The Efficacy of Ropivacaine 0.5% in Transversus Abdominis Plane Block to Relieve the Postoperative Pain of Female Laparoscopic Surgery Grade II.

Background: The aim of this study was determination of the effect of the transversus abdominis plane block (TAP block) with ropivacaine 0.5% in relieving postoperative pain after laparoscopic gynecologic surgery. Materials and Methods: The population of the double-blinded clinical trial study included 200 women candidates for elective laparoscopic gynecologic surgery who referred to Al-Zahra and Beheshti hospitals in Isfahan during 2016-2018. In the TAP block group in addition to standard general anesthesia, an anesthetic drug Ropivacaine (Naropin, 0.5%) was injected at a dose of 0.5 mg/kg between transverse abdominal muscle and internal oblique muscle facia. And in control group just received standard general anesthesia. Hence, the severity of pain and nausea and vomiting is recorded at the time of recovery, at 30 min, 2, 4, 6, 12, and 48 h after the surgery. Results: The results of this study showed that in all periods of time (30 min, 2, 4, 6, 12, 24, 36, and 48 h after the surgery), mean pain score in TAP block group was lower than control group (P < 0.001). Hence that, in the 48 h after the surgery, the pain score in the TAP block group with a mean of 0.46 ± 0.50 was significantly lower than the control group with a mean of 1.06 ± 0.68 (P < 0.001). Nausea and vomiting between the two groups were no significant differences. There was no decrease in narcotic use or length of stay among those who received the TAP block. Conclusions: TAP block with ropivacaine 0.5% had a significant role in reducing postoperative pain of laparoscopic surgery.

Prevalence, population structure, distribution of serotypes, pilus islands and resistance genes among erythromycin-resistant colonizing and invasive Streptococcus agalactiae isolates recovered from pregnant and non-pregnant women in Isfahan, Iran.

BACKGROUND: The information on antibiotic resistance and molecular features of Group B Streptococcus (GBS) are essential for epidemiological purposes as well as vaccine development. Therefore, we aimed to assess the antimicrobial resistance profiles and molecular characteristics of GBS isolates in Isfahan, Iran. A total number of 72 colonizing and invasive GBS were collected from pregnant and non-pregnant women. The GBS isolates were analyzed for resistance profiles, capsular genotyping, and detection of PI-1, PI-2a, PI-2b, hvgA, ermB, ermTR, lnuB and, mefA genes. Besides, erythromycin-resistant strains were subjected to multilocus sequence typing (MLST). RESULTS: The prevalence of colonizing and invasive GBS were 11 and 0.05%, respectively. The frequency of capsular serotypes was as follows: III (26.3%), Ia (20.83%), Ib and V (each 15.2%), IV (9.7%), II (8.3%), VII (2.7%), and VI (1.3%). Overall frequencies of PIs were as follows: PI-1, 37.5%, PI-1 + PI-2a, 30.5%, PI-1 + PI-2b, 29.1% and PI-2b, 2.7%. Two maternal colonizing GBS (2.6%) were hvgA positive and were belonged to ST-17/CPS-III/PI-1 + PI-2b lineage. Among 30(41.6%) erythromycin resistant GBS, 21 isolates (70%) harbored ermB gene, followed by ermTR (23.3%) and mefA (10%). One clindamycin-resistant isolate harbored the lnuB gene. MLST analysis revealed the following five clonal complexes (CCs) and nine STs: (CC-19/ST-335, ST-19, and ST-197), (CC-12/ST-43, ST-12), (CC-23/ST-163, ST-23), (CC-17/ST-17) and (CC-4/ST-16). CONCLUSION: The study shows an alarmingly high prevalence of erythromycin-resistant GBS in Iran. In addition, we report dissemination of ST-335/CPS-III clone associated with tetracycline and erythromycin resistance in our region. The distribution of capsular and pilus genotypes varies between invasive and colonizing GBS that could be helpful for vaccine development.

Thyroid peroxidase in human endometrium and placenta: a potential target for anti-TPO antibodies.

