Medical Journal of Tabriz University of Medical Sciences
Year:2006 | Volume:28 | Issue:4|Papers Count:29

Background and Objectives: HIV/ AIDS is a worldwide problem which affects 95 percent of the population in developing countries. The purpose of this study was to examine HIV-risk behaviors and knowledge of psychiatric patients, regarding AIDS in the teaching hospitals of Tehran.Materials and Methods: A cross sectional study was conducted using a questionnaire administrated to 230 psychiatric patients. Quota sampling was used in order to ensure a certain distribution of demographic variable.Results: The study revealed that 33.9 and 9.1 percent of patients were drug-users and injecting drug-users respectively, in the past 10 years. 76.2 percent of injecting drug users had needle-sharing partners. 19.6 percent of patients had been sexually abused in the past. 27.8 percent had had sex with multiple partners and 16.1 percent were homosexual. 26.5 percent of patients had had sexual contact with injecting drug users. 37.9 percent of sexually active patients had had sex after or whilst using drugs and alcohol. 6 percent of patients reported to have had a test for HIV (exonerative) and 30.8 percent worried about a possible HIV infection.There are significant links between gender (p<0.001), occupational status (p<0.004) and living situation (p<0.05) and drug and alcohol users. Males, workers and those living institutions had a higher rate of drug and alcohol abuse. There is significance between gender (p<0.001) and the number of hospitalization (p<0.007), and injecting drug users. Males and patients who had more than six admissions to hospital were more likely to be injecting drug users. Regarding the gender, females reported a higher rate of sexual abuse (p<0.001).Multiple partners with occupational status (p<0.05) and civil status (p<0.02) and living situation (p<0.04) with homosexual intercourse showed significant association, so that employees reported higher rate of multiple partners. Widows and people who have lived in institutions had a higher rate of homosexual contact. 21.7 percent of patients had a very low level of knowledge about aids: 28.7 percent of patients had a low level knowledge and 18.3 percent of patients had a good knowledge. With respect to the basic facts of HIV, 13.5 percent of patients had a good knowledge and 53.1 percent had either a very low or a low level of knowledge. Regarding the routes of transmission, 33.1 percent of patients had either a very low or a low level of knowledge, and 24.8 percent had a good knowledge. With respect to the methods of prevention, 48.3 percent of the patients had either a very low or a low level of knowledge, and only 9.6 percent of patients had a good knowledge. The total knowledge score was significantly associated with age (p<0.03), level of education (p<0.001), occupational status (p<0.04), living situation (p<0.04) duration of illness (p<0.001) and number of those hospitalized (p<0.001). So that older patients, patients with basic education, housewives, people who have lived in institutions, patients who have been ill for longer than eight years and people with more than six psychiatric admissions had a lower score on the AIDS-knowledge test.Conclusion: This study concluded that sexual history, HIV education and risk-reduction counseling are essential components of the care of adults with mental disorders.

Background and Objectives: Carpal tunnel syndrome (CTS) results from compression of median nerve within carpal tunnel. Unfortunately there is not standard test or tests for definitive diagnosis of CTS. CTS is presented with a constellation of symptoms and signs. Two point discrimination test is used for quantify the quality of sense in peripheral nerve injuries. The main purpose of this study is 2 PD evaluation in patients with CTS and comparing with other clinical tests and electrodiagnostic study.Material and Methods: In a cross sectional study 77 patients (154 hands) with CTS diagnosis and consecutive sampling evaluated. 2 PD test, clinical tests and electrodiagnostic study performed. Montecarlo test was used for statistical analysis.Results: Mean age of patients was 44.9 years (from 25-79).Mean time of clinical symptoms was 19.44 months. 2PD was abnormal in 41.6% (64 from 154 hands). Meaningful statistical correlation was found between 2PD test and Tinel's sign (p=0.007), and Phalen test (p=0.02).Also meaningful statistically correlation was found. between 2PD abnormality and electrodiagnostic study (p=0.03). There was not meaningful statistical correlation between 2PD and duration of symptoms.Conclusion: 2 PD test is not recommended as a screening and diagnostic test in CTS, but 2PD abnormality with other clinical sign of CTS reveals advanced nerve injury in CTS. Therefore; it is recommended that 2 PD abnormality be considered as an indication for surgical release of CTS.

