مجله دانشگاه علوم پزشکی اردبیل
پیاپی 15 (بهار 1384)

Pre-eclampsia is one of the common causes of maternal mortality. A main problem with induction of general anesthesia in these patients is exagergted increase of blood presscure during laryngoscopy and intubation that is associateed with a significantly increased intracranial pressure with the risk of cerebral hemorrhage. There are some strategies to minimize extreme increase in blood pressure during laryngoscopy and intubation. The aim of this study was to evaluate the effect of Fentanyl-Droperidol combination (Talamonal) on reducing cardiovascular responses due to laryngoscopy and intubation in preeclamptic parturient. Thirty preeclamptic parturients who were admitted for emergency caesarean section under general anesthesia were studied. All patients had diastolic pressures sustained at ≥ 100 mmHg, and had received antihypertensive therapy. A standard general anesthesia was induced in all patients. Fentanyl-Droperidol combination was used only in the case group five minutes before induction of anesthesia. Arterial pressure and heart rate increases, improved in approximately 86.6 % of the case group. The mean increase in systolic pressure, and heart rate following laryngoscopy and intubation was significantly different in two groups (P=0.0001). There was no significant difference in the mean Apgar score of the neonates at 1 and 5 minutes after delivery in two groups. Using Fentanyl-Droperidol Combination during induction of anesthesia produced a clinically significant decrease in sympathetic response to laryngoscopy and intubation in most mothers, without any adverse effect on the neonates.

Ulnar nerve involvement is the second most common local mononeuropathy. The ulnar nerve consists of motor and sensory fibers that arise in C8-T1 roots and extends to the lower trunk and medial cord of brachial plexus. Manifestations of this nerve involvement range from elbow pain and intermittent hand paresthesia to marked sensory loss, wasting and weakness of hand muscles and a claw hand. Ulnar nerve lesion in the elbow region commonly follows surgery in which general anesthesia is used (particularly in patients with coronary artery bypass graft surgery). The patient presented in this article was a 56-year-old male who was involved in left ulnar nerve lesion after undergoing coronary artery bypass graft. In electrodiagnostic study we noticed diffused demyelination lesion of the ulnar nerve with dominancy in elbow region along with secondary axonal degeneration. Therefore, suitable positioning of elbow is recommended to avoid the nervous complications of these operations.

Narcotic abuse is one of the main problems in the world today, and individuals ’ view towards it is important for managers and social problem analysts.Regarding the threats and harms of the prevalence of narcotics in society, this research was done to determine the rate of tendency to narcotics among people over ten years old in Ardabil province. This was a descriptive cross-sectional research. A two-section questionnaire was used to collect the data. 600 men and women over ten years of age were chosen through systematic cluster sampling and the required information was gathered by referring to their houses and interviewing them. The collected data were analyzed by SPSS software using descriptive and analytical statistics. 3.5% of the samples had positive family history of using narcotics. 18% were smokers. 84.7% believed that one can use narcotics everywhere. 30% claimed that using narcotics reduces one ’ s physical discomfort, and 30.2% expressed that one can give up the narcotics whenever necessary. On the whole the tendency towards addiction among the subjects was 53.57%. This tendency was higher in rural areas compared to the cities (56.72% versus 49.81%). This difference was statistically significant (p<0.001). Illiterate people had the most tendency rate towards addiction (55.61%). There was a statistically significant relationship between tendency towards addiction and positive family history (p< 0.05). The highest tendency rate (54.33%) was seen in 11- 20 age group. the results showed that the consequent dangers of addiction are not known for people and that the great tendency for narcotics shows the need to inform the society in order to prevent the addiction.

cervical dysplasia indicates the growth disorder of cervix and is characterized by the appearance of cancerous and precancerous cells in cervix. Cervical dysplasia often has no symptoms but can progress to cervical cancer in 5 % of the cases. Early diagnosis of these pre-invasive lesions with pap smear can prevent, to a great extent, the progress of lesion to cancer. The prevalence of cervical dysplasia is different in different parts of the world and depents, to a great extent, on its etiology. This study was an attempt to determine the prevalence and types of cervical dysplasia in 5000 cases of pap smears. This descriptive cross-sectional study was conducted on 5000 cases of pap smears selected randomly from among 8249 pap smears in the period between March 2003 to August 2004. Some samples were studied retrospectively and some others prospectively. The population of the study was composed of women referring to Ardabil health care centers for pop smear test. The data were collected with questionnaires and were analyzed using SPSS software (ver.11). Cervical dysplasia was found in 56 cases (1.12%) 0.66% of which was CIN I, 0.3% CIN II and 0.16% CIN III. The total percentage of cervical displasia in this study was 1.12%. This prevalence in other similar studies varies between 0.4% in Scotland and 12% in USA. Nevertheless, the prevalence found in this study is in line with most of the similar researches.

