Association of thyroid function test abnormalities with preeclampsia: a systematic review and meta-analysis.

BACKGROUND: Preeclampsia is a life-threatening disorder during pregnancy and postpartum periods. Preeclampsia can affect the activity of many organs. It is very important because if this disorder is associated with changes in thyroid function, it can affect the results of maternal and fetal tests. Accordingly, the aim of this meta-analysis study was to assess the abnormalities in thyroid function tests in preeclampsia. METHODS: Studies were selected through a systematic search of the MEDLINE/PubMed, Scopus, Web of Science Core Collection, and Google Scholar databases in 31st August 2021. Also, reference lists of review articles and relevant studies were manual-searched to identify other potentially eligible studies. English studies that compared TSH, T4 and T3 of normal pregnant with preeclamptic women (Known to be normotensive before pregnancy; gestational age 20 week or more; singleton pregnancy; no previous history of thyroid dysfunction) were screened. Data sets were screened for eligibility by two independent reviewers. Articles were assessed by the Newcastle-Ottawa Scale. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for quality assessment of evidence on outcome levels. RESULTS: After reviewing 886 published studies, 63 observational studies were selected and used for this meta-analysis. The study population included 21,528 pregnant women. The findings revealed that TSH (SMD = 1.70, 95%CI: 1.39 to 2.02; p < 0.001) was significantly higher in preeclamptic women. TT4 (SMD = -0.82, 95%CI: -1.16, -0.49; p < 0.001), TT3 (SMD = -0.88, 95%CI: -1.36 to -0.41; p < 0.001) and FT3 (SMD = -0.59, 95%CI: -0.91 to -0.27; p < 0.001) were less in preeclamptic women. There was no statistically significant difference in FT4 between two groups (SMD = 0.002, 95%CI: -0.27 to 0.27; p = .990). The results of publication bias and sensitivity analysis confirmed the reliability and stability of this meta-analysis. The quality of evidence was regarded as moderate, low, and very low for these risk factors according to the GRADE approach. CONCLUSIONS: Findings of this meta-analysis indicated preeclamptic women were more at risk of changes in thyroid function tests. In order to prevent thyroid disorders, it is recommended that thyroid function tests be performed in women with pre-eclampsia.

Impact of Various Parameters as Predictors of The Success Rate of In Vitro Fertilization.

A woman who is infertile is defined as a woman who is unable to conceive after having unprotected sex for more than one year. 20-25% of couples worldwide suffer from infertility each year (60 to 80 million couples). In vitro fertilization (IVF) plays a significant role in the treatment of various types of infertility, including fallopian tube defects, endometriosis, immunity, and male causes. IVF is a complex procedure that can be used to aid fertility or prevent genetic problems in the fetus. The objective of this review is to investigate factors that affect IVF failure and success rates. Need for this review is predicated on the different results obtained from previous studies, the high prevalence of infertility, and the lack of a similar study in this field. Articles were regarded as suitable if they evaluated the association between any factor and IVF outcome. A comprehensive search of databases was completed from their inception until March 2021. Our search resulted in 1278 articles. After assessing the titles and abstracts, we selected 70 articles for further reading. Our review shows that the effectiveness of IVF treatment depends on many factors. These include the physical environment, genetics, psychological factors, serum levels of certain hormones, sperm characteristics, as well as the age and body mass index of couples. Based on the results of our study, nutrient supplementation maybe beneficial for the enhancement of semen quality. For better IVF outcome, it is better for obese women to balance their body mass index (BMI) before IVF procedure initiation.

A Qualitative Study on Stigmatization Associated With COVID-19.

Objective: To survey and analyze the experience of stigma among patients with coronavirus disease 2019 (COVID-19) in Iran.Methods: This qualitative study was conducted from September to December 2020 in the Fars, Khorasan Razavi, and Yazd provinces of Iran. Sampling was done via the snowball method. Based on data saturation criteria, 24 adults aged > 18 years who had been diagnosed with COVID-19 were recruited. Semi-structured telephone interviews were conducted with each patient. Data were analyzed following the conventional content analysis method.Results: The results showed that during their illness with COVID-19, the participants experienced a difficult and anxious course, with rejection and alienation from their first-degree relatives taking them by surprise. The 3 main themes extracted from this study were (1) fear and rejection, (2) discrimination, and (3) loneliness. These experiences changed the attitudes of the participants toward life and themselves.Conclusions: The results show the importance of being aware of social stigma among patients and that primary care physicians play an integral role in addressing this issue, especially during pandemics. Psychological counseling sessions for those afflicted is recommended, and education and training should be provided to the public regarding the proper treatment of patients with COVID-19. Quantitative studies in this field are highly recommended.

