Statistical Significant Reduction Research Articles

Effectiveness of a smartphone – based education intervention to improve breastfeeding and neonatal nutritional status: a randomised controlled trial

Exclusive breastfeeding is critically important during the first six months of an infant's life, offering numerous health benefits for both mothers and babies. A randomized controlled study was conducted involving a sample of 674 new mothers (224 in the control group and 450 in the intervention group) new mothers with their child aged under one month for a period of six months to evaluate the effectiveness of a breastfeeding smartphone-based educational intervention at Kenyatta National Hospital in Nairobi, Kenya. Participants were randomly assigned to the intervention group which received (mobile app-based education + routine care) and the control group (routine care). A total of 412 mother-infant dyads completed the study, representing 61.1% of the recruited participants in the study, with 206 in the intervention group and 206 in the control group. After six months, the following findings were observed; the intervention group showed a significant (p<0.01) improvement in breastfeeding knowledge, with a mean (±S.D.) score of 70.33% (±7.68), compared to 58.52% (±16.5) in the control group, resulting in a difference-in-difference of means (DID means = 3.53%, p<0.01). Attitudes toward breastfeeding improved significantly (p<0.01) in the intervention group, with a mean score of 73.58% (±6.79), compared to 47.75% (±9.96) in the control group, with a difference-in-difference of means (DID means = 1.60%, p<0.01). Practices significantly (p<0.01) improved, with the intervention group scoring 73.95% (± 2.66), while the control group scored 53.89% (±9.85), resulting in a difference-in-difference of means (DID means = 9.12%, p<0.01). At baseline, the mean (±S.D.) weight of infants was 2.82 kg (±0.87) and 2.98 kg (±0.62) in the control and intervention group respectively. Both groups experienced an increase in weight, with the control group averaging 7.36 kg (±0.91) and the intervention group averaging 7.82 kg (±0.94). Both groups had increased in height, with the control group measuring the mean (±S.D.) 67.42 cm (±2.43) and the intervention group measuring 67.95 cm (±2.87). There was significant (p<0.01) weight gain in intervention group infants (DID means = 0.28 kg, p<0.01) and length gain (DID means = 1.31 cm, p<0.01). Finally, the intervention group underweight reduced to 4.9%, stunting to 1.9%, and wasting to 4.4% resulting in statistical significant (p<0.01) reduction in malnutrition prevalence. The mobile app-based intervention significantly improved breastfeeding knowledge, attitudes, practices, and infant health, reducing malnutrition prevalence effectively. Hospital-based nutritionists should consider using mobile apps to monitor lactating mothers' exclusive breastfeeding adherence, while policymakers support their integration in post-natal care. Key words: Smartphone intervention, breastfeeding knowledge, attitude, practices, Infant nutritional status, Kenya

Interventions to prevent Neonatal Healthcare-associated Infection: a systematic review of RCT

Abstract Background Healthcare-acquired infections (HAI) in neonatal intensive care unit (NICU) specifically refer to infections that occur in newborn infants within the healthcare environment. Preterm infants, often more vulnerable to infections, in the NICU may be exposed to various medical interventions, devices, and environments that can increase the risk of infections. This systematic review aims to evaluate the effectiveness of interventions proposed to prevent neonatal healthcare-associated infections. Methods PubMed, Scopus and Web of Science databases were searched to identify any RCT study coming from high income countries, published from 2004, that investigated the efficacy of any intervention to prevent HAI in NICU. All type of HAI were considered. Results A total of seven studies were included (2 from USA, 5 from UE). Three studies focused on: administration of donor milk; probiotic Bifidobacterium breve; intravenous Staphylococcus aureus immune globulin; all failed to demonstrate any protective action. Of the four remaining studies that investigate different aspect of the vascular catheterization process only two lead a a statistical significant reduction of HAI. Garland et al. demonstrate in 85 neonates how vancomycin-heparin lock solution is capable to reduce catheter related blood stream infection (CRBSI) 8/43 neonates (18.6%) in the control group vs 0/42 in the vancomycin-heparin-lock group (P = 0.006). Bertini et al. demonstrate in 86 preterm infants how utilization of AgION catheter in Umbelical vein catheterization (UVC) lead to CRBSI rate reduction (2 vs. 22%; p = 0.005), shorter hospital stay (p = 0.04), lower case fatality rate due to Blood stream infection (p = 0.01). Conclusions Among the proposed methodology only the one acting on the catheterization process provide a statistical significant reduction of HAI onset. Widespread observation of proposed protocol may results in reduction of HAI in NICU. Key messages • Modfiication on the catheterization process provide a statistical significant reduction of HAI onset. • Knowing these measures assure reduction of HAI.

