Complications, Indications and Results of Two Screening Methods: Amniocentesis and Chorionic Villus Sampling

Background: Chorionic villus sampling (CVS) and amniocentesis are two invasive methods of diagnostic approaches for prenatal diagnosis. The indication, adverse effects and final outcome of these two methods are different. The goal of this study was to compare indication, complications and outcomes of CVS and amniocentesis in pregnant women underwent prenatal screening program.Methods: Medical records of 1464 women who underwent CVS, or amniocentesis were reviewed in two tertiary hospitals (imam and women hospitals, affiliated hospitals of Tehran University of Medical Sciences).Results: For 1073 patients amniocentesis was performed while for 391 cases CVS was one. Mean maternal age, gestational age, and age at birth of the neonates were significantly lower in CVS group than the other group. Mean needle time was significantly higher in CVS group. Mean needle time was significantly higher in CVS Group (1.3 vs. 1.5, P < 0.001). The most finding of CVS result was minor Thalassemia while trisomy 21 was the most finding in amniocentesis group. Rupture of membranes was the most side effects in amniocentesis group and intrauterine fetal death was the most complication in CVS group.Conclusions: Indication, results and complications of CVS and amniocentesis are different

Association Between Depression and Chronic Complications in Clients With Traumatic Spinal Cord Injury

The aim of this study was to evaluate the association between depression and chronic complications, in clients with traumatic spinal cord injury (TSCI). Eight hundred and thirty Traumatic Spinal Cord Injury (TSCI) patients were enrolled in this study. All cases filled up the Valid and Reliable Persian version of the Beck Depression Inventory (BDI). Each patient was examined by a constant neurosurgeon, and a TSCI research fellow to determine the level of injury, AIS (ASIA impairment scale) grade, and chronic complications. Eight hundred and thirty individuals participated in the study. Mean Spinal Cord Independence Measure (SCIM) score was 57.5±20 in cases with BDI<10, while it was 57.2±15.6 in patients with 9<BDI<19, 55.5±16.3 in cases with 19≤BDI<30 and 52.3±14.9 in cases with BDI≥30 (P=0.02). Also, the prevalence of pressure ulcers, neuropathic pain, spasm, suicide attempts, and sexual dysfunction were significantly higher among cases with major depression (BDI≥30). Mean visual analogue scale (VAS) was significantly higher and mean SCIM was significantly lower in patients with BDI≥30. There was a significant negative correlation between SCIM and BDI scores (r=-0.5, P=0.004) and significant positive correlation between VAS and BDI (r=0.65, P=0.04). Depression is an important risk factor in patients with TSCI for development of secondary complications. Chronic complications and greater functional dependency were observed more frequently in cases with BDI≥10

Laparoscopy Versus Laparotomy in Ectopic Pregnancy

Background: Ectopic pregnancy (EP) is the implantation of fertilized ovum in any site of the reproductive tract except uterine cavity. To choose laparotomy or laparoscopy for treatment is based on the patient’s&nbsp;hemodynamic status, her past surgical history, and the physician’s experience in endoscopic surgery. The goal of this study was to compare clinical and laboratory findings in women who have undergone laparoscopy or laparotomy for EP.Methods: In this cross-sectional study, 103 women, who had undergone laparoscopic or laparotomy treatment due to EP diagnosis, were enrolled. A structured questionnaire was used to collect information. Past fertility&nbsp;history, past medical and drug history, clinical symptoms and signs, laboratory findings (including Hb and serum β-hCG levels), size of EP mass and its location, endometrial thickness, free fluid in pelvic or abdominal&nbsp;cavity, type of treatment, and method were recorded.Results: Of the study population, 58 had undergone laparotomy and 45 had undergone laparoscopy. Mean age, mass size, and B-hCG level before surgery were significantly higher in women who had undergone&nbsp;laparotomy. Right tubes followed by left tubes were the most affected sites. Unstable vital sign was recorded in the laparotomy group more than the laparoscopy group.Conclusions: Results of the current study showed that women who had undergone laparotomy had significantly higher mean age, mass size, and B-hCG level and were more unstable than the laparoscopic group

