مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و دوم شماره 4 (پیاپی 88، مهر و آبان 1389)

Hirschsprung's disease (HD) is a relatively common problem among children and may be in differential diagnosis with many other diseases and even physiological conditions or functional abnormalities. Therefore, proper diagnosis is very important. On the other hand, determining the true agangliosis level is vital; because the wrong estimation would lead to inadequate or excessive resection. Determination of the level of agangliosis in HD is achieved by intraoperative examination of obtained frozen sections. This study aimed at comparing the frozen section and permanent section of HD in one staged surgery. Forty patients with definitely diagnosed HD were operated by Transanal one-stage endorectal pull-through (TOSEPT) approach. Intraoperative biopsies were performed from the most distal portion suspected to have no ganglions and extended toward the transitional zone and several frozen sections were evaluated pathologically. After operation was completed, the result of permanent sections in each patient was compared with those of frozen section study. The mean concordance rate of results in frozen section and permanent section studies was 98.17±1.60%; 100% in 36 cases, 83.3% in 2 cases, and 80% in 2 cases. The concordance rate was 100% in the first and the last samples. The reported discrepancies were as follows: in the 5th sample out of 6; “few" was reported in the frozen section but " some" was reported in permanent section. In the 4th sample out 5; "a few" and "some" was reported in frozen and permanent sections, respectively. This study showed that there is a high concordance between the results of frozen section study and permanent section in patients with HD. Therefore, permanent section can be replaeed by the frozen section studies

β-lactam antimicrobials represent the most common agents used for treatment of bacterial infections. β-lactamase production among gram negative bacteria is one of the leading cause of antibiotic resistance worldwide. The persistent exposure of bacterial strains to a multitude of β-lactams has induced dynamic and continuous production and mutation of β-lactamases in these bacteria, expanding their activity even against the newly developed antibiotics. Extended-spectrum β-lactamase (ESBL) producing bacteria are main problems for the current antimicrobial resistance study groups. This study aimed at evaluating the frequency of ESBL producing gram negative bacilli isolated from hospitalized patients. In an analytic-descriptive setting, 191 Gram negative bacteria isolated from hospitalized patients admitted in different wards of Sina Hospital, Tabriz were evaluated during a 15-month period. Broth dilution, double disc synergy and E-test were employed for assessing the presence of ESBL-producing organisms. Acinetobacter and Pseudomanas species were excluded due to technical limitations for evaluating the presence of ESBL in these bacteria. The probable risk factors for the presence of ESBL-producing Gram negative bacilli were also evaluated. Ninety three (49%) isolates were found as the ESBL-producing bacteria. These included Klebsiella pneumoniae (62.9%), Escherichia coli (49.2%) and Enterobacter spp. (19.2%) isolates. Citrobacter spp and Serratia spp. isolates were also found as β-lactamase producing. The duration of stay, hospitalization in ICU, prolonged use of antibiotics, infection with Klebsiella species, catheter usage and previous hospitalization during the last 3 months were significantly related to the presence of ESBL-producing bacilli (P<0.05). The mortality rate was significantly higher in patients infected with ESBL-producing bacteria (11.8% vs. 2%; P=0.041). The current study showed that the rate of infection with ESBL-producing gram negative bacilli is notable; so preventive policy should be considered, particularly regarding the antibiotic prescriptions.

Chromosome Y is a sex-determinant chromosome in human. Microsatellites located on this chromosome are being applied for paternity test, sex determinations in neonates and DNA finger-printing. The application of these markers in most cases depends on the polymorphic situation of them. The aim of this study was to study some of Polymorphic these markers located on Y chromosome among male population from Eastern-Azerbaijan. Fifty unrelated males and several females as a negative control were randomly selected from the interested population. DNA from whole blood cells were extracted and all the individuals were studied by three pairs microsatellites (DYS438, DYS390, DYS385) selected from the chromosome Y. PCR products were electrophoresed on ploy-acrylamid gel (SSR-PCR technique) and bands were analyzed. None of the studied markers were amplified in female controls indicating that these markers are male specific and they do not have a copy on autosomal or X chromosomes. DYS385, a poly-allelic marker, showed the highest percentage of polymorphism (95%) in this population. Markers DYS435 and DYS390 showed relatively less polymorphism respectively. This result indicates that in the population of East Azerbaijan DYS385 is one of the best markers for paternity test and DNA finger printing. In case of combination use of this marker with other two markers, the efficiency of the result would be highly increased

