Tehran University Medical Journal

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Background: The NCEP step II diet produced a desirable lipoprotein response in hypercholesterolemia. A relation between plasma concentrations of small dense LDL and cardiovascular risk factors has also been mentioned in children. This study was conducted to determine the effects of the National Cholesterol Education Program (NCEP) step 2 diets on the low density and high density lipoprotein particle size in dyslipidemic adolescents.
Methods: Forty- four dyslipidemic adolescents, aged 10-18 years, participated in this case-control study. The control group was not given a diet prescription and was simply instructed to “eat as usual”. Their eating patterns reflected the consumption of macronutrients, fruit, vegetables and dairy products, typical of what many Tehranian eat. NCEP step 2 diets was a diet with 30% of calories as total fat, less than 7% saturated fat, less than 200 mg cholesterol, less than 15% of calories as monounsaturated fat and less than 10% as polyunsaturated fat per day. Lipoprotein particle size was the major outcome variables, which was measured after 3 months of intervention. Lipoprotein particle size was estimated by nondenaturing polyacrylamide gradient gel electrophoresis using Krauss and Burke methodtion.
Results: The mean body mass index was 26.3±4.2 kg/m2. Baseline characteristics of these adolescents did not differ significantly across the NCEP step 2 and control diet groups. The NCEP diet resulted in higher reduction in total cholesterol (-13±4 vs –2±0.3 mg/dl, p<0.001), LDL (-9±2 vs 3±0.6 mg/dl, p<0.01) and higher increase in size of the LDL (1.7±0.4 vs 0.1±0.4 mg/dl, p<0.001). HDL particle size did not change significantly. The prevalence of hypercholesterolemia decreased significantly (p<0.05) in NCEP step 2 group (68% in NCEP step 2 vs 100% in the control group) after 3 months.
Conclusion: NCEP step 2 diet not only reduces the serum LDL concentration of hypercholesterolemic adolescents but also has a favorable effect on the LDL particle size distribution. The related mechanism needs to be studied in future experimental designs.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Vulvovaginal candidiasis is a fungal disease with itching, and vaginal thick white discharge. Most of non-albicans species have less sensitivity to azoles. So, definition of candida species which lead to vulvovaginal candidiasis is very important to perfect usage of drugs. In the present study 191 Candida isolates from 175 patients who admitted in Gynecology department of Mahdieh Hospital during the period 1385-1387 were identified by multiplex PCR.
Methods: One hundred seventy five vaginal swab specimens from patients were cultured on Sabouraud Dextrose Agar (SDA). The internal transcribed spacer 1 (ITS1) region between the 18S and 5.8S rRNA genes and a specific DNA fragment within the ITS2 region of Candida albicans were amplified and the multiplex PCR products were separated by electrophoresis in 2% agarose gel (200 mA, 140V), visualized by staining with ethidium bromide, and photographed.
Results: One hundred ninety one Candida isolates were identified in vaginal swab specimens from 175 patients. In 89.7% of cases, single candida species and in 10.3% cases, multiple candida species were isolated. C. albicans (65.1%), C. glabrata (13.1%), C. tropicalis (6.2%), C. krusei (4%), C. guilliermondii (0.6%), C. parapsilosis (0.6%), C. glabrata and C. albicans (5.7%), C. albicans and C. parapsilosis (1.1%), C. glabrata and C. tropicalis (0.6%), C. krusei and C. tropicalis (0.6%), C. albicans and C. tropicalis (0.6%), C. krusei and C. albicans (0.6%), C. glabrata and C. krusei (0.6%), and C. glabrata and C. krusei and C. albicans (0.6%) were the cause of disease.
Conclusion: Our findings suggest that, the common cause of both recurrent and non-recurrent vulvovaginal candidiasis was C. albicans, and then C. glabrata. Also the most common mixtures of Candida species were combination of them

