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Introduction: Wilms' tumor is the most common malignant and primary renal tumor in children. Studies, which have been done in some countries, have introduced numerous factors such as age of incidence, stage, lymphadenopathy, histopathology and etc. Effective in the survival rate of this tumor according to the importance of this tumor in children, we decided to perform a study about the survival rate of Wilms' tumor and the effective factors on it.
Materials and methods: This is an analytic study on 128 patients affected with Wilms' tumor whom referred to the oncology ward of Hazrat-e-Ali Asghar Hospital between 1977 and 2001. In addition to the current status of the patients, demographic characteristics, signs and symptoms, laboratory studies at the time of diagnosis and the stage of the disease were recorded and ultimately survival analysis was performed using the Kaplan-Meier procedure and life table. Cox Regression was used to determine the effective factors.
Results: The mean survival rate was 82.99 months. The number of patients was equal in both genders (64 patients in each gender) and the survival average did not have any significant statistical relationship with gender (power=%92.4). Most of the tumors were in stage 3 at the time of diagnosis. The survival of the patients was reducing significantly with the progression of the stage of tumor (P=0.002). The existence of metastasis (P=0.000, odds ratio=0.207), splenomegaly (P=0.018, odds ratio=0.336), and recurrent (P=0.037, odds ratio=0.184), were significantly reducing the survival of the patient. To determine the severity of effective factors on the survival rate of the patients Cox Regression Method was used in which, absence of metastasis and positive blood group were from well-prognosis predictive factors in these patients.
Conclusion: 5-year survival rate of the patients was 63.28% in this study. Which was lower in comparison with the results of other studies in other countries. This can be the result of delay in consulting with medical centers, the diagnosis method and or the Referral State of this center. Recent studies have shown that age and tumor size has minimal values in the prognosis of the patients due to improvement in the quality of treatment and our study support this idea. Genetic factors will probably be used in determining the survival of these patients and also in thcir treatment.

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Introduction: Depression is one of the psychiatric disorders that causes loss of energy, decrease of concentration and daily activity that these also became decreased in motivation and educative activity of students. The aim of this study was assesed to determine the prevalence of depression and it's related factors of Arak university of medical sciences in 79-80.
Materials and Methods: This study was cross-sectional and the sample of study consisted of all medical sciences students that came to university on fall of 79 (N=153) that were screened for depression at the biginning time of educational course and then 3 terms later by using personal data questionair and short form (21 statements) of Beck Depression Inventory Test.
Results: From 153 students, 38 (%22.1) respondants at biginning of course obtained the score in between 17 and>17 were determined as depressive case, then after 3 terms this figure increased to 58 (%38.5), this differences was significant differences between depressive and nondepressive groups in variables such as proper of dornitory condition 3, satisfaction of field of study 3.64, satisfaction with the educative conditions of the university 3.49, satisfaction with student-management relationship 3.77, appropriate cmotional-supportative and security condition in between family and students 4.32, economical condition of safe and families 3.58, at biginning time and then 3 terms later in arrangement of above were 2.82, 3.66, 3.37, 2.79, 2.66, 4.17 and 3.67 that these diffrences due to constant samples were significant and has had significant roles in prevalence of depression.
Conclusion: This study showed that depression was increased in students of Arak University of Medical Sciences after 3 terms and it is related with some stressful factors such as family, social and economical factors.

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Introduction: The existence of acoustic trauma secondary to drill noise during chronic ear surgeries has not yet been clearly demonestrated. This investigation aims to document the hearing loss that occures in patients who underwent mastoidectomy.
Materials and Methods: Sixty-three (38 male and 25 female) consecutive patients (11-57 years) who underwent modified radical mastoidectomy were included. In a concurrent clinical trial design, we measured bone conduction thresholds before and after (1 week and 1 month) operation on both sides.
Bone conduction thresholds were assessed in 250, 500, 1000, 2000, 3000 and 4000 Hz frequencies.
Results: Paired-test results showed a satistically significant temporary (TTS) and permanent threshold shifts (PTS) were occured in the 2000-4000 Hz region for operated (on addition to 1000 Hz) and non-operated ears, but clinically PTSs were not remarkable and TTSs were important only for operated ear (P<0.05). The correlation between duration of noise exposure and magnitude of threshold shift was only significant in operated ear in 2000-4000 Hz region (P<0.05).
Conclusion: We could not demonestrate any permanent hearing loss caused by drill-generated noise, but resultant noise is able to produce TTS in the operated ear in 2000-4000 Hz region. We found poor relationship between duration of noise exposure and magnitude of threshold shifts.

