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Introduction: Reconstruction of defects in heel and malleoli with exposed bone has always been a challenge. Heel is a weight bearing region which needs sensation. Distally-based sural island flap is one of the options available for these kinds of defects. Here, in this study we have paid special attention to how these flaps become sensate.
Materials and Methods: This case-series study carried out on 14 patients who reffered to 15 Khordad Hospital, Tehran, from 2000 to 2003 and their defects had been covered with distally based sural island flap. Appearance of pain, temperature, light touch and two - point discrimination evaluated in flap region and compared with the contralateral site.
Results: From 14 patients with this flap; 11 subjects (9 males and 2 females) entered into the study. Seven subjects had been injured during motorcycle accident. In 10 patients (91%), two-point discrimination in flap region was.13.2 mm, which was the same as the other side.
Conclusion: Covering the defects in heel, malleoli and distal third of leg with sural island flap is technically easy and with minimal donor site morbidity. Major vessels in the lower extremities are spared and this flap can be used in weight bearing areas with relatively good sensation.

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Introduction: There are a few clinical trials on human that show the effect of topical vitamin E on keloid and hypertrophic scars. In this investigation we try to study this effect and also show the effect of the concentrations which have not been considered yet in improving hypertrophic scar and keloid healing. Materials and Methods: In a double-blind randomized clinical trial, 32 patients who had hypertrophic scar from 12 weeks ago were given three ointments including placebo and ointments contaning injectional vitamin E (d-α tocopheryl) with different concentrations (300Iu/mg and 600Iu/mg). The scars size, erythema and hardness were evaluated by patients and physicians after 1, 4 and 12 weeks. Data was analyzed using ANOVA and Kruskal Walis tests. Results: After 12 weeks there were no signs or symptoms of dermatitis and rash. Comparison of the scar size after 1 week showed difference between the high concentrated ointment with the others and in the 12th week all of the ointments were different (p<0.001). Evaluation of the scar erythema, in the 1th, 4th and 12th week showed significant difference between vitamin ointments and placebo (p<0.001), also scar hardness in the 12th week was significantly different between groups(p<0.001), but in the first and 4th week no difference was detected in hardness. Conclusion: This study shows that topical vitamin E has good effects on keloid and hypertropic scars. Their effect in decreasing size and erythema is more considerable than scar hardness.

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Introduction: Cataract is one of the most important and a major disease in human. The prevalence of cataract in age 65-74 get to 50%, and over 75 it arrives to 70%. Absolute cure for cataract is surgery that can be done by different techniques such as intracapsular, extracapsular, and phacoemulsification. Cataract surgery has different side effects such as hemorrhage, Glaucoma, posterior capsular opacification and astigmatism. This study decides to compare astigmatism after two techniques of cataract surgery phaco and extracapsular. Materials and Methods: This study is a double blind randomized clinical trial, which has been experienced on 112 patients. Patients were divided in two groups (A and B). In group A surgery was done by phaco technique which has a small incision of 3.2 mm and does not need suture. But in group B, (extracapsular group) the incision is bigger about 10 mm and needs suture. Then keratometry was done for each patient before surgery, one week and 2 months after surgery for determining astigmatism. Data was analyzed by independent and paired sample T tests. p< 0.05 was considered meaningful. Results: From 112 patients that had been studied, 56 patients underwent phaco technique and 56 patients underwent extracapsular technique. Mean of astigmatism before surgery in group phaco was 0.79±0.71 D and in extracapsular was 0.90.55 D (p>0.05). Mean of astigmatism 1 week after surgery in phaco group was 1.110.72 D and in extracapsular group was 3.991.46 D (p<0.05) and mean of astigmatism two months after surgery in phaco group was 1.00.71 D and in extracapsular group was 3.281.29 D (p<0.05). Conclusion: Induced astigmatism in phaco group was 0.21 D and in extracapsular was 2.38 D, that has meningful difference. Other criteria such as age, lens number, sex and left or right eye do not have any effect on induced astigmatism.

