medical journal of mashhad university of medical sciences1735-401357420140923Comparison of the hemodynamic effects of Etomidate versus propofol, Rapid Sequence Intubation, on none surgical patientsComparison of the hemodynamic effects of Etomidate versus propofol, Rapid Sequence Intubation, on none surgical patients602608320210.22038/mjms.2014.3202FASeyyed Mostafa Moosavi TekyeAssociate Professor of Anesthesiology/ Mashhad University of Medical Scienses, Mashhad, IranSeyyed Mostafa PashangResident of Anesthesiology/ Mashhad University of Medical Scienses, Mashhad, IranJournal Article20140223Introduction <br />Rapid sequence intubation is planned to protect airway from aspiration and keep patient's ventilation in critically ill cases. Intubation need a sedative drug that has the least hemodynamic instability effect and complications. This prospective-randomized study compared the hemodynamic effects of Etomidate and propofol during Rapid sequence Intubation on non surgical patients. <br />Materials & Methods <br />Critically ill patients with ASA III, IV who needed rapid sequence intubation were divided into two groups of 47 patients. Patients first sedated with 2µ/kg fentanyl and ventilated with bag and mask (sellick's maneouvre). In group 1 1mg/kg propofol and in group 2 0.3 mg/kg etomidate were injected.Vital signs and oxygen saturation were recorded before and five minutes after intubation. <br />Results <br />Demographic data were similar in two groups. Systolic and diastolic blood pressure, heart rate and oxygen saturation were similar in two groups before intubation, but five minutes after intubation hemodynamic changes were less in etomidate group (p=0.000, p=0.000, p=0.047, p=0.004 respectively). <br />Conclusion <br />Usage of etomidate for sedation in rapid sequence intubation had better hemodynamic stability effect than propofol.Introduction <br />Rapid sequence intubation is planned to protect airway from aspiration and keep patient's ventilation in critically ill cases. Intubation need a sedative drug that has the least hemodynamic instability effect and complications. This prospective-randomized study compared the hemodynamic effects of Etomidate and propofol during Rapid sequence Intubation on non surgical patients. <br />Materials & Methods <br />Critically ill patients with ASA III, IV who needed rapid sequence intubation were divided into two groups of 47 patients. Patients first sedated with 2µ/kg fentanyl and ventilated with bag and mask (sellick's maneouvre). In group 1 1mg/kg propofol and in group 2 0.3 mg/kg etomidate were injected.Vital signs and oxygen saturation were recorded before and five minutes after intubation. <br />Results <br />Demographic data were similar in two groups. Systolic and diastolic blood pressure, heart rate and oxygen saturation were similar in two groups before intubation, but five minutes after intubation hemodynamic changes were less in etomidate group (p=0.000, p=0.000, p=0.047, p=0.004 respectively). <br />Conclusion <br />Usage of etomidate for sedation in rapid sequence intubation had better hemodynamic stability effect than propofol.medical journal of mashhad university of medical sciences1735-401357420140923Evaluating the frequency of hamstrings muscle Pain and tightness in Patients suffering from lumbosacral spinal StenosisEvaluating the frequency of hamstrings muscle Pain and tightness in Patients suffering from lumbosacral spinal Stenosis609615320310.22038/mjms.2014.3203FASeyyed Reza SaeidianAssistant professor of physical medicine and rehabilitation/ Jundishapur University of Medical Sciences, Ahvaz, IranMasoud ZeinaliAssistant professor of neurosurgery/ Jundishapur University of Medical Sciences, Ahvaz, IranAlireza TeimooriAssistant professor of neurosurgery/Jundishapur University of Medical Sciences, Ahvaz, IranSeyyed Mahmood LatifiMSc, PhD by research/ diabetes research center, Jundishapur University of Medical Sciences, Ahvaz, IranJournal Article20131122Introduction <br /> Pain and hamstring muscles tightness is a common disorder among patients suffering from lumbosacral spinal stenosis. The origin of this problem may be the irritation of the spinal nerve roots or from the muscles.The purpose of this study was to determine the impact of muscle pain treatment in patients suffering from spinal stenosis. <br />Materials & Methods <br /> By an experimental study, during four years, all patients suffering from the lumbo sacral spinal