Could metformin modulate the outcome of chronic murine toxoplasmosis?

Toxoplasmosis is a pervasive parasitic infection possessing a chief impact on both public health and veterinary medicine. Unfortunately, the commercially-available anti-Toxoplasma agents have either serious side effects or diminished efficiency, specifically on the Toxoplasma tissue cysts. In the present study, metformin (The first-line treatment for type 2 diabetes mellitus) was investigated for the first time against chronic cerebral toxoplasmosis in mice model experimentally-infected with ME49 strain versus spiramycin. Two metformin regimens were applied; starting one week before the infection and four weeks PI. Parasitological, ultrastructural, histopathological, immunohistochemical, immunological, and biochemical assessments were performed. The anti-parasitic effect of metformin was granted by the statistically-significant reduction in tissue-cyst burden in both treatment regimens. This was accompanied by markedly-mutilated ultrastructure and profound amelioration of the cerebral histopathology with remarkable decline in the brain CD4+ and CD8+ T cell count. Besides, diminution of anti-Toxoplasma IgG and brain GSH levels was evident. Ultimately, the present findings highlighted the powerful promising therapeutic role of metformin in the management of chronic toxoplasmosis on a basis of anti-parasitic, anti-inflammatory, and anti-oxidant possessions.

The Effects of Different Forms of Contraceptives on the Coagulation Profile

Background: The association between combined oral contraceptive pills and increased risk of venous thromboembolism has been extensively researched but little has been reported on its effects on all haematological parameters and coagulation factors. This study aimed to evaluate the effects of different forms of oral contraceptives on the coagulation profile of female subjects in Enugu metropolis. This case-control study was conducted among women attending the Family planning unit of University of Nigera Teaching Hospital, Ituku Ozalla, Enugu State. Methods: The subjects were 36 women undergoing oral contraceptive medication and the control were 36 healthy women not taking this medication. ABO blood grouping and Full blood count (FBC) were carried out while prothrombin time (PT) and activated partial thromboplastin time (APTT) of test subjects were determined using test kits from Technoclone Austria. Most of the test subjects were found to be of the O + blood group. The haematological profile of test subjects showed a statistically significant increase in Red blood cell (RBC), packed cell volume (PCV), neutrophil, eosinophil, mean platelet volume (MPV) and plateletcrit while showing statisticallysignificant reductions in mean cell volume (MCV), mean cell haemoglobin (MCH), mean cell haemoglobin concentration (MCHC), lymphocyte, basophil, platelet volume distribution width (PDW) and red cell distribution widths in comparison to the control group. There was a significant decrease in the PT of test subjects (16.06±1.35 secs) in comparison to the control group (19.63±1.28 secs) while the slight increase in their APTT values was not significant. Conclusion: Thrombotic markers such as increased Red cell markers; RBC, haematocrit and platelet indices; MPV, PCT were increased along with decreased PT levels and prolonged APTT values though not significant can link oral contraceptives medication use to a hypercoagulable state in subjects thereby increasing their risk to venous thromboembolism.

