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Ïntussusception is the most common cause of intestinal obstruction in children. Disease in typic form manifests itself by colic abdominal pain and episodic vomiting with bloody stool. Ïn Ïleoileal types, manifestations may not be typical. Diagnosis is based on clinical finding through barium enema and sonography. Treatment is nonsurgical reduction, and if contraindicated, surgical reduction. Ôur patient was a 3.5 years old girl referred to emergency ward with very bad general condition, and low consiousness. Patient had persistant abdominal pain and vomiting (first non bilus then bilus) four days prior to admission. Ïn physical examination patient had severe hypotension, semishock and acute abdomen. Âfter stabilization, patient was transferred to operation room. Ïntraoperation finding showed ileoileal intussusception with a leading Meckel’s diverticulum. Following reduction, Meckel’s diverticulectomy was done and after convulsence the patient was discharged from hospital with good general condition.

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Background and purpose: Neonatal icter is one of the most prevalent diseases in neonatal period and may lead to serious important complications such as kern icterus. For appropriate therapeutic approach to these patients, there is need of blood sampling and in some cases, repeated blood sampling, in order to measure bilirubin which causes certain complications such as infection, anemia, pain etc. Therefore non invasive measurement of bilirubin is an interest of researchers. Purpose of this study is to compare between measures of transcutaneous bilirubinometry (TÇB) and serum bilirubin (SB) in neonate patients.
Materials and methods: This study was a clinical trial and done by simple sampling.was method. Neonates admitted in NÏÇÜ and neonatal ward with clinical indication of measuring bilirubin were studied. Âfter giving instruction to the patients and matching TÇB measuring conditions, rate of bilirubin was labelled on forehead of the patients and serum bilirubin was measared by conventional method.
Results : From 105 TÇB and SB measurements, 49.5% were males and 50.5% were females. Gestational age of mother was 31.53 + 3.68 weeks and birth weight 1905.80 ± 778.50 grams. 76.6% of them at the time of sampling were under phototherapy and 18.1% were transfused. General correlation index between SB & TÇB was 0.686 and for females 0.750, birth weight between 1500 to 2500 grams, gestational age between 32 and 36 weeks (0.821) and in patient without phototherapy it was 0.699.
Çonclusion: This study revealed that, there is a favorable correlation between transcutaneous bilirubinometry (TÇB) and serum bilirubin (SB) in neonate patients. Thus TÇB can be used as a screening method.

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Background and purpose : The low amount of blood sugar in neonates is an important and prevalent problem which needs serious attention because of its cerebral complications. High birth weight is one of the risk factors for hypoglycemia. There is no general agreement about how to approach the high birth weight neonates who do not have the symptoms of hypoglycemia but are at a high risk of it. In some centers the neonates blood sugar is checked before beginning the breast feeding and treatment but it imposes risk of opening the vein, hospitalization and also cost of care. So in this study the effects of breast feeding on blood sugar in high birth weight neonates have been studied.
Materials and methods : This study is a before/ after clinical trial on high birth weight neonates (BW>3800 gr) who were born in Imam and Razi University hospitals. Each neonate was its own control and the intervention was breast feeding. Simple sampling method was used to recruit the subjects and the exclusion criteria were neonates with symptomatic hypoglycemia, blood sugar less than 30mg/dl and absence of breast feeding in the first 2 hours after birth. After measuring the blood sugar, breast feeding was done and then 0.5 and 2 hours after that, the blood sugar was measured again and compared with the first amount (before breast feeding).
Results : A total of 94 neonates with birth weight of 4120+234 and 39.6+1 weeks of gestational age were studied. Most of the neonates were at the first and second parity (38.2% & 40.4%) and given birth through caesarian section (63.8%). History of hypertension in 7.2% and gestational diabetes in 6.4% were positive. Blood sugar at birth was 52. 25+ 15.5 mg/dl and blood sugar of 0.5 and 2 hours after breast feeding were 56. 89+ 14. 45 mg/dl and 68+ 14.5 mg/dl respectively. The differences between the blood sugar at birth and after 0.5 and 2 hours of breast feeding were significant (P<0.05). Birth weight and the commencing time of breast feeding were the factors significantly related to neonates blood sugar.
Conclusion : Breast feeding increases the blood sugar in high birth weight neonates and decreases the chance of being in hypoglycemic group and this effect in Neonates with near normal birth weight, early onset of breast feeding and longer length of time after beginning the breast feeding is much more significant.

