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Material and methods: This is a Double blind Randomized clinical trial study which was performed on 66 children of 2-7 years of age who had been referred for first time, for nonbrain non-liver elective surgery (class 1 Anesthesia). This study was designed to define the efficacy of oral ketamine on Anxiety and Agitation and crying of children after separation from these parents, toleration of Anesthesia mask and IV needle. Sleeping before Anesthesia and entry into the operating room samples were divided in to two groups, cases and control. 5mg/kg of ketamine plus 0.2cc/kg of fruit juice was given to the case group while only 0.2cc/kg of fruit was given to the control group 30 minutes before the operation.
Results: Our results showed that 78.8% of children in the case group did not cry when they were separated from their parents and 78.8% of them did not show any resistance. 34.4% of children in the case group showed no response and 59.4% also had low response. Only 6.1% of children in the control group had no response while 78.8% of them had responses such as intense body movements and pulling of hand. 69.7% of the case group were cooperative when putting on the anesthesia mask while 75.8% of the control group refused to wear the mask, 81.8% of the children in the case group were asleep before Anesthesia while all of the children in the control group were awake and uneasy.
Conclusion: These findings indicate that ketamine can be used as a preanesthetic drug to decrease the anxiety and fear of children and to calm them before their transfer to the operating room.

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Introduction: Although more  than  two  decades  is  passed  from  the  discovery  of  H.pylori  and  its  role  in  pathogenesis  of  upper  GI  disease, a  uniform  protocol  for  H.pylori  treatment  is  not  administrated  yet.  This  research  is  conducted  to  evaluate  knowledge,  attitude  and  practice  of  physicians  about  H.pylori  disease  and  treatment  and  its  changes  after  reading  a  review  article.
Materials  and  Methods: This  is  an  interventional  study. First we  prepared  a  compact, review  article  for  the  purpose  of  teaching  H.pylori  pathophysiology, diagnosis  and  treatment.  Then  thirty  questions  was  brought  out  to  evaluate  knowledge, attitude  and  practice  of  the  physicians  about  H.pilory   diagnosis  and  treatment. After  the  first  evaluations  we  gave  our  article  to  the  physicians  to  study.  One  month  later  we  repeated  the  evaluation  with  the  same  questionnaire.  Data  was  analyzed  by  SPSS  software.
Results:  304  physicians  participated  in  this  study.  The  mean  evaluated  knowledge  was  49.64-58.75  with  95%  confidence  interval;  which  after  education  increased  to 57.94-74.14 (p<0.05). Mean  level  of  attitude  and  practice  was  53.01-71.67  with  95%  confidence  interval. After  studying  it  increased  to  61.54-80.83 (p<0.05).
Conclusion: The  first  step  of  the  study  showed  that  test  and  treat  is  the  protocol  of  choice  for  many  physicians.  After primary  evaluation  and  introducing  the  compact  article  there  was  a  noticeable  change.   

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Introduction:  Atypical  antipsychotic  drugs  in  comparison  with  typical  antipsychotics  produce  fewer  extra  pyramidal  symptoms  at  clinically  effective  doses.  However  there  has  also  been  a  growing  number  of  reports  of  new  onset  diabetes  mellitus  in  patients  receiving  these  drugs. The  aim  of  this  study  was  the  comparison  of  diabetes  mellitus  incidence  in  mentally  janbazan  (Iran-Iraq  war  veterans) undertaken  typical  with  atypical  antipsychotics.
Materials  and  Methods: In  this  study  the  incidence  of  new  onset  Dm  was  assessed in 200  subjects  referred  to  Amiralmomenin  clinic, Isfahan, Iran. Every  patient  was  included  in  this  study  if  he  was  receiving  atypical  or  typical  antipsychotic  drugs  or  combination  of  both  types, at  least  for  one  year.  Sampling  was  convenient. Fasting  blood  sugar, triglyceride  and  cholesterol  before  taking  the  drugs  was  documented  in  their  records. New  onset  DM  was  defined  based  on  126  mg/dl  or  more  for  FBS  which  was  confirmed  with  GTT.  For  comparison  of  FBS  mean  pre  and  post  interventions, NIDDM  incidence, the  relation of  background  variables  with NIDDM  and  the  relation  of  NIDDM  incidence  with  dosages  and  duration  of  drug  therapy, paired t-test, chi-square, logistic  regression  and  ANOVA  were  used.
Results: Subjects  were  divided  into  three  groups  based  on  the  type  of  drugs  used  135 patients  using  typical  antipsychotics  (chlorpromazine, perphenazine, haloperidol, …), 39 patients  using  atypical  antipsychotics  (clozaoine  &  riaperidon)  and  26  patients  receiving  combination  of  drugs. It  was  found  that  DM  developed  following  treatment  in  three  groups  were  12.8%, 6.7%  and  3.8% respectively.  There  was  no  significant  differences  between  three  groups  regarding  the  incidence  of  new  onset  DM.
Conclusion:  Findings  showed  that  patients  treated  with  antipsychotic  drugs  had  a  moderately  increased  risk  of  DM especially  with  atypical  antipsychotics.  It  is  suggested  to  evaluate  every  patients  before  treatment  for  risk  factors  of  DM.
 

