مجله پزشکی دانشگاه علوم پزشکی تبریز
سال چهل و سوم شماره 1 (پیاپی 151، فروردین و اردیبهشت 1400)

Schizophrenia is a psychiatric illness characterized by negative symptoms (apathy, social withdrawal, lack of motivation) and cognitive deficits, while impairment in self-care, grooming, and oral health is also noted. This study aimed to evaluate oral health status and xerostomia among hospitalized patients in Razi Hospital in Tabriz, Iran during 2019.

In this descriptive-analytic study, a total of 80 people (equal genders) including 40 hospitalized patients with schizophrenia and 40 healthy matched controls were recruited conveniently from among non-psychiatric outpatient poly-clinic referrals. Oral health status was measured by decayed, missing, and filled permanent teeth (DMFT) index and xerostomia index. Data were analyzed through SPSS version 25 by student's t-test, chi-square, Pearson, and Spearman correlation tests. P-values under 0.05 were considered statistically significant.

In both groups, 75% out of males were smokers. The mean DMFT in the cases was significantly greater than the controls (P=0.02). There was no difference between genders in both groups. The means of xerostomia indices were significantly higher in the case group. (t=3.47, P=0.001).

Based on cognitive deficits and negative symptoms in patients with schizophrenia, oral hygiene is considerably lower than normal populations. This is a great hint for policy-makers, clinicians, healthcare professionals, and family members to emphasize on prevention of oral and dental lesions among afflicted patients.

Electroencephalography is a record of the electrical activity of the brain that is used to diagnose brain dysfunction and to determine the location of brain injury and to determine seizure activity. There is. The sedative medication used should not only have an effect on the brain’s electrical activity, but it also calms the baby. Since there have been no studies to compare the effects of intranasal oral hydrate and dexmedetomidine on sedation in children for electroencephalography, this study aimed to compare the effects of intranasal intravenous dexmedetomidine with intramuscular dexmedetomidine on electroencephalography in children.

This clinical trial study was performed on 62 children candidates for electroencephalography in Imam Hossein Pediatric Hospital in Isfahan. Age, weight, and clinical data including sedation score, mean arterial pressure, respiratory rate, arterial oxygen saturation, and heart rate at pre-medication times, 15, 30, 45, and 60 minutes after drug administration. And analyzed.

The mean age of the children candidates for electroencephalography was 16.90 ± 1.32, out of which 35 (56.5%) were male. The results showed no significant difference between the two groups in terms of sedation, mean arterial pressure, respiratory rate, and percentage of arterial oxygen saturation (p> 0.05). But the difference between the two groups was statistically significant for the variable heart rate. Heart rate was significantly lower in group B (dexmedetomidine group) than in group A (oral chlorate hydrate group) (p-value = 0.032), and time as an influencing factor in changing mean sedimentation, mean arterial pressure, respiratory rate, and heart rate (p-value <0.05). But there was no significant effect on the change in arterial oxygen saturation percentage (p = 0.478).

Chloral hydrate administration was more effective than intranasal dexmedetomidine treatment in maintaining heart rate but overall the results showed no significant difference between the two groups in terms of clinical data and child sedation score in the two groups. Was.

Hypertrophic cardiomyopathy is a common genetic cardiovascular disease with autosomal dominant inheritance and MYBPC3 gene has been frequently linked to its pathogenesis. Since, carriers of the 25 nucleotides deletion located on intron 32 of the MYBPC3 are at increased risk of heart disease we aimed to investigate this variant in hypertrophic cardiomyopathy patients and healthy population.

DNA was extracted from 350 Blood samples including 42 hypertrophic cardiomyopathies and 308 healthy subjects and the region containing the deletion was amplified by PCR method. PCR products were analyzed on agarose gel and genotyping results were recorded.

