Journal of Shahid Sadoughi University of Medical Sciences
Year:2014 | Volume:22 | Issue:5|Papers Count:21

Introduction: In this randomized prospective study, 2% - diltiazem topical gel and 0.03% -GTN ointment were compared in patients with chronic anal fissure. Methods: This semi-experimental study consisted of sixty six outpatients (34 females and 32 males) with chronic anal fissure, who referred to the gastroenterology clinic. Patients were randomly classified into two groups. Group A received GTN ointment (0.03%), whereas group B was treated with Diltiazem gel (2%). The treatment was administered twice daily for 8 weeks. Healing and side-effects were recorded to be compared after 8 weeks. Results: In group A, the anal fissure was thoroughly healed within 53.3% of patients, moderately healed for 6.7% of patients and not healed in 25.8% of patients. Moreover, side-effects were noted in 15(46.9%) patients (P= 0.482). Two (6.2%) patients had intolerable headache and discontinued the study, 11 (34.3%) patients suffered from headache and 2 patients (6.2%) were reported to have orthostatic hypotension. In group B, healing occurred in 21(67.7%) out of 31 patients and 1 (3.2%) case of headache was noted(P= 0.0001). Conclusion: The present study has demonstrated that topical diltiazem can be preferable to GTN owing to the absence of side-effects.

Introduction: The b-thalassemia is one of the most common genetically transmitted blood disorders in the world. Sometimes Homozygote people demonstrate milder form of this disorder called intermedia. In this study, the effect of Hydroxy Urea (HU) was investigated in Thalassemia intermedia patients who were treated monthly by packed cell transfusion as patients with major thalassemia in Bu-Ali Hospital of Ardebil. Methods: This semi-experimental study consisted of 63 intermediate Thalassemia patients. All patients entered to study after completing inform consent and all transfusions were ceased and patients were treated by HU for 3 and 6 months. All patients underwent CBC, Serum ferritin, liver and kidney function tests before starting HU and after 6 months of treatment. Moreover, at the end of 6 months, the patients’ transfusion need was evaluated. The test results were analyzed utilizing descriptive statistical methods (such as tables, graphs) and non-parametric Wilcoxon test via SPSS software (Version 18). Results: After 6 months, 60 patients (95.2%) were completely needless of transfusion. In 3 patients (4.8%) transfusion interval prolonged more than one month. The study findings demonstrated a decrease in mean of ferritin level, and an increase in mean of hemoglobin level. Furthermore regarding the complications, AST, ALT, and BUN significantly increased after treatment with HU. Conclusion: In thalassemia intermedia patients, HU can obviate the need for regular transfusion and increase the mean of Hb level.

Introduction: Pain is a complex medical problem that its postoperative inadequate control can produce adverse effects on patients’ physiological, metabolic and mental states. Adding new supplements can lead to an increased duration of analgesia. Therefore, this study aimed to compare the addition of neostigmine and ketamine to 0.25% -bupivacaine for epidural analgesia in increasing duration of postoperative analgesia. Methods: In this double blind clinical trial, 90 patients aged over 50 years, candidate for elective hip surgery with ASA class I, II, were randomly divided to three groups: Neostigmine, Ketamine and control groups. All patients received 2cc/segment of 0.25%-bupivacaine for epidural anesthesia. Furthermore, 60 micrograms of neostigmine were added in first group and 40 mg of ketamine in the second group. Level of postoperative pain was based on VAS and duration of analgesia and amount of analgesic was compared between the three groups. Results: The mean of pain score at 6 and 12 hours after surgery was significantly lower in the ketamine group than the other groups. Moreover, in neostigmine group, it was less than that of placebo group (P£0.01). The mean of duration of postoperative analgesia in the Ketamine group was significantly higher than those of other groups and in neostigmine group it was more than placebo (P£0.01). The mean dose of analgesic (Pethidine) was the least in the Ketamine group (P£0.001). Conclusion: The study findings revealed that utilizing Neostigmine and Ketamine with 0.25%-bupivacaine for epidural anesthesia increased the duration of analgesia for postoperative and reduced analgesic consumption that was reported to be more effective with Ketamine than Neostigmine.

