Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 582 590 EN Payam Dindoost Department of Gastroenterology, Middle East Liver Diseases Center (MELD Centers), Tehran, Iran. Narges Chimeh Department of Psychiatry, Family Research Institute, Shahid Beheshti University, Tehran, Iran. Blain F Hollinger Department of Gastroenterology, Baylor College of Medicine One Baylor Plaza, Houston, USA. Esmaeil Saberfar Department of Virology, Bayerpaul (BP) Vaccines and Pharmaceutical Company, Tehran, Iran. Mehdi Norouzi Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Seyed Mohammad Jazayeri Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Occult hepatitis B (OHB), or persistent hepatitis B virus (HBV) viremia in surface-antigen-HBsAg-negative patients, has been recognized as a medical concern during the last decade. The exact magnitude, pathogenesis and clinical relevance of OHB are unclear. This review organizes the published data on OHB and presents an overview of the current hypotheses on OHB's pathogenesis and clinical relevance.Many explanations have been offered for the pathogenesis of OHB, ranging from the inability of standard immunoassays to diagnose OHB to the involvement of the versatile virus-host factors. Also, special care should be taken regarding the diagnosis of OBH. It seems that both shared viral-host factors are involved in the pathogenesis of OBH. Further molecular studies on cohort patients group need to explore such association. https://acta.tums.ac.ir/index.php/acta/article/view/4570 https://acta.tums.ac.ir/index.php/acta/article/download/4570/4262

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 591 595 EN Ebrahim Eskandari-Nasab Genetic of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. AND Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Eslam Kharazi-Nejad Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Alireza Nakhaee Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Masoumeh Afzali Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Seyed Payman Tabatabaei Department of Cardiology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Kourosh Tirgar-Fakheri Department of Anesthesiology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Mohammad Hashemi Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. 2015 10 11 Compelling evidence suggests that the oxidative stress plays a key role in the pathophysiology of cardiovascular disease (CVD). Superoxide dismutase (SOD) enzymes play a major role in detoxification of reactive oxygen species and protection against oxidative stress. We examined the possible association between a 50-bp insertion/deletion in the SOD1 promoter 1684-bp upstream of the SOD1 ATG with CVD in an Iranian population. A total of 400 individuals including 200 CVD patients and 200 healthy subjects from the same ethnic background as the control group were participated in this study. Genomic DNA from all subjects was screened for the 50-bp SOD1 promoter deletion using a polymerase chain reaction (PCR) assay. Our finding showed an association between SOD1 DEL/DEL (9% vs. 2.5%) and INS/DEL genotypes and risk of CVD and these genotypes increased the susceptibility to CVD (OR=2.096, 95% CI: 1.336-3.286, P= 0.001 for the INS/DEL genotype; OR=4.811, 95% CI: 1.734-13.346, P= 0.003 for the DEL/DEL genotype). Additionally, the DEL allele of the SOD1 variation was found to be more prevalent in the CVD patients with the frequency of 26.3% and 13.5% in cases and controls, respectively, and this difference reached statistical significance (OR=2.281, 95% CI: 1.586-3.279, P= 0.001).  The analysis of SOD1 genotypes according to patients' characteristics revealed that the SOD1 Ins/del and Del/Del genotypes were more prevalent in CVD patients with a history of CVD or hypertension or DM (P<0.05), whereas the majority of Ins/Ins genotype carriers had no history of these diseases. Overall, our results demonstrated that SOD1 50-bp Del/Del and Ins/Del genotypes, as well as Del, allele, were associated with an increased risk of CVD. https://acta.tums.ac.ir/index.php/acta/article/view/4569 https://acta.tums.ac.ir/index.php/acta/article/download/4569/4267

