مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و هشتم شماره 3 (پیاپی 123، امرداد و شهریور 1395)

Backgrounds and

The most common correctable cause of male infertility is varicocele. The inguinal microsurgical techniques are innovative techniques that allow the ligation of all of the veins. Diameter and number of the veins ligated seems to be effect the treatment results. The purpose of this study was to investigate the effect of the number and diameter of ligated veins on the changes of semen analysis parameters.

In a descriptive analytical study, 50 patients with varicocele were studied. Preoperative semen analysis was performed in two steps. In all of them, inguinal microscopic was done. Results were compared with semen analysis after 6 months.

Fifty patients with mean age 30±0.7 years were enrolled. The patient’s complaint was pain in 28% of case and infertility in 72% of case. Varicocele grading was 12% grade 1, 42% grade 2 and 46% grade 3. A significant difference was seen in the sperm count, morphology and motility before and after the surgery. There were no significant differences in other parameters of semen analysis. In patients with over 10 ligated veins, a significant improvement in the sperm count, morphology and motility was seen. In other patients with less than 10 ligated veins, the improvement was seen in the sperm count only. The diameter of the ligated veins had no effect on the changes in semen analysis.

Our results indicate that the varicocelectomy has improving effects on the semen analysis parameters. Improvement in the sperm count, morphology and motility was occurred with increasing the number of ligated veins. However, venous diameters had no effect on the semen analysis parameters.

The optimal treatment for Pilon fractures remains controversial. This study was conducted to evaluate the clinical outcome of the treatment of type C2 and C3 Pilon fractures (AO/OTA Classification) using limited open reduction and fixation with mini-plate and supplementary transarticular Kirschner wire.

31 type C2 and C3 Pilon fractures, including 5 open fractures, were included in this study. For 10 patients, including 5 open fractures, temporary external fixation spanning ankle joint was conducted as early as possible. Other 21 patients were temporarily immobilized in splint. At the final stage, tibial and fibular fractures were reduced and fixed using limited open reduction and transarticular Kirschner wires and mini-plates. Clinical and radiographic evaluations were performed. The American Orthopedic foot and Ankle Society Score (AOFAS) were obtained for the evaluation of function.

Anatomic reduction in articular surface was obtained in 29 (94%) patients. No nonunion or skin necrosis was observed during the follow up period. Minor infection occurred in 2 patients and deep infection occurred in 1 patient. Malunion occurred in 3 (9%) patients. The final functional results, based on the AOFAS score, were excellent and good in 74.41%, average in 19.35% and poor in 3.22% of the patients.

Limited open reduction and fixation with mini-plate and transarticular Kirschner wires is a reliable treatment for closed and open AO/OTA type C2 and C3 Pilon fracture of the distal tibia.

Backgrounds and Omentin is a member of adipokines secreted from visceral adipose tissue which increaseS insulin sensitivity. The aim of the present study was to investigate the effect of endurance and resistance training on plasma omentin-1 levels in male rats.
In this experimental study, twenty-four Wistar male rats¬ with average weight¬ of 220±20 gr were acclimatized with lab condition and then randomly divided into three groups of Control (C), Resistance training (RT) and Endurance training (ET). Endurance training group underwent an endurance training program for eight weeks (five bouts per week of treadmill running each 60min with 20 m/min). Resistance training group was subjected to a three-day per week resistance training program consisting of climbing a ladder carrying a load suspended from the tail. At the end of the experimental period, blood samples were taken to assess plasma omentin-1, insulin and glucose levels. Data were analyzed using one-way ANOVA and statistical significance was set at P>0.05.
The results showed that endurance training significantly increased plasma omentin-1 levels and decreased plasma insulin and glucose levels while plasma omentin-1 and insulin levels did not change significantly in the resistance group.
Endurance training was more effective on omentin-1 levels than resistance training. Either training programs inhibited weight gain observed in the control group. It might be hypothesized omentin-1 contributes to metabolic effects of exercise training.

