Medical Journal Of the Islamic Republic of Iran
Volume:27 Issue: 4, Winter 2013

The transfer of the tibialis posterior tendon to the dorsum of foot can restore the function of the paralyzed dorsiflexor muscles of the foot and ankle. In order to reduce the wound complication in the insertion site of tendon to bone by a plantar knop we used a new method of fixation by an absorbable screw inserted dorsally. we performed this operation on 15 patients in a 3 years period. All patients had drop foot deformity due to irreversible lesions of the peroneal nerve. The inclusion criteria was the peroneal nerve palsy that was not improved after 18 months even by using nerve releasing or nerve repairing. All patients were evaluated after 6 months for ankle function and wound complications. Of 15 patients one was excluded from study. At 6 month ten patients got excellent score (66%) and 4 good score (26%) further ankle function. There was no wound complication at insertion site. This simple modification for insertion site fixation had good result in restoring ankle function whiles eliminated the possibility of plantar pressure sores caused by fixation knop.

Smoking within students community of the medical sciences can negatively impact the attitudes of the society in future. The objectives of this study were to assess the prevalence and trends of smoking among students of Tehran University of Medical Sciences. This study was conducted in four consecutive years from 2006 to 2009. The study sample was taken from the first- to fourth-year، undergraduate and graduate (doctorate) students of Tehran University of Medical Sciences. Census was applied for sampling. Structured questionnaires were distributed to students of each class. The study was anonymous and self-administered. From 2006 to 2009، a total of 1568 to 1761 students participated in the study each year. Over the study period، i. e. 2006-2009، the prevalence of cigarette smoking was decreased (the overall prevalence was 12. 5% in 2006، 12. 9% in 2007، 10. 8% in 2008، and 10. 5% in 2009). The corresponding values for the one month prevalence were 8. 2%، 7. 8%، 6. 1%، and 5. 8%، while those for the prevalence of daily smoking were 3. 4%، 4. 0%، 2. 9%، and 1. 8%، respectively. The decreasing trend was particularly more significant for female students. The findings suggest that the prevalence of smoking among students of Tehran University of Medical Sciences was in the lower end of the spectrum، in comparison to other universities in Iran and other countries. Additionally، similar to the pattern observed in the developed world، this trend was decreasing، particularly among girls. Implementing preventive measures for accelerating the decreasing trend، as well as continuous monitoring is recommended.

Every year more than 2 million people depart from Iran to Saudi Arabia for Hajj ritual which can be faced with some different diseases. There are not much information about frequencies and trend of diseases in Hajj. The main objective of this study was to determine the trend of prevalent diseases during five consecutive Hajj rituals among Iranian pilgrims. We established a specific surveillance system for all Iranian pilgrims who had participated in Hajj from 2004 to 2008. We monitored the pilgrims’ health status before departure، through their journey. The understudied diseases were 19 selected types of diseases in the Hajj. The occurrences of diseases were recorded on a researchers-made questionnaire. We used chi-square test for analysis with the alpha lower than 5% to reject the null hypothesis. During 5 consecutive periods، a total of 254،823 of Iranian pilgrims were monitored for more common diseases with this system. The most prevalent diseases were as follows: at least one type of respiratory involvement (71. 26%)، common cold like syndrome (47. 15%)، and musculoskeletal disorders (18. 67%)، The frequency of respiratory involvement was lower in 2006 than other years (p <0. 001). There were statistically significant differences between the numbers of hospitalization and patients who were referred back to Iran with the year of Hajj (p <0. 001). Health managers should be informed about trend and frequency of more prevalent diseases in Hajj. Easy access to health information via such surveillance system can be possible.

Proposing a strategy for sellar reconstruction in endoscopic transsphenoidal transsellar approach for pituitary adenoma. 240 patients with pituitary adenoma underwent pure endoscopic endonasal transsphenoidal surgery. Intra-operative CSF leaks were classified as grade 0، no observable leak; grade 1، CSF dripping through an arachnoid membrane defect of less than 1 mm; and grade 2، CSF flowing through an arachnoid defect of more than 1 mm. Sellar reconstruction was performed according to our staging system; in stage I، the defect was covered with oxidized cellulose and sphenoid sinus filled up with Gelfoam. In stage II، a layer of fat was applied on the defect and fascia lata placed epidurally. In stage III، one or two layers of fascia were used with adding surgical glue and/or lumbar drainage. Mucosa of sphenoid sinuses was kept intact as much as possible and approximated at the end of procedure. intra-operative CSF leaks grade 0، 1 and 2 resulted in 133 (55. 4%)، 78 (32. 5%) and 29 (12. 1%) patients، respectively. Stage I of reconstruction was used in 126 patients (52. 5%) with no intra-operative CSF leak or sever prolapse of arachnoid membrane. Stage II was performed in 80 patients (33. 3%) with either leak grade 1 (73 patients) or grade 0 with severe prolapse of the suprasellar components induced in the sella (2 cases) or in whom extra-pseudocapsular dissection performed (5 cases). Stage III was performed in 34 cases (14. 2%) with either CSF leak grade 2 (29 patients) or grade 1 with simultaneous severe destruction or removal of sellar floor laterally، superiorly or inferiorly (5 patients) which made it impossible to place the fascia underlay to the bone. A minimum of 18 months follow-up showed development of 2 CSF leaks (0. 8%)، one pneumocephalus (0. 4%) and 2 meningitis (0. 8%) cases. Given the low postoperative CSF leak rate، we demonstrated that our adopted sellar reconstruction strategy focusing mostly on the adopted intra-operative CSF leak grading system is safe and useful for overcoming devastating complications like postoperative CSF leaks.

