Medical Journal of Tabriz University of Medical Sciences
Year:2006 | Volume:27 | Issue:4|Papers Count:30

Background and Objectives: Recently a variety of studies reported high prevalence of vitamin D deficiency in adult individuals in different countries. Vitamin D deficiency could be one the major hea:hh problem which may induce bone disorders particularly osteomalacia, and fracture as a result of osteoporosis. The aim of the present study was to evaluate the possible prevalence of vitamin D deficiency in reproductive age women in city of Tabriz.Material and Methods: This was a cross-section study and constitute of 252 reproductive age, 15-49 years, women of Tabriz city whom randomly selected from general population.From each subject 5 ml vein blood was obtained and serum levels of calcium, phosphor, alkaline. phosphatase, and vitamin D were measured. A demographic questioner was filled. Weight and height were measured using seca scale and cotton ruler, which was stick to wall respectively. Body mass index was calculated based on weight and height results. Vitamin D was measured by radioimmunoassay. Data was analyzed using ANOVA and Pearson correlation coefficient tests.Results: The results indicated that vitamin D deficiency in women was as follows: sever vitamin D deficiency 15.1%, moderate deficiency 15.5%, and mild deficiency 33.7%. Of those women 3.7% were underweight and 59.8% had different stage of obesity. Only 37.5% had BMI in normal range. There was a significant correla\tion between serum level of vitamin D and weight (p<0.05). There was a correlation between educational level and vitamin D concentration of serum (p<0.05).Conclusion: Basetd on this study, it is speculated that vitamin D deficiency is prevalent in women of Tabriz city. Therefore, it is suggested that intervention education and sun exposure are recommended for women's health promotion.

Background and objectives: Endotracheal intubation is one of the most important procedures in Pediatric Intensive Care Unit (PICU) for maintaining the patency of airways and applying Positive Pressure Ventilation (PPV), however, it is always temporary and needs a logic decision for termination (extubation) at a proper situation either to restore the physiologic respiration or to avoid imposing the risk of recurring respiratory failure.There are several risk factors for extubation failure including: occlusion of air ways by hypersecretion, ineffective cough reflex, central nervous system (CNS) dysfunction and etc. We planned to study these risk factors. Methods and Materials: In an Analytical cross-sectional study, from January 2003 to August 2005 the risk factors of reintubationin two groups of patients compared, both groups consisted of 30 children, one with successful extubation and another with extubation failure. In each group, age, gender, underlying disorder, duration of mechanical ventilation before extubation and the results of blood gas analysis before each intubation and extubation were recorded, the results were statistically analyzed by T-test and X2 (chi-square). Results: This study showed that neuromuscular disorders (including: spinal muscular atrophy, Guillain-Barre syndrome, muscular dystrophies and congenital myopathies) are the main underlying disease in extubation-failure group (P= 0.0002). Besides, in comparison between two group of patients-who had successful versus failed extubation, hypercapnia (PaCo2>50mmHg) was showed to be the most common cause of both the first intubation (P=0.001) and reintubation (P=0.004) in patients who failed extubation.conclusion: This study shows that neuromuscular disorders are the most common causes which defeat weaning from ventilator or result in reintubation by induction of hypercapnia.Therefore the weaning process must be done gradually in these patients, and conjoined with supportive measures such as close observation at least for 72 hours after extubation, watching recurrence of hypercapnic respiratory failure.

