Journal of

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Introduction: It is felt that there is an information void regarding the effect of macronutrients on cardiovascular responses such as cardiac output,heart rate,stroke volume,systolic blood pressure,diastolic blood pressure and mean arterial pressure, therefore, this study was designed to explore these effects at Shaheed Beheshti University in 2001. Materials & Methods: This clinical trial was carried out on 10 healthy subjects and 15 type 2 diabetics. Cardiovascular responses defined before and 15,30,60,90 and 120 minutes after the intake of wheat starch,sodium caseinat and olive oil. The calorie level was 10 kcal per kg of ideal body weight. Statistical analyses were done by analysis of variance with repeated measures, independent - t test and dependent- t test. Results : The age of healthy subjects (4 women ,6men)was 36.6±5.8(mean±SD)yr,body mass index was 24±1.2Kg/m² , age for the type 2 diabetics (4 women ,11men)was 38.9±5.2(mean ±SD )yr , body mass index was 24±1.6Kg/m². In healthy subjects, macronutrients caused marked and gradually developing postprandial increases in cardiac output, while in type 2 diabetics,cardiac output had no changes. In healthy subjects, systolic blood pressure and mean arterial pressure rose after the ingestion of macronutrients (P<0.05). In type 2 diabetics after the ingestion of macronutrients there was a fall in systolic blood pressure and mean arterial pressure(P<0.05).In both groups, diastolic blood pressure showed no changes . Conclusion: There were considerable differences in the speed of development and the pattern of the cardiovascular responses between type 2 diabetics and healthy subjects (P<0.05).Finally we conclude that diabetes in the early stages probably involves the cardiovascular system.

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Introduction: Hearing loss is the most common sensory neural defect in humans, affecting 1 in 1000 neonates, with over half of these cases predicted to be hereditary in nature. Most hereditary hearing loss is inherited in a recessive fashion, accounting for approximately 80 % of non-syndromic hearing loss (NSHL). Mutations in GJB2 gene are major cause of inherited deafness in the European and American populations. To date, more than 90 mutations have been reported in this gene. Although most of these mutations are rare but 35delG mutation is the most common deafness causing allelic variant of GJB2 in most parts of the world. Methods: In this project, 120 probands from 120 families with ARNSHL in Yazd Province were studied. Mutations Screening of GJB2 was performed by Amplification Refractory Mutation System (ARMS)-PCR for detection of 35delG and then all samples excluding 35delG homozygote were analyzed by DHPLC and Direct Sequencing. Results: GJB2-related deafness was present in 7.5% of this population. We identified 4 mutations (35delG, 312del14, 314del14 and 167delT) and 4 polymorphisms (V153I, V27I, E114G and R127H) in this study. Conclusion: Prevalence of GJB2 mutations in this population was lower than American and European populations, and also other provinces of Iran. Interestingly, 312del14 rather than 35delG was the most common mutation found in the population under study. 56.25 % of GJB2 mutant alleles carried 312del14 mutation. To date, this frequency has not been reported in any of the world populations.

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Introduction: Post operative pain is an unpleasant experience following various stimuli resulting in a response by the body. This process causes physiological disturbances in all of the systems of the body. Methods and Materials: In this clinical trial , 60 upper abdominal surgery patients were selected post operatively and divided into two groups of 30 patients each. In one group, bupivacaine intrapleural injection and in the other group, opioid injections were administered in the recovery room. Pain intensity with visual analogous scale was measured 6 hours after the operation. Results: There was no difference in VAS according to patient's age, sex, and type of operation, but in the Bupivacaine injected group, VAS score was significantly lower. Conclusion: Intrapleural injection of bupivacaine is more useful and reliable than opioids for controlling post operative pain.

