مجله دانشگاه علوم پزشکی اردبیل
پیاپی 21 (پاییز 1385)

Laryngoscopy and tracheal intubation could lead to hemodynamic responses in the from of hypertension and tachycardia as well as arrhythmia and myocardial ischemia. This alterations can be life-threatening particularly in elderly people. This clinical trial compared the effects of two rapid-onset narcotics, Alfentanil and Remifentanil, on the hemodynamic responses to the induction and tracheal intubation in elderly patients. This double-blind clinical trial was conducted on 40 subjects aged 65 and above. They were candidate of cataract surgery under general anesthesia. The patients were randomly allocated to two groups of 20. The first group, was gaiven Alfentanil 10 m g/kg and for second group Remifentanil 0.5 m g/kg was injected prior to the induction of anesthesia. Both groups were similiar in the method of anesthesia except in narcotics. The first group was infused with Alfentanil 1 m g/kg/min and Remifentanil 0.1 m g/kg/min was used for the second group. Hemodynamic variations including heart rate, systolic, diastolic and mean arterial blood pressure were measured and recorded eight times (before induction, aften injection, after intubation and five times during anesthesia). Data were analyzed with SPSS software using descriptive and analytical statistics such as T-test, chi squre and ANOVA. Immediately after injection of narcotic drugs, all hemodynamic variants decreased. Howerver diastolic blood pressure in Remifentantil group significantly more than Alfentanil group (P<0.05). After laryngoscopy and tracheal intubation all hemodynamic variants increased and slowly decreased in less than 10 minutes. Systolic, diastolic and mean arterial blood pressure decreased significantly in remifentanil group than alfentanil group (P<0.05). Although heart rate decreased during few minutes after intubation, there was not significant difference between two groups regarding this decrease (P>0.05). Ephedrin was used to treat severe hypotention in those under Remifentanil (11 patients) more than those under Alfentanil (4 patients) (P<0.05). According to the resukts of this study Remifentanil could prevent hemodynamic variation induced by laryngoscopy and treacheal intubation more than Alfentanil. However in some cases Remifentanil leads to hypotension during anesthesia. There is no important difference between two drugs in increasing heat rate after laryngoscopy and intubation.

pericardial effusion is characterized by the accumulation of excessive fluid in the pericardial space, which can lead to cardiac dysfunction or death. Most of the previous studies have been performed in developed countries and its epidemiologic aspects in developing countries were not well-recognized. The aim of this research was determination of etiology, clinical and paraclinical findings in patients with pericardial effusion. This was a cross-sectional, descriptive and retrospective study. From all of the patients admitted to Buali hospital between 2001 to 2003, 49 patients that showed moderate to massive pericardial effusion in echocardiography were selected and studied in terms of history, physical examination, CXR, ECG and pericardial fluid analysis (if performed). From 49 patients 25 (51%) were female and 24 were male. Age ranges of patients were 11 to 85 years. The age of 42% of the patients was above 60 years. The most common clinical complaints were dyspnea (44.9%) and chest pain (24.5%). ECG in most of them (53.1%) were normal sinus rhythm. Cardiac electrical axis in 83.7 % was normal, but ECG in 83.7% of cases showed low voltage QRS complex. The most common findings in CXR was cardiomegaly (85.7%) and 14.3% of patients had normal CXR. Common etiologies of pericardial effusion were chronic renal failure (16.3%), tuberculosis (8.2%), heart failure (8.2%) and malignancies (6.1%). Etiology of disease in 44.8% of patients was unknown. It seems that most of pericardial effusions occur in higher ages. It can be due to high prevalence of different diseases such as heart failure, chronic renal failure or malignancies in senile persons.

