Hirudo medicinalis sucks blood directly through the external mammalian skin. We recently observed a healthy 64-year-old Iranian man, who presented with numerous asymptomatic multilobular oval-to-round well-defined 0.5 to 1.5 cm cystic lesions with central umbilication (central black eschar) over the upper portion of his chest. We made the diagnosis of epidermoid cyst, giant comedone and leech bite on the basis of the constellation of clinical features. The patient was treated with oral ciprofloxacin at a dose of 2 g daily, and 2% topical erythromycin solution. Despite improvement, the evidence of cystic lesions persisted. There was no history of similar lesions in any other family member. There was no history of trauma. The patient was not using any topical or systemic medication. Two weeks before his visit, he had a history of leech therapy under the supervision of a general practitioner. His medical history was significant for leech therapy of the lesions, five days previously. He was followed up for another two weeks and after disappearance of the inflammation, with the patient under local anesthesia, the well-circumscribed mass was completely evacuated with a sharp curette and comedone extractor. The patient was subsequently lost to follow-up. Conclusion: Considering the efficacy of leeches, it would be favorable to breed a germ-free leech. In Iran, the use of the leeches in surgery, in recent years, has been infrequent. It appears that the positive effects of this ancient remedy may now be explained through scientific methods, promising potentially even more uses of this admirable creature in medicine.

Background: Leishmaniasis is still one of the endemic parasitic infections in many countries comprising Iran. During the past decades, several medical and surgical approaches have been applied and studied to achieve the best option to treat the cutaneous leishmaniasis in Iran and the world. This study was carried out to evaluate the effect of topical Achilles millefolium in conjunction with intralesional glucantime on acute cutaneous leishmanial lesions. Materials and Methods: sixty patients with confirmed acute cutaneous leishmaniasis were recruited in the study. Patients were randomly allocated into two groups to receive twice daily topical gel of Achilles millefolium 5% (containing 5% poly phenol) (group A) or placebo (group B) for four weeks along with weekly injection of intralesional Glucantime. Results: There was no significant difference between the two groups according to age, gender, and duration of the disease. Also, there was no significant difference in complete and relative cure rates between the two groups (P = 0.35) using Visual Analog Scale (VAS). Application site reactions were occurred in 12 patients including redness in 8 cases in group-A and 2 cases in group-B, severe itching in one case in group-A and increasing wound secretion in another case in group-A (P = 0.014). Conclusions: Given the result of the present study, there is no significant difference in cure rates of lesions between yarrow and placebo topical gels as an adjuvant drugs with intralesional glucantime in treatment of acute cutaneous leishmanial lesions.

Background: Lidocaine 7%-tetracaine 7% is one of the combinations recently offered for performing laser-assisted hair removal. The aim of this study was to compare the effects of this combination with placebo on the side effects of laser-assisted hair removal. Materials and Methods: This clinical trial was carried out on 110 women who referred to Isfahan Spadana laser clinic for laser-assisted hair removal. Lidocaine 7%-tetracaine 7% was applied on one-half of the face, whereas placebo was applied on the other side to create local anesthesia, and after 30 min, the place was cleaned and investigated for complications (edema, erythema, and pallor); then laser therapy was begun. At the end of the therapy, the patients' pain was estimated using Visual Analog Scale (VAS). The data were analyzed using SPSS software by Chi-square and paired t-tests. Results: The mean age of patients was 27.74 ± 10.8 years. Average levels of anesthesia at 30 min after using lidocaine 7%-tetracaine 7% and placebo based on VAS were 3.6 ± 1.4 and 8.4 ± 1.5, respectively (P = 0.001). In other words, patients felt less pain by using lidocaine 7%-tetracaine 7%. The frequency of complications in patients was not significantly different between the two groups. Conclusion: Considering the better effect of lidocaine 7%-tetracaine 7% compared to placebo and its minimal side effects, we can use it before performing laser-assisted hair removal.

