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Shiravani Z, Mirshekari K, Larki MH, Shafiee N, Haghshenas MR, Ghaderi A, Fattahi MJ. Evaluation of the genetic diversity of KIR genes in patients with endometrial cancer. J Reprod Immunol 2024; 162:104217. [PMID: 38387251 DOI: 10.1016/j.jri.2024.104217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 01/01/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024]
Abstract
Endometrial cancer (EC) constitutes more than half of all genital cancers in women, with an increasing incidence in different countries. Natural killer cells (NK cells) are kinds of innate immune cells that are controlled by sets of receptors, such as killer cell Ig-like receptors (KIRs), which can inhibit or activate NK cells. In this study, we evaluated the diversity and genetic association of KIRs in confirmed cases of endometrial cancer compared to healthy controls. A total of 151 women with EC and 167 age/race-matched healthy controls were analyzed for KIR genes. Demographic and histopathologic data were gathered in questionnaires, and 16 KIR genes along with two variants of KIR2DS4 (KIR2DS4fl and KIR2DS4del), were genotyped by usingsequence specific primers-polymerase chain reaction (SSP-PCR) method. A comparison between cases and controls revealed that although there were not any significant differences in A haplotype associated genes and also the variants of KIR2DS4 (p >0.05), B haplotype associated genes such as KIR2DS2 and KIR2DL2 decreased significantly in EC patients in comparison with healthy controls (p=0.03 and p=0.01, respectively). Furthermore, we found that EC mostly developed in cases with the AA genotype; however, the carriers of Bx and C4T4 genotypes were less frequent in patients with EC. Our results revealed that KIR2DS2 and KIR2DL2, along with Bx and C4T4 genotypes, have a protective impact against developing endometrial cancer in Iranians.
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Affiliation(s)
- Zahra Shiravani
- Gynecology Oncology Division, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kimia Mirshekari
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marjan Hematian Larki
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nargess Shafiee
- Gynecology Oncology Division, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Haghshenas
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Ghaderi
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Javad Fattahi
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Haghshenas MR, Shiravani Z, Samare-Najaf M, Khansalar S, Razavinasab SA, Ghaderi A, Jamali N. Clinical significance of IL-37 serum level and polymorphism in patients with endometrial cancer. Eur Cytokine Netw 2023; 34:63-69. [PMID: 38526176 DOI: 10.1684/ecn.2023.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Endometrial cancer (EC) is recognized as the second most common type of cancer among women. Interleukin-37 (IL-37) is a recently discovered member of the IL-1 cytokine family characterized by its anti-inflammatory properties, which are believed to have both anti-tumour and tumorigenic effects. However, the precise role of IL-37 in the development of EC remains largely unknown. In the current study, we aimed to explore genotype and allele frequencies of the IL-37 gene (rs4241122) and measure IL-37 protein levels in patients with EC, with a view to determining the clinical significance in these patients. A total of 105 patients with confirmed EC and 105 healthy controls, aged 31-73, participated in the study. IL-37 serum levels were investigated using an ELISA method, while the frequency of genotypes and alleles of the IL-37 gene was determined using the ARMS-PCR method. The findings demonstrate a significant increase in IL-37 serum levels in EC patients compared to controls (p<0.0001). Moreover, higher levels of IL-37 were strongly associated with unfavourable indices, such as EC grade III, poorly differentiated tumours, and regional spread of tumour cells (p<0.05). However, genotyping of the IL-37 gene revealed no significant difference between the two groups, and there was no association between IL-37 genotype and IL-37 protein level or clinicopathological characteristics (p>0.05). The results of this study suggest that elevated serum levels of may contribute to tumour progression, probably through its immune suppressive activity. Clinically, IL-37 may serve as a promising factor and/or therapeutic target for EC management, although, further studies are warranted.
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Affiliation(s)
- Mohammad Reza Haghshenas
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Samare-Najaf
- Biochemistry Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soolmaz Khansalar
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Abbas Ghaderi
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Navid Jamali
- Department of Laboratory Sciences, Sirjan School of Medical Sciences, Sirjan, Iran
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Najib FS, Bahrami S, Shiravani Z, Alavi SMA. Choriocarcinoma in tubal pregnancy: A case report. Clin Case Rep 2023; 11:e7977. [PMID: 37780932 PMCID: PMC10533381 DOI: 10.1002/ccr3.7977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023] Open
Abstract
Key Clinical Message Choriocarcinoma of the fallopian tube is extremely rare and highly susceptible to early metastasis. Clinical manifestations of ectopic pregnancy and choriocarcinoma are the same, and all patients with ectopic pregnancy should be evaluated for choriocarcinoma based on histopathological findings. Adjuvant chemotherapy (after surgery) is the proposed treatment for tubal choriocarcinoma. Abstract Choriocarcinoma is a malignant epithelial tumor of the chorionic villi that often manifests after a normal or molar pregnancy. The primary tubal choriocarcinoma associated with ectopic pregnancy is extremely rare and can be misdiagnosed as an ectopic pregnancy since symptoms including vaginal bleeding, amenorrhea, elevated beta-human chorionic gonadotropin (BHCG) levels, and pelvic pain are shared. A 34-year-old G4P3003 woman presented with a one-week history of vaginal bleeding and right lower abdominal pain, which had intensified a day before admission. Clinical and paraclinical examinations pointed to a ruptured tubal pregnancy; hence, an emergency laparotomy was performed, and a right salpingectomy was carried out on the patient. However, a nonsignificant decline in BHCG level was observed, and histological examination revealed tubal choriocarcinoma; hence, a metastasis workup was carried out, yet no metastasis was detected. Six sessions of chemotherapy consisting of Etoposide, Methotrexate, Dactinomycin, Cyclophosphamide, and Vincristine (EMA-CO) were administered without complication, in such a way that the BHCG level normalized after three sessions of chemotherapy. Evaluations after 1 year from the completion of chemotherapy revealed that the patient had no subsequent problems. Choriocarcinoma of the fallopian tube is extremely rare and highly susceptible to early metastasis. Clinical manifestations of ectopic pregnancy and choriocarcinoma are the same, and all patients with ectopic pregnancy should be evaluated for choriocarcinoma based on histopathological findings. Metastasis workup should be considered for all individuals with choriocarcinoma. Adjuvant chemotherapy (after surgery) is the proposed treatment for tubal choriocarcinoma.