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Vulvovaginal candidiasis is a common mucosal infection among immunocompetent, healthy women, and is caused by opportunistic yeasts that belong to genus Candida. In this study, we isolated and identified the Candida species in the vagina of patients who admitted in Gynecology Department of Mahdieh Hospital in Tehran, Iran to evaluate the in vitro activities of fluconazole, miconazole, itraconazole and flucytosine against 191 clinical Candida isolates by the NCCLS microdilution method.
Methods: 191 Candida were isolated from vaginal secretions and identified with conventional mycological methods in the diagnosis of Candida species. The identity of all strains was confirmed genotypically by multiplex PCR. In vitro susceptibility testing of vaginal Candida isolates was performed by the NCCLS broth microdilution method. The results were read at 48 h.
Results: Most C. albicans isolates (>90%) were sensitive in vitro to the antifungal agents tested. Most C. glabrata isolates showed sensitivity to miconazole and then flucytosine while they were more resistant to Itraconazole and fluconazole. Many isolates of C. tropicalis were susceptible to miconazole and then fluconazole. They showed a little resistance to all antifungals tested and flucytosine-resistance was the most frequent in the C. tropicalis isolates. High susceptibility to miconazole was observed in isolates of C. krusei and their susceptibility to the rest of the antifungals tested was dose-dependent. fluconazole -resistance was the most frequent in the C. krusei isolates.
Conclusion: Most isolates tested were susceptible to miconazole. A trend toward increased resistance among C. glabrata and C. krusei strains to antifungals tested was noted. Our findings suggest that, miconazole should be the agent of choice for the treatment of resistant vaginal candidiasis.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Recent studies present a high prevalence of multiple sclerosis (MS) in Iran. Treatment with interferon is now the first choice in management of MS. CinnoVex^TM (an interferon beta 1-a) is available in Iran, with achievement of the technology of producing beta interferon. The aim of the present study is to evaluate the efficacy and safety of CinnoVex^TM in a national study named CINA study.

Methods: This study was conducted from 2007 to 2008 in cities of Tehran, Isfahan, Mashhad, Tabriz, and Shiraz. Patients with relapsing/remitting MS with 16-50 years of age and EDSS of <4 received CinnoVex^TM (30µg/week, IM) after diagnosis by a neurologist. EDSS, drug side effects, and frequency of relapse were evaluated for one year in four 3-month visits.

Results: A total of 1050 patients entered the study. Complete data were collected from 627 (60%) patients. Mean age was 30.7±8.6 year and 514 (82%) were female. The most common onset presentations were sensory symptoms (44%). Changes of EDSS through the study showed a significant decrease in the last 3-month of evaluation (p<0.05). Drug side effects were observed in 47%, 50%, 61%, and 61.4% (p>0.05) and relapse was occurred in 13.4%, 15.7%, 16.9%, and 2.4% of the patients in the first, second, third, and forth evaluation visits (p=0.001), respectively.

Conclusion: CinnoVex^TM prevents progression and improves clinical course of MS. The conventional side effects of beta interferon therapy, however, are observed with CinnoVex^TM.

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Background: Helicobacter pylori has been classified as the class I carcinogenic agent by world health organization. Colonization of the human stomach with H. pylori is a risk factor for gastroduodenal diseases. The secreted vacA toxin is an important H. pylori virulence factor that causes multiple alterations in gastric epithelial cells and T cells. Several families of vacA alleles have been described, and H. pylori strains containing certain vacA types (s1 and m1) are associated with an increased risk of gastric disease, compared to strains containing other vacA types (s2 and m2). We examined the association between H. pylori vacA s alleles and gastroduodenal diseases in Iran. Methods: A total of 149 H. pylori strains were obtained from patients with gastritis, peptic ulcer, and gastric cancer referring to endoscopy units of several cities in Iran. Biopsy culture and DNA extraction were performed and the frequency of vacA s alleles was investigated by using PCR amplification. Linear regression and binary logistic regression models were used to analyze the association between vacA (vacuolating cytotoxin A) s alleles and gastroduodenal diseases. Results: There was no significant association between the frequency of vacA s alleles and gastroduodenal diseases (gastritis or peptic ulcer disease and gastric adenocarcinoma (P> 0.05)). Conclusion: It is proposed that the H. pylori vacA s1 genotype could not be considered as an important determinant of gastroduodenal diseases in Iranian population and probably if s1 allele is associated with other virulence alleles of this gene, it will cause diseases.

