introduction & Objective: Cellular blood products such as whole blood, packed RBC and platelet concentrate may contain a large number of donor leukocytes. These transfused cells are responsible for several transfusion reactions which include febrile reactions, platelet refractoriness due to alloimmunization and some cell associated virus transmission, especially cytomegalovirus. Advances in biotechnology resulted in production of filters capable of depleting residual leukocytes below the threshold receded to prevent these complications. The aim of this study was to determine the efficacy of prestorage and poststorage leukocyte reduction filters.Materials & Methods: In this experimental study 140 leukocyte filters used in patients with major thalassemia with age range of 1 to 18 years old were studied. They received packed RBC with pre storage or post storage filtration in pediatric hematology clinic of Be'sat hospital, Hamadan, Iran. In addition to filter efficiency, some transfusion reactions such as hypotension, urticaria, flushing, fever and chills were analyzed with chi-square and independent t-test.Results: Calculated efficiencies of pre storage and post storage filtration were 99.70%±69% and 92.74%±12.47% respectively, which is statistically significant (P=0.000).Fever, chills, urticaria and flushing which are some transfusion reactions, were not seen in any patients received filtrated packed RBC. No transfusion complication except hypotension (which was seen in 14 patients in both groups) was seen. Maximum remained leukocyte in pre storage packed RBC was 20/mm3 and 524/mm3 in post storage blood.Conclusion: According to the calculated standard deviation, pre storage leukocyte filters are superior to post storage filters, and so post storage filtration is not a reliable method to reduce remaining white blood cells in transfused blood.

Introduction & Objectives: The goal of our study was to elucidate the time and factors influencing the transition from non-injection to injection among male heroin users.Materials & Methods: In this retrospective cohort study conducted in Iran from April to August 2007, the data was obtained from the subjects who had never injected heroin at study entry. The total population included 7743 (402 women and 7341 men) substance dependents in Iran. In this study we enrolled 1641 non-injecting male heroin users. The data was collected through Inventory Rapid Situation Assessment (RSA).Results: The results revealed that among the 1641 never injectors, 591 had initiated injection (The incidence of initiation into injection was 36% after 6.5 years). Independent predictors of transition into injection among non-injecting heroin users were being single, unemployment, attending injecting friends' gatherings, age at first heroin use (early adolescent drug use).Conclusion: The study suggests that several factors increase the risk of injecting drugs among heroin users. Interventions to prevent injecting should identify risk factors associated with the transition from heroin sniffing to heroin injection.

Introduction & Objective: Some researches have shown that 14% of internet users suffer from OCD behaviors, psychosis status, depression, and etc. Also, in other studies characteristics such as social withdrawal, low self-esteem, etc have been considered. This study aims to investigate internet addiction and its relationship to psychiatric symptoms.Materials & Methods: In order to perform this descriptive and cross-sectional research, a total of 120 students of Isfahan universities was selected based on quota sampling. The samples completed demographic questionnaires, YDQ, Internet Addiction Test (IAT), and Symptom Checklist-90-Revision (SCL-90-R). Finally, scores of psychiatric symptoms were predicted by internet addiction scores. Also, mean psychiatric symptoms in internet addicted and non-addicted were compared. The data was analyzed using Multiple Logistic Regression & MANCOVA by SPSS12 Software.Results: Based on our findings, there are significant differences between mean psychiatric symptoms in all of SCL-90-R subscales and GSI, PSDI, PST in addicted and non-addicted (P<0.05). Also, findings showed that there are positive and significant correlation between scores of psychiatric symptoms (such as depression, anxiety, hypochondriasis, OCD, Interpersonal Sensivity, aggression, paranoia, phobia and psychosis), and GSI, PSDI, PST and internet addiction. (P<0.01). Also, internet addiction (with controlling sex variable) influences on psychiatric symptoms.Conclusion: The findings of this research suggest that internet addiction should be considered a serious health problem because of its side effects on the youth. Also, it is necessary for psychiatrists and psychologists practicing in mental health areas to be aware of mental problems due to internet addiction such as anxiety, depression, aggression, occupationl and educational dissatisfaction.