مجله پزشکی دانشگاه علوم پزشکی تبریز
سال سی و دوم شماره 3 (پیاپی 87، امرداد و شهریور 1389)

Although pathogenesis of myasthenia gravis is rather well-known, the mechanism of immune system stimulation is unknown.Genetic amplitude varying on the basis of clinical presentations has been reported.The relation between existences or lack of some special types of HLA (Human leukocyte antigen) with this disease or its severity has been also reported. The aim of this study was to determine HLA-I antigens in patients with myasthenia gravis.

in a case-control study, 50 patients with confirmed Myasthenia gravis and 50 sex-matched healthy persons (kidney donor) were enrolled during 18 months. Different types of HLA-I were determined and compared between two groups. Relation between anti cholinestrase dosage and different types of HLA-I was evaluated.

The frequency of HLA-I types of A9 (OR=7.73), A29 (OR=10.76), B8 (OR=0.88), B53 (OR=8/81), and BW4 (OR=6/50) was significantly higher in patients with myasthenia Gravis.In addition, the frequency of HLA-I type of BW6 (OR=0/10) and B5 (OR=0/263) was significantly lower this patient group.The administered dose of Anti cholinestrase in patients with A2 and A3 HLA-I types was significantly higher. The age of disease onset in those with HLA-A2 was significantly lower. HLA- BW6 was significantly frequent among the female patients.

There is significant relation between types of HLA-I and myasthenia gravis.

One of the disadvantages of dental composites is polymerization shrinkage and subsequent microleakage. Since the use of a thin layer of flowable composite under composite restorations is one of the methods in improving marginal seal and microleakage reduction, the aim of the present study was to evaluate the effect of flowable composite liner on the microleakage of gingival margin of class V cavities restored with a seventh-generation (all-in-one) adhesive resin. In buccal surfaces of 30 sound human premolars (with closed apex and extracted for orthodontic reason) class V cavities were prepared and their gingival margins were located 1 mm below CEJ. The teeth were randomly divided into two groups. In group 1, the samples were restored without flowable composite liner while group 2 specimens were restored using flowable composite liner. In order to restore the teeth, in both groups all-in-one adhesive resin and Z100 composite (using incremental technique) were used. Following finishing and polishing, the samples were subjected to thermocycling. Then they were immersed in 2% basic Fushin solution for 24 hours. Following sectionings the microleakage of gingival margin of the samples was evaluated under stereomicroscope. Non-parametric Mann-Whitney U test was used to compare the gingival microleakage of two groups. There were statistically significant differences in microleakage scores between two groups (P<0.0005). The use of flowable composite liner in composite class V cavities restored with an all-in-one adhesive resin significantly reduced the microleakage of gingival margin.

Researchers believe that there is interaction between personality and high risk sexual behaviors. The purpose of this research was to study the personality trait in individuals with high risk sexual behaviors and to compare with that among individuals without high risk sexual behaviors. In this study, all individuals with high risk sexual behaviors who referred to AIDS counseling center at Red Crescent community were selected during 3 months. They were matched with a group of normal subjects with regard to demographic characteristics. The data were collected using questionnaire in two categories; demographic items and five factor model inventory. Investigation results showed that the high risk sexual group had significant differences in Neuroticism, flexibility, openness, and Conscientiousness. there is special personality structure that makes people vulnerable to problems such as high risk sexual behavior and subsequently to AIDS. Sever pattern personality traits are seen subjects with high risk sexual behaviors.

Recent findings suggest that epicardial adipose tissue plays an important role in the pathogenesis of cardiovascular disease and metabolic syndrome. The aim of this study was to investigate the fatty acid profile of epicardial and subcutaneous adipose in patients undergoing coronary bypass graft surgery, and to assess the association between these profiles and cardiovascular risk factors. Blood samples (one day before surgery), and epicardial and subcutaneous adipose tissue (during coronary artery bypass grafting) were collected from 32 non-diabetic male patients with coronary artery disease (CAD). Serum lipids and lipoproteins were measured by standard enzymatic methods and fatty acid composition of adipose tissue was determined by gas chromatography (GC). The saturated fatty acids were higher in epicardial adipose tissue (P=0.007) and polyunsaturated fatty acids were lower than subcutaneous adipose tissue (P=0.03). The level of HDL-C was inversely correlated with ω6 fatty acid content of epicardial adipose tissue (r=-0.502). The fatty acid profiles of epicardial and subcutaneous adipose tissue, and probably their associations with cardiovascular risk factors are different.

