Endometrial Progesterone and Estrogen Receptors in Relation to Hormonal Levels in Women with Unexplained Recurrent Miscarriage / Receptores endometriais de progesterona e estrogênio em relação aos níveis hormonais em mulheres com aborto recorrente inexplicável

Abstract Objective Recurrent miscarriage has been linked to hormonal disturbance due to dysregulation of its receptors rather than to the availability of the hormone. We aimed to investigate endometrial expression of progesterone and estrogen receptors in relation to serum and endometrial hormonal levels in unexplained recurrent miscarriage. Methods The present case control study included 20 cases with unexplained recurrent miscarriage and 20 parous women as controls. Ovulation was confirmed using an ovulation kit and 10 to 12 days after detecting the urinary luteinizing hormone surge, all women were subjected to a blood sample and to an endometrial biopsy. Progesterone and estrogen levels were measured in serum and in endometrial tissue and receptor concentrations were in the endometrial sample. Results Women with recurrent miscarriage showed significantly lower concentration of receptors in both the cytoplasm and the nucleus of endometrial tissue compared with controls. The nuclear/cytoplasm ratio of progesterone receptor was significantly higher in cases compared with controls, implicating that recurrent miscarriage is probably linked to nongenomic activity of the hormone; this was also significant for estrogen receptor. Serum progesterone and estrogen hormonal levels were comparable between groups while both hormones were significantly reduced in the endometrium of recurrent miscarriage cases. Receptors significantly correlated with endometrial hormonal level but not to serum level. Conclusion Recurrent miscarriage might be linked to reduced endometrial progesterone and estrogen receptors and appears to be more related to nongenomic activity of progesterone. Endometrial receptors expression correlates to tissue hormonal level rather than to serum hormonal level.

Deep anterior lamellar keratoplasty versus penetrating keratoplasty in the treatment of stromal corneal dystrophies / 国际眼科杂志(Guoji Yanke Zazhi)

?AIM:To compare the efficacy and safety of penetrating keratoplasty ( PK) and deep anterior lamellar keratoplasty ( DALK) in the treatment of stromal corneal dystrophy.?METHODS:A systematic review and Meta-analysis was conducted for studies comparing visual acuity [ best-corrected visual acuity ( BCVA ) ( LogMAR ) ] and corneal endothelial cell count ( ECC) as well as safety outcomes of DALK and PK surgeries, including graft-related outcomes and intraoperative and postoperative complications. Embase, PubMed, and Google Scholar were searched for eligible studies until June 2019. Continuous and dichotomous variables were expressed as weighted mean difference ( WMD ) and risk ratios ( RRs ) , respectively, along with their respective 95％confidence intervals ( CIs) .? RESULTS: Five comparative studies recruiting 350 patients with macular and/or lattice corneal dystrophy (59.71％ males) were eventually included. No significant differences were noted in the mean BCVA after both types of surgeries. However, following DALK procedures, corneal ECC was significantly higher two years postoperatively ( WMD=401.62 cell/mm2 , 95％CI:285.39-517.85, P< 0.001 ) , and graft and endothelial rejection rates were significantly lower ( RR=0.30, 95％ CI: 0.14-0.64, P=0.002;RR=0.09, 95％ CI: 0.02-0.46, P=0.004, respectively) when compared to patients undergoing PK procedures. However, DALK procedures were associated with increased risks of intraoperative Descemet' s membrane perforations and postoperative double anterior chamber ( All P<0.001) .?CONCLUSION: DALK procedures are relatively more efficacious over the follow up periods with better safety outcomes than PK in patients with stromal CDs, conerning rejection and better visual outcome.

Vulvar lipoma: A case report

Abstract The present study is a case report of vulvar lipoma. The vulva is a rare site for the development of lipomas, and the aim of the study is to determine if the current imaging modalities can diagnose lipomas correctly. A 43-year-old patient presented with a painless, slowly progressive, oval, mobile and non-tender right vulvar mass compressing the vagina and totally covering the introitus. Both the ultrasonography and magnetic resonance imaging (MRI) exams suggested the diagnosis of lipoma. Surgical excision was performed, and the histopathological examination of the mass confirmed a lipoma.

Association of altered serum levels of Chemerin, Paraoxonase-1 (PON1), Asymmetric Dimethyl arginine (ADMA) and obesitin the development of Polycystic Ovarian Syndrome (PCOS) in Egyptian women

Chemerinwas recently added to the adipokine family and was identified in human ovarian follicles and follicular fluid that suggests a direct correlation between chemerin and PCOS. Asymmetric dimethyl arginine (ADMA) is involved in endothelial dysfunctionthe atherogenic potential of ADMA has been investigated in young patients with PCOS. Oxidative stress is considered to be implicated in the pathophysiology of PCOS.Paraoxonase 1 (PON1) is an antioxidant enzyme and its concentration has been shown to be inversely associated with oxidative stress. Objectives: Evaluation of serum chemerin, ADMA, PON1in obese and non-obese polycystic ovarian patients to postulate their role in pathogenesis of PCOS. Methods: Ninetynuligravida women aged 20-35 (60 with PCOS and 30 controls) were recruited. Fasting blood was obtained on day 2 or 3 of the menstrual cycle. Clinical evaluation, hormonal profile, Chemerin, ADMA and PON1 were assessed. Results: There was a significant increase in serum chemerinlevels in PCOS obese group when compared with PCOS non obese patients and healthy controls non obese and obese respectively. Serum ADMA level was increased significantly in PCOS obese group as compared to the PCOS non obese group , control non obese and control obese. Paraoxonase was decreased stepwise significantly from the control non obese group and control obese group to PCOS non obese patients then PCOS obese patients to. Conclusions: it could be suggested that increased chemerin has a role in PCOS development andaltered ADMA and PON1 associated withobesity and oxidative stress may exacerbate the condition.

Cardiovascular and haemodynamic changes in healthy and cardiac patient undergoing dental extraction

A clinical study was performed to investigate the role of Midazolam as sedative agent on the possible incidence of ischemic changes which occur during dental extraction for ambulatory patients receiving local anaesthesia and also to identify which group of cardiac patients is mostly at risk during minor oral surgical procedures. Forty patients aged between 20- 50 year represent the materials of this work, of the forty patients, ten healthy patients act as a control group. The thirty patients had a cardiac disease. All patient were monitored for recording [HR], [SBP], [DBP] and [MAP] by automatic non invasive blood pressure monitor. Midazolam 1 mg was given IV. to all patients and the previous parameters were recorded after 5 minutes, at 1 and 5 minutes post injection of local anaesthetic [Mepicaine] and at 1 and 5 minutes after tooth extraction. The threshold for myocardial ischemia used in this study includes RPP values more than 12.000 and PRQ values less than 1.0. Sedation produced significant decrease in the RPP values in all groups [P < 0.05]. Whereas, it produced insignificant change in PRQ values. This beneficial effect of sedation would be recommended for cardiac patients, especially hypertensive patients who have more risk than the other patients to develop myocardial ischemia during dental extraction under local anaesthesia