Malihe Hasanzadeh; Mina Baradaran Khalkhale; Akram Behroznia
Volume 2, Issue 2 , May and June 2017
Abstract
Introduction: The prevalence of ectopic pregnancy is 1 to 2% and a previous cesarean section scar ectopic pregnancy or hysterectomy occurs as rare as 1 per 2000 pregnancies. In the current case report, the authors introduced ectopic pregnancy in cesarean scar with unstable hemodynamic condition and surgical ...
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Introduction: The prevalence of ectopic pregnancy is 1 to 2% and a previous cesarean section scar ectopic pregnancy or hysterectomy occurs as rare as 1 per 2000 pregnancies. In the current case report, the authors introduced ectopic pregnancy in cesarean scar with unstable hemodynamic condition and surgical management to preserve uterus.
Case Presentation: A 31-year-old pregnant female in the 9th week of pregnancy was admitted with vaginal bleeding and slight pain in the hypogastrium. The cesarean scar pregnancy was confirmed by sonography. In the course of hospitalization, due to the patient’s hemodynamic instability, the emergency laparotomy was performed. In the previous cesarean section scar, a 3 × 4 cm mass with a massive hematoma was found. It was removed and placental bed was sutured. Since the vaginal bleeding continued, the uterine artery ligation was carried out and due to severe bleeding, Foley catheters were packed inside the uterus. Two days later, the patient was discharged from the hospital in good general condition.
Conclusions: Despite the rarity of ectopic pregnancies in the previous cesarean section scars, paying attention and having this kind of pregnancy in mind can aid its early diagnosis and reduce possible morbidity and mortality including uterine rupture and severe bleeding, which can be considered as its irreversible complications.
Bouhlol Ghorbanian; Yousef Saberi
Volume 2, Issue 2 , May and June 2017
Abstract
Background: Atherogenic indices are among risk factors of diabetes which can cause cardiovascular diseases. The purpose of this study was to examine the effect of a 10-week aerobic training on atherogenic indices, lipid profile, and body composition in women with type II diabetes.
Methods: In this ...
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Background: Atherogenic indices are among risk factors of diabetes which can cause cardiovascular diseases. The purpose of this study was to examine the effect of a 10-week aerobic training on atherogenic indices, lipid profile, and body composition in women with type II diabetes.
Methods: In this quasi-experimental study, 40 postmenopausal women with type II diabetes (aged 40 to 60 years) were selected using convenience sampling method and were randomly assigned to experimental (n = 20) and control (n = 20) groups. The exercise protocol included a 10-week aerobic training [aerobic exercise and walking for 3d/wk, 45 to 60 min/d with 45 to 60% heart rate reserve (HRR)]. The atherogenic indices of non-HDL cholesterol (non-HDL-c), atherogenic index of plasma (AIP), low-density lipoprotein cholesterol to high-density lipoprotein ratio (LDL-c/HDL-c ratio), total cholesterol to high-density lipoprotein ratio (TC/HDL-c), lipid product index (LPA), lipid profile, and body composition were measured before and after the intervention. The obtained data were analyzed using t-test. The statistical significance criterion was set at P < 0.05.
Results: The results showed that the levels of TG, LDL-c/HDL-c, and TC/HDL-c significantly decreased as a result of the intervention. However, the changes of LPA, AIP, HDL-c, LDL-c, TC, non-HDL-c, and body composition indices were not significant.
Conclusions: Considering the results of the current study, it seems that aerobic exercise and walking with appropriate volume and intensity can affect atherogenic indices, lipid profile, and body composition in diabetic patients and can reduce the risk of cardiovascular diseases, especially atherosclerosis, among these patients. Further studies are needed to achieve more accurate results.
Soodabeh Darvish; Koorosh Etemad; Azar Mosaheb; Ghasem Yazdanpanah
Volume 2, Issue 2 , May and June 2017
Abstract
Objectives: This study aimed to compare maternal and neonatal side effects of natural vaginal delivery (NVD) under neuro-axial analgesia with usual NVD and C-section.
Methods: In this single center prospective cohort study, deliveries carried out in a 7 months’ period were evaluated after getting ...
