Pregnant Women in the Exposure to COVID-19 Infection Outbreak: The Unseen Risk Factors and Preventive Healthcare Patterns

These days, the most important health challenge in the world is the outbreak of novel coronavirus (COVID- 19) infection. In December 2019, this viral disease originated as human-to-human transmission (HHT) in China's Wuhan city and then epidemically spread around the globe [1]. Based on the WHO data, HHT happens with close contact through sneezing and producing the respiratory droplets of infected individuals. There are two possible transmission routs for COVID-19: (i) settling these droplets in the mouth or nasal mucosa and lungs of people with inhaled air, and (ii) touching the disease-ridden surfaces or infected objects and subsequently touching hands to the mouth, nose, or eyes [2]. Due to the convenient ways to transmit viral infection, the aggressive prevalence of COVID-19 pneumonia, and its extensive social and economic impacts, there is an urgent need to explore health management tactics for slowing down the transmission of COVID-19 and decreasing the related-illness and death rate. It has been proven that this viral infection has a more pronounced effect on the elderly and patients with underlying diseases (e.g., hypertension, diabetes mellitus, cardiovascular diseases (CVDs), etc.) [3] Pregnant women are one of the most critical population groups with a need to take additional precautions against the Covid-19 outbreak as a high risk of vertical transmission of COVID-19 in the late third trimester has been reported [4,5]. Besides, the presence of gestational diabetes mellitus (GDM) and preeclampsia in pregnancy may significantly weaken the immune system and increase the risk of COVID-19 infection. In the recent decade, there has been a profound demand for utilizing the in vitro fertilization (IVF) procedure among infertile couples. Studies have shown that the risk of developing GDM and preeclampsia in women treated with IVF is much greater than with women who conceived naturally [6,7]. Therefore, there is a higher risk of Accepted ManuscriptCOVID-19 infection in women undergoing IVF. The prenatal anxiety, depression, and stress are also considered as prevalent public health issues in pregnant women. These psychological reactions can result in adverse birth outcomes such as miscarriage, preterm birth, low birth weight, and fetal death. Under the COVID-19 outbreak, stressor anxiety-related concerns of mothers about their health and the health of their babies are growing exponentially. In nulliparous pregnant women, the adverse mood symptoms accompanied by childbirth fear may have irreversible effects on mother and child health. As a result, a set of health management practices in the event of COVID-19 outbreak must be adopted not only during late pregnancy but also during the first 3 months partu

Labor induction with randomized comparison of cervical, oral and intravaginal misoprostol

Background: This study attempts to evaluate the safety and effectiveness of 50μgm intracervical misoprostol in comparison with intravaginal and sublingual for the induction of labor at term pregnant women. Methods: This study is designed as a parallel clinical trial study. Three hundred and fifteen term pregnancies requiring induction of labor were treated with the maximum used misoprostol intracervical, sublingual, and vaginal doses. Participants were randomly allocated into three groups of 105. The dose was repeated every 4 h until adequate uterine contraction and Bishop Score were achieved. The duration of induction to births, time to the active phase, the rate of births, and the need for caesarean section were compared in three groups. Additionally, labor course and side effects were recorded and analyzed. Data were analyzed using SPSS software. A significance level of p < 0.05 was considered for statistical analyses. Findings: Labor was successfully induced in all cases most (63%) of which required a single dose of misoprostol. Ninety-three (93.0%, p < 0.05) cervical participants proceeded to vaginal births. This figure was also the same in the vaginal and sublingual group of 83 cases (83.0%). The other 41 cases received caesarean section with more indications of failure to progress and meconium-stained liquor. The results indicated that 278 (92.7%) births were achieved in less than 10 h. Time from start of medication to the active phase of labor and childbirth was 3.01 پ} 0.86 and 6.1 1.3 h in the Cervical group, 4.2 پ} 0.66 and 8.4 0.92 h in the sublingual group, and 5.06 1.1 and 9.2 1.5 h in the vaginal group respectively (p < 0.001). The Caesarean rate was lower in the cervical group than in the two other groups (p = 0.05). No significant differences were observed between the study groups in terms of Apgar score and meconium- stained amniotic fluid. Furthermore, no maternal and neonatal complications were observed. Conclusion: In addition to the sublingual and intravaginal routes of administration, intracervical misoprostol at a single dose of 50μgm appears to be an effective method for induction of labor in women with an unfavorable cervix. Like all medical interventions, a discussion of the risks, benefits, and alternatives to induction of labor with this medication in each woman should be undertaken before treatment. Trial registration: This clinical study was approved by the Iranian Registry of Clinical Trials with IRCT ID: IRCT2 01904 15043 278N1. Registration date was on May 13, 2019 and May 27, 2019 respectively (http:// www. irct. ir). Keywords: Misoprostol, Labor induced, Term birt

