MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2012 | Volume:34 | Issue:2|Papers Count:26

Background and Objectives: Enhanced external counterpulsation (EECP) was first introduced in the 1960s as a noninvasive procedure for the treatment of angina, refractory to medical therapy. Since its inception, technological advances have facilitated the procedure and rekindled interest in EECP as a mean to treat symptomatic Coronary artery disease and Acute hear failure. Here we studied the Effect of Enhanced External Counter pulsation on a group of patient with chronic heart failure.Materials and Methods: 30 consecutive patients (21 male, 9 female) were treated with EECP. Therapeutic effects of EECP on the quality of Life, echocardiographic parameters and 6 min. Walk test were assessed before and after the intervention.Results: A nonsignificant difference was found in scores of quality of Life between pre and post EECP treatment (p=0.1). Echocardiographic finding revealed significant improvement of (LVEDD), left ventricular ejection fraction (LVEF) by Simpson method (P=0.002) but the changes was not significant with MPI method (P=0.30). (LVESD) left ventricular end diastolic diameter (LVEDD) and left ventricular end systolic diameter (LVESD) were also significantly reduced after EECP intervention (p=0.032, p=0.015). Exercise duration in 6 min. walk test was significantly increased after treatment (p=0.0001).Conclusion: This study demonstrated that EECP improves exercise tolerance. But does not significantly improve the LVEF and quality of Life in patient with chronic heart failure.

Background and Objectives: Melasma is a brown hyperpigmentation that involves face and neck of women. The aim of this study was to investigate the Iron deficiency anemia, folate and Vitamin B12 deficiency among these patients.Materials and Methods: In a cross-sectional descriptive study 70 females who were diagnosed with melasma were included and Hemoglobin, Hematocrit, Serum Iron and Ferritin Levels, Folate and VitB12 were measured in all of them.Results: Mean age of patients was 33.42±7.35. Family history of melasma was positive in 30% of them. Abnormal Uterine Bleeding (AUB) was reported in 40%. The recruits had mean hemoglobin level of 11.2±1.63 g/dl. (14.3%) had low serum iron levels 8.6% of patients abnormal ferritin levels. Low levels of serum folate and serum Vitamin B12 were observed in 3 patients and 1 patient succedingly.Conclusion: This preliminary study showed that prevalence of Iron deficiency and float and vitamin B12 deficiency among a group of patient with melasma but larger studies with control group are needed.

Background and Objectives: Hypercalciuria is an important phenomenon with known complications such as, colicy abdominal pain and stone formation, in this study we tried to find the effect of immobilization on calcium excretion in a group of immobilized hospitalized children.Materials and Methods: Urine calcium and calcium creatinine relation were measured in the first day and 7 days after hospitalization in 37 child (older than 2 years) who were bedridden and immobilized because of their primary disease. The same parameters were measured in 40 matched healthy children as control group.Results: The incidence of hypercalciuria were significantly higher in case group (45% vs 10%, p=0.0001). Microscopic hematuria was discovered in (30%) of hypercalciuric patients.Conclusion: Hypercalciuria in immobilized children is significantly higher than healthy children and microscopic hematuria is an important finding in this condition.

Background and Objectives: Voice is an important communication tool of human and larynx is the organ of making voice. Vocal cord nodules are usually seen in those persons who abuse there voice. The aim of this study was to compare the surgical technique and speech-therapy on voice healthing in patient with laryngeal nodules.Materials and Methods: In this study 60 Patients with the diagnosis of vocal cord nodules were divided in two groups. First group were treated by speech therapy and surgical microscopic excision applied in other group. Results were compared 3 months after completing each modalities.Results: From a total number of 60 patients (M/f–36/24), there were 30 patients (M/F 18/12 mean age 38.3±9.1) in surgical group and 30 patients (M/F 18/12 mean age 37.1±8.71) in voice therapy group. There were no significant differences between the quality of voice in these two group, (P=0.22), the size of laryngeal nodule had a positive correlation with the degree of voice change.Conclusion: The study showed that there is no difference between surgical methods and speech therapy modalities for treatment of laryngeal nodules.

