مجله علمی پزشکی جندی شاپور
سال نهم شماره 1 (پیاپی 64، فروردین و اردیبهشت 1389)

Evaluation of the maximum mouth opening can be as diagnostic index in the clinical evaluation of the temporomandibular joint. Limitation of maximum mouth opening is one of joint dysfunction which can be result of infection, soft tissue scar, mandibular condylar fracture, or other temporomandibular disorder. since significant controversy has always been existed around the subject of " maximum mouth opening", and due to the importance of this subject, this study was designed to investigate the normal range of maximum mouth opening in healthy subjects presented to dental school of Ahvaz university of medical sciences (AJUMS).Subjects and In this descriptive study, the sample population consisted of 210 adults referred to the Faculty of Dentistry of AJUMS. The subjects were examined for maximum mouth opening. All subjects had a negative medical history, autoimmune disease, orthodontic treatment, orthognatic surgery, dental or skeletal crossbite, extreme brachycephalic or dolichocephalic facial patterns. Following selection of sample population, the range and the mean value of maximum mouth opening and their relation with sex, age body height were recorded and maximum mouth opening was measured. The data statistically analyzed using T-test. Of the 210 subjects, 48.6% were male and 51.4% were female. Mean value of age and was 32.5 years. The mean value of the body height was 175.8 cm for men and 160.6 cm for women. The mean value of maximal mouth opening was 49.9 mm, in the entire sample. The mean value and the range of maximal mouth opening was 52.19 mm for men and 47.8 mm for women. Significant differences were found between mouth opening in the male and female. (P=0.001). Also a significant difference was found between body height and maximum mouth opening (P=0.001). In this research, a significant relationship was found between maximum mouth opening and height. This finding comes in agreement with the hypothesis that height may have an association with in maximum mouth opening.

The unpredictable nature and course of epilepsy may have a significant impact on both the physical and psychological functioning of the child and the family. On the other hand, parental knowledge and believes concerning epilepsy has significant impact on adjustment and quality of life for both the child and family. Therefore, this study was set out to investigate the level of knowledge about epilepsy and its relationship with general health in parents of epileptic children. Subjects and This cross-sectional study included 35 parents (27 mothers, 8 fathers) of children who had been diagnosed for epilepsy by convenience sampling at Golestan hospital in Ahvaz. Parental knowledge was measured using the self-made epilepsy knowledge questionnaire, while general health was measured using the GHQ-28. Twenty three parents (65.7%) of parents were considered to have psychological problems. In 91.4% of parents, the level of knowledge about epilepsy was low to moderate. Significant correlation were found between level of parental knowledge and general health (P<0.001). The present study showed that parental knowledge about epilepsy was generally low and it was correlated with decreased general health. Therefore, the present findings suggest the importance of psycho-social support and assessment of parents with epileptic children. Also, providing more information and education about epilepsy may decrease these psychological problems.

Suction curettage is the preferred method for evacuation of hydatidifrom mole. The possibility of the persistent of the disease after first curettage is about 20%. Residual tissue is one of the causes of continue secretion of hCG and misappropriate decrease of hCG. The purpose of this study was to evaluate the efficacy of second curettage to remove any residual tissue in the uterine cavity in decreasing the possibility of development of persistent trophoblastic disease. Subjects and In this case-control study we followed 160 patients, in two equal case and control groups, with hydatidiform mole after routine evaluation. We performed an ultra-sonograpahy a few hours after first suction curettage for case–group and a second curettage on the next day when endometrial thickness above 10mm or any residual tissue in uterine cavity was observed. While in control group routine suction curettage was performed. Both groups were followed-up routinely until negative or persistent βhCG weekly. There was no significant differences between the groups with respect of age, parity, uterine size and other risk factors. Sonography results in case group was abnormal in 34.8% of patients. Twenty five percent of case group developed persistent trophoblastic disease, in whom 8% showed normal, and 17 % showed abnormal sonography. While 34 % of control cases developed persistent trophoblastic disease, in whom showed normal and abnormal sonography respectively. This study showed that in the first instance, the prognosis is much better of no residual tissue is left after the first evacuation. Secondly if a residual tissue is present, a second curettage is effective in reducing the incidence of development of persistent trophoblastic disease more than suction method. Finaly the stage of the disease is a good prognostic factor in overall response to treatment.

