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Background and purpose : This study was performed in order to determine the correlation between body mass index , maternal and fetal complicationsin patients admitted to Imam Khomeini Hospital in sari during the year 1999.
Materials and methods : This research was a cohort study , done on 726 pregnant women (under weight 154 cases. Normal weight 335 cases and over weight 237 cases). These three groups were matched by the following criteria : obstetrical history, socioeconomical status and the frequency of prenatal care.
Results : In over weight women , prevalence of pre eclampsia , gestational edema , multifetal pregnancy , multiparity , insufficient weight gaining , malpresentation and perinatal mortality were greater than normal weight women. In under weight women prevelance of premature ruptune of membranes , malpresentation were greater than normal weight women.
Conclusion : Low and high BMI can contribute to the complications of pregnancy , thus pregnancy in women with abnormal weight should be considered as ahigh risk factor to be able to prevent complications by special cure .

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Background and purpose : Macrosomia can increase maternal & neonatal complications.These complications and their relevance to macrosomia was evaluated in this study.
Materials and Methods: This was a cohort study done , by selecting 5440 delivery files, in which 4400 cases had natural delivery and 104 patients with cesarean section . Patients with full term delivery of neonate with 4000 grams were selected as a case group and the patients with full term delivery of neonate with 25000-3999 grams weight were selected as a control group. Factors like , parity , and delivery status were the same for both groups , the patients with repeated cesarean were omitted in this study.
Results : The results of this study showed that the total rate of cesarean section in control group was 15.5% against the rate of 11.5% in control group (P<0.037) , and the main reason of cesarean in macrosomic group was due to fetal distress. Shoulder dystocia and excretion of moconium was the only complication of Macrosomic infants , which showed no statistically significant difference (P<0.002) , post delivery bleeding and administration of oxytocin for acceleration of labour in case groups showed no significant difference with cantrol groups (P<0.01).
Conclusion : This study indicated that , despite high rate of vaginal delivery , of macrosomic infant , excluding shoulder dystocia , delivery of macrosomia and post delivery bleeding , there was no significant difference in maternal complications and further study is recemmonded in such type of deliveries

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Background and purpose : Panic disorder (PD) and MVP are relatively Çommon disorders, and the relation between them has been noticed by researchers. The question, weather, MVP is more common in PD patients than the whole non PD population, has not been answered yet. Ïn order to answer the question, this study was designed and performed.
Materials and methods : This descriptive study, has been done on the patients referring to psychiatric clinic from 1998 to 2001. The patients with confirmed diagnosis of PD according to DSM-ÏV, were under clinical trial and echocardiography by cardiologist for the probable presence of MVP.
Results : During this study, 181 patients suffering from PD were under study, of which, 127(70. 2%) were females and 54 (29. 8%) men. Mean age in females was 26 and 32.6 years respectively. Ïn all, 64(38.1%) of the patients had MVP according to perloff criteria.
Çonclusion : Ït seems that MVP in the patients suffering from PD has relatively more prevalence as a result, cardiovascular examination in confirmed PD patients would be useful.

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Background and purpose: Hysterectomy is one of the most common surgery in women and is followed by post-operative infections of respiratory and urinary tracts, wound, volva and boils. Prophylaxis with antibiotics is a preventive measure against post-hysterectomy infections. This comparitive study was conducted to compare the abdominal post-hysterectomy infections managed with 24 h-versus 7 days-antibiotic medication regimen.
Materials and methods : The study design was a randomized controlled clinical trial. 506 patients matching the criteria of the study were selected and randomly allocated into two groups. 6 patients were excluded from the study because of the need for intervension of bladder pelvis and intestine. 300 patients were divided randomly in two groups of 24 h-and 7 days-antibiotic therapy, both groups were followed up for febrile complications while admitted and for up to two weeks later.
Results: Two groups were matched for age, level of education, BMÏ, hemoglobin prior to operation number of the admitted days and duration of surgery. There was no significant difference in occurance of febrile complications in two groups.
Çonclusion: Due to lack of difference in post operation febrile complications for 24 h-and 7 days-oral antibiotic prophylaxis, it is recommended to confice antibiotic only to 24 hours and avoid unnecessary prescription of antibiotic at home, which is common in iran.

