A comparison between the effects of metformin and N -acetyl cysteine (NAC) on some metabolic and endocrine characteristics of women with polycystic ovary syndrome

Objective: To compare N-acetyl cysteine (NAC) and metformin on polycystic ovary syndrome (PCOS).Method: Study was performed as a randomized double-blind clinical trial on women with diagnosis of PCOS without additional complications. In one group, oral NAC 600 mg, three times a day and in the other group, 500 mg oral metformin, three times a day were prescribed. Duration of treatment was 24 weeks, and after finishing this period of treatment, fasting blood glucose (FBS) and insulin, lipid profile and Homeostasis Model Assessment (HOMA) index were measured (all the blood samples were taken while fasting) and were compared in the two groups.Results: Forty-six women in NAC group and 48 women in metformin group finished the study. The two groups did not show significant difference according to age, body mass index (BMI) of more than 30; mean BMI, AUB, FBS, fasting blood insulin, lipid profile and HOMA index before treatment. After 24 weeks of treatment; BMI >30 17 (35.4%) versus 7 (15.2%), p = 0.033, mean BMI (28.36 ± 2.27) versus (27.11 ± 3.55), p = 0.44, number of women with the complain of abnormal uterine bleeding (AUB) 24 (50%) versus 13 (28.3%), p = 0.037, FBS (90.02 ± 6.24) versus (86.61 ± 7.81), p = 0.021, fasting insulin (10.40 ± 2.64 versus 8.89 ± 2.20, p = 0.004), HOMA Index (2.09 ± 0.69 versus 1.71 ± 0.45, p = 0.001), low density lipoprotein (LDL) (141.83 ± 26.98 versus 127.89 ± 28.70, p = 0.017) were less in NAC group. Triglyceride (TG) and total cholesterol did not show significant difference between the two groups after treatment. High-density lipoprotein (HDL) was higher in NAC group.Conclusion: NAC can improve lipid profile and fasting blood sugar (FBS) and fasting blood insulin better than metformin. © 2015 Taylor & Francis

A comparative study on the efficacy of nifedipine and indomethacin for prevention of preterm birth as monotherapy and combination therapy: a randomized clinical trial

Introduction: Preterm delivery is an important issue in obstetrics, which is the most common cause of neonatal mortality and morbidity. Therefore, finding a way to prevent it is always under serious concern. Objective: The study aimed to compare the efficacy of two tocolytic agents, nifedipine and indomethacin, for inhibiting preterm uterine contractions as monotherapy and combination therapy. Materials and methods: A double-blind randomized clinical trial was performed on pregnant women with gestational age of 26�34 weeks of pregnancy who referred to hospital for preterm labor. They were randomly assigned to three groups. Indomethacin plus placebo, nifedipine plus placebo, and a combination of indomethacin and nifedipine were administered to the three groups. Inhibiting contractions for 2 hours and prevention of delivery for 48 hours and 7 days were evaluated. Also, duration of pregnancy, the number of preterm births, and the interval between entering the study and delivery were compared between three groups. Results: One hundred fifty women were eligible for the study. Two women in the nifedipine group and one woman in the combined group were excluded from the study because of hypotension. The women of the three groups did not have significant difference according to age, BMI, gravidity, parity, Bishop score, gestational age, and the number of contractions at entering the study. Thirty-six women (72) in the indomethacin group, 36 women (72) in the nifedipine group, and 41 women (89.4) in the combination group had stopped contractions within the first 2 hours of intervention (p =.002). Inhibiting contractions for 48 hours (p =.003), inhibiting contractions for 7 days (p =.021), gestational age at birth (p =.001), number of pregnancies more than 37 weeks (p =.007), and neonatal weight (p =.020) were significantly more in the combination group. Conclusion: Combination therapy with nifedipine and indomethacin was more effective than monotherapy with either of these two medications for inhibiting preterm labor, delaying delivery, and prolongation of the duration of pregnancy. © 2019 Informa UK Limited, trading as Taylor & Francis Group

Evaluation the relationship between serum progesterone level and pain perception after cesarean delivery

