مجله زنان مامائی و نازائی ایران
سال بیست و چهارم شماره 3 (خرداد 1400)

Breast cancer is the most common cancer in women worldwide. One of the late and long-term complications of chemotherapy regimens used in the treatment of these patients is chemotherapy induced amenorrhea (CIA). Studies have shown that CIA improves prognosis in breast cancer patients with positive estrogen receptor. So, this study was performed with aim to determine the frequency of CIA in patients with breast cancer.

This retrospective descriptive-analytical study was performed on 96 premenopausal breast cancer patients aged less than 50 years old who underwent chemotherapy in Ayatollah Rohani Hospital of Babol during 2009_2015. Chemotherapy regimens include six cycles of adriamycin and cyclophosphamide (AC) per two weeks or four cycles of AC followed by four cycles of one taxane. Demographic data of the patients, date of amenorrhea and return of menstruation, chemotherapy regimen, size of tumor and number of metastatic lymph nodes were collected by researcher-made questioner and were analyzed with SPSS software (version 18) and T-test and Chi-square test.

In this study, 96 patients (37.5%) had age of ≤40 years and 60 patients (62.5%) aged 40-50 years. Fifty eight patients (60.4%) experienced chemotherapy-induced amenorrhea. 44 subjects (73.3%) of patients aged 40-50 years and 14 (38%) of those aged < 40 years experienced CIA (p=0.001). CIA was 61% in AC regimen and was 59.5% in AC and taxane regimen (p=0.87).

CIA is common that is more common in patients older than 40 years. Addition of taxane to anthracycline-based chemotherapy regimen didn’t increase CIA.

Breast cancer is the most common cancer and the leading cause of death due to cancer among women. This study was performed with aim to compare the effect of 8 weeks of aerobic exercise and pomegranate juice supplementation on serum levels of estrogen, progesterone and P53 protein in women with breast cancer.

This quasi-experimental study was performed as pretest and posttest in 2019 on 40 women with breast cancer in Qom province. The subjects were randomly divided into four groups: control, pomegranate juice, aerobic exercise, and aerobic exercise + pomegranate juice consumption (n=10 in each group). The groups of aerobic exercise and aerobic exercise + pomegranate juice consumption performed aerobic exercise for 8 weeks and 3 sessions each week. Also, the groups of pomegranate juice consumption consumed 100 cc of pomegranate juice on the day of the training session fasting. 4 cc blood samples were taken from the participants 48 hours before and after the implementation of the protocol to evaluate the research variables. Data were analyzed by SPSS statistical software (version 20) and independent t-test and one-way analysis of variance. p < 0.05 was considered statistically significant.

The results showed that 8 weeks of aerobic exercise significantly decreased serum levels of estrogen, progesterone (p <0.05) and significantly increased p53 protein levels (p <0.05) in women with breast cancer. According to the results of the study, estrogen and progesterone decreased in pomegranate juice consumption and aerobic exercise groups, but this decrease was not significant (p <0.05). The results also showed that consumption of pomegranate juice for eight weeks caused  no significant decrease in estrogen and progesterone levels and a significant increase in p53 levels in women with breast cancer (p <0.05).

Aerobic exercise + pomegranate juice consumption reduces the risk factors for breast cancer and increases the protein associated with p53 cell death in women with cancer.

Luteal phase support is an inevitable part of IVF programs, for this purpose, progestogenic therapies are used. Lutogel and Utrogestan are two progestogenic therapies that can be used as supportive drugs for the luteal phase. Utrogestan is a known drug to support the luteal phase. The aim of this study was to use Lutogel in case of effectiveness and tolerance as effective micronized progesterone to support the luteal phase in IVF patients due to the reduced availability in Iran.

This randomized clinical trial study (RCT) was performed on 200 patients referred to Infertility Clinic of Tehran Taleghani Hospital in 2019-2020. The subjects were divided into two equal groups and from the same day of getting oocyte one group was treated with 200 mg vaginal Lutogel and the other with 200 mg vaginal Utrogestan. Then the two groups were compared in terms of effectiveness, tolerability, safety, positive clinical pregnancy rate, successful pregnancy rate up to 12 weeks and abortion rates. Data were analyzed by SPSS statistical software (version 21) and Mann-Whitney, Chi-square and logistic tests. P <0.05 was considered statistically significant.

