Medical Journal of Tabriz University of Medical Sciences
Year:2008 | Volume:29 | Issue:4|Papers Count:22

Background and Objectives: Carpal tunnel syndrome is the most common entrapment neuropathy, which after clinical examination is the best method for it’s diagnosis. The aim of this study is the comparison of the validity of some median sensory nerve conduction velocity measurement (MSNCV) techniques in diagnosis of carpal tunnel syndrome (CTS).Materials and Methods: Eighty five referred hands to electrodiagnostic laboratory with suspected CTS were recruited for this study. Subjects with no symptom or signs of median neuropathy were recruited as control group. Patients or control groups with positive history of cervical radiculopathy, peripheral neuropathy, or other disorders affecting neuromuscular function were excluded. In both CTS and control groups, electrodiagnostic studies including one-segment and two-segment techniques, for measurement MSNCV in wrist segment, were performed. In one segment study, transcarpal palm-to-wrist median mixed NCV was measured.In two segment studies antidromic transcarpal wrist-to-palm MSNCV (W-PMSNCV) and distoproximal ratio (D/P) were calculated.Results: ROC curves were constructed for one segment and two segment studies, from the patients and controls data.The W-P MSNCV £ 50.45 m/s, corresponding to an optimal cutoff point on ROC curves discriminated CTS from controls with sensitivity of 97.6% and specificity of 96.5%.D/P ratio at optimal cutoff point of ³1, discriminated CTS from controls with sensitivity of 97.6% and specificity of 83.5% the likelihood ratio (assessing the discrimination power of a test ) were 27.86, 14.08, 5.92 in W-P MSNCV, D/P ratio and mixed NCV, respectively.Conclusion: W-P MSNCV is more sensitive than D/P ratio and mixed NCV in diagnosis of carpal tunnel syndrome.

Background and Objectives: Cystic fibrosis is the most common fatal genetic disorder among newborns. The inheritance pattern of this disease is autosomal recessive, with an incidence of 1 in 2500 newborns and carrier frequency of 1 in 25. This disease is due to mutations in CFTR gene. Most of the common mutations so far reported from this gene are located on exon 10, including the known mutation, DeltaF508 mutation. In this study we studied the exon 10 of this gene in CF patients referred from East Azerbaijan region by applying PCRSSCP method.Materials and Methods: Cystic fibrosis patients diagnosed by specialists were referred to the genetic center of Tabriz for molecular analysis. DNA was extracted from the whole peripheral blood and was analyzed for the mutations of exon 10 of CFTR gene by applying PCR-SSCP technique.Results: In this study, 95 unrelated families were referred and on the basis of clinical and para- clinical manifestations, 46 families were selected for the study of exon 10 of CFTR gene.Twelve different patterns of SSCP were observed among 30 affected families (65%). Between them 12 patients showed homozygous and 17 showed heterozygous pattern for SSCP of exon 10. In one of the families, the affected child was deceased and its parents showed heterozygote pattern.Conclusion: By applying this technique (PCR-SSCP) in our region, we could detect cystic fibrosis patients. This data can be used in population screening and in complement with sequencing in prenatal diagnosis of affected families.

Background and Objectives: Because of disadvantages of routine cancer therapies such as chemotherapy and radiotherapy, different microbial metabolites such as enterotoxins, bacterial proteins, recombinant toxins, and combination therapies have been used recently in treatment of cancers. Antitumor effects of verotoxin1 have been known from several years ago, that produced from some kinds of Escherichia coli. Our purpose was to study the synergistic cytotoxicity of verotoxin1 and monophosphoryl lipid A (MPL, a nontoxic derivative of bacterial lipopolysaccharide with adjuvant and tumor necrosing properties) on induced fibrosarcoma of Balb/c.Methods and Methods: For animal experiments lethal dose 50 percent (LD50) calculated with Reed & Munch method by ten fold dilutions of verotoxin1 in different groups (5 mice in each group). Then intradermal tumors (mean diameter of 0.7-1 centimeter) induced with WEHI- 164 (3*106 cells in each mice) cells on back of animals, and divided in four groups. Group 4 used as control (heat inactivated verotoxin1, and groups 1, 2 and 3 injected with verotoxin1 (25 ng), MPL (50 mg), and combonations of MPL (25mg) and verotoxin1 (25ng) respectively. After treatment, eradication or decrease in volume of tumors monitored daily and compared in 4 groups with ANOVA.Results: verotoxin1 like standard vero cell line indicated cytotoxicity on WEHI-164 line in in vitro experiments. Simultaneouse treatment of tumors with verotoxin1 & MPL eradicated malignant fibrosarcoms of balb/c. 100 ng of verotoxin1 calculated as LD50 in Balb/c. Tumors injected with MPL indicated a little increase (not significant P>0/05) in volume in comparison with controls. Although animals of control group died after severe weight loss.Conclusion: Our results indicated that verotoxin1 have synergistic effects with MPL in eradication of malignant fibrosarcomas of Balb/c. After further studies, it can be used for treatment of different tumors. Application of tow microbial metabolite as a treatment of tumors proposed and studied in this study.

