MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2007 | Volume:29 | Issue:3|Papers Count:32

Background and Objectives: Intrathecal injection of opioids has been introduced to improve analgesia and decrease of hemodynamic instability due to sympathetic blockade of local anesthetics during spinal anesthesia.There is a little information regarding effects of the intrathecally administered opioids on the fetus and of possible adverse neonatal effects of preeclamptic parturients. This study designed to evaluate neonatal effects of adding fentanyl to small-dose lidocaine for spinal anesthesia in severe preeclamptic parturients undergoing cesarean section.Methods and Materials: Sixty parturient's with severe preeclampsia scheduled for cesarean section were allocated in this double-blind, and case-controlled trial. Thirty patients received 50 mg lidocaine 5% with 10 μg fentanyl (study group) and in the other 30 patients 100mg lidocaine 5% was used (control group). Apgar scores and umbilical artery acid-base values were recorded.Maternal blood pressure and quality of analgesia during surgery were recorded.Results: There were no statistically significant with regard to neonates Apgar scores at 1 (7.80±1.34 in study group and 7.90±1.15 in control group; p=0.759) and 5 minutes after birth (8.70±0.46 in study group and 8.83±0.37 in control group; p=0.229). Umbilical artery pH values did not differ between two groups. There was statistically significant fall in blood pressure in control group than the study group (63.33% vs 20% respectively; p<0.0001). Pain and discomfort during surgery were experienced more frequently in control group (83.33%) than the study group (16.66%; p<0.0001).Conclusion: Adding of fentanyl to small-dose of lidocaine during spinal anesthesia in severe preeclamptic patients undergoing cesarean section did not produce neonatal side effects. This combination improved the quality of anesthesia.

Background and Objectives: At present, no data are available on risk factors of migraine and tension – type headaches among Iranian hospital staffs. Therefore, we identified sociodemographic and occupational risk factors of migraine and tension- type headaches among hospital staffs of Shiraz (Iran).Materials and Methods: This was a case- control study using prevalence data a random sample (stratified random sample) of 1023 hospital staffs of Shiraz (Iran). Subjects were stratified by personnel category (nurse, clerical and manual). For each patient, two controls of the same sample were selected who had never been diagnosed as having migraine or tension type headaches. Logistic regression was used for data analysis.Results: The subjects were 115 (11.5%) patients with migraine and 199 (19.5%) patients with tension type headaches diagnosed both by IHS criteria and clinical examination of 115 patients with migraine were 97 (84.3%) female and 18 (15.7%) male, and of 199 patients with tension type headache were 154 (77.4%) female and 45 (22.6%) male. The most prevalence of migraine and tension type headache was among 30-39 (16.5%) age group and 40-49 (25.8%) age group. In multiple logistic regression odds for migraine in hospital staffs who had positive family history of headache was 2.7 (95%CI: 1.6-4.5) and for tension- type headaches was 1.8 (95%CI: 1.1-2.9). The odds ratios for migraine and tension type headaches in hospital staffs who had abnormal sleeping pattern were 1.8 (95%CI: 1.0-3.1) and 2.6 (95%CI: 1.5-4.5) times higher than those with normal sleeping pattern. Migraine was gender dependent and females odds was 2.5times of males (95%CI: 1.2-5.2). Tension- type headache was significantly associated with history of second job, inadequacy sleep and systolic blood pressure (P<0.042) too. Migraine and tension type headaches were not significantly associated with other factors.Conclusion: Family history of headache and sleeping disorders had been identified as the most significant effects on occurrence of migraine and tension- type headaches in hospital staffs of Shiraz (Iran). Migraine was gender dependent. Tension- type headache was significantly associated with history of second job, inadequacy sleep and systolic blood pressure.

