Efficacy of oral celecoxib and hyoscine butyl-bromide versus placebo during copper intrauterine device placement in women delivered only by elective cesarean section: a randomized controlled study

Objective: To compare the efficacy and tolerability of celecoxib to hyoscine butyl bromide (HBB) and placebo in reducing pain scores during placement of copper intrauterine devices (IUD) in parous women who have undergone elective cesarean section and who have had no previous vaginal deliveries. Methods: We conducted a randomized, double-blind, placebo-controlled trial at a tertiary University hospital from April 2018 to September 2018. The study included women who had never delivered vaginally and who desired copper IUD insertion. We randomized the study participants in a 1:1:1 ratio to celecoxib, HBB or placebo groups. They took the tablets orally two hours before IUD insertion. The study outcomes were the self-reported pain measurements, using a 10-cm Visual Analogue Scale (VAS), taken during tenaculum placement, sound insertion, IUD insertion and five minutes post-insertion, as well as an ease of insertion score. Results: The study included 105 women (n=35 in each group). The baseline characteristics were similar among all groups. The mean pain score in the celecoxib group was lower during IUD insertion than placebo (1.97 vs 4.34, p<0.001). Moreover, the ease of insertion score was significantly better with celecoxib [1.56 vs. 3.03, p< 0.001] than with placebo. Similarly, Women in the HBB group were more likely to report lower pain scores during IUD insertion (2.91 vs 4.34, p<0.001) and lower ease of insertion score [1.43 vs. 3.03, p< 0.001]. Conclusions: The use of celecoxib and HBB may both reduce the pain associated with copper IUD insertion among women with no previous vaginal delivery. However, celecoxib is better tolerated with fewer side effect

Root extracts of Saussurea costus as prospective detoxifying food additive against sodium nitrite toxicity in male rats

Financiado para publicación en acceso aberto: Universidade de Vigo/CISUGThe goal of this study was to investigate the effects of three different extracts of Saussurea costus roots (ethanol, methanol, and water) as a food additive in alleviating the harmful effect of sodium nitrite in rat meals. Thirty-five adult male rats were divided into five groups as follows: control, sodium nitrite (NaNO2; 75 mg/kg BW, single oral dose), S. costus 70% ethanol, 70% methanol, and aqueous extracts (300 mg/kg BW), respectively for four weeks followed by a single dose of NaNO2 24h before decapitation. Results showed that the 70% ethanol extract of S. costus has a higher concentration of total phenolic content, total flavonoids, and antioxidant effect than the 70% methanol and water extracts. Rats pretreated with S. costus extracts reduced the harmful effects induced by NaNO2 and improved the hematological parameters, liver, and kidney function biomarkers as well as lipid profile as compared to the NaNO2 group. Furthermore, S. costus improved the histopathological alterations in the liver and kidney induced by NaNO2 and improved meat sensory evaluation. Conclusively, the 70% ethanol extract of S. costus roots is the most effective extract as an antioxidant against the toxicity of sodium nitrite in male rats and might be used safely as a natural additive in the food industry

Epidemiological, clinical, and therapeutic characteristics of Behçet's disease: a monocentric study in Tunisia

Introduction:&nbsp;to describe the epidemiological, clinical, therapeutic and evolving characteristics of Behçet´s disease and identify prognostic factors. Methods:&nbsp;we have realized a retrospective, single-center study, conducted over a period of 26 years and including 130 patients presenting Behçet´s disease and hospitalized in an Internal Medicine Department. Results:&nbsp;the mean age of the Behçet´s disease at onset was 30.3 ±8.8 years and that at diagnosis was 34.6 ±9.4 years. The sex ratio (male/female) was 2.5. The mean delay of diagnosis was 53.5 months. Oral aphthosis was constant. The frequency of the manifestations was: genital aphtosis 71.5%, pseudofolliculitis 84.6%, erythema nodosum 11.5%, positive pathergy test 50%, ocular disease 36.9%, venous thrombosis 30%, arterial disease 4.6%, joint damage 30.8%, neurological disease 19.2% and digestive disease 0.8%. The male gender was significantly associated with ocular involvement (p =0.02), venous disease (p =0.01) and occurrence of relapses (p =0.01). The mean follow up was 68.5 ± 77.3 months. The poor survival prognostic factors were male gender, ocular involvement, venous disease, cardiovascular disease, a duration of follow up ≤12 months and a diagnostic delay ≤ 24 months. Conclusion:&nbsp;improving the prognosis of Behçet´s disease requires a shortening of the time to diagnosis, multidisciplinary collaboration, intensive treatment of functional threats, regular monitoring, and patient adherence

