فهرست مطالب شهرام حبیب زاده

Masks play a crucial role in preventing and controlling viral epidemics transmitted predominantly through the air. This study aimed to develop and validate a tool to measure people’s attitudes and behaviors related to mask usage during highly contagious viral epidemics.

In this psychometric study, the initial questionnaire was developed and face validity and content validity were assessed by 17 experts and three lay experts. Reliability was evaluated through internal consistency using Cronbach’s alpha and test-retest reliability using the Intraclass Correlation Coefficient (ICC). Construct validity was measured using exploratory factor analysis (EFA) with the principal component extraction method and Varimax rotation.

Based on a review of previous studies, an initial 27-item questionnaire was crafted. During the face validity stage, two items were excluded. Through calculating the Content Validity Ratio (CVR) and the Content Validity Index (CVI), three and one items respectively removed. The average scale level content validity index (S-CVI/Ave) was 0.95. Cronbach's alpha coefficient was found to be 0.76 for attitude and 0.66 for practice sections; the ICC was equal to 0.873. EFA revealed two factors explaining 63.98% of the total variance.

This questionnaire demonstrated sound reliability and validity in Persian, providing an effective means to assess attitude and behavior related to mask usage during highly contagious viral epidemics. It stands as a valuable tool for use in Iran and other countries.

Due to the high risk of Covid-19 disease, especially delta variant in pregnant women, as well as the novelty of this epidemic in the world and the lack of similar studies in Iran and the region, it seems necessary to perform a study on mortality rate and laboratory and clinical findings of the disease in pregnant women. Therefore, this study was performed aimed to determine the laboratory and clinical findings in hospitalized pregnant women with Covid -19 based on disease outcome during the outbreak of Delta variant (summer and autumn 2021) in Ardabil province.

In this cross-sectional and descriptive study, all pregnant women with Covid-19 admitted to the hospitals of Ardabil province in summer and autumn 2021 at the time of delta outbreak were included. Finally, 187 infected pregnant mothers were studied. Demographic information, clinical signs and laboratory findings were studied in all mothers. Data were analyzed by SPSS (version 24) and Fisher Exact test and Pearson Correlation. P<0.05 was considered statistically significant.

Of the 187 infected pregnant women, 8 mothers died. Comorbidity was observed in 41 pregnant women. The most common clinical finding was shortness of breath (Dyspnea) and cough, and the most common laboratory finding was lymphopenia. Comparing the cured and dead mothers according to laboratory findings using Fisher's exact test showed that the difference between ALT (p <0.05), lactate dehydrogenase (p <0.001), AST (p <0.001), BS (P <0.05), creatinine (p <0.05) and total bilirubin (p<0.05) were statistically significant between the two groups.

Infection to delta variant of Covid-19 disease resulted in 187 hospitalizations and 8 deaths of pregnant mothers in Ardabil province. Shortness of breath (Dyspnea) and cough were the most common clinical findings and lymphopenia was the most common laboratory finding.

Currently, the coronavirus pandemic is one of the most important health problems all over the world. The aim of this study was to evaluate the performance of Ardabil University of Medical Sciences during the coronavirus epidemic in Ardabil province.

This cross-sectional study was performed in Ardabil province in northwestern Iran. All patients admitted to hospitals in Ardabil province were recruited. All data were collected from the information registration portal, which was designed according to the instructions of Iranian Ministry of Health and Medical Education. In this portal, demographic characteristics, clinical and laboratory presentations and other data for patients in all hospitals were recorded in one format. SPSS-19 software was used for simple statistical analysis.

During the period from the beginning to preparation of this report, four peaks of Covid-19 were observed in Ardabil. The total number of PCR samples was 76673, of which 33189 (43%) were positive. The number of hospitalized patients was 28792, of which 13716 were positive and the number of outpatients was 47881, of which 19473 were positive.

The results of this study indicate that despite the implementation of national guidelines by Ardabil University of Medical Sciences, the number of hospitalizations and death rates of COVID 19 are still relatively high.

Due to the increasing prevalence of bacterial resistance, there is a growing attention to application of auxiliary treatment of pharyngitis. The aim of this study was to investigate the effect of honey throat spray in the auxiliary treatment of patients with a diagnosis of pharyngitis.

At the start, different physicochemical quality parameters of the honey sample were evaluated. Then, the bottles of honey and the placebo throat spray were prepared. The numbers of 70 patients with the diagnosis of pharyngitis were included in a one-step and double-blinded study. In addition to standard treatment, each patient received either one of the honey or placebo throat spray. The clinical symptoms of the patients were compared between the two groups at baseline and then at 24 hours, 48 hours, 5 days and 10 days after the starting the treatment procedure.

