Tehran University Medical Journal

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Background: In order to evaluate bone induction and repair in cranial bone defects by the use of combination of Octacalcium Phosphate/Bone Matrix Gelatin (OCP/BMG), this study was conducted.

Materials and Methods: We used 40 young male Sprague dawley rats (5-6 weeks age). A full thickness standardized trephine defect, 5mm in diameter, was made in the rat parietal bone and OCP combined with BMG was implanted into the defect. No OCP/BMG particles were implanted in control group that was otherwise treated identically. On the 5th, 7th, 14th, and 21st days after implantation, the rats were killed and bone samples collected. After processing the tissues by routine histological procedures, 5mm thick sections of bone were cut and stained with Haematoxyline and Eosin (H& E) and alcian blue and examined by light microscope.

Results: On the 5th day after implantation, inflammatory cells were seen around the implanted materials, especially around the OCP particles. A few clusters of cartilage cells were observed between the BMG particles in the central position of defects on the 7th day after implantation. On the 14th day after implantation, osteogenesis was seen at the margins of the defects. In addition to bone formation from the margins toward the center, interstitial growth of new bone tissue was seen around the implanted materials. By the end of 21st day, almost all of the OCP/BMG particles were absorbed and bone trabeculae, bone marrow cavities and bone marrow tissues were seen. In the control group, at the end of 21th day, a few areas of new bone were seen near to the defect margins and host bone, but much less than in the experimental group.

Conclusion: Therefore, implants of OCP/BMG appear to stimulate new bone growth in bone defects and these biomaterials could be used in the repair of cranial bone defects and injuries in clinical situations.

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Background: Routine Para clinic evaluation of preoperative patients tends to cause unnecessary costs, extra risk to the patients, inefficient operating room schedules and extra medico legal risk. Furthermore, it seldom affects clinician's preoperative evaluation and decision making process for healthy patients. Numerous studies have shown that about 60% of these will not be performed if they are ordered according to recognizable indications based on history and physical examinations unfortunately the ‘indication based’ method can not replace to “routine” method due to difficulty and complexity to performing.

Materials and Methods: We reviewed records of 1700 patients on a retrospective descriptive study in Sina Hospital from September 2000 to the end of September 2001. These patients had undergone general surgical procedures and were categorized as American society of anesthesiologists classification I or II. Results of complete blood count, fasting blood sugar, blood urea nitrogen, serum creatinin, sodium, potassium, chest X-ray, electrocardiogram and urinalysis were compared between patients under 40 years of age (n= 894) and patients aged 40 and over (n= 806).

Results: Among 4935 tests performed in patients under 40 years of age, only 1004 (20.3%) were indicated, and treatment plan was not altered due to the results of routine tests in any case. In the other group, patients aged 40 and over, 6300 tests were performed, from which 3361 (53.3%) were indicated and treatment plans of 5 patients were influenced by the results of routine tests.

Conclusion: Routine preoperative Para clinical tests is not cost effective method, otherwise the “indication based” also is difficult and complex method. We offer routine preoperative Para clinical tests only in patients over 40 years to combine ease of “routine” with a great reduction in medical costs and no adverse affect to patient care.

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Background: Pre-eclampsia is characterized by hypertension development and proteinuria during pregnancy. Hypertension disorder is a leading cause of maternal and fetal morbidity and death in worldwide. Although the pathophysiology of hypertension during pregnancy is unclear, but there is consensus that early diagnosis and aggressive treatment is warranted to prevent complicated to both fetus and mother. The changes of serum trace elements during pregnancy are paramount important to predict and good understanding the situation of patients. The aim of this study was about this issue.

Materials and Methods: In a case-control study we investigated the possible differences in the level of serum calcium, phosphorus and total protein in 55 healthy pregnant and 52 pregnant with hypertensive disease at 32-40 weeks of gestational age during the recent two years in Loghman hospital of Tehran. Some information such as age, blood group, parity number and blood pressure was taken from patients by a questionnaire.

Results: The case population consisted of 22 sever preeclampsia, 15 mild preeclampsia, 8 eclampsia, and 7 chronic hypertensive. The mean serum calcium concentration (mg/dl) was 9.180.74 in control group, 8.810.9 in mild preeclampsia, 7.850.38 in sever preeclampsia, 7.83 0.47 in eclampsia, 8.91 0.3 in chronic blood pressure. The mean serum phosphorus (mg/dl) level observed, 4.27 in sever preeclampsia, 3.74 in eclampsia, 3.59 in mild eclampsia, 4.09 in chronic blood pressure, and 3.43 in control pregnant women. The mean serum total protein concentration level in sever preeclampsia and eclampsia was 5.46 and 5.04 mg/dl respectively.

