Journal of Advances in Medical and Biomedical Research
Volume:28 Issue: 131, Nove Dec 2020

Coronavirus disease (COVID-19) can induce coagulopathy at the base of sepsis-induced coagulopathy (SIC), which is an important cause of death in these patients. Cytokine storm causes imbalance in coagulation and fibrinolytic system. A combination of hypercoagulability state, decrease or inhibition of fibrinolysis and endotheliopathy causes thromboembolic events. Underlying diseases such as diabetes and hypertension with a high rate of mortality in COVID-19 and some conditions like aging and obesity are the main disorders with hemostatic disturbance and increase of coagulopathy. Therefore, it seems that the combination of COVID-19 infection and these risk factors increase the risk of thromboembolic complications all together.

From the first reported case of Coronavirus disease 2019 (COVID-19) on December 30, 2019 in Wuhan, China, the number of confirmed cases of the disease has been increased continuously and exponentially up to now. The event has emerged as a clear threat to global health such that the World Health Organization (WHO) officially declared the outbreak of the disease a pandemic on March 11, 2020. The disease has infected approximately 195,000 people and killed about 7,700 in the Eastern Mediterranean Region. As COVID-19 is spreading globally, its economic consequences also mounting across all countries. This perspective research designed to examine briefly the economic consequences of COVID-19 on the Middle East and North Africa (MENA) Region Countries.

 Sildenafil citrate is a potential new strategy for the management of intrauterine growth restriction (IUGR) and preeclampsia, although its efficacy still needs to be approved. Accordingly, the aim of this study was to systematically assess the effectiveness of sildenafil on improving fetal Doppler indices, as well as the most common adverse effects of sildenafil. 

 Online databases, i.e., PubMed, Web of Science, Scopus, Embase, and Cochrane Reviews, were searched from their date of creation up to 26 Jan 2019. We conducted two meta-analyses, one for fetal Doppler indices and the other for adverse events of sildenafil. Eligible studies were randomized controlled trials (RCTs), in which the effects of sildenafil on fetal Doppler indices have been evaluated. The quality of studies was appraised through the five components of the Cochrane checklist (for quality appraisal of RCT studies) by two of the authors.

 Out of 1,087 reviewed sources, seven studies were included for meta-analysis. The following results were observed for the effect of sildenafil on the umbilical artery (UA): A significant effect on the umbilical artery pulsatility index (UA PI) (P=0.03) was observed in dosages more than 60 mg/d (P=0.008). Sildenafil was effective in UA PI of the individuals suffering from eclampsia (P=0.008); however, no significant effect was observed on IUGR disorder. Furthermore, sildenafil had no effect on the umbilical artery systolic/diastolic (UA S/D) ratio. Sildenafil was not effective on the middle cerebral artery pulsatility index (MCA PI) or on the middle cerebral artery systolic/diastolic (MCA S/D) ratio. Regarding adverse events, headaches occurred significantly more in mothers consuming sildenafil (P=0.03). 

 Obviously, we need more accurate RCTs in this issue before any decision can be made.

 Based on the cultural and structural boundaries in Iran in terms of the presence of doulas through the delivery, the importance of making the delivery more desirable for mothers, and since few important studies have been conducted on this topic in Iran, this study evaluated the effects of the presence of a doula on anxiety and pain in pregnant women during delivery.

 This randomized clinical trial was conducted on 80 pregnant women referred to Ayatollah Musavi Hospital (Zanjan, Iran) in 2016. For women in the intervention group, the doula provided emotional and physical support. The motherschr('39') pain severity and anxiety were measured by using a visual analog scale (VAS) and Spielberger questionnaire, respectively. Categorical and continuous variables were compared using chi-square and t tests, respectively.

 We found that a higher proportion of patients had experienced mild anxiety about entering the postpartum period (47.5% vs 15%) and exiting it (80% vs 40%; P<0.05) compared to the control group.  Also, the mean VAS score was significantly higher in the control group at 4-5 cm (86.5±11.39 vs 78.62±14.0; P=0.007) and 7-8 cm of cervical dilatation (99.0±4.41 vs 95.0±8.47; P=0.01) stages.

 The presence of a trained doula during labor can ease the mental consequences of delivery and decrease womenchr('39')s anxiety and pain during labor.

 It has been postulated that depressed individuals with low total cholesterol levels may be more likely to die prematurely from suicide. This study aimed to examine the association between low serum cholesterol and suicide in depressed attempters.

 In this cross-sectional study, 180 suicide attempters, who met the inclusion criteria and were willing to participate in the study, were recruited in 2017. The data was collected using a demographic questionnaire and the Beck Depression Inventory-Second Edition (BDI-II). The blood cholesterol level was measured via an auto-analyzer.

 The mean age was 26.39±10.75 years. The average cholesterol level in the moderate, severe, and serious depression groups was 151.30±35.23, 145.89±36.32, and 145.15±33.33, respectively. The mean age was higher in the group with a higher depression level, though the difference was not significant (P=0.06). The percentage of suicide attempts in single individuals was significantly higher (P=0.02). The mean cholesterol level in the group with the highest level of depression was the lowest, but the difference was insignificant (r=-.01, P=0.85). Only in females, the level of blood cholesterol showed a nearly significant difference between groups with different severities of depression (P=0.05). Cholesterol had a significant correlation with suicide frequency (P=0.008, r=0.28).

 Our results revealed no significant association between low serum cholesterol and suicide in attempters with depression; but low total serum cholesterol may be associated with depression and suicide in depressed subjects. Yet, more studies are required for verification of this causality.

 The blink reflex recovery cycle indicates the excitability of interneurons in the brainstem. In this study, we aimed to investigate the blink reflex and R2 recovery cycle in patients with benign essential blepharospasm (BEB).

