Objectives: To compare the effects of leukocyte- and platelet-rich plasma (L-PRP) and pure platelet-rich plasma (P-PRP), both among themselves and with the control group, in preventing intra-abdominal adhesions in an experimental rat model study. Materials and Methods: 34 Sprague-Dawley rats were randomized and divided into the control group (n=8), L-PRP (n=8), and P-PRP (n=8) treatment groups. The fourth group was used only for PRP preparation (5 rats for L-PRP and 5 rats for P-PRP) and was not included in the outcome analysis. All of the rats were operated on by the same two surgeons under general anesthesia for the uterine horn adhesion modeling. Apart from the control group, 1 mL of L-PRP and P-PRP solutions prepared for the other two treatment groups were applied to the lesion. Postoperative adhesion evaluation was performed on the 14th postoperative day. Adhesions were evaluated both macroscopically (presence, severity, and degree of adhesion) and histopathologically (levels of inflammation and fibrosis), and the evaluation was blinded by two similar surgeons. Results: One rat was lost during the study in each treatment group. There was a statistically significant difference in terms of the extent of adhesions among the groups (P = 0.025), the tenacity of the adhesions (P = 0.045), and total adhesion scores (7.13±2.7, 3.86±1.5, and 6.71±2.1; control, L-PRP, and P-PRP, respectively, P = 0.028). This difference was due to Group 2 during binary comparisons. However, the statistical difference between the groups after Bonferroni correction disappeared, apart from the tenacity of adhesions category. In the tenacity of adhesion category, the difference was only between the control group and L-PRP (12.5% in the gentle traction separation control group vs. 85.7% in L-PRP; P = 0.005). On histopathological examination, there was no difference between the groups in inflammation or fibrosis. Conclusions: In the experimental rat uterine horn adhesion modeling, neither L-PRP nor P-PRP was effective in preventing postoperative adhesion formation. However, the adhesion formed in the L-PRP group was more readily separated by gentle traction than in both the control and P-PRP groups.
Objectives: Neonatal sepsis is associated with significant mortality and morbidity, and its rapid diagnosis remains a clinical challenge due to the non-specific nature of its symptoms. The hematological scoring system (HSS) is a low-cost, rapid diagnostic tool based on a complete blood count (CBC). This study aimed to investigate clinical and laboratory findings and to evaluate the diagnostic accuracy of HSS in the rapid diagnosis of neonatal sepsis in a tertiary care center. Materials and Methods: This cross-sectional-analytical study was conducted on 80 neonates (aged <28 days) with suspected sepsis admitted to Tabriz children’s hospital. Based on blood culture results, infants were divided into two groups: definite sepsis (n=3) and non-sepsis (n=77). Clinical symptoms and laboratory parameters (including CBC and CRP) were recorded, and the HSS score was calculated for each infant. The diagnostic accuracy of HSS was evaluated using receiver operating characteristic (ROC) analysis, and indices such as sensitivity and specificity were calculated. Results: The mean gestational age and birth weight were significantly lower in the sepsis group (P<0.001). Gram-positive cocci, specifically Staphylococcus aureus (Coagulase-positive), were the most common causative agents (n=2, 66.7%), followed by Klebsiella pneumoniae (n=1, 33.3%). Among clinical signs, lethargy, hypothermia, and cyanosis were significantly more frequent in the sepsis group (P < 0.05). CRP, I/T ratio, and HSS scores were significantly higher, and platelet counts were lower in the sepsis group (P < 0.001). The ROC curve for HSS showed an area under the curve (AUC) of 0.88. At the optimal cut-off point (≥4), sensitivity was 100% (95% CI: 43.9–100), specificity 83.1%, positive predictive value (PPV) 15.8%, and negative predictive value (NPV) 100%. Conclusions: In this cohort with a low prevalence (3.75%) of culture-proven sepsis, the HSS demonstrated high diagnostic accuracy, particularly with a perfect sensitivity and NPV within our limited sample, effectively ruling out sepsis when the score is low. Incorporating this simple, inexpensive tool into clinical assessment may improve decision-making regarding antibiotic initiation and reduce unnecessary antibiotic exposure. However, the precision of sensitivity and PPV estimates is limited by the small number of sepsis-positive cases.
