Environmental extreme temperature and daily preterm birth in Sabzevar, Iran: a time-series analysis

OBJECTIVES@#Most of the studies on the effect of heat stress on preterm birth (PTB) are conducted in temperate climates. Evidence on this effect in hot and arid countries with low and middle income is limited. This paper describes the short-term effect of exposure to the hot and cold environment on a daily number of PTB in Iran.@*METHODS@#The daily number of PTB was obtained from all hospitals of the city. Meteorological and air pollution data from 2011 to 2017 were obtained from a metrological station in the city. A semi-parametric generalized additive model following a quasi-Poisson distribution with the distributed lag non-linear model was selected as a modeling framework for time-series analysis to simultaneously model the short-term and lagged effect of heat stress on PTB in the Sabzevar city.@*RESULTS@#The minimum and maximum daily temperature were - 11.2 and 45.4 °C respectively. The highest risk estimate at extreme cold temperature was found for apparent temperature (relative risk (RR) 1.83; 95% CI 1.61: 2.09). This pattern was seen for both models. For extreme hot temperatures, the model with mean temperature showed the highest risk increase for both the main model and air pollution adjusted model (RR 1.36; 95% CI 1.25: 1.49). The lowest risk estimate in extremely cold conditions was found in the model with mean temperature. However, for extremely hot temperature conditions, the lowest risk estimate was found for both maximum and apparent temperature.@*CONCLUSION@#Obstetricians working in semi-arid areas should be aware of the influence of environmental extreme temperature on the incidence of PTB.

Pregnancy outcome in delayed start antagonist versus microdose flare GnRH agonist protocol in poor responders undergoing IVF/ICSI: an RCT

Background: Over the years, many article on different aspects of pathogenesis and management of poor ovarian responders have been published but there is no clear guideline for treating themyet

Objective: This study was designated to compare the effectiveness of a delayed start protocol with gonadotropin-releasing hormone [GnRH] antagonist and microdose flare-up GnRH agonist protocol in poor ovarian responders

Materials and Methods: This randomized clinical trial consisted of 100 poor ovarian responder women in assisted reproductive technologies cycles. They were divided randomly in delayed-start antagonist protocol [with estrogen priming followed by early follicular-phase GnRH antagonist treatment for 7 days before ovarian stimulation] and microdose flare-up GnRH agonist protocol. The main outcome was clinical pregnancy rate and second outcome was the number of retrieved oocytes, mature oocytes, 2PN number, fertilization rate, and implantation rate

Results: Fertilization rate, clinical pregnancy rate, and ongoing pregnancy rates were not significantly different between the two studied protocols. Number of retrieved oocytes [5.10+/-3.41 vs. 3.08+/-2.51] with p=0.002, mature oocytes [4.32+/-2.69 vs. 2.34+/-1.80] with p=0.003, number of 2PN [3.94+/-1.80 vs. 2.20+/-1.01] with p=0.001 and implantation rate [19.40% vs. 10.30%] with p=0.022 were significantly higher in delayed antagonist group

Conclusion: The delayed-start protocol can improve ovarian response in poor responders by stimulating and synchronizing follicle development

Recurrent vulvovaginal candidiasis: could it be related to cell-mediated immunity defect in response to candida antigen?

Background: Recurrent vulvovaginal candidiasis [RVVC] is a common cause of morbidity affecting millions of women worldwide. Patients with RVVC are thought to have an underlying immunologic defect. This study has been established to evaluate cell-mediated immunity defect in response to Candida antigen in RVVC cases

Materials and Methods: Our cross-sectional study was performed in 3 groups of RVVC patients [cases], healthy individuals [control I] and known cases of chronic mucocuta-neous candidiasis [CMC] [control II]. Patients who met the inclusion criteria of RVVC were selected consecutively and were allocated in the case group. Peripheral blood mon-onuclear cells were isolated and labeled with CFSE and proliferation rate was measured in exposure to Candida antigen via flow cytometry

Results: T lymphocyte proliferation in response to Candida was significantly lower in RVVC cases [n=24] and CMC patients [n=7] compared to healthy individuals [n=20, P<0.001], but no statistically significant difference was seen between cases and control II group [P>0.05]. Family history of primary immunodeficiency diseases [PID] differed significantly among groups [P>0.0l], RVVC patients has family history of PID more than control I [29.2 vs. 0%, P=0.008] but not statistically different from CMC patients [29.2 vs. 42.9%, P>0.05]. Prevalence of atopy was greater in RVVC cases compared to healthy individuals [41.3 vs. 15%, P=0.054]. Lymphoproliferative activity and vaginal symptoms were significantly different among RVVC cases with and without allergy [P=0.01, P=0.02]

