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ABSTRACT Objective To investigate the effect of mini‐pulse methylprednisolone in the treatment of patients with COVID‐19 hospitalized in the intensive care units (ICU). Methods This is a single‐blind parallel non‐randomized clinical trial that will be carried out on 60 hospitalized COVID‐19 patients and conducted between February 2020 and December 2020 in Ardabil City Hospital, Ardabil, Iran. The t‐test and chi‐square test were used to compare the results of the two groups. A p‐value of less than 0.05 was considered statistically significant. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 26 software. Results The mean (±SD) age of patients was 57.53 ± 13.71 years. Thirty‐five patients (58.3%) were male and 25 (14.7%) were female. Twenty‐eight patients had fever. During admission, the mean (±SD) of the oxygen saturation was 80.73 ± 8.31. No significant relationship was observed between the study variables in the two groups at baseline. Conclusion The results of the present study showed that in patients treated with methylprednisolone, blood oxygen saturation increased and heart rate and breathing rate decreased significantly. Also, mini‐pulse treatment with methylprednisolone significantly reduced the number of days of hospitalization and the incidence of mortality.

Introduction Brucellosis is one of the most prevalent infectious diseases in the world that infects humans directly through contaminated livestock or indirectly through animal products and induces high medical and economic damage annually. Objective Using geographic information system (GIS) software to determine the hot spots of brucellosis and the spatial correlation and type of disease distribution. Methods We extracted the incidence cases of the disease from 2016 to 2020 in this retrospective cross-sectional study using the disease registration system of Ardabil University of Medical Sciences. The interpolation method (IDW) was employed for spatial analysis and disease distribution and determination of hotspot points, Moran I and General G analysis were used to determine spatial autocorrelation at a significant level ( P

Introduction: 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. Methods: 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

Background: Toxoplasmosis during pregnancy can causes adverse outcomes. Regarding its importance in prenatal care, seroprevalence of Toxoplasma gondii infection among pregnant women was studied in Ardabil City, during 2021-2022. Methods: In a cross–sectional study with a cluster sampling, 244 pregnant women that attended in health care centers of Ardabil City, Ardabil Province, Iran in 2021-2022 were selected. Serum samples were collected and Anti- Toxoplasma IgM (immunoglobulin M) and IgG (immunoglobulin G) was detected. Furthermore, a questionnaire filled for all participants during samples collection and risk factors assessed. Data were analyzed by SPSS software. Results: Participant's age ranged from 16 to 43 years with average of 23± 5.24 years. IgG anti- T. gondii antibody was detected in 22.1% of pregnant women (54/244). In none of participants IgM anti- Toxoplasmosis antibody was detected. There was no significant relationship between demographic variables and risk factors of toxoplasmosis with serology test results. Conclusion: Approximately, 77.9% of pregnant women had no antibody against the T. gondii infection. Therefore, health education, counseling of pregnant women and screening in high-risk pregnant women is recommended to prevent from fetal complications.

Abstract Background Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. Methods In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. Results Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. Conclusions Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.

Background & Aims: Urinary tract infection (UTI) is one of the most common human infections which is more prevalent especially in patients with diabetes mellitus. The aim of this study was to compare the uropathogens isolated from the urine culture of diabetic and non-diabetic patients and their antibiotic resistance pattern in patients admitted to Imam Khomeini Hospital in Ardabil from 2012 to 2013. Materials & Methods: In this descriptive cross-sectional study, the medical records of all patients admitted to Imam Khomeini University Hospital in Ardabil province from the beginning of 2012 to the end of 2014 were reviewed and the required information including age, sex, or the absence of diabetes was recorded. Results: E. coli was the most common uropathogens isolated from both diabetic (58.1%) and non-diabetic (53.6%) patients followed by yeast (19.4%) in both groups. Other common organisms in diabetic and non-diabetic patients were Staphylococcus aureus (8.4%) and coagulase negative Staphylococcus (7.1%), respectively. Among diabetic patients, E. coli had the highest sensitivity to polymyxin (100%), tetracycline (100%), and amikacin (88.9%). In non-diabetic patients, E. coli had the highest sensitivity to amikacin (90.4%), nitrofurantoin (86%), cefoxitin (85.3%), and gentamicin (82.1%). Conclusion: Our findings indicated that susceptibility profiles of uropathogens are different in diabetic and non-diabetic individuals, therefore, empirical treatment for diabetic and non-diabetic patients will be different.

