Medical Journal of Tabriz University of Medical Sciences
Year:2006 | Volume:28 | Issue:2|Papers Count:30

Background and objectives: Postoperative wound infections have an enormous impact on patient's quality of life and contribute substantially to the financial cost of patient care. The potential consequences for patients range from increased pain and care of an open wound to sepsis and even death in complicated cases could be occurred. Factors influencing the development of a wound infection include host resistant, surgical technique, and the number and type of organisms present in the wound at the end of operation. Many patients who are in the hospital for prolonged periods of time or who have substantial illness, have being increased numbers of resident organisms on the skin. Since a long time ago Staphylococci aureus and most recently vancomycin resistant Staphylococci aureus have shown an important role in postoperative wound infections so the choice of treatment for post- surgical infections requires an understanding of the rate incidence of vancomycin resistant Staphylococci aureus, usual infecting flora, available antimicrobial agents and their susceptibility patterns. For this reason, the aim of this study is identifying the aerobic and facultative anaerobic bacteria of postoperative infections and to determine the sensitivity pattern of isolated bacteria to common antibiotics.Materials and Methods: Samples were prepared from postoperative wound infections of 40 hospitalized patients in Orthopedic wards of Shohada Medical and Educational Center, Urology and Surgery wards of Imam Khomeini Medical Center of Tabriz during 1379-1380 and were examined by microscopic and aerobic culture methods. Isolated bacteria were identified and susceptibility tests were carried on by Bauer & Kirby method.Results: Of the total specimens studied 14 (35%) culture were negative and the remaining 26 (65%) had positive results. In 15 cases (37.5%) one bacteria,8 cases (20%) two organisms and 3 cases (7.5%) three organism were obtained. The isolated bacteria in different wards showed different sensitivity pattern to antibiotics. In Orthopedic ward, 11cases of S. aureus showed the highest sensitivity to vancomycin (1=18.18%, S=54/54%) but, in other wards, 4 species of S.aureus were found the resistant to vancomycin and showed sensitivity only to rifampicin.Conclusion: In view of the high rate of postoperative wound infections specially with vancomycin resistant Staphylococcus aureus, strict control measures are needed to reduce the level of infection in hospitals.

Background and Objectives: Diabetic retinopathy is one of the four important reasons of blindness through out the world. The goal of present project was evaluation of types of diabetic retinopathy patients that were under coverage of Hamadan diabetic center in 1999.Materials and Methods: This work was a descriptive-analytic retrospective study based on medical files of two thousands diabetic patients. It is acquired from patients' files including ophthalmologic examination and patients past medical history and interview.Results: Our results showed that 262 persons (96male and 166 female) of diabetic patients (13.1%). had one of the different kinds of diabetic retinopathies. The highest rate of frequency (26.6%) belonged to patients who had 16-20 years of positive history of illness. The rate of retinopathy was increased by increasing the diabetes period (p<0.01). According to our results, patients over 60 years had the highest rate (19.8%) and patients under 20 years had the lowest rate (3.1%) of diabetic retinopathy. This difference was significant (p<0.01). By evaluating factors related to diabetic retinopathy: hypertension had the highest association (54/6%).Hyperlipidemia, renal failure, cigarette smoking and ischemic heart disease were in the subsequent steps.Conclusion: Frequency of diabetic retinopathy in our study (13.1%) was lower than other studies and hypertension was the most important risk factor.

Background & objective: Scalp hair is very important from cosmetic aspects in addition to barrier function, so alopecia may result in psychiatric complications. Androgenetic alopecia is one of the most important categories that many of topical and systemic therapies have significant side effects. This survey has compared effectiveness of 2% minoxidil solution with 2% progesterone solution.Methods and Materials: Seventy female patients with female pattern androgenetic alopecia were selected .Thirty five patients applied 2% topical progesterone, 2ml daily, and 35 patients applied 2% minoxidil solution 2ml daily for a year. All patients admitted monthly for follow up assessment according to subjective and objective (increase in hair number per centimeter square) aspects.Results: In 85% of patients who applied 2% minoxidil hair loss stopped and new hair grew. 71% of other group had same results (P=0/145).Conclusion: Topical progesterone is an effective, cheap and available therapy for treatment of androgenetic alopecia, so more surveys about its effectiveness are necessary.

