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Introduction: Diabetes is one of the most prevalent diseases in the world. Today there are 100 milion diabetics around the world and in Iran it is about 1.5 milion. The prevalence of symptomatic neuropathy is 15% but with NCV it will increase to 50%. Regarding the suffer produced by neuropathy and that there is no effective treatment for that, this is necessary to investigate new treatment options. Materials and Methods: This is a clinical trial study, done during a 3 months period in vali-e-asr hospital in year 2004. 100 diabetic patients were selected randomly and divided into two equal groups. A complete sensorimotor assessment was performed and a questionnaire consisting history and clinical symptoms including limb pain, murmur and paresthesia and examinations such as pin prink test, position and vibration assessment, was completed. NCV was also done and blood sugar and HbA1c was measured. In case group 2000 micrograms vit B12 was prescribed twice weekly and in control group 10mg nortiptiline every night was prescribed. After 3 months patients were assessed again. Data was analysed using mean and standard deviation and Chi square, K-S, Leven, T and Mann Whitney tests. Results: Based on visual analage scale the difference between pain number before and after treatment was decreased 3.66 (3.66-4.25) in case and 0.48 (0.54-1.13) in control group (P<0.001). Also the difference between paresthesia number before and after treatment was decreased 2.98 (2.51-3.44) in case and 1.06 (064-1.47) in control group (P<0.001). The difference between murmur number before and after treatmat was decreased 3.48 (2.93-4.02) in case and 3.48(2.93-4.02) in control group (P<0.001). There was no significaut difference between NCV, vibration, position and pin prink test results. Conclusion: Changes in clinical symptoms in case group in comparison to those in control group was significant, but changes in physical assessment findings (pin prink, Position, vibration and NCV) was not significamt.

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Introduction: Diagnosing parturients in risk of cesarean section early in the beginning of active phase of labor, is very important. This may let take necessary action to accelernate labor (delivery) and prevent maternal mortality and morbidity due to late cesarean section. Materials and Methods: During a period of 8 months from July 2004 to March 2005, 216 primiparous women, with term pregnancy and cephalic single fetus, referred to Imam Reza hospital in (during) active phase of labor, were studied. Changes of cervical dilatation and descent of the conceptus were observed. Parturients were devided to two groups, vaginal delivery and cesurean section. Protraction or arrest disorders were the indications of cesarean deliveries. Findings were analysed through using T-Test, unilateral variance and Chi square test. Results: The more changes in cervical dilatation in the first 2 hours of active phase of labor, the less possibility of cesarean delivery (p<0.001). Also the more rate of the conceptus descent in the first 2 hours of active phase of labor, the less rate of cesarean section (p<0.001). There was no significant statistical relationship between condition of membranes at the onset of active labor and method of delivery, however there was a significant relationship between oxytocin augmentation and method of delivery (p<0.001). Conclusion: In primiparous women with term pregnancy, vaginal delivery would be fairly predictable by observing changes of cervical dilatation and conceptus descent during the first 2 hours of active phase of labor.

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Introduction: Estimation of fetal weight is very important in preventing delivery complications and also in selecting delivery method. This is specially important in potential macrosomia, IUGR and also preterm labor. The objective of this study is to compare the accuracy of ultrasonic, clinical and mother, fetal weight estimation in pregnant women in Kerman. Materials and Methods: In this cross sectional study 246 women with singleton, term pregnancies admitted for cesarean section within the following week, were studied. Estimation of fetal weight (EFW) was done using sonography and then by two obstetricians and one senior resident who were unaware of the other clinical and ultrasonic results. Mothers' estimation of their baby weight was also asked. Statistical analysis was done by paired T and Chi square tests. We also used ROC (Radar Operating Characteristics) curve to compare the accuracy of different tests. Results: Fetal birth weight was 3339±443 gr. In the 2500-4000 gr birth weight the sensitivity of predicting clinical birth weight was 11.8% with 99.6% specificity and for sonographic EFW was 12.6% with 92.1% specificity. Conclusion: Clinical estimation of birth weight in term pregnancies is as accurate as routine ultrasonic estimation obtained in the preceding week of delivery.

