Preliminary study showing no association between G238A (rs361525) tumor necrosis factor-α (TNF-α) gene polymorphism and its serum level, hormonal and biochemical aspects of polycystic ovary syndrome.

BACKGROUND: Polycystic ovary syndrome (PCOS) is the main cause of female infertility. Interactions among genetic, biochemical, and immunological factors can affect the pathogenesis of PCOS. As a proinflammatory cytokine, tumor necrosis factor-α (TNF-α) plays an important role in this regard. The present study aimed to evaluate the association of the rs361525 gene single-nucleotide polymorphism (SNP) and TNF-α serum levels with the hormonal and biochemical characteristics of PCOS in Iranian individuals. METHODS: The SNP rs361525 in the TNF-α gene was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in a total of 111 PCOS patients and 105 healthy females. Serum levels of TNF-α, lipid and hormone profiles, and biochemical factors were measured using enzyme-linked immunosorbent assay (ELISA) and calorimetric methods, as appropriate. RESULTS: The TNF-α serum level was higher in women with PCOS compared with the control group (p <  0.0001), and it was significantly correlated with the homeostasis model assessment (HOMA) factor (r = 0.138, p <  0.05). No significant differences were found in the genotype and allelic frequencies between the two groups (p >  0.05). Higher levels and significant differences were found for the HOMA factor, luteinizing hormone/follicle-stimulating hormone (LH/FSH), testosterone, and body mass index (BMI) in the PCOS group compared with the control group (p <  0.0001). High LH/FSH ratios (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.20-3.28, p <  0.01), and high HOMA factor (OR = 5.04, 95% CI = 2.82-9.01, p <  0.001) were significantly associated with an increased risk of PCOS. CONCLUSIONS: Despite the lack of significant difference between rs361525 polymorphism of the TNF-α gene and PCOS, the serum level of TNF-α was increased in PCOS patients and positively correlated with the HOMA factor. Elevation of the LH/FSH ratio and HOMA for insulin resistance (HOMA-IR) increased the risk of PCOS. Therefore, TNF-α could indirectly contribute to PCOS progression.

Higher expression of HSP70 and LOX-1 in the placental tissues of pre-eclampsia pregnancies.

BACKGROUND: Pre-eclampsia, a hypertensive disorder of pregnancy is the main cause of fetal and maternal morbidity and mortality. Growing evidences suggest that placental oxidative stress involves in the pathogenesis of pre-eclampsia. The HSP70 is a novel marker of oxidative stress which binds with high avidity to LOX-1. The aim of this study was to evaluate the co-expression of HSP70 and LOX-1 in the placental tissues of normotensive and pre-eclamptic pregnancies. MATERIALS AND METHODS: The placental tissues were collected from 35 healthy women with normal pregnancies and 33 women with pre-eclampsia disorder. Expression of HSP70 and LOX-1 on the placental tissues was examined by using immunohistochemistry technique. The intensity of the molecules' expression was determined by semi-quantitative scoring. RESULTS: The 34.3% and 37.1% of the healthy women did not express the HSP70 and LOX-1 on their placenta, respectively. All pre-eclamptic patients expressed HSP70 and LOX-1 with various scores. Indeed, the majority of the pre-eclamptic subjects had ≥3+ scores of the expression of HSP70 and LOX-1 on their placenta (60.6% and 66.7%, respectively). The percentage of the ≥3+ scores of the expression of HSP70 and LOX-1 was significantly higher in patients than those in healthy women (p<0.0001 for both). Similarly, the majority of the pre-eclamptic subjects had ≥3+ scores of the co-expression of HSP70 and LOX-1 molecules (57.6%) which was significantly higher in patients than those in control group (p=0.0001). CONCLUSIONS: These results showed higher expression of HSP70 and LOX-1 in the placental tissues of pre-eclampsia patients which represent the possible contribution of these molecules in the disease pathogenesis. Further studies need to clarify their role in the pathogenesis of preeclampsia disorder.

A randomized comparison of the efficacy, side effects and patient convenience between vaginal and rectal administration of Cyclogest(®) when used for luteal phase support in ICSI treatment.

