مجله دانشگاه علوم پزشکی اردبیل
پیاپی 16 (تابستان 1386)

Pterygium is a common ophthalmic disease which can cause astigmatism and restriction of visual field and cosmetic problems. Regarding the high recurrence rate using the common methods and because similar studies have never been done in Ardabil province, we decided to study the recurrence rate of pterygium after surgery with intraoperative application of mitomycin C.

In this descriptive cross-sectional study all patients with primary pterygium who had undergone surgery between February 2001 and September 2003 were assessed and followed up for postoperative examinations. The findings were then statistically analysed.

In this study 83 eyes of 80 patients were examined. The highest prevalence of pterygium was in age group 31-40. Most of the patients had undergone unilateral surgery. In terms of size the most prevalence of pterygium was 3-4 mm. 4 cases (4.8%) had recurence one of which was observed in the first 2 months after surgery and three others in 2-6 months after it. In 50% of the recurred cases pterygium was 4 mm and in the rest of them it was 5 mm in size. After operation just 2 cases had granuloma which did not respond to topical corticosteroids and were excised by surgery.

This study shows that the recurrence rate of pterygium after surgery with intraoperative mitomycin C is very low and this method has no serious complications. Using this method routinely is recommended. Moreover the recurrernce rate of pterygium is associated with its size.

Oculocardiac reflex (OCR) is presented with bradycardia and other arrhythmias, is induced by mechanical stimulation and therefore, encountered during strabismus surgery. The aim of this study is to determine the incidence and risk factors of cardiac arrhythmias during strabismus surgery in children and adults. In this prospective, randomized and double-blind study, 46 patients ASA class I and II underwent elective strabismus surgery with general anesthesia and were allocated to one of the two groups: children under 12 and adults over 12. All patients received standard general anesthesia based on their age. Demographic data, type of involved muscle, the incidence, (type and frequency) and the cause of arrhythmias and skillfulness of the surgeon (professor-assistant) were recorded. There were 26 patients in children group and 20 patients in adult group. The overall incidence of arrhythmias was 91% with 96.15% in children and 85% in adults. There was not any significant difference in the incidence of arrhythmias, and the mean rate of occurence between two groups. Most of the arrhythmias were due to external ocular muscles traction. Conjunctival traction and pressure on the globe were the other causes. Stimulation of median rectus muscle as the most important arrythmogenic factor was seen in 13 children and 12 adults. Bradycardia and tachycardia were among common arrhythmias, but there was no significant difference between two groups (P>0.05) in terms of their incidence. This study showed that the incidence of arrhythmias during strabismus surgery is high in both children and adults. This reflex does not often lead to hemodynamic compromise, however, for its early diagnosis and treatment, close and continuous monitoring of the patient as well as cooperation and communication between anesthesiologist and surgon is needed. Keywords:

Hearing is perhaps the most important sense in human beings without which communication with the environment would greatly diminish. Chronic perforation of tympanic membrane, ossicular erosion and tympanosclerosis are major causes of hearing diorders. Nevertheless, a conducting hearing loss is the commonest complication of chronic otitis media. Cholesteatoma which is the most dangerous complication of chronic otitis media is treated by surgery. Tympanosclerosis is also one of the most important complications of chronic otitis media, which leads to conductive hearing loss through ossicular fixation. This study is an attempt to determine the effect of different kinds of chronic otitis media on the hearing of the patients. In this survey, 440 patients with chronic otitis media, who were surgically treated in the department of otolaryngology between 1998-1999, were studied in terms of various pathology of middle ear and the resultant level of hearing impairment. 37 patients (8.4%) were involved bilaterally with otitis media. The number of operations on the left ear was 10% more than those on the right. The most common pathology recognized in examination was nonprulant perforation of tympanic membrane in 179 cases (40.7%) and the most common pathology recognized in surgery was cholesteatoma in 140 cases (30.2%). From 440 patients, 430 cases had conductive hearing loss and 92 cases (20.9%) had sensorineural hearing loss. Cholesteatoma of middle ear caused the highest proportion of conductive hearing loss and majority of the cases with sensorineural hearing loss (about 30%) whereas tympanosclerosis caused the most severe sensorineural hearing losses. The findings indicated that cholesteatoma and tympanosclerosis were the most common causes of both conductive and sensorineural hearing loss with tympanosclerosis as the cause of the most severe sensorineural hearing loss. However granulation tissue is the most common histopathology in patients with chronic otitis media at references and papers.