Background: For many years the association of skin tags and endocrynopathies has been postulated, although many reports are available but it has never been evaluated to mean normal population. Dyslipidemia is a frequent disorder among people and seemed to be necessary for screening within skin tag condition. This study is designed to find any possible association between skin tags and dyslipidemia. Materials and Methods: From April 2009 to June 2011, 168 patients enrolled the study. Among the remaining 152 patients, there were 89 females (58.5%) and 63 males (%41.5). Based on the TLGS study 136 men and 220 women enrolled the control group of study. The mean age was 28.4 years. Patients trained to have normal free diet for at least 1 month then referred to the laboratory. Blood samples were taken over 12 hours fasting with 2 hours intervals. Hypertriglyceridemia was defined as plasma level ≥160 mg/dl for men and ≥130 mg/dl for women. Hypercholesterolemia pointed at its value >200 mg/dl. Normal HDL levels was defined as >39 mg/dl for men and >35 mg/dl to women. Results: Mean skin tag number was 12.6 per subject. The most frequent localizations of skin tags were neck and upper chest (mean number: 13.4, 48.9%) followed by axilla (mean number: 11.6, 33%) and breast (10.2, 10.1%) in the patient group. The mean cholesterol level of case group was 192.2 ± 33.1 mg/dl, while it was 187.0 ± 42 mg/dl in the control group). The mean ± SD for triglyceride was 132.1 ± 69 mg/dl in comparison to 129 ± 74 in the control group. Conclusion: The study showed no significant differences between normal population and patients' lipid profile.

Background: Basal cell carcinoma (BCC) is the most common cutaneous neoplasm in human beings. Ultraviolet radiation is one of the most important predisposing factors for BCC. Although some recent investigations have shown a high serum level of phospholipids in actinic keratosis and BCC, this subject is still debated and needs approval. This study aimed to evaluate the association between serum lipid level and development of cutaneous BCC. Materials and Methods: In this case-control study, lipid profile including triglyceride (TG), Cholesterol (CHOL), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were measured in 30 patients with BCC and 30 healthy controls. Data were analyzed by descriptive statistical tests including t tests and Chi square test. Results: This study shows that the mean age of the case and control groups were 63.93 ± 12.09 and 61.57 ± 21.1 years (mean ± SD), respectively. The average amount of triglyceride, cholesterol, HDL and LDL in the BCC patients were 139.73 ± 69.11 mg/dl, 179.20 ± 43.42 mg/dl, 39.40 ± 9.30 mg/dl and 110.70 ± 34.13 mg/dl, respectively, whereas these amounts in the control group were 141.83 ± 80.41 mg/dl, 173.60 ± 96.32 mg/dl, 36.97 ± 6.35 mg/dl, 110.70 ± 34.13 mg/dl and 104.87 ± 30.85 mg/dl, respectively. No significant difference was found in the lipid profile of the case and control groups (P > 0.05%). Conclusion: This study shows that the serum lipid levels in patients with BCC has no significant difference in comparison with the control group and, therefore, relevance between BCC and serum lipid level is not proven. Further studies with a larger sample size are necessary for evaluating this subject.

Background: In the previous studies, it has been shown that mumps-measles-rubella (MMR) vaccine resulted in regression of warts via immunomodulatory effect and induction of immune system. Due to the high prevalence of warts in various populations, we evaluated the efficacy of MMR vaccine injection in the treatment of cutaneous warts. Materials and Methods: This double-blind randomized controlled clinical trial was conducted in Hazrat-e-Rasoul Hospital in Tehran in 2011-2012 on 24 patients with warts who were allocated to two groups including MMR group and normal saline group. MMR vaccine was injected intralesionally in the MMR group, whereas normal saline was injected into the lesions in the second group. These injections were repeated every 2 weeks intervals for maximum 3 injections. All patients were followed up every 15-day interval up to 45 days and then up to 6 months regarding relapses and finally, side effects, probable relapse, and therapeutic outcomes were evaluated and compared. Results: At the end of follow-up period, therapeutic outcomes in the MMR group included no cure in 2 cases, relative cure in 4 cases, and complete cure in 18 cases. In normal saline group, these rates included no cure in seven cases, relative cure in nine cases, and complete cure in six cases (P < 0.001). No significant complication occurred in the two groups. Conclusion: MMR vaccine may result in desirable therapeutic response. The hypothesis that is considered here is that MMR vaccine, via induction of cellular and humoral immune system, accelerates the destruction of virus and infected host cells.

