Medical Journal of Tabriz University of Medical Sciences
Year:2001 | Volume:35 | Issue:51|Papers Count:18

Background and Objectives: External otitis, known by different names, is a painful disease which occasionally may be life threatening. In addition to human being, other mammals are also involved to external otitis. This study intended to obtain enough information about aerobic and facultative anaerobic causative agents of external otitis and their antibiotic sensitivity pattern. Materials and Methods: Samples were obtained from 75 patients and examined by microscopic and cultural procedures.Results: Out of 79 isolated organisms, 65 were bacterial and 14 were fungal isolates. Pseudomonas sp.(31.65%) and enterobacteriace species were the most common agents of bacterial infections. Except in some cases, third generation cephalosporins were hundred percent effective on enterobacteriacea species. Cephtazidime, another third generation cephalosporin and new quinolones such as ciprofloxacin and norfloxacin had extremely good effects on Pseudomonas species, while carbenicillin and penicillin had no effect at all on Pseudomonas and Staphylococcus aureus respectively. Seven isolates (53.8%) of Staphylococcus aureus strains and 32% of Pseudomonas strains showed penicillinase activities.Conclusions: Aerobic and facultative anaerobic bacteria such as Pseudomonas species and Enterobacteriacea organisms constitute as main causative agents of external otitis and are sensitive to quinolones and third generation cephalosporins respectively.

Background and Objectives: Norplant is one of the contraception methods being accepted among females because of its long activity and low motivity. However, norplant has some complications that sometimes makes users to refuse it, and that is why we decided to study discomforting complications after its usage in a descriptive manner on Iranian women.Materials and Methods: In this research clinical discomforting complications and satisfaction rates were studied on 100 female users of norplant in health centers of Kermanshah state. The data gathered by well - trained questionners, was analysed by using descriptive methods.Results: After norplant implantation in 100 females, 16 cases had amenorrhea, 77 cases observed abnormal uterine bleeding, while 7 had no changes in the menstruation. In 40 females no change in weight was noticed, however 25 cases showed weight loss, 35 cases gained the weight and 39 cases had complications in implantation site. The prevalence of some signs increased in some women after usage of norplant as compared to pre-usage stage: headache was initially reported in 3 cases, but after norplant usage 42 females had the problem. Likewise hirsutism, hair loss and acnea, initially observed in 1,3 and 7 cases respectively were later reported by 5,30 and 16 cases respectively . Initially depression and mastalgia were not reported by any female, however after norplant usage 28 and 5 cases complained respectively. In some women, most common reasons for selection of norplant were long activity (62 cases), effectivity (42 cases) and easy to use (42 cases).Conclusion: It appeared that norplant results in significant increase in: abnormal uterine bleeding (p<0.001), hair loss (p<0.001), headache (p<0.001), acnea (p<0.05), depression (p<0.001) and mastalgia (p<0.05), but this method has no significant effect on hirsutism (p>0.1) and breast discharge (p>0.1). Satisfaction was complete in 56%, 19% partially agreed to, 18% disagreed with norplant and 7% had no idea about this contraceptive method. Important discomforting complications of norplant were: abnormal uterine bleeding, headache, weight gain, loss of hair and depression.

Background and Objectives: Recent studies suggest an association between body size and composition, and hematological indices of iron status. The purpose of this study was: 1) to assess body mass index (BMI) among nonpregnant, non-lactating women of reproductive age (15-49 years) from Marand district, East Azarbaijan province and, 2) to evaluate the association between BMI and hematological indices of iron status.Materials and Methods: the samples (1,049 eligible women) were selected by cluster random sampling. The data on demographics and gynecological history were gathered through interview. Height and weight were measured and BMI was calculated. Fasting blood samples were withdrawn to measure hematological indices (Hb, Hct, and MCV).Results: Based on the findings, the mean BMI of the subjects was 24.49 kg/m2, which is within the normal range. Mean BMI increased with age significantly (p<0.0001) and was higher among the urban population. There was a significant association between the quartiles of BMI, Hb and Hct. BMI positively correlated with the number of pregnancies (p=0.0067, r=0.0102).Conclusion: Despite the high prevalence of iron deficiency anemia and the need to combat it, prevention of obesity and possible iron overload in reproductive ages of women is also necessary.

