مجله پزشکی بالینی ابن سینا
سال بیست و یکم شماره 2 (پیاپی 72، تابستان 1393)

Introduction & Even a little bleeding can adversely affect the surgeon''s ability to visualize the region to be operated in ENT operations. The aim of this study is to compare the effects of isoflurane and sevoflurane on hemodynamics and bleeding in controlled hypoten-sion. This study was a double-blind clinical trial. Ninety patients who were candidates for endoscopic sinus surgery and tympanomastoidectomy in Amirkabir hospital of Arak were randomly assigned into two groups of isoflurane and sevoflurane. Remifentanil was infused at 0. 1 µg/kg/min for both groups during surgery and the amount of bleeding and hemodynamic parameter were recorded. The data was analyzed by SPSS-20 and ANOVA statistical test. Underlying and hemodynamic variables were similar between the two groups preop-eratively. The amount of blood loss during surgery showed that there were no significant dif-ferences between the two groups (P=0. 802) and no significant differences in hemodynamic variables (heart rate، systolic/diastolic blood pressure and arterial oxygen saturation) were observed between the two groups during the surgery. It is concluded that there is no difference between sevoflurane and isoflurane in controlled hypotension.

Introduction &

Chronic periodontitis is an inflammatory disease of the tooth supporting tissues by a specific group of microorganisms، leading to progressive destruction of the periodontal ligament. The aim of this study was to evaluate the effect of amoxicillin and metronidazole as an adjunct، after scaling and root planning in reducing pocket depth and clinical attachment loss in chronic periodontitis (moderate to severe) patients.

In this clinical trial randomized control study، scaling and root planning were performed for 30 chronic periodontitis (moderate to severe) patients. 15 patients were given amoxicillin 500 mg and metronidazole 250 mg every 8 hours for 7 days as an adjunct after scaling and root planning، For 15 other patients only scaling and root planning were per-formed. Probing depth and clinical attachment loss were measured in each group in base line and were compared 1 month before and after scaling and root planning. Statistical analysis was done using a paired t-test، ANOVA and by SPSS16 software.

Mean pocket depth and clinical attachment loss in the test group compared to control group، 1 month after the intervention was not statistically significant (P=0. 082، P = 0. 540).

Amoxicillin and metronidazole as an adjunct to scaling and root planning do not have a significant impact on reducing pocket depth and clinical attachment loss over one month after treatment in patients with chronic periodontitis.

Introduction & The vestibular system is sound sensitive and the sensitivity is related to the saccule. The vestibular afferents are projected to the middle ear muscles (such as the stapedius). The goal of this research was studying the relationship between the vestibular hearing and the sound-evoked muscle reflex of the middle ear to 500 HZ. This study was a cross sectional-comparison done in audiology department of Sheikholreis C‍‍linic (Hamadan، Iran). The study groups consisted of thirty healthy people and thirty patients with benign paroxysmal positional vertigo. Inclusion criteria of the present study were to have normal hearing on pure tone audiometry، acoustic reflex، and speech discrimination scores. Based on ipsilateral acoustic reflex test at 500HZ، they were divided to normal and abnormal groups. Then they were evaluated by cervical vestibular evoked myogenic potentials (cVEMPs) and finally classified in three groups (N) Normal ear، (CVUA) Contra lateral vertiginous ear with unaffected saccular sensitivity to sound، (IVA) Ipsilateral vertiginous ear with affected saccular sensitivity to sound. Thirty affected ears (IVA) with decreased vestibular excitability as detected by ab-normal cVEMPs، revealed abnormal findings of acoustic reflex at 500HZ. Whereas، both un-affected (CVUA) and normal ears (N) had normal results. Multiple comparisons of mean values of cVEMPs (p13،n23) and acoustic reflex at500HZ among the three groups were sig-nificant. The correlation between acoustic reflex at 500HZ and p13 latencies was significant. The n23 latencies showed significant correlation with acoustic reflex at 500HZ. The vestibular sensitivity to sound retains the ability to trigger sound-evoked re-flex of the middle ear at 500 HZ.

