Expectant management of missed miscarriage

Early pregnancy losses occur in 10-20% of all pregnancies. Surgical evacuation has always been the mainstay of management of miscarriages. The main aim of this study was to understand the success rate of expectant management of miscarriage with regards to gestational sac size and period of gestation. The secondary outcome was to measure the satisfaction level and the rate of pregnancy after 6 month of expectant management. Patients diagnosed with missed miscarriages were requested to choose between expectant or surgical management. Those decided for expectant management on “wait and watch” approach were assessed weekly up to 5 completed weeks until complete miscarriage was achieved spontaneously. Surgical evacuation was performed if medically indicated or requested by the patients at any time or at the end of fifth week if complete miscarriage was not achieved. Out of 212 cases, 75 (35.4%) opted for expectant management. Complete miscarriage was achieved in 85.3% of subjects by the end of fifth weeks respectively. Mean of Gestational sac size and period of gestation was not found to influence the success rate of complete spontaneous miscarriage in the expectant management. No morbidity was recorded during the five weeks of the study period. Mean satisfaction score was 9.7±8.3. Pregnancy occurred in 47% of patients within 6 months follow up. The Receiver operation characteristic (ROC) curve analysis suggested the end of second week as the cut off for surgical intervention. This study revealed that expectant management of missed miscarriage is a reliable management of missed miscarriage within the first two weeks

Fat Bloom and Polymorphism in Chocolate Prepared with Modified Tea Seed Oil

Abstract In order to produce cocoa butter replacer (CBR), tea seed oil was modified with enzymatic interesterification. The modified product was then added to dark chocolate formulation as a replacement for 10%, 15% and 20% of cocoa butter (CB) to study fat bloom formation and polymorphic structure in these samples. Keywords Fat bloom; Polymorphism; Chocolate; Modified tea seed oil Practical Applications According to our results, higher levels of fat bloom occurred in the chocolate sample without CBR (chocolate containing 100% CB, CBCH), compared with other chocolate samples. However, among the chocolates containing enzymatic interesterified sample (EIS) at various levels of 10%, 15% and 20%, the chocolate sample containing 10% of EI (EICH) showed lower fat bloom development during storage period (20 days). The results of polymorphic structure evaluation using X-ray diffractometer (XRD) showed new β-crystalline form with the XRD pattern close to that of β-VI and the m.p. appeared similar to β-V in CB. Also, XRD pattern of EIS showed β′-crystalline form in this sample. Presence of two crystalline forms (β and β′) in the EICH revealed that, adding 10% of the CBR prepared in the current study to chocolate formulation had probably no adverse effect on β-crystal formation in the chocolate sample

Evaluating the effect of an Iranian traditional medicine-based herbal candy on body composition and appetite in overweight and obese adults: A preliminary study

Objective: Obesity is an important public health concern in the world. Considering the limited medications and their side effects and lack of a known effective way to reduce appetite, traditional herbs have been considered a complementary treatment for obesity. Therefore, this study was conducted to evaluate the effect of an Iranian Traditional Medicine (ITM)-based herbal candy on body composition and appetite in obese and overweight adults.Materials and Methods: In this preliminary study that conducted in nutrition clinic of Ghaem Hospital of Mashhad, participants were selected from overweight and obese people and randomly assigned to either groups. Participants in the intervention group received herbal candy which contained a combination of Portulaca oleracea, Plantago psyllium, and peanut oil, while participants in the control group received placebo candy for 8 weeks. The primary (appetite response, and weight changes) and secondary (body mass index (BMI), anthropometric parameters, blood pressure, and laboratory variables) outcomes were collected at baseline and during the intervention.Results: Fifty participants between the age of 18 and 65 years old were included in this study. Herbal candy resulted in a greater reduction in mean weight and BMI compared to placebo (p<0.001). Mean of hunger, satiety, and eating capacity indicators decreased more significantly at all three intervals (30 min after herbal candy, 1 hour after meal and 2 hours after meal) at lunch and dinner meal in the intervention group compared to the control group (p<0.05).Conclusion: A combination of produced herbal candy at a dose of 4 g (2 pcs), given half an hour before each meal for 8 weeks, can be effective in reducing weight and appetite in obese and overweight people

A cross sectional study to explore factors affecting adolescent-parents attachment in a rapidly developing society in Malaysia