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Introduction: Acute  renal  failure (ARF)  is  one  of  the  relatively  incident  complications  in  surgical  emergency  wards  and  is  defined  as  increasing  serum urea  and  creatinine   and  decreasing  GRF. In  this  study  we  investigated  acute  renal  failure  incidence  in  patients  admitted  to  emergency  surgical  ward.
Materials  and  Methods: This  is  a  cross  sectional  analytical  study  in  which  all patients  with  primary  diagnosis  of  emergency  surgery  (traumatic  or  non traumatic) admitted  in  emergency  surgery  ward  were  selected. After  history  taking  and  physical  assessment  patients  having  history  of  kidney  disease  were  excluded. Urinalysis, BUN  and  creatinine  tests  were  performed  for  all  samples. Data  was  analyzed  by  SPSS  software.
Results: In  this  study  2100  patients  (1280  male)  were  assessed  during  a  10  month  period. 5.66%  of  samples  had  some  degree  of  ARF. 1136  patients  undergone surgery  due  to  accidents  and  trauma  (72%  multiple  trauma  and  28%  single  trauma) and  964  patients  due  to  nontraumatic  emergencies.  ARF  was  seen  in 6.84%  of  the  first  and  4.25%  of  the  second  group. ARF incidence  in  male  and  female  was  5.6%  and  5.7%  respectively.
 ‍Conclusion: The overall  incidence  of  ARF  in  this  study  was  not  so  different  from  developed  countries.   ARF  was  significantly  more  incident  in  traumatic (especially  multiple  trauma)  and  old  aged  patients.  This  factors  must  be  considered  as  ARF  risk  factors  in  emergency  wards.

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Introduction: Different hormonal responses may appear in severe head injured patients (including increase in serum Cortisol & GH level). These changes can also be seen in recovery and rehabilitation periods, so influencing the patients, outcome.
Materials and Methods: Forty severely head injured patients, referred to emergency units of Alzahra & Kashani hospitals were studied in a cohort study (selected by convenient sampling) after dividing into two equal groups. Craniotomy was performed for one group and conservative (non-surgical) therapy for the other. In the first and seventh day of admission serum Cortisol and growth hormone were checked (using RIA method). Data was analyzed by paired and student t tests.
Results: There were significant differences between mean of GH in the first and also in the seventh day(both with P<0.05) and between mean of GH and Cortisol from first to seventh day in two study groups(P<0.05). But there were no significant differences between mean of Cortisol in the first or seventh day in two study groups.
Conclusion: Results of this study showed that craniotomy as an independent factor can raise serum GH and Cortisol levels in severely head injured patients.

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Introduction: Sweet,s syndrome (SS) is characterized by painful plaque on extremities, face and neck fever and peripheral leukocytosis. In this study patients with Sweet,s syndrome are described in a 10 years period.
Cases: This is a case series study in which 9 patients admitted to dermatology unit of Bu-Ali hospital were studied between 1992 to 2002. Basic characteristics of skin lesions in each patient were as following: red, painful and raised lesions on hand and lower leg of the first patient large, flaccid bullae containing hemorrhagic fluid on both lower legs and upper portion of one thigh and scar over both ankles in the second patient papule and nodule on left hand with pain, itching and hemorrhagic secretion in the third patient bullae over internal surface of thighs and trunk and hyperpigmented, diffused macula over abdomen in the forth patient painful papule and nodule on hands and right lower leg in the fifth patient painful plaque and nodule in the sixth patient erythematous and painful papule on both lower leg and abdomen in the seventh patient erythematose papule and nodule with burning sensation over abdomen and right hand in the eight patient and painful bullae on neck and right lower leg in the ninth patient.
Conclusion: Some special findings were found in these patients. For example, hemorrhagic and flaccid bullae, epidermal changes such as regional hyper keratosis and acanthosis and scar formation due to the illness which were not mentioned in previous reports of the disease.

