akram ghahghaei-nezamabadi

Uterine fibroids are one of the most common benign tumors that cause abnormal bleeding and pain in women of reproductive age. One of the objectives of this study is to evaluate the effect of cabergoline drug on the size and volume of uterine bleeding as well as menopausal symptoms in women with uterine myomas.

This double-blind clinical trial was conducted among 80 women with fibroid myomas and Abnormal Uterine Bleeding (AUB). The participants were allocated to two groups after random allocation. Group I received Cabergoline, 1 tablet (0.5 mg/w) orally once a week for 3 months. Group II obtained a placebo tablet (0.5 mg/w), taken at the same time. 

80 patients were included in the study (40 patients in the control group and 40 patients in the cabergoline treatment group). No statistically significant difference was observed between the two groups in terms of age, number of pregnancies, number of births, body mass index, uterine myoma characteristics, myoma type, myoma volume, and myoma number. A 37% decrease in myoma size was observed in the cabergoline recipients, as well as a 25% decrease in the placebo group, which is not statistically significant (p-value >0.05).

Cabergoline drug reduces the volume of bleeding and the number of uterine myomas, but this reduction is not statistically significant and requires more studies in this field.

Considering the prevalence of Human Papillomavirus (HPV) infection and the lack of HPV vaccination program in Iran among young women and the importance of quality of life and sexual performance in women, we decided to conduct a study to examine the relationship between HPV infection and sexual dysfunction and quality of life in Iranian women.

In this cohort study, 250 married women who infected with HPV were recruited via convinence sampling from colposcopy clinic of Arash women hospital (Tehran, Iran) from April 2020 to May 2022.They were evaluated concerning their sexual function in the domains of desire, arousal, lubrication, orgasm, satisfaction and pain with the female sexual function index (FSFI) questionnaire (the total FSFI score is calculated by the sum of the nineteen items). Sexual quality of life-female (SQOL-F) items (Likert-type scale with a cut-off of 65 points) were organized into four sub-scales: psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression. All patients filled out the female sexual function index (FSFI) and sexual quality of life (SQOL) questionnaires. Variables were analysed via correlation coefficient and linear regression tests.

Mean age and mean marriage duration were 38.5±4.5 and 12.2±7.2, respectively. There was a weak correlation between FSFI and SQOL (r=0.15, p=0.001).Time of marriage and genital warts were the predictors on the FSFI and SQOL.

The findings suggest that HPV infection can impair sexual function and quality of life. This research contributes valuable insights, especially considering the prevalence of HPV.

The study aims to determine the adverse effects of a mild COVID-19 infection on maternal and neonatal outcomes in pregnant women living in the eastern part of Tehran. In this prospective cohort study, we followed two groups of pregnant women until term and their pregnancy and neonatal outcomes. RT-PCR (reverse transcriptase polymerase chain reaction) positive tests of nasopharyngeal swabs were confirmed in one group, where at least three signs and symptoms associated with COVID-19, and/or chest CT scans identified highly specific findings for the disease were present. The control group is composed of healthy pregnant women tested negative for COVID-19. The study included 319 pregnant women (108 with mild COVID-19 infection and 211 healthy). A higher percentage of mothers with mild COVID-19 infection had preterm births (47.9% vs. 30%, p=0.007), and their neonates required hospitalization more often (45.8% vs. 22.6%, p<0.001). PTB was positively associated with maternal hypertension (relative risk (RR): 5.40), mild COVID-19 infection (RR: 2.05), and older age (RR: 1.05). Among the risk factors for neonatal hospitalization, PTB (RR: 5.94), maternal hypertension (RR: 2.74), and mild COVID-19 infection during pregnancy (RR: 2.57) were significant. The outcomes of pregnancy are significantly impacted by maternal infection with COVID-19, even if it is mild. Preterm births are more likely to happen in mothers with mild COVID-19 infection, and neonates need more hospitalizations.

 Immunosuppression, HPV persistence, and smoking are the main-related risk factors of Cervical Intraepithelial Neoplasia (CIN) recurrence. However, age as a basic factor may be a main factor related to CIN recurrence. Therefore, our study aimed to detect the potential role of women's age in CIN recurrence.

 This cross-sectional study was conducted on 329 patients who underwent conization in the gynecology-oncology clinics of Arash and Imam Khomeini hospitals affiliated with Tehran University of Medical Sciences between March 2016 and March 2021.

