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Introduction:  Atypical  antipsychotic  drugs  in  comparison  with  typical  antipsychotics  produce  fewer  extra  pyramidal  symptoms  at  clinically  effective  doses.  However  there  has  also  been  a  growing  number  of  reports  of  new  onset  diabetes  mellitus  in  patients  receiving  these  drugs. The  aim  of  this  study  was  the  comparison  of  diabetes  mellitus  incidence  in  mentally  janbazan  (Iran-Iraq  war  veterans) undertaken  typical  with  atypical  antipsychotics.
Materials  and  Methods: In  this  study  the  incidence  of  new  onset  Dm  was  assessed in 200  subjects  referred  to  Amiralmomenin  clinic, Isfahan, Iran. Every  patient  was  included  in  this  study  if  he  was  receiving  atypical  or  typical  antipsychotic  drugs  or  combination  of  both  types, at  least  for  one  year.  Sampling  was  convenient. Fasting  blood  sugar, triglyceride  and  cholesterol  before  taking  the  drugs  was  documented  in  their  records. New  onset  DM  was  defined  based  on  126  mg/dl  or  more  for  FBS  which  was  confirmed  with  GTT.  For  comparison  of  FBS  mean  pre  and  post  interventions, NIDDM  incidence, the  relation of  background  variables  with NIDDM  and  the  relation  of  NIDDM  incidence  with  dosages  and  duration  of  drug  therapy, paired t-test, chi-square, logistic  regression  and  ANOVA  were  used.
Results: Subjects  were  divided  into  three  groups  based  on  the  type  of  drugs  used  135 patients  using  typical  antipsychotics  (chlorpromazine, perphenazine, haloperidol, …), 39 patients  using  atypical  antipsychotics  (clozaoine  &  riaperidon)  and  26  patients  receiving  combination  of  drugs. It  was  found  that  DM  developed  following  treatment  in  three  groups  were  12.8%, 6.7%  and  3.8% respectively.  There  was  no  significant  differences  between  three  groups  regarding  the  incidence  of  new  onset  DM.
Conclusion:  Findings  showed  that  patients  treated  with  antipsychotic  drugs  had  a  moderately  increased  risk  of  DM especially  with  atypical  antipsychotics.  It  is  suggested  to  evaluate  every  patients  before  treatment  for  risk  factors  of  DM.
 

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Introduction: Acute  renal  failure (ARF)  is  one  of  the  relatively  incident  complications  in  surgical  emergency  wards  and  is  defined  as  increasing  serum urea  and  creatinine   and  decreasing  GRF. In  this  study  we  investigated  acute  renal  failure  incidence  in  patients  admitted  to  emergency  surgical  ward.
Materials  and  Methods: This  is  a  cross  sectional  analytical  study  in  which  all patients  with  primary  diagnosis  of  emergency  surgery  (traumatic  or  non traumatic) admitted  in  emergency  surgery  ward  were  selected. After  history  taking  and  physical  assessment  patients  having  history  of  kidney  disease  were  excluded. Urinalysis, BUN  and  creatinine  tests  were  performed  for  all  samples. Data  was  analyzed  by  SPSS  software.
Results: In  this  study  2100  patients  (1280  male)  were  assessed  during  a  10  month  period. 5.66%  of  samples  had  some  degree  of  ARF. 1136  patients  undergone surgery  due  to  accidents  and  trauma  (72%  multiple  trauma  and  28%  single  trauma) and  964  patients  due  to  nontraumatic  emergencies.  ARF  was  seen  in 6.84%  of  the  first  and  4.25%  of  the  second  group. ARF incidence  in  male  and  female  was  5.6%  and  5.7%  respectively.
 ‍Conclusion: The overall  incidence  of  ARF  in  this  study  was  not  so  different  from  developed  countries.   ARF  was  significantly  more  incident  in  traumatic (especially  multiple  trauma)  and  old  aged  patients.  This  factors  must  be  considered  as  ARF  risk  factors  in  emergency  wards.