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Introduction: Type II Diabetes is one of the most prevalent endocrine diseases in the world that results from a combination of insulin resistance and ß-cell failure. Regarding importance of nutritional factors in management of diabetes, this study was designed to explore the effect of sesame oil on blood glucose and lipid profile in type II diabetic patients at Yazd Diabetes Research Center in 2007. Methods: A quasi-experimental study was conducted on 25 patients with type II diabetes mellitus (age: 51.5±6.28y BMI:27.3±3kg/m2 disease duration:7.08±5.03y Fasting blood glucose level: 181±51.9mg/dl). Subjects received 30 g/day sesame oil for 6 weeks. Sesame oil was supplied to the patients, who were instructed to use it in place of other cooking oils for 42 days. Plasma glucose, glycated hemoglobin (HbA1c), lipid profiles [Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG)] were measured at baseline and after 45 days of sesame oil substitution. 24 hours dietary recalls were obtained at the start , middle and end of study. Data was analyzed using analysis of variance with repeated measures and paired t-test. Results: Following 42 days intake of sesame oil, there were significant decrease in FBS (181±51.93 vs 154±39.65 mg/dl), HbA1c (9.64 ± 2 vs 8.4 ± 1.74 percent), TC (226.68 ± 31.4 vs 199.8 ± 37.87 mg/dl), LDL-c (123.9 ± 34.56 vs 95.53 ± 32.54 mg/dl) compared to pre-treatment values. (P <0.05) . Blood TG level decreased after intake of sesame oil but this difference was not significant (P=0.2).Also, the changes of HDL-c levels were not significant (P=0.1). Conclusion: Sesame oil consumption results in considerable decrease in blood sugar, HbA1c and blood lipid levels (TC and LDL-C) in type II diabetics.

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Introduction: Intensive care unit is one of stressful wards for patients and stress creates some alterations in physiologic indicators of patients. So it is necessary to use a low expense and comforting method to stabilize physiologic indicators. The purpose of the present research is to determine the effect of foot massage on physiologic indicators including pulse, respiration, mean arterial pressure, temperature and arterial blood oxygen saturation. Methods: This research was a quasi experimental study and a clinical trial with repeated measures in which 46 patients with brain stroke hospitalized in intensive care unit of Tajrish Shohada Hospital in Tehran were studied. Information was collected 10 minutes before and 10 and 30 minute intervals after foot stroke massage on the second, third and fourth days of ICU admission. Data was analyzed with repeated measures ANOVA statistical method. Results: Findings showed that after 5-minute foot massage, pulse rate, respiratory rate and mean arterial blood pressure significantly decreased (P<0.001) and spo2 increased (P<0.001). Decreasing temperature was significant but alterations were little and clinically it can be said that body temperature had no alteration and approximately remained constant. Conclusion: Findings showed that parasympathetic activity after foot massage results in alteration of various body physiologic responses, relaxes patients and decreases their anxiety. Therefore anxiety of patients can decreased with using a simple, low expense and non invasive method and can stabilize physiologic indicators and decrease effects of vital signs instability.

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Introduction: The aim of this study was diagnosis of premature rupture of membranes in suspected patients by measurement of prolactin and B-hCG levels in vaginal washing in order to reduce perinatal mortality and morbidity. Methods: The study included 211 pregnant women who were referred to the emergency of Imam Hossein hospital at 28-38 weeks of pregnancy for leakage or prenatal care from April, 2007 to April, 2008. The expulsion of fluid from the cervix was evaluated and fern and nitrazin tests were done. B-hCG and prolactin levels of vaginal washing fluid were measured. The presence of 2 of 3 parameters of fern test, nitrazin and cervical fluid was defined as absolutely premature rupture of membranes. Mann-Withney U-test was used for analysis. The Roc curve was calculated. Results: There were 132 patients in PROM group and79 patient in the control group. The average age in the PROM and control groups was 26.9‌±6.08 and 26.2±4.84 years, respectively(P=0.074). Both groups were matched for parity and gravidity. Prolactin levels in PROM group were 2930±3737mIU/l versus 23.18±120mIU/l in the control group (P=0.000). B-hCG was 439.78±1867mIU/l in PROM and 17.72±30mIU/l in control group (p=0.000). Sensitivity and specificity of prolactin according to cut-off of 16.0 mIU/l was 79.41% and 96%, respectively. Sensitivity and specificity for B-hCG with cut-off point of 12.5 was 69.85% and 69.33%, respectively. Conclusion: The measurement of prolactin and B-hCG levels in patients with suspected premature rupture of membranes can help in decision-making and treatment.

