مجله دانشگاه علوم پزشکی رفسنجان
سال سوم شماره 2 (پیاپی 10، بهار 1383)

Chronic anal fissure is a common disease of the anorectal area. According to manometric studies, the increase of anal sphincter pressure is the most common cause of chronic anal fissure. Therefore, treatment is focused on decreasing the anal sphincter pressure. The injection of botulinum toxin into anal sphincter is one of the treatments, but its ideal dose has not been identified yet. The aim of the study was to compare the effects of the two different doses of toxin on fissure healing rate, and also assessement of the complication of the treatment. 70 patients with history of more than 3 months anal problem, with signs of chronic anal problems, such as skin tag and or visible internal anal sphincter muscle fiber at the base of ulcer were enrolled. 38 patients were men and 32 patients were women. Mean age was 35.3+11.2 years, and average length of illness was 10.29+4.15 months. The results showed 82.85% of patients had posterior anal fissure. The most common symptom was pain with defecation. In each group, four patients were lost from the study and 62 patients completed the study. One of the patients from the low dose group (I) and 4 patients from the high dose group (II) had gas incontinence. After one week, only 4 patients from the high dose group (II) had recovery, but no patient of the low dose group (I) had recovery. After two weeks, 20% of the patients in group I and 50% of the patients in group (II) had recovery. After 8 weeks, 80% of the patients in the group I and 90.6% of group II had recovery (P=0.29). Two patients in group I had rapid recurrence before six months. There wasnt any rapid recurrence in group II. At the end of the study, 22 patients from group I and 29 patients from group II had complete recovery. Six patients from group I and 3 from group II showed no response to the treatment, and most of them had chronic anterior part fissure. Four patients in group I and 2 patients in group II had recurrence after the one year follow-up. It seems that higher�doses of botulinum toxin in-patients with chronic anal fissure increases the treatment response without permanent side effects.

Sesame oil is one of the vegetable oils that has been used in traditional medicine for ages. Evidences indicate that unsaturated fatty acids can modulate learning and memory. In this study the effect of intrahippocampal injection of sesame oil on spatial learning and memory in N-MARI intact and castrated adult male rats was investigated. The animals were microcannulated, and divided into 3 intact and 3 castrated groups (n=7 in each group). The intact and castrated control groups (no injection), the castrated and intact saline sham and sesame oil. Test groups received bilaterally, 0.5 m l saline or sesame oil into the CA1 region of hippocampus every day for 5 days immediately before the training. Then each rat was trained 30 times every day, for a total of 5 days with Y-maze. After a month, all the groups were tested (one session) for memory test. Statistical analysis of data showed that sesame oil increases learning in both castrared and intact groups, but it did not change the spatial memory in intact animals. Also it did not prevent memory decline in castrated animals. It seems that sesame oil increases learning task. On the other hand, it is probable that sesame oil has an interaction with sexual hormones to exert its enhancement effect on learning task.

The motor activity in muscles is the result of the interaction between central and peripheral nervous system input in the spinal cord. This interaction, which occures at the site of convergence of the common interneurones, can modify the motor activities to meet the demands of the external requirements. Stimulation of group I and II afferents in common peroneal nerve (CPN) in human elicits poly- synaptic excitation of quadriceps motoneurones. The interneurones in this pathway are the point of convergence for many ascending and descending volleys. In this study, the gain modulation of this reflex at the positions of several knee and hip joints was investigated in 14 volunteers. Single 0.2ms pulses were delivered to CPN at the intensity of 1.5 ´ motor threshold in anterior tibials. The excitatory responses were recorded in ongoing EMG of voluntarily contracted ipsi-lateral rectus femoris at different knee and hip positions. The changes of the reflex at different intensities of contraction in rectus femoris at two knee positions of 180o & 130o, were also investigated. The CPQ reflexes showed a significant attenuation with the knee flexion and hip extension (P £ 0.001, P £ 0.01). A positive significant correlation was found between the reflex magnitude, and the level of contraction at extended knee position, however at the flexed position this correlation was not significant. The results of this study indicated a strong inhibition of CPQ reflex, which is possibly raised from activation of stretch receptors in quadriceps muscles. This inhibitory effect is probably acting at premotoneuronal level.

Iodine deficiency disorders (IDD) are among the most important epidemic disorders in the world and also in our country. The surveillance of IDD may be implemented to: assessing the prevalence of IDD, identifying the high risk areas for intervention and monitoring and evaluateing IDD control programmes, as salt iodized programme. The aim of this study was to determine the total goiter rate (TGR), urinary iodine in 6-11 years old students in Yazd city 10 years after iodized salt program. In this study, 1989 primary school students (1367 boys and 622 girls) aged 6-11 were selected by multistage “probability proportionate to size” cluster(PPS) sampling method in Yazd city. Thyroid examination and goiter classification were made according to WHO standard protocol by two trained physicians. Urine and household salt samples were collected from one-thirteenth of the total population (140 individuals). Urinary iodine was determined by digestion method. Salt iodine was determined by rapid test kit. TGR of Yazd city was 40.2% (Girls 41% and boys 39.9%). Prevalence of goiter grade 1 and grade 2 were 38.7% (39.2% for girls and 38.5% for boys), and 1.5% (1.8% for girls and 1.4% for boys), respectively. The rate of goiter was not significant between the two sexes). Age specific TGR at 6-6.9,7-7.9, 8-8.9, 9-9.9 and 10-11 age groups were 39%, 37.7%, 42%, 40% and 42.1%, respectively. Age spesific goiter grade 1 in this age groups were 38.7%, 35.2%, 40.5%, 38.8% and 39.9%, respectively. Age spesific goiter grade 2 in this age groups were 0.3%, 2.3%, 1.5%, 1.3% and 2.2%, respectively. TGR in this age groups were not significant(p=0.3). The mean of the urinary iodine was 258±122 μ g/l (244 ± 115 and 265 ± 125 μ g/l) in girls and boys respectivly, which were not significantly different. In general, 10% of Yazd study population had urinary iodine concentrations less than 100 μ g/l, 26.4% were in adequate range (100-200 μ g/l), 63.6% were higher than 200 μ g/l the urine iodine 40.7% of the 3rd group were higher than 300 μ g/l. In general, 3.2% of household salt samples did not contain iodine, 5.6% had 15ppm level, and 91.2% had above 30ppm level. Thus, approximately 96.8% of salts had iodine. The results of this study indicated that TGR, specially goiter grade 2, had significantly decreased in Yazd, and according to urinary iodine status, not only the mean of urinary iodine was elevated, but also was higher than ideal range of WHO. Thus, according to this index, it can be concluded that since the year 2002, Yazd city is IDD free.