stenosis in Ahwaz, Imam Khomeini hospital were recruited. They were sent for a ten days period of conservative therapy for their back. Their pain scale were measured before and after the treatment via visual analogue (VAS). If they did not respond to the early treatment and had suffered from hamstring tightness and pain more than 5.5 scale, they were sent for another conservative treatment for their hamstring muscles. Before and after the treatment changes of patients' pain and their ability to extent their knees were compared by paired T test. <br />Results <br />Overall 196 patients recruited . Seventy patients had suffered from a pain with the scale more than 5.5, along with the pain in extending their knees. Following receiving the conservative treatment for their hamstring muscles, their pain and ability to extent their knees improved (p=0.002). <br />Conclusion <br />This study showed that some of the lumbosacral canal stenoic patients suffered from their hamstring muscle involvement too. The diagnosis and especial treatment of these muscles leads to a better outcome and avoiding unnecessary work ups.Introduction <br /> Pain and hamstring muscles tightness is a common disorder among patients suffering from lumbosacral spinal stenosis. The origin of this problem may be the irritation of the spinal nerve roots or from the muscles.The purpose of this study was to determine the impact of muscle pain treatment in patients suffering from spinal stenosis. <br />Materials & Methods <br /> By an experimental study, during four years, all patients suffering from the lumbo sacral spinal stenosis in Ahwaz, Imam Khomeini hospital were recruited. They were sent for a ten days period of conservative therapy for their back. Their pain scale were measured before and after the treatment via visual analogue (VAS). If they did not respond to the early treatment and had suffered from hamstring tightness and pain more than 5.5 scale, they were sent for another conservative treatment for their hamstring muscles. Before and after the treatment changes of patients' pain and their ability to extent their knees were compared by paired T test. <br />Results <br />Overall 196 patients recruited . Seventy patients had suffered from a pain with the scale more than 5.5, along with the pain in extending their knees. Following receiving the conservative treatment for their hamstring muscles, their pain and ability to extent their knees improved (p=0.002). <br />Conclusion <br />This study showed that some of the lumbosacral canal stenoic patients suffered from their hamstring muscle involvement too. The diagnosis and especial treatment of these muscles leads to a better outcome and avoiding unnecessary work ups.medical journal of mashhad university of medical sciences1735-401357420140923Effectiveness of safeguard measures in controlling a nosocomial outbreak of Crimean-Congo hemorrhagic feverEffectiveness of safeguard measures in controlling a nosocomial outbreak of Crimean-Congo hemorrhagic fever616621320710.22038/mjms.2014.3207FAMehdi Hassani AzadInfectious specialist assistant/ Imam Reza hospital, school of Medicine, Mashad University of Medical sciences, Mashad, IranFarshid AbediAssociated professor of infectious department/ school of Medicine, Mashad University of Medical sciences, Mashad, IranSadegh ChiniKarAssociated professor & Head of Arbo viruses-Hemorrhagic Fever/ Iran Pasteur Institute, Pasteur Institute, Thran, IranAmin BojdyAssistant professor / department of infections diseases, school of Medicine, Mashad University of Medical sciences, Mashad, IranJournal Article20140115Introduction : <br />Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection. Humans become infected through tick bites, contact with infected blood or organs or tissues of human or animals. The disease has caused nosocomial outbreaks with high mortality. Following the admission of a CCHF patient to infectious ward of Imam Reza Hospital in Mashhad a nosocomial outbreak occurred. <br />Materials and Methods: <br />In 1391, all steps for standard precaution in Health Personnel in the infectious ward of Imam Reza hospital observed for Crimean-Congo hemorrhagic fever. <br />Results: <br />A total of 44 healthcare workers were in contact with the CCHF patients in this study. IgM and IgG antibodies against CCHF virus were studied on their sera, while Crimean-Congo fever antibody titers were negative in all 44 (100%).<span style="text-decoration: line-through;">.