Background and Objective: Multiple sclerosis (MS) is a T cell- mediated autoimmune disease with central nervous system lesions which characterized by mononuclear cellular infiltrate, edema, demyelination, and occasionally axonal loss. MS is a chronic disease requiring long-term monitoring of treatment. This study performed to evaluate the effects of interferon beta - Ia on brain lesions of MS patients by then MRI images.Materials and Methods: In this study, 30 patients who had MS criteria were selected.Neurologic examinations were done on them and primary MRI was preformed. Then they were treated with interferon beta-1 a for six months. After then, another MRI was preformed and neurologic reexamination done again. We compared results of first and second MRIs and examinations results were analyzed with SPSS, Paired T-test & Chi-square. Results were reported in percents and means. The level of meaningfulness was considered as P<0.05.Results: Out of 30 patients, 22 of them were female and 8 of them were males. Mean age at the time of study was 31.2 (SD=5/68) years. There were, decrease of motor signs in 13 cases, decrease of sensory signs in 5 cases, decrease of cerebellar & brain stem signs in 5 cases and decrease of spinal signs in 7 cases. There was decrease in the size of MRI plaques in supratentorium in 17 cases, in cerebellum and brain stem in 14 cases, and in cervical cord in 4 cases. There was decreased number of MRI plaques in supratentorium in 4 cases, cerebellum and brain stem in 10 cases and in spine in 2 cases. In first MRI number of lesions were in 30 cases in supratentorium, 13 cases in infratentorium and 13 cases in spine. Conclusions: Interferon beta-la is effective in decreasing the size of MRI plaques in MS patients. Also it is useful in decreasing clinical signs.

Background and Objectives: Spinal Muscular Atrophy (SMA) is one of the neurodegenerative disorders leading to weakness and atrophy of voluntary muscles. This disease forms the second most common fatal autosomal recessive disease after cystic fibrosis, with an incidence of 1 in 10000 newborns. In most of the patients of SMA, exon 7 and/or exon 8 of SMN 1 gene is deleted. In this study we analyzed both exons in SMA patients referred from East Aterbaijan region applying molecular methods.Materials and Methods: SMA patients diagnosed by neurologists were referred to the lab. DNA was extracted from the whole peripheral blood and was analyzed for exons 7 and 8 of SMN1 gene by applying PCR-RFLP technique.Results: Our study indicates that 43.3% (13/30) of SMA type I patients and 6.25% (1/16) of SMA type II patients had deletions in both exons 7 and 8 of SMNl gene. Among SMA type II patients, 6.25% had deletions in both exons. Deletion of exon 7 or exon 8 alone was observed in 6.25% of SMA patients affected by type II.Conclusion: Deletions of exon 7 and exon 8 of SMN 1 gene was observed in most of the SMA type I and type II patients.

Background and Objectives: Drug interactions are accounted as one of the most important problems of Medical doctors. In this study, we investigated incidence of drug interactions in prescription of physicians and some factors which affect on drug interactions.Materials &Methods: Primary study showed overall incidence of 7% drug interactions in Golestan province, therefore, 5300 prescriptions were gathered. After primary soft ware analysis, clinical significance of each interaction was determined. All data entered into SPSS- 10 software and analysed by X2 test.Results: Overall incidence of drug interaction was 8.7% from that 8.72% was severe, 69.3% was moderate and the rest had minor clinical significance. 79% of them were obtained with clinical importance. Prescriptions of male physicians and general practitioners had significant increase in drug interactions. Increase in mean number of drugs in each prescription caused significant increase in incidence of drug interactions.Conclusions: There are several factors that affect the incidence of drug interactions in prescriptions of medical doctors. Continuous education of physicians may be considered to reduce it.c

Background and Objective: Therapeutic effects of methotrexate (MTX) and azathioprine (AZA) in rheumatoid arthritis (RA) patients have been compared in a few double blind studies and there is only one in study Iran which showed different results. We conducted a double - blind, clinical trial.Materials and Methods: From jun 2003 to jul 2004, 76 patient with active RA were entered into a 24-week, prospective, double - blind, clinical trial and were randomly assigned to two treatment groups (41 in MTX and 35 in AZA). In the course of study patients received MTX 7.5 mg weekly or AZA 100 mg daily. All patients were evaluated for clinical (tender and swollen joint counts, Ritchie arthicular index, duration of morning stiffness, pain score (VAS), grip test and bboratory variables (Hemoglobin, platelet, WBC, ESR, CRP, RF) at the beginning of study and every 8 weeks thereafter.Results: sixty nine Patients completed the trial. There were no statistically significant differences among the treatment groups in the time of onset of response, clinical improvement, overall physician assessment and laboratory variables at 8th and 24th weeks except higher decrease in RF titer in MTX group.Adverse drug reactions were slightly more common in AZA group and withdrawals because of side effects was 2 in AZA because of neutropenia and 1 in MTX because of elevation of SGPT.Conclusion: No significant difference in the therapeutic results of AZA and MTX on RA patients was noted. but adverse events were higher in AZA group.