Introduction &

Primary dysmenorrhea is one of the common problems in women، especially in young women. Although dysmenorrhea is not life threatening، it can have ad-verse effect on quality of life and cause disability or ineffectiveness. With regard to the young society suffering from it، various treatments are offered for dysmenorrhea one of which is medicinal plants. This study investigated the effect of Melissa officinalis and Salvia officinalis on primary dysmenorrhea

This study was a clinical trial study performed on 50 girls with dys-menorrheal taking Salvia officinalis as infusion for five days before menstruation and five days during the menstruation. The consumption of the plants was repeated in the next two periods in the same way. Severity of pain، blooding duration and dysmenorrhea duration were evaluated with VAS (Visual Analog Scale) Questionnaire in their next two cycles. Data were analyzed by chi-square، t-test and WILCOXON statistical test.

The results of this study showed that after using the plants، pain severity and pain duration significantly reduced P<0. 01)so that pain severity decreased from 6. 30 to 3. 94 and 3. 24، (on a scale of 1 to 10) after taking the plants in the first and second periods، respectively. The maximum pain duration before the treatment was 1 to 6 h (28. 6%) and this number reduced to less than 1 h after using these medicinal plants (38. 0%). Mean of blooding duration was 6. 36 days before the treatment. After the first and second duration، this value reached 6. 48 and 6. 34 days، respectively. It was determined that taking oral seda-tives reduced from 56% to 26% and 22% after the first and second periods، respectively. Fi-nally، after the second period، 42% of the girls reported high rates of satisfaction because of using the medicinal plants.

Generally، it was showed that Melissa officinalis and Salvia officinalis signifi-cantly reduced pain severity and pain duration in the girls with primary dysmenorrhea. These medicinal plants can be used as a therapy method and raise the life quality of suffering women.

Introduction &

Epidemiologic data linking adherence to the Dietary Approaches to Stop Hypertension (DASH) diet and metabolic syndrome in Iranian population is sparse. We aimed to evaluate the association between adherence to the DASH dietary pattern and risk of metabolic syndrome in a group of Isfahani female nurses.

This cross-sectional study was carried out among 420 female nurses aged >30 years selected by a multistage cluster random sampling method. Usual dietary in-takes were assessed using a validated food frequency questionnaire. Fasting blood samples were drawn to measure metabolic profiles and blood pressure was recorded. Additional co-variate information was obtained using questionnaires. The metabolic syndrome was defined according to the guidelines of National Cholesterol Education Program Adult Treatment Panel III (ATP III). The DASH score was constructed based on high intake of fruits، vegeta-bles، whole grains، lean meat،and low-fat dairy. The data was analyzed by SPSS18 software and one-way ANOVA، Chi-square and ANCOVA statistical tests.

After controlling for confounders، individuals in the highest tertile of the DASH diet score had 81% lower risk of metabolic syndrome than those in the lowest category (OR: 0. 19; 95% CI: 0. 07-0. 96). In addition، participants in the highest tertile of adherence to DASH diet had 62، 72، 78 and 86% lower odds for enlarged waist circumference، hyper-triglyceridemia، low HDL-c levels and high blood pressure than those in the lowest tertile، respectively.

Findings of the present study revealed that adherence to the DASH eating plan reduced the risk of metabolic syndrome and all of its features، except hyperglycemia.

Introduction &

Diabetic nephropathy is one of the micro vascular complications of uncontrolled diabetes. Chronic hyperglycemia results in the formation of glycated proteins and activation of pathways leading to diabetic nephropathy. Increasing RAGE and TGF? production in the kidney tissue is a major pathway involved in diabetic complications. In this survey، the effect of myoinositol and Crocin on RAGE and TGF? expression in the kidney of diabetic rats was studied.

In this experimental study after rendering rats with diabetes with strepto-zotocin، they were treated with oral 1% myoinositol and injection of 100 mg/kg BW crocin for 12 weeks. Changes in both RAGE and TGF? expressions in the kidney tissue were as-sessed by semi-quantitative RT-PCR method. The data was analyzed by SPSS 18 software and one way ANOVA and Tukey statisticaly tests.

