مجله پزشکی بالینی ابن سینا
سال بیست و چهارم شماره 1 (پیاپی 83، بهار 1396)

Tonsillectomy is one of the most common procedures performed by otolaryngologists. Intraoperative bleeding is a significant problem, which requires hemostasis and causes prolonged operative time. Several different techniques are used to perform this operation. The Ligasure Vessel Sealing System (LVSST) has been widely used in head and neck surgery because of its effectiveness and safety.
This project was conducted at the department of otolaryngology of Besat Hospital, Hamadan, Iran. In this double-blinded clinical trial, 82 subjects, who were candidates for tonsillectomy and qualified in eligible criteria, were randomly assigned to 2 group of 41 subjects. Surgery was performed using Lvsst for one group and cold knife dissection for the other group. Measured outcomes for efficacy and adverse effect were intraoperative blood loss, operation time, post-operative pain in visual analogue scale, and post-operative bleeding for28 days after surgery. The SPSS 16 software was used for data analysis.
Method of LVSST was significantly better than CKT in operation time and bleeding on the first day after surgery, yet, postoperative blood loss in the first week after surgery in LVSST group was significantly higher than the CKT group. Severity of sore throat after surgery with Ligasure was higher than CKT the group, however the difference was not significant. Intraoperative bleeding in the LVSST group was significantly lower than that of the CKT group (P = 0.000).
The results of this study showed that the prevalence of respiratory symptoms LVSST was better than CKT in intraoperative (not post-operative) blood loss and operation time, yet there was no difference regarding postoperative pain. For workers with a history of allergies, this ratio is higher.

Gastric cancer is a multifactorial disease and the fourth most common cancer in the world and the second cause of death from cancer. This study was designed and performed to investigate CDH1 and RUNX3 genes expression in healthy and tumor marginal tissue of people with gastric cancer.
In this case-control study, 64 samples including 32 samples of gastric tumor tissue and 32 samples of normal tissue from the patient's were prepared. Next, RNA was extracted from tissue and cDNA was made. Finally, using Real Time Polymerase Chain Reaction (PCR), gene expression measurements were also performed for CDH1 and RUNX3. Paired t test was used for data analysis.
Overall, in 87.5% of patients with gastric cancer, CDH1 margin dropped to 7.35 in tumor tissue compared to healthy tissue gene expression, and in 90% of patients, RUNX3 gene expression was reduced by as much as 46.5 times. Significant differences were found between normal and cancerous cells of these patients.
Given the role of RUNX3 gene, CDH1 and decreased expression of tumor suppressor genes as they are significantly in tumor tissue of patients with gastric cancer is justified.

During the recent years, vitamin D deficiency was determined as a risk factor for cardiovascular diseases. The purpose of this study was to evaluate the association of vitamin D with ischemic heart disease in the city of Hamadan.
A case control-study was performed with 72 patients with ischemic heart disease, which had been confirmed by angiography in the case group. Vitamin D levels were measured in 74 patients with no disease in the control group. The results were analyzed by the SPSS-21 software and statistical tests.
Overall, 31.9% of the patient group and 24.6% of the control group had deficiency of vitamin D (P = 0.04). After adjustment of all risk factors, the risk of ischemic heart disease in patients with deficiency was 2.047 times more than those with enough vitamin D (P = 0.05).
Vitamin D deficiency could be considered as a risk factor for ischemic heart disease, however more studies need to be done to confirm this relationship.

Acne is one of the most common diseases in dermatology. It has been claimed that acne and weight gain are clinical markers of hyperandrogenism, and it seems that obesity is associated with increased responsiveness to androgenic hormones and acne severity. This investigation may aid in finding the possible relationship between severity of acne and Body Mass Index (BMI) in order to improve the management of acne patients.
This was a case-control study. After signing a consent form, 220 individuals that had referred to the outpatient clinic of dermatology of Hamadan Farshchian Hospital were recruited. All of the participants in the study population were females. There were a total of 110 patients with acne serving as the case group and 110 females, without acne as the control group. Two groups were age-matched and compared with respect to BMI.
There was a significant relationship between weight and acne )P = 0.001), yet no correlation was found between acne severity and BMI )P = 0.348).
This study showed that acne and weight are related. Since overweight and metabolic syndrome is associated with higher risk of cardiovascular disease and diabetes, identification and treatment of obesity in these patients is essential. Therefore, it could be suggested that control of obesity and metabolic syndrome may also improve management of acne patients.

Chronic renal disease compromises of several renal involvements and several causative risk factors such as debates mellitus, hypertension, and old age. Ocular involvement seems to be related to chronic renal failure and hemodialysis as indicated by different studies. The aim of this study was the evaluation of prevalence of ocular manifestation in hemodialysis patients of Hamadan Besat hospital.
This research was a cross sectional descriptive study, in which ocular signs in 74 hemodialysis patients, who referred to Besat hospital of Hamadan, Iran, during year 2015, were evaluated. Collected information related to patients included age, gender, dialysis duration, and background risk factors of chronic renal failure. All patients had been exanimated by an ophthalmologist.
Fifty percent of patients in the study were male and 50% were female. Average age of patients was 58.8 years and median duration of dialysis was 40.16 months. Mean visual acuity was 4.58 (of 10). Most common ocular manifestations were: macula abnormality (59.5%), cataract (56.7%), eye pain (56.7%), eye redness (52.7%), dry eyes (50%), and eyelid edema (43.2%), respectively.
Hypertension and diabetes mellitus are the most common causes of chronic renal failure. The most common ocular manifestations were macular abnormality followed by cataract. According to high prevalence of these complications in hemodialysis patients, regular monitoring of patients for early detection and thus effective treatment seems to be necessary to improve their quality of life.