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Background and purpose: This study was undertaken to determine the effects of high dose IV desferal on symptoms, LV size and function in thalassemic patients
Materials and methods : 15 thalassemic patients with cardiomyopathy all of whom were on cardiotonic drugs for at least one month, aged between 15-25 yr, with ferritin> 1200ng/ml and Hb>9gr/dl were included in the study. They recieved IV desferal of 130mg/kg/day (max 5gr) during 10-14 hr for 5 consequtive days. Cardiac evaluation including history, plysical exam, ECG and Echocardiography were performed just before recieving desferal, 2 days and one month after completing the regimen. In additon visual and auditory consultations were done before and after the intervention to detect probable side effects.
Results : By administering high dose IV desferal, the cardiovascular symptoms reduced considerably and systolic function showed significant improvement so that a reduction in LVEF from 49.1 ± 1.8% to 58/8 ± 2.9% at first follow up and to 57.8 ± 2.1% at second follow up was observed. EPSS decreazed from 9.6 ± 0.8 mm to 6.7 ± 0.8 mm at first follow up and to 6.5 ± 0.6 mm at second follow up (p<0.001). However, there was no significant effect on diastolic function, ECG and physical findings. No remarkable visual and auditory side effects were demonstrated.
Conclusion : Based on the data it can be concluded that high dose IV desferal has improving effects on thalassemic cardio myopathy with high ferritin level.

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Background and purpose : Hypospadias is a common congenital anomaly of urogenital system. In spite of different techniques for treatment of hypospadias and complications such as fistula after operation, most surgeons are keen of doing operations with the least complications and best results. TIP urethroplasty has been introduced for hypospadias repair in recent years and is becoming popular for its low complications, simplicity of operation and very good cosmetic results. In this study we evaluate 66 patients with all forms of hypospadias that were operated using this technique.
Materials and methods: This study is based on medical records of 66 boys with age between 8 month to 13 years with mean of 2.96+/-2.31 that were operated from March 1997 to May 2004 with TIP urethroplasty The patients were followed up after operation and complications such as infection, fistula and stenosis were looked for. The mean duration of follow up was 3 months. All patients had primary hypospadias and there was no case of secondary operation. For evaluation of data we used frequency, mean and standard deviation.
Results: 57(86.4%) pateints had distal and 9(13.6%) pateints had midshaft and proximal hypospadias. In all patients the cosmetic result of glans and neo-meatus was very good and like healthy boys. Urination was normal in all boys and there was no incidence of urinary retention. We did not see any complications in 59(89.4%) patients. 7(10.6%) had fistula that 5 were in distal group and 2 were in mid and proximal groups. We did not have any wound infection or dehiscence of repair.
Conclusion: TIP urethroplasty is a simple and quick way to rapair hypospadias. Complications of this operation was low in our study and the only complication was fistula by the rate of 10.6% that was acceptable compared to other reports. Other complications such as infectious, stricture, or dehiscence were not seen.

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Background and Purpose: Succinylcholine isn’t used in Emergency Department intubations routinely, that, this study was performed to compare success and complications of tracheal intubation with and without succinylcholine administration.
Materials and Methods: This interventional study was done on 150 patients admitted in Emergency Department of Hazrat Rasoul Akram Hospital who underwent intratracheal intubation. Demographic data were evaluated. The Cases were entered in protocol A (rapid sequence intubation with succinylcholine) or B (modified RSI without succinylcholine) randomly and then intubated. During and after intubations, results and complications were recorded in checklists and analyzed via SPSS11 software.
Results: The mean age in group A was 34.1±5.1 yrs while in group B was 35.1±5.3 yrs. In group A, 35 cases (46.6%) were female and 40 cases (53.4%) were male and in group B 37 cases (49.3%) were female and 38 cases (50.7%) were male. The differences between groups were not significant. In group A, 74 cases (98%) were intubated in first attempt and 1 case (2%) in second attempt. Bradicardia was seen in 3 cases (4%), hypotension in 8 cases (10.6 %), vomiting in 8 cases (2.6 %), hypertension in 2 cases (2.6 %) and hypoxia (O2 sat<90%) in 9 cases (12%). In group B, 64 cases (88%) were intubated in first attempt and 9 cases (12%) in second attempt. Bradicardia occurred in 2 cases (2.6%), hypotension in 9 cases (12%), vomiting in 3 cases (4%), hypoxia in 11 cases (14%) and hypertension in no case. In this study, the success rate of intubation in RSI with succynilcholine was higher significantly. There are no significant differences regarding in complications between two groups.
Conclusion: Our study showed that in emergency patients intubation the which there is no contraindication for succynilcholine, it is better to try RSI.