Approximately 9% of newborns require some assistance to begin breathing at birth. Considering to prevalence of high risk neonates, the aim of this study is to determine causes of low apgar neonatal birth. In this retrospective study, 150 neonates with apgar score less than 7 at 1st minute and 150 neonates with normal apgar were considered randomly from 2003/08/23 to 2004/08/22 in Alzahra hospital which is the main referral center of high risk pregnancy in the north west of Iran and also 20-25 childbirth take place every day. The most important cause of low apgar score in neonates Preterm labor (case 48/6%, control 11/3%, P<0/001); Congenital anomalies(case 26%, control 2/66%, P<0/001); use of general anesthesia in caesarean section (case 32/8%, control 10/4%, P= 0/006); Vaccum extraction(case 8%, control 0/7%, P<0/002); Breech presentation (case 17/3%, control 4/7%, P<0/001); Prolonged labor (case 16/7%, control 3/3%, P<0/001); Aloruptio Placenta(case 0%, control 15/4%, P<0/001); PROM (case 19/3%, control 3/3%, P<0/001). It was concluded that low apgar score is significantly associated with a number of fetus, maternal and delivery factors. Findings demonstrated that the main related factors to low apgar score are preterm labor, and utilization of general anesthesia in caesarean labor. The support of vaginal labor, local anesthesia instead of general anesthesia as well as prevention of preterm labor is the practical ways to prevent from low apgar score of newborn infants.

Despite an improvement in fetal assessment, stationary umbilical cord acid-base reference values are used as measures of obstetric care quality. The aim of the present study was to evaluate the significance of umbilical artery blood gas analysis in relation to neonatal morbidity and mortality. In this cross sectional study 268 neonates with no major congenital anomaly but needed resuscitation at least with bag and mask had amniotic fluid mecuniome staining, non physiologic route of delivery or 5 minute Apgar score less than 7 were enrolled in this study. Umbilical artery blood sample obtained and analyzed for blood gas immediately after delivery in the tertiary obstetric hospital of Tabriz. There was a significant correlation between gestational age, birth weight, Apgar score (min 1 and 5), need for advanced stage of resuscitation, asphyxia and neurological complications with umbilical artery PH (P<0.05). There was significant correlation between umbilical artery PaCO2 and gestational age, birth weight, Apgar score (min 1), need for progressive resuscitation, asphyxia and neonatal mortality (P<0.05). There was a significant correlation between umbilical artery HCO3 and birth weight, Apgar score (min 1) and asphyxia (P<0.05).There was a significant correlation between gestational age, Apgar score (min 1 and5) and asphyxia and range of umbilical artery BE (P<0.05). Umbilical artery blood sample analysis gives an objective value for acid-base status, fetal oxygenation and diagnosis of asphyxia but can not predict duration of hospitalization of neonates.

Introduction of 64-Slice Multidetector Computed Tomography (MDCT (has resulted in a great improvement in the non-invasive coronary artery imaging. In a retrospective cross sectional study we evaluated the diagnostic accuracy of 64-Slice MDCT versus invasive coronary angiography in patients with the suspected coronary artery disease who underwent both MDCT and invasive coronary angiography (ICA). Computed tomography angiography and invasive coronary angiography findings of each coronary segment were compared to determine the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MDCT in the detection of significant lesions(≥50% diameter decrease stenosis or total occlusion with no luminal flow shown). a total of 125 patients were evaluated with both methods. In per patient assessment, the sensitivity, specificity, PPV and NPV of MDCT were 97.6%, 85.2%, 95.2% and 92% respectively. These values in per vessel evaluation were 86.3%, 92.2%, 86.8%, and 92.2%, and also corresponding values in per segment evaluation were 69.8%, 94.8%, 69%, and 95% respectively. We concluded that coronary angiography with 64-Slice MDCT has high diagnostic performance for evaluation of significant coronary artery disease (CAD) in patients with the suspected coronary artery disease but cannot replace conventional coronary angiography at present time.

