Increased maternal pregnancy complications in polycystic ovary syndrome appear to be independent of obesity—A systematic review,meta‐analysis,and meta‐regression

Polycystic ovary syndrome (PCOS) is associated with an increased risk of maternal pregnancy and delivery complications. However, the impact of clinical features of PCOS and other potential risk factors in PCOS is still unknown. We aimed to investigate the association of PCOS with maternal pregnancy and delivery complications with consideration of risk factors and potential confounders. The meta‐analysis included 63 studies. PCOS was associated with higher miscarriage, gestational diabetes mellitus, gestational hypertension, pre‐eclampsia, induction of labour, and caesarean section. The association of PCOS with these outcomes varied by geographic continent, PCOS phenotypes, and study quality. Pre‐eclampsia and induction of labour were not associated with PCOS on body mass index‐matched studies. No outcome was associated with PCOS on assisted pregnancies. Age was significantly associated with higher miscarriage on meta‐regression. There were no studies assessing perinatal depression. We confirm that PCOS is associated with an increased risk of maternal pregnancy and delivery complications. The association of PCOS with the outcomes is worsened in hyperandrogenic PCOS phenotypes, in specific geographic continents, and in the highest quality studies but disappears in assisted pregnancies. Future studies in PCOS are warranted to investigate proper timing for screening and prevention of maternal pregnancy and delivery complications with consideration of clinical features of PCOS.     

Oculocardiac Reflex during Strabismus Surgery: Experience from a Tertiary Hospital

Purpose: To evaluate the incidence of the oculocardiac reflex (OCR) and its associated risk factors during strabismus surgery at a tertiary referral center.

Methods: Over a 2-year period, all strabismus surgery candidates were enrolled in the study. OCR was defined as heart rate reduction ≥15% after traction on extraocular muscle(s). The rate of OCR was determined and possible associations were explored. Variables included age, gender, type of strabismus, nature of surgery (weakening versus strengthening), specified extraocular muscle, times of surgery, and the sequence of operated muscles (eg, first, second, or third operated muscle). We avoided the use of atropine pre- and postoperatively.

Results: Seventy-six patients with mean age of 15±12 years were enrolled; 51.3% of subjects were male. OCR occurred in 65 out of 76 (85.5%) patients and with 84 out of 173 (48.6%) operated muscles. OCR was more common in subjects less than 20 years of age; however, it showed a decreasing trend afterwards. OCR was more frequent during operation on cyclovertical muscles than horizontal recti (P=0.02). Moreover, during procedures on horizontal rectus muscles, OCR was more common if baseline heart rate was more than 61 (P=0.008). OCR was not correlated with gender, type of strabismus, nature of surgery, times of the surgery, or the sequence of operated extraocular muscles.

Conclusions: The great majority of patients undergoing strabismus surgery, especially younger subjects, those undergoing operation on cyclovertical muscles, and subjects with higher baseline heart rate, experience OCR during strabismus surgery. During surgery on cyclovertical muscles, the amount of pull is usually more due to more difficult exposure.     

Trend of salt intake measured by 24-hour urine collection samples among Iranian adults population between 1998 and 2013: The Isfahan salt study

Background and aimFew population-based studies conducted in the Eastern Mediterranean region assessed salt intake by the measurement of 24-h sodium urine excretion (24-hUNa). The current study aimed to assess the trend of mean salt intake in Iranian adults between 1998 and 2013.Methods and resultsThese cross-sectional studies were performed on 564, 157, 509 and 837 randomly selected healthy adults aged >18 years from Isfahan city, Iran, in 1998, 2001, 2007 and 2013, respectively. BP was measured using a mercury sphygmomanometer according to a standard protocol. Single 24-h urine was collected to assess 24-hUNa as a surrogate of salt intake, and 24-h urinary K (24-hUK).The estimated trend of salt intake was 9.5, 9.7, 9.6 and 10.2 g/day in total population (P < 0.001). The increase in salt intake between 1998 and 2013 was significant only in men, (P < 0.001). The risk of pre-hypertension was 21% and 18% significantly greater in the highest quartiles of UNa/UK after adjustment for potential confounders in 2001 and 2013, respectively, [OR (95% CI): 1.21 (1.03–1.64) and 1.18 (1.02–1.38), respectively].ConclusionsThis population-based study indicated that mean salt intake was about two times of recommendation in Isfahan city, Iran, and suggest that it would be essential to implement a salt reduction strategy program in Iranian population. Longitudinal national studies with larger samples examining the trend of salt intake are warranted.     

Tumour necrosis factor a −308 promoter polymorphism in patients with rheumatoid arthritis

There are controversial reports that TNF-a promoter polymorphism may be an independent marker of susceptibility to rheumatoid arthritis (RA). We used Polymerase chain reaction amplification and Restriction fragment length polymorphism for analysis of the polymorphism at position -308 in promoter of TNF-α gene in 34 patients with RA and 30 healthy individuals. Distribution of TNF-genotypes in RA patients did not differ from that in controls. Moreover, there was apparent association between the -308 TNF-α polymorphism and erosions in hand x-Ray was found (P value = 0.043). We suggest that TNF-α -308 promoter polymorphism is not a genetic risk factor for RA susceptibility but may be associated with radiographic damage in rheumatoid patients. All work was funded by the Chancellor for Research of Mashhad University of Medical Science.     

Extensively Drug-Resistant Tuberculosis, Pakistan

Frequency of extensively drug-resistant tuberculosis in Pakistan increased from 1.5% in 2006 to 4.5% in 2009 (p<0.01). To understand the epidemiology, we genotyped selected strains by using spoligotyping, mycobacterial interspersed repetitive units–variable number of tandem repeats, and IS6110 restriction fragment length polymorphism analysis.     

Conjunctival and pulmonary hemodynamic properties in sickle cell disease subjects with and without pulmonary hypertension

Conjunctival microvascular hemodynamic alterations were reported for the first time in sickle cell subjects with and without pulmonary hypertension. Assessment of the conjunctival microcirculation using noninvasive imaging may improve understanding of microvascular hemodynamic alterations that occur due to pulmonary hypertension in sickle cell disease.