International Journal of Reproductive BioMedicine
Volume:17 Issue: 9, Sep 2019

Chlamydia Trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. 

Given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present meta-analysis was conducted to determine the rate of treatment failure with azithromycin.

Databases including MEDLINE, ISI - Web of Science, PubMed, EMBASE, Scopus, ProQuest, and Science Direct were searched for articles published between 1991 and 2018. The quality of the selected articles was assessed using the Cochrane risk of bias assessment tool. Heterogeneity was determined using the I2 and Cochrane Q-Test. Subgroup analysis and meta-regression were used to compare the prevalence rates on different levels of the variables. 

A total of 21 articles that met the inclusion criteria were ultimately assessed. The pooled estimate of azithromycin failure rate was 11.23% (CI 95%: 8.23%-14.24%). Also, the azithromycin failure rate was 15.87% (CI 95%: 10.20%-21.54%) for the treatment of urethritis, 7.41% (CI 95%: 0.60%-14.22%) for cervicitis, and 7.14% (CI 95%: 10.90%-3.39%) for genital chlamydia. The pooled estimate of failure rate difference was 2.37% (CI 95%: 0.68%-4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. The meta-regression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 0.826; p = 0.017).

Azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections. 

Key words: Azithromycin, Chlamydia trachomatis, Urogenital, Treatment failure, Meta-analysis. 
Abstract

Chlamydia Trachomatis is one of the most common pathogens transmitted through the genital tract in humans that leads to urogenital infection. 

Given the high prevalence of chlamydia infection and its adverse effects on the health of women and men, the present meta-analysis was conducted to determine the rate of treatment failure with azithromycin.

Databases including MEDLINE, ISI - Web of Science, PubMed, EMBASE, Scopus, ProQuest, and Science Direct were searched for articles published between 1991 and 2018. The quality of the selected articles was assessed using the Cochrane risk of bias assessment tool. Heterogeneity was determined using the I2 and Cochrane Q-Test. Subgroup analysis and meta-regression were used to compare the prevalence rates on different levels of the variables. 

A total of 21 articles that met the inclusion criteria were ultimately assessed. The pooled estimate of azithromycin failure rate was 11.23% (CI 95%: 8.23%-14.24%). Also, the azithromycin failure rate was 15.87% (CI 95%: 10.20%-21.54%) for the treatment of urethritis, 7.41% (CI 95%: 0.60%-14.22%) for cervicitis, and 7.14% (CI 95%: 10.90%-3.39%) for genital chlamydia. The pooled estimate of failure rate difference was 2.37% (CI 95%: 0.68%-4.06%), which shows that azithromycin has a higher failure rate in the treatment of chlamydia compared to doxycycline and other examined medications. The meta-regression results showed that the patient's age contributes significantly to the heterogeneity for azithromycin treatment failure rate (β = 0.826; p = 0.017).

Azithromycin has a higher failure rate than doxycycline and other studied medications in treating urogenital chlamydia infections.

Nicotinic acid (niacin) is a broad-spectrum lipid-modifying agent that has potent antioxidant properties and reduces the production of lipid peroxidation.

The purpose of the present study was to investigate the maturation, embryo development and cryo-tolerance merit, and levels of malondialdehyde (MDA), total oxidant status, and total antioxidant capacity following the supplementation of bovine oocytes maturation medium with different concentrations of niacin.

Immature cumulus-oocyte complexes were cultured in tissue culture medium-199 maturation media supplemented with 0, 100, 200, and 400 µM niacin under a standard in vitro culture condition. After 24 hr of culture, the nuclear maturation rate was assessed. Then, two groups of immature cumulus-oocyte complexes were cultured in TCM-199 either with or without 400 µM niacin and evaluated for embryo development. Also, matured cumulus-oocyte complexes in both groups were frozen using a standard vitrification procedure. After vitrification, oocytes were warmed in two steps and evaluated for embryo development. In addition, the level of total antioxidant capacity, total oxidant status, and MDA were measured.

