مجله پزشکی بالینی ابن سینا
سال بیستم شماره 2 (پیاپی 68، تابستان 1392)

Introduction & The diagnostic value of endoscopic and microscopic procedures for viewing different structures of middle ear has been widely assessed however، no published study is available for comparing the diagnostic value of them in chronic otitis media patients. The present study conducted to compare diagnostic value of these two procedures for as-sessment of middle ear normal structures and possible defects in these patients. In a prospective descriptive analytical study، fifty eight consecutive pa-tients older than 15 years who suffered from chronic otitis media and were candidates for tympanoplasty with or without mastoidectomy were included into the study and underwent operation. After entering the middle ear by post auricular incision and elevation of a tym-panomeatal flap، and prior to surgery، the middle ear was first examined by an operating mi-croscope in different bed and microscope positions and by performing gentle maneuvers on the head and then was reevaluated using a rigid 0 & 30 degree sinoscope. The visible areas of middle ear were separately noted. Structures of epitympanum، posterior mesotympanum، and hypotympanum structures were more visible using endoscope compared with microscope (P<0. 05). Among different parts of mesotympanum، oval window، round window، and eustachian tube were more ob-servable by the former procedure (P<0. 05). Regarding evaluation of the ossicular chain mo-bility and reflexes of round window as well as ossicular chain erosions by microscope and endoscope، no significant difference was detected (P>0. 05). Endoscopic and microscopic procedures had similar diagnostic values to view ossicular chain mobility and reflexes of round window as well as to detect ossicular chain erosions، but different anatomical parts and more hidden pits of the middle ear such as epitympanum، posterior mesotympanum، and hypotympanum are more visible by an endoscopic tool. In case of pathologic conditions، endoscopic approach is recommended for better observation and adequate evaluation of the location before and after the removal of the lesion.

Introduction &

Recently، it has been suggested that there might be an association between oral diseases such as dental caries، as well as periodontitis and general health. Re-garding the fact that albumin is an indicator of general health، the aim of the present study was to evaluate the relationship of salivary albumin concentration with dental caries.

In this descriptive-analytical study 108 patients aged 13-19 years old who had teeth caries were placed in 3 groups with mild، moderate and severe dental caries according to their DMFT value (n=36). Five ml of unstimulated saliva were taken from each participant via Navazesh method and their albumin concentrations were assessed by nephelometery method. Data were analyzed by t-test and ANOVA.

The mean concentration of salivary albumin in three experimental groups was 84. 442±42. 915، 97. 964±66. 717 and 89. 850±33. 003، respectively. ANOVA showed that the difference among the mean values was not significant (P=0. 09) but the relationship between salivary albumins and sex was significant (P=0. 009).

According to the results of the present study there was no significant relationship between albumin and dental caries in 13-19 year old individuals.

Introduction & It has been shown that there is a correlation between cholesterol con-centration and coronary heart disease (CHD). Cholesteryl ester transfer pro-tein (CETP) plays a central role in lipoproteins metabolism and it has been suggested that various polymorphisms in CETP gene can affect the enzyme activity and blood lipid parame-ters. There was not enough information about distribution and effects of Msp1 genotypes on lipid levels، especially in Iranian population. Therefore، we studied CETP Msp1 polymor-phism and its effects on lipid parameters in subjects with and without hypercholesterolemia. In this experimental study، 100 subjects with hypercholesterolemia and 200 healthy individuals were selected as the study population. Lipid parameters and CETP activity were measured in serum. Determination of Msp1 genotypes was performed using polymerase chain reaction and restriction fragment length polymorphism techniques. Frequency of M1 allele in hypercholesterolemic and healthy subjects was 27% and 21. 25% respectively. The frequency of M1M1 genotype was significantly high in hypercho-lesterolemic patients compared to healthy ones. The levels of LDL-C and TC in patients with M1M1 genotype were higher than patients with M1M2 and M2M2 genotypes. CETP activity was high in all subjects with M1M1 genotype. It has been concluded that the Msp1 polymorphism of CETP probably affects lipid parameters and CETP activity.

Introduction & Conductive hearing loss following otitis media (OM) attenuates and delays sound passing through the middle ear. This may impair central auditory functions (such as binaural hearing) and lead to central impairments that persist after the peripheral loss has resolved. This study investigated the effects of chronic otitis media (COM) on central auditory function in children. In an analytic cross-sectional design، 64 young children were divided into three different groups and evaluated: children suffering from OM (OM group)، children with a history of OM but normal hearing sensitivity on the test day (Non-OM group)، and a control group. The binaural masking level difference (MLD) was performed for all partici-pants. The data were analyzed using SPSS 16. Our findings revealed that children with a history of COM had significantly smaller MLD values than normal subjects (P < 0. 001). Additionally، we found a negative correlation between the MLD values and the degree of hearing loss in OM patients (P =0. 01، r= -0. 82). The results of this study suggest that COM could compromise children''s central auditory function to process binaural information.

