Sublingual Misoprostol versus Foley catheter for cervical ripening in women with preeclampsia or gestational hypertension: A randomized control trial

Background: Delivery is the only definite cure for hypertensive disorders. Therefore, cervical ripening and labor induction are important to achieve favorable outcomes. Objective: This Randomized Control Trial (RCT) is aimed to compare the effects of sublingual misoprostol and Foley catheter in cervical ripening and labor induction among patients with preeclampsia or gestational hypertension. Materials and Methods: A total number of 144 women with preeclampsia or gestational hypertention with indication of pregnancy termination, who were referred to academic hospitals of the University of Medical Sciences in Mashhad, Iran, between March 2015 and December 2016, were randomly divided into two groups. In group one (n = 72), 25 μg of misoprostol tablet was administrated sublingually every 4 hr up to six doses. In group two (n = 72), a 16F Foley catheter was placed through the internal cervical os, inflated with 60 cc of sterile saline. Results: There were no significant differences between groups regarding the demographic characteristics, primary bishop score, and pregnancy termination indication. The cervical ripening time (primary outcome) (8.2 vs 14.2 hr, p < 0.00), induction to delivery interval (15.5 vs 19.9 hr, p < 0.00), and vaginal delivery before 24 hr (63.9% vs 40%, p = 0.03) were significantly different between the two groups. There was no significant difference between groups in view of oxytocin requirement (p = 0.12), neonatal Apgar score (p = 0.84), or neonatal intensive care unit admission (p = 78). Conclusion: This trial showed that the application of sublingual misoprostol, compared to the Foley catheter, can reduce cervical ripening period and other parameters related to the duration of vaginal delivery. This misoprostol regimen showed inconsiderable maternal complications

Quality of life in peptic ulcer patients referring to Al-Zahra hospital of Isfahan, Iran

Aim: The purpose of this study was to determine quality of life in peptic ulcer patients referring to Al-Zahra hospital of Isfahan. Background: Peptic ulcer disease (PUD) is one of the most prevalent diseases. Its prevalence is 6-15% and about 10% of people experience its symptom in their life. PUD can have a considerable impact on patients’ quality of life (QOL). Patients and methods: This descriptive- analytic survey was done on 93 randomly patients referred to Al-Zahra hospital of Isfahan city in Iran. Data gathering was done via questionnaire including five domains: physical, psychological, social, behavioral and economical. For data analysis, t-test, Pearson correlation and ANOVA test were used. Results: 93 patients with mean age of 38.54 years, including 43 (46.2%) women and 54 (53.8%) men, were studied. There was a negative significant between quality of life and age and between disease duration and psychological, economical domains and between the mean of QOL scores in physical and social domains with the number of cigarette per day, also there was significant relation between social domain and gender, and physical, psychological and behavioral domains with marital status; Physical, social domains with smoking. Also there was a negative significant between physical, social and behavioral domains with years of smoking. Conclusion: Study results showed that quality of life is in a relatively good level among patients, thus some diseases such as peptic ulcer can effect on quality of life. So, treatment and prevention of these diseases may improve their quality of life

The relationship between genetic variants associated with primary ovarian insufficiency and lipid profile in women recruited from MASHAD cohort study

Background and aim: Primary Ovarian Insufficiency (POI) is defined by the occurrence of menopause before the age of 40 years. It is often associated with cardiovascular disease (CVD). The purpose of this study was to explore the relationship between POI-associated genotypes cardiometabolic disorder risk factors. Methods: One hundred seventeen women with POI and one hundred eighty-three healthy women without POI were recruited in this study. DNA was extracted and analyzed using ASO-PCR or Tetra ARMS-PCR. Lipid profiles were also assessed. Results: Multivariate logistic regression analysis showed that individuals with GG vs. TT genotype of the rs1046089 SNP were more likely to have a higher serum LDL (p = 0.03) compared to the control group. There was also a significant association between low serum HDL and rs2303369 and rs4806660 SNP genotypes in the POI group. In the POI group, the percentage of those with high total cholesterol was lower in those with a CC genotype compared to those with a TT genotype (p = 0.03). Conclusion: Some SNPs reported to be associated with POI appear to be independently associated with dyslipidemia. These results may be helpful to identify subjects with POI who may be susceptible to CVD

Association between Genetic Variants Linked to Premature Ovarian Insufficiency and Inflammatory Markers: A Cross-Sectional Study

