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1.
Glob Heart ; 19(1): 38, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38681970

RESUMO

Background: Opium consumption has been an overlooked health issue in the Iranian population, and the prognostic role of opium consumption in patients undergoing coronary revascularization is unknown. Hypothesis: We aimed to assess the association between opium consumption and long-term cardiovascular outcomes after percutaneous coronary intervention (PCI). Methods: We screened 2203 consecutive patients who underwent elective PCI between April 2009 and April 2010 at Tehran Heart Center. Exclusion criteria were unsuccessful PCI, non-elective PCI, and missing opium use data. Opium consumption was defined as self-reported ever use of any traditional opium substances. Outcomes of interest were all-cause mortality and a composite of major adverse cardiac and cerebrovascular events (MACCE). The association between opium use and study outcomes was evaluated using the inverse probability of treatment weighting (IPTW) method. Cumulative hazard curves were demonstrated to further assess the association visually. Furthermore, the effect of opium consumption on individual components of MACCE was evaluated in a competing risk setting. Results: A total of 2025 elective PCI patients were included (age: 58.7 ± 10.67, 29.1% women), among whom 297 (14.6%) patients were opium users. After a median follow-up of 10.7 years, opium consumption was associated with a higher risk of all-cause mortality (IPTW-hazard ratio [HR] = 1.705, 95% CI: 1.125-2.585; P = 0.012) and MACCE (IPTW-HR = 1.578, 95% CI: 1.156-2.153; P = 0.004). The assessment of MACCE components suggested a non-significant borderline trend for higher non-fatal myocardial infarction (IPTW-sub-distribution HR [SHR] = 1.731, 95% CI: 0.928-3.231; P = 0.084) and mortality (IPTW-SHR = 1.441, 95% CI: 0.884-2.351; P = 0.143) among opium users. Conclusions: Opium consumption is associated with a more than 50% increase in long-term risk of mortality and MACCE in patients undergoing PCI. These findings accentuate the importance of preventive strategies to quit opium addiction in this population.


Assuntos
Ópio , Intervenção Coronária Percutânea , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Irã (Geográfico)/epidemiologia , Seguimentos , Fatores de Tempo , Dependência de Ópio/epidemiologia , Fatores de Risco , Doença da Artéria Coronariana/epidemiologia , Idoso , Estudos Retrospectivos , Taxa de Sobrevida/tendências
2.
Acta Obstet Gynecol Scand ; 103(5): 824-831, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38415823

RESUMO

INTRODUCTION: Our objective was to investigate outcomes in twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery (FLS) at <18 weeks vs ≥18 weeks, and to conduct subgroup analysis of TTTS with FLS at <16 weeks vs 16-18 weeks. MATERIAL AND METHODS: PubMed, Scopus and Web of Science were searched systematically from inception until May 2023. Primary outcome was survival, and secondary outcomes included preterm premature rupture of membranes (PPROM), preterm birth and gestational age (GA) at delivery. RESULTS: Nine studies encompassing 1691 TTTS pregnancies were included. TTTS stage III was significantly more common in TTTS pregnancies treated with FLS at <18 weeks (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.24-6.54), and procedure duration was shorter at <18 weeks (MD -5.27 minutes, 95% CI -9.19 to -1.34). GA at delivery was significantly earlier in TTTS pregnancies treated with FLS at <18 weeks (MD -3.12 weeks, 95% CI -6.11 to -0.13). There were no significant differences in outcomes, including PPROM, PPROM at <7 days post-FLS, preterm birth at <28 and <32 weeks, delivery at <7 days post-FLS, and survival outcomes, including fetal demise, live birth and neonatal survival. Similarly, TTTS stage III was more common in TTTS with FLS at <16 weeks than at 16-18 weeks (OR 2.95, 95% CI 1.62-5.35), with no significant differences in the aforementioned outcomes. CONCLUSIONS: In early TTTS treated with FLS, outcomes were comparable between those treated at <18 weeks compared with ≥18 weeks except for GA at delivery, which was 3 weeks earlier. In the subset treated at <16 weeks vs 16-18 weeks, the procedure was feasible without an increased risk of very early preterm birth or perinatal mortality.


Assuntos
Ruptura Prematura de Membranas Fetais , Transfusão Feto-Fetal , Terapia a Laser , Nascimento Prematuro , Gravidez , Feminino , Recém-Nascido , Humanos , Transfusão Feto-Fetal/cirurgia , Transfusão Feto-Fetal/complicações , Resultado da Gravidez , Nascimento Prematuro/etiologia , Gravidez de Gêmeos , Idade Gestacional , Fetoscopia/efeitos adversos , Fetoscopia/métodos , Terapia a Laser/efeitos adversos , Estudos Retrospectivos
3.
Fetal Diagn Ther ; 51(1): 66-75, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37879304

