High dose vs. low dose oxytocin for labor augmentation: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To compare the safety and efficacy between high dose and low dose oxytocin administration for labor augmentation. METHODS: We searched for the available studies during March 2020 in PubMed, Cochrane Library, Scopus, and ISI Web of science. All randomized clinical trials (RCTs) that assessed safety and efficacy of high dose vs. low dose oxytocin for labor augmentation were considered. The extracted data were entered into RevMan software. Dichotomous and continuous data were pooled as odds ratio (OR) and mean difference (MD) respectively, with the corresponding 95% confidence intervals (CI). Our main outcomes were cesarean delivery rate, spontaneous vaginal delivery rate, uterine hyperstimulation and tachysystole, and labor duration from oxytocin infusion. RESULTS: Eight RCTs with 3,154 patients were included. High dose oxytocin did not reduce cesarean delivery rate compared to low dose oxytocin (OR=0.76, 95% CI [0.52, 1.10], p=0.15). After solving the reported heterogeneity, high dose oxytocin did not increase the rate of spontaneous vaginal deliveries vs. low dose oxytocin (OR=1.06, 95% CI [0.84, 1.32], p=0.64). Low dose oxytocin was linked to a significant decline in uterine hyperstimulation and tachysystole (p>0.001). A reduction in labor duration was found in high dose oxytocin group over low oxytocin regimen (MD=-1.02 h, 95% CI [-1.77, -0.27], p=0.008). CONCLUSIONS: We found no advantages for high dose oxytocin over low dose oxytocin in labor augmentation except in reducing labor duration. Low dose oxytocin is safer as it decreases the incidence of uterine hyperstimulation and tachysystole. More trials are needed to confirm our findings.

Case study-based systematic review of literature on lymphoma-associated cardiac tamponade.

This study aimed to compile all the relevant studies of patients presenting with pericardial tamponade before or after diagnosis of lymphoma, describe the clinical presentations of patients with lymphoma and cardiac tamponade, and assess the difference in overall survival based on the timing of cardiac tamponade diagnosis. A comprehensive search strategy was conducted in the following databases: PubMed and Cochrane Library, using the following keywords: Lymphoma AND Cardiac Tamponade. The criteria for eligibility included cases with a confirmed diagnosis of lymphoma and cardiac tamponade, human studies, and publications in English language. The statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) version 20. We included 48 research articles (n = 52 cases) with adequate reporting of measured outcomes. The median age of the patients was 52 (9-94) years. Only 6 patients were noted to have primary cardiac lymphoma, while the majority of cases were considered to have secondary cardiac lymphoma (88.5%). According to the data on the type of lymphoma reported through cytology and immunohistochemistry, 49 patients were diagnosed with non-Hodgkin lymphoma, and of these cases the most common subtype was large B-cell lymphoma (42.9%). Overall, the average duration of illness was 14 ± 23 days. A total of 13 patients had distant heart sounds, 12 cases were noted to be hypotensive, and 13 subjects were found to have increased jugular venous pressure. Our retrospective study demonstrated that most patients presented with pericardial tamponade after lymphoma diagnosis, and those were mostly secondary cardiac lymphoma of the non-Hodgkin type with large B-cell as the most common subtype. Dyspnoea, oedema, and constitutional symptoms were the most common presenting signs. The median overall survival of patients with lymphoma and cardiac tamponade is 4 months, with no significant difference in mortality in the presentation timing before and after the diagnosis of lymphoma.

Efficacy and Safety of Intravenous Tramadol versus Intravenous Paracetamol for Relief of Acute Pain of Primary Dysmenorrhea: A Randomized Controlled Trial.

