مجله پزشکی بالینی ابن سینا
سال بیست و یکم شماره 3 (پیاپی 73، پاییز 1393)

Introduction & Most women in the course of their lives will experience menstrual bleeding. Some have bleeding almost all the time. Different approaches have been proposed and drugs with fewer side effects are preferred. The aim of this study was to compare the ef-fects of herbal medicines (fennelin & vitagnus) and mefenamic acid in the treatment of severity of menstrual bleeding. This double blind clinical trial was carried out in one hundred and five students with severe menstrual bleeding at Hamadan University of medical sciences in 2010. The students were randomly grouped in four groups and herbal medicines of fennelin & vitagnus, mefenamic acid and placebo. The severity of menstrual bleeding was detected by the Higham table during one cycle before and two cycles after the intervention. The data analyzed by SPSS/16 and P<0.05 was considered significant. Demographic characteristics of the students were similar in the four groups. There was not a significant difference in the mean of severity of menstrual bleeding during the one cycle before intervention between the four groups, but the difference was significant dur-ing the two cycles after the intervention. Mefenamic acid reduces menstrual bleeding com-pared with vitagnus & fennelin and showed no statistically significant difference. All three drugs; mefenamic acid, fennelin and vitagnus have been effective in reducing menstrual bleeding. The two herbal medicines (vitagnus and fennelin) can be used as effective and safe drugs to reduce menstrual bleeding. (Sci J Hamadan Univ Med Sci 2014; 21(3):171-176)

Introduction & Light curing and composite placement is effective on microleakage prevention. The aim of the present study was to compare the effect of two incremental com-posite placement and two light curing methods on microleakage of composite class one resto-rations. In this experimental study 60 maxillary premolars after class one prepa-ration were assigned to 4 different groups according to light curing method (soft or full power) and two incremental methods (horizontal or oblique) 1. Horizontal incremental placement with full power cure 2. Horizontal incremental placement with soft star cure 3. Oblique incremental placement with full power cure and 4. Oblique incremental placement with soft start cure. After etching and bonding, teeth were restored with Tetric Ceram HB composite. Samples were thermocycled and immersed in 0.2% fuchsin solution for 48 hours. Samples were sectioned buccolingually and evaluated under stereomicroscope (40×). Micro-leakage was scored as follow; 0: No microleakage, 1: Microleakage till enamel edge, 2: Microleakage between dentin edge and floor of the cavity and 3:Microleakage extended to the floor of cavity or pulp. Data was analyzed by SPSS software version 16 using Kruscal Wallis and Mann Whitney U test at the significant level of 0.05. There was a significant difference between four experimental groups, micro leakage (P=0.000). The mean micro leakage of group 1 was significantly different from groups 2, 3 and 4 (P<0.001) and between groups 3 and 4 (P<0.05). Additional, the mean micro leakage of group 2 had no significant difference with the mean scores of groups 3 and 4 (P>0.05). Restorative material placement technique and curing mode was effective on the microleakage of class 1 composite restoration, however, curing mode was more effective on reduced composite microleakage compared to the placement technique. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 177-184)

Introduction & Reducing in muscle strength of the shoulder girdle is a side effect of breast cancer treatment. The aim of this study was to determine the effect of 4 weeks of resistance and mobility training on the shoulder girdle strength of women with breast cancer. In this randomized clinical trial study twenty-seven postmenopausal women with breast cancer (mean age, 51±5.96 years), (mean height, 158.08±7.2 cm), (mean weight, 63.08±11.06 kg) who underwent surgery, chemotherapy and radiation therapy, were purposefully selected and divided into two groups of intervention and control. Intervention group performed 4 weeks (4 sessions per week) of resistance training with flex-band and stretch training at home, but the control group did not participate in any sports or physical program. Muscle strength before and after intervention was measured using a handheld dynamometer. The data were analyzed using ANCOVA. Significant differences were seen between intervention and control groups in shoulder flexion, scapula abduction and upward rotation, shoulder internal rotation, shoulder external rotation, shoulder horizontal adduction and scapula depression and adduction strength, as all strength variables increased after 4 weeks exercise. Since strength plays an important role in ADL performance and shoulder girdle function in breast cancer survivors, it seems that muscle strength improvement following combined home based exercise program can help patients after treatment to easier and faster rehabilitation. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 185-195)

