مجله دانشگاه علوم پزشکی اردبیل
پیاپی 19 (بهار 1385)

Sinusitis is inflammation of perinasal sinuses. Gold standard for diagnosis and etiology of bacterial sinusitis is a positive culture of punctured samples in sterile conditions, which is invasive procedure. This study was designed to compare the effects of clarithromycin versus amoxicillin on treatment of acute community acquired bacterial sinusitis in children. This study was conducted as a single-blind clinical trial, with 30 randomly selected patients in each of two groups (case and control). Acute sinusitis was defined as sinusitis not lasting more than 4 weeks. Inclusion criteria were defined as existence of post nasal septic drip or nasal prulent secretions plus at least 3 out of 4 conditions as follows: unilateral local pain on face or head, halitosis, deterioration of symptoms in recent 5 to 7 days and axillary temperature equal to or greater than 38 degrees centigrade. For one group of patients (group A) clarithromycin (KLACID) 15 mg/kg in two divided doses, and for another group (group B) amoxicillin 40 mg/kg in three divided doses, were administered. The collected data were analyzed by SPSS (rel 9) using Chi-square and t-test. In view of response to treatment, 9 persons in group B (30%) and 26 persons in group A (86%) felt healthy on tenth day of therapy. The difference was statistically significant (P=0.001) using Chi-square test. Mean days before patients’ improvement was calculated to be 10 ± 0 (mean ± SD) days for group B and 6±1.9 days for group A. The difference was statistically significant (P=0.001). Despite relatively small sample size, the difference found between effectiveness of two drugs was significant (p=0.001). Thus clarithromycin can be used as one of the effective drugs in treatment of acute bacterial sinusitis.

Benign prostatic hyperplasia is one of the most common diseases in males and Transurethral Resection of Prostate (TUR-P) is a standard method for its surgery. Distilled water is used to clean the field of operation from blood and debris. The overabsorption of this washing fluid can lead to hemodynamic disorders and neurological complications called TUR-P syndrome. Because of hemolysis and ATN, most of the urologists, nowadays, prefer to use non-hemolytic solutions such as cytol and glycine 1.5%. Distilled water is widely used in Iran. Replacing this water with a nonhemolytic and hypoosmolar solution with reasonable price such as manitol 3% seems reasonable. This study was carried out to campare manitol 3% with distilled water during TUR-P. In a double-blind randomized clinical trial, we studied 78 patients with BPH who were admitted to Shahid Moddares hospital in Tehran for TUR-P. These patients were allocated to disstiled water group and manitol 3% group. Na, K, Cr, BUN, CBC, U/A, U/C, 24 hr urine volume and creatinine were checked preoperatively to determine GFR, Na, K, BUN and CBC were checked right after, 4 hours after and on the morning after the operation. Clinical signs of TUR-P syndrome were recorded in the patients as bradycardia, hypertension and neurologic sign. Mean age was 68.6 in distilled water group and 66.4 in the manitol group. Mean weight of resected tissues, mean volume of the solution used and mean resection time were 19.8 gr, 19 litre, 50.8 minutes respectively in distilled water group and 20.2 gr, 20.3 litre and 51 minutes in the manitol 3% group. These differences were not statistically significant. The difference between decrease in serum Na and serum osmolality was not significant in two groups, however, hemolysis rate in two groups was statistically significant (p<0.01). The incidence rate of TUR-P syndrome was 34% in the distilled water group and 18% in manitol group. This difference was not statistically significant. Postoperative creatinine increase was 0.625 mg/dl in distilled water group and 0.04 mg/dl in manitol group. This was not statistically significant. Regarding the role of distilled water in hemolysis and ATN and due to the unavailability of non – hemolytic solutions such as glycine and cytol in Iran, the use of manitol 3% soluion which is a cost-effective, non hemolytic and hypoosmolar solution is recommended.

Thrombosis with high mortality is a serious complication of prosthetic heart valves and requires treatment, which includes reoperation or using filbrinolytic medications. Regarding the importance of the issue and high mortality rate in reoparation, the present study was performed to determine the efficacy and pragnosis of fibrinolytic therapy on mechanical prosthetic valve. This prospective study was preformed on seventeen patients with PVT who had undergone treatment with streptokinase (SK). After the primary diagnosis, the response to treatment was echocardiography and TEE. Patients with large clots or equal to 1cm clots, pregnant women and patients who had been operated in a month prior to the study were excluded. Of the 17 patients (9 female and 8 male, mean age= 43.8 ± 11) 14 had mechanical double-let prostheses (8 mitral & 6 aortic) and 3 patients had single-let prostheses (1 aortic and 2 mitral). 71.3% of the patients with a double-let prosthesis responded completely to the treatment with SK. In none of the patients with a single-let prosthesis the treatment was successful. Also treatment of acute thrombosis was more effective in aortic position (71.4%) than in mitral– valve (50%) (p=0.02). Mortality rate due to cerebral bleeding was 5.8%. Two systemic embolic events (11.8%) occurred (1 cerebral and 1 renal) with transient signs. The use of fibrinolytic agents was effective, relatively safe and available especially in patients with less than two weeks’ presentation, small clot and NYHA class I and II and in aortic-position thrombosis.