Background and Objectives: Helicobacter pylori is the major cause of acute and chronic gastritis, gastric and duodenal ulcer and increased incidence of gastric adenocarcinoma and elevated gastric mucosa Iymphoproliferation. Reactive oxygen species have been suggested as one of the main causes of cell injury in H. pylori associated gastritis.Materials and Methods: In this study to evaluate oxidative stress in H. pylori infection the activities of Superoxide Dismutase (SOD) and Glutathione Peroxidase (GPX) were measured in gastric juice of sex and age matched H. pylori positive (n=43) and negative (n=43) individuals. This was determined through endoscopic and urease rapid test examinations.Results: The mean activities of SOD and GPX in the gastric juice of the patients (H. pylori positive) were significantly higher than those of control group (H. pylori negative) (p=0.0001 in both cases). Correlation test between the mean activities ofthe both enzyme in gastric juice of control group revealed a direct and significant relationship was noticed (r=0.702, p=0.0001) while in the patient group a reverse but non-significant correlation was found (r=-0.028, p=0.859).Conclusion: Since the activity of GPX is considered as being complementary to the activity of SOD, direct correlation between the activities of the two enzymes in gastric juice in uninfected group, and indirect correlation between these in that of infected group may suggest the presence of oxidative stress in H. pylori infection.

Background and Objective: The process of transition from student to qualified nurse has long been recognized as a stressful experience. If it is left unresolved, may leads to decrease of job satisfaction, and increase probabilities of leaving the profession. Therefore, it is necessary to recognize stressful experiences of the new graduated nurses during transition period in order to decreases stress and increase retention of them in clinical centers.Material and Methods: This descriptive study on 200 new graduates that were working in teaching centers and affiliated hospitals of tabriz Medical Sciences University which during research conduction placed at the end of first six month of work. A questionnaire was obtained assessing individual and managerial stressful experiences.Results: most new graduates had high level of individual and managerial stressful experiences. Need to new skills (65%), conflict between some of role experiences and personal value (63.1%) and lack of necessary skills for doing nursing procedures (58%) in the individual stressful experiences part, as well, incongruity between condition of work setting and what learned in education course (70%), not implementation of orientation program in the first job (69.3%) and finally, high expectations in relation to workload in the managerial part (65%), identified as highest stressful experiences.Conclusion: Concerning high level of stress during transition period, efforts of nursing schedulers in other to decrease stress of new graduates, simplification of adjustment with transition process and their clinical skill development are necessary.

Background and objective: Apical seal is an important factor in successful root canal therapy and it can be achieved by gutta-percha and a root canal sealer. The purpose of this study was to compare the effect of Tubli-seal, AH26 and Zinc oxide and eugenol as root canal sealers on apical seal.Materials and Methods: A total of 110 one-rooted extracted human central incisors were instrumented with step-back technique. No 35 K-file was selected as master apical file and flaring was done up to¹60. The teeth were randomly divided into three experimental and two control groups. The root canals of each group were obturated using gutta percha and one of Zinc oxide and eugenol, Tubli-seal, and AH26 sealers. In the positive control group no sealer was used for root canal obturation. Dye penetration technique was used for evaluating the rate of longitudinal microleakage. Dye penetration was measured by a milimetric ruler under stereomicroscope, and LSD test was used for statistical analysis.Results: The results showed that there was no significant difference in apical microleakage between Tubli-seal and Zinc oxide and eugenol sealers (P=0.63). However, there were significant differences among AH26 and two other sealers, and among positive control group and experimental groups (P<0.01).Conclusion: According to the results of this study, it seems that Zinc oxide eugenol sealer is not a good sealer for successful root canal treatment.

