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Background and objective: To determine the effects of duration of second stage of labor on the newborn’s Apgar score in primigravida women admitted in Fatemeh Zahra Hospital. Materials and methods: Case control study on the 120 primigravide women (40 women with a duration second stage more than 2 hours and 80 women with a duration second stage less than 2 hours). The criteria such as pregnancy history, quality of prenatal care and socioeconomical status were the same for the both groups. Patients with preterm labor, cesarean section, multiple pregnancy, malpresentation, malformation and receipt sedation of narcotic less than one hours to baby’s birth were excluded. From this study statistically analysis had done by Chi-square and Z-test and person’s coefficient correlation. Results: Statistically significant relationship was observed between the age of the mothers and the duration second stage of labor, so that, the mothers with more than 30 years of age had prolonged duration in second stage of labor (P<0.05). More than half of the sample population had used oxytocin for augmentation of labor, which this difference was significant (P<0.05). Conclusion: The different studies showed that the duration of second stage of labor was significantly associated with fetal lactate and low Apgar score less than 7 at birth, but didn’t have any role in five-minute low Apgar scores and neonate morbidity.

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Background&Objective: Decrease in production of erythropoietin has been noted as one of the main factors causing anemia in ESRD patients, and administration of recombinant human erythropoietin (rhEPO) has been used to correct the anemia. Iron deficiency, including functional iron deficiency, limits the efficacy of rhEPO therapy in ESRD patients. This study examined the effects of maintenance intravenous iron sucrose (Venofer) on haemoglobin level and, optimization of erythropoietin therapy. Materials&Methods: Forty eight haemodialysis patients with haemoglobin level<9 gr/dl who were dialyzed three times weekly went under the study. Two thousands units of rhEPO were given subcutaneously at the end of each dialysis for seven weeks. At the end of the seventh week, those with haemoglobin level<9 gr/dl and with ferritin level <200 ng/dl (29 patients) were chosen for intravenous administration of 100 mg Venfor during the next five consecutive haemodialysis while maintaining the rhEPO dose at 2000 units with each dialysis. A week after the last dose of Venofer, haemoglobin and serum ferritin were determined. Results: Average haemoglobin level among the patients before administration of rhEPO was 7.5 gr/dl. After seven weeks of subcutaneous rhEPO at 2000 units with each haemodialysis, the average haemoglobin level raised to 8.5 gr/dl. The effect of maintenance IV Venofer was an increase in average haemoglobin level to 10.4 gr/dl. The same effect was seen on the ferritin level. The ferritin level of 131 ng/dl increased to 237 ng/dl a week after last dose of IV venofer. Conclusion: Intravenous (IV) iron improves haemoglobin response and, thus, optimizes rhEPO therapy.

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Background & Objective: The breast cancer is the most common malignancy in women. MDM2 expression is determined in some carcinomas, sarcomas, leukemias,and breast cancer. The purpose of this study was to determine the expression of MDM2 gene in primary breast cancer and it’s relationship with grade, stage and axillary lymph node involvement. Materials & Methods: the study was the cross-sectional one, that was performed on 75 samples of patients with breast cancer admitted in Mostafa Khomeini hospital Tehran, Iran (2000-05). After preparing the samples, a tissue section from each samples was obtained. One of the tumoral sections and one of the lymph node sections were stained by H&E. We determined the type of the tumor, the number of lymph nodes, the stage and the grade of the tumor. We studied MDM2 with polyclonal antibody by IHC. Results: The meanSD of patients were 5412.5 years old. 69.3% of patients had lymphoid involvement. 32% of samples were positive for MDM2. 58.7% of samples were in stage II and the most of patients (42.7%) were in grade III. In this study, there was not any relationship between MDM2 and tumor grade, but there was a relationship between stage of tumor and lymph node involvement with MDM2 gene (P<0.05). Conclusion: This study showed that MDM2 gene is a prognostic factor in breast cancer.

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Background and Objective: Maternal position during the second stage of labor can be considered to be an intervention in the natural course of labor. This study aimed to establish the effect of sitting versus lithotomic position on duration of second stage of labor, preneal truma and neonatal outcome.

