Methotrexate and misoprostol against misoprostol alone for early medical abortion: comparative study

Vaginal mifepristone oral misoprostol have proven to be highly effective medical abortion methods and are used widely in in modern countries. The objective of this study is to compare the efficacy for two medical abortion regimens used in one clinic setting misoprostol alone, intramuscular methotrexate and vaginal misoprostol. An intervention study was conducted on a total of 100 randomly selected women with gestations of first-trimester pregnancy, who sought a missed abortion. Study population was assigned as two groups, the first was subjected to vaginal administration of Misoprostol and the second was subjected to EV1 injection of methotrexate and self-administration of vaginal misoprostol After 72h. All patients were followed up for recording any side effects of the drugs, progress of abortion and if there was any need for surgical interference [manual vacuum aspiration [MVA] or dilatation and curettage. Success rate of the methotrexate regimen was 80% and did not differ significantly from the misoprostol regimen that had success rate of 84%.In this real-use setting, the use of misoprostol in combination with methotrexate or alone for the missed abortion termination are both safe and effective methods without serious side effects

predictive value of Intima-media thickness of the common carotid artery in the prevention of stroke

Non invasive measrument if intime-media thickness [IMT] of the common carotid aretery by high reolution ultrasonography and its important in stroke patient.The study was designed to study this relation in our locality.Thirty patients with ischemic stroke that were admitted in the medical department of Al Yarmook teaching hospital were tested by the aid of echocardiology department to measure intima-media thickness of the common carotid artery and they were compared with 20 persons[matching age and sex] without history of stroke or trasnient ischemic attack. The mean ot IMT of common carotid artery in stroke patients was 1.24mm while in control group the mean was 0.765 mm. There is a significant relation between the increased IMT of common carotid artery and stroke

[ difference of psychopathology in patients with multiple sclerosis with and without substance abuse]

Background and Aims: Substance abuse may have different effects on multiple sclerosis. Till now, studies on substance abuse and its correlation with psychopathology, type and severity of multiple sclerosis are limited. We conducted this study to evaluate the psychopathology of patients with multiple sclerosis with and without substance abuse

Methods: In this case-control, cross-sectional study performed in 2012, 125 patients with multiple sclerosis in Kerman were enrolled. From all, 100 patients did not have substance abuse and 25 ones had substance abuse. In each group, the Millon Clinical Multiaxial Inventory-III [MCMI-III] test was done by patient and the patients' Expanded Disability Status Scale [EDSS] were determined. We used DSM IVTR criteria to diagnose substance abuse

Results: The frequency of obsessive convulsive disorder [OCD] was significantly higher in patients without substance abuse and paranoia, delusional, and sadistic were significantly higher in substance abuse group [P<0.05]. The achieved Expanded Disability Status Scale [EDSS] was significantly higher in substance abusers. Also, the type of multiple sclerosis was different between the two groups. The relapsing-remitting type was higher in the group without substance abuse and the progressive-relapsing type was higher in the group with substance abuse

Conclusion: Psychiatric disorders were seen in both groups. Substance abuse had correlation with psychopathology, type and severity of multiple sclerosis

Subtotal gastrectomy for a carcinoma of stomach without post operative chemotherapy

A 47-year old female was complaining of upper abdominal pain. Ultrasound revealed chronic calculus cholecystitis. OGD showed a large tumor in the gastric antrum. Biopsy indicated adenocarcinoma. On exploration it was observed that the tumor in the distal part of the stomach had invaded the serosa with multiple node enlargement. Cholecystectomy with subtotal gastrectomy and roux-en-y gastro jujenostomy and excision of the greater and lesser omentum and supragastric and infragastric lymph node excision were undertaken. The postoperative period was uneventful. No postoperative chemotherapy was given and the patient is free of distant metastasis and local recurrence after six years

[Approach to antiplatelet and anticoagulant therapy before endoscopic procedures]