As per results, the quality of honey sample was met to the standard honey criteria. The treatment and placebo groups were statistically similar in terms of demographic specifications or clinical symptoms at the time to enter the study. Pharyngitis recovery was better in treatment group than in the placebo group; this positive effect was statistically significant for symptoms of morning phlegm and painful swallowing, 24 hours after the starting treatment. In treatment group, after 48 hours, symptoms of fever and painful swallowing were resolved, while this indicator was 23% in placebo group. Also, throat pain of 85.71% of patients in treatment group and 17.14% of patients in placebo group was relieved. Overall, the mean recovery time in treatment group was shorter than placebo group.

The findings of this study showed that the use of honey throat spray as auxiliary treatment of pharyngitis can improve the clinical symptoms of pharyngitis and reduce recovery time.

Crimean-Congo hemorrhagic fever (CCHF) is a viral disease that is transmitted to humans through the tick bite, contact with blood and tissues of infected animals in slaughterhouses as well as infected patients in hospital. The mortality rate of CCHF is 20 - 50%.

The patient was a 20-year-old man, an Iranian farmer, who lived in Ardabil County.
The epidemiologic survey showed that his right leg has been bitten by a tick in the past week. The onset of the disease was a sudden high fever, chills and muscle pain. Molecular analysis of blood by RT-PCR showed that it was positive for CCHF disease.

Clinical and epidemiological findings are the most important strategies for diagnosis of CCHF disease.

Background & Nowadays, bacterial resistance and the increase in the therapeutic costs are considered as the most important global concerns of medical care system regarding complicated infections. Imipenem is a member of the carbapenem class of beta-lactam antibiotics prescribed mostly in our hospitals because of its broad activity against bacterial infections. Drug Utilization Evaluation (DUE) process is an official, ongoing and systemic program that collects information in order to identify and improve the adverse effect of drugs and the cost of medicalization. The objective of this study was to evaluate the administration and use of imipenem in the educational Imam Khomeini hospital in Ardabil in 2018. In this prospective, descriptive, cross- sectional study, 110 hospitalized patients, who received imipenem from September to December of 2018, were included in this study. Patient's demographic data, dosing, dosage adjustment in renal failure and other co-prescribed antimicrobial drugs were extracted from current medical file of hospitalized patients and evaluated with medical guidelines. 64% of patients received imipenem in the first day of hospitalization and 75.5% of patients were empirically received imipenem while antibiogram test was ordered for only 24.5% of patients. Serum creatinine were ordered for most of the patients, but correct dose regimens for patients who get non-empiric antibiotic therapy were only 25.5%. High rate of empiric prescription without considering the result of antibiogram test and immediate initiation of antimicrobial therapy at the time of admission were the most important aspects of irrational use of imipenem observed in this study. Paying more attention to sampling, culturing and sensitivity test and prescription of imipenem based on specific guidelines are recommended.

Maternal death during pregnancy or delivery and 42 days after the termination of pregnancy for any reason other than an accident is called maternal mortality. Maternal mortality due to the complications of pregnancy and childbirth is a sensitive indicator of women status in society, access to care, efficiency and quality of healthcare, capacity of the service system to meet the needs of women and demonstrates the economic and social conditions of each society. In addition, mortality due to pregnancy and delivery complications is one of the most important indicators that shows the condition of developing countries. In this regard, this study was conducted to investigate the causes of maternal mortality and related risk factors in pregnant women in Ardebil, Iran, from 2006 to 2016.  In this cross-sectional study, registered information were extracted regarding   the mortality of pregnant women, including demographic characteristics, indicators related to pregnancy, childbirth, and causes of death from 2006 to 2016 from the Family Health Unit of Provincial Health Deputy. Finally, the collected data were analyzed.  According to the obtained results, there were 39 cases of maternal mortality from 2006 to 2016. However; there was no maternal mortality in 2008 and 2015. The mean age of dead mothers was 30±1.8 years (age range: 15-44 years). Considering the mortality stage, 10 patients died during pregnancy (25.6%), one patient died during labor (2.5%), 12 patients died 24 h after delivery (30.7%), and 16 patients died after 24 h. On the other hand, 11 (28.2%) mothers had normal vaginal birth (NVD) and 28 cases (71.8%) had a cesarean section. Moreover, 31 women (79.48%) were at risk. There was a positive relationship between the type of delivery (cesarean section or NVD), parity (the first and second pregnancy), and risk factors during pregnancy with maternal mortality. Hemorrhage was the most common cause of maternal mortality. It is worth mentioning that there was no significant relationship between the causes of maternal mortality.  According to the obtained results, there was a significant relationship between the number of pregnancies and type of delivery with maternal mortality. Moreover, hemorrhage was the most common cause of maternal mortality. Regarding the high levels of cesarean section effects on maternal mortality, it is recommended to carry out vaginal delivery. In this regard, it is necessary to take measures to conduct vaginal delivery without pain to reduce cesarean section rates. In addition, due to the high mortality rate in middle-aged mothers with a high number of pregnancies, it is suggested to use contraceptive methods, such as oral contraceptives, condoms, and birth control.