Food insecurity and hunger not only affect physical health, but also have social and psychological consequences. Therefore, monitoring food security and fighting against food insecurity and hunger is necessary in a society. This study was carried out to investigate the determinants of food insecurity in northwest of Tabriz (Asadabadi region). This cross sectional study was conducted on 300 subjects in 2004-2005. The prevalence of food insecurity was assessed using a short questionnaire. Information regarding the socio-economic and cultural status of the subjects was collected through a questionnaire. In order to assess the status of food security on the basis of income, occupation, education level and family size, distribution of secure and insecure groups was individually determined, and then Chi-Square test was used to test the significance of the relationship between these groups. Nutritional status was assessed using food frequency questionnaire. Food groups that had significant correlation with income (relationship between groups and subgroups of foods with income was determined using Pearson correlation coefficient) were selected as a criterion for comparing secure and insecure groups. Mean frequency of criteria foods consumption in two groups was compared using independent-sample t-test. The prevalence of food insecurity was 36.3%. Food insecurity increased with family size and declined with income, education and job status of the head of the family (p<0.01). The results of food frequency showed that the mean frequency of bread and potato consumption in food insecure group was meaning fully higher compared to food secure group. Mean frequency consumption of rice, vegetable, fruit, red meat and dairy products in food insecure group was significantly lower compared to food secure group (p<0.001). The results of this study confirmed the impact of socio-economic and cultural status of the families on food security. It also indicated that nutritional problems are prevalent in society. Therefore, it is necessary to give practical solutions to fight against food insecurity as a major problem in society.

Myocardial infarction is a comman cause in hospitalized patients with mortality rate of about 30%. Ontime diagnosis, earlier management and simply (time) factor have very important role in effective treatment, prevention of progression of injury and improvement of prognosis in the patients. Nearly 60% of mortality in this disease is in the first hour after onset of symptoms. Therefore this study was done to evaluate the refferal process, admission and hospitalization in patients with myocardial in farction at Buali hospital Ardabil. This descriptive and cross-sectional study was done on 77 patients with primary diagnosis of acute myocardial infarction based on clinical findings and ECG changes in the form of 1mm ST segment elevation in two adjacent leads or new LBBB or LBBB with unknown onest. Fourteen subjects were excluded from the study based on subsequent examination of continuous ECG and enzymatic evidence rulling out the presence of MI. Data were analyzed with descriptive and inferential statistics. Referral time of patients after onset of symptom was 6.72 ± 5.53 hours. 73.02% of the patients referred with delay (90 minutes after onset of symptom). Mean referral time after onset of symptoms was 7.15±7.07 hours, 60.32% of the patients were outpatients, 34.92% were samples referred by other medical centers and 4.76% by emergency service in the latter group there was no delay in referring time. Mean admission time from emergency room to CCU was 1.04±0.94 hours. 47.62% of the patients underwent thrombolytic therapy with stereptokinase. In this group mean time from entrance to emergency until beginning thrombolytic therapy (Door to Needle time) was 1.22±0.34 houre. Because earlier beginning of thromolytic therapy had important role in decreasing mortality and morbidity in patients with myocardial infarction, we can increase survival rate in these patients by recognizing factors delaying, admission and earlier initiation of treatment.

Early diagnosis of diabetes can prevent many unwanted and irreversible consequences which require a lot of expenses as well as advanced treatment methods and experts. The present study set out to compare prevalence of diabetes in first degree relatives (FDR) of patients with type II diabetes mellitus (T2DM), glucose intolerants and controls. In This case-control research, 277 healthy subjects (129 males and 148 females) with the age of 11-95 were selected from among FDR in three groups, namely those with type II diabetes, glucose intolerants and controls and were evaluated in terms of diabetic condition. World health organization criteria were applied to recognize case(s) of diabetes and glucose intolerants. Odds ratio of being type 2 diabetic or IGT, in FDR of patients with T2DM and subjects with IGT, 5.261 compared to controls was (with 95% CI of 2.15-12.82). Prevalence of T2DM and IGT in both male and female FDR of patients with T2DM and with IGT, was significantly higher than that of controls (p< 0.005). Significantly higher prevalence of T2DM and IGT in FDR of patients with T2DM and with IGT, compared to controls, offers a very quick and cost-effective method of diagnosing covered cases of diabetes in country's health care systems.

