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Abstract Background and Objective: The high occurrence of early childhood caries (ECC) is one of the most common problems in children dentistry. Streptococcus mutans and lactobacilli.spp are closely associated with the development of early childhood caries (ECC). Therefore, the aim of this study was to investigate the frequency of streptococcus mutans and lactobacilli.spp in 3-5 –year- old children with and without dental caries. Material and Methods: This case-control study was conducted on 60 children aged 3 -5-years, without any history of systemic disease, who had not received any antibiotic therapy and fluoride usage during the last month. The cases were divided into three groups of early childhood caries, usual caries and caries-free. The infected dentin samples were collected from cervical and proximal in ECC and usual caries group, respectively. Also in all the three groups, the samples of dental plaque from buccal surfaces were collected and immediately immersed into Brain Heart Infusion (BHI) broth medium. After that, the diluted sample was plated onto MitisSalivarius agar (Difco) for detecting streptococcus mutans and Rogosa agar (Difco) for detecting lactobacilli.spp. Data were analyzed by Chi- Square and ANOVA. Results: of the samples taken from dental plaque, S. mutans is observed in 90% of ECC, 80% of proxymolcarries and in 25% of caries-free individuals. Based on the results, the presence of S.mutans in the group of caries is significantly higher than that of without caries, but there is no significant difference between the two groups of caries. In addition, lactobacill.spp is isolated from 60% ofthe samples, but there is no significant difference between two groups of caries and caries-free. The average of decayed, missing and filled teeth (DMFT) index in the group with early childhood caries (6.95±1.572) and usual caries (5.80±1.105) is different significantly. Pearson correlation test shows that there is a significant relationship between caries experience and the amount of S.mutans, but there isn’t this relationship withlactobacill.spp. Conclusion: The findings show that the children with early decay have the higher level of S.mutans in their dental plaque. The most common strain isolated from dentin, without consideration of their location, is S.mutans. Key words: Early dental care, Dental caries, DMFT index, Streptococcus mutans, Lactobacilli.spp.

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Abstract Background and Objective:Staphylococcusaureus is one of the important factors causing nosocomial infections. Typically 25-30 percent of healthy people carry the bacteria in their anterior nasal cavity. The physicians(50%), nurses (70%) and hospital staff (90%) are the carriers of this bacteria, leading to the infection of inpatients. The emergence of antibiotic-resistant Staphylococcus strains to vancomycin and methicillin has brought about several problems in treatment of the infections caused by Staphylococcus strains. Hence, we aimed to study the frequency of staphylococcus aureus carriers and resistance pattern among medical personnel of the surgical ward in ShahidRajaee hospital, Tonekabon. Material and Methods: this analytic-descriptive study was conducted on the samples taken from nasal carriage of medical staff of surgical ward (N=120). Antibiotic- resistant of Staphylococcus strains was assessed by antibiogram and disk diffusion (DAD), in accordance with CLSI standards. Results: of 34 (28.33%) who are nasal carriers of staphylococcus, 12 are over 30 years old and 24 under 30. Based on antibiogram, 1.97% of specimens are sensitive to Gentamicin and Co-trimoxazole, 1.94% to Ciprofloxacin, 2.88% to Vancomycin and 6.20% to Methicillin. In addition, 100% of specimens are resistant to Ampicillin, 1.97% to Penicillin and 2.88% to Amoxicillin. Four isolates areresistant,both to methicillin and vancomycin. Conclusion:In this study, the spectrum of S. aureus resistant and sensitive strains to some antibiotics is similar to other studies, but a dramatic increase is seen in the rate of MRSA and non-susceptible cases to vancomycin. The Effectiveness of Penicillin, Amoxicillin and Ampicillin is still very low on S. aureus samples. Key words: Prevalance Resistance Pattern, Staphylococcus aureus, Medical Staff, Nasal Cavity, Tonekabon

