خونریزی

Rhinoplasty is a challenging and complex surgery because it is designed to meet the unique needs of the patient. In rhinoplasty surgery, many factors contribute to achieving the desired result. These factors include the surgeon's care and observation, analysis of the existing anatomy, choice of surgical technique, degree of soft tissue and cartilage trauma, amount of bleeding, quality of surgical instruments and anesthesia, and anything that helps reduce bleeding.

This double-blind study was conducted on 50 patients aged 18 to 45 years undergoing septorhinoplasty surgery referred to Motahari Hospital in Jahrom city in 2022. Patients were randomly divided into dexmedetomidine and control groups. The degree of sedation, bleeding and surgeon satisfaction were evaluated and recorded. Data analysis was performed using SPSS software, version 21 (IBM SPSS, Armonk, NY, USA) and descriptive statistics (mean, standard deviation, percentage, number, frequency) and inferential statistical tests (Mann-Whitney U test, Kruskal-Wallis, t-test, chi-square test). The significance level in all tests was considered P<0.05.

The majority of patients in the study groups were female and the mean age of patients in the dexmedetomidine group was 34.36±7.33 years and in the control group was 36.60±9.59 years. The study groups were similar in terms of age and body mass index (P<0.05). The frequency of patient sedation in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05). The results showed that at the beginning of the operation and 90 minutes later, the satisfaction level of the patient surgeon in the dexmedetomidine group was significantly better than the control group (P<0.001). In the dexmedetomidine group, the field of view of the surgeon was relatively clear and completely clear. The amount of bleeding in the dexmedetomidine group was lower than the control group, but it was not statistically significant (P<0.05).

Dexmedetomidine increased the surgeon's satisfaction by reducing bleeding and improving the surgeon's visual field. Therefore, this drug can be used as an anesthetic aid in surgery.

The accidental discovery of thrombocytopenia is a medical challenge and may be of little clinical importance or indicate a serious disease affecting the hematopoietic system. In this article, we have discussed how to manage incidental isolated thrombocytopenia identified during occupational health examinations.

In this study, to effectively address the thrombocytopenia found accidentally in screening tests, researchers searched reliable databases such as Scopus, PubMed, Google Scholar, and others.

In general, thrombocytopenia may result from a decrease in platelet production, an increase in platelet consumption, or an increase in platelet separation from the circulatory system. In dealing with thrombocytopenia, a thorough history, physical examination, and targeted laboratory tests can identify patients who need immediate intervention. Common causes of thrombocytopenia include false thrombocytopenia, drug use, congenital thrombocytopenia, chronic liver disease, distributed thrombocytopenia, concurrent deficiency of folic acid and vitamin B12, immune thrombocytopenia purpura, thrombotic thrombocytopenic purpura, viral infections, and systemic autoimmune disorders. Additionally, assessing the risk of bleeding in these individuals should be considered.

Thrombocytopenia discovered in screening tests is a relatively common finding and has numerous underlying causes. A systematic approach is required to identify its underlying causes. Knowing the list of common benign causes of isolated thrombocytopenia and the alarm symptoms of this disorder can help an occupational health specialist identify high-risk people and take the necessary measures.

Familiarity with dental management to control bleeding in patients taking anticoagulant drugs is necessary. Purpose of this study was to investigate level of awareness of general dentists and final year dental students of Yazd about dental management for patients prone to unusual bleeding in 2023.

This cross-sectional study selected 135 general dentists and final-year general dental students in Yazd using convenient sampling. Level of knowledge was evaluated using the questionnaire of Moshaverinia et al., which was valid and reliable. Data were analyzed using Mann-Whitney and Kruskal-Wallis statistical tests of SPSS V.25 statistical software.

50 of the general dentists were male (58.8%), 35 were female (41.2%), 28 of the students were male (56%), 22  were female (44%). Mean ages of general dentists and students were 29.20 ± 4.93 and 25.16 ± 1.63, respectively. Average knowledge score of dental students was 8.72 ± 2.67 (Range: 1-14), while that of general dentists was 8.20 ± 2.86 (Range:2-15). There was no statistically significant difference between average knowledge score of general dentists and variables such as age, gender, work experience and university. There was no statistically significant difference between average score of students' knowledge and variables of age, gender and academic semester. There was no statistically significant difference between the average knowledge score of general dentists and students.

