A Systematic Review of Elective Laser Therapy during Pregnancy.

Introduction: Currently, lasers are used to treat many diseases and their complications. However, the use of lasers in pregnant patients is still controversial. Methods: In this review, the application of lasers in the fields of urology, surgery, obstetrics, dermatology, and musculoskeletal disorders is evaluated. The following keywords were used to search through PubMed, Google Scholar, and Scopus: pregnancy, laser, urolithiasis, endovenous laser ablation (EVLA) or treatment, leg edema, varicose vein, venous insufficiencies, hair removal, pigmentation, telangiectasia, vascular lesions, Q switch laser, diode laser, holmium, holmium-YAG laser, erbium laser and Pulsed dye laser, low-level laser therapy, high-intensity laser therapy, pain, musculoskeletal disorders, twin to twin transfusion syndrome (TTTS), amnioreduction, and safety. Results: Totally, 147 articles were found, and their abstracts were evaluated; out of 53 articles extracted, 14 articles were about dermatology, 24 articles were about urology, 12 articles were about obstetrics and gynecology, 10 articles were about musculoskeletal disorders and three articles were related to surgery. Conclusion: Laser therapy can be used as a safe treatment for urolithiasis, skin diseases, TTTS and varicose veins of the lower extremities. However, the use of laser therapy for musculoskeletal disorders during pregnancy is not recommended due to lack of evidence, and also we cannot recommend endovenous ablation.

Comparison of the effect of the pelvic floor muscle biofeedback prior or postradical prostatectomy on urinary incontinence: A randomized controlled trial.

OBJECTIVE: This study aimed to evaluate the pre- and postoperative effects of pelvic floor muscle training (PFMT) and the biofeedback method on the management of urinary incontinence (UI) in patients who underwent radical prostatectomy (RP). MATERIAL AND METHODS: Fifty-seven patients were enrolled in this study from September 2019 to July 2020. They were randomly divided into three groups each of 19 patients: two case groups (biofeedback before and after RP) and a control group. All patients underwent RP, followed by PFMT and 24-hour pad use instructions after the postoperative removal of the Foley catheter. Then, the rate of patient-reported pads/day usage was recorded and compared among the three groups at the end of the 1st, 3rd, and 6th months of catheter removal. RESULTS: Compared with the control group (only 15%), 63 and 52% of the patients who used pre- or postoperative treatment interventions, respectively, regained urinary continence during the first postoperative period, showing significant downward rates of pads/day use (P » .01 and .001, respectively). However, the results were not significant between the two case groups. CONCLUSION: Our study revealed that applying the biofeedback method for pelvic floor muscles could be an efficient interventional approach in patients with UI, leading to the earlier regaining of continence following RP.

Extracorporeal Shockwave Therapy Combined with Drug Therapy in Chronic Pelvic Pain Syndrome : A Randomized Clinical Trial.

PURPOSE: Chronic prostatitis/ chronic pelvic pain syndrome (CP/CPPS) is a nonspecific pelvic pain in the absence of signs of infection or other obvious local pathology for at least three of the last 6 months. Evidence for treatment approach is limited. So the aim of this study is to investigate the effect of extracorporeal shock wave therapy (ESWT) combined with pharmacotherapy in the treatment of CP/CPPS. MATERIALS AND METHODS: In this randomized clinical  trial, 31 patients with CP/CPPS were investigated in two groups: the intervention group (n=16) was treated with a combination of an alpha-blocker, an anti-inflammatory agent, a muscle relaxant and a short course of antibiotic in combination with 4 sessions of focused ESWT (a protocol of 3000 impulses, 0.25 mJ/mm2  and 3 Hz of frequency). The control group (n=15) received the aforementioned pharmacotherapy with 4 sessions of sham-ESWT . Follow-up was performed 4 and 12 weeks following ESWT by using the Visual Analogue Scale (VAS), International index of Erectile function (IIEF) 5, National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI) and International Prostate Symptom Score (IPSS) questionnaires. Post void residual (PVR) urine and maximum flow rate (Qmax) were also assessed in both groups. RESULTS: The patients mean age was 43.7 ±12.6 years. In both groups, the mean scores of NIH-CPSI (total and sub-domains) and VAS showed statistically significant improvements after 4 and 12 weeks compared to the baseline (P < .001). In the intervention group, IPSS (mean difference: 4.25) and Qmax (mean difference: 2.22) were also significantly improved (P < .001).  There was a significant improvement in NIH-CPSI (mean difference: 1.1) and VAS scores (mean difference: 1.1) in the intervention group as compared to the control group (P < .01). Qmax, PVR and IIEF score were not statistically different in the two groups. CONCLUSION: ESWT in combination with pharmacotherapy could improve the treatment outcome in patients with CP/CPPS.