Familial Mediterranean fever which is the prototype of the hereditary periodic fever syndromes is common in the countries around the Mediterranean Sea. Regarding the geographical position of the northwest of Iran, having Turkish originality and its vicinity to the Mediterranean Sea, the incidence of this disease is significant in Ardabil. The goal of this study was to introduce Familial Mediterranean Fever as a disease with significant outbreak in this area. This research is a descriptive study which has been done during one year from October 2004 to October 2005. According to the Tel-Hashomer criteria, the patients suffering from Familial Mediterranean Fever were collected from private clinics and pediatric rheumatology clinics records. Then from 112 patients only 74 ones were studied. All of the patients were interviewed and filled out a questionnaire. Familial Mediterranean fever is common among children under 18 (76%) and more common in male than female. Abdominal pain has been the most common complaint (74%) and abdominal pain and fever (95% and 84% respectively) were the main clinical symptoms. The most common period of pain was 12-72 hours and the common recovery (attack free) period was from 1 week to 1 month (63/5%). Majority of the patients had hospital admission for diagnostic work up (85%) and some of them (32%) had been under surgical operation mistakenly. On the whole 92% of the patients had taken medications as a result of wrong diagnosis and 20% had positive familial history. 50% of the patient's parents were first degree relatives and in 59.5% delay in diagnosis was more than 3 years. Results of this study and introduction of this group of patients in a one-year research indicate that: Familial Mediterranean Fever is more common in the Northwest of Iran although physicians are not familiar with that. The common age for manifestation of this disease is under 18 and its presentation after the age of 40 is very rare.

Children are one of the most vulnerable groups of society. Any qualitative and quantitative problem in offering health services to them is a main health and social problem. Cooperative health centers for the first time in Iran were established in East Azerbaijan as a proper strategy for solving health problems and limitations of expansion of government health centers. This study was conducted to evaluate their quality of services to children under one year old in comparison with governmental health centers. This descriptive and cross-sectional study was done on 7 cooperative health centers and 14 neighboring government health centers selected by convenience method. Data were collected by filling checklists obtained from observation of services offered to these children by healthcare personnel as well as studying the children's health records. Descriptive (absolute and percent frequency distribution, mean and standard deviation) and inferential (independent samples t-test) statistics were used for analyzing the data. The findings showed that the quality of health care for children under one was good (85.71%) in cooperative centers and moderate (78.57%) in government health centers and their statistical difference was significant (P=0.002). In terms of services about growth monitoring of child, nutrition of infant and mother's education, cooperative health centers had better practice compared to government health centers (P= 0.001, 0.007and 0.023respectively). Regarding the equipment both centers had good facilities (85.71%) and there was no statistically significant difference between them (P= 0.912). The results showed that, in most cases, the quality of health care given to children under one was good in cooperative health centers and moderate in government centers. This optimum performance of cooperative centers can encourage health care authorities to plan for the expansion of such centers to compensate for the deficiencies of health services especially in children under one year old.

Leishmanin skin test (Montenegro test) is a best indicator for evaluation of delayed-type hypersensitivity reaction and cell-mediated immunity in leishmaniasis. A standard antigen is needed for this test. In this research, several batches of leishmanin antigen were produced under standard conditions, and their immunogenicity, specificity, sensitivity and potency were evaluated. In order to produce leishmanin, standard strain of Leishmania major (MRHO/IR/75/ER) was cultured in equal volume of�liquid medium of D-MEM and Tc Medium 199 in large scale. Parasites from stationary phase of growth were harvested and washed under strict standard conditions and used for preparation of leishmanin. Immunogenicity of prepared antigen was tested by skin testing in pre-immunized guinea pigs. Specificity of the reagent and abnormal sensitization were evaluated by skin testing in healthy individuals in non-endemic areas of Tehran and Tabriz. Sensitivity and potency of leishmanin reagent were evaluated by skin testing in recovered individuals from cutaneous leishmaniasis (CL) in endemic areas of rural and urban areas. The findings indicated the productions of leishmanin are sterile and safe with high immunogenicity. Specificity of the products was shown to be higher than 99% with no abnormal sensitization to reagent. Sensitivity and potency of preparations were determined > 96% with mean induration between 15-18 mm in endemic areas of rural CL, and > 93% with mean reactivity of 12-14 mm in endemic areas of urban CL. The findings indicated that this product is safe and sterile with high immunogenicity, specificity, sensitivity and potency and has no abnormal sensitization. These products which are easily available inside the country could be used easily for skin testing and detection of delayed-type hypersensitivity response in leishmaniasis.

