شیوا رفعتی

One of the factors influencing in anthropometric indices of newborns is placental position. Considering the importance of the placenta in the blood supply and development of the fetus and the results obtained in this field, the present study was conducted with aim investigate the relationship between placenta placement and newborn anthropometric indices.

This prospective and observational study was conducted in 2023 on pregnant women referred to the prenatal clinic of Mustafa Khomeini Hospital. The information of pregnant mothers and newborns was recorded through interview and the information of placental location was extracted from the ultrasound report of the third trimester. Data analysis was done using SPSS statistical software (version 16) and Kruskal-Wallis and chi-square tests. P<0.05 was considered significant.

In this study, 154 pregnant women with mean age of 31.80±5.50 years and gestational age of 38.58±0.86 weeks were studied. The highest frequency of the placenta location was in the anterior part (42.59%) and the lowest in the lateral part (9.88%). No significant relationship was found between the location of the placenta and anthropometric indices and gender of the baby (P>0.05). There was a significant relationship between the placenta location and gravidity (P=0.030).

In this study, no significant relationship was found between the placenta location and the anthropometric indices of the newborn.

Patients with cancer are in conditions where they may face challenges that can undermine their human dignity. Preserving the sense of dignity in incurable cancer patients is one of the important goals of palliative care. The present study aimed to determine the sense of dignity from the perspective of cancer patients undergoing chemotherapy at Shahid Mustafa Khomeini hospital.
This descriptive study evaluated the perspective of 200 cancer patients undergoing chemotherapy at Shahid Mustafa Khomeini hospital regarding their sense of dignity using standardized Patient Dignity Inventory questionnaire. The data were analyzed using SPSS software version 19 and T-test, Pearson correlation, Chi-square and ANOVA tests were utilized.
The overall dignity score was 2.5 out of 5, with a standard deviation of 1.06. The dignity scores of the patients were 2.7±1.2 in the dimension of symptom disturbance, 2.4±0.98 in the dimension of anxiety and uncertainty, 2.4±0.95 in the dimension of loss of autonomy, and 2.9±1.5 in the dimension of loss of sense of worth. The sense of dignity did not have a significant correlation with age, marital status, having children and time of cancer diagnosis. However, it had significant correlations with gender (P = 0.006), satisfaction with income (P = 0.0001), education level (P = 0.0001), having religious beliefs (P = 0.0001) and the extent of cancer invasion (P = 0.0001).
The most significant concerns of the studied patients were anxiety, uncertainty and loss of autonomy. Identifying various sources of experienced stress in these patients can greatly assist the therapeutic and caregiving team in making appropriate decisions.

Understanding patients' rights can lead to their observance and an increase in patient satisfaction with the received healthcare services. The aim of this study was assessing the level of awareness of clinical medical students at medical universities in Tehran regarding patients' rights.

This was a cross-sectional descriptive-analytical study conducted at medical faculties in Tehran. A total of 442 medical students were randomly selected. The "Patients' Rights Charter" questionnaire, provided by the Ministry of Health of Iran, was used for data collection. Data analysis was performed using SPSS software, version 19, and independent t-test, Pearson, and ANOVA tests were employed. Significance level was P < 0.05.

14.9% of the medical students had a poor level of awareness, 70.4% had a moderate level, and 14.7% had a good level of awareness. The lowest level of awareness was observed in respecting patient privacy and maintaining patient confidentiality, while the highest level of awareness was in the right to choose and make decisions freely. There was a significant relationship between the students' gender and age and their level of awareness. However, no significant relationship was found between academic level, university of study, prior knowledge of patients' rights, and the level of awareness.

The majority of medical students in this study had a moderate level of awareness. It is recommended to enhance awareness through more precise teaching of medical ethics courses and by conducting educational workshops for students, as well as organizing seminars and courses for medical practitioners, to improve their level of awareness.

A 62-year-old man referred to the emergency department 48 hours ago with chief complaint of repeated bloody vomiting. The patient is admitted and the necessary measures are taken. Within 24 hours, he received 6 units of blood. The patient has undergone endoscopy, but endoscopic endorsement has failed to stop the bleeding. The surgeon consulted and visited the patient. He considered urgent emergency laparotomy. The patient is alert and refuses surgery. The hemodynamic status of the patient is not stable and gastrointestinal bleeding continues. These questions are posed to medical staff and hospital managers: "What is our duty”? "Should we respect the choice of the patient and witness the progress of the disease and deterioration of the patient's condition"? "Can he be discharged from the hospital on the basis of the patient's refusal to take medical treatment"? "Can we take appropriate diagnostic and therapeutic measures with the use of legal capacity and support despite patient’s opposition? "How can one regard autonomy, beneficence, and nonmaleficence at the same time, in this situation "? In this study, which is one of the problems of medical ethics, the ethical, legal, and health aspects of the presented patient are discussed.

