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Objective@#The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery. @*Methods@#This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed. @*Results@#Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001). @*Conclusion@#Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.Trial RegistrationIranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4
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Objective@#The aim of this systematic review and meta-analysis study was to determine the pooled estimate of the effect of antenatal magnesium sulfate (MgSO4) on intraventricular hemorrhage (IVH) in premature infants. @*Methods@#Two review authors independently searched all randomized clinical trials from international databases, including Medline (PubMed), Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Registers of ongoing trials (ClinicalTrials.gov), from January 1989 to August 2017. Two independent review authors were responsible for data collection. After extracting the necessary information from the evaluated articles, metaanalysis of the data was performed using Stata version 14. Also, sources of heterogeneity among studies were determined by Meta regression. @*Results@#In this study, among 126 articles that were extracted from primary studies, 7 papers that evaluated the effect of MgSO4 on IVH were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed that pooled relative risk (95% confidence interval [CI]) was 0.80 (95% CI, 0.63 to 1.03) for the effect of MgSO4 on IVH. @*Conclusion@#Results of this study showed that although MgSO4 had a protective effect on IVH in premature infants, this effect was not statistically significant. Further studies are needed to determine the best dosage, timing, and gestational age to achieve the optimum effect of MgSO4 on IVH.Systematic Review Registration International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42019119610
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Objective@#The aim of the present study was to compare the efficacy of vaginal isoniazid (isonicotinic acid hydrazide [INH]) and vaginal misoprostol in cervical ripening before hysteroscopic surgery. @*Methods@#This randomized controlled trial included patients scheduled for hysteroscopic surgery during April 2016 and June 2017. The inclusion criteria were as follows: postmenopausal women or those at premenopausal age who had not had a vaginal delivery and candidate for diagnostic or operative hysteroscopy with closed cervix before intervention. The INH group (intervention group) received 900 mg of vaginal isoniazid (three 300-mg pills) 6–8 hours before hysteroscopic surgery. The misoprostol group (control group) received 400 micrograms of vaginal misoprostol 6–8 hours before hysteroscopic surgery. Finally, the efficacy of the 2 agents was comparatively analyzed. @*Results@#Baseline characteristics were comparable between the groups. In 67 cases in the INH group (95%) and 45 in the misoprostol group (50%), hysteroscopic entry was successful without additional mechanical dilation, and this difference was statistically significant (P=0.001). The odds ratio (OR) obtained in this study was 0.57 for both INH and misoprostol groups (OR, 0.57; 95% confidence interval, 0.43–0.75). Further, 19 cases in the INH group vs. 45 cases in the misoprostol group did not respond to the intervention, indicating statistically significance (P=0.001). @*Conclusion@#Vaginal INH is more effective than misoprostol in cervical ripening before hysteroscopic surgery and can be a good alternative to misoprostol.Trial RegistrationIranian Registry Clinical Trial (IRCT) Identifier: IRCT2015112821506N4
ABSTRACT
Objective@#The aim of this systematic review and meta-analysis study was to determine the pooled estimate of the effect of antenatal magnesium sulfate (MgSO4) on intraventricular hemorrhage (IVH) in premature infants. @*Methods@#Two review authors independently searched all randomized clinical trials from international databases, including Medline (PubMed), Web of Sciences, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Registers of ongoing trials (ClinicalTrials.gov), from January 1989 to August 2017. Two independent review authors were responsible for data collection. After extracting the necessary information from the evaluated articles, metaanalysis of the data was performed using Stata version 14. Also, sources of heterogeneity among studies were determined by Meta regression. @*Results@#In this study, among 126 articles that were extracted from primary studies, 7 papers that evaluated the effect of MgSO4 on IVH were eligible for inclusion in the meta-analysis. The results of the meta-analysis showed that pooled relative risk (95% confidence interval [CI]) was 0.80 (95% CI, 0.63 to 1.03) for the effect of MgSO4 on IVH. @*Conclusion@#Results of this study showed that although MgSO4 had a protective effect on IVH in premature infants, this effect was not statistically significant. Further studies are needed to determine the best dosage, timing, and gestational age to achieve the optimum effect of MgSO4 on IVH.Systematic Review Registration International Prospective Register of Systematic Reviews (PROSPERO) Identifier: CRD42019119610
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OBJECTIVE: Endometriosis, a common hormone-dependent chronic inflammatory disease causes various symptoms including pelvic pain, which affect the physical and psychological quality of life in women of reproductive age. The present study aimed to assess the quality of life of Iranian women with endometriosis using the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire. METHODS: This cross-sectional study performed in Tehran between October 2014 and July 2016 included 70 Iranian women with endometriosis. The Iranian version of the WHOQOL-BREF questionnaire was used to measure quality of life in these women. The Pearson's correlation coefficient, the paired and the independent t-tests, and a linear regression model were used to statistically analyze the data using the SPSS software version 16.0. RESULTS: The total mean score of the WHOQOL-BREF questionnaire was 80.58. The highest and the lowest mean scores were observed in the environmental (28.15) and the physical health domains (10.59), respectively. A multiple linear regression model (backward method) showed that insurance coverage was associated with the total WHOQOL-BREF score, whereas age, insurance coverage, and income level were associated with domains 1 through 4, respectively (P < 0.05). CONCLUSION: Endometriosis affects various aspects of the quality of life of Iranian women who therefore require holistic management focused on both, the physical and psychological aspects of treatment.