Background and Objectives: As the number of elderly people is increasing rapidly in the world and Iran, providing their health imposes enormous costs on health budget. There are many factors such as nutrition which influence physiological requirements, healthy and happy life in the elderly and prevent disease. The present study was aimed to assess energy and macronutrient intakes, dental health and anthropometric indexes in elderly people.Material and Methods: In this descriptive study, 79 elderly people (aged over 65 years,31 men and 48 women) in ''Khuban" private nursing home were studied. Dietary assessment was assessed using direct observation 3-days weighing food method and analyzed using nutritionist III software, and dental health was assessed by Dentist. Weight, height, waist and hip circumferences were measured and used to estimate Body Mass Index (BMI) and waist to hip ratio. All data were analyzed using SPSS software (Ver. 11.5), Student t-test and one way ANOVA.Results: Mean BMI in men and women were 23.34±0.8 kg/m2 and 21.93±0.65 kg/m2, respectively. The mean daily intake of energy, carbohydrate, fat and protein in men was greater than in women whereas adequate intake of protein (compared with RDA) in women was more than in men (P=0.021).Fifty seven, twenty four and nineteen percent of the elderly had denture, no teeth and few natural teeth, respectively. Dental health showed no association with macronutrient intake and anthropometric indexes.Conclusion: As nutritional status was not associated with dental health, thus more investigation by considering factors such as diseases and medication is required to conduct proper nutritional interventions to meet nutritional needs in the elderly.

Background and Objectives: Malfunction of Prosthetic Heart Valve is one of the most dangerous side effects for patients who receive them. The incidence of prosthetic thrombosis was % 0.1 a year in aorta and % 0.35 in mitral valve status. This side effect almost in all occasions occurs because of undesirable anti coagulation therapy. Surgical therapy is the major intervening one which is associated with the highest mortality and morbidity risk. And Thrombolitic therapy has always been a matter of discrepancy as a surgical therapy alternative.In this ten-year study we intended to review the results of surgical therapy interventions with those of Thrombolitic therapy in patients hospitalized with malfunction of heart valve. Our analysis is not based on a randomized study design but is a retrospective analysis of non selected patients.Material and Methods: In this study we reviewed 65 patients who were hospitalized and treated at Shahid Madani Hospital for the malfunction of prosthetic metal heart valve from 1996 to 2005. The etiology of the malfunction of the valve, clot status at the time acceptance, clinical signs, the kind of therapy used together with the assessment of the interventions of surgical therapy and thrombolitic therapy were extracted and the results were reported as frequency percentages.Results: Out of 65 patients 46 (%70.7) had prosthetic mitral valve and 19 patients (%29.3) had prosthetic aorta valve. The clinical signs of 54 cases (%83) were recorded aspiration problems, 5 cases (%7) reduction of palpation sound of the prosthetic valve, 4 cases (%6) environmental embolisms and 2 cases (%3) had palpation problems and in 57 patients (%88) INR was reported to be lower than the therapy level. In these patients 17 cases had received thrombolitic therapy of whom 11 patients (%84.6) were recorded to show positive response to therapy and 3 cases (%17.6) showed incomplete reaction and candidate for surgical therapy and 3 cases (%17.6) death were recorded. The cases with surgical therapy had significant differences (P<%5). The surgical therapy was performed in 51 patients of whom 10 (%20) died, which was significantly more than mortality and morbidity in medical therapy group (P<%5).During therapy 30 cases were reported with Thrombus, 11 cases with Panus and 10 cases with Thrombus on Panus.Conclusion: Treatment with Thrombolitic in most cases of acute Thrombosis of prosthetic metal left valves, especially in acute cases (a short time after the symptoms started) proves to be efficient, especially considering the fact that emergency surgery, which has the probability of many side effects and with a high degree of mortality and morbidity, seems to be vital.

Background and Objectives: Nutritional rickets is a major public problem of health in developing countries. This study was performed to evaluate the relationship between the vitamin D status of nursing mothers and their breastfed infants.Materials and methods: In this 2 years study infants admitted in Tabriz Children's Hospital (during Feb. 2004 to Feb. 2006) with either hypocalcemia or rickets caused by vitamin D deficiency were selected. Serum level of 25OHD of 40 infants with rickets and their nursing mothers (case group) were compared with those of 40 infants without rickets (out patients) and their mothers (case group).Results: The majority (75%) of young infants with vitamin D deficiency present with hypocalcemic seizure. The mean serum level of 25OHD in infants with rickets and their mothers were significantly lower than control group (P=0.002 and P=0.029, respectively).Conclusion: Maternal vitamin D deficiency acts as an important risk factor in pathogenesis of nutritional rickets in the breastfed infants. The results provide justification for vitamin D supplementation in breast- fed infants and nursing mothers in East- Azarbaijan.

