MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2011 | Volume:33 | Issue:1|Papers Count:21

Background and Objectives: Laser refractive surgeries such as LASIK are effective techniques to correct the refractive errors, but it increases the higher order aberrations and subsequently decreases visual quality. The aim of the present study was to evaluate changes of higher and lower order aberrations after LASIK in myopia and myopic astigmatism.Materials and Methods: In this cross-sectional survey 100 eyes from 50 patients with myopia and myopic astigmatism were evaluated. Complete eye examinations were performed and best corrected visual acuity was determined in all patients preoperatively. Furthermore, ultrasonic pachymetry and topography linked aberrometry was performed. Higher and lower order aberrations (HOAS, LOAS) were measured. Uncomplicated LASIK was performed with Schwind ESIRIS system and at least 3 months after LASIK all parameters were recontrolled.Results: Mean pre- and postoperative manifest refraction spherical equivalent (MRSE) was -4.78±2.01 D and -0.34±0.20 D (P<0.001). Mean pre-LASIK total aberrations were 5.66±2.24mm that decreased to 1.47±0.67mm postoperatively. Following operation, focus and astigmatism (LOAS) decreased from -21.41±8.02mm and 4.34±3.24mm to -2.78±2.10mm and 2.48±1.53mm, respectively (P<0.001). Mean preoperative HOAS was 0.27±0.11mm that increased to 0.48±0.30mm postoperatively (P<0.001). This increase was correlated with amount of SE correction.Conclusion: Conventional LASIK corrects myopia and myopic astigmatism and decreases total aberrations and LOAS, but increases HOAS that is positively correlated with the amount of attempted MRSE correction.

Background and Objectives: Anesthesia for ophthalmic surgery requires management of intraocular pressure (IOP) during preoperative period. Any degree of IOP increasing could reduce visual acuity. Administration of narcotics concomitant with anesthetics has the ability to reduce this increase of IOP. This clinical trial aims to compare the efficacy of Remifentanil and Alfentanil in preventing an increase in IOP after administration of succinylcholine, intubation and during anesthesia.Materials and Methods: This double blind clinical trial was intended to 50 patients undergoing elective general surgery for cataracts. Patients were randomly divided to two groups; Alfentanil (20 mg/Kg in 30 second) for group 1 and Remifentanil (1 mg/kg in 30 second) for group 2 were injected before induction of anesthesia and 0.5 mg/kg/min Alfentanil for group 1 and 0.1 mg/kg/min Remifentanil for group 2 were infused during the anesthesia. Systolic and diastolic blood pressure, heart rate and IOP from normal eye were measured before the induction, after administration of thiopental and succinylcholine, after tracheal intubation and 2 minutes later and were repeated in 2-minute intervals until the end of operation.Results: IOP decreased after injection of anesthetics and remitted lower all through the operation in both groups, but IOP decreased after injection of succinylcholine in Remifentanil group while it increased in Alfentanil group (P<0.05).Conclusion: Results of this study indicate benefits of both Remifentanil and Alfentanil for managing IOP after induction and during anesthesia. It seems that Remifentanil is better than Alfentanil in controlling the IOP after injection of succinylcholine.

Background and Objectives: Several risk factors are associated with development of exudative age-related macular degeneration (ARMD). Disequilibrium between body oxidants and antioxidants status has been proposed as one of the main risk factors of the disease. The aim of the present study was to investigate the possible role of hyperhomocysteinemia and reduced paraoxonase activity in pathogenesis of the exudative ARMD.Materials and Methods: In a case-control study, forty-five patients with the exudative ARMD referring to Tabriz Nikookari Hospital, and 45 healthy people as control were recruited. Paraoxonase-1 (PON1) activity, homocysteine and oxidized low density lipoprotein (LDL) were measured by spectrophotometric and ELISA methods.Results: PON1 activity level was significantly reduced in patients with the exudative ARMD than the control group (P<0.05). The levels of homocysteine and oxidized LDL were markedly higher than those of the controls (P<0.05, in both cases).Conclusion: Increased plasma oxidized LDL levels as an index of oxidative stress in the exudative ARMD patients may be due to higher levels of homocysteine. Moreover PON1 activity is not sufficient in prevention of the exudative ARMD; because exudative ARMD is a multifactorial disease.

