Ovarian cysts formation during depot formulation of GnRH-a therapy and the effect of pretreatment with oral contraceptive pills on subsequent implantation and pregnancy rate in ART cycles

Long protocol of Gonadotropin-Releasing Hormone-analougue (GnRH-a) can result in the formation of ovarian cyst by the transient initial stimulatory effect which increases the levels of both follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These cysts require surgical drainage or result in poor ovarian response. Ovarian cyst formation can be prevented by taking oral contraceptives (OCs) which suppress LH and FSH after initiation of GnRH-a therapy. This study was designed to investigate ovarian cyst formation during therapy with depot formulation of GnRH-a and also the effect of taking (OCs) before starting the treatment with depot formulation of GnRH-a, on the formation of ovarian cyst, implantation and pregnancy rate in assisted reproductive tecnique (ART) cycles. Fifty four infertile women who were candidate for ART, underwent two treatment protocols in a prospective randomized trial: (a) OC+HMG+diphereline and (b) HMG+diphereline. In group (a) patients were pretreated with OC for 14 days starting from the first day of mensturation and on the day 14 received 3.75 mg IM depot diphereline. Patients in group (b) received 3.75 mg diphereline by intramuscular injection on the second day of menstruation. Sonography was performed on the first day of menstruation and also 7 and 14 days after diphereline injection. Ovarian cyst incidence, gonadotropin consumption, follicular growth, implantation rate and pregnancy in the two groups were studied. No ovarian cyst with diameter over 26 mm was developed with depot formulation of GnRH-a in any of the two groups (a and b). There was no significant difference between the two groups in the follicular growth (9.2±2.1 and 9.4±2.9), number of oocyte (5.0±2.8 and 5.4±5.7), implantation rate (0.02±0.08 and 0.03±0.10) and pregnancy rate (0.09 and 0.11). We divided the patients into two groups based on their ages: (20-34) and (�35). It showed no significant difference in the gonadotropin consumption, mean number of follicles and mean number of embryos in groups (a and b) based on their ages. No ovarian cyst developed with depot formulation of GnRH-a. So, in women with a history of ovarian cyst formation in previous cycles depot form of GnRH-a may be considered. Pretreatment with OCs during therapy with depot formulation of GnRH-a and gonadotropin didn't increase the number of oocyte, implantation rate and pregnancy. Copyright © 2008 by School of Pharmacy Shaheed Beheshti University of Medical Sciences and Health Services

Comparison of cervical repositioning error in individuals with forward head posture with and without neck pain

Background and purpose: Proprioception is one of the somatic senses which is used by the nervous system for muscular control. Inappropriate posture or pain could result in impaired proprioception. One of these poor postures is forward head posture (FHP). The aim of this study was to investigate cervical repositioning error in FHP subjects with and without neck pain and normal individuals. Materials and methods: A case-control study was conducted consisting of people who had FHP without neck pain (n=31), individuals with FHP and neck pain (n=31), and healthy subjects (n=31). Cervical total range of motion (ROM) and then repositioning error in target angle (50 of full ROM in each movement(of flexion, extension, right and left lateral flexion, and right and left rotation were measured by cervical range of motion (CROM) device. Pain intensity was measured using the visual analog scale (VAS). Results: Cervical ROM in FHP subjects was significantly less than that of healthy subjects in most movement directions. The absolute repositioning error of the target angle in FHP subjects was found to be significantly more than that of healthy subjects in most movement directions (p<0.05). The mean VAS score in patients with neck pain was 4±0.68. Conclusion: FHP whether with or without pain may increase the cervical repositioning error. But presence of pain do not leads to higher rates of error. © 2016, Mazandaran University of Medical Sciences. All rights reserved

From public health policy to impact for COVID-19: a multi-country case study in Switzerland, Spain, Iran and Pakistan

Objectives: With the application of a systems thinking lens, we aimed to assess the national COVID-19 response across health systems components in Switzerland, Spain, Iran, and Pakistan. Methods: We conducted four case studies on the policy response of national health systems to the early phase of the COVID-19 pandemic. Selected countries include different health system typologies. We collected data prospectively for the period of January-July 2020 on 17 measures of the COVID-19 response recommended by the WHO that encompassed all health systems domains (governance, financing, health workforce, information, medicine and technology and service delivery). We further monitored contextual factors influencing their adoption or deployment. Results: The policies enacted coincided with a decrease in the COVID-19 transmission. However, there was inadequate communication and a perception that the measures were adverse to the economy, weakening political support for their continuation and leading to a rapid resurgence in transmission. Conclusion: Social pressure, religious beliefs, governance structure and level of administrative decentralization or global economic sanctions played a major role in how countries' health systems could respond to the pandemic

Conditional stability of unstable viscous shock waves in compressible gas dynamics and MHD

Extending our previous work in the strictly parabolic case, we show that a linearly unstable Lax-type viscous shock solution of a general quasilinear hyperbolic--parabolic system of conservation laws possesses a translation-invariant center stable manifold within which it is nonlinearly orbitally stable with respect to small $L^1\cap H^3$ perturbations, converging time-asymptotically to a translate of the unperturbed wave. That is, for a shock with $p$ unstable eigenvalues, we establish conditional stability on a codimension-$p$ manifold of initial data, with sharp rates of decay in all $L^p$. For $p=0$, we recover the result of unconditional stability obtained by Mascia and Zumbrun. The main new difficulty in the hyperbolic--parabolic case is to construct an invariant manifold in the absence of parabolic smoothing.Comment: 32p