 Totally, 329 cases were enrolled in the study. Most women were in their thirties. CIN recurrence was about 10.0% (32 cases). The CIN recurrence rate was 8.9% in women younger than 30, 10.2% in 30-40, 11.3% in 40-50, and 5.6% in 50–60 decades. There was no significant (p-value=0.802) difference in recurrence rate among age groups. There was a significant (p-value=0.023) difference in the frequency of endocervical involvement regarding age category, women aged 40 to 50 had the most frequent marginal involvement with 26.8%, while there was no significant (p-value=0.802) difference in frequency of marginal involvement regards age category.

 CIN cases with age higher than 40 years need to have more caution and tight follow-up visit after conization.

This study aimed to evaluate the effect of random biopsy and endo-cervical curettage (ECC), alone and together, in the diagnosis of high-grade cervical lesions in women with normal colposcopy.

This cross-sectional study was conducted on 356 women who underwent colposcopy examination in the gynecology-oncology clinic of Roointan-Arash Women’s Hospital, affiliated with Tehran University of Medical Sciences. All eligible women underwent colposcopy. In colposcopy examination, up to four biopsy samples were randomly taken for each quartile of the cervix and ECC was performed. Finally, the rate of intraepithelial neoplasia (CIN) and the relation between random biopsy and ECC and CIN diagnosis was determined.

In total, 27 (7.6%) low-grade squamous intraepithelial lesions (LSIL) and 19 (5.3%) high-grade squamous intraepithelial lesions (HSIL) were detected in cases that underwent random biopsy. There was a significant association between the abnormal random biopsy results and having multiple sexual partners (p=0.001), cigarette (p=0.041), and hookah (p=0.033) smoking. Furthermore, 31 (8.7%) LSIL and 42 (11.8%) HSIL were reported in women who underwent ECC. There was a significant relation between the abnormal results of ECC and hookah consumption (p=0.008) and human papillomavirus (HPV) infection (p=0.011). The concordance (p=0.001) between random biopsy and ECC result was 71.2% and only in 28.8% of the cases one of the methods was normal and the other was abnormal.

The present study showed that the simultaneous use of ECC and random biopsy in women with normal colposcopy increases the detection rate of precancerous lesions by up to 28.8%.

Gestational trophoblastic neoplasia (GTN) is a rare neoplasm and is a spectrum of proliferative disorders of placenta. Invasive mole is a subtype of GTN that almost always arises after molar pregnancy. This report presents a 35-year-old woman with an atypical presentation of invasive mole after a normal pregnancy. The patient presented with a complaint of vaginal bleeding after normal vaginal delivery. Invasive mole was diagnosed based on findings of imaging and elevated beta human chorionic gonadotropin (ß-hCG) levels. Hysterectomy was finally decided upon due to severe vaginal bleeding and the patient’s request. Although GTN occurs after normal delivery, the patient recovered without receiving chemotherapy. It is important to consider all subtypes of GTN as a differential diagnosis of patients with abnormal postpartum bleeding and elevated ß-hCG levels even after a normal pregnancy.

Dual oxidases (DUOX1, DUOX2) belong to the NADPH oxidase (NOX) family, which produce H2O2 necessary for thyroid hormone biosynthesis. This study aims to evaluate gene expression for DUOX1, DUOX2 in PCOS patients and its relation with thyroid hormone and magnesium levels.

Totally 88 cases were studied including 24 people with PCOS and hypothyroidism, 44 people with PCOS and normal thyroid function, and 20 hypothyroid patients without PCOS. In comparison 40 healthy controls in the age group of 16-35 years matched for age group and BMI were evaluated. Using Vegaro syringe 5 cc of blood was sampled from all 128 people and after RNA extraction and cDNA synthesis using Real-Time PCR technique, the expression level of DUOX1 and DUOX2 genes was investigated.

The results of hormonal tests showed that there is a significant difference between the level of T4, T3, and TSH hormones in hypothyroid patients with or without PCOS in comparison to the control group. Regarding the level of Mg, the results showed that there is a significant difference between the levels of Mg in PCOS group with or without hypothyroidism in comparison to the control group. Gene expression results showed that the relative changes of DUOX1 gene expression in different groups compared to the control group were significantly reduced P<0.05. In the polycystic group with hypothyroidism, the gene expression level showed a decrease compared to the normo-thyroid polycystic group and the hypothyroid non-PCO group, which was statistically significant P<0.05.

