مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و یکم شماره 3 (پیاپی 83، پاییز 1388)

High plasma levels of lipoprotein (a) [LP (a)] are associated with an increased risk of coronary heart disease (CHD).The effect of habit and nutritional factors on lipoprotein (a) levels still unknown. Therefore, the objective of the present study was to assess the serum levels of lipoprotein and its relation with life habits and nutritional status in group of reproductive-age women. Method & Materials: The present research was a descriptive and cross-section study and constituted of 252 reproductive-age (15-49 years) women of Tabriz. They are randomly selected from general healthy population. For each individual a demographic questioner, food frequency questioner and two mid week 24 hour food recall questioner was filled. Weight and height was measured. Body mass index was calculated, 5 ml of venous blood was obtained and serum level of lipoprotein (a) was measured by immumotubidometry method. In each individual data were analyzed using statistical methods including T-test, and variance analysis. P<0.05 was considered significant. A mean serum level of lipoprotein (a) was 41.2 ± 28.4 in women. Serum levels of lipoprotein (a) was in normal range (<30 mg/dl) in 44.6%. 55.4% of women had a higher levels (more than 30 mg/dl). There were no relationship between food habits, daily energy intake, fat, protein and other nutrient intake, age, weight, height, BMI, mid arm circumflex with serum levels of lipoprotein (a).Women with moderate regular exercise had a lower lipoprotein (a). level compared with those who hadnt such a regular exercise program (P<0.05). Based on this study, it is speculated that serum levels of lipoprotein (a) is higher than normal range in a large percentage of reproductive age women. In addition, regular exercise reduces the serum level of lipoprotein (a). Therefore, regular exercise educations are recommended for women’s health promotion.

Febrile seizure is the most common seizure disorder occurring in childhood. A simple febrile seizure is a generalized seizure but it is brief and occurs often once during a 24 hours period. Unfortunately in %15-20 of patient's recurrence of seizure occurs. Here we assessed the effectiveness and safety of intramuscular or oral Phenobarbital on preventing the further seizure in acute phase of a febrile illness. Method & Materials: In this clinical trial, healthy children with diagnosis of simple febrile seizure, who were admitted to the pediatric neurology unit of Tabriz Children Hospital were included three groups; case group (one) (intramuscular Phenobarbital), case group(two) oral Phenobarbital, and controls. Fifty three patients in group one received, intramuscular Phenobarbital initial dose of 10mg/kg (up to 200 mg), fifty four patient received oral Phenobarbital initial dose of 15mg/kg (up to 300 mg), and 12 hours later 5 mg/kg/d orally until the fever had subsided, in both groups. Fifty nine patients observed as controls. Rate of recurrence of seizure was compared in two groups, during the acute phase of disease. There was no significant difference in sex, age, etiology, degree of fever, history of neonatal admission, family history of febrile seizure and epilepsy between groups. In control group recurrence of seizure occurred in 11 patients (18.6%) while in case groups happened in 3 patient (2.8%), including one (1.8%) in case group one and 2 patients (3.7%) in case group two, and the differences was significant (P=0.008). However there was no significant difference between oral and intramuscular. Blood level of Phenobarbital, 2 hrs after loading dose in both administration groups was in therapeutic level and the difference between Phenobarbital levels was not significant between two intervention groups. There was no serious side effect of Phenobarbital in case groups. The results of this study indicate that Phenobarbital can prevents the recurrence of seizure in children with simple febrile seizure when it is administered in its acute phase of same febrile illness.

