Journal of Mazandaran University of Medical Sciences
Year:2007 | Volume:16 | Issue:56|Papers Count:26

Background and purpose: There are evidences indicating increased 99mTc-MIBI uptake by the gastric wall in myocardial perfusion SPECT connected with dyspepsia symptoms. In this study we aimed at investigating the frequency and structure of dyspeptic symptoms in patients showing gastric wall hyperactivity in 99mTc-MIBImyocardial perfusion SPECT and to determine any association between the existing symptoms and this scintigraphic finding.Materials and Methods: 1120 consecutive outpatients referred for myocardial perfusion SPECT were interviewed about the dyspeptic symptoms, current gastric medications and previous gastroduodenal interventions. The intensity of gastric wall activity was graded qualitatively as A or hyperactive gastric wall (equivalent to the heart activity) and B (less than heart activity).Results: Increased gastric wall uptake was seen in 1.78% of the patients. Dyspeptic symptoms were present in 80% and 19.3% of A and B patients, respectively (P<0.001). The dyspeptic symptoms were classified as ulcer-like in 37.5%, dysmotility-like in 43.75% and GERD-like in 18.75% of the dyspeptic A patients. Considering the classification of dyspepsia, there was no significant difference between the different groups. All of the eight different symptoms of dyspepsia had significantly higher prevalence in group A (all P values were less than 0.001). The history of previous upper GI endoscopy past history of previous gastroduodenal surgery and frequency of current use of gastric medications were significantly higher in group A.Conclusion: Although the clinical role of gastric wall hyperactivity detection is not yet clearly defined, report of this infrequent accidental finding should be part of the report of radio nuclide imaging of the heart and may identify a category of patients, who require additional diagnostic gastrointestinal investigation to specify other possible noncardiac origins of their pain (and even the only origin of patients symptoms).

Background and purpose: Symptoms of chronic rhinisinositis (CRS) are cumbersome and refractory to most systemic medications and even after surgical intervention, the recurrence of symptoms are frequent. In order to study the beneficial effects of Origanum vulgar inhaler in relaxing the symptoms, this study was conducted in Boo Ali Sina Hospital, Sari, Iran.Materials and Methods: The study was a randomized double blind placebo controlled clinical trial carried out from April to December 2005. The diagnosis of CRS was made by an ENT specialist upon clinical and CT scan fmdings and or signs during functional endoscopy sinuses surgery (FESS). Patients younger than 15 years old, with a history of allergic eye disease and symptoms of infections were excluded. Patients were randomized in case and control groups (32 in each) according to age, sex and disease chronicity. After verbal explanation of the trial, an informed consent form was signed by each patient. The study was approved by the medical ethics committee of the Mazandaran University of Medical Sciences, Iran. Origanum vulgar was gathered from local mountains (Kojor area, Nour, Mazandaran, Iran), and identified by an experienced botanist. The airial organs of the herb were dried, macerated followed by 75% hydroalcoholic extraction and standardized by Emerson method. The active ingredient and placebo in the same bottles were administered to the patients and they were asked to add 5 ml of the liquid to boiling water and inhale it for 15 minutes, three times a day for two weeks. A telephone contact was made to the patients, to increase the compliance to treatment. A questionnaire was filled in for each patient before and after the intervention by a doctor blind to groups. Chi square test was used for comparing the differences in symptoms and P< 0.05 was considered statistically significant. Results: Sixty four patients were recruited and allocated equally in case and control groups matched for age, sex and duration of symptoms. 15.6 and 25 percent of the cases and controls had history of sinuses surgery. All symptoms including headache, nasal congestion, sinus pain, post nasal discharge, eye pain and purulence in nasal cavity were significantly reduced after the intervention except hyposmia and nasal discharge (p<0.001). No side effect was reported.Conclusion: Inhalation of 75% hydroalcoholic extrac of Origanum vulgar is effective in relaxing most symptoms of CRS.

