Evaluation of the effect of cognitive behavioral therapy on tocophobia: A systematic review and meta-analysis

Non-medical approaches including cognitive behavioral therapy (CBT) have been proposed for the management of tocophobia. A new method of performing CBT is through internet. The aim of this systematic review and meta-analysis was to evaluate the effect of internet-based and traditional CBT on tocophobia. A literature search was conducted on qualitative and quantitative articles from 2000 to 2019 in Pubmed, Scopus, Web of Science and Cochrane databases using search terms referring to tocophobia and CBT. Identified articles were screened in two steps; 1) title and abstract and 2) full text screening. The quality of the quantitative and qualitative studies was assessed using the quality criteria proposed by the Cochrane Collaboration and Jonna Briggs Institute (JBI) checklist respectively. Out of the 382 relevant studies, 9 studies were eligible for the review. A high level of heterogeneity was observed in the studies (I² = 94%, P < 0.001). The meta-analysis showed that both internet-based, and traditional CBT were effective in reducing tocophobia. CBT was more effective in interventions in the Middle Eastern compared to European countries. More than five CBT sessions could significantly reduce tocophobia. Healthcare providers and midwives should have basic knowledge on physiological interventions to reduce tocophobia.     

The description and histopathology of Leptorhynchoides polycristatus n. sp. (Acanthocephala: Rhadinorhynchidae) from sturgeons, Acipenser spp. (Actinopterygii: Acipenseridae) in the Caspian Sea, Iran, with emendation of the generic diagnosis

Of the three known species of Leptorhynchoides Kostylew 1924, two are reported from North American fishes: Leptorhynchoides aphredoderi Buckner and Buckner 1976 and Leptorhynchoides thecatus (Linton 1891) Kostylew 1924. The third species, Leptorhynchoides plagicephalus (Westrumb 1821) Kostylew 1924, is commonly found in the Caspian and Black Sea from at least four species of sturgeons including Acipenser stellatus Pallas 1771 and the Acipenser nudiventris Lovetzsky 1828 from which Leptorhynchoides polycristatus n. sp. was found. No taxonomic work has been reported for L. plagicephalus for the last 90 years. L. polycristatus n. sp. can be readily confused with L. plagicephalus because of many superficial similarities. Such similarities include the general shape of the trunk, proboscis, and organ systems. However, L. polycristatus is clearly distinguished from the other three species primarily by having (1) 19–20 proboscis hooks per row; (2) the shortest hooks are anterior and the longest at the middle; the opposite is true in L. plagicephalus; (3) with a cuticular collar enveloping the base of the proboscis hooks; (4) the surface of its proboscis hooks is ribbed; (5) with a broad collar of multiple rectangular cuticular crests encircling the anterior end of the trunk; this is the only member of Leptorhynchoides with such a structure; (6) with many large ovoid uninucleated cells in the subcuticular layer of the trunk; (7) with paired glandular clusters near the male reproductive opening and of suction cup-like sensory structures on the bursa; (8) with dorsoventral ligament across the vagina; (9) cement glands are in a cluster of eight arranged in two horizontal tiers of four glands each; (10) with female gonopore near terminal; (11) with structures interpreted as possible microtriches on the surface of the trunk; (12) and with thinner eggs. L. polycristatus caused extensive histopathological damage to host intestinal layers. The armed proboscis invades and attaches to the host mucosa causing villi compression and necrosis of the epithelial lining with subsequent hemorrhaging and granulocyte migration. No encapsulation of the acanthocephalan is visible, and the worm can migrate deep into the smooth muscle layers of the muscularis extrema. The presence of L. polycristatus in the lumen of the host intestine obstructs and damages the absorbing surface of the host affecting the nutritional potential. Dead, necrotic host epithelial tissue and remnants of villi and crypts are visible.     

Surgery for Graves’ disease: a 25-year perspective

Background

Optimal treatment of Graves’ disease (GD) remains controversial. The authors retrospectively reviewed the surgical cases of GD at a single academic tertiary center.