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Background: Cardiotoxicity of anthracyclines (ANTs) in medium and high doses (more than 350 mg/m2) has been already known but it is still unclear whether or not minimal doses (lower than 350 mg/m2) can also affect cardiac function. The goal of this study was to assess the cardiotoxicity of ANTs in children under minimal doses and evaluation the association of this toxicity with probable risk factors such as age at beginning of regimen, gender or type of malignancy. Methods: In a prospective study 50 children suffering from different malignancies ad-mitted in pediatric oncology department of Besat Hospital of Sanandaj City in 2010 to 2012, under ANTs regimen (Daunorubicin, Doxorubicin) in doses lower than 350 mg/m2 were followed by serial echocardiography for 1-3 years. The deviation from normal values of echocardiographic parameters was measured for all patients in this period and even one parameter's deviation was considered as cardiac dysfunction and ANTs cardi-otoxicity. The association of this toxicity and probable risk factors was analyzed by proper statistical methods in SPSS 18th version. Results: In 22% of patients, mostly children older than 11, at least one of echocardio-graphic parameters including: ejection fraction (EF), left ventricular end systolic diame-ter (LVESD), left ventricular end diastolic diameter (LVEDD), left ventricular mass (LVM) and left ventricular posterior wall diameter (LVPWD) changed during our follow up. The most important risk factor for cardiotoxicity in this study was age at beginning of ANTs regimen. Acute myeloid leukemia (AML) had the most abnormal values among all types of malignancies. In this study there was no statistically significant as-sociation between cardiotoxicity and gender or duration of follow up. Conclusion: Anthracyclines even in doses lower than 350 mg/m2 can induce cardiac dysfunction and alter echocardiographic parameters, although these changes are not always accompanied by clinical signs or symptoms as they were in this study. So long term echocardiographic follow up and cardioprotective techniques are recommended in prescription any doses of these cardiotoxic drugs.

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Background: Rabies is an acute encephalitis that causes more than 60,000 deaths worldwide. The only way to save individuals bitten by a rabies-infected animal is the timely use of effective vaccines. Treatment with new generation vaccines is expensive. Therefore, there is a global movement towards the production of less expensive vaccines which retain and improve upon the quality and effectiveness of the vaccine. Production and evaluation of non-classical vaccines is one of the approaches taken in this regard. In this study, we describe a new eukaryotic expression system to express the nucleoprotein N gene of rabies virus which, if suitable, may be evaluated for anti-rabies vaccine production. Methods: The complete sequence of the N gene of rabies virus PV subtype was amplified by real-time polymerase chain reaction and cloned into the pCDNA3.1(+) vector. The cloned gene was excised from the vector by restriction enzyme digestion and sequenced. Due to mutations detected in the N gene, the gene coding sequence was purchased as a recombinant pGH/N vector. Vector pGH/N was amplified and following enzymatic digestion, the excised N gene was once again cloned into vector pCDNA3.1(+). Successful cloning was confirmed using restriction digests and quick check. The recombinant vector pCDNA3.1(+)/N was transformed into cultured BSR cells and protein N expression was analyzed using fluorescent antibody test (FAT). Results: Electrophoresis confirmed amplification of the nucleoprotein N gene and subsequent restriction enzyme digestion showed that the N gene had been successfully cloned into the recombinant pCDNA3.1(+)/N vector. However, DNA sequencing revealed the presence of mutations within the N gene. Restriction digest of the commercial pGH/N vector showed that the N gene had been excised from the vector. Successful cloning of the N gene into the pCDNA3.1(+) expression vector was confirmed using restriction digests and quick check. Protein expression in BSR cells was assayed by immunostaining with anti-ribonucleocapsid FITC-conjugated antibody and visually confirmed by fluorescence microscopy. Conclusion: This study showed that the protein N of rabies virus subtype PV can be expressed in a eukaryotic expression system using the pCDNA3.1(+) expression vector.