Introduction & The consumption of chemical compounds and medicinal herbs are different ways to control pain. On the other hand، the complications of chemical drugs and their expensiveness cause people to use herbal medicines The aim of this study was to inves-tigate the antinociceptive effect of hydroalcoholic leaf extract of Hedera helix in male rats. In this experimental study، 36 adult male rats were divided into 6 groups: control، morphine (1mg/kg)، Hedera helix extract (100، 200، 300mg/kg، i. p.) and naloxone (1mg/kg) with Hedera helix extract (200 mg/kg). The analgesic effects of Hedera helix ex-tract were assessed with writhing and tail flick tests. The results of this study showed that doses of 200 and 300mg/kg of Hedera helix ex-tract decreased pain significantly. However، dose of 300mg/kg of Hedera helix extract showed more antinociceptive effect of Hedera helix extract. The naloxone and Hedera helix extract combination increased the number of writhing compared with the Hedera helix ex-tract group. In this study analgesic effect of the hydroalcoholic extract of Hedera helix was observed. The antinociceptive effect of extract was probably occurred by activation of opioid system.

Introduction &

Ficin is a member of plant cystein proteases that is abundant in fig. This enzyme has many pharmacological and industrial uses. In the present study، the enzyme was purified by a simple procedure and its proteolytic activity was assayed on several plant and animal proteins.

Ficin was extracted from unripe fig، precipitated by ammonium sulfate and purified using ion-exchange chromatography on a Carboxymethyl Sepharose column. Proteolytic activities of the purified enzyme were determined in 4 buffering conditions on casein، alpha lactalbumin، beta lactoglobulin and gelatin proteins.

Purified enzymes include two bands with molecular mass of 24 and 26 KDa. Re-sults of proteolytic activity showed that ficin can digest casein. It has moderate hydrolytic activity on beta lactoglobulin and gelatin but ficin can not hydrolyze alpha lactalbumin.

It seems ficin has selective effects on some proteins so it can be a good candi-date for digestion of casein and making related drugs.

Introduction & This research was designed to investigate and compare the effective-ness of stimulant therapy (Ritalin)، neurofeedback، parental management training and interac-tion of the treatments on the improvement of Attention Deficit Hyperactivity Disorder (ADHD)، and quality of mother-child communication. This is a pseudo-experimental research with pretest-posttest de-sign including ADHD children living in Tehran; 40 subjects were randomly selected from clients of child psychiatric/psychological clinic، and then placed in 4 intervention groups based on objectives of the research. The subjects were measured by Conner''s Parenting Scale-48 and Parental Stress Index before and after the interventions. Recruited data were analyzed by ANCOVA. The findings of the research reveals that there is a significant difference among the treatments on improving conduct and attention/concentrationproblems; in other words، interaction of the treatments caused more therapeutic effect than other treatments. Also، there was no significant difference among the treatments on improving psychosomatic problems، impulsivity، anxiety، parent reinforcement، parental attachment، and parental competency. Finally، interaction of treatments and then ritalin had the most therapeutic effect compared to other treatments.

Introduction & Initial information is necessary for decision and policy making. A weak information system leads to poor decision-making but the accuracy of data registration and collection can be a valid supporter for assessing health system and management deci-sions in programming. For the first time، we checked the accuracy of the data col-lected from the households in the health centers in Hamadan In this field study، 1825 household files selected by two-stage sampling were included in census of 2011. To access to the households'' files، among 19 health centers which have health homes، nine centers were randomly chosen، and then sample size was divided by proportional stratified sampling. After determination of the list of households، the researchers extracted households’ information from family files. Then we visited the se-lected households to assess the accuracy of the data registration. Based on the results، most misreporting and registration problems were observed in birth date (n=122 or 6. 68%)، backyard status of their houses (n=103 or 5. 67%)، smoking status of the participants (n=98 or 5. 37%) and level of education (n=89 or 4. 88 percent)، re-spectively. In this study، the lowest rate of inaccuracy in registration of data was observed in follow-up care of tuberculosis patients (n=1 or 0. 06%)، vaccination program follow-up for children under 6 years (n=3 or 0. 17%) and female population residing in the households (n=4 or 0. 22%)، respectively. The results showed that the overall accuracy of the collected data was 98. 22%. In the current system of health statistics of Hamadan، data collection are done based on forms، in which the definitions of some terms may be unclear، or the interviewers may have different interpretations of the definitions. Comparing the results of this study with those of other studies indicates that the accuracy rate of data collection and registration in Hamadan health centers is relatively high.

