[Comparing the effects of spontaneous pushing versus Valsalva pushing technique on outcome of delivery in primiparous women]

The valsalva pushing technique is used routinely in the second stage of labor in many countries, and it is accepted as standard obstetric method in Iran. The purpose of this study was to determine the effects of spontaneous pushing, versus, valsalva pushing technique in birth on outcome of delivery in primiparas. This clinical trial study was conducted on 100 primiparas. Samples were randomized to either a spontaneous pushing group [open glottis pushing while breathing out] or a valsalva type pushing group [closed glottis pushing while holding their breath]. The length of stages of delivery, perineal tears, postpartum hemorrhage and satisfaction were evaluated in mothers and apgar scores at 1 and 5 minutes were evaluated in newborns. Data were analyzed using statistical Mann-Whitney, Chi-square and independent t-test. The duration of expulsion phase of the second stage of labor was significantly longer in valsalva-type pushing [P=0.004]. The result indicated that the incidence of episiotomy in spontaneous pushing group [P=0.003] and postpartum hemorrhage in valsalva pushing group [P=0.002] was more. The baby fared better with spontaneous pushing, with higher 1- minute apgar score. After the birth, women expressed greater satisfaction with spontaneous pushing. Educating women for the spontaneous pushing technique in the first stage of labor and providing support for spontaneous pushing in the second stage result in a shorter second stage without interventions and in improved newborn outcomes

[Effect of initiation time of oral hydration on the return of bowel function and woman's satisfaction after elective caesarean section in primiparous women]

Abdominal operations as gynaecological procedures result in gastrointestinal dysmotility. Early feeding and ambulation are nonpharmacologic interventions which can be useful in re-initiation of bowel function. This study was done to evaluate the effect of early oral hydration on the return of bowel function and woman's satisfaction after elective caesarean section in primiparous women. In this randomized clinical trial, 120 primiparous women undergone elective cesarean section were assigned to control and intervention groups in Hajar hospital, Shahrekord, Iran during 2007. In the interventional group, oral hydration with liquids was started 4 hours after surgery regardless of presence of bowel sounds and solid food was started after bowel sounds appeared. The control group recieved liquid diet 12 hours after the operation if it was tolerated, they were given soft diet and regular food at the next meal. The return of bowel activity, time of ambulating, satisfaction, discharge from the hospital and complications were compared in two groups. The data were analyzed using SPSS-15, Chi-Square, T and one way ANOVA tests. The mean postoperative time interval to first hearing of normal intestinal sounds in interventional versus control groups were [9.5 +/- 1.38 and 12.5 +/- 2.5 hours] the first passage of flatus [15.7 +/- 3.61 vs.22.4 +/- 4.1 hours], time to first sensation of bowel movement [10.8 +/- 1.99 versus 15.7 +/- 3.4 hours] and defecation [18.9 +/- 3.65 versus 23.4 +/- 4.85 hours]. These differences were significant [P<0.05]. Also discharge from the hospital [0.96 +/- 0.18 versus 1.1 +/- 34 days] were significantly shorter in interventional group [P<0.05]. The women in the early feeding group got out of bed [patient mobilisation] earlier than their interventional group [14.1 hours versus 18.8 hours [P<0.05]. Maternal satisfaction was significantly higher among the early fed women [P<0.05]. Early oral hydration after elective cesarean section associated with rapid resumption of intestinal motility and increased woman's satisfaction

[Comparison of the effect of Hoku point [LI4] acupressure with that of San-Yin-Jiao [SP6] acupressure on labor pain and the length of delivery time in primiparous women]

