Evaluation of WHO’s partogram alert line for prediction of the APGAR score at the first minute after birth

Background and aim: The early diagnosis of abnormal progress of labour and prevention of long term delivery are the main keys to reduce fetal mortality rate due to hypoxia and tissue ischemia. One of the WHO’s proposed methods for prevention of abnormal delivery is using partogram. Therefore, this survey was conducted to evaluate WHO’s partogram alert line for APGAR score at the first minute after birth. Methods: This descriptive–analytical study was performed on 140 pregnant women under partogram in Shahrood Fatemieh hospital. Using the partogram alert line, the progress of labour, mother’s and infants condition started to be controled from 3 cm dilation of the cervix. Decision for resuscitation was made based on respiration, heart rate and skin color of the infant 20 to 30 seconds after the birth. Tools of this research were a questionare, inspection form consisted of WHO’s partogram and step by step resuscitation form. χ2, t–test and analytical methods of sensitivity, specificity and negative and positive values were used for data analysis. Results: The results showed that 68.8% of the subjects cervical dilatation remained on or to the left side of the alert line and 28.6% was on the right side and 2.9% was on or to the right side of the active line. According to χ2 test, there was a significant relationship between the first minute APGAR score after delivery and the location of cervical dilation. The value of alert line for surveying of APGAR score at the first minute after birth had a sensitivity of 25%, specificity of 96.87% , negative and positive predictive value of 75.6% and 76.92%, respectively. Conclusion: Our results showed that using WHO’s partogram prevents long term delivery, helps for on time diagnosis of fetal distress and reduction in stillbirth and fetal mortality. So, partogram should be a part and parcel of fetal and maternal health care

Evaluation and comparison of clinical and para clinical diagnosis of Candida vaginitis in women referred to Shahrood city health care centers years between 2004-2007

Background and aim: Candida vaginitis is the second common cause of vaginitis and Candida albicans is cause of 90 percent of vaginal fungal infections. Because antifungal drugs are among the cheapest vaginal drugs this study was performed to evaluate and compare clinical and paraclinical diagnosis of candida vaginitis in women referred to health care centers in Shahrood cityfrom 2004 to 2007. Methods: This deh1ive-analytic research was performed on 300 women with vaginitis infections who were referred to the Shahrood city health care centers. Two samples of secretions were taken from both endocervix and exocervix using speculum and spread on two glass slides and then one sample was taken from posterior culdesac secretions with a cotton soup and entered into a tube containing sterilized physiological serum. A questionnaire was filled out by a midwife for every patient. Standard laboratory methods (cultures Pap smear wet smear and etc.) were used to evaluate the samples and the second questionnaire was filled out by the midwife. Finally results were analyzed by statistical methods. Results: Based on clinical results 132 persons (44%) had candida infection but the infection was not proved by cell culture in 30 patients ((10%) and wet smear in 111 persons (37%). No candida infection was found in cytology survey. Based on clinical results vaginal pH was measured 5.01. The amount of pH was found 5.52 5.8 and 5.71 based on wet smear cell cultures and Pap smear respectively. The physical examination sensitivity for detecting vaginal candidiasis was 63.33% compared to the cell culture. Conclusion: The results of this study show that some para-clinical examinations should be considered for diagnosis of vaginal candidiasis. These para-clinical experiments help to prevent and reduce the side effects of some unnecessary medications

Dynamic Hub Covering Problem with Flexible Covering Radius

Abstract One of the basic assumptions in hub covering problems is considering the covering radius as an exogenous parameter which cannot be controlled by the decision maker. Practically and in many real world cases with a negligible increase in costs, to increase the covering radii, it is possible to save the costs of establishing additional hub nodes. Change in problem parameters during the planning horizon is one of the key factors causing the results of theoretical models to be impractical in real world situations. To dissolve this problem in this paper a mathematical model for dynamic single allocation hub covering problem is proposed in which the covering radius of hub nodes is one of the decision variables. Also Due to NP-Hardness of the problem and huge computational time required to solve the problem optimally an effective genetic algorithm with dynamic operators is proposed afterwards. Computational results show the satisfying performance of the proposed genetic algorithm in achieving satisfactory results in a reasonable time. Keywords: hub location problem, dynamic hub covering problem, flexible covering radius, dynamic genetic algorithm

