Iranian Red Crescent Medical Journal Iranian Red Crescent Medical Journal http://www.irmj.ir 48 journal48 en jalali 1387 4 1 gregorian 2008 7 1 10 3 online 1 fulltext

en General Medicine General Medicine Review Article Review Article Stress urinary incontinence (SUI) is the most common form of urinary incontinence in women and is associated with high financial, social, and emotional costs. The history and physical examination can identify most patients with a significant stress incontinence component without the need for urodynamic testing. A variety of pharmacologic agents have been used off-label, but an evidence-based pharmacologic treatment has not been readily available. The development of a selective serotonin and norepinephrine reuptake inhibitor will add a potentially useful drug to the primary care physician's practice for treating female patients with SUI. In August 2004, a selective serotonin and norepinephrine reuptake inhibitor, duloxetine, became the first medication approved for the treatment of women with moderate to severe SUI throughout the European Union. As of November 2005, however, duloxetine has not been approved for the treatment of SUI in the United States. Stress; Urinary incontinence; Women; Diagnosis; Treatment 152 158 http://www.irmj.ir/browse.php?a_code=A-10-18-24&slc_lang=en&sid=en M Deutchman mark.deutchman@uchsc.edu 480031947532846001732 Yes University of Colorado Health Sciences Center, Fitzsimons, Aurora, USA. M Wulster-Radcliffe 480031947532846001733 No

en General Medicine General Medicine Review Article Review Article National Cancer Registry of the Slovak Republic, National Health Information Centre, would like to respond to many requests for easy and comprehensible access to the national and international data on cancer epidemiology. The working group created a new analytic web-page called "National portal on cancer epidemiology". All the data are valid, adapted for publications and quotation and the access to the web-page www.nor-sk.org is free for the wide professional public.http://irmj.ir/admin_review_set.php?slc_lang=fa&sid=1 تنظيمات بخش داورى Cancer, Epidemiology; Information system 159 162 http://www.irmj.ir/browse.php?a_code=A-10-18-25&slc_lang=en&sid=en M Ondrusova martina.ondrusova@nczisk.sk, http://www.nor-sk.org 480031947532846001734 Yes National Health Information Centre, Lazaretska 26, 811 09 Bratislava, Slovak Republic. D Ondrus 480031947532846001735 No L Dusek 480031947532846001736 No J Muzik 480031947532846001737 No

en General Medicine General Medicine Original Article Original Article nonseminomatous germ cell tumors of the testis (CS I NSGCTT). Efforts to identify patients at high risk of relapse has led to a search for prognostic factors of CS I NSGCTT. The aim of this study was to analyse long-term experiences with different therapeutic approaches in CS I NSGCTT patients according to relapse risk factors. Methods: From 2/1992 to 5/2008, a total of 352 CS I NSGCTT patients were included in the study and stratified into different risk-adapted therapeutic approaches (groups 1-3). 114 patients (group 1) with vascular invasion and majority of embryonal carcinoma component in the primary tumor were treated with 2 cycles of BEP chemotherapy. Results: Relapse was experienced in 2 patients (1.75 %). Among 12 patients (group 2) with vascular invasion and majority of teratomatous elements in the primary tumor undergoing primary retroperitoneal lymph node dissection (RPLND), 10 were found to be in pathological stage I. Relapse was observed in two patients (16.7 %), one of whom died 29 months following orchiectomy. Two patients (18.2 %) with pathological stage II received adjuvant chemotherapy and finally died. 226 patients (group 3) without vascular invasion were followed after orchiectomy. Relapse was observed in 41 patients (18.1 %). They were treated with BEP chemotherapy, of whom three died. The overall survival rate of all the patients in group B1-3 was 98.3 %. Conclusions: Surveillance procedure is recommend only in patients without vascular invasion in the primary tumor. Testicular cancer; Surveillance; Chemotherapy; Retroperitoneal space, Lymph node; 163 168 http://www.irmj.ir/browse.php?a_code=A-10-18-26&slc_lang=en&sid=en D Ondrus dondrus@ousa.sk 480031947532846001738 Yes Comenius University Medical School, St. Elisabeth Cancer Institute, Heydukova 10, 812 50 Bratislava, Slovak Republic M Ondrusova 480031947532846001739 No