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Introduction: Many progresses has been made in the field of digital replantation which is based on progresses in microsurgery and surgeons skills in hand trauma. In this study, procedure and results of 97 digital replantatios are investigated. Materials and Methods: In this descriptive study 66 patients with 97 amputated fingers, who underwent replantation were studied. Only completely amputated fingers were studied and fingers with even the least connection to the proximal stump by a skin bridge were omitted from the study. Amputations were at the level or distal to the MCP joint. Results: Success rate of replantation was %57.7 which is 56 fingers from the total of 97 fingers. 58 patients were male and 8 female. Patients age was between 9-52 years. The total hospitalization period was 3-5 days for unsuccessful and 12-16 days for successful replantations. After the operation, Aspirin was used as the anticoagulant and heparin was used only after reexploration or in severe crushing injuries or in cases with vein graft use. Type of surgery and postoperative care was the same in all patients. Conclusion: Based on the results, it seems some reasons of lower success rate in our study in comparison to other countries are wrong transportation method of the amputed fingers and delay in patient transportation. Also surgeons, skill in plastic surgery seems to be effective.

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Introduction: Free radical-mediated peroxidation of biological molecules, such as lipids, is implicated in the pathogenesis of multiple sclerosis and it's animal model experimental allergic encephalomyelitis(EAE). Low concentration of antioxidant vitamin E has been observed in serum of multiple sclerosis. However, it is not known whether vitamin E has protective effect in EAE. Vitamin E may inhibit EAE by effect on the level of uric acid and Nitric Oxide (NO) production. Materials and Methods: In this experimental study some male C57BL/6 mice were placed in two therapeutic groups (n=8 per group) with age and weight-matched as follow: 1)Vitamin E-treated EAE mice (10mg/kg/every two days of vitamin E given i.p from day-3 until day+19 after disease induction, 2) Non-treated EAE mice (EAE control) received vehicle alone with same schedule. In addition, 5 age and weight-matched male C57BL/6 mice served as normal (non-EAE) controls. Clinical score of disease, uric acid and NO levels of the groups were analysed. Results: Results showed that vitamin E-treated mice had significantly less clinical score of EAE (4±0.8) than non-treated EAE induced mice (5.3±0.44), (p<0.01). Also, there was difference at the onset day of the disease between vitamin E-treated and non-treated EAE-induced mice (day 13±1 and day 11±1, respectively), although was not significant. Concentration of uric acid in vitamin E treated mice were significantly lower than EAE control (p<0.001). There was no difference at the level of NO between the groups. Conclusion: Vitamin E had no effect on NO level, but decreased serum uric acid level. It suggests that vitamin E can reduce or delay the onset of EAE by increasing uric acid consumption.

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Introduction: Renal cell carcinoma can be presented with extension of thrombosis to renal vein and inferior vena cava. Management of these patients consists of radical nephrectomy and thrombectomy. In this study we reviewed approach to these patients. Materials & Methods: This is a case series report. During 1379 to 1384, 148 patients diagnosed with renal cell carcinoma (RCC) limited to Gerota’s fascia (stage T3 or less) were admitted to Hasheminejad hospital. Fourteen patients had inferior vena cava (IVC) involvement. Radical nephrectomy as well as thrombectomy was performed in 8 patients. This investigation is done on these 8 patients. Results: Patients' average age was 51.4 years. Six patients were male (75%) and 2 female (25%). The most common symptoms were flank pain (75%), gross hematuria (62.5%) and structural symptoms (50%). All patients had tumors limited to Gerota’s fascia without any distant metastasis. Infrahepatic involvement of IVC was seen in 6 patients and in 2 patients thrombosis extended above the hepatic vein (infrahepatic). No perioperative mortality was seen. Postoperative complications were atelectasia in 2 patients and deep vein thrombosis in one which was treated with conservative management. Conclusion:By skillful surgical approach in patients with RCC and IVC involvement, thrombosis can be completely excised without increasing the rate of complications and longterm survival could be expected.