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Introduction: In order to determine the importance and power of physical examination diagnosis, we decided to compare the results of physical examination in patients with distal forearm penetrating wound and whatever is observed during surgery as golden standard. Materials and Methods: This cross-sectional analythical study was performed on 91 patients with distal forearm sharp injury. Findings of physical examination were compared to what was found during surgery (definitive diagnosis) as golden standard. Results: Based on findings, physical examination value of diagnosis for FDP and FDS was determined. In FDS clinical examination value had 88% sensitivity, 40% specificity, 94% positive predictive value, 22% negative predictive value and 1.46 positive likelihood ratio, and 0.3 negative likelihood ratio and FDP clinical examination value had 97% sensitivity, 25% specificity, 93% positive predictive value, 50% negative predictive value, 1.29 positive likelihood ratio and 0.12 negative likelihood ratio. Conclusion: Physical examination view point of rule in of flexor tendon injury because of sharp and penetrating trauma is more valuable than rule out.

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Introduction: Oral Ketamine is used as a low side effect analgesic in comparison with opioids, in different pain syndromes. This study is designed to evaluate the effect of oral Ketamine in renal colic treatment. Materials and Methods: In this clinical trial study 104 patients with renal colic, hospitalized in emergency department, were divided in to two groups by Random block design. Group B received Pethidine (1 mg/kg up to 100 mg) and placebo, and group A received Pethidine with the same dose and Ketamine (0.5 mg/kg). All patients were assessed for pain by using VAS chart, for nausea by a 0-3 scale and for the number of vomiting at baseline and 1, 2 and 3 hours after taking drug. The results were analyzed by t-test. Results: Average pain score and vomiting in all times and nausea score in one and three hours after receiving drugs were reduced significantly in patients who took Pethidine and Ketamine comparing patients who took Pethidine and placcbo(p < 0.05). Conclusion: Regarding the significant effect of Ketamine in reduction of pain, nausea and vomiting without side effects, it is possible to use Ketamine as an adjuvant drug in treatment of renal colic and to reduce narcotic dosage.

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Background: Today, the use of nano-materials is one of the most common methods of making modern medications these materials are very useful in increasing the accessibility of drugs to target. The aim of this study is to obtain immunogenic nano-vaccine against meningitis caused by Haemophilus influenza.

Materials and Methods: In this experimental study, the PRP (polyribosylribitol phosphate) antigen of Haemophilus influenza was conjugated to keyhole limpet hemocyanin (KLH), a powerful immunogen molecule, and a nanoparticle with high adsorption called poly lactic co-glycolic acid (PLGA). The two-part and three-part conjugated antigens were injected into male SW1 race mice. The animals were randomly divided into five groups, which received PRP, PRP+KLH, PRP-KLH, PRP-KLH-PLGA, and PRP-TT intramuscularly together with complete Freund’s adjuvant, respectively. Twenty eight days after injection, blood samples were obtained and increases in serum antibody titer were determined with ELISA technique. For evaluation of the amount of the produced antigen cell entrance into immune cells, immune cells uptake assay and flow cytometry technique were used.

Results: The results showed increases in serum IgG antibody titers of animals immunized with conjugate vaccines. The findings also suggest the higher phagocytosis of conjugated triplex-containing nanoparticle by host immune cells.

Conclusion: The findings of this study indicate that antigen-containing PLGA has considerably higher absorption and immunogenicity and can be more powerful vaccines against Haemophilus meningitis.

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Background: The speech disorders may produce irreparable damage to childs speech  and language development in the psychosocial view. The voice, speech sound production and fluency disorders are speech disorders, that  may result from delay or impairment in speech  motor control mechanism, central neuron system disorders, improper language stimulation or voice abuse.

Materials and Methods: This study examined the prevalence of speech disorders in 1393 Arakian students at 1 to 6th grades of primary school. After collecting continuous speech samples, picture description, passage reading and phonetic test, we recorded the pathological signs of stuttering, articulation disorder and voice disorders in a special sheet.

Results: The prevalence of articulation, voice and stuttering disorders was 8%, 3.5% and%1 and the prevalence of speech disorders was 11.9%. The prevalence of speech disorders was decreasing with increasing of student’s grade. 12.2% of boy students and 11.7% of girl students of primary school in Arak had speech disorders.