The results showed general dentists and final-year dental students in Yazd had moderate knowledge of dental management for coagulopathic patients.

Bleeding agents play a vital role in preventing complications from uncontrolled bleeding, such as death and organ damage. In addition to maximum coagulation speed and minimal blood loss, these compounds should have features such as biocompatibility, degradability, hemocompatibility, suitable mechanical properties, reasonable price, and ease of use. Recent research shows that some natural polymers such as oxidized cellulose, chitosan, starch, collagen and alginate have blood clotting properties. This study has investigated the binding performance, polymer source of these materials and products available in the market.

In this research, the role of bleeding coagulation by natural polymers was investigated in 55 authentic English and Farsi articles. International and Persian publications such as Elsevier, Springer, Wiley Online Library, ScienceDirect and SID were used. Keywords and functional words such as blood clots, sodium alginate, chitosan, hemostatic, oxidized cellulose, collagen and starch were used for searching.

The first step in wound healing is ligation. Subsequent steps that contribute to tissue regeneration include inflammation, proliferation, and remodeling. These materials are divided into synthetic and natural in the world market and research works. Natural coagulant polymers include oxidized cellulose, chitosan, collagen, starch, and alginate. Next, description of natural polymers, brief introduction of synthetic polymers, physical structure of binders and commercial samples have been discussed.

The use of natural polymers as hemostatic agents shows the high potential of these substances in improving therapeutic processes and reducing the side effects caused by synthetic substances, which can lead to the development of new and effective strategies in the management of acute bleeding.

Bleeding management during and after surgery, including the use of cell salvage device (CS), is one of the pillars of patient blood management.The purpose of this article is to investigate the coagulation status of heart surgery patients after using the CS device.

This cohort study (three days) was conducted in the third referral hospital in July 2019 after the establishment of patient blood management. The criteria for entering the study were selecting heart surgery patients who had given informed written consent to join the comprehensive program "patient blood management". After surgery and using the CS device, the patient's vital signs, the total bleeding volume in mL from the chest tube, as well as coagulation parameters were considered in the intensive care unit after surgery for three days.

In July 2019, for sixteen heart surgery patients the CS device was used, including 7 women and 9 men, with an average age of 61.36 years. Three days post-surgery, their vital signs stabilized, and no further surgical intervention was necessary. Follow-up tests revealed a significant reduction in bleeding from the first 6 hours through the end of the first day and from the second to the third day (p = 0.027). Platelet levels and PTT showed no significant changes over time (p = 0.009 and p = 0.006).

The patients’ vital signs were stable after using the device in the intensive care unit, and there was no correlation between the amount of bleeding and the laboratory parameters.

This study was conducted to compare the effect of two doses of remifentanil infusion on the amount of bleeding, intraoperative hemodynamic changes, and complications after rhinoplasty surgery with general anesthesia.

This prospective randomized clinical trial study was conducted on 80 patients who were candidates for rhinoplasty from March 1401 to August 1402 in Al-Zahra Hospital, Isfahan, Iran. The participants were divided into two groups of 40 people using random allocation software. remifentanil infusion was adjusted in the first group with a dose of 0.15-0.25 mg/kg/min and in the second group with a dose of 0.25-0.35 mg/kg/min. The goal was to maintain mean arterial pressure (MAP) between 60 and 65 mmHg, to achieve this goal, reducing or increasing the rate of remifentanil infusion was used. During the operation, a heart rate of less than 50 beats per minute was considered bradycardia and was treated with atropine 0.015 mg/kg. In addition, the remifentanil infusion rate was reduced if MAP fell below 60 mmHg for more than 60 seconds. Patients were evaluated and compared during operation and recovery in terms of hemodynamic parameters, intraoperative bleeding and postoperative complications.

