Journal of Isfahan Medical School
Year:2010 | Volume:28 | Issue:109|Papers Count:12

Background: Low vitamin D status may contribute to pathogenesis of congestive heart failure. We evaluated the effect of vitamin D supplementation on the left ventricular function and the NYHA Functional class of chronic heart failure patients.Methods: This double–blind, randomized, placebo–controlled trial was performed during Oct 2007 until Aug 2008 in Chamran and Noor Hospitals, Isfahan, Iran. One hundred and ten patients randomly received 50’000 IU vitamin D3/w plus 500 mg Ca/d [case group] or placebo plus 500 my Ca/d [control group] for 6 months. Biochemical variables, LVEF and NYHA Functional class status were assessed at baseline and after 6 months.Findings: Eighty two patients completed the study. Vitamin D supplementation increased the mean of 25-Hydroxyvitamin D concentration by 33.9 ng/ml (P<0.001); whereas placebo treatment was associated with an increase of only 6.2 ng/ml (P>0.05). After 6 months treatment, the case and control groups showed improvement in left ventricular ejection fraction values and also left ventricular endsystolic volume; the extent of changes between two groups has significant difference (P<0.05). The NYHA class improved in the case group but remained constant in the control group.Conclusion: Vitamin D3 improved left ventricular function and NYHA class in chronic heart failure (CHF) patients and might serve as a new agent for the future treatment of the disease.

Background: Anatomists had been searching to find methods for preserving soft human tissues and produce natural samples with durable, dry, odorless, and portable in briefcase properties. Plastination is a modern method for preparing such tissue samples. In plastination, water and fat are extracted from tissues and replaced with a dissolver fluid, which in its turn is replaced with a special kind of polyester. Usually, the organs like hearts, lungs, kidneys, striated muscles, vessels, nerves, connective tissue, etc, which are treated with formalin, loss their beautiful color and take a dull appearance after fixation. Tissue staining with natural dyes is one method for somehow preserving tissue natural color and increasing its appearance activity to prepare better samples in terms of appearance and suitable clearance of different parts (valves, muscles, trabeculae…). Also, we have to prepare non fragile samples.Methods: At first, some visceral organs (sheep hearts) were prepared and fixed by formalin 5% for 4 to 10 days. Then they were dissected for anatomic details and were put in a chemical dye called eosin and natural dye called ronnas. After dehydration by acetone in -25 °C and defeating with acetone in +30 °C, samples were put in the vacuum chamber to replace acetone instead of polymer under the vacuum pressure; finally the samples were cured with the ultra violate wave.Findings: We found that after fixation and before plastination staining of organs with eosin and ronnas resulted in beautiful appearance of tissues.Conclusion: Staining of organs resulted in beautiful appearance of tissues which are effective in increasing the attractively of teaching and learning anatomy. Also, it has affection in the raising appearance quality and has positive impression in the quality of education.

Background: The main cause of Alzheimer's disease (AD) is loss of cholinergic function. So, the choice strategy of therapy is to increase the level of acetylcholine (Ach) in the brain of by acetylcholinesterase inhibitors (AchEIs) such as Donepezil. This study evaluated the effect of donepezil on cerebral blood flow using non-invasive transcranial doppler (TCD) sonography.Methods: This clinical trial was performed on AD patients in two groups of case and control, each consisting of 11 patients. The case group who received donepezil medication was examined by TCD before (baseline), after four weeks of oral treatment with 5 mg/d donepezil and a further four weeks of 10 mg/d donepezil, administered orally. The control group did not receive any medications effective on AD and were examined by TCD only once. Peak systolic velocity (PSV), end-diastolic velocity (EDV) and mean flow velocity (MFV) velocities of posterior cerebral artery (PCA) and middle cerebral artery (MCA) were assessed and mini-mental state examination (MMSE) was carried out.Findings: There were not any significant difference between the case and control groups, in terms of age and sex. In the case group, mean MMSE score reached 20.2 ± 2.8 from a baseline value of 15.8 ± 3.3 after four weeks of oral treatment with 5 mg/d donepezil, and reached 20.6 ± 3.9 after four more weeks at 10 mg/d donepezil (P<0.0001). In MCA, the difference in PSV and MFV values after four weeks of treatment at 10 mg/d donepezil was statistically significant, compared with the baseline values (P=0.002 and 0.025, respectively). In PCA, the values of MFV and EDV after four weeks of treatment with 10 mg/d donepezil were statistically significant in comparison with the baseline value (P=0.015 and 0.014, respectively).Conclusion: Donepezil, especially administered in doses of 10 mg/d, has an effect on increasing cerebral blood flow velocity and MMSE score in AD, but more extensive trials by other researchers are recommended.

Background: Exercise is commonly reported as a factor for decreasing dysmenorrhea symptoms. The aim of the present study was to investigate the effect of six weeks flexibility training on symptoms of dysmenorrhea.Methods: Thirty-four students of The University of Isfahan suffering from primary dysmenorrhea (Age: 20.47 ± 1.54 years, Weight: 54 ± 8.22 Kg, Height: 161 ± 5.34 cm, Body Mass Index: 20.72 ± 2.76) were divided in two exercise (n=20) and control (n=14) groups. Exercise group engaged in a 6 weeks flexibility training program include abdomen, back, hamstring and hip adductors stretches. They performed 10 movements, each 3 times, lasting 10 seconds, 4 days per week. One second was added to those movement times each week. Prior and after 6 weeks of flexibility training, all subjects completed menstrual distress questionnaire. Severity of pain evaluate with Visual Analogue Scale. The descriptive and inferential statistic tests like Man-Withney U, Wilcoxon, and independent and paired sample t-test were used for analyzing the statistical information.Findings: After 6 weeks flexibility training, experimental group indicated significant increase in flexibility measurements (back, hamstring, hip adductors) and significant decreases in their mood symptoms (from 14.20 ± 7.42 to 5.35 ± 3.00), physical symptoms (from 15.90 ± 5.93 to 8.75 ± 6.09) and severity of pain (from 6.37 ± 2.69 to 3.79 ± 2.39) (P<0.001). There were no significant changes in flexibility measurements and dysmenorrhea symptoms in control group.Conclusion: Our findings indicated that selected flexibility training in 6 weeks would decrease dysmenorrhea symptoms.