Labor pain is very severe. Unrelieved labor pain can increase catecholamine levels and have adverse effects on the mother and infant. Labor pain is usually accompanied by fear, which can cause slow progress of labor. Analgesic medications are not prescribed because of their adverse effects on women and their infants. The aim of this study was to compare the effect of Hoku Point [LI4] acupressure and San-Yin-Jiao [SP6] acupressure on pain intensity in primiparous women during the active phase of labor in Iran Hospital in Iranshahr city in 2008-2009. This was a randomized controlled trial and included 90 primiparous women in Iran Hospital in Iranshahr. The subjects were randomly assigned into 3 equivalent groups [n=30]: Hoku, SanYinJiao and control groups. Data of each woman were recorded in a questionnaire. Labor pain was measured by means of a subjective labor pain scale [VAS], before and after the intervention at the stages of 4, 5, 8 and 10 cm cervical dilation. Length of delivery time was calculated in two stages: from 4 cm cervical dilation to 10 cm cervical dilation, and 10cm cervical dilatation to the delivery. The SanYinJiao group received acupressure at SanYinJiao point [four-finger widths patient's fingers above the tip of the inner malleous, just posterior to the border of tibia above the ankle], for 20 minutes on two feet during contractions. Hoku group received acupressure at Hoku Point [over the area of the web of skin between the thumb and the forefinger] in the same manner on both hands of the subjects. Using SPSS software, data were analyzed by ANOVA and Tukey HSD tests. The results indicated that there was a significant difference between the severity of the pain and post intervention at 4 cm dilatation, and post intervention at 4, 6 and 8 cervical dilation in the 3 groups [p<0/001]. There was not a significant difference at the stage of 10 cm cervical dilation between the groups [p=0.7]. There was a significant difference in the duration of the active phase of labor between 3 groups [p<0/001]. There was not a significant difference in the length of delivery time between the groups [p=0.7]. According to the results of this study, it seems that acupressure affects the intensity of labor pain and shortens the duration of the active phase of labor. Also acupressure may be useful for the women who prefer a nonpharmacological analgesia without side-effects

[ effect of chewing sugar free gum after elective cesarean-delivery on return of bowel function in primiparous women: a randomize clinical trial]

An important cause of delayed recovery from abdominal surgery is delay in return of bowel Function. The aim of the present study was to assess the effects of chewing sugar free gum after elective Cesarean-delivery on return of bowel function in primiparous women in Hajar hospital of Shahrekord. In a randomized clinical trial, 120 patients, who were scheduled for elective cesarean were randomly allocated to 2 groups of gum-chewing group [n=60] and control group [n=60] postoperatively. The patients in the gum-chewing group chewed postoperatively sugar free gum 4 times daily as soon as they recovered from anesthesia till the time they passed flatus or defecated. Control group recieved routine postoperative dietary management. The mean scores of postoperative time interval to first hearing of normal bowel sounds, passage of flatus, defecation and sensation of bowel movement were compared between the two groups. The data were then analyzed using chi square and t-test [p<0.05]. The mean postoperative time interval to first hearing of normal intestinal sounds [6.5 +/- 1.5 versus 12.5 +/- 2.5 hours], the first passage of flatus [12.2 +/- 2.0 vs.22.4 +/- 4.1 hours], first sensation of bowel movement [7.4 +/- 1.7 versus 15.7 +/- 3.4 hours] and defecation [15.5 +/- 2.5 versus 23.4 +/- 4.8 hours] were significantly lower in the gum-chewing group compared with control group. [p<0.001]. The staying period in the hospital [0.96 +/- 0.18 versus 1.1 +/- 34 days] was significantly shorter in gum-chewing group. [p<0.001]. Chewing gum after elective Cesarean-delivery is safe, inexpensive and helpful which is well tolerated, and associated with rapid resumption of intestinal function and speeds recovery shorter hospital stay

[Comparison of the effects of gum chewing with those of early initiation of oral feeding and routine regimen on recovery of bowel function in primiparous women after cesarean section]