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Background and purpose: Evaluation is one of the most important bases of promoting the quality of education. It is very important to know the attendings’ and students’ viewpoints as evaluated and evaluator groups. So in this study the viewpoint of the attendings and students of School of Medicine of Mazandaran University of Medical Sciences (MUMS) about the students evaluation of the attendings, were studied.
Materials and Methods: In this descriptive-cross sectional study, all faculty members (FM) and students of the school of Medicine were included in the study by census sampling. Data collection was done using a questionnaire including demographic questions and educational variables, the FM and students viewpoint about manner of evaluation (time, the way of distributing the forms and the explanation), the student's features in evaluation (awareness, truthfulness and puposes) and the instrument of evaluation (questionnaires and items).
Results: 345 individuals (95 FM and 250 students) took part in this study. The manner of evaluation (time, distribution and explanations) to most of FMs' and students’ opinion was appropriate. About student's awareness and truthfulness in filling in the questionnaires a considerable percentage of FMs (20-40%) had a negative opinion and over half of them had a negative attitude about the whole process of evaluation. About the items of theoretical, practical and clinical questionnaires, while the students laid stress on aspect such as: being a teacher and concepts transferring, on attendings opinion these aspects were less important.
Conclusion: To most FMs and students opinion, the manner of evaluation is appropriate but a considerable negative attitude exists among attendings about students’ awareness and truthfulness in filling in the questionnaire. The priorities of evaluation are different in these two groups’ point if view.

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Background and purpose: Educational evaluation is a structured process for determination of quality and effectivness of an educational program. Of the most common and studied methods used for evaluation of academic staff is evaluation by students, however, "self-assessment" of the academic staff has not been videly used and there are few studies about it. So the purpose of this study was to assess the correlation between the results of the academic staff "self assessment" and assessment by the students.
Materials and Methods: This study was an analysis of correlation. Study population was clinical faculty members of Mazandaran University of Medical Sciences, recruited by simple sampling method. Tool of data collection was a questionnaire consisted of demographic and educational variables and questions about evaluation of theoretical and clinical teaching of member of staff. Validiy and reliabiliy of the questionnaire were approaved. Each faculty member was assessed by students and themselves and correlation between them was analysed using SPSS 13.
Results: Totally 35 member of staff participated in self assessment, with a mean age of 43.7±7.46 years, 73% male. 95.6% of the staff and only 80.6% of the students have positive attitude toword assessment of the staff by students (p<0.001). Not only there was a weak correlation between the results of staff "self assessment" and their assessment by students (r= 0.020, r=0/125) but also there was a significant difference between them (p<0.001). Differences between these measures was higher in minor teaching departments.
Conclusion: There was a weak correlation between measures of members of staff "self assessment" and their assessment by students, so educational intervention, for improvement of competency for "self assessment" should be designed and implemented.

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Background and purpose: Ambulatory medicine is one of the most important parts of medical education. Due to its profound relation with professional future of physicians, ambulatory medicine is especially under attention and many studies have been performed to survey its quality and to design some ways to promote it. There is obvious deficiency in our evidence about ambulatory medicine. The aim of this study was to survey the quality of teaching of the ambulatory medicine from the viewpoint of the faculty members and students of medical faculty of Mazandaran.
Materials and Methods: This was a descriptive and cross-sectional study. The study's population consisted of students, residents and clinical faculty members who were included by simple sampling. Data collection was performed by a questionnaire with 22 questions about demographic and educational variables as well as respondents’ opinions about environmental conditions, independent activities, instructors’ supervision, and social training in the ambulatory clinics. The validity of the questionnaire was controlled by content validity with expertise consultation, and its reliability was controlled by test-retest(r=0.85). Data were analyzed using spss13 software.
Results: Response rate was 79%, the mean age of 36 faculties was 43.6+- 8.7 years and 32% of them were female. The mean age of 146 students was 25+-3.6 years and 61% were female. The attitude of the majority of the students (88.3%) towards the quality of ambulatory teaching was negative, but majority of faculties (66.7%) had positive attitudes. There was no significant difference among teaching departments. Attitude of junior trainees was even worse. Attitude of faculty members and students was similar towards inappropriate physical environment of ambulatory clinics, but it was significantly different from independent activities of trainees in clinics (p=0.000) relational drugs prescription (p=0.000) management (p=0.004), and supervision of faculty members (p=0.000).
Conclusion: The overall attitudes towards the current condition of ambulatory teaching (especially trainees) were negative because of the impossibility of independent activities for trainees, low supervision of faculties, absence of teaching for rational drug prescription, differential diagnosis and management.

