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

Comparison between Emergency Severity Index plus peak flow meter and Emergency Severity Index in the dyspneic patients with chronic obstructive pulmonary disease: A randomized clinical trial

Introduction: It is unclear whether the Emergency Severity Index (ESI) can identify high-risk patients with Chronic Obstructive Pulmonary Disease (COPD). This study aims to compare the mistriage rates of the ESI plus the Peak Expiratory Flowmeter (PEF) approach and ESI approach among dyspneic patients with COPD. Methods: This study was a randomized clinical trial conducted between July and October 2018. We randomly assigned COPD patients with dyspnea to the ESI + PEF or ESI groups. Triage levels, disposition rates, number of resources used, and time to first physician contact were compared in patients admitted to the Intensive Care Unit (ICU), the Pulmonary Care Unit (PU), or discharged from the ED. Reliability of the ESI was evaluated by using the interobserver agreement (Kappa). Results: Seventy COPD patients were equally assigned to the ESI + PEF and ESI groups. The under-triage rates were 11.42% and 0%, the over-triage rates were 31.42% and 2.85% in the ESI and ESI + PEF groups, respectively. The triage levels of the patients admitted to the ICU (2 vs. 3), the PU (2 vs. 4), or discharged from the ED (3 vs. 2) were significantly different between the ESI + PEF and ESI groups. Conclusions: Addition of PEF to the ESI provides a more accurate method for triaging COPD patients compared to ESI alone. We recommend using PEF for the triage of COPD patients in the ED. Keywords: Dyspnea, Chronic obstructive pulmonary disease, Triage, Emergency severity index, Emergenc

Effect of dates in late pregnancy on the duration of labor in nulliparous women

Background: Long-term delivery is an important significant issue which is associated with mortality and fetal and maternal disorders. Based on the previous studies, consumption of dates affects uterine contractions and duration of delivery processes. This study aimed to study the effect of date consumption in late pregnancy on the duration of delivery processes in nulliparous women in 2013. Materials and Methods: This randomized clinical trial was conducted among 182 nulliparous women 18–35 years who presented to OmAlBanin Hospital in Mashhad in 2013. The comparison has been made between 91 pregnant women who consumed 70–76 g dates daily from the 37th week of pregnancy and 91 pregnant women who did not consume dates. Data collection tool was a questionnaire and a checklist of daily dates' intake. Data were analyzed using the Statistical Package for the Social Sciences software and statistical tests – chi-square and Mann–Whitney test, and P value <0.05 was considered significant. Results: The average length of active phase (P = 0.0001), length of second phase (P = 0.0001), and third phase (P = 0.004) in two groups had statistically significant difference. The average length of the second phase (P = 0.03) and the third phase (P = 0.02) in case of spontaneous start of delivery in the intervention group was significantly lower than the control group. Use of oxytocin to accelerate delivery had a significant difference between the two groups (P < 0.001). Conclusion: According to the results of this study, consuming dates in late pregnancy was effective in decreasing length of labor processes and reduced the need of oxytocin for labor acceleration. Thus, it is recommended to consume dates in women without contraindications

Screening for Celiac Disease Using Anti Tissue Transglutaminase in Patients with Esophageal SCC between 2004 and 2009

  Introduction: Esophageal Squamous-Cell Carcinoma (SCC) is one of the most common malignancies in Iran. To reduce the incidence of esophageal SCC, it is important to recognize the controllable risk factors and prevent them. Celiac disease is widely known as a possible risk factor for esophageal SCC.  Thus, we decided to assess the frequency of celiac disease in esophageal SCC patients in North east of Iran in order to suggest correlation between two diseases. Materials and Methods: In a Cross-sectional study one hundred and forty-three cases of esophageal SCC were examined for anti tissue transglutaminase antibody (anti-tTG) between the years 2004 and 2009 in Ghaem and Omid Hospitals of Mashhad University of Medical Sciences, Iran. The enzyme-linked immunosorbent assay was the test of choice in this study since it provides the sensitivity and specificity needed for the diagnosis and screening of celiac disease. The results of this test were compared with those of the control group which were compatible in terms of sex and age. Data were analyzed through SPSS software and statistical analysis such as x2, exact x2 and T-test. Results: 19.6% patients (SCC) had positive anti-tTG (>20) which was significantly different to 7.9% in control group (p -value=0.005). Comparing age groups of patients for positive anti_tTG using exact x square test showed significant difference in patients with Conclusion: There seems to be a correlation between positive anti_tTG and esophageal SCC; that is to say, celiac disease might play a role in the earlier manifestations of esophageal SCC

Parametry syntézy síťovaného chitosanu ovlivňující adsorpční vlastnosti

Kromě mnoha jiných aplikací je možné chitosan využít jako účinný absorbent k odstranění nečistot z odpadní vody Chitosan ve formě pelet dosahuje skvělých mechanických a hydromechanických vlastností, které umožňují využití materiálu pro průmyslové aplikace. Studie se zabývá tvorbou pelet chitosanu a síťovaného chitosanu, které byly syntetizovány metodou inverze fází. Parametry syntézy (množství chitosanu, koncentrace kyseliny, koncentrace činidel a teplota) jsou optimalizovány tak, aby došlo k maximálnímu záchytu modelové organické molekuly (červené barvivo). Adsorpce modifikovaných pelet chitosanu dosahuje vysokých hodnot především díky zvýšenému specifickému povrchu a poréznosti. Účinnost adsorpce je dále umocněna síťováním. Adsorpce je modelována pomocí Freundlichova modelu a výsledkem je dobrá shoda s předpokladem vícevrstevné adsorpce. Vyšetření materiálu studiem kinetiky dokládá komplexnost adsorpce na povrchu chitosanu, nicméně, dostatečně přesnou představu poskytuje již jednoduchý model z oblasti fraktální kinetiky. Materiál je navíc možné po degradaci snadno recyklovat pomocí hydroxidu sodného a to až pětkrát, než dojde k signifikantnímu poklesu adsorpčních schopností.Among countless applications, chitosan has the potential to be an effective and cheap adsorbent for pollutant removal in (waste) water. In form of beads, it also exhibits good mechanical and fluid dynamic properties that are suitable for utilization in large-scale adsorption processes (e.g. as column packing). The present study investigates the beading process to prepare chitosan and cross-linked chitosan beads by phase inversion method. Beading parameters (i.e. chitosan amount, acid concentration, non-solvent agent concentration, and temperature) are optimized to obtain an appropriate adsorbent structure to uptake large organic molecules (reactive red 2, a dye, is utilized as model pollutant). Chitosan beads present remarkably enhanced adsorption capacity, mainly thanks to increased specific surface area and porosity. The addition of a cross-linker (diepoxyoctane) further improves pollutant removal. The adsorption process is well-fitted by the Freundlich model, suggesting a multilayer adsorption. The kinetic study also substantiates the complexity of the adsorption mechanism on bead surface, which, however, is satisfactorily predicted by a simple fractal kinetic model. Finally, it is proved that chitosan and cross-linked chitosan beads can be recycled (by washing with NaOH solution) at least 5 times before sensible performance loss