Medical Journal of Tabriz University of Medical Sciences
Year:2006 | Volume:28 | Issue:3|Papers Count:29

Background and Objectives: Pain after laparoscopy results from the stretching of the intraabdominal cavity, peritoneal infiltration, and phrenic nerve irritation caused by residual carbon dioxide in the peritoneal cavity. Proper postoperative analgesia is essential in facilitating early mobilization and discharge of these patients. Administration of systemic analgesics before surgery, is one of the methods to achieve this goal, attempting to capitalize on a pre-emptive analgesic effect. This study evaluated the pre-emptive effect of a small dose of ketamine on pain contoll after the diagnostic gynecologic laparoscopies.Materials and Methods: Sixty infertile, ASA I, II women were evaluated in this prospective, randomized, double-blined, and placebo-controlled clinical trial. After general anesthesia, 30 patients received preincision ketamine 0.4 mg/kg Iv, and in other 30 patients nonnal saline was administered. Pain score (Visual Analogue Scale), analgesic consumption, side effects, and time of discharge were recorded.Results: Patients received preincision ketamine had lower pain score in the first 6 hours after operation compared with the placebo group (p<0.001).The mean time of first request for analgesia in the ketamine group was longer than the placebo group (108±20min vs 32±10min respectively; p<0.001). The mean analgesic consumption in the ketamine group, was less than that in the placebo group (50±25mg vs 125±25mg respectively; p<0.001). Time to discharge from postanesthesia care unit (PACU) was similar in two groups. Hemodynamic variables and side effects were not significantly different between two groups.Conclusion: Pre Operative administration of Small dose of vitamin is safe, and provides preemptive analgesia in patients undergoing diagnostic gynecologic laparoscopies.

Background and Objectives: Tuberculosis (TB) is a chronic infectious and one of the ancient disease that has long been a major public health challenge in the world. WHO declared TB as a global health emergency. On the other hand some micronutrient with antioxidant and immunomodulator properties have vital role to decrease oxidative stress and regulation of immune homeostasis. Therefore the aimed this study was to determine the effects of vitamin Azinc supplementation on oxidative stress status in patient with active pulmonary tuberculosis.Material and Method: Research was designed as a double-blind placebo controlled trial on thirty-five newly diagnosed active pulmonary TB outpatients from Tuberculosis & Lung Diseases Research Center of Tabriz. Patients were assigned into 2 groups; one group received anti-TB drugs and vitamin A - zinc supplementation (vitamin A: 1500μgRE and zinc: 15mg) and the other group received the anti-TB drugs and placebo. Five ml venus blood was obtained from all subjects at the beginning and 2 months after intervention. Weight and height were measured and BMI was calculated. Plasma level of vitamin A and total antioxidant was determined by using HPLC and kit methods respectively, Serum malondialdehyde was measured based on thiobarbituric acid reaction florimetry method, and zinc by flame atomic absorption.Results: serum MDA reduced and plasma total antioxidant elevated significantly in vitamin A- zinc supplemented and control patients (P<0.001), but there was no significant difference between case and control group.Conclusion: Anti-TB treatments reduce Serum malondialdehyde level, elevate plasma total antioxidant and decrease stress oxidative in patient with tuberculosis.

Background and objectives: B-cell chronic lymphoproliferative disorders (B-CLPD) are a heterogeneous group of disease that characterized based on cell morphology and immunological markers as proposed by the FAB group. Immunophenotyping is an essential diagnostic tool for discriminating B from T-cell disorders and for distinguishing B-cell chronic leukemias from each other. In order to design appropriate immunophenotyping panels, 54 patients with B-CLPD investigated.Materials and Methods: Blood samples from 54 Patients with typical or atypical B-chronic lymphocytic leukemia (B-CLL), Adult T cell Leukemia /lymphoma (ATLL), B prolymphocytic leukemia (B-PLL), B-non-Hodgkin's lymphoma (B-NHL) in leukemic phase, and Hairy cell leukemia (HCL) were studied by applying specific anti bodies to 26 different antigens on B,T, and NK cells with direct immuno fluorescence method by flow cytometr.Results: Except in B-CLL (typical and atypical), CD5, CD19, and CD23 did not co-express on the cells of patients with HCL and B-NHL in leukemic phase. The intensity of aberrantly expressed CD5 in B-CLL is lower than on the residual CD5+/CD19-cells that seem to be normal T-cells in the same patients. Intensity of CD19 and CD22 in typical B-CLL is lower than other B-cell disorders and unlike some reports only few percent of typical B-CLLs were CD22 negative. No significant difference for expression of CD20 was found among the patients.Expression of other lymphoid markers with some exception was the same reported cases. Conclusion: Flow cytometry is a significant diagnostic tool for classification of such disorders and therefore, in order to benefited by this machine that use relatively expensive reagents, we propose three panels: the first panel for all new patients with T and B-CLPD, second panel for study of T and NK nature of cells and third panel that help to identify different B lymphoid cells in B-CLPDs.