Subject(s)
Female , Humans , Cross-Sectional Studies , Endometriosis , Global Health , Insurance Coverage , Linear Models , Pelvic Pain , Quality of Life , World Health OrganizationABSTRACT
A 37-year-old woman underwent surgery to remove bilateral vulvar masses. The masses were firm, non-tender, and immobile. Pathologic finding was a well-delineated creamy grayish mass with a homogenous grayish solid surface and mild edema, chronic inflammatory infiltration, and focal dilation of the ducts with squamous metaplasia. The diagnosis was hyperplastic and hypertrophied Bartholin's gland. Hyperplasia is a rare etiology for an enlarged Bartholin's gland. Clinical presentation of Bartholin's gland nodular hyperplasia is rather specific, although inflammatory lesion is the most common cause of swelling of the Bartholin's gland in all age groups. Bartholin's hyperplasia should be considered in cases with a solid mass. Total surgical excision is required for diagnosis. Only a few cases of Bartholin's gland hyperplasia have been reported in the literature. Our patient has been receiving regular follow-up examination and there is no evidence of dyspareunia, perineal pain, and recurrent disease 12 months after surgery
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Background: The virginity is a matter of concern in many eastern countries, especially Muslim societies. In some cultures, integrity of hymen before marriage causes deprivation of social rights for the females; even in some cases an honor killing is plausible
Materials and methods: In this descriptive cross-sectional study, total records of all virgin patients who underwent hysteroscopy for medical reasons in Hazrat Rasool Hospital between 2004 and 2014 were studied. Data were analyzed by SPSS version 19 using descriptive scales and simple proportion and ratios
Results: 400 women with AUB [abnormal uterine bleeding] were referred to Hazrat Rasool Hospital for the diagnosis and treatment. 12 cases [3%] were virgin and 388 [97%] were non-virgins. In 12 Virgin patients admitted for hysteroscopy, 3 [25%] hymenal damage were reported, and in 9 virgin patients hymen remained intact postoperatively
Conclusion: Regarding the high prevalence of congenital and acquired uterine diseases and successful treatment of these problems by hysteroscopy, it seems prudential to focus on more comprehensive teaching programs in the gynecologic endoscopic field. This will help better and earlier diagnosis and treatment of virgin patients, due to seeking earlier medical care
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Ovarian fibroma is the most common benign solid tumor of the ovary, which is often difficult to diagnose preoperatively. The choice treatment for ovarian fibroma is surgical removal, but discussions for the operative approach, laparoscopic or open, in the literature seem to be scant. Case Presentation: We presented a unique clinical experience of laparoscopic approach to a case of 15 cm unilateral ovarian fibroma in a 24 year old patient, with a successful and complete resection of the tumor beside ovarian tissue preservation in December 2012 in Rasoul-e-Akram hospital, Tehran, Iran. In conclusion, we should not forget the role of laparoscopy as a diagnostic procedure even in suspicious cases of ovarian fibroma with solid tumor, ascites, and pleural effusion
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The largest percentage of failed invitro fertilization [IVF] cycles, are due to lack of implantation. As hereditary thrombophilia can cause in placentation failure, it may have a role in recurrent IVF failure. Aim of this case-control study was to determine whether hereditary thrombophilia is more prevalent in women with recurrent IVF failures. Case group comprised 96 infertile women, with a history of recurrent IVF failure. Control group was comprised of 95 healthy women with proven fertility who had conceived spontaneously. All participants were assessed for the presence of inherited thrombophilias including: factor V Leiden, methilen tetrahydrofolate reductase [MTHFR] mutation, prothrombin mutation, homocystein level, protein S and C deficiency, antithrombin III [AT-III] deficiency and plasminogen activator inhibitor-1 [PAI-1] mutation. Presence of thrombophilia was compared between groups. Having at least one thrombophilia known as a risk factor for recurrent IVF failure [95% CI=1.74-5.70, OR=3.15, p=0.00]. Mutation of factor V Leiden [95% CI=1.26-10.27, OR=3.06, P=0.01] and homozygote form of MTHFR mutation [95% CI=1.55-97.86, OR=12.33, p=0.05] were also risk factors for recurrent IVF failure. However, we could not find significant difference in other inherited thrombophilia's. Inherited thrombophilia is more prevalent in women with recurrent IVF failure compared with healthy women. Having at least one thrombophilia, mutation of factor V Leiden and homozygote form of MTHFR mutation were risk factors for recurrent IVF failure