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Affiliation(s)
- Fateme Sadat Najib
- Department of Obstetrics and Gynecology, Division of Oncology Gynecology, School of MedicineShiraz University of Medical SciencesShirazIran
- Infertility Research CenterShiraz University of Medical SciencesShirazIran
| | - Samaneh Bahrami
- Department of Obstetrics and Gynecology, Division of Oncology Gynecology, School of MedicineShiraz University of Medical SciencesShirazIran
- Department of Obstetrics and Gynecology, Division of Perinatology, Imam Khomeini HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, Division of Oncology Gynecology, School of MedicineShiraz University of Medical SciencesShirazIran
- Maternal‐Fetal Medicine Research CenterShiraz University of Medical SciencesShirazIran
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Shiravani Z, Bahrami S, Najib FS, Alavi SMA. Borderline Brenner tumor of the ovary with mucinous metaplasia: A case report. Clin Case Rep 2023; 11:e7967. [PMID: 37780922 PMCID: PMC10533387 DOI: 10.1002/ccr3.7967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/18/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023] Open
Abstract
Key Clinical Message To date, there have been disparate reports regarding borderline forms of Brenner tumors, while research on concomitant mucinous proliferation is even more irregular; however, it has been observed that proper diagnosis and treatment have proven to have a favorable prognosis on the aforementioned tumor. Abstract Brenner tumor is a rare epithelial ovarian neoplasm responsible for 2%-3% of all ovarian tumors. These tumors are usually asymptomatic and can usually be found incidentally in pathological studies. They can also manifest themselves as abdominal pain or abnormal uterine bleeding. A 41-year-old female with a history of anemia referred to the hospital suffering from abdominal pain for at least 1 month before the referral period. Physical examination revealed a mobile palpable mass in the left lower abdomen. Ultrasound and pelvic computed tomography scan (CT scan) revealed a left ovarian complex cyst. Left salpingo-oophorectomy was performed on the patient, and the cyst was removed. Pathological findings revealed an atypical proliferative Brenner tumor with mucinous metaplasia. To date, there have been disparate reports regarding borderline forms of Brenner tumors, while research on concomitant mucinous proliferation is even more irregular; however, it has been observed that proper diagnosis and treatment have proven to have a favorable prognosis on the aforementioned tumor.
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Affiliation(s)
- Zahra Shiravani
- Department of Obstetrics and GynecologyDivision of Oncology GynecologySchool of MedicineShiraz University of Medical SciencesShirazIran
- Maternal‐Fetal Medicine Research CenterShiraz University of Medical SciencesShirazIran
| | - Samaneh Bahrami
- Department of Obstetrics and GynecologyDivision of Oncology GynecologySchool of MedicineShiraz University of Medical SciencesShirazIran
- Department of Obstetrics and GynecologyDivision of PerinatologyImam Khomeini HospitalAhvaz Jundishapur University of Medical SciencesAhvazIran
| | - Fateme Sadat Najib
- Department of Obstetrics and GynecologyDivision of Oncology GynecologySchool of MedicineShiraz University of Medical SciencesShirazIran
- Infertility Research CenterShiraz University of Medical SciencesShirazIran
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Shiravani Z, Nazari Z, Yazdani F, Najib FS, Jahromi MA, Momtahan M, Pourseyed S, Moradialamdarloo S, Tafti MH. Evaluation of the Therapeutic Effect of Quadrivalent Human Papillomavirus (HPV) Vaccination on Cervical Intraepithelial Neoplasia Lesions. Indian J Surg Oncol 2023; 14:504-509. [PMID: 37324297 PMCID: PMC10267085 DOI: 10.1007/s13193-022-01657-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Cervical cancer is the most common health problem among global young women. Cervical intraepithelial neoplasia (CIN) is a pre-invasive stage of cervical cancer, the major cause of which is human papillomavirus (HPV), and vaccination has a promising effect on reducing the progression of CIN lesions. The current study was a retrospective case control investigation in two centers, Shiraz and Sari Universities of Medical Sciences from 2018 to 2020 to evaluate the effect of quadrivalent HPV vaccination on CIN lesions (I, II, and III). Eligible patients diagnosed with CIN were selected and divided into two groups: one group received HPV vaccine and the control group did not. The patients were followed up after 12 and 24 months. The information about tests (e.g., Pap smear, colposcopy, and pathology biopsy) and history of vaccination was recorded and statistically analyzed. 150 patients were classified into the control group (without HPV vaccination) and the other 150 patients were in the Gardasil group (with HPV vaccination). The patients' mean age was 32 years old. Two groups were not significantly different according to age and CIN grades. Between two groups in 1 and 2 years' follow-up examinations, the high-grade lesions in both Pap smear and pathology were significantly diminished in patients in the HPV vaccinated group in comparison with the control group with p-values 0.001 and 0.004 in 1 year follow-up respectively and 0.00 after 2 years follow-up. HPV vaccination can prevent the progression of CIN lesions in 2-year follow-up examination.
