The effect of Nifedipine on embryo transfer outcomes: A randomized clinical trial

Background: Endometrial receptivity is crucial for embryo implantation, and excessive uterine contraction reduces success. Nifedipine which is a calcium channel blocker, could decrease uterine contraction and improve pregnancy outcomes. Objective: This study aimed to assess the effect of Nifedipine before embryo transfer on the pregnancy outcome in women undergoing in vitro fertilization (IVF) in a tertiary center in Iran. Materials and Methods: 150 women who were candidates for IVF were randomly assigned into 2 groups: group 1 received 20 mg Nifedipine 30 min before embryo transfer, and group 2 received no intervention. Blood pressure of the participants was monitored every 10 min for 1 hr under the supervision of an anesthesiologist. Finally, implantation rate and chemical and clinical pregnancy rates were compared between groups. Results: At the end of the study, 140 participants were included in the final analyses. No significant difference was observed in clinical pregnancy rates between groups (20% vs. 22%, p = 0.51) Conclusion: Nifedipine administration before embryo transfer does not improve the implantation and clinical pregnancy rates in women undergoing IVF. Key words: Nifedipine, In vitro fertilization, Uterus, Contraction

Neuroprotective Strategies in the Perioperative Period: A Systematic Review

Surgery and anesthetics may cause brain damage, and the resulting neurological defect can impair the patient's cognitive function. This disorder is one of the most common complications after surgery and causes disorders in several cognitive areas of the patient. The mechanism of this disorder is not fully understood, but Neuronal inflammation is one of the main causes of this disorder. The purpose of this systematic review study was to evaluate neuroprotective drug strategies for the treatment or prevention of surgical disorders associated with anesthesia. We searched the keywords "neuroprotective", "neuroprotection", "postoperative" and "perioperative" in the databases of web of science, Scopus, PubMed, science direct and Google Scholar with a 5-year time limit. At first, 492 articles were obtained and finally, after detailed survey based on exclusion and inclusion criteria, 31 studies were selected to extract data. Findings from studies show that medication and treatment strategies used in group of mice and rats under surgery with treatment can improve Neuronal inflammation and brain damage compared to mice and rats with surgery only and reduce the side effects of surgery and anesthetics

Comparison of Preventive Acetaminophen and Placebo in Pain Reduction After Cesarean Section; A Randomized Clinical Trial

Background: In subjects having a cesarean section, pain can increase hospital length of stay and postoperative complications. The preventive analgesia in the postoperative phase is known to be more effective than analgesic treatment in response to pain. Objectives: In this study, the analgesic efficacy of preventive intravenous acetaminophen was compared with placebo in relieving postoperative pain after cesarean sections under spinal anesthesia. Methods: In this double-blind randomized controlled study, 49 women undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups by block randomization in a referral hospital in Tehran in 2016. The intervention group received intravenous acetaminophen (Apotel®) (1 gram) and the placebo group received normal saline on arrival to the recovery room within 20 minutes. Then the total consumed doses of meperidine, visual analogue scale (VAS) score of pain, and the incidence of vomiting were determined and recorded for 24 hours postoperatively. Results: Pain scores (VAS) were lower in the acetaminophen group throughout the study, but the difference was only significant at forth to eighth hours after the surgery (P = 0.0001). The total consumed doses of meperidine to treat the pain was significantly lower in the acetaminophen group at the fourth to the eighth hours after the surgery (P = 0.0001). The incidence of vomiting was the same between the groups (P > 0.05). Conclusions: A single dose preventive intravenous acetaminophen has good efficacy in reduction of postoperative pain and reduces opioid use after cesarean sections under spinal anesthesia up to 8 hours after the administration

The relationship between thyroid function tests and sleep quality: cross-sectional study

