Septic arthritis of sternoclavicular joint is rare and due to special setting including intravenous drug abuser, occult bacteremia, subclavian catheterization. The most common bacteria is staphylococcus aureus. We reported a 65 years old man patient with septic arthritis of sternoclavicular joint due to klebsiella pneumonia.

Objective: Cervical cancer is one of the most common malignancies in women. In many countries incidence of this cancer is reducing because of screening tests such as pap smear. After the pap smear if the pathologist reports abnormal cervical cytology, colposcopic examination of the uterine cervix remains the gold standard in the evaluation of patients. Because in some patients, dysplasia is in the endocervical canal and can not be visualized the time of colposcopic examination, endocervical curettage (ECC) must be performed. The usefulness of endocervical curettage has been debated for years because of pain and discomfort of patients in the time of ECC and inadequate specimen. In this study we want to look for specimen adequacy of outpatient endocervical curettage and compare it with similar cases had done in operation room with anesthesia. Methods: This retrospective study is Cross- sectional and was done on pathologic results of outpatient & inpatieut specimens that had underwent endocervical curettage and cervical biopsy. Data was collected from pathology reports and were analyzed by softwere Spss15. This study was done in Shahid Sadoughi hospital. Results: In total 340 cases of outpatient Endocervical cuettage only in 70 patients (20/6%) pathologists reported adequate specimen and in 340 cases of outpatient cervical biopsy, pathologists reported adequate specimen in 334 patients(98/2%). Among 524cases of ECC in operation room in 476 patients(90/8%) Pathologists reported adequate specimens and all of cervical biopsies in operation room had adequate specimen. Conclusion: These findings suggest that many specimens of outpatient Endocervical curettages are insufficient but similar samples of inpatient are sufficient. Therefore to obtain adequate specimens , that is better to do endocevical curettage in operation room or use other sampling methods that we mentioned it.

Brucellosis caused by Brucella spp, is an infectious and zoonotic disease of wild and domestic animals of worldwide distribution. Aim: The present research was conducted to determine the sero-prevalence of brucellosis in humans, Homo sapien (L, 1758) population in Charsadda, Khyber Pakhtunkhwa (KP), Pakistan during August 2014-January 2015. Methods: Blood samples (n=200) were collected randomly during February-December 2014. They were screened for brucellosis by using Serum Plate Agglutination Test (SPAT) and Polymerase Chain Reaction (PCR). Results: Two species, B. abortus and B. melitensis were present separately or in the same sample by SPAT while only separately by PCR. Out of 200 samples of humans 10% and 7.5% were positive by using SPAT and PCR, respectively. The prevalence of the disease in males were, 12% by SPAT while 9% by PCR, in female, 8% by SPAT (males to females’ ratio of 3:2) while 6% by PCR(males to females’ ratio of 4:3). In different age groups of humans, i.e., 1-20, 21-40, 41-60, and >60 were as 10.38, 9.52, 12.00, and 7.14% by SPAT while 7.79, 8.33, 4.00, and 7.14% by PCR, respectively. In professional groups of humans, i.e., farmers, animal keepers, servants, house-wives and others, the prevalence was 11.42, 12.5, 0, 8.75 and 10.71% by SPAT while 8.57, 6.25, 0, 7.5, 7.14 and 3.75% by PCR, respectively. Conclusion: The sero-prevalence of brucellosis in humans is existed in the study area. Recommendation: An effective control programme of the disease is recommended.

Professionalism is an important competency in medical education. Evaluation as a solution could help us to distinguish the current situation of professionalism. The aim of this article is to study the evaluation methods for professionalism in medical education. Methods and Materials: This paper reviews the analytic literature on evaluation of professionalism. We searched the approved databases in medical education by keywords related to evaluation of professionalism since 1999 until 2014 and found 23 best evidences to describe the evaluation in professionalism. Results: Evaluation of professionalism is studied according to content of evaluation, evaluator, time, place and methods. Content of evaluation is summarized in some sections like ethics, personality, professional principles. Evaluators are physicians, members of healthcare team and patients. The evaluation could be done in real or invitro environments. The methods of evaluations are diverse and the reliability and validity of them are suspicious. Conclusion: According to studied articles, the evaluation of professionalism is different of other evaluations in methods of evaluation, tools, time and evaluator. We can’t define a special tool for all details of professionalism, which is helpful in all situations. It’s better to apply a special tool for every detail and notice to measuring scores, validity and reliability of tools.

Sleep is the key element in strengthening academic performance and physical growth. Children must have adequate sleep and rest in order to achieve developmental functions. Sleep is important for the child to perform his physical development and duties in the best way. It is seen that sleep deprivation causes daytime sleepiness and carelessness in both children and adolescents. It is stated that the lack of sleep leads to behavioral problems in children. Sleep varies according to age groups. These periods are infancy, toddlerhood, preschool age, school age and adolescence. One of the behaviors that needs to focus on in order to increase the quality of life and improvement of health, psychosocial development, thrive and the process of growth from infancy to adulthood, is the behavior of sleep hygiene. A poor sleep hygiene decreases the quality of sleep, which leads to a poor quality of life. In this review sleep in childhood and affecting factors has been tackled.

