مجله دانشگاه علوم پزشکی اردبیل
پیاپی 25 (پاییز 1386)

A common side effect associated with succinylcoline is postoperative myalgia. The pathogenesis of this myalgia is still unclear; therefore there is no ideal method of decreasing the rate and severity of fasciculation and postoperative myalgia. The aim of this prospective and randomized study was to evaluate the influence of low-dose succinylcholine for tracheal intubation on the rate and severity of fasciculation and postoperative myalgia. In this study, 60 patients of ASA physical grading I or II were randomly entered into two groups of 30 patients each. One fasciculation was evaluated on the basis of Mingus and myalgia on the basis of Harvey Induction of anesthesia was performed with fentanyl/thiopentone, and then succinylcholine 1 mg/kg (control group) and 0.6 mg/kg (case group) were administered to patients for tracheal intubation. There was not fasciculation in 50% (15 patients) of study group and on the rest no severe fasciculation occurred. Furthermore, the severity of fasciculation in the study group was significantly lower than that of control group (p<0.0001). In 16 (53.3%) patients of study group and 4 (13.3%) of control group myalgia were not occurred. Severity of myalgia was also significantly lower in study group than the control group (p<0.0001). Acceptable intubating conditions in all patients of two groups. Decreasing the dose of succinylcholine (from 1 mg/kg to 0.6 mg/kg) both provides acceptable intubation conditions, and reduces the rate and intensity of succinylcholine induced fasciculation and postoperative myalgia.

Heart failure (HF) is a pathophysiologic state in which cardiac dysfunction leads to insufficient pumpage of blood for metabolic needs of body. One of the important problems in primary approach to patients with HF, is estimation of HF severity. The present research is an attempt to investigate the accuracy of CXR in diagnosis of HF severity especially in emergency wards. This sensitivity analysis study was conducted on 59 patients admitted to emergency ward of Buali Hospital during March–September 2003, with primary diagnosis of HF. One randiologist used to observe and report radiologic findings without knowing the results of each cardiography.Then cardiologists used to check on the reports and selected patients whose EF was under 50% and eventually sensitivity and specificity of radiologic findings in diagnosing severity of HF (EF≤35%) were calculated. 59 patients (53% female and the rest male) were investigated whose age mean was 65.6±10.9 EF mean was 33.4±9.09. In the diagnosis of pulmonary arterial hypertension, CXR had 72% sensivity and 18% specifity, considering the reliance on the CXR in diagnosis of severe HF (EF≤ 35%) findings were: cardiomeglay (94%), pulmonary artery congestion (75%), interstitial edema (78%) and alveolar edema (76%) with high specifity the reliance on the combination of pulmonary cephalization, interstitial edema and pleural effusion was to have 92% sensivity and 10% specifity. According to high sensitivity of cardiomegaly, pulmonary arterial congestion, interstitial edema and pleural effusion, lack of there findings in CXR reduce probability of severe HF. Alveolar edema because of its high specificity increases probability of severe HF. CXR also has high sensivity in diagnosis and R/O of PAH.

Tuberculosis has been the most common fatal disease among adults. It was ranked as the 7th most prevalent disease in the Global Burden of disease. It was also predicted to retain similar rank based on the Disability-Adjusted life Years (DALY) Criteria in the year 2020, whereas this rink has decreased for other infectious diseases. Tuberculosis varies in socio-demographic characteristics in different geographic areas. Therefore understanding its pattern could be useful in designing a preventive strategy. This study was conducted to identify socio-demographic pattern of this disease on the basis of smear. This cross-sectional retrospective study was conducted in Ardabil city by reviewing 232 samples of patients who were under treatment for TB during last four years. Information was collected from patients’ records which were kept in Ardabil health center. The Data were analyzed through SPSS. 37.5% of cases were male and the rest were female. 86 of subjects had positive smear, 44 negative smear and 98 were diagnosed as extra pulmonary tuberculosis and 4% as relapse. The average age of cases was 42 with SD=19.4 ranging between 2 and 86 years. Positive smear’s pulmonary TB more prevalent in urban areas than rural areas while negative smear’ pulmonary TB and relapse were more frequently observed in the rural areas. Smear positive was 59.3% smear negative was 59.1% and extra-pulmonary TB 67.3% were more common in women than men. However, relapse rate was equal in both sexes. the average age of our subjects was compatible to the findings of other studies.66% of patients with pulmonary tuberculosis had positive smear which is close to 65% that was reported in the national program for prevention of TB. The ratio of positive smear’ pulmonary TB to extra-pulmonary and negative smear’s pulmonary TB was 60% which differs to the expected ratio of one. Relapse rate was 1.7% which is less than expected rate (4%). This shows that DOTS was a successful program.