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Introduction: Studies showed that following spontaneous epilepsy in rats, the permeability of CA1 region of Hypocampus to calcium is increased. In this study the role of voltage dependent calcium channels on the development of kindling induced by Pentylenetetrazol (PTZ) was investigated in rats.
Materials and Methods: In this experimental study rats were divided into two groups. In the test group, Verapamil (calcium channel blocker) was injected in the Hippocampus (4 g/4 min). After 20 minutes kindling was established by PTZ in subconvulsive dose (37.5 mg/kg ip). Convulsing activities were monitored for 20 min. The control group was the same age and undergone the same procedure exept for the injection, in which ACSF was injected without Verapamil.
Results: Verapamil significantly (p<0.01) reduced the number of needed stimulations to progress from stage 0 to 5 of the convulsion and also significantly (p<0.05) prolonged the fifth stage of seizure.
Conclusion: The results of this study suggested that interahippcampal injection of Verapamil facilitated the Pentylenetetrazol kindling in rats but had inhibitory effects on kindled animals.

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Background: Permanent pacemakers are applied to treat some 2nd and 3rd degree AV blocks. Previous studies have shown the hemodynamic changes that may occur after pacemaker implantation. In this study, we have evaluated these hemodynamic changes from a different view point, with measurement of urinary sodium and blood pressure. Materials and Methods: This is a before and after clinical trial study in which 30 patients, who were hospitalized for permanent pacemaker implantation for the first time in Tehran heart center during 3 years, including 12 women (mean age 62.92 years) and 18 men (mean age 60.07 years), were tested for urinary specific gravity and sodium, blood pressure, blood sodium and potassium, before and after pacemaker implantation. Paired sample T test and Chi Square test were used for statistical analysis. Results: Systolic blood pressure was 136.5 mmHg and 120.6 mmHg before and after pacemaker implantation, (P<0.001). Also, after pacemaker implantation, urinary sodium rose from 83.45 meq/L to 106.61 meq/L (p=0.018). Conclusion: This study is consistent with previous studies, which showed hemodynamic changes after permanent pacemaker implantation including decrease in blood pressure and elevation of serum neuropeptides.

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Introduction: Bronchogenic cysts are rare congenital lesions which originate from ventral foregut and most commonly originated in the central mediastinum. They rarely have symptoms and at the time of diagnosis they usually are large, infectious or complicated. In this study a case report of bronchogenic cyst is reported. Case: The patient to be presented is a 47 years old man with sudden onset of chest pain, severe dyspnea, tachypnea and decreasing right lung sounds. Symptoms of pneumotorax were observed in lung radiography. The patient was treated by inserting chest-tube, but there was no response to the treatment. Urgent thoracotomy was performed. A large single bronchogenic cyst was detected in the right lung parenchyma attached to intermediate bronchus. Complete resection was performed. According to the pathology report, pneumothorax was developed secondary to rupture of the bronchogenic cyst. Conclusion: Lung parenchyma is not a common area for developing bronchogenic cyst but it has special importance because of it's severe complications. Since exact diagnosis is not always possible before surgery, it is necessary to perform resection in all suspicious cases.

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Introduction: Allium Sativum (garlic) is used widely in the world, especially in Iran. This plant is used in cooking foods as an odorant. In Iran it is believed that it is useful for gastrointestinal disorders. So in this study the effect of Allium Sativum extract on acid and pepsin secretion in rat is investigated. Materials and Methods: This experimental study is performed on two groups of rats (12 in each group: control group and allium sativum group). After anesthesia with nesdonal (50 mg/kg, ip), rats had gone under surgical tracheotomy, laparatomy and gasterodeodenostomy. In garlic group Allium Sativum extract (100mg/kg) was introduced into the stomach by gasterodeodenostomy canula. In order to stimulation of acid and pepsin secretion, Pentagastrin was used (25mcg/kg, ip). Stomach secretion was washed out and acid was measured using titerimetery and pepsin using Anson method. Data was analyzed using t-test. Results: Allium Sativum caused a meaningful increase in acid and pepsin secretion in garlic group comparing to control group (p<0.001). Pentagastrin also increased acid and pepsin secretion in control group (p<0.001). Conclusion: Using garlic in nutritional regimen causes an increase in acid and pepsin secretion in those using this plant.