Backgrounds and Helicobacter is a genus of Gram-negative bacteria with a characteristic helix shape. Today, a large number of non -H. pylori Helicobacter species in a wide variety of animals and humans have been described. Except helicobacter pylori, Non-pylori Helicobacter species has also been associated with some gastric problems such as gastritis, peptic ulceration and Mucosa-Associated Lymphoid Tissue (MALT) lymphoma in the human. However, due to the lack of sufficient researches on this subject in Iran, the main purpose of this study
is scrutiny of these microorganisms on human health and the prevalence of Non-pylori Helicobacters in stray dogs as a reservoir for these microorganisms in Iran.
In this study, 55 healthy stray dogs (randomly) were used. For evaluation of the general health condition of the dogs, 0.5ml of blood collected from the cephalic vein and evaluated after staining.
The dogs were anesthetized and samples were collected from stomach by gastroscopy. Infection confirmed by a positive urease test and studied by Giemsa staining and using light microscopic routs.
Results & In gastric samples, non-pylori helicobacter spp., have been observed. 87.5% of samples were positive for urease test. In light microscopic studies (we observed some spiral gram negative bacteria with 2-7 coils), 80% of samples were positive. Therefore the prevalence of helicobacter can vary from 80 to 87.5% in stray dogs. Among the investigated specimens, 25 specimens were contaminated along with several species of Helicobacter. It should be noted that, it is not possible to identify the species by using light microscopy.

Backgrounds and Research suggests that both preterm and term infants can be remember and understand their own womb odor and prefer them to environmental odors. Studies show that use of olfactory stimuli during painful medical procedures reduces pain responses of infants. The main purpose of this study is investigating the effect of breast milk odor on pain response in preterm infants during and after venipuncture.
This study is a randomized clinical trial research. 90 preterm infants who were eligible to participate in the study were randomly selected and divided to two groups; control and breast milk. In breast milk group, infants were exposed to the smell breast milk odor five minutes before sampling to thirty seconds after it finishes. Infants’ pain has been measured using PIPP score, 30 seconds before venipuncture, during sampling and 30 seconds after the end of venipuncture
Statistical analyses showed that there are significant difference between pain score of infants of two groups during sampling (p=0.01) and after the end of venipuncture (p=0.05)
According to the results breast milk odor can be used for reduction of preterm infants’ response to pain during and after blood sampling

Beta interferon (IFNβ) protein is produced as a recombinant drug and used in treatment of some diseases like Multiple Sclerosis. In eukaryotic cells, IFNβ mRNA is rapidly degraded and its half-life is too short. One of the contributing factors to this short half-life is presence of the AU rich element (ARE) in 3´UTR of this mRNA. This region has an inhibitory effect on translation too. Our aim in this research was to delete ARE from IFNβ gene in order to increase its mRNA stability and translational level.
In order to delete an 18 nucleotide sequence from ARE, the Megaprimer PCR technique was used. The PCR product was digested with EcoRI and BglII enzymes. The vector was partially digested with the same enzymes. The digested PCR product was purified and cloned into the vector. Then, the recombinant vectors were transfected into CHO cell line.
The first PCR reaction product contained a deletion mutation and was used as megaprimer in the second reaction. Partial digestion of the vector yielded a variety of fragments with different weights. The sufficient fragment was purified from the gel and used as a cloning vector. Final product of PCR was cloned into the vector. The accuracy of the cloning reaction was confirmed and the recombinant vector was transfected into CHO cell line.
An 18 nucleotide region of IFNβ mRNA was deleted. The influence of this microdeletion on mRNA stability and translational efficiency needs to be surveyed in future.

