Severe maternal morbidity among women with a history of cesarean section at a tertiary referral teaching hospital in the southeast of Iran.

OBJECTIVES: Although the cesarean section (C-section) is known as a lifesaving procedure, it can also increase the risk of maternal mortality and morbidity. This study was conducted to achieve two objectives: (1) determination of maternal near miss (MNM) indicators and pregnancy outcomes among women with a history of C-section and (2) investigation of the women's experience of near miss events during childbirth to provide a deeper understanding of the weaknesses of care delivery process. STUDY DESIGN: The present study was conducted using a prospective cross-sectional study using the World Health Organization (organ system dysfunction-based) criteria. METHODS: All subjects were women at more than 22 weeks of gestation who gave birth in Ali ibn Abi Talib Hospital, Zahedan, Iran, and were referred to this hospital for childbirth or those within 42 days of pregnancy termination. Logistic regression was used to predict the risk factors for severe maternal outcomes (SMOs). RESULTS: Nearly 58% of all MNM cases were related to women with a history of C-section. The MNM ratio was estimated at 8.04 per 1000 live births. Moreover, the frequent causes of SMOs were reported as severe hemorrhage (58.3%), severe pre-eclampsia/eclampsia (27.8%), medical condition (8.3%), and sepsis or severe systemic infection (5.6%). Abnormally invasive placenta (61%) was the most common cause of severe hemorrhage. After adjustment for potential confounder variables, the hemoglobin level of <11 g/dl (odds ratio [OR] = 0.18, 95% confidence interval [CI] = 0.09-0.36) and place of residence (OR = 0.41, 95% CI = 0.19-0.90) remained as independent risk factors for SMOs in the final model of multivariate analysis. CONCLUSION: A risk assessment system is needed to diagnose and manage the risk factors for SMOs during prenatal care. In addition, there should be a continuous audit of the indication and number of C-sections performed across health facilities.

The clinical evaluation of platelet-rich plasma on free gingival graft's donor site wound healing.

OBJECTIVE: It has been proved that platelet-rich plasma (PRP) can promote wound healing. In this way, PRP can be advantageous in periodontal plastic surgeries, free gingival graft (FGG) being one such surgery. MATERIALS AND METHODS: In this randomized split-mouth controlled trial, 10 patients who needed bilateral FGG were selected, and two donor sites were randomly assigned to experience either natural healing or healing-assisted with PRP. The outcome was assessed based on the comparison of the extent of wound closure, Manchester scale, Landry healing scale, visual analog scale, and tissue thickness between the study groups at different time intervals. STATISTICAL ANALYSIS USED: Repeated measurements of analysis of variance and paired t-test were used. Statistical significance was P ≤ 0.05. RESULTS: Significant differences between the study groups and also across different time intervals were seen in all parameters except for the changes in tissue thickness. CONCLUSION: PRP accelerates the healing process of wounds and reduces the healing time.

Early versus late traumatic cataract surgery and intraocular lens implantation.

PurposeTo determine the proper time for traumatic cataract surgery after open globe injuries.SettingFarabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.DesignRandomized clinical trial.Patients and methodsIn a randomized clinical trial, 30 eyes with traumatic cataract after open globe injury with IOL implantation underwent early (in the first week after the trauma) and 30 eyes underwent late cataract surgery (from the first to second month after the trauma). We excluded patients who were under 12-year-old. All patients were visited at 1 week, 4 weeks, 12 weeks, and 6 months after surgery. In each visit, patients were examined regarding visual acuity, intraocular pressure (IOP), anterior chamber inflammation, IOL position, and posterior synechiae. In addition, posterior segment evaluation and fundoscopy were performed. Intraoperative complication including posterior capsular rupture, anterior vitrectomy, and zonulysis as well as the site of IOL implantation were documented and post-operative complications including raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were listed.ResultsBest-corrected visual acuity 6 months after surgery was not different between the two groups. Also in early cataract surgery group, the rate of posterior capsular rupture was not significantly higher than the late surgery group (P=0.069). On the other hand, zonulysis was significantly higher in the late procedure group (P=0.039). Other complications including anterior vitrectomy, raised IOP, anterior chamber inflammation, visual axis opacity, posterior synechiae, subluxation of IOL, and IOL pigment deposition were not different in the two groups.ConclusionsEarly and late traumatic cataract surgery and IOL implantation after open globe injuries, have no significant difference regarding the post-surgical BCVA and prominent intraoperative and post-operative complications.