Glucosamine is a natural amino sugar that can prevent demolition in osteoarthritis. Considering the advantages of effervescent form of drugs, including attractiveness of effervescence and easiness of consumption, it was decided to formulate this drug as effervescent granules. Subjects and Flow, compactibility and solubility of the glucosamine powder were primarily tested. The experimental design was utilized to evaluate the effect of formulation factors on glucosamine granules. Using the cupermental drawing, 27 effervescent formulations were produced by dry granulation method. Independent variables were ratio of effervescent materials, ratio of dicalcium phosphate (DCP)/Mannitol and particle size and the responds were flow rate, pH and shelf-life. Using the common points of optimum responses, the best formulation was chosen and after physicochemical considerations, sweetener, colorant and flavoring agents were added. Glucosamine powder had poor flow and compactibility characteristics while dissolved readily in water. Altering the ratio of effervescent materials had a little effect on flow rate, while the ratio of DCP/mannitol and particle size were more effective. All of the independent variables affected the shelf-life significantly while the ratio of DCP/mannitol was less effective. Factorial design was a proper method to achieve better results of glucosamine formulation in a short duration of time. In conclusion, considering the results of physico-chemical aspects, the formulation containing glucosamine, sodium bicarbonate, tartaric acid, citric acid, dicalcium phosphate, mannitol, PEG4000, aspartame, Tomate red as colorant and aromatic orange as flavorant, with the expiration date of 530 days was chosen as the best formulation.

Multiple Sclerosis (MS) is the most common progressive neurologic disease in young adults. It characterized by widespread demyelinative lesions within central nervous system (CNS). Because of variable distribution of demyelination throughout the CNS, people with MS may experience disorders of balance, coordination, strength, sensation and vision. The aim of this study was to investigate difference in performance between people with MS and control subjects on clinical functional balance tests.Subjects and We studied 40 people with confirmed MS and 40 healthy persons. Our settings were in Ahvaz school of rehabilitation Sciences, Jundishapur university of medical sciences and center of MS society of Khuzestan. with use of clinical functional balance tests (Berg Balance Scale, Timed Up and Go test, modified Romberg test with opened and closed eyes, and lateral reach test to right and left side) subjects were measured on their ability to maintain balance. Participants with MS performed more poorly than control subjects in all balance tests (P= 0.001). The ability to maintain balance is a markedly problomatic in people with MS.

Ultraviolet radiation (UVR), in comparison with the other non-ionizing radiations is more energetic and could produce some biological effects. WHO has reported some of UV effects such as skin cancer and cataract. As a result, the integral observation of UV levels and their effects at ground level is important to assess present and future environmental and health implications of atmospheric UV radiation. Since the amount of UVR has not previously been measured in Khuzestan, the aim of the present study was to measure the amount in Ahvaz area in different months of the year and allocate the maximum UVR during day time. In this research, daily quantity of solar UVR were measured in Ahvaz during one year 2007-2008 using a Hand-held Lux-uv-Ir-meter. Three measurements in each day: at noon, and 2 hours before and 2 hours after noon. Averaging the UVR measurements for each month showed that the maximum and the minimum amount of UVR were in Khordad (June-July) and Azar (January-February) respectively. Comparison of UVR measurements during a single day showed that the maximum was at noon hours. Although UV radiation levels are influenced by geographical and climate situations and therefore any comparison between the results of UV measurements at different areas of the world is inappropriate. However, it is possible to compare the average of the measured data in this study with those from the relatively near areas. According to the results the amount of solar UV is highest in summer time, it is recommended to wear appropriate sunglasses and limit time of exposure in the midday sunshine during this period.

Serous otitis media is one of the most common childhood diseases and can lead to delay in speech development. In these study children, aged less than 6 years old, from rural health centers were examined for the prevalence of otitis media as well as to assess the factors associated with this disease.Subjects and In this cross-sectional study 856 children from the rural and metropolitan areas of Hovaiezeh city were participated. The prevalence of otitis media as well as the factors associated with the disease such as: age, sex, maternal feeding, familial smoking, social and economic conditions were assessed. The prevalence rate of otitis media was high with a value of 31% for children of less than 6 years age. The prevalence rates of otitis media in different age and sex groups showed that this disorder was more frequent for boys against girls in 0-2 and 4-6 years old comparing with 2-4 years old children. The prevalence of disease had significant positive correlation with no maternal breast-feeding, familial smokers and low economic conditions. Considering the high prevalence of disease in study area, more attention in health services and promote the culture of breastfeeding at least in the first 2 years of life, reduce smoking by family members and creating employment is necessary. We hope the result of this research may raise attention to the importance of prevention and management of otitis media in less than 6 years-old children.

Drowning is recognized as a major global public health problem with significant opportunities for prevention. The aim of this study was to examine the incidence and characteristics of the drowned in Khuzestan province. Subjects and We analyzed 2002–2006 data from the Legal Medicine Organization (LMO) of Khuzestan province, through a retrospective study. During 2002 to 2006, a total of 834 persons suffered fatal drowning in Khuzestan province. The mean age was 21.6±12.8 and M/F ratio was 4.8:1. The most common age groups of drowned victims were 15-19 (25.3%) and 20-24 (22.1%) years (7.3 and 6.5 per 100 000 population/year, respectively). Victims under the age of 15 years (including age groups of 0-4, 5-9 and 10-14 years) comprised 24.3% of all drowning deaths. Rivers and canals were the locations with the highest number of drowned victims (74.7% and 11.3% respectively). Most of drowned victims (94.5%) were native. The manner of death was found as following: 88.7% accidental, 2.3% suicidal, 0.7% homicidal and 8.3% undetermined. Khuzestan province has a mean drowning rate of 3.9 per 100 000 population-year which has second ranking in the drowning related mortality after Mazandaran province (7.6 per 100 000 population-year). Effective prevention of drowning requires programming and policies that address known risk factors.