Human immunodeficiency virus (HIV) is a globally widespread infection that spreads mainly through sexual contact, mother to child and intravenous drug use. The disease can vary from an asymptomatic state to advanced immune deficiency and AIDS-related opportunistic infections and complications. Patients may be diagnosed at different stages of the disease. In this study, we aimed to analyze the clinical and epidemiological characteristics of patients with HIV and its consequences during the past 10 years (2005-2014) in Ardabil city.
In this descriptive and case series study, patients with HIV (including live and dead patients) referring to the Ardabil behavioral counseling center were included during 2005-2014 years. The checklist containing demographic data, modes of transmission, time of diagnosis, clinical and therapeutic problems during this period, etc. was prepared for each patient. In dead patients, the causes of death as well as the interval between diagnosis and death were investigated.
In this study, 60 patients with HIV were evaluated, the mean age was 42.96 years, 76.7% of patients were male and 48.2% were intravenous drug users. In 39.7% of cases, patients have probably been infected through intravenous injection and 33.3% by sexual contact. The mean CD4 lymphocyte cell count of patients was 252 cells per ml. The most common early symptoms of the disease were fever (63.33%), aphthous stomatitis (35%) and diarrhea (28.33%). In 7 cases (50%), tuberculosis was the most common opportunistic infection. 6 patients (10%) had coinfection with hepatitis B or C. 28 patients (46.6%) died within the time of study. The median time from diagnosis to death was 44.84±39.65 months and cardiorespiratory failure was the most common cause of death among patients.
This study showed that most patients were middle-aged and intravenous drug use was the most common risk factors for HIV. The most common way of transmission was intravenous injection and hepatitis C and tuberculosis were the most important comorbidities, respectively. Raising community awareness about the disease, early diagnosis and appropriate care during illness are basic measures to deal with this global problem.

The Erythrocyte Sedimentation Rate (ESR) is indirect measures that can be used to assess a patient’s gerenal level of inflammation. An extremely elevated ESR (>100 mm/h) has a 90% predictive value for a serious diseases. This study has been done for preparing more information about the reasons of ESR (>100 mm/h) in adults who had been referred to ImamKhomeini hospital.
This is a descriptive study and whole hospitalized patients in this hospital with the ESR levels more than 100 included in this study from September 2014 to September 2015.
127 patients have been encountered in this study and 59.08% of them were female and 40.92% were male. The average age of the participants were 55.54 and the average ESR level were 112.6 with the highest affluence of 34% for infection and 13% for other diseases. The most important illnesses in this study were osteomyelitis (14%), CKD (14%) RA (10%). The levels of Hb and Cr have been evaluated that are 9.27 for Hb and 2.1 for Cr.
In comparison to different studies, the most important reasons for the rise of ESR level are infection diseases and secondary reasons malignancies and autoimmune diseases and kidney defects are the reasons for the rise of ESR level.

Technological developments, globalization, the need for immediate reaction to environmental changes , reduction in costs in the presence of of intense competition, and a decrease in loyalty among the staff are all to emphasis the need for Succession Planning in organizations. This study aimed to assess the current and desired situations of Succession Planning by gap analysis in Iran Ministry of Health and Medical Education in 2013.
This study is cross-sectional. A questionnaire benefiting from the existing literature was developed by a research team about current and the desired situations of Succession Planning. After ensuring validity and reliability, the questionnaire was distributed among 268 people from general managers, Heads of offices, deputies of general managers, Heads of expert groups, responsible Experts and Experts by the census. The data were analyzed by SPSS18 , using Paired T-test .
The current situation of organizations for Succession Planning based on the six axes including planning, organizational culture, systems approach, model of competence, professional upgrade path and the role of senior managers in the research, was acceptable rating over 50 percent. At the same time the gap between the current and desired situation in all aspects, was significant. Average rating of the status quo was 1.06 with a standard deviation of 2.90 while it was 3.82 with a standard deviation of 0.89 for the desired situation.
Given the acceptable points in the current situation and a significant gap between current and desired situation for Succession Planning, it seems that the critical issue of Succession Planning should be taken into close consideration due to the nature and specific features of the organization under the study.