Background and Objectives: Babies weighing less than 1500 gm (VLBW) are of major concern because of maximum prenatal morbidity and mortality. Objective Of this study was to evaluate the antenatal profile of the mothers and neonatal surveillance.Materials and Methods: This was a Descriptive cross sectional study of data collected from hospital records of 305 preterm infants with birth weight of less than 1500 gram (VLBW) in NICU of Alzahra Hospital Mar 2005-2006. The maternal demographic profiles, risk factors of preterm labor and outcome of infants were examined.Results: From 913 neonates, who were admitted, there were 305 (33.4%) preterm infants, who were VLBW, mean gestational age was 29.79±2.83 and mean birth weight was 1202.66±241.52 gram. Amongst the various risk factors for preterm labor, Preeclampsia was the most common (24.6%). In 128 preterm infants (42.1%) RDS was occurred. The survival rate in VLBW group was 68.2% and mortality in our series was 29.5%.there was 7 infants who referred to Pediatric Hospital for surgical interventions.Conclusion: approximately one third of neonatal admitions at 2005-2006 were VLBW infants and Preeclampsia was the most common (24.6%) risk factor of preterm labor. Better neonatal survival rate and lesser complications will possible due to better prenatal care and control of Preeclampsia.

Bacground and objectives: Tracheostomy is a surgical procedure in which an opening is made in the anterior wall of the trachea to establish an air way. Tracheostomy is the best choice of airway control if we need a prolonged airway. Tracheostomy complications consist of: 1- early (at the first hours): hemorrhage, pneumothorax, surgical trauma to esophagus and recurrent laryngeal nerve. 2- early (in the first week): tracheal erosion, tube displacement, tube obstruction, subcutaneous emphysema, lung abscess and aspiration 3- late: tracheo cutaneous fistula, tracheal stenosis, tracheoesphageal fistula, tracheomalacia, delayed hemorrhage.Materials and Methods: This study is a cross- sectional study in which 210 patients with tracheostomy were assessed in Tabriz Imam Khomeini's hospital in 5 years (2000-2005). Data were collected from the patient's files. Data were analyzed statistically with SPSS program.Results: From 210 patients, 114 cases (54.3%) were complicated. The mean age of patients was 53±19.6 year. 78.6% of patiernts were male. The majority of complications were early and assessed in the first week. The most common complication was hemorrhage (25.7%), followed by aspiration (10%), hypercapnia (10%), tracheoesophageal fistula (8.6%) and tracheitis (7.1%). The effective agent on complications rate was the cause of trachrostomy. Prolonged intubation that was the most cause of tracheotomy, had incremental effect on early complication in the first week such as subcutaneous emphysema and aspiration.Conclusion: The most common complication of tracheostomy was hemorrhage. Thus, more attention to control and prevention from it is important. Because of association between tracheostomi'es causes and it's complication, attention to causes is important and more attention and prevention for contral of it's complication must be done.

