Tehran University Medical Journal

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Background: Regarding the complications of chronic intractable epilepsy, the presence of respectable lesions in many these patients that can be diagnosed with noninvasive sensitive techniques such as MRI and SPECT and the unrecognized significance of epilepsy surgery in our country, we have decided to review the management of medically intractable epilepsy in patients, who underwent epilepsy surgery in neurosurgery department of Loghman Hakim hospital between 1997-2003.

Materials and Methods: In this study we retrospectively review 30 cases of medically intractable epilepsy that had underwent epilepsy surgery. All patients before surgery were investigated with brain MRI, brain SPECT, EEG and IQ test. Type of surgery was determined by MRI, SPECT and EEG findings. Pre - and postoperative seizure frequency and surgery complications studied. Seizure control was measured with Engel criteria.

Results: Patients mean age was 22.4 years. Three cases (10%) were females that all underwent temporal mesial lobectomy. In 18 cases (60%) there were concordant brain lesion with seizure origin that 9 cases (30%) underwent mesial temporal lobectomy and remainder 9 cases (30%) underwent lesionectomy.other12 cases (40%) that have uncertain brain lesion but suffer from drop attack due to one or combination of atonic, tonic, tonic clonic, clonic, myoclonic, absence or clonic underwent anterior callosotomy. patients that underwent mesial temporal lobectomy, anterior callosotomy and lesionectomy were seizure-free in 77.7%, 58.3% and 55.5% of cases respectively.

Conclusions: Provided to correct patient selection for epilepsy surgery we can manage intractable epilepsy properly. Regarding to the complication of intractable epilepsy, acceptable epilepsy surgery results and available sensitive noninvasive diagnostic techniques such as MRI in our country, epilepsy surgery should be considered seriously in our country and promoted.

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Background: To evaluate the ability of Ankle/Brachial Index (ABI), that is a sensitive and specific test for detection of PAD, to foretell the possibility of ischemic heart diseases in diabetic patients.

Materials and Methods: All of diabetic patients who visited in our diabetes research center between May 2000 and May 2001 and were confirmed diabetics since 2 or more years ago were enrolled in the study. The ABI was calculated for all of the patients and their demographic specifications and ischemic heart disease risk factors were recorded. All of the patients refer to perform an exercise test, but 279 patients were conferred to performing stress test. They were containing: 127 patients with ABI =<1.1(group I) and 47 patients with ABI>=1.4(group III) as case groups and, 105 patients with 1.1 60 years (P = 0.02). 238 patients were in group I (25.1 %), 625 patients in group II (65.9 %) and 85 patients in group III (9 %). 52.8% of 125 patients in Group I, 19.6% of 107 patients in group II, and 44.7% of 47 patients in Group III had positive exercise test. I, II (P  0.00)- II , III (P = 0.05) A total of 108 patients from among the 279 patients had positive exercise test (38%), and most of them were from groups I &III. 72.2% of group I , and 52.5% of group II had high blood pressure (P  0.00). Both hypertensive and normotensive patients with ABI =<1.1 & >=1.4 had positive exercise test significantly more than patients with 1.1=1.4 is an independent predictor of coronary artery diseases in diabetic patients especially in those who are hypertensive.

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Background: This investigation was conducted in order to study angiographic findings in patients with cerebral aneurysm.

Materials and Methods: The study conducted on 136 cases of ruptured cerebral aneurysms between 1995-2000 confirmed by means of 4-vessel cerebral angiography to get an insight to racial, geographic and environmental factors predisposing to the occurrence of subarachnoid hemorrhage and aneurysm formation. Results: The data analysis revealed the following

Results: 58% of the population comprised of male and 42% female with a mean age of 46 years. 89% of the aneurysms were found in the anterior circulation and 11% occurred in the posterior cerebral circulation. The most common site in both the sexes was the anterior communicating artery. 9.6% of the patients displayed two separate aneurysms. 5.2% of the aneurysms were found to be giant aneurysms and 3% of the patients had fusiform aneurysms.

Conclusion: The low average age, a predilection in male population and the prevalence of aneurysms at carotid and middle cerebral artery bifurcation and the distal branches of anterior cerebral artery and a higher incidence of anterior communicating artery in women were the findings observed in this study.