A histologic, histomorphometric, and radiographic comparison between two complexes of CenoBoen/CenoMembrane and Bio-Oss/Bio-Gide in lateral ridge augmentation: A clinical trial.

BACKGROUND: Several grafting materials have been used for alveolar ridge augmentation. The literature lacks researches to compare CenoBone to other grafting materials. The aim of this study was to compare CenoBone/CenoMembrane complex to Bio-Oss/Bio-Gide complex in lateral alveolar bone augmentation in terms of radiographic, histologic, and histomorphometric parameters. MATERIALS AND METHODS: In this randomized controlled trial, ten patients who needed lateral ridge augmentation were selected and augmentations were done using either of CenoBone/CenoMembrane or Bio-Oss/Bio-Gide complexes. In the re-entry surgery in 6 months following augmentation, core biopsies were taken and clinical, radiographic, histologic, and histomorphometric evaluations were performed. RESULTS: No statistically significant difference was seen between groups except for the number of blood vessels and percentage of residual graft materials. CONCLUSION: CenoBone seems to present a comparable lateral ridge augmentation to Bio-Oss in.

Birth outcomes in a tertiary teaching hospitals and local outposts: a novel approach to service delivery from Iran.

OBJECTIVE: The aim of this study was to compare the outcomes of childbirth care in a tertiary teaching hospital and Safe Delivery Posts (SDPs) to determine the safety of out-of-hospital care by midwives in Zahedan, Iran. STUDY DESIGN: A quasi-experimental design was applied in this study. METHODS: In this study, 2063 women who gave birth in SDPs, along with 983 women who underwent vaginal delivery in a tertiary teaching hospital, were evaluated in 2011-2012. Retrospective chart review was applied to collect data from the medical records of mothers and neonates. Only low-risk women with a singleton live birth, cephalic presentation, gestational age ≥37 weeks, spontaneous labour, and no prior history of uterine scar were recruited. RESULTS: Based on the findings, episiotomy, perineal tear, cervical laceration, postpartum haemorrhage and need for blood transfusion (or hysterectomy) were less commonly reported in the SDP group, compared to the hospital group. In the SDP group, 15 (0.73%) women were transferred to the hospital after delivery. Overall, one (0.10%) case from the hospital group and two (0.10%) cases from the SDP group were admitted to the intensive care unit. One-minute Apgar score lower than seven, resuscitation, NICU admission and neonatal death were more commonly reported in the hospital group, compared to the SDP group. Overall, hospital transfer was reported in 12 (0.58%) neonates born in SDPs. CONCLUSION: In the present study, women who gave birth in SDPs had more opportunities to experience natural birth with fewer adverse outcomes. However, considering the possibility of life-threatening complications for mothers and newborns, substantial evidence is required to improve the quality of care before implementing such novel strategies in different settings.

Population attributable danger of hereditary heart breaks. Risk factors among newborns in Yazd, Iran.

Background: hereditary heart problem are cardiac problems that develop prior to birth and influence the newborns' basic performance of heart. Different kinds of deficiency can range from mild (e.g. a small hole between the heart chambers) to severe (like a flaw or weakness into a heart part). Material & Method: This case-control research performed to evaluate PAR congenital heart defects danger parameters between newborns from 2012 to 2013 in Yazd hospitals. The defects were identified through echocardiography and recorded based on the 10th Revision of Diseases International Classification (DIC10). The total amount of cases were 96, of whom 14 were excluded regarding that the shortage of cooperation or insufficient data. One hundred and sixty five sex and region matched controls selected through random sampling involved in the research. Population Attributable Risk (PAR) utilized to evaluate and measure the priorities of the danger parameters. Finally, the Levin formula utilized to evaluate the regulate community ascribable portion. Result: Regulated odds rates evaluated for the danger parameters. The outcomes revealed that the greatest odds ratio belonged to the maternal history of stillbirth, lack of multivitamin use before pregnancy, maternal obesity, and overweight. The calculation of the adjusted Population Attributable Fraction in risk factors indicated that the highest fraction of the causes of natural heart malformations was associated with overweight and obesity. Conclusion: The current research showed that several factors that can impact the congenital heart defects. It concluded that although overweight and obesity had a weaker association than the other 2 parameters, they have a higher prevalence and a greater attributable risk.

