مجله دانشگاه علوم پزشکی شهرکرد
سال دوازدهم شماره 4 (پیاپی 48، زمستان 1389)

Hepatitis B virus is the most frequent cause of acute and chronic hepatitis in the world. HBeAg should be assessed in the carriers of hepatitis B virus for the viral replication status. HBeAg+ patients with elevated aminotransferase should be treated with antiviral agents. Our aim was to determine the frequency of HBeAg positivity and the level of hepatic aminotransferase in the HBsAg+ population.

In a case-control study in 2006, 144 infected patients with hepatitis B virus were examined for the presence of HBeAg and the level of serum aminotransferase by ELISA and biochemical test. The patients were selcted from Imam Reza Hospital in Mashhad city.

The frequencies of male and female in 144 hepatitis B infected patients were 94 and 50, respectively. They were between 2 to 85 years old with the mean of 37.4±2.3. Serum HBeAg was positive in 26 patients (18% of the total) with a mean serum AST level of 83 IU/L. HBeAg- group had a mean AST level of 56.2 IU/L. Statistical analysis showed a significant difference in the mean serum levels of AST between two groups (P=0.007). There was also a significant difference in the levels of serum ALT between HBeAg+ (79 IU/L) and HBeAg- (73.7 IU/L) groups (P=0.018).

Based on our results the HBeAg positivity is associated with the increased level of liver enzymes. So the impact of HBeAg marker on serum level of hepatic aminotransferase in HBsAg+ patients should be assessed in future studies.

Analgesics and anesthetic pain relief in labor often have unwanted sedative effects in the mothers and their newborns. It seems that using non-pharmacologic methods, such as acupressure, affect on labor pain and delivery time. The purpose of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in nulliparas women in Iranshahr hospital in 2008-2009. A randomized clinical trial study was performed on 60 eligible nulliparas women who were at the beginning of active phase of labor (4 cm dilatation of cervix). The women were randomly assigned to one of the two groups: SP6 acupressure or SP6 touch. The participants, received acupressure or touch on SP6 acupoint, 3 Kun above the tip of the inner malleous just posterior to the border of tibia above the ankle, for 20 minute during contractions on two feet. Labor pain was measured four times with visual-analogue scale (VAS): before and after the intervention in 4, 6, 8 and 10 cm cervical dilation. Length of delivery time was calculated in two stages: from 4 cm cervical dilation to full cervical dilatation and full cervical dilatation to the delivery. The data were analyzed using SPSS software and descriptive statistical, paired t-test, chi square and independent t-tests. There was a significant reduction in the severity of pain in 4, 6 and 8 cervical dilation in case group compared to control group (P<0.001). The length of delivery time in active phase was less in case group compared to control group P<0.001, but there was hot difference in second place of delivery. SP6 acupressure may be applied in a non-invasive and easy to use fashion for pain control in the labor.

Rat and human skin tumors have high similarity in physiology and show comparable biochemical responsiveness. In this study we have recorded numerical and structural chromosomal changes in metaphases chromosomes in induced-breast cancer in rats. In this experimental study, a carcinogenic substance (7, 12-Dimethylbenz [α] anthracene, DMBA) (2. 5 mg) was subcutaneously injected to SD rats. Since tumors were appeared in effected rats, they became subjects for histopathology and imunohistochemistry studies as well as cell culture, metaphase chromosomal preparations and finally G-banding staining. The data showed some un-randomly numerical and structural changes in different number of chromosomes. We found a gain in chromosomes number 8, 9, 10, 18 and a loss of numerical chromosomal changes in chromosomes number 4, 6, 12, 16 ِِِِِDeletion was seen in chromosomes number 1, 4, 5, 6, 17 and marker chromosomes in diploid and triploid model of analyzed chromosomal sets. According to our reported chromosomal changes and also published articles, we predict that SRD5A2, BCAM, SIRT2, AKT2, MLANA, RHOB, CANX, TERT are probably involved in development of skin cancer. In addition, we recommend that the genes located in these chromosomal segments, which have been reported in these studies, should be subjected to more investigations.