Background and Objectives: Cryptorchidism is one of the most common congenital malformations in males that carry various complications. Early diagnosis can help to prevent future complication The aim of present study was to accurately assess the prevalence of cryptorchidism and the role of mid-wive's and general Practitioner's in early detection and referral of boys with undescended testis for surgery.Materials and Methods: 6237 (69.1%) of 9019 male live births, were examined for cryptorchidism at primary health services. In a subgroup of cases, the persistence of cryptorchidism was re-assessed during a follow-up examination first by a general practitioner and then was referred to a surgeon if undescended testes were suspected.Results: In the re-examined subgroup 35% of the boys had cryptorchidism.Prevalence of undescended testis was 1.35% in open population.Conclusion: In order to establish reliable information on the detection of cryptorchidism, all male births in the open population must be examined systematically.This study showed that measurable improvements in early detection of cryptorchidism can be achieved through a combination of education of primary care, GPs and expert specialists' team and agreed local standards for referral.

Backgrounds and objectives: Atopic dermatitis is a common chronic skin disease which causes pruritus and relapsing eczematous lesion, leading to major problems in private and social life. Vitamin E has few side effects (comparing to common treatments), for this reason Vitamin E has recently been recommended as a new treatment.Materials & Methods: For this clinical trial 100 patients with Atopic dermatitis were visited in Skin clinic of Tabriz Sina hospital. These patients were divided into two groups by simple randomization. In group 1, patients took vitamin E (400 Iu/day) in group 2 took topical corticosteroid and oral Antihistamines. Patients were followed up for 8 months.Results: The results of the treatment were positive in the 66% of the patients in group I and 62 % of the patients in group II. There is no statistical difference in response to therapy in both groups (P> 0105), but satisfaction is very high in patients received vitamin E. There is significantly inverse relationship between age and response to therapy in patients who took vitamin E. In this study no side effects reported from vitamin E. Conclusion: According to this trial, vitamin E may affect the same as common treatment with topical corticosteroid and oral Antihistamines in improving signs & symptoms of Atopic dermatitis and quality of life. By considering the lack of side effects of therapeutic dose of vitamin E, it can be a suitable therapy for Atopic dermatitis.

Background and Objectives: Febrile seizure is the most common seizure disorder occurring in childhood. Simple febrile seizures are brief (<15 minute), generalized and only once during a 24 hour period. Unfortunately in %15-20 of patients recurrence of seizure occurs in the same febrile illness. A case control study was conducted to assess effectiveness and safety of Phenobarbital in preventing further seizure in acute phase of same febrile illness. Materials and Methods: In this Clinical trial, neurologically healthy children with diagnosis of simple febrile convulsion admitted to the division of pediatric neurology in Tabriz children hospital were included in this study. In 100 Children (case group) consecutively Phenobarbital was administered intramuscularly at initial dose of 10 mg/kg, 12 hours later 5 mg/kg/d orally until the fever had subsided. Control group (100 Children) didn't take Phenobarbital. Rate of reoccurrence of seizure was compared in two groups.Results: There was no significant difference in sex, age, history of neonatal admission, family history of febrile seizure and epilepsy between two groups. In control group 15 patients (15%) had experienced further seizure in acute phase of the same febrile illness, in compare of case group only one patient (1 %) had experienced further seizure and this difference was significant (P=0.0001). in addition There was no significant side effect of Phenobarbital in case group.Conclusion: The results indicate that Phenobarbital can prevent further seizure in children, with simple febrile seizure in acute phase of febrile illness.