Sleep Quality in Women with Endometriosis

Background: Endometriosis is a gynecological disorder characterized as the implantation of endometrial tissue outside the uterine cavity. Psychological symptoms such as anxiety, bipolar disorder, depressive symptom and impaired quality of life are common in these women. Sleep quality had not been considered in these women as it should be. The goal of this study was to evaluate sleep quality in women with endometriosis.Methods: In this cross-sectional study 61 married women with laparoscopically diagnosed endometriosis asked to fill valid and reliable Pittsburgh Sleep Quality Index (PSQI).Results: Mean age and mean education level were 31.4±6.7 years and 11.7±3.1 years, respectively. Dysmenorrhea followed by dyspareunia was the most common symptoms (68.8% and 40.3%). Mean PSQI score was 6.1±3.4, twenty eight (45.9%) had PSQI score equal or less than 5 and 33 (54.1%) had PSQI score more than 5 (poor sleep). Mean PSQI was significantly different between cases with and without dysmenorrhea and dyspareunia.Conclusion: Sleep quality should be considered in women with endometriosis

Microbiomes and Pediatric onset multiple sclerosis (MS): A systematic review

Background: Gut microbiomes play a role in developing and regulating autoimmune diseases such as multiple sclerosis (MS). We designed this systematic review to summarize the evidence of the effect of gut microbiota in developing pediatric-onset MS. Methods: PubMed, Scopus, EMBASE, Web of Science, Google Scholar, references of the references and conference abstracts were comprehensively searched by two independent researchers. The search was done on January 1st, 2023. Data regarding the total number of patients, the name of the first author, publication year, country of origin, mean age, duration of the disease, body mass index (BMI), type of MS, Expanded Disability Status Scale (EDSS), age at disease onset and stool composition were extracted. Results: A literature search revealed 4237 published studies. After removing duplicates, we had 2045 records for evaluation. Twenty-three full texts were evaluated, and four case-control studies remained for systematic review. Three studies were conducted in the United States and one in the Netherlands. The number of participants in included studies ranged between 24 and 68. The mean age of patients at the time of study varied between 11.9 and 17.9 years, and the mean age at the onset of the disease ranged between 11.5 and 14.3 years. Most included patients were female. The results show that median richness (the number of unique taxa identified, which was provided by two studies) was higher in controls, and also Margalef index, which was reported by one study was higher in control group than the case group. The results of two studies also demonstrated that median evenness indexes (taxon distribution, Shannon, Simpson) were higher in control groups, as well as PD index (Faith's phylogenic diversity metric). Conclusion: The result of this systematic review (including four studies) showed disruption of the microbiota-immune balance in pediatric-onset MS cases

Perspectives of Iranian Medical Nurses about Do-Not-Resuscitate (DNR) Orders

Objective: To study the attitudes of Iranian medical nurses towards the do-not-resuscitate (DNR) decision.Methods: In this cross-sectional study, 200 nurses working in Imam Khomeini Hospital, (affiliated to Tehran University of Medical Sciences, Tehran, Iran) were enrolled. They answered to a questionnaire with two sections: the first one consisted of demographic questions (age, sex, and level of education), and the second included questions about DNR orders derived from a previously conducted study by Hosaka et al.Results: A total of 168 questionnaires returned (response rate (RR=85%)). About 61% felt that DNR order is sporadically necessary. Near 66% had participated in DNRs in their practice and the most case was the patient with&nbsp;terminal cancer. The most common person who decided DNR orders were physicians. Sixty seven percent believed that DNR cards are useful for establishing in clinical settings.Conclusion: As DNR is not routine in Iran, enrollment of nurses in this decision should be clearly defined

Comparison of oral and intra venous midazolam for sedation in children undergoing upper gastrointestinal endoscopy

