مجله دانشگاه علوم پزشکی مازندران
پیاپی 55 (آذر و دی 1385)

Background and Iron deficiency and its related anemia is a common Iranian pregnant women problem. This study evaluated the efficacy of daily and weekly ferrous sulfate supplementation in pregnant women. 150 pregnant women enrolled into this randomized controlled field trial. They were received 50 mg elemental iron daily in control group and 100 mg elemental iron weekly in other group for 12 weeks duration. Serum ferritin and serum hemoglobin was measured at the start and immediately after 12 weeks of the study. Collected data were analyzed with SPSS10 software. After 12 weeks of Iron supplementation, no significant differences were observed in serum hemoglobin (gr/dl) and serum ferritin (g/dl) levels in daily and weekly groups (p>0.05). Also the frequency of anemia after 12 weeks in two groups was not significantly different (p>0.05). According to the results and tendency of pregnant women to the weekly regime and less consumption of ferrous sulfate pills in this group, weekly regime is reccomended for suplementation.

Background and This study was designed to identify the cells involved in the healing of the parietal bone defects after implantation of octacalcium phosphate (OCP) combined with bone matrix gelatin (BMG). Sixteen young male Sprague Dawley rats (5-6 weeks age) were used. A full thickness standardized trephine defects, 5mm in diameter, was made in the rat parietal bone and OCP combined with BMG (in ¼ ratio) was implanted into the defect. No OCP/BMG particles were implanted in control group that was otherwise treated identically. Cellular identification was carried out on days 7th and 14th after implantation, by light and transmission electron microscopy. Ultrastractural identification of cells involved in the healing of the defects in experimental group on day 7th after implantation, showed full secretory chondroblasts and also showed the integration of newly formed matrix with the defect margins. On day 14th after implantation the results revealed the typical osteoblasts that are active in the defect margins. In experimental group, bone defects were healed through intramembranous ossification route.

Background and Cataract surgery is the most frequent surgery in old patients. Forty six percent of people older than 75 years of age have cataract. These elderly patients frequently have associated diseases. It is important to select the best anesthetic method with least complications. This study compared 3 anesthetic methods. Regarding to patients, and surgens, comfort, frequency of nausea and vomiting in the patients undergoing cataract surgery. This cross sectional observational study with simple sample recruitment was performed on 120 patients divided in three groups of 40 cases, with general anesthesia, topical anesthesia +light IV sedation and local anesthesia + light IV sedation in summer 2004 in Feiz Medical Center. Data collected using check list. One way Anova and Chi-square tests were used to compare mean qualitative and frequency of qualitative variables. The level of statistical significance was set at P< 0.05. There were significant differences in mean score of surgeons, and patients, comfort, mean severity of nausea after surgery and mean score of pain between 3 groups (P<0.001). There was no significance difference in frequency of vomiting after surgery between 3 groups (P=0.33) It has been suggested that topical anesthesia +light IV sedation is a safe and effective method for cataract surgery.

Background and Contrast-induced nephropathy (CN) is one of the most common causes of iatrogenic acute renal failure. In fact CN is the third leading cause of new ARF in hospitalized patients. Radiocontrast-associated ARF is a significant problem in patients with cardiovascular disease. The risk factors for cardiovascular disease also predispose these patients to an increased risk of renal failure. Various strategies have been suggested for preventing CN. Since adenosine may play a role in pathogenesis of CN, theophylline, an adenosine receptor antagonist, has been investigated as a means to reduce the risk of this complication. The effects of oral theophylline (200 mg b.d) & placebo (b.d) 24 h before and for 48 h after coronary artery angiography were studies on serum Cr, BUN, Na+, K+& GFR of 70 high risk patients for CN whom were divided into two equal groups. All patients were hydrated well. No differences were observed in average serum Cr, BUN, Na+, K+& GFR before angiography between the two groups. After angiography, the average serum Cr, BUN, Na+ & K+ did not also change significantly in either groups, however, the changes of average GFR was different in two groups. Following angiography, patients in the theophylline group had no significant change in average GFR (83.01 ± 26.73 vs 81.36 ± 24.91 ml/min), but patients in the control group showed a statistically significant fall in average GFR (86.10 ± 34.88 VS 80.70 ± 30.43 ml/min) (P<0.05). Although in our study we had no significant raise in Cr and contrast-induced nephropathy, but since the average GFR fall significantly in control group, in contrast to case group we concluded that theophylline prevents from some changes in renal function which produced by high osmolality contrast agents, and may have some degree of benefits to reducing CN in high risk patients.