Overweight and eating disorders are among prevalent nutritional problems, especially in adolescent girls. With attention to the scarcity of data on the subject, this study was carried out to determine Body Mass Index (BMI) status and its’ relation to eating attitudes, among adolescent girls in Tabriz. In a systematic random method, 1887 high school girls, aged 14-18 years, were selected. According to the definitions of Center for Disease Control (CDC) and International Obesity Task Force (IOTF) and using the body mass index percentiles, subjects were divided. Eating attitudes were assessed by using Eating Attitude Test-26 (EAT-26) questionnaire. Prevalence of underweight, normal weight, at risk of overweight, and overweight in the studied subjects was 5.6, 77.6, 12.4-16.1, and 3.6-4.4%, respectively. Body mass index was positively correlated with EAT-26 score (r=0.22, P<0.01). At risk of overweight or overweight students, had higher EAT-26 score than normal or underweight individuals (P<0.01). Abnormal BMI is prevalent among high school girls in Tabriz. BMI is an important factor for the development of abnormal eating attitudes. In adolescent girls, abnormal BMI can lead to abnormal eating attitudes.

Recognition and study of psychological and biological risk factors of coronary heart disease are an important task. The aim of this article is to study the psychological risk factors of coronary heart disease and relation of five personality factors and eight coping styles with this disease. The study subjects were 120 individuals, including (60 patients with confirmed coronary artery disease who were hospitalized in Tabriz Shahid Madani cardiac center hospital. Sixty age and sex match normal people) people age 40-60, were selected randomly. The NEO personality factor test, coping styles test and demographic test, were performed in each individuals and the data were analyzed by multiple regression analysis, Independent t-test and Pearson correlation. Among the five personality factors only neuroticism factor had meaningful difference between two groups (P < 0.05). Among the coping styles had a meaningful difference between T-test analysis revealed that styles avoidance and self-control had significant difference between two groups (P < 0.05). Psychological risk factors that prepare individuals for coronary heart disease include: Neuroticism factor (that is saturation from traits like hostility, grief, pessimism, negative affects), avoidance coping style (that is negative and emotional policy in encounter with stressful events of life) and self-control style that prevent to appear feelings and emotions of individual and to create affective inhibition.

The prevalence of abdominal aortic aneurysm (AAA) increases with age and affects almost 5% of the population who are >50 years old. A debate still exists on relation and coincidence between AAA and coronary artery disease (CAD (. This study aims at evaluating the prevalence AAA in patients with CAD. In an analytic-descriptive cross-sectional study, 234 candidates for coronary artery angiography were studied in Tabriz Imam Khomeini and Madani Hospital during 18-month period. According to results of angiography, 184 patients had CAD. Abdominal duplex ultrasonography was employed for examining the cases for presence of AAA. Abdominal aortic diameter ≥ 30 mm was considered as the presence of AAA. Frequency of AAA was compared between CAD patients and those with no CAD. Frequency of AAA was 4.3% and 0 in patients with and without CAD, respectively (P=0.208). According to ROC curve analysis, the age of patients with CAD was ≥ 67 years. In this age group, frequency of AAA was 14% and 0 patients with and without CAD, respectively (P=0.008). Frequency of AAA was 2.2%, 5% and 8.8% in patients with 1vessel, 2vesseles and 3vesseles CAD, respectively (P=0.269). According to the current study, age is a significant risk factor for AAA in patients with CAD. Therefore, it is recommended that the screening program with duplex ultrasonography be considered in older patients with CAD.

Metabolic bone disease is a common complication of long-standing liver disease that results in osteopenic and osteoporotic bones. It can significantly affect morbidity and quality of life of these patients. Fractures are also associated with an increased mortality. The aim of this study was to compare the rate of bone mineral density (BMD) between patients with chronic liver disease and healthy control group. Thirty patients with chronic liver disease and twenty-seven individuals without chronic liver disease (Control group) were enrolled in this study. The chronic liver disease group included post hepatitis cirrhosis, autoimmune hepatitis, and primary biliary cirrhosis and primary sclerosing cholangitis. The cirrhotic patients were divided to Child- A, Child- B and Child- C by severity. The control group was free of any hepatic disease and any other factor leading to alterations in bone density. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (DEXA) at lumbar spine and femoral neck. Although statistically not significant, the mean bone mass (mean Z. Score) was lower and the frequency of osteoporosis was higher in chronic liver disease compared to those of the control group (P>0.05). The mean bone mass was decreased from Child-A to Child-C (P>0.05). The results of this study confirmed that chronic liver disease could reduce BMD and increase the frequency of osteoporosis. This risk increases with severity of cirrhosis. The evaluation of the patients according to their age, gender and Child classification, and also having the risk factors for osteoporosis is necessary for performing BMD screen test for those who have chronic liver disease.

