Intrauterine insemination with husband semen: an evaluation of pregnancy rate and factors affecting outcome

Purpose  The aim was to determine pregnancy rate following intrauterine insemination (IUI) and its associated factors in a university assisted reproductive technique center in Tehran, Iran. Methods  A retrospective analysis of 350 IUI cycles with ovarian stimulation by clomiphene citrate and/or gonadotropins was performed. Results  The overall pregnancy rate was 22% (77/350). Of the 77 pregnancies, 88.3% resulted in live birth, 7.8% in spontaneous abortion, 2.6% in blighted ovum and 1.3% were ectopic. Logistic regression analysis revealed three predictive variables as regards pregnancy: number of the treatment cycle (OR:3.5 CI:1.9 – 6.4 p:0.006), duration of infertility (OR:2.1 CI:1.2 – 3.7 p = 0.001) and age (OR:2.15 CI:1.1 – 4.4 p = 0.04). Pregnancy rate did not have any independent relation to sperm count, type of infertility, number and size of follicle and side of ovulatory ovary. Conclusion  Our results indicate that clomiphene citrate and/or gonadotropins IUI is a convenient and useful treatment option in women with younger age ( <30 years) and fewer treatment cycles and fewer infertility duration (4 years). Capsule Best results for intrauterine insemination with ovarian stimulation is obtained in women with younger age, fewer treatment cycles and fewer infertility duration. This study was conducted in Human Reproduction Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.     

Risk factors for prolonged hospitalization after gynecologic laparoscopic surgery

Objective

To determine perioperative risk factors for prolonged hospitalization after gynecologic laparoscopic surgery.

Methods

Data on patients who underwent gynecologic laparoscopic surgery at a single academic institution from January 2000 to January 2009 were evaluated. Patient demographics, clinical history, intraoperative data, and postoperative adverse events were analyzed. Logistic regression analysis identified significant predictors of prolonged hospitalization (hospital stay > 48 h after surgery). A risk score was created from the analysis to predict prolonged hospitalization.

Results

Eight hundred seven patients were included. The median body mass index was 26.5 kg/m² (range, 14.2-72.3 kg/m²), and the median age was 49 years (range, 12-88 years). Four hundred fifty-nine patients (56.9%) underwent surgery for benign conditions, and 348 (43.1%) underwent surgery for malignant disease. A total of 78 patients (9.7%) had a prolonged hospitalization. Independent predictors of prolonged hospitalization were age > 54 years (P < 0.0001), operative blood loss > 120 mL (P < 0.0001), intraoperative or postoperative blood transfusion (P = 0.0237), and early postoperative complication (P < 0.0001). Having a prior laparoscopy was associated with a shorter hospital stay (P = 0.0276). The risk score showed how changes in perioperative factors change the risk of prolonged hospitalization.

Conclusion

Factors such as age, blood loss, perioperative blood transfusion, and postoperative complications are associated with prolonged length of stay after laparoscopic surgery, while having a prior laparoscopy is associated with a shorter hospital stay. A clinical scoring system can be used to estimate probability of prolonged hospitalization after gynecologic laparoscopic surgery.     

Impact of obesity on diastolic function in subjects < or = 16 years of age

The aim of this study was to investigate the impact of obesity on diastolic function in children and adolescents. Echocardiographic measurements were compared in 28 obese subjects (14 males, 14 females) and 15 age- and gender-matched lean controls (8 males, 7 females). Two-dimensional ultrasound imaging, M-mode imaging, and pulse-wave conventional and tissue Doppler measurements were used to assess cardiac structure and function at rest. No differences were evident between lean and obese subjects in age (13.3 +/- 0.5 vs 12.4 +/- 0.4 years), height (163 +/- 4 vs 159 +/- 2 cm), or systolic blood pressure (119 +/- 3 vs 123 +/- 2 mm Hg). Body mass (54.6 +/- 4.0 vs 85.8 +/- 3.6 kg, p < 0.0001) and body mass index (20.5 +/- 0.7 vs 33.3 +/- 1.0 kg/m2, p < 0.00001) were significantly greater in the obese subjects, whereas measurements of wall thickness (interventricular septal wall 0.86 +/- 0.04 vs 0.89 +/- 0.02 cm, posterior wall 0.83 +/- 0.04 vs 0.91 +/- 0.02 cm) and fractional shortening (38.6 +/- 1.2% vs 38.8 +/- 1.2%) did not significantly differ. The E/E' ratio (6.86 +/- 0.20 vs 8.30 +/- 0.32, p < 0.01), E' (13.93 +/- 0.38 vs 12.29 +/- 0.44 cm/s, p < 0.05), the E'/A' ratio (2.49 +/- 0.17 vs 2.05 +/- 0.09, p < 0.05), and the deceleration time of early transmitral blood flow velocity (125.3 +/- 7.7 vs 154.5 +/- 6.8 ms, p < 0.01) were significantly different between the groups, suggesting reduced diastolic function in the obese subjects. In conclusion, these data suggest that indexes of diastolic function, including tissue Doppler measures, are significantly impaired in obese young subjects.     

