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Introduction: Candidiasis is the second common cause of vulvovaginitis. We evaluate the frequency of species of Candida in vaginal candidiasis. Materials and Methods: In this cross-sectional anaiythical study, 220 patients with typic and nontypic signs and symptoms of vaginal Candidiasis were studied. Smear and culture were done. For positive culture, evaluation of germ tube, clamidospor production and carbohydrate assimilation and fermentation was done. Data was presented by descriptive statistics and analyzed using Chi square, Man-Whitney and Kolmogrov tests. Results: 40% of patients showed positive culture and smear. Frequancy of Candida Albicanse (42.03%), Dublininsis (29.5%), Glaberata (14.75%), Gilermondy (6.81%), Norvejensis (2.27%), Tropicalis (2.27%), and Kefayer (2.27%) were determined. There was no significant relationship between antibiotic and OCP consumption and type of identified Candida. Conclusion: Frequency of non Albicanse species is increasing. We suggest treatment based on culture and smear, because non Albicanse vaginitis usually is resistant to Azols.

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Introduction: Chronic and relapsing abdominal pain is one of the most common reasons that bring children to pediatric clinics. About 20% of these children are suffering from idiopathic hypercalciuria. Since Hydrochlorothiazide is effective in relieving hypercalciuria, we assessed its effects on reducing these relapsing pains in girls with idiopathic hypercalciuria. Materials and Methods:In this single blind clinical trial study, 100 girls, aged 5-12 years old, with chronic relapsing abdominal pain and hypercalciuria were divided to two groups by random block design. All children and their parents were trained about consuming plenty of liquids and decreasing salt in foods. In addition to these measures, Hydrochlorothiazide (1 mg/kg/day) was also administered to children in the case group. The control group was assessed for the number of abdominal pain episodes for 3 months following the commencement of the diet and the case group for 3 months after becoming normocaciuric. The results were analyzed by T-test. Results: The mean number of pain episodes in Hydrochlorothiazide group in the first, second, and third months were 0.38, 0.4, and 0.26 respectively much lower than the corresponding months in the control group which were 1.60,1.94, and 1.84 in that order (p<0.001). Conclusion: It seems that single dose daily Hydrochlorothiazide is a safe and effective drug in the treatment of chronic relapsing abdominal pain in children with idiopathic hypercalciuria.

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Introduction: Abdominal pregnancy is 1 in 10000 live births and advanced abdominal pregnancy is rare. Abdominal pregnancy is associated with high morbidity and mortality with the risk for death 7 to 8 times greater than tubal ectopic pregnancy and 90 times greater than intrauterine pregnancy. In this article a case of advanced abdominal pregnancy is reported. Case: The patient was a 35 year’s old (G4P3) woman presented with undelivered pregnancy after two years. After diagnostic procedures laparatomy was done. During the operation, fetus adhesion to the omentum was released. A 9 kg calcified fetus was delivered. Then the placenta and left adnex was removed completely. Conclusion: Regarding the high mortality rate of abdominal pregnancy, in every pregnancy specially in the precence of it’s risk factors (such as PID, history of ectopic pregnancy, history of infertilitry and using drugs to induce ovulation, IVF, prior tubal surgery and …) and also suspicious symptoms, this probability and early intervention must be considered.