Objectives: Trochlear dysplasia represents a primary etiological factor in the development of patellar instability within veterinary orthopedics. Wedge‑resection trochleoplasty is frequently used to deepen the femoral trochlear groove, yet the temporal pattern of macroscopic and histological healing following this procedure in rabbits remains insufficiently characterized. This study aimed to evaluate time‑dependent macroscopic and histological cartilage repair following wedge‑resection trochleoplasty in rabbits. Materials and Methods: Fifteen skeletally mature New Zealand White rabbits underwent standardized wedge‑resection trochleoplasty of the right femoral trochlea and were allocated to postoperative evaluations at 4, 8, or 16 weeks (n = 5 per group). Macroscopic assessments were performed using the International Cartilage Repair Society (ICRS) scoring system, and histological repair was evaluated using the ICRS Visual Histological Assessment Scale II across proximal, middle, and distal trochlear regions. Results: Macroscopic and histological scores progressively increased over time, demonstrating continuous cartilage remodeling and improvement in trochlear contour at 4 → 8 → 16 weeks. Distal regions exhibited significantly higher repair scores than proximal regions at all time points (P < 0.05). Conclusions: Wedge‑resection trochleoplasty in rabbits resulted in time‑dependent improvement in both macroscopic appearance and histological cartilage repair, with the most pronounced regeneration observed at 16 weeks. These findings offer quantitative insight into postoperative cartilage remodeling following wedge‑resection trochleoplasty.
Objectives: Diabetic ketoacidosis (DKA) is one of the most severe acute complications of type 1 diabetes mellitus (T1DM) and remains a major cause of mortality in the pediatric population. Early diagnosis of T1DM can prevent the occurrence of DKA; however, late diagnosis is still common in many areas. This study aimed to determine the prevalence of DKA as the first clinical manifestation of T1DM in children admitted to Bandar Abbas children’s hospital in 2024 and to investigate its association with demographic and clinical characteristics. Materials and Methods: This prospective, cross-sectional, descriptive-analytical study was conducted among 140 children and adolescents aged 6 months to 18 years with newly diagnosed T1DM. Data were collected using a checklist designed by the researcher and informed by medical records and clinical history. The variables studied included age, sex, duration of symptoms before diagnosis, severity of DKA, place of residence, parental education level, and clinical outcomes. DKA was diagnosed based on the criteria of the International Pediatric Endocrinology Association. Statistical analysis was performed using SPSS version 26, and statistical significance was defined as P < 0.05. Results: The mean age of the participants was 3.95 ± 8.94 years, and 51.4% of them were girls. DKA was observed in 80 patients (57.1%) as the initial manifestation of T1DM. In terms of severity, moderate DKA was the most common (38.8%), followed by severe (35.0%) and mild (26.2%). Patients with DKA had a longer duration of symptoms before diagnosis and were more often from rural areas. Also, younger age and lower maternal education level were associated with a higher prevalence of DKA. No mortality was observed in this study, and all patients recovered with appropriate treatment. Conclusions: The prevalence of DKA at the time of onset of T1DM in children in southern Iran is high. Late diagnosis, rural residence, younger age, and lower parental education are factors associated with increased incidence of DKA. These results emphasize the importance of public education and implementation of early diagnosis strategies to reduce the burden of DKA in children.
Mertihan Kurdoğlu graduated from Hacettepe University Faculty of Medicine, Department of Medicine (English). He completed his specialty in Obstetrics and Gynecology at Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology between 2001 and 2005. In 2006, he worked as a specialist at Çankırı State Hospital. Between 2007 and 2014, he worked at Van Yüzüncü Yıl University, Faculty of Medicine, Department of Obstetrics and Gynecology. Between 2014 and 2016, he worked in the Gazi University Faculty of Medicine, Department of Obstetrics and Gynecology. During this period, he was assigned by Gazi University to the Division of Minimally Invasive Gynecology and Research, Department of Obstetrics and Gynecology, at the University of Texas Medical Branch in Galveston, Texas, USA, where he received training in robotic surgery under the supervision of Associate Professor Gökhan Sami Kılıç. He is currently working in the field of urogynecology at Gazi University Hospital in Ankara, Turkey. He has published more than 150 scientific papers in national and international journals, receiving nearly 2,700 citations, and has contributed 10 book chapters to national and international textbooks. He has previously served as a member of the editorial board of the Van Medical Journal, as editor of the Turkish Journal of Obstetrics and Gynecology, and as editor-in-chief of the Eastern Journal of Medicine. Currently, he serves as editor-in-chief of the International Journal of Women’s Health and Reproduction Sciences, alongside Prof. Dr. Arash Khaki.