Background and Objectives: The increasing use of devices such as cell phones poses a question whether these waves have effect on different tissues of the human body. So far many studies have been conducted on ultrastructural influence of these waves on organs such as brain, kidney, etc. According to its location, retina is directly exposed to this radiation. The aim of the present study was to investigate the effects of electromagnetic waves with frequencies from 50 Hz to 60 Hz on ultrastuctural and morphometric changes in different layers of the retina.Materials and Methods: Male rats were divided into two groups; experimental and control. Experimental group was under magnetic field (3 millitesla) for 4 weeks. Samples were evaluated by light and electron microscope.Results: In experimental group, total retinal thickness was significantly increased compared with the control group (132±7.78 vs. 89.47±3.83, P=0.0005). Furthermore, external nuclear layer thickness was 32.23±3.2 microns in experimental group compared to that in the control group (20.15±1.43 microns) (P=0.0005). In the experimental group, the number of nucleus in each 25×25 micron area was 13.64±0.89 compared with the control group (7.30±0.95) (P=0.0005). Moreover, core dimensions of light receptor cells in the experimental group was 3.85±0.36 compared to the control group (2.62±0.23) (P=0.0005).Conclusion: Light receptor cells show increased proliferation under the effect of magnetic field.

Background and Objectives: Pulmonary complications of breast cancer radiotherapy are inevitable. One of methods to assess respiratory alterations is pulmonary function test named spirometry. The aim of the present study was to investigate the effect of radiotherapy on pulmonary function test and to study the related factors.Materials and Methods: Seventy five patients with stage II and III (TNM staging) of breast cancer undergoing ipsilateral mastectomy and 6 cycles of chemotherapy were included in our study. Spirometry was performed before and 3 months after radiotherapy; the patients were examined at the same time by a specialist for respiratory complications. The measured parameters were forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) which were normalized by age and sex.Results: The Mean age of the patients was 45.6±7.92 years. The mean length and width of tangential field was 18.2±1.8 and 6.7±1.37 cm, respectively. The mean central lung distance was 2±1.07 cm corresponding to 22% of the irradiated volume of lung at maximum. The mean FEV1 percent before and after radiotherapy were respectively 74.9±15.99 and 78.86±12.55, respectively (P=0.09). Moreover, the mean FVC percent before and after the radiotherapy were 72.17±14.26 and 74.60±11.36, respectively (P=0.07).Conclusion: Three months seem not to be enough for showing pulmonary changes due to 60Co radiotherapy. Moreover, the role of minimizing central lung distance through planning may be crucial to reduce the possibility of radiation pneumonitis.

Background and Objectives: The main etiology of infantile hypertrophic pyloric stenosis (IHPS) is still unknown. Recently, it has been suggested that Helicobacter pylori might be a cause of IHPS on the basis of its epidemiologic and clinical features. We performed this study to evaluate the possible relationship between IHPS and H. pylori.Materials and Methods: In a case-control study, 20 infants with definite diagnosis of IHPS referred to Tabriz Children’s Hospital were evaluated during an 18-month period. Thirty otherwise healthy sex and age-matched infants were randomly recruited as the control. Serum antibody against H. pylori (IgG) was measured by serological method in infants and their mothers. Furthermore, stool H. pylori antigen was evaluated by ELISA in the infants.Results: Twenty infants with IHPS, 18 males and 2 females with a mean age of 42.40±19.09 days and 30 controls, with a mean age of 44.67±12.65 days were enrolled (P>0.05). In the case group, 18.2% of the infants had positive H. pylori infection comparing with 23.1% of the controls (P=1). All the mothers of the case group had positive H. pylori infection comparing with 95.8% of those of the control group (P=1). Considering a simultaneous infection of H. pylori, 18.2% of the mothers and infants of the case group had positive H. pylori infection comparing with 33.3% of the mothers and infants in the control group (P=0.617). The mean titer of infant serum H. pylori antibody was comparable between the two groups (14.21±8.18 ng/dl vs.11.80±19.07 ng/dl in the case and control groups, respectively; P=0.342). On the other hand, mean stool antigen was significantly higher in the case infants (1.74±4.59 ng/dl vs.0.62±0.44 ng/dl; P=0.010).Conclusion: According to our results, there might not be a connection between H. pylori infection and IHPS in infants.

