JOURNAL OF ISFAHAN MEDICAL SCHOOL (I.U.M.S)
Year:2007 | Volume:25 | Issue:86|Papers Count:21

Background: Due to geographical, racial, nutritional and socio-economical effective factors in pubertal age, assessment of pubertal stages should always be based on native, up-to-date and reliable references data from the same background population. This study is conducted to determine the age of different pubertal stages in school-age girls of Isfahan.Methods: This was a cross-sectional study of 5.5 to 17 years-old girls of Isfahan among 3204 population in 2006. The data was collected through the multistage cluster probability sampling basis. Pediatric endocrinologist evaluated pubertal stages by inspection and palpation according to Tanner staging. Weight, height and skin fold thickness were measured and recorded. The subjects were asked about menarche occurrence and the age of its onset if there is any. The difference between mentioned factors and different pubertal stages were calculated and analyzed by Covariance statistical estimation.Findings: The mean age and standard deviation of thelarche, pubarche and menarche was 10.46±1/37, 11.15±1/30 and 12.56±1/15 year, respectively. Different pubertal stages have a significant relation to BMI and skin fold thickness (p<0.01). In the population under study, the puberty onset is considered sooner than 7.72 years-old as precoious puberty and later than 13.8 year-old as delayed puberty.Conclusion: It is concluded that thelarche and menarche age in girls living in Isfahan is higher than some other countries like USA, whereas menarcheal age is the same as other studies in Iran.

Background: Finding factors that can increase neurogenesis are of great importance. To find these factors, it seems that neural stem cells culture is an ideal method. To analyze the effect of different factors in a limited period of time and with the least cost, finding an easier and more efficient method than normal manual counting method is needed. The aim of this study was using flow cytometry as an alternative method to evaluate neural stem cells neurogenesis.Methods: Neural stem cells from E14 mouse brain have been differentiated in a one- step and a two -step methods. After performing immunohistochemistry for neuronal and astrocytic markers, manual and flow cytometry methods have been compared in determining the percentage of neurons and astrocytes. Then, the percentage of neurons and astrocytes generated in two different differentiation methods has been compared using flow cytometry.Findings: Our findings showed that there wasn't any statistical difference between manual and flow cytometry methods in determining the percentage of neurons and astrocytes. Comparing differentiation methods by flow cytometry, showed that the percentage of both neurons and astrocytes were significantly different in these two methods (p<0.001).Conclusion: Flow cytometry is a simple and reliable method that can replace manual counting method to evaluate neurogenesis of the neural stem cells. This method would be very useful especially when a high content screening of different factors and compounds is needed.

Background: Stereotactic radiosurgery/radiotherapy is a modern therapeutic technique for surgically-inaccessible intracranial lesions. For the first time in Iran, all necessary hardwares for the stereotacticlinear-based radiosurgery technique have been developed.Methods: Stereotactic treatment includes eight steps: making dental mold and thermoplastic mask for each patient and attaching his/her head to the head support device; mounting localizer on the head support device and then taking CT scanning slices of patient’s head with localizer; treatment planning; attaching head docking device on the linac’s couch and collimators on linac’s head; putting patient on the couch and attaching his/her head to head docking device and translating patient’s head in three axis by head docking device to put intra cranial target on the linac’s isocenter; treatment.Findings: Quality assurance tests performed on constructed system showed a total uncertainty of 4.45 mm which is within acceptable ranges. Using isocentric treatment method with available collimators, we can treat a 17 mm width target; though for treating greater targets, we should use multi isocentric methods.Conclusion: Stereotactic treatment gets its own importance in view of two parameter: a) precision: as intracranial targets does not exceed of 40 mm in diameter so localization must be performed with a high precision; b) high dose: as doses in range of 10 to 40 Gy is delivered to target in one fraction, any error may yield a irreparable damage to radiosensitive critical organs in brain. Possibility of designing and constructing any modern radiotherapy modality in our country was a direct deduction of this project.