According to previous studies، most of the speech recognition disorders in older adults are the results of deficits in audibility and auditory temporal resolution. In this paper، the effect of ageing on timecompressed speech and auditory temporal resolution by word recognition in continuous and interrupted noise was studied. A time-compressed speech test (TCST) was conducted on 30 young and 32 older adults with normal hearing thresholds. Lists of monosyllabic words were used at three time compression ratios. Auditory temporal resolution was determined by measuring the monosyllabic word recognition score (WRS)، in the presence of continuous and interrupted noise، at three signal-to-noise ratios (S/Ns). There was a significant difference in TCST scores at the three compression ratios within and between young and older adult groups (p< 0. 001). Similar results were obtained in WRSs at the three S/Ns in the presence of interrupted and continuous noise (p< 0. 001)، and in the degree of auditory temporal resolution (p=0. 007). A significant correlation was found between the level of test difficulty of TCST with WRSs in both young (r = 0. 549، P=0. 002) and older adults (r= 0. 531، P=0. 003). Our results showed that ageing remarkably affects the processing of fast speech stimuli and temporal resolving ability. These results are more supportive of the effect of ageing on speech perception than on loss of hearing.

Oxidative stress is detrimental to semen quality and has a significant role in the etiology of male subfertility. Dietary intake of antioxidants were compared between thirty two men with oligolastheno/ teratazoospermic (cases) and 32 normospermic volunteers (controls) attending fertility clinic in Mirza Koochak-khan Hospital in Tehran, Iran. All participants were nonsmokers and matched according their age and Body Mass Index (BMI). Nutrient consumption was calculated using a semi- quantitative food frequency questionnaire. Semen samples were collected and were assessed by measuring volume, concentration, motility and morphology. infertile subjects had a significantly lower intake of zinc and folate compare to control ones (p<0.001). Dietary intake of vitamin C and E was lower than recommended values in 59.4% of case group that was significantly different from control ones (p<0.05). In control group, 36.4 and 40.9% of participants had insufficient dietary intake of vitamin C and E, respectively. Significant correlations were found between folate (r=0.5, p<0.001), zinc (r=0.6, p<0.001) and percentage of motility and also between vitamin E and morphology (r=0.3, p=0.03), zinc and concentration (r=0.4, p=0.004) in all participants. In summary, a low intake of folate, zinc, and vitamin E were related to poor sperm concentration and motility.

Segmental vitiligo is a small subset albeit persistent form of focal vitiligo with dermatomal distribution and resistant to medical therapy. In recent years, surgical therapy as hair follicle autograft transplantation has been a hot topic in management of segmental vitiligo. In this study, we evaluated the efficacy of this method in segmental vitiligo lesions. The study recruited 10 patients who suffered from resistant segmental vitiligo to evaluate the effect of transplantation of pigmented hair follicles on re-pigmentation of the affected area. In this method, one or two punched-biopsy skin sample with a diameter of 5mm were harvested from occipital area of the scalps. Grafts were trimmed and divided into the follicular segments with at least one follicle in the interior and then inserted in the depigmented areas. Follow-up plan studies were scheduled to evaluate presence of pigmentation in the perifollicular areas. After 2 weeks, re-pigmentation was detectable surrounding the grafted hair follicles in 60 % of the cases. After 6 months, all of the patients had detectable re-pigmented area of about 2-9 mm. giving the surprising result of the study, hair follicle autograft transplant is an effective treatment option in the persistent segmental vitiligo.

Marjolin''s ulcer is a rare, aggressive condition that arises on chronic skin lesions and diseases. In this article, we will report 83 cases of this disease. Retrospectively, we retrieved 83 records of patients with cancer arising from chronic skin conditions. Data concerning demography, type of original skin insult, time interval between original lesion and cancer, cancer histology, and lymph node involvement were recorded. The mean age was 55.30 years (range: 21-90). There were 51 males (61.5%) and 32 females (38.5%). Foot was the most prevalent site of primary skin lesion (49.4%) followed by scalp (15.6%). Original skin insults were burn (87.9%), osteomyelitis (2.4%), radiation (2.4%), electrical burn (1.2%), surgical scar (2.4%), pemphigus (1.2%), bite (1.2%), and bed sore (1.2%). Histologic diagnosis were well differentiated SCC (38.6%), SCC, differentiation not reported (24.1%), moderately differentiated SCC (13.2%), BCC (9.6%), poorly differentiated SCC (6.0%), melanoma (2.4%), verrucous carcinoma (2.4%), MFH (1.2%), mucoepidermoid carcinoma (1.2%), and leiomyosarcoma (1.2%). Most of the cases occurred more than 20 years after the initial skin insult. There were 6 (7.2%) cases that developed within 1 year (acute Marjolin''s Ulcer). Forty three patients (69.3%) had palpable regional lymph nodes. Data in this series were in confirmation with many other reports. Marjoln''s ulcer should be considered as a significant post-skin injury complication.

