[Origin of left coronary artery arising from the right coronary cusp]

Anomalous coronary artery origin is a rare clinical entity with varied clinical outcomes ranging from asymptomatic to sudden cardiac death. The incidence of anomalous origin of left coronary artery arising from the right coronary cusp is 0.3-1%. CT angiography is the choice method for coronary anomalies, but often coronary angiography in RAO [right anterior oblique] view shows the coronary course. We present a case that referred to our hospital with post myocardial infarction angina for coronary angiography. A resting 12-lead electrocardiogram showed ST-segment elevation in leads v2, v3, v4. A transthoracic echocardiogram indicated LVEF 25% [Left ventricular ejection fraction], septal akinesia and apical dyskinesia. Coronary Angiography showed an anomalous origin of the left coronary artery from the right coronary cusp and significant stenosis in LAD [left anterior descending] and LCX [left circumflex] arteries with poor run off

[Evaluation of the validity of two hemoglobinometry methods for measurement of hemoglobin levels in whole blood donors in Yazd, 2010-2011]

Hemoglobin screening methods before blood donation need to be not only simple, rapid and inexpensive but also sensitive for detection of both low and high hemoglobin levels to prevent false rejection of potential donors. The aim of this study was to evaluate the validity of two methods of hemoglobinometry in blood donors. In this cross sectional study, 198 blood donors were randomly selected. The hemoglobin levels of two blood samples taken by means of a single finger stick were determined by Hemocue 201+ and Hemocontrol and hemoglobin level of a venous blood sample was measured by Cobas hematology analyzer as standard method. Venous hemoglobin range of 12.5-17.9 g/dl was regarded as inclusion criteria for blood donation. The sensitivity, specificity and correlation between reference method and each of the hemoglobinometers were assessed. Data analysis was performed by means of correlation tests, regression analysis and paired t-test. Mean hemoglobin levels measured by Cobas, Hemocue and Hemocontrol were 15.9 +/-1.68, 16.28 +/-1.91 and 16.30 +/-196 g/dl, respectively. Hemoglobin levels measured by hemoglobinometers were higher than that measured by the standard reference. This difference was not significant in low hemoglobin levels, contrary to high hemoglobin levels. Each of the two methods showed significant correlation with standard method when hemoglobin levels were lower than normal limit. Increased hemoglobin levels led to decreased correlation coefficient which was not significant with hemoglobin levels higher than 18g/dl. Our study results showed that these heomoglobinometers were not valid for screening high hemoglobin levels in blood donors and a large number of potential donors would be falsely rejected. Further studies to find valid methods are recommended

[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

[Aneurysmal Bone Cyst: a Case Report]

Aneurysmal bone cysts mostly occur in long bones and spine. It is relatively rare in the maxillofacial region. In this article, we present a 19-year- old woman with the complaint of swelling in the left mandibular premolar tooth. She had got antibiotic therapy after the diagnosis of dental cellulites. On the X-ray study, a well- defined unilocular bony lesion within the preapical premolar tooth was observed. The patient referred after six months with vast swelling in the left mandible associated with parestesia and rapid growth. In 3D CT study a multilocular lesion suggestive of vascular lesion was observed. Surgical resection was done with curettage and immediate reconstruction of the plate. Aneurysmal bone cyst is a non-neoplastic but locally aggressive tumor that due to its occasional rapid growth should be differentiated from other multilocular processes like amiloblastoma, ossifying fibroma, epithelial cyst and also giant cell granuloma and sarcomas. Treatment of choice is conservative surgical excision of the mass with curettage or enucleation

[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

Isolation and genetic characterization of metallo-p-lactamase and carbapenamase producing strains of Acinetobacter baumannii from patients at Tehran hospitals

