مجله دانشگاه علوم پزشکی اردبیل
پیاپی 8 (تابستان 1382)

Today, laparoscopic surgeries, because of reducing postoperative complications, are increasingly developing. Intraperitoneal insufflations of CO2 and systemic absorption of it during laparoscopy results in hypercarbia. Using N2O during maintenance of anesthesia in these patients can enhance hypercarbia. This is because N2O increases the volume of pneumoperitoneum. This study was performed to determine the effect of N2O in enhancing hypercarbia during laparoscopy. Sixty Patients, with physical status I or II, undergoing outpatient diagnostic gynecologic laparoscopy according to ASA (American Society of Anesthesiology) scaling took part in this clinical and single blind trial, and were randomly divided in to two groups, each with 30 patients. In all patients, general anesthesia with end tracheal intubation was administered. The technique of anesthesia and ventilation were the same in all patients. Only, during the maintenance of anesthesia, N2O was not administered to group I (control) of patients, but in group II (case), patients received N2O, in 50% concentration in oxygen. The variables under study were evaluated and recorded at certain times and finally the data were analyzed using chi-square test, student t-test and EPI-5 software. There was no significant difference between two groups in terms of demographic data, homodynamic variables (heart rate, mean arterial pressure, and electrocardiogram changes), oxygen saturation, and the use of any additional analgesic drug (instead of N2O in group I). Comparing the End tidal CO2 (Etco2) in two groups indicated that Etco2 increases in those patients who used N2O during maintenance of anesthesia (p=0.02). With regard to significant difference between two groups in the enhancement of intraoperative hypercarbia (although it was not associated with homodynamic changes in this study), it is better not to use N2O in general anesthesia for laparoscopic procedures.

Even though the medical sciences have developed increasingly, ectopic pregnancy is still an important cause of maternal mortality. Despite many researches on medical therapy of ectopic pregnancy (EP), surgery is still the first management of patients with EP. Most of these patients have become pregnant for the first time and keeping their fertility in the future is very important. Surgery especially salpangectomy can do nothing to keep this fertility. It seems that efficacy of medical therapy of EP, especially in Iran is unknown. This research was conducted to determine the efficacy of medical therapy of EP with Methotrexate in some patients. In a prospective uncontrolled clinical trial study 26 patients with EP were hospitalized in Yazd Madar hospital. Six of them did not have any indications of medical therapy and were treated surgically.20 patients were treated with Methotrexate considering all the requirements. These patients received Methotrexate 1mg/kg daily. For the prevention of side effects, folinic acid with a dose of 0.1 Methotrexate was given. The efficacy of treatment was determined afterwards with the serial measuring of serum level. The data were analyzed using Chi-Square test and SPSS software. The average age of these patients was 27.19 years and most of them had spotting as a symptom. They had been married for 6.9 years on average and most of these patients (42.3%) were experiencing their first pregnancy. Fourteen patients (53.8%) had a history of infertility and 26.9% had a history of abortion. 50% had experienced a previous abdominal surgery. Four patients had recurrent EP and the average of gestational age at the time of diagnosis was 6.2 weeks. Finally fifteen patients (75%) were treated successfully. Four out of five patients, who had a failed medical treatment, had a serum level higher than 1000 IU/L. Five out of eight patients, (62.5%) who were followed, experienced normal intrauterine pregnancy after one year of treatment. Medical therapy of Ectopic pregnancy with Methotrexate seems to be safe and effective but when serum level exceeds 1000 IU/L it is less likely to succeed.

The quality of services given to emergency patients at a hospital as well as these patients ’ satisfaction of the services is an index of overall services in that hospital. This study is an attempt to evaluate the degree of satisfaction among the patients referring to the emergency rooms of the hospital of Ardabil University of Medical Sciences during fall and winter 2000. In this cross-sectional prospective study, 600 emergency patients referring to emergency rooms of Alavi, Fatemi, Buali and Aliasghar hospitals were selected. They filled a questionnaire. The data were analyzed by SPSS software. The findings indicated that 78.1% of the whole subjects were generally satisfied with the services. The greatest degree of satisfaction belonged to specialty services (93.8%) and the physicians ’ and nurses ’ contact (92.3% and 91.8% respectively). The least degree of satisfaction belonged to hospital charges (40.2%), and unavailability of non-emergency drugs in hospital pharmacy (42.9%). According to the results of this study the medical centers need to offer more coverage of national health insurance services. Furthermore it seems necessary to equip these emergency rooms with round the clock pharmacies and provide the required drugs.

When a cesarean is necessary, it can be a life-saving technique for both mother and infant. In recent twenty years, the cesarean childbirth rate has increased dramatically. Moreover a cesarean costs nearly twice as much as a vaginal birth. The world Health organization states that a cesarean rate greater than 10-15% cannot be justified. The aim of this study was to determine the cesarean rates and its indications in social security hospital of Ardabil. In this cross-sectional study was conducted all of the deliveries (both cesarean and normal delivery) in Ardabil social security hospital were investigated using a questionnaire including the characteristics of indication. The data were analyzed using SPSS software. 45.4% of the deliveries were done using cesarean and 54.6% of them with a normal procedure. 55.8% of all the cesareans had an accepted indication. 44.2% of cesareans were controversial or elective, 22.7% were repeated cesarean, 8.4% were breech presentation and 2.3% were golden baby and 10.8% of the cesareans did not have a clear indication. The cesarean section rates in this study were higher than world rates. As a result the rising cesarean birth rate must be stopped and reversed with health interventions.