Background and objectives: Blood gas analysis is one of the main diagnostic tools for acid -base imbalances. By considering the invasive nature of arterial blood gas analysis out its problem hazards such as arterial spasm, there is an increasing trend toward non-invasive methods such as venous blood gas analysis. This study was aimed to survey the validity and clinical agreement of venous blood gases in main ten diseases occurring in intensive care unit to determine whether they can substitute the arterial blood gases.Material and methods: In a cross sectional - analytical study 10 disease which consist the most burden of admission in intensive care unit was surveyed. Duration of study was one year (Oct 2004- Oct 2005).In this study the venous blood was simultaneously sampled with arterial blood and their different parameters such as pH, PCo2, Hco3, and Po2 were analyzed. The results were assessed with different statistical methods such as validity and clinical agreement or kappa test.Results: findings indicate that in respiratory distress syndrome, sepsis, pneumonia, renal failure, diabetic Ketoacidosis, and status epilepticus, there is a good validity and fair to good clinical agreements (>40%) between arterial and venous blood gas analyses. But in other disease such neural seizure, shock, congestive heart failure and congenital heart disease there is a low validity and negligible kappa test (<20%).Conclusion: based on the findings, at least in 6 of 10 diseases, venous blood gas analysis can be substitute those of arterial blood. The result can be used to develop guide lines for intensive care unit.

Background and objective: Children with neurological Impairment which have sever disability are high risk for high rate of respiratory problems. There are some reasons such as recurrent aspiration due to motor dysfunction of oropharynx or Gastro esophageal reflux and poor cough or airway clearance and respiratory muscle weakness for above mentioned problems.A study in Canada indicated that from 228 children with recurrent pneumonia 220 (92%) of them had an underlying disorders. 114 (47/9%) of them were involved with Aspiration syndrome secondary to discoordination of orophayngeal muscles, which has lead to poor clearance of respiratory tract. In these patients, cerebral palsy accounted for nearly half of the cases. In the other hand in neuromuscular disorders, reduced muscular strength can result in respiratory muscles involvement. Regardless of silent trend, respiratory failure is the leading cause of mortality in spinal muscular dystrophy, Duchene, myasthenia gravis and congenital myotonic dystrophy.This study was aimed to recognize the prevalence and Type of pulmonary involvement in patients with neurological impairment who had been hospitalized in Tabriz Children Hospital.Materials and methods: in a Comparative - Cross sectional study from September 200 I to September 2005, fifty patients with different types of neurological disorders were compared with fifty patients who were hospitalized due to other Diseases.Two group were matched for age and gender. The results were analyzed with chi-square.Results: The findings indicate that pulmonary involvement in case group has higher prevalence than control (P=0.0002). at the same time in pulmonary collapse with (P=0.01) consolidation (P=0.003), Bilateral pulmonary involvement (P=0.04) there is significant difference between two groups.Conclusion: Patients with neuromuscular disorders have high rate of respiratory problems which are silent and the diagnosis may be delayed. It is advised that enough attention should be payed to prevent aspiration. Chest physiotherapy and suitable nutritional and antibiotic intervention would be inevitable.

