مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و دوم شماره 6 (پیاپی 90، بهمن و اسفند 1389)

Impacted third molar surgeries are common in dental settings. Post-operation complications including pain and dry socket are also common. Reducing these complications is one of the necessities in oral surgeries. Although a few studies have found prophylactic metronidazole as an effective means of preventing dry socket, in most of these studies interventional factors have not been controlled properly. Therefore, the present study was aimed at evaluating the effect of metronidazole on prevention of pain and dry socket after controlling the interventional factors. A clinical trial was conducted in double-blinded manner on 42 patients with two mandibular impacted third molars. In each subject, both third molar teeth in mandible were selected, one as control. In case group, metronidazole gel (25%) was placed in the socket after tooth extraction. All operations were carried out by one oral surgeon under same circumstances. Demographic data, and pain and dry socket were evaluated by clinical examination and completing questionnaires 4 days after surgery. The interval between two surgeries was at least one month. The data were statistically analyzed by SPSS and Fisher’s exact test. Four days following surgery, 3 subjects in the case group (3.6%) and 5 subjects in the control group (6%) experienced dry socket. There was no statistically significant difference between the cases and controls (P=0.72). Metronidazole gel (25%) placement in the socket is not efficient in reducing complications after surgical removal of third molars.

Diabetes mellitus is the most common disease of endocrine system. Due to diabetes long-term complications many patients undergo operations. Hemodynamic instability during induction of anesthesia due to diabetic autonomic neuropathy is common. The present study aimed at assessing hemodynamic responses to tracheal intubation in diabetic patients. In a descriptive-cross sectional and double blind study, 30 diabetic and 30 non-diabetic patients referred for ophthalmic surgeries were studied in two groups regarding heart rate, systolic, diastolic and mean arterial blood pressures before anesthesia, during laryngoscopy, during intubation, and at 1st, 3rd and 5th minutes after intubation. Age, gender, drug effects, complications, duration of the disease, autonomic neuropathy and hypertension were also noted. Five patients (16.66%) had diabetic autonomic neuropathy. Regarding the hemodynamic responses, there were no significant differences between diabetic and non-diabetic patients; however they significantly differed within each group. The presence of diabetic autonomic neuropathy seems not to give rise to greater changes and hemodynamic instability. Hemodynamic stability is observed during anesthesia induction and intubation in these patients.

Diabetic retinopathy is one of the common complications of diabetes which can cause irreversible visual loss. The present study aimed at evaluating the effect of lovastatin on visual acuity and central macular thickness in patients with refractory diabetic macular edema. In a before - after study, 40 patients with refractory diabetic macular edema were allocated. Lovastatin (20 mg/day) was prescribed for 3 months and the effect of this drug was evaluated on visual acuity (by log MAR) and central macular thickness (using Optical Coherence Tomography). The mean visual acuity at the first visit (0.42±0.2 and 0.46±0.3 in right and left eyes, respectively) did not differ from that after 3 months. Moreover, central macular thickness at the first visit (275±34 µm and 286±54 µm in right and left eyes, respectively) was not significantly different from that after 3 months (278±34 µm and 287±76 µm in right and left eyes, respectively). These findings indicate that 3 month intake of lovastatin (20 mg/day) did not have effect on central macular thickness and visual acuity in patients with diabetic macular edema.

Psychological empowerment is defined based on perceptions of manpower toward its role in the organization and includes competence, efficiency, job significance and trust. This study aimed at estimating the extent of the managers’ psychological empowerment according to three aforementioned effective factors in Tabriz University of Medical Sciences. In a descriptive and correlative study, 55 middle medical managers from Tabriz University of Medical Sciences in 2007-2008 were recruited. The Psychological empowerment questionnaire and the empowerment procedures questionnaire were used. The mean organizational status, managerial strategies, and self efficiency sources were 58.75, 65.94 and 65.52, respectively (within acceptable range). The mean psychological empowerment, significance perception, competence, and the feeling of efficiency were 77.29, 86.76, 75.15 and 76.16, respectively (strong); however the sense of trust was relatively strong (71.11). The three aforementioned organizational conditions had a significance and positive correlation with psychological empowerment (P=0.001). Furthermore, the correlation of self efficiency factor with psychological empowerment was more than that of the other factors. The managerial strategies had a significant and positive correlation with self efficiency and organizational conditions. The self efficiency had significant and positive correlation with organizational conditions. Organizational status, managerial strategies, and self efficiency sources had significant and positive correlation with psychological empowerment.