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Abstract Background and Objective: Every organization requires ongoing evaluation of existing conditions. The purpose of this study is to assess and analyze the standards and criteria that each Laboratory system is required to observe and upgrade them, to determine the gap between the ideal and the current status and finally to present the strategy and executive plan in order to achieve the desirable status. Material and Methods: This study was performed in a medical diagnostic laboratory in Gorgan by using the quality system checklist related to medical diagnostic laboratories, which was revised in 2009. Internal evaluation matrix (Internal Factor Evaluation) was used to examine the main factors in the context of establishing a quality management system in a clinical laboratory.After examining the factors, determining the laboratory status, recording the results of monitoring (in terms of strengths and weaknesses) and determining the gap between existing and desirable status, we provided the appropriate and effective solutions in line with defined standard. Results: of 164 items thatshould have been done in the first assessment, 111 (67.7%) items are in performed group and 53 (32.3%) are not in. After compiling and running a plan, 147 (89.6%) are performed, 15 (9.2%) needed to be modified and 2 (1.2%) still not performed. It is evident that a significant difference (p< 0.05) and a tangible improvement in current problems are seen after establishing the qualitysystem in the laboratory. The lab equipment, lab space and facilities, pre-examination process, testing process and post-examination process are considered .Regarding the health and safety in the laboratory, lab equipment, lab space and facilities, pre-examination process, testing process and post-examination process, no significant difference is observed between before and after the implementation of the program. Conclusion:after establishing the quality system in laboratory, a significant difference and tangible improvement in the current problems are observed. It is implied the importance of pre-planned responses to problems and the performance of strategic planning. Keywords: Strategic Planning, Medical Diagnostic Laboratory, Quality Control

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Abstract Background and objective: Hepcidin is a cystein-rich antimicrobial peptide, which is secreted by the liver. It fights against wide spectrum of bacteria, viruses and fungi and it is a major regulator of iron homeostasis. Today, scientists have made many efforts on the production of hepcidin. Baculovirus expression system is one of the best eukaryotic expression systems for production of recombinant hepcidin and production of the recombinant vector is one of the most important steps in this expression system. Material & Methods: First, the total RNA was separated from HepG2 cell line as a source of hepcidin expression. Then, after synthesis of total cDNA, human hepcidin sequence was amplified, using specific primers by PCR method. Next, hepcidin sequence was cloned into pTZ57R/T vector. After digestion of recombinant vector using ECoRI and BamHI restriction enzymes, recombinant pFastBac HT B vector containing human hepcidin cDNA was produced. Results: Coding sequence of human hepcidin is correctly cloned into pTZ57R/T vector and sub cloning into pFastBac HT B vector is performed successfully. The presence of a clear band near 274 bp resulted from PCR amplification and restriction enzyme are the confirmation of the cloning of human hepcidin. Conclusion: According to our knowledge, the present study is the first work that focuses on recombinant vector containing coding sequence of human prohepcidin. This recombinant vector can be used for human hepcidin production. Key words: Vector, Hepcidin, Iron

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Abstract Background and objective: In recent years, the resistance of opportunistic fungal strains to commercially available antifungal agents has been increased. The serious side effects of these compounds on mammalian cells forced the researchers to search for new antifungal substances. Thus we decided to investigate the antifungal properties of silver nanoparticles against Aspergillusfumigatus. Materials & Methods: To investigate the antifungal effect of the round silver nanoparticles with 10nm diameter against Aspergillusfumigatus, the diameter of colonies after 8 days as well as the number of colonies in different days was determined, using direct drop test. After that, to measure the Minimum Inhibitory Concentration (MIC) and Minimum Fungicide Concentration (MFC) values of silver nanoparticles and fluconazole, Micro Dilution Broth method was performed. At the end, the MIC and MFC values of silver nanoparticles were compared to MIC and MFC of fluconazole. Results: The results obtained from direct drop test confirm that the silver nanoparticles can decrease the diameter of fungal colonies in dose dependent manner. The data of silver nanoparticles on the number of colonies in different days shows that the number of colonies increases up to sixth day and then becomes fixed. Based on the results of Micro Dilution Broth method, the MIC and the MFC values of this component are 31.25 and 62.5ppm, respectively. Conclusion: The present study confirms that silver nanoparticles with 10nm diameter have antifungal activity against Aspergillus fumigates. Key words: Silver nanoparticles, Aspergillusfumigatus, Antifungal activity.