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Background and purpose: Beta-thalassemia major (TM), a chronic, genetically determined hematological disorder, has received little investigation on the psychological aspects of the disease and the psychosocial adjustment of patients with this anemia. In the present study, the aim was to explore the nature of psychopathology according to age, sex, school performance, severity and complications of the disease in TM patients compared with demographically matched healthy persons.
Materials and Methods: A controlled anterograde cohort study was conducted at the Thalassemia Unit of Boo-Ali Hospital from June 2003 to November 2005 in Sari, Iran. Psychological aspects were evaluated by the Persian version of symptoms checklist-90-revised questionnaire. Information on relevant demographic characteristics, school performance, severity and complications of the disease was collected by one of the investigators who had created the questionnaire.
Results: 125 persons with TM completed the questionnaires and were compared with 125 controls and 250 totally. The mean age of the participants was 18.51± 2.0 years and with a range of 15-25 years. 132 (52.8%) were female with equal family status, social and economic status. Patients group reported a significantly lower level of marital status (P<0.01), education level (P<0.0001), school performance (P<0.0001). TM patients were found to have significantly more psychiatric disorders than the control subjects with GSI: 1.16 ± 0.47 vs. 1.01 ± 0.6 (P<0.03), PSD: 54.99 ± 12.59 vs. 46.42 ± 18.76 (P<0.0001), and PSDI 2.02±1.02 vs 2.45 ± 2.22 (P<0.05). We recorded significant changes in the mean scores of somatization (P<0.0001), interpersonal sensitivity (P<0.0001), depression (P<0.003), anxiety (P<0.05) and psychoticism (P<0.03) in the TM patients as compared to the control subjects.
Conclusion: These findings show that beta-thalassemia major patients are at risk for psychiatric symptomatology and need appropriate psychiatric consultation.

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Background and purpose: There has not been enough attention towards the domains of development in pediatrics,so there are many deficiencies in monitoring the achievement of developmental milestones in our country. One of the important ways for the improvement of this problem is to use screening method. PEDS questionnaire is one of the screening tools for development. The aim of this study was to investigate about parents' evaluation of developmental status for their children.
Materials and Methods: This was a cross-sectional descriptive study. The population included infants and children under the age of 6 in day care centers of Sari. Sampling method was clustering. The tool for data collection was PEDS questionnaire (Parents' Evaluation of Developmental Status) which consisted of 38 questions about demographic data and medical history of children as well as parents' concern about different developmental domains along with ''Yes'' , ''No'' and ''little'' answers. The data were analysed using SPSS11 software. Chi square and Wilcoxon were used. P<0.05 was considered significant.
Results: Out of 829 questionnaires, 736 were returned (88.7%). The Sample age was 4.23 ± 1.32 gl . Fifty percent of participants were male. By average, in each developmental domains, 3.2% of parents had major concern and 9.5% had partial concern. The most common domains of concern were communication with others (6.4%), behavior (6.1%), speaking (4.3%), preschool and school education (3.1%), children's understanding (2.5%), the self care (2.1%), the use of fingers (1.4%), the use of legs and arms (1.1%). Parents' concern had a significant relationship with parent's education, residence and history of illness in children (P<0.05). Out of 23.4% of the infants and children who had later returned to the diagnosis center, 80% had behavioral disorder, 87.6% had speech disorder and 16.6% had hearing impairment..
Conclusion: A considerable percentage of parents was concerned about developmental domains of their children, but follow up at referral centers was low. Parents' concern led to the diagnosis of an illness for a child in most cases.