Background: First aid is increasingly supported by high-technology devices designed to reduce time-to-treatment and improve prehospital care. These include automated external defibrillators (AEDs), drone delivery systems, cardiopulmonary resuscitation (CPR) feedback tools, hemorrhage-control technologies, anti-choking suction devices, and overdose-response kits. Objective: To systematically evaluate the clinical effectiveness, operational performance, and feasibility of smart first-aid technologies used in prehospital or simulated emergency settings, with emphasis on time-to-treatment, safety, and outcome improvement. Methods: We conducted a PRISMA-compliant systematic review of peer-reviewed studies indexed in MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and IEEE Xplore. Eligible studies evaluated smart first-aid devices in prehospital or high-fidelity simulated contexts, reporting clinical, performance, time, feasibility, or safety outcomes. Selection and data extraction were performed in duplicate. Results: Twenty-two studies met inclusion criteria across six device categories. Bystander AED use was associated with higher survival to discharge (OR ≈ 1.73) and improved neurological outcomes (OR ≈ 2.12). Drone-AED programs arrived before EMS in ~64–67% of cases, gaining 180–200 seconds. CPR feedback tools improved compression quality by ~15–20 percentage points; survival impact was mixed. Mechanical CPR showed no consistent survival benefit. Civilian tourniquet and hemostatic dressing use improved hemorrhage control and reduced transfusion needs. For opioid overdose, 4 mg intranasal naloxone was as effective as 8 mg, with fewer adverse effects. Conclusions: Smart first-aid devices can reduce treatment delays and enhance process metrics. Early defibrillation showed the strongest clinical benefit, while drone delivery demonstrated promising system-level advantages. Future research should emphasize standardized outcomes, pragmatic trials, and equitable implementation. Study heterogeneity and limited randomized evidence remain key limitations.
Background: Hempseed protein hydrolysate (HPH) exhibits potent antioxidant activity but suffers from physicochemical instability and low bioavailability, limiting its pharmaceutical and nutraceutical applications. Sterol stabilizers can liposomal membrane integrity, yet comparative studies on their effects in HPH-loaded nanoliposomes remain limited. Objective: To develop and characterize HPH-loaded nanoliposomes (HPH-NLs) stabilized with cholesterol (CHO), curcumin (CURC), and gamma-oryzanol (GO), and to evaluate their physicochemical properties, encapsulation efficiency, structural characteristics, and antioxidant activity. Materials and Methods: HPH was produced from hemp protein concentrate via pepsin-catalyzed enzymatic hydrolysis. Nanoliposomes were prepared using the thin-film hydration-sonication method. Formulations were characterized for particle size, polydispersity index (PDI), zeta potential, encapsulation efficiency (EE%), and morphology (SEM). Structural interactions were analyzed by Fourier transform infrared spectroscopy (FTIR) and differential scanning calorimetry (DSC). Antioxidant activity was monitored over 30-day storage. Results: Enzymatic hydrolysis significantly enhanced HPH antioxidant activity compared to non-hydrolyzed protein (DPPH: 42.3% vs. 35.8%; ABTS+: 41.1% vs. 39.1%). All formulations exhibited nanoscale dimensions (<110 nm). GO-stabilized nanoliposomes (GO-NL) demonstrated superior characteristics: smallest particle size (70 +/- 5 nm), lowest PDI (0.183), highest EE% (92 +/- 2.1%), and greatest retention after 30 days (89.5%). FTIR confirmed HPH encapsulation through amide I/II bands. DSC revealed that GO eliminated the cooperative gel-to-liquid crystalline phase transition, indicating enhanced membrane stability. During storage, GO-NL maintained 90.5% of DPPH scavenging activity, significantly outperforming CURC-NL and CHO-NL (P <= 0.05). Conclusions: GO functions as a dual-action stabilizer, simultaneously enhancing membrane integrity and providing antioxidant protection. GO-stabilized HPH nanoliposomes demonstrate enhanced physicochemical stability and antioxidant retention under in vitro storage conditions. These findings support further investigation of this system for potential nutraceutical applications, pending evaluation of release kinetics, gastrointestinal stability, and cellular uptake.