Background and Objectives: Shock is an important causes of mortality and morbidity among children. Hypovolemic shock is the most common one and needs early recognition and rapid intervention patients. The aim of this study is to determine the effective factors on the outcome of children with decompensate shock.Materials and Methods: In this retrospective study in a pediatric Intensive Care Unit (PICU) outcome was determined in two groups, those who discharged and those who deceased Characteristics patients’ in each groups including: age, sex, etiology of the shock, laboratory findings, organ involvement and early or late interventions compared between two groups.Results: predictors of mortality were thrombocytopenia, presence of respiratory failure and renal failure, hematologic and neurologic dysfunction, early use of volume expander, early intubation and early use of sedation. Parameters such as age, sex, leukocytes count and cardiovascular and liver dysfunction were not significantly different between two groups. In multivariate study, early intubation (OR=1.17, 95%CI=1.07-1.28, p=0.05) and early use of sedation (OR=1.36, 95%CI=1.09-1.42, p=0.04) were the only dependent predictor of mortality.Conclusions: Early intubation and sedation are reliable predictors of mortality in pediatric patients with decompensated shock.

Background and Objectives: Dyslexia is a situation in which the progression of reading ability in a child is lower than expected age, education and intelligence. The goal of this is study is to investigate effectiveness of Neurofeedback treatment such as operative conditioning procedure on Dyslexia disorder. Materials and Methods: 2 students (1 male, 1 female) with dyslexia were selected by available sampling from five LD canters and received 20 sessions of Neurofeedback treatment. Nama reading and dyslexia test were used to evaluate student’s improvement.Results: After receiving the neurofeedback treatments the patients improved and this improvement remained stable after two and three month of follow ups.Conclusions: The Neurofeedback treatment is an effective way of treatment in dyslexia disorder.

Background and Objectives: Hair diameter could be used as main factor in evaluating hair mass, as hair diameter is known as a more accurate factor in hair counting for evaluating hair mass. According to age, gender, skin type, hair loss type and hair growth after treatment, hairs diameter are different. The study of hair diameter in Patients with hair loss referring to the department of dermatology before and after treatment and the hair diameter of their immediate family and comparing it with control group.Materials and Methods: Between 2009-2010, 240 patients who were visited in our department of dermatology because of hair loss and control group without hair loss were studied. Hair samples from different areas of their scalp were taken by hair Pull method and its diameter was measured with digital micrometer with 1 micrometer accuracy. Then findings were evaluated.Results: There were not significant differences in age between different groups. Hair diameter had increased after treatment (P=0.027) and was higher in women than men (P=0.01), and in bright brown hair than dark brown (P=0.04). Hair diameter after treatment in each gender was increased {men (P<0.001) and women (P=0.027)} which this increase was higher in men than women (P<0.001). Mean hair diameter in frontal area was lower than other regions (P=0.03).Conclusion: In this study we observed that hair diameter was different according to gender hair color and type of hair lost. The hair diameter is increased after treatment (P=0.027) and it is higher in women than men (P=0.01) and in bright brown hairs than dark browns (P=0.04).

Background and Objectives: Hemiparetic cerebral palsy is more impairment of one side of the body as a result of non-progressive disturbances in premature brain. We study the present compared effect of constraint-induced movement therapy (CIMT) with virtual reality (VR) on upper limb function of children with hemiparetic cerebral palsy.Materials and Methods: In this single center study, 24 children with hemiparetic cerebral palsy were subdivided in 3 different groups (CIMT group, VR group, and control groups). One and half hours sessions of practice were executed every other day for 4-week. Measures were conducted pre, post and 3-month after the therapeutic periods by Pediatrics Motor Activity Log and Bruininks-Oseretsky. Samples were analysis by statistical methods.Results: Data analysis showed a non-significant difference between VR and CIMT groups (speed and dexterity means in VR: 1.22±0.23, CIMT: 1.35±0.37). Data analysis for follow up session indicated a non-significant difference between post-test and follow up for 3 groups.Conclusion: Results showed positive effect of both interventions, it can be possible to substitute VR with CIMT to improve the upper limb function of children with hemiparetic cerebral palsy.