Background and objectives: Febrile convulsions (FC) are the most common seizure disorder during childhood, and a common cause of admission in Tabriz Children's Hospital. Objective: of this study was to determine epidemiologic, clinical and laboratory features of first febrile convulsions in children admitted in hospital.Materials and Methods: We performed a prospective study of all children age between one month and 12 years, with a diagnosis of febrile convulsion admitted to the hospital during one year. From Dec 2003 to Nov 2004 analysis was made by X2, the level of significance was set at P<0.05.Results: Peak incidence of FC was in second year of life. There was a preponderance of boys. The most common cause of fever in our patients, were upper respiratory tract infections (48.2%) and gastroenteritis (32.1%). In 93.4 cases seizure occurred within 24 hours of the onset of fever. Antipyretic measures were not effective in preventing seizures. The average length of seizures was 5.7 min and the duration of seizures was less than 15 min in almost 94.1% while in 3.8% they lasted 30 min or more (Febrile status epileplicus). Simple FC occurred in 75.2%, complex FC in 24.8% (recurrence during 24 hours in 18%, longer than 15 min in 5.3% and focal seizures affected only 1.4%). Age under one year was significantly with complex FC (P=0.042).Conclusion: Results of This study show that epidemiological and clinical features of first FC are very similar to those in other countries except that there is lower incidence in focal FC. Age under one year is a risk factor for complex FC.

Background and objectives: Asthma is one of the most important reasons of hospitalization in children, which together with infections cause the 50% of admissions to hospital in children with 1 to 4 years of age and 33% who are 5 to 9 years old. Although deaths due to asthma usually happen out of the hospital, but high risk children may be identified upon their previous medical history before admission to PICU. Patients who do not respond considerably to primary treatments in emergency department must be transferred to PICU for close observation, monitoring and further treatment. Hypoxia, dehydration, acidosis and hypokalemia make these patients susceptible to cardiac Dysrhythmia and cardio respiratory arrest.Mortality rate due to asthma is increasing predominantly because of under diagnosis, delayed referral and inappropriate treatment. According to burden of asthma and its fatality if not be classified or treated properly, the early recognition of high-risk asthmatic children who must be admitted to PICU and to avoid unnecessary admissions, play a significant role in management of asthma, therefore we planned this study to identify predictive factors of PICU admission for asthmatic children.Materials and Methods: This comparative (analytical) and cross-sectional study on 70 asthmatic children (40 patients admitted to ward and 30 patients to PICU) carried out to determine epidemiologic and clinical factors, laboratory and radiologic findings and treatments in two groups of patients, who admitted to PICU versus respiratory ward. Statistical tests including T-test and Chi-square were used to analyze and compare results between these groups.Results: This study showed no meaningful difference in epidemiologic and radiologic findings, but revealed some statistically significant difference in presenting clinical signs such as: Cyanosis (P=0.002), Tachypnea (P=0.04) and Tachycardia (P=0.01) between two groups of patients, who admitted to PICU versus respiratory ward. Besides, there were some meaningful differences in their laboratory findings, including lower PaO2 (P=0.03) and higher PaCO2 (P=0.04) in patients admitted to PICU than who admitted to ward. Previous positive history of PICU admission and/or inappropriate medical treatment was more common in PICU admitted patients than ward admitted group.Conclusion: Results tto this study showed that cyanosis, rapid respiratory and pulse rates, low PaO2 , high PaCO2, previous positive history of PICU admission and inappropriate medical treatment, all prepare an asthmatic patient to need PICU readmission. The guidelines for PICU admission of asthmatic patients can be formed using the findings of this study.

