The purpose of this study is to examine the questions of the Likert scale with the Classical Test Theory and the Item Response Theory, then putting together the results of these two approaches and answering the question "Are the results of these two approaches consistent? or do they contradict each other?" . The research method is descriptive and in terms of data, it is a secondary analysis method. The subjects studied in this research included 977 students of the junior high school students, that by removing individuals in the data screening stage, finally, the analysis of extraversion items was based on the information of 783 subjects, the analysis of openness items on the information of 763 subjects, and analysis of conscientiousness items on the information of 784 subjects. The research instruments were 3 subscales of extraversion, openness and conscientiousness of the Neo Personality Test. The results of the statistical analysis showed that the higher the internal consistency of the items, the more accurate and valid the results obtained from the graded response model, and for items with low internal consistency through this model, it should be acted cautiously; Because it may show the threshold of the items inverted or the discrimination coefficient of the questions false negative or positive. All in all, the simultaneous use of different methods of statistical analysis will be of aid in better analysis and obtaining more accurate results.

Background: Acute hepatitis B infection can debilitate a patient for weeks and occasionally has a fatal outcome, while chronic infection is a major threat to the individual. To assess the response of nonresponder and hyporesponder children to the booster dose of Cuban recombinant hepatitis B vaccine is the background of this survey.Methods An interventional, descriptive study has been conducted on children who had been immunized with Cuban recombinant hepatitis B vaccine and if their antibody titers were ≤10 mIU/ml (nonresponder) or 10-100 mIU/ml (hyporesponder) booster doses of the same vaccine were administered in their deltoid muscle. Findings: The response of 141 children, with a mean age of 1.9 years, to the first and second booster dose of vaccine was 94.3% and 100% respectively. The anti-HBs titers in nonresponders and hyporesponders were 468 ± 383 and 783 ± 346 mIU/ml respectively with significant differences between the two groups (P=0.001).Conclusions: This study demonstrates moderately increased antibody production in the majority of vaccines with single booster dose of the vaccine.

Metabolic and genetic hepatitis may be manifested initially as acute hepatitis and wilson disease is more likely to present with chronic liver disease or a neuropsychiatric disorder and a normal urinary copper excretion effectively rules out the diagnosis of acute hepato - lentricular degeneration. In fulminant hepatitis B in less than 5% in the beginning of disease. HBsAg marker may be negative but other HBV infection markers will be positive. Herbalism in Iran especially in liver diseases is a common problem of physicians and swallow of alive, river fishes is an ancient behaviour in managing icteric patients. Fortunately the patient had done none of them. A serum protein electerophoresis performed and revealed high gamma globulin. In a yaung female patient with paranchymal hepatitis and hypergammaglobulinemia with negative viral markers for hepatitis and normal urinary copper excretion, autoimmune liver disorders will be in suspicion. These disorders are chronic but occasionally have no overt manifestation, until an overlap syndrome develops that is indistinguishable from acute hepatitis. The most common of these disorders, is type I autoimmune hepatitis, it is more common in females than in males and its peak incidence is in young peoples. This form of autoimmune hepatitis characterized by hypergammaglobulinemia and a positive test for antinuclear antibodies or antismooth muscle antibodies or both of them. Type II. Characterized by presence of anti-liver-kidney-microsmal antibody and in type III autoimmune hepatitis, antibodies to soluble liver antigen is positive. Type IV autoimmune hepatitis is a-seronegative autoimmune hepatitis and only in liver biopsy diagnosis confirms. In this patient both of antinuclear antibodies and anti-smooth muscle antibodies were positive. Because of bleeding processes with unresponsiveness to vit k and FFP; liver biopsy did not perform and prednisolone plus Imuran started, jaundice and fever disappeared there after, and prothrombine time (pt) became normal.

