---

 Background & Objective: Hepatitis C Virus is the most common cause of post-transfusion hepatitis. This study was conducted to evaluate the prevalence of hepatitis C in multiply transfused patients.

 Methods: 45 patients with B- thalassemia major, 4 patients with hemophilia and 1 patient with aplastic anemia were studied prospectively during 2000. An initial questionnaire was used to collect the data regarding age, sex, duration and interval of at blood translation family history and the type of blood product received and the date of first infusion and then a blood sample was taken for detection of antibody against HCV.

 Results: 62% of the subjects were male and 38% of them were female with the age range of 6 months- 29 years old. 92% of the patients used packed red blood cells. 27 patients had a positive family history of thalassemia and two seropositive patients (4%) had thalassemia. Duration and mean amount of blood transfused were significantly higher in patients with HCV infection. Data analysis showed now significant relationship among variables of the study and hepatitis C cases.

 Conclusions: It is concluded that multiply transfused thalassemic patients are at high risk for HCV infection. Thus, routine screening of blood and anti- HCV test in these patients is necessary.

---

  Background & Objective : Diabetes is one of the most important world health problems and a chronic disease that needs continuous care. Therefore, these kinds of patients should take self- care education. This study is an attempt to investigate the effect of nutritional education on blood sugar level and macronutrients intake in IDDM patients.

  Methods : 24 IDDM patients under 20 were selected for educational program on nutrition. The data were collected two times using food questionnaire (24- hour recall) and blood sugar level before and after education was estimated. The data were analyzed by paired t-test, using SPSS and Food Processor.

  Results : There was not statistically significant relationship between blood sugar level before and after education. Also the results showed that there was statistically significant relationship between macronutrients intake before and after education (P=0.35). After education, macronutrients were similar to WHO recommendations. HbA₁C level in most of the patients was 9-12% which refers to the moderate control of this diseases and hypoglycemia decreased from 4.2% to 3%.

  Conclusions : There were no remarkable changes in blood sugar but the amount of HbA₁C and Macro Nutrients showed that education had a positive effect on patients.

---

  Background & Objective : The fast population growth is one of the basic problems in Iran and using family planning devices has a remarkable role in decreasing it. The findings of researches carried out nationwide indicate the effectiveness of instruction in the application of family planning methods and devices. The objective of this study is determining the level of knowledge of 15-49 year-old women under Ardabil health and treatment center services.

  Methods : 138 qualified mothers were chosen randomly from among 15-49 year-old women under Ardabil health and treatment centers services. These subjects were selected from among 14 centers (10 mother from each center) and had secondary school level of education. This descriptive cross-sectional and prospective research was conducted by filling out the pre-planned questionnaire and preparing educational booklets and giving them to the mothers under the study as pretest and post-test procedures during the time span of December 2000 to May 2001.

  Results : No meaningful relationship was found between employment and utilizing family-planning devices. The results of Mc-Nemar test and t-test showed that statistically the instruction given with regard to the method of beginning to take anti-gestation pills, method of the intervals of taking the anti-gestation pills, taking measures at the time of forgetting to take anti-gestation pills, the preference of vasectomy to tobectomy, the interval between the injection of anti-gestation ampoules and the duration of IUD effectiveness before and after studying the manuals demonstrated a significant difference.

  Conclusions : Education plays an important role in increasing the knowledge level of the population under study and hence it improves their performance about family planning. So this instruction is recommended to be followed seriously.

---

  Background & Objective : Failure To Thrive (FTT) refers to the insufficient physical growth or inability in keeping the desired growth rate in a period to time.

  It is a problem in Iran as far as hygienic nutrition is concerned. FTT is a multifactor problem which is caused by various organic and nonorganic agents. This study was conducted to pinpoint the major risk factors involved in the growth of children under 2 years of age who are the most vulnerable age-group in terms of growth disorders.

  Methods: This case-control study was conducted in 2002-2003 on 120 infants (60 cases with FTT and 60 controls) in Namin health centers. The case group was under the third percentage of their growth chart or they had -2SD in growth chart at least in three months. The control group was composed of infants with normal growth chart.

  The demographic characteristics of parents, and the nutritional and antropometric (height/weight, head circumference) characteristics of the subjects were measured. The collected data were analyzed by SPSS software, using chi-square and ANOVA.