Autoimmune thyroid disease is the most common endocrine disorder during pregnancy. Thyroid autoantibodies (TAs) have been suggested to serve a role in implantation failure and spontaneous abortion. Until now, there are no data on the potential interaction of TAs with human reproductive organs. Here, we set out for the first time to test this hypothesis by studying the expression of thyroid peroxidase (TPO) at gene and protein level in human reproductive organs. Endometrial samples were taken from normal women, and placenta tissues were collected after full-term caesarian section. Expression of TPO messenger RNA (mRNA) was investigated by qRT-PCR. In addition, polyclonal anti-TPO antibodies were produced and the expression of TPO protein in mentioned tissues was evaluated by immunohistochemistry and Western blot analysis. The reactivity of anti-TPO antibody in human embryos was evaluated by immunofluorescent staining. For the first time, our study showed that TPO is expressed at gene and protein levels in endometrium and placenta. TPO expression was mainly localized to glandular and luminal epithelial cells in the endometrium. In placenta, the syncytiotrophoblasts and invasive trophoblast cells were the main cell types that expressed TPO protein. Specific band of approximately 110 kDa was observed in all endometrial and placental tissues by Western blot analysis. However, no expression of TPO protein was observed in human embryo. TPO expression in endometrium and placenta may explain higher frequency of abortion and infertility in patients with thyroid autoimmunity.

Can the Decreased Expression of Human Leukocyte Antigen Class â and â ¡ by Spermatozoa Lead to Recurrent Spontaneous Abortion?

BACKGROUND & OBJECTIVE: Unexplained recurrent spontaneous abortion (URSA) is defined as an unknown cause of occurrence of three or more clinically detectable pregnancy losses before 20 weeks of gestation, but it occurs presumably as a result of the immune system dysfunctions. We supposed that the disruption of semen or spermatozoa might be responsible for the dysfunction of the immune system in women with URSA. Semen and spermatozoa (as antigens) induce female reproductive tract (FRT) immunity. This stimulated immunity is necessary for pregnancy occurrence. The disruption of semen or spermatozoa can be a result of altering a variety of surface molecules on spermatozoa, especially polymorphic human leukocyte antigen (HLA) molecules or antigens. Despite the importance of HLA antigens in reproduction, to the best of our knowledge, no one has studied the relation of HLA expression between spermatozoa and URSA. Therefore, this paper aims to assess this relation. METHODS: Semen samples were collected from 15 URSA couples and 20 normal couples. After purification of normal spermatozoa, the HLA class I and II expressions were evaluated by flow cytometry methods. RESULTS: Results showed that the expression of both HLA class I and II by spermatozoa, in URSA couples, was significantly less than the control couples. CONCLUSION: The decreased expression of polymorphic HLA class Ⅰ and Ⅱ by spermatozoa can be related to URSA occurrence.

The expression of human leukocyte antigen by human ejaculated spermatozoa.

BACKGROUND: After coitus and insemination, an inflammatory response is evident in the female reproductive tract (FRT). Semen contains a variety of immune-activating components that have a major role in the induction of an immune response in the FRT. One of the most important is (human leukocyte antigen) HLA molecules which are present in soluble form in seminal plasma and in membrane form on the surface of cells (such as epithelial and leukocytes) existing in semen. Nevertheless, there is considerable debate over the expression of HLA antigens by human spermatozoa. Considering the critical role of HLA molecules in reproduction and the induction of an immune response, it is very important to clearly define HLA expression by spermatozoa and the role of these molecules in sperm morphology, motility, and strength to fertilize an egg. Therefore, the objective of this study was to determine HLA expression by ejaculated spermatozoa. The results of this study will facilitate the design of future studies. METHOD: Semen samples were collected from 50 healthy men with normal semen status by masturbation after 2-3 days of sexual abstinence. After purification of normal spermatozoa, HLA class I & II expression was evaluated by quantitative real-time PCR and flow cytometry methods. RESULTS: The results showed the expression of both HLA class I & class II by spermatozoa. The results also showed that the expression of HLA class Ⅱ was significantly more than HLA class Ⅰ. CONCLUSION: Spermatozoa express both HLA class I & class II molecules.

Vitamin D3 induces the expression of membrane progesterone receptors (mPRs) on naive CD4+ T lymphocyte cells in women of reproductive age.

