Tehran University Medical Journal

Background: Infectious complications of hysterectomy remain common despite the use of antibiotic. The usual existing methods of preoperative antisepsis do not control the vaginal bacteria that are the primary cause of contamination at the surgical site. Our goal was to assess whether febrile morbidity after total abdominal hysterectomy is decreased by the addition of povidone-iodine gel at the vaginal apex after the routine vaginal preparation with povidone-iodine solution.

Methods: We carried out a prospective randomized trial on women admitted for elective abdominal hysterectomy. Inclusion criteria included planned abdominal hysterectomy for benign or malignant gynecologic conditions. Exclusion criteria consisted of emergency surgery, current treatment for pelvic infection, and known povidone-iodine allergy. A total of 168 patients were randomized to either the control group or the intervention group, who received 20 cc povidone-iodine gel placed at the vaginal apex immediately before the operation. Both groups received the routine preoperative preparation of antimicrobial prophylaxis, abdominal and vaginal scrubbing with povidone-iodine solution prior to the operation. The primary outcome was post-operative febrile morbidity. Other outcomes included abdominal wound infection, vaginal cuff cellulitis or pelvic abscess. Data was analyzed using Fisher's exact test. p<0.05 was considered statistically significant.

Results: The overall rate of febrile morbidity was 20.5%. Febrile morbidity occurred in ten of 80 (12.5%) women receiving the povidone-iodine gel preparation and 24 of 86 (27.9%) women not receiving the gel (p<0.05). The rate of abdominal wound infection was 18.6% (16) in the control group, and 5% (4) in the gel group (p<0.05). Vaginal cuff cellulitis was seen in three patients from the control group versus one woman from the gel group (p>0.05). Pelvic abscess was diagnosed in one patient from the control group and in no patients from the gel group (p>0.05).

Conclusion: Preoperative vaginal povidone-iodine gel is an effective technique for reducing febrile morbidity and the risk of abdominal wound infection after hysterectomy.

Background: Whatever its etiology, the inflammatory reactions of preeclampsia lead to the activation of endothelium and result in vascular damage. CRP is considered a sensitive index of systemic inflammation, so it is used as predictive factor for disease. This study was carried out to test the screening and predictive abilities of the CRP test in order to detect and diagnose pregnant women prone to preeclampsia prior to the onset of symptoms.

Methods: In this prospective cohort study, conducted in Arash Hospital between 2005 and 2006, we determined the CRP levels of 201 pregnant women at 10-16 weeks of pregnancy. Based on exclusion criteria and illness, 31 patients were excluded and 170 patients were followed until the end of their pregnancies.

Results: In this study, the mean serum CRP values of those who had preeclamptic and those who had normal pregnancies were compared and the statistical differences were significant: 6.18 mg/L for preeclamptic patients compared with 4.12 mg/L for normal patients (p=0.003). Using a chi-square test, we found that patients whose CRP level was ≥4 were six times more likely to have preeclampsia than those with CRP levels <4 (k=9.4 p=0.002 OR=6.15 95% CI=0.69-22.28).

Conclusion: This study confirms the results of previous reports indicating a significant relationship between rising serum CRP in the first trimester of pregnancy and preeclampsia at third trimester. More studies consisting of other inflammation factors are necessary to find an acceptable and reasonable screening test to diagnose pregnant women who are prone to preeclampsia.

Background: Approximately 10 percent of all pregnancies continue to 42 weeks'gestation. The true prevalence of pregnancies lasting longer than 41 or 42 weeks'gestation has been difficult to establish because many such diagnoses occur as a result of an inability to accurately establish time of conception. Several studies indicate that menstrual dating is often inaccurate and can lead to induction of labor for a presumed but inaccurate diagnosis of postterm pregnancy. It is now widely accepted that a more precise method of determining gestational age is the first trimester measurement of crown-rump length of the fetus.

Methods: We carried out a cross- sectional study on patients who were referred for a prenatal care to Arash hospital, Medical Sciences/University of Tehran. Women in the first trimester of pregnancy who presented to the center during the study period with precise  date of last menstrual period were eligible to enroll. They underwent an ultrasound dating scan between 8 and 12 weeks, measuring crown-rump length. The estimated date of delivery (EDD) was changed if there was a discrepancy of more than 5 days from the gestation, calculated from the last menstrual period (LMP). For the remaining women (no-scan group), gestation was determined using the LMP. Data were analyzed using SPSS, 11. Statistical significance was assessed with Chi-square, student t-test and Anova, using a significance threshold of < 0.05.

Results: Of 217 women who were enrolled, 10.6% of the patients who underwent an ultrasound dating scan were postdate versus 3.7% of the patients whose gestational age calculated from LMP (p=0.005).

Conclusions: The application of first trimester sonographic measurement of crown-rump length of the fetus results in a significant reduction of the diagnosis of postterm pregnancies.

Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Postpartum hemorrhage is a major cause of maternal mortality and morbidity. It has been identified that active management of third stage of labor is an effective way in preventing postpartum hemorrhage. This randomized controlled trial was conducted to compare sublingual misoprostol versus intravenous oxytocin in the management of postpartum hemorrhage in nulliparous women.
Methods: In this randomized controlled trial conducted in Arash hospital from 2006 to 2009, Five hundred forty two nulliparous pregnant women were enrolled. They were randomized to receive either 400 microgram sublingual misoprostol or 20 IU oxytocin intravenously, immediately after the birth of newborn.
Results: Post partum Hemorrhage was significantly lower in women who received sublingual misoprostol (p<0.0001). Patients who received misoprostol had shorter length of third stage of labor (6.45 minute in misoprostol Vs 6.9 minute in oxytocin group, p=0.003). Comparison of hemoglobin levels in two groups before and after delivery showed that there is a significant lesser hemoglobin drop in misoprostol group p=0.046. Side effects were more common in misoprostol group (p<0.0001). However, they were not serious shivering (35.66%) in misoprostol group and headache (9.63%) in oxytocin group were the most common adverse effects.
Conclusions: Sublingual misoprostol is more effective than intravenous oxytocin in preventing postpartum hemorrhage and is recommended for prevention of postpartum hemorrhage.

Background: Although the conventional vaccines have been instrumented in the incidence of many infectious diseases, the advances in genetic engineering and bioinformatics have provided the opportunity for developing improved and new vaccines.
Methods: Reverse vaccinology was pioneered by a group of researchers investigating development of a vaccine against serogroup B Neisseria meningitidis. Reverse vaccinology analyzes the entire genome of a pathogen with the aid of computational programs to identify potentially antigenic extracellular proteins.
Results: Using this method for Neisseria meningitidis genome analysis, 600 secretory or surface-exposed proteins were identified and, subsequently, 350 proteins were expressed and purified. Finally, seven proteins capable of activating the immune system against a range of strains were identified.
Conclusion: Improved computational techniques are now able to provide researchers with high-confidence predictions for complex biological characteristics. This will herald a move to computer-aided biotechnology in which time-consuming and expensive large-scale experimental approaches are progressively replaced by functional bioinformatic investigations.

Background: Primary pancreatic lymphoma is really rare and comprising about 0.2-4.9% of all pancreatic malignancies. The diagnosis of this lymphoma is very difficult because the clinical symptoms and signs resemble those of pancreatic adenocarcinoma.
Case presentation: A 30-year old man was admitted to the hospital with the complaint of left upper abdominal pain. Because of his splenomegaly and pancytopenia he was candidate for splenectomy but during operation a large mass was found in the pancreas and biopsy was taken from it. Pathology reported lymphoblastic lymphoma of pancreas.
Conclusion: It is important to differentiate between primary lymphoma and the adenocarcinoma of the pancreas as prognosis and treatment of them differ significantly. Primary pancreatic lymphoma should be considered in differential diagnosis of pancreatic tumors and an attempt to obtain tissue diagnosis is always necessary before radical surgery, especially in young patients.

Background: Biliary cirrhosis is a chronic disease marked by the progressive destruct-tion of liver. There is no known cure for this disease however, medications may slow its progression. The present study was designed to investigate the effect of quercetin as a plant derived flavonoid on the hepatic injury reduction of biliary cirrhotic rats.
Methods: Thirty male Sprague-Dawley rats aged 6-7 months were randomized into three groups of ten each. One group served as control (sham operated), while the other two groups underwent a complete bile-duct ligation (BDL). Four weeks after the opera-tion, serum bilirubin, alkaline phosphatase (ALP), alanine amino-transferase (ALT), and aspartate amino-transferase (AST) were measured in two BDL groups to confirm the occurrence of cirrhosis. Then one of the BDL groups received placebo and the other one injected intraperitoneally with 50mg/kg of quercetin once a day for a period of four weeks. At the end of the study, hepatic enzymes and serum bilirubin were measured again. Liver species were tested for histological characteristics.
Results: Quercetin could decrease serum level of bilirubin (7.4±0.9 vs. 8.9±1.6 mg/dL P<0.05), ALP (1387±76.9 vs. 2273±65.3 IU/L P<0.001) and ALT (601.9±38.1 vs. 644.8±37.4 IU/L P<0.05) compared to cirrhotic group. AST was higher in cirrhotic groups compared to control both in the 4th and 8th week. However, the difference between BDL and BDL+Q groups was not statistically significant. Quercetin decreased ALT/AST ratio, as an indicator of liver damage. No significant histological changes were observed in quercetin group.
Conclusion: These data suggest that although quercetin did not change histological characteristics of liver, it could significantly decrease bilirubin, alkaline phosphatase and alanine amino-transferase, indicating less liver injury.