Journal of Arak University of Medical Sciences

Evaluation of the role of alendronate in prevention of steroid-induced osteopenia in ALL and NHL in children

Afsaneh Akhondzadeh

Background: Osteopenia is a common and sometimes disabling consequence of the treatment of common neoplastic diseases, such as acute lymphoblastic leukemia (ALL) and lymphoma in children. The aim of the present study was to evaluate the preventing effects of alendronate on steroid-induced osteopenia in children with ALL and non- Hodgkin’s lymphoma (NHL).

Materials and Methods: In this clinical trial, 30 children with ALL and NHL were purposefully selected. All patients received the same induction chemotherapy protocol. Then they were randomly divided into two matched groups. All of them received equivalent supplement of 400 IU/d vitamin D and 30-40mg/kg/d calcium. The patients of the case group received 35mg/week alendronate for 6 months as well. Lumbar spine and whole body bone densitometry were performd before and after intervention and Z score was calculated for all patients.

Results: The mean age of the studied population was 6.11(±3.36) years and 15 of the children (50%) were male. There was no statistically significant difference in lumbar spine and whole body bone densitometry and Z score before and after intervention between the two groups (p>0.05). The improvement of bone densitometry and Z score were seen in both groups after intervention which was more in the case group but it was not statistically significant (p>0.05).

Conclusion: Administration of 35 mg/week alendronate for 6 months does not cause significant improvements in bone densitometry variables in children with ALL and NHL.

The Comparison of the Effects of Halothane and Lidocaine Infusion on Bispectral Index System (BIS)

Seyedeh Masomeh Hosseini Valami

Background: Familiarity with different methods and medications in anesthesia and producing sufficient depth of anesthesia are very important in anesthesia practice. Due to the central analgesic and sedative effect of lidocaine in the presence of the sufficient blood level, it can be used for general anesthesia. This study was carried out to compare the effect of halothane with lidocaine infusion on BIS during maintenance of anesthesia.

Materials and Methods: In this randomized double-blind controlled clinical trial, 66 patients scheduled for elective inguinal herniorrahaphy were randomized into two equal groups. For maintenance, one group received halothane (1%) with O2-N2O and another group received lidocaine infusion (100 &mug/kg/min). BIS was checked every 5 minutes for half an hour. Statistical analysis of data was done by Chi-square and T-test through SPSS software. P-values less than 0.05 were considered meaningful.

Results: Mean of BIS was 65.72 in the lidocaine group and 56.7 in the halothane group during the first 30 minutes. There was a significant statistical difference between the two groups (p<0.05).

Conclusion: Mean of BIS in lidocaine group was higher than that in the halothane group. If this indicates the presence of a light level of anesthesia, increasing the dose of hypnotics and opioids leads to an increase in the depth of anesthesia. However, since there is not any device for monitoring the effect of opioids on the central nervous system and the level of anesthesia, simultaneous monitoring of BIS and hemodynamic parameters seems to be a more reasonable idea.

Role of Retinoic Acid in Neural Patterning of Mouse Embryonic Stem Cells

Mohsen Sagha

Background: Retinoic acid (RA) is a vitamin A derivative and one of the most important inducing signals in vertebrates that is involved in differentiation, morphogenesis, apoptosis, and reproduction. This study was done to evaluate the role of RA in in vitro neural patterning of mouse embryonic stem cells (mESCs).

Materials and Methods: In this experimental study, upon formation, embryoid bodies (EBs) from mESCs, Royan B1, were induced by 1 µM RA for four days and then plated for eight days. Untreated EBs were considered as the control group. Finally, in both groups, neural induction and patterning of EB-derived neural cells were evaluated by using immunostaining, flowcytometry, and RT-PCR methods.

Results: RA induced neurogenesis in ES cells, from which 35% showed to express MAP2. RT-PCR analysis also indicated that RA-treated neural cells derived from ES cells could at the same time express Mash1, Pax6/7, and Dbx1/2 as dorso-ventral (DV) pattering markers and Hoxb4, Hoxc5, and Hoxc8 as the rostro-caudal (RC) axis markers.

Conclusion: RA induces in vitro neural induction along with neural patterning of ES-derived neural cells in DV and RC axes. Keywords: Mouse embryonic stem cells, neural patterning, retinoic acid

Comparison of the Effect of Mefenamic Acid and the Hydroalcoholic Extract of Urtica Dioica on the Volume of Heavy Menstrual Bleeding in Students at Azad University of Babol (2011-2012)

Nourossadat Kariman

Background: Heavy menstrual bleeding is one of the leading causes of low quality of life and iron deficiency anemia in women of reproductive age. This study was conducted to compare the therapeutic effects of mefenamic acid and the hydroalcoholic extract of Urtica dioica on the volume of bleeding in heavy menstrual bleeding.