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Introduction: Studies showed that following spontaneous epilepsy in rats, the permeability of CA1 region of Hypocampus to calcium is increased. In this study the role of voltage dependent calcium channels on the development of kindling induced by Pentylenetetrazol (PTZ) was investigated in rats.
Materials and Methods: In this experimental study rats were divided into two groups. In the test group, Verapamil (calcium channel blocker) was injected in the Hippocampus (4 g/4 min). After 20 minutes kindling was established by PTZ in subconvulsive dose (37.5 mg/kg ip). Convulsing activities were monitored for 20 min. The control group was the same age and undergone the same procedure exept for the injection, in which ACSF was injected without Verapamil.
Results: Verapamil significantly (p<0.01) reduced the number of needed stimulations to progress from stage 0 to 5 of the convulsion and also significantly (p<0.05) prolonged the fifth stage of seizure.
Conclusion: The results of this study suggested that interahippcampal injection of Verapamil facilitated the Pentylenetetrazol kindling in rats but had inhibitory effects on kindled animals.

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Background: Permanent pacemakers are applied to treat some 2nd and 3rd degree AV blocks. Previous studies have shown the hemodynamic changes that may occur after pacemaker implantation. In this study, we have evaluated these hemodynamic changes from a different view point, with measurement of urinary sodium and blood pressure. Materials and Methods: This is a before and after clinical trial study in which 30 patients, who were hospitalized for permanent pacemaker implantation for the first time in Tehran heart center during 3 years, including 12 women (mean age 62.92 years) and 18 men (mean age 60.07 years), were tested for urinary specific gravity and sodium, blood pressure, blood sodium and potassium, before and after pacemaker implantation. Paired sample T test and Chi Square test were used for statistical analysis. Results: Systolic blood pressure was 136.5 mmHg and 120.6 mmHg before and after pacemaker implantation, (P<0.001). Also, after pacemaker implantation, urinary sodium rose from 83.45 meq/L to 106.61 meq/L (p=0.018). Conclusion: This study is consistent with previous studies, which showed hemodynamic changes after permanent pacemaker implantation including decrease in blood pressure and elevation of serum neuropeptides.

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Introduction: Bronchogenic cysts are rare congenital lesions which originate from ventral foregut and most commonly originated in the central mediastinum. They rarely have symptoms and at the time of diagnosis they usually are large, infectious or complicated. In this study a case report of bronchogenic cyst is reported. Case: The patient to be presented is a 47 years old man with sudden onset of chest pain, severe dyspnea, tachypnea and decreasing right lung sounds. Symptoms of pneumotorax were observed in lung radiography. The patient was treated by inserting chest-tube, but there was no response to the treatment. Urgent thoracotomy was performed. A large single bronchogenic cyst was detected in the right lung parenchyma attached to intermediate bronchus. Complete resection was performed. According to the pathology report, pneumothorax was developed secondary to rupture of the bronchogenic cyst. Conclusion: Lung parenchyma is not a common area for developing bronchogenic cyst but it has special importance because of it's severe complications. Since exact diagnosis is not always possible before surgery, it is necessary to perform resection in all suspicious cases.

