Tehran University Medical Journal

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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.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Human bone marrow mesenchymal stem cells (hMSCs) can differentiate into several types of mesenchymal cells, including osteocytes, chondrocytes, and adipocytes, but can also differentiate into non-mesenchymal cells, such as neural cells, under appropriate experimental conditions. Until now, many protocols for inducing neuro-differentiation in MSCs in vitro have been reported. In this study, we induced differentiation into neural phenotype in the hMSCs population by new protocol. In this treatment, hMSCs could express neural markers more than other reports, associating with remarkable morphological modifications. 
Methods: The Bone marrow specimens were aspirated from the iliac crest of normal men. hMSCs were isolated and cultured in DMEM containing 15% FBS. Between 4-8 passages conversion of hMSCs into neurosphere-like structures and induction this cells to nerve precursors in the low-attachment plastic bacterial dishes with bFGF, EGF & RA were initiated. After seven days terminal neural differentiation was initiated by plating the cells on poly-L-ornithin and Laminin coated dishes. Cells were differentiated for 7-14 days. We used flowcytometry and immunocytochemistry analysis for assessment of specific neural stem cell markers in induced cells.
Results: Flowcytometery analysis showed that after induction, 90±2.52 percent of the cells will express neuronal marker Nestin and about 41±1 percent of the cells will express Tuj-1 and about 67±1.05 percent of the cells will express GFAP. Immunocytochemistry and morphologically modifications revealed the same results.
Conclusion: Results showed that hMSCs treatment with bFGF, EGF & RA the number of Tuj1 neurons. These data confirmed that hMSCs can exhibit neuronal differentiation potential in vitro, depending on the protocols of inducement.

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Background: Induction of labor implies stimulation of contractions before the spontaneous onset of labor and is indicated when have benefits to eighter mother or fetus. Uterine contractions and an appropriate cervix are two important factors in labor and are contributed to good outcomes. Nowadays, there are many therapeutic modalities for it such as misoprostol. Both vaginal and oral misoprostol may be used for eighter cervical ripening or labor induction. The tablets are stable at room temperature. Regarding the issue importance and lack of similar studies in Iran, this study was conducted to compare the efficacy of sublingual and vaginal misoprostol for labor induction. Methods: This study was conducted as a randomized double-blind clinical trial. In this survey, 250 women were randomly assigned to receive 25 g vaginal misoprostol plus sublingual placebo or 25 g sublingual misoprostol plus vaginal placebo in Arash hospital Tehran, Iran from 2008 to 2010. The maternal and fetal complications, Bishop Score, and time of pain onset and it’s interval with labor were monitored in two groups analyzed. Results: Mean Bishop Score, and time of pain onset and its interval with labor were similar in two groups (p>0.05). 43 patients (34.4%) in sublingual and 54 (43.2%) in vaginal group had normal vaginal delivery (p>0.05). The frequencies of maternal and fetal complications were similar between two groups (p>0.05). Conclusion: It may be concluded that there is no difference between efficacy of sublingual and vaginal misoprostol in pregnancy outcomes, maternal and fetal complications and so each one may be used according to pregnant woman’s condition and physician attitude.

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Background: Intravaginal misoprostol has been shown to be an effective agent forcervical ripening and induction of labor. The aim of present study was to assess the effects of adding hyoscine to vaginal misoprostol on its success rate. Methods: In a clinical trial, 74 women who were referred to undergo legal induction of labor during first pregnancy trimester in Arash Hospital, in Tehran, Iran, between March 2006 and March 2007 were enrolled, and were randomly divided in to two groups of misoprostol (400 μg/4h, vaginal) (n=37) or misoprostol (400 μg/4h, vaginal) plus hyoscine (20 mg IV) (n=37). Their complications including nausea, vomiting, fever, abdominal pain, need for analgesics, diarrhea, vaginal bleeding, decline in hemoglobin more than 3 g/dl, need for blood transfusion and failure of treatment according to the failure of induction of labor or cervical opening in 24 hours after starting treatment and the total duration of hospitalization were compared between groups. Results: There were no significant differences between groups regarding the rate of side effects like nausea, abdominal pain and vaginal bleeding. In misoprostol plus hyoscine group, the success rate in abortion was significantly higher (40.5% vs. 18.9%, p=0.04) and total duration of hospitalization were significantly lower (1.16±0.41 vs. 1.42±0.45 days, p=0.01). There was no case of fever, need for blood transfusion or significant vaginal bleeding in both groups. Conclusions: Adding 20 mg hyoscine via IV rout to vaginal misoprostol will raise the success rate in induction of abortion, and decreases the total duration of hospitalization without adding adverse effects.