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Preterm birth [PTB] is responsible for 70% of neonatal mortalities. Various factors influence the risk of neonatal mortality in different populations Our objective was to evaluate neonatal survival rate of preterm infants, and to define its predictors in Iranian population. This retrospective cohort study included all preterm [26-37 weeks] infants [n=1612] born alive in Shahid Akbar-abadi university hospital, during one year period [April 2010-2011]. These infants were evaluated for fetal-neonatal, maternal, and pregnancy data. Survival analysis was performed and viability threshold and risk factors of neonatal mortality were evaluated. Total overall mortality rate was 9.1%. Survival rate were 11.11% for extremely low birth weights [LBW] and 45.12% for very early PTBs. The smallest surviving infant was a 750 gr female with gestational age [GA] of 30 weeks and the youngest infants was a 970 gram female with GA of 25 weeks plus 2 days. History of previous dead neonate, need to cardio-pulmonary resuscitation [CPR], need to neonatal intensive care unit [NICU] admission, postnatal administration of surfactant, presence of anomalies, Apgar score <7, multiple pregnancy, non-cephalic presentation, early PTB, very early PTB, LBW, very low birth weight [VLBW] and extremely low birth weight [ELBW], were risk factors for mortality in preterm neonates Our study revealed that neonatal survival rate is dramatically influenced by birth weight especially under 1000 grams, GA especially below 30 weeks, neonatal anomalies, history of previous dead fetus, multiple pregnancy, non- cephalic presentation, and need for NICU admission, resuscitation and respiratory support with surfactant
Subject(s)
Humans , Female , Male , Survival Rate , Infant Mortality , Perinatal MortalityABSTRACT
A case of cervical ectopic pregnancy in a 37 years old woman with history of two previous cesarean sections and one dilatation/curettage. The case was the advanced cervical pregnancy reported in Iran, which diagnosed in 12 week of gestation by MRI and finally treated by hysterectomy
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To evaluate total plasma homocysteine level during the acute phase of central retinal vein occlusion [CRVO] compared with a matched healthy group in Iranian population, and determine whether hyperhomocysteinemia is also a risk factor for CRVO. A study group contains 54 patients presenting with CRVO in recent one month, acute phase of the decease, was compared for fasting total plasma homocysteine level with a matched control group of 51 patients evaluated in the same clinic for a non retinal disease diagnosis. The mean total plasma homocysteine level was 14.76 +/- 7.67 micro mol/l in cases, and 11.42 +/- 3.74 micro mol/l in control subjects. It shows a significant difference [p=0.005] in mean plasma homocysteine level between the cases and control group. Odds ratio of CRVO for individuals with hyperhomocysteinemia was 2.88 [95% Cl=1.08-7.71 and p=0.03]. The overall multivanable-adjusted odds of CRVO in participants with plasma homocysteine level above 15 micro mol/l was 4.71 [95% Cl=1.46-15.19 and p=0.009] Hyperhomocysteinemia was not statistically different in each age group [<60 years: 27%. 61-70 years: 33.3%, 71-80 years: 31.6%, >81 years: 33.3%], Chi-square test, p=0.98]. Elevated total plasma homocysteine level is an independent risk factor for CRVO in Iranian population. In addition to an evaluation of all conventional cardiovascular risk factors, measurement of total homocysteine for evidence of hyperhomocysteinemia may be important in the initial investigation and management of patients with CRVO