RESUMO

BACKGROUND: Pseudoamniotic band sequence (PABS) is a rare iatrogenic consequence of invasive fetal interventions, most commonly fetoscopic laser surgery (FLS) in monochorionic multiple pregnancies complicated by twin-to-twin transfusion syndrome (TTTS). OBJECTIVES: The aim of this study was to investigate prenatal risk factors and perinatal outcomes for pregnancies involving PABS after FLS for TTTS and compare outcomes between those undergoing fetoscopic band release versus not. METHOD: We conducted a systematic search of PubMed, Scopus, and Web of Science on studies reporting PABS following FLS for TTTS. A meta-analysis of pooled proportions was conducted. RESULTS: There were 16 studies covering 47 pregnancies complicated by PABS following FLS, mostly case series and case reports. The incidence of PABS was 2%, with the recipient twin affected in 94% of the cases. Pregnancies complicated by PABS were associated with inter-twin septostomy in 32% and chorioamniotic separation (CAS) in 90%. The mean gestational age (GA) at FLS and delivery were 17.7 and 30.9 weeks, respectively. Preterm premature rupture of membranes (PPROM) happened in 62% of pregnancies. The risk of preterm birth (PTB) <34 weeks, <32 weeks, and <28 weeks were 94%, 67%, and 31%, respectively. There were 41% fetal demises and 64% live births among the affected fetuses. Results of fetoscopic band release versus not were comparable, including GA at delivery, PPROM, and PTB at 32 weeks. It was noted that the likelihood of PTB by 28 weeks (67% vs. 23%) and fetal death (50% vs. 39%) were higher in the band release group. It was similar between groups in terms of postnatal amputation. CONCLUSIONS: PABS causes amputations or fetal death in more than one-third of cases. Pregnancies with an inter-twin septostomy, CAS, advanced TTTS staging, and early GA are more likely to experience PABS. In addition, more than a third of FLS-treated TTTS resulted in PTB and PPROM. PABS cases with prenatal band release showed higher rates of PTB and fetal death, but the data were from small, heterogeneous studies.


Assuntos
Ruptura Prematura de Membranas Fetais , Transfusão Feto-Fetal , Terapia a Laser , Nascimento Prematuro , Gravidez , Feminino , Recém-Nascido , Humanos , Lactente , Nascimento Prematuro/etiologia , Transfusão Feto-Fetal/cirurgia , Transfusão Feto-Fetal/complicações , Fetoscopia/efeitos adversos , Fetoscopia/métodos , Morte Fetal/etiologia , Idade Gestacional , Terapia a Laser/efeitos adversos , Fatores de Risco , Gravidez de Gêmeos , Estudos Retrospectivos
4.
Braz. dent. j ; 35: e24, 2024. tab, graf
Artigo em Inglês | LILACS-Express | LILACS, BBO - Odontologia | ID: biblio-1550091

RESUMO

Abstract This research aimed to evaluate the effect of the radiopacity of a Bulk-Fill composite (X-TraFil, VOCO, Germany) and a Conventional composite (P60, 3M ESPE, USA) and assessment of the margin location in the enamel and dentin on the diagnosis of secondary caries. 76 intact premolars with MOD preparation were divided into two equal groups and filled with the conventional and bulk-fill composite. Four regions were considered to simulate carious lesions (two regions in enamel and two regions in dentin). In each group, half of the regions in the dentin and half in the enamel were randomly selected for secondary caries simulation and filled with a wax-plaster combination while the remaining regions stayed intact. Bitewing imaging was done using the PSP digital sensor. Five examiners reviewed the images, and lesions were recorded. Caries diagnosis indicators and paired-sample t-test were used for statistical analysis. The reproducibility and accuracy of the examiners' responses were evaluated using the kappa and agreement coefficient (α=0.05). The sensitivity, specificity, and accuracy of diagnosing secondary carious lesions in enamel were significantly better under conventional than bulk-fill composite. Similarly, the sensitivity and accuracy of diagnosing secondary caries in dentin were significantly higher under conventional composite than bulk-fill composite (p<0.05). No significant differences were found in the agreement and kappa coefficient between conventional and bulk-fill composites in the enamel and dentin (p>0.05). The diagnostic accuracy of carious lesions was higher under conventional composite than bulk-fill composite. However, the location of the secondary was ineffective in caries diagnosis.


Resumo Essa pesquisa teve como objetivo avaliar o efeito da radiopacidade de resina composta Bulk-Fill (X-TraFil, VOCO, Alemanha) e de resina composta convencional (P60, 3M ESPE, EUA) e a avaliação da localização da margem no esmalte e na dentina no diagnóstico de cárie secundária. 76 pré-molares intactos com preparo MOD foram divididos em dois grupos iguais e restaurados de acordo com o grupo experimental. Quatro regiões foram consideradas para simular lesões de cárie (duas regiões no esmalte e duas regiões na dentina). Em cada grupo, metade das regiões na dentina e metade no esmalte foram selecionadas aleatoriamente para a simulação de cárie secundária e preenchidas com uma combinação de cera e gesso, enquanto as regiões restantes permaneceram intactas. As imagens de bitewing foram feitas usando o sensor digital PSP. Cinco examinadores analisaram as imagens, e as lesões foram registradas. Os indicadores de diagnóstico de cárie e o teste t de amostra pareada foram usados para análise estatística. A reprodutibilidade e a precisão das respostas dos examinadores foram avaliadas usando o kappa e o coeficiente de concordância (α=0,05). A sensibilidade, a especificidade e a precisão do diagnóstico de lesões cariosas secundárias no esmalte foram significativamente melhores com a resina composta convencional do que com a resina composta bulk-fill. Da mesma forma, a sensibilidade e a precisão do diagnóstico de cáries secundárias na dentina foram significativamente maiores com a resina convencional do que com a resina bulk-fill (p<0,05). Não foram encontradas diferenças significativas na concordância e no coeficiente kappa entre as resinas convencionais e bulk-fill no esmalte e na dentina (p>0,05). A precisão do diagnóstico de lesões cariosas foi maior com a resina composta convencional do que com a resina composta bulk-fill. Entretanto, a localização do secundário foi ineficaz no diagnóstico de cárie.