en General Medicine General Medicine Original Article Original Article Background: The notorious complications of measles and the contribution of maternal rubella to congenital malformation of the fetus (congenital rubella syndrome) resulted in inclusion of vaccination against measles and rubella in national preventive programs. The aim of the present study is to evaluate the coverage of mass vaccination of Measles and Rubella (MR) and to determine the prevalence of complications of these vaccines in the target population of Guilan Province, Iran. Methods: This is a population based epidemiologic cross-sectional study. After completion of a nationwide mass vaccination of MR for the age group of 5-25 years in 2003, in private and governmental medical and health centers of Guilan Province, demographic and epidemiologic information about the vaccination coverage and complications were extracted from the data banks. Statistical analysis was performed using software EPI 2002. P value< 0.05 was considered significant. Results: The target population considered for MR mass vaccination was estimated approximately 1,034,975 persons. 99.04% (1024998) of them were vaccinated from Dec. 2003 to Jan. 2004. Complications appeared in 765 cases (7 per 10000). 96% of the complications were of common types such as fever and headache, requiring no treatment. Gender difference in MR vaccine complications was significant as 5.6 per 10000 in males in comparison to 9.26 per 10000 in females. Similarly, the prevalence of complications was highest in the age group 10 to 14 years and least in the age group 20 to 25 years. Conclusion: Mass vaccination for Measles and Rubella, aiming at eradicating these diseases, was highly successful in terms of wide coverage, positive feedback from the public and low complication rate in this region. Measles; Rubella; Complications; Iran 175 169 http://www.irmj.ir/browse.php?a_code=A-10-18-28&amp;slc_lang=en&amp;sid=en F Mansour-Ghanaei ghanaei@gums.ac.ir 480031947532846001740 Yes Razi Hospital, Sardar-Jangle Ave, Guilan University of Medical Sciences, Rasht, Iran. H Rahimi 480031947532846001741 No H Joukar 480031947532846001742 No AH Bagherzadeh 480031947532846001743 No A Heidarzadeh 480031947532846001744 No A Rahbar 480031947532846001745 No H Rokhshad 480031947532846001746 No SM Rezvani 480031947532846001747 No H Balou 480031947532846001748 No A Sarshad 480031947532846001749 No

en General Medicine General Medicine Original Article Original Article Background: Post-transplant diabetes mellitus (PTDM) contributes to the risk for cardiovascular diseases and infection, reducing graft and patient survival. This study was conducted to identify the incidence and risk factors for development of PTDM. Methods: We studied 50 non-diabetic adult dialyzed patients awaiting renal transplantation prospectively. Oral glucose tolerance test (oGTT) was performed pre- and post-transplantation. The relationship between age, weight (BMI), dialysis modality, family history of diabetes, and duration of dialysis and PTDM was assessed. Results: Based on oGTT1, 13 patients had unknown diabetes mellitus; however, after transplantation only 9 had similar results. Based on oGTT2, 6 (16.22%) patients had actually PTDM. The age of patients with PTDM was significantly higher than that of those with normal test (43±17 vs 31±11 years old). There was a significant relationship between duration of dialysis with PTDM, as normal oGTT was seen in 85.2% of patients dialyzed for less than 1 year. There was no significant relationship among dialysis modality and family history of diabetes and BMI with PTDM. Conclusion: Risk factors for diabetes in our study were age and duration of dialysis before transplantation. Therefore, identifying them might allow modification of post- transplant immunosuppressant with non-dibetogenic agents in high risk patients. Diabetes mellitus; Oral glucose tolerance test; Kidney 176 180 http://www.irmj.ir/browse.php?a_code=A-10-18-29&amp;slc_lang=en&amp;sid=en MJ Mojahedi hamim@mums.ac.ir 480031947532846001750 Yes Mashad University of Medical SciencesMashad, Iran. P Layegh 480031947532846001751 No M Hami 480031947532846001752 No F Khosravi 480031947532846001753 No

