مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و ششم شماره 2 (پیاپی 110، خرداد و تیر 1393)

Osteoporosis is the most common disease of the bone and minerals metabolism which affect approximately 40% of women over the age of 50 years. Previous researches have showed that the densitometry of wrist was associated with densitometry of neck and trochanter of femur. We evaluated the frequency of osteoporosis of wrist with hip and lumbar spine. In a cross sectional descriptive analytic study we studied 100 post menopause women which achieved inclusion criteria. The densitometry was done for subdominant wrist, lumbar and femur for all the patients with x ray of lateral lumbosacral and vitamin D level checked for all patients. The men age of the patients was 57±6.9 years which were in the range of 50 to 76 years. The t-score mean in the wrist area was -2.6±0.5 which was more than its number in lumbar and hip area. 59.6% of studied cases were found to be osteoporotic due to their densitometry. The correlation between vitamin D serum level with bone density of wrist was not statistically significant (P=0.19) With regard to the findings of the present study and with considering the false rise in lumbar T-score induces low frequency of the lumbar osteoporosis in comparison of other area. Also we can conclude that wrist T-score in detection of hip osteoporosis can be used because of lumbar DJD.

Insecurely attachment style is one of effective factors in many mental disorders. The aim of present research was to predict the hopelessness; impulsivity and dissociative and paranoid symptoms in securely; ambivalent and avoidant attachment students. The type of the study was descriptive. Subjects of this study were 400 students (200 male and 200 female) from University of Tabriz who were chosen by multistage cluster random sampling. Borderline personality scale (Schizotypal Trait questionnaire-B form) and adult attachment inventory were used for data gathering. There were significant differences in hopelessness; dissociative symptoms, impulsivity and total score of STB between securely attached people and people with avoidant insecurely attachment (p<0.05) and between securely attached people and ambivalent attached people in impulsivity and total score of STB (p<0.05); but no significant differences was found between two above groups in hopelessness and dissociative symptoms (p>0.05), while there wasnt any differences between avoidant and ambivalent attached people in hopelessness; dissociative symptoms, impulsivity and total score of STB (p>0.05). In comparison with securely attached people, people with insecurely avoidant attachment experience more hopelessness; dissociative symptoms and impulsivity; and people with insecurely ambivalent attachment experience more impulsivity. Altogether, insecurely attached people are more prone to borderline personality disorder.

Botulinum Toxin (BTX) injections commonly used to improve facial aesthetics by smoothing hyperdynamic rhytides in upper face. The BTX, by blocking acetylcholine release from motor neurons at the neuromuscular junction, plays an important role in aesthetics. Our aim was to evaluate the efficacy and side effects of Dysport in the treatment of forehead & glabellar lines. In this Pilot clinical trial, 20 patients with moderate to sever Glabellar and frontal line were divided equally in two groups: A (3 and 5 injection points in Glabellar by 50 u Dysport®) and B (7 points injection in frontal by 35 u Dysport®). The pretreatment Capture photos of patients were taken then it was repeated 2, 4, 8, 16, 20 and 24 week after the injections. The Irct registration number: IRCT201209179844N2. The mean age of patients was 41.7±8.2 years (Range: 29 - 55 years). The Mean onset of injection efficacy in group A and B was 7 and 6 ±2.1 days, respectively (P>0.05). The affectivity of both methods (completely disappearing of forehead & glabellar lines) was evaluated at the second week after injection; frequencies of the grade1, 2, and 3 healing in group A and B were: 10, 70, 20 percent and 10, 80, and 10 percent, respectively (P>0.05). The mean of durability of both methods was similar: 4.1 ±1.2 months. Beside the common side effects of injection (Pain at the injection site and Headache) no other serious complications (Ptosis, Heavy eyebrows) were observed. Overall, 90% of patients were satisfied or quite satisfied with the Dysport injection therapy.

