MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2002 | Volume:35 | Issue:52|Papers Count:20

Background and Objectives: Otitis externa is a common and painful ear infection that occur mostly in hot and humid conditions. It is associated with many predisposing factors. The involvement of aerobic bacteria in external otitis is nearly obvious but role of anaerobic bacteria as pathogens in external otitis has been recently documented. The aim of this study was to manifest the role of anaerobic bacteria and some of the predisposing factors in causing external otitis. Materials and Methods: This study was conducted in year 1998 on 75 patients with clinical diagnosis of otitis media. The patients included 33 males (44%) and 42 females (56%). Seventy five specimens from these patients were cultured on different media for the isolation of aerobic, anaerobic and facultative anaerobic organisms. For the isolation of anaerobic organisms, kanamycin - vancomycin laked blood (KVLB) agar, bacteroides bile – esculin (BBE) agar and enriched thioglycollate medium were utilized using anaerobic culture conditions.Results: The highest morbidity was seen in autumn and among 30 to 40 years old patients. In total, 88 organisms were recovered. Amongst them, anaerobic bacteria (2 Bacteroides and 7 Fusobacterium species) were isolated solely from nine specimens and mostly these were recovered in mixed cultures. Amongst aerobic and facultative organisms, gram-negative bacteria were the most prevalent (28.4%) pathogens.The study also revealed that predisposing factors to external otitis such as underlying disease, antibiotic administration, ear scratching habits, ear cleaning, swimming, smoking, use of headphone and other ear canal blocking instruments, all had significant relation to the development of external otitis (p<0.0001).Conclusions: Anaerobic bacteria specially Fusobacterium species take part as pathogens in causing external otitis and many predisposing factors are effective in infection process.

Background and Objectives: The changes during geriatric period occur in parallel with reduction in organ functions. Cardiovascular responses to laryngoscopy and endotracheal intubation also suffers in this age as these changes cause disturbances in myocardial oxygen demand and its supply. The aim of this study was to evaluate cardiovascular changes against endotracheal intubation in geriatric patients.Materials and Methods: This was a double blind study performed in Tabriz University of Medical Sciences in about one hundred patients referred for cataract surgery. Their physical status was ASA (American Society of Anesthesiologists) class II. Data collection was performed using a questionnaire including demographic informations, cardiovascular parameters, duration and number of intubation attempts. All patients in this study were anesthetized in a similar manner.Results: Results of this study, which were analyzed by simple t - test on a statistical program, revealed that 71% of patients experienced cardiovascular changes. Mean laryngoscopy period was 24.86 seconds. Cardiovascular changes occurred 90 seconds afterwards.Conclusion: It is advised that duration of laryngoscopy should be limited to less than 15 seconds. Care should be continued for 5 minutes after intubation. Administration of drugs such as lidocaine and nitroglycerin, adequate preinduction of oxygen and maintaining a deep plan of anesthesia for intubation are some of the other important factors to be kept in view for controlling cardiovascular changes in these patients.

Background and Objectives: Despite the advances made in medicine, neonatal septicemia continue to be one of the most significant causes of neonatal morbidity and mortality. This study was undertaken to determine various bacterial causative agents associated with neonatal septicemia and their antibiotic sensitivities.Materials and Methods: This study was carried out to assess causative agents and their sensitivity to antibiotics in 92 cases of neonatal septicemia in Tabriz Children Hospital.Results: Out of 92 cases, blood culture were positive in 38 patients at the time of admission (primary) and in 54 cases sepsis was secondary, indicating that they had nosocomial infection. The most common causative organisms were: coagulase negative Staphylococcus; 41 cultures positive (28 primary cases and 13 nosocomial) and Klebsiella positive in 35 cases (31 nosocomial and 4 primary). All of the pathogens were resistant to ampicillin. Staphylococcal strains were found resistant to cloxacillin (93%), cephalothin (33%) and vancomycin (3%). Klebsiella strains were resistant to cephalothin (90%), gentamicin (80%) and amikacin.

