Zahedan Journal of Research in Medical Sciences
Volume:15 Issue: 2, Feb 2013

Surgical intervention has been recently advocated in the treatment of morbid obesity. The objective of this study was to review surgery as an alternative in the treatment of morbidly obese adolescents. This research was conducted by searching English websites such as PubMed, Up to Date, and Google Scholar, as well as some Persian websites including SID, Iranmedex, and Magiran. Articles published from 2000 to 2010 on interventional and clinical trials were reviewed for treatment of morbid obesity in adolescents. Keywords used in internet searches include obesity; adolescence; and surgery. The results obtained from the studies indicated that 4% of American adolescents suffer from morbid obesity. So far, pharmacological treatment and other approaches toward this type of obesity have been inefficient. Hence, surgery was employed as one of the new approaches to the treatment of this disorder. According to the National Health Institute criteria, in the treatment of adolescent candidates for surgery, anthropometric measurements are performed together with the measurement of other co-morbidities of obesity. Adolescents whose percentiles are ≥99 are considered as morbidly obese patients. The results of the studies suggested that for the extremely obese adolescents, who do not respond to other types of medical interventions within 6 months, surgery can be performed. Adolescents with BMI of ≥40 kg/m2 and skeletal maturity, or those with co morbidities of obesity, or 13-year-old girls and boys ≥15 years of age can be candidates for surgery. However, the side effects of obesity should not be neglected. Therefore, before the adolescent obesity become morbid obesity, preventive measures should be taken through changes in lifestyle.

Psoriasis is a chronic inflammatory skin disease characterized by excessive cellular replication. Vascular adhesion protein-1 (VAP-1) is an adhesion molecule with an enzymatic activity that partakes in the migration process of lymphocytes into sites of inflammation. The current study aimed to investigate the plasma lipids and VAP-1 in serum of psoriatic patients in Kermanshah (Iran). This was a descriptive analytical study carried out on 80 psoriatic patients, and 80 healthy volunteers as control group. Serum lipids (triglyceride (TG), cholesterol (Ch), HDL-cholesterol and LDL-cholesterol) were determined by enzymatic methods. The level of VAP-1 protein was evaluated by ELISA method. The mean levels of cholesterol, TG, HDL and LDL in patients were 167.7, 123.4, 44.1 and 112.3 mg/dl, respectively. However, these values in control group were 156.7, 113.3, 45.5 and 102.4 mg/dl, respectively. In addition, the mean of VAP-1 protein in psoriatic patients and control group was 289.8 and 192.7 ng/ml, respectively. Cholesterol level and VAP1 protein in psoriatic patients were found to be significantly higher than those of control group. The current study showed that the levels of cholesterol and VAP-1 in psoriasis patients were significantly higher than control group. This higher level may be account for high prevalence of cardiovascular diseases among these patients and it may be useful to do early screening and treatment of psoriatic patients to prevent the atherosclerosis and its complications.

Premature birth is a cause of prenatal mortality and covers 60-80% of deaths caused by the congenital defects. Despite eye-catching developments in medical sciences, premature birth statistics are still high and impose hefty costs on the society. Laboratory indexes such as IL-6 and IL-8 are used to predict the preterm delivery. In this study, the role of IL-6 and IL-8 of cervix in women with preterm labor and term delivery were compared. This case-control study was performed on 89 patients, 60 patients in control group and 29 patients in the study group, who had symptoms of preterm labor. Endocervical swab samples were collected from all patients in order to study IL-6 and IL-8 levels using ELISA technique. SPSS-15 statistical software was used for the analysis of data. T-test was used to assess different qualitative variables. 78 patients (87.63%) and 11 patients (12.35%) had term and premature deliveries, respectively. The two groups had not significant difference in terms of weight and size. A significant statistical difference only in cervix IL-8 was observed between the two term and preterm groups after comparison of the mean variables. Cervico-vaginal level of IL-8 in premature deliveries is higher than term deliveries and it can be used to predict premature delivery.