Background and Objective: The outcomes of patients with traumatic thoracolumbar spine fractures have evolved dramatically over the past 20 years due to development of surgical instruments and techniques. The goal of treatment is attainment of spinal stability with protection or improvement of the patient's neurologic status, allowing rapid and maximal functional recovery. Transpedicular screw-rod method is one of the recent surgical methods.This study aimed at evaluating the results of this approach in patients with thoracolumbar spine fractures.Materials and Methods: In a descriptive –prospective study, 52 patients with traumatic fracture of thoracolumbar spine hospitalized in Tabriz Imam Khomeini and Shohada hospitals were evaluated during a 22 months period. All patients were operated with transpedicular screw-rod system and were followed up for 6-18months. The post-operative improvement of neurological deficit, anatomical alignment, the rate of fusion and surgical complications were determined.Results: Fifty two patients (40 males, 12 females) with the mean age of 39.20 years were enrolled in the study. Neurological deficits were seen in 59.6% of the patients on admission.The improvement of neurological deficits, anatomical alignment and fusion occurred in 51.6%, 80.77%and 92.3% of the patients after operation, respectively. Kyphosis was seen in 15.4%of the patients during the follow-up period. The complications of the surgery were wound infection (5.8%), thromboembolic events (1.9%) and pneumonia (1.9%). The overall rates of complications were 9.6%. Considering the technical failure, broken screw was seen in 1.9%.Conclusions: The transpedicular screw-rod procedure has not been introduced in our centers for a long period. So the results are promising and acceptable and the procedure is proposed as the preferred method in this kind of patients. The forthcoming studies are recommended for finding and elimination of the probable causes result in the kyphosis.

Background and Objectives: Patency of ductus arteriosus one week after birth in a full term newborn is abnormal and must be occluded with surgical or nonsurgical methods. The main aim of this study is to survey of nonsurgical occlusion of patent ductus arteriosus (PDA) with coil, and also to assess complications of this method.Materials and Methods: Medical files of 21 patients in whom PDA were closed with coil in Tabriz Shahid Madani Hospital during 2006 were studied. The statistical analysis was performed with SPSS.Results: In 13 patients (61.9%) PDA was closed in cath lab. After 24 hours PDA was closed in 16 (76%) patients. In two cases this method was unsuccessful. In 6 months follow up PDA closure was happened in 18 patients (85.7%) and just one patient had residual shunt who is waiting for second coil. In two cases that coil embolization happened, coils were removed with catheter and snare in cath lab without any complications.Conclusion: Success rate of PDA closure with coil in our center was comparable with other centers and because we didn't have any complications and most of patients were discharged from hospital after 24 hours so non surgical method instead of surgical can be substituted for PDA in most patients.

Background and objective: In recent years, increasing homocysteine (Hcy) levels have also been considered in neurological disorders that are not vascular in origin. Parkinson's Disease (PD) is one of them. It is not well clarified that the increment of serum Hcy in PD is a primary entity or is secondary to administration of drugs like L-dopa. The aim of this study was to assess the serum Hcy level in patients with PD.Materials and Methods: In a case-control study, 47 patients with clinically diagnosed PD (the case group) were compared with 47 age and sex-matched healthy people (the control group). Serum Hcy levels were measured by ELISA method and compared between the two groups. Then the serum Hcy levels were evaluated within subgroups with different severity.Results: Mean age of PD patients was 67.1±9.0 and control group was 66.7±9.3 years. Both of case and control groups included 31 males and 16 females. The mean serum Hcy level was significantly higher in the case group (20.7±10.6 mmol/L vs. 17.0±5.9 mmol/L; p=0.04). There was no significant correlation between the mean serum Hcy level and severity in subgroups of patients with PD (p=0.91). There was not also significant differences between the mean serum Hcy level with neither different drug consumers nor different symptoms of the disease (p>0.05).Conclusion: This study revealed that the mean serum Hcy level of patients with PD patients is higher than people without PD, but there was no significant difference in serum Hcy level between groups with different severity of PD disease.

Bacground and Objectives: Start codon is the first codon that can be translated to amino acid after transcription of mRNA from DNA. In all prokaryotes and eukaryotes the genetic code for start codon is ATG that will translate to methionine at the beginning of peptide chain via tRNA, rRNA and other parts of protein synthesis machine but a rare exception was recognized in this universal rule. This kind of exception on universal rule of start codon in eukaryotic genes is important and notable.Materials and Methods: After isolation, cloning and sequencing of phospholipase B2 gene from pathogenic mold Aspergillus fumigatus (afplb2), usual ATG start codon was not seen at predicted region of obtained sequence and instead of this codon, GTG codon was present at predicted position.Results: Control of every possible factor for prevention from any mistake for sequences of afplb2 gene were not leads to any mistake and also triple reading of both strand of afplb2 gene were not shown any misreading on the length of cloned gene. Search in the web and submitted genes sequences at different Gene Banks was shown two similar exception on the sequences of start codon and replacement of GTG to ATG on glyceraldehde-3-phosphate dehydrogenaseencoding (gpdA) gene from Phytophotora infestans and gene encoding alpha-aminoadipylcysteinyl- valine synthetase (pcbAB) from Cephalosporium acremonium.Conclusion: It seems that a point mutation has been replaced a purine (G) “guanine” with another purine (A) “adenine” and due to point mutation valine amino acid has been replaced with methionine at the beginning of peptide chain.