HLA-DRBeta1, circulating Th1/Th2 cytokines and immunological homunculus in coronary atherosclerosis

Coronary atherosclerotic disease is one of the most endangering health disorder worldwide. This study was designed to investigate the correlation between HLA-DR1 alleles and circulating Th1/Th2 type cytokines in coronary atherosclerosis. By Elisa, Th1/Th2 type cytokines were determined in serum samples of 31 subjects with unstable angina, 27 subjects with chronic stable angina and 24 individuals as normal control. By SSP-PCR, more than 100 alleles of HLA-DRBeta1 were typed in 24 subjects who had skewed serum levels of Th1/Th2 type cytokines. Lipid profiles were determined by the routine methods of clinical laboratory in all subjects. The mean serum concentration of IL-10 in normal control subjects was higher in comparison to the patient groups.0.33±0.59 pg/ml versus 0.064±0.3 pg/ml in unstable angina pectoris group (p<0.028) and 0.22±0.6 pg/ml in chronic stable subjects. There was no statistically significant difference among the groups in serum levels of other desired cytokines (IFN-Gamma, IL-4). 33.33% of normal control subjects were HLA-DR16 positive whereas none of the subjects with chronic stable angina or individuals with unstable angina pectoris was positive for this antigen. The mean concentration of serum LDL-cholesterol in normal control group was high 142.046±35.40 (pg/ml).This preliminary study shows that the atherogenic effect of the LDL- cholesterol may be dampened by HDL-cholesterol through anti inflammatory cytokine IL-10 and HLA-DR16, a phenomenon interpretable via immunological homunculus theory.     

Injury surveillance information system: A review of the system requirements

Purpose: An injury surveillance information system (ISIS) collects, analyzes, and distributes data on injuries to promote health care delivery. The present study aimed to review the data elements and functional requirements of this system. Method: This study was conducted in 2019. Studies related to injury surveillance system were searched from January 2000 to September 2019 via the databases of PubMed, Web of Knowledge, ScienceDirect, and Scopus. Articles related to the epidemiology of injury, population survey, and letters to the editor were excluded, while the review and research articles related to ISISs were included in the study. Initially 324 articles were identified, and finally 22 studies were selected for review. Having reviewed the articles, the data needed were extracted and the results were synthesized narratively. Results: The results showed that most of the systems reviewed in this study used the minimum data set suggested by the World Health Organization injury surveillance guidelines along with supplementary data. The main functions considered for the system were injury track, data analysis, report, data linkage, electronic monitoring and data dissemination. Conclusion: ISISs can help to improve healthcare planning and injury prevention. Since different countries have various technical and organizational infrastructures, it is essential to identify system requirements in different settings.     

Unhappy triad of the knee: What are the current concepts and opinions?

The association between injuries to the anterior cruciate ligament, medial collateral ligament, and medial meniscus (MM) has been known to orthopedic surgeons since 1936; O'Donoghue first used the term "unhappy triad" of the knee to describe this condition in 1950. Later studies revealed that involvement of the lateral meniscus is more common than MM in these cases, leading to a change in the definition. Recent studies have revealed that this triad may be primarily linked to knee anterolateral complex injuries. Although there is not a definite management protocol for this triad, we try to mention the most recent concepts about it in addition to expert opinions.     

Third trimester growth restriction patterns: individualized assessment using a fetal growth pathology score

Objective: To qualitatively and quantitatively characterize third trimester growth patterns in fetuses/neonates with growth restriction using Individualized Growth Assessment.

Methods: Serial fetal size measurements from 73 fetuses with proven growth restriction were evaluated using a novel composite parameter, the Fetal Growth Pathology Score (FGPS1). Third trimester FGPS1 measurements plotted against fetal age were examined for patterns. Identified patterns were characterized using the four components of the FGP1 [head circumference (HC), abdominal circumference (AC), femur diaphysis length (FDL), estimated weight (EWT)]. A secondary characterization using age of onset, duration and magnitude of the growth abnormality process was also performed. Frequencies and magnitudes of abnormal values in different FGPS1 patterns were compared.

Results: Five growth restriction patterns were found in 70/73 (95.9%) of the cases, with progressive worsening [Pattern 1 (37.0%)] and abnormal growth identified only at last scan [Pattern 2 (27.4%)] being the most common. These two patterns were usually statistically different from each other and the other three with respect to size parameter abnormalities and abnormal growth process characteristics (MANOVA). Growth abnormalities in all parameters of the FGPS1 contributed to the five abnormality patterns although AC and EWT were most important. The age of onset, duration and magnitude were similar between patterns except for Pattern 2, which had a late onset and a short duration (GLM?+?contrasts).

Conclusions: Our study represents the first detailed evaluation of third trimester growth restriction using methods that consider the growth potential of each fetus. Five distinctive and repetitive patterns were found, suggesting that fetal growth restriction evolves in different ways. Further research is needed to determine the relationships of these patterns to physiological/biochemical changes and adverse outcomes associated with growth restriction.     

Association of Dietary Patterns with Sociodemographic and Health-related Factors among Coronary Artery Disease (CAD) Patients

This study aimed to identify the association of dietary patterns with sociodemographic and health-related characteristics among coronary artery disease patients. In this cross-sectional study, the participants were 250 patients coronary artery disease aged ≥ 40 years old. Data collection was done using questionnaires related to sociodemographics, health-related factors, and food-frequency intake information. Three dietary patterns (traditional, western, and healthy) were obtained using principal component analysis. The result showed that dietary patterns were associated with sociodemographic and health-related factors. According to the result, all the factors were taken very seriously when planning a promotional program for healthy lifestyle in prevention of CAD.     

Comparison of artificial neural network and logistic regression models for prediction of outcomes in trauma patients: A systematic review and meta-analysis

Background

Currently, two models of artificial neural network (ANN) and logistic regression (LR) are known as models that extensively used in medical sciences. The aim of this study was to compare the ANN and LR models in prediction of Health-related outcomes in traumatic patients using a systematic review.