Materials and Methods: This clinical trial study was done on 110 term nuliparuse women with normal conducte of labor in second stage, which divided randomly in sitting position, (n=55) and lithotomic position (n=55) in teaching hospital in Yazd, Iran during 2005-06. Duration of second stage, Perinea trauma and first 5 minutes APGAR evaluated and compared in two groups. Data analyzed by SPSS-11.5 with T student and Chi square tests. P<0.05 was significant.

Results: Duration of second stage of labor was 34 and 42 minutes in sitting and lithotomic position respectively (P<0.05). Perinea damage was seen in 15 (27.3%) and 24 (43.6%) women of sitting and lithotomic position respectively (P<0.05). No significant difference existed between the groups in neonatal first 5 minutes APGAR.

Conclusion: This study showed that sitting position reduce second stage duration and perinea trauma versus lithotomic position.

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Background and Objective: Hemodialysis is one of the common therapulic proceduce for terminal renal failure. Insufficient and low efficient hemodialysis increases the mortality rate, therefore the assessment of hemodialysis efficacy is important. This study was done to determine the hemodialysis efficacy based on urea reduction ratio (URR) model and kt/v (Clearance Time Volume) criteria in Gorgan, Northern Iran. Materials and Methods: In this descriptive and analytical study 113 heomdilysis patients were selected prior to hemodilysis and five minutes after pump stopping, arterial blood urea nitrogen (BUN) was measured and then kt/v and URR were calculated. Also kt/v relations with weight, gender, educational level, length of hemodialysis session, blood flow rate, TMP (Terans Membran Presure), filter Ku/f (Clearance Ultrafiltration), preliminary disease, time of hemodialysis per week and the type of vessel access were determined. Data analyzed using SPSS-13 and independent t-test, chi-square, fisher exact test and Pearson correlation coefficient. Results: The mean of hemodilysis history was 37 months and mean of Patient's ages were 51.6 years. 77.9% of subjects had hemodialysis efficacy according to Kt/v and URR critrial. There was a statistical significant correlation between hemodialysis efficacy and time of hemodialysis session, blood flow rate, time of hemodialysis per week and type of vessels access (P<0.05), but there was not any significant correlation between hemodialysis efficacy and weight, gender, education, TMP, filter Ku/f and preliminary disease. Conclusion: This study suggested that hemodialysis efficacy in this center was better that other studies in Iran.

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Background and Objective: Mucocutaneons manifestations are common in hemodialysis patients.The aim of this study was evaluate the prcvalence of cutaneous and mucosal manifestations in end stage renal disease (ESRD) patients who are on the maintenance hemodialysis.

Materials and Methods: This cross sectional study was performed on 100 (51 males, 49 females) hemodialysis patients in 5 Azar hospital in Gorgan, North of Iran during 2009. Patients selected on randomly based an all of them completely examined by a deramatologist for any changes in skin, hair, nail and mucous membrane. If necessary biopsy perform and refer to a pathologist. Data analysed with SPSS-13, mann-whitney, t-test, Chi-Square and Fisher tests.

Results: The average age was 49±12.3 years. The most common causes of ESRD was dibetes mellitus. The most common skin lesion was xerosis (78.3%), after that pruritis (39.1%) lentigo (34.8%) skin discoloration (32.6%) leukonychia (32%) thining of nail bed (24%) were common lesions. Lentigo was more common in female than male 42.85% vs 21.50% (p=0.042). Xerosis (p<0.01), scaling (p=0.042), lentigo (p<0.01), folliculitis (p<0.01), idio pathic guttate hypopigmentation (p<0.01) leukonychia (p<0.01) and half and half nail (p<0.01) have meaningful correlation with age. There was also meaningful correlation between dialyis duration and skin discoloration (p<0.031) and leukonychia (p<0.041). Clubhing and ca-p product also have meaningful correlation (p<0.027). Pruritis (p<0.048) and skin fungal infection (p<0.047) (tinea versi color) also have meaningful correlation with serum ferritin level.

Conclusion: Mucocutaneous manifestation were common in end stage renal disease patients.