Genetic counseling results revealed that 26.2% of patients were sporadic cases vs 59.5% with positive family history and there was a history of sudden cardiac death in the first degree relatives of 42.3% of the patients. Genotyping results showed that all samples had a single band of 198 bp, indicating no MYBPC3Δ25bp variant in HCM patients as well as 308 controls. Bioinformatics assessments revealed that MYBPC3Δ25bp had a frequency of 0.00438 on Iranome database with the highest incidence reported in the Baloch population.

Since hypertrophic cardiomyopathy is related to sudden cardiac death, population studies in terms of predisposing factors are of particular importance. Our study results showed that MYBPC3Δ25bpshould not be considered as risk factor in the patients of northwest of Iran. However, according to the bioinformatics findings and reports of neighboring countries, it is suggested that MYBPC3Δ25bp to be studied in the eastern and southern Iranian hypertrophic cardiomyopathy patients.

Melasma is an acquired Hypermelanosis often difficult to treat. In this study, we assessed efficacy and safety of 5% hydroquinone cream plus non-ablative fractional 1540 erbium YAG laser and 5% hydroquinone cream alone in the treatment of melasma

We selected 40 patients of melasma aged between 18 and 60 years for the study. Group 1 were treated with a cream of 5% hydroquinone and group 2 treated with a solution of hydroquinone 5% plus three sessions of non-ablative fractional 1540 erbium YAG laser at monthly interval. Improvement was assessed by the melasma-area-and-severity-index (MASI) score.

The two groups did not differ significantly in (MASI( score in the first month of treatment (p = 0/135), while during the second to fifth months, there were significant differences between the two groups (p <0.05) and (MASI( score was more reduced in the second group. The two groups did not show significant differences in the incidence of complications (erythema, hyperpigmentation, hypopigmentation). (p= 0/746, 0/158, 0/574, 0/135, 0/135 respectively, the first month, second month, third month and fourth month)

A combination of hydroquinone and laser therapy had better results in the treatment of melasma. But due to some disagreements about the use of lasers in the treatment of melasma we recommend more studies with larger sample size to be taken to definitely show better therapeutic effect of laser.

L5 Sacralization is normal variation in lumbar anatomy, but many authors believed this condition because of concentration of pressure in L4/ L5 level can speed up degenerative process (disk degeneration or listhesis…). However no study was compare spondylolisthesis radiological parameters in patient with and without sacralization of L5, our purpose is evaluation of radiological parameters in spondylolistesisL4/L5 in patient with and without L5 sacralization.

In cross sectional study we divided 78 patient with spondylolisthesis of L4/L5 in two group with (n=24) and without (n=54) L5 sacralization and evaluated facet osteoarthritis, degree of listhesis (%), disk degeneration, and facet orientation in two group and result was compared,

There was no significant difference in the degree of anterior slippage of L4 on L5 (17.02±6.21 versus 16.65±4.87, p=0.809), facet orientation (54.99±12.18 versus 56.23±4.35, p=0.642), facet osteoarthritis (3.43±0.59 versus 3.53±0.37, p=0.527), or disc degeneration (4.50±0.51 versus 4.35±0.61, p=0.340) between the two groups

There is no significant relation between radiological parameters in two group and we thought influence of L5 sacralization on degenerative process of L4/L5 less significant than previously expected, but future study with large number of patient need to clarify the role of fixed L5 on degenerative process in lumbar spine.

Patients admitted in especial units such as coronary care unit (CCU) require intensive care for different aspects including skin problems. Here in this report we aimed to perform a survey on different skin lesions in patients admitted in CCU by the time of admission and when discharging.

In this cross-sectional study, we had a survey on 200 patients admitted in CCU in AL-Zahra hospital, Isfahan. A dermatologist observed and examined each patients for any skin lesions by the time of admission and when discharging from CCU.

Here we showed that 15 percent of patients admitted in CCU have at least one skin lesion and also we indicated that seborrhea dermatitis and then rosacea have the most prevalence by the time of admission in CCU. Other skin lesions were acute skin failure. We also showed that prevalence of bed sore and pressure sores increased amazingly during admission.