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 596 600 EN Fatemeh Sadat Nayeri Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tahereh Esmaeilnia Shirvani Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Majid Aminnezhad Department of Pediatrics, Maternal-Fetal & Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Elaheh Amini Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hossein Dalili Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Faezeh Moghimpour Bijani Department of Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE method ((Intubation, Surfactant administration and extubation)). A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation) and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group). In the second group (INSURE group), surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage), PDA (Patent Ductus Arteriosus), air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia) and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005) in INSURE group in comparison to CMV group. A decline (P=0.01) in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively). This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to perform this method as the initial treatment for neonates with mild to moderate RDS. https://acta.tums.ac.ir/index.php/acta/article/view/4568 https://acta.tums.ac.ir/index.php/acta/article/download/4568/4315

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 601 606 EN Akram Beheshti Department of Dermatology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Hodda Ghadami Department of Dermatology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Ameneh Barikani Department of Community Medicine, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Fatemeh Haj Manouchehri Department of Pathology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. 2015 10 11 Vitiligo Vulgaris is a pigment disorder as the lack of skin pigmentation which its most prevalent cause is autoimmune. Vitamin D has various effects on the natural and acquired immune of the body because of its effectiveness on the T cells and B cells, macrophages and dendritic cells.The object of this study was assessment of the Vitamin D in patients with vitiligo vulgaris in dermatologic clinics in Qazvin in 2012. The 100 patients with Vitiligo were studied through a cross-sectional study. The required data were collected by the questionnaire (age, gender, job, family background, consumption of the dairies and vitamin D supplements), examination (type of skin) and para clinical test (measurement of the serum 25-hydroxyvitamin D level). The 42 (42%) and 58 (58%) people of the population under study were respectively male and female. The mean age of the population under study was 28.7±1.17. The mean serum of 25-hydroxyvitamin D level was 42±24.14 which had a significance difference with a normal level (p<0.04). The mean serum 25-hydroxyvitamin D level among patients with Vitiligo had a significance difference with a normal level. https://acta.tums.ac.ir/index.php/acta/article/view/4567 https://acta.tums.ac.ir/index.php/acta/article/download/4567/4284

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 607 612 EN Elaheh Hooshmand Department of Health and Management, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran. AND Department of Health and Management, Health Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Sogand Tourani Department of Health Services Management, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran. Hamid Ravaghi Department of Health Services Management, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran. Hossein Ebrahimipour Department of Health and Management, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran. AND Department of Health and Management, Health Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2015 10 11 Lack of scientific and confirmed researches and expert knowledge about evaluation systems for clinical governance development in Iran have made studies on different evaluation systems for clinical governance development a necessity. These studies must provide applied strategies to design criteria of implementing clinical governance for hospital's accreditation. This is a descriptive and comparative study on development of clinical governance models all over the world. Data have been gathered by reviewing related articles. Models have been studied in comprehensive review method. The evaluated models of clinical governance development were Australian, NHS, SPOCK and OPTIGOV. The final aspects extracted from these models were Responsiveness, Policies and Strategies, Organizational Structure, Allocating Resources, Education and Occupational Development, Performance Evaluation, External Evaluation, Patient Oriented Approach, Risk Management, Personnel's Participation, Information Technology, Human Resources, Research and Development, Evidence Based Medicine, Clinical Audit, Health Technology Assessment and Quality. These results are applicable for completing the present criteria which evaluating clinical governance application and provide practical framework to evaluate country's hospital on the basis of clinical governance elements. https://acta.tums.ac.ir/index.php/acta/article/view/4566 https://acta.tums.ac.ir/index.php/acta/article/download/4566/4296