Background and Objectives: A well-functioning arteriovenous fistula (AVF) is essential for maintenance of hemodialysis in patients with chronic renal failure. Color Doppler ultrasonography has been proven to be effective in the assessment of anatomical vascular features. The majority of studies were done in patients with clinically presumed AVF complications. However, only limited data are available about the well-functioning mature arteriovenous fistulas. The purpose of the present study was to evaluate completely asymptomatic AVFs with color Doppler ultrasound.Materials and Methods: In an analytic-descriptive cross-sectional study, 50 patients with clinically well-functioning AVFs were evaluated during a 14-month period in Tabriz Imam Khomeini Hospital. These patients had normal blood pressure and routine serum laboratory factors were within normal range. The AVFs were assessed by color Doppler ultrasound and the flow parameters and probable present complications were investigated.Results: Fifty patients, 30 males and 20 females with a mean age of 51.58±20.27 years were recruited. The mean duration of hemodialysis was 47.88±36.61 months. The mean flow volume was 1009.76±561.84 mL/min. The mean resistive index was 0.51±0.08 in the studied population. The mean pulsative index was 0.89±0.16 with a mean peak systolic velocity of 87.90±33.65 cm/s and a mean diastolic velocity of 56.28±18.36 cm/s. Each aneurysm, stricture and hematoma was present in 4% of the studied AVFs. Overall presence rate of any complication was 12%.Conclusion: Based on our results, color Doppler ultrasound may be used for evaluating the condition and function of the AVFs in patients under hemodialysis. The rate of occult complications in apparently normal-functioning AVFs is considerable and routine screening programs might be helpful.

Background and Objectives: Knee pain is a common complaint after intramedullary nailing of tibia. Several entry sites have been described, but the optimal site remains a topic of debate. The aim of this study was to compare two surgical approaches, transpatellar and medial parapatellar tendon in tibial intramedullary nailing for treatment of tibial fractures.Materials and Methods: In a randomized clinical trial, 50 patients with fracture of tibial shaft were recruited during a 16-month period in Tabriz Shohada Hospital. Intramedullary nailing was employed as the surgical technique in all patients through two different approaches; transpatellar (group T) and medial parapatellar tendon (group M). Patients were randomly assigned to each group (25 patients in each group). Pain was assessed by visual analogue scale (VAS), as well as range of motion (ROM) 2 weeks and 1, 3 and 6 months after operation.Results: There were 23 males and 2 females with a mean age of 28.68±5.76 years in group T and 21 males and 4 females with a mean age of 28.80±5.82 years in group M (P=0.667 and 0.942, respectively). The mean score of pain (VAS) was significantly higher in group T three and 6 months after operation comparing with that in group M (P=0.013 and 0.009, respectively). Range of motion as well as length of skin incision and nail out of anterior tibial cortex was not significantly different between the two groups.Conclusion: Based on our results, both approaches are safe; however, the transpatellar approach might be along with more pain for the patients. Therefore, the medial parapatellar tendon approach is recommended in this regard.

Background and Objectives: It is assumed that left atrial (LA) volume provides more accurate prognostic information about patients with acute myocardial information (AMI), because it presents severity of diastolic function impairment by the time. The aim of this study was to evaluate the effect of left atrium size on patients' outcome after acute myocardial infarction.Materials and Methods: In this cohort study 100 patients with AMI during admission were entered into the study. The patients were followed up for 9 months. Their one month survival rate was evaluated. Demographic, atherosclerotic risk factors, arrhythmic and mechanical side effects of MI were recorded. Moreover, echocardiographic indices such as systolic and diastolic function and left atrial volume were evaluated.Results: In our study patients with higher LA volume index (>32 mL/m2) had more mortality rate (6/22, 27.3%) compared to patients with lower LA index (1/78, 1.3%) (P=0.001). There was no statistically significant difference in mortality rate considering gender and age of the patients (P>0.05). In univariate analysis, there was no statistically significant difference in mortality rate with regard to hypertension, diabetes mellitus, cigarette smoking and dyslipidemia. However mortality rate was significantly higher in ST segment elevation MI, diastolic dysfunction, restrictive pattern, left ventricular ejection fraction less than 40% and LA volume index ³32 mL/m2. In multivariate analysis (logistic regression), only LA volume index ³32 mL/m2 was an independent predictor of increased mortality rate after AMI (P=0.008).Conclusion: LA volume index is an independent predictor of poor prognosis in patients with AMI, even after adjustment with clinical predictors and conventional indices of echocardiography.