Introduction & Chronic hepatitis B and C will result in limitation of physical and mental functions which in turn reduce the quality of life (QOL) of the patients. The aim of this study was to determine the quality of life among chronic hepatitis B and/or C patients in Hamadan province from March 2011 to March 2012. A case- control study was done using SF-36 questionnaire (Persian ver-sion) scoring system for 64 chronic hepatitis B and/or C patients referred to Hamadan He-patic Clinic and they were compared with 120 controls referred to the Blood Transfusion Center in Hamadan. Different variables including gender، marital and job status، education and location were compared between the two groups. In addition، the correlation of QOL with age، type of hepatitis (B or C)، habit history، type of habitation، admission history، period of diagnosis، number of children and the stage of treatment were assessed among chronic hepatitis B and C patients. All scores of the QOl among chronic hepatitis patients were significantly lower than those of control group (P<0. 05)، and also the QOL of chronic hepatitis QOL of chronic hepa-titis group was significantly higher than that of the case group (P>0. 05) but QOL among farmers in the case was higher than that of the control. The lowest score in chronic hepatitis patients related to emotional function (26? 39)، and the highest score was seen in pain vari-able (55? 27) The score of QOL in the end of the treatment was high (49? 20) however، the difference was not significant among patients based on treatment steps. According to this study، we suggest that despite of new treatment and care strategies; chronic hepatitis B and C patients still have lower QOL.

Introduction & In the last decade، indiscriminate self medication has increased in our country that can lead to many complications. The aim of this study was to determine the causes of self-medication among Hamadan province pharmacies visitors. This cross-sectional study was conducted among 428 Hamadanprovince pharmacies visitors in the spring and summer of 2012. Sampling was conducted by classifi-cation with proportional assignment between pharmacies in different cities in Hamadan prov-ince. The data collected by questionnaires were described using SPSS-16. Pain medications (29. 9%)، antibiotics (20. 6%) and anti-cough and cold medications (12. 6%) had the highest rate of consumption. Previous use of medication، symptoms im-provement (32. 2%) and similar prescription (25. 3%) were the main reasons of self-medication among the participants. Considering the high prevalence of self medication، designing and implementing educational programs is essential to enhance perceived risks of self-medication between dif-ferent groups of society.

Adrenocortical carcinoma is a rare and severe malignant tumor that in 60% of cases are functional and the most common clinical manifestation is Cushing''s syndrome with a progressive course. The only treatment is surgical removal of the entire tumor and effec-tiveness of medical treatments، including mitotane and chemotherapy for survival is still questionable. Case Report: A 36-year-old man with progressive muscle weakness، high blood pressure، and sudden heart failure is presented. In laboratory tests، hypokalemia، hyperglycemia، increased cortisol، increased serum estradiol and DHEAS were observed. There were an adrenal mass and multiple lung and liver metastases on imaging studies and CT-guided biopsy confirmed adrenal tumor. High serum concentrations of estradiol and cortisol appear to be effective on heart involvement and acute onset of diabetes، hypertension، and severe heart failure require more evaluations in young adults.

Fahr syndrome is a rare phenomenon of idiopathic calcification of the basal gan-glia in the brain that is accompanied with psychiatric symptoms such as delusions، hallucina-tions، depression and neurological motor and cognitive deficits. This syndrome is acciden-tally diagnosed on brain CT scans of patients with mental disorders. Case Report: Our patient was a 35 year old man with persecutory delusions، visual and auditory hallucinations admitted to Baharan hospital in Zahedan in 2012. On mental status examination، he showed persecutory delusions، psychomotor retardation، lack of eye and verbal contact، slow affection، depression، sleep and appetite disturbance and sexual dysfunction. IQ test revealed subnormal and MMPI proved psychopathology with schizoaf-fective symptoms. In paraclinical studies، symmetric and extensive calcification of brain structures was reported، Despite all laboratory indices such as serum calcium and phosphorus were within normal range. According to his history، mental state examination and clinical evaluation the diagnosis of Fahr''s syndrome was made. The patient was treated with olanzapine 1mg and citalopram 20mg daily.