MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2003 | Volume:46 | Issue:81|Papers Count:27

Background: this study was designed to evaluate serum lipid profile level in-patients with wet AMD. We compared it with control group for further therapeutic decisions about this probable risk factor. Case-Control study.Methods: forty eyes of 38 patients with Wet AMD (diagnosis was based on indirect ophthalmoscopy and flourescein angiography) were studied here. Serum lipid profile (total cholesterol, low density lipoprotein, Hi-density lipoprotein, triglyceride) was measured and comparedwithage and sex- matched control group.Other risk factors including hypertension, hyperopia, cataract & smoking) were also evaluated and compared.Results: the Control group consisted of 18 females and 20 males (47.4% & 52.6% respectively) with mean age of 69.63 ± 6.78 (45-80 Y/O). 16 of patients (17 eyes, 42.5%) were female and 22 (23 eyes, 57.5%) were males with mean age of69.53 ±7.04 (45-81 Y/O). 2 cases were bilateral and 36 cases were defined unilateral.Mean level of serum triglyceride in control group was calculated 159.89±83.01 mg/dl in comparison to patients (125.6±48.97mg/dl) which showed an statistically significant difference with Higher levels in Control group. (t = -2.236, df=76, p=0.028).All other factors evaluated did not show statistically significant difference between the two groups (chi-square & t test).Conclusion: In regard to above results it seems that all studied factors except serum TAG level (which was higher in control group than patients) had no significant difference between two groups.Thus due to the controversial and almost opposing results of this study and previous studies, larger studies with larger sample size are needed to shed on the matter.

Introduction: amblyopia is defined as the loss of visual acuity in one or both eyes, without any obvious organic cause. The aim of this study is to compare the prevalance of amblyopia between the students who had been examined before school age and students who did not examine (control group).Methods: in total 1211 boys and girls students in middle school (573 students in grade 1 and 638 students in grade 3) were randomly examined in different area (North, South, East and West) of region 5 of Mashhad education.The examination included visual acuity, refractive error, and eye deviation. Visual acuity was measured using a Snellen E chart for use at 6m. A Hine Retinoscope performed cycloplegic refraction. with distance subjective retraction by oculus trial lenses.Results: the students age range was from 11to 17years with mean of 12.8 years old. The prevalance of amblyopia was 1.92% in grade 1 students (who examined before school age) and 1.41% in grade 3 students of middle school (control group who did not examine before school age). The chi-square statistic was used to compare the prevalance of amblyopia between two groups of students in grade 1 and 3. It was not statistically significant (X2= 0.034, p= 0.54). The chi square statistic was also used to test relationship among amblyopia, type of retractive errors and previous family history. The relationships were found to be highly statistically  significant (X2= 100.3, p= 0.00, X2 =178.2, p=0.00).Conclusion: preschool age is critical period of development for visual system. However, the prevalance of amblyopia between two groups of students in grade 1 and 3 of middle school was nearly the same. This indicates that the preschool vision screening for amblyopia was not effective and useful in region 5 of Mashhad education.

Introduction: rupture of intervertebral disc material into the intradural compartment is a rare event, but lumbar disc disease must be considered in differential diagnosis of mass lesion causing nerve rootor cauda-equina syndromes. Any age group with the exception of children can be affected. The neurological symptoms and findings are generally more sever than lateral  Extradural disc herniation.The purpose of this study is to determine the incidence of lumbar intradural disc rupture and describeits clinical and radiological presentation.Positive mechanical findings suggesting nerve root compression or distortion are found in 75% of these patients. Radiologic evaluation of the patient with suspected intradural disc herniation is most effectively done with a combination of myelography and CT scanning. The treatment of Intradural disc herniation is surgical removal. Methods: this descriptive study is from October 1997 to September 2002, 2308 patients (mean age: 45.6 years old) with lumbar disc herniation recognized by MRI and / or myelography or CT myelogram who underwent surgery were studied. Results: mean age for this disease has been 45.6 years and males are affected more than females in a ratio of 8 to 2. Neurological findings were motoric, sensory and sphincteric disorders. The most neurological complication was dropfoot. The short time results were good.Conclusion: Lumbar intradural disc herniation must be considered in differential diagnosis of intradural mass lesions. The worse the preoperative deficit, the less likely a postoperative recovery of neurological function, therefore the "time" is very important.