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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: Hemorrhoid is a common disorder causing pain, and its standard treatment is Hemorrhoidetomy. Also, pain is a common problem after surgery and control of it prevents physiologic and psychiatric complications. Kegel exercise is one of the relaxing and none invasive methods for reduction of pain. In this study the effect of kegel exercise on pain relief post hemorrhoidetomy is investigated. Materials and Methods: This study is a single blind randomized clinical trial. Samples were patients admitted for hemorrhoidetomy to Shahid Sadooghi hospital of Yazd. They were randomly divided in two experiment and control groups (each group 30 persons). Before operation, Kegel exercise was educated to experiment group and after surgery pain range were recorded. Data was analyzed using descriptive and analythic statistics (t and Pearson correlaton tests). Results: Findings showed that the mean score of post surgery pain in the first 48 hours after operation in experimental group was 26.50±5.82 and in control group 31.26±5.94, that have meaningful difference (P=0.003). Regarding the amount of analgesics, the mean use of analgesics after surgery in experimental group was 18.9±14.83 and in control group 52.83±29.89 which has meaningful difference (P=0.00001). Type of analgesics in the two groups 18, 24 and 48 hours after surgery with p=0.04, p=0.04 and p=0.05, had significant difference. There were not any correlations between pain intensity and numbers of Kegel exercise. Conclusion: Based on results, Kegel exercise decreased post hemorrhoidetomy pain and using analgesic drugs was decreased in experimental group. Preoperative education of this method is useful in pain management postoperatively.

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Introduction: Diabetes mellitus is a chronic disease that has well known effects on most organs, but there have been controversies in few different studies about the effects of diabetes on hearing. So this study was carried out in 2003-2004 in Kermanshah Diabetes Research Center to assess the effect of diabetes on hearing. Materials and Methods: This is a case-control study. 82 diabetic cases (26 types I and 56 type 2 cases) were studied along with 82 controls matched both in age and sex. Cases were selected randomly, their range of age was 15 to 55 years and their duration of diabetes was more than 3 years. After completing questionnaires, all cases and controls undergone autoscopic examination. Those with other ear disease with hearing impairment were omitted. Audiometery including pure tone audiometery, speech audiometery, and impedance audiometrey with well tone AD19 formed was done on 164 (diabetic and control) persons. Data was analyzed using t-test. Results: Audiometric findings with different frequencies in the two groups revealed that there was a significant relationship between diabetes and hearing impairment (p<0.001). This relationship was more significant in high frequencie, older age and type 2 diabetes, but there were no relationship between control of blood sugar (HbA1c), duration of diabetes, sex, microvascular and macrovasculur complications with hearing loss in diabetic patients. Conclusion: These finding demonstrate that diabetes can cause mild to moderate hearing impairment especially in high frequencies. The mechanism of this effect is unknown. Complementary studies with more patients and with more accurate devices such as Otoacustic Emission (OAE) and Audiometric Brainstem Reflex (ABR) are recommended

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Introduction: Relationship between Multiple Sclerosis (MS) and primary headaches is not well recognized yet and the studies that have been done had different results. The aim of this study was to investigate the relation between primary headaches and multiple sclerosis. Materials and Methods: In this historical cohort study, 117 patients with actual MS were selected by convenience sampling as case group and 351 healthy subjects as control group. The incidence of primary headaches was assessed by a physician using a questannaire. Variables under investigation were age, sex, type of MS, Expanded Disability Status Score (EDSS), and characteristics of headache based on International Headache Society (IHS) classification. Data analysis was done using Chi-square, t-test, Fisher exact test, and logistic regression. Results: 53.8% of MS group and 27.4% of control group had chronic headaches (p=0.0001). Frequency of Migraine and tension type headaches among patients with headache in MS group were 73.1% and 26.98%, and in control group were 40.6% and 58.7% respectively. There was a statistically significant relation between Relapsing-Remitting MS and migraine headache (p<0.001).There was not any correlations between headache and using Interferone, MS duration, and EDSS. Conclusion: The results of this study indicate that primay headaches, especialy migraine without aura, are common in MS patients comparing to general population.