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Introduction: Dehydroepiandrostrone (DHEA) and its sulfate form is an adrenal hormone and is the most common steroidal hormone in body and despite of other adrenal hormones increases with age, so it is called youth fountain. Recently, DHEA is noticed increasingly because of its multiple effects. Its effect on insulin sensitivity is controversial. In this study the relation between Dehydroepiandrostrone (DHEA) level and Insulin sensitivity is investigated. Materials and Methods: In this cross-sectional analytical study, samples were selected among female relatives of diabetic patients referring to Isfahan Endocrine Research Center. They were divided into three groups including diabetic, impaired glucose tolerance and normal glucose tolerance, each 30 persons. In these groups blood sugar, lipid, CBC, Insulin and DHEA-S levels were evaluated and the rate of Insulin sensitivity was determined using Homeostatic Modle Assessment- Insulin Resistance (HOMA-IR) and the relation between insulin sensitivity rate and DHEA in the three groups was compared. Data was analyzed using one way analysis of variance and t-tests. Results: The mean of variables in the three groups of diabetic, impaired glucose tolerance and normal glucose tolerance for DHEA-S was 127, 113, 129 mcg/dl Insulin 7.7, 1.10, 8.3 mcg/ml HOMA-IR 1.6, 3.5, 1.8 and fasting blood sugar 86, 135, 89 mg/dl respectively. Comparison of mean of variables showed that the difference between DHEA-S in groups was not significant. Also there was no meaningful relationship between DHEA-S and blood sugar. In the group with normal glucose tolerance, DHEA-S with HOMA-IR and insulin had a partial meaningful relation (p<0.06). Conclusion: Overally DHEA has no meaningful relation with insulin sensitivity and HOMA-IR, but this relation is meaningful in the three groups and the relation between DHEA-S with HOMA-IR in the group with normal glucose tolerance is partially meaningful.

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Introduction: Post operative pain, nausea and vomiting are common complications after hemorrhoidectomy and cause unpleasant expriences for patients. Today, scientists are increasingly moving forward to find new drugs with fewer side effects and costs to control these complications. So this study was planned to evaluate the effect of Dexamethasone on post operative pain, nausea and vomiting. Materials and Methods: This study was a double blind randomized controlled clinical trial that carried out on 112 patients scheduled for hemorrhoidectomy. Patients were diveded into two groups. Case group received 8mg Dexamethasone and control group received 2 ml normal saline intramuscularly 30 minutes before the operation. The method of surgery and general anesthesia were the same in all patients. Pain and nausea score were recorded using visual analog scale (VAS) and vomiting was recorded by asking of them at 0, 2, 4, 6 hours after operation. The patients were followed for 6 hours after the end of the operation and data was analyzed using t and chi square tests. Results: There was a significant difference between the two groups regarding prevention of post operative pain and nausea (p=0.00001). But there was no significant difference between the two groups regarding prevention of post operative vomiting. Conclusion: The result of this study suggested that injection of Dexamethasone before hemorrhoidectomy can decrease incidence of postoperative pain and nausea but dose not have any effects on postoperative vomiting. Therefore Dexamethasone is recommended before hemorrhoidectomy.

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Introduction: Familial adenomatous polyposis (FAP) is a rare disease with hundreds to thousands adenomatous polyps in large intestine which inherits in the form of autosomal dominant, but 25% of patients have no positive family history. Rectorrhagia and rectal prolapsus are the most prevalent symptoms. Diagnosis is based on clinical findings and results of colon investigation, and prompt colectomy prevents carcinoma in patient. In this article a case report of familial adenomatous polyposis is presented. Case: The patient is a 17 years old teenager, a known case of familial adenomatous polyposis, who was refered with severe obstruction signs of gastrointestinal tract. The disease was diagnosied when he was 5 years old. In 6 years old he was treated by partital colectomy and in 11 years old by total colectomy and ileorectal anastomosis. The patient was investigated by endoscopy and small bowel transit. Because of many polyps in stomach, duodenum and jejunum polypectomy, gastrectomy and duodenotomy were done. Diffuse carcinoma in situ was reported in pathology. Conclusion: Rectal and colonic polyps are rarely obsereved below 10 years old, but rectorrhagia and rectal prolapsus suspects the diagnosis of FAP in children. In the case of dysplasia and carcinoma abdominal pain, anemia and weight loss will be presented. In children with suspecting FAP, screening of extracolonic manifestation and dysplasia should be considerd and elective surgery should be done.

