مجله دانشگاه علوم پزشکی رفسنجان
سال سوم شماره 3 (پیاپی 11، تابستان 1383)

Clinical diagnosis of congenital hypothyroidism (CH) is impossible without screening this disorder in neonates. Recall of neonates, on the other hand, is time consuming and results in economical and psychological burden on parents. The aim of this study was to evaluate the recall rate in congenital hypothyroidism screening project in Isfahan, using first an approach involving measures of both TSH and T4 and then using TSH alone, and comparing the results of each of the mentioned approaches with each other and other societies.

From June 2002 to August 2003, the blood of 3-7 day old neonates referred from 17 hospitals and maternity wards in Isfahan were collected the serum were separated and TSH and T4 level were measured. The level of TSH and T4 were measured using IRMA and RIA methods, respectively. If neonates’ serum TSH level was more than 20 mIU/L or T4 level was less than 6.5 m g/d, in the first step or TSH level was >20mIU/L in the second step, they were recalled. Neonates with TSH>10 and T4<6.5 on their next measurement after the recall, were considered as congenitally hypothyroid ones, and underwent treatment.

Serum T4 & TSH of 39601 neonates were measured in this study (29493 and 10108 neonates by first and second recall approach, respectively). Seven hundred neonates were recalled (647 neonates on the first step and reminder based on the second step). Recall rate on the first stage was higher than the second stage (2.2% VS 0.5%, p<0.05). Most of the recalled neonates in the first recall step were recalled for low T4 level (p<0.05). The prevalence of CH was one in 338 live births.

Although recall rate was in acceptable range both by first and second step, but using TSH alone for screening and recalling seems to be more practical and effective in our society, than using both T4 and TSH for this purpose.

Lecithin (phosphatidylcholine) is known as a precursor of acetyl choline. The studies on experimental animals, have shown that the cholinergic system has an important role in learning and memory. Therefore, in this study we investigated the effects of different doses of lecithin on the spatial learning. The adult male NMRI rats (250 ± 25 g and 4.5-5 months) were used. All animals were trained for a spatial learning task using T-maze and were trained for subsequently nine days based on standard method (n=7). Animals were divided into 5 groups as follows: Lecithin (480,240,120 IU/kg) 0.1ml/10g B.W was administrated for 9 days subsequently in groups 1-3, one hour before each day the experiments. lecithin’s sham group (group 4) received distilled water by gavaged, and the control group (group 5) received normal food. Statistical analysis, ANOVA, has shown that lecithin, in all three doses, decreased the mean of running times (p<0.05, p<0.001, p<0.001), but it had no significant effect on the number of errors. It seems lecithin increase acetyl choline, which in turn improves the function of cholinergic system in hippocampus.

Patients with cardiac syndrome X are affected by exertional angina, positive exercise test, normal coronary arteriogram. It seems that these people have an altered perception of cardiac pain, due to increased sensitivity to adenosine. Previous studies have shown that intravenous or oral aminophylline, an adenosine receptor blocker, improves exercise tolerance in patients with this disorder. In this study the effects of oral theophylline on clinical presentations and exercise test in patients with cardiac syndrome X referring to Cardiology clinic of Imam Khomeini hospital in Sari were studied during the year 2003. This study was a double-blind placebo controled clinical trial done on the patients with cardiac syndrome X. Twenty Patients (18 women and 2 men), mean age 50 years, with syndrome X were studied. Patients were randomly divided into two control and case groups, both of the groups had similar basic features. In the case group theophylline with the dose of 150 to 225mg (according to the age and cigarette smoking was given twice a day, and the control group received placebo for three weeks. All patients underwent treadmill exercise testing at the end of the three week period. The number of episodes of chest pain was recorded. Two paired student's t test was used for comparison of the obtained results. In this study the total exercise duration in the case group was longer than the control group (p<0.05), and the number of episodes of chest pain in the case group was less than the control group (p<0.05). There was no significant differences in the magnitude of ST segment at the peak of exercise and the time of angina at exercise test between the two groups. It seems that oral theophylline has a favorable effects on the control of the symptoms of cardiac syndrome X like the duration of exercise test and the number of episodes of chest pain, but its effects on the symptoms and ST segment changes need further studies.