Anterior cruciate ligament injuries are common in athletes. Although mechanical stability through surgery is often suggested, this procedure is not adequate for regaining normal knee function. Therefore, perturbation training as a part of neuromuscular training is recommended. The purpose of the present study was to investigate the effect of modified perturbation training protocol on lower extremity function in these patients. In this clinical trial study, 10 men with anterior cruciate ligament tear in the range of 18-45 years were treated with 10 sessions of modified perturbation training protocol. The effect of training on lower extremity function was evaluated through Subjective IKDC questionnaire, Cross Hop functional test and Isokinetic knee extensor and flexor peak torques and their ratio in 60 and 180 degree per second constant velocities. After training, Subjective IKDC, Cross Hop test and concentric extensor torque (in 60 degree per second velocity) scores were significantly increased in injured leg (P<0.05) (The mean scores of Cross Hop test before and after training were 410.90 and 534.33 cm respectively, the mean scores of IKDC questionnaire before and after training were 64.59% and 79.43% respectively and the mean of values of concentric extensor torque in 60 degree per second velocity in injured leg were 108.81 and 136.92 Newton/Meter respectively). There were no significant differences in other torque values. Before training, torque ratios were significantly higher in injured leg but after training, there were no significant differences in both legs. The modified perturbation training protocol may improve lower extremity function in athletes via increasing neuromuscular coordination and accelerate their returning to sport activities.

According to extensive use of latanoprost in treatment of glaucoma and increasing administration of Non Steroidal Anti Inflammatory Drug, (NSAIDs) in ophthalmology, this question comes important to answer that what is NSAIDs effects on Latanoprost intra ocular pressure (IOP) lowering properties. Our purposes are to evaluate the effect of Diclofenac Sodium0.1%on IOP reduction by latanoprost0.005% and to evaluate the effect of Diclofenac Sodium0.1% on IOP without co-administration of Latanoprost0.005%. 42 eyes of 21 patients were enrolled in this study. First for one eye of subjects Latanoprost0.005 eye solution and for other eye artificial tear administered for 4 weeks. Then Diclofenac Sodium0.1% eye solution was administered for 2 weeks for both eyes and then changes of mean IOP in each group were surveyed. Usage of Diclofenac Sodium0.1% eye solution is discontinued and 2 weeks later the changes of mean IOP in each group were surveyed again. In co-administration of Latanoprost and Diclofenac Sodium0.1%, mean IOP increased from 1 4.38 to 15.52 mmHg after administration of Diclofenac Sodium0.1 %. This change was significant (P=0.03).In the other eye mean IOP was decreased from 15.33 to 14.81 mmHg after Diclofenac Sodium0.1% administration. This change was not significant (P=0.205) Diclofenac Sodium0.1% decreases the IOP lowering effect of Latanoprost while Diclofenac Sodium0.1% doesn’t have significant influence on IOP alone. (without co-administration of Latanoprost).

Neonatal jaundice as a result of bilirubin accumulation is one of the diseases that affect infants during the first days of life. AFP (alphafeto protein) with many physiologic roles is made in liver and yolk sac of fetus; it increases during pregnancy and decreases rapidly after delivery. This study conducted about the serum bilirubin (Bi) and AFP correlation in patients with hyperbilirubinemia in neonatal period. One hundred normal and healthy neonates with icter and hyperbilirubinemia enrolled in this study, all were under 28 day's age, and had only exaggerated physiologic jaundice. Septicemia and any other pathologic conditions "except jaundice" were excluding criterias.For each cases questioner fulfilled, AFP and Bi measured at the same time. Data analyzed by SPSS-13. 66 cases were male and 34 were female, the mean amount of AFP and age of patients showed no meaningful relation between them (P=0.21).There was not meaningful relationship between AFP and sex (P=0.24).AFP and the onset time of icter (P=0.1) and serum bilirubin (P =0.87) did not show significant correlation. Weight of birth and blood groups ABO and Rh (P= 0.24, P=0.06, P= 0.526 respectively) had no meaningful relationship. There was not significant relationship between AFP and serum bilirubin, age, sex, weight, onset of icter and blood groups of patients.

