مجله پزشکی بالینی ابن سینا
سال نوزدهم شماره 4 (پیاپی 66، زمستان 1391)

Introduction & Both sodium valproate and electroconvulsive therapy (ECT) are ef-fective treatments for mania، but there is no clinical trial evidence for safety when they are used together. The aim of this study was the comparison of cognitive impairment and seizure parameters in manic patients receiving electroconvulsive therapy with or without concurrent treatment with sodium valproate. In this clinical trial study we recruited forty hospitalized manic patients who were to receive ECT for at least six sessions and randomly assigned them to either group C، who continued to take sodium valproate during the study، or group D، who discontinued it. Through the course of ECT sessions، Mini Mental Status Examination (MMSE)، applied stimulus intensity (seizure threshold)، and motor seizure duration were repeatedly measured. The data was analyzed using t &? 2 statistically tests. Baseline MMSE scores were nearly equal in the two groups. By the end of the sixth session، the scores decreased by 1. 15 in group C and increased by 0. 65 in group D (mean dif-ference between the groups =1. 8، P=0. 028). A rising trend in the applied stimulus intensity was observed in both groups. Seizure thresholds were lower in group C in most of the ses-sions، but after adjustment for sex، these differences were no longer significant. Seizures of the sixth session were 3. 95 seconds shorter than of the first one in group C (P=0. 045). This shortening did not occur in group D. There were 15. 8% more inadequate seizures (i. e. dura-tion less than 25 seconds) in group C than in group D (P=0. 006). The two groups did not dif-fer in the number of applied ECT sessions. Continuing sodium valproate during ECT results in poorer cognitive performance and more inadequate seizures.

Introduction & Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age. According to the Rotterdam criteria، this syndrome is identified by presence of two of three criteria: (1) polycystic ovaries (2) oligo/anovulation and/or (3) clinical or biochemical evidence of hyperandrogenism. Low mature oocyte and embryo have been reported in polycystic ovary syndrome patients undergoing assisted repro-duction. An inverse correlation between follicular fluid homocysteine (Hcy) concentration and oocyte and embryo maturity has also been found. This study has been implemented to do more evaluation on the relationship between homocysteine levels in follicular fluid and oo-cyte and embryo quality. 30 PCOS patients as case group and 30 women with male factor infertil-ity as control group were included in the study. The follicular fluid in the cases was collected during ovary punition and Hcy level was measured by ELISA method. The oocytes and em-bryos were classified into several groups. The Hcy levels of follicular fluid of two groups were compared and its relation with oocyte and embryo quality was assessed. Although the homocysteine concentration in follicular fluid of the case group was higher than the control group، the differences were not statistically significant. Moreover، no significant correlation was found between oocyte and embryo quality and homocysteine concentration of follicular fluid of the two groups. In our study، no significant correlation was found between oocyte and embryo quality and homocysteine concentration of follicular fluid of PCOS patients but further stud-ies with larger sample sizes are recommended.

Introduction & Magnesium is a NMDA receptor antagonist and a calcium channel blocker. The aim of the study is to evaluate the analgesic efficiency of preoperative magne-sium sulfate infusion in patients undergoing elective cesarean surgery. In a randomized double blind trial study approved by local ethics com-mittee، 68 parturient who were admitted for elective cesarean section through spinal anesthe-sia were divided into two equal groups. Magnesium group (M) received IV magnesium sul-fate 50 mg/kg as a bolus and then 10 mg/kg/h IV as continuous infusion at the time of sur-gery. The control group (S) received the same amount of isotonic saline. Both groups were completely monitored and the data about blood pressure، heart rate، side effects and severity of pain (VAS) was recorded for 24 hours in the obstetric ward. The patients who had VAS = 4–6 received supp. Diclofenac Na (100 mg) and the patients who had VAS=7–10 received Diclofenac Na (75 mg) by intramuscular injection. The rate of diclofenac Na consumption was recorded for each patient. The pain scores in the magnesium group were significantly lower than the control group at 2 and 24 hours post operatively (P<0. 05). Diclofenac dose consumption was also significantly lower in the magnesium group (137 ± 54 rather than 231± 67) and (P<0. 005). IV magnesium sulfate administration during cesarean section in the parturients anesthetized intrathecally، decreases analgesic consumption after surgery and improves post-operative analgesia.