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Introduction: Serum Alkaline Phosphatase (ALP) is a glycoprotein that is secreted from osteoblasts. In fractures, the rate of ALP will be changed. Low intensity pulsed ultrasound accelerates the growth and remodeling of fractures. However the relation between pulsed ultrasound and changing the rate of serum ALP in New Zeland rabbit is not studied yet. The aim of this study is to investigate the effect of pulsed ultrasound on serum ALP during bone healing of tibia in New Zealand rabbit. Materials and Methods: This is an experimental study. 54 male and mature New Zealand rabbits were randomly divided into six groups (3 experimentals and 3 controls). All of them were operated for inducing a model of experimental fracture. After repair of wounds, the right leg of experimental groups was exposed to pulsed ultrasound for 2, 4 and 6 weeks. The control groups were kept without any intervention during the same time. After experiment, the rabbits were anesthesied and blood samples were taken from their hearts for ALP serology, and then the rabbits were killed. Blood was centrifuged and serum ALP was read by spectrophotometer. Data was analyzed by Mann-Whitney U and Kruskal-Wallis tests. Results: Results showed that the mean serum ALP level in experimental group after 4 weeks exposing to pulsed ultrasound was significantly higher as compared to control group (p= 0.03). There was no significant difference between the other groups. Conclusion: The results of this study demonstrate that pulsed ultrasound wave increases serum ALP and accelerates the bone healing.

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Introduction: Celiac disease (CD) or gluten-sensitive enteropathy is a malabsoption of nutrients due to hyoersesitivity of gluten. Some etiologic facrors are environmental, immunologic and genetic factors. The frequancy of Celiac disease is not studied in western regions of Iran, therefore this study is done to determine the frequancy of Celiac disease in general population of rural regions of Arak. Materials and Methods: This is a descriptive, cross-sectional study in which 700 people between 20-56 years old in rural regions of Arak were selected by multistage random sampling (364 male and 336 female). After completing questionnaires, blood samples were collected and serum IgA levels (to rule out IgA deficiency), and serum t-TG Ab were assessed. All cases that had positive serologies and those who had high clinical probability of having Celiac disease underwent second duodenal segment biopsy. Data was presented using mean, standard deviation and frequency distribution. Results: Serum IgA levels were normal in all samples. 8 cases were positive for t-TG Ab, 38 cases had high normal levels of t-TG Ab and the others had less than 6 Au/ml t-TG Ab. Only in patients with high normal serology, histology was positive. 1% (10 in 1000 people) of all studied subjects demonstrated intestinal lesions due to Celiac disease. Most of them were asymptomatic. Conclusion: CD frequency in rural regions of Arak in people between 20-65 years old was 10 among 1000 cases. This frequency is the same as studies done in northern and southern regions of Iran but was higher comparing to the other parts of the word. This amplifiles the importance of screening of CD in Iran. Also the sensitivity and specificity of t-TG Ab was found high because all cases with high normal levels of t-TG Ab were approved by histology.

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Introduction: Oral Ketamine is used as a low side effect analgesic in comparison with opioids, in different pain syndromes. This study is designed to evaluate the effect of oral Ketamine in renal colic treatment. Materials and Methods: In this clinical trial study 104 patients with renal colic, hospitalized in emergency department, were divided in to two groups by Random block design. Group B received Pethidine (1 mg/kg up to 100 mg) and placebo, and group A received Pethidine with the same dose and Ketamine (0.5 mg/kg). All patients were assessed for pain by using VAS chart, for nausea by a 0-3 scale and for the number of vomiting at baseline and 1, 2 and 3 hours after taking drug. The results were analyzed by t-test. Results: Average pain score and vomiting in all times and nausea score in one and three hours after receiving drugs were reduced significantly in patients who took Pethidine and Ketamine comparing patients who took Pethidine and placcbo(p < 0.05). Conclusion: Regarding the significant effect of Ketamine in reduction of pain, nausea and vomiting without side effects, it is possible to use Ketamine as an adjuvant drug in treatment of renal colic and to reduce narcotic dosage.