OBJECTIVE: Vitamin D3 and progesterone (P4) both belong to steroid hormones. These hormones have effects on the function of each other in different ways. The immunomodulatory activity of vitamin D3 and P4 and their role in inducing maternal tolerance for fetus have been shown in various studies. The purpose of this study was to evaluate the effect of vitamin D3 on the expression of membrane progesterone receptors (mPRs) on CD4+ T cells. MATERIALS AND METHODS: Naive CD4+ T cells were isolated from peripheral blood of 38 healthy women of childbearing age. After stimulating by anti-CD3 and anti-CD28 monoclonal antibodies (mAb), these cells were exposed to either various concentrations of vitamin D3 or no exposure at all in a culture medium at 37 °C for 3 days. In the final stage, the mean fluorescence intensity (MFI) of mPRα and mPRß were evaluated using polyclonal and monoclonal antibodies and several gating strategies on CD4+ T cells. RESULTS: Vitamin D3 significantly increased the expression of mPR α and mPR ß on the surface of CD4+ T cells (p ≤ 0.05). CONCLUSION: The present study demonstrated the potential effect of vitamin D3 on increasing the expression of P4 receptors on CD4+ T cells. This study shows a new aspect of correlation between vitamin D3 and P4 that may influence P4 performance. Therefore, our findings suggest that the appropriate level of this vitamin may affect the optimum P4 immunomodulatory activity during pregnancy.

Decreased Toll-like Receptor (TLR) 2 and 4 Expression in Spermatozoa in Couples with Unexplained Recurrent Spontaneous Abortion (URSA).

Studies have shown that toll-like receptors (TLRs) play some important roles in reproductive processes such as ovulation, spermatogenesis, sperm capacitation, fertilization, and pregnancy to the best of our knowledge, no study has evaluated the expression and role of these molecules and their impairment in spermatozoa; accompanied by pregnancy complications such as recurrent spontaneous abortion (RSA). Therefore, this study investigates the alteration of toll-like receptor 2 (TLR2) and toll-like receptor 4 (TLR4) expression in spermatozoa in men whose spouse have unexplained RSA. Fifteen fertile couples and fifteen couples with unexplained recurrent spontaneous abortion (URSA) were included in this study. The level of TLR2 and TLR4 expression in untreated and lipopolysaccharide (LPS) or PAM3CYS in treated spermatozoa were examined by flow cytometry. The results showed reduced expression of TLR4 in untreated spermatozoa and decreased LPS or PAM3CYS levels in treated spermatozoa in the URSA group compared to the control group. No significant differences were found in TLR2 expression of untreated spermatozoa in RSA and control groups. After the treatment of spermatozoa with LPS, the TLR2 expression was decreased in both groups. After the treatment of spermatozoa with PAM3CYS, the level of TLR2 expression was significantly increased in the URSA group; while no significant differences were shown in the control group in comparison to untreated spermatozoa. We have concluded that decreased TLR4 expression and a differently increased TLR2 expression in response to ligand treatment in spermatozoa is associated with URSA.

Comparing the Frequency of Endometritis in Unexplained Infertility and Anovulatory Infertility.

BACKGROUND: Acute pelvic inflammatory disease (PID) is a common reason for infertility. This study aimed to evaluate the frequency distribution of endometritis in women with unexplained infertility and comparison with frequency distribution of endometritis in anovulatory infertility to identify the importance of endometritis due to subacute PID evaluation in the case of infertility. MATERIALS AND METHODS: This case-control study was done on 100 women with unexplained infertility and ovulatory infertility who referred to Shahid Beheshti clinic in 2013 in Isfahan, Iran. They were divided into two groups of unexplained infertility and anovulatory infertility. Endometrial samples were given from all the patients by Pipelle biopsy under sterile conditions, and then prepared samples were sent to the pathology laboratory to evaluate the existence of plasma cells by a pathologist to diagnose endometritis. RESULTS: Frequency distribution of acute PID history among the patients in both groups showed a significant difference (P < 0.05). Prevalence of endometritis in unexplained infertility group was 34% and in anovulatory group was 21% (P < 0.05). Prevalence of vaginitis was 46% in unexplained group and 40% in anovulatory group (P < 0.05), and prevalence of PID was 4% in unexplained infertility group and 0% in anovulatory infertility group. CONCLUSION: The prevalence of endometritis and vaginitis was more in the unexplained infertility group rather than the anovulatory infertility group that may reveal the importance of endometritis evaluation in the cases of unexplained infertility.

