Duodenal Obstruction during Pregnancy.

Intractable vomiting and elevated liver enzymes during pregnancy seem to be associated to the obstetric etiologies; however, other causes such as acute surgical emergencies should be considered. The patient was a 26-year-old woman at 18 weeks of gestation with intractable vomiting, intolerability of oral intake, weight loss, and absence of abdominal pain. Her physical examinations and laboratory tests had no remarkable findings except elevated liver function test (LFT) and hypokalemia. Considering the lab data and normal abdominopelvic ultrasound, magnetic resonance imaging was performed which revealed dilation of the D1-3 and collapse the D4 sections of duodenum. She underwent exploratory laparotomy which confirmed duodenal obstruction caused by Ladd's band. After the Ladd's operation, the patient started oral intake of nutritious, and her LFT decreased to normal ranges. After the last follow-up, she has had gained 18 kg and gave birth at 36 weeks of gestation due to the premature rapture of membranes and delivered a 2 kg small for gestational age otherwise healthy infant. The experience gained from this case was to consider all possibilities (such as small bowel obstruction) and evaluate them in a pregnant patient to consider other causes of nausea, vomiting, and abnormal LFTs in a pregnant patient.

Quality of life in patients with thalassemia major and intermedia in kerman-iran (I.R.).

Thalassemia is the most common hemoglobin disorder in the world and thalassemia major and intermedia stand among the most severe forms. Due to recent improvements in treatment, patients with thalassemia have longer life expectancies; hence it is of utmost importance to pay careful attention to their quality of life together with life expectancy. This study was conducted to assess the quality of life in patients with thalassemia and also to compare it between thalassemia major and intermedia. In this cross-sectional study, patients who referred for blood transfusion or follow-up visits were evaluated for their quality of life (QOL). Short Form-36 questionnaire was applied to evaluate QOL. In this study, 308 patients with a mean age of 22.95±4.82 years were evaluated. The scores of QOL were regarded as moderate in eight domains under evaluation; the least score was given to General Health (53.05±16.96) whereas the highest score was given to Physical Functioning (67.95±22.68). The QOL in the patients with thalassemia major was better than those with thalassemia intermedia regarding Physical Functioning and Role Limitation Emotional domains. Compared to injecting chelators, patients who received oral chelators showed to have a better QOL considering Social Functioning and Mental Health domain. The patients under study didn't have a satisfying QOL ; the QOL of patients with thalassemia major was better than that of patients with thalassemia intermedia in only 2 domains of sf-36(Physical Functioning & Role limitation-Emotional). It is then essential that experts pay proper attention to improve QOL among patients.

Overextension of nonsetting calcium hydroxide in endodontic treatment: literature review and case report.

Premixed non-setting calcium hydroxide (CaOH(2)) paste in pressure syringe system is commonly used in root canal therapy. The aim of this paper is to present a case involving an iatrogenic extrusion of the medicament during endodontic treatment and a literature review of similar reports. The present case demonstrates severe tissue necrosis and other deleterious effects following the extrusion of CaOH(2) paste beyond root apex. A 21-year old female was referred for endodontic treatment of her maxillary left first premolar. After completion of the canal preparation, root canals were filled by premixed CaOH(2) paste. In the second appointment, a gingival detachment and an irregular zone of necrosis adjacent to the tooth apex was observed. To treat this complication, a mucoperiosteal flap was raised and the extruded material and necrotic tissues were currettaged and the area sutured. The patient was prescribed antibiotics and followed up at 2 weeks, 6 months and 2 years. Two week follow up showed good soft tissue healing. Two years postoperatively, complete radiographic and clinical healing was observed. We can conclude that the application of CaOH(2) should be carried out with care and preferably applied free hand or with a lentulo spiral rather than in a pressure syringe.

Xerostomia after radiotherapy and its effect on quality of life in head and neck cancer patients.

