Cuáles son los efectos de la relajación sobre los niveles de depresión en mujeres con embarazos de alto riesgo

Se llevó a cabo la revisión crítica a través de CASPe¹ como lista de comprobación para ensayo clínico aleatorizado, el estudio presenta un aporte relevante puesto que permite apropiarse de una técnica de relajación para disminuir el riesgo de depresión en mujeres embarazadas de alto riesgo obstétrico [Fragmento de texto].

Health care providers’ perception of facilitators and barriers for the practice of skin-to-skin contact in Saudi Arabia: A qualitative study

To identify Health Care Providers’ (HCPs’) perceived facilitators, barriers and requirements for implementing the practice of Skin-to-Skin Contact (SSC) immediately after vaginal birth.

The lived experience of women with a high-risk pregnancy: A phenomenology investigation

Pregnancy is a time of transformation, hope, expectation, and worry for women and their families – none more so than when the pregnancy is at-risk. The objective of this study was to describe the lived experience of women during high-risk pregnancy.

Ansiedad, depresión y soledad en cuidadores de personas con enfermedad crónica

Objetivo principal: Determinar la relación entre ansiedad, depresión y soledad en cuidadores familiares de adultos mayores con enfermedades crónicas. Metodología: Diseño descriptivo correlacional. Se utilizó la Escala hospitalaria de ansiedad y depresión (α=.83) y la escala de Soledad (α=.95). Se hizo un cálculo de tamaño de muestra con programa G-Power 3.1.9.7 y se aplicó un muestreo a conveniencia. Se analizó con estadística descriptiva e inferencial, como Pearson y chi2. Resultados principales: Participaron 178 cuidadores familiares con una m de 45 años. Se encontró relación de la edad con la percepción de soledad (r=-.200) y el tiempo del cuidado con la puntuación de depresión (r=-.199) y ansiedad (r=-.179). Conclusión principal: Se encontró que, a mayor edad del cuidador, mayor es la percepción de soledad, y a mayor tiempo de cuidado, menor es la depresión y ansiedad, permitiendo implementar futuros programas de atención para mejorar la calidad de vida de los cuidadores.

Vocación para el cuidado humano en estudiantes de enfermería en una universidad de México

Objetivo: Comparar el nivel de vocación en estudiantes de segundo, cuarto, sexto y octavo semestre de la licenciatura en enfermería de una universidad privada en México. Metodología: Diseño comparativo, transversal; la muestra fueron 127 estudiantes de pregrado en enfermería de diferentes semestres. Se utilizó el instrumento “Vocación de servicio para el cuidado humano”, una cédula de datos; se usó el consentimiento informado. El procesamiento de datos se realizó en SPSS, se utilizó estadística descriptiva e inferencial. Resultados: 86% fueron mujeres, el promedio de edad fue 21.1±4, el promedio de felicidad fue 8.7±1.4, 60,6% tiene una buena vocación; existen diferencias entre el nivel de vocación de octavo semestre respecto a los demás (p<.05), existe relación entre la felicidad y vocación (r=.385; p<.01). Conclusión: El nivel de vocación en los estudiantes de Enfermería es bueno, existen diferencias significativas entre el nivel de vocación a medida que aumentan los semestres. La felicidad y la vocación se relacionan y condicionan potencialmente el desempeño profesional.

El concepto del estrés de aculturación desde la mirada del inmigrante hispano en los Estados Unidos

Objetivo principal: Clarificar el significado de estrés de aculturación del inmigrante hispano, además de conocer cada una de las dimensiones y características propias del concepto, con la finalidad de comprender mejor las necesidades de la persona inmigrante que vive en los Estados Unidos. Metodología: El análisis de concepto se hizo a través de los ocho pasos propuestos por Walker y Avant. Resultados principales: Se identificaron tres dimensiones del concepto estrés de aculturación: (1) estresores personales, (2) estresores del entorno y (3) estresores sociales. Como antecedentes del concepto se identificó el arrepentimiento, la culpa y negación. En general, las consecuencias se reflejan en la salud mental del inmigrante hispano. Además, se reconoció los instrumentos de medi-ción que evalúan el estrés de aculturación. Conclusión principal: Se obtuvo una definición clara del concepto estrés de aculturación desde la perspectiva del inmigrante hispano, que ayudará a estimar la validez de constructo de las mediciones de este concepto. Las dimensiones reportadas con mayor frecuencia son consideradas en el inventario de estrés en hispanos, sin embargo, se recomienda analizar la validez de constructo del concepto. Sería importante considerar las consecuencias derivadas del estrés de aculturación en la prevención y tratamiento de la salud mental.