A remarkable aspect of the patient's illness is hepatomegaly, splenomegaly right upper abdominal discomfort and jaundice. In lab tests increasing of SGOT and SGPT with high level of alkaline phosphatase and gammaglutamyltranspeptidase with hypergammaglobulinemia, moderate increasing of bilirubine was seen while all the viral hepatitis markers for hepatitis A, Band C were negative. Liver ultrasonographyrevealed diffuse increase in echogenecity as compared with that of kidneys. C.T scan of liver showed some hepatic lesions that suggested of metastatic lesions. Diffuse increase in echogenecity of the liver of this patient on sonograghy and low density of hepatic parenchyma on C.T scan could be fatty infiltration of the liver. Regardless of the cause, cirrhosis has a similar appearanceon imanging study.This patient as mentioned in her medical history did not consume alcohole, but in lab tests we noted her triglyceride and cholesterol were high and because of rheumatiod arthritis she has been on metothorexate since two years ago. On lab tests all the viral hepatitis markers were negative and esophagogasteroduodenal endoscopic examination showed no ponal hypertention (no dilatation of esophagalveinsin inferior part of esophagus). Steatosisin mostpatients with non- alcoholic fatty liver may have appearance of malignant liver. hypercalcemiamay be co- existence with cancer of liver in this patient. hypercalcemia may have many causes but what are the clues to the cause of hypercalcemia in this case? hyperparathyroidism, hyperthyroidism, thiaside diuretic consumption, chronic renal failure, Addison's disease and ingestion of excess vit A or vit D may cause hypercalcemia, as in this case; because of Rheumatoid arthritis, she has been prescribed excess dosage of vit D Serum protein electrophoresis of this case revealed hypoalbuminemia and hypergammaglobulinemia a phenomena we see too often in chronic liver diseases.In this patient, liver biopsy is the best diagnositic tool and it is usefull to determine kind of treatment and alimentary restrictions. In liver biopsy assay by grading for steatosis and staging for fibrosis you can find the depth of liver lesions. Liver biopsy was done and pathologist data was non-alcoholic steatohepatitis, precirrhotic stage.Conclusion: in non-alcoholic fatty liver with cirrhottic stage, steatos is is diffuse in most patients but, occasionally it is focal in imaging study, both ultrasonography and C.T. Scan may be misinterpreted as showing malignant tumours of liver. In such cases MRI can distinguish space occupying lesions from focal fatty infiltration. But gold standard of diagnosis is liver biopsy. In this patient pathologist data was macro and microvesicularballooning, PMN cells infiltration aroundthe hepatocytes and fibrosis around the hepatocytes. And bridging fibrosis.Scoring: grade II stage IIIThe patient advised for weight loss, avoiding of fatty meals and home Remedies for one year and vitamin E and, B couplex prescribed. Some experts use clofibrate or metformine.

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.

The CSF smear stained with Indian ink and showed shining round agents in the dark field resembling fungal infection. CSF culture in commeal media performed and amphotricin B 0.6 mg/kg/bw started. Two periodic CSF cultures in Saboureux and commeal media were positive for cryptococcus and another skul CT scan with contrast was performed. And an increasing density of brain paranchyma along the caudate nucleus was reported indicating hemorrhages or brain calcification!?EEG was performed and low voltage waves in all the zones of brain, indicating diffuse brain parenchyma lesion was reported.An HIV1 antibody assay was non reactive, anti HTLV 1,2, Hepatitis B markers and quantitative immuno globulin's were normal.CSF for mycobacterium tuberculosis antigens with PCR assay was done and it was negative. Flowcytometry of peripheral blood was done and it was at a normal range. Continuing amphotricin B therapy made a high serum creatinine so, with adjusting the dosage, the drug continued with 3 weeks treatment the condition became better but in spite of receiving amphotricin B. the situation of patient gradually got worse and in blood culture for bacteria, citrobacter diversus was grown with sensitivity only to cotrimoxazole. Another blood analysis was done and showed leukocytosis and neutrocytosis. Eventually the patient with concurrent infection (nasocomal sepsis) and renal insufficiency expired.Definitive diagnostic of cryptococcal infections requires cultures of organism. Yield from culture is dependent on the quality and the processing of specimens.Detection of cryptococcus antigen by latex agglutination test in CSF serum or urine is sensitive in 90% or more of patients with cryptococcal meningitis. High titers of cryptococcal antigen in serum and CSF before treatment have been correlated with high mortality and poor outcome. Antigen titer is also useful in monitoring therapeutic response to treatment. Practice guidelines for the treatment of cryptococcal disease have recently been published.Treatment is dependent on the anatomic site of disease and immune status. All individuals with significant cryptococcal infection require evaluation of CSF because of predilection for infection of the CNS. For these patients with CNS disease treatment with Amphotricin B in combination with flucytosine is indicated. For HIV infected persons who develop cryptococcal disease regardless of CNS involvement, lifelong maintenance therapy with fluconazal is recommended.Our patient must be treated with Amphotricin B plus flucytosine 400 mg/day for 6 months but unfortunately flucytosine was not available and on the other hand renal insufficiency and concurrent citrobacter diversus sepsis and multiorgan failure expired the patient.