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Background: In the recent years, oxidative stress was attended as one of the causal factors of ischemic stroke. In terms of the role of genetic, geographic and ethnic factors in the prevalence of stroke, This study was designed to compare the oxidative stress indexes of stroke patients with normal healthy subjects in this geographic area. Methods and Materials: In this case-control study, 36 patients older than 50 years with ischemic stroke and 45 healthy subjects with same age and sex, were enrolled. Five milliliter blood were drawn from all subjects. Samples were centrifuged and plasma was separated. Total antioxidant capacity, lipid peroxidation and thiol levels were measured respettively by FRAP, TBA and HU methods. Then the result was analyzed using t-test. Results: Results showed total antioxidant capacity and thiol plasma levels were lower in stroke patients in compare to healthy subjects, but only the thiol group had significant difference(P=0/001). Although lipid peroxidation showed a slight but non-significant difference in stroke patients in compare to control group. Conclusion: These findings suggest oxidative stress in patients with acute ischemic stroke may be conseaqence of an imbalance in oxidant/antioxidant homeostasis. Therefore it may be useful to recommend antioxidant medications or diet for these patients.

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  Background: Stroke is one of the important causes of death. However the prognostic factors are not clearly defined. There are many evidences which show the role of inflammatory factors during the progression of stroke but the relation of CRP and stroke is still vague. This study was designed to determine the relation between CPR Level and WBS with severity of stroke (according to CNSS score) and volume of infarct in stroke patients.

  Methods and Materials : This is a cross sectional study performed during the winter and spring of 2007 on 49 patients with stroke hospitalized in Vali-e-Asr hospital of Arak.Clinical examination was done by using CNSS scoring. The CRP and WBC were measured in the first 72 hour of onset of the disease. The CT scanning together with infarct volume estimation was performed at the same time.

  Results : There was no correlation between the volume of infarct with CRP serum level (r=-0.14, p=0.39 ) and WBC (r=-0.17, p=0.92 . Also there was no correlation between CNSS score with CRP level (r=-0.04, p=0.81) and WBC (r=-0.124, p=0.40) too, but there was a significant correlation between CNSS score and stroke volum in brain CT scan (r=-0.43, p=0.006 ).

  Conclusion: According to data in this study there was no correlation between serum acute phase reactant, the volume and severity of infarction.

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Introduction: Stirility is a problem throughout the world. Decreasing the growth and developmental rate of embryo and arresting in certain step of development like two cell block, could be the reason of infertility in some couples. Previous study show that arrest and retardation in embryo development can produced by low temperature exposure. We aimed to evaluate the effect of Ethanol on growth and development of mouse two-cell arrested embryo. Material and methods: The 4-6 week old female mice were coupled with male mice following superovulation and positive vaginal plaque mice were killed 48 hour after HCG injection by cervical dislocation method. Two cell embryo were collected in RPMI medium and divided and cultured (in M16 medium) in three groups. The 2nd and 3rd groups were exposed to 4°C for 24 hour in order to delay and arrest for cleavage and developmental rate. The 2nd group (2nd control) were incubated immediately, while the 3rd group (experiment) were exposed to % 0.1 Ethanole for 5 minutes and the 1st group (1st control) without any exposure to low temperature group were incubated . Results: The data analysis by one-way ANOWA show that the developmental rate of embryos exposed to low temperature (4°C) significantly decreased (P=0.001), retardation and arrest being produced. The mean of cleavage rate between groups were not significantly affected, but the mean percent of degenerated embryos between groups have significant differences (P=0.045). On the other hand the mean percent of morulla is significantly different between groups (P=0.005) similarly the mean percent of blastocyst and hatched blastocyst have significant differences between groups (P=0.014) (P=0.001) after 120 hr evaluation. Conclusion: Effect of %0.1 Ethyl-alchol on arrested two cell embryos can significantly increase the mean percent of morulla and development up to blastocyst and hatching blastocyst stage related to control group, without any significant effect on cleavage rate