One of the most important roles of the lumbar intervertebral disc is to provide the stability between adjacent vertebras. This function will be confused during the lumbar disc herniation. stabilizer exercises (SE) have been recommended for patients with low back injury to improve the lumbar function, so these patients may perform their activities of daily living (ADL) more easily. This study has been designed to investigate the effects of the SE in the patients with lumbar disc hernia. Sixty patients (22-55 years old) with lumbar disc hernia at L4-L5 or L5-S1 (without any motor or sensory deficiency) were randomly divided into two groups of thirty (experimental and control). The SE protocol includes 4 stages, from easy to advanced, and each stage was taught to the experimental group in the first session of each week. The exercises had to be performed ten times at home twice a day. Parameters were measured at the first session and repeated each week. The pain was measured by visual analogue scale, trunk flexion in the long sitting position (without pain), straight leg raising (SLR) angle without pain and time to complete the following ADL tasks climbing 5 steps, 10 meter fast walking without pain, lying prone from the standing position and standing from the prone position. The measurements were repeated after a four week follow up. Significant pain relief (p<0.0001), left and right SLR angle improvement (p<0.005) and increased trunk flexion (p<0.0001) were found in the experimental group, but not in the control group. The time required to fulfill the ADL tasks were also reduced significantly (p<0.05). These results were stable after the follow up period. The results showed that the SE protocol may improve the ADL performance in the patients with lumbar disc hernia, which may indicate the effectiveness of the SE to provide enough stability in the lumbar region of these patients.

Styrene is one of the aromatic solvents that releases in plastic processing in dustries. This study was conducted to determine whether low to moderate exposure to styrene affect the liver function in workers of an industrial plastic production. A cross sectional study was performed comparing serum hepatic transaminases [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)], cholestatic enzymes [alkaline�phosphatase (ALP) and γ-glutamyl transferase (GGT)], and bilirubin�in 58 workers of plastic pruduction industry who were exposed�to styrene and 52 workers without exposure (control group) from the same factory. Exposure to styrene was�assessed in air by dosimetry and gas chromatography during the working hours. Mean concentration of styrene defined as 18 ppm in air. After statistical analysis, a significant difference was noted for mean ALT and total bilirubin between the case and control groups. Eventhough the means of the other laboratory data (AST, GGT, ALP, direct bilirubin), were higher in the case group compared to the control but the differences were not significant. The consistent findings of increased total bilirubin and ALT concentrations in this study provide evidence�for the diminished hepatic clearance of bilirubin with�associated metabolic�dysfunction in workers exposed to styrene, so periodic evaluation of liver function tests is recommended for plastic processing industries workers.

Ba ckground: Thyroid hormones are well known to be essential for normal development of the brain in human and animals. In particular, thyroid deficiency during the prenatal periods causes significant impairments of structural development and organization of the brain. Therefore in this study, the effects of maternal hypothyroidism on morphometrical changes of synaptic sites of pyramidal cells in the mouse brain was evaluated. T his study was carried out on 24 balb/c mice. The animals were divided into two experimental and control groups. The experimental group was made hypothyroid by chemical thyroidectomy with oral propylthyouracil (PTU) in drinking water, while the control group was kept intact. On the 20th postnatal day, by using histological technique preparation and histochemical staining (Golgy) method, we were able to investigate the effects of maternal thyroid hormones deficiency, on the development of pyramidal synaptogenesis in postnatal period of the mouse. Our findings showed that maternal hypothyroidism during pregnancy cansed a significant decrease of the dendritic spines in the experimental group (31.08 ±0.45) compared with the control group (39.88 ±0.55), (p<0.05). In addition, an increase gap among the synaptic sites of pyramidal cells in the brain cortex among the experimental group (3.78 ±0.86) in contrast with the controls (2.57 ±1.05) were observed (p<0.005). The results of this study indicated that there is a key role for thyroid hormones in connection with maturation and neuronal development of brain cortex. Also hormonal reduction during pregnancy can affect the development and neuronal synaptogenesis of the next generation.

Caffeine as a methyl xanthine compound inhibits the breakdown of cyclic AMP, and causes an increase of the intracellular Ca+2 of different cells. It also may be involved in enhancement of learning and memory via this rout. In this study the effect of caffeine on learning and memory has been evaluated. In this study the effects of different concentrations of caffeine (10, 20, 40, 80 mg/kg), on the learning and memory in male rats weighting 250-300 gr, were evaluated. The rats (30) were divided into 5 groups (4 test groups and 1 control group). The effects were assessed by using the one way active avoidance method. The test groups recieved different doses of caffeine in 3ml/kg normal saline (N.S), and the animals in the control group recived only N.S (3ml/kg) intraperitoneally, 30 minutes before each test. The data obtained from the test group was compared with the control group statistically. Our results indicated that caffeine affect on learning and memory dose depently. Using 10 mg/kg caffeine significantly increased the mean percentage of learning (p<0.05), and the doses of (10, 20, 40 mg/kg) significantly elevated the level of short term memory. Although in the case of the long term memory all doses of caffeine (10, 20, 40 and 80 mg/kg) showed a significant difference between the test and the control groups, the result for 80 mg/kg dose was reversed. Our results indicated that caffeine in low doses enhances the prosess of learning and memory but in higher doses it may suppress them.