Cut‐off scores of the Depression Anxiety Stress Scale‐8: Implications for improving the management of chronic pain

Abstract

Aim

Mental distress, non-specific symptoms of depression and anxiety, is common in chronic pelvic pain (CPP). It contributes to poor recovery. Women's health nurses operate in multidisciplinary teams to facilitate the assessment and treatment of CPP. However, valid cut-off points for identifying highly distressed patients are lacking, entailing a gap in CPP management.

Design

This instrumental cross-sectional study identified a statistically derived cut-off score for the Depression Anxiety Stress Scale-8 (DASS-8) among 214 Australian women with CPP (mean age = 33.3, SD = 12.4, range = 13–71 years).

Methods

Receiver operator characteristic curve, decision trees and K-means clustering techniques were used to examine the predictive capacity of the DASS-8 for psychiatric comorbidity, pain severity, any medication intake, analgesic intake and sexual abuse. The study is prepared according to the STROBE checklist.

Results

Cut-off points resulting from the analysis were ordered ascendingly. The median (13.0) was chosen as an optimal cut-off score for predicting key outcomes. Women with DASS-8 scores below 15.5 had higher analgesic intake.

Conclusion

CPP women with a DASS-8 score above 13.0 express greater pain severity, psychiatric comorbidity and polypharmacy. Thus, they may be a specific target for nursing interventions dedicated to alleviating pain through the management of associated co-morbidities.

Implications for patient care

At a cut-off point of 13.0, the DASS-8 may be a practical instrument for recommending a thorough clinician-based examination for psychiatric comorbidity to facilitate adequate CPP management. It may be useful for evaluating patients' response to nursing pain management efforts. Replications of the study in different populations/countries are warranted.

Stress and burnout in nursing home and égida workers during COVID‐19

Abstract

Aims

Finding out whether there are differences in the levels of stress and burnout between workers providing care to dependent adults and those caring for independent older adults would provide comparative information about two different models of care. During the COVID-19 pandemic, workers caring for older adults were subjected to maladaptive situations that produced stress and burnout.

Design

A cross-sectional survey design using the STROBE checklist.

Methods

A total of 900 nursing home and égidas workers were assessed for stress and burnout. Data were collected online from October 2020 to February 2021, when Puerto Rico was experiencing the peak of the third wave of COVID-19. MANOVAs were performed to study the interactions between the workplace and having had COVID, the workplace and the size of institution and the workplace and position held.

Data Sources

October 2020 to February 2021.

Results

All interactions were significant. Nursing homes showed higher levels of stress and burnout when workers had undergone COVID, when the size of the institution was larger and for technical staff other services; in égidas, having undergone COVID did not influence stress or burnout, which increased when the institution was smaller and for executive staff.

Conclusions

This study showed that the effects of the COVID-19 pandemic affected nursing home workers more significantly than those working in other types of residential models with independent older adults.

Implications for the Profession and/or Patient Care

Applying preventive interventions aimed at reducing stress and burnout would facilitate the adaptation of workers caring for older adults and help to improve the quality of care.

Impact

This study analysed the impact of COVID-19 on the stress and burnout of workers providing services to older adults. Nursing home workers who have had COVID-19 have higher stress and burnout. The size of the institution has a different effect depending on whether older adults are dependent or independent. Workers in institutions dedicated to the care of the older adults.

Reporting Method

This study has adhered to the relevant EQUATOR guidelines: STROBE.

Patient or Public Contribution

During the different waves of the COVID-19 pandemic, it was difficult to establish direct contact with workers providing care to older adults; this reason made it necessary to apply online systems to obtain information. The workers appreciated the fact that the implications for stress and burnout of the situation experienced during this difficult process were investigated.

Tiempos de pandemia: nivel de satisfacción de docentes universitarios en el desarrollo de las clases virtuales

Las TICs permiten que el estudiante acceda al material de estudio y, a su vez, interactúe con el profesor y con otros estudiantes. La pandemia COVID-19 ha obligado a docentes a impartir clases virtuales de urgencia para cumplir con las actividades académicas programadas.

