Altered Th17/Treg ratio in recurrent miscarriage after treatment with paternal lymphocytes and vitamin D3: a double-blind placebo-controlled study

Background: Recurrent miscarriage [RM] affects 2-5% of pregnant women. Paternal lymphocyte immunotherapy is a common treatment for RM patients but the outcome has not been consistent. Therefore, combined therapy with other immunosuppressive drugs such as 1a, 25-dihydroxy-vitamin-D3 [vitamin D3] may improve the outcome

Objectives: To investigate the effect of vitamin D3 on the balance of two essential T cells subsets, T helper [Th] 17 and T regulatory [Treg] cells, which regulate tolerance

Methods: The expression levels of CD4 and forkhead box protein 3 [FOXP3] in Treg cells, and the expression levels of CD4 and IL-17 in Th17 cells, were evaluated pre- and 3 months post-immunotherapy in RM patients treated with a combination of paternal lymphocytes and vitamin D3 compared with RM patients receiving lymphocyte immunotherapy alone

Results: Vitamin D3 therapy decreased the frequency of Th17 cells in addition to reducing the Th17/Treg ratio in peripheral blood of RM patients compared with the control group [p<0.05]

Conclusion: Considering that RM patients have a higher Th17/Treg ratio in peripheral blood, vitamin D3 may be a candidate therapeutic approach in this disease

Comparing the effects of low-dose contraceptive pills to control dysfunctional uterine bleeding by oral and vaginal methods

Background and Objective: Contraceptive pills are generally taken orally and can cause side effects such as nausea, vomiting and hypertension. The vaginal use of these pills can reduce such complications. Our objective was to compare the efficacy and side effects of low dose contraceptive pills by oral and vaginal route in the management of dysfunctional uterine bleeding-[DUB]

Methods: This comparative observational study was conducted at Beheshti and Alzahra [SA] teaching hospitals, affiliated to Isfahan University of Medical Sciences in 2010-2011. One hundred women who presented with DUB were randomly assigned into two groups of equal number, receiving the low dose oral contraceptive pills by oral or vaginal route for three month. The amount and duration of bleeding were compared at the beginning and at the end of the study and side effects by these two methods compared

Results: The results of this study showed that both oral and vaginal routes effectively reduced the duration and amount of bleeding due to DUB after three courses of treatment. This effect was better in the vaginal method compared with oral administration [P = 0.03]. Regarding the side effects, nausea and vomiting were significantly higher in the oral group than in the vaginal group [P = 0.03]. Vulvovaginitis infection was more frequent in the vaginal group than in the oral group [P = 0.03]

Conclusion: Low dose contraceptive pills are effective in reducing the amount, time, and duration of bleeding in patients with DUB. In addition, reduction of gastrointestinal side effects by vaginal route helps to use these pills by the patient with proper training of physicians, midwives and patients

Can sex-hormone binding globulin considered as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome?

This study aims to evaluate the sex hormone binding globulin [SHBG] level as a predictor of response to pharmacological treatment in women with polycystic ovary syndrome [PCOS]. This study was conducted in 2009-2012 in Isfahan, Iran. Anovulatory women with a diagnosis of PCOS were studied. Metformin was started at 500 mg three times a day. If no ovulation occurred, Clomiphene citrate was added. The study comprised 273 infertile women with PCOS completed the study, 75 [28%] of them became pregnant 6 months after treatment [7.36% with metformin and 20.14% with metformin and clomiphene citrate]. Patients who responded to metformin treatment had significantly lower mean SHBG levels compared to those who did not [0.88+0.32vs. 0.2642+0.44 nmol/L, respectively, P<0.0001]. The area under the ROC curve [AUC] for prediction the response to treatment was 0.85. The baseline level of 27 was the most appropriate cut of point HSBG for the prediction of conception. HSBG had a sensitivity of 88%, and specificity of 73.6%. It had a false positive level of 26.4% and false negative level of 12%. Its positive predictive value was 56.4% and its negative predictive value was 94%. The chance of conception increased for reducing a unit of fpg [OR = 0.69; 95% CI = 0.54-0.86; P = .002], as well as reducing of every unit of HSBG [OR = 0.47; 95% CI = 0.39-0.56; P <0.001], and for reducing each unit of insulin in [OR = 0.082; 95% CI = 1.021-0.33; P <0.001]. HSBG test is suggested as an appropriate test for predicting pregnancy achievement of PCOs women after pharmacological treatment

