Anthropometric, clinical and biochemical comparison of the four polycystic ovarian syndrome phenotypes

Objectives: Polycystic ovarian syndrome [PCOS] phenotypes in different races and ethnicities present with various features. This study aimed to investigate the anthropometric, clinical and biochemical differences according to the four Rotterdam phenotypes of PCOS

Design: A cross-sectional study was conducted

Setting: Two private infertility clinics and a public endocrinology clinic in Rasht, Iran

Subjects: One hundred and sixty one women with PCOS aged between 15 and 41 years from March 2010 to July 2012 were included. Polycystic ovarian syndrome was diagnosed by irregular menstruation [IM], polycystic ovary [PCO] and hyperandrogenism [HA]

Intervention: Demographic data, and fertility features were collected and anthropometric, clinical and biochemical characteristics were measured

Main outcome measures: There were significant differences in mean levels of 17-hydroxyprogesterone [P = 0.010], luteinizing hormone [P = 0.047], and ratio of luteinizing hormone / follicle stimulation hormone [P = 0.017] among the four phenotypes

Results: Most of the subjects were categorized into the IM + PCO + HA phenotype [54%], followed by IM + HA [28%], IM + PCO [13%], and PCO + HA [5%]. Among the four phenotypes, there were no significant differences in terms of demographic characters, fertility features and anthropometric measurements [P > 0.05], but there were significant differences in the prevalence of hirsutism, alopecia and morphology of PCO [P < 0.05]

Conclusion: Phenotypes of PCOS in women from Rasht are similar in most anthropometric, clinical and biochemical features

Midwives' educational needs and knowledge about sexually transmittable infections in the Islamic Republic of Iran

This study aimed to evaluate the educational needs and knowledge about sexually transmittable infections [STIs] demonstrated by midwives. In a cross-sectional study in 2014, 144 midwives in Rasht, Islamic Republic of Iran, were surveyed. The Persian version of the Sexually Transmitted Disease Knowledge Questionnaire [STD-KQ] and a researcher-made questionnaire to evaluate educational needs and profile were used. The participants obtained 74% of the total score of STD-KQ. Thirty-one percent of participants were categorized in high or very high need of education. Seventy percent of midwives mentioned they were trained on all STIs at university. However, only 6.3% of midwives were aware of existing STIs guidelines. Participants reported that in the last two years they were only educated about HIV/AIDS and hepatitis B at their workplace. Thus, a comprehensive educational programme to empower midwives for complete STIs control is recommended

Metabolic syndrome in patients with Polycystic Ovary Syndrome in Iran

Background: The prevalence of metabolic syndrome [MetS] in polycystic ovary syn-drome [PCOS] has been studied in different populations, but their results were so con-troversial regarding Iranian women. These controversial data indicated the need for more investigation of MetS characteristics in PCOS patients in our population. So this study aimed to evaluate the clinical and laboratory characteristics and metabolic features of patients with PCOS in Rasht

Materials and Methods: This prospective cross sectional study was conducted on 215 PCOS women who lived in Rasht, north of Iran, from March 2010 to July 2012. The participants were then divided into two groups of women with MetS [n=62] and women without MetS [n=153]. The diagnosis of PCOS and MetS were based on the Rotterdam 2003 criteria and the Adult Treatment Panel III [ATP III] criteria, respectively. Demographic characteristics, fertility characteristics, family history and laboratory findings were assessed

Results: The prevalence of MetS in women with PCOS was 28.8%. In PCOS women of both groups, the waist circumference [WC] exceeded 88cm in 72.6%, hypertension [systolic blood pressure [SBP] and/or diastolic blood pressure [DBP] >/= 130/85mm Hg] was prevalent in 9.3%, fasting blood sugar [FBS] level was >/= 110 mg/dl in 6%, triglycerides [Tg] level were >/= 150 mg/dl in 47%, and high-density lipoprotein [HDL] level was <50 mg/dl in 86%. The values of WC, SBP, DBP, body mass index [BMI], ovarian size, Tg, cholesterol, FBS, 2-hour blood sugar, aspartate aminotransferase [AST], and alanine aminotransferase [ALT] were significantly greater in PCOS women with MetS than women without MetS. Also HDL and luteinizing hormone [LH] levels in women with MetS were significantly lower than women without MetS

Conclusion: Prevalence of MetS in PCOS women was 28.8%, indicating that this value is higher than other studies conducted on PCOS women in Iran and other studies conducted on general population in Iran. PCOS women are considered as a high-risk population for MetS. The special strategies are required to prevent MetS and its associated complications in PCOS women

Comparison between unilateral and bilateral ovarian drilling in clomiphene citrate resistance polycystic ovary syndrome patients: a randomized clinical trial of efficacy