en General Medicine General Medicine Original Article Original Article Background: Dispatching field hospitals meeting the needs of the sufferers is the ideal response to disasters such as earthquakes. The aim of this study is determining the settings of such a field hospital. Methods: A twelve-member expert panel selected used the RAND Appropriateness Methodology to rate scenarios derived from best current evidence, and additional comments resulted from Nominal Group and Modified- Delphi Techniques. A 9-point rating scale was used that permits the categorization of the items as appropriate, uncertain, or inappropriate. A descriptive analysis was undertaken of the final results of the panel meeting. Results: Of extracted evidence categorised as items in six chapters, 72.90% was considered appropriate, 15.89% uncertain and 11.21% inappropriate. In the first round, agreement was found for 87.06% of the 85 items. Following discussion on divergent ratings, much higher agreement was achieved, reaching 93.46% of the 107 final items. Conclusion: Using RAND/UCLA Appropriateness Method, on the basis of the best current evidence, an expert panel assessed the items of Principal Tasks of Field Hospital, Staffing pattern and equipment as sufficient and appropriate in a multidisciplinary field hospital, developing updated and clear recommendations for rapid access to the setting of the field hospital in earthquakes. Hospital; Earthquake; RAND/UCLA Appropriateness Method; Trauma 181 189 http://www.irmj.ir/browse.php?a_code=A-10-18-30&amp;slc_lang=en&amp;sid=en A Loghmani a_loghmani@yahoo.co.uk 480031947532846001754 Yes Isfahan University of Medical Sciences, N Jafari 480031947532846001755 No M Memarzadeh 480031947532846001756 No

en General Medicine General Medicine Original Article Original Article Background: Osteoporosis a serious and debilitating disease resulting in an increased risk of fracture, causing significant morbidity and mortality. This study was performed to determine the risk of osteoporosis in postmenopausal women in Shiraz, southern Iran. Methods: This is a descriptive cross-sectional study of 405 menopausal women over 55 who referred to health centers from June to October, 2005. The health centers had been chosen by random cluster sampling from different geographic areas of Shiraz. For gathering data, a modified questionnaire, based on postmenopausal osteoporosis evaluation form of NAMS (North American Menopausal Society) as well as an interview and examination were used. Results: The mean age of menopause was 49 years. Disease and medication intake which are considered as osteoporosis risk factors existed in 12.6% of the subjects. 8.4% of the subjects had positive family history, and lifestyle accounted for 78% of the high risk. The minimum and maximum lifestyle risk factors were inactivity and lack of exercise (33.3%) and no exposure to sunlight (5.9%), respectively. 15.3% of the subjects were smokers. From 75 individuals who had done BMD test, 58 had osteoporosis and 17 had no evidence of osteoporosis. Regarding risk factors, there was no significant difference between osteoporosis and nonosteoporotic individuals. Conclusion: In general, lifestyle is the most common risk factor in our sample. Lack of physical activity and smoking as life style risk factors are the most common causes of osteoporosis in menopausal women. Menopause; Osteoporosis; Risk factor; Iran 190 193 http://www.irmj.ir/browse.php?a_code=A-10-18-31&amp;slc_lang=en&amp;sid=en Shokrollahi shokrp@sums.ac.ir 480031947532846001757 Yes Rivaz 480031947532846001758 No Robatjaze 480031947532846001759 No