Background and Objective: Amongst the most common causes of hepatitis are viral agents, of which HBV, with regard to its variety of transmission and disease progression, seems to be the most important. HBV infection may result in chronic hepatitis and carrier states in those patients that their immune system failes in virus clearance. Histocompatiblility antigens (HLA) are associated with many infectious and noninfectious diseases and play an important role in immune response and outcome of disease, progression, prognosis, and response to therapy and also susceptibility to disease or protection against it. In this situation the role of cytotoxic T lymphocyte is essential in the control of B hepatitis. These lymphocytes identify virus antigens with HLA class I and eliminate infected hepatocytes.Materials and Methods: In a case control study 50 patients who were HBsAg positive and more than 16 years old and 50 healthy individuals as control group were selected. Patients who were referred to the hepatitis clinic of Tabriz University Of Medical Sciences (Sina Hospital) whose HBsAg were positive for more than 6 months enrolled in our study. Control group matched with patients regarding to the age, sex and socioeconomic states. Sera from patients were sent to immunology laboratory to determine HLA class I antigens. The data of this case control study was evaluated by chi-square test, using the statistical package of social science (SPSS, INC. Chicago, IL) with P.value <0.05 as significantly.Results: An increase of frequency HLA-B38 (p<0.0005), HLA-CW7 (p<0.003), and a decrease of frequency in HLA-B35 (p<0.004), HLA-CW4 (p<0.016), HLA-BW4 (0.004), were detected in HBsAg positive patients in comparison with control group. Correlation of HLA-A2 and HLA-A3 with chronicity of HBV infection was observed.Conclusion: We noticed that, HLA have an important role in immune response and can be related with chronicity in B hepatitis.

Background and Objectives: Duchenne muscular Dystrophy is a neuromuscular disorder with muscular atrophy. This disease is consequence of mutations in dystrophin gene located on X chromosome and its inheritance pattern is recessive. The incidence of this disease is one out of 3500 alive male newborns. In two third of the cases the disease is due to new mutation. The reason for such a high Frequency of new mutation in the gene is suspected to be due to the size of the gene. This gene is consisted of 79 exons spanning 2400 kb. Among 70% of the patients the gene has large deletions or duplications. In the rest of the cases the gene has tolerated point mutations.Materials and Methods: DMD patients from East Azarbaijan diagnosed by neurologists were referred to the lab. DNA was extracted from the whole peripheral blood and was analyzed for 26 exons of dystrophin gene by applying Multiplex-PCR technique.Results: We found that 21 patients out of 46 referred patients (46%) had large deletions in one of the exons investigated. Three of these patients (14%) had deletions in one of proximal exons whereas the remaining (86%) had deletions in one of the distal exons (exons number 40 to 52). Fifteen out of 46 families (32.6%) had No affected person other than proband which this indicates that the disease was most likely due to new mutation.Conclusion: Forty six Percent of DMD patients from Eastern Azarbaijan had deletion in one of the exons and mainly distal exons of dystrophin gene (exons 40 to 52) were involved in these patients.

Background and Objectives: Men are unavoidably exposed to ambient electro magnetic fields (EMF) generated from various electrical gadgets and from power transmission lines because of their situation of job. So the protection is important controversy exists about the EMF effects on various organs. The main goal of this study was to evaluation that the EMF can increase the risk of infertility in men or not. One of the critical issues is that EMF may adversely affect the reproductive system and men infertility.Materials and Methods: To examine this, rat parents 50 male and 50 female 15 weeks age were mated in animal house of Tabriz University of Medical Sciences. Later on rat pups (30 numbers) were exposed to 50 Hz EMF (non-ionizing radiation) during in utero development (approximately 3 weeks) and postnatal life (5 weeks). The materials were processed and observed under light and transmission electron microscope.Results: In the experimental rats, boundary tissue was found disrupted in its various layers.It showed infoldings, which were perhaps due to the loss of collagen and reticular fibrils from the inner and outer non-cellular layer. The myoid cells showed few polyribosomes, pinocytotic vesicles and glycogen granules. Their mitochondria were without cristae. The connections between individual myoid cells were apparently lost.Conclusion: Based on this study the results suggest that EMF exposure causes profound changes in the genital organs of male rats. On long-term exposure, it could result in irreversible damage, which may lead to sub fertility and hence should be avoided.