Background: The scaphoid fractures are of the most prevalent fractures of the wrist and there are different ways for the treatment of these fractures. The aim of this study was to compare results and complications of three of these methods.Methods: In this randomized clinical-trial study, among patients referred to Kashani hospital in Isfahan, Iran, from September 2006 to September 2008, 39 with scaphoid fracture, with more than 1 mm displacement, were enrolled. They were randomly assigned into three groups (13 patients in each). In the first group, close reduction and immobilization (cast) was used. In the second group, percutaneous fixation with pin and in the third group, one percutaneous screw was used. The patients were evaluated monthly with X-Ray, and by Mayo Wrist Scoring. The evaluated information was obtained and compared.Findings: The mean time of union was significantly shorter in the third group and there was no malunion, nonunion or any other complication in this group. Results of Mayo Wrist Scoring was better in third group, too.Conclusion: The percutaneous screw fixation in scaphoid fractures causes better fixation and results in shortening of union period and, if technically possible, can be suggested as a good method of treatment for these types of fractures.

Background: Letrozole is an aromatase inhibitor which can decrease estrogen production in peripheral tissues and endometriosis. Danazole, as an androgen, inhibits estrogen production in ovaries and recently has been introduced as an aromatase inhibitor; this study was designed to compare the effects of danazole with letrozole to relieve symptoms of endometriosis.Methods: In this randomized clinical trial study, 105 patients confirmed endometriosis by laparoscopy.These patients were randomly assigned to three groups: group 1 received letrozole tablet (2.5 mg/day), calcium (1000 mg/day) and vitamin D (800 IU/day), group 2 received danazole tablet (600 mg/day), calcium (1000 mg/day) and vitamin D (800 IU/day) and group 3 (placebo group) received calcium (1000 mg/day) and vitamin D (800 IU/day). Pelvic pain, dysmenorrhea and dyspareunia were assessed in participants before study and monthly during the study for six months. Data were analyzed via SPSS15 software with Freidman and Wilcoxon tests.Findings: Mean age was not statistically different in three groups. Totally, 105 participants were enrolled in this study; 38 patients in letrozole group, 37 patients in danazole group and 31 patients in placebo group. In letrozol group, the mean of chronic pelvic pain, dysmenorrhea and dyspareunia score were less than danazole and placebo groups. The Wilcoxon test showed significant difference between mean of dysmenorrhea score at the 5th month after treatment compare to the 1st month in letrozol group (P=0.025).Conclusion: This study showed that letrozole is more effective than danazole in relief chronic pelvic pain, dyspareunia and dysmenorrhea.

Background: Studying the effects of environmental factors on the early stages of development and progression of atherosclerosis process can serve as a guide for future studies and offer strategies for primary prevention of chronic diseases. This study aimed to assess the relationship of air pollution and plasma surrogate endothelial markers in the pediatric age group.Methods: This cross-sectional study conducted in 2010 involving 118 children and adolescents aged 10-18 years randomly selected from different areas of Isfahan city, the second large and air-polluted city in Iran. The association of air pollutants’ levels with serum thrombomodulin (TM) and tissue factor (TF) was determined.Findings: A significant relationship between TF and Pollution Standard Index (PSI) was found. This relationship was remarkable with PM level, although we could find this relationship more or less with other gasses as well. In this study, no significant relationship was found between TM and PSI.Conclusion: The relationship of air pollution level with the inflammation system and subsequently coagulation factors can be an important factor in atherosclerosis development from early life. This finding should be confirmed in future longitudinal studies and must be given due attention in preventive policies.

Background: Invasive Haemophilus Influenzae type b (Hib) disease is a major problem of the public health in the countries have not implemented Hib vaccine in their routine immunization. The aim this study was to summarize the best available evidences regarding vaccine efficacy of Hib in the children younger than 5 years of age.Methods: The study was a systematic review and meta-analysis of randomized controlled trials and quasi-experimental studies on children of general population with at-least two years of follow-up. We searched Medline, OVID, ISI, Cochrane (Central Register of controlled trials), Proquest, scopus, DARE, HTA, and NHSEED from first available time to the end of 2008. Types of acceptable interventions were conjugate Hib vaccines (PRP-T, HB-OC, PRP-OMP, PRP-D) compared with placebo, no treatment or not-relevant vaccines. The summary estimated effect was calculated with Random Effect model. The publication bias was assessed by Egger's and Begg's tests.Findings: We find nine article that met inclusion criteria. The pooled estimate for vaccine efficacy was 84% (95%CI: 69-92%) against invasive Hib diseases. The tolerability of vaccine was acceptable in all studies and the incidence rates of side effects were rare.Conclusion: The study shows that conjugated Hib vaccine could prevent about 84 percent of Hib aggressive diseases. In the case of approval in an economic evaluation, it is reasonable to implement such vaccine in the routine immunization system of Iran.