---

  Background & Objective: Spinal anesthesia is one of the usual techniques in the surgery of hip fractures among the aged. On the other hand the hemodynamic complications of this method and the treatment of these complications by abundant Ir liquids and drugs such as Ephedrin and phenylephedrin have potential risk for aged patients. Intrathecal opioids have synergistic effects on the duration and quality of spinal block. Thus a number of efforts have been made to prevent the hemodynamic complications and probability of inadequate block by decreasing the dosage of local anesthetic drug and adding opioid drugs to it. This study investigates the hemodynamic effects and the quality of spinal anesthesia using the above-mentioned method.

  Methods: Forty-six patients above 60 years of age with hip fracture were randomized into 2 groups (A and B). Group A received a spinal of hyper tonic bupivacaine (5 mg) and fentanyl (20 m g) and group B received 12.5 mg of hypertonic bupivacaine for spinal anesthesia. Vital signs before and during the surgery, quality and quantity of blockage, amount of fluid and Ephedrine used, were recorded every 5 minutes.

  Results: MAP (Mean Arterial Pressure) fall and the dosage and frequency of ephedrine consumption were significantly different in two groups. MAP decrease in-group A was 23.6 ± 10.79 and in-group B it was 36 ± 11.1 (p=0.001). The average requirement of ephedrine in the groups were 2.25 ± 3.49 mg in-group A and 10 ± 8.45 mg in-group B (P=0.001). The average occurrence of hypotension and ephedrine usage was 0.71 ± 1.08 times in-group A and 2.91 ± 2.94 times in-group B (p=0.001). 29 % of group A had pain in the terminal stage of surgery but this amount in-group B was 13.6%. Tachycardia was 29.2 % in-group A and 68.2 % in group B (p=0.001).

  Conclusions: Adding 20 m g fentanyl to bupivacaine and decreasing its dosage can prevent the complications of intrathecal anesthesia. (MAP fall and the tachycardia occurred in the process of its treatment) to a great extent. But to lower the incidence of failure and obtain reliable block, more controlled studies must be accomplished.

---

  Paraplegia can be caused by different factors like rupture or repair of the aortic aneurysm or aortic thrombosis, aortic dissection, anterior spinal cord artery emboli, coagulation disorders and lupus disease, all of which cause impaired spinal cord blood flow and spinal cord ischemia. In addition, hypotension may be the cause of spinal cord infarction but Medline researches have reported a few cases of spinal cord infarction in patients laparotomized for the reasons other than aortic lesions. In this paper we report one case of paraplegia who had experienced spinal infarction and paraplegia after internal bleeding and two times laparatomies due to long lasting hypotension. In this case regarding the patient ’ s age, occupation and physical health, the possibility of cardiovascular lesions and consequent thromboembolism seems very unlikely. Furthermore, considering the two operations performed and the temporal space between them, the only factor that could have led to ischemia and infarction of the spinal cord in this patient is long-standing hypotension.

---

  Background & Objective : Inpatient information is the best source for researches, medical education, process of patient treatment and legal organizations. Moreover, correct, complete and ontime registration of this information can play a crucial role in the production of necessary data for these kinds of researches. Regarding the importance of the issue, in this study we evaluated the quality and quantity of these data in the hospitals under Ardabil University of Medical Sciences.

  Methods : In this research 370 rcords from eight hospitals of Ardabil 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 check list, was completed. The information under study including demography, admission and discharge, inter-hospital and inter-ward transfer, diagnosis, treatment, surgery, death of the patients and authentications (recorded or not) were identified in the check list. The data were analyzed using descriptive statistics.

  Results : The results showed that sex, marital status, date and place of birth had not been recorded in 5.9%, 15.7%, 2.4%, 51.6% of records respectively. Primary, interim and final diagnosis and treatment measures were not recorded about 28.1%, 41.1%, 39.2% 48% of the patients respectively. Although 13% of these patients were hospitalized due to accidents, impairments and poisoning, only in 8.5% of them the external causes were recorded. At 68.6% of the records, condition on discharge and at 76.3% of them recommendation on discharge had not been recorded. 3.5% of records related to dead patients, but only in 31%, main cause and in 8% underlying couse of death was record. 25% of the studied records were not coded. 13.7% of existing codes did not match the final diagnosis .At 52.4% of these records the correct method of writing diagnosis was not observed by physicians and at 36.5% coding had not been done carefully.

