Spontaneous Intracerebral Hemorrhage (ICH) associated with pregnancy and SARS-CoV-2 infection: a case report.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is predominately known as a respiratory disease associated with pneumonia, acute respiratory distress syndrome and multiorgan failure. However, extra-pulmonary complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly being recognized. In this regard, some studies implied the hemostatic and vascular involvements in patients with SARS-CoV-2 infection. CASE PRESENTATION: We describe a case of spontaneous Intracerebral Hemorrhage (ICH) in a pregnant patient with COVID-19 and history of cesarean section a week before the occurrence of ICH. The patient underwent emergent craniotomy with acceptable outcome. Hemorrhagic events, including ICH, may happen during COVID-19 infection with several possible mechanisms. CONCLUSION: COVID-19 patients, especially high-risk groups, are at a risk of intracranial hemorrhage. Therefore, close follow-up must be maintained and hemorrhagic events must be kept in mind in these cases.

Diagnostic accuracy for alternative cervical cancer screening strategies: A systematic review and meta-analysis.

We performed a systematic review and meta-analysis to evaluate the accuracy of screening cervical cancer tests as alternative standalone methods. The combined estimates of sensitivity of visual inspection with acetic acid, visual inspection with lugol's iodine, conventional pap smear, liquid-based cytology, High risk HPV testing by clinician, High risk HPV testing by self- sampling, cervicography were 64%, 80%, 55%, 70%, 70% and 67% respectively; the combine values of specificity of these screening strategies were 88%, 88%, 96%, 59%, 94%, and 95% respectively. Our findings draw attention to an attractive opinion to facilitate the collection of specimens for DNA HPV by patients in settings where they don't have access to a regular screening programs.

Investigation of TGF-ß1 gene variant and expression in a group of Iranian women with endometriosis.

PURPOSE: Endometriosis is defined as a common gynecologic and inflammatory disease. Transforming growth factor-beta 1 (TGF-ß1) gene and its protein level might play a role in the pathogenesis of endometriosis. The present study aimed for the first time to assess the associations between endometriosis risk and - 509 C/T (rs1800469) variant of the TGF-ß1 gene as well as TGF-ß1 mRNA expression in eutopic endometrium tissue of patients with and without endometriosis among a group of Iranian women. METHODS: Genotyping was carried out in 100 endometriosis patients (cases) with confirmed histological diagnosis of endometriosis and 197 non-endometriosis subjects (controls). The expression level of TGF-ß1 mRNA was determined using Real-Time PCR assay in 15 eutopic endometrium tissue of women with endometriosis and 15 healthy controls. RESULTS: There was a significant association for allele and genotype frequencies of rs1800469 variant and endometriosis. No significant difference for TGF-ß1 expression was observed between eutopic endometrium of patients and healthy group. Also, evaluation of TGF-ß1expression across the menstrual cycle showed the same level of TGF-ß1 among case and control subjects. CONCLUSION: Our investigations indicated enough evidence for the effect of TGF-ß1 genetic variant on endometriosis risk in an Iranian population. Furthermore, we could not find any relations between TGF-ß1 mRNA expression and susceptibility to endometriosis.

A Case of COVID-19 Mortality in a Pregnant Woman with Diabetes Ketoacidosis.

SARS-CoV-2 is a newly identified virus that causes COVID 19, spreading very fast in the world. Uncontrolled diabetes in pregnancy can increase the risk of pregnancy outcomes. Pregnant women are at high risk of developing a viral infection, like SARS-COV and on the other hand, diabetes ketoacidosis (DKA) which is coupled with COVID-19, can increase maternal mortality. The patient was a 27-years-old female G3P1L1Ab1 with a history of a previous cesarean section. On 26 March 2020, a fetal ultrasound revealed intra-uterine fetal death (IUFD) and also diagnosis of DKA and COVID-19 in the patient that she was expired eventually due to the uncontrolled DKA. In this case report, a pregnant woman with a diagnosis of IUFD, DKA and COVID-19 simultaneously is described. To the best of the authors of this paper's knowledge, no previous work has been reported for the comorbidity of diabetes and COVID-19 in pregnancy, but it seems that the coincidence of the above-mentioned diseases can delay the recovery period and also can increases maternal and fetal mortality. When DKA and COVID-19 appear in the patient simultaneously, we cannot control DKA by the routine protocol treatments of DKA which were used formerly.

The Effect of Metformin on Expression of Long Non-coding RNA H19 in Endometrial Cancer.