Total anomalous pulmonary vein connections are formed 1-3% of all congenital heart disease. There isn’t any priority with respect to the gender. Nowadays total correction is associated with less mortality and morbidity. Obstruction of pulmonary vein maybe is intern sic forms of disease or perhaps it would be the complication of after surgery. All of the neonates and the patients who were admitted in children hospital and all the patients who were admitted in Madani Hospital for surgery and their diagnosed were TAPVC were contained in this study. Diagnoses were on the base of echocardiography and cathetrism and in two cases of them were associated with CT angiography. The age of surgery, associated diseases, syndrome, existing PH, the need for type of TAPVC, existing heart failure after surgery, the period of hospitalization in ICU and the period of using of mechanical respirator and need to a mechanical reventilation, need to long term inotrope after surgery, rhythm of after surgery, existing pulmonary venous obstruction before and after surgery of patients was recorded in questioner. The data was entered to computer by using SPSS software and they were analyzed by using statistical tests T-Test, X2 and one way ANOVA. 23 patients with TAPVC were entered to this study. 16 patients were male and 7 patients were female. 8 patients were dead before the surgery. 15 patients were operated. The average age was 36/29±30/20 months. From the 15 operated patients, 8 patients were supra cardiac in which 4 patient (26.7%) of them returned to SVC (1case returned to azygous vein) and the rest 3 patient (26.7%) returned to left in nominate vein. 4 patients were dead (26.7%). Nowadays the early correction of TAPVC is company with less mortality and morbidity. Using of inhaled Nitric Oxide for controlling of pulmonary hypertension is necessary and we must think about providing for this gas in this hospital. The age of operated patients were high that was because of lately see pediatric cardiologist in higher ages. So it is so necessary to inform the parents about congenital heart disease. Diagnosis and treatment of obstruction of pulmonary (either by intrinsic or extrinsic) veins maybe resolved with resurvey or putting Stent which using of it in this center will be beneficial.

Admission to an intensive care unit is recognized as an extremely stressful experience for both patients and their families. Also the responses of nurses to visitors in ICU unit are different. Because of the problems that visitors cause for patients and unit managing they limit visits. At present, family visiting policy at intensive care units contains more limitations. The aim of this study was to analyze the effect of open ICU visiting on nurses and family's beliefs about nursing care. A semi-experimental study was designed. Because of the opposition to changing visiting policy at wide level, sample was contained 14 employed nurses at intensive care unit from Sina hospital in Tabriz, from 2007 to 2008, which each completed one researcher-structured questionnaire. Questionnaire was developed by using likert scale with 28 questions about personal and social factors of nurse's beliefs about changing visiting policy from restricted to open and its validity and reliability was calculated. Results showed that before changing in visiting policy nurse's beliefs was negative (78/6). Based on maximum score= 4 mean of scores was 76.71±6.31 and after open visiting was 79.64±5.94. Difference between scores distribution of nurse's beliefs before and after changing visiting policy was meaningful by using Wilcoxon test (P= 0.038). And correlation between nurse's beliefs and social factors was not meaningful (r= 0.053, P= 0.85). According to study findings, predominant factors in nurse's beliefs were social factors, specially: colleague's believes, supervisors roles, unit managers and policies.

The prevalence and magnitude of childhood obesity are increasing dramatically. Childhood obesity has contributed to an increased incidence of metabolic syndrome among children. This study aimed at evaluating the prevalence of metabolic syndrome in obese children and adolescents and investigating its association with various degrees of obesity. This descriptive, cross-sectional study was carried on 235 overweight and obese children and adolescents aged 4 to 18 years. After physical examination, blood pressure and body mass index (BMI) were assessed. The subjects were classified according to CDC 2000 data of body mass index: 1. at risk for Over weight (95th percentile>BMI>85th percentile), 2.Over weight (97th percentile > BMI ≥ 95th percentile), 3.Very over weight (BMI ≥97th percentile). After conversion of BMI to a Z-Score, we defined obesity on the basis of Z-Score ≥ 2. Plasma glucose and lipids profile were measured after 12 hr fasting. Metabolic syndrome was diagnosed when at least three of following were present: Blood pressure>95th percentile, HDL-cholesterol <5th percentile, Triglyceride > 95th percentile, BMI Z-Score ≥ 2 (all adjusted for age and sex) and fasting glucose > 100 mg/dl. The overall prevalence of the metabolic syndrome was 31.9%. Prevalence increased with weight status; Metabolic syndrome was in 11.6%, 6.3%, and 40.8% of at risk for overweight, over weight and very over eight cases, respectively (P<0.0005). The high serum triglyceride was the most common component of the metabolic syndrome (53.2%). Low HDL-cholesterol, hypertension level and fasting hyperglycemia was present in 24.7%, 20.4%, and 28.9% of the subjects, respectively. There was significant correlation between impaired fasting glucose and severity of obesity (P<0.05). The prevalence of the metabolic syndrome is high among overweight and obese children and adolescents, and increases significantly with severity of the obesity. This study indicates the necessity of early prevention through constant education about correct nutrition and physical activity.

