---

Background and Objective: Jaundice is a common problem among neonate undiagnosed case finally lead to kern-icterus, with significant increasing rate of subsequent morbidity. This study was done to determine the etiology of of severe indirect hyperbilirubnemia in term neonates. Materials and Methods: This cross sectional descriptive study was performed in Taleghany hospital of Gorgan on neonates admitted due to severe hyperbilirubinemia from Sep 2004-Sep 2005. Severe hyperbilirubinemia was considered as bilirubin≥18 mg/dl in term neonates weighing more than 2500g. Bilirubin (total, direct), blood culture, retic count, coombs test, level of glucose 6 phosphate dehydrogenase enzyme, complete blood cell count, mother's and neonate's blood group, urine culture and C-reactive protein tests were measured. Results: 766 term neonates (>2500g) were hospitalized due to hyperbilirubinemia. Severe hyperbilirubinemia was detected in 12% of cases (54 boys, 38 girls). The etiology of 41 cases were unknown, 25 cases were diagnosed as sepsis, 15 neonates were glucose 6 phosphate dehydrogenase enzyme deficient, 7 cases had UTI, 3 neonates had ABO incompatibility and one neonate was due to breast feeding. Conclusion: This study indicated that the most common etiology of severe hyperbilirubinemia in this region is unknown. Sepsis, glucose 6 phosphate dehydrogenase enzyme deficiency, UTI, ABO incompatibility and breast feeding were among other reasons for severe indirect hyperbilirubinemia.

---

Background and Objective: The prevalence of hepatitis B infection is increasing worldwide. The main way to prevent hepatitis B transmission to newborns can be through accurate detection of HBsAg positive pregnant women and implementation of standard protocol for their infants. Therefore, this study carried out to determine the frequency of HBsAg in pregnant women in Gorgan, Iran. Materials and Methods: This cross sectional study was done on 1553 pregnant women whom attended to Dezyani hospital in Gorgan, North of Iran during 2008-09. Blood samples were taken and tested for HBsAg and HBeAg using ELISA method. Results: HBsAg was found positive in 15 (1%) pregnant women. However, HBeAg were negative in all cases. Seven of these cases (46.7%) were not diagnosed before admission to the hospital for delivery and therefore had not received any immunoprophylaxis or HBIG treatment for their newborns. In contrary, six mothers and their newborns received immunoprophylaxis due to falsely diagnosed HBsAg seropositive. Conclusion: This study showed that the current protocols for dealing with HBsAg seropositivity and case finding among pregnant women in this region should be thoroughly revised. Furthermore, it is suggested that pregnant women during third trimester should be screened for HBsAg.

---

Visceral leishmaniasis, also known as Kala-azar, is one of the main parasitic vector borne diseases, which transmitted by sand fly. The current study reported the seven positive cases of Kala-azar in Maravetapeh county in Golestan province, Iran from 2007-15. Using geographic information system, villages which had confirmed cases of Kala-azar were identified and their geographical information was registered. Villages with confirmed cases of Kala-azar were introduced as at risk villages for visceral leishmaniasis. All of these cases were aged under 6 years and in all of them fever and splenomegaly was reported. All subjects had lower normal range of hemoglobin and plateles. These cases were reported from 6 villages in 3 districts of Maraveh Tapeh County. All of these villages are in hot and dry areas of county and they have mountainous and semi-mountainous geographical status with higher altitude compare to other villages. Fifty two villages of county were recognized as at-risk villages for Kala-azar. Kala-azar presented in sporadic condition in Maravetapeh County. Continuous case finding of Kala-azar for early diagnosis and treatment is necessary.

---

Kawasaki disease is a medium-size vasculitis with peak incidence among infants of 9 to 11 month age. This case report represents a female infant of 18-month age whom was admitted to the Taleghani Pediatric Center of Gorgan, Iran; with referral for admission due to persistent fever for roughly 2 weeks despite various outpatient treatments. Upon the admission, Echocardiographic study was performed to assess whether the patient fulfils cardiac criteria of Kawaski disease which was consistent with the diagnosis and also positive for serious coronary complications in the infant. General condition of the patient improved as the treatment with both IVIG and Corticosteroids was initiated and carditis seemed to vanish in echocardiographic studies but as expected aneurysmal growth can last for over 80 days and in this case serial echocardiographic studies confirmed the formation of giant coronary aneurysms. Diagnosis of Kawasaki disease is based on persistent fever and consistency with clinical criteria and the main purpose of this case report was to emphasize the need to consider this disease in cases of persistent fever to avoid the serious following complications.

---

Background and Objective: Hemodialysis is an important replacement therapy for 70-90% of patients with end-stage renal disease (ESRD). Arteriovenous fistula (AVF) is the vascular access of choice in these patients due to its higher efficiency and lower risk of mortality compared to arteriovenous grafts. This study was conducted to determine the frequency of vascular access types used in hemodialysis centers of Gorgan, Iran.
Methods: This descriptive-analytical study was done on 200 hemodialysis patients (101 men and 99 women) at 5 Azar and Sayyad Shirazi hospitals in Gorgan, north of Iran, during April 2020 to July 2021. The subjects were selected by the census method. Information including age, sex, education level, duration of dialysis, the initial and current types of vascular access, site of vascular access, history of diabetes or hypertension, race, and history of smoking were recorded in a checklist.
Results: The mean age of women and men was 58.34±4.71 and 57.95±13.76 years, respectively. In addition, 61.5% of the patients were under 3 years old. The most commonly used vascular access to initiate dialysis was non-cuffed temporary catheters (69%) and AVF (24%). Smoking, ethnicity, diabetes, hypertension, and gender had no significant association with the type of vascular access used. In addition, there was no significant relationship between the duration of dialysis and the type of vascular access.
Conclusion: Considering the diversity of catheters and fistulas, it is necessary to emphasize that the use of AVF in patients undergoing dialysis for the first time and the timely placement of AVF in ESRD patients can improve the quality of life of the patients. It is also recommended to use jugular catheters instead of subclavian catheters when required.