Background and objectives: Role and interaction of iron and antioxidant vitamins on DNA damage are not clear, so we decided to determine the effect of iron only (as Fe+3) or together with Nitrilotriacetic acid (NTA) on DNA, and then assay effects of vitamin C, E and b - carotene on iron induced DNA damage in an In vitro model.Materials and Methods: Caco-2 cells, the model of gut epithelium, were incubated with medium containing supplemented iron (0-560 micromole/Litter) as FeCl3 or iron plus NTA (Fe/NTA) for 30 minutes, and then DNA damage was measured. In the second part of study, the cells were incubated with 160 mM/L of iron (as Fe+3/ NTA) together with various doses of vitamin C (0-320 m M/L), E(0-320 mM/L), or b-carotene (0-12 mM/L).Then DNA damage was measured.Results: Our study showed iron as Fe3+ doesn't have any effect on DNA, while together with NTA, caused significant DNA damage at doses higher than 160 mM/L. Vitamins C and E at low doses (2.5 and 2.5-10 m M/L, respectively), decreased iron-induced DNA damage(p<0.05). b- carotene doesn't have significant effect in reducing of iron-induced DNA damage. At higher doses, all vitamins increased iron-induced DNA damage (p<0.05).Conclusion: In this in vitro model, soluble iron at high concentrations can cause DNA damage. In the presence of high concentration of antioxidant vitamins, this effect of iron can be strengthened.

Background and Objectives: Spinal Muscular Atrophy (SMA) is one of the major neurodegenerative disorders leading to weakness and atrophy of voluntary muscles and causes death in patients. This disease forms the second most common fatal autosomal recessive disease after cystic fibrosis, with an incidence of 1 in 10000 newborns and carrier frequency of 1/40 to 1/50 in different populations. SMA could be classified into three groups based on the age of onset. Linkage analysis has revealed that all three forms of SMA maps to 5q 11.2-q13.3. Application of microsatellites located in the region could be useful for identifying carriers in affected families. Materials and Methods: Families of SMA patients diagnosed by neurologists and molecular genetic method were investigated in this study. Parents of patients were studied for the polymorphism of micro satellites selected from the SMA region. Linkage analysis was performed to detect carriers in these families with confidence of more than 98%.Results: In this study 21 affected families were analyzed. Three different microsatellites located in the interested region (D5S637, D5S1408 and D5S1414) were utilized. D5S637 in none of the families was polymorphic. D5S1408 in 2 families (9.5%) and D5S1414 ill most of the families (70%) were polymorphic.Conclusion: we could utilize D5S 1414 to detect carriers of SMA ill affected families from east azerbaijan by linkage analysis.

Background and Objectives: Dialysis is the last treatment of renal failure. Regard the increasing patients undergoing dialysis because of increasing survival, sexual dysfunction is a common finding in male hemodialysis patients. In the USA 82% of dialytic patients have importance but in Iran we have no statistics about this problem and this is the reason for doing this research. Material and Methods: This is a clinical trial A total of 148 male patients were included in the study. We studied married men, aged 18 years or older, who were treated with chronic (hemodialysis, HD) for at least six months. The IIEF domain scores were calculated and erectile dysfunction grading was determined on erectile function domain and relation of some parameters such as diabetes duration of dialysis, cigarette smoking with importance by use of odd Ratio and SPSS was assayed.Results: The prevalence of any level of (Erectile dysfunction, ED) was 92.5% for all hemodialysis subjects. The prevalence of severe ED was 61.5% There was no problem in 7.4 percent of cases. Prevalence of another features of impotence were calculated; premature ejaculation (33.1%), anejaculation (45.27%), retrograde ejaculation (5.4%) and decreased libido (70.2%). There was significant relation between parameters such as age, duration of dialysis, diabetes, depression, smoking, frequency of dialysis, cause of renal failure, drug usage, hypertension with impotence. Conclusion: ED is extremely prevalent among HD patients. Increasing age, prolonged duration on dialysis, depression, diabetes and non use of ACEIs, were associated with higher prevalence of ED. Evaluation for ED should be included, in routine assessment of hemodialysis patients. Because the most of organic changes are irrevessibe and the treatment becomes problematic, charging the style of life and sexual assessment is recommonded.