Wet type Age-related Macular Degeneration (Wet type AMD) is a debilitating ocular disease which generally occurs among elderly population. Tumor Necrosis Factor alpha (TNF-α) is a reactive phase protein which is associated with Alzheimer, atherosclerosis, type 2 diabetes mellitus and aging. In this case-control study, 40 eyes of 40 patients with wet type age-related macular degeneration and 49 normal eyes of 49 healthy people were randomly selected and serum levels of TNF-α, lipid profile and fasting blood glucose were checked. The difference of mean ages and male to female ratio were not statistically significant (P=0.441, P=0.091). Serum level of TNF-α was significantly higher among patients with retinal degeneration (Median (IQR) = 0.2 (0.1-0.58) vs. 0.1 (0-0.2); P=0.002). TNF-α would have a role in the pathogenesis of the wet type age-related macular degeneration and pharmaceutical and/or non-pharmaceutical interventions might decelerate or even cease the progression of this ominous disease.

XRCC1 protein plays an important role in the base excision and single-strand break repairment, and also, as a scaffold protein, it attaches the proteins of the DNA repair complex. Changes this system increases the occurrence of the malignancies. We examined the association of polymorphisms in codon 194 (Arg/Trp) and 399 (Arg/Gln) of XRCC1 gene and the risk of the breast cancer in Azerbaijani women in the Northwest of Iran. In this descriptive - analytical study, 91 patients with breast cancer and 91 healthy individuals as controls were studied. The DNA compliment mass extracted from peripheral blood cells and the different genotypes were determined at codons 194 and 399 of XRCC1 gene by PCR-RFLP technique and Sequencing. The P-value calculated using Fisher's exact test. There was no difference in the distribution of genotypes at codon 194 of xrcc1 gene in case and control group (all were homozygous CC) (p>0.05). The genotype distribution in the control group at codon 399 was 0, 83.51 and 16.48 percent for Arg/Arg, Gln/Arg and Gln/Gln, respectively. In the cancer group, the genotype distribution was 16.48, 46.15 and 37.36 percent, respectively for the same order of genotypes. The results indicated a significant association between genotypes of Arg/Arg and Gln/Gln at codon 399 of xrcc1 gene and breast cancer risk in this population (p<0.0001). Also, there is a significant association between Arg/Gln and loss of breast cancer risk (p<0.0001). There was no difference between genotypes at codon 194 of xrcc1 gene in case and control groups. In addition, our results illustrated a significant association between the xrcc1 codon 399 polymorphisms and the risk of breast cancer in an Azeri women.

Standard Full-field Electroretinography (SFE) is an invaluable procedure for evaluating the function of the retinal photoreceptors, pigmented epithelium and Müller cells. It is consists of scotopic, photopic, maximal response, oscillatory potential and 30 Hz flicker responses. Standardization of the results is a crucial step in interpreting the results efficiently and facilitates the process of the treatment. The aim of this study was to determine the normative data base of SFE method in Tabriz, IRAN. Eighty-five healthy individuals (with the age of 1st to 7th decades) who were resident in Tabriz city, were randomly selected and SFE was performed with DTL electrodes according to the ISCEV instruction. The mean ages of male and female participants were 35.6±19.7 and 35.3±14.3 years, respectively (P=0.95). The standardization of the results of electroretinography is mandatory in any ophthalmology center to diagnose the relevant diseases and manage them properly.

In Closed Chain kinetic problem, Foot Hyperpronation leads to lower extremity weakness. The purpose of this study was to examine the effect of closed chain hip exercise in correcting foot hyperpronation. Thirty male subjects with foot hyperpronation participated in this study and were divided into case and control groups. First foot hyperpronation was measured by goniometer and the strength of hip abductor and lateral rotator muscles assessed using hand-held dynamometer, then the interventional group participated in closed-chain hip rotation strengthening exercises three days a week for six weeks. The control group asked to continue their daily activity. After a 6 weeks, Foot hyperpronation and muscles strength were measured again. Data analysis with paired and independent samples t test was performed (p≤ 0/05). There was significant increase between pre¬ and post-tests in the strength of hip abductor and external rotator muscles and foot hyperpronation in the case group while no differences was found in the control group. Also, both groups at pre-test, had no significant differences in the strength of hip abductor and external rotator muscles and foot hyperpronation however, significant differences were observed in the post test. Body components such as rings are linked together like a chain that each them affects others, thus after performing weight-bearing closed chain hip rotation exercise and increasing muscles strength of proximal lower extremity it can be correct foot hyperpronation in distal lower extremity.