It is estimated that as many as 75% of women experience at least one episode of vulvovaginal candidiasis during the lifetime and about 5% will have recurrent infections. There are clear association between vaginal candidiasis and uncontrolled diabetes mellitus. The purpose of this study was to determine whether non-diabetic women with recurrent vaginal candidiasis have an impaired glucose metabolism. This case-control study was carried out with 32 patients suffering from recurrent vulvovaginal candidiasis as case group and 30 control patients who had negative history of vaginal candidiasis during the previous year and had referred to the clinics for reasons other than vaginal candidiasis. The case group had referrd to the gynecology clinics three times during the previous year and were recognized to have vaginal candidiasis. They were being treated by antifungal drugs and had at least one positive candida culture. Both groups underwent standardized oral glucose tolerance test with 75-gram dose of glucose. The data were analysed using Chi-square and t-test. Women with recurrent vaginal candidiasis had a mean body mass index greater than the control subjects (23.4 versus 21.5, p=0.001). They had no more incidences of overt or preclinical diabetes mellitus than the control subjects, but a greater proportion of them had at least one glucose concentration above the 95th percentile (p=0.015). Glucose concentrations were significantly higher in recurrent vaginal candidiasis cases than in control subjecs at 30, 60 and 75 minutes after the intake of 75-gram dose of glucose (p<0.05). This amount of glucose led to a 15.8% increase in serum glucose level in case group compared to the control group. Glucose tolerance test was mildy impaired in women with recurrent vaginal candidiasis. The plasma glucose concentration increased in 2 hours after 75 g glucose intake. Although the obtained results were not in the range of occult diabetes, it can designate the important of glucose tolerance test in women with recurrent vaginal candidiasis.

Some special characteristics of mycobacterium tuberculosis such as long time incubation period in culture media needed for colony appearance, unavailability of serologic methods for diagnosis, along with necessity of starting treatment in the patients with severe conditions as well as isolation limitations requires the introduction of rapid and innovative diagnostic tests. On the other hand, some diagnostic tests such as Polymerase Chain Reaction (PCR) require special experimental conditions which are not easily available to clinicians. This study was designed to determine the diagnostic value of serum adenosine deaminasae in pulmonary tuberculosis and evaluate its efficacy in pulmonary tuberculosis diagnosis. This cross-sectional study started in spring 2002. Continuous sampling was done and admitted patients were observed, examined and interviewed using a diagnotic test. All patients admitted with a suspected pulmonary tuberculosis diagnosis based on physical examination, history and chest X-Ray results were followed up for six months to ensure that mycobacterium tuberculosis infection was appropriately diagnosed. Blood samples were taken for serum ADA and complementary diagnostic tests. Following certain necessary tests and work-ups patients with or without tuberculosis were identified. 131 Patients were evaluated completely. 103 had tuberculosis and 28 patients had other diseases. No statistically significant difference was found between mean level of serum ADA in two groups. But a serum level of ADA greater than 51 U/L was associated with 90% positive predictive value and specificity in differentiating two groups. Serum ADA is not a suitable test for pulmonary tuberculosis diagnosis.