Postoperative nausea and vomiting are among the main complication after anesthesia and various methods are used for the prevention of this complication. In this study, the effect of the pre induction use of 10mg Metoclopramide’ 8 mg Dexamethasone and the combination of the both, on decreasing in the rate of nausea and vomiting after cataract surgery in intravenous anesthesia is compared with placebo. In this double blind clinical trial, one hundred patients of cataract surgery who are appropriate for this study were, randomly divided in to four groups. In the group of placebo (P), 2cc normal saline, in group (M), 10mg metoclopramide, in group (D), 8mg Dexamethasone, and in group (M+D), 10mg metoclopramide and 8 mg Dexamethasone, one minute before the induction of anesthesia was injected. Patients were received the anesthetic drugs in the sameway and after the tracheal intubation infusion of propofol was started. After the end of surgical operation, the appearance of nausea and vomiting in the recovery room and also 6 and 24 hours after the surgery are recorded in the patient's information forms. Finally the data were analysed by statistical software of SPSS and the statistical tests. After the use of these drugs, the rate of nausea in the recovery room decreased from 44% in placebo to 20% in metoclopromide group, 16% in Dexamethasone group, and 8% in combination of metoclopromide and Dexamethasone; and the rate of vomiting decreased from 20% in placebo group to 4% in metoclopromide group, 4% in Dexamethasone group, and 0% in combination of these two drugs, both the nausea and vomiting the effect of combination of metoclopromide and Dexamethasone in decreasing of postoperative mausea and vomiting was significant (P<0.05). The 24 hour following of nausea and vomiting, also had the same results. With regrard to the results of this study, implication of the combination of 10mg metoclopromide and 8mg Dexamethasone before the induction of anesthesia remarkably decreased the rate of postoperative nausea and vomiting and is useful for the high risk groups for this complication especially in out patient surgery.

nausea and vomiting is one the most common problem during pregnancy. There are several reports about treating effect of acupressure for nausea and vomiting. Our propose was to investigate of p6 acupressure in reducing and relieving of symptoms of nausea and vomiting during pregnancy. A single blind clinical trial has been conducted in order to examine the effect of P6 acupressure on nausea and vomiting of pregnancy in women referring to health center of Ardebil at 2005. 75 women complained of nausea and vomiting after being matched on the basis of the intensity of nausea and vomiting and pregnancy period were invited to participate in the study. Subjects were divided into three groups of treatment, placebo, and control (25 persons in each group), accidentally. Women in treatment group use acupressure wristbands with pressure to P6 acu-point, in placebo group use acupressure wristbands without pressure to P6 and control with no intervention. The symptoms were evaluated for 6 days and twice daily using a questionnaire inspired by Rhodes Inventory of Nausea and Vomiting. In the first 3 days all there groups equally filled the questionnaire and in the second 3days the treatment and placebo groups filled there out. Data of frequency, duration, and severity of nausea and frequency of vomiting were analyzed by Analysis of variance and Wilcoxon means were compared with Tukey and Kruskal-wallis tests. Analysis revealed that the participants in three groups didnt have significant differences in regard to age (treatment 24.3±3.9, placebo 24.9±4.3, control 25.4±3.3 year), gestational age (treatment 12.4±2.8, placebo 12.9±3.1, control 12.4±2.8 week) number of parity (treatment 1.7, placebo 1.6, control 1.4 times) education, job, number of pregnancy. The mean score of nausea severity decreased from 25.1±18.6 to 12.0±11.0 in treatment group, from 22.8±14.6 to 16.1±12.31 in placebo group but increased from 16.3 ±7.48to 17.5±8.92 in control group. The mean of vomiting frequency also decreased from 3.1±3.33 to 1.5±1.66 and from 3.1±4.30 to 1.9±3.68 in treatment and placebo group, respectively; but its value changed from 1.2±2.2 to 1.4±1.4 in control group. Differences between pre-treatment and treatment period of nausea and vomiting symptoms was not significant in treatment group than placebo groups (p<0.043) and it was more in the placebo compared to control group (p<0.009). Comparing of means in treatment and placebo groups showed significant difference in nausea frequency and severity but not significant differences in duration of nausea and frequency of vomiting. P6 acupressure wristband is effective in the treatment compared to control and placebo for reduction of severity, duration and frequency of nausea and frequency of vomiting. The wristband without pressure to P6 acu-point also is affected in reducing nausea and vomiting symptoms but its effect is lower than P6 wristband.