According to the results of the present study and the previous studies that have been published in the field of Duox1, it can be assumed that the reduction of Duox1 expression can interfere with the oxidative stress system. Further studies with other molecular techniques may help to understand the exact action mechanism of these genes.

In Iranian traditional medicine, donkey dung, known as "Anbar-Nesara" is used for its antimicrobial and antiallergic properties. Incorrect medical beliefs can lead to the incorrect use of complementary medicine and the creation of unnecessary harmful effects. Although there have been many reports about the traditional medical benefits and the use of Anbar-Nesara, we describe a woman with severe wound infection following surgical and administration of Anbar-Nesara smoke.

We compared two different methods of visual inspection of the cervix, including Visual inspection of the cervix with acetic acid (VIA) and Visual inspection of the cervix with Lugol's iodine (VILI) in terms of sensitivity and specificity in diagnosis of pre-malignant cervical lesions in comparison to colposcopy guided biopsy.

In this cross-sectional study, a total number of 200 women who were referred to the colposcopy clinic of Arash women’s hospital (Tehran, Iran) for cervical cancer screening, underwent VIA, VILI, and colposcopy guided biopsy during 2018-2019.

 The calculated sensitivity and specificity of VIA and VILI in this population were (100% and 69.5%) and (100% and 60%), respectively, whereas the sensitivity and specificity of both VIA and VILI tests in combination were 100% and 77.2%. The positive and negative predictive values were 32.7% and 100%, respectively, when combined form of VIA and VILI was applied in this population.

VIA and VILI alone or in combination could be used as screening tests to evaluate the presence of cervical cancer and in case of positive results, supplementary tests such as colposcopy guided biopsy could be performed for definite diagnosis.

Borderline oligohydramnios always produces a dilemma of management and counseling among obstetricians. This study was designed to compare the effect of sildenafil plus fluid therapy versus fluid therapy alone on pregnancy outcomes and AFI improvement in pregnant women complicated by idiopathic borderline oligohydramnios.

This randomized clinical trial was conducted in Arash Women’s Hospital, Tehran, Iran from 2017 to 2020.  Fifty-one pregnant women with idiopathic borderline oligohydramnios were allocated to two groups. Group 1 received fluid therapy and Group 2 received fluid therapy and Sildenafil 25 mg three times daily for six weeks. AFI was measured at the time of randomization, 24 h after treatment and then weekly for six weeks. The changes in AFI, type of delivery, gestational age at delivery, and neonatal outcomes were compared between the two groups.

After the intervention, the change in AFI between two groups was not statistically significant. Maternal and fetal outcomes are compared between two groups and there was no significant difference between them. The median (Inter-quartile range) AFI after intervention, in Sildenafil group compared with hydration group, were in 24 hours (8.5 vs. 8, p=0.27), first (9.5 vs. 9.1, p=0.74), second (9 vs 10, p=0.12) third (10.4 vs. 9.4, p=0.33), fourth (10.8 vs 9.1, p=0.1) and Fifth week (10 vs 9.3, p=0.5) of follow-up respectively, but none of them were statistically significant.

The findings showed that sildenafil plus fluid therapy do not improve the pregnancy outcomes in women with isolated borderline oligohydramnios compared to fluid therapy alone.

Ovarian cancer is the fifth leading cancer-related cause of death in women worldwide and is often diagnosed at advanced stages. Regarding the low sensitivity and specificity of the currently available diagnostic techniques, in the present study, we aimed to evaluate the accuracy of RMI and ROMA indexes and comparing these two indexes with CA-125 and HE4 parameters for the diagnosis and differentiation between benign and malignant ovarian tumors. Also, we determined the optimal cut-off level of these markers in patients who attended Arash Women’s Hospital.

In this cross-sectional study, we included 137 women with ovarian mass who were attended the gynecology clinic of Arash Womenchr('39')s Hospital, Tehran, Iran (April 2017-April 2019), and were eligible according to the inclusion criteria. We included patients with an adnexal mass over 3 cm. Our exclusion criteria were as the following: pregnancy, age under 18 and over 90 years, taking hormonal agents, renal failure, suspected ovarian torsion, ovarian cancer and taking antibiotics, nitric oxide compounds, and heavy metals. Based on serum CA125, HE4, and ultrasound findings, ROMA and RMI indexes were determined for each patient, and the sensitivity and specificity of HE4, RMI, ROMA, and CA125 were compared with the result of the operative histopathologic assessment.