The results indicated that although the treatment with 400 µM niacin increased in vitro nuclear maturation (87.6±5.3), it did not improved the embryo development to the blastocyst stage. Higher cleavage and blastocyst rates were observed in vitrified oocytes that were cultured with supplemented 400 µM niacin compared to the control group (without niacin) (53.6±2.7 and 10.6±1.6 vs. 46.2±4.1 and 6.3±2.4, respectively). Also, the addition of 400 μM niacin to the maturation media could decrease MDA levels after maturation.

Niacin could improve the quality of in vitro embryo production (IVP) embryos and tolerance of bovine oocytes to vitrification.

Preterm labor (PTL) is a serious emergency wherein robust management is imperative for achieving improved outcome.

To evaluate the efficacy and safety of nifedipine alone vs nifedipine with vaginal progesterone in managing threatened PTL.

This comparative study was carried out at the Pakistan Institute of Medical Sciences, Islamabad over a 2-year’ period, from September, 2013 to August, 2015. The study included 276 patients with threatened PTL. Half of them were allocated to nifedipine alone group whereas the remainder half to the additional progesterone group. In nifedipine alone group (group A), all the patients were given 20 mg of rapid release nifedipine orally. If uterine contraction continued, a 10 mg dose was repeated every 20 min with a maximum of 40 mg within the first hour. After completing the first hour, 20 mg was given every 4-6 hr for 72 hr. In the additional vaginal progesterone group (group B), following successful tocolysis with nifedipine, additional - maintenance tocolysis was ensured with vaginal progesterone 200 mg daily.

Successful acute tocolysis was achieved with nifedipine among 86.23% patients. Mean pregnancy prolongation was 11.13±5.08 days in group A while 29.73±3.10 days in group B. (p≤ 0.001)

Acute tocolytic therapy with nifedipine was successful in the majority of our patients. The additional daily use of vaginal progesterone suppositories resulted in significant prolongation of pregnancy as well as reduction in the rate of low birth weight and neonatal ICU admissions.

Radiations emitting from mobile phones have been proposed to affect people’s health, mediated by various mechanisms like induction of oxidative stress.

This study aims to investigate the effect of cell phone exposure on the oxidative status of mice preantral follicles (PFs) during in vitro culture.

PFs (n= 2580) were isolated mechanically from 16 to 18 day-old NMRI mice (n= 50) and divided into control and cell phone-exposed groups. PFs were cultured for 12 days and ovulation was induced using human chorion gonadotropin. The developmental parameters including size, survival, antral cavity formation, ovulation and oocyte maturation were assessed. In parallel, enzymatic antioxidants activities, total antioxidant capacity (TAC), and Malondialdehyde (MDA) levels were evaluated.

The diameters and the rates of survival, antrum formation, ovulation, and metaphase II oocytes of exposed PFs to cell phone were significantly lower than those of the control group (p ≤ 0.001). The PFs exposed to cell phone had significantly lower superoxide dismutase (SOD), glutathione peroxidase (GPX), and catalase (CAT) activity compared with the control group. In the cell phone exposed PFs, the TAC level was significantly lower (p ≤ 0.001) and MDA levels was significantly higher (p ≤ 0.001), compared to the those of control group.

Exposure to cell phone compromised the developmental competence of mice PFs by increasing oxidative stress.

Premenstrual syndrome (PMS) is a common problem among women and is identified by reversal emotional, psychological, and physical signs during the luteal phase. These signs, however, lower down in the follicular phase. The cause of PMS isn't very well-known up to now Control group and many researchers have suggested that mineral compounds and vitamins can inhibit these symptoms

The objective of this study is to compare the serum level of some trace elements and vitamin D between normal controls and patients with PMS.

300 female students (19-21 yr old) from Falavarjan County were randomly selected and asked to complete a standard questionnaire on PMS during three menstruation cycles. The students were divided into two groups: healthy persons (control) and PMS persons, and PMS was determined on the basis of the answers to the questionnaire. Thereafter, the serum concentrations of zinc, iron, calcium, magnesium, potassium, sodium, and Vitamin D3 were measured and compared between the two groups.

Our results showed that the PMS prevalence was about 41.5%. The level of vitamin D decreased in both the control and PMS groups, with a significantly lower range of vitamin D (p ≤ 0.05) in the PMS group. Other factors had no significant change between the two groups.

