Relationship Between Anatomic Features of the Placenta, the Type of Abnormal Placental Cord Insertion and Adverse Pregnancy Outcomes in Singleton Pregnancies: A Prospective Observational Study.

INTRODUCTION: This study aimed to evaluate the potential value of placental anatomic features and various types of normal and abnormal cord insertion types in predicting adverse maternal-fetal outcomes in singleton pregnancies. We also tried to assess the association between these outcomes and various types of placental cord insertion. METHOD: This prospective observational study was performed on singleton pregnancies. For each patient placental features including diameter, thickness, type of cord insertion, and the shortest distance between the cord insertion point and placental edge were recorded. The relationship between these factors and the development of multiple adverse pregnancy outcomes including preterm labor, intrauterine fetal death (IUFD), and the rate of neonatal intensive care unit (NICU) admissions were evaluated and reported. RESULTS: Overall 308 patients were enrolled in the study. Smoker mothers had significantly smaller placentas (P-value = .008), and those with lower diameter placentas were more likely to suffer from IUFD (P-value = .0001). Shorter placental cord insertion distances led to more episodes of preterm labor (P-value = .057). Eccentric-type placental cord insertion was significantly associated with the development of preeclampsia (P-value = .006). DISCUSSION: Abnormalities in placental diameter and cord insertion can lead to significant maternal-fetal complications including preterm labor, IUFD, and preeclampsia.

Unusual Presentation of Hypothyroidism in a Pregnant Woman, Mimicking Gestational Trophoblastic Neoplasm.

Hypothyroidism is a common health issue worldwide with varying clinical manifestations. We report a woman who experienced an incomplete abortion and undiagnosed hypothyroidism who was referred to the oncologist with the suspicion of metastatic gestational trophoblastic neoplasm (GTN). A 29-year-old woman with incomplete abortion was referred to an oncologist for possible GTN due to persistent active vaginal bleeding, an elevated beta human chorionic gonadotropin (hCG), abnormal cervical inspection exam, abnormal liver function tests, ovarian enlargement, ascites, and a pleural effusion. She was found to have hypothyroidism in further work-up. She was managed with thyroid hormone replacement therapy and her condition improved after 6 weeks. Complete resolution of the ovarian mass and pericardial and pleural effusion was achieved. This case describes an important experience; hypothyroidism should be considered in the differential diagnosis of any woman with an incomplete abortion presenting with an ovarian mass. Evaluation and correct diagnosis are important to prevent mismanagement.

A randomized-controlled clinical trial investigating the effect of omega-3 fatty acids and vitamin E co-supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes.

BACKGROUND: Limited data are available that evaluated the effects of combined omega-3 fatty acids and vitamin E supplementation on glucose homeostasis parameters and lipid concentrations in gestational diabetes (GDM). OBJECTIVES: The present study was designed to determine the effects of omega-3 fatty acids and vitamin E co-supplementation on glucose homeostasis parameters and lipid concentrations among women with GDM who were not on oral hypoglycemic agents. METHODS: This prospective randomized, double-blind, placebo-controlled clinical trial was carried out among 60 patients with GDM. Patients were randomly allocated to take either 1000-mg omega-3 fatty acids from flaxseed oil plus 400-IU vitamin E supplements (n = 30) or placebo (n = 30) for 6 weeks. Fasting blood samples were obtained from at the beginning of the study and after 6-week intervention to quantify related variables. RESULTS: After 6 weeks of intervention, changes in fasting plasma glucose (-11.8 ± 11.0 vs +1.5 ± 11.9 mg/dL, P < .001), serum insulin concentrations (-1.8 ± 6.9 vs +5.8 ± 12.1 µIU/mL, P = .004), homeostasis model of assessment-estimated insulin resistance (-0.8 ± 1.6 vs +1.4 ± 2.8, P = .001), homeostasis model of assessment-estimated beta cell function (-0.2 ± 27.7 vs +22.8 ± 48.2, P = .02), and quantitative insulin sensitivity check index (+0.01 ± 0.02 vs -0.01 ± 0.02, P = .01) in the omega-3 fatty acids plus vitamin E group were significantly different from the changes in these indicators in the placebo group. Changes in serum triglycerides (+10.8 ± 41.5 vs +34.2 ± 35.5 mg/dL, P = .02), VLDL-cholesterol (+2.1 ± 8.3 vs +6.8 ± 7.1 mg/dL, P = .02), low-density lipoprotein (LDL)-cholesterol (+11.6 ± 18.8 vs +1.7 ± 15.9 mg/dL, P = .03) and HDL-cholesterol concentrations (+1.9 ± 8.7 vs -2.4 ± 7.7 mg/dL, P = .04) were significantly different between the supplemented women and placebo group. However, after controlling for baseline total cholesterol levels, maternal age, and BMI at baseline, the changes in serum LDL-cholesterol concentrations were not significantly different between the 2 groups. We did not find any significant effect of joint omega-3 fatty acids and vitamin E supplementation on total cholesterol concentrations. CONCLUSIONS: Overall, we demonstrated that omega-3 fatty acids and vitamin E co-supplementation in GDM women had beneficial effects on glucose homeostasis parameters, serum triglycerides, VLDL-cholesterol, and HDL-cholesterol concentrations, but it did not influence total-cholesterol and LDL-cholesterol levels.