Background and objectives: Brain death is defined as irreversible and concomitant cessation of all cortical, subcortical and brainstem functions. This event can develop as the final outcome of different severe illnesses which are usually seen in Pediatric Intensive Care Unit (PICU).Because of emotional, familial and financial consequences of this condition for patient's family and its impression on PICU function, it is necessary to be diagnosed in a proper time. Besides, confirmation of brain death in any patient, will result in discontinuation of all given therapeutic and supportive measures, therefore it is critically important for patient and his or her family members and physicians to be ascertained that "Brain Death" has surely happened. Apnea test is a tool to prove brain death.Materials and Methods: Within a period of 29 months (from November 2003 to March 2006), a Cross-Sectional study was done on 30 patients suspected to be dead by brain criteria, the apnea test was carried out for all patients in a standard manner. In each case, if arterial partial pressure of CO2 rose above 60 mmHg and no spontaneous true respiratory movements started, the test was considered to be positive and the patient's brain death confirmed.Findings: All of 30 studied patients had positive apnea tests and died finally, although we found extensor plantar reflex in one and withdrawal reflex in extremities of 3 patients. Results: Apnea test is the less expensive, the most rapid and practical confirmatory test for brain death with a sensitivity equal to 100% in diagnosis of this condition.It is possible to use this test even in small hospitals where ever a mechanical ventilator and an arterial blood gas analyzer are available.

Background and objectives: The role of pulse oximetry in early detection of hypoxemia has been emphasized in different studies. The clinicians are always worried about critical nature of respiratory problems and hypoxemia, but in clinic it is not clear that which level of hypoxemia is tolerable. In the other hand significant hypoxia can result in serious complication in a few minutes. In practice there are different sites for pulse oximetria but in our survey we could not find any study about validity of pulse oximetry that has been done in ear, toe and finger simultaneously. This study was conducted, to answer the question of, the most suitable site for pulse oximetry in newborns and children more than one month of age.Materials and Methods: in a comparative-cross sectional study from December 2004 to January 2005, one hundred newborns and one hundred children at age of one month or older have been included. The method of sampling was convenience. Blood samples for blood gas analysis were obtained only from patients who needed this test. We used NOVAMETRIX pulse oximeter and GEM3000 blood gase analyzer. In this study the hypoxemia was defined as SpO2 < 92% and SaO2 <90%. The results were analyzed with validity formula (sensitivity, specificity, positive and negative predictive values). We used kappa test for clinical agreement.Results: in children mean SaO2 on ear, finger and toe were 5.5±3.19, 3.7±3.329, 2.6±5.4 and bias were 0.02±3.71, - 0.82±3.43, -1.94±3.18 respectively. At the same time newborns showed the mean Sp02 on ear, finger and toe 96.8±2.2, 95.4±3.2, 94.8±2.4, and bias were 1.53±3.42, 0.22±3.48 -, 0.45±3.9 respectively. Negative predictive values of SpO2 on ear, finger and toe, in children more than one month of age showed 97%, 98%, 93% and in newborn group were 93.5%, 93.6%, 90% respectively. The highest level of clinical agreement was in ear (69.7% and 54%) and the lowest level in toe (56.5% and 28%).Conclusion: pulse oximetry plays the main role in the early detection of Hypoxemia while significant hypoxia results in serious complications in a few minutes. This study indicated that pulse oximetry of toe either in children or newborns have a higher rate of clinical agreement. At the same time, ear and finger have better negative predictive value that means 93.5% - 98% of patients with SpO2≥92% have SaO2≥90% and no hypoxemia.

Background and objectives: Fibroblasts of periodontal Ligaments (PDL-F) have a critical role in periodontal regeneration. it has been reveled that phenytoin induces cell proliferation in gingival fibroblasts (GF). We hypothesized that if phenytoin shows the same effects on PDL-F, it will be considered as a potentially effective mean for periodontal regeneration. This study was aimed to evaluate the effects of phenytoin on GFs and PDL- Fs.Materials and methods: A total of ten wistar rat were used as a source of fibroblasts.Gingival tissue was harvested from the papilla of the maxillary central incisors and periodontal ligament was obtained from the mid portion of the extracted lower incisors. After culturing the fibroblasts in a suitable medium, they were assigned to the test and control groups. In the test group, phenytoin was added to medium and the controls left untreated. After 48 houres, The Proliferation fibroblasts were evaluated by an ELISA method (wst-1 and proliferation of both PDL-F and GF were analyzed by independent sample t-test. Results: phenytoin had significant proliferative effects on GF. (p<0.05). However, it induced proliferative effects on PDLF rather than GF. On the other hand the comparison of effects of phenytoin on PDLF and GF were significant (p<0.001).Conclusion: It can be concluded that, phenytoin reveals the same proliferative effects on GFs, in vitro as in vivo and this might be induced on PDL-Fs too.

