Medical Journal of Tabriz University of Medical Sciences
Year:2009 | Volume:30 | Issue:4|Papers Count:23

Background and Objectives: Hearing loss (HL) is the most common sensory deficit in humans. In more than 80% of these cases, the mode of transmission is autosomal recessive. To date 85 loci have been mapped for nonsyndromic deafness with different inheritance patterns. DFNB1 is a locus that contains Connexin26 gene (Cx26 or GJB2). Mutations in Cx26 are responsible for 50% autosomal recessive, non-syndromic hearing loss (ARNSHL) in Caucasians. Around 90 different GJB2 mutations have so far been reported to be associated with recessive, non-syndromic hearing loss.Materials and Methods: We assess the contribution of Cx26 gene in ARNSHL in 100 probands from the East Azerbaijan Providence. The first phase was screening for 35delG mutations. Heterozygous or negative patients to this mutation (85 patient), were tested for other associated mutations in the coding region of Cx26 gene by applying Single (Strand Conformation Polymorphism/Heteroduplex Analysis, SSCP/HA); a technique with high sensitivity, simplicity and versatility. DNA was extracted from the peripheral blood. Results: We detected at least 14 different SSCP patterns in 62 chromosomes (36%) of 170 affected chromosomes. Homozygote pattern was detected in 2 chromosomes and in 60 chromosomes had heterozygote pattern. 67% of patients were born in consanguineous families. Conclusion: Different SSCP patterns were detected in 36% of patients in coding second exon of Cx26 gene. This proves the value of such studying in this disorder in the Azarbaijan Providence.

Background and Objective: Admission to hospital and the prospect of surgery is accepted as extremely anxiety-provoking, resulting in behavioral and cognitive sequel, which can have far-reaching effects on recovery. The prospect of having surgery generates anxiety whether the surgery is a major or minor procedure. The objective of this study was to investigate the effect of pre-operative nursing visit on preoperative anxiety in patients operated on for ENT problems Material and Methods: Using a controlled trial, 45 patients having elective ENT surgery, were visited by perioperative nurse (experimental group). A control group on 45 patients received routine care alone. Outcome measures used in the study was pre-operative waking serum cortisol level.Results: The results showed that mean cortisol level of patients in the experimental group was 16.92±6.78 (micg /100), and mean cortisol level of patients in the control group was 27.88±6.47(micg /100).Conclusion: The results showed that cortisol levels of patients in the experimental group were lower than patients in the control group, and this deference is statistically significant.According to significant deference between two groups, it is concluded that pre-operative nursing visit can decrease waking cortisol levels of patients having an elective ENT surgery.

Background and Objective: Asthma management has improved markedly over the last 50 years, largely due to the introduction of inhaled corticosteroids (ICS) in the early 1980s.Nevertheless, good-quality outcome in asthma hinge not just on the availability of medication but also on their appropriate use by patients. The outcome of non adherence is loss of opportunities for patients to improve their health, and loss of medication by health-care systems, with subsequent effect of increased mortality. This study was conducted to survey the effect of education and regular follow up on adherence rate of children with mild to moderate persistent asthma.Materials and Methods: In a semi-experimental study (before and after), two groups of children with mild to moderate persistent asthma, referred to outpatient clinic of Tabriz University of Medical Sciences were compared. First group included 200 asthmatic children who were treated at least for duration of one year by conventional method. The second group included 300 patients at the same age and severity of disease that were treated at least one yearby a comprehensive plan of education and regular follow up visits as well. Data were analyzed by chi-square and P<0.05 was considered as significant difference. Results: Findings indicate that in first group 100(50%) and second group 295(84/3%) had adherence rate more than 50% (P=0.00). Considering adherence rate of ³ 50% there was significant difference between two groups with mild persistent asthma (P=0.00).Conclusion: Our findings indicate that education and scheduled follow up can result in higher degree of adherence.