Background and objectives: Carotid body tumor in relatively rare tumors and appears as pulsative neck mass on the lower mandibular angle. Considering it’s clinical signs, slow growing nature and also problems associated with biopsy suggest, alternative diagnostic means.Materiauls and Methods: In this descriptive study all the patients record who hospitalized in Imam and Ghazi hospital due to the neck man were reviewed and 39 patients with carotid body tumor who admitted between 1375 to 1380 were selected.Results: 21 patients out of 39 were male and 18 were female the mean age of the patients were 45 years the most common compliant of the patients were neck mass (100), pain (%12), tongue deviation (%3), dizziness (%2). Eight Patients were referred from the other centers due to bleeding following biopsy. Two patients had bilateral tumor. Sixty percent of the tumor size was greater than 4cm. Carotid body excision carried out in all the patients. In two case internal carotid artery were repaired because of estrogenic injure and ligation of internal carotid artery were carried out in one case due to both antigenic injure and sever bleeding. The histopathology repots showed paraglomia for all case except are case of jugular Glumous.Conclusion: The carotid body tumors are commonly benign and following excision there in no recurrence. Pre-operative diagnosis usually prevented from intra operative bleeding.

Background & Objectives: Pre-hospital care is an important component in management of critical patients. Today, in urban health care system, initial approach and management of critical patients generally is provided by pre- hospital emergency medical services. The more this approach is appropriate, the accurate and rapid, the less mortality and morbidity. Also the confidence to this system will increase among people. To increase the quality of pre-hospital care services. It is imperative to evaluate the current status. Considering the importance of this subject. We conducted this study to evaluate the quality of per-hospital care and compare it with current standard protocols.Materials and Methods: The study method was descriptive- cross sectional. The data was collected from 500 transported patients by emergency medical services which were selected by sequentional sampling by questionnaire and interviewing the emergency technicians. Crude data was interpreted by statistical descriptive methods.Results: The mean duration between notification and arrival of EMS system on the scene was 12.54 minutes with SD of 1.24 minutes and the mean duration between scene and hospital (transportation) was 34.37 minutes with SD of 2.40 minutes. The overall mean duration between notification and hospital was 47.31 minutes. The patient’s vital sign were measured by emergency medical technologists as following: Blood pressure in 92.3% of patients, pulse rate in 38.00% of patients, respiratory rate in 83.07% of patients and temperature in 71.15% of patients. The GCS was measured in 73.07% of patients. Intravenous access was established in 93.26% of patients but just 81.1% of them were functional. Pre-hospital treatment protocols for patient management shows considerable differences qualitatively and quantitatively in comparison with current world standard protocols.Conclusion: Our results indicate that there is a great necessity to improve in the field of Prehospital care by conduction of regular quality assessment reviews, improvement of the present equipment, the educational curriculum and treatment protocols.

Background and objectives: Asthma is a chronic inflammatory disease of airways that results from complex interaction of genetic and environmental factors and its prevalence is increasing. As the high prevalence of the disease, detection of risk factors is necessary. Although there are many studies about subject in different parts of world, but differences in prevalence and risk factors in different countries and ethnics, necessitate conducting of this study.Methods and material: in a case-control study 120 patients with persistent asthma and 2-8 years old age group and 240 non-asthmatic children at the same age as control group were selected. The asthma risk factors were compared in two groups .Data was analyzed with spss12, chi square and T-test. The significant level was defined as p<0.05 in this study.Results: there was significant differences between two groups in risk factors such as low birth weight (P<0.001, OR=3.54), Rhinitis (P=0.005, OR=2.05), breast feeding (P=0.001, OR=5.4), family history of asthma (P=0.003, OR=7.5) and Passive smoking (P=0.001, OR=2.36).Conclusion: In this study risk factors of asthma was assessed and the most important factors were history of asthma in first degree family, none breast-feeding and low birth weight respectively.