Considering the increasing prevalence of the malignant diseases and their great effects on the different aspects of the patients’ life and even their family, the disclosure of its diagnosis and trust telling to the patients have been changed to one of the main medical ethics challenges. This study aimed for the evaluation of patient’s tendency and their family to disclosure of malignant disease. This study was a cross-sectional research. It has been done with a questionnaire on the 270 people. The sample consisted of three groups: 100 patients without cancer disease, 100 patients’ family members, and 70 patients with cancer disease, who referred to Mustafa Khomeini Hospital. The data were analyzed through SPSS-16 software in this study, 74% of the patients with cancer and 85% of patients without cancer and 50% of patients’ families had tendency to know the diagnosis of malignant disease. In the case of prognosis, 39% of cancer patients and 75% of without cancer patients, were agreed to complete knowledge, and 42% of cancer patients and 22% of without cancer patients, agreed on relative knowledge. Regarding the result of this study and respecting the individuals' rights, it seems better for the patients with malignant disease to be informed of their diagnosis and prognosis by the health care workers. Furthermore, it would be better to implement strategies for improvement of patient-physician relationship through physicians' communication skills with patients.

Blood transfusion is common in infants. Due to the weakened immune system of newborns and the risk of blood transfusion complications, it is necessary to pay more attention following or after to blood transfusion. The aim of this study was to evaluate the frequency and risk factors of blood transfusions in hospitalized neonates.
A cross-sectional study was performed on 1106 infants admitted in the neonatal intensive care unit (NICU) of Mustafa Khomeini University Hospital, Tehran, Iran, from spring 2009 to 2012. Frequency and the reason for of blood components transfusion including fresh frozen plasma, platelets, whole blood, packed red blood cells, cryoprecipitate and relationship with gestational age, sex, birth weight, Apgar score, duration of hospitalization, use of mechanical ventilation were assessed. Statistical analysis was performed with SPSS statistical software, version 16 (IBM, Armonk, NY, USA) and statistical test, chi-square test, independent t-test and analysis of variance (ANOVA).
Among 1106 infants admitted to the neonatal intensive care unit, 221 infants (%19.98) received blood products. 82 of all (37%) were female and 139 (%63) were female. 113 (51%) of neonate were preterm and 108 (48%) were term. From 361 times of blood transfusions, 121 infant (54.75%) received at least one blood product. The frequency of blood transfusion was between 39 and 1 times, with an average of 3.65 times per infant. Frequency of fresh frozen plasma infusion was 173 (47.9%), packed cell 122 (33%), platelet 32 (8.8%), cryoprecipitate 20 (5.1%) and whole blood 3 unit (0.83%). The most common causes for fresh frozen plasma transfusion was replacement therapy 140 (80%), for packed cell, to correct symptomatic anemia 68 (55.6%), for platelet transfusions was to prevent bleeding in neonates with thrombocytopenia 20 (62.5%) and cryoprecipitate for bleeding caused by DIC in 18 infant (90%). There was significant relation between frequency of blood transfusions with gestational age (P=0.002), birth weight (P=0.01), cause of hospitalization (P=0.001) using of ventilator (P=0.002), and length of hospital stay (P=0.001).
With attention to the guidelines of blood transfusions and controlling factors affecting premature birth and low weight infants, reducing length of hospital stay and duration of mechanical ventilation, frequency and complications of blood transfusion can be effectively decreased.

Empathy plays an important role in the interaction between physician and patient. This study aimed to assess the empathic attitudes of medical students that studing in Medical Sciences schools of Tehran city, in 2015.
In this cross-sectional study, 373 medical students were selected using stratified random sampling. Data was collected using the Jefferson Scale of Empathy-the Student Version. Data was analyzed using descriptive and inferential statistics via the SPSS v.16 software. The significant level was set as pEthical Considerations: Participants verbal consent was obtained and anonymously and confidentiality of the completing questionnaires was assured to them.
Findings: According to the empathy scale (20-140), the medical students had a mean empathy score of 82.94 (SD=±7.08), with the highest level for perspective-taking dimension (26.81±2.80). Empathy scores among students varied depending on gender, age, and marital status (p Empathy with patients was different among medical students in various years of education. Such, the rate of empathy with patient was reduced with increasing the students’ age and educational level. Regarding to significance of empathy as a moral virtue, it is recommended planning to strengthent empathy with patients and inclusion of it in medical students’ curriculum, in order to improve the mental and spiritual health of patients.

