Comparison of Nebulized Lidocaine and Intratracheally Injected (Spray-as-you-go) Lidocaine in Pain and Cough Reduction during Bronchoscopy.

Background: Patients undergoing bronchoscopy often suffer from pain, coughing, and suffocation. Therefore, lidocaine is prescribed through various methods to induce local anesthesia. This study aimed to compare nebulized lidocaine and intratracheally injected lidocaine in pain and cough reduction during bronchoscopy. Materials and Methods: This clinical trial was performed on 96 patients, divided into two groups of intervention (receiving lidocaine via a nebulizer before bronchoscopy) and control (receiving lidocaine through the working channel of bronchoscope). Then, the patientsá¾½ cough frequency was recorded during the procedure, and the pain level was measured using a numerical rating scale at the end of the procedure. The data were analyzed with SPSS software (version 16) using the chi-square and Fisher's exact tests. Moreover, the linear and Poisson regression tests were applied to analyze the main variables in this study. Results: There was no significant difference between the two groups regarding demographic characteristics (P>0.05). Moreover, the linear regression test revealed that the intervention (nebulized lidocaine) group had significantly lower pain scores (1.54±0.08) than the control (intratracheally injected lidocaine) group (2.5±0.26) (P=0.013). In addition, the Poisson regression test showed a statistically significant difference between the intervention (35.22±2.93) and control (48.85±5.96) groups in terms of cough frequency (P<0.0001). Conclusion: This study indicated that nebulized lidocaine has higher efficacy in reducing the patientsá¾½ pain and cough during bronchoscopy than intratracheally injected lidocaine.

Quality of life and asthma control in pregnant women with asthma.

BACKGROUND: Asthma is the most commonly occurring respiratory illness during pregnancy. Associations with complications of pregnancy and adverse perinatal outcome have been established. However, little is known about quality of life (QoL) in pregnant women with asthma and how it relates to asthma control particularly for Iran. OBJECTIVE: To determine the relationship between asthma related QoL and asthma control and severity. METHODS: We conducted a prospective study in pregnant women with asthma. We used the Asthma Control Questionnaire and the Asthma Quality of Life Questionnaire (AQLQ) and the guidelines of the Global Initiative for Asthma for assessment of asthma severity. RESULTS: Among 1603 pregnant women, 34 were diagnosed with asthma. Of these 13 had intermittent, 10 mild, 8 moderate and 3 severe persistent asthma. There was a significant decrease of QoL with poorer asthma control (p = 0.014). This decline could be due to limitations of activity in those with poorer asthma control, which is underlined by the significant decline of QoL with increasing asthma severity (p = 0.024). CONCLUSION: Although the majority of pregnant women with asthma had a favorable score in AQLQ, reduced QoL was related to increased asthma severity and poor asthma control. This underlines the importance of controlling asthma during pregnancy not only for the prevention of adverse pregnancy outcomes but also for the preservation of QoL.

Prone-Position Ventilation in a Pregnant Woman with Severe COVID-19 Infection Associated with Acute Respiratory Distress Syndrome.

A 25-year-old pregnant woman (gestational age: 24 weeks) presented with severe coronavirus disease-2019 (COVID-19) infection. Deterioration of her respiratory status resulted in her admission to the intensive care unit and mechanical ventilator support. Considering the lack of improvement in oxygen saturation, teleconsultation was performed, suggesting prone-position ventilation (PPV). Significant improvements were observed in oxygen saturation. The patient was extubated after five days of intermittent PPV and supine-position ventilation and was discharged 20 days after admission. Also, assessments revealed that the fetus was unharmed by the intervention. We suggest considering PPV for pregnant women with acute respiratory distress syndrome (ARDS).

Environmental tobacco smoke exposure during pregnancy affects complications and birth outcomes in women with and without asthma.