 This prospective case-control study compared the blink reflex and R2 recovery in 18 BEB patients with 18 age- and gender-matched healthy individuals. The blink reflex was measured in a stimulation duration of 0.2 ms, and R1, R2, and R2’ were recorded for all subjects. The R2 recovery cycle was measured by stimulation of the supraorbital nerve at four interstimulus intervals (ISI) of 200, 300, 500, and 1000 ms, with the same intensity as the previous test. The R2 recovery index was calculated and compared with the control group via independent sample t-test. Two-tailed P-value less than 0.05 was considered statistically significant.

 The blink reflex (R1, R2, and R2’ responses) distal latencies and amplitudes in the BEB group were not significantly different from the control group (P>0.05). The R2 recovery index in all intervals was significantly higher in the BEB group than the control group (P=0.00). The most significant difference between the BEB and control groups regarding the R2 recovery indices was observed at ISIs of 300 and 200 ms (80.36 vs. 16.99 and 75.70 vs. 12.57, respectively). There was a negative correlation between the patient’s age at the onset of disease and the R2 recovery index; however, it was not statistically significant (P>0.05).

 Our findings showed that the R2 recovery reflex was higher in BEB patients than the normal population. Therefore, it can be a helpful index for differentiating BEB cases from psychogenic or malingering ones.

 Fatigue is defined as a feeling of disability and weakness that leads to a reduction in the capacity of individuals to do their job and daily activities. Sleep disorders are one of the most important causes of fatigue in nurses. The present study aimed to determine the level of occupational fatigue and sleep quality among nurses working in various wards of public hospitals.

 This cross-sectional study was conducted on 234 nurses working in diverse wards of the two public hospitals affiliated to Ilam University of Medical Sciences, Iran selected by the convenience sampling method. The data were collected using a demographic questionnaire, Occupational Fatigue Exhaustion Recovery scale, and Pittsburgh Sleep Quality Index. Finally, the data were analyzed by descriptive statistics, independent t-test, and one-way analysis of variance using the SPSS software version 21.

 The mean sleep quality index of the nurses working in the nursing station was at the appropriate level (3.83±2.32), whereas the nurses working in other wards had an unsuitable level of sleep quality index. Moreover, the mean score of occupational fatigue was high among the nurses of female Post-cardiac Care Unit (post-CCU) (58.12±12.24) and moderate among the nurses of other hospital wards. The results of t-test indicated significantly lower mean scores of sleep latency, taking sleeping medications, and acute fatigue in nurses with a second job, compared to nurses with a single job (P<0.05).

 Sleep problems and occupational fatigue in nurses of the female Post-CCU and nursing stations were higher and lower than the nurses working in the other hospital wards, respectively. Furthermore, the second job variable was found to be important and influential.

Tetanus is a neurological disorder caused by Clostridium tetani. Although vaccination has significantly reduced the incidence of tetanus worldwide, the occurrence of sporadic cases requires effective and timely treatment. In this study, we report the case of a 45-year-old man who had difficulty in swallowing and opening mouth. The patient had the history of a small puncture wound with a nail in his toes about 12 days ago.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in a pandemic (1). Early diagnosis and testing of symptomatic individuals and asymptomatic carriers (2) remain essential since the latter group can transmit the virus (3,4). Current assays for SARS-CoV-2 detection are mostly based on quantitative real-time PCR (RT-qPCR)(5). However, cross-contamination remains a challenge in RT-qPCR assays. Here, we would like to share the most interesting route of sample contamination in SARS-CoV-2 molecular diagnosis laboratories and the necessity of personnel testing. We set up our molecular diagnosis laboratory three months ago using RT-qPCR. We strictly adhered to biosafety guidelines to ensure personnel safety and avoid cross-contamination of samples. We use (i) two extraction negative controls (EXNC), (ii) one no template control for every 10 samples, and (iii) one negative control. Note that to minimize the probability of contamination, the positive control was prepared last, after each patient’s sample was added to the corresponding tube. After one month and a half, we noticed a slightly positive signal (Cq = 38) in one of the EXNC. Upon repeating the run, both EXNC showed a Cq = 38. We narrowed down the cause to the personnel. Thus, all the personnel were tested for SARS-CoV-2 by the reference laboratory of the Pasteur Institute of Iran. We were astonished when we found that the person who was in charge of extractions tested positive for SARS-nCoV-2. This same person also handled the extraction kits. Thus, a SARS-CoV-2 PCR-negative technician was assigned to perform viral RNA extraction. The results were perfectly satisfactory. How is it possible when the RNA extraction technologist used all necessary personal protective equipment and level 2 biosafety guidelines? Since the SARS-CoV-2 PCR-positive person handled the extraction kits, she contaminated all the buffers and solutions probably by inadvertent touching of her mask or face. What we observed is the trickiest route of cross-contamination in a molecular diagnostic laboratory even when the most experienced user is working. When molecular diagnostic laboratory personnel do not use shields, it is probable that they touch their masks or faces inadvertently. Especially when they work long hours, and the mask becomes wet because of the exhalation, the outer surface of the mask is certainly contaminated. We strongly recommend that all the personnel working in SARS-CoV-2 molecular diagnostic laboratories have to be tested. In fact, personnel of every molecular diagnosis laboratory should be tested especially for respiratory diseases that can be transmitted through exhalation of infected individuals.   Ethical considerations Ethical issues (Including plagiarism, informed consent, misconduct, data fabrication and/or falsification, double publication and/or submission, redundancy, etc.) have been completely observed by the authors.    Conflict of Interest Authors declared no conflict of interest.