Carbapenems are therapeutic choice against infections caused by gram-negative bacilli including strains of Acinetobacter baumannii. Resistance to these antibiotics is mediated by efflux pumps, porins, PBPs and B-lactamases. The aim of this study was to determine the possibility of existence of MBLs, OXAs and GES-1 betalactamase genes among clinical isolates of Acinetobacter collected from Tehran hospitals. Two hundred and three Acinetobacter isolates were collected from patient at Tehran hospitals. The isolates were identified using biochemical tests. The susceptibility to different antibiotics was evaluated by disk diffusion method and MICs of imipenem were determined using Micro broth dilution method [CLSI]. PCR was performed for detection of bla[VIM-2], bla[SPM-1], bla[IMP-2], bla[GES-2], bla[OXA-51, bla[OXA-23] betalactamase genes. Clonal relatedness was estimated by PFGE with the restriction enzyme Smal. Of 100 isolates of imipenem resistant Acinetobacter spp. collected from Tehran hospitals in 2009 and 2010,6 isolates produced metallo-beta-lactamases and 94 isolates produced OXA- type carbapenemase. The bla[spm-1], bla[GES-1], bla[OXA-51, bla[OXA-23] genes were detected by PCR among 6, 2, 94 and 84 isolates of A. baumannii, respectively. The MICs of isolates to imipenem were 8-128 microg/mL. PFGE analysis of 29 bla[OXA-51] and BLA[OXA-23]-positive A baumannii isolates gave 6 different patterns. This is the first report of SPM-1 and GES-1 beta-lactamase producing A. baumannii. Production of the OXA-23, OXA-51, GES-1 and SPM-1 enzyme presents an emerging threat of carbapenem resistance among A. baumannii in Iran

[Effect of medicinal smokes on some nosocomial infection factors]

Bacterial resistance to antibiotics is a main problem in the treatment of infectious diseases. Thus, searching for alternative drug is essential in Iran and particularly Chaharmahal va bakhtiari province. People use medicinal smokes such as donkey dung and Peganum harmala seed smokes for treatment of infectious diseases. Therefore, this study was aimed to evaluate the antimicrobial property of donkey dung and Peganum harmala seed smokes on Staphylococcus aureus and Pseudomonas aeroginosa. In this interventional and laboratory study, groups of Peganum harmala seed smoke and donkey dung were considered as case groups and antibiotic disks as positive control group. Pseudomonas aeroginosa and Staphylococcus aureus were cultured in suitable medium [Blood Agar, EMB and Mueller-Hinton agar]. Antibiogram blank disks were fumigated separately with Peganum harmala seed and female donkey dung smoke then placed on microbial plate with sterile methods. Following 48 hours incubation at 37°C, the zone of growth inhibition evaluated by measuring the zone around the disks. Fumigation process was done in special chest that designed for this research. We repeated fumigation each 20 minutes for 24 times. Data about measuring the zone of growth inhibition were analyzed by using and mean statistic exam. Staphylococcus aureus was sensitive to Peganum harmala seed, and fdonkey dung smokes and Pseudomonas aeroginosa was sensitive to female donkey dung smoke. Staphylococcus aureus was resistant to cloxacilllin and Pseudomonas aeroginosa was sensitive only to erythromycin and ciprofloxacin. The increasing time of fumigation in sensitive cases enhanced antimicrobial effects and the zone of growth inhibition. Antimicrobial effects of donkey dung smokes on resistance pathogens such as Pseudomonas aeroginosa, Staphylococcus aureus revealed the necessity of performing expanded research about composition and property of this smoke

[Pediatric pain management by nurses in educational hospitals of Shahrekord in 2006]

Pain is a health problem and major part of the life in childhood, pain associated with different illnesses is one of the most common symptoms that children experience in the hospitals. Relieving pain is always an essential part of nurses caring role, but yet they feel weakness in pain management. The purpose of this study was to determine pediatric pain management by nurses, in the education hospitals of Shahrekord, Iran. This research was a descriptive and analytic study which conducted on 100 nurses. The data gathering tool was a questionnaire with for subscales: demographic data, knowledge [20 items], attitude [20 items], and practice. Data were analyzed by the independent T-test, one way ANOVA test, and Pearson correlation. The finding showed that the mean knowledge, attitude and practice of pediatric pain management by nurses were 13.09 +/- 1.9, 76.1 +/- 7.2, 8.42 +/- 2.9 and majority of nurses demonstrated knowledge [73.1%], attitude [69.1%] and practice [71.3%] moderated. There was not a significant difference between practice with knowledge and attitude of nurses about management of pain in children. This study demonstrated that the knowledge, attitude and function of the nurses about the pediatric pain management were intermediate. It showed that they need to become more aware of pharmacologic pain management with opioids, risks of addiction, non pharmacologic pain management, and respiratory depression and assessment tools of pain