Conclusion: In conclusion, sever preeclampsia and eclampsia are associated with decreased level of calcium, total protein, and increased concentration of phosphorus.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Ample evidence indicated that glucocorticoids, when administered after training, enhance memory consolidation in a variety of tasks. The mechanisms underlying the enhancing effects of glucocorticoids on memory consolidation are not well known. The aim of this study was to determine the role of NMDA receptors and calcium channels in glucocorticoid-induced enhancement of avoidance memory consolidation in mice.
Methods: Experiments were performed on 166 male albino mice (about 30gr). The animals were trained in an inhibitory avoidance (IA) task (0.5mA shock for 3 seconds). In Experiment 1, dose- response effects of corticosterone on memory consolidation were determined. Immediately after training in IA task, the animals were received different doses of corticosterone (0.3, 1 or 3mg/kg). In Experiments 2 and 3, effects of corticosterone on memory consolidation were examined in the presence or absence of verapamil, a calcium channel blocker, (2.5, 5 or 20mg/kg) or MK-801, an antagonist of NMDA receptor (0.1mg/kg), respectively. In all experiments, retention test was done two days later.
Results: Results from first experiment revealed that corticosterone at dose of 0.3mg/kg significantly improved consolidation of avoidance. Data from experiments 2 and 3 showed that both verapamil, in doses of 2.5 and 5mg/kg, and MK801 significantly blocked corticosterone-induced enhancement of memory consolidation.
Conclusion: Finding of this study clearly demonstrated that the memory enhancing effects of corticosterone, at least in part mediate via calcium channels and NMDA receptors.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Leg cramp is the painful contraction of the muscles that often occurs at night. Pregnancy is the most common cause of muscle cramps that usually occur in the second trimester of pregnancy. Although the reasons of the spasms had not been determined, the imbalance between the absorption and elimination of serum electrolytes such as Ca, Mg and potassium and also insufficiency of some vitamins and probably the changes in activities of motor neurons of spinal cord, can be the source of these problems. The aim of this study was the evaluation of frequency and predisposing factors of leg cramps.
Methods: In a cross sectional descriptive analytic study, a group of 400 women in the third trimester of pregnancy were asked to record the symptoms of leg cramp. Their education level and job recorded and their total serum level of Ca and Mg was measured in the first visit. Exclusion criteria included systemic medical conditions such as thyroid disease, diabetes, osteoporosis and prenatal disorders such as gestational diabetes mellitus and preeclampsia and patient cooperation.
Results: In our study the prevalence of leg cramp was 54.75%. There was a statistically significant relationship between leg cramp and serum level of magnesium (p=0.04). There was no relation between calcium serum level and leg cramp (p=0.294). The women's age, their nutritional habits and individual characteristics were not signify-cantly related to occurrence of leg cramp.
Conclusion: Leg cramp is a common symptom in pregnancy and in patients with low serum levels of magnesium, a magnesium supplement can be helpful.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Calcium metabolism disorders can be acute or chronic and chronic disorders can cause different disease states such as dental problems.
Methods: In this descriptive cross-sectional study done in Children's Medical Center affiliated to Tehran University of Medical Sciences during 2005-2009, all (93) patients with hypoparathyroidism, nutritional rickets, hypophosphatemic rickets and renal osteodysthrophy from the endocrinology and nephrology departments of the Center were referred to a dentist there for orodental examination. Subsequently, the frequency of dental problems including taurodontism, enamel hypoplasia, dental abscess, dental caries and gingivitis were recorded and analyzed.
Results: Nutritional rickets was the most common disorder in this study and delay in dentition was the most frequent dental problem in the patients (61.9%). Most cases of taurdontism and enamel hypoplasia were seen in patients with hypoparathyroidism (33% and 50%, respectively). Dental abscess, dental caries and gingivitis were more common in patients with renal osteodysthrophia (50%, 90% and 20%, respectively). In addition, dental caries and delay in dentition were the most prevalent disorders in this study (69.8% and 49.5%, respectively).
Conclusion: According to the above findings, it seems that effective screening, regular periodic examinations, proper diagnosis and timely treatment of dental diseases are the main principles of prevention of orodental problems. Moreover, dentists as well as pediatricians should be aware of the features of the aforesaid disorders which lead to dental problems so that early intervention could prevent subsequent serious and more invasive dental problems.