Background and objectives: Tibial shaft factures is one of the common fractures due to motor vehicle accidents. However, there is controversy in the treatment of aforesaid fractures. In this study we assessed the effect of Enders nailing in the treatment of these fractures.Materials and Methods: This is a descriptive and crosses - sectional study. Fifty-eight patient (41 male and 17 female) with a mean age of 37/24±13/25 years and 64 tibial shaft fractures were treated at shohada hospital between 2000 and 2003, with 2- 4 enders nailing.Results: thirty-four (47%) of fractures were close and therty (47%) of them were open. Fortyeight (75%) united radiologically at 4.5 month, 11(17%) at 4-8 month, 5 (7.8%) not united after 8 month. Six (3/9%) patients had less than 10° malunion and 5 (7/8%) had infection .five (7/8%) patients had soft tissue irritation at the proximal tibia due to protruding Ender nails.Conclusion: Enders nailing of tibial shaft fractures especially with non segmental combination ones is an acceptable technique in the treatment of tibial shaft fractures.

Background and Objectives: Nowadays, in study of psycho-body effects of stress, monoamine system of brain has gained special attention and known that stress cause behaviors which emerged by activating of monoamine systems including serotonergic system. The present investigation aimed to study the effects of brain serotonergic system on stress-induced behavioral responses.Methods and Materials: Four groups of albino Wistar male rats (250-300g) were selected. Control group were exposed to tail pinch stress for 5 min. Tail pinch stress causes a variety of behavioral responses including gnawing, licking and aggression in rats. In the present study, duration of gnawing was measured. In other groups microdialysis probes were implanted in the raphe nucleus under cloral hydrate (500 mg/kg Lp) anaesthesia. In the sham group ringer solution was perfused (2m mol/min) with tail pinch stresses (5min) that was performed. In the third group high concentration of potassium (100 mM/Lite) was added in ringer solution and in the fourth group cadmium chloride substituted with calcium chloride and then exposed to stress.Stress-induced behavioral responses were measured like sham and exam groups. Results: There was no significance difference in sham group compared with control group. Duration of behavioral response was decreased significantly in third group (p<0.001). But in fourth group behavioral response is which and compared with control and sham groups, showed significant increase (p<0.003).Conclusion: Our result suggests that: brain serotonergic system in response of animal to stress and model of behavior response has inhibitory effect. Our results enhance previous information about monoamine system in process of stress and these results lead to specifY of treating diseases caused by stress and avoiding the adverse effects of prescribed drugs.

Background and Objectives: Extracorporeal shock wave lithotripsy (ESWL) has replaced most surgical and endourologic froms of therapy for urinary tract stone disease.Despite its proved safety and efficacy, its adverse effects on renal function are still to be identified. A newer diagnostic technique, color Doppler utltrasonography, has brought a new insight into renal function. It enables precise evaluation ofthe renal vascular supply. Change in intrarenal vascular resistance after ESWL were studied with Doppler ultrasound techniques.Material and Methods: In 55 consecutive patients the resistive index (RI) was measured at an interlobar artry before and 30 min after ESWL in the treated kidney. In 22 patients follow-up Doppler study performed I week after ESWL.Results: In the treated kidney, RI significantly increased from 0.62±0.05 (mean±SD) on baseline to 0.66±0.06 (p= 0.0001). There was no significant correlation of increase in RI with patient age. A follow-up doppler study showed that the mean RI didn't return to pretreatment level after 1 week and elderly patients (> or=60 year old, n=3) had higher RI levels (0.76±0.05) on baseline than younger patients (< 60 years old, n=I9) (0.64±0.06). No correlation was found between ESWL voltage or number of shock waves and changes in RI before and after ESWL. Conclusion: Because of increasing RI levels on baseline, patients have a risk of post -ES WL renal tissue damage. The measurement of change in RI with Doppler ultrasound techniques after ESWL may provide useful information for clinical diagnosis of renal tissue damage.

