The effect of Nifedipine on embryo transfer outcomes: A randomized clinical trial.

Background: Endometrial receptivity is crucial for embryo implantation, and excessive uterine contraction reduces success. Nifedipine which is a calcium channel blocker, could decrease uterine contraction and improve pregnancy outcomes. Objective: This study aimed to assess the effect of Nifedipine before embryo transfer on the pregnancy outcome in women undergoing in vitro fertilization (IVF) in a tertiary center in Iran. Materials and Methods: 150 women who were candidates for IVF were randomly assigned into 2 groups: group 1 received 20 mg Nifedipine 30 min before embryo transfer, and group 2 received no intervention. Blood pressure of the participants was monitored every 10 min for 1 hr under the supervision of an anesthesiologist. Finally, implantation rate and chemical and clinical pregnancy rates were compared between groups. Results: At the end of the study, 140 participants were included in the final analyses. No significant difference was observed in clinical pregnancy rates between groups (20% vs. 22%, p = 0.51). Conclusion: Nifedipine administration before embryo transfer does not improve the implantation and clinical pregnancy rates in women undergoing IVF.

Novel Regional Nerve Blocks in Clinical Practice: Evolving Techniques for Pain Management.

This review examines the use of novel US-guided nerve blocks in clinical practice. Erector spinae block is a regional anesthesia technique doing by injecting a local anesthetic among the erector spinae muscle group and transverse processes. The phrenic nerve is a branch of the cervical plexus, arising from the anterior rami of cervical nerves C3, C4, and C5. The quadratus lumborum muscle is located along the posterior abdominal wall. It originates from the transverse process of the L5 vertebral body, the iliolumbar ligament, and the iliac crest. US-guided peripheral nerve procedures have a considerable scope of use, including treating headaches and hiccups to abdominal surgical pain, cesarean sections, musculoskeletal pathologies. These nerve blocks have been an effective addition to clinical anesthesia practice. The use of peripheral nerve blocks has improved postoperative pain, lessened the use of opioids and their potential side effects, and decreased the incidence of sleep disturbance in patients. More research should be done to further delineate the potential benefits of these blocks.

Symptom Prediction and Mortality Risk Calculation for COVID-19 Using Machine Learning.

Background: Early prediction of symptoms and mortality risks for COVID-19 patients would improve healthcare outcomes, allow for the appropriate distribution of healthcare resources, reduce healthcare costs, aid in vaccine prioritization and self-isolation strategies, and thus reduce the prevalence of the disease. Such publicly accessible prediction models are lacking, however. Methods: Based on a comprehensive evaluation of existing machine learning (ML) methods, we created two models based solely on the age, gender, and medical histories of 23,749 hospital-confirmed COVID-19 patients from February to September 2020: a symptom prediction model (SPM) and a mortality prediction model (MPM). The SPM predicts 12 symptom groups for each patient: respiratory distress, consciousness disorders, chest pain, paresis or paralysis, cough, fever or chill, gastrointestinal symptoms, sore throat, headache, vertigo, loss of smell or taste, and muscular pain or fatigue. The MPM predicts the death of COVID-19-positive individuals. Results: The SPM yielded ROC-AUCs of 0.53-0.78 for symptoms. The most accurate prediction was for consciousness disorders at a sensitivity of 74% and a specificity of 70%. 2,440 deaths were observed in the study population. MPM had a ROC-AUC of 0.79 and could predict mortality with a sensitivity of 75% and a specificity of 70%. About 90% of deaths occurred in the top 21 percentile of risk groups. To allow patients and clinicians to use these models easily, we created a freely accessible online interface at www.aicovid.net. Conclusion: The ML models predict COVID-19-related symptoms and mortality using information that is readily available to patients as well as clinicians. Thus, both can rapidly estimate the severity of the disease, allowing shared and better healthcare decisions with regard to hospitalization, self-isolation strategy, and COVID-19 vaccine prioritization in the coming months.

The relationship between thyroid function tests and sleep quality: cross-sectional study.