Background and Objectives: Eating disorders are disease which is prevalent in adolescent girls. This study was carried out to determine prevalence of high school girls which are at risk for eating disorders, and their relation to demographic parameters, in Tabriz.Materials and Methods: 1887 high school girls were selected by simple random method. Eating Attitude Test-26 (EAT-26) was used. After determination of it.s validity and reliability, prevalence of at risk students for eating disorder and their relation to demographic parameters were assessed.Results: The questionnaire had good validity and reliability (0.76, 0.8, respectively). Mean and standard deviation of EAT-26 score was: 11.71±8.48. 16.7% (C.I with 95%: 15.1-18.3%) of students were at risk for eating disorders. There was not any significant deference in prevalence of eating disorders in different age groups. EAT-26 score and eating disorder prevalence were higher in students, who considered themselves as obese, inclined to weight loss, were smoker, and who had menarche at below than 11 years (P <0.05). Conclusion: Our results are less than studies in Tehran, Arabian countries, and some European ones. Our results show that eating disorders can be seen in our community. Body weight attitude, age of menarche and smoking have role in increasing of eating disorders incidence.

Background & Objectives: Cerebral palsy is one of the most common disabling conditions affecting children. It's a nonprogressive encephalopathy. Motor delay is hallmark of CP. It occurs as the result of injury in each phases of brain growth and may be accompanied by speech, auditory, visual abnormality, seizure, learning disorder and mental retardation. The most important risk factors are prematurity and low birth weight. The purpose of this paper is to present etiology, types (classification), associated disorders and motor development of these children in East Azarbaijan.Materials and Methods: We studied 155 children under 11 years old in two years. Cases were those reffered to Rehabilitation center of Tabriz children hospital with diagnosis of CP. The information collected using checklists.Results:Nearly one third 34.8% of Patients were under 2 yeares old 62.6% of them were males. Quadriplegic form was recorded as the most frequent type (46.5%), Diplegic was 38.7% and hemiplegic 7.8%, seventy percent (70.3%) of children had spastic forms. Other forms include: 10.3% mixed, 14.2% hypotonic, 5.2% athetoid. Speech disorders and strabism were the most common associated disorders. (47.7%, 41.2% respectively) 18.8% had prominent cognitive problems and 17.5% had seizure.Low brith weight and prematurity were the most common risk factors (63.3%, 51.3% respectively) The mean age of head control and sitting were 11.55 ± 8.76 and 21.53 ± 14.26 months respectively. 64% of children in age group 2-6 years walked with assistance.Conclusion: The most important risk factors for CP are low birth weight and prematurity. These provide a powerful means of development monitoring and follow up for this neonate. Greater than 60% of cerebral palsied children became ambulatory and prominent cognitive problem was seen in 18% of patients, therefore early intervention & rehabilitation can decrease the impact of brain injury on the development of cerebral palsy.

Background and objective: b -Thalassemia is a hereditary autosomal disorder with decreased or absent b-globin chain synthesis. This study was designed to identify the common and rare b -thalassemia mutations in the Azerbaijan provinces, Northwestern Iran, and to set up a prenatal diagnostic laboratory.Materials and Methods: One hundred unrelated patients with known b-thalassemia major and intermedia, registered with the thalassemia clinics in provincial capitals of Tabriz and Ardebil, were examined. Mutations were studied in 200 chromosomes, by Polymerase Chain Reaction-Amplification Refractory Mutation System (PCR-ARMS) and direct Sequencing methods.Results: Seventeen different b- thalassemia mutations were found in this region of Iran. The results showed that IVS-II-1 (G®A) mutation was the most frequent, comprising 21% of all mutations. Other common mutations were IVS-I-110 (G®A) 18%, FSC-8/9 (+G) 14.5%, FSC-8 (-AA) 8% and IVS-I-1 (G®A) 7.5%. The other mutations were as follows; IVS-I-5 (G®C), FSC-44 (-C), Cd15 (TGG®TGA), FSC-5 (-CT), IVS-I-6 (T®C), IVS-II-848 (C®A), FSC- 36/37 (-T), -28 (A®C), FSC-25/26 (+T), IVS-II-745 (C®G), FSC-16 (-C) and IVS-I-25 (-25bp del). Overall these comprise 95% of b-thalassemia mutations in this region and 5% of the mutations still await exploration.Conclusion: The results of this study showed the similarities and differences between this region with the other regions of Iran and neighboring country This is the first comprehensive study in this region and could be useful for developing b-thalassemia molecular screening plan in Azerbaijan-Iran.