The present study aimed to compare the habits and features of obese (BMI>25) and normal (BM<25) individuals and express a method to ameliorate the life styles using a cross-sectional experiment. Two groups of case (n=110) and control (n=100) subjects were randomly selected. The samples were then divided into two groups (obese and normal), respectively. For each group, BMI was calculated. If the obtained BMI was>25 kg/m2 then it was designated in the case group (obese). Samples with BMI between 20-25 kg/m2 were assigned into the control (normal) group. The Miller-Smith life style questionnaires were used for both groups. Data were analyzed using Chi-square and t-tests. No significant differences were found between the two groups tested in terms of the mean age, gender, level of education, marital status insurance, the length of sleep during 24 h, cigarette smoking and losing job or spouse. However, a significant relation was found in using vegetables, sausage, fried potatoes, enriched breads, low fat milk, low salt, candies and chocolates (P<0.05). The present study suggests that one way to control obesity and prevent diseases is to ameliorate the life styles with education to people.

In many parts of the world Tinea Capitis is a public health problem, especially in primary school children. The control of the disease is dependent on patient's education for increasing their knowledge and health. The aim of this study was to evaluate on knowledge, attitude and performance in male primary school students regarding Tinea Capitis in Chabahar in 2007-2008. In this quasi-experimental (case – control) study, 115 primary school students were randomly selected from two primary school in the city of Chabahar. Students were assigned into two groups. Tools and data collection methods were included: questionnaire, check list and laboratory samples of scalp and hair. At the beginning of the research, a pre-test was performed on the students and according to the data obtained, an educational program were prepared and was performed for experimental group. Post-test was done after two months. Data was analyzed using chi-square, Mann-Whitney, Wilcoxon and McNemar tests. The findings showed a significant increase in the knowledge, attitude, performance in experimental group (P<0.001). In addition, experimental group demonstrated a significant decrease in Tinea Capitis (P<0.01). The results of this study showed that there is a significant relationship between Tinea Capitis and weight, type of skin and parent's education (P<0.05). The results of this research show that the risk of Tinea Capitis transmission is a public health problem and health education is a suitable response to this problem.

Soft tissue injuries, such as tendons or ligaments, are common problems causing pain and functional disorders. The aim of this study was to investigate the effect of local infiltration of morphine in reducing the post operative pain in soft tissue injuries. In a double blind clinical trial study, 80 patients with soft tissue injury who were admitted in Kashani hospital, Shahrekord, Iran, were divided into 2 groups: control group received local placebo (normal saline) and case group received local morphine. Severity of pain was measured using a scale questionnaire 3, 10 and 24 hours after the surgery. Data were analyzed using independent t-test, Chi square and Fisher tests. The results of this study showed that mean age was 32.5±6.34 years for control group and 30.6±7.7 years for case group. Mean incision length was found 5.5 cm for control group and 5.57 cm for case group (P<0.05). A significant decrease in severity of pain was found 3, 10 and 24 hours after the operation in patients who received local morphine compared with control group (P<0.05). Infiltration of morphine has good advantages in reducing pain in patients with soft tissue injury after the operation.

The liver has an important role in the metabolism of chemical drugs and plasma protein synthesis. Cabergoline is used in the treatment of hyperprolactinemia and parkinson disease and some of other disorders. This study aimed to find the effect of cabergoline on the liver enzymes and serum proteins. In this experimental study 40 adult male Wistar rats were divided in to five equal groups. The drug was subcutaneously injected for 14 days. The experimental groups received 0.1, 0.5 and 1 mg/kg respectively. The control group had no drug and the last group received distilled water. At the end, blood samples were taken from all subjects and liver enzymes, ALT (Alanine Transaminase), AST (Aspartate Transaminase), ALP (Alkaline Phosphatase), Albumin and total protein were determined by outoanalyzer in order to evaluate the liver function. The results were analyzed by non-parametric (K Independent Sample) tests. No significant differences were observed in the level of ALT and AST enzymes between cases and control groups. The level of ALP in case groups (471±28.7, 474±53.06) showed a significant decrease compared to the control group (551±31.64). Total protein showed a significant decrease in the groups who received medium and maximum doses of cabergoline (7.71±0.11 and 7.70±0.09 compared to 8.36±0.14). Albumin showed a significant decrease in the groups who received medium and maximum doses of cabergoline (4.6±0.05 and 4.46±0.02 compared to 4.71±0.08 in control group). As there was no significant difference in the level of AST and ALT as the main indicators of liver function, it could be concluded that cabergoline as a dopamine antagonist has no side effects on the liver parenchymal cells, but more study seems to be needed.