Background and Since bleeding due to prolongation of the third stage of labor is one of the most common causes of mortality in the developing countries, we decided to conduct a comparative study on the effects of normal saline injection into umbilical vein on the shortening of the third stage of labor. This study was an experimental scientific research in order to compare the effects of different dosages of intraumblical venous injection of normal saline on the third stage of labor in women who admitted to lmam hospital in Sari. A total of 120 matched pregnant women who had normal delivery without any complications were divided into three equal groups of 40 subjects in each. Twenty and 30 ml normal saline was administered to groups 1 and 2, and the third group was considered as control. In control group the third stage of labor was accomplished without any intervention. This research showed that the injection of 20 or 30 ml normal saline intravenously into the umbilical cord shortened the duration of labor. Also the length of the third stage of labor with the injection of 30 ml normal saline was shorter than that in 20 ml normal saline group but this difference was not statistically significant. The results of our study suggest a clinically important beneficial effect of intraumblical normal saline injection in the treatment of retained placenta.

Background and Different methods such as surgery, chemotherapy, radiotherapy, hormone therapy and immunotherapy are used for treatment of melanoma cancer. Unfortunately they dont always have desirable results and they may have unfavorable side effects. Researchers try to find new, more effective drugs with low side effects. In this study we evaluated the cytotoxic effect of ACA-1, a water extract of a traditional Iranian medicinal herbs on a melanoma cell line SKMEL-3. The SKMEL3 cell line was obtained from Pasture institute, Tehran, Iran and cultured in RPMI media supplemented with 10% FBS. Equal number of cells were added to a 96 well microplate and were incubated with various doses of ACA1 (5,2,1,0.2,0.1,0.05,0.02 and 0.01 mg/ml) for 24, 48 and 72 hours in parallel. The cytotoxic effects of the drug was evaluated using MTT assay. The Results showed that ACA1 has significant cytotoxic effects with dose and time dependent manner on SKMEL3. The optimum dose (5 mg/ml) showed 47% cytotoxicity in 24 h, 65% cytotoxicity in 48 h and 71% cytotoxicity in 72 h. Based on the results of this research, ACA1 is a suitable candidate for chemotherapy of melanoma patients. Further studies are necessary in order to find effective drugs, their effects on other cell lines and approved in vivo models and clinical trials.

Background and During recent years, nitric oxide (NO) has been considered as a molecule involved in migraine headaches. This free radical involves in initiation of migraine headaches via NO/cGMP signaling pathway and vascular relaxation specially big intracranial arteries. Therefore, we studied the effects of aqueous extract of Origanum vulgare and Melilotus officinalis prescribed in migraine treatment in traditional & modern medicine, on NO level in cultured endothelial cells. Each crude herb (25g) was mixed with 200 ml distilled water. End extract obtained after filtering and drying. Endothelial cells propagated in DMEM medium containing 10% FCS and 1-2% penicillin-streptomycin. The nitrite concentration was measured as an indicator of nitric oxide production according to the Griess reaction and with ELISA in 540 nm. Concentrations of 100, 200 and 400 g/ml of Origanum vulgare, reduced NO levels compared with control to 13.1 % (p<0.05), 25.8% (p<0.01) and 33.9% (p<0.001) respectively. However, despite our expectation melilotus officinalis increased NO level. The concentrations of 100, 200 and 400 g/ml of the herb, increased NO levels to 12.7 (p<0.05), 36.5% (p<0.001) & 72.9% (p<0.001) respectively. We concluded that aqueous extract of Origanum vulgare probably decreases migraine headaches by reducing NO and aqueous extract of Melilotus officinalis does not act through this mechanism.

