Pregnancy and renal transplantation

Context: The current study aimed at providing an evidence-based and up-to-date review of the literature regarding the assessment and outcomes of pregnancy in patients with renal transplant. Design: It was a review of the current literature. Conclusions: According to the current study findings, the function or survival of renal allograft was not adversely affected by getting pregnant. Therefore, ideal care for these patients needs a multidisciplinary approach including maternal-fetal medicine, nephrology, and neonatology specialists. © 2018, Nephro-Urology Monthly

Deregulation of stemness-related genes in endometriotic mesenchymal stem cells: Further evidence for self-renewal/differentiation imbalance

Background: Any irregularities in self-renewal/differentiation balance� in endometriotic MSCs can change their fate and function, resulting in endometriosis development. This study aimed to evaluate the expression of OCT4 transcripts (OCT4A, OCT4B, and OCT4B1), SOX2, and NANOG in endometriotic MSCs to show their aberrant expression and to support self-renewal/differentiation imbalance in these cells. Methods: MSCs were isolated from three endometriotic and three normal endometrium samples and characterized and analyzed for the expressions of OCT4A, OCT4B, OCT4B1, SOX2, and NANOG using the qRT-PCR. Results: The expressions of OCT4 transcripts and NANOG increased significantly in endometriotic MSCs, whereas SOX2 expression did not show any significant difference. Conclusion: Our findings provide further evidence for confirming the self-renewal/ differentiation imbalance in endometriotic MSCs, as the main underlying cause of endometriosis development. This study also paves the way for further research on endometriosis treatment by focusing on endometriotic stem cells. © 2020, Pasteur Institute of Iran. All rights reserved

Effects of ultrasound guided ganglion stellate blockade on intraoperative and postoperative hemodynamic responses in laparoscopic gynecologic surgery

Introduction: Laparoscopic gynecologic surgery is one of the most well-known procedures. Pneumoperitoneum with carbon dioxide insufflation can cause unfavorable hemodynamic effects due to catecholamine and vasopressin release. Aim: To examine the effects of stellate ganglion block on hemodynamic response and postoperative pain. Material and methods: In a prospective double blinded randomized parallel study we included 40 patients with ASA physical status I and II, aged between 18 and 50 years with a gynecologic problem candidate for laparoscopic surgery under general anesthesia. The patients were randomly divided into two groups. Fifteen minutes before anesthesia induction, the patients underwent ultrasound guided stellate ganglion block with 10 ml of lidocaine 1 and the control group underwent stellate ganglion block using 10 ml of distilled water as placebo. After induction of general anesthesia, systolic and diastolic blood pressure and heart rate were recorded, especially after blowing of CO2 gas, the position change, depletion of CO2, and tracheal extubation in recovery. The postoperative pain was calculated using the visual analogue scale (VAS) at three times (0, 30, and 24 h after surgery). Results: Our results showed that mean systolic and diastolic blood pressure and heart rate did not show any significant difference at the measurement times (p > 0.05), and mean VAS of patients in the two groups was significantly different for the three measurement times except 24 h after surgery (p < 0.05). Conclusions: Stellate ganglion block before laparoscopic gynecologic surgery has no significant effect on intraoperative and postoperative hemodynamic responses; however, it can decrease VAS in the early postoperative period. © Creative Commons licenses: This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY -NC -SA 4.0). License (http://creativecommons.org/licenses/by-nc-sa/4.0/)

Biological and predatory characteristics of Andrallus spinidens (Hem.: Pentatomidae) on fourth instar larvae of Spodoptera littoralis (Lep.: Noctuidae), under laboratory conditions

Biological and predatory characteristics of Andrallus spinidens (F.) on fourth instar larvae of Egyptian cotton leafworm, Spodoptera littoralis (Bois.), were investigated, under laboratory condition, at 25 ± 1°C, 60 ± 5% RH and a photoperiod of 16: 8 L: D h. The analysis was based on an age-stage, two-sex life table. The intrinsic rate of increase (rm), finite rate of increase (λ), net reproductive rate (R0), gross reproductive rate (GRR) and mean generation time (T) of A. spinidens on S. littoralis were 0.0821 day-1, 1.0821 day-1, 102.77 offspring, 192.61 eggs and 58.68 day, respectively. The mean reproductive value of A. spinidens was estimated as 342.58 ± 48.18 eggs per female. The intrinsic birth rate (b) and intrinsic death rate (d) for A. spinidens on S. littoralis were 0.0894 and 0.0073, respectively. The first stage nymphs of A. spinidens live only on water but the second, third and fourth stage nymphs fed on 12.22, 26.22 and 41.28 of S. littoralis larvae, respectively. The fifth stage nymphs were more voracious and preyed on more than 70% of the larvae (94.36). At the adult stage, both male and female of A. spinidens were able to kill up to 85% of the larvae. In conclusion, the results prove that this predator pentatomid bug can be used as an efficient biological control agent against the noctuid pest, S. littoralis

Effects of vitamin D on endometriosis-related pain: A double-blind clinical trial

