Iranian Red Crescent Medical Journal
Year:2013 | Volume:15 | Issue:3|Papers Count:20

Background: Childbirth might be a traumatic event for some women.Objectives: This study was conducted with the objective of investigating the prevalence of Post-Traumatic Stress Disorder (PTSD) following childbirth.Patients and Methods: The study was designed using a descriptive correlation scheme. The participants were selected from the women referred to the healthcare centers affiliated with Zahedan University of Medical Sciences, Zahedan, Iran. Personal interviews were conducted with 600 women who were 6-8 weeks postpartum and had been undergone to this center for postpartum and child care.Results: One hundred and three (17.2%) women had symptoms of PTSD following childbirth based on the PTSD Symptom Scale (PSS). The results of logistic regression analysis revealed a significant correlation between maternal occupation (P=0.01), depression level (P<0.001) and anxiety level (P<0.001) with PTSD following childbirth.Conclusions: PTSD from childbirth occurs in some women. Early identification of risk factors should lead to early therapeutic intervention in the mothers at risk of PTSD.

Background: Respiratory failure is a major problem in neonatal medicine in all over the world and has different causes. Using mechanical ventilation is one of its major treatments.Objectives: Different strategies have been expressed in this context, including high frequency mechanical ventilation.Patients and Methods: This study is a prospective randomized clinical trial conducted on all newborns with respiratory failure hospitalized in the NICU of Tehran vali-asr Hospital during 2009.These patients were divided in to two groups through block Randomization method; conventional mechanical ventilation group and high frequency ventilation group.Results: Intraventricular hemorrhage (IVH) and air leak (e.g. pneumothorax) were less in HFPPV group than conventional group (P=0.012 and P=0.038). The mean time needed for mechanical ventilation was lower in HFPPV group, but this difference was not statistically significant (P=0.922). Needing to O2 in 28 days of age was almost equal in both groups (P=0.99). Mortality, and refractory hypoxia and PVL were lower in HFPPV group, but the difference was not statistically significant (P=0.301, P=0.508, P=0.113).Conclusions: Treatment of neonatal respiratory failure with high rate mechanical ventilation may reduce some complications.

Background: Adolescent smoking problem has still remained as a public health concern, but factors that attributing to the initiation of adolescent smoking are not well known in Iran.Objectives: The aim of this study is to estimate the prevalence of smoking, and its associations among high school male adolescents in Iran, in the context of the theory of planned behavior (TPB).Patients and Methods: This was a cross-sectional study involving male adolescent students (high school) in the city of Zarandieh, Iran. A multiple-stage sampling protocol was used. The participants completed an anonymous, voluntary, and self-report questionnaire. Prevalence was estimated, and demographic variables, psychological factors, and the theory of planned behavior components were used to indicate factors contributing to adolescents’ cigarette smoking.Results: In all, 365 students were entered the study. The mean age of respondents was 16.49±1.11 years. The prevalence of current smoking was 15.1%. The result obtained from logistic regression analysis revealed that all theory of planned behavior (TPB) components [knowledge (OR=0.75; 95% CI: (0.59-0.97), attitude (OR=0.75; 95% CI: (0.65-0.86), self-efficacy (OR=0.82; 95% CI: (0.71-0.95), subjective norms (OR = 0.84; 95% CI: (0.72-0.98)] were significant predating factors for adolescents smoking habits. In addition, having parents who smoke (OR = 4.75; 95% CI: (1.38- 12.35), smoking friends (OR=3.76; 95% CI: (1.20-11.76), and smoking siblings (OR=4.21; 95% CI: (1.17-11.16) were significant contributing factors to adolescents’ cigarette smoking behavior.Conclusions: The results showed that the prevalence of cigarette smoking in adolescents was high, and the theory of planned behavior (TPB) components were significant predictors of cigarette smoking. It seems that interventions targeting adolescents’ smoking habits might benefit using the TPB model.

Background: Vitamin A has different functions in the body and after being converted to acid form; it can play many roles in immune system regulation. Therefore, this vitamin can be used as a supplement in the treatment of diseases, such as cancer and autoimmune diseases. Vitamin A is a fat-soluble compound and its long-term consumption in high doses can have some adverse effects.Objective: The current study aimed to investigate the possible complications and find solutions to minimize the adverse effects.Patients and Methods: This study was a double blind randomized clinical trial. In the main study, vitamin A (as retinyl palmitate) was given to 35 multiple sclerosis (MS) patients in order to regulate their immune system with a dose of 25000 IU/day for a period of six months. To investigate the possible biochemical complications, lipid profiles, fasting blood sugar (FBS), liver enzymes, and C-reactive protein (CRP) were tested.Results: Vitamin A did not have a significant difference in lipid profiles, FBS and liver enzymes between the two groups receiving vitamin A and the placebo, but CRP increased in patients who were taking vitamin A, 1.65±0.43 (mg/L) and 2.88±0.67, (Mean±SEM), before and after the intervention respectively (P=0.029), and statistical analysis showed significant differences with the group receiving placebo (P=0.011) and CRP level in vitamin A group was 1.3 mg/L more than those of the placebo group after intervention (P=0.011).Conclusions: Considering that no significant difference was found in the proven vitamin A side effects, due to the increase in CRP, frequent clinical and biochemical controls are required along with vitamin A supplementation.

