فهرست مطالب tahereh poordast

The lack of improvement in some endometriotic people’s pain after surgery even while using hormone treatment may suggest an inappropriate response to routine hormonal therapies.

This study aimed to determine a cut-off point for selecting the most appropriate treatment based on the hormone receptors of endometriotic lesions.

In this cross-sectional study, by reviewing the medical records of participants and testing their archive samples and phone interviews (if needed), 86 symptomatic women after endometriosis surgery who were operated into governmental hospitals, Shahid Faghihi and Hazrate Zeinab Shiraz Iran were enrolled between March 2017 and March 2019. Women were divided into 2 groups: responsiveness (n = 73 for dysmenorrhea, n = 60 for dyspareunia) to medical treatment and surgery, and unresponsiveness (n = 13, n = 7). We examined the pathological slides of 86 women to determine the amount of hormone receptors and the relationship between the type of medical treatment and the level of hormone receptors on pain relief within 1 yr after surgery.

Based on the receiver operating characteristic curve, dysmenorrhea in the presence of tissue estrogen receptors > 60% (p = 0.1065), and dyspareunia in the presence of tissue progesterone receptors > 80% (p = 0.0001) responded well to medical treatment after surgery. In the presence of endometrioma-dysmenorrhea showed the best response to oral contraceptive pills (69.4%), while in deep infiltrative endometriosis-dyspareunia showed the best response to progesterone treatment (75%).

Prescribing an appropriate hormone therapy based on a specific immunohistochemistry staining pattern can improve the life quality of postoperative endometriosis individuals.

The endometriosis treatment was critical due to complications associated with current drug delivery system. The present study was conducted with aim to compare the curative effect of Vitamin D3 (VTD3) and Omega–3 (OG3) with Diphereline during the treatment of endometriosis.

In this study, endometriosis was induced in different groups containing 60 adult female rats. The rat model was categorized into 6 groups untreated and treated (Olive Oil (solvent), VTD3 (42 mcg/kg/day), OG3 (450 mg/kg/day), VTD3+OG3, Diphereline (3 mg/kg/day)). The suspension containing combination of Diphereline and supplements was injected and treated for 4 weeks to analyze the effect of supplements. The interleukin -6 (IL-6) and Tumor necrosis factor – alpha (TNFα) inflammatory responses were measured from the serum samples while endometrial implants was dissected and histopathological investigation was done.

At the end of four weeks, pathologic score decreased significantly with simultaneous measurement of inflammation score of endometriotic lesion, size of implant area, IL-6, TNFα response and compared with untreated female rat. No significant different was observed in groups undergoing treatment of VTD3, OG3 and Diphereline. The combined effect of VTD3+OG3 has similar responses with Diphereline treated endometrial implants.

treatment of VTD3 deficiency and making a change in dietary habits of high-risk population for endometriosis from adolescence may also play a preventative role in adulthood.

Ectopic pregnancy (EP) is one of the major causes of maternal mortality during the first trimester of pregnancy.

Four treatment methods for EP including single-dose methotrexate (SD-MTX), double-dose methotrexate, expectant and surgical management were considered.

In this cross-sectional study, the clinical characteristics of 365 women aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017 to March 2019 in hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Receiver operating characteristics curves were plotted to determine the cut-off points for size of ectopic mass and beta-human chorionic gonadotropin (β-hCG) that suitably discriminated between double-dose methotrexate and surgery management.

The most common site of EP was adnexa. According to the receiver operating characteristics analysis, surgery was the best plan for the women with an ectopic mass > 34.50 mm in diameter or with an initial β-hCG level > 6419 mIU/ml. The β-hCG levels in the women successfully treated with SD-MTX were significantly lower than in those with failed treatment (p = 0.02). The SD-MTX group had a higher success rate and significantly shorter duration of hospitalization, and so this was a more effective medical treatment in comparison with the DD protocol.

Surgery is proposed as the best option for the cases with large ectopic mass or high β-hCG level. SD-MTX had a higher success rate and shorter hospital stay than the DD protocol, and so was found to be an efficient and safe alternative. Further randomized clinical trials with larger sample sizes are recommended to validate the current results.