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Background: The occlusion of the artery and vein grafts are currently a major problem in coronary bypass surgery. Degradation of collagen and elastin, the most abundant extracellular matrix proteins in the vessel wall by matrix metalloproteinase (MMPs), leads to a rearrangement of the extracellular matrix and vascular wall structure. The present study aimed to compare the histological and biochemical characteristics of arteries and veins which could have a role in the failure of the graft. Methods: This study was a cross-sectional study of 80 patients conducted at Heart Hospitals in Isfahan, Iran, between July 2012 and November 2013. Samples were collected from the remains of vessels used in bypass surgery of 11 male nondiabetic patients. The histologic, collagen elastin ratio and MMPs levels of the vessels were investigated. MMPs were determined using the Gelatin Zymography method. For elastin and collagen content measurement, the sample was digested by cyanogen bromide and hydrochloric acid and then hydroxyproline was measured with a spectrophotometer. Results: The amount of active and inactive MMP-2 and MMP-9 of the left internal mammary artery (Lima) was similar to aorta, but the amount of MMP-2 and MMP-9 in the radial artery and saphenous vein were significantly higher than aorta. Elastin to collagen ratio in Lima (1.92±1.15) was similar to the aorta (3.4±1.66), but this proportion in saphenous vein (1.07±0.47) and radial artery (1.14±0.39) was significantly lower in the aorta (P≤0.05). Most patients had atherosclerotic plaque in radial while there was atherosclerotic plaque in Lima of only one case. Conclusion: The presence of atherosclerotic plaques in radial and thickening of the intimal layer of the saphenous vein in the majority of patients and decrease of collagen to elastin ratio and the high level of matrix metalloproteinase enzymes in the radial and saphenous vein can induce early pathological conditions, and remodeling of the vessels involved. So the results of this study confirm that Left Internal Mammary Artery (LIMA) is the most suitable candidate for bypass surgery.

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Background: Hypernatremic dehydration in neonate is a serious potentially life treating can damage the central nervous system. The aim of this study was to determine the clinical and laboratory signs of hypernatremic dehydration in term infant. Methods: A cross sectional study was performed from April 2010 to March 2012 in 111 neonates with sodium>145 mmol/l who were admitted at the Mostafa Khomeini and Hazrat Zainab Hospitals in Tehran, Iran. The incidence of clinical and laboratory findings and relationship between some risk factors influencing the severity of hypernatremia were reviewed. The patients were subdivided in two groups: Na<150 mmol/l (group 1) and Na≥150 mmol/l (group 2). Premature infants less than 37 weeks, congenital malformations, formula fed, sepsis and organic disease were excluded. The Student’s t-test, Mann-Whitney U test and Chi-square test were used for statistical data analysis. P<0.05 were considered significant. Results: One hundred and eleven of 2015 (5.2%) patients had hypernatremia. Fifty eight (52.25%) infants were male and sodium ranging was from 146 to 175 mmol/l with an average of 150.3 mg/dl. The most common clinical findings in both groups 1 and 2 were lethargy (81%, 84.5%), fever (74.1%, 73.6%), poor feeding (67.3%, 73.6%), weight loss (60.2%, 84.9%) and a decrease in urine volume (31%, 52.8%). Oliguria, restlessness, seizures, weight loss, orange urine, pathologic hyperbilirubinemia were significantly higher in group 2 than group 1 (P<0.05). There was correlation between severity of hyprnatremia and weight (P=0.022) and age of neonate (P=0.046), time of first feeding (P=0.016), serum creatinie>1.5 mg/dl (P=0.016) and bilirubin level (P=0.01). The relationship between type of nutrition, type of delivery, parity, maternal age, sex, gestational age, discharge, maternal education level were not significant. Conclusion: Sufficient attention to the warning signs of hypernatremia such as lethargy, weight loss, oliguria, poor feeding, fever, restlessness and determination of serum sodium levels in suspected cases can significantly reduce the potential complications of hypernatremic dehydration in neonate.