Background and objectives: Cerebral palsy is one of the most common disabilities affecting children. 75% of these patients are spastic form. Spasticity is the most functional problem in those patients. Various methods have been used for relieving spasticity. Botulinum toxin injection is one of methods. The objective of this study was to determine the efficacy and tolerability of Dysport (botulinum toxin type A) in children with the spastic type of cerebral palsy to improve daily care or functional mobility.Materials and methods: Dysport was studied in 24 children with spastic cerebral palsy.Results are compared with 11 children with same problem, all patients received rehabilitation therapy, spasticity score, joints range of motion and functional status evaluated after 72 hours and then every 1 month, until 5 months. Results are compared with T-test.Results: The effect of injection was evident within 72 hours and lasted for 3-4 moo Improvement in spasticity and range of motion had meaningfull difference in injection group (P: 0.00). Functional status improved, five nonambulatory patients be came ambulatory with assistance and five children with assisted ambulation had gait pattern improvement. Two children had untoward side effects after BTX injection (generalized weakness).Conclusion: This study demonstrated Dysport (botulinum toxin A) is useful as an adjunctive therapy in ameliorating spasticity and functional improvement in children with cerebral palsy.

Background & Objective: Coagulase Negative Staphylococci (CNS) have been one of the most important causes of nosocmial infections and have been reported from bacteremia, endocarditis, wound and urinary tract infections and the other infections. As the situation has not been determined in Iran, this study designed to evaluate out breaks of CNS in an Iranian hospital by Pulsed field gel electrophoresis (PFGE).Material and Methods: In this study 211 clinical strains of staphylococci were isolated from patients who have spent more than 48 hours in the related wards and units. The identification was determined by specific tests. In vitro susceptibility of CNS strains was determined by disc diffusion of Kirby- Bauer recommended by American Society of Microbiology methods.Results: Among these strains, 63 CNS selected that, 50% were Staphylococcus hemolyticus, 25.7% were Staphylococcus epidermidis and 3.6% were Staphylococcus saprophyticus.According to results, the percent of resistance against Ampicillin, Erythromycin, Ofloxacine, Cefalotin, Cloxacillin, Gentamicin, SXT, Tetracycllin and Vancomycin was 91%, 82.5 %, 22.3%, 22.2%, 17.5%, 17.5%, 16.7%, 12%, 0%, respectively.Conclusion: PFGE of CNS strains by Sma I digestion pattern revealed a significant diversity within S. hemolyticus strains without any epidemic strain.2 epidemic strains were detected within S. epidermidis strains. It is suspected that, the colonization of S.hemolyticus strain has a preventive role against S.epidermidis outbreaks in hospitals. Although the behavior of S.hemolyticus strains in outbreaks is not obvious.

Background and Objectives: Phototherapy is one of the most common and non invasive methods in treatment of unconjugated hyperbilirubinemia of the neonate. Adverse effects of phototherapy include loose stool, skin rash, over heating and dehydration. This study was done to show the probable changes of platelet and WBC count in patients receiving phototherapy.Subjects and Methods: 150 healthy, full term icteric neonates admitted in Tabriz Children's Medical Center were chosen. They had normal weights, non-hemolytic hyperbilirubinemia and there was no source of infection. During phototherapy cases needing exchange transfusion or suspicious of sepsis were excluded from study. Two samples, before and after phototherapy, were taken and analysis was done by automated cell counter, then the results were analyzed statistically.Results: This study showed that during phototherapy there is an increase in platelet and WBC counts. Rise of WBC count had a meaningful correlation with increasing age (P =0.033), while platelet count correlated with duration of phototherapy (P =0.020).Conclusion: Possibly phototherapy increases the release of platelets from bone marrow in full term healthy neonates with sufficient platelet storage. Phototherapy also may stimulate the marginated WBC's to enter the circulation leading to increase in WBC count.  