The use of anticoagulant and antiplatelet agents has become more prevalent during the past decades. These drugs may potentially cause gastrointestinal [GI] bleeding. Thus, there is an increasing need for GI endoscopy in patients who take these medications. In patients who take anticoagulant and antiplatelet agents, the appropriate conditions under which endoscopic procedures should be performed remain unclear. In this manuscript, we reviewed studies regarding this context in an attempt to present a practical guideline for management these patients

Missed bullet: a case report

A 27-year old Iraqi male patient with no known chronic illnesses presented with pain in the lower abdomen associated with frequency of micturition and blood in the urine with bouts of fever of about six years' duration. He gave a history that when he was 10years old during the war in Basrah, Iraq 1991,while he was playing football in the street one of his friends pointed out a red stain on the side of his T-Shirt. Removal of the shirt showed a small bloody wound over the left side of his back. No surgery was done at that time and the wound was treated by cleaning and dressing. Physical examination was normal apart from suprapubic tenderness. Blood test normal. Urine analysis-red blood cell 6-8/H.P.F. KUB: full size bullet in the pelvis. CT-Scan: Intravesical metallic foreign body [bullet] with right lateral wall linear calcification likely related to the site of entrance. Operation was done under spinal anesthesia and the bullet extracted from the urinary bladder. The post-operative period was uneventful and the patient was discharged after two days in a good condition and the stitches removed after eight days

Drug induced liver injury: a review article

The incidence of drug induced liver injury [DILI] is about 1/1000 to 1/10000 among patients who receive therapeutic drug doses. Drug induced hepatotoxicity is a major cause of acute and chronic liver disease. The severity of liver damage ranges from nonspecific changes in liver structure to acute liver failure, cirrhosis and liver cancer. Some common agents that can cause liver injury are acetaminophen, antibiotics, statins, INH and herbal drugs. Drug-induced hepatotoxicity can be categorized based on the pattern of liver enzyme alteration [hepatocellular, cholestatic or mixed pattern], the mechanism of hepatotoxicity [direct, immune mediated or idiosyncratic] and hjstologic findings on liver biopsy [steatosis or sinusoidal obstruction syndrome]. Treatment options for DILI include discontinuing the drug, conservative measurements and liver transplantation in the case of non-acetaminophen induced hepatotoxicity

Lipoid proteinosis: a case report urbach and wiethe disease

Lipoid proteinosis [LP] is a rare autosomal recessive disease characterized by the deposition of an amorphous hyaline material in the skin, mucosa and viscera. The classic manifestation is onset in infancy with a hoarse cry due to laryngeal infiltration. Skin and mucous changes develope, and the disease follows a slowly progressive course. In this case report, a 49 year-old man presented with a longstanding hoarseness since childhood, dysphagia and asymptomatic skin lesions. Esophageal biopsy showed the deposition of homogenous eosinophilic hyaline-like material compatible with LP

[ overview on acute liver failure; prognosis and treatment]

Acute liver failure [ALF] is an uncommon, devastating syndrome of which over 2000 cases occur annually in the USA, with a mortality rate of about 80%. ALF is defined by the sudden onset of hepatic encephalopathy and coagulopathy [INR>/=1.5] in an otherwise healthy person. The most common etiologies are acute viral hepatitis A and B, medication overdose [e.g., acetaminophen] and idiosyncratic drug reactions. The outcome of ALF is determined by its etiology, the degree of hepatic encephalopathy present on admission and by complications, particularly infection. In the era of orthotopic liver transplantation and with improvements in the intensive care of patients with ALF, spontaneous recovery and overall survival now exceed 40% and 65%, respectively. Increased information about the etiologies and treatment options of this syndrome will improve the survival rate of our patients. In this study, we have decided to discuss the main issues of ALF by reviewing the literature and recent papers

[Liver mass: an overview on diagnosis]

