Background Endometriosis affects the responsiveness to ovarian stimulation. This study aimed to assess the role of Dienogest pretreatment for endometriosis suppression as compared to Gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis pursuing IVF treatment. Methods In this randomized controlled trial, 134 women with endometriosis-related infertility were randomly allocated to group A (n = 67) who had monthly depot GnRHa for 3 months before ovarian stimulation in IVF treatment (Ultra-long protocol), and Group B (n = 67) who had daily oral Dienogest 2 mg/d for 3 months before starting standard long protocol for IVF. The primary outcome measure was the number of oocytes retrieved. The secondary outcome measures included the number of mature oocytes, fertilization rate, quality of life assessed by FertiQoL scores, cost of treatment, and pregnancy outcomes. Results Although there was no statistically significant difference between both groups regarding ovarian stimulation, response parameters, and pregnancy outcomes, the Dienogest group had a lower cost of treatment (2773 vs. 3664 EGP, P < 0.001), lower side effects (29.9% vs. 59.7%, P < 0.001), higher FertiQoL treatment scores (33.2 vs. 25.1, P < 0.001) and higher tolerability scores (14.1 vs. 9.4, P < 0.001 < 0.001). Conclusion Our study indicates that Dienogest is a suitable and safe substitute for GnRHa pretreatment in endometriosis patients. Trial registration NCT04500743 “Retrospectively registered on August 5, 2020”.
Background This study aims to detect the effects of increased BMI on labor outcomes in primigravida pregnant women. Methods A cross-sectional study involved 600 full-term singleton primigravida pregnant women who presented in the active phase of labor to the labor ward. They were divided according to BMI into three equals groups; women with normal BMI (group I), overweight women (group II), and women with class I obesity (group III). Results We found that high BMI was associated with a significantly increased risk of Caesarean section (C.S.) (13% in group I, 18% in group II and 40% in group III). Women with higher BMI and delivered vaginally had a significantly prolonged first and second stage of labor, consequently increased the need for oxytocin augmentation as well as the oxytocin dose. Regarding the maternal and fetal outcomes, there are significantly increased risks of postpartum sepsis, perineal tears, wound infection, as well as significantly increased birth weight and longer neonatal stay in the neonatal unit (NNU). Conclusion Obese primigravida pregnant women were at higher risk of suboptimal outcomes. Besides, prolonged first and second stages of labor and the incidence of C.S. have also been increased.
Arsenic, a widely studied medicinal and toxicological element, is known to induce oxidative stress and damage to cells. The present study was aimed at to assess the effect of vitamin E (alpha-tocopherol) and/or DDB (dimethyl diphenyl bicarboxylate) with or without the chelator DMSA (Meso 2,3-dimercaptosuccinic acid) on arsenicinduced hepatotoxicity. Fifty four adult male albino rats were divided into nine groups. Group I was the control and received only intraperitoneal injection normal saline 2 times per week for two weeks. Group II was injected with sodium arsenite in normal saline 2 times /week for 2 weeks. Group III was injected with sodium arsenite and received oral DMSA daily for 2 weeks. Group IV was injected with sodium arsenite and received oral vitamin E (alpha -tocopherol) daily for 2 weeks. Group V was injected with sodium arsenite and received oral DDB daily for 2 weeks. Group VI received sodium arsenite, vitamin E and DDB for 2 weeks. Group VII received sodium arsenite, DMSA and vitamin E for 2 weeks. Group VIII received sodium arsenite, DMSA and DDB for 2 weeks. Group IX received sodium arsenite, DMSA, vitamin E and DDB for 2 weeks. Physiological and biochemical parameters were undertaken to measure Alanine Amino-Transferase (ALT), Aspartate Amino-Transferase (AST), Malondialdehyde (MDA), reduced Glutathione (GSH) and Glutathione Peroxidase (GPx). Histochemical and histpathological parameters were also undertaken to assess the structural-functional mirror changes. The results of this study showed that vitamin E and DDB were almost similar in their antioxidant hepatoprotective effects with stronger inhibiting action of DDB to lipid peroxidation while the greatest effect was achieved by their combination with a chelating agent like DMSA with restoration of almost the normal hepatic histology.
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