Original Research Article
Anesthesia
Shahram Sayadi; Shideh Ariana; Maral Hosseinzadeh; Arezou Ashari; Tannaz Yeganegi; Elham Memari; Ebtehaj Heshmatkhah; Dariush Abtahi
Volume 8, Issue 3 , May and June 2023, Pages 1-1
Abstract
Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality, which can occur unexpectedly without warning, and without any underlying causes. We hypothesized that administering fibrinogen concentrate to cesarean section patients before surgery would ...
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Background & Objective: Postpartum hemorrhage is the most common cause of maternal morbidity and mortality, which can occur unexpectedly without warning, and without any underlying causes. We hypothesized that administering fibrinogen concentrate to cesarean section patients before surgery would reduce perioperative blood loss.Materials & Methods: In this double-blind randomized controlled parallel group study, a single dosage of fibrinogen concentrate or a placebo was given to 260 cesarean section patients at random (by G*Power software, Heinrich-Heine-Universität Düsseldorf, Germany) in a university-affiliated general hospital between November 11, 2022, to January 8, 2023. Individuals in the fibrinogen group received a dose of one gram of fibrinogen concentrate and those in the placebo group received normal saline solution with the same volume in the placebo group. Total blood loss was the primary outcome of this study.Results: A total of 280 cases were screened and 260 were randomized. With a P-value of 0.001, the median (IQR) volume of bleeding in the fibrinogen group was 660 (341.25) mL, as opposed to 790 (475.00) mL in the placebo group. Comparatively, only 10 (7.7%) of the fibrinogen group and 26 (20%) of the placebo group required blood transfusions (P=0.006). No adverse event related to fibrinogen was reported. Conclusion: Empiric treatment with fibrinogen concentrate results in reduced blood loss.
Original Research Article
Maliheh Arab; Nafiseh poorzad; Giti Noghabaei; Ghazaleh Fazli; Behnaz Ghavami; Tayebeh jahed Bozorgan
Volume 8, Issue 3 , May and June 2023, Pages 2-2
Abstract
Cancer survivorship care tries to discover improved healthy lifestyles for cancer patients, rather than just managing the complications; thus, it seems necessary to identify the aspects associated with general well-being in order to design proper care, and confront difficulties that cancer survivors ...
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Cancer survivorship care tries to discover improved healthy lifestyles for cancer patients, rather than just managing the complications; thus, it seems necessary to identify the aspects associated with general well-being in order to design proper care, and confront difficulties that cancer survivors encounter such as anxiety, depression, cognitive dysfunction, weakness and fatigue, pain, sexual dysfunction, and sleep disorders (1-4). Cancer survivorship assessment from the National Comprehensive Cancer Network clinical practice guidelines in oncology (NCCN guidelines. survivorship, version 2.2020) is one of the most common and valid tools for measuring the quality of life in cancer survivors (3-6).Gynecological cancer survivors have been growing, as a result of advancements in national cancer screening strategies, resulting in early-stage diagnosis, and cancer treatments developments; thus, general mortality to incidence ratios have been declined from 2000 to 2015, in Iran. However, lack of a valid documented assessment tool to measure their requirements for supportive care is detected (7). It seems indispensable to provide a translated adapted version of NCCN survivorship questionnaire, to offer the Iranian cancer care providers have the prospect in comparison and approaches in a transcultural framework. The present study proposed to represent a renovated double back translation to revise and culturally adapt the original English version of cancer survivors’ assessment questionnaire into the Persian version in order to achieve a reliable tool that meets the clinical research needs of Iranian researchers at the desired level. The aim was to develop a comprehensive scale that comprises all features of gynecologic cancer survivors` requirements in Iranian population, equivalent to NCCN guideline hypothetical concept.
Original Research Article
Fariba Almassinokiani; Mahzad Alimian; Parinaz Hamednasimi
Volume 8, Issue 3 , May and June 2023, Pages 3-3
Abstract
Background: Hysterectomy is the most common gynecological surgery. Every year, a large number of women around the world undergo this type of surgery for various reasons. Regardless of the type of surgery, bleeding during surgery and after surgery is the most common. Tranexamic acid is a cheap, available ...