Background: Wound healing is a complex process and has been an ongoing challenge all over the world. Some studies have suggested light cure as a modality to accelerate wound repair. It can induce fibroblast proliferation, increase collagen synthesis and activate cellular processes involved in expression of procollagen type I and III mRNA. This study was designed to assess the macroscopic effect of halogen dental curing blue light on full-thickness open wound healing in NMRI mice. Materials and Methods: Forty male NMRI mice were divided into control and treatment groups. A full-thickness wound of 6 mm in diameter was induced on the lower back of all mice under general anesthesia and sterile conditions. The mice of the treatment group received a 5-min exposure of halogen light Coltolux II (QHL), 420-500 nm, daily for 7 days. The diameter of the wound was measured in both the treatment and the control groups every second day up to Day 14. Data were analyzed by SPSS version 12 software using Student's t-test. A significance level of P ≤ 0.05 was considered for each comparison. Results: There was a significant difference in wound diameter between the control and the treatment groups at all measurements after Day 3 (P ≤ 0/05). Conclusion: The results of this study suggest improvement of full-thickness wound healing by daily irradiation of halogen dental curing blue light of 420-500 nm for 7 days.

Congenital micronychia may involve big toes or may involve other nails. The etiology of micronychia is not clear but amniotic bands, teratogens (drugs, alcohol), Nail Patella Syndrome etc. A 44-year-old woman with multiple isolated congenital micronychia over her hands and feet was selected. The major affected nails were thumbs and Index fingers. Surgical method were done step by step: Anesthesia of the area, extraction of short nail, elevation of nail bed, longitudinal nail bed incisions, suturing the lateral nail bed to the nail wall, covering the nail bed by a splint of plastic suction tube, bandage with gauze Vaseline. Finally, we hypnotized that in congenital micronychia, the main pathology is in nail bed; through this theory by nail bed expansion better outcomes are coming.

Background: Cutaneous leishmaniasis (CL) is still considered as a health problem in the world. Several methods of control in different regions, together with obtaining integrated information on its natural foci, are needed to decrease its prevalence. This study was designed to evaluate the effects of simultaneous interventions on CL control. Materials and Methods: A standard questionnaire was used to identify patients among pilgrims to Emamzadeh Agha Ali Abbas (Isfahan Province, Iran). Subsequently, three methods of controlling the disease, including, spraying residential buildings with Baygon, baiting with zinc phosphide poisons, changing the vegetative cover of the region, improving the environment, and mounting a mesh on all doors and windows of buildings in residential areas were used. The control measures were then evaluated by comparing the number of pilgrims affected by CL after and before the interventions. Results: While 23 pilgrims (1.4%) were affected with CL before the intervention (pretest), five (0.3%) persons were found to have CL after taking control measures. The Chi-square test did not indicate any significant difference in the relative frequency of CL (P = 0.731). Conclusion: The only scientific method for preventing and controlling zoonotic CL (ZCL) is a combination of the control methods (improving the environment and fighting off the disease districts and vectors) together with changing the vegetative cover of the region. Any measure for controlling this disease must be taken and programmed in accordance with the relevant experts' views, in coordination with the participation of other organizations and the society.

Background: Despite advances in acne therapy in recent years, treatment failure is common. Isotretinoin is the only drug that affects almost all factors in acne pathogenesis, but side-effects are common at the doses reported in published studies in the literature. The aim of this study was to investigate the efficacy of low daily dose isotretinoin in moderate to severe acne patients. The secondary objective was to measure the rate of relapse 5 years after the completion of therapy. Materials and Methods: In this retrospective, noncomparative study, 146 patients with moderate to severe scare prone acne. Treatment regimen consisted of isotretinoin, fixed 20 mg daily, and duration of treatment-based on the weight of patient, until total cumulative dose of 120 mg/kg of body weight is achieved. No topical or other systemic therapy was allowed during the trial. Liver function tests (serum glutamic-oxalocetic transaminase, serum glutamate pyruvate transaminase, direct and total bilirubin), and lipid profiles (total cholesterol, low-density lipoprotein, high-density lipoprotein, triglyceride) were evaluated for all patients, before the initiation of treatment and again after the 2 ^nd month of treatment. All data analyzed by Microsoft Office Excel 2007; in descriptive statics frequency and SPSS.18 software. Results: At the end of treatment course, (96.4%) demonstrated complete clearing of their acne, defined as no acne or occasional isolated lesions. In 5-year follow-up, relapse accrued in 11 (7.9%) of patients. All adverse effects were mild, and discontinuation of treatment was not necessary. Conclusion: Low dose isotretinoin was found to be a safe and effective choice for patients with moderate to severe scar prone acne vulgaris.