5.
Pesqui. bras. odontopediatria clín. integr ; 24: e220192, 2024. tab, graf
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1550593

RESUMO

ABSTRACT Objective: To investigate the effects of two different dentifrice fluoride concentrations on the color stability of the composite. Material and Methods: Twenty-seven specimens (2×4×5 mm) each of microfilled (Gradia, GC, Japan) and nanohybrid (Grandio, VOCO, Germany) composites were prepared. The specimens were randomly divided into six groups (control, Fluoflor caries protection toothpaste with 1450ppm Fluoride (EXW, France), and Fluoflor kids toothpaste with 500ppm Fluoride (EXW, France) (n = 9). The specimens were immersed in a mixture of artificial saliva and toothpaste in a ratio of 1:3 and applied for 60 seconds every 12 hours for 42 days. The control samples were incubated in artificial saliva at 37°C. Primary and secondary color measurements were performed using color parameters (L∗a∗b) with a spectrophotoshade (MHT Optic Research AG, Niederhasli, Switzerland). Data were analyzed using a two-way analysis of variance at a significance level of 0.05. Results: According to the two-way ANOVA analysis, there was no significant difference in color change between the composites and no difference in the level of discoloration between different fluoride concentrations(p>0.05). Also, None of the dentifrices caused clinically significant color changes(∆E˂3.3). Conclusion: No clinically unacceptable color changes were observed in the microfilled and nanofilled composites with different concentrations of fluoride toothpaste.


Assuntos
Cremes Dentais/química , Cor , Resinas Compostas/química , Fluoretos/química , Técnicas In Vitro/métodos , Análise de Variância , Dentifrícios
6.
Prenat Diagn ; 2023 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-37902170

RESUMO

Ebstein anomaly (EA) is a rare congenital cardiac malformation associated with high perinatal mortality. In this systematic review and meta-analysis, we aimed to investigate the outcomes of pregnancies affected by EA or tricuspid valve dysplasia (TVD) with circular shunt, focusing on two prenatal management approaches: (1) expectant management (EM) and (2) transplacental non-steroidal anti-inflammatory drugs (NSAID) therapy. We searched PubMed, Scopus, and Web of Science systematically from its inception until June 2023. The random-effect model was used to pool the data. Heterogeneity was assessed using the I2 value. Twenty-one studies with a total of 610 fetuses with EA/TVD with circular shunt were included in the synthesis, of which 17 studies (583 fetuses) were on EM and 4 studies (27 fetuses) used transplacental NSAID therapy. The NSAID group had higher rates of moderate to severe tricuspid regurgitation, hydrops, and pericardial effusion on prenatal ultrasound compared with the EM group. However, ductal constriction was achieved in 81% of NSAID cases, mitigating the disease pathophysiology, although 65% of them experienced oligohydramnios. Notably, the NSAID group showed significantly higher rates of live birth (86%) and survival to hospital discharge (89%) compared with the EM group (67% and 43%, respectively). Despite these promising results, it's important to acknowledge that the number of cases treated with NSAIDs was small, with limited safety data. Therefore, caution is advised in interpreting these findings, and patients considering NSAID therapy should be informed about these limitations. Future multicenter studies are necessary to further explore the safety and effectiveness of NSAID therapy in this particular population.

7.
Biomed Pharmacother ; 165: 115048, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37385212

RESUMO

Nowadays, immunotherapy is one of the most essential treatments for various diseases and a broad spectrum of disorders are assumed to be treated by altering the function of the immune system. For this reason, immunotherapy has attracted a great deal of attention and numerous studies on different approaches for immunotherapies have been investigated, using multiple biomaterials and carriers, from nanoparticles (NPs) to microneedles (MNs). In this review, the immunotherapy strategies, biomaterials, devices, and diseases supposed to be treated by immunotherapeutic strategies are reviewed. Several transdermal therapeutic methods, including semisolids, skin patches, chemical, and physical skin penetration enhancers, are discussed. MNs are the most frequent devices implemented in transdermal immunotherapy of cancers (e.g., melanoma, squamous cell carcinoma, cervical, and breast cancer), infectious (e.g., COVID-19), allergic and autoimmune disorders (e.g., Duchenne's muscular dystrophy and Pollinosis). The biomaterials used in transdermal immunotherapy vary in shape, size, and sensitivity to external stimuli (e.g., magnetic field, photo, redox, pH, thermal, and even multi-stimuli-responsive) were reported. Correspondingly, vesicle-based NPs, including niosomes, transferosomes, ethosomes, microemulsions, transfersomes, and exosomes, are also discussed. In addition, transdermal immunotherapy using vaccines has been reviewed for Ebola, Neisseria gonorrhoeae, Hepatitis B virus, Influenza virus, respiratory syncytial virus, Hand-foot-and-mouth disease, and Tetanus.