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Background: Hysterectomy is the most common gynecological surgery. Every year, a large number of women around the world undergo this type of surgery for various reasons. Regardless of the type of surgery, bleeding during surgery and after surgery is the most common. Tranexamic acid is a cheap, available and low-complication drug that has been considered in recent years to control bleeding. The present study investigated the effectiveness of Tranexamic acid on the bleeding during laparotomy hysterectomy in women aged 35 to 55 years.Methods and materials: This study was a randomized, double-blind clinical trial performed on 80 patients undergoing laparotomy hysterectomy. Using a random number table, patients were divided into two groups A (receiving Transid) and the other group receiving drug B (not receiving Transid), both of which received 100 ml of normal saline prepared to reduce bias in the prepared syringe.Results: Mean age of the patients was 46.24 ± 5.21 years. Based on the results of mean hemoglobin before surgery, the rate of infection, infusion and induction in the control and intervention groups were not statistically different (P> 0.05). Also, the mean of hemoglobin variables before and after, hemorrhage estimated by the surgeon and hemorrhage estimated according to Hernandez formula were not statistically different in the two groups (P> 0.05).Conclusion: Tranexamic acid administration has no effect on the amount of bleeding during hysterectomy laparotomy.
Original Research Article
fereshteh fakour; Roya KaboodMehri; Amirhossein hajizadeh Fallah; Maryam Dourandeesh; Fatemeh Gholamalipour; Seyedeh Maryam Attari; forozan Milani; zahra pourhabibi
Volume 8, Issue 3 , May and June 2023, Pages 4-4
Abstract
Background and objective: Most pain relief methods are associated with some side effects and limitations. Magnesium sulfate, due to its osmotic properties and absorption of cervical water (moisture) can shorten labor duration and decrease labor pain via improving effacement and cervical edema. ...
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Background and objective: Most pain relief methods are associated with some side effects and limitations. Magnesium sulfate, due to its osmotic properties and absorption of cervical water (moisture) can shorten labor duration and decrease labor pain via improving effacement and cervical edema. The aim of our study was to evaluate the effect of intravaginal magnesium sulfate on pain severity and duration of the first and second stages of labor. METHODS: In this double-blind randomized clinical trial study, 70 nulliparous women were allocated into two groups after the beginning of the active phase of labor. In the group 1, 10 ccs of magnesium sulfate 50% was poured on the whole cervix during the vaginal examination. In the group 2, a placebo (sterile water) in the similar way and amount was used. Then the two groups were compared in variables of demographic, obstetrics, clinical, pain severity, and duration of the first and second stages of labor, maternal and neonatal outcomes.RESULTS: In different dilatations, pain severity in the group 1 was significantly lower (p=0.0001). The duration of the first and second stages of labor was shorter in the group 1 (p=0.0001). The two groups were similar in neonatal outcomes, drug side effects, and treatment satisfaction(p>0.05).CONCLUSION: Intravaginal magnesium sulfate improves the condition of the cervix, reduces the duration and the severity of labor pain, and has no medical or neonatal side effects.
Original Research Article
Behjat Khorsandi
Volume 8, Issue 3 , May and June 2023, Pages 5-5
Abstract
Background and Objective: Understanding the reproductive and sexual needs of pregnant women seems to be crucial in increasing the effectiveness of services and addressing their needs and expectations. Therefore, the aim of this study was to explain the needs and concerns of reproductive and sexual health ...
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Background and Objective: Understanding the reproductive and sexual needs of pregnant women seems to be crucial in increasing the effectiveness of services and addressing their needs and expectations. Therefore, the aim of this study was to explain the needs and concerns of reproductive and sexual health of pregnant women during the COVID-19 pandemic.Method: This is a qualitative study with a content analysis approach. In this probe, 16 interviews were accomplished with 15 pregnant women who had referred to public and private pregnancy care centers. Data analysis was performed predicated on the content analysis approach using MAXQDA software version 12. Results: Based on 16 interviews conducted with pregnant women during COVID-19 pandemic, 19 women were found to be suffering from mental disorders, fears, Disrupting prenatal care and sexual problems.Conclusion: According to the results of this study and other studies in the area of reproductive and sexual health, due to its importance in the quality of individual and married life, it should be considered in health planning activities and scores of studies and interventions in these areas are thus suggested
Original Research Article
Dhai Abdulalazize Rashid; Fadia Jassim Alizzi
Volume 8, Issue 3 , May and June 2023, Pages 6-6
Abstract
Background: The endometrial receptivity is controlled by biomarkers, hormones, growth factors, and cytokines interaction, disorders in these biomarkers will affect endometrial receptivity and this may possibly have correlated with unexplained infertility, the aim of study is to assess the correlation ...