Toxoplasmosis is an important infection which is caused by Toxoplasma Gondi. This protozoa infection is prevalent among many warm-blooded animals and spreads worldwide. Toxoplasmosis could lead to still birth in pregnant woman and death in immune deficiency cases. The purposes of this study were determination of serum Cholesterol, HDL and LDL in patients infected with toxoplasmosis.
In this descriptive and analytical – cross sectional study, 200 persons who referred to Farabi laboratory (Ardabil) during summer and fall 2014, were examined. After preparation of blood sample and serum, Electro chemiluminescence(ECL) technique was used to detect contamination of toxoplasmosis and in order to determination of the serum levels of Cholesterol, HDL and LDL lipids, it was applied Auto analyzer technique. Finally data was analyzed through SPSS19 using independent t-test method.
From 200 studied cases (150 women and 50 men), 22 cases (14 women and 8 men) were positive for toxoplasmosis (Anti-toxoplasmosis Ig G were above 30). Cholesterol, HDL and LDL lipids were measured in both case (22 infected cases) and control (22 non-infected persons) groups. The mean of Cholesterol, HDL and LDL were 147.27, 32.23, 95.63 in control group and 173.59, 49.32 and 94.91 in case group respectively.
The amount of Cholesterol and HDL in case group (Toxoplasmosis positive) were higher than control group (Cholesterol Sig. = 0.016 and HDL Sig. = 0.001), whereas the amount of LDL had no significant difference between these two groups (LDL Sig. = 0.92).

Hepatitis C virus (HCV) is a, enveloped,, single-stranded RNA virus of the family Flaviviridae, is transmitted primarily through contact with infected blood. Afterprimary infection, approximately 80% of patients will have chronic disease. The study was conducted to determine active hepatitis C infection rate among Ardabil city blood donors. In this cross sectional study from all of donated blood samples during three years, cases that were positive in both: ELISA screening test and confirmatory specific RIBA test were studied. RT-PCR was used to confirm active infection. All of the55262 blood samples from 2009 to 2012 were evaluated. In 60, blood donors screening HCV ELISA test were positive (0.01%). Confirmatory, specific RIBA test in 19 of them (31%) were positive. ELISA was falsely positive in about 70% of cases. Among 19 patients with positive RIBA test, polymerase chain reaction performed and in 12 of them (63%) active infection were documented. Probability of a positive PCR test in asymptomatic volunteer blood donors with positive ELISA test was 20%. Only 63% of persons with true positive antibodies against hepatitis C (positive RIBA test) had positive RT-PCR test, so approximately 37% of infected patients have resolved spontaneously. Before disease labeling, it is necessary to confirm infection with performing specific RT-PCR test because ELISA test is falsely positive in some cases and positive RIBA test may be related to past spontaneously reso lved infection.

The issue of patients’ rights has become the spotlight of attention over the two past decades. Expectations’ of patients from health centers and respecting their rights are of importance. This study was performed to evaluate respecting patients’ rights and expectations’ of patients in hospitals of medical science university of Ardabil. This study performed to determine the extent to which patient's rights and expectations’ are respected in hospitals of Ardabil when judged against national patients’ rights charter. Methods and Materials: A descriptive-analytical cross-sectional study was conducted on 200 hospitalized patients in three major hospitals of Ardabil University of Medical Sciences in 2012 (hospitals of Ardebil University of Medical Sciences; Imam Khomeini, Fatemi, and Bu-Ali hospitals). The sample of patients was distributed based on the ratio of the number of beds in each ward to the total number of beds in each hospital. Data were collected using questionnaire and interview at discharge time and analyzed through descriptive and analytical statistics methods, utilizing IBM SPSS Statistics 21 software. The results of this study have shown that; the overall adherence level to the patients’ rights charter was 50.69% and overall patients’ expectations was 85/5%. Levels of respecting and patients expectations to the factors “Communication with patients”, “Providing information for patients”, “Privacy”, “Access to good healthcare services”, “Free choice of services and the right of refusal”, “Right to have informed consent”, “Access to health education”, “Confidentiality of patients’ information” and “Handling of complaints” were (68.5%, 90%), (4.5%,74.46%), (56.37%,83%), (54%,88.5%), (19.12%,81.9%), (61.16%,87.6%), (64%,88%), (46.16%,82.6%) and (42.5%,93.2%) respectively. Respecting to the charter have significant differences according to sex and age, also there were significant differences between expectations, education, age and residency of patients (p<0.05). Our results show that adherence levels to the national patients’ rights charter in hospitals of Ardabil, were intermediate and low and patients expectations’ were high similar to other cities of Iran. Therefore for more satisfaction of patients, it seems necessary to increase personals and medical students’ knowledge about patients’ rights.

