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.
