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عضویت

جستجوی مقالات مرتبط با کلیدواژه « congenital anomalies » در نشریات گروه « پزشکی »

  • Sedigheh Ekraminasab, Elahe Dadbinpour, Shiva Rafati, Ali Dadbinpour, Fatemeh Ghasemi, Mahta Mazaheri *
    Background
    Maternal factors like age, existing medical conditions, and exposure to medications/substances during pregnancy are crucial in the development of congenital anomalies. This study aims to investigate maternal risk factors associated with congenital anomalies in newborns in Yazd from 2018 to 2021.
    Methods
    This particular research entails a cross-sectional descriptive analysis where the data concerning all live births and their respective mothers from the years 2018 to 2021 in the hospitals situated in Yazd were culled from the database of the National Mother and Newborn Health Registration System affiliated with Shahid Sadoughi University of Medical Sciences.
    Results
    Over four years, approximately 122,098 mothers' information was recorded in the mother's information registration system. The outcomes about social factors indicated that 1.3% of mothers with limited educational background and 0.62% of educated mothers had newborns with abnormal conditions. The heightened occurrence of newborns with congenital anomalies among mothers with lower educational attainment in comparison to their educated counterparts was deemed statistically significant (P < 0.001). Moreover, mothers under the age of 19 exhibited a 1.2% frequency of abnormalities, a rate significantly surpassing that of other age brackets.
    Conclusion
    The discernment that very young mothers and those with limited education exhibit a higher frequency of abnormalities underscores the necessity for enhanced medical attention and awareness within these specific demographic segments. Nevertheless, further comprehensive inquiries regarding risk factors among mothers and high-risk cohorts are imperative.
    Keywords: Congenital Anomalies, Newborn, Maternal Age, Risk Factors}
  • S.M.R. Rabani*
    Aims

    The urinary tract is a site for common anomalies. Ureteropelvic junction obstruction and double collecting system are among the most common anomalies in the body, but gathering all of these anomalies reported in our patient and being unilateral may be a rare entity. Hereby, we report a case with such a rare condition.

    Patient & Methods

    The patient is a 19-year-old army male who presented with left lower quadrant abdominal pain after blunt abdominal trauma, accompanied by gross hematuria.

    Findings

    Ultrasonography suggested an ectopic pelvic left kidney with hydronephrosis and ureteropelvic junction obstruction with distal ureteral dilatation. Exploration was done through a Gibson’s retroperitoneal incision, and pyeloplasty accompanied by ureteroneocystostomy was carried out.

    Conclusion

    The collection of unilateral renal ectopia, double collecting system, lower moiety ureteropelvic junction obstruction, and finally ending to a common ureter with ureterovesical junction obstruction, seems to be a rare condition, but we found all of these in a young male.

    Keywords: Congenital Anomalies, Kidney, Urinary Tract System}
  • Mahin Hashemipour, Jila Yousofi, Rojin Chegini, Silva Hovsepian*
    Background

    Congenital hypothyroidism (CH) is one of the most prevalent endocrine disorders in children. According to the literature, there is a high prevalence of other anomalies and syndromes in infants diagnosed with CH.

    Objectives

    This study finds the prevalence of concurrent anomalies and the prevalence of each one.

    Methods

    This was a systematic review study based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA). The research question was the comparison of children with and without CH in terms of having extra-thyroidal congenital anomalies. A systematic literature search through PubMed, Science Direct, Scopus, and the Web of Science databases was done using the following key words: Congenital hypothyroidism, birth defects, congenital anomalies.

    Results

    From the 655 initially retrieved articles, 24 articles remained, and 4 additional references were found by reviewing the references of the final articles. Finally, 28 articles were selected. The prevalence of extra-thyroidal anomalies ranged from 5% to 50% in girls and from 4% to 80% in boys. Meanwhile, 20% of the permanent CH patients and 13% of the patients with transient CH had extra-thyroidal congenital malformations. Cardiac anomalies were more prevalent in girls (female to male ratio=1.6 [0.7 to 5.5]), and urogenital anomalies were more reported in boys. Most of the studies did not report the association between non-thyroidal anomalies and thyroid stimulating hormone, gender, etiology of CH, and transient and permanent CH.

    Conclusions

    Congenital anomalies are more common in CH patients compared with the general population, even in the absence of congenital syndromes or chromosomal abnormalities. The most common anomalies are cardiac, craniofacial, urogenital, and nervous system.

    Keywords: Congenital Hypothyroidism (CH), Birth Defects, Congenital Anomalies}
  • Chaitra B E*, Athira KP, Mohit Kumar
    Background & Aims

    According to the March of Dimes (MOD) global report on birth defects, 7.9 million births occur annually worldwide with serious birth defects. The prevalence of congenital anomalies in India is 6-7%. Worldwide, NTDs affect 323,904 infants with a prevalence rate of 0.5 to 11 per 1000 births. Although prenatal sonography has been developed in recent years, the definitive diagnosis of fatal fetal malformations is best made by fetal autopsy. An autopsy not only confirms, but also provides additional information and is useful in advising parents about the risks and prevention of similar malformations in future pregnancies. The aim of the study is to study the spectrum of Neural tube defects in foetal autopsies.

    Materials & Methods

    This retrospective study was conducted in the Department of Pathology, Hassan Institute of Medical sciences, Hassan, Karnataka, India. 97 fetal autopsies were performed between July 2010 to June 2020, out of which 39 cases had CNS malformations. 36 cases with NTD were included in this study. All the essential clinical data were retrieved from the autopsy forms and case files. In every case, the location and morphology of the NTD and associated morphologic anomalies were noted. The statistical analysis was performed by using frequency and percentage using SPSS version 24.

    Results

    Out of 36 cases, the majority of the cases were Spina bifida (27.78%) followed by Anencephaly (25%).