Background: Endometriosis is a disabling disease of reproductive-age women. Dysmenorrhea, dyspareunia, and pelvic pain are the main symptoms of endometriosis. Its etiology is not clear. Endometriosis may have various causes, including vitamin D deficiency, but its effect is controversial. Material/Methods: In this double-blind clinical trial, we enrolled patients with endometriosis diagnosed and treated by laparoscopy, with scores of at least 3 for of dysmenorrhea and/or pelvic pain at 8 weeks after surgical treatment. They were randomly prescribed vitamin D (50 000 IU weekly for 12 weeks) or placebo. Severity of pain in the 2 groups (placebo and treatment) was compared by VAS test at 24 weeks after surgical treatment. Results: There were 19 patients in the vitamin D group and 20 in the placebo group. Baseline characteristics in the 2 groups were similar. Following the treatment with vitamin D or placebo, we did not find significant differences in severity of pelvic pain (p=0.24) and dysmenorrhea (p=0.45) between the 2 groups. Mean pelvic pain at 24 weeks after laparoscopy in the vitamin D group was 0.84�1.74 and in placebo group it was 0.68�1.70 (p=0.513). Mean dysmenorrhea was 2.10�2.33 in the vitamin D group and 2.73�2.84 in the placebo group (p=0.45). Conclusions: After ablative surgery for endometriosis, vitamin D treatment did not have a significant effect in reducing dysmenorrhea and/or pelvic pain. � Med Sci Monit

Conservative management of ovarian fibroma in a case of Gorlin-Goltz syndrome comorbid with endometriosis

Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests. © 2018, Royan Institute (ACECR). All rights reserved

Conservative management of ovarian fibroma in a case of Gorlin-Goltz syndrome comorbid with endometriosis

Ovarian fibromas are the most common benign solid ovarian tumors, which are often difficult to diagnose preoperatively. Ovarian fibromas, especially in bilateral cases, may be cases of Gorlin-Goltz syndrome (GGS), a rare autosomal dominant disorder with predisposition to basal cell carcinomas (BCCs) and other various benign and malignant tumors. This case report describes a 25 year-old female with GGS, bilateral ovarian fibroma, endometriosis and septated uterus, which was referred to the Gynecology Clinic of Rasoul-e-Akram Hospital in October 2016. This patient had facial asymmetry due to recurrent odontogenic keratocysts. In young cases of ovarian fibromas as reported here, conservative surgical management can preserve ovarian function and fertility. These patients must be followed up by a multidisciplinary team and submitted to periodic tests. © 2018, Royan Institute (ACECR). All rights reserved

Hemoperitoneum due to bleeding from a vein overlying a subserous uterine myoma: A case report

Background: Fibroids are the most common pelvic tumors in women; serious complications are rare but can be life-threatening. Case presentation: We present a case report of a 38-year-old Persian woman with acute abdominal pain and a history of uterine fibroids. The patient refused to undergo a laparoscopic myomectomy. Her ultrasound examination revealed free fluid in the abdominal cavity, and her vital signs were indicative of vasogenic shock. A diagnostic laparoscopy was performed to identify and control the source of bleeding: 400 ml of blood and blood clots were removed. Active bleeding was seen from a vein overlying a subserosal myoma. A laparotomic myomectomy was performed, and the patient was discharged 3 days after surgery with no complications. Conclusion: Surgeons should consider the possibility of this complication in women with acute abdominal pain and a history of uterine leiomyoma. © 2020 The Author(s)

Advances in intravesical drug delivery systems to treat bladder cancer

Chemotherapeutic agents administered intravesically to treat bladder cancer have limited efficacy due to periodic dilution and wash-out during urine formation and elimination. This review describes the pathophysiology, prevalence and staging of bladder cancer, and discusses several formulation strategies used to improve drug residence within the bladder. These include the use of amphiphilic copolymers, mucoadhesive formulations, hydrogels, floating systems, and liposomes. Various in vitro and in vivo models recently employed for intravesical drug delivery studies are discussed. Some of the challenges that have prevented the clinical use of some promising formulations are identified

Panel 7: otitis media:treatment and complications

Objective: We aimed to summarize key articles published between 2011 and 2015 on the treatment of (recurrent) acute otitis media, otitis media with effusion, tympanostomy tube otorrhea, chronic suppurative otitis media and complications of otitis media, and their implications for clinical practice. Data Sources: PubMed, Ovid Medline, the Cochrane Library, and Clinical Evidence (BMJ Publishing). Review Methods: All types of articles related to otitis media treatment and complications between June 2011 and March 2015 were identified. A total of 1122 potential related articles were reviewed by the panel members; 118 relevant articles were ultimately included in this summary. Conclusions: Recent literature and guidelines emphasize accurate diagnosis of acute otitis media and optimal management of ear pain. Watchful waiting is optional in mild to moderate acute otitis media; antibiotics do shorten symptoms and duration of middle ear effusion. The additive benefit of adenoidectomy to tympanostomy tubes in recurrent acute otitis media and otitis media with effusion is controversial and age dependent. Topical antibiotic is the treatment of choice in acute tube otorrhea. Symptomatic hearing loss due to persistent otitis media with effusion is best treated with tympanostomy tubes. Novel molecular and biomaterial treatments as adjuvants to surgical closure of eardrum perforations seem promising. There is insufficient evidence to support the use of complementary and alternative treatments. Implications for Practice: Emphasis on accurate diagnosis of otitis media, in its various forms, is important to reduce overdiagnosis, overtreatment, and antibiotic resistance. Children at risk for otitis media and its complications deserve special attention