مجله دانشگاه علوم پزشکی اردبیل
پیاپی 5 (پاییز 1381)

Endometriosis is a gynecologic disease. The prevalence of endometriosis in the reproductive age of women varies between 3-10%. Cesarean scar endometriosis is a rare event and rare cases have been reported in gynecologic and surgical articles. The incidence of cesarean section scar endometriosis is not accurately determined but ranges from 0.03% to 0.15% and in some other articles the incidence up to 1% has been reported. Frequently the cesarean scar endometriosis is not diagnosed until before surgery (80%) and usually the patients are operated on the basis of some pre-operative diagnoses such as kelloid, hematoma, suture granuloma, incisional herina and neoplasm. The most common symptom is cyclic and periodic pains in the area of operation which appear approximately 1-7 years after cesarean section. The accurate diagnosis is made by pathology. In this article a patient with cyclic and severe pain in cesarean scar area for 8 years is reported. The patient had been treated with anti- inflammatory drugs for several years without any diagnosis. The patient was operated with diagnosis of subcutaneous mass and probably suture granuloma and the final pathologic report was Endometriosis. The choice treatment for cesarean scar endometriosis is surgery, and awareness about this unusual complication of it will increase the probability of preoperative diagnosis.

Chronic otitis media infection exists among 1.5-2 percent of people and its purulent discharges can create some difficulties for the patients. Chronic otitis media is mainly due to pseudomonas aeruginosa and staphylococcus aurous. Severe and irreversible damages should be expected unless follow up treatments are exactly performed in such patients. This study was conducted to determine the most prevalent microorganisms involved in otitis infection and their sensitivity to antibiotics. This is a descriptive study in which 60 patients who referred to nose and throat clinics of Ardabil University of Medical Sciences (2000-2001) were selected. Using applicator, some samples were taken from suppurative discharges of middle ear. These samples were then cultured in lactose broth and Nutrient broth. In order to isolate pathogenic microorganism, samples were also cultured in blood agar. Sensitivity of isolated pathogenic microorganism was determined against some antibiotics. The data obtained were analyzed using SPSS software. 56 out of 60 patients were culture positive. Microorganisms isolated from suppurative otitis media were Staphylococcus areus (31.6%), pseudomonas aeuroginosa (26.6%), proteus (20%), candida albicans (6.4%), Staphylococcus epidermidis (4.6%), aeuromonas (1.6%) and others (6.4%) respectively. Sensitivity of microorganisms to antibiotics was found to be Ciprofloxacin (94.6%), Co-trimoxazole (66.3%), Cloxacilin (64.3%), Chloramphenicol (64.3%),Cephalexin (64.3%), Erythromycin (60.7%), Amikacin (44.6%), Streptomycin (39.3%), Penicillin (5.4%) respectively. Since staphylococcus areus was the most prevalent micro-organism in otitis media infection, and isolated microorganisms were more sensitive to Ciprofloxacin, antibiogram test is necessary prior to the treatment of otitis media.

Breast cancer is the most common cancer occurring among women and the second leading cause of death from cancer among them. The mortality rate of breast cancer is directly related to the stage of the disease when diagnosed, and is reduced by regular breast cancer screening program. This survey is carried out to identify the knowledge, attitude and practice of women in Ardabil about BSE. In this descriptive study, 150 women with 20-25 years of age, were selected through systematic cluster sampling. Knowledge, attitude and practice of them about BSE were investigated through face to face interview, and the obtained data were analyzed using descriptive and analytic statistics. 44% of women had some information about breast cancer. 44.7% of them had average information about BSE. There was statistically significant relationship between knowledge of BSE on the one hand and age, marital status and history of previous breast examination on the other. 52% of them believed in BSE for early detection of breast cancer. Their attitude towards BSE was positive (51.3%) and there was a significant relationship between their knowledge and attitude. 18% of the subjects practiced BSE at least once, and their overall practice was in a weak level (46.7%). Qualitative researches could be recommended to recognize the factors effective in the improvement of acceptance of breast cancer screening methods among women.

Control of TB is regarded as a health priority program in underdeveloped countries, and Iran in no exception in this regard. Annual risk of infection (ARI) is an important index in this program. This index shows the percentage of people in a society who have been contaminated, and consequently their skin test has changed from negative to positive. In this study, Tuberculin skin test is conducted on Ardabil primary school students and its changes, if any, after one year have been regarded using renewed skin test in order to show ARI in this age group. 780 students were selected from among 17 primary schools using simple random sampling method. They were 8-14 years old, (mean 9.92). Tuberculin skin test was performed on all subjects two times with a one- year interval (May 1998-1999). The test results were recorded and analyzed. In this study PPD over 10 mm was considered positive. In 55 (7.1%) students the test was positive in both tests, and in 33 (4.2%) students, PPD changed from negative (first time) to positive (second time) and in 78 subjects the results were doubtful. 765 students (98.1%) had history of BCG vaccination. This study indicated that, firstly, over the time, BCG has little effect on Tuberculin skin test, and secondly, the high rate of tuberculin skin test changes from negative (first time) to positive (second time) represents probability of severe contamination in this area.

