Comparison of Efficacy and Side Effects of Different Administration Routes of Misoprostol (Oral, Vaginal, and Sublingual) for Second-Trimester Abortion

Background The current study was designed to compare the effectiveness and side effects of oral, vaginal, and sublingual misoprostol in termination of second-trimester pregnancy. Materials and Methods: In this clinical trial (2014 to 2015), 85 pregnant women in the second trimester of pregnancy were included in Imam Reza hospital, Kermanshah, Iran. They were randomly divided into three groups as follows: oral misoprostol (n=28), vaginal misoprostol (n=30), and sublingual misoprostol (n=27). Misoprostol was administered orally (oral misoprostol group), vaginally (vaginal misoprostol group), or sublingually (sublingual misoprostol group). The dosage was similar in three groups (400 micrograms every four hours up to a maximum of five doses). The mothers were followed and induction-abortion interval time, number of dosages required, and misoprostol side effects were documented. The data were analyzed by SPSS version 20.0 software. Results: The mean (standard deviation) age of the sample was 28.27 (±4.97) years. Mean gestational age was 16.58 weeks and mean gravidity was 1.99. Mean number of administered misoprostol doses was 3.89 and most patients responded to three doses of misoprostol. Mean abortion time was 20.08 hours. No side effects were reported in 60% of the subjects. Others experienced side effects such as nausea (16.5%), fever and chills (12.9%), and vaginal bleeding (9.4%). The abortion duration in 35.3% of the subjects was within 18 hours. The most successful method was oral route (82.1%), followed by vaginal route (80%), and sublingual route (70.4%). The abortion duration was statistically different between the three groups (P= 0.001). Conclusion: Finding of the presented study showed that misoprostol is a safe medication to be used for medical abortion in the second trimester of pregnancy. Oral route of administration was superior to vaginal or rectal use of misoprostol

The risk factors of acute attack of benign paroxysmal positional vertigo

ntroduction: Many people suffer from vertigo. Its origin in 85% of cases is otological while in 15% is central etiology. Benign paroxysmal positional vertigo (BPPV) is the most common cause of the true vertigo. In this research we evaluated the risk factors of acute attack of BPPV. Materials and Methods: This study was performed on 322 patients, presenting with BPPV. Diagnosis was confirmed by history and Dix-Hallpike manoeuvre. The underling risk factors documented carefully. Data analyzed by SPSS and K.square test. Results: Number of 321 patients (including 201 females and 120 males) with BPPV included in our study. Their average age was 41. They showed symptoms for 1 month to 15 years (mean 8 months). Emotional stress was positive in 34% and trauma was the only risk factor in 8.12% patients. Ear surgery and prolonged journey were respectively the main risk factors in 7.2 and 12.8% of patients. Conclusion: The confirmed risk factors of acute attack of BPPV were as trauma, major surgery and ear surgery especially stapedotomy, vestibular  neuronitis and prolonged bedrestriction. Meniere was not considered as risk factor. In our study the psychological conflict was the major risk factor for BPPV. Other new risk factors which introduced for first time included; sleep disorder, fatigue, professional sport, starving and prolonged journey

Assessment of the Amount of Hepatohistopatological and Enzymatic Changes after Chronic Lead Intoxication In Utero and Throughout Life in Rat

Background and Objectives: In order to evaluate the functional changes of liver after lead intoxication, activity of enzymes, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP), as well as pathological changes of the liver were assessed in the present study.Methods: Male and female Albino Rats (40 in total) in five 8-rat groups were exposed to 0, 5, 10, 15, and 40mg lead acetate dissolved in 1 liter drinking water, from the onset of embryonic life to 16th week of life. At the end of 16th week, the animals were anesthetized with chloroform, and blood sampling from heart was performed. After serum separation for biochemical analysis, liver was taken out and fixed in 15% formalin for histopathological studies. Activity of ALT, AST, and ALP, as well as lead concentration of the serum samples were measured using spectrophotometrical method and graphite furnace atomic absorption, respectively. The tissue sections were histologically studied under light microscopy after staining by hematoxylin/eosin. The results were analyzed using analysis of variance and Tukey's test, and p<0.05 was considered significant.Results: In this study, liver enzymes activities had direct relation with the serum lead concentration, and showed a significant increase compared to the control groups. Histological changes were observed as inflammation, lymphocyte infiltration to liver tissue, and liver cells necrosis.Conclusion: According to the results of this study, long-time exposure to lead results in dose- and time-dependent liver injury