Peripheral blood smear and CBC revealed leukocytosis (15, 500), an absolute lymphocytosis (80%) and an increase in the number of atypical lymphocytes. The most striking finding of peripheral film was Downey cells, a large mononuclear cell with eccenteric nucleus. Atypical lymocytes represented 12% of WBCs. These finding strongly suggest Infectious Mononuleosis, but it should be kept in mind that atypical lymphocytes may also occur in other diseases, like CMV infection, toxoplasmosis, Bacterial endocarditis, streptococcal infections and hypersensitivity states.Both relative and absolute neutropenia often develop early in the course of Inf Mononucleosis. Toxic granules and Dohle bodies may also be present.So the definitive diagnosis of Inf Mononucleosis is established by EBV-Specific serology. Recovery of the virus does not distinguish between current and past infections. In those cases where Inf Mononucleosis produces clinically apparent disease, aditional tests such as Hetrophil antibodies titer and WBC count and differential, find a place in diagnosis. So hetrophil antibody test (Paul-Bunnell) was done and it was positive.Recent advances in immunology have permitted the application of latex agglutination, RIA and Elisa assay to detection of the hetrophil response.Aplastic anemia is the most serious hematologic complication of Inf Mononucleosis. Less serious but more common than paneytophenia is the occurrence of hemolytic anemia affecting 0.5% to 3% of the patients with Infect Mononucleosis. Almost all episodes of hemolysis resolve spontaneously.Thrombocytopenia and platelet function abnormalities have also been described in Inf mononucleosis. Abnormal platelet aggregation and release of PLT factors have been reported. Dermatological manifestation occurs between 5%-10%, administration of antibiotic agents and appearance of a Maculopapular rask is a common complication of antibiotic therapy in IM, especially who receive ampicillin or penicillin. Exudative pharyngeal infection may be the result of streptococal infection. Neurologic complication occurring with EBV infection include: encephalitis, Meningitis, optic neuritis Guillian Barre' synd, SSPE, depression and psychosis. Depression occurs quite frequently in some patients objects appear distorted and change in size that is called "Alice in wonder -land syndrome".This patient received corticosteroid and after that acute symptom relieved. Routine administration of steroids in all cases to engender unnecessary risk. Additional therapies include INF-2, Metronidzole, Tinidazole, Acyclovir and There agents decrease anaerobic flora in the throat. Clinical controlled trials have not demonstrated any benefit in Acyclovir therapy.

on chest X-ray there are calcified lesions on hilar regions of both lungs; lesions that inalicates the presence of old heald granulomatous disease.The patient has immigrated from Afghanistan, where tuberculosis is a common problem of people, the patient has hyponatremia a finding more common in T.B. meningitis so another L.P was performed and CSF was sent for Stewart, PCR assay and culture for tuberculosis in the second CSF exam. The level of protein had increased (350 mg/dl) while CSF glucose decreased and a shifting CSF, PMN to lymphocyte were reported.Anti tuberculosis drugs were initiated (INH, RMP, PZP, ETB) and blood gasometric test, PPd and B.A. lavage for B.K performed, in the third hospital day, febrile agglutination tests, L.F.T, kidney function tests were performed and dark field illumination test of centrifuged CSF was done and it was negative. Cold agglutination assay and standard tube test for brucella, both of them were negative too. Headache in-patients thought to have tuberculosis should always raise the possibility of T.B meningitis. In the early stage of disease headache and fever may be the only symptoms. Analysis of CSF usually shows lymphocytic pleocytosis.Hypoglycorochia is present in approxinately 70% of cases. Smears of CSF are rarely positive in TB meningitis. CSF, PCR assay for BK was positive, but blood cultures sputum culture and CSF culture were all negative. After starting anti TB drugs additional treatment with dexamethasori and pyridoxine, the situation of patient gradually because better and after 4 weeks hospitalization he was discharged and ased him to come back to outpatient clinic for control of treatment of T.B.