Background and Objectives: Ureteral stones are important conditions which are observed primarily or secondarily after ESWL or PNL. They cause obstruction of urinary tract and Intervention for stone release also has some complication. The aim of this study was to evaluate the efficacy of the addition of Tamsulosin to traditional expulsive therapy for the treatment of distal-ureteral stones and release of obstruction.Material and Methods: Between march 2005 until march 2006 a series of 36 patients randomly were included in one clinical trial study for the management of symptomatic distalureteral calculi .they randomly divided into group 1 (N=18) who received indomethacin and hydrochlorotyazid and group 2 (N=18) who received the same therapy plus Tamsulosin (0.4 mg/daily). There were no differences between the groups with respect to age, sex, or stone size.The primary endpoint was the expulsion rate. Need for analgesics and hospitalization, were the secondary endpoints.Results: Group 1 (control): 13male, 5female .Group2:14 male, 4female. The expulsion rate was significantly higher in group 2 than in group 1, (87.5% versus50%) (P<0.05) and Lower analgesics use was found in group 2, as well as significantly fewer hospitalization for recurrent renal colic (11.1%versus 82.4%). Both groups experienced few side effects associated with expulsive therapy.Conclusion: In conservative management of uncomplicated distal-ureteral stones, Tamsulosin can increase stone expulsion rate and decrease need to analgesics and hospitalization.

Background and objective: Sepsis is an important cause of neonatal mortality especially in premature and low birth weight infants and may be a primary pathology or a complication of other disorders. Complications in near term infants are similar to term newborns, but premature infants with gestational age of 35 wks or less have significant mortality. This study conducted in premature infants to determine bacterial causes and antibiotic sensitivity of neonatal sepsis.Materials and Methods: In a descriptive cross sectional study, bacterial causes of confirmed sepsis in newborns with gestational age of less than 35 wks, who were born in university hospital of Ghaem in Mashad was studied and antibiotic resistance of pathogens was determined.Results: 32 cases of 175 premature infants had confirmed sepsis with positive blood culture. 12 of them had early onset sepsis in first 72 h of life and 20 cases had late onset sepsis. The most common microorganisms were Klebsiella (43.7%) and coagulate negative staphylococci (40.6%). Antibiotic resistance of Klebsiella sepsis to amikacin, gentamaycin, ampicillin and cotrimoxasol were 30%; 77%; 88%; and 18% respectively.Conclusion: In neonatal sepsis antibiotic treatment should be selected with respect to the most prevalent pathogens. Antibiotic coverage of Staphylococci and gram negative bacilli is necessary based on our study.

Background and Objectives: Different factors are involved in inducing and progressing of atherosclerosis. One of these factors is endothelin-1. Since in atherosclerotic vessels obvious and certain changes with abnormality in transferring of calcium ions are seen, some researchers suggested that calcium channel blockers can slow down the process of atherosclerosis.Materials and Methods: Thirty six male Newsland white rabbits were divided into four groups: The normal control group, normal group receiving amlodipine, high-cholesterol diet group and high-cholesterol diet with amlodipine group. After 8 weeks all animals anesthetized and blood and tissues samples were colleted.Results: The levels of cholesterol and triglyceride in groups of high-cholesterol diet and high-cholesterol diet plus amlodipine in comparison to control group increased significantly (p=0.000). In plasma endothelin-1 level results indicate that difference among groups of amlodipine, high-cholesterol diet and high-cholesterol diet plus amlodipine with control group is significant (p=0.000). The tissue levels of endothelin in aorta artery difference among groups of high-cholesterol diet and high-cholesterol diet plus amlodipine with control is significant (p=0.000) but difference between amlodipine and control groups is not significant and difference between high-cholesterol diet and high-cholesterol diet plus amlodipine groups is significant (p=0.000).Conclusion: High-cholesterol cause increase of plasma and tissue endothelin and amlodipine decrease levels of cholesterol and triglyceride and also in high lipid situation has effect on endothlin level and decrease of it in plasma and tissue.