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Background: Mycoplasma contamination in cell cultures is considered as a major economic, research and production problem. In this study, mycoplasma-infected Vero cell lines were treated by various dilutions of ciprofloxacin and enrofloxacin in a timely manner. Removal of mycoplasma contamination from infected cell cultures was evaluated and demonstrated by polymerase chain reaction (PCR) method. Methods: This study was done from October 2013 to May 2014, in Human Rabies Vaccine Laboratory, Pasteur Institute Production and Research Complex, Tehran, Iran. Different dilutions of ciprofloxacin and enrofloxacin were used in sequential passages for treatment of infected Vero cell line. Based on lowest passages of the cell line, antibiotic treatment with ciprofloxacin and enrofloxacin was done. Amelioration of the infection and removal of mycoplasma contamination was confirmed in each step by PCR method. The technique for order of preference by similarity to ideal solution, TOPSIS method, was used to suggest the most efficient concentration of ciprofloxacin and enrofloxacin. Results: Proposed concentration of ciprofloxacin is 20 μg/ml, and in the second order is 200 μg/ml. For enrofloxacin the best proposed concentrations are 30, 300 and 3 μg/ml respectively. Ciprofloxacin and enrofloxacin and ability of them for removal of mycoplasma and also the time of treatment were verified by evaluation of the recurrence of infection through consecutive subcultures of the treated cell line. Conclusion: Our results showed that 20 μg/ml of ciprofloxacin was the dilution of choice for mycoplasma elimination followed by 200 μg/ml of ciprofloxacin. Concentrations of 3, 30 and 300 of enrofloxacin, respectively, are appropriate for mycoplasma removal. More detailed works would be needed to verify the authenticity of the proposed simple and affordable way of mycoplasma elimination.

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Background: Multiple Sclerosis (MS) is a neurodegenerative disease of the central nervous system (CNS). The hippocampus is a vital center for learning and memory it is extremely vulnerable to neurodegenerative diseases. The male hormones could be neuroprotective for the CNS. The current study is an attempt to investigate the effect of testosterone on learning and spatial memory following the demyelination of CA1 area by the injection of ethidium bromide in the rats' hippocampus. Methods: This experimental study has been conducted on healthy rats in the faculty of science of the Urmia University from September 2013 to February 2015. For demyelination in all previously gonadectomized healthy rats, 3µl ethidium bromide was injected into the CA1 area of rats by stereotaxic surgery. In addition, the treatment groups received 1µl testosterone (6µg/µl) during a 20-day timeframe on a daily basis after demyelination by the ethidium bromide. The control groups had no drug injection. The process of the learning and spatial memory of the rats were closely monitored by the radial Maze. The demyelination and remyelination in the hippocampus were checked by the myelin-specific coloring (Luxol fast blue and Cresyl violet). Results: The histological results suggest that the testosterone is capable of minimizing the destructive impacts of ethidium bromide in the treatment group as well as enhancing the remyelination process. In the group treated by testosterone, the percentage of the pyknotic cells 20 days after demyelination induction, represented a significant reduction compared to that of ethidium bromide group (P=0.008). The behavioral studies analyses show that the amount of the food finding time in those groups received ethidium bromide was significantly longer than those of the control groups (P=0.001). Furthermore, the application of the testosterone in the treatment groups reduced the extent of demyelination while the memory impairment induced by the ethidium bromide was significantly improved (P=0.001). Conclusion: Testosterone can act as a neuroprotective factor that reduces the extent of demyelination and the number of pyknotic cells. It also may improve the learning and memory impairment induced by ethidium bromide.

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Background: Surgery and pain increases cortisol levels with inducing hormonal responses. By reducing stress, adverse effects of cortisol can be controlled and accelerated the healing process. Religious practices like listening to Quran have important roles in reducing anxiety. Moreover, the level of cortisol hormone of the blood is one of the best indicators of the stress level. The aim of this study was to investigating the effect of listening to Quran on the plasma cortisol level of the umbilical cord in cesarean with spinal anesthesia.

Methods: A clinical trial study was designed and conducted on sixty primigravid mothers who were hospitalized to deliver their first baby by elective caesarian operation, 30 of them were selected as intervention group and 30 of them were selected as control group. For the subjects of the intervention group, the personal information questionnaires were completed and their vital signs were recorded. Also, their blood was sampled for measuring cortisol level. Then they listened to Quran. After spinal anesthesia, vital signs were recorded and the blood of umbilical cord was sampled for measuring the cortisol level. For the subjects of the control group, all the steps were done except listening to Quran. Two groups were statistically homogenous in the variables of age, gestational age, systolic blood pressure and diastolic blood pressure, pulse rate and cortisol levels before the intervention. The mean and SD cortisol in intervention group before and after listening to the Quran were 39.08±10.71 versus 41.10±5.05.

