Magnesium Gargle versus Ketamine Gargle in Postoperative Sore Throat Pain; A Randomized Placebo-Controlled Clinical Trial

Background: A wide range of approaches have been tested for the prevention and treatment of postoperative sore throat pain (POST pain). This study attempted to compare the effects of gargling with Ketamine or Magnesium Sulfate on POST pain.  Materials and Methods: In a randomized clinical trial, 60 patients scheduled for prone position laminectomy were randomly assigned into three groups: Ketamine (n=20), Magnesium (n=20), and Control (n=20). The Magnesium group received magnesium sulfate gargle (30 mg/kg in a total of 30 ml 5% Dextrose water), the Ketamine group received Ketamine gargle (0.5 mg/kg in a total of 30 ml 5% Dextrose water) and the control group received 30 ml 5% Dextrose water gargle; all these solutions were administered 10 min before anesthesia induction. Visual Analog Scale (VAS) for throat pain was recorded in the recovery room; immediately after arrival and then, at 2, 4, and 24 hours postoperatively in the ward. Would there be any VAS equal to or more than 3 of 10, rescue analgesics were administered immediately and their cumulative doses were recorded.  Results: The incidence of complaint-free patients in the Ketamine group was significantly higher than in the other two groups. The incidence of sore throat with VAS≥3, mandating rescue analgesia, was significantly lower than the other two groups. patient satisfaction after surgery was significantly higher in the Ketamine group.  Conclusion: Patients experiencing POST pain treated with “Ketamine gargle” had better results compared with “Magnesium Sulfate” or “Placebo” gargle.&nbsp

The prevalence of hypovitaminosis D and its risk factors in pregnant women and their newborns in the Middle East: A systematic review

Background: Pregnant women and newborns are at risk for vitamin D deficiency (VDD). Also, poor health outcomes for pregnant women with VDD are reported in the published literature. Objective: The aim of this systematic review was to estimate the prevalence of hypovitaminosis D and the associated risk factors for hypovitaminosis D in Middle Eastern pregnant women and their newborns. Materials and Methods: The international electronic databases PubMed and Scopus for the years 2000-2017 were utilized to identify studies of vitamin D status for pregnant women and newborns in the Middle East. Of the 1,785 reports identified, 1,734 met exclusion criteria and 51 studies were included for this review. Results: The prevalence of circulating 25-hydroxyvitamin D (25(OH)D) < 50 nmol/L as a marker of vitamin D status in pregnant women and their newborns was between 24.5-98% and 22-100%, respectively. The prevalence of 25(OH) D < 25 nmol/L in pregnant women and their newborns was over a wide range between 16.7-80% and 22- 82%, respectively. Predictors for low maternal and neonatal 25(OH)D concentrations included decreased vitamin D synthesis due to reduced exposure to sunlight and decreased nutritional intake of vitamin D. A predictor of low neonatal 25(OH)D concentrations included maternal vitamin D status and the correlation between vitamin D concentrations in maternal and cord blood. Conclusion: The high prevalence of VDD in the pregnant women of the Middle East underscores the necessity of implementing national prevention and intervention strategies. A clear policy for clinicians and healthcare workers is needed for screening and maintaining sufficient vitamin D status during pregnancy. Key words: Vitamin D, Pregnancy, Newborns, Cord blood, Middle East

Sexual and reproductive health needs of HIV-positive people in Tehran, Iran: a mixed-method descriptive study

Background: People Living with HIV (PLHIV) are highly stigmatized and consequently hard-to-access by researchers and importantly, public health outreach in Iran, possibly due to the existing socio-cultural situation in this country. The present study aimed to evaluate the sexual and reproductive health needs of PLHIV in Tehran, the capital of Iran. Methods: As a mixed-method descriptive study, this project was conducted in 2012 in Tehran, Iran. In this study, we evaluated and discussed socio-demographic characteristics, family and social support, sexual behaviors, fertility desires and needs, PMTCT services, contraceptive methods, unintended pregnancy and safe abortion, and Pap smear tests among 400 participants referring to the behavioral disorders consulting centers. Results: Of the sample 240 (60%) were male and 160 (40%) were female. About 50% of women and 40% of men were 25-34 years old. More than 60% of men and 96% of women were married, while more than 50% of the participants had HIV-positive spouses at the time of study. According to the results, fertility desire was observed among more than 30% of female and 40% of male participants. Results of the in-depth interviews indicate that the participants are not satisfied with most of the existing services offered to address their sexual and reproductive health needs. Conclusion: Despite the availability of services, most of sexual and reproductive health needs of the PLHIV are overlooked by the health system in Iran. Paying attention to sexual and reproductive health needs of PLHIV in Iran not only protects their right to live long and healthy lives, but also may prevent the transmission of HIV from the patients to others within the community

