Hormozgan Medical Journal
Year:2007 | Volume:11 | Issue:1 |Papers Count:17

Introduction: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The prevalence range from 1 to 14% of all pregnancies, depending on the population studied and the diagnostic tests employed. Risk assessment for GDM should be undertaken at the prenatal visit. Women with clinical characteristics of GDM should undergo glucose testing as soon as possible. If they are found not to have GDM at that initial screening, they should be retested between 24 and 28 weeks of gestation. Women of average risk should have testing undertaken at 24-28 weeks of gestation.Low risk status requires no glucose testing. Risk factors of GDM include, obesity, history of diabetes in first degree relatives, previous history of diabetes, glycosusia, history of birth with more than 4 kg still birth or malformation, polyhydamnius, age more than 25 years, member of an ethnic group with a high prevalence of diabetes, maternal low birth weight.  GDM of any severity increases the risk of fetal macrosomia, neonatal hypoglycemia, heart hyperthrophy, jaundice, polycythemia, and hypocalcemia, obesity and stillbirth.

Introduction: Hyperemesis gravidarum (HG) is a relatively common problem. Despite its obvious effect on quality of life in pregnancy, it can lead to dangerous complications. This study was conducted to evaluate the hypothesis that there is meaningful association between hyperemesis gravidarum and gastric infection with Helicobacter pylori. Methods: This is a prospective case-controlstudy in which 90 pregnant women aged 15-37years with gestational age of 6-16 weeks from LMP participated. 40 pregnant women with hypermesis gravidarum were selected from inpatient pregnants of Dr. Ali Shariati Hospital as cases and 50 normal pregnant from refereres to obstetric clinic of hospital as control group randomly. After filling written consent from, 5 cc venous blood sample was taken for detection of serum IgG and IgM for Helicobacter pylori and IgG> 20 was considered positive. Statistical analysis was performed with the use of t-test. P-value < 0.05 was considered statistically significant.Results: Seropositivity for Helicobacter pylori was detected in 22 cases out of 40 hyperemetic women (55%) which was not statistically significant. In our study a significant correlation was seen between high BMI and seropositivity for Helicobacter pylori in mothers with hyperemesis gravidarum. Conclusion: Although infection with Helicobacter Pylori in hyperemetic pregnant women was higher than seronegative ones, it is not statistically significant.

Introduction: Deviation from normal fetal weight and growth contribute to morbidity and mortality in the perinatal period. Over 50 formulas for EFW (estimated fetal weight) have been published and yet the ideal formula has not been determined. The objective of this study was to evaluate the accuracy of sonographic estimation of fetal weight using Hadlock formula in comparison to birth weight.Methods: In this descriptive-analytic study, 96 pregnant women without major fetal anomaly participated. Sonography was preformed 10 days prior to delivery. Biparietal diameter (BPD), femor length (FL) and abdominal circumference (AC) were measured and fetal weight was calculated according to Hadlock Formula.The fetal weight was determined immediately after birth. The difference between these two weights was analysed by t-test and variance analysis. P <0.05 was considered significant.Results: In these 96 pregnant women the range of birth weights was 2000-4100 grams. The mean difference between sonographic EFW and birth weight was 237.8 grams. In 26%, it was less than 100 grams and in 66.7%, less than 300 grams. There were no significant difference between weight groups of < 3000 grams, 3000-3500 grams and > 3500 grams.  Conclusion: Sonographic EFW has acceptable value in clinical decision-making.

Introduction: The atrial septal defect (ASD) is an acyanotic congenital heart defect with left to right shunting that can occur in any portion of the atrial septum. Auscultationand electro cardiographic (ECG) findings are characteristic for diagnosis of atrial septal defect. This study was done for detection of sensitivity and specificity of these findings in diagnosis of ASD in children. Methods: This descriptive-analytic study was done on 100 patients with ASD that referred to pediatric heart clinic during 2000-2004 and compared with 205 normal children that were matched for age and sex. Physical examination, ECG and echocardiography of two groups were compared. Data were collected and analyzed with SPSS software and statistical tests. Results: Mean age of patients with ASD was 7.71±4.60 and in control group was 6.92±4.75. Male to female ratio in case and control groups were 1.56/1 and 1.07/1, respectively. Sensitivity and specificity of fixed and wide splitting of the S2 in patients with ASD were 96% and 100%, respectively. Sensitivity and specificity of ejection systolic murmur in pulmonic area in patient with ASD were 97% and 100%, respectively. Sensitivity and specificity of rsR' pattern in ECG of patients with ASD were 79% and 99.02%, respectively. Sensitivity and specificity of right ventricular hypertrophy (RVH) without rsR' in ECG of ASD patients were 29% and 100%, respectively. Sensitivity and specificity of tall p wave in the patients with ASD were 39% and 100%, respectively. Based on statistical analysis, fixed and wide splitting of the S2 and ejection systolic murmur in pulmonic area are more helpful for diagnosis of patients with ASD than other findings. Conclusion: The findings of this study showed that auscultatory and ECG findings of ASD are as helpful in children as in adults. This is especially true in centers that modern diagnostic instruments (such as TEE and TTE) are not available.