One sip of water with LT-4 supplementation—a key to euthyroidism in Hashimoto’s thyroiditis

PurposeRecommended pharmacotherapy for hypothyroidism in Hashimoto’s thyroiditis (HT) is oral supplementation with levothyroxine (LT-4). However, serum thyrotropin (TSH) levels within normal range are not consistently achieved with LT-4 medication.Patients and methodsWe report on 35 HT patients with LT-4 therapy in this retrospective evaluation. In general, we recommend that a maximum of two sips of water, which would then amount to < 50 mL, be ingested at the same time as LT-4. We report on follow up examinations measuring TSH and antibodies against thyroid peroxidase (TPOAb) after 6 months to five years.ResultsAfter median time of 643 days (range 98-1825) we found in 35 HT patients a statistical significant reduction of serum TSH (p < 0.001) and TPOAb (p = 0.006). The patients median body weight was 71 kg (range 48–98) and a daily LT-4 dosage was used with median 69.1 µg (range 25–150). This results in a daily LT-4 dose of median 1.01 µg/kg bodyweight (range 0.3–2.3).ConclusionsThe reduction of water ingestion to a maximum of two sips, which is <50 mL, combined with LT-4 supplementation helps to achieve euthyroidism in HT. In addition, it reduces the L-T4 medication dosage needed to lower TSH serum levels and decreases TPO antibodies in HT.

Navigating the Incidence of Postoperative Arrhythmia and Hospitalization Length: The Role of Amiodarone and Other Antiarrhythmics in Prophylaxis.

Antiarrhythmic drugs play a pivotal role in managing and preventing arrhythmias. Amiodarone, classified as a class III antiarrhythmic, has been used prophylactically to effectively prevent atrial fibrillation postoperatively in cardiac surgeries. However, there is a lack of consensus on the use of amiodarone and other antiarrhythmic drugs as prophylaxis to reduce the occurrence of all types of postoperative arrhythmias in cardiac and non-cardiac surgeries. A comprehensive PubMed query yielded 614 relevant papers, of which 52 clinical trials were analyzed. The data collection included the class of antiarrhythmics, timing or method of drug administration, surgery type, type of arrhythmia and its incidence, and hospitalization length. Statistical analyses focused on prophylactic antiarrhythmics and their respective reductions in postoperative arrhythmias and hospitalization length. Prophylactic amiodarone alone compared to placebo demonstrated a significant reduction in postoperative arrhythmia incidence in cardiac and non-cardiac surgeries (24.01%, p<0.0001), and it was the only treatment group to significantly reduce hospitalization length versus placebo (p = 0.0441). Prophylactic use of class 4 antiarrhythmics versus placebo also demonstrated a significant reduction in postoperative arrhythmia incidence (28.01%, p<0.0001), and while there was no significant statistical reduction compared to amiodarone (4%, p=0.9941), a lack of abundant data provides a case for further research on the prophylactic use of class 4 antiarrhythmics for this indication. Amiodarone prophylaxis remains a prime cornerstone of therapy in reducing postoperative arrhythmia incidence and hospitalization length. Emerging data suggests a need for a broader exploration of alternative antiarrhythmic agents and combination therapies, particularly class 4 antiarrhythmics, in both cardiac and non-cardiac surgeries. This meta-analysis depicts the effectiveness of amiodarone, among other antiarrhythmics, in postoperative arrhythmia incidence and hospitalization length reduction in cardiac and non-cardiac surgeries.

Combined Treatment of Peri-Implantitis in Patients with Type 2 Diabetes Mellitus

Objective: To evaluate the outcome of combined therapy of peri-implantitis in patients with type 2 diabetes mellitus. Methods: Study included 46 patients with type 2 diabetes mellitus diagnosed peri-implantis. 24 implants with early peri-implantitis, 18 implants with moderate peri-implantitis. The diagnostic parameters used for assessing peri-implantitis include clinical indices, Probing Pocket Depth (PPD), Bleeding on Probing (BOP), peri-implant radiography, data at the re-examination were retrospectively compared to baseline data. Patients underwent treatment with HbA1c levels &lt;7.2% or less than 154 mg/Dl. Results: A statistical significant reduction in both PPD and BOP were seen at all-time points as compared with the baseline clinical measurements. Stable clinical measurements PPD and BOP were demonstrated after 1 year the initial treatment, remaining stable during the following three years. The mean BOP in patients before treatment of peri-implantitis was 2.5 ± 0.31, after 6 months treatment month treatment 0.6 ± 0.1. The mean PPD in patients before treatment of peri- implantitis was 5.2 ± 0.24, after 6-month treatment pocket was 3.2 ± 0.1. Conclusion: Conservative treatment with systemic antibiotics, pocket elimination was an effective therapy in peri-implant mucositis and еarly periimplantitis, when peri-implantitis category moderate surgical treatment combined conservative therapy effective method in patients with type 2 diabetes mellitus.

