Introduction. Anti-Müllerian hormone represents the primitive follicular number and ovarian age. Low level of AMH is in relation to early menopausal state and decreased ovarian reserve. AMH level changes occur prior to FSH level in representing ovarian failure. The aim of this study is to compare sensitivity and specificity of AMH with FSH in diagnosis of POF. Material and Methods. This descriptive study is done on 96 patients referred to Dr. Rasekh Clinic. Serum level of AMH and FSH was measured at Day 3 (3rd day of menstrual cycle) and data were analyzed through SPSS 21 software. Results. Results of AMH and FSH serum level indicate that AMH has more sensitivity (80% versus 28.57%) and almost equal specificity (78.89% versus 78.65%) compared with FSH. Also negative predictive value of AMH (98.61%) and FSH (87.5%) is different. But positive predictive value is the same (17.39%). Diagnostic accuracy of AMH is more than FSH and has significant differences. Conclusion. According to the results of this study, AMH serum level is more sensitive than FSH serum level. Also AMH has more negative predictive value. Besides, this hormone can be measured at any time of menstrual cycle, against FSH. AMH seems to be more useful in early diagnosis of POF.
The intrauterine device (IUD) is the most common method of reversible contraception in women. However, IUD can perforate the uterus and also migrate into pelvic or abdominal organs. A 43-year-old woman with a 5-year history of IUD placement and without specific symptoms, decided to remove her IUD and undergo tubal ligation. Radiological assessment, including a pelvic X-ray and ultrasonography, revealed no copper IUD within the uterus. Retrieval attempts with cystoscopy were unsuccessful. The IUD was found embedded in the fundal part of the bladder wall and was subsequently removed through a laparotomy incision. Although there are cases in the literature that were successfully managed with cystoscopy, in chronic cases, the formation of granulation tissue may preclude retrieval of an IUD using this intervention.
Background: Vulvovaginal candidiasis (VVC) is a significant health issue due to Candida spp. Although Candida albicans is considered a major causative agent of vaginal candidiasis, non-albicans species have increased during previous decades. Objectives: This research aimed at molecular identification and assessing antifungal susceptibility of VVC isolated Candida spp. Methods: A professional physician examined two hundred and ninety-five suspected females with vaginitis. The specimens were collected by sterile cotton swabs. Swabs were inoculated on Sabouraud dextrose agar plates and then incubated for 48 - 72 hours at 35°C. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used to detect all Candida species. Broth microdilution, according to the M27-A3 and M27-S4 CLSI documents, were employed for determining the antifungal susceptibility tests of caspofungin (CAS), voriconazole (VRC), itraconazole (ITC), fluconazole (FLU), clotrimazole (CLO), ketoconazole (KTO), amphotericin B (AMB), and nystatin (NYS). Results: A total of 295 females suspected of vulvovaginal candidiasis were examined. The culture results were positive in 50.5% (149 of 295) of specimens. According to molecular identification techniques, C. albicans 133/149 (89.2%), C. glabrata 8/149 (5.4%), and C. kefyr 2/149 (1.4%) were the main species. A mixed infection of C. albicans and C. glabrata 6/149 (4 %) was detected. The geometric mean values to all Candida strains were in increasing order as the following: CAS, 0.075 µg/mL; VRC, 0.091 µg/mL; ITC, 0.15 µg/mL; AMB, 0.22 µg/mL; CLO, 0.23 µg/mL; KTO, 0.28 µg/mL; NYS, 0.88 µg/mL; FLU, 1.48 µg/mL. Further, the MIC ranges of all Candida isolates to the tested antifungal agents were in increasing order as follows: CAS: 0.031 - 0.25 µg/mL, KTO and ITC: 0.031 - 2 µg/mL, VRC: 0.031 - 4 µg/mL, CLO and AMB: 0.031 - 8 µg/mL, NYS: 0.06 - 4 µg/mL, and FLU: 0.12 - 128 µg/mL. Conclusions: We reported 1 (7.2 %) C. glabrata isolate resistance to FLU and 2 (14.3%) C. glabrata isolates susceptible-dose-dependent (SDD) to CAS. We also reported 6 (4.5%), 5 (3.8%), and 2 (1.5%) C. albicans resistance to ITC, FLU, and AMB, respectively, but 100% C. albicans susceptible to CAS and VRC.
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