Objective: Sex hormones play role in development of autoimmune diseases such as multiple sclerosis (MS). In our previous systematic review, we included three studies and reported the pooled odds ratio (OR) for increasing 1 year of age at menarche and risk of MS as 0.88. So, we designed this systematic review and meta-analysis to estimate the pooled mean age at menarche difference between women with MS and controls and also update the odds of developing MS by increasing age at menarche.
Materials and methods: We performed a comprehensive systematic search on PubMed, Scopus, EMBASE, and Web of Science on July 1^st, 2023. Also, grey literature including conference abstracts and references of the references were investigated to find potentially relevant articles.
Results: A total 634 records were retrieved by systematic search. Also, one relevant record was identified from grey literature. After deduplication, 331 articles were remained for title/abstract screening and of those, 29 full-texts were evaluated. Finally, 15 studies were included in final analysis. The SMDs of age at menarche (control group – case group) ranged between -0.18 and 1.41. The pooled SMD of age at menarche (controls-cases) was 0.17 (95% CI: 0.09-0.25) (I2=85.1%, p<0.001). OR for age at menarche and risk of MS ranged between 0.8 and 1.76, and the pooled OR for increasing 1 year of age at menarche estimated as 0.92(95% CI: 0.89-0.94) (I²=41.6%, P=0.07).
Conclusion: The results of this systematic review show that the mean age at menarche is higher in controls than women with MS, and the risk of MS decreases by increasing age at menarche

Objective: Influenza causes significant mortality and morbidity in pregnant women and neonates especially in developing countries. This study aimed to investigate the maternal and neonatal outcomes in pregnant women with influenza and compare them with non-infected mothers.
Materials and methods: This case-control single-center cohort study was conducted during the influenza season in 2022 and included all pregnant women with influenza during pregnancy. Baseline characteristics including age, body mass index, job, vaccination, and ethnicity were documented and outcomes including premature rupture of membranes (PROM), preterm labor, cesarean section, neonatal distress, and neonatal hospitalization were evaluated and compared with the control group.
Results: In this study 39 pregnant women in each case and control group were evaluated. There was no significant difference in demographic data between the two groups. None of the participants in the case group received the influenza vaccine during pregnancy. The rate of cesarean section (63.2% vs 43.5%), neonatal distress (38.5% vs 12.8%), and neonatal hospitalization (43.5% vs 15.3%) was significantly higher in the case group than in healthy women (P-value=0.022, 0.010, 0.006 respectively).  Although, the rate of PROM was not significantly different between the two groups (P=0.556). Preterm labor was higher in the case group than in the control group, but the difference was insignificant (P=0.135).
Conclusion: The study findings suggest that pregnant women infected with influenza are at higher risk of neonatal complications and vaccination is helpful in these mothers as preventive measures to reduce complications.

Objective: To investigate the relationship between maternal and neonatal vitamin D serum levels in term infants with and without sepsis.
Materials and methods: This is a case-control study with 320 participants which include , 80 mothers and babies with neonatal sepsis and 80 control mothers and babies without neonatal sepsis that included in  their quantitative vitamin D levels were compared with each other survey.
Results: Demographic and clinical characteristics of infants (age at admission, gender) and mothers (age, education level) were recorded. Blood samples were taken to check serum vitamin D levels of these babies along with their mothers. Vitamin D levels were classified as deficiency less than 10 ng/ml, moderate deficiency 10-30 ng/ml, mild deficiency 20-30 ng/ml and normal 100-30 ng/ml.33 (41.3%) of the infants born in the neonatal sepsis group and 45 (56.3%) of the control infants were male. Using Fisher’s exact test, no significant difference was found between the two groups in terms of gender distribution, P=0.082. The median age of infants in the neonatal sepsis group was 5 (3-9) days and in the control group was 5 (4-6) days. The mean (age of mothers in the patient group was 29.6 (6.4) years and in the control group was 29.7 (5.6) years. The median range of maternal vitamin D levels in the neonatal sepsis group was 23.8 (15.0-30.0) and 28.6 (17.1-34.0) ng/ml in the control group. According to the Mann-Whitney U statistical test, the vitamin D level of mothers in the neonatal sepsis group was significantly lower than that of the group was the control (p=0.020).
Conclusion: According to the result of the Mann-Whitney U test, the vitamin D level of mothers in the neonatal sepsis group was significantly lower than the control group (P=0.020). Mother’s vitamin D level maybe related to the incidence of neonatal sepsis.