Liver lesion is a common condition, which often detect incidentally. A large proportion of liver masses can be diagnosed by progression in imaging modalities. Although, definite diagnosis of liver mass's nature can be made by biopsy of lesion and histopathologic examination, but with imaging findings, we can approach to the diagnosis. In this study, we review many valuable articles and scientific references to define main aspects of diagnosis of liver masses

193 nm ArF excimer laser induced changes in aqueous humor of rabbit's eyes

The changes in aqueous humor of rabbits' eyes after land 4 weeks of corneal photoablation with 193 nm argon fluoride [ArF] excimer laser with two different intensities [300 mJ/cm[2] and 500 mJ/cm[2]] were investigated. In the 1[st] group the right eyes were submitted to 300 mJ/cm[2] and left for one week, the 2[nd] group was submitted to 300 mJ/cm[2] and left for 4 weeks, the 3[rd] group was submitted to 500 mJ/cm[2] and left for one week and finally the 4[th] group was submitted to 500 mJ/cm[2] and left for 4 weeks. The left eyes from each group were used as control. Measurements of the total protein content, the refractive index [RI], sodium dodecyle sulfate polyacrylamide gel electrophoresis [SDS PAGE], column chromatography and ultraviolet spectroscopy profiles for aqueous humor were carried out. Non significant changes in the protein content and the refractive index [RI] were observed after 1 week of treatment with 300 mJ/cm[2]. All measurements detected significant changes after 4 weeks of treatment with 300 mJ/cm[2] and after 1 and 4 weeks of laser treatment with 500 mJ/cm[2]. The ultraviolet absorption spectrum revealed apparent depletion in ascorbic acid concentration. It was concluded that, ArF excimer laser [193 nm] leads to change in aqueous humor and formation of new protein with different molecular weights accompanied with a loss and oxidation of ascorbic acid and formation of dehydroascorbic acid

[ comparison of solubility of zinc phosphate and polycarboxilate based on Iranian standard No 2725 and 2726]

Zinc phosphate and polycarboxilate cement have wide application in operative, pedodontics dentistry and fixed prosthodontics. The Ariadent zinc phosphate and polycarboxilate cements are manufactured in Iran. One of the important and necessary properties of each cement to be used in oral cavity is its low solubility. The purpose of the present study was to determine and compare the solubility of Harvared zinc phosphate and polycarboxilate cement with Ariadent. In this experimental study that was based on specification No 2725 and 2726 of Iranian standard, ten discs shaped samples with 1 +/- 0.03 mm width and 10 +/- 0.3 mm diameter was constructed for each cement. Zinc phosphate solubility with spectrophotometry and polycarboxilate solubility with conductivity evaluation was measured. The data were analyzed with T test. Statistical analysis was significant [p<0.05]. The mean value of solubility for Harvard and Ariadent zinc phosphate cement was in order 1.23 +/- 0.24 and 0.86 +/- 0.15 mgr P205 per gr. There was statistically significant difference between the two above cements [p=0.001]. The mean value of solubility for Harvard and Ariadent polycarboxilate cement was in order 39.27 +/- 4.40 and 37.85 +/- 3.05 simence on the meter per kg. There was no statistically significant difference between the two above cements [p=0.4]. In accordance to determined values from Iranian standard No 2725 and 2726, the mean value of solubility of 4 experimental cements in this study was within standard limits

[Comparison of anti-H.pylori therapeutic responses in two groups of patients with and without cagA Ab]