The present study was aimed to investigate for preparing herbal ointment in order to treatment burned wounds and Pseudomonas aeruginosa infection. Methods: Because of resistance of Pseudomonas aeruginosa to antibiotics and cost of health care to improve infection in burn Patients is increasing, hence we decided to review about 51 article considered more effective health care. This paper demonstrate that herbal medicine such as Origanum vulgare, Zataria multiflora, Satureja khuzestaniea and natural Honey can inhibit pseudomonas aeruginosa Infection in burn patients. Results: Results of researches on Origanum vulgare, Zataria multiflora, Satureja khuzestaniea indicated that they have antibacterial activity against pseudomonas aeruginosa. This research demonstrated Minimum Inhibitory Concentration (MIC) of natural honey is 12.5-25% (ml/ml). Conclusion: According to results of current research we hope in future are used drugs to the clinic with a wider range as a complementary therapy and also for burned infections.

The present study was aimed to investigate frequency of bla per gene in hospital isolates of P. aeruginosa. Methods: The number of 100 isolates of P. aeruginosa were isolated from in burn Hospital in Tehran during a 1-year study in 2013-2014.The identification were carried out by colonial morphology, pigment formation, positive Oxidase test,; growth test at 42ºC on Nutrient agar, OF, Arginine dehyrolase and Motility tests. Results: The results indicated that 15% of burned hospital isolates contain bla pe gene. This study indicated that zone diameter mean of growth inhibition = 14 mm to ceftazidime.The rate of MIC to ceftazidime was 20 µg/ml. Conclusion: According to results of current research we hope in future be used drugs to the clinic with a wider range as a complementary therapy and also for burned infections.

In order to clarify the association between maternal body mass index and gestational weight gain with maternal and fetal complications. Methods: In this descriptive cross-sectional investigation, pregnant women with 18-30 years of age referring to health care centers in sari, Mazandaran, Iran were enrolled Results: In this study 400 pregnant women were examined. The mean ± SD age of study population was 27.8 ± 4.8 years. 125 participants (31.3%) were presented with low IOM and 77 patients (19.3 %) were high IOM. The mean weight of fetal birth weight was 3.2±0.4 kg. Weights of 377 newborns were between 2500 to 4000 gr. 8 cases (2%) had low birth weight and 15 cases (3.8%) were over than 4000 gr. The mean ± SD of newborns length was 49.6 ±5.6 cm. The mean ± SD of head circumflex of newborns was 34.4± 3.6 cm. There was no significant association between mothers BMI and infant head circumflex, height and weight. There was no significant correlation between macrosomia and mothers IOM (p=0.07). There was no significant association between infants’ weight and mothers IOM (p=0.3). There was significant correlation between BMI and IOM (p=0.000). Preterm delivery was noted in 6 women (6.5%) with BMI more than 29 and in 1 participant (1.2%) with BMI of 26.1 to 29. There was significant association between BMI and preterm birth (p=0.001). Gestational diabetes mellitus was noted in 6 women with BMI more than 29 (p=0.000). Gestational diabetes mellitus was reported in 6 women with normal IOM (p=0.04). Preeclampsia was noted in 3 women with BMI of 26.1 to 29 (p=0.04). Conclusion: Pregravid overweight or gaining weight will increase the risk of overweight birth.

The Majority of expatriate TB cases were identified in Bahrain mainly through passive case finding. Expatriate with LTBI have a 10% risk of developing active TB during their lifetime, with the greatest risk being within 2, 3 years of country entry. Expatriate TB was highest in labors between 20-49 years age group. The key to control TB in Bahrain is either to add PPD testing or doing IGRA, for all pre-employment during expatriate entry to the Kingdom. PPD testing is remaining the preferred method with IGRAs as a supplemental assay in subjects more than 2 years of age. If either TST or IGRA are positive, then active disease must be excluded by chest X-ray and sputum for microscopy and culture. Diagnosis and treatment of latent tuberculosis infection are considered an essential component of TB control strategy and should be a major component of the overall public health plan for controlling TB in Bahrain.

The aim of this study was evaluated the satisfaction of patients referred to the Orthopaedic Department of Imam-Khomeini Hospital of sari over a period of 3 years. Methods: This is a cross-sectional study. Patient satisfaction were collected by Patients Satisfaction Questionnaire (PSQ) and analyzed with SPSS v18. Results: In this study the highest satisfaction of patients was from para clinical services 69.78 ± 21.45 and the lowest satisfaction was from the department environment and the services 57.20 ± 22.86. There was no statistically significant difference between the sex (P>0.05). Patients with a history of hospitalization were significantly less satisfied with the services provided at the clinic (P=0.033). Between rural and urban patients satisfaction from reception and guard was statistically significant difference (P=0.01). Patients who had no health insurance less satisfied with the reception and guard (P=0.044), physician (P=0.049) and drugstores (P=0.032). Conclusion: The highest level of satisfaction was from the para clinical services and the lowest rate of their satisfaction was department environment and the services, that need planning to improve the department and particularly about cleanliness of toilets can be greatly improved this problem and increased patient satisfaction. The present study showed that a history of previous hospitalization, residence, and having health insurance (despite funding) are significantly associated with patient satisfaction of certain levels of service provided. But gender and level of education is not associated with patient satisfaction.