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Abstract Background & Objective: Hepatitis E virus is one of the most common causes of acute infection in adults. Pregnant and transplant patients are more in risk of HEV infection. Fecal-oral is the main route of HEV transmission but recently transmission by blood transfusion has been observed. This study was aimed to determine the prevalence of HEV-Ab in hemodialysis patients in Gorgan, Iran. Material and Methods: In this cross-sectional descriptive study, we investigated 150 hemodialysis patients of Panje Azar hospital in Gorgan. These patients were evaluated for the presence of HEV total Ab by ELISA method. Results: of 150, 6 patients (4%) are positive for HEV-Ab. There has been no significant relation between anti HEV Ab and variables such as age, gender, ethnicity, duration and number of hemodialysis in a week and (P>0.05). Conclusion: This study, which is the first report from this area, show that the lower prevalence of anti HEV Ab in hemodialysis patients in comparison with pregnant and childbearing age women. Keywords: Hepatitis E Hemodialysis Elisa Gorgan

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Abstract Background and objective: Soil bacteria, particularly Bacillus genus have the potential of producing a range of bioactive substances with antimicrobial and antifungal properties. They have the ability to produce hundreds of active and effective biologic compound against microorganisms. Therefore, it seems to be a proper candidate in the biocontrol of fungal pathogenesis. Material & Methods: In this study, soil samples were collected from different parts of Gorgan in order to isolate Bacillus and to determine their antifungal activity against T.mentagrophytes. The Isolates that had the highest antifungal effects were analyzed by PCR and 16s rRNA sequencing. Results: of 54 strains, 14 have antifungal activity. The Isolates, S4 and S12, identified as B.cereus and B.thuringiensis respectively show the highest antidermatofit effect. These isolates based on 16s rRNA sequence analysis show 97% homology with Bacillus cereusstrain KU4 and Bacillus thuringiensisstrain ucsc27. Conclusion: According to the results, it seems that the soil Bacilli have biocontrol potential against dermatophytic agents such as T.mentagrophytes. Keywords: Antifungal effects, Bacillus, Rhizospheric soil, T.mentagrophytes

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Abstract: Background and Objective: A wide variety of opportunistic pathogens has been detected in hospital surfaces. Among these , Pseudomonas species are one of the leading causes of nosocomial infections, frequently found in hospital environments. The purpose of this study was identification of antimicrobial susceptibility of Pseudomonas spp. isolated from different Section of ShahidRajaeii hospital, Tonekabon. Material and Methods: the samples (460) from different sections of Shahid Rajaeii hospital, Tonekabon were collected between December 2010 and June 2011. The identification of the strains was performed by using biochemical tests and API20NE (Biomerieux) ,and antimicrobial susceptibility of the isolates against different antibiotics was determined by disc diffusion test. Results: of 460, 61(%13/26) strains of Pseudomonas are isolated from all the sources. The highest rate of Pseudomonas spp. is recorded in Surgery and ICU, while the lowest in Dialysis ward. Of 61 strains of Pseudomonas, 52 (85/25%) are belonged to Pseudomonas aeruginosa, six (9/83%) to Pseudomonas stutzeri, two (3/28%) to Pseudomonas putida and one (1/64%) to Pseudomonas fluorescens. Conclusion: the environments of the hospital can be the vehicles of Pseudomonas spp. therefore, both the patients and personnel should have extra attention to their personal hygiene to avoid Pseudomonas infection. Keywords: Nosocomial Infections Pseudomonas Antibiotic Susceptibility

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Abstract Background and Objective: Having knowledge about potential risks and the usage of safety equipment in laboratories can decrease the risk of occupational exposure. The aim of this study was to evaluate the predisposing factors for occupational exposure and to assess the usage of safety equipment among personnel of medical diagnostic laboratories in Birjand. Material and Methods: In this descriptive analytic study, all staff of laboratories was assessed by using a questionnaire including demographic data, type of accidental exposures and the use of protective equipment. Using SPSS software, we analyzed the data. Results: Of 110, 84 (76%) have at least one accidental exposure to patients’ specimens in that 55% of accidents are related to sample preparation step. In 82% of contacts, carelessness is the underlying cause of exposure. Gown, glove, fume hood and mouth mask are routinely used by 97%, 48%, 34%, 1% of personnel, respectively. Nearly all of (97%) personnel were vaccinated against hepatitis B and 78% of them have performed routine blood test for detecting any infections. Conclusion: The results of current study show that accidental exposures to patients’ samples are common among personnel of medical diagnostic laboratories. The level of preventive education and the rate of safety equipment usage are low therefore, we recommend planning of some training sessions to persuade the personnel for using safety equipment. Keywords: Medical laboratory, Occupational Exposure, Specimens, Vaccination