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Background: Hypertension disorders are the most common medical complication during pregnancy. Preeclampsia is an important cause of mortality. The pathophisiology of it is still unknown. But sex hormon especially testosterone may be has a role in preeclampsia. We were conducted the comparison of serum free testosterone level in preeclamptic with normotensive pregnant women. Methods and Materials: This research was a case-control study included 27 women with singleton pregnancy who were complicated with preeclampsia (11 with severe preeclampsia and 16 with mild preeclampsia) and 62 normotensive pregnant women who were matched for age, body mass index (BMI) and gravity. Serum levels of free testosterone were measured by ELISA method. Results:Serum testosterone level was higher in preeclamptic group (1.66 ng/ml) than in mean of the control group (1.27 ng/ml), but this difference was not significant. Mean of testosterone levels in sever preeclampsia were higher than mild preeclampsia patients, however it was not statistically significant (2.08, 1.37, respectively). Conclusion: It seems that testosterone has not significant role in the pathogenesis of preeclampsia. .

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Background: Pyelonephrities is the urinary tract infection. Using supplemental dugs may decrease duration of treatment and hospitalization. We studied the effect of vitamin C on the recovery of symptoms due to pyelonephrities Methods and Materials: In this clinical trial, double blind, study, 64 patients with uncomplicated pyelonephrities were assessed in 2 groups randomly. Case group took vitamin C capsules, and control group took placebo capsules. In both groups, primary treatment was ceftriaxon capsules during hospitalization and they took ciprofloxacin capsules for 14 days after discharging. Symptoms and Urinary analysis were assessed in the first day of administration and then on the 7th and 14th days after discharging. Data were analyzed with Chi-Square test. Results: Mean of fever duration in vitamin C group (1.130.34 SD day) and placebo group (1.560.62 SD day) significantly decrease (p=0.001). There was a significant difference in dysuria duration in vitamin C group 2.191.06 SD day with placebo group (2.971.06 SD day) (p =0.007). In flank pain, nausea and vomiting duration difference was not significantly (p≥ 0.05). Conclusion: It seems vitamin C, as a supplemental drug improves some pyelonephrities symptoms, such as fever and dysuria, decreases of the hospitalization period

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Background: Hydatid cyst, a parasite disease, can involve liver more than other organs. The most serious complication of the cyst is rupture which may spread out to biliary duct, hollow organ, or abdominal cavity directly. Elective treatment is emergent surgery. Case: A 28 rural woman referring with abdominal pain, nausea and vomiting due to car accident. Abnormal findings consisted of: abdominal distention, reduction of bowel sounds, tenderness and generalized guarding and hive lesions in the anterior chest wall, upper abdomen, and both forearms. In sonography, a lot of free liquid in abdominal and pelvic cavity, and three hetroechoic masses in the right lobe of the liver were reported. Four days after abdominal surgery the patient was discharged with Albendazole order. Conclusion: Intra-abdominal rupture of hydatid cyst is the most serious that due to trauma complication and elective treatment is emergency surgery.

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Abstract Background: Current electrocardiography (ECG) criteria are insensitive for the detection of posterior acute myocardial infarction (AMI) and most of these cases remain undiagnosed. The purpose of this study has been evaluated of prevalence and clinical value of ST-segment in posterior electrocardiography leads during acute myocardial infarction. Materials and Methods: In cross- sectional analytic study, posterior ECG leads (V7, V8 and V9) as well as standard 12 leads in 210 consecutive patients with acute myocardial infarction admitted to CCU wards of Shahid Rijaie hospital. Reinforcing, continuous arrhythmia, hypotension, cardiologic shock, marked heart failure and/or acute pulmonary edema were considered. Related parameters to basic characteristics and next process of patients in two groups with/ without ST- segment elevation in posterior ECG lead were compared. Results: There were 153 patients with ST-segment elevation 1 mm in 2 contiguous leads. 12.4% patients had STE1 mm in 2 posterior leads, either as an isolated finding (4.6%) or in association with STE at inferior or lateral sites (7.8%). The standard 12-lead electrocardiogram was normal in two patients and 5 other patients were admitted with the diagnosis of non-Q infarctions. Tall R waves in V1/V2 developed in 5 cases. In-hospital complications were significantly more frequent among patients with STE in posterior leads (47.4% vs. 20.9% respectively, P=0.01). Conclusion: STE in posterior electrocardiography leads is not uncommon during acute myocardial infarction and may portend a worse in-hospital course.