Background: The abundance of infections associated with intensive care unit (ICU) is increasing due to the increased use of aggressive medical equipments like the central venous catheter (CVC). This study was designed and performed in 2010-2011 at Alzahra hospital, which is a referral center. This study aimed at determining the relative abundance and microbial sensitivity of organisms, which were creating contamination with CVCs in hospitalized patients in the ICUs of Alzahra hospital. Materials and Methods: This is a cross-sectional study performed on 71 patients who were hospitalized in the Alzahra hospital ICU and had CVCs during 2010-2011. The data obtained was analyzed by SPSS version 20 software and descriptive statistical approaches and chi-square and t-test trials. Results: In the sample culture obtained from the patients' catheter in 19 cases (26/8%), no microorganism was grown and in 52 cases (73.3%) at least one type of microorganism including bacteria or fungus was grown. In this study, average hospitalization time in patients who got positive results from their catheter culture was significantly more compared with patients who did not grow any kinds of microorganism in their sample cultures. Conclusion: In this study, CVCs microbial contamination has a high prevalence, which is a major cause of prolonged patients staying in ICUs, and therefore, it is essential to take precaution and discharge the patient early for decreasing the catheter contamination and preventing the hospital infections incidence in the ICU patients.

Background: Fragile fractures are most likely manifestations of fatigue damage that develop under repetitive loading conditions. Numerous microcracks disperse throughout the bone with the tensile and compressive loads. In this study, tensile and compressive load tests are performed on specimens of both the genders within 19 to 83 years of age and the failure strength is estimated. Materials and Methods: Fifty five human femur cortical samples are tested. They are divided into various age groups ranging from 19-83 years. Mechanical tests are performed on an Instron 3366 universal testing machine, according to American Society for Testing and Materials International (ASTM) standards. Results: The results show that stress induced in the bone tissue depends on age and gender. It is observed that both tensile and compression strengths reduces as age advances. Compressive strength is more than tensile strength in both the genders. Conclusion: The compression and tensile strength of human femur cortical bone is estimated for both male and female subjecting in the age group of 19-83 years. The fracture toughness increases till 35 years in male and 30 years in female and reduces there after. Mechanical properties of bone are age and gender dependent.

Accumulating data clearly claimed that Punica granatum L. (pomegranate) has several health benefits. Pomegranates can help prevent or treat various disease risk factors including high blood pressure, high cholesterol, oxidative stress, hyperglycemia, and inflammatory activities. It is demonstrated that certain components of pomegranate such as polyphenols have potential antioxidant, anti-inflammatory, and anticarcinogenic effects. The antioxidant potential of pomegranate juice is more than that of red wine and green tea, which is induced through ellagitannins and hydrosable tannins. Pomegranate juice can reduce macrophage oxidative stress, free radicals, and lipid peroxidation. Moreover, pomegranate fruit extract prevents cell growth and induces apoptosis, which can lead to its anticarcinogenic effects. In addition, promoter inhibition of some inflammatory markers and their production are blocked via ellagitannins. In this article, we highlight different studies on the therapeutic effects of pomegranate and their suggested mechanisms of actions.

Background: Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone. Materials and Methods: The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session. Results: Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group. Conclusion: The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis.

Background: Helicobacter pylori antimicrobial resistance is an important factor responsible for treatment failure. The purpose of this study was evaluating the prevalence of point mutations in clarithromycin-resistant clinical isolates of H. pylori in Isfahan city of Iran. Materials and Methods: Thirty isolates of H. pylori from 130 biopsy specimens were isolated by culture and confirmed by biochemical and PCR tests. The MIC of clarithromycin antibiotic for 30 clinical isolates of H. pylori was determined by E-test method. The point mutations in the 288 bp of 23S rRNA gene of H. Pylori were investigated in four clarithromycin-resistant clinical isolates by PCR followed by sequencing. Results: Among 30 isolates of H. pylori, 4 cases were resistant to clarithromycin. One point mutation was found at position T2243C in the 23S rRNA gene in all resistance isolates. Conclusions: In our study, H. pylori resistance to clarithromycin associated with point mutation at position 2243 (T2243C).