There was no significant difference between the two groups in the changes of hemodynamic parameters during surgery and recovery (P>0.05). The average bleeding volume in the two groups receiving remifentanil 0.15-0.25 mcg/kg/min and 0.25-0.35 mcg/kg/min Remifentanil was 44.25±23.1 and 28.25±15.5 ml, respectively, and the difference between the two groups was significant (P<0.001). According to the surgeon's opinion, intraoperative bleeding in the 0.25-0.35 mcg/kg/min remifentanil group was significantly lower than 0.15-0.25 (P=0.001).

According to the findings of the present study, it seems that the use of 0.25-0.35 min/µg/kg dose of remifentanil compared to 0.15-0.25 min/µg/kg dose, is associated with a significant reduction in bleeding during rhinoplasty, and also the use of this dose is not associated with the occurrence of serious hemodynamic disorders, including bradycardia and severe drop in blood pressure.

Uncontrolled post-operative bleeding can lead to several problems and tissue repair disorder indentistry. This study has been conducted to compare the effect of Chitohem and natural silk on the onset of clot formations.

This laboratory study was carried out with a dependent parallel design. Three drops of blood were taken from each of 32 participants in the study. Fifty milligram Chitohem and natural silk powder were poured on two blood drops, respectively. The clot formation time was measured for all three groups simultaneously. Duration between pouring powder and starting of clot formation was recorded. Data analysis was performed using paired t-test and repeated measure ANOVA methods using SPSS 17 software.

Participants composed of 20 (62.5%) women and 12 (37.5%) men. The average age of the participants was 43.33 ± 4.08 years. The average time periods of the onset of blood clot formation in Chitohem group, natural silk and control group were 90.97 ± 29.99, 141.97 ± 49.10, and 195.44 ± 58.70 second, respectively. Paired t-test showed the mean time of clot formation was significantly different among groups (p = 0.0001).

Conclusions  :

Based on the obtained results, it seems that although effect of “organic natural silk” on coagulation time was less than “Chitohem”, but silk has an acceptable hemostatic effect. The simultaneous use of natural silk and Chitohem can have a synergistic effect.

Postpartum hemorrhage (PPH) is one of the main causes of maternal mortality. The present study was conducted with aim to investigate the relationship between low levels of fibrinogen and the severity of PPH and the importance of administering fibrinogen concentrate or cryo to reduce bleeding.

This prospective cohort study was conducted from 2017 to 2019 on 122 mothers with uterine bleeding in the first 24 hours after delivery in Mashhad. In case of persistent bleeding and rejection of traumatic causes, misoprostol was prescribed, and blood samples were taken at this time (time H0). Patients were divided into severe and non-severe groups by considering the severity of bleeding from H0 to 24 hours. Data were analyzed by SPSS software (version 16) and independent t-test and Mann-Whitney, paired t, Chi-square and Fisher's tests. P<0.05 was considered statistically significant.

Of 122 mothers, 38 and 84 were in the severe and non-severe groups, respectively. More than 50% of the mothers had a normal delivery, and there was no significant difference between the two groups in terms of delivery method (p=0.883). Postpartum fibrinogen level in H0 was significantly lower in the severe group compared to the non-severe group (p<0.001). The mean fibrinogen level was 274.8±115.8 mg/dL in the severe and 368.4±78.5 mg/dL in the non-severe groups.

Early administration of products containing fibrinogen can help to reduce the amount of bleeding in case of PPH and thus reduce the number of bleeding complications and possible interventions. In future studies along with increasing the sample volume, sampling 12 and 24 hours after delivery is also suggested to control the level of fibrinogen.

Bleeding during rhinoplasty is a complication that causes the surgeon to lose vision and will cause other complications. So far, various methods have been proposed to reduce bleeding during nose surgery. The present study aims to compare the effect of oral clonidine and tranexamic acid on intraoperative bleeding in patients undergoing rhinoplasty.

In this randomized, double-blind clinical trial, 120 patients who were candidates for elective rhinoplasty surgery were included. In the first group, three µg/kg of clonidine was administered orally 90 minutes before surgery. In the second group, 250 µg/kg bw tranexamic acid capsules were administered orally two hours before surgery. There was no intervention in the control group. Bleeding levels, hemodynamic parameters, and surgeons' visual satisfaction were evaluated.