Post-delivery surgical repair of the perineal region is frequently associated with pain and discomfort. The surgical technique may play a role in the intensity of pain and the wound healing process. This study was conducted to compare the influence of applying standard continuous versus interrupted suturing on pain sensation and the frequency of wound infection following episiotomy. In a randomized double blind clinical trial, 148 healthy women with normal vaginal delivery and sustained episiotomy were studied in the Hajar hospital, Shahrekord. In one group, perineal muscles, fascia and skin tissues were repaired with continuous non-locking sutures. Standard interrupted locking suturing was applied for the next group. Pain feeling and wound infection were evaluated at 2 hours, 10th and 40th days of post-delivery by Visual Analog Scale and the signs of discoloration of skin, edema, purulent discharge, and wound dehiscence, respectively. Data were analyzed by t-student, X2 and Mann-Whitney tests. Pain intensity, the amount of consumed suturing material and the allocated time were less in the cases with continuous suturing (P<0.001). The mean of pain intensity was 2.66±2.5 versus 3.84±2.56 and 0.53±1.63 versus 0.6±1.04 at 10th and 40th days after delivery in continuous and standard interrupted suturing groups, respectively (P<0.05). Signs of wound infection were observed only in 4 cases (12.5%), all of which belonged to the standard interrupted suturing group. There was a statistically significant inter-group difference in terms of the frequency of observed wound infection (P<0.05). The pain intensity and the chance of wound infection is less in continuous suturing of episiotomy wounds. It also is a safer and more cost-effective method as it lowers the bedding time of the mother and needs for surgical material.

Diabetes mellitus is one of the most common metabolic disorders due to partial or complete deficiency of insulin or insulin resistance. The most common problems in uncontrolled diabetes are chronic complication including renal and cardiovascular failure. Zinc as an essential trace element, can affect some aspects of insulin synthesis, secretion and function. The aim of this study was to evaluate the effect of zinc supplementation in diabetes control status in a group of type-II diabetic patients. In this clinical trial, 60 diabetic patients (type-II) were divided in 2 groups, randomly. One of them consumed 25 mg/day zinc and the other had 50 mg daily for 2 months. Fasting blood glucose (FBS), 2 hour post prandial blood glucose (2hpp), glycosylated hemoglobin (HbA1c), and serum levels of zinc were evaluated in patients before and after zinc supplementation. Wilcoxon and Mann-Whitney tests were used for statistical analysis. 22 patients in each group with the mean age of 48 years completed the study. Serum levels of zinc in the group with 25 mg/day supplementation didn’t show significant change, but in the second group increased significantly after supplementation (160±30 μg/dl vs 140±30, p=0.002). HbA1c significantly reduced after supplementation (9.7±1.86 vs 8.9±1.5, p=0.02). There were not significant changes in FBS and 2hpp before and after zinc supplementation. Our results indicate that elevation of zinc level in diabetic patients has favorable effect on HbA1c and diabetes control status. It is assumed that some of the diabetic patients suffer from a latent zinc deficiency and this may be unfavorably affect diabetes control status.