Background: Premature menopause (PM) is the cessation of ovarian function before age 40. PM women are more likelyto have cardiovascular diseases (CVDs), diabetes, and mental disorders. This is the first study that assessed the associationof single nucleotide polymorphisms (SNPs) with anti-heat shock protein 27 (Hsp27), High-sensitivity C-reactive protein(hs-CRP), and PM and serum pro-oxidant-antioxidant balance (PAB), as putative risk factors for CVDs. We aimed toexplore the association of oxidative stress markers with eight different SNPs shown to be related to premature menopause.Materials and Methods: In this cross-sectional research, we included 183 healthy women and 117 premature menopausalwomen. We determined baseline characteristics for all participants and measured serum hs-CRP, anti-HSP-27 antibody titer, and PAB levels using the established methods. Genotyping for eight SNPs was done usingthe tetra amplification refractory mutation system polymerase chain reaction (Tetra-ARMS PCR) and allele-specificoligonucleotide PCR (ASO-PCR) methods.Results: We found a significant difference between mean serum PAB levels and the genetic variant of rs16991615(P=0.03). ANCOVA showed a significant effect of the genotypes rs4806660 and rs10183486 on hs-CRP serum levelsin the case and control groups, respectively (P=0.04 and P=0.007). ANCOVA also showed an association betweenrs244715 genotypes and anti-hsp27 serum levels in the case group (P=0.02). There was a significant effect of thegenotypes of rs451417 on the serum hs-CRP level in the control group (P=0.03).Conclusion: There was a significant association of the genetic variants related to PM with oxidative stress and inflammatorymarkers (serum PAB, anti-hsp27 antibody, and hs-CRP). Accordingly, this seems to be an effective approach topredicting susceptible subjects for cardiovascular and mental disorders as well as various cancers

Reference intervals for routine biochemical markers and body mass index: a study based on healthcare center database in northeastern Iran

Age‐ and sex‐specific reference intervals (RIs) for some biochemical tests may be useful for their interpretation, due to the variations in lifestyle and genetic, or ethnic factors. The aim of this study was to obtain RIs for some routine biochemical markers including a serum lipid profile, fasting blood glucose (FBG), aspartate and alanine aminotransferase (AST and ALT), uric acid, and body mass index (BMI) in subjects who attended primary healthcare centers. The large database of primary healthcare centers uses RIs to report results for children, adolescents, and young and old adults. RIs were obtained by using the indirect method, recommended by the CLSI Ep28‐A3 guidelines. RIs for FBG, BMI, and serum lipid profile, including triglyceride, total cholesterol, high‐density lipoprotein cholesterol, and low‐density lipoprotein cholesterol in people aged 18 to 120 years, were obtained without age/sex segmentation. RIs for serum AST, ALT, and uric acid were obtained without age segmentation, though these RIs were higher in males than females. The RIs for AST, ALT, and uric acid were higher in men, while the RIs for the other variables were similar in both sexes. This is the first study reporting the use of indirect RIs for BMI

Relationship between knowledge and attitudes of rural people with information resources about family physicion program in Shahrekord (2010)

Background: The family physician program and referral system considered as one of the important programs of country’s health that has been implemented since 2005.Considerng that health is a spontaneous phenomenon and information in this regard should be given to individuals, the present study was conducted to determine the relationship between knowledge and attitudes of rural people with information resources about family physician program in Shahrekord. Methods: In this descriptive analytic survey, 1100 individuals under the program of rural family physician in Shahrekord were selected by multistage sampling method. Data collected using a questionnaire and analyzed by t-test and ANOVA tests. Findings: Mean age of studied population was 34.23.5% of rural population have been trained regarding family physician program. There was significant relationship between the mean scores of knowledge and attitude of rural people with the training giving (p<0.05). Most of the rural population had received their information in this regard from health workers and health centers employee (34%).There was significant relationship between information resources and knowledge and attitudes of villagers (P<0.001). Conclusion: The findings of current study indicated that people’s information about the program was moderate. Considering that most of the rural population had received their information from health workers, so, implementation of educational programs for doctors and health workers and transfer to other members of society can improve the quality and effectiveness of this program

Case Report: Polyarteritis nodosa or complicated Henoch-Schonlein purpura (IgAV), a rare case [version 2; referees: 2 approved]

