Objective:Treatment of female infertility consists different strategies including metabolic, hormonal and surgical therapeutic modalities. Non-vitamin supplements with antioxidant activity as carnitines, Inositols, Poly Unsaturated Fatty Acids (PUFAs), coenzyme Q10 and melatonin are among those with most popularity, but their prescription may confer some warnings. Materials and methods:This review narrates the antioxidant mechanism of these supplements, beside their effect on outcomes of infertility treatment while considering side effects, warnings and ranges of doses. Results:Carnitines are used for energy production and fat metabolism, while they have anti-aging and antioxidant effects. Supplementation with carnitines improve obesity outcomes, especially in Poly Cystic Ovarian Disease (PCOS) patients. Rare cases have shown increasing risk of seizure with levocarnitine. Coenzyme Q10 (Ubiquinone) has shown benefit in patients with PCOS or poor ovarian responders. It significantly increased live birth rate and the side effects are minimal even in higher doses. Poly Unsaturated Fatty Acids (PUFAs) have shown impact on follicular development and embryo quality. The hazard is increasing lipid low density lipoprotein (LDL) in high doses. Use of inositols in female infertility treatment is due to its metabolic effect and insulin resistance in PCOS patients resulting in decreasing use of gonadotropins. They have produced acceptable results about count of follicles and oocyte quality. Hypoglycemic effects of inositols have been reported as side effect, especially in combination with other hypoglycemic agents. Melatonin can increase the clinical pregnancy rate, and improve the outcomes about oocyte and quality of embryo via receptor- and non-receptor- action. Dizziness, drowsiness, and headache are reported in higher doses of melatonin. Conclusion:The attitude that all supplement can be prescribed without restriction endangers susceptible patients. Hence, increasing our knowledge about efficacy and safety profile can help individualize prescription of supplements for female infertility.
Objective:To describe a rare case of non-menstrual staphylococcal toxic shock syndrome (TSS) with Staphylococcus aureus urinary tract infection as the suspected primary source and to highlight the successful use of linezolid as adjunctive therapy when clindamycin resistance is present. Case report:A 42-year-old woman presented with fever, vomiting, diarrhea, and severe vulvar pain. One month prior, she experienced vaginal pruritus with excoriations and fissuring that never fully resolved. On examination, she had conjunctival injection, tongue inflammation with non-vesicular lesions, and a diffuse erythematous macular rash. Laboratory evaluation revealed elevated transaminases, thrombocytopenia, and bandemia. Urinalysis demonstrated 100,000 CFU of Staphylococcus aureus. Gynecologic examination revealed vulvar and vaginal erythema with ulcerated cervical lesions. Vaginal culture also grew heavy Staphylococcus aureus. Given the constellation of fever, rash, mucosal involvement, hepatic dysfunction, and positive Staphylococcus aureus cultures, a diagnosis of toxic shock syndrome was made. The isolate was resistant to clindamycin, necessitating treatment with vancomycin, piperacillin-tazobactam, and linezolid. The patient improved and completed 14 days of antibiotic therapy with complete resolution of symptoms. Conclusion:Staphylococcus aureus urinary tract infection is an exceedingly rare source of toxic shock syndrome. Clinicians should maintain a high index of suspicion for TSS in patients with any staphylococcal infection presenting with fever and multisystem involvement. Linezolid is an effective alternative to clindamycin for toxin suppression, particularly in cases involving clindamycin-resistant organisms. Prior mucosal barrier disruption may be an important risk factor for TSS development.