Pleural effusion is the most common manifestation of pleural disease. Biochemical examination of this fluid is usually done to try to identify the cause of a pleural effusion. Distinguishing whether the effusion is an exudates or transudates is the first step and is based on Light’s criteria. The aim of this study was comparing this pleural fluid categorization by using this criteria to the ultimate diagnosis of pleural disease. Patients and Methods; In a cross – sectional survey, we selected all patients with pleural fluid analysis, admitted in Alzahra University hospital. Then by light’s criteria we classified pleural fluid to Exudative and Transudate. The aim of this study was to review the help of this Scale and comparing to ultimate diagnosis. Result; In this survey we found 71(74.7%) Exudative pleural effusion and 24(25.3%) transudate pleural effusion. Pleural fluid LDH and protein were the best parameter for this classification. Pleural fluid glucose was a significantly higher in transudate fluids. Cloudy appearance of pleural fluid is also a helpful criteria for differentiating exudates from transudates. Conclusion; Light’s Criteria is still the cornerstone to classify pleural fluid to exudates and Transudates and bounding the different etiologies producing fluid in the pleural space. Additional parameter like PCR, cytology and histology and other new tests are needed to add for pleural fluid analysis to reach the ultimate diagnosis.

his study was conducted to investigate the toxicity and analgesic effects of the leaf methanolic extract of Maytenus senegalensis (Lam.) Exell. Methods; Acute toxicity was investigated via intraperitoneal route using mice and rats, analgesic activity was investigated using two models; acetic acid-induced writhing in mice and formalin induced pain in rats. Results; The extract was determined to have LD (50) of 1264.91 mg/kg in both mice and rats. It significantly (0.001) inhibited acetic acid-induced writhes in mice at all doses administered (75, 150 and 300 mg/kg) in a dose dependent manner and significantly (0.01) inhibited formalin induced pain in rats, in a non-dose dependent manner. The inhibitory effect observed was higher in the extract compared to the standard used (piroxicam). Conclusion; The results obtained suggested the extract to be relatively toxic in both mice and rats with a dose dependent anti-nociceptive activity.

Despite the use of triple therapy for H.pylori eradication, significant number of the patients still has same complaint. In view of their complaint and increase number of the studies showed decrease in the cure rate of triple therapy, we look at the prevalence of Helicobacter Pylori (HP) in symptomatic patients post a fourteen days’ course of triple therapy in documented HP gastritis by histopathology. Method and Materials: A retrospective study, which includes one hundred and five patients, whom underwent endoscopies for epigastric pain, from May2014 till February 2015,and have had gastric biopsies that showed chronic active gastritis with presence of HP. Triple eradication therapy in the form of omperazole 20mg BID, amoxicillin 1g BID and clarithromycin 500mg BID was given for 14 days. These patients were selected as they remain symptomatic post eradication therapy. The presence of HP after eradication was confirmed by stool antigen test six weeks after the end of treatment with complete avoidance of antibiotics, proton pump inhibitors and histamine 2 receptor antagonists during this period. Result: The rate of eradication in these symptomatic patients was 61.9%. Failure of eradication was seen in 33.3% of the male group (10 patients) and 40% of the female group (30 patients). Conclusion: Our study showed that triple therapy eradication rate was 61.9%, which is lower than international findings; this may be explained by fact that we only screened the symptomatic patient post eradication therapy and not all patients who received the course. Studies on HP sensitivity for antibiotic should be done to guide eradication regimens to reach acceptable eradication rates.

the aim of this study was assessment the clinical and paraclinical effects of enhanced external counter pulsation (EECP) therapy in patients with coronary artery disease. Patients and Methods: We performed a retrospective analysis of data related to all patients who received EECP treatment at Shafa hospitals in Sari, Iran from 21 March 2013 to 21 March 2015. All patient’s data included demographic data, history of underlying disease, clinical sign and symptom, laboratory data (hemoglobin, triglyceride (TG), cholesterol, Low-density lipoprotein (LDL), High-density lipoprotein (HDL)) and left ventricular ejection fraction (LVEF) in before and after treatment by EECP were collected. Results: the data of 48 patients (include 25 men) with mean age of 62.20±10.15 years were collected. The mean of TG, Cholesterol, LDL and HDL were not significantly change after EECP therapy. However, the mean of hemoglobin (10.47±0.81mg/dl vs. 10.20±1.03mg/dl, P=0.019) and LVEF (40.10±5.40% vs. 36.04±5.64%, P<0.0001) were significantly increased after EECP therapy. Also, the mean of systolic (112.81±6.75mmHg vs. 124.27±9.56mmHg, P<0.0001) and diastolic (71.35±5.90mmHg vs. 75.52±5.38mmHg, P<0.0001) blood pressure were significantly decrease after treatment with EECP. Clinical improvement of chest pain, muscle weakness, dyspnea and daily activity were observed in 14 patients (29.2%), 11 patients (22.9%), 24 patients (50%) and 28 patients (58.3%), respectively. Finally 31 patients (64.6%) were satisfy form this treatment. The complication included low back pain in 6 patients (12.5%) and paresthesia in 4 patients (8.3%). Conclusion: In conclusion, the results of our study show EECP therapy is a safe treatment and can reduced systolic and diastolic blood pressure, increase hemoglobin level and LVEF and improve clinical condition of CAD patients.

to evaluate the efficacy and tolerability of the oral third generation cephalosporin Cefodox in the treatment of community-acquired pneumonia in children. Patients: the study was conducted in pediatric outpatient clinic at prince Rashid military hospital over six months from 1-09- 2013 to 28-02-2015. A total number of 270 children aged from1 to 14 year with diagnosis of chestinfections were included in the study. Patients who have any chronic illnesses, immunodeficiency or were taking any antibiotics within 5 days of diagnosis were excluded. Methods: according to the age, patients were divided into three age groups: first group with age 1-4 years, second group from 4-8 years and the third group 8 to 14years. Males to females ratio was (1.7:1).All patients were started on oral Cefodox twice daily for 10 days.Follow up was done for all patients at day 5 and day 10 after treatment.Chestradiograph was performed to all patients on day 10. Results: The efficacy of the drug Cefodox was evaluated by the change and improvement of the clinical symptoms, physical examination and chest radiograph.All children in all age groups and both sexes showed improvement in all parameters by day 10 without complications and significant drug reactions. Conclusion: Cefodox is effective, well tolerated and safe in the treatment of children with community-acquired pneumonia.

