مجله زنان مامائی و نازائی ایران
سال پانزدهم شماره 1 (فروردین 1391)

Polycystic ovary syndrome (PCOS) is one of the prevalent diseases in women. Insulin resistance is a predominant clinical feature in this syndrome. Leptin and ghrelin have significant effects on PCOS. Studies in this field are limited with conflicting results، so this study was designed to evaluate serum leptin and ghrelin and their relationship with insulin resistance and anthropometric indices in women with PCOS. This case-control study conducted with simple method sampling on 30 PCOS women and 30 healthy controls in Alzahra hospital of Tabriz in 2010. Weight، height، waist and hip circumferences، level of blood glucose، serum leptin and ghrelin were measured by standard methods. Body mass index (BMI)، waist to hip ratio (WHR) and insulin resistance were calculated. Mean of leptin، ghrelin and their relationship between insulin resistance، BMI and WHR were determined by SPSS software version 11. 5. Mean of serum leptin level and insulin resistance in PCOS patients were respectively 21. 68±4. 52 (ng/ml) and 3. 47±0. 54 IU and in control group were respectively 17. 96±3. 00 (ng/ml) and 1. 81±0. 31 IU (P=0. 001). Ghrelin level in PCOS patients and control groups were respectively 210. 33±10. 98 (ng/ml) and 216. 00±14. 76 picomole/liter (P=0. 08). There was a positive correlation between serum leptin level and BMI، WHR and insulin resistance in PCOS patients (r=0. 84، r=0. 55، r=0. 67، respectively، P<0. 05). In controls، serum leptin level was correlated with BMI and insulin resistance (r=0. 93، r=0. 77، respectively، P<0. 05). No significant relationship was found between serum ghrelin and insulin resistance and anthropometric indices in patients and controls. Serum leptin level is higher in PCOS patients but the difference of serum ghrelin level in two groups was not significant. In women with PCOS serum leptin is an effective factor in insulin resistance، while ghrelin is not. In these patients، serum leptin is influenced by anthropometric indices، while serum ghrelin is not.

Despite the technological advances in health care, routine analgesic procedures in postoperative pain control remain inadequate and require complementary therapies and interventions. Reflexology is one of the most popular forms of alternative and complementary therapy which its effectiveness has not been clearly demonstrated. So with respect to high rate of cesarean in Iran and the importance of pain relief after cesarean section and improving mobility, reducing the risk of thromboembolic events and having more ability to take care of newborn in first hours of birth, this study was performed to determine effect of foot reflexology on pain and anxiety in women after elective cesarean section.

This clinical trial study was conducted on 61 women who were planning to have a cesarean delivery in pastor hospital of Mashhad in 2011. Samples were randomly divided into foot reflexology group and routine cares group with simple sampling method. The case group received routine cares and foot reflexology for 10 minutes in each foot; whereas the control group received only routine cares. Post operative pain and anxiety were evaluated by visual analogue scale (VAS). Data were analyzed using SPSS version 14 and statistical tests such as, T test, paired t-test, Man-Whitney, chi-square, Fisher exact tests were done and p<0.05 was considered significant.

There was no statistically significant difference in pain intensity before intervention between two groups by using t-test (p=0.814), but after intervention, the difference was significant by Man-Whitney test (p=0.004). There was not statistically significant difference between two groups regarding postoperative anxiety score (p=0.215).

Foot reflexology proved useful as an effective nursing intervention in controlling post cesarean pain.

Postoperative pain is a major problem in general surgery which can severely effect on patient. Studies have shown that gabapantin can produce analgesia and reduce the need for opioids in postoperative patients. In this study the efficacy of gabapantin were studied as a premedication for reduce pain and need for opioids in abdominal hysterectomy. This double-blind clinical trial was performed in Alzahra maternity of Rasht in 2011. 60 patients who undergo elective abdominal hysterectomy randomly were divided into gabapantin group (1200mg) and placebo group (capsule like gabapantin). Patients visited immediately after recovery and on second and forth hours after surgery in recovery room and VAS was recorded. Data were analyzed with SPSS version 16 by t-student and Mann-Whitney tests. Age and surgery duration were matched in both groups. VAS was significantly difference in two groups for each of 3 visiting times (p=0.0001). Also the need for petidine was significantly more in control group than case group (p=0.0001). Administration of gabapantin can reduce postoperative pain and improve sedation after surgery. Gabapantin as a premedication can also reduce need for opioids prescription.

Knowledge effect on attitude provides behavior’s change. Education is effective while leads to select the best and most safe type of delivery by change of attitudes. This study was performed to compare effectiveness of two teaching methods, role playing and lecture on primigravida women’s knowledge, attitude and performance according to type of delivery.

In this single blind clinical trial study, 67 primigravida women in 34-36 weeks, with normal pregnancy and without indication of cesarean who referred to Mashhad Health Care Center in year 2010, divided randomly into role-playing and lecture educational groups. Pretest and posttest performed by using a questionnaire (valid, made by researcher and reliable with the factor analysis) in both groups. Training in role-playing group was employed by three scenarios in seven stages. Data were analyzed by different proportions, T-paired, independent T & chi-square methods and SPSS software version 14.