Neuromuscular problems after the treatment of acute lymphoblast leukemia (ALL) have been reported in children and thought to be induced by vincristine. Peripheral neuropathy is its dose-related toxicity. Clinical signs of vincristine neuropathy are early loss of Achilles tendon reflexes, followed by loss of other deep tendon reflexes accompanied with sensory disturbances. This study aimed to evaluate the electrophysiological consequences of vincristine chemotherapy in children. Methods & Materials: In a prospective cohort one year study, the electrophysiologic testing was performed in 42 children, 25 of them with ALL and 17 of them non-ALL malignancies. It was performed before and 5 weeks after chemotherapy in above patients. Changes in the electrodiagnostic parameters before and after administration of vincristine and its relation with the dosage were determined. Twenty five children had ALL, M/F 16/9 and 6.08±3.85 years and 17 children had other malignancies including: lymphoma, neuroblastoma, rhabdomyosarcoma, retinoblastoma and Willm's tumor, M/F 7/10 and 6.54±4.45 years. In the ALL group, there was no significant change of motor and sensory NCV and amplitude of SNAP after 5 weeks however, the amplitude of CMAP was significantly decreased in both upper and lower extremities and F-wave latency was increased in both lower and upper extremities after chemotherapy. Post chemotherapy decreased CMAP amplitude was detected in 96% of ALL cases, majority of them it was moderate (70.8%). Sixteen (66.7%) patients suffered from gait abnormality. In the non-ALL group five (29.4%) cases were treated with regimen similar to that employed in the ALL group (group B) and 12 (70.6%) patients were treated with other regimens (group C). Neuropathy was detected in nine (52.9%) patients, five (100%) cases in group B and four (33.3%) cases in group C. In group B, mild, moderate and severe neuropathies were detected in 1 (20%), 3 (60%) and 1 (20%) cases, respectively. Patients in group C were affected with mild neuropathy. There was a direct relation between the degree of CMAP amplitude decretion with higher dosage of vincristine (P=0.007). This study showed that the electrophysiologic changes of vincristine chemotherapy are common in children and usually detected in the form of a motor-axonal neuropathy. Gait abnormality is also a common manifestation.

The multi-drug transporter NorA contributes to Staphylococcus aureus resistance to flouroquinolon antibiotics by promoting their active extrusion from the cell. Recent studies demonstrated that plant alkaloids such as noscapine can enhance the antimicrobial activity of some antimicrobial against resistant strains. The aim of the present study was to investigate the synergistic effect of ofloxacin, and noscapine on Staphylococcus aureus isolatated from patients. Method and Materials: Ninety five multi-drug resistant isolates of Staphylococcus aureus were obtained from the hospitalized patients and outpatients of three hospitals in Tehran, Iran. Of these 95 isolates, 49 isolates were highly resistant to several antibiotics including ofloxacin. Serial dilution method was performed to determine minimum inhibitory concentration (MIC) of ofloxacin alone, noscapine alone and combination of the two agents.

The results showed that MICs of ofloxacin were 16 µg/ml on 20 isolates, 32 µg/ml on 21 isolates and 64 µg/ml on 8 isolates. MIC of noscapine was between 0.5 µM/ml and 1.0 µM/ml. Combination of ofloxacin and noscapin leads to 2-4 times increase in MIC of ofloxacin.

Noscapine diminished the antimicrobial activity of ofloxacin on Staphylococcus aurous.

Cholestatic jaundice in early infancy is an important clinical condition. Idiopathic neonatal hepatitis and extra-hepatic biliary atresia (EHBA) is two main of different etiology, and it's necessary to distinguish between these two entities. It is important that EHBA be rapidly diagnosed, because an immediate surgery may prevent further potentially fatal consequences. A rapid, ubiquitous, non-invasive and accurate technique with the least complications is crucial for early diagnosis of EHBA. The hepatobiliary scan identifies diseased gallbladders and bile drainage problems, and ultrasonography is an easy and cheap method of survey of biliary tract. In this study, we evaluated and compared two different diagnostic method, ultrasonography and HIDA scan for this purpose. Method & Materials: In these two years prospective study ultrasonography, HIDA scan and liver biopsy was performed in a group of patients with cholestasis. We considered the result of liver biopsy as the gold standard. Accordingly sensitivity, specificity, positive and negative predictive values and accuracy of ultrasonography and HIDA scan were calculated and compared together. Sixty infants, 35 males and 25 females mean age (56.1±17.8 days) were studied According to the results of liver biopsy, there were 16 (26.7%) cases of EHBA, and 24 (40%) cases of idiopathic hepatitis. Ultrasonography detected EHBA in 15 cases and HIDA scan diagnosed it in 38 patients. Sensitivity, specificity, positive predictive values, negative predictive value and accuracy of ultrasonography were 87.5%, 97.7%, 93.3%, 95.7%, and HIDA scan, these value were 100%, 50%, 42.1%, 100% respectively. This study showed a lower sensitivity but higher specificity of ultrasonography for diagnosis of EHBA in compared with HIDA scan