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ackground and Purpose: For the past years, tubes have been inserted into the stomach via the nose (nasogastric Tube: NGT) for the purpose of evacuating gas and liquid routinely, and for the prevention of nausea, and vomiting. However, there are no evidences regarding its efficacy. The aim of this study was to evaluate the post abdominal surgery complications either NGT inserted or not.
Materials and Methods:In this clinical trial comparative study, 100 consecutive patients who underwent abdominal surgery (elective or urgency) were included in the study. They were divided in two groups: one was inserted NGT before anesthesia and remained until after initiation of bowel movement (control) and another without an incubated (case).
Results:Post surgery complications was similar in both groups (P>0.05): nausea (26% vs. 18%), vomiting (4% vs. 6%), fever (10% vs. 6%), bowel movement time (22.8 ± 10.84 vs. 21.84 ± 9.21), pulmonary complications (2% in both), wound infection (4% in both), duration of stay in hospital (2.58 ± 1.62 vs. 2.47 ± 1.6 days) in controls and cases respectively. Only sore throat was significantly more frequent in control group (74% vs. 16%).
Conclusion:These results suggest that routine and prophylactic insertion of NGT is not necessary, cannot reduce complications and also leads to patients' discomfort. Therefore, it must be saved in some specific indications.

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Tracheo-innominate artery fistula (TIF) is a rare, life threatening and catastrophic complication, which may occur 7 to 14 days after surgery. The Incidence Rate of TIF is 0.1-1% and survival rate of patient is 14.3%. Herein, we describe TIF in a patient 50 days post tracheotomy, based on our research, it appears that our case is the first finding with the latest onset of TIF after tracheotomy, which now has been improved by early diagnosis and surgical treatment.

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Background and purpose: Diabetes mellitus is associated with coronary artery disease, and diabetic patients are frequently referred for Çoronary Ârtery Bypass Grafting (ÇÂBG). Plasma Haemoglobin Â1c (HbÂ1c) shows mean blood glucose over a 3 months period. This study aimed to determine whether elevated plasma HbÂ1c levels were associated with increased postoperative morbidity and mortality in patients undergoing ÇÂBG.
Materials and methods: Plasma HbÂ1c was measured prospectively in 135 consecutive patients undergoing emergency and elective ÇÂBG in the two cardiac surgery departments of Mazandaran Heart Çenter and Shafa Hospital in Sari, Ïran from 11 Âpril 2009 to 11 September 2009. Âll patients were under observation for 6 months after operation to assess the postoperative morbidity and mortality.
Results: Ôf 135 studied patients (81 males and 56 females) who were admitted for emergency and elective ÇÂBG, 88 subjects (65.1%) were non-diabetic and 47 (34.9%) were diabetic patients. The mean age was 52 years ranged from 33 to 78 years. Suboptimal HbÂ1c levels were found in 48 (54.5%) patients without diabetes and in 24 (51%) patients with diabetes. Wound infection, low cardiac output state, need for Ïntra Âortic Balloon Pump, long hospital stay, and Çerebrovascular Âccident were more common after ÇÂBG in non-diagnosed (suboptimal HbÂ1c) patients. No significant difference was found in terms of length of hospital stay between the two groups.
Çonclusion: Ït seems that the complications of ÇÂBG surgery is significantly higher in patients with high level of plasma HbÂ1c level and those patients whose blood sugar was controlled inappropriately.

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A high percent of patients with Sarcoidosis experience symptoms related to different organs. Several studies showed that ocular involvement is the most current extra thoracic symptom of this disease. The main disorders contributed to this disease are: Anterior and Posterior uveitis, conjunctiva involvement and papillary edema. However most studies concentrate on the critical complications which mentioned above, some other disorders like granules of conjunctiva, cataracts, hemorrhage, optic disk swelling and proptosis were also seen after sarcoidosis. In this article we review these disorders and other probable cases. Based on the reviewed literatures, there is not any similar study like our review in Iran.