en General Medicine General Medicine Original Article Original Article required in selected cases. Maintenance of the airway during obstetric anesthesia is difficult to achieve, and still remains the single most important cause of anesthetic related maternal morbidity and mortality. The purpose of this study was to determine the capability of the following preoperative airway predictive tests, in isolation and combination, to predict difficult visualization of larynx (DVL) in obstetric patients: upper lip bite test (ULBT), modified Mallampati test (MMT), sterno-mental distance (SMD), thyro-mental distance (TMD), horizontal length of the mandible (HLM), and inter incisor gap (IIG). Methods: 203 consecutive obstetric patients with ASA grade 1 and 2 undergoing general anesthesia for cesarean delivery were evaluated preoperatively using the ULBT, MMT, SMD, TMD, HLM, and IIG tests. The cut-off points for the airway predictors were ULBT III, Mallampati III and IV, ≤ 13.5 cm, ≤ 6.5 cm, ≤ 9 cm and ≤ 4cm, respectively. During direct laryngoscopy by a blinded expert anesthesiologist, the laryngeal view was graded, using the Cormack and Lehane classification. Laryngoscopic grades III and IV were considered difficult laryngoscopy. The sensitivity, specificity and positive predictive value for each test in isolation and in combination were determined. Results: The difficulty to visualize the larynx was found in 37 (18.2%) parturients. The sensitivity, specifity and positive predictive value for these tests were: ULBT (94.6%, 97.6%, 89.7%), MMT (29.7%, 74.7%, 20.8%), SMD (13.5%, 86.7%, 18.5%), TMD (10%, 99.4%, 10%), HLM (62.2%, 43.4%, 19.7%), and IIG (0%, 98.8%, 0%). Conclusion: The best single predictor was ULBT and the best combination of the tests was ULBT and MMT. Data analysis showed that demographic data, MMT and IIG were independent predictors of DVL. Thus, the ULBT is a useful predictor of difficult intubation in obstetric patients and also the combination of ULBT and MMT is a valuable airway predictor in parturients. Methods; Intubation; Obstetrics; Patients 194 201 http://www.irmj.ir/browse.php?a_code=A-10-18-32&amp;slc_lang=en&amp;sid=en E Allahyary 480031947532846001760 No S.R Ghaemei ghaemir@sums.ac.ir 480031947532846001761 Yes S Azemati 480031947532846001762 No

en General Medicine General Medicine Original Article Original Article Background: Over 50% of patients with AML still relapse after autologous stem cell transplantation. We investigated the efficacy and feasibility of a new conditioning regimen consisting of a moderate dose of Idarubicine plus conventional dose of oral Busulfan in patients undergoing autologous transplantation without favorable cytogenitic state and high dose therapy with Cytarabine or other drugs. Methods: Ten Patients were given three days of bolus infusion of IDA followed by four days of oral Busulfan as conditioning regimen. Unpurged peripheral blood stem cells were used in all cases. All the cases were in first complete remission (CR1). The reasons for the selection of these patients in the first remission were that they had not received high dose chemotherapy or did not have available cytogenitic state. Results: The transplant related mortality occurred in one case (refactory thrombocytopenia, leading to CNS hemorrhage). The median CD34+ cell infused was 8Ï106/kg. The median days to neutrophil recovery > (0.5 Ï 10 9) and platelet recovery > (20 Ï10 9/kg) were +9 days (4-12 days); +16 (2-30 days) respectively. The patients needed transfusion of a median of 15 platelet units and 7 blood units, respectively. Six out of 10 patients (60%) had variable grades of mucositis (three cases had grade III, two grade II and one case grade I). After a median follow up of 48 months from ASCT, 8 patients out of 10 (80%) were alive in continuous complete remission. One case had relapse after 6 months of transplantation. Conclusion: The findings of the study demonstrated the efficacy and feasibility of a conditioning regimen based on a moderate dose of IDA plus Busulphan in AML. The results concerning anti-leukemic efficacy are promising but need to be confirmed on larger series. Acute myeloid leukemia; Stem cell transplantation; Idarubicin; Busulphan 202 207 http://www.irmj.ir/browse.php?a_code=A-10-18-33&amp;slc_lang=en&amp;sid=en MA Mashhadi dralimashhadi@yahoo.com 480031947532846001763 Yes M Ramzi 480031947532846001764 No K Alimoghaddam 480031947532846001765 No

