The Effects of Calcium-Vitamin D and Metformin on Polycystic Ovary Syndrome: A Pilot Study

SummaryObjectiveThe aim of this study was to evaluate the effects of calcium-vitamin D and metformin on the menstrual cycle and ovulation in patients with polycystic ovary syndrome (PCOS).Materials and MethodsIn this pilot study, 60 infertile PCOS patients were enrolled in a randomized clinical trial and divided into three equal groups. Group 1 received 1,000 mg of calcium and 400 IU of vitamin D per day, orally. Group 2 received the same as Group 1, plus 1,500 mg/day of metformin. Group 3 received 1,500 mg/day of metformin. The patients were treated for 3 months and followed up for a further 3 months. Regularity of menses, number of large follicles (≥ 14 mm) and pregnancy rates were compared among the three groups.ResultsGeneralized estimating equation tests showed that the number of dominant follicles (≥ 14 mm) during the 2–3 months of follow-up was higher in the calcium-vitamin D plus metformin group than in either of the other two groups (p = 0.03).ConclusionThe effects of metformin and calcium-vitamin D in regulating the menstrual cycle suggest that they could also be effective for the treatment of anovulation and oligomenorrhea, with possible consequences for pregnancy rates in PCOS patients

Low grade Endometrial Stromal Sarcoma of uterine corpus, a clinico-pathological and survey study in 14 cases

BACKGROUND: Endometrial stromal sarcoma (ESS) is a rare disease with probably less than 700 new cases in the USA or Europe per year. The aim of this study was to evaluate the behavior of low-grade endometrial stromal sarcoma (LGESS) in relation to their clinical and pathological features and to identify possible prognostic factors. PATIENTS AND METHODS: Fourteen patients with histologically proven ESS were included in the analysis. Endometrial stromal sarcoma is characterized by proliferations composed of cells with Endometrial stromal cell differentiation. Low-grade endometrial stromal sarcoma has an infiltrating margin and typically show extensive worm-like vessel invasion. RESULTS: The median age was 44.35 ± 6 years. The most common presenting symptom was vaginal bleeding, occurring in twelve patients (86%). Diagnosis was made through Fractional dilatation and curettage in four patients (28.5%). Eight patients had a total abdominal hysterectomy and salpingo-ophorectomy (57%). Radiotherapy as adjuvant therapy was administered to four patients (28.5%). The median follow-up time was 45.6 months (range 24–84). The median overall survival of the 14 patients was 45.35 ± 21 months (range 20–83). Three of 14 patients demonstrated a recurrence of disease at 9, 72, and 96 months respectively. The recurrent diseases were treated with surgery, chemotherapy, and radiotherapy. No patient died of the disease. Clinico-pathological parameters did not significantly differ between patients with and without recurrence, but patients with no myometrial invasion and low mitotic count <= 5/HPF showed longer disease-free survival. CONCLUSION: Five-year survival rate was 93%. Survival probabilities were calculated by the product limit method of Kaplan and Meier that showed, patients with no myometrial invasion and low mitotic count <= 5/HPF have longer disease-free survival, but P value was not significant

The Effect of the CO2 Fractional Laser or Premarin Vaginal Cream on Improving Sexual Function in Menopausal Women: A Randomized Controlled Trial

Introduction:Sexual dysfunction is a complex problem in postmenopausal women with a prevalence rate of 68 - 86 %. This study aimed to evaluate the effect of a fractional CO2 laser or vaginal cream on the improvement of sexual function in menopausal women. Methods:This is a two-group clinical trial study.   Postmenopausal women with the inclusion criterion were enrolled and randomly divided into two groups of intervention (n=25) and control group (n=25). In the intervention group, the CO2 laser therapy was performed every month for three months, and in the control group, Premarin vaginal cream was applied (0.625 mg  )، 1 gr, three nights a week for 3 months. Vaginal Health Index scoring( VHI)  and Female Sexual Function Index( FSFI) questionnaires were completed before and after three months of treatment.Results:The effects of the laser treatment was greater than the Premarin group with respect to improvement in sexual desire, orgasms, sexual satisfaction, less pain during sexual relations, and overall sexual function. ( P&lt;0.05)Conclusion:It seems that the fractional CO2 laser may be more effective than hormonal therapy in improving sexual function in postmenopausal women