Existence and stability of viscoelastic shock profiles

We investigate existence and stability of viscoelastic shock profiles for a class of planar models including the incompressible shear case studied by Antman and Malek-Madani. We establish that the resulting equations fall into the class of symmetrizable hyperbolic--parabolic systems, hence spectral stability implies linearized and nonlinear stability with sharp rates of decay. The new contributions are treatment of the compressible case, formulation of a rigorous nonlinear stability theory, including verification of stability of small-amplitude Lax shocks, and the systematic incorporation in our investigations of numerical Evans function computations determining stability of large-amplitude and or nonclassical type shock profiles.Comment: 43 pages, 12 figure

Developing "Code of Ethics for Medical Professionals, Medical Council of Islamic Republic of Iran"

Background: The medical profession has always been an inspiration for human societies throughout its diverse history. This position and historical authority in the field of ethics has had a different and higher status, in such a way that many of the norms of general ethics and professional ethics, especially principles, such as trust, confidentiality and respect for human dignity, have been developed by medical professionals. Developing guidelines of general and professional ethics is one of the inherent duties of the Medical Council of the Islamic Republic of Iran (IRIMC) as a professional organization. In this regard, the Supreme Council of IRIMC has approved the "Code of Ethics for Medical Professionals"and, in accordance with its legal authority, has annexed it to the disciplinary regulations of IRIMC. Methods: A draft document, the result of extensive literature review, was discussed in 27 expert panel meetings and after receiving and endorsing the stakeholders' point of view, was approved by the IRIMC Supreme Council. Results: The first edition of "Code of Ethics for Medical Professionals, Medical Council of Islamic Republic of Iran"was developed on July 6, 2017 by the Supreme Council of IRIMC. The guideline was set to take effect one year after its enactment. The first edition was revised and completed and final edition was adopted on August 9, 2018 by IRIMC in 13 chapters and 140 articles (original full text is available in the Supplementary file 1). Conclusion: According to the approved decision by the Supreme Council of IRIMC on May 10, 2018, the final edition takes effect as of October 7, 2018. © 2020 The Author(s)

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2·5 air pollution, 1990–2019: an analysis of data from the Global Burden of Disease Study 2019

Background: Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods: We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings: In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation: Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Funding: Bill &amp; Melinda Gates Foundation

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : an analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2.5 originating from ambient and household air pollution.Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2.5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure-response curve from the extracted relative risk estimates using the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2.5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2.5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals.Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2.5 exposure, with an estimated 3.78 (95% uncertainty interval 2.68-4.83) deaths per 100 000 population and 167 (117-223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13.4% (9.49-17.5) of deaths and 13.6% (9.73-17.9) of DALYs due to type 2 diabetes were contributed by ambient PM2.5, and 6.50% (4.22-9.53) of deaths and 5.92% (3.81-8.64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2.5.Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2.5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

Estimates, trends, and drivers of the global burden of type 2 diabetes attributable to PM2.5 air pollution, 1990-2019 : An analysis of data from the Global Burden of Disease Study 2019

Background Experimental and epidemiological studies indicate an association between exposure to particulate matter (PM) air pollution and increased risk of type 2 diabetes. In view of the high and increasing prevalence of diabetes, we aimed to quantify the burden of type 2 diabetes attributable to PM2·5 originating from ambient and household air pollution. Methods We systematically compiled all relevant cohort and case-control studies assessing the effect of exposure to household and ambient fine particulate matter (PM2·5) air pollution on type 2 diabetes incidence and mortality. We derived an exposure–response curve from the extracted relative risk estimates using the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. The estimated curve was linked to ambient and household PM2·5 exposures from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, and estimates of the attributable burden (population attributable fractions and rates per 100 000 population of deaths and disability-adjusted life-years) for 204 countries from 1990 to 2019 were calculated. We also assessed the role of changes in exposure, population size, age, and type 2 diabetes incidence in the observed trend in PM2·5-attributable type 2 diabetes burden. All estimates are presented with 95% uncertainty intervals. Findings In 2019, approximately a fifth of the global burden of type 2 diabetes was attributable to PM2·5 exposure, with an estimated 3·78 (95% uncertainty interval 2·68–4·83) deaths per 100 000 population and 167 (117–223) disability-adjusted life-years (DALYs) per 100 000 population. Approximately 13·4% (9·49–17·5) of deaths and 13·6% (9·73–17·9) of DALYs due to type 2 diabetes were contributed by ambient PM2·5, and 6·50% (4·22–9·53) of deaths and 5·92% (3·81–8·64) of DALYs by household air pollution. High burdens, in terms of numbers as well as rates, were estimated in Asia, sub-Saharan Africa, and South America. Since 1990, the attributable burden has increased by 50%, driven largely by population growth and ageing. Globally, the impact of reductions in household air pollution was largely offset by increased ambient PM2·5. Interpretation Air pollution is a major risk factor for diabetes. We estimated that about a fifth of the global burden of type 2 diabetes is attributable PM2·5 pollution. Air pollution mitigation therefore might have an essential role in reducing the global disease burden resulting from type 2 diabetes