Introduction: in newborns, hyperglycemia is more frequent than hypoglycemia and has been associated with increased mortality as well as increased incidence of intraventricular hemorrhage. In order to determine the prevalence of stress hyperglycemia in Neonatal Intensive Care Unit (NICU) admissions, mortality rate, cause of admission and mortality this study has been done in NICU of Emam Reza Hospital for 13months since 1998. Material and Methods: all babies with blood sugar more than 150 mg/dl (case group) and third admission with normoglycemia (control group), were elected. Pregnancy complications, cause of admission and mortality were compared in two groups. T-student and Chi-square test did data analysis.Results: during study, 42 patients from 1430 patients who were admitted hyperglycemia (3%). No significant difference was found between two groups about age on admission, sex, gestational age and weight.The most hyperglycemic patients were involved: Asphyxia, infection and intracranial hemorrhage. The prevalence of stress hyperglycemia in neonates with low apgar score was higher than normal score, similar to neonates that undergone CPR. Stress hyperglycemia was higher with systemic acidosis. On the other hand, the severity of acidosis on hyperglycemic group was higher than control group. Significant difference was found between two groups about coagulation test. Mortality rate in hyperglycemic group was more than control group and relative risk of mortality in stress hyperglycemic patients was 1.45 times more of central. The mortality rate was correlate with serum glucose level. The most mortality rate was in asphyxic hyperglycemic patients. Conclusion: Finally we concluded that asphyxia, infection, intracranial hemorrhage history of CPR and low apgar are important stressful factors which are able to induce releasing stress hormones and following hyperglycemia during acute illness.

Introduction: ARMs and associated abnormalities (AA) are one of the most problematic and common entities in pediatric, Surgery A.A recognition for optimal treatment and best recovery and prevention of disability is very important. About 50% of patient with high type and 25% of low type ARM have associated anomalies, some body single and the others multiple combined anomalies (anomalies in urogenital, musculoskeletal, gastrointestinal, cardiovascular and ophthalmic systems). Among these anomalies, sacral anomaly is very important because has direct effect on the function of urogenital and gastrointestinal system. Recognition of incidence of AA can help the physician to choose the best diagnostic and treatment modalities. This descriptive study in 64 patients with ARMs that have been operated at the pediatric surgery ward, Mashhad University, Medical School ITom1995-1998 and followed for 4-7 years.Result: With regard to the results of physical examination, abdominal and chest X-Ray, ultrasonography, Echocardiography and Spinal cord studies (MRI, C.T Scan...), voiding cystourethrogram (VCUG), Intra venouspyeloureterography (LV.U), distal colostogram, and Barium enema, 32 patients (50%) had associated anomalies (follow up period 4 to 7 years) Of 64 patients in this study; 32 cases (50%) had associated anomalies, mostly of urogenital system (31.2%). The prevalence of other associated anomalies were as bellow: Musculoskeletal system (18.6%), Gastro- intestinal tract (14%), Cardio- vascular system (6.2%), Opthalmic system(6.2%), Soft tissue (3%), Skull (3%), Right lung agenesis(1.5%). This studied the frequency of sex and type of LA in our cases. 62.5% were male, 37.5% female and had, 70.3% high type and 23.4% low type LA; 6.25% cloacal type. Conclusion: All newborns should evaluate for normal anus, if has LA, careful assessment of the genital tracts in females and the genitourinary system in all patients is imperative many children with a high LA have associated spinal cord anomalies, particularly tethered cord. Therefor should be better to evaluate with spinal U.S. & MRI. These infants require evaluations for signs of the VACTERL association including careful cardiac assessment. For these patients Urine analysis (UIA) chest X-Ray, ultrasonography, VCUG, Echocardiography, careful follow up is mandatory.

Introduction: since the most patients with measles in recent years were young adults, in this study to evaluate the immune status of young adult population.Method: For this purpose, the serum samples of 172 students from seven parts of Mashhad were collected and tested for measles specific IgG antibodies by ELISA method. The age of these subjects was 14-19 years and divided in 6 groups.Result: the result found that 50 (%29) of the subjects were seronegative (antibody titer<8 or concentration <20 lu/ml) and 9 (%5) were equivocal (8<antibody titer<12 or 20 lu/ml< concentration>30) and 113 (%67.5) were seropositive (12<antibody titer or concentration>30 lu/ml). Thus, 29 percent of subjects had negative results and probably most of them remained nonresponder. The most cases of seronegative subjects were found in age 14-16/9, and the least inI7-19/9 years old. Thus, the correlation of the age and negative results in this study was significant (p=0.0003).In addition the correlation of the age and serum level antibody was significant but reverse. (p=0.038).Males were significantly more seronegative than females. (p<0.0001)Besides the serum level of males were less than females. (p<0.0001) The correlation of the residence and negative results was significant (p<0.0001) and the part with number two (Tehran street and Shohada square) have most negative results. In addition, the correlation of the residence and serum level antibody was significant (p<0.0001).Conclusion: further studies are necessary to evaluate the true immune status of the population. However, the vaccination campaign prevented further measles cases, apparently by increasing the population's immunity, It seems that, high risk population (Soldiers...) should vaccinated.