Rosacea, seborrhea dermatitis and drug allergic reactions after pressure sores are the most frequent skin lesions in CCU and there might be an association between rosacea and cardiovascular diseases.

Premature birth is an important issue in developed and developing countries. Surfactant replacement therapy of respiratory distress syndrome (RDS) causes a change in the normal pattern of the disease and increases the likelihood of survival of more premature newborns with chronic pulmonary damage. The purpose of this study was to investigate the effects of budesonide and surfactant on the treatment of respiratory distress syndrome and the prevention of bronchopulmonary dysplasia.

In a randomized clinical trial, 128 preterm infants less than 1250 g or gestational age of 26-30 weeks that were admitted to Al-Zahra Hospital from 2017 to 2018 with RDS and needed surfactant replacement therapy were enrolled. They were randomly allocated into two groups. In one group (group Surfactant), the surfactant was administered intratracheally 2.5 cc/kg and in the second group (group Surfactant + Budesonide), budesonide was administered 0.25 mg/kg in addition to the intratracheal surfactant. The primary outcome was bronchopulmonary dysplasia and the secondary outcome was complications of prematurity.

In this study 128 neonates including 48 (60.9%) boys and 50 (39.1%) girls were studied. The mean gestational ages of studied neonates were 28.32±1.60 weeks. The mean duration of mechanical ventilation, continuous positive airway pressure (CPAP), high flow nasal cannulae (HFNC), and need for supplemental oxygen were significantly shorter in the group that received surfactant and budesonide combination. The required FiO2 at four hours after surfactant treatment was significantly lower in group Surfactant + Budesonide than the Surfactant group (p = 0.01). In the group Surfactant, 38 neonates (59.4%) and in group S+B, 24 cases (37.5%) developed bronchopulmonary dysplasia (BPD), (p = 0.04). The mortality rate was 15 neonates that 6 cases were in group S+B (p =0.29).

In our study, using surfactant with budesonide combination in comparison with surfactant alone is associated with less respiratory support and BPD rate. Future studies with a larger number of patients before routine use of surfactant and budesonide combination is recommended.

Some studies have shown that vitamin C has a positive effect on reducing headaches after spinal anesthesia, but studies in this field are inadequate. The aim of this study was to determine the effect of vitamin C infusion on the decrease of headache after spinal anesthesia in cesarean section.

This clinical trial study was performed on 160 patients undergoing cesarean section referred to Kowsar Hospital of Yazd in 2017. The patients were randomly divided into two groups including group 1, 2 gr of vitamin C in 500 cc normal saline, and group 2, 500 cc of normal saline was injected preoperatively. The two groups were compared for headache incidence.

At the time of recovery, 2 hours later, the frequency of headache in the intervention group was significantly lower than the control group (P <0.05). But there was no significant difference between the two groups regarding headache at 4, 6, 12, 24, and 48 hours postoperatively (P>0.05).

Considering the patient's condition, and according to the anesthesiologist and surgeon, vitamin C can be used to reduce pain in patients undergoing cesarean section with spinal anesthesia.

Visceral leishmaniasis (VL) or Kala-azar is an endemic disease in some areas of Iran, including East Azarbaijan, Ardabil, Fars and Bushehr provinces. The disease is sporadic in other parts of the country. According to the reports of numerous cases of the disease from Ahar and Osku counties (cities), East Azarbaijan province and the lack of new study on the prevalence of the disease, this study was designed to determine the seroprevalence of VL in the children of Ahar and Osku counties, in East Azarbaijan Province.

In this descriptive cross-sectional study, blood samples were collected in the test tube without anticoagulants, from children under 8 years from rural areas of Ahar and Osko, in 2018. The samples were evaluated using Direct Agglutination Test (DAT) to measure anti Leishmania infantum antibodies for titer up to 1:3200.

