Comparison of the effects of gonadotropin-releasing hormone and raloxifeneon the size of uterine leiomyoma

BACKGROUND: Uterine leiomyoma is a prevalent benign tumor. Several studies have shown the positive effects of raloxifene in the treatment of leiomyomas. Since raloxifene has fewer side effects than the gonadotropin-releasing hormone (GnRH) agonist, if proven effective, it can be applied easily. This study aimed to compare the medical effects of raloxifene and GnRH on uterine leiomyoma size. METHODS: This clinical trial included 53 women with uterine leiomyoma. Participants were randomly divided into 2 groups of raloxifene and GnRH. The GnRH group received 1 dose per month (intramuscular injection) and the raloxifene group received 60 mg raloxifene orally/day for 3 months. The size of the leiomyoma, prior and during the intervention, was determined by a sonographist. During the study, repeated measurement was used for comparing the trend of alterations in the tumor size. RESULTS: Analysis of changes in leiomyoma tumor size (log of tumor size) by repeated measurement showed that decrease in tumor size in the raloxifene group was significantly higher than GnRH group (P = 0.042). The trends of changes in endometrial thickness were different in the 2 groups and the reduction of thickness was more significant in the GnRH group (P = 0.026). CONCLUSION: This study showed that raloxifene is an appropriate medicine to reduce the size of uterine leiomyoma and is more effective than GnRH.

Cerebral Subdural Hematoma Following Spinal Anesthesia: Report of Two Cases

Postdural puncture headache and cerebral subdural hematoma are among complications of spinal anesthesia with some common characteristics; however misdiagnosis of these two could result in a catastrophic outcome or prevent unwanted results by urgent interventions. With the purpose of increasing awareness of such complications and a speedy diagnosis, we report two cases of postspinal anesthesia headache that was timely diagnosed as cerebral subdural hematoma and prevented the likelihood of a disastrous outcome

Comparison of the effects of gonadotropin-releasing hormone and raloxifeneon the size of uterine leiomyoma

BACKGROUND: Uterine leiomyoma is a prevalent benign tumor. Several studies have shown the positive effects of raloxifene in the treatment of leiomyomas. Since raloxifene has fewer side effects than the gonadotropin-releasing hormone (GnRH) agonist, if proven effective, it can be applied easily. This study aimed to compare the medical effects of raloxifene and GnRH on uterine leiomyoma size. METHODS: This clinical trial included 53 women with uterine leiomyoma. Participants were randomly divided into 2 groups of raloxifene and GnRH. The GnRH group received 1 dose per month (intramuscular injection) and the raloxifene group received 60 mg raloxifene orally/day for 3 months. The size of the leiomyoma, prior and during the intervention, was determined by a sonographist. During the study, repeated measurement was used for comparing the trend of alterations in the tumor size. RESULTS: Analysis of changes in leiomyoma tumor size (log of tumor size) by repeated measurement showed that decrease in tumor size in the raloxifene group was significantly higher than GnRH group (P = 0.042). The trends of changes in endometrial thickness were different in the 2 groups and the reduction of thickness was more significant in the GnRH group (P = 0.026). CONCLUSION: This study showed that raloxifene is an appropriate medicine to reduce the size of uterine leiomyoma and is more effective than GnRH

Production of hepatocyte-like cells from human umbilical vein mesenchymal stem cells

The human umbilical vein, as a readily available stem cell source, is a good alternative to harvest mesenchymal stem cells. Human umbilical cord vein mesenchymal stem cells have recently been isolated and have demonstrated the ability to differentiate into various cell types such as fat, bone, cartilage and neuronal cells. In this study, we have investigated whether human umbilical cord vein mesenchymal stem cells are also able to differentiate into hepatocyte-like cells. Hepatic differentiation was performed with a 2-step protocol and the use of hepatocyte growth factor and oncostatin M for cell culture. During four weeks of induction, most cells displayed a cuboidal morphology. Immunological analysis indicated that umbilical cord vein mesenchymal stem cells-derived hepatocyte-like cells expressed liver-specific protein markers such as albumin and cytokeratin-18. The hepatocyte-like cells also displayed several characteristics of hepatocytes, including expression of transthyretin, glucose 6-phosphatase, cytokeratin-8,18, alpha-fetoprotein, hepatocyte nuclear factor-3β and albumin. The result of indocyanine green cell uptake, as a test substance to evaluate hepatocyte-like cell function, was positive for differentiated cells. Glycogen storage was examined by periodic acid-Schiff staining. Accumulation of intracellular glycogen was detected in the hepatocyte-like cells. Based on these observations, we have concluded that umbilical cord vein mesenchymal stem cells are endowed with hepatogenic potential and may provide a stem cell source to be used as cell therapy for liver diseases