Objectives: Varicocele is a major cause of male infertility, primarily driven by oxidative stress, inflammation, and apoptosis within testicular tissue. Chrysin, a natural flavonoid with potent antioxidant and anti-inflammatory properties, has shown potentiall benefits in reproductive disorders. This study aimed to evaluate the protective effects of chrysin in ap experimental rat model of varicocele. Materials and Methods: Thirty-two adults male Wistar rats were randomly allocated into four groups: Sham, Chrysin (50 mg kg/d), Varicocele, and Varicocele + Chrysin. Varicocele was induced by partial ligation of the left renal vein. After eight weeks of treatment sperm parameters, testicular histopathology, serum oxidative stress markers (MDA, SOD, GPX, TAC), and testicular expression of TNF a, IL. 18, Bax, and Bcl 2 (RT qPCR) were assessed. Statistical analyses included Analysis of Variance (ANOVA) on Kruskal-Wallis tests with appropriate post hoc comparisons. Results: Induction of varicocele markedly decreased testicular mass and compromised sperm parameters including concentration, motility, and morphology while also producing pronounced structural damage within the seminiferous tubules and lowering Johnsen scopes. Oxidative stress was markedly elevated, as indicated by increased MDA and reduced SOD, GPX, and TAC levels. Additionally varicocele upregulated TNF a, IL 18, and Bax while downregulating Bcl 2, resulting in an increased Bax/Bcl 2 ratio. Chrysin treatment significantly ameliorated these changes by improving sperm parameters, preserving testicular architecture reducing lipid peroxidation, restoring antioxidant capacity, and modulating inflammatory and apoptotic gene expression. Conclusions Chrysin exerts strong protective effects against varicocele induced testicular dysfunction through antioxidant, anti inflammatory, and anti apoptotic mechanisms. These findings support its potential as a natural therapeutic candidate for managing varicocele-associated male infertility.
Objectives: Chia seed oil is a nutritionally valuable functional oil rich in polyunsaturated fatty acids, particularly omega-3, whose health benefits strongly depend on oxidative stability during processing and storage. This study aimed to optimize chia seed oil extraction using microwave and moisture pretreatments through response surface methodology (RSM), with emphasis on maximizing oil yield, improving lipid quality, and enhancing omega-3 stability during processing and storage, as assessed by peroxide value (PV) and oxidative stability index (OSI). Materials and Methods: An I-optimal response surface design was applied to investigate the effects of seed moisture content and microwave pretreatment time on oil content (%), PV, and OSI. Model adequacy was evaluated using analysis of variance and diagnostic statistical criteria. Optimal extraction conditions were identified through numerical optimization and experimentally validated. In addition, a 90-day storage stability study was conducted to compare oils produced under optimized and conventional conditions, monitoring PV and OSI changes during storage. Results: The developed RSM models were statistically significant and showed strong predictive performance. Optimal conditions (approximately 8.05% seed moisture and 135.9 s microwave treatment) resulted in the highest oil yield while maintaining low PV and enhancing OSI. During storage, oil obtained under optimized conditions exhibited slower oxidative deterioration and greater resistance to lipid oxidation compared with conventionally extracted oil, indicating improved preservation of omega-3-rich polyunsaturated fatty acids, which are highly susceptible to oxidative degradation. Conclusions: Microwave-moisture pretreatment optimization represents an effective strategy for producing high-quality chia seed oil with high content of omega-3 fatty acid, and improved oxidative stability during processing and storage, supporting its nutritional and health-related value for functional food and nutraceutical applications.