The pain of the chest and abdominal injuries in patients who undergoing mechanical ventilation is controlled by regional or systemic administration of drugs. We designed this study for comparison of effect of intravenous and epidural injection of fentanyl on pain reduction and hemodynamic status in patients with abdominal and thoracic injuries. In this prospective clinical trial study, we randomly allocate 60 patients aged 16 to 80 years who were undergoing mechanical ventilation due to thoracic or abdominal injuries, to two groups. In B group during first 24 hour of admission pain management was done by epidural infusion of fentanyl and in the next 24 hours, this method was changed to intravenous infusion of fentanyl. In A group, initially method was intravenous and after 24 hours, we changed it to epidural method. We assessed pain score and hemodynamic status at the specific times. In both groups after first 2 hours, pain sore was significantly lower in intravenous method but after 6 hours, pain score was significantly lower in epidural method. Hemodynamic status in epidural method was significantly more stable than IV method. This study showed that for patients who were undergoing mechanical ventilation due to chest or abdominal injuries, intravenous infusion of fentanyl provides more pain relief during first two hours but after six hours epidural method is better than intravenous infusion.

The paper tries to examine the effect of avastin on visual acuity in patients with Ischemic and non-ischemic diabetic macular edema which was estimated convenient, inexpensive, safe, and quick in contrast to laser or deep vitrectomy. In this clinical trial study, patients with clinically significant macular edema (CSMA) were subjected to fluorescein angiography (FA) and people whose foveal avascular zones (FAZ) were over 1000 µm were defined as ischemic diabetic macular edema. Patients were divided into two ischemic and non-ischemic groups. The best corrected visual acuity (BCVA) and the central macular thickness (CMT) in all eyes were measured and recorded by optical coherence tomography (OCT). All patients received 3 vitreous injections of bevacizumab (avastin) at 1-month intervals. One month after the third injection, BCVA and CMT were measured again and patient’s information was compared before and after the injection. Out of 87 eyes (66 patients), 23 eyes (26.4%) belonged to ischemic group and 64 eyes (73.6%) belonged to non-ischemic group. In ischemic group, BCVA improved from 0.653 ±0.309 LogMAR to 0.404 ±0.255 LogMAR (p=0.001), while no significant change was seen in non-ischemic group (from 0.881 ±0.332 to 0.879 ±0.378). In ischemic group, CMT was increased from 362.9±34.66 to 278.76 ± 45.57 and in non-ischemic group it was enhanced from 353.47 ±67.61 to 239.87±55.44 (p=0.001). In spite of the great impact of vitreous injection of avastin in reducing the central macular thickness in both ischemic and non-ischemic groups and sensible improvement of patients’ visibility, the visibility itself was not improved considerably in ischemic group.

In this study, the history of viral infections of measles, chickenpox and mumps in childhood was compared between the two groups of adults with multiple sclerosis (MS) and healthy people. In this case-control study, a group of 45 MS patients and a group of 135 healthy people who were similar based on some variables were invited. Patients had a definite diagnosis of MS and control group consisted of people accompanying MS patients. Data were collected by a trained expert in face-to-face interview sessions. For data analysis, odds ratio index was calculated and 95% confidence interval was also computed. The mean age of respondents at the time of viral infections was also compared between the two groups. The proportions of infected people by measles, chickenpox and mumps among MS patients were 58%, 56% and 40%, respectively. These proportions in healthy group were 68%, 52% and 44%, respectively. There was not any significant difference between these proportions in the two groups. Mean age of morbidity for measles, chickenpox and mumps among patients were 6.8±3.1, 8.7±2.98 and 10.6±4.7 years, and were significantly higher that these mean ages (4.1±2.1, 5.3±3.1 and 8.4±2.8, respectively) among healthy people (p<0.001). Although there was not any significant difference between the history of morbidity of measles, chickenpox and mumps in the two groups of MS patients and healthy people, the mean ages of these viral infections among MS patients were significantly higher than healthy people.