Human milk is a complex biologic fluid that contains nutritional and protective factors such as Osteoprotegerin (OPG), at level that is 1000-fold higher than that found in normal human serum. Since OPG and Receptor activator of nuclear factor-kappa B ligand (RANKL) system are tightly involved in bone remodeling and immuno activity the present study was designated to evaluate the effect of breastfeeding on serum Soluble receptor activator of nuclear factor-kappa B ligand (sRANKL)/ OPG ratio in full term neonates in comparison with those of formula feeding full term neonates. In this cross-sectional study serum levels of OPG and sRANKL in 45 breastfed infants were compared with those of 44 formula-fed full term infants. The levels of serum OPG, sRANKL, were determined by standard techniques using enzyme-linked immunosorbent assay kits (ELISA methods). The serum levels of OPG were significantly higher in breastfed infants (P<0.001). No marked differences were observed between the serum levels of sRANKL in the two study groups (p=0.8). High OPG and level in serum of breastfed infants are important factors involved in remodeling of bone and immuno activity may prove superiority of breast feeding over formula feeding during infancy.

Mother who is overweight and obese before pregnancy are known to be at risk of uterine dysfunction, induction and cesarean section. The purpose of this study was to determine the relationship between pre pregnancy body mass index and the childbirth method. In this cross-sectional study, 1354 pregnant women were recruited randomly in Besat Hospital in Sanandaj (the capital of Kurdistan province in the West of Iran). Inclusion criteria were singleton term pregnancy, having medical records, and referring to the health care center up to the 12th week of pregnancy. Data collection was done through two parts questionnaires including: demographic characteristic and question regard to route of delivery. The incidence of overweight (BMI>26) was thirty-eight percent. Chi-square test proved a significant statistical relation between body mass index and induction (p<0.05) and delivery route (p < 0.05). There was significant relation between cesarean causes and BMI (p<0.05). Obese and overweight women need more attention during pregnancy. In this regard, training, nutrition and health consultation, and reaching appropriate weight before pregnancy can improve mother and newborn health.

Cesarean delivery is the most common operation. There are several techniques for cesarean. The aim of this study was to compare the results of the Maylard incision with vertically incision surgical techniques. In this randomized clinical trial study, 84 pregnant women with a previous cesarean section were selected and they were divided into two groups (42 women in each group). Age, sex, height and weight were matched. Then the Maylard incision and the vertically incision were performed. Operation time, intra and postoperative complications, postoperative pain and satisfaction were assessed. The differences of the surgery duration and the frequency of the hemorrhage were not statistically significant (p>0.05). While, the after surgery pain and the patients satisfaction was significantly higher in the group with the vertical incision operation (p<0.05). The Women's satisfaction in maylard incision was 95.2% and in vertical incision was 33.3%, the difference was statistically significant. The Maylard incision is abloto provide more satisfaction. Postoperative pain and analgesic drugs consumption in the maylard technique is less. In other factors, there were not difference between two methods of vertical and maylard incision.

The overweighed cases like the patients with the injury of ankle sprain having problems with their Balance control system. The aim of this study was to investigate the effect of fatiguing exercise on the static and dynamic balance changes in athletes with the ankle sprain. In this Case- Control study, 30 active athletes and 14 cases with previous severe ankle sprain as case group and 16 healthy cases as control group were inverted in a treadmill running protocol in 2 experimental sessions. Center-of-pressure sway velocity in single-legged stance and time to stabilization (TTS) after a unilateral jump-landing task (first session) and maximum reach distance in the Star Excursion Balance Test (SEBT) (second session) were assessed before and immediately after the treadmill exercise. In the unfatigued condition, between-groups the significant difference was found only in the anterior-posterior TTS (P< 0.5, ES<0.39). Group-by-fatigue interactions were found for mean SEBT (P<0.03, ES <0.43) and anterior-posterior TTS (P<0.02, ES<0.48). Prefatigue versus postfatigue SEBT and TTS tests differences were greater in previously injured athletes, whereas static sway velocity increased similarly in both groups. Fatiguing duo to running significantly affected static and dynamic postural control in participants with a history of ankle sprain. Fatigue-induced alterations of dynamic postural control were greater in athletes with a previous ankle sprain. Thus, even after successful return to competitions, ongoing deficits in sensorimotor control may contribute to the enhanced ankle reinjury risk.

