Association of proprotein convertase subtilisin/kexin type 9 protein and oxidative stress indicators in women with preeclampsia: A case-control study.

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) protein is one of the factors associated with oxidative stress and dyslipidemia disorders. Objective: This study aimed to evaluate the lipid profile, PCSK9 levels, and oxidative stress in preeclampsia. Materials and Methods: This case-control study was conducted at Sina hospital in Hamadan University of Medical Sciences, Hamadan, Iran from August 2020-May 2021. The average maternal age of included participants was 30 yr with 30 preeclampsia and 30 healthy pregnant women. After clinical examination, the fasting blood samples were collected, and the serum PCSK9 protein concentration, superoxide dismutase, glutathione peroxidase activities, and glutathione levels were determined by enzyme-linked immunosorbent assay. Total antioxidant capacity, total oxidant status, and malondialdehyde levels were determined manually. Results: The average maternal age of participants were 29.97 ± 4.75 and 31.23 ± 5.85 yr, respectively. The concentrations of total cholesterol, low-density lipoprotein cholesterol (LDL-C), PCSK9, total antioxidant capacity, and malondialdehyde levels were higher in the preeclampsia group compared with control (p < 0.02). Total oxidant status, glutathione levels, superoxide dismutase, glutathione peroxidase activities were lower in the cases group compared with the control group (p < 0.01). The PCSK9 variable had a significant negative association with antioxidant parameters; however, a significant positive association was observed between PCSK9 level and parameters of LDL-C. Conclusion: PCSK9 is associated with increased serum levels of LDL-C and oxidative factors in pregnant women that increase the risk of endothelial damage and hypertension in preeclampsia.

Immunohistochemical Localization of Endothelin- 1 and Endothelin A Receptor in Human Primary Tooth Enamel Organ.

Statement of the Problem: Enamel organ (EO) is an ectodermal derived structure, which is involved in the different aspects of tooth development. Tooth development shares the same regulatory molecules and genes expressed in other developing organs. Endothelin- 1 (ET-1) and Endothelin A receptor (ETAR), (ET-1/ETAR) axis, are involved in differentiation of embryonic stem cells and organ development. Purpose: The present study aimed to investigate the ET-1 and ETAR expression profiles during the development of human primary tooth EO with the relatively large sample size. Materials and Method: In this experimental study, 33 human fetuses aged from 13 to 23 weeks (3 samples from each fetal age) were collected. The samples were divided into three age groups (<16 weeks, <19 weeks, ≥19 weeks) and cut for hematoxylin and eosin (H&E) and immunohistochemistry (IHC) staining. A two-way ANOVA test was conducted to examine the expression levels of ET-1 and ETAR in different layers of human primary tooth EO. The statistical significance was assumed at p ≤ 0.05. Results: There were statistically significant differences between the expression levels of ET-1/ETAR axis in the four-layered human primary tooth EO in different fetal ages (13-23 weeks). Besides, there were significant differences between the expression levels of ET-1/ETAR axis in all layers of human primary enamel organ and types of teeth. Conclusion: Due to the profile of expression of ET-1/ETAR axis, it can be concluded that this axis contributes to the differentiation of all human primary EO layers and secretion of enamel. ET-1/ETAR axis is one of the signaling molecules, which may have crucial roles in tooth development.

Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study.

Menopause is one the most crucial stages in a female's life. Identifying the education gaps regarding menopause is important, thus this study aims to explain the health-related needs of females during menopause. Scopus, PubMed, Scientific Information Database, and Web of Science databases were searched for the available observational (cohort, case-control, and cross-sectional), systematic review, meta-analysis, and clinical trial studies (2007-2021) using keywords, such as 'Educational Needs Assessment,' 'Assessment of Healthcare Needs,' 'menopause,' 'climacteric,' 'premenopause,' and 'postmenopause.' A total of 180 out of 5,705 papers were evaluated after considering the inclusion and exclusion criteria. The educational needs of females during menopause in the reviewed studies include osteoporosis, oral and dental problems, metabolic disorders, cardiovascular diseases, hypertension, lung diseases, infectious diseases, musculoskeletal problems, urinary problems, breast cancer, defecation problems, genital disorders, special diseases such as eye diseases and hypothyroidism and hormone therapy, mental disorders, cognitive function, sleep disorders, sexual disorders, physical activity, supplement consumption, public health issues, health education, fall, and nutrition. The study results reveal that females during postmenopause require training, counseling, and support in all aspects to get through this challenging time, and providing these services, infrastructure, appropriate policy, and the use and support of the medical team's capacity are all required.