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Objectives: This study aimed to compare maternal and neonatal side effects of natural vaginal delivery (NVD) under neuro-axial analgesia with usual NVD and C-section.
Methods: In this single center prospective cohort study, deliveries carried out in a 7 months’ period were evaluated after getting informed consent. The study is approved by the ethics committee of Shahid Beheshti University of Medical Sciences. Mothers were categorized into 3 groups of C-section, NVD with an analgesia, intervention, and usual NVD. Afterwards, maternal and neonatal side effects after delivery were assessed using physical examinations, laboratory results, and interviews.
Results: Overall, 121 mothers were equally assigned to 3 groups. No significant differences were found in the first and fifth-minute APGAR scores of the neonates born in these 3 groups. Moreover, none of the neonates’ fifth-minute APGAR scores were less than 7. In addition, hypoxia (umbilical artery pH < 7.2) was observed more in the neonates delivered by NVDs with analgesia interventions compared to the other 2 groups. In comparison with the mothers in the other 2 groups, headache and pruritus were more prevalent among the mothers who had NVDs under neuro-axial analgesia.
Conclusions: Given the advantages of natural vaginal deliveries for mothers and their fetuses and considering the side effects of C-sections without medical indications, propagating painless NVDs could be a proper solution for increasing the prevalence rate of NVDs in the society. Conducting further studies on larger samples is recommended.
Waleed El-Khayat; Fatmafaisal Ibraheem; Amal Mohsen Ahmed; Ashraf Abdelrahman Ramadan; Sara E Khalifa; Mohammed Faisal Ebrahim
Volume 2, Issue 2 , May and June 2017
Abstract
Background: Abnormal uterine bleeding is a very common gynecological problem, especially in perimenopausal women. Intracavitary lesions have been reported in more than 40% of the referred patients.
Objectives: To compare the diagnostic accuracy of 3-dimensional sonohysterography (3D-SHG) versus hysteroscopy ...
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Background: Abnormal uterine bleeding is a very common gynecological problem, especially in perimenopausal women. Intracavitary lesions have been reported in more than 40% of the referred patients.
Objectives: To compare the diagnostic accuracy of 3-dimensional sonohysterography (3D-SHG) versus hysteroscopy in the evaluation of uterine cavity in patients with perimenopausal bleeding and suspected intracavitary lesions, to evaluate the correlations between these findings and histopathological results, and to determine if 3D-SHG is superior or comparable to hysteroscopy in the diagnosis of these lesions.
Methods: A total of 50 women with perimenopausal bleeding and suspected intracavitary lesions, detected by either 2D transvaginal ultrasound or hysterosalpingography, were subjected to 3D saline-infusion sonohysterography (3D-SIS), office hysteroscopy, subsequent surgical procedures (i.e., fractional curettage, hysterectomy, polypectomy, or myomectomy), and finally histopathological examinations.
Results and Conclusions: Based on the findings, 3D-SIS is comparable to hysteroscopy in the diagnosis of intracavitary lesions in terms of sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy
Soheila Aminimoghaddam; Ghazal Kamyabi; Fariba Yarandi; Soghra Zarei
Volume 2, Issue 2 , May and June 2017
Abstract
Background: Endometrial carcinoma is the most common cancer of the female genitalia and its prevalence is 2% to 3% along the females’ lifetime. This adenocarcinoma is diagnosed in the early stages because the patients become symptomatic early in the course of disease. The correlation of the lower ...
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Background: Endometrial carcinoma is the most common cancer of the female genitalia and its prevalence is 2% to 3% along the females’ lifetime. This adenocarcinoma is diagnosed in the early stages because the patients become symptomatic early in the course of disease. The correlation of the lower uterine segment involvement (LUSI) with the recurrence, and the survival rates in patients with endometrial adenocarcinoma are always questionable. Confirming the prognostic significance of LUSI can fundamentally improve the current state of patients’ surveillance. The current study aimed at investigating the association of lower uterine segment involvement with deep myometrial invasion in endometrial adenocarcinoma.