Background and Objectives: Since paper currency is widely exchanged for goods and services, money could play a role in spreading bacteria through contact. This study was performed to survey the bacterial contamination of paper money in Iran, and the potential to spread organisms from person to person.Materials and Methods: In this study 100 bills (500, 1000, 2000, 5000, 10000 rials) and 150 coins (50, 100, 250 rials) were collected from different parts of general community in Mashhad.Pathogenic or potentially pathogenic organisms were isolated and identified by broth wash and culture on appropriate media. Results: Bacterial contaminations were as follows: 46% Bacillus species, 18.8% coagulase-negative staphylococci, 11.2% Enterobacter species, 7.6% E.coli. In this study coagulase-positive staphylococci (2%), Klebsiella species (0.8%), Pseudomonas species, Citrobacter and Arizona species (0.4%) were the least isolated bacteria. Twenty percent of banknotes and 1% of coins had no significant contamination detected by our methods. Bacterial contaminations on coins are similar but it isn't so in banknotes. Conclusion: Our results and information from other Studies do suggest that paper currency is commonly contaminated with bacteria and this may play a role in the transmission of potentially harmful organisms. According to our results cash should not be handed by children and should be kept away from food and cosmetics.

Background and Objectives: Tracheal intubation is a safe and practical way currently used in airway management. In this regard, preanesthesia airway assessment and prediction of probable difficult laryngoscopy and intubation remained a basic and important problem. Several predictive methods, including mallampati score were used for assessment of airway. The aim of this study was to evaluatet effectiveness of mallampatti's test on laryngoscopic grading.Materials and Methods: In a prospective, randomized, double blind Study 500 patients undergoing surgery were evaluated to compare mallampati classes with grading of laryngoscopy. The incidence of mallampati classes from I to IV and laryngoscopic grading from 1-4 were determined alone and laryngoscopic grading were compared in each of the mallampati classes separatively. Statistical analysis was preformed using Fisher's exact test.Results: In this study the distribution of laryngoscopic grading in the different classes of mallampatti and the sensitivity of mallampati in prediction of laryngoscopic grading for different classes were determined.There was significant difference in distribution of laryngoscopic grading in the different classes of mallampati score (P<0.001). The results between sex groups in women were statistically Significant. (In men P=0.110 and in women P=0.001). But in comparing the sex groups with each other, there was not any significant differences (P=0.05). In addition the Specificity of the test, the accuracy, positive predictive value and negative predictive value were 17.02%, 90.4%, 47.05% and 91.09%, respectively. Also the sensitivity of mallampati score in diagnosis of difficult laryngoscopy was 47.05%.Conclusion: Difficulty in managing of the airway is the most important cause of major anesthesia related morbidity and mortality. Therefore the sensitivity for mallampati score to detect laryngoscopic grading was determined.According to the results, it is better to use multiple tests simultaneously for evaluating and predicting of difficulty in airway.

Background and Objective: Measles is one of the most contagious viruses known to man and despite the availability of an effective vaccine; measles continues to cause thousands of deaths annually in the world. In 2003, an estimated 530000 Measles deaths occurred in the world. In 2000, following rapid success with the polio eradication initiation, Iran hopes to eliminate and eradicate measles by following the recommended world health organization (WHO) strategies. Therefore, seroepidemiology survey of measles in 5-25 years old in 2003 before measles/rubella mass vaccination campaign should be achieved.Materials and Methods: 225 samples were collected from the Tabriz city. All samples were centrifuged to separate serums and then stored at 4-8 °C and transported to National Measles Laboratory in Tehran University of Medical Sciences. The Hemagglutination Inhibition (HI) test was used to determine the level of anti-measles antibodies.Result: Anti-measles antibody was detected in 91.6 % of persons and 8.4% were negative. The highest level of Anti-measles antibody was observed in 20-25 year old age group (94.9 %), while the lowest value was measured in 15-19 years old age group (85.7 %).Conclusion: Results of this study indicates that the immune status to measles in Tabriz city is suitable. Although there is high level of anti-measles antibody, but 19 percent of measles cases that reported in Azarbayjan-Sharghi province in 2003 were from this city, therefore the disease was endemic before mass vaccination in Tabriz city. Seroepidemiological studies before and after mass vaccinations are powerful tools to monitor the effectiveness of immunization programs. Comparison of the results obtained, offers an opportunity to look for clustering of susceptible individual based on serological profile.