BACKGROUND: It is known that environmental tobacco smoke (ETS) has adverse effects on pregnancy and birth outcomes. We aimed to assess the impact of ETS in pregnant women with and without asthma. METHODS: A cohort study was conducted from August 2014 to June 2015 enrolling 1603 pregnant women during their 2nd trimester. Data on tobacco exposure were collected at first visit and women were followed through pregnancy till postpartum. RESULTS: Of the 1603 women, 231 reported passive smoking, 223 non-asthmatics and 8 asthmatics. Women exposed to ETS during pregnancy were more likely to have an infant admitted to the pediatric ward (10.8% vs. 6.5%, p = 0.026) and to have low one- and five-minute Apgar scores (1 min: 6.1% vs. 2.6%, p = 0.011; 5 min: 2.2% vs. 0.7%, p = 0.039). Complications of pregnancy were also elevated in women exposed to ETS (53.7% vs. 42.3%, p = 0.002). Asthma had no additional effect beyond the impact of ETS except for cesarean sections that were more frequent in women with asthma exposed to ETS. CONCLUSIONS: Due to the small number of women with asthma exposed to ETS, combined effects of asthma and ETS were only found for cesarean sections. Still counseling of pregnant women about adverse effects of ETS should consider women's asthma as an additional reason to avoid ETS.

Effect of synthetic amorphous calcium phosphate nanoparticles on the physicochemical and biological properties of resin-modified glass ionomer cements.

The aim of this study was to find an optimum dose of the synthetic amorphous calcium phosphate (ACP) nanoparticles to be incorporated in resin-modified glass ionomer cements (RMGICs) for triggering the release of PO43-/Ca2+, alkaline phosphatase (ALP) activity and osteogenic differentiation of mesenchymal stem cells (hMSCs) without significantly affecting the essential properties of the cements. RMGICs were formulated from the powder composed of melt-derived strontium fluoro-aluminosilicate glass (SFAG) and synthetic ACP nanoparticles (0-20 wt%), as well as commercial polyalkenoic acid liquid. The effect of ACP incorporation on the workability, microstructure, Ca2+/PO43-/F- ion release and compressive strength was investigated. The response of hMSCs to the optimized cements was assessed by MTT cytotoxicity, ALP activity, and staining tests. The working time of the formulated RMGICs decreased significantly upon increase of ACP content from 5 to 20%. ACP (5%)-incorporated RMGICs showed improved photopolymerization and setting. An insignificant reduction was recorded in the compressive strength of RMGICs with addition of 1.5-5% ACP. The fluoride release didn't significantly decrease due to addition of 5% ACP. Upon incorporating 5% ACP, the biocompatibility of RMGICs rose to about 20%. In addition, ALP activity and osteogenic differentiation of hMSCs noticeably increased after exposure to ACP-incorporated RMGIC. ACP (5%)-incorporated RMGICs could be promising candidates for both restorative and regenerative dentistry owing to the optimum mechanical strength, prolonged ion release, and their effective role in the cell differentiation and biomineralization demanded for pulp regeneration.

Correction to: Prospective cohort study of pregnancy complications and birth outcomes in women with asthma.

In the original publication, the university name of the authors in the affiliations was published as University of Medical Sciences, Sabzevar, Iran. The correct university name should read as Sabzevar University of Medical Sciences, Sabzevar, Iran.

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma.