Clinical features and risk factors associated with acute respiratory distress syndrome in pregnant women diagnosed with COVID-19: a multi-center case-control study.

OBJECTIVES: The aim of this study was to evaluate differences in clinical features and laboratory parameters in critically ill pregnant women with acute respiratory distress syndrome (ARDS) compared to moderate and severe pregnant women with coronavirus disease-2019 (COVID-19) but without ARDS. METHODS: This was a retrospective multicenter study of all pregnant women with COVID-19 diagnosed with ARDS between February 15, and May 1, 2020 in nine level III maternity centers in Iran (ARDS group). The control COVID-19 pregnant women were selected from 3 of 9 level III maternity centers between March 15 and April 20, 2020. Univariate statistics were used to look at differences between groups. Cluster dendrograms were used to look at the correlations between clinical and laboratory findings in the groups. A value of p <.05 was considered statistically significant. RESULTS: Fifteen COVID-19 infected women with ARDS were compared to 29 COVID-19 positive and ARDS negative control (moderate: (n = 26) 89.7% and severe: (n = 3)10.3%). The mean maternal age (35.6 vs. 29.4 years; p = .002) and diagnosis of chronic hypertension (20.0% vs. 0%, p = .034) were significantly higher in the ARDS group. There was no significant difference between the two groups in their presenting symptoms. The ARDS group had a significantly higher prevalence of tachypnea (66.6% vs. 10.3%, p = .042) and blood oxygen saturation (SpO2) <93% (66.6% vs. 10.3%, p = .004) at presentation. Relative lymphopenia (lymphocyte ratio < 10.5%, 66.6% vs. 17.2%, p = .002), lymphocytes to leukocytes ratio (11.3% vs. 17.7%, p = .010), and neutrophils to lymphocytes ratio (NLR) >7.5 were significantly different between the two groups (all p < .05). CONCLUSION: Our data demonstrate that symptom-based strategies for identifying the critically ill pregnant women with SARS-CoV-2 are insufficient; however, vital signs and laboratory data might be helpful to predict ARDS in critically ill COVID-19 pregnant patients.

Migration of intrauterine device caused asymptomatic acute appendicitis: A case report.

Missing of IUD is not always due to expulsion. If the patient is sure that it has not got expulsed, further investigations such as abdominal ultrasound and X-ray should be performed to look for the device before any device-related complications.

Clinical characteristics and outcomes of pregnant women with COVID-19 and comparison with control patients: A systematic review and meta-analysis.

In a large-scale study, 128176 non-pregnant patients (228 studies) and 10000 pregnant patients (121 studies) confirmed COVID-19 cases included in this Meta-Analysis. The mean (confidence interval [CI]) of age and gestational age of admission (GA) in pregnant women was 33 (28-37) years old and 36 (34-37) weeks, respectively. Pregnant women show the same manifestations of COVID-19 as non-pregnant adult patients. Fever (pregnant: 75.5%; non-pregnant: 74%) and cough (pregnant: 48.5%; non-pregnant: 53.5%) are the most common symptoms in both groups followed by myalgia (26.5%) and chill (25%) in pregnant and dysgeusia (27%) and fatigue (26.5%) in non-pregnant patients. Pregnant women are less probable to show cough (odds ratio [OR] 0.7; 95% CI 0.67-0.75), fatigue (OR: 0.58; CI: 0.54-0.61), sore throat (OR: 0.66; CI: 0.61-0.7), headache (OR: 0.55; CI: 0.55-0.58) and diarrhea (OR: 0.46; CI: 0.4-0.51) than non-pregnant adult patients. The most common imaging found in pregnant women is ground-glass opacity (57%) and in non-pregnant patients is consolidation (76%). Pregnant women have higher proportion of leukocytosis (27% vs. 14%), thrombocytopenia (18% vs. 12.5%) and have lower proportion of raised C-reactive protein (52% vs. 81%) compared with non-pregnant patients. Leucopenia and lymphopenia are almost the same in both groups. The most common comorbidity in pregnant patients is diabetes (18%) and in non-pregnant patients is hypertension (21%). Case fatality rate (CFR) of non-pregnant hospitalized patients is 6.4% (4.4-8.5), and mortality due to all-cause for pregnant patients is 11.3% (9.6-13.3). Regarding the complications of pregnancy, postpartum hemorrhage (54.5% [7-94]), caesarean delivery (48% [42-54]), preterm labor (25% [4-74]) and preterm birth (21% [12-34]) are in turn the most prevalent complications. Comparing the pregnancy outcomes show that caesarean delivery (OR: 3; CI: 2-5), low birth weight (LBW) (OR: 9; CI: 2.4-30) and preterm birth (OR: 2.5; CI: 1.5-3.5) are more probable in pregnant woman with COVID-19 than pregnant women without COVID-19. The most prevalent neonatal complications are neonatal intensive care unit admission (43% [2-96]), fetal distress (30% [12-58]) and LBW (25% [16-37]). The rate of vertical transmission is 5.3% (1.3-16), and the rate of positive SARS-CoV-2 test for neonates born to mothers with COVID-19 is 8% (4-16). Overall, pregnant patients present with the similar clinical characteristics of COVID-19 when compared with the general population, but they may be more asymptomatic. Higher odds of caesarean delivery, LBW and preterm birth among pregnant patients with COVID-19 suggest a possible association between COVID-19 infection and pregnancy complications. Low risk of vertical transmission is present, and SARS-CoV-2 can be detected in all conception products, particularly placenta and breast milk. Interpretations of these results should be done cautiously due to the heterogeneity between studies; however, we believe our findings can guide the prenatal and postnatal considerations for COVID-19 pregnant patients.

