مجله پزشکی بالینی ابن سینا
سال شانزدهم شماره 4 (پیاپی 54، زمستان 1388)

Introduction & Acute promyelocytic leukemia(APL) is a kind of acute leukemia characterized by a balanced t(15, 17) translocation which fails to develop into mature cells and proliferate in an unregulated fashion. In the recent years, in addition to combinatoral chemotherapy to treat unmature cancerous cells, differentiation therapy by differentiating agents as a novel procedure are used. Since it is not possible to use high concentration of differentiating agents due to their side effects, some compounds are also used to increase their differentiating potency. In this study the effect of bee venom and 1,25-Dihydroxyvitamin D3 individually and in combination on proliferation and differentiation of HL-60 cancerous cells were assayed. In this experimental in vitro study, toxic and non-toxic concentrations of honey bee venom and 1,25- Dihydroxyvitamin D3 were determined using Trypan blue stained cell counting and MTT assay. In addition,differentiation of cells was assayed by Wright-Giemsa staining and NBT reduction test. Data were analized by one –way ANOVA test using SPSS software. Our findings showed that both bee venom and 1,25-Dihydroxyvitamin D3 in a dose and time dependent manner caused cell death at high concentrations and inhibited cell proliferation at lower concentration. 1,25-Dihydroxyvitamin D3 at 5nM concentration induced differentiation of HL-60 cells towards monocyte during 72 hours. Bee venom at 2.5 µg/ml concentration suppressed proliferation of HL-60 cells but had not any effect on their differentiation, whereas in combination with 5nM 1,25-Dihydroxyvitamin D3 enhanced anti-proliferative and differentiation potency of 1,25-Dihydroxyvitamin D3.. Non-toxic and inhibitory concentrations of bee venom can increase anti-proliferation and differentiation potency of 1,25-Dihydroxyvitamin D3.

Introduction & This study was performed to determine the role of frozen section examination (FSE) of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. Twenty patients with high grade intraepithelial neoplasia undergoing conization biopsy and frozen section examination were cross- sectionally studied from March 2008 until September 2009.The results of permanent paraffin sections were compared using FSE. In this cross-sectional study, 15 out of 20 cases (75%) showed the same results in frozen and permanent sections of cone biopsy specimen. Two patients out of the remaining 5 ones had higher grade of CIN in frozen section, 2 had lower grade and one was considered the same because CIN1 in FSE was normal in permanent sections.although The Paired Sample t-test showed no significant difference between the two groups of frozen and permanent section results (P-value=0.716, CI=95%). Frozen section evaluation of cervical cone biopsy specimens in patients with CIN II-III is accurate, efficient, and cost-effective.

Introduction & The measurement of Intraocular pressure (IOP) is very important not only in the diagnosis and management of glaucomatous conditions but also in any ophthalmologic examination. So this study was designed to compare the results of noncontact pulsair and tononpen tonometry with goldmann known as gold standard method. In this cross sectional study on 150 patients after a complete ophthalmic examination; tonometry was performed with goldmann (G), pulsair (P) and tonopen (T). Mean values obtained from the three methods and the difference between the first two methods and G were measured and with descriptive statistical methods, t tests and regression tests were analyzed. Mean measured IOP with P was greater than G and T (P=0.03). Correlation coefficient between the 3 methods was acceptable (r2=0.71). Mean difference between P and G does not differs significantly from 0 (P=0.19), but this value between T and G differs significantly from 0 (P=0.02). Both T and P underestimate IOP in high ranges. Both T and P tonometry measures have acceptable accuracy in comparison with G, but in suspicious cases such as glaucoma or ocular hypertension G is better as a gold standard method.

Introduction & This study compared the personality profile of cancer patients with that of normal persons. The aim was identifying personality traits related to people who suffered from cancer, and helping them to cope with the situation and adjust with life. This research was a casual comparative study. For this purpose 100 persons were selected from hematology and oncology center and asked to complete (NEO) personality inventory. Then 94 persons were selected as matched group. The result showed that neuroticism was high in cancer patients (p<0.00). Also there were significant differences between normal people and cancer patients in adaptibility and extroversion with high scores in normal people (p<0.05). But there were no significant difference between the two groups in agreeableness and conscientious. In general the result of this research demonstrated that the cancer patients were more neurotic and less adaptable and extrovert therefore they need psychotherapy.