Background and Objectives: Research has suggested that individual differences in Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS) are related to positive and negative affects in asymmetrical brain regions. This study aimed to investigate the effect of BIS/BAS differences on brain oscillation in response to neutral, positive and negative stimuli.Materials and Methods: In this study EEG was recorded in 36 undergraduate students (18 individuals with high BAS sensitivity, comprising 18 individuals with high BIS sensitivity) during viewing affective pictures. In each cases artifact-free EEG epochs were transformed to frequency domain by means of the Fast Fourier Transformation (FFT) algorithm. Absolute power mean of alpha band (8-12 Hz) of the interior and posterior areas was calculated for each participant.Results: Results revealed an increased response to neutral stimuli in BAS group within the left frontal and left parietal areas. No significant effect was found in BIS group in this condition. Left frontal activity for positive stimuli and right frontal activity for negative stimuli were found in the BAS and BIS group, respectively. Predicted effects for BAS and BIS with in posterior regions were not significant.Conclusion: These findings are consistent with the hypothesis of brain regions to positive and negative affect in frontal areas, but this pattern does not exist in the posterior areas.

Background and Objectives: Myofascial pain syndrome (MPS) is a regional pain, originating from a myofascial trigger point (MTP). The key to diagnosis of MPS is a distance between the pain location and the causative trigger point in skeletal muscle. In the present study, we aimed to evaluate the effect of physiotherapy and acupuncture on relieving the MTP induced headaches.Materials and Methods: In this study eighty patients with headache associated with the neck region’s MTP were enrolled into the study.Results: The mean number of headaches after intervention in the physiotherapy group, was not different from the acupuncture group. The mean reduction of VAS score in the acupuncture group was significantly higher than the physiotherapy group. After treatment, Benchmark of Modified Mc Gill criteria’s in the physiotherapy group was not different from the Benchmark Modified Mc Gill in the acupuncture group. The mean reduction in the HIT in acupuncture group was significantly higher than physiotherapy group, reduction of A-PRI score in the acupuncture group was significantly lower than physiotherapy group.Conclusion: Both physiotherapy and acupuncture are effective for therapeutic approaches relieving MPS related headaches, but endurance of the pain relieving effect is more significant in acupuncture method.

Background and Objectives: Recent studies have shown that there is a correlation between hyperglycemia and mortality in critically ill children. The aim of this study was to evaluate the correlation between hyperglycemia, mortality and PRISM score in a group of severely ill children.Materials and Methods: In this cross-sectional study, all children admitted to PICU (pediatric intensive care unit) of Tabriz Children Hospital between 2009-2010 were recruited. Blood glucose³150 mg/dL in two samples was considered as hyperglycemia and PRISM-III score was used for evaluation of the illness severity.Results: In a two years period, 213 boys (58.8%) and 149 girls (41.2%) with the total mean age of 28.3 months (1.5 month to 13 years) were studied. Mortality rate (P=0.001) and need for mechanical ventilation (P=0.02) were higher in the hyperglycemic patients. Sensitivity of PRISM score for prediction of the mortality was 81% with cut-off point of 9.5.Conclusion: Increase in blood glucose in critically ill children has an important role in increasing the mortality rate. PRISM score is a sensitive tool for risk prediction and has powerful correlation with hyperglycemia and mortality rate in critically ill children.

Background and Objectives: Intertrochanteric fractures are the most common fractures that needs surgical fixation. There are some instruments applying to fix the intertrochanteric fractures. The aim of this study was to assess the positive predict value of Tip-Apex Distance (TAD) on intertrochanteric fractures treated by (DHS, Dynamic Hip Screw).Materials and Methods: In a single center descriptive prospective study 100 Patients with intertrochanteric fractures who were treated by DHS were evaluated. These patients assessed for their Tip-Apex Distance and rate of fixation failure.Results: 53 male and 47 female with mean age of 76.71±11.17 were included. 43% of subjects were in grade IV of osteoporosis, 21% in grade V and 29% in grade III. In 57% the screw was located at posterior-inferior side in 40% it was placed in central and in 3% superiorly mean of TDA was 23.5±1.83 mm. The most common complication was failure of screw.Conclusion: Based on the findings, an intertrochanteric fracture is higher in men than woman. Most patients with intertrochanteric fractures suffered from osteoporosis. The distance between the screw head to the apex has a significant possitive association with fixation failure.