Background and Objective: Spinal anesthesia would possibly produce an undue degree of hypotension in volume depleted, vasoconstricted patients with preeclampsia but, recent studies have not found these concerns. This study compared the incidence and severity of hypotension in preeclamptic and healthy parturients.Materials and Methods: In this prospective, double-blind, and clinical trial study, we compared the incidence and severity of spinal anesthesia associated hypotension in severely preeclamptic (n=30) and mild (n=30) versus healthy (n=30) parturients undergoing cesarean section. After administration of IV fluids, spinal anesthesia was performed with hyperbaric 0.5% bupivacaine 10 mg, plus sufentanyl 3.3 mg. Blood pressure was recorded before and at 2- minute intervals after SA. Clinically significant hypotension was defined as the need for ephedrine systolic BP decrease to <100 mmHg in healthy parturient or 30% decrease in mean BP in all groups, and was treated with intravenous ephedrine 2.5 mg up to a maximum 50 mg.Results: All patients had satisfactory anesthesia. There were no significant differences in the incidence and severity of hypotension between three groups (P>0.05). Baseline values of HR were similar in the three groups. The incidence of HR changes was also similar between the groups (P=0.410). Apgar scores and the biochemical markers of umbilical arterial blood were similar between the groups (P>0.05). Conclusion: This study shows that the incidence and severity of hypotension in severely and mild preeclamptic patients, as compared with healthy parturients undergoing spinal anesthesia for cesarean section were similar, and also their neonatal outcome were similar.

Background and objectives: High myopia is one of the causes of decreased vision in young people that generally corneal refractive surgeries (LASIK or PRK) cannot successfully resolve their problems. In this research efficacy of intraocular phakic lens implantation were evaluated in this group of patients.Materials and methods: In these research results of phakic lens implantation in 28 eyes of 14 patients with high myopia evaluated. Main outcome measures were refraction, BCVA, UCVA, IOP and pachymetry; which were evaluated at first day, one and six month after operation. Results: Meaningful increase in visual acuity of this patients with and without spectacle correction was seen (P<0.005). No vision threatening complications were seen in these patients. Preoperative and postoperative pachymetries don't show significan changes.Conclusion: That phakic intraocular lens implantation is a suitable procedure in patients whom are not good candidate for keratorefractive surgeries.

Background and Objectives: Incidence of Y. enterocolitica has been increased in the world and several studies have proposed relation between Y. enterocolitica infection and acute diarrhea in children. In this study rate of Y. enterocolitica emergence in children under 14 years old and role of some interventional factors including: age and season were investigated. The efficiency rate of KOH and cold enrichment methods and resistant pattern of Y. enterocolitica were also studied.Materials and Methods: Five hundred diarrheic specimens collected from children under 14 years old (in case of infants rectal swab were used) who were referred to microbiology laboratory of children medical center of Emam hospital in Tehran (1381) and were cultured on selective media for Y. enterocolitica, Shigella spp., pathogenic E. coli and Salmonella spp. In order to increase rate of Y. enterocolitica isolation, samples were enriched at cold (4°C) and KOH prior to cultivation in selective media.Results: Six strains of Y. enterocolitica serotype O: 3 were isolated from 500 diarrheic specimens of children under 14 years old. In addition to Y. entercocolitica other enteropathogenic bacteria including Shigella spp. in 36 cases, enteropathogenic E. coli in 26 cases and Salmonella spp. in 12 cases were isolated. All of the Y. enterocolitica positive specimens showed many leukocytes and in 4 cases associated with red blood cells. Clinical manifestations included: diarrhea, abdominal pain and vomiting in all of patients and fever in two of the cases were recorded. Isolated strains of Y. enterolitica were sensitive to aminoglycosids, cotrimoxazole, ceftizoxim and resistant to ampicillin, cefazolin and cephalothin.Conclusion: Isolation rate of Y. enterolitica increased using enrichment in 4°C and KOH. The rate of Y. enterocolitica isolation was not as high as other enteropathgens and showed association with seasons and age.

