MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2012 | Volume:34 | Issue:1|Papers Count:28

Background and Objectives: Dermatoscopy can be applied to diagnose pigmented skin lesions and to follow up of suspicious cases of melanoma or other non-melanocytic skin malignancies. The aim of the present study was to compare dermatoscopic and histopathologic results in basal cell carcinoma (BCC) and melanocytic nevus of face.Materials and Methods: In an analytical-descriptive study, 67 patients suspected with BCC or melanocytic nevi of face were randomly selected. The skin lesions were evaluated with dermatoscope and results were compared with pathological diagnosis of biopsied samples.Results: Based on the dermatoscopic study, asymmetry, blue-white structures, and atypical network were present in 14 (23%), 1 (1.6%) and none of the patients, respectively. Furthermore, 27 cases (46.6%) were diagnosed with melanocytic nevi, 28 (48.3%) with BCC and 3 (5.2%) were considered as mixed type. There was significant correlation between gender and dermatoscopic diagnosis (P=0.0001). Sensitivity and specificity of dermatoscopy in diagnosis of the BCC was 100% and 97%, respectively. These values were respectively 96.4% and 97% in diagnosis of the melanocytic nevi.Conclusion: Dermatoscopic study can be not only helpful in improving clinical diagnosis while guiding missed malignant lesions to pathologic evaluations, but also useful in evaluating further suspicious or recurrent cases.

Background and Objectives: Pelvic floor organ prolapse or relaxation may cause female sexual dysfunction. This study designed to evaluate effects of pelvic organ prolapse repair with preservation of vaginal epithelium on sexual function.Materials and Methods: In a prospective study, 30 female patients with pelvic organ prolapse, female sexual dysfunction with or without incontinence were recruited. The patients were initially assessed using ICIQ-UISF and PISQ-R questionnaires. Three months after modified colporrhaphy and mid urethral sling, PISQ-R was filled out again for all patients to evaluate the sexual function. Thereafter, the patients’ conditions before and after surgery were compared with statistical analysis.Results: After surgery, none of the patients had incontinence or mass sensation during intercourse. Moreover, they had no sexual dysfunction due to incontinence or pelvic organ prolapse. Although 63.4% of the patients had no pain or dyspareunia because of surgery, sexual desire significantly reduced (P=0.01) and sexual satisfaction did not change (P=0.13).Conclusion: Although modified method of colporraphy did not induce dyspareunia, it did not change sexual satisfaction rate. It seems that female sexual dysfunction is multifactorial and only colporrhaphy is not effective.

Background and Objectives: Although there are different indices to predict survival of cirrhotic patients such as Child-Pugh score and MELD Score, the anticipatory role of serum sodium concentration has been considered recently. The aim of this study was to evaluate the role of serum sodium level in prediction of the survival of cirrhotic patients.Materials and Methods: In a descriptive-analytical study, 106 patients with decompensated cirrhosis were recruited during 9 months. All the patients were followed up at three-month intervals for one year with emphasis on their survival status.Results: The mean serum sodium level in expired patients was 137.66±5.18 meq/L versus 141.64±4.22 meq/L in live cases (P<0.001). Furthermore, the majority of the expired cases had low levels of sodium; in a group of sodium level< 130 meq/L, 85.7% died at the follow up period. In addition, the serum sodium cut-off values of 132.5 and 125 meq/L respectively resulted in sensitivity of 83% and 100% in prediction of the survival.Conclusion: Serum sodium level can be used as an independent survival predictor in decompensated cirrhotic patients and it seems that combination of sodium with MELD score can be a better indicator.

Background and Objectives: Missing the diagnosis of thyroid dysfunction in type 1 diabetes mellitus (DM) may have many deleterious consequences. Screening of these patients for thyroid abnormalities at initial diagnosis of type I DM may identify only a small proportion of affected subjects. The aim of this study was to determine thyroid functional status, the prevalence of thyroid autoimmunity, their natural history and the results of long term follow up of a large cohort of population with type 1 DM.Materials and Methods: A total of 386 type 1 diabetic patients with no known thyroid dysfunction prior to diagnosis of diabetes were enrolled into the study and followed up from 1 to 17 years. (9.8±4 years) Clinical examination was performed and serum TSH and thyroperoxidase antibodies titer were measured at first presentation and repeated at regular intervals.Results: Among 386 studied patients with type 1 DM, aged 15.6±7.7 years, sixty three (16.3%) patients developed thyroid dysfunction during the follow up period; fifty three (13.8%) subjects with hypothyroidism, 9 patients (2.3%) with hyperthyroidism, and 2 patients with postpartum thyroiditis. In this longitudinal study, 115 (30%) patients had high titers of TPO antibodies in their sera. Using Caplan-Meier curve, 50% of subjects developed thyroid abnormalities during the first 10 years after diagnosis of type 1 DM.Conclusion: The results of this study showed that thyroid dysfunction was more prevalent in type 1 diabetic patients. A large proportion of individuals developed thyroid dysfunction during the long term follow up.