The nasal polyp is the most common benign tumor of the nose, which due to nasal obstruction and others problem for patients. Most study for treatment of nasal polyps are alone surgery with functional endoscopic sinus surgery (fess) or medical treatment. Study for comparison between surgical and medical treatment are little. The aim of this study we evaluated the results of medical and surgical treatment in a group of patients with nasal polyp. In this prospective study which performed between 2004-2006 those patients referred to ENT department of Tabriz Imam Hospital were allocated. The patients were treated either surgericaly or medically results of treatment were compared between two groups. From a total number of 200 patients (127 male and 73 female) 100 patients (M/F 59/41 age 40/69) were treated medically. Patients in both groups were followed for up to six months. For the following findings nasal obstruction nasal mass, nasal discharge, post nasal discharge, facial pain, smell dysfunction, sneezing, dyspnea, nocturnal snoring, sinus sensitivity, facial pressure and radiololgic finding (sinusitis). Frequency of nasal obstruction and nasal mass surgericaly treated patients of second group was significantly high than medically treated first groups after 6 month. But frequency of sneezing in second group was higher than first group. Symptom Improvement in surgericaly treated nasal polyps was better than medically treated patients.

Although coronary arteriovenous fistula (CAVF) is uncommon but it accounts half of congenital anomalies of the coronary arteries. The aim of this study is to evaluate clinical findings, origin and result of surgery in a group of patients with CAVF. In this multicenter study patients with the diagnosis of CAVF who admitted in Tehran Shahid Rajaee hospital and Tabriz Shahid Madani hospital were selected. In all patients, demographic data, clinical, and imaging findings and also results of surgery were collected. Between 1988-2006, 18 (11 were male and 7 female, 3-58 years) CAVF patients were admitted. 13 patients were less than 20 years old and 5 over 20. In 12 patients (66.5%) CAVF originate from the right coronary artery and in six patients (33.5%) from the left. Most common site of termination of CAVF was right ventricle (50%). There was not any CAVF to left side of the heart. Surgical closures of CAVF were performed in 16 patients, in 14 of them fistula were closed by cardiopulmonary bypass (CPB). Careful investigation is recommended for diagnosis of CAVF. It should be considered in the differential diagnosis of potent ductus arteriosus. Operation is indicated for CAVF patient with significant shunt.

Esophageal, gastric and colorectal cancers are the most common recorded cancers in the East Azerbaijan province. Because of the high incidence of gastrointestinal malignancies in this province and with considering the variety of cultural and geographic situations, we decided to calculate and compare the age-adjusted standardized rates of these cancers in different cities of the province. Methods and Materials: From March 2006 to 2007 in a cross-sectional study, all new cases of gastrointestinal malignancies diagnosed in different teaching hospital of Tabriz University of Medical Sciences, all those receiving chemotherapy, radiotherapy or registered in different endoscopic center, pathology laboratory as gastrointestinal malignancy were collected and recorded in above period. We also entered those patients who died and those who started to receive opiate analgesic in offer mentioned period. In this year a total number of 1346 patients, 398 patients had esophageal cancer (male220/398, 55.3% and female 178/398, 44.7%), 612 patients had gastric cancer (male 436/612, 71.2% and female 186/612, 28.8%) and 337 patients had colorectal cancer (male187/337, 55.4% and female 150/337, 44.6%). In those with gastric cancer, male to female ratio was 2.49 and the mean age of the males was significantly higher than females (P<0.0001). Gastric cancer with the age-adjusted standardized rates of 25.99 per 100000 of males and esophageal cancer with 11.65 per 100000 of females were the most common gastrointestinal malignancies. We found that, Ahar had the highest incidence rate of esophageal and gastric cancer. While, Tabriz and Sarab had the higher incidence rate of colorectal cancer. Because of high incidence of gastrointestinal malignancies among Azerbayjanian people, there is a continues need for future studies in term of genetic susceptibility, geographical condition, cultural factors and nutritional habits.

