Tehran University Medical Journal

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The author conducted 1-year study investigating the causation and management of eye trauma at Farabi Eye' center. All patients sustaining eye injuries who were evaluated by ophthalmology service over one year interval were included.
. A formal questionnaire was completed with details of the injuiy being obtained. An ophthalmologic examination was performed on each patient, and examination findings and diagnostic tests obtained, diagnosis and treatment were recorded and analyzed.
Nine hundreds and sixty-one injuries (65%) occured in males and 503 (35%) in females. The average age was 30 years. This study included 1464 eye injuries.
Four handreds and eighty-five (nearly 30%) of patients were in pediatric age group. Seventy percent of all patients were admitted within 24 hours of their injury. Fourty percent of all injuries occurred in the street, 30% at home, 15% at the work place , the rest either in school or sport field.
Among those older than 65 years of age, 70% of injuries were the result of fall. Seventy percent of all eye injuries were caused by blunt trauma. Diagnosis and management were recorded.
Conclusions : Tehran and other metropolitans population is more likely to sustain eye trauma as the result of an assault and is less likely to be involved in a work- or sports-related one.
Given poor compliance without patient management and follow-up, aggressive primary management may be indicated to optimize visual outcome

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Abdominal masses in neonatal period is one of the main causes of patients bed ridden in infantal surgery wards. The rapid encounterance with these patients has caused a decrease in mortality and morbidity. This study is a kind of historical research which has been conducted on data base management systems of two above mentioned hospitals between years 1361-1378. The final outcome was only 25 cases. From these neonatus, 68 percent were male and 32 percent were female. Most of the patients were in their first neonatal week. The etiologies related to urinary system (56 percent), were found to be in the first place. Tumors of different origins (20 percent), ovarian masses (12 percent) and gastrointestinal tract (12 percent) had their own places respectively. Majority of cases have had surgical operations (92 percents). The case fatality rate among these patients was 24 percent which most of it was because of benign causes. The rate of mortality in male was much larger than female neonatus. We concluded that the inspection of embryo's urinary system with ultrasound and primary examination of neonatus, is vital and in most of the cases, an urgent surgery is indicated. Also laboratory assessment and radiological examination in suitable therapeutic procedures in first 48-72 hours in recommended.

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One of the disturbing complications of propofol is pain on injection and the incidence ranges from 28% to 90%. Metoclopromide is commonly used as an anti emetic drug. Some investigators reported that this drug could reduce the pain on injection of propofol. The aim of this study was to assess and comparison of the efficacy of propofol pretreatment with metoclopromide in incidence and severity of its pain on injection.
Materials and Methods: In a randomized, prospective, double-blinded, placebo-controlled trail, 150 patients 18 to 40 yr old were randomly allocated in one three groups. C group (2ml of normal saline), L group (40mg lidocaine in 2ml), M group (l0mg metoclopromide in 2ml). Immediately after injection of study or placebo drugs, 10 mg of propofol with injection rate of 0.5 ml/s (In 4 Seconds) were injected in to the same vein that was inserted to the most prominent dorsal hand vein. Pain severity was measured using Visual Analogue Pain Scale that were educated to the patients before the trail (0 for no pain and 100 for the most aggressive pain in life) and values other than zero was encountered pain appearance. Patients with signs of sedation were excluded.
Results: There was no statistically significant difference between patients in three groups in number of men and women (P = 0.66), age (P = 0.29) and weight (P = 0.49). Furthermore severity (P = differences (C = 41.18, L - 25.4 and M = 13.1, P < 0.001) and patients in metoclopromide group experiences lower pain than other two groups (P < 0.001). Pain incidence in Control group was 77.1% and it was significantly reduced in lidocaine and metoclopromide group (P = 0.002), but there were no significant difference between them (P = 0.051). The 0.69) and incidence (P ~ 0.29) of pain has no significant difference between men and women. Pain severity between three groups has significant results showed that metoclopromide could significantly reduce the seventy of pain on injection of propofol more than lidocaine (opposite to diazepam), but they had no difference in pain incidence. It might lie on the different mechanisms that they produce pain. Pain on injection of diazepam is primarily attributed to propylene glycol, as a vehicle, but the pain mechanism in propofol is remaining unknown.
Conclusion: Finally as regards to other useful effects of metoclopromide including postoperative nausea and vomiting and propofol induction dose reduction, especially when there is a medical condition where lidocaine is contraindicated, it may be a reasonable alternative before injection of propofol.