Background and purpose: Breast cancer is the most common malignant tumor and the leading cause of carcinoma death in women, with more than 1.000.000 cases occuring world wide annually. Recently, particular attention has been paid to sensitive/rapid and cheap laboratory methods for diagnosis of metastatic breast cancer. Evaluation of serum tumor markers including CEA and CA15-3 is one of these methods.Materials and Methods: The study was performed on 150 patients with breast cancer in Imam Khomeini and Shafa hospitals-Sari, Iran(2004-2005).Before modified radical mastectomy procedure, blood level of CEA and CA15-3 was measured with an ELlSA method using CANAg kit, then mastectomy and axillary lymph node specimens were evaluated. The information was analyzed using SPSS 11 statistical software.Results: In our study, the patients were between 32-75 yrs (mean: 51.6 yrs). The patients were divided into two groups: I (89 cases): Breast cancer with axillary lymph node metastases.II (61cases): Breast cancer without axillary lymph node metastases.Statistical differences was observed between the amount of CEA and CA15-3 in the two groups (P<5%).CA15-3 and CEA showed the best efficiency in the level of 35 u/ml and 2.5u/ml, respectively. Sensitivity and specificity of CA15-3 are 78% and 88%, respectively. Sensitivity and specificity of CEA are 48% and 83%, respectively.Conclusion: CA15-3 tumor marker is useful for diagnosis of metastatic cases but CEA tumor marker does not have optimal sensitivity.

Background and purpose: Brucellosis is a major bacterial zoonosis of global importance.Effective host defence against brucella depends on immunoglobulin G-mediated phagocytosis of the bacteria and it has been shown that the FC RIIA polymorphism (FCg RIIA-R131 vs FCg RIIA -H13I) determines the capacity of immunoglobulin G-mediated phagocytosis via this receptor. The aim of this study was to evaluate the FCg RIIA polymorphism in patients with brucellosis and to reveal any relation between this polymorphism and disease progression.Materials and Methods: In this study we evaluated FCg RIIA polymorphisms (R/R13I, R/H13I, H/H13I) in 67 patients with serologically proven brucellosis and 67 healthy volunteers matched for age, sex and geographical area. FCg RIIA polymorphism was determined using a polymerase chain reaction method (SSCP-PCR).Results: The frequency of FCg RIIA-R/R131 genotype was higher in patients with brucellosis compared with controls (47.8% vs 28.4%). This genotype has a (OR=2.1, 95%CI=1.3-4.2, P=0.039) significant correlation with brucellosis. However, no significant difference was found between patients with brucellosis and controls (P=0.2)Although the frequency of FCg RIIA-R/R131 was higher in patients with brucellosis compared with controls, we did not find any statistically significant differences (53.8% vs46.3%, P=0.2). As a result, there was no significant association between FCgRIIA genotype and severity of brucellosis. Conclusion: Based on the results, the dominance of homozygous genotype of FCg RIIA-R/R13 I III patients with bracellosis emphasize the importance of this predisposing genetic risk factor in contracting the disease.