According to disadvantages and complications of cardiopulmonary bypass (CPB), cardiothoracic surgeons in world- wide have become interested in off-pump CABG. Generally, coronary artery surgery accomplished in two Method, first routine method, in which CABG is performed with the help of CPB (PUMP MACHINE). In this method, the field of the operation is motionless and free of blood, however the complications of the CPB are still present. Second off- pump method that surgery is performed without using CPB. In this method, the heart is beating during operation, and normal activities of heart and lung are maintained, this method devoid of the disadvantages of the previous one.The first CABG surgery was done on a beating heart in 1960. In Iran cardiac surgery has commenced since 40 years ago, and is developing rapidly, but about operations with off-pump Method and results, there is no documented study. Off-pump CABG not only avoids of disadvantages of CPB but also has economic benefits. The goal of our study was to investigation the results (Ghaem, Javad-al-aemeh, Mosa-ebne-jafar Hospitals) in Mashhad, so that it can be a useful guide for future cardio-thoracic surgeons.

Introduction: spasticity and related phenomena are common morbidity after stroke. The primary aim of this study was to investigate the role of Botulinum toxin-A (Dysport) on spasticity and related problems in hemiplegic patients after stroke. Method: this study was performed in a before and after clinical trial. The patients were selected after primary examination and assessments. They received 500 to 1000 units of Dysport into affected limb muscles. The patients were 29 adults (19 males, 10 females), mean age 53 years (range 17 to 73 years) and mean duration of symptoms 37 months (range 8-120 months) Result: Most of outcome measures showed improvement in first weeks that were statistically significant. Passive and active range of motion increased (particularly in elbow joint). Resting angle improved and muscle tone reduced (P<0.01). Mean pain value was reduced from 41% to 25.5% (P=0.046). These changes had been persisted until fourth week assessment, 24% of patients reported mild or moderate side effects but any serious complication was observed.Conclusion: Botulinum toxin-A is useful and safe for treating patients with stroke who have difficulties due to spasticity but its expensive price limits its practical usage. Therapeutic effect of BTX-A was significant more particularly on muscle tone reduction, pain and spasm.

Introduction: total knee replacement in elderly patients has been well documented as effective for relief of pain, correction of deformity, and improvement of function. In this present study, to evaluate the five years functional outcome of knee replacements in old patients, with special attention to activities in which the patients participated.Method: In patient with total knee arthroplasties performed between 1998 and 2002 inpatients who were 60 to 79 years old to determine the appropriate management for patients who have severe osteoarthrosis. 31 knee replacements were performed in 27 patients. Ten knees (ten patients) were lost to follow-up. Follow-up data for the remaining 21 knees in 17 were used to perform the survivorship analysis. All of the operations were performed with the use of cementing techniques, Twenty-one unrevised knees were available for clinical evaluation with the scoring Knee Society at an average of five years postoperatively. The activity levels of the patients were assessed with the activity score of Tegner and Lysholm. Radiographs were examined for evidence of loosening of the component.Result: According to the system of the Knee Society, the average knee score was 94 points and the average functional score was 89 points. Nineteen knees (90 per cent) had good or excellent function, The average activity score improved from 1.3 points (range, 0 to 4 points) preoperatively to 3.5 points (range, 1 to 6 points) at the latest follow-up examination, All but two patients had improvement in the activity score postoperatively Conclusion: Researchers consider arthroplasty with cementing total knee prosthesis to be effective operative treatment with durable results for osteoarthrosis in old patients when other,  less invasive measures have failed. Within the average 2.5 year follow-up interval of this study, polyethylene wear, osteolysis, and loosening of the prosthesis were not major problems for these old patients, although it is possible that this observation could change with an even longer  duration of follow-up.