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Background: Non-palpable undescended testis (NUDT) is one of the problems encountered in pediatric surgery. As studies show, about 30-40 % of NUDT is associated with intraabdominal testis (IAT), in the case of IAT various surgical techniques have been presented for example multistage orchiopexy, orchiopexy by microvascular anastomosis orchiopexy by transaction of spermatic vessels at two stages, hormonal manipulation, in which there is no definitive success and there are several associated complications. Orchiopexy in one stage by transaction of spermatic vessels of the base of vas artery is a suitable method.

Methods: This study is descriptive and prospective and was performed in Bahrami and Tehran children hospital from 2000-2001 on intraabdominal undescended testis. The patients were followed for at least 2 years.

Results: From 31 patients, 70.9% were over 4 years old, 93.5% were hospitalized over 3 days, and operation time in 64.5% was lower than 3 hours. The most common early complication was vomiting (16.1%) and the most common late complication was wound infection (6.5%). There was a %80/6 chance of testicular anomaly. In follow up period, there was no decreasing in testicular size.

Conclusion: One stage orchiopexy by spermatic vessel transaction is a safe technique with high success rate and low complication rate with acceptable increase in operation time and hospital stay. Based on our experience, we recommend this technique for non-palpable undescended testis.

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Background: Cardiac connective tissue dysplasia syndrome consists of mitral valve prolapse (MVP), anomalously located chordae tendinae of the left ventricle, or a combination of the two. MVP is marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. The nonclassic form of MVP carries a low risk of complications. Patients with severe classic MVP can suffer from mitral regurgitation (MR), infective endocarditis, and, infrequently, sudden death from cardiac arrest. Anomalously located left ventricular chordae tendinae are fibrous or fibromuscular bands that stretch across the left ventricle from the septum to the free wall. They have been associated with murmurs and arrhythmias. The purpose of this study is to assess the performance, as measured by the physical working capacity (PWC170) and maximal oxygen consumption (VO2 max), in athletes with cardiac connective tissue dysplasia syndrome.
Methods: Of the 183 male athletes studied, 158 had cardiac connective tissue dysplasia syndrome and 25 were normal, healthy controls. Their mean age was 16.23 (± 5.48) years and mean training time was 5.2 (±- 4.6) years. Athletes with cardiac connective tissue dysplasia syndrome were divided to four groups. Group 1 consisted of those with MVP Group 2 had patients with an additional cord in left ventricle Group 3 was made up of athletes with a combination of MVP and additional cord Group 4 contained athletes with a combination of MVP and MR. All sportsmen were studied by echocardiograph, veloergometer, and those with arrhythmias were studied and recorded using a Holter monitor.
Results: The most common form of this syndrome in our study groups was MVP. The PWC170and VO2 max among the athletes with the combination of MVP+MR (Group 4) was lower than that of athletes in other groups (P<0.05). The most common arrhythmia among the athletes with anomalously located left ventricular chordae, Group 2, was Wolf-Parkinson-White (WPW) syndrome and early repolarization syndrome. The PWC170 and VO2 max in athletes with WPW syndrome, was lower than the other athletes who did not have WPW syndrome (P<0.05).
Conclusion: The lowest PWC170 and VO2 max were in those athletes with a progressive abnormality. However, the PWC170 and VO2 max among athletes with anomalously located left ventricular chordae was normal. Therefore, among athletes with a combination of anomalously located left ventricular chordae and disruption of rhythm, the PWC170 and VO2 max are lower than normal.