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Abstract Background: This study was done to asses the educational barriers and problems, and improves the problems from the medicine students’ viewpoint in Arak, 2006-07. Materials and Methods: In this descriptive, cross-sectional study, a valid and reliable questionnaire concluding 71 questions about problems related to education, equipments, personnel, professors, motivation and evaluation methods was distributed among all interns (n=28) and externs (n=44). Results: Inappropriate duration of basic science education was 68%, too much general lesson was 86% did not provide a task description was 84.5% and lesson plan was 91.7% were considered at the start of course. Most of students were asked for learning clinical skill on mulage before practicum (84.5%) and internship (79.9%). Most of students believed that teaching pathology (86.1%) and pharmacology (97.3%) of each course may present by that course in clinic. Lake of sufficient diversity (71.8%), training equipment and inappropriate conference hall (54.9%) and library (76.1%) were considered. Inappropriate behavior 81.7% and corporation with students (58.6%) were reported. About professors, the mean was 16.8±5.1. The most of students worried about their unclear occupational future (87.1%) and 78.6% were believed that exams can not evaluate their knowledges. Conclusion: Asking for lesson plan present in start of course and clinical skills learning on the mulage before practicum and internship are including students demands that can easy to do. Umlaut of basic and clinical courses and teaching pathology and pharmacology courses in clinic can facilitate the basic and clinical courses learning.

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Background: Since cardiac surgeons have not kept up with advancements in pacing technology, there has been a tendency to limit the implantation of pacemakers by surgeons. This study compares two eras of pacing therapy including pacemaker implantation by cardiac surgeons and pacemaker set-up by a group of cardiologists in Shahid Rajaee Hospital in Tehran. Materials and Methods: In this cross-sectional study, we compared the existing data from all pacemaker implantations in the first half of 1999 (surgical era, era 1) to that of the first half of 2001 (cardiologists era, era 2). Results: During era 1, a total 114 pacemakers (46.5% male, mean age 63.3 ±18.4) and during era 2, 299 pacemakers (63.9% male, mean age 63.9±18.2) had been implanted. Indications for implantation were nearly similar, with AV block as the most common reason in 21.9% and 19.1% of implantations in eras 1 and 2, respectively. Single chamber pacemakers comprised 86% of implantations during era 1 compared to 54% during era 2 (p<0.01). The mean duration of admission was 18 days during era 1 while it was 10 days during era 2. Pacemaker malfunctions were detected following 7.9% of implantations in era 1 compared to 0.3% of cases in era 2 (p<0.01). Re-do procedures were performed after 2.7% of implantations during era 1 in comparison to 0.3% during era 2 (p<0.01). Conclusion: Pacemaker implantation was performed better by a coordinated pacemaker service run by cardiologist trained in pacemaker implantation.

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Background: The existence of estrogen and progesterone receptors, p53, human epidermal receptor-2(HER-2) and cathepsin-D are among the prognostic markers for breast cancer. In this study, we investigated the relationship between these factors and lymph-node involvement. Materials and Methods: In this case-control analytic study, 105 patients with breast cancer were investigated. After detecting breast mass, surgical biopsy was done and the status of the estrogen and progesterone receptors, p53, HER-2, and cathepsin-D were studied. Collected data were registered in a checklist and were subjected to analysis. Results: There was no relationship between lymph-node involvement and estrogen and progesterone receptors, p53, cathepsin-D and HER-2. Conclusion: In order to get more precise results about hormonal receptors, p53, HER-2 and cathespin-D, a similar research with a larger sample size over a longer period of time is needed.