    Conclusion

    Congenital disorders are a great public health issue in developing countries. The multidisciplinary approaches to fetal malformations have ever increasing importance in prenatal medicine. Fetal autopsy has a vital role in diagnosis of congenital malformations and detecting the cause of death.

    Keywords: Congenital Anomalies, Fetal Autopsy, Neural Tube Defects}
  • مقدمه

     اصطلاح ناهنجاری مادرزادی به ناهنجاری های ساختاری یا عملکردی در زمان بارداری اطلاق می شود. در حدود 12 مرگ مرتبط با ناتوانی های مادرزادی در هر 10000 نوزاد متولد شده رخ می دهد.

    هدف

     این مطالعه برآنست که شیوع و فاکتورهای مرتبط بر ناهنجاری های مادرزادی منفرد و چندگانه را در بین تولدهای زنده شهر زاهدان در جنوب شرقی ایران ارزیابی کند.

    مواد و روش ها

     این مطالعه مقطعی بر روی 59087 تولد زنده در یک بیمارستان مرجع در شهر زاهدان واقع در جنوب شرقی ایران در طی سال های 1397-1387 صورت گرفته است. تمام تولدهای زنده توسط پزشکان اطفال بررسی و ناهنجاری های مادرزادی براساس طبقه بندی بین المللی بیماری ها دسته بندی شدند.

    نتایج

     از بین تمام 59085 تولد زنده، حداقل 883 تولد زنده یک ناهنجاری قابل توجه داشتند و میزان شیوع ناهنجاری های مادرزادی در حدود 149 به ازای هر 10000 مورد بود. ناهنجاری های سیستم های عصبی و گردش خون پرتکرار بودند که به ترتیب در 213 و 187 مورد از تولدهای زنده رخ داده اند. اسپینابیفیدا  رایج ترین ناهنجاری سیستم مرکزی بود. شایع ترین ناهنجاری سیستم گردش خون بدشکلی های نامشخص قلب (1/17%) و سیستم گردش خون (7/18%) و مجرای شریانی باقی مانده (7/11%) بود. ارتباط معناداری بین ازدواج فامیلی والدین، سن مادر، وجود یک ناهنجاری در خانواده و خویشاوندان با ناهنجاری های مادرزادی منفرد و چندگانه وجود داشت (به ترتیب 02/0 = p، 02/0 = p، 001/0 > p و 01/0 = p).

    نتیجه گیری

     شیوع ناهنجاری های مادرزادی 149 مورد به ازای هر 10000 تولد زنده بود. بیشترین شیوع ناهنجاری های مادرزادی مربوط به سیستم عصبی مرکزی بود. افزایش دانش عمومی در مورد نقایص جنینی می تواند شیوع ناهنجاری های مادرزادی را کاهش دهد.

    کلید واژگان: ناهنجاری های مادرزادی, بستری, ایران, تولد زنده, شیوع, عوامل خطر}
    Azam Asemi-Rad, Zahra Heidari, Hamidreza Mahmoudzadeh-Sagheb *, Yousef Mehdipour, Bita Moudi, Nadia Sheibak, Saeid Ebrahimi
    Background

    The term congenital anomalies (CAs) refer to structural or functional abnormalities at the time of conception. Approximately 12 deaths related to congenital disabilities occur in every 10,000 babies born.

    Objective

    This study aimed to evaluate the prevalence and associated factors of single and multiple CAs in live births in Zahedan, Southeast Iran.

    Materials and Methods

    This cross-sectional study was conducted on 59,087 live births in a referral hospital in Zahedan located in the southeast of Iran during 2009-2019. All live births were examined by pediatricians and the CAs and categorized based on the international classification of diseases.

    Results

    Of 59,085 live births, at least 883 had a significant anomaly, and the prevalence rate of CAs was about 149 per 10,000. Anomalies of the nervous (24.1%) and cardiovascular systems (21.10%) were the most frequent, occurring in 213 and 187 of the live births, respectively. Spina bifida is the most common anomaly of the central nervous system. The most common anomalies in the cardiovascular system were unspecified heart malformations (17.1%), cardiovascular malformations (18.7%), and patent ductus arteriosus (11.7%). Significant correlations were found between the parent's consanguinity marriage, the mother's age, an existing anomaly in the family, and relatives in single and multiple CAs (p = 0.02, p = 0.02, p < 0.001, p = 0.01, respectively).

    Conclusion

    The prevalence of CAs was 149 per 10,000 live births. The highest prevalence of CAs was related to the central nervous system. Increasing the public's knowledge about fetal defects can reduce the prevalence of CAs.

    Keywords: Congenital anomalies, Hospitalization, Iran, Live birth, Prevalence, Risk factors}
  • Sahar Hassan *, Nassrin Malik Aubead
    Background & Objective

    Congenital anomalies are a global issue and the primary reason of death in both developed and advanced countries. Congenital anomalies occur at varying rates in various populations. The purpose of this research was to determine the prevalence and pattern of congenital anomalies in newborns, as well as the associated maternal and environmental factors in newborns, presented at the Babylon teaching hospital for motherhood and pediatrics in AL-Hilla city, between 2017 and 2021.

    Materials & Methods

    This study follows a descriptive design, and was based on population data from the statistic registry covering the AL-Hilla city, Iraq, 2017 to 2021. The registry covers live and still births. Also, maternal and neonatal information regarding sex, birth weight, parental consanguinity, and maternal age, were recorded.

    Results

    There were 214 congenitally deformed newborns among the 46,777 births in AL-Hilla city. There were 109 males (50.69 percent) and 103 females (47.90 percent). The most common congenital malformations discovered were those relating to the neurological system, followed by those relating to the musculoskeletal system.

    Conclusion

    Anomalies in the central nervous system were most apparent, however, this research can help to determine the approximate distribution of the prevalence of congenital anomalies in AL-Hilla city in Iraq. Also, by identifying their main types, information can be applied to improve the clinical performance and public policies of Iraq.