BACKGROUND: Xerostomia is one of the one complications following radiotherapy that can affect quality of life (QoL). This study aims to assess the severity of xerostomia in patients with head and neck cancers after radiotherapy and its effect on QoL. METHODS: In this longitudinal prospective study, the severity of xerostomia and related QoL were was assessed in 63 head and neck cancer patients who referred to the Radiotherapy Ward. Patients completed a xerostomia questionnaire (XQ) at the beginning, and 2, 4, and 6 weeks after treatment over a period of 6 months. Additionally, unstimulated saliva was collected using the spitting method at all 4 visits. RESULTS: QoL significantly worsened with increased time (P = 0.0001); meanwhile, the severity of xerostomia increased significantly (P = 0.0001). However, there was no significant change in the amount of saliva at these 4 time points (P = 0.23). Regression analysis showed that with each milliliter decrease in saliva secretion, the QoL score decreased 2.25%. With one score increase in xerostomia, from the QoL mean score there was a 1.65% decrease. CONCLUSION: The decrease in saliva and xerostomia that resulted from radiotherapy plays an important role in worsening QoL among patients who undergo radiotherapy for head and neck cancers. Although the amount of saliva has a significant association with QoL, the xerostomia score which shows subjects' general feeling also independently impacts QoL. In future studies, we recommend patient assessments for periods longer than 6 months.

Association between cigarette smoking and socio-demographics, lifestyle and mental health factors in a sampled Iranian population.

The objective of this study was to evaluate associations between cigarette smoking and socio-economic variable in an Iranian male population. Isfahan Healthy Heart Program (IHHP) is a community oriented health study from which we obtained our data regarding male subjects. Socio-demographic variables--sex, age, marital status, educational level, occupation, and income--and physical activity level were derived from the questionnaire. Nutritional status was asked by the Food Frequency Questionnaire and the general dietry index (GDI) was calculated. A general health questionnaire (GHQ) comprised of 12 items was used to assess mental health. Smoking status was investigated by a self reported questionnaire as a dependent variable. A logistic regression model was used for statistical analysis. Current smokers comprised 26.2% of respondents while 8.5% were ex-smokers. High income (OR 2.04; 95% CI 1.13-3.67), GDI (OR 1.83; 95% CI 1.44-2.32) and high stress (GHQ > or = 4 OR 1.71; 95% CI 1.48-2) were associated with smoking. Older age (OR 0.991; 95% CI 0.985-0.998), university education level (OR 0.53; 95% CI 0.37-0.77), unemployment (OR 0.8; 95% CI 0.64-0.99) and obesity (BMI > or = 25 kg/m2 OR 0.63; 95% CI 0.55-0.73) were associated with non-smoking status. Our findings confirm an association between socio-demographics, lifestyle and mental health variables with smoking in the Iranian population, consistent with other studies worldwide. These factors should be considered when developing smoking cessation strategies.

Effect of Long-term Smoking on Whole-mouth Salivary Flow Rate and Oral Health.

BACKGROUND AND AIMS: Change in the resting whole-mouth salivary flow rate (SFR) plays a significant role in patho-genesis of various oral conditions. Factors such as smoking may affect SFR as well as the oral and dental health. The primary purpose of this study was to determine the effect of smoking on SFR, and oral and dental health. MATERIALS AND METHODS: One-hundred smokers and 100 non-tobacco users were selected as case and control groups, respectively. A questionnaire was used to collect the demographic data and smoking habits. A previously used questionnaire about dry mouth was also employed. Then, after a careful oral examination, subjects' whole saliva was collected in the resting condition. Data was analyzed by chi-square test using SPSS 15. RESULTS: The mean (±SD) salivary flow rate were 0.38 (± 0.13) ml/min in smokers and 0.56 (± 0.16) ml/min in non-smokers. The difference was statistically significant (P=0.00001). Also, 39% of smokers and 12% of non-smokers reported experiencing at least one xerostomia symptom, with statistically significant difference between groups (p=0.0001). Oral lesions including cervical caries, gingivitis, tooth mobility, calculus and halitosis were significantly higher in smokers. CONCLUSION: Our findings indicated that long-term smoking would significantly reduce SFR and increase oral and dental disorders associated with dry mouth, especially cervical caries, gingivitis, tooth mobility, calculus, and halitosis.