Background and Objectives: Arterial and venous thrombosis is a common cardiovascular problem. Genetic background could influence the frequency and severity of vascular thrombosis and its response to therapy. Polymorphisms of two genes CYP2C9 and VKORC1, are identified as main genetic factors that influence warfarin dosage requirements.Materials and Methods: Peripheral blood samples were obtained from 200 patients who were hospitalized for different cardiovascular disorders. After DNA extraction, RFLP-PCR technique was used to determine the polymorphism of CYP2C9 gene in collected DNA samples.Results: With using of Hardy-Weinberg Equilibrium, expected genotype frequencies of *1/*1, *1/*2, *1/*3, *2/*2, *2/*3 and *3/*3 in the CYP2C9 gene in collected were 72.6, 13.2, 11.3, 0.94, 1.88 and 0 percent in females and 64.8, 20.2, 12.7, 1.06, 0.94 and 0 percent in males respectively. The changes of allelic frequency in this study were not significantly different in females and males (p>0.05) the frequency of *2/*1 genotype was more prevalence in males than females (p<0.05).Conclusion: In this study, the main aim was determine the frequency of CYP2C9 gene in high risk group of patient that may experience the thrombotic events.

Background and Objectives: Native spirometric parameters are widely used for evaluation of lung function. Here we studied the spirometric parameters including residual volume (RV) and functional residual capacity (FRC) in a group of young female.Materials and Methods: 150 healthy non-smoker female students with (mean age of 20.5±1.19) were studied. Spirometric parameters, FRC, TLC, RV, FEV1, FVC, FEV1/FVC, were measured using Zan 500 plethysmograph and result were compared with standard values for Caucasians.Results: In comparison between native and non-native individuals, the values of inspiratory capacity and residual volume had a significantly difference between these two groups (P<0.05). Except for TLC other measured parameters had a significant differences with proposed values (P<0.05). Values for lung function tests in Iranian young individuals were at the range of 94-106 percent of the proposed value for caucasian female.Conclusion: Results obtained from this study indicate a significant difference between spirometric parameters of Iranian females and proposed values for Caucasian.

Background and Objectives: Musculoskeletal disorders (MSDs) are a worldwide health chaleng. Prevalence of MSDs has increased as four times since 20 years ago. They are common cause of work related or work aggravated disorders during the last days. Housewives are a large population in society and housewifery can be known as an occupation. In present study we assessed the prevalence of MSDs in housewives in one region of Tehran.Materials and Methods: In this observational cross sectional study, 120 housewives randomly were allocated from one of the total 20regions of Tehran. Validate Persian version of Nordic MSDs questionnaire used for data collection.Results: MSDs in housewives were more prevalent in low back, knees and shoulder areas. With increasing of age, MSDs were significantly increased in neck, shoulders, elbows, pelvis and knees areas. There was significant association between prevalence of MSDs, and body mass index, educational level, marital status and number of children.Conclusion: We found high prevalence of musculoskeletal disorders among housewives, more studies in large scales for better assessment of this relationship and suitable interventions are needed.

Background and Objectives: Oppositional defiant disorder (ODD) is described by pattern of disobedient, hostile and defiant behavior toward authority figures. The quality of family life seems to be an important factor in the development of ODD in children. The purpose of this study was to examine the effect of mother’s communication patterns on reducing the symptoms of oppositional defiant disorder in children.Materials and Methods: The subjects of this study were a group of mothers who had children with oppositional defiant disorder. The degrees of disobedient in children were measured by oppositional defiant disorder rating scale (ODDRS). 15 mothers with ODD child’s were entered an 8 week training and were taught methods of communication and how to manage and cope with ODD. After 3 month the degree of disobedient were measured by ODDRS in trained mothers’ child in 15 ODD child’s without trained mothers.Results: The result of this study revealed that mother training significantly decrease (P<0.05) the degree of disobedient measured by ODDRS in their children.Conclusion: Our study shows that education mother’s communication patterns have an effect on reducing symptoms oppositional defiant disorder of children’s.