Background and Objectives: In most instances, it is necessary to restore endodontically treated teeth by a simple method, with low cost in a short time. The purpose of this study was to evaluate the effect of flowable composite in fracture resistance of endodontically treated maxillary premolars restored with composite.Method and Materials: In this in vitro study, 48 sound human maxillary premolars, extracted for orthodontic reasons closed apex, were randomly divided into 3 groups of 16. In groups 2, 3 after preparation of the standard access cavity and endodontic treatment, the palatal cusp was reduced to 1.5 mm coronal to the CEJ, leaving the remaining buccal cusp 3mm in buccolingual thickness at the height of contour and similar thickness in CEJ. Samples were prepared as follows: intact (unprepared) teeth (Group 1), composite restoration. Without flowable composite (Group 2), composite restoration with 2 mm thickness of flowable composite (Group 3). After therrnocycling, each tooth was loaded in compression until fracture occured. Data were analyzed with one-way ANOVA and Tukey test. The pattern of fracture was analyzed by Chi- Square test.Results: The mean fracture resistance in groups 1-3 were 689.59±179, 632.86±119 and 583.92 ±186 (in N) respectively. The differences between groups were not statistically significant (p>0.05). The maximum number of favorable fractures occurred in group I. There were greater number of unfavorable fracture in groups 2 and 3.Conclusion: Composite restoration of endodontically treated maxillary premolars had satisfactory results. Flowable composite had no significant effect on fracture resistance of teeth and did not result in favorable fracture.

Background and objectives: Carpal Tunnel Syndrome (CTS) is the most common mononeuropathy encountered in clinical practice. Conventional electro diagnosis studies have been useful in the diagnosis of this condition. The Terminal Latency Index (TLI) is a derived neurophysiological value that adjusts the Distal motor Latency (DL) for the terminal distance and motor nerve Conduction Velocity (CV).Several studies have suggested utility of the median TLI for diagnosis of CTS.The goal of this study is to evaluate prospectively the sensitivity of the median TLI in the diagnosis of CTS and compare it with other electrodiagnosis techniques.Material and Methods: This study was done on 111 patients as CTS group & 62 healthy subject as control group. In all groups five selected tests of electrodiagnosis were done and all of them were compared with TLI sensitivity.Results: The mean TLI was 0.3±0.05 in the CTS group and 0.42±0.03 in the control group. The sensitivity of TLI was 73% The TLI wasn't statistically better than the other tests, but in three cases from the CTS group, the TLI was the only abnormal test.The 7 and 14 cm method had meaningful sensitivity in contrary to other tests.Conclusion: The sensitivity of TLI has no meaningful difference with other routine electro diagnostic tests in diagnosis of CTS.The median TLI is a useful but not more sensitive electrodiagnostic test for CTS.

Background and objective: headache is one of the most common complaints in medical practice. According to our knowledge headache in Medical students has not been investigated in IRAN. The aim of this study performed for demonstrating of the headache prevalence, symptoms profile and type of headache in Tabriz university medical students.Materials and Methods: In this study 340-medical students with age between 18 to 28 years old, were investigated. The prevalence and type of headache was based on a details structured headache assessment questionnaires.Besides demographic data, headache characteristics and pattern of health care utilization were evaluated. In addition, questions were included referring to the use of drugs. This was a descriptive analytic and cross- sectional study.The target population was the medical students at Tabriz University of Medical Sciences from April 2004 to April 2005. The base of classification of headache was the criteria of International Headache Society (IHS).Results: All of the interviewers (100%) completed the questionnaire: 133 men (39.1%) and 207 women (60.9%). The prevalence of headache was 54.4%, 40% of women and 14.4% of men suffered from headache. Prevalence of migraine 23.8% and tension type of headache was 3.8%. A positive family history of headache was found among 56.2% of students who had headache. Only 17.8% of students sought medical assistance during headache episodes, and 72.4% took medication. Acetaminophen (56.6%) followed by Ibuprofen (18.6%) were the most commonly used drugs. Antimigraine drugs (Sumatriptan and Ergotamine) were used in 14.1%.Conclusion: The results of this study show that headache is highly prevalent Migraine sufferers in this student population might be due to the high female-to-male ratio (1.5:1). It is likely that analgesic use or overuse also coexists with headache in these students, since a large majority of them rely on nonprescription medications.

