Ahmadreza Dehpour, PharmD, PhD
Vol 59, No 6 (2021)
This study was conducted to review the related articles and draw a final conclusion regarding the application of reflexology for delivery (labor and cesarean section) pain management in women all over the world. In this systematic review, relevant articles were searched in Google Scholar, PubMed, Cochrane Library, Science Direct, and Scopus databases from the year 2000 to 2018. All the human clinical trials that examined the effects of reflexology methods on delivery pain (labor or Cesarean section) were included, and others were excluded from the study. All the 18 included original articles (with 1391 patients) reported that reflexology significantly reduces the pain of delivery, confirming its decreasing effect on labor, Cesarean section, and post-delivery pain. Results of all articles showed that if true reflexology is performed on the right location of the body and at the appropriate time, the pain of delivery can be significantly decreased. Reflexology is appropriate pain relief and prophylaxis for any kind of pain, especially delivery and post-delivery pain. It is a safe remedy with no adverse effects reported so far.
The aim of the current study was to investigate the rates of stress, anxiety, and depression among people in south Iran (a group from the general population without a history of any chronic medical problems, and cohorts of patients were recruited from epilepsy, diabetes, and cardiac disease clinics). We surveyed a sample of people during September 2020: a group of the general population without a history of any chronic medical problems, people with epilepsy, people with diabetes mellitus (DM), and people with cardiac problems. The survey included four general questions and two COVID-19 specific questions [contracting COVID-19, relatives with COVID-19]. Furthermore, the survey included the DASS (Depression-Anxiety-Stress Scale)-21 questionnaire. 487 people were surveyed (154 people with epilepsy, 127 patients with DM, 98 people with cardiac problems, and 108 healthy individuals). Among people without a history of any chronic medical illnesses, 14% had any psychological problems. The highest rates of depression and anxiety were observed among patients with DM (52% and 57%, respectively), and the highest rate of increased stress was observed among people with cardiac problems (40%). The existence of any underlying medical problem was significantly associated with higher rates of depression, anxiety, and stress among the participants. While many patients with underlying chronic medical conditions suffer from depression, anxiety, and stress during the COVID-19 pandemic, we cannot establish a cause and effect relationship between the COVID-19 pandemic and increased psychological problems among these patients.
Pelvic organ prolapse (POP) is the descend of pelvic organs, including the uterus, bladder, and rectum, to the vaginal wall. Patients with POP may present with symptoms such as vaginal bulging with other symptoms like urinary, defecatory, or sexual dysfunction. This study was conducted to evaluate the changes of POP symptoms one year after pessary fitting. Patients with symptomatic pelvic organ prolapse who presented to the pelvic floor clinic of an academic hospital between August 2016 and April 2019 were considered. Pelvic organ prolapse symptoms, including urinary, defecatory, sexual, and bulging symptoms, were recorded before and one year after pessary fitting. Pelvic floor distress inventory (PFDI)-20 and pelvic floor impact questionnaire-7 (PFIQ-7) were evaluated before and after treatment for all subjects. We analyzed the characteristics of 110 patients who used the pessary for 12 months. At the baseline, the most common prolapse symptoms were vaginal bulging and pelvic pressure. All urinary, defecatory, and sexual symptoms significantly improved one year after regular pessary use (P<0.001). Changes in PFDI-20 and PFIQ-7 before and after pessary use showed a significant improvement in both frequency and satisfaction of sexual function (P<0.001). The study showed significant improvement in bulging, urinary, and defecatory symptoms. Although the majority of patients were not sexually active, a significant proportion of sexually active patients reported an increase in sexual satisfaction.