    Keywords: Congenital Anomalies, Neonates, Iraq, Prevalence, pattern}
  • Anahita Dehghani Soltani, Azita Tehranchi, Hossein Behnia, Fatemeh Zahedipour
    Objectives

    Hemifacial microsomia (HFM) is an asymmetric craniofacial malformation, which results from hypoplasia of the first and second branchial arch components and is characterized by a wide spectrum of phenotypic expressions, varying from the underdevelopment of the temporomandibular joint, mandible, facial and trigeminal nerves, masticatory muscles, ears, and hypoplastic maxillary, temporal, orbital, and zygomatic bones to conductive hearing loss due to external and middle ear deformities. Management of this developmental defect is multidisciplinary and associated with various phenotypic spectra and severities. A wide range of treatment protocols, such as surgical interventions, have been proposed, especially for mandibular hypoplasia, including rib or fibular bone grafting, distraction osteogenesis (DO), orthognathic surgery, and a combination of these procedures.

    Case:

     In this study, the treatment course and 17-year follow-up of a patient with HFM were described. The treatment included autogenous costochondral grafting, followed by full-time application of an asymmetric hybrid functional appliance, fixed orthodontic therapy, orthognathic surgery, and contour modification surgery to achieve optimal facial aesthetics.

    Conclusion

    Patients can benefit from functional jaw orthopedics psychosocially and the consequent enhanced facial symmetry during childhood and adolescence is really advantageous

    Keywords: Hemifacial microsomia, Facial asymmetry, Congenital anomalies, Unilateral hypoplasia}
  • Kenza Hattoufi *, Hassan Aguenaou, Aicha Kharbach, Amina Barkat
    Background
    Rubella is an acute viral disease generally mild in its clinical manifestations. However, it is most serious for pregnant women due to the high frequency of congenital abnormalities that it causes, known as congenital rubella syndrome. This study aimed to determine rubella seroprevalence among a group of Moroccan parturients and survey physicians’ opinions regarding the situation of congenital rubella syndrome in different regions of Morocco.
    Methods
    We prospectively enrolled 1500 women hospitalized in the Maternity Souissi of Rabat for delivery and 14 pediatricians/neonatologists who were practicing in public and private centers representing different regions of Morocco. Data on rubella serological status were extracted from the medical records of mothers. The physicians involved in this study were visited to answer the survey in person, or they completed the survey by e-mail or phone discussion.
    Results
    Among enrolled women, and after excluding those who did not bring back evidence of a serological assessment, 222 (17.5%) women performed a rubella serology of which 84.7% were immunized against rubella. The opinion poll of physicians showed an almost absence of reports on congenital rubella syndrome cases. All practitioners surveyed were interested to join the establishment of congenital rubella syndrome reporting system.
    Conclusion
    To achieve the goals set for congenital rubella syndrome elimination, it is of primary importance to protect women from the childbearing age by vaccination and measures that help avoid any further contact with the virus. There is also a need to expand serological screening to detect and monitor seronegative women. In addition, it is necessary to diagnose and notify new cases of congenital rubella syndrome.
    Keywords: Congenital anomalies, Congenital Rubella Syndrome, Parturient, Rubella, Seroprevalence}
  • Masood Mahdavi Rashed, Ahmad Mohammadipour, Samaneh Najafi, Malihe Seyedhoseini *

    Caudal duplication syndrome is a rare congenital disease caused by duplication of cloaca and notochord embryonic structures in various forms. The estimated prevalence of this syndrome is 1 per 100,000 births. A range of anomalies is observed in urinary and gastrointestinal tracts as well as in skeletal and neural structures of the spine and even limbs of these patients. Various factors such as genetic disorders and conjoined twinning have been mentioned in etiology of the disease. We introduce a case of this rare disease referred to our center for imaging as an infant with increased soft tissue in perineum without excretion of meconium from birth but with evidence of duplication in the genitourinary system (vagina and urethra) and gastrointestinal tract (rectum and colon) that was subject to reconstructive surgery.

    Keywords: Caudal Duplication Syndrome, Congenital anomalies, Genitourinary Duplication, Infant}
  • فائزه طریقت، عرفان گلشن، سعید دستگیری *
    زمینه و اهداف

    سالانه در جهان حدود سیصد هزار نوزاد در 28 روز اول زندگی به علت ابتلا به ناهنجاری های مادرزادی می میرند. سایر نوزادان، اغلب با ناتوانی های مختلف در سنین بالاتر در طول زندگی مواجه خواهند شد. اغلب موارد نقص های تولد در کشورهای با درآمد پایین و متوسط رخ می دهد. در ایران، سالانه بیش از یکصد هزار مورد از ناهنجاری های مادرزادی برآورد می‌شود که بیش از هفتاد درصد آن‌ها قابل پیشگیری می‌باشند. با توجه به اینکه تاکنون مطالعه ای به تعیین شیوع ناهنجاری‌های مادرزادی در یک بازه طولانی مدت در ایران نپرداخته است، این مطالعه با هدف برآورد شیوع انواع نقص های تولد در شمال غرب ایران براساس داده های رجیستری TRoCA انجام شد.

    مواد و روش ها 

    در این مطالعه، تولدهای ثبت شده در رجیستری TRoCA در دو دهه بین سال های 1379 تا 1399 برای برآورد شیوع کلی و بر حسب انواع مختلف ناهنجاریها براساس طبقهبندی ICD-10 مورد بررسی قرار گرفت. شیوع کلی با تقسیم تعداد موارد گزارش شده به تعداد کل تولدهای زنده و مرده در منطقه در بازه زمانی مشخص شده به دست آمده است. در موارد مورد نیاز نیز، حدود اطمینان نود و -پنج محاسبه شده است.

