احمد خالق نژادطبری

Congenital abnormalities are of the main causes of death and disability in children, infants and neonates in most countries in the world where a remarkable part of these disorders can be prevented with timely measures. The aim of this study was to provide the epidemiological characteristics of congenital anomalies in Iran.

This cross sectional investigation was conducted on neonates of the birth year of 2016 in six major geographical regions in Iran including Tehran (capital), East Azerbaijan (northwest), Isfahan (center), Khuzestan (southwest), Sistan and Baluchistan (southeast) and Fars (south) Iran. Congenital defects were classified according to the coding system of the International Classification of Diseases (ICD_10). The sources of ascertainment of congenital defects were records of the cases diagnosed with birth defects, and hospital discharge forms. Fully trained and supervised data officers including midwives, nurses and medical coders were assigned to collect and management of the data for this investigation.

The prevalence of congenital anomalies in Tehran was estimated at 163.2, East Azerbaijan 356.4, Isfahan 326.0, Khuzestan 94.3, Sistan and Baluchistan 264.1, and Fars 376.0 per 10,000 births. The prevalence of major defect groups of genital organs, limb anomalies and heart defects were ranked the first, second and third, respectively, in the country. Hydrocele, undescended testicle and club-foot were the most common anomalies diagnosed in the organs in the study regions.

Congenital anomalies are considerably prevalent in Iran, and it is estimated more than 100.000 cases of birth defects occur annually in the country. It seems, therefore, necessary to develop and implement new methods of screening procedures before, during and after birth to avoid occurring congenital anomalies in the country.

In many patients with ulcerative colitis,control of the disease is possible through medical methods, but in some cases,surgery is indicated.So far,no comprehensive study on the consequences of surgery in children with ulcerative colitis has been published in Iran. present study was conducted for the same purpose.

All children with ulcerative colitis admitted in Mofid Children Hospital with indication for surgery for ten years were included in the study.Information on demographic characteristics,surgical indications, duration of medical treatment,type of surgical procedure,complications of surgery, were evaluated.

21patients who underwent surgery during these years were included in the study. The mean age of patients was 11.12 ± 5.65 years. 42.9% were male. In terms of surgical indications, anemia in 100%, Intestinal bleeding in 33.3%, FTT in 14.3%, recurrent defecation in 9.5% and severe colic abdominal pain in14.3%.In terms of early surgical complications,intestinal perforation in4.8%, peritonitis 4.8%,wound infection23.8%, pelvic abscesses14.3%, deep vein thrombosis4.8%,intestinal obstruction9.5%, Pouchitis 9.5% and anal fissure 4.8% were reported.23.8% of patients underwent redo laparotomy for improvement surgical complications.The mean follow-up period of patients in terms of surgical outcomes was 6.79 ± 4.24years. During this period, improvement in gastrointestinal function was reported in 100% of patients. Long-term complications of surgery include , delayed fistulas were reported in 23.8% of cases. Fecal incontinence was reported at 4.8%. Long-term complication-free survival at 5 and 10 years after surgery was estimated to be 92.3% and 56.4%, respectively.

Surgical treatment in children with ulcerative colitis,candidate for surgery,accompanies with favorable outcomes and correctable short and long-term complications.

Congenital anomalies are also known as birth defects and congenital disorders. Congenital anomalies occur in about 3-7% of the newborn babies worldwide. The purpose of this study was to determine the incidence of congenital anomalies and their determinants in hospitals affiliated with Isfahan University of Medical Sciences in 1395.

This cross-sectional study was conducted in all infants born in 1395. The data were analyzed with the SPSS software version 20 using Binary logistic regression.

Of 5455 births in Isfahan hospitals, 121 neonates were diagnosed with major congenital anomalies. The total incidence of major congenital anomalies was 2.2 per 100 births. The results showed a statistically significant relationship between maternal blood group, consanguinity, sex and height of infant with congenital anomalies in newborns (P <0.05). Moreover, 26.7% of all abnormalities were related to limbs and the lowest percentage was related to genetic abnormalities, digestive system, anus, and spine with an incidence of 0.7% for each.