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Background: The aim of this study is to describe the mental health and social profile of adolescent thalassemic patients through self-report and GHQ-12 test.

Materials and Methods: With convenience sampling, 156 consecutive adolescent thalassemic patients, recruited during a 20month period, filled in a semi-structured self-administered questionnaire in addition to a GHQ-12 questionnaire.

Results: 100 cases (64.1%) denied having health problems. 71 patients (45.5%) described their health status as not bad and 39 cases (25%) as good. The average GHQ-score was 6.12 (0.95 CI- 5.69-6.56). Nine cases (5.8%) scored low (0-1) and 21 cases (13.5%) scored borderline (2-3), while the score of 124 patients (79.5%) was favorable (4-12). There was a significant difference between mean scores in different age groups (p= 0.036) and 78 percent of those with low scores were in their late adolescent period (18-21 yrs). 15 patients (9.6%) had quit school due to their health problems. Mean GHQ score for quitters was significantly lower than those going on with their studies (p= 0.017).

Conclusion: These adolescent thalassemic patients seemed to have coped properly with their disease. Possibility of denial should also be considered. Further studies for detection of high-risk groups for psychosocial derangements can help us in applying appropriate and timely preventive and supportive measures.

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Background: Chang in the serum K+ level may increase perioperative morbidity and mortality in kidney transplant recipients. Thus this research was done with the aim of evaluated of K+ change in kidney transplant recipients. Hence the following study was carried to evaluate the fluctuation of potassium ion in the kidney transplant recipient patients.

Materials and Methods: In a simple randomized clinical trial the serum K+ level was assessed in 40 kidney transplant candidates as following interval, pretransplantation, during renal art, anastomosis, after diuresis and post transplantation period. After hydration with 5 ml/kg normal saline all patient were undergone general anesthesia identically. They were premedicated fentanyl (2µg/kg), induction was performed by thiopental sodium (5 mg/kg). Tracheal intubation was facifitated with atracurium (0.6 mg/kg). Anesthesia was maintained with N2O + O2 50%, halothane 0.1% and fentonyl 1 µg/kg every 30 min.

Results: The least mean K+ level was during anastomosis (ie. 3.5±0.24 mmol/L) and showed a decrease in the serum K+ level compared to preoperative period (mean 4.4±0.48 mmol) (P< 0.001). The maximum serum K+ level detected preoperatively and postoperatively were 5 (mmol/ L) and 4.7 (mmol/L) respectively.

Conclusion: Despite the above results we inferred that range of serum K+ level was maintained within normal. Therefore with suitable pereoprative assessment hyperkalemia is a rare occurrence in transplant recipients.

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Background: Chang in the serum K+ level may increase perioperative morbidity and mortality in kidney transplant recipients. Thus this research was done with the aim of evaluated of K+ change in kidney transplant recipients. Hence the following study was carried to evaluate the fluctuation of potassium ion in the kidney transplant recipient patients.

Materials and Methods: In a simple randomized clinical trial the serum K+ level was assessed in 40 kidney transplant candidates as following interval, pretransplantation, during renal art, anastomosis, after diuresis and post transplantation period. After hydration with 5 ml/kg normal saline all patient were undergone general anesthesia identically. They were premedicated fentanyl (2µg/kg), induction was performed by thiopental sodium (5 mg/kg). Tracheal intubation was facifitated with atracurium (0.6 mg/kg). Anesthesia was maintained with N2O + O2 50%, halothane 0.1% and fentonyl 1 µg/kg every 30 min.

Results: The least mean K+ level was during anastomosis (ie. 3.5±0.24 mmol/L) and showed a decrease in the serum K+ level compared to preoperative period (mean 4.4±0.48 mmol) (P< 0.001). The maximum serum K+ level detected preoperatively and postoperatively were 5 (mmol/ L) and 4.7 (mmol/L) respectively.

Conclusion: Despite the above results we inferred that range of serum K+ level was maintained within normal. Therefore with suitable pereoprative assessment hyperkalemia is a rare occurrence in transplant recipients.

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Background: Patients with type 2 diabetes are often obese and require large dose of insulin to achieve glycemic control. Insulin therapy often cause weight gain and results in increasing insulin requirements. This study was conducted to evaluate the efficacy of metformin in combination with insulin in patients with type 2 diabetes poorly controlled with insulin therapy alone.