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Introduction: Up to 12% of patients undergoing coronary artery bypass graft have pulmonary complications. Smoking can cause a six-time increase in pulmonary complication after major surgery. The most common pulmonary changes after CABG are decrease in FRC, VC and atelectasis. In this study, the effect of oral N-acetyl-cystein in reduction of severity of hypoxemia and atelectasis in current smokers who smoked more than 10 packs/year and had undergone CABG was evaluated. Methods: In the study, 54 current smoker patients were selected randomly and allocated to two drug and placebo groups. In the study group, 300mg N-acetyl-cystein (ACC long) containing vitamin C was prescribed two times a day from 4 days before operation up to 3 days after surgery and in control group, effervescent vitamin C tablet was prescribed as placebo. Patients with body mass index more than 35, NYHA class IV, those who needed intra aortic balloon pump and those who needed reoperation due to bleeding were excluded from the study. In all patients, spirometry was done in the preoperative visit and FEV1/FVC was determined. Induction and maintenance of anesthesia was similar in all patients. Arterial blood gas samples were obtained immediately after anesthesia induction and 4 to 6 hours after extubation. Chest X ray was taken before, 6 to 10 hours after extubation and 3rd postoperative day. Severity of atelectasis was also measured. Quantitative & qualitative data was analyzed by ANOVA and Chi-square tests, respectively. Pvalue<0.05 was considered as statistically significant. Results: Both groups were similar with respect to demographic data including ejection fraction, NYHA class, FEV1/FVC, cigarette smoking and Lima harvesting. The ratio of arterial oxygen pressure to fraction of inspiratory oxygen Pao2/FIo2 was not significantly different after induction but this difference was strongly significant (Pvalue<0.005) after extubation. Duration of mechanical ventilation was significantly shorter in patients who had N-acetyl-cystein, but duration of ICU stay was similar. Linear and segmental atelectasis was significantly less in the study group. Conclusion: N-acetyl-cystein can improve oxygenation and ventilatory parameters in pathological lungs, but further studies with different doses and different situations are needed .

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Congenital hepatic fibrosis (CHF) is a rare disease that primarily involves hepatobiliary and renal systems. It is characterized by hepatic fibrosis, portal hypertension and renal cystic disease. We present a 22 years old man with fever, abdominal pain, icterus and hematemesis. On complete work up of the patient and liver with kidney biopsy, the diagnosis was congenital hepatic fibrosis.

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Introduction: Most women experience significant changes in quality of life(QOL) during and after menopausal and few researchers have quantified these changes. The aim of the present research was to assess quality of life(QOL) and determine factors related to its impairment among postmenopausal Iranian women. Methods: This cross-sectional study was conducted by cluster sampling method among 300 post-menopausal women in Yazd, Islamic Republic of Iran in 2008. Data was collected using the menopause quality of life questionnaire(MENQOL) by interview. Content validity and Cronbach's alpha were used respectively to ensure the validity and reliability of the questionnaires. Inferential and descriptive statistics via SPSS.15 software were used for data analysis. Results: The mean scores for quality of life in various dimensions were as follows: vasomotor dimension 12.34±4.71, psychological dimension 18.15±8.89, physical dimension 41.09±16.37 and in sexual dimension it was 10.97±6.52. There were significant relationships between psychological , physical and sexual dimensions and education level, economic level ,health level (p < 0.05) regardless of Spearman’s correlation, There were significant relationships between ,physical and sexual dimensions and number of pregnancies and age(p < 0.05). Conclusion: Menopause causes a decrease in quality of life that is dependent on work and other sociodemographic variables. It is therefore necessary to develop effective interventional programs to improve quality of life after menopause.

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Introduction: Multiple Sclerosis is a chronic disease of central nervous system. Disease is more common in young adults and females and causes neurologic symptoms and signs. Cytokine IL-7 is a 25– kDa glycoprotein that has an important role in Lymphopoiesis. Interleukin VII receptor gene has been identified to be associated with multiple sclerosis, so its assessment is important. Methods: We investigated 60 Iranian patients with clinically definite MS and 60 normal healthy controls with negative family history for MS. After blood sampling, DNA was extracted from the whole blood, then we used 2 sets of primers for promoter and exon 4 of IL-VII gene. These fragments were amplified by PCR technique and early screening was performed by SSCP technic in the presence of control samples. Then different patterns with control samples were sent for DNA sequencing. Results: We observed one SNP in promoter. Most of the alleles of the patients were homozygote. There were two 2 SNPs and two sequence variations in exon 4 as P.H165H and P.V138I, which has been submitted in European Bioinformatics Institute under the access number of FR863587. Conclusion: Further studies on control group will be required to reveal the effects of these SNPs on the ILVII-R α protein and they can probably be useed as a biomarker for early diagnosis of MS.