</span> <br />Conclusion: <br />There was no serologic evidence of healthcare-related CCHFV transmission in recent outbreak in Imam reza hospital.Introduction : <br />Crimean-Congo hemorrhagic fever (CCHF) is a fatal viral infection. Humans become infected through tick bites, contact with infected blood or organs or tissues of human or animals. The disease has caused nosocomial outbreaks with high mortality. Following the admission of a CCHF patient to infectious ward of Imam Reza Hospital in Mashhad a nosocomial outbreak occurred. <br />Materials and Methods: <br />In 1391, all steps for standard precaution in Health Personnel in the infectious ward of Imam Reza hospital observed for Crimean-Congo hemorrhagic fever. <br />Results: <br />A total of 44 healthcare workers were in contact with the CCHF patients in this study. IgM and IgG antibodies against CCHF virus were studied on their sera, while Crimean-Congo fever antibody titers were negative in all 44 (100%).<span style="text-decoration: line-through;">.</span> <br />Conclusion: <br />There was no serologic evidence of healthcare-related CCHFV transmission in recent outbreak in Imam reza hospital.medical journal of mashhad university of medical sciences1735-401357420140923Evaluation of the Quality of life in patients with chronic urticariaEvaluation of the Quality of life in patients with chronic urticaria622628320810.22038/mjms.2014.3208FAJavad GhaffariAssociate Professor/ subspecialist of Allergy and Clinical Immunology, Mazandaran University of Medical Sciences, Sari, IranJamshid Yazdani CharatiAssistant Professor/ Department of Biostatics, Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, IranDaniel ZamanfarAssistant Professor/ Subspecialist of Pediatric Endocrinology, Diabetes Research Center, Mazandaran University of Medical Sciences, Sari, IranAzita SadoghGeneral Practitioner/ Mazandaran University of Medical Sciences, Sari, IranJournal Article20140115Introduction: The aim of this study was to evaluate the effects of chronic urticaria on the quality of life in patients referred to Tooba allergic clinic and Bou Ali Sina Hospital in sari. <br />Materials & methods: This cross sectional study was performed on 155 Patients with chronic urticaria referred to Tooba allergic clinic and Bou Ali Sina Hospital in sari during 2013. A standard questionnaire based on the Dermatology Life Quality Index (DLQI) included demographic characteristics, criteria of the disease and various questions related to chronic urticaria was selected. Each question had five items included: always, often, sometimes, just a little and not at all. Then each item was scored between 0-4 respectively. The total score was calculated from 0 to 100. The worst score of quality of life was considered 100 and the best quality of life scored zero. <br />Results: Out of total 155 cases, 132 were enrolled in which 99 (75%) were female subjects and 33 patients (25 %) were male (female to male ratio, 3 to 1). Seventy nine (60%) had degree of diploma or a bachelor of science. Most of the patients were married (87 people) and 58 of the patients were housekeepers. The numbers of lesions were often between 1 and 10 in 55 cases (42%). Daily living activities were the worst among patients under the age of 20 years, and the best daily activities belonged to the patients older than 40 years. While more severe disease was associated with worse quality of life. <br />Conclusion:This study showed that chronic urticaria in some aspects of quality of life of patients affected and the disease is more severe the situation is getting worse every day thoughts and activities.Introduction: The aim of this study was to evaluate the effects of chronic urticaria on the quality of life in patients referred to Tooba allergic clinic and Bou Ali Sina Hospital in sari. <br />Materials & methods: This cross sectional study was performed on 155 Patients with chronic urticaria referred to Tooba allergic clinic and Bou Ali Sina Hospital in sari during 2013. A standard questionnaire based on the Dermatology Life Quality Index (DLQI) included demographic characteristics, criteria of the disease and various questions related to chronic urticaria was selected. Each question had five items included: always, often, sometimes, just a little and not at all. Then each item was scored between 0-4 respectively. The total score was calculated from 0 to 100. The worst score of quality of life was considered 100 