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 613 618 EN Payam Sarraf Department of Neurology, Iranian Center of Neurological Research, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mahrooz Malek Department of Radiology, Medical Imaging Center, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran Iran. Mahsa Ghajarzadeh Department of Neurology, Brain and Spinal Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran. Shahin Miri Department of Medical, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ehsan Parhizgar Department of Medical, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Seyedeh Zahra Emami-Razavi Department of Physical Medicine & Rehabilitation, Brain and Spinal Injury Research Center (BASIR), Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It accounts 90% of all entrapment neuropathies all over the world. Ultrasound is a non-invasive, cost effective and available para-clinical method which could be applied for CTS diagnosis. Cross-sectional area of the median nerve at the level of the inlet is considered as a diagnostic criterion in CTS cases. In this study, thirty-eight patients with electrophysiologically confirmed idiopathic CTS and 22 healthy controls were enrolled. Seventy-one affected nerves and 42 unaffected nerves were evaluated within 14 days after electrophysiological examination. The largest cross-sectional area (CSA) was measured at the level of the carpal tunnel inlet and the maximum nerve perimeter was also recorded by means of the software. Mean CSA and perimeter were 14.02 ± 4.5 mm2 and 1.7±0.28m in all patients and 8.2±2.1 mm2, 1.3±0.19 m in controls (P<0.001, P<0.001). Mean CSA and Perimeter were significantly different between patient's groups and control. The best cut off point for CSA of the tunnel inlet was 10.5 mm2 with sensitivity and specificity of 80% and 76% (AUC (Area under the Curve) = 0.9, P<0.001). The best cut off point for inlet perimeter was 1.44 m with sensitivity and specificity of 85% and 77 % (AUC=0.87, P<0.001). Our findings showed that median nerve CSA at carpal tunnel inlet could be used as the diagnostic criteria for CTS. https://acta.tums.ac.ir/index.php/acta/article/view/4565 https://acta.tums.ac.ir/index.php/acta/article/download/4565/4332

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 619 622 EN Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Akbar Mokhtarpour Department of Dermatology, Ardebil University of Medical Sciences, Ardebil, Iran. Mohammad Reza Saki Department of Medicine, Student Research committee, Shiraz University of Medical Sciences, Shiraz, Iran. 2015 10 11 Hand eczema is a common distressing skin problem. It is an immune reaction to haptens. Thus, substances that inhibit Immune system can be effective in the treatment of hand eczema. In this study, topical fumaric acid 5% cream is compared with topical steroid in the treatment of hand eczema. Patients with hand eczema were randomly divided into two groups. One group received fumaric acid 5% in a cream base, and the other received triamcinolone 0.1% in the same cream base. Both groups used creams twice daily for one month. Patients were checked for erythema, excoriation, population and lichenification, EASI score, and pruritus before and after treatment. In both groups, the mean of all signs of the disease and EASI score decreased after one month of treatment. There was no significant difference between the two treatments in decreasing erythema, but excoriation, population, lichenification, EASI score and itching were all decreased more in triamcinolone 0.1 % group. Although fumaric acid can inhibit the immune system; it was less effective for the treatment of all signs of hand eczema except erythema in comparison to triamcinolone. These results may be justified for two reasons: low penetration of topical fumaric acid through the skin or a low concentration used in this study. https://acta.tums.ac.ir/index.php/acta/article/view/4580 https://acta.tums.ac.ir/index.php/acta/article/download/4580/4508

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 532 544 EN Marjan Ghazisaeidi Department of Health Information Management, Faculty of allied medical Sciences, Tehran University Medical Sciences, Tehran, Iran. AND Department of Health Information Management, Faculty of Health Management and Information Sciences, Iran University Medical Sciences, Tehran, Iran. Maryam Ahmadi Health Management and Economics Research Center, Faculty of Health Management and Information Sciences, Iran University of Medical sciences, Tehran, Iran. AND Department of Health Information Management, Faculty of Health Management and Information Sciences, Iran University Medical Sciences, Tehran, Iran. Farahnaz Sadoughi Department of Health Information Management, Faculty of Health Management and Information Sciences, Iran University Medical Sciences, Tehran, Iran. . Reza Safdari Department of Health Information Management, Faculty of allied medical Sciences, Tehran University Medical Sciences, Tehran, Iran. 2015 10 11 Readiness assessment provides a proper image of the existing conditions and an explanation of facilitated operational plans and functional approaches to successful implementation of electronic health record. Readiness assessment requires indices adjusted to particular conditions in each country. Therefore, the present study attempts to provide an acceptable model in Iran and to provide an assessment of public and teaching hospitals in medical education university. After reviewing related papers and descriptive study of five selected countries, the initial model was designed in the form of a questionnaire for analysis through Delphi and distributed among 30 experts nationwide. Along identification of components in the proposed method, a 7-point Likert scale was used to determine priority of each component. Then, all general -education hospitals at Tehran University of Medical Education were examined based on this model in terms of total, relative, or no readiness. The final model was designed in five dimensions: cultural, leadership and management, technical infrastructure, governance and operational dimensions; Educational Hospitals were evaluated in this dimension. 28.6 % of general--teaching hospitals are ready for pre-implementation. It seems to establish uniform strategic and executive team in Health center is essential for the preparation them in abovementioned area in the least possible time. https://acta.tums.ac.ir/index.php/acta/article/view/4579 https://acta.tums.ac.ir/index.php/acta/article/download/4579/4509