Studies showed that consumption of a low-caloric and low-glycemic index diet are associated with a decrease in gene expression in subcutaneous fat tissue. The aim of present study was to determined effect of low-glycemic index diet versus low-fat diet on the body weight, body fat mass and reduction plasma leptin level in obese patients.Subject and A randomized controlled trial comprised 46 obese females, ages 18-55 years old, BMI >27, who visited Motahary clinic in Shiraz, Iran. Body weight, BMI, fasting glucose, fasting and post-prandial leptin level were measured at the beginning and at the end of 6 weeks. Changes in body weight, BMI, waist / hip ratio, fasting glucose and fasting post-prandial leptin levels were also significantly reduced in both dietary groups. No significant differences were observed in any parameter measured between the two groups. Low-glycemic index and low-fat diets have comparable effects on leptin level, body fat mass and BMI.

Iran is one of the countries located on the -thalassemia belt. The prevalence of this disease is in the margin of Caspian sea, Persian gulf and Oman sea, In Iran. The most prevalent is found in several provinces which include Mazandaran, Gilan, Khuzestan, Fars, Bushehr, Hormozgan, Sistan-Baluchestan and Keram. Khuzestan province, with a population of about 4 million, is located in south-west of Iran has different rates of thalassemia affecting various resident ethnic groups, including Arab, Lor and Fars. The aim of the present study was to determine the survival of -thalasemia major patients according to ethnicity and gender of the patients and to compare these results of with those reported for Hormozgan and Sistan-Baluchestan provinces.Subjects and In this cross-sectional study 109 thalassemia major patients from the more than 2000 file of the patients who referred to the Shafa hospital between 1999-2006 were selected by questionnaire. Life table, Kaplan- Meier test and logarithmic rank were used for data analysis. Of the 109 patients with major thalassemia, 53.2% were male and 46.8% were female. Of ethnic 13.9% were Fars, 13.9% Lor, 69.4% Arab and 2.8 % other ethnicities. The age survival proportion were 5 (97%), 10 (87%), 15 (76%), 20 (68%) and 30 (41%) years. The results of this study showed that survival of patients in Khuzestan was less than compare with Sistan-Baluchestan and Hormozgan provinces. In addition, the results showed that ethnicity (Arab, Fars and Lor) and sex of patients with major thalassemia in Khuzestan province has no significant effect (P >0.17) on their survival.

The main clinical manifestation of sickle cell disease is vessel obstruction. Activation of both blood coagulation system and platelets in sickle cell disease and also protein C-protein S deficiency increase risk of thrombosis in these patients. We present a case of 16 years-old girl with homozygous sickle cell anemia. She was referred with generalized and extremity pain to Shafa hospital clinic. Gradually during two months her pain became worse and she suffered from severe right leg edema. Color doppler sonography revealed a sub-acute thrombophelebtis on right leg with deep and superficial branches of femoral and poplyteal veins with severe decreasing blood flow. She was put on intravenous heparin and maintenance oral warfarin. After three months of treatment with warfarin, obstruction was completely resolved and treatment was continued for further five months. During the course of treatment, protein C-protein S were less than normal range. This may be one of the risk factor to increasing thrombosis in our patient. Protien C-protien S were measured in patient's centrifuged serum by full automatic coagulometer ACL 8000 and specific kits.In sickle cell diseased-patient who present with extremity pain and edema, due to vein thrombosis, measurement of protein C-protein S levels and other diagnostic measures, in addition to other medical interventions, appropriate anticoagulant therapy with IV heparin and oral warfarin are needed.

The nephrotic syndrome is a clinical complex characterized by a number of renal and extrarenal features, The most prominent of which are proteinuria of >3.5 g per 24 h (in practice, >3.0 to 3.5 g per 24 h), hypoalbuminemia, edema, hyperlipidemia, lipiduria, and hypercoagulability. These patients are at increased risk for vascular thrombosis, especially venous, and pulmonary embolization and the superimposition of separate rapidly progressive glomerulonephritis upon preexisting nephrotic syndrome has also been described. We report a 37-years old female patient with nephrotic syndrome who presented initially with pulmonary embolism and sudden and severe dyspnea. Then at follow-up who developed acute renal failure with oliguria, edema, hypertension and active urinary sediment tation with hematuria, RBC cast and dysmorphic RBC that compatible with rapidly progressive glomerulonephritis. Nephrotic syndrome and two complications responded to treatment.