Ankle injuries are among the most prevalent injuries with which a physician may encounter. In this study, the efficiency of the functional treatment was compared with the immobilization treatment in healing the acute ankle sprain. This clinical trial study was carried out on 100 male patients whose ankle sprain had been diagnosed by Yasuj Shahid Beheshti Hospital. Using block allocation randomization method and regardless of damage degree, patients were divided into two groups, functional method (1st group) or immobilization with plaster (2nd group), for treatment. Several variables such as range of motion, pain intensity, inflammation, joint tenderness and returning to work after 2, 6 and 12 weeks were examined. After two weeks, the average pain intensity in the first group (33.2±3.2) has been decreased compared to the second group (55±1.2), which showed a significant difference between the two groups (p<0.05). The average ankle range of motion in the first and second groups was 29.08±1.2 degrees and 20.4±2.2 degrees, respectively which had been increased significantly in the first group compared to the second group (p<0.03). Similarly, a considerable difference was observed in decreased inflammation and tenderness in the first group compared to the second one. In acute ankle sprains, the functional treatment is better than the immobilization treatment in alleviating pain, inflammation and improving the range of joint motion.

Labor pain is an important factor in increasing mother anxiety. The objective of this study was to assess the efficacy of transcutaneous electrical nerve stimulation (TENS) on specific acupuncture points for reducing labor pain in the first stage of labor. In this double-blind clinical trial study, 64 nulliparous healthy women who were selected based on inclusion criteria and were in their active phase of labor’s first stage, were randomly divided into 2 equal groups; according to their admittance file numbers and by lottery, the odd numbered patients were assigned to the TENS group and the even numbered to the control group. In either groups two electrodes were put on the Hegu points of both hands and two electrodes were put on the Sanyinjiao points of both feet, after cervix was dilated 4 cm. Pain scores (through visual analogue scale) were studied in both groups. Finally, the collected data were analyzed by independent t-test. The pain intensity was significantly decreased in the TENS group compared to the control group (p=0.001). Duration of the labor’s first stage in the TENS group (180 min) was significantly shorter than control group (238 min) (p=0.001). The number of labor induction with oxytocin were 16 in the TENS group (50%) and 25 in the control group (78.1%) (p=0.019). Application of TENS on acupuncture points can be used as a non-medicinal and without complication method for mother and fetus to reduce pain in the first stage of labor.

Fat embolism syndrome symptoms is due to the presence of free fat globules originates from bone marrow and deposit in parenchyma of the lung, brain, and other organs and in most cases is particularly due to long bones, or pelvic fractures and can be accompanied by considerable complications and mortality. The aim of this research is to evaluate effect of early fixation of femoral fractures on preventing of fat emboli. In a double blind nonrandomized clinical trial study 174 patients with femoral fractures enrolled in four groups and in the first 12 hours after fracture occurrence were treated as below Group I: included 53 patients were treated by means of open reduction and internal fixation with screws and plate. Group II: included 46 patients were treated by means of skeletal traction. Group III: included 33 patients that were not treated by means of any methods of fracture fixation. Group IV: included 42 patients were treated by means of interlocking intramedullary nailing. With use of Chi-square, ANOVA and Tukey post hoc test there were significant differences among groups (p=0.003). 11 patients in all groups and in Group A, any patients, in Group B, four patients (7.8%) in group three, six patients (18.1 %) in group four, one patient had fat embolism syndrome (4.2%). The main point in the prevention of fat embolism syndrome is stabilization of fracture site of long bones as soon as possible.