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Background: Invasive procedures such as bone marrow aspiration in children with oncologic malignancies are painful and may produce anxiety for both patients and their parents. Various pharmacologic treatments have been used to sedate children undergoing bone marrow aspiration. This prospective randomized study was designed to compare the effectiveness of these combinations, as well as their associated hemodynamic and respiratory side-effects and recovery in pediatric patients undergoing bone marrow aspiration.
Methods: Fifty children with oncologic malignancies whose ages ranged between 2-12 years were enrolled in this study. Patients were randomly assigned either to the Propofol- Alfentanyl group or the Midazolam- Ketamine group for analgesia and sedation during bone marrow aspiration in the operating room. Time to induce sedation, sedation score and recovery time were recorded.
Results: There were no statistical differences between groups in weight, age, sex and duration of procedures. Procedures were completed with satisfactory sedation levels in all patients in the study groups according to the modified Ramsay score. Induction and recovery times in the Propofol- Alfentanyl group were significantly shorter than in the Midazolam- Ketamine group (p<0.001). After Midazolam- Ketamine sedation, a statistically significant increase in systolic blood pressure and heart rate were seen, however the opposite was observed after Propofol- Alfentanyl sedation. Other side effects, such as nausea and vomiting, agitation myoclonus and aspiration, were not seen in our patients.
Conclusion: Both Propofol- Alfentanyl and Midazalam-Ketamine combinations can be used safely and effectively for sedation and analgesia during bone marrow aspiration in the pediatric patient group.

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Background: Acute appendicitis is one of the most common abdominal emergencies. Many studies comparing the two routes of open and laparoscopic appendectomy have been performed comparing the duration of each operation, duration of hospitalization, amount of post-operative pain medication required and infectious complications were the most commonly evaluated factors.

Methods: This clinical trial study, performed between March 2005 and March 2006 at Golestan and Imam Khomayni hospitals in Ahvaz, Iran, included 100 patients. Open appendectomy and laparoscopic appendectomy were carried out on 50 patients each. Duration of surgery and hospitalization, amount of pain medication and infectious complications were compared, with chi-square, ANOVA and t-test used for statistical analysis.

Results: The average length of hospital stay for laparoscopic appendectomy was 44.48 hours and for open appendectomy was 54.80 hours (p<0.01). The average of amount of pain medication for laparoscopic appendectomy was 2.40 doses and for open appendectomy was 30.46 doses (p<0.01). The laparoscopic and open procedures averaged 31.8 and 35.2 minutes, respectively (p=0.5). Only one (2%) laparoscopic case had infection, while four (8%) open appendectomy subjects suffered from this complication. Patients who underwent laparoscopic appendectomy had no intra-abdominal abscesses.

Conclusions: Duration of hospitalization was statistically much shorter using the laparoscopic appendectomy than that of the open procedure (P<1%). The amount of pain medication administered was also statistically less in the laparoscopic procedure (P<1%). However, the amount of time to complete each procedure was not statistically different. Most importantly, complications such as wound infection and intra-abdominal abscess were remarkably less using laparoscopy. We recommend laparoscopic appendectomy over open appendectomy.

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Background: Nosocomial infections increase patients' morbidity, mortality and length of hospital stay especially in neonatal intensive care units (NICUs) and have become a matter of major concern. Controlling and preventing nosocomial infections need enough information about epidemiology of these infections. This study aims at estimating the incidence rate and the most frequent bacteria which cause these infections in neonatal intensive care unit of Ghaem university hospital, Mashhad.
Methods: In this study which is performed during a twelve month period in 2004 and 2005 at neonatal intensive care unit of Ghaem hospital, 971 hospitalized neonates were studied. Data were collected considering the standard surveillance protocols. Early onset neonatal nosocomial infections and late onset neonatal infections were defined as illness appearing from birth to seven days and from eight to twenty-eight days postnatal age respectively. Statistical analysis was performed using the χ2 test.
Results: In this study 32 cases of nosocomial infections were identified so the incidence rate of nosocomial infection in this ward was 3.29%. Fifteen babies identified with early onset neonatal nosocomial infection and the rest have presented with late onset neonatal infections. In order of frequency, the sites of infection were: primary bloodstream (84.4%) and pneumonia (15.62%). Coagulase negative staphylococci were the most common bacteria (43.74%) isolated in these patients. Other isolated bacteria were Klebsiella pneumonia (31.42%) and other gram negative bacilli such as E.coli, Pseudomonas aeroginosa and Acintobacter spp. The mechanical ventilation and umbilical catheter were associated with nosocomial infections as risk factors in our study (p<0.01).
Conclusion: Our findings show that the neonatal intensive care unit of Ghaem hospital has low rate of nosocomial infections. However, as neonatal intensive care unit is an area of great concern in terms of nosocomial infection, preventive measures especially hand washing should be intensified.