Endometriosis is a gynecological disease and disorder that occurs when endometrial cells are shed through the fallopian tubes and are implanted on the surfaces of pelvis and abdomen. They form lesions that respond to hormones of the menstural cycle and will stimulate inflammation. It is controversial whether [99mTc]Tc-RBC scan would be sufficient for localizing bleeding sites. This study evaluated the value of [99mTc]Tc-RBC in diagnosing endometriosis. Twenty patients were included in the study for endometriosis localization. Between the 2nd and the 5th days of menstruation, when the lesions were highly activated, [99mTc]Tc-RBC scan was performed and compared with TVUS, pelvic MRI and laparoscopic surgery findings. Scans of the patients were reported by two nuclear medicine specialists who were blind to patients’ history. The patients’ age range was 21-48 years (mean age: 35±8.79). The sensitivity, specificity, positive predictive value and negative predictive value for the right pelvic bleeding sites were 73.3%, 80.0%, 91.7% and 50%, respectively while the corresponding indices on the opposite pelvic site were find to be 87.5%, 75.0%, 93.0% and 60%, respectively. Radiolabeled red blood cell scintigraphy has the potential to be used as an alternative procedure for diagnosing endometriosis.

There is a growing need for information regarding the recent coronavirus disease of 2019 (COVID‑19). We present a comprehensive report of COVID‑19 patients in Iran.

One hundred hospitalized patients with COVID‑19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and postdischarge follow‑up were analyzed.

The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C‑reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), and lymphocytopenia (74.2%) on admission. Lower lobes of the lung were most commonly involved, and ground‑glass opacity (81.8%) was the most frequent finding in computed tomography scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom aggravation, 8.6% were readmitted to the hospital, and three patients (4.3%) died.

This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with COVID19. The most common presenting symptoms are nonspecific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom aggravation.

Coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the susceptibility amongst different groups of the population. Pregnant women are one such group. This study was conducted to investigate the effect of COVID-19 on pregnancy and maternal/neonatal outcomes.

This case series was conducted on 16 pregnant women with COVID-19 from March 21 to May 11, 2020. Clinical characteristics, pregnancy complications, medication used, maternal/neonatal outcomes, and fatality rate were investigated through this study. The mean age of the patients was 30.06 yrs. Patients from all three trimesters were included (1 in first, 5 in second, and 10 in the third trimesters). The most common clinical symptoms were shortness of breath (n = 10), dry cough (n = 10), myalgia (n = 8), and chills (n = 7). Also, three cases had papulosquamous skin lesions with fissuring. The most common laboratory results were leukocytosis (n = 8), increased liver enzymes (n = 6), elevated CRP (n = 5), and thrombocytopenia (n = 4). There was one case of maternal mortality, five of premature labor pain (PLP), two of preeclampsia, and two of placenta accreta. Twelve pregnancies were terminated (nine cesarean sections, three vaginal deliveries). Among neonates, we had 6 cases of preterm labor. All neonates had negative PCR results.

Clinical manifestations and paraclinical results were similar to non-pregnant patients. There was no evidence of vertical transmission. PLP and premature rupture of membranes (PROM) were the most common complications in the second and third trimesters of pregnant COVID-19 women, which can lead to rupture of the uterus. Termination and delivery should be planned individually.

There is a growing need for information regarding maternal and neonatal outcomes during coronavirus pandemic. In this study, a comprehensive investigation was done regarding the possibility of vertical transmission using the available data in the literature.

A systematic search was conducted using electronic databases, including PubMed, Scopus, Web of Science, Embase, and Scholar. All studies containing infected COVID-19 pregnant women who had given birth were included, and the search was done up to April 14, 2020.

Overall, 21 articles were reviewed, and clinical characteristics of 90 pregnant patients and 92 neonates born to mothers infected with COVID-19 were reviewed. The most common symptoms included fever, cough, and dyspnea. The main laboratory findings included leukocytosis, lymphopenia, thrombocytopenia, and elevated C-reactive protein. The most commonly reported complications were preterm labor and fetal distress. Three mothers were admitted to ICU and required mechanical ventilation; among them, one died, and one was on extracorporeal membrane oxygenation. Overall, 86 neonates were tested for the possibility of vertical transmission and 82 cases were negative in RT-PCR, while 4 were positive. Out of 92 neonates, one died, and one was born dead. Nineteen patients reported having no symptoms, while breathing problems and pneumonia were reported as the most common neonatal complications.