    یافته ها

    در این مطالعه مجموعا 297734 تولد ثبت شده در رجیستری TRoCA در دو دهه گذشته بررسی شد. شیوع کلی مادرزادی در این مطالعه 9/262 در ده هزار تولد به دست آمد (CI95%: 257.2–268.7). ناهنجاری‌های سیستم ادراری تناسلی (59.2 per 10 000 births, 95% CI: 56.5–62.0)، نقص های اندامی (46.3 per 10 000 births, 95% CI: 43.9.5–48.8)، ناهنجاری‌های سیستم عصبی (39.4 per 10 000 births, 95% CI: 37.2–41.7)، ناهنجاری‌های گوارشی (27.8 per 10 000 births, 95% CI: 25.9–29.7) و ناهنجاری‌های مادرزادی قلبی (37.1 per 10 000 births, 95% CI: 34.9–39.3) مسیول 80 درصد نقصهای تولد در منطقه بودند. طی این بازه زمانی شیوع ناهنجاری‌های مادرزادی سیر افزایشی حدود سه برابری داشت. اغلب موارد ابتلا مذکر بودند (3/61 درصد) و ازدواج فامیلی در 5/12 درصد از والدین دارای فرزند مبتلا مشاهده شد.

    نتیجه گیری 

    تهیه برنامه های خدمات مراقبتی متناسب با وقوع ناهنجاری‌های مادرزادی جهت غربالگریهای قبل از تولد با توجه به شیوع قابل توجه انواع ناهنجاری‌های مادرزادی در کشور توصیه می شود.

    کلید واژگان: ناهنجاری های مادرزادی, شیوع, نقص های تولد, ایران}
    Faezeh Tarighat, Erfan Golshan, Saeed Dastgiri*
    Background and Objectives 

    Every year, about three hundred thousands of infant deaths occur because of congenital anomalies. Some continue to live with various types of disabilities. Low and middle income countries have higher rate of congenital anomalies. It is estimated more than 100,000 cases of birth defcets occure annualy in Iran where 70 percent are preventable. There is no long term investigation on the epidemiology and secular trend of congenital anomalies in Iran. The aim of this study was to document the time trend and epidemiological features of congenital anomalies in the northwest of Iran using the Tabriz Registry of Congenital Anomalies (TRoCA) programme.

    Material and Methods 

    A total of 297,734 births were registered in the region by TRoCA registry during the study period to estimate the occurrence of total and selected groups of congenital anomalies based on the standard coding system of the International Classification of Diseases (ICD). Total prevalence was calculated by dividing the numerator (registered cases of congenital anomalies in the TRoCA region) by the relevant denominator (total live and stillbirths in the TRoCA region) for the same period of time.

    Results 

    An overall prevalence rate of 262.9 (CI95%:257.2–268.7) was estimated in the region. Anomalies of genito-urinary tract (59.2 per 10 000 births, 95% CI: 56.5–62.0), limb defects (46.3 per 10 000 births, 95% CI: 43.9.5–48.8), nervous system anomalies (39.4 per 10 000 births, 95% CI: 37.2–41.7), gastrointestinal anomalies (27.8 per 10 000 births, 95% CI: 25.9–29.7) and congenital heart diseases (37.1 per 10 000 births, 95% CI: 34.9–39.3) were accounted for 80 percent of birth defects. Total prevalence of anomalies was more than tripled in the region over the past two decades. More cases were observed in males, and those with consanguineous marriage.

    Conclusion

    The increasing trend of the occurrence of congenital anomalies indicates that appropriate care programmes and more effective prenatal screening procedures need to be implemented in the region.

    Keywords: Congenital Anomalies, Registry, Prevalence, Birth Defects, Iran}
  • Saleheh Tajalli, Minoo Fallahi, Maryam Hafezi Bashardoust, Mohammad Kazemian, Jamileh Heshmatpanah
    Background

    Despite the significant improvement in neonatal intensive care, neonatal death is still one of the most important challenges worldwide. Understanding the causes of neonatal mortality is important for health policymakers.
    This study aimed to assess neonatal mortality in an Iranian referral level Ш Neonatal Intensive Care Unit (NICU).

    Methods

    This cross-sectional study was conducted on the neonates who were referred to a level Ш NICU between 2014 and 2019. Data collection was performed by the research assistants, using a pre-designed checklist from the neonatal medical records. All the neonatal records of the patients who died during the infancy period were collected. Data were analyzed using SPSS (version 23).

    Results

    In total, 388 (12%) out of 3,078 inpatient neonates died In this study. The mean gestational age of neonates who died was 34.9 weeks and 53% of them were males. In addition, 92 (23%) of them died when they aged between 0-7 days and hyponatremia was the most common (30.9%) abnormal laboratory finding among them. The main causes of mortality included sepsis (26%), congenital multiple anomalies (21%), prematurity (20%), surgical procedures (15%), congenital heart disease (8%), inborn metabolic disorder (6%), hypoxic-ischemic encephalopathy (2.8%), and some unknown reasons (1.2 %), respectively. Sepsis, as the most common disorder in neonatal mortality among the patients, was detected in 74 (58.27%) preterm infants, and Acinetobacter was the main microbial detected pathogen. The rate of sepsis was significantly different in different gestational ages (P<0.001).

    Conclusion

    Based on the obtained results, sepsis, prematurity, and congenital multiple anomalies are the most common causes of mortality among neonates. Causes of mortality during the first month of life were different indicating the need for evidence-based interventions and proper policymaking in the field of neonatal health.

    Keywords: Congenital anomalies, Infant, Iran, Mortality, neonatal intensive care}
  • Mohammad Esmaeil Masinaei Nejad, Narges Khanjani *, Maryam Khodadadi, Esmail Najafi
    Background

    Congenital malformations are defects that are present at birth. The purpose of the present study was to determine the status of congenital malformations and their risk factors in Noghab village, South Khorasan Province.

    Methods

    In this case-control study, 152 cases with congenital anomalies and 152 controls were enrolled. A researcher-made checklist and face-to-face interviews were used to record patient data. Chi-square test, Mann-Whitney U, and univariate and multivariate logistic regression in SPSS 22 were used for statistical analysis.