Background and purpose: Inhaled drugs increase the effect of medications prescribed in the treatment of chronic airways diseases with fewer side effects compared to other methods. There are many users of metered dose inhaler (MDI), but the rate of improper use in patients, nurses and general practitioners is high. The purpose of this study was a) to assess the rate of MDI misuse in patients compared to nurses and b) to evaluate the effect of verbal and practical education in the use of MDI in nurses.Materials and Methods: Following ethical approval from Medical Ethics Board of the Mazandaran University of Medical Sciences, the present study was carried out in two separate stages. In the first stage which was a cross-sectional study, 110 subjects (55 nurses and 55 patients) were recruited from Mazandaran University Hospitals through a non-randomly and purposeful sampling method. A 0 - 100 scale check list was used to measure the skill of nurses and patients in the use of MDI. In the second stage, a randomized clinical trial was designed to assess the effect of verbal and practical education in the use of MDI on 55 nurses (experimental group=25, control group=30). Nurses in the experimental group only, received the education and they were then asked to administer MDI after three weeks.Results: The mean score for patients' skill was 63±37 which wasnot significantly correlated with age. The two lowest scores were related to slow inspiration (52.7%) and coordination between inspiration and using MDI (52.8%). The mean score for nurses' skill was 51±21/2.The lowest score was related to performance of a deep exhalation and holding the spray at 2.5-5cm distance (21.8%).Data analysis indicated that there was a significant difference between pre and post education score in the experimental group using paired t-test (P=0.0001, T=16.26). There was also a significant difference between the experimental and control group on MDI skill using t-test (p=0.0001, T=-8.19). Conclusion: The results of this study demonstrate that patients had higher score compared with nurses in the use of MDI. It is also shown that educational program may have an important role in improving nurses' skill in the administration of MDI.

Background and purpose: Pleural effusion is a common finding in many pulmonary or extrapulmonary diseases and its analysis is essential for differentiating transudates from exudates. Light's criteria are questioned by some researchers and measuring of cholesterol in pleural effusion is proposed due to its simplicity and low cost. This study evaluates the diagnostic value of pleural fluid cholesterol for differentiating transudates from exudates.Materials and Methods: In this prospective study, 70 cases of pleural effusion with definite diagnosis according to clinical gold standards were included and cholestrol, LDH and protein in pleural effusion and simultaneous in blood serum were measured. Pleural cholesterol alone, and its ratio with serum cholesterol, pleural-LDH and its ratio with, serum-LDH, pleural protein and its ratio with serum protein, combination of pleural Cholestrol + LDH were compared with Light's criteria.Results: Sensitivity and specificity of pleural cholesterol was 85% and 100%, respectively with 90% efficiency, pleural/serum cholesterol showed a sensitivity of 87% , specificity of 95% , with 90% efficiency. Lights's criteria gave a sensitivity of 87%, specificity 79%, with 91% efficiency. Combination of Pleural + pleural/serum cholesterol showed sensitivity of 87% , specificity of 100% , with 90% efficiency and for Pleural-LDH + pleural-cholesterol sensitivity, specificity and efficiency were 97% , 83% and 92% respectively.Conclusion: The use of pleural fluid cholesterol is useful as Light's criteria for distinguishing pleural transudates from exudates but not superior. Combination of pleural fluid cholesterol and LDH slightly improves the specifity and efficiency of differentiation. The advantage of cholesterol measuring is its simplicity, low price and that it can be used along with routine diagnostic pleural effusion tests.

Background and purpose: Coronary heart disease is one of the main causes of death and disability in human society. Nowadays, one of the ways of identifying the risk factors is to examine the inflammatory markers.The purpose of this research was to study the relation of inflammatory markers with the intensity of coronary involvement, which is distinguished through angiography.Materials and Methods: In this cross sectional-analytical study 200 patients, whom undergone angiography at Mazandaran Heart Center during 2004-5, were recruited. The intensity of the coronary heart involvement was determined based on angiography or the number of involved vessels and the intensity of vessel narrowness. The patients were then divided into two groups: high risk and low risk.The patients' information was recorded in a questionnaire and in order to study the inflammatory markers, their blood was sampled to measure WBC, platelet, ESR and CRP. Data were analyzed using T and chi-square tests, in SPSS version 11.Results: One hundred and fifty seven (%78.5) out of the 200 patients were men Ninty four patients (%47) were put in high risk group and 106 (%53) in low risk group. There was no significant relationship between gender, job, body mass index, education, duration of heart disease, suffering from diabetis mellitus, dyslipidemia, smoking, the number of WBC, platelet and ESR with the intensity of coronary heart disease. Patients of high risk group attended the hospital more frequently than low risk group, because of heart disease (P=%24) and that the amount of CRP in these patients was more than the low risk group significantly (P=%47).Conclusion: Regarding the inflammatory markers, it seems that only CRP has a relationship with the intensity of the coronary involvement.More studies for examining the causes, effects and suggesting interventions for the control of the condition seem to be necessary.

