Hypothermia in Iranian newborns. Incidence, risk factors and related complications.

OBJECTIVE: To determine the incidence rate and factors associated with hypothermia in Iranian newborns and to discover the effect of hypothermia on neonatal morbidity and mortality. METHODS: We selected a random sample of 1952 neonates using a multistage sampling technique from February 2004 to February 2005 in University Teaching Hospitals in Iran. We measured repeatedly at different time points the rectal temperature of these newborns. At each time of measurement, those with rectal temperature <36 degrees C were considered as hypothermic. RESULTS: The obtained results showed that approximately one third of newborns became hypothermic immediately after birth. In addition, the regression analysis revealed that low birth weights, prematures, low apgar scores, infants of multiple pregnancies and those who received cardiopulmonary resuscitation had higher risk for being hypothermic. It was also found that hypothermia increases the risk of metabolic acidosis, jaundice, respiratory distress, hypoglycemia, pulmonary hemorrhage and death, regardless of the newborn's weight and gestational age. CONCLUSION: There is an urgent need to train mothers and all levels of neonatal care staff to control this health problem in our country.

Modeling repeated ordinal responses using a family of power transformations: application to neonatal hypothermia data.

BACKGROUND: For analyzing a repeated ordinal response, it is common to use a multivariate cumulative logit model. This model may fit poorly, especially when a nonsymmetric response is available. In these cases, alternative strategies should be utilized. METHODS: In this paper, we present a family of power transformations for the cumulative probabilities to model asymmetric departures from the random-intercept cumulative logit model. To illustrate this method, we analyze the data from an epidemiologic study to identify risk factors of hypothermia among newly born infants in some referral university hospitals in Tehran, Iran. RESULTS: For hypothermia data, using this family of transformations and comparing the goodness-of-fit statistics showed that a model with the cumulative complementary log-log link gives us a better fit compared to a model with the cumulative logit link. CONCLUSION: In some areas, using the ordinary cumulative logit link function does not lead to the best fit. So, other link functions should be evaluated to discover the best transformation for the cumulative probabilities.

The effect of HMG and recombinant human FSH on oocyte quality: a randomized single-blind clinical trial.

OBJECTIVE: To compare the effect of HMG and rhFSH on oocyte quality in ICSI cycle. SETTING: Vali-e-Asr university teaching hospital. METHOD: Prospective single-blind randomized clinical trial. SUBJECTS: Sixty women undergoing ovarian stimulation for ICSI were randomized to receive a standard protocol of either HMG or rhFSH in down-regulation cycles. INTERVENTIONS: Prior to microinjection, each oocyte was assessed regarding the nuclear maturity, morphology of zona plucida, cytoplasmic appearance and polar body morphology. Fertilization rate was followed. MAIN OUTCOME: The percentage of metaphase II oocytes in HMG and rhFSH groups. STATISTICAL ANALYSIS: Statistical analyses were carried out by the Mann-Whitney, Fisher's exact, chi2 tests and Student's t-test. RESULTS: No significant differences were found between two groups in regard to the demographic data, the ovarian response and pregnancy/implantation rates (P>0.05). The percentage of metaphase II oocytes in HMG and rhFSH groups were 81.3% versus 80.6%, respectively. CONCLUSIONS: There were no significant differences between parameters such as, oocyte quality and percentage of metaphase II oocytes between these two groups.

A survey of relationship between anxiety, depression and duration of infertility.

BACKGROUND: A cross sectional study was designed to survey the relationship between anxiety/depression and duration/cause of infertility, in Vali-e-Asr Reproductive Health Research Center, Tehran, Iran. METHODS: After obtaining their consents, 370 female patients with different infertility causes participated in, and data gathered by Beck Depression Inventory(BDI) and Cattle questionnaires for surveying anxiety and depression due to the duration of infertility. This was studied in relation to patients' age, educational level, socio-economic status and job (patients and their husbands). RESULTS: Age range was 17-45 years and duration and cause of infertility was 1-20 years. This survey showed that 151 women (40.8%) had depression and 321 women (86.8%) had anxiety. Depression had a significant relation with cause of infertility, duration of infertility, educational level, and job of women. Anxiety had a significant relationship with duration of infertility and educational level, but not with cause of infertility, or job. Findings showed that anxiety and depression were most common after 4-6 years of infertility and especially severe depression could be found in those who had infertility for 7-9 years. CONCLUSIONS: Adequate attention to these patients psychologically and treating them properly, is of great importance for their mental health and will improve quality of their lives.

Embryonal rhabdomyosarcoma of the uterine cervix: case report and review of the literature.

OBJECTIVES: Sarcoma botryoides rarely arises in the uterine cervix. It usually presents in the adolescent age group. The peak incidence is in the second decade. A combined modality approach to treating rhabdomyosarcoma (RMS) has markedly improved survival. We present two cases of cervical RMS. One of them had a very aggressive clinical course. CASE: Two cases of RMS in young women who presented with rapidly progressive cervical tumor are reported. They were treated with two-stage surgical procedure and chemotherapy. CONCLUSIONS: A combined modality approach to treating RMS using multidrug chemotherapy, radiotherapy, and surgery has markedly improved survival. One of our cases has been free of disease for more than 5 years.

Cutaneous metastasis from carcinoma of the cervix at the drain site.

BACKGROUND: Metastasis to the skin occurs rarely in gynecologic cancer, especially in cervical carcinoma. Although carcinoma of the cervix is the second to the fourth most common malignancy in women, cutaneous involvement originating from cervical cancer is particularly unusual, even in the terminal stage of the disease. CASE: We present a case of cervical cancer recurrence with skin metastasis. The extensive skin lesion on the abdominal wall occurred 4 years after radical surgery and postoperative radiotherapy. This was a biopsy-proven metastasis from the patient's primary cervical carcinoma. CONCLUSION: As far we know this is the second case (after Copas et al., Gynecol Oncol 1995;56:102-4) of skin and subcutaneous tissues metastasis from cervical carcinoma at the drain site. Palliative chemotherapy and radiotherapy have a useful role in controlling symptoms.