Background and Objectives: There are several important constructions besides sella turcica and pituitary gland, and because of their close contact, it may cause several pathological lesions.Keeping this in view, we studied patients undergoing surgery for such tumors and observed the pathological lesions developed.Materials and Methods: This was a retrospective and prospective study of patients with tumors of the sellar and parasellar areas admitted to Department of Neurosurgery, Imam Khomeini Hospital of Tabriz from year 1994-1999. Patients were clinically examined for any pathological lesions developed before or after surgery.Results: During the period of 5 years, 57 patients were admitted to Imam Khomeini Hospital. Clinically most of these patients were found to have pituitary adenoma, followed by craniopharyngioma. Visual defects were the most common presentation of these tumors in the patients studied, and the most common complication developed after surgery was diabetes insipidus.Conclusion: As the appropriate diagnosis and timely treatment of tumors of sellar and parasellar areas reduces the complications, these tumors must be in differential diagnosis of all patients presenting defects of vision, cranial nerves and endocrine functions.

Background and Objectives: Increased incidence of MRSA in any area is clinically and epidemiologically significant. Studying and reporting of the rate of the incidence is the task of the investigators. The present research was a pilot study to reach this aim.Materials and Methods: To find the prevalence of MRSA in Ahwaz area, a total of 70 isolates of Staphylococci were collected from different clinical specimens routinely sent to various hospital laboratories of the city. Isolates were identified based on coagulase and conventional biochemical reactions. Kirby-Bauer disk diffusion method with methicillin disk was used to find the rate of resistant strains.Results:The results showed that 40 staphylococcal isolates were coagulase positive and the rest (30) coagulase negative. Of the total 70 isolates of Staphylococci, 23(32.85%) isolates were resistant to methicillin. Of these 23 MRSA,15(37.5%) isolates were found to be coagulase positive and 8(26.67%) as coagulase negative.Conclusion: Resistance pattern of Staphylococcus to various antibiotics, specially methicillin is towards increasing trend. Prevalence of MRSA was comparatively more than as reported elsewhere in Iran or other countries.

Background and Objectives: The objective of the study was to determine the distribution pattern of Multiple Sclerosis (MS) plaques in central nervous system of MS patients and also occurance of sinusitis in these patients.Materials and Methods: The study included 126 MS patients who were referred to MRI Center of Imam Khomeini Hospital, Tabriz. The following criteria were evaluated: age, sex, distribution of MS lesions. Atrophy of corpus callosum and coincidence with sinusitis were also observed in these cases. Results: Clinical and MRI findings in all aspects were compatible with other studies, except for the incidence of sinusitis that was calculated 14% in MS patients, which is completely different from other studies.Conclusion: Low coincidence between MS and sinusitis suggests that there is not an etiologic correlation between them.

Background and Objectives: Oxygen radical injury may be a common pathogenic mechanism in several neonatal diseases. Oxygen toxicity is a major problem during the postnatal adaptation period especially among premature infants. While reactive oxygen free radical are generated continuously either in hypoxic state or during the supportive oxygen therapy, which is frequently used in these patients, their antioxidant defense mechanisms are inadequate. Since ceruloplasmin (Cp) is an important extracellular antioxidant and vitally important in regulating the ionic state of iron particularly oxidizing Fe2+ to Fe3+, its concentration and enzymic activity can be of great significance on the first day of life.Materials and Methods: Cp oxidase activity and its concentrection in cord blood of full term and premature neonates were measured by manual kinetic method using p - phenylene diamine as substrate and immunochemical technic respectively.Results:The mean activity of enzyme in the cord blood sera from 52 term neonates was 200 HU/L(range 81-300 HU/L) while, in the samples of 50 premature infants it was 110 HU/L (range 0-290 HU/L). The concentration of Cp in the groups were 12 mg/dl (range 7-28 mg/dl) and 8mg/dl (0-18 mg/dl) respectively. After supportive oxygen therapy the oxidase activity of the ceruloplasmin and its apoenzyme concentration again were measured in 25 cases of premature infants. Comparing with the rest of the premature infants significant reduction (p<0.05) was noticed in the oxidase activity of enzyme without any marked decrease in the apoenzyme concentration.Conclusion: It can be concluded from this study that ceruloplasmin measurement is an index of antioxidant capacity of neonate and if oxygen is to be administered to these babies, they should simultaneously receive injection of Vitamin C to protect them from reactive oxygen species (ROS).