The most effective groups of drugs for the treatment of surgical pain are opioid analgesics. But due to the development of tolerance, chronic use of opioids limits their effectiveness. However, the real need and analgesic response to opioids in postoperative pain has not been determined in addicted patients. Therefore this study was performed, to evaluate the analgesic response to morphine in postoperative pain of ovariohysterectomy in morphine dependent rats, compared with the non dependents. The present study was carried out on 36 adult female rats. Animals were divided into four groups (6 in each group): Control– ovariohysterectomy, control – sham, dependent– sham and dependent – ovariohysterectomy groups. Rats became dependent to morphine by taking morphine in their drinking water for 21 days. Rats were anaesthetized with ether, and after incision of the abdomen, uterus and ovaries were removed above the cervix. Latency time was assessed by Tail flick test before and after the operation and after inducing morphine 4 mg/kg (sub cutaneously). Data were expressed as latency time and percent of maximal possible effect [%MPE]. The results of present study showed that the mean latency time to noxious stimulus in tail flick test was not significantly different before and after the surgery in the four groups of animals Which indicated. that latency time in morphine dependent rats (9.1 ± 0.4s), was not significantly different from control rats (10.1 ± 1.25s) in tail flick test. Morphine injection increased the latency time in all of the groups significantly. The percent of MPE showed that the maximum analgesic effect of morphine in morphine dependent rats [48.7 ± 11.8s] after ovariohysterectomy was significantly higher than sham – dependent rats (19.6 ± 5s). The present study showed that there was not a significant difference in analgesic response to morphine after ovariohysterectomy in normal and morphine dependent rats. But ovariohysterectomy only increased the analgesic effect of morphine in dependent animals.

Imipramine is one of the common drugs therapies in enuretic children which is effective 50-60% on average. The main purpose of this research was to investigate the therapeutic effect of the combination of imipramine and oxybutynin compared to imipramine alone in uncomplicated nocturnal enuretic children. This clinical trial study was carried out on 80 primary school children (6-12 years old) with uncomplicated enuresis that were selected among 2500 school children with screening by questionnaire. The children were randomly divided into two groups (40 in each group). One group was treated with Imipramine in combination with Oxybutynin and the other group was treated with Imipramine and placebo for a period of 3 months. After the treatment period, the treated and untreated children were determined. The frequency of cured with Imipramine and Oxybutynin therapy was 95%, and with Imipramine and placebo was 60% therefore there was a significant difference between the two therapeutic methods, clinically and statistically (P=0.00017). The Result of this study showed that Imipramine and Oxybutynin treatment was more effective than Imipramine alone, although we recommend further studies to determine the rate of relapses and side effects of the above methods.

Backgrond: Researches have been carried out for several years, to find a way to treat muscular disorders, including weakness and atrophy which are consequences of the lack of movements. Clinicians are looking for a way to prevent these weaknesses and atrophies specially, when active movements are forbidden. It seems that mental practice can be a good answer to this problem. The aim of this study was to identify the efficacy of this kind of exercises on increasing muscle strength. This study was performed on 30 young healthy females (20-30 years old), who were randomly divided into case and control groups. The case group performed imaginary maximal contractions of the elbow extensors for 3 weeks while the control group performed mathematical exercises at the same period of time. The amount of muscle extension torque of elbow was determined by Isostation B200 Dynamometer, before and after the intervention. The statistic analysis was performed with non-parametric tests of Mann-Whitney and Wilcoxon. Mental practice of strengthening tasks produced 50 percent increase in the isometric torque of elbow extension while control group showed only 7 percent increase in their torques. It seems that we can use mental practice to increase or keep the muscle strength. It is suggested that physiotherapists combine this new method with the other common methods in their rehabilitation programs.

World Health Organization (WHO) estimates that about 350 million people are infected with Hepatitis B virus (HBV) worldwide. It is estimated that about 2 million people die from HBV complications such as cirrhosis, hepatocellular carcinoma every year. The aim of this study was to determine the frequency of HBsAg+ among women referring to Niknafs Delivery Center of Rafsanjan (NDCR), from April to July 2003. This was a cross- sectional descriptive study evaluating 600 pregnant women referring to NDCR from April to July 2003. Serum samples were checked for HBsAg+ by ELISA 0/13. Data were recorded and analysed by SPSS 11.5 Soft Ware using x 2 Fisher tests. According to the results of this study from 600 pregnant women 8(1.3%) were HBsAg+ (1.26%-1.35%,CI 95%). The mean age was 26.2 ±5.3 and the mean number of pregnancies were 2.14±1.4. There were significant differences in the history of husband’s IVD-usage, tatooing, previous IVD usage, not being native, between the two groups (p<0.05). Considering the frequancy of HBsAg+ in this study in order to reduce the infection and morbidity rate of HBsAg+ in women, mass education at the time of marriage and prenatal period is needed.