Regardless of the decrease in incidence of gastric cancer in Western countries during the past decade, it is one of the leading causes of death in developing countries. Gastric cancer is one of the most common malignancies in Iran and its incidence is particularly high in the northwest of the country. This study aimed to evaluate the diagnostic and therapeutic procedures of patients with gastric cancer admitted at Tabriz medical centers. One hundred and fifty documented patients with diagnosis of gastric caner) confirmed by pathologic study) were studied in a prospective analytic-descriptive study during an 18-month period with no interventions. Demographic data (age, sex), presenting signs and symptoms, possible predisposing factors and diagnostic procedures (upper GI series, endoscopy, CT scanning, sonography) and therapeutic modalities (operation, chemotherapy, and radiotherapy) were determined in these patients. During the follow-up period, median survival rate and the probable complications were assessed. One hundred and fifty patients, 114 males and 36 females with the mean age of 62.41±11.36 years were enrolled in the study. Dysphagia (30%), loss of appetite 28%) and continuous abdominal pain (26.7%) were the most common symptoms, lasted for a mean time of 3.14 months before definite diagnosis. Smoking (42%), previous upper gastrointestinal sign or symptoms (34%) were the most frequent well-known risk factors. Upper GI endoscopy was performed in all patients followed by CT scanning and sonographies were applied in 87.1% and 37.3% of the patients for staging. CT scan was avoided in many cases with reports of metastasis by sonography. Surgery, chemotherapy and radiotherapy were employed in 46%, 53.3% and 36.7% of the patients, respectively. 18 patients underwent a combination of them. Cachexia (72%) was the most frequent complication during the follow-up period. The median survival time was6.84 months which was significantly lower in patients in stage IV and patients with diffuse type adenocarcinoma. The diagnostic procedures and therapeutic modalities in patients admitted in our center due to GC are in conformity with the instructions in the literature. According to pattern of the disease which results in delayed refer and a serious cost on the community more studies on earlier diagnosis are recommended.

Numerous studies have been performed on habitual nasal to oronasal breathing switching in exercise. However no investigation has reported quantative comparison between habitual and obligatory nasal to oronasal breathing time in exercise. Twenty healthy non-athlete non-smoker subjects (10 males and 10 females) age 20±2 years were randomly selected and then were exercised in two protocols. In first protocol, they were exercised on ergometer in incremental method of exercise (incrementally graded exercise) until opening of mouth (habitual OSP) occurred, and in second protocol, this incremental exercise on ergometer were done with closed mouth until involuntary opening of mouth occurred (obligatory OSP) and ventilation rate were simultaneously measured in two protocols. The habitual and obligatory OSP were 152.68 ± 11.85 and 464.7 ± 12.88 seconds in males and 157.75 ± 19.64 and 271.43 ± 12 seconds in females, respectively. A significant correlation was showed between habitual OSP and workload, and between obligatory OSP, workload and ventilation differences.: Our data showed that obligatory OSP was longer than habitual OSP in males and habitual OSP is shorter than obligatory OSP in two genders. Also increase of ventilation slope was faster in females than in males.