Background: Exercise has beneficial effects on brain function, and induces constructional changes in different parts of brain, synapses, hippocampal neurogenesis, neuronal activity, synaptic structure, synthesis and enhancement of neurotransmitters as well as learning and spatial memory.Methods: In this study, 40 rats were divided in four groups according to their exercise level: control, 40, 30, and 8 days exercise. Spatial learning and memory was recorded in the Morris water maze during 8 days.Latency and the length of swim path were used to evaluate spatial learning and long-term memory (the percent of the time). The data was analyzed by using the analysis of variance (ANOVA) test. Findings: Significant increase was found in total means of eight day long-term memory among three exercise groups in comparison with control group (p<0.05). Comparing the results between exercise and control groups, we found a significant decrease in total means of eight-days path length, in 40 days-exercise (p<0.01) and 30 days-exercise (p<0.05), and latency in 40 days-exercise groups (p<0.05).Conclusion: Results of this study confirmed the hypothesis that longer period of acute exercise would have progressive and improving effects on learning and spatial memory. Long-term memory is more affected by simultaneous exercise rather than periodic or previous exercise. This should be related to the fact that different periods of exercise can influence various pathways in cells and might have different impacts on synapses in hippocampus; for instance short-term exercise increased mRNAs synapsin I, long-term exercise increased MAPK type 1 and 2, neurotransmitter and vesicular transferring protein.

Background: Antioxidants play an important role in scavenging of free radicals and protection against degenerative diseases. Previous studies have reported high antioxidant activity in some amino acids. In this study, the effect of L- Arginine (L-Arg) on serum lipid levels and serum lipid peroxidation were investigated in hypercholesterolemic rabbits. Methods: A number of 15 rabbits (0.5-1.5 kg) were randomly divided into three groups (n=5) fed high-cholesterol diet (hypercholesterolemic control group), high-cholesterol diet + L-Arg (treatment group), and normal diet (normal control) for twelve weeks and then blood samples were obtained at the end of the experiment to analysis of serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), antioxidant capacity (AC), malondialdehyde (MDA), and conjugated diens (CDS). Antioxidant effects of L-Arg were investigated by use of erythrocyte and hepatocyte systems. Findings: Significant differences were found in serum levels of TC, TG, LDL, AC, MDA, and CDs between L-Arg treatment group and hypercholesterolemic control group. HDL level in treatment group showed no significant difference in comparison to hypercholesterolemic control group. The results of In vitro studies also showed increasing L-Arg antioxidant effects with increasing its concentration and the most antioxidant capacity was seen in 250 mmol/L. This finding confirms the observed antioxidant effects of L-Arg in animal studies. Conclusion: The findings indicate that L-Arg has reduced effect on serum lipid levels and antioxidant activity in hypercholesterolemic rabbits.

Background: Although lifestyle changes have led to changes in the epidemiology of Hepatitis A infection in different countries, there is no special guideline for its prevention. The latter is because of the lack of information about the prevalence of this infection. Hence, in this study the anti-HAV seroprevalence was determined in Isfahan province, Iran.Methods: In this cross-sectional study conducted in 2005, a number of 816 subjects aged over 6 years who were selected by multi stage random cluster sampling from urban and rural areas of Isfahan province were studied.Demographic data and blood samples were collected and anti-HAV antibodies were measured by ELISA method. Chi-square test was used for statistical analysis and p<0.05 was considered significant. Findings: The subjects of this study included 428 female and 388 male. The overall anti-HAV seroprevalence rate was 8.09%. There were statistical differences between HAV seropositivity in regions of Isfahan province which the most was seen in Borkhar and Meimeh (28.6%) (p<0.001). There was no significant difference in HAV seropositivity between the subjects grouped according to demographic factors excepting marital status [12.4% in single pepole and 5.7% in married subject (p=0.006)].Conclusion: HAV seroprevalence in Isfahan province is not so high that can be caused by improved sanitary conditions. More studeis in other parts of Iran are needed to set new strategy for post exposure prophylaxis and hepatitis A vaccination.