en General Medicine General Medicine Original Article Original Article Background: A remarkable increase has been observed in hospital expenditure in many countries during recent years, drawing especial attention to the problem. This study was conducted to present one of the operational research techniques pattern in evaluation of the hospital efficiency. Methods: The ratio analysis method was used to evaluate the hospital efficiency. This method is not effective in cases in which the relationship between an input and several outputs or several inputs and several outputs are involved.Data Envelopment Analysis Pattern (DEA) is one of the operational research techniques, lacking the problems of ratio method while efficiency evaluation can determine the critical parts of hospital, reducing the efficiency of the whole hospital and meanwhile compensating the deficiency in a particular measurement. In order to introduce this method in hospital efficacy evaluation, 18 general hospitals affiliated to Iran Social Security Organization were included. Results: This study revealed that Data Envelopment Analysis Pattern had more capacity than previous methods in relation to evaluation of the complicated organizations like hospitals. Conclusion: Operational research techniques in efficiency evaluation would provide the possibility to compare different efficiencies among various hospitals and present the necessary solutions to compensate the insufficiency and to correct them for the managers.This technique was used for the first time in this study to measure hospital efficiency in Iran Hospital, Efficiency; Data envelopment analysis; Ratio analysis 208 214 http://www.irmj.ir/browse.php?a_code=A-10-18-34&amp;slc_lang=en&amp;sid=en N Hatam hatamn@sums.ac.ir 480031947532846001766 Yes

en General Medicine General Medicine Original Article Original Article Background: Shoulder pain is a common complication of hemiplegia, and many risk factors may predispose a stroke patient to shoulder pain. The aim of this study was to find out the factors that can predict the hemiplegic shoulder pain (HSP) after stroke. We used explorative design methods based on Logistic Regression. Methods: The sample of this study consisted of 152 patients (77 female and 75 male) with diagnosis of acute cerebrovascular accident (CVA) referred to the Department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences during a period of 3 years. Several variables were considered through patients’ personal medical history, physical examination, laboratory data, questionnaire, psychological tests and interview. Results: 32% of the patients had an experience of HSP after stroke. The critical time for the occurrence of HSP was between 2 and 6 months after the onset of CVA. Logistic Regression showed that the best predictors for HSP were “Activity of daily living ability”, “Increased light touch threshold” and “Increased vibration threshold”. Conclusion: Patients with serious sensory and motor disability have more chance for HSP symptoms after stroke, so each stroke treatment method should include a plan for prevention of HSP. Stroke; Hemiplegia; Shoulder pain 215 219 http://www.irmj.ir/browse.php?a_code=A-10-18-35&amp;slc_lang=en&amp;sid=en H Hadianfard hadianj@sums.ac.ir 480031947532846001767 Yes MJ Hadianfard 480031947532846001768 No

en General Medicine General Medicine Original Article Original Article Background: Improper inflation of endotracheal tube cuff is associated with various complications. Recently, there has been high referral of patients with post-intubation complications to the clinics affiliated to Shiraz University of Medical Sciences. Herein, we examined the practice of cuff pressure monitoring at 9 adult intensive care units in 3 university-affiliated hospitals. Methods: The present study was performed on 57 tracheally intubated patients, whose cuff pressures were measured using either a cuff pressure gauge on 12 patients (Group 1) or manual palpation of the pilot balloon on 45 cases (Group 2) during summer 2004. The intracuff pressure (P1), intracuff volume (V1), and pressure exerted by the cuff against the tracheal mucosa (ΔP) were determined., analyzed and compared with the recommended values. Results: The P1 in Group 1 was 35.3 ±32.8 SD cmH2O, with 33.3% of the patients having values below 20 cmH2O. In group two, P1 was 88.8±27.1 cmH2O, all of which being above 40 cmH2O. The ΔP for the Groups 1 and 2 were 16.3 ±11.1SD cm H2O and 35.5 ±15.6 cm H2O, respectively. Conclusion: Our findings indicated that manual palpation of balloon cuff to monitor cuff pressure was not an accurate procedure. They also suggested that measures to increase the knowledge and skills of ICU staff and posting of cuff pressure monitoring protocols might help improve the practice. Intensive care unit; Endotracheal intubation; Monitor; Pressure 220 224 http://www.irmj.ir/browse.php?a_code=A-10-18-36&amp;slc_lang=en&amp;sid=en F Zand nekooeiana@sums.ac.ir 480031947532846001769 Yes AA Nekooeian 480031947532846001770 No M Rohani 480031947532846001771 No