Introduction: Cronary artery disease is the mall cause of mortality in developed countries. Classic risk factors have not been able to explain epidemiologic variants in this disease, hence other risk factors including systemic infections are under survey.This study was designed to evaluate the possible role of local and systemic infections in producing acute coronary syndrome (ACS). Methods: This prospective case-control study was conducted on all patients admitted with ACS diagnosis (unstable angina, myocardial infarction) in CCU ward of Fatemieh hospital, Semnan. The control group was selected among those patients admitted to internal ward due to noninfectious disease. Overall 200 cases and 200 controls entered the survey. Leukocyturia, hematuria and urine culture results were obtained and compared. SPSS software, Hest and Chi-square test were used for data analysis and P < 0.05 was considered significant. Results: The case and control groups had no significant difference considering age and sex. Mean age of cases and controls were 60.03±19.32 and 59.9±17.2 years, respectively. Hematuria was seen in 18.5% of cases and 5% of control group (P< 0.0001). Albuminuria was seen in 6% of cases and 7% of controls which was not a meaningful difference. Conclusion: The results show that evidences of mild urinary tract infection such as leukocyturia and hematuria are-seen more prevalent in patients with ACS than control group. This can be a clue to a mild underlying inflammation, infection due to uncommon microorganisms or leukocyturia and hematuria during a systemic infectious process.

Introduction: One of the most common complications of myocardial infarction (MI) is subsequent psychological problems including anxiety and depression which most patients experience, reduces vital function and increases mortality. Clinical symptoms such as anxiety, preoccupation and negative ideas about probable ensuing cardiac attack imperil physical and mental health of patients. The objective of this study was of determine the level of anxiety and depression in patients during various periods: before, after and 3-months after muscle relaxation and cognitive psychotherapy. Methods: This experimental study was conducted on 60 patients with myocardial infarction who were put randomly in case and control groups. Assessment of anxiety and depression was done by pt and D Scales of MMPI (short form). SPSS software was used for data analysis. Results: Results showed that after treatment, anxiety and depression in cases were reduced significantly (P<0.01) in periods before, after and 3 months follow up after therapy, while this was constant in the control group. Conclusion: Muscle relaxation and cognitive psychotherapy have distinguishable effects on reducing level of anxiety and depression in patients with MI. This modalities can minimize the need for pharmacotherapy and make it possible to use nonmedical methods.

Introduction: Hypertension is an important and uprising public health challenge in developing countries. The aim of this study was to determine prevalence, awareness, treatment and control of hypertension and assessment of associated risk factors in adult residents of Shiraz. Methods: This study cross-sectional was conducted in 2000-2001. Multistage cluster sampling method was used to select 3245 male and female aged 19-99 years from adult population. Prevalence of hypertension and prehypertension were determined according to JNC7 criteria. Information about history of hypertension, use of antihypertensive drugs, history of hypertension in first degree relatives, current use of cigarette of hubble-bubble were obtained. Chi-square test and analysis of variance was used for data analysis and P < 0.05 was considered significant. Results: Prevalence of hypertension was 27.5% (28.1% in female and 26.8 in male, P<0.001). 2749 out of 3245 had no history of hypertension or use of antihypertensive medications whose mean, systolic, diastolic and pulse pressure were 121.1±14.6mm Hg, 78.6±9.6mm Hg and 1±10.1mm Hg, respectively. Prevalence of prehypertension was 48.1%. 54.8% of hypertensives had awareness of hypertension and 61% were on drug therapy. Of those on drug therapy, only 39% had normal blood pressure. Obesity (OR: 3.1, 95% CI: 2.5-4) current smoking (OR: 1.3.95% CI, 1.07-1.5) and positive family history of hypertension (OR: 1.37, 95% CI: 1.17-1.6) were positively associated with hypertension (P<0.001).Conclusion: This finding illustrates high prevalence of hypertension, prehypertension and associated risk factors in adult population of Shiraz, indicating the need for more effective preventive programs and better control of hypertension.

Introduction: Recent studies have shown that breast feeding reduces blood pressure (BP) in childhood, but association of breast feeding and BP in adulthood is not clear. The aim of this study was to evaluate association between breast feeding in infancy with BP in early adult life. Methods: This cross-sectional study was done through random sampling on 384 students aged 18-32 years in Azad university of Semnan. Confounding variables were recorded in questionnaire by interview. At the first time, height and weight were measured. BP was measured in three sessions (morning, noon, evening) every other day. Duration of breast feeding was categorized into three groups (below 3 month or formula fed, 3-5 months, ³6 months). Data was evaluated statistically by Chisquare and One-way ANOV A test.Results: Of 483 cases, 214 were male and 170 were female. The difference between mean age, number of smoking and BMI were not significant in three groups. Also the 3 groups were fully adjusted for sex distribution, family history of hypertension and high blood sugar. There was no significant difference in systolic and diastolic BP between 3 groups. Conclusion: There is no association between breast feeding in infancy and blood pressure in early adult life.