El objetivo es analizar el nivel de satisfacción de docentes en el desarrollo de las clases virtual en tiempos de pandemia. El diseño fue observacional, descriptiva, de corte transversal, enfoque cuantitativo, el universo estuvo compuesto por docentes de la FENOB-UNA Casa Central y Filiales, con una muestra de 114 docentes, la selección se realizó a través de un muestreo no probabilístico de casos consecutivos, la recolección de datos se hizo a través de una encuesta en línea con un cuestionario elaborado por las investigadoras, validada por expertos. Los hallazgos más relevantes fueron: mayoritariamente de sexo femenino, del grupo etario de 36 a 55 años, de estado civil casado, procedentes del departamento Central, son docente catedráticos y ejercen su labor solamente en la FENOB-UNA, cuenta con conexión a internet, utiliza computadora portátil y destina 2 horas para las clases. El análisis entre las características sociodemográficas y el nivel de satisfacción con el desarrollo de las clases virtuales es estadísticamente significativo con la variable edad. Se concluye que el nivel de satisfacción de docentes en el desarrollo de las clases virtuales en tiempos de pandemia fue medianamente satisfecho.

ABSTRACT

ICTs allow the student to access the study material and, in turn, interact with the teacher and other students. The COVID-19 Pandemic has forced teachers to teach emergency virtual classes to comply with scheduled academic activities. The objective is to analyze the level of satisfaction of teachers in the development of virtual classes in times of pandemic. The design was observational, descriptive, cross-sectional, quantitative approach, the universe was made up of teachers from the FENOB- UNA Central House and Subsidiaries, with a sample of 114 teachers, the selection was made through a non-probabilistic sampling of cases. consecutive, data collection was done through an online survey with a questionnaire prepared by the researchers, validated by experts. The most relevant findings were: mostly female, in the age group of 36 to 55 years, with married marital status, from the Central Department, are professors and work only at FENOB-UNA, have an internet connection, He uses a laptop and allocates 2 hours for classes. The analysis between the sociodemographic characteristics and the level of satisfaction with the development of virtual classes is statistically significant with the age variable. It is concluded that the level of satisfaction of teachers in the development of virtual classes in times of pandemic was moderately satisfied.

Chronic venous insufficiency and venous leg ulcers: Aetiology, on the pathophysiology‐based treatment

Abstract

The chronic venous disease covers a wide spectrum of venous disorders that are characterized by severely impaired blood return that primarily affects veins in the lower extremities. Morphological and functional abnormalities of the venous system led to chronic venous insufficiency (CVI), and present as leg heaviness/achiness, edema, telangiectasia, and varices. The term ‘chronic venous insufficiency’ (CVI) refers to a disease of greater severity. Venous dysfunction is associated with venous hypertension and is associated with venous reflux due to poorly functioning or incompetent venous valves, which ultimately reduces venous return, leading to a cascade of morphological, physiological, and histologic abnormalities such as blood pooling, hypoxia, inflammation, swelling, skin changes (lipodermatosclerosis), and in severe cases, venous leg ulcers (VLU). This review summarizes recent knowledge about the aetiology, risk factors, and pathophysiology of VLU and compared the possibilities of their treatment.

Validación de contenido “Escala de autoeficacia para el amamantamiento, formato corto” en mujeres puérperas

Objetivo. Determinar la validez de contenido de la Escala de Autoeficacia para el Amamantamiento en mujeres puérperas. Metodología. Diseño metodológico de validación, con cinco etapas: 1. Adaptación sociocultural de la escala; 2. Validación de contenido; 3. Prueba piloto; 4. Factibilidad pragmática mediante Ensayo Clínico Aleatorio; 5. Análisis factorial exploratorio. Resultados. Etapa 1-2: Los jueces modificaron en los 14 ítems, la palabra “poder”, por la palabra "Tengo la confianza". Índice de Validez por Ítem (1.7); Criterio de Validez (12%) y el Índice de Validez de Contenido (8.78). Etapa 3-4: Prueba piloto, α=.85. Se encontraron diferencias entre el grupo control y experimental en el re-test (p< .05). Etapa 5: Las subescalas explican el 39.91% de la varianza. Conclusión principal. Instrumento válido y confiable para medir la autoeficacia para el amamantamiento en mujeres puérperas. La intervención educativa y persuasión verbal mejora significativamente el nivel de autoeficacia mediante el componente educativo.

