Objective assessment of obstructive sleep apnea in normal pregnant and preeclamptic women

Objective: Obstructive sleep apnea (OSA) is a risk factor for adverse pregnancy outcomes. The aim of this study was to evaluate the association between OSA and preeclampsia. Methods: Between 30 and 39 weeks gestation, objective sleep apnea were evaluated in 38 normal pregnant and 40 preeclamptic women. Preeclampsia was defined by having a blood pressure (BP) > 140/90 mmHg on two occasions after the 20th week of pregnancy with excess protein in the urine (> 300 mg in 24 h) or 30 mg persistent proteinuria (+ 1 in dipsticks) in random samples. Objective sleep apnea was evaluated using an overnight in-hospital sleep evaluation using the SOMNOwatch plus Respiratory Screener. OSA was defined as an apnea–hypopnea index (AHI) ≥ 5, and further grouped into severity categories: mild (5–14.9), moderate (15–29.9), and severe (≥ 30). Results: Mean AHI was 33.3 ± 12.1 in preeclamptic women and was 23.8 ± 15.8 in normal pregnant women (p = 0.008). There was significant difference in prevalence of OSA severity (none, mild, moderate, or severe) between groups. Out of 33 preeclamptic women, 11 women had moderate and 22 women had severe OSA. Whereas, among 33 normal pregnant women, 8, 13, and10 women had mild, moderate, and severe OSA, respectively. Two normal pregnant women had no OSA (AHI< 5). Conclusion: Our study suggests women are susceptible to developing OSA during pregnancy that is associated with an increased risk of preeclampsia.     

Non-invasive management of fused upper incisors

The union of two different dental sprouts which can happen in any phase of dental development is commonly called fusion. This developmental anomaly may cause clinical problems including esthetic impairment, which are mainly treated by endodontic and surgical treatments. There are a few reports of conservative not invasive treatment of fused incisors teeth through restorative or prosthetic techniques. They are rarely reported in mandibular posterior teeth. This paper presents an unusual case of fusion of 7 and 8, and also 9 and 10 teeth which was treated with a nonendodontic and nonsurgical conservative approach. Patient was a healthy18-year-old female with chief complaint of bad-looking teeth that in intraoral examination revealed the fusion of 7 and 8, and also 9 and 10 teeth. The space between the mesial of the 6 and 11 teeth was reconstructed. Diastema between the fused teeth was closed. A new lateral tooth was replaced between the fused teeth (7 and 8) and 6 tooth with direct fiber-reinforced composite. The space between the fused teeth (9 and 10) and also tooth 11 was partially closed. Gingival papillas were reconstructed using pink composite. The mandibular anterior missing teeth were replaced with rochett bridge. At the end of treatment the esthetic of the patient was improved. As the treatment was not invasive, major complications are not expected; however, there is potential for eventual long-term periodontal problems due to poor oral hygiene. Debonding of the rochett bridge may happen as well.     

Identification of disease-causing variants in the EXOSC gene family underlying autosomal recessive intellectual disability in Iranian families

Neurodevelopmental delay and intellectual disability (ID) can arise from numerous genetic defects. To date, variants in the EXOSC gene family have been associated with such disorders. Using next-generation sequencing (NGS), known and novel variants in this gene family causing autosomal recessive ID (ARID) have been identified in five Iranian families. By collecting clinical information on these families and comparing their phenotypes with previously reported patients, we further describe the clinical variability of ARID resulting from alterations in the EXOSC gene family, and emphasize the role of RNA processing dysregulation in ARID.     