A study on outcome of hepatic fibrosis in chronic hepatitis B patients on anti-viral therapy

Background: Hepatitis B infection is a global public health problem. Chronic hepatitis B (CHB) infection leads to complications such as cirrhosis, liver failure, and hepatocellular carcinoma. Effective antiviral therapy significantly improves the stages of fibrosis in these patients. Hence, the liver stiffness measurement using transient elastography (Fibroscan) in CHB patients undergoing treatment is important to evaluate the effectiveness of the therapy and to predict the prognosis. Aims and Objectives: To see the outcome of Hepatic Fibrosis by non-invasive measurement in CHB patients after 6 months of oral anti-viral therapy. Materials and Methods: Seventy new CHB patients are included in a prospective hospital-based study and at the end of 6 months 53 patients were analysed. Results: Our study showed a significant statistical reduction in Liver Fibrosis as well as improvement of serological and biochemical parameters in CHB patients. Conclusion: There is liver fibrosis reversal in CHB patients after 6 months of anti-viral therapy and Fibroscan helps not only as a marker for initiation of treatment depending on the degree of fibrosis but also indicates the response or progression of the disease.

Reducing diabetes burnout syndrome using self-instructional training

Patients with type 2 diabetes mellitus (T2DM) experienced diabetes burnout, which influences the patient’s daily living. Some treatments had been introduced to reduce this burnout, but self-instructional training method remained unknown for its effectiveness. This study was aimed to analyse the influence of self-instructional training toward diabetes burnout syndrome. This research was a quasy-experimental study involving patients with diabetes mellitus type 2. About 72 respondents were chosen using purposive sampling. This study divided the respondents into control and treatment groups. The treatment group gained self-instructional training in 4 meetings. Data was obtained from pre-test and post-test using diabetes burnout scale questionnaire and analysed with Paired T-test and Independent T-test. Study results showed that the treatment group had a significant decrease in diabetes burnout (severe to low level) (p=0.000). Diabetes burnout score among treatment group was lower compared to the control group (24.69±4.73; 19.19±4.24). In the control group, there was no significant statistical reduction about diabetes burnout (p=0.110). Besides, this study presented the difference diabetes burnout syndrome between treatment and control group (p=0.000; p&amp;lt;0.05). This study showed self-instructional training could minimize the occurrence of diabetes burnout syndrome among T2DM patients. This method has been proven to influence patient’s behaviour positively.

Label extension, single-arm, phase III study shows efficacy and safety of stempeucel® in patients with critical limb ischemia due to atherosclerotic peripheral arterial disease

BackgroundPeripheral arterial disease (PAD) of lower extremities comprises a clinical spectrum that extends from asymptomatic patients to critical limb ischemia (CLI) patients. 10% to 40% of the patients are at the risk of primary amputation. This study was planned in “no-option” patients of CLI due to atherosclerotic PAD to assess the efficacy and safety of pooled, allogeneic, adult human bone marrow-derived mesenchymal stromal cells which is already approved for marketing in India for CLI due to Buerger’s disease.MethodsThis was a single-arm, multi-centric, phase III study where mesenchymal stromal cells was injected as 2 million cells/kg body weight in the calf muscle and around the ulcer. Twenty-four patients of lower extremity CLI due to PAD with Rutherford III-5 or III-6 and ankle–brachial pressure index ≤ 0.6 and having have at least one ulcer with area between 0.5 and 10 cm2 were included in the study. These patients were evaluated over 12 months from drug administration.ResultsOver a period of 12 months, statistical significant reduction of rest pain and ulcer size along with improvement in ankle–brachial pressure index and ankle systolic was observed. The quality of life of patients improved together with increase in total walking distance and major amputation-free survival time.ConclusionMesenchymal stromal cells may be a feasible option to treat “no-option” patients with atherosclerotic PAD.Trial registration This study is registered prospectively in National Institutes of Health and Clinical Trials Registry—India (CTRI) website: CTRI/2018/06/014436. Registered 6th June 2018. http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=24050&EncHid=&userName=stempeutics.