Background and Objectives: Tympanoplasty and Mastoidectomy are surgical procedures performed in the Cases of middle ear infections. Tympanoplasty is an operation for eradicating middle ear infection as well reconstruction of hearing mechanism. When according to preoperative examinations, audiometry findings and intraoperative findings, there is any doubt on eradicating the pathology from middle ear; the surgeon (otologist) decides whether to perform a mastoidectomy in addition to tympanoplasty. Mastoidectomy has been proven to be beneficial in eradicating the pathology in the presence of cholesteatoma and granulation tissue and recalcitrant chronic active infection, however in the cases of simple perforation of tympanic membrane without cholesteatoma or active infection, performing a mastoidectomy in addition to tympanoplasty is contraversy. Theorically mastoidectomy improves middle ear aeration and success rate of tympanoplasty.Methods and Materials: In the present study 60 cases with middle ear infection and simple perforation of tympanic membrane randomly divided in to two subgroups of 30 cases. One group underwent a tympanoplasty procedure and the other one, tympanoplasty with mastoidectomy procedure. The Success rate of the operation in two subgroups concerning the tympanic membrane graft condition and hearing improvement was comparisoned after two months.Results: In the tympanoplasty group 3 cases and in the tympanoplasty- mastoidectomy group 2 cases of post operative perforation of membrane were found. Graft succes rate in the former group was %90 and in the latter was 93.3%. Statistically the difference between two groups concerning hearing improvement and graft Success rate is not significant.Conclusion: Mastoidectomy with tympanoplasty is not necessary in simple perforation of tympanic membrane for better graft taking and better audiometry results.

Background and Objectives: Intertrochanteric fracture of femur is one of the common injuries in the geriatric population. Despite improvements in management of these patients, mortality rate is more than the expected rate and the patient recovery and regaining the previous level of function fall short of expectation. In this prospective study, we tried to evaluate the mortality rate, locomotion of patients with intertrochanteric fracture and the relationship between the mortality rate and treatment outcome with various factors.Materials and Methods: During a period of five years between September 1999 and August 2004, 964 patients with intertrochanteric fracture who met our inclusion criteria, underwent surgical treatment and internal fixation. One hundred and twenty four patients were lost of follow up and finally 840 were evaluated.Results: Among 840 patients with the mean age 69 years (range 50 to 104), 152 died within six months after surgery (18.1%). Among 688 patients who were alive at the end of six-month period, only 420 patients (61%) could regain the prefracture ability to walk. Concerning independent variables there were a significant relationship between age, smoking, ASA score, blood transfusion during surgery and duration of hospitalization with the mortality rate of the patients during six-month period after surgery. On the other hand the age of the patient, sex, prefracture ability to walk, time interval between fracture and admission to hospital and transfusion during surgery were significantly associated with the walking ability of the patients after a six-month period of follow up.Conclusion: Despite improvements in management of intertrochanteric fractures, mortality rate of these patients is higher than normal population and most of them do not regain the prefracture walking ability. Different factors can affect mortality and outcome of these patients which should be addressed as appropriate.

Background and Objectives: It has been reported that reactive oxygen species (ROS) may influence the morphology and motility of spermatozoa and its passage to oocyte. Enzymatic and non- enzymatic compounds act as cell defence barrier against oxidation, especially lipid peroxidation. In this study the rate of lipid oxidation and the levels of non- enzymatic antioxidant compounds were measured in semen fluid and spermatozoa and their diagnostic values were evaluated.Materials and methods: In this single- blind study from the partners referred to infertility centere of alzahra hospital, Tabriz, IRAN, forthy normozoospermic fertile males and sixthy asthenozoospermic infertile males were selected. The levels of malondialdehyde (MDA) in the semen fluid and spermatozoa were measured by thiobarbituric reaction (yagi) and dosage of vit. C by 2, 4- Dinitrophenyl Hydrazine method. The concentrations of vit. E in the samples was determined using HPLC by B. L. Lee method. Lysate of spermatozoa was prepared by continuous freezing and thawing procedure. The motility and morphology of the spermatozoa were evaluated on the basis of WHO suggestion.Results: The levels of MDA in semen fluid and spermatozoa in the asthenozoospermic infertile males were higher than those in normozoospermic fertile males (P<0.001). The concentration of vit. C in plasma semen of fertile males was higher than that of infertile males (P<0.001) but comparing with fertile males its concentration in the spermatozoa of infertile males was higher (P<0.001).Specificity, sensitivity and positive, negative predictive values of semen plasma MDA (95% , 86% , 91% and 93% respectively) and spermatozoa MDA ( 90%, 83%, 90% and 87% respectively) were more than those of antioxidant vitamins and diagnostic value of spermatozoa vit. C was higher than those of semen plasma vit. C and vit. E.Conclusion: Simultaneous measurement of the levels of MDA in Semen plasma and spermatozoa and vit. C in spermatozoa may be helpful in the diagnosis of asthenozoospermic infertile males.