Comparative evaluation between diameter difference of thumb and asymmetry of lateral cerebral ventricles in child with developmental delay; a new finding

How to Cite This Article: Keihanidoust Z, Shariat M, Rahimian E, Tehrani F, Saddighi Gh. Comparative Evaluation between Diameter Difference of the Thumb and Asymmetry of Lateral Cerebral Ventricles in Children with Developmental Delay: A  New Finding. Iran J Child Neurol. Summer 2015;9(3):9-12.Abstract Objective Anthropometry (measurement of body dimensions) has been used for clinical diagnosis of growth and developmental disorders during pregnancy and after birth. Different brain volumes have also been shown in abnormal developmental disorders. This study compares the different horizontal diameters of the left- and right-hand thumbnails and asymmetry of lateral cerebral ventricles in children with developmental delays. Materials &amp; Methods This retrospective case control study was carried out in the Pediatric Neurologic Outpatient of a university hospital in Tehran, Iran (2009–2011). Twenty-eight patients with motor developmental disorders (case) and 28 healthy individuals (control) had brain MRIs and volume of lateral cerebral ventricles size had been studied. The maximum horizontal diameters of the left and right thumbnails were measured by calipers during physical and neurological exams by a pediatric neurologist. Finally, we compared and analyzed different horizontal diameters of the left and right hand thumbnails and asymmetry of lateral cerebral ventricles. Results There was a significant correlation between asymmetry of brain lateral ventricles size and mean difference of horizontal diameter of thumb nails (P = 0.0001). A meaningful relation between brain hemispheres asymmetry and developmental delay (P = 0.04) was seen. Conclusion The asymmetry of thumbnails can be a marker for asymmetry of lateral ventricles and child developmental delays

A new therapeutic strategy for gastroesophageal reflux disease resistant to conservative therapy and monotherapy in preterm neonates: a clinical trial

Background: Gastroesophageal reflux disease (GERD) is one of the most common problems in neonates. The main clinical manifestations of GERD are frequent regurgitation or vomiting associated with irritability, anorexia or feeding refusal, failure to thrive, Sandifer posturing, apnea, bradycardia and stridor in infants. Since the clinical manifestations of GERD are often non-specific in preterm infants, it has been described as the clinical syndrome responding to anti-reflux treatment. Aims: To our knowledge, no clinical trial has compared the efficacy of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) in preterm infants, nor has any study assessed the effect of adding a prokinetic agent to an acid suppressant and compared them together in these infants, so the present study was conducted. Study design: This study was performed on 58 preterm newborns (mean age, 9.72 ± 6.78 days, 43.2% boys and birth weight of 1,571.9 ± 596.59 grams) with GERD resistant to conservative therapy and monotherapy hospitalized in neonatal wards and NICUs of Shariati and Bahrami Children Hospitals during 2014-2016. Neonates were randomly assigned to a double-blind trial with either oral metoclopramide plus omeprazole (group A) or oral metoclopramide plus ranitidine (group B). After one week and one month, their symptoms and signs were evaluated again. The response rate in each group was the primary outcome and the side effect of drugs in each group was the secondary outcome. Results: Our study showed that both regimens were effective in the treatment of GERD resistant to conservative therapy and monotherapy in premature infants. The response rate of “omeprazole plus metoclopramide” was significantly higher than the response rate of “ranitidine plus metoclopramide” (91.37 ± 7.5 vs. 77.06 ± 3.38, respectively; p = 0.04) (primary outcome). There were no drug-related complications of drugs in both groups in our study (secondary outcome). Conclusion: This study showed that combined therapy led to the response rate of > 70% in each group, but it was significantly higher in group A (> 90%). Both combination therapies led to higher response rate in comparison with conservative therapy and monotherapy used before intervention

