BackgroundThis study aimed to evaluate quality of life and psychological distress in Iranian women with recurrent miscarriage and to compare it in women without miscarriage.MethodsThis was a comparative study of quality of life among women with and without recurrent miscarriage. Cases were selected from patients with complain of recurrent miscarriage and comparison group were selected from women attending to two teaching hospitals for annual screening. Quality of life (QOL) was measured using the 36-Item Short Form Survey (SF-36). In addition the Hospital Anxiety and Depression Scale (HADS) were used to measure anxiety and depression. Comparison was made between two groups using the independent samples t-test and chi-square.ResultsIn all 105 women with recurrent miscarriage and 105 healthy women were studied. The socio-demographic status for both groups was similar. Women with recurrent miscarriage showed a significant higher degree of psychological distress [mean (SD) anxiety score was: 10.6 (2.3) vs. 9.1 (2.2), P < 0.0001; and mean (SD) depression score was: 11.0 (2.3) vs. 9.5 (1.9), P < 0.0001]. In addition women with recurrent miscarriage reported significantly lower level of quality of life in all domains (role physical, general health, vitality, social functioning, role emotional, and mental health, all P values < 0.0001), except for physical functioning (P = 0.06) and bodily pain (P = 0.17).ConclusionThe findings demonstrated that women with recurrent miscarriage reported extensive functional disability, and lower level of well-being compared to women without recurrent miscarriage. The findings have some implications for prenatal care and suggest that appropriate treatment of recurrent miscarriage is essential.
Thrombocytopenia has been reported as an adverse reaction of numerous drugs. Vancomycin is often overlooked as a culprit but has been associated with several cases of thrombocytopenia that were not well described in the literature. A literature search was conducted to find reports of thrombocytopenia induced by vancomycin. Biomedical databases including 'PubMed', 'Scopus', and 'Web of Science' were searched using terms 'vancomycin', 'platelet', 'pancytopenia', 'thrombocytopenia', and 'bleeding'. English language articles published before July 2015 were included. Thirty-nine papers including 29 case reports (30 cases), five observational studies, two clinical trials, two letters, and one case series remained for final analysis. The main route of administration was intravenous infusion. This adverse reaction seems to be duration dependent with the mean time to platelet nadir count of 8 days in reported cases. The interval may be significantly shorter in re-exposure to the drug. Platelet nadir counts ranged from 2000 to 100,000/mL in patients who experienced bleeding. Vancomycin-specific antibodies were detected in 13 of 17 patients who were tested in the case reports. Based on the Naranjo Adverse Drug Reaction Probability Scale, reaction was 'definite', 'probable', and 'possible' in 1, 15, and 14 patients, respectively. Among 30 cases, vancomycin was discontinued in 29 patients and platelets returned to normal counts within 5-6 days in 17 of them; in one patient, vancomycin was not discontinued, but platelet count recovered 11 days after the nadir time. Transfusion might be recommended if severe thrombocytopenia and bleeding occurs. Intravenous immunoglobulins, corticosteroids, rituximab, and plasma exchange should be reserved for patients with resistant thrombocytopenia and severe bleeding as mentioned in a number of reports.
OBJECTIVESThalassemia is a common genetic disease in Iran, especially in the north and south of Iran. The present study sought to determine the survival rate of patients with thalassemia in highly endemic regions of Iran and its variation in patients born before and after 1971.METHODSThe present historical cohort study extracted data from the health records of patients with beta-thalassemia major, beta-thalassemia intermedia, and sickle beta-thalassemia who had presented to thalassemia treatment centers in the past years. The collected data were analyzed using the Kaplan-Meier test, the log-rank test, and the chi-square test.RESULTSOf the total of 5,491 medical records (2,647 men and 2,634 women; mean age, 23.81±11.32 years), 3,936 belonged to patients with beta-thalassemia major, and 999 and 89 to patients with beta-thalassemia intermedia and sickle beta-thalassemia, respectively. In 467 cases, the type of thalassemia was not clear. The cumulative survival rate was calculated as 0.92, 0.83, 0.74, and 0.51 by ages 25, 35, 45, and 55, respectively. The hazard ratio of death was 4.22 (p<0.05) for beta-thalassemia major and 0.77 for beta-thalassemia intermedia (p=0.70). It was calculated as 1.45 for men patients and as 3.82 for single patients.CONCLUSIONSThe present study showed relatively high survival rates in patients with thalassemia. The survival of patients was unfavorable in poorer regions (Zahedan and Iranshahr). Factors including women gender, a higher level of education, being married, and living in metropolises decreased the risk of death at younger ages and improved survival.
To determine the cost-effectiveness of seven contraceptive methods from the providers’ perspective, the cost per adjusted couple-years of protection [ACYP] was calculated for each method based on region-specific conversion factors. More than 74, 800 ACYPs were provided during March 1999 to February 2000. Intrauterine devices and implants offered the highest and lowest ACYP respectively. Condom was the single most expensive contraceptive method. Vasectomy was the most cost-effective method and implant provided the highest cost per ACYP.
Background: Several studies have demonstrated an association between chronic pain and impairment of cognitive capabilities. Since the number sense is one of the cognitive ability involved in the evaluation of pain intensity using some pain measurement tools, impairment of number sense may impact pain assessment. Therefore, the validity of number-based pain assessment tools should be re-evaluated. Objectives: This study aimed to determine whether number sense is altered in chronic and acute pain patients compared to healthy subjects. Methods: Overall, 150 participants were recruited and divided into the three groups of controls, chronic and acute pain patients. Pain intensity was evaluated using numeric and verbal rating scales as pain assessment tools. Number sense was assessed using number naming, number marking, and line bisection tasks. Deviation from correct answers was measured for each task. Results: Patients with chronic pain (migraine headache) had higher pain intensity scores than acute pain subjects. Chronic pain patients showed significant deviation from the expected responses compared to controls in the line bisection task. Conclusions: Chronic pain patients may have impaired number sense and may differently use number-based pain assessment tools in comparison with healthy individuals.
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