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Introduction: Allium Sativum (garlic) is used widely in the world, especially in Iran. This plant is used in cooking foods as an odorant. In Iran it is believed that it is useful for gastrointestinal disorders. So in this study the effect of Allium Sativum extract on acid and pepsin secretion in rat is investigated. Materials and Methods: This experimental study is performed on two groups of rats (12 in each group: control group and allium sativum group). After anesthesia with nesdonal (50 mg/kg, ip), rats had gone under surgical tracheotomy, laparatomy and gasterodeodenostomy. In garlic group Allium Sativum extract (100mg/kg) was introduced into the stomach by gasterodeodenostomy canula. In order to stimulation of acid and pepsin secretion, Pentagastrin was used (25mcg/kg, ip). Stomach secretion was washed out and acid was measured using titerimetery and pepsin using Anson method. Data was analyzed using t-test. Results: Allium Sativum caused a meaningful increase in acid and pepsin secretion in garlic group comparing to control group (p<0.001). Pentagastrin also increased acid and pepsin secretion in control group (p<0.001). Conclusion: Using garlic in nutritional regimen causes an increase in acid and pepsin secretion in those using this plant.

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Introduction: Dehydroepiandrostrone (DHEA) and its sulfate form is an adrenal hormone and is the most common steroidal hormone in body and despite of other adrenal hormones increases with age, so it is called youth fountain. Recently, DHEA is noticed increasingly because of its multiple effects. Its effect on insulin sensitivity is controversial. In this study the relation between Dehydroepiandrostrone (DHEA) level and Insulin sensitivity is investigated. Materials and Methods: In this cross-sectional analytical study, samples were selected among female relatives of diabetic patients referring to Isfahan Endocrine Research Center. They were divided into three groups including diabetic, impaired glucose tolerance and normal glucose tolerance, each 30 persons. In these groups blood sugar, lipid, CBC, Insulin and DHEA-S levels were evaluated and the rate of Insulin sensitivity was determined using Homeostatic Modle Assessment- Insulin Resistance (HOMA-IR) and the relation between insulin sensitivity rate and DHEA in the three groups was compared. Data was analyzed using one way analysis of variance and t-tests. Results: The mean of variables in the three groups of diabetic, impaired glucose tolerance and normal glucose tolerance for DHEA-S was 127, 113, 129 mcg/dl Insulin 7.7, 1.10, 8.3 mcg/ml HOMA-IR 1.6, 3.5, 1.8 and fasting blood sugar 86, 135, 89 mg/dl respectively. Comparison of mean of variables showed that the difference between DHEA-S in groups was not significant. Also there was no meaningful relationship between DHEA-S and blood sugar. In the group with normal glucose tolerance, DHEA-S with HOMA-IR and insulin had a partial meaningful relation (p<0.06). Conclusion: Overally DHEA has no meaningful relation with insulin sensitivity and HOMA-IR, but this relation is meaningful in the three groups and the relation between DHEA-S with HOMA-IR in the group with normal glucose tolerance is partially meaningful.

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Introduction: Post operative pain, nausea and vomiting are common complications after hemorrhoidectomy and cause unpleasant expriences for patients. Today, scientists are increasingly moving forward to find new drugs with fewer side effects and costs to control these complications. So this study was planned to evaluate the effect of Dexamethasone on post operative pain, nausea and vomiting. Materials and Methods: This study was a double blind randomized controlled clinical trial that carried out on 112 patients scheduled for hemorrhoidectomy. Patients were diveded into two groups. Case group received 8mg Dexamethasone and control group received 2 ml normal saline intramuscularly 30 minutes before the operation. The method of surgery and general anesthesia were the same in all patients. Pain and nausea score were recorded using visual analog scale (VAS) and vomiting was recorded by asking of them at 0, 2, 4, 6 hours after operation. The patients were followed for 6 hours after the end of the operation and data was analyzed using t and chi square tests. Results: There was a significant difference between the two groups regarding prevention of post operative pain and nausea (p=0.00001). But there was no significant difference between the two groups regarding prevention of post operative vomiting. Conclusion: The result of this study suggested that injection of Dexamethasone before hemorrhoidectomy can decrease incidence of postoperative pain and nausea but dose not have any effects on postoperative vomiting. Therefore Dexamethasone is recommended before hemorrhoidectomy.

