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Introduction: One  of  the  most  important  health  problems  of  the  country  is  parasitic  infections, specially  intestinal  parasites  which  have  relatively  high  prevalence  rate  through  out  the  world. Theses  infections  can  cause  iron  deficiency  anemia, physical  and  mental  retardation  among  children  and  family  members.  Since  mothers  come  to  account  as  the  base  of  the  family  and  each  their  deviation  of  health  can  consider  as  a  risk  factor  for  them  and  the  other  family  members, this  study  was  conducted  to  determining  prevalence  rate  of  intestinal  parasitic  infections  among  mothers  and  associated  demographic  factors.
Materials  and  Methods:  This  survey  is  a  descriptive  analytical  study  which  cross-sectionaly  was  done  based  on  systematic  randomized  sampling  method  on  1650.  Mothers  in  three  regions  of  the  town.  Their  feces  were  examined  three  times  by  formalin  ether  concentration  technique.  Of course  for  gathering  data  about  demographic  factors, questionires  were  filled  all  infected  mothers.
Results: of  1650  case, 801  mothers (48.5%)  were  infected  by  intestinal  infections:110  mothers  (13.73%) m were  infected  by  pathogenic  intestinal  infection, Giardia  lambia 89 case (5.39%)  was  the  commonest  infection, entamoeba  histolytica  12  cases  (72%), hymenolepsis  nana  5  cases (3%), ascaris  3  case (1.18%)  and  tenia  saginata  1 cases  (0.6%)  respectively. 691  mothers  (869.2%)  were  infected  by  nonpathologenic  intestinal  infection.  E.coli  313  case(19%), blastocystic  hominis  267  cases  (16.18%), endolimax  nana 67  cases (4%), lodamoeba  buetschlii 34  cases, (25%)  and  chilomastix  mesnili  10  cases  (0/6%)  respectively.
Conclusion:  In this  survey, there  was  no  significant  relationship  between  infection  rate  and  demographic  factors  like  age, job, level  of  literary  and  residence  region. However  the  findings  showed  that  the  highest  rate  of  pathogenic  intestinal  parasitic  infections  were  7.8%  (43 cases) in  down  town, 6.72%  (37  cases)  in  town  center  and  5.45%  (30  cases)  in  uptown.

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Introduction: During the history of internal medicine Goiter has always been at the center of attention as one of the most important endemic disorders. It is estimated that about one billion people around the globe are affected with Goiter. Iran is recognized as an cndemic area for Goiter. The aim of this study was to reveal the pattern of distribution of different thyroid disorders in-patients with Goiter in Markazi Province.
Material and methods: It was a descriptive-cross-sectional study that enrolled 2138 patients with Goiter who were selected randomly and by categorized sampling (F=1542, M=596) TSH serum titers were checked for screening and if abnormal, detailed thyroid function tests were done. We used Radon ELISA Kits previously checked with RIA in our study. Patients were first examined for Goiter and graded if Goiter was found, and if it was nodular, the patient was referred for sonography, thyroid scan and FNA. Then the patients were further evaluated based on clinical findings and laboratory results for various thyroid disorders.
Results: In this study we evaluated 2138 pts with Goiter (72% (1542)=F, 28% (596)=M) from which 83.1% had a simple Goiter, 6.94% were hypothyroid, 3.36% had subclinical hypothyroidism. 4.8% were hypothyroid, and 1.17% had subclinical hypothyroidism.
13 pts (0.7%) had nodular Goiter that in one case it was diagnosed as papillary carcinoma. Three patients had coid nodules and the rest had multiple warm nodular or diffuse Goiters. In 44.3% of cases Goiter was in grade IA and in 34% cases it was graded as IB. Goiter was the most prevalence (32.5%) in 10-19 age group and it was least prevalence (2.1%) in pts over 70.
Conclusion: Goiter is endemic in Markazi Province, but its prevalence in the children of recent decade is declining and in previous decades, clinical and subclinical forms of hypothyroidism and hypothyroidism are more prevalent.

