MEDICAL JOURNAL OF TABRIZ UNIVERSITY OF MEDICAL SCIENCES
Year:2009 | Volume:31 | Issue:1|Papers Count:25

Background and Objectives: Lifestyle factors, and particularly diet, play an important role in the development and control of metabolic syndrome. Accordingly, this study was aimed to assess nutritional intake and obesity indices of patients with metabolic syndrome in Tabriz. Materials and Methods: In this descriptive study, 65 patients (20 males and 45 females) with metabolic syndrome (according to WHO criteria), referred to endocrinal glands and metabolism clinic of Sina hospital of Tabriz were participated. Obesity indices including weight, body composition and triceps skinfold thickness was measured and nutritional intakes were determined.Results: The mean of BMI, body fat, fat free mass and triceps skin fold thickness were 30.4±4.8 kg/m², %34.2±9.1, %65.7±9.7 and 29.4±7.7mm, respectively. According to BMI and body fat percentage, %89.2 and %63.1 of participants were overweight and obese respectively.Proportion of protein, carbohydrate and fat from energy were 13.5%, 46% and 40.5%, respectively. Dietary intake of energy, protein and fat were adequate, however, dietary fiber intake was less than recommended values in 97% of participants. Conclusion: Because of high prevalence of obesity and imbalanced diet, nutritional education is required to improve the lifestyle.

Background and Objectives: CLL (Chronic Lymphocytic Leukemia) is the most common form of leukemia in the western world and because of prolonged survival of patients, the prevalence is high. Chemotherapy is usually not indicated in early and stable disease and using chlorambucil with or without steroids has been the drug of choice in the treatment of CLL for many years .Clinical studies have shown that using fludarabin can cause a complete response in significant number of untreated and/or previously treated CLL patients. The aim of this study was evaluation of CLL patients and determining the effects of treatment with fludarabin. Materials and Methods: A retrospective (descriptive/cross sectional) study of CLL patients who were admitted to Hematology and Oncology Research Center of Tabriz University of Medical Sciences, between 1995-2005 was made and 126 patients enrolled. Collection of data was carried out according to special questionnaire and response to fludarabin was analyzed by SPSS-11 software.Results: The mean age of patients at diagnosis was 63.7±8.9 years, 69.8% were males.Illness and fatigue were the most common presenting symptoms in 54% and lymphadenopathy was the most common clinical sign in 88.9%. Most of the patients were in stage C in Binet system (52.4%) and/or stage IV in Rai system (44.4%). Chemotherapy with chlorambucil and prednisolone was the most common regimen used (60.3%) and 49.2% of patients were in partial remission with this treatment. Forty two patients treated with fludarabin and 50% were in partial remission, 35% in static disease, 10% in progressive disease and 5% in complete remission (P=0.053).Conclusion: The median survival with fludarabin was 43.9±27.2, months and in the case of chlorambucil + prednisolone and cyclophosphamide + vincristine + prednisone (CVP) or cyclophosphamide + vincristine + prednisone + doxorubicine (CHOP), it was 45±26.5, months and 50±32.2, months respectively (P>0.05). P value in relation with survival and response to fludarabin was 0.05. Above all, fludarabin is the treatment of choice as first and second line therapy and for patients who have failed therapy with standard regimens.

Background and Objectives: With advances in video endoscopic technology and wide spread use of laparoscopy in abdominal surgery, success rate removal of adrenal gland has increased. In this study which is the first our experience in laparoscopic adrenalectomy for pheochromocutoma, we attempted to report treatment outcomes of laparoscopic adrenalectomy.Materials and Methods: This study is a case series assessment. Among the patients who underwent surgical removal of adrenal Mass, eleven diagnosed for pheochromocytoma treated laparoscopically. 6 males and 5 females with mean age 36±13 (14-55) were in this study. In 5 cases mass located in right adrenal and 6 in left adrenal. Mean size of mass was 3.8±0.72 (2.8-4.8) cm. All patients received preoperative blocker before operation. The laparoscopic adrenalectomy was performed by transabdominal approach. Results: In our study eleven successful laparoscopic adrenalectomy was performed and we had no conversion to open surgery. Intraoperative cardiovascular instability was found in 5 patients who had sever symptoms before operation. The mean of instability of cardiovascular was 1.09±1.5 (0-3) (systolic blood pressure more than 200 mmHg and heart rate more than 120 per minute). Most of theses changes controlled after ligation of adrenal veins. Intraoperative bleeding during laparoscopy was not significant. Mean operative time was 161±22.7 (120-195) minutes. There was no correlation between operative time and tumor size. Post operative complication was seen in only one patient, this was one case of pneumothorax after operation. Hypertension recovered after operation in all patients. Conclusion: Laparoscopic adrenalectomy is a safe and effective procedure. It could be an alternative opproach for open surgery in selected patients.

