مجله دانشگاه علوم پزشکی اردبیل
پیاپی 11 (بهار 1383)

Paraplegia can be caused by different factors like rupture or repair of the aortic aneurysm or aortic thrombosis, aortic dissection, anterior spinal cord artery emboli, coagulation disorders and lupus disease, all of which cause impaired spinal cord blood flow and spinal cord ischemia. In addition, hypotension may be the cause of spinal cord infarction but Medline researches have reported a few cases of spinal cord infarction in patients laparotomized for the reasons other than aortic lesions. In this paper we report one case of paraplegia who had experienced spinal infarction and paraplegia after internal bleeding and two times laparatomies due to long lasting hypotension. In this case regarding the patient ’ s age, occupation and physical health, the possibility of cardiovascular lesions and consequent thromboembolism seems very unlikely. Furthermore, considering the two operations performed and the temporal space between them, the only factor that could have led to ischemia and infarction of the spinal cord in this patient is long-standing hypotension.

Depression is one of the most common disorders which can affect every individual. However some individuals (including the students of medical sciences) who are involved in health issues are more vulnerable in this regard. The early diagnosis of this disorder among the students can lead to primary prevention and avoid any further progression and deteriration. This in turn can result in mental health among these students as well as the society. The present study set out to investigate the rate of depression among the students of Ardabil university of medical sciences. This research is an analytic-descriptive study conducted on 324 students from Ardabil University of Medical Scinces. A questionnaire including two sections was used to collect the data. The first section was about the demographic information and the second section included questions about depression based on Beck depression test. The data were analyzed by SPSS soft waire using descriptive and analytical statistics. The results showed that 57.4% of total subjects (186 students) suffered from various degrees of depression. 128 of these students were suffering from clinical depression. The prevalence of depression among midwifery students was 21.4 %. Chi- square test showed a significant relationship among prevalence of depression in these students with their educational semester, the number of their siblings, any kind of major physical disorder in the subject or, a serious psychological problem among their family members, as well as any significant event during the previous year. According to obtained results there was a high degree of depression among medical university students and serious measures should be taken in the future in order to prevent this social concern.

The emergence of multi-drug resistant salmonella strains h ave made t h e treatment of typhoid fever difficult all over the world. It is even more complicated w h en t h e hi g h cost of newly marketed antibiotics, their side effects and arising bacterial resistance to them are considered. Knowledge of antibiotic sensitivity and resistance of salmonella can make prevention of side-effects and emergence of resistance as well as the treatment measures more effective in this region. This descriptive study was performed in a 6-year period between 1992-97 on 397 patients who were culture positive (blood and stool) in terms of typhoid. The drug resistance was determined based on the anti-biogram of salmonella separated from blood and stool culture of the patients. The total number of patients was 397 (237 males, 160 females). All of the subjects were above 12 years old. The resistance of strains of salmonella separated from the blood and stool culture to an antibiotic was 76.9 and 79.6 percent respectively. Resistance to ampicillin, amoxicillin, co-trimoxazole and chloramphenicol was highest among others. There were 60 strains with multi-drug resistance 34 of which (8.57% of all patients) were separated from blood culture and 26 (6.55% of all patients) from stool-culture. The amount of microorganisms multi-drug resistance separated from blood and stool was 6.55% and 8.57% respectively (15.12% in total). Using antibiotics without the knowledge of bacterial resistance and sensitivity can complicate the issue.

Bell ’ s palsy (BP) is a relatively common disease characterized by the sudden onset of facial paralysis. In this disease, the facial muscle is paralyzed and the patient cannot close the eye or control the saliva in the involved side. The incidence rate of this disease in the world is between 11.5-40.2 cases per 100,000. The cause of this disease is yet to be found. This study is an attempt to investigate the demographic. Characteristics of these patients as well as the environmental factors involved in this disease in Ardabil. In this cross-sectional study which was cauducted in Ardabil province during a 2-year period (2001-2003) all the patients referring to neurology clinics were evaluated by a questionuaire in terms of demographic features and whether they were affected by the disease. 140 cases (out of 6550) were affected by Bell ’ s palsy. The incidence rate was high among 20-30 year-olds (17.85%) and was equal among females and males. Incidence of BP was higher in cold seasons. A high incidence was also observed among farmers, who sweat abundantly due to their job nature. The results are consistent with hypotheses regarding viral etiologies [e.g., reactivation of herpes simplex] of Bell ’ s palsy and it can be activated by cold exposure. The results also indicated that the disease is more prevalent in cold seasons.