CagA antigen is found in 60-80% of Helicobacter Pylori organisms. It seems that CagA positive strains have more virulence. The aim of this study was to compare the eradication rate of CagA positive and CagA negative genotypes using current quadruple regimens. The patients who had positive results for Helicobacter Pylori after endoscopy in Hazrat-Rasool Hospital were enrolled into the study. In 56 patients with positive rapid urease test [RUT], Anti CagA was determined and a 2-week quadruple regimen [Omeprazole, Amoxicillin, Metronidazole, and Bismuth] was prescribed. The UBT was performed two months after the end of treatment. Of 56 patients who were infected with Helicobacter Pylori, 36 [64.3%] had CagA antibody. 15 [26.8%] patients had positive UBT and 41 [73.2%] patients had negative tests. The success rate of treatment was 69.44% [25 patients] in CagA positive and 80% [16 Patients] in CagA negative participants. This difference was not statistically significant [P=0.533]. The presence of CagA is associated with higher success rate in conventional triple regimens but sufficient data for quadruple therapeutic regimens are not available. We did not find any association between CagA positivity and eradication rate of H.pylori

attitude of Saudi consumers toward dental advertising in Riyadh

The objective of this project was to measure the cognitive and effective responses of a random sample of the Saudi population to the advertisement in general and dental advertisement in specific. Seven hundred questionnaires were randomly distributed. The Data were analyzed by age and gender for significance difference at [P<0.05]. five hundred and fourteen questionnaires were collected [274 males and 240 females] with different occupations and educational levels. Fifty six percent of the participants were attracted to advertisements while [44%] weren't. Females showed more interest in advertisement [6.71%] compared to males. TV was the most exciting advertising media to both females [82.9%] and males [70.8%]. On the other hand [57.6%] of respondents were significantly affected by the recommendation of Saudi Dental Society on the advertisements of dental products. Advertisements which included dental floss and mouth washes increase the respondents [82%] awareness of proper oral hygiene. However, 55% of the respondents reported lack of interest to buy national products. This study contributes to our understanding of different variables that precede and determine Saudi consumers' attitudes towards advertisements. It also suggests that a stronger focus on the presented factors is necessary to improve the effectiveness of the advertisement on Saudi consumers and to improve the used advertising media to accommodate the Saudi cognitive preference

Diagnostic precision of the electrocardiogram for detection of culprit lesion of infarct related artery in acute st elevation myocardial infarction

Despite impressive advances in diagnosis over the past decades, ST elevation myocardial infarction [STEMI] continues to be a major public health problem in the many countries. In majority of patients with some STEMI, changes can be documented when serial electrocardiography [ECG] are compared: however, many factors limit the ability of ECG to diagnose and localize myocardial infarction [MI]. The aim of this study was to evaluate accuracy of ECG in diagnosis and localization of MI. This prospective study was conducted on patients with STEMI who were admitted in Modarress Hospital, in Tehran. All patients underwent electrocardiography and angiography. Then, findings of these two noninvasive and invasive diagnostic methods were described with two independent operators. 140 STEMI patients [80 patients with anterior and 60 patients with inferior MI] were enrolled in this study. Presence of complete right bundle branch block [CRBB] in ECG of patients with anterior MI had the least negative predictive value [NPV=69%]. ST segment depression more than 1mm in lead d1 had the most positive predictive value [ppb=97%] for right coronary artery involvement. ST segment elevation in leads v5 and v6 had the least positive value [ppv= 81%] for LCX involvement. ST segment depression in inferior leads had the most negative predictive value [94%] for LAD involvement. In patents with STEMI, electrocardiography alone is not a good diagnostic method to diagnose and localize MI