There is a relationship between personality and reckless sexual behaviors. This research's objective is to investigate the relation between personality traits related to behavioral inhibition/activation brain systems with using or dont using the condom in illegitimate sexual contacts and compare with normal people. Method and Materials: In this prospective four months period all people who had referred to Tabriz Red Crescent Community Aids Consultation Center were allocated and arranged in two groups: Those with high risk sexual contacts and those with low risk sexual contacts. Control group was allocated from the same community. In each groups data were collected by questionnaires that was focused on five main areas. Demographic information, behavioral inhibition/activation systems scale, Essence personality questionnaire, positive and negative affects scale, anxiety trait questionnaire. Our data was analyzed by MANOVA test. Results of this study revealed that those with high risk sexual relationships, significantly had a stronger behavioral activation system in compared with low risk group (P=. /035), they also had higher neurosis than control group (P=. /005), higher extroversion than low risk group (P=. /015), more positive affect than control group (P=./033) and low risk group (P=./002), higher negative affect than control group (P=./006), those with low risk sexual relationships significantly suffered higher neurosis than control group (P=./035), lower extroversion than control group (P=./008), higher negative affect than control group (P=./048), higher anxiety trait than control group (P=./003). 25percent of those with high risk, and 9percent of those with low risk sexual relationships behavior had been neurotic pills purring. In people with illegitimate sexual relationships, behavioral activation brain System is linked with lack of condom usage behavior. And personality traits related to behavioral inhibition brain system are linked with consistent condom usage behavior. Illegitimate sexual relationship is associated with by personality disorder.

Ocular hypertension (OHT) is the most common cause of primary open- angle glaucoma (POAG). High serum lipoproteins level may be a potential risk factor for progressing of OHT to glaucoma. The aim of this study was to compare serum lipoproteins level in patients with POAG. In this case-control study intraocular pressure was measured with Goldman contact tonometer in 50 patients with POAG and 50 patients with OHT. Retinal examination and primary were performed in all individuals. In both groups with intraocular pressure greater than 21 mmHg with normal optic nerve and primary findings were considered as OHT and those with at least 2 abnormal findings from the 3 criteria considered as POAG. We allocated only those patients who were open angle in gonioscopy. In each group total cholesterol, LDL, HDL and triglycerides were measured. Mean Serum triglyceride level POAG patients was 215.32 ± 44.28 mg/Dl and in OHT patients195.02 ± 42.63 mg/dL. The difference between these two groups was statistically significant (P=0.022). Mean Serum Cholesterol average was 245.88 ± 34.40 mg/dL in POAG and 231.42 ± 41.98 mg/dL in OHT patients. Serum Lipoproteins levels in POAG patients were more than OHT patients. Particularly hypercholesterolemia and hypertriglyceridemia may accelerate the progression of OHT to POAG.

Few data are available about dietary patterns of adolescents and to our knowledge no information are available in this regard in Iran. The present study aimed to identify major dietary patterns among adolescent girls in Tabriz. In this cross-sectional study, usual dietary intakes of students of Talaat intelligent guidance school of Tabriz from a total number of 257 female students aged 11-15y were assessed using a 162-item semi-quantitative food frequency questionnaire (FFQ). Students of this school were from all districts and had been elected by an entrance exam. Foods from FFQ were classified into 40 food groups and entered a factor analysis by SPSS. We identified there were 6 major dietary patterns by factor analysis: (1) Western pattern (pizza, organ meats, fruit juice, sweats and desserts and etc) (2) Sweat junk foods pattern (dried fruits, jams and honey, sugars, tea, sweats and desserts, fruit juice and etc) (3) Asian pattern (legumes, potato, other vegetables, dough, high-fat dairy products, margarine, refined grains and etc) (4) Salty junk foods pattern (carrot, puffs, Potato chips, popcorn, crackers, pickles and etc) (5) low protein- soft drinks-oil pattern (cruciferous vegetables, green leafy vegetables, soft drinks, tomatoes, other vegetables, vegetable oils, mayonnaise and etc) (6) Iranian traditional dietary pattern (Hydrogenated fats, garlic, broth, tea, poultry and red meats). Overall, these dietary patterns explained 39.4% of total variance. Our findings suggest 6 major dietary patterns among adolescent girls in Tabriz. The associations of these dietary patterns with health conditions remain to be identified in further studies.