Background and Objectives: Increasing concentration of cAMP in beta cells stimulates the insulin secretion and almost the cyclic nucleotide phosphodiesterases (PDEs) are the only cAMP degrading enzymes. Between different PDE Families, PDE3 is the most important isoenzyme in pancreas and liver. In this study, PDE inhibitors combined with the stimulating effect of glucose, as the most important physiologic stimulant of insulin secretion, were examined in anesthetized rat (in-vivo) and isolated langerhans islets of rat (in-vitro).Materials and Methods: The effects of PDE inhibitors such as IBMX (non-selective), Milrinone, Amrinone and Trequinsin (PDE3 selective) and Dipyridamole (PDE5 selective) in the rat’s isolated islets and anesthetized hyperglycemic rats (within 90min) were studied. As, insulin secretion by isolated islets and plasma concentration of glucose and insulin with hepatic glycogen storage after 90 min. hypertonic glucose infusion, were measured.Results: Milrinone, Amrinone and Trequinsin despite Dipyridamole stimulated islets insulin secretion. All PDE inhibitors with some differences, decreased blood glucose in rats.Dipyridamole and IBMX had no effect on insulin, although Milrinone and Trequinsin increased and Amrinone decreased it. Rats’ liver glycogen storage decreased by Amrinone, Trequinsin and IBMX, while increased by Dipyridamole.Conclusion: PDE3 inhibitors in rats' isolated islets; despite the PDE5, stimulated insulin secretion. In hyperglycemic rats, PDE inhibitors had different effects. We conclude that PDE inhibitors with different effects act by mechanisms other than PDE inhibition, too.

Background & Objectives: Desirable sexual relationship between the couples is an effective factor in stability, happiness and health of family. One of the important reasons for sexual dysfunctions is marital problems. The objective of this research which has been done for the first time in Iran is phenomenological assessment of women’s sexual experiences after child birth.Materials & Methods: This research had been done by using of open and in-depth interviews along with verbal and non-verbal probing and armful sampling. Voluntaries expressed their views about their sexual experiences after child birth, speeches were taped and then manuscriped and analyzed with using of Colizzi method.Results: In this research 6 main themes has been included which each one composed of several sub themes. Main themes included: physiologic changes, psychologic changes, family relationships, coping, changing of behaviors and views and explanation.Conclusion: Identification and relief of women’s undesirable sexual experiences in this period will have central role in protection of family health and natural and innate relationship, so attention to sexual health should become a main part of cares. This way we hope can solve women’s problems.

Background and Objective: Today the comminuted femoral fractures are very common because increment of vehicles traffic and accident. These fractures can lead to long-term disabilities. This type of fracture has always been a problem for the society of orthopedic surgeons, and various methods of treatment have been suggested in the literature and references.The goal of the study was to determine the outcomes of using minimal invasive technique, which is referred to a new method and technique.Materials and Methods: This study is a prospective one, which was carried out on 36 patients with comminuted femoral fractures who had not suffered burning, open fracture, head injuries. The patients had referred to the Shohada hospital in the course of six months (From 23 October 2004 to 20 April 2005), and undergone plating surgery with minimum manipulation, and followed up from 6 to 12 months. Follow up evaluation study were include the time of union and the status of the extremities from the view point of rotation, shortening and lengthening.Results: The results showed that complete union rate was 77.8% (24 out of 36 patients) with the delayed union were seen in 22.7% (7 out of 36 patients) in six months. There was no serious complication in the follow- up period other than a few superficial infections. There was no significant correlation between the union rate and sex. However, there was a statistically significant correction between age and union. Lengthening of the extremities ranging from 1-2 cm was observed in 10 patients, while shortening of lower than 1cm was also observed in 4 patients. Rotation disorder existed in 8 patients with internal rotation and in 2 patients with external rotation.Conclusion: The new plating technique with minimum manipulation can be regarded as a suitable substitute for the previous ones. The basic principle of this method is not damaging the soft tissue at the fracture site which leads to faster healing of the bone. This technique is, in fact, a biologically stabilizing method similar to the closed intramedullary nailing technique.

Background and Objectives: Acute Myocardial Infarction is one of the most common diseases all over the world and the first cause of death in Iran. Reperfusion therapy is the cornerstone of the effective treatment of these patients. Early thrombolytic therapy leads to better coronary reperfusion and a greater reduction in mortality and reinfarction rates. The main purpose of this study is to determine and compare the different time intervals before and after arriving at hospital in both groups who received thrombolysis (T+) and did not receive thrombolsis (T-).Methods and Materials: This was a cross sectional comparative study carried out in Shahid Madani Hospital of Tabriz University of Medical Sciences. We randomly assigned 150 patients with acute myocardial infarction with elevation of ST segment, in 2 groups with and without administration of thrombolysis.Results: Mean onset–to–call time in T+ group was less than T- group.15% of patients had call–to–needle time less than 90 minutes and in over the 90% of patients, door–to–needle time was greater than 30 minutes.Conclusion: significant pre–hospital delay and considerable in–hospital delay shows necessity of thrombolytic therapy pre–hospital or as soon as possible early after entering emergency room.

