[Evaluation of the effect of vaginal misoprostol on cervical priming in patients candidate for dilatation and diagnostic curettage: a randomized clinical trial]

Dilatation of cervix is essential in case of dilatation, curettage, and hysterectomy. Complications encountered during the procedure are partly related to difficulty in cervical dilatation. Also, it is important to find materials which can facilitate passage through the cervix. The present study was done with the objective of evaluating the effect of vaginal misoprostol on cervical priming in patients who are candidate for dilatation and curettage. This study was performed as a randomized clinical trial on 60 women who were candidate for dilatation and curettage. In 30 patients [case group], misoprostol 200micro g [one tablet] was inserted into posterior fornix of vagina 4 hours before operation, whereas in other 30 patients [control group], placebo was used. Then, two groups were compared in terms of their need to use Hegar dilator thinner than number 5 for dilatation of cervix, the duration of operation, and curettage. Data were analyzed using descriptive statistics, chi-square test, and t-test. The confidence coefficient was 95%, and the significance level was considered p<0.05. There was no significant difference between the patients of two groups in age, parity and previous mode of delivery. Hegar dilator thinner than number 5 for dilatation of cervix was used in 4 patients [13/3%] of the case group and 11 persons [36/7%] of the control group [p<0/05]. The mean duration of dilatation and curettage was 8.9+1.9 minutes in the control group and 5.6+1.39 minutes in the case group, that was significantly different [p<0.05]. According to the results of this study, vaginal misoprostol can be a suitable drug for cervical priming before dilatation and curettage; it also facilitates dilatation of cervix

value of qualitative detection of human chorionic gonadotropin in vaginal washing fluid for diagnosis of preterm premature rupture of membranes

This study was performed to determine the sensitivity and specificity of qualitative hCG testing of vaginal washings for diagnosis of preterm premature rupture of membranes [PPROM]. A total of 92 singleton pregnant women at 20 - 37 weeks of gestation were placed in two equal groups of documented rupture of membranes and intact membranes as control. Confirmatory tests included pooling of amniotic fluid in the vaginal vault with positive ferning test. Patients with vaginal bleeding and obvious fetal anomaly were excluded. After cleaning the vagina with a sterile tampon and irrigation with 5 ml sterile saline, fluids were collected from the posterior vaginal fornix. Samples were tested by a pregnancy test strip with sensitivity of 25 mIU/ml. Data were collected and analyzed using t-test, Mann-Whitney, Chisquared, Fisher's exact tests. The groups had similar demographic characteristics. The hCG test was positive in 38 [83%] of the ruptured membranes group and in 4 [8%] of the control group. Sensitivity, specificity, positive predictive value, and negative predictive value were shown to be 83%, 91%, 90%, and 84%, respectively. The qualitative determination of hCG in vaginal washings proved a simple, rapid, noninvasive, and reliable test in the diagnosis of PPROM.

Validity and Reliability of the Iranian Version of the Insomnia Severity Index

Background: The Insomnia Severity Index (ISI) is a short subjective questionnaire which helps physicians in making decisions about patients suffering from insomnia. The present study was an attempt to test the reliability and validity of the Iranian version of the ISI and to measure the correlation between ISI items and polysomnography results in chronic insomnia patients. Methods: Two groups responded to the Persian translation of four questionnaires; ISI, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and General Health Questionnaire (GHQ). The first group consisted of 135 patients diagnosed with chronic insomnia, and the second group was comprised of 55 normal people. After completing the questionnaires, the insomniac patients underwent standard overnight polysomnography. Results: The internal consistency demonstrated by Cronbach’s alpha coefficient was above 0.8 for both groups. The Intra-class correlation coefficient was above 0.7 after two weeks for both groups. The correlations between ISI, PSQI, ESS, and GHQ were high. In addition, close correlations were found between scores obtained from the ISI questionnaire items in insomniac patients with corresponding polysomnographic variables. Conclusion: The Iranian version of the ISI is a reliable and valid instrument. It is a valuable short and first-line questionnaire for insomnia research and clinical work.