Most of the last research indicated that there was not significant difference between cognitive-behavior therapy (CBT) and Exposure and response prevention (ERP) methods to reduce the symptom of Obsessive-Compulsive disorder (OCD). In this study we compared the efficacy of above methods in a group of patients with obsessive-compulsive disorder. In this prospective study a group of patients with obsessive-compulsive disorder were randomly assigned in 3 groups: Cognitive-behavior therapy, exposure and response prevention and controls. Patients in 3 groups were matched with respect to the variables such as age, sex, academic and marital status. In this study we used the following tests. Moudsley Obsessive-Compulsive Inventory (MOCI), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI). All patients in each group completed three questionnaires in 3 and (pre test, post test, and after 2 months. The data were analyzed by multivariate analyses of variance-one way (MANOVA-1 way), and post hoc test (T tukey). Finding indicated the treatment effect of cognitive-behavior therapy and exposure and response prevention on obsessive-compulsive disorder were more significant than waiting-list in short-term and long-term (P<0/01). The Inter group difference between cognitive-behavior therapy and exposure and response prevention was not significant. There was not significant difference between ERP and CBT in symptom reduction of OCD.

Renal transplantation is the treatment of choice for chronic renal failure. Using an appropriate and fine ureterovesical anatomizes technique can prevent most complications regarding this aspect of transplantation. Extravesical ureteroneocystostomy is becoming more popular in renal transplantation because of ITS few complications and technical ease. This low complication rate is due to limited bladder dissection and shorter urethral segment required from the donor. In this study, we evaluated a comparison between Barry and Barry-Tagochi ureteroneocystostomy techniques in a group of renal transplant recipients. Method and Materials: From September 2004 to March 2007, we recorded all urological complications after renal transplantation in a sort of renal transplant recipient. They were operated by Barry-Tagochi or Barry ureteroneocystostomy techniques. We followed them up to 12 mouths. For the following complications including: urinary fistula, urethral stenosis and vesicoureteral reflux and complicated hemturia. From a total number of 198 patients 100 Barry-Tagochi and 98 Barry anatomizes were performed. The incidence of urological complications in Barry-Tagochi and Barry reimplantetion techniques were 4(4%) and 5(5.1%) respectively. The difference was not statistically significant (P=0.71). Urinary leakage occurs in one person in each group (%).and urethral obstruction occurred in 3 patients in each group (%).No complicated hematuria or symptomatic VUR happened in patients in each groups. The mean urethral anatomists time was recorded about 8.26±2.28 minutes (range 4-16 minutes) for Barry- Tagochi and 9.9± 3.34 minutes (range 5-20 minutes) for Barry procedure, with a significant difference (P=0.0001). After VCUG mild to moderate reflux was noted in 2(4%) of 50 transplant patients in Barry- Tagochi group. No treatment was required for a total number of 50 these patients. Our study proved that Barry –Tagochi extravehicular ureteroneocystostomy could be a rapid and simple method, without significant incidence of urological complication. This technique has become the choices of urethra vesicle anatomists during renal transplantation in our centre.

Lumbar spinal stenosis syndrome results from narrowing of the spinal canal, nerve root canal or the intervertebral foramen and leading to compression of the spinal cord or nerve roots correspondingly. Spinal stenosis syndrome affects mainly patients at their 5th-6th decades of life. In older patients condition may increase the operative risk or could be a predictor of worse outcome. This prospective study was done in a group of 50 consecutive patients, older than 60 with lumbar spinal stenosis. We measured with Japanese orthopaedic association score (JOA) completed pre-operatively and at least 6 month postoperatively. We used the JOA for outcome measurement. The study group includes 25 males and 25 females, the mean age of patients were 67.28 and 66.84 respectively. Overall 86% of the patients had excellent or good results. The most affected levels were L4 and L5. No mortality was noted in this series. Major complication was dural tear in one patient. Decompresive laminectomy is palliative in selected elderly patients with spinal canal stenosis with symptom who didn’t respond to conservative treatment. As a result surgery should be considered as a treatment option in these patients.