Background and Objective: Hearing loss in neonates is one of the most important disabilities in which any delay in early diagnosis and intervention will cause a great undesirable impact on speech, language and cognitive abilities. So it is always recommended that if there is significant prevalence of neonatal hearing loss, screening programs should be performed at least on high risk population of neonates to detect cases actively. To determine prevalence of hearing loss, frequency and significance of risk factors in high risk neonates of studied population.Materials and methods: An analytic-cross sectional study on 600 neonates who had at least one of risk factors admitted at Pediatrics, Alzahra and Taleghani hospitals was performed during years 2004-2005. Our protocol was inpatient OAE, outpatient OAE after 2 weeks in “ refer” cases of first OAE, and ABR in “refers” of 2nd OAE. All Data analysed by Chi² Test، t-Test and Exact Fisher (with the help Univariate analysis) Test.Results: The frequency of hearing loss in our samples was 3.5%. Mean age of definite diagnosis was the day 105. The most common risk factors that surveyed were hyper bilirubinemia, ototoxic medications usage (at neonatal period), and birth weight less than 1500g.The statistically significant risk factors with increased probability of hearing loss were ototoxic medication usage of mother during pregnancy, and birth weight less than 1500g; Hyperbilirubinemia requiring exchange transfusion had marginally significance.Conclusion: Because of significant frequency of hearing loss in our sample population, hearing screening among high risk neonates is effective, feasible, and cost-effective. Casecontrol and cohort studies can clarify ambiguities about other aforementioned risk factors.

Background and objectives: Pemphigus Vulgaris (PV) is a rare, life- threatening autoimmune disease of the skin and mucous membranes characterized histologically by intraepidermal blister and acantholysis and immunologically by the presence of antiepidermal autoantibodies with the IgG nature in the serum of patients and bound to the epithelial intercellular spaces of lesional epithelium. This study was performed to determine circulatory and depositing IgG before treatment and effects of immunosuppressive therapy on the circulatory IgG.Materials and Methods: Sixty-two patients (34 females and 28 males) with clinically and pathologically confirmed P.V were studied prospectively over a one – year period of time during which direct and indirect immunofluorescent tests were performed before and after treatment. They had mild or moderate forms of disease. All patients received prednisolon 1-2 mg/kg/day and Azathioprine 2-3 mg/kg/day or methylpredisolon (1 gr/day for 4 days) and cyclophosphamide (500 mg/first day) pulse therapy due to general condition.Results: Thirty- four females and 28 males enrolled, the mean age were 39.5 years (SD= 12.7). Before treatment, 20 and 52 cases were positive for skin depositing (+ or ++) and circulatory IgG (1/20 – 1/60), respectively. Two to 3 month later, 37 were IgG positive with titers 1/20 to 1/160. The correlation between circulatory IgG before and after treatment was weakly positive (P= 0.05, r= 0.415).Conclusion: The amount of circulatory IgG wasn’t considerably decreased by treatment protocols.

Background and objectives: Neonatal Jaundice is one of the important disorders of neonatal period. There are different etiologic factors and glucose-6- phosphate dehydrogenase (G6PD) deficiency is one of the causative agents. G6PD deficiency is the most important disorder in hexose monophosphate pathway, it is x-linked and more than 200 milion have this disorder. Since the incidence of this disease was not known in East Azerbaijan province, so this cross sectional study was done.Methods and Material: The enzyme level was measured in icteric neonates referring to pediatric medical center from January 2004 for one year. Informations such as age, gender, initiation time of icter, bilirubin, hemoglobin, reticulocyte count, were obtained from the chart of patients.Results: In 569 icteric neonates the G6PD was measured, 13 neonates (2.28%) had enzyme deficiency. All of them weighed over 2.5 kg except one, 10 of them were male and 3 female.Bilirubin level was 22.41±5.88 mg/100.Conclusion: G6PD deficiency is reported to be 40% in Nigeria, while its incidence in Iran is 10-14.5% and in our study it was 2.28%. It is necessary to perform the study in larger population in East Azerbaijan.