Cardiovascular risk factors in L-NAM E hypertension

In a previous study, hypertension was induced by administration of L-NAME for 1, 2 and 4 weeks. Hypertension was prevented when L-NAME was combined with L-arginine but not with dipyridamole. To study the changes in ECG, cardiac weights and plasma lipids associated with L-NAME hypertension. Wistar rats were allocated into a control group, 3 groups of rats that received L-NAME [20 mg/kg] for 1, 2 and 4 weeks, and 2 other groups that received L-NAME in the same dose for 2 weeks combined with L-arginine [40mg/kg] or dipyridamole [3mg/ kg]. The absolute weight of left ventricle [LV] and whole heart [WH] were significantly increased in L-NAME 4 weeks group, but such significant increase was lost when corrected for body weight [LV/BW and WH/BW]. In L-NAME and L-arginine 2 weeks group, there was no change in absolute or relative weights, whereas in the L-NAME and dipyridamole 2 weeks group, there was significant decrease in LV, WH and LV/BW. Concerning ECG parameters, there was no significant difference amongst control group and L-NAME I, 2 and 4 weeks groups as regards P-R interval, QRS complex and R-wave voltage. Both Q-To and Q-Tc intervals were significantly shortened in L-NAME 4 weeks group than control, L-NAME I week and 2 weeks groups. In L-NAME and L-arginine 2 weeks group, P-R interval was significantly shorter than control group. Also, L-NAME and dipyridamole 2 weeks group showed significant in R wave voltage than control and L-NAME 2 weeks groups. Treatment for 2 weeks with L-arginine or dipyridamole shortened Q-To and Q-Tc than control or L-NAME 2 weeks groups. In NAME-treated rats for I, 2 and 4 weeks, there was no significant changes in plasma levels of total cholesterol, HDL-cholesterol and LDL- cholesterol, nor atherogenic index or triglycerides. L-NAME hypertension up to 4 weeks duration was not associated with cardiac hypertrophy or ECG changes. Also, the lipid profile was not significantly modified from the normal pattern

Level of health awareness of Saudi patients on renal replacement therapy

To assess health awareness in patients on renal replacement therapy [RRT] in Saudi Arabia. This is a cross-sectional survey using a 22-item questionnaire in 143 randomly selected adult RRT patients [40 on hemodialysis [HD], 61 on peritoneal dialysis [PD] and 42 with renal transplant [TX]]. The study was carried out at King Abdul-Aziz Medical City, Riyadh in April 2006. The questionnaire was designed to evaluate patients' knowledge in 5 areas: 1. causes of renal failure, 2. biology of the kidneys, 3. symptoms of kidney disease, 4. therapeutic options available, 5. national kidney patients support facilities. The association between the level of awareness [the percentage of correct answers] to different demographic factors was assessed. Three fifths of the patients had less than secondary education. The average mark for correct responses of all patients was 45.9% with a highest [58%] for the category on biology of the kidney and lowest [36.8%] for national kidney patients support facilities. The PD group had the highest score [54.4%] followed by HD [44.3%] and finally TX [35.1%]. The level of our patients' health awareness is lower than satisfactory. Level of education seems to be a contributory factor

[Effects of volatile oil extracts of Anethum graveolens L. and Apium graveolens L. seeds on activity of liver enzymes in rat]

Various products from celery [Apium graveolens] and dill [Anethum graveolens] were used to relieve some of liver dysfunctions in Iranian traditional medicine, yet the potential effects of these two medicinal plants on liver function have not been investigated. To investigate the effects of volatile oil of these plant seeds on some hepatic enzymes including SGPT, SCOT and ALP in rats and also to identify the active components of volatile oils of these plants by GC/MS. Following the preparation of volatile oils, rats were intraperitoneally injected by 500 and 1000 micro l/kg of oils and the enzyme activity was measured at 6, 24, 48, 72, 96, 120, 144 and 168 hr post-injection. GC/MS analysis showed that the D-carvon and D-limonen are the major active components in volatile oil of dill and D-limonen and myrcen of celery. Serum activity of SGPT 24h post-injection of dill essence [500 micro l/kg], celery essence [500 micro l/kg], dill essence [1000 micro1/kg]and celery essence [1000 microl/kg] decreased by 12.85, 11.6, 13.7 and 12.6%, respectively. In the same way, the SGOT activity, under the similar conditions, decreased by 8.7, 10.5, 11.6 and 12.9%, respectively. Activity of SGPT, SGOT and ALP 168 hr post-injection of celery essence at dose of 1000 micro 1/kg, decreased by 21.2, 18.4 and 13.5%, respectively. Injections of dill and celery hydroalcoholic extracts at both doses caused lower enzyme activities. Active ingredients of dill and celery may act as an antioxidant or to decrease the production of free radicals, causing stabilization of hepatocyte membrane and decreasing the release of enzymes into the blood