Positive BHCG levels were 22% in Lutogel and 23% in Utrogestan groups that had no significant difference (P=0.866). Rate of pregnancy based on positive FHR in sonography was 18% in Lutogel and 22% in Utrogestan groups that no significant difference was found between the two groups (P=0.480). Rate of successful pregnancy up to 12 weeks was 13% for Lutogel and 15% for Utrogestan groups which showed not significant relationship between the two groups (P=0.684). The incidence of pregnancy more than 20 weeks was 14% in both Lutogel and Utrogestan groups, with no statistically significant difference (p=1.000).

The rate of positive BHCG, pregnancy based on positive FHR in sonography, and successful pregnancy up to 12 weeks were the same in the use of two Lutogel and Utrogestan drugs. Also, there was no difference in the incidence of complications. For this reason, each of these drugs can be used to support the luteal phase in patients undergoing IVF.

Sexual dysfunctions related to the long-term of methadone and buprenorphine are common. In order to investigate the effects of Methadone maintenance therapy (MMT) and buprenorphine maintenance treatment(BMT) on women sexual function with opioid abuse dependence, the present study was performed with aim to evaluate the effect ofmaintenance treatment with methadone and buprenorphine on sexual function of females with opioid abuse dependence .In order to the effective measures regarding choosing the best practice , consultation and decision making will be taken.

This cross-sectional descriptive-analytic study was performed in 2015-2017 on 89 women with opioid abuse. Demographic information, sexual function and satisfaction of women who were previously treated with MMT and BMT were completed and collected using the Female sexual function index(FSFI) and Larson Sexual satisfaction questionnaire (LSSQ) in two stages with an interval of 3 months. Data were analyzed by SPSS software (version 20) and Independent T, Mann-Whitney U and Chi-Square tests.

The total scores of FSFI (Female Sexual Function Index) were significantly higher in the BMT group (p < 0.05). The scores of sexual desire and arousal subscales were significantly improved in the BMT group compared with the MMT group (p < 0.05). No significant difference was observed between the two groups in terms of the level of sexual satisfaction in two studied stages (p=0.25).

The use of BMT in women with opioid abuse can have a more positive effect on sexual desire and arousal than those in the MMT group. This issue likely leads to more adhesion to the use of maintenance treatment. In other cases, these two drugs are similar in terms of efficacy and causing satisfaction from sexual function.

Intratechal opioids in combination with local anaesthetic drugs are commonly used for analgesic induction during cesarean section. Lipophilic opioids such as Fentanyl and Sufentanil are among most commonly used intratechal opioids. Pruritus is one of the most common complications of opioids. So, this study was performed with aim to compare the frequency and severity of pruritus following intratechal administration of fentanyl or sufentanil with Bupivacaine in elective cesarean section.

This double-blind randomized clinical trial study was performed in 2019 on 50 pregnant women candidate for elective cesarean section and referred to Shahid Mostafa Khomeini hospital in Tehran. The subjects were randomly divided into two groups. One group received 25 microgram intratechal fentanyl and another group received 2.5 microgram sufentanil both in combination with 12.5 miligram hyperbaric bupivacaine 0.5%. After the surgery, data about age, BMI, surgery duration and pruritus were evaluated. Data were analysed by SPSS software (version 21) and Chi-square and Independent t-test. P<0.05 was considered statistically significant.

There was no significant difference between the two groups in terms of age (P=0.428), BMI (P=0.339) and surgery duration (P=0.296). Frequency of pruritus was 68% in fentanyl and 88% in sufentanil groups; this difference was not statistically significant (P=0.088). Pruritus severity (P=0.361) and use of anti-pruritus drug (P=0.333) showed no significant difference between the two groups.

Pruritus is a common side-effect of intratechal fentanyl and sufentanil. There was no evidence in favour of higher prevalence of pruritus in the sufentanil group than the fentanyl group.

The prevalence of overweight and obesity and its complications are rapidly increasing in the world. Therefore, new ways are needed to prevent and cure this health dilemma. This study was performed with aim to compare the effect of six weeks of resistance training along with blood flow restriction (Kaatsu) with two different intensities on body fat percentage, muscle strength, and serum level of Irisin in overweight women.

This semi-experimental study was performed in 2019 on 42 overweight women in Mashhad. The subjects were randomly assigned into three groups: resistance exercises with blood flow restriction (BFR) and intensity of 20-30% of 1repetition maximum (1RM), resistance training with BFR and intensity of 40-50% and control group. The training groups received training three sessions per week and 60-50 minutes each session for six weeks. Before and after the intervention, serum levels of Irisin, muscle strength and fat percentage were taken. Data were analyzed by SPSS software (version 23) and ANCOVA test. p < 0.05 was considered statistically significant.

