Acute Myocardial Infarction Due to Dissection of the Coronary Arteries Associated with Premature Atherosclerosis in Late Postpartum: A Case Report of Maternal Death

AbstractIntroduction: Atherosclerotic coronary artery disease is the most common form of heart disease that is associated with high rates of acute myocardial infarction (AMI) and death in young people.Methods: Given the importance of pregnancy and the postpartum period and the fact that AMI is associated with poor maternal outcomes in postpartum, the present study reports acute myocardial infarction due to dissection of the coronary arteries associated with premature atherosclerosis in late postpartum.Results: The case was the maternal death of a 34-year-old woman at 42 days postpartum without any history of underlying diseases or symptoms, whose autopsy report read AMI due to coronary artery dissection associated with atherosclerosis.Conclusions: This report emphasizes the importance of postpartum care and attention to any symptoms witnessed during this period

Diagnostic values of ultrasound and the Modified Alvarado Scoring System in acute appendicitis

BACKGROUND: Making the diagnosis of acute appendicitis is difficult, and is important for preventing perforation of the appendix and negative appendectomy results. Ultrasound and clinical scoring systems are very helpful in making the diagnosis. Ultrasound is non-invasive, available and cost-effective, and can accomplish more than CT scans. However, there is no certainty about its effect on the clinical outcomes of patients, and it is operator dependent. Counting the neutrophils as a parameter of the Alvarado Scale is not routine in many laboratories, so we decided to evaluate the diagnostic value of the Modified Alvarado Scaling System (MASS) by omitting the neutrophil count and ultrasonography. METHODS: After ethical approval of methodology in Tehran University of Medical Sciences ethical committee, we collected the data. During 9 months, 75 patients with right lower quadrant pain were enrolled in the study, and underwent abdominal ultrasonography and appendectomy, with pathological evaluation of the appendix. The MASS score was calculated for these patients and compared with pathology results. RESULTS: Fifty-five male and 20 female patients were assessed. Of these patients 89.3% had acute appendicitis. The sensitivity, specificity, PPV, NPV and accuracy rate of ultrasonography was 71.2%, 83.3%, 97.4%, 25% and 72.4%, respectively. By taking a cutoff point of 7 for the MASS score, a sensitivity of 65.7%, specificity of 37.5%, PPV of 89.8%, NPV of 11.5% and accuracy of 62.7% were calculated. Using the cutoff point of 6, a sensitivity of 85.1%, specificity of 25%, PPV of 90.5%, NPV of 16.7% and accuracy of 78.7% were obtained. CONCLUSION: Ultrasound provides reliable findings for helping to diagnose acute appendicitis in our hospital. A cutoff point of 6 for the MASS score will yield more sensitivity and a better diagnosis of appendicitis, though with an increase in negative appendectomy

Correlation between workplace culture, learning and medication errors

The occurrence of medication errors in intensivecare units can bring about irreparable damageand even lead to death in hospitalized patients.In this respect, numerous investigations have suggestedthat many factors including workplace culture and learningfrom error can affect the incidence rates of such errorsin these units. Accordingly, the present study was to shedlight on the correlation between workplace culture, learningfrom error, and reporting rate of medication errorsamong nurses in intensive care units affiliated to teachinghospitals of Shahid Beheshti University of Medical Sciencesin Iran.Methods: A descriptive-analytical study was conductedamong 120 nurses working in intensive care units in fourteaching hospitals in the city of Tehran. Then, the questionnairesdeveloped by Gulley et al., Rybowiak et al., andWakefield et al. were used to collect the data related toworkplace culture, learning climate, and medication errors.Results: The findings of this study indicated that increasedlearning from error in nurses working in intensivecare units could lower reporting rate of medication errors(r=-0.312, p-value=0.001); there was also a significantrelationship between workplace culture and reportingrate of medication errors, so that enhancing workplaceculture could reduce reporting rate of medication errors(r=-0.239, p-value=0.012).Conclusion: Improving workplace culture via supportingemployee creativity and innovation as well as promotinglearning environment through an employee reward systemalong with avoidance of punishments and reprimands fornurses during the occurrence of errors could be effective inmitigating the incidence rates of medication errors

Evaluation of some factors affecting the risk of kidney damage in patients with hypertension

