مجله پزشکی بالینی ابن سینا
سال بیستم شماره 3 (پیاپی 69، پاییز 1392)

Introduction & Cardiovascular diseases are the main cause of death in all countries in the recent century and congestive heart failure (CHF) is the reason of death in most pa-tients. The most common causes of CHF are ischemic heart disease، myopathies، valvular disease and hypertension. Mortality reduction is the aim in CHF treatment. Combination of glucose-insulin-potassium (GIK) has been used in the treatment of acute coronary syndrome and chronic CHF for two decades and different results reported. The current study performed to evaluate the efficacy of GIK to accelerate resolving signs and symptoms in patients with acute CHF. NT. pro BNP and H. s CRP are two components which increase in acute CHF and decrease after treatment. These parameters were evaluated in our clinical trial study. 50 patients admitted with the diagnosis of acute CHF and EF<40% were divided in two groups and the case group received GIK and control group placebo (half saline). Both groups received the classic treatment of CHF and the above mentioned parameters were measured in the first hour and third and fifth day. Appropriate reduction in both parameters، which means good result in treatment، was observed in both groups but without statistical significant difference. GIK has been used with good results in acute MI and chronic heart failure، but in order to prove better efficacy and decrease in mortality in acute CHF more research is needed.

Introduction &

Some studies have reported successful eradication rates using se-quential therapy but more recent studies performed in Asia did not find a similar benefit. Due to inconsistencies in the comparison of standard triple drugs therapy and sequential regimen، in the previous researches we decided to compare these treatments in Persian patients.

This study is a randomized clinical trial، performed in one hundred and forty patients suffering from dyspepsia with indication for H. pylori eradication between No-vember 2010 and March 2012. Patients were randomized in two equal groups. The patients in the first group (standard) were treated by omeprazole capsule 20 mg BID، amoxicillin cap-sule 1 gr BID، clarithromycin tablet 500mg BID for 14 days; while the patients in the second group (sequential) were treated by omeprazole capsule 20 mg for 10 days، amoxicillin cap-sule 1 gr BID for 5 days، then clarithromycin tablet 500 mg and tinidazole tablet 500 mg BID for other 5 days. 4-6 weeks after the treatment، we compared the eradication of H. pylori be-tween the two groups by urease breathe test with C14.

H. pylori infection was successfully cured in 57/70 (81. 43%) with a 10-day sequen-tial therapy، in 60/70 (85. 75%) with the standard fourteen-day triple therapy، respectively.

We detected no significant differences between the 10-day sequential eradication therapy for H. pylori and 14-day standard triple treatment among the patients.

Introduction & The World Health Organization estimates that 1. 3 million Tubercu-losis cases occur in children each year. Due to the lack of sputum examination in children، the diagnosis of pediatric tuberculosis is based on three criteria; close contact history، chest x ray finding and positive tuberculin skin test.. On the other hand، BCG vaccine that in our na-tional immunization schedule، routinely administered is able to make a positive skin test. The aim of this study is to evaluate the tuberculin skin test reactions in children who have re-ceived BCG vaccine. This analytic cross sectional study was performed on 564 cases of 1-6 year old children previously vaccinated with BCG at birth and chosen by cluster sampling. Data of each child obtained for age، sex and retained BCG scar. In the second step informed parental consent was obtained then TST was administered by injecting 0. 1 ml of 5 units puri-fied protein derivated (PPD) into the volar surface of the forearm. The TST induration was measured 48-72 hours after injection of PPD. TST administration and measurement of indu-ration were done by trained healthcare workers. Data were analyzed with One-Way ANOVA and t-test by SPSS version14. In our study، out of 564 children، 288 were male and 278 were female. 319 (56. 4%) cases didn’t show any reaction. Out of all، 228 cases (40. 6%) had TST reaction 1-10mm 9 cases (1. 6%) had TST 10-15 mm and only 8 cases (1. 4%) had TST induration>15 mm. Mean indurations diameter was 2. 9±1. 8 mm and according to the definition of positive TST only 12 cases (2. 1%) had positive TST. There was no statistically sexual preference in TST reaction but with increasing of age induration diameter of TST decreased meaning that there is an inverse relationship between age and TST reaction. According to our results، BCG vaccination at birth did not have any major effect in tuberculin skin test and each child with positive TST after 2 year age should be evaluated carefully.

Introduction & Study of bone quality before treatment is very important. The aims of this study were to assess bone quality with density values obtained by cone-beam computed tomography (CBCT) and to determine the correlations between bone density and primary stability of dental implants. In this experimental in vitro study 32 implants were inserted into fresh sheep bone. The bone densities of implant recipient sites were determined by CBCT. The maximum insertion torque value of each implant was recorded and stability was measured by Osstell. Spearman’s correlation coefficient was used to evaluate the correlations among the variables. The mean density value، insertion torque، and Osstell value were 1481. 78? 166. 614، 74. 69? 16. 33 and 73. 78? 4. 025 N/cm2 respectively. Statistically no significant correlations were found among the variables. The bone quality evaluated by CBCT showed no correlation with the primary stability of the implants.