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Introduction: In developing countries there are various researchable health subjects. However due to low budjet of research programmes in these countries, priority setting of research designs have a special importance.
Materials and Methods: In a descriptive cross-sectional study, a questionnaire consisting of 100 questions was designed. 363 health personl and 302 non-health specialists participated in this study. Questionnaire was coded and analysed by EPI 6 software.
Results: Our results demonstrated that all of the cities of Markazi province had a similar problems, but the amount of people contributions in health activities has altered their health awareness. Furthermore, health problems in view of people and specialists is different. People stated health problems as a global difficulties while specialists had a detailed viewpoints.
Conclusion: This study showed that it is necessary to guide practical researches based on determined health priorities.

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Introduction: Postoperative hypothermia is physiologically stressful by elevating blood pressure, heart rate and plasma catecholamine concentration. This study conducted to evaluate the effects of intravenous fluids temperature on perioperative hemodynamic situation. Materials and Methods: This was a randomized clinical trial study Perioperative pulse rate, blood pressure, intraoperative esophageal and skin temperature were measured in 60 volunteer patients undergoing orthopedic surgeries subjects randomly divided into two groups according to intraoperative IV fluids management. In 30 patients (hypothermia group) all IV fluids infused were at room temperature. In the other 30 patients (normothermia group) all IV fluids were warmed using and dry IV fluid warmer. Results: The core and skin temperature of hypothermia and normothermia group decreased significantly from induction of anesthesia toward end of surgery but its reduction was more in hypothermia group (P<0.005). Postoperative mean arterial blood pressure increased significantly more in hypothermia group versus normothermia group (P<0.005). Shivering was observed in 21 of 30 hypothermia and 11 of 30 normothermia group (p<0.005) and recovery time was significantly lower in normothermia group (36±5 vs. 26±3 min, P<0.005). Conclusion: Infusion of warm fluids helps to reduce the variation of postoperative mean arterial blood pressure, core and skin temperature, occurrence of shivering and recovery time.

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Introduction: Among the risk factors for coronary artery disease, less attention has been paid to physical activity, especially in children and adolescents. Various studies have shown that their level of physical activity is lower than the standard for maintaining lower health. In this study, the pattern of physical activity of children and adolescents in the central regions of Iran is examined.
Method: In this descriptive study, which is part of the first phase of the Isfahan Healthy Heart Project and was conducted in 2002, awareness of the attitude and performance of 4,000 urban and rural children and adolescents in preschool to high school in Isfahan (Isfahan, Najafabad) and Markazi (Arak city) and the parents of these students and 500 teachers and school officials have been examined about physical activity and the duration of watching TV through a questionnaire. Sampling was selected in the form of a random cluster and in proportion to the urban and rural population living in the two provinces. Data were analyzed with SPSS software and p<0.05 were considered significant.
Results: About 40 percent of middle and high school students in the two provinces practiced regular sports at school less than two hours a week. Regular morning exercise and school sports were more common in girls than boys (p<0.00001), but regular extracurricular exercise and sports team membership were more common in boys (P<0.001). More than 77 percent of parents were unaware of the importance of childhood exercise in their children's health. The average TV viewing time for children of different ages was 4 hours a day.
Conclusion: The level of physical activity of middle and high school students in the central regions of Iran is less than the desired level and the duration of watching TV is more than the recommended values.