Materials and Methods: In a randomized clinical trial in outpatient diabetes clinic at university medical center, 39 patients with poorly controlled type 2 diabetes who were receiving insulin therapy were randomly assigned to receive metformin in combination with inslin or insulin alone for six months.

Results: Hemoglobin A1C levels decreased by 1.56 percentage (95% cl, 0.77 to 2.34 percentage point) in metformin group, a significantly greater change (P=0.008) than the increase of 0.03 percentage points in the insulin alone group. Average final hemoglobin A1C levels were 7.96% in the metformin group and 10.32% in the insulin alone group (difference 17%). For patients who did not received metformin, the insulin dose increased 9.37 units (95% cl 6 to 12 units) or 37% more than did the dose for patients who received metformin. (P<0.0005): for these patients, the insulin dose decreased 6.6 units (95% cl-1.24 to –11.96) Patients in insulin alone group gained an average of 3.08 kg of body weight (95% cl 1.56 to 4.58 kg) patient in the metformin group gained an average of 1.8 kg (95% cl 0.21 to 3.36 kg) Difference (1.9%) was not meaningful. Change of total cholesterol, low density lipoprotein cholestrol and triglyceride levels was not significant.

Conclusion: The addition of metformin to insulin therapy resulted in hemoglobin A1C concentrations that were 17.8% lower than those achieved by insulin therapy alone. This improvement occurred with use of 37% less insulin. Metformin is an effective adjunct to insulin therapy in patients with type 2 diabetes.

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Background: Despite several years of intensive investigation, relatively few studies have been made of children with lupus nephritis. The prognosis of children with lupus nephritis is poor for those with diffuse proliferative glomerulonephritis and active interstitial inflammation. As newer treatment modalities become available for patients with severe lupus nephritis, it become increasingly important to identify patients at risk for renal failure. The aim of this study was to evaluate the clinical course, histopathology, serologic features and prognostic significance of some parameters, to identify the risk factors for renal failure and mortality in children with lupus nephritis.

Materials and Methods: Retrospectively 30 children under 16 years of age with lupus nephritis from 1989 to 1999 were studied. All patients received renal biopsy and follow-up biopsies were performed in 3 children. Lupus nephritis was classified by the World Health Organization (WHO) criteria. The clinical and serologic parameters at the time of renal biopsy were recorded.

Results: All children underwent renal biopsy within 1 year of disease onset. There were 1 (3.3%) patients with class II, 5 (16.7%) with class III, 21 (%70) with class IV, and 3 (%10) with class V nephritis based on initial biopsy according to the WHO classification. The mean follow-up time was 60 months. Follow-up biopsies were histologically stationary in 2 patients and progressive in one. The overall renal and patient 5- year survival rates were 46.66% (14/30) and 93.33 %( 2/30) respectively. They were 47.61% (10/21) and 95.21 %( 20/21), respectively, of patients with class IV proliferative glomerulonephritis. Children with renal pathology (class V in the WHO classification system) at initial biopsy, were at high risk for renal failure 66.66% (2/3) or morality %33.33 (1/3) despite aggressive treatment. The results revealed that those with persistent hypertension, anemia, and decreased creatinine clearance rate, nephrotic proteinuria, at initial biopsy were more prone to develop renal failure (P<0.01).

Conclusion: The prognosis of children with class IV nephritis in our study was better than reported in other series in recent years. However, those with class V disease, persistent hypertension, anemia, low creatinine clearance and nephrotic proteinuria at the time of diagnosis are at increased risk for renal failure. The improved results may be due to initial histological classification, better supportive care and selective use of aggressive therapy such as methylprednisolone pulse therapy and intravenous cyclophosphamide for those with high risk factors.