Background: Endometrial cancer is the fourth most widespread cancer among females, with a growing prevalence in recent years. Management by combined therapies along with surgery, radiotherapy, and chemotherapy have improved patients' prognoses. Besides, the development of new therapies helps preserve fertility and prognosis in aggressive tumors. The purpose of this research was to identify the efficacy of metformin on the H19 long non-coding RNA expression in endometrial cancer to provide further insight into the pathogenesis and treatment of the disease. Methods: A total of 23 patients with endometrial cancer, diagnosed by biopsy or diagnostic curettage, were recruited and divided into three groups, before and after metformin treatment and placebo. Real-time PCR was used to evaluate the H19 expression in cancer tissue in all patients. Results: : It has been observed that in endometrial tissue of the "after-metformin" treatment group, the H19 expression level was significantly reduced, compared with the "before-metformin" treatment group, but not in comparison with the placebo. These findings indicate that metformin reduced the H19 expression in endometrial cancer. Conclusion: Anti-diabetic drugs, such as metformin, may be beneficial by reducing the H19 expression in endometrial cancer due to the H19 relation to cancer progression.

Prediction of preterm labor by the level of serum magnesium using an optimized linear classifier.

Background: This study investigates the possibility of predicting preterm labor by utilizing serum Magnesium level, BMI, and muscular cramp. Methods: In this case-control study, 75 preterm and 75 term labor women are included. Different factors such as serum magnesium level, mother's age, infant's sex, mother's Body Mass Index (BMI), infant's weight, gravid, and muscular cramp experience are measured. Preterm labor is predicted by developing a linear discriminant model using Matlab, and the prediction accuracy is also computed. Results: The results show that each of the studied variables has a significant correlation with preterm labor. The p-value between BMI and preterm labor is 0.005, and by including the muscular cramp, it becomes less than 0.001. The correlation between serum magnesium level and the preterm labor is less than 0.0001. Using these three significant variables, a linear discriminant function is developed, which improves the accuracy of predicting preterm labor. Conclusion: The prediction error of preterm labor decreases from 31% (using only serum magnesium level) to 24% using the new proposed discriminant function. Based on this, it is suggested to use the optimized linear discriminant function to enhance the prediction of preterm labor, since the serum magnesium level cannot predict the preterm labor accurately.

Association of vascular endothelial growth factor (VEGF) Gene polymorphisms and expression with the risk of endometriosis: a case-control study.

Endometriosis is a polygenic and multifactorial gynecology situation which might be associated with angiogenesis. In the current study we assess the role of vascular endothelial growth factor (VEGF) - 2578 A/C, and + 936 C/T polymorphisms in susceptibility to endometriosis and checking the expression of VEGF mRNA in eutopic tissue of endometrium with and without endometriosis. The study was comprised of 300 patients who underwent laparascopic or laparotomy surgery with 100 cases who had confirmed histological diagnosis of endometriosis, and 200 controls with no histological diagnosis of disease. The genotyping of VEGF polymorphisms was done by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique and the gene expression in tissue was determined using Real-Time PCR assay. There was no important difference of allele distribution of the - 2578 A/C (P = 0.7) and + 936 C/T (P = 0.5) polymorphisms among endometriosis cases and controls. Study of VEGF expression during the menstrual cycle, showed that endometrial tissue in cases group expressed more VEGF mRNA at the secretory phase compared to the proliferative phase (P = 0.03). Our results suggest that - 2578 A/C and + 936 C/T polymorphisms of VEGF did not seem to have impact on endometriosis predisposition in our study population. Also we did not find any link between VEGF mRNA expression and risk of endometriosis.

Successful treatment using Actinomycin D in a case of methotrexate-resistant ectopic pregnancy: A case report.

Ectopic pregnancy is an urgent clinical condition that represents a serious hazard to reproductive power, and thus threatens woman's health. Commonly, methotrexate is considered for early resolution of placental tissue. Despite its potential advantages such as minimizing hospitalization and quick recovery, its high skin and gastrointestinal side-effects and requiring time monitoring may limit its application. Recently, high effectiveness of the single-agent chemotherapy agents, such as Actinomycin D, has been suggested. Herein, a case of methotrexate-resistant EP that was successfully treated with Actinomycin D was described.

Electrosurgery and clinical applications of electrosurgical devices in gynecologic procedures.