Presence of variations in middle cerebral artery (MCA) is one of difficulties encountered during diagnostic and therapeutic procedures. Although the frequency of these variations is low in MCA, a high rate of aneurysms in this artery makes it necessary to recognize these variations and to know their prevalence. This study aimed at evaluating the variations in MCA in 100 male human brains in East Azerbaijan province. In a descriptive study, dissection results of 100 male human brains died of different etiologies were studied in Forensic Medical Center of East Azerbaijan during one year. After photographing the fresh samples, bilateral MCAs were reviewed and the variations were categorized. The results were compared with reference schemes in related books of anatomy. In this study, 100 male human brains, aged 25 to 50 years, were dissected. Central or perforating branch was normal in all cases. The reference anatomical scheme was seen in 43% of cadavers. Duplicated MCA was seen in 1% of samples; however, accessory MCA was not detected. According to our results, frequency of the main variations including duplicated and accessory MCAs is moderate to low. Other variations are not significant regarding diagnostic and therapeutic procedures.

Osteoarthritis, the most common joint disease of humans, is a non-inflammatory disease. However, an inflammatory component may be present in some patients at some phases of the disease. In this study, we aimed to compare the effect of oral prednisolone with intra-articular corticosteroid injection in treatment of inflammatory osteoarthritis of knee. In randomized control study, we evaluated 33 patients with inflammatory osteoarthritis of knee. In 18 patients, triamcinolone (40mg) was injected intra-articularly and in 15 patients oral prednisolone (25mg per day) was administered for 10 days. Clinical response was assessed with severity of knee pain, duration of morning stiffness (min), joint effusion and joint warmth at 0, 10, 30, 60 days of treatment. Pain reduction in intra-articular injected group was significantly more than that in oral preduislone group in days 10 (P<0.0001), but the difference between two groups in days 30 and 60 was not significant. There was significant reduction in duration of morning stiffness (P<0.0001), joint effusion (P< 0.008) and joint warmth (P< 0.05) in both groups and no significant difference was seen between them in days 10, 30, and 60. Therefore, although intra-articular steroid rapidly reduced knee pain, in general oral prednisolone is as effective as intra-articular triamcinolone in improvement of inflammatory signs of knee osteoarthritis at 2 months.

Serum paraoxonase (PON1) is a high-density lipoprotein (HDL)-associated esterase that can prevent the formation of oxidized low-density lipoprotein (ox-LDL). PON1 activity is reduced in cardiovascular diseases. In the present study, distribution of PON1 phenotypes in patients with coronary artery disease (CAD) was determined. Also, as studies on the association between PON1 activity and the extent of coronary stenosis are limited, the relationship between paraoxonase and arylesterase activities of PON1 with extent of coronary stenosis has been investigated. Sixty one patients with coronary stenosis of <50% and sixty three patients with coronary stenosis of >70% were included in this study. Paraoxonase and arylesterase activities were measured using paraoxon and phenylacetate as substrates, respectively. Phenotyping of the PON1 Q192R polymorphism was determined by double-substrate method. In patients with stenosis of <50%, 41%, 46% and 13% of the patients belonged to phenotypes of Q, QR and R, respectively. The corresponding values in patients with stenosis of >70% were 48%, 41% and 11%, respectively. Patients with stenosis of <50% had significantly higher paraoxonase and arylesterase activities (P= 0.02 and P = 0.04, respectively) compared to those with stenosis of >70%. The levels of HDL-C in patients with stenosis of <50% were significantly higher than those of >70% stenosis group (P=0.025). In the present study, phenotype distribution of PON1 in subjects with CAD was determined. Also, there were significant differences in paraoxonase and arylesterase activities and also HDL-C levels between patients with coronary stenosis of <50% and those with coronary stenosis of >70%. Therefore, this study provides further support for the important role of paraoxonase activity in coronary atherosclerosis.

Entamoeba infection is a major cause of dysentery in developing countries. Association between Entamoeba histolytica as a protozoa and occurrence of hemolytic uremic syndrome is growing. On the other hand, metronidazole is also deemed as a cause of hemolytic uremic syndrome. This may make the clinicians suspicious about the real pathogenesis of hemolytic uremic syndrome. In this case report a 9 year old girl presented to emergency department with acute renal failure following an amebiasis dysentery and 5 days of metronidazole usage. With diagnosis of hemolytic uremic syndrome, the patient was put under appropriate treatment protocol.