Results: The reduction of cortisol level of the intervention group (who listened to Quran) was significantly greater than of the control group P=0.035. Systolic blood pressure of the intervention group in the operating ward had statistically significant reduction relation to the systolic blood pressure before operation P=0.043. However systolic blood pressure of the control group in the operating ward had not statistically significant reduction relation to the systolic blood pressure before operation P=0.357. Listening to Quran has no effect on diastolic blood pressure and pulse rate.

Conclusion: Listening to Quran before caesarean affects the change of plasma cortisol level and the systolic blood pressure.

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Background: Smoking is a harmful habit and saliva is the first fluid that is exposed to cigarette smoke as a source of oxidant and peroxidant agent. Salivary antioxidant system plays an important role in its anti-cancer potential. Uric acid has a role as antioxidant in the body and could increase plasma antioxidant capacity and has a specific role as inhibitor on radicals and peroxidant agent. Therefore, the aim of this study was to evaluate indicators of oxidative stress or malondialdehyde (MDA) as an important parameter of lipid peroxidation and total antioxidants capacity in smokers and non-smoking persons. Methods: In this case-control study which was conducted in clinical biochemistry labratory, Mazandaran University of Medical Sciences on Spring 2016. The sample on salivary fluids was collected by spitting method in tubs from 50 smokers (cases group) and nonsmokers (controls group) after all night fasting. As soon as saliva was collected, at the first step total whole salivary fluids were centrifuged and the superior parts were transferred in a tub and stored at -80 ℃ until analyzed. Total antioxidant capacity (TCA) of their saliva was evaluated by Ferric reducing ability of plasma (FRAP) method, lipid peroxidation parameter (MDA) with thiobarbituric acid (TBARS) and uric acid by calorimetry (uricase) methods. The data were analyzed via SPSS software and independent t-test was used to compare the two groups. Results: Indicators of oxidative stress, in the case group was 1.17±0.29 nmol/ml significantly higher than compared to control group with 0.91±0.16 nmol/ml. TCA in the case group was 220.66±39.68 μmol/l compared to control group 272.26±40.64 μmol/l was significantly lower (P< 0.05). Conclusion: The result of this study indicates that smoking can reduce total antioxidant capacity and increase lipid peroxidation parameters. In addition, duration of cigarette using has destructive effects on body that it can lead to several diseases. The important thing is to keep trying to quit smoking. For smokers who are willing to quit, it would be recommend that smokers be managed with a combination of behavioral support and pharmacologic therapy.

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Background: Osteoblastoma is one of the rarest primary benign bone tumors which accounts for 1% of all bone neoplasms and 3.5% of benign bone tumors, with the potential for local invasion and recurrence. Osteoblastoma is not homogeneous. Differences in histological details have led to the division of these lesions into subtypes. The histologic features in most cases are distinctive, there are various changes that make the diagnosis challenging. Although involvement of this disease is more in the spines or small long bones, but it has been reported involvement of jaws in this disease. Correct diagnosis is very important because it may be misdiagnosed osteosarcoma  with hypercellular cases.

Case presentation: In this case report, it is described patient a 7-year-old girl with a lesion in the posterior maxilla and bone resorption in May 2016, Sari, Mazandaran province, Iran. Differential diagnosis of the radiological and clinical findings suggested an osteosarcoma. In terms of pathology, osteoblastoma was included a well-vascularized connective stroma tissue with plenty of veins which osteoid and primitive woven bone can be seen actively. In microscopy diagnosis, samples were shown cortical bone with a natural appearance, prominent osteoblasts and surrounding granulation tissue containing blood vessels that confirmed maxilla osteoblastoma. The lesion was examined by histopathology method for final recognition and the results revealed osteoblastoma.

Conclusion: Although jaw osteoblastoma is a rare tumor and presents with microscopic features that can mimic a variety of other types of malignant entities. It is important to avoid of other non-specific clinical and radiographic protests that led to the recognition problems. The importance of interdisciplinary cooperation between the surgeon, radiologist and pathologist must be pressured.