Sexual and Reproductive Health Needs of HIV-Positive People in Tehran, Iran: A Mixed-Method Descriptive Study

Background: People Living with HIV (PLHIV) are highly stigmatized and consequently hard-to-access by researchers and importantly, public health outreach in Iran, possibly due to the existing socio-cultural situation in this country. The present study aimed to evaluate the sexual and reproductive health needs of PLHIV in Tehran, the capital of Iran. Methods:As a mixed-method descriptive study, this project was conducted in 2012 in Tehran, Iran. In this study, we evaluated and discussed socio-demographic characteristics, family and social support, sexual behaviors, fertility desires and needs, PMTCT services, contraceptive methods, unintended pregnancy and safe abortion, and Pap smear tests among 400 participants referring to the behavioral disorders consulting centers. Results:Of the sample 240 (60%) were male and 160 (40%) were female. About 50% of women and 40% of men were 25-34 years old. More than 60% of men and 96% of women were married, while more than 50% of the participants had HIV-positive spouses at the time of study. According to the results, fertility desire was observed among more than 30% of female and 40% of male participants. Results of the in-depth interviews indicate that the participants are not satisfied with most of the existing services offered to address their sexual and reproductive health needs. Conclusion:Despite the availability of services, most of sexual and reproductive health needs of the PLHIV are overlooked by the health system in Iran. Paying attention to sexual and reproductive health needs of PLHIV in Iran not only protects their right to live long and healthy lives, but also may prevent the transmission of HIV from the patients to others within the community

Effects of Recruiting Midwives into a Family Physician Program on Women's Awareness and Preference for Mode of Delivery and Caesarean Section Rates in Rural Areas of Kurdistan

<div><p>Background</p><p>The accepted rate rate of caesarean section is 15%. It is expected that an increase in the density of midwives in the family physician program lead to a decrease in this indicator. This study aimed to compare the rates of caesarean section and women's awareness and preference for mode of delivery before and after the implementation of the family physician program in health centres with and without an increase in midwives density.</p><p>Methods</p><p>In this cross-sectional study, using multistage cluster sampling method a total of 668 mothers with two-month-old children were selected from among all mothers with two-month-old children who were living in rural areas of Kurdistan province. Using the difference-in-differences model and Matchit statistical model, the factors associated with caesarean section rates and women's awareness and preference for mode of delivery were compared in centres with and without an increase in midwives density after the implementation of the family physician program. To compare the changes before and after the program, we used the data collected from the same number of women in 2005 as the baseline.</p><p>Results</p><p>After adjusting for baseline data collected in 2005, the resutls showed no significant change in caesarean section rates and women's awareness and preference for mode of delivery in the centres with and without an increase in midwives density after the implementation of the family physician program. The Matchit model showed a significant mean increase 14%(0.03–0.25) in women’s awareness of the benefits of natural childbirth between 2005 and 2013 in health centres where the density of midwives increased compared with health centres where it did not. The difference-in-differences model showed that the odds ratio of women’s preference for caesarean section decreased by 41% among participants who were aware of the benefits of natural childbirth, (OR = 0.59, 95% CI: (0.22–0.85); P>0.001).</p><p>Conclusions</p><p>The results of this study showed that an increase in the density of midwives in the family physician program led to an increase in women's awareness of the benefits of natural childbirth. An increase in women’s awareness of the benefits of natural childbirth was associated with a decreased preference for caesarean section, however this reduction did not have a significant impact on caesarean section rates; possibly, this finding might be attributed to the complexity of this problem that needs a mixed strategy involving various stockholders.</p></div

Sampling frame in rural area of Kurdistan province in the survey of 2005 and 2013.

<p>Sampling frame in rural area of Kurdistan province in the survey of 2005 and 2013.</p

Difference in difference modeling on women’s preference for caesarean section and undergoing caesarean section in rural areas of Kurdistan province.

<p>Difference in difference modeling on women’s preference for caesarean section and undergoing caesarean section in rural areas of Kurdistan province.</p

A simplified structure of PHC network in rural areas of Iran [29].

<p>A simplified structure of PHC network in rural areas of Iran [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0151268#pone.0151268.ref029" target="_blank">29</a>].</p

Density distribution of midwives, family physicians and Bhevarzes in health centers in the survey of 2005 and 2013.

<p>Density distribution of midwives, family physicians and Bhevarzes in health centers in the survey of 2005 and 2013.</p

The estimated effect on increasing inthe density of midwives in family physician program according to Matchit model on caesarean section, women’s preference for caesarean section, and women’s awareness of the benefits of natural childbirth in the rural health centers in Kurdistan province.

<p>The estimated effect on increasing inthe density of midwives in family physician program according to Matchit model on caesarean section, women’s preference for caesarean section, and women’s awareness of the benefits of natural childbirth in the rural health centers in Kurdistan province.</p