Background: Vaginal flora of healthy women is dominated by Lactobacillus species which can prevent bacterial vaginosis.Objectives: The current study aimed to determine the differences in vaginal lactobacilli composition of Iranian healthy and bacterial vaginosis (BV) infected women and compared their cytotoxic effects with commercial vaginal probiotics.Patients and Methods: One hundred and seventy eight vaginal specimens were collected from healthy and BV infected women. Lactobacillus colonies were obtained by culturing on laked blood BHI and MRS medias and genetically defined by 16s rRNA sequencing. Differentiating the specimens to normal, intermediate and BV infected were carried out by Ison and Hey grading protocol. Identification of Lactobacillus strains in vaginal specimens were performed by Multiplex PCR. The inhibitory effects of lactobacilli on Hela (tumoral cervical cells) and HNCF-pi52 (normal cervical cells) were conducted by MTT and trypan blue assays.Results: L. crispatus, L. gasseri, L. iners, L. jensenii, L. acidophilus and L. rhamnosus were the most frequently occurring species in vagina of healthy Iranian women. L. crispatus and L. jensenni were significantly higher in the normal than in the BV infected groups. Also the cytotoxic effect of L. crispatus on tumoral cervical cells was higher than other lactobacilli including commercial probiotics.Conclusions: As L. crispatus and L. jensenni were significantly higher in BV infected women and the cytotoxic effect of L. crispatus on tumoral cervical cells was high, introduction of new probiotics seems necessary.

Background: Neisseria gonorrhea is the etiological agent of the sexually transmitted disease (STD) gonorrhea, and primarily infects the mucous membranes of the urethra, end ocervix, pharynx or rectum of females which may result in substantial morbidity. N. gonorrhea also causes disseminated infection, with complications that may result in ectopic pregnancy, tubal infertility, chronic pelvic pain or maternal transmission of gonorrhea, and also increases susceptibility to HIV.Objectives: In the present investigation, we used conventional agar-based culture method, and nucleic acid amplification of CCPB gene for detection of Neisseria gonorrhea in end ocervical swabs samples collected from pregnant women studied.Patients and Methods: End ocervical swabs specimens for this study were obtained from 1100 pregnant women who presented to Shiraz (Iran) Hospitals from 2009 to 2011. In the present investigation we used conventional agar-based culture method, and nucleic acid amplification test (NAAT) of CCPB gene for detection of Neisseria gonorrhea in end ocervical swabs samples collected from pregnant women studied. From each pregnant woman two end ocervical swabs were taken: one swab placed in tubes containing phosphate buffered saline for Polymerase Chain Reaction, and the other to inoculate on culture media.Results: Among 1100 end ocervical swabs examined, 13 (1.18%) samples had positive results by polymerase chain reaction (PCR) on Neisseria gonorrhea CCPB gene. All end ocervical swabs culture had negative results for Neisseria gonorrhea. 84 (7%) of the women had vaginal discharge, in whom PCR on end ocervical swabs of these individuals had negative findings.Conclusions: Nucleic acid amplification tests (NAATs) are very appropriate in detection of infected individuals. Detection techniques such as NAATs are independent of bacterial viability, and have a potential to limit false negative samples, therefore, in our country, the application of different laboratory diagnosis methods including NAATs with culture as gold standard for determination antimicrobial susceptibility is essential.