Clostridium difficile as an etiologic agent of pseudomembraneous colitis and major cause of nosocomial antibiotic-associated diarrhoea is typed by phenotypic and molecular methods. The aim of this study was to investigate the distribution of ribotypes of the organism in the given region and time. In this study 18 strains isolated from patients from different hospital wards of Poland in 2002 and 2003, were examined and identified by susceptibility to vancomycin and metronidazole. The samples were re-identified using UV and latex agglutination to ensure the existence of A and B toxins. DNA was extracted and after amplification by PCR and electrophoresis, the strains were ribotyped. The findings showed that all the strains were susceptible to vancomycin and metronidazole and all the colonies showed greenish-yellow fluorescence under UV. Moreover, all the strains were positive in terms of latex agglutination. Seven strains were toxin A positive and all were toxin B positive except one strain. In molecular ribotyping it was found out that these strains belonged to seven ribotypes, namely 12, 14, 17, 18, 29, 70 and 90 most of which were ribotype 17 (61%). Our observations imply that in each area a particular ribotype of c.difficile is of higher prevalence and ribotyping of this clostridium is necessary for epidemiologic studies. Identification and PCR-ribotyping of common strains of this organism in Iran are recommended for epidemiologic follow-ups.

One of the most common ways in intubation without muscle relaxant is using propofol and remifentanil. The common practice is injection of remifentanil and then propofol. This occasionally produces severe hemodynamic changes. The aim of this study is to inject propofol followed by remifentanil for evaluating the effect of the order of injection on decreasing these complications. 40 patients with American Society of Anesthesia (ASA) class I-II, who underwent minor elective surgery with airway mallampati class I-II entered the study. Patients were randomized into 2 groups each with 20 patients. The first group received 2.5mg/kg propofol followed by 1.5 g/mg remifentanil while the second group received 1.5 g/mg remifentanil followed by 2.5 mg/kg propofol. Laryngoscopy and hemodynamic changes were compared in two groups.Resutls: There was no difference between two groups in laryngoscopy attempts (P=0.145) but the frequency of easy laryngoscopy in the first group (85%) was more than the second group (60%) (P=0.031). Systolic blood pressure changes after laryngoscopy in the first group (20 7.7 mmHg) was less than the second group (28 6.7 mmHg) (P=0.001). There was no statistical significant difference between two groups in diastolic blood pressure and heart rate changes (P=0.88, P=0.86 respectively). Administrations of propofol before remifentanil during anesthesia induction produces acceptable hemodynamic changes in patients.

Regarding the admitted cases at early infancy in Tabriz Pediatrics Medical Center, this research was carried out to determine the role of Hep.B. vaccination in the incidence of ITP. We studied all patients’ admission files in Tabriz Pediatrics Center from 1993 to 2002. The patients were under 6 months of age and hospitalized with the impression of ITP. There were 25 infants whose ITP was diagnosed upon their clinical findings, blood counts and bone marrow aspiration and confirmed by exclusion of other causes of thrombocytopenia. Hep. B. vaccination has been included in routine immunization in Iran since 1993. In order to compare the incidence rate of ITP before and after 1993, we also sought all ITP patients’ files at the same age group who had been admitted to Tabriz Pediatrics Center during the decade before the beginning of routine Hep.B. vaccination (i.e. 1982 to 1992). This study shows a considerable increase in incidence of ITP in infants under 6 months of age between 1993 asnd 2002 compared to the decade before the beginning of Hep.B.vaccination, which is statistically significant (P=0.0029). Although there is no facility to measure antibodies in Iran and many other countries, and this is one of the reasons for lack of proof for existence of a relationship between vaccination and ITP incidence, the study of cases in two different periods may strengthen the role of Hep.B. vaccination in the occurrence of ITP at early infancy.

Providing health services for all population subgroups of a community is a major hallmark for health administration. Little is known about health status of Ashayer population in Iran. This study aims at evaluating health status and quality of health service delivery to them.

In a cross-sectional research 320 households (1800 persons), entered the study. Moreover, blood samples from 458 dogs were taken and studied with both Direct Aglutination Test (DAT) and a newly presented dipstick test. All children under 12 were also studied with DAT. In computing the sample size the generalizability for 63 variables with a minimum and maximum probability level of 90% and 97% respectively were taken into account and since the cluster sampling was employed, the Design Effect would be at least 1.56 and for different variables in the first sample it would be at most 4.