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Affiliation(s)
- Zahra Shiravani
- Gynecology Oncology Division, Department of Obstetrics & Gynecology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zinab Nazari
- Gynecology Department, Mazandaran University of Medical Sciences, Emam Khomeini Hospital, Kasra Medical Building, 2nd Floor, Sari, Iran
| | - Freshteh Yazdani
- Gynecology Oncology Division, Department of Obstetrics & Gynecology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Fatemeh Sadat Najib
- Infertility Research Center, Department of Obstetrics and Gynecology, Shiraz Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh Jahromi
- Pathology Department, School of Medicine, Maternal-Fetal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhdeh Momtahan
- Gynecology Oncology Division, Department of Obstetrics & Gynecology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | - Sara Pourseyed
- Gynecology Oncology Division, Department of Obstetrics & Gynecology, School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
| | | | - Mojgan Hajisafari Tafti
- Fellowship of Gynecology Oncology, Department of Obstetrics & Gynecology, School of Medicine, Shahidsadoughi University of Medical Science, Yazd, Iran
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Ahmadloo N, Heidarpourfard M, Najib FS, Shiravani Z, Omidvari S, Mosalaei A, Mohammadianpanah M, Ansari M, Nasrollahi H, Khanjani N, Kadkhodaei B, Hamedi SH. The Feasibility and Safety of Induction Chemotherapy Followed by Definitive Chemoradiation in Patients with Locally Advanced Cervical Cancer: A Single-Arm Phase II Clinical Trial. Asian Pac J Cancer Prev 2023; 24:1321-1330. [PMID: 37116155 DOI: 10.31557/apjcp.2023.24.4.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND The present study aimed at investigating the feasibility and safety of induction chemotherapy followed by definitive chemoradiation (dCRT) in patients with locally advanced cervical cancer. MATERIALS AND METHODS In this single-arm clinical trial, patients with cervical cancer (stages IB3-IVA) received a median four cycles of induction chemotherapy (paclitaxel and carboplatin, every three weeks) followed by dCRT (which consisted of the whole pelvis at the dose of 45-50 Gy along with weekly cisplatin (40 mg/m2) followed by intracavitary brachytherapy at the total dose of 80-90 Gy). Primary end point was local control at three months, which was assessed by gynecologic examination and pelvic MRI. The secondary outcome of the study was treatment-related toxicity. RESULTS Seventy-four patients with the mean age of 51.6 ± 9.5 years were included. The most frequent (51.4%) disease stage was IIB. Complete and partial clinical responses were observed in 60.8% and 14.9% of patients, respectively. The frequency of progressive disease and stable disease were 14.9% and 9.5%, respectively. Grade II and III neutropenia (during neoadjuvant chemotherapy were 13.5% and 2.7%, respectively; these figures during chemoradiation were 29.7% and 13.5%, respectively. A treatment interruption was observed for 60.8% (45 cases) of patients during chemoradiation and 31.1% during induction chemotherapy. DISCUSSION AND CONCLUSION Induction chemotherapy followed by chemoradiation is feasible in patients with locally advanced cervical cancer; however, the toxicity should be managed properly to avoid delayed e treatment. More than three quarters of the patients achieved complete or partial clinical response within a three-month follow-up.
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Affiliation(s)
- Niloofar Ahmadloo
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Marzieh Heidarpourfard
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sadat Najib
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Division of Oncology and Gynecology, Department of Obstetrics and Oncology, Shiraz University of Medical Sciences, Shiraz, Iran
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shapour Omidvari
- Breast Diseases Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Mosalaei
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mansour Ansari
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Nasrollahi
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nezhat Khanjani
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Kadkhodaei
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sayed Hasan Hamedi
- Department of Radiation Oncology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Lotfi F, Khodabandeh F, Jafari A, Rezaee M, Rahimi H, Shiravani Z, Keshavarz K. Economic burden of cervical cancer and premalignant lesions associated with human papilloma virus: a societal perspective. Expert Rev Pharmacoecon Outcomes Res 2023; 23:439-447. [PMID: 36876411 DOI: 10.1080/14737167.2023.2186400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women, the cause of which is mostly human papilloma virus (HPV). The aim of this study was to determine the economic burden of cervical cancer and premalignant lesions associated with HPV infection from a societal perspective. METHODS The study is a partial economic evaluation (cost of illness), which was conducted cross-sectionally in the referral university clinic in Fars province in 2021. The prevalence-based and bottom-up approaches used to calculate the costs, the indirect costs were calculated by human capital approach. RESULTS The mean cost of premalignant lesions associated with HPV infection was USD 2,853 per patient, which 68.57% was direct medical costs. In addition, the mean cost of cervical cancer was USD 39,327 per patient, the largest share of which (57.9%) was related to indirect costs. The mean annual cost of cervical cancer patients in the country was estimated at USD 40,884,609 as well. CONCLUSION Cervical cancer and premalignant lesions associated with HPV infection imposed a significant economic burden on the health system and patients. The results of the present study can help health policymakers with efficient and equitable prioritization and allocation of resources.