Urinary tract infections account for about 40% of hospital acquired (nasocomial) infections, and about 80% of them are associated with urinary catheters. This study was conducted to determine the prophylactic effect of one-dose Amikacin on acquired infection related to catheterization. A double blind, clinical-controlled trial of prophylactic one dose (500 mg) Amikacin IV was performed on selected groups of 60 patients of Fatemi Hospital in Ardabil, who had bladder catheter. Patients were randomly assigned to receive Amikacin and placebo (n=30 cases in each group) and were adjusted for age as much as possible. Before and after intervention the urine sample was taken from all patients and to determine the type of microorganisms the simple and selective culture media (such as nutrient agar, EMB agar) and differential tests for the detection of specific isolated microorganisms (Coagulase test Garv Manitol IMVIC were performed. The data analyzed using descriptive-analytical statistics by SPSS statistical software v.16. The findings showed that the mean urinary catheter days in the intervention group were 7.06 and in control group was 7.5 days. The prevalence of bacteriuria was 6.6% in the intervention group and 26.6% in the control group [RR: 4.03] (p≤0.04). The most common microorganisms isolated were E. coli 13.3 3% and Klebsiella 13.33%. There was some evidence that one dose of Amikacin prophylaxis can reduce the rate of bacteriuria.

Nowadays, coronary artery disease is the most common cause of death in developed countries and in the whole world. According to the WHO reports, it will be the main cause of death in 2020. Myocardial infarction is the most common diagnosis among hospitalized patients in industrialized countries. This disease causes more mortality and morbidity than others. Coronary artery bypass grafting surgery (CABGS) is one of the common treatments for ischemic heart disease but it may have some complications. In this study we wanted to evaluate the incidence of CABGS complications in Imam Khomeini Hospital of Ardabil in the first month after CABG. This study was a cross sectional analytic descriptive type and performed on all of the patients underwent CABGS in Imam Khomeini Hospital during 2011-2012. All of the data from patients (like demographic, past medical history, physical exam findings, paraclinical findings and CABGS complications) were inserted in special forms after gathering, and analyzed by SPSS v.16. In this study, 211 patients were studied. About 145 (68.72%) of them were male and 66 (31.28%) were female. Seventy patient (33.17%) were more than 70 years old. About 33.22% of patients had a history of cigarette smoking and 9.95% were opioid abused. The 34.12% of patients had hypertension (HTN) history, 40.28% diabetes mellitus (DM), 17.06% history of hyperlipidemia and 63.98% had a history of the previous MI. Chest pain was the most common complication among the patients (93.36%). According to our study the prevalence rate of post CABGS complications were: bleeding after surgery 13.27%, postoperative myocardial infection 8.05%, neurological disorders 12.32%, renal complications 2.36%, respiratory symptoms 11.37% and 34.59% for cardiovascular complications. Also the total mortality was 5 (2.36%) persons. The data analysis showed that there was a significant relationship between sex with survival status, local infection and neurological disorders, and also there was a significant relationship between age with post CABGS survival, bleeding after surgery and renal complications. There was also a significant relationship between DM and post CABGS survival, local infections and respiratory complications and between HTN and local infections. According to the results of this study, the most common post CABGS complications were cardiovascular complications, especially arrhythmias.

