مجله پزشکی بالینی ابن سینا
سال بیست و چهارم شماره 2 (پیاپی 84، تابستان 1396)

Coronary artery bypass surgery is still a selective treatment for patients with a severe coronary artery disease all over the world. It has been tried to perform actions before and after the surgery to increase the survival rate and the quality of life of the patients. The aim of this study was to compare heart rate recovery changes before and after cardiac rehabilitation in these patients.
This clinical trial study was conducted on 70 patients with coronary artery bypass surgery. For all patients, 12 rehabilitation sessions were considered. Before the beginning and after finishing the recovery and rehabilitation sessions, patients were evaluated using the exercise-stress test by the standard Bruce method and the amounts of heart rate recovery (HRR) were calculated before and after the sessions. Data were analyzed using descriptive statistics and paired t-test with the SPSS 19 software.
The mean HRR among the patients before the recovery was 21.01 ± 7.74 and after the recovery was 25.53 ± 7.62 (P = 0.000). The mean HRR among the patients with normal left ventricular (LV) function before the recovery was 22.33 ± 7.42 and after it was 25.17 ± 6.59. Also, the mean HRR in patients with mild LV dysfunction before the recovery was 20.23 ± 8.48 and after it was 24.85 ± 8.02 and the mean HRR in patients with moderate LV dysfunction before the recovery was 20.84 ± 3.87 and after it was 30.67 ± 8.41.
The results showed that the mean HRR after the recovery significantly increased compared to before the recovery.

Urinary calculi is the second common chronic renal disease. Todays, the extracorporeal shock wave lithotripsy (ESWL) is the most common method of treatment of kidney calculi, though this method was invented 30 years ago. This study was conducted to compare the effects of oral diclofenac sodium versus acetaminophen codein on pain during ESWL.
After signing informed consent, 90 patients with urinary calculi were randomly allocated into three equal groups (n = 30). In this study, one hour before the ESWL, 30 patients received the acetaminophen codeine (acetaminophen 650 mg plus codeine 20 mg) orally and 30 patients received diclofenac sodium 50 mg orally and 30 patients did not receive any drug. Severity of pain was assessed by the four-point scale during the procedure.
The results of our study showed that there was no statistically significant difference among the three groups regarding gender, weight, age, overall satisfaction, and pain severity during ESWL. Although morphine consumption and pain severity in groups of acetaminophen codeine and diclofenac sodium was lower than in the third group, this different was not statistically significant (P = 0.086).
Oral prescription of acetaminophen codeine and diclofenac sodium, one hour before ESWL, has a similar effect on pain management.

Brucellosis is an endemic zoonosis in Iran. There are some reports regarding brucellosis infection in family members sharing the same risk factors and remain unrecognized. The aim of this study was to screen household members of index cases with brucellosis for detecting additional unrecognized cases in Hamedan, Iran.
Two-hundred and thirty family members of brucellosis index cases were enrolled in the study. The standard tube agglutination test (STA), Coomb's wright, and 2-mercaptoethanol (2ME) agglutination were checked in all the samples. A case with STA titer ≥ 1:80, 2-mercaptoethanol (2ME) agglutination ≥ 40 and compatible signs and symptoms was considered positive for brucellosis. A questionnaire containing demographic characteristics, previous history and risk factors for brucellosis, and symptoms and signs of brucellosis was completed for each subject. Data were analyzed using the SPSS 17 software.
Forty-eight (20.8%) of the family members were seropositive for brucella agglutinin and most of them (31 cases) were symptomatic. The most common symptoms were backache (41.7%), fatigue (41.7%), and arthralgia (39.6%). Significant differences were found between seropositivity and a previous history of brucellosis, contact with livestock, and clinical findings. All symptomatic seropositive cases were treated for brucella infection and recovered without any complications.
According to the results of the present study, family members of brucellosis patients are at risk of disease acquisition, and screening of household members provides an effective way for early diagnosis and prompt treatment. However, cost benefit of screening should be evaluated to reach definite decision for the implementation of the screening as a nationwide program.

