Misoprostol for induction of labor in women with severe preeclampsia at or near term

To examine the misoprostol efficacy and safety in induction of labor of women with severe preeclampsia at or near term when the cervix is unfavorable. A prospective comparative study was conducted in Al Thawara General Hospital Sana'a, Yemen, from June 2009 to June 2010. One hundred and thirteen women met the inclusion criteria. They were divided into 2 groups. The study group [n=56] and the control group [n=57]. The study group were given 50 micro g of Misoprostol intravaginally every 4 hours to a maximum of 6 doses. Maternal age, gestational age, parity, initial cervical status, the rate of cesarean section, and neonatal outcomes were analyzed and compared to the control group. The vaginal delivery was achieved in 69.6% in the study group versus 15.8% in the control group [p<0.0001]. The overall cesarean section was performed in 30.3% of the study group versus 84.2% [p<0.0001]. The mean time from insertion to delivery was 12.12 +/- 2.1 hours and the mean dosing was 2.77 +/- 1.3. There were no significant differences between the 2 groups in the frequency of abnormal fetal heart rate, Apgar score and admission to the neonatal intensive care unit. Misoprostol when given intravaginally in 50 micro g 4-hourly dosing regimen is an effective agent for ripening the cervix in this group of women

effects of ultrasound on BBB integration in ischemic brain injury Model

Ultrasound [US] has been used in neuroprotection after cerebral ischemia, however the mechanism of action remains unclearly. We have previously shown the protective effect of ultrasound on infarction volume and brain edema in ischemic brain injured at normothermic condition. Ultrasound may also amplify the effect of fibrinolytic medications in thrombolysis process. We have also shown that hyperthermia can exacerbate cerebral ischemic injury and that the efficacy of tissue plasminogen activator [tPA] is reduced in the presence of hyperthermia. In this study, the effects of US alone or in combination with tPA on brain ischemic injury were evaluated. Focal ischemic brain injury was induced by emblazing a pre-formed clot into the middle cerebral artery in rats. Principally, we examined whether US can reduce the perfusion deficits and, the damage of blood-brain barrier [BBB] in the ischemic injured brain. There are two series of experiments at this study. In the first series, animals were randomly assigned to four groups [n = 7 per group] as follows: 1-control [saline], 2-US [1W/cm2, 10 duty cycle], 3- US+high- tPA [1W/cm2, 10 duty cycle +20 mg/kg] and 4- high -tPA [20 mg/kg]. We also examined the effects of US and tPA on BBB integrity after ischemic injury. The animals were assigned into four groups [n = 7 per group], treatment is the same as above. BBB permeability was assessed by the Evans blue [EB] extravasations method at 8 h after MCA occlusion. BBB permeability was evaluated by fluorescent detection of extravagated Evans blue dye and Perfusion deficits were analyzed using an Evans blue staining procedure. The perfused microvessels in the brain were visualized using fluorescent microscopy. Areas of perfusion deficits in the brain were traced, calculated and expressed in mm[2]. The results showed that US improved neurological deficits significantly [p < 0.05]. The administration of US significantly decreased perfusion deficits and BBB permeability. In the control set, for the US+high tPA, high tPA only and US only groups, the mean perfusion deficits [ +/- SD] were 14.32 +/- 3.15, 7.03 +/- 4.08, 5.92 +/- 1.90 and 9.14 +/- 3.37 mm2, respectively, 8 h after MCA occlusion [P < 0.05]. These studies suggest that US is protective in a rat embolic model of stroke due to decreased perfusion deficits

[Comparison of the topography of carotid territory stenosis in north American and Iranian stroke patients]