Laparoscopic ovarian drilling [LOD] is an alternative method to induce ovulation in polycystic ovary syndrome [PCOS] patients with clomiphene citrate [CC] resistant instead of gonadotropins. This study aimed to compare the efficacy of unilateral LOD [ULOD] versus bilateral LOD [BLOD] in CC resistance PCOS patients in terms of ovulation and pregnancy rates. In a prospective randomized clinical trial study, we included 100 PCOS patients with CC resistance attending to Al-Zahra Hospital in Rasht, Guilan Province, Iran, from June 2011 to July 2012. Patients were randomly divided into two ULOD and BLOD groups with equal numbers. The clinical and biochemical responses on ovulation and pregnancy rates were assessed over a 6-month follow-up period. Differences in baseline characteristics of patients between two groups prior to laparoscopy were not significant [p>0.05]. There were no significant differences between the two groups in terms of clinical and biochemical responses, spontaneous menstruation [66.1 vs. 71.1%], spontaneous ovulation rate [60 vs. 64.4%], and pregnancy rate [33.1 vs. 40%] [p>0.05]. Following drilling, there was a significant decrease in mean serum concentrations of luteinizing hormone [LH] [p=0.001] and testosterone [p=0.001] in both the groups. Mean decrease in serum LH [p=0.322] and testosterone concentrations [p=0.079] were not statistically significant between two groups. Mean serum level of follicle stimulating hormone [FSH] did not change significantly in two groups after LOD [p>0.05]. Based on results of this study, ULOD seems to be equally efficacious as BLOD in terms of ovulation and pregnancy rates

relationship between vaginal bleeding in the first and second trimester of pregnancy and preterm labor

Vaginal bleeding is a common complication during pregnancy, which is observed in about 1/4 of pregnancies and in half of cases can lead to abortion. If vaginal bleeding happens during pregnancy some adverse pregnancy outcomes, including perinatal mortality and morbidity, low birth weight and preterm delivery will be increased. The aim of this study was to determine the relationship between vaginal bleeding and its characteristics in the first and second trimester of pregnancy and preterm labor. This is a case-control study conducted on 440 pregnant women referred to Al-Zahra Hospital in Rasht, Iran. Data were collected by a form. The form included demographic characteristics and confounding factors, the occurrence of bleeding during pregnancy and its features. Data were analyzed by T test, chi square and logistic regression in SPSS 16. Findings showed that vaginal bleeding was associated with 3 times increased risk of preterm delivery [OR: 3, 1.84-4.89]. Also, findings showed that bleeding characteristics including bleeding time, frequency, severity and intensity was significantly associated with preterm labor. According to significant association between vaginal bleeding and preterm delivery, it seems that performing some interventions to prevent preterm labor could be appropriate.

Role of dyslipidemia in preeclamptic overweight pregnant women

Obesity is an independent risk factor of preeclampsia with unknown mechanism and hyperlipidemia might be a probable case of it. The objective of this study was to determine the role of hyper-triglyceridemi in association with high prepregnancy body mass index and the risk of preeclampsia. The authors conducted this case-control study of 42 preeclamptic and 41 normotensive overweight pregnant women. The two groups were comparable with respect to age, gestational age, and body mass index. Blood samples were collected at the time of diagnosis of preeclampsia, after 14 hour fasting to determine plasma lipid concentrations. Enzymatic photometric tests were used to determine lipid profile. Data was analyzed with independent "t-test", Chi-square and one-way ANOVA and post HOC Tukey HSD test. The statistical significance was set at 0.05 levels. In the subjects with preeclampsia, serum triglyceride and total cholesterol levels were significantly increased and plasma HDL-cholesterol concentrations were decreased compared with the controls, [p<0.05], but plasma LDL cholesterol levels didn't differ between the two groups. Women who developed severe preeclampsia had higher concentrations of TG and cholesterol and lower levels of HDL compared to noromotensive group. Mean TG: 375.16 vs. 202.85, p<0.001, Mean cholesterol: 245.64 vs. 214.32, p=0.04, Mean HDL: 40.80 vs. 48.95, p=0.03]. We noted that dyslipidemia, particularly hypertriglyceridemia was highly correlated with prepregnancy high BMI in preeclamptic women. These findings continue to support a role for dyslipidemia in BMI related preeclampsia

study of menarcheal age in northern Iran [Rasht]

