مجله دانشکده پزشکی اصفهان
پیاپی 104 (فروردین 1389)

Along with increased age, learning and memory being two of the survival necessities decrease and may even deteriorate. This has motivated researches in the field of geriatric medicine to find new medicines effective on learning and memory amplification. Studies have shown that through advanced age, increased oxidative stressors lead to damaged brain processes including cognitive functions. Since types of red grape juice contain antioxidants, this study aimed to examine the effect of this material on passive avoidance memory in 1-year old rats. Twenty rats, each weighing about 270-330 g, were divided into two test and control groups. Both groups with no limitation had access to water vessel. In the control group, the water container contained pure water and in the test group it contained 80% pure water along with 20% grape juice. To prevent modification of ingredients, vessels contents were regularly refreshed. The passive avoidance memory and learning test was done in the learning device following intending treatments for all groups and in similar conditions. In this test, increased time delay for the first time of entry to the dark chamber and sum of the remaining time in the lighted chamber as well as decreased remaining time in the dark chamber indicate improved passive avoidance memory. To data analysis, the Mann-Whitney test was employed. Compared with the control group, learning and passive avoidance memory indices had significantly increased in the test group. Our results show that drinking grape juice causes increased learning and passive avoidance indices in rats; probably the reason was existence of antioxidant substances in the grape juice.

Glioblastoma multiform (GBM) is the most frequent and malignant primary tumor of brain. Today, the intracellular pathways and the mediators of these pathways are one of the treatment methods regarding to malignancies. Cyclo-oxygenase, C-kit, and Ki67 are the immunohistochemestry agents to staging and treatment of tumors. The aim of this study was to determine the relationship between the aforementioned mediators and GBM in the sample of Iranian patients. In a cross sectional study with control group, the GBM and other brain tumors pathology slides were extracted from the pathology laboratory files in Shahid Bahonar medical center in Kerman University of Medical sciences. The immunohistochemestry patterns of all slides were reviewed by two pathologists, separately; considering the COX-2, Ki67 and C-kit markers. The frequencies of the markers were compared between GBM and non-GBM patients by t-test and non parametric Mann-Whitney tests. Spearman correlation coefficient was used between age and degree of markers. The GBM patients were 81 and 45 patents were in the control group among which medoloblastoma and oligodendroglioma were the most prevalent tumors. There was complete agreement between two pathologists. Relationship between COX-2, Ki67 and C-kit in two groups of study were not observed. The result of current study was difference from the other studies. These differences might due to genetic variation in Iranian patients from other ethnic groups. Further studies like cellular and experimental studies should apply to investigate the frequency of markers in brain tumors.

Diabetes disease is a common disease in the world and diabetic retinopathy that is an eye disease, involve these patients so hardly that leads patients to blindness in elderly. Because of high incidence of type II diabetes in the society and the danger of retinopathy in this group of patients, in this study we attempted to introduce a classification and predictive model according to Classification and Regression Tree (CART) model for this disease.This study was performed according to the information of about 3734 patients with type II diabetes, consulted to Isfahan Metabolic and Endocrine Research Center from 1991 to 2006. According to the CART model, a classification pattern was introduced for predicting of retinopathy in these patients. In this study, classification tree model (CART) obtained with accuracy of 67 percents according to duration of disease, age, sex, systolic blood pressure, triglyceride, cholosterol and fasting blood sugar. This classification model had the sensitivity of 71% and specifity of 62%.By this study founds that the duration of diabetes is one of the most important element of retinopathy, in such a manner that the danger of retinopathy in type II diabetes patients with more than 7.5 years is more than other patients.

Using chest tube (CT) after heart surgeries lead to effective drainage of mediastinal and plural area which is essential for preventing pericardial effusion, hemothorax and pneumothorax. The aim of this study was to assess the effects of time of extracting chest tubes after coronary artery bypass graft surgery (CABG) on clinical outcomes of surgery. 307 patients who were candidate for coronary artery bypass graft surgery were randomly divided into groups one and two and their chest tubes were extracted respectively 24 and 48 hours after surgery with condition of drainage less than 40 cc in 4 hours. Then their pre-surgery data (age, gender, history of diabetes, myocardial infarction, stroke and left ventricular dysfunction, history of aspirin consumption, plavix, heparin and warfarin), during surgery data (time f aortic pump and klamp) and post-surgery data (number of breathes, rate of oxygen saturation, rate of pain, pain killer consumption, creation of plural effusion and pericardial effusion) were analyzed. The mean age of patients was 59.60 ± 9.24 years and 67.1% of them were male. There was no significant difference between two groups considering diabetes history (40.2% vs. 34.5%), myocardial infarction (45.8% vs. 36%), stroke (2.88% vs. 2%) and aspirin consumption (92.5% vs. 85%). Time of aortic pump and clamp was significantly higher in the second group (P < 0.001 and P = 0.001, respectively). The mean time of remaining of chest tubes was 22.80 ± 3.4 hours and 40.13 ± 3.58 hours in the first and second groups respectively (P < 0.001). The rate of oxygen saturation was higher in the first group; but this difference became significant in the first 24 hours after surgery (P = 0.047) and it was not significant in the second 24 hours after surgery. The mean pain was measured using Visual Analog Scale (VAS) and only until 30 hours after surgery the difference between two groups was significant (2.22 ± 2.49 vs. 2.93 ± 2.57, P = 0.016). In 7, 14 and 30 days follow-ups, no pericardial effusion was reported and the mean of happening of plural effusion was lower in the first group than the second one (3.7% vs. 5.5%, P = 0.59).Early extracting of chest tubes after coronary artery bypass graft surgery when there is no significant drainage can lead to pain reduction and consuming oxygen is an effective measure after surgery toward healing; it does not increase the risk of creation of plural effusion and pericardial effusion.