Methods: In the current retrospective cohort study, 54 patients with stage I endometrial endometrioid adenocarcinoma who underwent surgery in Mirza-Koochak-Khan Hospital, Tehran, Iran, from 2004 to 2014 were divided into 2 groups according to the presence of LUSI. In the current cohort study, the data from the patients exposed to LUSI were obtained by questionnaires to measure deep myometrial invasion besides post-operative adjuvant radiotherapy. The median of follow-up period was 48 months for all of the patients, which started after their surgery, and the measurement period for variables were similar to those of the follow-up period, which was 48 months. They were compared regarding to age, tumor grade, depth of myometrial invasion, lymphovascular involvement, extra uterine diseases, the extent of lymphadenectomy, adjuvant therapy, recurrence rate, time, and location. The data analysis was conducted by the SPSS v.16 statistical software (Chicago, IL, USA) at the significance level of 5%. In the investigation, Chi-square, the Kolmogorov-Smirnov, t test, and the Mann-Whitney U tests were used.
Results: Group 1 consisted of 13 patients with LUSI and group 2 had 41 patients without LUSI divided by a non-random sampling method. According to the results of the Mann-Whitney U test, there was a significant difference between the mean age of patients with LUSI and that of the ones without LUSI (P = 0.03). It showed that the mean age in the former group was significantly higher than that of the latter. A Chi-square test showed no significant association between the lymphovascular involvement and the presence of LUSI (P = 0.1). The Fisher exact test showed that patients with LUSI had significantly higher rate of radiotherapy after surgery rather than the ones without LUSI (P < 0.001).
Conclusions: In conclusion, there was a significant association between the lower uterine segment involvements with deep my ometrial invasion in the endometrial endometrioid adenocarcinoma. In other words, there was a significant difference in the depth of myometrial invasion between the groups, and the patients with LUSI had deeper myometrial invasion (the Mann-Whitney U test, P < 0.001).
Zinat Ghanbari; Tahereh Foroughifar; Jayran Zebardast; Samrand Salimi; Saman Tootoonchi; Sara Shabihkhani; Mahnaz Mokhtari Garakani; Tayebeh Forooghifar
Volume 2, Issue 2 , May and June 2017
Abstract
Background: It seems that some herbal medicines such as sage or vitagnus traditionally used as treatment agents are effective on menopausal symptoms such as hot flashes; therefore, the current study aimed at assessing the effect of vitagnus on menopausal symptoms.
Methods: The current study was a ...
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Background: It seems that some herbal medicines such as sage or vitagnus traditionally used as treatment agents are effective on menopausal symptoms such as hot flashes; therefore, the current study aimed at assessing the effect of vitagnus on menopausal symptoms.
Methods: The current study was a prospective clinical trial conducted on 100 menopausal patients divided into 3 groups. In each group, hot flash was treated with vitagnus, sage, or placebo pills and patients were followed-up at the days 15 and 30 after the treat- ment. The data were analyzed by descriptive (percentage, mean, and standard deviation) and inferential (chi-square, t-test, McNa-mara, repeated ANOVA) statistics with SPSS software, version 21 (IBM SPSS, Armonk, NY, USA).
Results: Average of hot flash in vitagnus group was 55.19 ± 14.53; it was also 60.26 ± 14.44 and 60.73 ± 12.30 in the sage and control groups. According to the Cooperman questionnaire score, comparison of hot flash data showed no significant difference between the groups before treatment (the Cooperman questionnaire score < 14) (P = 0.894), (15 - 20) (P = 0.262), (21 - 35) (P = 0.800), (35 < the Cooperman questionnaire score) (P = 0.867). The current study analysis showed no significant difference between the groups in the severity of menopause symptoms at 15-day follow-up (the Cooperman questionnaire score < 14) (P = 0.477), (the Cooperman’s questionnaire score 15 to 20) (P = 0.620), (the Cooperman questionnaire score 21 to 35) (P = 0.243), (35 < the Cooperman questionnaire score) (P = 0.278). But, the severity of menopause symptoms at 30-day follow-up showed significant differences between the groups, except between 15 - 20 and 21 - 35 scores (the Cooperman questionnaire score < 14) (P = 0.306), (15 - 20) (P = 0.005), (21 - 35) (P = 0.007), (35 < the Cooperman questionnaire score) (P = 0.785).
