Serum heat shock protein 70 in preeclampsia and normal pregnancy: a systematic review and meta-analysis

Background: Preeclampsia, a severe complication of human pregnancy is one of the main causes of maternal, fetal, and neonatal morbidity and mortality with unclear pathogenesis. Heat shock protein 70 [HSP70] is one of the factors that can mediate cytoprotective, antiapoptotic, and immune regulatory effects

Objective: This meta-analysis was performed with aim to evaluate HSP70 in preeclampsia and normal pregnancy

Materials and Methods: The original publications reporting the serum HSP70 levels in preeclampsia and normal pregnancies published before November 2015 were identified by searching PubMed Central, Scopus, and ISI Web of Knowledge databases by two researchers, separately. The keywords were[ preeclampsia] and [HSP70] or [Heat shock protein 70] Statistical analyses were performed using STATA software [version 11]

Results: Out of 127 studies, seven eligible case-control studies were identified which consists of 350 preeclampsia and 429 normal pregnancies. Our pooled analysis of data from 7 studies which met the inclusion criteria, provides evidence that there is a significant association between HSP70 and preeclampsia. Cochran's test results showed the heterogeneity of the studies [p<0.001] and the I2 index was 91%. The standardized mean differences [SMD] based on a random effect model with trim and fill method was 0.92 [95% CI: 0.33-1.51]; also there was a significant association between HSP70 and preeclampsia [Z=3.07, p=0.002]

Conclusion: The results showed that serum HSP70 concentration was significantly higher in preeclamptic patients than the control group. Therefore HSP70 may be identified as a diagnostic factor

Cervical bacterial colonization in women with preterm premature rupture of membrane and pregnancy outcomes

Background: One of the most important etiologies in pretermpremature rupture of membranes [PPROM] is cervical bacterial colonization

Objective: This study evaluated cervical bacterial colonization in women with PPROM and the pregnancy outcomes

Materials and Methods: In this cohort study, 200 pregnant women with PPROM at 27-37 wk of gestation who were admitted in an academic hospital of Mashhad University of Medical Sciences from March 2015 to July 2016 were studied. samples were obtained from endocervical canal for detection of routine bacteria and Gram staining. Also, we obtained one blood culture from neonates. Maternal endocervical culture, chorioamnionitis, neonatal intensive care unit admission, neonatal positive blood culture, neonatal sepsis, and mortality were documented

Results: Most common isolated microorganism of endocervical culture were Escherichia coli [24.2%], Coagulase negative Staphylococci [27.2%], Enterococcus and candida each one [11.7%]. The prevalence of GBS was only 2.2%. Simultaneous positive blood cultures were seen in 3% of neonates. Among them, Gram-negative bacilli accounted for [66.6%], while Gram-positive cocci and candida made up only [16.7%]. Endocervical colonization was associated with a higher admission rate [p=0.004], but there was no significant correlation between endocervical colonization and chorioamnionitis, positive blood culture and neonatal mortality rate

Conclusion: With regard to low GBS colonization rate, appropriate antibiotic regimens should be considered in PPROM cases according to the most prevalent micro organisms of endocervical bacterial colonization. Maybe cervical bacterial colonization had some effects on neonatal outcomes. There was no significant association between endocervical bacterial colonization and chorioamnionitis, positive neonatal blood culture and neonatal mortality

Clomiphene citrate versus letrozole with gonadotropins in intrauterine insemination cycles: a prospective randomized trial

Background: Clomiphene citrate is one of the effective drugs for infertilitytreatment due to oligo-ovulation or anovulation. Intrauterine insemination [IUI] isone of more adherent methods for treatment of infertile cases which is followed bycontrolled ovarian hyperstimulation [COH]

Objective: the aim of this study was to evaluate Clomiphene citrate versus letrozolewith gonadotropins in IUI cycles

Materials and Methods: In this prospective randomized trial, 180 infertile patientswho were referred to Milad Hospital were selected. The first group received 5mg/day letrozole on day 3-7 of menstrual cycle. The second group received 100mg/day Clomiphene in the same way as letrozole. In both groups, humanmenopausal gonadotropin was administered every day starting on day between 6-8of cycle. Ovulation was triggered with urinary Human Chorionic Gonadotropin[5000 IU] when have two follicles of >/=16 mm. IUI was performed 36 hr later

Results: The number of matured follicles, cycle cancellation, and abortion were thesame in both groups. Endometrial thickness was higher at the time of humanmenopausal gonadotropin administration in letrozole group. Chemical and clinicalpregnancy rates were much higher in letrozole group. Ovarian hyperstimulation wassignificantly higher in clomiphene group

Conclusion: Letrozole appears to be a good alternative to clomiphene citrate withfewer side effects

Accuracy of color Doppler ultrasonography and magnetic resonance imaging in diagnosis of placenta accreta: a survey of 82 cases

Background: placenta adhesive disorder [PAD] is one of the most common causes of postpartum hemorrhage and peripartum hysterectomy. The main risk factors are placenta previa and prior uterine surgery such as cesarean section. Diagnosis of placenta adhesive disorders can lead to a decrease of maternal mortality and morbidities