INTRODUCTION: Many pharmaceutical, surgical, and complementary medical interventions are used for primary dysmenorrhea treatment. However, no consensus has been reached about the most effective intervention. OBJECTIVE: To compare the efficacy and safety of IV tramadol versus IV paracetamol in relieving acute pain of primary dysmenorrhea. METHODS: This randomized controlled trial was conducted in a tertiary referral hospital and included 100 patients between 18 and 35 years old diagnosed with primary dysmenorrhea. Patients received either 1-g paracetamol or 100-mg tramadol in 100-mL normal saline as an IV infusion over 10 min. Pain intensity was measured by using a visual analog scale at 15, 30, 60 min, and 2 h. We recorded drug side effects and requirements for rescue analgesics. RESULTS: Pain scores were significantly lower in the tramadol group compared with the paracetamol group at 15, 30, 60 min, and 2 h (p < 0.001). Fewer patients in the tramadol group needed rescue analgesics compared with the paracetamol group (p = 0.04). No significant differences were reported in side effects between both groups. CONCLUSIONS: IV tramadol is superior to IV paracetamol in relieving acute pain of primary dysmenorrhea with a comparable side effect profile.

Evaluation of a combined approach of clinical skills training utilizing near-peers, in-campus faculty and clinicians: An innovative integrated model.

INTRODUCTION: Training clinical skills is essential in medicine. Different models of clinical skills courses have been previously suggested. Here, we report an innovative approach adopted to train junior medical students in clinical skills in a multimodal fashion by near-peers, basic scientists with clinical background and senior clinicians. METHODS: This quasi-experimental study was conducted at Alfaisal University College of Medicine at Riyadh. An electronic survey was conducted among year-2 and year-3 medical students seeking their perception about the (a) organization, (b) delivery, (c&d) self- and peer-assessment in clinical skills courses. Total 298 male and female medical students (91%), consisting of 164 from year 2 and 134 from year 3, participated by filling out a questionnaire (Cronbach's alpha 0.93). RESULTS: Out of maximum five, the average ratings for the course were 3.81, 3.72, 3.67 and 3.73 in organization, delivery, self-evaluation and peer-assessment respectively, with no significant difference between both subgroups. The in-campus sessions rated higher than hospital sessions (p < 0.001). As tutors, interns were rated higher than clinicians (p < 0.001). The qualitative analysis suggested high satisfaction. CONCLUSIONS: The clinical skills course that was conducted in a multimodal fashion utilizing diverse tutors showed a positive attitude of students toward the organization and delivery of the course.

Assessment of first-year medical students' perceptions of teaching and learning through team-based learning sessions.

Team-based learning (TBL) is an emerging teaching and learning strategy being employed in medical schools. The College of Medicine at Alfaisal University has adopted a TBL approach as an instructional method for first-year medical students. The aim of the present study was to describe the TBL method employed at Alfaisal University College of Medicine and to assess first-year medical students' perceptions of this learning modality for the anatomy- and physiology-based blocks/courses in organ systems form of curriculum. A five-point Likert scale questionnaire was structured based on Kirkpatrick's theory and assessed three major domains: reaction, learning, and behavior. Confirmatory factor analysis (CFA) and Cronbach's α-coefficient tests were used to assess the validity and reliability of the construct, respectively. CFA showed an adequate validity of the survey and Cronbach's α revealed an acceptable internal uniformity (0.69). A total of 185 respondents rated reaction, learning, and behavior toward introduction of TBL as 3.53 ± 1.01, 3.59 ± 1.12, and 3.57 ± 1.12, respectively. Excellent students rated TBL highly in all major domains compared with borderline students (reaction, behavior, and learning domains with P values of <0.049, <0.035, and <0.031, respectively). Students who had prior teamwork experience rated TBL higher in terms of their learning experience compared with those who were rarely involved in team work. This study demonstrated that Alfaisal University first-year medical students perceived TBL positively as a teaching and learning strategy for functional anatomy, and prior involvement in teamwork and academic performance correlates with higher ratings of TBL.

Research-oriented series: a portal into the culture of biomedical research for junior medical students at Alfaisal University in Saudi Arabia.