Introduction &

Bone morphogenetic proteins are a group of cytokines that belongs to superfamily TGF?. These proteins play an important role in evolution of many of organs and tissues through germinal period followed by amending and rebuilding of bone tissue and car-tilage. The aim of this study was to clone and expression analysis of BMP-2 gene in E. coli bacteria.

In this experimental study the sequence of cDNA related to the mature peptide of human morphogenetic protein-2 (BMP-2) in E.coli was synthesized and cloned in a PET system. After sequencing, recombinant plasmid pET28a/BMP-2 was transformed into the expression host, E.coli BL21 (DE3). The transformed bacteria were cultured in LB me-dium containing kanamaycin antibiotic at 37° C for O/N. Then, induction with IPTG took place. The expression was evaluated by reverse transcriptase PCR and SDS-PAGE followed by western blotting to confirm its identity. The observed band on SDS-PSGE showed the presence of the expressed protein at the 14k Dalton segment which was confirmed by west-ern blotting technique.

The gene sequence was amplified by PCR. After gene and plasmid preparation, lega-tion was performed. Sequencing confirmed accuracy of cloning. Protein expression was demonstrated by RT-PCR and SDS-PAGE. Results were confirmed by western blotting.

In this study over-expression of this recombinant protein was achieved in a pro-karyotic system. Different concentrations of inducer were applied and harvesting was per-formed in different times after induction. The best expression was detected in 4 hours after induction with a concentration of 1mM IPTG. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 196-202)

Introduction & Prostatic carcinoma is the most common malignancy throughout the world among the males over middle age and the second leading cause of cancer-related deaths in western countries. The currently most established prognostic factors in prostatic carcinoma are histological grade (Gleason system) and tumor stage. Various new prognostic factors that have been suggested to provide additional information include proliferative activ-ity (Ki-67 labeling index),over expression of the oncogene bcl2 and Her2-neu and inactiva-tion of the p53 tumor suppressor gene. The aim of this study was to compare p53, Ki-67, bcl2 and Her2-neu biomarkers frequency in low grade and high grade prostatic carcinoma. In this cross sectional study, 76 cases of prostatic carcinoma patients with different combined Gleason score were studied after they had been admitted to the pathology wards of Beheshti and Be’sat hospital in Hamadan city between 2006-2011.Age, Combined Gleason's score and histologic grade record in each case. p53, Ki-67, bcl2 and Her2-neu ex-pression were investigated immunohistochemically. The biomarkers of p53, Ki-67, bcl2 and Her2-neu between low grade and high grade prostatic carcinoma were compared. The tumors were considered low grad when Gleason score was 6 or less, and high grad when the Gleason score was 7 to 10. This investigation revealed that the frequency of p53, bcl2, Her2-neu and Ki-67 ex-pression is 68.4%, 34.2%, 78.9% and 52.6%, respectively. In this study 81.6% of high grade and 55.3% of low grade tumors were immunoreactive for p53 (P=0.013). Over expression of bcl2 was found in 36.8% of high grade and 31.6% of low grade of prostatic carcinoma (P=0.405). 81.6% of high grade and 76.3% of low grade carcinoma were positive for Her2 –neu (P=0.390). Ki-67 positivity was found in 68.4% of high grade and 36.8% low grade car-cinoma (P=0.006). The most important findings of our study are that the frequency of p53 and Ki-67 proteins expression is correlated with high grade of prostatic carcinoma. However, there was not any significant difference of bcl2 and Her2-neu biomarker in the two grades of prostatic carcinoma. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 203-210)