Background and Awareness during general anesthesia is a frightening experience that often causes patients to panic and feel helpless even when there is no pain and no feel of body movement and manipulation by the surgeon. Awareness monitoring is still complicated and controversial. Now a days this is based on electroencephalography data such as the bispectral index (BIS) or spectral edge frequency (SEF). However, there are not such divices for awareness monitoring during anesthesia at our medical centers. The postoperative interview is most frequently used for awareness monitoring. The validity of this method is questionable however, given the imperfect relation between awareness and memory. After approval by the Mazandaran University human investigation committee, we consented and included women ASA I whom undergon caesarian section under general anesthesia. The anesthetic procedure was standardized. Anesthesia was induced with thiopentone after loss of the evelash reflex, the lungs were ventilated with 100% oxygen. Patients were interviewed 24h after operation. The principal investigators classified each patient report as awareness condition for example dreaming, feeling manipulation and etc. p<0.05 was considered as significant. One of the most common intraoperative awareness was related to hearing the sound of conversations between personnel or divices and instruments (2.8%). The most frequent condition of awareness during anesthesia was being unable to move the body (7.9%). Dreaming during general anesthesia for caesarian section was observed in 2.3% of the patients. The limited use of drug during caesarian section leads to slight increase in awareness during general anesthesia. We conclude that it is important to monitor awareness during surgery. Our data showed that post operative interview is a useful method when BIS or SEF tools for monitoring of awareness during general anesthesia are not available.

Background and Spirometry is a powerful method in assessment and management of many respiratory disorders. Technological improvement has made it a reliable, relatively simple and available method in clinical settings. Native spirometric standard values are necessary for the interpretation of pulmonary function test. In this study, important spirometric values (FVC,FEV1, FEV1/ FVC, FEF25-75) of healthy adults > 18 years old in Sari city were compared with those of predicted standard equations to determine the nearest values. Five hundred and seven healthy adults (245 males, 262 females) selected by random sampling, with no previous history of smoking and without chronic or acute respiratory problems were subjected to spirometry with calibrated Fukudo Sangyo spirometer. The methodological guidelines of the American Thorasic Society were observed to perform spirometry. The results were analyzed by SPSS, paired t- test and Pearson correlation. The results indicated that the mean values of males are more than those of females. The highest values are from the 20-30 years age group.The correlation coefficient of height with the measured values is very high (99% confidence interval) but for the weight is low. The nearest standard predicted values to the measured values were from Eccs. According to the results and correlation coefficient test, measured values have the highest correlation with Eccs predicted values with 99% confidence interval and the Eccs standard seems to be the most proper standard for Sari community, more researches are recommended though.

Background and Suicide is one of the most important causes of death in the world. The prevalence of suicide varies in different parts of Iran and the world. This study was done to determine the prevalence and types of suicide and its relation to gender, age and education in Golestan prevalence in North of Iran. This cross-sectional study was carried out on 1857 patients admitted to general hospitals in Golestan province during 2003. The data were collected through questionnaires filled by health workers and analyzed using SPSS software. The prevalence of suicide was 117.8, 88.5 and 147.4 per 10000 in general population, males and females respectively. The rate of suicide in 20-24 age groups was 285.8 per 10000. The highest rate of suicide was observed in spring. Thirty one percent of samples had high school education. 48 percent of suicide attempts were with drugs and opium. Considering the ethnicity, the rate of suicide was 177 among native Fars, 79.6 in Turkman and 270 in Sistani per 10000, respectively. This study has shown that the rate of suicide is higher in this province comparing to other studies in some parts of Iran and other countries.

Background and Particular attention is paid to relation between emotion and cognition and complementary aspects of them has found a new dimention in both theorethical and practical domains which introduced by a concept called "Emotional Intelligence" (EI). An important aspect of this subject is to survey the relation between EI and marital adjustment (satisfaction). The purpose of this study was to determine the levels of EI and marital satisfaction, and their correlation among discordant and well-adjusted couples. This study was a descriptive-analytical research designed to compare the levels of EI and marital satisfaction and relation between them in two groups of discordant (25) and well-adjusted (25) married couples. All subjects completed EQ-i, ENRICH, and a demographic sheet. Statistical analysis were done by ANOVA, Tukey and Pearson,s correlation coefficient (r) using SPSS-10 program. A significant difference was between EI and marital satisfaction and their component scores among discordant and well adjusted couples. Moreover, there was only a significant relation between EI and marital satisfaction of the well adjusted couples, this was also observed in well adjusted wives and husbands scores. This project demonstrated the relation between EI and marital satisfaction as well as the different levels of them in both groups of discordant and satisfied couples. Also, the study indicated that the EI competencies are a basic and efficacient construct for improving the quality of satisfied marital relationships. Therefore, considering the efficacy and role of EI in the domain of interpersonal and marital relationships, it may aid to resolve or eliminate the problems of discordant couples.

