Comparison of Phototherapy Effect with and without Phenobarbital on the Newborns with Hyperbilirubinemia.

Objectives: Jaundice occurs in 60% of full-term and 80% of pre-term newborns. This study compared the effect of phototherapy with and without phenobarbital on icteric newborns. Materials & Methods: This study is a randomized clinical trial conducted from July until March 2018 at Imam Reza Hospital, Mashhad University of Medical Science, Iran. Full-term and near-term neonates with more than 2000 grams who were hospitalized in the mentioned period for jaundice were entered into the study. The newborns were divided into two groups using block randomization. Data were analyzed by SPSS version 19. Results: The average gestational age was 36.4 weeks (SD 2.39) in the intervention group and 36.9 weeks (SD 2.16) in the control group, with no significant difference between them. The mean hospital stay for the intervention group was 72 hours (SD 1.66), compared to 55 hours (SD 1.88) for the control group. At discharge, the serum bilirubin level in the intervention group was 11.53 mg/dL (SD 0.77), while it was 10.80 mg/dL (SD 1.09) in the control group, a statistically significant difference. Conclusion: According to this study, phototherapy with phenobarbital is not more effective than phototherapy alone in neonatal hyperbilirubinemia.

A systematic review of the effect of structured exercise on inflammation and body composition in inflammatory bowel disease.

PURPOSE: Given the substantial risk of treatment failure in inflammatory bowel disease (IBD), adjuvant therapies may play a role in disease management. We aim to carry out a systematic review to examine the effects of structured exercise on the inflammatory response in patients with IBD. Our secondary aim is to examine the effect of structured exercise programmes on body composition given both an increase in visceral obesity and the presence of sarcopenia have deleterious effects on outcomes in IBD. METHODS: A systematic review was carried out following the Methodological Expectations of Cochrane Intervention Reviews (MECIR) manual and the Cochrane Handbook for Systematic Reviews of Interventions. Title/Abstract and MeSH Terms were used to search for relevant studies. RESULTS: In total, 1516 records were screened for eligibility, and 148 records were reviewed for eligibility, of which 16 were included and a further 7 studies were identified from hand searching references. Four studies included body composition outcomes, and 14 studies reviewed the inflammatory response to exercise. CONCLUSION: Further studies of adequate duration are required to include patients with more active disease to demonstrate an inflammatory response to exercise. Body composition measurements including muscle mass and visceral adiposity may play a key role in response to medical therapy in IBD and should be included as exploratory outcomes in future studies. A meta-analysis was not carried out due to the significant heterogeneity amongst studies.

Higher dietary total antioxidant capacity is inversely associated with Helicobacter pylori infection among adults: A case-control study.

INTRODUCTION: Antioxidants appear to hinder the actions of Helicobacter pylori (H. pylori). The aim of this research was to evaluate the association between dietary total antioxidant capacity (DTAC) and H. pylori infection. METHODS: A case-control study was carried out among 200 patients with  H. pylori infection and 402 healthy subjects (18-55 years). Dietary data were collected using a validated 168-item quantitative food frequency questionnaire. DTAC was calculated based on the oxygen radical absorbance capacity of each food (except for coffee) reported by the US Department of Agriculture. RESULTS: Compared with participants in the lowest tertile of DTAC, those in the highest tertile had a significantly lower odds ratio (OR) in the crude model (OR, 0.29; 95% CI, 0.14-0.61; p for trend = 0.001), model 1 (adjustment for age and sex) (OR, 0.37; 95% CI, 0.24-0.58; p for trend < 0.001), and model 2 (adjustment for model 1 plus body mass index, waist circumference, physical activity, smoking, dietary intake of energy and fat) (OR, 0.20; 95% CI, 0.10-0.40; p for trend ≤ 0.001). CONCLUSIONS: A high DTAC is associated with a reduced risk of H. pylori infection in adults. Further studies are mandatory to elucidate the mechanisms and a dose-effect relationship.

Safety and efficacy of combining biologics or small molecules for inflammatory bowel disease or immune-mediated inflammatory diseases: A European retrospective observational study.

BACKGROUND AND AIMS: Few data are available regarding the combination of biologics or small molecules in inflammatory bowel disease (IBD) patients. We report safety and efficacy of such combinations through a retrospective multicentre series. METHODS: Combination therapy was defined as the concomitant use of two biologics or one biologic with a small molecule. Patient demographics, disease characteristics and types of combinations were recorded. Safety was evaluated according to the occurrence of serious infection, opportunistic infection, hospitalisation, life-threatening event, worsening of IBD or immune-mediated inflammatory diseases (IMID), cancer and death. Efficacy was evaluated as the physician global assessment of the combination and comparison of clinical/endoscopic scores of IBD/IMID activity prior and during combination. RESULTS: A total of 104 combinations were collected in 98 patients. Concomitant IMID were present in 41 patients. Reasons for starting combination therapy were active IBD (67%), active IMID or extra-intestinal manifestations (EIM) (22%), both (10%) and unclassified in 1. Median duration of combination was 8 months (interquartile range 5-16). During 122 patient-years of follow-up, 42 significant adverse events were observed, mostly related to uncontrolled IBD. There were 10 significant infections, 1 skin cancer and no death. IBD disease activity was clinically improved in 70% and IMID/EIM activity in 81% of the patients. Overall, combination was continued in 55% of the patients. CONCLUSIONS: Combination of biologics and small molecules in patients with IBD and IMID/EIM seems to be a promising therapeutic strategy but is also associated with a risk of opportunistic infections or infections leading to hospitalisation in 10%.

Dietary insulin index and load with risk of breast cancer in a case-control study.

OBJECTIVE: Circulating insulin levels have been positively associated with risk of breast cancer (BrCa); however, it remains unclear whether a diet inducing an elevated insulin response influences Breast risk. METHODS: In this study, 250 newly diagnosed breast cancer patients and 250 hospitalised controls were recruited using convenience sampling. The dietary insulin index (DII) was calculated by dividing the dietary insulin load by the total energy intake. RESULTS: Compared with those in the lowest tertiles of DII and dietary insulin load (DIL), subjects in the highest tertile were more likely to be overweight, have a family history of breast and other types of cancer and a history of benign breast diseases. After controlling for multiple potential confounders, a significantly increased BrCa odds was observed in the highest tertiles of DII and DIL score compared with the lowest tertiles (odds ratio (OR): 1.46; 95% CI: 0.67-3.19, P = .006) and (OR: 1.87; 95% CI: 0.92-3.80, P = .038), respectively. CONCLUSIONS: Our findings suggest that a diet that induces an elevated postprandial insulin response, indicated by higher DII and DIL scores, may increase the odds of BrCa, especially among women.

Prevalence of gestational diabetes and its association with stillbirth, preterm birth, macrosomia, abortion and cesarean delivery: a national prevalence study of 11 provinces in Iran.

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy that significantly affects perinatal outcomes. Objective: The aim of this study was to determine the prevalence of GDM and its relation with the incidence of stillbirth, preterm birth, macrosomia, abortion and cesarean section (C-section) delivery in pregnant women. Methods: This cross-sectional study was conducted on 3675 pregnant women in 11 provinces across Iran. Cluster sampling was used to select samples from mothers covered by health plans in 11 provinces of Iran. Prevalence of adverse pregnancy outcomes, including preterm delivery, type of delivery, macrosomic preterm birth, miscarriage, stillbirth, infant death, and birth weight were measured, using family record and face-to-face interviews. Data were analyzed by logistic regression, using STATA14.2 software. Results: About four percent of Iranian pregnant women had GDM during pregnancy. Prevalence of C-section was significantly higher in diabetic women than in the non-diabetic ones (53.19 vs 46.81, respectively, P < 0.001). Abortion in diabetic mothers was more than twice that of the non-diabetic mothers (P < 0.001). In the adjusted logistic regression model, the odds of stillbirth in mothers with GDM were 1.8 (95% CI: 1.11, 2.91, P = 0.018) times higher than that of the non-diabetics. The odds of macrosomia in diabetic women was about 7 times higher than the non-diabetic women (95% CI: 2.81, 17.14, P < 0.001). The odds of GDM had an increasing trend according to the BMI (p < 0.001). The risk of GDM were significantly lower, according to the daily physical activity (PA) (p < 0.001). Conclusion: The GDM prevalence has a decreasing trend in Iran. It increases the adverse pregnancy outcomes such as stillbirth, neonatal deaths, macrosomia, preterm birth, abortion and C-section delivery. As, some of these consequences like macrosomia are not treatable, thus early prevention is very crucial.

Use of "kangaroo care" to alleviate the intensity of vaccination pain in newborns.

OBJECTIVE: It has been demonstrated that newborns feel pain completely. Thus, they should be treated with this in mind. Recent research showed that non-pharmacological interventions such as "Kangaroo Care" may be useful for decreasing pain in newborns. We tried to determine the effect of kangaroo care on the pain intensity of vaccination in healthy newborns. METHODS: This study was a randomized case-control clinical trial. Subjects were 60 healthy full-term newborns delivered in a general Hospital, in Iran, from March to July 2006. They were randomly assigned to case and control groups. The case group received 30 minutes skin to skin contact, whereas infants in the control group were put, wrapped in a blanket, aside the mothers. Behavioral changes of newborns were evaluated and observed 2 minutes before, during, and 3 minutes after the intervention. All procedures were filmed. An assistant who was blinded to the study, scored behavior changes using Neonatal/Infant Pain Scale. Heart rate and oxygen saturation levels as displayed on the pulse monitor and duration of crying were recorded using a stopwatch. FINDINGS: Mean pain intensity during the intervention v was significantly lower in the case group (P<0.006). Mean pain intensity 3 minutes after intervention was also significantly lower in the case group (P<0.021). Mean duration of crying was significantly lower in case group as well (P<0.001). CONCLUSION: Kangaroo care may be used to decrease pain intensity in newborns undergoing painful procedures.

Role of intravenous extra fluid therapy in icteric neonates receiving phototherapy.

OBJECTIVE: To evaluate the role of intravenous extra fluid therapy in accelerating the reduction of jaundice in newborns who received phototherapy. METHODS: This study was performed on 100 terms, jaundiced neonates who had a total bilirubin of 18 mg/dl or more in the Pediatrics Ward of Ghaem Hospital, Mashhad, Iran from October 2007 to April 2008. The patients were randomly divided into 2 equal groups; group I (case group) were given extra parenteral fluid besides breast feeding, and group II (control group) received only breast milk. The rate of bilirubin decrement, length of hospital stay, and rate of blood exchange were compared. RESULTS: The rate of serum bilirubin decrease per hour in the first 12 hours after admission in group I (0.41 mg/dl [95%CI 0.1] versus 0.38 mg/dl in group II [95% CI 0.3], [p=0.22]). It was 0.41 mg/dl for group I (95% CI 0.0001), and 0.21 mg/dl (95%CI 0.06) for group II in the second 12 hours (p=0.02). After 24 hours, it was 0.38 mg/dl in group I (95% CI 0.0001), and 0.29 mg/dl in group II (95% CI=0.09) (p=0.037). The mean hospital stay was 68.5 hours in group I, and 67.4 hours in group II (p=0.95). CONCLUSION: Additional parenteral fluid therapy in icteric newborns can accelerate reduction in serum bilirubin levels in the first 24 hours.