Background: Antidepressant drugs are commonly employed for anxiety and mood disorders. Sertraline is extensively used as antidepressant in clinic. In addition, adipose tissue represents an abundant and accessible source of adult stem cells with the ability to differentiate in to multiple lineages. Therefore, human adipose-derived stem cells (hADSCs) may be useful for autologous transplantation. Materials and Methods: In the present study, we assessed the effect of antidepressant drug Sertraline on the proliferation and neurogenic differentiation of hADSCs using MTT assay and immunofluorescence technique respectively. Results: MTT assay analysis showed that 0.5 μM Sertraline significantly increased the proliferation rate of hADSCs induced cells (P < 0.05), while immunofluorescent staining indicated that Sertraline treatment during neurogenic differentiation could be decreased the percentage of glial fibrillary acidic protein and Nestin-positive cells, but did not significantly effect on the percentage of MAP2 positive cells. Conclusion: Overall, our data show that Sertraline can be promoting proliferation rate during neurogenic differentiation of hADSCs after 6 days post-induction, while Sertraline inhibits gliogenesis of induced hADSCs.

Background: Considering the high prevalence of female genital tract neoplasms, non-specific nature of the initial symptoms, higher possibility of metastasis by the time of diagnosis, importance of differentiating metastatic Mullerian tumors or metastatic breast cancer in the female genital tract, especially in the ovary, and lack of diagnostic markers with high sensitivity and specificity, the purpose of the current study was to evaluate the utility of Paired box protein8 (PAX8) expression in Mullerian and non-Mullerian neoplasms. Materials and Methods: In this descriptive-analytic, cross-sectional study, paraffin-embedded tissues of patients with definitive pathologic diagnosis of Mullerian and non-Mullerian tumors were selected. PAX8 immunohistochemical (IHC) staining was performed for all selected blocks. Immunopositivity of the slides for PAX8 was reviewed. It was defined as the presence of nuclear staining in at least 10% of the tumor cell nuclei. Results: Thirty-seven Mullerian (including 18 ovarian epithelial tumors, 17 endometrial carcinoma and two endocervical adenocarcinoma) and 37 non-Mullerian tumors were studied for PAX8 expression. Twenty-nine of 37 (78.4%) and one of 37 (2.7%) of the Mullerian and non-Mullerian tumors were positive for PAX8, respectively. The sensitivity and specificity of PAX8 by IHC for differentiation of Mullerian from non-Mullerian tumors was 78.4% and 97.3%, respectively. Conclusion: Our findings indicated that PAX8 could be used as a useful IHC marker for diagnosing Mullerian tumors. It has moderate to high sensitivity, but high specificity, for diagnosing carcinomas of Mullerian origin.

Traditionally, the management of chronic osteomyelitis emphasizes the excision of necrotic and infected material (sequestrectomy/debridement) followed by prolonged administration of antibiotics. Most children with chronic osteomyelitis undergo surgery with the inherent risk of damage to their growth plate. Treatment regimen based on findings of imaging with emphasis on antibiotics to potentially reduce the rate of surgical interventions is being increasingly reported. An 8-year-old thin built Indian boy belonging to lower socio-economic group presented to the orthopedic department with the chief complaints of pain in the left upper leg for the last 3 months. Radiograph of the affected limb showed features of chronic osteomyelitis with a large diaphyseal sequestrum on the medial cortex of tibia with incomplete involucrum. No surgery was performed; not even incision and drainage. The sinuses healed completely in 6 weeks time with appropritate antibiotics alone. Gradually, over a period of 8 months, the large tibial diaphyseal sequestrum got fully incorporated into the healthy diaphyseal bone indistinguishable from normal bony architecture with complete clinical remission of sepsis. Our rare case is an example of the evolving notion that antibiotics and supportive care alone may be sufficient enough in the treatment of chronic osteomyelitis even with large diaphyseal sequestrum in paediatric cases where excellent healing potential of the immune-competent child may potentially make surgical intervention redundant.