Giant cell lesions account for approximately 7% of all benign tumors of the jaws. The demographic characteristics of giant cell lesions vary in different populations. The aim of this study was to analyze epidemiology of giant cell lesions in Rasht between 1379 and 1387. This descriptive-cross sectional and retrospective study was based on data in pathology archives. Medical files of patients with diagnosis of giant cell lesion from Razi, Afrah and Poursina laboratories (referral laboratories for oral and maxillofacial specimens) were assessed. Data of age, gender and site of lesion were recorded. Twenty five cases of central giant cell granuloma (CGCG) and 74 cases of peripheral giant cell granuloma (PGCG) were found. The mean age of the patients was 25  15.5 and 45.27 17.4 years in CGCG and PGCG, respectively. Fifty six percent of CGCG cases and 56.3% of PGCG cases were females. Giant cell lesions comprised 4.2% of the oral lesions. Peripheral lesions found in older adults and females indicate the necessity of more evaluation about etiologic factors related to the females and older adults.

Standing balance deficits are common in hemiplegic patients after stroke. One method to treat these deficits is to provide the patient with visual feedback while balance activities are performed. The purpose of this research was to investigate the effects of using visual biofeedback with conventional physical therapy on static postural stability following stroke.

This randomized clinical trial included 32 patients (11 females and 21 males) with hemiplegia secondary to stroke. These patients were randomly assigned in two groups; control and experimental groups. These groups were matched for age, weight and height. Patients were tested using Equitest (amplitude of postural sway) and two digital weight scales (symmetry) before, 6 sessions and 12 sessions after physical therapy intervention. The trained group received visual biofeedback from Biodex Balance System combined with conventional physical therapy whereas the control group performed conventional physical therapy without biofeedback.

Significant improvements in static stroke balance measurements were found in trained group. In trained group, symmetry of weight bearing was increased (P = 0.008) and postural sway was decreased (P = 0.03).

This study revealed that visual biofeedback training with conventional physical therapy improved proprioception and decreased hemineglect effects in stroke patients. Improved proprioception resulted in symmetry and decreased sway, subsequently increased static balance in stroke patients.

Presence of mass and pain in breast could be a serious source of stress and anxiety, primarily due to the assumption of a malignant underlying pathology. The aim of this study was to evaluate the histological diagnosis in one hundred painful breast masses. In a cross-sectional setting, 100 patients with painful breast lumps, 98 females and 2 males with mean age of 37.86±8.79 (18-66) years, were enrolled. They were referred to Tabriz Imam Hospital and private pathology laboratories during a 12-month period. The effect of age on final diagnosis was also assessed. Among one hundred patients, pain was constant in 59 cases, fluctuating in 41 and severe in 4 cases. The right, left and bilateral involvement was seen in 53, 40 and 7 cases, respectively. Eighty four patients had benign histological findings, whereas 16 cases had malignant pathology. The benign pathologies consisted of fibrocystic disease (50 cases), fibroadenoma (30 cases), abscess (2 cases) and gynecomastia (2 males). All malignancies were ductal carcinoma type. The sensitivity and specificity of a painful lump in prediction of a malignant disease were respectively 31% and 69% in patients older than 40 years. This study showed that the age of patients is a key determinant of the pathological process underlying a painful breast lump. Majority of the patients with a painful breast mass would ultimately have a benign diagnosis, especially in younger ages; however they should be thoroughly evaluated.

Schizotypal personality may be seen as both a dimension of normal individual differences and an indicator of the predisposition to schizophrenia and schizotypal-spectrum disorders. Different scales have been ever developed for determining and measuring different aspects of schizotypy; however, little has been done on the translated versions of these models. Among these, Schizotypic Syndrome Questionnaire (SSQ) has been translated to Farsi. The aim of the present study was to evaluate the psychometric properties (reliability, validity and factor structure) of the SSQ. In an analytic-descriptive study, 200 students of Tabriz University of Medical Sciences were recruited during a 12-month period. Translated SSQ (in Farsi) was used in these volunteers. Furthermore, 4-Dimensional Personality Test questionnaire (4DPT) and Dissociative Experiences Scale-II questionnaire (DES-II) were applied. Reliability, validity and factor structure of Farsi version of the SSQ were determined. Two hundred students, 58 males and 142 females with a mean age of 21.54±2.71 (17-33) years were enrolled. All the scales of the SSQ and its total score had Cronbach's alpha > 0.5 and hence, the Farsi version of this questionnaire was valid. Most scales and the total score of the SSQ were also reliable. There was no significant difference between the two genders. Routine 3 and 12-factor structures were not reproducible for the translated version. There were significant positive correlations between the different scales of the SSQ. Assumed model of causative relations between the 12 scales was similar to the original report according to LISREL test. Based on our results, the Farsi version of the SSQ is reliable and valid and may be applied in Iranian population. Further studies with larger sample size are recommended to be carried out for factor analysis.