Ileuses is one of the most common problems after abdominal surgery including cesarean section [CS] which leads to inability to start feeding. Several studies have been performed on the effects of liquid diet in the postoperative period on the recovery of bowel movement but there has been no perfect study on the effect of gum chewing on this subject. The aim of this study was to compare the effect of early oral feeding with liquid diet on the recovery of bowel movements with that of gum chewing in primiparous women after [CS] in Hajar Hospital in Shahrekord in 2007. In this randomized clinical trial, 180 patients scheduled for elective cesarean section were randomly divided into three groups: gum-chewing group [n=30], early feeding group [n=30] and control group [n=30] postoperatively. The patients in the gum-chewing group chewed postoperatively sugar free gum four times daily, each time for 15 minutes, as soon as they recovered from anesthesia. In the early oral feeding group the women received a liquid diet within six hours after surgery, and control group received routine post operative dietary regimen. Data were analyzed by x[2], paired and independent t tests and one way ANOVA. p<0.05 was considered significant. recovery of bowel movements in the gum chewing and early oral feeding groups was significantly faster than that of control group and was faster in gum chewing group in comparison to early oral feeding group [P<0.05]. Gum chewing after CS is safe, inexpensive and beneficial which is well tolerated by the patients and associated with rapid resumption of intestinal function and rapid recovery of the patients after cesarean-section

[Effects of acupressure at the Sanyinjiao point [SP6] on labor pain and delivery time in nulliparous women]

Analgesics and anesthetic pain relief in labor often have unwanted sedative effects in the mothers and their newborns. It seems that using non-pharmacologic methods, such as acupressure, affect on labor pain and delivery time. The purpose of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in nulliparas women in Iranshahr hospital in 2008-2009. A randomized clinical trial study was performed on 60 eligible nulliparas women who were at the beginning of active phase of labor [4 cm dilatation of cervix]. The women were randomly assigned to one of the two groups: SP6 acupressure or SP6 touch. The participants, received acupressure or SP6 acupoint, 3 Kun above the tip of the inner malleous just posterior to the border of tibia above the ankle, for 20 minute during contractions on two feet. Labor pain was measured four times with visual-analogue scale [VAS]: before and after the intervention in 4,6, 8 and 10 cm cervical dilation. Length of delivery time was calculated in two stages: from 4 cm cervical dilation to full cervical dilation and full cervical dilatation to the delivery. The data were analyzed using SPSS software and descriptive statistical, paired t-test, chi square and independent t-test. There was a significant reduction in the severity of pain in 4, 6 and 8 cervical dilatation in case group compared to control group [P<0.001]. The length of delivery time in active phase was less in case group compared to control group P<0.001, but there was hot difference in second place of delivery. SP6 acupressure may be applied in a non-invasive and easy to use fashion for pain control in the labor

[Assessment of the quality of life of children and adolescents with type 1 diabetes: child and Parental views]

Improvement of the quality of life [Qol] in addition to controlling symptoms of the disease in children and adolescents with chronic illness such as diabetes mellitus is important. Problems such as diabetes are not only recognized by the physician and nurses but also by the patients. The impact of the diabetes and its complications on Qol is still unknown. The number of studies on Qol of diabetic patients is limited. The aim of this study was to carry out a comparative assessment of the views of children and adolescents with type I diabetes on the Qol. In this historical cohort study the views of the children and adolescents with type I diabetes, and the views of their parents were assessed. A questionnaire on pediatric quality of life including children's and parents' views was used to collect data in four sections of physical [8 items], emotional [5items], social [5 items], and school performance [5items]. Data were analyzed by inferential statistics, independent t-test, Mann-Whitney test and spearman correlation. The results of this study showed no significant difference between the mean scores of Qol of diabetic children and control group, but there was a significant difference between two groups in physical aspect of Qol in diabetic children and control subjects. Parents' views showed that parents of children with diabetes were more worried than those of controls. There was a significant difference between scores of total quality of life in its physical, emotional and social aspects between parents of the diabetic children and parents of the control group [p=0.001]. This study showed that views of the children and adolescents with type I diabetes were different from those of control group in regard to physical aspect. Also the views of parents of children and adolescents with type I diabetes were different from those of control group concerning quality of life in particular, emotional and physical aspects. Therefore we recommend in addition to providing medical care, programs for improvement of the level of mental health of these patients and their families be designed