Laser Therapy for Peyronie's Disease: A Randomized Control Double-Blind Pilot Study.

Introduction: The management of Peyronie's disease (PD) has remained a therapeutic dilemma for physicians and there is no gold standard treatment. In this paper, we decided to investigate the beneficial effect of the intralesional administration of verapamil compared with the intralesional administration of verapamil plus a low-intensity laser (LIL). Methods: Research was activated from May 2016 to May 2018 and a total of 38 men aged 18 years and older completed the investigation. The subjects were randomly divided into 2 groups. Group 1 was composed of 22 patients that were treated only by verapamil (5 mg) plus a sham laser weekly for 6 weeks, and group 2 consisted of 22 patients that received a laser, using the BTL-6000 HIGH-INTENSITY LASER 12 W machine and the same protocol of intralesional verapamil injection. The visual analogue scale (VAS) was used to evaluate pain during an erection, penile ultrasonography was used to measure plaque size, the penile curvature angle degree was measured using the photographs taken during an erection, and the International Index of Erectile Function questionnaire was used to assess erectile function. The follow-up treatment lasted for nine months, with visits performed in the 3rd and 9th months. Results: All study parameters decreased significantly after treatment in both arms, but the reduction in pain and penile curvature improvements in combination therapy revealed more significant changes in 3 months (p = .035, p=.032). Nevertheless, these improvements were not seen in the follow-up session after 9 months. Conclusion: A laser appears to be safe treatment modality in carefully-selected patients with PD. It has moderate efficacy in the short term.

Enhanced external counterpulsation in rehabilitation of erectile dysfunction: a narrative literature review.

BACKGROUND: Enhanced external counterpulsation (EECP) is a noninvasive treatment option widely applied in patients with erectile dysfunction (ED). The aim of this study is to review the efficacy of EECP in patients suffering from ED. METHODS: PubMed, MEDLINE, Google Scholar, Tripdatabase, Scopus, and Cochrane library databases were searched for articles with the following search terms: enhanced external counterpulsation and erectile dysfunction. No restrictions with respect to study setting, date of publication, and language were imposed. RESULTS: From an initial set of 208 records, 4 studies were selected after a final review. A total of 177 patients with a mean age of 59.98 years were included in these studies, with 20-35 hours per week of EECP treatment. Three studies used the International Index of Erectile Function questionnaire and one applied a four-item questionnaire and a peak systolic flow measurement. All of these parameters were significantly improved after the EECP treatment. CONCLUSION: To the best of our knowledge, this is the first study reviewing the clinical effectiveness of EECP in patients with ED. According to the articles reviewed in this study, an improvement in erectile function after EECP treatment courses has been observed in patients with and without coronary artery disease without any significant adverse effects.

The ESO Diffuse Interstellar Bands Large Exploration Survey: EDIBLES I. Project description, survey sample and quality assessment.

The carriers of the diffuse interstellar bands (DIBs) are largely unidentified molecules ubiquitously present in the interstellar medium (ISM). After decades of study, two strong and possibly three weak near-infrared DIBs have recently been attributed to the [Formula: see text] fullerene based on observational and laboratory measurements. There is great promise for the identification of the over 400 other known DIBs, as this result could provide chemical hints towards other possible carriers. In an effort to systematically study the properties of the DIB carriers, we have initiated a new large-scale observational survey: the ESO Diffuse Interstellar Bands Large Exploration Survey (EDIBLES). The main objective is to build on and extend existing DIB surveys to make a major step forward in characterising the physical and chemical conditions for a statistically significant sample of interstellar lines-of-sight, with the goal to reverse-engineer key molecular properties of the DIB carriers. EDIBLES is a filler Large Programme using the Ultraviolet and Visual Echelle Spectrograph at the Very Large Telescope at Paranal, Chile. It is designed to provide an observationally unbiased view of the presence and behaviour of the DIBs towards early-spectral type stars whose lines-of-sight probe the diffuse-to-translucent ISM. Such a complete dataset will provide a deep census of the atomic and molecular content, physical conditions, chemical abundances and elemental depletion levels for each sightline. Achieving these goals requires a homogeneous set of high-quality data in terms of resolution (R ~ 70 000 - 100 000), sensitivity (S/N up to 1000 per resolution element), and spectral coverage (305-1042 nm), as well as a large sample size (100+ sightlines). In this first paper the goals, objectives and methodology of the EDIBLES programme are described and an initial assessment of the data is provided.