Introduction & Cryptosporidium is one of the most important zoonotic and oppor-tunistic protozoa and can cause diarrhea in those with impaired immune systems, as well as the children. Considering the high sensitivity of children against infection caused by crypto-sporidium, its zoonotic nature and lack of treatment, this study aimed to determine the prevalence of cryptosporidium infection in children under 10 years old, referred to the health care centers of Hamadan district. This study was conducted in 2013 on 420 children (222 males and 198 females), who were referred to urban and rural health care centers in Hamadan district. Stool samples were examined using formalin-ether method and modified Ziehl-Neelsen staining technique. The results were analyzed with chi-square test. Of the 420 children studied, 2 individuals (0.47%) (A 16-month-old boy and a 6-year-old girl) were infected with cryptosporidium spp. The infection was observed only in rural areas and in children that were in direct contact with the animals. The results of this study showed a presence of cryptosporidium in rural areas compared to urban areas and in children in contact with animals. Therefore it is necessary to promote the public health awareness of rural population. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 211-217)

Introduction & The ability of dentist to select appropriate tooth color is one of the most important factors in cosmetic dentistry. The aim of this study was to examine the cumu-lative error in reconstruction of colors from shade selection to crown fabrication. In this cross-sectional study, Easyshade2 device was used to investigate the changes of color. 50 dentistry students were invited to select the color. L, a, b parameters of Vita lumin color samples were measured by Easyshade2 and the differences between them and L, a, b defined in the device memory for the color sample were recorded. Students se-lected the color using Vita lumin color samples. Tooth color was recorded by Easyshade2 and after PFM fabrication, color of FPD was measured by laboratory the results were ana-lyzed using one way ANOVA and student t-test. The mean error of the students compared with the control was about 9. Mean error of the students in comparison with the glaze was 7.6. The maximum cumulative error was re-lated to the student's error with the control (gingival) (?E= 14.4) and minimum error was re-lated to the cumulative student error with the glaze (incisal) (?E= 5.7). Differences be-tween the students and Easyshade2, Easyshade2 and the glaze or the students and the glaze were statistically significant (P<0.05). There are significant differences between the selected colors of the students, easy-shade2 and color of FPD was fabricated by the laboratory. The maximum cumulative error was related to the selection of color of gingival third by the students compared with the control. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 218-224)

Introduction & Alopecia areata is the most common skin disease that presents as areas without hair and may affect any hair bearing area of body. Different reports about ocular alterations in patients with alopecia areata are presented. The aim of this study was to evaluate the ocular alterations in patients with this disease. In this descriptive - analytic study, 251 patients with alopecia areata were studied. Patients data including age, sex, age of disease onset,first site of involvment, disease duration, number of relapses,family history of atopy, and disease severity were recorded. Eye examination by an eye specialist was performed in all patients, and results were recorded. Findings were analyzed with SPSS 16 software, and using one way ANOVA and? 2 statisti-cal tests. The mean age of patients in this study was 24.86 ± 5.92 years. Of the 251 patients, 200 (79.9%) had no ocular alterations and 51 (20.1%) showed visual alterations. Most of ocular alterations observed in this study were pigmentary changes of retina seen in 20 patients (8%). There was no significant correlation between disease severity and ocular changes. The results showed that ocular alterations were seen in some of patients with alopecia areata and not correlated with disease severity, mean patient age, patient gender, family history of atopy and allergy, the mean age of disease onset, mean number of relapses, and first site of involvment. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 225-230)

