مجله دانشگاه علوم پزشکی اردبیل
پیاپی 13 (پاییز 1383)

Laryngoscopy and tracheal intubation may lead to tachycardia, hypertension and dysrhythmia or myocardial ischemia. In this double blind study, the effects of midazolam and lidocaine on hemodynamic response to endotracheal intubation have been examined. 52 ASA class one patients, aged 20-50, who were candidate for elective inguinal hernia surgery with general anesthesia, were randomly assigned to two groups. All patients received normal saline or Ringer's lactate solution (5ml/kg) about 5-10 minutes before induction of anesthesia and were preoxygenated for 3 minutes. Group 1 received midazolam (0.05 mg/kg) and group 2 received lidocaine (1.5 mg/kg) during 3 minutes prior to intubation. Anesthesia was induced with fentanyl (100 µ g) and thiopental (5 mg/kg) and trachea was intubated by the aid of succinyl choline (1.5 mg/kg). Anesthesia was maintained with halothane (0.5-0.75%) and equal proportions of nitrous oxide and oxygen. Systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate were recorded before premedication and intubation, as well as immediately two and five minutes after intubation. The data were analyzed by SPSS software using paired t-test. After intubation Systolic and diastolic blood pressure, MAP and heart rate increased in both groups compared to the baseline values. The difference in increasing diastolic blood pressure and MAP between the two groups was significant (p<0.05), but the difference in increasing systolic blood pressure and heart rate between two groups was not statistically significant. The increase in diastolic blood pressure and MAP in group 1 was significantly more than group 2 (p<0.05). Clinically, midazolam was as much effective as lidocaine in controlling response to intubations. Consequently it can be used as an alternative lidocaine in intubations. It has also other priorities such as amnesia, anti-anxiety and anti-agitation.

Serious vascular complications of IV drug abuse are being encountered with increasing frequency. These patients often present with cellulitis, abscess and endocarditic. Due to having viral infections these people can be a hazard to health care workers. Medical intervention is usually conducted after the emergence of one of the dreadful complications of IV drug abuse. The subject is a 40-year old male prisoner who referred to Emergency Department with 24 hours history of chill and fever, intermittent bleeding from a painful ulcerated lump in right groin along with hypotension and severe edema of right lower extremity necessitating packing and initial resuscitative measures. It was clinically diagnosed as ruptured infected pseudo aneurysm and urgent exploration was undertaken. Excision of common femoral artery was conducted by interpositioning of saphenous graft between external iliac and superficial femoral artery along with ligation of deep femoral artery drainage of abscess and debridment of necrotic tissue. The patient recovered with limb salvage except seroma on original site of vein graft.

Lipoprotein [LP(a)] is formed by assembly of LDL particles and carbohydrate rich protein, apolipoprotein(a). LP(a) is elevated in patients with proteinuria or nephrotic syndrome, but it is still controversial whether this is due to hypoalbuminemia or proteinuria. We studied a group of 71 children suffering from nephrotic syndrome in the absence of renal failure. The levels of serum albumin, LP (a), triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), high density, lipoprotein- cholesterol (HDL- C), APOAI and APOB were measured by standard methods. The results were compared with those obtained from 75 age and sex matched normal children as control group. The concentrations of creatinin and protein in random urine samples obtained from children and the protein/creatinin ratio were calculated. The Relationship between measured parameters and/or serum albumin and proteinuria was evaluated. Compared to the control group the serum levels of total cholesterol, triglycerides, LDL-C, LP (a), APOB and APOAI increated (p<0.05 in all cases), but no marked differences were observed in levels of HDL-C in case group. The levels of serum albumin in patient group were significantly lower than that of control (p<0.05). Serum levels of lipids and lipoproteins including APOAI and APOB were more correlated with plasma albumin level than with protein/creatinin ratio in the patient group. The results indicated that in children nephrotic syndrome with on renal failure, the increase of serum levels of LP (a) is mainly related to hypoalbuminemia that stimulates liver synthesis of APOB and is not related to the degree of proteinuria. It was concluded that determination of APOB is the best marker of hyperlipidemia in nephrotic syndrome and normal serum albumin levels seem to be a factor that may determine the of treatment efficacy of hyperlipidemia in nephrotic syndrome.

