EFFECT OF VAGINAL SILDENAFIL ON IN VITRO FERTILIZATION SUCCESS RATES IN WOMEN WITH PREVIOUS FAILED IN VITRO FERTILIZATION ATTEMPTS

Objectives: Endometrial thickness of <9 mm is a predictor of in vitro fertilization (IVF) failure, although neither pregnancy rates nor the pregnancy outcomes are dependent on the endometrial thickness alone. The impact that uterine artery blood flow has on endometrial growth is dependent on nitric oxide which concentrations could be altered by halting a cyclic guanosine monophosphate-mediated pathway with a phosphodiesterase type 5 selective inhibitor such as sildenafil.Methods: In this clinical trial, 72 patients aged below 45 years which have had at least two earlier failed IVF attempts were randomly split into two groups each consisting of 36 patients. Both groups were started on a long IVF protocol. The case group was also administered 100 mg vaginal sildenafil suppositories daily, starting on day 3 of menstruation which was continued until human chorionic gonadotropin administration. Endometrial thickness was measured using ultrasonography in both groups plus pregnancy rates were assessed in both groups.Results: The mean age of the patients in Group A who received sildenafil; in this clinical trial, 72 patients aged below 45 years which have had at least two previous failed IVF attempts were randomly split into two groups each consisting of 36 patients was 33.8±4.8 in contrast to Group B (control group) with the mean age of 33.8±4.8. Mean endometrial thickness of 8.6±0.1 mm was recorded in Group B compared to 9.0±0.7 mm in Group A (p=0.03). Of all the 36 participants who received sildenafil citrate during the IVF cycle, 12 (33.3%) patients had successful pregnancies while 24 (66.7%) failed to get pregnant. In the control group, out of the 36 participants, 10 (27.8%) patients got pregnant while 26 (72.2%) failed the cycle (p=0.9).Conclusion: This study showed that although using vaginal sildenafil during the IVF cycle does improve endometrial thickness before implantation, this does not necessarily lead to higher pregnancy rates

Simultaneous Cesarean Section and Radical Nephrectomy With Tumor Thrombectomy During Pregnancy

Renal cell carcinoma (RCC) is uncommon during pregnancy. Accurate and timely diagnosis and careful preoperative planning are essential to optimize the patient outcomes. A 27-year-old pregnant woman presented with a large mass in left kidney and inferior vena cava (IVC) tumor thrombus, diagnosed at 33 weeks gestation. She was evaluated with an initial impression of pyelonephritis at other institutions and referred to our center after a delay of more than 3 weeks. RCC with IVC tumor thrombus has the potential to increase the likelihood of thromboembolic events including pulmonary embolism during pregnancy. Furthermore, simultaneous radical nephrectomy with IVC thrombectomy and Cesarean section (CS) is challenging and might be associated with significant intraoperative blood loss. After consultation with an obstetrician and cardiac surgery team, our patient underwent CS and simultaneous left radical nephrectomy with IVC thrombectomy at 34 weeks gestation. The postoperative course was uneventful and histologic analysis revealed pT3bN0M0 papillary RCC

Effects of Melatonin Supplementation on Hormonal, Inflammatory, Genetic, and Oxidative Stress Parameters in Women With Polycystic Ovary Syndrome

Purpose: The aim of the current study was to evaluate the effect of melatonin administration on clinical, hormonal, inflammatory, and genetic parameters in women with polycystic ovarian syndrome (PCOS).Methods: The present randomized, double-blinded, placebo-controlled clinical trial was conducted among 56 patients with PCOS, aged 18–40 years old. Subjects were randomly allocated to take either 5 mg melatonin supplements (n = 28) or placebo (n = 28) twice a day for 12 weeks.Results: Melatonin administration significantly reduced hirsutism (β −0.47; 95% CI, −0.86, −0.09; P = 0.01), serum total testosterone (β −0.11 ng/mL; 95% CI, −0.21, −0.02; P = 0.01), high-sensitivity C-reactive protein (hs-CRP) (β −0.61 mg/L; 95% CI, −0.95, −0.26; P = 0.001), and plasma malondialdehyde (MDA) levels (β −0.25 μmol/L; 95% CI, −0.38, −0.11; P < 0.001), and significantly increased plasma total antioxidant capacity (TAC) levels (β 106.07 mmol/L; 95% CI, 62.87, 149.28; P < 0.001) and total glutathione (GSH) (β 81.05 μmol/L; 95% CI, 36.08, 126.03; P = 0.001) compared with the placebo. Moreover, melatonin supplementation downregulated gene expression of interleukin-1 (IL-1) (P = 0.03) and tumor necrosis factor alpha (TNF-α) (P = 0.01) compared with the placebo.Conclusions: Overall, melatonin administration for 12 weeks to women with PCOS significantly reduced hirsutism, total testosterone, hs-CRP, and MDA, while increasing TAC and GSH levels. In addition, melatonin administration reduced gene expression of IL-1 and TNF-α.Clinical Trial Registration:www.irct.ir, identifier IRCT2017082733941N9, Available online at: https://www.irct.ir/trial/2605

Prevalence of Lymph Node Metastasis in Radical Prostatectomy; A Retrospective and Multicenter Study in Iran