Background and Objectives: The aim of this study was to investigate the interaction between personality traits according to five factor model and depression, hopelessness and suicidal ideation among students.Materials and Methods: The population of this study was the students of Tabriz University of Medical Sciences & Health Services, of which 200 students were randomly selected by simple method. All students were asked to complete the Beck Depression Inventory (BDI-II), NEO-FFI-R, Beck Hopelessness Scale (BHS) and Beck Scale for Suicide Ideation (BSSI).Results: There was a significant positive relationship between neuroticism and depression, hopelessness and suicidal ideation. Moreover, there was a significant negative relationship between extroversion and conscientiousness with depression, hopelessness and suicidal ideation. Neuroticism could explanation 73% of depression, 61% of hopelessness and 59% of suicidal ideation.Conclusions: Neuroticism has positive relation with low mood, hopelessness and suicidal ideation, whereas extroversion and conscientiousness have negative significant relationship with these factors.

Medical ethics is an interdisciplinary science which proceeds to morality issues and subject matters in the field of medical sciences. Medical ethics is also considered in different branches of the medical sciences including professions, medical researches and health system policy making. Several fields of human knowledge and insight including philosophy, law, sociology, psychology, economics and history contribute to the content of this topic. The medical ethics has been widely issued in the Persian literature. The aim of the present study was to explore reflection of the medical ethics among the Persian physicians using the first class Persian texts. Accordingly, Persian texts were not only filled with the ethical advices, but also included ethical characteristics of the physicians. Furthermore, these texts reveal that physician’s morality aggregates in his temperament and mentality. Moreover, the patient-physician relationship as well as issues such as secrecy, honesty and uprightness has been widely discussed in the Persian texts.

Background and Objectives: Most of the middle ear surgeries are performed by using microscope and bloodless surgical field plays an important role in the vision of surgeon and consequently in the quality of surgery. There are different methods to reduce systemic blood pressure to overcome bleeding. Two of the best methods are total intravenous anesthesia (TIVA) with propofol plus remifentanil and inhalation anesthesia with isoflorane. This study aimed at comparing hemodynamic changes of these two methods of anesthesia in middle ear surgery.Materials and Methods: In this single-blinded clinical trial, 60 adults candidate for elective middle ear surgery were randomly divided into two groups: group 1 was anesthetized with isoflorane and group 2 was anesthetized with TIVA. Thereafter, the hemodynamic changes of two groups were compared during surgery with equal bispectral index system (BIS) range.Results: There were no statistically significant differences between two groups regarding the mean arterial pressure (MAP), BIS and SaO2 as well as degree of the surgeon’s satisfaction with bleeding severity in operating field. The mean heart rate after intubation and also during surgery in group 1 was significantly higher than group 2.Conclusion: During middle ear surgery with BIS ranged 45±5, the degree of decrease in MAP and also the degree of surgeon’s satisfaction would not be significantly different between inhalation anesthesia (with isoflorane) and TIVA (with propofol plus remifentanil). However, a decrease in heart rate in TIVA method is more than that in the inhalation method.

Background and Objectives: Complications after gastrostomy have an important effect on all dimensions of quality of life in patients with gastric cancer. The purpose of this study was to define the effect of educating self-care program on the quality of life in patients with gastric cancer after gastrostomy in Tabriz Hospitals.Materials and Methods: Fifty four patients with gastric cancer undergoing gastrectomy were studied in two groups: experimental and control. Data were collected using three questionnaires: demographic, quality of life in patients with cancer, and quality of life in patients with gastric cancer. Experimental group was educated about self-care program face to face for 30 minutes. The quality of life in patients with gastrostomy in both groups before surgery and one month after discharge was assessed.Results: Before and after educating self-care program, the overall quality of life based on QLQ-C30 questionnaire in experimental and control groups was not statistically significant, but in experimental group significant differences were observed in global quality of life (P=0.04), emotional function (P=0.004), and physical problems (P=0.03). The overall quality of life based on QLQ-STO22 questionnaire before and after the educating self-care program in control group was not significantly different, but in experimental group significant differences were observed (P=0.04). Also in this group, some dimensions such as dysphagia (P=0.01), stomachache (P=0.001) and emotional problem (P=0.04) the quality of life improved. The mean difference was not significant in overall QOL between two groups, before and after intervention. However, differences were significant in the emotional (P=0.006) and psychological dimension (P=0.007).Conclusion: Education of self-care program after gastrostomy was effective on improving overall QLQ based on QLQ-STO22 questionnaire in test group and also was effective in improving some dimensions of quality of life such as psychological, emotional and global QLQ and effective on reducing physical and eating problems.

