[Caregiver burden in caregivers of renal patients under hemodialysis]

Introduction: Family of chronic renal disease patients conducts various supportive interventions for their patients at home and outpatient centers such as dialysis ward in hospitals. Caregivers of these patients often spend a lot of time caring for them and withstand fatigue and burden. Timely recognition of these burdens in the caregivers, have played a decisive role in promoting mental health

Objective: This study aimed to determine the level of caregiver burden and its related factors in caregivers of hemodialysis patients referring to Razi hospital in Rasht city

Methods: In this cross-sectional study, 154 hemodialysis patients referred to the Razi Hospital in Rasht who was chosen by Sequential sampling method. Data were collected through interview by completing two questionnaire of Zarit caregiver burden and socio-demographic of patients and caregivers. Data were analyzed by using descriptive [mean and standard deviation] and inferential tests [binomial test]

Results: Mean and standard deviation deviation of caregiver burden was 50.75 +/- 14 and 74.7 % of the caregivers had severe caregiver burden. In addition, 46.1% of hemodialysis patients had very little vigor to doing things and 42.9% of them required a lot of care as reported

Conclusion: In attention to the need of hemodialysis patients to receive care from family, it is recommended to pay more attention to these caregivers regarding assessment of their burden and taking actions to reduce burden

[Related factors to menopausal women's quality of life in Rasht]

Introduction: Menopause is one of the most critical stages of women's lives and is a physiological event that occurs in middle age women between 40-59 years which results in physical, mental and social wellbeing and influences their quality of life. Paying attention to postmenopausal women's quality of life can guarantee health for more than a third of their lifetime

Objective: This study aimed to determine the factors associated with specific quality of life in postmenopausal women referring to Retirement Fund in Rasht city

Methods: This cross-sectional study was conducted on 180 postmenopausal women who referred to Retirement Fund in Rasht selected by sequential sampling. Data were collected by a two part questionnaire including: researcher-made questionnaire on personal factors and Quality of Life Questionnaire Specific to Menopause [MENQOL]. Results were analyzed using descriptive [frequency distribution, mean and standard deviation] and inferential statistics [T independent test, Chi-square, Exact Fisher test and Regression]

Results: Findings showed that the overall quality of life of postmenopausal women in 54.4% of cases was good and 45.6% of cases reported it as moderate and only one case [0.6%] reported unsatisfactory quality of life. Also samples' quality of life in vasomotor, psychosocial and physical domain was satisfactory but reported unsatisfactory in sexual domain. Results of regression model indicated a significant relationship between quality of life and age [P=0.004], educational level [P=0.03], physical activity [P=0.03], marital satisfaction [P=0.02], employment after retirement [P=0.01], the organization covering retirement [P=0.004], not spending time with friends [P=0.004], no arthritic disease [P=0.006] and no hyperlipidemia [P=0.03]

Conclusion: Quality of life can be affected by several factors. Identifying quality of life condition of postmenopausal women is important in explaining the need for training, counseling, care and treatment of postmenopausal women and serves as basis for formulation and implementation of health care programs and further planning to improve their quality of life

[Survey influencing factors on prenatal care in referring maternal to health care centers in Rasht city]

Prenatal care is an indicator of health care system. Knowing the factors that prohibit reciving proper is essential in every society.The aim of the research was to determine mothers reciving prenatal care from health centers in Rasht and influencing factors from their view in 2008. This descriptive study surveyed 354 mothers referring to health centers in Rasht city who were chosen by cluster sampling. Data collection tool was a 3 part questionnaire. Data were analyzed through chi square. Findings showed that 53.4% of women reciving insufficient prenatal care. There was a significant correlation of care and employment condition [P=0.026] level of spouse's education [P=0.042] and income [P=0.005]. The most effective factors on reciving prenatal care from mothers' view were know [the manner and number of prenatal care] [85.3%]. Also there was a statistically significant relationship between efficiency of prenatal care and some socio demographic factors. In existence of prenatal care in health centers, almost half of women do not use these care provided. Provider's attention to the demographic and family characteristics and their needs are important in promotion of receiving better prenatal care

