Tehran University Medical Journal

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This is a mortality study in internal medicine wards of Amir-Alam Hospital, since the beginning of 1374 to end of 1376. Here, we reviewed, prevalence of disease lead to death, the ward and invasive interventions and duration of admission of patients before death. In this study, records of 85 patients were reviewed. 68.2% of patients were men and 31.8% women. Mean of age was 61.6% with minimum of 18 and maximum 95 years. The most prevalent diseases leading to death were cardio vascular (41.2%), cancer 29.4%, GI tract diseases (10.6%), pulmonary diseases (8.3%), CNS (7.1%), hemathologic (4.7%), DM (3.5%). Mean duration of stay in hospital before death was 6.6 days (max 30-min 1). This figure in different wards were: ward 1 (7 days), ward 2 (11 days), ward 3 (5.9 days) ICU (5 days) and CCU (4.7 days). 90.5% of patients died due to their diagnosed illnesses. Invasive tests and intervations were performed in 40% of them. As a whole 35 patient were died in CCU. This research and others like it showes the failures of our patient management system and can guide us in approaching to better medical care.

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Defining the patient outcome and decision making about allocation of our limited fund and technology for comatose patients depends on our knowledge about frequency and outcome of various coma etiologies. We determined the various coma causes frequency and one-month outcome of non traumatic coma. . In addition the co existence of the primary neurologic signs with the one-month outcome of non traumatic coma was defined.
Methods and Materials: Our study is based on 130 comatose patients in a one-year study in Sina Hospital that consisted of 80 non traumatic and 50 traumatic patients.
Results: 74% of the cases were men and 26% were women. The most common etiology of coma was trauma (38.5%). The other common etiologies were cerebro‌vascular diseases (25.4%), cancer (10%) and hypoxia-ischemia (8.5%). The most common cause of coma in men was trauma (46.9%) while the vascular diseases were the most common etiology of coma in women (41.2%).In under 40 year patients trauma was the cause of coma in 57.5% of cases in respect to 28% in above 40 cases. On the other hand, vascular diseases and malignancies were the etiology of coma in 15% of under 40 year patients and 46.5% of above 40 year patients. Among traumatic etiologies of coma, subdural hematoma was the most frequent (40%). In our research none of patients who did not have one of pupillary, oculocephalic or motor reflexes in the 3rd and 7th day of the onset of coma had acceptable outcome after one month. With consideration of pupillary, corneal, oculocephalic and motor reflexes in combination, loss of at least two of them in the 3rd and 7th day accompanied with no acceptable outcome. On the other hand the presence of three or more reflexes in the 3rd and 7th day of coma was a good prognostic factor, with 80% and 88.9% chance of acceptable recovery respectively.
Conclusion: According of the study, the best time for prediction of outcome in a comatose patient, is the third or seventh the day after the onset of coma. Also relay on combination of brain stem reflexes, gives us more acceptable result.

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Background: To identify the clinical manifestations and mortality rate among neonates with early- and late-onset sepsis.
Methods: We retrospectively reviewed the hospital records in Children’s Hospital Medical Center, Tehran University of Medical Sciences of 104 neonates (50 females and 54 males) diagnosed with septicemia and treated from September 1994 to August 1995. Diagnosis of septicemia was based on standard criteria. According to the time of onset of disease, there were 50 neonate with early-onset and 54 with late-onset septicemia.
Results: Of the clinical signs in the 104 patients, respiratory signs were found in 31 patients, poor feeding in 57, jaundice in 42, apnea in 25 and hyporeflexia in 25. Blood cultures were positive in 31 (34.8%) of the neonates: the most common species isolated was Staphylococcus aureus with eight cases, while five had Staphylococcus epidermidis, all of whom had a single species of bacterium isolated. Seventy-three (70%) had normal birth weights (equal to or heavier than 2500 g) and 31 (30%) were classified as low birth weight (birth weight less than 2500 g). Cerebrospinal fluid culture was positive in four (6%) of the patients, including one case of Escherichia coli, one Salmonella typhi, one Klebsiella, and one Staphylococcus aureus. The frequency of infection in male and female infants was 53% and 47%, respectively. Among the infants with early-onset sepsis, 16 (32%) were low birth weight. Overall, the mortality rate among these patients was 30%, including 18 out of the 50 with early onset and 14 out of the 54 with late onset sepsis. Of these infants, 23 had meningitis, including 13 (26%) with early-onset sepsis and 10 (9.6%) with late-onset sepsis. Among the low birth weight infants, the mortality rate was higher (42%) than that of the infants with normal birth weight (26%).
Conclusion: Because of the high mortality rate among low birth weight neonates with sepsis, we suggest that this group of patients should receive more care and there should be greater effort to ensure that they are treated with the appropriate antibiotics. Furthermore, all healthcare givers responsible for the management of neonates with sepsis should receive additional continuing education courses to ensure that they are aware of the risks, complications and mortality rate among these patients.

