مجله پزشکی بالینی ابن سینا
سال بیست و دوم شماره 4 (پیاپی 78، زمستان 1394)

Introduction & The main indication of mechanical ventilation is in the treatment of neonates with respiratory failure. With the increased use of mechanical ventilation, its complications have increased too. The aim of this study was to evaluate the prevalence of complications and short-term improvement in infants undergoing mechanical ventilation in the neonatal intensive care unit (NICU). In this prospective-analytic study, all infants requiring mechanical ventilation and admitted in the neonatal intensive care unit of Fatemiyeh and Be’sat hospitals, have been evaluated for one year (2012). Their data included: neonatal age, sex, gestational age, birth weight, weight at admission, diagnosis, length of hospitalization, disease outcome (improvement-died), need for mechanical ventilation, complications and culture results (blood, endotracheal tube, urine, CSF) insert in check list. The data were analysed by SPSS and c2 statistical test. In this study, a total of 114 infants hospitalized in intensive care unit and needed mechanical ventilation was studied of whom 72 were male and 42 were female. The mean of gestational age in the admitted neonates was 32.9 ± 0.85 weeks. The majority of neonates (80.70%) were undergoing mechanical ventilation with respiratory distress syndrome (RDS). 67% of neonates were suffering from complications of mechanical ventilation. The prevalent complication was seen in the neonates was narrowing or obstruction of the endotracheal tube (52.63%). 47.37% of infants died and respiratory distress syndrome was the common cause of death in these neonates (46.29%). In our study, there was significant relationship between resuscitation at birth (P=0.002), time required for mechanical ventilation (P=0.0000) and Apgar score (P=0.0000) and complications of mechanical ventilation. The results show that the high prevalence of pulmonary complications is associated with mechanical ventilation and decreasing the use of invasive methods of respiratory care and reduced complications can increase the survival rate of these infants.

Introduction & Sodium arsenite disturbs the differentiation of adult rat bone marrow mesenchymal stem cells (rMSCs) to Osteoblast through oxidative stress. We aimed to investigate the preventive effect of vitamin E, a strong antioxidant, in sodium arsenite toxicity on rMSCs differentiation to osteoblast. rMSCs were cultured in Dulbecco’s Modified Eagles Medium containing 15% Fetal Bovine Serum and divided into: control, sodium arsenite (20 nM), vitamin E (50 µM) and sodium arsenite + vitamin E for 21 days in the osteogenic media containing 10% of fetal bovine serum. Cell viability, bone matrix mineralization, intercellular and extracellular calcium, alkaline phosphatase activity, DNA damage and cell morphological changes were evaluated. Data were analyzed using one-way ANOVA and Tukey's test and means were considered significantly different at P<0.05. Cell viability, bone matrix mineralization, calcium deposition, alkaline phosphatase activity and nuclei diameter decreased significantly in the sodium arsenite group. The mentioned parameters increased significantly in cells treated with sodium arsenite + vitamin E to the control level (P<0.05). Cytoplasmic extensions were also observed in the vitamin E group. Vitamin E reduces sodium arsenite toxicity, increasing osteogenic differentiation in rMSCs.

Introduction & Diabetes mellitus is one of the most common chronic diseases in western developed countries and developing countries, whose prevalence is increasing worldwide. One of the vascular complications of diabetes is diabetic retinopathy. Given the prevalence of diabetic retinopathy and its complications in patients with type 2 diabetes, the aim of this study was to investigate the prevalence of retinopathy in diabetic patients and to determine the relationship between microalbuminuria and retinopathy in patients with type 2 diabetes in Hamadan. This study was a cross-sectional study in which 284 medical records of patients referred to the Diabetes Center of Hamadan were studied whose eye examinations were recorded and their laboratory tests have been measured at a laboratory center. Then, the data obtained from the average of experiments during the last year and examinations carried out were entered in the check list and the statistical results of the data were analyzed and the relationship between microalbuminuria and retinopathy was evaluated. In our study, 284 patients were studied. 154 (54.22%) of the patients in our study had retinopathy. In persons who had retinopathy, 36.36% of patients were with mild NPDR, 27.92% with moderate NPDR, 7.79% with severe NPDR and 27.92% had PDR. In our study, 32.04% of patients had microalbuminuria, and of these, 80.21% also had retinopathy. There was a significant relationship between retinopathy and microalbuminuria. The results of this study showed that the prevalence of retinopathy in our study is about 54 percent, which is relatively a higher prevalence than that in other similar studies. Also, due to the strong correlation between the presence of microalbuminuria and retinopathy and also duration of diabetes, a closer look at diabetic patients for microalbuminuria in periodic eye examinations is recommended.