Percentage of changes in knowledge scores was significant in two groups (P=0.001). Participants’ attitude was significant before and after intervention in both groups (P<0.05). Mean difference of pre-test and post-test of knowledge and attitude scores was not significant in two groups (P>0.05). There was no significant difference in performance between two groups, but elective cesarean in role playing was one-fifth of the lecture group.

Lecture was more effective in raising knowledge level and reducing elective caesarean section.

Overweight and obesity are becoming problems in the world. The study was performed with the purpose of evaluating the prevalence of oligomenorrhea and its relation with obesity in girls with age 15 - 20 years old in Jahrom. In this cross- sectional and analytical study, 618 students were considered randomly among all of high school girls during 2004-2005. The questionnaires with content of medical history and menstrual pattern were completed after explanation about it to them. Height and weight of everybody were checked and the ratio of wrist to hip circumference was recorded in each questionnaires. Data was analyzed using SPSS software version 10. The mean age was 17.1. In obese and overweight subjects, no significant difference was observed regarding menarche and its duration with other groups. The prevalence of obesity was 1.3% and prevalence of oligomenorrhea in obese subjects was 21.6%. In obese group 84% have androgenic type of obesity. Obesity is significantly associated with oligomenorrhea.

Since duration of labor is an effective factor on outcome of pregnancy, the study was conducted to evaluate the effect of oral propranolol and oxytocin with oxytocin alone on duration of labor and type of delivery in nulliparous women with prolonged pregnancy. A double blind randomized controlled trial was performed on 146 nulliparous women with gestational age 40-42 weeks, cephalic presentation, bishop score ≥5, normal body mass index, intact of membrane, estimated fetal weight ≤4kg who referred to Khomeyni hospital of Ilam in 2009. Participants were classified into two groups, case group (propranolol and oxytocin) and control group (oxytocin alone).Before induction, the case group received 20 mg propranolol and control group received placebo with similar capsules orally TDS. Then induction was started initially with 2 mIU/min oxytocin in both groups and increased until obtain well contractions (3 contractions per 10 min) or 30 mIU/min. Data analyzes using SPSS software version 16, t-test and x2 test. p<0.05 was considered significant. All participants were matched for factors affecting duration of labor. Mean± SD duration of active phase and second stages of labor in first and second days after induction was significantly shorter in case group than control group. Cesarean rate had significantly decreased in the control group but no significant difference of third stage and Apgar was found between both groups (p=0.987). Propranolol decreases the labor duration and the number of cesarean delivery.

The improvement of knowledge in the field of molecular genetics and diagnostics of breast cancer can help us better to understand the biological process that leads a normal breast cell to be transformed into a malignant one with invasive and metastatic confidants. The aim of this study was to introduce the Relative Quantitative Real-time PCR technique based on sybr green dye for relative quantification of progesterone receptor A (PR-A) gene expression in normal and malignant neoplasia in human breast tissue. 20 malignant samples (Grad 2) and 10 normal samples of human breast tissue were collected before treatment and without contamination. After RNA extraction and cDNA synthesis, PR-A and GAPDH genes for measurement of relative quantification were amplified by Real-time PCR according to the standard method. The obtained Ct value were analyzed by SDS version 1.4 software, GLM program and T-test student procedure were performed in SAS version 9.1 software to determine statistical significance. PR-A gene can be expressed as in both normal and malignant breast tissue but expression of PR-A gene in malignant breast tissue was over expressed than normal cases (p≤0/05). The statistical significance difference test for comparing of PR-A gene expression in malignant breast tissue to the mean of normal samples showed an increased in 70 percent of samples. Also there was no significant correlation between over expression of PR-A gene and marital status and menopause (p ≤0.05). Furthermore, results indicated a linear correlation was between expression of PR-A gene and the age of cancer patients (p ≤0.05). PR-A gene can be used as a biomarker for prognosis, screening and diagnosis of malignant patients against normal persons at the beginning stages of breast cancer.

Some previous studies have indicated that mode of delivery especially cesarean section might be as a risk factor for post partum depression. This study aimed to determine the relationship between cesarean section and post partum depression. This cohort study was conducted on 310 women referring for delivery to Rasool Akram hospital of Rasht in 2010. Post partum depression was determined in cesarean group (156 cases) and vaginal delivery group (154 cases) using Edinburg standard questionnaire. The women diagnosed with depressive mode in third trimester based on Edinburg score more than 12 were excluded. The questionnaires were completed again, 6 weeks after delivery. Other information were also completed and analyzed in two groups by using SPSS software version 16. The frequency of post partum depression was 5.2% in vaginal delivery and 7.7% in cesarean group and difference was not statistically significant (p=0.37). After controlling age, history of PMS and abortion, the odds ratio of post partum depression was 2.53 in cesarean group compared to vaginal delivery group using logistic regression test (95% CI=0.93-6.88, p=0.07). Only history of PMS was significantly related to post partum depression (OR=4.36, 95% CI: 1.48-12.83, p=0.008). This study revealed that cesarean section is not significantly related with post partum depression.