Objectives: Endometriosis is a chronic inflammatory disease and one of the common causes of infertility in women. Increasing evidence suggests that the pathogenesis of endometriosis is not limited to hormonal changes, but also that immune dysregulation plays a key role. The present study aimed to investigate the presence of autoimmunity in the ovarian reserve of patients with endometriosis. Materials and Methods: In this case-control study, 200 women were selected between April 2024 and April 2025. Based on endometriosis, patients were split into two groups: 120 infertile women without endometriosis and 80 infertile women with endometriosis. All patients had blood samples measured for antibodies to antinuclear antibodies (ANA), to anti-thyroid peroxidase (ATPO), to lupus anticoagulant (LAC), and to antiphospholipid antibodies (APLA). Ovarian reserve was evaluated by measuring anti-Mullerian hormone (AMH). Clinical signs and disease severity were recorded. The data were analyzed using SPSS version 22, with a significance level of 0.05. Results: Patients were 34.95 +/- 5.6 years of age and had a body mass index (BMI) of 25.20 +/- 3.56 kg/m(2). The Adhesion (P < 0.0001), sliding (P < 0.0001), kissing ovary (P < 0.001), and uterosacral involvement (P < 0.0001) were all significantly more frequent in the group with endometriosis. It showed that the prevalence of ANA (26.3% vs. 10.1%; P = 0.003), LAC (38.8% vs. 6.7%; P = 0.003), and ATPO (22.5% vs. 10.1%; P = 0.025) was significantly higher in the endometriosis group, while no difference was observed in APLA (P = 0.686). In patients with endometriosis, a significant decrease in oocyte count (P = 0.033) and a significant increase in cycle count (P = 0.045) were observed. Conclusions: In this study, comparing infertile women with those without endometriosis, a significantly higher prevalence of ANA, LAC, and anti-TPO antibodies was observed in women with endometriosis, along with reduced ovarian reserve indices. These findings indicate systemic immune involvement and suggest that ovarian dysfunction may be linked to autoimmune responses. Identification and follow-up of patients with positive antibody tests may therefore be important for fertility management and the prevention of declines in ovarian reserve.
Objectives: This study aimed to evaluate the diagnostic and predictive value of superior vena cava (SVC) Doppler indices in the early detection of intrauterine growth restriction (IUGR) and to examine their incremental contribution beyond conventional arterial Doppler parameters of the umbilical and middle cerebral arteries. Materials and Methods: This cross-sectional analytical study was conducted at a high-risk pregnancy clinic of Kowsar Medical Center between October 2025 and February 2026 on 85 singleton pregnancies at 24-36 weeks' gestation. Fetuses with structural or chromosomal anomalies and pregnancies requiring urgent termination were excluded. Standard fetal biometry and Doppler ultrasound of the umbilical artery (UA), middle cerebral artery (MCA), and SVC were performed. IUGR was defined according to ISUOG criteria and stratified into mild, moderate, and severe subgroups. Statistical analysis was performed using SPSS 26, with P < 0.05 considered significant. Results: The mean maternal age and gestational age were 30 years and 33 weeks, respectively. Most IUGR cases were moderate to severe. Reduced SVC Doppler resistance indices were observed in 58% of IUGR fetuses and were significantly associated with growth restriction (P < 0.05). In contrast, the SVC-to-Aorta diameter ratio did not differ significantly between IUGR and normally grown fetuses. Functional SVC Doppler parameters demonstrated stronger discriminatory value than static vessel size measurements. Conclusions: SVC Doppler indices offer meaningful complementary information regarding fetal hemodynamic redistribution in IUGR. Decreased SVC resistance reflects central circulatory adaptation to placental insufficiency. Integration of venous Doppler assessment with established arterial indices may improve fetal surveillance, although larger prospective studies are needed to confirm clinical utility.