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Background and purpose: Wheezing is a common respiratory problem which is related to hypersensitivity of airways, GERD (Gasteroesophageal Reflux Disease) is one of the underlying factors of respiratory diseases and wheezing in infants (different rates). For the patients with refractory wheezing, detection and treatment of underlying disorders is very important. So, in this study, frequency of Gasteroesophageal reflux was detected in infants<2y with refractory wheezing.
Materials and Methods: This is a cross-sectional descriptive study on the patients referred to pediatric clinic during 2003-2005. Infants with refractory wheezing under 2 (Based on HX, PE) were introduced gradually, and patients with the evidence of foreign body aspiration, congenital heart disease, thracheoesophageal fistula and neurological impairement were excluded. Fleuroscopic barium study for detecting GERD was performed for the patients. Data were analyzed using SPSS11 software.
Results: During 2 years, 50 patients were studied. Age of the patients was 10.26 ± 5.48 m and 54% of them were male. The most common complaints were wheezing and retraction. Also, 78% of the patients were under dronchodilator treatment, among them 30.8 % responded to the drug. In fleuroscopic study using barium, 60% of the patients demonstrated GERD. Numbers of respiratory attack and admissions significantly were related to GERD.
Conclusion: GERD is one the underlying factors of recurrent respiratory symptoms and refractory wheezing in infant below 2 years of age. So, evaluations for the detection of GERD should be performed in this patients.

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Background and Purpose: Cholelithiasis is a common problem among patients with homozygous major and intermediate β-thalassemia due to chronic hemolysis, ineffective erythropoesis and other factors that causes variety of side effects. Hydroxyurea (HU) decreases hemolysis by increasing HbF production in homozygous β-thalassemia patients. Up to now, there have not been evidences about relationship between use of Hydroxyurea and cholelithiasis in the patients. The aim of this study was to determine the relationship between use of HU and incidence of cholelithiasis in patients with major and intermediate β-thalassemia referred to thalassemia research center of Mazandaran University of medical sciences at Boo-Ali Sina hospital of Sari, IRAN.
Materials and Methods: This historical cohort study was performed in 2006. Study population was major and intermediate β-thalassemia patients referred to Boo-Ali Sina Hospital of Sari, IRAN. The patients were divided to two groups: case and control groups. The case group (36 patients) was consisted of major or intermediate β-thalassemia patients using hydroxyurea at least for one year, and the control group were: non-hydroxyurea user patients or beginning to use the drug less than 3 months. The groups were matched on order to age, gender and severity of the disease. Severity of the disease was determined according to grading, clinical and laboratory characteristics of the patients. Data about demographic information, severity of the disease and results of hepatobiliary ultrasound were recorded in a questionnaire. The data was analyzed using SPSS (11) software and t-test, Chi-square test and fisher exact test.
Results: Thirty-six [20 women (55.6%)] patients in case group and 36 [19 women (52.8%)] patients in control group were studied. The mean duration of use of hydroxyurea was 67.9 ± 25.5 months with maximum 108 months (9 year). The mean dosage of the drug was 14.9 ± 5.9 mg/kg with maximum dosage 34 mg/kg. Thirteen (48.1%) patients in control group (12 cholelithiasis, 1 sludge) and 6 (19.4%) patients in case group (5 cholelithiasis, 1 sludge) had abnormal hepatobiliary sonography. The difference between two groups was significant statistically (P<0.02). Among the different variables, a significant relationship was detected between gender of the patients and effect of HU on cholelithiasis.
Conclusion: This study showed that the incidence of cholelithiasis in major and intermediate β-thalassemia patients using hydroxyurea was less than non-hydroxyurea user patients did. As a result, it seems that there was a preventive effect of hydroxyurea in incidence of cholelithiasis in major and intermediate β-thalassemia patients.