Liposomes: Ideal drug delivery systems in breast cancer.

Breast cancer (BC) has been recognized as the most common type of cancer in females across the world, accounting for 12% of each cancer case. In this sense, better diagnosis and screening have been thus far proven to contribute to higher survival rates. Moreover, traditional (or standard) chemotherapy is still known as one of the several prominent therapeutic options available, though it suffers from unsuitable cell selectivity, severe consequences, as well as resistance. In this regard, nanobased drug delivery systems (DDSs) are likely to provide promising grounds for BC treatment. Liposomes are accordingly effective nanosystems, having the benefits of multiple formulations verified to treat different diseases. Such systems possess specific features, including smaller size, biodegradability, hydrophobic/hydrophilic characteristics, biocompatibility, lower toxicity, as well as immunogenicity, which can all lead to considerable efficacy in treating various types of cancer. As chemotherapy uses drugs to target tumors, generates higher drug concentrations in tumors, which can provide for their slow release, and enhances drug stability, it can be improved via liposomes in DDSs for BC treatment. Therefore, the present study aims to review the existing issues regarding BC treatment and discuss liposome-based targeting in order to overcome barriers to conventional drug therapy.

The Effect of Oral Vitamin E on Semen Parameters and IVF Outcome: A Double-Blinded Randomized Placebo-Controlled Clinical Trial.

BACKGROUND: Male infertility is a main clinical problem that affects about 7% of all men worldwide. Many patients with male infertility are caused by a reduced antioxidant capacity of semen. Several antioxidant supplements, especially vitamin E, are proposed to help male infertility treatment. This project was goaled to study the effects of oral synthetic vitamin E (400 IU/day) for eight weeks on betterment of semen parameters and pregnancy rate. METHODS: After dropping the cases, 124 infertile couples with a male factor who were admitted to the IVF program were included. The male patients with idiopathic abnormal motility and/or morphology were randomized into two groups: 61 receiving vitamin E and 63 as the control group receiving placebo for eight weeks. The pretreatment semen parameters of both groups were compared with those of posttreatment. The pregnancy outcomes were considered between the two groups. RESULTS: There were no significant differences statistically between before and after treatment in the term of sperm volume, count, motility, and morphology. Furthermore, the IVF outcomes of the two groups were not different significantly, either. Interestingly, the percent of normal sperm in the placebo group was significantly decreased after eight weeks. CONCLUSION: Vitamin E supplementation might neutralize free radical activity to keep sperm from more oxidative damages. Further studies regarding the influence of higher acceptable doses of vitamin E on semen characteristics and fertility rates are needed. This study was registered as a two-arm, blinded, randomized, placebo-controlled clinical trial (IRCTID: IRCT2014020616506N1, 2014-03-18).

Comparing four different methods for the management of ectopic pregnancy: A cross-sectional study.

Background: Ectopic pregnancy (EP) is one of the major causes of maternal mortality during the first trimester of pregnancy. Objective: Four treatment methods for EP including single-dose methotrexate (SD-MTX), double-dose methotrexate, expectant and surgical management were considered. Materials and Methods: In this cross-sectional study, the clinical characteristics of 365 women aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017 to March 2019 in hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Receiver operating characteristics curves were plotted to determine the cut-off points for size of ectopic mass and beta-human chorionic gonadotropin (ß-hCG) that suitably discriminated between double-dose methotrexate and surgery management. Results: The most common site of EP was adnexa. According to the receiver operating characteristics analysis, surgery was the best plan for the women with an ectopic mass > 34.50 mm in diameter or with an initial ß-hCG level > 6419 mIU/ml. The ß-hCG levels in the women successfully treated with SD-MTX were significantly lower than in those with failed treatment (p = 0.02). The SD-MTX group had a higher success rate and significantly shorter duration of hospitalization, and so this was a more effective medical treatment in comparison with the double-dose protocol. Conclusion: Surgery is proposed as the best option for the cases with large ectopic mass or high ß-hCG level. SD-MTX had a higher success rate and shorter hospital stay than the double-dose protocol, and so was found to be an efficient and safe alternative. Further randomized clinical trials with larger sample sizes are recommended to validate the current results.