The event of menarche is an exceptional phenomenon, which occurs once in a lifetime. It is the precursor of future fertility. The onset of menarche is mainly dependent on genetic factors, however geographical and nutritional factors among other factors have been attributed to the events of menarche. The aim of this study is to determine the age of onset of menarche and the factors which induce it in northern Iran. This is a cross sectional study which will assess the onset of menarche in girls between the age of 11-16 years. The subjects were either in middle or high school and had experienced menarche within 6 months prior to the study. This study revolves around 600 girls who were selected using stratified randomized sampling techniques. The data was collected in the form of a questionnaire which focused on age, weight [was measured to the nearest 0.1 kg using a balance beam scale], height [was measured to nearest 0.1 cm with a manual height board], and Body Mass Index [BMI: kg/m2] was used as an index of relative weight. Principal Component Analysis [PCA] was applied to analyze Socio-economic Status [SES]. The defined standard age of the first menstrual event was applied as the standard. The data collected was analyzed using the Statistical Package for the Social Sciences [SPSS.10] statistical analysis software and the Chi-square and Analysis of Variance [ANOVA] tests were applied. In an effort to establish the factors associated with the age of menarche, multivariate analysis was performed based on linear logistic regression which was performed using a model where all the variables changing the risk estimated by more than 10%. Statistical significance was determined at P<0.05. The mean age at menarche was observed to be 12.99 +/- 1.33 yrs [ranging from 10.16 to 15.91 yrs]. The study showed that menarche occurred during the summer for 270 [45%] patients making it the most common season for menarche while winter was the least common season. The mean age of menarche was delayed in patients from low SES groups and it occurred earlier in patients from high SES. In girls with low BMI, menarche occurred earlier in comparison to girls with high BMI. There was a significant correlation between session and age of menarche [p<0.05]. There was no significant relationship statistically between BMI and age of menarche [p>0.05]. Linear regressions showed no significant effect of BMI on the age of menarche but there was a significant correlation between season and SES on the age of menarche. The age of menarche and the most common seasons for menarche were similar to previous studies. Results from this study showed that the age of menarche decreased with higher SES. And also the age of menarche in girls with high and low BMI occurred earlier. However, previous studies showed that it occurred earlier in high BMI and later in low BMI. It appears that genetic and environmental factors have influenced these differences

Seasonal variation of the onset of preeclampsia and eclampsia

Preeclampsia is one of the three leading causes of maternal mortality. Studies have suggested that the incidence of preeclampsia may be partially dependent on the month or season of delivery. This study was conducted to evaluate whether seasonal variation has any effect on the incidence of eclampsia or preeclampsia. From 1999 to 2001, a cross-sectional study in Alzahra Hospital was performed using all deliveries with gestational age more than 20 weeks. Variables of maternal age, parity, occurrence of preeclampsia and eclampsia, and season were evaluated and analyzed by chi-square test in SPSS 10. During the period of the study, there were 12,142 deliveries at Alzahra Hospital in Rasht. There were 2,579 [21.3%] deliveries in spring, 2,696 [22.2%] in summer, 3,645 [30%] in autumn, and 3,222 [26.5%] in winter. There was no statistically significant relationship between the age, parity and season. Hypertensive disorder was reported in 609 pregnancies [5%], with 11,533 [95%] having no hypertensive disorder. Data showed that 397 patients [3.3%] had preeclampsia and eclampsia. The highest rate of preeclampsia was in spring [3.6%], and the lowest rate was in summer [3%], but it revealed no statistical difference in the incidence of preeclampsia with season. We found no correlation between preeclampsia or eclampsia and season. It may be due to relative similarities between seasons in North of Iran. For example, there are relative similarities between spring and summer, and between autumn and winter

comparison between suppository diclofenac and pethidine in post-cesarean section pain relief: a randomized controlled clinical trial

Narcotic drugs are usually used for postoperative pain control which could cause several complications such as respiratory depression and apnea. Therefore, replacement of these drugs with safer analgesics is recommended. The aim of this study was to compare the analgesic effects of suppository diclofenac and pethidine in post-cesarean section [C/S] patients. In this clinical trial, pregnant women who were admitted to Alzahrah Hospital, Isfahan, Iran, between August and February 2004 and met the inclusion criteria were recruited. After obtaining informed consent, the patients were randomly assigned [block randomization] to two groups. In group A, 100 mg rectal suppository diclofenac was used after operation at four time points: at the end of operation and 8, 16 and 24 hours after the operation. Group B received pethidine 1 mg/kg intramuscularly at similar time points. The pain scores were assessed at 2, 10, 18 and 26 hours after C/S using the Visual Analogue Scale [VAS]. Age, gestational age, parity, history of previous abortion, C/S and abdominal surgery, level of education, pain score, side effects and satisfaction level were assessed. Analysis was carried out with ANCOVA model and X[2] Mantel Haenszel tests by SPSS.10 software. P<0.05 was considered significant. Two hundred forty patients met inclusion criteria. Age, parity, history of previous abortion, history of previous C/S and abdominal surgery, level of education and satisfaction level were similar in the two groups [P>0.05]. There was no significant difference between side effects in the two groups except for dizziness in 11 cases in group B. There were significant statistical difference between pain intensity in 10, 18 and 26 hours after C/S in group A and group B [2.05 +/- 2.07, 1.4 +/- 1.6 and 0.5 +/- 1.1 vs. 2.6 +/- 2.2, 2.3 +/- 2.2 and 1.3 +/- 1.9] respectively. The results of the present study showed that the use of suppository diclofenac is an appropriate replacement therapy for pain relief after C/S