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Background: The endometrial receptivity is controlled by biomarkers, hormones, growth factors, and cytokines interaction, disorders in these biomarkers will affect endometrial receptivity and this may possibly have correlated with unexplained infertility, the aim of study is to assess the correlation between integrin Alpha v Beta3 expression, endometrial thickness and sub- endometrial blood flow resistance index in unexplained Infertility. Methods: case control study includes two group of woman, infertile women with unexplained infertility considered as a case group and fertile control group. The study carried out on Kamal – Al-Samurai fertility center in the period from October 2020 - September 2021. Six days after detecting urinary LH surge, asked to come to two do dimension 2D transvaginal ultrasound to assess endometrial thickness and sub-endometrial blood flow color Doppler resistance index and endometrial samples was taken and examined immunohistochemically to detect Alpha v Beta3 integrin. Result: total women enrolled in the study were 80. The endometrial thickness was lower and resistance index was higher in case group (p < /i> < 0.001). The expression of integrin Alpha v Beta3 in infertile group was significantly low ((p < /i> < 0.001) with significant positive correlation between integrin score and endometrial thickness (r= -0.708 & p < 0.001) and significant negative correlation between integrin score and sub-endometrial resistance index (r= -0.786 & p <0.001). Conclusion: Alpha v beta 3 integrin expressions and endometrial thickness are reduced significantly in mid-luteal phase while the sub endometrial blood flow color Doppler resistant index significantly increased, and using them together can possibly be used as a diagnostic predictor of unexplained infertility.
Original Research Article
Melad Alias Alsanity; Chiman Younus Hasan
Volume 8, Issue 3 , May and June 2023, Pages 7-7
Abstract
Background: For decreasing unintended pregnancies and maternal mortality, women need to use contraceptive methods accurately. For choosing or discontinuation of any method, different factors may interfere with the options. The aim of the study was to predict factors influencing contraception in our community.Methodology: ...
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Background: For decreasing unintended pregnancies and maternal mortality, women need to use contraceptive methods accurately. For choosing or discontinuation of any method, different factors may interfere with the options. The aim of the study was to predict factors influencing contraception in our community.Methodology: A descriptive cross-sectional study was carried out in primary healthcare centers in Duhok city, period from 1st December 2021 to 1st April 2022. The studied sample was 400 married women aged between (18-45) years old. Information on sociodemographic, obstetrical, contraceptive methods used, factors of choosing, and discontinuation were obtained from respondents. The statistical calculations were performed in John's Macintosh Project (JMP) Pro 14.3.0.Results: Out of 400 women 269(67.25%) aged 18-34, 106(26.50%) completed primary education, and 204(51.00%) desire to conceive. Withdrawal was the most common used method 257(64.25%), oral contraceptive pills 43(10.75%), intrauterine device 39(9.75%), and male condom 35(8.75%). Discontinuation of contraceptives took place for the desire to get pregnancy 256(64.00%). Most of failure rate were seen among withdrawal users which recorded 77(19.25%), and those who experienced side effects were 42(10.50%).Conclusion: Educational program are requested to improve the behavior and attitude toward family control
Original Research Article
Hamza Radhi; Shaymaa Abdulhameed Khudair; Miaad Adnan; Muntaha Kadhem Mejbel; Ahmed S. Abed; Nizar Awish Jassem
Volume 8, Issue 3 , May and June 2023, Pages 8-8
Abstract
Background and Objective: The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; 90% ...