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Background and purpose: Osteopenia and osteoporosis are well known and common complications of beta thalassemia major (TM). This research was undertaken in order to find the prevalence and related factors and also effect of ongoing treatment on the conditions. Materials and methods: All medical records of patients older than 16 years were reviewed. Non transfusion dependent patients called as thalassemia intermediate. Demography of patients was extracted, the results of the BMD and Z-Score of femoral neck and lumbar vertebrae were reported comparing normal matched subjects. Z-Scores <-1, -1 to -2.5, and bigger than -2.5 were considered as normal, osteopenic and osteoporotic respectively. Results: 125 patients had at least one BMD measurement. 73(58%) patients were TM and the remainders were non transfusion dependent. Mean age was 24 ± 6 and F/M ratio was 3/1. According to Z-Scores, 17% , 61% and 17% were normal, osteopenic and osteoporotic respectively. Age and severity of pathology were correlated, and 7% reduction of BMD/ year was calculated (P<0.000). BMD of lumbar vertebra was worse in men (P<0.001). A negative significant correlation was detected between BMD and the mean of hematocrit in the last 5 years (P<0.005). Correlation of the age at starting transfusion and severity of BMD was not significant. Nineteen patients had 2 BMD measurements, 3 ± 1 years apart. Patients who had osteoporosis in the first measurements were using oral medicine (Alendronate). No significant improvement was noticed and in fact femoral BMD was worse in men (P<0.001). Conclusion: BMD measurements was less than anticipated. Osteopenia and even osteoporosis are common. Treatment duo to non compliance or inadequacy was not effective and more intensive treatment is needed.

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Background and purpose: Ône of the most important physician’s job difficulties is the patient’s dissatisfaction and malpractice lawsuit, and its effects on their personal and professional life. Ünfortunately despite of all progresses made, and new technologies in the field of disease diagnosis and management, the prevalence of medical lawsuits is increasing over the time. Medical errors can occur in any part of health care system. Ëpidemiological research is needed to determine how many medical errors are made in hospitals. Ôur goal is to determine the frequency of malpractice lawsuits, motivations, the prevalence and type of errors, and finally to give some solutions to minimize the risk of medical malpractices and to improve patient safety.
Materials and methods: Âll malpractice lawsuits referred to forensic medicine department and medical council in Sari in the years 2006-2011 Jan were used to collect information about errors and the data were analyzed using statistical exams.
Results: Âmong 192 cases, in 27.1 % of them medical errors were discovered. The most frequent lawsuits and medical errors were committed in 2009 (22.4%, 28.8%). The most frequent medical errors were recognized in orthopedics, dentistry, general surgery, general practice and plastic surgery, 86.5% of practitioners were male and 13.5% were female. Ïn the majority of cases a surgical procedure was done and occurring medical error resulted in patient disability.
Çonclusion: The data showed that the frequency of malpractice lawsuits and medical errors were increasing during the years of study. We can drive efforts in planning reeducational and medical ethics courses, improving the insurance coverage and revising management system to reduce medical errors.

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Background and purpose: High incidence of chronic diseases such as diabetes, cardiovascular diseases, cancer, etc. signifies the role of nutrition in maintaining health and preventing diseases. Nutrition education to medical students could be of great benefit since they will have a key role in natural health system and patients usually follow physicians’ advice about diet. This study was done to investigate the viewpoints of general practitioners towards nutrition knowledge and the role of medical schools on this issue. Materials and methods: This descriptive study was conducted in general physicians practicing in Sari’s private or governmental clinics. To collect the data a valid and reliable researcher made questionnaire was used containing demographic characteristics and 45 questions about teaching of clinical nutrition and efficacy of the educational program. The data was then analyzed using SPSS V.16. Results: A total of 100 physicians participated in study of whom 58% were male and 78% practiced in private clinics. More than 80% of physicians rated the importance of nutrition knowledge in clinical practice as high or very high. Regarding the competency in management of nutritional issues, 66% of physicians assessed their competency as moderate. More than 60% had inadequate information on nutritional needs of diabetics, obese people, pregnant women, and children. Also, 70 percent evaluated the teaching course of clinical nutrition in current curriculum as non-relevant. More than half of the cases (59%) mentioned that nutritional course is essential for general physicians and clinical residents and suggested that theoretical courses should be presented in early periods of study alongside other practical courses. Conclusion: This study indicated the importance of nutritional knowledge and skill in clinical practice in view of general physicians and insufficiency and non-relevance of teaching courses. Hence, it is essential to review nutrition education in medical schools.