Incidence and etiology of stroke among hospitalized children, a case-series study

Objectives: Stroke is a sudden blockage or rupture of brain vessels resulting neural defect or impairment. This study aimed to investigate the incidence and causes of stroke in hospitalized children (Tehran-Iran, 2008-13). Methods: One month to 15 years old admitted children due to stroke entered this case series study. Diagnosis was confirmed with brain imaging. Participants' demographic data, potential risk factors and neuroimaging findings were obtained from Hospital Reporting System. Recorded data were studied and considered regarding to the incidence of stroke and its causes. Indeed we investigated cardiological causes as well as different items related hematological disorders. Results: Of 20000 admitted subjects in Imam Hospital during 5 years, stroke was diagnosed in 15 cases. The incidence among the population study was 0.75 per 100000 children. Stroke was more frequent in males than female ( ). The most common age of stroke was 4-6 years and mean age of stroke was 58.8 months equal to 4.9 years. The most frequent stroke was hemorrhagic stroke (26%), followed by vascular (20%) and coagulopathy disorders (20%). Conclusion: The incidence of stroke in children was 0.75 per 100000. Hemorrhagic stroke due to major trauma, coagulopathy and vasculopathy were observed as most frequent causes that necessitate implementing some strategies for prevention, earlier diagnosis and treatment

Luteinizing hormone changes in gonadotropin-releasing hormone antagonist protocol in in vitro fertilization cycles: A cross-sectional study

Background: Because of the unexpected and often dramatic inhibition of luteinizing hormone (LH) secretion related with the usage of gonadotropin-releasing hormone (GnRH)-antagonist, there has been a probable need for exogenous LH supplementation. There is a basic and clinical evidences that show late development of follicle needs an LH but there is a threshold for LH requirements during folliculogenesis.Objective: The purpose of this study was to evaluate the changes in serum LH and the identification of patients who benefit from the addition of LH.Materials and Methods: Seventy volunteers for antagonist protocol in IVF cycle were enrolled in this prospective cross-sectional study. The study was carried out in Reproductive Health Research Center, University of Medical Sciences between July 2016 and February 2016. Serum LH level was estimated 24 h before and after the first(GnRH) antagonist injection. The primary outcome was the serum level of LH and its change in the three groups and the secondary outcome was Egg and Embryo quality.Results: LH changes above or below 50% had no effect on the number of follicle, the number of oocyte, Germinal vesicle oocyte, metaphase 1 oocyte, metaphase 2 oocyte, endometrial thickness, and chemical and clinical pregnancy.Conclusion: We evaluated the changes of serum LH in the patients who were entered in the antagonist protocol. Our study showed no significant difference in LH levels 24h before and after the injection of the antagonist between the three groups, and LH changes did not affect the outcome of pregnancy

When Is Non-Invasive Prenatal Testing Reliable in Pregnancies with a Vanishing Twin? - A Systematic Review of Case Reports

Background: Fetal demise can complicate aneuploidy screening in a multi fetal pregnancy. The cell-free DNA (CF-DNA) from a non-viable conception may be discordant with the viable fetuses. The Aim of study was to review the waiting period, follow-on single fetal demise in a twin gestation before performing NIPT (Non-Invasive Prenatal Testing).Methods: In this review article we searched through online databases of CINAHL, Cochrane, Database of Abstracts of Reviews of Effects (DARE), PubMed, Medical Library, and Google Scholar for English literature between 2011 to 2020, with the following keywords: “NIPT”, “non-invasive prenatal screening testing”, “cell-free DNA”, “vanishing twin” and “co-twin demise”. We included the studies regarding the duration between the twin vanishing or reduction and NIPT false results.Results: 201 studies across the eight scientific websites were detected; 178 of which were excluded for duplication or being irrelevant. And 29 studies were fully read. 4 case series, finally, met the criteria for systematic review. The findings suggested that the NIPT screening test can be falsely-positive several weeks after vanishing twins although the live fetus is normal. Therefore, the time duration in which the placenta can release CF-DNA of the vanished twin is unknown. In addition, several weeks after reduction, the fetal CF-DNA increases and then decreases, thus CF-DNA analyzing in multifetal pregnancies with reduction can be challenging as well.Conclusion: In pregnancies with vanishing twin or reduction, evaluating NIPT results is more complex than single fetal pregnancy. According to the reviewed studies, after a fetal demise, the cytotrophoblast continues to release to the CF-DNA in the maternal circulation for a variable time, which may cause a false-positive result if the demised twin is aneuploidy