Background and Objectives: Use of the radial artery as conduit for coronary artery surgery has increased in recent years. This study reports the effects of Radial artery harvesting on hand muscles power and function and neural sensation in operated patients.Materials and Methods: Thirty patients, who had the radial artery used for myocardial revascularization were selected and underwent assessment of bilateral hand function with dynamometer for power grip forearm circumference, cyclical exercise fatigue tests. Also we recruited thirthy patients as control group for better comparison (patients with previous CABG, without Radial graft), and all above tests were performed bilaterally for this group.Then neurologic function was evaluated in distribution of Median, Lateral antebrachial cautaneus (LAC) and superficial radial nerves both electro diagnostically with sensory nerve Action potential (SNAP) parameters measurement and clinically to pin prick sensation.Results: 1) There was no significant difference detected between left hands of case and control groups in power grip parameters (P>0.05). But cyclical exercise fatigue test was significantly reduced in left hands of case group compared to control group (P<0.05).2) SNAP of LAC nerve was absent in 36% at operated side, that was different from unoperated side (24%) (P<0.05). 40% of patients reported hypoesthesia in cutaneus distribution of this nerve.There was no difference between median and radial nerves SNAP's at both sides.Conclusion: Harvesting of Radial artery does not adversely affect subsequent hand function, but may be shows early fatigue signs in prolonged and hard activities.Mild sensory abnormalities in distribution of some peripheral nerves especially LAC was detected. These symptoms caused by trauma or devascularization. But because of overlap in sensory area, prominent sensory complication is not seen.

Background and objectives: Numerous pathogens can be transmitted by exposing to blood and other body fluids. Health care workers are exposed to human biological fluids, and these factors cause fatal and chronic diseases. Thus, health protection of these individuals and primary prevention of these diseases with compliance of preventive principles may be necessary.Materials and Methods: This is a descriptive study in which we had observed the practice of 280 health care workers (33 specialists, and 50 residents of obstetric and gynecology, 19 midwifes, and 15 nurse's aids, 34 nurses and 129 midwifery students) in delivery, operating rooms and surgical-obstetrical wards of medical educational - centers of Tabriz. Stratified random sampling was used for sample selection. Data were gathered by a checklist through observation of subjects' practice. Descriptive (frequencies, percent, mean and standard deviation) and inferential statistics (chi square, fisher test, t test and ANOVA) were used for data analyses.Results: Results showed that samples practice was good among 18.6% of participants and moderate in 61.4% of them. The level of practice of midwives (60.5 %) and midwifery students (45.5%) were the highest one and the lowest one respectively. There was statistically significant difference between personnel and students practices with their job (P<0.001), ward (P<0.001), age (P<0.013), work shift (p<0.017) and course of midwifery students (p<0.002).Conclusion: Results of this study showed that personnel and students practices are well only among 18.6%. of subjects. Therefore probable causes of this low rate should be considered and managers should provide educational programs about prevention of blood borne diseases. They also should provide some protective equipment against mentioned diseases for health care workers in order to increase their motivations for using prevention principles.