Considering new pandemic attack with new emerging (H1N1) influenza virus، the study was designed for evaluating clinical and epidemiologic characteristics of patients in Imam Khomeini hospital، admitted with presumptive diagnosis of H1N1 influenza. In all of the patients clinical and paraclinical findings and outcome (including mortality rate and definitive diagnosis) were evaluated. Bed occupancy rate in infectious disease ward and ICU and also mean days of admission were calculated. This is a cross sectional study. All 118 patients with acute respiratory symptoms and possible diagnosis of emerging H1N1 influenza that had been admitted at least 24 hours in hospital from 20 October to 1 February 2009 were enrolled in the study. Data collection was done based on questionnaires، with a team other than researchers. The questionnaire included demographic data، clinical symptoms، laboratory findings، radiographic manifestations and outcome of patients. Data analysis was performed with SPSS software version16. A total of 118 patients were studied: 71 patients (60. 2%) were female and 47 patients (39. 8%) were male. Mean (±SD) age of admitted patients was 33. 81±15. 64 years old. The most of admitted patients were in age range of 15 to 30 years old. The most common findings in CXR were bilateral respiratory consolidations and the most common symptoms were fever، weakness and fatigue. About 12. 7% of patients had diarrhea. Leukopenia (WBC < 4000) and leukocytosis (WBC > 10000) occurred respectively in 4. 58% and 33. 2% of cases. Nine patients (7%) were admitted in ICU. In 21 patients (18%) RT-PCR test results were positive and three of these patients had been admitted in ICU. In patients admitted in ICU while their diagnosis was confirmed، mortality was 33%. 48. 3% of patients had at least one predisposing medical condition. Total admission days were 577 days، consisting 519 days in infectious disease ward and 58 days in ICU. Average of hospitalization days per a patient was 4. 88 days. Except epidemiologic clues، there was no pathognomonic sign or symptom to differentiate influenza H1N1 from other respiratory tract infections. High proportions of pregnant women، bilateral respiratory consolidations، and presence of diarrhea and leukopenia in considerable number of patients were the most important findings of the study.

Transmission of tuberculosis occurs usually by aerosols, Produced with patient’s cough. So early diagnosis and proper treatment of patients as a disease reservoir, has a special importance. It seems that every TB patient can infect 10 to 15 people annually during contagion period. For these reasons this study has been planned to evaluate delay time in TB diagnosis.

This is a descriptive analytical cross sectional study performed among all of the TB patients diagnosed in 18 months of study in Ardabil province(from April 2010 to September 2011). Data for questionnaire was collected with interview and analysis, was done with SPSS software version 16. ANOVA, t test, chi-squared statistical tests were used for hypothesis assay.

126 patients whom diagnosis confirmed by scientific tuberculosis committee of province were entered the study.68 patients (54.4%) were smear positive. Mean, standard deviation and median for these patients were 43.8,64.3,20 days respectively. The same numbers for smear negative patients were 43.4, 70.7, and 21 days. There was not any significant statistical difference between smear negative and smear positive patients in patients delay. (P=0.9) the same numbers for diagnosis delay for smear positive versus smear negative patients were 15.6, 22.1,5 days and 46.2,49.2,24 days respectively. This difference was significant statistically (P=000).With definition of patient delay as medical request after 14 days symptomatic illness, it was revealed that only 38.3% of smear positive patients were returned to any treatment centers in fewer than 14 days of symptoms onset. Despite this, proper diagnosis was made in 70.1% of smear positive patients in less than 15 days. Marital state, less than high school education, residence in villages were associated with patients delay. Symptomatic productive cough were associated with reduced latency of diagnosis.

Greater patients delay for treatment request was associated with decrease in diagnostic delay. Delay in diagnosis of smear negative pulmonary tuberculosis and extrapulmonary tuberculosis was more than smear positive pulmonary tuberculosis. The most delays in reaching the correct diagnosis are related to patient. Increasing public knowledge about signs and symptoms of tuberculosis and disease spread ways, along with increasing access to health care services can be useful strategies.

One strategy in management of patient with dyspepsia in absence of malignant or ulcer signs is H.pylori infection role testing, and treatment of all positive cases. Because of high prevalence of pylori infection in Ardebil, and its probable role in chronic gastritis and dyspepsia as well as recently, FDA approved H.pylori stool antigen test for screening of suspicious patients, this study was design to evaluate the frequency of pylori infection in dyspepsia.

In this study, 100 dyspeptic patients of gastroenterology clinics of Ardebil city that had not responded to current therapies such as h2 blockers were entered study with excluding patients who taking antibiotics, proton pump inhibitors or Non Steroidal Anti inflammatory Drugs (NSAIDs) in last two weeks, and alarming danger signs such as weight loss, bleeding and melena. Stool antigen detection test for H.pylori were done for them.

100 patients enrolled in the study. The study group consists of 60 men and 40 women. The average age was 35 years (14-57 years).The prevalence of H. pylori was 72% among dyspeptic patient. Statistically significant differences were not seen between H.pylori infection and the sex, smoking, marriage and infection. There were no differences in clinical symptoms of dyspepsia among patients with and without H.pylori.

Among patients bothersome postprandial fullness was the most common symptom. Clinical signs were not useful in differentiate H.pylori infection persistence in dyspeptic patients. It seems that in hyper endemic areas for H.pylori such as Ardabil H.pylori has high association with dyspepsia, but for further explanation about its role in symptom creation, further population based studies With an emphasis on cost analysis and treatment outcome are needed.