Background and Objectives: Depression is one of the most common psychiatric disorders which involve women two times more than men. Pregnancy accompanied by other predisposing factors can result in onset or exacerbation of depression. Fifteen percent of depressed patients finally commit suicide. The aims of this study is to find the relationship between depression and age, level of education, economic status, gravidity, gestational age, emotional relationship with partner, and occupational stauts.Material and Methods: This is a descriptive study which was carried on 300 pregnant women. Data were collected by Zung questionnaire which was completed by pregnant women. The data analysed by Chi-square test and SPSS software. Results: In this study 32% of pregnant women were suffered from depression. among this group 22.33% had mild depression, 6.67% moderate depression, and 3% severe depression. Following conditions were related with high frequency of depression: poor economic status, primigravidity, having more than three pregnancies, unemployment, and poor emotional relationship with partner. There wasn't significant difference between depression and age group, level of education, and gestational age.Conclusion: Prevalence of depression in pregnancy is reported in textbooks up to 22%, but in our study and similar studies in our country prevalence of depression is higher. We found significant relationship between depression and poor economic status, primigravidity, having more than three pregnancies, and poor Emotional relationship with partner (p.value£0.05).

Background and Objectives: LASIK (laser in situ keratomileusis) is the most common referactive surgery especially for myopia and retinal nerve fiber layer damage may be occure due to increased intraocular pressure during making the flap. To evaluate the effect of on retinal nerve fiber layer (RNFL) thickness measurements obtained with aCT (optical coherence to mography) Material and Methods: 28 eyes (14 patients) undergoing LASIK were enrolled in this study.aCT examination was performed I week prior to and 4 week after LASIK surgery. Intraocular pressur was normal at all preoperative and post operative examinations. Mean RNFL thickness measurements along the whole circle and the four sectors were obtained by aCT and compared with paired t test.Results: Mean patient age was 30±3.5 (SD) years (range, 24 to 36 years). Mean preoperative spherical equvalant refractive errors was - 4.75±2 diopters (0) (range, - 1.75to - 9.50) Mean ablation depth was 72.5±25.5mm (rang, 30mm to 118 mm 11). Mean RNFL thicknesses obtained by aCT were unchanged 1 week and 4 weeks after LASIK (p > 0.05, for all comparsions, paired t test).Conclusions: LASIK does not affect RNFL thickness.

Background and Objectives: Contamination of cereal commodities with mycotoxins represents a significant hazard to consumer health and has thus received increasing attention from food safety authorities and legislators. For trichothecenes, in particular, the imminent implementation of legislative limits has focused attention on ways to prevent entry of such mycotoxin contaminants into the food and feed chains. Various speeies of Fusarium genus are produeer of different myeotoxins (nearly 70 toxins) that called Triehotheeenes and T-2 Toxin, HT-2 Toxin, DON, NIV, NEO, DAS, FUS-X are the most important mycotoxins of this group. These mycotoxins can enter into the human food chain and cause primary and secondary mycotoxicosis in humans and animals. Also some of these mycotoxines have been used as biological weapons.Materials and Methods: In this survey, contamination of some randomly eollected agricultural products such as cucumber, aubergine, pea, apple, pear and tomato to trichothecenes producer Fusarium was investigated using dtrect microscopic examination and eulture samples in specific media such as Sabouraud's Dextrose Agar(S) and S medium + Chloramphenieol (sq.Results: From studied foodstuffs the following species of Fusarium mold were identified: F. lateritium var. ciceri, F. lateritium var. mori and F. oxysporum var. tuberose.Conclusion: Regarding to the health problems resulted from mycotic contamination of nutritional produets, the study calls for more attention of regional health and agricultural authorities and legislators.