[Fatigue resistance and failure mode of endodontically restored premolars with indirect composite resin restoration-in vitro]

The present study aimed at determination of the fatigue resistance and failure mode of cusp-replacing onlays in endodontically treated premolars using indirect composite resin restorations. In this experimental study, 84 human premolars were randomly divided into 7 groups of 12. These groups were prepared as follows: Intact teeth used in group1 as control, the second group covers the endodontically treated teeth, restored with indirect onlays using Z-250 composite resin, the next two groups [i.e. 3, 4] were similar to the second group, but subjected to 1 and 2 million fatigue load cycles, respectively. Groups 5, 6, 7 were similar to groups 2, 3, 4, respectively, however, in these groups Tetric Ceram used as the restorative material. All specimens were loaded using a Universal Testing Machine until fracture occurred and the mode of failure observed with naked eye. Kruskal-Wallis and Chi-Square tests were used to analyze the data [alpha=.05]. All specimens withstood the masticating simulation. The mean fracture strength for groups 1 to 7 were: 1276.92, 1269.05, 1217.80, 1188.13, 1228.97, 1127.86, 1105.58, respectively. No statistically significant differences were found between the groups in fracture strength and failure mode. There was no statistically significant difference between two types of resin composite [P=0.203] and load cycles [P=0.298] after zero, 4 and 8 years aging. Within the limitation of this study, restored premolars with indirect composite onlays show fatigue resistance equal to natural tooth up to 8 years after restoration. Furthermore, no statistically significant differences were found between 4 and 8 years of load cycles. Tetric Ceram Z-250 restoration agent showed no effect on the tooth fracture resistance with the most observed fractures to be occur under CEJ with no capability to be restored

[Leukocyte adhesion deficiency syndrome and report of three cases]

Leukocyte adhesion deficiency syndrome [LADS] is a rare inherited immunodeficiency in which the frunction of leukocytes, particularly the phagocytes are disturbed. In the present study, we report three cases with LADS [2 male infants and 1 female child] who had a history of delay in separation of umbilical cord. One infant admitted for skin infection and two patients admitted in hospital following bacterial and fungal infections in nose and finger. All cases had a remarkable leukocytosis, neutrophilia and decreased of CD 11 and CD 18. LADS is a congenital syndrome causes recurrent bacterial and fungal infections. Usually all patients have a history of delayed separation of umbilical cord

Evaluation of Auditory Brainstem Response [ABR] in neonatal hyperbilirubinemia

Jaundice is a common problem in newborns and clinical presentations resulting from early stages of hyperbilirubinemia toxicity. ABR is useful test to recognize the primary brain stem encepholapathy. This study has been carried out with the objective of evaluating the ABR in recognizing hearing disorders in newborns suffering from Jaundice. In this study, we describe ABR obtained in 60 full term newborns, with birth weight more than 2500 gr, and Bilirubin concentration Between 18-54mg/dl without immune hemolysis and hearing disorder risk factor, from march 2005 until January 2006. ABR was carried out before commencing therapy, While first ABR was abnormal, repeated ABR was done after treatment exactly after 3 months. In this study, sixty newborns were evaluated by ABR for detecting early hearing disorder. Mean weight were 3000 +/- 250 gr, Gestational age 38 +/- 1 weekes, bilirubin concentration 36 mg/d.l +/- 9 [18-54 range]. 17 patients had abnormal ABR pretreatment, and 12 patients done normal ABR second evalution after treatment [Bili: 26 +/- 3], 5 patients had persistent abnormal [mean Bili: 43 +/- 5]. ABR abnormalities includes latencies wave I,III,V and loger duration interpeaks I-V,I-III and III-V. [Mean values of ABR latencies when compared with a group of normal babies as a control group were significantly increased before treatment, but returned to normal value after treatment [p=0.001]. Our study proved that newborns with serum bilirubin ranging from 18 to 54 mg/dl would be increase in ABR waves I,III,V and also increase in interpeak I-III,III-V,I-V that may be irreversible in those infants with bilirubin more than 32 mg/dl