Out of 209 children <8 years in selected centers in Ahar and Osku, two cases (0.95%) revealed anti-Leishmania antibodies titer 1:3200. Initially, one of the two positive individuals in the study had a suspicious antibody titer of 1:1600, whose antibody titer increased to 1:3200 after 4 weeks.

The Kala-azar, in spite of low endemicity, is one of the health problems in Ahar and Osku in East Azarbaijan Province. This study suggests the necessity of supplementary studies based on molecular approaches in the region and other parts of the province.

Diagnosis of polyneuropathy is typically made using sensory and motor nerve conduction studies (NCS). These tests include measurement of amplitude, velocity, and delay of sensory and motor waves. These waves cannot assess the entire length of the nerve, proximal parts in special. F-wave is the only test capable of measuring the entire length of the nerve. The purpose of this study was to evaluate the value of F-wave in patients with diabetic polyneuropathy.

This is a retrospective study assessing the value of nerve conduction studies and F-wave in the diagnosis of 148 patients with diabetic polyneuropathy referred to hospitals under the supervision of the University of Iowa from October 1, 2016, to September 5, 2018. Motor neurons of median, ulnar, peroneal, and tibial nerves and sensory neurons of median, ulnar, and sural nerves were assessed using two techniques of NCS and F-wave. Then the data were compared.

The results of this study showed that F-wave in all of the evaluated nerves (median, ulnar, tibial and peroneal) detected abnormalities to more extents than routine NCS (P <0.001). When total neuronal abnormalities were accumulated, this value was 82٪ for NCS, while 99٪ for the F wave (P < 0.001).

Findings of the current study showed that the assessment of delayed nerve conducting through F-waves can diagnose diabetic polyneuropathy to better extents as compared to NCS. Further evaluations are recommended.

Hip flexor muscles' tightness has been considered as one of the main risk factors for neuromuscular impairment of lower extremities not only lead to change the movement patterns but also probably result in changing the neuromuscular features of other muscles. The purpose of this research is study was to evaluate the iliopsoas tightness’ effect on electromyographic activity of hip extensor synergists during gait.

In this case-control study fifteen 11-14 years old adolescents with iliopsoas tightness as experimental group, and 15 healthy adolescents which matched based on age, height, weight, body mass index, dominant leg and sport experience participated voluntarily as control group. Surface electromyographic activity of the gluteus maximus, adductor magnus and biceps femoris, were measured between groups during stance phase of gait.

Individuals with restricted hip flexor muscle length demonstrated more gluteus maximus activation during terminal stance (p=.001), more biceps femoris activation during mid stance (p=.002) and late stance (p=.001) and more adductor magnus activation during mid stance (p=.04) and late stance (p=.001).

Adolescent soccer athletes with hip flexor muscle tightness exhibit more biceps femoris and adductor magnus and gluteus maximus activation during stance phase of gait. Thus, individuals with hip flexor muscle tightness appear to utilize different neuromuscular strategies to control lower extremity motion.

After breast cancer, uterine cervical neoplasms is the most common cancer in women. It is believed that genetic factors are effective in developing cancer. Bcl-2 is a well-known anti-apoptosis gene that increases cell viability without stimulating effect on cellular proliferation. Today it attempts to use natural compounds to control or treat diseases. Carotenoids are one of these compounds. Deinoxanthin is a carotenoid isolated from Deinococcus radiodurans. Since this bacterium has a unique ability to withstand radiation, and radiation is a well-known cause of cancer carotenoid synthesized by bacterium is worthwhile. The aim of study is evaluating the effect of deinoxanthin on the expression of Bcl-2 in Hela cell line.

Active culture of bacteria was purchased from Genetic and Biological Reserve of Iran then deinoxanthin was extracted. Hela was prepared of Pasteur Institute of Iran and cultured. Cells were divided into two treatment and control groups. Deinoxanthin was affected on the treatment group and its toxicity was measured using MTT. Real-time PCR was used to measure gene expression. RNA was extracted from two groups and cDNA was made.