Assuntos
Neoplasias da Mama , COVID-19 , Animais , Humanos , Feminino , Sistemas de Liberação de Medicamentos/métodos , Materiais Biocompatíveis , COVID-19/terapia , Administração Cutânea , Pele , Lipossomos , Imunoterapia , Agulhas
8.
Am J Obstet Gynecol MFM ; 5(6): 100914, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-36889438

RESUMO

OBJECTIVE: This study aimed to systematically investigate a wide range of obstetrical and neonatal outcomes with respect to 2 types of prepregnancy bariatric surgery, Roux-en-Y gastric bypass and sleeve gastrectomy, through: (1) providing a meta-analysis of the effect of bariatric surgery (Roux-en-Y gastric bypass vs no surgery and, separately, sleeve gastrectomy vs no surgery) on adverse obstetrical and neonatal outcomes, and (2) comparing the relative benefit of Roux-en-Y gastric bypass vs sleeve gastrectomy using both conventional and network meta-analysis. DATA SOURCES: We searched PubMed, Scopus, and Embase systematically from inception up to April 30, 2021. ELIGIBILITY CRITERIA: Studies reporting on pregnancies' obstetrical and neonatal outcomes with respect to 2 types of prepregnancy bariatric surgery-Roux-en-Y gastric bypass and sleeve gastrectomy-were included. The included studies either indirectly compared between the procedure and controls or directly compared between the 2 procedures. METHODS: We performed a systematic review followed by pairwise and network meta-analysis in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In the pairwise analysis, multiple obstetrical and neonatal outcomes were tabulated and compared between 3 groups: (1) Roux-en-Y gastric bypass vs controls, (2) sleeve gastrectomy vs controls, and (3) Roux-en-Y gastric bypass vs sleeve gastrectomy. Primary outcomes included small for gestational age, large for gestational age, gestational hypertension/preeclampsia, and gestational diabetes mellitus. Secondary outcomes included preterm birth, anemia, cesarean delivery, and biochemical profile. The random-effects model was used to pool the mean differences or odds ratios and the corresponding 95% confidence intervals. Heterogeneity was assessed using the I2 value. The Newcastle-Ottawa scale was used to assess individual study quality. To resolve inconclusive findings and to rank current treatments, network meta-analysis was conducted for the primary outcomes. Quality of evidence was assessed with the Confidence in Network Meta-Analysis approach and the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) tool within the summary of findings table. RESULTS: A total of 20 studies were included, reporting on 40,108 pregnancies, of which 5194 underwent Roux-en-Y gastric bypass, 405 underwent sleeve gastrectomy, and 34,509 were controls. Compared with controls, Roux-en-Y gastric bypass increased the risk of small for gestational age infants (odds ratio, 2.56; 95% confidence interval, 1.77-3.70; I2, 29.1%; P<.00001), decreased the risk of large for gestational age infants (odds ratio, 0.25; 95% confidence interval, 0.18-0.35; I2, 0%; P<.00001), decreased gestational hypertension/preeclampsia (odds ratio, 0.54; 95% confidence interval, 0.30-0.97; I2, 26.8%; P=.04), decreased gestational diabetes mellitus (odds ratio, 0.43; 95% confidence interval, 0.23-0.81; I2, 32%; P=.008), increased maternal anemia (odds ratio, 2.70; 95% confidence interval, 1.53-4.79; I2, 40.5%; P<.001), increased neonatal intensive care unit admission (odds ratio, 1.36; 95% confidence interval, 1.04-1.77; I2, 0%; P=.02), and decreased mean gestational weight gain (mean difference, -3.37 kg; 95% confidence interval, -5.62 to -1.11; I2, 65.3%; P=.003). Only 3 studies compared sleeve gastrectomy with controls, and found no significant differences in primary outcomes or in mean gestational weight gain. The network meta-analysis showed that Roux-en-Y gastric bypass (malabsorptive procedure) resulted in greater decrease of large for gestational age, gestational hypertension/preeclampsia, and gestational diabetes mellitus, and a greater increase in small for gestational age infants when compared with sleeve gastrectomy (restrictive procedure). However, the small number of studies, small number of sleeve gastrectomy patients, limited outcomes, and data heterogeneity resulted in low-to-moderate network GRADE of evidence. CONCLUSION: This network meta-analysis showed that Roux-en-Y gastric bypass, compared with sleeve gastrectomy, resulted in greater decrease in large for gestational age, gestational hypertension/preeclampsia, and gestational diabetes mellitus, but in greater increase in small for gestational age infants. Certainty of evidence in the network meta-analysis was of a low-to-moderate GRADE. Evidence is still lacking for periconception biochemical profile, congenital malformations, and reproductive health outcomes for both interventions; thus, future well-designed prospective studies are needed to further characterize these outcomes.


