Contributing death factors in very low-birth-weight infants by path method analysis.

BACKGROUND: Neonatal deaths account for 40% of deaths under the age of 5 years worldwide. Therefore, efforts to achieve the UN Millennium Development Goal 4 of reducing childhood mortality by two-thirds by 2015 are focused on reducing neonatal deaths in high-mortality countries. The aim of present study was to determine death factors among very low-birth-weight infants by path method analysis. MATERIALS AND METHODS: In this study, medical records of 2,135 infants admitted between years 2008 and 2010 in neonatal intense care unit of Alzahra Educational-Medical centre (Tabriz, Iran) were analysed by path method using statistical software SPSS 18. RESULTS: Variables such as duration of hospitalisation, birth weight, gestational age have negative effect on infant mortality, and gestational blood pressure has positive direct effect on infant mortality that at whole represented 66.5% of infant mortality variance (F = 1018, P < 0.001). Gestational age termination in the positive form through birth weight, and also gestational blood pressure in negative form through hospitalisation period had indirect effect on infant mortality. CONCLUSION: The results of the study indicated that the duration of low-birth-weight infant's hospitalisation is also associated with infant's mortality (coefficient -0.7; P < 0.001). This study revealed that among the maternal factors only gestational blood pressure was in relationship with infants' mortality.

Intravenous paracetamol versus intramuscular pethidine in relief of labour pain in primigravid women.

BACKGROUND: Intramuscular pethidine is one of most common opioids used for labour analgesia. There are a number of concerns in the literature regarding the use of pethidine. The aim of this study is to compare analgesic efficacy of paracetamol with pethidine for labour pain in normal vaginal delivery. MATERIALS AND METHODS: In this single-blinded, randomised control trial, 80 primigravid singleton women with full-term pregnancy candidate for normal vaginal delivery, were entered the trial and divided in to pethidine (A) and paracetamol (B) groups. At the time of admission, age and body mass index of mother and gestational age based on last day of period were recorded. In both groups, intravenous promethazine and hyoscine were administered to each patient at the first stage of delivery. From beginning of active phase of delivery, patients in group A received 50 mg intramuscular pethidine injection. At the same time patients in group B, received an intravenous solution infusion containing 1000 mg paracetamol and 300 cc of normal saline. After child birth, average labour pain was assessed using Visual Analogue Scale (VAS) by direct questioning from patient in both groups. RESULTS: After patients' selection, 19 individual omitted during study due to exclusion criteria and finally 30 patients in paracetamol group and 31 patients in pethidine group remained to enter the trial. There was no significant difference in age and BMI of mothers between both groups (P > 0.05). Maternal age and labour duration in paracetamol group had no meaningful difference with maternal age and labour duration of patients in pethidine group (P > 0.05). The average VAS pain score was significantly lower in paracetamol comparing to that of pethidine group (8.366 out of 10, 9.612 out of 10, respectively, P < 0.001). CONCLUSION: It is concluded that intravenous paracetamol is more effective than intramuscular pethidine to relief labour pain in normal vaginal delivery.

Effect of Urinary Incontinence on Quality of Life among Iranian Women.

OBJECTIVE: Present study aimed to evaluate the effects of stress, urge and mixed urinary incontinence on the quality of life and mental health of Iranian women with urinary incontinence (UI). MATERIALS AND METHODS: This was a cross sectional study of quality of life and mental health among women without and with different types of urinary incontinence (n = 140). Quality of life (QOL) and mental health were compared and measured using the Urogenital Distress Inventory (UDI-6), the Incontinence Impact Questionnaire (IIQ-7) and the 12-items General Health Questionnaire (GHQ-12). RESULTS: Women with any types of urinary incontinence showed a significant lower degree of mental health. Women with mixed incontinence reported significantly lower QOL and mental health (P < 0.0001) compared to those with stress and urge incontinence, while there was no significant difference between women with stress and urge incontinence (P= 0.95). CONCLUSION: Patients with UI showed inferior mental health and QOL while these symptoms were more severe among patients with mixed urinary incontinence.

Spontaneous rupture of pyometra.

Spontaneous perforation is a very rare complication of pyometra. The clinical findings of perforated pyometra are similar to perforation of the gastrointestinal tract and other causes of acute abdomen. In most cases, a correct and definite diagnosis can be made only by laparotomy. We report two cases of diffuse peritonitis caused by spontaneous perforated pyometra. The first case is a 78-year-old woman with abdominal pain for which laparotomy was performed because of suspected incarcerated hernia. The second case is a 61-year-old woman with abdominal pain for which laparotomy was performed because of symptoms of peritonitis. At laparotomy of both cases, 1 liter of pus with the source of uterine was found in the abdominal cavity. The ruptured uterine is also detected. More investigations revealed no malignancy as the reason of the pyometra.