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Background and Objective: Smoking is one of the important risk factors for many diseases and increases the premature death.Transtheoretical models is one of the behavioral models for behavior understanding specifically in addictive behaviors. This study was done to evaluate the application of transtheoretical model to determination of smoking behavior among smokers.

Methods: This descriptive - analytical study conducted on 450 male smokers in Gorgan, northern Iran during 2014. Data gathering instruments were Diclemente smoking stages of change, Velicer decisional balance and temptation, Prochaska processes of change measurements along Fagerstrom test for nicotine dependency.

Results: Based on the stages of changes, 39.1%, 13.8%, 42.4%, 2.7% and 2% of subjects were in precontemplation, contemplation, preparation, action and maintenance stage, respectively. There was a significant relationship between stages of change with all transtheoretical model variables and nicotine dependency (P<0.05). Cons of smoking, self-reevaluation, self-liberation, and social liberation had the highest effect while helping relationship had the lowest effect.

Conclusion: Cons of smoking, self-reevaluation, self-liberation, and social liberation had the strongest predictors of smoking stages movement. Helping relationship had the lowest predictor of smoking stages movement.

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Background and Objective: Hemodialysis is an important replacement therapy for 70-90% of patients with end-stage renal disease (ESRD). Arteriovenous fistula (AVF) is the vascular access of choice in these patients due to its higher efficiency and lower risk of mortality compared to arteriovenous grafts. This study was conducted to determine the frequency of vascular access types used in hemodialysis centers of Gorgan, Iran.
Methods: This descriptive-analytical study was done on 200 hemodialysis patients (101 men and 99 women) at 5 Azar and Sayyad Shirazi hospitals in Gorgan, north of Iran, during April 2020 to July 2021. The subjects were selected by the census method. Information including age, sex, education level, duration of dialysis, the initial and current types of vascular access, site of vascular access, history of diabetes or hypertension, race, and history of smoking were recorded in a checklist.
Results: The mean age of women and men was 58.34±4.71 and 57.95±13.76 years, respectively. In addition, 61.5% of the patients were under 3 years old. The most commonly used vascular access to initiate dialysis was non-cuffed temporary catheters (69%) and AVF (24%). Smoking, ethnicity, diabetes, hypertension, and gender had no significant association with the type of vascular access used. In addition, there was no significant relationship between the duration of dialysis and the type of vascular access.
Conclusion: Considering the diversity of catheters and fistulas, it is necessary to emphasize that the use of AVF in patients undergoing dialysis for the first time and the timely placement of AVF in ESRD patients can improve the quality of life of the patients. It is also recommended to use jugular catheters instead of subclavian catheters when required.
 

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Background and Objective: Ensuring suitable access to hemodialysis, which provides high-quality dialysis over an extended period, is a significant challenge for patients with End-Stage Renal Disease (ESRD). One crucial aspect of this is maintaining the performance of hemodialysis catheters. Our study, which aimed to evaluate the one-year performance of long-term catheters in chronic hemodialysis patients in Golestan Province, is a critical step toward improving patient care in this population.
Methods: This descriptive-analytical study was conducted on 99 patients (34 men and 65 women) with ESRD who were candidates for starting or continuing dialysis with a catheter in the educational and therapeutic centers of Golestan Province, Iran during 2021-22. Transjugular catheters were placed for the patients, and after one year, variables such as age, gender, history of diabetes, history of hypertension, catheter placement site (right or left jugular), and antiplatelet medication use were evaluated concerning the performance of long-term catheters in providing adequate flow for hemodialysis.
Results: In 91 patients (91.9%), the one-year catheter performance was assessed as satisfactory. The age of 61.6% of the patients were over 60 years old. Sixty-nine patients (69.7%) had a history of hypertension, and 58 patients (58.6%) had a history of diabetes. Fifty-seven patients (57.6%) received antiplatelet medication. The catheters were placed on the right side in 82 patients (82.8%). Catheter performance in patients taking antiplatelet medication was non-significantly higher than in those not taking antiplatelet medicines.
Conclusion: The performance of long-term catheters in chronic hemodialysis patients with ESRD showed no significant correlation with age, gender, diabetes, hypertension, antiplatelet medication use, or the side of the jugular vein where the catheter was placed.