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Background and purpose: The purpose of the study was to asses the natural and clinical course of isolated ventricular defect in children.
Materials and methods: Patients and Methods: From 1997 to 2011 we prospectively studied a total of 218 infants and children diagnosed as isolated ventricular septal defects. The Çhi-squar or Fisher exact Test and ÂNÔVÂ were used to compare the differences where appropriate. Â valve less than 0.05 was considered statistically significant. The patients who had an additional hemodynamic significant heart defect were excluded.
Results: Â total of 218 patients, 125 females VS 93 males (57% VS 43%) were followed up for the mean time of 55.7 months (Range 12-170 mo) The distribution of perimembranous, muscular, subarterial and inlet type VSD were 65.1%, 32.1%, 1.4% and 1.4% respectively. Regardless of type of VSD, spontaneous closure was observed in 86 (39.5%) cases. Forty four (31%) perimembranous VSD and forty two (57.2%) muscular defect closed spontaneously. Ïnlet or subarterial defects were not closed spontaneously. Regardless of type VSDS, 71 (52.6%) of small and 15 (25%) of moderate size defect closed spontaneously. Fifty (24.3%) cases needed surgical Treatment. Âortic regurgitation developed in 11 (5%) patient. Ïnfective endocarditis was observed in 3 (1.7%) in patients. Ôther complications were pulmonary hypertension in 39 (17.9%), congestive heart failure in 12 (5.5%), sub pulmonic stenosis in 16 (7.3%) mitral regurgitation in 6 (2.8%) and sub aortic ridge in 7 (3.2%) patients.
Çonclusion: Ït is concluded that patients with VSD should be followed closely through life because the complications such as pulmonary hypertension, Ëisenmenger syndrome, infective endocarditic sub pulmonic stenosis, aortic ridge and aortic regurgitation may develop, although spontaneous closure of the defect is to be expected in many cases (39.51%), a significant percentage of defects may need surgical treatment (24.3%).

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Abstract Background and purpose: There is strong correlation between cardiovascular diseases and risk factors such as hypertension, diabetes mellitus, serum cholesterol level. However, only 50% of coronary arteries diseases (CADs) are associated with such factors. Different studies investigating the correlation between homocystein and CADs found different or even paradoxical results. This study aimed at investigating the association between plasma homocystein levels with mortality and complications of Myocardial Infarction. Materials and methods: A cross-sectional study was carried out on patients admitted to hospital complaining from chest pain during 24 hr who had no history of previous MI and with the diagnosis of STEMI. The patients were divided into two groups of normal and increased homocystein level. They were followed during hospitalization to determine complications of STEMI and mortality rate. Results: From the total of 230 patients, normal homocystein levels was observed in 150 patients (65.2%) and 80 patients (34.8%) had increased homocystein level. Death occurred in two patients with normal homocystein level, and in four patients with increased level of homocystein. Electrical complications were seen in 40 cases among patients with normal homocystein level and in 19 cases among the other group. Mechanical complications (including 2 VSD and 1 tamponade) were detected in patients with increased homocystein level, while these complications were not fond in the other group. Also, no mitral regurgitation was seen due to rupture in papillary or chordae muscles. Conclusion: This study found that there was not a significant difference between two groups of normal and increased homocystein level regarding mortality rate and electrical complications. However, among mechanical complications, VSD and tamponade were significantly greater in the group with increased level of homocystein.

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Background and purpose: After anemia thrombocytopenia is the most common disorder in pregnancy which is encountered in 10% of pregnancies. Thrombocytopenia in pregnant women may lead to maternal and neonatal morbidity. This condition could involve some complications in pregnancy, so diagnosing its causes is important for treatment. This study was performed to determine the incidence, causes and complications of thrombocytopenia in pregnancy. Materials and methods: In this prospective study, all pregnant women with gestational age of ≥ 24weeks and also those in pregnancy termination stage who referred to two teaching hospitals in Babol, during 2008-2009 were selected. Among this population those with platelet count less than 150,000/ µL were chosen. Causes of thrombocytopenia, method of delivery, maternal and neonatal complications in these patients were recorded. Platelet count less than 100,000/ µL was considered severe thrombocytopenia. Results: During the study period, 4589 pregnant women were examined and thrombocytopenia was reported in 239 cases. The incidence of thrombocytopenia in pregnancy was 5.2%. The causes of thrombocytopenia were gestational thrombocytopenia in 222 patients (92.9%), ITP in 11 patients (4.6%), preeclampsia in five patients (2.1%) and HELLP syndrome in one patient (0.4%). Six pregnancies (2.5 %) resulted in IUFD and bleeding occurred only in one patient with ITP during and after delivery. No neonatal complication was seen in newborns of women with thrombocytopenia. Conclusion: The results showed that gestational thrombocytopenia was the most common cause of thrombocytopenia in pregnancy which revealed no complication for patients and their fetuses. However, differential diagnosis should be made to avoid diagnosis of HELLP syndrome or preeclampsia that require urgent termination of pregnancy to prevent further complications.