Background and Objectives: In the past, morphine was used as the only pain relieving agent for pains with different origins. Although the importance of morphine as an inclusive pain relieving substance has been reduced, it is still considered as a strong and a widely used opioid. Therefore, the aim of the present study was to investigate the effect of morphine addiction on embryonic development.Materials and Methods: In the present study Wistar rats, taken as experimental model, were divided into three groups. Each group was treated by morphine as follows: Group 1 and 2, to which 0.1 mg morphine was added to drinking water and to the 3rd group, it was injected subcutaneously. For having a constant effect of addiction, the dose was increased continously. In the 1st group only male rats, in the 2nd group both male and female rats and in the 3rd group only female rats received morphine. In the newborns from all the three groups, birth weight crown - rump length, crown - heel length and the length of limbs were measured.Results: The results of this study showed that male addiction (Group 1) had no effect on embryonic weight and length. However, female addiction and addiction of both male and female (Group 2) resulted in a significant (p<0.05) reduction of weight and length. Furthermore, female addiction caused an increased mortality rate, especially after weaning.Conclusion: Reduction in birth weight and length in newborns, is an indication of intrauterine growth retardation imposed by mothers long-term addiction.

Background and Objectives: Childhood malnutrition is a major problem, specially in developing countries and even in some areas of developed countries. This study was undertaken to assess childhood malnutrition in health care centers of Kermanshah.Materials and Methods: To study the prevalence of malnutrition in children of Kermanshah city, 400 children (54.8% boys and 45.3% girls), under one year to 36 months old were evaluated on a descriptive cross-sectional study.Results: The results were as follows in terms of weight/age (Wt/A) criterion: 11.11% , 14.7% and 31.85% children of one years age, 1 to 2 years old and 2-3 years old respectively were found malnourished. In terms of weight/height (Wt/Ht) criterion the data implied a wasting rate of 7.18%, 15.67% and 22.12% among under one year, 1-2 years and 2-3 years old children respectively. According to height/age (Ht/A) criterion, the data implied to a stunting rate of 5.22%, 12.68% and 8.84% among under one year, 1-2 years and 2-3 years old children respectively. No statistically significant correlation was found between the growth status, age, education, family size, fathers occupation and gender of children, however significant correlation was observed among the rate of malnutrition, family income and order of birth (p<0.05).Conclusion: Inappropriate choice of weaning foods can lead to malnutrition, therefore, nutritional education is essential for creating awareness and desirable weaning practices among mothers.

Background and Objectives: Bacterial meningitis and other cerebral infections are associated with high rate of mortality and complications. The aim of this study was to evaluate kinds of bacterial otologic diseases that cause intracranial infections in adults and advise the best ways of treatment with least mortality, morbidity and complications.Materials and Methods: One hundred adult patients with otogenic intracranial infections were studied in about 17 years (1983 to 2000). Forty one patients had acute otitis media, 37 suffered with chronic otitis media (20 cholesteatoma) and 22 had otorrhea.Results: Streptococcus pneumoniae was the most common cause of meningitis with acute otitis media (69%) and otorrhea (50%), whereas other bacteria like Proteus mirabilis, Pseudomonas aeruginosa and anaerobes were found in chronic otitis , and in 25% of the cases cultures were negative. Thirty two patients underwent mastoidectomy, 10 were operated for different intracranial abscesses, while 5 patients died.Conclusion: We found that rapid diagnosis of otogenic bacterial meningitis is essential for antimicrobial treatment. In patients with chronic otitis media, effective antibiotics on gram negative bacilli and anaerobes should be used. Surgical procedure is required in patients whose neurological infections fail to improve under antibiotic treatment and all patients with brain abscess must be operated.