Background and Objectives: Urinary tract infections (UTI) are the most common acquired infections in the hospitals and urinary catheter is the most common cause. These infections are the frequent cause of significant morbidity, sepsis and death along with cost effective medical care. Keeping this in view, a study was carried out to determine the incidence of catheter - associated bacteriuria in hospitalized patients and to find out the most common encountered microorganisms, along with their antibiotic sensitivity pattern.Materials and Methods: A prospective study was carried out in Department of Neurosurgery (Ayatollah Taleghany Medical Center, Kermanshah) on 202 hospitalized patients. Two urine specimens were collected at the interval of 72 hours from each patients. After isolation and identification of the encountered organisms, the sensitivity tests was carried out with routine 11 antibiotics.Results: Out of 202 patients surveyed, 48 patients (24%) developed bacteriuria after 72 hr. of catheterization. We characterized 48 isolated organisms, of which 98% Enterobacteriaceae and an isolate of Candida albicans (2%) which probably had an endogenous origin, were the causative agents. Most of the 87.7% isolates included E. coli, Klebsiella pneumoniae and Enterobacter cloacae. Isolated strains were only susceptible to Amikacin and Nalidixic acid and the rate of resistance to all other antibiotics was between 32% to 100% .Conclusion: The range and extent of nosocomial infections depend firstly on the organisms occurring in the hospital, secondly on the incidence of transmission depending on the standard of hygiene in the hospital and, finally on the resistance of the patient. Our findings show that the hygienic measures and nosocomial infections should be rigorously controlled. All patients having a urinary catheter should be submitted to the microbiological tests and a proper management should be used in case of bacteriuria. In the last we recommend that antimicrobial current regimen should be reconsidered because of the resistance of the organisms, such as E.cloacae, K.pneumoniae, and Proteus mirabilis that were responsible for almost half of the cases of catheter-associated bacteriuria in our study, none of them correlated with the current antimicrobial current regimen of this ward.

Background and Objectives: The incidence of complications resulting from otitis media with suppurative abscess has significantly decreased since the introduction of antibiotics. At the beginning of the 20th century, 50% of all cases of otitis media developed a coalescent mastoiditis. By 1959, the incidence had fallen to 0.4%. Additionally, during the time of Friedrich Bezold (1824-1908) 20% of otitis media patients with mastoiditis developed subperiosteal abscess. Interestingly, the incidence of subperiosteal abscess has increased. Today nearly 50% of patients diagnosed with coalescent mastoiditis have subperiosteal abscess.Materials and Methods: To review the contemporary presentation, diagnosis and management of a spectrum of mastoid abscess, retrospective case series were evaluated in the hospitals associated with the Department of Otolaryngology, Head and Neck surgery at the Tabriz University of Medical Sciences. Results: twelve patients with mastoid abscesses were reported in recent 10 years.Two patients displayed classic Bezold’s abscess with PUS escaping the mastoid near the incisura digastric and tracking along the digastric and sternoclidomastoid muscles in the neck. One patient exhibited temporoparietal swelling secondary to mastoid abscess eroding from the root of the zygomatic process. Nine patients with mastoid displayed postauricular swelling with otorrhea, cholesteatoma and granulation tissue in middle ear and mastoid cavity.Three patients with mastoid abscess had normal tympanic membrane and cavity. Only one third of patients showed pathologic tympanic membrane, otalgia, fever and tenderness.Conclusion: The clinical presentation, pathogenesis and routes of abscess spread are presented. Medical and surgical management was reviewed so as to find out the complications associated with suppurative otitis media. The diagnosis of subperiostal mastoid abscess is frequently delayed, thus medical and surgical management along with method for accurate diagnosis are essential.