Background and Objectives: Benign prostatic hyperplasia (B.P.H) and inguinal hernia are both age dependent processes and the incidence of them increases steadily with aging in adult male and many older men have B.P.H and inguinal hernia simultaneously. Open prostatectomy and inguinal herniorrhaphy by two separate incisions consume a lot of time that is a risk factor for old patients. We suggest a technique in which complications and time need for simultaneous treatment of B.P.H and inguinal hernia is low.Materials and Methods: A prospective study carried out in 83 patients with symptoms of B.P.H and inguinal hernia carried out in Amiralmomenin and Emam Hospitals (group 1), during seven years (September 1998-2005). Routine blood tests and ultrasonography of urinary tract demanded for all of patients. By midline incision, preperitoneal space was exposed, hernial sac separated and then hernial defect closed by two or three number zero prolan sutures before prostatectomy. Age, laterality of inguinal hernia, operating time, post operative complications and the rate of recurrence for inguinal hernia in all group recorded. Result of group 1 compared with another 54 patients (group 2, just only isolated hernia).Results: Over a 7 year period, , from 83 patients only 80 patients followed up for 1-2 year (mean 16.2 months) and 95 inguinal hernia were repaired in group one. The mean age of patients was 73.7 years and mean operating time for herniorrhaphy part was 11.2 minutes, sixty five patients have unitateral and 15 have bilateral hernia. Eighty hernias were indirect and 15 were direct.Seventy five primary and 20 were recurrent hernias. Wound hematoma and wound infection were not seen. The recurrence rate for inguinal hernia was 4.2% (4 hernias). However, in patients with inguinal herniorrhaphy as a separate approach (group two), mean age of patients was 46.8 years and mean operating time was 35 minutes. There was only one case of wound hematoma (1.5%) and also chronic inguinal pain (1.5%). Recurrence rate for inguinal hernia was 3% (two cases).Conclusion: Simultaneous preperitoneal herniorrhaphy and open prostatectomy consumes less time in comparison with prostatectomy and inguinal herniorrhaphy as separate operations and it is a reliable and safe alternative for patients with both prostate enlargement and groin hernia. The operation method is simple and effective, especially for older men with bilateral inguinal hernia or recurrent inguinal hernia.

Background and objective: Alzheimer disease is a progressive disorder and the most common cause of dementia. One of the probable mechanisms of Alzheimer disease is the vascular injury. Hyperhomocysteinemia is considered as a risk factor of the vascular diseases because it is detected in 25% of the patient with the vascular disorders. The aim of this study is to investigate relationship between homocysteine level of serum and Alzheimer disease and its relationship with the severity of disease.Materials and Methods: This investigation was performed as a case- control study on 40 Alzheimer patients and 40 non- Alzheimer ones. Alzheimer patients were selected based on the diagnostic criteria of the American psychological association. The severity of illness was determined based on Reisberg scale and the patients were divided into three groups. Mental status of the patients was evaluated by Mini Mental State Examination (MMSE) too. Serum samples of the patients and the control groups were taken and freezed and after collecting of the samples, the serum levels of homocysteine were measured by ELISA method.Results: The average serum homocysteine level in the patient group was 23.01±14.40 mmol/L and in the control group it was 15.40±6.23 mmol/L (P=0.003). The average serum homocysteine level in the first group of the patients was 21.7±12.7 mmol/L, in the second group 22.3±13.8 mmol/L and in the third group 24.9±17.2 mmol/L that demonstrates the serum homocysteine level is related with severity of the illness but this relationship was not statistically significant (p=0.8). The relationship between MMSE score and serum homocysteine level of patients was not significant too (P=0.4).Conclusion: The average serum homocysteine level in Alzheimer patients was higher than control group which is concordant with the most of studies conducted in this field but did not show a significant relationship with the severity of illness.