Background and objective: Brainstem auditory evoked potentials (BAEPs) are a set of seven positive waves recorded from the scalp during the first 12 millisecond following a click; BAEPs are effective in evaluation the integrity of peripheral and central auditory pathways. Chronic renal insufficiency leads to hearing organ damage due to toxic influence of nitric compounds, electrolyte disorders and ototoxic materials. The aim of this study is evaluation of hearing organ function with BAEPs in patients with chronic renal failure under hemodialysis.Materials and Methods: This study is a case-control and analytical study. Forty patients with CRF under hemodialysis in Tabriz Imam hospital and 40 individuals without CRF were selected. We used BAEP test in both of them. The data was analyzed with SPSSII and independent- sample t-test and Chi- Square tests.Results: There was a significant difference between two groups in BAEP changes, in III, IV,V waves and I- III and III-V intervals (P<0.05). There was no correlation between duration of dialysis and BAEP changes. A significant correlation was found between potassium of serum and BAEP changes (P<0.05). There was no correlation between BAEP changes and other laboratory amounts (P>0.05).Conclusion: The elongation of wave III and V, and I-III and III-V interval in BAEP have been demons trated in other studies. Our study is consistent with those studies. Hemodialysis dose not permanently improve hearing, but it may temporarily prevent its further deterioration. BAEP test may use for monitoring hearing organ damage in course of uremia.

Background and objectives: Pityriasis Rosea is a relatively common skin disease that its etiology and treatment has not cleary defined. The aim of this study was to avaluate the efficacy of oral erythromycin in patients with Pityriasis Rosea.Materials and Methods: Fifty patients were selected which were the divided into 2 groups. In group A (test group) the patients were treated by erythromycin while in group B (plecebo group) the patients neceived chlorpheniramin or diphenhydramin. Duration of therapy in both groups were 14 days. Both groups were compassable with regard of age, sex and aveag duration of diseaze at the time of reposting to the clinic. At the end of 2 weeks, the responses were categorized as complete response, partial response or no response.Results: Upper respiratory tract infection before the appearance of the skin lesions was reported in 72% of ail patients .Complete response was observed in 16 patients (64%) in the treatment group (A) and none in the second group (B) (P= 0/0001). There was not any side effect in the treatment period with oral erythromycin.Conclusion: oral erythromycin was effective and safe in the treatment of the patients with pityriasis rosea.

Background and Objective: Anxiety disorder is the common psychiatric disorder. This research studies the first words said by patients which finally help in diagnos by psychiatrist.Materials and Methods: This research was an analytical cross-sectional study. We studied 200 admitted patients to Asad Abadi medial center that was diagnosed one of anxiety disorder via DSM-IV criteria. Finally data were analyzed by SPSS 11 software and Chi-square, t-test and One Way ANOVA tests.Results: In this study the phobia was shown in 3.8%, panic disorder in 19.9%, GAD in 15.1%, agoraphobia in 2.1%, obesity disorder in 20.5%, post stress anxiety disorder in 2.7% and social phobia in 3.1%. The mean of time between start of symptoms and admitted by physician was 30.88 month. Family history was positive in 58.3%. Somatic disorder was in 16.6%. The most common symptoms in these patients were anxiety (24.9%) and tremor in hand and foot (20.9%).Conclusion: "Darikhma" is an Azari word (equivalent of gloominess). Some physicians know it as cheerlessness or restlessness. In this study there is significant relationship of Darikhma with Panic disorder in addition of depression meaning of the word. There was no relationship between it and other anxiety disorder even there was a reverse relation between it and GAD.

Background and Aims: Numerous surgical procedures have been used to correct distal hypospadias, but in past 8 years repair of urethra with" Tubularized Incised Plate" technique or TIP has become prefered technique for distal hypospadias repair. In this study we report our experience about this procudure.Materials and Methods: This study was a descriptive retrospective study, patients, including 37 child boy with hypospadias with age range 9 months to 12 years, that between 2001 - 2003 years in Emam and Children hospitales of Tabriz under went to hypospadias repair with "TIP" procudure. All of the patients followed during hospitalization in first step and then 6 months post operation. This technique was the first repair to correct of hypospadias in all of these children.Results: Mean age of patients at the first repair was 44.19 months. The location of meatus was cronal in 2 patients, distal shaft in 27 patients, mid shaft in 5 patients and mega meatus with intact prepuce (MIP) in 3 patients. Mean operation time was 94 minutes. Mean hospitalization time was 5.9 days. 1 patient (2.70%) had bleeding from operation site during hospitalization. During follow up urethro cutaneus fistulas occurred in 3 patients (8%). During follow up all of the patients was voiding from a single urinary tract and in the straight stream.The total success rates of surgery was 92%. No significant difference in results was between this study and similar reports.Conclusion: Currently repair of urethra with TIP procudure is one of the most popular procudures for hypospadias repair. This procedure is potentially applicable in all cases of distal and mid shaft hypospadias.