Letrozole as the first-line treatment of infertile women with poly cystic ovarian syndrome (PCOS) compared with clomiphene citrate: A clinical trial.

BACKGROUND: The purpose of this study was to determine the efficacy and safety of letrozole on ovulation induction and pregnancy in comparison with clomiphene citrate in PCOS patients. MATERIALS AND METHODS: The study was based on prospective randomized clinical trial comparing the efficacy of letrozole as the first-line management of the PCOS patients in comparison to clomiphene citrate during 2009 to 2011 and was performed in one private infertility clinic. The study included 100 patients divided into 2 equal groups. RESULTS: Pregnancy occurred in 29 of 50 patients in letrozole group (58%) and 24 of 51 patients in clomiphene group (47%). The difference was not statistically significant (P value = 0.23). Thirty patients in clomiphene group and 36 patients in letrozole group showed regular menses after or during the treatment course. No significant difference between the 2 groups was observed (P value = 0.21). CONCLUSION: Our findings suggest letrozole and clomiphene citrate are equally effective for induction of ovulation and achieving pregnancy in patients with PCOS.

Evaluation of intravenous hydroxylethyl starch, intravenous albumin 20%, and oral cabergoline for prevention of ovarian hyperstimulation syndrome in patients undergoing ovulation induction.

BACKGROUND: The purpose of this study was to compare the three different strategies, intravenous (IV) hydroxylethyl starch (HES), IV human albumin (HA), and oral Cabergoline (Cb) in the prevention of ovarian hyperstimulation syndrome (OHSS). MATERIALS AND METHODS: In this prospective randomized clinical trial, 91 women at high risk of developing OHSS were allocated into the three groups, group one received 2 vial (2 × 50 ml) IV HAs, in group two, 1000 ml of 6% HES was administered IV, both groups 30 min after oocyte retrieval within 4 h. Group three, 31 infertile patients received oral Cb 0.5 mg daily for 7 days after oocyte retrieval. Patients were visited 14 ± 1 days after in-vitro fertilization and if ß-human chorionic gonadotropin level >10, transvaginal ultrasonography was performed 2 weeks later to confirm intrauterine pregnancy. Patients were followed up weekly for 3 months for signs of OHSS and were also informed about the signs of OHSS and asked to contact immediately if any symptoms of were detected. RESULTS: None of the participants in group HES developed severe OHSS and only 3 patients (10%) developed mild to moderate OHSS. The incident of severe OHSS was significantly higher in albumin group compared to Cb and HES group (P = 0.033 and P < 0.001, respectively). Also, the probability of developing severe OHSS was higher in Cb group than group HES (P = 0.031). CONCLUSION: The findings from this study suggest that administration of 1000 ml of HES 6% has a higher prophylactic effect compared to administration of IV HA and oral Cb.

Altered Th17/Treg Ratio in Recurrent Miscarriage after Treatment with Paternal Lymphocytes and Vitamin D3: a Double-Blind Placebo-Controlled Study.

BACKGROUND: Recurrent miscarriage (RM) affects 2-5% of pregnant women. Paternal lymphocyte immunotherapy is a common treatment for RM patients but the outcome has not been consistent. Therefore, combined therapy with other immunosuppressive drugs such as 1a, 25-dihydroxy-vitamin-D3 (vitamin D3) may improve the outcome. OBJECTIVES: To investigate the effect of vitamin D3 on the balance of two essential T cells subsets, T helper (Th) 17 and T regulatory (Treg) cells, which contribute to the immune tolerance during pregnancy. METHODS: The expression levels of CD4 and forkhead box protein 3 (FOXP3) in Treg cells, and the expression levels of CD4 and IL-17 in Th17 cells, were evaluated pre- and 3 months post-immunotherapy in RM patients treated with a combination of paternal lymphocytes and vitamin D3 compared with RM patients receiving lymphocyte immunotherapy alone. RESULTS: Vitamin D3 therapy decreased the frequency of Th17 cells in addition to reducing the Th17/Treg ratio in peripheral blood of RM patients compared with the control group (p<0.05). CONCLUSION: Considering that RM patients have a higher Th17/Treg ratio in peripheral blood, vitamin D3 may be a candidate therapeutic approach in this disease.