Crocin administration caused a significant reduction in the RAGE and TGF? expres-sion in comparison with the untreated diabetic rats. Oral administration of myoinositol could not induce any significant changes in the expression of both genes in the diabetic rats.

According to the results of this study، crocin has the ability to block pathways leading to diabetic nephropathy through reducing RAGE and TGF? expression in the kidney tissue، maybe through its ability to reduce the serum glucose and AGEs، and antioxidant ac-tivity. Considering the positive effects of myoinositol in diabetic complications in previous studies، more studies are needed to find the mechanism of its action.

Introduction & The Modified Modified Ashworth Scale (MMAS) is a clinical meas-ure that has been recently developed for the assessment of muscle spasticity. There is a dearth of research on the validity of the MMAS. The aim of the present study was to investi-gate the relationship between the MMAS and the biomechanical measure of work-velocity slope in assessing knee extensor muscle spasticity in patients with hemiparesia. Fourteen patients with post-stroke hemiparesia were included in this cross sectional study. Knee extensor spasticity was assessed with MMAS. An isokinetic dy-namometer was used to impose knee passive flexion with the angular velocity of 10، 30، 60، and 90 °/Sec to measure Torque-angle data. Work (Joule) was calculated at each velocity to determine the slope of the work-velocity curves as the biomechanical measure of muscle spasticity. The mean work decreased as the velocity increased but was not statistically signifi-cant (P = 0. 07). The mean slope was – 0. 35 [J / (°/Sec)]. There was no significant correlation between the MMAS and the work-velocity slope (r =0. 31، P = 0. 28). There was no significant relationship between the MMAS and the biomechanical measure of work-velocity slope. Further studies with larger sample size are suggested.

Introduction & Patients suffering from epilepsy can experience a wide range of neuropsychological disorders such as impaired memory، attention and information process-ing. The aim of the present study was to evaluate and compare the performance of neuropsy-chological epileptic patients according to their pharmacotherapy. In this retrospective causal- comparative study، 90 patients with idio-pathic grand mal epilepsy in three groups of 30 subjects taking drug valproate acid، car-bamazepine and combination lamotrigine (with carbamazepine or valproate) were selected in Hamadan clinics in 2012. 30 cases of normal subjects with an age range of 15 to 55 years were included (control group). The four groups of subjects were matched in age and educa-tion and were evaluated according to continuous performance tests، Benton visual retention test، and Paced Auditory Serial Addition Test (PASAT). The data was analyzed by SPSS software and Manova، Scheffe، Tamhane tests. The results show that the rate of PASAT in normal group was significantly higher than epilepsy group (P=0. 01)، but among the groups taking valproate acid، carbamazepine and combination lamotrigine (with carbamazepine or valproate) no significant difference was observed in the level of depression. In PASAT and Benton visual retention tests the results were similar. In continuous performance test n the scale of incorrect response the results were reversed and with regard to the correct response، the previous results were confirmed. On omission reply scale، the group which used combination lamotrigine and the normal group showed similar results، thus they were separated from the group using carbamazepine and valproate. On reaction time scale، patients taking carbamazepine significantly (P=0. 01) differed from patients taking amotrigine and valproate and from the normal group. There are significant differences between the AEDs as valporate، carbamazepine and combination therapy in terms of their neuropsychological profiles.

