The Effect of Vitamin A on Decreased β-hCG Production in Molar Pregnancy

Background and Aim: Gestational trophoblastic disease (GTD) is defined as a group of disorders; they are characterized by uncontrolled trophoblastic cell proliferation and overproduction of β-HCG. It seems that an inappropriate diet is one of the major risk factors of GTD. Regardless of the size of the uterus; mole depletion by curettage suction is usually the preferred treatment. This study aimed to evaluate the effect of vitamin A and curettage suction on the faster reduction of β-hCG level, and faster recovery of disease, consequently. Materials and Methods: In this study case (n=26) and control (n=26) groups received 50,000 IU of vitamin A intramuscularly, before and after curettage. β-hCG was measured weekly and after reaching zero every month for six months. RIA was used for measurement. Results: Vitamin A reduced the level of β-hCG to zero in the patient compared to the control, one week earlier; this effect was statistically significant (P-Value <0.05). One of the members of the control group during follow-up progressed to gestational trophoblastic disease (GTN). There was no significant relationship between ABO blood groups among the two groups (P-Value: 0.9). There was no significant relationship between gravity, parity and hematology parameters between the two groups (P-Value >0.05). Conclusion: Finally, it can be said that vitamin A intake in patients with GTD, along with other therapies, can improve the speed of recovery; it can prevent the disease progression. However, it does not prevent progression to GTN, completely. Therefore, further studies are needed in future studies

The Association between Cerebroplacental Ratio (CPR) And Neonatal Outcome In Small Gestational Fetus

Background: Restriction of fetal growth is one of the major problems in gynecology and obstetrics for which no effective treatment has been proven so far. The disorder is associated with significant morbidity and perinatal mortality.Methods: In this study, 104 pregnant women with SGA fetuses (3-10%) between preterm (>28 weeks) to full term were evaluated. The patients were divided into two groups: group A, the group with normal CPR as the reference group, and group B with abnormal CPR (ratio <1ref with normal UMA PI and Normal caldopler that were IUGR). Their demographic data including maternal age, gestational age, BMI of the pregnant mother, birth weight, fetal sex, and number of deliveries were examined.Results: After collecting data and analyzing them, the results showed that the mean neonatal weight was 1432.81 (±560.81) in the abnormal CPR group, and 1845.42 (± 473.32) in the normal group. In addition, the mean Apgar scores of 5 and 1 minutes were significantly different between the groups, being lower in the abnormal CPR group (p-value <0.05). The results also revealed, Apgar scores of one and five minutes were significantly correlated with CPR and gestational age (p-value <0.05).Conclusion: Finally, according to the data obtained from this study, it has been shown that CPR can be helpful as a predictive index of neonatal outcomes in patients with SGA

Prevalence of positive recto-vaginal culture for Group B streptococcus in pregnant women at 35-37 weeks of gestation

&amp;nbsp;Abstract&amp;nbsp;Background: Recto-vaginal colonization of Group B streptococcus (GBS) has been known as an important issue in mother and newborn’s health, which is getting frequent in developing countries. Screening test have been introduced and utilized in many countries and is recommended by many researchers. However, due to lack of information in prevalence of GBS, especially in Iran, there are doubts and controversies regarding whether it is necessary to execute any effort to run screening tests. The aim of this study is to determine the prevalence of positive recto-vaginal culture for GBS in pregnant women between 35-37 weeks of pregnancy in Tehran.&amp;nbsp;Methods: In this cross-sectional study, pregnant women in 35th-37th week of pregnancy were included. All hospitals in Tehran, Iran, were stratified and clustered, and the sampling was done randomly. All recto-vaginal samples were referred to Firoozgar Hospital’s pathology laboratory in less than an hour and the results were reported afterwards. Other demographic information and pregnancy and neonatal-related complications such as previous pre-term delivery, PROM (Premature rupture of membrane) and neonatal sepsis and maternal infection were evaluated.&amp;nbsp;Results: The prevalence of positive GBS cultures was 22.76% (234 Out of 1028). No significant difference was found in positive cultures with mother’s age, educational level, and history of pregnancy, maternal omplications, and previous neonatal sepsis.&amp;nbsp;Conclusion: Due to similar results with other countries, recto-vaginal GBS culture screening is recommended in Iranian urban pregnant women regarding high prevalence and higher neonatal complication.&amp;nbsp

Comparison between two doses of betamethasone administration with 12 hours vs. 24 hours intervals on prevention of respiratory distress syndrome: a randomised trial