Introduction & This finite elements study for the first time has investigated the pattern of strain distribution in bone around dental implants in one and two implant supported overdenture treatment planning in protrusive and laterusive movements, in order to choose the best plan biomechanically. To simulate the dental- implant and the bone, with Catia software, Jaws 3-D design was designed and 100 Newton forces were applied to dental implant models in protrusive and laterusive movements. In the design of one implant, the highest amount of strain was observed in laterusive movement in the third cervical and buccal (4097 &epsilonµ) and in the design of two implants the highest amount of strain in protrusive movement was observed in the apical third of the lingual surface of the bone around the implant (2435&epsilonµ) and in laterusive movement in the apical fifth of lingual and buccal surface of bone around the implant (1668 &epsilonµ). The results of this study revealed that the strain and stress in the single implant design is more than two implants design. These results suggest the use of single implants in patients with minimal chewing force and in occlusion with minimal lateral force.

Introduction & Cox model is a common method to estimate survival and validity of the results is dependent on the proportional hazards assumption. K- Nearest neighbor is a nonparametric method for survival probability in heterogeneous communities. The purpose of this study was to compare the performance of k- nearest neighbor method (K-NN) with Cox model. This retrospective cohort study was conducted in Hamadan Province, on 475 patients who had undergone kidney transplantation from 1994 to 2011. Data were extracted from patients’ medical records using a checklist. The duration of the time between kidney transplantation and rejection was considered as the surviv­al time. Cox model and k- nearest neighbor method were used for Data modeling. The prediction error Brier score was used to compare the performance models. Out of 475 transplantations, 55 episodes of rejection occurred. 5, 10 and 15 year survival rates of transplantation were 91.70 %, 84.90% and 74.50%, respectively. The number of neighborhood optimized using cross validation method was 45. Cumulative Brier score of k-NN algorithm for t=5, 10 and 15 years were 0.003, 0.006 and 0.007, respectively. Cumulative Brier of score Cox model for t=5, 10 and 15 years were 0.036, 0.058 and 0.058, respectively. Prediction error of k-NN algorithm for t=5, 10 and 15 years was less than Cox model that shows that the k-NN method outperforms. The results of this study show that the predictions of KNN has higher accuracy than the Cox model when sample sizes and the number of predictor variables are high.

Introduction & Dental caries is an infectious disease caused by colonization of Streptococcus mutans bacteria, which is begun by decalcification of non-organic part of teeth and continued with destruction of organic matrix. According to the incidence of relative resistance of biocide and also antibiotics in the normal micro flora of mouth specially viridians species and recent trends in the use of medicinal herbs to prevent and treat diseases due to fewer side effects, in this study, the MBC and MIC effect of hydro alcoholic extract of Mentha Piperita and NaCl on S. mutans in vitro were evaluated. In this experimental study hydro alcoholic extract has been prepared from Mentha Piperita with Maceration method (soaking in a solvent). After the preparation of the S. mutans strain standard and sterilization of hydro alcoholic extract by filtering, the antibacterial effects have been evaluated by Agar well diffusion, Agar disk diffusion and broth micro dilution methods (Concentration in the range of 0.78 - 800 micrograms per milliliter (µg/ml)). Meanwhile, the concentration range of sodium chloride 0.5 - 10 % was prepared and its effect on the test bacteria was determined. In Agar well diffusion method and Agar disk diffusion method the hydro alcoholic extract of Mentha Piperita and NaCl had no antibacterial effect on S. mutans. In broth micro dilution method, hydro alcoholic extract of Mentha Piperita had no antibacterial effect on S. mutans but the MIC and MBC of NaCl was 5% and 5.5%, respectively. Our results indicated that the hydro alcoholic extract of Mentha Piperita had not any antibacterial property against S. mutans but the most effective antibacterial concentration of NaCl was 5 - 5.5 percent.

Introduction & The aim of this study was todeterminetheamount of external apical root resorption(EARR)within two orthodontic appliances (standard edgewise and MBT).Material & Methods In this retrospective study, panoramic radiographs of 83 orthodontic patients (27 male and 56 female) were evaluated. 46 patients had been treated with standard edgewise appliance (29 patients with extraction and 17 patients without extraction) and 37 patients had been treated with MBT appliance (27 patients with extraction and 10 patients without extraction).EARR were evaluated in 24 teeth (anterior teeth, premolars and first molars) in each patient. SPSS software and ordinal regression test were used for statistical analysis. In this study the most EARR was seen in upper lateral incisors, then lower lateral incisors.EARR in upper canines and lower second premolars was significantly related to extraction of first premolarin MBT appliance. In non extraction cases, EARR was not related to the orthodontic appliance. Incisors teeth are the most disposed teeth to EARR. Orthodontic treatment with extraction increased EARR in canines and second premolars. MBT appliance may increase EARR.