Conclusion: The prevalence of speech disorders of primary school students in Arak is similar to the prevalence of speech disorders in Kermanshah, but the prevalence of speech disorders in this research is smaller than many similar researches in Iran. It seems that racial and cultural diversity has some effect on increasing the prevalence of speech disorders in Arak city.

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Background: Understanding the real needs of children with cerebral palsy and their families  helps the therapists to provide adequate health care service for them. This study aimed to determine the needs  of  mothering handling training for family caregiving of children and youth with CP at home based on the level of gross motor function.

Materials and Methods: This research was a descriptive, analytical and cross sectional study that was performed on 186 children 4-12 year olds with CP from the rehabilitation clinics in the city of Arak. They were selected by simple and purposeful sampling. Clinical tests were Gross Motor Measure Function Classification System Expanded & Revised (GMFCS E&R) to assess the severity of gross motor function lesions and canadian Occupational performance measure (COPM) to determine the needs. Data were analyzed by descriptive tests such as: statistical test and two-way ANOVA.

Results:  The most important need of mothering handling training was self care training specially toileting, feeding, eating and functional mobility related to children with CP in the level of V of GMFCS E&R (transported in a manual wheelchair). There were no significant differences in needs of mothering handling training in areas of sex and severity of gross motor function lesions (p>0.05).

Conclusion: It seems that therapists should combine maternal handling trainings with other interventions in therapy programs, especially in the area of self- care.

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Abstract

Background: One of the problems in children with cerebral palsy is impaired eating and drinking liquids. The purpose of this study is to compare the effect of oral motor stimulations on feeding function in the children with spastic cerebral palsy by two medical and family centered approaches.

Materials and Methods: This research was a descriptive-analytical cross sectional study that performed on 40 children 2-8 year olds with spastic Cerebral Palsy from the rehabilitation clinics in the city of Arak. They were selected by simple and purposeful sampling. Applied instruments were Gross Motor Measure Function Classification System Expanded & Revised (GMFCS E&R) and oral motor assessment scale(OMAS). Data were analyzed by statistical tests such as: Kolmogorov-Smirnov, reporting mean, standard deviation, data analysis frequncy distribution table, independent t-test, dependent t-test, chi-square and MANOVA.

Results: The difference of swallowing function assessed by OMAS in both groups managed by family centered and clinician centered approach prior and post management statistialy was meaningful (p=0.001(. The difference between swallowing function of both groups post intervention was not meaningful in view of first and second assessor, also it had no statistical significance(p=0.89 , p=0.07)

Conclusion: In general, we can conclude that oral motor stimulation is effective on swallowing function of cerebral palsy children in both treated groups. The effect of these stimulations on swallowing function in children with cerebral palsy between clinician centered and family centered approaches was equal.

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Background and Aim: Swallowing disorder is a common and constant problem in people with Down Syndrome. In experimental method electromyography can be used to evaluate Mastication . The aim of this study was to evaluate the electromyography of the masseter and temporal muscles during Mastication in 2 to 12 years old children with Down syndrome in Arak.
Material and methods: This is a descriptive-analytical and case-control study, that conducted with the purpose of electromyographic study of masseter and temporal muscles during Mastication  on 15 children from available 2 to 12 years old Down Syndrome and 15 children that were matched according the method of person-to-person matching in terms of age and gender with samples with Down syndrome
Ethical considerations: In this study, conscious consent was obtained from all parents and no physical harm was inflicted on individuals.
Findings: About the comparison of the mean of amplitude (intensity) of electrical signal of muscle between two groups except right temporal muscle during Mastication  and about the mean of the mean frequency when Mastication  except for left temporal muscle, in other cases the difference was significant. In the case of comparing the median frequency of the electrical signal of the muscle in most muscles the difference was not significant.
Conclusion: Mean amplitude (intensity) and frequency of the mean electrical signal of the muscle when chewing in most muscles was different between the two groups with Down syndrome and normal, but the differences in mean median frequency in most muscles were insignificant.