Background and Objectives: The effects of smoking on internal diseases such as cancer, cardiovascular diseases, and lung diseases are well studied. However, its effect on the skin is not properly known. Effects of smoking on the skin are not the same as seen on other organs, thus changes appearing in a person are important. In this article well known lesions on the skin have been reviewed and a research on the elastic tissue is presented.Materials and Methods: In this study biopsies were taken from the upper and inner arm of ten 60 year old male cigarette smokers, which were then compared with those obtained from 10 age matched controls who were not smokers. Results: In the present study abnormalities were observed in the elastic tissue of the non-sun exposed skin of heavy cigarette smokers. To minimize the effects of photoageing, all the skin biopsies were taken from a sun-protected area and compared with those from sex and age matched non-smokers who were the controls. Microscopical examination showed that the elastic bundles were wider and thicker in the smokers as compared to the bundles observed in subjects of the control group. Conclusion: From the results obtained it can be concluded that smoking cigarette affects not only internal organs but also cutaneous tissue.

Background and Objectives: Upper urinary tract is a common site for congenital malformations. Some of these malformations could be clinically silent for a long period of time and grow insidiously, and many of them must undergo surgical treatment. On the basis of previous findings, this study was performed to provide statistically adjustable incidence of upper urinary tract malformations in apparently asymptomatic individuals in order to justify the necessity of ultrasonography of kidneys and bladder and to investigate the above mentioned anomalies, particularly in pediatric group under 6 years of age. Materials and Methods: During a period of 2 years, 465 children and 535 adults, without any clinical suspicion of urinary problems were studied, initially by sonography and followed up by IVU or CT scan , as indicated.They were referred to the radiology and sonography center for evaluation such as chest X- Ray, sonography of liver and gall bladder or skull and limb radiography etc.Results: Upper urinary tract malformations were found in eighteen (4%) children and 17 (3%) adults by sonography alone, or by relevant sonography and IVU, CT scan or isotope scanning.Conclusion: According to the outcome of this study, we suggest that screening by sonography should be mandatory for everyone especially when they are under 6 years of age.

Background and Objectives: One of the physiological and pharmacological methods for the study of sympathetic innervation is by the usage of cocaine. Cocaine decreases neuronal reuptake of noradrenaline. In all blood vessels the network of sympathetic innervation is small that cannot influence response to noradrenaline in presence of cocaine. The present study was carried out to investigate innervation of sympathetic nerves in different arteries and veins of rabbit. The purpose of the work presented here was to investigate sympathetic innervation at the level of larger vessels of rabbit.Materials and Methods: In this study we investigated sympathetic innervation in four arteries and veins of rabbit by glycoxylic acid staining technique. Arteries and veins were cut as small pieces and were bathed in Krebs to stain with glycoxylic acid technique. After staining, using fluorescence microscope sympathetic innervation can be seen as bright blue fluorescence network.Results: The result of present study revealed that: in aorta, there were a poor innervation at medio - adventitial junction, occasionally in outer media. Reval had a very poor innervation with only a few varicosities at medio - adventitial junction. In Saphenous and arteries an extensive innervation was observed at medio - adventitial junction. Which were associated with fine axons and varicosities between smooth muscla cells of outer media. No nerves was observed in venacava. Apoor innervation was observed in renal vein with 8-10 axons entering media from adventitia. Saphenous vein showed an extensive innervation in media and adventitia. Ear vein had a very littie evidence for innervation. Conclusion: In agreement with physiological and pharmacological methods it can be suggested that in ear artery and saphenous artery or vein sympathetic innervation is very extensive but in others, that we investigated, sympathetic innervation is very poor.