[Treatment of carotid paraganglioma: review of a 15 - years experience]

Carotid body tumor is a highly vascular mass occurring between the origins of the internal and external carotid arteries, and should be considered in the evaluation of all lateral neck masses. The aim of this study is to review an institutional experience in the management of this tumor. 16 patients with carotid paragonglioma were treated in our institution during a period of 15 years. There were 12 women and 4 men with a mean age of 44 years. A slow growing painless lateral neck mass was the main finding in all patients. There was no evidence of a functional or malignant tumor. Carotid angiography and CT scan with contrast was performed in near all patients to define the vascular anatomy of the lesion. None of them underwent embolization. Complete tumor resection was done in all patients vascular reconstruction was necessary in two patients. Hypoglossal nerve was sacrificed in one patient and transient marginal nerve deficit was existed in one. No stroke occurred. High index of suspicion and earlier detection by radiologic finding and early surgical resection by an experienced team offer a safe and effective method for complete excision of tumor with a reduced morbidity rate

[Usage of direct laryngoscopy in patients with laryngopharyngeal lesions]

Endoscopy of laryngopharyngeal diseases by direct laryngoscopy [DL] is still a valuable and useful endoscopic method for diagnosis, treatment and following them up. In this study, the safety of DL as an outpatient procedure is associated. This prospective study was performed on 146 patients who needed an endoscopic evaluation based on primary clinical diagnosis during two years in ENT ward of Ghaem hospital. While DL, macroscopic evaluation and biopsy was done and patient's tolerance during DL with local anesthesia, complications, age and sex, chief complaint, primary clinical findings and the results of endoscopy and pathology was written in a questionnaire and then analyzed. In 146 patients, laryngoscopy was done with local anesthesia in 84% and as an outpatient procedure in 75% and complications resulting to admission were not seen .Age average was 55 +/- 14, male to female ratio 2 to 1, the most common decade 6 and 7, and the most common complaint was dysphonia. Also, 51% of lesions were neoplastic that the squamous cell carcinoma was the most common. 21% of squamous cell carcinomas were seen in hypopharynx and 78% in the larynx. In the larynx, supraglottis was the most common site [69%] while the glottis and infraglottis were the next sites [18% and 6% respectively]. Male to female ratio of laryngeal and hypopharyngeal carcinoma was 5.3 to 1 and 3 to 4 consequtively. Much less incidence of benign neoplasm in our patients compared with other populations and older age in average, are seen in our results. Also, much more involvement of supraglottis compared with the glottis of the larynx, and male to female ratio of 3 to 4 in hypopharyngeal carcinoma of our patients are of other main differences seen in this study. Similar studies using the newer techniques and equipments such as videolaryngoscopy are needed to confirm the accuracy and safety of them compared with DL in the future

[Report 9 cases of adenoid cystic carcinoma of trachea]

Primary malignant neoplasm of trachea are very rare and there is limited information about them. Adenoid cystic carcinoma is a slow-growing malignant tracheal tumor and the best method of treatment is surgical resection. This study was conducted for evaluation of patients with adenoid cystic carcinoma of trachea after treatment. In this descriptive study, all patients treated for adenoid cystic carcinoma between 1995 to 2006 in Mashad Ghaem hospital and Tehran Imam Khomeini hospital, were analyzed statistically. Of nine patients, female to male ratio was 2/1,the mean age of patients was [56.3] years, dyspena and stridor were the most common presenting symptoms [88.8%] and CT scan was the best diagnostic imaging method. The most common site of involvement was in lower third of trachea [44.4%]. [77.7%] of patients underwent surgical resection, hospital mortality after tracheal resection occurred in one patient due to complication [14.2%] aspiration pneumonia. During three years follow up just one patient [11.1%] had tumor recurrence and resection with post operative radiotherapy was performed in this cases overall three-year survival was 88.8%. Because of the nature of adenoid cystic carcinoma in trachea, surgical resection is the best method of treatment, but if surgical margin is positive, post operative radiotherapy will be necessary. In patients who are not candidates for resection, radiotherapy can be an effective alternative treatment