Renal oncocytomas (RO) are benign rare tumors within intercalated cells of the collecting duct in the kidney, incidence about5 % of all renal tumors. Most of these tumors incidentally found on CT scans, It’s commonly seen more in male at age of 40 years, CT criteria’s are poor predictors for proper diagnosis and does not exclude malignant renal cell tumors, Case ;50 year male patients presented t with long standing right loin pain on physical examination the patient was in pain and Right flank fullness and mass was felt, renal CT scan was done in the hospital and showed 7.5*8.4 cm inhomogeneous enhanced soft tissue mass within right kidney, so renal cell carcinoma was the top of differential diagnosis. So the decision was for right radical nephrectomy. Which was done at December 2014? At histopathology report, the cut surface show a tumor with a brown color occupying 60% of the renal tissue still confirmed within the renal capsule grossly. The tumor measured 605 cm in maximal dimension microscopic description was shown a tumor composed of sheets nests and tubules composed of oncocytic polyclonal cells having central nuclei with rare mitotic figures, the final diagnosis of right nephrectomy specimen was consistent with oncocytoma the excision was complete. The patient then was referred to medical oncology clinic at our hospital, it was discussed at multidisciplinary urology clinic, and the decision was to keep this patient on regular follow up.

Hysterectomy pertains tothe removal of the uterus and the cervix without removal of adenexes. Hysterectomy is one of the most common surgical procedures and in the United States it ranks as the second common operation after cesarean. The objective of this study is to investigate the related variables involved among women with hysterectomy in the Shahid Mustafa Khomeini hospital inthe city of Ilam, Iran. Methods: A retrospective case-control study was conducted on 150 women including 75 in the control group and 75 as the case group. The cases were women with hysterectomy during 2009-2011, and the control group was randomly selected out of women referred to the hospital in these years and hospitalized due to other causes other than hysterectomy.Data were analyzed using SPSS software, version 17. T-test and Chi-square test were used as appropriated.Precision the prediction models evaluated using a receiver operating characteristic (ROC) curve. Results: In this study, of the all operations (2009-2011) performed on women in the Shahid Mustafa Khomeini hospital in Ilam, 76 women (3.8%) had undergone hysterectomy.The mean age of women with hysterectomy and the control group were 48.2 and 28.8 respectively. The mean numbers of pregnancies forthe control group as well as women with hysterectomy were 2.18% and 6.33%, respectively. The most common cause of hysterectomy was abnormal uterine bleeding (52%). There was a significant relationship between age and the risk of hysterectomy (P < 0.001). Considering the pelvic mass, 4 (5.3 %)of the cases and 33 individuals (44%) who had a history of hysterectomy had such a mass (P < 0.001, OR = 13.94). Conclusion: As revealed in this study, hysterectomy in most cases is performed aboutthe menopause age when the incidence of abnormal uterine bleeding is relatively common. Thus, it might be possible to treat the patient with maintenance therapy in order to reduce the prevalence of hysterectomy.

Breast carcinoma is the most common cancer in females , its incidence increase with age . The aim of this study is to analyses the biological features of breast carcinoma in postmenopausal women . Methods: Our study included 68 postmenopausal patients who underwent modified radical mastectomy in King Hussein Medical Center during the period between January 2012 and December 2014. We divided our patients into two groups : the first group was 46 Young postmenopausal patients ( YPM ) their ages from 50 to 64 years. The second group consisted of 22 elderly postmenopausal patients ( EPM ) who were 65 years of age and above . Results: Both age groups ( YPM and EPM ) had the same range of tumor size which is 2 cm and above.Tumor size was found in 80 % and 81 % respectively . YPM patients were found to have greater lymph node involvement 76 % in comparison to EPM which was 63 % . They also showed that the incidence of peritumor vascular invasion in YPM is 60 % while in the EPM patients is 50 %.Both age groups showed similar Estrogen and Progesterone receptor expression 80 % and 77 % respectively . Conclusion: Although both groups showed almost the same range of tumor size , older patients were found to have tumors with more favorable biologic characteristics in comparison to younger age group in regard to lymph node involvement and peritumor vascular invasion . Tumor responsiveness to hormonal therapy was similar in both groups .

Diabetes mellitus (DM) is a metabolic disorder characterized by high blood glucose (HBG) either because of low production of insulin by the pancreas or receptors do not respond to insulin secreted. Methods: The present study is a part of survey regarding the frequency of DM in Usheri Dara (UD), Dir Upper (DU), Khyber Pakhtunkhwa (KP), Pakistan during June 2013-August 2014. A questionnaire was designed having information about the most of aspects of DM. They were distributed randomly among the people (n=500) of the community of UD, which was divided in 7 quadrates, viz., Katten, Jabbar, Almas, Tarpatar, Usheri Khas, Batal and Garkohi. Results: Out of 500 respondents, 66 were found to have DM, thus making a frequency rate of 13.2%. However, maximum (8.6%) of the DM patients feel increased thirst and frequent urination at night, moreover, minimum (1.8%) of them feel decreased appetite. Further, in maximum number (6%) of the patient, DM occurred at the age of 31-45 years, furthermore, in minimum (0.6%) of them at the age of 2-15 years. However, maximum number (6%) of family members of patients suffered from DM was 4-7, moreover, minimum (0.6%) were 1-3. Further, insulin used by maximum numbers (5%) of DM patients was humulin70/30. Furthermore, minimum (0.4%) of them use lispro. However, medicines used by maximum numbers (3.4%) of DM patients were orinase tablets, moreover, minimum (1%) of them use glucophage Conclusion: It was concluded that the most common occurring age of DM at diagnosis was 31-45 years. Consequently, adopting healthy life style and use of proper treatment is recommended.