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Intruduction: Testicular feminization syndrome is a disorder with the prevalence of 1 in 20000 to 64000 male births. It,s characteristics are female phenotype, male caryotype (64XY) and normal to increased testosterone and LH levels. In this article a case of testicular feminization is reported. Case: The patient was a 16 years-old woman with primary amenorrhea and without secondary sexual characteristics. The patient had normal female external genitalia, absent axillary and pubic hair, immature breast, and repaired bilateral inguinal hernia with pathology report of immature testicular tissue. FSH and LH levels were elevated. Testosteroe level was normal. Sonography and CT scan of pelvis did not show uterus and adnex. Karyotype was 46XY. Conclusion: It is recommended that due to the risk of neoplasia, the existing testes must be removed. Also hormone therapy must be done for the patient.

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  Introduction: The increasing use of EMF (electromagnetic field) generating apparatus (refrigerators, computers, TV, etc) caused an increasing interest in investigations of its adverse effects on human health. This study is done to investigate the effects of EFM on Balb/c mice.

  Materials and Methods: This is an experimental study in which at first a circuit generating low frequency electromagnetic field (50 Hz, 15G) was designed. Then adult virgin female mice were placed in coil and exposed to 15 gauss electromagnetic field for 4 day and 6 hour per day. Then their blood was examined to assay the level of hormones (FSH, LH, estradiol, progesterone). Also ovary and uterus sections were studied with light & electronic microscope.

  Results : Results showed that the weight and size of ovary was not significantly affected in females exposed to the low frequency electromagnetic field and their offspring. Our results also showed that the number of ovary follicles were significantly affected in exposed females (p<0.05). Also the study of micrographs showed hetrochromatinated oocytes and follicular cells and increasing polysomes, accumulation of mitochondria and cleft nucleus. Decreasing amount of FSH, LH and 50% decrease in couplation rate was also seen as compared with the control group.

  Conclusion: Results of this study is indicator of EFM effects on gonads^, structure and endocrine system and decreases fertility.

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Introduction: Performing correct research in different aspects of community as well as medical sciences can be a way to resolve many problems. In order to create a systematic knowledge of research method in academic members of Arak University of medical sciences and enabling them in providing proposals and performing researches, a clinical research center was developed. This study is done to investigate the effect of this center on improving clinical researches in the University. Materials and methods: This is a HSR, before and after, interventional study in which, clinical academic members of Arak University of medical science were evaluated. First the information of the pre intervention period was gathered (jan2002-jan2004). Then the intervention was done in the form of developing a research center in Vali-Asr hospital, performing serial research workshops, research conferences, research consultations and planning data bases during a 2 years period. Again data was gathered and then compared to those of pre intervention period. Results: The comparison of pre and post intervention periods showed that in pre intervention period from 38 proposals 30 and in post intervention period from 89 proposals 76 were approved by research committee of the University. In the two pre and post intervention periods 14(46.6%) and 50(65.8%) of accepted proposals were clinical respectively. Also from the view point of quality, 11 and 15 proposals were HSR, 2 and 22 clinical trials and 8 and 8 descriptive, respectively. The number of published articles in first period was 45 and in second 84. Presented articles in internal and external congresses were 33 and 59 in the two periods overally, which 25 and 51 articles were presented in the country and 8 and 8 in abroad congresses, respectively. Conclusion: Regarding the results it seems developing research center in this University and other similar Universities can have a significant effect on the process of clinical researches.

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  Introduction: Patients` staying in recovery unit is associated with risks and complications and is expensive. Decreasing the duration of staying can both increase patients` safety and decrease hospital costs. Laryngeal mask airway (LMA) as a new instrument has been widely used for airway management and in this study, its effect on recovery time is investigated.