Assuntos
Anemia , Diabetes Gestacional , Derivação Gástrica , Ganho de Peso na Gestação , Hipertensão Induzida pela Gravidez , Obesidade Mórbida , Pré-Eclâmpsia , Nascimento Prematuro , Gravidez , Feminino , Humanos , Recém-Nascido , Derivação Gástrica/efeitos adversos , Derivação Gástrica/métodos , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Hipertensão Induzida pela Gravidez/etiologia , Hipertensão Induzida pela Gravidez/cirurgia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/etiologia , Metanálise em Rede , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Anemia/complicações , Anemia/cirurgia , Gastrectomia/efeitos adversos , Gastrectomia/métodos
9.
Childs Nerv Syst ; 39(4): 953-961, 2023 04.
Artigo em Inglês | MEDLINE | ID: mdl-36456748

RESUMO

INTRODUCTION: Secondary craniosynostosis subsequent to shunting is one of the late complications of ventricular shunt placement in the early childhood. Several interventions have been used to treat high intracranial pressure associated with this condition. This study aimed to evaluate the patients' clinical symptoms and head circumference before and after a method of decompressive craniotomy, coined as external-internal cranial expansion (EICE). METHODS: A retrospective study was conducted, and the patients who had undergone EICE for the treatment of post-shunt craniosynostosis between 2010 and 2020 were enrolled. This approach was a combination of a hinge multiple-strut decompressive craniectomy and internal cranial flap thinning by drill. Data, extracted from medical records, were used to evaluate the patients' symptoms and head circumferences before and 12 months after surgery. RESULTS: A total of 16 patients were enrolled in the study, of which eight were females. Before the surgery, 9 patients (56.2%) suffered from visual impairment, and all had intractable headache. Papilledema was recorded in all, with 3 cases having optic disc paleness. After cranial expansion, only two patients had headaches, diagnosed as migraine-type and psychosomatic headaches, respectively. In two patients, progressive visual impairments got worsening after surgery, which would be due to severe preoperative optic nerve atrophy. Patients' head circumferences significantly increased after the surgery (mean of 48.97 ± 4.28 cm vs. 45.78 ± 4.31 cm; P value < 0.0001). CONCLUSION: In lower resource countries, where newer technologies like distraction osteogenesis is not easily available, external-internal cranial expansion can be considered an effective alternative for patients with post-shunt craniosynostosis.


Assuntos
Craniossinostoses , Crânio , Feminino , Humanos , Pré-Escolar , Masculino , Estudos Retrospectivos , Crânio/cirurgia , Craniossinostoses/complicações , Craniossinostoses/cirurgia , Pressão Intracraniana , Cefaleia
10.
BMC Public Health ; 22(1): 1631, 2022 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-36038891

RESUMO

BACKGROUND: Prevalence of short and long sleep duration varies in different countries and changes over time. There are limited studies on Iranians' sleep duration, and we aimed to evaluate the prevalence of short and long sleep duration and associated factors among people living in Kermanshah, Iran. METHODS: This population-based cross-sectional study was conducted between November 2014 and February 2017. Data was collected from 10,025 adults aged 35 to 65 years using census sampling, and we evaluated the short and long sleep duration (≤ 6 and ≥ 9 h, respectively) and its relation with the socio-demographic factors and health-related status of the participants. RESULTS: Mean age of participants was 48.1 years (standard deviation = 8.2), and 47.4% of participants were male. Of our participants, 11.6% had short, and 21.9% had long sleep duration. Age ≥ 50 years, female gender, being single, mobile use for longer than 8 h per day, working in night shifts, moderate and good levels of physical activity, BMI ≥ 30, past smoking, and alcohol use were associated with short sleep duration (P < 0.05). Female gender and living in rural areas were associated with long sleep duration (P < 0.05). CONCLUSION: In the Ravansar population, short and long sleep duration are prevalent, with long sleep duration having higher prevalence. People at risk, such as night shift workers, as well as modifiable factors, such as mobile phone use, can be targeted with interventions to improve sleep hygiene.


Assuntos
Doenças não Transmissíveis , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Prevalência , Sono
11.
J Cardiovasc Electrophysiol ; 33(8): 1863-1870, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35634869

RESUMO

INTRODUCTION: Physical techniques used for the prevention of vasovagal syncope have limited evidence for efficacy. We aimed to evaluate multimodal supervised physical training as a treatment approach. METHODS: In this 1:1 randomized trial, patients with ≥2 episodes of clinically diagnosed vasovagal syncope were included. On top of standard care, the intervention arm performed supervised tilt training and aerobic exercise in six sessions at a cardiac rehabilitation center (three sessions during the first month, and then at 3-month intervals), plus home tilt training. The control arm received standard care with a similar protocol of home tilt training. The primary outcome was time to first syncopal recurrence during 1 year of follow-up. RESULTS: Fifty participants were randomized (mean age: 34.5 ± 14.8 years; 64% female). The rate of syncopal recurrence was 28% and 64% within the intervention and control arms, respectively, with significantly higher syncope-free survival at 1 year in the intervention arm (Log-rank p = .003). The frequency of recurrent syncopal events was significantly lower with physical training (p = .017). Participants in the intervention arm reported significantly higher adherence to the home tilt training program (80% vs. 52%; p = .037). CONCLUSION: Among patients with recurrent vasovagal syncope, a supervised program of tilt training and aerobic exercise reduced syncopal recurrence. Future trials are warranted to further investigate multimodal supervised physical techniques as a therapeutic approach in treating vasovagal syncope.