According to the area under the ROC curve, regardless of the patientschr('39') menopausal status, the highest diagnostic value was dedicated to RMI with 89% under the curve area and 95% confidence interval (81.6-96.4%). Diagnostic values of other markers were as the following: 87.7%(95%CI=80.3-95%) for HE4, 87.3(95%CI=79.1-95.4%) for CA125, and 86.2%(95%CI=78.7-93.6%) for ROMA. In terms of menopausal status, HE4 had the highest diagnostic value in premenopausal patients, while in the menopausal group CA125 had the highest diagnostic value.

Measurement of HE4 before menopause and CA125 during menopause seems to be helpful in the early detection of ovarian cancers in women with ovarian masses.

Context: Ovarian cancer is the most fatal gynecological malignancy with no effective screening strategy for early detection. As most cases are being detected in advance stages, conventional therapies are not beneficial for the majority of patients. Cancer-testis antigens (CTAs) are a group of tumor associated antigens with specific expression pattern in cancers which potentiate them for application as cancer biomarkers and targets for immunotherapy.
Evidence Acquisition: We performed a computerized search of the MEDLINE/PUBMED databases with key words: ovarian cancer, cancer-testis antigen, biomarker and immunotherapy.
Thirty five CTAs have been shown to be expressed in ovarian cancer. At least 13 of them have been shown to elicit immune responses in different studies. The pattern of expression for some of them may facilitate molecular classification of different histologic classes of ovarian cancer. In addition, some CTAs such as NY-ESO-1 and MAGE have been used as targets for immunotherapeutic approaches with promising results.
The expression pattern of CTAs in ovarian cancer and the preliminary results of clinical trials indicate that CTAs can be used as targets for immunotherapy of ovarian cancer patients.

Embryonal (Botryoid) Rhabdomyosarcoma (RMS) is an aggressive malignancy that arises from embryonal rhabdomyoblasts. It is commonly seen in the genital tract of female infants and young children. The primary site of these tumors is closely related to the age of the patient. Embryonal Rhabdomyosarcoma has a marked tendency for local recurrence after excision. Due to young age of affected patients who desire fertility, the management of this rapidly growing malignancy is very critical and poses challenges.

We report on two cases embryonal rhabdomyosarcoma of uterine cervix, who were referred to Imam Khomeini hospital during year 2014. Both of them were young virgin females. The presenting symptom for both was vaginal bleeding and protrusion of polypoid mass from the hymen. After neoadjuvant chemotherapy, radical hysterectomy was offered to them. One of them refused, thus local excision was done. Both patients received adjuvant chemotherapy yet in the patient with local excision, the tumor recurred with multiple metastases.

There are several methods of surgical approach and variation in adjuvant therapy in the management of embryonal rhabdomyosarcoma. If we choose a conservative approach for surgery of early stage, surgical margin should be negative and in other cases doing radical surgery is the best.

General concern is that the pregnancy rate is higher with GnRH-agonist as a protocol of pituitary suppression. GnRH-antagonist protocol provides a shorter period of administration and an easy flexible protocol. In this study, the outcomes of GnRH agonist and antagonist in ICSI cycles are compared in normo responder patients. In this randomized clinical trial, 300 normoresponders undergoing ICSI were randomly divided to GnRh agonist (n=150) and GnRh antagonist (n=150) groups. The main outcome measurements were chemical, clinical and ongoing pregnancy rates (PR). The mean duration of stimulation were 9.6±1.6 and 8.2±1.6 days in agonist and antagonist groups respectively (p=0.001). The mean number of MII oocyte retrieved in agonist and antagonist groups were 7.7±4.0 and 6.9±4.3 respectively (p=0.03). There was no significant difference between two groups regarding mean number of gonadotrophin ampoules, follicles, occytes, total embryos and good quality embryos, OHSS incidence, and abortion rate. Chemical pregnancy rate was 35.3% in agonist and 39.3% in antagonist group. Clinical pregnancy rate was 35.3% in agonist and 34% in antagonist group. Ongoing pregnancy rate was 45 (31.3%) in agonist and 44 (29.3%) in antagonist group. There was no significant difference between two groups in pregnancy rates. In this study antagonist protocol was shown to be an easy, safe and friendly protocol in Iranian normoresponder patients, having similar outcomes with standard agonist protocol but shorter period of stimulation.