Background & objectives: 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. Methods: 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. Results: 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. Conclusion: 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.

Background & Aims: Acinetobacter baumannii is one of the most important pathogenic bacteria causing nosocomial and opportunistic infection with the high rate of antibiotic resistance. The aim of the present work was to study the antimicrobial resistance pattern of Acinetobacter isolates recovered from patients admitted to Imam Khomeini Hospital and identifying the related risk factors. Also, in this study, the efficacy of different combined antimicrobial therapy against A. baumannii was evaluated. Materials & Methods: In this retrospective study, a total of 108 medical records related to patients admitted to Imam Khomeini Hospital in Ardabil province from 2011 to 2013 was entered into the study. For each patient, demographic, bacterial culture, and antibiogram data were obtained and analyzed. Results: Results indicated that pulmonary infections were the most common clinical source of Acinetobacter infection. The highest rate of resistance (100%) was related to ceftizoxime, chloramphenicol, furazolidone, nitrofurantoin, cephalothin, cephalexin, ticarcillin, piperacillin, amoxicillin, and aztreonam followed by ceftazidime, imipenem, co-trimoxazole, ceftriaxone, cefotaxime, and cefixime (80%). The lowest rate of resistance was seen against polymyxin B, ampicillin/sulbactam and meropenem. Our results indicated that 86.9 % and 91.7% of isolates were resistant to ceftriaxone and imipenem, respectively. Since carbapenems are the drug of choice and the last-resort agent for the treatment of MDR strain of A. baumannii , this high resistance level would be a serious concern. Conclusion: The epidemiological survey will be helpful in controlling infections in hospital environment and prescribing proper antimicrobial agents.

Introduction: 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%. Case Report: 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. Conclusion: Clinical and epidemiological findings are the most important strategies for diagnosis of CCHF disease.

Background & objectives: 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. Methods: 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. Results: 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%. Conclusion: 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.

BACKGROUND: Infection with COVID-19 has resulted in considerable mortality all around the world. This study aimed to investigate the effect of convalescent plasma on the treatment of hospitalized patients with COVID-19 in Imam Khomeini Hospital at Ardabil, Iran. MATERIALS AND METHODS: In this quasi-experimental clinical trial, patients over 18 years of age with polymerase chain reaction-positive COVID-19 were admitted based on the clinical criteria of respiratory distress with hypoxia (O2 saturation 24) with moderate-to-severe lung involvement and in the 1st week of respiratory disease who were not intubated were nonrandomly assigned to two groups: convalescent plasma therapy (CPT) group (197 cases) and control group (200 cases). We used the Chi-square, t-test, Fisher's exact test, and Pearson's correlation coefficient for statistical analysis. RESULTS: Analyses revealed that length of stay in hospital was significantly lower in the CPT group as compared to the control group (P = 0.001). Twenty-four cases (22.0%) in the CPT group and 85 cases (78.0%) in the control group needed intubation. Furthermore, mortality was 17 cases (18.3%) in the CPT group and 76 cases (81.7%) in the control group, the difference of which was also found to be statistically significant (P < 0.05). CONCLUSIONS: It seems that CPT can be used as an alternative treatment at the early stages of COVID-19 to prevent the progress of the disease, reduce the need for intubation and consequently the length of stay in hospital, and finally, decrease mortality.

