The effect of COVID-19 pandemic on antibiotic usage during pregnancy.

OBJECTIVES: To investigated the usage of antibiotic during pregnancy before and during COVID-19 pandemic in Kingdom of Bahrain. METHODS: This was a retrospective study of antibiotic usage in 2 groups of patients. The first group was 280 patients who attended the in active labor room pre-COVID pandemic. The second group was 193 patients who attended the labor room after the COVID-19 pandemic. Most of the data discussed below explores the impact of COVID-19 infection before the development of full vaccinations against COVID-19 in Bahrain. RESULTS: The analysis confirmed higher usage of antibiotics during pregnancy post-COVID-19 outbreak (27.9% vs [versus] 5%), and the most notable difference was observed during the third trimester (17.1% vs 3.2%) followed by the second trimester (7.3% vs 1.1%). Likewise, there were more patients treated for urinary tract infection (16.1% vs 3.6%) and bacterial vaginosis (10.4% vs 0.7%) during the post-COVID period. There was no difference in the percentage of patients treated for upper respiratory tract infection among the groups. CONCLUSION: The analysis confirmed higher usage of antibiotic during pregnancy post COVID19.

Three-dimensional biomimetic reinforced chitosan/gelatin composite scaffolds containing PLA nano/microfibers for soft tissue engineering application.

In the current study, we successfully prepared chitosan/gelatin composite scaffolds reinforced by centrifugally spun polylactic acid (PLA) chopped nano/microfibers (PLA-CFs). Herein, different amounts of PLA-CFs (0 %, 1 %, 2 %, 3 %, and 4 % w/v) dispersed in chitosan/gelatin solution were used. Morphological characterization of prepared scaffolds revealed that at the initial stage of adding PLA-CFs, the chopped fibers were localized at the wall of the pores; however, as the fiber load increased, aggregations of chopped-fibers could be seen. Also, mechanical evaluation of scaffolds in terms of compression and tensile mode showed that samples reinforced with 2 % PLA-CFs had enhanced mechanical properties. Indeed, its tensile strength increased from 123.8 to 247.2 kPa for dry and 18.9 to 48.6 kPa for wet conditions. Furthermore, the tensile modulus associated with both conditions increased from 2.99 MPa and 44.5 kPa to 6.43 MPa and 158.4 kPa, respectively. The results of cell culture studies also confirmed that the prepared composite scaffold exhibited appropriate biocompatibility, cell proliferation and migration. The cell infiltration study of the samples revealed that scaffolds reinforced with 2 % PLA-CFs had significantly better cell penetration and distribution compared with the control ones on both days (7 and 14).

Multilayered 3-D nanofibrous scaffold with chondroitin sulfate sustained release as dermal substitute.

Electrospun nanofibers for skin tissue engineering applications face two main challenges. The low thickness of electrospun mats is the main reason for their weak load-bearing performance at clinical applications and limited cell penetration due to their small pore sizes. We have developed multi-layered nanofibrous 3D (M3DN) scaffolds comprising gelatin, polyvinyl alcohol, and chondroitin sulfate (CS) by an electrospinning method and attaching three electrospun layers via ethanol to cause interface fibers to come in contact with each other. Prepared M3DN scaffolds revealed a sustained CS release profile. The improved mechanical performance, stable release of CS, and penetration capability of the cells and blood vessels through the spaces between layers in the prepared multi-layered nanofibrous scaffolds demonstrate their potential applications in response to the increasing demand for replacement of damaged dermis. The results of animal studies on the dorsal skin of Rat with full-thickness wounds have shown that the reconstruction of full-thickness skin lesions is significantly higher for M3DN scaffolds than a control group (treated with sterile gauze). The amount of epithelization, collagen arrangement, and inflammatory cells (acute and chronic) has been investigated, and their associated results demonstrated that M3DN scaffolds have great potential for full-thickness wound restoration.

Cardiac ECM/chitosan/alginate ternary scaffolds for cardiac tissue engineering application.