Knowledge of reproductive physiology and hormone therapy in 40-60 year old women: a population-based study in Yazd, Iran.

UNLABELLED: Background : Evidences shows that menopause affects women's health, but women's knowledge of proper care and maintenance is insufficient. OBJECTIVE: To determine knowledge of hormone therapy (HT), reproductive physiology, and menopause in a population of 40-60 year old women. MATERIALS AND METHODS: This cross-sectional study was conducted through a cluster sampling among 330 women in Yazd, Islamic Republic of Iran, in 2010. Data was collected using a questionnaire containing questions about reproductive physiology related to menopause and HT by interviewing. Inferential and descriptive statistics via SPSS.15 software were used for data analysis. RESULTS: Overall, 2.1% of women were current takers of HT, 13.4% had taken it in the past but had stopped and 84.5% had never taken hormone replacement therapy. Iranian women had low knowledge of HT, reproductive physiology, and menopause. Most of the women (85.5%) knew that hot flashes are common around menopause and only 77.2% knew decreasing estrogen production causes the menopause. They knew little about the effects of progestagens and the effects of HT on fertility. Logistic regression determined that age, educational level and BMI were the most important factors predicting use of HT after adjusting for other variables. CONCLUSION: Iranian women have a low HT usage rate and the majority of them are lacking of the knowledge about HT and menopause. Women need improved knowledge of the risks and benefits of HT as well as education about the reproductive system around menopause.

Screening of donated whole globes for photorefractive keratectomy.

PURPOSE: To introduce a screening method for diagnosis of photorefractive keratectomy (PRK) in donated whole globes. METHODS: Donated whole globes with either no or an unknown history of refractive surgery on family interview were evaluated in the Central Eye Bank of Iran. After disinfection of globes by immersion in 3% povidone iodine for 3 minutes, followed by irrigation with 0.9% normal saline, gross inspection and slit-lamp biomicroscopic examination of the corneas were performed. Corneas with a disciform, round-shaped hazy area within the central 8 mm of the cornea, suggestive of previous PRK (case), and corneas without this criterion (control) were excised and sent for histopathology. Then, sensitivity and specificity of the screening method were calculated by analyzing the histopathology results of case and control corneas. RESULTS: Twelve thousand five hundred fifty-four donated whole globes from 6832 donors were examined. Twenty case corneas from 10 donors and 54 controls from 27 donors were evaluated by histopathology. Age and sex of the donor population in both case and control groups were comparable with the entire donor population. PRK was confirmed by histopathology in all 20 case corneas but not in any of the control corneas. Both the sensitivity and specificity of this screening method were 100%. CONCLUSIONS: Gross inspection of donated whole globes after exposure to povidone iodine followed by slit-lamp biomicroscopic examination, with particular attention to finding a midperipheral-to-midperipheral disciform hazy area within the central 8 mm of cornea, is a safe, simple, and inexpensive screening method, with high sensitivity and specificity for diagnosing PRK.

Concordance between clinical and histopathologic diagnosis in recipient corneas.

PURPOSE: To specify a concordance rate between the preoperative clinical and the postoperative histopathologic diagnosis in recipient corneas referred to the pathology department of Central Eye Bank of Iran. METHODS: Concordance and discrepancy between the preoperative clinical and postoperative histopathologic diagnosis of recipient corneal buttons were evaluated. RESULTS: Overall, 340 corneal specimens were evaluated. The total concordance rate between the clinical and histopathologic diagnoses was 97.5%. The concordance rate in keratoconus, nonspecific scar and opacity, mustard gas keratopathy, combined keratoconus and dystrophy, postkeratorefractive keratectasia, and chemical burns was 100%. Discordant cases were observed in acquired corneal endothelial decompensation, corneal dystrophies, infectious keratitis, and miscellaneous causes, with the rate of 6.0%, 4.1%, 2.8%, and 16.6%, respectively. CONCLUSIONS: Our series demonstrated a significantly high concordance between the preoperative clinical and the postoperative histopathologic diagnosis in recipient corneas with different types of corneal disorders.

Chronic and delayed mustard gas keratopathy: a histopathologic and immunohistochemical study.