Effects of FIFA 11+ injury prevention program in reducing the Non-Specific knee injuries incidence rate among soccer players. A systematic review and meta-analysis

Soccer players most frequently suffer from severe leg injuries, particularly effecting the knee. Soccer players worldwide, of all ages, genders, and levels of expertise, frequently encounter with knee injuries. These injuries have a negative influence on physical activity and lost workdays, as well as high medical expenses. Therefore, it is imperative to assess the effectiveness of various injury prevention programs in lowering the number of knee injuries related to soccer. The main aim of this study is to assess the potential effects of Federation Internationale de Football Association (FIFA) 11+ injury prevention program in reducing the non-specific knee injuries in soccer players. Methodology: A systematic search was conducted in the PubMed, PubMed Central, Cochrane central library, Ovid Medline, Worldwide science (Organization), and APA Psycnet databases from February 2002 to February 2022. A total of 65,232 records were in databases, with 98 records from organizations, and after removing duplicate entries and completing the screening procedure, this meta-analysis included three cluster randomized control trials with 3,833 participants that matched our inclusion criteria. The major criteria for inclusion and exclusion were randomized control trials that used the FIFA 11 + injury prevention program for not less than 6 months and reported the overall incidence rate of knee injuries without addressing individual knee injuries. Results: The FIFA11+ injury prevention program was found to be effective based on total injuries per 1000 hours of exposure, according to pooled statistics. There was significant statistical reduction in knee injury risk ratio (IRR) of 0.477 (95% confidence interval (CI), 0.367- 0621 p=0.000). Teams using FIFA 11+ injury prevention program demonstrated up to 47% of reduction in knee injuries as compared to the control group which performed usual warm up exercises as intervention. Conclusion: This comprehensive review and meta-analysis show how effective the FIFA 11+ injury prevention program is at preventing non- specific knee injuries in soccer players. This protocol is registered in international prospective register of systematic reviews PROSPERO (CRD42022298748).

Highly porous phosphate-based glasses for controlled delivery of antibacterial Cu ions prepared via sol-gel chemistry.

Mesoporous glasses are a promising class of bioresorbable biomaterials characterized by high surface area and extended porosity in the range of 2 to 50 nm. These peculiar properties make them ideal materials for the controlled release of therapeutic ions and molecules. Whilst mesoporous silicate-based glasses (MSG) have been widely investigated, much less work has been done on mesoporous phosphate-based glasses (MPG). In the present study, MPG in the P2O5-CaO-Na2O system, undoped and doped with 1, 3, and 5 mol% of Cu ions were synthesized via a combination of the sol-gel method and supramolecular templating. The non-ionic triblock copolymer Pluronic P123 was used as a templating agent. The porous structure was studied via a combination of Scanning Electron Microscopy (SEM), Small-Angle X-ray Scattering (SAXS), and N2 adsorption-desorption analysis at 77 K. The structure of the phosphate network was investigated via solid state 31P Magic Angle Spinning Nuclear Magnetic Resonance (31P MAS-NMR) and Fourier Transform Infrared (FTIR) spectroscopy. Degradation studies, performed in water via Inductively Coupled Plasma-Optical Emission Spectroscopy (ICP-OES), showed that phosphates, Ca2+, Na+ and Cu ions are released in a controlled manner over a 7 days period. The controlled release of Cu, proportional to the copper loading, imbues antibacterial properties to MPG. A significant statistical reduction of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) bacterial viability was observed over a 3 days period. E. coli appeared to be more resistant than S. aureus to the antibacterial effect of copper. This study shows that copper doped MPG have great potential as bioresorbable materials for controlled delivery of antibacterial ions.