Usually, among the candidate patients for cardiac valve's surgery, the coronary artery angiography is performed according to their age and gender. By this research, the prevalence of coronary artery disease is studied; in addition we have tried to consider the risk - factors of coronary artery disease to predict the probability of coronary artery disease among them. we studied prospectively a population of 320 patients (144 male and 176 female) who were candidate to cardiac valve's surgery and underwent preoperative angiography in the cath - Lab of Imam Khomeini hospital in Tehran, from April - 1999 to October - 2003. There was aortic valvulopathy in 131 patients, mitral in 90 and combined Mitro-aortic in 99. Angina was present in 35% and coronary artery disease risk factors in 27.8% of patients. The prevalence of coronary artery disease was 13.1 %. The prevalence of coronary artery disease in patients with angina was significantly higher (22.3% versus 8.2% in patients without angina). In addition the prevalence of coronary artery disease was significantly higher in patients with coronary artery disease risk factors (22.5% versus 9.5% in patients without risk factors). Three predictive factors of CAD in these patients were age, presence of angina pectoris and presence of CAD risk Factors. The prevalence of CAD in patients who have neither angina nor risk factors was 4.6%. In this group of patients no male under 60 years old and only 3.5% of female patients under 65 years old had coronary artery disease. The study showed that due to the low prevalence of coronary artery disease in patients with none of the coronary risk factors or without angina, we can avoid preoperative coronary angiography in males under 60 years old and females under 65 years old who have neither angina nor risk factors of CAD.

Uremia polyneuropathies especially peripheral neuropathy in chronic hemodialysis patients are very common and its orevalance different and reported between 18-80%. This study was designed to investigate prevalence of neuropathy and its relation ship with duration and adequacy of dialysis in Booali Hospital. This study was an analytic-descriotive study that has been done on 30 patients under hemodialysis and the examinations of which was done by neurologists. To analyze the KT/V for dialysis adequacy, a software from HDCN site was used EMG and NCV to the lower and upper parts were performed to all patients by a neurologist. The required tests were extancted from patient's serial tests. In this study patients with hepatitis C, D, diabetes and Amiloid were excuded from the study. Collected data were analyzed using descriptive statistical method in SPSS program. EMG showed that 40% of patients had carpal tunnel syndrome (65.7% Mild, 13.3% Moderate, and 13.3% Sever in which then was no significant relationship between efficacy and time length. In 56.7% of patients KT/V had higher than 1.2 (Normal), 16.7% had KT/V between 1-1.2 (Acceptable) and 16.7% have KT/V less than 1 (Non Acceptable). Inspite of the new and improved method of hemodialysis, in comparson with the past the prevalence of neuropathy was higher in hemodialysis patients and there was no change in the prevalence of neuropathy. There is no significant relationship between dialysis efficacy and neuropathy. It seems that caulative factors neuropathy like urea were not prevent and they are made within the body.