Real-time PCR showed the anti-apoptotic expression of Bcl-2 decreased by 4/85 and given that p-value of 0/05 was (p-value=0) this decrease is significant.

Regarding the results of Real-time PCR it can be concluded deinoxanthin extract has an inhibitory effect on the uterine cancer cell line has an inhibitory effect after 48 hours and the amount of anti-apoptotic expression of Bcl-2 has significantly decreased (p-value=0).

According to the experimental studies, the levels of heat shock protein 27 (HSP27) and brain-derived neurotrophic factor (BDNF) are decreased in diabetes which is associated with impaired cognitive function in the brain. Therefore, the increased expression of these two proteins in some brain regions associated with learning and memory can be one of the positive effects of aerobic training on cognition improvement at diabetes. The aim of the present study was to evaluate the effects of aerobic treadmill exercise training (ATET) on HSP27 and BDNF proteins in the prefrontal cortex and hippocampus of streptozotocin (STZ)-induced diabetes in rats.

Twenty healthy adult male Wistar rats approximately 3-month old, weighing 250 ± 25gr were used in this study. Experimental diabetes was induced by a high-fat diet (HFD) for 4 weeks and a low dose of STZ (35 mg/kg, intraperitoneally). Then diabetic animals were divided into two groups (n=10 per each group): control group (C) and aerobic training group (E). The exercise program was treadmill running at 13 m/min, 25 min/day, for 5 days/week at 0˚ slope for the first week, with a gradual increase to 27 m/min for 60 min/day in week 8. Un-paired t-test was used to compare two groups with the considered significant at p<0.05.

The results showed that ATET significantly increased protein expression of HSP27 and BDNF in the hippocampus and prefrontal cortex as compared to C group.

Our findings showed that aerobic treadmill exercise program can increase the protein expression of HSP27 and BDNF associated with cognition and synaptic plas ticity and thus counteract the neurodegenerative diseases of the nervous system.

According to previous research’s, the function of endothelial nitric oxide synthase (eNOS) impairs in diabetes. Therefore, the present study conducted aimed to investigate the effects of eight weeks high intensity interval training (HIIT) on the levels of eNOS gene expression in left ventricle tissue of type 2 diabetic rats.

in experimental research, the 14 male Wistar rats with eight weeks old and the average weight of 160±10 g feeding of high fat and sweet diets (30% fat and 25% fructose) for seven months. The rats after confirming the type 2 diabetes, randomly assigned into two groups of six rats consist of control and HIIT groups. The rats in the HIIT group trained for eight weeks and five sessions per week. The 24 hours after last training sessions, blood samples collected and the left ventricle removed and the levels of eNOS gene expression measured by Real Time PCR assay in heart tissue.

There was a significant increase in eNOS gene expression in HIIT group compared to the control group (p=0.011). Moreover, the levels of glucose, insulin and insulin resistance (HOMA-IR) was significantly lower in the HIIT group compared to the control group (p<0.05).

It seems that HIIT play an important role in improving heart tissue endothelial function and improve the insulin sensitivity in diabetic rats by high fat and sweet diets.

The health of the fetus during the 9 months of pregnancy is very important for every pregnant couple. Identifying carriers of the genetic diseases and their diagnosis before birth, controls the disease's prevalence and does not impose huge costs on the patient's family and community. This study aimed to evaluate the rapid prenatal diagnosis importance in the chromosomal abnormalities identification.

50 amniotic fluid samples were studied by karyotyping and fluorescence in situ hybridization (FISH). Karyotyping was performed on me taphase chromosomes to identify all the chromosomal abnormalities and FISH detected chromosomal abnormalities by using X and Y probs, as the rapid method.

We identified one cases of Down syndrome (2%), three cases of extension in the polymorphism region of P arms of chromosome 15(15p+) (6%), one cases of extension in the polymorphism region of chromosome 9 (9 qh+) (2%), one case of peristaltic inversion in chromosome Y (2%), one case of XYY mosaic embryo, 46, XY /47, XYY variant (2%) and one case with the extra unknown segment on P arms of chromosome 15 (2%).