PURPOSE: To specify histopathologic and immunohistochemical features of chronic and delayed mustard gas keratopathy. METHODS: Corneal buttons from patients with chronic and delayed mustard gas keratopathy were examined for routine histopathology, special histologic stainings, and immunohistochemistry for CD31 and CD68. RESULTS: Twenty-five corneal buttons from 25 patients with chronic and delayed mustard gas keratopathy were evaluated. Irregular epithelial thickness (100%), degenerative changes (24) (96%), thickened epithelial basement membrane (23) (92%), keratocytes loss (18) (72%), and destroyed Bowman layer (18) (72%) were predominant histopathologic features. Amyloid degeneration was the most commonly observed degenerative change in the specimens (83%). Immunoreactivity for CD68 and CD31 was detected in 88% and 56%, respectively. CONCLUSIONS: In this observational case series, although all corneal layers from epithelium to the endothelium were involved from mild to severe degrees, the anterior corneal layers were more affected on histopathology than the posterior parts in chronic and delayed mustard gas keratopathy.

Meesmann corneal dystrophy; a clinico-pathologic, ultrastructural and confocal scan report.

PURPOSE: To report the microstructural features of Meesmann corneal dystrophy (MCD) in two patients. CASE REPORT: The first patient was a 10-year-old boy who presented with bilateral visual loss, diffuse corneal epithelial microcystic changes, high myopia and amblyopia. With a clinical impression of MCD, automated lamellar therapeutic keratoplasty was performed in his left eye. Histopathologic examination of the corneal button disclosed epithelial cell swelling and cyst-like intracytoplasmic inclusions. The cells contained moderate amounts of periodic acid-Schiff-positive and diastase-sensitive material (glycogen). Transmission electron microscopy revealed numerous vacuoles and moderate numbers of electron-dense membrane-bound bodies in the cytoplasm, similar to lysosomes, some engulfed by the vacuoles. The second patient was a 17-year-old female with a clinical diagnosis of MCD and episodes of recurrent corneal erosion. On confocal scan examination of both corneas, hyporeflective round-shaped areas measuring 6.8 to 41.4 µm were seen within the superficial epithelium together with irregular and ill-defined high-contrast areas in the sub-basal epithelial region. The subepithelial nervous plexus was not visible due to regional hyperreflectivity. CONCLUSION: This case report further adds to the microstructural features of Meesmann corneal dystrophy and suggests confocal scan as a non-invasive method for delineating the microstructural appearance of this rare dystrophy.

Comparison of keratocyte density between keratoconus, post-laser in situ keratomileusis keratectasia, and uncomplicated post-laser in situ keratomileusis cases. A confocal scan study.

PURPOSE: To compare keratocyte density in corneal stromal layers in keratoconus, post-laser in situ keratomileusis (LASIK) keratectasia, uncomplicated post-LASIK cases, and normal unoperated corneas by confocal scan. METHODS: Thirty-one unscarred corneas from 22 patients with keratoconus, 24 clear corneas from 17 cases with post-LASIK keratectasia, 12 corneas from 7 uncomplicated post-LASIK cases, and 26 corneas from 13 normal unoperated cases were evaluated by using confocal scan. None of the cases were contact lens wearers. Keratocyte densities were determined in 3 stromal layers in each cornea and compared with densities in the corresponding layers of normal unoperated corneas. Cell densities in different corneal layers were also compared in each group. RESULTS: In overall, 93 eyes from 59 patients with mean age of 30 +/- 7.3 years were enrolled. There was no difference in mean keratocyte density at 3 stromal layers between keratoconic and normal unoperated corneas. In post-LASIK keratectasia, keratocyte density in the anterior and posterior stromal layers was significantly lower than that in normal unoperated group. In uncomplicated post-LASIK cases, the keratocyte density at 3 stromal layers was lower than that in normal unoperated group. No difference in keratocyte density was found between post-LASIK keratectasia and uncomplicated post-LASIK cases. Furthermore, in post-LASIK keratectasia, there was a meaningful difference in keratocyte density between the anterior and posterior and between the middle and posterior stromal layers; such a difference was not observed in the uncomplicated post-LASIK cases. CONCLUSIONS: Mean keratocyte density in post-LASIK keratectasia and uncomplicated post-LASIK cases was lower than that in normal unoperated group. Given the different distribution of keratocytes between the stromal layers in the 2 LASIK groups, there was a nonhomogenous distribution of keratocytes in stromal layers in post-LASIK keratectasia. A homogenous distribution of keratocytes in uncomplicated post-LASIK cases may be a factor in prevention of corneal ectasia.