Introduction: Secure attachment to parents prevents adolescents from externalizing behaviours especially in developing countries. The aim of this study was to identify the contributors to parental attachment in a developing society. Methodology: This cross sectional study was performed on urban secondary students (aged between 13 and 17 years) based on multistage sampling in Pasir Gudang District, Johor, Malaysia. The depression, anxiety and stress (DASS-21) and Inventory of parent and peer attachment (IPPA) questionnaires were used along with a questionnaire for demographic information. Analysis of covariance (ANCOVA) was used to identify the main effect of study parameters on IPPA scores for father and mother. Results: A total of 2980 students (46.9% male and 53.1% female) participated in this study. Mean and SD for age was 14.39±1.28. Depression score and school form had a significant main effect on both paternal and maternal attachment (p<0.05). Age (p=0.003), ethnicity (p=0.01), history of intimate relationship (p=0.03), paternal education level (p=0.006) and maternal education level (p=0.04) had a main effect on paternal attachment, while gender (p=0.02) and stress (p=0.001) were shown to have significant main effect on maternal attachment. Discussion: The findings of this study revealed different contributors for adolescent attachment with father and mother. Local, cultural and economic structure of the community should be taken into account in order to plan for an intervention strategy to secure adolescent’s relationship with parents

Dietary calcium intake and socioeconomic status are associated with bone mineral density in postmenopausal women

Osteoporosis is characterized by a decrease in the strength and density of bone and is a major cause of premature death in elderly. This cross-sectional study aimed to determine the relationship between bone mineral density and calcium intake and socioeconomic factors among postmenopausal women in Tehran, Iran. Postmenopausal women (50 to 65 years old) who were referred to the National Iranian Oil Company (NIOC) Central Hospital were recruited in this study. Socio-demographic, dietary information, anthropometric measurements and bone mineral density (BMD) assessment were obtained from participants. A total of 299 healthy postmenopausal women (mean age of 56.34 ± 4.46 years) participated in this study. The BMD of lumbar spine (L2-L4) was 1.08 ± 0.14. About 2/3 of the respondents had normal BMD at lumbar spine while others were either osteopenic (32.1%) or osteoporotic (1.3%). Only, about one fourth of respondents met the DRI (Dietary Reference Intake) for calcium. Higher intake of calcium (OR, 0.993; CI, 0.990-0.996) and higher household income per capita (OR, 0.997; CI, 0.995-0.99) were shown to be significantly protective against osteopenia/osteoporosis. About one third of women had osteopenia/osteoporosis at lumbar spine. Lower socioeconomic status might limit adequate consumption of calcium intake and subsequently contribute to poor bone health

Antiphospholipid antibodies and COVID-19 mortality and thrombotic events; A systematic review and meta-analysis

Introduction:Among various proposed pathologic mechanisms during the coronavirus disease 2019 (COVID-19) pandemic, overproduction of autoantibodies is not widely studied. Antiphospholipid antibodies (aPLs) are target proteins that have affinity toward charged phospholipids. APLs are thought to have pro-thrombotic potentials that increase during thromboembolism. The present systematic review and meta-analysis aimed to evaluate the relationship between serum aPLs level and COVID-19 mortality, severity, and thrombotic events.Methods: This systematic review and meta-analysis was conducted on all open access published articles in Medline, Scopus and Google Scholar. Studies evaluating individuals over the age of 18 years who were diagnosed with COVID-19 and had positive aPLs; and provided data on mortality or thrombotic events were included. Results: Of the initially identified 512 articles, 22 studies (overall 1462 patients) were finally included in the analysis. The prevalence of positive aPLs was 48.1%. Among the 372 patients with positive aPLs, 156 patients (41.9%) had severe COVID-19 that indicated a significant relationship between COVID-19 severity and aPLs positivity (p<0.05). The prevalence of thrombotic events in aPLs positive patients was 26.3% that indicated a significant relationship between aPLs positivity and the development of thrombotic events (p=0.03). APLs positivity was related to anytime mortality in COVID-19 patients (p=0.01).Conclusion: The present review demonstrated that aPLs are linked to COVID-19 severity and thrombotic events but not short-term mortality. Further studies with longer follow up periods are warranted

Effect of Chewing Gum on Post Cesarean Ileus in the North East of Iran: A Randomized Clinical Trial