Ardabil province is the main area of Iran affected by relapsing fever (RF) for which Borrelia Persica is the most common cause. The aim of this study was to determine the epidemiologic characteristics of the disease, and the frequency of infection among ticks in this region in order to take necessary measures to decrease it is incidence and increase awareness about the characteristics of this disease. In this study a total of 391 patients who were diagnosed to have been effected by tick borne relapsing fever were investigatated in terms of clinical epidemiology between 1998 and 2001. The kind of Borrelia as well as the clinical characteristics of the disease were observed. The kind and prevalence of Borrelia infection was determined in 1,421 ticks collected from 130 indoor and 14 outdoor sites. The ticks were crushed and the suspension obtained was injected into the peritoneum of two mice and two guinea pigs to determine the frequency of infection among the ticks living in this region. Data including the tick species determination were collected through a questionnaire and analyzed using Chi-square and ANOVA tests. The most prevalent clinical manifestations were fever, chills and headache. Other findings included nausea, vomiting, sweating, abdominal pain, arthralgia, cough, photophobia, eosinophilia, hematuria, jaundice, petechiae and sclera congestion. Laboratory tests performed on 60 patients showed leukocytosis, high erythrocyte sedimentation rate (ESR) and anemia. Of the 1,421 ticks collected, 45.9%, 40.3% and 13.8% were infected by Ornithodoros lahorensis Ornithodoros tholozani and Argas persicus species, respectively. The prevalence of ticks was highest in Khanadabil village. The ticks collected from three villages were found to be infected with Borrelia. The clinical manifestations were similar to those reported in other studies. Petechiae occurred less frequently in our study compared to louse-borne RF. The high frequency of anemia in this region, which was not stated in other reference articles, requires further investigation.

Spinal anesthesia is one of the usual techniques in the surgery of hip fractures among the aged. On the other hand the hemodynamic complications of this method and the treatment of these complications by abundant Ir liquids and drugs such as Ephedrin and phenylephedrin have potential risk for aged patients. Intrathecal opioids have synergistic effects on the duration and quality of spinal block. Thus a number of efforts have been made to prevent the hemodynamic complications and probability of inadequate block by decreasing the dosage of local anesthetic drug and adding opioid drugs to it. This study investigates the hemodynamic effects and the quality of spinal anesthesia using the above-mentioned method. Forty-six patients above 60 years of age with hip fracture were randomized into 2 groups (A and B). Group A received a spinal of hyper tonic bupivacaine (5 mg) and fentanyl (20 m g) and group B received 12.5 mg of hypertonic bupivacaine for spinal anesthesia. Vital signs before and during the surgery, quality and quantity of blockage, amount of fluid and Ephedrine used, were recorded every 5 minutes. MAP (Mean Arterial Pressure) fall and the dosage and frequency of ephedrine consumption were significantly different in two groups. MAP decrease in-group A was 23.6 ± 10.79 and in-group B it was 36 ± 11.1 (p=0.001). The average requirement of ephedrine in the groups were 2.25 ± 3.49 mg in-group A and 10 ± 8.45 mg in-group B (P=0.001). The average occurrence of hypotension and ephedrine usage was 0.71 ± 1.08 times in-group A and 2.91 ± 2.94 times in-group B (p=0.001). 29 % of group A had pain in the terminal stage of surgery but this amount in-group B was 13.6%. Tachycardia was 29.2 % in-group A and 68.2 % in group B (p=0.001). Adding 20 m g fentanyl to bupivacaine and decreasing its dosage can prevent the complications of intrathecal anesthesia. (MAP fall and the tachycardia occurred in the process of its treatment) to a great extent. But to lower the incidence of failure and obtain reliable block, more controlled studies must be accomplished.

Inpatient information is the best source for researches, medical education, process of patient treatment and legal organizations. Moreover, correct, complete and ontime registration of this information can play a crucial role in the production of necessary data for these kinds of researches. Regarding the importance of the issue, in this study we evaluated the quality and quantity of these data in the hospitals under Ardabil University of Medical Sciences. In this research 370 rcords from eight hospitals of Ardabil were studied. In each hospital samples were selected randomly based on the number of patients hospitalized in one year. Then according to admission and discharge sheets a certain check list, was completed. The information under study including demography, admission and discharge, inter-hospital and inter-ward transfer, diagnosis, treatment, surgery, death of the patients and authentications (recorded or not) were identified in the check list. The data were analyzed using descriptive statistics. The results showed that sex, marital status, date and place of birth had not been recorded in 5.9%, 15.7%, 2.4%, 51.6% of records respectively. Primary, interim and final diagnosis and treatment measures were not recorded about 28.1%, 41.1%, 39.2% 48% of the patients respectively. Although 13% of these patients were hospitalized due to accidents, impairments and poisoning, only in 8.5% of them the external causes were recorded. At 68.6% of the records, condition on discharge and at 76.3% of them recommendation on discharge had not been recorded. 3.5% of records related to dead patients, but only in 31%, main cause and in 8% underlying couse of death was record. 25% of the studied records were not coded. 13.7% of existing codes did not match the final diagnosis. At 52.4% of these records the correct method of writing diagnosis was not observed by physicians and at 36.5% coding had not been done carefully. The results indicated that the process of medical recording by health care services was performed deficiently and this leads to the loss of valuable information about the hospitalized patients. As a result, the authorities, physicians and specialists in medical recording should pay special attention to this problem. Physicians and specialitists of medical record to this problem were necessary.