Primary hyperparathyroidism due to a giant parathyroid adenoma: a case report

Parathyroid adenomas account for most cases of primary hyperparathyroidism. Parathyroid adenomas rarely attain huge proportions and since they are usually small in size, preoperative localization using sestamibi scanning or ultrasonography is required to avoid unnecessary bilateral neck exploration. We report herein the case of a 47 year old woman who was diagnosed as having a parathyroid tumor after she presented with bone pain. Detected by clinical findings, ultrasonography and parathyroid scintigraphy by 99m Tc-MIBI, her tumor was found to be a huge adenoma of the parathyroid, measuring 5.5x3.5x2 cm and weighing approximately 30 grams. This size and weight of tumor is a very rare finding in parathyroid adenomas, and deserves documentation

[Comparison of two commonly used IUDs in pain and menstrual bleeding]

The intrauterine device [IUD] is the most widely used reversible method of contraception in the world. One of the most common side effects of intrauterine device is increasing of menstrual blood loss, which may cause discontinuation and iron - deficiency anemia. BY considering the effects of IUD type on menstrual bleeding this study was conducted to compare the side effects of T Cu 380A and Cu safe300 IUDs including bleeding, pain on during 3-month period in clients referring to family planning center of Shahrekord Hajar hospital. This study was a randomized single-blind clinical trial, during which 70 candidates applied for IUD were randomly placed in two groups of IUD T Cu 380A and Cu safe300. The major side effects were recorded in the following 1, 2, 3 months. The comparisons were made using t-test, Mann-Whitney, Chi-Square and Wilcoxon tests by SPSS soft ware. Menstrual bleeding and dysmenorrheal was more commonly occurred during the 3 month of implantation in both groups but bleeding and pain was significantly lower in Cu safe300 group than the other group. With regard in this study showed menstrual blood loss and dysmenorrheal in the 3 months after IUD insertion a in Cu safe300 users were less than T Cu380A users therefore recommending to be possible this kind IUD to distribute in the health centers

[ effects of group therapy on mental health condition in mothers of thalassemic patients]

Thalassemia is the most common hereditary chronic anemia in human. It causes terrible effects on psychological health condition of family members, especially mothers. Due to the advantages and a very few side effects of group therapy, the current study aimed at determining the effects of group therapy on mental health condition of the thalassemic patients' mothers. A clinical trial was conducted on 60 mothers of thalassemic patients in Hajar hospital of Shahrekord medical university and Seieed Al Shohada hospital in Farsan. At the beginning of the study all mothers were administered a demographic and mental health questionnaire [GHQ28] and among those who scored higher than 23, were randomly designated to the experimental and control groups. In the treatment period of the study the participants in the experimental group attended 8 weekly sessions of group therapy. Data were analyzed using ANOVA, t-test, paired t-test, and Pearson Correlation. Before the experiment there was no significant difference between the two groups of subjects in both questionnaires in all dimensions [P>0.05]. After the treatment period a significant difference was observed between the two groups in all dimensions of mental health [P<0.05]. The results also showed that there was no correlation between demographic variables and mental health conditions. The results of this study showed that group therapy has a considerable positive effect on recovery and improvement of mental health of mothers of the chronic patients, like thalassemia in all dimensions

[Giant parathyroid adenoma presenting with bone pain]