Background and Most traditional tea shop owners use a bowl to wash tea cups in Sari city (North of Iran). There are more than 140 traditional tea shops in the city. Unfortunately most people drinking at these shops as well as health authorities do not pay attention to the health criteria of the shop. The objective of this study was to examin the tea cups washing water of traditional tea shops for contamination to fecal coliform in Sari city. Twenty traditional tea shops (16%) were randomly selected for this study in different areas of the city. Multistage (3 stages) samples were taken from tea set of the shops. All samples were collected from the tea sets of the shops without prior notice. The samples were transferred to the laboratory in cold box as quickly as possible. Forty four samples from a total of 60 (66.6%) were positive for total coliforms. Also 32 samples (33.3%) were positive for fecal coliforms. Number of bacteria in the samples varied from zero to over 1100 per 100 cc sample. The study showed that in warmer situations the contamination was higher. The results showed that the differences between contamination rates in both groups of internal and external traditional tea shops were insignificant. The results showed that only two samples in multistage sampling were not contaminated and in all other samples at least in one stage of sampling, contamination was detected. The results of this study is an important message for food administration.

Background and Echocardiography and routine E.C.G are standard methods for left ventricular hypertrophy (LVH). However, urine albumin to creatinine ratio (UACR) recommended by recent investigations is more available and less expensive than echocardiography for detection of LVH. According to inclusion and exclusion criteria, 124 hypertensive patients (62 cases with LVH and 62 cases without LVH) were selected and divided into two groups. Eechocardiography and routine E.C.G were done for all patients. Urine albumin (nephlometric methods) and creatinine were measured and in patients with urine albumin>100mg/dl, ACR was calculated. No significant differences were observed in mean B.U.N and creatinine, FBS and BMI between two groups. The comparison of UACR between two groups indicates that the frequency of patients with UACR> 100 mg/g in group with LVH, was more than the group without LVH (sensitivity 32.5% and specificity 92%). By combination of these tests a higher sensitivity was obtained (with Cornell criteria 37.1%).Thus, if UACR > 100 is combined with one of the markers of E.C.G for LVH diagnosis, more cases would be detected. Albumin to creatinine ratio in a randomized urine sample, in hypertensive patients. with LVH is higher than patients without LVH and UACR>100 can be applied for diagnosis of LVH More over by combination of E.C.G to ACR a higher sensitivity would be obtained.

Background and Although the necessity of NPO condition during normal labour is a controversial subject among obstetricians and anesthesiologists, the most valid midwifery references emphasize on necessity of vein catheter use in all cases during normal labour. Now a days, most hospitals routinely use vein catheter even in cases with no indication and this may lead to decrease of motility and comfort of parturient, increase in cost and probability of blood transmitted pathogens. According to the policy of the ministry of health on decreasing venous injection, this study carried out to assess the real necessity of vein catheter and describing various drugs during labour. This is a descriptive-analytical study carried out in Niknafs hospital of Rafsanjan. 380 pregnant women hospitalized for normal delivery and actually delivered normally were selected. Proper questinaires were filled in labour unit and the data analyzed using SPSS software. The mean age, gravidity and parity were 25.9, 2.3 and 1.1 respectively. In average, the patients had 5.1cm cervix dilatation when they were admitted and after that they stayed in labour unit until delivery which took an average time of 3 hours and 34.3 minuites. The mean time between admission and start of vein catheter use was just 33.3 minuits. The mean volume of infused fluid during labour via vein catheter was 365 ml. According to valid midwifery texts, there was no indication for vein catheter use in 87.3% of subjects. Only 21.7% of the subjects did not get syntocinon via vein catheter whereas 36% with physician order and 42.3% without physician order received syntocinon. Except for that, only 6.7% of the patients got other drugs. The type of fluid in 76.3% of the cases was ringer lactate solution. In average they received 115.72 ml fluid per hour. Regarding the small average amount of received fluid (mostely ringer lactate solution), it can be concluded that vein catheter does not have that much effect on preventing hypoglycemia and dehydration, it is not useful very much for prescribing other drugs and it provides a ready way for useless and wide syntocinon use that can lead to various side effects like neonatal hyper bilirobinemia. Therefor, it is essential to restrict the use of vein catheter to cases with real indication and appropriate time.