Since preserving the structure of treated teeth is a critical success factor, studying the effects of tooth structure loss on fracture resistance of the tooth tissue appears necessary. The aim of this study was to evaluate the consequences of the loss of different tissues regarding fracture resistance of teeth undergoing root canal treatment without the use of indirect restorations.
In this experimental study, 70 healthy maxillary first premolar teeth were randomly divided into 7 groups of 10 members, including control group, endodontic access preparation only, MOD cavity preparation, cutting buccal cusp, cutting palatal cusp, cutting buccal cusp and marginal ridge, and cutting the palatal cusp and marginal ridge. The coronal section of teeth was restored incrementally with light cure composite. Finally, samples underwent compressive load with 45˚ angle from each cusp slope in the middle of cusp with an instant speed of 1 mm per min in the Instron machine. Fracture resistance was measured and samples were examined under stereo-microscope to evaluate the mode of failure.
The resistance to fracture in root canal treated teeth in different groups in order from first to seventh was 797.13 ± 52.92, 722.50 ± 131.40, 432.15 ± 203.20, 592.66 ± 195.86 124.53 ± 33.09, 85.17 ± 18.45, and 26.03 ± 5.21 Newton. ANOVA test showed statistically significant differences between the groups in terms of their fracture resistance (P = 0.000).
The results showed that fracture resistance levels of teeth were significantly affected by amount of their tissue loss. In this study, removal of teeth palatal cusp and marginal ridge had a significant effect on decreasing the fracture resistance, while removing the buccal cusps alone cannot have a significant effect.

Research shows a relationship between diabetes (type II) and obesity. Bioelectrical Impedance Analysis (BIA) is a relatively new and approved method for the measurement of body composition. The aim of this study was to compare diabetic and non-diabetic adults on the basis of waist-hip ratio, total fat, percentage of fat, trunk fat, and soft lean mass.
In this cross-sectional descriptive study, from a population of 23,395 adults, 928 diabetics (type II) were selected and matched with 928 healthy adults on the basis of age, gender, height, and weight. The analysis of data was performed by paired test and correlated samples t-test.
The comparison of males in all age groups, females less than 40, and females more than 60 years old showed no statistically significant difference on the basis of all outcome measures. In females between 40 and 60 years of age, fat percentile and trunk fat were less and soft lean mass was more observed among diabetics compared to non-diabetics, and the differences were statistically significant. The waist-hip ratio was less among diabetic females in the 50-60 age group compared with the matched non-diabetics.
Diabetes is not related to male body composition, but is related to the body composition of females between 40 and 60 years of age, which can be due to the effects of diabetes on hormone glands during the menopause age. Among diabetic females between 50 and 60 years of age, a decrease in the waist-hip ratio can be due to the decrease in total fat and trunk fat.

Campylobacter jejuni is one of the most common causes of food poising in humans. Rapid and specific detection of these bacteria has an important role in diagnosis and treatment of infection. The aim of this study was to design a specific PCR for the detection of Campylobacter jejuni.
In this experimental study, oxidoreductase gene from the Campylobacter jejuni was selected for rapid and specific detection. For this purpose, specific primers were designed and charecterized by bioinformatics software. Bacterial genome was extracted by phenol-chloroform method and PCR was optimized to obtain a specific product. Specificity of the designed reaction was investigated using six bacterial species. The sensitivity of the PCR reaction was calculated by the serial dilutions method.
The designed primer was specific to oxidoreductase gene of Campylobacter jejuni and after optimization, a unique 167-bp band was amplified. This primer was specific to Campylobacter jejuni and did not show any cross reaction with other bacterial genomes. The detection limit of this reaction was 5 pg of genomic DNA.
The optimized PCR used in this study was a rapid, sensitive, and specific method for detection of Campylobacter jejuni. For confirmation of this method, detection of C. jejuni from food samples is proposed.

Hyperlipidemia is one of the most common chronic diseases found in millions of people. Studies have shown that the patient’s adherences to medication instructions provided by the pharmacist or doctor are important, yet unfortunately many patients do not adhere to proper usage of these drugs. The aim of this study was the evaluation of the effect of education by pharmacists for hyperlipidemic patients treated with statins on patient beliefs about the proper use of medications and compliance.
In this interventional clinical trial study, the studied population was all hospitalized patients with heart disease treated with statins at Hamadan Farshchian hospital from January 2016 to June 2016. The sample size in this study was 50. Information was obtained in relation to each patient, using 2 questionnaires including demographic characteristics and beliefs questionnaire. Data were analyzed using the SPSS.19 software and t test, Mann-Whitney, and X2 tests. Significance level was considered less than 0.05
Statistical test results showed that before the intervention, treatment belief was not significantly different between the 2 groups (P = 0.54), yet after the intervention the treatment belief increased in the intervention group (P = 0.007) and concern about using the drug declined.
These findings suggest that education by pharmacists in patients with hyperlipidemia could have a positive and effective role on their belief about the proper use of drugs. In other words, it could have a role in the control of chronic diseases and could help promote public health.