To Assess satisfaction rate , outcome ,and complications of using malleable penile implants as a treatment of erectile dysfunction . Methods: a study was carried out in Prince Hussein Bin Abdullah II centre from 2010 to 2015 on 75 patients who underwent penile implants . We used a questionnaire for erectile dysfunction on those patients and compared their satisfaction before and after the operation . Results: All patients and their partners were satisfied with the results which improved their quality of life , an exception was with seven patients who had psychological rejection to implant which was removed after 2 weeks from operation . Conclusion: It is a simple invasive procedure with high rate of success (95%) and minimal complications and contraindications , so it can be considered as definite treatment for erectile dysfunction in most cases . But psychologically preparing the patient is recommended in this procedure .

Objective: Percutaneous nephrolithotomy (PCNL) is a procedure that is now routinely used to treat large and complex renal stones. Since first described by Frenstorm and Johanson, many advances to the surgical technique were developed including the lithotripters used to fragment and remove stones. In this study we compared the efficacy and safety of PCNL using pneumatic and ultrasonic lithotripsy.. Methods: the study was carried in Prince Hussein Bin Abdallah the II Center of urology and organ transplantation. Two groups of patients who underwent PCNL between July 2013 and June 2014 were compared. Group A ,50 patients, underwent PCNL using pneumatic lithotripsy. And group B, 53 patients underwent PCNL using ultrasonic lithotripsy. The 2 groups were compared in terms of stone size, location, operative time, hospital stay, blood loss and stone free rats. Results: there were no significant differences in stone size, location or stone free rates. But the ultrasonic lithotripsy group (group B) had significantly lower operative time, number of hospital days and average blood loss. Conclusion: PCNL is a safe procedure, and the use of ultrasonic lithotripsy significantly decreased operative time, hospital stay and blood loss.

Timely prediction of adverse pregnancy and perinatal outcome has been the endeavor of clinicians since a long time. Identification and validation of a serum based biomarker is the need of the hour and many tentative molecules have been studied with variable results. Two such molecules are inhibins and insulin like growth factors. This study was planned to assess the utility of inhibin A and IGF-1 as predictors of adverse pregnancy and fetal outcomes. Methods: The study population comprised of all pregnant women presenting to the ante natal clinic in SSK hospital between gestation periods of 24-28 weeks fulfilling the inclusion criteria. The criteria adopted for inclusion in the study included primi-gravida with singleton pregnancy or multi-gravida with high risk factors in the previous pregnancy such as gestational hypertension, preeclampsia, eclampsia, placental abruption, intrauterine growth retardation, intrauterine fetal demise, preterm delivery and early pregnancy loss. Results: The mean levels of inhibin A were significantly higher in women with overall adverse pregnancy outcome such as preeclampsia, gestational hypertension, and preterm delivery as compared to the normal counterparts. No significant difference in the level of IGF-1 was observed with various adverse outcomes. Inhibin A at the cutoff of > 443pg/ml was found to be reliable marker of preeclampsia and preterm delivery. Conclusion: We may hypothesize from our findings that second trimester inhibin A levels may be further evaluated through large prospective studies as an reliable biomarker of adverse pregnancy outcome.

Beta thalassemia is an inherited disorder characterized by absent or reduced amounts of beta globin chains. Vascular Endothelial Growth Factor (VEGF) is a significant regulator of hemangioblast differentiation. This study was aimed to assess serum VEGF levels in patients with beta thalassemia major in comparison with control group. Methods: This historical cohort study was conducted on 36 patients with ß–thalassemia major who had received regular blood transfusion and 26 healthy people which were referred for checkup in a general hospital, Sari, north of Iran, during March to May 2015. Demographic characterization and laboratory tests such as Complete Blood Count (CBC), and evaluation of levels of serum ferritin, serum VEGF, hepatitis B virus antibody and hepatitis C virus antibody were carried out for our patients. The statistical analyses were performed by SPSS (16) software. The Pearson correlation coefficient test was used to test the significant correlations for quantitative parameters. A value of P<0.05 was considered statistically significant. Results: Mean serum VEGF level in case and control groups was 153.8 ± 77.5 and 120.2± 45.4 pg/ml, respectively. Serum VEGF level was higher in beta thalassemia major (p= 0.037). Serum VEGF level was significantly higher in splenectomized patients (P=0.006). There was not any significant correlation between serum VEGF levels and Hemoglobin, WBC and platelet count and neither was with serum ferritin level (p>0.05). Conclusion: Serum VEGF level was higher in thalassemic patients. Splenectomized patients had higher serum VEGF levels than others.