Background & objective: Pneumocystis pneumonia (PCP) is responsible for pulmonary infection in immunocompromised patients. This study aimed to investigating the frequency of Pneumocystis colonization in patients hospitalized in the intensive care unit (ICU) and evaluating the relationship between PCP and Pneumocystis coloniza­tion. Methods: In the current cross sectional study bronchoalveolar lavage (BAL)fluids of 100 patients were collected from surgery and neurosurgery ICUs with different underlying corticosteroid therapy conditions. Patients were divided into 2 groups (patients who received corticosteroids and not received corticosteroids). Direct examination on BAL fluids was performed by the Gomori methenamine silver andGiemsa staining techniques. Additionally, 2 filtered air samples of the 2 above mentioned units were collected. A nested-PCR targeted mtLSUrRNA gene and sequencing were used to identify Pneumocystis spp. Results: In direct microscopy, 31 out of 100 hospitalized patients (31%) showed positive results. Twenty-three (46%) of smear positive patients were from the group of patients who received corticosteroid, the other 8(16%) were from the group of patients who didn’t receive corticosteroids (P= 0.001). Pneumocystis jirovecii DNA was detected in 77 out of 100 BAL samples by nested-PCR (77%) in which 40(52%) and 37(48%) samples were obtained from the patients who received and not received corticosteroids, respectively. Pneumocystis genome was found in 1 of the 2 filtered air samples. Conclusion: A significant number of patients who received corticosteroids were also colonized by P. jirovecii that may predispose to PCP or be transmitted to susceptible patients. A significant relationship was observed between the mean hospital stay and detection rate.

Background: Developing and guiding new knowledge are futile unless the organizational culture can also be transformed. Future leaders cannot emerge out of an organizational environment that is not conducive to the accumulation of experiences. Objective: The aim of this study was to explore the role of organizational culture in creating a succession- planning system at the Ministry of Health and Medical Education in 2014. Methods: The present qualitative framework analysis held interviews with 23 director generals, administrative directors and deputies from the headquarters of the Iranian Ministry of Health and Medical Education in 2014 who were selected through snowball sampling. The data obtained were analyzed in MAXQDA-10. Codes were extracted using inductive techniques. Results: The cultural factors affecting succession-planning at the Ministry of Health and Medical Education were identified and classified under three main areas, including the cultural factors related to the directors with four themes (Directors’ job security, Constructive competition, Transparency and trust development, Creating opportunities), to the personnel with four themes (Organizational identity and loyalty, Trust in the organization, Talent and merit, Peer envy) and to the system with two themes (Values and beliefs, Politicization). Conclusion: Findings of the study show that establishment and institutionalization of the succession planning to the Ministry of Health and Medical Education is deeply affected by the components of organizational culture. Accordingly, unprofessional organization culture can deprive the organization of numerous advantages in multiple-succession planning.

Background: Many of the cognitive behavioral models and therapeutic protocols developed so far for psychological disorders and chronic diseases have proved effective through clinical research. Objective: This study aimed to determine the effectiveness of teaching cognitive-behavioral techniques on locus of control in hemodialysis patients. Methods: This controlled clinical trial study was conducted in 2015 with 76 patients selected by census and treated with a hemodialysis machine in the dialysis department of Vali-Asr Hospital in the city of Meshkinshahr. A total of four patients were excluded because of their critical conditions while the rest, who were recruited, were randomly divided into two equal groups of 36 patients as the intervention and control groups. First, the locus of control was measured in both groups through a pretest, and cognitive-behavioral techniques were then taught to the intervention group during eight 45 to 90-minute sessions. The locus of control in patients of both groups was finally re-measured through a posttest. Data were collected using Rotter's Locus of Control Inventory. The Wilcoxon test and Mann–Whitney U test were respectively used in SPSS18 for data analysis. Results: In the pretest and posttest stages respectively, 4.8% and 14.3% of samples in the control group as well as 14.3% and 33.3% of samples in the intervention group enjoyed internal locus of control. The difference between the pretest and posttest scores of internal locus of control in the intervention group was significant (p=0.004), which indicates the positive effect of cognitive-behavioral psychotherapeutic intervention on internalization of locus of control in this group. Conclusions: Given the external locus of control in most of the study patients and also the positive significant effect of cognitive-behavioral psychotherapy on internalization of locus of control in this group of patients, it appears necessary to have a psychology resident present in the hemodialysis department to teach the necessary cognitive-behavioral techniques to internalize the locus of control. Trial registration: The trial was registered at the Thai Clinical Trial Registry (http://www.clinicaltrials.in.th) with the TCTID: TCTR20170707003. Funding: The authors received no financial support for the research, authorship, and/or publication of this article

Background & objectives: 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. Methods: 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. Results: 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. Conclusion: 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.