Background and Objectives: Oxidation of low-density lipoprotein (LDL) is now widely accepted as a key event in the development of atherosclerosis. Oxidative modification of LDL leads to enhanced uptake by the macrophage receptor in the arterial wall, resulting in an accumulation of lipid within the cytoplasm of the cell. The resulting foam cell formation is a perquisite step in the development of the atherosclerotic plaque. Human plasma LDL comprises mainly three subtractions, varying in size and density and chemical composition. The aim of present study was to evaluate and compare of susceptibility to oxidation of three LDL subtractions in coronary heart disease (CHD) patients and control group as risk factor in diagnosis of CHD.Material and Methods: The study group consisted of 60 men [mean age (47±7)] with suspected CHD undergoing coronary angiography and the control group consisted of 60 men [mean age (44±9)] that had no any history for atherosclerosis or CHD. Cholesterol and triglyceride concentration were measured by enzymatic methods. LDL subtractions were isolated by density gradient ultracentrifugation and susceptibility to oxidation was studied by CU2+in the 234 nm absorbing oxidation products.Results: Three LDL subtractions were isolated from plasma by density gradient ultracentrifugation. The kinetics of the oxidation of subtractions was preformed in the presence of Cu2+ in the 234 nm absorption. Comparing of lag time in study groups were showed that the lag time of LDL1 (p(0.0001), LDL2 (p<0.0001) and LDL3 (p<0.0001) were significantly reduced in patients group, and a significant correlation between cholesterol with LDL2,LDL3 lag time in control and patient groups (r=-0.329, p<0.05 and r=0.453, p<0.01 respectively) and also triglyceride in both groups were found (r=-0.407, p<0.001 and r=-0.830, p<0.01 respectively).Conclusion: These finding could be explain of the arising atherogenesity from LDL1 to LDL3 in both patient and control groups and also indicate that susceptibility to oxidation in patients group is more talented than control group. These results suggest that measurement of susceptibility to oxidation of LDL subtractions could be a useful laboratory technique for predicate of premature CHD.

Background and Objectives: Upper GI bleeding in children is am special challenge for the medical team and parents. The causes may range from benign treatable to severe life threatening. This study has been carried out to determine causes of upper GI bleeding and to analyze demographic, endoscpic and pathologic findings.Materials and Methods: During 2 years of study (Nov 2001 - Nov 2003), 90 children under 16 years of old, who referred to our hospital with upper GI bleeding, were admitted and after stabilization of the vital signs and completion of a questionnaire, underwent endoscopy and biopsy. In this study endoscopy was the preferred diagnostic modality of UGIB and pathologic studies used as complement.Results: These 90 patients included, 45.6 female and 54.4 male, with the mean age of 7.7 years.The most common age group was 6-10 years (school age) with 40% of cases. Fresh bloody vomiting was the most common presenting symptom (73% of cases).25.6% of cases had an acute febrile illness before UGIB and 30% of them had used aspirin as an antipyretic. 17.8% of all cases had a history of aspirin ingestion which had caused erosive gastritis in 50% of them. 18.9% of cases had an underlying liver disease. The mean hospital stay was 7.4 days, The longest mean hospital stay with 15.4 days was due to esophageal varices. Bleeding from esohageal varices, was the most common cause of anemia, thrombocytopenia and prolanged PT, PTT and the most common indication for packed cell, platelete and FFP transfusion. Finally common causes of UGIB was as follows: errosive gastritis (33%), gastritis (21%), esophageal varices (19%), peptic ulcer (13%), esophagi is and erosive esophagitis (5%).Conclusion: Endoscopy (esophagogastroduodonoscopy) is the best and most sensitive diagnostic measure in UGIB. Bleeding esophageal varies is the most complicated and has the longest mean hospital stay. Bleeding following aspirin ingestion is the most preventable cause of UGIB.

Background and Objective: One of the important and obvious revolutions on education and practice of medicine is Evidence Based Medicine (EBM). EBM is conscientious, explicit and judicious use of current best evidence in making decisions about individual patients. The aim of this study was to determine attitude of faculty members of Tabriz University of Medical Sciences and health services to EBM. Accordingly, it was focused on measuring the rate of retrieval, critical appraisal and application of EBM among clinical faculty members.Materials and Method: Questionnaire research method was applied by this survey. Totally, 130 questionnaires were distributed among surveying society and 106 relevant questionnaires were gathered. Data were analyzed by in Microsoft Excel.Results: Of responders 43.4% announced that they are familiar with EBM. However 45.3% of responders reported that they would apply EBM in decision-making, and 33.3% claimed that their retrieved clinical evident had correspondence with their special patient. Of 46/1% reported Pub Med as their main source of retrieving for EBM, about 18.5% said that they use WWW, only 29.7 % reported that they use specifically developed EBM sites. Most of them announced that they did not know specific search strategy, except 1.9% that clearly announced to using particular and appropriate strategy for evaluating their own retrieved clinical evident. Conclusion: The results of this research showed that the clinical faculty members have not a clear cognition about EBM. Most of them applied clinical evidences but they didn't know how they can evaluate EBM and where they can find quality evidences. So, an obvious gap is seen between modem medical education and practice of study group. It is suggested that our trainer needs learning new approaches that are known as representative of medical informatics.