  Results: The findings indicated higher frequency of respiratory infections, diarrhea and vomiting in case group (p<0.05). The control group, on the other hand, outnumbered the case group in terms of the number of infants under 6 months who were exclusively breast-fed (p<0.05). Most of the infants with FTT had a lower birth weight than control group (p<0.05). The number of mothers with lower level of education and those who were housewives and also the number of family members were significantly higher in case group than control group (p< 0.05). However, no significant difference was observed between two groups in terms of frequency of breast feeding and birth rank.

  Conclusions : The results indicated that some risk factors such as respiratory infections, birth weight, education, mother ُ s knowledge, exclusive breast feeding and the frequency of diarrhea and vomiting have far more important role in growth disturbances in children compared to factors such as frequency of breasr feeding and birth rank.

---

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

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

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

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

---

  Background & Objectives: Neonatal mortality rate is a main indicator of hygienic development and recognition of the mortality causes is the first step for reduction of the mortality rate and promotion of this indicator. Therefore, in this study, the causes of neonatal mortality have been investigated in Ardabil medical university related hospitals.

  Methods: This study is a retrospective, cross-sectional and descriptive-analytical one that has been done on the bases of admission's units and filling the medical record form for all neonates who have been admitted to Alavi and Imam Khomeini hospitals in Ardabil from September 2006 to September 2007. The questions of forms consisted of infant’s sex, birth weight, gestational age, cause and age of death. The data were analyzed by SPSS software with utilizing T- test and Chi-Squares.

  Results: During this study, there were 1881 admissions of which there were 148 deaths (7.86%). The causes of mortality were hyaline membrane disease (HMD) (52.02%), sepsis (14.86%), pneumonia (9.45%), congenital anomaly (12.83%), asphyxia (7.43%) and meconium aspiration (3.37%). Among the dead neonates, 54.72% were male and others were female. There were 550 LBW neonates and 111 deaths in this group result of our study showed that mortality rate in LBW neonates was 20.18%. There were 578 preterm neonates and 122 deaths in this group prevalence of mortality rate in preterm neonates was 21.10%.

  Conclusion: Prematurity and low birth weight are the most important and fixed cases of infant mortality. The most common causes of mortality were hyaline membrane disease and sepsis. Therefore, the prevention of preterm labor for reduction of prematurity and its related complication recommended which may lead to decreased rate of neonatal mortality.

---

  Background & Objectives: Birth weight less than 2500gr (as result of preterm delivery and/or intrauterine growth restriction (IUGR)) is a major cause of both neonatal health. Predominate cause of LBW in developed countries is premature birth, whereas in developing countries is more often IUGR. Different risk factors, including demographic and behavioral during and before pregnancy are effective in LBW incidences which can reduce LBW and neonatal mortality rate by identification and control of these risk factors. The present study has been carried out with purpose of identification and decreasing the LBW rate in Ardabil.

 Methods: In this case – control study all infants delivered in 2006 in hospitals in Ardabil were investigated. Every neonate whose weight was less than 2500gr was taken as a case (n=470) and 482 neonates whose weight was more than 2500gr was taken as a control. Data gathering was done through questionnaires, interviewing the mothers and physical examination. The data were analyzed statistically through SPSS.

 Results: In the present study, the presence of LBW amount is %6.4 in Ardabil hospitals. The results of our study showed that a significant relationship existed between prematurely and gestational age<37wk, mother’s age, mother’s job and maternal weight, premature rupture of membranes (PROM), maternal diseases, multiple births, bleeding during pregnancy, interval between pregnancies less than <2 years, prior history of low birth weight, use of drugs by mother in pregnancy, congenital malformation with LBW. In this study relation between parity, the use of Folic Acid, Fe, cigarette smoking and addiction of mother, living area (village or city), family marriage, health care and mother’s education were not significant with LBW.

  Conclusion: The LBW important risk factors in Ardabil hospitals were prematurity or gestational age <37wk, multiple pregnancies, PROM, mother’s age over 35 years, and mother weight <50kg, maternal diseases.