Many researches have been conducted on autoregulation of cerebral blood flow (CBF), but its possible variations coincidence with postvagal tachycardia have not yet been studied. The present study searched for the effect of this phenomenon on CBF in young and middle-aged persons. 52 healthy volunteers including 13 young males (mean age 23.9±0.8), 13 young females (mean age 24.2±0.7), 13 middle-aged males (mean age 58±0.9) and 13 middle-aged females (mean age 56.4±0.7) went under the study. Flow velocity in middle cerebral artery (MCA) was assessed using transcranial Doppler (TCD) ultrasonography apparatus. Eckberg’s neck suction device was utilized to stimulate carotid baroreceptors. The data were analyzed using Minitab and SPSS software (rel. 10). Concomitant to the carotid baroreceptors stimulation there was a significant reduction in heart rate in all groups (p<0.05), but mean cerebral blood flow did not change significantly. After ending the carotid baroreceptors stimulation and concomitant to PVT, mean cerebral blood flow increased in all groups except middle-aged males. This increase in CBF became significant in middle-aged females (p<0.05). The results of the present study indicate that cerebral blood flow autoregulation act effectively concomitant to acute stimulation of carotid baroreceptors and this efficacy is maintained until the middle-age, but when faced with PVT, cerebral blood flow autoregulation dose not act effectively.

Since the students majoring in different fields of medicine are going to play key roles regarding community health in the future, it seems necessary to characterize problems threat e ning their mental health. This study was performed in order to evaluate students’ mental health status in Ardabil university of medical sciences. In this descriptive and analytical study, 426 students, selected nonradomly were requested to fill out General Health Questionnaire (GHQ) with 28 questions as well as personal information questionnaire. The data were analyzed using descriptive statistics and Chi-squre. The findings indicated that fear to speak among peers (31.2%), lack of concentration (24.2%) and losing self-confidence (18.1%) were obsessing the students. According to cut point 23, 28.1% of students were assumed to have mental disorder. There was no significant difference between male and female students in terms of mental disorders but there was a meaningful relationship between their status and their economic problems, living place as well as their interest in their course (p<0.05). This study suggests further psychological evaluation and adequate counseling service to promote students’ mental health.

Coronary artery diseases are the leading causes of mortality and morbidity in industrial countries and in Iran. Myocardial infarction and unstable angina are essential clinical syndromes of coronary artery diseases, with the difference that the mortality and morbidity of NonST-elevated myocardial infractions is more than U/A and requires more intensive care. Rapid differentiation and diagnosis of NSTEMI from U/A plays a major role in effective treatment of patients and improvement of their prognosis. This study was designed to determine the incidence of nonST-elevated MI among patients hospitalized with initial diagnosis of U/A. This is a descriptive and analytical study performed on patients hospitalized with U/A diagnosis between 2001 and 2002 in Ardabil Buali hospital. The data (including demographic characteristics, patients’ clinical findings, ECG changes, laboratory findings) were collected using a questionnaire and analyzed by SPSS software using descriptive and analytical statistics. mean patient age was 61 and prevalence of nonST-elevated MI among patients with U/A was 23 patients (22.1%). Mean age of patients with NSTEMI was 60.5 and its prevalence was greater in male (69.9%) than in female (30.4%). The most prevalent ECG change in patients was T wave inversion and ST depression (78.3%) and in U/A patients it was T wave inversion (60.5%). The difference was statistically significant (p<0.001). 64.7% of the NSTEMI patients and 27.4% of the patients with U/A had severe chest pain (p<0.004). Prevalence of NSTEMI was about 1/5 of patients hospitalized with diagnosis of U/A and ECG changes among these patients (as T wave inverison and ST depression along with negative T wave) is more prevalent compared to those with U/A. Clinical manifestation and complications were more severe in these patients than U/A group.

Although peripheral neuropathy involvement is well recognized in chronic renal failure, there are only a few studies on the evalution of central nervous system in these patients. Blink reflex as a simple and non-invasive test for evaluation of central nervous system can be helpful in patients with uremic neuropathy. This case-control and prospective study was performed on 18 patients with chronic renal failure (mean age 41.2) and 21 healthy subjects (maen age 37). Supraobital nerve stimulation was used to compare the subjects in two groups in terms of R1, IR2 and CR2 response latencies. The data were analyzed using SPSS (Ver.10). Healthy subjects’ mean latencies for R1, IR2 and CR2 were 10.7, 31.9 and 33.1 milliseconds respectively. In chronic renal failure group it was 11.7, 34.3 and 35.1 millisecond respectively. The difference was statistically significant (p<0.05). In addition to peripheral neuropathy, cranial nerve involvement is seen in chronic renal failure. Therefore, blink reflex can be used as a simple and non-invasive method for evaluation of cranial nerve involvement.