There were no differences in the clinical characteristics of pregnant women and non-pregnant COVID-19 patients. COVID-19 infection has caused higher incidence of fetal distress and premature labor in pregnant women. Although the possibility of vertical transmission in infected pregnant women is rare, four neonates’ test results for COVID-19 infection were positive in this review.

Vaginal aplasia is a rare congenital anomaly with different surgical techniques suggested for vaginal reconstruction.McIndoe vaginoplasty is an easy one of these surgical methods with a low morbidity rate, but its long-term results need to be further investigated. Therefore, the female genital anatomy and sexual function was examined after performing McIndoe vaginoplasty in patients with müllerian anomaly or androgen insensitivity syndrome. In this historical cohort study, the data of 25 patients undergoing McIndoe vaginoplasty with amniotic graft from 2006 to 2017 at four selected hospitals of Shiraz affiliated with Shiraz University of Medical Sciences in Iran were extracted from medical records. Then, the patients were called to refer for physical examination and fill the Female Sexual Function Index (FSFI) questionnaire. In addition, 31 women of the same age range and without a sexual problem, vaginal surgery, or delivery were selected as the control group. Finally, the results of vaginal measurements and FSFI scores of the two groups were compared together. Theaverage vaginal length of the case and control groups were 5.60±2.38 and 8.47±1.31 cm, respectively. Furthermore, the mean proximal vaginal diameter in case and control groups were measured 2.94±0.92, and 4.12±0.70 cm, respectively (P<0.001). The mean FSFI score of the case group was 12.81±7.87, and 24.19±2.90 for the control group (P<0.001). The vaginal indices and FSFI of the patients using mold routinely were still lower than the control group (P<0.05) although theyhad a larger vagina (P<0.001). Vaginal reconstruction using McIndoe vaginoplasty with amniotic graft failed to provide normal vagina function and anatomy for patients with congenital vaginal aplasia in long-term follow-up.

Stress urinary incontinence is one of the most common diseases which canreduce the quality of life in women. Urodynamic test is a common method of diagnosis of this disease.This study is designed for investigating the necessity of urodynamic test in patients with urinary stressincontinency before transobturator tape (TOT) surgery. Urodynamic test before surgery can affect thequality of life in patients.

This study was a randomized clinical trial. The sample size was 48 patients divided into twogroups of 24 women in January 2018. Women with urinary incontinence complaints were randomlydivided into two groups. For the first group, the urodynamic test was done. Both groups were evaluatedone month and six months after TOT surgery based on the results of the I-QOL questionnaire.

The mean I-QOL score was 83.9 ± 3.3 in questionnaire group and 81.6 ± 4.6 in urodynamicgroup one month after surgery with no statistically significant (P = 0.052) difference. The quality of lifescore after 6 months was 87.2 ± 4 in the questionnaire group and 85.4 ± 3 in the urodynamic groupwith no statistically significant differences with each other (P = 0.084).

In this study, the urodynamic test only had additional information related to lower urinarytract symptoms and it did not have effects on improving the outcome of the surgery. The test onlyimposes economic burden. Therefore, the urodynamic test is not required before surgery in patientswith urinary stress incontinence.

There is limited evidence about the anti-diabetic effects of selenium supplementation in women with gestational diabetes mellitus (GDM).

This study investigates the effects of selenium supplementation on glucose homeostasis in women with GDM.

A total of 60 pregnant women with GDM were enrolled in this prospective randomized, double-blind, and placebo-controlled clinical trial. They were randomly assigned to take either 100µg selenium supplements as tablet or a placebo daily for 12 wk since 24-28 wk of gestation. The primary outcomes were changes in the glucose homeostasis, including fasting plasma glucose, the 2-hr post prandial blood glucose, serum insulin level, glycosylated hemoglobin (Hb A1C), and the homeostasis model assessment of insulin resistance(HOMA_IR) at the initial period and 3 months after intervention.

The mean maternal age of the patients who took selenium supplements was 29.19 ± 6.16 (range 18-41) years. In the placebo group, the mean maternal age was 31 ± 4.43 (range 24-39) years. Compared with the placebo group, fasting plasma glucose, 2-hr post-prandial blood glucose, glycosylated hemoglobin(Hb A1C), serum insulin level, and homeostasis model of assessment-estimated insulin resistance(HOMA_IR) were not significantly changed in the selenium group at the end of study (p = 0.25, p = 0.87, p = 0.34, p = 0.57, and p = 0.31, respectively).