Preservation of facial nerve in surgery of first branchial cleft anomaly: five cases of duplicated external ear canal

We report five cases of duplicated external ear canal with especial attention to its histology and surgical care of facial nerve for their complete resection. These five patients were selected from 50 cases of first bronchial cleft anomalies including atretic external ear canals, preauricular fistula, cyst and sinuses. The characteristic histopathology and clinical features such as external opening around the auricle and upper neck above the level of the hyoid bone were not observed in other patients. There were no other abnormalities in the real external ear canal [EEC] and auricle. Three of them were connected to the natural EEC with an opening, hence producing ear discharges. Histologic appearances of well formed canal included a circumferential epithelial lined up and canal consisting of stratified squamous epithelium with skin adnexes. A remarkable cartilaginous skeleton [type 2 of first branchial cleft anomaly according to Work's classifications] was also observed. All of them were treated surgically, with preservation of the facial nerve and excising the superficial parotid gland along with the ductal opening and the tract

[Glossopharyngeal neurinoma; diagnostical and therapeutical aspects]

Among posterior fossa tumors, neurinoma arising from glossopharyngeal nerve are rare; only about 46 cases of glossopharyngel neurinoma have been reported. Though a typical jugular foramen syndrome has been described for tumors of this region, the clinical onset may often closely resemble that of acoustic neurinoma thus misleading the diagnosis. Although this tumor shares with the far more common acoustic norinorna the presenting symptom of hearing loss, it may be distinguished by an elicit able history of hoarseness, demonstration of abnormal palatal function and absence of expected findings upon standard radiographic examination of the petrous bones and internal auditory canal. This is the report of our experience with five such cases treated successfully and we have found that identification of this tumor may be accomplished with currently available diagnostic techniques, including computerized tomography and MRI. Because of its different surgical implication, such a rare condition must be clearly recognized. Our aim is to emphasize the importance of particular focus on clinical symptoms, imaging findings and surgical management of this tumor

Oral Lesions at Birth

The aim of this study was to determine the frequency distribution of oral lesions at birth. 11 11 Method: All babies delivered in Mashhad sina hospital were examined for oral lesions immediately after birth for one year since 1.1.82. In this cross sectional descriptive study, frequency distribution was detected from data. During the study period 3298 babies were delivered. Oral lesions included 76% ii Epstein pearls, 35% Bone nodule, 0.33% ankyloglossia, 0.12% natal teeth, 0.03% congenital epulis, 0.03% cleft lip, 0.06% cleft palate, 0.03% cleft lip and palate. In this study Epstein pearls were the most common lesion at birth and cleft lip, with or without cleft palate and congenital epulis, were the lowest ones

[Sudden idiopathic sensorineural hearing loss in Ghaem hospital. Mashhad]

Objective: determining the epidemiologic pattern of sudden idiopathic sensorineural hearing loss in hospitalized patients

Material and Method: patients to the hospital due to sudden sensorineural hearing loss were evaluated thoroughly [history, physical examination, lab tests, imaging]. Those with a certain diagnosis were excluded, and in the unknown etiology group the preferred information was obtained. All patients were treated with prednisone, acyclovir, and low salt diet. Daily audio logic tests were performed

Results: the peak incidence was the fourth decade, with women being affected more than men. The onset was more common in the early morning and in the fall. The accompanying signs were tinnitus [90%] and vertigo [50%]. Hearing loss was profound [>90dB] in 80% of the patients. Hearing enhancement in 75% of hospitalized patients was negligible [none or less than 20dB], and only in 15% was there a dramatic response [improvement more than 50dB]

Conclusion: hearing enhancement [prognosis] in severely affected patients is not prominent despite using widely accepted therapy