Background and Objectives: Multiple sclerosis is one of the most important neurologic diseases because of frequency and tendency to affect young adults. The identification of patients with clinically silent lesions is important, because early therapies are demonstrated to be effective in preventing or delaying disability in MS patients. Some physiologic and radiologic tests such as MRI and evoked potentials can discover asymptomatic lesions. MRI is a choice method in diagnosis, and BAEP is a non-invasive method with greater capacity and a lower cost in disclosing brainstem plaques. This study is designed for comparing the role of these two tests in MS patients.Materials and Methods: Thirty patients which have had definite MS criteria clinically and paraclinically without brainstem involvement have been taken part in this study, they have been performed BAEP and MRI, which the abnormal findings in BAEP were mainly based on interpeak latencies I-III> 2.5 ms, III-V> 2 and latency of wave V> 5.7 ms. Finally, the findings of these two methods have been compared.Results: BAEP in 33.3% of patients and MRI in 36.66% of patients were abnormal. The rate of synchronization of abnormality between two tests in all patients was 13.3%; however, the involvements of brainstern by both methods were 56.6% of cases. So, in high percent of patients with definite MS which have had involved asymptomatic brain stem, combined use of these two methods cause identifying more positive cases. Comparison between BAEP & MRI abnormalities and sex, types of disease and duration of disease didn't show significant difference.Conclusion: BAEP is a good Method in evaluating of brainstern Involvement with emphasis on brainstem. However, there is no significant differentiation between two methods in determination positive cases of brainstem involvement. Therefore, neither of these two methods could replace each other in following of the definite MS patients with brainstem involvement, but combined use of these tests could be identified more positive cases.

Background and Objective: Obesity is one of the most common problems in the world.Cardiovascular disease, diabetes, and hypertension result from obesity. This study was carried out to determine the effect of low calorie diet (LCD) alone and with Saturja Khozestanica Jamzad (SKJ) on weight loss.Materials and Methods: This double-blind clinical trial study was carried out on 87 healthy, overweight, obese women (age: 20-50 y, BMI= 25-40 kg/m2).The subjects were categorized to 3 groups receiving:1) low calorie diet daily 2) low calorie diet and one capsule of SKJ per day (250 mg/d) and 3) low calorie diet and one capsule of placebo per day (250 mg/d).Anthropometric indices include: height at baseline and weight, waist and hip circumferences at baseline and after 1 month were measured. BMI and waist to hip ratio (WHR) was calculated at baseline and after 1 month.Paired t test and ANOVA were used to data analysis.Results: Mean±SE BMI changes for three groups receiving LCD, SKJ+LCD, and LCD+ placebo were 2±0.1, 1.7±0.1, and 1±0.1 (p<0.01), respectively. Changes in WHR were 0.01±0.003, 0.04±0.008, and 0.03±0.006 for 3 groups (p< 0.01), respectively, too.Conclusion: SKJ and LCD resulted in reduce in BMI and WHR more than LCD and placebo. Low calorie diet is the best strategy for weight loss, although it may be achieved by SKJ as a supplement with LCD.

Background and objectives: In tuberculosis, the most of the laboratory findings such as immunologic and biochemical parameters show significant changes. These changes can result from secondary injuries that rarely have been studied. It is understood that phagocytic function of neutrophiles, macrophages and monocytes is coincident with respiratory explosion and culminates to rising of free radical production. This increase along with its destructive effects on lipids and lipoproteins, results in atherosclerosis. In this study serum lipids profile and Lp (a) were evaluated in pulmonary tuberculosis patients as risk factors for cardiovascular diseases and compared with those of control group.Material and Methods: In this study a total of 40 male patients suffering from pulmonary tuberculosis before starting treatment with mean age of 38.2±10.7 years were selected as patient group. Forty healthy male with mean age of 39.3±9.3 years were chosen as control group. The subjects with cardiovascular disease, diabetes, metabolic and renal diseases were excluded from the study. The serum levels of Lp (a) were measured by immunoturbidometric and the of lipids profile by standard methods.Results: Comparing with control, significant elevation in the level of Lp (a) in the patients group were noticed (p<0.05). No marked differences between serum levels of cholesterol, triglyceride, LDL-C and HDL-C between the two groups were observed (p>0.05). In the both groups the correlations between serum levels of Lp (a) and those of lipids profile were not meaningful (p>0.05).Conclusion: Our data suggest that the increased level of Lp (a) in patients with pulmonary tuberculosis may be one of the important risk factors of atherosclerosis. Further studies to find the factor causing the Lp (a) elevation and administration of special dietary regime or drug to reduce the level of this atherogenic lipoprotein may be useful in these patients.