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Affiliation(s)
- Farhad Lotfi
- National Center for Health Insurance Research, Tehran, Iran.,Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Khodabandeh
- Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Rezaee
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Rahimi
- School of Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Asadi N, Roozmeh S, Vafaei H, Asmarian N, Jamshidzadeh A, Bazrafshan K, Kasraeian M, Faraji A, Shiravani Z, Mokhtar Pour A, Alamdarloo SM, Abdi N, Gharibpour F, Izze S. Effectiveness of pentoxifylline in severe early-onset fetal growth restriction: A randomized double-blinded clinical trial. Taiwan J Obstet Gynecol 2022; 61:612-619. [PMID: 35779909 DOI: 10.1016/j.tjog.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Management of pregnancy complicated by severe early-onset fetal growth restriction (FGR) is one of the most challenging obstetrical issues. So far, there has not been a proven option for the treatment or improvement of this condition. Improper immune response during placentation leads to inadequate trophoblast invasion and impaired utero-placental perfusion. Pentoxifylline improves the endothelial function and induces vasodilation by reducing the inflammatory-mediated cytokines. We have evaluated the effect of Pentoxifylline on fetal-placental perfusion, neonatal outcome, and the level of oxidative stress markers before and after the intervention in the setting of severe early-onset FGR. MATERIALS AND METHODS This study is a pilot randomized clinical trial on 40 pregnant women who had developed early-onset growth restricted fetus. Pentoxifylline and placebo were given with a dose of 400 mg per os two times daily until delivery. Serial ultrasound examination regarding fetal weight, amniotic fluid and also utero-placenta-fetal Doppler's were done. For the assessment of serum Antioxidant level, blood sampling was done once at the beginning of the study and again, at least, three weeks after the investigation. After delivery, umbilical-cord blood gas analysis, APGAR score at 1 and 5 min, NICU admission, and neonatal death were recorded and compared between the two groups. RESULTS Utero-placenta-fetal Doppler's in the Pentoxifylline group did not significantly change compared to the control group. Fetal weight gain was significantly higher in the Pentoxifylline group before (996.33 ± 317.41) and after (1616.89 ± 527.90) treatment (P = 0.002). Total serum antioxidant capacity significantly increased in the Pentoxifylline group (p < 0.036). Average 5 min Apgar score was significantly higher (P < 0.036) and the percentage of babies admitted to NICU was significantly lower (P < 0.030) in the treated group. CONCLUSION Using Pentoxifylline in pregnancy affected by FGR might show promising effects. In this study, Pentoxifylline improved the neonatal outcome, increased fetal weight gain, and reduced neonatal mortality by decreasing the level of oxidative stress markers and cutting down the inflammatory cascade.
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Affiliation(s)
- Nasrin Asadi
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Shohreh Roozmeh
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Homeira Vafaei
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Naeimehossadat Asmarian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Akram Jamshidzadeh
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Fars, Iran.
| | - Khadije Bazrafshan
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Maryam Kasraeian
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Azam Faraji
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Zahra Shiravani
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Mokhtar Pour
- Fellow of the Royal College of Pathologists Australasia (FRCPA), Department of Histopathology, Faculty of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia.
| | - Shaghayegh Moradi Alamdarloo
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Nazanin Abdi
- Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
| | - Fereshte Gharibpour
- Maternal-fetal medicine Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Sedigheh Izze
- Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
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Najib FS, Poordast T, Mahmudi MS, Shiravani Z, Namazi N, Omrani GR. Does Vitex Agnus-Castus L. Have Deleterious Effect on Fertility and Pregnancy Outcome? An Experimental Study on Rats for Prediction of Its Safety. J Pharmacopuncture 2022; 25:106-113. [PMID: 35837144 PMCID: PMC9240410 DOI: 10.3831/kpi.2022.25.2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 11/03/2021] [Accepted: 02/04/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives Herbal medicine is a worldwide health topic. Vitex agnus–castus L. (VAC) is a popular plant used for gynecologic problems due to its hormonal effects. The aim of this study is to reveal VAC extract effect on fetus when this herb is used started from antenatal period or during pregnancy. Methods Performed from starting day of January 2019 till February 2019, 48 rats were assigned in randomly divided eight-member six groups control (C1), treated group with 365 mg/kg VAC from initiation of insemination (T1) and 30 days prior to pregnancy (T2), control that underwent caesarean section on 15th day of gestational age (C2) and treated group with 365 mg/kg VAC from initiation of insemination (T3) and 30 days prior to pregnancy (T4) that underwent caesarean section. Weight, sex and number of fetuses, abortion and still birth rate and estradiol level were evaluated using t-test by SPSS software. Results We showed increased weight among T1 group considering totally and sex-dependent which is significant (all p-value < 0.05). We also detected significantly decreased weight in T2 in total (p-value < 0.0001) and when considering female fetuses (0.043) but not males (0.17). Although the results showed slightly non-significant increased weight among fetuses of T3 (totally or based on the fetus sex) compared to the control group (C2), T4 group had statistically decreased weight compared to control group. Pregnancy rate and pregnancy outcome were affected by VAC usage. The time of VAC initiation also affected live birth and abortion rates. Conclusion VAC extract may affect pregnancy rate, live birth rate, abortion and stillbirth rates. Its effect on the weight and the sex showed dual pattern depends on the time of initiation and pregnancy trimester of evaluation. Prescribing this medicinal plant for patients being prone to pregnancy should be with caution. Further study is recommended.