Robust cardiac segmentation corrected with heuristics

by Alan Cervantes-Guzmán, Kyle McPherson, Jimena Olveres, Carlos Francisco Moreno-García, Fabián Torres Robles, Eyad Elyan, Boris Escalante-Ramírez

Cardiovascular diseases related to the right side of the heart, such as Pulmonary Hypertension, are some of the leading causes of death among the Mexican (and worldwide) population. To avoid invasive techniques such as catheterizing the heart, improving the segmenting performance of medical echocardiographic systems can be an option to early detect diseases related to the right-side of the heart. While current medical imaging systems perform well segmenting automatically the left side of the heart, they typically struggle segmenting the right-side cavities. This paper presents a robust cardiac segmentation algorithm based on the popular U-NET architecture capable of accurately segmenting the four cavities with a reduced training dataset. Moreover, we propose two additional steps to improve the quality of the results in our machine learning model, 1) a segmentation algorithm capable of accurately detecting cone shapes (as it has been trained and refined with multiple data sources) and 2) a post-processing step which refines the shape and contours of the segmentation based on heuristics provided by the clinicians. Our results demonstrate that the proposed techniques achieve segmentation accuracy comparable to state-of-the-art methods in datasets commonly used for this practice, as well as in datasets compiled by our medical team. Furthermore, we tested the validity of the post-processing correction step within the same sequence of images and demonstrated its consistency with manual segmentations performed by clinicians.

IL-6 serum level, ARDS, and AKI as risk factors for the COVID-19 infection’s mortality in children

by Idham Jaya Ganda, Try Kartika Eka Putri, Syarifuddin Rauf, Amiruddin Laompo, Ninny Meutia Pelupessy, Sitti Aizah Lawang, Nadirah Rasyid Ridha, Bahrul Fikri, Muhammad Nasrum Massi

Introduction

Dysregulated immune responses are developed in Coronavirus disease-2019 (COVID-19) and Interleukin-6 (IL-6) levels are reflecting the severity of the clinical presentation. This study aimed to analyze IL-6 serum level, Acute Respiratory Distress Syndrome (ARDS), and Acute Kidney Injury (AKI) as risk factors for mortality in children with COVID-19.

Methods

This prospective cohort study was conducted on children with COVID-19 infection confirmed by Real Time Polymerase Chain Reaction (RT-PCR) who were admitted to infection center at Dr. Wahidin Sudirohusodo Hospital from September 2021 to September 2022. Subjects were selected using the consecutive sampling method.

Results

A total of 2,060 COVID-19 RT-PCR tests were performed, and 1,065 children were confirmed positive. There were 291 cases that met the inclusion criteria, with 28.52 percent non-survives and 71.48% survives. The risk factors for mortality were IL-6, ARDS, AKI, Prothrombin Time / Activated Partial Thromboplastin Time (PT/aPTT), oxygen saturation, Absolut lymphocyte count (ALC), leukocytes, Length of Stay (LOS), and nutritional status (p80.97 pg/ml with 93% sensitivity and 90% specificity. Area Under Curve was 0.981 (95% CI), 0.960–1.000). A multivariate analysis showed IL-6 levels with OR 18.570 (95% CI 5.320–64.803), ARDS with Odds Ratio (OR) 10.177, (95% Confidence Interval (CI) 1.310–9.040), and AKI with OR 3.220 (95% CI 1.070–10.362). A combination of increased IL-6, ARDS, and AKI can predict a mortality probability as high as 98.3%.

Conclusion

IL-6, ARDS, and AKI are risk factors for mortality in children with COVID-19. IL-6 level was the highest mortality risk factor.

Anethole attenuates motor dysfunctions, striatal neuronal activity deficiency and blood brain barrier permeability by decreasing striatal α-synuclein and oxidative stress in rotenone-induced Parkinson’s disease of male rats

by Sadegh Moradi Vastegani, Seyed Esmaeil Khoshnam, Samireh Ghafouri, Nima Bakhtiari, Yaghoob Farbood, Alireza Sarkaki

Introduction

Anethole is the main compound of the essential oil of anise and several other plants, which has antioxidant, anti-inflammatory, and neuroprotective properties. Oxidative stress is considered as an important factor in the pathogenesis of PD. In the present study, we aimed to investigate the effects of anethole against rotenone-induced PD.