Effect of dexamethasone on reducing pain and gastrointestinal symptoms associated with cesarean section: a systematic review and meta-analysis

Background: Dexamethasone has analgesic and antiemetic actions that have been documented in the literature. Therefore, we performed a systematic review and meta-analysis to investigate its overall effectiveness in reducing a variety of negative outcomes after cesarean section. Objectives: To investigate the efficacy and safety of dexamethasone for reducing pain associated with cesarean section, nausea, vomiting, pruritus, postoperative need for analgesia, postoperative antiemetic requests and headache. Methods: We searched PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science for relevant clinical trials. We then performed a systematic review and meta-analysis, including only randomized, placebo-controlled clinical trials. Our main population target was women undergoing elective cesarean delivery. The intervention under consideration was dexamethasone administered both by intravenous (IV) or subcutaneous (SC) over a variety of doses. The comparator was a placebo. Our main outcomes included: (1) perceptions as indicated by pain scores, (2) occurrence of nausea and (3) occurrence of vomiting. Secondary outcomes included: (4) occurrence of pruritus, (5) need for postoperative analgesia, (6) need for postoperative antiemetic drugs and (7) occurrence of headache. We assessed the quality of included studies using the risk of bias tool described in Cochrane\u27s handbook for systematic reviews of interventions. Results: We found that dexamethasone seemed to significantly reduce scores for pain at rest (p<0.001), as well as occurrence of nausea (p<0.001) and vomiting (p<0.001). The drug also showed significant reduction of negative symptoms in other secondary outcomes, including need for postoperative analgesia (p<0.001) and postoperative antiemetic drugs (p<0.001). However, the drug showed no significant effect in reducing headache and pruritus or in improving pain at movement scores. Conclusion: Dexamethasone appears to decrease perception of pain at rest and protects against nausea and vomiting. However, it does not seem effective against headaches or pruritus

Total phenolic and flavonoid contents and antioxidant, anti-inflammatory, analgesic, antipyretic and antidiabetic activities of Cordia myxa L. leaves

MBackground: Many plants of genus Cordia are traditionally used as astringent, anti-inflammatory, anthelminthic, antimalarial, diuretic, febrifuge, appetite suppressant and cough suppressant and to treat urinary infections, lung diseases and leprosy. The aim of the study is to determine the total phenolic and flavonoid contents of total ethanol extract and different fractions of C. myxa L. leaves, in addition to evaluation of some pharmacological activities including antioxidant, anti-inflammatory, analgesic, antipyretic and antidiabetic effects. Methods: Air dried powder of C. myxa leaves were extracted using 95% ethanol and fractionated successively with petroleum ether, dichloromethane, ethyl acetate and finally with n-butanol. The fractions were concentrated and then investigated for their antioxidant, anti-inflammatory, analgesic, antipyretic and antidiabetic activities using phosphomolybidinum and DPPH assays, carrageenan-induced paw edema, hot plate, yeast -induced pyrexia and streptozotocin-induced hyperglycemia methods, respectively. Results: The ethyl acetate fraction showed the highest antioxidant activity with high phenolic and flavonoid contents (31.03 ± 0.15 mg gallic acid equivalent/g dried weight and 811.91 ± 0.07 mg rutin equivalent/g dried weight, respectively). Dichloromethane and ethyl acetate fractions exhibited higher anti-inflammatory activity with percentages of inhibition 45.16% and 40.26%, respectively, which were quite comparable to that of indomethacin (51.61%). The petroleum ether and dichloromethane fractions showed the highest analgesic activity with reaction time 289.00 ± 3.00 and 288.33 ± 20.82, respectively. Evaluation of antipyretic activity revealed that the total ethanol extract and different fractions showed high antipyretic activities after 2 h, which were very close to that of the standard acetyl salicylic acid with a rapid onset (30 min). The total ethanol extract and the petroleum ether fraction exhibited the most potent hypoglycemic effect with a significant reduction in blood glucose level especially after 3 h to 95.67 ± 5.77 mg/dl and 87.67 ± 10.26 mg/dl, respectively and percentages decrease in blood glucose level were 68.22% and 70.78%, respectively. Conclusion: Cordia myxa L. extract and fractions exhibited antioxidant, anti-inflammatory analgesic, antipyretic and antidiabetic activities which may be attributed by the presence of active phytoconstituents