Background and Objectives: According to the high prevalence of drug poisoning in children, a study on demographic aspects and common causes of poisoning and accessibility of drugs was carried out in Tabriz Children Medical Center.Materials and Methods: This was a retrospective study of data collected from 334 medical files of patients, who had been admitted due to drug poisoning from Aug 2000 to Mar 2004.Results: This study showed that the most common causative agents in order of decreasing prevalence are: benzodiazepines, non steroidal anti inflammatory drug (NSAID), tricycles antidepressants as drug group and opium and ibuprofen as single drug (p<0.001).79.6% of all poisoning cases were accidental (p<0.001), and 81.5% of them had less than 6 years of age (p<0.001), but there was no meaningful difference for sex (p<0.7).Conclusions: The high prevalence of poisoning with benzodiazepines and tricycles antidepressants shows their excessive consumption in our community which is due to increased incidence of depression and other psychiatric disorders, besides, the carelessness of families to keep the drugs out of reach of children may play a role.This fact that opium is the second most common single drug, and opioids which are in 5 th prevalent drug group that cause poisoning in children, shows that illegal drug addiction might be common in our community and their availability of those agents for our children.

Background and Objectives: Development of scientific technology and new methodology has been revolutionized medical sciences. Also, hysteroscopy increasingly used as a method of choice for treatment of intrauterine pathology.The purposes of this study were to show the results of the application of hysteroscopy in intrauterine disorders, to review the existing literature regarding hysteroscopy and to evaluate the evidence regarding the purposed risks and benefits of the procedure.Material and Methods: This is a descriptive and crosses - sectional study that was carried out in teaching hospitals during 3 years in 301 patients from early 2000 to 2002. Results were analyzed with statistical methods.Results: Abnormal uterine bleeding and infertility were the most common clinical compliant of patients in % 65.8 and %10 of cases, respectively. In %61.5 of the cases hysteroscopy used for diagnosis and %38.5 for treatment. Endometrial polyp (%33.9) and sub mucosal myoma (%29.9) were the most common diagnosis. Uterine perforation happened in one patient (% 0.3).Conclusion: The results of this study indicate that the hysteroscopy can be used as a safe and effective method for management of intrauterine diseases. It should be considered as a first- line conservative surgical therapy for the management of symptomatic intrauterine benign diseases.

Background and objectives: Until recently brain Abscess was a lesion that was diagnosed only after autopsy, but development in neurosurgery decreased the incidence of mortality and morbidity. In this study we attempted to compare the result of different surgical technique and follow up patients after surgery.Materials and Methods: In a prospective study between 2001-2003, 27 patients with brain abscess went under clinical and paraclinical examination and then went under operation with aspiration or excisional technique and their data registed and analyzed.Results: In this study 27 cases of brain abscess were reviewed with dominancy in male (male/female ratio: 2.2/1). Most of patients with brain Abscess were under 30 years old. The most predisposing factors were chronic otitis media (COM) and cyanotic heart disease (29.6% and 22.1%) Most of abscess secondary to COM located in cerebellum (P<0/005) and abscess secondary to sinusitis of frontal sinus localized in frontal lobe (P<0/005). After operation all cases received antibiotic therapy for 6-8 weeks, and in follow up with serial CT Scan most of them had normal CT scan after 3 month.Conclusion: In the differentional diagnosis of all patients with signs and symptoms of increased intracranial pressure we should remember brain abscess and with appropriate treatment would have good result.