Background and Objectives: The hereditary coagulation disorder patients are excessively at risk for hepatitis C virus (HCV) due to multiple blood and coagulation factors transfusions. Hepatitis C treatment was first based on the use of interferon alpha but later combination therapy with peginterferon plus ribavirin increased the sustained virologic response to 50%. The present study aimed to evaluate the response rate to treatment with peginterferon plus ribavirin in hereditary coagulative disorder patients with chronic hepatitis C.Materials and Methods: This study is a descriptive analytical and applied study without control group. Forty HCV positive hereditary coagulative disorder patients referred to our clinic during 2007-2008 were enrolled. Liver biopsy was not performed in any of the studied patients due to its potential risks. Treatment included peginterferon alpha-2a (180 mg/week) plus ribavirin (800-1200 mg/day) for 24-48 weeks. Early virologic response (EVR) was defined as a negative HCV-RNA level at the end of 12 weeks of treatment.Results: In 12.9% of the patients, a positive history of previous treatment for hepatitis C with interferon and ribavirin was found. Virus genotype was 1b in 21.9% of patients, 1a in 37.5% and 3a in 34.4% and a combination of 3a and 1a in 6.3%. The mean pretreatment viral load was 1220183.7 copies/mL and viral load after 3-month treatment was zero (P<0.001).Conclusion: Among EVR enhancing factors (low virus level and young age of the patients), the young age was an important factor leading to full EVR achievement. Lack of severe complications and appropriate drug response excluding the viral genotype is indicative of the advantages of combination therapy of peginterferon plus ribavirin in hereditary coagulative disorder patients with chronic hepatitis C.

Background and Objectives: Leptin is a peptide hormone and product of obesity gene which has effects on the food intake, regulation of the body adipose tissue and action of insulin. The aim of this study was to evaluate the relationship between leptin and indicators of the obesity, lipid profile, energy and macronutrients intake among apparently healthy and young subjects.Materials and Methods: In this cross-sectional study seventy eight subjects (37 males and 41 females) aged 20 to 32 years old were evaluated with respect to the anthropometric indices (waist circumference, body mass index, waist to hip ratio and waist to stature ratio), energy and macronutrients intake (by means of 3-day food record), fasting lipid profiles and blood sugar, leptin and insulin levels.Results: Females had significantly higher level of circulating leptin than the males (P<0.001); however circulating insulin (P=0.001) and insulin resistance (P=0.019) were higher in males. There was significant relationship between obesity indicators and leptin levels. However, after adjusting for confounders, only waist circumference, body mass index and total cholesterol had significant relationship with serum leptin level. There were no significant differences for energy intake from the macronutrients between the both genders.Conclusion: Circulating leptin levels elevate with obesity in males and the body mass index is the best predictor of leptin.

Background and Objectives: Probable predicting factors of ovarian response include age and body mass index (BMI), ovarian volume, number of antral follicles and the hormonal markers. The available data is heterogeneous and sometimes conflicting in this regard. The aim of this study was to evaluate some predicting factors of ovarian response during IVF cycle.Materials and Methods: In an analytic cross-sectional study, 100 female candidates of IVF were recruited in Tabriz Alzahra Infertility Center during a 14-month period. Ovarian response was categorized and evaluated in two sections according to the number of retrieved follicles (£10 and >10) and oocytes (appropriate response: 5-14 oocytes, inadequate: £4 oocytes, excessive response: ³15 oocytes). Patient’s age and BMI, as well as smoking status, and ovarian volume, number of antral follicles and serum FSH, LH and estradiol levels were evaluated as predictive parameters of ovarian response.Results: Ninety six women with a mean age of 29.8±5.9 years were enrolled. Significant predictors of inadequate number of retrieved follicles were older age, high BMI and high basal serum FSH and low number of antral follicles.Conclusion: Significant predictors of inadequate number of retrieved oocytes were older age, high BMI and basal serum FSH, longer duration of infertility, and low ovarian volume and serum estradiol. Smoking, level of serum LH and number of antral follicles were not significantly related with the number of retrieved oocytes. The current data can be used for prediction of ovarian response in patients undergoing IVF cycle.