and the best quality of life scored zero. <br />Results: Out of total 155 cases, 132 were enrolled in which 99 (75%) were female subjects and 33 patients (25 %) were male (female to male ratio, 3 to 1). Seventy nine (60%) had degree of diploma or a bachelor of science. Most of the patients were married (87 people) and 58 of the patients were housekeepers. The numbers of lesions were often between 1 and 10 in 55 cases (42%). Daily living activities were the worst among patients under the age of 20 years, and the best daily activities belonged to the patients older than 40 years. While more severe disease was associated with worse quality of life. <br />Conclusion:This study showed that chronic urticaria in some aspects of quality of life of patients affected and the disease is more severe the situation is getting worse every day thoughts and activities.medical journal of mashhad university of medical sciences1735-401357420140923Comparison of recurrence rate and post-operative complications of total and subtotal thyroidectomy in surgical treatment of multi nodular goiterComparison of recurrence rate and post-operative complications of total and subtotal thyroidectomy in surgical treatment of multi nodular goiter629635321010.22038/mjms.2014.3210FAAmin JahaniAssistant of General Surgery/ Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranParvin LayeghAssistant Professor of Endocrinology and Metabolism / Endocrine Research Center,Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranFarnoosh YariStudent of Medicine/Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMehdi AsadiAssistant Professor of General Surgery/ Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20140523Introduction : Surgery is an option for multinodular goiter (MNG), but extension of surgery is controversial due to risk of recurrence and post operative complications. So, we decided to compare these problems between subtotal (ST) and total (TT) thyroidectomy as surgical treatment of MNG. <br />Materials & Methods: This cross-sectional retrospective study was done between 2011-2012 . 104 patients with benign MNG ( 52 in TT and 52 in ST groups) that operated before year 2006 in Imam Reza Educational Hospital ,were enrolled. Rate of recurrence and surgical complications compared between two groups. P < 0.05 considered significant. <br />Results : Mean age of patients was 45.3 years .Mean duration of Follow up was 74 months . 8 patients in ST group( 15.4 %) and no patient in TT group had recurrence of goiter . ( p< 0.05) . There was no significant differences in transient and permanent hypoparathyroidism , transient and permanent recurrent laryngeal nerve palsy , mortality ,hematoma,wound infection and hospital stay duration between two groups. <br />Conclution : Total thyroidectomy as procedure of choice for multinodular goiter is recommended in Educational Hospitals with experienced surgens.Introduction : Surgery is an option for multinodular goiter (MNG), but extension of surgery is controversial due to risk of recurrence and post operative complications. So, we decided to compare these problems between subtotal (ST) and total (TT) thyroidectomy as surgical treatment of MNG. <br />Materials & Methods: This cross-sectional retrospective study was done between 2011-2012 . 104 patients with benign MNG ( 52 in TT and 52 in ST groups) that operated before year 2006 in Imam Reza Educational Hospital ,were enrolled. Rate of recurrence and surgical complications compared between two groups. P < 0.05 considered significant. <br />Results : Mean age of patients was 45.3 years .Mean duration of Follow up was 74 months . 8 patients in ST group( 15.4 %) and no patient in TT group had recurrence of goiter . ( p< 0.05) . There was no significant differences in transient and permanent hypoparathyroidism , transient and permanent recurrent laryngeal nerve palsy , mortality ,hematoma,wound infection and hospital stay duration between two groups. <br />Conclution : Total thyroidectomy as procedure of choice for multinodular goiter is recommended in Educational Hospitals with experienced surgens.medical journal of mashhad university of medical sciences1735-401357420140923Survival Rate and its Related Factors in Patients with Acute Myocardial InfarctionSurvival Rate and its Related Factors in Patients with Acute Myocardial Infarction636646321110.22038/mjms.2014.3211FAEhsan Mosa FarkhaniMSc in Epidemiology/ Mashhad University of Medial