PURPOSE: This study compares the efficacy, side effects and patient convenience of vaginal and rectal routes of administration of progesterone suppositories (Cyclogest) when used for luteal phase support during in vitro fertilization cycles, through the use of antagonist protocols. METHODS: 147 patients who underwent intra-cytoplasmic sperm injection cycle were randomized on the day of the embryo transfer (ET) by a computer-generated randomization program to receive 400 mg of Cyclogest either vaginally or rectally twice daily for up to 8 weeks. A pregnancy test was conducted 2 weeks after embryo transfer. If the pregnancy test was negative, the application was discontinued. On day 14th after embryo transfer, patient's acceptability and side effects were assessed using a questionnaire which was given to the patients on the day of ET prior to performing the pregnancy test. The clinical pregnancy rate at the 8th week of gestation and the level of luteal progesterone were evaluated. RESULTS: There were no substantial differences in the demographics or other characteristics between the two groups. There were no significant differences in serum P concentration 6 days after ET, the clinical pregnancy and abortion rates. The difficulty of administration route, the discomforts experienced following administration, and the proportion leaking out on the 14th day were similar between the two groups. Significantly more patients administering the medication per vagina had perineal irritation (21.3 vs. 2.2 %). The prevalence of tenesmus (35.1 vs. 21.1 %) and rectal itching (26.7 vs. 2.8 %) were significantly more in rectal route. CONCLUSIONS: This study demonstrates that the efficacy of Cyclogest is similar when administered via both the vaginal and rectal routes. Although their side effects differ, the ease of administration for patients and their preference are similar.

Preferred postpartum contraception methods and their practice among married women in Zanjan, Iran.

OBJECTIVES: To explore the preferences of women; once at the time of delivery and then three months later, in using contraceptive methods during post partum period. METHODS: A sample of 575 women who gave birth during July 2007 and February 2008 in Vali-Asre teaching hospital of Zanjan, were recruited and interviewed once after delivery and then three month later. The interview questions included demographic characteristic and questions assessing the tendency of mothers to use the contraceptives they preferred at time of delivery and three months later. RESULTS: According to 537 (93.4%) of interviewed mothers, they intended using at least one contraceptive after getting discharged from the hospital. This figure dropped to 438 (76.1%) three months after delivery. Women who expressed the desire to use minipill after delivery were 169 (29.3%). However this value rose to 187 (32.2%) three months later. The difference was not statistically significant. There was significant relationship between type of contraceptives used and women's age, number of children, place of residence and level of education three months following delivery. CONCLUSION: Results suggest that health care must focus extensively on giving necessary information and consultation to pregnant women also their partners to help to improve selection of most favourite and safe method of contraception.

Evaluate the outcome and identify predictive failure of outpatient laparoscopic cholecystectomy.

OBJECTIVE: To evaluate the outcome of undertaking out-patient laparoscopic cholecystectomy (OLC) and identifying its predictive failures. METHODS: One hundred and forty-nine consecutive patients with symptomatic cholelithiasis scheduled for preplanned elective laparoscopic cholecystectomy (LC) from August 2004 to December 2006 were included in the study. Patients with associated severe diseases, ASA class III and IV who would have required post operative surgical care, residents of remote areas and other surgical reasoning were entered in Inpatient's Laparoscopic Cholecystectomy (ILC) group (n = 57) and others were enrolled in OLC group (n = 87). Five patients converted to open surgery and thus were excluded from the study. All patients were recruited during the initial outpatient visit and the full preoperative details were explained to them. All of the related factors of OLC were recorded in every visit. Significant differences were evaluated using Chi-square and fisher exact test. RESULTS: Eighty seven patients (58.3%) were selected for outpatient group from which 69 patients (79.3%) successfully underwent outpatient LC. Eighteen (20.7%) patients (failure rate) were not discharged at all. Comparing successful and unsuccessful OLC, the mean age was 41.1 +/- 12.7 vs 51.3 +/- 16.1 years (P = 0.005), also the mean operation time was 33.7 +/- 13.3 vs 33.1 +/- 13.8 minutes and the ability for oral intake existed in 66 patients (95.7%) vs 15 patients (83.3%) (P = 0.1) respectively. Pain was the most common cause of failure of OLC. CONCLUSIONS: OLC is safe and feasible with low readmission. It achieves high levels of patient satisfaction and acceptance, when patients are carefully selected. A prospective study with a larger sample size should be warranted to verify whether OLC can be useful for high age and high ASA class patients.

