Association between epidural analgesia and postpartum psychiatric disorders: A meta-analysis.

Aim: Women during the postpartum period are at risk for psychiatric disorders such as postpartum depression (PPD), post-traumatic stress disorder (PTSD), and anxiety. It is controversial whether labour epidural analgesia have a protective role on PPD, PTSD, and anxiety or not. This study is a meta-analysis of previously published observational studies to investigate the association between epidural analgesia and PPD, PTSD, and anxiety. Methods: We searched Cochran Library, PubMed, ProQuest, EMBASE, Scopus, Web of Science, PsycINFO, and MEDLINE from inception until December 2022. The outcome measures were positive screen of PPD, PTSD, and anxiety among women who received labour epidural analgesia. The Newcastle-Ottawa Scale was used to assess the quality of the observational studies. Statistical analysis was performed using Stata 17.0 software. The mean differences or odds ratios were pooled based on random effect. Results: We included 31 studies (12,064 women) in the review. The meta-analysis of PPD studies reported mean (standard deviation) showed no significant association between epidural analgesia and PPD (Mean Difference = 0.01; 95% Confidence Interval = -0.14 to 0.16; p-value = 0.88). The meta-analysis of PPD studies reported percentage showed no statistically significant difference in terms of the chance of depression between the exposed and non-exposed groups (Log Odds Ratio = -0.61; 95% CI = -1.48 to 0.26; p-value = 0.17). The meta-analysis of PPD studies reported OR showed indicate a lower chance of depression in the epidural group compared to the non-epidural group (Effect size = 1.01; 95% CI = 0.64 to 1.38; P-value = 0.00). In the case of PTSD, due to the heterogeneity of the tools and the methodology of the studies, it was impossible to reach a definitive conclusion and measure the studies in a meta-analysis. The meta-analysis of anxiety studies showed that no significant association between epidural analgesia and anxiety (MD = -1.36; 95% CI = -3.38 to 1.14; p-value = 0.29). Conclusion: Based on the meta-analysis of observational studies, epidural analgesia for labour pain relief has no protective effect on postpartum psychiatric disorders.

Comparing the effect of intermittent diazepam and continuous phenobarbital in preventing recurrent febrile seizures among children under 6 years old: A systematic review and meta-analysis.

Background: Febrile convulsion (FC) is the most common and preventable seizure in children. This study aimed to assess the effectiveness of the diazepam and phenobarbital for preventing recurrent FC. Materials and Methods: In this systematic review study, literature published in English language were carefully searched in biological databases (Cochrane Library, Medline, Scopus, CINHAL, Psycoinfo, and Proquest) by February 2020.Randomized clinical trials (RCTs) and Quasi randomized trial were included in the review. Two researchers checked the literature independently. The quality of studies was assessed using the JADAD score. The potential risk for publication bias was assessed by Funnel plot and Egger's test. Meta regression test and sensitivity analysis were used to identify the reasons for heterogeneity. Given the results of assessing heterogeneity, the random effect model in RevMan5.1 software was used for meta analysis. Results: Four out of 17 studies had compared the effect of diazepam and phenobarbital in preventing recurrent FC. The result of the meta analysis showed that the use of diazepam in comparison with phenobarbital reduces the risk of recurrence FC by 34% (risk ratio = 0.66, 95% confidence interval [CI] = [0.36-1.21]), but the relationship was not statistically significant. In assessing the effect of diazepam or phenobarbital versus placebo, the results showed that the use of diazepam and phenobarbital has reduced the risk of recurrent FC by 49% (risk ratio = 0.51, 95% CI = [0.32-0.79]) and 37% (risk ratio = 0.63, 95% CI = [0.42-0.96)]), respectively, and these relationships were statistically significant (P < 0.05). Results of the meta regression test showed that the follow up time can be a reason for the heterogeneity between trials with the comparison of diazepam versus phenobarbital (r = 0.047, P = 0.049) and Phenobarbital versus placebo (r = 0.022, P = 0.016). According to the results of Funnel plot and Egger's test, there was evidence of publication bias (P = 0.0584 for comparison of diazepam vs. phenobarbital; P = 0.0421 for comparison of diazepam vs. placebo; P = 0.0402 for comparison of phenobarbital vs. placebo). Conclusion: The results of this meta analysis indicated that preventive anticonvulsants can be useful in preventing recurrent convulsions in cases of febrile seizures.

Association between nutritional risk status and health related quality of life: An investigation on the aging patients with cardiovascular disease.