Chronic Plantar Fasciitis: Comparison of Ultrasonic Guided Percutaneous Fasciotomy vs New Technique Combining Fasciotomy with Amniotic Membrane Allograft

Category: Basic Sciences/Biologics Introduction/Purpose: Plantar fasciitis is a common condition affecting approximately one in ten people in their lifetime. Treatment is typically conservative and symptoms are self-limiting. Operative treatment is indicated in recalcitrant cases. Minimally-invasive partial plantar fasciotomy can be performed using ultrasound-guided percutaneous techniques and is an attractive alternative to traditional surgery. Methods: A retrospective review was performed on consecutive patients who underwent either an ultrasound-guided fasciotomy or a combined percutaneous fasciotomy with a flowable amniotic matrix allograft. All ultrasound-guided percutaneous fasciotomy procedures were performed using the Tenex TX2 cutting device. Human amniotic allograft consisted of an injection of 0.5 mL of a flowable placental tissue matrix. Outcomes were assessed at short-term (2, 8, and 16 weeks) and long-term follow-up (26 and 52 weeks). Results: Both groups demonstrated a significant reduction in pain from baseline after the respective interventions and demonstrated a high level of patient satisfaction. The only significant difference in the 2 groups was at short-term follow-up in which the percutaneous fasciotomy with the amniotic membrane allograft (n=12) showed a statistically-significant reduction (p&lt;0.05) in pain when compared to the fasciotomy alone group (n=11). There was no difference between the 2 groups at long- term follow-up. Conclusion: Treatment of chronic plantar fasciitis using ultrasound-guided fasciotomy is an attractive alternative to traditional surgery. Ultrasound-guided fasciotomy did improve pain from baseline with high level of patient satisfaction. Furthermore, the combination of percutaneous fasciotomy with a flowable amniotic matrix allograft may provide a greater reduction in pain earlier in the post-operative period, but does not seem to alter the long-term outcome of the procedure. More subjects are needed to possibly detect long-term effects.

Obesity - a chronic disease requiring treatment

The globally increasing prevalence of obesity represents a key medical and socioeconomic challenge. Due to related comorbidities and complications such as arterial hypertension, diabetes mellitus, fatty liver disease, and arteriosclerosis, obesity leads to a significant statistical reduction in lifespan. Currently, bariatric surgery is the most effective approach to manage body weight and comorbidities while lifestyle intervention as basic obesity therapy and medical treatment often do not lead to sufficient and sustainable weight loss. However, recent medical approaches show now promising effects on weight control and might close the gap towards bariatric surgical procedures. For instance, semaglutide has been approved by EMA in January 2022 for medical treatment of obesity concomitant to basic lifestyle therapy in adults with a BMI of ≥ 30 kg/m2 or ≥ 27 kg/m2 and weight-related comorbidity. Apart from weight control, improvement in cardiometabolic risk factors can be achieved with this treatment. Moreover, other drugs, mostly based on incretin mono- or multiagonism, are currently developed and may open further effective treatment options for obesity and its complications in the near future.On a health political level, first steps for the development of a structured treatment program (DMP) for obesity are in progress to enable early guideline-based and structured treatment of obesity, and to prevent the obesity associated complications.

Preliminary Results of a Prospective Clinical and Radiological Study with Roentgen Stereophotogrammetric Analysis (RSA) after Implantation of a Posterior Dynamic Stabilization Device in the Lumbar Spine

Introduction: Posterior dynamic stabilization (PDS) can be based on interspinous distraction devices (IDD). The goals of these implants are maintaining or restoring intervertebral range of motion (ROM) in a controlled fashion and avoiding a complete restriction of mobility. Clinical and radiological data with the Wallis® spacer as one type of IDD have been rarely reported. The goal of this study was to present clinical and radiological data including roentgen stereophotogrammetric analysis (RSA) after a short- to mid-term follow-up period.&#x0D; Patients and Methods: 10 patients were included in this prospective monocentric study and had PDS of the lumbar spine with an IDD (Wallis® spacer). Before and soon after operation and 3, 6, and 12 months later clinical and radiological evaluations were performed. Pain and disability were analyzed by use of visual analog scale for back and leg pain, Oswestry Disability Index, Roland-Morris Disability Questionnaire and Short-Form-36 Health Survey. The ROM of the operated levels and the total lumbar spine was determined by use of lateral functional x-ray images with calculation of the differences of the segmental and total lumbar spine angles in flexion and extension. Furthermore, RSA was used to measure the segmental ROM.&#x0D; Results: After a follow-up of 12 months, the results of the pain intensity and the disability and health related quality of life scores showed statistical significant improvement. The segmental angles of the operated levels demonstrated statistical significant reduction in ROM during the different follow-up examinations. The discrepancy of the conventionally determined segmental angles and the data measured by RSA were low with a mean of 1.77°. The mean total lumbar spine angles did not change statistically significantly during the postoperative controls.&#x0D; Conclusions: According to the radiological results of this study, the used implant leads to a posterior dynamic stabilization. The clinical findings are promising, but they are to be interpreted with caution because of the small number of patients and the lack of a control group.