A biological dressing versus 'conventional' treatment in patients with massive burns: a clinical trial.

BACKGROUND: For many years, burns were treated by daily saline-soaked dressings until the burns healed primarily. Today, wounds are closed via grafting techniques, or by using synthetic and biological dressings. Due to less experience and interest in the use of biological dressing in developing countries, the aim of this study was to compare the outcome of biological dressings versus 'conventional' treatment in patients with massive burns. METHODS: One hundred eighteen patients with total body surface area (TBSA) burns of 30% to 75%, by flame or scalds, were investigated from October 2002 to June 2006. The patients were divided into two groups. Those in the first group received conventional treatment (n=53) and those in the second group (n=65) received treatment with a biological dressing (Xenoderm). RESULTS: Mortality rates in the conventional group and biological group were 19 (35%) and 7 (10.8%), respectively (p=0.001). The mean hospital stay was 31.3 days vs 18.2 days and the number of dressings was 22.1 vs 9.9, respectively (p=0.0005). CONCLUSION: The results of this study indicate that a biological dressing (Xenoderm) gave a better outcome and lower mortality. However, a randomized clinical trial that compares the number of operations and decreasing need for split thickness skin grafts is warranted.

Luteal Phase Support in the Intrauterine Insemination (IUI) Cycles: A Randomized Double Blind, Placebo Controlled Study.

OBJECTIVE: To evaluate the impact of luteal phase support with vaginal progesterone on pregnancy rates in the intrauterine insemination (IUI) cycles, stimulated with clomiphene citrate and human menopausal gonadotropin (hMG), in sub fertile couples. MATERIALS AND METHODS: This prospective, randomized, double blind study was performed in a tertiary infertility center from March 2011 to January 2012. It consisted of 253 sub fertile couples undergoing ovarian stimulation for IUI cycles. They underwent ovarian stimulation with clomiphene citrate (100 mg) and hMG (75 IU) in preparation for the IUI cycle. Study group (n = 127) received luteal phase support in the form of vaginal progesterone (400 mg twice a day), and control group (n = 126) received placebo. Clinical pregnancy and abortion rates were assessed and compared between the two groups. RESULTS: The clinical pregnancy rate was not significantly higher for supported cycles than that for the unsupported ones (15.75% vs. 12.69%, p = 0.3). The abortion rate in the patients with progesterone luteal support compared to placebo group was not statistically different (10% vs. 18.75%, p = 0.45). CONCLUSION: It seems that luteal phase support with vaginal progesterone was not enhanced the success of IUI cycles outcomes, when clomiphene citrate and hMG were used for ovulation stimulation.

Association between polycystic ovarian syndrome, overweight, and metabolic syndrome in adolescents.

PURPOSE: Polycystic syndrome (PCOS) is associated with multiple metabolic abnormalities. Studies in the adolescent population are still limited and the results have been much different. The aim of this study was to investigate the association between PCOS, overweight, and metabolic syndrome in adolescents. METHODS: 30 PCOS adolescents were randomly selected from a PCOS population with NIH 1990 criteria and 71 adolescents from the normal adolescents. Anthropometric, hormonal and metabolic parameters were evaluated in four sub-groups including obese and non-obese PCOS and obese and non-obese normal adolescents. RESULTS: The prevalence of overweight and metabolic syndrome in adolescents with PCOS was 52% and 33.3% respectively vs 22.4% (P = 0.005) and 11.26% in control (normal) adolescents (P = 0.0001). Among all subjects, including obese and non-obese adolescents with or without PCOS, the prevalence of insulin resistance, hypercholesterolemia, central obesity, and metabolic syndrome was higher in obese PCOS with 61.5%, 46.2%, 53.8%, and 69.2%, respectively. CONCLUSIONS: Obesity and IR are important risk factors for metabolic syndrome in PCOS. Considering the long-term health risks, it is necessary to identify metabolic disorders in adolescents with PCOS as early as possible.