Retinopathy is one of the most important complications of diabetes mellitus that results from chronic hypeglycemia, oxidative stress and inflammation. Tumor necrosis factor-beta2 (TGF-β2) is an important factor in the inflammation pathway due to hyperglycemia. Garlic is one of the most frequently used plants in Iranian diets that has hypoglycemic and antioxidant propertis. So, this study aimed to examine the effects of aqueous garlic extract on TGF-β2 gene and protein expression in retinal tissues of type 1 diabetic rats.
In this experimental study, 24 male Wistar rats were divided into four groups (n = 6) including control rats, type 1 diabetic rats, type 1 diabetic rats treated with the garlic extract and garlic control. To induce diabets type 1, streptozotocin (STZ, 65 mg/kg) was used. Seven days after the STZ injection, the glucose level was measured by a glucometer. at the end of the treatment period(30 days, gavage of the garlic extract (1mL/100g)), the serum sample was isolated and stored in -20ºC for determination of the glucose level. Also, the rat's eyes were removed and their retial tissues separated quickly and stored in -70ºC for gene expression evaluation and protein assay. To determine the gene expression level, RNA extraction, cDNA synthesis and real-time polymerase chain reaction were performed. The TGF-β2 protein level was also measured by the ELISA kit.
The TGF-β2 mRNA expression was increased 1.37 fold in diabetic rats compared to control rats and decreased 1.96 fold in garlic-treated diabetic rats compared to untreated diabetic rats. The TGF-β2 protein level was increased 3.08 fold in diabetic rats compared to control rats and decreased 2.56 fold in garlic-treated diabetic rats compared to untreated diabetic rats.
Garlic extract significantly decreased the TGF-β2 level in retinal tissues of diabetic rats. The TGF-β2 is an important factor in inflammation and damage to retinal; so, it is logical that garlic consumption can reduce diabetes complications by decreasing this factor.

Enhanced oxidative stress and changes in antioxidant capacity are considered to play an important role in the pathogenesis of chronic diabetes mellitus. Vitamin E and astaxanthin are strong antioxidants and it has shown to reduce oxidative stress. This study aimed to investigate the effects of vitamin E and astaxanthin on histological structure of prostate, seminal vesicle and epididymis in diabetic rats.
In this experimental study, 28 adult male Wistar rats were divided into four groups. The control group received soybean oil, diabetic group received soybean oil, the treated diabetic group received vitamin E and treated diabetic group received astaxanthin. To induce diabetes, 55 mg/kg streptozotocin (STZ) was injected intraperitonealy. The diabetic-treated group received 0.72 mg/kg vitamin E and 720 mg/kg astaxanthin for 50 days, respectively. The prostate, seminal vesicle and epididymis were studied after the histological procedure and hematoxylin and eosin staining.
The height of glandular epithelium was decreased in the diabetic group compared to the control (P 0.05). In the epididymis, the height of epithelium was increased in the diabetic group compared to the control (P > 0.05) and decreased in the treated groups. The diameter of tubules was decreased in the diabetic group and increased significantly after treatment with astaxanthin. In the seminal vesicle, the height of epithelium and diameter of nucleus were decreased in the diabetic group compared to the control (P > 0.05). Also, vitamin E and astaxanthin-treated groups showed decrease in these parameters (P Vitamin E and astaxanthin can improve histological changes in prostate and epididymis in diabetic rats.

Insects as the largest category of arthropods include numerous groups and families that the most important of them belong to order Diptera, family Culicidae. Because of feeding on the human's blood, a number of species of this family have been known as responsible for the transmission of pathogens for many diseases such as malaria, filariasis, encephalitis, yellow fever and dengue fever in the world. Given that no research has been conducted to determine the fauna of existing mosquitoes in the city of Poldokhtar, Lorestan Province, the present study aimed to exactly determine the mosquitoe's fauna in this city to perform appropriate prevention measures.
In this faunistic and cross-sectional descriptive study, four urban areas and four rural areas in four geographic directions in the city of Poldokhtar were determined. In each urban area, two places and in each designated rural area, four places including two human places and two animal places were selected. From the early of April 2015 to the early of January 2016, larvae, pupae and adult mosquitoes of the Culicidae family were collected. Sampling methods for larvae, pupae and mature were ladling, night catch, total and hand catch with an aspirator. Characteristics including the name of the collector, date of collection, code related to habitat, habitat status (permanent or temporary), type of vegetation cover, type of substrate, and the situation of sunlight were recorded in the related form. The samples were identified by resources and valid identification keys. The data were analyzed using the SPSS software version 19.
Totally, 5392 mosquito adults of the Culicidae family including 1818 mosquito adults and 3574 larvae in designated areas in the city as well as four rural areas were collected. The three genera Anopheles (21.9%), Culex (64.6%), and Culiseta (13.5%) were diagnosed. Also, from three genera, 12 species were identified as follows: Culex theiler, Cx. mimeticus, Cx. perexiguus, Cx. hortensis, Cx. pipiens, Cx. sitiens, Cx. tritaeniorhynchus, Culiseta langiareolata, Anopheles superpictus An. stephensi, An. turkhudi and An. dthali.Culex pipiens (19.9.5%) and Culex theileri (19.5%) were the most abundant species, respectively.
The results of this study indicate the presence of various species of mosquitoes throughout the city of Poldokhtar. Also, the results can lay the groundwork for doing more comprehensive and special studies particularly regarding the possible role of different species of mosquitoes in human and animal health in the future.