Introduction & All-trans retinoic acid، a derivative of retinoids، is widely used to in-duce prolifferation، differentiation and apoptosis in normal، precancareous and cancerous cells. Cisplatin، an effective drug for cancer treatment، induces apoptosis via cross-linking to DNA. Previous studies on ovarian and melanoma cancer cells have showed synergistic ef-fects of cisplatin and retinoic acid. Our aim is to study such synergistic effect on gastric de-rived cell line، AGS. In this experimental study gastric cancer cell line was cultured with dif-ferent concentration of retinoic acid and cisplatin and their combination. The cell death was evaluated with clonogenic assay and Acridine Orange/ Ethidium Bromide staining. The results showed that all-trans retinoic acid had not significant effect on cell death in gastric cancer. The results showed that high doses of retinoic acid and cisplatin can cause cell death via necrosis and early apoptosis، respectively. The plates were treated with the combination of 10 µM retinoic acid and 5، 10 µg cisplatin، and more cell death were ob-served (P<0. 001). It seems that، suseptability of this cell line to retinoic acid is dose depend-ent. In this study، we concluded that the combination of retinoic acid and cisplatin was more effective on cell death than cisplatin and retinoic acid alone.

Introduction & Oral lesions have important diagnostic and prognostic roles in HIV infected patients. It seems that HAART reduces the prevalence of oral lesions. The aim of the present study was to evaluate the prevalence of oral lesions in HIV infected patients on/not on HAART. In this retrospective study، 40 HIV infected patients receiving HAART and 40 who were not on HAART were evaluated in Behavioral Consultation Center in Kermanshah. The diagnosis of the oral lesions was recorded by using established presump-tive clinical criteria. Data were gathered and analyzed using SPSS version 16 by chi-square test. In the current study 80 HIV infected patients with mean age of 38. 86 were chosen. 72. 5% and 27. 5% of participants were male and female respectively. The most common le-sions in those receiving HAART were hairy leukoplakia، hairy tongue and oral pigmentation. However the prevalence of these lesions had declined in comparison to those who were not on HAART but the difference was not significant (P>0. 05). Although comparing lesions in the two groups showed no significant difference، the total number of lesions significantly reduced in patients receiving HAART (P=0. 046) According to the results of the present study using anti retroviral therapy leaded to reduction in the oral lesions in HIV infected patients. However، more research in this field seems necessary.

Introduction & Heat shock proteins help the cells’ ability to keep their structures against different stresses. The purpose of this study was to investigate the effect of one ses-sion continuous and intermittent aerobic exercise on blood responses of HSP72، cortisol and creatine kinase (CK). This study is semi-experimental in which 21 male student athletes were divided in continuous group (n=7)، intermittent group (n=7) and control group (n=7). Exer-cise protocol of continuous group included 1 hour running with 80% maximum heart rate in-tensity and that of intermittent group was 3 stages of 20 minute running with the same inten-sity as of continuous group. Blood sampling of basal، pre exercise، immediately after exer-cise and 90 minutes after exercise were gathered and the amounts of HSP72، cortisol and CK، were measured by ELISA، RIA and Enzymatic methods respectively. The data was analyzed with one way ANOVA and repeated measure analysis of variance at P? 0. 05 significance level. HSP72 levels in the continuous group and intermittent group despite an increase in the average did not show a statistically significant difference. Changes between the groups were significant in immediately after exercise and 90 minutes after exercise (P. values respectively 0. 017 and 0. 002). CK changes in continuous group were significant but cortisol changes in different stages hadn’t significant difference Exercise with its role associated with cortisol and CK will stimulate HSP72 and continuous exercise will make further increase in HSP72 and CK increasing leads to a greater HSP72 response.

Introduction & Gastro-esophageal acid reflux disease (GERD) is the most common disease of the digestive system in the world and Iran. The main Symptom of GERD is heart-burn. GERD reduces the quality of life and leads to esophageal adenocarcinoma. The aim of this study was to determine the prevalence of heartburn in students of Hamadan University of Medical Sciences. This study was a cross-sectional descriptive study on 388 randomly se-lected students. They had the inclusion criteria. The survey tool included questionnaire (demographic questions and symptoms of heartburn and acid regurgitation). Data were ana-lyzed with descriptive statistics. Chi square and t- tests were used to examine the relation-ships between variables. Out of the 388 students، 270 (69. 6%) reported symptoms of heartburn. The relation-ship of BMI، sex، marital status، body mass index، ethnicity of individuals، fruits and fresh vegetables، and most food with heartburn was not significant (P> 0. 05) but the relationship was significant with age، smoking and smoking hookah، the college، semester، tea consump-tion and pickles، spices، smoked and canned foods، soft drinks and high-fat (P <0. 05). A lot of people in this study had heartburn. But they were not concerned about its cause and suitable treatment.