Atherosclerotic stenosis of carotid territory is the most common cause of ischemic stroke. A higher frequency of intracranial arterial stenosis has been reported in Africa and the Far East. 304 geriatric ischemic stroke patients admitted in Mackenzie hospital, Canada and the same number of geriatric ischemic stroke patients with similar sex ratio admitted in Valie-Asr hospital, Iran during 2003-2005 were enrolled in a double center and prospective study. Diagnosis of brain infarction in the carotid territory was made by stroke neurologists. All of the patients underwent transcranial and carotid doppler studies. Doppler studies performed were based on the standard method by a neurosonologist. Fisher exact test served for statistical analysis and p<0.05 was declared significant. In Iranian group 71 patients [23.3%] and in North American group 83 patients [27.3%] had extracranial ICA stenosis without a significant difference df=1, p=0.305. Sever >/=70% Extracranial ICA stenosis was found in 14 Iranian patients [4.6%] and 23 North American patients [7.5%] without a significant difference. df=1, p=0.17. In Iranian group, 14 cases [4.6%] and in North American group 5 cases [1.6%] had intracranial stenosis in carotid territory which was significantly different df=1, p=0.038. Mixed intracranial and extracranial carotid territory stenosis was present in 2 Iranian and 1 North American patient. Atherosclerotic stenosis of intracranial branches of carotid territory is more common in Iranian than North American populations

Etiology overlaps based on the brain infarct topography

Etiologic overlaps may occur in patients with ischemic stroke depending on the diagnostic investigations and classification criteria. Consecutive ischemic stroke patients admitted in Mackenzie hospital, Canada from August 2003 to August 2004 underwent a standard battery of diagnostic investigations by stroke neurologists. Stroke mechanism was defined based on the Toast criteria. Stroke topography subtypes were small and large artery territory infarcts. A total of 302 stroke patients [159 female, 143 male] were registered. Small and large artery territory infarcts consisted 25.5% and 74.5% of our topography respectively. Etiologic overlaps were found in 17.5% of the patients. Cardiac source of embolism was significantly more frequent in patients with large artery territory infarcts [p= 0.002] but frequency difference of corresponing large artery atherosclerotic stenosis was not significant in these topographies [p= 0.378]. Etiologic overlaps were more frequent in patients with small artery territory infarcts [p= 0.004].Etiologic overlaps are frequent and should be considered for optimal management of the ischemic stroke patients

Silent brain infarction in stroke patients: a pilot double-center study

Silent Brain Infarcts [SBI] are associated with an increased risk of subsequent stroke. SBI are incidentally revealed by CT or MRI executed in stroke patients.A prospective study was undertaken involving 200 consecutive patients aged >45 years with brain infarct admitted in University of Alberta Hospital, Canada [100 patients] and Valie-Asr Hospital, Iran [100 patients] in 2003. Patients were divided in age groups aged <65 and >65. All of the patients underwent brain CT. A stroke neurologist with knowledge of stroke history subsequently reviewed the scans and diagnosed SBI. The relations of race, gender and age groups with SBI were analyzed with chi-square and Fisher exact tests.SBI were present in 26.9% of patients aged <65 and 48.6% of patients aged >65. Canadian patients were significantly more preponderant to SBI in age group> 65 [p= 0.013]. The mean age of Canadian patients was significantly higher than Persians [p<0.001]. Within a total of 200 patients the female gender was significantly more preponderant to SBI [p= 0.02] which was not related to age and race groups. Small vessel territory infarct was present in 87% of our patients with SBI.SBI are common in stroke patients. The frequency of SBI is higher in female gender and the elderly

Risk factors for leukoaraiosis in North American and Iranian stroke patients

Leukoaraiosis [LA] or white matter thinning and rarefaction are common in stroke patients. This pilot double- center study was designed to evaluate LA risk factors in stroke patients. This cross sectional study was conducted on 100 consecutive stroke patients in Walter Mackenzie Hospital, Canada and 100 consecutive stroke patients in Valie-Asr Hospital, Iran in 2004. Diagnosis of ischemic stroke and LA was performed by stroke neurologists using CT scan. The effects of race, gender, age groups, hypertension, diabetes, hypercholesterolemia and smoking on frequency rate of LA were evaluated. The frequency rate of LA was the same in stroke patients living in North America or Iran. But, the frequency of LA in female stroke patients was more frequent than males [p<0.005]. LA was significantly predominant in stroke patients with age >/= 65-yrs than those with age<65-yrs [p<0.05]. The frequency of LA was significant in hypertensive patients. However, the frequency rate of LA was not influenced by diabetes, hypercholestrolemia and smoking. Female gender, age and hypertension seem to be the main risk factors of leukoaraiosis. In addition, there was no difference between the frequency rates of LA in patients living in Iran or North America