Early pregnancy deficiency of vitamin D and the risk of preeclampsia

This study aimed at investigating the relationship between maternal deficiency of vitamin-D in early pregnancy and the risk of development of preeclampsia, and assessing the vitamin-D status of newborns of preeclamptic mothers. Prospective study. A prospective study was conducted in two tertiary hospitals in Jeddah, Saudi Arabia from May 2005, till January 2007. Five hundred healthy pregnant women were chosen for the study, a blood sample was extracted from each patient at gestational age 15-20 weeks and serum saved. By the end of ante- natal care, the 41 patients who developed preeclampsia were classified group 1, while 70 normo-tensive patients constituted group 2. At the time of delivery a cord blood sample is taken from newborns of patients in the two groups. Sera of each patient and her newborn are checked for S. active vitamin-D and S. Calcium. Comparison is made between women of the preeclamptic group and the control regarding age, parity, mean s. active vitamin-D and s. Calcium. Similar comparison is made between patients with severe [n=15] and mild preeclampsia [n=26]. Newborns of preeclamptic and control women are also compared regarding the mean levels of s. Vitamin-D and s. Calcium. There was no statistical difference between the two groups regarding the mean age and parity. The sera of patients with preeclampsia showed significantly lower levels of mean active vitamin D [44.87 +/- 3.66] and S. Calcium [8.33 +/- 0.525] than in the control group [59.05 +/- 4.73 and 9.66 +/- 0.67] with no statistical difference between mild and severe preeclampsia. Sera of newborns of preeclamptic patients have significantly lower levels of s. active vitamin-D [38.8 +/- 2.492] and s. calcium [8.26 +/- 2.39] than newborns of the control patients. Early pregnancy deficiency of active vitamin-D is a risk factor for development of preeclampsia. Measurement of s. vitamin-El in early pregnancy can be a reliable screening test for the prediction of development of preeclampsia. External administration of vitamin-El in early pregnancy is expected to be of value in prophylaxis of preeclampsia

Effect of mercury intoxication on thyroid funtion and blood cholesterol

Mercury is a heavy metal and transition element in periodic table that has many uses in industries, agriculture and medicine. This element can enter the body through different routs including food materials, ventilation and skin. To investigate the short and long term effect of mercury on thyroid hormone in the sera from rats. Mercuric chloride in doses of 3 mg/kg [short term or 10-day injection] and 1 mg/kg [long term or 45- and 60-day injection] was injected intraperitoneally into three test groups of rats [n=5]. Following each period of injections, the blood samples were collected for T[3], T[4], TSH and T[3] uptake measurements. Blood cholesterol level was measured simultaneously for monitoring cholesterol changes. After the 10-day injection, values for T[3], T[4] and TSH in test group were decreased 29, 18 and 30 percent, respectively, compared to control group [P<0.04]. T[3] uptake was increased 23 percent [P<0.04]. The 45-day injection caused a decrease in the levels of T[3] T[4], and TSH as 30, 16 and 40 percent, respectively. T[3] uptake and blood cholesterol levels were increased 25 and 8 percent respectively. Following the 60-day injection, the levels of T[3], T[4], and TSH in test group were decreased 51, 28 and 44 percent, respectively. T[3] uptake and blood cholesterol levels were increased 22 and 11 percent respectively [P<0.05]. Based on data obtained from current study, it seems that mercury chloride can lead to hypothyroidism and causes an increase in blood cholesterol level. Direct toxic effect of mercury on liver leads to low protein synthesis and may contribute to increase the serum concentration of T[3] uptake. Higher level of cholesterol may be attributable to resulting hypothyroidism, which in turn lowers T[4] and T[3] concentrations