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 545 551 EN Abdolreza Medghalchi Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Science, Rasht, Iran. Mohammad Javad Mohammadi Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Science, Rasht, Iran. Reza Soltani Moghadam Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Science, Rasht, Iran. Hossein Dalili Departments of Pediatrics, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Congenital nasolacrimal duct obstruction (CNLDO) is a common disease in children. The classic treatment of CNLDO is probing that was done around one year old. However, controversy exists regarding the outcome of probing in children older than one year. This study aimed to find the cure rate of initial probing for CNLDO and identify factors producing the failure rate in old age. In this retrospective interventional case series study, 100 eyes of 92 patients aged 9-48 months with CNLDO underwent probing with general anesthesia. According to the intraoperative results of probing, CNLDO were categorized in two groups of membranous obstruction at the end of nasolacrimal duct obstruction (NLD) and complex obstruction at canaliculus, lacrimal sac and N LD. Patients were categorized in three groups according to the age of probing into under 12, 12 to 24 and over 24 months. Success rate was defined as successful irrigation of NLD intraoperatively and absence of lacrimation and discharge at 1 week, one, three and six months postoperatively. The average age of patients and probing were 47.35±25.59 and 17.32±7.85 months respectively. Membranous obstruction accounted for 72% of patients and remainder had complex type. An overall cure rate of 91%, 89% and 60% was found in patients aged 9-12, 12-24 and 24-48 months respectively. Surgery success rate after six months was 91% in membranous group and 52% in complex group. There was a significant relation between the type of obstruction and opening of NLD (p<0.O01). This study showed that the probing failure of probing after one year was related to the complexity of obstruction rather than the age of the patient. It is recommended that probing could safely be done in under 4 years old. https://acta.tums.ac.ir/index.php/acta/article/view/4578 https://acta.tums.ac.ir/index.php/acta/article/download/4578/4511

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 552 556 EN Hossein Dalili Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmadreza Farsar Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamed Barakati Child Health Office, Ministry of Health and Medical Education, Tehran, Iran. Farima Raji Maternal- fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal- fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Farshad Pourmalek Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Parvaneh Musavi Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Susan Saadvandian Child Health Office, Ministry of Health and Medical Education, Tehran, Iran. Manijeh Yunesi Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohadeseh Fallahi Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 This study was designed to assess the frequency of exclusive breastfeeding in two health centers of Shahid Beheshti University of Medical sciences in Khak Sefid, Tehran, Iran. A total of 175 mothers, referred for the third dose of their infants' DPT vaccination program participated in the study by completing a questionnaire regarding characteristics of their pregnancy, delivery and exclusive breastfeeding within the first six months of birth. Two-variable analysis and logistic regression test were applied to evaluate factors influencing exclusive breastfeeding. Results indicated that the frequency of exclusive breastfeeding, i.e., breastfeeding within the first six months of birth without the use of any other food with or without vitamin supplementation, was 31.17% (95% CI=23.77%-38.57%), which means 48 infants of 154<179 days old Among 154 infants (<179 days old) 48 did not have a history of being separated from their mothers. In logistic regression analysis, the variables which were directly associated with exclusive breastfeeding, with 0.05 significance level of alpha, included breastfeeding within the first hour of birth, eight times or more breastfeeding per day and receiving breastfeeding education during pregnancy. Variables with a negative association with breastfeeding included lack of breast milk, presence of a breast problem that could hinder breastfeeding, bottle feeding, physician or family's advice not to breastfeed and infant's refusal to breastfeed. Frequency of breastfeeding within the six months of birth is less than similar frequencies which are obtained by asking about breastfeeding on the day of the interview. It is recommended to apply real frequency for assessment, evaluation and programming of exclusive breastfeeding during the first six months of birth. https://acta.tums.ac.ir/index.php/acta/article/view/4577 https://acta.tums.ac.ir/index.php/acta/article/download/4577/4512