Background: The global prevalence of diabetes mellitus is increasing rapidly. Measurement of glycated hemoglobin, predominantly HbA _1c , is fundamental to the management of patients with diabetes. HbA _1c is used to monitor long-term glycemic control, adjust therapy, assess the quality of diabetes care and predict the risk for the development of complications. While HbA _1c is the standard method for long-term glycemic control in diabetic patients, there are different methods for measurement of HbA _1c and all laboratories do not use the reference method (high-performance liquid chromatography [HPLC]).The objective of this study is comparison of three different methods with HPLC to find out which method has an acceptable concordance and correlation with the reference method. Materials and Methods: Fifty-eight diabetic patients were assessed in this study. The blood sample of each patient was checked with Diazyme (enzymatic assay), Nycocard (boronate-affinity binding) and Biosystem (micro column chromatography). The values of HbA _1c of each method were compared with the Knauer-HPLC results. Results: The means of the differential values between each method and HPLC in the ANOVA test are as follows: M = 1.8, SD = 1.09 for Nycocard-HPLC; M = 1.5, SD = 1.08 for biosystem-HPLC; M = 1.3, SD = 1.2 for Diazyme-HPLC. Pearson's correlation coefficient between HPLC and Nycocard; 0.76, HPLC and Diazyme; 0.75 and between HPLC and Biosystem was 0.68. Linear regression parameters for each method with HPLC were also determined. Conclusion: Diazyme had a better performance and showed a greater concordance with HPLC among others, although it was not an ideal alternative for HPLC.

Background : Avascular necrosis (AVN) of femoral head is one of the multifactorial pathologies, which can disturb hip joint and its range of motion. There have been several therapeutic methods for this pathology, but the results are controversial. Some studies show that core compression prevents the progress of the disease and its symptoms. This study aims to explore this issue. Materials and Methods : This clinical trial was conducted on patients who were diagnosed with AVN of femoral head stage I, II _A, at educational hospitals of Isfahan in 2010. The patients who met the inclusion criteria and suffered from AVN of femoral head stage I, II _A for any reason (primary or secondary), entered the study. Six and 12 months after surgery, final assessment in terms of range of motion, return to work, and severity of pain based on vancouver associated score (VAS) was made and recorded. The duration of hospitalization and rate of infection were also recorded. The data were entered into and analyzed by the SPSS software. Results: Mean and standard deviation of pain severity before surgery was 6.82 ± 1.74 in the participants. After 6 months, pain severity reduced to 4.05 ± 1.29, and after 12 months, it reached 2.41 ± 1.82. On the basis of analysis of variance with repeated observation, the severity of pain was significantly reduced in 1 year (P<0.001). Conclusion: It can be concluded that core decompression in patients with AVN of femoral head stage I, II _A can improve pain in hip area and increase range of motion.

Background: Medicated gums are intended to be chewed and act either locally, absorbed via the buccal mucosa or swallowed with saliva. We prepared the metformin gum to overcome its side effects including vomiting, diarrhea, and abdomen discomfort. Furthermore, it could be useful for those who have swallowing problems. Materials and Methods: Metformin hydrochloride (250 mg) with suitable sweeteners was mixed manually for 5 min. This mixture was spray dried, freeze dried, or directly mixed with chewing gum base. Glycerin, xylitol, and menthol were added and the produced paste was kept in the freezer for 2 h to be stable. As the metformin shows bitter taste, we tried to mask this unpleasant taste with using different methods explained. The releasing pattern was evaluated by using a mechanical chewing machine. The best formulation with the optimized releasing pattern, suitable physicochemical properties and pleasant taste were selected. Content uniformity, releasing percent, and other physicochemical properties were identified as well. Taste, flavor, and appearance characteristics were evaluated by using a self-made questionnaire based on the hedonic test method. Results: The chewing gum dosage content was about 86.2%. The release rate of metformin chewing gum was about 70% after 5 min of mastication. Masking the bitter taste of drug was achieved by using acesulfame-isomalt as sweeteners and prepared it by freeze drying equipment. Conclusion: Metfornin chewing gum had suitable appearance and appropriate invitro characteristics that fallow the pharmacopeia suggestions. This chewable gum showed bitterness suppression with a suitable release rate.