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Background: Over the past two decades we have seen a marked increase in the survival of very low birth weight infants. This increase in survival has been attributed to increased use of corticosteroids, regionalization of perinatal care, improved methods of mechanical ventilation, availability of exogenous surfactant, and improved nutritional therapy. However, the reduction in mortality has not been accompanied by a reduction in neonatal morbidity or long-term handicaps. Preterm labor is a major issue in Iran. Besides various etiologies, preterm labor may be due to a biochemical alteration, such as magnesium. It is known that magnesium plasma levels fall during pregnancy. Since magnesium has an inhibitory role on myometrial contractions attention has been paid to the role of magnesium deficiency in preterm labor. Hypomagnesemia leads to neuromuscular hyperexcitability resulting in muscle cramps and uterine hyperactivity. The aim of this study was to determine the relationship between serum magnesium levels and preterm delivery in order to circumvent the high morbidity of preterm delivery by early diagnosis of this deficiency.
Methods: Serum magnesium was measured in 42 cases of preterm labor of idiopathic etiology (28-37 weeks) and 42 normal pregnancies at the same gestational age.
Results: Hypomagnesemia was variable in preterm labor cases, with only slightly low values in normal pregnant women.
Conclusion: Our study indicates that serum magnesium levels during pregnancy can be a valuable predictive tool for preterm labor. Hypomagnesemia must be considered in all pregnant women with preterm labor and supplementation must be provided effectively.

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Background: Infectious diseases are usually treatable however, infectious disease is one of the most common causes of mortality in hospitals. Furthermore, an apparent functional stagnation around the weekends in hospitals can increase the mortality rate. The goal of this study is to describe the causes and predisposing factors of mortality and to evaluate the role of holidays on patient mortality in infectious disease wards.

Methods: In this retrospective descriptive-analytic study, we examined the files of patients who had expired while hospitalized in the infectious disease ward of Imam Khomeini Hospital from 2002 to 2004. All of the information was gathered from patient files and the mortality committee of Imam Khomeini Hospital. Patient mortality rates were determined for each year. Mortality rates for the various days of the week were estimated and compared for 2004.

Results: The total number of patients included in this study was 3979. Of these, 216 cases had expired, 143 of whom were male (66%). The common causes of mortality were sepsis (26%) bacterial pneumonia (22%) and tuberculosis (19%). The mortality rates were 5.08%, 5.31% and 5.84% in 2002, 2003 and 2004, respectively. In 2004, mortality rates were 9.21%, 10.21% and 4.56% for holidays, pre-holidays and other days of week, respectively. A significantly higher rate of mortality was observed for holidays and pre-holidays compared to the other days of week. (P value <0.05).

Conclusions: Fortunately, the mortality rate of 5.43% in this infectious disease ward was not high. Since sepsis, bacterial pneumonia and tuberculosis were the most common causes of mortality, extra care of patients with these diseases is necessary. As a result of the findings of this study, we recommend increasing expert hospital staff and improving the quality of diagnostic and treatment services during holidays and pre-holidays.