Background and Objectives: Rheumatic fever is one of the most common illnesses in developing countries, and the leading cause of cardiac death in some countries including Iran after coronary artery disease. In this study knowledge and practice of general physicians, as the first line of managing group involved with these kind of patients, were evaluated.Materials and Methods: The method of study was based on complete answers to a questionnaire given to 115 general physicians of all over the east Azarbaijan.Results: Knowledge level of diagnosis of physicians was mostly between intermediate to low (68.7%). Knowledge of primary and secondary prevention also ranged from intermediate to low level (57.4%). Conclusion: According to the above study, knowledge and practice of above mentioned general physicians was mostly from intermediate to low level. Thus, for paying attention to the primacy of rheumatic fever, we should improve our educational and managing methods for training general physicians in a best way to combat against this significant disease.

high incidence of colorectal cancer and its mortality rate in Iran. The purpose of this study was to assess the effect of an educational program on the level of individuals knowledge toward colorectal cancer. Materials and Methods: In this study, 80 parents (aged over 50 years) of students studying in female high school were selected as samples. Data were collected through a questionnaire consisted of two parts: demographic data and knowledge of samples concerning colorectal cancer. Data were collected and analysed in two phases, before and 10 days following the educational program.Results: In terms of knowledge of the nature of colorectal cancer and its screening method by fecal occult blood test (FOBT), the findsing of the research showed that the samples had low or moderate level of knowledge about colorectal cancer before educational program. However, the mean scores increased after the educational program. The results with 99% confidentiality showed that education was effective on the level of subjects knowledge.Conclusion: It is recommended that education should be given to all individuals in order to increase the level of knowledge about risk factors, screening and preventional methods of this cancer.

Background and Objectives: Branch retinal vein occlusion (BRVO) is a common vascular disorder. Severe systemic and ocular conditions associated with branch retinal vein occlusion have been reported for example, systemic hypertension (HTN) and hyperopia, commonly observed in BRVO. One study has shown a high prevalence of elevated intraocular pressure in eyes with BRVO. This study was done to describe the etiology and visual acuity results of BRVO.Materials and Methods: Eighty one (81) cases of branch retinal vein occlusion, who were 50 to 70 years old, were studied in Nikoukari Hospital. These cases included 37 males (45.7%) and 44 females (54.3%). Results: In this study, 37 (45.7%) men and 44 (54.3%) women were retrospectively studied. Hypertension, diabetes, trauma were observed in 3.7%, 6.2% and 37% patients respectively. Hyperlipidemia, hypercholestrolemia, smoking and alcoholism had rare incidence. BRVO in right eye was commonly observed in 50.6% cases. The most common etiological agents were: hypertension, diabetes mellitus and trauma. The most common sufferer branch of retinal vein was supratemporal branch. Average visual acuity at first visit was finger count (53.1%) and the maximum amount of visual acuity was 8.10. Concluion: Hypertension, diabetes mellitus and trauma are the most common etiological factors in BRVO. Average visual acuity may increase after three months. Complications of BRVO that were seen in this study included: macular edema, macular ischemia and vitreous hemorrhage.

Background and Objectives: Intravenous regional anesthesia (IVRA) was first described by Bier in 1908. IVRA is a simple and effective method of providing anesthesia to peripheral tissues that anatomically have a blood supply that can be occluded by a pneumatic cuff. The aim of this study was to improve surgical conditions such as muscle relaxation, acceleration of beginning sensory and motor block, and decreasing pain sensation by addition of 2 mg of atracurium (a short muscle relaxant) to local anesthetic solution (40 ml of 0.5% lidocaine) for hand and elbow reduction surgeries. Materials and Methods: This was an applied, single blind study performed on 40 patients hospitalized for hand and elbow reduction surgeries. Patients were selected randomly and were divided into two groups: Group I (study group) (n=20) to which 2 mg of atracurium was added to local anesthetic solution and in Group II (control) (n=20) simple local anesthetic solution was used. Data collection was performed using a questionnaire and results were analyzed by SPSS Win statistical program.Results: Results of this study revealed that beginning of sensory and motor block was shorter in study group as compared with patients of control group. It also showed that recovery period in the study group was more delayed. It was noticeable that there was no significant difference between two groups statistically.Conclusion: Results of this study suggest that adding 2 mg of atracurium to local anesthetic solution, although shortens time of beginning sensory and motor block, but delays return of motor function in the postoperative period.