Molar pregnancy presents as tubal ectopic pregnancy.

Hydatidiform moles are abnormal gestations characterized by the presence of hydropic changes affecting some or all of the placental villi. Hydatidiform moles arise as a result of the fertilization of an abnormal ovum. In this report, the patient was a 29 year old Asian woman who had induction of ovulation with letrozol. Since the majority of molar gestations arise within the uterine cavity thus the occurrence of a hydatidiform mole within ectopic gestational tissue is rare. It is important to differentiate a hydatidiform mole from a conventional ectopic pregnancy, particularly in infertile women who have a history of ovulation induction.

A randomized clinical trial to compare levonorgestrel-releasing intrauterine system (Mirena) vs trans-cervical endometrial resection for treatment of menorrhagia.

OBJECTIVE: To compare the acceptability, efficacy, adverse effects, and user satisfaction of the levonorgestrel intrauterine system (LNG-IUS) and trans-cervical resection of the endometrium (TCRE) for the treatment of menorrhagia. METHOD: 104 women with menorrhagia were divided into 2 groups: 52 women had the LNG-IUS inserted and 52 underwent TCRE. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, and rates of acceptability and satisfaction, were recorded at 6 and 12 months after the procedure. RESULTS: After a year there were reductions of 93.9% and 88.4% in menstrual blood loss in the TCRE and LNG-IUS groups, respectively. Amenorrhea was more common in the TCRE group and spotting and systemic effects in the LNG-IUS group. Satisfaction rates of the TCRE group were higher than the LNG-IUS group (80.8% vs 69.2%), but the difference was not statistically significant. CONCLUSION: Although both treatments were found to be equally effective, LNG-IUS was less invasive and can be advised for younger women with a desire to preserve fertility.

Simvastatin effects on androgens, inflammatory mediators, and endogenous pituitary gonadotropins among patients with PCOS undergoing IVF: results from a prospective, randomized, placebo-controlled clinical trial.

OBJECTIVE: To evaluate effects of simvastatin on selected biochemical parameters and reproductive outcome among patients with polycystic ovary syndrome (PCOS) who undergo in vitro fertilization (IVF). METHODS: Patients with PCOS were randomized to receive either oral simvastatin, 20 mg/d (n = 32), or placebo (n = 32) in a prospective, double-blind, randomized clinical trial (NCT 005-75601) in parallel with controlled ovarian hyperstimulation for IVF. All patients were determined to be at average risk for cardiovascular disease, based on high-sensitivity C-reactive protein (hsCRP) measurement at entry. After an 8-week treatment interval concluding at periovulatory human chorionic gonadotropin administration, selected clinical and laboratory parameters were measured. RESULTS: Mean serum total testosterone level decreased by 25% in the simvastatin group, compared to a 10% reduction in the placebo group (P < 0.001). A trend of lower serum luteinizing hormone levels was noted in experimental and control groups (29% vs 22%, respectively), although this difference was not significant (P > 0.05). Neither fasting insulin nor quantitative insulin sensitivity check index were significantly impacted by simvastatin (P > 0.05). As expected, total cholesterol was not modified among placebo patients but was significantly reduced after simvastatin (P = 0.001). In addition, hsCRP and vascular cell adhesion protein-1 were both significantly lower after simvastatin therapy compared to controls (P ≤ 0.005 for both). At study completion, no important change in body mass index was observed in either group (P ≥ 0.60). Although oocyte maturation, fertilization, and clinical pregnancy rates were all higher after simvastatin, none of these improvements were statistically significant. CONCLUSIONS: This report presents data from the first prospective, randomized, placebo-controlled clinical investigation of simvastatin in the setting of PCOS and IVF. Simvastatin seems to be compatible with gonadotropin therapy for IVF and can offer beneficial endocrine and cardiovascular effects for patients with PCOS who undergo embryo transfer. Although the observed improvements in reproductive function were mild, the reductions in hsCRP and vascular cell adhesion protein-1 after simvastatin treatment were significant, suggesting the need for further clinical trials to clarify simvastatin's impact on reproductive physiology.