Background and Obesity is an undesirable outcome of changing of life style and behavior. In order to control obesity associated diseases, this study was aimed to determine the prevalence of obesity and its associated factors in population aged 20 to 70 years in urban areas of the province of Mazandaran, in North of Iran. A population based cross-sectional study with a sample of 3600 subjects using cluster sampling techniques, was conducted in urban areas of four cities: Sari, Gaemshahr, Babol and Amol. In each city, 30 random clusters were selected based on cumulative family health number under coverage of different urban health centers using systematic sampling techniques. In each cluster, 15 men and 15 women aged 20 to 70 years were selected and assessed. The anthropometric measures (height, weight) were measured with standard methods and the social, demographic and some life style data were collected with interview using a designed questionnaire. In assessment of obesity, a standard recommended WHO method based on BMI distribution was used. The logistic regression model was used to estimate the age adjusted odds ratio and its 95% confidence interval and the P-value <0.05 was considered as significant level. The mean (±SD) age of men and women were 38.5±14.2 and 37.5 ±13.0 years respectively. The overall prevalence of obesity and overweight were 18.8% and 34.8% respectively (27.8%, 33.5% for men and 9.9% and 36.2% for women). The pattern of obesity was significantly different with age in both genders. The results of logistic regression model showed that the odds ratio of obesity for age increased up to 60 years and then it tended to decrease slightly (P<0.0001). The age adjusted odds ratio for obesity was greater roughly 3.6 times in women compared with men (P<0.0001). The adjusted odds ratio decreased with increasing the level of education (P<0.0001) while the odds ratio was 0.19 for education at university level (P<0.0001). The adjusted odds ratio was tended to decrease with occupational activities, physical activity level in leisure time and exercise level. The results of this study indicate an increased rate of obesity and overweight in urban population. With respect to these findings, low level of physical activity and education, parity, family history of obesity, marriage at earlier age, gender and aging were responsible for obesity. Therefore, community based multiple strategies are required to combat the increasing rate of obesity and its subsequent complications.

Background and Chlamydia trachomatis infection is one of the most prevalent bacterial sexually transmitted infection in most countries. This organism may stay in genital tract for long time and cause subtle yet progressive damage in fallopian tubes. In this study we evaluate the correlation between chlamydia antibodies and tubal and other factors of infertility. In this case control study, 28 patients with tubal factor infertility, 28 patients with non tubal factor infertility and 30 normal patients were enroled. Presence or absence of tubal factor was assessed by direct vision via laparscopy, then titres of IgA and IgG were evaluated in all of them using ELISA method in the same labratory. Data were recoded and analyzed using SPSS software and chi-square, Fisher's exact, T-test and Mann- Whitney test. Positive titre of IgG was higher in tubal factor infertility but it was not statistically significant between three groups (p>0.294). Positive titres of IgA were more common in non tubal factor infertility (p=0.007). Though positive and negative titres of IgA (P=0.224) and IgG (P=0.273) were not statistically different in fertile and infertile patients. Positive and negative titres of IgA and IgG were also not statistically different in patients with or without PID (p>0.05). No correlation was found between the positive titres of IgG and IgA against Chlamydia and tubal factor infertility.