Student contributions to research have been shown to effectively reflect on their communication and critical thinking skills. Short-term research courses offer opportunities for medical students to advance their research experience in subsequent high-demanding long-term research opportunities. The purpose of the present study was to describe the development, implementation, and evaluation of a research-oriented series (ROS) on undergraduate students at Alfaisal University in Saudi Arabia. The ROS was designed to comprise eight sessions. Each session addressed core principles and the practice of research concepts and was based on theoretical morning sessions supplemented by afternoon practical sessions delivered by experienced senior medical students and faculty members. Students were assessed comprehensively by the end of the ROS. The series was conducted twice, and 35 students were involved each time. A total of 70 enrolled students (35 men and 35 women) with grade point averages of >3.5 and <3.5 were asked to fill out an anonymous, online, self-administered questionnaire assessing their perception of knowledge, skills, and confidence after attending the ROS and evaluating their senior peers. Ninety percent of the medical students responded to the online survey and rated the ROS highly in improving their research knowledge, skills, and confidence. Male students reported significant gains compared with their female peers (P<0.05). Grade point averages did not play a role in student gains after attending the ROS. Qualitative responses were in support of three recurring themes favoring the unique learning environment in the ROS. In conclusion, the ROS offers a short-term systematic approach to fundamental steps and concepts of biomedical research.

The interplay between academic performance and quality of life among preclinical students.

BACKGROUND: The high academic performance of medical students greatly influences their professional competence in long term career. Meanwhile, medical students greatly demand procuring a good quality of life that can help them sustain their medical career. This study examines validity and reliability of the tool among preclinical students and testifies the influence of their scholastic performance along with gender and academic year on their quality of life. METHODS: A cross sectional study was conducted by distributing World Health Organization Quality of Life, WHOQOL-BREF, survey among medical students of year one to three at Alfaisal University. For validity, item discriminate validity(IDV) and confirmatory factor analysis were measured and for reliability, Cronbach's α test and internal item consistency(IIC) were examined. The association of GPA, gender and academic year with all major domains was drawn using Pearson's correlation, independent samples t-test and one-way ANOVA, respectively. RESULTS: A total of 335 preclinical students have responded to this questionnaire. The construct has demonstrated an adequate validity and good reliability. The high academic performance of students positively correlated with physical (r = 0.23, p < 0.001), psychological health (r = 0.29, p < 0.001), social relations (r = 0.11, p = 0.03) and environment (r = 0.23, p < 0.001). Male student scored higher than female peers in physical and psychological health. DISCUSSION: This study has identified a direct relationship between the academic performance of preclinical students and their quality of life. CONCLUSION: The WHOQOL-BREF is a valid and reliable tool among preclinical students and the positive direction of high academic performance with greater QOL suggests that academic achievers procure higher satisfaction and poor achievers need a special attention for the improvement of their quality of life.

Undergraduate research: an innovative student-centered committee from the Kingdom of Saudi Arabia.

INTRODUCTION: Concern has been expressed in recent times whether medical schools have adapted sufficiently to cater for the increasing demand of physician-scientists. Studies have shown that research involvement at the undergraduate level is vital to accommodate this growing need. Enhanced communication skills, improved problem-solving abilities and better future employment opportunities are among the other many benefits of undergraduate research (UR). Herein, we report projects run by a unique student driven undergraduate research committee (URC) at Alfaisal University, Riyadh, Saudi Arabia aimed at providing the future generation of physicians training opportunities for pursuing a research intensive career. METHODS: The article describes the unique structure of the URC and provides an in-depth description of the various programs and activities used in promoting students' research activities. We analyzed students' perception of URC activities via a questionnaire and analyzed research-output of the first graduating batches through their publication record. RESULTS: Overall, more than 60% of the graduating students were involved in the various research programs offered by the URC and around 50% published in peer-reviewed journals with an average impact factor of 2.4. CONCLUSIONS: Research involvement by medical students is an essential need of the twenty-first century and models like URC could provide crucial platform for research training to the new generation of physician-scientists.

A bibliometric review on the top 20 cited articles in the Jackson heart study.

Background: Cardiovascular diseases are higher in African American population, and in the past three decades, less decline in mortality was observed in African Americans compared with white Americans American health disparities resulted in establishing one of the largest single-site investigations to examine causes of cardiovascular diseases in African American population, namely the Jackson Heart Study (JHS). Methods: In January 2020, we used the jacksonheartstudy.org website to obtain the list of publications produced by the JHS from 1999 to 2018. The citation's frequency was obtained for 455 articles using the search engine "google.com". The top 20 cited articles were characterized based on the first author's name, the month and year of publication, and the journal's name and its impact factor. Results: The frequency of citations for the 20 most-cited articles in the Jackson heart study ranged from 282 to 5545. The average number of citations was 1045.60. The top 20 articles were represented in 8 different peer-reviewed journals. Conclusion: The top 20 cited articles in the JHS were in the genetics field and were all observational in type. Future direction of the JHS should be directed toward well established interventional studies.