  Materials and methods: In a double blind randomized controlled clinical trial, 62 ASA Ι & Π patients were divided into two equal groups. In one group laryngeal mask and in the other, tracheal tube was used. The anesthetic drugs were similar in both groups. Patients with upper airway infections, as well as patients undergoing thoracic and upper abdominal surgeries were excluded. Those with more than one hour duration of anesthesia and more than 30 seconds need for intubations were also excluded. Duration of anesthesia was measured in minutes. Duration of recovery staying (in minutes) and complications were also recorded. Data was analyzed using Chi Square and Mann Whitney U tests.

  Results: There were no significant differences in age, sex and mean time of anesthesia between the two groups. But mean recovery time in LMA group with 10.65 minutes and tracheal tube group with 16.71 minutes was significantly different (P=0.007). Two patients (6.45%) in LMA and 11 patients (35.48%) in tracheal tube group developed complications during recovery period which was a statistically significant difference (P = 0.004).

  Conclusion: Laryngeal mask airway, decreased recovery time and the number and severity of respiratory complications. Complications such as cough, laryngospasm, bronchospasm, and arterial hypoxemia were significantly less in patients with laryngeal mask airway compared to patients with tracheal tube, so the use of LMA is recommended.

 

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Introduction: Infertility is an emotional crisis with physical, economic and psychosocial challenges, because it interferes with all personal life aspects. This event is a sever tension of life and produces strong emotional shock in the infertile couple. This study is done with the aim of comparison the psychiatric problems of infertile men and women referring to infertility clinic of Hamadan Fatemyeh Hospital. Materials and Methods: This is a cross-sectional analytical study. Sample size was 400 infertile men and women which were selected by convenience sampling. Data was collected by a demographic questionnaire and SCL90, and analyzed through descriptive statistics and independent T test. Results: Our study indicates that infertile women experience mental problem significantly more than men. With p<0.05 infertile women in 9 categorize of SCL90 including depression, anxiety, phobia, psychosomatic, interpersonal sensitivity, hostility, paranoid ideation and psychotics are significantly different from infertile men. Conclusion: It seems women experience more stress in personal, social and sexual life and women are more sensitive to infertility phenomena that probably is due to cultural problems, mental susceptibility and/or special forms of social communication

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Introduction: The reason of infertility can have a direct influence on the plan and outcome of management. In this paper we intend to show the effect of tuberculosis (TB) history on female infertility among infertile couples attending to Rooyan infertility management center. Materials and methods: In this case-control study our cases were those who were diagnosed as infertile female and controls were those women whose husbands were infertile due to some male factor. We used logestic regression for analyzing the association of history of Tuberculosis and female infertility with attributable risk estimation. Results: 308 cases were compared to 314 controls. Considering the odds ratio and its 95% confidence interval, there was a significant difference between the history of TB and infertility (OR=4.7, 95% CI: 1.01-29.91). The attributable risk of TB for female infertility was 0.023±0.01 (which is significant at 5% level). Conclusion: These figures show that at least 2% of female infertility can be prevented by prevention and proper treatment of tuberculosis.

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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: Investigations has showed that prenatal exposure to Morphine causes drug dependency and behavioral complications in new born rats. In this study effect of prenatal Morphine on the development of basal ganglia in rat embryos is investigated. Materials and Methods: In this experimental study 36 female rats with body weight between 250-300 grams were selected. After crossing with male rats they were divided into six groups of 12days control-Morphine, 14days control-Morphine and 17days control-Morphine groups. Morphine groups received 0.01mg/ml Morphine through their drinking water until the 12, 14 and 17th day of pregnancy (20ml each rat). Then rats were anesthetized and embryos were taken out and fixed. Their body weight and crown-rump length were measured. Then 5 micrometers sections were provided and stained using H & E method which were then evaluated using mutic program. Results: Body weight and length of embryos were reduced significantly in the 12&14th day of Morphine group rats in compare to their controls. The significant reduction of Basal Ganglia thickness was also found in all Morphine groups compared to their controls. Conclusion: Results showed that prenatal Morphine exposure may cause impairment in change development of Basal Ganglia.

