Objective To comparatively evaluate the outcome of treatment with 150 versus 200 units (U) of botulinum toxin in achieving pain-free intercourse and relieving muscle contraction in order to allow gynecological examination. Methods In this comparative prospective observational study, 99 patients with vaginismus were treated with botulinum toxin injections from September 2016 to August 2021. Diagnosis and grading of vaginismus severity were assessed using a Female Sexual Function Index (FSFI) questionnaire. Under local or general anesthesia, botulinum toxin diluted with preservative-free saline (150 U and 200 U) was injected into, above, and below the right and left bulbospongiosus muscle and the lateral submucosal areas of the introitus and perineal body using an insulin syringe. Patients were recalled after 2 weeks, and the postoperative outcome was recorded using a similar preoperative questionnaire. Results Overall, the mean age of patients was 30.2 years. The baseline and clinical characteristics were comparable between the 2 groups (p > 0.05). Significant improvements were seen in the pain and anxiety scores of finger penetration, dilator use, intercourse, and cotton swab in individual groups. The intergroup comparisons between 150 U and 200 U of Botox were not statistically significant (p > 0.05). Conclusion Low-dose Botox (150 U) is equally effective as high dose Botox injections (200 U) in vaginismus patients. Therefore, Botox-150 U can be used to treat vaginismus as an alternative to high doses of the same substance.

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Background: Red cell distribution width (RDW) is an inflammatory biomarker and a component of complete blood count that gains increased attention. Pre-eclampsia (PE) is a unique pregnancy syndrome for which inflammation was proposed for pathogenesis. Objectives: We aimed to examine RDW's role in PE and explore confounders that limit its implication in practice. Materials and methods: A case-control study recruited 120 participants matched in body mass index (BMI) and gestational age into 3 subgroups; late-onset severe PE cases (30/120), late-onset non-severe PE cases (30/120), and healthy controls (60/120). Participants' demographics (age, BMI, systolic and diastolic blood pressure (SBP, and DBP), hematological and biochemical parameters were evaluated. Results: RDW was significantly higher in PE cases (P-value < 0.01 ); In addition, RDW was positively correlated to SBP, DBP, and protein urea, r =0.5, r = 0.46, and r = 0.47 ; P-value < 0.0001, respectively. Liver enzymes, hemoglobin, and white blood cell count were all significantly linked to RDW (r = 0.27, P-value = 0.015), (r = 0.32, P-value = 0.005), (r = -0.27, P-value = 0.02) and (r = 0.39; P-value = 0.0004) respectively. Applying ROC Curve analysis showed that RDW cut-off value of > 14.4% discriminated PE cases from healthy controls (P-value < 0.001). At a cut-off value > 15.6% RDW distinguished severe from non-severe PE cases (P-value < 0.001). Conclusion: RDW was significantly correlated to PE predictors and severity markers independent of gestational age and BMI. The ROC curve showed that RDW distinguished PE from healthy controls in addition to non-severe from severe PE cases with high sensitivity and specificity. Being an inexpensive, reliable test with good predictive and prognostic value warrants further studies for RDW's role in PE screening and follow-up.

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Objective Oxidative stress (OS) occurs when excess free radicals damage the DNA. Moreover, 8-oxo-2’-deoxyguanosine (8-OHdG) is a well-known biomarker for OS linked to cellular damage and gene instability. However, its role in female subfertility has not been properly assessed. We aimed to examine the level of OS represented by 8-OHdG based on the cause of subfertility and to test its correlation with reproductive hormones, intracytoplasmic sperm injection (ICSI) parameters, and outcomes.Methods A cross-sectional study examined 108 subfertile couples with endometriosis, polycystic ovary syndrome (PCOS), tubal factors, and unexplained infertility undergoing ICSI treatment with two different stimulation programs. We included couples whose partners had normal sperm parameters. Levels of follicular fluid (FF) 8-OHdG were correlated with the causes of subfertility and fertilization rates and compared between pregnant and non-pregnant cases.Results Based on the causes of subfertility, FF 8-OHdG was the highest among endometriosis cases, followed by PCOS cases. Furthermore, FF 8-OHdG was higher in non-pregnant (2.37±0.75 ng/mL) vs. pregnant (1.58±0.39 ng/mL), <i>P</i><0.001. A two-way analysis of variance showed that only subfertility affected ICSI outcomes, whereas the stimulation program did not. FF 8-OHdG correlated positively with female age and inversely with estradiol and good-quality embryos. The receiver operating characteristic estimated 8-OHdG cutoff value of 1.8 ng/mL predicted clinical pregnancies with 86.7% sensitivity and 74.4% specificity (<i>P</i><0.001).Conclusion Higher FF 8-OHdG levels negatively impacted ICSI outcomes. FF 8-OHdG discriminated between cases of clinical pregnancy with good specificity and sensitivity. Because OS can be measured and treated, this opens up a therapeutic and prognostic avenue for improving ICSI outcomes.