FISH is a useful method with high sensitivity to provide rapid results for couples who don't have enough time to end their pregnancy legally. In cases of X-linked diseases, it is a reliable method to learn the sex of the fetus. FISH is not able to detect structural anomalies, therefore karyotyping is required for absolute right outcomes of chromosome abnormalities.

Different factors affect walking biomechanics disturb the postural control. Genu valgus is one of the most important lower limb malalignments that affects the postural control and disrupts the posture. The purpose of the present study was to investigate the acute effect of knee brace on the electromyography activity of lower limb muscles in individuals with genu valgus during walking.

In this semi-experimental and a laboratory typ study,. 24 boys with genu valgum (20-30 years old) volunteered to participate in the study. The electrical activity of the selected muscles was recorded by an electromyography system during walking with and without knee brace. Paired t-test was used for statistical analysis at a significance level of 0.05.

There was a significant increase in electrical activity of the semitendinosus muscle during walking with knee brace compared to walking without it (p = 0.037, d = 0.89). The electrical activity of other lower limb muscles did not show any significant differences during acute use of knee brace (P >0.05).

The semitendinosus muscle in individuals with genu valgus is weak. Therefore, significant increase in the electrical activity of the semitendinosus muscle during wearing of knee brace means delaying the fatigue and indicating improvement in the muscular function.

Apoptosis is the physiological cell death that in natural conditions leads to the elimination of old, damaged, waste, and harmful cells. The aim of this study was the effect of eight weeks of high-intensity interval training (HIIT) with and without caloric restriction on gene expression of myocardial Bax and Bcl2 in mice.

Present study was an experimental multi-group design with a control group conducted on 30 two-month old male mice. Subjects were divided into five homogenous groups including base control, control, caloric restriction, interval exercise training, and caloric restriction + interval exercise training. Training groups participated in interval exercise training five sessions per week for 8 weeks. The level of gene expression of myocardial Bax and Bcl2 was evaluated by real-time PCR. Data were analyzed using the one-way ANOVA at the level of (P<0.05).

The results showed that the training group had a significant increase in gene expression of myocardial Bcl2 in comparison with caloric restriction + exercise training (P<0.05) and a significant decrease in gene expression of myocardial Bax compared to the caloric restriction group (P<0.05). Also, exercise training and exercise training + caloric restriction significantly increased the gene expression of myocardial Bcl2 and significantly decreased Bax/Bcl2 ratio compared to caloric restriction, base control, and control (P< 0.05).

It seems that high-intensity interval training without caloric restriction would provide a suitable environment for increasing the integrity of the mitochondrial membrane of myocardial cells and possibly apoptosis.

Cardiac atrophy is the most important complications resulted by cancer Given the role of exercise in protecting against cancer complications, the aim of the present study was to determine the effect of 10 weeks of endurance training on protein levels of NF-kB and gene expression of Atrogin-1 and MuRF-1 in cardiac myocyte of female Balb/C mic with breast cancer.

The present study was an experimental study. Twelve female BALB/c mice after inducing breast cancer were randomly divided into two groups (n=6) including endurance training group (E) and the control group (C). E group performed 65 min at a constant running speed corresponding to 60% vVo2max at 15% inclination, ten weeks (five days a week). The Left ventricular of animals was extracted 24h following the last training session. Protein levels of NF-kB and gene expression of Atrogin-1 and MuRF-1 were determined by, respectively, western blot and qReal-time PCR. Statistic data values also were measured by independent samples t-test at the 0.05 levels of significance.

The results of the present study showed a significant decreased in cardiac protein levels of NF-kB (p<0.001) and cardiac gene expression of Atrogin-1 (p<0.001) and MuRF-1 (p=0.003) in comparison with control group. Endurance training group had significantly greater heart weights compared to control group (p<0.001).

it seems that 10 weeks of endurance training possibly affect mechanisms involved in cancer-induced cardiac atrophy such as NF-kB/Atrogin-1/MuRF-1 axis results in decreasing cardiac atrophy in mice with breast cancer.