Six weeks of resistance training along with Kaatsu with two variable intensities resulted in a significant increase in strength in the post-test (P=0.001). Changes in irisin levels and fat percentage were not significantly different between the two groups (P≤0.05).

Resistance training along with Kaatsu significantly decreased fat percentage at 20-30% of intensity without changes in serum level of irisin.

Fibrinogen is one of the most important inflammation factors and a prediction index in cardio vascular diseases. This study was performed with aim to evaluate the effect of aerobic exercise with constant and variable intensities on body composition and some physiological indicators and coagulation factors in middle aged overweight women.

This semi-experimental and practical study was performed in 2015 on 30 women in three groups: aerobic exercise with constant intensity (n=10), variable intensity (n=10) and control (n=10) in the city of Bojnourd. The aerobic training program included eight weeks of aerobic training, 30 minutes of aerobic training with a constant intensity with 60% of heart rate and variable intensity included 2 minutes of bike pedaling with 50% of maximal heart rate and 1 minute of bike pedaling with 70% of maximal heart rate. The levels of fibrinogen, PT, PTT, platelet count and non-coagulation factor were collected 24 hours before and 48 hours after the training session. Data were analyzed by SPSS software (version 25) and dependent t-test, Analysis of covariance (ANCOVA) and tukey post hoc test for intra-group and inter-group changes, respectively. P<0.05 was considered statistically significant

Weight (constant intensity, P=0.001 and variable intensity, P=0.001), body mass index (constant intensity, P=0.001 and variable intensity, P=0.001), systolic (constant intensity, P=0.03 and variable intensity, P=0.001), and diastolic blood pressure (constant intensity, P=0.001 and variable intensity, P=0.001) decreased significantly in both groups. However, body fat percentage decreased significantly only in the constant intensity group (P=0.001). Prothrombin time (PT) (constant intensity, P=0.004 and variable intensity, P=0.009), thromboplastin time (PTT) (constant intensity, P=0.005 and variable intensity, P=0.01), fibrinogen (constant intensity, P=0.001 and variable intensity, P=0.02), and platelet counts (constant intensity, P=0.02 and variable intensity, P=0.001) significantly decreased in both groups. However, non-coagulation factor significantly increased in both groups (constant intensity, P=0.003 and variable intensity, P=0.001). The amount of flexibility (constant intensity, P=0.003 and variable intensity, P=0.001) and maximal oxygen consumption (constant intensity, P=0.001 and variable intensity, P=0.001) increased significantly in both groups

Eight weeks of aerobic training with two constant and variable intensities by reducing body composition indices, coagulation factors and increasing fitness indices in overweight women can possibly improve cardiovascular health and reduce inflammation.

Metabolic syndrome is a growing public health concern around the world and there is an urgent need to control it by using the methods with minimal side effects. Therefore, this study was performed with aim to evaluate the effect of cuminum cyminum on metabolic syndrome indicators.

This three-blind clinical trial study was performed in 2019 on 66 women of reproductive age who had at least three metabolic syndrome indicators and referred to the comprehensive health service centers of Rafsanjan city. The subjects were selected by convenience and randomly assigned to the two groups of receiving 500 mg of cuminum cyminum and placebo. Before and after 8 weeks of the intervention, waist circumference, FBS, HDL, and triglyceride were measured. Data were analyzed by SPSS software (version 18) and Kolmogorov-Smirnov, independent t-test, Mann-Whitney U, paired t-test and Wilcoxon tests. P<0.05 was considered statistically significant.

The mean of waist circumference, TG, HDL, and systolic blood pressure before and after the intervention had significant difference in the cuminum cyminum group (P<0.05). These changes were not significant in the control group. The mean of FBS did not significantly change in the cumin group)P=0.739), but in the control group, the FBS level increased (p=0.004). The mean of diastolic blood pressure in both groups significantly decreased after the intervention (p<0.05), but the decrease was more in the cumin group (p<0.001).

Consumption of 500 mg of cuminum cyminum twice a day can improve the indicators of metabolic syndrome in women of reproductive age.

Young people's interest in strength exercises has led to the high use of anabolic steroids (AAS) regardless of its long-term side effects. Therefore, this review study was conducted with aim to investigate the effect of AAS drugs on male fertility.