Impact of Physical Activity on Gestational Weight Gain in Overweight and Obese Pregnant Women: A Meta-Analysis

Background: Regular physical activity and exercises play an important role in a healthy pregnancy in overweight and obese women. Objective: To investigate the effect of exercise parameters (frequency, duration and intensity) and Physical Activity (PA) on maternal Gestational Weight Gain (GWG) in overweight and obese pregnant women. Methods: PubMed and Cochrane database were used to locate the literature; randomized controlled trials comparing PA with standard care on combined overweight and obese pregnant women, published in English language from January 2011 to March 2020 were selected. PA interventions, including walking, aerobic and resistance exercise either alone or in combination compared with standard care during pregnancy in overweight and obese pregnant women were screened. Mean Difference (MD) with 95% Confidence Interval (CI) between the intervention and standard care for GWG was calculated. Results: Twelve studies with 1667 pregnant women were included. The result showed a statistically significant reduction of GWG in the PA group as compared to the standard care (MD 0.99 kg, p&lt;0.00001 &amp; I2=25%). Overweight and obese pregnant women who performed exercises for the duration of 45-60 minutes/session (MD -1.01 kg, P=0.0008 and I2=61%), a frequency of 3 times/week (MD -1.19 kg, P=0.0002 and I2=58%) and light to moderate intensity (MD -1.37 kg, P&lt;0.0001 &amp; I2=62%), reported good weight control during pregnancy as compared with standard care group. Conclusion: There was a statistically significant reduction in GWG in overweight and obese pregnant women. Owing to the promising results shown by exercise intervention and PA in maternal weight control, these interventions should be used as a tool for managing weight gain during pregnancy as routine care.

Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty.

One of the most important challenges faced by orthopedic surgeons is periprosthetic joint infection (PJI). PJI is a common cause for total joint arthroplasty failure with an incidence of 0.3-1.9%. PJI can be devastating for the patient and extremely costly for the healthcare system. There is concern that a major cause of PJI is intra-operative colonization and recent studies have shown a decrease in PJI with the use of dilute povidone-iodine (Betadine®, Avrio Health L.P, Stamford, CT) irrigation prior to wound closure. This study presents our experience with the use of dilute Betadine® irrigation prior to wound closure and its effect on our post-operative hip and knee arthroplasty acute infection rate. Retrospective chart review performed at our hospital looking at PJI amongst patients who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2013 and 2017 comparing different irrigation methods (n = 3232). The study group (n = 1207) underwent irrigation prior to wound closure with dilute Betadine for 3min and the control group (n = 1511) underwent irrigation using normal saline (NS). Using a logistic regression model where the following variables were adjusted for; ASA, age, sex, foley insertion, surgical duration and diabetes mellitus status a statistical significant reduction was seen in any infection (OR 0.45 [0.22; 0.89], p value < 0.05) and SSI (OR 0.30 [0.13; 0.70], p value 0.01) with the Betadine group. No significant reduction was seen with deep infections with the Betadine group compared to the NS group. PJI is a devastating complication following total joint arthroplasty and we found Betadine compared to NS irrigation provides an inexpensive and simple method to lower any PJI and more specifically SSI in THA and TKA. III.