Sciences, Mashhad, IRAN0000-0002-0474-5611Mohammad Reza BaneshiPhD in Biostatistics/ Research Center for Modeling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IRANFarzaneh ZolalaPhD in Epidemiology/ Regional Knowledge Hub for HIV/AIDS Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IRANJournal Article20131209<em>Introduction</em> <br />Acute Myocardial Infarction (AMI) is one of the most common cause of mortality causes in Iran. The aim of this study was to provide a model for predicting the survival of patients with AMI in Imam Reza hospital in Mashhad. <br /><em>Materials and Methods</em> <br />We recruited 607 patient aged>25 years, admitted to the CCU of Imam Reza hospital in Mashhad. This was a 5-year retrospective study in which patients had been followed during 2007 to 2012. The main outcome of the study was death due to AMI. The effect of independent predictors on survival was examined in a multivariate Cox regression model. <br /><em>Results </em> <br />Using multivariate Cox regression analysis, variables remaining in the final model including: age ( HR:1.04, P=0.000), male gender (HR:0.71, P=0.03), diabetes (HR:1.93, P=0.000), history of ischemic heart disease (HR:1.35, P=0.04), acute transmural myocardial infarction of unspecified site (HR:3.23 P=0.007), and type of intervention and diagnostic procedures. By multiplying the significant variables into the regression coefficient, a risk score was calculated. Applying cut offs at percentiles of 25 and 75, three risk groups were identified. in low and high-risk groups 5-year survival rate was 91% and 20% respectively. <br /><em>Conclusion </em> <br />Identification of additional risk factors and providing a new approach to high-risk group may lead to increase in survival of these patients.<em>Introduction</em> <br />Acute Myocardial Infarction (AMI) is one of the most common cause of mortality causes in Iran. The aim of this study was to provide a model for predicting the survival of patients with AMI in Imam Reza hospital in Mashhad. <br /><em>Materials and Methods</em> <br />We recruited 607 patient aged>25 years, admitted to the CCU of Imam Reza hospital in Mashhad. This was a 5-year retrospective study in which patients had been followed during 2007 to 2012. The main outcome of the study was death due to AMI. The effect of independent predictors on survival was examined in a multivariate Cox regression model. <br /><em>Results </em> <br />Using multivariate Cox regression analysis, variables remaining in the final model including: age ( HR:1.04, P=0.000), male gender (HR:0.71, P=0.03), diabetes (HR:1.93, P=0.000), history of ischemic heart disease (HR:1.35, P=0.04), acute transmural myocardial infarction of unspecified site (HR:3.23 P=0.007), and type of intervention and diagnostic procedures. By multiplying the significant variables into the regression coefficient, a risk score was calculated. Applying cut offs at percentiles of 25 and 75, three risk groups were identified. in low and high-risk groups 5-year survival rate was 91% and 20% respectively. <br /><em>Conclusion </em> <br />Identification of additional risk factors and providing a new approach to high-risk group may lead to increase in survival of these patients.medical journal of mashhad university of medical sciences1735-401357420140923Epidemiology of cutaneous leishmaniasis in population covered by Mashhad university of medical sciences in 2011Epidemiology of cutaneous leishmaniasis in population covered by Mashhad university of medical sciences in 2011647654321310.22038/mjms.2014.3213FAMohammad KhajedalueeAssociate Professor of community Medicine/ Mashhad University of Medical Sciences, Mashhad, IranMohammad Javad YazdanpanahAssociate Professor of Dermatology/ Cutaneous Leishmaniasis Research Center, Ghaem Hospital, Department of Dermatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranSeyedMohsen SeyedNozadiProfessor of community Medicine/ Mashhad University of Medical Sciences, Mashhad, IranAbdolmajid FataProfessor of Parasitology & Mycology/ Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-5175-529xMohammad Reza JuyaNon-Communicable & Communicable Diseases health department/ Mashhad University of Medical Sciences, Mashhad, IranMohammad Hasan MasoudiNon-Communicable & Communicable Diseases health department/ Mashhad University of Medical Sciences, Mashhad, IranMona Najaf NajafiResident of Community Medicine and Member of Student Research