Introduction & Medicinal plants are widely used throughout the world. Hypothyroid-ism is an important hormonal disease that causes some disorders in body organs. Salvia offi-cinalis has been known as a medicinal plant since ancient times. In this study the Salvia offi-cinalis extract (SOE) effects on thyroid hormones and TSH in hypothyroid rats have been investigated. In this experimental study the SOE extract was prepared and 40 male rats were randomly divided in five groups. Control، propylthiouracil (PTU) in 4 groups + SOE. The animals were induced hypothyroidism by administration of PTU 0. 1% orally in tap water for 14 days. The blood samples were collected and T3 & T4 and TSH hormones were analyzed. Hypothyroid groups were divided into 4 groups and received (PTU+ SOE 40 mg/kg +levothyroxine sodium، 15mcg/kg، orally in tap water) and LV+ SOE). All test groups were treated with SOE and levothyroxine sodium for one week. The blood samples were col-lected and for T3 & T4 and TSH hormones were analyzed at the end of the 3rd week. All data were expressed as mean ± SEM and all statistical procedures were performed by MANOVA test. Our results showed that the T3 & T4 plasma levels in hypothyroid animals treated by SOE had significant differences (P<0. 05) compared with the control group. Our findings suggest that the SOE has stimulatory effect on thyroid gland func-tion and raises plasma T3 & T4 levels.

Introduction & Tea is one of the most commonly consumed drinks in the world. Tea is recognized as a source of fluoride whose intake may increase the risk of developing dental fluorosis، particularly if other sources of fluoride augment the intake. Since the amount of fluoride in different types of tea consumed in our country is unknown، the purpose of this study was to evaluate the fluoride level of 22 commercial brands of tea popular in Iran. This descriptive study was conducted to assess the fluoride content of black tea (10 brands)، bagged black tea (9 brands)، and green tea (3 brands). 2 g from three samples of each tea brand taken out randomly were added to 200 ml deionized water and boiled for 10 minutes. After the infusion temperature coming down to the room temperature، the infusion was filtered and its volume made up to 200 ml by adding deionized water. The fluoride levels were measured using ion-selective electrode، and reported as mg/lit. Data were analyzed by ANOVA and Tukey test. The Fluoride content was found 1. 51 mg/lit in black tea bag، 1. 038 mg/lit in green tea and 0. 869±0. 360 mg/lit in black tea sticks. (P<0. 05)، However، there was no statistically sig-nificant difference of fluoride concentration between green tea and black tea sticks (P= 0. 52). This study showed that fluoride content of some tea brands were so high that drinking a few cups daily may increase the risk of developing dental fluorosis. Therefore، their consumption must be limited particularly in children، and in all inhabitants of regions with high fluoride levels in water supply.

Introduction & Disulfiram is used for treatment of alcohol intoxication. Based on the results of different studies، excessive amounts of the drug can affect the body''s endocrine function. This study investigated the effect of disulfiram on the activity of the pituitary - thy-roid in adult male rats. In this study 50 adult male Wistar rats weighing approximately 200 to 220 g were used in the experimental، control and intact groups. Experimental groups received 50، 100 and 200 mg/kg oral doses of disulfiram for 10 days and control group received 1 ml saline for 10 days and intact groups did not receive any thing. At the end of the tenth day، the rats were bled from the heart and T3، T4 and TSH hormones were measured by commercial kits Gama Counter and the results were analyzed using one-way (ANOVA) with SPSS ver-sion 18. Results show that there was no significant changes in T4 plasma level، but T3 and TSH level increased significantly when the control and intact groups were compared. Disulfiram had no significant effect in T4 plasma level but T3 and TSH level in-creased significantly. It probably happened due to increasing serotonin and reducing soma-tostatine and also enhancing the activity of 5-Deiodinase enzymes following the entry of cal-cium ions into the cells.