Background and Objectives: Adenotonsillectomy is one of the most common surgeries in pediatrics.Post operative local pain and referral otalgia is one of the most annoying post tonsillectomy complications and inappropriate pain control causes child discomfort from oral intake and dehydration and prolongation of convolsences period. Different protocol used by otolaryngoloists for pain management in different medical centers. However there isn't unique order in references for post tonsillectomy pain control. The aim of this study was comparison of analgesic effects of acetaminophen and diclofenac suppository in children adenotonsillectomy pain control.Materials and Methods: 150 children (4-14 y) who were candidate for tonsillar surgery in double blind porspective case control study from September 2005 to Jun 2006 admitted and operated by unique otolaryngology and anesthesiology team. Paracetamol or diclofenac suppository used for all patients and postoperative pain assessed by Wong Baker pain score. All results analyzed by SPSS ver 14.Results: There wasn't significant different between analgesic effect of paracetamol and diclofenac suppository (P>0.05). There wasn’t correlation between sex and age and analgesic effects. There wasn’t high frequency of postoperative bleeding after diclofenac usage.Application of suppository immediately after cut off of anestethic drug was more effective in pain control (P<0.05).Conclusion: Analgesic effect of paracetamol and diclofenac were equal on post tonsillectomy pain control.

Background and Objectives: Ultrasonography of prostate is one of the most useful modalities in urology that is widely used for evaluation of prostatic diseases as well as volume measurement and detection of neoplastic lesions. This study was aimed to determine the volume of prostate and ideal management based on well detection during 1997-2000.Materials and Methods: In this clinical trail the studied population included patient’s referred in Sina hospital during 2 Years with prostatism and surgical indication. First were determined volume with Trans Abdominal sonography and last determined with Water displacement method.Results: There was a significant statistical relation between estimated volumes using transabdominal sonogrphy and real volume. (R=0.95, P<0.001), as the Linear relation between these two parameter Showed that abdominal ultrasonograpgy shows the prostate Volume greater than real volume. The linear relation is:Prostate volume after operation =0.479 ´ sonographic volume of prostate + 7.043 The mean sonographic volume was 63.8899 and mean volume after operation was 33.8116. Conclusion: Based on our results, volume of prostates in transabdomind sonography is more than real volume and the results of this study can improve management of BPH.

Background and Objectives: Staphylococcus epidermidis is one of the prevalent bacteria causing septicemia in neonates and children. Methicillin resistance in S. epidermidis isolates like S.aureus isolates has been shown and is of major clinical importance. This study was carried out to evaluate antibiotic resistance of S. epidermidis isolates and to detect methicillin resistance by oxacillin disc diffusion test and PCR.Materials and Methods: Blood cultures of 2943 in-patients of Children Hospital of Tabriz with fever and signs of septicemia were studied, which 100 S. epidermidis isolates were recovered. Oxacillin disc (1mg) diffusion method and PCR were carried out to detect the methicillin resistance. Conventional disc agar diffusion test was also applied to evaluate the antibiotic sensitivity of our isolates against 9 routine use antibiotics according to CLSI (Clinical and Laboratory Standards Institute).Results: Result of PCR showed mecA gene in 89 isolates out of 100 S. epidermidis, while 11 isolates lacked the mecA gene. Oxacillin disc method detected 85 resistant isolates, while 5 isolates with mecA gene were recorded as sensitive and one isolate lacking this gene was diagnosed as oxacillin resistant.Conclusion: Oxacillin disc diffusion method showed sensitivity of 94.4% and specificity of 90.9% compared to PCR. Among routine use antibiotics the highest resistance was against penicillin and the least was against vancomycin. Results of this study indicated that oxacillin disc diffusion method had a low sensitivity and specificity in detection of methicillin resistance. Therefore accurate detection of methicillin resistance in S. epidermidis needs both phenotyping and genotyping methods.