Background and Objectives: Neveropthy of visual never in glaucoma is clearified by Retinal nerve fiber layer thickness. Primery open angle glaucoma resulted in functional and structural damage. The main objective of this study is quantifying the pattern of retinal nerve fiber layer loss in primary open angle glaucoma using optical coherence tomography.Materials and methods: Retinal nerve fiber layer thickness was assessed with circular scan (Radius=1.73 mm) in 30 eye with primary open angle glaucoma and is age and refractive error matched normal control. Glaucomatous patients were divided into three subgroups according to their visual field mean deviation:early (>-3dB), Moderate (-3 to -7 dB), and Moderately advanced (-7 to -15 dB). Results: Retinal nerve fiber layer thickness values in inferotemporal and supratemporal were significantly lower in all groups of glaucomatous eyes than in normal eyes (p<0.001).In early stage, inferotmporal thickness was significantly lower than supratemporal (p<0.001).Conclusion: In addition to diffuse Retinal nerve fiber layer loss, a localized defect was present in infero temporal quadrant in early stage of POAG. This study shows that optical coherence tomography (OCT 2) was able to show the location and extent of injury of retinal nerve fiber layer, which is consistent with other standard studies such as computerized perimetery.

Background and Objectives: There are geographical variations in the etiology of chronic renal failure in children because of genetic and environmental factors. The aim of this study is to determine the etiology of chronic renal failure (CRF) in children who referred to Children's Hospital of Tabriz and compare with the results of other centers.Materials and Methods: Fifty five children with CRF were investigated from September 1999 to July 2004 retrospectively. The cause of CRF was detected based on personal and family history, physical exam, Para clinic and imaging findings and renal biopsy.Results: The patients were between 4 months to 14 years old (Mean age 8.5 yr.). The male to female ratio was 1.3 (P>0.05). The chief etiologies of CRF included congenital malformations and urologic diseases (44%), glomerular diseases (25%), and hereditary nephropathies (18%). The most common cause in each group was vesicoureteral reflux (VUR), Focal segmental glomerulosclerosis and nephronophthisis respectively. The cause of CRF in 13% of cases remained unknown. The rate of consanguinity was higher in patients with hereditary nephropathies than others (P<0.05).Conclusion: Our findings, compared with data from developed countries, show a particularly high frequency of VUR and highlight the need for more attention to urinary tract infections in children.

Background and Objectives: Experimental autoimmune encephalomyelitis (EAE), as a model for human multiple sclerosis, is an inducible inflammatory and demyelinating disease of the central nervous system. It is suggested that females are more susceptible than males to develop EAE. Objective of this study is detection of the role of sex of rat in sensitivity of animal to disease.Materials and Methods: In this study, we induced EAE and investigated the susceptibility of male and female C57BL/6 mice to EAE, using a myelin oligodendrocyte glycoprotein peptide (MOG 35-55). Mice were immunized subcutaneously in the flanks with 200µg of MOG35-55 peptide and complete Fround's adjuvant. Also, mice received intraperitoneally with 400ng pertussis toxin in 300-400µl phosphate buffer on the day of immunization and 2 days later. The mice were observed daily for clinical signs and scores were assigned based on the following scale: 0: no clinical signs, 1: affected tail tonus, 2: tail paralysis, 3: mild hind leg paresis, 4: severe hind leg paresis, 5: one hind leg paralysis, 6: complete hind legs paralysis, 7: complete hind and fore legs paralysis and 8: death.Results: The results show that, incidence of EAE was 100 percent in both male and female groups. The onset of disease was faster in the female mice (day 9±1) in comparison with the male mice (day 11±1). Also mean clinical score of disease between male and female were different (4.7±1 and 5.8±0.4, respectively), but this difference was not significant.Conclusion: These findings suggest that MOG35-55 induced EAE is not gender-related in C57BL/6 mice. Other factors like the type of encephalitogen antigen might be, involved in the differences seen in of her strain.