Introduction & Male factor is the major cause of infertility in 20% of cases (WHO). There are known etiologies for 70% of cases. However، 30% of infertility cases are of idio-pathic origin. The Y chromosome and micro deletion of the long arm of the Y chromosome (Yq) in three regions (AZFa، AZFb، AZFc) are associated with spermatogenic failure and is a major etiology for oligo and azoospermia in infertile men. With the advent of assisted re-productive technology and intracytoplasmic sperm injection، knowledge about the various factors leading to spermatogenic impairment is one of the most important aspects of scien-tific research. Therefore، this study was designed to identify the frequency of microdeletions of Yq in azoospermia and oligozoospermia males refered to Hamadan Fatemieh hospital. 56 infertile males with non obstructive oligozoospermia and azoosper-mia and without any cytogenetic abnormality and 44 fertile men with normal cytogenetic were included in this case-control study. Semen analysis was done is each case to determine the spermatogenic statuse. Patients with normal karyotyping were analyzed for determination of microdeleton in Y chromosome in the AZFa، AZFb and AZFC regions with multiplex PCR method. The sequence tagged sites (STS) primers sY84، sY86 (AZFa); sY127، sY134 (AZFb); sY254، sY255 (AZFc) were used for each case. In this study the rate of mutation were 1. 87% in oligo and azoospermia infertile men، 4% in azoosperm and 0% in oligospermia patients. Of 56 cases، 1 case showed deletion in AZF region، 1 deletion was in AZFa (sY84)، 2 deletions in AZFb (sY127، sY134)، and 1 dele-tion in AZFc (sY254). That had 1 deletion in AZF a (sY84)، 2 deletions in AZFb (sY134، sY127)، and 1 deletion in AZFc (sY254). No microdeletions were seen in the SRY gene and no microdeletions were found in men in the control group. Our results emphasize that Y chromosome microdeletion analysis should be car-ried out in all patients with idiopathic azoospermia or severe oligospermia who are candi-dates for intracytoplasmic sperm injection. Moreover، it is highly suggested to perform fur-ther studies to discover the numerous etiologies of idiopathic male infertility.

Introduction & Mechanisms underlying migraine precipitation are largely unknown. Helicobacter pylori (H. pylori) infection has recently been associated with various extraintes-tinal pathologies and migraine. The relation between Helicobacter pylori and Migraine is controversial. The aim of this study was to investigate the correlation of the H. pylori infec-tion with migraine. In a case-control study، a total of 80 patients with migraine with aura and without aura who came to neurology clinic of Farshchian hospital affiliated with Hamedan Medical University were enrolled in the study and compared with a group of 80 controls. The patients with the history of anti h. pylori medication، chronic inflammatory dis-eases and malignancy were excluded. Helicobacter pylori infection was diagnosed by ELISA test for IgG. The diagnosis and classification of migraine were made according to the Inter-national Headache Society (IHS) criteria. The serum level of IgG was compared in each group by student t test. The mean age in migraine and control groups were 27. 26±8. 99 and 29. 04±9. 75 years respectively. The serum level of anti-Helicobacter pylori IgG were 39. 75±45. 09 and 24. 93±27. 88 Uarb/ml in migraine and control groups respectively (P=0. 013). The mean of IgG based on the demographic data were not different in both group (P>0. 05). This study demonstrated a higher level of anti-Helicobacter pylori IgG in patients with migraine.