Effect of metformin on proliferative markers in women with endometrial carcinoma: Systematic review and meta-analysis.

Objective: Endometrial carcinoma (EC) is the most common gynecologic malignancy in the USA and Western Europe. Surgery is the mainstay of both staging and treatment of EC. Fertility sparing medical therapies are often offered to young women who desire fertility. Metformin has been suggested to be an anti-cancer agent as evidenced by previous studies. It decreases Antigen Ki-67 (Ki-67) proliferation and expression which is associated with proliferative activity of malignant tumors. In this systematic review and meta-analysis, we assessed the efficacy of metformin on patients with EC. Materials and Methods: We searched PubMed, Cochrane CENTRAL, Web of Science, and SCOPUS for relevant clinical trials and excluded observational studies. The quality appraisal was evaluated according to GRADE, and we assessed the risk of bias using Cochrane's risk of bias tool. We conducted the analysis of continuous data using mean difference (MD). We included the following outcomes: Ki-67 index, glucose, insulin, P-S6, body mass index (BMI), C-peptide, Insulin-like growth factor (IGF-1), leptin, and hemoglobin. Results: Nine studies were eligible for our meta-analysis. We found that compared to the control group, metformin is highly effective in reducing Ki-67 proliferation and expression [MD=-10.14 (-19.10, -1.17)], (p=0.03), P-S6 [MD=-1.82 (-3.17, -0.46)], (p=0.009), plasma glucose level [MD=-1.76 (-4.88, 1.37), p=0.27], and BMI [MD=-1.07 (-1.49, -0.65)], (p<0.001). Conclusion: We conclude that metformin administration is effective in patients with EC. It decreases Ki-67 proliferation and expression, serum glucose, and p-S6 significantly.

The effect of hyoscine-N-butylbromide on pain perception during and after hysterosalpingography in infertile women: a systematic review and meta-analysis of randomised controlled trials.

This paper reports a systematic review and meta-analysis of the effectiveness of hyoscine-N-butylbromide (HBB) administration in hysterosalpingography (HSG). Four electronic databases were searched for randomised controlled trials (RCTs) that compared HBB versus placebo or no intervention in infertile women undergoing HSG. Pain during and after HSG and different adverse events including nausea, vomiting, and dizziness were evaluated. Three RCTs with 335 patients were included. The analysis showed HBB was significantly effective in reducing pain during and after HSG (MD = -0.76 mm, 95% CI [-1.35, -0.17], p = 0.01) and (MD = -0.81 mm, 95% CI [-1.07, -0.56], p < 0.001), respectively. There were no significant differences in adverse events between HBB and control groups. The methodological evidence quality was high as evaluated by GRADEpro. In conclusion, this review provides good evidence that prior administration of HBB is effective in reducing induced pain during and after HSG with tolerable side effects.

Efficacy of hyoscine in pain management during hysteroscopy: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis of relevant clinical trials from full-text, scientific journal archives to assess the efficacy of hyoscine for the management of pain during in-office hysteroscopy (OH) procedures. Cochrane CENTRAL, ClinicalTrials.Gov, MEDLINE, PubMed, SCOPUS and the Web of Science were searched for all clinical trials that matched our search criteria. A full assessment of bias was made using the Cochrane Group tool-set. The following outcomes were included: visual analogue scale (VAS) score for postoperative pain, postoperative need for analgesia, and procedure time. In the case of homogeneous data, the analysis was performed using a fixed effects system, and the random effects system was used with heterogeneous data. Inclusion criteria included only randomized clinical trials, and interventions that included patients receiving hyoscine-N-Butyl Bromide during OH, regardless of dose or mode of administration, and compared this with placebo. Three clinical trials were included. The actual mean difference (MD) of the VAS pain score showed no significant difference between hyoscine or placebo [MD: -0.28 (-1.08, 0.52), (p=0.49)]. For postoperative analgesia, the overall MD showed no significant difference between hyoscine or placebo [MD: 0.43 (0.16, 1.14), (p=0.09)]. For procedure time, the combined effect estimate failed to show any significant difference between hyoscine and placebo [MD: -0.66 (-2.77, 1.44) (p=0.54)]. Contrary to previously published data, our meta-analysis using the latest available RCTs fails to show hyoscine as being effective in reducing pain or the need for other forms of anesthesia in OH.