Neglecting children can have irremediable and harmful effects on them concerning their growth, evolution, acquisition, and health both at present and in the future. Since lack of nutrition knowledge and failing to observe the principles of infant nutrition is one of the important causes of malnutrition and its unpleasant consequences, we decided to carry out an assessment concerning mothers’ level of awareness about infant nutrition and the factors affecting this knowledge, as well as the effect of this knowledge on growth and development of children. This descriptive-analytical research was conducted to evaluate mothers’ knowledge of infant and neonatal nutrition and its effect on infant growth in Hir health center. The data were collected using a questionnaire, including 20 questions, which was filled out in the health center. Moreover weight, height and head circumference of 100 infants were measured. The data were analyzed using SPSS software. All mothers’ age ranged between15-36 and were housewives.15% were unlettered, 18% had high school education and others primary or secondary school education. 55% of children were female and 45% male. 67% of mothers had knowledge about proper neonatal and infant nutrition. 97% of them had little knowledge about when to start introducing different nutrients for infants, 3% had moderate knowledge in this regard. Regarding the findings of this study and the lower knowledge level of mothers about when to start giving different food to infants as well as the importance of proper nutrition in their growth, it is necessary to improve mothers’ knowledge and promote children’s health.

Yogurt is recommended as a treatment for acute diarrhea. This study was conducted to determine the effect of pasteurized yogurt consumption on acute non-bloody and non-mucoid diarrhea in hospitalized 6-24 month old infants as compared with that of routine treatment. In a clinical trial study 80 children with 6 to 24 months of age with diarrhea for less than four days and were hospitalized in Urmia Imam Hospital, were assigned into two groups. The first group consumed yogurt containing streptococcus thermophilus and lactobacillus bullgaris 5 ml/kg per day while the second group received the routine treatment. Those suffering from malnutrition, bloody stool and diarrhea without GI source were excluded. Reduction of diarrhea frequency to half compared to admission time was regarded as response to treatment. Weight gaining, duration of admission and reduction of diarrhea frequency were compared in two groups. The two groups were not significantly different in terms of age, weight and frequency of diarrhea at the time of admission. Mean hospitalization days, weight gaining, reduction of diarrhea frequency were 2.7±0.91 days, 435± 89.30 grams, and 4.30±1.74 times respectively for case group and, 3.1± 0.74 days, 383 ± 98.96 grams, and 3.60±1.23 times for control group respectively. No significant differences were observed between two groups regarding mean hospitalization days (P=0.035), reduction of diarrhea frequency (P=0.049) and weight gain (P= 0.017). Consuming pasteurized yogurt as a probiotic agent has a positive effect in treatment of acute nonbloody and nonmucoid diarrhea. Public use of yogurt is recommended.

Patients in unstable condition with blunt abdominal trauma require rapid evaluation of abdominal organs to assess the need for laparatomy. Ultrasonography is a fast technique which can be used in the resuscitation area to detect free intraperitoneal fluid as an indication of intraabdominal injury. This prospective study was designed to determine the efficiency of emergency abdominal sonography for evaluating patients with blunt abdominal trauma and to compare the accrurcy of ultrasonography with the results of diagnostic peritoneal lavage and CT scan. Emergency sonography was performed prior to diagnostic peritoneal lavage and CT scan on 174 patients with blunt abdorminal trauma. Sonography was performed with FAST (Focused Abdominal Sonography for Trauma) technique and six area of the abdomen where examined to detect free intraperitoneal fluid. The results of this study revealed that ultrasonography has a sensitivity of 95% a specificity of 80.8%., and an overall accuracy of 89.4% for detecting free intraperitoneal fluid. The positive and negative predictive value of sonography was 89.4% and 90.1% respectively. Ultrasonography is a reliable method for the emergent evaluation of blunt abdominal trauma and can be used instead of diagnostic peritoneal lavage.