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Introduction: Clonidine, as a premedicant in anesthesia, has a special role in decreasing anesthetic agents' dose and improving sedation. Because of its effects on body hemodynamics and electrolytes and the importance of these effects during anesthesia, we decided to investigate these side effects in this study. Materials and Methods: This is a double blind randomized clinical trial. Samples were 104 ASA Class Ι & Π, 20-40 years old patients, undergoing elective surgery and were divided equally into two groups (case and control). 90 minutes before induction of anesthesia, 5μg/kg Clonidine was given to the case and placebo to the control group orally. Blood samples were taken before and 4 hours after induction of anesthesia. Also 24 hours urine was collected and measured for volume and sodium and potassium concentrations. Data analysis was done using independent T test. Results: There wasn’t any significant difference between two groups in the mean concentration of blood sodium and potassium before and after taking the drug. But the mean sodium and potassium concentration in urine was significantly more in the case group (P = 0.022 and P = 0.003 respectively). The volume of 24 hours urine was also more in the case group (P = 0.008). Conclusion: Although Clonidine induces diuresis and increases sodium and potassium excretion, blood concentration of these electrolytes doesn’t change significantly.

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Introduction: Idiopathic hypercalciuria (IH) has been recognized as a common disorder in childhood and is an important and common factor in formation of renal stones. Recurrent urinary tract infection is a clinical presentation of hypercalciuria. Regarding that Hydrochlorothiazide is effective in hypercalciuria treatment, therefore in this study we assessed the efficacy of Hydrochlorothiazide in preventing recurrent UTI in hypercalciuric girl patients. Materials & Methods: This research was a single blind randomized clinical trial. 100, 1 to 12 years old girls, who were followed by pediatric nephrology outpatient clinic in Vali-Asr and Amir Kabir hospitals, with the diagnosis of idiopathic hypercalciuria and at least two urinary tract infections in year, were included in study. Patients were randomly divided into two equal groups. First group received a general preventive treatment consisted of a liberal fluid , urination every 2 hours , reducing dietary salt intake , washing genitalia from front to back , wearing cotton loose underwear and complete urination. In second group, in addition to the general treatment, Hydrochlorothiazide was used with initial dose of 1mg/kg/day in a morning dosage.Then, urinary tract infection recurrence in two groups was assessed by student T test. Results: All patients who received Hydrochlorothiazide were normocalciuric. In each group, incidence of UTI non recurrence was 34% (17 cases), that was not significantly different. Conclusion: This study rejected the presence of hypercalciuria treatment effect in preventing recurrent urinary infection. Therefore, the association between UTI and IH needs to be closely studied with the attention to eliminate confounding factors.

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Introduction: Therapeutic use of D-penicillamine is associated with several side effects. Proteinuria is the most common side effect of it, often due to membranous glomerulopathy. In this article we have reported a case of D-penicillamine induced focal segmental glomerulonephritis with systemic sclerosis. Case: In This article, we have presented a patient who had been under treatment with D-penicillamine and complicated by nephrotic range proteinuria resulting from focal segmental glomerulonephritis. Proteinuria was resolved one month after discontinuation of D-penicillamine without any additional treatment. She had no finding in favour of renal crisis of scleroderma. Conclusion: Such this pathologic form of renal involvment (FSGN) resulting from D-penicillamine has not been reported in the literature yet.

