[Preterm delivery in women with low PAPP-A at first trimester screening]

Previous investigations have shown that pregnancy-associated plasma protein-A [PAPP-A] levels are associated with adverse pregnancy outcomes including intrauterine growth restriction [IUGR] fetuses as well as preterm delivery. The aim of this study was to determine the rate of preterm delivery in women with low PAPP-A and at intermediate risk for chromosomal abnormalities in the first trimester screening. A total of 137 women who underwent Down syndrome screening between 11 to 14 weeks of gestation were studied from September 2011 to September 2013 at Perinatal Care Clinic, Imam Khomeini Hospital, Ahvaz, Iran. From those, 52 patients had low PAPP-A. Inclusion criteria were singleton pregnancies, at 11 to 14 weeks of gestation, at intermediate risk for Down syndrome [risk in 1:101 to 1:1000]. The intermediate risk was estimated based on maternal parameters, maternal serum markers [PAPP-A and b-hcG], and nuchal translucency [NT] using fetal medicine foundation [FMF], UK] software. The power of the study was 90%. The sample size was estimated based on prevalence of preterm delivery in pregnancies with low PAPP-A in the first trimester screening. Patients were followed-up until delivery to observe pregnancy outcomes. We evaluated the variables such as level of PAPP-A, outcomes of delivery, age, b-hCG, and gestational age. Among 137 normotensive pregnant women at intermediate risk for Down syndrome, 52 cases [38%] had low PAPP-A [<0.4 MoM]. Of 52, 14 cases [27%] had preterm delivery. None of our patients had pregnancy related or non related diabetes, preeclampsia, or chromosomal anomalies. 45 cases [86%] from 52 patients were equal or less than 35 years, while 7 patients were more than 35 years. Among 52 followed-up patients, 48 patients [92.4%] were at low-intermediate risk [risk in 1:251 to 1:1000], and 4 cases [7.6%] were at high-intermediate risk [risk in 1:101 to 1:250]. We found high frequency of preterm delivery in pregnant women with low PAPP-A level at the first trimester screening. Hence, this group of patients needs special and early preventive management. Furthermore, we suggest that future researches to be conducted with larger sample size and also cervix length measurement to be included

Comparison of giemsa staining, intraperitoneal injection and oral administration methods in rat brain infected with toxoplasma gondii

Toxoplasma gondii is one of the most common protozoan parasites in humans and animals in all countries of the world. The aim of this study was to detect Toxoplasma parasite in the brain of wild rats in Tehran using smear preparation, Giemsa staining, Intraperitoneal injection and oral administration to Souri mice. Forty rats were collected from different areas of Tehran. Smears were prepared from rat brains on glass slides and stained using Giemsa. In the second method, a cell suspension was prepared from rat brain and was given orally and injected intraperitoneally into Souri mice. In peritoneal method, peritoneum of the mice was examined for parasites. In oral method, the titer of Toxoplasma antibody in sera of Souri mice was determined using Toxoplasma IgG antibody kit and anti-mouse conjugate of Sigma company. All results were negative in Giemsa staining method. In the second method, the results were negative and no parasites were observed in peritoneum of Souri mice. In oral administration method, after ingestion of suspensions by Souri mice and measuring the IgG titer, 50% of them showed a positive titer after one month. In detection of Toxoplasma gondii, the method of smear preparation on glass slides followed by Giemsa staining, and intraperitoneal injection of brain suspensions to Souri mice are of less value in comparison with oral administration of suspensions and determining the titer of IgG in sera of Souri mice

[Measurement of cervical length changes during normal pregnancy by endovaginal ultrasound device]

Cervical inability to preserve pregnancy is called cervical insufficiency. On-time diagnosis of cervical insufficiency is important for taking appropriate preventive actions. Endovaginal sonography is a powerful predictor for spontaneous preterm pregnancy loss. Importance of cervical length measurement is to diagnose cervical insufficiency and to decide on cerclage. In this study, we evaluated endovaginal sonography assessment of cervical length changes during a normal pregnancy. In a prospective cross-sectional study endovaginal sonography on 150 pregnant women [50 in every trimester] was performed to measure cervical length and mean of the cervical lengths in the three trimesters was compared together by one way ANOVA test. The patients were followed until labor. Twin pregnancies and cases with history of uterus curettage, cervical anomalies, preterm labor and cerclage were excluded from the study. Mean of the cervical length in the first, second and third trimesters of pregnancy respectively were 39, 40.7 and 39.3 mm respectively. In addition, the minimum and maximum length of cervix in the same trimesters were 28 and 56 mm, 26 and 52 mm, 27 and 52 mm respectively. Minimum cervical length was seen in the first pregnancy and maximum cervical length was seen in past NVD. No significant statistical differences were seen between the means of cervical length in the three trimesters of pregnancy or maternal age. However, there was a significant statistical difference between mean cervical length and maternal parity [p=0.05]. The mean cervical length in three trimesters was 39 mm and considered as an accepted value for mean cervical length in different trimesters. According to presence significant correlation between cervical mean lengths and multiparity with no preterm labor history, it may be safer if there is no preterm labor history in a multiparity pregnant woman