Background and purpose: Ketamine efficacy as an analgesic adjuvant has been studied in several clinical settings with conflicting results. Sore throat and pain after swallowing following tonsillectomy is significant. The aim of this study was to investigate the effect of ketamine on sore throat (pain) after tonsillectomy.Materials and Methods: In this double blind clinical trial, fifty children were, divided in to two equal groups of Ketamine and control. The subjects aged 4-14 years old and physical ASA class 1-11 were randomized to receive pemedication with either ketamine 0.1mg/kg I.V. or placebo 5 minutes before induction of a standard general anesthesia.Results: The ketamine group showed significantly lower pain scores with less total pethidine consumption (P<0.005) during 6h after surgery. The mean pain score in ketamine group was 1.32 and in control group was 2.4. There were no differences in the incidence of vomiting between the groups. Conclusion: Premedication with a small dose of ketamine reduces pain after tonsillectomy in children who received an analgesic regimen combined with an opoid.

Background and purpose: Nonsteroidal anti-inflammatory drugs (NSAIDs) remain among the most widely prescribed drugs worldwide for the treatment of inflammation including pain-releasing, anti-pyretic and rheumatoid arthritis. The conventional NSAIDs exert their effects by inhibiting cyclooxygenase (COX) enzymes. Subsequent research and rational drug design validated the initial concept that a selective COX-2 inhibitor would illicit effective anti-inflammatory without the adverse ulcerogenic effect associated with the use of NSAIDs that inhibit both COX-1 and COX-2. Accordingly, in this work we report the synthesis of a new diaryl heterocyclic series, the 3, 4-diaryl-4-thiazoline-2- thione, as potential selective COX-2 inhibitors.Materials and Methods: The starting material thioanisole underwent Friedel-Craft reaction with acetic acid in the presence of trifluoroacetic anhydride followed by oxidation by MCPBA to give 4- (methylsulfonyl) acetophenone. This compound was then treated with Br2 in CHCl3 to give phenacyl bromide derivative. On the other hand, condensation of aniline derivatives with carbon disulfide in the presence of triethylamine gave the corresponding dithiocarbamate salt. Subsequently, reaction of aryl dithiocarbamate with methylsulfonyl phenacyl bromide furnished cyclic alcohol intermediate, which was dehydrated by 80% H2SO4 to give 3, 4-diaryl-4-thiazoline-2-thione.Results: All of the target compounds were characterized by their 1H-NMR, 13C-NMR, IR and mass spectral data. Conclusion: In view of the pharmacological importance of the selective COX-2 inhibitors,a series of 3,4-diaryl-4-thiazoline-2-thiones having pharmacophoric features of COX-2 inhibitors have been synthesized via convenient and efficient synthetic pathway, and structurally characterized by different spectroscopic methods.

Background and purpose: Lidocaine is an intennediate acting local anesthetic agents used very much in epidural ariesthesia and has less risk of cardiac or CNS problems compared with bupivacaine. This study evaluated the duration of motor and sensory block of epidural anesthesia with lidocaine alone, lidocoine plus epinephrine and lidocaine plus fentanyl.Materials and Methods: In this double blind study 60 ASA I and 11 patients that scheduled for elective orthopedic operation were classified by block randomization in to three groups. Epidural anesthesia had been prescribed with 380 mg 2% lidocaine plus lml nonnal saline 0.9% for group N, 380 mg 2% Lidocaine plus 100 m/g (lml from 1/10000 solution) for group E and 380 mg 2% lidocaine plus 500 pig fentanyl for group F. The onset of sensory block and duration of motor and sensory block were recorded.Results: The mean onset time of sensory block in three groups were the same and about 8-9 minutes. The duration of complete motor block in group E (46.5 min) and F (45.3 min) were significantly higher than group N (22.5 min). The duration of sensory block in group E (117 min) was higher than group Nand F (102 min). Hypotension happened in 40%, 50% and 60% of cases and bradycardia in 10%, 25% and 30% of cases of groups N, E and F respectively.Conclusion: The results of this study showed that there were no effects on onset time of epidural sensory block with epinephrine or fentanyl as an additive to lidocaine 2% but they have glittery direct effects on the duration of motor block. However, epinephrine can increase the duration of sensory block with lidocaine in epidural anesthesia.We suggest that in cases that relaxation and complete motor block is needed in epidural anesthesia epinephrine or fentanyl be added to lidocaine.