Materials and Methods: In this clinical trial, 90 women with heavy menstrual bleeding were selected and after a control cycle for evaluating the primary bleeding volume, using Excel software, were randomly allocated to Urtica dioica or control groups. Both groups were subjected to mefenamic acid treatment with 500 mg every 8 hours, from the first day to the end of bleeding, up to seven days, for two consecutive cycles. In Urtica dioica group, in addition to mefenamic acid, Urtica dioica capsules, five per day, two in the morning, two at noon, and one at night (every eight hours), from the first day to the end of bleeding, up to seven days, were prescribed. In the control group, instead of Urtica dioica capsules, placebo of Urtica dioica was prescribed with the same order. Data on the amount of bleeding (using PLBAC chart) was checked and compared by SPSS software.

Results: The amount of bleeding before and after treatment, between and within groups, was compared. The obtained results showed that the amount of bleeding reduced significantly in both groups after treatment (p=0.001). The reduction of bleeding amount in the Urtica dioica group was significantly higher than that in the control group (p=0.010).

Conclusion: It seems the extract of Urtica dioica can be effective in reducing the amount of bleeding in women of reproductive age with heavy menstrual bleeding. This drug, due to its short course of prescription, fewer side effects, and not having hormonal effects, seems to be an effective drug for treating heavy menstrual bleeding.

Comparison of Concentrations of Lipoprotein (a) and Serum Lipids Profile in Patients with Subclinical Hypothyroidism and Euthyroidism

Karon Shah Ebrahimi

Background: Subclinical hypothyroidism is the compensatory stage before overt hypothyroidism. In overt hypothyroidism, risk of ischemic heart disease increases due to elevation of lipoprotein (a) as atherogenic agent, but evidence for subclinical hypothyroidism is one of the controversial issues in researches. According to the atherogenic lipoprotein (a) and other serum lipids, this study is conducted to compare the serum lipoprotein (a) and other serum lipids in patients with subclinical hypothyroidism and euthyroidism.

Materials and Methods: In this descriptive - analytic study, 90 persons (60 with subclinical hypothyroidism and 30 euthyroid state) are participated and these referred to Imam Reza and Taleghani Hospitals which are located in Kermanshah. The sampling method is selected with available sampling methods. After differentiating data by age, sex and underlying disease (liver, kidney, drugs), then they were subjected to determination lipoprotein (a) and other serum lipids profile tests.

Results: In both cases and controls, 16/7% were men and 83/3% were women. Based on results, there is no significant difference between serum lipoprotein (a), triglycerides, cholesterol, HDL and LDL in both statistical groups (p>0.05). Also there is no association between lipoprotein (a) and other serum lipids (p>0.05).

Conclusion: Serum levels of lipoprotein (a) and other serum lipids in young patients with normal weight with subclinical hypothyroidism is not increase, thus it can be concluded early treatment is not necessary for them.

Assessing the Referral Rate of Family Medicine Program from the First Level to the Second Level Using Funnel Plot in Markazi Province (Iran) in 2011

Maryam Zamanian

Background: Funnel plot is a graphical tool for investigating publication bias in meta-analysis studies. The aim of this study is to introduce another application of funnel plot that is monitoring one of the Iranian family performance indices and determining the position of each health center of Markazi province in terms of patient referral rates by general practitioners to specialists and to compare it with bar and caterpillar plots.

Materials and Methods: In order to draw the funnel plot, the average monthly percent of referrals for each district of Markazi province in 2011 was computed. In this study, Iranian Ministry of Health and Medical Education standard figure of 10% was considered as the limit of referral to the second level of Iranian health services. The 99% confidence interval of the control limit for each district was computed according to 3 standard deviations of the percent of referrals relative to the total patient visits.

Results: Based on funnel plot results, five out of ten districts were in the expected range of referral (Ashtian, Saveh, Tafresh, Khomein, and Komijan). However, in other five districts, the referral rate was greater than the expected rate (Arak, Shazand, Zarandiyeh, Delijan, and Mahallat). Mahallat district had the highest rate of referral.

Conclusion: The funnel plot was more informative than the other two plots Thus, it can be viewed as a useful tool in monitoring health programs throughout the country.

The Nutritional Status of Pregnant Mothers Referring to Hospitals in Arak on the Basis of Anthropometric Measurements and Dietary Intakes

Mahmoud Reza Nakhaei

Background: Nutritional status assessment is a method for nutritional care which aims to determine nutritional needs and to meet nutritional requirements. Pregnant and lactating mothers are considered vulnerable groups. The use of this method, especially for determination of calorie and protein intake has positive effects on growth of neonates. Thus, the purpose of this study is to assess the nutritional status of pregnant women.

Materials and Methods: In this cross-sectional study, 80 pregnant mothers were selected from private and public hospitals in Arak. Data were gathered through a questionnaire including general information concerning pregnant mothers and their nutritional diet. The analysis of dietary intake was done by nutritionist IV software. Data were analyzed using SPSS software.