Maternal and neonatal morbidity and mortality rate in caesarean section and vaginal delivery.

BACKGROUND: The cesarean section is one of the most common procedures to prevent health-threatening risks to the mother and infant. Increasing rate of cesarean section attracted the attention of professionals and the overall objective of this study was to determine the frequency of maternal and neonatal morbidity and mortality rates in the two methods of delivery. MATERIALS AND METHODS: In a comparative cohort study, 300 cases undergoing caesarean section and 300 cases with vaginal delivery were selected in two main hospitals of Isfahan, Iran during 2013 and 2014. Demographic characteristics and factors related to mortality and morbidity of mothers and infants were studied. Mothers were also recruited 6 weeks after delivery to ask for complications. Mothers and infants mortality and morbidity were studied and analyzed by SPSS 22 software. RESULTS: Follow-up of deliveries up to 1-month after delivery suggested 2 cases of infant death (7%) in vaginal delivery group, while no case of infant death was reported in cesarean delivery group (P = 0.5). Incidence of fever was observed in first 10 days after delivery in 7 cases in the vaginal delivery group and 11 cases in the cesarean delivery group (2.3% vs. 3.7%, P = 0.4). CONCLUSION: Despite all the benefits of vaginal delivery compared with cesarean section, in many cases, especially in emergency cesarean section delivery can substantially reduce the maternal and neonatal mortality and morbidity. It is recommended to assess the complications of each method in all pregnant women about to give birth, and then decide on the method of delivery.

Exploration of the counseling needs of infertile couples: A qualitative study.

BACKGROUND: Identification of the main needs of infertile patients is essential to provision of appropriate supportive services and care based on their needs. Thus, the present study aims to explore infertile couples' counseling needs. MATERIALS AND METHODS: This study was carried out with an inductive qualitative content analysis approach during 2012-2013. The participants of this study included 26 Iranian infertile couples and 7 medical personnel (3 gynecologists and 4 midwives). The infertile couples were selected through purposive sampling and considering maximal variation from patients attending state-run and private infertility treatment centers as well as infertility specialists, offices in Isfahan and Rasht, Iran. Unstructured in-depth interviews and field notes were utilized for data gathering and replying to this research main question, "What are the counseling needs of infertile couples?" The data from medical personnel was collected through semi-structured interviews. Data analysis was carried out through conventional content analysis. RESULTS: Data analysis revealed two main themes. The first theme was "a need for psychological counseling," which included four subthemes: Emotional distress management, sexual counseling, marital counseling, and family counseling. The second theme was "a need for guidance and information throughout treatment process," which included three subthemes: Treatment counseling, financial counseling, and legal counseling. CONCLUSIONS: The counseling needs of infertile couples are varied, and they require various psychosocial support and counseling interventions. The participants of this study identified clearly the significance of psychological counseling and information throughout the long and onerous journey of infertility and its treatment.

Exploration of infertile couples' support requirements: a qualitative study.