Background and Objectives: Oral medication of medicine in the form of liposomes is given in order to keep safe and prevent it against the destructive effect of digestive enzymes so that medicine can resist action of gastric juices as well as after reaching to the small intestine, it gets absorbed in the blood through its epithelium. Various materials are used for the production of liposomes, which are prepared in the treatment centres by the pharmacists and then prescribed by the consulting physician to their patients for consumption. The recent method much focussed now - a - days is the method modified by Batelle Institute of England.Materials and Methods: Based on the method of Batelle Institute, liposomes containing insulin were prepared and their membrane was made resistant against digestive enzymes and gastric juice by treatment with aprotinine. The study was performed by giving orally the necessary amount of liposomes prepared as above to a group of male rabbits weighing 1 - 1.5 kg. To measure the effect of insulin before and after liposome administration, pre and post blood samples were withdrawn directly from the heart. To ensure the health of digestive system after giving liposomes and their speed of passing, serialography was done from the upper digestive system. Finally, results were compared with animals of the control group who did not receive liposomes.Results: 1) In the healthy animals level of blood sugar, after administration of liposomes of egg yolk containing 20 unit insulin / kg body weight, reached to zero.2) In some of the animals level of blood sugar increased due to the secretion of neurotransmitter epinephrine and cortisol hormone along with establishment of negative feeding. After reduction of these factors in the animal body, decrease in blood glucose level was observed which is indication of the beginning of the absorption of insulin from the epithelium of small intestine of the animals concerned. Conclusion: Results obtained in this study confirms the previous studies and indicates that administering insulin in the form of liposome has the advantage of being prevented

Background and Objectives: Septicemia is one of the main causes of neonatal mortality and meningitis. Septicemia accounts for 30-40% of mortality and permanent sequelae in up to 30% of survivers. This study was conducted to investigate prevalent bacteria causing septicemia in special care baby unit of Al-Zahra Hospital in Tabriz.Materials and Methods: In a period of two years (1995-1997), 837 neonates having clinical indications of sepsis were studied using blood culture system (brain heart infusion broth, Oxoid). The isolated bacteria were identified using conventional methods and the sensitivity of the bacteria was determined using disc diffusion method.Results: Of 837 blood cultures, 199 were positive. The most common causative bacteria were Klebsiella pneumoniae (82.4%), Coagulase - negative Staphylococcus (7%), Staphylococcus aureus (5.5%), E.coli (3.5% ), Pseudomonas aeruginosa (1% ) and beta - haemolytic Streptococcus (0.5 %). Klebsiella pneumoniae strains isolated in this study were resistant to most of the antibiotics routinely used and were predominantly isolated from neonates having catheters or fed parenterally. The same bacteria were isolated from hospital equipments and environment.Conclusion: Klebsiella pneumoniae was isolated as a main bacterium ( 82.4 %) from blood cultures of neonates in the special care baby unit of Al -Zahra Medical Center, followed by coagulase negative staphylococci, S. aureus, E. coli, Pseudomonas aeruginosa and beta - haemolytic Streptococcus sp. The same bacteria were isolated from hospital equipments and environment underscoring the importance of good hygiene in reducing rate of infection in these highly susceptible patients.

Background and Objectives: Sepsis is a major cause of morbidity and mortality among patients admitted to hospitals. Inspite of proper hospital care and management, an increasing trend in the number of such cases has been observed because of increased hospitalization, expanded use of invasive catheters, more intensive management of medical problems, along with factor of aging. The study was aimed at epidemiologic and etiologic survey of this disease along with study of clinical findings, mortality and the source of sepsis.Materials and Methods: In this descriptive retrospective study medical records of patients admitted to the division of infectious diseases, centre of education and treatment of 7th Tir Hospital of Tabriz University of Medical Sciences, were studied from clinical, paraclinical, epidemiological and etiological point of view, from 1987 to 1996.Results: In the course of l0 years, 92 patients with clinical septicemia were admitted to the hospital. Of these cases, 43 were men and 49 were women. More than 70 years age (20%) was the prevalent age group among these patients. Fever, tachypnea and tachycardia were the most prevalent findings. Sixty percent of patients had leucocytosis and 5.6% had leucopenia. In 33.7% cases urinary tract while, in rest of them skin was the source of sepsis. In 23.9% of patients, source of infection was not determined. E.coli was the leading microorganism responsible for infection followed by Staphylococcus aureus. Mortality among these patients amounted to 41.3%.Conclusion: Keeping in view that almost 9 of 1000 in-patients admitted to division of infectious diseases develop septicemia or sepsis and before being admitted to the hospital these patients consume a course of antibiotic therapy which makes microorganism to become resistant or to persist at the site of infection, it is necessary that as soon as the patients are admitted with clinical signs of sepsis or septicemia, samples from blood and if possible, from site of infection should be collected and send for culture to obtain the causative microorganism and antibiogram should be done so that proper antibiotic therapy could be started immediately.