Backgrond & In recent years, malaria has been a serious problem in Parsabad (a north-western town in Iran). A lot of health-care funding has been allocated to malaria campaign program in this area. The objective of this study was to investigate clinical epidemiology of malaria during 1999-2000. The data collected through epidemiology forms filled for 509 malaria positive cases during 1999- 2000 was analyzed by EPI2000 software. Frequency tables, X2 test and one way ANOVA were used in this analysis. All 509 Malaria cases diagnosed were P vivax. They belonged to the first seven-month of the year. 69.4% of malaria cases were related to the year 2000 and the others were related to 1999. The most frequent symptoms were chills in 488 cases (95.9%) and fever in 481 of them (94.5%). Sweating was found only in 3.9% of the reported cases. Mean age and standard deviation of patients was 22.9 + 15.6. There was no significant difference between men and women in terms of the distribution of fever and chills. The high prevalence of fever and chills was compatible with the findings of previous studies. If one of the two symptoms is positive in the residents of this area or those people traveling there, malaria should be suspected.

Several studies have introduced different methods to facilitate the fetal expulsion. One of these methods is episiotomy during the second stage of labor followed by instant repair of episiotomy incision. Perineal repair, its different methods and the outcomes have long been a matter of discussion and research. This study was performed in order to compare results of two different methods of perineal repair, namely standard (three stage) and two-stage method (leaving the skin unsutured). This study is a randomized clinical trial in which, 80 mothers were selected continuously and divided randomly into the two stage and three stage repair groups. A scaled pain ruler, a questionnaire and information checklist were used to collect the data. The setting of this study was the labor room, the postpartum unit and subjects’ homes. The finding of this study showed no significant difference between the outcomes of the two groups in terms of perineal pain in the first 4-6 hours, the 2nd day, 15th and 21st day, incision recovery on the 15th and 21st day, dyspareunia and the first postpartum pain-free intercourse. The findings of this research indicated that the results obtained from the two above-mentioned methods are not significantly different. However, since the two stage method requires spending less time and energy and reduces the time that mothers should stay in labor room, it is suggested to be used as one of the perineal repair methods.

Menarche is an important event during developing stages in females. Several factors can affect the determination of the menarche age including socioeconomic situation, family customs and nutritional status. Different researches show that obese girls become menarche earlier than thin ones. Regarding the importance of nutrition in menarche age, the present study was conducted to evaluate nutritional status among girls in Ardabil at menarche age (10-14 years old). The aim of this study was to determine the relationship among anthropometrics (e.g. weight, height, BMI, MAC), nutritional status, economic factors and menarche age. This cross - sectional study was done on 612 primary and secondary school girls at the age of 10-14 during 1999-2000. Height, weight and MAC of these subjects as well as their BMI were calculated. Their nutritional status (24-hour recall and food frequency) and menarche age were studied. Finally, the data were analyzed by SPSS ver.9 and Food Processor. There was a significant relation between height and menarche age (P<0.05). Menarche age reduced with increasing of weight and BMI, and the differences were significant (p<0.05). Menarche age of girls whose MAC was less than 22cm was lower than individuals with MAC≥22 cm and this difference was significant (P<0.01). Girls with≥40% caloric intake from fat had lower menarche age than the other groups but this difference was not significant. Food frequencies showed that the most frequently used foods in each week were two kinds of local bread (Lavash and Barbary), sugar, vegetable oil, chocolate, cheese, apple and rice. Menarche is affected by anthropometrical factors and nutritional status (particularly fat intake).

Desire for using a contraceptive method depends on individual general attitude and perception about it as well as individual understanding, needs and other people ’ s expectation about using that method. This research is conducted to determine reasons for mothers ’ desire in choosing a specific type of postpartum contraceptive method. This research is a cross- sectional study. The subjects were 384 lactating mothers who referred to Isfahan Health Centers for family planning services for the first time after delivery. The data were collected using questionnaires filled out through interview. Descriptive and inferential statistic methods were used to analyze the data. The results indicated that the most commonly used contraceptive method in lactating mothers was coitus interruptus (27.4%). The most common reasons of mothers for selecting this method was its safety (45.3%) and effectiveness (25.1%). Because of the high failure rate of coitus interruptus, health personnel should present proper and enough training to lactating mothers and their husbands about different contraceptive methods. They should also present the application of different contraceptive methods in breast feeding and increase couples ’ ability in making proper decisions as well as choosing safe and suitable contraceptive methods.