Objective: the purpose of this study was to compare the accuracy of color Doppler ultrasonography and magnetic resonance imaging [MRI] in the diagnosis of PADs

Materials and Methods: in this is cross-sectional study, Eighty-two pregnant women who were high risk for PAD underwent color Doppler ultrasound and MRI after 18 weeks of gestation. The sonographic and MRI findings were compared with the final pathologic or clinical findings. P<0.05 was considered statistically significant

Results: mean maternal age was 31.42+/-4.2 years. The average gravidity was third pregnancy. 46% of patients had placenta previa. The history of the previous cesarean section was seen in 79 cases [96%]. The diagnosis of placenta adhesive disorder was found in 17 cases [21%]. Doppler sonography sensitivity was 87% and MRI sensitivity was 76% [p=0.37]. Doppler sonography specificity was 63% and MRI specificity was 83% [p=0.01]

Conclusion: women with high-risk factors for PAD should undergo Doppler ultrasonography at first. When results on Doppler sonography are equivocal for PAD, MRI can be performed due to its high specificity

Acardiac acephalus twin pregnancy with poor prenatal outcomes: a case report

Introduction: Acardiac twin refers to a monochorionic pregnancy in which there is a twin with absent or nonfunctioning heart and a normal co-twin. This was a very rare disorder of monozygotic twin pregnancy. The aim of this report was to introduce a case of acardiac acephalus twin pregnancy

Case Presentation: A 32- year- old woman [G3 P2 L2] referred to the hospital because of a decrease in fetal movement at 32 weeks of gestation. Ultrasonography showed a dead fetus. Her earlier sonography showed the possibility of acardiac twin pregnancy, but she did not have any appropriate or special prenatal care for this problem. After delivery, there was a normal dead fetus without any gross abnormality and another acardiac fetus

Conclusions: Early diagnosis of acardiac twin pregnancy and appropriate prenatal care are of prime importance for appropriate intervention and best fetal outcomes

Obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART compared with spontaneous pregnancy

Introduction: Regarding to the recent advances in assisted reproductive techniques [ART], twin and multiple pregnancies have increased during past years

Objective: This study was performed to compare obstetrics and perinatal outcomes of dichorionic twin pregnancy following ART with spontaneous pregnancy

Materials and Methods: In this cross-sectional study which was performed in Ghaem Hospital, Mashhad University of Medical Sciences, 107 dichorionic twin pregnancy were enrolled in two groups: spontaneous group [n=96] and ART group [n=31]. Basic criteria and obstetrics and neonatal outcomes information including demographic data, gestational age, mode of delivery, pregnancy complications [preeclampsia, gestational diabetes, preterm labor, and intrauterine growth retardation [IUGR], postpartum hemorrhage], neonatal outcomes [weight, first and fifth minuteP PApgar score, Neonatal Intensive Care Unit [NICU] admission, mortality, respiratory distress, and icterus] were recorded using a questionnaire

Results: Preterm labor, gestational diabetes, and preeclampsia were significantly higher in ART group compared to spontaneous pregnancy group. However, other factors such as anemia, IUGR, postpartum hemorrhage, and intrauterine fetal death [IUFD] were not significantly different between groups. There were no significant differences between groups in terms of neonatal outcomes [weight, 1PstP and 5PthP min Apgar score <7, NICU hospitalization, mortality, respiratory distress, and icterus]

Conclusion: With regard of significantly higher poor outcomes such as preeclampsia, gestational diabetes and preterm labor in ART group, the couples should be aware of these potential risks before choosing ART

stromal overexpression of CD10 in invasive breast cancer and its association with clincophathologic factors

Breast carcinoma is the most common non-skin malignancy in women. More recently, it has been suggested that extracellular proteinase has also regulated growth factors and cytokines that might contribute to tumor progression. CD10 is a 90-110kd cell surface zinc-dependent metalloproteinase. Since CD10 is structurally similar to matrix metalloproteinase and stromelysin, it might facilitate cancer cell invasion and/or metastasis. The aim of this study was investigation the rate of CD10 expression in the stromal cells of invasive ductal breast carcinomas, Immunohistochemical aspects, then any other aspects to be able to clarify its correlation with other clinicopathological factors of this disease. One hundred patients with histopathologic diagnosis of invasive ductal carcinoma and 50 patients with fibroadenoma of breast [as the control group] have selected, then 150 paraffin blocks have obtained. The stained slides by immunohistochemistry method for CD10 marker have examined separately by two pathologists, and discrepancies have reviewed in common session to get the final result. Stromal CD10 has detected in 28% of the IDC. No kind of immunoreactivity has identified in the stromal cells of normal breast. Stromal CD10 expression in IDC has significantly correlated with increasing tumor size [p<0.001], increasing histologic grade [p<0.001], the presence of nodal metastases [p<0.001] and estrogen receptor negative status [p=0.003]. Stromal CD10 expression in IDC has closely correlated with invasion and metastasis and it might play an important role in the pathogenesis of IDC

Changes in daily activities of cancer patients after diagnosis: how do canadian and Iranian patients perceive the change?