Late developing supernumerary premolars: reports of two cases.

This paper presents two cases of late developing supernumerary premolars. Case 1 is a female patient with nonsyndromic multiple supernumerary teeth located in the maxillary right premolar-molar region, maxillary left premolar region, and the mandibular right and left premolar regions. In this patient surgical removal of all supernumerary teeth was carried out to avoid complications during orthodontic treatment. Case 2 is a female aged 19 years in whom formation of a mandibular supernumerary premolar was observed which was not present at age 13. The patient was made aware of the supernumerary tooth presence, and periodic radiographic assessment was planned.

Rhazes' prescriptions in treatment of gout.

BACKGROUND: Among the diseases that clinicians deal with, few do have a documented medical history that can be traced back to several centuries ago. A careful study of Rhazes' Treatments on Gout reveals a lot about the nature and therapy of gout. METHODS: We managed to study the perceptions about pathogenesis, symptomatology, diagnosis, and treatment of gout that have changed over time. We also discussed some of the past and present fallacies regarding this disease. RESULTS: Rhazes provided a detailed description on the vital role of genetics and the relationship between the development of gout, an indulgent way of living, and tophi at a period of time between 1st and 6th centuries AD. CONCLUSION: This study showed that the findings of Rhazes about treatments of gout were consonant with modern medical theories.

Meat consumption and cooking practices and the risk of colorectal cancer.

BACKGROUND/OBJECTIVES: The association between meat consumption and the risk of colorectal cancer (CRC) has been controversial. One of the difficulties in determining this association has been measurement of different attributes of meat consumption, including cooking methods and level of doneness. SUBJECTS/METHODS: We investigated the association between meat consumption and cooking practices and the risk of CRC in a population-based case-control study in the Western Australian Bowel Health Study. From July 2005 to February 2007, 567 incident CRC cases and 713 controls, who were frequency matched to cases for age- and sex, completed questionnaires on lifestyle and meat consumption. Estimated odds ratios (ORs) comparing meat consumption quartile groups were obtained from multivariate logistic regression models. RESULTS: The amount of red baked meat consumed had a statistically significant inverse trend of association with CRC (Q4 OR=0.73 95% confidence interval 0.53-1.01). When frequency was multiplied by serving size and by doneness, the association remained protective but was no longer statistically significant. The protective trends for red pan-fried meat were also borderline statistically significant. There were no other statistically significant or meaningful associations with any of the types of meat cooked by any method and the risk of CRC. CONCLUSIONS: Our data do not support the hypothesis that meat consumption is a risk factor for CRC.

Electroviscous sphere-wall interactions.

A theoretical analysis is presented to determine the forces of interaction between an electrically charged spherical particle and a charged plane wall when the particle translates parallel to the wall and rotates around its axis in a symmetric electrolyte solution at rest. The electroviscous effects, arising from the coupling between the electrical and hydrodynamic equations, are determined as a solution of three partial differential equations, derived from Cox's general theory [R.G. Cox, J. Fluid Mech. 338 (1997) 1], for electroviscous ion concentration, electroviscous potential and electroviscous flow field. It is a priori assumed that the double layer thickness surrounding each charged surfaces is much smaller than the particle size. Using the matched asymptotic expansion technique, the electroviscous forces experienced by the sphere are explicitly determined analytically for small particle-wall distances, but low and intermediate Peclet numbers.

Electroviscous cylinder-wall interactions.

A theoretical analysis is presented to determine the forces of interaction between an electrically charged cylindrical particle and a charged plane boundary wall when the particle translates parallel to the wall and rotates around its axis in a symmetric electrolyte solution at rest. The electroviscous effects, arising from the coupling between the electrical and hydrodynamic equations, are determined as a solution of three partial differential equations, derived from R.G. Cox's general theory [J. Fluid Mech. 338 (1997) 1], for electroviscous ion concentration, electroviscous potential, and electroviscous flow field. It is assumed a priori that the double layer thickness surrounding each charged surface is much smaller than the length scale of the problem. Using the matched asymptotic expansion technique, the electroviscous forces experienced by the cylinder are explicitly determined analytically for small particle-wall distances for low and intermediate Peclet numbers. It is found that the tangential force usually increases the drag above the purely hydrodynamic drag, although for certain conditions the drag can be reduced. Similarly the normal force is usually repulsive, i.e., it is an electrokinetic lift force, but under certain conditions the normal force can be attractive.