Introduction: The relationship between sleep and hormones have long been recognized. Studies indicated that sleep quality is one of the major modulatory effects on the endocrine system. In this study, we aimed to assess the serum concentration of thyroid hormones in individuals who suffered from low quality sleep. Material and Methods: Based on the Pittsburgh Sleep Quality Index and ISMA Stress questionnaire, we divided 83 participants into two groups. Forty-one individuals with low quality sleep group and 42 with good quality sleep group, all from the male students of a medical school in Tehran, Iran, participated in this descriptive and cross-sectional study. Then, serum levels of thyroid hormones including free T3, free T4, and TSH were assessed and compared between two groups. Results: There were a significant increase in serum levels of FT4 (p=0.01) and TSH (p=0.02). There were also meaningful correlations between sleep score and stress score (p=0.008) as well as stress score and FT4 (p=0.03) in the case group. Conclusions:The current study showed that thyroid function tests (T4 and TSH) significantly rose in the poor sleep condition. We also found correlations between sleep score, stress score, and FT4 in the poor sleep condition group that suggest low sleep quality can affect thyroid hormones

Novel regional nerve blocks in clinical practice: evolving techniques for pain management

This review examines the use of novel US-guided nerve blocks in clinical practice. Erector spinae block is a regional anesthesia technique doing by injecting a local anesthetic among the erector spinae muscle group and transverse processes. The phrenic nerve is a branch of the cervical plexus, arising from the anterior rami of cervical nerves C3, C4, and C5. The quadratus lumborum muscle is located along the posterior abdominal wall. It originates from the transverse process of the L5 vertebral body, the iliolumbar lig-ament, and the iliac crest. US-guided peripheral nerve procedures have a considerable scope of use, including treating headaches and hiccups to abdominal surgical pain, cesarean sections, musculoskeletal pathologies. These nerve blocks have been an effective addition to clinical anesthesia practice. The use of peripheral nerve blocks has improved postoperative pain, lessened the use of opioids and their potential side effects, and decreased the incidence of sleep disturbance in patients. More research should be done to further delineate the potential benefits of these blocks

Symptom Prediction and Mortality Risk Calculation for COVID-19 Using Machine Learning

Background: Early prediction of symptoms and mortality risks for COVID-19 patients would improve healthcare outcomes, allow for the appropriate distribution of healthcare resources, reduce healthcare costs, aid in vaccine prioritization and self-isolation strategies, and thus reduce the prevalence of the disease. Such publicly accessible prediction models are lacking, however.Methods: Based on a comprehensive evaluation of existing machine learning (ML) methods, we created two models based solely on the age, gender, and medical histories of 23,749 hospital-confirmed COVID-19 patients from February to September 2020: a symptom prediction model (SPM) and a mortality prediction model (MPM). The SPM predicts 12 symptom groups for each patient: respiratory distress, consciousness disorders, chest pain, paresis or paralysis, cough, fever or chill, gastrointestinal symptoms, sore throat, headache, vertigo, loss of smell or taste, and muscular pain or fatigue. The MPM predicts the death of COVID-19-positive individuals.Results: The SPM yielded ROC-AUCs of 0.53–0.78 for symptoms. The most accurate prediction was for consciousness disorders at a sensitivity of 74% and a specificity of 70%. 2,440 deaths were observed in the study population. MPM had a ROC-AUC of 0.79 and could predict mortality with a sensitivity of 75% and a specificity of 70%. About 90% of deaths occurred in the top 21 percentile of risk groups. To allow patients and clinicians to use these models easily, we created a freely accessible online interface at <ext-link ext-link-type="uri" xlink:href="http://www.aicovid.org/" xmlns:xlink="http://www.w3.org/1999/xlink">www.aicovid.net</ext-link>.Conclusion: The ML models predict COVID-19-related symptoms and mortality using information that is readily available to patients as well as clinicians. Thus, both can rapidly estimate the severity of the disease, allowing shared and better healthcare decisions with regard to hospitalization, self-isolation strategy, and COVID-19 vaccine prioritization in the coming months