The current global perspective of the knowledge-attitude-behavior of the general public towards the corona virus disease -19 pandemic: Systematic review and meta-analysis on 67,143 participants.

BACKGROUND: Determining the success of infectious disease outbreak prevention is dependent mainly on public knowledge and compliance regarding the guidelines of precautionary behaviors and practices. While the current literature about the COVID-19 pandemic extensively addresses clinical and laboratory-based studies, a gap remains still present in terms of evaluating the general public knowledge and behaviors towards the COVID-19 pandemic. The aim of this review was to form a preliminary and contemporary understanding of the general public knowledge, attitude, and behaviors towards the COVID-19 pandemic globally. METHODS: A systematic search was conducted in various databases until May 2020. Each study's characteristics including the sample size, region, and study type were examined individually. A meta-analysis with a random-effects model and pooled prevalence with 95% confidence interval (CI) of all evaluated outcomes such as adequate knowledge, positive feelings, worrisome about the COVID-19 pandemic, and practice were recorded and reported from each study. Parameters such as random distribution, blinding, incomplete outcome data, selective reporting, and other biases were utilized to assess the quality of each retrieved record. Both Begg's and Egger's tests were employed to evaluate symmetry of funnel plots for assessment of publication bias. The overall quality of evidence was evaluated using GRADEpro software. RESULTS: A total of 26 studies with 67,143 participants were analyzed. The overall prevalence of knowledge, positive attitude, worrisome, and practice of precautionary measures were 0.87 (95%CI, 0.84-0.89), 0.85 (95%CI, 0.77-0.92), 0.71 (95%CI, 0.61-0.81), and 0.77 (95%CI, 0.70-0.83), respectively. Subgroup analysis demonstrated that social distancing was less practiced in Africa than other regions (p = 0.02), while knowledge of prevention of COVID-19 was reported higher in Asia (p = 0.001). Furthermore, people in developing countries had a higher prevalence of worrisome towards the COVID-19 pandemic with a p-value of less than 0.001. The quality of evidence was noted to be of low certainty in practice domain but moderate in the remaining outcomes. CONCLUSION: Assessing the public's risk perception and precautionary behaviors is essential in directing future policy and health population research regarding infection control and preventing new airborne disease outbreaks.

Systematic review of the safety and efficacy of tramadol during office hysteroscopy

Office hysteroscopy (OH) is a common procedure in gynecology. Pain is the most frequently reported problem in OH. In this study, we aimed to investigate the role of tramadol administration in relieving pain in women undergoing OH. We searched PubMed, the Cochrane Library, ClinicalTrials.gov, MEDLINE, Scopus, and Web of Science databases for relevant clinical trials based on our search terms. We included randomized controlled trials and included all published trials in all six searched databases from their inception until February 28th 2021. We included pain as the primary outcome, and the incidence of adverse events of tramadol as secondary outcomes. We performed the analysis of continuous data using mean difference (MD) and dichotomous data using risk ratio (RR). We found that tramadol led to significantly less pain during the actual procedure [MD=-1.27, 95% confidence interval (CI): (-1.66, -0.88); p<0.001], immediately after the procedure [MD=-1.03, 95% CI: (-1.40, -0.67); p<0.001], and 30 minutes after the procedure [MD=-0.74, 95% CI: (-1.06, -0.41); p<0.001]. Regarding safety endpoints, no significant difference was noted for dizziness [RR=1.88, 95% CI: (0.79, 4.47); p=0.16] or vomiting [RR=1.80, 95% CI: (0.40, 8.18); p=0.45]. Based on the available data, we conclude that tramadol administration seems to be both effective and safe for patients undergoing office hysteroscopy.

Relationship between shortage of basic life needs and quality of life of medical students in Yemen: A study utilizing validity and reliability of WHOQOL-BREF questionnaire.