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Background and Objective: The fetal head's persistent posterior position, which ranges from 1 to 5% during birth, has long been acknowledged as a significant challenge of intrapartum treatment. 10% to 20% of fetuses are found to be in the occiput posterior (OP) position at the beginning of labor; 90% of them rotate to the occiput anterior. This research aims to analyze the rate of delivery in the OP position (also called sunny-side-up) concerning the outcome of manual rotation carried out contingent upon the OP position remains persistent. Perinatal outcomes were the secondary goals.Methods: This prospective cohort study was carried out in Obstetrics & Gynecology Clinic (OGC) at Faruk Medical City, Iraq. The study included all women who experienced a singleton pregnancy after 36 weeks, had an effort to rotate the fetus manually and had the fetus remain in the persistent OP position. The primary result was the delivery's occiput position. Perineal injuries, labor length, and the method of delivery have been the secondary outcomes. According to the outcome of manual rotation, two groups were contrasted.Results: The overall number of women participating was 250, and the manual rotation success rate was 59.1%. The success was strongly correlated with a reduction in the OP position during vaginal, cesarean, operative vaginal delivery, episiotomy, and obstetric anal sphincter injury.Conclusion: Reduced incidence of OP position at anal sphincter injury during operative vaginal delivery is linked to attempts at manual rotation in the case of persistent OP position.
Original Research Article
Sahar Hassan; Nassrin Malik Aubead
Volume 8, Issue 3 , May and June 2023, Pages 9-9
Abstract
Background: 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.Objective: The purpose of this study was to determine the prevalence and pattern of congenital anomalies ...
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Background: 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.Objective: The purpose of this study 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.Methodology: This study follows a descriptive design, was based on population data from the statistic registry covering the AL-Hilla city, Iraq, 2017 to 2021. The registry covers live, still births also maternal and neonatal information regarding sex, birth weight, parental consanguinity, maternal age, were recorded. After clinical examination, if required, were done to confirm diagnosis.Results: There were 214 congenitally deformed newborns among the 46,777 births in AL-Hilla city. There were 109 men (50.69 percent) and 103 women (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, the research was able to supply a rough estimate of the prevalence of congenital anomalies in AL-Hilla city and identify their main types which could be important for informing public policy and clinical practice.
Original Research Article
forozan milani; Seyedeh Hajar Sharami; Sodabeh Kazemi; morvarid ghassab shirazi; Ezat Hesni; Seyedeh Fatemeh Dalil Heirati; Misa Naghdipour Mirsadeghi; Alireza Foruzan; MARYAM GHALANDARI
Volume 8, Issue 3 , May and June 2023, Pages 10-10
Abstract
Background and objective: The Covid-19 pandemic can cause complications for pregnant women and more serious maternal, fetal and neonatal care related to this disease should be considered in health systems. The aim of the present study was to investigate the maternal, fetal, and neonatal ...
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Background and objective: The Covid-19 pandemic can cause complications for pregnant women and more serious maternal, fetal and neonatal care related to this disease should be considered in health systems. The aim of the present study was to investigate the maternal, fetal, and neonatal outcomes of pregnant women with COVID-19 disease.Methods: We performed a prospective study with a longitudinal design of all pregnant women hospitalized due to moderate and severe COVID-19 referred to Al-Zahra hospital, Rasht, Iran. After patient discharge, patients were followed until delivery, maternal, fetal, and neonatal outcomes were assessed by a 4-part researcher-made questionnaire.Results: In total, 166 pregnant women with Covid-19 were included in the study. The median gestational age in patients was 35.5 weeks and the median delivery age was 38 weeks. Delivery in 137 (82.5%) women were cesarean section and 29 (17.5%) had a vaginal delivery. The most common clinical symptoms among patients were fever, cough, and dyspnea with 50.9%, 38.5%, and 31.5% frequency, respectively, 9.6% had poor prenatal outcomes, 15 patients (9%) were admitted to ICU and 4 patients died (2.4%). Poor maternal outcomes were reported in 61.5% of patients with severe clinical symptoms, (p <0.001). There was no significant relationship between the severity of the disease and the type of delivery (p = 0.41)Conclusions: In our study we observed an increase in poor maternal, fetal and neonatal outcomes particularly in pregnant women with severe symptoms, although careful care is still recommended for affected pregnant women to reduce fetal, neonatal, and maternal complications. Further research will be needed to devise plan for pregnancy care and future health care crises.