Introduction & Hospitalization can significantly disrupt sleeping patterns. considering the prevalence of insomnia and widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted this study to assess the quality of sleep and hypnotic drug use in hospitalized adult patients in 2007. This descriptive analytical cross-sectional study involved an assessment of sleep quality for patients whose consent had been obtained when admitted to the internal ward of Hamadan Ekbatan hospital. The Pittsburg sleep quality index (PSQI) was used to measure the quality of sleep in patients and completed at the time of admission and discharge. Also the relation of factors such as age, sex. Marital status, education and sedating drug use prior to and during hospitalization with sleep quality were assessed. 300 patients entered this study and completed PSQI sleep questionnaires two twice, at the time of admission & discharge. At the time of admission only 36% of patients had good sleep quality (PSQI score <5) while this percent decreased to 18.3% at the time of discharge. Mean global PSQI score was 7.6 at the time of admission versus 9.4 at the time of discharge indicating the patients’ worse sleep quality at the time of discharge (Pv<0.05). 23% of patients received hypnotic drugs while in the hospital with no evidence of preadmission hypnotic use. Benzodiazepines were prescribed for all of them. Quality of sleep at the time of discharge was significantly worse than it at the time of admission and it seems that despite widespread use of sedative drug in the hospital, there are still patients with poor sleep quality in the hospital.

Introduction & Despite the high prevalence of depression and hypertension, the relationship between these disorders has received little attention. Some prospective studies indicate that depression poses a risk factor for hypertension. Depression has been found to be associated with an increased risk of developing cardiovascular diseases. The present study was conducted to examine the prevalence of depression in hypertensive patient's refering to medical and health centers in Hamadan city. In a descriptive cross-sectional study 525 hypertensive patients who referred to the medical and health centers of Hamadan city in 2008 were studied. Depression status was evaluated by Beck depression inventory. Obtaining a score higher than 18 indicated depression. The data were analyzed with SPSS software(version 10), chi-square and parson regression coefficient tests Depression prevalence in the hypertensive patients was 48.6%. Positive correlation was detected between age and score of depression(r=0.56 P.V=0.000). The rate of depression was significantly higher in the females than the males (c2=34 P.V=<0.5). Depression prevalence in the lower socioeconomic classes and the widows were higher than in the married and high class patients (P.V<0.05). Hypertensive patients are prone to depression. The lifetime co- morbidity of two diseases is significantly higher in females than males. The presence of a positive correlation between hypertension and depression indicates that hypertension is a risk factor for developing depression. High prevalence of depression suggests the need for depression screening and neurological consultation in hypertensive patients.

Introduction & Shoulder joint is the most common articular dislocations in the body. There are many surgical techniques for the treatment of recurrent shoulder dislocation. The aim of the study is to evaluate the short-term results of surgical technique of modified Bankart repair for recurrent anterior shoulder instability. Twenty patients underwent an operation at Tabriz Shohada hospital, from May 2005 to december 2007 and were followed up for at least 18 months. The data was analyzed by descriptive statistical methods. There were 85% male and 15%female participants in the study, with the average age of 24.7 years(14-46years). The mean number of dislocation episode before surgery was 6(3-11). Two had minor glenoid rim fracture. There was no case of rotator cuff tear. During the follow up after surgery, two patients had recurrence of dislocation. The mean Rowe score was 94 and no infection or neurological complication was reported. Average external rotation loss was 5º. According to the above-mentioned data, modified bankart procedure is an acceptable method for treatment of recurrent dislocation of the shoulder.