In spite of extensive advances in diagnosis and treatment of cutaneous diseases, cutaneous fungal infections are still one of the important reasons to refer to dermatology centers. Incidence of dermatophytosis species is different in various regions. Recognition of these agents has important role in its treatment and eradication. The aim of this study was to determine the various species of dermatophytes in patients referring to Haft-e-Tir Hospital, Tabriz. This descriptive-analytical study was done on 518 patients referring to Haft-e-Tir hospital from 1997 until 1998. Direct examination in their cutaneous and nail lesions was positive for dermatophytosis. All the samples from their lesions were cultured in special culture media including dextrose agar and sabouraud's dextrose agar plus chloramphenicol and cyclohexamide. The collected data were analysed by SPSS software. There were positive cultures in 70.3% of the cases. Trichophyton verrucosom was the most common agent in all of cutaneous and nail infections. Involvement was more common among the subjects under 15 as well as among males and villagers. Tinea corporis was the most common clinical form of the disease. The findings indicated that zeophilic species and anthropophilic respectively are the most common dermatophytosis species in the region under study. Culture was positive only in 3/4 of the samples.

Regarding the recent implementation of new information system in medical universities, it seems quite necessary to perform an evaluation study on its effectiveness as well as on the functioning of health care systems regarding the different parts of this system. The aim of this study was to investigate skills of family health personnel in health centers of Ardabil province on correctly completing two common data forms called family planning form and maternity care data form. This can be a reasonable criterion for how well the new system is working in the field of family health. This is a descriptive-analytical study. All family health care personnel from Ardabil province heal care centers were entered into the study. They were asked to enter data related to 10 case presentations into blank forms. After filling out the forms they were checked and evaluated for correctness and final scores were analyzed by SPSS. From all the data collected from 9 cities of the province, 38.5% lacked an academic education and 52% were graduated in midwifery. Mean personnel skill was 4.38 out of 10 and only 11.7% had acceptable skills in filling out the forms. Those with academic education outperformed the non-academic ones. Discrepancies regarding the correct ways of filling the forms, were observed among different cities’ health care centers. The findings indicated family health personnel were not skillful enough in completing the data forms. This led to their weak and non-dependable statistic which in turn would waste budget and energy. Moreover, the validity of the collected data would be under question. So the form 108 is very complicated and needs revision.

Post-episiotomy perineal pain is one of the most common causes of maternal morbidity and is often poorly treated. This study was performed to investigate effectiveness, side effects and patient satisfaction when lidocaine gel and placebo are used. In this double-blind clinical trial a total of 124 women who had normal viginal delivery with mediolateral episiotomy without other complications were randomly selected to receive lidocain gel or placebo. Pain intensity was assessed by numerical rating scale (0-10) after perineal pain in different intervals. Pain relief was assessed by number of pain pills, amount of gel used and the degree of painlessness. Repair of episiotomy was assessed by physical examination on 1 and 10 days after delivery. The data were used to fill out a questommaire. Finally, these data were analysed by SPSS ll (rel 11). There was no significant difference in the amount of pain pills taken, the amount of gel used and patients satisfaction between two groups. Regarding the healing of episiotomy there was no significant difference between two groups in the first and tenth day examinations and all wounds healed on 10th day. Satisfaction of the patients regarding the use of gel was the same in two groups. Despite the findings of some similar studies, topical gel of 2% lidocaine was not significantly different from placebo for healing eposiotomy and relieving its pain. But in both groups result of healing on 10 th day postpartum was good. More studies are required to indicate the effect of high dose of lidocaine on pain relief and the positive effects of using gel on wound healing.

