Rectal vs. sublingual misoprostol in cesarean section: Three­arm, randomized clinical trial.

BACKGROUND: Misoprostol is a myometrial stimulant with uterotonic properties and can be administered rectally, vaginally, or sublingually. Numerous studies have investigated the effect of misoprostol on the prevention and treatment of PPH (postpartum hemorrhage) after vaginal delivery, but its use to control PPH during cesarean section has not been widely studied. METHODS: In this clinical trial study, 180 pregnant women who were candidates for cesarean section were included in the study. They were divided into 3 groups of 60 people (sublingual misoprostol group, rectal misoprostol group, control group). In all three groups, the volume of blood lost was recorded in the checklist at the end of surgery. Data were entered into SPSS software and analyzed. RESULTS: The mean bleeding in the control group was 225.4±63.9, while it was 137.9±33.8 and 118.9±28.5 in the sublingual misoprostol group and rectal misoprostol group, respectively. We had significantly more bleeding in the control group (p<0.001) compared to the other two groups. CONCLUSION: These results confirm the positive effect of misoprostol in reducing bleeding and show the superiority of using rectal misoprostol compared to other methods of reducing bleeding during cesarean section.

Effect of Melissa officinalis on systolic and diastolic blood pressures in essential hypertension: A double-blind crossover clinical trial.

For a long time, Melissa officinalis (M. officinalis) has been used to treat cardiovascular diseases. Therefore, this study aimed at evaluating the effects of M. officinalis on systolic and diastolic blood pressures in hypertensive patients. We conducted a double-blind, controlled, randomized crossover clinical trial on 49 patients who received either M. officinalis capsules (400 mg/d; n = 23) or the placebo (n = 26) three times per day for a 4-week period. After a 2-week washout period, the M. officinalis group received placebo and the other group received M. officinalis for another 4-week period. The systolic and diastolic blood pressures were measured once at baseline and then every 2 weeks for 10 weeks. The statistical analysis of the obtained data revealed that the chronology of the consumption of M. officinalis and placebo had no effect on the systolic and diastolic blood pressures in these two studied groups. Moreover, it was found that systolic and diastolic blood pressures significantly decreased after the consumption of M. officinalis, compared to placebo. Systolic and diastolic blood pressures in group A at the beginning of the study were 152.30 ± 5.312 mmHg and 95.52 ± 1.988 mmHg, respectively, and, after the first phase (drug use), reached 129.88 ± 9.009 mmHg and 80.13 ± 5.488 mmHg, respectively. Systolic and diastolic blood pressures in group B at the beginning of the study was 152.26 ± 5.640 mmHg and 94.44 ± 2.607 mmHg, respectively, and after the second phase (drug use), reached 131.77 ± 8.091 mmHg and 81.46 ± 7.426 mmHg, (p = .005), respectively. Also, no significant side effects were observed during the study. According to the results, M. officinalis can reduce systolic and diastolic blood pressures of the patients with essential hypertension.

Total delay and associated factors in pulmonary tuberculosis patients in Golestan province.

BACKGROUND: Delay in diagnosis and treatment of TB is a critical component in TB control program which thereby spreading illness in the community. Sicnce Golestan province has the high risk with high rates of tuberculosis in the country, therefore, the analysis of the factors associated with treatment delay in this province for effective interventions and proper planning is considered necessary. METHODS: 689 patients documents of TB cases in the health department of Golestan University of Medical Sciences in 2016 were enrolled in this survey. The response variable in this study was having the delay or not (via determining the 34 day as cut-off point in the interval between the date of onset of the symptoms and the date of treatment start-up). The data were analyzed using SPSS 24 software and final significant level for multivariate logistic regression model was considered 0.05. RESULTS: Median (mean) treatment delay was calculated 49(77.75) days. In the current study 60.4% of patients had total delay greater than 34 days. In final model variables such as type of PTB (OR=0.645), contact history (patients who had no contact with TB patients (OR=1.441)) and patients who their contact history were unknown (OR=1.654)) had significant relationship with delay in starting treatment after 34 days of onset of symptoms of PTB patients in Golestan (p<0.05). CONCLUSION: It should beam emphasis on increasing the community's awareness of the symptoms of tuberculosis and effective collaboration should be made between the Infectious Disease Control Center and the private and public sectors.

Survival Factors in Patients With End-stage Renal Disease in Mazandaran Province, Iran.

INTRODUCTION: Survival analysis for patients with end-stage renal disease and factors influencing their survival is crucial due to the increase in the number of these patients along with their high mortality rate. This study aimed to analyse the survival rate of patients in north of Iran undergoing hemodialysis and to assess factors influencing their survival. MATERIALS AND METHODS: A historical cohort study was conducted on 500 patients on maintenance hemodialysis in 3 hospitals of 2 cities (Sari and Babol) in Mazandaran province during a 6-year period from 2007 to 2013. The Cox regression analysis was used to assess the impact of sex, age, education, smoking habit, primary cause of kidney failure, living with family, cardiovascular diseases, weight, age at diagnosis, and age at initiating hemodialysis on survival of the patients. RESULTS: The median survival time for the 500 hemodialysis patients was 108 months. Death occurred in 174 patients (34.8%). History of smoking, age, being unemployed, being illiterate, and renal cyst, congenital diseases, and unspecified diseases as the cause of kidney failure were the associated factors with survival of the patients. The 1-, 2-, 3-, 5-, 10-, and 12-year survival for these patients was estimated to be 84%, 77%, 71%, 58%, 43%, and 33%, respectively. CONCLUSIONS: This study showed a high level of mortality and poor survival prognosis for patient undergoing maintenance hemodialysis. History of smoking, age, being unemployed, being illiterate, and renal cyst, congenital diseases, and unspecified conditions as the cause of kidney failure were the associated factors with survival of these patients.