Breast cancer therapy has remained one of the major healthcare challenges. Based on the critical role of cyclin-dependent kinase 4/6 (CDK 4/6) in cell cycle progression, targeting this signaling appears promising for cancer therapy. Palbociclib, a selective CDKs 4/6 inhibitor, is the first-line treatment for estrogen receptor-positive breast cancer. However, poor absorption or side effects may negatively affect its efficiency. This prompted us to incorporate palbociclib into the nanostructured lipid carriers (NLCs) and evaluate the anticancer effect of the nanoformulation (Pa-NLCs) in in vitro and in vivo models of breast cancer. Pa-NLCs were developed by high-pressure homogenization followed by assessment of the physicochemical characteristics and bioactivities in MCF-7 breast cancer cells and female Wistar rats exposed to the carcinogen 7,12-dimethylbenz(a)anthracene (DMBA). The prepared Pa-NLCs demonstrated suitable physicochemical characteristics, including the controlled release pattern, efficient cellular uptake, and cytotoxicity, while free palbociclib failed to show significant effects. Rats treated with Pa-NLCs exhibited significantly reduced tumor volumes, increased survival rates, and histopathological improvement. Free palbociclib was significantly less efficient than Pa-NLCs. Pa-NLCs, by improving the pharmacological profile of palbociclib and providing longer-lasting effects, can be considered as a promising nanoformulation against breast cancer.
Cataract surgery sometimes is associated with adverse effects, such as dryness, burning, and patient discomfort. This study evaluates the treatment of dry eye syndrome and pain caused by corneal damage following cataract surgery with pregabalin compared to placebo. In our double-blind clinical trial, a total of 60 cases were divided into two groups. The pain score was assessed by the Numeric Rating Scale (NRS), and the impact of pain and dryness on the patient's performance was evaluated by the Brief Pain Inventory (BPI). The patient's pain score was evaluated postoperatively and followed for six weeks after the procedure. After the sixth week of the study, NRS, BPI, and photophobia in the pregabalin group were significantly different from the placebo group. Pregabalin can significantly reduce chronic and resistant eye pain after cataract surgery.
Oral health is one of the most critical aspects of nursing care in critically ill patients. The study aimed to investigate the effect of oral health protocol on dental and gingival plaque index in patients with endotracheal tubes admitted into the ICU. This double-blind clinical trial was conducted on 70 patients admitted into ICU randomly by tossing a coin, and 35 patients were assigned to each of the experimental and control groups. Oral care was performed in the experimental group using the chlorhexidine (CHX) solution, toothpaste, and oral moisturizer protocol; in the control group, according to the routine method, 0.2% CHX was used twice a day. The data were collected at the time of inclusion and four days later, using the MGI and the O'Leary dental plaque index. The mean ages in the experimental and control groups were 38.4±14.4 and 41±14.5 years, respectively. In the experimental and control groups, 77% and 83% of the subjects were male, respectively. After the intervention, the mean gingival index in the experimental and control groups was 0.59±0.31 and 0.90±0.41, and the plaque index was 42.53±15.97 and 53.52±11.9, respectively. The differences before and after the intervention in each group and the difference between the two groups in both gingival and dental plaque indices were statistically significant (P=0.0001). The results showed that the oral health protocol was more effective in improving gingival and dental plaque indices than the routine (CHX) method.
Acute pulmonary embolism (APE) is a potentially fatal disorder. The literature shows that estrogen therapy is correlated with an increase in mortality and morbidity. Accordingly, the purpose of the present study was to investigate the prevalence and prognostic significance of the recent history of estrogen therapy in women with APE. This study was conducted on female patients admitted to our hospital between January 2008 and January 2016. A total of 276 patients (mean age=62.66±08 y) with confirmed APE were divided into groups with and without recent estrogen therapy. The relationships between estrogen and clinical findings, risk factors, imaging findings, and in-hospital mortality were analyzed. Among the 276 women with APE at presentation, 37 (13.4%) patients had a recent history of estrogen therapy. The estrogen group had a lower frequency of hypertension (21.6% vs49.8%; P< .001), immobilization of at least 3 days (16.2% vs 33.5%; P= .035), and pleural effusion (0% vs16.7%; P= .007) than the group without recent estrogen use. Among the 276 patients, the rate of 1 year’s mortality was 15.8% for the group without recent estrogen therapy. No death occurred in the estrogen group. Older age, tachycardia, tachypnea, malignancy, and lack of obesity were the predictors of 1 year’s mortality. Among the patients with APE in our study, 13.4% had a history of recent estrogen therapy. No death occurred during the 1-year follow-up of these patients.
