Objective: Oxidative stress affects the development of ovarian follicles during in vitro culture thus applying an antioxidant is necessary. The aim of this study was to investigate the effect of coenzyme Q₁₀ (CoQ₁₀) on the expression of apoptosis-related genes of mouse ovaries during in vitro culture.
Materials and methods: The immature mouse ovaries were cultured in the presence of 50 μM CoQ₁₀ for 7 days. Histological examinations were performed and the 17 beta-estradiol concentration was measured on the seventh day of culture. The relative expression of Caspase 3, Bax, Bad, and Bcl 2 genes were investigated by real-time RT-PCR.
Results: The rates of normal follicles in the presence of CoQ₁₀ was significantly increased compared to the control group. Also, in CoQ₁₀-trated group a significant increase in the level of 17 beta-estradiol was seen compared to the control group. The mRNA expression of anti-apoptotic gene Bcl2 was significantly increased while the expression of pro-apoptotic genes (Caspase3, Bax and Bad) significantly declined in CoQ₁₀ treated group compared to those of control group.
Conclusion: The supplementation of the ovarian culture media with CoQ₁₀ improved the follicular development through alteration in expression of apoptosis-related genes and stimulated the production of estradiol.

Objective: Comparison of two different intervals of misoprostol administration after mifepristone in second trimester abortions.
Materials and methods: This 12-month prospective study was conducted at a tertiary care facility. Only pregnancies with congenital deformity or sterilisation failure were included in the study's recruitment of 100 women who visited the hospital for a second trimester abortion between 12 and 20 weeks; cases with scarred uteri were omitted. In a systematic random selection of 50 women in each group, the administration of 200 mg of mifepristone orally was followed by two distinct intervals of intravaginal misoprostol administration at 24- and 48-hour intervals. After 24 hours, group A women received intravaginal 400 mcg misoprostol three hourly, up to a maximum of five doses, while group B received the same doses after 48 hours. Induction abortion interval noted on various parameters and paired t test and chi square test applied.
Results: The mean IAI following misoprostol administration was 8.14 2±.03 hours in group A and
7.71 ±2.56 hours in group B. This difference was statistically insignificant. Average misoprostol doses for group A were 1.68±0.71 and for the group, B were 1.68±0.84; both doses were found to be statistically insignificant when used to induce abortion. All women aborted successfully in each group. There was no significant difference in side effects in both groups.
Conclusion: Based on the results it was observed that shorter interval between mifepristone and misoprostol i.e., 24 hours can be chosen to decrease the hospital stay as there was no significant difference was seen after intravaginal misoprostol in terms of  induction abortion interval, number of doses and side effects.

Objective: Metabolic syndrome is a risk factor affecting reproductive health and pregnant outcomes. So far, the effect of this syndrome on the success rate of assisted reproduction techniques (ART) has not been investigated. The aim of this study was to investigate the relationship between metabolic syndrome and the success rate of ART in infertile women in Isfahan.
Materials and methods: A prospective cohort study performed on 147 women candidates using in-vitro fertilization/ intra cytoplasmic sperm injection (IVF/ICSI) and/or ICSI methods referred to Isfahan Infertility Center in two groups with metabolic syndrome(n=49) without metabolic syndrome(n=98), by convenience sampling methods in Isfahan, Iran in 2018. Body mass index (BMI) and waist, abdominal circumference, Serum triglyceride (TG), cholesterol and FBS were measured. If βHCG test was positive (day 15-16 after ART), transvaginal sonography (TVS) was done 15 days later. Pregnant women were followed up to the 20th week of pregnancy. To analyze, t-test, chi-square and logistic regression tests were used.
Results: The frequency of metabolic syndrome was 33.4% (n=49).The frequency of ART was not significantly different between women with and without metabolic syndrome (p=0.321). The relative frequency of pregnancy (p=0.907) and abortion (p=0.896) did not show a significant difference between the two groups. Independent t-test showed that the mean FBS, HDL, TG, systolic and diastolic BP, abdominal circumference and BMI in the studied units did not differ significantly based on the occurrence of pregnancy and abortion.
Conclusion: According to the results of this study, there was no significant difference between the indicators of metabolic syndrome and the success rate of ART in achieving, pregnancy and pregnant outcomes in the first twenty weeks of pregnancy.

Objective: Fetal occiput posterior (OP) position is associated with more maternal and neonatal complications. This study aimed to investigate the effect of maternal position during labor on fetal OP position and pregnancy outcomes.
Materials and methods: This randomized clinical trial study included 180 primigravida women in labor with a single fetus and approved OP position. Participants were randomly allocated into three groups: semi-prone position (n=45), knee-chest position (n=45), and supine position (n=90). All participants were placed in the defined positions 15-30 min in labor until delivery. Data collected using Visual Analogue Scale and researcher made checklist. The ANOVA, Tukey post hoc, and the chi-square test were used to analyze.
Results: Among all participants who had OP, after intervention 16.3% in the semi-prone position, 14/3 % in the knee-chest position, and 33.7% of the control groups remained with OP at birth (X³=7/87, P=0.019). The rate of natural delivery was significantly higher in the semi-prone position and knee-chest position. The duration of active phase of labor and low back pain were significantly reduced in the semi-prone and knee-chest position compared to the control groups (P<0.05). There were no differences in the duration of the third stage of labor, APGAR score, and the rate of neonatal addition to neonatal intensive care unit, using oxytocin, and perineal tears (P>0.05).
Conclusion: The semi-prone and knee-chest positions increase the spontaneous rotation of occiput to the anterior position, vaginal delivery rates as well as a reduction in duration of active phase of labor and low back pain after delivery.