The mean age of patients (28.67±5.35) years and 96 (80.0%) were women. Regarding the effect of drug and surgeon’s visual satisfaction, there is a significant difference between the clonidine and tranexamic acid groups (P=0.055); the mean bleeding volume in the clonidine group was 112.0±0.47 and in the tranexamic acid group was 132.0±0.36. In addition, the clonidine group (P=0.008) and tranexamic acid (P<0.001) showed a significant difference in terms of bleeding volume compared with the control group (195.0±28.1). The three variables of drug type, weight, and duration of anesthesia can explain and predict 51% of the changes (blood volume).

The results of the present study showed that clonidine can be more effective in reducing bleeding than tranexamic acid, and by creating a relatively dry and bleeding-free environment, it can improve the quality of the surgeon’s vision and reduce the duration of rhinoplasty surgery.

Excessive bleeding during and after childbirth is a serious complication that can endanger the life of the mother. The present study reported a case of active arterial bleeding after normal delivery.

The patient is a 22-year-old woman, G2L1 (second pregnancy), who underwent natural childbirth due to labor pains, decreased fetal movements, and exceeding the due date. The baby girl was born naturally without any complications, with an Apgar score of 9 and a weight of 3050 grams, without dystocia or any specific abnormalities. Approximately three hours after delivery, the mother experienced dizziness and fainting while trying to get out of bed. At that time, the patient's pulse was 120 bpm, and she appeared pale. The patient's blood pressure was reported as 60/90, and there was no vaginal bleeding. The uterus was palpated in its normal position above the suprapubic area. The vagina and cervix were checked again and found to be without any abnormalities or bleeding. Due to the persistence of the patient's symptoms, an emergency abdominal and pelvic ultrasound was requested, which was performed after several hours of delay. Consultation with a urologist was requested, and it was suggested to perform a cystogram and abdominal ultrasound on the patient. The abdominal ultrasound reported a large hematoma measuring 3.14 x 7.5 x 17 cm in front of the uterus and behind the bladder. The patient was transferred to the operating room and underwent general anesthesia. The abdomen was opened through a wide incision. A large hematoma measuring 17 x 18 cm was found in the area behind the bladder and in front of the uterus, extending up to the fundus of the uterus and broad ligaments. The hematoma was drained and found to be located in the lower uterine segment, without any connection to the cervix or inside the uterus.

Active primary and secondary intra-abdominal hemorrhage is one of the surgical emergencies after delivery. The patient should undergo surgery immediately and the bleeding should be controlled.

 The nature of septorhinoplasty surgery and hemodynamic instability in patients causes intraoperative bleeding, which affects the quality of the surgical field of view, intraoperative and postoperative complications, and surgical outcome.

This double-blind randomized clinical trial study was conducted on 60 patients aged 18 to 44 who were candidates for septoranioplasty surgery. Patients were randomly divided into two equal groups. Group 1: received bisoprolol 2.5 mg and group 2 received placebo as a control group. Hemodynamic symptoms will be measured before induction, after induction, 1 minute after induction, 5 minutes after induction, 30, 60, 90 and 120 minutes during operation, entering recovery and exiting recovery. The amount of bleeding during the operation was estimated based on the amount of bleeding in the suction.

In the times before and after induction, 1 minute, 5, 15, 30, 60, 90, 120, in recovery and outside of recovery, there was a significant difference between the two groups in the average systolic and diastolic blood pressure and blood pressure. There was no mean arterial (P<0.05). While the heart rate in these minutes was reported to be significantly lower in the bisoprolol group than in the control group (P<0.05).

The results of this study showed that the use of a dose of 2.5 mg of bisoprolol before the operation can significantly reduce the heart rate, but it does not make a significant difference in the hemodynamic changes and the bleeding rate of patients in septorhinoplasty surgery.

In rhinoplasty, bleeding reduces the surgeon's vision, so bleeding control is very important. Also, edema and ecchymosis are the most common side effects of rhinoplasty. Many drugs have been used to reduce edema and ecchymosis around the eyes after surgery, but they are not suitable for all patient groups due to some side effects. Administration of magnesium sulfate before or during surgery is approved which can stabilize hemodynamic parameters, especially by reducing blood pressure and heart rate. Labtalol is also a competitive blocker of alpha-1 and beta-adrenergic receptors, which reduces heart rate and blood pressure. The aim of this study was to compare the effect of intravenous magnesium sulfate and labetalol on bleeding during rhinoplasty and also edema and ecchymosis afterwards.