Background and Objectives: Worldwide, an estimated 644,000 new cases of head and neck cancers are diagnosed each year. To the best of our knowledge, no epidemiologic study has been hitherto focused on the head and neck cancers in our centers. Therefore, this study aimed at evaluating the frequency of different types of these cancers during the past decade.Materials and Methods: In an analytic-descriptive and cross-sectional study, medical files of 610 patients, 470 males and 140 females with a mean age of 58.36±15.74 years, with definite diagnosis of head and neck cancer were reviewed in Tabriz Imam Khomeini and Imam Reza Hospitals during 1997 to 2007. The inclusion criteria were the diagnosis of head and neck cancers according to the international accepted definition and presence of a rather complete data about the patient. Possible risk factors were also documented in each patient.Results: In total, 610 patients with diagnosis of head and neck cancer, 470 males and 140 females with a mean age of 58.36±15.74 years were enrolled. Different cancers were located in larynx (45.2%), oral cavity (12.6%), lip (11.5%), nasopharynx (11%), hypopharynx (7.2%), maxillary sinuses (2.3%), tonsils (2.1%), salivary glands (7%), nasal cavity (0.8%) and oropharynx (0.2%). Squamous cell carcinoma (SCC) was the most common pathologic subtype (75.2%). Majority of the SCC cases (80.6%) were well-differentiated tumors. History of smoking was significantly higher in patients with cancer of larynx, oral cavity and nasopharynx and history of alcohol intake was significantly higher among the patients with oral cavity and lip cancers.Conclusion: According to the current data, diverse reports are available regarding the frequency of different types of head and neck cancers. Further studies in similar centers are recommended for comparison.

Background and Objectives: personality traits affect the copying style of individual coping styles. It has been shown that there are a relationship between positive personality trait and functional coping styles and negative personality trait and dysfunctional coping styles. The aim of this research was to determine the relationship between personality traits and coping styles in a group of HIV positive and drug addicted male.Materials and Methods: The study group consists of 50 HIV positive and drug addicted males. Participants were asked to complete the NEO Personality and Coping style Inventories. Collected data were analyzed by statistical methods.Results: the results of the study revealed that there was a significant positive correlation between neuroticism and emotional – focused coping (r=0/496), significant negative correlation was found between agreeableness and emotional – focused coping (r=-0/374), significant positive correlation was found between extroversion and problem – focused coping (r=0/334) significant positive correlation was found between consciousness and emotional – focused coping (r=0/330). Also we found that neuroticism significantly predicted emotional – focused coping in our HIV positive patients (R²=0/25).Conclusion: The results of this study showed that there are a significant relation between personality and emotional- focused coping style in HIV positive addicted males.

Background and Objectives: Alopecia Areata (AA) is a disease with local hair loss that may be associated with other autoimmune diseases including thyroid dysfunction, diabetes mellitus, pernicious anemia, systemic lupus erythematous, etc. This study aimed at evaluating the results of some serum laboratory tests related to autoimmune disorders in patients with AA.Materials and Methods: In a prospective descriptive study, 58 patients with AA were evaluated in Tabriz Sina Hospital during a 15-month period. Serum laboratory results (red blood cell count, white blood cell count, platelet count, C-reactive protein, hematocrit, erythrocyte sedimentation rate, hemoglobin, fasting blood sugar), thyroid tests (TSH, free T4 and T3), as well as serum antinuclear antibody (ANA) and rheumatoid factor were measured.Results: Thirty three males and twenty five females with the mean age of 30.1±13.4 years were enrolled. Previous history of vitiligo and atopy was positive in 1.7% and 10.3% of the studied population, respectively. Laboratory findings indicative of thyroid dysfunction, diabetes mellitus, anemia, positive ANA and positive rheumatoid factor were detected in 8.6%, 6.9%, 8.6%, 22.4% and 15.5% of the patients, respectively.Conclusion: Comparing with normal population, some underlying autoimmune disorders may be present in patients with AA, especially thyroid dysfunction. Therefore, screening tests might be simple and beneficial.

Hydatid disease is caused by larva of genus Echinococcus. Echinococcus granulosus is the most common cause of hydatid disease in humans. This disease occurs either through direct ingestion of parasite eggs from contact or from the contaminated water or food. The disease most commonly occurs in the liver (80%) and the lungs (15%). Bone hydatidosis is very rare (0.5%-2.5%). Here, we present a case of hydatid cyst of the femur in a 34-year-old woman presented with pain and mass increasing in size. X-ray finding revealed an osteolytic cystic lesion of the metaphyseal part of the femur. The patient was operated with the probable diagnosis of a tumoral bone lesion. After excision, histopathologic finding showed bone hydatid cyst and the patient was treated by albendazole.