The effects of sequential use of oxytocin and sublingual nitroglycerin in the cases of retained placenta

Objectives: To evaluate the effects of adding sublingual nitroglycerin to oxytocin, for delivery of retained placenta after vaginal delivery.

Method: The study was performed as a placebo controlled clinical trial on women who did not finish delivering placenta after 30 min of active management of the third stage of labor. In case group, 1 mg nitroglycerin and in the control group, placebo was prescribed sublingually.

Results: In total, 80 women finished the study. The number of manual removal of placenta did not show significant difference between the two groups [25 women (62.5%) in the case and 30 women (75%) in the control group, p?=?0.335]. There was no significant difference between the two groups according to duration of the third stage of labor, hemoglobin index, decline in HB index?>30% and maternal vital signs after treatment. There was no significant difference between the two groups according to adverse effects [eight women (20%) in the case group and four (10%) in the control group (p?=?0.348)].

Conclusion: The sequential use of oxytocin and sublingual nitroglycerin could not lead to delivery of more placentas and did not reduce the necessity of manual removal of placenta in comparison with placebo.     

Detrimental Effects of COVID-19 Measures on Mental Health and Social-Economic Disparities

The COVID-19 pandemic has struck nations worldwide, pushing worldwide health and socioeconomic systems to extreme limits. Various factors, such as drastic alterations in public environments, prolonged quarantine, revenue loss, and anxiety of disease contraction, have caused mental turmoil. Although there was a need to cope with an excess of psychological strain among the public, post-COVID patients, and those with a previously diagnosed psychiatric condition, mental health programs faced a substantial decline in services, mirroring the dramatic rise in psychological issues. Interestingly, certain coping strategies play protective or deleterious effects on mental health outcomes. Moreover, social media exposure has played a double-edged role in the mental health of the public during the pandemic, leaving grounds for further debates. Protean cultural themes have taken center stage in the discussion on social resilience and compliance to COVID-19 measures, driving their impact through certain work ethics, social capital, and public attitudes in different societies. On the other hand, exceedingly rising poverty rates cemented the deleterious economic impact of the pandemic. Attention has been called to the racial implications of the pandemic, driving millions of individuals with low socioeconomic position (SEP) and belonging to minority groups out of the paid workforce. Interestingly, we turn attention to an array of elements implicated in this dramatic effect, such as public transport, living arrangements, and health insurance coverage among these vulnerable groups. We attempt to address the mechanisms COVID-19 channeled its mental health and socioeconomic impacts by explaining the risk factors and pave the way for stronger crisis management in the future by evaluating the socioeconomic and psychological effects in stark detail.     

Update of endovenous laser therapy and the latest application studies

Endovenous laser therapy (ELT) has been applied in clinical practice as a therapy for truncal vein incompetence for about 10 years. One characteristic of ELT is the broad spectrum of different treatment protocols using a variety of laser systems and different forms of endovenous application. The principles behind the way ELT is carried out and the clinical results are described in detail in the following article.Despite good clinical results with effective, relatively pain-free occlusion of incompetent truncal veins, undesired side effects have been observed such as ecchymosis, phlebitis and recanalization. These can mainly be traced to thermal lesions in the vein wall concentrated in certain spots with transmural ablations of the tissue and perforations. In recent years systematic experimental investigations and the analysis of clinical results have increased understanding of the connection between endovenous laser application and clinical results. This has led to a continuous development and optimization of ELT. Particularly the use of longer wavelengths and radially irradiating optical fibers, together with endovenous laser irradiation with continuous pull-back of the optical fiber seem to have had a positive influence on the side effects. As a result ELT treatment is coming closer to the goal of standardizing an effective method for the treatment of varicose veins. Further controlled studies are required to compare optimized ELT treatment protocols with not only other endothermal modes of treatment but also with conventional open surgery.     

Comparison of the efficacy of topical 1% lindane vs 5% permethrin in scabies: a randomized, double-blind study

BACKGROUND: Permethrin, a pyrethroid insecticide, is not yet available in Iran and may be a useful substitute for the control of scabies in Iran. AIM: To compare the efficacy of topical lindane with topical permethrin in the treatment of scabies in a population in Iran. METHODS: In a double-blind, randomized study, all consecutive patients with scabies were randomized into two groups. One group and their family contacts received 1% lindane cream, and the other group and their family contacts were treated with topical 5% permethrin cream. Subsequently, patients were followed up at 2- and 4-week post-treatment. RESULTS: Of the 99 patients enrolled in the study, 47 patients received 1% lindane cream, and 52 patients were treated topically with 5% permethrin cream. Permethrin provided an improvement rate of 84.6% after two weeks, whereas lindane was effective only in 48.9% of patients. CONCLUSION: Permethrin (5%) cream was found to be significantly more effective in the treatment of scabies in comparison with lindane in this study, and it seems that it could be an alternative treatment.     