Objective:Birth companion is a contributory factor for humanization of labor, influencing favorable maternal and perinatal outcomes. Objective: To describe maternal and perinatal aspects of pregnancies that ended either with or without the participation of a companion during the labor period. Materials and methods:This cross-sectional descriptive study was conducted in Brazil using data collected from the National Health Survey (PNS-2019). Participants were Brazilian women aged 15 to 49 years who had experienced pregnancy at some point in their lives and whose most recent delivery occurred between July 2017 and July 2019. Prevalence and 95% confidence intervals (95% CI) were calculated to characterize maternal and perinatal aspects according to the participation of a companion. Results:The target population was estimated at 5.3 million women who underwent either cesarean section (54.58%) or vaginal delivery (45.42%) between July 2017 and July 2019. The prevalence of companion support was high (84.98%), with similar rates observed for cesarean section (85.52%) and vaginal delivery (84.33%). Private health insurance coverage, the number of prenatal appointments, and the place of the last delivery were associated with differences in companion participation rates in both delivery methods. In cesarean deliveries, the presence of complications during delivery and the number of postpartum appointments also influenced companion participation rates. In vaginal deliveries, older maternal age, higher parity, and episiotomy were associated with companion participation rates. Conclusion:The participation of a companion during labor is high and independent of the delivery method; however, socioeconomic inequalities and unequal access to quality health services persist. Initiatives to strengthen policies supporting the humanization of labor and childbirth, and to guarantee the right to a companion during delivery, particularly within Brazil's Unified Health System (SUS), are essential for expanding and making the support more equitable for women in labor.
Objective:Obesity is a global health threat, especially among women of reproductive age, and it adversely affects the health of both mothers and their children. This study aimed to identify and analyze the causes and management challenges of maternal obesity in Iran from the perspectives of key informants. Materials and methods:This is a qualitative study. We conducted semi-structured, in-depth interviews with 20 experts, from September to December 2023. We analyzed data using Leichter's (1979) framework through an inductive-deductive approach, facilitated with MAXQDA 2020 software. Results:We identified challenges in managing maternal obesity and categorized them into 10 main categories and 21 sub-categories, grouped within five constructs according to Leichter's framework: Situational factors (climate changes and international sanctions), Structural factors (high prevalence of overweight and obesity among women and unfavorable economic conditions), Socio-cultural factors (misconceptions and misuse of traditional Iranian medicine), Environmental or International factors (social norms and values, and the limited influence of international organizations), and Governance and Executive factors (weak governance by the Ministry of Health and Medical Education (MoHME) and poor inter-sectoral cooperation). Conclusion:Addressing maternal obesity is essential to achieve Sustainable Development Goals (SDGs), particularly in low- and middle-income countries (LMICs). Current challenges such as food insecurity, economic decline, and insufficient maternal awareness threaten maternal health in relation to obesity. Tackling these issues requires a coordinated, multi-sectoral approach involving healthcare system strengthening, public awareness campaigns, and empowerment of women and families. Prioritizing maternal obesity within national health agendas is critical for an effective response. Further research on maternal obesity in Iran is recommended to uncover root causes and develop effective interventions, providing policymakers with the evidence needed for informed decision-making.
Objective:This study investigated the association between Anti-TPO levels and ovarian reserve markers, including anti-Müllerian hormone (AMH) and antral follicle count (AFC), in euthyroid infertile women. Materials and methods:In this cross-sectional analytical study, 231 euthyroid infertile women were enrolled and classified as Anti-TPO positive (n = 92) or Anti-TPO negative (n = 139). Serum levels of AMH, FSH, LH, TSH, prolactin, and Anti-TPO were measured, and AFC was assessed by transvaginal ultrasonography. Because hormonal variables were not normally distributed, logarithmic transformation was applied prior to parametric analyses. Data were analyzed using independent t-tests, Pearson correlation, and multivariate regression (α = 0.05). Results:No significant differences were observed between groups in log-transformed AMH, AFC, FSH, or LH levels (p > 0.05). Age was negatively associated with log-AMH. Subgroup analyses demonstrated that in Anti-TPO-positive women, higher Anti-TPO levels were associated with lower log-AMH and higher log-FSH. Multivariate regression identified age as the only independent predictor of log-AMH levels (β = -0.337, p < 0.001). Conclusion:Ovarian reserve decline appears primarily age-related; however, thyroid autoimmunity may have a potential modulatory role in ovarian function. Consideration of thyroid autoantibody status may be clinically relevant in infertility evaluation.
Objective: Eating the placenta after birth, or placentophagia, is common in mammals but questionable in humans. There is little scientific evidence to support the claims made by practitioners that it promotes lactation, prevents depression, and aids in postpartum healing. Materials and methods: This paper reviews the historical background, cultural relevance, ethical considerations, advantages, and potential risks of human placentophagia. The placenta does contain hormones and nutrients, but their efficacy and bioavailability have not been established. Furthermore, safety concerns (such as bacteria and endocrine disturbance) raise doubts about its practice. Results: Placentophagia is not recommended by the American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention because the production of human placentophagy products is unregulated and presents potential health risks. Conclusion: This review considers the benefits or harms of placentophagia on human health, summarizes recent studies, addresses ethical and medical viewpoints, and emphasizes the need for further research.