Methods

Male Wistar rats were randomly divided into six groups. Control group received DMSO + sunflower oil, model group received rotenone (2 mg/kg, s.c, daily for 35 days), positive control group received L-Dopa, and test groups received anethole (62.5, 125, and 250 mg/kg, i.g, daily for 35 days) 1 hour before each rotenone injection. Body weight changes, rotarod test, stride length test, and extracellular single unit recording were performed after treatment. After behavioral test, Brain water content and blood brain barrier (BBB) permeability were evaluated, and the levels of malondialdehyde (MDA), superoxide dismutases (SOD), alpha-synuclein and MAO-B were measured in the striatum.

Results

Chronic administration of rotenone induced body weight loss and caused significant dysfunction in locomotor activity, neuronl firing rate, and BBB. Rotenone also decreased SOD activity, increased MDA level, and elevated the expression of alpha-synuclein and MAO-B in the striatum. However, treatment with anethole attenuated body weight loss, motor function, neuronal activity, and BBB function. Furthermore, Anethole treatment attenuated oxidative stress and decreased the expression of alpha-synuclein and MAO-B compared to the rotenone group.

Conclusion

Our results show that through its antioxidant properties, aethole can improve the cellular, molecular and behavioral characteristics of rotenone-induced Parkinson’s disease.

Intravenous acetaminophen for postoperative pain in the neonatal intensive care unit: A protocol for a pilot randomized controlled trial (IVA POP)

by Victoria Anne Archer, Samira Samiee-Zafarghandy, Forough Farrokyhar, Daniel Briatico, Luis H. Braga, J. Mark Walton

Background

In neonates, uncontrolled pain and opioid exposure are both correlated with short- and long-term adverse events. Therefore, managing pain using opioid-sparing approaches is critical in neonatal populations. Multimodal pain control offers the opportunity to manage pain while reducing short- and long-term opioid-related adverse events. Intravenous (IV) acetaminophen may represent an appropriate adjunct to opioid-based postoperative pain control regimes. However, no trials assess this drug in patients less than 36 weeks post-conceptual age or weighing less than 1500 g.

Objective

The proposed study aims to determine the feasibility of conducting a randomized control trial to compare IV acetaminophen and fentanyl to a saline placebo and fentanyl for patients admitted to the neonatal intensive care unit (NICU) undergoing major abdominal or thoracic surgery.

Methods and design

This protocol is for a single-centre, external pilot randomized controlled trial (RCT). Infants in the NICU who have undergone major thoracic or abdominal surgery will be enrolled. Sixty participants will undergo 1:1 randomization to receive intravenous acetaminophen and fentanyl or saline placebo and fentanyl. After surgery, IV acetaminophen or placebo will be given routinely for eight days (192 hours). Appropriate dosing will be determined based on the participant’s gestational age. Patients will be followed for eight days after surgery and will undergo a chart review at 90 days. Primarily feasibility outcomes include recruitment rate, follow-up rate, compliance, and blinding index. Secondary clinical outcomes will be collected as well.

Conclusion

This external pilot RCT will assess the feasibility of performing a multicenter RCT comparing IV acetaminophen and fentanyl to a saline placebo and fentanyl in NICU patients following major abdominal and thoracic surgery. The results will inform the design of a multicenter RCT, which will have the appropriate power to determine the efficacy of this treatment.

Trial registration

ClinicalTrials.gov NCT05678244, Registered December 6, 2022.

Feasibility of linking universal child and family healthcare and financial counselling: findings from the Australian Healthier Wealthier Families (HWF) mixed-methods study

Objectives

‘Healthier Wealthier Families’ (HWF) seeks to reduce financial hardship in the early years by embedding a referral pathway between Australia’s universal child and family health (CFH) services and financial counselling. This pilot study investigated the feasibility and short-term impacts of HWF, adapted from a successful Scottish initiative.

Methods

Setting: CFH services in five sites across two states, coinciding with the COVID-19 pandemic. Participants: Caregivers of children aged 0–5 years experiencing financial hardship (study-designed screen). Design: Mixed methods. With limited progress using a randomised trial (RCT) design in sites 1–3 (March 2020–November 2021), qualitative interviews with service providers identified implementation barriers including stigma, lack of knowledge of financial counselling, low financial literacy, research burden and pandemic disruption. This informed a simplified RCT protocol (site 4) and direct referral model (no randomisation, pre–post evaluation, site 5) (June 2021–May 2022). Intervention: financial counselling; comparator: usual care (sites 1–4). Feasibility measures: proportions of caregivers screened, enrolled, followed up and who accessed financial counselling. Impact measures: finances (quantitative) and other (qualitative) to 6 months post-enrolment.