Assuntos
Síncope Vasovagal , Adulto , Exercício Físico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Síncope Vasovagal/diagnóstico , Síncope Vasovagal/prevenção & controle , Teste da Mesa Inclinada/métodos , Resultado do Tratamento , Adulto Jovem
12.
J Med Case Rep ; 16(1): 175, 2022 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-35491424

RESUMO

BACKGROUND: Among all ectopic pregnancies, between 0.5% and 3.5% are ovarian ectopic pregnancies, a potentially life-threatening condition when ruptured due to its serious potential for hemorrhaging. A majority of ovarian ectopic pregnancies are diagnosed by the 7th week of pregnancy when the patient becomes symptomatic, and ultrasound can be used to diagnose this condition. CASE PRESENTATION: We present the case of a 39-year-old Persian woman in the 12th week of gestation who presented with vaginal bleeding and abdominal pain and was diagnosed with ovarian ectopic pregnancy. Her notable laboratory finding was ß-human chorionic gonadotropin > 15,000, which indicates definite pregnancy. Transvaginal ultrasound (TVS) revealed no evidence of intrauterine pregnancy, but a well-circumscribed gestational sac in the left ovary. The patient was successfully treated with resection of the gestational sac and partial left salpingo-oophorectomy. Histopathological studies confirmed the diagnosis of ovarian ectopic pregnancy. CONCLUSION: The case emphasizes the ability of ovarian ectopic pregnancy to develop asymptomatically through the course of pregnancy and points to the necessity for high-quality prenatal care and the importance of determining the fetal site during pregnancy.


Assuntos
Gravidez Ectópica , Gravidez Ovariana , Adulto , Gonadotropina Coriônica Humana Subunidade beta , Feminino , Humanos , Ovário , Gravidez , Primeiro Trimestre da Gravidez , Gravidez Ectópica/diagnóstico por imagem , Gravidez Ectópica/cirurgia , Gravidez Ovariana/diagnóstico por imagem , Gravidez Ovariana/cirurgia
13.
J Obstet Gynaecol ; 42(6): 1905-1910, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35592922

RESUMO

The maternal mortality ratio (MMR) is a significant indicator of the quality of a health care system. Despite considerable progress in reducing MMR in Iran in the past few years, we still face a long road ahead in eliminating preventable maternal deaths. In the present study, we evaluated all 80 cases of maternal deaths in 20 hospitals under the supervision of Tehran University of Medical Sciences between March 20 2013 and March 19 2020. During this time, these hospitals recorded 335,216 live births, with an MMR of 24 per 100,000 live births. The average age of deceased mothers was 31.9 ± 6.9 years. Direct causes accounted for 48.75% of maternal deaths, with haemorrhage being the most common direct cause of mortality (17.5%). Moreover, cancer (17.5%) and cardiovascular diseases (17.5%) were the most common indirect causes of maternal mortality. Even after accounting for the COVID-19 pandemic's effects, we have noticed an increase in maternal mortality. As a result, implementing a comprehensive approach for high-risk pregnancies is critical.Impact StatementWhat is already known on this subject? Although we have been able to reduce MMR in Iran to a reasonable level, previous measures would not be sufficient to accomplish future goals. Furthermore, we have a long way to go before reaching the ultimate goal of eradicating avoidable maternal deaths by 2030.What do the results of this study add? The causes, determinants and risk factors of maternal mortality were investigated in this study. With this level of detail, we can observe a steadily increase in MMR in recent years, regardless of the COVID-19 pandemic. The majority of pregnancy-related deaths can be avoided.What are the implications of these findings for clinical practice and/or further research? MMR reduction is a measurable goal that can be attained by improving financial resources, implementing safe delivery, team training, preparing multidisciplinary care with integration for high-risk pregnant women, establishing good provider relationships, and communicating with patients and providers for early warning signs and structural changes.


Assuntos
COVID-19 , Morte Materna , Complicações na Gravidez , Adulto , COVID-19/prevenção & controle , Causas de Morte , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Morte Materna/etiologia , Morte Materna/prevenção & controle , Mortalidade Materna , Pandemias , Gravidez
14.
Arch Gynecol Obstet ; 306(3): 857-863, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35233666

RESUMO

PURPOSE: Comparison of colposcopy-guided biopsy and endocervical cytologic (ECC) results in patients with negative Papanicolaou (Pap) and positive high-risk (HR) HPV tests in the three groups of HPV 16/18, non-16/18 HR-HPV (other HR-HPV), and concurrent infection of either HPV 16/18 and at least one subtype of other HR-HPVs. METHODS: This cross-sectional study was conducted among women aged 30-65 who had negative Pap and positive HR-HPV DNA tests. Pap test was performed using liquid cytology. For HPV DNA testing, the polymerase chain reaction (PCR) method was used. RESULTS: Among 394 participants, 111 (28.2%) were in the HPV 16/18, 226 (57.4%) in the Other HR-HPV, and 57 (14.4%) in the concurrent group. The mean age of participants was 35.71 ± 7.1 years. Cervical intraepithelial neoplasia (CIN) grade 2/3 were seen in 29 (26.1%) patients of HPV 16/18, 60 (26.5%) of other HR-HPV, and 18 (31.6%) of concurrent infection group (P = 0.593). HPV 52 was the most common subtype in the other HR-HPV group (15%). CONCLUSIONS: The risk of high-grade CIN lesions in patients with negative Pap test and positive other HR-HPV was not significantly less than patients with positive HPV 16/18. Besides, the risk of losing the patients to 1-year follow-up seems high.