Functional endoscopic dilatation of the sinuses: patient satisfaction, postoperative pain, and cost

BACKGROUND: The purpose of this study was to determine how functional endoscopic dilatation of the sinuses (FEDS) compares with functional endoscopic sinus surgery (FESS) in a select group of patients with respect to (1) elimination of symptoms, (2) patient satisfaction, (3) postoperative narcotic use, and (4) cost. A retrospective study was performed of 70 patients with chronic rhinosinusitis who underwent FEDS or FESS as primary or revision treatment. METHODS: Symptoms and satisfaction based on the Sino-Nasal Outcome Test (SNOT-20) questionnaires and global patient assessment, postoperative narcotic use, and costs were compared after 3-month follow-up. RESULTS: SNOT-20 change scores indicated that both FEDS and FESS had clinically meaningful treatment responses. Patient satisfaction was higher and postoperative narcotics usage was less with FEDS. The cost for primary procedures was similar, whereas the cost for revision surgery using FEDS was considerably less. Turbinate lateralization and scarring was more common in the FEDS group, particularly early in the study. The incidence of recurrent sinus infections during the follow-up period was similar for both groups. Only one patient in the FEDS group required a repeat intervention within the short-term follow-up period. CONCLUSION: Both FEDS and FESS resulted in significant improvement in SNOT-20 scores for selected patients with mild disease. Patient satisfaction and postoperative narcotic use of FEDS compare favorably with FESS. Cost of FEDS was comparable with FESS for primary procedures but was less than FESS for revision procedures. Long-term efficacy and final cost of FEDS remain to be addressed, taking into account the need for revision procedures after initial FEDS, by means of long-term studies and objective outcome measures.     

Evaluating the Effect of a COVID-19 Predictive Model to Facilitate Discharge: A Randomized Controlled Trial

Background  We previously developed and validated a predictive model to help clinicians identify hospitalized adults with coronavirus disease 2019 (COVID-19) who may be ready for discharge given their low risk of adverse events. Whether this algorithm can prompt more timely discharge for stable patients in practice is unknown. Objectives  The aim of the study is to estimate the effect of displaying risk scores on length of stay (LOS). Methods  We integrated model output into the electronic health record (EHR) at four hospitals in one health system by displaying a green/orange/red score indicating low/moderate/high-risk in a patient list column and a larger COVID-19 summary report visible for each patient. Display of the score was pseudo-randomized 1:1 into intervention and control arms using a patient identifier passed to the model execution code. Intervention effect was assessed by comparing LOS between intervention and control groups. Adverse safety outcomes of death, hospice, and re-presentation were tested separately and as a composite indicator. We tracked adoption and sustained use through daily counts of score displays. Results  Enrolling 1,010 patients from May 15, 2020 to December 7, 2020, the trial found no detectable difference in LOS. The intervention had no impact on safety indicators of death, hospice or re-presentation after discharge. The scores were displayed consistently throughout the study period but the study lacks a causally linked process measure of provider actions based on the score. Secondary analysis revealed complex dynamics in LOS temporally, by primary symptom, and hospital location. Conclusion  An AI-based COVID-19 risk score displayed passively to clinicians during routine care of hospitalized adults with COVID-19 was safe but had no detectable impact on LOS. Health technology challenges such as insufficient adoption, nonuniform use, and provider trust compounded with temporal factors of the COVID-19 pandemic may have contributed to the null result. Trial registration  ClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT04570488","term_id":"NCT04570488"}}NCT04570488.     

Hyperhidrosis: Anatomy,Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins

Clinical features, anatomy and physiology of hyperhidrosis are presented with a review of the world literature on treatment. Level of drug efficacy is defined according to the guidelines of the American Academy of Neurology. Topical agents (glycopyrrolate and methylsulfate) are evidence level B (probably effective). Oral agents (oxybutynin and methantheline bromide) are also level B. In a total of 831 patients, 1 class I and 2 class II blinded studies showed level B efficacy of OnabotulinumtoxinA (A/Ona), while 1 class I and 1 class II study also demonstrated level B efficacy of AbobotulinumtoxinA (A/Abo) in axillary hyperhidrosis (AH), collectively depicting Level A evidence (established) for botulinumtoxinA (BoNT-A). In a comparator study, A/Ona and A/Inco toxins demonstrated comparable efficacy in AH. For IncobotulinumtoxinA (A/Inco) no placebo controlled studies exist; thus, efficacy is Level C (possibly effective) based solely on the aforementioned class II comparator study. For RimabotulinumtoxinB (B/Rima), one class III study has suggested Level U efficacy (insufficient data). In palmar hyperhidrosis (PH), there are 3 class II studies for A/Ona and 2 for A/Abo (individually and collectively level B for BoNT-A) and no blinded study for A/Inco (level U). For B/Rima the level of evidence is C (possibly effective) based on 1 class II study. Botulinum toxins (BoNT) provide a long lasting effect of 3–9 months after one injection session. Studies on BoNT-A iontophoresis are emerging (2 class II studies; level B); however, data on duration and frequency of application is inconsistent.     

Assessment of women's empowerment: An exploratory study to develop a valid and reliable Persian-version tool

Abstract

Lack of a valid and reliable women's empowerment tool was reported by previous studies in Iran. The authors of this paper, accordingly, intended to fill this gap by developing a valid questionnaire. 600 women in Dezful city, southeast of Iran, took part in the study in 2014–2015. Multistage sampling method was used to recruit the participants. Our exploratory factor analysis revealed that 18 items of the model loaded on 4 factors. Internal consistency of the questionnaire was suitable as Cronbach's alpha coefficient was 0.77. Considering high validity and shortness of the questionnaire, it can be used as a trustful and comprehensive tool to measure women's empowerment in future studies.