  Conclusions : The results indicated that the process of medical recording by health care services was performed deficiently and this leads to the loss of valuable information about the hospitalized patients. As a result, the authorities, physicians and specialists in medical recording should pay special attention to this problem. Physicians and specialitists of medical record to this problem were necessary.

---

 Background & Objective: Foods of high fat may increase the risk of coagulation heart attacks. They can also increase coagulating factors and lead to higher mortality due to cardiovascular diseases and heart attacks. The aim of this study was to find out the effect of saturated (butter) and unsaturated (sunflower oil) fat intake on coagulating factors such as factor VII and fibrinogen as well as Bt, serum cholesterol and triglycerides.

 Methods: In this clinical trial 46 male healthy individuals from Ardabil University of Medical Sciences took part in this study (age: 18-28 years old) in 2002. These individuals were divided into two groups. The first group consumed 30 g of butter and the second group took 30g of sunflower oil everyday, for 14 days. Before the fat intake and at the end of first and second week blood sample was taken test to fibrinogen, factor VII, cholesterol, BT and triglycerid. Also during the study the 24-hour food-recall was taken three days a week. The collected data were analyzed with SPSS and Food Processor.

 Results: The results indicated that butter intake increases factor VII significantly at the end of the first and second week (p<0.05). But no significant about sunflower oil. BT decreased after butter intake at the end of first and second week. This decrease was significant at the end of first week (p<0.05). Bt increased significantly after sunflower oil intake at the end of second week (p<0.05). Serum fibrinogen after butter intake decreased significantly at the end of first and second week (p<0.05), but was not significant after sunflower oil intake (p<0.05). There was no significant difference in serum cholesterol and triglyceride level after butter intake, but at the end of first week after sunflower intake serum cholesterol decreased significantly (p<0.05).

 Conclusions: We concluded that the intake of saturated fat can affect factors in a short period of time and sunflower oil can decrease serum cholesterol level and as results increase the bleeding time.

---

  Background &Objective: Infarctian size is the most important prognostic factor in patients with acute myocardial infarction (AMI). Reperfusion therapy using thromboliatics is the most important measure in order to limit the infarction, size. Infarction size on the other hand, associates directly with left ventricular (LV) function. The presence of Q wave on electrocardiogram (ECG) after thrombolytic therapy is associated with increased mortality during first months after AMI. Moreover electrocardiographic changes after thrombolytic therapy can predict LV function. This study is an attempt to evaluate the relationship between electrocardiographic Q wave and LV function after thrmobolytic therapy in patients with MI.

  Methods: 176 patients with first episode of AMI (diagnosed based on WHO criteria) who were receiving streptokinase took part in this analytical study. ECG of the first day after admission and ECG of discharge day (usually the sixth day) were evaluated in terms of the presence of pathologic Q wave. LV function was evaluated by Echocardiography using Simpson method. The data were analyzed by SPSS program using chi-square test.

  Results: On discharge day 82.4% of the patients had pathologic Q wave and 17.6% were without it. 51.6% of patients without pathologic Q wave, had normal LV function (LVGF>55%) while 26.9% of them had Q wave (p= 0.001). 73.3% of males and 56.4% of females had Q wave on ECG.

  Conclusions: Presence of Q wave on ECG in patients with AMI after thrombolytic therapy correlates with LV function and indicates impaired LV function in these patients.

---

 Background & Objective: Studying the epidemiology and impact of headache can help improve patient care, estimation of burden of disease and classification systems. Migraine is common worldwide and has a geographically variable prevalence in the world. Moreover, its peak of incidence is the age of 20-30. The aim of this study was to determine the prevalence of migraine among the medical students in order to plan for future health interferences.

 Methods: In this cross-sectional study 631 students filled out a questionnaire designed according to the criteria of the international headache society. The data were analyzed using SPSS software (release 12) and descriptive statistics.�

 Results: 76.6% of the subjects were female and 23.4% of them were male. The females were 20.6 and males were 21.4 years old on average. The total prevalence of migraine was 7.3% (1.6% with aura, 5.4% without aura and 0.3% with both of them). Moreover, females, single subjects and students of medicine, except the migraine with aura that was more prevalent among students of associate degrees. A positive family history of headache was found in 45.6% of the students. 65.2% of those suffering from migraine had not referred to a physician and were unaware of their headache.