Background and Diabetes is a common disease with opthialmic complications which leads to partial vision loss and blindness. Diabetic retinopathy is one of the main causes of blindness in the world and the most common new blindness among 20-74 years-old patients in Westem countries. Diagnosis of ophthalmic complications in diabetic patients is an important priority of the health system and the purpose of this study was to determine the prevalence of retinopathy and risk factors in diabetic patients attending to Imam Khomeini hospital in Sari. Five hundred and forty diabetic patients attending to diabetics center of Imam Khomeini hospital enrolled for this study. Medical history was taken and the patients undergone physical exam with blood pressure control, height and weight and BMI, Laboratory tests (HbA1C) including serum urea and keratinin and proteinuria and serum lipid. Standard ophthalmic exams including: visual acuity, intra ocular pressure, slit lamp exam, dilated pupils were examed by ophthalmologist and ETDRS grading was done. Data were analyzed using t-test, x2, Mann Withney test and regression analysis. P value of < 0.05 was considered for significancy. Five hundred and forty diabetic patients including 150 men and 390 women were studied. One hundred and eighty five patients 5 with type one diabetes and 180 with type two diabetes had diabetic retinopathy. The prevalence of diabetic retinopathy was 34.3%. There were significant differences in range of risk factors such as BMI, duration of diabetes, diabetic control, blood sugar control, level of HbA1C, serum urea and keratinin, proteinuria, blood pressure, level of serum lipid (P<0.05).

Background and The rate of infertility is estimated 12-21% in Iranian couples. Cooperation of couples is needed for treatment. One potential risk factor for the development of marital problems is difference between partners in their approach to infertility. The aim of this study was to know the infertile couple's approach to infertility and marital adjustment. In this cross sectional study, 160 infertile couples reffering to Royan infertility center of Tehran were enrroled. The data concerning the infertility approach and marital adjustment were recorded in, Copper Smith self esteem and Dyadic adjustment scale (DAS) questionaire. SPSS soft ware was used for the ststistical analysis of the data. Findings showed that having children was very important to both husbands and wives and both involved in and wanted to talk about trying to have a baby. There was no difference between self esteem and marital adjustment in men and women. There was ststistically significant difference between approach to infertility and marital adjustment in both husbands and wives. Husbands’ and wives’ approach to infertility and marital adjustment can be used by psychologists in evaluation of infertile couples. Increase of couple interest and involvement in infertility treatment may lead to positive change in couples communication about infertility and to a more positive effect of infertility on the marriage.

Background and Anesthesiologists have become the first priority since they can play an important role in crisis situations to support respiratory and cardiac urgencies. In this survey, the effects of the resident anesthesiologists were studied on the death of patients having been hospitalized in the Intensive Care Unit of Imam Khomeini training and treatment center, Sari from 2000 to August 2004. In this survey, the subjects of the "case group" (passed-away patients during the residency of the anesthesiologist) have been compared to the subjects of the "control group" (having no resident anesthesiologist). The following variables were considered for analysis: age, gender, hospitalization reasons, the original ward, reason of and the service of reference to the Intensive Care Unit, the cause of death, hospitalization period in the original ward and Intensive Care Unit, as well as the number of the visits paid by anesthesiologist. Other interfering variables (such as facilities) were not taken into account, since they had been the same for both groups. Data were analyzed using the SPSS software and the descriptive and analytical (X2,Z,T) statistical tests. The findings of this survey showed that men have died more than women (61.9% vs 38.1%) in the intensive care unit. The total hospitalization period reduced from 14 to 11 days, having an anesthesiologist residing in this ward. It was revealed that the presence of an anesthesiologist reduced the death rate from 24% to 14%. According to the findings of this survey, it has been revealed that the presence of an anesthesiologist can have an outstanding effect on the reduction of the death rate. It is taken for granted that choosing patients must be done in accordance with Classic Indications since there are limited number of beds in ICU and the admission request for different patients. In equal situations, those patients who have better opportunity and less mortality probability and better prognosis in this unit have priority.

Background and Patients education should be done according to assessment and determination of their educational needs and their gender. The purpose of this study was to determine and compare educational needs from the view point of men and women with coronary artery bypass at discharge time. This was a descriptive-comparative study. Questionnaire was used to determine the educational needs of 100 men and 100 women who had undergone CABG for the first time in six domains (activity, medication, diet, treatment & complication, enhancing quality of life and skin care) and then compared the results. The findings showed that the immediate educational needs of patients were information about their activity while the least important mensُ need was information about improving quality of life and for women it was information about diet. Findings showed that there was a significant difference between mensُ and womensُ educational needs except medication (P<0. 0001). Accordings to the results of this research there was a significant difference between mensُ and womensُ educational needs, therefore attention should be paid to the specific educational requirements of different genders. So it is highly recommended that the educational needs of men and women are determined and adequate and proper education should be given to them at the time of discharge.