Recurrent respiratory papillomatosis (RRP) is the most common benign laryngeal tumor and the second common cause for hoarseness in children. Despite its omplete benign histology, it has a great tendency to spread through the respiratory track and frequent recurrences may occur following surgery, possibly due to the virus survival in apparently healthy adjacent tissues. According to the most recent evident experiences, the treatment of choice for RRP disease is repetitive resections with CO2 laser. The present study evaluates the efficacy of adjuvant medical therapies for eradication of this disease in affected children. This was an experimental study with sequential control (self-control). The subjects were children who referred to ENT-H&N surgery dept. of Hazrat-e- Rasoul hospital in Tehran between Mar 1998 and Mar 2001 with chief complaint of hoarseness and respiratory obstruction. Among these children patients with confirmed diagnosis of RRP were selected as study samples and the effect of acyclovir and alpha-interferon combination in reducing the severity and recurrence of RRP was evaluated. Totally 18 patients entered this study (10 (55.5%) females and 8 (44.5%) males). The mean age of the patients was 6.5 and 94% of them were the first child of young mothers (under 25 years of age). The signs of respiratory obstruction in most of the cases with a mild to moderate severity was the main cause of referral in 45% of the subjects. Laryngeal lesions were mostly superficial and limited to glottis region. Severity and spread of RRP disease was greater in children under 3, which led to tracheotomy in 3 of them. The combined administration of alpha-interferon and acyclovir, made a significant reduction in disease severity and spread in 55.6% of the patients. The findings of this study indicated that combination of acyclovir and alpha-interferon can be effective in reducing RRP recurrences and severity. Nevertheless, because of small sample size(due to rarity of RRP), Further multi-institutional studies are required to obtain a greater sample size and more valid results.

Infection with Toxoplasma gondii can cause severe illness when transmitting to fetus or when it is reactivated in immune-suppressed persons. The aim of this study was to determine the prevalence of antibodies against toxoplasma gondii in women referring to laboratory of health center for medical examinations before marriage. This descriptive cross-sectional study was performed on 504 samples collected from women in Arabil, Iran, in 2002. The samples were studied by indirect immunofluorescent assay (IFA) for determination of IgG and IgM antibodies to toxoplasma. The seroprevalence of IgG antibody at a titer of ³ 1:20 was 34.7%. The highest antibody titer frequency was observed in 1:20 titer (11.7%) and the lowest belonged to 1:3200 (0.4%) and 1:6400 (0.4%) titers. 20 persons (4%) showed IgM antibody against Toxoplama gondii. No statistically significant differences were observed between the prevalence of antibodies on the one hand and age and history of contact with cat or domestic animals on the other. since 65.3% of these women in Ardabil were seronegative, health education is required to omit the risk factors, especially during the pregnancy.

Preeclampsia is still one of the leading causes of maternal and fetal morbidity and mortality. Despite active researches over the past many years, the etiology of this disorder in human pregnancy is an enigma. Oxidative stress has been implicated in the pathophysiology of preeclampsia. Essential nutrients such as vitamin C can scavenge free radicals inducing cellular damage. The present study was designed to investigate the plasma levels of vitamin C in patients with preeclampsia (case) and normotensive pregnant women (control). In this case-control study vitamin C as an antioxidant was estimated and compared spectrophotometrically in 40 preeclamptic and 80 normotensive pregnant women referring to Alavi Hospital of Ardabil province, Iran. The collected data were analyzed using descriptive and inferential statistics. The plasma levels of vitamin C were significantly lower in patients with preeclampsia (0.147 ± 0.030 mg/dl) compared to controls who were normotensive pregnants (0.347 ± 0.119 mg/dl). Attempts at prevent preeclamsia are justified but since no reliable screening test has been offered as yet for women at risk, assessment of plasma level of vitamin C in patients prone to preeclampsia is strongly suggested.

Gestational Diabetes Mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the pregnancy. Diagnosis of this disorder can prevent complications in mother and her fetus during pregnancy. This study was an attempt to determine GDM prevalence in pregnant women referring to Ardabil health centers. In this cross-sectional study 601 pregnant women with 24-28 weeks of gestational age were screened by glucose challenge test (GCT) using 50 gr of oral glucose. GCT was considered positive if the serum level of glucose was larger than or equal to 140 mg/dl. Oral Glucose Tolerance Test (OGTT) was done on GCT+ subjects with 100 gr oral glucose. The diagnostic criteria were these of National Diabetes Data Group.Also a questionnaire was used to record history, age, height, blood pressure, weight before pregnancy and other characteristics. The data were analyzed using SPSS software. From 601 pregnant women, 64 cases (10.6%) were GCT+. OGTT indicated that from these 64 cases, 8 cases had GDM (GCT +, OGTT+). GDM prevalence was estimated 1.3%. There was a statistically significant relationship between BMI, mean age and mean diastolic blood pressure on the one hand and GCT and GDM positivity on the other (p<0.05). There was a significant relationship between increasing of BMI and the prevalence of GDM positivity GCT (p<0.05), but the relation was not significant between increasing of systolic blood pressure and gravidity with prevalence of GDM and positive GCT. It seems that the prevalence of GDM in Ardabil is low and general screening is not necessary for all pregnant women. The prevalence of GDM showed an increase with the age of pregnant women, BMI and obesity.