Background: Polyarteritis nodosa (PAN) is a vasculitis that affects medium-sized arteries. PAN is a rare disease and requires a high clinical suspicion for diagnosis. PAN and HSP (newly named Immunoglobulin A-associated vasculitis) have narrowing differential diagnosis. Here, we reported a case of PAN. Case presentation: Our patient was a 65-year-old woman that came to hospital due to abdominal pain and skin lesion on the right upper and right lower extremities. All rheumatologic tests were negative. A biopsy of the skin lesion was reported as mild hyperkeratosis, slight spongiosis with intact basal layer. The dermis showed moderate to severe perivascular PMN infiltration with vessel wall degeneration and extravasation of RBCs. A colonoscopy reported diffuse mucosal erythema and erosions were seen in the rectum until 6cm of anal verge. An electromyogram test and nerve conduction velocity study of the upper extremities reported bilateral mild carpal tunnel syndrome, and in the right lower extremities mononeuritis multiplex could not be ruled out. Abdominopelvic CT scan reported diffuse wall thickening of terminal ileum associated with mesenteric fat and narrow enhancement of inferior Mesenteric artery with patchy filling defect. After evaluation, the patient received corticosteroid pulses plus cyclophosphamide. Conclusion: Diagnosis and treatment of PAN are important and PAN should be considered in a patient with skin lesions and neurological impairment

Re-investigation of functional gastrointestinal disorders utilizing a machine learning approach

Abstract Background Functional gastrointestinal disorders (FGIDs), as a group of syndromes with no identified structural or pathophysiological biomarkers, are currently classified by Rome criteria based on gastrointestinal symptoms (GI). However, the high overlap among FGIDs in patients makes treatment and identifying underlying mechanisms challenging. Furthermore, disregarding psychological factors in the current classification, despite their approved relationship with GI symptoms, underlines the necessity of more investigation into grouping FGID patients. We aimed to provide more homogenous and well-separated clusters based on both GI and psychological characteristics for patients with FGIDs using an unsupervised machine learning algorithm. Methods Based on a cross-sectional study, 3765 (79%) patients with at least one FGID were included in the current study. In the first step, the clustering utilizing a machine learning algorithm was merely executed based on GI symptoms. In the second step, considering the previous step's results and focusing on the clusters with a diverse combination of GI symptoms, the clustering was re-conducted based on both GI symptoms and psychological factors. Results The first phase clustering of all participants based on GI symptoms resulted in the formation of pure and non-pure clusters. Pure clusters exactly illustrated the properties of most pure Rome syndromes. Re-clustering the members of the non-pure clusters based on GI and psychological factors (i.e., the second clustering step) resulted in eight new clusters, indicating the dominance of multiple factors but well-discriminated from other clusters. The results of the second step especially highlight the impact of psychological factors in grouping FGIDs. Conclusions In the current study, the existence of Rome disorders, which were previously defined by expert opinion-based consensus, was approved, and, eight new clusters with multiple dominant symptoms based on GI and psychological factors were also introduced. The more homogeneous clusters of patients could lead to the design of more precise clinical experiments and further targeted patient care

Mechanism of vasorelaxation induced by Achillea wilhelmsii in rat isolated thoracic aorta

Background: Achillea wilhelmsii (A. wilhelmsii) is used in Iraninan folk medicine for the treatment of hypertension; also, in previous reports, the hypotensive and antihypertensive effects of this plant have been indicated. The aim of the present study is to investigate the vasorelaxant effect of the hydroalcholic extract of A. wilhelmsii and its underlying mechanisms in isolated rat aorta. Materials and Methods: The effect of the hydroalcholic A. wilhelmsii extract was tested on the contractile response of Wistar rat aorta induced by potassium chloride (KCl) and phenylephrine (PE) using a pressure transducer that is connected to the PowerLab. Results: The cumulative concentrations of A. wilhelmsii (0.5-8 mg/ml) induced a vasorelaxation both in endothelium-intact and endothelium-denuded aortas precontracted by high K + (6 Χ 10−2 M) or 10−6 M PE. A. wilhelmsii, at a concentration of 4 mg/ml, reduced Ca 2+ -induced contraction (P < 0.001 vs. control) after PE or KCl had generated a stable contraction in the Ca 2+ -free solution. Furthermore, after incubation with diltiazem, the vasorelaxant effect of A. wilhelmsii reduced in the endothelium-denuded aortas precontracted by PE or KCl (P < 0.001 vs. control). In contrast, A. wilhelmsii-induced relaxation was not affected by glibenclamide, BaCl 2 , ruthenium red, methylene blue, or heparin. Conclusions: The results showed that A. wilhelmsii had a vasorelaxation effect, which was not endothelium-dependent. The relaxation was mediated by inhibition of extracellular Ca 2+ influx through voltage- and receptor-operated Ca 2+ channels (VDDCs and ROCCs) in vascular smooth muscle cells