Primary hyperparathyroidism is a quite frequent disorder however, giant parathyroid adenoma is a rare entity. We described a 39-year old woman presenting with lower extremities bone pain within the recent 3 years. She had been receiving levothyroxin during the past 10 years due to hypothyroidism, meanwhile, she had a bulge right thyroid lobe. Laboratory examinations revealed she was euthyroid, however, scanning showed parathyroid adenoma. During surgery, an adenoma measured 2x3x6cm, weighted 22gr was resected. Giant parathyroid adenoma present with non-characteristic symptoms, thus, routine laboratory measurements including serum calcium and phosphorous should be proposed for suspected individuals

[ comparison of the acupressure and pyridoxine effect on severity of both nausea and vomiting in primigravida women]

Gastric disorders especially nausea and vomiting are the most common complaint during pregnancy. Previous studies have shown that nearly 20% of pregnant women visited physician for these problems. The aim of this study was to compare the effect of acupressure and Vit. B6 [pyridoxine] on reduction of nausea and vomiting in primigravida women. In a clinical trial study, 100 women with gestational age of 10-16 weeks and single fetus were randomly selected from primigravida women who referred to antenatal care centers of Ahvaz for nausea and vomiting. Then they were allocated to acupressure [n=50] or pyridoxine group [n=50]. Treatment with acupressure or pyridoxine was carried out for four days. In acupressure group sea band was placed on the neiguan [p6] point of hand and in pyridoxine group, each patient had 40 mg of Vit. B6 every day. Severity of nausea and vomiting was recorded by each subjects. Data was analyzed by Chi-square, Manwithney, Wilcoxon and t-tests. Our results showed that nausea score and frequency of vomiting were decreased significantly by both treatments [p<0.001]. Also acupressure was significantly more effective in reduction of vomiting frequency [p<0.001]. The severity of nausea was not different in two groups. Our results showed that acupressure was more effective than Vitamin. B6 in treatment of pregnancy vomiting. Regarding the fact that sea band is cheap, comfortable, available and easily use, it is recommended to reduce vomiting in pregnancy

Thyroid hemiagenesis associate with thyroid papillary carcinoma: a case report

Thyroid hemiagenesis with or without isthmus is a rare congenital disorder. Papillary thyroid carcinoma associate with hemiagenesis is very rare. A 42 years old female with chief complain of cervical mass was referred to our center. In physical examination, she had a 1.5 _ 1.5 nodule in right lobe of thyroid. The result of thyroid nodule fine needle aspiration was reported papillary thyroid carcinoma. The right thyroid lobe was resected but there was not any trace of thyroid in left side and isthmus on trachea. In thyroid scan that was achieved one month later, iodine absorption was observed only in right thyroid bed. As a result the left lobe thyroid hemiagenesis and isthmus were approved. The final pathology report was thyroid papillary carcinoma. It was a rare case of thyroid hemiagenesis associate with thyroid papillary carcinoma that usually diagnosed accidentally

Liver weight and the dimensions of its vessels and biliary ducts: a study on 40 Iranian cadavers

The number of liver transplantations are increasing in Iran. Precise knowledge concerning the anatomical dimensions and the effect of racial and environmental factors on them is of importance. This study was carried out to determine the anatomical dimensions of the liver, its vessels and biliary ducts in cadavers autopsied in the Medical Foundation in 1997. A total number of 40 cadavers without any abdominal surgeries or crushed intra-abdominal organs were studied. The personal and demographics attributes along with anatomical dimensions of the hepatic artery, portal vein, biliary, hepatic and cystic ducts ducts, their variants and probable anomalies along with the total liver weight were recorded. The cadavers were within the age range of 37 +/- 9 years and the weight range of 64 +/- 9 Kg. In all cases the portal vein was normal with a length ranging 8.3 +/- 2.2 cm. In 15% of the subjects the hepatic artery [right branch of superior mesenteric artery] was abnormal. The length of extra-hepatic ducts was 8.6 +/- 1.7 cm and the weight of the liver was 1453 +/- 260 g. The anatomical dimensions of liver, its vessels and biliary ducts were different from western reports. It is recommended to perform more detailed research on corpses from habitants of the region