Results: The average weight gain for pregnant mothers at the end of pregnancy was 10.1kg. The mean of body mass index for the mothers was 22.2 kg/m2, and the average weight for neonates was 2.5 kg. The average energy intakes in mothers were equal compared with RDA, and the average protein intake was greater compared with RDA. There was a significant positive correlation between weight gain during and total body weight at the end of pregnancy (r=0.93) (p<0.01). Also, there was a significant negative correlation between weight of pre pregnancy and percent of weight gain at the end of pregnancy (r=-0.39) (p<0. 01). A significant positive correlation was found between total body weight at the end of pregnancy and birth weight of neonates (r=0.34) (p<0. 01).

Conclusion: Adequate nutritional status of mothers influenced normal body weight in neonates.

Comparison Between the Effect of Fluconazole and Oral Protexin Combination and Fluconazole on the Treatment of Vulvovaginal Candidiasis

Sedigheh Amir Ali Akbari

Background: Genital tract infections are one of the main causes of frequent referrals to gynecological clinics. Vulvovaginal candidiasis is the second common infectious vaginitis. On the other hand, probiotics are microorganisms that can have beneficial effects on the host. Noticing the limited number of studies reporting new treatments for this disease, the present study was designed to compare the effects of the combination of fluconazole and oral protexin and fluconazole on the treatment of vulvovaginal candidiasis.

Materials and Methods: A double-blind clinical trial was conducted on 90 women who were referred to the 12-e-Bahman Clinic in 2011. The patients were randomly classified into "combination of fluconazole and oral protexin" or "fluconazole and placebo" groups. Data were analyzed by descriptive statistics and inferential statistics (t-test, Chi-square test, Fisher’s exact test, and McNemar’s test).

Results: The combinations, fluconazole-oral protexin and fluconazole-placebo, were equally effective in reduction of complaints and symptoms however, the effect of fluconazole-oral protexin on dysuria was more (p=0.02). Also, the fluconazole-oral protexin combination elicited a better therapeutic response (p=0.01). In addition, fluconazole-oral protexin combination treatment demonstrated a better recovery time (p=0.04).

Conclusion: This study demonstrated that complementary treatment with probiotic lactobacillus increased the efficacy of fluconazole in treatment of vulvovaginal candidiasis. Further research, however, is suggested.

The Relationship Between Snoring and Sleep Behavior and Movement Disturbances (SBMDs) in 2-12 Years Old Children in Qom City

Abolfazl Mozaffari

Background: Sleep behavior and movement disturbance (SBMD) is of a relatively high prevalence in children and has a significant impact on their performance in daily activities and quality of life. Snoring, on the other hand, is considered one of the main causes of sleep disturbance in children. This study aims to assess the relationship between snoring and SBMD in 2 to 12 years old children in Qom city.

Materials and Methods: In this case-control study, 100 children with snoring and 100 healthy children were studied over 3 months. The parents took Berlin questionnaire on snoring and childhood sleep questionnaire. Data analysis was done using SPSS software version 18.

Results: There was a significant correlation in mean SBMD between case (13.78) and control (11.45) groups (p<0.001). Independent t-test indicated a significant difference between the case and control groups in the mean of SBMD (p<0.001). Also, significant relationships were seen between snoring and adenotonsilar hypertrophy (p<0.001) and apnea and SBMD (p=0.036), but there was not any relationships between SBMD and age, children less than 7 and more than 7 years old (p=0.231), and severity of snoring and SBMD (p=0.202).

Conclusion: This study demonstrates the importance of sleep disorders, especially snoring and SBMD and their relationship, in children. Sufficient attention to this issue can raise parents and physicians awareness and pave the way for early diagnosis and treatment of these disorders.

Immunogenicity in Guinea Pigs by IpaD-STxB Recombinant Protein

Hosein Honari

Background: Shigellosis is a major global issue of human health. To date, no effective vaccine has been found against Shigella. One of the major virulent factors in Shigella dysenteriae type 1 is Shigella enterotoxin or STx. STxB has immunogenic, adjuvant, or carrier properties. Vaccine candidate antigens can be coupled with this adjuvant for production of an appropriate vaccine. IpaD has a key role in invasion, virulence, and infection by Shigella.

Materials and Methods: In this study, the gene sequences of STXB and ipaD were obtained from gene bank and corresponding genes were prepared as synthetic construct and then transferred to E. coli BL21DE3. By PCR amplification and enzymatic digestion, protein expression levels were assessed. Its protein expression was confirmed by Western blot technique. After extraction by affinity chromatography, the recombinant protein was injected four times to guinea pigs. The pigs were, then, challenged by Shigella felexneri 2a and active toxin of E. coli O157:H7.

Results: The results showed that groups of guinea pigs challenged with 28×LD₅₀of toxin completely survived. Furthermore, guinea pigs were challenged by inducing Shigella felexneri 2a in their eyes. The results showed that the control pigs got cataracts, whereas the immune pigs were in health.

Conclusion: The findings of this study suggest that this recombinant protein is a good candidate for production of a recombinant vaccine against Shigella family.