Results

355/434 caregivers completed the screen (60%–100% across sites). In RCT sites (1–4), 79/365 (19%–41%) reported hardship but less than one-quarter enrolled. In site 5, n=66/69 (96%) caregivers reported hardship and 44/66 (67%) engaged with financial counselling; common issues were utility debts (73%), and obtaining entitlements (43%) or material aid/emergency relief (27%). Per family, financial counselling increased income from government entitlements by an average $A6504 annually plus $A784 from concessions, grants, brokerage and debt waivers. Caregivers described benefits (qualitative) including reduced stress, practical help, increased knowledge and empowerment.

Conclusions

Financial hardship screening via CFH was acceptable to caregivers, direct referral was feasible, but individual randomisation was infeasible. Larger-scale implementation will require careful, staged adaptations where CFH populations and the intervention are well matched and low burden evaluation.

Trial registration number

ACTRN12620000154909.

The lived experience of Omani adolescents and young adults with mental illness: A qualitative study

by Omar Al Omari, Gerald Amandu, Samir Al-Adawi, Zubaida Shebani, Ibtisam Al Harthy, Arwa Obeidat, Khloud Al Dameery, Mohammad Al Qadire, Iman Al Hashmi, Abduallh Al Khawldeh, Mohammed ALBashtawy, Maen Aljezawi

There is currently limited knowledge about the firsthand experiences of adolescents and young adults with mental health problems and the meanings they ascribe to these experiences, particularly within Arab countries. This study, therefore, aimed to explore the lived experience of Omani adolescents and young adults with a mental health problem. A sample of 15 participants aged 13–22 diagnosed with a range of mental health problems took part in the study. A qualitative interview guide consisting of open-ended questions was used to allow participants to speak in-depth about their experiences. Using the thematic analysis approach to uncover patterns in the data, three major themes emerged: “living in darkness”, “perilous journey” and “uncertain future”. Results show that the progress of adolescents and young adults with mental health problems is characterized by several challenges; the most significant of which is having insufficient knowledge about their illness, leading to unnecessary delays in their treatment. These findings shed light on the breadth and depth of the experience of adolescents and young adults with mental health problems and lay the groundwork for further examinations. Implications lie in the development of approaches for preventing or mitigating difficulties faced by adolescents and young adults with mental health problems.

Prevalence of surgical wound infection and related factors in patients after long bone surgery: A systematic review and meta‐analysis

Abstract

The goal of this systematic review and meta-analysis is to provide an overview of the prevalence of surgical wound infection and related factors in patients after long bone surgery. A comprehensive, systematic search was conducted in different international electronic databases, such as Scopus, PubMed, Web of Science and Persian electronic databases such as Iranmedex and Scientific Information Database using keywords extracted from Medical Subject Headings such as “Prevalence”, “Surgical wound infection”, “Surgical site infection” and “Orthopedics” from the earliest to the May 1, 2023. The appraisal tool for cross-sectional studies (AXIS tool) evaluates the quality of the included studies. A total of 71 854 patients undergoing long bone surgery participated in 12 studies. The pooled prevalence of surgical wound infection in patients who underwent long bone surgery reported in the 12 studies was 3.3% (95% CI: 1.5%–7.2%; I ² = 99.39%; p < 0.001). The pooled prevalence of surgical wound infection in male and female patients who underwent long bone surgery was 4.6% (95% CI: 1.7%–11.7%; p < 0.001; I ² = 99.34%) and 2.6% (95% CI: 1.0%–6.3%; I ² = 98.84%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with femur surgery sites reported in nine studies was 3.7% (95% CI: 2.1–6.4%; I ² = 93.43%; p < 0.001). The pooled prevalence of surgical wound infection in open and close fractures was 16.4% (95% CI: 8.2%–30.2%; I ² = 95.83%; p < 0.001) and 2.9% (95% CI: 1.5%–5.5%; I ² = 96.40%; p < 0.001), respectively. The pooled prevalence of surgical wound infection in patients with diabetes mellitus (DM), hypertension (HTN) and cardiovascular disease (CVD) was 4.6% (95% CI: 2.3%–8.9%; I ² = 81.50%; p < 0.001), 2.7% (95% CI: 1.2%–6.0%; I ² = 83.82%; p < 0.001) and 3.0% (95% CI: 1.4%–6.4%; I ² = 69.12%; p = 0.006), respectively. In general, the different prevalence of surgical wound infection in patients undergoing surgical treatment after long bone fracture may be caused by underlying factors (gender and co-morbidity) and fracture-related factors (surgery site and type of fracture).