 Conclusions: Compared to similar researches there is a low prevalence of migraine among the students but most of the students do not take measures to cape with and treat them in the proper manner. This requires necessary health interferences.�

---

 Background & Objectives: Research has always been considered as a powerful tool in creating change and development and like any other process it demands careful planning, providing facilities and special resources. Investigating research trends can pave the way for systematic thinking in this regard. This study was conducted to examine trends in research methodology in order to promote the research quality in Ardabil University of Medical Sciences.

 Methods: In this cross-sectional descriptive study, data regarding research methodology and its administration was evaluated by a questionnaire during six years from 1997 to 2003. The data regarding the author of the research were collected through the interview. These data were then analyzed by SPSS software (release 12) using descriptive statistics.

 Results: Between 1997 and 2003, 196 research proposals were approved. The number of research designs increased from 3 to 45 during this period. Most of these studies (58.2%) had cross-sectional design. The experimental researches came second with 43 cases (21.9%). During this period the number of trials and analytic studies increased, but descriptive studies were still in the highest rank. Only 32% of the proposals were completed properly and in most of the cases they were not completed in the proper way and some subsections of the forms such as design, variable table, methods of data analysis, data collection procedures and administration problems were incomplete or missing in most of the designs. These problems were more evident before the establishment of research consultation office in 2001. 75% of the researchers had attended research workshop before conducting any research.

  Conclusion: The findings indicated a remarkable increase in the number of researches compared to the preceding years. Moreover, they have been more analytically-oriented. However, descriptive researches are in the top rank. Some necessary measures have to be taken in order to improve the present condition.

---

  Background & Objectives: Cesarean section is one of the most common surgeries in women. In developed countries the rate of cesarean section is reported to be 21.2%. In Iran, the rate of cesarean section is even higher than the international norms. In a study in Ardabil, in 2001, cesarean section rate came out to be 42.86%. Postoperative pain after cesarean is one of the complications that all mothers experience in one-way or another. Besides bothering mother it can disorder newborn feeding, ambulation of mother and bonding between newborn and mother if it is not controlled effectively. This study was conducted to compare the effect of intramuscular Methadone and Diclofenac suppository for pain relief after cesarean section in Alavi hospital, Ardabil.

  Methods: This study was a double blind clinical trial. 56 women who experienced cesarean section for the first time were randomly divided into two groups. Diclofenac suppository (100 mg every 8hr) was given to first group and Methadone (5 mg every 8hr) was injected to the second group for 24 hours. Then, the severity of pain was measured with numerical scoring in serial postoperative visits. The data were analyzed by SPSS software using descriptive and analytical statistics such as chi-square and ANOVA.

  Results: The findings indicated that the severity of pain in 2^nd, 3^rd and 4^th postoperative visits was significantly lower in patients who received Diclofenac suppositories than the other group (p<0.05). But overall, there was no statistically significant difference between the pain severity in Methadone receiving group (Mean & SD= 5.85 ± 3.5) and Diclofenac receiving group (Mean & SD= 6.46 ± 2.9).

  Conclusion: There was no significant difference between Diclofenac suppository and Methadone in terms of decreasing the postoperative pain after cesarean section. However, regarding the restrictions in the use of opioids, Diclofenac can be a suitable replacement for these drugs.

---

 Background & Objective: Each year thousands of children under five years old die due to acute respiratory infection and diarrheal diseases. A huge number of infants and children are hospitalized and visited by the physicians whereas most of these diseases can be prevented with timely treatment. Child health maintenance and improvement is one of the most important considerations in each society. Moreover, identifying child morbidity patterns should be a matter of concern in order to improve the health services. This study provides an overview of the leading causes of hospitalization among children with the aim of determining the most important causes of hospitalization and offering appropriate strategies to decrease them.

 Methods: This cross-sectional study was conducted in 2001 in Ardabil Ali-Asghar hospital. The subjects were randomly selected from the admission list on a daily basis. A questionnaire including demographic characteristics such as age, sex, time of admission and primary diagnosis was completed for each subject. The data were analyzed by SPSS software using descriptive statistics.

 Results: A total of 1945 patients were admitted almost half of which were studied. Febrile convulsion was found to be the most common cause of hospitalization (26%) while gastroenteritis (22.1%) and pneumonia (20%) were in the second and third order. Other causes included epilepsy, drug poisoning, meningitis, mumps, drug encephalitis, asthma, etc.