Asymptomatic bacteriuria among pregnant women referred to outpatient clinics in Sanandaj, Iran

OBJECTIVES: Determine the prevalence of asymptomatic urinary tract infection (AUTI) among pregnant women. We also determined the antibacterial susceptibility of the isolates to various antibiotics and associated risk factors in AUTI. MATERIALS AND METHODS: One thousand five hundred and five consecutive pregnant women were included in the study. Mid-stream urine specimen for complete examination of urine was obtained. RESULTS: Of 1505 pregnant women, 134 (8.9%) had bacteriuria. The mean age of the all the pregnant women included in the study was 28.40 years with a standard deviation of 6.16. Age ranged from 15 to 45 years of age. The urine culture of the asymptomatic pregnant women (1505 cases) showed growth in only 134 cases (8.9%). Escherichia coli was the commonest organism 79 (58.96%) followed by CN Staphylococcus 22 (16.8%) and S aureus 18 (13.43%). Escherichia coli, which comprised 58.96% (79) of the isolates, were 88.62%, 87.35%, and 83.55% sensitive to cefotaxime, ciprofloxacin and cefotizoxime respectively. Similarly, E. coli were 89%, 70%, and 20% resistant to ampicillin, cotrimoxazole, and nitrofurantoin respectively (OR 1.57 95% CI 1.01, 2.44). After analyzing, four variables, hemoglobin levels seem to be independently associated with asymptomatic bacteriuria (OR = 9.41 (1.65-50.38). CONCLUSION: Prevalence of asymptomatic bacteriuria among pregnant women was 8.9%. The predominant organisms were Escherichia coli 79 (58.96%), followed by CN Staphylococcus 22 (16.8%). Most strains of Escherichia coli showed that they were resistant to ampicillin, tetracycline and gentamicin

The effect of vitamin D supplementation on gestational diabetes in high-risk women: Results from a randomized placebo-controlled trial

Background: Vitamin D deficiency is common in pregnancy, leading to increase in the frequency of preeclampsia, cesarean delivery, neonatal bacterial vaginosis, and gestational diabetes. The current study was designed and implemented to investigate the effect of vitamin D during the first and second trimesters of pregnancy in reducing the risk of gestational diabetes mellitus (GDM) in women who are at high risk [history of GDM, birth macrosomia, family history, and high body mass index (BMI)]. Materials and Methods: In a randomized, double-blind, and placebo-controlled trial, 90 pregnant women who had at least one risk factor for GDM were randomized into intervention (46 participants) and control (44 participants) groups. Participants in the intervention group took 5000 units of vitamin D daily and the control group took placebo until the 26th week of pregnancy. Then the glucose challenge test (GCT) and the glucose tolerance test (GTT) were performed to evaluate GDM. Results: Mean ± standard deviation (SD) age was 31.28 ± 6.38 years and 29 ± 6.24 years for the intervention group and the placebo group, respectively, (P > 0.05). In addition, there were no significant differences between two groups in terms of vitamin D levels and GCT (P > 0.05), and the difference was not significant. The incidence of diabetes in the intervention groups was statistically lower than in control group (11.4% vs 34.8; P < 0.01). The results showed that abnormal GCT in the placebo group was statistically higher than in intervention group (35.9% vs 10.9 P < 0.005). Conclusion: The results of the current study showed that the prescription of vitamin D supplementation in the first and second trimesters of pregnancy was effective in reducing GDM and controlling GTT and GTC

Effect of early amniotomy on labor outcome in nulliparous women: a randomized clinical trial