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Affiliation(s)
- Fateme Sadat Najib
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Monireh Sufi Mahmudi
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Namazi
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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10
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Shiravani Z, Atbaei S, Namavar Jahromi B, Hajisafari Tafti M, Moradi Alamdarloo S, Poordast T, Noori A, Forouhari S, Sabetian S. Comparing four different methods for the management of ectopic pregnancy: A cross-sectional study. Int J Reprod Biomed 2022; 20:177-184. [PMID: 35571502 PMCID: PMC9099365 DOI: 10.18502/ijrm.v20i3.10709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/12/2020] [Accepted: 06/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Ectopic pregnancy (EP) is one of the major causes of maternal mortality
during the first trimester of pregnancy. Objective Four treatment methods for EP including single-dose methotrexate (SD-MTX),
double-dose methotrexate, expectant and surgical management were
considered. Materials and Methods In this cross-sectional study, the clinical characteristics of 365 women
aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017
to March 2019 in hospitals affiliated to Shiraz University of Medical
Sciences, Shiraz, Iran. Receiver operating characteristics curves were
plotted to determine the cut-off points for size of ectopic mass and
beta-human chorionic gonadotropin (β-hCG) that suitably discriminated
between double-dose methotrexate and surgery management. Results The most common site of EP was adnexa. According to the receiver operating
characteristics analysis, surgery was the best plan for the women with an
ectopic mass > 34.50 mm in diameter or with an initial β-hCG level > 6419 mIU/ml. The β-hCG levels in the women successfully
treated with SD-MTX were significantly lower than in those with failed
treatment (p = 0.02). The SD-MTX group had a higher success rate and
significantly shorter duration of hospitalization, and so this was a more
effective medical treatment in comparison with the double-dose protocol. Conclusion Surgery is proposed as the best option for the cases with large ectopic mass
or high β-hCG level. SD-MTX had a higher success rate and shorter hospital
stay than the double-dose protocol, and so was found to be an efficient and
safe alternative. Further randomized clinical trials with larger sample
sizes are recommended to validate the current results.
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Affiliation(s)
- Zahra Shiravani
- Gynecology Oncology Division, Department of Obstetrics and Gynecology,
School of Medicine, Shiraz University of Medical Science, Shiraz, Iran
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical
Sciences, Shiraz, Iran
| | - Sana Atbaei
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran
| | - Bahia Namavar Jahromi
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran
- Infertility Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran
| | - Mojgan Hajisafari Tafti
- Department of Obstetrics and Gynecology, School of Medicine, Shahid
Sadoughi University of Medical Sciences, Yazd, Iran
| | - Shaghayegh Moradi Alamdarloo
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz
University of Medical Sciences, Shiraz, Iran
| | - Adel Noori
- Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sedighe Forouhari
- Infertility Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran
| | - Soudabeh Sabetian
- Infertility Research Center, Shiraz University of Medical Sciences,
Shiraz, Iran
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11
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Shiravani Z, Poordast T, Alamdarloo SM, Najib FS, Hosseinzadeh F, Shahraki HR. Chamomile Extract versus Clotrimazole Vaginal Cream in Treatment of Vulvovaginal Candidiasis: A Randomized Double-Blind Control Trial. J Pharmacopuncture 2021; 24:191-195. [PMID: 35028170 PMCID: PMC8716701 DOI: 10.3831/kpi.2021.24.4.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/10/2020] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives Vulvovaginal candidiasis (VVC) treatment is advised for all women due to its symptoms and complications. In this study, the standard treatment, clotrimazole, was compared with chamomile extract cream in outpatient clinics. Methods We recruited 73 women with VVC, who were randomly allocated into two groups, clotrimazole versus chamomile extract cream. After two weeks of treatment with the same criteria, cheese-like vaginal discharge, itching and burning sensations, strawberry cervix, and recovery percentage was evaluated. Results Thirty patients in each group were analyzed. There was no significant difference in age and number of pregnancies between groups (p = 0.85 and 0.09, respectively). Comparing before and after treatment, cheese like discharge (p < 0.001), itching (p < 0.001), burning (p < 0.001) had significantly improved in both groups. Further, the recovery percentage was not significantly different between groups (88.9% vs 75% in the chamomile vs clotrimazole groups, respectively). Conclusion Chamomile is as effective as clotrimazole in VVC treatment; a higher percentage of women who used this medication recovered, although this did not reach significance. In addition, no complications were reported in either group.