Background and Objectives: Thyroid nodules are a common disorder. The majority of thyroid nodules are defined as "cold" because they concentrate little or no iodine in scintiscan in comparison to the adjacent thyroid tissue.Material and Methods: In this retrospective study, 800 patients with cold thyroid nodules were surveyed and the result of thyroid scans were collected from their charts and analyzed by appropriate statistical test. In this retrospective study the results of new approach to cold thyroid nodules by FNAB were compared to previous method of selection of patients for surgery and the sensitivity, accuracy and benefits of FNAB were determined.Results: 674 (84.2%) of the cases were females and 126 (15.8%) were males. An over all female to male ratio of 5 to 1. The frequency of malignancy among surgically excised cold nodules was 23.3%. The proportion of malignant nodules was more frequent in patients in the 4th decade and less frequent in patients younger than 20 years or older than 70 years.The mean age of the patients was 36.9 years. Neck mass was the most common symptom and the most common site of the nodule was in the right lobe.In order to evaluate the accuracy of FNA we compared the preoperative FNA findings with post operative pathologic results in 491 nodules from patients whom underwent surgery. In 491 thyroid nodules in which both results (FNA and pathologic) were available, false negative results were 14.2% and false positive findings were 5.8%. By comparing FNA and pathologic diagnosis in our study, FNA examination showed sensitivity of 85.5% and a specificity of 94.2% and an accuracy of 90%.Conclusion: Fine needle aspiration is simple tool for diagnosis of single cold nodules, with sensitivity. 85% and accuracy of 90% with minimal complications and in majority of cases, prevent a major surgery in patients which clinically surgery in indicated. Its minimal complications like pain and occasional entrance to trachea seem to be negligible.

Background and objectives: Early and late sepsis in newborns is common causes of early deaths or long-lasting disabilities in infants. They have varied etiologies and death rates.In this survey, the bacterial etiologic agents for neonatal sepsis cases and their antibiotic sensitivity patterns were determined.Materials and Methods: during 2003-2004, blood samples were collected and processed by culture from 198 newborns who were clinically diagnosed with early sepsis in Western Mazandaran area hospitals. Subsequent to bacterial isolation and identification, disk diffusion antibiotic susceptibility testings were performed according to the NCCLS guidelines.Results: The study population was 69.7% boys and 38% of them were born with normal vaginal delivery with the rest being C-section delivered babies. The patient risk factors included premature delivery, very low birth weight (<1.5 kg) and Hyaline membrane disease (HMD). The average age of the studied population was 10.53±1.48 days old and the mean length of therapy was 9 days. 63% of these neonates were infected by early sepsis and 37% were infected by late sepsis. The highest death rates (45%) were associated with the very low birth weights. Coagulase negative Staphylococci (34,5%) and Klebsiella pneumoniae (17.2%) comprised the most isolated bacteria. The Gram positive isolates showed the highest sensitivity and resistance rates to vancomycin (96%) and to cloxacillin (65.5%) respectively.The highest sensitivity and resistance rates for the Gram negative isolates were towards ciprofloxacin (95%) and cephaloth in (94%), respectively.Conclusion: The prevalence of early sepsis rates were higher in the boy infants and also in those delivered by C-section operation. The highest risk factor was pre-mature delivery. The high prevalence of antibiotic resistance rates in the isolated bacteria was the major cause of failed therapy and deaths. Adequate pregnancy care in order to reduce pre-mature labor, with considering hygienic principles in hospitals, late sepsis can be avoided and prompt antibiogram tests are measures necessary to reduce morbidity and mortality of early sepsis.