Objective: Erectile dysfunction (ED) is a common cause of sexual disorders in men with limited treatment options. This study aimed to determine the efficacy of low-intensity extra corporal shockwave therapy
(LI-ESWT) in patients suffering from ED.
Materials and methods: A single-group, pre-test, and post-test pre-experimental study were conducted. Thirty-one ED patients were prospectively selected according to the eligibility criteria. In each session, 3000 shocks were applied at 5 points over the penis. Eight sessions were delivered in total with a
2–3-day interval. The patient’s condition was assessed using the International Index of Electric Function (IIEF-5) questionnaire at baseline and one month after the last treatment session. Paired t-test was used to determine the difference between the pre-test and post-test.
Results: Mean age of the patients was 44.6 (± 14.70) ranging from 25 to 78 years. The majority of them were married (83.9%) and service providers (51.6%). We have also found 51.6% overweight, 9.7% obese, 48.4% diabetic, 45.2% hypertensive, 12.9% with enlarged prostate, 45.2% smoker, 25.8% alcoholic, and 71% with sleep disturbances. During the pre-test, 9.7% had severe ED and 51.6% had moderate ED. After the treatment, no patients were found with severe ED, and few of them had moderate ED (9.7%). The mean difference in IIEF-5 score during the pre-test and post-test was statistically significant (p= < 0.001).
Conclusion: The study showed efficacy of LI-ESWT in a subset of patients with ED. Future studies with larger sample size, placebo group, and longer follow-up periods are recommended.

Objective: This study was conducted for determining pregnancy outcome after selective fetal reduction in twin pregnancies based on the gestational age at the time of the procedure in a referral academic center between 2017 and 2021.
Materials and methods: This retrospective cohort study included all women with twin pregnancies who were diagnosed with a genetic or structural anomaly of one fetus or a desire to reduce the number of fetuses in order to reduce pregnancy complications visited in the period of 2017-2021. Reduction was performed due to an abdominal approach at 11 to 23 weeks of pregnancy. Maternal and pregnancy information were recorded.
Results: A total of 159 cases of twin dichorionic pregnancies were included. The highest frequency of reduction was performed at the gestational age of 18-20 weeks, and the most common cause of reduction was major structural anomalies in the fetus .The results showed the average gestational age (GA) at the time of delivery to be 37.6 weeks, the average birth weight of 2,999 grams, the incidence of miscarriage (loss before 22 weeks) to be 9.4% and a rate of preterm birth (delivery before 37weeks) of 33.3%. There is not a statistically significant relationship between the gestational age at the time of reduction and preterm birth, the birth weight, the incidence of RDS and the incidence of SGA.
Conclusion: Fetal reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks reduction of twins to singleton pregnancy is associated with lower risk of preterm birth (delivery before37 weeks). It causes an increase in birth weight and perinatal outcome in remaining co-twin so we recommend fetal reduction after counselling with patients for their unique situation to improve pregnancy outcome.

Objective: Dengue cases in pregnancy have high morbidity and mortality. More so if it leads to immune thrombocytopenic purpura which causes a drastic decrease in platelet, increasing chances of bleeding and mortality and pregnancy itself being a state of hemodynamic instability.
Case report: Here, we present a case of dengue causing secondary immune thrombocytopenia. Managing these cases is challenging and need a multidisciplinary approach and should be done at a higher center. In previous reports, thrombocytopenia in such cases responded to steroids or IVIG. But in our case patient did not respond to either of them but to Romiplostim. There are only a few studies on the use of Romiplostim in dengue and dengue induced ITP and more study is required.
Conclusion: Dengue induced persistent thrombocytopenia is rare but should always be kept in mind in managing these cases.

Objective: Present a case of zuclopenthixol associated priapism, literature review and focus on the stuttering priapism entity as a potential serious complication as well as providing information about possible preventive treatments.
Case report: A 44 year-old male patient with history of cocaine abuse with associated priapism presents with acute painful erection after starting zuclopenthixol for treatment of a psychotic episode. This episode was later followed by many other similar episodes defined as stuttering priapism.
Conclusion: Acute ischemic priapism is a potential serious side effect of antipsychotics that physicians especially psychiatrists needs to be aware of especially if the patient has previous episodes in order to prevent reoccurrence.

Objective: In Raynaud's phenomenon of the nipple there is a change in color, accompanied by pain or discomfort during breastfeeding.
Case report: A 29-years old female patient, breastfeeding, develops a severe bilateral nipple pain during and after breastfeeding and biphasic change in nipple color, with difficulties in the breastfeeding technique. She was medicated with nifedipine and recommended application of warm compresses to the nipples and use of electric breast pump, showing complete resolution after four weeks of treatment.
Conclusion: Raynaud's phenomenon of the nipple should be considered in breastfeeding women who report nipple pain or discomfort. In clinical practice, nipple pain is a very frequent complaint, and responsible for many cases of early abandonment of breastfeeding. It is therefore essential to make an early diagnosis and implement a correct and immediate treatment.

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