Background: Electrosurgery is widely used in reproductive related surgeries and technological advancements to improve efficacy and reduce potential complications. However, some reports have indicated lack of sufficient knowledge and training about basic principles and technical aspects of electrosurgery among obstetricians and gynecologists. Methods: In this paper we present a summary on basic concepts and principles of electrosurgery and review the recent evidence on the use of electrosurgical devices in gynecologic procedures including endometrial ablation, gynecologic malignancies, loop electrode excision procedure (LEEP), and infertility. Result: Considering the extensive use of these technologies in reproductive related surgeries, procedures including laparoscopy, hysteroscopy, and loop procedures further highlights the importance of more detailed training in this field. Gynecologists must learn the basics in more detail and update their knowledge on the growing body of evidence regarding the advancements of these technologies to reduce potential complications and select the most cost-effective treatment options for each patient. Conclusion: Try to understanding the underlying biophysical principles and more in-depth familiarity with various electrosurgical devices could lead to less complications and optimize evidence-based gynecological practice.

Outcome of treatment with EMA/EP (etoposide methotrexate and actinomycin-D/ etoposide and cisplatin) regimen in gestational trophoblastic neoplasia.

Background: Gestational trophoblastic neoplasia (GTN) originates from placental trophoblast and is a highly chemosensitive and curable gynecologic malignancy. The present study was conducted to evaluate the effectiveness and safety of EMA/EP (etoposide, methotrexate, actinomycin-D, etoposide, and cisplatin) regimen in the treatment of high-risk GTN as well as patients' outcome. Methods: Hospital charts of all patients with confirmed diagnosis of high-risk GTN who received EMA/EP regimen treatment during a 12-year period (2001-2012) at the tertiary center of comprehensive women's hospital in Tehran, Iran, were reviewed from 2012 to 2013, retrospectively. Results: In this study, 25 patients with GTN who were treated with EMA/EP regimen during the study were identified. Complete remission rate in GTN patients with failure of single agent chemotherapy who were treated with EMA/EP regimen, as the first- line treatment, was 100%, while it was 81% in those with primary high-risk GTN. Overall remission rate in high-risk GTN patients treated with EMA/EP regimen was 88%. Anemia (92%) and leucopenia (72%) were the most common adverse effects of EMA/EP chemotherapy regimen. Acute myeloid leukemia (AML) and mortality, as the most severe adverse effects of EMA/EP regimen, were seen only in 1 patient. Conclusion: According to the results, EMA/EP regimen could induce complete remission in 88% of patients with high-risk GTN. Application of EMA/EP is recommended as the first- line therapy in patients with failure of single agent chemotherapy. However, proper care should be considered to prevent and reduce EMA/EP hematologic toxicity.

A comparison between the effects of metformin and megestrol on simple endometrial hyperplasia.

INTRODUCTION: Endometrial hyperplasia is one of the most serious causes of severe abnormal bleeding and also can be a precursor of endometrial carcinoma. OBJECTIVE: The purpose of the present study was to compare the effects of metformin and megestrol on the endometrial hyperplasia. METHODS: The study was performed as a randomized clinical trial on 42 cases of histopathologically confirmed simple endometrial hyperplasia without atypia. The eligible women were randomly assigned into two groups. In metformin group, metformin was prescribed, 500 mg twice a day (1000 mg daily), for a duration of 4 weeks, and then, followed by 1500 mg daily, for 8 more weeks. In the megestrol group, megestrol was prescribed 40 mg daily for 12 weeks. At the end of the duration of the treatment, endometrial sampling was performed and the results were compared between the two groups. RESULTS: The women of the two groups did not have significant difference according to age, BMI and gravidity, parity and history of abortion. Overall, 18 women (81.8%) in metformin group and 12 women (60%) in the megestrol group had normal endometrial histology, after 12 weeks of treatment (p = 0.11). CONCLUSION: Metformin is comparable with megestrol for the treatment of simple endometrial hyperplasia.

Sentinel lymph node in cervical cancer.

Background: Cervical cancer is the second most common type of cancer among women. Effective screening programs can help cancer detection in early phases and reduce death. Metastasis to lymph nodes is one of the most prognostic factors in patients who underwent surgery. Also, a positive result from pathology report alert oncologist as a cause of death. Sentinel lymph node biopsy has been widely studied and clinically used for many types of cancer. Methods: Two techniques exist for detecting sentinel node in cervical cancer, which are Blue dye and gamma probe with radioactive isotope (99mTc). Moreover, lymphoscintigraphy has many advantages over the stain method. Detecting the sentinel node is performed via laparoscopy or laparotomy; former method is better and more accurate. Results: Various researchers have focused on this method and its positive results; its superiority against full lymphadenectomy has been declared in previous studies. Moreover, the role of sentinel lymph nodes biopsy in cervical cancer is still being extensively studied. Sentinel lymph nodes (SLN) method has a higher accuracy level to detect metastasis. Conclusion: Hence, it can be considered as a more appropriate alternative for pelvic lymph node dissection (PLND), which is a standard technique. Altering the method to a standard clinical method needs in-depth researches and studies.