Determination of prevalence of celiac disease among patients with gastrointestinal symptoms was the main objective of this study. Other factors which cause digestive disorders in such patients were also studied. This cross sectional-descriptive study was conducted in Tehran province in 2006-2007; to conduct the study 5176 people were selected randomly. Out of them 670 patients with gastrointestinal symptoms were tested to determine the amount of IgA and tissue Transeglutaminase (tTg). The amount of IgA tTG was measured in individuals with IgA deficiency. Out of 670 patients, 427 (63.37%) and 243 (36.37%) patients were women and men, respectively; their average age was 42.5. Anti-tTG test was diagnosed positive in 22 patients (17 women and 5 men) (3.3%). Eight patients showed IgA deficiency. The result of IgG tTG test was found positive in three patients out of the abovementioned 8 patients. This study shows a high dispersion of celiac among Iranian patients with the gastrointestinal symptoms (3%). Routine serologic tests are recommended for diagnosing the unknown cases of sensitivity to gluten.

The purpose of the study is to analyze the impact of 9-week intensive aerobic exercises and the calcium and vitamin D supplement intake on the indicators which show bone formation in young women. 44 non-athletic women in their thirties (27.18±3.65) were studied randomly in four groups: 1) Exercise, 2) Calcium and vitamin D supplement, 3) Exercise and supplement, and 4) control. The subjects exercised three sessions a week for 9 weeks, each session lasted 30-45 minutes. The blood and urinary samples were collected from the experimental and control groups while they fasted either before or after exercise program. The concentration of alkaline phosphates and procollagen I, C terminal (PICP) had been measured using DGKC and HPLC techniques, respectively. The collected data had been combined with the statistical t-tests and were analyzed by ANCOVA (p<0.05). Significant increasing of ALP and PICP was observed in exercise group (p=0.001) and exercise + supplement group (p=0.001). In supplement group, alkaline phosphate and procollagen type 1, C-terminal show a significant decrease (p=0.001), while the difference was not significant in the control group. Generally, the research results show that the intensive aerobic exercise and adequate intake of calcium and vitamin D affect positively the bone mass development during youth and they reduce fracture risk; however, such claim needs further investigations.

Colporrhaphy is a common surgical operation in women. There are many problems in this disease such as pain, lack of effective pain control, unpleasant psychological and physiological effects, etc. this study was conducted with the aim of analyzing the effect of the Kegel exercises as noninvasive relaxation methods on alleviating pain subsequent to conducting colporrhaphy operation. The present study was a clinical trial, randomized and double-blind study which was conducted on 64 patients who had undergone colporrhaphy operation in 2009. Our samples were divided into two groups. Kegel exercises were used in case group before surgical operation in order to alleviate pain while routine cares were used in the control group. The severity of pain, volume of narcotic consumption, and frequency of narcotic consumption during first 48 hours were studied. The data were analyzed with SPSS-12 software and student t-test. According to Visual Analogue Scale (VAS), the mean pain severity after surgical operation in two case and control groups stood at 5.9±0.8 and 7.9±0.5, respectively. In the meantime, the average frequency of drug consumption stood at 4.09±1.03 times, the average amount of drug consumption in the case and control groups stood at 47.4±46.9 and 154.7±51.4 mg, respectively. The above results were statistically significant (p=0.05). Using Kegel exercises after Colporrhaphy surgical operation is associated with less pain and frequency and amount of drug consumption has been distinguished less. It is recommended to use Kegel exercises as a noninvasive and non-pharmaceutical method in order to reduce pain after colporrhaphy operation.

Considering the fact that breech presentation is the most common abnormal presentation, the present paper compares the preparation of those people who had been born with breech and cephalic presentation. In this cross-sectional study we examines 1847 children in primary schools in Zahedan who had been born in 1994-1999; they were selected randomly from three elementary schools in Zahedan. Questionnaires were used to collect information and information about educational preparation of students were gathered using the standard and approved questionnaires by the Education Department of Iran archived in the patients’ profiles. To analyze the data, t-test and χ2 test had been used and p<0.05 was considered significant. Out of the 1847 examined children, 1446 children (3.78%) were male and 401 ones (7/21%) were female. 1738 patients (94%) had cephalic presentation (evident group) and 109 (6%) had breech presentation (cases). There was a significant statistical difference among the age averages of the mothers with the fetus presentation (p=0.001) and also among the average marks of the educational preparation of students and the fetus presentation (p=0.017) and children born with the breech presentation had higher scores in preparation. There was no significant difference between the mean score of the educational preparation and child delivery method (p=0.13). This study showed that school preparation scores, regardless of the mode of delivery, in breech presentation are higher than that in cephalic presentation.