Evaluation the relationship between psychological profile and salivary cortisol in patients with recurrent aphthous stomatitis

Background: Recurrent aphthous stomatitis (RAS) is one of the most common oral mucosal diseases which are diagnosed with recurrent and painful ulcers. The possible association between psychological factors and salivary stress related factors in patients with aphthous ulcers has been discussed in various studies. The aim of this study was to evaluate salivary cortisol level, anxiety, and depression in patients with RAS. Materials and Methods: In this case control study, 30 patients with RAS and 30 healthy individuals were enrolled by matching their age and sex. Anxiety and depression were assessed by beck anxiety inventory and beck depression inventory. Unstimulated saliva of both groups were collected and then tested by DiaMetra kit and the ELISA method. Data were analyzed by SPSS using an Independent t‑test and Mann–Whitney test. A statistical significance level of <0.05 was considered. Results: The mean salivary cortisol in the case group was 5.35 ng/ml and in the control group was 4.73 ng/ml which was not statistically significant (P > 0.05). There was no significant difference in anxiety and depression level between the two groups (P > 0.05). According to Spearman correlation coefficient, there was an average, negative, and significant correlation between salivary cortisol and anxiety and depression scores in the case group (P < 0.05). Conclusion: This study shows that, although the mean salivary cortisol was slightly higher in patients with aphthous lesions, anxiety, and depression were not possible factors for RAS. There was a moderate, negative correlation between salivary cortisol level and stress and anxiety in patients with RAS. Key Words: Anxiety, aphthous, cortisol, depression, saliva, stomatiti

Labor induction with randomized comparison of cervical, oral and intravaginal misoprostol

Background: This study attempts to evaluate the safety and efectiveness of 50μgm intracervical misoprostol in comparison with intravaginal and sublingual for the induction of labor at term pregnant women. Methods: This study is designed as a parallel clinical trial study. Three hundred and ffteen term pregnancies requiring induction of labor were treated with the maximum used misoprostol intracervical, sublingual, and vaginal doses. Participants were randomly allocated into three groups of 105. The dose was repeated every 4h until adequate uterine contraction and Bishop Score were achieved. The duration of induction to births, time to the active phase, the rate of births, and the need for caesarean section were compared in three groups. Additionally, labor course and side efects were recorded and analyzed. Data were analyzed using SPSS software. A signifcance level of p< 0.05 was considered for statistical analyses. Findings: Labor was successfully induced in all cases most (63%) of which required a single dose of misoprostol. Ninety-three (93.0%, p< 0.05) cervical participants proceeded to vaginal births. This fgure was also the same in the vaginal and sublingual group of 83 cases (83.0%). The other 41 cases received caesarean section with more indications of failure to progress and meconium-stained liquor. The results indicated that 278 (92.7%) births were achieved in less than 10h. Time from start of medication to the active phase of labor and childbirth was 3.01±0.86 and 6.1±1.3h in the Cervical group, 4.2±0.66 and 8.4±0.92h in the sublingual group, and 5.06±1.1 and 9.2±1.5h in the vaginal group respectively (p<0.001). The Caesarean rate was lower in the cervical group than in the two other groups (p=0.05). No signifcant diferences were observed between the study groups in terms of Apgar score and meconium-stained amniotic fuid. Furthermore, no maternal and neonatal complications were observed. Conclusion: In addition to the sublingual and intravaginal routes of administration, intracervical misoprostol at a single dose of 50μgm appears to be an efective method for induction of labor in women with an unfavorable cervix. Like all medical interventions, a discussion of the risks, benefts, and alternatives to induction of labor with this medication in each woman should be undertaken before treatment. Trial registration: This clinical study was approved by the Iranian Registry of Clinical Trials with IRCT ID: IRCT201904 15043278N1. Registration date was on May 13, 2019 and May 27, 2019 respectively (http://www.irct.ir). Keywords: Misoprostol, Labor induced, Term birt

Cone-Beam Computed Tomographic Evaluation of Artifact Effects of Three Different Sealers