Introduction & BTEX compounds (Benzene, Toluene, Ethylbenzene, Xylene iso-mers) are among the most consumed and dangerous volatile organic compounds which can cause adverse health effects in humans. The water pipe smoke contains numerous toxic compounds such as BTEX compounds.The aim of this study was to evaluate the personal exposure to BTEX compounds at traditional restaurants of Hamadan. This cross sectional study was descriptive- analytical. To sample the BTEX compounds in the air inhaled during smoking of 25 people at 12 traditional restau-rants, the NIOSH 1501 method was used, and the samples were analyzed by gas chromatog-raphy. The mean duration water pipe per serving was 52.23±9.28 min. The mean tempera-ture and relative humidity at the traditional restaurants were 33.24±1.72° C and 35±0.095%, respectively. The mean concentration of Benzene, Toluene, Ethyl Benzene,O,M and P-xylene in the exhaled air ofthe subjects were 1495, 2806, 2559, 810, 932 and 1146 ppb, respec-tively. The concentration of Benzene, Toluene and Ethyl Benzene in subject's inhaled air during smoking was more than the limit determined by Environmental Protection Agency. In this study we found that water pipe smoke can cause absorption of high levels of BTEX compounds through inhalation and can be considered as one of the main sources of exposure to these compounds which is followed by the increased risk of adverse health ef-fects. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 231-239)

Hemangioma is the commonest tumor of vertebral body and is seen in 10% of people as an incidental finding but in less than 1% becomes symptomatic. The commonest sign is pain and rarely causes neurological symptom or pathologic fracture. Case Report: The patient was a 55 year old man with the history of back pain for 2 year and a progressive gait disturbance within 3 weak before admission. Both legs were spastic on ex-amination and an aggressive hemangioma of T7 vertebrae with epidural extension was dis-closed in imaging. He had simultaneously asymptomatic hemangioma of T11. He underwent neoadjuvant embolization and anterior corpectomy and both anterior and posterior fixation. After 3 months the patient’s operative myelopathy symptoms resolved and after one year follow-up he was asymptomatic. Despite the high prevalence of vertebral hemangioma it rarely causes myelopathy and needs surgical treatment. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 240-244)

Pulmonary tuberculosis (TB) is caused by the bacteria Mycobacterium tubercu-losis (MT). Rare cases of pulmonary thromboembolism along pulmonary or extra pulmonary TB were reported during the first weeks of anti-tuberculosis therapy. Case Report: A 28-year-old woman was admitted with complaints of ankles pain, fever, noc-turnal sweating, dyspnea and productive coughs. Patchy consolidations were seen on her chest x-ray and three sputum positive acid-fast bacillus (AFB) smears were reported in her investigations. The patient underwent anti-tuberculosis drugs and her clinical condition was improving while at the eight day of the treatment, the patient conditions suddenly deterio-rated and suffered from severe dyspnea, chest pain and haemoptysis. Moreover, sinus tachy-cardia with T waves inversion in precordial leads (V1-V3) were seen on the electrocardio-gram. Diagnosis of pulmonary thromboembolism was confirmed on computed tomography contrast angiography. In addition, echocardiography and color Doppler sonography of the lower extremities were normal. There was no evidence for hypercoagolopathy impairments in the patient. The patient was treated with warfarin and anti-tuberculosis drugs for six months, and she was completely cured and became smear negative at the end of the therapy. As a result, although pulmonary thromboembolism is a rare complication of TB it should be considered in the patient with TB particularly during the first weeks of anti-TB treatment when respiratory symptoms exacerbations occur.

Richner-Hanhart syndrome (tyrosinemia type II) is a rare autosomal recessive disease associated with high serum tyrosine levels caused by the deficiency of tyrosine ami-notransferase enzyme. Case Report: We report a 7-year-old female patient with complaints of hyperkeratosis lesions of palms and soles which started 3 years ago. Chromatography of serum amino acids showed a tyrosine level of 120micromole/L (normal range: 22-87). She had normal ophthalmologic examination and mild mental retardation was detected. One month after the tyrosine- and phenylalanine-restricted diet, her tyrosine level dropped to 42 micromol/L level, her keratotic lesions subsided, and a symptomatic relief in learning was achieved. Tyrosinemia type II should be suspected in patients demonstrating dermatologic signs, especially palmoplantar keratosis, associated with bilateral pseudodendritic corneal lesions unresponsive to antiviral therapy and mild to moderate mental retardation, although our patient without ophthalmic lesions is a very rare case of this syndrome. (Sci J Hamadan Univ Med Sci 2014; 21 (3): 251-254)