Upper motor lesions may produce muscle spasticity which increases the resistance against normal movements. This study aimed at evaluating the therapeutic efficacy of electrical stimulation (ES) on upper limb spasticity following stroke.

In a randomized clinical trial, 75 patients with post-stroke upper limb spasticity were studied during a 19-month period in Tabriz Imam Khomeini Hospital. These patients were randomized in three 25-patient groups; group E received motor level ES on extensor muscles of affected forearm; group F received sensory level ES on flexor muscles of the affected forearm; and group C or control who received sham ES on the affected forearm. ES was applied for 15 days, 0.5 h daily in the interventional groups. Stretching was also employed for all the patients. The grip index, hand index, passive and active range of motion (ROM) and Ashworth scale was determined and compared between the three groups at baseline, after halting the interventions and 6 weeks afterwards.

Spasticity improvement was significantly more prominent in group F compared to the control group 6 weeks post-intervention. Improvement of upper limb function was better in groups E and F compared to the control group. The gripping force was significantly increased after intervention and 6 weeks afterward in group E and to lesser degree in group F. The active ROM was significantly enhanced in some directions (flexion and extension) 6 weeks after cessation of intervention in group E compared to the control group.

ES on flexor and extensor levels in the upper limb along with stretching techniques may improve the spasticity and hand function after stroke.

Increasing Helicobacter pylori resistance to common antibiotics has created various treatment methods in different geographical areas. This study aimed at determining in vitro susceptibility of H. pylori to clarithromycin, metronidazole, amoxicillin and tetracycline, the four antibiotics commonly used in eradication therapies. Patients with chronic dyspepsia referred to our clinic for upper endoscopy were included. Patients with history of antibiotic or proton pump inhibitor consumption in recent two weeks prior to the endoscopy, and those with malignancy were excluded. Endoscopy samples were prepared for histology, rapid urease test, culture and antibiogram. Antibiotic resistance was evaluated with two methods; agar dilution and disc diffusion tests. Among 185 patients, 124 cases (67%) were histologically positive. Sensitivity and specificity of culture, compared to the histology, was 66.1% and 100%, respectively. Reported resistance was 17.1 % for clarithromycin, 64.6% for metronidazole and 9.8% for amoxicillin. No resistance was observed for tetracycline. Resistance to metronidazole was more common in patients younger than 50 years (P=0.01). Sixty four percent of the specimens with resistance to clarithromycin showed co-resistance to metronidazole. According to high resistance to metroniazole in our study, especially in young patients, this drug is not recommended for H. pylori as the first line treatment in Iran. We suggest that in patients who failed to respond to clarithromycin, culturing and determining microbial susceptibility to other antibiotics be performed.

Parotid surgery accompany with complications including facial nerve paresis, cosmetic deformities, gustatory sweating syndrome, salivary fistula, wound hematoma and infection. The aim of this study was to review an individual surgeon’s experience of parotidectomy and to evaluate its complications.

In a retrospective and descriptive analytical study, fifty patients with parotid tumor over six year (2000-2006) period were operated and evaluated considering early and late complications.

Fifty patients were recruited in this study; 24 (48%) males and 26 (52%) females. Thirteen patients underwent total parotidectomy (7 patients with benign tumor and 6 patients with malignant tumor). The remaining was under superficial parotidectomy. Post-operative complications included transient facial paresis (8%), gustatory sweating syndrome (12%), salivary fistulae and sialoceles (4%), hematoma (2%) and flap necrosis (2%). Wound infection and permanent facial nerve weakness were not observed in the present study. All the cases of gustatory sweating syndrome (Frey’s syndrome) were in benign disease group.

Despite lack of nerve stimulator during the surgery, the frequency of facial nerve weakness was low, compared to the previous studies. Therefore surgical technique plays major role in controlling the parotidectomy complications including facial nerve paresis.