Background and Objectives: Stressful life events are the strongest predicting factor in onset of depression. Therefore in recent years more attention has paid to define the role of coping strategies on stressful life events. The purpose of this study was to determine the relationship between personal characteristics, severity of depression and coping strategies in patients affected by major depression.Materials and Methods: This is a descriptive analytical study. One hundred Patients (57 female, 43 male) who referred to psychiatric clinic of Razi hospital of Tabriz that their diagnosis was confirmed by DSM-IV-TR criteria and clinical interview, evaluated by the folkman-Iazarus Questionnaire.The collected data were analyzed by SPSS V11.0 soft ware.Results: The findings showed that there were significant deference between sex, level of education, occupational status, severity of depression and most of coping strategies (p<0.05). There was no significant deference between age and coping strategies except self controlling. Conclusion: Personal characteristics and severity of depression affects on coping strategies in depressed patients. Male, patients with high level of education, mild depression and employed patients used more effective coping strategies such as confronting coping, self controlling, seeking social support, and planful problem solving than other depressed patients.They also used less maladaptive coping strategies such as escape-avoidance, wishful thinking, and self blame.

Background and Objectives: Nasolacrinal duct obstruction is a common cause of refer to ophalmic cinics. Medical treatment and probing doing haven't efficacy in the management of nasolacrimal duct obstruction in a dults and surgical treatment required for these cases.Comparison of effect of probing with mitomycin-C and external dacryocystorhinostomy on idiopathic distal lacrimal duct occlusion in adults.Matherials and Methods: Eighty patients with idiopathic distal lacrimal duct occlusion enrolled in this randomized prospective trial.Forty patients underwent external dacryocystorhinostomy under general anesthesia and other 40 cases underwent probing with injection of MMC (0.4 mg/ml) under Rand-Stien analgesic protocole and finally effects of these two procedures on improvement of the complaints were evaluatedResults: Two weeks postoperatively 92.5% of cases in probing group and 97.5% of cases in DCR group had improvement in symptoms but the difference between two groups is not statistically significant (P=0.2950) 6 months post operatively 77.5% of cases in probing group and 92.5% of cases in DCR group had improvement of symptoms. The difference between these two groups is statistically significant (P=0.003).Conclusion: probing with MMC injection is beneficial in idiopathic distal lacrimal canal obstruction of adults however its efficacy declines with time.

Background and objectives: Achalasia is an uncommon esophageal motility disorder of unknown etiology. While it has been described throught the world, there have been few epidemiological studies of this disorder in the Asia.The aim of this cross sectional study was to describe the clinical and preclinical features of patients with achalasia in Iran.Materials and Methods: We conducted a cross sectional database review of 83 patients with achalasia referred for esophageal manometry at the Taleghani hospital during April 2002 to September 2004 and 29 patients with achalasia that hospitalised for therapeutic procedures during may 2003 to July 2004.Results: Median age of onset of symptoms was 38±15.74 years. The presenting symptoms were dysphagia to solids (100%) to liquid (79.3%), chest pain (27.5%), Regurgitation (17.2%), difficulty belching (27.5%), heart bum (13.7%) and weight loss (24%).Endoscopy was reported as normal in 6/29 patients (20.6%) and achalasia was suggested in only 21/29 (72.4%) barium examination.No cases of complications after pneumatic dilatations were identified among these patients. Conclusion: The clinical and preclinical features of Achalasia cases were similar to those described in other countries. Fortunately the complication of pneumatic dilation was low and out patient management is safe.

Background and Objectives: Breast cancer is the most common cancer in women.Combinations of internal and external factors like trace elements are involved in initial development of breast tumors. The aim of this study was to evaluate and compare serum levels of Zn, Cu and Cu/Zn ratio in breast cancer patients and control group.Material and Method: This case - control study was composed of 50 Iranian women diagnosed with breast cancer and 50 normal individuals. The age range of patients and controls was 30-50 yrs. Blood samples were obtained and were isolated immediately and levels of Zn and Cu were measured using atomic absorption spectroscopy (AAS).Results: Mean levels of Zn and Cu in breast cancer patients were 0.969±19 and 1.47±48 mg/L, respectively. The mean concentrations of Zn and Cu in normal individual were 1.07±35 and 1.09±20 mg/L, respectively. While there was a significant correlation between Cu levels of patient and control (p<0.001). In addition, the ratio of Cu/Zn in breast cancer patient and controls were 1.52 and 1.12, respectively. This difference was statistically significant (p<0.001).Conclusion: It is speculated that changes of trace elements particularity Zn and Cu could have a forewarning for the distinction and cure breast cancer.