Dependence on substance or addiction is a psychological disturbance. This is referred to as substance abuse in psychological classifications and is the second most common psychological disturbance. On the other hand depression is an instance of disturbance, which is observed among the victims of substance abuse. This study set out to evaluate the effectiveness of Cognitive-Behavior Therapy (CBT) of depression among patients with substance abuse. Using experimental method, 28 men and women (23-35 years, normal IQ) with substance abuse were randomly selected according to DSMIV criteria. These subjects had been under anti-addiction medication for two years, without adequate control, and were divided into two groups. The two groups received the following treatments for 6 weeks: 1- Cognitive Behavior Therapy. 2- No specific psychological treatment (control group). Two instruments were used to collect data namely Beck Depression Inventory (BDI) to evaluate depression and demographic forms to record the information. The data were analyzed using repeated measurements including a pretest and two posttests. In pretest, according to scores of both groups from Beck test, there was a severe depression among the subjects. However in the second and third posttests these scores fell significantly. The intra-group and inter-group tests showed that these reduction in scores was related to the intra-group differences. CBT has had an important role in treatment of depression among patients with substance abuse. Psychological intervention was able to help them change their cognition by decreasing depression and enable them to have a more positive belief in controlling themselves against dependency. It seems that taking psychologically team-approach (both theoretically and practically) about control strategies and treatment of depression in patients with substance abuse can deeply improve their life style as well as their individual and social relations.

Despite all improvements in diagnosis and treatment, one third of patients with Myocardial infarction lose their life. Different studies have shown that cardiac arrhythmia are the most common cause of death in MI, and cardiac blocks are one of the important groups of these arrhythmia, which are effective in prognosis, duration of hospitalization and hospital mortality of the patients. In this study, 630 patients with AMI, who were admitted in CCU of Bou-Ali hospital in Ardabil from January 1998 to January 2001 were studied and the data were callected with the help of questionnaires and secondary data analysis method. The data were analyzed with statistical methods. 9.4% of cases in this study had AV block and 30.2% had bundle branch block. 40.5% of men and 37.6% of women had at least one kind of block(in AV node or bundle branch), but no significant relation was found between sex and these blocks. Also, 62% of in-hospital mortalities of patients with AMI were in association with blocks (AV or bundle branch) and only 38% of mortalities were without blocks. This showed a meaningful relation between hospital mortality and these kinds of blocks (p <0.05). The total frequency of AV and bundle branch blocks due to AMI, was 39.6% which is similar to other studies, but what is remarkable in this study, is the higher prevalence of bundle branch blocks due to AMI.

Despite the ever increasing use of oral contraceptives there is uncertainty about the stroke risk associated with their use. Some cases of pulmonary Emboli and stroke have been reported among women taking these pills. The present research was conducted to investigate the relationship between taking contraceptive pills and the risk of ischemic stroke. In a case-control study, women with definite ischemic stroke were selected from Alavi Hospital in Ardabil who had no prior stroke. The control group was age-matched (± 3years) to cases and were selected from other wards of the same hospital. A questionnaire was administered to elicit information about prior exposure to various risk factors, including the oral contraceptive pill (OCP). The data were analyzed by SPSS software (Ver. 12) and statistical methods such as chi-square, multivariate regression and ANOVA. The risk factor were estimated by odds ratio. OCP consumption was associated with an increased risk of ischemic stroke (OR=5.4 95% CI=1.1-5.3), and after adjustment for other risk factors of stroke it was OR=2.7 (95% CI=0. 95-7.2) with p=0.05. According to this study there was weak evidence for an association between ischemic stroke and OCP consumption. Extended studies are needed to clarify the relationship between risk of stroke and the present/ past use of OCP.

Nutritional status of individuals and community are influenced by different factors. Investigating nutrition and food problems as well as determining dietary pattern play a crucial role in determining nutrition programs and policies, preventing food deficiency, improving nutrition level and preventing malnutrition diseases. The aim of this study was to determine calorie and nutrients intake, food habit and dietary pattern in rural areas of Ardabil. In this cross-sectional study 250 families from 15 rural areas of Ardabil were selected using simple random method. Nutrition status of all the individuals was studied using 24 hour recall and food frequency. Data were analyzed using SPSS and Food processor. This study showed that intake of some nutrients (Zinc, Selenium, Folic acid and Vitamin B2) in the subjects were significantly less than Recommended Dietary Allowance (RDA) of WHO (P<0.001), but intake of protein, iron and calcium was more than the RDA of WHO (P<0.001). Calorie intake of 20% of rural people was less than 75% of RDA(mostly seen among men). The findings of food frequency showed that main foods of rural individuals in Ardabil were local bread (Lavash), potato, egg, milk, biscuit, yogurt, garlic, onion, vegetable fat, butter and tomato. This study showed unsuitable intake of some nutrients. In order to improve the nutritional status of these people, regular intake of different groups of foods should be instructed.