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Background: Fumes generated during electric welding are one of air pollutants of working place in industrial companies, which can cause some clinical signs and diseases in worker, including mucosal irritation, changing of semen quality and cancer. Chronic exposure of workers with these fumes can cause reduce sperm motility and forward penetration and decrease in normal sperm count. Although a lot of researches were done in this field up to now, there is little information about histopathological effects of these fumes on germinal epithelium. The aim of this study was to identify structural changes of germinal epithelium in Rat as an experimental model after exposure to fumes of electric welding in exposure chamber.
Material and Methods: A total number of 60 Sprague Dawley Rats were chosen and divided into experimental (40) and control (20) groups. Each of groups was subdivided into 2, 4, 6 and 8-week subgroups. The number of Rat in each subgroup of experimental and control group was 10 and 5 respectively. Animals were housed in standard situation. After adaptation experimental group were exposed to fumes of electric welding (AMA 2000 electrode, 100 Ampere, 0.1 cm/s speed of electrode welding) for 2 hour/day and 5 day/week. The rate of air turn over in exposure chamber was fixed to 12-15/hour. The amount of O3, CO, CO2, NO + NO2 and particulate matter were measured by Galtec detectors and Cellulose acetate filter respectively. According to time table animals were killed and specimens from testis were taken and fixed in formaline buffer solution and processed routinely. Sections with 5-7 micrometer in thickness were stained by H-E, PAS, PNA and Alcian blue pH=2.5. The thickness of germinal epithelium was measured and data were analyzed by Kruskall Wallis test.
Results: The results of this study showed a few quantitative and qualitative changes in germinal epithelium. Vasodilatation of vessels in tunica albuginea and interstitial tissue, decreasing of eosinophilia in myoid cells, increase in size of spermatogonia especially dark type, disorganization of association between sertoli and spermatogenic cell lineage and spermatogenic arrests in spermatocyte I period. There were significant difference between experimental and control group for thickness of germinal epithelium (p<0.001).
Conclusion: It seems that although some adaptation response was appeared in experimental group, a lot of structural changes also appeared in germinal epithelium. The amount and severity of these changes were dependent to 3 factors include the amount of fumes, the variety of it and the duration of exposure.

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Background: No evidence exists regarding the prevalence of the hypertriglyceridemic waist phenotype in adolescents. We aimed to evaluate the prevalence of this phenotype in a representative sample of Tehranian adolescents.
Materials and Methods: Anthropometry and biochemical measurement were assessed in a population-based cross-sectional study of 3036 Tehranian adolescents (1413 male and 1623 female) aged 10-19 years. Hypertriglyceridemic waist phenotype was defined as concurrently having serum triglyceride concentration ≥110 mg/dl and waist circumference ≥90th percentile for age and sex. Overweight (≥95th percentile) and at risk for overweight (≥85th-<95th percentile) was defined based on the standardized percentile curves of body mass index suggested for Iranian adolescents.
Results: The prevalence of the hypertriglyceridemic waist phenotype was 6.4% (95%CI: 5.5-7.2) among Tehranian adolescents (males: 7.3%, 5.9-8.7 and females: 5.6%, 4.4-6.7). Overweight subjects had the highest proportion of hypertriglyceridemic waist phenotype than those at risk for overweight and those with normal-weight (male: 42.9 vs 2.9 and 0.0%, respectively, P<0.01 female: 32.5 vs 11.3 and 1.3%, respectively, P<0.01).
Conclusion: This study provides evidence showing high prevalence of the hypertriglyceridemic waist phenotype in Tehranian adolescents, particularly among overweight adolescents. This finding highlights the need for effective preventive and therapeutic strategies relying on diet, physical activity and lifestyle modification.

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Background and Aim: Today, work related stress has become a common and costly problem in work places that most of studies in the last 30 decades have engaged in this problem. Several reports indicate that the occupations such as nursing which have high psychological job demands and low decision latitude are very stressful. This stress can cause harmful physical and psychological effects on nurses’ health. On the other hand, job stress may result in high rates of injury, tardiness and absenteeism at work place and reduced productivity and organizational commitment leading to low quality of nursing care. Numerous studies suggested that learning new activities and skills such as communication skills is one of the best strategies against job stress .The purpose of this study was to test the effectiveness of communication Skills training in reducing work stress level among nursing personnel in rehabilitation centers.

Materials and Methods: The quasi- experimental design was conducted. A sample of 48 nursing personnel participated in the study. Subjects were randomly assigned to one of two experimental or control groups. Subjects in experimental group participated in a 7- hour’s workshop, all subjects were pre and post tested (one month later) for job stress and communication skills with the Karasek’s Job Content Questionnaire (JCQ) and communication skills test.