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Background: Cervical ripening usually begins prior to the labor when there is an unripe cervix. Complications will increase significantly when the cervix is not ripped. Misoprostol is a pharmacologic agent available for cervical ripening and labor induction. The aim of this study was to compare the efficacy and safety of administration of a single dose of 25 mg vaginal Misoprostol (A) with 100 mg Misoprostol (B) for cervical ripening.
Methods: Sixty subjects with pregnancies of at least 40 gestation weeks, and an unfavorable cervix (Bishop Score <6) were randomly assigned to receive one dose oral misoprostol 100 mg or 25 mg vaginal misoprostol. The main dependent variables were mode of delivery, time interval from induction to cervical ripening, need for additional oxytocin, perinatal results and maternal side effects.
Results: The mean time from the indication of induction to cervical ripening was the same in the two groups (3.63 h in oral group and 3.9 h in vaginal group). Two groups did not differ statistically in the percent of patients who were delivered vaginally or with cesarean section during 24 hours (20% in group A versus 10% in group B).
Conclusion: Based on the results of our study, Misoprostol is an effective drug for the cervical ripening and labor induction in the term pregnancies. 25 mg vaginal tablet of Misoprostol is as effective as 100 mg oral misoprostol for cervical ripening.

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Background: Sputum induction has been recently introduced as an effective and inexpensive method for obtaining high quality sputum samples in patients without spontaneous sputum. As all Iranian physicians might not be familiar with this method yet, the results of this study could be of help in this regard.

Methods: During June 2010 to January 2011, all pulmonary tuberculosis (PTB) suspected patients, with clinical and/or radiological evidence in favor of PTB who had been referred to the Pulmonary Diseases department of Imam Khomeini Medical Center were enrolled in the study, if they were without spontaneous sputum. Sputum induction was performed using ultrasound nebulized hypertonic 3% sterile saline for 20 minutes. The laboratory was requested to report if the samples were of the intended quality (Polymorphonuclear Cells/Squamus Epithelial Cells≥2). The patients' demographic data, HIV serology and chest radiological findings in favor of PTB were recorded and analyzed.

Results: In 50 patients with suspected PTB [23 men (mean age (±SD), 51.21±20.24) and 27 women (mean age (±SD) 55.40±18.00)], cough was the most common complaint. The most prevalent radiological findings were infiltration and consolidation. PPD was positive in 21 (42%) patients. Sputum induction led to obtaining proper sputum samples in 90% of the patients. Positive sputum smear and culture were seen in 13 (26%) cases.

Conclusion: Sputum induction is a cost-effective and minimally invasive method which is associated with satisfactory results for obtaining high quality sputum samples in patients without spontaneous sputum.

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Background: Uterine contractions and an appropriate cervix are two important factors in labor contributing to good pregnancy outcomes. Oxytocin and prostaglandins, such as misoprostol, are used for the induction of labor. Misoprostol is used for cervical ripening and labor induction. The aim of this trial was to compare the efficacy and safety of titrated oral misoprostol solution with oxytocin for labor induction in pregnant women with an unfavorable cervix.

Methods: In this randomized double-blind clinical trial, 140 women with a gestational age of 34-42 weeks and an unfavorable cervix were recruited. The participants had an indication for labor induction and had been referred to the Women's Hospital in Tehran, Iran between January 2010 and January 2011. The participants were randomly assigned to receive 20 µg/hour titrated oral misoprostol plus intravenous placebo or 6 mU/min oxytocin plus oral placebo. In case contractions were inadequate, the drug doses were gradually increased. Pharmacological complications, the mean interval from the start of induction till vaginal delivery and delivery type were monitored and analyzed in both groups.