Background and Objectives: Impacted third molars surgeries are common in maxillofacial surgery clinics. Post operation complications like pain, swelling, trismus are common. Most of the patients avoid surgery because of post operative discomfort. Reducing these factors is one of the necessities in dental treatments. Several studies have been conducted in case control methods. In most of these studies, interventional factors have not been controlled properly, so there are differences among results. In order to obtain an exact response in application of corticoesteroids, this study was carried out through a cross over method after controlling interventional factors.Methods and materials: A clinical trial was conducted as cross over and double blinded method. Thirty eight patients were included in the study. In every patient two third molar teeth from mandible were selected, one as a control tooth. For case group 40 mg methylprednisolone was injected in masseter muscle. All of operations were carried out by one oral surgeon. When the interval of both operations of case and control tooth was more than seven minutes, the patient was excluded from the study. In specification, systemic conditions and required information were prepared, and pain, swelling, trismus were evaluated after 48 hours and also after first week of operation by examination and completing questionnaire by participant assistant of the investigation. The interval of both operations was at least one month. The data were statistically analyzed by SPSS and Wilcoxson test.Results: There is a meaningful difference between pain, swelling and trismus scales after 48 and one week post operation in both case and control groups:(P<0.05).Conclusion: Methylprednisolone affects properly on impacted third molar surgery and post operation morbidity.

Background and Objectives: Trabeculectomy is indicated when lOP cannot be controlled enough with medical treatment. Poor filtration after surgery is indicated by increasing IOP and a encapsulated bleb. The aim of this study was to assess the outcomes of long-term effectivness of subconjunctival mitomycin-C as an adjunct to needle revision of failing filtering blebs.Materials and Methods: In a noncomparative, randomized clinical trial 22 consecutive patients (22 eyes) who underwent 0.2 mg/ml of mitomycin-C injection adjunct to needling revision of a failed filtering bleb after trabeculectomy. The success of the needling revision was defined if the intraocular pressure was <21 mmHg with or without antiglaucoma medications. Main outcome measures were intraocular pressure, visual acuity, complications and number of glaucoma medications used at the final visit.Results: Mean preoperative intraocular pressure was 29.04±8.64 mmHg, which was reduced by 8.71±2.59 mmHg to a mean postoperative intraocular pressure of 20.36±7.98 mmHg. Mean follow-up was 6.40±4.27 months, with success rate 68.2%. The most common complication was choroidal detachment in 13.6% of patients and shallow anterior chamber 4.5%. Conclusions: Bleb revision-needling and subconjuctival mitomycin-C injection can reduce IOP significantly without major complication. Subconjuctival injection mitomycin-C may enhance success of the needling procedure in failing filtering blebs.

Background and Objectives: The existence of overhang in the amalgam restorations has many adverse effects on the health of periodontal tissues. The purpose of the present study was to assess the amount of prevalence of proximal overhang in the amalgam restorations performed by students of the operative department of Tabriz faculty of dentistry in the year of 2006-2007.Materials and Methods: In this descriptive and sectional study 400 patients who had referred to the operative department of Tabriz faculty of dentistry were the population under assessment. They were selected randomly and posterior amalgam restorations were performed for them by the students of 7th, 10th and 11th semesters. The data about the existence of proximal overhang in terms of the restoration type and educational semester of the students were collected first by a sharp probe and then by using bite-wing radiography by the consent of the patient. Chi .square test was used for analyzing the data (a=0.05).Results: The overall prevalence of the overhang was obtained 25.7%.Respectively 15.6%, 32% and 28% of the performed restorations by the students of 7th, 10th and 11th semesters had overhang. 23.5% of the mesioocclusal/distoocclusal restorations, 23% of mesioocclusodistal restorations and 29.4% of the build-ups had overhang. More percentage of overhangs (68.94%) was distinguished by combinations of clinical and radiographic evaluation. There was a statistically significant relationship between students, educational semester and presence of overhang (p=0.031), while the association between restorations, type and overhang was not significant (p=0.39).Conclusion: The prevalence of overhang was relatively low in the restorations performed by the students of Tabriz faculty of dentistry. Furthermore the most precise method for overhang assessment was using the combination of the clinical examinations by the use of probe and bitewing radiography.