Several factors contribute to the development of gastric erosions, including corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs), alcohol, and stress. These factors can cause or worsen gastrointestinal ulcers by activating inflammatory pathways or by altering gastric mucosal blood flow. Dapsone is an antimicrobial compound with anti-inflammatory properties. The aim of this study was to evaluate the protective effects of dapsone against gastric erosions-induced by alcohol, stress, or indomethacin. Gastric damage was induced in male rats in different three experimental models: ethanol (5 ml/kg, p.o.)-, water-immersion stress-, and indomethacin (30 mg/kg, p.o.)- induced ulcer. Rats in each of these three experimental models were divided into 5 groups: Normal group, 2. Control group (gastric damage + vehicle), 3. Gastric damage+ dapsone 1 mg/kg, 4. Gastric damage+ dapsone 3 mg/kg, 5. Gastric damage+ dapsone 10 mg/kg. In this study, the J- score ulcer index and histopathological assessment were performed. In addition, inflammatory cytokines levels, NF-κB expression and MPO activity were determined. Dapsone reduced the tissue injuries and erosion area in all three experimental groups compared to the control group. In addition, serum levels of inflammatory cytokines, TNF-alpha and IL-1β were reduced in the dapsone treatment groups. The expression of NF-κB and tissue concentration of myeloperoxidase (a marker of neutrophil activation) was also reduced in rats given dapsone. To conclude, dapsone exhibits significant protective effects against the development of experimental gastric erosions in rats and these effects seem to be related to its anti-inflammatory and antioxidant properties.
Oxygenation index (OI) based on arterial blood gas (ABG) test is an invasive procedure and requires indwelling arterial lines. However, the oxygen saturation index (OSI) assessed by the pulse oximetry method is simple and noninvasive for monitoring oxygenation saturation in newborn neonates with chronic lung disease. This study aimed to evaluate and compare OI and OSI among neonates in NICU who underwent mechanical ventilation. A cross-sectional study was carried out among fifty neonates (term and preterm) who were admitted to the NICU of Abuzar Hospital in Ahvaz, Iran. All neonates were examined by both ABG and pulse oximetry methods. Approximately 2 cc of arterial blood sample was taken and sent to the laboratory to determine blood gases. At the same time, the level of peripheral capillary oxygen saturation (SpO) was recorded using a pulse oximeter. OI and OSI were calculated according to their formula. Spearman’s correlation, linear regression, and Bland-Altman scatter plot were used to determine the correlation, association, and agreement between OI and OSI, respectively. Of the total 50 neonates, 26 were female. The mean (range) gestational age was 35.28±3.01 (28-39) weeks, and post-neonatal age was 6.05±7.04 (1-25) weeks. There was a linear and significant association and correlation between OI and oxygen OSI (P<0.001), while the Bland-Altman scatter plot confirmed the agreement between them in mean values. Therefore, OSI utilizing pulse oximetry as a noninvasive method can be a substitute for OI in neonates with respiratory failure. It can also reduce workloads and costs.
Factor VII deficiency is a rare congenital coagulopathy disorder. In most cases, this disorder is diagnosed in childhood. Common symptoms of congenital factor VII deficiency are different and consist of cutaneous, mucosal hemorrhage, gastrointestinal bleeding, and joint bleeding. CNS hemorrhage is a fatal and severe complication of congenital factor VII deficiency. The incidence of gross hematuria is a rare symptom of factor VII deficiency. Isolated presentation of hematuria is rarer and usually is accompanied by bleeding in other sites. The patient reported here is a 6-month-old girl who was diagnosed with congenital Factor VII deficiency following episodes of isolated gross hematuria. We decided to report this case to demonstrate if there is no other organic cause in the investigation of a child with recurrent hematuria, we should also consider a coagulation factors deficiency. Since isolated hematuria is a rare symptom in the coagulation factors deficiency, the coagulation tests may be of less interest.