The efficacy of sour tea (Hibiscus sabdariffa L.) on selected cardiovascular disease risk factors: A systematic review and meta‐analysis of randomized clinical trials

This study sought to summarize clinical evidence of sour tea (Hibiscus sabdariffa L.) administration on cardiovascular disease risk factors. PubMed, Scopus, Institute for Scientific Information Web of Science, and Google Scholar were systematically searched from inception to June 2019 to identify randomized clinical trials, which assessed the effect of sour tea consumption on lipid profiles, fasting plasma glucose, and blood pressure in adult populations. Mean and standard deviation for each parameter were extracted to calculate effect size. Cochrane Collaboration tools were used to evaluate risk of bias assessment. A total of seven randomized clinical trials consisting 362 participants were included in the meta‐analysis. Pooled effect size demonstrated that sour tea consumption significantly reduces fasting plasma glucose (?3.67 mg/dl, 95% confidence interval, CI [?7.07, ?0.27]; I² = 37%), systolic blood pressure (?4.71 mmHg, 95% CI [?7.87, ?1.55]; I² = 53%), and diastolic blood pressure (?4.08 mmHg, 95% CI [?6.48, ?1.67]; I² = 14%). Although no significant effect was observed on triacylglycerol, total cholesterol, and high‐density lipoprotein cholesterol following sour tea consumption, a trend toward a significant reduction was found in low‐density lipoprotein cholesterol serum concentrations (p = 0.08). This systematic review and meta‐analysis suggests that sour tea consumption could have beneficial effect in controlling glycemic status and blood pressure among adult population.     

Effect of intraumbilical vein oxytocin injection on third stage of labor

ObjectiveManual removal of placenta is performed in 1–3% of cases, and although it is a well-established and relatively safe procedure, it is not without complications. We carried out this study to determine whether intraumbilical vein oxytocin injection reduces the need for manual removal of placenta and shortens the third stage of labor, in comparison with placebo.Materials and MethodsIn this randomized clinical trial, 178 women with singleton pregnancy and normal delivery were studied in 1 year. Immediately after fetus delivery, oxytocin infusion (20 IU/L) was started in both groups. Moreover, 10 IU oxytocin and 1 mL normal saline were injected into the umbilical vein of women in the experimental and control groups, respectively. The duration of third-stage labor, need for manual delivery of placenta, and drug side effects were evaluated in both groups. With regard to the mean level of hemoglobin before and after delivery, the two groups were compared using the Levene test and independent t test, and other qualitative variables of the two groups were compared using the χ² test.ResultsThe women who received intraumbilical vein oxytocin had a shorter third stage of labor as compared with the placebo group (4.24 ± 3.27 min vs. 10.66 ± 7.41) (p < 0.001) and there was less need for manual delivery of placenta in the experiment group (1.1% vs. 5.1%) (p = 0.024).ConclusionIt was concluded that intraumbilical vein administration of 10 IU (1 mL) oxytocin immediately after fetus delivery was clinically effective in shortening the third stage of labor.     

Proprioception,dynamic balance and maximal quadriceps strength in females with knee osteoarthritis and normal control subjects

Background: Osteoarthritis (OA) is one of the most common musculoskeletal complaints worldwide. The knee is the most frequently involved joint of the lower limb in OA. Knee joint proprioception, dynamic balance and maximal quadriceps strength may be impaired in patients with knee OA. Objective: To investigate whether females with knee OA have reduced knee joint proprioception, balance responses and quadriceps strength compared with normal controls. Methods: We undertook a cross‐sectional study of 30 females with knee OA and 30 controls. Knee joint proprioception was measured using electrogoniometer. Dynamic balance response was determined using a step test. Quadriceps strength was measured isometrically using a modified Tornvall chair. Results: Subjects with OA had greater mean error, poorer dynamic balance and less quadriceps strength than non‐symptomatic ones (P < 0.001). Increasing age was associated with a decline in proprioceptive acuity for both controls and patients (r = 0.40, P < 0.001). In subjects with knee OA, decreased dynamic balance was associated with increasing weight (r = 0.30, P < 0.001) and reduced quadriceps strength (r = –0.37, P = 0.002). Conclusion: Compared with age and sex‐matched controls, females with symptomatic knee OA have reduced knee proprioception, balance responses and quadriceps strength.     