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Introduction: The aim of this study was to assess the relationship between serum level of aminoterminal pro B-type natriuretic peptide and prognosis in patients with respiratory distress in emergency ward of Rasoul Akram Hospital(Tehran, Iran). Methods: In this cohort study which was conducted in the emergency ward of Rasoul Akram hospital, after considering inclusion ad exclusion criteria, 62 subjects with respiratory distress entered the study. Blood samples of these patients were used for assessment of NT-Pro-BNP levels Finally, the survival of the patients was defined after 15 days and the levels of NT-Pro-BNP was compared between alive and dead patients. Data was analyzed by SPSS (Ver. 16). Results: Mean NT-Pro-BNP level was 8141.41(SD=10403.95). 10 patients (16.1%) died (8 females and 2 males) and 52 patients (83.9%) survived after 15 days. Mean NT-Pro-BNP level was 4674.34 (SD=6680.23) and 26170.20 (SD = 7073.80) among survived and died patients, respectively and the difference was statistically significant (p<0.001). Conclusion: Serum NT-Pro-BNP level can predict the prognosis of patients with respiratory distress due to such diseases as pulmonary edema, COPD exacerbation and CHF.

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Introduction: In spite of improvements in composite function, marginal microleakage in deep composite restoration is still considered as a challenge due to unstable bond between composite and dentin. Therefore, this study aimed to investigate effect of applying different materials on marginal microleakage in posterior composite restoration. Methods: A standard distal box was prepared on 80 human premolar. The gingival floors were 1 millimeter under CEJ. The specimens were divided to four groups. In the first group, 1 millimeter amalgam was used as the first increment in proximal box on gingival floor, in the second group flow able composite, and in the third group, RMGI were used. Other cavities were filled by condensable composite. In the fourth group (control), all the cavities were filled only by condensable composite. The specimens, after 6 months of storage, were placed under cyclic load (10000 cycle- 80 N- 1 Hz), and then were immersed in 2% methylene blue for 6 hours. Afterwards, the specimens were sectioned in the middle of restoration. Extension of dye penetration at the cervical margin was examined under a stereo microscope at 25x magnification and the leakage was evaluated by Fuks degree. The study data were statistically analyzed using the Mann- Whitney U-test (p<0.05). Results: Microleakage was observed in all the groups. The third group demonstrated the most leakage and the least was for the first group. No statistically significant difference was observed between the groups. )p-value =0.689) Conclusion: In cavities with gingival floor under CEJ, different filling methods have no effect on marginal sealing.

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Introduction: Monocytes can interact with platelets due to their surface molecules such as P-selectin glycoprotein ligand-1 (PSGL-1), and form monocyte-platelet complex. In the present study, the effects of platelets interaction of platelet concentrates (PCs) and peripheral blood monocytes were investigated in vitro as a model to predict the probable interactions of these cells and consequently activation of monocytes.

Methods: In this experimental study, units of whole blood and PCs were prepared from Tehran Blood Transfusion Center. After isolation of monocytes from the whole blood, these cells were treated with PC- derived platelets. The activation of monocytes was assessed before and after treatment by the analysis of the respiratory burst of monocytes using dihydrorhodamine 123 (DHR-123). The study data were analyzed using the non-parametric test of Wilcoxon.

Results: The purity of monocytes was determined as 86.1±2 using NycoPrep method. The respiratory burst of monocytes was increased after exposure with platelets. In fact, the difference was significant when platelets were used on the 5th day of storage (P=0.001).

Conclusions: The study findings revealed that platelets have an efficient capacity to stimulate and activate monocytes. The possible involvement of molecules in the interaction of platelet-monocyte demand to be further studied in future.

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Introduction: Intraosseous mucoepidermoid carcioma of the jaw is cosidered as a rare primary central tumor wich rarely occurs within children.