Regarding the high prevalence of drug abuse in the society, the study aims at analyzing the effect of the group therapy on the social adjustment of the crack addicted patients who are under the maintenance treatment. The semi-experimental study was conducted on 24 crack addicted patients who had been selected using random sampling method. They were divided into two 12-member groups of control and case. The general Health Questionnaire (GHQ-28) (as pretest and post-test) was used to homogenizing the two groups. Bell Adjustment Inventory was used to examine the impact of group therapy on subject’s social adjustment. p<0.05 was considered significant. The control and case groups enjoy a similar condition before starting treatment process. The results showed that after the treatment the average scores of the case group in social adjustment and general health dimensions became less than that before treatment (p=0.0001). No significant relationship was found among history of crack abuse, times the patient had quitted the drug, education level, age, marital status and the social adjustment. The group therapy as a psychological treatment is effective to improve crack addicted people social adjustment and also their general health condition.

Explicit and implicit memories have different cerebral origins and learning approaches. Defective emotional words processing in children with autism may affect the memory allocated to such words. The aim of this study was comparing two types of (explicit and implicit) memories during processing the two types of (emotional and non-emotional) words in autistic children and their healthy counterparts. The present cross sectional study was conducted on 14 autistic children, who had referred to Autism Medical Treatment Center on Tehran, and 14 healthy children in kindergartens and schools across Tehran. For the explicit memory, a list of words was presented to the subjects of our study and they were asked to repeat the words they heard one time immediately and one time with delay. For implicit memory, the subjects were asked to identify the heard words among the presented words. Statistical analysis was performed using two-way analysis of variance. The results showed that the normal children have higher efficiency in explicit and implicit memory than the children with autism (p<0.01). The two-way analysis of memory type and word type showed that the former affects memory significantly (p<0.05) while word type had no significant effect. Autistic children suffer from impaired memory. This defect is higher in implicit memory than in the explicit memory. It is recommended to apply rehabilitation, training, learning approaches and also explicit memory for interventions of autistic children.

Attention Deficit Hyperactivity Disorder (ADHD) is a risk factor for Borderline Personality Disorder (BPD) during adulthood. Studying the relationship between childhood ADHD disorder symptoms and depression and borderline personality disorder symptoms among students was the main aim of this study. A total of 291 students, who were studying in Shiraz and Tabriz universities inThe academic year of 2010-2011, were selected from three groups of Humanities, Basic Sciences, and Technical-Engineering Sciences using simple sampling method. They participated in the study through completing Wender Utah Rating Scale (WURS), Borderline Personality Scale (STB) and Beck Depression Inventory (BDI-II). Pearsons correlation coefficient and multiple regression analysis were used to analyze the data. The results showed that there is a significant positive relationship between childhood ADHD and borderline Personality Disorder (BPD) in adulthood and childhood ADHD is able to predict BPD in adulthood (p<0.01). Similarly, the relationship between symptoms of childhood ADHD and depression was positive and significant (p<0.01). There is a relationship between symptoms of childhood ADHD, BPD and depression in students. It is recommended to pay due attention to the comorbidity disorders such as BPD and depression in the treatment of ADHD disorder.

