مجله علمی پزشکی جندی شاپور
سال هفتم شماره 3 (پیاپی 58، پاییز 1387)

Adenoid is responsible for some upper respiratory tract infections including otitis media and para nasal sinusitis. Adenoid tissue contains a burden of both aerobic and anaerobic microorganisms relative to adenoid size. The number of these microorganisms, some of which are pathogenic, increase with enlargement of the adenoids. The aim of this study was to compare the efficacy of two commonly administered antibiotics (amoxicillin and erythromycin) in control of infections produced by aerobic microorganisms. In this randomizad clinial trial, 84 patients with recurrent acute otitis media and who were candidates for adenoidectomy and ventilation tube insertions were allocated into three groups: Amoxicillin (group 1), erythromycin (group 2) and no treamtnet (group 3). adenoid tissue cultures revealed that aerobic bacteria in group with antibiotic treatment was obviously lesser than group 3.Pathogen bacteria and B-Lactamase producing agents were lesser in group 1 and this antibacterial activity was stronger in amoxycilline. both erythromycine and amoxicillin can reduce pathogen bacterial mass and reduction in aerobic and B-Lactamse producing agents in adenoid tissue of patients with recurrent otitis media.

Therapeutic exercise is one of the methods to reduce pain and to strengthen muscles in patients with shoulder impingement syndrome. There are many exercise protocol for shoulder rehabilitation. The aim of this study was to compare the effect of two exercise regimen (traditional vs functional) on pain and maximal voluntary contraction (MVIC) of shoulder muscles.Subjects and Measures: 24 men and women (mean age: 18-50) with shoulder impingement syndrome were randomly assigned to one of two exercise groups. MVIC of shoulder muscles (pectoralis major, upper trapezius, middle trapezius, infraspinatus, anterior, middle and posterior deltoid) by surface electromyography and pain assessed during before and after four week treatment. In both groups resting pain was reduced after treatment (P<.000). There was no significant difference between two groups (P<.007). MVIC force of all shoulder muscles increased after treatment in both groups (P<.05). There was no significant difference between two groups except for pectoralis major muscle that had more MVIC force in functional group(P<.006).Pain reduction after therapeutic exercise was associated with an improved MVIC force in both groups but there was more reduction in pain and increase in MVIC in the kinetic chain group than the traditional.

The aim of this study was to evaluate the effects of static magnetic fields (SMF) on hypothalamic-pituitary-thyroid (HPT) hormonal disturbances. One hundred and ninety two male rats were divided into four experimental protocols. Each experimental protocol consisted of four groups and each group contained 12 rats. After one-week adaptation, rats were exposed to SMF (0, 6, 12 and 24 mT, at 50 Hz) for 40 or 120 minutes daily (at 9 a.m.) for 17 or 34 days. At the end of each experiment, the animals were anaesthetized; blood sera were collected and kept frozen under -200C until use. TSH and thyroid hormones were measured by IRMA and RIA methods using -counter equipment. The results were analyzed by ANOVA statistical method, followed by Tukey posthoc test.No change was observed in TSH and thyroid hormones following exposure to SMF of 40 min/day for 17 days. TSH at many SMFs protocols, exposed or sham-exposed animals have not affected, except those rats exposed to 24 mT (120 min/day for 34 days) which was higher than other groups with same protocol (P<0.05), also T3 resin uptake significantly has decreased. There were statistically significant increased in serum free thyroxine index and total thyroxine values at 12 and 24 mT (40 min/day for 34 days) compared with other groups (P<0.01 and P<0.001 respectivel). Serum free thyroxine index and total thyroxin values at 24 mT (120 min /day for 17 days) was significantly lower compare to sham-exposed animals (P<0.05), however TSH and free thyroxin levels did not change significantly (P>0.05) using this SMFs. SMF, with low duration (17 days) and short time exposure (40 min/day) can not alter HPT hormonal axis secretion in male rats. But it can enhances HPT axis disorders with increasing duration (34 days) and long time exposure (120 min/day)

The use of ultrasound in the evaluation of pregnancy and its complications is growing. Determination of fetal gender is important; not only for answering parents curiosity about their fetus gender but is also important for revealing variable medical conditions. In this study we evaluated ultrasound accuracy in determination of fetal gender during 16-40 weeks of pregnancy. In this prospective and descriptive study, transabdominal sonography performed on 500 pregnant women at gestational age of 16-40 weeks. Sonography reports, obstetric history and parent’s tendency about knowing fetal gender were noted. Sonography reports on fetal gender were classified into male or female, possibility of male or female and undetermined. Neonatal gender was confirmed by telephone call after birth and compared with the sonography results. Transabdominal sonography accuracy correlated with gestational age, multifetal, amniotic fluid changes and maternal BMI.In 500 pregnancies 529 fetuses were seen. Fetus gender was determined as definite in 95.6%, possible in 2% and undetermined in 2.3% of cases. There was only one male case determined incorrectly as female, (it was one of the twins in 19 weeks gestation). Thus, accuracy of sonography in determining male fetuses was 99.6% and in female fetuses 100% and the over all accuracy was 99.8%.Transabdominal sonography is an accurate and reliable method in gender determination.