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Introduction: Familial adenomatous polyposis (FAP) is a rare disease with hundreds to thousands adenomatous polyps in large intestine which inherits in the form of autosomal dominant, but 25% of patients have no positive family history. Rectorrhagia and rectal prolapsus are the most prevalent symptoms. Diagnosis is based on clinical findings and results of colon investigation, and prompt colectomy prevents carcinoma in patient. In this article a case report of familial adenomatous polyposis is presented. Case: The patient is a 17 years old teenager, a known case of familial adenomatous polyposis, who was refered with severe obstruction signs of gastrointestinal tract. The disease was diagnosied when he was 5 years old. In 6 years old he was treated by partital colectomy and in 11 years old by total colectomy and ileorectal anastomosis. The patient was investigated by endoscopy and small bowel transit. Because of many polyps in stomach, duodenum and jejunum polypectomy, gastrectomy and duodenotomy were done. Diffuse carcinoma in situ was reported in pathology. Conclusion: Rectal and colonic polyps are rarely obsereved below 10 years old, but rectorrhagia and rectal prolapsus suspects the diagnosis of FAP in children. In the case of dysplasia and carcinoma abdominal pain, anemia and weight loss will be presented. In children with suspecting FAP, screening of extracolonic manifestation and dysplasia should be considerd and elective surgery should be done.

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Introduction: A pseudoaneurysm is a pulsetile hematoma secondary to bleeding into soft tissue, which involves peripheral vessels in the most cases. A femoral artery pseudoaneurysm that is a rare complication, mainly occurs following prior arterial catheterization but it may also be formed with trauma. In this article a superficial femoral artery is reported. Case: The patient is a 24 years old woman who was admitted with a wound in the posteroinferior region of right tight 10 days before her recent referral. The skin of the wound had been repaired. After 1 week pain, progressing swelling in inferior region of tight and knee, fever, shivering and limping were presented. In physical examination, 90 degree flexion of knee, edema, warmth and tenderness in inferior region of tight were observed. Any pulse of dorsalis-pedis and posterior-tibialis was not touched. In the next step blood laboratory test, simple X-ray, Doppler sonography and magnetic resonance imaging (MRI) of right lower limb were accomplished. Finally, with the diagnosis of femoral artery pseudoaneurysm, excision of the pseudoaneurysm with reverse saphenous vein grafting was performed. Conclusion: Pseudoaneurysm should be noticed in patients with history of penetrating trauma and symptoms due to infection. In these cases sonography is necessary to get the exact diagnosis. The size of aneurysm and patient’s symptoms, determine the method of treatment.

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Background: There has been an increase in the number of women willing to have a caesarean birth because of their fear of childbirth. It seems the childbirth preparation educational class is a good way to remove or alleviate fears associated with pregnancy and childbirth.This research designed to identify the effect of childbirth preparation classes on childbirth fear on the primiparous women. Methods and Materials: The present study is a clinical trial which was carried out in 2007 at Milad Hospital, with 100 nulliparous pregnant women. Childbirth fear was measured by childbirth attitudes questionnaire. Normal pregnant women in the second trimester with childbirth fear score was 28 or more were randomly selected and dirided into experimental and control group with 50 subject in each qroup. The experimental group attended nine childbirth preparation class sessions and control group received routine antennal care. Results: The mean scored fear of childbirth in case and control group were 39.35±6.96 and 40.71±6.23 respectively. There was not significant difference between two groups. After the sessions, comparing childbirth fear score between two groups in third trimester showed the mean score of childbirth fear among experimental group was lower than control group (29.82+/- 7.18 compare to 38.03+/-9.27), and the differences statistically was significant (p<0.001). Mode of delivery was significantly different between the two groups. Conclusion: Primiparous women attended childbirth preparation classes acquired lower score of childbirth fear in compare to women received routine prenatal care. The results of this research showed relaxation training decreased childbirth fear and increased normal vaginal delivery.

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Background: Hospitals need performance evaluation systems for development and competition in order to evaluate the effectiveness and efficiency of their plans, processes and human resources. The objective of this research is to design an evaluation system at hospitals through the use of the Balanced Scorecard. Methods and Materials: In this comparative study, the selected countries consisted of Australia, USA, Canada and New Zealand, and 34 public hospitals of Iran which were applying strategic planning. Performance evaluations were examined in terms of 6 aspects including mission, vision, strategies, perspectives, objectives and measures .A pattern was designed for performance evaluation of public hospitals in Iran and was validated using experts’ survey of DELFI method. Results: All countries had mission and vision as important aspects of their performance evaluation model while health effectiveness promotion was the most important strategy. High quality health services, resource development, innovation and guaranty in continuous services were other strategies. Perspectives of Balanced Scorecard included customer, internal processes, learning and development of staff and financial affairs. All of the countries had objectives and measures for each of the perspectives. Iranian hospitals had mission, vision, strategies and objectives but for them perspectives had not been defined and measures were not congruent with strategies and objectives. In the model, 4 perspectives were determined to describe hospital strategies and to use competition benefits as well. Conclusion: Applying measures of 4 perspectives including "Patients and Community", "Internal process and Productivity", "Growth and innovation" and "financial aspects" to doevaluation of Iranian public hospitals collates their performance, improves productivity of their resources and enhances patients and community satisfaction.