The study is about to examine the effect of the selective physical exercises on gross motor activities of children with attention deficit hyperactivity disorder (ADHD). In this quasi-experimental study out of 120 students with ADHD who were studying under supervision of Tehran Department of Education of Exceptional Children, a number of 20 children (8.8±0.7 years old) with ADHD were selected randomly and based on pre-test. The measuring tool was the Bruininks-Oseretsky test of motor proficiency. The selected motor program (SPARK physical education program) including reinforcement activities, playing and sporting for children was repeated for 18 sessions by our subjects. The Kolmogorov-Smirnov test (KS-test) was used to check normal data distribution and the correlative t-test and independent t-test were used to compare mean values. Eighteen sessions of the selected motor activities for the experiment group made significant differences in all variables of the study, but it was not the case for the control group. The experiment group’s differences were running speed and agility (p=0.001), balance (p=0.001), bilateral coordination (p=0.001) and strength (p=0.001). With regard to results of the study, it can be claimed that the selected physical education program which has been inspired by Spark physical education program is able to improve gross motor skills in children with ADHD.

Since making communication with others is the most important function of speech, undoubtedly, any type of disorder in speech will affect the human communicability with others. The objective of the study was to investigate reasons behind the [high] prevalence rate of stammer, producing disorders and aglossia. This descriptive-analytical study was conducted on 118 male and female students, who were studying in a primary school in Zahedan; they had referred to the Speech Therapy Centers of Zahedan University of Medical Sciences in a period of seven months. The speech therapist examinations, diagnosis tools common in speech therapy, Spielberg Children Trait and also patient's cases were used to find the reasons behind the [high] prevalence rate of speech disorders. Psychological causes had the highest rate of correlation with the speech disorders among the other factors affecting the speech disorders. After psychological causes, family history and age of the subjects are the other factors which may bring about the speech disorders (P<0.05). Bilingualism and birth order has a negative relationship with the speech disorders. Likewise, another result of this study shows that only psychological causes, social causes, hereditary causes and age of subjects can predict the speech disorders (P<0.05). The present study shows that the speech disorders have a strong and close relationship with the psychological causes at the first step and also history of family and age of individuals at the next steps.

Acute pain intensity after surgical operation is an important predictor of the chronic post-operation pain. Thus, controlling acute pain can play an important role during the convalescence of the patient after surgery. Preemptive analgesia indicates that if controlling the pain process starts before onset of the painful process, it will be more effective than after onset of the painful process. This study was designated with regard to the importance of controlling pain and special properties of celecoxibs. As a double-blind clinical trial, the study was conducted on 80 people who have undergone leg surgery. Patients were divided into two 40-member groups and were treated with 200 mg celecoxib or placebo two hours before surgery. The statistical blocks were used for randomization purposes. Both the patient and the person who was responsible for checking the pain intensity and opioid intake were not informed on the prescribed medicine. After the surgery was wrapped up, the patient’s pain intensity was estimated based on Visual Analog Scale (VAS) 2, 6, 12 and 24 hours after surgery. After 24 hours, the uptake amount of the consumed opoid was recorded in the information form. The difference in VAS of patents two hours after surgery was not significant statistically (p=0.2); while in celecoxib group it became significantly lower than placebo group in the hours 6 (p=0.038), 12 (p=0.037) and 24 (p=0.038) after surgery. Also pethidine intake has been significantly decreased (p=0.042) in celecoxib group compared to the placebo group. Taking 200 mg celecoxib two hours before operation will decrease significantly pain intensity and opoid intake after surgery.

Liver cancer is the fifth most common cancer in men and seventh most common cancer in women. This study aims at analyzing epidemiologically the liver and bile duct cancer in Fars province during 2001 to 2008. In this epidemiological study, the crude incidence rate (CIR) was measured per 100,000 people and the liver cancer’s age-standardized incidence rate (ASR) was measured using direct standardization and world’s standard population. Out of 344 registered liver cancer cases, 54.4% were men and 45.6% were women. The ASR of liver cancer in 2008 was estimated 3.4 cases per 100,000 which has a significant ascending trend (p=0.001). The ASR in this study shows that like other countries in West Asia, Fars Province is categorized as a region with low incidence rate.