Methods: A 12-year-old girl, referred to the dentistry school of Yazd, participated in this study, who complained of swelling in right posterior region of maxilla. She did not have any pain, paraesthesia, and tenderness. Moreover, cervical lymphadenopathy was absent. Intraoral examinations revealed buccal and palatal expansion without ulcer and in color of mucosa, which extended from 14 to 18 region in the right side of the maxilla and palatal tilt in theeth 14, 15, 16. On radiographic examination, CT scan showed destruction of medial wall and inferior border of maxillary sinus, hard palate and buccal cortical plate. Histopathological features confirmed mucoepidermoid carcinoma. Right partial hemimaxillectomy was performed as the treatment option.

Discussion: Pathogenesis of these tumors is still unrecognized. Neoplastic transformation of the epithelial lining of maxillary sinus or minor salivary gland can cause intraosseous mucoepidermoid carcinoma.

Conclusion: As the study findings revealed, due to invasive process of these tumors specifically in maxilla, early diagnosis and radical resection play an important role in regard with eradication of this tumor as well as improvement of such patients, and their survival rate.

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Introduction: Since the disability may be associated with functional impairments and the fact that exercise can reduce disability and maintain the function of individuals, so, we decided to conduct a study on the effects of resistance training on shoulder strength, pain and function in wheelchair users with impingement syndrome of shoulder.

Methods: In this randomised clinical trial study, In this randomized controlled intervention study, 20 wheelchair users with spinal cord injury suffered from shoulder pain (the mean age (39/3±6/4)) were chosen and divided randomly into two groups: the control (age:37/5±5/81, height:82/25±4/20, weight:77/25±12/98) and experimental groups (age:42/1±8/11, height:84/95±4/7, weight:74/23±11/39). Before performing the training programs, the pretests of the level of muscle strength, pain and function were measured for both the control and experimental groups. The experimental group performed selected exercises for 8 weeks, 3 sessions a week, each session lasted 60 minutes. After performing the training course, post-tests were administered in similar circumstances in both groups.  Data were analyzed by using covariance and dependent t-test.

Results: The results showed that the experimental group had a significantly improvement in the strength of external shoulder rotator muscles (from 7/66±1/38 to 10/71±1/73), pain (from 52/48±7/96 to 30/31±5/24) and the shoulder function (from 55/49±6/66 to 72/88±6/52) (P≤0/05).

Conclusions: This study showed that strength training has improved the strength, pain and shoulder function in wheelchair users, so participation in exercise training programs can be suggested for these persons.

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Introduction: Salmonella is one of the most important causes of gastroenteritis in humans. Salmonella enterica Serovar Typhimurium has many hosts in addition to humans, and its prevalence in the community is high. The aim of the study was comparing the genetic diversity of Salmonella enterica serovar Typhimurium isolated from human fecal samples by both of ERIC-PCR and BOX-PCR method.
Methods: In this cross-sectional study, 60 Salmonella enterica serovar Typhimurium were obtained from the human fecal samples. These strains were identified by standard microbiological and biochemical tests. Then, ERIC-PCR and BOX-PCR were carried out for determination of molecular relatedness of Salmonella enterica serovar Typhimurium using specific primers.
Results: The results showed that all 60 Salmonella enterica serovar Typhimurium were separable using ERIC 1, ERIC 2 and BOXAIR. In electrophoresis, 2-11 bands with 20-3200bp for ERIC-PCR and 2-10 bands with 200-1500bp for BOX-PCR were observed. Therefore, 13 different clusters (C1-C13) in ERIC-PCR and 21 different clusters (C1-C21) in BOX-PCR were identified.
Conclusion: The results showed that Salmonella enterica serovar Typhimurium strains were non-homolog. Therefore, ERIC-PCR and BOX-PCR methods are appropriate methods for molecular typing of Salmonella strains and determine the original infection source for the epidemiological survey as well as infection prevention program.

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 One of the challenges that medical sciences has long been facing is to find the best therapeutic method for the damaged tissues. The main purpose of tissue engineering and regenerative medicine is the development of biological implant or engineered tissues to repair, regenerate or replace the damaged tissue and maintain the organ function. At the moment, a lot of research has been done in the field of nanotechnology on the application of nanomaterials in medicine, because the surface of these nanomaterials increases with decreasing their size with change or increases in effect concommitantly. In recent decades, the production of medical textiles (Including nano fibers) has been provided good services to the regenerative medicine. In the field of biomedical applications, it is often necessary to combine biological and medical sciences with materials science and engineering. One of the most important application of tissue engineering is the usage of nanofiber matrix as scaffolds for the cell growth and proliferation. In this paper, various types of engineered scaffolds and their functions have been presented and evaluated.
 