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Background: Although nonoperative management is as an alternative method for surgery in the management of blunt splenic trauma, there are many contraversies in criteria for appropriate selection of the best method of management in patients. This study was conducted to find clinical and diagnostic criteria for selection of patients for surgery.

Methods: One hundred and one patients with blunt splenic injury entered in our prospective observational and cross sectional study. Patients with unstable hemodyna-mics and obvious abdominal symptoms underwent emergency splenectomy was performed. In stable patients, abdominal and pelvic CT scan with IV contrast was performed. Patients with stable hemodynamics who lack obvious abdominal symptoms, admitted in ICU ward. Patients' demographics, blood pressure changes, hemoglobin concertration, severity of trauma with injury severity score (ISS) scoring system, CT scan findings, amount of blood transfusion Hospitalization time and mechanism of injury were recorded.

Results: From 101 patients, 61(60.3%) underwent early laparotomy. 40 patients were planned for conservative management. In 30 patients (29.7%) nonoperative management was successful. In 10 patients (9.9%) This management failed and they underwent surgery. Hypotension, hemoglobin concentration dropping more than one episode and blood transfusion requirement more than one time, increased the risk of operation. Higher ISS number and ISS≥16 had a direct relation with operative management. In patients who underwent early laparotomy CT grade of injury was higher. CT findings correlated well with laparotomy findings.

Conclusion: Nonoperative management was successful in 75% of selected patients. With correct selection of patients and concerning to homodynamic status, hemoglobin concentration changes and injury severity score in conjunction with CT findings, we can use this management in greater number of patients.

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Background : Septic Arthritis is an acute infection of intra-arthicular space. Delay in diagnosis and in appropriate treatment may lead to prolongation of treatment duration and poor outcome. We decided to evaluate clinical aspects of this disease in our department pediatric department, Imam Khomeini Hospital complex, Tehran, Iran during a 10 years period.

Methods : In a retrospective cross-sectional study, 60 patients with age from 1 month to 14 year-old during 1996-2005 were evaluated. The demographics characteristics, clinical observations (signs & symptoms) and paraclinic values were gathered from medical records and analyzed with statistical tests.

Results : Pain and Swelling was seen in all, joint limited motion in 80% ( 50 cases) claudicating in 64% ( 38 cases), fever in 80% ( 48 cases), monoarticular disease in 80% ( 48 cases) and polyarticular one in 20% ( 12 cases) of them. Hip was most Common involved joint 62% ( 37 cases), elevated ESR was seen in all patients. CRP was positive in 85% ( 51 cases). Leuckocytosis was found in 65/8% ( 17 cases) of cases. In infectious cases, Staphylococcus aurous was responsible organism in 65.6% ( 16 cases), klebsiella in 12.4% ( 3 cases), Streptococcus pneumonia in 12.3% ( 3 cases), group b streptococcus in 4.1% ( 1 case), Hemophilus Influenza type b in 4.1% ( 1 case) of study patients. With therapy ESR was normalized in 64% ( 39 cases) and CRP was normalized in all patients.

Conclusions: In general, all children with complaint of fever, pain, and limited joint motion or claudicating should be suspected for septic arthritis.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Diabetes and dysglycemia have a high prevalence in Iranian population but the information about their impact on the cardiovascular disease (CVD) risk is scarce in this population. This study aimed to determine the risk of CVD according to glucose tolerance status.
Methods: We ascertained cases with incident CVD in a population of 1752 men and 2273 women, 40 years old and over and free of CVD at the beginning of study, during a follow up with a median of 7.6 years. To calculate hazard ratio (HR) for CVD, we controlled traditional risk factors, including age, body mass index, waist, total cholesterol, HDL-cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, education, smoking, hypertension medication, lipid lowering medication and family history of premature CVD and diabetes.
Results: Cardiovascular events occurred in 197 men and 143 women. Its incidence density was 11.8 per 1000 person-years (95% confidence interval: 10.6 to 13.1) totally. Multiple adjusted HR in women with known diabetes was 3.88 (95%CI: 2.40 to 6.27) and with newly diagnosed was 2.34 (95%CI: 1.39 to 3.95) and the corresponding values for men were 1.72 (95%CI: 1.00- 2.95) and 1.52 (95%CI: 1.01- 2.31) respectively. Impaired fasting glucose and impaired glucose tolerance increased 56% the risk of CVD in women (HR: 1.56 with 95% CI, 1.00 to 2.45), just in the age adjusted model.
Conclusion: All diabetic patients should receive primary prevention for CVD intensively, regardless of whether they are newly diagnosed or are known cases specially, females who have abnormal glucose metabolism.