Objective: This study aimed to evaluate the effectiveness of PAW in inhibiting and eliminating four major pathogenic bacterial species: Pseudomonas, Salmonella, Escherichia coli, and Staphylococcus aureus. Materials and methods: Plasma-activated water (PAW) was generated using a dielectric barrier discharge (DBD) cold plasma device (10 kV, 20 kHz, 4.5 L/min airflow). Two-pipette electrodes generated plasma columns with reactive species. Water hardness, pH, and ozone were measured in triplicate. Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, and Salmonella spp. were cultured, suspended to 0.5 McFarland, diluted serially, and cultured using the pour plate method. Plasma-generating electrodes were immersed in bacterial suspensions and treated for 2.5, 5, 10, and 15 minutes. Samples were cultured in triplicate using the pour plate method and colony counts were analyzed using t-tests and ANOVA. Results: Plasma-activated water (PAW) significantly altered pH and hardness and exhibited high bactericidal activity. Hardness increased dramatically post-plasma, while pH decreased. Ozone levels increased with plasma exposure. Duncan’s test (p < 0.05) confirmed significant bacterial reduction. PAW completely eliminated some strains within 2.5-5 minutes. PAW eliminated Pseudomonas aeruginosa at all time points. S. aureus was reduced to 78 ± 9 CFU/mL at 2.5 minutes and eliminated thereafter. E. coli was eliminated at 5-15 minutes, with 53 ± 7 CFU/mL remaining at 2.5 minutes. Salmonella spp. was reduced to 66 ± 8 CFU/mL at 2.5 minutes and eliminated thereafter. Conclusion: Increased ozone concentration along with ROS and RNS enhances disinfection, inactivating Pseudomonas aeruginosa, Salmonella spp., Escherichia coli, and Staphylococcus aureus within 5 minutes. Reactive species disrupt bacterial cell walls and membranes, providing antimicrobial effects. Plasma-activated water offers a portable, user-friendly, and eco-friendly alternative to chemical disinfectants for microbial decontamination in food, medical, sanitation, and hospital settings, while conserving water.
Objective: Infertility is a global health challenge, affecting many couples worldwide. Male infertility contributes to 20–50% of cases. Although semen analysis parameters are widely regarded as key indicators of male fertility, their association with in vitro fertilization (IVF) success remains debated. This study evaluated the relationship between specific semen parameters and grade A embryo formation in IVF among infertile men. Materials and methods: This retrospective cross-sectional study was conducted at a referral infertility center from March 2019 to March 2021, involving 104 men diagnosed with male-factor infertility. Semen parameters, including sperm count, motility, morphology, and volume, were analyzed. The primary outcome was the formation of at least one grade A embryo, defined as a successful IVF outcome. Statistical analyses included chi-square tests and logistic regression. Results: The median age differed significantly between the successful and unsuccessful IVF groups (36 vs. 38 years, p=0.050). No significant differences were observed in semen volume, sperm count, motility, or morphology between groups. Logistic regression revealed that younger age was associated with a higher likelihood of grade A embryo formation (OR=0.935, p=0.012), whereas semen parameters showed no significant association with embryo quality. Conclusion: This study found no significant association between semen parameters and grade A embryo formation in IVF, suggesting that traditional semen analysis has limited predictive value for embryo quality. Although younger age was associated with a higher likelihood of success, the effect size was small (OR=0.935, p=0.012), and its clinical impact may be limited. These findings highlight the potential for successful embryo development despite suboptimal semen parameters and underscore the need for a broader approach to assessing male fertility beyond standard semen analysis.