Introduction: true precocious puberty (TPP) is caused by early maturation of hypothalamic GnRH secretion, and much more common in girls than in boys. In these patients psychological disturbance and inadequate final height are the major problem.Method: this studied causes, changes in secondary sexual characteristics, height and weight velocity in 34 patients with TPP that treated with GnRH agonist. In this study used Chi-Square and Mann-Whitney U tests for statistical analysis.Result: Three out of 5 boys had neurogenic tumor (hamartoma, Astrocytoma, Neurofibromatosis) and 27 out of29 girls had idiopathic TPP. Treatment with GnRH analogues produced a prepubertal height velocity and reduction of secondary sexual characteristics, but weight gaining do not reduced and significantly (P<0.01) heighr than normal (4.52kg/year versus 1.52kg/year). Conclusion: We concluded that the outcome of our treatment with GnRH agonist depots was more effective on. reducing the height velocity and caused considerable regression in secondary sexual characteristics but we observed that it couldn't prevent patients becoming obese.

Background: carbamazepine and Na-vaplroate acid are two drugs that" widely used in treatment of epileptic patients. In some previous studies have been shown that these drugs change level of the serum lipids and liver function tests (3,4,5). For examples in one study have been shown that carbamazepine increases serum lipids but valproic acid doesn't (3). In the same study these drugs have no effect on SGOT & SGPT but increases GGT (3).It is necessary to mention that this study has not previously performed in Iran. Investigation about the effect of two antiepileptic drugs; carbamazepine and valproic acid on serum lipids and liver function tests in epileptic patients under the age of thirty, treatment 6  months and comparison with each other.Material and Method: This study was a descriptive study and its cases were the patients of Alzahra Emergency room and AI-Zahra and Khorshid clinics. There are two groups (A&B) of epileptic patients in this study. Each group consists 40 patients. Patients of group A have been treated with carbamazepine at least for 6 months and patients of group B have been treated with valproic acid at least for 6 months. Patients of both groups are not more than 30 years old. In this study tested serum lipids (TG, Te. LDL HDL) and liver function tests (SGOT, SGPT, PT) and then deterll1ined the mean of each parameter in each group to compare them with each other. Data of this study were analyzed by Mann- Whitney test.Results: In this study the mean of TG, HDL, SGOT, SGPT and PT are not significantly different between group A and group B (pv>0.05).Conclusion: But the mean of TC and LDL are significantly different between the both groups (pv<0.05). In other words the means of TC and LDL are significantly greater in the patients of group B treated with valproic acid.

Material and Method: this is a descriptive study about the etiology of 310 epileptic patients who were refered to Ghaem Hospital. Results: Most of them were between 10- 18 and F/M ratio was 1.3. 58.7% have patients had idiopathic and cryptogenic epilepsy and 41.3% had symptomatic epilepsy. The serial, prevalence of etiology is in follow: idiopathic and cryptogenic 58.7%, posttraumatic 13.5%, cerebral vasculas disorder 0.6%, tumor 5.8%, infection disease 3.9%, hereditary metabolic' disease 3.9%, vascular malformation 2.6%, neurocutaneus disorders 1.3%, degenerative disorders 1.3%, perinatal insult 1.3% and collagen vasculas disorders 0.6%. verage age of patients who had idiopathic epilepsy was 19.4 and for symptomatic was 31.9. Discussion: regarding high incidence of posttraumatic epilepsy, more study in etiology of accidents and ear collisions with head trauma are suggestive.

Introduction: diabetes is one of the prevalent diseases in the world. Diabetic patients are more in risk of CVD than other populations. This evaluation was done in order to determine the prevalence of type 2diabetes and its relation with CVD risk factors. Method: this was a cross-sectional study carried out in 1998 in Isfahan Cardiovascular Research Center. Sampling was random cluster and the sample size was noted 800 subjects in order to reach the 95% of confidence interval Information related to age, sex, blood pressure measurements, weight, height and waist & hip was received through questionnaire and clinical examinations. For measuring blood glucose, WHO standard method (FBS) > 140 mg/dl fasting blood glucose or (2hpp) ≥ 200 mg/dl blood glucose 2 hours after eating glucose intake of75  grams.And also patients taking drugs or previously identified as a diabetic patient was used and information was analyzed using SPSS for windows version 10.Result: comparison of means was determined through unpaired students and T. test method and relation of diabetes with CVD risk factors was determined by multiple step-wise regression. The prevalence of diabetes in the whole evaluated population was 6.5% (6.4% male & 6.7% female) according to 2hpp method and 68% (6.8% male & 6.7 % female) according to FBS method. In this study, based on FBS and 2hpp examinations a significant relation was seen between diabetes, age, family history, BMI & systolic blood pressure type II diabetes and WHR only according to FBS examination. The relation between diabetes and diastolic blood pressure was  not significant according to both methods. The prevalence of diabetes in Isfahan is quite eye catching.This prevalence reached almost the same level by the 2 FBS and 2hpp methods but according to WHO standards the better method for such determination would be 2hpp.Conclusion: this study showed a significant relation between CVD risk factors and type II diabetes in Isfahan. Therefore, paying attention to such risk factors meaning identification and reduction of these elements is of great role in the population health.

