Alborz University

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Background: Risky sexual behaviors expose people to sexual transmitted diseases. These behaviors are usually common among homeless people, so educational programs would help them to avoid high risk behaviors. Understanding STD awareness and the common types of risky behaviors among homeless people would provide a good context for designing appropriate educational plans.
Aim: This study was performed to evaluate the STD awareness and the prevalence of risky behaviors among temporary residents of homeless shelters in Tehran.
Methods: This descriptive survey performed in 2017. The standard sample size was 306. Random sampling was adopted. A questionnaire containing 45 questions was used. The questionnaire had four categories including demographic data, STD awareness, risky sexual behaviors and opinion poll. For calculating descriptive statistics IBM SPSS Statistics v21. software was exerted.
Results: The level of awareness among 80% of the cases was so poor and the most known STD was hepatitis B. About 64% percent of the cases had low literacy and all had at least one of the high risk behaviors. Violent sexual behavior was the most common trait and homosexual relationship was the least.
Conclusion: Several factors endangering homeless people, including low level of knowledge about risky behaviors, being in a sexually active age range, illiteracy and attempting a high number of risky sexual behaviors. This study showed homeless shelters need codification of appropriate training workshops based on the level of awareness for each disease with considering illiteracy among homeless people.

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PPH is one of three main causes of maternal mortality in the developing countries. Atony is responsible for 75-90 % of PPH. In the lack of essential actions for reparation there will be substantial increase of maternal deaths. Recently TXA benefits in reduction of PPH is considered by many researchers. TXA is a finaquinolysis inhibitor. It’s been years TXA is commonly used in surgeries such as coronary artery bypass craft, scoliosis, orthoplasty as well as idiopathic metrorrhagia. 
Case Presentation: A  24 years woman  G2P1L1 was admitted in Hospital for termination of pregnancy. (GA=40 w+4d) The main complaints were reduction of fetal movements and AFI=6-8cm.Misoprostol inserts for labour induction, after 6 hrs induction continues with oxytocin. By normal delivery baby  with normal Apgar score has been born weighing 3100 gr. Placenta and appendix normally delivered. But the uterine was sleazy and atonic. Hemorrhage was +1. Corrugate has been done, there was no remains. Uterotonic agents such as syntosinon, methergine, sublingual misoprostol and two hand uterine massage has been performed. But there was persistently uterine atony and active hemorrhage. Afterwards, finally Amp Tranexamic Acid has been used. Behind 10 minutes of IV injection uterine was well contracted with normal bleeding.
Conclusion: According to literatures and anti fibrinolytic effect of TXA we can use this medicine for resistant atonic uterus.

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Introduction: Wernicke-Korsakoff syndrome is a serious brain condition which can occurs due to long term vitamin B-1, or thiamin deficiency and cause damage to hypothalamus and thalamus. The main symptoms are such as: Nystagmus, abducens nerve palsy, eye movement, ataxia and confusion. The risk factors which included are: Anorexia nervosa, hyperemesis gravidarum, Alcohol consumption and fasting. This syndrome must be diagnosed as soon as possible otherwise it can lead to serious liver and heart defects or even patients death.
Case Presentation: Patient was a 30 years old  G2P1L1 mother , she had her first delivery 13 years ago. Through her current pregnancy, she has lost 20 kg weight due to anorexia and hyperemesis.
She has got admitted two times during her current pregnancy to two different referral centers duo to hyperemesis gravidarum. On 6th Sep 2017 , during 16 weeks of her pregnancy she got admitted in hospital with chief complaints of abdominal and sides pain and blurred vision. With fractional blood pressure between 140/80 to 160/100, ketonuria 1+, proteinuria 1+ and glycosuria 3+.During her hospital stay there were symptoms such as blurred vision, oculomotor nerve palsy, nerve IV paralysis, staring eyes and distraction. Laboratory investigations demonstrated elevated liver enzymes, increased ESR level. There was oliguria too. She went under medication such as  magnesium sulfate therapy , Atenolol and methylprednisolone. EKG revealed mild ST segment depression on anteroseptal leads. There was also hypokalemia (K=2/7). According to internal specialist consultation, in attention to increased ESR, severe oliguria, elevated liver enzymes and and CNS involvement, prednisolone was prescribed. After two weeks on 22th Sep, according to three primatologist consultation with uncertainty to preeclampsia termination of pregnancy was decided. Misoprostol suppositories was inserted. After eight hours eventually Fetus and placenta expulsion occurred completely. After delivery according to neurologist consultation with possibility to thromboembolism heparin therapy has been started. Thyroid investigations revealed hyperthyroidism state as normal T3 and T4 but TSH<0/1 level. Methimazole was prescribed. According to ophthalmologist there was central. After 4 days of delivery there were decreased level of consciousness CVP Line was inserted through the internal jugular vein. Duo to inadequate condition of airway protective reflexes and throat discharge she was intubated. WBC level was 20000, PLT was normal, broad-spectrum antibiotics was prescribed. And 18 days postdelivery with brain death patient became bradycardia. Unfortunately CRP failed and patient died.