Since cardiovascular diseases are the number one cause of death in worldwide, and the traditional treatments have limitations, the emergence of cardiac tissue engineering (CTE) can be a promising approach. In this study, scaffold fabrication from the solubilized cardiac extracellular matrix (ECM) accompanied with alginate and chitosan for CTE was carried out. The influence of blending ratios on chemical and physical properties of the scaffolds including FTIR spectroscopy, porosity, pore size, and their mechanical properties were investigated. The porosity of scaffolds was more than 96% with very high swelling rate while maintaining their stability in PBS solution. Blending ECM with chitosan and alginate significantly improve the tensile strength of ECM. FTIR spectrum of scaffolds demonstrated interaction of solubilized ECM with two opposite-charged polysaccharides. The proliferation of human mesenchymal stem cells (hMSCs) on the ternary scaffolds using MTS assay, revealed that blending ECM with polysaccharides at ratio of 75: 25 (E75/P25) led to improve the proliferation of hMSCs on scaffolds. Scanning electron microscope (SEM) revealed the porous structure and the presence of hMSCs cells inside the pores. In addition, histological analysis confirmed that cardiomyocyte penetration inside scaffolds after 7 days of culture. The immunofluorescence staining revealed that higher expression of cardiac marker (cTnT) in ternary scaffold in comparison with ECM.

Evaluating the Impact of Patient No-Shows on Service Quality.

PURPOSE: Patient no-shows are long-standing issues affecting resource utilization and posing risks to the quality of healthcare services. They also lead to loss of anticipated revenue, particularly in services where resources are expensive and in great demand. METHODS: In order to address common reasons why patients miss appointments, this study reviews the current literature and investigates various tools and methods that have been implemented to mitigate such issues. Further, a case study is conducted to identify the rate of no-shows and underlying causes at a radiology department in one of the leading hospitals in the MENA region. RESULTS: Our results show that the no-shows are high due to multiple factors, such as patient behavior, patients' financial situation, environmental factors and scheduling policy. CONCLUSION: In conclusion, we generate a list of recommendations that can help in reducing the rate of patient no-shows, such as patient education, application of dynamic scheduling policies and effective appointment reminder systems to patients.

Spectrum of autoimmune vesiculobullous diseases in Iran: a 13-year retrospective study.

BACKGROUND: Autoimmune bullous diseases (ABDs) represent a group of rare, acquired disorders characterized by overlapping features with involvement of the skin and mucous membranes, resistance to treatment, and potential lethality that comprise pemphigus, bullous pemphigoid (BP), epidermolysis bullosa, dermatitis herpetiformis, and linear immunoglobulin A bullous dermatosis. AIM: The main aim of this study was to identify the epidemiologic characteristics and clinical courses of these common diseases in Hamadan, Iran. Few surveys have been carried out to demonstrate the whole spectrum of ABDs in the literature. Notably, in Hamadan we are the first. MATERIALS AND METHODS: This 13-year retrospective study was designed to evaluate all of documented data obtained from hospitalized patients with ABDs at Farshchian Hospital from October 1999 to October 2012. We collected information on epidemiologic data, clinical aspects, histologic findings, and therapy prescribed. Data were analyzed using SPSS. RESULTS: Of 168 patients, 78% had pemphigus. The age of patients at presentation ranged from 1 month to 115 years, with a mean of 47.5±19.93 years. Mucosal or skin involvement of ABDs was statistically significant (P<0.001). The incidence of ABDs differed significantly based on anatomic location (P=0.003). We documented three deaths. CONCLUSION: Compared to previous literature, our findings showed equal epidemiologic properties in Iran. Although pemphigus was the most common ABD followed by BP, it is expected that in line with the global trend, an increase in BP will be driven by population aging in Iran.

Treatment results of high dose cabergoline as an adjuvant therapy in six patients with established severe ovarian hyper stimulation syndrome.