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Affiliation(s)
- Zahra Shiravani
- Infertility Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Poordast
- Infertility Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shaghayegh Moradi Alamdarloo
- Department of Perinatology, Maternal-fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Sadat Najib
- Infertility Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Hosseinzadeh
- Department of Midwifery, School of Nursing and Midwifery, Estahban branch, Islamic Azad University, Estahban, Iran
| | - Hadi Raeisi Shahraki
- Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
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12
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Namavar Jahromi B, Fardid M, Esmaili E, Kavosi Z, Shiravani Z, Jafari A, Keshavarz K. Cost-Effectiveness Analysis of Different Methods of Treatment of Tubal Ectopic Pregnancy in the South of Iran. Value Health Reg Issues 2021; 28:90-97. [PMID: 34839112 DOI: 10.1016/j.vhri.2021.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 06/16/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the cost-effectiveness of different methods of treating tubal ectopic pregnancy in the south of Iran. METHODS This study was an economic evaluation that analyzed and compared the cost-effectiveness and cost utility of 3 treatment methods, including single-dose methotrexate, double-dose methotrexate, and surgery in patients with tubal ectopic pregnancy. In this study, a decision tree model was used. The outcomes included in the model were the percentage of successful treatment and the average utility score of each treatment method. The study was conducted from the social perspective, and a one-way and probabilistic sensitivity analysis was performed to measure the effects of uncertainty. RESULTS The incremental cost-effectiveness ratio of surgery compared with single-dose methotrexate was positive and equal to $5812 purchasing power parity; moreover, the results of one-way analysis showed the highest sensitivity toward the effectiveness of single-dose methotrexate. Scatter plots also revealed that surgery in 82% and 96% of simulations was at the acceptable region compared with a single-dose and double-dose methotrexate, respectively and was below the threshold. It was identified as a more cost-effective strategy. Furthermore, the acceptability curves showed that in 81.4% of simulations, surgery was the most cost-effective treatment for thresholds less than $20 950 purchasing power parity. CONCLUSIONS On the basis of the results of this study, surgery can be used as the first line of treatment for ectopic pregnancy. In addition, the best drug strategy was single-dose methotrexate because this strategy reduced costs and increased treatment success and quality-adjusted life-years compared with double-dose methotrexate.
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Affiliation(s)
- Bahia Namavar Jahromi
- Infertility Research Center and Shiraz Otolaryngology Research Center, Department of Otorhinolaryngology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Fardid
- Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Elahe Esmaili
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Kavosi
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Khosro Keshavarz
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
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13
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Kasraeian M, Hashemi A, Hessami K, Alamdarloo SM, Vahdani R, Vafaei H, Najib FS, Shiravani Z, Razavi B, Homayoon N, Nayebi M, Bazrafshan K, Jahromi MA. A 5-year experience on perinatal outcome of placenta accreta spectrum disorder managed by cesarean hysterectomy in southern Iranian women. BMC Womens Health 2021; 21:243. [PMID: 34130685 PMCID: PMC8207599 DOI: 10.1186/s12905-021-01389-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
Background We aimed to investigate the risk factors of placenta accreta spectrum (PAS) disorder, management options and maternal and neonatal outcomes of these pregnancies in a resource-limited clinical setting. Methods All women diagnosed with placenta accreta, increta, and percreta who underwent peripartum hysterectomy using a multidisciplinary approach in a tertiary center in Shiraz, southern Iran between January 2015 until October 2019 were included in this retrospective cohort study. Maternal variables, such as estimated blood loss, transfusion requirements and ICU admission, as well as neonatal variables such as, Apgar score, NICU admission and birthweight, were among the primary outcomes of this study. Results A total number of 198 pregnancies underwent peripartum hysterectomy due to PAS during the study period, of whom163 pregnancies had antenatal diagnosis of PAS. The mean gestational age at the time of diagnosis was 26 weeks, the mean intra-operative blood loss was 2446 ml, and an average of 2 packs of red blood cells were transfused intra-operatively. Fifteen percent of women had surgical complications with bladder injuries being the most common complication. Furthermore, 113 neonates of PAS group were admitted to NICU due to prematurity of which 15 (7.6%) died in neonatal period. Conclusion Our findings showed that PAS pregnancies managed in a resource-limited setting in Southern Iran have both maternal and neonatal outcomes comparable to those in developed countries, which is hypothesized to be due to high rate of antenatal diagnosis (86.3%) and multidisciplinary approach used for the management of pregnancies with PAS.
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Affiliation(s)
- Maryam Kasraeian
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefe Hashemi
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Professor Alborzi Clinical Microbiology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shaghayegh Moradi Alamdarloo
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran. .,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Razie Vahdani
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Homeira Vafaei
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Sadat Najib
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran.,Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Behnaz Razavi
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Nahid Homayoon
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Mahsa Nayebi
- Department of Obstetrics and Gynecology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Zand Avenue, Shiraz, Iran
| | - Khadije Bazrafshan
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Akbarzadeh Jahromi
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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14
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Askary E, Poordast T, Shiravani Z, Ali MA, Hashemi A, Naseri R, Moradialamdarloo S, Karimi Z, Izanloo E, Najib FS. Coronavirus disease 2019 (COVID-19) manifestations during pregnancy in all three trimesters: A case series. Int J Reprod Biomed 2021; 19:191-204. [PMID: 33718763 PMCID: PMC7922300 DOI: 10.18502/ijrm.v19i2.8477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 12/15/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) pandemic has raised concerns about the susceptibility amongst different groups of the population. Pregnant women are one such group. This study was conducted to investigate the effect of COVID-19 on pregnancy and maternal/neonatal outcomes. Case presentation This case series was conducted on 16 pregnant women with COVID-19 from March 21 to May 11, 2020. Clinical characteristics, pregnancy complications, medication used, maternal/neonatal outcomes, and fatality rate were investigated through this study. The mean age of the patients was 30.06 yrs. Patients from all three trimesters were included (1 in first, 5 in second, and 10 in the third trimesters). The most common clinical symptoms were shortness of breath (n = 10), dry cough (n = 10), myalgia (n = 8), and chills (n = 7). Also, three cases had papulosquamous skin lesions with fissuring. The most common laboratory results were leukocytosis (n = 8), increased liver enzymes (n = 6), elevated CRP (n = 5), and thrombocytopenia (n = 4). There was one case of maternal mortality, five of premature labor pain (PLP), two of preeclampsia, and two of placenta accreta. Twelve pregnancies were terminated (nine cesarean sections, three vaginal deliveries). Among neonates, we had 6 cases of preterm labor. All neonates had negative PCR results. Conclusion Clinical manifestations and paraclinical results were similar to non-pregnant patients. There was no evidence of vertical transmission. PLP and premature rupture of membranes (PROM) were the most common complications in the second and third trimesters of pregnant COVID-19 women, which can lead to rupture of the uterus. Termination and delivery should be planned individually.