Results: Results revealed the following: (1) subjects in both groups after pretest were the middle level of stress and communication skills. (2) After training the experimental group scored higher on the rating of communication skills than control group and had successfully maintained their improvements for 4 weeks. (3) After training the experimental group showed lower level of stress than control group and had successfully maintained their improvements for 4 weeks.

Conclusion: As a result of this research communication skills training could reduce level of stress among nursing personnel, thus. It is recommended to apply communication skills training programs for nursing personnel working at rehabilitation centers in order to assist them to coping with their job stress and improve the quality of nursing care.

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Background and Aim:-thalassemia is the most common inherited disorder of hemoglobin (Hb) synthesis in the world. Alpha thalassemia most frequently results from the loss of one (- ) or both (- -) of the duplicated  genes () on chromosome 16. Carriers of deletional forms of -thalassemia (-/- /-, or --/) are clinically normal but have a mild hypochromic, microcytic anemia. Compound heterozygotes (--/- ) called Hb H disease. Fetuses who inherit no  genes (--/--) (Hb Bart&aposs Hydrops fetalis syndrome) die either inutero or shortly after birth, More than 95% of recognized -thalassemia involves deletion of one or both  globin genes on chromosome 16.

Materials and Methods: The assay was tested on 114 Iranian individuals with low MCV and MCH levels but normal HbA2 who had not responded to Iron treatment. patients was referred to the Department of Biotechnology, Pasteur Institute of Iran by Health Centers. Genomic DNA was isolated from white blood cells by salting out method. We have developed a reliable, single - tube multiplex polymerase chain reaction (PCR) assay for the 7 most frequent - thalassemia deletions (-- SEA , --THAI, --FIL , -α20.5 , --MED, -α4.2 , -α3.7).

Results: DNA fromd thalassemia carriers was tested for the presence of different types of  globin gene deletion (s). The - 3.7 and - 4.2 single gene deletions, and the Mediterranean (-- MED and - 20.5) double gene deletions were found in some samples.

Conclusion: The - 3.7 deletion was found to be the most common cause of  globin gene deletion in our samples. Multiplex PCR for α gene deletion analysis is simple, rapid and sensitive.

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Background and Aim: Anemia is one of the common problems in patients with chronic renal impairment. The most common cause of anemia in this patients is a decreased in erythropoietin hormone excretion, however other common cause include low life of red blood cells, loss of blood during dialysis, frequent blood sampling, uremia, iron, vitamin B12 and folic acid deficiency. Until introduction of erythropoietin in 1982, blood transfusion was an alternative for correction and maintaining hematocrit in normal range in dialyze patients. In current date, any dialyzed patient take rh-erythropoietin .

Materials and Methods: The goal of this study is to evaluate erythropoietin utilization and comparing the effectiveness of the commercial product in the Iranian drugs market. The study was performed at nephrology and dialyze ward of Immam Khomeini hospital in a one year period.

Results and Conclusion: Of the 30 patients&apos subject of study, 13 patients received eprex and 17 received epocim. Average dose of erythropoietin 2000IU was three times per week. The average plasma hemoglobin and hematocrit of patients prior to the treatment were 9.38 g/dl and 28% respectively. Increase in the hemoglobin and hematocrit in the group who received eprex was significantly higher than epocim group (p=0.001 and p=0.026 respectively). The incidents of side effects including hypertension, headache, pain at injection site, and influenza-like in eposim group were considerably higher than eprex.

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Background: Hyperglycemia is a metabolic response to surgical stress. In this study, patients’ blood glucose changes were measured before, during and after elective eye surgeries under general anesthesia, with two methods: glucometer and glucose oxidase enzyme lab assay. Probable influencing factors and the correlation rate of these two methods were evaluated.

Methods: This analytic cross – sectional original study was performed on 230 American Society of Anesthesiologists (ASA) Class 1or 2 non–diabetic patients. All the patients underwent a similar general anesthesia and their blood glucose levels were measured simultaneously with two cited methods on three occasions.

Results: In all cases, post-surgery blood glucose in comparison to pre-surgery levels increased significantly in both methods irrespective of independent variables of the study. Considering these independent variables, increase in blood glucose levels was significant in most of the patients. The mean increase in blood glucose post-surgery in comparison to pre–surgery, measured with lab assay, had significant statistical correlation with the type of eye surgery but not with other variables like age, gender and duration of surgery. Correlation of the two methods were also partially significant statistically.