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Background: Lochia is the slight vaginal bleeding between 24 hour to 12 week after delivery. There isn't any standard definition for difference between normal and abnormal lochia in post-partum period. The aim of this study was to determine the relationship between ultrasonic findings of the postpartum uterus after normal vaginal delivery with the duration of lochia discharge.

Methods: In this cross-sectional study was done in Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran, from 2014 to 2015. In this study 160 women with non-complicated vaginal delivery were entered. Inclusion criteria were: Term pregnancy with gestational age > 37, singleton fetus with cephalic presentation. Exclusion criteria were pre-term pregnancies, previous Cesarean section or other uterine surgeries and twin fetuses. Transvaginal ultrasound was done in first 48 hours after delivery, endometrial thickness echogenicity and uterine size was evaluated. Maternal age, parity, duration of labor and neonatal weight were evaluated. Then the mothers were followed for 6 weeks. The quality and the quantity of lochia discharge were asked by the phone.

Results: Lochial discharge last more than 6 weeks in 96 out of 160 (60%). One had less than 4 weeks. The uterus length, thickness, height and endometrial length did not show any relationship with the duration of lochial discharge, but endometrial strip thickness significantly correlated with the duration of lochial discharge period (P=0.04). None of clinical variables like the number of gravidity, parity, live birth or child birth weight, were correlated to the duration of lochia discharge period, but the labor time was correlated to the duration of lochia discharge period (P=0.04). Although both endometrial thickness and labor time in univariate analysis were correlated to the lochia duration time but this was true just for endometrial thickness in multivariate analysis.

Conclusion: The endometrial thickness in first 48 hours after normal vaginal delivery could predict the duration of lochia discharge, there wasn’t any correlation between lochia discharge period and other ultrasound parameters.

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Background: Blood transfusion is common in infants. Due to the weakened immune system of newborns and the risk of blood transfusion complications, it is necessary to pay more attention following or after to blood transfusion. The aim of this study was to evaluate the frequency and risk factors of blood transfusions in hospitalized neonates.

Methods: A cross-sectional study was performed on 1106 infants admitted in the neonatal intensive care unit (NICU) of Mustafa Khomeini University Hospital, Tehran, Iran, from spring 2009 to 2012. Frequency and the reason for of blood components transfusion including fresh frozen plasma, platelets, whole blood, packed red blood cells, cryoprecipitate and relationship with gestational age, sex, birth weight, Apgar score, duration of hospitalization, use of mechanical ventilation were assessed. Statistical analysis was performed with SPSS statistical software, version 16 (IBM, Armonk, NY, USA) and statistical test, chi-square test, independent t-test and analysis of variance (ANOVA).

Results: Among 1106 infants admitted to the neonatal intensive care unit, 221 infants (%19.98) received blood products. 82 of all (37%) were female and 139 (%63) were female. 113 (51%) of neonate were preterm and 108 (48%) were term. From 361 times of blood transfusions, 121 infant (54.75%) received at least one blood product. The frequency of blood transfusion was between 39 and 1 times, with an average of 3.65 times per infant. Frequency of fresh frozen plasma infusion was 173 (47.9%), packed cell 122 (33%), platelet 32 (8.8%), cryoprecipitate 20 (5.1%) and whole blood 3 unit (0.83%). The most common causes for fresh frozen plasma transfusion was replacement therapy 140 (80%), for packed cell, to correct symptomatic anemia 68 (55.6%), for platelet transfusions was to prevent bleeding in  neonates with thrombocytopenia 20 (62.5%) and cryoprecipitate for bleeding caused by DIC in 18 infant (90%). There was significant relation between frequency of blood transfusions with gestational age (P=0.002), birth weight (P=0.01), cause of hospitalization (P=0.001) using of ventilator (P=0.002), and length of hospital stay (P=0.001).

Conclusion: With attention to the guidelines of blood transfusions and controlling factors affecting premature birth and low weight infants, reducing length of hospital stay and duration of mechanical ventilation, frequency and complications of blood transfusion can be effectively decreased.

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