مجله دانشگاه علوم پزشکی اردبیل
پیاپی 14 (زمستان 1383)

Recurrent meningitis is a rare incident and is likely to have multiple etiologies, which could lead to repeated admissions to the hospitals. A detailed investigation of congenital and anatomic anomalies facilitating bacterial entry into the subarchnoid space is mandatory in these patients. A proper diagnosis can often be obtained through taking a complete history, previous admissions, and complete clinical and radiological examinations. The present case is a 25-year-old woman with 8 admissins because of meningitis. After being hospitalized for a long time and relative improvement, she was operated for the first time. The surgery was repeated due to rhinorrhea and the diagnosis of mondini congenital dysplasia in direct relationship with intranasal space. This led to the complete recovery of the patient. Anosmia her only problem at the present time.

Previous studies have suggested that early smoking initiation predicts the duration of smoking, its daily consumption and increased chances of nicotine dependence. The peresent study was an attempt to determine the psychological predictors of transition in different stages of cigarette smoking. A total of 1132 students in 45 school classes were assesed two times, 8 months apart (Age range: 14-19). The subjects filled out a questionaire about cigarrete consumption behavior and predictor variables. 8 menths later they completed a second questionnaire regarding the cigarette consumption. The data were analyzed using logistic regression. Among non-smokers, using alcohol was a predictor of experimenter smoker whereas positive attitude toward smoking predicted regular smoker. Drug abuse and positive attitude toward smoking set out to be strong predictors of transmission from experimenter smoker to regular smoker. Smoking prevention should begin during and before high school period. This study may support interventions that aim at changing high-risk behaviors.

Ectopic pregnancy (EP) is the most common cause of maternal mortality in the first trimester. 10% of maternal death is due to EP and only one-third of women with previous ruptured ectopic pregnancy could have a normal delivery in future. Research about prevalence and risk factors of this kind of pregnancy, could help early diagnosis and treatment of EP and improve the prognosis of fertility rate in the future. In this retrospective, descriptive and cross-sectional study, seventy-two patients with EP diagnosis admitted and treated in Yazd hospitals were studied. The data were collected using a questionnaire and hospital records. Sonography and laparoscopy confirmed the diagnosis. The data were analyzed by SPSS using Chi-Square test. 11176 pregnancies were recorded in Yazd between March 1999 and March 2000 and seventy-two of these pregnancies were ectopic. So prevalence of EC in yazd was found to be 0.5%. Most of the patients (58 cuses) were 20 to 39 years old. 52.8% of the patients had primipar. 25% had a history of one to three times abortion. From 43 patients who used contraceptive, 19 ones used OCP (oral contraceptive). 39 patients had a history of previous surgery, 7 patients had a history of EP and 25 patients had a history of treatment of infertility. The most common symptom of patients was abdominal pain. Only 4 out of 72 patients were treated with a medical method using methotraxe and the rest of them were operated. Three out of these four patients were finally obliged to undertake surgery. The prevalence of EP was 0.5%, which is lower than the national scale.

Hypertension is the most common medical problem in pregnancy, with an incidence rate of 6-8%. The patients with preeclampsia are exposed to more maternal and fetal complications. This requires more intensive prenatal cares. The diagnosis in early stages of disease has an important role in decreasing maternal and neonatal mortality and its comsequent complications. This study was an attempt to determine the epidemiological factors and complications of preeclampsia among patients admitted to Alavi hospital, Ardabil. This descriptive retrospective study was conducted on 176 women with preeclampsia. The data were collected using a questionnaire and medical records of patients. These data were analyzed using descriptive and inferential statistics. 75% of the patients had severe preeclampsia and 25% had mild preedampsia. Regarding the predisposing factors, history of preeclampsia was observed in 23.1% of the cases, mother's underlying diseases in 12.5%, twin in 2.3% and hydramnios in 4%. The method of delivery in 62.5% of the cases was cesarean section. 67.6% of preeclamptic patients had maternal and fetal complications (10.2% Maternal and 57.4% fetal). The maternal complications were: abruptio placenta, (44.4%), eclampsia (22.2%) and coma (11.1%). The fetal complications were: IUGR (42.4%), prematurity (39.6%) and IUFD (9%). In this study the incidence of severe preeclampsia was higher, which may be due to insufficient prenatal cares and delay in diagnosis. Further studies about the effect of prenatal cares on pregnancy outcomes in preeclamtic women are recommended.