    Results

    One hundred and nineteen (72.5%) patients were male. The overall prevalence of congenital abnormalities in the village was 4.5%. The most prevalent types of disorders were neurological (35.4%) and multiple abnormalities (30.5%). According to multivariate logistic regression, consuming barberries daily during pregnancy, having first-degree relatives with anomalies, daily use of herbal medicine and weekly consumption of pickled vegetables during pregnancy, and the existence of a chronic disease in the father were significantly associated with congenital disorders in the offspring.

    Conclusion

    In addition to the previously known risk factors for congenital malformation, consumption of barberries, herbal medicine and pickled vegetables during pregnancy, might be risk factors for congenital anomalies. These products should be used with caution in pregnant women.

    Keywords: Genetic disorders, Congenital anomalies, Barberry, Prevalence, Iran}
  • بهزاد کرمی متین، مسلم صوفی، علی کاظمی کریانی، شاهین سلطانی*، بیتا شکری، شیوا امانی، زهرا شهبازی
    هدف

     ناهنجاری مادرزادی شامل طیفی از اختلالات کارکردی یا ساختاری است که می تواند به صورت یک اختلال تنها یا گروهی از اختلالات رخ دهد. مطالعات نشان می دهند عوامل اجتماعی و اقتصادی در شیوع ناهنجاری های مادرزادی تاثیرگذار هستند، به طوری که کشورهای با درآمد متوسط و کم، بار بیشتری از ناهنجاری های مادرزادی را به دوش می کشند. هدف مطالعه حاضر، شناسایی مهم ترین تعیین کننده های اجتماعی و اقتصادی ناتوانی و مرگ ومیر زودرس ناشی از ناهنجاری های مادرزادی در کودکان زیر پنج سال در جهان بود. 

    روش بررسی

     این پژوهش یک مطالعه مقطعی بود که با استفاده از آخرین داده های موجود در سال 2017 انجام شد. متغیر وابسته در این مطالعه، سال های زندگی تعدیل شده بر حسب ناتوانی بود. در این مطالعه داده های 196 کشور جهان مورد تحلیل قرار گرفت. کشورها بر اساس تقسیم بندی سازمان جهانی بهداشت، به شش منطقه جغرافیایی آفریقا، اروپا، آمریکا، مدیترانه شرقی، غرب اقیانوس آرام و جنوب شرق آسیا تقسیم شدند. تحلیل داده ها با استفاده از آزمون تحلیل واریانس یک طرفه و رگرسیون خطی انجام شد.

    یافته ها

    پایین ترین میزان DALY مربوط به کشور لوگزامبورگ (856/29) و بالاترین مقدار آن (21714/7) مربوط به کشور سودان بود. منطقه آفریقا بالاترین میانگین DALY (4250/56±9392/78) و منطقه اروپا پایین ترین میانگین (1961/64±2969/11) را به خود اختصاص دادند. میزان DALY ناشی از ناهنجاری های مادرزادی برای کودکان زیر پنج سال برای کشور ایران در سال 2017 حدود 7721/48 در صد هزار نفر جمعیت بود که در مقایسه با میانگین منطقه اروپا و آمریکا بالاتر و در مقایسه با منطقه آفریقا و مدیترانه شرقی پایین تر بود. نتایج تحلیل رگرسیون خطی نیز نشان داد متغیر میانگین تعداد سال های تحصیل قوی ترین پیش بینی کننده DALY (β=-0/44 ، P=0/001) ناشی از ناهنجاری های مادرزادی برای کودکان زیر پنج سال بود.

    نتیجه گیری

    میانگین تعداد سال های تحصیل قوی ترین پیش بینی کننده میزان سال های زندگی ازدست رفته به علت ناتوانی و مرگ ومیر زودرس ناشی از ناهنجاری های مادرزادی برای کودکان زیر پنج سال است. این مطالعه پیشنهاد می دهد توزیع عادلانه خدمات غربالگری و مراقبت سلامت و زیرساخت های آموزشی برای گروه های محروم و پایین اجتماعی و اقتصادی بایستی در دستور کار سازمان های بین المللی و نظام های سلامت ملی قرار گیرد.

    کلید واژگان: ناتوانی, ناهنجاری مادرزادی, مرگ ومیر, عوامل اجتماعی اقتصادی, فقر}
    Behzad Karami Matin, Moslem Soofi, Ali Kazemi Karyani, Shahin Soltani*, Bita Shokri, Shiva Amani, Zahra Shahbazi
    Objective

     Congenital anomalies are functional or structural anomalies that can occur as a single or a group of anomalies. Studies have shown that socioeconomic factors can affect congenital anomalies such that the middle- and low-income countries suffer more from the congenital anomalies. This study aimed to determine the essential socioeconomic determinants of the disability-adjusted life year (DALY) for congenital anomalies in children aged <5 years.

    Materials & Methods

    This is a cross-sectional study using the latest available data in 2017, which were extracted from the international databases of the World Bank, the Institute for Health Metrics and Evaluation, and the United Nations Educational, Scientific, and Cultural Organization. In the study, we analyzed data from 196 countries divided into 6 geographical regions of African Region (AFRO), European Region (EURO), Pan American Health Organization (PAHO), Eastern Mediterranean Region (EMRO), Western Pacific Region (WPRO), and South-East Asia Region (SEARO). To identify the main determinants of the DALY, gross domestic products (GDP) per capita, poverty rate, government, private and external health expenditures per capita, mean years of schooling, and literacy rate were used. Data analysis was performed in STATA v.15 using the one-way ANOVA and the linear regression analysis.