Background and purpose: Most women consider menopausal symptoms as natural period in their life. Many of them experienced some problems before and after the condition. There are many side effects of hormone therapy for menopausal symptoms.In different regions with various diet regimens, menopausal symptoms are different. Glycyhrhza glabra has constituents with estrogen like activity. In this study for the first time aqueous Glycyrrhza glabra extract was evaluated for decreasing menopausal symptoms.Materials and Methods: Aqueous Glycyrrhza glabra extract prepared by maceration method. The extract was concentrated and then powdered. The powder used as 250 mg capsule and standardized by glycyrrhizha content. After matching for age, menopausal age and BMI, 29 and 24 women were allocated in case and control groups respectively. Three 250 mg capsules were prescribed per day to women in case group and women in control group received placebo.The mean number of hot flashes and degree of menopausal symptoms, KI (Kupperman Index) were calculated every two weeks and classified as; without symptom, weak, medium and severs. Data were analyzed using T-test and the effects of drug on hot flash and KI were assessed in different weeks.Results: The mean age and menopausal age were 50.5± and 48± respectively. Results showed that the mean numbers of hot flashes, KI and FSH decreased significantly in case group but they were not significant in control group. Also estradiol hormone increased significantly in case group. Conclusion: Aqueous Glycyrrhza glabra affects hot flash and KI and is a simple and cheap drug for menopausal symptoms without any side effects.

Background and purpose: Mosquito control and personal protection from mosquito bites is currently one of the most important measures to control mosquito born diseases. The use of repellents is an obvious practical and economical means' of preventing the transmission of these diseases to human. Dimethyl phthalate (DMP) is one of the safest repellents, which is used alone or in combination with other repellents. This study evaluated DMP lotion, which synthesied and formulated in Iran, and Trench ointment for protection time (PT) and failure time (FT) against Culexpipiens (complex), under laboratory condition.Materials and Methods: Tests were conducted on human subjects to determine the repellent protection time and failure time (FT) by screen cage method induced by Iranian and foreign dimethyl phthalate (DMP) lotion and Trench ointment.Results: Our result sindicated that PT of Iranian DMP against Cx. pipiens was 299 min (SE=± 7.03), which was not significantly different from two other repellents. There were significant differences in FT among three repellents. The FT of Iranian DMP was significantly less than two other repellents. PT and FT of trench ointment against Cx.pipiens (complex) was 5.5 and 8 hour, respectively.Conclusion: Iranian DMP lotion is comparable with foreign DMP lotion, but the formulation needs improvement to increase its repellent FT. Iranian DMP lotion must be evaluated under field condition, before usage in large scale.