Introduction & This study was conducted to evaluate the effect of early clinical exposure on medical students’ attitude toward their preparation for attending clinical setting. In an interventional before -after study, 52 fourth semester medical students studying at Hamadan University of medical sciences were enrolled in the study. The participants filled out a self-structured questionnaire before and after taking part in a 4 month course in three different wards including: surgery, pediatric and internal wards. The staff’s opinions about the program were also gathered. Mean attitude score increased significantly after taking part in the course in these areas: satisfaction about basic science lessons (P=0.019), understanding social determinants of health (P= 0.03) and understanding clinical thinking and simple clinical skills (P= 0.01). Passing the course did not have any significant effect in communication skills and current semester scores (P.0.05 in both issues). Forty one percent of the academic staff in the mentioned wards believed in the necessity of early clinical exposure in basic science stage, 29.5% denied it's necessity and 29.5% did not express their opinions. It seems that despite the mean score increase of some items, early clinical exposure program doesn’t have any positive effect on the measured items. Therefore, it is recommended to change the medical education program.

Introduction & Stroke is the third cause of death in developed countries and the most common neurologic disease resulting in disability. Nowadays, several risk factors for stroke are recognized properly. Life style and risk factors such as hypertension and diabetes are different among various cultures and countries. This study was designed to evaluate strokes epidemiology and their cardinal risk factors in patients who referred to Farshchian hospital of Hamedan during 2014-2015. In this cross sectional-descriptive study 684 files of patients hospitalized in neurology ward of Farshchian hospital has been evaluated whose diagnosis was confirmed by clinical signs and CT scan study during 2014-15. Their information was derived to complete the check list including age, sex, location and cardinal risk factors such as history of past stroke, hypertension, diabetes mellitus, smoking, dyslipidemia and history of cardiac diseases. Corresponding data were analyzed by SPSS 16 software. Of 684 patients, 355 individuals (51.9%) were males and 329 individuals (48.1%) were females, of whom 547 cases (79.97%) had ischemic stroke and 137 cases (20.03 %) had hemorrhagic stroke. The mean age for women, (67.83 years,) were meaningfully more than that of men (64.18 years), (P=0.0002), and the group age of 60 to 69 years with 29.68 percent had the most abundant cases of strokes overall. 396 individuals (57.89%) were urban and 288 individuals (42.11%) were rural. 245 individuals (35.82%) had previous stroke and 294 individuals (42.98%) had familial history of stroke. The most frequent risk factors were hypertension with 54.24 percent, cardiac diseases with 35.38 percent, smoking with 29.68 percent, diabetes type 2 with 19.01 percent and dyslipidemia with 18.42 percent in order of abundance. The relation between cardiac disease and urbanity was meaningful (P=0.02), and in hemorrhagic stroke, prevalence of hypertension was significantly higher than ischemic stroke (P=0.009). Hypertension (P=0.006), familial history of stroke (P=0.00001) and cardiac diseases (P=0.01) in patients with recurrent attack were meaningfully more often. This study indicated that women suffer from stroke at older ages than men and abundance of stroke in men is a decade prior than women. Amidst common risk factors, cardiac disease in urban population is higher and prevalence of hypertension in hemorrhagic stroke is higher than ischemic cases. Hypertension, familial history of stroke and cardiac diseases in patients with recurrent attack are more frequent as well.