Determination of maximum injected contrast agent leading to maximum signal intensity (SI) is of great importance in magnetic resonance imaging (MRI). Different parameters including strength of the magnetic filed in MRI, used sequences, and imaging factors play role in an increase in SI. The aims of this study were to investigate the maximum relationship between concentration of contrast agent and SI on T1-weighted image in 0.3 T and 1.5 T MRI scanners by use of sine echo sequence. A water-filled phantom containing vials of different concentrations of Gd-DTPA (0 to 19.77mmol/L) was used. Mean SI was obtained in region of interest using T1-weighted images. Clinical standard head coil was used in this study. Coil non-uniformity was corrected on SI. Maximum SI can be seen at concentration of 5.95 and 4.96 mmol/L for 0.3 T and 1.5 T, respectively. In addition, the maximum linear relationship between contrast agent concentration and SI were 2.02 and 2.70 mmol/L for 0.3 T and 1.5 T, respectively. Maximum SI can be seen at concentration of 5.95 and 4.96 mmol/L for 0.3 T and 1.5 T, respectively. In addition, the maximum linear relationship between contrast agent concentration and SI were 2.02 and 2.70 mmol/L for 0.3 T and 1.5 T, respectively. This study showed that magnetic field strength might have effect on the relationship between maximum contrast agent concentration and SI.

Illicit drug abuse is a major problem all over the world. The United Nations estimates that 5% of the world population (aged 15-64 years) use illicit drugs at least once a year (annual prevalence). Many adverse effects of the illicit drugs arise on skin and therefore dermatologists and general practitioners should be aware of these changes. This study aimed at evaluating the skin lesions in substance-dependent patients. In a descriptive setting, 66 substance-dependent patients were evaluated during a 16-month period in Tabriz Sina and Razi Hospitals and Sheikholraeis Clinic. Diagnosis of drug abuse was based on DSM-IV criteria. Thorough history taking about the type of illicit drug and the major route of use, as well as a complete physical examination emphasizing the skin lesions were done by a dermatologist. Accordingly, frequency of skin lesions was determined. Sixty six male drug abusers with a mean age of 32.8±8.1 (18-55) years were recruited. The mean duration of drug abuse was 56.3±41.4 (3-204) months. Inhalation (87.9%), oral consumption (13.6%) and intravenous injections (4.5%) were the main routes of drug abuse, respectively. Opiate (63.3%), crystal (24.2%), hashish (21.2%), heroin (19.7%) and crack (12.1%) were the main substances used in the studied population, respectively. The main skin lesions were acne (21.2%), cicatricial lesions (21.2%), atrophic glossitis (18.2%), nicotinic stomatitis (13.6%), burn (9.1%), mycotic glossitis (9.1%), crusted skin lesions (7.6%) and pruritus (7.6%). According to our results, many skin lesions are not characteristic for non intravenous drug abusers. Further studies with larger sample size and in different drugs are recommended.

Surgical wound infection is one of the important complications of cardiac surgery. Several risk factors including obesity and diabetes are associated with wound infection. The aim of the present study was to evaluate the wound infections after cardiac surgery, related risk factors and pattern of antibiotic resistance of the bacteria. Patients were divided into two groups; wound infection (case) group and without infection (control) group. Swabs from wound secretion and tissues of sternum were prepared for culture by standard methods. After obtaining colonies and Gram staining, using biochemical test and several differential tests, bacteria were identified. Sensitivity to antibiotics was examined by disk diffusion method (modified Kriby-Bauer). In this period, 2127 patients underwent cardiac surgery in Shahid Madani hospital. The incidence rate of wound infection was 1.17%. In the study period, 11 patients (44%) of case group died of mediastinitis. The only independent predicting factors for wound infection were long-time intubation and use of vasoconstrictors. Complications seen in the case group were mediastinitis (56%), wound infection (40%) and foot infection (4%). Organisms isolated from infection sites were mainly Staphylococcus aureus, Entrobacter spp., Pseudomonas aeroginosa and Staphylococcus epidermidis. Antibiogram results showed that bacteria had the most sensitivity to ciprofloxacin, cefotaxime, amicacine and cefteriaxone. In this study, long-time intubation and use of vasoconstrictors were predictors of wound infection in all cardiac surgery patients. The incidence of wound infection might be reduced by improving intubation time or quality of intubation period and use of vasoconstrictors as needed.

Goldenhar syndrome or oculoauriculovertebral dysplasia is a non-accidental association of hemifacial microsomia, auricular anomalies, epibulbar dermoid and vertebral malformations. Etiology of this syndrome is unknown. Although some malformations are more frequent in infants of diabetic mothers, developmental defects of first and second bronchial arch are not frequent findings in these patients. Here, we report an infant of diabetic mother with manifestations of Goldenhar syndrome.