Introduction: Cesarean delivery is the most common surgery in obstetrics, and pain relief after cesarean section is an important concern for obstetricians and their patients. Objective: The aim of this study was to evaluate the relationship between serum progesterone level and pain perception after cesarean delivery. Method: The study was performed as a prospective cohort study on 166 pregnant women who were candidates for elective cesarean delivery due to previous cesarean section. Before surgery, serum progesterone level was measured. Pain score of women was evaluated 4, 8, 12, and 24�h after surgery using visual analog scale (VAS) score, and correlation between progesterone level and pain was evaluated. Results: The median value of serum progesterone was 119.45�ng/ml. Mean pain score in hours 4, 8, 12, and 24 were 6.80�±�2.11, 5.31�±�1.48, 3.89�±�1.68, and 2.30�±�1.26, respectively. The women were divided according to mean progesterone level of 119.45�ng/ml into two groups of high progesterone level (�119.45) and low progesterone level (<119.45), and the pain score was evaluated in different times (hour 4, 8, 12, and 24) for both levels of progesterone. The mean pain score in the 4, 8, 12, and 24�h were significantly lower in high progesterone group (progesterone level �119.45). The number of women with low pain score (less than five) in hours 12 and 24 was significantly higher in high progesterone level group. With increasing BMI, progesterone level was lower and women with higher BMI, had a higher pain score in hours 4, 8, 12, and 24, while women with lower BMI had a lower pain score during the same hours. (p�=�.004, r�=�0.223; p�=�.004, r�=�0.223; p�=�.039, r�=�0.160; and p�=�.007, r�=�0.207). Progesterone level and BMI (p�=�.025, r�=���0.174), and progesterone level and pain score in hours 4, 8, 12, and 24 (p�=�.000, r�=���0.324; p�=�.000, r�=���0.474; p�=�.000, r�=���0.329; and p�=�.000, r�=���0.417, respectively) showed a negative significant correlation. Putting three variables of age, gestational age, and BMI in a multiple regression model, progesterone level showed significant negative correlation with the pain score in hour 4 (p�=�.000, r�=���0.305), hour 8 (p�=�.000, r�=���0.461), hour 12 (p�=�.000, r�=���0.328), and hour 24 (p�=�.000, r�=���0.409). Conclusions: Serum progesterone level showed a negative correlation with the pain score after cesarean section. © 2018 Informa UK Limited, trading as Taylor & Francis Grou

A comparative study on the efficacy of nifedipine and indomethacin for prevention of preterm birth as monotherapy and combination therapy: a randomized clinical trial

Introduction: Preterm delivery is an important issue in obstetrics, which is the most common cause of neonatal mortality and morbidity. Therefore, finding a way to prevent it is always under serious concern. Objective: The study aimed to compare the efficacy of two tocolytic agents, nifedipine and indomethacin, for inhibiting preterm uterine contractions as monotherapy and combination therapy. Materials and methods: A double-blind randomized clinical trial was performed on pregnant women with gestational age of 26�34 weeks of pregnancy who referred to hospital for preterm labor. They were randomly assigned to three groups. Indomethacin plus placebo, nifedipine plus placebo, and a combination of indomethacin and nifedipine were administered to the three groups. Inhibiting contractions for 2 hours and prevention of delivery for 48 hours and 7 days were evaluated. Also, duration of pregnancy, the number of preterm births, and the interval between entering the study and delivery were compared between three groups. Results: One hundred fifty women were eligible for the study. Two women in the nifedipine group and one woman in the combined group were excluded from the study because of hypotension. The women of the three groups did not have significant difference according to age, BMI, gravidity, parity, Bishop score, gestational age, and the number of contractions at entering the study. Thirty-six women (72) in the indomethacin group, 36 women (72) in the nifedipine group, and 41 women (89.4) in the combination group had stopped contractions within the first 2 hours of intervention (p =.002). Inhibiting contractions for 48 hours (p =.003), inhibiting contractions for 7 days (p =.021), gestational age at birth (p =.001), number of pregnancies more than 37 weeks (p =.007), and neonatal weight (p =.020) were significantly more in the combination group. Conclusion: Combination therapy with nifedipine and indomethacin was more effective than monotherapy with either of these two medications for inhibiting preterm labor, delaying delivery, and prolongation of the duration of pregnancy. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Evaluation the relationship between serum progesterone level and pain perception after cesarean delivery