MicroRNA: A Potential Diagnosis for Male Infertility.

Male infertility is one of the major global health problems, in particular, in more than half of the affected men. Genetic factors are important for identifying men with idiopathic infertility along with semen analysis. Valid and useful information can be obtained through non-invasive molecular research. Among these, small single-stranded non-coding RNA molecules of microRNAs (abbreviated miRNAs) are non-invasive biomarkers with a diagnostic value by regulating the post-transcriptional gene silence through repression and prevention of the translation process. The association between various types of male infertility and miRNA regulation changes has been evaluated to understand the biological function of miRNA and gene targets. Accordingly, further study of the function of miRNAs associated with reproductive disorders could lead researchers to further understand the molecular mechanisms of male infertility in order to find effective biomarkers and therapeutic strategies. Therefore, the present review article aimed at scrutinizing those researches investigating the altered miRNA expression in testicles, epididymis, and spermatozoa.

Role of Oxidative Stress and Antioxidant Supplementation in Male Fertility.

Nearly 15% of couples experience infertility as a universal health issue. About 50% of infertility cases have been known to be associated with the male partner . Oxidative stress (OS) represents an imbalance in the level of reactive oxygen species (ROS) and anti-oxidants. In fact, OS has been considered as one of the popular pathologies reported in about 50% of all infertile males. Therefore, the increased level of ROS may result in infertility via DNA damages or lipid peroxidation (LPO) as well as the inactivation of enzymes and oxidation of protiens in spermatozoa. Basically, OS results from lifestyle variables. As the absence of antioxidants and the respective deficiencies in the semen cause OS, variations in the lifestyle and anti-oxidant regimes may be advantageous to treatment strategies for resolving such an issue. Actually, anti-oxidants like vitamins E and C, glutathione, coenzyme-Q10, carnitines, selenium, Nacetylcysteine, carotenoids, zinc, and pentoxifylline decline the OS-induced sperm damages. Therefore, the present review overviews the oxidative biochemistry associated with sperm health and identifies which men would be most at risk of oxidative infertility. Hence, the review would show the techniques provided to diagnose OS and diverse therapeutic options.

Relationship between Religious Orientation, Anxiety, and Depression among College Students: A Systematic Review and Meta-Analysis.

BACKGROUND: Religious obligation helps people to develop mental health by creating internal commitment to special rules. This meta-analysis aimed to determine the relationship between religious orientation and anxiety among college students. METHODS: Major scientific databases including PubMed, Web of Science, Science Direct, EBSCO, ProQuest and PsycINFO were searched for original research articles published 1987-2016. A random effect model was used to combine Correlation coefficient. All analyses were performed using Stata MP. RESULTS: After screening of 7235 documents, 13 articles including 5620 participants met inclusion criteria in this meta-analysis. Correlation coefficient was -0.08 (95% CI= -0.19, -0.03) which indicated with increasing religious orientation, anxiety and depression reduced (P<0.001). Characteristics such as sex, geographic region, and type of religions were potential sources of heterogeneity. Based on fill-and-trim method the adjusted pooled r was obtained, -0.06 (95% CI= -0.16, -0.04). CONCLUSION: There was a weakness relationship between religious orientation and mental anxiety and depression. Therefore, it needs to improve knowledge of student about advantages of religious orientation.

Quality of Life and Its Influencing Factors of Couples Referred to An Infertility Center in Shiraz, Iran.

In this article which was published in Int J Fertil Steril, Vol 11, No 4, Jan-Mar 2018, on pages 293-297, the "Duration of tducation (male)" was misspelled in Table 1. The corrected one is "Duration of education (male)". In the sentence "These differences might be related to the use of a fertility-specific instrument (FertiQoL) in the study by Huppelschoten et al. (23) and the current study compared to the general QoL assessment instrument by Chachamovich et al. (24) and Rashidi et al. (15)." Which was at the page of 296 in the discussion section, the word "generic" was corrected in to "general".

Quality of Life and Its Influencing Factors of Couples Referred to An Infertility Center in Shiraz, Iran.