Chronic kidney disease (CKD) is an increasing cause of morbidity and mortality worldwide. Prospective data on risk factors for CKD are few. Hypertension is one of the risk factors for CKD. In the past serum creatinine concentration was used as marker of kidney function but it proffers a late reflection of reduced glomerular filtration rate(GFR), which limits its ability to detect impaired kidney function. Cystatin C and NGAL have recently been proven useful to quantitate CKD. Therefore in this study, we assessed the effect of some risk factors on reduction of estimated glomerular filtration rate (eGFR) in patients with high blood pressure. This study was performed on 42 hypertensive patients and 30 healthy volunteers, both with normal serum creatinine and urea concentration. In this study, we measured serum cystatin C and Plasma NGAL. Serum creatinine and urea levels of the patients were measured after an overnight fasting.  . Estimated glomerular filtration rate (eGFR) was considered as the gold standard method .Serum cystatin C and plasma NGAL were measured using commercially available human ELISA kits. Logistic   regression and T-test were used for statistical analysis. The results of logistic regression showed that among the variables studied, plasma levels of NGAL, age and duration of hypertension were significantly associated with the eGFR<78(P<0.05). Our findings suggest that, increased levels of NGAL, age and duration of hypertension predicts a higher odds of impaired renal functio

The Correlation between Post-Abortion Grief and Quality of Life in Females With a History of Abortion Visiting Health Centers and Hospitals of Shahid Beheshti University of Medical Sciences, Iran During Year 2016

Background: Grief is a common reaction pf parents to abortion. It may be followed by various psychological complications that affect women's individual-social quality of life. This study aimed to determine the correlation between post-abortion grief and quality of life of women with a history of abortion.Materials and Procedures: This descriptive-correlational study was conducted in 2016. Convenience sampling was applied to select 165 women with a history of abortion from health centers and hospitals affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran). A demographic and fertility questionnaire, the Perinatal Bereavement Grief Scale, and the World Health Organization Quality of Life Questionnaire were used to collect data. Descriptive statistics and Pearson’s and Spearman’s correlation tests were administered to analyze the data. All analyses were performed using SPSS 20.Findings: There was a significant relationship between quality of life and post-abortion grief (r = -0.387; p < 0.001) and the mean score of quality of life decreased with an increase in the intensity of post-abortion grief. Women with a history of abortion had a moderate level of post-abortion grief (mean score out of 100: 47.52 ± 9.01 ) and intensity of post-abortion grief in less than 3 months from abortion occurrence until completion of the questionnaire has been at its highest level (with a mean and standard deviation of 421.3 ± 99.3) and has declined over the time. However, there was no significant relationship between the intensity of the grief and the time of abortion. and desirable quality of life (mean score: 91.90 ± 14.43).Conclusion: The findings of this study suggested an association between more severe post-abortion grief and decreased quality of life, i.e. post-abortion grief had adverse effects on women’s quality of life. Therefore, fertility health policy makers are recommended to develop appropriate measures to reduce grief and improve the quality of life of women after abortion.

Female sexual outcomes in primiparous women after vaginal delivery and cesarean section

Background: Sexual function is an essential component of life and yet very little is known about the relationships between the female sexuality and the mode of delivery.Objective: To compare sexual outcomes after vaginal delivery and cesarean section.Methods: A cross-sectional study was conducted on women in two stages; early pregnancy and 3 to 6 months after delivery in health centers. Female sexual outcomes evaluated were female Sexual Function Index scores and the time required to resume sexual activities after delivery.Results: Sexual function did not differ significantly among two groups vaginal delivery n=90 and cesarean section n = 113 with regard to duration of marriage, educational level, contraception methods, and occupational status p = 0.8.The mean timing of the resumption of sexual activity was 8.9 ± 1.3, and there was no substantial conflict between the two groups. Mean frequency of intercourse in the post-partum period was 1.8±1.2 times per week with significant difference compared to pre pregnancy P<0.05. The individual domain scores after the delivery was significantly lower in comparison with pre-pregnancy p<0.004.Conclusion: No differences in sexual outcomes between vaginal delivery and cesarean section. Consequently cesarean section cannot be recommended in the view of maintenance of normal sexuality after child birth.Keywords: Women’s health, cesarean section, post-partum, vaginal delivery, female sexual functio

The Effectiveness of Cognitive-Behavioral Play Therapy on Anxiety and Academic Achievement among Children with LD