Introduction: Irritable bowel syndrome (IBS) is one of the most common disorders of GI tract. Irritable bowel syndrome is characterized by chronic pain associated with altered bowel function. No organic abnormalities can be demonstrated reliably in IBS and thus diagnosis rests on symptom-base criteria.In this study rates of abdominal and pelvic surgery were measured in patients with IBS. Methods: In this case-control study, the case group consisted of 314 patients with IBS who referred to a clinic of gastroenterology in Yazd during the years 2009-2012. As a matter of fact, patients of case group were compared with 319 patients without IBS and the rates of abdominal and pelvic surgery were measured. The study data was analyzed via Spss software (Version 16) applying chi-square test. Results: Within IBS Patients, 46.8% were males and 53.2% were females, and the mean age of patients was 37 years. Although there was no statistically significant difference between control and case group, the prevalence rates for cholecystectomy were 3 times greater (5.4% versus 1.6%), appendectomy was threefold higher (11% versus 3.8%) and inguinal hernia (2.5% versus 0.3%) was increased in IBS patients compared to those of the control group. Conclusions: IBS Patients have an increased prevalence rate for abdominal and pelvic surgery such as cholecystectomy and appendectomy. Therefore, IBS patients need to be cautiously attended in regard to recommending surgeries.

Introduction: Development of emotional schemas is regarded as one of the long term effects of child abuse and neglect. Therefore, the present study aimed to investigate the effect of Emotional Schema Therapy on emotional schemas of female victims of child abuse and neglect. Methods: In this quasi-experimental design, 30 women, who had the history of child abuse and neglect (according to the scores obtained in the child abuse and neglect questionnaire) and met entry criteria, were selected and then assigned into the experimental and control groups randomly (n=15). The experimental group received a 13-session intervention based on Emotional Schema Therapy and the control group was on a waiting list. The applied instruments consisted of child abuse and neglect questionnaire, Leahy Emotional Schema Scale (LESS) and Depression Anxiety Stress Scales (DASS-21). Moreover, the study data were analyzed by the analysis of covariance. Results: The study results demonstrated that Emotional Schema Therapy has decreased the emotional schemas of “Guilt” and “Simplistic View of Emotions” and increased “Acceptance of Emotions” in both posttest and follow-up stages. This effectiveness was confirmed via increase of emotional schema of “Consensus” in posttest stage and “Emotional Validation and Comprehensibility” in the follow-up stage. Conclusion: The study findings proposed that Emotional Schema Therapy can be regarded as an effective intervention in order to modify some dimensions of emotional schemas in women with child abuse and neglect history.

Introduction: Based on the findings of studies, brain tumors result in the decline of pediatric performance and quality of life. Therefore, this study aims at investigating different epidemiologic, demographic and clinical factors in children and adolescents with brain tumors in Arak, Iran. Methods: This case–control study was conducted on 50 children with brain tumor (with the age range of 1.5 – 19 years) as the case group and 50 children without brain tumor as the control group. Subjects were selected from inpatients and outpatients in the Valiasr Hospital of Arak, Iran from 2010 – 2013. A questionnaire including epidemiologic, demographic and clinical information was filled out for all subjects, and the study data was analyzed in SPPS software (Version 18). Results: There was a significant difference between the members of the two groups regarding habitation (p=0.008), the number of siblings (p=0.003), history of contact with pets or owning them (p=0.007),father’s history of constant contact with chemicals, heavy metals and pesticides (p=0.05), the consumption of vitamin and nutritional supplements during pregnancy (p=0.048), history of neurologic diseases (p=0.048), history of cancer and other malignant tumors except for those of the nervous system (p=0.005) and history of brain tumors in the first degree relatives of subjects (p=0.035). Conclusion: According to research results, several preventable and predictable factors are linked to pediatric brain tumors. Therefore, children prone to brain tumors are recommended to be examined and screened for these risk factors.