---

  Henoch-Schonlein Purpura (HSP), also known as anaphylactoid purpura is a common vasculitis of small vessels with cutaneous and systemic complications. Henoch-Schonlein Purpura is often associated with an infection, and a wide variety of noninfectious agents have been implicated in its pathogenesis. However, its association with entamoeba histolytica has once been reported. We report the case of a 7-year-old boy with HSP, diagnosed by HSP criteria and observation of numerous cysts and trophozoites of E. histolytica on stool smear. The patient was treated with steroid unsuccessfully but following anti amebic therapy signs and symptoms of disease were disappeared and the patient discharged from the hospital.

---

  Background & Objectives : Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is common through the world including Iran. Because of its chronic nature and lack of effective treatment, patients are always anxious and stressful and physicians are also exhausted of untreated patients. The cause of IBS is unclear and it has not effective treatment. Therefore, there is a need to find and introduce a proper method of treatment to control symptoms including abdominal pain and defecation changes. This study was aimed to determine the effectiveness of probiotic yogurt on the general relief of symptoms associated with IBS.

  Methods : Subjects were recruited from patients of gastroenterology clinic in Imam Khomeini Hospital, Ardabil. A total of sixty patients fulfilling the Rome II criteria took part in this study. Subjects were randomized into two groups of trial and control. Pre- and post- treatment symptoms were investigated using a questionnaire. Thirty one patients received probiotic and 29 patients normal yogurt for 4 weeks. Bottles of yoghurt were manufactured, and coded by a company. Both participants and researcher were blinded for the bottles' code. The symptoms were followed before and after two and four weeks of treatment and two weeks post- discontinuing of trial, too. Data were analyzed by SPSS (Ver. 17) and differences between groups were compared statistically using of chi-square and t-test.

  Results: A total number of 60 patients were recruited in this study of whom 36 (60%) were female and 24(40%) male. The average age of participants was 34.1±9 which did not differ between two groups. The onset of symptoms did not show any difference between two groups. The trial group had a history of 5.7±5.1 years while this was 6.5±4.9 for the controls. In overall, patients who were given probiotic yogurt had shown a better response in the control of abdominal pain and flatulence than those who were treated with normal yogurt. There was not a significant difference between two groups in the response to treat for other symptoms including epigastric pain, vomiting, frequency of defecation and feces consistency.

  Conclusion: According to our research, adding probiotic yogurt to the patient diet may help ease symptoms of IBS especially, abdominal pain and flatulence. Considering the high prevalence of irritable bowel syndrome and the lack of effective therapies, even a slight reduction in symptoms can have positive public health consequences.

---

  Background & objectives: Nosocomial infections increase patient’s mortality and are considered as a health problem. The aim of this study was to assess the risk factors for nosocomial infections and antimicrobial resistance pattern of isolated bacteria in NICU and PICU, in Bahrami and Children’s Medical Center hospitals, Tehran .

  Methods: In a prospective cross-sectional study from October 2008 to September 2009, risk factors and etiology of nosocomial infections were evaluated in all patients who showed infectious signs upon 48h admission. Infectious agents were diagnosed by the standard microbiological tests and antibiotic sensitivity of isolates was determined using dick diffusion method. The data for location of the hospital, admission history, presence of immunodeficiency, fever and using venous and urine catheters, suction, venous injection as well as cerebral shunt and surgery have been collected by a questionnaire and analyzed, statistically .

  Results: About 9.3% (70 individuals) of cases encountered with nosocomial infections. From whom, 24.3% were infected by Pseudomonas aeroginosa and 18.6% and 3.14% by Klebsiella pneumonia and Enterobacter spp, respectively. The location of the hospital, using of suction and surgery were the most common risk factors related to nosocomial infections (p<0.05).

  Conclusion: Our findings showed that the hospital location, suction and surgery were the most common risk factors and Pseudomonas aeroginosa, Klebsiella pneumonia and Enterobacter spp were the common infectious threats. So, we need to design the special program to improve nosocomial infection control in hospitals .

---

  Protein C is a vitamin K dependent glycoprotein. Protein C deficiency is a rare genetic disorder and its major sites of involvement are skin, eyes, lungs, central nervous system, and kidneys. This article presents a case of neonatal protein C deficiency with severe purpura fulminans and bilateral cataracts. He was initially treated with fresh-frozen plasma and then followed by warfarin. All necrotic skin lesions improved with treatment. He was the first child of his parents who were asymptomatic for protein C deficiency. We also reviewed literatures about coexistence of cataracts and protein C deficiency.