Widespread use of fluoroquinolones has resulted in an increasing incidence of resistance to these agents. Therefore antibiotic resistance surveillance has a great importance. This study was carried out to evaluate the antibiotic resistant pattern of Escherichia coli isolates against fluoroquinolones from ICU and out- patient clinic admitted patients with urinary tract infection in Imam Hospital of Tabriz. Urine samples were taken and E. coli were isolated by conventional laboratory methods. The isolated strains were testes by Disk Agar Diffusion (DAD) method and broth macro-dilution method (MIC) according to the CLSI guidelines. A total of hundred E. coli were isolated from urine samples. According to the results of DAD method 57 (57%) were resistant to nalidixic acid, 34 (34%) to norfoloxacin, 33 (33%) to ciprofloxacin and 30 (30%) to ofloxacin. Also 2 (2%) of isolates revealed intermediate resistance to ofloxacin. By broth macro-dilution 41% were resistant to ciprofloxacin (MIC ≥ 4µg/ml), while 6 isolates had intermediate resistance pattern (MIC=2 µg/ml) and 53 isolates were sensitive (MIC≤ 1 µg/ml) to ciprofloxacin. Our results revealed a high level of resistance against fluoroquinolones. It would be because of unjustified antibiotic usage. To overcome this problem inadvertent prescription should be limited and antibiotics should be administered based of microorganism sensitivity patterns.

According to WHO recommendation on importance of breastfeeding on infants` health and growth and also with regards to the effect of maternal nutritional status on quality and quantity of milk production, this study was carried out to investigate the nutritional pattern of lactating mothers and its effect on infant's growth status.

Mother's and infant's general characteristics and anthropometric measurements were collected from 182 urban and rural lactating mothers who were exclusively breast feeding their infants aged 90-120 days. Information on mother's dietary intake was collected using 24-hour recall method and the results compared with RDA. Multiple Regression model was performed to analyze the association between dietary intake of mothers and anthropometric measurements of infants.

The mean daily energy intake of mothers (2390±405 kcal/d) was significantly lower than RDA (2733 kcal), but it was close to calculated energy values (2458±258kcal). The mean energy intake of urban mothers was significantly lower than mothers in rural areas (P<0.05). The mean intake of bread, vegetables and cheese was higher in rural mothers, while the mean intake of rice, milk, yogurt and meat was significantly higher in urban mothers (P<0.05). The mean weight of infants was significantly correlated with BMI of nursing mothers (P<0.05, = ß 0.49). In group of mothers who were consuming more than 2500 Kcal, the mean weight of infants was significantly higher than the other group (P<0.03).

The observed positive effects of maternal dietary intake on infants` growth rate indicate the need for implementing proper nutritional educational programs in order to improve dietary intake of lactating mothers.

Depersonalization is a prevalent symptom in mental disorder, brain-organic disease and substance and drug abuse. It is defined as a recurrent change in self perception. The aim of this study is to explore depersonalization in patients with temporal lobe epilepsy, panic disorder and non-patient control group. Methods and Materials: Here we studied the depersonalization level by Cambridge personalization scale in a group of patients with temporal lobe epilepsy and panic disorders. The same study was done in a normal control group. Patients with temporal lobe epilepsy had a high score of depersonalization level (%35/87), followed by panic disorder patients (%31/53) and normal controls (%32/61). Depersonalization is a common phenomenon in temporal lobe epilepsy and panic disorder.

Hemangioma is a benign vascular tumor, most common located in head and neck that occurs on the palate. Hemangiomas have been subdivided into two microscopic types: Capillary and cavernous that cavernous hemangioma is less common. We report here a 53 years-old female with palatal pain, ulcer and bilateral cleft palate. The Histologic diagnosis of ulcer biopsy revealed cavernous hemangioma.

Approximately 3% of all head and neck neoplasms occur in parotid gland and less than 1% of these are oncocytic neoplasms. They are usually benign tumors and most commonly arise from the parotid gland. The world Health Organization histologic classification of salivary gland tumors divides parotid oncocytic neoplasms into three categories: Oncocytosis, oncocytoma, and oncocytic carcinoma. We report a case of oncocytoma in the parotid gland.

Multiple Sclerosis is a disease of central nervous system, whereas Guillain Barre Syndrome is a state of peripheral nervous system involvement. Co- incidence of these two autoimmune illnesses in the same patients is very rare and up to now, only one case has been reported in literature. Here we report a case of Multiple Sclerosis who later developed Guillain Barre Syndrome. A 31-year old female, who was a known case of Multiple Sclerosis for several months and had been treated with interferon Beta 1a. She developed progressive limb weakness, starting from Lower Limbs and progressing to arms and face. Guillain Barre Syndrome (acute motor axonal neuropathy type was diagnosed based on her physical and electro diagnostic examinations. She treated with intravenous immunoglobin and discharged with partial recovery.