Objective: The study explored the lived experiences of adolescent parents in the Philippines and how they were able to transitioned from adolescence to young adulthood. Materials and methods: It adopts a descriptive phenomenological approach exploring the parenting phenomenon experienced by purposively selected adolescent parents (n=24). Results: Using an inductive thematic analysis of the content of the entire data set, the research identified one predominant theme: "Rise where you stumbled," along with four sub-themes of adolescent parenting experiences, namely, "a child turns our world upside down," "beating the odds," "in good company," and "our hope and joy." Conclusion: This study presents a cautionary narrative for adolescent parents in comparable circumstances. It reveals its multifaceted challenges and opportunities for effectively navigating its dynamics, emphasizing the psychosocial factors that facilitated the desired behavior and the underlying motivations that drove their forced transition from adolescence to young adulthood.
Objective:This study targeted to investigate the potential role of breast milk iodine concentration (BMIC), insulin-like growth factor-1 (IGF-I), and brain-derived neurotrophic factor (BDNF) during the early stage of lactation in child neurocognitive development. Materials and methods:In this secondary analysis, we examined 122 breastfeeding mothers and their healthy children, all of whom were breastfed for at least six months. Levels of BDNF, IGF-1, and BMIC were assessed in breast milk samples obtained between the third and fifth days after lactation began (before any iodine supplementation intervention). Three-year-old children were administered the Bayley-III screening test to assess their cognitive, motor, and language development. Results:The median (interquartile range) concentrations of iodine, BDNF, and IGF-1 in breast milk during the starting few days of lactation were 285.0 (181.0-366.0) μg/l, 0.59 (0.52-0.76) ng/ml, and 12.5 (9.6-18.3) ng/ml, respectively. The mean (standard deviation) cognitive, motor, and language scores were 101.0 (10.8), 93.4 (14.6), 100.1 (13.5) and, respectively. Linear regression models revealed a negative relation between breast milk iodine and children's cognitive development ((β unadjusted = -0.004 (P = 0.010); β adjusted = -0.003 (P = 0.024)). However, no associations were found between breast milk BDNF and IGF-1 and cognitive, language, or motor scores in three-year-olds. Conclusion:Our findings indicate that early exposure to iodine, BDNF, and IGF-1 in breast milk, measured prior to iodine supplementation, has no substantial association with neurodevelopment in three-year-old children. The weak negative association between BMIC and cognitive scores may reflect prenatal iodine status, warranting further research to explore long-term effects of supplementation.
Objective: Respiratory Distress Syndrome (RDA) is a common complication in premature neonates due to immature lungs, and antenatal corticosteroid administration could reduce its incidence. We aim to investigate the role of antenatal melatonin administration in preventing RDS among women with placenta accrete spectrum who usually mandate early delivery. Materials and methods: This is a single-blinded randomized controlled trial performed in a tertiary hospital among women with placenta accrete spectrum. The melatonin group received Melatonin 10 mg/daily for two weeks before elective cesarean section in addition to corticosteroids, and the control group just received corticosteroids. The RDS occurrence was compared between two groups. Results: In total, 60 participants were involved in the study (30 in the melatonin group and 30 in the control group). RDS was diagnosed for five (16.7%) neonates in the melatonin group and nine (30.0%) neonates in the control group (P-value= 0.228). Among neonates with RDS, no neonate in the melatonin group required intubation, and six (66.7%) neonates intubation needed in the control group (P = 0.016). Conclusion: Antenatal melatonin administration may reduce the need for intubation in preterm neonates with RDS, though the lower incidence of RDS observed in the melatonin group was not statistically significant. The small number of RDS cases limits the ability to draw definitive conclusions regarding intubation rates and hospitalization duration. Larger-scale, multicenter studies with long-term follow-up are needed to validate these findings and better understand melatonin's role in neonatal respiratory care.