Objectives- Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Drug treatment of AF usually leads to unsatisfactory rate of recurrence. The Cox-maze III procedure for atrial fibrillation has been offered effective in restoring sinus rhythm in patients with mitral valve disease.Methods- This research is a cross sectional and descriptive study from 2002 to 2004. 10 consecutive patients with rheumatic mitral valve disease and chronic AF underwent Cox-maze III procedure concomitantly to mitral valve replacement. Associated procedures were tricuspid valve repair in 4 patients and Aortic valve replacement in 2 patients. Our indications to perform Maze-III Procedure were chronic AF, medical history of previous thromboembolic events and large left atrium on preoperative transthoracic echocardiography.Results- There were 2 men and 8 women with a mean age of 40±8 years. Mean aortic crossclamp and cardiopulmonary bypass times were 90±11 and 144 ± 18 minutes respectively. There was no in hospital mortality. Normal sinus rhythm was restored early post operative in 60% and late in 80% of patients. Right atrial and left atrial contractility was found in 80% and 70% of the patients in trans esophageal echocardiography 6 month postoperation.Conclusions- The maze III procedure associated with mitral valve replacement is a safe and effective surgical technique for conversion of AF to sinus rhythm and restore atrial contractility in rheumatic heart disease.

Background and Objectives: Aortic Stenosis occurs in approximately 3% to 8% of patients with congenital cardiovascular defects. Valvular AS is the most common causes of aortic stenosis and the second most common form is subvalvar aortic stenosis. Males are affected 2 to 3 times as often as females. The most common type is fibrotic form or ridge, and then fibromascular type and tunnel like is the rare form. Best surgical method for repairing is resection of obstructive lesion with myomectomy for best prevention of recurrence. There is no study in this category in Iran, so we did this study to know best time and surgical method therefore we decide to evaluate results and complications of surgery in one of popular centers of pediatric cardiac surgery in Iran with choosing best time and route of operation can inhibit progression of disease that can lead to aortic insufficiency. We hope results of this study can reduce mortality and morbidity of this disease.Materials and Methods: all documents of patients with subaortic stenosis admitted in pediatric ward of Shahid Rajaee hospital between mehr of 1993 - 2003 studied and 279 cases included. All data coded and entered to computer and analyzed with SPSS software accordingly. Results: 103cases (36.9%) were female and 176 cases (63.1%) were male. Mean age was 15.59±5.62 yrs. 193 cases (69.1%) operated that 83 cases (29.7%) had pressure gradient over 40mmHg and 113cases (40.5%) operated due to other cardiac diseases. Type of operation in 144 cases (74.61%) were fibrotic and fibromascular resection with or without myotomy (2cases with MVR and 3 cases with AVR), 44 cases (22.79%) fibrotic and fibromascular resection with myomectomy and 5 cases (33.33%) operated operated with Konno Rastan In this center no operation made with Ross or modified Konno. After surgery 28 cases (33/73%) had pressure gradient over 40mmHg had recurence. 12 cases died during follow up. Discussion: with respect to results of this study type of operation in this center often is fibrotic resection and fibromascular resection with or without myotomy that cumulative frequency of them is about 144 Cases (74/61%). Standard treatment of this disease is deletion of stenosis and myectomy for avoiding recurrency and frequency of this type in this center is 44 cases (22/79%) that maybe is cause of high rate of recurrence in this study.