Matrix-assisted laser desorption-ionization-time-of-flight mass spectrometry as a reliable proteomic method for characterization of Escherichia coli and Salmonella isolates

Aim: Identification of pathogenic clinical bacterial isolates is mainly dependent on phenotypic and genotypic characteristics of the microorganisms. These conventional methods are costive, time-consuming, and need special skills and training. An alternative, mass spectral (proteomics) analysis method for identification of clinical bacterial isolates has been recognized as a rapid, reliable, and economical method for identification. This study was aimed to evaluate and compare the performance, sensitivity and reliability of traditional bacteriology, phenotypic methods and matrix-assisted laser desorption-ionization-time-of-flight mass spectrometry (MALDI-TOF MS) in the identification of clinical Escherichia coli and Salmonella isolates recovered from chickens. Materials and Methods: A total of 110 samples (cloacal, liver, spleen, and/or gall bladder) were collected from apparently healthy and diseased chickens showing clinical signs as white chalky diarrhea, pasty vent, and decrease egg production as well as freshly dead chickens which showing postmortem lesions as enlarged liver with congestion and enlarged gall bladder from different poultry farms. Results: Depending on colonial characteristics and morphological characteristics, E. coli and Salmonella isolates were recovered and detected in only 42 and 35 samples, respectively. Biochemical identification using API 20E identification system revealed that the suspected E. coli isolates were 33 out of 42 of colonial and morphological identified E. coli isolates where Salmonella isolates were represented by 26 out of 35 of colonial and morphological identified Salmonella isolates. Serological identification of isolates revealed that the most predominant E. coli serotypes were O1 and O78 while the most predominant Salmonella serotype of Salmonella was Salmonella Pullorum. All E. coli and Salmonella isolates were examined using MALDI-TOF MS. In agreement with traditional identification, MADI-TOF MS identified all clinical bacterial samples with valid scores as E. coli and Salmonella isolates except two E. coli isolates recovered from apparently healthy and diseased birds, respectively, with recovery rate of 93.9% and 2 Salmonella isolates recovered from apparently healthy and dead birds, respectively, with recovery rate of 92.3%. Conclusion: Our study demonstrated that Bruker MALDI-TOF MS Biotyper is a reliable rapid and economic tool for the identification of Gram-negative bacteria especially E. coli and Salmonella which could be used as an alternative diagnostic tool for routine identification and differentiation of clinical isolates in the bacteriological laboratory. MALDI-TOF MS need more validation and verification and more study on the performance of direct colony and extraction methods to detect the most sensitive one and also need using more samples to detect sensitivity, reliability, and performance of this type of bacterial identification

Trends in HIV/AIDS morbidity and mortality in Eastern 3 Mediterranean countries, 1990–2015: findings from the Global 4 Burden of Disease 2015 study