BACKGROUND: Asthma is the most common potentially serious medical complication in pregnancy. The purpose of this study was to determine the association between maternal asthma and a spectrum of adverse neonatal and maternal outcomes. METHODS: Events during pregnancy and birth outcome were evaluated in 34 asthmatic as well as 1569 non-asthmatic pregnant women who were enrolled in a prospective cohort study undertaken at the antenatal clinics of Mobini Hospital in Iran. The women were interviewed and classified according to clinical severity and asthma control as per GINA guidelines. Information on asthma symptoms was collected by a questionnaire as well as by spirometry and physical examination. All subjects were followed until delivery, and postpartum charts were reviewed to assess neonatal and maternal outcomes. Eosinophil cells counts were obtained and total IgE was measured by ELISA. Results were assessed by multivariate logistic regression adjusting for maternal age and parity, and for birth outcomes, for gestational diabetes, and hypertension/pre-eclampsia. RESULTS: The well-known relationship between family history of asthma and asthma in pregnancy was again supported (p < 0.001). Women with asthma had more bleeding events 3 weeks or more before delivery (OR 3.30, 95% CI 1.41-7.26), more often placenta problems (OR 6.86, 95% CI 1.42-33.02), and gestational diabetes mellitus (OR 3.82, 95% CI 1.06-13.75). No significant differences between asthmatic and non-asthmatic mothers regarding duration of gestation, birthweight, low Apgar scores, or neonatal respiratory difficulties were found. Total IgE antibody levels and eosinophil counts did not differ by asthma control and severity. CONCLUSIONS: Asthma in pregnancy poses some risk for pregnancy complications and adverse perinatal outcomes. Managing asthma effectively throughout pregnancy could benefit women and their babies and help to reduce the health burden associated with asthma during pregnancy.

The influence of polymeric component of bioactive glass-based nanocomposite paste on its rheological behaviors and in vitro responses: hyaluronic acid versus sodium alginate.

Different biocomposite pastes were prepared from a solid phase that was nanoparticles of sol-gel-derived bioactive glass and different liquid phases including 3% hyaluronic acid solution, sodium alginate solutions (3% and 10 %) or mixtures of hyaluronic acid and sodium alginate (3% or 10 %) solutions in 50:50 volume ratio. Rheological properties of the pastes were measured in both rotatory and oscillatory modes. The washout behavior and in vitro apatite formation of the pastes were determined by soaking them in simulated body fluid under dynamic situation for 14 days. The proliferation and alkaline phosphatase activity of MG-63 osteoblastic cells were also determined using extracts of the pastes. All pastes could be easily injected from the standard syringes with different tip diameters. All pastes exhibited visco-elastic character, but a nonthixotropic paste was obtained using hyaluronic acid in which the loss modulus was higher than the storage modulus. The thixotropy and storage modulus were increasingly improved by adding/using sodium alginate as mixing liquid. Moreover, the pastes in which the liquid phase was sodium alginate or mixture of hyaluronic acid and 10% sodium alginate solution revealed better apatite formation ability and washout resistance than that made of hyaluronic acid alone. No cytotoxicity effects were observed by extracts of the pastes on osteoblasts but better alkaline phosphatase activity was found for the pastes containing hyaluronic acid. Overall, injectable biocomposites can be produced by mixing bioactive glass nanoparticles and sodium alginate/hyaluronic acid polymers. They are potentially useful for hard and even soft tissues treatments.

Development of injectable biocomposites from hyaluronic acid and bioactive glass nano-particles obtained from different sol-gel routes.

Bioactive glass nano-powders with the same chemical composition and different particle characteristics were synthesized by acid-catalyzed (the glass is called BG1) and acid-base catalyzed (BG2) sol-gel processes. Morphological characteristics of powders were determined by TEM and BET methods. The powders were separately mixed with 3% hyaluronic acid solution to form a paste. In vitro reactivity of pastes was determined by soaking them in simulated body fluid. Rheological behaviors of paste in both rotation and oscillation modes were also measured. The results showed that BG1 particles was microporous with mean pore diameter of 1.6 nm and particle size of ~300 nm while BG2 was mesoporous with average pore diameter of 8 and 17 nm and particle size of 20-30 nm. The paste made of BG2 revealed better washout resistance and in vitro apatite formation ability than BG1. According to the rheological evaluations, both pastes exhibited shear thinning but non-thixotropic behavior, meanwhile paste of BG2 had higher viscosity than BG1. The oscillatory tests revealed that the pastes were viscoelastic materials with more viscous nature. Both pastes could be completely injected through standard syringe using low compressive load of 5-50 N. Overall, The biocomposites can potentially be used as bioactive paste for the treatment of hard and even soft tissues.