The study tries to compare the effect of carbohydrate and protein supplements intake during exercising on the hormonal response to a resistance exercise session. The subjects of the study were 20 young men who divided into two 10-member groups. During a resistance exercise session, they received drinks containing carbohydrate (CHO group) and or protein (PRO group). The blood samples were collected before and after exercise and their cortisol and insulin contents were measured. The results showed that while PRO group experienced a 17.23-unit increase in its cortisol content, it was only 0.71 units in the CHO group. Insulin response in CHO group (8.12) was significantly more than that in PRO group (4.69) (p=0.01). The results indicate that compared to protein supplements, using carbohydrate supplements during exercising enables the human body to achieve a better hormonal environment after the exercise.

Emotion regulation and anxiety sensitivity are two psychological components which play important roles in causing anxiety disorders. This study aims at predicting the Obsessive-Compulsive Disorder (OCD) based on the emotion regulation and anxiety sensitivity in university students. In this descriptive correlation study, a total of 317 students of University of Mohaghegh Ardabili were selected using available sampling method in 2010-2011 academic year and they were asked to fill out the obsessive-compulsive inventories designed for emotion regulation and anxiety sensitivity. The results of regression analysis showed that reappraisal and anxiety sensitivity are the best indicators of OCD in students. The results indicated that the reappraisal and anxiety sensitivity play a significant role in predicting OCD in students.

Regarding the high outbreak rate of the eye disorders and problems particularly accommodation disorders and convergence insufficiency in computer users, the study tries to determine the convergence, accommodation system, condition, fusion reserves and vision dimension in bank employees (who work with computers) and the control group (who are not computer users) and then to compare the mentioned parameters in the two groups. In this cross-sectional and observational study a total of 44 bank employees and 44 people as the control group members were selected randomly. Initially, refractive problems were reformed, and then accommodation, convergence and vision dimension evaluative tests were conducted. The test included measuring the near point of convergence, jump convergence, phoria, accommodation range (one eye, both eyes), ease of accommodation (one eye, both eyes), positive and negative related accommodation, near fusion versions and TNO. Our results showed that there was a not significant difference among the near point of convergence, jump convergence, near phoria, accommodation range (one eye and both eyes), ease of accommodation (one eye, both eyes), positive and negative related accommodation in bank employees and control group. Regarding the studies, the outbreak rate of accommodation and convergence disorders is higher in bank employees than the control group which would be due to over working with computer within a fixed interval.

General practitioners working in remote and rural areas sometimes need consultation with cardiologists. One practical and cost-effective way is transmission of patients’ electrocardiographic images via ordinary fax machine to the cardiologists, but there is an important question that how much agreement exists between the diagnoses made by reading an original electrocardiogram and its copy transmitted via fax. In this cross-sectional study, 60 original electrocardiographic images were given to cardiologists for diagnosis. In the next step those electrocardiographic images were faxed to the hospital through a simple cheap fax machine, one month later the same cardiologist was asked to put his diagnosis on the copied versions of electrocardiographs, and the results were compared. In 59 studied cases, the two method of diagnoses were exactly the same and only in one case the diagnoses were different. Therefore, Kappa agreement coefficient was calculated as 96%. According to the results of this study, general practitioners working in deprived areas can be certainly recommended to send patients’ electrocardiographic images to the cardiologists via fax in the case of needing consultation.

Obsessive-Compulsive Disease (OCD) incidence rate in children and adolescents is about 1-2 percent; males develop the disease more than females and it clearly is associated with attentiondeficithyperactivity disorder (ADHD), depression and body dysmorphic disorder. Regarding the fact that initial diagnosis and treatment of disorders with OCD in children can protect them from further problems in their life, in this study, the premature OCD with motor tic disorder in an 8-year-old boy is reported.