One of the most common gastrointestinal diseases is gallstone and its complications, that leads to hospitalization and expensive cost. Since Causative factors in this disease are so many that some of them can be preventable and there has not been a study on the risk factor and gallstone, this study investigates the relationship between riskfactor and gallstone, This was a case-control. study A total of 150 patients with gallstone using the simple nonrandomized method were selected and were compared with 150 hospital controls with which they were matched. The risk factors for gallstone formation (age, gender, family history, parity, obesity, diabetes mellitus, hyperlipidemia) were assessed in all of subjects. The association of gallstone with all these risk factor was evaluated with statistical tests including chi-square, ANOVA. In this study, 117 cases (78%) were female and the other 33 cases (22%) were male. 42 persons (28%) were between 40-49 years old and about body mass index 63 persons (42%) were at the range of 25-299 (overweight). The mean serum level of triglyceride in women of case-group was 152.7±7.5 in comparison with 117.8±57.7 mg/dl in control group (p=0.001). Mean duration of oral contraceptive pills in case was 6.9±4.9 in comparison with 3.1± 2.9 years in control group. There was a positive correlation between Goldstone, BMI and mean serum trighyceridz level in women (p=0.001, p=0.001). There was not any arelationship between the parity, smoking, hyper chlostrolemia, hypertriglyceride (in men), positive family history and gallstone. In this study, bidy mas index, the period of taking oral contraceptive pills and triglyceride play roles in gallstone formation. Since these factors can be interventional, it is essential that good plannings be devised to improve them.

Barrett’s esophagus is the most severe complication of gastroesophageal reflux which may lead to Adenocarcinoma of the esophagus. The epidemiologic aspects of this condition is not completed studied in Iran. The aim of this study is to appraise short segment Barrett’s esophagus in patients which are evaluated due to their reflux related symptoms in a university endoscopy center. During this cross-sectional study, short segment Barrett’s esophagus was investigated in 100 consequent patients with reflux symptoms (heart burn and/or acid regurgitation) for at least one year. After obtaining their consent for upper endoscope, they were studied interms of short barrett esophagus Four biopsies from esophageal side of gastroesophageal junction for histologic evaluation, and one from antrum for rapid urease test used for Helicobacter pylori were obtained. Barrett’s esophagus was confirmed by appearance of intestinal metaplasia by two pathologists. Among 100 eligible subjects, 39 patients were male and 61 were female with a mean (±SD) age of 42.31±15.12 years. Prevalence of short segment Barrett’s esophagus in this study was 8%. Barrett’s esophagus was not related to gender, symptoms and their severity but was significantly more frequent in patients experienced their symptoms for more than 5 years. Barrett’s esophagus was not related to the presence of esophagitis. Infection with Helicobacter pylori was related to less esophagitis but was not related to presence of Barrett’s esophagus. According to the high prevalence of Barrett’s esophagus in subjects with reflux related symptoms in our region, upper gastroesophageal endoscopic evaluation of patients with symptoms more than 5 years is recommended even before age 40. Patients may benefit from Concentration the attention of the endoscopist for taking biopsies.

Eczema is an inflammatory skin reaction to exogenous and endogenous factors which originate by processes within the body. One of clinical forms is Dry palmar Eczema. This condition affects housewives and cleaners who frequently immerse their hands in water and detergents. Emollients and topical steroids are used in all cases of Eczema. It is believed that alpha-hydroxy acid agents causes the regrowth and increase the viable epidermal thickness. This study showes the effects of Alpha- hidroxy acids and Vaseline on housewives hand Eczema. At this clinical trial, 22 housewives who had mild dry palmar Eczema were entered to study. One hand was treated by A.H.A (7% glycolic acid) and the other hand by vaselin (placebo) for a month, four times daily. Collected data were analyzed by SPSS soft ware. Age mean of patients were 26±2 years. There was a significant relationship between Alpha-hydrocy acid and erythema improvement whith 99% confidence (p<0.01) and also between Vaseline and arrhythmia improvement with 95% confidence (p<0.04). There was a significant relationship between performing preventive recommendation and the decline in the number of complaints (p<0.01). Improvement was seen in the epidermal atrophia in 50% of the cases in Alpha-hydroxy acid group (p<0.0001). Whereas in the Vaseline group' it was not seen. Improvement and repair in Damages of stratum corneum of Epidermis by A.H.A agents is better done than through Vaseline. Howere, Vaseline is also effective in decreasing complaints and Erythema.

Vast usage of Amalgam and it's poisoning nature related to mercury necessited the hygiene aspects of mercury to be put in to consideration. The aim of this study was to assess knowledge, attitude and practice of dentists towards the principles of mercury hygiene. In this descriptive analytic study, 116 dentists in their private clinic were selected randomly and were analyzed for the above parameters by questionnaire. Data were analyzed in spss.14/win software with descriptive statistic methods, t test and Pearson correlation test. The mean of knowledge, attitude and practice of dentists were 45.74±13.28, 68.96±10.62 and 17.43±17.55 respectively. There was no statistically significant correlation between the knowledge and attitude and practice of principles of mercury hygiene. Besides there was no significant correlation between sex, specialty and graduation time with those parameters. Despite positive attitude and knowledge, practice of Tabriz dentists is not favorable. According to the positive attitude and the willingness of the dentists for knowledge enhancement and optimizing the practice for mercury hygiene, appropriate programming for mercury hygiene instruction during the educational period and continuing educational program can be very advantageous.