In modern civilization, community participation is considered to be the most important way of development in different parts of the society. Establishing social development and health promotion centers (SDHPC) is the first step which is taken in this regard. In these centers, social development is implemented along with health promotion. During some planned activities people practice participation and having sense of responsibility while they move towards development and health. They understand that the key for solving majority of health problems are in their own hands. In the framework of an action research, interventions based on dynamic, reevaluation activities, were done in two parts: Formation of activity committees and establishment of population laboratory. SDPHC set its programs based on a planned approach to community health and community mobilization was the first practical action in this plan. Aiming at presentation and evaluation of community mobilization model, different activities consisting of mobilization of heath volunteers, raising participation of regional stake holders, recognizing social literature to ensure effective and pervasive communication with people, propagation and call for participation along with general enumeration of society was done to find authoritative people. Health volunteers helped to recognize 60 key persons. 53 of them accepted participation. Objectives of the center were explained to them in three meetings, and their opinions were collected. A study of community literature showed that this region had a moderate to high cultural behaviors, and moderate to low income level and education with suitable interest in participation. The Evaluation of provincial broadcasting organization, municipality and other organizations was not desirable except for education organization. Publishing a newsletter was not welcomed by people but it created a bright perspective among governmental authorities. 287 persons accepted invitations voluntarily and took membership. After regional census, it was found that 4355 households with a total population of 19652 were living in this region 9305 (48%) of whom were females. Mean age of population was 26 and mean household dimension was 4.5. 8352 persons (42%) were married. Majority of women were house wives and majority of men had self managed job. The process of community mobilization in this project was evaluated to be successful but for establishment and continuation of activities in SDHPC most of the organizations and different groups of people should be encouraged to participate.

Fat embolism syndrome (FES) is mainly due to the obstruction of blood vessels with fat globules, reached to circulation. FES is associated with traumatic and non traumatic diseases. The prevalence is 2-5% in long-bone fractures. The purpose of this study is to evaluate manifestations, laboratory findings and the diagnosed cases of fat embolism. In this retrospective study all the patient records associated with injury were evaluated and those diagnosed with the traumatic fat embolism were selected. The data including sex, age, type of fracture, clinical and laboratory findings and symptom onset time were collected using a questionnaire. These data were then statistically analyzed. 17 out of 1660 patients were found to have fat embolism most of which belonged to middle-aged men. The most common clinical features consisted of: respiratory failure, tachycardia and consciousness level alterations. Fat embolism was mainly associated with tibial and femoral shaft fractures. Low level of Pao2 (Pao2<60) is the most reliable laboratory test in this study. Fat embolism should be regarded as a threarening factor in patients (especially middle-aged ones) with fractures in long bons of lower limbs. Pao2 Level of can also be used as a reliable laboratory finding.

Hysterectomy is the most common surgery among nonpregnant women. A review of indications of hysterectomy can provide the specialists with new insights about these patients’ treatments. The aim of this study is to investigate the indications and methods of hysterectomy in patients referring to Alavi hospital. This cross-sectional study was done in Alavi hospital for two years (2002-2003). The data from 257 hysterectomized patients collected through interview and studying their records were entered into previously-designed questionnaires. The collected data were then analyzed using SPSS software. The number of hysterectomies decreased 38.4% in 2003 compared to 2002. The mean age of patients was 45.8±8.09. The most common indication of hysterectomy was lyomyoma in 42.2% of cases. Abdominal hysterectomy and vaginal method were done in 93% and 7% of the cases respectively. In patients who were operated for pregnancy and delivery complications, the most common indication for hysterectomy was placenta increta (50%). The most common complication was hyperpyrexia (25.7%). The prevalence of complications of abdominal hysterectomy and vaginal method was 26.3% and 16.6% respectively. Lyomyoma is the most common indication of hysterectomy in patients referring to Alavi hospital. Besides, abdominal operation is the most prevalent method of hysterectomy in this hospital. Complications of vaginal method are less than those of abdominal method.

Understanding children’s behavior and its affecting factors is the foundation for practicing dentistry for children effectively and, at the same time instilling a positive dental attitude into them. A number of studies have been done in this regard during the last three decades. This study is another attempt to find out proper strategies in order to control and optimize the diagnostic and trearment measures as well as to investigate the effect of mothers ’ personality characteristics on children ’ s behavior. The sample consisted of 104 randomly selected children (53 boys and 51 girls) at the age of 3 to 6 together with their mothers. The children had no previous dental experiences and no mental or physical disabilities entailing special care. Children’s behavior was assessed during three different dental visits according to Frankle ’ s Behavioral Rating Scale, in which four distinctive scales, namely absolutely negative, negative, positive and absolutely positive were precisely defined and scaled. The first visit was dental examination, the second was fluoride therapy and the last one was restorative dental treatment. Meanwhile, their mothers ’ personalities were determined through an interview conducted by a psychiatrist and based on DSMIV criteria and using General Health Questionnaire (GHQ) these personality characteristics were categorized in four groups: Normal, Depressed, Anxious and Obsessional. The findings revealed that 12.5% of children had no cooperation during 3 visits, most of whom were 3 to 4 years old. The difference was significant compared to 4-5 and 5-6 year old children (p<0.05). In addition, sex did not influence children ’ s behavior. This study showed that children of mothers with obsessional personality were the most cooperative ones during the 3 visits compared to mothers with other personality characteristics. This difference was statistically significant at the first visit, (p<0.05). Mother ’ s personality has the strongest effect on children’s behavior during the first dental visit.