 Conclusion: According to the findings of this study, standard case management is necessary especially about febrile convulsion which is the most common cause of hospitalization. Since the present pattern is different from similar studies, further investigations are required to identify its causes.

---

 Renal poly cystic sinus is a rare disease which is bilateral and has benign course. It usually breaks out after the fifth decade of life. The cysts in this disease are mainly of lymphatic origin. They can be associated with inflammation, stone or obstruction. Unlike the multicystic and polycystic kidney in which the cysts are formed in the cortex, in this disease they are seen in the sinus of the kidneys. What makes this case unique and necessery to report is its rareness and differentiation from other renal cystic lesions. The author could not find any previous report about the coexistance of edema of mons pubis with renal polycystic sinus. This study reports a bilateral poly cystic sinus which exists with intermittent edema of mons pubis. The patient is a 24-year-old female who complained of a mild pain in the flank area with intermittent edema of the mons pubis. The patient underwent urologic and gynecologic examinations which lead to the final diagnosis of renal bilateral poly cystic sinus disease. The disease had a benign course and the patient is under observation after the biopsy.

---

  Background & Objectives : Smoking is one of the major problems in the world today. It threatens people ’ s health. Pregnant women are no exception in this regard. Today, it is found that smoker women bear low birth weight babies, but the studies don ’ t offer clear findings about passive smoking in pregnancy and its effect on weight and height of newborns. This study is an attempt to determine the effects of passive smoking on the weight and height of the newborn babies.

  M ethods : This was a retrospective cohort study. We studied 100 pregnant mothers who were exposed to cigarette smoke and 100 others who were not. A checklist was completed in order to select those who could enter the study. A questionnaire was then filled out for both groups including the information related to the newborns ’ physical specifications.

  Results: This study showed that the average age of the mothers, their education, their husband ’ s education, number of pregnancies and the sex of babies born weren ’ t meaningfully different between the two groups. In the case group the mothers were exposed to cigarette smoke for 2.36 ± 2.28 hours on average and most of them (72%) were exposed to their husbands ’ cigarette smoke. The findings also indicated that difference in weight, height and head circumference among two groups ’ newborns were 11 grams, 0.15 cm and 0.02 cm respectively. The T-test indicated no significant difference between the two groups.

  Conclusion: The study showed that the newborns ’ of mothers exposed to the smoke had lower weigh, height and head circumference than the babies ’ of the control group subjects although the difference was not statistically significant.

---

 Background & Objectives: Mother ’ s milk is the best food for the newborns and has positive effects on both mother and infant health, decreasing infant mortality, satisfying emotional needs of mother and infant and economizing the domestic as well as social expenditures. Unfortunately, because of different economical, social and cultural reasons in many parts of the world breast feeding and its length of time has decreased. WHO emphasizes breast feeding in the first six months of life in developing countries. This study is an attempt to determine the causes of unsuccessful breast feeding in the first six months after birth in Ardabil.

  Methods : This descriptive analytical�study was conducted on 160 mothers who had 2- month- old or younger infants and did not have exclusive breast feeding until the end of 6 months. The researchers referred to 4 health centers, selected based on cluster sampling, in order to select the qualified mothers and complete the questionnaires in their presence.

 Results: Most of the mothers (37.5%) have begun feedings supplementary nutrition to their infants at the age of 2-4 months. The most common (90.5%) cause for the lack of the exclusive breast feeding was found to be insufficiency of mother milk.Most of the mothers (67%) stated the infant cry as the main reason for this insufficiency. There is a significant relationship between exclusive breast feeding on the one hand and the delivery, time of first feeding, occupation and mother ’ s education on the other (p<0.05).

  Conclusion : Social and economic conditions and misbeliefs have all affected the success of exclusive breast feeding. Most of these problems can be prevented through proper trainings.

---

  Background and objectives: Establishing centers to stop addiction in our country is one of the measures taken to confront this problem. Unfortunately, it has been shown that about 80% of the addicted people who refer to these centers relapse. The present study set out to investigate the possible causes of this problem.

  Methods: This is a case control study in which a questionnaire was used to collect the required data. The subjects were all addicted people who referred to Shahid Mellat Doust and Shahid Family treatment centers in 2000. The criterions for entering the study in case group were the last record of the addicted person ’ s abandonment in Tehran ’ s welfare center ( based on the patients ’ records) and using narcotics at the present time. The control group subjects, on the other hand, had abandoned using narcotics at least four months before and had never used any substance so far.