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Background: Trauma is the most common cause of mortality in the first four decades of life. In our country, cardiovascular diseases and trauma are leading causes of mortality, respectively. By gathering information on trauma mortalities, we can learn more about causes, and that knowledge can lead to prevention.
Methods: This is a prospective descriptive study in Tehran during 12 months period (Sep 1999- Sep 2000). Two hundred and forty five trauma deaths in six hospitals were evaluated. The data was collected through a questionnaire, designed in Sina Trauma and Surgery Research Center (STSRC) used for the study. The questionnaires were completed by trained physicians visiting trauma patients in emergency room and wards round the clock. Data obtained included patient demographics, level of prehospital care, medical and operative procedures performed in emergency rooms (ER) and wards (according to ICD-10 coding), Glasgow Coma Scale (GCS) and vital signs at time of presentation to emergency rooms, Injury Severity Score (ISS), length of hospital stay and outcome of patients.
Results: Twenty and forty five (3%) of 8000 trauma patients was died. Mean age was 40.7 (±23.5) years old and 208 (84.9%) patients were male. The highest mortality rate was seen in the age group of 25 to 30 years. Road Traffic Accident was the main cause of death followed by falling with 174(71%) and 41(16.85), respectively. Among victims of road traffic accident, pedestrians and motorcyclists were prominent with 119 and 28 cases respectively. The majority of cases were dead due to head injuries (69%) and abdominal trauma was the second cause with 19 (7.8%) cases.
Conclusions: Based on our findings the mechanism of injury have the positive effect on trauma outcome .Traffic accidents and assault is preventable and must be attended.

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Background: This study have conducted in order to determine of direct or indirect effective factors on mortality of neonates with low birth weight by path analysis.

Methods: In this cohort study 445 paired mothers and their neonates were participated in Tehran city. The data were gathered through an answer sheet contain mother age, gestational age, apgar score, pregnancy induced hypertension (PIH) and birth weight. Sampling was convenience and neonates of women were included in this study who were referred to 15 government and private hospitals in Tehran city. Live being status of neonates was determined until 24 hours after delivery.

Results: The most changes in mortality rate is related to birth weight and its negative score means that increasing in weight leads to increase chance of live being. Second score is related to apgar sore and its negative score means that increasing in apgar score leads to decrease chance of neonate death. Third score is gestational age and its negative score means that increasing in weight leads to increase chance of live being. The less changes in mortality rate is due to hypertensive disorders in pregnancy.

Conclusion: The methodology has been used could be adopted in other investigations to distinguish and measuring effect of predictive factors on the risk of an outcome.

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Background: Much has changed in neonatal care for extremely low birth weight (ELBW birth weight <1000g) infants over the recent years in Iran, resulting in an increase in their survival rate. We determined neonatal survival and short-term morbidity rates among ELBW infants, and the correlation of these factors with mortality risk.
Methods: All single live-born ELBW babies delivered at Vali-e-Asr Hospital over a four-year period were identified. Data that were prospectively collected included: maternal age, prenatal and perinatal complications, antenatal steroid use, birth weight, gestational age, route of delivery, sex, need for resuscitation, APGAR score, need for mechanical ventilation, and complications including respiratory distress syndrome (RDS), sepsis, jaundice, intraventricular hemorrhage (IVH), necrotizing entrocolitis (NEC) metabolic and hematologic and cardiac disorders. Information was statistically analyzed and a probability value of <0.05 was considered significant.
Results: A total of 93 neonates were included in the study. The survival rate in the delivery room was 36.6%. The lowest birth weight was 400g, with a mean birth weight of 850.43(±136.48)g, and the lowest gestational age was 22 weeks. The mean gestational period was 28.31(±2.77) weeks. The most frequent complication after birth was RDS(69.89%) and the least frequent was NEC (6.4%). Short and normal gestation was observed in 44.08% and 48.4% of the neonates, respectively. There was a significant relationship between neonatal mortality and the need for resuscitation after birth, RDS and need for a respirator (p<0.05). Furthermore, there was significant increase in mortality among neonates with gestational age <30 weeks, birth weight under 750g and lack of steroids before birth (p<0.05).
Conclusions: To enhance perinatal and neonatal care and decrease the rate of preterm labor, improved standard resuscitation and increased administration of antenatal steroids and respirators are required.