Background and Objectives: Extended-spectrum b-lactamases (ESBLs) enzymes are one of the reasons for accruing drug resistance in E. coli isolates. The aim of this research was to investigate the antibacterial susceptibility patterns of isolates to b-lactam antibiotics and also to study the presence of blaTEM gene in E. coli isolates.Materials and Methods: During 5 months, 188 isolates of E. coli were collected from Imam Reza and Shahid Madani hospitals of Tabriz and clinical centers of Khoy and identified by differential tests. In order to determine resistant patterns of isolates to antibiotics, disk diffusion method was used. The production of ESBLs in isolates resistant to ceftazidime was determined by combined disk test (CDT). Polymerase chain reaction (PCR) was carried out for the detection of blaTEM.Results: Of 94 isolates collected from Tabriz, 29 (30.85%) and 38 isolates (40.42%) were respectively resistant to ceftazidime and cefotaxime, among which 38 (56.71%) cases were recognized as ESBL producer. Moreover, 7.89% of ESBL producer isolates contained blaTEM gene. In 94 isolates collected from Khoy, 24 (25.53%) resistant isolates to ceftazidime and 25 (26.5%) isolates resistant to cefotaxime were recovered. Among b-lactam resistant isolates of Khoy, 24 (52.12%) ESBL producer were obtained, of which 12.5% contained blaTEM gene.Conclusion: Detecting this type of resistance using molecular methods coupled with phonotypic methods and taking control of antibiotic is considered essential.

Background and Objectives: Brucellosis is the most common zoonotic infection worldwide. Despite the control of the disease in many developed countries, it remains endemic in Iran. The aim of this study was to describe the epidemiology of human brucellosis in East Azerbaijan province of Iran.Materials and Methods: All new diagnosed cases of brucellosis surveyed in surveillance system during 2001-2009 were analyzed.Results: Of 5732 surveyed patients with the mean age of 30.9±18 years, 3146 (54.8%) were male. The annual incidence rate of brucellosis per 100, 000 populations increased from 27 to 113 in 2001 and 2005, respectively. Thereafter, it decreased to 45 in 2009. Children under the age of 10 years constituted 9.8% of all the patients. Most of the cases were reported between May and July. Moreover, farmer men and housewives had the highest numbers of the disease. In addition, 86.4% of the patients reported consumption of unpasteurized milk and dairy products and 80% of patient reported contact of animal.Conclusion: Brucellosis is an important public health concern in East Azerbaijan province of Iran.

Background and Objectives: Fractures of the tibial shaft are the most common fractures. The preferred treatment of these fractures is closed reduction and interlocking IM Rod that is not available in all medical centers; hence the open methods are used. The objective of this study was to present a simple and easily available method for closed reduction of these fractures.Materials and Methods: In a prospective study, 30 patients with tibial shaft fractures underwent closed reduction and interlocking IMR fixation on a radiolucent table with a side post. The patients were followed up for union, range of motion, infection, alignment, and return to preinjury activities and ability to use the Iranian lavatory.Results: The mean age of the patients was 32.30±11.70 years. In a group of patients underwent surgery within first 48 hours, the mean duration of union was 62.7±13.5 minutes and for operations performed after 48 hours it was 68±15.62 minutes. In 3 patients there was limited knee flexion. There was neither neurovascular injury nor deep infection. The mean time for union was 5.93±1.45 weeks and return to normal daily activities was possible at 9.83±2.13 weeks. There was delayed union in 10%, shortening in 10% and malrotation in 16.7% of the patients. Our method was successful in 100%. Ultimately, 96.7% of the patients were satisfied by surgery and were able to do preinjury activates.Conclusion: The post at the side of table provides a very effective way for closed reduction of tibial shaft fractures.