  Results: The mean age for case group was 35.99 and that of the control group was 35.09. Regarding the age distribution 98.59% of the case group and 100% of the control group were men. 88.7% of the case group and 97.2% of the control group were urban residents. Considering the job, 40.8% of the case group and 19.4% of the control group were unemployed. 52.1% of the case group and 61.6% of control group were living with their spouses. Opium was the most commoly used narcotics in both groups. In studying the relationship between the variables under study through logistic regression the job was not a main factor in the relapse. The duration of time being away from addiction had a deductive effect on the relapse, and this effect was statistically meaningful (p=0.001). Adding one month ’ s time to the period of being clear (not using the narcotics) caused 98% deduction in returning to narcotics.

  Conclusion: Because 80% of the patients who referred to the related centers began using narcotics again during the first 6 months after abandoning, it is necessary to improve the preventive measures to help the patients pass this critical period.

---

Background & Objectives: Senile cataract is one of the most common diseases in the world and a common cause for reduced visual acuteness and blindness. It is due to many factors the most important of which is aging. Other risk factors include gender, smoking, sunlight, living environment, high risk professions, family history, systemic diseases, etc. The present study was an attempt to investigate this disease epidemiologically and draw a general profile for it in order to pave the way for further research.

 Methods: This was a cross-sectional descriptive and retrospective study. The files of the patients who had received senile cataract surgical operation in Alavi hospital from March 1999 to February 2000 were investigated to collect the required data. The data were analyzed using appropriate statistical methods.

 Results: 218 patients were studied. The prevalence of this disease was found to be 83.9% which was observed among males more than females and was more common in the 6^th decade of life. The disease was mostly seen in the left eye and reduced visual activity to the light perception was the most common clinical complaint among the patients. 29% of the patients were diabetic and 22.1% of them had hypertension.

  Conclusion: Because of high prevalance of cataract, it is necessary to have good medical care and management. Moreover, some training and guidelines seem necesarry.

---

  Background & Objectives: Nitroglycerin is found to have vasodilatory effect. It has also a relaxing effect on the smooth muscles of other organs including uterus. This study investigates the effect of intravenous nitroglycerin in emergency cesarean sections in which rapid and transient uterine relaxation for rapid and nontraumatic extraction of the fetus is necessary.

  Methods: Sixty pregnant women who were candidated for emergency cesarean and needed rapid uterine relaxation for different reasons were selected. These subjects underwent spinal anesthesia and at the time of uterine incision, 100 micrograms of nitroglycerin was injected to them intravenously. The time lapse between nitroglycerin administration and fetal extraction, the degree of uterine relaxation, the amount of intraoperative hemorrhage, uterine tone after fetal delivery and APGAR scores of the infants were all controlled and recorded. Also with regard to the vasodilatory effect of nitroglycerin and probably its resultant homodynamic problems, blood pressure, heart rate and arterial O₂ saturation were recorded before and after nitroglycerin injection and throughout the surgery.

  Results: The results showed that in 53 (88.3%) of the patients the uterus was acceptably relaxed and the fetus was delivered very easily. Only in 7 patients (11.7%) uterine relaxation was not acceptable. The mean decrease in systolic and diastolic blood pressures after nitroglycerin administration compared with before injection BP was 12.97 mmHg (12.210 %) and 7.86 mmHg (12.208 %), respectively. There was not seen any prolonged effect of the drug such as uterus relaxation tone or abnormal bleeding. Also, none of the delivered infants had low APGAR scores. Besides, in patients with acceptable uterine relaxation the first and fifth minute APGAR score of infants were higher (p = 0.008, p = 0.000).

  Conclusion: This study shows that nitroglycerin can relax uterine smooth muscles very rapidly and transiently and in emergencies it can be an appropriate alternative to the other tocolytic agents with prolonged effect or onset time.

---

 Background & Objectives: Postpartum depression, as a mental disorder, is seen in some women and can threaten their mental health as well as their infants. At least 7% of mothers suffer from this problem after parturition. Studies indicate that many variables are associated with this disorder during and after the gestation period. The aim of this study was to achieve the rate of postpartum depression and its relevant variables among women who referred to the parturition ward of Buali and Emam Hossein hospitals in Tehran.