Cerebrovascular accidents (CVA) are among the most common neurologic problems affecting people of middle and old ages and are one of the causes of seizure in these age groups. Epileptic seizure in patients with stroke occurs in the forms of early and late seizures and could be seen as simple or generalized. The aim of this study was to evaluate the incidence of early seizure in patients with stroke. All 716 patients with cerebrovascular accidents admitted to Imam Khomeini Hospital during the year 2002 participated in this descriptive study. The data were collected using the patients, records. The stroke was diagnosed through clinical findings, CT Scan and MRI (if necessery). Early seizures were documented in 46 (6.4%) of 716 patients, including 16 cases (5%) with atherosclerotic thrombosis, 10 (8.4%) with embolic infarction, 10 (5%) with intra cerebral hemorrhage and 10 (16.9%) with subarachnoid hemorrhage. Twenty-four (52%) out of 46 patients had Tonic- clonic seizures, 14 (30.5%) simple partial seizures, 5 (11%) complex partial seizures and 3 (6.5%) tonic-clonic status. It was found that incidence of early seizures in stroke is 6.4%and early seizures are more common in subarachnoid hemorrhage and embolic infarction than embolic and atherothrombotic infarction.

Aortic coarctation occurs in 6 to 8% of patients with congenital heart disease. It is the fourth most prevalent heart disease which requires catheterization and surgical involvement in the early years of life. If surgical repair is not conducted on-time, it can lead to heart failure (HF) and death. That is why we decided to study this disease in shahid Madani hospital, Tabriz. 53 patients with aortic coarctation who underwent surgery from early 1999 to late 2003 in Tabriz Shahid Madani Research and Health center were studied retrospectively. 88% of the cases were diagnosed during routine examinations. The most frequent complaints of the patients were palpitation (45%) and exertional dyspnea (41%), and the most important signs were systolic ejection murmur in 96%, weakness of lower limbs pulses in 86% and hypertension in 45%. In ECG, 96% of the patients had LVH and in CXR, 45% had cardiomegaly. In angiography, 100% of the patients had apparent aortic coarctation, which in 14 this was associated with Patent Ductus Arteriosus (PDA) In other 15 cases, PDA was not reported in angiography but was discovered during operation. The most common surgeries were resection, end-to-end anastomosis (43%) and Dacron patch angioplasty (39%). In both methods the pressure graradient decreased to under 10 mmHg in the site of anastomosis and the late complications in the patch method was more than the other one.The diagnosis of this disease had been delayed in these patients because of imprecise examination of all four limb's pulses at the first examination of the patients, the patient's own ignorance, misdiagnosis, mismanagement and symptomatic therapy. In spite of PDA and low blood pressure in coarc region, these patients did not have severe pulmonary hypertension. Resection and end-to-end anastomosis is associated with less common late complications and if conducted in early ages, it can lead to complete recovery.

 Flatulence is one of the most common postoperative disorders, which leads to abdominal distension, respiratory disorders and the openning of sutures. Some of the drugs used to alleviate the abdominal flatulence are associated with complications and harmful effects, which gives us a hint to adopt herbal medicine. The present study investigates the effect of supermint on the flatulence intensity after cesarean section.
  

 This double-blinded clinical trial study was conducted on 107 women (47 cases as placebo group and 60 cases as drug group) who had cesarean section in shahid Mobini hospital, Sabzevar. After stopping the administration of IV fluid, the subjects in both groups received 40 drops of drug and placebo every 20 minutes for 3 days.
  

 The intensity of flatulence in the first 20 minutes (p=0.042), in second 20 minutes (p=0.001), in the third 20 minutes (p<0.001) and 120 minutes after intervention (p<0.001) was lower in drug group compared to before intervention.
  

 Supermint is effective in reducing the postoperative flatulence in cesarean section and is recommended to be used in these cases.