The tissue reaction to stitch strings used in the intraoral surgery that can aggravate inflammation is an important issue. This study aimed to compare the tissue reaction formed around three types of stitches, including Demesilk (Demetech corporation,USA) that is not produced inside the country, Pedsilk and Suture, which all are natural nonabsorbable, on rats.
In this experimental study, 12 male rats with an approximate weight of 250 g were selected and divided into two equal groups. After anesthesia, the back hair of the animals was shaved and all three types of stitch strings were used differently in each sample. The first type of stitch was Pedsilk, the second type Suture, and the third one was Demesilk. In certain days (the second and seventh days), one group of the rats were sacrificed with a certain amount of fatal ketamine and all three types of stitch strings were removed separately and transmitted to laboratory and compared regarding inflammation, granulation and fibrosis formation. The data were analyzed using the Friedman and Wilcoxon tests with the SPPS software.
Statistical assessment carried out in all three types showed a significant difference among the strings in most cases. The manner of Pedsilk and Demesilk with regard to inflammation was similar in which the possibility of inflammation increased as the time passed and this possibility decreased in the Suture. The manner of both Pedsilk and Demesilk regarding the granulation tissue was similar in which the possibility of the formation of the tissue did not have a remarkable decrease as the time passed. In Suture, this possibility decreased remarkably. The manner of all three strings, Suture, Pedsilk and Demesilk, increased significantly regarding fibrosis tissue formation as the time passed (P The common use of stitch strings in intraoral surgeries and the fact that a stitch string is considered as an external body in a wound zone increases the risk of infection and inflammation in Demesilk and Pedsilk, but this possibility decreases in the Suture type. As a result, after the surgery, the use of the Suture in covering the surgery zone is supposed to be the most important factor in amending the tissue and the success of the surgery.

Textile industries, due to a high volume of wastewater and harmful environmental factors such as a variety of dyes, are significant industries in industrial wastewaters treatment. So, the aim of this study was to examine the efficiency of dye removal from the textile industry wastewater using the titanium dioxide photocatalytic process under UV-LED light irradiation (UV-LED/TiO2) in the treatment of the Nakh Rang factory wastewater in Hamadan City, Iran.
In this experimental study, in every experiment, 100 mL sample was placed inside the LED reactor to expose to the UV light and TiO2. The effects of some parameters such as contact time, pH and dosage of TiO2 were examined, and decomposition kinetics and the synergistic effects were also determined for each process.
The results of the experiments showed that the UV-LED/TiO2 process can remove the dye from textile wastewater with the efficiency of 80.23% and can also remove the chemical oxygen demand (COD) with the efficiency of 64.75% under the optimum conditions and during 120 minutes. Also, the reaction of dye decomposition in this wastewater was a first-order kinetic function.
The results of this study show that the UV-LED/TiO2 can be used effectively to remove the dye and reduce the COD of the textile industry wastewater under optimal operating conditions.