    Results

     The lowest and highest rates of DALY was reported in Luxembourg (856.29 per 100000 population) and Sudan (21714.7 per 100000 population), respectively. The AFRO and EURO regions had the highest (9392.78±4250.56), and the lowest (2969.11±1961.64) mean of DALY. In Iran, the DALY rate was reported 7721.48 per 100000 population, which was higher than those in the EURO and PAHO regions and lower than those in the AFRO and EMRO regions. The results of linear regression analysis showed that mean years of schooling was the strongest predictor of DALY (β=-0.44, P=0.001) followed by the poverty rate (β=0.36, P=0.002). The results of one-way ANOVA indicated that the rate of DALY was significantly different between different social and economic groups, and it was higher in the lower socioeconomic groups. 

    Conclusion

     Mean years of schooling and poverty rate are the strongest predictors of DALY for congenital anomalies in children under 5 years of age. Low-income countries, especially those in the AFRO and EMRO regions, are the most prone to the disability and premature death caused by congenital anomalies in children under 5 years of age compared to the high-income countries. Therefore, the equitable distribution of screening and health care services and educational infrastructures for deprived and lower socioeconomic countries should be taken into account by national and international health organizations.

    Keywords: Disability, Congenital anomalies, Mortality, socioeconomic factors poverty}
  • سعید دستگیری *، عبدالحسن کاظمی، محمد حیدرزاده، مرتضی علیان، بهرام صمدی، علی سیف فرشاد، فروغ السادات سیاح ملی، حسین میرزاجان زاده، مریم بیگم یاسینی
    زمینه و اهداف

    هدف مطالعه ی حاضر آن است که مصداق های «قاعده ی عسر و حرج» در وقوع ناهنجاری های مادرزادی و اختلالات ژنتیکی را توضیح و نشان دهد که براساس قوانین جاری کشور می توان از تعداد بیشتری از این بیماری ها پیشگیری نمود.

    مواد و روش ها

    در مطالعه ی حاضر داده های مربوط به بیماری های مادرزادی از 2 برنامه ی بزرگ میدانی و بر پایه ی بیش از 6465849 تولد در کشور به دست آمده است. جهت بررسی جوانب فقهی قاعده ی عسر و حرج یک بررسی جامع کتابخانه ای انجام گرفت. برای ارزیابی مصادیق قاعده ی فوق با تعدادی از علمای حوزوی بحث و تبادل نظر به عمل آمد و با متخصصین پزشکی کودکان، ژنتیک، روان پزشکی و نوزادان از لحاظ تعاریف تشخیص های مرتبط با اختلالات مادرزادی و ژنتیکی تبادل نظر و مشاوره ی گسترده ای انجام گردید.

    یافته ها

    سالانه حدود 100 هزار نفر بیمار مادرزادی و ژنتیکی به جمعیت عمومی کشور اضافه می گردد. وقوع این بیماری ها در 18 ساله ی گذشته، بیش از 3 برابر افزایش پیدا کرده است.

    نتیجه گیری

    اگر وقوع ناهنجاری های مادرزادی کنترل نشوند، به تدریج خزانه ی ژنی جمعیت را در آینده معیوب و دچار انواع نقایص ژنتیکی خواهد نمود. با استناد به قانون فعلی سقط درمانی، بیماری هایی که منجر به عسر و حرج پدر، مادر، خانواده، اجتماع و همین طور نسل-های آینده شوند را می توان به تشخیص متخصصین مربوطه در قبل از ولوج روح (تا 16 هفتگی بارداری) برای سقط درمانی ارجاع داد. با اجرای صحیح این قانون، همه ساله از ورود حداقل 70 هزار نفر با ژن های معیوب و بیماری مادرزادی و ژنتیکی به خزانه ی ژنتیکی جمعیت جلوگیری می گردد.

    کلید واژگان: ناهنجاری مادرزادی, اختلال ژنتیکی, پیشگیری, اپیدمیولوژی, نفی عسر و حرج}
    Saeed Dastgiri*, Abdolhassan Kazemi, Mohammad Heidarzadeh, Morteza Alian, Bahram Samadi, Ali Seif-Farshad, Foroogh Sadat Sayyah Melli, Hossein Mirzajanzadeh, Mariam Beigom Yasini
    Background and Objectives

    The aim of this study was to explain the examples of "the Jurisprudential Rule of "Osr o- Haraj" or Denegation of Intolerable Hardship in the occurrence of congenital anomalies and genetic disorders and show that according to the current laws of the country, more of these diseases can be prevented.

    Material and Methods

    Data for occurrence of congenital anomalies were derived from two major regional and national epidemiological studies based on 6,465,849 births in the country. A comprehensive review of literature was carried out on the details of ‘Denegation of Intolerable Hardship Rule. The details of medical termination of pregnancies diagnosed for congenital anomalies and the role of ‘Denegation of Intolerable Hardship’ principle in the prevention of birth defects were explored in several Focused Group Discussions formed by peditricians, geneticists, psychiatrists, neotatalogists and expert jurisprudents.

    Results

    The statistical estimates indicate that there are now nearly 100,000 births with one of the birth defects occurring every year in Iran. The total prevalence of the anomalies has more than tripled in the last 18 years.

    Conclusion

    The occurrence of congenital anomalies and genetic disorders will undermine the gene pool of the population if preventive measures are not properly implemented in the community genetics services to control those disorders. According to the current law on therapeutic abortion, disorders that lead to the hardships of father, mother, family, community, as well as future generations may be diagnosed by the three specialists (before the 16th week of pregnancy, the time of onsetting the soul). They can then be referred for medical abortion. A minimum of 70,000 birth defects may be avoided using the therapeutic termination of pregnancies diagnosed for congenital anomalies if the ‘no hardship and negation of distress and constriction’ principle is suitably explored in maternal, pediatric, neonatal settings and for public health authorities.

    Keywords: Congenital Anomalies}
  • Mahtab Ranjbar, Ebrahim Masoudnia*, Mohsen Haghshenas Mojaver
    Introduction

    Congenital anomalies are one of the most important causes of disability and mortality in childhood seen in developing and developed countries. Mothers with physically-abnormal newborns have unfavorable lifestyle compared to mothers with healthy infants.