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Affiliation(s)
- Elham Askary
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Poordast
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Ashraf Ali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atefeh Hashemi
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Naseri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shaghayegh Moradialamdarloo
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zinat Karimi
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Izanloo
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Sadat Najib
- Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Shiravani Z, Najib FS, Momtahan M, Robati M, Hajisafari Tafti M, Namazi N. Are Ovarian Dermoid Cysts Should Be Always Considered Benign? A Case Series Study of Different Malignant Transformation. Indian J Surg Oncol 2020; 11:156-158. [PMID: 33364686 DOI: 10.1007/s13193-020-01159-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Zahra Shiravani
- Department of Obstetrics and Gynecology, Division of Oncology Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fateme Sadat Najib
- Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhdeh Momtahan
- Department of Obstetrics and Gynecology, Division of Oncology Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Minoo Robati
- Department of Obstetrics and Gynecology, Division of Oncology Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojgan Hajisafari Tafti
- Department of Obstetrics and Gynecology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Niloofar Namazi
- Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Najib FS, Hashemi M, Shiravani Z, Poordast T, Sharifi S, Askary E. Diagnostic Accuracy of Cervical Pap Smear and Colposcopy in Detecting Premalignant and Malignant Lesions of Cervix. Indian J Surg Oncol 2020; 11:453-458. [PMID: 33013127 DOI: 10.1007/s13193-020-01118-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 06/01/2020] [Indexed: 12/19/2022] Open
Abstract
The objective of this study was to determine the diagnostic accuracy of pap smear and colposcopy in detecting the premalignant and malignant lesion of the cervix. In this cross-sectional study, a total number of 160 women who presented with abnormal clinical problem or routine checkup during a 6-month period were included. All the patients underwent pap smear and colposcopy by the same gynecologists team, and finally, cervical biopsy was performed in all the individuals. The demographic and clinical characteristics as well as the obstetrics history were recorded. The diagnostic accuracy of each test was calculated according to the biopsy as gold standard. The sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were recorded and compared between two modalities. Overall, we included a total number of 160 patients with mean age of 37.6 ± 7.32 (ranging from 24 to 63) years. The sensitivity and specificity of pap smear were found to be 47.19% and 64.79%, respectively. The PPV and NPV of the pap smear were calculated to be 88.69% and 38.46%, respectively. The sensitivity and specificity, PPV, and NPV of the colposcopy were calculated as 64.72%, 52.74%, 76.32%, and 95.41%, respectively. The overall diagnostic accuracy of the pap smear and colposcopy was reported to be 82.2% and 96.3%, respectively. The results of this study demonstrate that colposcopy has a higher diagnostic accuracy in detecting cervical premalignant and malignant lesions compared to the pap smear.
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Affiliation(s)
- Fatemeh Sadat Najib
- Infertility Research Center, Obstetrics and Gynecology Department, Division of Oncology Gynecology, Shiraz University of Medical Sciences, OB & GYN ward, Faghihi Hospital, Zand Blvd, Shiraz, Iran
| | - Masooumeh Hashemi
- Fellowship of Oncology Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Shiravani
- Infertility Research Center, Obstetrics and Gynecology Department, Division of Oncology Gynecology, Shiraz University of Medical Sciences, OB & GYN ward, Faghihi Hospital, Zand Blvd, Shiraz, Iran
| | - Tahereh Poordast
- Infertility Research Center, Obstetrics and Gynecology Department, Division of Oncology Gynecology, Shiraz University of Medical Sciences, OB & GYN ward, Faghihi Hospital, Zand Blvd, Shiraz, Iran
| | | | - Elham Askary
- Infertility Research Center, Obstetrics and Gynecology Department, Division of Oncology Gynecology, Shiraz University of Medical Sciences, OB & GYN ward, Faghihi Hospital, Zand Blvd, Shiraz, Iran
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17
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Kadkhodayan S, Shiravani Z, Hasanzadeh M, Sharifi N, Yousefi Z, Fattahi A, Sadeghi R. Lymphatic mapping and sentinel node biopsy in endometrial cancer--a feasibility study using cervical injection of radiotracer and blue dye. Nucl Med Rev Cent East Eur 2015; 17:55-8. [PMID: 25088102 DOI: 10.5603/nmr.2014.0017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 04/13/2014] [Accepted: 04/16/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility and accuracy of sentinel lymph node (SLN) detection using preoperative lymphoscintigraphy and intra-operative gamma probe/blue dye for endometrial cancer patients. MATERIAL AND METHODS Twenty four consecutive patients with endometrial cancer were recruited. All patients underwent lymphatic mapping and sentinel node biopsy using combined intracervical radiotracer and blue dye injections. Pelvic lymph node dissection was performed for all patients. Para-aortic lymphadenectomy was done in high risk patients. All SLNs were examined by frozen section and Hematoxylin and Eosin (H&E) permanent sections. RESULTS Pre-operative lymphoscintigraphy showed at least one SLN in 21/24 patients. Intra-operatively, at least one SLN could be harvested by gamma probe and/or blue dye methods. A total of 95 SLNs were detected. Four SLNs were detected only by blue dye, 42 only by radiotracer, and 49 were hot/blue. Median number of SLN per patient was 3. Three patients had positive pelvic lymph nodes. All of them had positive SLN (no false negative case). Frozen section could identify SLN involvement in two of three patients with positive pathology. CONCLUSION Lymphatic mapping and sentinel node biopsy is feasible and accurate in endometrial cancer patients using combined radiotracer and blue dye methods. Frozen section accuracy was lower and underscores the importance of expert pathologists for SLN mapping technique.
