Echocardiography and Management of Sick Neonates in the Intensive Care Unit

To evaluate the influence of echocardiographic examination in the clinical management of the sick neonate, 241 patients, admitted to the neonatal intensive care unit of a tertiary referral center that had echocardiograms with data available for review, were enrolled in a retrospective study. Asymptomatic murmurs (45%) followed by extracardiac anomalies/dysmorphic features (24%) were the most common clinical indications for requesting an echocardiogram. Congenital structural abnormalities (33%), hemodynamically significant patent arterial duct (3%), persistent pulmonary hypertension of the newborn (6%), and left ventricular dysfunction (3%) were the echocardiographic findings that subgrouped as structural or functional abnormalities. Patent oval foramen and hemodynamically nonsignificant patent arterial duct (20%) and physiologic pulmonary artery stenosis (1%) were categorized as normal structural group. Thirty‐four percent of neonates had normal heart anatomy. This investigation changed the clinical management in at least 66% of newborns scanned, including emergency surgical intervention for 7%, medical treatment for 22%, and routine cardiologic follow‐up for 37% of patients. Asymptomatic murmur in our critically ill neonates has been associated with a higher incidence of cardiac disease. Hence, echocardiography is an important tool for diagnosis of cardiac abnormalities that can influence the management and outcome of the sick newborn in the intensive care unit. A preliminary echocardiogram performed by the neonatologist under the supervision of a pediatric cardiologist for interpretation and review is an alternate when there is not a cardiologist “in house.”     

Sublingual versus vaginal misoprostol for second trimester termination: a randomized clinical trial

Purposes

To evaluate the efficacy of two routes of administration of misoprostol (sublingual and vaginal) for medical termination of second trimester pregnancies.

Methods

One hundred and thirty-four women referred for second trimester termination were enrolled in this randomized clinical trial. They were divided to receive 400 μg every 6 h misoprostol either sublingually or vaginally. They were followed for 48 h, at which point they underwent D&C if the termination was not complete. Efficacy was defined as successful termination without the need for interventions.

Results

There were no differences between the vaginal and sublingual groups in terms of tablets mean dose of misoprostol applied (1360 ± 2.4 vs. 1320 ± 2.3) or endometrial thickness after termination of pregnancy (13.02 ± 5.2 vs. 13.3 ± 6.6 mm). The success rate was 61.2 % (n = 41) in the vaginal group versus 70.1 % (n = 47) in the sublingual group (p = 0.3). Twenty-six patients (38.8 %) in the vaginal group underwent D&C due to retained tissue, compared with 20 patients (29.8 %) in the sublingual group. In primigravids, the success rate was significantly higher in the sublingual group than vaginal group. There was no significant difference with regards to complications between the two groups.

Conclusion

The sublingual route of misoprostol administration has the same efficacy as the vaginal route and can be applied for second trimester pregnancy termination in primigravid women in outpatient settings due to its simple administrations.     

Intranasal ketamine reduces pain of digital nerve block; a double blind randomized clinical trial

BackgroundLow dose ketamine can be used as analgesic in acute pain management in the emergency department (ED).ObjectiveEfficacy of IN ketamine in acute pain management in the ED.MethodThis is a double blind randomized clinical trial on patients older than 15 years who needed digital nerve block (DNB). Participants randomly received IN Ketamine (1 ml = 50 mg) or placebo (normal saline, 1 ml) 5 min before DNB. In both groups, patients' pain score was recorded by visual analogue score (VAS) at baseline, after DNB and 45 min after completion of DNB. Adverse effects of ketamine and changes in vital signs were also recorded and compared with placebo group.ResultsA total number of 100 patients were enrolled in the study with the median (IQR) age of 36.5 (26) years, including 65 men and 35 women. IN ketamine resulted in less pain compared to placebo after performing DNB and 45 min after the procedure. Median (IQR) basic VAS score was 50 (15) in ketamine group, and 49 (27) in control group. Median (IQR) block pain VAS score was 28.5 (19) in ketamine group and 47.5 (31) in control group. Median (IQR) procedural pain VAS score was 21.5 (16) in ketamine group and 43.5 (29) in control group. Only 7 patients had adverse effects in either group.ConclusionThe findings of this study suggest that IN ketamine can be effective in reducing pain in patients with acute pain, without adding significant side effects.     