BACKGROUND: Due to high prevalence of infertility, increasing demand for infertility treatment, and provision of high quality of fertility care, it is necessary for healthcare professionals to explore infertile couples' expectations and needs. Identification of these needs can be a prerequisite to plan the effective supportive interventions. The current study was, therefore, conducted in an attempt to explore and to understand infertile couples' experiences and needs. MATERIALS AND METHODS: This is a qualitative study based on a content analysis ap- proach. The participants included 26 infertile couples (17 men and 26 women) and 7 members of medical personnel (3 gynecologists and 4 midwives) as the key informants. The infertile couples were selected from patients attending public and private infertility treatment centers and private offices of infertility specialists in Isfahan and Rasht, Iran, during 2012-2013. They were selected through purposive sampling method with maximum variation. In-depth unstructured interviews and field notes were used for data gathering among infertile couples. The data from medical personnel was collected through semi-structured interviews. The interview data were analyzed using conventional content analysis method. RESULTS: Data analysis revealed four main categories of infertile couples' needs, including: i. Infertility and social support, ii. Infertility and financial support, iii. Infertility and spiritual support and iv. Infertility and informational support. The main theme of all these categories was assistance and support. CONCLUSION: The study showed that in addition to treatment and medical needs, infertile couples encounter various challenges in different emotional, psychosocial, communicative, cognitive, spiritual, and economic aspects that can affect various areas of their life and lead to new concerns, problems, and demands. Thus, addressing infertile couples' needs and expectations alongside their medical treatments as well as provision of psychosocial services by development of patient-centered approaches and couple-based interventions can improve their quality of life and treatment results and also relieve their negative psychosocial consequences.

Role of soap and water in the treatment of wound dehiscence compared to normal saline plus povidone-iodine: A randomized clinical trial.

BACKGROUND: The incidence of cesarean section is increased. About 3-30% of the women who undergo cesarean experience surgical site infections (SSIs). Many methods, have been used to decrease the incidence of SSIs, but despite much effort, no definite efficacious method has been suggested. MATERIALS AND METHODS: In this parallel, single-blinded, randomized control trial, 56 women with post-surgical superficial wound dehiscence were divided into two groups in a 1:1 ratio. One group was irrigated with normal saline for irrigation and Firooz® baby soapand the other with normal saline for irrigation and povidone-iodine. Formation of granulation tissue was monitored in both groups. Also, the reason for surgery, length of wound dehiscence, and duration of hospitalization and wound union after were compared in both group's. RESULTS: The soap group patients were irrigated for 4.18 ± 1.96 days compared to 5.36 ± 2.83 days for the patients in povidone-iodine group (P = 0.414). The granulation tissue was formed after 3.88 ± 1.94 days in the soap group compared to 4.48 ± 2.92 days in the other group (P = 0.391), and the duration of hospitalization was 5.48 ± 2.04 days in the soap group compared to 6.3 ± 2.95 days in the other group (P = 0.423). So, no differences were observed between the two groups. CONCLUSION: It can be concluded since there is no difference between the results of two groups, irrigation with normal saline and soap is safe, easy and causes no harm or allergy compared with povidone iodine and normal saline.

A comparative cohort study for detecting the incidence of trisomy 21 in ART and non-ART neonates.

BACKGROUND: One of the most important points concerning the patients who undergo assisted reproductive techniques (ART) for getting pregnant can be the possible neonatal chromosomal abnormalities as a result of these methods. OBJECTIVE: This study was conducted to help answering a part of this question. MATERIALS AND METHODS: This is a historical cohort study from April 2006 to April 2007. Data were collected from women admitted in Mehregan Hospital and Esfahan Infertility Center. 225 of 2000 infertile women who had taken ART methods and 225 of 1800 women undergoing no ART treatment were included in our study. All of the cases were aged 35 or more. Data were obtained from patient files from 2 infertility centers of Isfahan, Iran. RESULTS: Chromosomal analysis was successfully performed for all clinically suspicious infants for trisobmy 21. As a result, 4 cases of trisomy 21 in ART group and 7 in non-ART group were found. Two cases from IUI, 1 case of IVF and 1 of ICSI were found to have trisomy 21 in infants. There was no statistically difference in occurring trisomy 21 in our two groups of study and this was also the same for women undergoing IVF and ICSI. CONCLUSION: ART methods did not increase the rate of Trisomy 21 according to our study although we found less in ART group, it was not statistically significant.

Variations in T-helper 17 and Regulatory T Cells during The Menstrual Cycle in Peripheral Blood of Women with Recurrent Spontaneous Abortion.