The remarkable increase in the number of chronic diseases and failing in the definite treatment of these illnesses in order to meet the needs of these patients as well as the high costs of control and management of these diseases require special attention to the promotion of health in them. The first step in planning for this promotion is a study of the factors inflouencing health promotion in order to use them in planning to control and manage chronic diseases. Granded theory is a powerful research method to study social structures and processes. This method was employed in the present research to collect and analyze the data in chronic patients. Semi-Structured interviews were used to collect the data which were analyzed using continuous comparison method. Six main themes including the meaning of health, life style, individual factors, spiritual beliefs, support and education emerged, all of which were effective in the process of health promotion in these patients. The findings indicated the concepts found in the research were interactively influencing each other to promote health in chronic patients. Support and education overshadowed other factors and had them under its influence. So, it is necessary to emphasise the role of these two factors in health-promoting activities in chronic patients and leading the patients towards health promotion through increasing self-reliance and creating a supportive environment.

Oxidative stress has a role in the pathogenesis of type II diabetes due to increase in insulin resistance or disorder in insulin secretion and atherosclerosis. Food antioxadants including carotenoids protect against diabetes by preventing oxidation reactions. Therefore, this study was conducted in Sabzevar to study the relationship between carotenoids and blood sugar and lipids in type II diabetic patients. This cross-sectional analytical study was conducted on type II diabetic patients who were randomly sampled. Their height and weight were measured and relevant data on nutritional intake and frequency in 3 successive days were collected through 24-hour recall. Measures were domesticated and converted to grams. Carotenoids of the intakes were calculated. Blood sugar, triglycerides and serum cholesterol after 12 hours fasting were measured through enzymatic procedures. Data analysis was carried out by descriptive statistics and partial correlation. 75 type II diabetic patients with mean age of 54.05±14.2 years, mean BMI of 27.02±5.03 Kg/m2 participated in the study. Their mean blood sugar, triglyceride and cholesterol were 196.36±87.82, 262.84±147.89 and 243.98±60.76 mg/dl respectively. Mean daily intake of beta carotene was 1236.56±810.21 mcg, alpha carotene 878.170±149.04 mcg, lutein 1163.40±819.77 mcg, zeaxanthin and lycopen were 2195.77 ±988.70 mcg. Our results showed that most carotenoids negatively correlated though not significantly with their blood sugar and lipids.

A great amount of evidence shows that Oxidative stress is high among hemodialysis patients. The purpose of present investigation is examination of the effect of zinc supplementation on improvement of oxidative stress in chronic hemodialysis patients. In this double blind clinical trial 65 chronic hemodialysis patients were studied in two groups Group one (35 patients) received placebo and group two (30 patients) received 100 mg elemental zinc (as zinc sulfate) daily for 2 months. The placebo and supplement discontinued in next 2 months. Then, the study continued for two other months in the cross-over from. The levels of serum zinc, total glutathione, malondialdehyde (MDA), total serum antioxidant capacity and the activity of whole blood superoxide dismutase (SOD) were determined on 0th, 60th,120th,180th days, in fasting, predialysis samples. Food record was recorded for one day prior to dialysis in above-mentioned days and their dietary zinc was assessed. Basal serum zinc levels in both groups were below 80 μ g/dl. The zinc upplementation led to significant increase in the levels of serum zinc in both groups. The levels of serum total antioxidant capacity, total glutathione and activity of whole blood SOD increased significantly during zinc supplementation period. The concentrations of serum MDA decreased significantly in zinc supplementation period in both groups. During the placebo period the levels of MDA in first group increased significantly, whereas the concentration of glutathione in second group decreased significantly. The body mass index (BMI) values did not change significantly during the study. It can be concluded that in patients undergoing hemodialysis the oxidative stress enhanced during nonsupplementation period (zinc sulfate). Low serum zinc levels are improved by zinc administration and zinc supplementation improves oxidative stress.