Multi-objective optimization for periodic preventive maintenance

This article investigates a JIT single machine scheduling problem with a periodic preventive maintenance. Also to maintain the quality of the products, there is a limitation on the maximum number of allowable jobs in each period. The proposed bi-objective mixed integer model minimizes total earliness-tardiness and makespan simultaneously. Due to the computational complexity of the problem, multi-objective particle swarm optimization (MOPSO) algorithm is implemented. Also, as well as MOPSO, two other optimization algorithms are used for comparing the results. Eventually, Taguchi method with metrics analysis is presented to tune the algorithms' parameters and a multiple criterion decision making (MCDM) technique based on the technique for order of preference by similarity to ideal solution (TOPSIS) is applied to choose the best algorithm. Comparison results confirmed supremacy of MOPSO to the other algorithms

JIT single machine scheduling problem with periodic preventive maintenance

This article investigates a JIT single machine scheduling problem with a periodic preventive maintenance. Also to maintain the quality of the products, there is a limitation on the maximum number of allowable jobs in each period. The proposed bi-objective mixed integer model minimizes total earliness-tardiness and makespan simultaneously. Due to the computational complexity of the problem, multi-objective particle swarm optimization (MOPSO) algorithm is implemented. Also, as well as MOPSO, two other optimization algorithms are used for comparing the results. Eventually, Taguchi method with metrics analysis is presented to tune the algorithms’ parameters and a multiple criterion decision making technique based on the technique for order of preference by similarity to ideal solution is applied to choose the best algorithm. Comparison results confirmed the supremacy of MOPSO to the other algorithms

M-Guard Stent in Stemi Patients with High Thrombus Burden Lesions: A Prospective, Single Arm Study

Introduction: Primary PCI is the preferred modality to restore blood perfusion in STEMI patients, but myocardial reperfusion is sometimes lower than optimal. Distal embolization seems to play the leading role. There is rare evidence suggestive of M-Guard stents; a recent innovation which protects against distal embolization may be beneficial in this circumstance. Materials and Methods:This was a prospective single arm study. Patients with acute STEMI admitted at the Cardiac Emergency Unit of Imam Reza Hospital from July 2011 to November  2012 who had a large bulk of thrombus in their angiogram, underwent M-Guard stenting and were followed up for six months for chest pain and secondary revascularization. Results: The 23 patients, aged between 34 and 84; 65.2%, were male and had undergone primary PCI, mechanical thrombus aspiration, and M-Guard stenting. Left Anterior Descending (LAD) (63.9%) and Right Coronary Artery (RCA) (39.1%) were most commonly involved. 78.2%, 13.1%, and 8.9% of patients had primary Thrombolysis in Myocardial Infarction (TIMI) Thrombus grade five, four, and three. Among them, 86.9% achieved TIMI Flow grade three and 13.04% TIMI Flow grade two. The rate of transient "no-reflow" phenomenon was 21%. One patient died after stenting in the setting of cardiogenic shock. There was one case of in-stent restenosis five months after the procedure. Of the other 15 accessible patients, after six months, none experienced a second angioplasty or any ischemic symptoms. Conclusion: Using M-Guard stents in acute STEMI patients having undergone primary PCI with high thrombus burden is probably associated with lower rates of the "no-reflow" phenomenon and improved vessel reperfusion.

The Epidemiologic, Clinical and Laboratory Findings of Patients with Guillain Barre´ Syndrome in Southern Iran Since 2007 to 2012

Background ;Objective: Guillain Barre´ syndrome is an autoimmune neuropathy which is considered to be the most acute areflexic paralysis with albuminocytologic dissociation.1 Areflexia or hyporeflexia, pain in limbs, autonomic dysfunction, progressive bilateral and symmetric weakness of limbs, numbness and paresthesia are described as the clinical features of GBS.Nevertheless, with having less prognosis, the treatment is usually effective. Most patients diagnosed with GBS were previously infected with CMV or C.jejuni. Subtypes of the disease are either Axonal or Demyelinating. Due to increase use of Guillain Barre´ in south of Iran, the present study has done a retrospective study on the epidemiology of Guillain Barre in the south part of Iran.Materials & Methods: We performed our retrospective study in Namazi hospital in Shiraz, Iran. Medical records were analyzed using computer and were presented through percentages.Results: 214 patients were studied in which 119(55.6%) of them were men and 95 (44.4%) of them were women. 15 % of the participants had respiratory disturbance and 5.1% of them had histories of common cold and 1.4 of them were vaccinated before the study. Moreover, six people had died but 208 patients were treated and healed either by prescribed dosage of IVIg (69.2%) or plasmapheresis (24.3%) and one patient was also seen who had HIV virus.Conclusion: This study provides more details on the epidemiology of GBS in Shiraz, and south of Iran. Our study also revealed the difference in pattern of GBS in Iran and other countries. however, there is still a need for further clarification of the issues