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Introduction: Stress  is  a  condition  that  causes  tension, disturbance  in  body  and  mind , discomfort  and  unpleasant  status.  Adolescents  are  the  most  susceptible  group  of  the  community, a  susceptibility  which  intensifies  with  age  and  kind  of  stressful  events  that  happened  during  life. In  this  study  we  intend  to  find  types  of  stressors  and  their  severity  in  central  area  of  Iran.
Materials  and Methods: This  is  a  descriptive  study  carried  out  on  2000  students between  12-18  years  from  urban  and  rural  selected  school  of  Isfahan, Arak  and  Najaf  Abad  in  1381 (2002) as  a  part  of  an  annual  report  on  healthy  heart  assessment   program.  Sampling  methods  was  randomized  clustering, and  after  collecting  data  based  on  GHQ12 (generalized  health  questionaire)  data  was  analyzed  by  mean, standard  deviation  and  chi-square  based  on  SPSS  version  software.
Results: Of  the  total  subjects  under  9360 (51.2%)  were  males, and 887 (48.8%)  were  female, with  a  mean  age  of  15/97±1/90, 15/52±2/20  respectively.  In  general, the  proportion  of  female  students  with  high  GHQ  score  was  higher  than  male  students. 38.8%  against  32.7%. The  score  was  higher  in  Arak  than the  other  two  cities.  The  most  common  stressful  item  was  concern  for  a  future  career, which  was  also  the  most  effective  life  event, and  next  to  it  was  the  parental  death.
Conclusion: The  severity  of  stress  in  female  students  of  central  area  of  Iran  was  higher  than male, with  a  direct  positive  correlation  with  age, moreover, the  most  common  stressful  item was  concern  for  a  career  and  the  most  effective  life  event  was  also  the  same, and  next  to  it  was  the  parental  death.    
 

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Introduction: Continues  monitoring  of  oxygen  saturation  by  pulse  oximetery  is  known  as  a  routine  technique  in  critical  care  of  patients.  But  previous  researches  showed  some  differences  in  its  measurement  according  to  probe  placement.
Materials  and  Methods: In  this  cross  sectional  analytical  study  36  admitted  neonates  below  one  months  age  were  selected. Sampling  method  was  convenience  and  sample  size  was  estimated  according  to  α=5%  and β=20% .Samples  oxygen  saturation  was  measured  three  times  by  hand  and  foot  pulse  oximetery  and  direct  method. Data  was  analyzed  using  paired  t  test.
Results: Analysis  of  results  showed  significantly  dofference  between  both  two  pulse  oximetery  methods  with  arterial  blood  gas.  Comparison  of  oximetery  methods with  direct  one  showed  more  accuracy  of  foot  probe (p<0/05).
Conclusion: We  concluded  that  pulse  oximetery  do  not  reliably  predict  changes  in  saO2  and  also  probe  placement  causes  some  differences  in  oximetery  results.
 
 

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Introduction: Therapeutic use of D-penicillamine is associated with several side effects. Proteinuria is the most common side effect of it, often due to membranous glomerulopathy. In this article we have reported a case of D-penicillamine induced focal segmental glomerulonephritis with systemic sclerosis. Case: In This article, we have presented a patient who had been under treatment with D-penicillamine and complicated by nephrotic range proteinuria resulting from focal segmental glomerulonephritis. Proteinuria was resolved one month after discontinuation of D-penicillamine without any additional treatment. She had no finding in favour of renal crisis of scleroderma. Conclusion: Such this pathologic form of renal involvment (FSGN) resulting from D-penicillamine has not been reported in the literature yet.

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Introduction: An association between depression and altered immunity has been suggested by a number of studies but has not been consistently demonstrated .The effect of maternal depression response on fetal immune system have not been investigated. Thus in this study we evaluated the effects of depression on some parameters of innate and humoral immune system of pregnant women and their infants. Materials and Methods: 62 pregnant women (including 32 depressed and 30 healthy) and their infants in Taleghani hospital of Arak in 2004 were included in this study. All depressed mothers had a diagnosis of depression by Beck Depression Inventory (BDI) and clinical interview based on DSM-IV system. The level of immunoglobulins and components were evaluated by single radial immunosdiffusion (SRID) method of Mancini. Leukocyte and lymphocyte counts were determined by Hycel (an automated cell counter) and for more accurancy were also evaluated by manual method. Statistical analysis was performed using K-S, Mann-Withney, One way ANOVA, Kruskal-Wallis and Pearson tests. P<0/05 was considered significant. Results: Serum IgM level and serum C4 level of infants of mothers with depression were significantly lower than infants of healthy mothers. Lymphocyte number and percentage in infants of depressed mothers was also significantly higher than infants of healthy mothers. The mean cord/maternal blood ratio of IgG in infants of depressed mothers was also significantly lower than infants of healthy mothers. Serum IgG level of depressed mother was significantly higher than other mothers. Conclusion: Fetal impact of stress and depression during pregnancy is just beginning to be understood and research in this area is developing. Our results indicated that maternal depression adversely affects the development and function of fetal immune system. These results are in agreement with the immunological findings of preterm and LBW infants.