Introduction & The management of mutilated primary incisors in early childhood caries is a clinical challenge. This study''s purpose was to compare the resistance strength of 3 different types of posts in restoring broken primary incisors: (1) composite posts، (2) ortho-dontic wire posts and (3) quartz fiber posts. This semi experimental in vitro study was performed on 27 extracted human primary maxillary incisors. The coronal portion of specimens was sectioned 1-mm above the cementoenamel junction. Complete pulpectomy was performed for all specimens. The post space was created using a straight fissure bur approximately 3 mm. Samples were randomly divided into 3 groups. Group 1 (composite posts and composite core)، group 2 (quartz fiber posts and composite core) and group 3 (orthodontic? wire posts and composite core). Mounted specimens were subjected for fracture strength on an instron testing ma-chine at 45 angles. Mean fracture strength value for group 1 was 248. 9± 72. 36 N، group 2 was 446. 7±116. 4 N and group 3 was 365. 6± 31. 3. This result showed significant differences among the three groups. Quartz fiber posts showed greater fracture strength for extensively damaged primary incisors than composite posts and orthodontic wire posts.

Introduction & The plasminogen activator inhibitor-1 (PAI-1) is an important regula-tor of fibrinolysis at sites of vascular injury and has been implicated in the pathogenesis of thrombosis at the arterial sites. The aim of this study was to examine the effect one month aerobic exercise and vitamin E consumption on plasminogen activator inhibitor-1. In this quasi experimental study thirty inactive healthy collegiate fe-males voluntarily participated in the study and were randomly divided into three groups: training with vitamin (endurance training accompanied by 400 IU/day vitamin E)، vitamin (400 IU/day vitamin E) and control (No vitamin and no exercise training). Endurance train-ing included 4 weeks of running on treadmill، 3 days a week. The duration and intensity of exercise in each session for the first week was 30 minutes at 65% of maximum heart rat and for the three remaining weeks were increased by 5 min and 5%، respectively. Two blood samples were taken before and 48 hours after training for measuring PAI-1 antigen. Data analysis revealed that PAI-1 antigen increased in control group significantly (P? 0. 05)، while PAI-1 decreases and increases in training with vitamin، and vitamin groups، respectively were not statistically significant. Changes in PAI-1 were significantly different among the three groups (P? 0. 05)، but using analysis of covariance it was revealed that these differences were due to differences in resting levels of PAI-1. Based on the findings of present study، it could be concluded that short-term regular training combined with vitamin E consumption and chronic vitamin E consumption singly result in improvements in fibrinolytic system due to decrease or prevention of PAI-1 antigen.

Orbital pseudotumor، also known as idiopathic orbital inflammatory syndrome (IOIS)، is a benign، non- infective inflammatory condition of the orbit without identifiable local or systemic causes. The disease may mimics a variety of pathologic conditions. We pre-sent a case of pseudotumor observed in a patient admitted under the name of orbital celluli-ties. Case Report: A 26-year-old woman reffered to our hospital with the history of left ocular pain and headache 2 days before her visit.. Ophthalmological examination of the patient was normal except for the redness and lid edema، mild chemosis and conjunctival injection. Gen-eral assessment was normal but a low grade fever was observed. She was hospitalized as an orbital cellulitis patient. She was treated with intravenous antibiotics. On the third day، sud-denly diplopia، proptosis in her left eye and ocular pain in her right side appeared. MRI re-vealed bilateral enlargement of extraocular muscles. Diagnosis of orbital pseudotumor was made and the patient was treated with oral steroid. She responded promptly to the treatment. Antibiotics were discontinued and steroid was tapered in one month period under close fol-low up. The clinical features of orbital pseudotumor vary widely. Orbital pseudotumor and orbital cellulitis can occasionally demonstrate overlapping features.. Despite complete physical examination and appropriate imaging، sometimes correct diagnosis of the disease would be difficult

Multiple endocrine neoplasia type IIa (MEN IIa) is an autosomal dominant syn-drome characterized bypheochromocytoma، medullary thyroid carcinoma and hyperparathy-roidism. Pheochromocytoma approximately occurs in 50% of patients with MEN IIa. This tumor has the capacity to produce ACTH ectopically and becomes manifest like Cushing syndrome،although it is very rare. Case Report: We report a 26-year-old woman patient with severe muscle weakness، skin le-sions in extremity، hypertension، new onset diabetes and in the laboratory data hypokalemia، metabolic alkalosis، high serum level of cortisol، metanephrine، normetanephrine، calcitonin and bilateral adrenal mass in computed tomography as the first clinical manifestations of an ACTH-secreting pheochromocytoma. In the patients with hypertension، new onset diabetes and hypokalemia Cushing syndrome and pheochromocytoma should always be ruled out.