The conjunctiva is a mucus membrane that covers the internal surface of the eyelids and the external surface of the globe. Conjunctivitis comprises a variable group of infectious and non-infectious diseases. Bacterial conjunctivitis is a common type of ocular infections. The aim of this study was to determine the bacterial agents in conjunctivitis. This descriptive study was done on 148 patients with conjunctivitis who were hospitalized in pediatric hospital of Tabriz from March 2001 to February 2002 and had suppurative discharge. Suppurative discharge of the conjunctiva was sampled and cultured on suitable media. Antibiogram of the isolated strains was done using the disk diffusion method. The data were analyzed by SPSS software using descriptive statistics. The isolated organisms were in the following frequency: Pseudomonas aeroginosa (40), Staphylococcus aureus(26), Klebsiella pneumonia(20), coagulase negative Staphylococci spp(18), Enterobacter spp(12), E.coli(10), Seratia marcescens(6), Acintobacter spp(4), Beta-hemolytic streptococcus group A(4). These bacteria had varied degrees of resistance to ciprofloxacin (37%), Chloramphenicle (52%), Gentamycin (70%) and Co-trimoxazol (71%). In different studies the prevalence of conjuctivitis infection is reported to be 20-40% but we found 94.5%. Regarding the importance of bacterial conjuctivitis infection in hospital and the possibility of the transmission of resistant infection to the society, some measures shoud be taken to decrease these infections.

Haemodialysis has been used as a replacement therapy in patients with end- stage renal failure for several decades. But it is not clear yet how much haemodialysis a uremic patient needs? There are different methods for the assessment of needs and adequacy of dialysis. One of these methods was measurement of KT/V of haemodiolytic patients. The aim of this study was to determine dialysis adequacy of haemodialytic patients in Ardabil dialysis center. In this descriptive study, all of the hemodialytic patients (70 cases) in 2002 were studied. Urea and blood cells were determined in the patient's blood samples both before and after dialysis. KT/V methods were used to determine the adequacy of dialysis. The data were collected and analyzed by SPSS software using descriptive (mean,standard deviation) and analytical (X2) statistics. The findings showed that KT/V was smaller than 1.2 in 90% of cases. 54.3% of patients were dialysed three times a week mean of dialysis duration was 2.4 ± 1.63 years. Mean of hemoglobin was 8.27 ± 1.69 gr/dl. There was no significant relationship between dialysis adeqnacy and instrument type. 90% of haemodialytic patients in this center did not have adaquate dialysis in terms of KT/V criteria. As a result it seems necessery to pay more attention in order to improve the present condition.

Congenital cataract surgery is one of the complicated and difficult surgeries in ophthalmology. Its prevalance is one per 2000 live birth but it is one the main causes of blindness in children. This prevalence is even higher in underdeveloped countries (30 in 100000 cases). Lensectomy & vitrectomy by vitrectome device are the latest methods in this regard. The objective of this study was to evaluate the post-operative results of this method of surgery in patients operated because of congenital cataract. After the diagnosis of the congenital cataract and primary examinations, the patients, in necessary cases, were examined under anesthesia and if possible, in all patients retinoscopy was conducted and intraocular presure was measured. If the examination of the retin was possible, the red reflex was determined. Then the patients were garded to D( absence of cloudy lens), 1( the presence of opacity up to 1 mm), 2A (the area of apaque part less than nonopaque area), 2B (the area of opaque part more than nonopaque area) and 3 ( complete opaqcity of lens). All of the patients were evaluated in two groups: first, only congenital cataract second cataract due to trauma. In the first group (with 24 patients and 33 eyes). 26 eyes (79%) had very good postoperative condition, 4 eyes (12%) had good condition and 3 eyes (9%) were nearly good. In the second group including 17 patients, 9 eyes (56%) were very good and 4 eyes (26%) good and 4 eyes (26%) moderate in terms of postoperative results, and none of them had poor results. Because of the good surgical results of lensectomy and vitrectomy in congenital cataract and rapid visual acuity they are still methods of choice in congenital cataract surgery.