    Objective

    The aim of this study was to determine the difference between mothers of infants with and without physical abnormalities in terms of psychosocial factors.

    Materials and Methods

    This is a case-control study with two study groups; the case group (n=133) consists of mothers who had babies with birth defects referred to health centers in Amol city, Iran for postnatal care in 2018. The control group (n=133) included mothers with healthy infants in this city. They were selected using a convenience sampling method. Measurement tools included a Socio-demographic form, Health-Promoting Lifestyle Profile (HPLP), Multidimensional Perceived Social Support Scale (MPSSS), Coping Strategies Scale - Short Form (CSS-SF), Prenatal Distress Questionnaire (PDQ), and General Health Questionnaire - Short Form (GHQ-SF). Data were analyzed using descriptive statistics, chi-square test, and t-test.

    Results

    A total of 266 mothers with a mean age of 31.9±5.6 years were examined. There was a significant difference between the two groups of mothers in terms of overall HPLP score (P=0.01), and its dimensions of spiritual growth (P<0.05), physical activity, nutrition (P=0.01), and stress management (P<0.05). Moreover, a significant difference was reported between them in terms of MPSSS and its dimensions of social support from friends, family, and significant others (P=0.01). Furthermore, There was a significant difference between them with respect to GHQ dimensions of anxiety/insomnia, and depression (P<0.01); CSS dimensions of escape avoidance and emotion-focused coping strategies (P=0.01); and PDQ and its dimensions of concerns about the delivery and the health of the baby, and about the body weight/image (P=0.01).

    Conclusion

    Mothers of infants with and without birth defects are significantly different from each other in terms of psychosocial factors. It seems that poor psychosocial variables in mothers during pregnancy can act as a risk factor for congenital anomalies.

    Keywords: Congenital anomalies, psychosocial variables, Mothers}
  • معصومه معزی*، افسانه ملکپور، بهروز پورحیدر، صادق محمدخانی
    مقدمه

    ناهنجاری مادرزادی، از علل شایع مداخلات پزشکی، بیماری های طولانی مدت و مرگ می باشند. مطالعه حاضر با هدف تعیین عوامل خطر ناهنجاری مادرزادی در معلولین کودک ثبت نام شده در بهزیستی شهرکرد صورت گرفت.

    روش

     در مطالعه تحلیلی گذشته نگر از نوع مورد - شاهد حاضر،  جمعیت مورد مطالعه ، 350 نفر از معلولین ثبت نام شده در بهزیستی شهرکرد و 350 کودک سالم جورسازی شده بلحاظ جنسی در سطح جامعه بود. اطلاعات دموگرافیک و فاکتورهای خطر احتمالی از طریق پرونده بیمار و  مصاحبه با والدین در پرسشنامه  ثبت گردید.

    یافته ها

     بیشترین فراوانی ناهنجاری مربوط به اختلالات قلبی (31/1%)، فلج مغزی (18/3%) و سندروم داون (14/9%) بود. وزن، قد و دور سر حین تولد، سن پدر و مادر ، قومیت پدر و مادر، وضعیت اقتصادی ، تحصیلات، نوع زایمان، فصل تولد، شاخص توده بدن مادر ، ابتلاء مادر به دیابت، هیپوتیروییدیسم، فشار خون بالا و بیماری عفونی ،استعمال سیگار و اعتیاد پدر و مادر، عدم مصرف اسیدفولیک و آهن ، مصرف دارو توسط مادر، هیپوکسی جنین، ازدواج فامیلی و سابقه خانوادگی ناهنجاری در دو گروه تفاوت معنی داری داشت (0/05<P). در رگرسیون لجستیک، زایمان سزارین (4/9=OR)، وضعیت اقتصادی پایین (21/7=OR)، سن بالای پدر (1/8=OR)، داشتن سابقه خانوادگی ناهنجاری مادرزادی در فامیل درجه 1 (2/6=OR)، سیگاری بودن پدر (7/02=OR) و هیپوکسی نوزادی (4/7=OR) معنی دار باقی ماندند (0/05<P).

    نتیجه گیری

     از آن جا که شناسایی زود هنگام ناهنجاری های مادرزادی به منظور مداخلات پیشگیرانه بسیار مهم است ،توجه به عوامل خطر حاصل از این مطالعه در جلوگیری از تولد کودک دارای ناهنجاری مفید خواهد بود. لذا توجه حمایتی و مراقبتی ویژه به مادران باردار دارای عوامل خطر از گروه اقتصادی اجتماعی ضعیف جامعه و نوزادان آنها توصیه می گردد.

    کلید واژگان: ناهنجاری مادرزادی, عوامل خطر, کودکان معلول}
    Masoumeh Moezzi*, Afsaneh Malekpour, Behrouz Pourheidar, Sadegh Mohammadkhani
    Introduction

    Congenital anomalies are common causes of medical interventions, long-term illness and death. The aim of this study was to determine the risk factors of congenital anomalies in disabled patients under 15 years old registered in Welfare Organization of Shahrekord.

    Methods

    The present study was a case–control study. 350 disabled patients registered in the Welfare Organization of Shahrekord and 350 matched healthy children were included in study. Demographic information and probable risk factors were recorded in the checklist through the patient's file and interviews with parents.

    Results

    The most common anomalies were cardiac disorders (31.1%), cerebral palsy (18.3%) and Down syndrome (14.9%). The body weight, length and head circumference at birth, mean father's and mother's age at the time of pregnancy , Father's and  mother's ethnicity, economic status , education, type of delivery, birth season, maternal body mass index during pregnancy, maternal diabetes mellitus, hypothyroidism, hypertension  and infectious disease during pregnancy, parental addiction, parents' smoking, folic acid and iron intake during pregnancy, drug use during pregnancy ,hypoxia, consanguinity and family history of congenital anomaly were significantly different in two groups (p <0.05). Based on the results of logistic regression Type of delivery (caesarean section) , low socioeconomic status, father’s age, family history of congenital anomalies, father’s smoking and infant hypoxia had a significant correlation with the congenital anomalies.