Background and Objectives: Memory is important and learning isn.t biologically possible without it. Information come from sensory memory to short-term memory is entered to longterm memory by repeating. Since a lot of processing activities are done in short-term memory, therefore the factors effecting on it are very important. The purpose of this study was comparison of short- term memory quotient (SMQ) between smoker and non .smoker men. Materials and Methods: This was a descriptive comparative study which carried out on 50 smoker and 50 non smoker men who occupied in Tabriz public hospitals and were 30-40 year old. Subjects were selected through simple random sampling. Data was collected by using Wexler memory test and GHQ test by means of pen and paper. Vulnerable samples in GHQ test were excluded and non-Vulnerable people were investigated by Wexler memory test.Descriptive statistics (frequencies, mean and standard deviation) and inferential statistics (Ttest) were used for data analysis through SPSS 11 for windows.Results: This study showed that the mean of SMQ in non-smoker men was better than smoker men. It was 99.00 in non-smoker men and 92.5 in smoker men. There was statistically meaningful difference between the mean of SMQ in smoker and non-smoker men (p=0.017) by use of T-test.Conclusion: Based upon the results of this study it can be concluded that smoking has negative effect in short-term memory performance.

Background and Objectives: Nowadays, trauma causes a large amount of death and injury all over the world. Head trauma represents 80% or more of these injuries. It has proposed that the Zn supplementation could change the outcome of patients with head trauma. This study aimed at evaluating the effect of zinc supplementation on recovery trend of head injury.Methods & Materials: In a clinical trial, 65 patients with head trauma were randomized in two groups; the case group consisted of 32 patients received 10 mg/day of ZnSO4 orally for 2 weeks; and the control group consisted of 33 patients just received placebo. These two groups were age and sex matched and all received conventional therapy, as well. The recovery trend and the nutritional condition were evaluated at the end of study and compared between two groups. After six months, GOS was determined and compared too.Results: Mean of age in supplement group was (n= 32, 27 male and 5 female) and placebo group 30.2±11.6 (n= 33, 28 male and 5 female) year. Laboratory results, GCS, subcutaneous fatthickness and mid-arm circumference were not significantly different between two groups on admission. At discharge, mean level of serum HCRP were significantly lower in the case group (p=0.047) than placebo group. There was no other significant difference regarding GCS, GOS, serum albumin and Zinc, subcutaneous fat thickness and mid-arm circumference between two groups (p>0.05). After six months follow-up, there were 9 (28.1%) and 7(21.2%) deaths in the case and control group, respectively (p=0.518).Conclusion: Zinc supplementation in patients with head trauma significantly lowered the level of serum CRP comparing with placebo. No nutritional effect was seen in patients received Zn supplement and according to GCS and GOS changes, there was no benefit. Further studies are recommended to be carried out.

Background and Objectives: In the recent years endoscopic sinus surgery has been established a succesfull treatment of chronic sinusitis, and more attention has been given to CT scan evaluation of paranasal sinuses. The goal of this study is to determine the incidence of anatomic variants such as nasal septal deviation, concha bullosa, paradoxical middle turbinate, uncinate process variants, agger nasi cell, haller cell, obstructed osteomeatal complex and other uncommon variants in patient with chronic sinusitis, and to find the relationship of this variants and chronic sinusitis as predisposing factors. Materials and Methods: during 2 years (2004, 2005) nasal and paranasal sinus CT scans of 100 patients with chronic sinusitis, and 100 healthy persons that have been refferd to the CT scan department of Imam Khomeini and shams hospitals, were evaluated. The subjects that were reviewed in CT scan were inflammatory condition of paranasal sinuses and anatomic variations of this region.Results: the incidences of anatomic variants in the patient group were: nasal septal deviation 65%, concha bollusa 18%, agger nasi cell 1%, obstructed osteomeatal complex 14%, and other variants haven’t been seen. In the control group the incidences of anatomic variants were: nasal septal deviation 71%, concha bollusa 10%, agger nasi cell 2%, obstructed osteomeatal complex 3%.Conclusion: Although anatomic variants have been suspected as a potential cause of osteomeatal complex and middle meatal narrowing and obstraction and resultant sinusitis, the study showed that existence of anatomic variants didn’t associate with higher incidence of chronic sinusitis, except of the presence of concha bollusa and obstructed OMC that have a relationship with chronic sinusitis.