Background and Objectives: Toxoplasmosis is one of the most common zoonosis parasitic diseases and it is a major cause of severe vision loss in young people. Indicating the importance and high prevalence of toxoplasmosis in our country. This study was done to determine the clinical characteristics in a group of patients with ocular toxoplasmosis.Materials and Methods: In this retrospective study, all patients with ocular toxoplasmosis who was referred or diagnosed ophthalmology specialized in hospital of tabriz university of medical sciences between (2003-2009) and the frequency and type of symptoms in patients with ocular toxoplasmosis were determined.Results: The most common presentation was blurred vision. Floaters, eye pain, vision loss, redness epiphora, strabismus, headache, cataract and fear from light were the other cause of referring. Among the symptoms blurred vision had the highest percentage (89%).178 cases had congenital toxoplasmosis and 13 cases had acquired disease. The most common complication was serous retinal detachment.Conclusion: The most common results of this study showed that common ophthalmologic symptoms such as blurred vision could be the sign of ocular toxoplasmosis and should be seriously considered particularly in endemic areas.

Background and Objectives: In this study we evaluated distribution of corneal biomechanical measurements including (Corneal Hysteresis=CH and Corneal Resistance Factor=CRF) in a group of normal myopia and myopic-astigmatism population.Materials and Methods: 180 eyes with myopia and myopic-astigmatism candidate for laser refractive surgery included in this cross-sectional study. Complete examination of anterior and posterior segments, manifest refraction spherical equivalent (MRSE), OrbscanII and Zywave aberrometry were performed preoperatively. Ocular Response Analyzer (ORA) was used to measure CH, CRF, Goldman-correlated Intra Ocular Pressure (IOPg) and Corneal Compensated IOP (IOPcc). Distribution of all corneal biomechanical properties and correlation between these parameters and MRSE, age and sex were determined.Results: Mean age was 28+/-7 years. Mean MRSE -4.21 +/- 1.19 D. Mean CH, CRF, IOPgand IOPcc were, 10 +/- 1.28 mmHg, 10.16 +/- 1.45 mmHg, 15.7 +/- 2.67 mmHg and 16.68 +/- 2.41 mmHg respectively.28.4% of all myopic population had CH about 10mmHg, and 71% had CH, 9 up to 11mmHg. CRF in 25.9% of myopic population was 10mmHg, and in 48.7% was 9 up to 11mmHg. There was very poor positive correlation between MRSE & CH (Rs=0.001, P=0.71) and MRSE & CRF (Rs=0.01, P=0.18).Conclusion: Our study demonstrated the distribution of corneal biomechanical properties in normal myopia and myopic-astigmatism population who were candidates for laser vision correction. This study revealed that, there was no statistically significant correlation between corneal biomechanical properties and MRSE, age and sex.

Background and Objectives: Beneficial effects of human milk has questioned the logic of enteral feeding delay in low birth weight preterm infants. This study aims to investigate the benefit of trophic feeding in the first 24 of birth in low birth weight preterm infants.Materials and Methods: In a prospective cohort, from 2008-2009 in Neonatal Intensive Care Unit, 90 preterm infant (1000-1500 gr, 26-31 weeks) were entered the study. 45 infants received trophic feeding enterally within the first 24 hours of birth (group A) and 45 infants received it within the next 24-48 hr (group B) who were studied due to important infancy outcomes until discharge.Results: There were no statistically significant differences in the clinical and maternal characteristics of infants in two groups. Duration of Parenteral nutrition in group A (7.87±4.39 days) was significantly shorter comparing to group B (12.49±6.41 days (P<0.001)). Infants in group A attained their birth weight sooner than infants in group B (12.16±5.03 vs. 19.25±7.13 months) (P<0.001)). Infants in group A had a sooner discharge from NICU than infants in group B (11.00±9.99 vs 18.18±1.99 days) (P=0.003). The incidence of sepsis and necrotizing enterocolitis were not different between two groups.Conclusion: Results of this study verifies the beneficial effect of trophic feeding in the first day of life in low birth weight preterm infants.

There were three methods of uterine incisions in cesarean operation: mostly transversal, rarely vertical incision of anterior wall of lower segment and occasionally vertical incision of corpus or fundus of uterus. In new technique the posterior wall of lower segment is transversally incised, which is indicated in some complicated conditions of term pregnancies; such as the large or multiple myoma in lower segment of uterus or placenta, increta, in anterior wall of lower segment or adhesion of bladder. Here we report a woman with large myoma who underwent the C-sections by posterior wall incision technique.