INTRODUCTION: Kangaroo mother care (KMC) was first suggested in 1978 by dr.Edgar Ray in Bogota, Colombia. It was developed initially as caring for low birth weight infants. Quantitative studies on the effect of KMC on maternal attachment behavior are few. It is specially true about different maternal behavior in various cultures. This study was done to evaluate KMC on attachment behaviors (affectionate, care giving, proximity) of Iranian primiparous mothers with term infants, shortly after birth. Methods: This is a randomized trial that was done in one of Tehran's training hospitals. 90 samples were selected randomly and were divided to case and control groups. In the case group, newborn was let to have contact with mother's nude body. Newborn's nude body (without blanket or sheet) had contact with mother's skin for 15-20 minutes. The mother was asked to touch and breast-feed her baby after birth. But in the control group, the routine hospital procedure was undertaken. Results: The result showed that there is difference between affectionate behaviors including looking (P<0.01), talking (P< 0.02), proximity behaviors (close contact with mothers, P<0.001) and embracing the newborn. There was also a significant difference in the attachment behaviors in 2 groups. However, regarding care taking behavior, this difference was not significant. Conclusion: Therefore, immediate contact as a kangaroo method between mother and newborn has a positive effect on attachment behavior and should be carried out in early hours post partum. Midwives, who are the first care giver for mother and newborn, should be concerned about this (skin to skin) contact and increase the time of contact.

Introduction: Puberty is a stage of human growth with physical, sensational and cognitional changes. Numerous studies have been conducted about different aspects of puberty by psychologists, legal experts and jurisprudents. The studies show that puberty tends to different social and legal consequences and puberty age is related to factors such as race and socioeconomic status. In this study, puberty age is investigated in Bandar Abbas with a specific geographic condition. Methods: In this descriptive study, 8 schools were randomly selected as clusters of 9 to 13 years old, from both educational negions of the city. A predesigned questionnaire for mental, psychological and physical changes was completed for each student. For statistical analysis, Hest and analysis of variance with significance level of 0.5 ware used. Results: Results show a significant difference between age of those with physical puberty and without physical puberty (P< 0.05). There was also, a significant difference between mental and psychological grade mean in different age groups. This difference was higher in 11-year age group, especially between 9 and 10 year age group with 11-year age group. On the other hand, a significant relationship between age and religious puberty was clear, but there was not a statistical relationship between mental and physical puberty. Conclusion: Results of this study reveals that, puberty age, based on integration of mental, psychological and religious puberty, is between 12 and 13 years old with average of 12.6. This age is in agreement with physical puberty. It seems that social and religious low for girls in this geopraphic region such as religious duties celebration should change from 9-years old to an upper age.

Introduction: Violence is a behavioral pattern designed to exert power and control over a person in an intimate relationship through the use of intimidating, threatening, harmful or harassing behavior. This clinical social challenge is spread over all stages of women's life especially pregnancy and its prevalence during pregnancy is unknown. Determining prevalence of violence and its related factors surely may decrease adverse effects of this problem, substantially. Methods: This cross-sectional descriptive-analytic research was done on 587 pregnant women. Sampling method was random and accessible. Data gathering was preformed via observation and interview. An interview form and an observation checklist were filled. Data validity was assessed by content validity method and tool reliability was checked via synchronous observation. Chi square, Hest and Mann- Withney U tests were used for data analysis.  Results: Results show that 14.5% of women had experienced physical violence from their partners during pregnancy. There was a statistically significant (P<0.05) relationship between violence and the following variables: being a relative of husband, criminal history of husband, feeling about conjugal and sexual relationship, husband's occupation, suicidal attempt, infection during pregnancy, restrictions on living expenses, being in communication with others and having independent income, age at marriage, educational level, number of gravidity, parity and living children, and duration of common life with each other. Conclusion: Considering high prevalence of physical violence in pregnant women and the diagnosed social risk factors in this survey, it is recommended that all health personnels, screen pregnant women according to related factors in each prenatal visit to recognize the victims in advance and prevent hazardous sequela and consider necessary precautions during pregnancy and labour.