Maternal exposure to SSRIs or SNRIs and the risk of congenital abnormalities in offspring: A systematic review and meta-analysis

by Weiyi Huang, Robin L. Page, Theresa Morris, Susan Ayres, Alva O. Ferdinand, Samiran Sinha

Background

The association of maternal exposure to selective serotonin reuptake inhibitors (SSRIs) or serotonin and norepinephrine reuptake inhibitors (SNRIs) with the risk of system-specific congenital malformations in offspring remains unclear. We conducted a meta-analysis to examine this association and the risk difference between these two types of inhibitors.

Methods

A literature search was performed from January 2000 to May 2023 using PubMed and Web of Science databases. Cohort and case-control studies that assess the association of maternal exposure to SSRIs or SNRIs with the risk of congenital abnormalities were eligible for the study.

Results

Twenty-one cohort studies and seven case-control studies were included in the meta-analysis. Compared to non-exposure, maternal exposure to SNRIs is associated with a higher risk of congenital cardiovascular abnormalities (pooled OR: 1.64 with 95% CI: 1.36, 1.97), anomalies of the kidney and urinary tract (pooled OR: 1.63 with 95% CI: 1.21, 2.20), malformations of nervous system (pooled OR: 2.28 with 95% CI: 1.50, 3.45), anomalies of digestive system (pooled OR: 2.05 with 95% CI: 1.60, 2.64) and abdominal birth defects (pooled OR: 2.91 with 95%CI: 1.98, 4.28), while maternal exposure to SSRIs is associated with a higher risk of congenital cardiovascular abnormalities (pooled OR: 1.25 with 95%CI: 1.20, 1.30), anomalies of the kidney and urinary tract (pooled OR: 1.14 with 95%CI: 1.02, 1.27), anomalies of digestive system (pooled OR: 1.11 with 95%CI: 1.01, 1.21), abdominal birth defects (pooled OR: 1.33 with 95%CI: 1.16, 1.53) and musculoskeletal malformations (pooled OR: 1.44 with 95%CI: 1.32, 1.56).

Conclusions

SSRIs and SNRIs have various teratogenic risks. Clinicians must consider risk-benefit ratios and patient history when prescribing medicines.

Comparison of the preconditioning effect of different exercise training modalities on myocardial ischemia-reperfusion injury

by Reihaneh Mohammadkhani, Kamal Ranjbar, Iraj Salehi, Alireza Komaki, Ebrahim Zarrinkalam, Parsa Amiri

The study of exercise preconditioning can develop strategies to prevent cardiovascular diseases and outline the efficient exercise model. However, the exercise type with the most protective effect against ischemia-reperfusion injury is unknown. In this study, we examined the effects of three kinds of exercise preconditioning on myocardial ischemia-reperfusion in adult rats and explored the possible underlying mechanisms. Male Wistar rats subjected to ten weeks of endurance, resistance, and concurrent training underwent ischemia (30 min) and reperfusion (120 min) induction. Then, infarction size, serum levels of the CK-MB, the redox status, and angiogenesis proteins (VEGF, ANGP-1, and ANGP-2) were measured in the cardiac tissue. Results showed that different exercise training modes have the same reduction effects on infarction size, but ischemia-reperfusion-induced CK-MB was lower in response to endurance training and concurrent training. Furthermore, cardiac VEGF levels increased in all three kinds of exercise preconditioning but ischemia-reperfusion-induced ANGP-1 elevated more in endurance training. The cardiac GPX activity was improved significantly through the resistance and concurrent exercise compared to the endurance exercise. In addition, all three exercise preconditioning models decreased MPO levels, and ischemia reperfusion-induced MDA was lower in endurance and resistance training. Overall, these results indicated that cardioprotection of exercise training against ischemia-reperfusion injury depends on the exercise modality. Cardioprotective effects of aerobic, resistance, and concurrent exercises are due to different mechanisms. The preconditioning effects of endurance training are mediated mainly by pervasive angiogenic responses and resistance training through oxidative stress amelioration. The preconditioning effects of concurrent training rely on both angiogenesis and oxidative stress amelioration.