Introduction & Diarrhea is the most common cause of morbidity and mortality in all age groups, especially children, the elderly and immunocompromised patients. Various studies have been reported regarding the relationship between the children acute diarrhea and Aeromonashydrophila and Yersinia enterocolitica. This study aimed to investigate the prevalence of the bacteria and their sensitivity to common antibiotics and the prevalence of virulence genes in the bacteria in Hamadan, Iran. In this study, 120 stool samples collected from children less than 10 years of age with acute diarrhea were examined for Aeromonashydrophila and Yersinia enterocolitica. Identification of the bacteria was performed by biochemical reactions and PCR using 16S rRNA genes. Moreover, the prevalence of virulence genes earA and hyl of Aeromonashydrophila and ail and ystB genes of Yersinia enterocolitica were investigated using PCR. Antibiotic susceptibility of isolated bacteria was performed by disk diffusion method. Out of 120 stool samples, 2 (1.7 %) Aeromonashydrophila and 3 (2.5%) Yersinia enterocolitica were isolated. All isolates of Aeromonashydrophila were sensitive to the chloramphenicol, co-trimoxazole, gentamicin, meropenem, amikacin and 50% of isolates were sensitive to the ceftriaxone and azithromycin. All Aeromonashydrophila isolates were resistant to erythromycin. All isolates of Yersinia enterocolitica were sensitive to the chloramphenicol, co-trimoxazole and meropenem. The 33.3% of the isolates were sensitive to gentamicin and amikacin and 66.6% of them were susceptible to ceftriaxone. However, all of Yersinia enterocolitica isolates were resistant to erythromycin and azithromycin. The prevalence aerA and hyl genes in Aeromonashydrophila were reported 100% and 50%, respectively. The prevalence of ail and ystB genes in Yersinia enterocolitica was reported as 66.6%. Identification and analysis of Aeromonashydrophila and Yersinia enterocolitica in diarrhea of children has etiologic importance and presence of the bacteria in samples of diarrhea should be considered.

Introduction & Jaundice is a common problem in infants in the first days after birth. Jaundice due to serious complications such as kernicterus requires special attention. The objective of this study was to determine the prevalence and risk factors affecting neonatal jaundice. In this cross-sectional study of 579 infants admitted to the Imam Sajjad Yasouj hospital in 2014 were studied using, convenience non_probability sampling method. By reviewing data type and RH, hemoglobin, G6PD, direct Coombs test - total bilirubin, unconjugated bilirubin was extracted. Gender, weight, gestational age, Apgar score, method of delivery, number of previous breast feeding and jaundice in infants were examined. Using SPSS software, descriptive statistics and independent t-test, ANOVA and chi score, data analysis was performed. In this study on 3461 newborns, 579 infants (72.16%) had jaundice. G6PD deficiency in infants was 12.95%. In this study, the prevalence of risk factors for premature yellowing was ABO incompatibility and G6PD deficiency pre-maturity, pottery hematoma, and RH incompatibility, respectively. Of total number of 579 cases, 58.2% were born through normal vaginal delivery and the rest through cesarean section and also 53.2% were boys and the rest were girls. The most common blood groups were A and AB and the most common blood group of mothers was O. The mothers’ mean gestational age was 38± 2. Among infants with jaundice, 15.9% were premature (35-37week) and 3.45% (20 cases) suffered from neonatal infections due to their mothers’ infection during pregnancy. There was no significant relationship between sex, type of delivery, birth weight, Apgar score, history of mothers’ drug use in the birth prevalence of premature hepatitis (P> 0.05). But, a significant relationship between the frequency of breast-feeding, pre-maturity, ABO incompatibility and G6PD and jaundice was found (P<0.05). The prevalence of hepatitis was 16.72%, largely due to ABO incompatibility and G6PD deficiency. It is recommended to determine the infants’ blood group (especially infants of mothers with blood group O) and measure neonatal bilirubin to prevent injury in infants who are at risk.

Penetrating trauma to anterior neck can induce cerebral ischemia due to carotid artery injury. Brain ischemia also can present after surgical carotid repairs. Early diagnosis and suitable treatment modality prevent from permanent neurologic deficit post operatively.Case Report: A 30 years old man with stab wound to zone two left side of neck underwent exploration and penrose insertion. Due to excessive bleeding through drain tube, patient was transferred to Besat Hospital of Hamadan. Surgical repair of external carotid artery successfully was done. Four days later patient developed right hemiparesis suddenly. According to MRI and color Doppler sonography finding of thrombosis of left common and internal carotid artery, reoperation was done. After thrombectomy cerebral ischemia and hemi-paralysis improved. Surgical approach to symptomatic penetrating neck trauma is oblique cervical incision, control of bleeding, repair of internal carotid, repair or ligature of external carotid artery base on some factors and preferential repair of internal jugular vein. Meticulous and fine surgical technique for both vascular repair and protection of adjacent normal vessels for avoiding to blunt trauma or compression with retractors is noticeable. Exact postoperative care as repeated clinical examination with goal of early diagnosis of internal carotid artery thrombosis and rapid diagnostic and treatment planning of this complication are important factors for taking of good result in treatment of penetrating trauma to carotid.