Objectives: This study investigates mothers' perceptions of respectful maternity care (RMC) during childbirth in Urmia, Iran, focusing on experiences of disrespect and service satisfaction. Materials and Methods: A cross-sectional analytical design was employed, involving 400 mothers who experienced either vaginal deliveries or unplanned cesarean sections. Data were collected one month postpartum using tailored questionnaires that assessed RMC, experiences of disrespect and abuse, and service satisfaction based on the SERVQUAL model. Results: The findings revealed that 61.25% of mothers rated their RMC as good, with a mean score of 76.12 +/- 12.99. Among the dimensions of respectful care, participatory care received the lowest score (76.15 +/- 6.67), whereas avoidance of violence scored the highest (86.22 +/- 12.59). Alarmingly, 97.2% of mothers reported experiencing at least one form of disrespect, predominantly related to inadequate pain relief during labor (61%). Furthermore, 90% expressed dissatisfaction with service quality, particularly in responsiveness (-1.98). Key predictors of perceived respectful care included the type of hospital, lack of basic insurance, maternal assessment of service quality, and types of violence encountered. Conclusions: The results underscore an urgent need for reforms in monitoring mechanisms to improve the quality of maternal care, ensuring that dignity and respect are upheld during childbirth. Addressing these issues is crucial for enhancing the overall maternal healthcare experience in Iran.
Objectives: Preoperative anxiety (POA) as an unpleasant reaction in surgical cases is associated with negative intra-postoperative outcomes. This study aimed to determine the main influencing factors on moderate to severe POA in elective surgeries in our hospital. Materials and Methods: This Cross-sectional study was conducted at Alzahra hospital, Rasht, Iran. Firstly 1772 participants were interviewed for the State-Trait Anxiety Inventory to screen cases with more than or equal to 44 scores indicating at least moderate anxiety. Then eligible cases enrolled in the survey and demographic data and the causes of POA were documented. Results: Among 1772 cases candidate for elective surgeries, the data from 530(29.6%) with at least moderate POA were analyzed. Fear of Anesthesia complications (22.45%), post-operation pain (21.16%), and surgery complications (12.5%) were the most common causes of POA. While fear of transfusion was the least important cause (0.64%). Two hundred forty-one participants suffered from one POA factor and 11 from 4 factors. A higher level of education, occupation, and the history of anesthesia and surgery were significantly associated with lower degrees of POA ( P = 0.0001). Conclusions: The prevalence of moderate to high degrees of POA was acceptable in this study; however, most were avoidable. Therefore individuals screening for detecting high-risk cases in the routine workup and assessing the need for psychiatrists’ intervention would be helpful to improve the conditions.
Objectives: The present study aimed to evaluate the effect of Biebersteinia multifida on the quality of life (QoL) in patients with systolic heart failure (HF). Materials and Methods: This parallel, double-blind, placebo-controlled experiment was conducted from November 2018 to May 2020. A total of 60 patients aged 40-75 years with systolic HF were allocated into two groups of intervention (B. multifida) and placebo. All subjects received the B. multifida and placebo capsules twice daily for 60 days. The Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 6-Minute Walk Test (6MWT) were used to determine the primary outcomes improving QoL. The secondary results were improved heart function by echocardiography and serum biochemical markers. Results: There was no significant difference between the study groups before treatment in terms of demographic data and results P > 0.05). Following therapy, the primary outcomes were not different between the two groups (P > 0.05), but the 6MWT was improved in the intervention group. Moreover, the left ventricular myocardial performance index (LVMPI) in the intervention group was significantly higher than the placebo group (P= 0.034). Conclusions: B. multifida root extract, as a supplemental drug, can improve myocardial function and modestly increase the QoL in patients with systolic HF.
Testicular hypoxia, defined as insufficient oxygen supply to the testes, is a critical factor in male infertility and reproductive health issues. N-acetylcysteine (NAC), through its antioxidant properties and role as a glutathione (GSH) precursor, has been proposed as a protective agent against testicular hypoxia. This review evaluates whether NAC improves sperm quality and hormonal receptor regulation by reducing oxidative stress and modulating redox balance. We also summarize NAC’s effects on androgen receptors (ARs), estrogen receptors (ERs), and follicle-stimulating hormone receptors (FSHRs), highlighting its potential to influence spermatogenesis and endocrine function. Evidence from experimental studies and clinical trials suggests that NAC may improve sperm concentration, motility, morphology, and DNA integrity, though results on morphology remain inconsistent. Clinical findings indicate improvements in sperm parameters and oxidative stress biomarkers; however, effect sizes vary, and study limitations must be considered. This narrative review supports NAC as a potential therapy for hypoxia-related male infertility, while emphasizing the need for further clinical trials to clarify optimal dosing, treatment duration, and long-term safety.