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Abstract Background and Objective: Nowadays, downsizing the government to have an effective and flexible organization is considered to be government’s top priority in the world and outsourcing is one of the ways to achieve this goal. Accordingly, Shahid Beheshti University of Medical Sciences has delegated some of its hospitals' duties to the private sectors. The present study has been carried out to assess the performance of outsourced clinical laboratories. Material and Methods: This Descriptive Evaluation study was carried out during 6 month (May 2011 till February 2012). The data was collected by two questionnaires with close-ended questions and one with open-ended questions, and analyzed by Wilcoxon, using SPSS software. Results: There is an improvement in outsourcing laboratory services. For example, increase in the number of tests (32%) and in the type of tests (37%). Consequently, increase of hospital income (51%). The number of personnel is decreased and their responsibility and behavior are improved. Conclusion: Overall, it seems that outsourcing laboratory program could achieve its major goals such as: Absorbing non-governmental resources in both administrative and financial aspects, omitting extra expenditure, acquiring benefits, and upgrading productivity of laboratories. Key words: Outsourcing Laboratory Peformance

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Abstract Background and Objective: Nowadays, downsizing the government to have an effective and flexible organization is considered to be government’s top priority in the world and outsourcing is one of the ways to achieve this goal. Accordingly, Shahid Beheshti University of Medical Sciences has delegated some of its hospitals' duties to the private sectors. The present study has been carried out to assess the performance of outsourced clinical laboratories. Material and Methods: This Descriptive Evaluation study was carried out during 6 month (May 2011 till February 2012). The data was collected by two questionnaires with close-ended questions and one with open-ended questions, and analyzed by Wilcoxon, using SPSS software. Results: There is an improvement in outsourcing laboratory services. For example, increase in the number of tests (32%) and in the type of tests (37%). Consequently, increase of hospital income (51%). The number of personnel is decreased and their responsibility and behavior are improved. Conclusion: Overall, it seems that outsourcing laboratory program could achieve its major goals such as: Absorbing non-governmental resources in both administrative and financial aspects, omitting extra expenditure, acquiring benefits, and upgrading productivity of laboratories. Key words: Outsourcing Laboratory Peformance

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Abstract Background and Objective: Resistance to antiretroviral agents is a significant concern in clinical management of HIV-infected individuals. Resistance is the result of mutations that develops in the viral protein targeted by antiretroviral agents. Material and Methods: In this cross-sectional study, the blood samples of 40 HIV-positive patients were collected. Twenty of them were drug-naïve and the rest were under treatment for at least one year by antiretroviral agents. Virus genome was extracted from patient's plasma with high-pure-viral-nucleic-acid kit. Then, by means of reverse-transcriptase and specific primers of protease genes were amplified and sequenced. Sequences of genes, drug- antiretroviral- resistant mutations and subtypes were determined using Stanford University’s HIV-drug-resistance databases. Results: Drug-naive patients show 15% resistance to nucleoside-reverse-transcriptase inhibitor (NRTI) and 20% resistance to non-nucleoside-reverse-transcriptase inhibitor (NNRTI). Anti-protease resistance is not observed in any patients. In under treatment patients, drug resistance to NNRTI (25%) is more than drug resistance to NRTI (20%) and the rate of drug resistance to protease inhibitor is 5%. Conclusion: Our findings show a high prevalence of drug-resistant mutations in Iranian-drug-naïve-HIV-infected patients. But in under treatment individuals, the rate of drug resistance is less than previous studies. Keywords: HIV Nucleoside Inhibitor Non-Nucleoside Inhibitor Protease Inhibitor