Background and Objectives: "Bipolar I" disorder is a common and recurrent disorder that could be chronic and cause impairment in social and occupational functioning of patients. Many studies have been performed to find the best therapeutic methods for this disorder. Some findings indicate that combination of a mood stabilizer plus an atypical antipsychotic (such as Risperidone) is a useful and well-tolerated therapeutic regimen and its adverse effects is less than "typical" antipsychotics (e.g.Haliperidol). This study compares Lithium carbonate and combination of Lithium plus Risperidone or Haloperidol in treatment of Acute Mania.Materials and Methods: This research is a double blind study that compares the efficacy of Lithium and combination of Lithium plus Risperidone or Haloperidol in 150 patients with acute mania that were hospitalized in Razi Psychiatry hospital of Tabriz. These patients were randomly divided into three groups including 50 persons in each one and were evaluated according to YRMS, GAF and DSM-IV-TR scales in 14 days-before the initiation and at the end of second week- of treatment.Results: The results indicate different therapeutic response in these groups especially in the group that receive combination of Lithium plus Risperidone. According to YRMS, GAF and DSM-IV-TR scales, these differences were statistically significant.Conclusion: In comparison of treatment with Lithium or combination of Lithium plus Haloperidol, combination of Lithium plus risperidone accelerates treatment, increases compliance and safety of treatment and reduces adverse effects.

Background and objectives: Evidence suggests that cesarean section following uncomplicated pregnancies increases mortality and morbidity of mother and neonates. The aim of present study was to estimate the prevalence of cesarean section and its correlates in Tabriz city.Method and material: In this cross - sectional study 1473 women were face -to – face interviewed who attended to 6 hospitals in Tabriz for delivery in September 2004. The questionnaire was included some questions regarding demographic characteristics and type of labor. Chi square test and independent t - test was used for statistical analysis by SPSS and EPI software.Results: In this study, 672 (45.6%) of all cases had cesarean section. Higher age of women, higher level of education, higher level of socio-economic status and hospitalization in private hospitals were associated with cesarean section (p<0.001). The mean age of subjects with cesarean section and vaginal delivery were 25.51±5.4 and 27.69±5.3 respectively (p<0.001).Conclusion: We concluded that Prevalence of cesarean section, especially in private hospitals is high. An educational program aimed at changing attitude toward cesarean section and enhance knowledge of women about painless delivery may be a successful prevention.

Background and Objective: Malnutrition is prevalent in cancer patients and is one of the major factors in morbidity and mortality. Malnutrition can be resulted of local and systemic tumor or side effects of anticancer treatments especially radiotherapy. Malnutrition plays an important role in decreased response and tolerance to radiotherapy. Therefore this prospective study was carried out with aim of determining and comparing nutrition status before and at the end of radiotherapy in cancer patients.Material and methods: The nutritional status of 61 volunteer cancer patients with mean age of 53±16 years who were referred to the radiotherapy center of Imam Khomeini hospital was evaluated. Nutritional status was evaluated by standard questionnaire patient- generated global assessment (PG-SGA), dietary intakes of 3 days were assessed by using 24-hour recall food questionnaire method.Results: The nutritional status of patients on the basis of well nourished, moderate malnutrition and severe malnutrition category before radiotherapy were 44.3%, 32.8%, 23% , whilst, at the end of radiotherapy were 32.8%, 26.2% and 41% respectively and the percentage of increase in malnutrition were statistically significant (p= 0.008).The mean daily energy intake, percentage of energy from carbohydrate, protein and fat before radiotherapy were 1900±111.6 (kcal), 55%±1.5, 16%±0.83, 28%±1.3 and at the end of radiotherapy were 1500±175.3 (kcal), 55%±2.0 16%±1.3, 28%±1.6 respectively. Despite the reduction of energy intake the difference was not significant. A significant decrease in body weight (p=0.001) and body mass index (p= 0.002) at the end of radiotherapy was observed in all patients. Symptoms which may reduce nutritional intake such as anorexia, dry mouth, nausea, vomiting and hypogeusia were worsen (except vomiting) after treatment.Conclusion: For getting the best outcome from treatment nutritional assessment should be an integral part of therapy for every cancer patient especially before and during radiotherapy and proper nutritional (enteral tube and parenteral feeding) interventions should be made available to the patients.