Background: Hearing loss is the most common sensor ineural deficiency in human beings. Cochlear implantation is introduced worldwide to treat the severe to profound sensor ineural hearing loss, and can result in both speech comprehension and production.Objectives: The present study aims to determine the effect of cochlear implantation on the improvement of the auditory performance in 2-7 years old children.Patients and Methods: The present follow-up study is a kind of cohort study which was conducted on 98 children between 2-7 years old who had referred to Fars Cochlear Implantation Center. The patients’ information was gathered from their profiles both before and after the operation. The auditory performance score was obtained in 3 stages; 6 months, 1 year, and 2 years after the cochlear implantation through the Cap test. The data was analyzed using the nonparametric Friedman test as well as Mann-Withney, Kruskal-Wallis, and Spearman’s Ranks Correlation coefficients.Results: The mean and the median of the auditory performance score of the children who had undergone the cochlear implantation revealed a significant improvement from 6 months to 1 year, and 2 years after the implantation. It showed a significant statistical association between implantation age, type of hearing loss, regular reference, and the length of being present in the rehabilitation program with the auditory performance. It showed no significant association between sex, mother’s level of education, being monolingual or bilingual, and family size with the auditory performance.Conclusions: This study revealed that the type of hearing loss, Presence in the rehabilitation program, and the age of cochlear implantation can be major prognostic factors of the response to the treatment, then the country’s health policy makers and health planners must executively take into account the infants’ hearing screening program during the first 6 month of age.

Background: Retinopathy of prematurity (ROP) is a vascular retinal disease that can cause low vision or blindness and affects premature newborns of very low birth weight.Objectives: The purpose of this study was to determine the incidence and risk factors for ROP among very premature infants in Mashhad located northeast of Iran.Material and Methods: In this cross-sectional study performed between 2006 and 2010, predisposing factors and severity of ROP were evaluated in very premature infants (dlt;32 gestational weeks). Consecutive infants were enrolled at birth and screened for ROP at 4 to 6 weeks of age by indirect ophthalmoscopy. Severe ROP was defined as stage 4 or 5. Chi-square, Student’s t-, and Fisher’s test were used for statistical analysis.Results: The incidence of ROP was 26.2%. Significant differences between the ROP and control groups were observed, these include; gestational age, sex, birth weight, Apgar score, durationof parenteral nutrition, oxygen therapy, phototherapy, maximum PaO2 and minimum SpO2 (P dlt; 0.05). Severe ROP was seen in 31.4% (11.32) of ROP cases (5.4% of newborns).Conclusion: The incidence of ROP is relatively high in this region. Risk factors for ROP among very premature infants include hypoxia, severe hyperoxia, relatively low blood SPO2, gestational age, birth weight, and Apgar score.

Background: Beta-thalassemia is a type of anemia in which the patients may require splenectomy and this can lead to thrombocytosis with increased risk of stroke. Transcranial Doppler ultrasound is a method for determining cerebral vessel stenosis.Objectives: The aim of this study was to investigate whether the risk of a future stroke secondary to cerebral artery stenosis can be predicted with the use of transcranial Doppler ultrasound in beta-thalassemia major patients.Patients and Methods: This study included 54 beta-thalassemia major patients divided into 2 groups; group A consisted of 28 patients who have thrombocytosis secondary to a previous splenectomy and group B comprised of 26 patients who did not have a splenectomy with normal platelet count, as well as a control group of 30 healthy individuals.Results: Transcranial Doppler ultrasound of the cerebral vessels were performed in all participants, and the results for each group were compared with the controls. In addition, patients were evaluated for evidence of high flow velocity in the cerebral vessels that met the clinically significant criteria of³50% stenosis. Transcranial Doppler ultrasound velocity criteria for dgt; 50% stenosis, indicating a risk of stroke, were not documented in any patients but increase in cerebral blood velocities in many arteries in group A and in some arteries in group B were revealed.Conclusion: Following splenectomy, thrombocytosis can predispose the patients to an increase in cerebral blood velocities more than respected with anemia. But by transcranial doppler ultrasonography no evidence of significant stenosis were found in intracerebral arteries to conclude that the beta-thalassemia major patients were more prone to the development of stroke secondary to this abnormality.

Background: Dysthimia in adults is a chronic depression disorder which is characterized by a mild depression for at least 2 years. Remarkable psycho-social involvements, greater disturbances in psycho-social functions compared to other forms of depression and lack of definite findings about preferred treatment for this disorder led us to evaluate the effectiveness of Mindfulness based cognitive therapy (MBCT) method adjunct to pharmacotherapy compared with pharmachothrapy alone in treating dysthymia in this thesis.Objectives: This study aimed to evaluate the effectiveness of mindfulness-based cognitive therapy on a chronic type of depression disorder called dysthymia.Patients and Methods: This study is a clinical trial of an interventional method which was carried out on dysthymic and double depressed patients who had referred to psychiatric clinics of Shiraz University of Medical Sciences, Shiraz, Iran. In doing so, 50 patients above the age of 18 were selected through convenience sampling and assigned into intervention and control groups. The control group only received medications while the intervention group in addition to receiving medication, participated in 8 sessions of a mindfulness based cognitive therapy course which was held once a week and each session lasted for 2 to 2.5 hours. All the participants filled out Beck Depression Inventory II and five facet mindfulness questionnaire. The data were analyzed using the SPSS statistical software (version 16) and univariate covariance and independent t test statistical methods.Results: In this study, no statistically significant differences were found between the two groups regarding the demographic characteristics. The mean difference between the two groups was statistically significant for the variables in post-test considering the pre-test. The experimental group participants showed significant improvement in terms of the defined variables; a trend which was not observed in the control group participants.Conclusion: The results of this study show that adding MBCT to pharmacotherapy in treatment of dysthymic patients can cause significant improvement in depression symptoms and mindfulness skills in patients compared to pharmacotherapy alone.