Chlorination is the most common and successful method for disinfection of drinking water, especially in developing countries. However, due to the probability of formation of disinfection by-products especially Trihalomethanes (THMs) that are known as hazardous and usually carcinogenic compounds, this study was conducted to assess the investigation of THMs in drinking water of Abbas Abad water treatment plant in 2015.
In this study, 81 water samples were gathered during autumn season of 2015. Temperature, pH, Ec, turbidity, and residual chlorine were measured on site. After samples preparation in the laboratory, THMs concentrations were determined using gas chromatography. All statistical analyses were performed using the SPSS statistical package.
The results showed that the minimum and maximum mean concentrations (µg/l) for bromodichloromethane were 1.47 ± 0.57 and 1.90 ± 0.26, for bromoform were 1.47 ± 0.35 and 2.36 ± 1.10, for dibromochloromethane were 1.47 ± 0.42 and 1.53 ± 0.55, and for chloroform were 3.40 ± 0.70 and 7.53 ± 1.00, and all compounds were determined for stations 1 and 3, respectively. Also comparing the mean concentrations of assessed THMs with ISIRI and World Health Organization (WHO) Maximum Permissible Limits (MPL) showed significant differences (P Although the mean concentrations of THMs were lower than MPL, yet due to discharge of restaurants and gardens’ wastewater into the Abbas Abad River, pre-chlorination process of water in Abbas Abad water treatment plant, high retention time and increasing loss of foliage into the water, especially in autumn season, the formation of Trihalomethanes compounds could increase. Therefore, periodic monitoring of THMs in drinking water distribution network is recommended.

Amphetamine and methamphetamine are man-made materials. They were only used as drugs at the beginning, but gradually outspreaded as psychedelics because of their sympathomimetic effects. Different studies have shown that the frequency of amphetamine and methamphetamine abuse has been increasing; also, there is a close relationship in amphetamine and methamphetamine abuse with psychiatric disorders. Therefore, this study aimed to investigate the frequency of amphetamine and methamphetamine abuse in psychiatric inpatients and evaluate the effects of different factors on that.
In this cross-sectional-descriptive study, 2543 patients were admitted to the psychiatric ward of Hamadan Farshchian hospital in 2013; in order to evaluate amphetamine and methamphetamine abuse, they were enrolled. For detection of amphetamine and methamphetamine, urine test using immunochemical and chromatographic methods was conducted.
The frequency of amphetamine and methamphetamine abuse in psychiatric inpatients was 7.3% (186 cases). Most of the abusers were male (87%), young (mean age: 36 years) and married (60%). However, there was no significant association between age, gender, marital status and frequency of abuse (P > 0.05). Half of abusers were unemployed and 67% of them did not have high school diploma. The most important psychiatric disorder among the abusers of these two substances was bipolar mood disorder (65.1%). Moreover, in this study, there was no significant association between amphetamine and methamphetamine test results (P > 0.05).
The results showed that the frequency of amphetamine and methamphetamine abuse in psychiatric patients was more than other people and patients with mood disorders were at a greater risk. Furthermore, this study indicated that the prevalence of abuse of these substances among females has increased compared to previous studies.

Pulmonary fungus ball is a rare complication in pre-existing pulmonary cavitary lesions, due to some chronic pulmonary diseases including tuberculosis, lung abscess and sarcoidosis. Fungus ball is mostly caused by aspergillus. In many patients, fungus ball is asymptomatic, but in a significant number of them it can develop cough and hemoptysis, which may be massive and fatal. The cornerstone of assessment is chest imaging, along with sputum culture or aspergillus antibody in patient's serum. The purpose of this report is increment in attention to this complication in patients with previous pulmonary tuberculosis (TB).
The patient was a 23-year-old woman with chief complaint of fever, cough and hemoptysis, who was hospitalized in the Infectious Diseases Ward of Farshchian Sina hospital in March 2016. She had a history of anti-TB therapy from two years before. Sputum and bronchoalveolar lavage (BAL) were negative for cytology and Mycobacterium tuberculosis, but cultures of both samples were positive for Aspergillus niger. Her lung contrast-enhanced computerized tomography (CECT) scan revealed the presence of a fungus ball inside the upper lobe cavity of right lung. After lobectomy, fungal mass was confirmed by histopathology.
In patients with pulmonary complaints (especially hemoptysis) and history of cavitary pulmonary tuberculosis, the differential diagnosis of community-acquired pneumonia, lung abscess, reactivation of tuberculosis and lung cancer as well as fungal infections should be considered