Iodine deficiency disorders have been one of the main health-nutritional problems in Iran for many years. Prior to the iodine-supplementation program, Ardabil province was one of the regions with endemic goiter in Iran. The program of control and prevention of iodine deficiency has been performed here since 1989 through production, distribution and consumption of iodized salt. This study was performed in 2001 on 7-10 years-old pupils of Ardabil as a part of national monitoring survey of iodine deficiency control. In a cross sectional- descriptive study, 1200 students (equal number of boys and girls) were selected randomly. The prevalence of goiter was determined by clinical examination and according to WHO classification. Urinary iodine content was determined in one tenth of the cases using digestion method. Total goiter rate was 9.3 in all the subjects (10.7% in girls and 7.9% in boys). Median urinary iodine was 18.8µg/dl. In 80.7% of the cases urinary iodine was above 10µg/dl and was less than 5µg/dl in 4.2%. Urinary iodine below 2µg/dl was not observed. The results showed that the rate of goiter among pupils has significantly decreased since 1996 and urinary iodine levels in schoolchildren of Ardabil complied with WHO index. So, Ardabil province can be considered as an “iodine deficiency free” zone.

Gastric cancer is the second most common cause of cancer in terms of mortality in the world. Ardabil province, in northwestern Iran, has the highest rate of gastric (predominantly cardia) Adeno carcinoma in Iran. The most common site of upper gastrointestinal cancer in Ardabil is cardia region (its right-side wall). Therefore this study aimed to investigate comparatively histopathology of right and left side of cardia and z-line considering the incidence of inflammatory and precancerous lesions. This descriptive and cross-sectional study was performed on one hundred adults who referred to Aras clinic for endoscopy. Endoscopy was done with video endoscope and a single biopsy was taken from right and left side of cardia and z-line respectively and one from antrum for H.Pylori. All the samples of the biopsy material were fixed in formalin in separate bottles and pathologic study of the samples with regard to inflammatory and precancerous lesions were done according to Sydney classification of gastritis. The collected data were analyzed by SPSS software using descriptive and analytical statistics. 61 (61%) patients were male and 39 (39%) female. The age range of patients was 19-80 years old (standard deviation 53±16.2). Mild to severe inflammation in left and right side of cardia and z-line was 82.6%, 84%, 97.1%, 93%, mild to severe atrophy in 22.8%, 28.7%, 26.5%, 24.4% and metaplasia type 1 to 3 in 2.2%, 6.4%, 2.9%, 12.2% respectively. Suspected dysplasia in cardia and z-line was only in one case. Analysis of these variables with McNamara, Wilcoxon and Lambda tests showed no statistically meaningful difference considering the histopathological findings in left and right side wall of cardia and z-line This study showed no statistically meaningful difference between right and left wall of cardia and z-line considering the incidence of inflammatory and precancerous lesions. This observation is not consistent with high incidence of right sided cardia cancer. Further study with multiple biopsy sample and more sensitive methods is recommended for the diagnosis of precancerous lesions.

Jaundice is a common disorder in preterm and term newborns and G6PD deficiency is one of its etiologic agents. With respect to high incidence of G6PD deficiency in Iran, this study was conducted to determine the clinical correlation of this deficiency with time of jaundice onset and mean level of serum bilirubin. Management and complication rates are also evaluated in these neonates in comparison with those without this deficiency. This is a case-control study performed through G6PD assay in icteric newborns admitted to neonatal intensive care unit in 22 Bahman hospital in Mashhad within 3 years. This case group was compared with the control group who were randomly selected from among icteric neonates without G6PD deficiency. The data were collected by a questionnaire and analyzed by SPSS. This study was done on 505 icteric neonates. The case group consisted of 34 newborns (6.7%) with G6PD deficiency. M/F ratio in case group was higher than control group (P= 0.01). Mean level of total serum bilirubin was significantly higher in case group (P=0.047). There were no significant differences in duration of phototherapy and hospitalization between two groups, but exchange transfusion rate in case group was twice as much. Complications such as seizure and kernicterus in both groups were the same. Due to high incidence of G6PD deficiency in our study (6.7%) and significant incidence in female patients, determination of enzyme level is recommended in all newborns with jaundice regardless of their gender. Because of higher level of serum bilirubin in G6PD deficient patients, phototherapy must be done as soon as possible to avoid invasive procedures such as exchange transfusion.