Background: Mental stress is considered to be a precipitating factor for acute coronary events. Mental stress delays rehabilitation in patients and may increase the complications of coronary events. We aimed to assess the association of subjective or perceived mental stress with the occurrence of acute coronary events. Methods: This prospective case-control study was carried out in Borojen health centers in 2006-2007. Fifty hospitalized patients with acute myocardial infarction and ST elevation on electrocardiogram were enrolled as cases; unmatched controls were enrolled from amongst patients with coronary artery disease without recent acute coronary events. Equipments for data collection were client’s demographic questionnaire and subjective stress functional classification (SS_FC) questionnaire.Findings: Overall, 78.9% of cases with acute myocardial infarction had highlevels of stress (class III and IV), whereas 29.3% of controls reported high stress levels during the same period (p<0.001).Conclusion: Considering that patients with myocardial infarction reported a higher stress level during the month proceeding the acute coronary events than controls did, stress might be associated with coronary events.

Background: Mortality of Myocardial Infarction (MI) may due to arrhythmia or pump failure. Leukocytosis especially neutrophilia is a feature of inflammatory response. This study was performed to evaluate the association between leukocytosis at time of admission and further heart failure after the acute MI.Methods: This case-control study performed among patients with acute MI. In patients referred to the hospital during first 24 hours of chest pain, blood sample was achieved for measuring cardiac enzymes and blood cell count. Echocardiography was performed after 3-5 days. A number of 69 patients with ejection fraction<45% underwent heart failure (case group) and 69 matched patients with ejection fraction³45% (control group) were checked for major cardiac risk factors, as well as for sex.Findings: Leukocytosis (WBC³11000) was observed in 47.8% and 20.3% of patients in case and control groups, respectively (p=0.001). Neutrophilia (neutrophil>65%) was observed in 69.6% and 34.8% of patients in case and control groups, respectively (p<0.0001). There was significant relationship between leukocytosis and neutrophilia and future heart failure. Monocytosis (monocyte>2%) was seen in 33.3% and 40.6% of patients in case and control groups, respectively (p=0.3).Conclusion: Leukocytosis and neutrophilia can be considered as predicting factors for heart failure in acute phase of MI and it can be used for determining the risk of heart failure in those patients.

Background: Bispectral index (BIS) is a new method for determination depth of anesthesia. In most of our operating rooms depth of anesthesia is measured according to clinical features; however, it has not enough accuracy. The aim of this study was to compare BIS numbers between inhalation and intravenous anesthesia at different times of anesthesia.Methods: This was a prospective descriptive study. One hundred and fourteen patients divided between two groups; inhalation anesthesia and intravenous anesthesia. The patients in each group randomly were divided among three subgroups. BIS was measured in one phase of anesthesia in each group: Immediately after intubation, surgical incision, and wound closer. Then, the data was analyzed by t-test, chisquare and analysis of variance (ANOVA) tests in SPSS software.Findings: There was no significant difference in any phases of study for frequency of desired BIS between inhalation and intravenous anesthesia groups. However, mean of BIS in the inhalation anesthesia group was significantly more than other group (p<0.05). There were no significant differences between the frequency of desired BIS in inhalation and intravenous anesthesia in three phases of BIS measurements (p>0.05).Conclusion: Ordinary used clinical findings are not enough to evaluate desired depth of anesthesia. When we use BIS monitoring, we can produce enough depth of anesthesia; also, sometimes we can decline dose of anesthetic drugs.

Background: Prophylaxis of Rh immunization has a critical role in the Rh negative pregnant women for prevention of fetal erythroblastosis. The aim of this study was to evaluate the fetomaternal hemorrhage (FMH) in relation to the delivery mode.Methods: In this case- control study. 170 pregnant women (85 terminated by normal vaginal delivery and equal number by cesarean section) were studied in 2005 in Ghaem hospital affiliated to Mashhad university of medical sciences.The data was collected by a questionnaire, Klei hauver and Betke test was done, and the correlation between measured variables and FMH was studied. The results were analyzed by SPSS software (SPSS, Inc. Chicago, IL) version 11.5 by using The Students’t and Man-Whitney U tests. Findings: The extent of fetomaternal hemorrhage was significantly different according to the gestational hypertension, twin pregnancy, still birth, abruptio placenta, placenta previa, gestational age and sex of the fetus; but there was no significant difference according to the mode of delivery, maternal blood group and Rh, maternal age, gravidity and the extent of fetomaternal hemorrhage.Conclusion: In this study, there was no difference in the extent of FMH according to the mode of delivery and so the needed doses of anti-D.