Background and Objectives: Infertility is defined as failure in pregnancy after one year of unprotected intercourse. The most common causes of infertility reported in different researches are including male factor, female factor, both male and female factor and unexplained infertility.The aim of this study was to survey the epidemiology of infertility in Royan Institute.Materials and Methods: In this descriptive study, 2492 infertile couples were studied. These couples were selected by systematic sampling among couples referred to Royan Institute between 1995 and 2001. Demographic data and diagnostic methods which were existed in files, were recorded in questionnaires. Results were analyzed by SPSS version 11.5.Results: In this study, the frequency of primary and secondary infertility was 90.1% and 9.9%, respectively. Among 2492 couples, 50.5% had male factor, 28.6% had female factor, 11.6% had both male and female factors and in 9.3% of couples, the cause of infertility was unknown. Results showed that 32.3% of men had normal spermogram, 23.6% of men were azospermia, 40.3% had sperm disturbance and 3.8% were not able to collect sample for semen analysis. Among women, different infertility factors included: ovarian factor (20.36%), tubal factor (12.64%), uterine factor (4.13%), endometriosis (1.28%), recurrent abortion (0.68%) and 50.48% of women were normal.Conclusion: Although male infertility is the most common cause of infertility in Royan Institute, we could not conclude that male infertility is the most common cause of infertility in Iran because Royan Institute is a referral center especially for male infertility. We suggest conducting similar researches in other centers of infertility in Iran to evaluate the most common cause of infertility.

Backgrounds and Objectives: Acne is a chronic inflammatory disease of the pilosebaceous unit which in some cases may accompanied by scarring, pigmentory changes and Cosmetic problems. In these cases social and behavioral disturbances would be unticipated. Current treatments of mild and moderate forms of acne is often less effective in sever acne. Recently, isotretinoin has revolutionalized the management of sever and resistant acne.Side effects of isotretinion particularly cheilitis & xerosis are mother of concern and sometimes patients do not welcome this treatment. In this survey the roles of Vit E and cod liver oil in reducing side effects of isotretinoin were compared.Materials and Methods: This study was performed on 60 patients on 0.5 mg/kg/day isotretinoin treatment for 6 months. All enrolled were divided into two genders, age & severity matched groups. The first group received 800 Iu/ day Vit E during treatment and the second group received 800 Iu/ day cod liver oil capsules. All patients were observed for the complications at 1 th, 4 st and 6 th weeks during treatment.Results: The mean age of patients was 22 years. Female to male ratio stranded at 3/2 In 40% of patients, the face was the only site affected and in remaining the shoulder & the trunk were mainly involved. Cheilitis was the most common side effect among these patients (69%).Epistaxis was the second side effect in both groups (22%). Other side effects were xerosis, pruritus, epigastric pain and nail fragility. The frequency & the severity of complications were less common at 4th and 6th weeks of treatment.Conclusion: Isotretinoin is an effective drug in sever acne. So minimizing its side effects will help the physician not to interrupt the therapy. Regarding the other benefits of Vit E supplement and its probable effects on reducing the complications of isotretinoin and ministering vit E to these patients would be a proper decision.

Background and Objectives: Diagnosis of developmental dysplasia of the hip (DDH) is important at birth. DDH occurs in 1-1.5 per 1000 live births and in girls is more commonly than boys. Early detection of DDH in newborns (up to 2 months) is known to be most successful for both treatment and prevention of complications of DDH. Clinical examination at birth is onset step in diagnosis of DDH. Because the obstetrics have earliest contact with newborns, therefore we decided to asses the role of clinical examination and risk factors in DDH.Materials &methods: A retrospective analytic descriptive study done in Alzahra educational center in Tabriz. We studied 12494 records of live births between 2002-2004, and selected records which had at least one positive clinical finding for DDH. Data were gathered and analyzed using SPSS/11 soft word, by X2 test.Results: The prevalence of positive clinical finding for DDH in this study was 2.8 per 1000 live births. Limitation of abduction was the most common clinical finding (52.9%). The rate of occurrence of DDH was 47% in the newsboys with at least one abnormal clinical finding which confirmed by ultrasonography. There fore, prevalence of DDH was 1.36 per 1000 live births.Often the newsboys with DDH had at least one risk factor (70.6%). Breech presentation and oligohydramnious were two most common factors associated with DDH. In addition there were Statistically significant different between risk foctors and DDH (p= 0.043).Conclusions: According to this study, the highest suspicion of DDH is reserved for infants with positive clinical findings and with positive risk factors.