More attention should be paid to premarital genetic counseling in order to identify the consanguinity factor as a risk factor for genetic abnormalities. Moreover, pregnant women should be educated about the timely intake of micronutrients to control abnormalities.

Offering a postgraduate degree not based on the present and future needs of the society, not only does not relieve any of existing innumerable problems, but may lead to loss of money and national wealth, dependency, craving for obtaining academic degrees, jobbery propagation, professional errors, unemployment of the university graduates, waste of energy and disappointment of those who undertake educational endeavor hoping for academic excellence. It seems not the objective criteria but rather regional rivalries have often been the main drive for offering postgraduate degrees. The main objective of this study has been to define the extent of developing postgraduate degrees of medical sciences throughout the country.
Methods and Procedure: Several of more than 60 input, procedural, output and outcome indicators with prospective data gathering the main of which being the course expenditure scale, local expenses scale, rate of the applicants to the capacity of each course, outcome (considering professional, managerial, knowledge-transferring and productive aspects) scale, the whole number of possible future full- or part-time positions or whether it is conceivable at all have been selected. Experts have mainly been consulted where data was not achievable.
No limitation has been shown for 28 postgraduate degrees. Twenty postgraduate degrees are not required presently and their development may be limited (i.e. refusal of issuing new permit, reducing quota, every-other-year admissions or gradually getting on with other tasks). Twenty three postgraduate degrees may only be offered by one or two universities while 62 ones can be offered by up to 5 universities. Two of them should only be developed by the military authorities. Twenty three postgraduate degrees have been offered only recently (during 2013-2014) or no detailed data could be retrieved about them.
MScs in the Medical Education, Human Ecology, Medical Parasitology, Medical Entomology and Vector Control, Ageing health, Health and media, Toxicology, øFood Sciences in Crisis and Disaster Midwifery, Physiology, Exercise Physiology, Medical Library and Information Science and Health Services Management as well as MScs and PhDs in Medical Ethics, Medical Histology, History of Medical Sciences, Molecular Medicine and Anatomical Sciences should not be developed up to 2020.

It is obvious due to lack of resources،resources; we should devote our limited resources to priorities in order to reach an acceptable level of health. The objective of this study is research priority setting for Pediatric Surgery Research Center with the participation of all stakeholders. This is a Health System Research (HSR) project. In order to apply governance and leadership issues with the participation of 41 people including faculty members in Pediatric Surgery Research Center of Shahid Beheshti University of Medical Sciences، other pediatric specialists and health system stakeholders and the people associated with the health system inside and outside of the university. This study was performed with little change in 2010 using the Council on Health Research for Development (COHRED) model. Based on the model، at first the stakeholders were identified and the field situation of pediatric surgery was analyzed. Then، research areas and titles were specified and research priorities were setup by giving scores according to the criteria. The seven obtained research areas in order of priority are pediatric trauma، pediatric cancers، pediatric urology diseases، undescended testicles in children، developmental genetics and congenital defects، emergency in children and application of laparoscopic surgery in children. SinceBecause each of the research areas are composed of multiple subareas. Finally we specified 43 research subareas as research priorities. These subareas include epidemiology، risk factors، prevention، screening، diagnosis، treatment، follow-up، complications، knowledge and attitudes of parents، quality of life، economy aspects and data bank for further research. ‍ In this project، research priorities were setup for Pediatric Surgery Research Center of Shahid Beheshti University of Medical Sciences with the participation of all the stakeholders based on the recommended model of WHO (COHRED). It seems that reliability of the priorities is in moderate level، but there is a certaincertain validity in obtaining the best content in terms of the study conditions.