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Hereditary angioedema is a rare disorder of complement system which is often seen with autosomal dominant hereditary. Clinical characteristics include non- pruritic and non-pitting mucocutaneous edema that could involve all parts of the body. This study reports seven cases of hereditary angioedema with classical manifestations accompanied by low function of C1INH (type 2). One death occurred due to laryngeal edema. This case study aimed at increasing the knowledge regarding hereditary angioedema, its early diagnosis and correct managements.

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Introduction: Previous studies have reported a relatively high incidence of total and subtotal thyroidectomy complications in Iran. Fear of this complication has led some internists and patients to avoid thyroid surgery. The aim of study was to determine the recent decade frequency of total and subtotal thyroidectomy complications in Sari, Iran. Material & Methods: In this cross-sectional study, the patients underwent total or subtotal thyroidectomy during 2001-2011 at two referral hospitals in sari (Imam Khomeini as academic and Shafa as private hospital) were enrolled. The questionnaire included demographic information, diagnosis and pathology of the disease, type of thyroid surgery, serum calcium level after the surgery, recurrent laryngeal nerve injury, and hematoma data. Frequencies, Odds ratio and their 95%CI were reported. Results: Among the 382 subjects (66 men and 316 women), 86 cases (22.5%) underwent total and 296 cases (77.5%) underwent subtotal thyroidectomy. The final pathology was malignant in 25.1%. Hypocalcaemia occurred in 40.3% of patients (CI95%: 35.5-45.3) that 4.2% (CI95%: 2.3-6.6) were permanent. Recurrent laryngeal nerve injury was reported in 0.8% (CI95%: 0.3-2.3) [0.3% permanent (CI95% :0.05-1.5)] and two cases (0.5%) complicated by cervical hematoma (CI95%: 0.1-1.9). Total thyroidectomy was associated with more complications than subtotal. [OR: 6.4 (CI95%: 2.6-16.1), P = 0.0001]. Conclusion: The findings of this study show that total and subtotal thyroidectomy complications has significantly decreased that can be due to improved surgical techniques and increased proficiency of surgeons.

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Background and purpose: Nonsteroidal anti-inflammatory drugs such as ibuprofen are the most commonly used drugs for pain relief after impacted third molar surgery. Recently, new generation of these drugs have been introduced that act more selectively and have lower gastrointestinal side effects. To the best of our knowledge there are not enough studies about the effectiveness of these drugs. This study compared the efficacy of celecoxib with ibuprofen and acetaminophen codeine. Materials and methods: A randomized clinical trial was conducted in 180 patients attending oral and maxillofacial surgery department affiliated to Tehran University of Medical Sciences. Patients were divided into three groups to receive a single dose of celecoxib 100mg, Ibuprofen 400 mg or acetaminophen codeine (acetaminophen 300mg + codeine 20mg) after surgery. A questionnaire was completed by the patients in which the pain intensity was recorded at 2, 4, 6, 10, 16, and 24 hrs after surgery. Results: At 2 and 4 hr after taking the medications the pain intensity was significantly lower in the group receiving celecoxib (P<0.05). Considering the time of use of rescue medication, there was no significant difference between ibuprofen and celecoxib (P>0.05) while significant difference was found in the acetaminophen codeine group (P<0.05). Also, considering the pain intensity, ibuprofen and celecoxib had similar effects and both were superior to acetaminophen codeine. Conclusion: Ibuprofen and celecoxib showed similar effects in decreasing the intensity of pain in subjects so, celecoxib could be considered as the drug of choice when there are contraindications for ibuprofen.