A 15 years old girl, was referred to Infectious ward of Imam Reza Hospital with high fever, moderated jaundice, bradycardia diarrhea, confusion and blanching erythromatous maculopapular rash.In abdominal examination the liver was felt two-cm beyond the ribs and spleen was just palpable. The patient was pale and had impairment of co- ordination. Her mother gave the history of a couple a weeks fever and two times gasterointestinal hemorrhages.The temperature was 34.5 centigrade, pulse 65 beats/min.Bloodpressure100/60.Urine was dark and Sclerae were icteric. She had no dyspenea, No neck rigidity and no convulsion. The patient and her family are living in a town in the south of Khorassan province, Laboratory tests performed in the patient's residing town were: WBC 10500, Neut 65%, Lym 25%, Mono  9%, Baso 1%, Eo 0%, CRP ++, ESR 25, In urine analysis protein was trace with normal cytologyThe patient had been adminestered Ampicillin, Cefexime and Co-trimoxazole. The patient hospitalized, and her drugs were discontinued and new laboratory tests performed:Stool and Blood culture, CBC (HI), Bilirobine (T and D), SGOT, SGPT, HBSAg, HCV anti, IgM anti HAV, PT, PTT, LDH, Ret. Count, urine analysis, febrile agglutination tests, and a CX Ray, abdominal ultrasonography and EKG were done and IV liquids started. The results of laboratory tests were: HCT 36, Platelate 50000,WBC 3500, Dif. Count %, Neut 50, Lym 40, Mono 9, Baso 1, PT 15, :pTT 45, Ret count 2.5, ESR (mm/hr) 40, MCV 79, Al phos 4.00,HBSAg Neg, anti- HCV Neg, anti HAV IgM Neg, Bil (T) 4, Bil (D) 1, SGOT 120, SGPT 110, Wright (STA) Neg, Vidal 1/80, CX Ray= normal, abdominal Sonography normal, Blood cult (1 st report) Neg, Urinalysis, Protein, Trace, WBC 1-2/ hpf, Urobilinogene ++, Bact Neg. Because of bicytopenia, bone marrow needle aspiration puncture performed and it was normal bone marrow, except for Erythroleukophagocytosis. After receiving a laboratory result the diagnosis became clear.

HAM is an endemic neurologic disorder in many tropical and subtropical countries including North of Khorasan Province-Northeastern of Iran.The typical clinical presentation of this disease is a progressive myelopathic syndrome with spastic paraparesis, pain, paresthesia and difficulty in sphincteric control (4,9,10,11).In addition to myelopathy, HTLV-1 produces a lot of neurological syndromes such as cerebellar, bulbar, ALS-like, neuropathic and even myopathic syndrome (1,3,10,11). It's attractive that HTLV-1 could imitate neuroimaging (MRI) findings of degenerative (such as cerebellar and spinal atrophy) and demyelinating disease (Multiple Sclerosis); so it shares the differential diagnosis with many other neurological diseases (2,3). The diagnosis will be made too difficult because only a small proportion of HTLV-I infected individuals (estimated at 2-5%) develop a myelopathyor any other syndromes (10).Therefore, positive serologic tests Elisa for this virus in the blood alone are not a reason of HAM/TSP disease (7).In this article, we have presented two cases of this disease with respect to clinical presentations and neuroimaging (MRI) findings.First patient referred to our center with a predominantly cerebellar ataxia. The serologic tests of HTLV-1 in the CSF and blood documented the disease. MRI revealed cerebellar and spinal atrophy, second patient admitted with a typical myelopathic syndrome and CSF and blood serologic and PCR tests confirmed HAM/TSP with her.Brain T2-W MRI of this patient revealed a lot of hypersignal plaques. It is interesting that without any evidence of ouvert visual derangement, there was an increased P-I00 latency on VEP. So the relation between demyelinating disease (MS) and neurological features of HTLV-l (clinical and paraclinical, especially MRI findings) is attractive.