INTRODUCTION: The relationship between sleep and hormones have long been recognized. Studies indicated that sleep quality is one of the major modulatory effects on the endocrine system. In this study, we aimed to assess the serum concentration of thyroid hormones in individuals who suffered from low quality sleep. MATERIAL AND METHODS: Based on the Pittsburgh Sleep Quality Index and ISMA Stress questionnaire, we divided 83 participants into two groups. Forty-one individuals with low quality sleep group and 42 with good quality sleep group, all from the male students of a medical school in Tehran, Iran, participated in this descriptive and cross-sectional study. Then, serum levels of thyroid hormones including free T3, free T4, and TSH were assessed and compared between two groups. RESULTS: There were a significant increase in serum levels of FT4 (p=0.01) and TSH (p=0.02). There were also meaningful correlations between sleep score and stress score (p=0.008) as well as stress score and FT4 (p=0.03) in the case group. CONCLUSIONS: The current study showed that thyroid function tests (T4 and TSH) significantly rose in the poor sleep condition. We also found correlations between sleep score, stress score, and FT4 in the poor sleep condition group that suggest low sleep quality can affect thyroid hormones.

The effect of subjective sleep latency on BMI of medical interns during and before COVID-19 pandemic.

OBJECTIVES: Longer subjective sleep latency and eveningness chronotype are associated with higher BMI. Moreover, COVID-19 lockdown changes have been associated with increased BMI. The aim of this study was to investigate the effect of subjective sleep parameters on BMI of medical interns during and before COVID-19 pandemic. MATERIAL AND METHODS: This cross-sectional study was performed among medical interns. Bedtime, sleep latency, waking time, sleep duration, and reduced morningness-eveningness scores were evaluated. RESULTS: There was significant difference between bedtime before (00:11±50) and during (01:10±85) the pandemic in females (p<0.001). The mean circadian score before and during the pandemic showed significant decrease in females (p=0.011). The correlation between BMI with subjective sleep latency in females before and during the pandemic ((r=0.439, p=0.017), (r=0.422, p=0.014)) was significant. CONCLUSION: COVID-19 pandemic was associated with a change toward nocturnal life among female medical interns. Subjective sleep latency was significantly correlated with BMI in females.

Extracorporeal Hemoperfusion as a Potential Therapeutic Option for Severe COVID-19 patients; a Narrative Review.

The 2019 novel coronavirus (officially known as severe acute respiratory syndrome coronavirus 2, SARS-CoV2) was first found in Wuhan, China. On February 11, 2020, the World Health Organization (WHO) has declared the outbreak of the disease caused by SARS-CoV2, named coronavirus disease 2019 (COVID-19), as an emergency of international concern. Based on the current epidemiological surveys, some COVID-19 patients with severe infection gradually develop impairment of the respiratory system, acute kidney injury (AKI), multiple organ failure, and ultimately, death. Currently, there is no established pharmacotherapy available for COVID-19. As seen in influenza, immune damage mediated by excessive production of inflammatory mediators contributes to high incidence of complications and poor prognosis. Thus, removal or blocking the overproduction of these mediators potentially aids in reducing the deleterious cytokine storm and improving critically ill patients' outcomes. Based on previous experience of blood purification to treat cytokine storm syndrome (CSS) in severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), here we aimed to review the current literature on extracorporeal hemoperfusion as a potential therapeutic option for CSS-associated conditions, with a focus on severe COVID-19.

Effect of Preoperative Duloxetine on Opioid Consumption in Women Undergoing Abdominal Hysterectomy: A Randomized, Double-Blinded, Placebo-Controlled Trial.