BACKGROUND: Infertility adversely affects quality of life (QoL). The present study aims to evaluate QoL and its associated factors among infertile couples. MATERIALS AND METHODS: In this cross-sectional study, the Fertility QoL (FertiQoL) instrument was used to measure QoL among 501 volunteer couples who attended the Infertility Clinic at the Mother and Child Hospital, Shiraz, Iran. We used an additional questionnaire to assess participants' demographic and clinical characteristics. The relationship between the scores of QoL to the sociodemographic and treatment data was analysed. RESULTS: The subjects with lower income levels had lower relational, mind/body, emotional, and total core scores. Female participants without academic education had lower scores in the emotional subscale, while the male participants showed lower scores in emotional, mind/body, relational, social, and total QoL domains. Subjects who had undergone any type of treatment, including pharmacological treatment, intrauterine insemination (IUI), intra-cytoplasmic sperm injection (ICSI), and in vitro fertilization (IVF) showed significantly lower scores in the environmental domain. Participants with lower infertility duration obtained significantly greater QoL scores. Finally, tolerability, emotional, and environmental domains were significantly more desirable when the infertility problem was related to a male factor. CONCLUSION: Infertile couples with shorter duration of infertility and male etiology have higher QoL. Lower academic education, lower income levels, or prior unsuccessful treatments are associated with lower QoL.

The evaluation of the relationship between some related hormone levels and diet in obese or overweight patients with hirsutism: A randomized clinical trial.

INTRODUCTION: Hirsutism is a common disorder that has remarkable physical and mental effects on individuals. No appropriate diet has yet specified for individuals with hirsutism. The present study was carried out to examine the effect of high-fibre, low-caloric balanced diet on some related hormone levels in obese or overweight women with hirsutism who had referred to clinics affiliated with Shiraz University of Medical Sciences. MATERIALS AND METHODS: The present study was a clinical trial that was carried out on 47 obese or overweight women with hirsutism in 2014. The women were randomly assigned to an intervention group and a control group that, respectively, consumed a high-fiber, low-caloric balanced diet and a normal diet for 3 months. A demographic characteristics questionnaire and a researcher-designed diet questionnaire were filled out by the two groups before the intervention. Before and 12 weeks after the intervention, body mass index (BMI) was measured and blood samples (on the 3-5 days of menstruation) were collected. Factors of luteinizing hormone, follice stimulating hormone, sex hormone binding globulin, dehydroepiandrosterone sulfate, low-density lipoproteins, high-density lipoproteins (HDL), fasting blood sugar (FBS), CHOL, prolactin, triglycerides, insulin, 17-hydroxyprogesterone, and free androstenedione testosterone were measured. The collected data were analyzed through t-test, Chi-square, and intergroup analysis using SPSS 22.0. RESULTS: The mean age of the participating women was 27.23 ± 5.42 years. After the study, the level of FBS and insulin in the intervention group dropped while they increased in the control group. Moreover, the postintervention level of BMI in the intervention group on average decreased 1.89 units while it rose by 0.3 units in the control group, and there was a significant difference between the two groups (P < 0.001). CONCLUSION: The results of the present study showed that consuming high-fiber diet by obese or overweight women with hirsutism and polycystic ovary can reduce some factors including the level of FBS, insulin, and cholesterol and enhance blood HDL. Therefore, consuming this type of diet is recommended to treat this disorder.

Thyroid autoimmunity in pregnancy and its influences on maternal and fetal outcome in Iran (a prospective study).