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Background: Esophageal cancer is one of the most lethal diseases in the world. It has a high prevalence in Iran, especially in the Northern provinces. The main treatment of esophageal cancer is surgery. There are two common surgical procedures for its treatment, Transhiatal esophagectomy and transthoracic esophagectomy. The aim of this study was to compare the results of above methods in esophageal cancer. Methods: This cross-sectional study was done on patients with pathologic diagnosis of esophageal cancer that referred to surgery ward of Shahid Beheshti Hospital, in Babol, Iran in 2002-2008. Patients according to the location of tumor and physical status were undergone transhiatal or transthoracic esophagectomy. Demographic and surgical findings were recorded. The patients were matched according to age, sex, weight loss, serum albumin level and hemoglobin concentration in two groups. Results: Fifty nine percent of patients were under transhiatal esophagectomy and 41% were under transthoracic esophagectomy (n=166). Morbidity did not show significant difference (p=0.636) between transhiatal (42.9%) and transthoracic (47.1%) methods. Duration of surgery (min) in transhiatal method (180.7±35.1) was significantly (p<0.0001) lower than the transthoracic one (226.7±54.2). Duration of admission (days) did not show significant difference (p=0.44) between transhiatal esophagectomy (8±4.9) and the other method (8.5±1.6). Mortality in 30 days after surgery did not show significant difference (p=0.489) between two groups (4.1% against 7.4%). Conclusions: Based on our study, duration of surgery in transhiatal esophagectomy was lower than transthoracic method. Other parameters include morbidity, mortality, and duration of admission had not significant difference between two groups.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Placenta accreta is a life-threatening complication after previous cesarean delivery. The aim of this case report is to present a case of placenta percreta with bladder involvement and subsequent maternal death.
Case presentation: The patient was a 37-year old who had an unwanted pregnancy due to tubectomy failure two years afterwards. She was hospitalized at 26^th and 30^th week of gestation because of gross hematuria. Sonography reported placenta previa. Cesarean section was performed at 34^th gestational week. Due to severe hemorrhage, hysterectomy with resection of some part of the bladder was done. Died at the operating room after four hours of severe uncontrollable hemorrhage.
Conclusion: The increasing prevalence of different forms of placenta accreta is the result of the ever-increasing rate of cesarean deliveries. One of the strategies to prevent this catastrophic obstetric complication is decreasing the number of cesarean deliveries without appropriate indications.

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Background: Gastrointestinal mesenchymal tumors are classified as tumors that originate from smooth muscles. Gastrointestinal stromal tumors (GIST) are the most common types of the proposed tumors and can be seen in the GI tract from the esophagus to the anus, but they are mostly seen in the stomach. Mostly from the stomach and asymptomatic, the majority of patients would benefit from surgery as the best method of treatment.

Methods: In this retrospective study we evaluated the data of patients with the diagnosis of esophageal or gastric mesenchymal tumors admitted in Ghaem and Omid Hospitals affiliated to Mashhad University of Medical Sciences in Iran, from 1992 to 2010. We analyzed factors such as age, sex, presenting symptoms and signs, diagnostic methods, types of pathology, types of treatment, morbidity, mortality and 3-year survival rates.

Results: Twenty four patients (16 male, 8 female) with a mean age of 50 were included in the study. The common site of tumor was gastric fundus. The most common symptom at the time of diagnosis was epigastric fullness which was observed in almost 50% of the patients. The most common type of surgery in the patients was subtotal gastrectomy and no hospital mortality was recorded. Paralytic ileus was the commonest complication seen in five patients (20.5%). Adjuvant therapy had been performed in eight patients (33.1%). Following the patients three years postoperatively, there were only three deaths (12.45%).