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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: Glucose Six Phosphate Dehydrogenase (G6PD) catalyses the first step in pantose phosphate pathway to produce NADPH. NADPH plays an important role in oxidation and reduction of hemoglobine and reduces H202 level. However, in absence of G6PD, NADPH also will be decreased, as a result of severe defect in function of red blood cells occurred. So we decided to survey is prevalence in our region by studying on the umbilical cord blood. Material and Methods: Our study were descriptive-analytic and samples were gathered by Simple Sampling Method. EDTA was used as an anticoagulant. Enzyme activity was measured with the method of Fluorescent spot Test (FST). Chi-Square and logestic regression were used to analyses the data and P<0.05 was considered as significant. Result: From a total of 2160 neonates, 1103 case (51.1%) were male and 1057 case (48.9%) were female. 3.5% of the males and 0.8% of females and over all 2.2% of the neonates were G6PD deficient. Due to chi-square analyses and logestic regression, positive RH increases the risk by 1.6 as compare to negative RH. However we could not find any significant relationship between blood groups and prevalence of G6PD. Conclusion: As our results showed, the G6PD deficiency is more common in male than female. Relation between positive RH and G6PD deficiency were significantly increased. Prevalence of G6PD in Arak City showed 2.2% which is lower than that of north our country (8.7%) as well as lower than other part of the world (10-14.9%). We suggest using the screening umbilical cord blood test on the neonates to diagnose the G6PD deficiency and to promote the primary health care quality and public as well as reduction the social and economical problem of the society.

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Introduction: Considering the high incidence of hip fractures in the elderly, anesthetisis and orthopedic surgeons are frequently encountered with these fractures. Timely fixation of hip fractures decreass morbidity and mortality. Surgical bleeding and the resulting hemodynamic compromise, decrease in vital organ perasion and complications of blood transfusion are important problems in this age group. The ability to decrease Surgical rise; in these patients.
Material and Methods: In a semi-experimental and prospective study 40 victims of hip fracture (50-90 y/o) were selected. The goal was to clarify the relation between anesthesia technique and surgical bleeding 22 patients received spinal (group A) and 18 patients received general (group B) anesthesia.
Results: According to recorded data surgical bleeding was greater in group B (general anesthesia) Than group A, and these data was statistically significant.
Conclusion: In this study %60 of group A and %61.2 of group B were males and %40 of group A and %38.8 of group B were females. During the operation, blood loss was measured and recorded for each patient.

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Introduction: Osteoporosis is an important health problem and the most common metabolic bone disease, that according data statistic, more than 6000000 Iranian have this disease.
Material and Methods: This research is a descriptive analytical study which has been conducted in order to evaluate application prevention behaviors of osteoporosis in health caregivers and how them educating for women referred to the health care centers of Arak City in 2002.
The research units were composed of 24 health caregivers 110 women referred to these centers that had been selected by convenience.
Results: The results of the research show medium age of caregivers were 33.7 years and in women were 29.3 years. (%58). Caregivers and (%80.9) women had adequate education intake daily and (%80.2) caregivers and (%16.4) women had regular exercise, (%62.5) Caregivers and %63.5) women exposed to the sunlight. Also the results show (%49.1) units research in the day gave discussion of caregivers about osteoporosis. (%79) intake calcium, (%90) exercise, (%85.5) exposing to the sunlight, but (%80.9) women did not discuss about taking hormonal drugs.
Conclusion: The result show significant relation between age, educational level and family history of osteoporosis in health caregivers with before education, but relation between adequate calcium intake in women and education was nonsignificant and relation between doing exercise and education was significant.

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Introduction: The relation between Helicobacter pylori with iron deficiency is being studied in recent years. The aim of this study is finding the relation between Helicobacter pylori with the rate of hemoglobin and serum ferritin.
Material and Methods: This study is an observational study and a cross-sectional type which is done analytical-descriptive against 262 patients suffering from anemia and for each patient the amounts of Hemoglobin, MCV, serum ferritine and Helicobacter IgG titre is calculated and then the relation between these amounts and Helicobacter is evaluated.
Results: In 147 patients (56%), Helicobacter IgG antibody was negative. In 78 cases (29.8%) the serum ferritin was less than 120 µgr/dlit. Using statistical analysis (Logistic regression) revealed that there was a statistical relation between the amount of ferrittin and the chance of strickened with Helicobacter in individuals whom their ferrittin rate was less than 12, 1.93% of patients whom their ferrittin is more than 12 and the enhance is significant. By the way it was cleared that there is not any significant statistical relation between MCV reduction and the chance of being strickened with Helicobacter.
Conclusion: Serum ferrittine rate in patients with Helicobacter pilory infection reduced and this reduce was significance. Previous studies in other countries indicated to this issue.