Background and Objectives: Extended -spectrum b- lactamase (ESBL) producing bacteria have been detected worldwide. Production of these enzymes by bacteria often causes resistance to a wide variety of antibacterial drugs. Infection with this kind of bacteria has been life threatening, especially among patients in intensive care unit (ICU). In this study, the prevalence and plasmid profiles of ESBL producing Enterobacteriaceae isolated in Children hospital of Tabriz has been studied. A better knowledge of ESBL prevalence rate can lead to a more effective treatment strategy.Materials and Methods: Antibacterial susceptibility tests for the isolated bacteria were carried out according to Kirby & Bauer disk diffusion method. Strains were then screened for ESBL production by double disk and combined test methods followed by MIC determination with E-test. The plasmids of the ESBL producing isolates were extracted by alkaline lysis method. Electrophoresis of the purified plasmids were performed in 0.8% agarose gel.Overnight incubation at 44 °c was used for plasmid elimination.Results: All of the Pseudomonas aeruginosa and Enterobacter cloacae isolates and 90.9% of Klebsiella pneumoniae strains isolated from the ICU residing patients by E-test were shown to be ESBL- producers. Plasmid profiles of the isolated bacteria revealed five distinct clonal types.Conclusion: Selective pressure due to excessive antibiotic therapy often results in ESBL prevalence. Our results indicated that the ESBL enzymes belonged to the CTX-M and AmpC group. Further molecular studies are needed.

Background objectives: For the first time, in 1993, the world health organization presented a program for primary prevention and mental health promotion with the name of life skills training. this program has been applied in different countries, and in Iran. This research, presented, for evaluating the program has been applied in sanandaj. Materials and methods: This study has been experimental and performed in the forth grade of primary schools with systematic random sampling. Sample size included 167 students in control group and 173 students in case group. The study has been done in two steps: First, the content and concurrent validity of the questionnaire, evaluated, proved appropriate and it's consistency, proved acceptable too Second, the level of students' awareness of two groups about life skills has been evaluated by the questionnaires.Results: The results of the study showed that level of awareness has been increased in case group significantly (p<0.01). The result was different among the boys and girls. The average score in girls has been higher than boys (p<0.01). In students, the level of awareness of life skills is consistent with their educational status.Conclusion: In spite of our limits in doing research, the result showed, the program has been efficient. Of course the study showed, the training is more effective in girls than boys so it is necessary, to be flexible with the programs for boys and girls in future and, to promote the quality of the evaluation.

Background and Objectives: chronic otitis media is defined as irreversible inflammatory changes in the middle ear and mastoid bone; leading to otorrhea, hearing loss and numerous intracranial and intratemporal complications. Surgical techniques for the treatment of this disease are staged and performed by at least 6 months intervals .Generally after irradication of the infectious process in the first step, ossicular reconstruction is performed in subsequent stages.Unfortunately due to cultural and economic poverty, most patients refuse multiple admissions and continue to live with their hearing loss. The purpose of this study was to merge multiple stages of surgery and perform single stage ossicular reconstruction by remnants of the patient,s ossicles or pieces of the mastoid cortex.Materials and Methods: In this study, 33 patients admitted to the Otorhinolaryngology ward of Imam khomeini Hospital in Tabriz between 2003 -2004, underwent audiometric testing and subsequent surgery. Then results of audiometry 4 months after surgery were compared with preoperative values and analyzed by Wilcoxon test for two related samples SPSS 11/00.Results: In 16 patients tympanomastoidectomy and in 17 patients tympanoplasty was performed. Ossicular reconstruction was performed by the mastoid cortex in 5, sculptured malleus in 1 and sculptured incus in 27 patients. Mean follow- up time was 4 months postoperatively.Mean air bone gap(average gap between bone conduction thresholds and air conduction thresholds at 500Hz, 1000Hz, 2000Hz) was 47 dB before surgery. Mean speech reception threshold was 58dB before surgery. Postoperatively, mean air bone gap was 15dB and mean speech reception threshold was 25 dB (p<0.05). Air bone gap postoperatively was less than 20 dB in 25 patients and greater than 20 dB in 8 other patients.Conclusion: Single stage ossicular reconstruction by autologous material is a safe and effective method for the restitution of the sound transmitting system in patients with chronic otitis media.