Background and Assessment of learners’ performance is an important factors in teaching-learning process. When a factor is sensitive and has high influence on life, their assessment should be done precisely. Thinking dispositions are very important factors in medical education because of its specific condition. In this study a model is designed for fostering thinking dispositions of learners in which authentic assessment is an important element. Objective based research is developmental, and such a model was not designed for curricula. Data collection and comparing approaches about assessment and analyzing current assessments offered applied proposals. Based on research findings, the current assessments are response-based, that is students instead of product of response, only offers the specific response which the teachers expects but authentic assessment is a form of assessment in which students are asked to perform real-word tasks that demonstrate meaningful application of essential knowledge and skills. Because of the difficulties and unexpected problems in life and individuals needs to lifelong learning and conditions in medical course that require decision making in specific times, we must pay attention to reach thinking dispositions and it should be included in curriculum. Authentic assessment as an important aspect of curriculum can help fostering thinking dispositions of learners. Using this kind of assessments which focus on application of information and skills to solve real-word tasks have more important role in medical courses.

Background and Acne vulgaris is a very common cutaneus disorder as chronic inflammation of sebaceous glands of the skin of face, chest and back that affects everyone almost once in life time. The goal of this study was to determine the prevalence of Acne vulgaris in schools of Sari in 2003-2004. In this cross-sectional-analytical study, stratified sampling method was used, to divide male and female groups, and then a multistage random sampling was performed. All of the samples were examined for Acne vulgaris by a dermatologist, according to reliable clinical and diagnostic criteria. Questionnaires containing demographic, epidemiologic and clinical variables were filled in accordingly. Two hundred samples from each stratum (400 overall), with a mean age of 15±1.51 and range of 12 of 18 years were selected. One hundred and sixty three subjects (40.75 %) were affected, 50 (30.6 %) male and 113 (69.4 %) female with the condition being mild in 150 (92.02 %) and moderate in 13 (7.98 %) of the patients. The highest prevalence was in 16 years olds 52 (62.65 %) and the lowest was 2 (7.4 %) in 12 years olds. According to the relatively high prevalence of Acne vulgaris in puberty, especially in females, performing continuous epidermiologic studies can be a good step for interventional studies, and preventing psychologic problems caused by the disease and hence increasing the health level of the community

Testicular microlithiasis (TM) is an uncommon condition with reported prevalence of 0.6% in patients referred for scrotal ultrasound. Testicular microlithiasis was first reported by Priebe and Garret in 1970 and defined as multiple tiny calcification throughout the testis. The condition appears as characterstic small nonshadowing hyperechoic stippling foci in testicular parenchyma. Several associations have been reported with testicular microlithiasis. Considrable accrued evidence points to an association between testicular microlithiasis, intra tubular germ cell neoplasia and testicular tumor. This topic is of considerable attention to researchers. We recommend annual ultrasonic follow up and patient education about self- examination and bio-humeral evaluation for ruling out concurrent tumors.

Dermatofibrosarcoma protuberans (DFSP) is a rare coetaneous sarcoma that originates from fibroblasts of dermis and presents as a non tender coetaneous nodule. Local slow invasion, recurrence after therapy and low risk of metastasis are its main specifications. Pathology and immunohistochemistry are used to diagnose and wide surgery is the best approach for treatment. We present a case of recurrent DFSP and review the diagnostic and therapeutic modalities of this rare tumor. The patient was a 46 year old woman with 14 years history of a tumoral lesion in antero-superior part of her left shoulder and several recurrences after 4 excisional surgery for her lesion. Pathological and immunohistochemical surveys confirmed the diagnosis of DFSP. Previous studies performed on DFSP showed that it is a rare malignant coetaneous lesion that early diagnosis and appropriate treatment can lead to a better prognosis.

Injuries to the genitourinary organs are complications of vaginal delivery. We report a patient with no history of surgery presented 4 days postpartum with distended tender abdomen and peritoneal sign and renal failure. Abdominal X-Ray showed a large amount of ascites. In laparotomy 3.5 liter of urine was in cavity and laceration of 3 cm in the dome of bladder was seen. Repair was done. By reviewing the record, this is the fourth case of bladder rupture after normal vaginal delivery without previous history of cesarean section. In the postpartum patient presenting with ascites and azotemia, intraperitoneal bladder rupture should be suspected.