Background: A great attention has been made by fortification of bread with oat diet fibers. Oat fibers are known as a lowering substance of blood sugar, cholesterol, triglyceride, HDL and LDL.Methods: In this study 25 percent of wheat flour was replaced with oat flour to produce oat wheat bread and to investigate the effect of oat bread consumption on blood sugar, cholesterol, triglyceride, HDL and LDL. The extraction rate of Roshan variety wheat flour used in this study was 78 percent. Oat flour was prepared by milling of Caliber variety oat. To facilitate dehulling oat kernels was preheated at 75ºC for 20 minutes. Dehulled kernels were heated at 100ºC for 1 hour period to prevent enzyme activity and bitterness taste of oat flour. Baked oat bread was consumed by 21 volunteers with high blood sugar or high blood cholesterol. The amount of consumption was 150 grams bread per day with normal three daily meals during 15 days period. Blood samples were taken from volunteers before and 10 and 15 days after bread consumption, and fasting glucose, cholesterol, LDL and HDL of the samples were measured.Findings: The results showed that the fasting blood sugar, cholesterol, LDL and HDL of oat bread consumers significantly lower than the time before oat bread consumption. It showed also that blood triglyceride of consumer blood samples was not different with those before bread consumption, statistically.Conclusion: 25 percent oat flour bread reduced fasting blood sugar, cholesterol, LDL and HDL.

Background: Nowadays, duplex ultrasonography is used both for screening and for preoperative assessment of carotid arteries and has in many institutions completely replaced carotid angiography for the latter purpose. The study aimed to identify resistivity index abnormalities in common carotid arteries in patients with occluded or severely stenosed internal carotid artery.Methods: 16 patients with severe (>70%) internal carotid artery stenosis or occlusion were studied by Duplex ultrasonography for a period of 12 months.Findings: The mean age was 73.37±7.67 years. Resistivity index in common carotid artery was 0.85±0.03 on stenotic side compared with 0.74±0.04 on contralateral side (p<0.05). There was no side deference regarding flow velocities.Conclusion: In patients with occluded or severly stenosed internal carotid artery, compensatory vasodilatation occurs in same side in cerebral vessels and this is too significant to result in decrease of resistivity index on the contralateral common carotid artery.

Background: Many normal children have heart murmurs. Most of these murmurs are innocent but differentiation of innocent murmurs from those due to structural heart disease, pathological murmurs, is important. Some clinicians do not refer the suspected patients to cardiologist due to anxiety-provoking for the family. The aim of this study was to assess the children with heart murmurs who previously their murmurs labeledas an innocent murmur.Methods: During 18 months, 36 children with heart murmur been labeled as innocent were reassessed prospectively as outpatients by a pediatric cardiologist.Findings: Overall, 8 different type of congenital heart diseases in 36 patients (17 boys, 19 girls) were diagnosed. The mean age of diagnosis of innocent murmur was at 24 months old. The mean age of detection of congenital heart defects in these patients was 43.5 months old. Physicians referred 80% of patients while 75% of these were referred when were visited by other physicians than their family physicians. About 27% of patients needed medical and surgical attention at diagnosis time.Conclusion: Although, the diagnosis of innocent murmurs is correct in most of cases, more attention is needed in assessment and clinical examination of suspected children.

Background: The neurologic and adaptive capacity score (NACS) is a multi-item scale to measure the effects of intrapartum drugs on the neonate. The purpose of this study was to assess NACS after induction with thiopental.Methods: In this prospective study, for 76 elective cesarean section parturient, anesthesia induced with thiopental 4 mg/kg, succinyl choline 1.5 mg/kg and maintained with halothane and N2O/O2 (50/50). Iv fluids and all drugs administration were similar in all patients. Apgar (1th, 5th) and NACS were checked 15 minutes, 2 and 24 hours after birth. Findings: Eleven neonates (%14/4) had NACS£34, 15 minutes after birth. Only two neonates had NACS£34, 2 hours after birth. None of them had no NACS£34, 24 hours after birth. There was significant difference for NACS in all 3 times (p=0.0001). The most frequency of NACS was 38-40 in all the times.Conclusion: There was no significant changes in neuro adaptive and Apgar scores clinically.There was direct correlation between NACS and Apgar in all the times.