Conclusion: Regarding to the low mortality and morbidity of the surgeries, surgical treatment, if tolerated, is recommended for all Esophagogastric mesenchymal tumors patients.

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Background: Neonatal deaths stand for almost two-thirds of all deaths occurring in infants under one year of age. Congenital anomalies are responsible for 24.5% of these cases forming a highly important issue for health policy-makers.
Methods: We studied the pre-, peri- and post-natal conditions of 77 patients with multiple congenital anomalies (MCA) through genetic counseling at Several university Hospitals, in Tehran, Iran. The collected data were subsequently analyzed using SPSS software.
Results: The patients did not have a good prognosis, demonstrating the need for the diagnosis of such diseases early in pregnancy to be of utmost importance. We screened for trisomy and nuchal translucency, which the first showed a low risk and the second showed normal results in most cases.
Conclusion: Establishment of standards for prenatal diagnosis of congenital anomalies and monitoring their implementation seem to be necessary for the reduction of deaths due to congenital anomalies and infant mortality rate (IMR).

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Background: Very preterm birth (26-32 weeks) has an important effect on infant morta-lity and disability of infancy. The aim of this study was to investigate the prevalence of very preterm delivery and early neonatal morbidity (the first 28 days after birth).
Methods: In this cross-sectional retrospective study, among 4393 delivery in Arash Women's Hospital in Tehran, 59 deliveries were very preterm that resulted in 79 very preterm neonate births. We assessed maternal risk factors and neonatal complications in women who were admitted for delivery from March 2009 to March 2010.
Results: Among 59 pregnant women, 17 (12/27%) had multiple pregnancies and 17 (12/27%) had premature rupture of fetal membranes. Caesarean section method was more common than normal vaginal delivery (46 cases- 97/77%). Women aged 18 to 35 had the highest rate of preterm delivery (45/86%). Among 79 very preterm neonates about half of them were very low birth weight, 74 neonates (93/67%) suffered from respiratory distress syndrome and 13 deaths were reported.
Conclusion: Premature birth is a multi-factorial phenomenon. Identifying maternal risk factors and increasing knowledge about it can decrease the rate of preterm labor. The prevention of premature labor is better than cure. Further prospective studies with large number of patients and long-term follow-up are recommended for better understanding of the phenomenon.

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Background: Damages caused by scald burns are common and can cause severe complications and death. The purpose of this study was to define risk groups and then methods of prevention and treatment is designed to fit.

Methods: Data for this retrospective study of hospitalized patients in Shahid Motahari Hospital in Tehran from 2007-2011 were compiled. Data including age, sex, cause of burn, and degree of burn and ultimate fate of the victims were collected from scald burns. Burns caused by boiling water and hot food (Scald) , in two age groups : 12 and under 12 years ( children) and more than 12 years ( adults) were compared in terms of statistics .

Results: A total of 1150 patients consisting of males (57.9%) and females (42.1%) were studied. The most common age was 1 year old and 50% of patients were under 3 years of age. 87.9% burned with boiling water and 12.1% had experienced burns with hot food. Incentive to burn was 0.3% cross burning and 99.7% incident. A maximum number of burns in children 12 years and younger males (42.1%) and a minimum number in men over 12 years (15.7%) were observed. Mean percentage of burns was 11% in over 12 years group and 30.9% in 12 and under 12 years group. The average hospital stay was 11.4 days and the mortality rate was 4.8%. The final status of the patients was as fallows: full recovery 904 cases (78.6%), partial recovery 134 (11.7%), clearance with personal consent 41 (3.6%), death 55 (4.8%) and 16 cases (3.1%) were among other reasons.