Background and Objectives: Patients with chronic renal failure (CRF) may have a better and longer life with hemodialysis however, gradually impairment in functions of all organs develops in these patients. This may lead to uncontrolled complications such as Ca and P impairment due to abnormality in calcitriol formation which may lead to osteodystrophia. Aim of this investigation was to study osteodystrophia in CRF patients who were treated with hemodialysis. Materials and Methods: A total of 63 patients with CRF being treated with hemodialysis were selected and studied.Results: Out of 63 CRF patients studied, 37 (58.7%) were male patients and 26 (41.3 %) female patients. Amongst them jaws osteodystrophia was prevalent in 71.5%. The severity of osteodystrophia indicated a real relationship with duration of hemodialysis and aging of patients (p =0.002 and p= 0.003 respectively).Conclusion : The incidence of jaws osteodystrophia in patients with CRF who are under hemodialysis is more (57.5 % - 71.5 %) than that is observed in other bones of the body (51%). Panoramic radiography of jaws in diagnosis of osteodystrophia as well as for prediction of treatment result, is a suitable method.

Background and Objectives: Cranioplasty with methylmethacrylate in comparison with other methods of cranioplasty is associated with complications as well as benefits. Some of the complications are early and due to cytotoxic effects of monomer component of methylmethacrylate, such as hypotension, anaphylactic shock and sudden death, while many others are late and from foreign body properties e. g. infection, abscess formation, etc. These complications are related to factors such as defect size, frontal sinus involvement and previous history of infection.Materials and Methods: In this evaluation we reviewed the relation of complication of cranioplasty with methylmethacrylate with above mentioned factors. In the past 5 years, 58 patients were operated for cranioplasty with methylmethacrylate and evaluated with regard to age, sex, defect size, site, cause and complications during and after operation.Results: Eighty six percent of patients were males with mean age of 25.7 years and the most common cause of defect was trauma. In 15.5% of patients, there were postoperative complications that included seizures and infection.Conclusion: The complications observed in this study were not related to factors such as age, cause of trauma, defect site and size. Meanwhile, cranioplasty with methylmethacrylate in traumatic defect of any size and location in the skull, in all group of ages is optimal and is a super method.

Background and Objectives: Complete hydatidiform mole is the most common form of trophoblastic disease, the incidence of which greatly differs geographically and is fairly high in our country too. The aim of this study was to determine the frequency of molar pregnancy in our patients and assess the ultrasonic findings of the disease.Materials and Methods: From July 1985 to February 1997, 11,370 women with normal or pathologic pregnancies underwent ultrasonic examination in Obstetrics and Gynecologic (Al-Zahra) Hospital of Faculty of Medicine, Tabriz University of Medical Sciences and Azarbaijan Radiologic and Sonologic Clinics (Private). Results: Among 11,370 patients, 10,414 women had normal pregnancies and from 935 remainders with different associated pathologic conditions, 100 patients had hydatidiform mole (98 complete and 2 partial mole). In this study, the incidence of hydatidiform mole was 8.7 in 1000 pregnancies which approximate to Saleh and co-worker's study (1964-65), but has considerable differences in comparison to Javey and Sajjady’s findings (1970-75) and the Western and the Far East countries statistics.Conclusion: Occurrence of hydatiform mole is not a common finding, however its prevalence is fairly high in our country in comparison to other studies reported earlier.