Background and Objectives: Retinoblastoma is the most common intraocular malignancy in children. Understanding the modes of presentation of retinoblastoma is important for timely diagnosis. The aim of this study is to determine the characteristics and clinical presentation of retinoblastoma in Nikookari hospital as a referral center of northwest of Iran.Material and Methods: A retrospective clinical study was conducted using computerized and paper records to identify all children treated for retinoblastoma at the Nikookari hospital between 1990-2005. Demographic characteristics including presenting sign, age at presentation, unilaterality or bilaterality, lag time (time period between observation of first sign and diagnosis) and treatment modality were recorded and analyzed.Results: We analyzed the clinical records of 40 children (57 eyes). Of these, 23(57.5%) had unilateral involvement and in 17 patients (42.5%) both eyes were involved. The age of patients at presentation ranged from 5 to 62 months in unilateral group, with the mean±SD being 29.50±13.24 and from 2 to 36 months in bilateral groups, with the mean±SD being 18.52±10.22. mean lag time were 9.46±10.98 and 5.38±4.49 months in unilateral and bilateral cases respectively. Leukocoria was the most common presenting sign in 29 patients, followed by proptosis and strabismus. 22 eyes in unilateral cases and at least one eye in bilateral cases enucleated.Conclusion: The most common presenting sign is leukocoria. Because of delay in presentation and diagnosis of retinoblastoma preservation rate of globe was very low. A screening program with dilated fundoscopic examination of infants may be a method of improving the globe-preservation rate in retinoblastoma.

Background and Objectives: Many studies have been suggested that element's of soy extract can improve learning and memory and delay the onset of neurological disorders such as, Alzheimer's disease. However, there are a few investigations on the effects of total soy extract. So we studied the effect of total soy extract on spatial memory.Materials & Methods: In this study 30 female rats were allocated randomly to 3 groups: 1) sham (surgery without ovariectomy, 2) ovariectomized (OVX), and 3) treatment (OVX and Soy gavage). The animals of treatment group received 60 mg/kg per day total soy extract in drinking water for six weeks. Statistical analysis was performed using one way ANOVA (Tukey) test and SPSS software.Results: The results showed that ovariectomy impaired spatial memory (P<0.05) and oral administration of total soy extract ameliorated learning and spatial memory deficits of OVX rats.Conclusion: This study indicated that ingestion of total soy extract had positive effect on spatial memory especially in OVX rat.

Background and Objectives: High capacity of Carrot Seed Ethanol Extract (CSEE) in neutralizing free radicals suggests that the seeds are suitable sources of antioxidants. By in vitro experiments, protective effects of extract seed in peroxidation of membrane lipids, DNA and proteins have been reported. The study designed to evaluate in vivo protective effects of the CSEE on the Gentamicin (Gm) induced oxidative stress in Rats by measuring plasma levels of lipid peroxidation, Paraoxonase(PON1) activities and total antioxidant capacity. Materials and Methods: Forty male wistar rats were divided into five groups (5 ´ 8). They received daily; 0.5ml DMSO (group1, control group), group (2) 0.5ml DMSO containing 200mg/kg extract, group (3) 0.5ml DMSO with 400mg/kg extract, group (4) 0.5ml DMSO containing 400 mg/kg extract plus 5mg/kg Gm and group (5) 0.5ml DMSO with 5mg/kg Gm for 24 daies through Intra Peritoneal injection. The day after last injection 3ml blood samples were collected from the all rats, plasma separated and kept at -70°C.Lipid peroxidation was determined by measuring plasma levels of MDA using thiobarbituric reaction and oxidative stress was assessed (evaluated) by measuring plasma levels of total antioxidant capacity and activities of PON1 (Aryl esterase) by standard techniques. Results: The highest and the lowest levels of total antioxidant capacity were noticed in group (3) and group (5) respectively and in groups (2) and (4) comparing with control group, no significant differences were observed. The mean levels of plasma Malone Di Aldehyde (MDA),end product of lipid peroxidation, in groups (1), (3) and (5) were 2.3±0.1,2.1±0.10 and 3.4± 0.5 nmol/ml and comparing with other groups the elevation in the group (5) was marked. Significant increase in activity of PON 1 in group (3) and meaningful reduction in group (5) were found while comparing with control no significant changes were observed in those groups (2) and (4).Conclusion: Treatment of the Rats with CSEE (400mg/kg/day) by increasing the level of total antioxidant capacity and activity of PON1 reduces lipid peroxidation and inhibits the oxidative stress. 1t was concluded that the CSEE may have protective role against toxic and apoptotic agents.