Demographic and environmental factors are effective in the pathogenesis and prevention of Parkinson Disease (PD). Sex, family history of PD, farming, literacy, history of head trauma, smoking, well water consumption, overusing oil seeds and contact with herbicides and pesticides are apparently effective in this regard. This study set out to investigate the risk factors of PD. 100 patients with PD and 200 age matched controls refering to Neurology clinic of Birjand UMS were investigated in this case-control study during 2002-2003. PD was diagnosed by a neurologist and the demographic and environmental factors were recorded in a questionnaire. Student T and Chi-Squire tests were used for statistical analysis. 68% of the cases and 53% of the controls were male. Family history of PD, farming, literacy, stress and well-water consumption were significantly more frequent in PD group(p<0.05). Smoking and overusing oil seeds were more frequent in control group (p=0.007, p=0.001 respectively). Frequency rate of contact with herbicides, pesticides and history of head trauma were not significantly different in case and control groups. Family history of PD, farming, literacy, stress and well-water consumption are risk factors of PD, while smoking and using oil seeds could be protective factors against PD.

Neurofibromatosis is a congenital disorder with different kinds of disabling manifestations. There are several types of operations for these manifestations with relative improvement. This study set out to determine age, sex, clinical manifestations and evaluate methods of treatment of these patients. This descriptive, cross-sectional study was conducted through studying the hospital records of patients who had previously undergone surgery. 45 patients with neurofibromatosis who were hospitalized and operated in surgical ward of Firoozgar and orthopedic ward of Shafa hospital from 1995 to 1998 were studied in terms of clinical manifestations and treatment methods. Patients with central nervous system involvement were excluded from the study. 55% of the subjects were male and the rest of them were female. Most of the patients were in the second decade of their life. Skeletal abnormalities were seen in 35 patients (77.77%) and 16 patients (35.55%) were suffering from scoliosis which was the most common complication of this disease. With respect to the progression of the disease, brace was used in 2 patients, which led to their improvement. In 13 patients Horington Rod implantation was used, three cases of which developed scoliosis, who underwent surgical vertebral fusion. Pseudoarthrosis was seen in 8 patients (17/77%). Bone graft and plate were used in their operation. In five cases with pseudoarthrosis in lower limbs no: :union:: occurred. Two patients died with malignant shwanoma. scoliosis is the most common manifestation of neurofibromatosis which can improve in early stages with surgical treatment but pseudoarthrosis in lower limbs has not improved with bone graft and plate. Operation with pediculated fibula resulted in the improvement of this complication. Surgical intervention would be more effective in the early stages of the disease. 2 of thses 5 cases were reoperated with pediculated fibula graft and 3 others were amputated.

Cholangiocarcinoma is a malignant tumor of the biliary tract epithelium. Although it is not a common tumor, it has a high mortality rate so that the five-year survival of the patients is only 5%. Most patients are found to have irresectable tumor on initial presentation. These have led to an emphasis on the role of palliative treatment. 43 patients with Cholangiocarcinoma (from 1996-2003) based on ERCP were included in this study. Demographic aspects, clinical and Para clinical manifestations as well as the risk factors were investigated and survival rates of the patients were compared with or without stenting of the biliary tract. 27 patients (62.8%) were male and 16(37.2%) were female with mean age of 65. Ulcerative colitis accompanied with PSC was diagnosed in just one case. Jaundice, weight loss and pruritus were the main complaints of the patients. Twenty-seven cases received stent in biliary tract through ERCP while no treatment was performed in other patients due to technical failure or patients’ disagreement. Mean survival time for all patients was 125 days. There were no statistically significant difference between survival rate of the patients with stent and without it. In this study cholangiocarcinoma in our patients was less frequently seen to accompany UC and PSC. Curative surgical resection is not possible in the majority of cases, and palliative treatment only decreases the severity of the symptoms but has no significant effect on survival.