Background: Achillea wilhelmsii (A. wilhelmsii) is used in Iraninan folk medicine for the treatment of hypertension; also, in previous reports, the hypotensive and antihypertensive effects of this plant have been indicated. The aim of the present study is to investigate the vasorelaxant effect of the hydroalcholic extract of A. wilhelmsii and its underlying mechanisms in isolated rat aorta. Materials and Methods: The effect of the hydroalcholic A. wilhelmsii extract was tested on the contractile response of Wistar rat aorta induced by potassium chloride (KCl) and phenylephrine (PE) using a pressure transducer that is connected to the PowerLab. Results: The cumulative concentrations of A. wilhelmsii (0.5-8 mg/ml) induced a vasorelaxation both in endothelium-intact and endothelium-denuded aortas precontracted by high K ⁺ (6 Χ 10⁻² M) or 10⁻⁶ M PE. A. wilhelmsii, at a concentration of 4 mg/ml, reduced Ca ²⁺ -induced contraction (P < 0.001 vs. control) after PE or KCl had generated a stable contraction in the Ca ²⁺ -free solution. Furthermore, after incubation with diltiazem, the vasorelaxant effect of A. wilhelmsii reduced in the endothelium-denuded aortas precontracted by PE or KCl (P < 0.001 vs. control). In contrast, A. wilhelmsii-induced relaxation was not affected by glibenclamide, BaCl ₂ , ruthenium red, methylene blue, or heparin. Conclusions: The results showed that A. wilhelmsii had a vasorelaxation effect, which was not endothelium-dependent. The relaxation was mediated by inhibition of extracellular Ca ²⁺ influx through voltage- and receptor-operated Ca ²⁺ channels (VDDCs and ROCCs) in vascular smooth muscle cells.

Backgrounds: Antibiotic resistance is an increasing problem throughout the developed world, and knowledge about different resistance mechanisms is consequential for efficient treatment of bacterial infections. Although metronidazole has been frequently used in treatment regimens for H. pylori infection, but antibiotic resistance is now a major contributing factor in treatment failure. Nevertheless metronidazole has been greatly used as a critical component of combination therapies for H. pylori infection. Objective: This study is trying to describe the mutational mechanisms of metronidazole resistance in H. pylori in our clinical isolates in Isfahanian patients, Iran and compare with the findings of previous studies in world. Materials and Methods: MIC values of metronidazole for H. pylori strains were determined by E- test. Both rdxA and glmM genes used for confirmation of isolates as H. pylori and then amplification of another rdxA oligonucleotide pair was done. Finally, the six resistant strains were sent to sequencing for other processing and further analysis was done by software. Results: The result of six clinical isolates in comparison with 26695, J99 and 69A as a sensitive and resistant reference strains showed plenty of mutations. No frame shift and nonsense mutation was seen in our clinical isolates. Conclusion: An interesting finding in metronidazole-resistant strains in our study was the detection of one mutation not previously described in the literature in the rdxA gene and this W(209)R substitution presumably plays a role in inducing metronidazole resistance.

Background: Post-operative shivering is an unpleasant complication that various drugs are used to prevent and treat. It is tried to advice a suitable drug with the least side-effects. This study was carried out to examine the effect of intravenous Apotel on the post-operative shivering and core and peripheral body temperature. Materials and Methods: This clinical trial conducted in Al Zahra and Kashani Hospitals in Isfahan in 2012 on 64 patients undergoing upper limbs surgery with general anesthesia, which divided in two equal groups. In the first group, before induction, 15 mg/kg and up to 1 g paracetamol was infused in 100 cc normal saline within 20 min and control group was infused 100 cc normal saline during 20 min. Post-operative shivering and pain were recorded in the same time in addition to the core and peripheral temperature. The results were analyzed by SPSS ve.20 software. Results: In patients receiving Apotel, the core and peripheral temperature were significantly lower (P < 0.05). At 10 min after entering in recovery, 10 patients in the control group and 2 in the intervention group suffered from shivering (31.2% vs. 6.2%), which was significantly different (P = 0.02). Nineteen patients (29.7%) suffered from shivering in recovery (14 patients in the control group and 5 patients in the intervention group (43.8% vs. 15.6%)). In Apotel receiving group, the incidence of shivering in recovery was significantly lower (P = 0.014). Conclusion: Given the beneficial effects of Apotel in post-operative shivering and pain reduction, using the drug as a pre-drug is recommended in patients undergoing surgery with general anesthesia.