Early amniotomy is one of the main interventions to enhance the labor progress and prevent dystocia in pregnant women. However, the efficacy of amniotomy has not been approved via labor-related indices and outcomes and has remained a subject for debate and future research. The present study was conducted to evaluate the effect of early amniotomy on labor indices and outcomes in nulliparous women. This randomized clinical trial was performed on 151 singleton pregnant women who were referred to Besat Hospital in Sanandaj, Iran, from March 2016 to March 2018. Participants were randomly divided into an early amniotomy (EA) group and a control group. Duration of the first and second phases of labor, corioamionit, dystocia rate, Apgar score at the first and fifth minutes, prolonged labor and post-partum haemorrhage were evaluated and compared between the two groups. Data were recorded in a checklist and analysed using SPSS Version 23. The p value <0.05 was considered significant. Results showed that labor indices such as duration of the first and second phases, Apgar score one and five minutes after delivery and frequency of prolonged labor, foetal distress and postpartum haemorrhage were significantly improved in patients of the early amniotomy group, compared with the control group (p≤0.05). Early amniotomy significantly decreased the total labor duration without significant increase in the rate of maternal and neonatal complications

Shortening Anesthesia Duration does not Affect Severity of Withdrawal Syndrome in Patients Undergoing Ultra Rapid Opioid Detoxification

Ultra rapid opioid detoxification (UROD) is one of the new methods of detoxification. This method of detoxification involves putting patients under general anesthesia and actively giving them opioid antagonists. The objective of this study was to evaluate effects of anesthesia duration in UROD on severity of withdrawal syndrome. Sixty addicted patients seeking UROD procedure assigned randomly to one of the 2hr, 4hr or 6hr anesthesia duration groups. Premedication and anesthesia procedure (induction and maintenance) were the same for three groups. Detoxification was done for all patients with 50 mg oral naltroxane (prior to induction) and 20 mg intravenous naloxane (8 mg/bolus and 12 mg/infusion). Blood pressure, heart rate and respiratory rate were automatically measured and recorded every 5 minutes. The severity of withdrawal syndrome was measured and recorded every one hour during anesthesia, 2hours post-anesthesia, and 12 and 24 hours following the induction of anesthesia according to the Wang Scale modified by Lomier (WSMBL). Patients aged 20-58 in three groups. Three cases experienced delirium after detoxification that lasted 24 hours in one. Severity of withdrawal syndrome in patients of groups 2, 4 and 6 hour were 8.7, 7.4 and 5.1 respectively during anesthesia and 12.3, 11.1 and 13.9 after 18 hours of anesthesia. Results of this study showed that, in standard settings, UROD is a safe method for detoxification and has low complications. The withdrawal symptoms during and after anesthesia are low. Shortening the duration of anesthesia has no affect on severity of withdrawal syndrome during and after anesthesia

Mediators of repeat mammography in two tailored interventions for Iranian women

Abstract Background Many theory-based interventions exist that incorporate theoretical constructs (e.g., self-efficacy, behavioral control) believed to increase the likelihood of mammography. Nonetheless, little work to date has examined if increased screening among women receiving such interventions occurs due to changes in these targeted constructs. The aim of this study is to address this gap in the literature in the context of two interventions for improving regular screening among Iranian women. Methods A sample of 176 women over 50 years old in Tehran, Iran were randomly allocated into one of these three conditions: 1) an intervention based on Health Belief Model (HBM); 2) an intervention based on an integration of the HBM and selected constructs from the TPB (TPB); and 3) a control group (CON). Questionnaires were administered before the intervention and after a 6-month follow-up. The Preacher and Hayes method of mediation was used in analytic models. Results Changes in susceptibility, self-efficacy, and perceived control appeared to mediate HBM-CON differences in screening. Barriers attenuated the mediating effect of self-efficacy. Changes in barriers and self-efficacy appeared to mediate TPB-CON differences in screening. Conclusion This study was successful in identifying which theory-based constructs appear to underlie the effectiveness of HBM- and TPB-based interventions. Specific constructs have been identified that should be targeted in clinical practice to increase mammography practices among Iranian women