Background and objectives: Under five Year mortality rate is one the important indicators of health and development in various countries. Although it is reduced to half worldwide and in our country in the past decades but it is yet growing in some countries. This study has been done for documentation of children mortality trend in recent 10 years (1993-2003) in the East Azarbaijan province and also to demonstrate it's situation in the country and world. This study also will have a look to important causes of death in children in the province and will have some suggestions to improve the situation. Materials and Methods: This study is a descriptive study, in which all of the rural area population in East Azarbaijan was studied in 1993 and 2003. Variables like neonatal, infant and under five mortality rates were studied. Data were collected based on vital horoscope documentation which is used in health houses for data gathering. After correction, data were analyzed. Results: Under-five mortality rate in rural areas of East Azarbaijan province was %47.78 and %27.35 at 1993 and 2003 respectively. This province enjoys more decrease in child mortality rate in comparison with country's average in the past decade. The most important factors of mortality of children are accidents, acute respiratory infection and diarrhoea in order of occurrence.Conclusion: East Azarbaijan provience has reached to the lower average of the lower average of child mortality rate in the country during 1993-2003. In comparison with the country level East Azarbaijan has acceptable achievements in child mortality reduction and child health promotion.

Background and objectives: Meningococcal meningitis is a medical emergency, so far. The pharyngeal area of human is the only known reservoir of infection. The residents of crowded semi closed communities are at higher risk for acquisition of infection. In a prospective study, the changing of meningococcal carrier rate was considered during two months accommodation in dormitories among newly arrived students.Materials and methods: In this study, the carrier status of students defined by double tonsil pharyngeal sampling. The first one performed at the time of admittance and the second, two months then after. The meningococci were identified by routine standard methods.Serogrouping of some isolates characterized by slide agglutination test.Results: The alteration of meningococcal carrier rates was 8.4% to 17.5% for male students during September and November. It was 5% to 11% for females. In the second semester it changed from 8.5% to 14.9% and 5.7 to 7.7% for male and female students, respectively.Statistically the difference between the carrier rates of dormitory resident first semester male student was significant. The dominant serogroup was group A. The higher carrier rates found among addicted to smoking or those with smoker roommate.Conclusion: Dormitory resident male students are at higher risk of meningococcal carriage status in cold seasons. According to the results of present study although the maximum carrier rate did not reach to the critical 20% limit but it is close. This investigation offer the necessity for performance of similar studies in cold parts of country, there dormitory resident students spend much more time together. In order to prevent meningococcal diseases, parallel to military recruits and Hajj pilgrims, planning of meningococcal vaccination of university students might be useful.

The most common disease of the facial nerve is Bell's palsy. This disorder affects nerve peripherally. Regarding causation of Bell's palsy, a viral agent has long been suspected, but its definite cause has not been found yet. Familial occurrence of Bell's palsy is occasionally seen, so inheritance has been suspected in its ethiology too. In this paper, 6 cases running through two generations of an Iranian family with Bell's palsy are described. No any other neurologic disorder has been seen among cases. This report demonstrates the role of heredity as an ethiologic factor in Bell's palsy, and the mode of inheritance possibly to be autosomal dominant inheritance.

Dupuytren's contracture is a rare disease in 5thto 7th decades and is common in men. This case was an eighteen years old woman, with nodules in bases of 2nd & 3rd fingers from 9 years ego, and progressive weakness and atrophy in left upper limb, and flexion contracture in same fingers that referred to electrodiagnosis.