Due to the lack of retention and possible fracture resistance of amalgam and cavity preparation, several methods were suggested and evaluated. The aim of this study was to evaluate whether box preparation could reinforce the retention and fracture resistance of amalgam complex restorations.Forty eight non caries human first molars were selected and mounted in acrylic resin, the specimens were then randomly divided into 4 groups of 12 specimens. Two different restorative configurations were evaluated in groups.Groups1 and 2: Standardized MOD cavity preparation was made using a diamond bur with a high speed hand piece with air/water spray. The depth of the occlusal isthmus was 3 mm and proximal margins located above the cement enamel junction (CEJ). All box walls 10 degree of divergence against the occlusal plane. Groups 3 and 4: cavity preparation was made using a diamond bur with high speed hand piece with air/water spray. The occlusal surface of specimens were ground to 3 mm occlusal to the CEJ and then four boxes were prepared on buccal, lingual, mesial and distal surfaces.Specimens in groups 2 and 4 were used for retention test and specimens in groups 1and 3 used for fracture resistance test. In groups 2 and 4 were used for evaluation the retention of restoration. All groups were restored with amalgam. Each specimen was loaded in an universal testing machine at a cross-head speed of 1mm/min until fracture occur. Data were analyzed with t- test.The mean fracture resistance of groups 1 & 3 was: group 1784.3 N and 880.4 N respectively (P<0/05). The mean retention force of groups 2 and 4 was: 218.8 N and 317.4 N (P<0/05).In our study there was significant difference (P<0.00) between the fracture resistance of groups 1&3 and there was significant difference (P<0.000) between the retention of group 2. The retention in group 4 was significantly increased compare to the group 2, and fracture resistance in group 3 was significantly decreased compared with the group1.

Use of hearing aids is a common and an important programming of auditory rehabilitation. Hearing aid is an important device especially in children with hearing loss, because good hearing is effective for development of speech. The aim of this study was to assess the usefulness and disadvantages associated with use of this device among patients with hearing loss. This cross-sectional retrospective and descriptive study included 100 patients, visiting Social Support Organization (behzisty center) of Ahvaz, with sensory-neural hearing loss on hearing aids. Demographic charteristics, medical records history, options of hearing aids, advantages and disadvantages of those were analyzed.Of the 100 cases of sensory neural hearing loss, 68 % of patients were under 20 years old. Eighty three % of cases were psychologically satisfied with their hearing aid, and 55% had good progress in their education. Eighty four % of cases used post-auricular hearing aids. The disadvantages reported of using hearing aid were: not enough power (18%), ear mold impression (24%) and allergy to the mold (12%).Hearing aids are useful in patients with sensory neural hearing loss and can be used with comfort in majority of patients who need them. Good selection of hearing aid, suitable mold and teaching the patients can reduce the disadvantages associated with use of hearing aids.

Treatment of type 1 diabetes mellitus is hindered by the often large fluctuations in the blood glucose concentration experienced by affected individuals. It seems that variation in the rate of absorption of insulin from the subcutaneous injection sites may be an important factor causing these fluctuations. In this study the effectiveness of different patterns of insulin injections on glycemic control were investigated in this type of diabetes. Insulin injections were given in the abdomen for 3 weeks (standard rotational pattern) and rotated among arms, abdomen and thighs for 3 weeks (irregular rotational pattern) and finally were performed prebreakfast injections in abdomen and presupper injections in thigh for 3 weeks (regular rotational pattern). Fasting blood glucose levels were measured weekly also the end of every period, serum fructoseamine value were also determined. Statistical analysis of data showed that there is significant difference between mean serum fructoseamine values during standard, regular and irregular rotational patterns (p<0/001) and mean serum fructoseamine values during standard rotational pattern were lower than the corresponding values during regular (282/8 vs 376/7 µmol/l respectively) and irregular (282/8 vs 461/2 µmol/l respectively) rotational patterns and mean serum fructoseamine values during regular rotational pattern were lower than the corresponding values during irregular rotational pattern.The finding of this study suggests that injections pattern should be rotated using all of the available sites in an anatomic area before moving to the next is more effective method for glycemia control.

Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the median nerve which may leads to impairment of the hand function. Despite the definite causes of CTS, jobs with frequent and repetitive hand movements are at greater risk for this condition. The aim of this study was to evaluate the prevalence of CTS in a group of type writers in Ahvaz, Iran. In a cross-sectional descriptive study, 120 typewriters were evaluated for CTS. Diagnosis was made according to a questionnaire form and clinical examination including hand paresthesia. Furthermore, the relationship of age, employment history, weekly working hours and body mass index (BMI) as the associated risk factors were evaluated.Among the subjects studied, 80 (66.6%) perosns were female. The mean age was 34 years (range 21-49 years). Thirty three subjects had paresthesia (27.5 %, 23 females and 10 men). Five cases (4.2%) of carpal tunnel syndrome was detected. CTS was more common in the ages 40- 49 years females. Three was a direct (relationship)= relationship between sex (female), record of service more than 12 months, and over weight subjects with BMI 730 (P<0.01). CTS had a prevalence of 4.2% among type writers, and was more common in females. Using wrist splint, short periods of rest during heavy continues type writing, and insertion of a soft pad for keyboard can be effective to decrease the symptoms of this disease.

Sepsis is one of the serious infections of neonatal period. Since signs and symptoms of neonatal sepsis are nonspecific and delayed therapy may cause high mortality, empirical antibiotic therapy is suggested to cover common causative organisms. The etiology of neonatal sepsis may vary from country to country. The aim of this study was to determine bacterial pathogens causing neonatal sepsis in Ahvaz, a southwest province of Iran. During one year period, from December 2004 to November 2005, all neonates with probable diagnosis of neonatal sepsis who were admitted in two major pediatric hospitals of Ahvaz, were included in this study. Two blood samples were obtained from all neonates and cultured in Ethylene Methylene Blue, McConkey and sheep blood agar media. After primary isolation of organisms, complementary diagnostic tests were done for definite diagnosis of pathogens. Of 593 neonates with probable diagnosis of sepsis admitted in the mentioned hospitals, 83 had positive blood cultures. Fifteen cases were excluded because of isolation of unusual organisms, isolation from one sample tube or contamination. Overally, 68 cases (11.3%) had culture-proven sepsis. Of which 20 (29.6%) presented as early–onset sepsis and 48 (70.6%) were late-onset sepsis. The bacterial pathogens encountered in order of frequency were Klebsiella pneumonia (28%), Staphycococcus epidermidis (20.5%), Enterobacter (7%), Escherichia coli (16%), Pseudomonas aeruginosa (15%) and Staphycococcus aureus (1.5%). Group B streptococcus was not isolated from these cases. Most cases of S. epidermedis and Pseudomonas aeruginosa had history of previous admission in other hospitals.The results of this study showed that gram-negative organisms are the most common pathogens causing neonatal sepsis in Ahvaz. This should be considered when choosing appropriate antibiotics for empirical therapy of neonatal sepsis in this area.

Renal failure and diabetic retinopathy are two main complications of chronic diabetes. Fluroscien angiography is one of the most important and commonly employed diagnostic methods for evaluation of retinopathy. In this investigation we tried to evaluate the effects of fluroscien on renal function of diabetic patients. This prospective clinical investigation included 44 diabetic patients (22 males and 22 females) referred to the to the Imam Khomaini hospital in 2006 for diagnostic retinal angiography by fluroscien. Serum creatinine and blood urea nitrogen (BUN) levels were measured before and subsequently on the second and the third day after angiography, The data were analyzed by SPSS soft ware.(by t-test and chi- squire).Seventeen (38.6 %) (11 males and 7 female) had increased creatinine by at least 0.3 mg/dl and in 9 (20 %) (7 males and 2 females, P<0.05) patients this increase was equal to or more than 0.5 mg/dl. Changes in BUN in these patients were not prominent and no significant differences between the group who experienced an increased in serum creatinine level and those who did not. The most common complications after fluroscien angiography were nausea and vomiting which occurred in 7 patients (15.9%).Despite it is widely believe that fluroscien has no adverse effects on both renal function or serum creatinine, in this study we showed that it can increase serum creatitne in a significant portion, prominently male, diabetic patients.