Studies have linked the presence of hostility to some major diseases. However, it's believed that the conventional questionnaires are not capable of assessing the pure hostility. Hostile attitude scale (HAS) questionnaire is a newly developed means claimed to be appropriate in evaluation of pure hostility. This study aimed at evaluation of the HAS amongst a sample Iranian population. One hundred and fifty male students of Tabriz Medical Faculty were questioned by the HAS and the hostility section of the Minnesota Multiphasic Personality Inventory -2 (MMPI-2) questionnaires. The internal consistency of the HAS (Cronbach's alpha) and its criterion validity in comparison with the MMPI-2, as well as the correlation between the two scales was determined. The mean age of the recruited persons was 23.29±1.25 (21-26) years. The internal consistency of the original HAS was not acceptable (Cronbach's alpha=0.586). The question 14 turned to be a weak contributor to the scale's internal consistency and subsequently dropped from the scale. This revised HAS was not correlated with the MMPI-2 (Pearson's rho=-0.054, P=0.514). According to the revised scale, 15.3% of the students categorized as hostile (revised HAS score≥87.05). This study showed that the HAS is not validated enough in Iranian male student population; however a revised version would be reliably employed for determination of the hostile people.

In molecular and cellular biology viewpoint, cancer is indicted to some of rare diseases with similar molecular defects in cell function. In Iran, cancer is third cause of death following cardiovascular disease and accidents. The aim of the present study was to identify epidemiological features and geographical distribution of different types of cancer in East Azerbaijan province. In a descriptive –analytic and cross sectional study, demographic and specific information including biopsy location and type of tumor was derived from medical documents of 29 pathology centers in Tabriz. These data were then compared among age groups and between men and women. Total number of 4945 patients was diagnosed with cancer. The proportion of male to female was 1.38 to 1. According to the result of this study, stomach cancer was the most prevalent cancer in East Azerbaijan. The second and third most prevalent cancers were skin cancers and bladder cancer, respectively. Since pattern of prevalent cancers is different in Iran, considering the particular risk factors of each cancer type is important. More studies are suggested to be carried out considering the specific risk factors of three most prevalent cancers in the province with focus on life style, dietary habits and effort to find unknown risk factors.

The relationship between psychological factors and heart disease is one of the subjects that are being investigated in health psychology. In this regard the following research was designed to investigate the relationship among brain/ behavioral systems and personality dimensions with coronary heart disease. It may enhance our understanding of the neurophysiological mechanisms behind these factors. In this study, two groups of subjects (62 coronary heart disease patients and 62 healthy controls) were compared with one another based on their scores in Eysenck’s personality questionnaire and Corver and Whit’s BIS/BAS questionnaire. Data were analyzed using correlation coefficient and multivariate analysis of variance (MANOVA). There was a positive relation between BAS and extroversion and a negative relation between BAS and neuroticism (P<0/01). Also there was a positive significant relation between BIS and neuroticism and negative relation between that and extroversion. There was no significant relation between BIS/BAS and pesychoticism. Findings showed that the CHD patients differed from healthy controls in the level of neuroticism and extroversion (P<0/01). And there was significant relation between CHD patients and healthy controls in BIS/BAS systems (P<0/01). According to the results of the research, sexuality has not significant relation with BIS/BAS subscales and personality dimensions. The results showed that the psychological factors have a significant relation with CHD.

Detection of causes of sudden natural death is a major problem of physicians and exact inspection of rare causes of sudden death reduces number of white autopsies; hence well performance of justice. Anomalous origin of coronary arteries is one of these rare cases mostly in infants leading to death due to ischemia and heart failure. Attention to anomalous coronary at autopsy is very important for diagnosis of the cause of death. The received specimen from autopsy room of Tabriz legal medicine center was evaluated macroscopically and microscopically by using Hematoxylin and Eosin (H&E) staining method. The deceased was 3- month- old female infant the referred to East Azarbyjan Legal medicine center to determining the cause of death. At autopsy examination of the coronary artery, orifice of the left coronary artery unusually originated from left sinus of pulmonary trunk. The macroscopic and microscopic examinations also confirmed these findings and Ischemia due to the indicated cardiac anomaly. As anomalous origin of the coronary arteries can lead to natural death in infancy, examination of orifices of these arteries is very important for detection of the cause of death in infants and other cases.