Introduction & The efficacy of Percutaneous Nephrolithotomy (PCNL) in the treatment of renal stones has been proven in its indications. The main method of anesthesia in this procedure is general anesthesia. We used spinal anesthesia (SA) as an alternative method of anesthesia with many benefits. This study was intended to show the possibility of SA as a more comfortable method of anesthesia for the surgeon, the anesthesiologist and the patient via more cooperation of the patient during changing the position and prevention of some complications mostly in upper extremities and neck. In a prospective clinical trial study, a total of 112 patients underwent PCNL under SA with marcaine, from Nov 2004 till Feb 2009. Their mean age was 36 years (22-48), at first the syringe was stained by epinephrine and then 2 -3.5 ml marcaine was used for SA and addition of analgesics, sedatives or both., if needed. The rest of the procedure was done as routine. Stone clearance was achieved in 82% of the patients and the rest were managed by ESWL. The mean operation time was 126 minutes (90-220), 36% of the patients needed sedation, analgesia, or both, specially those with bigger stones. 6% of the patients had upper pole stones. Blood transfusion was needed only in one patient. No significant complication was observed in this study. PCNL under SA afforded the surgeon and the anesthesiologist the opportunity of more patient cooperation during position changes and precludes some morbidities that may happen under general anesthesia because the patient is awake and able to portend.

Introduction & It is known that postural control performance in upright standing position could be affected by abnormal posture alignment. Despite the fact that kyphosis is one of the most common spine abnormality, the effect of thoracic curve abnormality at sagittal plane on postural stability has received little attention to date. Therefore, the purpose of our study was to investigate the dynamic and static postural control among individuals with kyphosis in comparison with a control matched group. Nineteen males with increased normal thoracic kyphosis (> 40 degrees) were randomly selected as kyphotic group. Eighteen controls matched for age, weight and height were selected to participate in the study. We measured the amount of kyphosis using flexible ruler as a noninvasive and reliable method. Dynamic and static postural stability were assessed using the biodex stability system and the balance error scoring system respectively. ANOVA with repeated measures followed by Tukey HSD test and independent t-test were employed for statistical analyses (p<0.05). For dynamic postural assessment, the means of all stability indices were significantly higher in the kyphotic individuals than controls in the eyes-closed condition. With the platform in the most unstable position, kyphotic group were detected to have significantly poorer balance performance than controls in both eyes-open and eyes-closed conditions. For static balance evaluation, no difference was noted between both groups in stability performance during double and tandem stances. During the single-limb stance trials, the kyphotic group had poorer performance than controls while standing on the firm surface and foam surface (firm surface: p=0.044; foam surface: p=0.000). The findings suggest that postural control especially dynamic postural stability may be altered in individuals with increased thoracic kyphosis.

Introduction & Industrial wastewaters including heavy metals, are among the important sources of environmental pollution. Heavy metals such as chromium are found in plating wastewater and is harmful for human health and environment. The purpose of the present study was to investigate the absorption of heavy metals such as chromium onto modified holly sawdust as an cheaper absorbent. This study was a fundamental- application study done in Hamadan University of Medical Sciences, hygiene faculty water and wastewater chemistry laboratory. This study investigated the removal of hexavalent chromium by using modified holly sawdust with pH changes, contact time, absorbent dose and Cr(VI) concentrations in batch system. Then the result was analyzed by Excel software. The results showed that the removal efficiency decrease is accompanied by the increase of pH and initial chromium concentration. pH increase from 2 to 12(equilibrium time= 180 min, adsorbent dose= 0.6g/100CC, Cr(VI) concentrations= 60 mg/L), leaded to the removal efficiency decrease from 99.67 % to 29.78 %. Also removal efficiency decreased from 99.37 % to 40.24 % after increasing the initial chromium concentrations from 20 mg/L to 100 mg/L. Moreover the results showed the removal efficiency increased after increasing the adsorbent dose and contact time. By increasing adsorbent dose from 0.2 g/100CC to 1 g/100CC, the removal efficiency increased from 34.65 % to 99.76 %.Additionally, the removal efficiency increased from 48.53%to 99.76% by increasing contact time from 5 mins to 180 mins. Experimental isotherms and kinetics models were assessed by Langmuir and Freundlich isotherms and pseudo-first-order and pseudo-second-order kinetics models. The results showed that the data were acceptably explained acceptably by Langmuir isotherms and pseudo-second-order kinetics models respectively. The results showed that the removal of hexavalent chromium from aqueous solution using sawdust was more cost effective and efficient.