Background and Objectives: Clubfoot or pes equinovarus is one of the most common congenital foot anomalies observed in Iran, mainly in Azarbaijan. This has been well proved that the early diagnosis especially early proper treatment in newly born babies leads to successful results. The study was conducted on the patients with clubfeet who attended Shohada Hospital from year 1996 to 1998. twenty four selected patients were treated surgically by Turco procedure, and the result from the point of success and failures were evaluated, and the main factors of failure or recurrence of this abnormality were pointed out. Materials and Methods: Out of 50 patients referred to the hospital, 24 patients were selected having 33 clubfoot (9 patients being bilateral). All 33 feet were operated with Turco surgical technique in Shohada surgical center.Results: Unfortunately the clubfoot has a very high rate of recurrence and in our study this rate was 28%. This deformity affects boys (55%) slightly more than the girls and right side (58%) more than left. Mean age of operation was 1.9 years. It was found that the main factor for failure of this procedure was operation performed before 6 months and after 3 years of age. Within 28 % of recurrence there were: five cases who had the Turco procedure done with no K. wire fixation. In one case the K-wire was removed too early. In 3 cases POP was removed in 6 weeks. In 3 other cases the Turco procedure was not done classically. Four patients had excellent and 19 patients had good results, while 10 cases had recurrences.Conclusion: Considering the results, it is strongly suggested that the patients with clubfoot should never be operated at age less that 6 months and not more than 3 years and the best age for surgical intervention is age between 1 to 2 years.

Background and Objectives: Most of the countries are challenging with increasing rate of population growth in recents decades. World population has increased almost two times in the past 40 year and affected social, economical and cultural aspects of the countries. This issue is also very important in our country because in recent last two decades rapid population growth changes have been observed. Thus present study was undertaken to evaluate fertility behaviours.Materials and Methods: This study was retrospective analytical conducted in rural areas of East Azarbaijan from year 1988 to 1997. Data was collected from vital horoscope sheets of about one thousand health houses and then analyzed.Results: The following fertility behaviours were noticed:1) The population growth rate and total fertility had significantly (p<0.001) decreased 2.5 times from year 1988 to 1997.2) The decreasing trend of birth rate was significantly (p<0.001) high in women of >35 years old as compared with other ages.3) Family planning coverage had significantly (p<0.001) increased from 40 % to 75 % within ten years. 4) The comparison of population structure by age at 1988 and 1997 showed that the population of under five years old had decreased, while the population of ten to twenty and>65 years old increased.Conclusion: 1) Family planning programs should be continued effectively because in the near future the population of fertile women will have a big growth.2) Training of men should take place in order to get their support for family planning programs.3) Health programs should be conducted for teenagers and aged population in Azarbaijan province as soon as possible.

Most of the individuals who commit suicide have a background history of death - instincts and reversibly most of the attempted suicide cases are more likely to complete their instinct. Suicide and deliberate ways of self - harm vary in a different areas of world according to available devices for attempting suicide, educational level and job.This report is about, an 18 year old girl who inserted needle in her suboccipital region into cervicomedullary junction suddenly, without history of main psychopathology and deliberate self - harm, to commit suicide following feeling of hopelessness from succeeding in university entrance examination but failed to complete suicide and thus, finally she approached to Neurosurgery Clinic for suboccipital pain and swelling. After clinical observation, physical examination and evalution by plain radiography and computorized tomography of cervicomedullary junction, needle insertion was detected in the said region, thus the patient was operated and needle was removed. The patient did not had any neurosurgical and psychiatric problems in preoperative psychiatric consultation and postoperative follow up. Suicide and deliberate ways of self-harm vary among people of different age groups according to educational levels, job etc, however, the way described above is very rare. As the patient had knowledge about anatomy and physiology of cervicomedullay junction or vital node, she attempted to commit suicide in a psychological condition of hopelessness.