The prevalence of COVID-19 infection in patients with multiple sclerosis (MS): a systematic review and meta-analysis

Neurological Sciences - The prevalence of COVID-19 is different in studies conducted in different countries. The aim of this systematic review and meta-analysis is to estimate the pooled prevalence...     

Fatigue in multiple sclerosis: relationship with disease duration, physical disability, disease pattern, age and sex

To evaluate the relationship between disease duration, disability, disease pattern, age and sex with fatigue in MS patients. One hundred and seventy-three clinically definite MS patients and 87 age-matched healthy controls enrolled in this cross sectional study. Demographic data (sex, age), duration of the disease and disease pattern extracted from patient’s files and Kurtzke Expanded Disability Status Scale (EDSS) were recorded for each patient by an expert neurologist. Participants were asked to answer the validated and reliable Persian version of beck depression inventory (BDI) and FSS (fatigue severity score) questionnaires. Mean FSS and BDI scores were significantly different between patients and controls (p < 0.001). Patients with longer disease duration, higher EDSS and progressive type of disease had significantly higher FSS and BDI scores. Although men had higher EDSS, FSS and BDI scores were similar in both sex groups. FSS was significantly correlated with age, disease duration, BDI and EDSS. The analysis of covariance revealed that there is no difference in the covariance-adjusted means for fatigue among two disease groups (relapsing remitting and secondary progressive) except for EDSS. MS patients with longer disease duration, higher EDSS and progressive type of disease suffer from fatigue more than cases with lower EDSS, duration of disease and relapsing type of the disease.     

Associations between Skin Diseases and Quality of Life: A Comparison of Psoriasis, Vitiligo, and Alopecia Areata

The goal of this study was to compare depression and quality of life in three auto immune diseases: psoriasis, vitiligo, and alopecia areata. From January 2009 until January 2010, 300 patients (100 with alopecia areata, 100 with psoriasis and 100 with vitiligo) who were randomly selected (by simple random selection) from outpatient clinic of Razi Hospital (Center of Skin Diseases of Tehran University of Medical Sciences) were asked to answer to Beck Depression Inventory (BDI), SF-36 and Dermatology Life Quality Index (DLQI) questionnaires. DLQI scores were significantly higher in psoriasis cases than others (12.8 ± 6.1, P<0.0001) and SF-36 score were significantly lower (59.8 ± 19.5, P=0.007), both indicating poor quality of life. Significant correlation was found between DLQI and BDI in all disease groups (r=0.44, P<0.001). BDI scores were the highest in psoriasis group but this difference was not significant (P=0.2). Based on these results, dermatologists should consider psychological aspects of autoimmune skin diseases.     

Prevalence of multiple sclerosis (MS) in Iran: a systematic review and meta-analysis

Neurological Sciences - Prevalence of multiple sclerosis (MS) is increasing world-wide. Iran is not exception. As the prevalence reported differently in various provinces, we designed this...     

Sublingual versus vaginal misoprostol for cervical ripening before hysteroscopy: a randomized clinical trial

Purpose

To evaluate the efficacy of two routes of misoprostol (sublingual and vaginal) for cervical ripening before hysteroscopy.

Methods

One hundred and ten perimenopausal women who were referred to a tertiary hospital for surgical hysteroscopy enrolled in this double-blind randomized clinical trial. They were divided into two groups to receive 400 mg misoprostol either sublingually or vaginally 6 h before hysteroscopy. The duration of dilatation, Hegar number inserted into the cervix without resistance, and hysteroscopic and drug complications were recorded for all cases.

Results

Forty-nine women in sublingual and 51 in vaginal group participated in the study. Dilatation time was significantly lower in sublingual group (P < 0.001). Median Hegar number passed into the cervix without resistance was 5 in sublingual versus 4 in vaginal group (P = 0.002). Cramp followed by vomiting and diarrhea were the most common side effects of misoprostol in the sublingual group, while cramp followed by vomiting was the most frequent side effect in the vaginal group. Diarrhea was not reported in the vaginal group (P = 0.008).

Conclusion

Sublingual route of misoprostol could be considered as an effective medication before surgical hysteroscopy in perimenopausal women.