Background and Objectives: Todays, in order to avoid and prevent the complications associated with general anesthesia, the regional blocks are preferred. Among these blocks the brachial plexus block has a wider appeal, and because of the ease of application and fewer side effects, this block is widely used in different kinds of surgical procedure on elbow, forearm and hand. This block can be implemented using different methods such as transarterial and paraarterial approaches. The aim of the present study was to compare the two approaches with regard to their success rater, the speed of analgesia onset time and its duration, and their possible side effects.Materials and Methods: The present study was curried out from Oct 2004 to Dec 2005 on 100 patients aged 16 and higher, with ASA physical status class of I to III, who had been admitted to Shohada hospital, Tabriz, for elbow, forearm and hand surgeries. The patients all of whom submitted written consent to undergoing brachial plexus block, randomly divided in to 2 groups: group T and group P. The local anesthetic used was 22.5ml Lidocaine 2%, 17.5ml distilled water in total volume of 40ml and total dose of 450 mg, and 1.200000 epinephrine with a standard scalp veine 23 gauge, and 50 ml syringe. All the patients were sedated with fentanyl 1 mg/kg and Midazolam 1-5 mg.Results: There was no statistical difference between the groups in duration of analgesia but the onset of motor blockade was significantly faster in paraarterial method (3.5 minutes against 13.4 minutes; P<0.001). Success rate was 86% in T-group and 98% in P group (P=0.03). Two percent of patients in P group and 6% in T-group faced total failure of the block and 8% of the latter required supplementary drug.Conclusion: In view of finding of the study, paraarterial method for axillary block is preferable due to faster onset of blockade and higher success rate.

Background and Objectives: Experimental autoimmune encephalomyelitis (EAE) is a CD4+ Th1 cell-mediated inflammatory demyelinating autoimmune disease of the CNS that serves as an animal model for multiple sclerosis (MS). In this study we investigated the effectiveness of treatment with sesame oil on development of EAE and TH1 and TH2 responses.Materials and Methods: EAE was induced by immunization of 8 week old mice with MOG35-55 with complete Freund’s adjuvant. Therapy with sesame oil was started on day 2 before the immunization as intraperitoneally. IFN-g and IL-10 production from cultured spleen supernatants was determined by ELISA method.Results: After daily dosage the sesame oil significantly reduced the clinical symptoms in C57BL/6 mice with EAE (p=0.001). Also, treated mice displayed a significantly delayed disease onset compared with control mice. Mononuclear cells isolated from spleen of treated mice showed a significant decrease in the production of IFN-g compared with control mice (p=0.0001). II-10 production was also enhanced in splenic mononuclear cells in treated mice.Ratio IFN-g to IL-10 in sesame oil treated EAE mice is significantly less than non-treated EAE mice (p=0.01).Conclusion: The cells responsible for the pathogenicity of EAE have been characterized as Th1 cells that secrete IFN-g. This report indicates that sesame oil therapy protected mice from developing EAE by reducing Th1 cytokines with inducing Th2 cytokines. Thus, sesame oil treatment may be effective in MS patients by immunomodulating of TH1 immune response.