Operative stress and post-operative pain are important issues in medicine. After any types of surgery, the stress hormones release responding to pain. In this study we applied Bupivacain infiltration in surgical wounds of inguinal hernia amongst children aged 3-7 years and evaluted its effects on some stress hormones and plasma levels of glucose. In this prospective study, 116 children aged 3-7 years (24 females, 92 males) undergone unilateral repair of inguinal hernia under general anesthesia at Mofid children hospital during 2005-2007, were devided into 2 groups. Perincisional wound infiltration of 1-2 mg/kg of Bupivacain was performed in experimental group. In both groups, 10-15 mg/kg of Acetaminophen suppository were recommended at the recovery room. 4 ml of blood samples were obtained at three distinct stages (preincisional stage, at the end of operation and 4 hours after operation) to measure the insulin, prolactin cortisol and glucose plasma levels of subjects. Post operative pain was measured objectively by Hannalla scale. In both groups plasma prolactin levels increased at the end of operation along with insulin, cortisol and glucose. However, these differences became statistically significant just for insulin. There were no significant differences between other variables. In addition, although the plasma concentration of above mentioned variables became lesser in the 4th hour of post-operative period in experimental group, there were no statistically significant difference compared to the those of control group. Wound infiltration of Bupivacain decreases the stress hormones and pain during the post-operative period. We recommend this type of infiltration applying long-acting anesthetic agents with fewer numbers of side-effects.

Chronic intractable childhood constipation is a debilitating disease that need multidisciplinary approach care of these patients, typically consists of diet modification, cathartic agents, enema, biofeedback training, psychotherapy and the last surgical intervention. Rectal myectomy is one of the them. In our hospital, we have investigated more than 540 children (aged between 2 and 12 years, M/F=298/242) with chronic constipation that have not responded to current treatment by pediatricians and pediatric gastroenterologists. We excluded all children with known neurological, hormonal, drug, diet and anatomical causes of constipation. All cases had barium enema study and half of them underwent anorectal manometry. The number of bowel movements was one every 3 to 15 day. 65 patients with typical findings of Hirschsprung's that were proved by rectal biopsy were excluded. Posterior rectal myectomy (3 cm. length×1 cm. width) was done in 475 of causes and the spicemens sent for histological study. NID and Hirschsprung's was reported in 75 of them that deleted from our study and finally, 400 (M/F, 212/188) children were followed. Constipation resolved in 65% (260) patients in whom there were intermittent or no application of cathartic agents and their bowel movements increase eight or more over a 15 day period. 35% of children did not experience any significant changes in their defecation pattern, in whom other methods of management were applied (e.g. Daily enema, biofeedback, colon resection, Melon procedure). Children with chronic idiopathic refractory constipation may be subsided to rectal myectomy in approximately 65% of them. There were no significant complications through in this procedure.

Introduction & Breast cancer is the most common cancer among women and can be cured if detected at early stages. Our aim was to determine the knowledge, attitude and behavior of female teachers in Tehran towards breast cancer screening methods. A structured self-administered questionnaire was designed and teachers from schools located in different parts of Tehran were asked to fill them. The questionnaire included items about demographic characteristics, baseline knowledge about breast cancer, breast self-examination (BSE), clinical breast examination (CBE), and mammography. Their attitude about screening methods was assessed using a Likert scale. Behavior towards screening methods was also assessed by asking questions about number of times they had undergone breast cancer screening and its frequency. From 125 teachers that were asked to fill the questionnaire, 77 teachers (61.6%) returned them. Their age ranged from 24-54 years without, with the mean 39.8 ± 8.0 (SD). Their level of education ranged from 12-18 years with the mean of 15.4 ± 1.8 (SD). Only 3 cases knew the correct age for starting BSE and 39% knew that it should be performed each month. 57.1% knew how to perform BSE correctly. Only 4 cases (5.2%) knew the correct age to start CBE and 9 cases (11.7%) knew its frequency. The appropriate age for starting mammography and its frequency were correctly answered by 20.8% and 35.1% of the participants, respectively. The attitudes regarding the implementation of screening methods were favorable. BSE was not performed in the past 2 years by 50.6% and 27.3% did it 2-3 times in a year. Fifty-five cases (71.5%) had never referred for a CBE and those who had referred, did it with a mean period of 16.5 months. Twenty-five cases were aged over 40 and 15 of them had no history of mammography. Our results show a moderate level of knowledge about screening methods and a positive attitude towards them. However, most of the women do not practice screening methods.