Objectives: A growing number of women of reproductive age are battling breast cancer. The younger the age of the breast cancer, the more aggressive gonadal toxic treatments are needed. A large number of younger women with breast cancer are childless and plan to become pregnant after treatment. Thus, this study aimed to understand the structural determinants of health associated with the challenges these women face as they navigate childbearing after breast cancer treatment. Methods: PubMed, Scopus, Embase and Web of Science were searched up to July 2024. The review was preregistered (PROSPERO: CRD42024502269). We used "Newcastle-Ottawa Scale" for risk of bias assessment of studies. Results: A total of nine studies met the inclusion criteria. They were all of high quality and had little chance of being biased. Breast cancer survivors’ reproductive choices and childbearing are influenced by a number of structural determinants of health. These determinants include age, education level, socioeconomic status, housing, race, and ethnicity. Since age was a determinant in seven of eight studies reviewed (the lower the age, the greater the childbearing intention, fertility preservation, counseling, and pregnancy attempt), age appeared to be a more significant and influential factor. Conclusions: This review analysis revealed a connection between the reproductive practices of surviving women and the structural determinants of health and fertility. Reproductive-aged women who have struggled with this condition in the past may face various difficulties because of their fertility problems. Therefore, it seems beneficial to understand these factors and develop strategies to address these obstacles. This will allow these women to live a happy and hopeful life.
Objectives: Gynecomastia and mastalgia are the most typical clinical breast conditions. This systematic review aims to assess the effect of selective estrogen receptor modulators (SERMs) on pubertal gynecomastia and mastalgia. Methods: In this review study, online English databases such as PubMed, Scopus, Web of Science, and Cochrane Library were systematically searched without a time limit until January 10, 2025. Results: Tamoxifen and centchroman are both more effective than placebo in relieving breast pain. Centchroman can reduce the severity of mastalgia by 92-100%. Pain score significantly reduced in the centchroman group compared to the placebo group (P < 0.0001). Centchroman and tamoxifen similarly affected pain relief (P < 0.005). Tamoxifen was more effective than danzol in relieving breast pain (P < 0.001). The effects of tamoxifen were not dose dependent, as 10 mg and 20 mg did not follow a trend, but 10 mg produced significantly fewer side effects. There are inconsistent results when comparing the efficacy of danazol and centchroman at 12 weeks. However, tamoxifen outperformed danazol long-term AT 24 weeks. Four case series were included in the systematic review. Tamoxifen and raloxifene may be effective for the treatment of pubertal gynecomastia. In the first, reduction in breast nodule diameter was 86% in the tamoxifen group and 91%in the raloxifene group. However, a more significant improvement was observed in the tamoxifen group than in the raloxifene group (P = 0.03). In the second study, both groups had a statistically significant breast size reduction (tamoxifen group, P = 0.013; no treatment group, P = 0.038). In the third and fourth studies, the treatment success rate with tamoxifen was calculated to be 86 to 94%. Conclusions: Mild cyclic mastalgia can be treated by making appropriate lifestyle changes. Moderate to severe mastalgia usually requires medical treatment. Ormeloxifene, tamoxifen, and danazol were all effective in relieving breast pain. Tamoxifen and raloxifene may be effective for the treatment of pubertal gynecomastia.
Canan Tapkan studied medicine at Eskişehir Osmangazi University from 2004 to 2010 and completed her specialization in obstetrics and gynecology at Dr. Zekai Tahir Burak Obstetrics and Gynecology Hospital in 2015. Between 2016 to 2022, she worked at Ankara Keçiören Training and Research Hospital, where she also served as an administrative assistant for two years. In 2020, she actively participated in the pandemic response. Since 2022, she has been working at Ankara Atatürk Sanatorium Training and Research Hospital, where she has been actively training pregnant women at the Pregnancy School, which she established. In 2025, she received training at Ankara Bilkent City Hospital in assisted reproductive therapies.