Only 30 households(9.7%) used piped water supply inside their houses while most of the other families (41%) obtained their water from mobile water tanks. Residual water chlorine was measured to be zero in 88.7% of the samples taken from drinking water of Ashayer. 89 (27.8%) households had lavatories and 22 (7%) households had bathrooms inside their houses. 90.4% of those using raw vegetables washed them only with plain water. Monthly incidence rate for accidents was 230 per 10000. 18.1% of women in reproductive age had a history of abortion. Unwanted pregnancy rate was 38.9%. 47.1% of women with a labor history in past three years had never been visited by any person legally allowed to do so. Women in reproductive age had a poor knowledge about contraceptive methods. The minimum delay for vaccination was 16.9 (SD= 19.26) days regarding the third dose of OPV and the highest delay in vaccination was 46.44 (SD=60.7) days belonging to the third dose of HBV. From all 503 persons above 12 years old, 77 cases had hypertension. Periodontal easy bleeding was observed in 13.7 % and pyorrhea in 19.3%. 10.2 % had aching neck, 18.7% had backache and arthralgia was shown in 13.5%. The unmet need for physician's visit was 64.8%. The frequency of positive cases of leshmaniasis was 3.4% and 3.06% for boys and girls respectively. 28 male and 6 female dogs were positive in DAT test making an overall positive rate of 7.4%. Sensitivity of dipstick test was higher than 80 percent only when golden standard was considered to be DAT ≥ 1 /640.

Many of the health indices of Ashayer except for vaccination were suitable. This requires further attemps on the part of govermental and health outhorities. Kale-azar disease can spread to the north of the province as well as the neighboring provinces due to the migration of these tribes. It is predicted that Bilesavar and Parsabad cities will be added to the andemic regions of this disease in coming years. Using dipstick test recently offered by WHO is recommended to be used to screen the infected dogs.

The unsatisfied demands of employees can present itself in different forms such as lower output, efficacy, effectiveness and aborted objectives of the organization. Periodic evaluation and investigation of the demands of staff can increase satisfaction and motivation among them. In this descriptive-analytical study stratified systematic sampling was used for selecting the employees both with and without academic education. The total sample size was 615. The data were collected by means of a two-section questionnaire and analyzed by EPI Info 2002 and SPSS (ver.11) statistical packages. 23.2% the staff members were not satisfied with their job. 26.9% of those bearing an academic cerrtificate were not happy with their field of study. 63% of the personnel were not satisfied with the health authorities’ attitude towards their welfare state. There was a 51% dissatisfaction regarding the concern about the issues related to the staff. There was also a 44.2% of dissatisfaction among the staff members about the performance of the related deputies. 35.9% of the personnel were not satisfied with their manager about paying attention to their problems. The staff requirements were graded as follows: self-actualization, respectability, social belonging, security and physiologic needs. There was a reverse relation between the personnel satisfaction and level of management. The findings indicated that the staff were more satisfied with their direct manager (64%) compared with university administrations (49%). There was a significant relation between the personnel satisfaction and their level of education (p<0.05). The relation between satisfaction with organization performance and sex was not statistically significant. The findings indicated a significant relation between type of education and different levels of personnel’s needs. The relationship between satisfaction and Maslow’s hierarchy of needs was investigated using Chi-square test, which indicated a statistically significant relationship only between group D needs and job satisfaction (p<0.05). Staff satisfaction with university administrations of Ardabil university of medical sciences and health services was low. Moreover, the self-actualization and self-esteem needs were of high priority among the employees.