Cardiovascular disease is a major global health problem. Countries with low to moderate income contribute significantly to the global burden of cardiovascular disease accounting for 78% of all deaths and 86.3% of all disabilities. This study was an attempt to determine the factors contributing to premature myocardial infarction among young adults in Ardabil city. In this Case-control study 52 subjects, under 45, with myocardial infarction, admitted to Buali hospital in 2003-2004, were compared with 52 age and sex matched population based controls. Odds ratio and confidence interval of 95% were used to evaluate the risk factors such as smoking, physical activity, family history, history of diabetes and similar factors. Analysis of variance was used to compare the means. The mean age of the subjects was 37.2 and 96.2% of them were male. The positive family history of cardiovascular disease with odds ratio of 9.4 (95% CI=2.6-34.3) and current smoking with odds ratio of 2.8 (95% CI=1.3-6.2) associated with myocardial infarction. Mean of the body mass index and mean of concentration of FBS, LDL and HDL were different in case and control groups. Physical activity with odds ratio of 0.4 had protective effect. (95% CI= 0.2-0.8). There was no meaningful relationship between passive smoking, total cholesterol, education and job with myocardial infarction risk. Family history, smoking, high Fasting Blood Sugar, high LDL, Low HDL and physical inactivity are the most important factors associated with acute myocardial infarction. Proper health interventions should be considered in order to lower the risk factors among young adults especially those under 45 years of age with a positive family history of myocardial infarction.

More than one hundred countries face the problem of malaria disease. Studies have indicated that thalassemic individuals are relatively more resistant to malaria. The present research set out to investigate this hypothesis in Iraushahr where these is a high prevalence of moralia. The goal of this study is to compare the prevalence of malaria in thalassemic individuals with non- thalassemic ones in Iranshahr. In this case-control study 100 thalassemic individuals (case) and 100 non-thalassemic case (control) were selected. In addition to serum specimen, their blood sample from their fingertips were also taken to prepare peripheral blood smear. The tests were performed on 200 random samples in July (the peak time of malaria transmission). In this study, both indirect immuno flurecance Assay (IFA) and direct amear technique were used. The data were analyzed in SPSS software using descriptive and analytical statistics including T- test, chi-square and ANOVA. In IFA 20 subjects had positive titer while 80 ones had negative titer. Direct microscopic examination indicated that these, 20 cases had malaria parasite, 10 of whom were affected by p. vivax and 10 whit p. falciparum. In the non-thalassemic people (control group), 75 subjects had positive titers and 25 had negative titer. With respect to the direct smear anamination in non-thalassemic subjects, 18 had malaria parasite, of whom 7 had p.falsiparium and 11 had vivax. The results of malaria antibody titer indicated that the history of being affected by malaria the thalassemic subjects was 92% less than the non-thalassemic ones and this difference was statistically, significant (p<0.05) however, no significant relationship was found in terms of the results of direct microscopic examination and Ginsastaining. Since thalassemic people are more resistant againt malaria futhure researches are required to investigated the resistance to malaria in other blood disorders.

According to a recent report published by the Ministry of Health in Iran gastric cancer is the most common cause of death due to cancer in this country and cardiac cancer is the most common kind of upper GI cancer. This study is an attempt to determine the epidemiology of cardiac cancers in Ardabil. This descriptive cross-sectional study was conducted for four years (2000-2003) at the only private clinic in Ardabil. The results of endoscopy of these patients including the exact determination of the topography of cancer in cardia and other general information were recorded. The data were analyzed using SPSS software (version-10) During this study 4356 endoscopy were done and 533 histologically proven upper GI cancer were detected. Out of 533, 242 cases were located at E-G junction area, 82(33.9%), 130 (53.7%) in cardia region and 30(12/4%) cases were located at the proximal bady of stomach. 130(53.7%) cases of tumors were, in the right side of cardia. Bormann classification showed that most of cancers (43.8%) were ulceroinfiltrative. Statistical analysis indicated that there is a significant relationship between type and topography of cancer with dysphasia, weight loss and epigasteric pain(p<0.05). The results showed significiant relationship between type and topography of cacers with Bormann classification(p=0.001). Further epidemiologic studies are required to evaluate etiology of cardia cancers in Ardabil.