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Background: One of the most important components of coronary artery bypass graft surgery is need for blood transfusion that increases morbidity and mortality. The aim of this study was to evaluate the factors affecting the need for blood transfusion during off pump coronary artery bypass (OPCAB) surgery.
Methods: In this descriptive case control study 923 patients who had undergone OPCAB at Afshar Hospital in Yazd, Iran, from July 2008 to January 2010 were evaluated. The data was gathered from their records and was analyzed.
Results: 54% of male and 79% of female patient need blood transfusion. Mean age in patients needed transfusion was 61.58±11.11 years and in other group was 60.27±10.98 years of the patients that needed transfusion (p= 0.08). 563 (61%) of the patients needed transfusion with the average of two units. The need for blood transfusion was higher in female gender (p< 0.0001), low hematocrit (p< 0.0001), diabetes (p< 0.001), hypertension (p< 0.025) and multiple grafts (p< 0.027). There were no significant differences in preoperative hemostasis tests, affection to hyperlipidemia, CVA or renal failure, antiplatelet drug administration and the application of left internal mammary artery between the transfusion and non transfusion groups.
Conclusion: In this study preoperative hematocrit was most important risk factor in transfusion in patients that underwent OPCAB. Female gender, preoperative low hematocrit, multiple grafts, diabetes and hypertension increased the rate of blood transfusion. According to the high prevalence of blood transfusion in OPCAB, considering factors that affect the transfusion rate is essential.

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Background: Diabetes is a chronic non-communicable disease with increasing prevalence. Retinopathy is one of the main complications of diabetes. Early diagnosis and treatment of retinopathy can reduce the risk of low vision and blindness. The aim of this study was to apply regression analysis of current status data to determine risk factors of diabetic retinopathy in patients with type 2 diabetes being referred to the Ophthalmology Clinic of Yazd Diabetes Research Center, Iran.

Methods: In this analytical-observational study, 459 patients with type 2 diabetes were enrolled in the study and the ophthalmic examinations done by an ophthalmologist included visual acuity, intraocular pressure (IOP) measurement and slit-lamp examination. After pupil dilatation, funduscopy was done and the patients were classified according to ETDRS criteria. A proportional hazard model for current status data was used to identify the risk factors for retinopathy.

Results: The hazard rate of having retinopathy increased by 5% for an increase of one year in the duration of diabetes (p<0.05) and the hazard rate of having retinopathy was 1.1 times greater in patients who had used insulin for diabetes compared with other type 2 diabetes patients (p<0.05).

Conclusion: This study showed that a history of hypertension may reduce the risks of diabetic retinopathy. In patients with the early diagnosis of diabetes, regular examination of the fundus, blood sugar control and tight control of high blood pressure are recommended.