PURPOSE: This study examines quality of life of medical students in Yemen by evaluating validity and reliability of the World Health Organization Quality of Life questionnaire (WHOQOL) and assessing potential influencing factors. METHODS: This is a single-centered cross-sectional study conducted in Hadramout University College of Medicine, Mukalla, Yemen during the academic year of 2019. The WHOQOL questionnaire was distributed among medical students. For validity, item discriminate validity and confirmatory factor analysis were assessed and for reliability, Cronbach's α test was examined. Independent sample t-test and one-way Analysis of Variance (ANOVA) were used to examine the academic level, gender, academic performance, and basic life necessities including water, electricity supply, sewage treatment and type of residence. RESULTS: A total of 495 medical students have responded to this questionnaire which has demonstrated an adequate validity and good reliability. The mean score for students' self-rating of their quality of life in the major domains was found to be in a descending order (Mean ± SD): psychological health (55.18 ± 17.84), environmental (52.14 + 17.60), physical health (48.15 + 14.73) and social relations (45.09 ± 20.81). Demographics and basic life needs exhibit relationship with Quality of Life among medical students. CONCLUSION: The WHOQOL-BREF is a valid and reliable tool among medical students in Hadramout University. Demographics and basic life needs seem to impact Yemeni medical students' Quality of Life. Wellness and mentoring programs should be considered to ameliorate effects related to deteriorating medical students' Quality of Life in Hadramout University.

Medical therapy options for endometriosis related pain, which is better? A systematic review and network meta-analysis of randomized controlled trials.

Our objective was to assess and rank different pharmacological interventions for relieving endometriosis-related pain. We conducted an online bibliographic search in different databases from their inception until March 2019. We included randomized controlled trials (RCTs) that assessed different medical therapies in the management of endometriosis-related pain. We applied this network meta-analysis (NMA) based on the frequentist approach using statistical package "netmeta" (version 1.0-1) in R software. Our main outcomes were the change in severity of pelvic pain, dysmenorrhea score, non-menstrual pelvic pain score, and dyspareunia score. Overall, 36 RCTs were included in this study (patients no. = 7942). Dienogest (0.94), combined hormonal contraceptives (CHCs) (0.782), and elagolix (0.38) were the highest-ranked interventions for reducing the severity of pelvic pain at three months, while at six months, gonadotropin-releasing hormone (GnRH) analogues (0.75), levonorgestrel-releasing intrauterine system (LNG-IUS) (0.73), and dienogest (0.65) were linked to more reduction in pelvic pain. The ranking p-score showed that GnRH analogues was the highest-ranked treatment for reducing dysmenorrhea at 3 months (1.00), while CHCs were the highest-ranked treatment at 6 months (0.97), followed by GnRH analogues (0.89). GnRH analogues (0.63) and elagolix (0.54) at three months while desogestrel (0.94) and CHCs (0.91) at six months were the highest-ranked treatment to reduce non-menstrual pelvic pain. GnRH analogues and elagolix were the highest-ranked pharmacologic therapies for reducing dyspareunia. In conclusion, CHCs, GnRH analogues, progesterone, and elagolix were the best approaches in reducing the pain of endometriosis.

Factors associated with strain among informal care providers of patients with traumatic brain injury in Malaysia.

PURPOSE: This study aims to investigate the level of strain and various influencing factors among informal care providers of traumatic brain injury (TBI) patients. METHODS: A cross-sectional study was conducted in a single center in Malaysia via recruiting care providers of patients with TBI. The modified caregiver strain index (MCSI) questionnaires were utilized to ascertain the level of strain. The demographic data of informal care providers were also obtained. Independent sample t-test, analysis of variance (ANOVA), and a linear regression model were processed for data analysis. RESULTS: A total of 140 informal care providers were included in the study. More than half of informal care providers claimed to have strain (54.3%). Factors associated with increased strain include receiving tertiary education, being of Chinese background, and employed experience higher strain level. Informal care providers with characteristics such as being single, retired and provided care for 5 years experienced a lower level of strain. CONCLUSION: Guidance on integrating the TBI knowledge into practice, assessing the care provider's level of strain regularly and providing supportive measures may aid in supporting informal care providers at risk.