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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: Regarding the extensive use of IUD, as contraception. The present study was conduced to evaluate the complications resulting from muliload 375 and T Cu 380A IUD inserted in women referred to the health and treatment settings of Kermanshah medical sciences university in the year 2002.
Materials and Methods: The study was descriptive-analytic, on 122 women using M.L 375 IUD and 245 others using T 380A IUD were fully assessed. The tools used to collect data were questionnaires evaluating the following variables: Pregnancy, bleeding, ectopic pregnancy, uterine perforation, and expulsion, pelvic inflammation disease (PID). To analyze the data, descriptive statistic and X², student-T and Fisher tests were used.
Results: Severe bleeding during menstrual cycle was the most common complication in the two study groups, especially in the multiload 375 IUD group (75% vs. 41.6%; P<0.001). The multiload 375 IUD had a significantly higher dysmenorrhea rate compared to the T cu 380A (%70.8 vs. %40.8; P<0.001). The rate of intera-uterine pregnancy was low for the two device %1.7 vs. %2, and occurrence of ectopic pregnancy in multiload 375 IUD was 0.8% and in T Cu 380A group was not reported. There was no uterine perforation observed for either device.
Conclusion: According to the results gained, the common complications in each group were not dangerous and their severe and threatening complications were uncommon. The most frequent complications were severe bleeding during menstrual period, dysmenorrhea and spotting which were not life threating and could be controlled by supporting and training their users, although these complications were seen more among those using M.L 375 IUD. These two device were effective enough to prevent pregnancy. It seems that using T Cu 380A IUD is more suitable for those who want to have a long-term contraception.

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Introduction: Tribulus was traditionally used as a diuretic, mild laxative, urolithiasis, dysurca for treatment of urinary tract problems including stones, cystitis and infections, particularly Gonohrea. Antimicrobial cffects of methanol extract of Tribulus fruit on few gram positive and negative bacteria, the causative agents of some bacterial infections was evaluated and then compared with some in use antibiotics for these infections.
Materials and Methods: In this research as an experimental study. 40 gr powder of Tribulus fruit was dissolved in 100 ml pure methanol as a solvent with cold maseration method, the suspension was filtered after 5 day. The filtered suspension were concentrated with rotary evaporator apparatus in vaccum and was then dilluted with methanol to yield different concentrations. The antimicrobial activity of the extract and antibiotical were examined with disc diffusion and tube dilution standard methods to measure the diameter of inhibition zones, minimal inhibitory concentration and minimal bacterial concentration.
Results: The results were shown that the antimicrobial effect of the methanol extract of Tribulus fruit on ATCC strains of Streptococcus faecalis, Staphylococcus aureus, Escherichia coli and Pseudomonas acroginosa had bactriostatic effect with the concentration of 400, 200, 100, 100 ug/ml in order. The comparison of urinary tract infections, including Oxacilin, Ciprofloxacin, Penicilin G, Gentamycin, Cotrimoxazole, Nalidixic acid and Nitroforantoin were shown that Tribulus fruit extract in concentration used in this research had a similar or even better effect than some antibiotics on some of the bacteria used in this evaluation.
Conclusion: The Tribulus fruit extract has an efficient bactriostatic and bactricidal activity of few gram positive and negative bacteria, the causative agents of some bacterial infections and these cffects are comparable to those antibiotics in usc for treatment of these infections. Tribulus fruit extract could be suggested for treatment of these infections after the pharmacological and clinical complementary studies.