In this double-blind clinical trial, 60 rhinoplasty candidates were randomly assigned to receive either magnesium sulfate or labetalol. Magnesium sulfate infusion was done at 30-50mg/kg before induction of anesthesia and 10-20mg/kg/h during the surgery. Labetalol administration at 1mg/min was done during the surgery. We measured heart rate, bleeding rate, surgeon's satisfaction, postoperative complications, edema, and ecchymosis in both groups. The variables were analyzed in STATA V14 applying t-test, ANOVA, ANCOVA, and Chi-square.

In this study, 86.7% of patients were women. The average bleeding in the labetalol group (50.3±28.5cc) was less than that in the sulfate group (76.7±66.4cc) and this difference was on the borderline of significance (P≤0.05). The surgeon's satisfaction was significantly higher in the labetalol group (P<0.05). Edema (24 hours after the operation) and orthostatic hypotension were significantly lower in the sulfate group (P<0.05). There was no significant difference between the two groups in terms of average heart rate, sore throat, headache, respiratory depression, and ecchymosis rate (P>0.05).

According to this study, magnesium sulfate can be used in rhinoplasty to reduce edema and ecchymosis.

Gastrointestinal bleeding (GIB) is one of the most important diseases in internal medicine, which can occur due to bleeding in any of the gastrointestinal organs. The best diagnostic method for identifying the source of bleeding in patients is endoscopy and colonoscopy. Therefore, this study was conducted to determine the causes and the most common risk factors for GIB in patients referring to Shahid Mustafa Khomeini Hospital in Ilam.

In this retrospective analytical study, all patients with clear gastrointestinal bleeding symptoms, including melena, hematemesis, hematochezia, and passing clots, who referred to Shahid Mustafa Khomeini Hospital in Ilam from 2014 to 2019, were evaluated. The demographic information of the patients, their medical history, and the description of the medications they were taking, which were recorded in their medical records, were entered into the questionnaire form. Data analysis was performed using descriptive and inferential statistical methods.

In this study, 650 patients with an average age of 57.24 years, ranging from 19 to 99 years, were included. The majority of patients were in the older age group (above 60 years) and were male. The most common complaint among patients was hematemesis (41.4%), while anemia was the least common complaint (1.8%). The most common causes of gastrointestinal bleeding in both genders were peptic ulcer, gastric mass, and esophageal varices. There was a significant correlation between age and gastrointestinal bleeding symptoms (p < 0.05). Gastrointestinal bleeding symptoms, including hematemesis, melena, and rectorrhagia, were more common in men and in smokers. Alcohol consumption also had an impact on the occurrence of gastrointestinal bleeding with hematemesis, melena, and rectorrhagia.

Endoscopy and colonoscopy are the best diagnostic methods for patients with gastrointestinal bleeding. Therefore, this study was conducted to determine the causes and the most common risk factors for GIB in patients referring to Shahid Mustafa Khomeini Hospital in Ilam from 2014 to 2019. The findings of this study can help improve the diagnosis and management of gastrointestinal bleeding in these patients.

Neoadjuvant chemotherapy may increase complications after surgery, the incidence of these complications has not been accurately reported; Among these complications, we can mention the duration of surgery and the amount of bleeding during surgery, which are associated with subsequent complications, and there is no accurate information in this field; Therefore, the present study was conducted with the aim of investigating the effect of neoadjuvant chemotherapy on the amount of bleeding and length of surgery in breast surgeries in the form of a meta-analysis.

This study was conducted as a meta-analysis during 2022; A search using MEDLINE, Embase, the Cochrane Library, Google Scholar, ClinicalTrials.gov and the WHO International Clinical Trials Registry platform to identify studies evaluating the effect of neoadjuvant chemotherapy on complications after breast surgery with the keywords breast cancer/breast neoplasm; neoadjuvant therapy/neoadjuvant chemotherapy; Breast surgery/mastectomy was performed in this systematic review and meta-analysis.