Five-Day Intravascular Methotrexate Versus Biweekly Actinomycin-D in the Treatment of Low-Risk Gestational Trophoblastic Neoplasia: A Clinical Randomized Trial.

OBJECTIVES: Methotrexate (MTX) and Actinomycin-D (Act-D) are effective drugs used in the treatment of low-risk gestational trophoblastic neoplasia (LRGTNs). The aim of the present study was to compare intravenous (IV) MTX and IV Act-D in the treatment of LRGTNs. MATERIALS AND METHODS: Sixty-two patients with LRGTN were enrolled in a prospective randomized clinical trial between 2010 and 2013 in Moheb e Yas Hospital, Tehran University of Medical Sciences. Primary treatment regimens were IV MTX, 0.4 mg/kg daily for 5 days every 14 days (25 mg maximum daily dose), and IV Act-D, 1.25 mg/m (2 mg maximum dose) every 14 days. RESULTS: Thirty-two and 30 patients were enrolled to MTX and Act-D groups, respectively. Complete remission after receiving first-line chemotherapy was achieved in 79% of all cases, 80% in the Act-D group and 78.1% in the MTX group.Twenty percent of the Act-D patients and 21.9% of the MTX patients showed resistance to the first-line chemotherapy, of which 16.7% and 15.6% responded completely to the second-line monotherapy, respectively. Multiple drug therapy was needed in 3.3% of the Act-D group and 6.3% of the MTX group.We did not find any correlation between treatment response and beta-human chorionic gonadotropin level, uterine mass size, lung metastasis, antecedent pregnancy, and duration from diagnosis to treatment. Adverse effects were not statistically different between the 2 groups. CONCLUSIONS: Single-agent chemotherapy in the treatment of LRGTNs resulted in an overall complete remission rate of 79%, 80% in the Act-D group and 78.1% in MTX group, with no statistically significant difference. Whereas this study represents an important step in comparing single-agent treatments, comparison of other regimens will be required to determine the optimal single-agent therapy.

An unusual, giant and benign condyloma acuminatum lesion on the genital area for more than a decade.

Condyloma acuminatum, is a rare sexually transmitted disease. The virus responsible for condyloma is human papillomavirus.HPV-6 and HPV-11 are the most commonly detected HPV genotypes, but at least 20 other HPV genotypes have occasionally been found in genital wart tissue specimens. In fact genital HPV infection is common among sexually active populations. This disease may occur at any age after puberty and always seen in the mucosal area. It is characterized by slow growth. We reported here a case of a 42-year-old female patient with a 12 year history of a condyloma acuminatum lesion in her genitalia area without any medical treatment.

Human chorionic gonadotrophin as an indicator of persistent gestational trophoblastic neoplasia.

BACKGROUND: Gestational trophoblastic neoplasia (GTN) disease is excessive and inappropriate proliferation of trophoblast after termination of the pregnancy. Many attempts have been made to improve follow-up procedures, but no studies have evaluated Human Chorionic Gonadotrophin (HCG) as a post treatment indicator. Thus we aimed to know ß-HCG variability in post treatment pregnancies. METHODS: 40 Molar affected pregnancies were followed post-surgical treatment by serum ß-HCG level in a tertiary level hospital. All subjects were treated by evacuation and followed by ß-HCG every week for three weeks, then every month for six months. RESULTS: 30 women were normal (group I) and 10 (group II) diagnosed as GTN cases. Serum ß-HCG which obtained serially shown significant differences between two groups (p=0.001). The quantity of ß-HCG/week had significantly higher level than normal females (p<0.001) CONCLUSION: Our results suggested that ß-HCG serum level could be used as a strong indicator for identifying affected patients at early stage.

Simultaneous Endometrial Cancer with Extensive Pelvic and Vulvar Endometriosis: A Case Report.