Vitamin D deficiency was probably one of the most important causes of unpleasant symptoms of PMS between these students.

Ovarian stimulation (OS) for poor ovarian response (POR) patients is still a major challenge in assisted reproductive techniques. Aromatase inhibitors as co-treatment in antagonist protocol are suggested to these patients, but there are controversial reports.

To evaluate the effectiveness Letrozole (LZ) as adjuvant treatment in gonadotropin-releasing hormone (GnRH)-antagonist protocol in POR patients undergoing in vitro fertilization/ intracytoplasmic sperm injection cycles.

This double-blind randomized clinical trial was conducted in Arash women's hospital. One hundred sixty infertile women with POR based on Bologna criteria were allocated into two groups randomly: LZ + GnRH-antagonist (LA) and placebo + GnRH-antagonist (PA) groups. In the experimental group, the patients received 5 mg LZ on the first five days of OS with 150 IU of recombinant human follicle-stimulating hormone (rFSH) and 150 IU of human menopausal gonadotropin (HMG). The cycle outcomes were compared between groups.

The total number of retrieved oocytes and the metaphase II oocytes in LA-treated group were significantly higher than those in the control group (p = 0.008, p = 0.002). The dosage of hMG used and the duration of OS and antagonist administration in LZ-treated group were significantly lower than those of the control group. The number of patients with no oocyte, in the control group, was higher than the LZ-treated group, and the clinical pregnancy rate in LA-treated group (25%) was higher than the control group (18%); however, the differences were not significant statistically.

Adding 5 mg of LZ to rFSH/hMG antagonist protocol may improve the in vitro fertilization/intracytoplasmic sperm injection cycle outcome in POR patients.

Endometriosis, defined as the attendance of endometrial-like lesions in extra uterine locations, causes pain, infertility, and reduced quality of life.

To evaluate the relationship between food consumption and nutrient intake with risk of endometriosis.

Of the 156 women approached for the study, 78 women had endometriosis and 78 healthy women were included in the control group. Dietary data were collected using a validated 147-item semi-quantitative Food Frequency Questionnaire (FFQ) with the standard serving size. A logistic regression model was used to determine the association of macronutrients and energy intake with the risk of endometriosis.

In women with higher intake of protein, especially animal protein, monounsaturated fatty acids, soluble and insoluble fiber, oleic acid, eicosapentaenoic acid, and docosahexaenoic acid endometriosis is less common (p< 0.05). High consumption of vegetables, fruits, red meat, yellow vegetables, potatoes, legumes, dairy products, liquid oil, and low intake of fried potatoes was associated with a lower risk of endometriosis (p< 0.05).

Regarding the association of dietary intake on endometriosis risk, counseling about improving the dietary structure can contribute toward the prevention and control of endometriosis.

In vitro fertilization is an important therapy for women with polycystic ovarian syndrome (PCOS). The use of new ways of improving clinical results is yet required.

This study was aimed to investigate the efficacy of progesterone primed ovarian stimulation (PPOS) and compare with conventional antagonist protocol in PCOS.

A total of 120 PCOS women who were candidates for assisted reproductive technology treatment from August to January 2019 were enrolled in this RCT and were placed into two groups, randomly (n= 60/each). The PPOS group received 20 mg /day Dydrogesterone orally since the second day of the cycle and the control group received antagonist protocol. The pregnancy outcomes including the chemical and clinical pregnancy, the miscarriage rate, and the percent of gestational sacs/ transferred embryos was compared in two groups.

Number of MII oocyte, maturity rate, Number of 2 pronuclei (2PN) and serum estradiol levels on trigger day were statistically lower in PPOS group (p = 0.019, p = 0.035, p = 0.032, p = 0.030), respectively. Serum LH level on trigger day in PPOS group was higher than antagonist group (p = 0.005). Although there wasn’t sever ovarian hyper simulation syndrome in any participants, mild and moderate ovarian hyper simulation syndrome was less in PPOS group (p = 0.001). Also, the chemical and clinical pregnancy rate were higher in the antagonist group, althoughit was not statistically significant (p = 0.136, p = 0.093 respectively).

Our study demonstrate that PPOS does not improve chemical and clinical pregnancy rate of the infertile women with PCOS.