Background and Objectives: Actinic keratoses (AKs) caused by chronic UV radiations have the potential to progress to squamous cell carcinoma (SCC). Cry therapy is the most frequently employed method focused on lesions; however it is not useful for treatment of early or subclinical AKs. Therefore, combination therapy with topical agents may be more efficient. The aim of this study was to compare efficacy of cry therapy and acnalen gel 0.1% (a topical retinoid) with cry therapy and placebo in the treatment of AKs.Materials and Methods: In a randomized, double-blind, placebo-controlled trial, 112 outpatients with clinical diagnosis of AKs on face or scalp with at least 5 lesions were enrolled. The patients were randomized into two groups: cry therapy and placebo or cry therapy and acnalen 0.1% gel for a period of 100 days. Lesion counts were assessed at baseline, 40, 70 and 100 days after cry therapy.Results: One hundred patients with the mean number of 7.54±3.66 lesions for treatment group and 7.20±3.60 lesions for placebo group at baseline completed the study. In acnalen group the mean number of lesions reduced to 3.44±2.71 (mean reduction: 54.79 ± 3.8%) at day 100, while in placebo group it reduced to 3.68±2.97 (mean reduction: 48.60±4.5%). This difference was not statistically significant (P=0.62). Adverse events were not significantly different between the groups.Conclusion: Cry therapy and acnalen 0.1% gel during 100 days cannot be more helpful than cry therapy alone in the treatment of clinical AKs.

Background and Objectives: Measurement of level and distribution of the health and also the related factors is necessary for policy making and planning in health system. World health organization (WHO) invented the summary measures of health and global burden of diseases framework for measurement of health level and health problems in all countries. This study was aimed at determining the burden of common diseases in East Azerbaijan province.Materials and Methods: In accordance with WHO multidisciplinary GBD (global burden of disease) framework, DALY (disability adjusted life years) was used for calculation of the burden of diseases. For calculation of Years of Life Lost (YLL), result of 2006 population census and death registries of 2007 were used. Years lost due to Disability (YLD) were obtained from data of national burden of diseases project in 2002.Results: In 2007, the DALY was 739266 years, of which 274530 years were due to premature deaths and 464736 years due to disabilities. In both genders, ischemic heart disease formed 9.16% of the DALY, car accidents 7.57%, cerebrovascular accident 4.39%, and depression 4.15%. Moreover, 5.78% of myocardial infarction deaths occurred under 40 years.Conclusion: Cardiovascular diseases, mental disorders and accidents formed most of the burdens of diseases in East Azerbaijan.

Background and Objectives: Endoscopic electro-coagulation method has been suggested for the treatment of vesicoureteral reflux (VUR) in recent years. The aim of the present study was to evaluate the efficacy and postoperative complications of endoscopic electro-coagulation method in patients with VUR.Materials and Methods: Thirty patients with VUR were operated via endoscopic electro-coagulation. At the first phase of study (3-6 months after surgery) patients were followed up to evaluate early complications and operation success. At the second phase, the operated patients were followed up to evaluate the late complications within three years after surgery.Results: The results showed that 69.8% of the patients were cured completely. Early complications consisted of irritative symptoms and hematuria which were relieved few days after surgery.Twenty patients were followed for 3 years and no late complication was seen and operational permanency was 100%.Conclusion: The endoscopic electro-coagulation method is less invasive and has similar outcome to other VUR endoscopic surgery methods.

Background and Objectives: Administration of intrathecal opioid is one of the postoperative analgesia management methods. Experimental data suggested that transdermal nitroglycerine can enhance analgesic effect of opioids. The study was done to assess the effect of transdermal nitroglycerine on analgesia of intrathecal sufentanil and lidocaine in patients undergoing orthopedic surgery.Materials and Methods: In this prospective, double blinded, clinical trial, 24 patients scheduled for plating of tibia or fibula were randomized into two groups. In all of the patients, spinal anesthesia was done with 100 mg lidocaine 5% and 5 mg sufentanil. Twenty five minutes after injection, in 12 patients (nitroglycerine group) transdermal nitroglycerine patch and in the other 12 patients (placebo group) placebo patch was applied on the chest wall. Duration of analgesia, pain occurrence, analgesic consumption and visual analogue scale (VAS) within 24 hours after the operation was assessed.Results: The mean duration of analgesia was longer in nitroglycerine group (15.71 ± 9.02 hrs) than the placebo group (5.08 ± 0.93 hrs) (P=0.001). Pain occurrence in 24 hours after operation was 50% in nitroglycerine group and 100% in placebo group (P=0.01). The mean analgesic consumption (P=0.01) and VAS (P=0.03) was lower in the nitroglycerine group in 24 hours after operation.Conclusion: Transdermal nitroglycerine prolongs the duration of postoperative analgesia following intrathecal sufentanil and lidocaine, and reduces pain score and rescue analgesic consumption.