Can a Single Value of Cardiac Troponin I Predict Short-term Adverse Outcomes in Premature Newborns?

Background: Cardiac troponin I (cTn I) has been demonstrated as a possible useful biomarker for myocardial injuries. The present study aimed to evaluate potential relationships between this biomarker and neonatal morbidities among preterm neonates.Methods: This cohort study was carried out at an Iranian Hospital (Tehran-Iran; 2021). Newly-born preterm neonates entered the study. Blood sampling was performed immediately after neonatal intensive care unit (NICU)  admission and sent to the laboratory to detect levels of plasma cTnI. The correlations between the levels of plasma Tn I and each neonatal outcome were evaluated as the primary outcome.Results: A total of 101  NICU hospitalized neonates with the mean gestational age, 1st, and 5th minutes Apgar scores of 33.750±2.125 (Range: 29-37) weeks, 7.6471±1.766, and 9.188±1.205 entered the study. The mean and median of Troponin I levels were 0.131±0.126 and 0.0920 ng/ml. The results pointed out that neonates who died during hospitalization or required CPR (cardiopulmonary resuscitation) had lower troponin I in comparison with their controls; nonetheless, the differences were not significant (P=0.950 & P=0.557). The mean±SD of troponin I was not significantly different between neonates with and without PDA (p=0.741), asphyxia (P=0.298), and intubation (P=0.212). The occurrences of necrotizing enterocolitis, respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis were not also significant factors for the alteration of troponin I (P>0.05).Conclusion: Since there were no relationships between cTn I and neonatal outcomes, great caution should be implemented regarding the use of single cTn I value as a diagnostic marker for short-term neonatal adverse outcomes. Further investigations with larger sample sizes are strongly suggested

One Side Ovarian Rejuvenation: A Quasi-Experimental Study of the Effect of the Autologous Platelet Rich Plasma in Poor Ovarian Responders in IVF

BACKGROUND: The poor ovarian response is the most important limiting factor in the success of in vitro fertilization (IVF). The aim of this study was to evaluate the outcome of intraovarian injection of autologous platelet-rich plasma (aPRP) on the oocyte number and IVF outcomes in poor ovarian responders (POR). METHODS: This quasi-experimental study was performed from August 2021 to December 2021, in Vali-e-Asr Infertility Clinic affiliated with Tehran University of Medical Sciences, Tehran, Iran. There were 12 POR patients selected based on the criteria of Bologna group 4 who underwent two IVF cycles with similar antagonist regimens in a 70-day-interval. Immediately after the Oocytes Pick-Up (OPU), there was a 4cc of autologous PRP multifocal intramedullary injection done into their right ovaries in the first IVF cycle (case group). On the other hand, their left ovaries were considered as the control group. The patients underwent the second IVF cycle after 70 days. RESULTS: Those who had undergone aPRP experienced a significant increase of the mean of antral follicular count (AFC) (from 1.91±0.79 to 2.50±0.90, p=0.043). There was a significant increase in the number of embryos from the right ovary (intervention group) compared to the left ovary (control group) after PRP, but there was no significant difference in the number of embryos in the right ovary before and after the intervention (from 0.25 ±0.45 to 1.08±0.79, p=0.705). There was no significant change in the number of oocytes, AMH, and FSH in the case and control groups before and after the intervention (p&gt;0.05). CONCLUSION: According to the results of this study, it seems that in females with POR, intraovarian aPRP had no effect on the outcomes (embryos number, number of oocytes, FSH and AMH level), except for an increase in AFC