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Affiliation(s)
| | | | | | | | | | | | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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18
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Namavar Jahromi B, Shiravani Z, Salarian L. Perinatal outcome of pregnancies complicated by immune thrombocytopenia. Iran Red Crescent Med J 2012; 14:430-5. [PMID: 22997559 PMCID: PMC3438436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Immune thrombocytopenia (ITP) is an autoimmune disorder that leads to premature destruction of antibody-coated platelets. This study evaluated perinatal outcome and medications used for pregnancies complicated by ITP. METHODS Medical records of 132 pregnancies belonged to 125 parturients with ITP who delivered between March 2001 and January 2011 were reviewed. Cases were included if diagnosed before pregnancy or if their platelet counts (PCs) were less than 80,000/µL during pregnancy without any other cause. Maternal and fetal outcomes were compared. RESULTS Fifty six mothers (42.1%) had PC<50,000, 18 women (13.5%) developed preeclampsia and 15 (11.3%) were diabetics. Corticosteroid was used for120 cases (90.9%) and intravenous immunoglobulin for 14 women (10.5%). PCs of 114 neonates were available in the charts and 84 (83.2%) had PC>150,000/µL. Three neonates (2.3%) had PC<50 000, 31 neonates (23.3%) had preterm births and 32 (24.1%) needed NICU admissions. Fifty seven cases of ITP (43.2%) were diagnosed before pregnancy and 75 (56.8%) were diagnosed during pregnancy. There were 2 intrauterine fetal deaths and higher NICU admissions, 20 (34.48%) versus 12 (16%) in the first group (p=0.01). CONCLUSION Perinatal outcome of pregnancies with ITP is generally good. However neonates born from parturients with chronic ITP needed more NICU admissions.
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Affiliation(s)
- B Namavar Jahromi
- Perinatology Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Bahia Namavar Jahromi, MD, Perinatology Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98-711-2332365, Fax: +98-711-2332365, E-mail:
| | - Z Shiravani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - L Salarian
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Namavar Jahromi B, Salarian L, Shiravani Z. Maternal risk factors and neonatal outcome of the admitted patients for preterm spontaneous uterine contractions. Iran Red Crescent Med J 2011; 13:877-83. [PMID: 22737433 PMCID: PMC3371908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 09/10/2011] [Indexed: 10/29/2022]
Abstract
BACKGROUND Preterm birth (PTB) is one of the most important unsolved problems in reproductive medicine. This study aims to evaluate several maternal risk factors and outcome of pregnancies who were admitted for preterm spontaneous uterine contractions (PSUC). METHODS From September 2007 to February 2009, 327 cases who were admitted for PSUC were retrospectively studied. They were classified according to their fetal numbers and presence of true versus threatened preterm labor (PTL). RESULTS There were 297 (90.82%) singleton, 27 (8.25%) twin and 3 (0.91%) triplet pregnancies. Only 12 women (3.6%) fulfilled the ACOG criteria for PTL who delivered in a few hours and 315 cases (96.3%) were classified as threatened PTL and most of them were discharged undelivered from the hospital. 103 cases were missed and 224 mothers and their 247 neonates remained. 121 women from this cohort had PTB and delivered before 259 days (54%). Pregnancy outcomes including; the time interval between admission for PSUC and delivery, the mean gestational ages at birth, birth weights, number and duration of NICU admissions were evaluated in each group. CONCLUSION Regular uterine contractions even in the absence of cervical changes should be considered as a potential risk factor for PTB. The most frequently associated maternal risk factors were history of abortion, infertility and previous PTB, and the most frequently associated complications were preterm rupture of membranes, vaginal bleeding and febrile diseases.
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Affiliation(s)
- B Namavar Jahromi
- Department of Obstetrics and Gynecology, Perinatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Bahia Namavar Jahromi, MD, Associate Professor of Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, Iran. Tel.: +98-711-6272494, Fax: +98-711-6272492, E-mail:
| | - L Salarian
- Department of Obstetrics and Gynecology, Perinatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z Shiravani
- Department of Obstetrics and Gynecology, Perinatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Borhani Haghighi A, Motazedian S, Rezaie R, Mohammadi F, Salarian L, Pourmokhtari M, Khodaei S, Shiravani Z, Vossoughi M, Miri R. FP58-FR-03 Cutaneous application of menthol 10% solution as an abortive treatment of migraine without aura. J Neurol Sci 2009. [DOI: 10.1016/s0022-510x(09)70577-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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