Background: Selecting the best medication for upper GI endoscopy in children is a challenging issue. The goal of this study was to compare the effects of oral and intravenous midazolam for upper gastrointestinal endoscopy (UGIE) on children. Methods: In this randomized clinical trial study conducted in Amirkola Children's Hospital, 110 children were randomly assigned to oral or intravenous groups. An expert nurse recorded O2 saturation, heart rate before, during and 5 minutes after endoscopy for all patients. Sedation, separation from parents and child cooperation were recorded. Results: Heart rate before and during endoscopy was not significantly different between two groups while heart rate was significantly lower in IV group after endoscopy. Cooperation during bite block was significantly better in oral group. Cooperation during endoscopy was not significantly different between two groups. Separation from parents in both male and female ones was significantly better in oral group. Complications were reported in 7 cases in oral group and 6 in IV group. Conclusion: Oral midazolam in comparison with IV midazolam is better and may be a method of choice for pediatric UGIE purposes

Are Iranians Aware of Carbon Monoxide Poisoning: Symptoms and Its Prevention Strategies?

Carbon monoxide (CO) poisoning is still a health problem all over the world. Informing users about symptoms and suggesting annual inspection of CO producing devices will result in CO poisoning reduction. The goal of this study was to evaluate awareness about CO poisoning symptoms and its prevention ways in Iranian population. In this study, a total of 700 patients' family members attended Imam Khomeni hospital were asked to enroll in the study. A structured questionnaire was used including demographic characteristics, devices which were used at home, awareness of CO poisoning symptoms, awareness of CO detectors, the last time that tubal patency of devices are checked, if it is helpful to open the window to fix gas leak and if surveying devices by an expert at the beginning of the cold season is recommended. A total of 635 participants completed questionnaires. The most used device was gas water heater followed by gas heater. Five hundred and nine reported that they are aware of CO poisoning symptoms (80.1%), 398 (62.6%) stated that it is possible to detect CO leak and 566 (89.1%) told CO detectors would be helpful for reduction of mortality from CO poisoning. Fifty percent of participants had not checked their devices since they have bought their devices. Five hundred and thirty-six (84.4%) reported that opening window could help CO leak, and 596 (93.8%) agreed that an expert checked their fuel-burning devices at the beginning of the winter. Iranian people are not aware of all CO poisoning symptoms. Developing a national strategy for CO surveillance and people education will be helpful

Effects of Combining Methylprednisolone with Magnesium Sulfate on Neuropathic Pain and Functional Recovery Following Spinal Cord Injury in Male Rats

Methylprednisolone (MP) has been widely used as a standard therapeutic agent for the treatment of spinal cord injury (SCI). Because of its controversial useful effects, the combination of MP and other pharmacological agents to enhance neuroprotective effects is desirable. Magnesium sulfate (MgSO4) has been shown to have neuroprotective and antihyperalgesic effects. In the present study, we sought to determine the effect of combining MP and MgSO4, on neuropathic pain and functional recovery following spinal cord injury (SCI) in male rats. A total of 48 adult male rats (weight 300-350 g) were used. After laminectomy, complete SCI was achieved by compression of the spinal cord for one minute with aneurysm clips. Single doses of Magnesium sulfate (MgSO4), (600 mg/kg), Methylprednisolone (MP), (30 mg/kg) or combining MgSO4 and MP were injected intraperitoneally. Prior to surgery and during four weeks of study Tail flick latency (TFL) and BBB (Basso-Beattie-Bresnahan) score and the acetone drop test were evaluated. In mean values of BBB score, a significant difference was observed in SCI+veh compared with other groups (P<0.05). Mean TFL also was significantly higher in SCI+veh compared with other groups (P<0.05). Mean acetone drop test score and weight were significantly different in MgSO4, MP and combining MgSO4 and MP  treated groups compared with SCI+veh group (P<0.05). These findings revealed that MP, MgSO4 and combining MgSO4 and MP treatment can attenuate neuropathic pains following SCI in rats include: thermal hyperalgesia and cold allodynia. They also can yield better improvement in motor function and decrease weight loss after SCI in rats compared with the control group

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2—to end preventable child deaths by 2030—we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations