Coronavirus Disease 2019 (COVID-19) and Pregnancy: A Narrative Review.

A novel viral respiratory disease caused by severe acute respiratory syndrome, coronavirus 2 (SARS-COV-2), is responsible for a pandemic situation in the world. Pregnant women are susceptible to this virus due to physiologic changes in the immunologic system. The risk of some adverse pregnancy outcomes, such as death, stillbirth, preeclampsia, and intrauterine fetal distress, may increase in infected pregnant women. Infected women should be isolated and investigated, and they should admit to a designated hospital with adequate facilities and multi-disciplinary expertise to manage them. Furthermore, the chances of adverse neonatal complications, such as small for gestational age, large for gestational age, shortness of breath, thrombocytopenia with abnormal liver function, rapid heart rate, vomiting, and pneumothorax, may increase in an affected neonate. This study reviews the problems and guidelines of covid-19 in pregnancy.

ß-Thalassemia Major and Coronavirus-19, Mortality and Morbidity: a Systematic Review Study.

ß-Thalassemia (ß-thal) is one of the most common inherited diseases all over the world. These patients are very susceptible to infection disease, and the mortality and morbidity of infected patients will increase. The object of this systematic review study was to determine mortality and morbidity of infected ß-thal patients with coronavirus disease 2019 (COVID-19). We searched PubMed, Elsevier, and Scholar Google to obtain related papers. The time of search was 21 June until 17 July 2020. All original and review articles and case reports were searched with key words: COVID 19, beta or ß-thalassemia (ß-thal), mortality and morbidity. Data were extracted after quality assessment of all articles. We obtained seven, 21 and six articles from PubMed, Scholar Google and Science Direct, respectively. Finally, seven articles were discussed in our study. The total number of enrolled patients was 34. Twenty-six patients carried transfusion-dependent ß-thal major (ß-TM). The most common symptoms were fever, cough, pain and dyspnea. Nine patients died. The result of this study has shown that the mortality and morbidity of infected ß-thal patients will escalate.

High prevalence of OXA-type carbapenemases among Acinetobacter baumannii strains in a teaching hospital of Tehran.

Nosocomial infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has created a public health concern all around the world. In this study, 100 isolates of CRAB from hospitalized patients during 2015-2016 at Imam Khomeini Hospital were investigated to determine the rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains using Kirby-Bauer disk diffusion method. The minimum inhibitory concentrations (MICs) of six antibiotics were determined by broth microdilution method. Multiplex polymerase chain reaction (PCR) was performed to detect blaOXA-51 like and blaOXA-58 like, blaOXA-23 like, and blaOXA-24 like that are encoding resistance to carbapenems. All CRAB isolates were MDR and XDR and 2% of them were pandrug-resistant (PDR), whereas colistin, polymyxin B, and tigecycline were the most effective agents. All isolates were positive for blaOXA-51 like by PCR. The frequency of blaOXA-23 like and blaOXA-24 like was 81% and 22%, respectively. Findings of this study showed that very few therapeutic options remained for the treatment of CRAB infections and blaOXA-23 like is a dominant resistance gene in CRAB at this hospital.

Non-invasive prenatal diagnosis of ß-thalassemia by detection of the cell-free fetal DNA in maternal circulation: a systematic review and meta-analysis.

The discovery of fetal DNA (f-DNA) opens the possibility of early non-invasive procedure for detection of paternally inherited mutation of beta-thalassemia. Since 2002, some studies have examined the sensitivity and specificity of this method for detection of paternally inherited mutation of thalassemia in pregnant women at risk of having affected babies. We conducted a systematic review of published articles that evaluated using this method for early detection of paternally inherited mutation in maternal plasma. A sensitive search of multiple databases was done in which nine studies met our inclusion criteria. The sensitivity and specificity was 99 and 99 %, respectively. The current study found that detection of paternally inherited mutation of thalassemia using analysis of cell-free fetal DNA is highly accurate. This method could replace conventional and invasive methods.

High-resolution melting analysis for noninvasive prenatal diagnosis of IVS-II-I (G-A) fetal DNA in minor beta-thalassemia mothers.

OBJECTIVES: The high-resolution melting (HRM) technique is fast, effective and successful method for mutation detection. The aim of this study was to determine the sensitivity and specificity of the HRM method for detection of a paternally inherited mutation in a fetus as a noninvasive prenatal diagnosis of ß-thalassemia. METHODS: Genomic DNAs were prepared from 50 ß-thalassemia minor couples whose pregnancy was at risk for homozygous ß-thalassemia. Ten milliliters of the maternal blood from each pregnant woman were collected and after separating plasma stored at -80 °C until analysis. The extracted DNAs were analyzed by HRM real-time PCR for detection of IVS-II-I (G-A) as a paternally inherited mutation. The gold standard was the result of a chorionic villus sampling by a standard reverse dot blotting test. RESULTS: The sensitivity and specificity of HRM real-time PCR were 92.6% and 82.6%, respectively. Also, the positive and negative predictive values were 86.2% and 90.47%, respectively. CONCLUSIONS: HRM real-time PCR was a sensitive and specific method for determining the paternally inherited mutation in the fetus at risk with thalassemia major.

Which pamidronate protocol is the best for treating osteoporosis in beta-thalassemia major?

One of the most common complications in thalassemia major patients is osteopenia and osteoporosis. In this study, we compare the therapeutic effect of two treatment protocols involving infusion of 45 mg of pamidronate injection every 6 weeks (P45) and 90 mg pamidronate infusion every 4 weeks (P90). Bone mineral density was measured using dual energy X-ray absorptiometry (DEXA). Z-score of lumbar vertebra (as L total) and the femoral head (as F total) were compared before and after administration of two protocols. Bone density between the two groups was compared by Student t test and by the paired t test before and after the intervention. Data were analyzed using SPSS (18). Ninety-one patients were treated with pamidronate 45 mg (P45), and 36 patients were treated with pamidronate 90 mg (P90). Ninety-one and 36 patients received P45 and P90 protocol, respectively. Mean age was 29.4 ± 8.1 and 30.9 ± 8.0 years old in P45 and P90 groups, respectively. Sixty-two and 58 % of P45 and P90 group were female. The means of F total were -1.73 ± 1.11 and -1.47 ± 0.92 before and after treatment in patients P45 (P = 0.01) and were -1.83 ± 0.75 and -1.57 ± 0.99 in group P90 (P = 0.005), respectively. Before treatment, the means of L total were -2.95 ± 0.81 and -2.92 ± 0.66 (P = 0.8) and after treatment were -2.53 ± 1.13 and 2.81 ± 0.98 (P = 0.1) in P45 and P90 groups, respectively. In P45, between the mean of L total was statistically significant difference before and after treatment (P < 0.0001); however, there was no significant difference in the P90 group (P = 0.3). The study showed effectiveness of both protocols. As the medication is expensive and should be administrated parenterally, we recommend P45 protocol which is less expensive with fewer injections.

Crack abuse during pregnancy: maternal, fetal and neonatal complication.

OBJECTIVE: The aim of this study was to assess the effects of crack on pregnancy outcomes. METHODS: We studied 88 crack user pregnant women in this study. These women were matched to a drug-free group (n = 90) chosen from the population of the same hospital. Maternal outcomes including preeclampsia, placenta abruption, gestational diabetes and preterm labor, and neonatal complication including low birth weight and low Apgar score in 5 min were compared in crack using and drug-free groups. Data were analyzed by SPSS software. Chi-square test and Student's t-test and Relative Risks (RRs) were used in this study. RESULTS: The results of our study showed that crack abuse during pregnancy was associated with higher rate of preeclampsia p = 0.003 (RR, 1.731; 95% CI, 1.777-2.545), placental abruption p = 0.001 (RR, 2.439; 95% CI, 1.369-4.343), preterm labor p < 0.000 (RR, 3.249; 95% CI, 2.053-5.141) and low birth weight p < 0.000 (RR, 2.179; 95% CI, 1.462-3.247). CONCLUSIONS: Crack abuse had significant influence on pregnancy outcomes. Crack appears to influence the prevalence of low birth weight, preterm labor, preeclampsia and placental abruption.

Marriage and child bearing in patients with transfusion-dependent thalassemia major.

AIM: With good care, patients with transfusion-dependent thalassemia major (TDTM) can reach older ages, marry and reproduce. This study was conducted by the Thalassemia Research Center. MATERIAL AND METHODS: Medical notes of all TDTM patients and all non-transfusion-dependent thalassemia major (NTDTM) patients were reviewed from July to December 2012. Also, patients were interviewed. The questionnaire was made in consultation with research methodology experts and reliability was achieved by a pilot study of 12 patients, by the test-retest method (r = 0.9). Epidemiologic characteristics of patients and the pregnancy outcomes were recorded. Descriptive statistics were used with SPSS 17. RESULTS: Four hundred and nineteen medical records were reviewed. Three hundred and forty-five (82.5%) were TDTM. One hundred and seventy-five (50.7%) were female with a mean age of 25.4 ± 7.05 years and 42 (25%) had been married. Mean age of menarche and marriage was 15.4 ± 1.6 and 21.8 ± 4.5 years, respectively. Total number of live children is nine so far. Mode of delivery in female patients was cesarean section. Almost 78% of newborns weighed 2500-4000 g. Almost 22% of pregnancies were assisted. Male patients consisted of 170 (49.3%) and 55 (32.3%) of them had been married. Mean age at marriage was 24.27 ± 3.5 years. CONCLUSIONS: With better management, patients with TDTM can reach the age of reproduction. Medical teams should be prepared for this possibility.

The effect and side effect of hydroxyurea therapy on patients with ß-thalassemia: a systematic review to December 2012.

Hydroxyurea (HU) is being used for patients with transfusion-dependent ß-thalassemia major (ß-TM) as well as non transfusion-dependent ß-TM. As controversy exists regarding efficacy and safety of HU, we searched the published literature on efficacy, effectiveness and toxicity of HU in patients with ß-TM. The research sources we used were: Medline, SID, PubMed, Scopus, Request, Web of Knowledge, Springer, Ovid, Cochrane searched up to October 2012. Using search terms sensitive to studies of clinical trials combined with searches on terms related to thalassemia and HU. We selected studies on randomized trials, quasi experimental trials (before and after design), case reports (with 1-5 cases), side effect studies in patients with ß-TM, studies related to the mechanism of action and toxicity when used in patients with other hemoglobinopathies. We researched studies in English and Persian. Eligible articles were reviewed by two independent reviewers. Patient's characteristics, duration of trial, outcome and side effects were extracted. The main outcomes were synthesized under a random-effects model. Heterogeneity was assessed using the Q statistic, Tau(2) and I(2). Subgroup analyses were performed and the statistics data (STATA) software used. More than 500 articles were reviewed. No randomized clinical trial was found. Seventeen trials with before and after designs were found, 16 case reports (1-5 cases), 19 articles for mechanism of action and 16 studies for side effects were published from 1969 to October 2012. Hemoglobin levels after treatment showed modest but significant increase in non transfusion-dependent ß-TM (p < 0.0001) and in transfusion-dependent ß-TM (p < 0.0001).

Report on patients with non transfusion-dependent ß-thalassemia major being treated with hydroxyurea attending the Thalassemia Research Center, Sari, Mazandaran Province, Islamic Republic of Iran in 2013.

Hydroxyurea (HU) has been used to treat patients with non transfusion-dependent ß-thalassemia major (ß-TM) at the Thalassemia Research Center, Sari, Mazandaran Province, Islamic Republic of Iran since 1996. This study was performed to summarize and to share our experience. Medical records of all patients with ß-thalassemia (ß-thal) attending our center were reviewed in January 2013. Definition of ß-TM was based on complete blood count (CBC), hemoglobin (Hb) electrophoresis, and for some patients, by the amplification refractory mutation system-restriction fragment length polymorphism (ARMS-RFLP) method. Patients who had not been transfused before, or had only occasionally had blood transfusions, were selected. Age at first blood transfusion, initial HU therapy and time of study was extracted from the records. The lowest Hb level before using HU and the last Hb value when on the HU regimen as well as the difference, were reported. Number of saved packed red cells was calculated according to duration of HU use and the usual needs of the patients. Hydroxyurea was discontinued before a planned pregnancy and during gestation and lactation periods. Hydroxyurea was discontinued for male patients willing to reproduce. A p value of <0.05 was considered statistically significant. It was consistent with 1856 patients/year, and 3542 units of blood were saved. We found HU to be effective and safe in treating patients with non transfusion-dependent ß-TM. We strongly recommend HU therapy.

Comparing the effect of topical application of human milk and dry cord care on umbilical cord separation time in healthy newborn infants.

OBJECTIVE: Comparing the effect of topical human milk application and dry cord care on cord separation time. METHODS: This research was a randomized clinical trial study on 130 singleton and mature newborns. Newborns were placed randomly in groups of topical application of human milk and dry cord care. The umbilical separation time was compared in the two groups. Data was analyzed by SPSS software. Independent Samples t-Test, χ(2), Fisher were used in this study. FINDINGS: Median time of cord separation in human milk application group (150.95±28.68 hours) was significantly shorter than dry cord care group (180.93±37.42 hours) (P<0.001). CONCLUSION: Topical application of human milk on the remaining part of the cord reduces the cord separation time and it can be used as an easy, cheap and non invasive way for cord care.

Biocompatibility evaluation of a new hydrogel dressing based on polyvinylpyrrolidone/polyethylene glycol.

The composition of the dressings is based on polyvinylpyrrolidone (PVP), polyethylene glycol (PEG), and agar. The electron beam irradiation technique has been used to prepare hydrogel wound dressings. The in vitro biocompatibility of the hydrogel was investigated by check samples (hydrocolloid Comfeel), antibacterial test (Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia Coli k12), anti fungal test (Candida Albicans) and cytotoxicity test (Fibroblast L929). Results have shown cell attachment characteristics and nontoxicity of all samples. Antibacterial testing also showed that the antibacterial effect of the hydrogel sample to the check sample increased to 30%. Also, investigation of antifungal analysis did not show any trace of fungi growth on the surface of the hydrogel, whereas antifungal effect did not observe on the surface of the check sample. Finally, this hydrogel sample showed a good in vitro biocompatibility.

Nanotoxicology and nanoparticle safety in biomedical designs.

Nanotechnology has wide applications in many fields, especially in the biological sciences and medicine. Nanomaterials are applied as coating materials or in treatment and diagnosis. Nanoparticles such as titania, zirconia, silver, diamonds, iron oxides, carbon nanotubes, and biodegradable polymers have been studied in diagnosis and treatment. Many of these nanoparticles may have toxic effects on cells. Many factors such as size, inherent properties, and surface chemistry may cause nanoparticle toxicity. There are methods for improving the performance and reducing toxicity of nanoparticles in medical design, such as biocompatible coating materials or biodegradable/biocompatible nanoparticles. Most metal oxide nanoparticles show toxic effects, but no toxic effects have been observed with biocompatible coatings. Biodegradable nanoparticles are also used in the efficient design of medical materials, which will be reviewed in this article.

High maternal hemoglobin concentration in first trimester as risk factor for pregnancy induced hypertension.

BACKGROUND: High maternal hemoglobin (Hb) concentration was considered a risk factor for the developing of pregnancy hypertension. The purpose of this study was to determine whether high maternal Hb concentration in first trimesters associated with pregnancy induced hypertension in Iranian nulliparous women. METHODS: This study was carried out in teaching hospital in Sari, Iran. Samples were obtained from 1008 women who were almost on their 14(th) week pregnancy and were admitted to prenatal clinic of this hospital from October 2008 to December 2009. Their blood pressure was normal. After measuring Hb at first visit, they were divided into groups (11≤Hb<13.2 and Hb≥13.2). Pregnancy induced hypertension in these groups were compared. RESULTS: In normal Hb group, 14(2.75%) women had hypertension and in high Hb group, 21(4.2%) had hypertension (p=0.045). High hemoglobin concentration in the first trimester showed a risk factor for pregnancy induced hypertension (OR= 2.462; 95% CI, 1-6.9). CONCLUSION: The results showed that women with high hemoglobin concentration in the first trimester carried an increased risk of pregnancy induced hypertension.

Comparison of the effect of fish oil and ibuprofen on treatment of severe pain in primary dysmenorrhea.

UNLABELLED: Background : Primary dysmenorrhea is common among young girls and child-bearing women. The purpose of this study was to compare the efficacy of fish oil and Ibuprofen on the treatment of primary dysmenorrhea. METHODS: This clinical trial study was done on students of Babol University of Medical Sciences in 2010. One hundred- twenty students who had moderate and severe dysmenorrhea were randomly divided in two groups. The first group (0 girls) received 1000 mg/day fish oil capsule in all her cycle days and the second group received mg ibuprofen when their pain started (duration of this study was months). Student t-test, Mann Whitney and Freidman tests were used when appropriate. This clinical trial was registered in the Iranian Registry of clinical Trials (www.IRCT.Ir) (IR21101133004N4). RESULTS: There was a significant difference between the intensity of pain before and after treatment by ibuprofen (p=1) and fish oil (p=1). Furthermore, the reduction of pain in fish oil recipient was higher than the IBV prefer group (p=0001). CONCLUSION: The results show that the efficacy of fish oil is better than ibuprofen on treatment of severe pain in primary dysmenorrhea.