Objective: The study aimed to identify Colombian adults' positions in cases in which a counsellor can and should not do so in a situation where parents who are uncomfortable with all issues related to sexuality ask their daughter's school counsellor to help answer her questions about these topics.
Materials and methods: A convenience sample of 180 adults, including 19 school counsellors, was presented with a set of 24 vignettes created by orthogonally crossing three factors: (a) the context of the request (e.g., parents ask the educator to limit sexual information to purely biological aspects), (b) whether the adolescent requests additional information, and (c) the type of information provided by the educator (e.g., comprehensive information, including abortion).
Results: A cluster analysis of participants' appropriateness judgments regarding counsellor’s behavior revealed four qualitatively different positions: Depends on adolescent’s request (5%), Completeness of information (26%), Biological information is insufficient (31%), and at educator's discretion (16%). In addition, 18% (most religious) expressed no discernible position.
Conclusion: The majority of participants (57%) thus expressed the view that the most appropriate behavior on the part of the counselor was to provide the most comprehensive information possible, and certainly not to focus solely on the biological aspects of sex education during counseling. This view was largely independent of contextual elements such as the limits to communication set by the parents or even the limits to communication set by the adolescent.

Objective: Eclampsia is a major life-threatening complication of preeclampsia with severe features leading to significant perinatal and maternal mortality and morbidity. Magnesium sulphate (MgSO₄) is the first-line therapy for eclampsia prevention and treatment, however, its use is associated with serious adverse effects and there is no consensus on the optimal duration of its therapy. This study compares the efficacy and safety of abbreviated 12-hour versus standard 24-hour MgSO₄ therapy during postpartum in patients having preeclampsia with severe features.
Materials and methods: Patients having preeclampsia with severe features were randomized 1:1 into the 12-hour and 24-hour groups. Modified Pritchard regimen was used. The primary outcome was the incidence of seizures. Secondary outcomes included serious maternal morbidity and other adverse effects associated with MgSO₄ use. Perinatal outcomes were also recorded. Analyses were intention-to-treat.
Results: A total of 116 patients [57 (12-hour group) and 59 (24-hour group)] were included. The mean age was 25(±4) years, while the mean gestation period was 34 (±4) weeks. The incidence of seizures was comparable in the two groups [1 (2%), 3 (5%), p=0.62]. Patients in the 12-hour group [1 (2%)] had lesser postpartum drowsiness compared to the 24-hour group [15 (25%), p<0.001] and consequently, lesser problems in breastfeeding [1 (2%) versus 10 (17%), p=0.008]. There were no inter-group differences in other adverse effects including loss of reflexes, oliguria, respiratory depression, and proportion of patients requiring interruption of therapy. Perinatal outcomes were also similar.
Conclusion: In patients having preeclampsia with severe features, 12-hour postpartum MgSO₄ therapy is equally effective in preventing eclampsia and has lesser postpartum drowsiness and problems with breast feeding compared to the standard 24-hour therapy.

Objective: To determine the sperm DNA fragmentation in the semen of suspected sub-fertile men of Nepal and find its association with bacteriospermia demographic and lifestyle factors.
Materials and methods: A cross-sectional study was conducted with the subjects, males among
sub-fertile couples visiting a fertility center in Kathmandu Valley, Nepal for consultation. Information on demography and exposure factors was obtained with a structured questionnaire, and bacteriospermia and sperm DNA fragmentation was determined from the semen samples collected from the study subjects. The data obtained were used to assess sperm DNA fragmentation and its association with various risk factors in sub-fertile men of Nepal.
Results: Out of 186 samples analyzed, 41.4% had low DNA fragmentation (<15%), 38.7% had
moderate DNA fragmentation (≥15% and <30%), and 19.9% had high DNA fragmentation (≥30%). Among the risk factors analyzed, sperm DNA fragmentation was found to be significantly associated with the age of the patients (p<0.05). Other factors analyzed body mass index, smoking, alcohol consumption, physical activity, and bacteriospermia were not found to be associated with sperm DNA fragmentation in our study.
Conclusion: Sperm DNA integrity may be distorted with the increasing age of men, leading to decreasing fertility potential.