Calcium-Vitamin D Co-supplementation Affects Metabolic Profiles, but not Pregnancy Outcomes, in Healthy Pregnant Women.

BACKGROUND: Pregnancy is associated with unfavorable metabolic profile, which might in turn result in adverse pregnancy outcomes. The current study was designed to evaluate the effects of calcium plus Vitamin D administration on metabolic status and pregnancy outcomes in healthy pregnant women. METHODS: This randomized double-blind placebo-controlled clinical trial was performed among 42 pregnant women aged 18-40 years who were at week 25 of gestation. Subjects were randomly allocated to consume either 500 mg calcium-200 IU cholecalciferol supplements (n = 21) or placebo (n = 21) for 9 weeks. Blood samples were obtained at the onset of the study and after 9-week trial to determine related markers. Post-delivery, the newborn's weight, length, and head circumference were measured during the first 24 h after birth. RESULTS: Consumption of calcium-Vitamin D co-supplements resulted in a significant reduction of serum high-sensitivity C-reactive protein levels compared with placebo (-1856.8 ± 2657.7 vs. 707.1 ± 3139.4 µg/mL, P = 0.006). We also found a significant elevation of plasma total antioxidant capacity (89.3 ± 118.0 vs. -9.4 ± 164.9 mmol/L, P = 0.03), serum 25-hydroxyvitamin D (2.5 ± 3.5 vs. -1.7 ± 1.7 ng/mL, P < 0.0001), and calcium levels (0.6 ± 0.6 vs. -0.1 ± 0.4 mg/dL, P < 0.0001). The supplementation led to a significant decrease in diastolic blood pressure (-1.9 ± 8.3 vs. 3.1 ± 5.2 mmHg, P = 0.02) compared with placebo. No significant effect of calcium-Vitamin D co-supplements was seen on other metabolic profiles. We saw no significant change of the co-supplementation on pregnancy outcomes as well. CONCLUSIONS: Although calcium-Vitamin D co-supplementation for 9 weeks in pregnant women resulted in improved metabolic profiles, it did not affect pregnancy outcomes.

The Effects of Chromium Supplementation on Endocrine Profiles, Biomarkers of Inflammation, and Oxidative Stress in Women with Polycystic Ovary Syndrome: a Randomized, Double-Blind, Placebo-Controlled Trial.

UNLABELLED: Limited data are available indicating the effects of chromium administration on endocrine profiles, biomarkers of inflammation, and oxidative stress among women with polycystic ovary syndrome (PCOS). This study was done to assess the effects of chromium administration on endocrine profiles, biomarkers of inflammation, and oxidative stress in women with PCOS. Participants of this randomized, double-blind, placebo-controlled trial consisted of 60 patients with PCOS who received either 200 µg chromium supplements (n = 30) or placebo daily (n = 30) for 8 weeks. Endocrine profiles, inflammatory factors, and biomarkers of oxidative stress were assessed at study baseline and at the end of intervention. After 8 weeks of intervention, pregnancy rate in chromium group was higher than that in the placebo group: 16.7 % (5/30) vs. 3.3 % (1/30), P = 0.08. In addition, prevalence of acne (20.0 vs. 3.3 %, P = 0.04) decreased following the administration of chromium supplements compared with the placebo. Taking chromium led to a significant reduction in hirsutism (-1.8 ± 2.5 vs. -0.2 ± 0.8, P = 0.002), serum high-sensitivity C-reactive protein (hs-CRP) (-717.0 ± 1496.1 vs. +227.1 ± 1669.6 ng/mL, P = 0.02), plasma malondialdehyde (MDA) (-0.1 ± 0.7 vs. +1.1 ± 1.5 µmol/L, P < 0.001), and a significant increase in plasma total antioxidant capacity (TAC) concentrations (+250.7 ± 265.2 vs. +13.0 ± 201.6 mmol/L, P < 0.001). We failed to find any significant effect of chromium administration on endocrine profiles and nitric oxide (NO) and glutathione (GSH) levels. Overall, taking chromium for 8 weeks among women with PCOS had beneficial effects on acne, hirsutism, hs-CRP, TAC, and MDA levels, but it did not affect endocrine profiles, NO, and GSH. CLINICAL TRIAL REGISTRATION NUMBER: IRCT201506105623N44 ( www.irct.ir ).

