Metformin is one of the most prescribed drugs in the world giving potential health benefits beyond that of type 2 diabetes (T2DM). Emerging evidence suggests that it may have protective effects for retinal/posterior segment diseases including diabetic retinopathy (DR), age-related macular degeneration (AMD), inherited retinal degeneration such as retinitis pigmentosa (RP), primary open angle glaucoma (POAG), retinal vein occlusion (RVO), and uveitis. Metformin exerts potent anti-inflammatory, antiangiogenic, and antioxidative effects on the retina in response to pathologic stressors. In this review, we highlight the broad mechanism of action of metformin through key preclinical studies on animal models and cell lines used to simulate human retinal disease. We then explore the sparse but promising retrospective clinical data on metformin’s potential protective role in DR, AMD, POAG, and uveitis. Prospective clinical data is needed to clarify metformin’s role in management of posterior segment disorders. However, given metformin’s proven broad biochemical effects, favorable safety profile, relatively low cost, and promising data to date, it may represent a new therapeutic preventive and strategy for retinal diseases.

Objective(s): The aim of the study was to evaluate the efficacy of ilioinguinal and iliohypogastric nerve block with anatomical landmark and direct visualization technique on postoperative pain relief and use of opioids after lower segment caesarean section.Materials and Methods: In a double blinded randomized clinical trial that conducted in Shahid Akbarabadi hospital of Tehran, 150 pregnant women candidate for elective cesarean section included in the study and randomly allocated into two groups (nerve block with bupivacaine0.25% and control). Procedure of cesarean section was equal in all cases and patients were assigned randomly to receive nerve block with either 20ml of 0.25% bupivacaine (group A-case group) or 20ml of normal saline solution (group B - placebo group) 2 hours after operation. Opioids dose was measured during the postoperative period during 8 hours. Postoperative pain was assessed at 2, 4, 6, 8 hours postoperatively with a visual analog scale (VAS). Data analyzed by SPSS.Results: There was a significant decrease in opioid administration and pain on visual analog scale in group A (nerve block), as compared with Group (placebo). 8 hours after the operation, pain severity in both case and control groups were similar. Total dose of opioid administration was significantly lower in group A (p=0.00).Conclusion: This study shows that ilioinguinal and iliohypogastric nerve block with anatomical landmark and direct visualization technique is good substitution for opioid in postoperative pain control in cesarean sectionBangladesh J Obstet Gynaecol, 2014; Vol. 29(2) : 83-86

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Many studies have showed the role of androgens on ovarian follicular maturation. The present study investigated the effect of serum concentration of androgens, LH, and insulin-like growth factor 1 (IGF1) in the early follicular phase on the results of the ovulation induction (I/O) and intrauterine insemination (IUI) cycles. This cross-sectional study was done in the infertility clinic of Akbar Abadi hospital. Fifty-nine infertile patients who were not affected by polycystic ovary syndrome (PCO) and were candidates for induction ovulation or intrauterine insemination were chosen at random. The serum concentrations of androgens (free testosterone, dihydroepiandrosterone, and androstenedione), LH, and IGF1 were measured on the third day of menstruation. Sonographic monitoring was started from the ninth day of the cycle. The ampule of hCG was injected when there was at least one follicle with the diameter of 18 mm. The relationships of concentration of androgens, LH, and IGF1 with follicular growth parameters and pregnancy rate were analysed. There was no statistically significant link between the number and diameter of follicles with concentration of free testosterone, dihydroepiandrosterone, androstenedione, IGF1, and LH. There was no statistically significant link between the number of follicles in the ovaries and concentrations of testosterone (P = 0.090 and r = 0.223), dihydroepiandrosterone (P = 0.642 and r = 0.062), androstenedione (P = 0.526 and r = 0.084), IGF1 (P = 0.470 and r = 0.096), and LH (P = 0.446 and r = 0.102). There was no statistically significant link between the mean follicular diameter and concentration of testosterone (P = 0.822 and r = 0.03), dihydroepiandrosterone (P = 0.733 and r = 0.045), androstenedione (P = 0.526 and r = 0.084), IGF1 (P = 0.799 and r = 0.034), and LH (P = 0.626 and r = 0.065). Beta human chorionic gonadotropin (β-hCG) was positive in 11 patients (18.6%) and negative in 48 patients (81.4%). Serum concentrations of androgen profile, LH, and IGF1 in the positive (β-hCG) group were not significantly different in comparison with the negative β-hCG group. It seems that in women who were not affected by PCO, concentrations of free testosterone, dihydroepiandrosterone, androstenedione, IGF1, and LH in the early follicular phase were not related to follicular growth parameters and pregnancy rate.