Background and Objectives: Recent findings have shown that coronary arteries free from epicardial adipose tissue are protected against atherosclerosis progress. The adipose tissues with high atherogenic property have high exchange rate of fatty acids with the vicinity arteries wall. Moreover, composition of the lipids in diet has been found to determine the diversity and amount of fatty acids in the adipose tissue. Considering the different atherogenic properties of various fatty acids, the present study aimed at evaluating the effect of high cholesterol diet on epicardial adipose tissues fatty acids profile in rabbits.Materials and Methods: Sixteen New Zealand white rabbits were randomly divided into two equal groups. The control group received normal standard diet, whereas the study group was fed with the high cholesterol diet for two months. At the end of the study, the rabbits were anesthetized, 1-5 mg of the epicardial adipose tissue was removed and fatty acids composition of adipose tissues was determined by gas chromatography.Results: High cholesterol diet caused a significant increase in LDL and triglyceride and a marked decrease in HDL. After two months, in the epicardial adipose tissue, fatty acids 16: 0, 18: 1t and SFA showed a significant increase (P<0.05), whereas fatty acids 12: 0, 18: 1, 18: 2, 18: 3, MUFA, PUFA, w3 and w6 had a significant decrease (P<0.05).Conclusion: Consumption of high cholesterol diet for two months resulted in a significant increase in atherogenic fatty acids and a decrease in anti-atherogenic fatty acids in the epicardial adipose tissue.

Background and Objectives: Previous uncontrolled trials have suggested that topical terbinafine 1% cream could be useful in the treatment of seborrhoeic dermatitis. The aim of the present study was to evaluate the clinical efficacy of topical terbinafine 1% cream in patients with facial seborrhoeic dermatitis.Materials and Methods: Ninety outpatients with seborrheic dermatitis were randomized into three groups: topical terbinafine 1% cream (n=30), topical ketoconazole 2% cream (n=30), and placebo (n=30). The patients received one of these treatments twice daily for 4 weeks. Clinical evaluation of erythema, scaling and itching, each scored on a 0-3 scale was recorded at weeks 0, 4, and 12.Results: At baseline, the mean total clinical score was 5.04±2.02, 5.04±1.50 and 4.97±1.71 in the terbinafine, ketoconazole and placebo groups, respectively. At week 12, the mean total clinical score was 1.78±2.47, 1.81±2.43 and 3.73±1.74 in the terbinafine, ketoconazole and placebo groups, respectively. A significant decrease in the mean total clinical score was found in the terbinafine and ketoconazole groups compared with the placebo group (P=0.003), while response to terbinafine was not significantly different from that to the ketoconazole (P>0.05).Conclusion: Terbinafine 1% cream had a comparable efficacy and safety profile to that of ketoconazole 2% cream in the treatment of facial seborrheic dermatitis.

HTLV-1 (human T-cell lymph tropic virus) is the cause of two recognized human diseases; Adult T cell Leukemia/Lymphoma (ATLL) and HTLV-1 associated myelopathy (HAM) syndromes. Here, we report a patient who presented with confluent-violaceous maculopapular skin lesions, arthralgia and positive serology for rheumatoid factors. Later, the patient presented with thrombocytopenia anemia, walking disability and renal involvement. Future workup discovered the diagnosis of ATLL lymphomatous involvement and HTLV-1 positivity.

Subcutaneous fat necrosis of the newborn is an uncommon, benign process in full-term and post-term neonates who experienced a perinatal distress. It is a transient condition however, hypercalcemia may be a potentially life threatening complication of this otherwise self-healing process. Here, we describe a 15-day newborn boy presented with a history of firm subcutaneous nodules and overlying erythema which were located on the back and the arm. In the biopsy of the lesion, subcutaneous fat necrosis was diagnosed.

Emphysematous pyelonephritis is a gaseous necrotizing renal infection with high mortality and morbidity. In most of the cases, patients have the history of diabetes mellitus. The disease usually presents with pyelonephritis unresponsive to treatment and is diagnosed with CT scan. Treatment usually requires surgery and antibiotics. In rare cases, patients have unusual presentation of the disease. Here, we report two patients with inguinal hernia symptoms and emphysematous pyelonephritis.