AIM OF THE STUDY: Thyroid dysfunction and autoimmunity are common problems in women of child-bearing age. It could be associated with pregnancy morbidities in the mother and fetus. Due to lack of sufficient data about the prevalence of thyroid autoimmunity in pregnant women in Iran, and controversies about its complications on pregnancy outcomes, this study was conducted. MATERIALS AND METHODS: This is a prospective study on 600 singleton pregnant women in 15-28 weeks of pregnancy; they were residents of Fars province. We evaluated the prevalence of preeclampsia, intra-uterine growth retardation (IUGR), preterm delivery and low Apgar score and their association with TSH, thyroid peroxidase (TPO), and thyroglobulin (Tg) antibodies. RESULTS: Prevalence of anti-TPO and anti-Tg positivity is 12.8% and 8.5% among Iranian pregnant women. Mothers with either positive TPO or Tg antibody have a higher risk of preeclampsia (p = 0.019), preterm delivery (p < 0.001), IUGR (p < 0.001), and low first minute Apgar score (p < 0.001). This association was independent of thyroid dysfunction for preterm delivery (RR = 5, p < 0.001), and low Apgar score neonates (RR = 8.8, p < 0.001), but this association for preeclampsia was due to thyroid dysfunction (RR = 3.7, p = 0.003). About IUGR in either TPO or Tg positive mothers, this association results from the additive effect of thyroid dysfunction and thyroid autoimmunity (RR = 8.3, p < 0.001). Cesarean section delivery was significantly higher in abnormal TSH/positive anti-Tg mothers (p = 0.045). CONCLUSION: Thyroid autoimmunity independent of thyroid dysfunction could have significant adverse outcomes in the mother and fetus. Further investigation should be done to reveal the significance of screening and treating the thyroid autoimmunity during pregnancy.

Thyroid function in pregnancy and its influences on maternal and fetal outcomes.

BACKGROUND: Maternal thyroid function alters during pregnancy. Inadequate adaptation to these changes results in thyroid dysfunction and pregnancy complications. OBJECTIVES: This prospective study aimed to evaluate the prevalence of thyroid diseases in pregnancy and its outcomes in south of Iran. MATERIALS AND METHODS: This prospective study was conducted on 600 healthy singleton pregnant women who aged 18 to 35 years old at 15 to 28 weeks of gestation. We investigated the prevalence of thyroid dysfunctions in women. Multivariate analysis was performed to determine the effect thyroid dysfunction on obstetric and neonatal outcome. RESULTS: Thyroid stimulating hormone (TSH) levels of 0.51, 1.18, 1.68, 2.4, and 4.9 mIU/L were at 2.5th, 25th, 50th, 75th, and 97.5th percentile in our population. The prevalence of clinical hypothyroidism, subclinical hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism in all pregnant women was 2.4%, 11.3%, 1.2%, and 0.3%, respectively. In addition, 1.4% of patients had isolated hypothyroxinemia. Clinical hypothyroidism was associated with increased risk of preterm delivery (P = 0.045). Subclinical hypothyroidism had a significant association with intrauterine growth restriction (IUGR) (P = 0.028) as well as low Apgar score at first minute (P = 0.022). Maternal hyperthyroidism was associated with IUGR (P = 0.048). CONCLUSIONS: We revealed that thyroid dysfunction during pregnancy was associated with IUGR and low Apgar score even in subclinical forms. Further studies are required to determine whether early diagnosis and treatment of thyroid diseases, even in subclinical form, can prevent their adverse effect on fetus.

A prospective study of selenium concentration and risk of preeclampsia in pregnant Iranian women: a nested case-control study.

Preeclampsia remains a leading cause of maternal and perinatal mortality and morbidity worldwide; however, its specific etiology still remains obscure. Some studies implicate poor maternal selenium status predisposing the mother to preeclampsia. This study was designed to determine changes in plasma selenium levels in women having preeclampsia as compared with those with normal pregnancy. In a nested case-control study, 650 normal primigravida in their first 24-28 weeks participated in the study. After 3 months of follow-up of all subjects, blood selenium levels were measured in 38 women presenting consecutively with preeclampsia and in 38 women having a normal pregnancy by atomic absorption spectrophotometry. Birth outcomes were recorded, such as gestational age at delivery, height, weight, birth head circumflex and 1-min Apgar score. Preeclampsia affects about 5.84 % of pregnancies, and in our study, there were no significant differences in age, anthropometric indices, and family history of preeclampsia between the preeclamptic and control groups. The selenium concentrations in plasma in women with preeclampsia were significantly lower as compared with those in women with normal pregnancy (70.63 ± 21.41 versus 82.03 ± 15.54 µg/L, p < 0.05). Being in the bottom tertile of selenium concentration (less than 62.2 µg/L) was associated with greater risk of preeclampsia in pregnant women. The reduced selenium in the maternal circulations observed in the preeclamptic mothers support the hypothesis that insufficient selenium concentration may be a contributing factor to the pathophysiological mechanisms associated with preeclampsia, and optimizing the dietary selenium intake through supplementation could produce demonstrable clinical benefits.