Conclusions: The results of the current study showed that vitagnus and sage were effective on the reduction of menopausal symptoms in postmenopausal females. The effect of placebo on the improvement of menopausal symptoms was significant and it is recommended to be used as an agent to reduce the psychological outcomes of menopause.
Zahra Shahraki; Khadije Rezaie Keikhaie; Nooshin Amjadi; Zohrehsadat Hashemi Bonjar; Hosseinali Jahantigh; Fatemeh Doosti; Mahboobeh Shirazi
Volume 2, Issue 2 , May and June 2017
Abstract
Background: Preeclampsia is one of the causes of maternal and prenatal mortality and morbidity. The 24-hour urine sample is considered as a gold standard for preeclampsia diagnosis and shortening the time of urine collection will result in the patients’ convenience and shorter hospitalization. ...
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Background: Preeclampsia is one of the causes of maternal and prenatal mortality and morbidity. The 24-hour urine sample is considered as a gold standard for preeclampsia diagnosis and shortening the time of urine collection will result in the patients’ convenience and shorter hospitalization. The goal of this study was to determine thee diagnostic accuracy of 4 hour urine protein in comparison with 24 hour urine protein in pregnant women.
Methods: One hundred pregnant women, with a gestational age of more than 20 weeks, and were suspicious to preeclampsia were enrolled. The 24-hour as well as the 4-hour urine sample were collected. All data were analyzed using the SPSS software, version 20 (SPSS Inc., Chicago, IL, USA). The correlation coefficient was used to determine relationship between the 4 and 24-hour urine proteins. receiver operating characteristic (ROC) curve was used to determine optimal cut-off values of 4 hour proteinuria.
Results: The mean age and mean gestational age of participants was 26.8 & 6.1 years and 34.1 & 3.4 weeks. The mean 4-hour urine protein was 165.6 & 170.2 mg and the mean 24 hour urine protein was 926 & 1013 mg. The mean age, 4-hour urine protein, and 4 as well as 24 hour urine volumes were significantly different between cases with no, mild, or severe proteinuria. Pearson correlation coefficient between 4 and 24 hour proteinuria was strong (r = 0.97 and p < 0.001). The best cut off point for 4-hour proteinuria to determine proteinuria was 69.5 mg with a sensitivity of 93% and specificity of 100%. (Area under the curve = 0.99, p < 0.001).
Conclusions: Women that are suspicious to have preeclampsia, the total 4-hour urine protein values positively correlated with values of 24-hour samples.
Soheila Aminimoghaddam
Volume 2, Issue 2 , May and June 2017
Abstract
Combined oral contraceptive pills (OCPs) contain estrogen (ethinylestradiol) and progesterone (first-generation levonorgestrel and fourth-generation drospirenone). Progesterone has peripheral effects on the endometrium, fallopian tubes, and cervix and can promote contraception. These pills are used to ...
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Combined oral contraceptive pills (OCPs) contain estrogen (ethinylestradiol) and progesterone (first-generation levonorgestrel and fourth-generation drospirenone). Progesterone has peripheral effects on the endometrium, fallopian tubes, and cervix and can promote contraception. These pills are used to prevent pain caused by Mittelschmerz syndrome and endometriosis and to treat hyperandrogenism. To prescribe contraceptives, it is adequate to take the patient’s medical history and blood pressure. In the absence of risk factors, patients should be followed-up by history-taking, blood pressure measurement, urinalysis, Pap smear test, and examination of breasts, pelvis, and liver. The risk of venous thrombosis in new OCPs is twice higher than that of older generations and usually occurs in the first year of consumption. The only absolute contraindications for the use of new OCPs include chronic and acute cholestatic liver diseases. In fact, use of new OCPs increases the risk of liver adenoma, but not hepatocellular carcinoma. On the other hand, in female patients with genital tract cancers, risk of endometrial and ovarian epithelial cancers decreases following the use of OCPs. However, the risk of cervical adenocarcinoma increases after 5 years of consumption due to cervical eversion and impaired vitamin metabolism. These pills are contraindicated in women above 35 years who smoke more than 15 cigarettes daily or have uncontrolled hypertension, venous thromboembolism, migraine aura, severe hyperglycemia, breast cancer (diagnosed or suspected), or diabetes mellitus associated with cardiovascular diseases.