Background and purpose: Presence of behavior-emotional disorder BED at childhood is a very important problem and predisposing factor for mental disorder in adulthood. The aim of the present study was to determine the prevalence of BED and its associated factors in the primary school students in Sari, Iran.Materials and Methods: Totally, 926 urban and rural students were selected randomly by cluster sampling method. Tools of data collection were: Demographic feature questionnaire divided in two parts of Rater behavior- emotional disorder for parents (31 questions) and teachers (30 questions). Data were analyzed by descriptive tests, X2, Hest using SPSS software.Results: Findings of this study indicate the general prevalence of BED in the children based on the parent's report (15.8%) and of teacher's 24.9%. The highest rate of BED prevalence based on the parents and teacher's reports were the lack of attention deficit disorder 93.3% and absent minding 11.1% respectively. The lowest rate of disorders was antisocial behavior 1.5% and 0.4% respectively based on the parents and teachers reports. Our data showed that the relation between the total prevalence of BED based on the questionnaire of parents with the variables of sex, score of the students, the child number in family, somatic complaints (headache, asthma, stomach pain or nausea, eating problems, sleeping disorders, urine incontinency, stool incontinency) cooperation of parents in keeping the child and school leaving was significant at the level of 5%. Also, based on the teachers reports, the total prevalence of BED at the level of 5% in the students under study was significantly different considering the factors such as educational status, scores average, separation of parents and mistreatment with the child.In addition, there was no significant relationship between the total prevalence of BED in the students based on the reports given by the teachers and parents on the basis of being urban or rural.Conclusion: Knowing the prevalence of BED is very important for the individual's health in the future and because proper and scientific identification of the children's behavior problems is the first step in the control and treatment of this problem, more research is recommended in this field.

Background and purpose: Formaldehyde is a chemical traditionally used for fixing the cadaver. It is vaporized during dissection and practical studying on cadaver. Studies show that this vapour can cause some clinical sympotms such as throat, eye, skin and nasal irritation.This study was designed to determine the histopathological changes of rat kidney tissue exposed to formaldehyde for 18 weeks.Materials and Methods: This study was perfonned on 28, 6-7 weeks postnatal albino Wistar rats. The rats were divided into 3 case groups (E1: 4hrs/d, 4d/w; E2: 2hrs/d, 4d/w; E3: 2hrs/d, 2d/w) and one control group (C). The kidney specimens were sectioned and stained with H&E technique for histopathological study.Results: In all histopathology sections of groups E1, E2 and E3, the following similar changes were observed: Mild congestion in the glumeroles, focal congestion and vacuolar (hydropic) degeneration of tubular cells only mild non-specific congestion in renal vessels. There were no evidences of fibrotic change or inflammatory cells infiltration among interstitial tissue. Also there were no abnonnalities in the staining of nucleus and cytoplasm. In Control group (C), no histopathologic changes were observed.Conclusion: The results of this study showed that formaldehyde vapour with a concentrations used in our study, can not induce histopathologic changes which could be detectable by light microscope.Also, there is no direct relationship between the duration of exposure to formaldehyde vapour and the intensity of histopathologic changes in the kidney.

Background and purpose: An appropriate nutrition throughout the lifespan is important. As adolescent girls nutrition status can affect community health in future. We decide to determine the frequency and composition of food from different groups of foods in adolescent girls of Sari (North of Iran).Materials and Methods: In the winter of 2004, 240 adolescent girls (14-18 years of age) from Sari high schools were randomly selected and food frequency questionnaires were completed. Also they were asked about their meals and snacks. Data were analyzed using SPSS version 11.5 software and the charts were drown using Microsoft Excel software.Results: The results indicated that the most consumed foods in groups of meats, dairies, grains and potatoes, vegetables, fruits and junky foods were egg, yoghurt, rice, tomato, citrus and chocolate respectively.Conclusion: This survey showed Sari adolescent girls dietary habits (in the winter), and it could be a part of studies to design a food program for them.