Fabrication of indirect onlays and inlays and their cementation with resin cements have become increasingly popular. Resin cements used in indirect restoration cementations provide weaker bonds when compared with the bond strength supplied ژin a dentin bonding used for direct composites. This results in debonding of indirect restorations and consequent problems. Resin coat technique has been advocated as a solution. It is claim to increase the bond strength of resin cements to dentin using this technique. The purpose of this study was to evaluate the effects of storage time and resin coat technique on the panavia F cement tensile bond strength to dentin. Methods and Materials: Sixty extracted human third molars were divided into six groups of ten. The occlusal surfaces were trimmed to the exposure of the very first dentin layer. the specimens were placed under the following experimental conditions: Group 1: control group 1, no surface treatment on dentin with storage under distilled water for 24 hours. Group 2: control group 2, no surface treatment on dentin with storage under distilled water for 7 days Group 3: Resin coated dentin with clearfil liner bond 2V and storage under distilled water for 24 hours. Group 4: Resin coate dentin with clearfil bond 2V and storage under distilled water for 7 days. Group 5: Resin coated dentin with clearfil bond 2V and flowable composite and storage under distilled water for 24 hours Group 6: Resin coated dentin with clearfil bond 2V and flowoble composite and storage under distilled water for 7 days. Nickel chrome rod was bonded to the above surfaces using panavia F. Tensile bond strengths were evaluated with instron machine Paired t-test was used to detect differences among experimental groups and ANOVA test for comparison between the 6 groups. The mean tensile bond strengths ± standard deviations were as following: Group1:15. 94 ± 5. 27, Group 2:12. 43 ± 4. 75, Group 3:15. 36 ± 5. 41, Group 4:10. 61 ± 3. 53, Group 5:18. 45 ± 6. 18 and Group 6:13. 34 ± 4. 4 PMa. Statistical analysis showed no significant differences between groups 1 and 2. However, there was a significant difference between the highest strength was found in group 5, and the lowest one in group 4. (P< 0. 05). a7- day storage, to 1 day storage reduced paravia F bond strength to resin coated dentin (P< 0. 05). In all groups, inter facial failure was an adhesive failure between cement and dentin or resin coated dentin. Bonding strength was not improved by using resin coat technique. Usage of flow able composite in combination with clearfil liner bond 2V had not effect on bonding strength. Decrease in bonding strength after 7 days storage of resin-coated dentin was seen.

Localizing of radiation onto tumor volume is important in limits damage due to secondary radiation to surrounding normal tissues. The aim of the present study was to assess the effects of external electrical field on the absorbed secondary radiation using water phantom technique. A water phantom (20x20x10 cm3) was positioned in an electric field with different intensity from 11.25 kV/m to 90 kV, dosimetry was measured at 5 cm of depth for treatment fields with 5x5 cm2 to 20 x20 cm2 and SSD(source – skin- distance) =80 cm with γ radiation with cobalt 60. for estimating the enhancement of absorbed does due to the parameter of DER(Dose enhancement ratio) as the form DER= Defined and calculated.Variation of DER with respect to dimension of treatment fields and intensity of electric field showed that applying of electric field on radiation field caused the increment of absorbed dose and DER. With increasing rate between 5% -10% for fields 5×5 cm2 up 2 20× 20 cm2 in 90 kv/m intensity of electric field It seems that applying the electric field on water phantom in deferent photon fields prevent from recombination of produced ions in water phantom and caused 5% -10% enhancement in absorbed dose by transmitting more energy in the medium by this ions.

The sickle cell disease or sickle cell anemia is an inherited hematological disease which is the second most common blood disorder after thalassemia in Khozestan province. Recent studies have shown that the immune system in sickle cell patients is defected. The aim of this study was to investigate punitive leukocyte subpopulations in blood of these patients in comparison with control group. The study included two parts. The first part was a retrospective study on data collection derived from 50 files of patients admitted in Ahvaz Shafa hospital during 2004-2005. The sample patients including sickle cell thalassemia (n=35) and sickle thalassemia β0 (n=15). The data included WBC count and differential count of different leukocyte subpopulations. The second part was carried out with flow cytometry for immunophenotyping of peripheral blood lymphocytes of 22 patients (12 sickle cell: and 10 sickle thalassemia β0) who were referred to Shafa hospital for pain crises. Two ml citrated peripheral blood was obtained from these patients, RBC lysed, lymphocytes stained with monoclonal antibodies specific for T cell and B cell (CD4, CD8, CD5, CD20) and the data finally analyzed by flow cytometry. The data were compared statistically with control group (n=30) selected from normal population. None of the patients in the study had previously been treated with hydroxyurea or had a history of splenectomy.WBC count and atypical cell percentage in two patient groups were significantly increased (P<0.01). The neutrophil percentage increased in both patient groups but was significant in SCD (P<0.05). The eosinphil percentage was increased in both thalassemia groups which was significantly more so in sickle βo thalassemia patients (P<0.05). The lymphocyte percentage was reduced in both groups and was more significant in sickle cell patients (P<0.01). CD4+ and CD5+ lymphocyte subpopulations were significantly reduced in both patient groups (P<0.01). CD8+ lymphocytes and CD4+/CD8+ ratio were reduced in both patients groups but did not reach significance. CD20+ lymphocyte subpopulation was significantly higher in both patient groups (P<0.01). It seems that immune cells, especially B and T cells are changed in the these patients. This may have an important role in occurrence of some symptoms such as infection and pain crises. Further studies in immune system role in sickle cell and thalassemia is recommended in order understanding the cause of the symptoms associated with these diseases and help in their treatment plans.