Introduction: Spontaneous intracerebral hemorrhage (ICH) is a common disease. Among cerebrovascular accidents, ICH is the most fatal subtype and many of the survivors may be severely disabled. Comatose patients with these hemorrhages constitute a very special subgroup because of the high mortality rate and more uncertainty about the best surgical indications. Therefore, this study aimed to evaluate the factors affecting surgical results of ICH in these patients. Methods: In this cross-sectional retrospective study, 50 patients with spontaneous ICH participated who were treated by surgery at Urmia Imam Khomeini hospital between 2008-2013, and whose GCS(Glasgow Coma Scale) was ≤ 8. Outcome of patients was assessed by Glasgow outcome scale at the time of discharge from the hospital. Patients were evaluated in regard with such factors as level of consciousness before surgery, age, gender, hypertension, size and volume of hematoma and ventricular extension of hematoma. Results: 50 patients with the mean age of 49±11.4 years were evaluated. Glasgow coma scale in 16 patients was less than 5 and in 34 patients was 5 to 8. Volume of hematoma was small in 4 patients, medium in 18 patients, and large in 28 patients. Hematoma did not extend to ventricular system in 28 cases, whereas in 22 cases hematoma was extended to ventricles. Furthermore, mortality rate was reported 52% in our series. The study results indicated level of consciousness before surgery, volume of hematoma and ventricular extension of hematoma meaningfully affected the outcome. No relationship was observed between such variables as age, gender, hypertension and outcome. Conclusion: The findings of the present study revealed that within comatose patients with spontaneous ICH, the better the level of consciousness before surgery, the smaller hematoma volume and no ventricular extension of hematoma, the better the outcome will be.

Introduction: Dental caries and periodontal disease are probably the most common oral chronic diseases in worldwide, and their prevalence is progressively increasing from day to day. Therefore, this study was conducted to investigate the relationship between caries and periodontal disease. Methods: In this cross sectional study, 237 panoramic radiographies of patients aged 10 to 65 years (110males and 127 females) were selected utilizing convenience sampling. In order to measure the variables, a graduate caliper with 0.2 mm accuracy and Negatoscope with optimum light were used. Moreover, in order to diagnose the caries and minimize the errors, “calibration” method was selected. Results: There was no significant relationship between crown caries and mean of alveolar bone loss. (p=0.19). As the age increased in patients, the mean of alveolar bone loss also increased and a significant association was detected between the severity of caries, alveolar bone loss and male gender. Conclusion: Generally, no relationship was observed between dental caries and periodontal disease in this study.

Introduction: Hemophilia B is an X-linked recessive genetic disease caused by mutations in the coagulation Factor IX gene. Mutations in the Factor IX gene result in dysfunction or deficiency of coagulation factor of IX. Direct mutation analysis involves the ideal method for molecular diagnosis of the disease. However, due to the high number of identified mutations in the gen, the lack of a common mutation spectrum, the large size of the gene, and the heterogeneous nature of its mutations, direct mutation analysis is regarded expensive and time-consuming. Alternatively, indirect investigation of the mutations by use of linkage analysis applying polymorphic markers present in the factor IX gene region could be considered as an appropriate approach for prenatal diagnosis and carrier detection of haemophilia B. Methods: In the present study the single nucleotide polymorphic marker rs438601 in the intron 3 of factor IX gene was genotyped by Tetra-primer ARMS-PCR method with newly desingd specific primers on 142 unrelated control females in the Isfahan (a city in Iran) population. Then the allele frequency and degree of heterozygosity were estimated utilizing GENEPOP program. Moreover, χ2 test was applied in order to investigate the Hardy-Weinberg equilibrium. Results: Allele frequency was reported as 71.83% and 28.17%, respectively for C and G alleles. Observed heterozygosity was 53.52% and Analysis of deviations from Hardy-Weinberg equilibrium demonstrated that the Isfahanian population were in equilibrium for rs438601 marker. Conclusion: The study findings demonstrated that rs438601 marker due to high heterozygosity could be suggested as an appropriate diagnostic marker in linkage analysis and carrier detection of hemophilia B in regard with a sample of Iranian population.