Growth hormone deficiency is an important and treatable cause for short stature in early diagnosed cases. This study was conducted to determine the frequency of growth hormone deficiency in children with short stature referred.

In a cross sectional descriptive study, all short stature children referred to endocrinology clinic of Golestan hospital in Ahvaz, Iran during 2005 to 2006 were included if they had height below 3rd percentile for age and sex, no any chronic disorder causing short stature and normal initial investigations. Standard growth hormone stimulation tests were performed and patients with growth hormone maximum level of less than 10 ng/dl (in two tests), were considered as growth hormone deficient.

202 cases (59.9% male and 40.1% female) with age range of 1 to 15 and mean age of 9.1 years were studied. Frequency of growth hormone deficiency was 11.8%. In growth hormone deficient group, male/female ratio was 2.4/1 and family history of short stature was positive only in 4.2%. Height standard deviation score (SDS) of 75% of these cases was ≤ -3 and weight for age in 79.2% was ≥ 10 percentile. These data showed significant difference between short and normal children (P < 0.05).

In this study, frequency of growth hormone deficiency was average, compared to other studies. In children with standard deviation score < -3 and weight percentile ≥ 10, growth hormone deficiency should be more considered. Parents and health care providers should be urged to early referral of children with short stature.

Swallowing disorders are commonly observed in more than one-third of patients with multiple sclerosis (MS). However, dysphagia in multiple sclerosis usually receives limited attention. The purpose of this study was to identify associated factors with different kinds of swallowing disorders in these patients.Swallowing function of 101 consecutive multiple sclerosis patients evaluated by the “Northwestern Dysphagia Patient Check Sheet” and “Clinical Oropharyngeal Examination”, clinically. “Northwestern Dysphagia Patient Check Sheet” could have identified patients with pharyngeal stage disorders, aspiration, oral stage disorders, and/or pharyngeal delay. Then possible associations between these disorders and age, age at onset of disease, disease duration and neurological disability were studied. Oral stage disorders related to disease duration (P = 0.001) and neurological disability as measured by EDSS scores (P < 0.001). Moreover, the prevalence of pharyngeal delay rose with increasing disease duration, significantly (P = 0.004). But the significant associations were not observed between swallowing disorders and age, and age at onset of disease. The findings of this study emphasized the importance of assessment and management of swallowing function in multiple sclerosis patients, especially in patients with a high EDSS score and long disease duration.

Magnesium is an essential metal in carbohydrate metabolism that causes activation and release of insulin. In diabetic patients, increasing blood sugar results to decrease of serum Magnesium and its low concentration in urine.In this study, 48 NMRI rats (Razi co. Iran) categorized in 4 groups; normal control, diabetic control, normal with magnesium treatment, and diabetic with oral magnesium treatment of 10 g/lit (MgSo4) in water. Diabetes was induced with inter peritoneal prescription of 60 mg/kg streptozotocin (STZ). Glucose concentration was measured with enzymatic-calorimetric method. The learning and memory capacities (acquisition and processing of information, decision making and response initiating functions) were assessed by the passive avoidance in a shuttle box. The differences among sessions in the number of shuttle-avoidance responses were interpreted as learning and memory. The latency time (LT) for enter to dark compartment in 4 groups was measured in 1, 6, 24, 48 hours, one week and two weeks after initial shock through learning test. The statistical difference of glucose concentrations between normal and diabetic control groups was significant (P < 0.0001). But there was no significant difference among normal control and magnesium treatment diabetic groups. Memory capacities and function in 6 timescales showed statistical difference of mean latency time between normal and diabetic control groups (P < 0.001). There was not significant difference in latency time between magnesium treatment diabetic and normal control groups. The reduction of glucose concentration in diabetic rats after 4 weeks oral treatment with magnesium show a good correlation with increasing their avoidance and latency time of enter to dark compartment. Thus magnesium consuming of diabetic group resulted to modulation of memory through acquisition and processing of information, decision making and response initiating functions.

Disorder of sex development (DSD) is defined as a congenital mismatch between sex phenotype, gonadal and sex chromosome, which mainly present with atypical genital appearance or ambiguous genitalia. It consider as a medical emergency and the cases should be evaluate immediately for detection of life threatening conditions and determination of gender.Case Report: We report a 50 days old infant with 49,XXXXY syndrome presenting with ambiguous genitalia. 49,XXXXY syndrome is a rare sex chromosome aneuploidy disorder, which represented with its “classical triad” consists of mental retardation, radioulnar synostosis and hypogonadism.