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Background: It has been shown that coronary artery calcium scoring (CACS) can be used as a diagnostic method in coronary artery disease (CAD). The relationship between CACS and calcium metabolism in the body has been shown. The arterial calcification is an organized process similar to bone formation which is controled by parathormone (PTH). The relationship between PTH as an osteoregulatory factor and CACS has been also indicated. In this study, we tried to assess the value of serum PTH and CACS in patients planned to undergo coronary angiography (CAG) in order to find a simple, cost -benefit, noninvasive way, for ruling in/out obstructive CAD.
Methods: In a cross sectional study in Imam Khomeini hospital in 1390, CACS by using non-enhanced multi detector computed tomography (MDCT) and measurement of serum level of PTH, Calcium and Phosphate were done in 178 patients suspected to CAD which were scheduled to undergo coronary angiography serum PTH was measured by immuno-radiometric assay (IRMA) and serum Ca and Phosphate were measured by spectrophotometry methods.
Results: Of 178 Patients, 50 patients were females and 126 patients were male. Mean age of them was 56.2±11.6. The correlation coefficient between CACS and Gensini score (0.507, P<0.001), PTH (0.037, P=0.693), Ca (0.062, P=0.499) and Phosphate (0.061, P=0.506) were obtained. The level of serum PTH in the patients with and without coronary artery disease were 21.8±11.6 pg/dl, 23.2±11.5 pg/dl (P=0.427) respectively.
Conclusion: Our study showed association between CACS and CAD that was statistically significant while no relationship was found between PTH, CACS and CAD.

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Background: Calcium channel blockers have an important role in treatment of various cardiovascular diseases including hypertension, angina pectoris and cardiac arrhythmias, so study of cardiovascular effects of derivatives of these drugs are useful. Nifedipine is one of these drugs that used widely to treat hypertension and other cardiovascular diseases. The aim of the present study was to evaluate the central effects of synthesized dihydropyridine derivatives on systolic blood pressure and heart rate of rats and comparison to nifedipine. Methods: Sixty four male rats, after induction of anesthesia and intracerebral ventricu-lar cannulation using stereotaxis method, were divided into eight equal groups. One week after the stereotaxis surgery, the systolic blood pressure and heart rate were eval-uated in times 15 to 60 minutes after intracerebral ventricular injection of DMSO (di-methylsulfoxide) and nifedipine in doses of 80 to 320 microgram/rat and also three synthesized dihydropyridine derivatives (A, B and C) in dose of 240 microgram/rat. Effects of these drugs on systolic blood pressure and heart rate were analyzed using two way repeated measure ANOVA statistical test, followed by Bonferroni posthoc test. All data were considered significant at P<0.05. Results: The inhibitory effects of derivative B on systolic blood pressure and heart rate in dose of 240 microgram/rat in times of 15 and 30 minutes after injection were more potent than nifedipine (P<0.001), while A and C derivatives showed weaker inhibitory properties, compared with nifedipine. Also the inhibitory effects of derivative B on heart rate in dose of 240 microgram/rat were stronger than nifedipine in times of 15 to 60 minutes after injection (P<0.05). Conclusion: Novel dihydropyridine derivatives can possess more potent and stable in-hibitory effects on systolic blood pressure and heart rate, and some part of these properties at least, can be attributed to their direct inhibitory effects on brain neurons.

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Background: Tumoral calcinosis is a hereditary disorder of metabolic dysfunction of phosphate regulation. It is an idiopathic calcinosis that characterized by the deposition of calcium phosphate in periarticular tissues that causes typically lobulated, well demarcated calcification around large joints particularly the extensor surfaces. It is usually painless. It is common in puberty age and adolescents. The involvement of the hand phalanges is very rare that can make a mistake in diagnosis if it is infected. Tumoral calcinosis is seen the same in both sexes. The electrolyte levels of calcium and phosphorus is normal and sometimes is hyperphosphatemia. It is the first report of tumoral calcinosis in Iran. Case report: A 7-year-old girl presented with redness, yellowish discharge and painful swelling of the left hip and the third web space of left hand admitted to Vali-e-Asr Hospital, Tehran, Iran, in 2013. The onset of the disease was 3.5 years ago. She did not mention the family history of the disease. The pain was at the left hip first. Six months later the third and fourth phalanges of the left hand was swollen. Physical examination revealed an erythematous mass in the extensor surfaces of the third and fourth metacarpals of the left hand. It was tender in palpation. The smear and culture of discharge was staphylococcus aureus. X-rays revealed calcification of the third and fourth metacarpals of the left hand. The entire lesion was managed by surgical excision. Successful postoperative medical management in the form of low calcium and low phosphorus diet and oral cloxacillin was performed. Conclusion: Tumoral calcinosis involves rarely the interphalangeal joints of hand. Because of its compression over adjacent nerves, it is painful. Sometimes it has a sterile discharge and rarely superimposed infections may occur. Radiologists can play a major role in early diagnosis and probable complications.