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Abstract Background and Objective: Much research has shown that Human Papiloma Virus (HPV) plays an important role in cervix cancer and it is the cause of 99% of cervix cancer worldwide. Lots of research has been done to find a proper method for HPV diagnosis and screening in patients with genital warts. This study aimed at comparing PCR method with Pap smear test in HPV screening. Material and Methods: Considering the presence of DNA of HPV, 45 vaginal and cervix swap samples of women with genital warts were tested by means of specific PCR and Pap smear from September 2010 to April 2011. Results: Out of 45 vaginal and cervix swap samples of women suffering genital warts, 37 samples (82.2%) are positive. Of 45 Pap smear samples, 13 (29%) are neoplasia and 32 (71%) normal. Conclusion: The difference between the results of PCR and Pap smear is due to low specification and sensitivity of Pap smear. Thus it is recommended using diagnostic PCR method in addition to Pap smear in order to promote the quality of screening in individuals with genital warts. Keywords: Human Papiloma Virus (HPV) Genital Warts Molecular (PCR) Pap Smear

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Abstract Background and Objective: Diabetes mellitus is one of complications that thalassemia major patients face with. Hence, blood glucose monitoring is of vital importance to these patients. Because of high level of fetal hemoglobin in these patients, the measurement of hemoglobin A1c is not reliable and should be displaced by fructosamine test. Material and Methods: The current descriptive study was carried out on 33 beta-thalassemia major patients afflicted with diabetes mellitus (21 female and 12 male cases). Blood glucose level, fructosamine, hemoglobin A1c, serum ferritin and fetal hemoglobin were measured. Results: Blood glucose levels are 204±103 mg/dL and 221±101 mg/dL (p=0.63) fetal hemoglobin levels are 9%±7% and 13%±9% (p=0.22) serum ferritin levels are 1744±1534 ng/mL and 3253±1773 ng/mL (p=0.96) in female and male patients, respectively. The level of fructosamine (42±124 mmol/L) and glycosylated hemoglobin (8.9%±1.8%) are correlated significantly (r=0.69, p<0.01). Both Hemoglobin A1c (r=0.75, p<0.01) and fructosamine (r=0.54, p<0/01) show a significant correlation with blood glucose level. Conclusion: In diabetic thalassemia major patients with frequent blood transfusion, the level of fructosamine and glycosylated hemoglobin are related significantly, therefore they can be used alternatively. Keywords: Thalassemia major Fructosamine Hemoglobin A1c Diabetes Mellitus

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Abstract Background and Objective: One of the most common diseases of keratin tissues is dermatophytosis caused by dermatophyte fungi. Because of being contagious, it has a high prevalence rate in wrestling and body building gyms. This study was designed to evaluate the process of this disease and improve the hygiene of halls. Material and Methods: The Samples (N= 540) were obtained from athletes and gyms, and a questionnaire was used to gather information. To identify various specious of dermatophyte, the routine diagnostic procedures, culture media, and supplementary tests were performed. Results: Of samples taken from athletes, 59 wrestlers and 11 body builders suffer from dermatophytosis. Trichophytontonsurans (%28.81) and Epidermophytonfloccosum (%36.36) are the main isolates in wrestlers and body builders. Also the rate of epidermophytonfloccosum (%37.5) is the highest in the samples taken from gym mats and halls. Conclusion: Because of high prevalence of dermatophytosis, pay attention to increase of hygiene and training courses for coaches and athletes are crucially important. Keywords: Dermatophytosis Wrestling and Body Building Halls Challous

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Abstract Background and Objective: Understanding the resistance patterns of bacteria and their sensitivity and attempting to find new compounds with broad effective spectrum would be significant in controlling infection. This study aimed at evaluating antibacterial potential of three honey samples produced in Golestan province, Iran, against Enterococcus faecalis strains. Material and Methods: After the isolation and identification of bacterial strains, their antibiotic resistance was determined using Kirby-Bauer method. Then, seven isolates of Enterococcus faecalis with multidrug-resistance were selected and antibacterial activities of honey samples assessed by disk-diffusion, well-diffusion and minimum inhibitory concentration test (MIC). Results: The highest diameter of inhibition zone in disk-diffusion and well diffusion methods is 20 mm and 26 mm, respectively. Also the MIC is measured 62.5 mg.ml for all samples. Conclusion: In prohibiting microbial growth, all three samples were successful and they could prevent growing bacterial infection in spite of remarkable resistance of Entrococcus. Hence, further research should be conducted to assess the effects of honey samples against other bacteria. Keywords: Multidrug-Resistance Enterococcus spp Honey Golestan Province