Background and objectives: One of the main steps of root canal therapy has been revealed as root canal irrigation. An important requirement for an endodontic irrigant is antimicrobial activity. The purpose of this study was to determine the minimal antimicrobial concentrations of citric acid and doxycycline in combination with Tween 80 - a detergent - against Enteroccocus faecalis to gain a suitable irrigant with antibacterial properties.Materials and Methods: In this experiment, at first antibacterial activity of citric acid solutions of different concentrations (10%,15%,20% ... 50%) with using of Enteroccocus faecalis suspension in contact with citric acid was evaluated .Then for testing antibacterial activity of doxycycline against Enteroccocus faecalis, an antibiogram disk was used. At last antibacterial activity of different concentrations of doxycycline and citric acid and Tween 80 were determined by measuring the zones of inhibitions (mm) and was compared with routine intra canal irrigants like EDTA and sodium hypochlorite. The test groups were 12 as: 1, 2, 3, 7, 8 and 9 contained citric acid 5% , Tween 80 and doxycycline 1.5, 2.5, 5, 15, 25 and 50mg/ml respectively .Group 4, 5, and 6 contained citric acid 10% , Tween 80 and doxycycline 1.5, 2.5 and 5mg/ml respectively .Group 10, 11 and 12 were sodium hypochlorite 5.25%, EDTA 17% and citric acid 5%.Results: Comparison between groups (1, 4), (2, 5), (3, 6), (7, 8) and (7, 9) showed that differences were not significant statistically (Mann Withney U).The difference between groups 1, 2, 3, 7, 8 and 9 was significant.(Kruskal Wallis P=0.000 ) Our study indicated that increasing citric acid concentration has not any effect on its antibacterial activity. Measurement of zones of inhibitions showed that increasing doxycycline concentration more than saturated point (15mg/ml) in 5% citric acid dose not increases antibacterial activity of the solutions.Conclusion: Based on this study it seems that a solution with combination of 15mg/ml doxycycline, 5%citric acid and Tween 80 has maximum antibacterial effect on Enteroccocus faecalis. Using tooth models is suggested to get more findings.

One of the most important problems and difficulties of the educational systems is the subject of drop-out through which it leaves unpleasant effects. In this survey, 692 students were equally chosen in proportion to the number of the students of the faculties and they were matched considering age, sex, course of study and then they were compared based on the Statistical methods for comparing differences of means between two groups. Our findings showed that the rate of drop-out among Dentistry students was the highest and among the paramedical students it was the lowest in the whole (P<0.0007), the rate of the students̉ attitude toward the instructors was average. Study skills among the students who experienced drop-out, were less (P<0.04) Regarding the study skills and drop-out, and rate of studying among those who had drop-out, was 2.14 hours a day and among those who didn’t have drop-out, it was 2.8 hours a day, The rate of drop-out among students based on sex, marital status and self-concept was not meaningful The findings indicated that there is a meaningful relationship between depression and drop-out.Holding educational workshops to communicate effectively providing learning study skills introducing them to consulting centers, treating their depression, eliminating the stressful factors findings can be useful.

Muscular Dystrophies are a group of diseases presenting with muscular weakness.Within this group, “Duchene” is a well-known one. “Syrngomyelia” is another state in this group in which «cystic» dilatation in spinal cord is associated with reduced temperature and pain, whereas vibration and deep sensation are intact. In the latter disease muscles’ tones and their reflexes are abnormal. A variety of etiologic factors have been listed for above-mentioned diseases (trauma, meningitis, spinal tumor, hindbrain herniation and idiopathy). This article presents a 12 year old boy with the chief complaint of progressive weakness in lower and upper limbs. By doing physical examination, electrodiagnostic and laboratory tests as well as genetic consultation, he was diagnosed as a patient with “Duchene” myopathy. During further evaluation including imaging studies “Idiopathic Syrngomglia” was labeled for him. It is worthwhile to mention that combination of symptoms of “Douche myopathy” and “syrngomylia” is rare.