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Introduction: Spinal anesthesia is a conventional way of anesthesia for cesarean section (CS), which nausea and vomiting is a common complication of it. Metoclopramide is the standard medication used for preventing intraoperative nausea and vomiting (IONV). Because of extrapyromidal side effects of Metoclopramide and known antiemetic effects of low-dose Propofol and Dexamethasone, this study was performed to compare the effectiveness of these drugs for preventing IONV. Materials and Methods: This study, is a randomized clinical trial which is done on 144 parturients who were admitted for emergency CS. Patients were divided randomly into four groups and received: Metoclopramide 0.1 mg/kg IV, Dexamethasone 150 g/kg IV, Propofol 0.1mg/kg every 5 minutes from clamping umbilical cord till the end of operation and the fourth group received 2 ml distilled water. During the operation parturients were monitored for IONV. Data was analyzed using Kruskal-Wallis and one way ANOVA. Results: The Number of patients having nausea was lowest in Propofol and highest in Dexamethasone group. There was no statistical significant difference between Dexamethasone and placebo groups. The lowest rate of vomiting was in Metoclopramide and Propofol groups and there was no significant difference between them. Also the lowest level of retching was in the Prepofol group. Conclusion: According to results, the antiemetic effects of Propofol and Metoclopramide are similar. Amount of retching in Propofol was slightly lower than Metoclopramide and administration of Propofol was simple, cheap and without serious complications, so we recommend it for emergency CS.

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Introduction: Bone mineral density (BMD) measured by dual energy x-ray absorbtiometry (DEXA) is widely used in management of patients with osteoporosis. Factors which are specific to machine or operator, can influence the accuracy and precision of BMD estimations. In this study we investigated the effect of leg rotation and femoral neck on densitometry of femur. Materials and Methods: In a before and after, interventional study on 200 women between 30-70 years old, without metabolic bone diseases, densitometry was done first in standard position and then in 15ْ rotation of leg from standard position and then after changing femoral neck angle from 90ه to 80ْ in relation to central femoral neck axis . Density of femoral neck, ward triangle, greater trochanter, shaft of femur and total hip was measured and data was analyzed by means comparison test. Results: External rotation of leg by 15 ه from the customary position, increased the average BMD in femoral neck, wards area, trochanter and shaft (p<0.001, p<0.04, p<0.001, p<0.008 respectively).While no significant change was observed in average BMD of total hip. Change of femoral neck area angle from 90 ه to 80 ه in relation to central femoral axis decreased BMD in femoral neck (p<0.001), and significantly increased BMD in wards triangle, trochanter, shaft and total hip (p<0.001, p<0.001, p<0.001, p<0.04 respectively). Conclusion: Malrotation of hip can be an important confounding factor when interpreting serial BMD values. Regarding the less effect of malpositioning on BMD of total hip, this area may be prefered for assessment of densitometry result.

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Introduction: An association between depression and altered immunity has been suggested by a number of studies but has not been consistently demonstrated .The effect of maternal depression response on fetal immune system have not been investigated. Thus in this study we evaluated the effects of depression on some parameters of innate and humoral immune system of pregnant women and their infants. Materials and Methods: 62 pregnant women (including 32 depressed and 30 healthy) and their infants in Taleghani hospital of Arak in 2004 were included in this study. All depressed mothers had a diagnosis of depression by Beck Depression Inventory (BDI) and clinical interview based on DSM-IV system. The level of immunoglobulins and components were evaluated by single radial immunosdiffusion (SRID) method of Mancini. Leukocyte and lymphocyte counts were determined by Hycel (an automated cell counter) and for more accurancy were also evaluated by manual method. Statistical analysis was performed using K-S, Mann-Withney, One way ANOVA, Kruskal-Wallis and Pearson tests. P<0/05 was considered significant. Results: Serum IgM level and serum C4 level of infants of mothers with depression were significantly lower than infants of healthy mothers. Lymphocyte number and percentage in infants of depressed mothers was also significantly higher than infants of healthy mothers. The mean cord/maternal blood ratio of IgG in infants of depressed mothers was also significantly lower than infants of healthy mothers. Serum IgG level of depressed mother was significantly higher than other mothers. Conclusion: Fetal impact of stress and depression during pregnancy is just beginning to be understood and research in this area is developing. Our results indicated that maternal depression adversely affects the development and function of fetal immune system. These results are in agreement with the immunological findings of preterm and LBW infants.