Assuntos
Infecções por Papillomavirus , Displasia do Colo do Útero , Neoplasias do Colo do Útero , Adulto , Colposcopia , Estudos Transversais , DNA Viral/análise , Feminino , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Teste de Papanicolaou , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/patologia , Gravidez , Neoplasias do Colo do Útero/patologia , Esfregaço Vaginal/métodos , Displasia do Colo do Útero/patologia
15.
Am J Obstet Gynecol ; 226(6): 843.e1-843.e28, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35257668

RESUMO

BACKGROUND: Several studies have assessed preoperative and operative factors associated with fetal demise after laser for TTTS, yet these findings are not completely conclusive. OBJECTIVE: This study aimed to identify risk factors for single fetal demise (recipient and donor twins) after fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome. STUDY DESIGN: We searched PubMed, Scopus, and Web of Science systematically from the inception of the database to June 2020. We conducted a systemic review on studies investigating risk factors for fetal demise (donor and/or recipient) after fetoscopic laser photocoagulation in monochorionic pregnancies complicated with twin-to-twin transfusion syndrome. Initially, we investigated the cohort of women with twin-to-twin transfusion syndrome that underwent fetoscopic laser photocoagulation at our 2 high-volume fetal centers between 2012 and 2020 to identify risk factors for donor demise and recipient demise. Furthermore, we conducted a systematic review of the literature to better characterize these factors. Among studies that met the entry criteria, multiple preoperative and operative factors were tabulated. The random-effect model was used to pool the standardized mean differences or odds ratios and corresponding 95% confidence intervals. Heterogeneity was assessed using the I2 value. RESULTS: A total of 514 pregnancies with twin-to-twin transfusion syndrome managed with fetoscopic laser photocoagulation were included in the final analysis. Following the logistic regression, factors that remained significant for donor demise were selective fetal growth restriction (odds ratio, 1.9; 95% confidence interval, 1.3-2.8; P=.001) and umbilical artery blood flow with absent or reversed end-diastolic velocity of the donor (odds ratio, 2.06; 95% confidence interval, 1.2-3.4; P=.004). A significant factor associated with recipient demise was absent or reversed a-wave in the ductus venosus of the recipient (odds ratio, 1.74; 95% confidence interval, 1.07-3.13; P=.04). Data from 23 studies and our current cohort were included. A total of 4892 pregnancies with twin-to-twin transfusion syndrome managed with fetoscopic laser photocoagulation were analyzed for risk factors for donor demise, and 4594 pregnancies with twin-to-twin transfusion syndrome were analyzed for recipient demise. Among studies, the overall incidence rates ranged from 10.9% to 35.8% for donor demise and 7.3% to 24.5% for recipient demise. Significant risk factors for donor demise were intertwin estimated fetal weight discordance of >25% (odds ratio, 1.86; 95% confidence interval, 1.44-2.4; I2, 0.0%), selective fetal growth restriction (odds ratio, 1.78; 95% confidence interval, 1.4-2.27; I2, 0.0%), twin-to-twin transfusion syndrome stage III (odds ratio, 2.18; 95% confidence interval, 1.53-3.12; I2, 0.0%), umbilical artery blood flow with absent or reversed end-diastolic velocity of the donor (odds ratio, 2.31; 95% confidence interval, 1.9-2.8; I2, 23.7%), absent or reversed a-wave in the ductus venosus of the donor (odds ratio, 1.83; 95% confidence interval, 1.45-2.3; I2, 0.0%), and presence of arterioarterial anastomoses (odds ratio, 2.81; 95% confidence interval, 1.35-5.85; I2, 90.7%). Sequential selective coagulation was protective against donor demise (odds ratio, 0.31; 95% confidence interval, 0.16-0.58; I2, 0.0%). Significant risk factors for recipient demise were twin-to-twin transfusion syndrome stage IV (odds ratio, 2.18; 95% confidence interval, 1.01-4.6; I2, 16.5%), umbilical artery blood flow with absent or reversed end-diastolic velocity of the recipient (odds ratio, 2.68; 95% confidence interval, 1.91-3.74; I2, 0.0%), absent or reversed a-wave in the ductus venosus of the recipient (odds ratio, 2.37; 95% confidence interval, 1.55-3.64; I2, 60.2%), and middle cerebral artery peak systolic velocity of >1.5 multiple of the median (odds ratio, 3.06; 95% confidence interval, 1.36-6.88; I2, 0.0%). CONCLUSION: Abnormal blood flow patterns represented by abnormal Doppler studies and low fetal weight were associated with single fetal demise in women with twin-to-twin transfusion syndrome undergoing laser therapy. Although sequential selective coagulation was protective against donor demise, the presence of arterioarterial anastomoses was considerably associated with donor demise. This meta-analysis extensively investigated the association of a wide range of preoperative and operative factors with fetal demise. These findings may be important inpatient counseling, in further understanding the disease, and perhaps in improving surgical techniques.