Original Research Article
Omarov Nazarbek Bakytbekovich; Ahmed Al-Hili; Duaa Hamid Ali; Aisha Kamal Mahmoud; Entsar Hachim Muhammad; Ahmed S. Abed; Marwa Jabbar Saiwan; Haider Hussain Jlood
Volume 8, Issue 3 , May and June 2023, Pages 11-11
Abstract
The present semi-experimental study was conducted in 2019 on 192 Baghdad-based women aged 20 to 60 with active medical records. Two groups of 96 people, intervention and control, were created. The intervention group received training based on the constructs of health belief and stages of change models ...
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The present semi-experimental study was conducted in 2019 on 192 Baghdad-based women aged 20 to 60 with active medical records. Two groups of 96 people, intervention and control, were created. The intervention group received training based on the constructs of health belief and stages of change models to enhance Pap smear screening behavior. The control group participated in routine training on Pap smear screening behavior in health centers from health professionals. The participants completed a questionnaire created by the researchers in the pre-test and post-test stages. For data analysis, version 19 of SPSS statistical software and independent t-tests, paired t-tests, chi-square, and Fisher's exact test were utilized.A p-value of less than 0.05 was deemed statistically significant. Before the educational intervention, there was no significant difference between the two groups in the stages of behavior change (P>0.05). However, after the educational intervention, the intervention group significantly differed from the control group in the Pap smear screening change (P<0.01). Also, based on the paired t-test, the mean scores of the intervention group's knowledge, susceptibility, severity, barriers, and self-efficacy were significant before and after the intervention (P<0.05). After the intervention, the intervention group demonstrated significantly higher Pap smear screening behavior than the control group (P<0.01).The utilization of educational intervention of the stages of change and health beliefs models has proven to be highly effective in bringing individuals to the action stage.
Original Research Article
Obstetrics and Gynecology
Dariush Abtahi; Maral Hosseinzadeh; Ebtehaj Heshmatkhah
Volume 8, Issue 3 , May and June 2023, Pages 12-12
Abstract
Background: Globally, postpartum hemorrhage (PPH) remains a leading cause of maternal deaths. However, in many low and middle-income countries, information on the magnitude of and risk factors for PPH is scarce. Understanding the relative contributions of different risk factors for PPH is important. ...
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Background: Globally, postpartum hemorrhage (PPH) remains a leading cause of maternal deaths. However, in many low and middle-income countries, information on the magnitude of and risk factors for PPH is scarce. Understanding the relative contributions of different risk factors for PPH is important. We assessed the incidence of and risk factors for postpartum hemorrhage among women who had a cesarean section in Iran.Methods: Between March 2021 and March 2022, a prospective cohort study was conducted at a university-affiliated general hospital for women who had a cesarean section in Iran. We used Spearman’s correlation for the variables associated with PPH.Results: Among the 300 women, the overall incidence of postpartum hemorrhage was 15.7%. Risk factors for postpartum hemorrhage among deliveries by cesarean section were: body-mass index, previous PPH, preoperative anemia, and preoperative hypofibrinogenemia.Conclusion: The incidence of postpartum hemorrhage in the cesarean section was high. Extra vigilance in all women with cesarean section could address the risk factors identified.
Case Report Article
sedigheh Ghasemian Dizajmehr; Mahsa Mohammadi Irvanlou; Afshin mohammadi; farzaneh Rashidi fakari
Volume 8, Issue 3 , May and June 2023, Pages 13-13
Abstract
Background: ovarian mature cystic teratomas (OMCTS) is one of the most common benign ovarian tumors. Most of MCTs can be diagnosed at ultrasonography (us). Due to heterogeneous composition and a variety of appearance, in some non-diagnostic imaging reports it is suggested that we evaluate some tumor ...