Background & aim: Cesarean section (CS) accounts for 35% of all surgical operations in Iran. Post cesarean ileus is a complication of CS. There are various pharmaceutical and non-pharmaceutical ways for the treatment of this condition. Given the fact that the non-pharmaceutical approaches are better tolerated and often inexpensive, the present study was conducted to evaluate the effect of chewing gum on post cesarean ileus. Methods: This clinical trial was conducted on 93 patients undergoing CS (i.e., elective or urgent CS) at Sabzevar Mobini Hospital, Savzevar, Iran, between July 2013 and September 2014. The study population was selected using convenience sampling technique and assigned into two groups of chewing gum (n=35) and control (n=58) groups. The subjects in the chewing gum group were encouraged to chew gum at defined intervals. Both groups were evaluated for pain, bowel sounds, first defecations, gas passage, and feeling bowel movements. Data analysis was performed in SPSS software, version 21. Results: There was no significant difference between the two groups in terms of the auscultation of first bowel sound, first record of gas passing, and first defecation. The logistic regression models showed that chewing gum was significantly associated with reduced post-operative pain while controlling for surgery duration as a confounding factor (OR: 0.79, 95% CI for OR=0.63, 0.99). However, chewing gum showed no significant relationship with bowel sounds, first defecations, gas passage, and feeling bowel movements. Conclusion: As the findings indicated, the use of chewing gum after CS was ineffective in the reduction of ileus. However, this practice was only capable of mitigating post-operative pain, and therefore can be used as an adjuvant technique for the management of post-operative pain

Copy number analysis from whole-exome sequencing data revealed a novel homozygous deletion in PARK7 leads to severe early-onset Parkinson's disease

Parkinson's disease (PD), a neurodegenerative disease characterized by both motor neuron and non-motor neuron symptoms, is the most frequent neurodegenerative disease after Alzheimer's disease. Both genetic and environmental factors take part in disease etiology. Most cases are considered complex multifactorial diseases. About 15% of PD appear in the familial form, and about 5% of all cases arise from a single gene mutation. Among Mendelian causes of PD, PARK7 is one of the autosomal recessive forms due to loss-of-function mutations in both gene alleles. Both single nucleotide variants (SNVs) and copy number variations (CNVs) are observed in PARK7. This study presents an Iranian family with familial PD where some relatives had psychiatric disorders. A homozygous 1617 bp deletion in a female with early-onset PD was detected through copy-number analysis from whole-exome sequencing (WES) data in this consanguineous family. Further investigation by surveying microhomology revealed that the actual size of the deletion is 3,625 bp. This novel CNV that was in the PARK7gene is supposed to co-relation with early-onset PD and infertility in this family

Assessment of the reliability of a novel self-sampling device for performing cervical sampling in Malaysia

Background: The participation of women in cervical cancer screening in Malaysia is low. Self-sampling might be able to overcome this problem. The aim of this study was to assess the reliability of self-sampling for cervical smear in our country. Materials and methods: This cross-sectional study was conducted on 258 community dwelling women from urban and rural settings who participated in health campaigns. In order to reduce the sampling bias, half of the study population performed the self-sampling prior to the physician sampling while the other half performed the self-sampling after the physician sampling, randomly. Acquired samples were assessed for cytological changes as well as HPV DNA detection. Results: The mean age of the subjects was 40.4±11.3 years. The prevalence of abnormal cervical changes was 2.7%. High risk and low risk HPV genotypes were found in 4.0% and 2.7% of the subjects, respectively. A substantial agreement was observed between self-sampling and the physician obtained sampling in cytological diagnosis (k=0.62, 95%CI=0.50, 0.74), micro-organism detection (k=0.77, 95%CI=0.66, 0.88) and detection of hormonal status (k=0.75, 95%CI=0.65, 0.85) as well as detection of high risk (k=0.77, 95%CI=0.4, 0.98) and low risk (K=0.77, 95%CI=0.50, 0.92) HPV. Menopausal state was found to be related with 8.39 times more adequate cell specimens for cytology but 0.13 times less adequate cell specimens for virological assessment. Conclusions: This study revealed that self-sampling has a good agreement with physician sampling in detecting HPV genotypes. Self-sampling can serve as a tool in HPV screening while it may be useful in detecting cytological abnormalities in Malaysia

Case Report of a Vanished Aspirated Foreign Body; Cough may be more Helpful

Foreign body aspiration is a potentially life-threatening event especially in those who are younger than 5 years old. Aspiration could be presented as a spectrum, ranging from absolutely asymptomatic event to more sever events including choking, respiratory distress and cyanosis or even death. Although foreign bodies in lung may not be visualized on X-ray, X-ray radiography is considered as a first step in localizing aspirated foreign bodies. Bronchoscope as rigid or flexible optic fiber is the main device used in removing aspirated foreign bodies. However, in some cases, as the present case report, previous foreign bodies which were localized in lung could travel back to the mouth and be ingested. In this report, we discussed a case of foreign body aspiration in a 10 year-old girl referred to Dr. Sheikh Hospital, Mashhad, Iran, whose foreign body located in the lower lobe of the left lung returned and was ingested before bronchoscopy after some episodes of sever coughing