Introduction: Retinopathy of pre maturity is a disease that involves premature neonates that their retinal vascularization was not completed. Regarding developments in care of premature neonates it is expected that the prevalence of retinopathy of prematurity increases.The aim of this study was to screen retinopathy of prematurity in 2 years survey of preterm inants in Tabriz Alzahra hospital.Method and material: This is a descriptive study between 2005-2006. All of the preterm infants with gestational age under 32 week or birth weight less than 1500gr and all neonates with birth weight of 1500_2500gr who had unstable condition during admition in hospital were included in this study and examined with an ophthalmologist for screening of retinopathy of prematurity.Results: We screened 399 preterm infants from 2023 neonate who admitted in NICU. We found 29 neonates(7/27%) had retinopathy of pre maturity that 15 neonate healed with no intervention and 14 neonates received laser ablation therapy and one vitrectomy, and except one that who blind , all of these neonate has optimal level of vision. The plenty existed identified risk factors was oxygen therapy, mechanical ventilation with ventilator, blood transfusion and surfactant therapy receive and mother's preeclampsia.Conclusion: The prevalence of retinopathy of prematurity is low in NICU of ALZAHRA hospital. Since the danger of this disease in pre mature neonates, routine screening is recommended in all NICUs. Control of risk factors and screening program can prevent long term complication.

Background and Objectives: Nosocomial infections are one of the significant causes of mortality all over the world, but it can be easily managed by adequate application of disinfectants. The purpose of this study was to evaluate the bactericidal activity of some routine used disinfectants against clinical isolates of Pseudomonas aeruginosa.Materials and Methods: The susceptibility of 25 clinical isolates of P. aeruginosa to disinfectants namely germicide-P, cetrimide-C, povidone iodine and ethanol was determined by the standard suspension test as well as surface test. Also to evaluate the effect of organic load on the activity of the disinfectants, 5% bovine albumin was applied as dirty condition in standard suspension test.Results: According to the results of suspension test, the minimum bactericidal concentrations of all the tested compounds fell into use concentrations, i.e. 1/5, 1/120, 10% and 70° for germicide-P, cetrimide-C, povidone iodine and ethanol, respectively. Whereas the results of surface test that evaluated the ability of disinfectant to act against surface dried microbial load, were significantly different and showed various degrees of decline. Five percent organic load showed no significant difference in the results of AOAC test of any of the tested disinfectants against none of P. aeruginosa isolates.Conclusion: All the tested isolates showed various degrees of susceptibility when treated with the use dilutions of germicide-P, povidone iodine and ethanol and only cetrimide-C in the dilution of 1:30, within its use dilution was able to eliminate all isolates.

Background and Objectives: Psychosocial stress is one of important issues in mental health of all humanbing societies. This study was aimed to determine the ranking order of stressful life events (SLE) among general population of Tabriz -Iran.Materials and Methods: In this descriptive cross-sectional study through randomized cluster sampling 600 subjects older than 18 selected and assigned scores between 0-20 to each item on a relatively modified version of Holms-Rahe scale of stress ratings. Appropriate statistical analyses were used to analysis of data.Results: ''Death of child'' was ranked first and allocated the highest score (mean= 19.75, Std Error =0.005), while'' Summer Vacation'' was allocated the lowest score (mean = 4.06, Std Error =0.23) among 50 stressful life events. ''Death of spouse'' and '' Infidelity of spouse'' was ranked second and third respectively. Jail sentence, addiction, divorce, to stand accused, unsuccessful marriage, son or daughter running away, death of a close family member were included among the top 10 most SLE. Regarding gender differences, males and females shared all 10 events in their top 10 SLE and ranked those events similarly except for 4 items. However compared with males, females significantly gained higher total mean for both top 10 weights and all of 50 weighted (13.04 v.11.48, p=0).Conclusion: The result show that socio-cultural differences should be noted in using any stress ratings scales, and at individual level some influential factors particularly gender and age differences in weighting of the severity of SLE have to be observed. Despite this, there are yet shared events especially among top 10 SLE in different cultures that own the same stressful effect.