Background: Hepatitis B virus (HBV) infection is the most common and serious liver infection in the world. An estimated 350 million people are chronic carriers of this virus, of whom, more than 620,000 die from liver-related diseases annually. Due to the vaccination program, prevalence of HBV, particularly among the younger generation, is reported to have declined in recent years in Iran.Objectives: The aim of this study was to evaluate the prevalence of HBV infection in Mashhad, North-East of Iran.Patients and Methods: Three thousand one hundred and ninety eight (3198) individuals living in Mashhad were studied using cluster sampling method. HBV infection was determined by HBsAg ELISA commercial kit. Positive results were subjected for PCR using HBV-specific primers. HBeAg, HBeAb, and HBcAb-IgM ELISA tests were performed for HBsAg-positive samples.Results: Patients’ age ranged from 15 to 65 years (Mean=35.54±14.85). Thirty four (1.0%) of the subjects were positive for HBsAg, of whom, 2.9% (1 of 34 cases) were also positive in PCR-based screening. ELISA tests for HBeAg, HBeAb, and HBcAb IgM were positive in one (2.9%), 27 (79.4%) and one (2.9%) cases, respectively.Conclusions: According to our results, HBsAg was positive in 0.53 of the total population. The prevalence of HBV infection was seemingly low in Mashhad; however, an upward trend was observed in older subjects probably due to successful HBV vaccination coverage in the younger generation. Continuous surveillance and periodic population-based studies are essential to monitor the prevalence of HBV infection in Mashhad in the future.

Background: Numerous studies have shown that long term treatment with anticonvulsants may be an important risk factor for the onset of atherosclerosis, or worsening of its symptoms. There are many contradictory reports regarding these effects.Objectives: We performed a systematic review and meta-analysis of the published studies in order to see whether the atherogenic outcomes could be related to any serum biochemical abnormalities.Materials and Methods: Published articles indexed in PubMed, ISI web of science, Science Direct and Scopus databases from 1990 to 2011 were retrieved using a comprehensive search strategy. After omitting the unrelated articles and duplicates, articles met the eligibility criteria for critical appraisal were included in the analysis. Data were summarized in standard data abstraction forms and subjected to analysis by STATA software.Results: Finally, ten published studies were included in the meta-analysis. Results showed that carbamazepine and sodium valproate consumption are associated with a significant elevation of the serum homocysteine levels. On the other hand, medication with carbamazepine is associated with a reduction of the level of folate in the serum and that of sodium valproate is associated with a reduction of serum level of vitamin B12.Conclusions: According to the results of this study, as carbamazepine and valproate sodium consumption can result in elevated serum levels of homocysteine and decreased levels of folate and vitamin B12, and the atherogenic effect of increased serum homocysteine level is well established, the patients under these medications should be monitored for possible atherogenic effects.

Introduction: Cutaneous infection is an uncommon presentation of mucormycosis, usually seen after trauma, at the site of surgical drains or after occlusive dressings. The involved area is erythematous and painful, with varying degree of central necrosis. We report the case of chronic coetaneous infection of one year duration and without apparent necrosis in an immunocompetant patient.Case presentation: A 32-year-old immunocompetent woman presented with a large unilateral firm infiltrative plaque resembling cancer lesions, disfiguring the eyelids, nose and lips. The punch biopsy and then surgical debridement was done and the diagnosis of cutaneous mucormycosis was confirmed on histologic examinations with granulomatous reaction and characteristic broad, nonseptate, pale-staining hyphae.Conclusions: Mucomycosis should be in differncial diagnosis of any chronic infiltrative lesions even without visible necrosis and normal immune status of the patient.