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Background: ovarian mature cystic teratomas (OMCTS) is one of the most common benign ovarian tumors. Most of MCTs can be diagnosed at ultrasonography (us). Due to heterogeneous composition and a variety of appearance, in some non-diagnostic imaging reports it is suggested that we evaluate some tumor markers (CA125 and CA19-9) to complement imaging modalities. According to previous investigation a single elevated CA 19-9 is in association of specific radio-pathologic features, such as size, torsion, bronchial glands, fat and teeth components. Here we are presenting three various cases of OMCT with different characteristics.Case Presentation: case 1: asymptomatic, non-diagnose US, single- elevated CA19-9, smaller than in 10 cm with bronchial glands and fat component. Case 2: symptomatic, non-diagnostic US , normal CA19-9, larger than 10 cm with torsion and necrosis. Case 3: symptomatic, diagnostic US, single- elevated CA19-9, smaller than 10 cm, full of hair and Sebaceous material. Computer tomography (CT), in all of our cases was diagnostic based on OMCT. Apologia of pathologic pathway of elevated CA19-9 in both case 1 and 3 was in agreement with the result of previous investigations. In case 2, despite of large size and torsion, CA 19-9 level was low.Conclusion: single- elevated CA 19-9 level in OMCTs could impact benign characteristics of this kind of tumor.
Case Report Article
Maliheh Arab; Giti Noghabaei; Ghazaleh Fazli; Golnaz Fallah-Talouki; Hamed Tahmasebi; Masoomeh Raoufi; Behnaz Ghavami
Volume 8, Issue 3 , May and June 2023, Pages 14-14
Abstract
Introduction: Low-grade appendiceal mucinous neoplasm (LAMN) is a very rare condition, diagnosed in 0.2-0.7 % of appendectomies. Pathophysiology of the neoplasm involves accumulation of large volume of mucin in appendiceal lumen, resulting in its obstructive dilation. Most epithelial tumors affecting ...
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Introduction: Low-grade appendiceal mucinous neoplasm (LAMN) is a very rare condition, diagnosed in 0.2-0.7 % of appendectomies. Pathophysiology of the neoplasm involves accumulation of large volume of mucin in appendiceal lumen, resulting in its obstructive dilation. Most epithelial tumors affecting appendix are of the mucinous type and are manifested by mucin accumulation within an inflamed appendix with fibrotic and hyalinized wall.Case presentation: A 29-year-old female presented with history of chronic and intermittent episodes of abdominal pain and a palpable mass in the right lower abdominal quadrant. Sonography showed a 58 mm mass anterior to the uterus and adjacent to the ovary, probably a uterine myoma. Laparotomy revealed normal uterus, and ovaries with a translucent mass originating from appendix and fixed to cecum. Pathologic examination of the mass was reported as low grade appendiceal mucinous neoplasm.Conclusion: This is a rare case of appendiceal mucocele in a young female, mimicking pelvic mass, which was misinterpreted by sonography as gynecologic solid mass near uterus. Preoperative diagnosis of appendiceal mucocele is important due to the risk of concurrent GI and ovarian malignancy associated with the condition.Keywords: Mucocele; Appendix; pseudomyxoma peritonei; low-grade appendiceal mucinous neoplasm
Letter to the Editor
Maternal Fetal Medicine
Mostafa Rad; Nematullah Shomoossi
Volume 8, Issue 3 , May and June 2023, Pages 15-15
Abstract
This letter comes to you in the hope of stressing the need to understand age differences and relevant requirements in delivering bad news to end-stage children. Among variables affecting the way healthcare providers communicate bad news, the age of the recipient is a critical factor requiring caregivers’ ...
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This letter comes to you in the hope of stressing the need to understand age differences and relevant requirements in delivering bad news to end-stage children. Among variables affecting the way healthcare providers communicate bad news, the age of the recipient is a critical factor requiring caregivers’ meticulous tactfulness. For practical purposes, various strategies are already suggested in communicating unexpectedly bad news to patients abruptly taken to face their end of life (1). However, patients of different ages may require different strategies. For some healthcare providers and physicians, breaking bad news to an elderly end-stage client may be taken for granted because public mindset is wired to assent to end-of-life deaths. While this tendency appears controversial by itself, communicating bad news to younger patients with life-threatening irremediable diseases appears more perplexing which should be given due attention in practice and special priority in training.Young frivolous patients hope for life rather than death because children conceive of disease as a temporary stage of abnormal functioning of body systems; never do they expect dying if they become ill. The concept gradually transforms; for instance, school-age children may tend to blame themselves by attributing illness to their own actions but as they grow up, illness becomes increasingly attributed to external causes. Therefore, such conceptualizations should guide healthcare providers’ behavior toward their patients.