Use of adenosine as a diagnostic tool for dual atrioventricular nodal pathways: response of control patients to incremental doses of adenosine

BACKGROUND: Adenosine at low doses preferentially blocks fast over slow pathway conduction in patients with dual atrioventricular (AV) nodal physiology and typical AV nodal reentrant tachycardia (AVNRT). During atrial pacing, this effect is manifested as an abrupt increase in the AH interval with low doses of adenosine. This demonstration of dual AV nodal physiology may be useful as a diagnostic tool during electrophysiologic studies in patients with supraventricular tachycardia who are not easily inducible, as clear demonstration of dual AV nodal pathways may indicate that AVNRT is a likely diagnosis and that further attempts at arrhythmia induction should be tailored in that direction. However, to be a useful test, adenosine should not cause an abrupt increase in AH interval in patients without dual AV nodal physiology. HYPOTHESIS: This study was designed to investigate the prevalence of dual AV nodal pathways with administration of adenosine in patients with no history suggestive of AVNRT. METHODS: Thirty-seven patients who had no prior history of AVNRT and were undergoing electrophysiologic study for standard indications were enrolled. Baseline Wenckebach cycle length (WCL) and AV nodal effective refractory periods were measured at atrial pacing cycle lengths of 400 and 600 ms. The atrium was then paced at WCL + 50 ms, and WCL + 100 ms, while incrementally larger doses of intravenous adenosine were administered until AV nodal block occurred. RESULTS: The mean (+/- standard deviation) doses of adenosine required to cause AV nodal block while pacing at WCL + 50 ms and WCL + 100 ms were 7.1 +/- 3.9 and 7.4 +/- 4.5 mg, respectively. In 1 of 37 patients (2.7%, 95% confidence interval 0-8%), an abrupt prolongation of the AH interval was seen with the administration of adenosine during atrial pacing as well as during the atrial refractory period determination. In all other patients, no dual AV nodal physiology was demonstrated during the refractory period determination, and there were only gradual changes in the AH interval with atrial pacing during administration of adenosine. CONCLUSION: Among patients with no history suggestive of AV nodal reentrant tachycardia, only 2.7% have clinically silent dual AV nodal pathways using this method. Incremental adenosine infusion during electrophysiologic study can be used as a highly specific diagnostic tool for patients with dual AV nodal pathways.     

Human T-Lymphotropic Virus Type I (HTLV-1) Infection among Iranian Blood Donors: First Case-Control Study on the Risk Factors

Human T-cell lymphotropic virus type 1 (HTLV-1) infection is an endemic condition in Northeast Iran and, as such, identification of risk factors associated with the infection in this region seems to be a necessity. All the possible risk factors for HTLV-1 seropositivity among first-time blood donors were evaluated in Mashhad, Iran, during the period of 2011–2012. Blood donation volunteers were interviewed for demographic data, medical history, and behavioral characteristics and the frequencies of risk factors were compared between HTLV-1 positive (case) and HTLV-1 negative (control) donors. The data was analyzed using Chi square and t-tests. Logistic regression analysis was performed to identify independent risk factors for the infection. Assessments were carried out on 246 cases aged 17–60 and 776 controls aged 17–59, who were matched based on their ages, gender, and date and center of donation. Logistic analysis showed low income (OR = 1.53, p = 0.035), low educational level (OR = 1.64, p = 0.049), being born in the cities of either Mashhad (OR = 2.47, p = 0.001) or Neyshabour (OR = 4.30, p < 0001), and a history of blood transfusion (OR = 3.17, p = 0.007) or non-IV drug abuse (OR = 3.77, p < 0.0001) were significant predictors for infection with HTLV-1. Lack of variability or small sample size could be reasons of failure to detect some well-known risk factors for HTLV-1 infection, such as prolonged breastfeeding and sexual promiscuity. Pre-donation screening of possible risk factors for transfusion-transmissible infections should also be considered as an important issue, however, a revision of the screening criteria such as a history of transfusion for more than one year prior to donation is strongly recommended.