Introduction: The endoscopic fibrin glue or platelet-rich fibrin glue (PRFG) injection is an easy, safe and effective technique for the fistula. So far, the use of fibrin glue has been limited to selected cases.Case report: Our case is a three years old male child with a neck trauma resulting in a Esophago-Cutaneous fistula after a 3 month period of follow up we decided to use PRFG for this lesion after fine debridement of the fistula tract, and the surrounding fibrosed tissue twice with a one week interval. Our visit after two weeks showed complete recovery and normal general condition. A contrast study revealed complete disappearance of the lesion.Conclusions: In our case the PRFG completely resolved a long-standing fistula resistant to exhaustive conservative management. The treatment with PRFG has been proved to be effective in the selected cases and it seems that traumatic esophago-cutaneous fistula may be one of these selections. Application of fibrin sealant should be considered early in the management of these difficult clinical problems.

Background: Today, Severe hyperbilirubinemia is the most common cause of neonatal readmissions. Identification of the cause of neonatal hyperbilirubinemia is useful in determining whether therapeutic interventions can prevent severe hyperbilirubinemia.Objectives: We conducted this study to estimate the incidence of severe hyperbilirubinemia in Fars province and to determine the underlying causes and risk factors, which would be of value in identifying and implementing strategies to prevent morbidity from this condition.Patients and Methods: All infants less than 28 days referred due to severe indirect hyperbilirubinemia were included. Complete history, physical examination and lab work up were performed. This is a longitudinal prospective study in 2009-2010.Results: More common causes of severe indirect hyperbilirubinemia were blood group incompatibility, G6PD deficiency, sepsis and unknown. Risk factors of severe hyperbilirubinemia were Male sex, previous siblings with severe hyperbilirubinemia, early discharge, NVD, Breast feeding and cultural background of mothers.Conclusions: Our study showed severe neonate indirect hyperbilirubinemia is still prevalence in Fars province and ethnic and cultural background of the mothers was more effective than school education in preventing hyperbilirubinemia complication.

Background: Stroke, or cerebrovascular accident (CVA), is the second leading cause of death in the world and based on the World Health Organization (WHO) report in 2006, it is responsible for 9.9% of all deaths in the world which over 85% of these deaths occurred in developing countries.Objectives: The aim of this study was to investigate the data related to the frequency, risk factors, types and mortality of stroke in Birjand city.Patients and Methods: A retrospective cohort of consecutive patients with diagnosed stroke who were admitted to hospital (the only neurological center of Birjand) between 2002 and 2008 was designed. A stroke was defined according to clinical features and CT-scan which was confirmed by agreement of a staff neurologist. Collected data included date of admission, age, sex, and hospital outcome as well as related risk factors.Results: Totally, 1219 stroke (85.4% ischemic type) with the mean age of 69.6±12.9 years and female: male ratio of 1.09 was included in over 6 years. The stroke hospital admission rates were 48.6 and 103.4/100,000 population /year in the first and the last year of the study, respectively. There was an increasing trend in stroke incidence rate during the study (P dlt; 0.01). The most common epidemiological risk factors for stroke in our region were hypertension, cardiac diseases, a history of stroke, diabetes mellitus, dyslipidemia, and smoking (54.7, 24.4, 20.1, 14.9, 12.2, and 9%, respectively). Overall in-hospital mortality rate was 17.1%.Conclusions: The stroke hospital admission rate might be increasing in Birjand. Therefore, health care administrators and public health authorities must work harder to promote the knowledge and practice of society about the stroke related risk factors and prevention methods.

Dear Editor, Pain is the commonest complain of human being. If it becomes chronic it affects all the dimensions of life quality. There are many ways to relief pain but some of them have disadvantages that make not well feeling for patients.

Dear Editor, Nursing are known as a profession that is constantly exposed to various stresses. Stress job in this profession could lead to disturbances that seriously put at risk the mental health of nurses. Pressure caused by stressors in the job has the undesirable effect on the individual and the organization. Increased accidents and injuries, poor staff morale, low motivation, job satisfaction and Fatigue early are natural consequence lack of the elimination of workplace stressors.

Dear Editor, Electro diagnostic tests are electrical technologies for evaluating the body’s neurophysiology and used as a complementary method for diagnosing the neuromuscular disorders. These tests are commonly used to diagnosis these disorders: Anterior horn cell disease, Polyneuropathy, Mon oneuropathy, Plexopathy, Radiculopathy, Polyradiculoneuropathy, Neromuscular junction and Muscular disorders.

Dear Editor, Heretofore, appreciable assays have been made by the authors of this journal to demonstrate the efforts of different Iranian traditional medicine scholars. Among them, Ibn Sina was a unique prodigy who has been known as Avicenna in west (980-1037AD). He was the author of more than 200 books on different branches of science such as medicine, one of his most important works being: Al-Qanun fi al-Tibb (The Canon of Medicine).