Committee/ Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20131225Introduction: leishmaniasis in Iran is a major healthcare problem. Epidemiological studies are effective in disease control and preventive measures. The aim of this study was to investigate the epidemiology of cutaneous leishmaniasis in Razavi Khorasan province in 2011. <br /> Materials and Methods: This descriptive-analytical survey was conducted on cutaneous leishmaniasis patients in 2011. Recorded demographic and epidemiological information of patients were extracted from disease surveillance department of Mashhad university of medical sciences. Data were analyzed by SPSS version 11.5. <br />Results :The number of cutaneous leishmaniasis patients was 3558. According to the population coverage of Mashhad university of medical sciences, disease incidence was 7.2/10000 and 52% of patients were men. Most cases were children (under 10 years old) and youth (20-30 year old). Highest disease frequency was observed in students and housewives. The disease incidence in Torghabeh _Shandiz, Sarakhs and Daregaz was 92.3, 27.6 and 16 cases per ten thousands people, respectively. <br />Conclusion: The disease incidence in Razavi Khorasan was moderate compared to the other endemic areas of Iran. However, this frequency was still significant. According to high disease incidence in children and housewives, these groups needed to be trained in disease prevention and increase their level of health literacy.Introduction: leishmaniasis in Iran is a major healthcare problem. Epidemiological studies are effective in disease control and preventive measures. The aim of this study was to investigate the epidemiology of cutaneous leishmaniasis in Razavi Khorasan province in 2011. <br /> Materials and Methods: This descriptive-analytical survey was conducted on cutaneous leishmaniasis patients in 2011. Recorded demographic and epidemiological information of patients were extracted from disease surveillance department of Mashhad university of medical sciences. Data were analyzed by SPSS version 11.5. <br />Results :The number of cutaneous leishmaniasis patients was 3558. According to the population coverage of Mashhad university of medical sciences, disease incidence was 7.2/10000 and 52% of patients were men. Most cases were children (under 10 years old) and youth (20-30 year old). Highest disease frequency was observed in students and housewives. The disease incidence in Torghabeh _Shandiz, Sarakhs and Daregaz was 92.3, 27.6 and 16 cases per ten thousands people, respectively. <br />Conclusion: The disease incidence in Razavi Khorasan was moderate compared to the other endemic areas of Iran. However, this frequency was still significant. According to high disease incidence in children and housewives, these groups needed to be trained in disease prevention and increase their level of health literacy.medical journal of mashhad university of medical sciences1735-401357420140923Frequency of erm A, B, C genes in Erythromycin resistant Enterococci isolated from Clinical samples of inpatients of Teaching Hospitals in Qazvin & TehranFrequency of erm A, B, C genes in Erythromycin resistant Enterococci isolated from Clinical samples of inpatients of Teaching Hospitals in Qazvin & Tehran655662321510.22038/mjms.2014.3215FAMasoumeh AslanimehrAssistant Professor in Qazvin University of Medical Sciences/Cellular & Molecular Research Centre & Department of Microbiology , Qazvin, IranAmir PeymaniAssistant Professor in Qazvin University of Medical/ Department of Microbiology, Qazvin University of Medical Sciences, Qazvin, IranDavood Darzi RamandiMSc. In Microbiology / Qazvin University of Medical Sciences, Cellular & Molecular Research Centre & Department of Microbiology , Qazvin, IranTaghi Naserpour-FarivarProfessor in Microbiology/ Cellular & Molecular Research Centre & Department of Microbiology, Qazvin University of Medical Sciences, Qazvin, IranJournal Article20140406Introduction: <em>Enterococci</em> are among the most important causes of urinary tract infections. The aim of this study was to assess the frequency of <em>erm A, B, </em>and<em> C</em> genes in erythromycin-resistant <em>Enterococci</em> isolated from the clinical samples of inpatients of university teaching hospitals in Qazvin and Tehran. <br />Materials and Methods: From 2012 to 2013, a total of 165 samples of <em>enterococci</em> were isolated from the clinical samples of inpatients. Susceptibility to erythromycin in <em>enterococci</em> isolates was performed by agar dilution and disk diffusion methods according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Erythromycin resistance genes (<em>ermA, B,</em> and <em>C</em>) were identified by PCR. <br /> Results: Out of 165 clinical isolates of <em>enterococci</em>, 142 (86%) isolates were <em>Enterococcus faecalis</em> and 23 (13.9%) isolates <em>Enterococcus faecium</em>. The results of susceptibility test showed that 158 (% 95) isolates were resistant or with intermediate sensitivity to erythromycin. There was a good correlation between the results of disk diffusion and agar dilution methods. Of total samples, 147 (89%) isolates were resistant to erythromycin (MIC≥8 µg/ml), 11 (6.6%) isolates with intermediate sensitivity (MIC 1-4 µg/ml), and 7 (4.2%) isolates with complete sensitivity to erythromycin (MIC ≤ 0.5 µg/ml). <br /> Conclusion: The results of this study showed high prevalence of <em>ermA</em>, <em>B</em>, and <em>C</em> genes in erythromycin-resistant strains with <em>ermB </em>asthe most common resistance gene among these isolates.Introduction: <em>Enterococci</em> are among the most important causes of urinary tract infections. The aim of this study was to assess the frequency of <em>erm A, B, </em>and<em> C</em> genes in erythromycin-resistant <em>Enterococci</em> isolated from the clinical samples of inpatients of university teaching hospitals in Qazvin and Tehran. <br />Materials and Methods: From 2012 to 2013, a total of 165 samples of <em>enterococci</em> were isolated from the clinical samples of inpatients. Susceptibility to erythromycin in <em>enterococci</em> isolates was performed by agar dilution and disk diffusion methods according to the Clinical and Laboratory Standards Institute (CLSI) guideline. Erythromycin resistance genes (<em>ermA, B,</em> and <em>C</em>) were identified by PCR. <br /> Results: Out of 165 clinical isolates of <em>enterococci</em>, 142 (86%) isolates were <em>Enterococcus faecalis</em> and 23 (13.9%) isolates <em>Enterococcus faecium</em>. The results of susceptibility test showed that 158 (% 95) isolates were resistant or with intermediate sensitivity to erythromycin. There was a good correlation between the results of disk diffusion and agar dilution methods. Of total samples, 147 (89%) isolates were resistant to erythromycin (MIC≥8 µg/ml), 11 (6.6%) isolates with intermediate sensitivity (MIC 1-4 µg/ml), and 7 (4.2%) isolates with complete sensitivity to erythromycin (MIC ≤ 0.5 µg/ml). <br /> Conclusion: The results of this study showed high prevalence of <em>ermA</em>, <em>B</em>, and <em>C</em> genes in erythromycin-resistant strains with <em>ermB </em>asthe most common resistance gene among these isolates.medical journal of mashhad university of medical sciences1735-401357420140923Diagnosis and treatment of Restless leg syndrome in a child with chronic renal failure:A case reportDiagnosis and treatment of Restless leg syndrome in a child with chronic renal failure:A case report663668321910.22038/mjms.2014.3219FAMajid MalakiPediatric Health Research Center/ Tabriz university of Medical Sciences, Tabriz, IranAnoush AzarfarDepartment of Pediatrics/School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-2026-3495Aghillolah KeykhosraviDepartment of Pediatrics/ School of Medicine, Sabzevar University of Medical Sciences, IranYalda RavanshadEDC/ Mashhad University of Medical Sciences, Mashhad, IranJournal Article20140111Introduction: Restless leg syndrome is a common problem in chronic renal failure with adverse effects on the quality of life. <br />Case report: In this article we presented a 5 year old boy with chronic renal failure and restless leg syndrome who did not respond to oridinary treatments .Levodopa/carbidopa caused rapid and effective result with least adverse effects. <br /> Conclusion: levodopa/carbidopa can be used in treatment of Restless leg syndrome which is unresponsive to oridinary treatments.Introduction: Restless leg syndrome is a common problem in chronic renal failure with adverse effects on the quality of life. <br />Case report: In this article we presented a 5 year old boy with chronic renal failure and restless leg syndrome who did not respond to oridinary treatments .Levodopa/carbidopa caused rapid and effective result with least adverse effects. <br /> Conclusion: levodopa/carbidopa can be used in treatment of Restless leg syndrome which is unresponsive to oridinary treatments.