In line with the aim of the present review study, search was performed in the databases of Scopus, Pubmed, Proquest, Science Direct, ISC, Irandoc, Magiran and Google Scholar with the keywords of energy drugs, male fertility, spermatogenesis, androgenic anabolic steroid drugs and AAS without time restrictions. Among a total of 8453 articles extracted, after reviewing the title, abstract and inclusion and exclusion criteria, finally 33 articles were reviewed.

AAS drugs have long-term effects on the male reproductive system and disrupt spermatogenesis through four primary mechanisms including direct effects on gametes, hypothalamic axis change, pituitary and testis, erectile dysfunction or ejaculation, and decreased libido. It also reduces testosterone production and suppresses spermatogenesis by inhibiting negative feedback at LH and FSH levels. Most side effects are reversible after discontinuation, but long-term use during the reproductive ages and testicular developmental stages disrupts semen analysis and sperm function parameters, and there is no possibility of responding to alternative therapy. Not enough information has been reported about the time required to return male fertility after drug discontinuation.

Excessive use of AAS drugs has long-term adverse effects on male reproductive health, so, existence of various and unknown items of drugs in the market, advertising in clubs and cyberspace and high consumption of drugs regardless of its side effects, require management measures to solve this global health problem and maintain male reproductive health. Therefore, education is recommended to the community, athletes, coaches and health care providers.

Spontaneous abortion is one of the common complications of pregnancy that its etiology is unknown. Since vitamin D deficiency may be one of its causes, this systematic review was performed with aim to evaluate the relationship between vitamin D and abortion.

In this systematic review and meta-analysis, the literature published from 1990 until the end of 2019 were searched in databases of PubMed, Embase, Cochrane Library, Scopus, Web of Science, SID, Magiran, IranMedex with the keywords of Vitamin D, 25-hydroxyvitamin, 25-Dihydroxyvitamin D3, Pregnancy loss, fetal loss, miscarriage and abortion and the equivalent Persian keywords. The quality of the papers was examined using Ottawa checklist, and STATA software was used for the meta-analysis.

Among 311 papers found in the first stage, finally 5 papers (5203 individuals) met the study criteria. In terms of methodological quality, all of the included articles were of average level. The findings of the studies included in the meta-analysis showed that there is a relationship between low levels of vitamin D and abortion (Effect size: 0.02; 95% Confidence Interval: -0.02 to 0.06).

The results of the meta-analysis suggested a relationship between serum level of vitamin D and abortion; thus, it can be concluded that low levels of vitamin D are considered as a risk factor for abortion.

Anaplastic variant of juvenile granulosa cell tumor is one of the rarest ovarian malignancies. The aim of this study is to describe a case of anaplastic variant ovarian granulosa cell tumor in a 14-year-old girl with presentation of abnormal uterine bleeding and gradual abdominal enlargement.

The patient at the time of diagnosis with an inhibin A and B more than 500 Pg/ml and ovarian mass of about 30×20×15 cm underwent unilateral salpingo-oophorectomy and juvenile granulosa cell tumor was diagnosed with no follow-up. She has referred with ascites, recurrent mass and distance metastasis of liver after 10 months. The patient underwent four courses of BEP (Bleomycin, Etoposide, Cisplatin)and five courses of paclitaxel and carboplatin. Then, she underwent laparotomy for metastasectomy, which was not successful due to the extent of involvement. Eventually, she died six months after the second surgery.

This case report confirms the need for accurate follow-up of patients with juvenile granulosa cell tumor and appropriate justification for the patient and their caregiver to prescribe needed adjuvant therapies to prevent recurrence.

Phyllodes (PTs) tumors are fibroblastic neoplasms of the breast. PTs are relatively rare and include less than 1% of all breast neoplasms. In this study, a case of large tumor of Phyllodes following fennel consumption was reported.

The patient was a 47-year-old MCzabz female who complained of a large mass in the left breast and referred to Peymaniyeh Hospital in Jahrom. The patient had a history of infertility for 8 years. She had a 3 cm mass in the left breast from the past 2 years. During previous 7 months, she has used fennel for 3 months due to menstrual irregularities.

It seems that the increasing of the breast tumor size in this patient is due to arbitrary consumption of fennel; because fennel has a lot of estrogen, which affects Endoplasmic Reticulum, and tumor filament cells also have beta ER-estrogen receptors; in this patient, the arbitrary consumption of fennel for 3 months has led to the sudden increase in the volume of this mass in the breast.