Comparison of gestational diabetes mellitus and pre-eclampsia in women with high hemoglobin in the first trimester of pregnancy: a longitudinal study

To determine the association between high hemoglobin with gestational diabetes mellitus [GDM] and preeclampsia in pregnant women in the first trimester. This cohort study was conducted among 973 pregnant women who started their antenatal booking in the first trimester [first 14 weeks of gestation]. Women with first-visit high Hb levels [> 12.5 g/L] on first visit of the pregnancy period were selected as the study group and were compared with those who had normal Hb value [< 12.5 g/L] as controls. Adverse pregnancy outcomes including preeclampsia and GDM were compared between the two groups. Complete obstetric records of 448 women with high Hb levels and 486 women with normal Hb levels were studied. The follow up showed that the women with high Hb levels had significantly higher rates of preeclampsia and GDM than those with normal Hb levels; the risks were 5.4 [95% cl; 2.8 to 10.5] and 3.7 [95%cl; 2.2 to 6.4], respectively. This study found that high Hb in the first trimester is associated with higher risk of subsequent preeclampsia and gestational diabetes mellitus [GDM]

Icodextrin reduces adhesion formation following gynecological surgery in rabbits

Adhesion is a common complication of gynecology surgery so different barrier agents and solutions have been used during these operations to separate and protect tissues from adhesion after surgery. Adept is one of these solutions that have been postulated to reduce the chance of adhesion following gynecolgy surgery. To evaluate the effect of 4% icodextrin in reducing adhesion formation in comparing with sterile water and human amniotic fluid in rabbits. In this prospective experimental study 30 white Newzealand female rabbits were selected and randomized in to three treatment groups. The rabbits were anesthetized and an abdominal incison was made, uterine horns were abrated with gauze until bleeding occurred. Before closing the abdomen, the traumatized area was irrigated either by 30cc of sterile water, 30cc of 4% Adept or 30cc of human amniotic fluid. The solutions were labeled only as solutions A [steriel water], B [icodextrin], or C [human amniotic fluid]. On the seventh day after surgery, second laparotomy was performed to determine and compare adhesion formation in rabbits. There was significant difference between mean score of adhesions in 4% icodextrin group [2.1 +/- 0.70] in comparison to sterile water group [10.4 +/- 0.60] and amniotic fluid group [8.7 +/- 0.84]. But the difference between mean score of adhesions in amniotic fluid group in comparison to sterile water group was not significant [8.7 +/- 0.84] versus [10.4 +/- 0.60]. The use of 4% icodextrin solution was more effective than human amniotic fluid and sterile water in reducing adhesion formation in a gynecological surgery model in rabbits

Heterotopic abdominal pregnancy following ovulation induction with clomiphene citrate

Heterotopic abdominal pregnancy is a rare entity which poses unique management challenges. A 24-year-old Gravida 1 woman with history of two years infertility and treatment with clomiphene citrate presented with acute right lower quadrant abdominal pain. Heterotopic abdominal pregnancy was recognized at 16 weeks gestation by transvaginal ultrasound scan. We aimed to remove ectopic pregnancy with prevention of maternal complications and preservation of intrauterine pregnancy [IUP]. Surgical removal of the ectopic fetus and placenta was done. Abdominal pregnancy removed successfully without intra-or post-procedural complications, but the IUP was aborted spontaneously on the second postoperative day. Gynecologists should consider the possibility of heterotopic pregnancy following ovulation induction with clomiphene citrate which is increasing in recent years. A high index of suspicion to heterotopic pregnancy may be followed by a nonsurgical approach safely and affectively, if they are clinically stable and the abdominal pregnancy is recognized early in gestation