Introduction & Studies have shown the high prevalence rate of behavioral disorders in primary school students، which may underlie many complications and problems for the students and their families. The aim of this study was to determine the prevalence of behav-ioral disorders among primary school students. This is a cross sectional-descriptive study which have been done on 352 primary school students in Hamadan. Samples have been selected based on a multistage ran-dom sampling and Rutter behavioral disorder questionnaire (teacher form) was used for data collection. The data were analyzed by SPSS version 20 using chi-square. Our result showed that 16. 1% of the participants suffered from behavioral disorders. The prevalence was more among the boys. Father''s education and occupation، history of mental illness، parental divorce، and death of parents had significant relationships with the prevalence of behavioral disorders in these students. According to the results، designing and implementing educational programs for the prevention and treatment of student''s behavioral disorders appear to be essential.

Introduction & Biological effects of ultraviolet (UV) radiation on the body of live organisms، have been studied by researchers in recent years. UV affects human organs such as skin، eyes and immune system، as well as animals and plants. The main natural source of UV radiation is the Sun. So، the integral observation of UV levels and their effects at ground level is important to determine the present and future environmental and health implications of the solar UV radiation. Since the amount of UVR (UV radiation) has not already been measured in Hamadan، the aim of this study was to measure the amount in Hamadan city in different months of the year. This work was a cross-sectional study and has assessed the solar UVA radiation، by calibrated Hagner digital radiometer، model EC1 UV-A. The monthly quantity of solar UVR was measured in Hamadan during one year (2011-2012). The maximum UVA received on the ground level was 27. 3±1. 09 W/m2 in Shahrivar month (Aug 23 – Sep 22) while the minimum was 11. 8±1. 32 W/m2 in Azar month (Nov 22 – Dec 21). Total UVA radiation received on the ground level was 19. 74±1. 56 W/m2 during the period of measurment. According to the results of this study، it seems that the annual UVA in Hamadan city exceeded the amounts recommended by the WHO and further studies are needed to measure UVB and UVC to determine the total UV radiation level in thecity. Based on these results، it is recommended to wear appropriate sunglasses and minimize sun exposure during the midday hours.

Introduction & 40% lymphomas are extranodal and gastrointestinal (GI) tract is the most common site. Gastrointestinal lymphomas by definition have not liver، spleen، lymph node and bone marrow involvement. The most common gastrointestinal lymphomas are MALTOMA، diffuse large B cell lymphoma (DLBL)، burkitt، follicular and T cell lym-phoma. The most common patients are old men. The aim of this study was determination of immunophenotypes of gastrointestinal lymphoma and relationship between the site، age and immunophenotype with two years survival. In this cross sectional descriptive study 53 primary gastrointestinal lym-phoma were studied in admitted patients of Hamadan hospitals. Age، sex، and tumor immuno phenotypes (using with CD3، CD5، CD20، CD10، CD15، bcl2،?، k light chains) and two years survival were recorded. Results were analyzed using SPSS 16 and chi-square test. The most common age was 50-60 years and mild male preferential was seen. 60% were MALTOMA and 24. 5% were diffuse large B cell lymphoma. 47. 2% were in stomach and 30. 2% were in small bowel. Total two years survival was 64. 2% and in MALTOMA was 81. 2% and in DLBL was 38. 2% (P= 0. 005). In relationship between patient age and tumor site with two years survival there was no mean able relationship (P. value in first was 0. 938 and in the latter was 0. 308). The most common lymphoma was MALTOMA and DLBL. Two years survival in MALTOMA was better but age and tumor site have not relationship with two years sur-vival.

Maffucci syndrome is a rare clinical entity (approximately 200 cases have been reported in the medical literature) with a combination occurrence of multiple enchodroma and vascular tumors. Case Report: Our patient was an 18 year old girl born in a non-consanguineous marriage with finger and toe bones disorders (enchondroma) causing deformity of fingers and toes with multiple vascular tumors (cavernous hemangioma) in the distal upper and lower limbs. Entire laboratory investigations including thyroid function tests were normal. Cardiovascular ex-amination including EKG and echocardiography were also normal. The abnormal findings on brain CT SCAN with contrast were not observed. Angiographic and histologic stud-ies confirmed the cavernous hemangioma and radiography of fingers and toes approved bone lesions (enchondroma). A diagnosis of Maffucci syndrome was made by the above mentioned measures.