Introduction: Many pregnant women encounter several physical and mental disorders which may be of minor importance but can cause discomfort and disturbance. According to prenatal surveys, nearly 20% of pregnant women seek for medical cares due to the severity of gastrointestinal disorders among which nausea and vomitingare the most common ones. The aim of this study was to determine the effect of acupressure using Sea Band in reduction of nausea and vomiting during pregnancy. Methods: In a clinical trial study, 100 primigravid women with gestational age of 10-16 weeks, single fetus and complaint of nausea and vomiting were selected randomly from referrers to health care centers for prenatal care. They were divided equally to two groups: acupressure using Sea Band as case group and placebo Sea Band as control group. In acupressure group, buttoned Sea Band and in control group, placebo sea band were placed on Neiguan point of hand. Nausea severity and vomiting frequency were recorded. Checklist was filled for every person and all participants received forms for recording nausea and vomiting status for 4 days. Data analysis was done by SPSS software using Chi square, t-test and Wilcoxon tests. Results: Results showed that there is a significant difference in nausea severity and frequency of vomiting in case group before and after treatment (P<0.001). There was not a significant difference in reduction of nausea severity and frequency of vomiting in control group. Conclusion: It seems that acupressure is effective in treatment of nausea and vomiting during pregnancy and Sea Band is a cheap, comfortable, available and without side effect device which is suggested for reduction of nausea and vomiting in pregnancy.

Introduction: According to Lazarus and Folkman's model, stress appraisal is the strongest determinant of coping strategies and mental health. The purpose of the present study was to examine the influence of stress appraisal and coping strategies on mental health in 355 adolescents. Methods: This cross-sectional study was conducted on 355 (208 female and 147 male) adolescent students of Shiraz who were volunteer for university entrance examination. Four inventories including stress appraisal, ways of coping questionnaire (WQCQ), satisfaction with life scale (SWLS) and general health questionnaire (GHQ) were filled for data gathering. Results: Results from regression analysis indicated that primary stress appraisal accounted for a significant amount of the variance in coping strategies and also stress appraisal and coping strategies accounted for a significant amount of the variance in mental health. Data analysis was performed by regression model and determination coefficient was calculated. Conclusion: Stress appraisal as a situational variable and coping strategies play an important role in mental health. Thus, psychologists must try to instruct correct methods of situation appraisal and proper coping strategies to people.

Introduction: Behvarzes are responsible for offering the initial health care including oral and dental health in rural societies. Hence their knowledge and attitude toward oral and dental hygiene and health is a matter of importance. This study was carried out to assess the knowledge and attitudes of Isfahan township's Behvarzes toward prevention of oral and dental diseases. Methods: This descriptive-analysis study was done in 2001 on 143 (33 male and 110 female) Behavarzes who were working in health centers of Isfahan province. The questionnaires filled by behvarzes included 25 questions on knowledge and 10 questions about attitude. SPSS software, Hest and analysis of variance were used for data analysis. Results: Knowledge mean score was 13.95±2.39 out of 20 and attitude mean score was 25.33±2.39 out of 30. There was a significant direct correlation between knowledge and attitude (P<0.001). No significant relationship between knowledge and gender was observed. Indirect correlation was seen between working years and the level of knowledge and attitude. Conclusion: Mean knowledge of Behvarzes about oral and dental hygiene was not favorable, but their attitude toward it was positive. Educating Behavrzes regarding these issues is mandatory for excelling their knowledge. The indirect relationship between knowledge and working years entails planning educational courses for the veteran Behvarzes.

Introduction: Hydatid cyst mainly involves liver and lung. In the liver, it usually has a benign behavior, but occasionally it may rupture and produces obstructive jaundice. Rarely hydatid cyst of the liver ruptures directly into the peritoneal cavity. Case report: A 25-years-old man with progressive abdominal protrusion was admitted to our center. He had complaint of vague constant abdominal pain, early satiety and nausea 3 years prior to admission. Physical exam revealed severe abdominal distension with mild generalized tensemess and muscle wasting. Lab findings were normal except for 11% eosinophilia in peripheral blood smear.Sonography of abdomen revealed multiple hypoechoic cysts in the abdominalcavity. Abdominal CT scan confirmed sonographic finding and revealed additional cysts in the liver. High titer antibody against echinococcus granolosus was detected in serum of the patient. Mebendazole (100 mg/kg of body weight) was prescribed for one month. Complaint of patient abolished and the size of the cysts reduced obviously in the follow up visit.Conclusion: Hydatid cyst of peritoneal cavity is an unusual presentation of hydatid disease even in endemic areas and it is almost always secondary to rupture of the cystin liver. Although complete extraction of cyst is the best treatment for single cyst, three is no consensus about treatment of multiple cysts especiallyin peritoneal cavity. But in most centers, medical therapy is added to surgery to reduse the rate of recurrence. The patient was a case of hepatic hydatid cyst with spontaneous silent rupture into the peritoneal cavity but the clinical manifestations (abdominal distention and muscle wasting) was very similar to cirrhosis. Rupture of hydatid cyst may be asymptomatic or with mild symptoms.