Pemphigus vulgaris (PV) is one of the common autoimmune blistering diseases in Iran. In this Disease, Autoantibodies are found aginst one of the elements of epidermal cells adhesion called as desmoglein 3 Although, oral corticosteroids have been recognized as the first-line treatment, in many cases, due to appearance of side effects or poor therapeutic response, use of the other immunosuppressive drugs is common. In the recent years, we can point to IVIg and Mycophenolate Mofetil (MMf) as new therapeutic options for pemphigus vulgaris (PV). This reports a 41-year-old man with three Autoimmune Diseases (PV, Hypothyroidism, Alopecia universalis). Because of side effects of systemic corticosteroids and failure to control the disease, this used another immunosuppressive drug Use of Azathioprine and IVIg in combination with prednisolone, therapeutic regimen included prednisolone, cyclophosphamide and plasmapheresis were not  effective. Since the beginning of MMf, improvement was started during 4 weeks and completed after 8 weeks.

Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a nonbacterial inflammatory process .of bony structures with unknown etiology. Unpredictability and spontaneous resolution of episodic attacks is characteristic of the disease. CRMO affects children and young adults more frequently, and may accompany psoriasis or palmoplantar pustulosis.With regard to the difficulty in differentiation of this inflammatory process from bacterial or neoplasic disorders of bone tissue, acquaintance with its specifications could result in subtraction of unnecessary diagnostic and therapeutic manoeuvres.The diagnosis is based on its chronic course and favorable response to anti-inflammatory drugs, and ruling out other possibilities. This present a 17-years-old boy with CRMO who, due to alienation of most physicians with the disorder, endured different diagnostic work ups and took numerous drugs for a decade, before the correct diagnosis was given.

Hemangioendothelioma is a rare tumor that constitutes less than 1% of primary malignant bone tumors. Approximately one-third of patients has multicentric involvement. In fact multiple osteolytic areas in extremity should lead to a diagnosis of hemangioendothelioma.Hemangioendotheliomas are graded predominantly on the cytologic atypia of the endothelial cells. Patients with grade 1 hemangioendothelioma have an excellent prognosis, whereas those with grade 3 have a very poor prognosis.That present a rare case of multifocal bony hemangioendothelioma in a 40-year-old man.The patient complained of pain and swelling around, the left knee. Radiologic examination  demonstrated multiple purely lytic lesions with ill-defined margins, involving patella and diaphysis of the left femur and tibia.Biopsy examination revealed grade 2 hemangioendothelioma with extension to the soft tissue and skin. The patient treated with left hip disarticulation and adjuvant radiation therapy.

Second report of blood culture was positive for Salmonella Enterica and After two days stool culture was positive too, for S. Enterica. - Typhoid fever has one thousand features. The absence of specific symptoms or signs makes the clinical diagnosis of typhoid, difficult.In areas of endemic, a fever without evident cause, that lasts more than a week should be Considered typhoid fever until proved otherwise. The role of Vidal' s test is controversial, because the sensitivity, specificity and predictive values of this widely used test vary considerably among geographic areas.Sensitivity of stool culture increases with duration of the illness. The sensitivity of blood culture is higher in the first week of the illness and reduced by prior use of antibiotics.There is strong evidence that ciprofloxacin is the most effective drug for the treatment of typhoid fever but concern has been expressed about toxic effects in children. Because of sever form of typhoid fever in our patient and two episodes of gasteromintestinal hemorrhages and because of confusion state of patient, a third generation cephalosporin (Ceftriaxone) was initiated (60 mg/kg/bw) and Dexamethazone one mg per kilogram by intravenous infusion combined to Ceftriaxone.After3 days, dexamethazone discontinued but Ceftriaxone continued for a complete 10 days.Fever clearance time was not so long and on the fifth therapeutic day the fever completely subsided and jaundice disappeared. After starting dexamethazone, patient's confusion  disappeared andshe had a good appetite and a better condition.Chloramphonical, Amoxicillin and Co-trimoxazole remain appropriate for the treatment of typhoidfever in areas of the world where the Salmonella is still fully susceptible to these drugs. 3 months after discharging the patient, she was well, and there was no evidence of relapse.