The results of this trial suggest that supplementation with 100µg of selenium does not modulate glucose homeostasis in women with GDM.

Endometriosis is a common gynecological disease in which oxidative stress is a potential factor. Caffeine and caffeic acid are present in various foods and beverages with anti-oxidant, anti-inflammatory, and anti-carcinogenic properties. In this study, we aimed to investigate the ameliorative effects of caffeine, caffeic acid, and caffeine+caffeic acid treatments on oxidative stress in ectopic endometrial cells taken from patients and eutopic ones from women without endometriosis. In this experimental study, eutopic and ectopic endometrial cells were obtained from biopsies of women free of disease (n=10) and patients with endometriosis (n=10) who referred to Shiraz reference hospitals (2017-2018). Both eutopic and ectopic endometrial cells were divided into four groups: Treated with caffeine, with caffeic acid, with caffeine+caffeic acid, and the control. Also, antioxidant enzyme activities and the levels of glutathione (GSH) and malondialdehyde (MDA) were determined in each group. The data were analyzed using independent sample t test and one-way ANOVA followed by Tukey post-hoc test. Caffeic acid, but not caffeine treatment demonstrated a decrease in MDA level (P<0.001) as well as an increase in GSH level (P<0.001) and antioxidant enzyme activities in ectopic endometrial cells. Also, the treatment of the cells with caffeine+caffeic acid caused similar effects as those ectopic cells treated with caffeic acid. According to the findings of the present study, caffeic acid reduced oxidative stress which may alleviate the complications associated with endometriosis. However, more investigations are needed for evaluating the efficiency and safety of caffeic acid.

Endometriosis is a chronic inflammatory disease with the growth of endometrial cells out of uterus and in the peritoneal cavity. T cell subsets participate in the establishment and progress of the disease by producing different cytokines. To investigate a group of cytokines related to Th1/Th2/Th17/Treg subsets within both peripheral blood and peritoneal fluid (PF) samples from infertile endometriosis women. Peripheral blood and PF samples were collected from 30 infertile endometriosis and 30 non-endometriosis fertile women during laparoscopy. Concentration of cytokines, including TNF-α, IFN-γ, TGF-β1, IL-4, IL-10, IL-17 and IL- 23 were evaluated using ELISA method. Results indicated that the concentration of IFN-γ within serum was significantly reduced in endometriosis group (p=0.001). Regarding PF cytokines, TGF-β1 was increased in endometriosis group (p=0.030). Furthermore, the ratios of IFN-γ/TGF-β1 and IL-17/IL-23 were significantly different between endometriosis and non-endometriosis women in serum samples (p Based on the results of the present study, in women with endometriosis, the disturbance of cytokines network might gradually activate the inflammatory responses and tissue repair, resulting in endometriosis development after several years.

Small cell carcinoma of the ovary is an aggressive malignant tumor with no standard treatment. Despite surgery, chemotherapy and radiation, this tumor has a poor prognosis with rapid progression. The authors report a case of small cell carcinoma of the ovary in a 37-year-old woman who presented twice with an acute abdomen and unstable hemodynamics which led to two urgent laparatomies. The patient died two months after her diagnosis of small cell carcinoma of the ovary and one course of chemotherapy.

Preeclampsia is a common pregnancy-specific disorder associated with significant maternal and fetal morbidity and mortality worldwide. It has been proposed that the imbalance between two CD4 T cell subtypes, regulatory T cells (Treg) and Thelper 17 cells (Th17), is involved in the pathophysiology of preeclampsia.
To determine the serum levels of IL-17, IL-21, IL-23 and TGF-β in patients with preeclampsia.
Blood samples were collected from 30 preeclampsia patients,30 normotensive pregnant women and 30 healthy individuals with no history of malignancies or autoimmune disorders based on simple sampling. The serum levels of IL-17, IL-21, IL-23 and TGF-β were measured by the enzyme linked immunosorbent assay (ELISA).
The serum levels of IL-17 and TGF-β were significantlyhigher in preeclampsia patients compared to normal pregnant group and healthy individuals (p>0.0001) but interestingly, the opposite was the case for IL-23 (p=0.005). However, there were no significant differences in IL-21 between preeclampsia and normal pregnant group.
Our results conclude that contrary to IL-21, serum levels of IL-17 and TGF-β significantly increased in preeclampsia compared to normal pregnant women, supporting an imbalance of cytokine profile in preeclamtic patients.