Neoadjuvant treatment insignificantly reduces the duration of surgery (95% CI = -22.42-27.76, MD = 2.67, P = 0.083, I2 = 99%); Also, neoadjuvant treatment significantly reduces bleeding during surgery (95% CI = -107.44-23, MD = -75.85, P = 0.0001, I = 97%) (Figure 1, part B); It should be noted that the heterogeneity of both studies was significantly high.

Neoadjuvant chemotherapy with a partial face leads to an increase in the length of the surgical period and significantly leads to a decrease in the amount of bleeding during breast surgery.

Background & Aims:

 Controlling significant bleeding caused by accidents or battlefields is one of the main issues with emergency injuries. The current research was designed with the aim of investigating the binding performance of alginate, gelatin and alginate-gelatin superabsorbents in order to solve the aforementioned challenges.

Materials & Methods:

 In this experimental study, superabsorbents were prepared through crosslinking with calcium chloride and then freeze-drying. Physical properties of the synthesized superabsorbents were evaluated using FE-SEM analysis as well as porosity percentage and swelling ratio tests. Cell compatibility of superabsorbents was assessed using the MTT assay. Hemolysis, Blood Coagulation Index (BCI), RBC attachment, and platelet adhesion tests were utilized to evaluate the in vitro hemolytic activity of superabsorbents. Further, in vivo femoral artery surgery studies on rats were performed to investigate the hemostatic efficiency of the synthesized superabsorbents.

In vitro hemostatic ability results verified that synthetic sponges have better hemostatic properties than commercial ones. The results of cytotoxicity test revealed that alginate, gelatin, and alginate-gelatin superabsorbents are fully non-toxic, and h due to having a survival percentage more than 89%, they have significant cellular compatibility. Finally, in vivo hemostatic tests showed that the synthesized superabsorbents performed better than commercial samples in terms of bleeding control and decreasing coagulation time, as the amount of blood loss and coagulation time for optimum alginate-gelatin superabsorbent decreased respectively by 1.71 and 1.96 times compared to ChitoCell and 1.37 and 1.55 times compared to Gelita.

According to the results of the current study, the optimum alginate-gelatin superabsorbent has substantial in vitro and in vivo hemostatic efficacy. These results show the potential of this superabsorbent to enter the stage of clinical studies.

Dacryocystorhinostomy (DCR) is one of the most common ophthalmologic surgeries frequently associated with bleeding. Considering lack of a similar study, we decided to evaluate and compare the effects of remifentanil and tranexamic acid on the amount of bleeding during DCR surgery.

This double-blind randomized clinical trial included 162 patients who were candidate for DCR surgery at Feiz Hospital between 2019 and 2020. Patients were selected by gradual random sampling method and randomly divided into three groups receiving either tranexamic acid or remifentanil or normal saline(control group) during surgery. Bleeding rate, hemodynamic variables and duration of surgery were compared among the groups.

The mean volume of intraoperative blood loss was significantly higher in the control group than in the tranexamic acid and remifentanil groups. Also, the mean volume of intra operative blood loss was more in the tranexamic acid group than in the remifentanil group but the difference between the two groups was not significant in this regard(P>0.05). The mean postoperative blood loss was significantly higher in the remifentanil group than that in the tranexamic acid and control groups. Total (intraoperative and postoperative) blood loss was significantly higher in the control group in comparison to the blood loss in the remifentanil and tranexamic acid groups. Also, total blood loss in the remifentanil group was significantly higher than that in the tranexamic acid group (P<0.05). Changes in hemodynamic variables showed no significant differences among the groups.

We found lower amount of bleeding in the tranexamic acid and remifentanil groups compared to that in the control group. We recommend use of these two drugs for reduction of bleeding in the patients undergoing dacriocystorhynostomy. Also tranexamic acid is more effective than remifentanyl in this regard.

Bleeding is a common complication during heart surgery, and management of heparin and protamine consumption during operation affects hemeostasis. The dosage of protamine sulfate is variable based on the amount of heparin used and studies have reported different results. The aim of this study was to evaluate the effect of protamine sulfate administration after cardiac surgery on the drainage of the patient's blood secretions.