About angiogenesis, metastasis of breast cancer and exercise, Many studies have been done in recent decades to better understand of regulatory mechanisms. The purpose of this study was to investigate the Interactive effect of high-intensity interval training (HIIT) and quercetin supplementation (Q) on the expression of key angiogenic factors in tumor tissue of mouse with breast cancer.

Twenty-four female Balb/C mouse were injected with estrogen receptor-dependent breast cancer cells MC4L2 and then divided into three groups of tumor (T), tumor + of high-intensity interval training (TH) and tumor + high-intensity interval training + quercetin (THQ). The TH and THQ groups ran the treadmill 3 days a week for 6 weeks and each session 1 hour. The THQ group received 110 mg / kg quercetin solution for 6 weeks, 3 days a week with training. After completion of the work, the mouse were sacrificed and their tumor tissue removed and frozen in liquid nitrogen And stored at -70 ° C. Expression of TIE-2 and VEGF-A genes was measured by REAL TIME-PCR. ΔCt, ΔΔCt, and Fold change were calculated with the relevant statistical tests at the significant level (P <0.05) by GENEX software.

The results showed that THQ interaction significantly decreased the expression of TIE-2 and VEGF-A genes in TH and THQ groups compared to T group. In addition, quercetin in THQ group significantly decreased TIE-2 and VEGF-A gene expression compared to TH group.

interaction of HIIT and Q supplementation are probably effective in inhibiting tumor angiogenesis.

Foot pronation is in the open kinetic chain composed of eversion, abduction, and ankle dorsiflexion. Foot overpronation may be associated with different lower limb injuries. The purpose of this study was to investigate the effect of walking on the sand on co-Contraction of the lower limb muscles in individuals with overpronated foot.

The present study was a semi-experimental and laboratory type. Thirty healthy individuals and 30 individuals with foot overpronation volunteered to participate in this study. Muscle activity was recorded by an 8-channel electromyography system with a surface electrode during walking on sand. Two-way ANOVA test was used for statistical analysis at the significant level P<0/05.

The results demonstrated lower ankle-directed co-Contraction during walking on sand compared with walking on level ground (P<0/001). Other components of ankle-directed co-Contraction did not demonstrate any significant differences between walking on sand compared with walking on level ground (P>0/05).

Individuals with overpronated foot demonstrated lower ankle-directed co-Contraction during walking on sand compared with walking on stable level ground. Individuals with overpronated foot showed a greater ankle-directed co-Contraction than the healthy group. Decreased ankle-directed co-Contraction indicated a positive effect of walking on sand in individuals with foot overpronation.

Cleft lip and palate are the most common congenital malformations of the head and neck. These disorders have high economic cost for families and impose a heavy psychological burden on children. Performing early primary reconstructive surgery on cleft lip and palate is necessary to achieve the desired treatment results. The aim of this study was to evaluate the etiology of primary cleft lip and palate reconstructive surgery retardation.

In this descriptive study, 516 infants referred to Tabriz Children’s Hospital and Sina Hospital to do primary cleft lip and palate reconstructive surgery from 2009 to 2014, were studied. Ages at surgery, sex, comorbidities, cause of delay in referring the patients were evaluated. SPSS version 22 was used for statistical analysis.

The mean age of patients at surgery was 16.20 ± 25.97 months. There was a delayed referral for primary reconstructive surgery in 27.13% of the patients. The low weight of the child for surgery (30%), late visit of the child (19.28%), and lack of awareness among parents about the time of the visit (17.85%) were the most common causes of delay of reconstructive surgery.

Based on the findings of this study, the low weight of the child for surgery, late visit of the child, lack of parents’ awareness about the time of the visit, comorbidities, late diagnosis, and low level of socio-economic, were the most common causes of delay in referring to reconstructive surgery respectively.