Assuntos
Transfusão Feto-Fetal , Estudos de Coortes , Feminino , Morte Fetal/etiologia , Retardo do Crescimento Fetal/epidemiologia , Retardo do Crescimento Fetal/etiologia , Peso Fetal , Transfusão Feto-Fetal/complicações , Fetoscopia/métodos , Humanos , Fotocoagulação a Laser/efeitos adversos , Fotocoagulação a Laser/métodos , Gravidez , Ultrassonografia Pré-Natal/métodos
16.
Ann Med Surg (Lond) ; 69: 102770, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34484735

RESUMO

INTRODUCTION: Patients with COVID-19 infection may present a wide range of symptoms that make its diagnosis challenging, especially in patients with underlying conditions. PRESENTATION OF CASE: A 30-year-old postpartum woman presented to the Emergency Department (ED) of Arash Women Hospital with right flank pain. Physical examination revealed tachycardia and decreased sounds in the base of the lung. Chest CT scan demonstrated patchy consolidations in bases of the lungs in favor of COVID-19 infection. The patient underwent pharmacotherapy with Remdesivir, steroid, and interferon beta-1a for eight days and was discharged in a good condition. DISCUSSION: This study suggests that involvement of lungs' bases may be associated with gastrointestinal symptoms such as abdominal or flank pain in the COVID-19 patients. It makes the diagnosis difficult in a scenario such as the described patient in our study where there may be other differential diagnoses correlating with the patient's clinical course. CONCLUSION: COVID-19 should be in the differential diagnosis of any patient presenting to ED with relevant complaints. Correct and immediate diagnosis is critical for proper treatment and isolation of patients with COVID-19.

17.
Gynecol Surg ; 14(1): 17, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28890679

RESUMO

BACKGROUND: The aim of this study was to investigate the effect of salpingectomy on ovarian function by measuring AMH. METHODS: This study was a balanced, single-center, double-blind, randomized, controlled trial in Ruin Tan Arash Hospital, Tehran, between May 2013 and November 2014. A total of 30 patients undergoing elective abdominal hysterectomy were randomized into two groups, 15 with salpingectomy and 15 without salpingectomy. The primary objective of this study was to compare mean difference of anti-Mullerian hormone (AMH) between two groups. The secondary outcomes measured were follicle-stimulating hormone (FSH), operative time, and blood loss. RESULTS: Serum AMH levels decreased at 3 months after hysterectomy in all patients (pre AMH 1.32 ± (0.91); post AMH 1.05 ± (0.88), P < 0.001), the salpingectomy group (pre AMH 1.44 ± (0.94); post AMH 1.13 ± (0.86), P < 0.001), and no salpingectomy group (pre AMH 1.2 ± (0.9); post AMH 0.97 ± (0.92), P < 0.001). The rate of decline of AMH levels after surgery did not differ between the two groups (25% (17-33%) vs. 26% (15-36%), P = 0.23) among the women with salpingectomy versus without salpingectomy, respectively. There was no difference in the mean operative time (mean difference 0.33, 95% CI - 22.21 to 22.86, P < 0.92), mean blood loss (mean difference - 0.66, 95% CI - 15.8 to 14.46, P < 0.97), and post FSH (mean difference 0.34, 95% CI - 1.2 to 1.88, P < 0.65) between both groups. CONCLUSIONS: Salpingectomy with abdominal hysterectomy is a safe treatment that does not have a deleterious effect on ovarian reserve. TRIAL REGISTRATION: Iranian Registry of Clinical Trials, IRCT2014123118866N4 (www.IRCT.ir).

18.
J Tehran Heart Cent ; 11(4): 198-202, 2016 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-28496513

RESUMO

Cardiac manifestations of the hydatid cyst are relatively uncommon. Cardiac involvement may lead to the compression of vital organs, pulmonary hypertension, pericardial effusion, and even anaphylaxis. A 45-year-old woman presented to the Emergency Department of Tehran Heart Center with chest pain. Cardiac examination revealed relatively muffled heart sounds. Echocardiography demonstrated a round echolucent well-defined mass (47 × 25 mm) on the base and the mid lateral wall of the left ventricle (LV) without septation. Computed tomography angiography and cardiac magnetic resonance imaging revealed a large (52 mm) exophytic mass originating from the lateral wall of the LV with upward growth between the left anterior descending artery (LAD) and the left circumflex artery with no LV cavity obliteration. Coronary angiography showed upward displacement in the LAD with significant compressive narrowing. The patient underwent mass resection and grafting of the LAD. During surgery after the incision of the pericardium, the hydatid cyst entity of the mass was revealed. Hydatid cysts covered the anterolateral surface of the LV with adhesion to the pericardium. The patient recovered from the surgery uneventfully. Pathology report and immunological assays confirmed the diagnosis. During a 6-month postoperative follow-up period, she remained asymptomatic with complete recovery and no recurrence.

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