Backgrounds and Exposing with bioaerosols can be resulted in widespread adverse health effects including infectious and epidemic diseases, acute toxicities, allergies and even cancer. From this point of view, bioaerosol contaminations in hospitals can cause various secondary health problems. This study was conducted to survey the quality and quantity of bioaerosols in various hospital wards in winter.
In this cross-sectional descriptive study, the air samples were collected and analyzed according to NIOSH-0800 standard method. Air samples were taken through single-stage impactor using a high volume sampler at 28.3 ±0.2 l/min flow rate during 10 minutes. Sabouraud dextrose agar and blood agar plates were used as sampling media within impactor for fungi and bacteria, respectively.
The obtained results showed that, in average, the infants ward in Fatemeh hospital and general clinic in Abbasi hospital had the most bacterial contamination load. In contrast, the operating rooms in Fatemeh hospital and radiology ward in Abbasi hospital had the lowest bacterial contamination load. The independent T-test showed that the bioaerosol contamination in Abbasi hospital was significantly higher than Fatemeh hospital. Also, the most detected fungi were Aspergillus, Penicillium and Cladosporium.
This study indicated that the bioaerosol concentration in most wards of both hospitals exceeded the standard permissible limit (30 CFU/m3). Preventive control measures should be designated and implemented to decrease the exposure rate of patients and clients.

Backgrounds and Acute poliomyelitis is now an uncommon disease but its long term morbidities are still a challenge. Post polio syndrome includes new neuromuscular symptoms that polio survivors are often confronted with several years after acute polio. The purpose of this study was to assess quality of life, and physical and psychological function in persons with postpolio syndrome (PPS).
204 subjects with history of poliomyelitis were recruited in this cross sectional study. Finally, 52 people affected by post polio syndrome were compared with 50 healthy people (as control group) regarding the quality of life, and physical and psychological function. Utilized assessment instruments were: 36-Item Short Form Health survey (SF-36) and its two physical functioning and mental health subscales, visual analogue scale, fatigue severity scale and muscle manual muscle testing. The data were analyzed using mean and standard deviation, Independent t test, Kruskal-Wallis test and multivariate regression test. The level of significance was set at 0.05.
The mean age of patients in this study was 41.65±8.74. Comparing the patients with control group revealed that the patients reported a poorer quality of life, and physical and psychological function. Multivariate analyses identified that physical function was affected by muscle weakness, while psychological function was affected by pain and fatigue.
Quality of life, and physical and psychological function of people with PPS were reduced. These patients need support from multidisciplinary teams to cope with new neuromuscular problems.

Backgrounds and Candida albicans causes the infection in patients with organ transplantation, AIDS burning as an opportunistic yeast. Mucormycosis which is caused by Rhizopus oryzae, is an acute rapidly progressive and fatal infection in immunocompromised patients. The toxicity of antimicrobial drugs, resistance in fungi and drug interactions warrant the need for a more effective and less toxic drugs.
In this study, the minimum inhibitory and lethal concentration of Rumex alveolatus against Pathogenic fungi Candida albicans (NCPF 3153) and Rhizopus oryzae (ATCC 52311) was evaluated. The effect of ethanol and methanol extracts of stem and leaves of Rumex alveolatus, which was prepared with soxhlet method on the Candida albicans (NCPF 3153) and Rhizopus oryzae (ATCC 52311) was investigated with using disk diffusion test, MIC (minimum inhibitory concentrations) and MFC (minimum fungicidal concentration), then results were compared with fluconazole.
The results showed the effect of ethanol and methanol extracts of the stems and leaves in concentrations 25, 50,100, 200 mg/ml with inhibitory zone diameter between 21.66 to 10.33 mm against Candida albicans but not against Rhizopus oryzae and the highest inhibitory concentration was 31.25 mg / ml.
Due to the resistance Candida albicans strains to drugs such as fluconazole, this herbal extract is suitable alternative to synthetic drugs to treat candidiasis infections. The use of Rumex alveolatus plant as a antifungal agent is promising.