 Methods: In this cross-sectional descriptive study a questionnaire construced by researchers as well as Beck 21- item depression inventory were used to collect the data. The subjects (100 cases) responded to the questions individually in the hospitals. According to the type of variables, X² nonparametric test was used in the data analysis.

 Results: The results of this study indicated that 17% of the subjects were suffering from moderate and severe depression and among the 14 predictive variables of the postpartum depression four variables, namely, matrimonial dissatisfaction, unwanted gestation, unemployment and low economical status of family have significant relationship with the postpartum depression.

 Conclusion: In comparison with the previous studies, the prevalence of postpartum depression is in higher level therefore, it is necessary to increase the information of parturition ward staff about this disorder and inform them to refer any cases of depression to the counseling centers.

---

  Background & Objectives : Laryngoscopy and tracheal intubation may lead to tachycardia, hypertension and dysrhythmia or myocardial ischemia. In this double blind study, the effects of midazolam and lidocaine on hemodynamic response to endotracheal intubation have been examined.

  Methods : 52 ASA class one patients, aged 20-50, who were candidate for elective inguinal hernia surgery with general anesthesia, were randomly assigned to two groups. All patients received normal saline or Ringer's lactate solution (5ml/kg) about 5-10 minutes before induction of anesthesia and were preoxygenated for 3 minutes. Group 1 received midazolam (0.05 mg/kg) and group 2 received lidocaine (1.5 mg/kg) during 3 minutes prior to intubation. Anesthesia was induced with fentanyl (100 µ g) and thiopental (5 mg/kg) and trachea was intubated by the aid of succinyl choline (1.5 mg/kg). Anesthesia was maintained with halothane (0.5-0.75%) and equal proportions of nitrous oxide and oxygen. Systolic and diastolic blood pressure, mean arterial pressure (MAP) and heart rate were recorded before premedication and intubation, as well as immediately two and five minutes after intubation. The data were analyzed by SPSS software using paired t-test.

  Results : After intubation�Systolic and diastolic blood pressure, MAP and heart rate increased in both groups compared to the baseline values. The difference in increasing diastolic blood pressure and MAP between the two groups was significant (p<0.05), but the difference in increasing systolic blood pressure and heart rate between two groups was not statistically significant. The increase in diastolic blood pressure and MAP in group 1 was significantly more than group 2 (p<0.05).

  Conclusion : Clinically, midazolam was as much effective as lidocaine in controlling response to intubations. Consequently it can be used as an alternative lidocaine in intubations. It has also other priorities such as amnesia, anti-anxiety and anti-agitation.

---

  Background & Objectives: Recurrent respiratory papillomatosis (RRP) is the most common benign laryngeal tumor and the second common cause for hoarseness in children. Despite its omplete benign histology, it has a great tendency to spread through the respiratory track and frequent recurrences may occur following surgery, possibly due to the virus survival in apparently healthy adjacent tissues. According to the most recent evident experiences, the treatment of choice for RRP disease is repetitive resections with CO₂ laser. The present study evaluates the efficacy of adjuvant medical therapies for eradication of this disease in affected children.

  Methods : This was an experimental study with sequential control (self-control). The subjects were children who referred to ENT-H&N surgery dept. of Hazrat-e- Rasoul hospital in Tehran between Mar 1998 and Mar 2001 with chief complaint of hoarseness and respiratory obstruction. Among these children patients with confirmed diagnosis of RRP were selected as study samples and the effect of acyclovir and alpha-interferon combination in reducing the severity and recurrence of RRP was evaluated.

  Results: Totally 18 patients entered this study (10 (55.5%) females and 8 (44.5%) males). The mean age of the patients was 6.5 and 94% of them were the first child of young mothers (under 25 years of age). The signs of respiratory obstruction in most of the cases with a mild to moderate severity was the main cause of referral in 45% of the subjects. Laryngeal lesions were mostly superficial and limited to glottis region. Severity and spread of RRP disease was greater in children under 3, which led to tracheotomy in 3 of them. The combined administration of alpha-interferon and acyclovir, made a significant reduction in disease severity and spread in 55.6% of the patients.

  Conclusion : The findings of this study indicated that combination of acyclovir and alpha-interferon can be effective in reducing RRP recurrences and severity. Nevertheless, because of small sample size(due to rarity of RRP), Further multi-institutional studies are required to obtain a greater sample size and more valid results.