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} Background: Proper drainage of the mediastinal and pleural spaces following Off-Pump Coronary Artery Bypass (OPCAB) surgery is essential for the prevention of pleural and pericardial effusions, cardiac tamponade and late complications such as constrictive pericarditis. Drainage tubes themselves may induce some complications which can negatively affect the result of the surgery. In this study we assessed a new technique for chest drainage following OPCAB.
Methods: In this clinical trial, 171 patients were allocated to two groups. In the control group, the drainage technique included one drain in the left pleural cavity and another in the mediastinum, while in the case group the drainage technique included one drain in the left plural and one in the right pleural cavity.
Results: The amount of drainage in the case group was more than the control group (p=0.001). We found significant reductions in the incidence of arrhythmias in the case group (p=0.005). While one patient (1.2%) needed reoperation for bleeding control in the control group, no patients needed reexploration in the case group (p=0.497). The duration of hospital (p=0.022) and ICU (p=0.002) stays was shorter in the case group.
Conclusions: Based on the results of this study, changing the position of mediastinal drains in patients undergoing OPCAB surgery and shifting it to the right pleural cavity, reduces complications, such as arrhythmia and pericardial effusion, aside from establishing a better drainage.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Human amniotic membrane (HAM) forms the inner wall of the membranous sac that surrounds and protects the embryo during gestation. The main advantages of amniotic membrane transplantation (AMT) in the treatment of bacterial keratitis are its epithelial bandage properties. Previous studies have documented the presence of some antimicrobial proteins and peptides in amniotic fluid such as lactoferrin, lysozyme, bactericidal or permeability increasing protein, calprotectin (MRP8/14 protein complex), LL37, and neutrophil defensins (Human Neutrophil Peptides, HNP 1-3). Furthermore, the amniotic membrane does not express HLA-A, B, C or DR surface antigens, which may help avoid rejection after its transplantation. Thus, it can be used as a biological immune barrier. The purpose of this study was to evaluate the effectiveness of the amniotic membrane's healing properties in rabbits with pseudomonas keratitis.
Methods : By using an animal model, 14 rabbits were divided into two groups of controls and cases. A syringe was used to inoculate the corneal stroma of the animals by Pseudomonas aeruginosa ATCC27853. After 20 hours pseudomonas keratitis was created and amniotic membrane was transplanted to the cornea of the case group. The infiltration size were observed on the first, third and seventh days after the experiment.
Results : Corneal perforation was seen in the controls (P<0.001) but amniotic membrane prevented perforation in the case group (P=0.02).
Conclusion: Transplantation of amniotic membrane in the primary stages of pseudomonas keratitis treatment remarkably prevents corneal perforation and it can be used to control the disease process.

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Background: Cystic fibrosis (CF) is a multiorgan autosomal recessive disorder. As CF is highly heterogeneous in Iran and many mutations have a low frequency, routine molecular diagnostic methods are not very efficient. The use of highly polymorphic intragenic markers not only can facilitate phenotype prediction in prenatal diagnosis by gene tracking, but also can lead to the demonstration of possible associations between haplotypes and specific mutations. We determined IVS8 polyT and M470V polymorphisms in exon 10 of CFTR gene in this case-control study.

Methods: Polymorphisms of IVS8 polyT in 53 patients with CF were referred to Amirkola children's Hospital of Babol University of Medical Sciences, 2007 to 2011 and 49 fertile healthy individuals were determined by reverse dot blot method. M470V polymorphism was analyzed by PCR-RFLP.

Results: In IVS8 polyT study, T7 was the most frequent allele in healthy individuals than patients with CF (respectively, 82.8% Vs. 77.2%). T9 was more abundant in patients with CF than normal individuals (respectively, 21.7% Vs. 7.4%, P=0.005). T9/T9 genotype was more frequent in patients than healthy individuals (respectively, 15.1% and 2%, P=0.032). Study for M470V polymorphism showed that M/V was the most common genotype in normal individuals and patients with CF (respectively, 49% and 40.4%). M-T9 haplotype was highly associated with the disease in both patients with CF and normal individuals (respectively, 19.1% and 2.4%, (P<0.001)

Conclusion: The allelic distribution and heterozygosity results suggest that both M470V and IVS8 polyT can be helpful in the prenatal diagnosis of CF in Northern Iranians with a positive family history of the disease.