Methods

Demographic, clinical, and surgical data were analyzed for all patients with GD undergoing thyroidectomy over 25 years, in 3 periods: 1985 to 1993 (n = 32), 1994 to 2002 (n = 91), and 2003 to 2010 (n = 177).

Results

There were 300 patients with GD (85.7% women; mean age, 39.3 years; median length of follow-up, 24.6 months). Overall, perioperative morbidity occurred in 36 patients (12.0%), and there was no mortality. Thyroidectomy-specific morbidity was very low, and the incidental malignancy rate was 10.3%.

Conclusions

Surgical treatment of GD has a very high safety profile, with low perioperative and thyroidectomy-specific morbidity, even in patients with overt hyperthyroidism. Incidental malignancy in patients with GD is not uncommon.     

Is Venous Foot Pump Effective In Prevention of Thromboembolic Disease After Joint Arthroplasty: A Meta-Analysis

The goal of this meta-analysis was to evaluate the efficacy of venous foot pumps in prevention of venous thromboembolism following joint arthroplasty. Using different databases, we found 13 prospective clinical trials published meeting our inclusion criteria. In total, 1514 patients were included in the final analysis. Venous foot pump devices are effective in prevention of venous thromboembolic disease after total hip and knee arthroplasty compared to chemoprophylaxis. This was especially significant in prevention of major deep vein thrombosis and pulmonary emboli rate. The use of mechanical devices like venous calf or foot pump, either alone or in combination with less potent chemical prophylaxis, on the other hand can reduce the rate of venous thromboembolism and complications of potent chemoprophylaxis like wound hematoma.     

Evaluation of Onlay Island Flap Technique in Shallow Urethral Plate Hypospadiasis

Background:

Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications.

Objectives:

This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate.

Patients and Methods:

In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbit’s dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty.

Results:

Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate < 6 mm, 3 had a very small glans, and 18 had chordee. Meatus was located in distal shaft in 5 cases, mid shaft in 8, proximal in 6 and penoscrotal type in 4 patients. Chordee was corrected with Nesbit’s dorsal plication in 16 cases. Complications were: meatal stenosis in 2 cases and urethrocutaneous fistula in 2 patients, all of which were repaired surgically. Mean follow up time was 13 (3 - 20) months. All cases that had glansplasty have excellent esthetic appearance.

Conclusions:

This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome.     

In Vitro Inhibitory Effect of Berberis vulgaris (Berberidaceae) and Its Main Component,Berberine against Different Leishmania Species

Background

Leishmaniasis has been identified as a major public health problem in tropical and sub-tropical countries. The present study was aimed to investigate antileishmanial effects of various extracts of Berberis vulgaris also its active compoenent, berberine against Leishmania tropica and L. infantum species on in vitro experiments.

Methods

In this study in vitro antileishmanial activity of various extracts of B. vulgaris also its active compoenent, berberine against promastigote and amastigote stages of L. tropica and L. infantum was evaluated, using MTT assay and in a macrophage model, respectively. Furthermore, infectivity rate and cytotoxicity effects of B. vulgaris and berberine in murine macrophage cells were investigated.

Results

The findings of optical density (OD) and IC₅₀ indicated that B. vulgaris particulary berberine significantly (P<0.05) inhibited the growth rate of promastigote stage of L.tropica and L.infantum in comparison to meglumine antimoniate (MA). In addition, B. vulgaris and berberine significantly (P<0.05) decreased the mean number of amastigotes in each macrophage as compared with positive control. In the evaluation of cytotoxicity effects, it could be observed that berberine as compared with B. vulgaris exhibited more cytotoxicity against murine macrophages. Results also showed that when parasites were pre-incubated with B. vulgaris their ability to infect murine macrophages was significantly decreased.

Conclusion

B.vulgaris particularly berberine exhibited potent in vitro leishmanicidal effects against L. tropica and L.infantum. Further works are required to evaluate the antileishmanial effects of B.vulgaris on Leishmania species using clinical settings.