No Abstract

Objective: To review the potential role and specific impact of statin drugs in women with PCOS. The evidence for this use of statins in PCOS is limited and still under further investigation.
Materials and methods: A search was conducted using PubMed, DynaMed and PubMedHealth databases through October 16, 2016 using the terms polycystic ovary syndrome, PCOS, hydroxymethylglutaryl-CoA reductase inhibitors, hydroxymethylglutaryl-CoA , statin, atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin and simvastatin. English-language trials evaluating statins in PCOS were obtained and incorporated if they provided relevant data for providers.
Results: We summarize twelve trials involving statins in PCOS. The trials were predominantly 12 weeks to 3 months in length (8 of the 12 trials) and low to moderate dose of statin drugs were used. The majority (10 of 12) of the trials show that statins reduce testosterone levels or other androgen hormones (DHEA-S and androstenedione), half of the trials evaluating LH/FSH ratio show an improvement, and all had positive effects on lipid profiles.
Conclusion: Statins show promising improvements in serum levels of androgens and LH/FSH ratios translating to improved cardiovascular risk factors above and beyond simply lowering LDL levels. More investigation is needed to determine if statins can clinically impact women with PCOS long term, particularly those who are young and are not yet candidates for traditional preventative treatment with a statin medication.

Objective: To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section.
Materials and methods: The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter.
Results: There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants’ weight at the end of second month was lower in spinal opioid group (P value = 0.036).
Conclusion: The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation.

Objective: The purpose of the present study was to examine the impact of menstrual cycle abnormalities among patients with polycystic ovary syndrome (PCOS) on biochemical and anthropometric characteristics.
Materials and methods: We conducted a prospective observational study of patients 17-35 years of age with PCOS that attended the department of Gynecological Endocrinology of our hospital.
Results: A total of 309 women with PCOS participated in the study. In total, 72.2% suffered from menstrual cycle disorders. In our study 15.1% of women were overweight and 24% were obese. Also, 36% of the sample had androgenetic alopecia and 56.4% had acne. According to the stepwise discriminant analysis, we observed that glucose displayed the strongest association to the menstrual status (F to eliminate = 14.13), followed by endometrial thickness (F to eliminate = 10.89), waist circumference (F to eliminate = 10.17), LH levels (F to eliminate = 8.15) and PRL (F to eliminate = 4.45). Significantly higher levels of LH and TSH and lower levels of prolactin were found in women with menstrual disorders compared to those with normal menstrual cycles. Fasting glucose was also considerably higher among these patients although markers of insulin resistance such as the Matsuda, Quicki and HOMA-IR indices did not differ.
Conclusion: According to the findings of our study PCOS patients with menstrual disorders exhibit hormonal alterations and elevated fasting glucose. Future studies are needed in this field to corroborate our findings and determine the anthropometric and biochemical profile of patients with menstrual cycle irregularities.

Objective: To evaluate the symptoms of menopausal women and the link between sexual function, menopausal symptoms and demographic variables.
Materials and methods: This is a cross-sectional study in which 202 postmenopausal women admitted to the health care centers were selected. The Female Sexual Function Index (FSFI) questionnaire and Menopause-Specific Quality of Life (MENQOL) were the main means of data gathering.
Results: The results of our study suggested that suggested that women experienced a number of menopausal symptoms such hot flash, headache and neck pains, reduced physical strength weight gain, pain or leg cramps, intensified sexual problem than women who lack such symptoms. The FSFI scores were lower in women who were more than 60 years old, had low educational level (illiterate and elementary), and smoked cigarette. The most common symptoms were hot flashes (45%), Sleeplessness (37%), and pain in joints and muscles (36%). Moreover, the highest mean score belonged to symptoms associated with hot flashes (1.49 ± 1.38), sleeplessness (1.48 ± 1.71), and headache and neck pains (1.14 ± 1.59) table 2.
Conclusion: Women with a history of sexual problem experienced more intense menopausal symptoms. This study sheds more light on the link between sexual problems and menopausal symptoms, which can helps healthcare professionals to offer a desirable package to their patients.

Objective: To determine the effectiveness of counseling in reducing anxiety of nulliparous pregnant women.
Materials and methods: In this quasi-experimental study, 110 nulliparous pregnant women were selected out of all pregnant women referring to Fatemieh Hospital in Hamadan, Iran. Then, the subjects were divided into two groups in experimental and control (55 women in each). The data were collected through a questionnaire covering demographic and obstetric characteristics and Spielberger’s State-Trait Anxiety Inventory. The experimental group participated in four weekly sessions of group counseling about mother-infant attachment behaviors. Whereas, the control group only receive routine cares. Two groups were compared in terms of anxiety before and after the study.
Results: Before the intervention, no significant difference in anxiety level was observed between the two groups; however, state and trait anxiety levels of pregnant women in the experimental group significantly decreased after the intervention (p < 0.001). There was also significant difference in the mean score of state and trait anxiety levels between the two groups after the intervention (p < 0.001).
Conclusion: The results showed the effectiveness of prenatal counseling in reducing state and trait anxiety levels of pregnant women.

Objective: To evaluate the maternal and neonatal complications of vaginal birth after cesarean section (VBAC).
Materials and methods: This cross sectional study was conducted in Mashhad University of medical sciences. Eighty women with previous cesarean section who were candidate for VBAC were enrolled the study. Patients were followed up for 6 weeks after delivery. The complication of VBAC was compared between successful or unsuccessful VBAC cases. Data was analyzed by SPSS version 16.
Results: VBAC success rate was 91%. Post-partumhemorrhage occurred in 2.7% of woman with successful VBAC and 1.3% of CS cases. Maternal and neonatal death did not happen during our study, and none of our cases experienced uterine rupture, dystocia and neonatal tachypnea. Neonatal complications include NICU admission and neonatal resuscitation frequency in VBAC and CS were 6.8% and 57.1%, respectively (p = 0.002). Birth weight of neonates in successful VBAC was 2940 ± 768 grams and 3764 ± 254 grams in unsuccessful VBAC and this difference was significant (p = 0.007). Mean maternal admission duration in VBAC and CS were 1 ± 0.1 days and 2 ± 0.4 days (p < 0.001). Successful breastfeeding rate were higher in VBAC patients (95.8%) in comparison with CS (42.9%) and this difference was statistically significant (p = 0.002).
Conclusion: Our results revealed that VBAC can be considered as a safe maternal and neonatal delivery method in patients with past CS women.

Objective: To evaluate whether systemic inflammatory markers (neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) and red blood cell distribution width (RDW) to platelet ratio (RPR)) can be used as reliable markers for the diagnosis of premature ovarian insufficiency (POI) and to determine if there is a relationship between these markers and follicle stimulating hormone (FSH), Anti-Müllerian Hormone (AMH) levels.
Materials and methods: Written and electronic medical records were reviewed using searches for diagnoses with the terms of 'premature ovarian failure', 'premature ovarian insufficiency'. Patients younger than the age of 40 were diagnosed to have premature ovarian insufficiency based on their menstrual history and sonographic examination and they were compared with healthy females. Complete blood counts, day-3 hormone profiles, AMH levels of all subjects were analyzed.
Results: NLR was statistically higher in POI group compared with controls (p < 0.05). NLR had a positive correlation between FSH (r = 0.23, p = 0.045) and a negative association with AMH (r = - 0.27, p = 0.018). The area under ROC curve for NLR in POI was 0.66, with a threshold value 1.5 and sensitivity = 75.7 % and specificity = 46.0 %.
Conclusion: NLR can be a marker for the diagnosis of POI. There is a close relationship between NLR and ovarian reserve markers such as FSH and AMH.