Introduction: Cone-beam computed tomography (CBCT) is one of the most important diagnostic tools in maxillofacial imaging. Nowadays different sealers are used in root canal therapy and some of them can create artifact in CBCT images. The aim of this study was to evaluate the effect of different sealers including AH-26, Diadent, and Anyseal in creation of artifact bands in the CBCT images based on voxel size. Methods and Materials: A total of 44 single rooted extracted teeth were selected. The canals were prepared by crown-down technique. All teeth were manually filed up to master apical file (MAF) size 45 and 1 mm shorter than the apical foramen. The teeth were divided into 4 equal groups. The canals were filled with gutta-percha and either of sealers AH-26, Diadent or Anyseal by lateral condensation technique. The control group were filled just with gutta-percha without any sealer. The CBCT images were taken in voxel sizes of 0.3 and 0.15. The Fisher exact and McNemar tests were used for statistical analysis. Results: Although, the control group had the lowest ratio of presence to absence of artifact, the ratio of presence to absence of artifact in voxel size of 0.3 and 0.15 mm were significantly lower in Anyseal than AH-26 (P=0.031, P=0.020) and Diadent (P=0.001, P=0.002). No significant difference was detected between two voxel sizes (P&gt;0.05). Conclusion: In this in vitro study, all evaluated sealers induced artifacts in the CBCT images. Anyseal sealer had the lowest artifact in both evaluated voxel sizes.Keywords: Artifacts; Canal Sealer; Cone-Beam Computed Tomography; Root Canal Filling Material; Root Fractur

Anti-plaque efficacy of siwak as a mechanical tooth stick

Introduction: Dental plaque removal is an important goal in oral hygiene program. The public interest in herbal medicine and natural products has grown in the past few years. Siwak (Salvadora persica L. (kharijal)) is an ancient tooth stick that has preventive and therapeutic effects on oral cavity. The aim of the present study is to evaluate the effect of siwak chewing sticks on plaque accumulation on tooth surface. Materials and Methods: In this randomized clinical trial study 80 volunteer was selected randomly for complete the study chart. They were enrolled in the study for being in the one of the four study groups: active siwak, inactive siwak, usual tooth brush and no-oral hygiene. The participants wanted to use their instruction for 6 days. Base line (PI-1) and 3-day (PI-2) and 6-day (PI-3) plaque indexes was recorded by Sillness and Loe method. Data evaluation was done using SPSS-22 and Kruskal Wallis Test, Chi-Square Tests. Results: There was a significant reduction of the plaque index in PI-3 (p= 0.029). But in the others, there was no significant difference in the change of plaque index between groups (p&gt;0.05). Conclusion: It is concluded that siwak were able to reduce dental plaque as a mechanical tooth brush and if it uses in active form (fresh plant), the reduction of plaque accumulation is more prominent and effective

Antioxidant, antiradical, and antimicrobial activities of polysaccharides obtained by microwave-assisted extraction method: A review

The antioxidant and antimicrobial activities of polysaccharides extracted by microwave-assisted extraction (MAE) were reviewed. An ascending dose-dependent manner was found for the in vitro antioxidant (e.g., nitrite scavenging, phospho-molybdenum reduction, inhibition of lipid peroxidation (ILP), ferric reducing power, and ferrous metal ions chelating), and antiradical (against DPPH·, OH·, ABTS·, NO·, and O2·−) activities. There was a positive and significant correlation between ILP and erythrocyte hemolysis inhibition, showing the excellent antioxidative properties to prevent the risk of cell damage. These carbohydrate-based polymers in vivo could reduce malonaldehyde and protein carbonyls and increase stress-resistance-related enzymes such as catalase, superoxide dismutase, and glutathione peroxidase. They showed an effective bactericidal activity against a wide variety of gram-negative and gram-positive bacterial infections. The in vitro strong antifungal and antiviral activities of sulfated polysaccharides extracted by MAE were also diagnosed without any cytotoxicity effect. Therefore, these biomacromolecules might be used to develop functional foods and nutraceuticals. Keywords: Bioactive polysaccharide, Extraction, Microwave, Antioxidant, Antibacterial, Disease preventio

Plant/algal polysaccharides extracted by microwave: A review on hypoglycemic, hypolipidemic, prebiotic, and immune-stimulatory effect

Microwave-assisted extraction (MAE) is an emerging technology to obtain polysaccharides with an extensive spectrum of biological characteristics. In this study, the hypoglycemic, hypolipidemic, prebiotic, and immunomodulatory (e.g., antiinflammatory, anticoagulant, and phagocytic) effects of algal- and plant-derived polysaccharides rich in glucose, galactose, and mannose using MAE were comprehensively discussed. The in vitro and in vivo results showed that these bioactive macromolecules with the low digestibility rate could effectively alleviate the fatty acid-induced lipotoxicity, acute hemolysis, and dyslipidemia status. The optimally extracted glucomannan- and glucogalactan-containing polysaccharides revealed significant antidiabetic effects through inhibiting α-amylase and α-glucosidase, improving dynamic insulin sensitivity and secretion, and promoting pancreatic β-cell proliferation. These bioactive macromolecules as prebiotics not only improve the digestibility in gastrointestinal tract but also reduce the survival rate of pathogens and tumor cells by activating macrophages and producing pro-inflammatory biomarkers and cytokines. They can effectively prevent gastrointestinal disorders and microbial infections without any toxicity