Correlation of thioredoxin reductase (TrxR) and nitric oxide synthase (NOS) activities with serum trace elements in preeclampsia.

BACKGROUND: Preeclampsia is a dangerous disease of pregnancy with symptoms such as high blood pressure and proteinuria. The nitric oxide synthase (NOS) enzyme produces nitric oxide (NO) as a mediator of vasodilation and need to calcium and zinc ions for activity. The thioredoxin reductase (TrxR) as an enzyme containing selenium has been neutralized the damaging effects of oxidants. In this study, our aim was to evaluate the activity of eNOS and TrxR enzymes and the amounts of calcium, zinc, and selenium elements in serum of women with preeclampsia. MATERIAL AND METHODS: Thirty preeclampsia and 30 healthy pregnant women were enrolled in the study after clinical examination and confirmation by Obstetrician-Gynecologist. Venous blood samples were collected and the activity of NOS, TrxR enzymes, and the concentration of zinc, calcium, and selenium elements were measured in serum. RESULTS: The results of NOS and TrxR activities showed significant decreases in preeclampsia compared with control group (p < .05). In addition, concentrations of zinc, calcium, and selenium were markedly lower in preeclampsia compared to the healthy control group (p < .05). CONCLUSION: This study identified the role of the NOS and TrxR activities in preeclampsia disorder and may be one of the ways to prevent and reduce the risks of preeclampsia in high-risk women using diet control and stress reduction.

Effect of TQM educational interventions on the management policy standard of health promoting hospitals.

The purpose of this study was to manage total quality management (TQM) to increase the standard of management policy and contribute to achieve the standards for health promotion hospitals (HPHs). This was a quasi-experimental intervention study. A total of 35 managers participated in this study were selected in the census. Based on the TQM components, educational items were provided as lectures, posters and pamphlets. The TQM questionnaire and HPHs checklist used to collect data in three different periods: before the interventions, immediately after the interventions and 3 months after the interventions (follow-up). The data analysis was done by means of SPSS software (version 23). The results showed that the average difference of the components of the qualitative groups (p < 0.001), education (p = 0.004), evaluation and feedback (p < 0.001), customer-orientation (p < 0.001), suggestion system (p = 0.024), leadership commitment (p < 0.001) was significant over the three periods. Excluding the employment status before the educational intervention (p = 0.002), there was no significant relationship between the demographic characteristics and mean score of TQM (p > 0.05). Based on the findings of this study, the educational interventions had a positive effect on quality management and management policy. Therefore, educational interventions should be accompanied by changes in the culture and management policies of the hospital to meet HPH standards.

Evaluating Clinical Course and Risk Factors of Infection and Demographic Characteristics of Pregnant Women with COVID-19 in Hamadan Province, West of Iran.