Acquired immunodeficiency syndrome (AIDS) with a history of only three decades, has turned into a threatening pandemic disease world wide giving rise to 3.1 million deaths in 2005. Since there is no distinctive treatment or effective vaccine for AIDS, its epidemiology is similar to non-communicable and behavioral diseases. Since accurate knowledge and attitude is necessary for a healthy behavior, we conducted this study on high school students of Ardabil to determine their sources of acquiring information on AIDS as well as to find out their attitude and knowledge about this disease. This descriptive and cross-sectional study was conducted on 800 students in Ardabil high schools during the year 2002 using cluster random sampling method. A questionnaire with 4 groups of questions including demographic information, source of information used for AIDS and the amount each source is used as well as attitude and knowledge of the participants regarding AIDS was distributed in the school. The collected data were analyzed using SPSS. 378 (47.2%) out of 800 students were girls and the rest of them were boys. The media used for getting informed about AIDS was determined to be: 84.5% TV, 51.4% newspapers and magazines, 49.6% papers and books and 30.6% radio. 89% of the girls and 67% of the boys used TV. The difference was statistically significant(p<0.001). Sources of information in interview form were found to be health care workers with 17.7%, teachers with 10.2%, friends with 9.5%, religious authorities with 8.6%, family members with 8% and other relatives with 5.6%. A combition of the above-mentioned methods plus other souces formed 41.3% of the information source of the students about AIDS. Only 46.3% of the students had a proper insight in their interaction with role-playing patients of AIDS. 44% of the participants had weak and 56% had moderate knowledge about transmission ways of HIV and no one had good knowledge in this regard. There was no significant difference between age, sex and knowledge. The highest percentage of moderate knowledge score was seen in student studying experimental sciences. Only TV had a significant correlation with knowledge (p=0.001). This study entails that more attention must be paid to education through effective use of TV broadcasting. Films, pictures, teachers, clergymen, radio, books and papers had not an effective educational role among high school students regarding AIDS.

With respect to the importance of observing principles of documentation of medical records for educational, treatment, research, legal and statistical uses, the correct, complete and timely registration of this information can play a crucial role in the production of necessary data for these kinds of researches. This study was performed to investigate the process of documentation of medical records of the patients in hospitals under Ardabil university of medical sciences. In this research 370 medical records from eight hospitals under Ardabil university of medical sciences were studied. In each hospital samples were selected randomly based on the number of patients hospitalized in one year. Then according to admission and discharge sheets a certain checklist was completed. The information under study included dignosis, treatment, surgery, cause of the accident, patient condition on dircharge, postdischarge advice and cause of death (whether recorded or not) which were identified in the check list. The data were analyzed by SPSS using descriptive statistics. The findings showed that primary, interim and final diagnosis and treatment measures were recorded 71.9%, 58.9%, 60.8% and 52% respectively in the records studied. Althougt 12.7% of these patients were hospitalized dueto accidents, damage and poisoning, only in 8.5% of them the external causes were recorded. In 68% of the records, condition on discharge and in 76.3% of them recommendation on discharge had not been recorded. 3.5% of the records were related to dead patients, but only in 31% of them the main cause and in 8% underlying cause of death was recorded. In general, in 5 2.4% of these records the correct methods of medical recording were not observed by physicians. The results indicated that the process of documentation of medical record by physicians as the main presenters of health care services was performed incompletely. This can lead to the loss of valuable information about the hospitalized patients. It can also have negative impacts on the course of therapy. As a result, the authorities, physicans and specialists in medical recording should pay special attention to this problem.

The ischemic stroke is defined as cerebral dysfunction due to brain infarct which is induced by vascular obstruction. The related risk factors including hypertension, diabetes mellitus, cardioembolism and hyperlipidemia are investigated in several studies. The aim of this study was to determine the etiology of cerebral infarction in young adults (- year-olds). All the patients in the age rang of - admitted to the neurology ward of Alavi Hospital in Ardabil between 2004 and 2005 with a diagnosis of cerebral infarction were included in this study. A questionnaire including demographic data, personal and family history of stroke and cardiac infarct, hypertension, diabetes, smoking and hyperlipidemia was filled out for all patients. Blood sugar, cholesterol, anticardiolipin antibody and beta- glycoprotein were examined. The patients underwent echocardiography. The data were analyzed using SPSS software (release). The total number of the patients was, including females (71.1%) and males (28.9%). The mean age was (SD=). The etiologic factors based on their frequency were: cardioembolism (40%), positive antiphospholipid antibodies (35.5%), hyperlipidemla (22/2%), smoking (22/2%), hypertension (20%), oral contraceptive use (15/6%) and diabetes mellitus (13.7%). The most frequent etiologies of the cerebral infarcts in the young adults in this study were cardiogenic embolism and positive antiphospholipid antibodies. Other background factors were hyperlipidemia, smoking, hypertension, oral contraceptive use and diabetes mellitus respectively. Most of these etiologies can be intervened and prevented. The identification of these factors before occurrence of cerebral infarction can prevent this debilitating event.

Succinylcholine is a depolarising muscle relaxant that is used for rapid tracheal intubation in general anesthesia. It is a short-acting drug which is hydrolyzed by plasma cholinesterase. Some factors can decrease the activity of this enzyme in body. Some patients may have abnormal form of this enzyme that leads to prolonged duration of action and apnea. The subjects of this research were a male (55) and a female (57) who had prolonged apnea after administration of succinylcholine (4-8h), and they improved completely after mechanical ventilation.