Adenotonsillectomy is one of the most common surgeries in children, which may be associated with a risk of recurrence of the related symptoms. The aim of this study was to determine the prevalence and possible predisposing and associated factors of adenoid regrowth in children under 15 years old in Besat Hospital in Hamadan.
In this analytic-descriptive study, all the patients less than 15 years old who underwent adenoidectomy or adenotonsillectomy in Besat Hospital in Hamadan City between 2010 and 2016 were reviewed. The charts of the patients underwent revision adenoidectomy were evaluated and their demographic data, clinical findings such as recurrence symptoms, history of allergy, reflux, and the time interval between the first and second surgeries, and the predisposing and associated factors of adenoid hypertrophy recurrence were recorded. The data were analyzed using descriptive statistics with SPSS 16 software.
From a total of 2787 patients with adenoidectomy (2571 cases with adenotonsillectomy), 37 cases (1.3%) underwent revision adenoidectomy. Of 37 revision adenoidectomies, 48.65% were in females and 51.35% e in males. The mean age at the primary adenoidectomy was 5.16 and at the secondary (revision) adenoidectomy was 9.04 years. The mean of interval was 3.87 years between the surgeries. Also, 27% of the patients were passive smoker, 18.9% had a history of reflux and 10.8% had a history of allergic rhinitis. The most common chief complaints of the adenoid regrowth were snoring (35.1%) and mouth breathing (25.9%).
According to the results of the present study, adenoid re-growth in children under 15 years is not common (1.3%) and the predisposing factors of adenoid hypertrophy recurrence were passive smoking, reflux and allergic rhinitis, respectively. It is recommended that nasopharyngeal endoscopy be performed after the adenoid surgery.

Type 2 diabetes mellitus, due to its high incidence and mortality rates, is a major health problem around the world. Also, the type II diabetes is a type of metabolic disorder characterized by increased blood glucose, which is due to insulin resistance, insulin deficiency, or both. The current study aimed to assess the mean platelet volume (MPV) in type 2 diabetes patients compared to nondiabetics, and determine the correlation between MPV and fasting blood glucose, glycosylated hemoglobin (HbA1c).
This case-control study was conducted on all patients (n = 120) diagnosed with diabetes referred to the clinical laboratory of Besat Hospital in Hamadan City, Iran, during 2015-2016. The patients were divided into the two groups of case and control (n = 60, each group). The mean platelet volume was measured by an automated blood cell counter. The blood glucose and HbA1c levels were also measured in both groups. Data were analyzed using the Chi-square, t test and Mann-Whitney tests with the SPSS software version 16. The significance level was equal to 0.05.
The mean age of the control group was 41.78 years and that of the case group was 41.58 years. The mean platelet volume was 8.42% in the case group and 7.74% in the control group, which showed a significant difference between the two groups (P = 0.001). The mean platelet volume in people with HbA1c less than 7 in the case group was less than those who had HbA1c more than 7 and this difference was statistically significant (P = 0.001).
The mean platelet volume in diabetic patients was significantly higher than in the nondiabetic group. So, it seems that the elevated MPV can be used as a parameter for the diagnosis of vascular complications of diabetes.

Fasciola is a zoonotic helminth. The study of Fasciola spp. distribution seems necessary for implementation of control programs in endemic areas. The aim of this study was to identify the prevalence and intensity of Fasciola spp. in the slaughtered livestock of Hamadan slaughterhouse.
This cross-sectional descriptive study was performed in 2015. A total of 13607 slaughtered livestock were inspected and Fasciola infected livers were collected and transferred to the Parasitology Laboratory of Hamadan University of Medical Sciences. Finally, the prevalence rate and intensity of the Fasciola spp. were determined and data were analyzed using the Chi-square test with the SPSS software.
From the 13607 studied livestock, 10846 were sheep, 995 were cattle and 1766 were goats. The overall prevalence of the infection was 0.74%. The prevalence of cattle infection to Fasciola spp. was 1.5%, followed by goats 1.4% and sheep 0.5%. The intensity of infection in cattle was 22.07 ± 26.13, in goats was 17.32 ± 15.22 and in the sheep was 7.62 ± 11.29.
The prevalence of Fasciola in Hamadan is lower than that of the previous study in this area and some studies in the country, but the intensity of infection is high. The present study showed a relatively low enzootic of animal fasciolosis in Hamadan Province. Therefore, because the human fascioliasis has been recognized as an endemic problem in the neighboring provinces, a comprehensive community-based research should be planned to identify the situation of the disease in human population in this region.

Angiolymphoid hyperplasia with eosinophilia (ALHE) or epithelioid hyperplasia is an uncommon condition due to benign proliferation of dermal and subdermal vessels. It is most commonly seen in young to middle-age females. Skin lesions include single or multiple red papules, plaques and nodules. It most commonly involves head and neck. Its etiology has not been determined. The ALHE lesions are usually resistant to commonly suggested treatment methods including surgery. Recurrence of treated lesions is also common.
Herein, we report a 39-year-old woman who presented with multiple red papules and nodules on her forearm, hand and nail bed.
Condition and extension of lesions in this case is very significant. Her lesions were confirmed to be ALHE after histopathological assessment.