Introduction: Acknowledging the considerable influence of undernutrition on health outcomes and HRQOL, this study sought to appraise the nutritional risk status of elderly patients with cardiovascular diseases (CVD) through the utilization of the Nutritional Risk Screening (NRS). Additionally, the investigation aimed to evaluate the correlation between NRS status and HRQOL within the context of patients referred to a cardiac hospital in Tabriz, Iran. Methods: This cross-sectional study was conducted in Tabriz, Iran. The participants were selected randomly from patients referring to Shahid Madani Heart Hospital, a comprehensive university hospital during July to December 2018. A linear regression was used for control of confounding variables (age, gender, education level, marital status, and income levels) and predict the relationship between nutrition risk status and HQRL. Results: Of the 200 patients with CVD participated in this study, 68 (34%) of participants had normal nutrition status, 108 (54%) were at risk for undernutrition, and 24 (12%) had undernutrition. A total of 24 aging patients with undernutrition, 13 (54%) were divorced or widowed. 86% of patients with diabetes were at risk for undernutrition and 13.9% had undernutrition. There were statistically significant relationship between undernutrition and HRQOL dimensions, age, gender, and marital status. Conclusion: The study revealed a correlation between elevated undernutrition scores in patients and factors such as older age, female gender, and marital status of being divorced or widowed. Furthermore, the results imply that a notable elevation in the risk score for undernutrition in patients is significantly linked to impaired HRQOL among elderly individuals with CVD.

Push-out bond strength of the calcium silicate-based endodontic cements in the presence of blood: A systematic review and meta-analysis of in vitro studies.

OBJECTIVES: The push-out bond strength (POBS) of calcium silicate-based cements (CSCs) to the dentinal wall is considered one of the essential physical properties for clinical success. The presence of blood in the treatment area affects the POBS of these types of cement. This study aimed to evaluate the impact of blood contamination on the bond strength of CSCs and dentinal walls. MATERIAL AND METHODS: This systematic review was performed by searching electronic databases (MEDLINE-PubMed, Scopus, and EMBASE) to include relevant in vitro studies published between 1992 and April 2020. Two reviewers independently evaluated the selected studies and extracted data on the type of studied CSCs, evaluated area of the teeth, sample size, the dimension of a prepared area, slice thickness, storage duration, the setting of the universal testing machine (UTM), effects of blood contamination on POBS of CSCs and their failure modes. The bond strength of evaluated CSCs in studies was used for network meta-analysis. RESULTS: Initial searches identified 292 articles, while only 13 articles met the inclusion criteria. Full texts of these articles were evaluated, and data extraction was performed. The effect of blood contamination on bond strength to the dentinal wall was assessed in various CSCs such as PMTA, Biodentine, and AMTA. The network meta-analysis results showed that the bond strength of Biodentine was significantly higher than other types of cement in blood presence (p < .05). CONCLUSIONS: Based on the current systematic review, despite controversies among the result of the different articles and the lack of data for some CSCs like bioaggregate, it could be concluded that the bond strength of Biodentine to the dentinal wall is better than other evaluated CSCs in the presence of blood.

Identifying Factors Associated with Functional Limitation Among Diabetic Patients in Northwest of Iran: Application of the Generalized Additive Model.

BACKGROUND: Functional limitation is one of the most important health - related concerns of diabetic patients. This study aimed to identify the factors associated with functional limitation among diabetic patients using generalized additive model (GAM) as a flexible technique to reveal the non - linear and non - monotonic association between the response and a set of independent variables. METHODS: The source data belonged to two cross - sectional studies conducted in 2014. A total of 694 people with type 2 diabetes in the age range of 31 - 70 years were selected via convenience sampling from diabetes clinics in Ardabil and Tabriz. The data were collected by interviewers using structured questionnaires and checklists. The functional capacity was measured using the physical functioning subscale of the Medical Outcomes Study Short Form 36 - Item Health Survey (SF36). Participants with a total functional capacity of less than 90 were considered to have "moderate or high level of functional limitation." To identify the factors associated with functional limitation and reveal the shape of associations, the GAM procedure with "logit" link function was applied to the dataset of 378 diabetic patients without any missing data by smoothening of the effect of underlying factors. The Akaike information criterion (AIC) as the relative quality of the model's criterion was computed for GAM and compared with AIC of the simple logistic regression. RESULTS: Sex (P = 0.029), age (P < 0.001), BMI (P = 0.029), and SBP (P = 0.04) were significant in the GAM. Moreover, age with a linear function (df = 0.98), BMI with quadratic function (df = 1.75), and SBP with the degree 1.33 were significantly related to functional capacity. AIC of the GAM was lower than that of the logistic model. CONCLUSIONS: In our sample, GAM could identify some linear and nonlinear associations between underlying factors and functional limitation in diabetic patients. These complex associations could relatively increase the fit quality of the GAM when compared to logistic regression.