[ study of body mass index in students of Bam educational centers]

Nowadays obesity is assumed as a global health problem and its prevalence increased in recent decade. It is known as a risk factor for several diseases such as diabetes mellitus. hyperlipidemia, cardiovascular disease and cancer. This study was undertaken to evaluate the obesity and overweight in Bam students. 330 students [140 male and 190 female] with mean age of 21.78 +/- 2.61 were selected from Bam educational centers in stratified sampling. Weight and height were measured without shoes and unneeded cloths. Weight and height were measured using a standard protocol and body mass index [kg/m[2]] was calculated. The criteria used to define body composition were based on BMI cut-off points of the WHO expert committee. The results shows the mean and SD BMI were 21.082 +/- 3.216 overall, and 22.08 +/- 3.08, 21.59 +/- 3.31, respectively, in male and female students. 14.1% of students were underweight, 70.9% normal weight. 12.1% overweight and 2.1% obese. 12.7% of females and 13.8% of males had visceral obesity. A significant relation between family history of obesity and BMI is seen [P<0.05]. As results show some of female and male students are in a degree of overweight and obesity, therefore launching nutritional services and life style modification program are recommended

[Effect of Dexamethasone on postoperative periorbital edema and ecchymosis in rhinoplasty]

A double blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty Sixty rhinoplasty patients undergoing open rhinoplasty surgery with tip modification, hump resection and bilateral osteotomy were included in the study and were enrolled in 3 groups: group 1: 20: a single dose of 8 mg dexamethasone at the beginning of operation. Group 2: 20: three doses of 8 mg dexamethasone first at the beginning of operation and then 24 and 48 h postoperatively. Group 3: 20 control group with no medication used. Significant reduction in periorbital edema and ecchymosis was obvious in groups 1and 2 compared with control group 3. Periorbital edema and ecchymosis during the end of first postoperative week was lower in group 2 compared with group 1. steroid administration before osteotomy reduced edema and ecchymosis significantly. Patients can return to their normal lives earlier with this reduction in postoperative edema and ecchymosis

Parent's perception of obesity in their 6-12 year old obese child ; can parental education be effective?

Obesity in children is a major health problem and parents can play an important role in its prevention and treatment. However, some parents are unaware of the problem and believing that their obese children are healthy do not participate in any related preventive or educational programs. The aim of this study is to assess parental perception of obesity in children aged 6-12 years and to evaluate the effect of education could have on this. This study has been conducted in two stages [stage 1, descriptive and second stage, experimental]. Weight, length, and body mass index were calculated in children aged 6-12 years. Then 300 children with BMIs higher than those standard for sex and age were selected as obese. Questionnaires for each child were completed by one of the parents. Parents that believed their obese children were not overweight, were divided into two groups, randomly. One group was educated about obesity during four, 2-hour sessions whereas the other group were not. After two months, questionnaires were completed by both groups and compared. Findings of the study showed 41/3% obese children are girls and 58/7% are boys. Among parents of obese children, 23/3% believed that their obese children were not overweight and after education, 94/3% became aware of their child's obesity and overweight. In this study, there was no relationship between the mother's job or the child's sex and the mother's perception. Present beliefs of parents regarding obesity and overweight in children need to be assessed in communities and educational programs conducted if necessary

causes of pregnancy termination in the third trimester and its relationship with maternal and child fate