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Introduction: A pseudoaneurysm is a pulsetile hematoma secondary to bleeding into soft tissue, which involves peripheral vessels in the most cases. A femoral artery pseudoaneurysm that is a rare complication, mainly occurs following prior arterial catheterization but it may also be formed with trauma. In this article a superficial femoral artery is reported. Case: The patient is a 24 years old woman who was admitted with a wound in the posteroinferior region of right tight 10 days before her recent referral. The skin of the wound had been repaired. After 1 week pain, progressing swelling in inferior region of tight and knee, fever, shivering and limping were presented. In physical examination, 90 degree flexion of knee, edema, warmth and tenderness in inferior region of tight were observed. Any pulse of dorsalis-pedis and posterior-tibialis was not touched. In the next step blood laboratory test, simple X-ray, Doppler sonography and magnetic resonance imaging (MRI) of right lower limb were accomplished. Finally, with the diagnosis of femoral artery pseudoaneurysm, excision of the pseudoaneurysm with reverse saphenous vein grafting was performed. Conclusion: Pseudoaneurysm should be noticed in patients with history of penetrating trauma and symptoms due to infection. In these cases sonography is necessary to get the exact diagnosis. The size of aneurysm and patient’s symptoms, determine the method of treatment.

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Background: Inappropriate feeding is one of the major causes of malnutrition in children. This study was carried out to get an insight into mothers’ views and beliefs about the role of complementary feeding in children under the age of two. Materials and Methods: In this qualitative study, data were collected through 11 focus-group discussions (FGDs) with mothers, who had children under the age of two, in urban and rural areas of Damavand in 2007. Each FGD was held in the presence of a moderator, two note takers, and an observer. At the end of field work, all notes were collected and coded according to the objectives of the study. Then the subgroups for each objective were obtained, and emerging themes were extracted and reported. Results: In the study, six general themes were identified:(1) The mothers viewed complementary feeding as simple, soft, light foods which are especially made for children (2) the best time for introducing complementary feeding was 6 months of age (3) there were no complementary local foods in Damavand (4) for children under the age of one, a different type of food was separately prepared (5) home-made complementary food was preferred over the ready made type, and (6) children were fed with table food from the first year of life. Conclusion: Despite their sufficient knowledge about the advantages of complementary feeding, the majority of mothers, due to some socio-cultural limitations, had a weak performance. In this regard, in addition to making revisions in current training programs and protocols, providing effective and goal-oriented educational programs for mothers and others who take care of children is strongly recommended.

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Background: Nowadays, the use of inflammatory biomarkers in the diagnosis of appendicitis is on the rise. On the other hand, the role of oxygen free radicals in various inflammatory states has been verified. Noticing the high prevalence of negative appendectomy (9.3-22.2%), the aim of this study was to investigate the level of blood total antioxidant capacity (TAC) as a biomarker for early diagnosis of acute appendicitis. Materials and Methods: In this prospective analytical trial, over a one-year period, 407 patients, with preoperative diagnosis of acute appendicitis who had undergone operation, were studied. After measuring the TAC level, data were analyzed through the analytic ROC curve and parametric mean comparison tests. Results: Of all the patients, 298 were identified with appendicitis. TAC levels in adult female and male groups were respectively 663.9±164.75 and 752.58±167.37 µm/L which revealed a significant difference (p<0.0001). Also, in children, the mean of TAC level in perforated appendicitis sub-group was significantly greater than those in gangrenous and suppurative groups. Conclusion: TAC level can be used as a predictive factor for the diagnosis of perforated appendicitis in children however, it cannot be used as a biomarker for the diagnosis of appendicitis. Because of the significant difference existing between the level of TAC in male and female patients, further studies are suggested to investigate the level of inflammatory biomarkers with respect to menstrual cycle in women.