Introduction & Interleukine-1 receptor antagonist (IL-1RA) is a powerful anti-inflammatory cytokine which limits the biological effects of IL-1. Due to structural similarity between IL-1 and its antagonist، IL-1RA competitively binds to IL-1 receptor which leads to no signal transduction. Therefore، it is applied in the treatment of patients with inflammatory diseases such as Rheumatoid Arthritis. The aim of this study is cloning، expression and op-timization of IL-1RA in E. coli. In this experimental study synthetically prepared cDNA was amplified by PCR. After double digestion with NdeI and XhoI restriction enzymes، this gene was cloned in pET28a expression vector. Expression of desired gene was analyzed at RNA level by RT-PCR and at protein level by SDS-PAGE and followed by western blot to confirm SDS-PAGE results. Optimization of recombinant protein expression was performed in dif-ferent IPTG concentrations and harvesting times after induction. The presence of gene in pET28a was determined by colony-PCR and confirmed by restriction digestion. Transcription of cloned gene and expression of high yield recombinant protein were shown by RT-PCR and SDS-PAGE، respectively. The result of SDS-PAGE was confirmed by western blot. Expression was optimized in different induction time and IPTG concentrations The result of this study demonstrated expression of this recombinant protein at high level in E. coli system by pET28a expression vector. This study also showed a direct as-sociation between the increased level of expression and time of induction. Therefore، an overnight induction time with 0. 1 mM IPTG concentration is recommended for a high level expression.

Introduction & Peripheral nerve injury is common in trauma patients and 4. 5% of all soft-tissue injuries are accompanied by defects of peripheral nerve. Peripheral nerve injuries can lead to lifetime loss of function and permanent disfigurement. Designed conduits com-prised of natural and synthetic materials are now widely used in the construction of damaged tissues. The aim of this project was to prepare nanocomposite conduits from gelatin and bioglass for damaged peripheral nerve reconstruction. In this experimental study،compound water solution of gelatin and nano bioglass synthesized through sol gel method، was made. After preparing the solution، special mandrels were dipped in solution several times and freeze dried in order to be emptied of wa-ter via sublimation. The conduits had the following dimensions: internal diameter: 1. 6 mm، outside diameter: 2. 2 mm and length about 12 mm. In order to evaluate the biocompatibility of conduits we used cytotoxicity test by Chinese ovary cells and MTT assay by Miapaca-2 (pancreatic cancer cell line). The prepared nano bioglass and conduits were characterized using transmission elec-tron microscopy، scanning electron microscopy، fourier transformed infrared spectroscopy and X-ray diffraction. Results of biocompatibility test showed no sign of cytotoxicity and cells were found to be attached to the pore walls offered by the conduits. According to the results، nano bioglass conduits could be a good candidate for peripheral nerve regeneration.

Brucellosis is a common zoonotic disease which has a wide spectrum of clinical manifestations and complications in humans. Brucellosis is an endemic disease in Iran، and vein thrombosis is a rare complication of acute brucellosis. Case Report: A 58-year old woman admitted to the infectious diseases ward in Farshchian hospital had fever and severe headache beginning 15 days before admission. Moreover، she complained from fatigue، malaise، anorexia، skin lesions around the nose and cervical lym-phadenopathy. Sonogarphy of cervical soft tissues of the patient showed right internal jugu-lar vein thrombosis and numerous cervical lymphadenopathy in the right posteriocervical tri-angle. Doppler sonography of the cervical vessels of the patient showed thrombosis of the middle right internal jugular vein. The blood culture isolates were small gram-negative aero-bic coccobacilli in two separate cultures. Serologic tests of Wright، 2ME and IgG ELISA were positive in the patient. The patient was treated with doxycycline، rifampin and warfarin، and she improved completely after a 5 month follow-up. We should consider brucellosis in the patients with rare manifestations of brucel-losis such as vascular thrombosis in endemic areas because early diagnosis and treatment of the patients can decrease its complications and mortality rate.

Neurofibromatosis type 2 is an inherited autosomal dominant syndrome، charac-terized by multiple neoplasms of the central and peripheral nervous system associated with ocular abnormalities. The most common tumor associated with the disease is the vestibulo-cochlear and in later stages are meningioma and other brain tumors. Case Report: The patient was a 35 year old woman admitted to the Farshchian hospital in Hamadan due to unconciousness and respiratory distress She had sensorineural hearing loss and inability to see due to decrease visulal acuity. In addition، due to lower extremity paresis she has been unable to walk and wheelchair-dependent for many years. Brain CT scan and MRI showed multiple tumors in the posterior fossa causing obstructive hydrocephalus even-tually caused the patient''s death. Brain tumors، especially in the posterior fossa can cause death in Neurofibroma-tosis type 2. Early surgery can be life saving.