---

  Background & Objectives: Uncontrolled postoperative pain can cause many adverse effects such as tachycardia, hypertension, myocardial ischemia, decreased alveolar ventilation and poor wound healing. In this study we evaluated the preoperative administration of pregabalin in relieving postoperative pain after lower limb orthopedic surgery and reducing the need for opioids and their possible side effects.

  Methods: This study is a randomized, double-blind clinical trial. It was performed on 60 patients under lower limb surgery in Fatemi Hospital. Patients were randomly allocated to two groups, one group has received a 150 mg pregabalin capsule 2 hours before surgery and the other group has received placebo as a control. In both groups at 2, 6, 12 and 24 hours after surgery, the patients were evaluated and the pain score by a visual analogue scale (VAS), the score of sedation by Ramsay sedation scale and the incidence of nausea and vomiting were recorded in the checklists. Then, the data were analyzed by SPSS v16. P <0.05 was considered significant.

  Results: In this study 51.7% of patients were male and 48.3% were female. The age averages of these patients in both group were similar (p=0.578). Visual analog pain scores at 2 h after surgery reduced in pregabalin group (p<0.0001). Similar reduction was observed in other studied hours (p<0.0001) too. In the pregabalin group nausea and vomiting scores at all hours, sedation levels at 2 h and 6 h postoperation, and pethidine consumption in all hours have significantly been reduced (p<0.05).

  Conclusion: Preoperative administration of pregabalin is an effective method for reducing postoperative pain for patients, and with reduction in pethidine consumption, it can decrease problems of opioid usage.

---

  Background & Objective s: Poisoning is one of the most common causes that referred to the Emergence and one of the most important Medicine immediacy. Correct and immediate diagnosis and accommodative treatment can be life saving. Knowing the overall pattern of poisoning in any geographical area would help to better manage and treat the victims.

  Methods : In a cross sectional descriptive study, the required information was collected from the records of patients showing drugs and chemical poisoning who referred to Imam Khomeini hospital Collected data was statistically analyzed using SPSS software.

  Results : Out of 2852 case of poisoning, 106 people passed away due to severe complication. Of these 56.8% were men and 43.2% were women. The majority of cases (76.8%) were from urban areas. Suicide was the main cause of poisoning (66.53%). Accidental poisoning was recorded for 5.01% of cases. In 28.45% of cases, the cause of poisoning was not identified. The age group 21-30 years made the highest number of cases (52.3%). Tramadol, Benzodiazepines and Aceteminophen were the most poisons used respectively. Benzodiazeine was the most taken drug is in suicide (19.97%).

  Conclusion : Results showed that poisoning with Tramadol and Benzodiazepines is high in Ardabil Province. Opioids, Aluminum Phosphide and Organophosphores are the main causative of death in poisoned victims in the province of Ardabil.

---

  Background & Objectives : Poisoning is a common cause of hospital emergency visits in many countries. Incidence of poisoning is different based on cultural and economic characteristics. The aim of this study was to investigate the epidemiology of poisoning in pediatrics.

  Methods: This cross sectional study was performed on 336 patients under 13 years of age referring to Bu-Ali hospital during five years (2007-2011). Variables such as age, sex, residency place, hospitalized duration, cause of the poisoning, clinical signs, treatment and outcome were obtained by a checklist. Collected data analyzed by statistical methods in SPSS v16.

  Results : Among the subjects, 197 patients (58.6%) were male. The average age of the children was 4.1 years and the most common age range was 1 to 4 years with (210 patients, 62.5%). The mean duration of hospitalization of children was 1.7 day (SD= 0.2), 77.7 % of the children were living in the city and the summer was accounted as a common season in which the patients referred to the hospital (32.7 %). The most used materials were drugs with 60.71% and in 86.6% of patients the cause of poisoning was accidental.

  Conclusion : Results showed that the most common cause of poisoning among children are drugs and methadone was the most commonly abused substance. It requires that parents should be trained about keeping their children away from drugs somewhere.