Surgery and pain increases cortisol levels with inducing hormonal responses. By reducing stress, adverse effects of cortisol can be controlled and accelerated the healing process. Religious practices like listening to Quran have important roles in reducing anxiety. Moreover, the level of cortisol hormone of the blood is one of the best indicators of the stress level. The aim of this study was to investigating the effect of listening to Quran on the plasma cortisol level of the umbilical cord in cesarean with spinal anesthesia.
A clinical trial study was designed and conducted on sixty primigravid mothers who were hospitalized to deliver their first baby by elective caesarian operation, 30 of them were selected as intervention group and 30 of them were selected as control group. For the subjects of the intervention group, the personal information questionnaires were completed and their vital signs were recorded. Also, their blood was sampled for measuring cortisol level. Then they listened to Quran. After spinal anesthesia, vital signs were recorded and the blood of umbilical cord was sampled for measuring the cortisol level. For the subjects of the control group, all the steps were done except listening to Quran. Two groups were statistically homogenous in the variables of age, gestational age, systolic blood pressure and diastolic blood pressure, pulse rate and cortisol levels before the intervention. The mean and SD cortisol in intervention group before and after listening to the Quran were 39.08±10.71 versus 41.10±5.05.
The reduction of cortisol level of the intervention group (who listened to Quran) was significantly greater than of the control group P=0.035. Systolic blood pressure of the intervention group in the operating ward had statistically significant reduction relation to the systolic blood pressure before operation P=0.043. However systolic blood pressure of the control group in the operating ward had not statistically significant reduction relation to the systolic blood pressure before operation P=0.357. Listening to Quran has no effect on diastolic blood pressure and pulse rate.
Listening to Quran before caesarean affects the change of plasma cortisol level and the systolic blood pressure.

Infants undergo painful procedures during care and treatment. Pain in infants can lead to various risks. So، it seems essential to find a simple، safe، and acceptable method for relieving pain. The aim of this study was to assess the effect of massage on physiological pain responses of infants during and after blood sampling. In this single blind randomized clinical trial، 136 infants hospitalized in the intensive care unit of Mostafa Khomeini hospital affiliated to the Shahed University were studied in 2014-15. Infants were chosen by convenience sampling and were assigned to randomly allocated into two groups; experimental group (massage) (n=68) and control group (n=68). The experimental group received one minutes of direct rhythmic effleurage massage to the antecubital fossa. Patients in the control group received the routine care of the study setting. In the two groups، behavioral changes of the infants was measured using the (NIPS) Neonatal Infant Pain Scale before intervention، immediately after، and 5 minutes after the removing the needle by a researcher who was blind to the group the infant was allocated to. We assessed the physiological pain responses caused by blood sampling such as heart rate، respiratory rate and oxygen saturation level. Also، their cry duration was measured from onset until a crying free interval of more than five seconds. Data were analyzed using descriptive statistics، Mann-Whitney U، Fisher''s Exact Test، Repeated measurement، T-test، and Chi-square tests in SPSS. Results showed significant difference in the mean of pain intensity in experimental group was lower than control group (P<0. 001). There was statistically significant difference in the heart rate and respiratory rate between the groups after inserting and 5 minutes after removing the needle (P<0. 05). Moreover، the infants exposed to the massage cried significantly less during the procedure compared to the control group (P<0. 001). Results showed that massage could reduce some physiological responses of pain during blood sampling. Massage can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU.

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

The present study is an attempt to study the ethical intelligence of the medical students of state universities in Tehran. A total 359 the medical students (basic science, physio pathology, stagiaire and intern) from Tehran, Shahid Beheshti, Baghiatolah, Shahed were randomly selected. The present research is a descriptive survey was done in 91-92. The required data was collected with the help of MCI questionnaire to examine 10 factors and 40 variables. Data analysis was done by SPSS-16 version. In this study using descriptive tests and correlation test to analyze the data. The findings of the study indicate that moral competencies such as consistently with principles, values and beliefs, telling the truth, standing up for what is right, keeping promises, taking responsibility for personal choices, admitting mistakes and failures, embracing responsibility for serving others, actively caring about others, ability to forgive one’s own mistakes and ability to forgive others’ mistakes were below average. Results showed that there is significant difference between moral intelligence factors. Furthermore, the results of correlation test demonstrate a significant positive relationship between age and level of education with ethical intelligence. Moral intelligence is an acquired ability that can be promoted. Medical sciences’ educators can be helpful in the promotion of moral intelligence through ongoing training in the classroom and practice and encouragement of ethical behaviors. There is a need to develop education of moral intelligence.