Conclusion: In general it can be said, scald burns incidence in individuals aged 12 and younger were more than the older ones and the mean of burns was lower in individuals with over 12 years old. There was a sexual preference for males under 12 years. Mortality rate in the two groups has not any statistically significant difference. There was no statistically significant association between sex and mortality rate. Some of our findings are depending on cultural, social and economic conditions, so generalized this findings to other geographical areas should be done with caution.

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Background: HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV -seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV co-infection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to s urvey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012.

Methods: This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. Results: This study had 135 patients, 8 (5.9%) were females and 127 (94.1%) were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 (2.22%) cases of failure, 15 ( 11.1%) relapse , and 21 ( 15.8%) deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [ Hazard ratio: 0.392 (0.11-1.4) Relative Risk: 0.809 (0.593-1.103) (P=0.068) ]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 (0.141-0.45) Relative Risk: 0.686 (0.513-0.918) (P=0.001) Conclusion: Overall, receiving antiretroviral was the most important factor influencing the outcome of patients.

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Background: The mortality due to Coronary Artery Bypass Graft (CABG) in patients with chronic renal failure is more common than normal population. This study evalu-ates the impacts of prophylactic dialysis on decreasing mortality and morbidity of non- dialysis-dependent patients with renal failure after CABG surgery. Methods: In this study, fifty non-dialysis-dependent patients who were suffering from renal failure and needed to CABG, were selected by convenience sampling method. Se-quentially, they were allocated to prophylactic dialysis (n=20) and no prophylactic dialysis (n=30) groups, using a randomized block design. Exclusion criteria were under 18 year old patients and doing CABG for second time. Mortality rate and some complications such as acute renal failure, brain accident and atrial arrhythmias were compared between two groups after CABG. All cardiac surgeries were performed in a single centre and through a median sternotomy. P value less than 0.05 was considered as significant. Results: The mean age of patients was (65.3±9.9). The patients included %16 (n.8) of women and %84 (n.42) of men. There were 20 patients in intervention and 30 patients in control groups. Baseline characteristics were similar in two groups. Comparison be-tween intervention and control groups after surgery did not show any difference in mortality (P=0.14), acute renal failure (P=0.4), cerebrovascular accidents (P=1) and atrial arrhythmias (P=0.3), need to second surgery due to bleeding (P=1), need to dialysis (P=0.14), need to rehospitalization (P=1), duration of ventilator use (P=0.4), duration of need to hospitalization (P=0.11), duration of a patients stay in the Intensive Care Unit (P=0.4) and deep sternal infection (P=0.7) rates. Conclusion: According the results of this study, prophylactic dialysis, before conduct-ing CABG, does not have any significant effect on mortality and other complications. The only exception is lung complications in non-dialysis-dependent patients with renal failure.

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Background: Maternal mortality is one of the most important indicators of women health standard in developing countries. This study aimed to determine the prevalence of risk factors and etiology of maternal mortality in a geographic region of Iran. Methods: This descriptive- analytic cross sectional study included all pregnant women who died during pregnancy and six weeks after delivery due to pregnancy related fac-tor. The study was done in Sistan region in the north of Sistan and Baluchestan Prov-ince of Iran from April 2002 to March 2014. The immigrant women were excluded. Data were collected using 3 parts questionnaire. The validity and reliability of ques-tioner were approved by experts in this field. Data were analyzed using the statistical software SPSS version 18, Chi-square test and ANOVA analysis were performed. Results: The total number of deliveries during this time period was 60496. The total number of maternal mortality was 57 patients which means 94.2 out of 100.000 live births. Most of the dead mothers had more than 35 years old (46.9%), gestational age was more than 22 weeks (77.2%), gravidity more than 4 (21.1%), pregnancy interval lower than two years (46.9%) and 75.4% of death was in post-partum. The main cause of mortality was post-partum hemorrhage (19.3%). Conclusion: Based on our findings, some factors including multiparity, pregnancy his-tory more than 4 times, short interval between pregnancies lower than 2 years and ma-ternal age more than 35 years were some risk factors for maternal death. Maternal mortality in the postpartum period was more than pre-delivery period. Bleeding was the main cause of maternal mortality. Therefore monitoring of vital signs in the post-partum period and the proper management of bleeding are very important. It is sug-gested that risk assessment should be done for pregnant women in delivery ward for detecting high risk pregnant women. Suitable management for these women especially for patients with postpartum hemorrhage plays an important role to decrease the ma-ternal mortality.