Unwanted pregnancy is a general and worldwide issue that has an impact on not only the women but the families and societies as well. It may be caused by a failure to use contraceptive methods and paying less attention to family planning methods. This may result in negative effects on community health. This study is an attempt in this regard. In this descriptive-analytical study 600 pregnant women referring to health care centers in Ardabil were selected through cluster sampling (5 clusters). The data were collected in the form of questionnaires filled in by the researchers interviewing the subjects. These data were then analysed by SPSS software using descriptive and inferential statistics. The subjects ranged between 13 to 44 years old (Mean=25.13). Among them 93.5% were housewives and 18.5% were illiterate. Majority of them (72%) wanted to have two children. 30.8% of the present pregnancies were unwanted and 11.2% of the women had the experience before. Age average in unintentionally pregnant women was greater than that of intentionally pregnant ones (28.5 and 23.7 years old respectively). This difference was statistically significant. 75.7% of the unwanted pregnancies had happened despite using family planning methods. The rate of unwanted pregnancy among illiterate women was significantly greater than that among the educated ones (52.34% and 26.7% respectively). Also there was a significant relationship between the type of pregnancy on the one hand and the husbands’ education and the wife’s employment on the other (P<0.0001). With regard to 30.8% prevalence of unwanted pregnancy and irregular use of contraceptive methods, it can be claimed that training the pregnant women and providing them with necessary information have been insufficient. It seems necessary to teach them the methods of contraception and follow them up.

Although mucocele of the paranasal sinuses is rather common, it is rarely seen in maxillary sinuses. If the maxillary sinus is involved, it is presented with destruction of the sinus wall, swelling of the cheek, swelling of the g i ngivobuccal sinus, expansion to the inferior wall of the orbit, and ophtalmic presentation. In this case report a rare and noticeable case with maxillary sinus mucocele is presented. The case was first diagnosed with suspicious sinus malignancy based on CT scan but during the surgery the cyst was found to be a mucocele.

Respiratory distress is one of the most important causes of children admission in hospitals. In most cases, it is due to pneumonia, asthma or acute bronchiolitis. Since theses diseases have a lot of symptoms in common, we decided to study these disorders in more details to facilitate the appropriate diagnosis and treatment based on clinical, laboratory and radiologic findings. 238 children who suffered from respiratory distress and were admitted to pediatric ward in Ghaem hospital were studied. This descriptive study was performed during 3 years including 2 retrospective and one prospective year. The relationship between variables was analyzed using chi-square test. The patients were six months to five years old. Pneumonia (40.3%) asthma (30.3%) and bronchiolotis (16.8%) were the most common causes of respiratory distress. Totally, 61.1% of the patients were male. The mean age of the patients was 10.3 months in bronchiolitis and 36.6 months for asthma. The most common symptom among these three diseases was tachypnea. Most of the patients were admitted in winter and fall respectively. The main radiologic pattern in pneumonia was pulmonary infiltration and for asthma and acute bronchiolitis it was pulmonary hyperinflation. Proper attention to signs and symptoms as well as laboratory and radiologic fndings is necessary for accurate diagnosis. In this study the most common cause of respiratory distress in children under 5 was found to be pneumonia, asthma and bronchiolitis respectively.

Recent studies in Ardabil province indicated that upper GI cancer is the most common kind of cancer in this province. Due to the lack of any study concerning the survival rate of the patients in this province, the present research set out to evaluate the effect of demographic features of GI cancers, risk factors, histopathology type, the site of tumor and treatment on the survival rate of these patients. In this descriptive-analytical and prospective study, we followed up 420 upper GI cancer cases (141 esophagus cancers and 279 stomach cancers) who were initially diagnosed in the only subspeciality GI clinic of Ardabil province during four years from 2000 to 2003. The information related to 299 patients was recorded. The dates of death of 55 cases were found referring to the provincial death registration program while the addreses of 67 cases were not found. The 1-4-year survival rates in the patients with upper GI cancer in Ardabil province were 25.9%, 11.1%, 4.5% and 1.8% respectively. In this study men had a lower survival rate than women and patients with esophagus cancer had a longer survival rate. In the patients with stomach cancer "Signet ring cell type" histopathology had the lowest survival rate. The patients who had undergone surgery survived longer than other patients with no resectional surgery treatment. Histopathology grading, age at first diagnosis, positive familial history of GI cancer, as well as cigarette, alcohol and opium consumption had no effect on survival rate of these patients. Overall survival rate of our patients is very low this condition might be related to late diagnosis and less treatment facilities in Ardabil province.