Severity of postoperative pain in cesarean is categorized as moderate to severe levels, so it is necessary to use an appropriate analgesic protocol for alleviating post cesarean section pain; it made a better condition for mother for early communication with her baby. The aim of this research was to investigate the effect of intravenous paracetamol (acetaminophen) as an analgesic in comparison with Diclofenac suppository and intramuscular tramadol after cesarean. In this clinical trial study, 105 pregnant women randomly divide in three equal groups after cesarean section. In their post-operative period analgesic protocol for first group was Diclofenac suppository 100mg every 8 hours. For second group intramuscular tramadol 50mg every 8 hours and for third group intravenous acetaminophen 1gr/100ml every 6 hours were prescribed. Pain intensity was assessed at 2, 6, 24 hours after surgery using visual analogue scale. The reparative cesarean was the most indication of cesarean (48.6%). In this three groups visual analogue scale at 2, 6 and 24 hours after surgery had no significant difference (p=0.087). 26 person in Diclofenac group, 22 person in acetaminophen group and 34 person in tramadol group received additional narcotic (p ≤ 0.001). Intravenous acetaminophen or suppository Diclofenac is more effective than intramuscular tramadol for decreasing pain after cesarean section.

Regarding the increasing trend of obesity among societies, tendency for consumption and hence production and import of the so-called “herbal” weight loss products, has showed a significant growth. In this study, the presence of fifteen illicit drugs and chemicals in herbal weight loss products has been determined. Twelve weight loss products, which have been advertised by the manufacturers as “herbal”, were provided from different stores in Tehran and examined for the presence of the selected illicit drugs. The studied chemicals could be classified as; stimulants and analgesics, anorexics, anti-anxieties and anti-depressions. After sample preparation and extraction procedures, gas chromatography-mass spectrometry was employed for detection and confirmation of presence of the analytes. In addition, because of necessity of derivatization for some analytes, all samples were silylated and analyzed again. The most of the tested products contained highly dangerous and banned drug, sibutramine. Caffeine was also detected in most of the samples. It was also demonstrated that the products of the same brand could be different regarding the content of the drugs of abuse. In spite of the advertisement of the manufacturers of the weight loss products, majority of these products contained drugs of abuse and banned chemicals which could cause serious problems.

Cochlear implant is an operation for the patients who has abnormality in their cochlear system. This operation is conducting for adult whit bilateral hearing loss greater than 70 db and for pediatric older than 12 month whit hearing loss greater than 90 db. Complication of this operation isn’t low and some patients need revision surgery. Rate of revision in adult is 5/4 percent and in pediatric is 8-12/5 percent. The major cause in 2008 was device hard failure and other cause was colesteatoma and wound problem and displacement. Our goals was to detect the complication of cochlear implant and elevation of quality and outcome of operation. In this cross-sectional study, Complication of operation studied in 416 patients who implanted in Shiraz khalili hospital between 1383 to 1390 from their files and follow up. There was 9 revision surgeries (12/5%): three Cases had device failure, three had displacement because of trauma, and three Cases had foreign reaction. We have four minor body complications which had responded to medical therapy: one had facial nerve paresis. One Cast had acute otitis media. Two Cases had swelling of operation site. Here we have three kind of device 397 CI24Re, 9 Hires90k, 10 Med el. In this study 30% of our revision was device failure and 30% had trauma so we should elevate quality of our device and knowledge of our patient and their follow up.

Congenital Nasal Pyriform Aperture Stenosis (CNPAS) is an unusual cause of airway obstruction in the newborn and infants. CNPAS should be considered in the differential diagnosis of any infant with episodic apnea, cyclical cyanosis, and feeding difficulties. Computerized tomographic (CT) measurements and imaging features enable accurate diagnosis of this abnormality. In this report we demonstrated CT examination findings of CNPAS in a 9 –year-old girl.