Lymph node (LN) metastasis is considered an important prognostic factor in patients with prostate cancer. The aim of this study was to determine the rate of LN metastasis among an Iranian population who underwent radical prostatectomy (RP) with pelvic LN dissection (PLND). In a retrospective review of medical records, 450 RP cases were included and the data on LN metastasis were extracted from surgical pathology reports. Overall, 4.7% of the patients had LN metastasis. The rate of surgical stage T3 (50% vs. 13.5%; P=0.021) and pathological Gleason score ³7 (82.4% vs. 48.8%; P=0.002) was significantly higher among LN-positive patients. All patients with LN metastasis had a serum prostate specific antigen level >4 ng/ml. The diagnosis of prostate cancer is in an acceptable, but not ideal, stage of the disease; this may be due to screening examinations and tests

Uterine artery embolization in late postpartum hemorrhage due to pseudoaneurysm: case report

Background: Late postpartum hemorrhage (PPH) is defined as uterine bleeding between 24 hours until 12 weeks after delivery. Uterine artery pseudoaneurysm is a rare cause of life-threatening late postpartum hemorrhage (PPH). Emergency uterine artery embolization (UAE) is an appropriate method for control of hemorrhage. The aim of this report was to present a case of uterine artery embolization in late postpartum hemorrhage due to uterine artery pseudoaneurysm. Case Presentation: A 25-year-old woman with the history of three previous cesarean sections was admitted 35 days after the last cesarean. She had severe vaginal bleeding for 35 days after cesarean section. Because of severe vaginal bleeding 35 days after cesarean section, the patient was at nearly shock state (BP=90.60 mmHg, positive tilt test, tachycardia PR=120/m). In speculum examination, she had severe vaginal bleeding, but there was no lesion in vagina or cervix, also, bimanual examination of the uterus and adnexal area were normal. She reanimated by two liters of normal saline and uterotonic agents (oxytocin and methergine) were administered. Laboratory data showed severe anemia (Hb=6.5 gr/dl), but coagulation tests were normal. Ultrasonography didn’t show any abnormality. Because of continuation of vaginal bleeding after stabilization of the patient, UAE was planned. During pelvic angiography, a pseudoaneurysm was diagnosed and then it was treated by successful UAE. Conclusion: Uterine artery embolization is a conservative management for control of late postpartum hemorrhage. It can be a useful and alternative method for uterine and hypogastric artery ligation and hysterectomy, therefore it has an important role in treatment and fertility preservation for young women

Effect of Daily Caper Fruit Pickle Consumption on Disease Regression in Patients with Non-Alcoholic Fatty Liver Disease: a Double-Blinded Randomized Clinical Trial

Purpose: Despite numerous studies on the effects of complementary medicine, to our knowledge, there is no study on the effects of Capparis spinosa on disease regression in non-alcoholic fatty liver disease (NAFLD) patients. We compared the effects of caper fruit pickle consumption, as an Iranian traditional medicine product, on the anthropometric measures and biochemical parameters in different NAFLD patients. Methods: A 12-weeks randomized, controlled, double-blind trial was designed in 44 NAFLD patients randomly categorized for the control (n=22) or caper (n=22). The caper group received 40-50 gr of caper fruit pickles with meals daily. Before and after treatment, we assessed anthropometric measures, grade of fatty liver, serum lipoproteins and liver enzymes. Results: Weight and BMI were significantly decreased in the caper (p<0.001 and p<0.001) and control group (p=0.001 and p=0.001), respectively. Serum TG, TC and LDL.C just were significantly decreased in the control group (p=0.01, p<0.001 and p<0.001, respectively). Adjusted to the baseline measures, serum ALT and AST reduction were significantly higher in the caper than control group from baseline up to the end of the study (p<0.001 and p=0.02, respectively). After weeks 12, disease severity was significantly decreased in the caper group (p <0.001). Conclusion: Our results suggest that daily caper fruit pickle consumption for 12 weeks may be potentially effective on improving the biochemical parameters in NAFLD patients. Further, additional larger controlled trials are needed for the verification of these results

Evaluation of the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) diagnosed, undiagnosed, treated, and treatment goal in the elderly: Bushehr Elderly Health Program (BEH)

Abstract As the population ages, the global burden of cardiometabolic disorders will increase. This study aimed to investigate the prevalence of cardiometabolic disorders (diabetes, hypertension, and hyperlipidemia) in elderly and to evaluate the effects of various variables including age, sex, education, marital status, smoking, income, physical activity, dementia and depressed mood on untreated cardiometabolic disorders. This was a cross sectional study conducted in Bushehr Elderly Health Program. A total 2381 participants were included. Medical data were collected by trained interviewers. The mean age of the study participants was 69.34 years. Proportions of diabetes, hypertension, hyperlipidemia and hypercholesterolemia were 43.25%, 75.71%, 64.74% and 35.31% respectively. Untreated diabetes prevalence was higher for males (OR = 1.60, 95%CI = 1.20–2.15), older adults (OR = 1.02, 95%CI = 1.00–1.05), and pre-frail status (OR = 0.69, 95%CI = 0.52–0.92). Males (OR = 2.16, 95%CI = 1.64–2.84) and current smokers (OR = 1.42, 95%CI = 1.05–1.93), in contrast to married participants (OR = 0.25, 95%CI = 0.08–0.78), people with higher education levels (OR = 0.51, 95%CI = 0.29–0.89) and dementia (OR = 0.78, 95%CI = 0.61–1.00) were more likely to have untreated HTN. Untreated dyslipidemia is more common in smokers (OR = 1.78, 95%CI = 1.19–2.66) and males (OR = 1.66, 95%CI = 1.21–2.27), while untreated hypercholesteremia is more common in males (OR = 3.20, 95%CI = 1.53–6.69) and is reported lower in people with dementia (OR = 0.53, 95%CI = 0.28–1.01)