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Background: Hypertension is one of the major risk factors for cardiovascular disease. The studies show that factors such as vitamin D, parathyroid hormone, calcium and phosphorus are involved in the regulation of blood pressure. The purpose of this study was to investigate the relationship between blood pressure with vitamin D, parathyroid hormone, calcium, and phosphorus in sedentary postmenopausal women.

Methods: This investigation is in the form of a descriptive correlational study that was performed in September 2015. The statistical population was all healthy and sedentary postmenopausal women 50-70 years old in Urmia city, Iran. Fifty-four sedentary postmenopausal women were selected as subjects and voluntarily and bona fide participated in this study. General and anthropometric characteristics of height, weight, and body mass index (BMI) in subjects were measured by wall-meter with an accuracy of one millimeter, digital scale with precision of 100 g (Beurer, Germany), and dual emission X-ray absorptiometry (DXA) (Hologic, USA) machines, respectively. Diastolic and systolic blood pressure was measured by indicator machine. Serum levels of vitamin D, parathyroid hormone, calcium, and phosphorus were measured by ELISA and Auto-analyzer (BT 1500, Biotecnica, Italy machines, respectively. Results: The mean general, anthropometric, and physiological/laboratory variables of subjects were: age 54 yr, height 156 cm; weight 72 kg; BMI 29 kg/m2; systolic and diastolic blood pressure 76.20 and 110.70, respectively; vitamin D 25.22 ng/ml, parathyroid hormone 33.29 ng/ml, calcium 9.44 ng/ml, and phosphorus 3.26 ng/ml. Moreover, results showed that there was no significant relationship between systolic and diastolic blood pressure and vitamin D (P>0.581 and P>0.619, respectively). There was no significant relationship between systolic and diastolic blood pressure and parathyroid hormone (P>0.623 and P>0.341, respectively). There was no significant relationship between systolic and diastolic blood pressure and calcium (P>0.704 and P>0.141, respectively). There was no significant relationship between systolic and diastolic blood pressure and phosphorous (P>0.058 and P>0.357, respectively). Conclusion: The results suggest that there is no relationship between systolic and diastolic blood pressure with serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous in sedentary postmenopausal women 50-70 years old.

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Background: Studies show that aerobic exercise prevents osteoporosis in menopause by stimulating osteoblastic cells. Therefore, the purpose of this study was to investigate the effect of 12 weeks of moderate-intensity aerobic exercise on alkaline phosphatase gene expression, serum levels of alkaline phosphatase, parathyroid hormone, and calcium in sedentary women.

Methods: This investigation is a semi-experimental study that was performed in September 2015 at Urmia University, Iran. The statistical population was all healthy and sedentary postmenopausal women 50 to 65 years old in Urmia city. Twenty sedentary postmenopausal women with an average age 60.12±2.12 yr, weight 72.35±10.50 kg, and body mass index 29.46±3.24 kg/m2 voluntarily and bona fide participated in this study, and then subjects were randomly divided to the Exercise/E (10 women) and Control/C (10 women) groups by random sampling method. E group performed of 12 weeks walking and jogging moderate-intensity aerobic exercise at 65-70% maximal heart rate of training, three sessions per week and per session 50-60 (min), but the C group participated in no intervention. Twenty-four hours before and after the 12-week training program were taken blood samples in order to measure of alkaline phosphatase gene expression and serum markers of bone in the E and C Groups. Evaluation of gene expression and serum markers of bone were measured by real-time reverse transcription PCR (RT-PCR) and Auto-analyzer (Biotechnica, Italy)/ ELISA reader (Awareness Inc., USA) machines, respectively. Data analysis included descriptive and inferential (ANCOVA test) statistics using SPSS version 23 (Chicago, IL, USA) and a significance level of P≥0.05 was considered. Results: The results showed that alkaline phosphatase gene expression and parathyroid hormone after 12 weeks of moderate-intensity aerobic exercise in between-groups were significantly increased (P=0.027 and P=0.006, respectively), while serum levels of calcium and alkaline phosphatase were not significantly different (P=0.941 and P=0.990, respectively).

Conclusion: The results suggest that 12 weeks of aerobic exercise of walking and jogging at 65-70% maximal heart rate of training increases alkaline phosphatase gene expression and parathyroid hormone in sedentary postmenopausal women.

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