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Background: In order to selected indigenous potential probiotic bacteria, we surveyed antagonistic activities of 22 strains of acid and bile tolerant Lactobacillus, isolated from traditional dairy products by biochemical and molecular methods. Methods and Materials: In a fundamental practical study assessment of antimicrobial activity of this strain with neutrallized and Dual layer two methods against bacterial pathogene such as E-coli, L.monocytogenes, S.auteus and Y.entercolitica was done. These strain were identified with two methods for determining of biochemical and sequence of 16Sr DNA. Results: Dual layer method based on the growth of zone diameter were estabilished in three groups of strains inhibitors, semi inhibitors and non inhibitors. Neutralize method around well acidic extract containing strains C5i4, Y144, K213, C4i2, C612 and neutral extract C5i4 zone blight strains was observed. Based on the results, sequence area 16Sr DNA of four strains inclulde C4i2, C1d2, Y2c4, D3b1 indicator bacteria that revealed the highest percentage of inhibitor effect of bacterial indicators, were duplicate and sequency. So four strains L.Bacilus Pentosus, L.Bacillus Bervis and L. Bacillus Paraplantarum, were indentifed respectivey. Conclusion: It seems that indigenous lactobacillus from Iranian dairy products have potential as probiotics. So use of them as bio preservative prevent food bacterial contamination.

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Background: Inappropriate feeding is one of the major causes of malnutrition in children. This study was carried out to get an insight into mothers’ views and beliefs about the role of complementary feeding in children under the age of two. Materials and Methods: In this qualitative study, data were collected through 11 focus-group discussions (FGDs) with mothers, who had children under the age of two, in urban and rural areas of Damavand in 2007. Each FGD was held in the presence of a moderator, two note takers, and an observer. At the end of field work, all notes were collected and coded according to the objectives of the study. Then the subgroups for each objective were obtained, and emerging themes were extracted and reported. Results: In the study, six general themes were identified:(1) The mothers viewed complementary feeding as simple, soft, light foods which are especially made for children (2) the best time for introducing complementary feeding was 6 months of age (3) there were no complementary local foods in Damavand (4) for children under the age of one, a different type of food was separately prepared (5) home-made complementary food was preferred over the ready made type, and (6) children were fed with table food from the first year of life. Conclusion: Despite their sufficient knowledge about the advantages of complementary feeding, the majority of mothers, due to some socio-cultural limitations, had a weak performance. In this regard, in addition to making revisions in current training programs and protocols, providing effective and goal-oriented educational programs for mothers and others who take care of children is strongly recommended.

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Background: Helicobacter pylori iceA gene has been reported to be a genetic marker for the development of peptic ulcer in western populations. The aim of this study was to investigate the prevalence of iceA genotypes and their relationship with peptic ulcer in Iran. Materials and Methods: This observational study was carried out on 75 patients. Biopsy specimens were evaluated for the presence of Helicobacter pylori through rapid urease test. GlmM gene and iceA1 and iceA2 genotypes allelic verification and variation culture were determined via PCR. Results: In this study, iceA1 and iceA2 alleles were identified in peptic ulcer disease (PUD) patients. IceA1 genotype (64%) was more prevalent than iceA2 (21.3%). IceA1 strains were more observable in patients with PUD. No significant relationships were seen between iceA genotypes and the clinical outcomes following infection (p= 0.71). Conclusion: This study revealed a significant two-tailed correlation between iceA genotypes and PUD occurrence. The results indicate that iceA1 gene can be used as a reliable marker in predicting the clinical outcomes of Helicobacter pylori infection. Therefore, further in-vitro and in-vivo investigations are needed for reaching general consensus in this regard.