Hyperalgesia is considered as one of the marked signs of subchronic diabetes mellitus that could affect the life style of the patients. This study was designed to investigate the antinociceptive effect of chronic feeding of Allium schoenoprasum (AS) leaf in streptozotocin-diabetic rats using formalin and tail immersion tests. Rats were divided into control, AS leaf-treated control, diabetic, sodium salicylate (SS)-treated diabetic, and AS leaf-treated diabetic groups. The treatment groups received oral administration of AS leaf-mixed pelleted food (3%) for 8 weeks. Finally hyperalgesia were assessed using standard formalin and tail immersion tests. Averaged pain score for the first 0-10 min and the later 16-60 min after formalin injection was regarded as acute and chronic phases, respectively AS leaf treatment of diabetic rats reduced pain score in chronic phase of formalin test from 2.41±0.14 to 2.01±0.12 (P<0.05). Regarding hot tail immersion test, diabetic rats showed a significant reduction (5.9 s) in tail flick latency as compared to control ones (P<0.05). However, AS leaf treatment of diabetic rats did not significantly increase this latency relative to untreated diabetics. Taken together, 8-week administration of AS leaf could attenuate nociceptive score in chronic phase of formalin test in streptozotocin-induced experimental model of diabetes mellitus, but, had no effect on thermal pain. Perhaps, the anti-inflammatory property of the plant is responsible for its analgesic effect.

Physiological changes related to aging and muscular problems can increase the risk of injury in elderly. Falling down, accounts for a major risk in the mortality of this age group. Thus, we examined the effect of practice type (physical, mental and mixed practices) on the static and dynamic balance of the old people in Shahrekord. 60 old men and women in the range of 60 to 70 years were randomly divided into three experimental (physical, mental, and mixed practices) groups. Their static and dynamic balances were assessed in advance by using Stroke Stand (standing with one leg) and Star Excursion Balance tests, respectively. Based on the researchers’ protocol, 8 practice sessions were performed for all participants, afterwards. The same balance tests were repeated for the post test. Obtained data was analyzed by either one way ANOVA or two way ANOVA tests with Repeated Measures and Bonferroni Post Hoc tests at the level of P<0.05. Balance tests showed a statistically significant difference between the experimental groups in the post test (P<0.05). The mixed practice group had a better performance than the two other groups (P<0.05). The performance of the physical practice group was also better than the mental practice group, too (P<0.05). Combined application of the physical and mixed exercises make a better performance for increasing the muscle strength of lower extremities and improving the static and dynamic balance in old people.

Traditionally, burn wound healing activities have been claimed for Zizipus vulgaris L, but there is not any evidence in literature for this effect of the plant. Therefore, this work was carried out to investigate the effect of hydroalcoholic extract of Zizipus vulgaris L. on burn healing. In an experimental study burn wounds were made by placing a hot plate with a surface area of 1.5 cm2 for 10s on the back of animals. 40 mice were designated in 4 groups. Animal were treated with vehicle or test substance two times per day for 21 days. The first group received nothing, second group Vaseline. Third and fourth group 1% and 10% Jujuba ointment two times/day, respectively. Percent of burn wounds healing and total time required for complete healing were evaluated. Results showed that 1% dose of Jujuba extracts had significant burn wound healing compared to control group (P<0.01). Zizipus vulgaris L. has considerable healing effect on burn wounds and its usage might be beneficial in these patients.

Tuberculosis is one of the world’s most debilitating diseases and it is at the top of six most prevalent and dangerous infectious diseases recognized by World Health Organization. Although one out of every three people in the world is affected by Mycobacterium tuberculosis, cutaneous infection is a relatively uncommon event. Here, we report a rare form of cutaneous tuberculosis presented by multiple fistulas over the anterior chest wall. Case report: This is a 50 year old insulin-dependent diabetic man from Afghanistan who was presented with a history of multiple skin lesions over his anterior chest wall for 3 months duration. At first, there was a single non-painful, small papular lesion, which became fistulized and developed purulent discharge, later. The patient was suspected as a case of cutaneous tuberculosis according to his nationality and prolonged history of unresponsiveness to outpatient antimicrobial treatment. This diagnosis approved based on skin biopsy result as it revealed multiple granulomas consisted of giant Langhans cells and the detection of numerous acid fast bacilli in the Ziehl-Neelsen staining of the skin secretions. Six weeks after treatment with anti-tuberculosis drugs, the signs of improvement were appeared and 6 months later there was no active fistula any more.

Cutaneous tuberculosis may present itself in uncommon forms such as fistula. It might be seen anywhere including chest wall. Therefore, this impression should be considered in patients with prolonged skin lesions and featured by fistula formation.