Background and Objectives: Premature newborn birth is related to hospitalization of newborn and separation from family. Not paying attention to emotional and psychological stresses of parents of such child, causes inadequate attachment with their newborn at the time of discharge and will increase vulnerability of child and parents. This study is done due to lack of enough research in this field in our country.Material and Methods: A descriptive study with the population consisted of all mothers (n=300) with hospitalized premature newborn in NICU, in 3 teaching hospitals in Tabriz (Taleghani, Alzahra, Koodakan) during the first 6 months in year 2007. Data collected by PSS questionnaire (Parent Stressor Scale) developed by Margaret Miles & Funk 1998.Results: From NICU Environmental Stressors: "the presence of monitors and equipments" 64.3%, " presenting another infant having a machine breath(respirator) in the room" 38.3%, " the constant noises of monitors and equipments" 23%, and also from Baby Looks, Behaves and Special Treatments: "unusual or abnormal breathing patterns in child" 70.3%, "tubes and equipments on or near the child (for example: ventilator,.)"67% and "suddenly change of newborn skin color (for example, pale or blue) 49.3%, "seeing needles on the child’s body 44.7% , small size of child 41.7% and weak appearance of child" 31.7%, and also from Parental Relationship and Parent's Role: "being separated from child" 60.3%, "feeling inability of helping child during hospitalization" 51.7% and "feeling inability of protecting child from pain and painful procedures" 44.3% were respectively major stresses of the mothers. Also, from these three aspects of stressors, "Parental Relationship and Parent's Role" was the most stressful dimension.Conclusion: Due to inevitability of hospitalization of premature newborn in NICU, It is suggested that after premature birth, parents especially mothers should be prepared for first NICU face with their child, and making appropriate communication with newborn and NICU environment and paying more attention in playing a good parents role consider as the bases of family centered services.

Hereditary Sensory Autonomic Neuropathies (HSAN) are rare genetically group of disorders, affecting sensory and autonomic nervous system. HSAN are divided into five groups on basis of mode of inheritance, clinical symptoms and age at onset. Here we describe two children belonged to one family. Eight years old son, has suffered from multiple clinical features including, complete anesthesia to pain and temperature, multiple painless ulcers, erosive lesions of distal phalanges in toes, mutilating arthritis, osteonecrosis in tarsal bones and osteomyelitis of tibia, which were slowly progressive, since he was 2 years old. Twenty three years old daughter had similar clinical findings, but with greater severity and because of intractable and infective ulcers, below knee amputation had been performed for her. Now she is using prosthesis for right amputated leg. In electrodiagnostic tests, all Sensory Nerve Action Potentials (SNAPs) were unobtainable, But no evidence of motor nerves involvement was noted in our study. All of above results are compatible with HSAN type II. There is no cure or definite treatment for this disease. The aim of this article is presentation of these rare disorders and their clinical and electrophysiologic findings and finally emphasizing in rehabilitation treatments for prevention of progress and disease complications.

Thrombotic obstruction of cerebral venous system, i.e. thrombosis of major cerebral sinuses with or without involvement of deep or cortical draining veins, seems to be rare than other types of stroke; so, it includes only 2% of all strokes. Also, among cerebral venous sinus thromboses, involvement of straight sinus and deep cortical veins is the least common. First patient: this is 15 y/o lady who was on oral contraceptive (LD) for 1.5 months, for treatment of ovarian cyst. presented with increased ICP signs, decreased level of consciosness to our hospital and bilateral. Papilledema and Lt sided weakness detected in physical examination. Brain MRI-MRV showed straight sinus thrombosis. So, anticoagulation was started and she recoverd.Second patient: this 25 y/o lady who had received OCP (LD) for treatment of hirsutism and the dose had been increased. 5 Days before admission, she was with increased ICP, decreased level of conscconsess and Lt sided weakness in our hospital. Brain MRI-MRV showed Rt transverse and straight sinus thrombosis, but despite of anticoagulation therapy, patient was expired. Study for vasculitie tests and factor V leides was unremarkable in both patients.

Klebsiella pneumoniae is the etiologic agent of urinary tract infection and pneumonia. In patients with proper underlying condition it leads to nosocomial infection. Low birth weight premature neonate with respiratory distress syndrome admitted in Taleghani Hospital of Tabriz for 33 days. During this period the patient developed septicemia, meningitis, poly articular arthritis and osteomyelitis by klebsiella pneumonia. The patient then was admiited in Tabriz Pediatric hospital. According to antibiogram, the isolated klebsiella was resistant to most routine antibiotics, so the patient was treated with intravenous ciprofloxacin and cotrimoxasol for 4 weeks followed by oral medication for 4 weeks. Klebsiellae pneumonia especially nosocomial isolates are resistant to most of the antibiotics. Arthritis and ostemyelitis due to Klebsiella pneumonia is a rare entity. The presented patient after completion of treatment course by ciprofloxacin completely improved and showed excellent weight gain.