en General Medicine General Medicine Short Communication Short Communication Background: Subarachnoid hemorrhage (SAH) due to cerebral vessels aneurysm is a fatal disease with high mortality. Regarding the high mortality of the disease, this study was performed to evaluate the etiology, epidemiology, clinical manifestation, aneurysm and the diagnosis of the disease. Methods: 132 patients with SAH who were admitted in Neurosurgery Department of Nemazee and Beheshti hospitals affiliated to Shiraz University of Medical Sciences in Shiraz during September 2002 to March 2006 were evaluated for the mentioned factors. Results: Sixty-eight patients (51%) suffered from cerebral aneurysm among whom anterior common artery (33.8%) and middle common artery (23.5%) were more involved with aneurysm. Finally, 58.3% of the patients were completely treated, 19.6% were discharged with complications in spite of various treatment efforts and 21.9% expired. Conclusion: Regarding the high mortality of SAH due to aneurysm of cerebral vessels and considering various treatments measures, one third of patients still would experience the hemorrhage again. Therefore, attention to early diagnosis of the disease seems necessary. Background: Subarachnoid hemorrhage (SAH) due to cerebral vessels aneurysm is a fatal disease with high 225 229 http://www.irmj.ir/browse.php?a_code=A-10-18-37&amp;slc_lang=en&amp;sid=en SM Rakei foruzna@yahoo.com 480031947532846001808 Yes EA Alibai 480031947532846001809 No M Taghipour 480031947532846001810 No AR Rahmanian 480031947532846001811 No

en General Medicine General Medicine Short Communication Short Communication Background: Clinical presentation, diagnosis and treatment, and outcome of pulmonary Fungus ball have been known to depend on the underlying lung disease. We described clinical findings, diagnosis and results of surgical treatment of Fungus ball. Methods: From 1992 to 2005, we operated 31 patients with aspergilloma. Among them, 18 were male with a median age of 52 (30 to 70 years). 11 were afflicted with simple aspergiolloma and the rest with complex aspergiolloma. Results: Hemoptysis and cough were the most complaints. Diagnostic tools were CXR and CT scan. Tuberculosis and Bronchectasis were the most common underlying lung diseases. 39 procedures were performed in the patients. The most common surgical procedures were Lobectomy, wedgresection and closed tube cavernostomy with amphotericin installation in the cavity. The most common postoperative complications in the complex type were bronchopleural fistula, empyema and persistent space. Intraoperative mortality occurred in two cases because of bleeding during one to four year follow-up. Eight patients died because of sepsis and respiratory failure. Conclusions: Because of the underlying lung disease, postoperative complications and mortality rate were high especially in complex aspergiolloma. However, surgery is the approach of choice in these patients. In high-risk patients, tube cavernostomy could be helpful. Aspergilloma; Fungi; Tube cavenostomy; Lobotomy 230 234 http://www.irmj.ir/browse.php?a_code=A-10-18-38&amp;slc_lang=en&amp;sid=en M Aghajanzadeh 480031947532846001812 Yes F Safarpoor 480031947532846001813 No H Amani 480031947532846001814 No A Alavy 480031947532846001815 No A Sarshad 480031947532846001816 No

en General Medicine General Medicine Case Report Case Report Hand surgery is a distinguished sub-specialty of trauma and orthopedic management. Sprains and dislocations of the interphalangeal joint of the finger are relatively rare due to the protected position of this joint in the hand. However, unusual cases of a simultaneous Proximal and Distal Interphalangeal Joint Dislocation have been reported. We report this rare case of simultaneous dislocation of both interphalangeal joints of the little finger from Northern Iran. We observed that the mechanism, diagnosis and treatment of our case were similar to the published reports of the world literature. The patient had closed reduction of distal interphalangeal joint with excellent postoperative recovery. The importance of careful assessment of hand injuries with stress test of the joints under local anesthesia is reiterated. In conclusion, we recommend that this injury of rare occurrence be treated conservatively by manipulation, and if a good functional result is desired, adequate physiotherapy treatment is also required. Dislocation; Finger; Trauma; Surgery 235 237 http://www.irmj.ir/browse.php?a_code=A-10-18-40&amp;slc_lang=en&amp;sid=en A Karimi 480031947532846001817 Yes Department PoorSina Surgical AA Ranjbar 480031947532846001818 No M Hussein-Akbar 480031947532846001819 No