Objectives We used the results of the Global Burden of Disease 2015 study to estimate trends of HIV/AIDS burden in Eastern Mediterranean Region (EMR) countries between 1990 and 2015. Methods Tailored estimation methods were used to produce final estimates of mortality. Years of life lost (YLLs) were calculated by multiplying the mortality rate by population by age-specific life expectancy. Years lived with disability (YLDs) were computed as the prevalence of a sequela multiplied by its disability weight. Results In 2015, the rate of HIV/AIDS deaths in the EMR was 1.8 (1.4–2.5) per 100,000 population, a 43% increase from 1990 (0.3; 0.2–0.8). Consequently, the rate of YLLs due to HIV/AIDS increased from 15.3 (7.6–36.2) per 100,000 in 1990 to 81.9 (65.3–114.4) in 2015. The rate of YLDs increased from 1.3 (0.6–3.1) in 1990 to 4.4 (2.7–6.6) in 2015. Conclusions HIV/AIDS morbidity and mortality increased in the EMR since 1990. To reverse this trend and achieve epidemic control, EMR countries should strengthen HIV surveillance,and scale up HIV antiretroviral therapy and comprehensive prevention services

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016

Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Measurement of changes in health across locations is useful to compare and contrast changing epidemiological patterns against health system performance and identify specific needs for resource allocation in research, policy development, and programme decision making. Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we drew from two widely used summary measures to monitor such changes in population health: disability-adjusted life-years (DALYs) and healthy life expectancy (HALE). We used these measures to track trends and benchmark progress compared with expected trends on the basis of the Socio-demographic Index (SDI). METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive HALE and DALYs by sex for 195 countries and territories from 1990 to 2016. We calculated DALYs by summing years of life lost and years of life lived with disability for each location, age group, sex, and year. We estimated HALE using age-specific death rates and years of life lived with disability per capita. We explored how DALYs and HALE differed from expected trends when compared with the SDI: the geometric mean of income per person, educational attainment in the population older than age 15 years, and total fertility rate. FINDINGS: The highest globally observed HALE at birth for both women and men was in Singapore, at 75·2 years (95% uncertainty interval 71·9-78·6) for females and 72·0 years (68·8-75·1) for males. The lowest for females was in the Central African Republic (45·6 years [42·0-49·5]) and for males was in Lesotho (41·5 years [39·0-44·0]). From 1990 to 2016, global HALE increased by an average of 6·24 years (5·97-6·48) for both sexes combined. Global HALE increased by 6·04 years (5·74-6·27) for males and 6·49 years (6·08-6·77) for females, whereas HALE at age 65 years increased by 1·78 years (1·61-1·93) for males and 1·96 years (1·69-2·13) for females. Total global DALYs remained largely unchanged from 1990 to 2016 (-2·3% [-5·9 to 0·9]), with decreases in communicable, maternal, neonatal, and nutritional (CMNN) disease DALYs offset by increased DALYs due to non-communicable diseases (NCDs). The exemplars, calculated as the five lowest ratios of observed to expected age-standardised DALY rates in 2016, were Nicaragua, Costa Rica, the Maldives, Peru, and Israel. The leading three causes of DALYs globally were ischaemic heart disease, cerebrovascular disease, and lower respiratory infections, comprising 16·1% of all DALYs. Total DALYs and age-standardised DALY rates due to most CMNN causes decreased from 1990 to 2016. Conversely, the total DALY burden rose for most NCDs; however, age-standardised DALY rates due to NCDs declined globally. INTERPRETATION: At a global level, DALYs and HALE continue to show improvements. At the same time, we observe that many populations are facing growing functional health loss. Rising SDI was associated with increases in cumulative years of life lived with disability and decreases in CMNN DALYs offset by increased NCD DALYs. Relative compression of morbidity highlights the importance of continued health interventions, which has changed in most locations in pace with the gross domestic product per person, education, and family planning. The analysis of DALYs and HALE and their relationship to SDI represents a robust framework with which to benchmark location-specific health performance. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform health policies, health system improvement initiatives, targeted prevention efforts, and development assistance for health, including financial and research investments for all countries, regardless of their level of sociodemographic development. The presence of countries that substantially outperform others suggests the need for increased scrutiny for proven examples of best practices, which can help to extend gains, whereas the presence of underperforming countries suggests the need for devotion of extra attention to health systems that need more robust support. FUNDING: Bill & Melinda Gates Foundation