Tuberculosis (TB) is a major global health problem. Awareness of liver injury due to anti-TB therapy is vital because fulminant hepatic failure is a devastating and often fatal condition without liver transplantation. Here, we report for the first time, two patients of fatal liver injury due to anti-TB drugs in the presence of alpha-1 antitrypsin deficiency. Based on the triad of rapid loss in hepatocyte function, the onset of hepatic encephalopathy, and absence of a prior history of liver disease, the diagnosis of acute liver failure was established. Both patients had low levels of serum alpha-1 antitrypsin, consistent with alpha-1 antitrypsin deficiency. Despite aggressive medical therapy and supportive care, patients developed multi-organ failure and died. It seems measuring the serum levels of alpha 1-antitrypsin before beginning anti-TB therapies is necessary, especially when there is emphysema or bronchiectasis.

Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease with autosomal recessive inheritance pattern often seen around the Mediterranean Sea. It is characterized by recurrent episodes of fever and polyserositis and rash. Recently, MEFV gene analysis determines the definitive diagnosis of FMF. In this study, we analyzed 12 MEFV gene mutations in more than 200 FMF patients, previously diagnosed by Tel-Hashomer clinical criteria, in northwest of Iran, located in the proximity of the Mediterranean Sea. In the northwest of Iran (Ardabil), 216 patients with FMF diagnosis, based on Tel-Hashomer criteria, referred to the genetic laboratory to be tested for the following mutations; P369S, F479L, M680I(G/C), M680I(G/A), I692del, M694V, M694I, K695R, V726A, A744S, R761H, E148Q. All patients were screened for MEFV gene mutations by a reverse hybridization assay (FMF Strip Assay, Vienna lab, Vienna, Austria) according to manufacturer’s instructions. Among these FMF patients, no mutation was detected in 51 (23/62%) patients, but 165 (76/38%) patients had one or two mutations, 33 patients (15/28%) homozygous, 86 patients (39/81%) compound heterozygous and 46 patients (21/29%) were heterozygous. The most common mutations were M694V (23/61%), V726A (11/11%) and E148Q (9/95%) respectively. MEFV gene mutations showed similarities and dissimilarities in different ethnic groups, while it is common among Arabs and Armenians genotype. Since common 12 MEFV gene analysis could not detect up to 50% of our patients, who had FMF on the basis of clinical Tel-Hashomer criteria, clinical criteria is still the best way in the diagnosis of FMF in this area.

Background: Visceral leishmaniasis is one of the most important vector borne diseases in the world, transmitted by sand flies. Despite efforts to prevent the spread of the disease, cases continue worldwide. In Iran, the disease usually occurs in children under 10 years. In the absence of timely diagnosis and treatment, the mortality rate is 95–100%. The main objective of this study was to determine the spatial and temporal distribution of visceral leishmaniasis as well as its correlation with climatic factors for determining high-risk areas in an endemic focus in northwestern Iran. Methods: In this cross-sectional study, data on VL cases were collected from local health centers in Ardabil Prov­ince, Iran during 2001–2015 to establish a geodatabase using ArcGIS10.3. Data analysis was conducted using SPSS23 and ArcMap Spatial Analyst. MaxEnt model was used to determine ecologically suitable nichesfor the disease. Results: Two hotspots were found in Meshkinshahr and Germi counties with 59% and 23% of total cases, respec­tively. There was an increase in the incidence rate of VL in Ardabil County from 2.9 in 2009 to 9.2/100,000 population in 2015. There was no spa­tial autocorrelation between county and total number of cases (P> 0.05). Higher NDVI, lower altitude and southern as­pects had positive effects on the presence probability of VL. Conclusion: The number of cases of this disease have been rising since 2013 and doubled in 2015. According to the derived distribution maps, the disease is spreading to new locations such as Ardabil and Namin counties.