Training of pediatric residents is a dynamic process which should be changed as the nature and epidemiology of pediatric diseases change. In this study, we compared the training program of the pediatric residents with the disorders of the pediatric patients who had referred to pediatric offices. The study was conducted in pediatric offices in Shiraz, South of Iran. The main complaints of all the patients who were referred to these offices in the first 3 days of the four seasons of the year were recorded. Finally, descriptive statistics was used to determine the frequency of different complaints among these patients. There are 58 Pediatrics offices in Shiraz and 37 offices completed the questioners (64%). The most frequent complaints of the patients were related to infections, especially respiratory and gastrointestinal ones. Nutritional and growth problems were other frequent complaints. Nonetheless, a high number of the patients were referred due to skin, eye, or ear problems or for check up of the baby. There is an important training–practice problem in the curriculum of pediatric residents. Thus, we suggest decreasing the periods of inpatient subspecialty training and increasing the period of outpatient dermatology, ophthalmology, otolaryngology, and well-baby clinics.

Harlequin ichthyosis is a rare and the most severe form of congenital ichthyosis. Although prenatal diagnosis is difficult for this disorder، recently، this obstacle has markedly improved with the use of DNA-based prenatal diagnosis. Here in، we presented a neonate with harlequin ichthyosis born by assisted reproductive technology (ART). In this case، the diagnosis of harlequin ichthyosis was not established by conventional prenatal screening.

It has been reported that fractures are more common in epileptic patients relative to the general population. Seizures by repeated muscular contractions can increase fracture risk throughout the skeleton, but the reported papers about non traumatic vertebral fractures following a single episode of seizure are rare and mostly located in thoracic spine with only one or two vertebral fracture. The case we reported here was a 42 year old otherwise healthy man who had three vertebral fractures due to a single idiopathic seizure affected the lumbar region with no previous history of underlying disease, trauma, or drug use.

Current evidence consistently confirm inequalities in health status among socioeconomic groups, gender,ethnicity, geographical area and other social determinants of health (SDH), which adversely influence health of the population. SDH refer to a wide range of factors not limited to social component, but also involve economic, cultural,educational, political or environmental problems. Measuring inequalities, improving daily living conditions, andtackling inequitable distribution of resources are highly recommended by international SDH commissioners in recentyears to ‘close the gaps within a generation’. To measure inequalities in socio-economic determinants and core healthindicators in Tehran, the second round of Urban Health Equity Assessment and Response Tool (Urban HEART-2)was conducted in November 2011, within the main framework of WHO Centre for Health Development (Kobe Centre). For ‘assessment’ part of the project, 65 indicators in six policy domains namely ‘physical and infrastructure’,‘human and social’, ‘economic’, ‘governance’, ‘health and nutrition’, and also ‘cultural’ domain were targetedeither through a population based survey or using routine system. Survey was conducted in a multistage random sampling,disaggregated to 22 districts and 368 neighborhoods of Tehran, where data of almost 35000 households (118000 individuals) were collected. For ‘response’ part of the project, widespread community based development (CBD) projects were organized in all 368 neighborhoods, which are being undertaken throughout 2013. Following the first round of Urban HEART project in 2008, the second round was conducted to trackchanges over time, to institutionalize inequality assessment within the local government, to build up community participationin ‘assessment’ and ‘response’ parts of the project, and to implement appropriate and evidence-based actionsto reduce health inequalities within all neighborhoods of Tehran.

Cerebrovascular disease is one of the leading causes of death in the world، and about one-fourth of cerebrovascular deaths are due to ruptured cerebral aneurysms (CA). Hence it is important to find a way to reduce aneurysm formation and its subsequent morbidity and mortality. Proteolytic activity capable of lysing gelatin has been shown to be increased in aneurysm tissue and expression of plasmin، membrane-type matrix metalloproteinase- 1 (MT1-MMP)، and matrix metalloproteinase-2 (MMP-2) in aneurysmal wall is more than what we observe in normal cerebral arteries. MMP inhibitors such as doxycycline and statins may prohibit aneurysm formation and growth. MMPs are important in tissue remodeling associated with various physiological and pathological processes such as morphogenesis، angiogenesis، apoptosis and tissue repair. In this article we review the role of MMPs and MMP inhibitors in formation of aneurysm.