BACKGROUND: The beneficial role of cabergoline as a prophylactic agent to prevent ovarian hyper stimulation syndrome (OHSS) among high-risk patients has been demonstrated in previous studies. But data for its role as a treatment for established severe OHSS is still limited. We represent the treatment results of high dose oral cabergoline in management of six patients after the syndrome is established. CASE: High-dose oral cabergoline (1 mg daily for eight days) was prescribed as an adjuvant to symptomatic treatment for six hospitalized patients with established severe OHSS following infertility treatment cycles. In two cases OHSS resolved rapidly despite the occurrence of ongoing pregnancy. CONCLUSION: Considering the treatment outcomes of our patients, high dose cabergoline did not eliminate the need for traditional treatments, but it was a relatively effective and safe therapy in management of established severe OHSS, and prevented the increase in its severity following the occurrence of pregnancy.

Comparison of oral dydrogesterone with suppository vaginal progesterone for luteal-phase support in in vitro fertilization (IVF): A randomized clinical trial.

BACKGROUND: Luteal phase support is mandatory in assisted reproductive technologies (ART) for optimizing outcome, so the luteal phase is supported with either progesterone, addition of estradiol to progesterone, hCG or gonadotropin releasing hormone (GnRH) agonists. Supplementation of luteal phase with progesterone is prescribed for women undergoing routine IVF treatment. OBJECTIVE: To compare oral dydrogestrone with vaginal progesterone for luteal-phase support in IVF. MATERIALS AND METHODS: We performed this prospective, randomized trial in a tertiary infertility care unit in Taleghani Hospital, Tehran, Iran. In total 80 Women with a history of male factor infertility undergoing controlled ovarian stimulation for IVF treatment (fresh cycle) randomly were divided in two groups (group A or oral dydrogesterone group and group B or vaginal progesterone group). The inclusion criteria were the use of GnRH analogue down-regulation and age less than 40 years old with regular menstrual cycles. All women were euthyroid and normoprolactinemic. Group A (n=40) received 10 mg dydrogesterone QID (40mg daily) and group B (n=40) received 400 mg suppository vaginal progesterone (cyclogest) twice per day (800 mg daily). RESULTS: Clinical pregnancy rate in cyclogest group was higher than dydrogesterone group but the difference was not significant (p=0.52), furthermore the miscarriage rate in two group was the same .The difference between two groups regarding antral follicle, embryo number, luteal-phase duration, endometrial thickness, oocyte number and metaphase-II was not significant (p>0.05). CONCLUSION: The results showed that oral dydrogesterone is as effective as vaginal progesterone for luteal-phase support in women undergoing IVF.

Quantitative determination of 3,4-methylenedioxymethamphetamine by thin-layer chromatography in ecstasy illicit pills in Tehran.

3,4-Methylenedioxymethamphetamine (MDMA) is the major ingredient of ecstasy illicit pills. It is a hallucinogen, central nervous system stimulant, and serotonergic neurotoxin that strongly releases serotonin from serotonergic nerves terminals. Moreover, it releases norepinephrine and dopamine from nerves terminal, but to a lesser extent than serotonin. Poisoning and even death from abusing MDMA-containing ecstasy illicit pills among abusers is usual. Thus, quantitative determination of MDMA content of ecstasy illicit pills in illicit drug bazaar must be done regularly to find the most high dose ecstasy illicit pills and removing them from illicit drug bazaar. In the present study, MDMA contents of 13 most abundant ecstasy illicit pills were determined by quantitative thin-layer chromatography (TLC). Two procedures for quantitative determination of MDMA contents of ecstasy illicit pills by TLC were used: densitometric and so-called 'scraping off' methods. The former was done in a reflection mode at 285 nm and the latter was done by absorbance measurement of eluted scraped off spots. Limit of detection (LOD), considering signal-to-noise ratio (S/N) of 2, and limit of quantification (LOQ), regarding S/N of 10, of densitometric and scraping off methods were 0.40 microg, 1.20 microg, and 6.87 mug, 20.63 microg, respectively. Repeatabilities (within-laboratory error) of densitometric and scraping off methods were 0.5% and 3.6%, respectively. The results showed that the ecstasy illicit pills contained 24-124.5 mg and 23.9-122.2 mg MDMA by densitometric and scraping off methods, respectively.