Introduction: General anesthesia (GA) is a valuable option for too young children or those children with medically complex problems, who need vast dental treatment. Considering the high cost and potential risk of general anesthesia, it is important to select the most reliable techniques and materials to enhance success rate of dental treatment. Therefore, this study aimed to investigate the clinical and radiographical success rate of dental procedures performed on children under general anesthesia. Methods: In this descriptive cross-sectional study, the study sample consisted of 56 children who received dental treatment under general anesthesia in a surgical clinic in Yazd between 2006- 2011 and at least 6 months had been passed from their treatment. Clinical and radiographical examinations were performed for each patient. Chi-square and Fisher exact tests were statistically applied in order to compare the success rates of restorations and root canal treatments. Results: Stainless steel crown (SSC) was the most successful treatment with the highest success rate (99.2%). SSC had a significantly lower failure rate compared to amalgam (5.9%) and posterior composite restorations (28.6%) (P<0.001). Moreover, anterior Glass inomer restorations demonstrated the lowest success rate (69.2%) among all types of restorations (P<0.001). The success rates of both pulpectomy and pulpotomy procedures were found to be reasonably high at 97.3% and 96.4%, respectively. Conclusion: Regarding failure rate of amalgam and composite restorations, a definitive treatment plan consisting of SSC, pulp therapy and / or extraction may be preferred for oral rehabilitation of the children under GA.

Introduction: Type 2 diabetes is regarded as the most common and the most important metabolic disease which is progressively increasing in different societies. In this study, the effect of apple vinegar on lipid profiles and anthropometric indices was examined in Type 2 diabetes patients with dyslipidemia. Methods: Sixty-two Type 2 diabetic patients with dyslipidemia were randomly assigned into a control (n=30) and an experimental group (n=32). The experimental group was instructed to use 10 cc of apple vinegar soluble in a glass of water two times a day 1 hr before each meal for 8 weeks. Results: The participants’ serum lipid profiles (Cholesterol, TG, LDL and HDL) and also anthropometric indices(Weight, Height and Waist Circumference) were measured before and after the intervention. Finally, in spite of a reducing trend in cholesterol and LDL in apple vinegar group, no significant differences were observed between the two groups (pvalue>0.05). Conclusion: The present study revealed that consuming 20 cc of apple vinegar daily had no effect on serum lipoprotein profiles and anthropometric indices in Type 2 diabetes patients with dyslipidemia.

Introduction: Any type of exercise protocol has specific effects on the physiology of the body. Thus, according to the purpose of the training program and conditions of the subjects, a specific exercise protocol is needed to be considered. Therefore, the purpose of this study was to assess the effect of intermittent training on oxidative and glycolytic capacity in rat skeletal muscles. Methods: Forty male rats were divided into two old (27 mon, 389±31 g) and young groups (3±4 mon, 224±14 g), each of which were randomly divided into control and experimental groups (n=10). Training group performed intermittent exercise on a treadmill 6 times /week for 8weeks. It consisted of 10 bouts of 4 min running interspersed by 2 min of active rest. All rats were anesthetized, 24 hours after the last session exercise, and Soleus (SOL) and extensor digitorumlongus (EDL) muscles were removed rapidly. In fact, the tissues were analyzed in regard with CS and LDH enzymes activities. In order to analyze the study data, one way-ANOVA and Tukey's post-hoc tests were applied. Results: The results demonstrated that CS enzyme activity in EDL and SOL muscles increased significantly in both, old (OT) and young groups (YT) (p<0.05). Furthermore, although there was an increase in LDH enzyme activity in OT, it was not statistically significant. However, LDH enzyme activity was significantly higher in both EDL and SOL in YT (P>0.05). Conclusion: The results suggested that the training method described in the present study can be quite beneficial to the young and old, when a simultaneous increase in oxidative and glycolytic capacity is aimed.