Conclusion: Considering the results of this study and the fact that blood glucose changes under general anesthesia is usually unrecognized clinically, we recommend blood glucose measurement in non–diabetic patients during long surgeries. It is advantageous to use Accu–chek (Sensor model) glucometer for this purpose.

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Background: addiction and drug abuse have many risk factors in community and individual attitude also causes much diversity in community perception and attitude toward addiction.

Methods: in this study we assessed attitude toward an addict in 42 addict men and asked about problems in their community and recreational behaviors. They were residents of a rural area in Babol city. In the control group we assessed the same parameters in 268 non addicts in the same area. All of the addicts have been using opium more than many times a week at least for recent 6 months. Data collected via a semi structured questionnaire through conversation.

Results: There was a significant difference between addicts’ attitude toward toward addiction compare to non-addicts’. Both addicts and non-addicts indicated that the first three community problems in their area were unemployment, lack of recreational facilities and addiction, in respective order. Answering questions about recreational activities, both groups indicated that there were no recreational facilities in the community.

Conclusion: In planning a preventive approach, there is a major role for attitude toward addiction in any community. The conflict seen in this study between addicts’ attitudes toward an addicted person and addiction as a community problem has it’s interesting feature. Recreation and physical and cultural facilities need to pay more attention as indicated by our study participants. This seems to have an important impact in prevention of many community problems as well as addiction.

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Background: Malignant melanoma is one of the fatal cutaneous neoplasms which are curable by early diagnosis. This neoplasm is diagnosed by the biopsy of the suspected lesion. It is essential to classify the tumor based on its histology, thickness, phase of growth, level of invasion, mitotic rate, presence of regression, inflammatory infiltration and ulceration. These descriptions yield some knowledge about the progression of disease and suggest an estimate of the status of the screening system for early diagnosis.

Methods: This is a cross-sectional retrospective descriptive study. Pathological slides with diagnosis of malignant melanoma from 1377 to 1379 that present in the pathology department were assessed according to mentioned pathological indices and the 10-year survival calculated in this regard.        

Results: We assessed 47 cases with mean age of 57.38 (SD=5.85) and the gender distribution was 51.1% male and 42.2% female. More than 42% of cases were in Clarke level I, 2.1% Clarke level II, 6.4% Clarke level III, 40.4% Clarke level IV and 8.5% Clarke level V. Fifty three percent of patients were breslow thickness equal to or less than 0.75 millimeter(mm) , 8.5% between 0.76 to 1.69 mm , 27.7% between 1.7 to 3.6 mm and 10.6% greater than 3.61 mm. Mean breslow thickness show no significant difference between males and females but there is a significant relation between thickness and age of the patients. Mean 10-year survivals of patients were 75% and were greater in females than males. We found a linear relation between patient age and breslow thickness that is calculated by the following equation: Log Breslow thickness (mm) = - 0.625 + 0.016×age (year)

Conclusion: Complete recording of clinical and pathological data of patients with malignant melanoma make a proper stream to reach a surveillance system.

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Background: Difficult intubation (DI), often unexpected, remains a primary concern for anesthesiologists. The purpose of this study was to compare the sensitivity and specificity of ULBT with sternomental, thyromental and interincisor distances in predicting difficult intubation.

Methods: In a prospective study, 380 patients undergoing general anesthesia were included. In all patients sternomental, thyromental and inter-incisor distances and the ULBT score were evaluated preoperatively. The Cormack grade was determined after the induction of anesthesia and grade 3 or 4 was considered as difficult intubation. The best points with highest accuracy were determined by ROC curve. Sensitivity and specificity of these tests in predicting difficult intubation were calculated and evaluated.

Results: In 19 (5%) patients, intubation was difficult. ULBT class III, inter-incisor distance less than 4.5 cm, thyromental distance less than 6.5 cm, sternomental distance less than 13 cm were considered as difficult intubation and there were significant differences between them and laryngeal view (P<0.05, McNemar) but there was no difference between laryngeal view in both sex. The sensitivity and specificity of ULBT is significantly higher than thyromental and sternomental and Inter-incisor distances (the specificity were respectively 91.96% vs. 64.77%, 70% and 82.27% and accuracy were respectively 91.05% vs. 76.58%, 71.32%, 81.84% and 59.53%)

Conclusion: We conclude that the specificity and accuracy of ULBT is significantly higher than inter-incisor, thyromental and sternomental distances and is more accurate in airway assessment.