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Background: Diagnosis of acute appendicitis is one of the challenges that surgeons face in the emergency ward. Although Alvarado score has been recommended in the diagnosis of acute appendicitis, this criterion has some limitations in terms of age, sex, and race. The aim of this study was to evaluate the effectiveness of Alvarado score in the diagnosis of acute appendicitis based on the age and gender. Materials and Methods: In this cross-sectional study, 407 patients who underwent operation with the preoperative diagnosis of acute appendicitis from June 2008 to August 2009 were included in the study. The patients’ data were recorded by the investigators. The data were compared by parametric tests. The sensitivity and specificity were determined by the optimal cut-off point on ROC curve using MedCalc software version 10.2.0.0. Results: The optimal cut-off point for women was lower than men (6 and 7, respectively). The rate of negative appendectomy in the group with Alvarado scores 9 and 10 was 11.8%, while the negative appendectomy rate in the other two groups with Alvarado scores 7 and 8 and 5 and 6 were 29.9% and 52.8%, respectively. Conclusion: The diagnostic value of Alvarado score of 8 and less in physical examination is lower than the abdominal tenderness exam alone. Also, the cut-off point for the diagnosis of acute appendicitis in women should be considered lower than that in men. On the other hand, the cut-off point in adolescents and children is higher than adults.

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Background: Enterotoxigenic Escherichia coli bacterium is the most important bacterial agent causing diarrhea. Specific virulence factors, such as enterotoxins and colonization factors, distinguish ETEC from other classes of diarrheagenic E.coli. In this study, heat-labile toxin was purified which could be utilized for anti-toxin assay in GM1 gangelioside receptor-ELISA based method and for identification of ETEC producing toxin. Materials and Methods: In this experimental study, bacterial strain producing heat-labile toxin was first cultivated for production and purification of toxin. Then supernatant soluble proteins were precipitated with ammonium sulfate and purified using biochemical methods. Finally, purified protein was dialyzed against Tris 0.02 mM pH 8 and analyzed on gel electrophoresis. GM1 gangelioside receptor-ELISA based method was used for detection and assessment of the purified toxin. Through this method, the effect of anti-recombinant heat-labile toxin B subunit neutralization on heat-labile toxin was investigated. Results: Toxin purification was revealed by the presence of 12 and 28 KD protein bands. This study demonstrated that anti-recombinant heat-labile toxin B subunit antibody can detect the purified toxin and can inhibit its binding to GM1 receptor up to 80%. Conclusion: Purification of heat-labile toxin and gangelioside receptor-ELISA assay can be used for accurate detection and epidemiological study of clinical isolates.

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Background: Acute pancreatitis is a common cause of abdominal pain, without any characteristic signs, symptoms, or a gold standard diagnostic modality. The purpose of this study was to evaluate the diagnostic value of urine trypsinogen-2 strip test in acute pancreatitis. Materials and Methods: In this cross-sectional study, 76 patients with abdominal pain suspected to acute pancreatitis who were admitted to the Emergency ward of Valiasr Hospital, Arak, were evaluated. In 46 patients, acute pancreatitis was confirmed (pancreatitis group), whereas in 28 patients, acute pancreatitis was ruled out (control group). In both groups serum levels of amylase, lipase, CRP, and urine trypsinogen-2 were measured by quantitative and qualitative methods. Sensitivity and specificity of the tests were determined and data were analyzed using SPSS software. Results: Urine trypsinogen-2 dipstick was positive in 36 of the 45 patients in the pancreatitis group (sensitivity: 80%) and in 2 of the 28 patients in the control group (specificity: 92.8%). Urine trypsinogen-2 ELISA test was positive in 41 of the 45 patients in the pancreatitis group (sensitivity: 91.1%) and in 4 of the 28 patients in the control group (specificity: 89%). Amylase sensitivity and specificity were equal to 82.6% and 75%, respectively. Lipase sensitivity and specificity were 76% and 85.7%, respectively. Conclusion: Urine trypsinogen-2 dipstick can be used to differentiate acute pancreatitis from other causes of abdominal pain. This rapid, easy-to-use, and accurate test can be used in emergency wards and primary health care units with limited diagnostic facilities.

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  Background: Due to the lack of efficient anti-HIV vaccine, anti-HIV pharmaceuticals play an important role in controlling HIV infection. Also significant rise in drug resistance and drug toxicity has caused increased interest in finding new anti-HIV agents. In this study, a nano-sized version of lamivudine based on PEGylated chitosan was synthesized.

  Materials and Methods: In this research, nanoparticles of chitosan were efficiently PEGylated for increasing their stability in water and then the anti-HIV drug, lamivudine, was loaded on these PEGylated nanoparticles. After purification and lyophilization of new synthesized nanoparticle, the raw materials and final product were sampled and FTIR, HNMR and CHN analyses were done.