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Abstract Background and Objective: Celiac is an autoimmune disease that is characterized by an immune-system-related damage in the intestinal tissue after consumption of gluten. There is not any general agreement for gold standard. The Purpose of this study was the evaluation of specificity and sensitivity of anti-endomysial (EMA) and anti-tissue transglutaminase (TTG) serological test compared to small-bowel biopsy. Material and Methods: In the cross sectional study, we took blood specimen from 1825 patients with gastrointestinal disease. All the samples were tested by TTG and EMA kits using ELISA. The patients were studied in two groups. First, the individuals whom their serologic test was positive but their tissue condition was normal and second, those with positive serologic test with pathologic tissue results that show they have celiac disorder. Results: The mean of EMA and TTG shows that the level of antibodies in group 2 is significantly higher than that of the first group (P ≤0.001). There is positive correlation between modified marsh criteria of small-bowel biopsy and the two tests. The Sensitivity of EMA and TTG tests for celiac diagnosis is 92%. The specificity of EMA, TTG tests are 100% and 98.5%, respectively. Conclusion: EMA-IgA serology with cut-off point of more than 66 together with TTG-IgA serology with cut-off point of above 30 can be helpful to distinguish a wide range of patients who need small-bowel biopsy. Keywords: Celiac Anti-tissue Transglutaminase (TTG) Anti-endomysial (EMA)

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Abstract Background and Objective: Toxoplasmosis is one of the most prevalent parasitic infections worldwide. Contamination of pregnant women with toxoplasmosis may cause fetal death, preterm delivery and congenital toxoplasmosis. Due to importance of congenital Toxoplasmosis and the need of further study, this research was accomplished in Zahedan. Material and Methods: The serum samples (N= 221) were collected from pregnant women referring to reference laboratory of Zahedan in 2011. The IgG and IgM antibody levels against toxoplasmosis were investigated using ELISA method. Results: Out of all samples, 30.8% are IgG positive and 1.4% are both IgG and IgM positive. There is no significant difference between positive and negative groups using Chi-square tests. Conclusion: The main part of pregnant women in Zahedan (69.2%) is serologically negative against toxoplasmosis therefore, hygiene education to eliminate risk factors especially during pregnancy period seems to be imperative. Keywords: ELISA Antibody Pregnancy Toxoplasma Zahedan

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Abstract Background and Objective: Parasitic infection is one of the major health problems in the world. This study aimed at comparing the accuracy of two methods of direct examination and Formalin-Ether to detect the presence of parasitic infection among health-card applicants in Shahroud city, 2011. Material and Methods: This cross-sectional study was conducted on 801 patients seeking health-card. From each patient, three consecutive stool samples were taken and investigated, using direct examination and formalin-ether method. Results: The use of formalin-ether method in recognizing the parasitic infection specially giardia lamblia and entamobea coli is more than the direct method. Conclusion: The formalin-ether method is a more sensitive method than the direct method. But in circumstances that is urgency to respond or aims to see the shape of trophozoite, the use of direct method is recommended. Keywords: Parasitic Infections Health Card Direct Method Formalin-Ether

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Abstract Background and Objective: Of the most common hypochromic microcytic anemia are iron deficiency anemia and minor thalassemia, which are common in Iran and their differential diagnosis is extremely important. The level of 25-hydroxy vitamin D is the indication of vitamin D blood status. The aim of this study was to compare serum levels of vitamin D in people with minor thalassemia and iron deficiency anemia with healthy subjects in order to investigate the relationship between vitamin D deficiency and iron absorption. Material and Methods: In this case-control study, 24 patients with minor thalassemia, 20 patients with iron deficiency anemia and 24 healthy individuals participated. Groups were matched for age and sex. Testing of Vitamin D level by ELISA, ferritin by quantitative luminescence method and HbA2 by column chromatography was carried out. Results: The number of individuals with low level of vitamin D in iron deficiency group is 15 (75%), in minor thalassemia group is 8 (33/3%) and in the control group 11 (45.8%). Conclusion: In this study, the highest percentage of vitamin D deficiency is observed in cases with iron deficiency anemia. Because of association between vitamin D and anemia, iron and vitamin D supplementation is recommended to enrich the diet. Keywords: Anemia Minor Thalassemia Iron Deficiency Anemia Vitamin D