Turner syndrome (TS) is the most common chromosomal abnormalities in girls. Girls with TS have an abnormal or missing X chromosome that causes short stature, ovarian failure, and renovascular and cardiac anomalies. It has been shown that there is a tendency to obesity in TS. The aim of this project was to survey body mass index (BMI) in girls with TS and the changes of BMI after growth hormone (GH) therapy. Performed to evaluate if body mass index. In this prospective study BMI (kg/m2) of 43 girls with TS were calculated at baseline (at the diagnosis). 21 individuals were treated with 0.1IU/kg/day of GH subcutaneously for 6 months. Nine girls were excluded because of the delayed diagnosis (over 15 years old) and 13 girls did not complete the treatment. The mean age at diagnosis was 12.47 years old, and the weight and height of the girls were lower than standard. The mean of BMI was 18.78+3.69 and 18.56+2.05 before and after 6 month GH therapy, respectively. No significant changes in BMI was observed. The mean height of patients was 119 ± 4 cm (lower than normal) at the beginning of study and 123 ± 15 cm after GH therapy. This study documented that short – term GH administration was not associated with the changes of BMI in the girls with TS.

Anemia is one of the most common and serious clinical problems in childbearing age women, and the prevalence of anemia varys in different populations. To establish the most appropriate strategies for preventing and treating anemia, exact information in essential. In this cross-sectional investigation, an equiprobabilistic sample of 250 women aged 15-45 years referring to the health centers of Bam were studied. Demographic characteristics were recorded in a questionnaire for women and some blood factors representing anemia were measured in clinical laboratory. Data were analysed by ANOVA, X2 and Fisher tests. The mean age of women was 28.5 years, the mean number of pregnancies was 2.99 and the mean number of children was 2.84. The hemoglobin level below 12 g/dl was considered as anemia. The study showed a prevalence of 10% of anemia, and it was related to the factors including the number of pregnancies and number of children. Mean hemoglobin of the pregnant women was 12.68 g/dl and it was 13.27 g/dl in nonpregnant women. Based on the results of this study, special attention to the women with multiple pregnancies is suggested.

Stroke is one of the major causes of death and disability in every society. The disability resulting from stroke most commonly presents as hemiplegia or hemiparesis. The purpose of this study was to determine quadriceps and gasterosoleous muscles tonicity problems in hemiparetic patients, and the effects of strengthening exercises protocol on the treatment of these impairments due to the different critical opinions on the strengthening exercise's side effects. Thirty four hemiparetic patients secondary to stroke, mean age 52.4±6.2 years, participated in the study through simple non-probability sampling. All the patients were screened to ensure that the time passed since the onset of the stroke was at least 12 months. Patients were assigned randomly to either an experimental group or a control group. Muscle strength were measured using dynamometer and their muscle tone was graded on the modified Ashworth Scale before and after the 12 sessions of intervention. The experimental group received functional, balance and strengthening exercises (FBS) protocol. The control group received functional and balance exercises (FB) protocol. Independent and paired t-tests and Mann-Whitney and Wilcoxon tests were used for comparison between the pre-treatment and post-treatment results. The reduction of quadriceps tonicity only in the experimental group (p<0.0001) and gasterosoleous tonicity in both groups (experimental p<0.0001 & control p = 0.041) were significant after the intervention. Significant improvement after the treatment was seen in the experimental group in measures of quadriceps (p = 0.034) and gasterosoleous (p = 0.001) tonicity compared to the control group. The Mann-Whitney test identified a significant difference between the experimental group and the control group with respect to mean difference of quadriceps (p<0.0001) and gasterosoleous (p<0.0001) tonicity. The results of this study, in spite of conventional opinions, support the effectiveness of lower limb muscle strength training in reducing the spasticity, in addition to improving muscle strength in the chronic stages of rehabilitation following a stroke.