Outpatient versus inpatient balloon catheter insertion for labor induction: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To compare between outpatient and inpatient balloon catheter insertion for labor induction. METHODS: We searched in four different databases for the available trials during May 2020. We included randomized controlled trials (RCTs) that compared outpatient to inpatient balloon catheter for induction of labor. We extracted the available data from the included studies and pooled them in meta-analysis using RevMan software. The dichotomous data were pooled as risk ratio (RR) and the continuous data were pooled as mean difference (MD) with the corresponding 95% confidence intervals (CI).Our primary outcome was the rate of cesarean delivery. Our secondary outcomes were the length of hospital stay, Bishop score, and different adverse events including postpartum hemorrhage, Apgar score less than 7 at 5 minutes, and chorioamnionitis. RESULTS: Eight RCTs with a total number of 740patients were included. The cesarean delivery rate was significantly reduced among outpatient balloon catheter compared to inpatient balloon catheter (RR = 0.63, 95% CI [0.46, 0.86], p = 0.004). Outpatient balloon catheter was associated with shorter hospital stay duration in comparison with inpatient group (MD= -0.38, 95% CI [-0.61, -0.14], p = 0.002). Outpatient group was linked to a more favorable increase in Bishop score (MD = 0.88, 95% CI [0.78, 0.98], p>0.001). There were no significant differences between both groups regarding different adverse events. CONCLUSION: Outpatient balloon catheter priming is safe and effective in reducing cesarean delivery rates and shortening the length of hospital stay with a better Bishop score.

Amlodipine Compared with Benidipine in the Management of Hypertension: A Systematic Review and Meta-Analysis.

INTRODUCTION: Benidipine and amlodipine are two well-known drugs used in hypertensive patients with chronic kidney disease (CKD). AIM: In this systematic review we aimed to compare benidipine and amlodipine in terms of efficacy in the management of hypertensive patients. METHODS: We searched PubMed, Cochrane CENTRAL, SCOPUS and Web of Science for relevant clinical trials and excluded observational studies. Quality appraisal was evaluated according to GRADE and we assessed the risk of bias using the Cochrane's risk of bias tool. We included the following outcomes: Systolic blood pressure, diastolic blood pressure, heart rate, estimated glomerular filtration rate (eGFR), and urinary albumin/creatinine ratio. Data were pooled as mean differences (MD) with relative 95% confidence intervals (CI). RESULTS: Eight studies were eligible for our meta-analysis. We found no significant difference between both drugs regarding systolic (MD = - 0.21 [- 1.48, 1.89], (P = 0.81) and diastolic (MD = 0.01[- 0.51, 0.53], (P = 0.97)) blood pressure measurements. The overall heart rate did not differ as well (MD = - 0.03 [- 1.63, 1.57], (P = 0.97)). We found that benidipine was statistically better than amlodipine in terms of eGFR (MD = 1.07 [0.43, 1.71], (P = 0.001)), and urinary albumin/creatinine ratio (MD = - 43.41 [- 53.53, - 33.29], (P < 0.00001)). CONCLUSIONS: Finally we conclude that benidipine seems to show more positive and promising results in the management of hypertensive patients with chronic kidney disease.

A systematic review of contemporary evidence on SARS-CoV-2 and HIV coinfection: What does it look like up to date?

BACKGROUND: Preexisting alteration of the immune system by factors including older age, cardiovascular diseases, morbid obesity, diabetes, and chronic obstructive pulmonary disease (COPD) have detrimental effects on SARS-CoV-2 patients. Literature regarding SARS-CoV-2/human immunodeficiency virus (HIV) is still developing. MATERIALS AND METHODS: We reviewed the existing literature pertaining to SARS-CoV-2/HIV coinfection systematically. Research records' characteristics and patients' clinical data were collected. RESULTS: Seven research records were included, of which three were case series and four were case reports, reporting a total of 16 cases. There was one case of death, whereas (15/16) patients were discharged home. Majority of patients developed consistent clinical presentation of SARS-CoV-2. All patients had initial positive RT-PCR results, and four cases had HIV-related lymphopenia. CONCLUSION: Although the current literature is still growing to increase our understanding of SARS-CoV-2/HIV coinfection, people living with HIV should adhere to the guidelines of healthy behavior and practice during this pandemic.