Introduction: The slow progression of academic achievement is one of the symptoms of children with learning disabilities (LD), which can be regarded as an obstacle to achieve educational goals along with anxiety. Play therapy is a way of changing the behavior of the child that is based on the interaction between parents and the child. This aim of the study was to investigate the effectiveness of cognitive-behavioral play therapy on reducing the anxiety and academic achievement of children with LD. Methods: In a double blind randomized clinical trial, 30 students with learning disabilities were randomly selected through targeted method and were assigned into two experiment and control groups through completely randomized blocks method. Play therapy was presented based on Landreth's protocol to the experimental and the control group received merely the training of motivational skills. Subjects were evaluated in two time intervals of pre-test and post-test by the Spence Children's Anxiety Scale and three mathematical, dictation, and Persian courses. Data were analyzed by covariance analysis through SPSS software. Results: Primary outcomes indicated that play therapy was effective in reducing the anxiety index. Also, secondary outcomes indicated intervention based on play therapy was associated with increased academic performance (p<0.000). Conclusion: These results can be of importance in influencing psychological interventions as an independent or complementary approach along with other therapies in children with special needs. . Declaration of Interest: Non

Iltifat, Grammatical Person Shift and Cohesion in the Holy Quran

While discourse analyses go back to the second half of 1950s related researches in the rhetoric field represent initiative interests centuries before by Islamic rhetoricians Among the topics Iltifat as the grammatical person shift in one or a sequence of sentences has been quite controversial within the area which considers the discourse participant shift among the speaker addressee and absentee Following a brief introduction to the topic of Iltifat the present paper is aimed to present its common categories and sub-categories and its importance from the point of discourse analysis which is then followed by the consideration of possible defective results of the grammatical person shift on cohesiveness of Quran In preparing the research 20 surahs of the holy book have been randomly selected which have been analyzed on the basis of the application of an integrative approach of Halliday and Hasan 1976 and De Beaugrande and Dressler 1981 towards cohesion As a result the research demonstrates the holy book s cohesiveness and the high Quranic usage of reference and specifically personal reference within the grammatical person shift amongst all the cohesive elements that are studied in detail in the paper The matter is presented together with the 8 resulted subdivisions of Iltifat in Quran on the basis of the research as follows grammatical person shift number shift person and number shift number and gender shift shift in the addressee function shift dual Iltifat and finally sequential Iltifa

The Association of Prenatal Depression and Body Mass Index (BMI) in Pregnant Women Referred to Health Centers in Qom

AbstractIntroduction: Pregnancy is a period during which women experience physical and psychological changes. The considerable changes can be found in their bodies and weights and they are quickly exposed to being overweight and obesity. On the other hand, few studies have assessed the association of depression with body mass index (BMI). This study explored whether depression and BMI affect each other in pregnancy. It aimed to investigate the correlation between prenatal depression and BMI in pregnant women in Qom.Methods: This was a descriptive-correlational study conducted on pregnant women referred to health centers in 2016. Participants were selected using multi-stage cluster sampling. Samples of 236 pregnant women were divided into two groups: the second (14-28 weeks) and third (28-40 weeks) trimesters of pregnancy. Height and weight were measured to determine the initial BMI as well as BMI during pregnancy. Demographic information was collected from demographic and obstetric forms. Depression was measured using the Beck Depression Inventory (BDI-II). Data were analyzed using SPSS software and descriptive statistics, t-test, ANOVA, regression analysis and Pearson’s correlation coefficient, significant at P < 0.05.Results: The results showed BMI in the second trimester to be 48.3% in the normal range, 16.1% overweight, and 30.5% obese. In the third trimester, BMI was 16.9% in the normal range, 34.4% overweight, and 46.6% obese. The rate of depression was 19.5% in the second trimester and 17.8% in the third trimester. Pearson’s correlation test showed that the association between prenatal depression and BMI did not exist in the second trimester (P = 0.499). In the third trimester, there was a significant negative correlation (P = 0.024). Based on regression analysis, among the factors related to BMI (depression, number of family members, gravidity, number of living children, parity, mother’s age, unwanted pregnancy by father, unwanted pregnancy by mother), depression and were are the only predictive factors strongly associated with BMI (P = 0.002 and P = 0.028, respectively).Conclusions: In our study, there was an inverse correlation between depression and BMI of pregnant women, so that with increase in depression, BMI decreased. According to the different results of the research, further studies should be carried out regarding the effect of depression on BMI in order to be able to provide further assistance to pregnant women