---

Background & objective:   One of the objectives of health reform plan in Iran is to reduce the rate of cesarean section delivery. This needs research and use of results to improve the maternal and neonatal outcomes. The aim of this study was to compare the maternal and neonatal outcomes after normal vaginal and cesarean section delivery in hospitalized low-risk mothers in Arash Hospital in Tehran, Iran.

Methods: In this prospective cohort study, 1900 low-risk pregnant women, with 37-40 weeks of gestational age, referring to the emergency department and being hospitalized for delivery were included. The data were collected from two groups of patients (normal vaginal delivery and cesarean section delivery). Data on wound infection, abnormal postpartum hemorrhage, decrease of hemoglobin, transfusion requirement, injuries to the genitourinary system, fever until 10 days after delivery, neonatal respiratory complications, NICU admission, jaundice and obstetric injuries were collected by a questionnaire.

Results: From 1900 pregnant women, 62.1% had cesarean delivery and 37.9% had normal vaginal delivery. The reasons for cesarean delivery included repeated cesarean (68%), failure to progress (18.1%), and fetal distress (13/9%). Wound infection (p=0. 004), abnormal postpartum hemorrhage (p=0.042) and low hemoglobin (p<0.001) were more frequent in cesarean delivery group than in normal vaginal delivery group. But obstetric injuries were higher in normal vaginal delivery group (p<0. 0001). There was no difference between the two groups in terms of fever ten days after delivery and blood transfusion requirement. For neonatal outcomes, transient neonatal tachypnea (p=0.032), neonatal respiratory distress syndrome (p=0.002), and NICU admission (p<0. 0001) were more frequent in cesarean delivery group than in normal vaginal delivery group. There was no difference between the two groups in neonatal jaundice rate and neonatal injuries.

Conclusion: Due to the high rate of cesarean section delivery in our country and higher rate of maternal and neonatal complications after cesarean section delivery, appropriate strategies are required to be applied to decrease unnecessary cesarean section delivery and increase normal delivery with minimum maternal and neonatal complications.

---

Background & objectives: Treatment of dysmenorrhea in women is aimed to bring them to their normal condition. In the present study, the effect of mefenamic acid, a non-steroidal anti-inflammatory drug, was compared with that of transdermal glyceryl trinitrate (GTN) as a tocolytic drug in the management of primary dysmenorrhea.
Methods: A total of 160 nulliparous women aged 18-30 years with primary dysmenorrhea were included in this single blind, clinical trial, which was carried out from 2014 to 2015. The patients were randomly divided into two equal groups. At the beginning of menstruation cycle, the patients in group A received 500 mg oral mefenamic acid, followed by 250 mg mefenamic acid every 6 hours. The patients in group B initially were administered 2.5 mg transdermal glyceryl trinitrate 0.2% every 12 hours to the abdominal skin under the umbilical cord. Treatment was continued for up to 48 hours and repeated for three cycles. Pain scores were assessed by Numerical Rating Scale (NRS) every 4 hours. Adverse effects such as headache and gastrointestinal disorders were recorded. The decrease of pain scale was the primary outcome and adverse effects were the secondary outcome.
Results: The mean pain severity score in in the first 24-hours in mefenamic acid group was lower than that of the glyceryl trinitrate group (p=0.01). On the second day, the mean pain severity scores were not significantly different between the two groups. The mean pain severity scores in the second day of second cycle (p<0.001) and in the first day of third cycle (p=0.001) were significantly lower in mefenamic acid group than in glyceryl trinitrate group. The side effects were also higher in the glyceryl trisitrate group than in the mefenamic acid group, but this difference was not statistically significant. The most common complication was headache in the group receiving glyceryl trinitrate (18.75%) and nausea in the group receiving mefenamic acid (26.25%). The satisfaction rate was 42.2% in the patients receiving transdermal glyceryl trinitrate, while it was 78.5% in patients receiving mefenamic acid; therefore, the patients in the mefenamic acid group were more satisfied (p=0.004).
Conclusion: The analgesic effects of oral mefenamic acid were better than transdermal glyceryl trinitrate in the management of primary dysmenorrhea. The adverse effects of these two drugs were not significantly different, but the type of complications was different in both groups.