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Introduction: Today, issues related to meaning and spirituality are accepted as essential parts of chronic diseases’ experience as they may seriously affect people's attitude towards their ego, illness and future. The present study was conducted to investigate the spiritual health of the patients with gastrointestinal cancers and its association with general health.
Methods: This cross-sectional study was conducted on 128 patients with gastrointestinal cancer ≤54 years with knowledge of their disease type at Imam Reza Hospital and Shahid Madani Hospital in Tabriz, Iran. Samples were selected using the simple sampling method. The spiritual status of the patients was evaluated using the Paloutzian & Ellison (1982) questionnaire & General Health Questionnaire (GHQ-28) and the checklist designed by the researchers, containing demographic characteristics. Data analysis, including the descriptive analytic statistics, independent t-test, correlation coefficient and Pearson correlation coefficient and regression model were done using SPSS V16 software.
Results: Regarding Pearson correlation coefficient, there was a significant association between general health and spiritual well-being (p=0.003, r=0.71). Also, there was a direct and significant association between spiritual health in the religious section (p=0.01, r=0.51) and spiritual well-being in the existential (p=0.001, r=0.68) with general health.
Conclusion: Based on the results of this study, it could be concluded that most cancer patients have high spiritual health, this makes the patient more adaptable to their illness.
 

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Introduction: The aim of the present study was to compare the effectiveness of cognitive behavior therapy based on exposure and response prevention on the patients with contamination obsessive-compulsive disorder (OCD) and scrupulosity.
Methods: The method was semi-experimental pretest-posttest design by control group. Sixty OCD participants who were suffering from scrupulosity and contamination OCD were diagnosed by means of diagnostic interviewing, Yale-Brown Obsessive-Compulsive Scale and Penn inventory of scrupulosity. They were selected through convenience sampling method and were assigned in two experimental groups and one control group (each group 20). The cognitive behavioral therapy based on exposure and response prevention was performed on the subjects in nine individual sessions for 45 minutes for each experimental group. The data were analyzed using SPSS Inc., Chicago, IL; Version 16 by the multivariate analysis of covariance.
Results: The results of multivariate analysis of covariance and Bonferroni post hoc tests showed that cognitive behavioral therapy based on exposure and response prevention were effective in decreasing OCD in the experimental groups compared to the control group (0.001≥ P). Bonferroni post hoc test showed that there was a significant difference between the scrupulosity group and the contamination group and control group on the obsession variable (0.05 < P). There was no significant difference between the contamination group and the scrupulosity group on the compulsion variable (0.15 < p).
Conclusion: The findings suggest that cognitive behavioral therapy based on exposure and response prevention could help alleviate symptoms of obsessive-compulsive disorder in both religious and contamination OCD.

 

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Introduction: Bone is one of the tissues that have a true potential for regeneration. However, sometimes the bone defects are so outsized that there is no chance of bone self-repair and restoration or the damage is such that it is not possible to repair with medical or surgical interventions. In these situations, bone grafts are the treatment of choice, but due to several obstacles, including limitation in graft preparation and immunological incompatibility, bone grafts face some limitations. In these cases, with the help of regenerative medicine, the bone damages could be repaired. Regenerative medicine provides a new approach for large bone defects by cell therapy and tissue engineering. As, sometime the damaged tissues are so wide that there is no chance of self-repair, the engineered structures help to accelerate the tissue natural repairing. This review focuses on the importance of stem cells and scaffolding for bone tissue engineering. Also, the important characteristics of bone tissue engineered scaffolds like structure, porosity, stability, surface chemistry, bone induction and different met hods of scaffold fabrication are discussed. Up to now, various natural and synthet ic compounds were used for bone tissue engineering, including biopolymers, which are categorized to natural, synthet ic and ceramics. Bioceramics work as effective compound scaffolds in bone tissue engineering. From them bioglasses are one of the important materials which enhance the attachment, proliferation and differentiation of bone cells. Therefore, the current paper discussed biopolymers, as the effective compounds for regeneration of bone tissue.