Introduction: Cesarean delivery is the most common surgery in obstetrics, and pain relief after cesarean section is an important concern for obstetricians and their patients. Objective: The aim of this study was to evaluate the relationship between serum progesterone level and pain perception after cesarean delivery. Method: The study was performed as a prospective cohort study on 166 pregnant women who were candidates for elective cesarean delivery due to previous cesarean section. Before surgery, serum progesterone level was measured. Pain score of women was evaluated 4, 8, 12, and 24�h after surgery using visual analog scale (VAS) score, and correlation between progesterone level and pain was evaluated. Results: The median value of serum progesterone was 119.45�ng/ml. Mean pain score in hours 4, 8, 12, and 24 were 6.80�±�2.11, 5.31�±�1.48, 3.89�±�1.68, and 2.30�±�1.26, respectively. The women were divided according to mean progesterone level of 119.45�ng/ml into two groups of high progesterone level (�119.45) and low progesterone level (<119.45), and the pain score was evaluated in different times (hour 4, 8, 12, and 24) for both levels of progesterone. The mean pain score in the 4, 8, 12, and 24�h were significantly lower in high progesterone group (progesterone level �119.45). The number of women with low pain score (less than five) in hours 12 and 24 was significantly higher in high progesterone level group. With increasing BMI, progesterone level was lower and women with higher BMI, had a higher pain score in hours 4, 8, 12, and 24, while women with lower BMI had a lower pain score during the same hours. (p�=�.004, r�=�0.223; p�=�.004, r�=�0.223; p�=�.039, r�=�0.160; and p�=�.007, r�=�0.207). Progesterone level and BMI (p�=�.025, r�=���0.174), and progesterone level and pain score in hours 4, 8, 12, and 24 (p�=�.000, r�=���0.324; p�=�.000, r�=���0.474; p�=�.000, r�=���0.329; and p�=�.000, r�=���0.417, respectively) showed a negative significant correlation. Putting three variables of age, gestational age, and BMI in a multiple regression model, progesterone level showed significant negative correlation with the pain score in hour 4 (p�=�.000, r�=���0.305), hour 8 (p�=�.000, r�=���0.461), hour 12 (p�=�.000, r�=���0.328), and hour 24 (p�=�.000, r�=���0.409). Conclusions: Serum progesterone level showed a negative correlation with the pain score after cesarean section. © 2018 Informa UK Limited, trading as Taylor & Francis Grou

Efficacy comparison of titrated oral solution of misoprostol and intravenous oxytocin on labour induction in women with full-term pregnancy

A double-blind randomised trial was conducted on women with gestational age of 40�42 weeks of pregnancy and Bishop score of more than 5. The first group received oxytocin infusion and the second group received a titrated oral solution of misoprostol. Then, the two groups were compared by the primary outcome (the number of deliveries in the first 24 hours of intervention). The two groups did not have any significant difference in maternal and gestational age at the time of intervention, primary Bishop score, parity and neonatal weight. The number of deliveries in the first 24 hours was greater in the misoprostol group. Duration of onset of intervention to proper contractions was longer in the misoprostol group. However, the number of deliveries between 6�12 hours, 12�18 hours and 18�24 hours after induction was greater in the misoprostol group. The incidence of tachysystole and meconium was greater in the misoprostol group.Impact statementWhat is already known on this subject? Labour induction is widely used where the continuation of pregnancy might be dangerous for the mother or the baby. Of the various methods used for induction, misoprostol which is a prostaglandin E1 analogue has been reviewed more in recent years. Misoprostol has various routes of administration but in most studies only vaginal administration has been evaluated, leaving us with limited data about oral administration. What do the results of this study add? Oral misoprostol is a suitable method for labour induction and can be used as an alternative to oxytocin. What are the implications of these findings for clinical practice and/or further research? Misoprostol is not expensive, has a long shelf life, accessible in underdeveloped countries and rural areas and has several routes of administrations such as oral, sublingual and vaginal. Despite the fact that the oral route of misoprostol has a fast absorption and easier administration, there are relatively few studies assessing the the use of the oral route of misoprostol. Misoprostol is a suitable method for Labour induction and it has the potentials of being used as an alternative for oxytocin, however, the optimum dosages, the preferred route of administration, the maximum dose, the maximum time for administration, and maternal and neonatal safety should be studied more. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Efficacy comparison of titrated oral solution of misoprostol and intravenous oxytocin on labour induction in women with full-term pregnancy