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 557 561 EN Ali Labaf Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Kazem Jamali Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Jalili Department of Emergency Medicine, Center for Educational Research in Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Hamid R Baradaran Center for Educational Research in Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Parisa Eizadi Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 To evaluate the effect of frequent feedback on residents' communication skills as measured by a standardized checklist. Five medical students were recruited in order to assess twelve emergency medicine residents' communication skills during a one-year period. Students employed a modified checklist based on Calgary-Cambridge observation guide. The checklist was designed by faculty members of Tehran University of Medical Science, used for assessment of students' communication skills. 24 items from 71 items of observational guide were selected, considering study setting and objects. Every two months an expert faculty, based on descriptive results of observation, gave structured feedback to each resident during a 15-minute private session. Total mean score for baseline observation standing at 20.58 was increased significantly to 28.75 after feedbacks. Results markedly improved on "gathering information" (T1=5.5, T6=8.33, P=0.001), "building relationship" (T1=1.5, T6=4.25, P<0.001) and "closing the session" (T1=0.75, T6=2.5, P=0.001) and it mildly dropped on "understanding patients view" (T1=3, T6=2.33, P=0.007) and "providing structure" (T1=4.17, T6=4.00, P=0.034). Changes in result of "initiating the session" and "explanation and planning" dimensions are not statically significant (P=0.159, P=0.415 respectively). Frequent feedback provided by faculty member can improve residents' communication skills. Feedback can affect communication skills educational programs, and it can be more effective if it is combined with other educational methods. https://acta.tums.ac.ir/index.php/acta/article/view/4576 https://acta.tums.ac.ir/index.php/acta/article/download/4576/4514

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 562 564 EN Nasser Janmohammadi Department of Orthopedics, Mobility Impairment Research Center, Babol Medical Sciences Center, Babol, Iran. 2015 10 11 Numerous causes are reported for ulnar nerve compression at the wrist, known as Guyon's tunnel syndrome. In the present article, a patient with Guyon's tunnel syndrome during pregnancy concomitant with an anomaly of ulnar nerve is described. A 29-year-old Iranian woman presented with clinical features of Guyon's tunnel syndrome (pain and paresthesia in the fifth finger of the left hand and atrophy of the first dorsal interosseus muscle). Symptoms of the patient appeared during the third trimester of pregnancy. Electro diagnostic studies confirmed Guyon's tunnel syndrome. Surgical exploration revealed an anomalous arch of the ulnar nerve passing through the flexor carpi ulnaris (FCU) tendon. The anomalous arch of the ulnar nerve was released by resection of the segment of FCU tendon passing through the ulnar nerve arch. Therefore, in patients with Guyon's tunnel syndrome, the ulnar nerve anomaly should be kept in mind as a cause. Moreover, pregnancy may have a provocative effect on Guyon's tunnel syndrome similar to carpal tunnel syndrome (CTS). https://acta.tums.ac.ir/index.php/acta/article/view/4575 https://acta.tums.ac.ir/index.php/acta/article/download/4575/4515

Tehran University of Medical Sciences Acta Medic