Evaluating the Therapeutic Effects of Wet Cupping (Al-Hijamah) on Hematological Parameters, Kidney Function Tests and Lipid Profile in Adult Women

The purpose of this study is to evaluate the role of wet cupping in improving the kidney function tests, hematological parameters and lipid profile in adult women. Blood samples were collected and used for measuring uric acid, creatinine, urea, glucose, triglyceride, cholesterol, HDL cholesterol, LDL cholesterol and complete blood cell (CBC) counts. The necessary calculations were done to estimate the unmeasured parameters. The study subjects for body mass index showed that most of these women were overweight to obese. After about 2 weeks of doing wet cupping, 92% of the individuals were feeling good as compared with their condition before performing of wet cupping. The results have shown a significantly increased in the percentage of lymphocytes and platelets count due to blood cupping. Alongside, the results have revealed that creatinine and urea levels were significantly reduced post-cupping as compared to values seen in pre-cupping. Additionally, statistical significant reduction was observed in the triglyceride levels and triglyceride/HDL-cholesterol and LDL/HDL-cholesterol ratios in the women after cupping in comparison to that seen cupping. It can be concluded that wet cupping as a one of the traditional medicine can be safely used for reducing the risks of kidney disorders and cardiovascular diseases risks.

The Efficacy and Safety of Ketogenic Diets in Drug-Resistant Epilepsy in Children and Adolescents: a Systematic Review of Randomized Controlled Trials.

Drug-resistant epilepsy represents around one-quarter of epilepsies worldwide. Although ketogenic diets (KD) have been used for refractory epilepsy since 1921, the past 15years have witnessed an explosion of KD use in the management of epilepsy. We aimed to review evidence from randomized controlled trials (RCTs) regarding the efficacy and safety of KD in drug-resistant epilepsy in children and adolescents. A literature search was performed in the Pubmed, Cohrane, Scopus, ClinicalTrials.gov, and Google Scholar databases. Predefined criteria were implemented regarding data extraction and study quality. Data were extracted from 14 RCTs in 1114 children and adolescents aged from 6months to 18years. Primary outcome was seizure reduction after the intervention. In 6 out of the 14 studies, there was a statistical significant seizure reduction by > 50% in the KD-treated group compared with the control group over a follow-up of 3-4months. Secondary outcomes were adverse events, seizure severity, quality of life, and behavior. Gastrointestinal symptoms were the most frequent adverse events. Serious adverse events were rare. We conclude that the KD is an effective treatment for drug-resistant epilepsy in children and adolescents. Accordingly, RCTs investigating long-term impact, cognitive and behavioral effects, and cost-effectiveness are much anticipated.

Assessment and Comparison between Cervical Retraction Exercise and Muscle Energy Technique on Cervical Joint Position Sense in Individuals with Forward Head Posture

Background: Forward Head posture (FHP) one of the most common postural disorder causes a change in the biomechanical movement, affect the length---tension relationship in the cervical muscles, increase muscular activity level and impair cervical proprioception. Cervical Retraction and Muscle Energy Technique (MET) have been proposed to improve joint proprioception. Objective: To assess and compare the effect between Cervical Retraction and Muscle Energy Technique on cervical joint position sense in individuals with forward head posture using head repositioning test. Method: This is a comparative study where 60 subjects were selected as per inclusion and exclusion criteria and assigned to Group A (n=30; Cervical Retraction) and Group B (n=30; Muscle Energy Technique) respectively. Proprioceptive exercises were given to both the groups. The intervention was given for 2 weeks-3 sessions per week. Error in Cervical Joint Position sense was assessed pre and post intervention using Head Repositioning Accuracy test. The data was collected and statistically analysed. Results: The study showed statistical significant reduction (p&lt;0.05) in error in cervical joint position sense within the groups as well as between the groups for all the physiological movement (Flexion, Extension, Left Rotation and Right Rotation). Conclusion: Cervical Retraction as well as Muscle Energy Technique can be used to improve Cervical Joint position sense. However, Cervical Retraction is better as compared to Muscle Energy Technique. Keywords: Forward head posture, Cervical Joint Position sense, Cervical Retraction, Muscle Energy Technique, Head Repositioning Accuracy test.