Objective: This study aims to analyze the correlation between salivary alpha-amylase (sAA) and stress in adolescents with premenstrual syndrome (PMS), and to assess the predictive ability of sAA levels and stress for PMS. Materials and methods: Sixty-two adolescents with and without PMS (31 each) were grouped based on their PMS status, measured using the Shortened Premenstrual Assessment Form (SPAF). Stress was measured using the Kessler Psychological Distress Scale (K10). The levels of sAA were measured using Enzyme-Linked Immunosorbent Assay (ELISA). Data were analyzed using the Pearson correlation test, Receiver Operating Characteristic (ROC) curve analysis, and multiple linear regression analysis. Results: Stress and PMS expressed a significant positive correlation (p=0.001; r=0.66). sAA levels and PMS showed a significant positive correlation (p<0.05; r=0.42). The level of sAA in adolescents with PMS was 23.28±12.02 ng/mL, almost twice higher than in adolescents without PMS (12.10±7.5 ng/mL). The cut-off value of sAA level on PMS was ≥15.02 ng/mL with a sensitivity and specificity of 67.7%. The level of sAA and stress were significantly able to predict PMS (p<0.001). The correlation value of SAA levels and stress with PMS is positive (r=0.705), suggesting they can predict PMS by 49.7% (R2=0.497). Conclusion: There is a positive relationship between sAA levels and stress in adolescents with PMS. SAA levels and stress were able to predict PMS in adolescents with an accuracy of 49.7%.
Objective: Maternal mortality remains a major public health challenge in Madagascar, with notable regional disparities. Antenatal care (ANC) plays a critical role in preventing maternal deaths, yet its coverage and quality vary significantly across regions. This study aims to assess the association between ANC quality and maternal mortality rate (MMR), focusing on regional disparities and exploring potential non-linear relationships. Materials and methods: We conducted a retrospective ecological study using publicly available data from Madagascar’s 22 regions. ANC indicators included blood pressure monitoring, blood and urine tests, iron supplementation, and antiparasitic treatment. Linear regression and Generalised Additive Models (GAM) were used to examine associations and non-linear patterns. Statistical analyses were performed using R version 4.2.2, with a significance threshold of 5%. Results: Considerable disparities were observed in ANC coverage across regions. Linear models revealed no significant association between ANC indicators and MMR (p > 0.05). However, GAM identified significant non-linear relationships for blood pressure monitoring (p < 0.0045) and blood testing (p < 0.0055), suggesting potential threshold effects. Conclusion: Addressing maternal mortality in Madagascar requires enhancing both access to and the quality of ANC. Accounting for regional disparities and non-linear trends is essential in developing effective public health interventions.
Objective: Antioxidants have shown positive effects on semen quality by improving sperm parameters such as motility and viability. This study investigate the effects of curcumin on sperm parameters, apoptosis, and DNA fragmentation index (DFI) following freezing in oligoteratoasthenospermia (OAT) patients. Materials and methods: In this experimental study, a total of 40 semen samples obtained from 10 men aged 25–42 years with OAT according to WHO guidelines were treated with different concentrations of curcumin (0, 10, 20, and 30 μM) in a freezing medium. Following the freeze-thaw process, sperm parameters were evaluated. At the optimal dose, DNA fragmentation index (DFI) was assessed using the TUNEL (Terminal deoxynucleotidyl transferase dUTP nick end labeling) assay, and the expression levels of BAX (BCL2-associated X) and BCL2 (B-cell lymphoma-2) genes were measured by real-time PCR in both the optimal dose group and the control group. Results: The cryopreservation had a significant detrimental effect on sperm parameters. Curcumin treatment, particularly at the 20 μM dose, showed improvements in sperm motility, although these improvements did not reach statistical significance. Also in optimal dose (20 μM dose), there was a significant decrease (p < 0.001) in the level of DFI, in BAX gene expression and BAX/BCL2 ratio, as well as a significant increase in BCL2 gene expression, which It indicates a decrease in apoptosis. Conclusion: It seems that the addition of curcumin to the sperm- freezing medium has a positive impact on sperm motility. This improvement can be attributed to the reduction in apoptosis and the protective effects on sperm DNA. By mitigating apoptosis, curcumin helps preserve the viability and functionality of sperm cells.