Introduction: Acrylamide is a chemical compound which can be produced while frying carbohydrates in high- temperatures. Since the neurotoxicity of acrylamide was reported in the previous studies, the aim of the present study was to investigate the effects of co-administration of Glycyrrhiza Glabra and Vitamin C on acrylamide-induced weight loss and motor deficits in rats. Methods: In this experimental study, 40 Wistar male rats aged 28 days were divided in to five groups of 8 rats including Control, Acrylamide, Acrylamide + Vitamin C, Acrylamide + Glycyrrhiza Glabra and Acrylamide +Vitamin C + Glycyrrhiza Glabra. All treatments were administered for 6 weeks. Thereafter, locomotor activity indices were measured using open field apparatus. In order to analyze the study data, One-way ANOVA followed by Tukey's test was used. Results: The results showed that motor activity was significantly increased in vitamin C + Glycyrrhiza Glabra group compared with Acryl amide group. While treatment with vitamin C or Glycyrrhiza Glabra alone did not cause any significant changes in locomotor activity indices. In addition, rats treated with the combination of vitamin C and Glycyrrhiza Glabra significantly improved weight gain deficiency induced by Acrylamide. Conclusion: The study findings revealed that the co-administration of vitamin C and Glycyrrhiza Glabra can retard the locomotor dysfunction and improve the weight gain in acrylamide-treated rats.

Introduction: Immunoassay procedures for detecting and determining opioids in blood and other biologic fluids are based on Monoclonal antibodies. In the present study, monoclonal antibody against Morphine was taken into account. Methods: Hybridoma protocol was used in order to produce the monoclonal antibody against morphine in mice. For this purpose, five 6–8-week old female BALB/c mice were immunized with morphine C6- hemisuccinated derivative conjugated to cationized bovine serum albumin (cBSA). The spleens lymphocytes were fused with SP2/0 cells using polyethylene glycol (PEG). Hybridoma clones were subcloned by limiting dilution. Class and subclass of monoclonal antibody were determined using Roche isostrip test. Moreover, antibody was purified by protein G affinity chromatography and affinity was determined according to the method described by Beatty et al. Finally, the cross reaction of monoclonal antibody was determined with some structurally related molecules such as codeine and apomorphine. Results: Among 3 hybridoma clones that reacted with the morphine-BSA, but not with BSA, after thrice limiting dilution, one stable hybridoma monoclon was obtained. The monoclonal antibody (MAb) was found to be of IgG2b class and subclass and containing lambda light chain. The affinity of the MAb to morphine was obtained 2.8 ×109 M-1 by non competitive enzyme immunoassay. The titer of supernatant of cell culture medium was 1/400. The MAb was cross reacted with codeine (100%) and apomorphine (16.5%), though no reaction was observed with heroin, naloxone, naltrexone, and papavrin. Conclusion: The study findings revealed that the produced antibody against morphine was comparable with other antibodies for specificity and affinity; therefore it is usable in design of diagnostic immunoassay in biologic fluids.

Introduction: Choledochal cyst is a rare congenital abnormality of the biliary tract presented primarily in infants and young children. It is very uncommon for choledochal cyst to be demonstrated during pregnancy. In fact, its manifestations during pregnancy are nonspecific and variable. If symptoms of abdominal pain, and jaundice were observed, choledocal cyst should be considered as a differential diagnosis. MRI is regarded more reliable in order to diagnose the number and anatomic location of the cyst. Magnetic resonance cholangiopancratogeraphy is another diagnostic method which can be opted for in pregnancy. Moreover, Laprascopy can be utilized for the cyst fenestration treatment.