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Background: Inadequate ventilation, esophageal intubation and difficult intubation are the most common adverse respiratory outcomes in patient undergoing anesthesia .The aim of this study was to compare Mallampati test in supine and sitting positions in traditional approach and during phonation for predicting difficult laryngoscopy and intubation.
Methods: In this study performed in Imam Khomeini Hospital in Tehran, Iran, Mallampati test was performed on 661 patients who met the inclusion criteria for the study. The test was done in supine and sitting positions with and without phonation by a rater who was blind to Mallampati test. Subsequently, laryngoscopy view and difficult intubation were evaluated in the four aforesaid positions by Mallampati test for predicting difficult laryngoscopy and intubation. For each situations, sensitivity, specificity, positive and negative predictive values and accuracy were calculated.
Results: Overall, 28 (4.2%) patients had difficult laryngoscopy and 9 (1.4%) patients had difficult intubation. The highest sensitivity for Mallampati test in predicting difficult laryngoscopy and intubation was in supine and sitting positions without phonation, and the highest specificity was seen in sitting position with phonation. Negative predictive values were more than 95% in all different positions for Mallampati tests and the highest positive predictive value was seen in supine position with phonation.
Conclusion: According to our findings, the highest correlation between Mallampati test and different positions in predicting difficult laryngoscopy and intubation was seen in supine position with phonation. Phonation improved Mallampati score in supine rather than sitting position.

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Background: The aim of this study was to provide a valid Persian version of the Ages and Stages Questionnaires, in order to compensate the lack of developmental screening tools in Iran.
Methods: Forward and backward translation, face and content validity determination, and cultural and linguistic adaptation of the questionnaires were performed, consecutively. Next, a pilot study was carried out on 100 Iranian parents of 4- to 60-month-old children, recruited by consecutive sampling in Tehran, Iran during the year 2006 to determine the degree of clarity for each item and explore cultural adaptations. In order to determine inter-rater reliability, we had parents of 38 children complete the questionnaires. For determining the psychometric properties of the tests, we later recruited a representative sample of 555, 4- to 6-year-old children by consecutive sampling from health care centers in five main geographical areas in Tehran.
Results: Performing cultural and lingual adaptations, our expert team made some inevitable changes to the questionnaires. Almost in all age groups older than 10 months, cultural or linguistic changes were made in items in the “communication” domain. Overall, the questionnaires’ Cronbach alpha was 0.79. The constructive validity of the tests was also satisfactory. Another important finding was determination of the children’s developmental mean scores.
Conclusion: The culturally adapted Persian copies of the Ages and Stages Questionnai-res have proper validity and reliability for being used as developmental screening tools for children in Tehran.

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Background: Neonatal deaths stand for almost two-thirds of all deaths occurring in infants under one year of age. Congenital anomalies are responsible for 24.5% of these cases forming a highly important issue for health policy-makers.
Methods: We studied the pre-, peri- and post-natal conditions of 77 patients with multiple congenital anomalies (MCA) through genetic counseling at Several university Hospitals, in Tehran, Iran. The collected data were subsequently analyzed using SPSS software.
Results: The patients did not have a good prognosis, demonstrating the need for the diagnosis of such diseases early in pregnancy to be of utmost importance. We screened for trisomy and nuchal translucency, which the first showed a low risk and the second showed normal results in most cases.
Conclusion: Establishment of standards for prenatal diagnosis of congenital anomalies and monitoring their implementation seem to be necessary for the reduction of deaths due to congenital anomalies and infant mortality rate (IMR).

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Background: Adipokines are peptides secreted by adipose tissue that affect whole-body energy metabolism. Exercise training exerts beneficial effects on adipose tissue. However, less is known regarding visfatin’s, IL-6 & TNF-α response to an interval acute training. Therefore, we investigated the effects of acute interval exercise on plasma visfatin, TNF-α and IL-6 levels, in healthy female rats. Furthermore, correlate between changes probably these factors were also assessed.
Methods: This study was conducted experimentally. Forty five female sprague dawley rat were randomly divided into three groups: pre test (n= 15), treadmill exercise (n= 15) and sedentary controls (n= 15). The acute alternative exercise consisted of treadmill running: 3 session/ week for 8 week. The changes of plasma IL-6, TNF-α and Visfatin levels were measured by ELISA analysis. Data were analyzed using analysis of variance with measures (ANOVA) and post hoc Tukey test.
Results: Acute interval treadmill exercise led to significant decreases in visfatin (P= 0/036), IL-6 (P= 0/009) and TNF-α (P= 0/022) plasma levels between the groups. Also, this study no significant correlations between the changes in adipokines were observed.
Conclusion: Decreased levels of TNF-α and IL-6 correlated with intensity and duration exercise. Furthermore, probably there were some factors except weight decreasing that affects on visfatin decrease. Therefore, the reduction of this factor may cause in preventing metabolic disease.