Objective:To evaluate the efficacy of 50 mg/day intramuscular (IM) progesterone in achieving optimal serum P4 levels during endometrial preparation and investigate the association between serum P4 levels on embryo transfer (ET) day and subsequent fertility outcomes in hormone replacement therapy (HRT) frozen embryo transfer (FET) cycles. Materials and methods:This prospective cohort study included 121 women (aged 22-45 years) undergoing HRT-FET at Imam Khomeini Hospital Complex from December 2022 to January 2024. Endometrial preparation began with oral estradiol valerate (6 mg/day) on cycle day 2. Once an endometrial thickness of ≥8 mm was achieved, daily IM P4 (50 mg) was initiated. Serum P4 levels were measured on ET day, and oral dydrogesterone (20 mg/day) was added for patients with P4 levels <10.0 ng/mL. Primary outcomes included chemical pregnancy, clinical pregnancy, miscarriage, and ongoing pregnancy rates. Results:The mean serum P4 level on ET day was 22.8 ± 10.1 ng/mL, with 78.5% of participants achieving the target range (10-32.5 ng/mL) following IM P4 administration. Overall chemical pregnancy, clinical pregnancy, and ongoing pregnancy rates were 23.1%, 18.2%, and 14.1%, respectively, with a miscarriage rate of 5.0%. Multivariate analysis revealed that P4 levels >27.8 ng/mL were associated with reduced odds of chemical pregnancy (OR = 0.20; 95% CI: 0.05-0.86; p = 0.03), while no significant differences were observed in other pregnancy outcomes across P4 quartiles. Conclusion:Daily administration of 50 mg IM P4 effectively achieved optimal serum P4 levels in most patients. While higher P4 levels (>27.8 ng/mL) were associated with reduced chemical pregnancy rates, the absence of significant correlations with other pregnancy outcomes highlights the multifactorial nature of embryo implantation success. These findings emphasize the need for further research to refine P4 thresholds and identify additional predictive factors influencing pregnancy outcomes in FET cycles.
Objective: Building upon prior research, our investigation focused on examining changes in gene expression of Connexins 37 and 43 (Cx) influenced by β2-adrenergic agents in cumulus cell cultures from women with polycystic ovarian syndrome (PCOS) and poor ovarian response (POR), all of whom were candidates for in vitro fertilization (IVF). Materials and methods: This experimental study was conducted between April 2021 and November 2023, involving three groups: a control group (donated eggs) and two study groups (POR and PCO). All three groups received ovulation stimulation drugs. Following oocyte puncture, cumulus cells (CCs) were isolated and placed in a culture medium. After three passages, CCs were exposed to the ADR-β2 agonist isoproterenol and its antagonist propranolol (100nM for both drugs). RNA extraction was performed, and cDNA was synthesized. Real-time PCR was used to determine gene expression, and protein levels were measured through the Western blotting method. Results: The gene expression of Cx 37/43 was significantly reduced in all three groups (P<0.001). For women with PCO and POR, Isop notably decreased expressions (P<0.001), while Prop increased them (P<0.001). Western Blot results confirmed these findings. Conclusion: The findings of this in-vitro study suggest that the beta-2 adrenergic antagonist propranolol could upregulate gene expression of Cx37/43 in the cellular connections of CCs among infertile women. Consequently, propranolol may enhance communication between CCs and oocytes, facilitating the transfer of signalling messengers and other essential agents required for oocyte development. This novel discovery could have significant implications for oocyte growth and maturation, offering valuable perspectives on drug treatment and assisted reproductive technology. This novel discovery could have significant implications for oocyte growth and maturation, offering valuable perspectives on drug treatment and assisted reproductive technology.
Objective: It is estimated that infertility affects approximately 9-30% of couples in their reproductive age and microorganisms may play an important role in such genital system dysfunction. The aim of this study was to investigate the presence of lactobacilli, Gardnerella, Enterobacteriaceae, and streptococci in the vagina, cervix and endometrium of women who referred for infertility and the healthy women who referred for oocyte donation. Materials and methods: The endometrial, cervical and vaginal swab specimens were collected three days after the end of menstruation and cultured to isolate lactobacilli. DNA form these specimens was extracted and subjected to quantitative real-time PCR to determine the frequency of the above bacteria. All uterine biopsy samples were tested for the presence of bacterial DNA by PCR method. Results: 94% of uterine biopsy samples contained bacterial DNA. The frequency of lactobacilli identified by real-time quantitative PCR in these two groups was 40% (endometrial samples), 70% (cervical samples), and 80% (vaginal samples), which differed from lactobacilli isolated by the culture method. The number of lactobacilli from cervical endometrium of healthy donors was higher than in the diseased group. There was a significant difference in the mean of Gardnerella bacteria in the cervix and endometrium and Streptococcus in the cervix (p<0.05). Conclusion: Considering the decrease of lactobacilli and the increase of other bacteria, it is suggested to consider the composition and number of bacteria in the genital tract of asymptomatic infertile women as one of the possible causes of infertility.