Cardiovascular events are the most common cause of death in hemodialysis patients. Cardiac biomarkers and especially Cardiac troponin I has been used as a prognostic marker in hemodialysis patients and there is some controversies about its value. For these reasons this study has been done for evaluation of prognostic value of Troponin I and left Ventricular Hypertrophy in mortality of hemodialysis patients. This is a prospective descriptive-analytic study, has been done from 2006 -2011 All of new cases whom entered to dialysis center in 2006 studied with measurement of base line Cardiac Troponin I and left ventricular mass index. Patients fallowed up 5 years later without any specific intervention and survival rate was calculated crudely and in base of Cardiac Troponin I and left ventricular mass index separately after exclusion of non cardiac deaths. 76 patients followed up 5 years and 35 of them died. Mean age of patients was 57.4 ± 15.6 year. Mean Troponin I (cTnI) in dead patients was 0.92±0.68ng/l and in alive patients was 0.78±0.58ng/l (p=0.39). Mean Left Ventricular Mass in dead patients was 274.9±100.8 g/m2 and in alive patients was 249±77.7 g/m2 (p=0.23). A significant linear correlation was not founds between cTnI level and Left Ventricular Mass; Age was the most important cofactor of death. Significant correlation was not founded between cTnI level and Left Ventricular Mass with cardiac mortality. mortality. This may be due to some other factors such as age, quality of control of hypertension and other coexisted diseases, quality of life and home cares. Age had more important effect on death and this may reflect multiplicity of heath related problems in them.

Low dose aspirin has been widely used in the prevention and treatment of cardiovascular disease. The bimodel action of aspirin on serum uric acid showed that aspirin at a high dosage promoted uricusuria; while intermediate doses were (1-2gr/day) caused uric acid retention. The main goal of this study was to survey the effect of low dose aspirin on serum level of uric acid in patients with ischemic heart disease. The study design was cross-sectional and analytical type. In this study we selected 60 patients who used low dose aspirin among the patients of Imam Khomeini hospital's heart clinic (2008-9) and their information was registered in special questionnaires including serum level of uric acid and creatinine before and after prescription of aspirin. Data was then statistically analyzed using Paired t test and Willcoxon. Of 60 patients 11 (18.3%) were under 50 years and 49 (81.7%) were above 50 years. The male to female ratio was 1.72 (38: 63.3% versus 22: 36.7%). 53.3% of patients showed an increase in serum uric acid, but 46.7% did not. No significant differences in uric acid levels was found in patients under 50 years before and after administration of aspirin. Serum uric acid levels were increased after administration of 0.1unit of aspirin. Low-dose aspirin (80 mg/ day) caused a slight but significant increase in serum uric acid and creatinine levels in patients over 50 years of age.

Type 2 diabetes is a major cardiovascular risk factor such as HTN, HLP and smoking. A primary diabetic cardiomyopathy represents a high risk factor for heart failure in the absence of ischemic, valvular and hypertensive heart disease in the diabetic population. CAD is more common in diabetic patients and it is almost asymptomatic.Unquestionably, an early detection of LV damage and CAD is a major goal for the prevention of cardiac disease in the diabetic population. This study was done as Cross-Sectional method. The study sample consisted of 40 patients with type 2 diabetes mellitus without hypertension and cardiac symptoms (mean age 47 years) who recourse to diabetes clinic of Ardabil Imam Khomeini Hospital during 2009-2010. Left ventricular (LV) function was studied by echocardiography and exercise test using Bruce protocol. Data from the patients were collected and analyzed using SPSS 17 software. All studied cases had a normal systolic function. 22 cases (55%) had diastolic dysfunction and 8 people (20%) had a positive stress test, which all had diastolic dysfunction too. This study showed that an impairment of left ventricular diastolic function occurs early in the natural history of diabetes mellitus and CAD is more common in diabetic patients with diastolic dysfunction.