Results: The mean interval from the start of induction till vaginal delivery in misoprostol group was shorter than the oxytocin group (11.07±3.42 vs. 14.87±3.21 hours, P=0.001). The frequency of pharmacological complications and vaginal or cesarean deliveries were similar between the two groups (P>0.05).

Conclusion: Use of titrated oral misoprostol is a safe and effective method for labor induction in pregnant women with unfavorable cervix. Misoprostol is associated with a shorter interval from induction to vaginal delivery than oxytocin.

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Background: Gonadotropins are commonly used for superovulation in human and animals to retrieve more oocyte and increase chance of pregnancy. Ovarian stimulation in assisted reproduction technology produces lower implantation rates per embryo transferred than natural and ovum donation cycles, suggesting suboptimal endometrial development due to the hormones used to recruit more oocytes. Due to the frequent use of gonadotropins in the treatment of infertility in successive periods, the aim of this study was to determine the endometrial changes in response to repeated ovarian stimulation. Methods: This experimental interventional study has done in research center of Hamadan university of medical sciences in 2012. NMRI female mice six weeks old were used in this study and divided into 7 groups (5 each). The mice in group 1, 2, 3 and 4 received 1, 2, 3 and 4 times pregnant mare serum gonadotropin (PMSG) and 48 hours later 7.5 IU human chorionic gonadotrophin (hCG) respectively. For each group were considered a control group which received on time gonadortropin injection. The mouses were killed 13-16 hours after hCG injection and middle part of uterine horn cut for histological study using Hematoxylin and Eosin staining. The parameters that studied were surface epithelium of endometrium, glandular epithelium, and endometrial height and axis of uterine gland. Results: Our results showed that there are no significant differences in glandular epithelium, axis of glands and height of endometrium in experimental groups (P>0.05). The height of surface epithelium showed significant increases after ovarian stimulation in experiment group (P≤0.03). Our results showed that there are no significant differences in glandular epithelium, axis of glands, height of endometrium and height of surface epithelium between control groups and also it's experimental group (P>0.05). Conclusion: Changes in the height of surface epithelium could be one of the reasons for decrease implantation rates with repeated ovarian stimulation.

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Background: The goal of Induction therapy is to prevent acute rejection during the early posttransplantation period by providing a high degree of Immunosuppression at the time of transplantation. Induction therapy is often considered essential to optimize outcomes, especially in patients at high risk for poor short-term outcomes. The optimal prophylactic induction immunosuppressive therapy to prevent kidney transplant rejection remains controversial and historically, immunosuppressant selection was solely based on efficacy in preventing rejection. Methods: In a cross-sectional retrospective study, 410 cases of renal graft recipients were reviewed in the Hasheminejad Hospital, Tehran, Iran from March 2008 to March 2011. The adult patients with induction therapy with age over 18 years were studied for the indication, results and adverse effects of Induction therapy. Results: From 66 transplanted patients with induction therapy, 44(66.7%) patients were male. The mean age±SD of patients with induction therapy was 39.9±13.2 years. The most common cause of Induction therapy was cadaveric transplantation (45.5%), other causes was the prior history of transplantation (24.2%), without risk factor of rejection, panel reactivity test (PRT)>20% and delay graft function. Anti-thymocyte globulin (rabbit) is the most commonly used agent (97%) for induction therapy. The rate of acute rejection was 16.7% percent (11 patients), that the most of them related to the panel positive patients. The most common adverse effect of anti-thymocyte globulin was thrombocytopenia (15.2%) and the rate of New Onset Diabetes mellitus After transplantation (NODAT) and leukopenia was 10.6%, 1.5%, respectively. The urine culture was positive in 6 (9.1%) patients with induction therapy and positive blood culture was seen in one patient (1.5%). The viral and fungal infections were not seen. Conclusion: No standard Induction immunosuppressive regimen exists for patients undergoing renal transplantation. Anti-thymocyte globulin with low dose regimen is the most commonly used agent. The PRT>20% had the most association with acute allograft rejection. The most common side effect of induction therapy was thrombocytopenia.

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