Objective: This study aimed to evaluate the urodynamic findings in women with voiding dysfunction symptoms at a referral academic center. Materials and methods: Patients who underwent urodynamics to evaluate voiding dysfunction symptoms between 2019 and 2022 were retrospectively analyzed. Demographic and clinical data were obtained from the electronic data registration system of the urogynecology clinic. Urodynamic findings, such as post-void residual (PVR), maximum urine flow (Q max), detrusor pressure (P det), abdominal leak point pressure (ALPP), and detrusor overactivity, as well as their association with each symptom of voiding dysfunction, were analyzed and reported. Results: A total of 591 women were enrolled in the study, with a mean age of 54.09±12.3 years. The majority had experienced vaginal deliveries (82.9%). The most frequently reported symptom was incomplete voiding (71.1%), followed by post-void dribbling, intermittent stream and others. Post-void residual (PVR) >150 cc was identified in 2.7% of patients and was significantly associated with hesitancy and straining to void. It was also associated with increasing age and anterior and apical compartment prolapse. Conclusion: Voiding dysfunction symptoms do not reliably predict urodynamic findings. The low prevalence of post-void residual (PVR) in symptomatic patients and the lack of correlation between PVR and similar symptoms suggest that symptoms alone may not provide adequate evidence to indicate high PVR. Therefore, urodynamics may be necessary for evaluating patients with voiding dysfunction symptoms.
Objective: This study aimed to evaluate the prognostic value of the progesterone challenge test (PCT) in the diagnosis of hyperplastic and cancerous endometrium in high-risk postmenopausal women. Materials and methods: In this cross-sectional study, 72 postmenopausal women without abnormal uterine bleeding who had risk factors for endometrial cancer were recruited. Patients with endometrial thickness of 4 mm or more as determined transvaginal ultrasonography were tested with progesterone challenge test. If there were any bleeding (spotting to severe bleeding) in the next two weeks, the test would be considered positive. After two weeks, all of the participants despite the result of PCT underwent office endometrial biopsy. In the end, all the results of PCT were compared with endometrial biopsy results. Results: The mean age of the participants was 57.7 ±8.15 years. The progesterone challenge test was positive in 17 women (22%). Among the participants with positive progesterone challenge test, most of them show hyperplasia (62.5%) and 4.2% show endometrial cancer. According to the results, PCT had 37.5% accuracy, 20.8% sensitivity, 70.8 % specificity, 58.8% positive predictive value (PPV), and 30.9 % negative predictive value (NPV) for diagnosis of endometrial pathology. Conclusion: We suggest that due to the unacceptable sensitivity and specificity of the PCT, this test alone is not suitable for screening of endometrial cancer or hyperplasia.
Objective: Perinatal mortality is an indicating factor in social development, and international measures have been taken to reduce maternal and perinatal mortality. This study aims to collect the experts’ opinions about hospitals performance in providing perinatal services and emerge the key indicators for evaluation. Materials and methods: This is a qualitative study using the Delphi technique and based on the focus group discussion sessions with twelve experts, including pediatricians, perinatologists, neonatologists, neonatal care nurses, and midwives with at least five years of work experience. A coordinator managed the sessions, and the discussions continued until saturation. Thematic analysis was performed to extract the major themes and sub-themes. Results: Three main themes of input/structure, process, and outcome are extracted. The input/structure theme consists of human resources, physical space, equipment, and technical support and information. In human resources, the number and proficiency of healthcare providers and mental health problems are expressed. In terms of physical space, the areas and infrastructure facilities are discussed. The proper purchase and allocation of equipment are emphasized in the equipment sub-theme. The need to establish a Health Information Service in level-one centers is mentioned in the support sub-theme. The process theme consists of medical staff retraining and empowerment, referral, follow-up, education, and audits. The maternal and neonatal mortality and morbidity indices are cited in the outcome theme. Conclusion: Our findings provide a wide range of context-specific challenges the healthcare systems face in provision of perinatal health services. As a result of this study, the primary indicators for assessing the hospitals’ performance in providing perinatal services are emerged.