A double-blind randomised trial was conducted on women with gestational age of 40�42 weeks of pregnancy and Bishop score of more than 5. The first group received oxytocin infusion and the second group received a titrated oral solution of misoprostol. Then, the two groups were compared by the primary outcome (the number of deliveries in the first 24 hours of intervention). The two groups did not have any significant difference in maternal and gestational age at the time of intervention, primary Bishop score, parity and neonatal weight. The number of deliveries in the first 24 hours was greater in the misoprostol group. Duration of onset of intervention to proper contractions was longer in the misoprostol group. However, the number of deliveries between 6�12 hours, 12�18 hours and 18�24 hours after induction was greater in the misoprostol group. The incidence of tachysystole and meconium was greater in the misoprostol group.Impact statementWhat is already known on this subject? Labour induction is widely used where the continuation of pregnancy might be dangerous for the mother or the baby. Of the various methods used for induction, misoprostol which is a prostaglandin E1 analogue has been reviewed more in recent years. Misoprostol has various routes of administration but in most studies only vaginal administration has been evaluated, leaving us with limited data about oral administration. What do the results of this study add? Oral misoprostol is a suitable method for labour induction and can be used as an alternative to oxytocin. What are the implications of these findings for clinical practice and/or further research? Misoprostol is not expensive, has a long shelf life, accessible in underdeveloped countries and rural areas and has several routes of administrations such as oral, sublingual and vaginal. Despite the fact that the oral route of misoprostol has a fast absorption and easier administration, there are relatively few studies assessing the the use of the oral route of misoprostol. Misoprostol is a suitable method for Labour induction and it has the potentials of being used as an alternative for oxytocin, however, the optimum dosages, the preferred route of administration, the maximum dose, the maximum time for administration, and maternal and neonatal safety should be studied more. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Evaluation of the relationship between serum anti TPO antibody levels and mood disorders in euthyroid pregnant women

Introduction: Depression and anxiety during pregnancy have a negative impact on prenatal health and reduces mother�s child care capability. Up to 20 of the pregnant women experience mood disorders. Objective: The aim of this study was evaluating the relationship between serum anti-TPO antibody levels and mood disorders in pregnant euthyroid women. Materials and methods: Serum anti-TPO antibody levels were measured in the first trimester of gestation in euthyroid pregnant women. Then, the women were divided into two groups of positive and negative anti-TPO antibody. Depression and anxiety were evaluated by Hamilton depression rating scale (HAM-D) and Hamilton anxiety rating scale (HAM-A) during the first, second, and third trimester of pregnancy (all women had three assessments during pregnancy). Results: Thirty women with high serum anti-TPO antibody levels (case group) and 32 women with normal serum anti-TPO antibody levels (control group) were compared. Mean anti-TPO levels were 105.63 ± 54.17 and 5.57 ± 1.80 IU/mL in case and control groups, respectively (p =.000). The baseline characteristics and initial HAM-A and HAM-D scores were not significantly different in the two groups except for anti-TPO. Pair t-test showed that the level of anxiety and depression has increased significantly during pregnancy in both groups. Comparison of anxiety and depression level in both groups showed that in anti-TPO antibody positive group, anxiety, and depression levels were significantly higher than the anti-TPO antibody negative group. Conclusion: Depression and anxiety of euthyroid pregnant women in the second and third trimester of pregnancy have a significant correlation with serum anti-TPO antibody levels of the first trimester of pregnancy. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group

Evaluation of the relationship between serum anti TPO antibody levels and mood disorders in euthyroid pregnant women

Introduction: Depression and anxiety during pregnancy have a negative impact on prenatal health and reduces mother�s child care capability. Up to 20 of the pregnant women experience mood disorders. Objective: The aim of this study was evaluating the relationship between serum anti-TPO antibody levels and mood disorders in pregnant euthyroid women. Materials and methods: Serum anti-TPO antibody levels were measured in the first trimester of gestation in euthyroid pregnant women. Then, the women were divided into two groups of positive and negative anti-TPO antibody. Depression and anxiety were evaluated by Hamilton depression rating scale (HAM-D) and Hamilton anxiety rating scale (HAM-A) during the first, second, and third trimester of pregnancy (all women had three assessments during pregnancy). Results: Thirty women with high serum anti-TPO antibody levels (case group) and 32 women with normal serum anti-TPO antibody levels (control group) were compared. Mean anti-TPO levels were 105.63 ± 54.17 and 5.57 ± 1.80 IU/mL in case and control groups, respectively (p =.000). The baseline characteristics and initial HAM-A and HAM-D scores were not significantly different in the two groups except for anti-TPO. Pair t-test showed that the level of anxiety and depression has increased significantly during pregnancy in both groups. Comparison of anxiety and depression level in both groups showed that in anti-TPO antibody positive group, anxiety, and depression levels were significantly higher than the anti-TPO antibody negative group. Conclusion: Depression and anxiety of euthyroid pregnant women in the second and third trimester of pregnancy have a significant correlation with serum anti-TPO antibody levels of the first trimester of pregnancy. © 2019 Informa UK Limited, trading as Taylor & Francis Group