E.coli O157:H7 is a pathogenic bacterium that can be found in faecal contaminated foods and water. The organism causes special kind of diarrhoea known as haemorrhagic diarrhoea and highly resistant to many antibiotics. Our aim therefore is to know the prevalence rate in Ondo State and the antibiotics sensitivity pattern of the isolates. Methods: Five hundred (500) diarrhoeic stool samples were collected from apparently healthy individuals in the State. The samples were brought to the lab immediately and cultured on eosin Methylene blue agar overnight. Colonies with blue black colour were sub-cultured into sorbitol MacConkey agar a differential medium for the growth and differentiation of E. coli, biochemical analysis was done to ascertain the organism`s identity. Moreover, the sensitivity pattern of the isolates to conventional antibiotics was also carried out. Results: Out of 500 diarrhoeic stool samples examined in the cause of this research work, two hundred and thirty five were males, while two hundred and sixty five were females. Eighty (16%) were positive for E. coli O157:H7. Forty seven (20%) out of the males sampled were positive for the organism, while thirty three (12.5%) of the females sampled were positive. In relation to age group, the carrier rate was higher in age group 71-80 years in which fifty per cent (50%) were positive. The isolate were sensitive to the following antibiotics in an increasing order as follows: Septrin (0%), ampicillin (0%), Nalidixic acid (2.5%), augmentin (5%), ciproflox (5%), Peflacine (16.25%), tarivid (16.25%), Ceporex (16.25%), streptomycin (33.75%) and gentamycin (81.25%). The significance of these results was discussed. Conclusion: This result has been able to show that the prevalence of E. coli O157:H7 in Ondo State is low and gentamycin is the antibiotic that can be used to contain the infection in the communities. People also must be made to know the importance of hygiene in preventing the infection with the pathogen.

Objective: Hemodialysis is a treatment for End Stage Renal Disease (ESRD) patients. The incidence of ESRD has been increased up to 8% from 2004 to 2011. Based on some studies, various complications can occur in hemodialysis process. This study was conducted with the aim of investigating the incidence of adverse side-effects during hemodialysis in kidney patients. Methods: This descriptive-analytical study was done in 2015 (05 Feb to 12 April) on 142 patients under hemodialysis treatment. Data gathering was done by using a researcher-made checklist which was designed by studying authoritative sources. Data analysis was done by SPSS. V.16 using ANOVA and Chi-square tests. Results: Among 142 patients, 51.38% were female and 48.62 of them were male. Muscle cramp (72.53%) and Bleeding (2.11%) were the most and the least complications that have been attested during hemodialysis respectively. Conclusion: According to the various side-effects of hemodialysis process in this study, some actions such as reducing the pump rotation and nutrition education is recommended in order to increase the level of satisfaction in patients.

Objective: Chronic Suppurative Otitis Media (CSOM) is a common cause of disabled hearing impairment in developing worlds. We aimed todetermine the aerobic aetiological agents of CSOM among children 1 to 16 years-old, studying the microbial susceptibility to antibiotics and its implications for treatment. Methods: prospective case series study carried out in Khalifa Bin Zayed Hospital, Socotra Island in collaboration with Hadramouth Central Laboratories – Yemen, conducted during the period from June 2011 to June 2012.Study procedures involved completing the questionnaire, otoscopic ear examination and swab samples collected from one or both ears of children with CSOM for tests of microbial agents and sensitivity to antibiotics. Results: among 76 children with CSOM studied, 42 [55%] were male. The mean age was 6.1 (range from 1 years to 16 years). A total of 86 swab samples were conducted from one or both ears. Pseudomonas Aerogiunosa 28/86 [33%] was the commonest microbial organism to cause CSOM, followed by proteus spp 20/86 [23%], staphylococcus aureus 18/86 [21%], E. Coli 14/86 [16%], Klebsiella 2/86 [2%], Enterobacteria 1/86 [1%] and three samples were sterile accounting for 4%.Of antimicrobials tested to four species, Ciporfloxacillin has the highest susceptibility rate. Conclusion: The etiological agents of CSOM in the children studied demonstrates a commonest of Pseudomonas aeroguinosa, followed by proteus spp and staphylococcus aureus. All organisms were sensitive to ciprofloxacillin. Implications for treatment indicates quinolone as a good option in the treatment of CSOM. There is a need for better understanding of microbial and antimicrobial profiles of CSOM in the region.

Objective: The expressive touch is a complementary treatment method with the easiest practice among the independent functions of nurses Methods: The purpose of this study was to investigate the effect of expressive touch on physiological and psychological states of intensive care patients. The study was conducted by using the pretest-posttest experimental model with control group. 76 patients (38 control-38 experimental), who received treatment in the intensive care unit since they had a myocardial infarction for the first time, were included in the study after the power analysis. The State Anxiety Inventory was applied in the experimental group 15 minutes before the touch and 15 minutes after the touch; the haemoglobin, blood pressure and pulse values were recorded. In the control group, on the other hand, the data were collected within the same duration by using the same method without touching Results: The anxiety scores and blood pressure averages of patients before and after the touch on days 1 and 2 were found to be statistically significant between groups. The difference between the mean haemoglobin values was found to be significant on day 2. The difference between the pulse averages was not statistically significant. Conclusion: The expressive touch might be effective on decreasing the anxiety, increasing the haemoglobin values and decreasing the blood pressure and pulse of patients in the intensive care unit.

Objective: Health professions need to know behaviour and attitudes towards headache so that this knowledge could be used in admin of health care services. Therefore, the researchers undertook the present study to determine the nursing student behaviour and attitudes towards headache. The aim of this study was to determine headache frequent of nursing’s student and their behaviours and attitude towards headache. Methods: The study population included 592 undergraduate nursing students in nursing departments of health school at a university in Turkey. A randomly sample of 224 was recruited from the students. There was not eligibility criterion for the participants. The data were collected in May 2011. The researchers visited classrooms on two days and conducted interviews with the students in their classrooms. Results: The majority of the adolescents have had headache. Stress factors activating headache was 37.3%. Attitude of the adolescents towards headache treatment was negative in general. However, 77.2% of the adolescents explained that they have used medicine heal headache. Conclusion: This study has highlighted some issues that require further investigation and provided useful information that might guide the development of interventions for headache.