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Introduction: Patient hospitalization rate (P.H.R) is an important issue in health decision making because its increasing can imposes abundant expenditure on each patient or therapeutic or health systems like assurance companies. Moreover, it can increase the danger of nosocomial infections. So, description, examinating and modelling of P.H.R. can be as a guideline for above subjects and as an introduction would lead one to study the issue with insight.
Materials and Methods: For determining of P.H.R., Iwo samples of size 1428 and 816 of patients were chosen systematic randomly from Vali-Asr and Ta'min-Ejtemai hospitals, respectively during the year of 2002. Hospitalization rate, age, sex, location of birth place and residence place of patients recorded. Mixed distributions modelling and Poisson regression models as well as ordinary regression methods were applied to analyze and modelling the data.
Results: Means of P.H.R of patients at Vali-Asr hospital was 4.1±5.4 days. Two component Poisson was a relatively appropriate model was a very relevant model for analyzing of their P.H.R. By using mixed Poisson regression method a significant relationship among patient's age, marriage status and location of life with P.H.R was obtained. Findings in Ta'min-Ejtemai showed that the mean of P.H.R was 4.7±3.2 days. One component Poisson model was appropriate model for data distribution. A significant relationship among age, sex, location of life with P.H.R in this hospital was seen.
Conclusion: Our findings showed that P.H.R in Vali-Asr hospital follows two component Poisson model. For Vali-Asr data, the normal model was not appropriate even with changing the statistics variables, but for P.H.R data of Ta'min-Ejtemai, changing the logarithmic variable could transform data into approximate of normal model. Finally, comparison between mixed distribution Poisson model and acquired regression with simple linear regression in Val-Asr hospital presented different results, but in Ta'min-Ejtemai hospital had similar results.

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Introduction: Sympathetic stimulation and pressor responses including tachycardia, hypertension and tachyarrhytmias caused by laryngoscopy and tracheal intubation may result in severe complications in susceptible patients. Opioid anesthetics are one of the several drugs used to attenuate this response but prolonged postoperative respiratory depression is the major complication distracting from their high dose administration which is nceded for complete amelioration of pressor response. In this study Alfentanyl, as a rapid acting and short duration opioid (without prolonged respiratory depression), was used in two different dosages for controlling of pressor response.
Materials and Methods: In a single blind, controlled clinical trial, 236 patients in the range of 18 to 70 years old), whom needing laryngoscopy and tracheal intubation were selected and randomly divided into two equal groups. First group received low (current) dose (15u gr/kg) Alfentanyl, and the other received high dose (450gr/kg), prior to laryngoscopy and tracheal intubation. Type and dosage of induction drugs were the same and matched in both groups. Blood pressure and heart rate were measured before intravenous induction and after intubation of the tracheal in all patients. Mercurial sphygmomanometer and pulse oximeter were used for these measurements. Incidence of such
complications as hypotention, muscle stiffness and neurologic hyper reactivity, were also measured. Data were analysed by Z distribution and Chi square tests.
Results: Alfentanyl was cffective in controlling pressor response in both groups. In the case of heart rate, the mean difference between two groups was not significant. There was a significant difference mean arterial pressure between two groups (p<0.05). In high dose group, incidence of complications was higher for severe hypotension (p<0.05), stiff chest syndrome (p<0.05), and neurologic hyperreactivity (p<0.05).
Conclusion: High dose of Alfentanyl is more efficient in controlling of pressor response than low dose of the drug. High dose administration also may results in some complications. In this study current dose of Alfentanyl is recommended for controlling of pressor response, but high dose may be used with some modification in the dose of induction agents.

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Introduction: Basal cell carcinoma is the most common malignancy in humans. A number of treatment modalities are available. We performed this study in order to determine the efficacy of Mohs micrographic surgery in treatment of basal cell carcinoma.
Materials and Methods: This retrospective descriptive study was performed on 194 basal cell carcinoma (in 175 patients) were treated in Isfahan Al-Zahra Hospital from september 1999 to March 2003 with Mohs micrographic surgery. Data were obtained from patient's files and were analized by SPSS software.
Results: Of the 175 patients (with 194 basal cell carcinomas), 110 (62.85%) paticnls were male and 65 patients (37.14%) were females. The mean age of patients was 58±12.38 years. The majority of tumors were located on face and scalp. 180 of tumors were primary and 14 were recurrences. 17% of tumors were larger than 2cm. Recurrences of the tumor occured in 3 patients. The cosmetic results were excellent and good in 81%. The incidence of recurrnce rate was 0.9%.
Conclusion: Kecurrence rate is low when basal cell carcinomas treated with micrographic surgery so this treatment modality (when indicated) is also strongly recommended in Iran for the treatment of basal cell carcinoma.