Background and Objectives: The aim of this research is studying the rate of agreement between two methods of clinical interview according to DSM-IV-TR and MMPI test in diagnosing mood disorder.Materials and methods: In-patient and out-patients referre to Tabriz Razi hospital were selected randomly and assessed during two stages through clinical interview and MMPI test (short - form). Then the diagnostic efficacy Index of MMPI, kappa coefficient, P number and positive and negative diagnostic power with spss program were calculated to determine the agreement rate of the mentioned methods.Results: The obtained results shorted a poor convergence between MMPI test and the clinical diagnosis and the specificity of this test relative to its sensitivity indicates its higher function in excluding the mood disorder relative to including it.Conclusion: Various statements have been proposed are for the causes of decreased convergence in the evaluation methods mentioned above in which the dysfunction in expressing the diagnostic symptoms and criteria and the problems related to the low sensitivity of evaluation scales in short form MMPI test is remarkable.

Background and Objectives: In patients suffering of hand trauma, zone II injuries of flexor tendons could cause significant disability if not properly managed. In the treatment of such injuries prevention of adhesion and the resulting stiffness is of main concern. Surgical treatment should achieve a primary tendon repair of sufficient tensile strength to allow application of a postoperative rehabilitation program. The aim of this study was to analyze prospectively the results of such repair using the modified Strickland technique.Methods and Materials: In a period of 3 years, 50 patients with 70 flexor tendon lacerations were enrolled in this study. After repair using modified Strickland technique, the rehabilitation program using dorsal splinting and rubber band technique was started. The mean age of the patients was 28 years (ranging from 4 to 55 years). Eight patients did not followed-up and 42 patients with sixty flexor tendon repairs were followed for a mean period of eight months (ranging from 6 to 12 months).Results: Results of This study showed that according to Strickland's criteria in 47 tendon repairs (78.3%) the result was excellent with total active motion of 153 degrees. In 6 cases (10%) the result was good, in 3 cases (5%) it was fair and in four cases (6.7%) the result was poor.Conclusion: Despite improvements in repair site strength and in the understanding of repair - site biology, adhesions still frequently form between the tendon and surrounding fibro - osseous sheath. The result of this study showed that the modified Strickland's technique if used properly with attention to details of an atraumatic and delicate surgical repair and postoperative rehabilitation can produce good or excellent results in more than 85% of cases.

Background and objective: Dermatophytoses are the most common human fungal infections over the world. These infections have been nominated according to the anatomical site of involvement such as tinea capitis. Some predisposing factors may increase susceptibility including diabetes, Cushing syndrome, etc. The objective of this survey was to determine some predisposing factors for tinea corporis, because elimination or treatment of them not only ceases spreading of the lesion but also prevents reinfection.Materials and Methods: In this descriptive cross- sectional study patients who were visited in Sina Hospital in Tabriz and had confirmed tinea corporis with direct fungal smear were selected. Other regarding were age, sex, occupation and predisposing factors.Results: Of 76 confirmed cases, 46 (60.5%) were males and 30 (30.5%) were females. Tinea corporis was common in the third decade. The main predisposing factor was dry skin. Diabetes was found only in 4 (5.2%) patients.Conclusion: The main predisposing factor in thid survey for tinea corporis is dry skin that its diagnosis, treatment and some simple educations may inhence improvement of tinea corporis and prevents other superficial infections too.

Lipoid proteinosis is a very rare, recessively inherited disorder characterized by non-inflamatory persistent papules on the skin and mucous membranes. The pathogenesis of the disease in not yet clear. It usually presents in infancy with hoarseness. Therapy is mainly symptomatic.A 26-year old man born to consanguineous parents with lipoid proteinosis characterized by the deposition of hyaline-like material into the skin, mucous membranes and internal organs.This disorder is particularly interesting because of its rarity and wide range of clinical manifestations. The main signs of syndrome-papulondular, hyperkeratotic and verrucous lesions distributed over the skin, pock-like scars of the face, beaded papules on the palpebral margins, tongue firmness with short frenulum, wide spread popular lesions of the oral cavity, hoarseness, dysphagia and epileptic seizares were present. Neotigason 50 mg/day was effective in reducing skin ulceration and dysphagia.