Objective: To assess efficiency of Rubber Band Ligation as a first choice in the treatment of haemorrhoids. Methods: This study carried out in Queen Alia Hospital and Al-Husain Hospital (RMS) over the last two years were (106) patient’s referred from the surgical outpatients for the treatment of haemorrhoids, (86) proved to have haemorrhoids (78) f them were considered suitable for Rubber Band Ligation in which only first, second and third degree haemorrhids were treated by Rubber Band Ligation. Results: The results were assessed three months after completing treatment (86.3%) of the patients had excellent and good result, (4.5%) had poor results and were referred to surgery. Complications were generally minor (pain, bleeding, band slipping and band related abscess) and were manage satisfactorly Conclusion: Rubber band ligation is simple, safe, relatively painless and cheap outpatient procedure suitable for first, second and even third degree haemorrhoids, and we recommended it as a first choice in the treatment of haemorrhids..

Objective: Surgical site infection (SSI) is the second most common cause of hospital infections and is responsible for nearly 15% of these infections. Due to an increase in bacterial resistance, the lack of similar studies in our country, we conducted a study. Methods: in this clinical trial, The patients were randomly divided into two groups: the case group that received intravenous antibiotics for 24 hours (2 gr cefazolin during induction of anesthesia and then 2 gr every 8 hours until 24 hours) and the control group which received standard antibiotic regimen (2 gr cefazolin during induction of anesthesia and then 1 gr every 6 hours until 48 hours, then 500 mg oral cephalexin for 48 hours up to one week. Results: The number of patients participating in the study was 218, of which 167 were male (%76.6) and 51 female (% 23.4), respectively. The mean patient age 56.20 ± 13.40 years, respectively. Between two groups there was no significant difference in the frequency of fractures. In this study, there was no significant difference between age and gender of patients in the two groups. Finally, there was no statistically significant difference between the site and type of fractures. Discussion: This study showed that using a one-drug protocol is recommended for prevention of surgical site infection in internal fixation of closed fractures. In addition, using intravenous antibiotics reduces patient costs than those which is administered intravenous and oral together.

Objective: The performance of nurses, especially at the end hours of night shift depends significantly on their blood glucose levels. This study aimed to determine blood glucose level in night shift nurses and its related factors affecting the nurses performance it. Methods: the design of the study was cross-sectional descriptive-analytical and the partipiants who accepted to enter the study were 60 night shift nurses working in Juybar Azizi Hospital. Sampling was done to measure their blood glucose levels was done during 4 to 6 am. The information required for the study was recorded in predetermined checklists by the individuals. The researchers used For data analysis, independent t-test, one way ANOVA, Pearson correlation coefficient and SPSS software version 18 to analyze the data were run. The level of significance was considered as P <0.05. Results: Among the study sample, 46 of the participants were individuals (76.7%) were female and 14 ones (23.3%) were male. Their mean age was 28.8±5.2 years. The average work experience and night shift working hours were 4.9±4.1 year and 6.8±2.7 nights per month, respectively. The average measured blood glucose was 96.7±7.8mg/dl. The difference between the blood glucose levels was not statistically significant between men and women (P-0.75). There was a significant relationship among blood glucose level and age (r=0.33), Body Mass Index (BMI) (r=0.31) and work experience (r=0.26) (P<0.05) that by increasing age, BMI, and work experience, the blood glucose level increased, while no significant relationship was observed between the number of night shift per month and blood glucose level (P>0.05). Conclusion: The results obtained from the current study revealed that blood glucose levels in night shift nurses were in the range of fasting individuals, while blood glucose levels in older nurses and with more work experience and BMI were higher.

Objective: Thyroid nodules which are common in population consist of mostly benign nodules and less malignant neoplasms. Differentiating malignant nodules from each other arises a drastic problem in making a correct diagnosis Thus,this study was done to investigate the role of CD56 and its specificity and sensitivity in different types of thyroid neoplasms especially papillary carcinoma. Methods: 73 paraffin embedded-blocks of thyroid massses (nodules) were studied for CD56 immunohistologically from Imam Khomeini hospital ,Sari,Mazandaran.The 4-scaled semiquantitative method (0-3) was applied to estimate CD56 expression in tumor cells; less than 10% (0) or negative staining, 10-33% (1), 33-66% (2), more than 66% (3). Results: In this study 24.7% were male and 75.3% were female. 13.7% ,68.5 % and 17.8% of patients were less than 20, between 20- 50,and over 50 years old respectively.Simultaneously 50(68.5%) patients had both right and left lobes nodules.12(16.4%) ,6(8.2%)and 1(1.4%) patients had nodules in right and left lobes and isthmus respectively.Consequently, 4 (5.5%)patients showed left and right lobes ,and ithsmus nodules simultaneousely. There was no statistically significant difference between the sexes and ages and also anatomical regions in patients with and without PTC. 30 out of the 73 patients had papillary carcinoma(PTC) which 4 out of them expressed CD56 while 37 out of 43(86%) patients who had non-PTC showed positive results for CD56.Sensivity and specificity of negative result of CD56,positive predictive value(PPV) and negative predictive value(NPV) in the diagnosis of papillary carcinoma were 86.6%,86%,81.2% and 86.3% respectively. Conclusion: Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of negative result of CD56 in the diagnosis of PTC were 86.6%, 86.04%, 81.25%, 90.24% and 86.3% respectively. This study showed that CD56 was a valuable sensitive and specific marker in differentiating PTC from other thyroid tumors.