Observations show that the majority of women referring to hospitals to terminate their pregnancy in the third trimester have not initiated uterine contractions. Regarding the importance of infant - mother health and unnecessary cesarean section, the present research was conducted to determine the causes of pregnancy termination in the third trimester and its association with the fate of mother and fetus in Shahrekord in 2005. In this cross - sectional study 750 pregnant women who had been hospitalized to terminate pregnancy in the third trimester were selected randomly in three morning, afternoon and night shifts. Data collection tools were questionnaires and checklists which were completed through original examination of the patients, file study, interview with mother, and postnatal examination of the infant. The fate of infant and mother was determined through the type of delivery, pregnancy age and infant weight. The data were then classified and analysed using SPSS software, t-test, 2 and Pearson correlation coefficient. 298 [39.7%] of mothers referred to the hospital due to the labor pain and 452 [60.3%] of them were advised to terminate their pregnancy by the physician. 23.2% of the above mentioned patients had been hospitalized due to the causes such as previous cesarean section, tendency toward cesarean, and mother - infant problems during the pregnancy. The results showed that there was a significant relationship between cause of pregnancy termination and type of delivery after exclusion of repeated cesarean section cases and tendency toward cesarean, and the patients advised by the physician had undergone more cesarean section [P=0.001]. Pregnancy age in the group advised by physician for hospitalization was more than the group who had been hospitalized due to labor pain [P=0.003]. Infant weight had no significant difference in two groups. Elective termination prior to labor pain can enhance the risk of cesarean section. Taking precise pregnancy history, performing sonography in the first 26 weeks, gestation and training the pregnant women the time of referring to hospital can prevent termination of pregnancy

[ effect of maternal position in active phase on duration of labor and newborn's Apgar score]

It seems that mother's position and activity during labor can affect labor process and it's outcomes. This investigation aimed to investigate maternal position's effect in active phase on labor duration and newbom's Apgar. This is a quasi experimental study which is done on 256 mothers referring to Taleghani hospital in Arak city. Sampling was convenience and sample size was determined based on alpha =5% and beta =20%. Mothers were divided into two primi and multipara groups and each mother chose one of the lying on left side, semi ambulatory and ambulatory positions based on her own intent. The duration of first, second and third stages of labor and also the newborn's Apgar score in first and fifth minutes after birth was determined in each group. Data was analyzed using Shefe test. Results showed that more than half of mothers [55.5%] preferred semi ambulatory position. 98.8% of deliveries were normal vaginal delivery and most of newborn's Apgar score in first and fifth minutes after birth was 9 and 10 respectively. There was no significant difference between labor complications and maternal position and also between Apgar score and maternal position. It was found that the duration of first, second and third stages of labor in primiparas of ambulatory group were shorter than the other two primipara groups. But the difference was only significant in first stage[p<0.001]. In multiparas of the ambulatory group the duration of first and second stages were significantly shorter than the other two multipara groups [p<0.001].Overall findings showed that the duration of first stage of labor in ambulatory primiparas and first and second stages of multiparas were significantly reduced so it seems that ambulation of mother during labor can improve labor process

[ comparison of mental health in employed and unemployed women in Shahrekord -2005]

Women, as the major foundation of every family, play an effective role in achieving a breakthrough in the community goals. Thus drawing attention to their mental and physical health is of great importance and this can, in turn impinge on the family and community health. This study was carried out to compare the mental health of the employed women with the unemployed ones in the health centers of Shahrekord. In this descriptive analytical and cross-sectional study, 500 women [250 employed and 250 unemployed] were selected randomly from nine health centers and were studied through GHQ -28 questionnaire. Factors such as pregnancy, menopause, celibacy, infertility, history of mental health, history of chronic disease, death of a beloved during the past year, level of education below grade 9 and a job history of less than 6 months were excluded from the study. Data was analysed by SPSS through t-test and chi-square test. The results indicated that 66.8% of the unemployed were healthy but 33.2% were unhealthy. In the unemployed, 69.2% were healthy but 30.8% were unhealthy. So there was no significant difference between mental health in the two groups. Also there was not a significant correlation between the individual characteristics and mental health in the two groups. Mean of GHO scores in various domains of the disease in the healthy and unhealthy subjects represents that physical and functional disorders, anxiety and depression in the two groups were not statistically significant. So it is suggested that health managers and policy makers of the health centers in the province have to pay more attention to mental health specially in unemployed women