The assessment of undergraduate medical students' satisfaction levels with the objective structured clinical examination.

BACKGROUND: The objective structured clinical examination (OSCE) has been introduced as an efficient method for the assessment of medical students. OBJECTIVES: The aim of the present study was to determine the satisfaction level of undergraduate medical students of internal medicine department with the OSCE. MATERIALS AND METHODS: This was a descriptive cross-sectional study, performed on all available undergraduate students at the end of their internal medicine training period in Mashhad University of Medical Sciences. The students responded to 15 multiple-choice questions with confirmed validity and reliability. RESULTS: The majority of the students (94.5%) had a positive attitude toward the OSCE and mentioned that the OSCE format was a more appropriate type of exam than other methods of testing; however, 79.1% thought that the OSCE format was stressful. In addition, the participants' sex had no effect on their level of satisfaction with the examination. Likewise, there was no significant correlation between their level of satisfaction and their age, marital status, or lack of previous experience with this type of exam. CONCLUSIONS: If the exam standards are met and a uniform dispersion of the scientific content is maintained, the OSCE method of assessment can be recommended as an efficient and applicable method for assessing medical students.

Highly sensitive C-reactive protein levels in Iranian patients with pulmonary complication of sulfur mustard poisoning and its correlation with severity of airway diseases.

BACKGROUND: Sulfur mustard (SM) is a chemical warfare agent that can cause serious pulmonary complications. This study was designed to determine serum highly sensitive C-reactive protein (hs-CRP) and evaluate its correlation with lung function parameters in patients with chronic obstructive pulmonary disease (COPD) due to SM poisoning. METHODS: Fifty consecutive SM patients with stable COPD and a mean age 46.3 +/- 9.18 years were enrolled in this cross sectional study. Thirty healthy men were selected as controls. Lung function parameters were evaluated. Serum hs-CRP by immunoturbidometry assay was measured in both the patients and controls. RESULTS: In the case group, the mean forced expiratory volume in one second (FEV1) was 2.14 +/- 0.76 L (58.98% +/- 17.51% predicted). The mean serum hs-CRP was 9.4 +/- 6.78 SD and 3.9 +/- 1.92 SD mg/L in the cases and controls, respectively, with significant statistical differences (p < .001). There was negative correlation between the serum hs-CRP and FEV1 levels (p = .01). The serum hs-CRP levels were also correlated with Global Initiative for Chronic Obstructive Lung disease (GOLD) stages (r = .45, p < .001). CONCLUSIONS: Our findings suggest that the serum hs-CRP level is increased in SM patients with COPD and may have a direct correlation with disease severity. It may then be used as a marker for the severity of COPD in patients with SM poisoning.

Health-related quality of life in patients with chemical warfare-induced chronic obstructive pulmonary disease.

BACKGROUND: It is well known that inhalation of chemical warfare, mostly sulfur mustard, causes injury of the respiratory system. Chronic obstructive pulmonary disease is a common disease among these patients. Health-related quality of life is a common feature of studies in chronic obstructive pulmonary disease. The objective of our study was to assess the quality of life in these patients. METHODS: A total of 43 male patients with stable chronic obstructive pulmonary disease due to chemical gas injury were enrolled into this study. Severity of disease was defined by the global initiative for chronic obstructive lung disease (GOLD) guideline. Health-related quality of life was assessed using the St George Respiratory Questionnaire. Symptoms, activity, impact, and total score were calculated for each patient. RESULTS: The mean +/- SD age of patients was 42.5 +/- 7.4 years. According to the GOLD guideline, most (72%) of the patients were in stage 2 (mean: FEV1 1.9 +/- 0.75 L, 53.1% +/- 18.5% predicted). The mean +/- SD scores for each section of the St George Respiratory Questionnaire were 77.9 +/- 16.3 for "symptoms;" 70.2 +/- 19.6 for "activity;" 57.8 +/- 22.5 for "impact", and 64.9 +/- 19.5 as the "total score." There was a reverse correlation between FEV1 (% predicted) with symptoms (r = -0.47), activity (r = -0.61), impact (r = -0.44), and total score (r = -0.51) of the St George Respiratory Questionnaire. CONCLUSION: This study showed that lower lung functions as assessed by the St George Respiratory Questionnaire worsen the quality of life in patients with chemical warfare-induced chronic obstructive pulmonary disease.