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Background: The first duty of any government is to ensure the health of its children and neonates. Today's countries are classified as declining mortality in this group. To increase neonatal survival rate, classified causes of newborn mortality are the core strategy and policies. This study was aimed to determine the classification of causes of neonatal death in Iran.

Methods: Neonatal mortality refers to deaths of young children. It is measured by the neonatal mortality rate (NMR), which is the number of deaths of neonates per 1000 live births. This study was used data from 11693 neonatal deaths (from 22 weeks gestational age to neonatal death less than 30 days), in Iran's hospitals in 2012 that registered in the perinatal mortality surveillance system (hospital-based system). Demographic characteristics and other factors associated with neonatal death were investigated. To aid in cause of death analysis, burden of disease analysis, and comparative risk assessment we classified the causes of death according to international statistical classification of diseases version 10 (ICD 10), divided into three cause mortality strata.

Results: Results showed the most common cause of neonatal mortality was "certain conditions originating in the perinatal period" (77.92%) with the highest incidence of "disorders related to length of gestation and fetal growth" (37.7%) in this group. Also it shows that 20.82% of deaths caused by "congenital malformations, deformations and chromosomal abnormalities" and 1.26% cases had occurred as a result of "accidents and injuries". The greatest cause of death in the neonates with weight over one thousand grams was "certain conditions originating in the perinatal period" (71.29%), with the highest percentage in the disorders related to "length of gestation and fetal growth" (29.65%).

Conclusion: According to this study the "certain conditions originating in the perinatal period" special "disorders related to length of gestation and fetal growth" was the main cause of neonatal mortality. Also "congenital malformations, deformations and chromosomal abnormalities" was the second cause of neonatal mortality.

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Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.

Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.

Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.

Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.

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Background: Air pollution, especially the phenomenon of dust and particulate matter can cause mortality of many civilians, and causes various diseases including cardiovascular and respiratory diseases. One of the major pollutants in the air is particulate matter that concentration has increased over recent years. So, present study with aim of Quantification Health Endpoints Attributed to particulate matter in Tehran, Capital of Iran during the past decade (2005-2014) by AirQ software, version 2.2.3 (WHO European Centre for Environment and Health) was performed.

Methods: This study is a descriptive-analytic investigation. The process of performance this study lasted 12 months. Subject of this the study and research was in Environmental Health Engineering Department of Iran University of Medical Sciences. Exact data of every hour pollutants were taken from Department of environmental (DOE) Islamic Republic Iran and Air Quality Control Company of Tehran. Then validated according to the World Health Organization (WHO) guidelines and Statistical parameters for quantifying health effects were calculated in excel software. Finally, assessment of cases total mortality, cardiovascular mortality, respiratory mortality and cardiovascular disease and respiratory disease, with AirQ software was performed.

Results: The results of this study showed that the number of total mortality, cardiovascular mortality and respiratory mortality caused by exposure to Particulate matter smaller than 10 microns (PM10) in the past decade is 11776, 12121 and 33066 cases respectively. Also the total number of hospital admission due to cardiovascular disease and respiratory disease in the past decade is 20990 and 54352 cases in 2005-2014 years. Conclusion: According to the results of this study, during the last decade the level of air pollution and Concentration of pollutants in Tehran Increased. Effects and health consequences due to exposure to Particulate matter smaller than 10 microns (PM10) in Tehran Metropolis Is very severe and increased mortality and cardiovascular and respiratory diseases among the citizens of Tehran.