  Results: Results of HNMR spectroscopy showed that chitosan nanoparticle was successfully PEGylated. HNMR data confirmed FTIR results and indicated that lamivudine was conjugated on chitosan nanoparticle. In addition, CHN analysis data also confirmed both HNMR and FTIR data, and demonstrated that a high yield of chitosan nanoparticle PEGylation (approximately 97%) was done and illustrated a high capacity of lamivudine conjugation on nano-sized PEGylated chitosan (30% _W/W chitosan).

  Conclusion: In this study, lamivudine drug was successfully synthesized, based on PEGylated chitosan nanoparticle.

 

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Background: Occult hepatitis C virus (HCV) infection is defined as the presence of HCV-RNA in liver or peripheral blood mononuclear cells (PBMCs) in the absence of detectable hepatitis C antibody (anti-HCV) or HCV-RNA in the serum. Although occult HCV infection is less aggressive than classic chronic HCV infection, nevertheless it is important in management of hemodialysis (HD) patients. Occult HCV infection has been described in two different clinical settings: in patients with normal liver enzymes or in patients with abnormal values of liver enzymes. The aim of this study was to detect the occult HCV infection in hemodialysis patients with elevated liver enzymes.

Materials and Methods: This cross sectional study was performed in hemodialysis patients referring to 3 dialysis units in Tehran. In 30 anti-HCV negative HD patients with elevated liver enzymes, presence of HCV-RNA in plasma samples was tested by Reverse Transcriptase-Nested Polymerase Chain Reaction (RT-nested PCR). In cases with negative anti-HCV and plasma HCV-RNA, HCV-RNA was checked in PBMC specimens by RT-nested PCR.

Results: A total of 30 HD patients with mean age 54.4± 14.1years and mean dialysis duration 81.2 ±64.4 months were enrolled in the study. All HD subjects were negative for HCV-RNA in plasma and occult HCV infection with RT-nested PCR method.

Conclusion: Occult HCV infection was rare in HD patients with elevated levels of liver enzymes.

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Background: Peripheral nerve injures are common in clinical practice that includes from compression injury to complete disruption of nerve trunk. After injury nerves can grow and repair spontaneously, early end to end anastomosis is first choice for repair but only 50% of nerve fiber would be physiologically accurate and effective, thus several techniques for repair of nerve injury are introduced including combination of nerve transplant with silicon tubes, use of biologic and synthetic tubes for nerve conduit.

Materials and Methods: In this Exprimental study, 20 rats with the same weight were selected and kept in the same condition .The left sciatic nerve of them was cut and were divided in two groups.In the first group the facial flap method for repair of nerve injury was used .In the second group vein conduit method was used as standard method. Histological nerve repair was assessed after 45 days and the intact right sciatic nerve was used as control.

Results: Repair of nerve injury in proximal, mid and distal portion of nerve in facial flap method was more effective than vein conduit (P<0.05). Repair of nerve injury in proximal, mid and distal portion had no difference compared with control group (p>0.05).

Conclusion: Repair of nerve injury with facial flap method is more effective than standard method and can be used as a new method for nerve repair.

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Background: Derived hormones from Adipokines include leptin, adiponectin, resistin, apelin, omentin.The aim of present study was to investigate the effect of 12 weeks aerobic exercise on plasma levels of Apelin, Omentin and glucose in obese older women with diabetes type 2.

Materials and Methods: In this study, 30 obese older women were chosen. They were also divided in to two groups: control (n=15 Age: 53.3+5.88 BMI: 28.7+2.2) and experimental (n=15 Age: 52.6+ 7.12: BMI: 30.03+3.6) according to their fat percentage and BMI. The training program included aerobic exercises which were conducted increasingly, 3 times a week for 12 weeks. Blood samples were taken before starting the exercise training and also 24 hours after the last training session. U Mann-Whitney Test was used to evaluate the data and in order to compare each group's pretest and posttest, Wilcoxon test was used at the significance level of p&le 0.05.

Results: There were significant changes in apelin and glucose plasma levels in the training group (p=0.001 and p=0.006 respectively). Furthermore, no significant difference was observed between each group's omentin levels.

Conclusion: It was finally concluded that exercise training can facilitate the process of glucose entrance into a cell because of the continuous muscle contractions and also decrease the plasma glucose. Also each adipokine response might be depend on the intensity and duration of exercise training, separately.