Background and purpose: Pharmacovigilance is a science that focuses on the detection, assessment, and prevention of adverse drug reactions (ADRs) in the post-marketing phase. Its back bone is spontaneous reporting by health care workers via completing the yellow cards. Due to the low reporting of ADRs in the Mazandaran province, this study was designed to evaluate the knowledge, attitude and performance of pharmacists and nurses regarding ADRs reporting.Materials and Methods: This descriptive study was done on 286 health care workers including 67 pharmacists and 219 nurses, selected randomly from different cities of the province. The standard questionnaire of European pharmacovigilance research group was used as the data collection tool. In the field of knowledge, definition of pharmacovigilance, awareness of the national criteria for reporting the ADRs and awareness about the terminology occurrence rates of ADRs were questioned. To evaluate the attitude, reaction of subjects to the some simulated ADRs and reasons of underreporting were assessed. In the field of performance, numbers of reported ADRs and also the sites where reports sent from were asked. Data were analyzed using independent sample t-test for quantitative variables and Chi-square and Kendall's tau-b for nominal and ordinal variables, respectively using SPSS software. P< 0.05 was considered as significant level.Results: There was no satisfying knowledge in each of the two groups. In spite of exposure of more than 80% of subjects to the ADRs, the mean reported ADRs values for pharmacists and nurses were very low as 0.72±2.8 and 0.17±0.67 respectively (P<0.01). Nurses liked to report most of ADRs to the physicians, nursing stations and pharmacist in spite of the national center. Considering these reports, they were more active than the pharmacists (P<0.001). The main causes of underreporting of the suspected ADRs were not being sure about the causative effect of the drug, unawareness of the existence of a national center, the ADRs were too well known to report and the ADRs were too trivial.Conclusion: Since most of the heath care workers were not familiar with the spontaneous reporting system, interventions such as presenting pharmacovigilance workshops in the hospitals of the province focusing on the aims of pharmacovigilance, completing the yellow card, clarifying the reporting criteria and also considering the pharmacovigilance in the training courses of students are recommended.

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.

Mucopolysaccharidosis type maroteaux-lamy is a very rare hereditary disease. The disease is marked by the deficiency of the lysosomal enzyme N-Acetyl galactosamine-a-4-sulfate sulfatase (arylsulfatase B). It is inherited as an autosomal recessive trait. The most clinical manifestations are: corneal clouding, organomegaly, hernias, coarse facial features, cardiac insufficiency and skeletal abnormalities (dysostosis multiplex). The mental performance remains relatively normal. This is a case report of a child with clinical manifestations of mucopolysaccharidosis type maroteaux-lamy.

We report a rare case of paraovarian serous cystadenoma in a 19 years old girl that presentated with abdominal distention. In clinical examination the patient showed a mass with cystic consistency ccupying the entire abdominal space. Considering its larg mass, the primary diagnosis was mucinous cystadenoma of ovary. At surgery extra ovarian origin of the mass was demonstrated. Source of these turnors can be from mesothelial cells, or mesonephric and or para mesonephric duct. Complications of cyst are perforation, torsion, pain, abdominal distention or malignancy.

Pemphigus Erythematosus specially its localized form is a rare autoimmune blistering disease combining features of Pemphigus Foliaceus and Lupus Erythematosus. We reported a 60 years old woman with skin lesion which presented Erythemato squamo plaque with oozing in the right cheek. The chief compliant was burning and pruritus. Skin biopsy was obtained and discoid Lupus Erythemato was reported. She was prescribed with topical steroid but did not improve. All of the lab tests such as Anti DNA, ESR, RF, CRP, CH50, C3, C4, ANA were normal. The biopsy repeated and Pemphigus Erythematosus was reported. Direct immunoflurescent test confirmed the diagnosis. We treated the patient with systemic steroid (80 mg/day). The patient responed well and showed complete remission during 3 months.

Hyper IgE syndrome (Job's syndrome) is a primary immunodeficiency disease with recurrent infections especially staphylococcal, coarse face, skeletal abnormality and significant increase in serum IgE level (IgE >2000IU/ml). We present a 16 years old boy admitted with chronic cough, dyspnea, eczema and pneumatocele. He had a history of chronic dermal infection since 1 month after birth. The diagnosis of hyper IgE syndrome was made according to typical history and significant high serum IgE level.