Conclusion: Our findings revealed that T cells do not actively proliferate in response to Candida antigen in some RVVC cases. So it is concluded that patients with cell-mediated immunity defect are more susceptible to recurrent fungal infections of vulva and vagina. Nonetheless, some other cases of RVVC showed normal function of T cells. Further evaluations showed that these patients suffer from atopy. It is hypothesized that higher frequency of VVC in patients with history of atopy might be due to allergic response in mucocutaneous membranes rather than a functional impairment in immune system components

effect of 24 hours delay in oocyte maturation triggering in IVF/ICSI cycles with antagonist protocol and not-elevated progesterone: a randomized control trial

Background: The best time of final oocyte maturation triggering in assisted reproduction technology protocols is unknown. This time always estimated by combined follicular size and blood progesterone level

Objective: The aim of this study was evaluation of the effect of delaying oocyte maturation triggering by 24 hr on the number of mature oocytes [MII] and other in vitro fertilization cycle characteristics in antagonist protocols with not-elevated progesterone [p

Materials and Methods: All patients' candidate for assisted reproduction technology underwent controlled ovarian hyperstimulation by antagonist protocol. When at least 3 follicles with >/=18 mm diameters were seen by vaginal ultrasonography; blood progesterone level was measured. The patients who had progesterone level

Results: Number of retrieved oocytes, mature oocytes [MII], fertilized oocytes [2PN], embryos formation, number of transferred embryos and embryos quality has not significant differences between two groups. Also, fertilization and implantation rate, chemical and clinical pregnancy did not differ between groups

Conclusion: Delaying of triggering oocyte maturation by 24 hr in antagonist protocol with not-elevated progesterone [progesterone

Effect of granulocyte colony stimulating factor [G-CSF] on IVF outcomes in infertile women: An RCT

Background: Despite major advances in assisted reproductive techniques, the implantation rates remain relatively low. Some studies have demonstrated that intrauterine infusion of granulocyte colony stimulating factor [G-CSF] improves implantation in infertile women

Objective: To assess the G-CSF effects on IVF outcomes in women with normal endometrial thickness

Materials and Methods: In this randomized controlled clinical trial, 100 infertile women with normal endometrial thickness who were candidate for IVF were evaluated in two groups. Exclusion criteria were positive history of repeated implantation failure [RIF], endocrine disorders, severe endometriosis, congenital or acquired uterine anomaly and contraindication for G-CSF [renal disease, sickle cell disease, or malignancy]. In G-CSF group [n=50], 300 micro g trans cervical intrauterine of G-CSF was administered at the oocyte retrieval day. Controls [n=50] were treated with standard protocol. Chemical, clinical and ongoing pregnancy rates, implantation rate, and miscarriage rate were compared between groups

Results: Number of total and mature oocytes [MII], two pronuclei [2PN], total embryos, transferred embryos, quality of transferred embryos, and fertilization rate did not differ significantly between two groups. So there were no significant differences between groups in chemical, clinical and ongoing pregnancy rate, implantation rate, and miscarriage rate

Conclusion: our result showed in normal IVF patients with normal endometrial thickness, the intrauterine infusion of G-CSF did not improve pregnancy outcomes

Frequency of hearing impairment among full-term newborns in Yazd, Iran

Permanent congenital hearing loss, a common congenital anomaly, may affect speech and language acquisition, academic achievement and social development. Current standards emphasize early recognition of congenital hearing loss. This study was conducted to find the prevalence of hearing impairment in term newborns in Yazd, Iran. This was a descriptive-analytic study conducted in Yazd on 7250 term newborns. Otoacoustic emissions [OAEs] test was performed in all newborns during the first 24 hours after birth. Those who failed to respond at the first step were retested 15 days later. Those who failed to respond at the second step too, were tested by acoustic brainstem responses [ABR] test. Chi square test was used for data analysis. From 7250 newborns in the first step 598 [8.2%] and 682 [9.4%] ears [right and left, respectively] failed. In the second step 51 [0.7%] and 58 [0.8%] ears [right and left, respectively] failed. Consanguinity and route of delivery had significant effect on the frequency of hearing loss. The overall frequency of congenital hearing loss in this study was found high