BACKGROUND: COVID-19 is a new viral disease with a rapid outbreak. Pregnant women are at a higher risk of contracting viral infections including COVID-19. We aimed to evaluate the clinical course and risk factors of pregnant women diagnosed with COVID 19 in Hamadan Province, west of Iran. STUDY DESIGN: A retrospective cohort study. METHODS: The convenience sampling was performed using 50 papers and electronic files of pregnant women diagnosed with COVID-19 according to the WHO's temporary guidelines. They were hospitalized in health centers and clinics of Hamadan Province. The data-collecting tool employed was a researcher-made questionnaire. The data were analyzed via SPSS software version 19. RESULTS: The mean age of pregnant women with COVID 19 was estimated to be 29.20 ± 5.8 yr and their average gestational age estimated to be 28.8 ± 8.20 weeks. About 32% of them had an underlying disease, 32% a history of influenza, and 40% recently traveled to infected areas. The most common findings were CT scans and multiple mottling and ground-glass opacity chest radiology. The most common symptoms were fever, cough, and shortness of breath. About 8% of the women required ICU hospitalization and the average length of hospital stay was 4.04 ± 2.38 and 29% had premature births. Moreover, 28% of infected mothers had a normal delivery and 20% had a cesarean section. CONCLUSION: Early diagnosis of Covid-19 disease is essential in pregnant women. Because there is a possibility of worsening complications in the mother and fetus.

Evaluation of methylenetetrahydrofolate reductase (MTHFR) activity and the levels of homocysteine and malondialdehyde (MDA) in the serum of women with preeclampsia.

BACKGROUND: Methylenetetrahydrofolate reductase (MTHFR) has a key role in converting homocysteine to methionine so its deficiency might cause homocysteine accumulation and arterial destruction. The aim of this study was to evaluate the activity of methylenetetrahydrofolate reductase (MTHFR), homocysteine, and MDA levels in preeclampsia patients. MATERIAL AND METHODS: In this case-control study, 30 preeclampsia patients and 30 healthy pregnant women as control group were selected and matched for maternal age, gestational age, and BMI. Preeclampsia was confirmed by examining hypertension and urinary proteinuria. Serum homocysteine and MDA level as well as MTHFR activity were measured manually. RESULTS: Homocysteine and MDA levels were significantly different between women with preeclampsia and normal pregnancies (p-value <0.001). Also, the results indicate that MTHFR activity in the two groups was statistically different (p-value <0.001). CONCLUSION: It can be concluded that the regulation of homocysteine and its metabolic enzymes plays a significant role in controlling blood pressure and consequently in the pathophysiology of Preeclampsia and it can be a goal for prevention and treatments.

Prenatal Diagnosis of Mosaic Tetrasomy 18p in a Case without Sonographic Abnormalities.

Small supernumerary marker chromosomes (sSMC) are still a major problem in clinical cytogenetics as they cannot be identified or characterized unambiguously by conventional cytogenetics alone. On the other hand, and perhaps more importantly in prenatal settings, there is a challenging situation for counseling how to predict the risk for an abnormal phenotype, especially in cases with a de novo sSMC. Here we report on the prenatal diagnosis of a mosaic tetrasomy 18p due to presence of an sSMC in a fetus without abnormal sonographic signs. For a 26-year-old, gravida 2 (para 1) amniocentesis was done due to consanguineous marriage and concern for Down syndrome, based on borderline risk assessment. Parental karyotypes were normal, indicating a de novo chromosome aberration of the fetus. FISH analysis as well as molecular karyotyping identified the sSMC as an i(18)(pter->q10:q10->pter), compatible with tetrasomy for the mentioned region. Cordocentesis was done due to normal sonography and the results from amniocentesis were confirmed. The parents opted for pregnancy termination and post mortem examination now noted, low anterior hairline, large philtrum, low-set posteriorly rotated malformed ears with prominent antihelix, lower limbs joint contracture and digital anomalies, including long and narrow toes with clinodactyly of the 1st and 5th toes and postaxial polydactyly of one hand. De novo i(18p) can be considered as a special case in the sense that the major relevant phenotypes mentioned for it, i.e. feeding difficulties, abnormalities in muscle tone and developmental/mental retardation, cognitive and behavioral characteristics, recurrent otitis media and seizures, are mostly postnatal. This emphasizes the necessity to determine the nature of a de novo euchromatic marker chromosome, especially in cases with normal ultrasound result and the suitability of a cordocentesis in order to better predicting the pregnancy outcome and parental counseling.