Introduction: About one third of the world's population is infected with tuberculosis (TB) and each year, about 1.5 to 2 million people die from TB. Procalcitonin (PCT) is an inflammatory marker that its level has variable results. There are some discussions in the utilization of PCT as a diagnostic marker in active pulmonary TB. The aim of this study was to compare serum PCT before and after treatment in patients with pulmonary TB. Materials and Methods: This conducted on patients with pulmonary TB. Data were collected using a check list. The serum level of PCT was measured by ELISA test at the beginning and after six months of treatment. All data were analyzed using SPSS 16. Results: Forty-two patients with active pulmonary TB entered in this study. The mean age of the patients was 45.48 ± 12.54 years and 54.8% of them were male. Most of the patients (59.5 %) were rural inhabitants. There was a family history of TB in 26% of patients. The most common symptom (45.2%) was cough. Mean PCT prior to treatment was 1.25 ± 0.98 ng/ml. and 81% of the patients had PCT higher than 0.5 to 5. After treatment PCT level reduced significantly (P

Background & Objectives : 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. Methods: 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. Results: 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. Conclusion: According to the results of this study, the most common post CABGS complications were cardiovascular complications, especially arrhythmias.

Background & Objectives: 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. Methods: 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. Results: 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. I n 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. Conclusion: 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.

Background and Objectives: Trans-placental transmission of parvovirus B19 during pregnancy can causes adverse outcomes. Regarding its importance in prenatal care, we decided to study prevalence of parvovirus B19 infection among pregnant woman in Ardabil, Iran. Materials and Methods: In a community based study with a cluster sampling, 350 pregnant women that attended in health care centers in Ardabil were selected. Serum samples were collected and Anti-B19 specific IgG was detected using commercial enzyme-linked immunosorbent assays (Euroimmune Elisa kit, Germany). Furthermore, a questionnaire filled for all participants during samples collection. Results: 64.6% (226/350) of participants were Ardabil citizen and the rest were from rural area (124/350). Anti-B19-specific IgG antibody was detected in 69.1% of pregnant women (242/350). Participants' ages ranged from 15 to 34 years with average of 23 years. According to our study, seroprevalence of IgG antibodies had positive significant correlation with the participants' age (r=0.268) but there were no significant relations between B19 seropositivity and living area, family member, number of commensals, number of living children, and the amount of hemoglobin (p>0.05). Conclusion: Approximately, one-third of the participants were at risk of primary B19 infection. Therefore, health education of pregnant women and screening of infected pregnant women is recommended to prevent fetal complications.

Background & Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.

Background & Objectives: 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. Methods: 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. Results: 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. Conclusion: 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.

Two young men whom were cousin referred to our hospital because of severe abdominal pain ,started after mountain climbing over 2500 meter height . The pain was severe and so they were not able to continue and had to come back. Pain did not been relived in spite of coming back and nausea and vomiting added to previous symptoms at night. Pain was spread to left shoulder and periumbilical region and had periodic changes in severity. There was no history of similar pain before. In Physical examination conjunctiva was pale and oral temperature was 38.1 Celsius in both of them. Para clinic tests revealed thrombocytopenia, high serum LDH level and mild elevation in AST and billirubin. Sonography in both of them revealed some hypo echo areas in inferior pole and middle part of spleen. According to history of pain during mountain climbing in highs, Sickle Cell Anemia (SCA) was the most probable diagnosis. Hemoglobin electrophoresis and Gen analysis confirmed diagnosis. Treatment with nasal oxygen and hydration with slain –dextrose serums were started. Sever pain controlled with opioid analgesics and relived gradually without any complication such as splenetic bleeding or rupture. Patients discharged with good condition after pneumococcal vaccination. 4 weeks later in follow up visit, general condition were good and vital signs had no abnormality. Physical examination did not show any significant findings .Spleens were slightly smaller than expected without any tenderness in percussion. Splenic infarcts had resolved gradually without any specific treatment or surgical intervention.

Background: 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. Methods: 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. Findings: Males constituted 89.3% of the participants (n = 109). The mean age of subjects was 27.0 ± 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. Conclusion: 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. Keywords: Tramadol, Naloxone, Seizure, Intoxicated