    Conclusion

    Since early identification of congenital anomalies is essential for preventive interventions, considering the risk factors of this study will be helpful for primary prevention.
    Women at risk especially from poor socioeconomic should be mentioned and screened for more support and prenatal care.

    Keywords: Congenital anomalies, risk factors, Disabled children}
  • Iraj Sedighi, Shahla Nouri, Mohammad Kazem Sabzehei*, Mahta Sangestani, Younes Mohammadi, Jalaledin Amiri, Behjat Qazanfarzadeh
    Background

    Congenital anomalies are considered as one of the major causes of neonatal death. The prevalent pattern of congenital anomalies may vary diachronically or geographically. With regard to the pervasiveness of under-five mortality (probability of dying between birth and exactly 5 years old) in Hamadan province in the recent years, the present study intended to determine the risk factors of congenital anomalies of newborns in Hamadan province in 2017.

    Methods

    The present case-control study was conducted in the hospitals affiliated to Hamadan University of Medical Sciences for 6 months in 2017. The study targeted all the newborns from birth to hospital discharge. The neonatal cases with congenital anomalies were identified through clinical examination. A report sheet was assigned to a healthy newborn, as a control, per each case of congenital anomalies born on the same day and in the same hospital. Once data was collected, they were statistically analyzed by means of SPSS V. 16 software.

    Results

    According to the current results, the prevalence of congenital anomalies was 0.85% (8.5 per 1,000 live births). Genitourinary (40%), musculoskeletal (25.2%), eye, ear and neck (18.5%), chromosomal (5.9%), respiratory tract (3.7%) and cardiovascular system (2.2%) were the most common congenital anomalies, respectively. Consanguineous marriage, concomitant use of contraceptive methods and male sex were found to be the most important risk factors for congenital anomalies.

    Conclusions

    The present study aimed at identifying the various types and prevalence of congenital anomalies in Hamadan province. Regular prenatal examination and early diagnosis for prevention, early intervention and scheduled termination of pregnancy are recommended. Besides, public awareness of the disadvantages of consanguineous marriage and other pertaining risk factors affecting the incidence of congenital anomalies is also recommended.

    Keywords: Risk Factors, Congenital Anomalies, Newborns}
  • Satya Brata Padhy*, Subal Kumar Pradhan
    Background and Aim

    To determine the spectrum of congenital anomalies of kidney and urinary tract (CAKUT) in Indian children, and to evaluate its clinico-epidemiological characteristics.

    Methods

    A tertiary-care, hospital-based cross-sectional study conducted (November 2016-October 2018) at SCBMCH & SVPPGIP Hospital included children aged ≤14 years with a diagnosis of CAKUT. Incidence of individual congenital anomalies and clinico-epidemiological characteristics of each anomaly thus considered were evaluated.

    Results

    In 140 children, 9 types of congenital anomalies were reported; posterior urethral valve was most common (37.85%) followed by pelvi-ureteric junction obstruction (32.14%) and vesico-ureteric reflux (14.28%). Hypospadiasis (5%), renal agenesis (2.86%), multicystic kidney disease (2.86%), duplication of pelvi-calyceal system (2.14%), horseshoe kidney (1.42%) and ureterocele (1.42%) were other CAKUTs. A total of 68.57% were boys (girls=31.43%). The CAKUTs were observed more in children with: age 1-5 years (32.14%), unilateral disease (45%), and term delivery (67.86%), and in children of mother aged >30 years (58.57%). Diabetes was present in mothers of 4 children (gestational: 2, pre-gestational: 2), hypertension in 3, tobacco use in 5, oligohydramnios in 7 and polyhydramnios in 3 mothers. Majority of the children had asymptomatic (37.86%) manifestation followed by burning micturition (31.43%). Non-renal congenital anomalies were present in 15.71% children (gastrointestinal malformations: 5.71% were most common). Positive family history for CAKUT was seen in 7.8% cases.

    Conclusion

    The most frequent CAKUTs were posterior urethral valve and pelvi-ureteric junction obstruction in our study. The study also provided the clinico-epidemiological characteristics of CAKUT. These data can be helpful for prenatal counseling and management of CAKUTs.

    Keywords: CAKUT, congenital anomalies, children, Indian}
  • Fatemeh Mortazavi, Ramin Salimnejad, Reza Asghari, Maryam Eyvazi, Farhad Mortazavi, Simin Menshari, Hamed Shoorei*, Maliheh Ahin

    Radiologists frequently diagnose two ureteral duplications including complete and incomplete types. Incomplete ureter duplication, which is also called bifid ureter, refers to a situation in which the ureteric bud bifurcates before meeting the metanephric blastema. On the other hand, complete ureter duplication, which is also named double ureter, defines another situation in which two separate ureteric buds, on either side of the embryonic body, are formed from the mesonephric duct (Wolffian duct) and then arrive in the metanephric blastema. Therefore, two separate ureters, renal pelvis, as well as a duplex kidney (upper and lower poles) are formed in a common renal capsula. Embryologically, in complete ureter duplication, the ureteric buds rotate 108 degrees when incorporating into the urogenital sinus, which is known as Weigert-Meyer rule. In this posture, the upper and lower poles of the kidney are drained by the laterocranial and mediocaudal orifice, respectively. Complete duplication is more common in women than men and is often associated with vesicoureteral reflux, ectopic ureterocele, and/or ectopic ureteral insertion. In the present case report, a 40-year-old woman, mainly complaining of abdominal and lower back pain, was discovered to have bilateral complete ureteral duplication on computed tomography (CT) scan, as well as kidney, ureter, and bladder x-ray radiography. Moreover, the embryological causes were discussed in forming the duplicated ureter and duplex collecting system.
    Keywords: Ureteral Duplication, Congenital Anomalies, Computed Tomography Scan, KUB Radiography, Embryology}
نکته
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