Background: Endometrial cancer represents the most prevalent malignant genital tract neoplasm in high-income countries and is the second most common cancer worldwide following cervical cancer. Endometriosis is a benign condition wherein endometrial glands and stroma are found outside the uterine cavity. Case Presentation: During a routine care and ultrasound examination of the uterus and adnexa of a 64-year-old woman, an increased endometrial thickness (22 mm) was noted. In 2023, according to ultrasound report, the patient underwent diagnostic curettage with immunohistochemistry, revealing a pathological diagnosis of endometrial cancer (endometrioid adenocarcinoma) with positive staining for p16, estrogen receptor (ER), and vimentin. Subsequently, after one week, she underwent complete surgical staging. Extensive superficial endometriosis disseminated in the pelvis and vulva was noted during surgery and preoperative examinations. Final pathology confirmed a well-differentiated typical endometrioid carcinoma (grade 1) with 40% myometrial invasion and positive lymphovascular invasion. The patient was considered to be at stage 1A. Conclusion: Despite some studies suggesting an unclear association between endometriosis and endometrioid or clear-cell ovarian cancers, the correlation between endometriosis and endometrial cancer and its prognosis remains ambiguous. Additionally, although infertility has been linked to both endometrial cancer and endometriosis in various studies, the presented case exhibited no signs of infertility. Extensive pelvic endometriosis with vulvar involvement was present, yet the patient did not exhibit any symptoms. This is in contrast to the typical initial manifestation of endometrial cancer, which is abnormal uterine bleeding. The patient's condition was incidentally detected through routine care due to an abnormal increase in endometrial thickness, prompting this presentation.

Epithelioid Inflammatory Myofibroblastic Sarcoma With Poor Response to Crizotinib: A Case Report.

Introduction: Epithelioid type inflammatory myofibroblastic sarcoma (EIMS) is a subtype of inflammatory myofibroblastic tumor (IMT). It consists of round or epithelioid cells, and almost all types of EIMS contain rearrangements of the anaplastic lymphoma kinase (ALK) gene. Case presentation: We describe a 20-year-old female presenting with abdominal pain and a rapidly growing intraabdominal mass who underwent surgical tumor resection. She was diagnosed with EIMS. ALK and ki-67 expressions were detected in immunohistochemistry assessment. She was started with Crizotinib 200 mg twice a day, and chemotherapy was also initiated due to the recurrence of the disease 4 months after the initial treatment. She was unresponsive to all the medical regimens and died in 8 months. Conclusion: Approach to patients with EIMS is really challenging in terms of both diagnosis and treatment. Patients with combined surgical and non-surgical treatment regimen were seen to have a more favorable outcome in some EIMS cases. Therefore, it is essential to implement a multidisciplinary approach to diagnose and treat patients suspicious of EIMS.

Unexpectedly large myoepithelioma-like tumor of the vulvar region with two local recurrences: A rare case report and review of the literature.

Myoepithelioma-like tumors of the vulvar region (MELTVR) are rare. Only a limited number of MELTVRs are reported in the literature, and various aspects of this lesion still need to be clarified. In this study, we reported a case of MELTVR in a 46-year-old female. The uniqueness of the present case was its large size (12 cm) compared to the MELTVRs reported in earlier studies, the presence of two separate but attached lesions (one in labia majora and one in the mons pubis), and two recurrences within ten years after wide local excision. The second recurrence was managed with wide excision, and the patient remained disease-free during the two-year follow-up. This case highlights the local aggressiveness of MELTVR and the necessity of resection with an adequate margin. It also urges more awareness regarding the differential diagnosis of MELTVR with other lesions of the vulva, particularly when located in the labia majora and mons pubis.

Second recurrence of aggressive vulvar angiomyxoma: a case report.

Aggressive angiomyxoma is a rare benign tumor with diverse clinical and radiologic presentations, making its differential diagnosis challenging. Here we report the second recurrence of an aggressive angiomyxoma of the vulva in a 33-year-old woman who presented with pain and swelling. Clinical examination revealed a well-circumscribed large palpable mass extending from the inferior part of the right labia major into the right side of the gluteus. A second recurrence of aggressive angiomyxoma was suspected based on the patient's history, clinical examination, and magnetic resonance imaging report, and the patient underwent surgical resection with a negative margin. Histological evaluation of the extracted lesion confirmed the diagnosis of aggressive angiomyxoma. At the 1-year follow-up, the patient was recurrence-free. The present report urges more awareness regarding the aggressiveness of angiomyxoma of the vulva. Closer attention should be given to margin-free removal of such tumors, and patients should be routinely followed up for at least 2 years postoperatively for early diagnosis of recurrence, thereby reducing the risk of morbidity.