Background and objectives: Chronic Otitis Media (COM) is an inflammatory process in middle ear cleft, which correlate with irreversible pathology. Application of various surgical procedure dependent to intensity of disease.Tympanoplasty is the procedure of choice for patients with central tympanic membrane perforation without cholesteatima. The aim of this study was evaluation of tympanoplasty results, that recently otolarynoglogists apply frequently this procedure, but there are few reports about the results of this procedure.Materials and Methods: This was a randomized retrospective study of tymponoplesty results from 1998 to 2003 in Imam Khomeini Hospital. For this purpose, 300 cases were selected. 192 patient accepted to be examined. All patients underwent microsocpic otologic examination and oudiotympanometry and results collected.Results: In our study 13% perforation, 5.1% retraction, 0.5% tympanic membrane lateralization, 1.5%r tympanic membrane cholesteatome, 2% granulation, 1% tympanic membrane seleros of TM were detected. ABG after operation of patients had a 19.3 (0-10db). 30% were within (11-20 db), 43% (21-40 db) and 7.4% more than 40 db. 33.7% otalgia, 33.5% tinnitus, 24.7% headache, 20% disturbed taste and 6.8% discharges of ear after operation. 59.3% of all examined tympanic membranes were normal.Conclusion: There were no significant relation between the operation age and tymparoplasty sequels We detected a significant relation between pathology and operation sequels, our success rate in grafts were comparable to others quoted in literature.

Coagulopathy is a common finding in acute promyelocytic leukemia (APL) patients whereas bleeding is seen more frequent. Coronary arteri and lower extremity thrombosis and thromboembolism rarely reported during presentation. We report a 49 year old male whose disease presented as inferior myocardial infarction along with lower limb thromboembolism showed up adjunct to fibrinolytic therapy.

Small and great saphenous veins shown as the important and superficial veins of lower limbs which begin from dorsal venous network then continue upward. Great Saphenous vein is the longest vein of human body which initialy run from anterior side of medial maleoIus and then continues in medial side of leg and femoral regions. Finally it ends to femoral vein. In the same time small saphenous vein run from posterior side of lateral maleolus. Then it continues upward in posterior side of leg and arrive to popliteal vein between the two heads of gastrocnemius muscle. In this study we demonstrated that great and small saphenous veins have normal shape, size and relations, in the left side. But in the right side small saphenous vein did not end to poplited vein runs upward as a accessory saphenous vein and ends to great saphenous vein. Also right great saphenous vein observed as a normal vein as a shape and pathway. It seems it will be an important point for surgeons.

Anderson's disease or chylomicron retention disease is a rare genetic disorder associated with fat malabsorption and is characterized by severe diarrhea, steatorrhea, failure to thrive and, finally, ophthalmic and neurologic problems in infants.Gastrointestinal symptoms appear during the first months of life and if this disease is not diagnosed and treated early, ophthalmic and neurologic manifestations will appear due to lack of vitamins A and E during the second decade of life.In this paper a 4-month female is introduced. This infant has a history of gastrointestinal manifestations such as chronic diarrhea, fatty stool and failure to thrive which started at the age of 1.5-month and was admitted in Tabriz children's hospital due to fever and cough. After necessary preclinical evaluations pneumona was diagnosed and the patient was treated with antibiotics.In order to find the cause of FTT, some diagnostic evaluations were carried out during her hospitalization and, ultimately, after serological examinations, eye examination, upper GI-tract endoscopy and study of small intestinal biopsies, Anderson's disease or chylomicron retention disease was diagnosed and the patient received the necessary treatments.