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Background: Diabetes mellitus is a chronic disease that is associated with numerous complications like peripheral neuropathies. It has been shown that hyperglycemia may contribute to its development but the exact pathophysiology underlying this complication has not been fully understood. Since it has been suggested that oral magnesium supplementation can prevent hyperglycemia induced by diabetes, this study was designed to examine the protective effect of oral magnesium administration on thermal hyperalgesia in streptozocin (STZ) induced diabetic rats.

Methods: Male adult wistar rats were divided equally into control, magnesium-treated control, diabetic and magnesium-treated diabetic groups. In magnesium-treated diabetic rats, magnesium sulfate (10 gr/L) was added into drinking water since diabetes was established (10 days after STZ injection) and continued for 8 weeks. Mg-treated control animals received magnesium sulfate in the same dose and time period. The other two groups control and diabetic animals, only received tap water.

Results: A significant decrease in thermal pain threshold and plasma magnesium levels and also a dramatic increase in plasma glucose levels were seen in diabetic rats eight weeks after diabetes induction. Eight weeks magnesium therapy after the diagnosis of diabetes, could prevent reduction in thermal pain threshold and also restore plasma magnesium and glucose levels in magnesium-treated diabetic animals.

Conclusion: Oral magnesium can prevent hypomagnesaemia, hyperglycemia and thermal hyperalgesia in diabetic rats.

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Background: Rheumatoid arthritis (RA) is an autoimmune disorder with unknown etiology. In recent years, a great number of studies have investigated the possible role of reactive oxygen species in the etiology and pathogenesis of Rheumatoid Arthritis. The aim of this study was to analyze the level of activities of catalase, glutathione peroxidas (GSH-Px), Super oxide dismotase (SOD) in patients with RA compared with the healthy subjects.
Methods: In a case-control study sixty rheumatoid arthritis patients 18-75 years old and 60 healthy sex and age-matched controls were selected, Catalase activity was measured by determining the constant rate (k) of hydrogen peroxide decomposition. GSH-Px activity of plasma was measured with spectrophotometer by Glutathione oxide generation due to GSH-Px. SOD activity is measured by degree of inhibition effect of SOD in generating super oxide radicals by xanthine and xanthine oxidase. C-reactive protein and rheumatoid factor values were determined by agglutination and latex tests.
Results: The plasma activity of catalase (p<0.001), GSH-Px (p<0.01), plasma level of hemoglobin and hematocrit (p<0.05) were significantly lower in patients with RA comparing with controls. The reduction in SOD activity was not significant (p>0.05). There was a negative significant relation between C reactive protein and Rheumatoid factor values with the erythrocyte activity of catalase and GSH-Px (p<0.01).
Conclusion: These results suggested that oxidative stress plays a very important role in the inflammation and pathogenesis of RA.

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Background: The present study designed to assess the effect of Mg+Zn, vitamin C+E, and combination of these micronutrients on glycemic control and insulin resistance in type 2 diabetic patients
Methods: In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months group M: 200 mg and 30 mg Zn (n=16), group V: 200 mg vitamin C and 150 mg vitamin E (n=18), group MV: minerals plus vitamins (n=17), group P: placebo (n=18).Fasting blood glucose, fructosamine, HbA1c and serum insulin were measured at the beginning and at the end of 3 months supplementation. Insulin resistance was calculated by HOMA score. Treatment effects were analyzed by general linear modeling.
Results: After 3 months of supplementation fasting blood glucose decreased in MV group (165±46 vs 177±41 mg/dl, p=0.035). There was no significant change in fructoseamin, HbA1c, serum insulin or insulin resistance in treatment groups.
Conclusion: The results of the present study provide evidence for the effects of combination of Mg, Zn and vitamin C and E supplementations on improvement of fasting blood glucose but not fructosamine, HbA1c, serum insulin or insulin resistance in type 2 diabetic patients.