en General Medicine General Medicine Case Report Case Report Hydatid disease is the most common helminthic disease in human beings; however, spinal hydatid cyst accounts for 1% of all cases. We report a case of spinal hydatid disease that relapsed after surgery in a patient treated with Albendazol for 6 months, and also a combination therapy with albendazole and praziquantel without further surgical intervention. Vertebra; Hydatidosis; Albendazole; Disease 238 240 http://www.irmj.ir/browse.php?a_code=A-10-18-41&amp;slc_lang=en&amp;sid=en AA Mohammadi mohammadia@sums.ac.ir 480031947532846001820 Yes Faghihi Hospital, Shiraz University of Medical Sciences, B Sabet 480031947532846001821 No M Amini 480031947532846001822 No MK Mohammadi 480031947532846001823 No

en General Medicine General Medicine Letter to Editor Letter to Editor Stillbirth rate still continues to be high in the world. Some studies have reported stillbirth rate to be between 10.4 and 46.4 per 1000 birth.1 The aim of this case control study was to investigate the incidence of stillbirth and the risk factors at Babol hospitals, Northern Iran. A total of 4219 live births and 86 stillbirths were reported in the 7 month period. The rate of stillbirth was 19.9 per 1000 births (86/4305). This rate in a similar study in Kenya2 and India1 was 30.5 and 26.8 per 1000 births, respectively. As shown in Table 1, demographic characteristics were different in the case and control groups. High maternal age (>35 years) was more in mothers with stillbirth than that in those with live birth. Similar to our results, a study in Sweden showed an increased risk for late fetal death in pregnant and employed women ≥40 years.3 Gold and Tomich reported that job stressors such as work shifts and standing for long hours associated with increased risk of stillbirth and preterm birth.4 In our study, illiteracy in stillbirth mothers was nearly twice as compared to those with live birth. In China stillbirth rate was more in the no booked women too.5 Kumar and Singhi reported a higher rate in poor socio-economically levels.1 Inability to pay for health care can be a strong predictor of fetal death, underestimating the need to maternity care for low income women.6 A higher percentage of our stillbirth mothers were in highgravida (>3) than the groups with live birth. A study in Maputo revealed the same result.7 We showed a significant relationships between stillbirth and gestational age. More stillborn infants were premature (<37) and/or immature (<28). Low Birth Weights (<2500 gr) and also Very Low Birth Weights (<1500 gr) were significantly higher in cases than controls. Others showed that perinatal mortality reduced with an increase in the weight of fetus and gestation period.6,8 In India a history of previous stillbirth significantly increased the risk of stillbirth.1 Kumara and Singhi reported an increased risk among those who did not receive even a single antenatal care visit. Therefore, antenatal care that reduce the risk of stillbirths need to be identified.1 It was shown that those who received tetanus toxoid received a higher number of antenatal care1 which is identical to our results. We noticed an association between the risk of stillbirth and intake of iron tablets. Other studies demonstrated the same results.1,5,6 Most of our stillborn fetuses were boys as opposed to the control group which were mostly girls. Bekedam showed a significantly increased risk in women carrying male fetuses.9 It is concluded that a significant number of stillbirths are preventable with an accurate prenatal care. Identification of high risk pregnancies allows appropriate fetal evaluation that can reduce intrauterine stillbirth rates. 241 242 http://www.irmj.ir/browse.php?a_code=A-10-18-39&amp;slc_lang=en&amp;sid=en H Pasha 480031947532846001824 Yes M Faramarzi 480031947532846001825 No A Bakhtiari 480031947532846001826 No K Hajian 480031947532846001827 No