In this retrospective cross- sectional study, required data from 120 medical records patients, from 2011 to 2020 undergoing heart surgery, for example CABG, was extracted and examined. Patients were grouped (60 people in each group) and compared based on protamine sulfate intake and not receiving it, in the intensive care unit and body mass index, age, sex, ACT values ​​and blood drainage rate.

76 (63.37%) patients were male and 44 (36.66%) patients were female. Most patients were in the age range of 50-70 years and most patients were overweight. Blood drainage in the protamine group was significantly lower than the control group. There was no statistically significant difference between the two groups in terms of ACT values. Blood drainage in the protamine group was significantly lower in normal BMI and overweight individuals than in the control group. The amount of blood drained in the protamine group in women and in people over 70 years was significantly lower than the control group.

despite previous studies, our study showed a reduction in the amount of postoperative bleeding following re-prescribing of protamine sulfate in the intensive care unit, which eliminated the effect of heparin and the coagulation disorder caused by heparin. The limitations of the present study included patients under 12 years of age, patients weighing more than 120 kg, and patients requiring hypothermia treatment less than 28 Cº.

Diverticulosis is a major health problem in middle-aged and older adults. The cause of bleeding in the diverticulum is not clear, but arteriolar changes are considered as the main pathogenesis of diverticular bleeding. This study aimed at investigating the relationship between the risk factors for atherosclerosis and diverticular bleeding.

In this case-control study, 112 patients with diverticulitis over 40 years of age attending Babol Ayatollah Rouhani Hospital 2018-19 were studied in two groups of with and without diverticular bleeding. The participants were investigated in terms of high and low density lipoprotein cholesterol levels, triglyceride, systolic and diastolic blood pressure, history of diabetes, hypertension, and other factors.

The mean age of patients was 62.42±10.45 years. There were 62 patients (55.4%) with diverticular disease and 50 patients (44.6%) with diverticular bleeding. The risk of diverticular bleeding in patients with a history of heart disease was 4.25 times higher than that in patients without a history of non-coronary heart disease (P<0.001). Also, the risk of diverticular bleeding in patients with history of angiography and coronary stent was 3.11 times higher compared with patients without such history (P=0.004). In multivariate analysis based on adapted odds ratio, history of non-coronary heart disease, history of hypertension, elevated triglyceride and LDL levels, and decreased HDL levels were found as the risk factors for diverticular bleeding.

This study showed that along with ischemia in the arteries of heart, brain, and peripheral arteries, the risk of bleeding in intestinal arteries also increases in patients with diverticulosis.

Intensification of immune system sensitivity after pregnancy with cytokine storm caused by Covid 19 can lead to coagulation disorders and increase the amount of bleeding after delivery. Since bleeding following cesarean section is more likely to occur in women with Covid-19 than in women without the disease, the present study was performed aimed to investigate the amount of bleeding during caesarean section in women with covid-19.

This descriptive-analytical study was performed on 396 clinical files of women after cesarean section (35 women with Covid 19 and 361 women without Covid 19) in Al-Zahra and Imam Reza hospitals of Tabriz. Demographic information, history of midwifery and bleeding volume, platelets, prothrombin time, and relative thromboblastin time were extracted for each individual. Data were analyzed by SPSS statistical software (version 21) and student's t-test, chi-square and multivariate regression. P< 0.05 was considered statistically significant.

The rate of bleeding in patients with Covid 19 (1259.59 ± 127.69 ml) was significantly higher than patients without Covid 19 (351.74 ± 11.94 ml) (p=0.005). The rate of bleeding during cesarean section for patients with Covid 19 based on the severity of the disease indicated that the higher the severity of the disease, the higher the bleeding during cesarean section (P=0.001). Finally, it was found that severe Covid 19 increases the bleeding of cesarean section by 12.95 times (95% CI: 8.35-15.95).

Infection to high intensity Covid 19 can increase the risk of bleeding during cesarean section; therefore, measures and planning such as blood preparation and access to appropriate veins for blood transfusion management should be considered.