BACKGROUND: Disorders in immune system regulation may result in pregnancy abnormalities such as recurrent spontaneous abortion (RSA). This study aims to determine the ratio of regulatory T (Treg) and T helper (Th) 17 cells in unexplained RSA (URSA) women during proliferative and secretory phases of their menstrual cycles compared to healthy non-pregnant women. MATERIALS AND METHODS: In this case control study, 25 women with URSA and 35 healthy, non-pregnant women were enrolled. The percentage of Th17 and Treg cells in participants peripheral blood were determined by flow cytometry. RESULTS: The percentage of Th17 cells and their related cytokines in serum (IL-17A) were higher in the proliferative and secretory phases of the menstrual cycles of URSA women compared to the control women. However, a lower percentage of Treg cells and their related cytokines in serum, transforming growth factor (TGF) ß1 and interleukin (IL)-10 were detected in the proliferative but not the secretory phase of the URSA group. The ratio of Th17/CD4+ Treg was higher in the URSA group than the control group. We observed an increased ratio of Th17/CD4+ Treg during the proliferative and secretory phases in URSA women. CONCLUSION: The imbalance between Th17 and Treg cells during the proliferative phase of menstrual cycles in the URSA group may be considered a cause for spontaneous abortion.

Comparison study on effectiveness of pentoxifyllin with LD to prevent recurrent endometriosis.

BACKGROUND: About 75% of the symptomatic patients who involved with endometriosis have pelvic pain and dysmenorrhea. Pentoxifyllin is one of the drugs that according to its mechanism could be effective for pain relief of endometriosis which has been used for endometriosis treatment recently. OBJECTIVE: We conducted a comparative study for detecting the effect of pentoxifylin (as an immonomodelator) in preventing recurrence endometriotic pain with pentoxifylin plus a combined contraceptive pill with low dose estrogen (LD) and also the LD pill alone. MATERIALS AND METHODS: This was a comparative clinical trial on 83 patients with the chief complaint (CC) of pain (dysmenorrheal /or pelvic pain) and with the end diagnosis of endometriosis, in an operative laparoscopy. Patients, dividing to 3 groups, were treated with pentoxifylin, pentoxifylin+LD and LD alone for 10 months. The severity of pain (dismenorhea and/or pelvic pain) was detected by visual analogue scale (VAS) before and after the treatment. The severity of endometriosis in the patients was: I in class I and II in class II and III in class III. The groups were matched for the pain. The number of the patients in group 1, 2 and 3 were 28, 28 and 27 respectively. RESULTS: The pain was reduced in the groups of pentoxifylin+LD (p<0.001) and LD alone (p=0.00). The pain relief was not significant in the group of pentoxifylin alone (p=0.136). After treatment, the severity of pain was not significantly different between the LD group and the LD+penthoxyfillin group, but there was difference between these two groups and the group of penthoxyfillin alone. CONCLUSION: This study showed that penthoxyfillin actually could not have any effect on the pain relief of endometriosis. It also made it clear that penthoxyfillin could not increase the efficacy of LD when used with this medication.

The expression of Th1- and Th2-related chemokine receptors in women with recurrent miscarriage: the impact of lymphocyte immunotherapy.

PROBLEM: Recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses prior to the 20th week of gestation. The aim of this study was to investigate the expression of T helper (Th)1- and Th2-related chemokine receptors on CD4(+) T helper and CD8(+) T cytotoxic (Tc) cells in RM and control subjects. The effects of lymphocyte immunotherapy on the balance of Th1/Th2 and Tc1/Tc2 chemokine receptors were further evaluated in RM women. METHOD OF STUDY: The expression of Th1-related (CCR5 and CXCR3) and Th2-related (CCR3 and CCR4) chemokine receptors on CD4(+) or CD8(+) T cells from RM women were analyzed and compared with controls using flow cytometry. The expression of chemokine receptors in RM women was also compared before and after lymphocyte immunotherapy. RESULTS: The ratios of Th1/Th2 and Tc1/Tc2 chemokine receptors were higher in RM women compared to controls. The ratio of Th1/Th2 chemokine receptors was decreased in RM women after immunotherapy, while no significant change was identified in the Tc1/Tc2 after immunotherapy. CONCLUSION: This study indicates the Th1 dominant immune responses in circulation of RM women compared to controls. Moreover, lymphocyte immunotherapy might influence pregnancy outcome via a shift in the balance of the Th1/Th2 chemokine receptors.