The most common drug poisoning in Iran، especially in Tehran، is poisoning with tramadol which is a synthetic analgesic. Like poisoning with other opioids، poisoning with tramadol is commonly treated using naloxone. As documented in poisoning references، seizure is a serious and dangerous side effect of this poisoning. The aim of this study was to compare the prevalence of seizure between patients with tramadol overdose who received or did not receive naloxone in Imam Khomeini Hospital، Ardabil، Iran. In this cross-sectional، descriptive study during 2007-10 data about 122 patients with tramadol overdose in Imam Khomeini Hospital was collected using a questionnaire. The collected data was analyzed in SPSS. Males constituted 89. 3% of the participants (n = 109). The mean age of subjects was27. 0 ± 7. 2 years. Seizure was observed in 21 persons (17. 2%). No significant relationship existed between seizure and sex، age، and history of addiction to tramadol and other opioids (P > 0. 05). Among the 60 subjects who received naloxone، 28. 3% had seizure. The prevalence of seizure in persons who did not receive naloxone was 11. 2%. The highest prevalence of seizure caused by naloxone was seen during the first 1. 5 hours after injection. The lowest dose of naloxone that caused seizure was 1000 mg. Seizure caused by tramadol had no relationship with sex، age، and history of addiction to tramadol or other opioids. Moreover، seizure occurrence is rare in therapeutic dosage. Using naloxone in treatment of tramadol overdose increases the risk of seizure.

Orthomixoviridae family viruses (Influenza viruses) are major cause of death in human with respiratory diseases. Although avian influenza in iranian chickens are associated with H9N2 subtype, there was not any study for seroprevalence of H9N2 avian influenza virus in human of ardabil area as yet. This study was to carried out to determined antibodies to H9N2 avian influenza virus in different human populations during November to February 2010 in Ardabil area, which is situated in the northwest of Iran.Antibodies against H9N2 virus were measured using HI test in 311 sera from two populations (patient and healthy) with different sex and agegroups including 86 serum samples of patients hospitalized with clinical symptoms of respiratory disease, 88 sera of patients hospitalized without respiratory complications , 41 sera of veterinarian and vaccinators, 44 sera of hospitalized medical personnel who related to health profession, and 52 sera of farmers, poultry-farm and slaughter-house workers. Data was evaluated with SPSS.The results of the HI test showed that in patients: 37.2% with 22.03±10.74 titer of the patients hospitalized with clinical symptoms of respiratory disease and 23.9% with 21.88±10.41 from patients hospitalized without respiratory complications, in healthy: 29.3% with 21.14±10.59 titer from veterinarian and vaccinators, 18.2% with 20.00±10.00 titer from hospitalized medical personnel who related to health profession and15.4% with 26.02±11.35 titer from farmers ,poultry-farm and slaughter-house workers were positive (HI titers 1/20). Seroprevalence of 27.0% and 23.6% were determined in male and female, respectively (P≥0.05).The highest and lowest seroprevalence among four age-groups of two human populations (patient and healthy) were observed in 30≤ (26.5%) and 46-60 (22.4%) years, respectively, (P≥0.05). According to results of this study, different groups of humans were contacted with H9N2 avian influenza virus that the highest contact was detected in patients hospitalized with respiratory complication and in regard to occupation was observed in veterinarian and vaccinators.

Myocardial infarction is one of the most common causes of mortality throughout the world. Utilization of thrombolytic drugs at the first hours upon MI leads to decrease in the rate of mortality. Streptokinase (SK) is commonly used because of its cost and availability. The golden time for maximum effect of SK appeared to be first hours after MI. The drug efficiency diminishes after 3 hours and it will be ineffective after 12 hours. This study was aimed to investigate interval between onset of the clinical symptoms and streptokinase receiving in patients with acute myocardial infarction admitted for drug reception. This cross-sectional study was conducted in 150 patients with STEMI (ST elevation Myocardial Infarction) who were attended to emergency room of Imam Khomeini hospital and fulfilled a questionnaire containing the data about age, sex, educational level, onset of symptoms, referring time to emergency room, SK utilization, past medical history of cardiac diseases, type and location of AMI, contraindications and side effects of SK. In 111 men (74%) and 39 women (26%), the mean for interval between onset of symptoms and drug injection was 8 hour and 27 minutes ± 8 hour and 18 minutes. Only 41% of patients received streptokinase in less than 3 hours after chest pain. The main reasons for delaying in drug consumption were delayed decision to come to hospital in 61% of persons, long distance to hospital for 22% of individuals, delayed admission tor CCU for 13% of cases and delay in physician diagnosis for 0.043% of patients. To have a male sex and residency in city where the hospital was establilished were associated with less-delayed treatment start. However, the educational level, age and history of MI were not correlated with onset of treatment. Our results clearly show that the majority of patients receipt streptokinase more than 3 hours after chest pain. With considering the factors associated with delay to receive SK, teaching the patients with ischemic heart disease and giving information about golden time for thrombolytic therapy and its effect in prognosis as well as extending cardiac disease treatment centers in suburbs are recommended.