Formation of myelin depends on maturation and development of the axonal cytoskeleton andmitochondria. Collagen gel can specifically play role in the regulation and development of axonal cytoskeleton. This research is an experimental study in which forty eight male rats (200-250g) were used. After axotomy, 1 cm segment of the sciatic nerve in rats was removed, and the gap was then bridged by one of the four following polyvinylidene fluoride or PVDF + Collagen gel, Autograft, sham and control. Sciatic nerve was studied by electron microscope by the end of the 4th week and the 12th week. By the end of the 4th week after the regeneration the number of unmyelinated axons in autograft and Collagen Gel was not significant, by the end of the 12th week, the number of unmyelinated axons in autograft group was superior to that of nerve growth factor group (P<0.01). After 12 weeks of regeneration, microtubular density values of normal and autograft groups were not statistically different. The cristae of axonal mitochondria in experimental groups are orientate parallel with its long dimension. The results of study indicated that because of its positive effect on the growth and development of microtubules and mitochodria, collagen Gel combination with PVDF can be used to repair peripheral nerve injuries.

Panel-reactive antibody (PRA) is a routine test to evaluate for sensitized human leukocyte antigens (HLA) before kidney transplantation. The present study evaluates the correlation of renin-angiotensin system (RAS) polymorphisms with the level of PRA in renal transplant candidates. This study included 108 renal transplant candidates. The current patients sera were screened by standard complement-dependent microlymphocytotoxicity technique. RAS polymorphisms were determined by polymerase chain reaction. PRA<10, 10-29, 30-49, and ≥50 considered as negative, mild, moderate, and highly positive PRA, respectively. Twelve (11.1%) patients had positive PRA, among them 10 (83.3%) had mild and 2 (16.7%) of them had moderate PRA levels; we had no highly positive PRA. Ninety-six of cases (88.9%) were negative for PRA. There was no significant correlation between discrete RAS polymorphisms (alone or together) and the degree of panel antibody reactivity (P>0.05). We suggest that none of the RAS polymorphisms could predict the positivity degree of PRA level.

Contact Dermatitis (C.D) is a common condition and 5.4% of population are suffering from it. Main treatments are based on emollients and corticosteroids and in C.D cellular infiltration are mononuclears chiefly T. helper lymphocytes. The aim of this study was to have a new approach to herbals with new science covering and study the efficacy of alcoholic extracts of 4 herbals: henna, camomile cedar and aloevera in experimental C.D on mice. In a pilot experimental study first we chose 70 mice (ENMARY race, 50±10gr weight as case group, then we shaved behind of their left ears (at the days 0 and 1) and rubbed DNCB 400 mg/ml on the skin.At the 10th and 14th day the same amount of DNCB again was rubbed on the left ear. On the right ear the same amount of olive oil in Acetone dissolver was rubbed,as control group. Then at the times of 2, 10, 24, 48, 72, 96, 120, 150 hrs after the 2nd contact, the mice were killed with Ether, cutting the ears from base and prepared pathological sections for study of cellular infiltration. In second stage alcoholic extracts of 4 plants were prepared, then herbal cream with 4% concentration in cold cream as pallish cream were made, with considering the results of first stage that showed the maximal infiltration was at 120 hr after contact, the creams were rubbed every 12hr for 7 days on 40 mice in 4 groups that had been sensitized before with DNCB. 2 groups (20 mice) were considered as control (10 mice received no drugs and 10 mice received cold cream). 60 mice were chosen in the second phase and in general 130 mice were investigated. lymphocytic infiltration reduced after 7 days application of drugs for camomile group about 66/7%, cedar 50%, alaevera 12/5% and henna 0% Camomile chammazolen, Inositol had the best response (66/7% severe response) on improvement of contact dermatitis (P=0.02).