BACKGROUND: Pain is one of the most challenging issues following surgery, and it is crucial to provide adequate and appropriate pain control measures. OBJECTIVES: This study assessed the efficacy of preoperative duloxetine in controlling postoperative pain in women following an abdominal hysterectomy in Yas Hospital affiliated to Tehran University of Medical Sciences between December 2019 and April 2020. METHODS: The study involved 80 women who were candidates for elective abdominal hysterectomy. The participants were randomly assigned to one of two groups. Group 1 received a 60 mg duloxetine capsule two hours before surgery. Group 2 received placebo following the same schedule. The amount of administrated opioids and the time from surgery to the administration of opioids were recorded, along with the frequency of nausea and vomiting experienced. RESULTS: Two patients from each group withdrew before the study ended. In total, 38 women in each group were assessed. There were no significant differences in age, duration of surgery, and the amount of administrated opioids between the two groups. However, the number of patients who had nausea and vomiting differed significantly between the two groups (65% vs. 34%; P = 0.006). CONCLUSIONS: Our findings showed that duloxetine was not effective in controlling pain after abdominal hysterectomy. In addition, patients who received duloxetine had a significantly higher rate of nausea/vomiting.

The Impact of Optimal Dose of Ketamine on Shivering Following Elective Abdominal Hysterectomy: A Randomised Comparative Study.

BACKGROUND: Following surgery, patients frequently suffer from shivering, and this can lead to postoperative complications and discomfort. OBJECTIVES: This study aimed to compare the effect of ketamine on patients' shivering following an elective abdominal hysterectomy. Patients were given either Ketamine (0.25 mg or 0.5 mg/kg) or a placebo. The study and surgery took place in a subspecialty University Hospital for Gynecology and Obstetrics. METHODS: This study was an interventional, randomized, controlled clinical trial. Ninety-six women who underwent elective abdominal hysterectomy were randomly assigned to three groups. Ketamine was administered to all participants 20 min prior to the end of surgery. The first group received 0.25 mg/kg of intravenous ketamine. The second group received 0.5 mg/kg intravenous ketamine. The third group received a placebo of intravenous saline. Postoperative shivering, sedation grade, hallucination, nausea, vomiting, and nystagmus were measured for each patient up to 30 minutes. RESULTS: The study showed that patients suffered from less shivering in the two groups that received ketamine. The reduced shivering was seen 5, 10, and 20 min following surgery in the two groups that were given two doses of 0.25 and 0.5 mg/kg ketamine compared to the control group (P value < 0.05). There was a significant difference between patients receiving normal saline and those having 0.25 and 0.5 mg/kg of ketamine in the rate of sedation grade, nausea, vomiting, and nystagmus (P value < 0.05). The main differences in patients receiving ketamine were the sedation grade at zero time and postoperative hallucination experienced by those patients who received 0.5 mg/kg of ketamine. CONCLUSIONS: Ketamine reduced shivering in all patients following elective abdominal hysterectomy. This was regardless of dose. Patients were less likely to suffer from hallucinations and sedation grade with a lower dose of ketamine (0.25 mg/kg compared to 0.50 mg/kg).

Comparison of Intraperitoneal Normal Saline Infusion with Pulmonary Recruitment Maneuver in Reducing Shoulder and Upper Abdomen Pain Following Gynecologic Laparoscopic Procedures: A Randomized, Controlled, Triple-Blind Trial.

OBJECTIVES: The current study aimed at evaluating the effect of intraperitoneal infusion of normal saline (NS) and pulmonary recruitment maneuver (PRM) on the reduction of pain in shoulder, upper abdomen, and incision site after elective laparoscopic gynecologic surgery. METHODS: Totally, 280 patients (mean age: 30.5 years) that underwent laparoscopic gynecologic surgery from October 2013 to August 2015 were randomly and equally allocated into four groups. Group A received intraperitoneal infusion of NS 1.5 - 2 mL/kg of body weight; group B received PRM with five manual pulmonary inflations at a maximum pressure of 60 cm H2O; group C simultaneously received two former interventions; and finally the control group D received routine method of gentle abdominal pressure. All patients were assessed in the first 24 hours after surgery. RESULTS: There was an unsteady pattern for pain in shoulder, upper abdomen, and incision site at different time points across the studied groups over the trial. Patients in group B showed significantly lower shoulder pain 24 hours after laparoscopic gynecologic surgery (P = 0.01), while patients in group D had significantly lower incision site pain (P < 0.001). CONCLUSIONS: PRM was superior to intraperitoneal infusion of NS for reducing pain in the first 24 hours after laparoscopic gynecologic surgery.