Background and Objectives: Attention to historical Repair of injury with honey and antibacterial activity of its, to assay the antibacterial activity of Iranian honeys, a study was Conducted on 78 specimens collected from different parts of the country (15 provinces, 38 regions) with the cooperation of the National Animal Husbandry Research Institute.Materials and Methods: Most of the honey samples had a polyfloral origins. Different species of Astragallus, Thyme and Thistle were the most abundant floral origins of these honeys respectively. Citrus, Tamarix, Ferula gumosa, Alfalfa, lotus, Eucalyptus and Helianthus honeys were considered monofloral.The antibacterial activity of the honeys was assayed against Staphylococcus aurous by the agar well diffusion as standard. The mean total and non-peroxid antibacterial activity of the honeys were measured to be 2.28 and 0.97 phenol percent with standard deviations of 1.18 and 0.38 phenol percent respectively.Results: One of the Khorasan honeys, Babol, Birjar, Takab 6, Ghorveh 10, Takab 4 and Takab 2 honeys with activities of 5.73, 4.73, 4.72, 4.73, 4.61, 4.38 and 4.32 phenol percent had the highest total antibacterial activity respectively. Regarding the nonperoxid antibacterial activities of Takab 6, Takab 4, Takab 2, Divandareh and orumieh honeys were 2.75, 2.17, 2.04, 2.04 and 1.79 phenol percent had the highest activities respectively. Among monofloral honeys, Citrus, Tamarix, Eucalyptus and Helianthus did not have measurable antibacterial activity.Ferula gumosa, Alfaalfa and lotus specimens had Intermediates antibacterial activity.Conclusion: After the honey samples were grouped and numbered according to color. Analysis with Pearson correlation showed that in darker honeys the non-peroxide activity is higher and the peroxide activity is lower. This analysis also showed that the honey darkens increase with age.

Background and objective: Resistance to antibiotics used in routine treatment of urinary tract infections (UTIs) is ever increasing worldwide. Therefore information about susceptibility of strains causing UTIs is important. Nowadays ciprofloxacin as a new quinolone is a very important agent against bacteria isolated from UTIs. This study was performed to evaluate the susceptibility of the isolated strains against this valuable antibiotic.Material and methods: In present study, out of 571 urine samples 122 Gram negative and Gram positive bacterial strains isolated. All the isolates were identified by biochemical test, Gram stain and Susceptibility tests by disk agar diffusion method and MIC determination.Results: Our results indicate that the most prevalent bacteria isolated from UTIs were E. coli (63.9%) followed by S. aurous (29.9%). Isolated E. coli and S. aurous strains showed resistance to ciprofloxacin in 17.9% and 14.2%, respectively.Conclusion: Our results showed that resistance to ciprofloxacin is relatively high in our bacterial strains isolated from UTIs and can cause therapeutic problems. Therefore monitoring of resistance, especially monitoring of MIC of the isolated strains could be beneficial in using ciprofloxacin as a valuable antibacterial agent in treatment of UTIs.

Background and Objectives: Mandibular Fractures constitute a Substantial Proportion of cases of Facial Trauma. In this study we present the Frequency of various types of mandibular fractures regarding anatomic site and their etiology.Materials and Methods: The medical Records and radiographs of patients who were hospitalized at Imam Khomeini hospital in Tabriz for mandibular fracture over a 5 year period were retrospectively reviewed. Age, sex, anatomic site of fracture, number of fracture lines and its causes were recorded.Results: From 1996 to 2001, 210 patients with 336 fracture line in mandible were hospitalized. We found the following frequencies for specific mandible fractures locations: symphysis-parasymphysis 35%, body 27/4%, subcondylar 19/4%, angle 13/1%, ramous 3/6%, alveolar process 1/2%. The most common etiology was motor vehicle accidents fallowed by fighting and falls. 87/6% patients were males and most of patients were in 11 to 40 year-old age group.Conclusion: Knowing the prevalence of various types of mandibular fractures from the anatomic standpoint and their correlation to etiology can be helpful in accurate diagnosis and in selecting proper treatment method. Because motor vehicle accidents is the most common cause of this fracture, following traffic regulations and employment of safety devices can be effective in reducing of this injuries.

To report of a case with concomitant Duane and Brown syndrome. A 19 year old girl presented with chief complaint of left esotropia and palpebral fissure narrowing in adduction.Her past medical history revealed two operations: left medial rectus recession5 mm in first operation and left medial rectus marginal myotomy and right lateral rectus resection 6mm in second operation (11 and 8 years ago respectively).In recent examination she diagnosed as having concomitant Duane and Brown Syndrome and underwent right medial rectus recession 6mm and left lateral rectus recession 3 mm. After third operation left ET and globe retraction satisfactorily improved.Anatomical and developmental anomalies had important roles in Duane and Brown syndrome.It is possible that common teratogenic factor may cause concomitant accurence of both syndromes.