Background and Objectives: Traditionally canalicular lacerations were repaired by bicanalicular Crawford intubations and anastomosis of two cut ends. Recently monocanalicular silicon stent was used for canalicular laceration repairing. In this study we compared the success and complations rate of canalicular laceration repairing with monocanalicular (Mini-Monoka) and bicanalicular (Crawford) intubation.Materials and Methods: In group one, 20 canaliculi repaired with Mini- Monoka intabution and in group two, 50 canaliculi repaired with Crawford intubation. The stent left in place for 3 months. Anatomical patency was ensured by probing and irrigation at the time of stent removal and 3 months later. Subjective epiphora evaluated by grading to success, fair and poor. Data were analyzed by EP (version 6) software and chi Square. Statistically significant value was defined as P<0.05.Results: At final follow up anatomical patency was confirmed in 19 and 49 canaliculi in group 1 and 2, respectively (P=0.49). Subjective improvement was observed in 80% and 64% in group 1 and 2, respectively (P=0.31). Complications were granulation tissue (group 1=2 group 2=1), premature stent dislocation (group 1=3 group 2=3), canalicular stricture (group 1=3 group 2=9) and slit punctum(group 1=0 group 2= 16 ). No corneal complication was observed in both groups.Conclusion: The success rate of both methods of intubation was comparable. Slit punctum was seen only in bicanalicular intubation so Mini-Monoka monocanalicular intubation may be a suitable substitute for Crawford silicone tube.

Background and Objectives: One of the common matrials as a root-end filling is Mineral trioxide aggregate that has different usages in Endodontics. The purpose of this study was to compare the microleakage of gray and White MTA as a root.end filling material.Materials and Methods: 50 single-rooted teeth were divided into two experimental groups of 20 teeth each and two positive and negative control groups of 5.After cleaning, shaping, obturation an cutting away of 3 millimeter from the apex, 3 mm deep preparations were made. The root-end preparation of experimental groups were filled with white MTA and gray MTA. In positive and negative control groups no material was placed. Leakage was determined using a dye penetration method. Leakage was observed with a stereomicroscope at 16 magnifications. Accuracy of 0.1 mm was used for measurements. Data was analyzed using the ANOVA test at the 0.05 level of significance. Results: Amount of leakage was zero and 3 mm in negative and positive control groups, respectively .The mean leakage was 0.5 mm in the white MTA and 0.3 mm in the gray MTA. There was not any significant difference between two experimental groups (P=0.14). Conclusion: There was not any difference between apical leakage when we used white and gray MTA as a root-end filling material in this in vitro study.

Sarcomas of the larynx constitute (1-2)% of all laryngeal neoplasm and osteosarcomas are the rarest. Scarcity of reported cases and potential for early hematogenous metastasis especially in lung and local recurrence make thorough diagnosis and close follow up mandatory. Diagnosis can be easily missed if not suspected. There is no consensus regarding the use of radiotherapy or chemotherapy in the management protocol. In this manuscript we report on a 71-year-old male patient with osteosarcoma of the larynx.

Intussusception of the appendix (IA) is an uncommon type of intussusception with an incidence of 0.01% and an uncommon and unusual cause of ileocolic intussusception. The pediatric age group is most often affected and IA being a rare entity in adults. The IA is rarely diagnosed before surgery. Here we report on a case of IA in a 12-year-old male with ileocolic intussusception containing an inflamed appendix which was diagnosed with sonography preoperatively. An ample discussion and various classification of IA with its diagnosing and treating methods were followed.

Paget’s disease is a chronic skeletal disease with unknown etiology that usually occurs over 40 years old. Clinical data, radiographic and histopathologic findings of this patient confirmed Paget’ s disease. This patient is younger than 40 years old so this case is unusual manifestations of paget’s disease.

Laryngeal lipoma is a rare benign tumor in the larynx. The most common symptom is airway obstruction. The most usefull method of diagnosis is CT scan that shows a mass with low density. According to size and shape of tumor, endoscopic removal or external approach can be done. We report a case of laryngeal lipoma removed through an external approach.