Hepatitis B is an endemic serious disease in many parts of the world. A significant proportion of patients with chronic hepatitis B are infected with a variant form of the hepatitis B virus (HBV) which has a low or abolished hepatitis B e-antigen (HBeAg) production. The aim of this study was to determine the prevalence of HBeAg-negative chronic hepatitis B cases in Khuzestan province. One hundred and sixty-two patients (102 men and 60 women; mean age 31±11.16 years) with chronic hepatitis B infection (HBsAg+/HBV DNA+) in Khuzestan province were included. Their HBeAg status was assessed using enzyme immunoassay (ELISA). Of the 162 patients with HBsAg+/HBV DNA+, 99 (61.1%) were HBeAg negative and 63 (38.9%) were HBeAg positive. The mean age ±SD in the former group was 33.1 ±9.9 and in the latter group was 27.7±12.2 years (P<0.001). HBeAg status had close correlation with age. The results showed no significant correlation between ALT levels and HBeAg negativity. The results of this study indicate that HBeAg negative chronic hepatitis B has a high prevalence in Khuzestan province.

Most people of the community are un-intentionally exposed to electromagnetic fields produced by microwave, mobile phone, computer and television. On the other hand, infertility is considered as complex problem in the modern societies, which could be produced by environmental factors. Therefore knowing the exact effect of electromagnetic field as an environmental factor on organs especially reproductive organs is important. The aim of the present study was to investigate the effect of extremely low frequency electromagnetic fields on structure of spermatogonia in mice. In the present study, 30 male, 3 months old NMRI mice weighting 25-30 g were used. The mice were randomly divided into 3 groups of control, sham and experimental (n=10 in each group). The mice in experimental group were exposed to 5 mT electromagnetic field 4 hours/day for 2 months. The mice in sham group where place in a space similar to experimental group without exposure to electromagnetic field. Control group was kept in standard condition. After the experimental time, the mice in all three groups were sacrificed and testicular specimens were prepared for light microscopy. Light microscopic observations revealed that the thickness of germinal epithelium and the concentration of spermatozoa in the lumina of seminiferous tubules was reduced in experimental group. The nuclei of spermatogonia were also condensed in this group. Morphometric study showed that nuclear diameter of spermatogonia and diameter of seminiferous tubules were significantly (P<0.01) reduced in experimental group in comparison to control and sham groups. However, the number of spermatogonia cells was not different among three groups. It is concluded that exposure to 5 mT electromagnetic field would interfere with fertility by significant reducing of 1) the diameter of nuclei of spermatogonial cells, 2) the thickness of germinal epithelium in the seminiferous tubules.

Foreign body aspiration (FBA) can be a life-threatening emergency requiring immediate intervention. Foreign body aspiration is one of the most common and sometimes even life threatening conditions in children and other age groups. The peak incidence of foreign body aspiration occurred during the second year of life in the child and during the sixth decade in the adult group. Nuts are the most common foreign body aspirated by children. Symptoms of aspiration can be chocking, cough and/or cyanosis, though most of the patients do not have any complains. A precise history in favour of FBA should put the physician in doubt. Even though the radiological intervention can be negative in some cases, it should be performed for all patients suspected of FBA. Definite diagnosis is made with endoscopy and it is necessary to removing the foreign body for preventing consequent complications which includes: pneumothorax, pneumomediastinum, athelectasis, bronchectasis, lung abscess and recurrent pneumonia. Rigid endoscopy is choice for FBA removing, but in special cases surgical management may be necessary. In this case report, a 12-year girl with respiratory signs and undiagnosed FBA due to chicken bone which lead to lung abscess and no response to medicine therapy is reported.