Foods of high fat may increase the risk of coagulation heart attacks. They can also increase coagulating factors and lead to higher mortality due to cardiovascular diseases and heart attacks. The aim of this study was to find out the effect of saturated (butter) and unsaturated (sunflower oil) fat intake on coagulating factors such as factor VII and fibrinogen as well as Bt, serum cholesterol and triglycerides. In this clinical trial 46 male healthy individuals from Ardabil University of Medical Sciences took part in this study (age: 18-28 years old) in 2002. These individuals were divided into two groups. The first group consumed 30 g of butter and the second group took 30g of sunflower oil everyday, for 14 days. Before the fat intake and at the end of first and second week blood sample was taken test to fibrinogen, factor VII, cholesterol, BT and triglycerid. Also during the study the 24-hour food-recall was taken three days a week. The collected data were analyzed with SPSS and Food Processor. The results indicated that butter intake increases factor VII significantly at the end of the first and second week (p<0.05). But no significant about sunflower oil. BT decreased after butter intake at the end of first and second week. This decrease was significant at the end of first week (p<0.05). Bt increased significantly after sunflower oil intake at the end of second week (p<0.05). Serum fibrinogen after butter intake decreased significantly at the end of first and second week (p<0.05), but was not significant after sunflower oil intake (p<0.05). There was no significant difference in serum cholesterol and triglyceride level after butter intake, but at the end of first week after sunflower intake serum cholesterol decreased significantly (p<0.05). We concluded that the intake of saturated fat can affect factors in a short period of time and sunflower oil can decrease serum cholesterol level and as results increase the bleeding time.

Infarctian size is the most important prognostic factor in patients with acute myocardial infarction (AMI). Reperfusion therapy using thromboliatics is the most important measure in order to limit the infarction, size. Infarction size on the other hand, associates directly with left ventricular (LV) function. The presence of Q wave on electrocardiogram (ECG) after thrombolytic therapy is associated with increased mortality during first months after AMI. Moreover electrocardiographic changes after thrombolytic therapy can predict LV function. This study is an attempt to evaluate the relationship between electrocardiographic Q wave and LV function after thrmobolytic therapy in patients with MI. 176 patients with first episode of AMI (diagnosed based on WHO criteria) who were receiving streptokinase took part in this analytical study. ECG of the first day after admission and ECG of discharge day (usually the sixth day) were evaluated in terms of the presence of pathologic Q wave. LV function was evaluated by Echocardiography using Simpson method. The data were analyzed by SPSS program using chi-square test. On discharge day 82.4% of the patients had pathologic Q wave and 17.6% were without it. 51.6% of patients without pathologic Q wave, had normal LV function (LVGF>55%) while 26.9% of them had Q wave (p= 0.001). 73.3% of males and 56.4% of females had Q wave on ECG. Presence of Q wave on ECG in patients with AMI after thrombolytic therapy correlates with LV function and indicates impaired LV function in these patients.

Studying the epidemiology and impact of headache can help improve patient care, estimation of burden of disease and classification systems. Migraine is common worldwide and has a geographically variable prevalence in the world. Moreover, its peak of incidence is the age of 20-30. The aim of this study was to determine the prevalence of migraine among the medical students in order to plan for future health interferences. In this cross-sectional study 631 students filled out a questionnaire designed according to the criteria of the international headache society. The data were analyzed using SPSS software (release 12) and descriptive statistics. 76.6% of the subjects were female and 23.4% of them were male. The females were 20.6 and males were 21.4 years old on average. The total prevalence of migraine was 7.3% (1.6% with aura, 5.4% without aura and 0.3% with both of them). Moreover, females, single subjects and students of medicine, except the migraine with aura that was more prevalent among students of associate degrees. A positive family history of headache was found in 45.6% of the students. 65.2% of those suffering from migraine had not referred to a physician and were unaware of their headache. Compared to similar researches there is a low prevalence of migraine among the students but most of the students do not take measures to cape with and treat them in the proper manner. This requires necessary health interferences