Background and Objectives: Venous thromboembolism is a major complication associated with traumatic brain injury and is responsible for significant morbidity and mortality. There has been a general reluctance over the years to use anticoagulant prophylaxis for patients with head injury who have suffered intracranial bleeding or for whom intracranial surgery is needed. On the other hand, physical methods such as intermittent pneumatic compression (IPC) devices give a worthwhile reduction of venous thromboembolism but there still remains a substantial residual incidence. This study aimed at comparing physical-pharmacologic anti-thrombotic methods in these patients.Material and Methods: Patients with severe head trauma (consciousness level lower than 8 on Glasgow Coma Scale) were studied in a clinical trial over a one-year period. These patients were randomly assigned to three groups (age and sex matched). IPC applied for all patients.Low dose heparin (5000 u/q12h S.Q) prescribed in one group and low molecular weight heparin (Enoxaparin 40 mg/D) used in the other during the first 24-hour of admission. The incidence rate of deep vein thrombosis (DVT) was compared between the mentioned groups.Results: Forty five patients (15 cases in each group) were enrolled. The number of patients with DVT in the mere physical-prophylaxis group, low dose heparin group and Enoxaparin group was 7 (46.6%), 2 (13.3%) and 3 (20%), respectively. There was no significant difference for the incidence rate of DVT between the mere physical-prophylaxis and low dose heparin groups (p=0.109), the mere physical-prophylaxis and Enoxaparin groups (p=0.121), and the low dose heparin and Enoxaparin groups (p=1). No hemorrhagic complication occurred.Conclusion: The incidence rate of DVT is high in patients with severe head trauma. There was no significant difference between the mere physical and physical-pharmacologic antithrombotic methods; however the rate was lower in the latter. Further studies with larger sample size are recommended.

Background and Objectives: Differentiating benign from malignant tumors of parotid gland preoperatively is very important from the point of treatment planning. We design this study to evaluate the usefulness and accuracy of fine - needle aspiration cytology (FNAC) in the diagnosis of parotid gland masses.Materials and Methods: In a descriptive – case series study the results of FNAC of 124 parotid masses were analyzed and compared with corresponding histo pathological diagnosis.Results: The cytological findings were nondiagnostic in 2 (1.6%), true- negative in 84 (67.7%), true- positive in 24 (19.4%), false- negative 13 (10.5%), and false- positive in 1 (0.8%) cases in detecting malignant tumors. The sensitivity and specificity in detecting malignant tumors were 64.8% and 98.8% respectively.Conclusion: Fine- needle aspiration cytology is a valuable adjunct to preoperative assessment of parotid masses. Preoperative recognition of malignant tumors may help prepare both the surgeon and patient for an appropriate surgical procedure.

Background and Objectives: Relation between renin-angiotensin system gene polymorphism and renal allograft dysfunction is the matter of debate. We designed this study to evaluate this controversy in Iranian patients.Materials and Methods: The present study was performed on 108 renal transplant recipients.Following of the DNA extraction, the genotypes of the angiotensin converting enzyme (I/D), angiotensinogen (M235T) and angiotensin II type 1 receptor (A1166C) were determined by PCR. The magnitude of clearance of creatinine in the setting of each of the above reninangiotensin system polymorphisms was determined by MDRD formula. P£0.05 was considered to indicate statistical significance.Results: There was no association between the each genotype of the renin-angiotensin system and clearance of creatinine, serum urea, cyclosporine through level and the degree of urinary protein excretion rate, But in addition of the genotypes, the patients with DD+CC genotype in comparison of the patients with II+AA genotype had lower clearance of creatinine and higher creatinine level, urinary protein excretion rate (P=0.05, P=0.002, and P=0.03, respectively). Likewise, other combinations hadn’t such association.Conclusion: Although, none of the gene polymorphisms of the renin-angiotensin system had any impact on renal allograft function, but evaluation of combinations of these genotypes can predict the outcome of renal allograft function.

Background and Objective: Recurrent urinary tract infection is one of the most common causes of chronic renal failure of children. Therefore diagnoses of predisposing factors in recurrent UTI have an important role to prevent renal damage. There are some studies that focus on the relationship between hypercalciuria and damage to the urinary tract epithelium and voiding disfunction. But there are a few and limited study about association between idiopathic hypercalciuria and recurrent UTI.Our aim in this study was to evaluate idiopathic hypercalciuria in children with recurrent UTI who has not anatomical problems.Materials and Methods: During the period of 12 months from September 2003 to September 2004, 46 children who had recurrent UTI without anatomical problems (VUR, renal stone…) we measured 24 hours urine calcium and compared with 46 healthy children as control group.Results: Hypercalciuria was found in 34.8% children with recurrent UTI and in 8.6% of control group. (P<0.05)Conclusion: We concluded that idiopathic hypercalciuria is a common finding among recurrent urinary tract infection in children without urinary tract anatomical problems.