The purpose of the present study was to compare the effect of a two-dose administration of betamethasone with 12 hours interval vs. 24 hours interval on neonatal respiratory distress syndrome (RDS). The study was performed as a randomised clinical trial on 201 pregnant women with a gestational age of 26–34 weeks. In one group 12 mg of betamethasone every 12 hours for two doses and in the other group 12 mg of betamethasone every 24 hours for two doses were prescribed intramuscularly. There were no significant differences between the two groups according to maternal age, parity, gravidity, BMI, neonatal sex, need to surfactant, NICU admission, NICU stay, neonatal death, neonatal sepsis and Apgar score at minutes 1 and 5, but the gestational age at the beginning of the study and delivery receiving complete course of betamethasone and neonatal weight were lower in 24 hours group. RDS, necrotising enterocolitis, intra-ventricular haemorrhage and chorioamnionitis were more in the 24 hours’ group. Multiple regression analysis showed that RDS and IVH (p = .022, RR = 0.07, CI95% 0.006–0.96 and p = .013; RR = 0.9, CI95% 0.1–0.89, respectively) were more in the 24 hours group and neonatal death (p = .034, RR = 4.7, CI95% 1.07–16.2) and NEC (p = 0.038, RR = 2.5, CI95% 1.7–3.7), were more in the 12 hours group. In conclusion, it seems that 12 hours interval betamethasone therapy may be considered as an alternative treatment in the case of preterm labour for acceleration of lung maturity; however, it is suggested that more studies should be performed on this issue and various morbidities.IMPACT STATEMENT What is already known on this subject: Administration of a single course of corticosteroids in all women with a gestational age of 24–34 weeks of pregnancy who are at risk for preterm labour and delivery has been recommended. The accepted regimen by National Institutes of Health (NIH) is an injection of betamethasone for two doses with 24 hours interval. What do the results of this study add: Twelve hours interval betamethasone therapy may be considered as an alternative treatment in the cases of preterm labour for acceleration of lung maturity. What are the implications of these findings for clinical practice and/or further research: Prescription of two doses (complete regimen) is more important than the interval between two doses for obtaining the maximum effect in a preterm birth

Comparison between two doses of betamethasone administration with 12 hours vs. 24 hours intervals on prevention of respiratory distress syndrome: a randomised trial

The purpose of the present study was to compare the effect of a two-dose administration of betamethasone with 12 hours interval vs. 24 hours interval on neonatal respiratory distress syndrome (RDS). The study was performed as a randomised clinical trial on 201 pregnant women with a gestational age of 26–34 weeks. In one group 12 mg of betamethasone every 12 hours for two doses and in the other group 12 mg of betamethasone every 24 hours for two doses were prescribed intramuscularly. There were no significant differences between the two groups according to maternal age, parity, gravidity, BMI, neonatal sex, need to surfactant, NICU admission, NICU stay, neonatal death, neonatal sepsis and Apgar score at minutes 1 and 5, but the gestational age at the beginning of the study and delivery receiving complete course of betamethasone and neonatal weight were lower in 24 hours group. RDS, necrotising enterocolitis, intra-ventricular haemorrhage and chorioamnionitis were more in the 24 hours’ group. Multiple regression analysis showed that RDS and IVH (p = .022, RR = 0.07, CI95% 0.006–0.96 and p = .013; RR = 0.9, CI95% 0.1–0.89, respectively) were more in the 24 hours group and neonatal death (p = .034, RR = 4.7, CI95% 1.07–16.2) and NEC (p = 0.038, RR = 2.5, CI95% 1.7–3.7), were more in the 12 hours group. In conclusion, it seems that 12 hours interval betamethasone therapy may be considered as an alternative treatment in the case of preterm labour for acceleration of lung maturity; however, it is suggested that more studies should be performed on this issue and various morbidities.IMPACT STATEMENTWhat is already known on this subject: Administration of a single course of corticosteroids in all women with a gestational age of 24–34 weeks of pregnancy who are at risk for preterm labour and delivery has been recommended. The accepted regimen by National Institutes of Health (NIH) is an injection of betamethasone for two doses with 24 hours interval.What do the results of this study add: Twelve hours interval betamethasone therapy may be considered as an alternative treatment in the cases of preterm labour for acceleration of lung maturity.What are the implications of these findings for clinical practice and/or further research: Prescription of two doses (complete regimen) is more important than the interval between two doses for obtaining the maximum effect in a preterm birth.</p

Neural mechanisms underlying morphine withdrawal in addicted patients: a review

Morphine is one of the most potent alkaloid in opium, which has substantial medical uses and needs and it is the first active principle purified from herbal source. Morphine has commonly been used for relief of moderate to severe pain as it acts directly on the central nervous system; nonetheless, its chronic abuse increases tolerance and physical dependence, which is commonly known as opiate addiction. Morphine withdrawal syndrome is physiological and behavioral symptoms that stem from prolonged exposure to morphine. A majority of brain regions are hypofunctional over prolonged abstinence and acute morphine withdrawal. Furthermore, several neural mechanisms are likely to contribute to morphine withdrawal. The present review summarizes the literature pertaining to neural mechanisms underlying morphine withdrawal. Despite the fact that morphine withdrawal is a complex process, it is suggested that neural mechanisms play key roles in morphine withdrawal