Objective: Constipation is a prevalent issue among children and is generally treatable with simple therapeutic approaches. However, a considerable proportion of these children experience severe constipation that necessitates more invasive treatments, including surgical interventions. This study is designed to examine the effects of administering the Bowel Management Program (BMP) in the treatment of fecal incontinence and soiling among children with chronic refractory constipation.
Materials and methods: The research involved 24 patients who presented at the Children’s Medical Center exhibiting symptoms of functional constipation and fecal incontinence. Each patient was enrolled in the study after a thorough review of their medical history, a physical examination, and other paraclinical measurements like barium enema or rectal manometry, ruling out the organic causes of constipation. The bowel management program was subsequently established for these patients.
Results: This study examined 24 children, including 14 girls (58.3%) and 10 boys (41.7%), with a mean (SD) age of 4.8 (1.2) years for the girls and 5.4 (1.2) years for the boys. The analysis revealed that there was no significant correlation between symptom duration and treatment duration in relation to gender, as indicated by a p-value greater than 0.05. Spearman's correlation test showed a significant relationship between the children’s age and their treatment duration (p˂0.001, r=0.54) and also between their age and their clinical symptom duration (p˂0.001, r=0.59).
Conclusion: The results showed that the children’s age was significantly correlated with their treatment duration and clinical symptom duration. The bowel management program can be an effective treatment for overflow incontinence in children with chronic refractory constipation.

Objective: Pregnancy is one of the most important, influential, and critical periods in the lives of women and families. Women's attitudes toward pregnancy and motherhood can greatly impact how they face challenges during pregnancy. Many transformations occur in women's sexual lives during this period. Previous studies have reported conflicting results regarding sexual desire during pregnancy and various factors that affect women’s attitudes toward motherhood. Therefore, we decided to investigate the relationship between these factors.
Materials and methods: This cross-sectional study with descriptive and analytical objectives was conducted on 124 pregnant women referred to comprehensive health service centers. The research instruments included the Socio-Demographic and Obstetric Questionnaire, the Scale of Attitudes toward Motherhood and Pregnancy, and the Hulbert Sexual Desire Questionnaire.
Results: This study revealed a direct and significant relationship between the attitude toward the role of the mother and sexual desire in pregnant women (M1: 17.4±57.06, M2: 5.31±32.5, r=0.473; p<0.001). Also, the results showed that the sexual desire of pregnant women is average (32.5±5.31), and the attitude toward the role of the mother is low (57.06±17.4).
Conclusion: The results of the study showed that any improvement in attitudes toward motherhood and pregnancy enhanced sexual desire. It seems necessary to screen women and men in terms of attitudes toward motherhood and sexual health and factors affecting it during pregnancy.

Objective: Individuals with disabilities, including those with fibromyalgia, have historically faced barriers and stigma in healthcare settings. This issue extends to reproductive health areas, such as pregnancy. Previous research on the pregnancy experiences of individuals with disabilities has predominantly focused on physical or visible disabilities. Furthermore, many studies have overlooked the intersectionality of additional identities, including race and gender identity. This thematic analysis aimed to provide insight into the unique experience of pregnancy for individuals with fibromyalgia.
Materials and methods: A total of eight semi-structured interviews were conducted with participants who identified as having fibromyalgia, and had experienced a pregnancy with a live birth within the last
12 months at the time of the interview. Most participants identified as Black/African American. Interviews were analyzed using a reflective thematic analysis approach to identify key themes within the participants’ responses.
Results: Participants articulated four major themes concerning their experiences of pregnancy with fibromyalgia: (1) acquiring a chronic and unpredictable condition; (2) the adjustment to pregnancy and parenting; (3) building trust and addressing doubt: healthcare dynamics in fibromyalgia management; and (4) seeking and receiving social support: a multifaceted experience. Each theme contains important subthemes that reflect the dynamic and varied experiences associated with pregnancy with fibromyalgia.
Conclusion: This study elucidates the unique experience of pregnancy among individuals with fibromyalgia, a historically marginalized population. The findings highlight substantial opportunities for improving the pregnancy-related care provided by healthcare providers, including rehabilitation professionals, for individuals with fibromyalgia.

No abstract.