Background- Recent studies have reported the high prevalence of different degrees of vitamin D deficiency in Iran. The present study was conducted to determine the correlation between serum levels of vitamin D and Peak Bone Mass (PBM) in a group of Iranian population at the age of PBM. Material & Methods- The present cross-sectional study was conducted on 20-35 year-old adults participating in the first phase of the Iranian Multicentric Osteoporosis Study (IMOS). The correlation between serum levels of 25(OH)D and BMD values were assessed by Spearman correlation coefficient. Results-1941 individuals were studied. There was no significant difference between BMD values at the studied areas with vitamin D levels nor status groups in either gender. Conclusion- Our study revealed no association between serum vitamin D levels and BMD in individuals at the age of PBM.

Subdural empyema usually occurs in the second decade of life. Paranasal sinus infection or middle ear infections are the most common etiology of this condition. Interhemispheric subdural empyema is very rare condition. The most appropriate treatment is surgery. We describe a 16 years old boy with interhemispheric subdural empyema who had no complaints or history of sinusitis or otitis media. He introduced with fever, nausea, vomiting, seizure and hemiparesis. Our diagnosis with imaging determined and demonstrated interhemispheric subdural empyema. After the antibiotic treatment the patient went under operation and drainage of empyema. After the operation all of complaints of the patient improved. We suggest that if all patients with history and symptoms of paranasal sinusitis and middle ear infection have symptoms of ICP rising, Falx syndrome or seizure, the existence of SDE should be checked.

The aim of this study was to assess the diagnostic accuracy performance of Alvarado score in patients with suspected appendicitis with respect to histological examination . Methods: In this retrospective study we examined the files of 84 patients who underwent appendecictomies at Prince Hashem Bin Abdullah II Hospital in Aqaba and king Hussien Hospital in Amman from August 2013 to December 2015 . Alvaradao score was calculated from preoperative notes . All cases had subsequent histological examination which was also obtained from the patients’ files . Results: out of 84 patients who underwent appendiectomy , diagnosis was confirmed by histopathological findings in 68 patients . 63 of them with alvarado score of 7 or more ( 92,6 % ) , the normal appendiectomy rate was 19 % . the number of patients with score less 5 , 5 - 7 , 7 - 9 were 7 , 24 , 53 respectively , while the number of appendicitis in each group were ( 4,7 % ) , 8 ( 33,3 % ) , 49 ( 92,4 % ) . Conclusion: Alvarado scoring system is a simple and reliable test in the pre-operative diagnosis of acute appendicitis and should be encouraged in day to day practice to ensure best patient care and management .

In previous studies it has been demonstrated that different substances, can inhibit pain occurred through opioids, serotonergic, and cholinergic pain receptors these receptors can be inhibited while in presence of naloxone, ondansetron and atropine. Therefore the aim of this study was to determine the effect of Trachyspermum ammi essence on modulation of pain score by the use of formalin test in mice. Methods: In this experimental study, 20 male mice (20-25) were included. They were randomly divided into test and control groups. The test groups were intraperitoneal injected specific amount of inhibitors such as naloxone, ondansetron and atropine. After 10 min these specimens were injected Trachyspermum ammi essence and were observed for 60 min.to score pain effect caused by formalin injection. Results: Our result indicated that mean score of the pain during the observation for 60 min (every 5 minutes) of formalin test in groups that received ondansetron, naloxone and TAE it is significantly decrease the pain score whiles group of atropine which induced before TAE significantly (P<0.05) increased the pain score. Conclusion: In conclusion, this research demonstrated the possible role of cholinergic signaling in antinociceptive effect. Thus more studies are required to prove the further effects of this essence on different signaling systems

Objective: laryngoscopy and tracheal intubation are associated with hemodynamic and cardiovascular responses consisting of increased heart rate, blood pressure and tachycardia and dysrhythmias. The alpha2-adrenoreceptor agonists such as clonidine and tizanidine have several beneficial actions during the perioperative period. They improve hemodynamic stability in response to endotracheal intubation and surgical stress. In this study we compared the effect of oral clonidine and tizanidine on hemodynamic responses after laryngoscopy in patients undergoing coronary artery bypass surgery. Methods: Ninety patients age 30-70 years old underwent coronary artery bypass surgery with HR>50 b/min and EF>40% evaluated in this randomized double blinded study. Thizanidine 4 mg prescribed to group A, 0.2 mg clonidine to group B and placebo to group C, 90 minutes before laryngoscopy. systolic blood pressure, diastolic blood pressure, mean arterial blood pressure and heart rate recorded before, During , 1 minute after laryngoscopy and then each 5 to 15 minutes after that. Results: There was no significant differences in systolic blood pressure (p.value for repeated measure= 0.507), diastolic blood pressure (p.value for repeated measure=0.707) and mean arterial blood pressure (p.value for repeated measure=0.997) but there was a significant difference in heart rate (p.value for repeated measure= 0.036) between three groups. According to post_Hoc test there was a significant difference in heart rate between clonidine group and placebo group.( p.value=0.042) There was no significant differences in diabetes mellitus and hypertension, in side effects and in arrhythmia, ischemia and request for TNG, Esmolol and vasopressor between three groups. Conclusion: According to the recent study as in clonidine and tizanidine group (specially in clonidine group) heart rate reduced significantly after laryngoscopy , no significant side effects was reported and there was no significant differences in arrhythmia and ischemia and request for TNG, Esmolol and vasopressor between three groups, tizanidine and clonidine (specially clonidine) could be recommended as useful drugs for premedication in general anesthesia in patients undergoing CABG surgery.