Background and objective: Psoriasis is one of the most common and important dermatoses that may involve extracutaneous organs such as joints. Many factors may aggravate psoriasis such as stress, drugs and hypocalcemia. The present research was conducted to study the role of hypocalcaemia as a trigger factor in exacerbation of psoriasis.Materials and methods: In this cross-sectional comparative study from May 2000 to May 2003 in Sina Hospital. 98 hospitalized cases with psoriasis were compared with 100 patients who were hospitalized due to other diseases. Two groups were matched for age and gender. The type of psoriasis, age and sex of patients and serum calcium and albumin levels in two groups were documented in an especial questionnaire. The results were analyzed with SPSS software and c2 tests.Results: Of all 98 patients with psoriasis, 37.2% were hypocalcemic and 63.7% had normal serum calcium. There was no hypercalcemia. In other group 9% were hypocalcemic, 89% and 2% were normocalcemic and hypercalcemic respectively. In 64.9% of hypocalcemic psoriatic patients, low serum albumin was noted. But all of control group had normal levels.Conclusion: As hypocalcemia is a trigger factor of psoriasis, we can consider vitamin D analogues (e.g. calciptotriol) as a safe therapy for psoriasis and daily consumption of calcium supplements is suggested.

Background and Objective: Maxillofacial fractures are one of the most common basic problems of traumatic patients. There is an urgent need for radiography in order to recognize such fractures. Special radiographic techniques are administered after exact physical examinations. So the decision to choose a special technique depends on clinical findings. The aim of this research is to investigate the midface and mandibular fractures by radiography in patients.Materials and Methods: This research is a qualitative study on the frequency of fractures among 236 patients reffered to Imam Hospital of Tabriz during 1384-1385. The investigated parameters for each patient include: age, sex, cause of fracture, the affected region, clinical symptoms and radiographical techniques. For statistical analysis, spss software, version 13, using descriptive methods was applied.Results: According to this research, the most common involved cases and regions were men of 21-30 years old and zygoma and condyle, respectively. Most of the fractures occured in summer during to car accidents. The most common clinical symptoms in midface were ecchymosis around the eyes and edema. As well as pain and swelling in mandible. The most required radiographies were panoramic and waters. CT-scan was ordered in %75.9 of patients with fractures in midface.Conclusion: Results obtained from this study, point out that maxillofacial fractures have high frequency. There are special clinical symptoms that are common in midface or mandible fractures and can be helpful in detecting the suitable radiography for each affected region. This study also showed the true emphasize on using CT-scan for recognition of midface fractures.Some more analytical studies with high range and sample number are suggested in long time periods in order to study the relationship between ordered radiographical techniques and each region of fracture as well as the relationship between clinical symptoms with each fractured area separately.

Nosocomial infections are rapidly increasing in the entire world. Although a lot of advances have been made, but evidences show that it is still necessary to observe methods for prevention of spreading infection in general practice especially for gynecology and dentistry. Thereby it is important to conduct a research project to determine effectiveness of training in performance of gynecology units in Tabriz. In this interventional study all of the public providers which counts to 75 and one fourth of private sector which includes 75 private service providers were chosen randomly, as a sample. The research tool was questioner and checklist in four sections with 42 items. Educational program conducted for all of the service providers and auxiliary workers of them. Collected data compared before and after education. Performance of 73% of study populations before intervention and 27% of them after intervention was not acceptable.Investigating bacterial contamination in metal instruments showed that 15.1% of them before and 11.1% after intervention were positive. Our results showed failures in decontamination, cleaning, sterilization, disinfection improved performance of gynecologists and midwives in most of cases. Problems in hand washing and few items remained unchanged after intervention.Results of this intervention are similar to a number of studies that have been published in recent years in Iran (Kermanshah, Rasht, Waramin, Tehran cities) and England. The main recommendation in all studies was promotion of knowledge and skills of health workers. Thus planning and continiuous monitoring of out-patient services in using the standards and forcing them to use disposable equipments, substitution of autoclave for oven and expansion of continiuous education should be emphasized.

b-thalassemia is a heterogenous group of genetic alteration characterized by a deficient synthesis (b+) or an absent (bo) of b- globin chains. However, between these two clinical forms there are a wide range of clinical phenotypes. We reported a very rare bo thalassmia mutation, Cd25/26(+T), in a family with normal body structure and transfusion dependent from Azerbaijan-Iran for the first time. The comparison of hemoglobin level revealed that they have a high level HbF (98%) that help their normal growth.