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Background and purpose: A post-cesarean wound complication occurs despite compliance with surgical techniques. The purpose of this study was to compare wound complications after cesarean sections in high-risk women with or without anticoagulant treatment. Materials and methods: This cross-sectional study included all women requesting elective or emergency caesarean section in Kerman Afzalipour Hospital, 2012. The subjects were selected using convenient sampling. This cross-sectional study included all women requesting elective or emergency caesarean section in Kerman Afzalipour Hospital, 2012. The subjects were selected using convenient sampling. Patients with transverse cesarean section were followed up until day 10 after delivery that they referred for removing the stitches. Patients with transverse cesarean section were followed up until day 10 after delivery that they referred for removing the stitches. Results: The mean age of participants was 28 years old. Among the subjects 71.6% underwent emergency cesarean section and post-cesarean wound was seen in 1.9%. There were 2.6% (n=18) who received anticoagulant treatment. Most of these patients aged 20 to 27 years old and the most common complications were superficial and deep wound dehiscence. There was a significant correlation between the symptoms and receiving anticoagulation (P<0.001). Significant differences were seen between the two groups in rate of wound complication following cesarean section (P <0.048). Conclusion: Use of anticoagulation in patients with cesarean section has complications such as wound dehiscence, bleeding, hematoma, and infection. Efforts should be made to increase the rate of normal deliveries, thereby reducing the number of caesarean section and its complications.

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Background and purpose: Kidney transplant is the most cost-effective strategy in treatment of patients with kidney failure. But allograft dysfunction is still discussed as one of the main problems in these patients. The aim of this study was to identify the factors associated with the development of complications after kidney transplant. Materials and methods: This correlation- descriptive study was performed in kidney transplant recipients (2002-2006) in Mashhad Imam Reza Hospital. Data was recorded in a researcher-made check list including type of dialysis, history of dialysis, cause of kidney disorder, donor kidney anatomy, parathormone hormone level, and complications after kidney transplant including length of hospitalization, urinary infection, and post-renal transplant diuresis. Results: The results showed relationships between age of recipients and wound infection, donor kidney anatomy with lynfocel, deceased or live donor with length of hospitalization, and post-renal transplant diuresis with acute tubular necrosis. We found relationships between history of transplant with length of hospitalization, lynfocel, and acute tubular necrosis. Also, a significant correlation was found between history of dialysis with length of hospitalization (B=0.153, P=0.002) and acute tubular necrosis (B=-0.137, P=0.002). Moreover, there was a significant association between parathormone hormone level with length of hospitalization and post-renal transplant diuresis (B=0.473, P= 0.004 and B=0.398, P=0.011, respectively). Conclusion: Old age recipients, high frequency of dialysis, low level of parathormone hormone, deceased or live donor, and donation of right kidney were amongst the main factors in development of post-transplant complications.

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Background and purpose: Blood transfusion is one of the essential and important parts of modern medicine. Blood transfusions are life saving for some patients, but some risks such as body's response should always be considered. This study was conducted to determine the incidence of transfusion outcomes and identifying the relationship between demographic profile of patients and some properties of blood products.

Materials and methods: This descriptive study was carried out in all patients being admitted to the emergency department in Sari Imam Khomeini hospital whom underwent blood transfusions (in 2014). After recording demographic data, the history of transfusion reactions, clinical signs and symptoms, severity of side effects, the numbers of blood infusion packs over the last 24 hours were evaluated. Statistical analyses were performed in SPSS ver. 16 applying T-test and Chi square test.

Results: A total of 961 patients had blood transfusion including 529 (55%) males and 432 (45%) females. Twelve patients (1.24%) developed acute blood transfusion complications. The most common reactions included chills (83%, n=10), fever (58%, n= 7), and dyspnea (58 %, n= 7). There were no significant correlations between the incidence of complications and other variables such as age, sex, initial hemoglobin level, previous medical history, and the age and number of injected blood products (P>0.05).

Conclusion: In this study, the incidence of acute transfusion reactions was lower than that in other studies in Iran. Reduction in the number of red blood cell packs injected into patients can be one of the reasons for reducing the risk of acute transfusion reactions.