Osteoporosis along with decreased bone density can lead to bone structure loss which increases the risk of fractures. Recent identification of genetic factors impels researchers to assess association of genetic variations with osteoporosis. The aim of this study was to evaluate the relationship between FokI and ApaI polymorphisms of vitamin D receptor (VDR) gene and serum calcium level, serum 25-OH vitamin D level and osteoporosis in Iranian postmenopausal women.
In this study, we included 194 over 50 years old postmenopausal women with osteoporosis and osteopenia and 50 over 50 years old healthy postmenopausal women as the control group. To study the polymorphisms, genomic DNA was extracted from blood samples containing EDTA anticoagulant. Genotyping of FokI and ApaI polymorphisms of VDR gene was performed using PCR-RFLP method.
Weight, height, age, serum 25-OH vitamin D, and calcium level were compared in three groups of control, osteopenia, and osteoporosis. The mean of serum calcium level was not significantly different but the means of age, weight, height, and serum 25-OH vitamin D level were significantly different between the patients and control group. Also, the differences in the distribution of FokI and ApaI genotypes were not statistically significant among the patients with osteopenia, osteoporosis and the control group.
It seems that there is no association between FokI and ApaI polymorphisms of VDR gene and osteoporosis.

Deaths from cardiovascular diseases following chronic kidney diseases are rising widely .The aim of this study was to evaluate the efficacy of a combined regular exercise during dialysis on intervening risk factors for vascular calcification diseases.
Forty-five selected hemodialysis patients with a mean age of 61±9.02 years weighing 69±11.25 kg¡ were randomly assigned to the exercise (n=24) and control (n=21) groups. The exercise group participated in a 16-week combined exercise program. Training program included foot pedal ergometer and foot resistance exercises using weights during dialysis sessions three times a week. Parameters associated with calcification and renal function (FGF23¡ PTH¡ P and Ca) and quality of life were measured before and after the training program period.
Following four months combined training¡ parathyroid hormone and phosphorus levels significantly reduced. There were not any significant changes in blood fibroblast growth factor 23 and calcium levels. Also¡ exercise significantly improved the quality of life and physical functions in hemodialysis patients.
Physical activity in hemodialysis patients is associated with changes in some factors related to vascular calcification and also improvement in the quality of life.

Backgrounds and Neck deep infections are potentially threatening life conditions which can occur while using broad spectrum antibiotics. Early diagnostic and therapeutic interventions are essential in approaching these infections. As these infections are prevalent and there are difficulties in diagnosis and curing these infections and threatening morbidities they have, we decided to study the results of culture and anti-bio gram in these patients, for determination of these parameters, sensitivity, resistance of antibiotic used for these organisms and selection of appropriate antibiotic.
In 100 patients admitted with a diagnosis of deep neck spaces infection between July 2008 and November 2012, pus was aspirated and sent to microbiology lab for gram staining, culture and anti-bio gram. Types of isolated bacteria and the sensitivity and resistance rate were defined.
In our study 100 patients with a diagnosis of deep neck spaces infection were studied. Average age was 33.8 ± 13.43 years old. 65% were male, 4% had diabetes, 3% had the history of abscess/cellulitis, 3% had liver disease, 2% had the history of opiate addiction and 6% had the history of alcohol consumption. In 71% culture was negative and in 29% it was positive. 68.9% were gram positive cocci and 31.1% were gram negative bacilli. From 29 positive cultures, 13(44.8%) were Streptococcus Viridans, 5(17.2%) were Staphylococcus, 5(17.2%) were Klebsiella Pneumoniae, 2(6.9%) were beta hemolytic Streptococcus, 2 (6.9%) were Haemophilus Influenzae and 2(6.9%) were Entrobacter. Final diagnosis was peritonsillar abscess and cellulitis. In 22% the etiology was pharyngitis, in 18% was Odontogenic, in 5% were upper respiratory tract infections, in 2% was dermatologic infection and in 1% was foreign body. Etiology was unknown in 51% of the patients. The most sensitivity was to Vancomycin (100%), Imipenem (100%), Erythromycin (80%) and Levofloxacin (80%). The less sensitivity was to Gentamycin (50%) and Penicillin G (28.6%). There was no statistically significant relation between the culture results and demographic variants or patient’s medical history.
Deep neck infection is a life threatening disease. Antibiotics should be started after blood sampling for culture and antibiogram and continued according to antibiogram results. Beginning antibiotics before blood sampling will result in wrong findings in culture and antibiogram.