Luteal phase estradiol versus luteal phase GnRH antagonist administration: their effects on antral follicular size coordination and basal hormonal levels.

BACKGROUND: The differential efficacy between long GnRH agonist with antagonist can partly be due to the preexisting differences in the early antral follicles before ovarian stimulation. OBJECTIVE: To compare the effect of pretreatment by estradiol with GnRH antagonist on antral follicular size coordination and basal hormone levels in GNRH antagonist protocol. MATERIALS AND METHODS: On cycle day 3 (control/day 3), women underwent measurements of early antral follicles by ultrasound and serum FSH and ovarian hormones then were randomized to receive oral estradiol 4mg/day (n=15) or 3mg cetrorelix acetate (n=15) in luteal phase before subsequent antagonist protocol. Participants were re-evaluated as on control/day 3. RESULTS: There was a significant reduction of mean follicular sizes in each group after medical intervention (7.63±2.11 Vs. 4.30±0.92 in group A and 8.73±1.96 Vs. 4.13±1.11 in group B) (p=0.0001). The magnitude of follicular size reduction was significantly higher in group B (-4.60±2.04 Vs. -3.33±2.28) (0.027). There was a non significant attenuation of follicular size discrepancies in two groups. FSH and inhibin B levels in the day 3 of the next cycle in both groups were significantly decreased but did not have significant difference between two groups. CONCLUSION: Both luteal E2 and premenstrual GnRH antagonist administration reduces the follicular sizes significantly and GnRH antagonist acts more potently than E2 in this way but attenuation of follicular size discrepancies in both treatment is not significant.

Comparing early oral feeding with traditional oral feeding in upper gastrointestinal surgery.

BACKGROUND/AIMS: Due to the lack of interest in using early oral feeding and the need for a trial study in this regard, this study aimed to compare the outcome of early oral feeding and traditional oral feeding in patients with upper gastrointestinal surgery. METHODS: Fifty-two patients who underwent upper gastrointestinal surgery were randomly assigned into two groups in a consecutive manner as either the early oral feeding group or traditional oral feeding group. Tolerance of oral feeding, ileus, nausea and vomiting, post-operative stay, and complications were recorded. RESULTS: Tolerance of oral feeding for the two groups was 24 (92.3%) in the early oral feeding group and 21 (91.3%) in the traditional oral feeding group (p=0.89). The post-operative hospital stays were 5.62 and 8.04 days in the early oral feeding and traditional oral feeding groups, respectively (p<0.0001). There were significant differences between the two groups in terms of the time of the first gas passing/defecation, the post-operative hospital stays, starting time of oral feeding, and satisfaction regarding early nasogastric tube removal. CONCLUSIONS: The results of this study show that early oral feeding is a safer and more cost-effective procedure in upper gastrointestinal surgery.

Xenoderm versus 1% silver sulfadiazine in partial-thickness burns.

OBJECTIVE: The aim of this clinical trial was to evaluate the effectiveness of using lyophilised porcine skin (Xenoderm) compared with 1% silver sulfadiazine (SSD) in partial-thickness burns with regard to wound infection, length of hospital stay, number of dressings and doses of analgesics used (oral and injection). METHODS: A total of 78 burns patients were included in this randomised study; their burns were caused by scalds or flames. They had second degree burns and had a burn area of 1060% of total body surface area (TBSA). Thirty-seven patients were treated with daily washing, followed by topical application of SSD dressing (the SSD group) and 39 with a biological dressing, i.e. Xenoderm (the Xenoderm group). The differences were evaluated using unpaired Student's t-test, Mann-Whitney U test and Chi-square test. RESULTS: There were no significant differences between the two groups with respect to age, gender, TBSA, cause of burn, and thickness of the burn or burn site. But there were significant differences regarding degree of wound infection, length of hospital stay, number of used dressings and given doses of analgesics. CONCLUSION: Xenoderm seems to be more effective than SSD dressing in terms of pain control, degree of wound infection, used wound dressings and length of hospital stay for partial-thickness burns. Prospective randomised studies are now necessary to compare possible reductions in the use of split thickness skin grafts and re-epithelialisation times.