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Introduction: Oxidative stress may play a critical role in neurodegenerative disorders but the relation between oxidative stress and learning ability in normal rats is not investigated, so the aim of this study was to investigate the correlation between oxidative stress and two way active avoidance learning in Wistar rats. Materials and Methods: This is an experimental research. 14 Wistar rats were assigned for assessed learning ability in shuttle box. One day after shuttle box learning, cerebrospinal fluid (CSF) and blood samples were obtained. Concentration of Nitric Oxide and Ferric reduction/antioxidant power were assessed. Data was analyzed using Pearson correlation test. Results: The results of the present study demonstrate that there are positive correlation between shuttle box learning ability and Ferric reduction/antioxidant power (p<0.001, r =0.66 4) and Nitric Oxide concentration (p<0.001, r = 0.724) in serum, but not in CSF. Conclusion: The results of this study suggest that high concentration of antioxidant power and Nitric Oxide concentration in blood can improve shuttle box learning in rats

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Introduction: Pain relief has been received the highest level of medical attempts continuously but still many patients suffer from it. Narcotics' side-effects have led investigators to apply other techniques for controling acute postoperative pain to reduce narcotics requirements. Recently, some concepts have been presented implying that Metoclopramide does have analgesic effects and this led us to conduct the present study in order to determine Metoclopramide's effect on alleviating pain after cesarean section. Materials and Methods: In this clinical trial, 80 patients who were candidates of elective cesarean section were studied in two groups. 10 minutes before the cesarean section's ending time, the control group was given 25 mg Pethidine accompanied by 10 mg Metoclopramide and control group 25 mg Pethidine and distilled water. Then when patients were conscious after cesarean section, for a period of 6 hours received after-care for their vital signs and side-effects of prescribed drugs. Their pain score (VAS) and nausea rate was measured and if necessary, Pethidine was injected with certain dose. Injection time for first dose of Pethidine and its required amount were recorded in a checklist within first 6 hours after cesarean section. Data was analyzed using ANOVA and T tests. Results: Prescription of Metoclopramide inhaunced analgesic effect of narcotics and a meaningful decrease was found in pain score (p=0.002) and nausea rate (p<0.005). Injection time for the first dose of Pethidine was also prolonged in the group who received Metoclopramide compared to control group (p=0.019) and an obvious decrease was occurred in received Pethidine's amount within the first hours after cesarean section (p<0.005). Drugs side-effects were not found in patients. Conclusion: The results indicate that use of Metoclopramide accompanied by Pethidine in ending time of cesarean section, does have considerable effects in controlling acute pain after surgery and increasing analgesic effect of narcotic drugs. Therefore, use of Metoclopramide as a proper supplement drug with low side-effects is recommended.

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Introduction: End stage renal disease (ESRD) is a major health problem and each year the number of patients is increasing. If the disease becomes irreversible, patients must always be hemodialyzed. Since mortality rate will increase due to inadequate dialysis, determining the efficacy of hemodialysis and improving its quality is very important. The main goal of this research is investigating the efficiency of hemodialysis. Materials and Methods: This is a cross-sectional analytical study which was conducted on 103 people who were under dialysis treatment in the Vali-e-Asr hospital of Arak in year 2003. Weight, blood pressure (before and after dialyze), time of dialysis, BUN and Cr before dialysis and 5 minutes after turning of the pump and before the second dialysis were measured. Data was analyzed by T test and Pearson correlation. Results: The mean of KT/V was 0.58 ± 0.1 normal protein catabolic rate (nPCR), 0.36 ± 0.11 g/kg per day and time average concentration of urea (TAC), 43.3 ± 14 mg/d which had a significant difference with standard measures (p<0.05). KT/V was 0.49 ± 0.18 and 0.47 ± 0.10 for men and women respectively which was significantly different (p<0.03). There was a positive and linear relationship between education level and TAC, KT/V and number of dialysis per week. Conclusion: Regarding the low efficiency of hemodialysis in 80% of patients and lower levels of hemodialysis efficacy indicators in comparison to standard measures, periodic assessment and also investigating the reasons of low efficacy of hemodialysis is recommended.