Being diagnosed with cancer has major impacts on a patient's life. This study was conducted to explore how specific daily activities of patients change as a result of cancer diagnosis or its treatment and how these patients feel about such changes. This was a cross-sectional descriptive study. Cancer patients referred to our clinics and by completing a questionnaire, they reported their daily activities and how they changed after diagnosis. A total of 201 patients in Canada and 167 patients in Iran completed the questionnaire. The research setting was the outpatient cancer clinics of the Jewish General Hospital in Montreal, Canada [February to April 2008] and Imam Reza Hospital and Ghaem Hospital in Mashhad, Iran [March to August 2008]. More than 40 percent of the patients reported changes after the diagnosis in at least 8 out of 22 daily activities listed in the questionnaire. While a negative perception towards the changes was more common, some patients also perceived some changes as positive. More than half of the participants [56.9%] who were employed at the time of diagnosis experienced changes in the amount or type of their paid work after being diagnosed with cancer. The impact of a cancer diagnosis and treatment on a patient's daily activities is drastic. There is a need to provide support and interventions to help patients maintain daily activities they need and/or like. Further studies are needed to better understand the nature of such interventions

Evaluation of selected thrombotic factors among pregnant women with preeclampsia and normal pregnant women

Preeclampsia is one of the common complications during pregnancy with considerable maternal and fetal mortality and morbidity. Hypercoagulability due to thrombophilic factors is discussed as the etiology involved in this disease. The aim of this study was to evaluate selected thrombotic factors among pregnant women with preeclampsia and normal pregnant women. This case-control study was performed on 200 pregnant women at third trimester of pregnancy between 2012 and 2013. 100 pregnant women admitted to Qaem and Imam Reza hospitals of Mashhad, due to preeclampsia, were selected as case group and 100 pregnant women without preeclampsia referred to OB/GYN clinic of these hospitals as control group. Blood samples were taken from two groups for evaluation of the coagulation factors including factor V Leiden, protein C, protein S, antithrombin III, anti-cardiolipin antibodies, and lupus anticoagulant antibodies. Two groups were not significantly different in terms of maternal age and parity [p>0.05]. Levels of factor V Leiden, protein C, protein S, antithrombin III, anti-cardiolipin antibodies and lupus anticoagulant antibodies were compared between two groups. The number of patients with abnormal factor V Leiden and protein C was significantly higher in case group than in the control group [p<0.01 respectively], but other factors were not significant different between two groups. Thrombophilia disorders were significantly more in case group compared to control [p<0.001]. The risk of thrombophilia disorders is higher in preeclamptic patients than normal pregnant women

[Uterine rupture following incomplete molar pregnancy: a case report]

Background: In molar pregnancy, when hydatidiform changes are local and some embryonic components are observed, the term of partial mole is used. The risk of persistent trophoblastic tumor after partial mole is much lower than complete mole. In this persistent cases almost all are non metastatic. The aim of this study is to report a case of uterine rupture following incomplete molar pregnancy

Case presentation: The patient was a 26 year old woman with obstetric history of an abortion and one molar pregnancy and no child. She was referred to emergency unit in Ghaem University Hospital, Mashhad, Iran in May 2011. She had an evacuation curettage following molar pregnancy three months before and without any follow up visit. The patient was referred to emergency unit with hemorrhagic shock. She immediately underwent laparotomy. The uterine fundal rupture was repaired and evacuation curettage performed. In post operative evaluation, she had a nine millimeter metastatic nodule in base of right Lung. As a patient in low risk stage III, she received weekly intramuscular methotrexate [40mg/m2] for six courses. In follow up visit beta-hCG titer was negative [<10miu/ml] at 5th week

Conclusion: In cases of in complete molar pregnancy risk of metastasis is very low. Serial beta-hCG titer is the most accurate method for detection of persistent gestational trophoblastic disease [GTN]. In neglected cases like this case preservation of ruptured uterus in GTN is possible

Incidence of chemotherapy-induced amenorrhea after adjuvant chemotherapy with taxane and anthracyclines in young patients with breast cancer

Chemotherapy-induced amenorrhea is one of long term side effects of adjuvant chemotherapy in patients with breast cancer which may interfere with their future reproductive function. Although amenorrhea is well recognized, the actual incidence following taxanes remains uncertain. In a cross sectional study, we identified breast cancer patients aged 45 years or younger who were treated with adjuvant anthracycline and taxane-based regimens at three different oncology departments from 2001-2008. One hundred and nineteen patients met all eligibility criteria and consented to participate in a regular follow up program. The median age at diagnosis was 33.5 years [range, 25-41]. Seventy [58%] patients developed amenorrhea for at least 12 months following completion of treatment, and regular menses were maintained in another 49 [42%] patients. No statistically significant association was found between age and development of amenorrhea, although those who experienced cessation of menses were older. Although taxane containing chemotherapy was associated with higher rate of amenorrhea compared to FAC, this was not statistically significant [P=0.11]. Also, treatment with tamoxifen and Estrogen Receptor [ER] positive status was significantly correlated with chemotherapy induced amenorrhea