Fixation and unfixatjon of folley catheter in cesarean section, a comparative study

It is recommended to fix Folley catheter during and after cesarean section. In such circumstances, not only the bladder is drained continuously but also it doesn't disturb surgeon. But Folley catheter induces infection, in this study we didn't fix Folley catheter and evaluated studied patients for complications. In this prospective study, 100 parturient who needed elective cesarean section and entered two hospitals in Ahwaz were evaluated. Control and study groups had 50 parturients each. In control study only eight women [16%] out of fifty needed Folley catheter fixation and Bladder trauma wasn't seen in both the groups. It is recommended to fix Folley catheter during casarean section, but it is uncomfortable for parturients. Hematuria and urinary tract infection were evaluated in both groups but the results weren't significantly different. It is suggested not to fix Folley catheter routinely but only in those patients in which it is indicated

Transvaginal sonography and cervical length changes in normal pregnancy

Transvginal sonography [TVS] is the gold standard for investigating cervical Length. The aim of this study was investigation of cervical length changes during normal pregnancy by TVS. This epidemiotogical study was carried out from 22[en] April 2006 to 21[st] April 2007 on 150 pregnant women who had contacted Ahwaz Imam Khomani Hospital. Cervical Length changes in normal pregnancies were studied by TVS in three trimesters. Gestational age of studied population was 8 to 37 weeks. Anova and Chi Square tests were used for statistical analysis. In the 2[nd] trimester the cervical length was at minimum [26mm] and mean cervical length was [40.72 mm]. In the 1[st] trimester cervical length was the maximum of [56 mm] and mean cervical Length was [39.03 mm]. Mean cervical length was the shortest [37.83 mm] in the under 20 years and longest [40 mm] in the over 35 year's age group. Transvaginal Sonography is useful, for cervical length evaluations and management of preterm deliveries and cervical insufficiency

In vitro interactions of miconazole with sulfametoxazole against candida species

Finding the synergism effect of miconazole and sutfametoxazole on 4 species of candida. Interactions of miconazole in combination with sulfametoxazote were tested in buffered yeast-nitrogen base using checkerboard method. Plates were inoculated with 20 micro l cells suspensions of each yeast and incubated at 30°C for 24 hour. In this method, the MICs were described as the lowest antimicrobial concentration inhibiting visible fungal growth on the plates. Minimal fungicidal concentration [MFC] was described as the first tube showing no growth on the plate. The MIC of miconazole was 11.3O micro g/ml for Candida albicans. 8.9 micro g/ml for Candida tropicalis 8.6 micro g/ml for Candida papapsilosis and 5.2 micro g/ml for Candida krusei. When miconazole were combined with sulfametoxazole, miconazole MICs decreased to 1.54 micro g/ml for C. albicans, O.5 micro g/ml for C. tropicalis, O.383 micro g/ml for C. parapsilosis and O.275 micro g/ml for C. krusei. The data show that combination of miconazole and sulfametoxazole was synergistic on C. albicans, C. tropicalis, C. parapsilosis and C. krusei

[Efficacy of continuing medical education on knowledge of general practitioners]

Continuing medical education [CME] is a necessary way to keep graduated physicians knowledge and practice up-to-date, thus, play an important role in improving health care. Several years after implementing these programs in the country of Iran, it is necessary evaluate the efficacy of these programs. The aim of this study was to evaluate knowledge of participants in CME program before and after of CME programs. All general practitioners [GPs] who were participated in CME programs of the Mazandaran University of Medical Sciences [Sari, Iran] in the spring of 2006 entered in the study. A self directed and multi choice questionnaire was designed to seek demographic characteristics and knowledge of them about titles by programs. Its reliability was evaluated by internal consistency and validity by attending. The questionnaires were distributed before and after of each program. Data was analyses by SPSS and paired T- test. From 300 participates, 235 persons were completed the questioner [q] [response rate=78%]. The mean points of ENT q before and after program was 9.15 +/- 1.95 and 9.75 +/- 1.61, respectively [total point 20]. In addition, these mean points were 9.85 +/- 2.29 and 10.22 +/- 1.79 [total 18] for general surgery, 11.79 +/- 2.65 and 14.12 +/- 3.38 [total 23] for psychiatry, 6.48 +/- 2.55 and 8.52 +/- 3.3 [total 19] for ophthalmology, 5.83 +/- 2.39 and 9.07 +/- 2.53 [total 17] for urology, and 7.79 +/- 2.11 and 10.68 +/- 2.54 [total 24]for dermatology. The mean scores of knowledge of GPs were low and CME programs could not improve it, therefore, it is necessary to re-evaluate the contents and methods of CME programs for improving knowledge of general practitioners