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Homeira Vafaei,1 Shohreh Roozmeh,1 Kamran Hessami,1,2 Maryam Kasraeian,1 Nasrin Asadi,1 Azam Faraji,1 Khadije Bazrafshan,1 Najmieh Saadati,3 Soudabeh Kazemi Aski,4 Elahe Zarean,5 Mahboobeh Golshahi,6 Mansoureh Haghiri,7 Nazanin Abdi,8 Reza Tabrizi,9 Bahram Heshmati,10 Elham Arshadi11 1Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 2Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; 3Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; 4Department of Obstetrics & Gynecology, Reproductive Health Research Center, Guilan University of Medical Sciences, Rasht, Iran; 5Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; 6Department of Psychology, University of Guilan, Rasht, Iran; 7Department of Perinatology, Maternal-Fetal Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran; 8Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; 9Health Policy Research Center, Institute of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; 10Medical Journalism Department, Paramedical School, Shiraz University of Medical Sciences, Shiraz, Iran; 11Department of Obstetrics and Gynecology, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Nasrin AsadiMaternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Maternal- Fetal Medicine (Perinatology), Hafez Hospital, Chamran Ave, Shiraz, IranTel +98-71-36128257Fax +98-71-362128257Email nasadi2012@yahoo.caBackground: The coronavirus disease of 2019 (COVID-19) pandemic has become the most challenging issue for healthcare organizations and governments all over the world. The lack of evidence-based data on the management of COVID-19 infection during pregnancy causes an additional stress for obstetrics healthcare providers (HCPs). Therefore, this study was undertaken to evaluate depression, perceived social support, and quality of life among obstetrics HCPs.Materials and Methods: This cross-sectional multicenter study was conducted in eight cities in Iran. During the study period, 599 HCPs were separated into direct, no direct, and unknown contact groups according to their exposure to COVID-19-infected pregnant patients. The Patient Health Questionaire-9 (PHQ-9), Multidimensional Scale of Perceived Social Support (MSPSS), and Short Form-36 (SF-36) were used to assess depression, perceived social support, and quality of life.Results: Obstetrics and gynecology specialists had significantly higher social functioning and general health scores compared to other HCPs (residents/students or nurses/midwives). Depression was negatively correlated with most of the domains of quality of life, regardless of the COVID-19 contact status of the study participants. Social support, however, was positively correlated with some domains of quality of life, such as physical functioning, energy/fatigue, and emotional well-being, among staff members who had either direct contact or no contact with COVID-19 patients.Conclusion: During the COVID-19 outbreak, the depression score among obstetrics HCPs was negatively associated with quality of life. Social support, however, had a reinforcing effect on quality of life.Keywords: coronavirus, COVID-19, healthcare provider, obstetrics, quality of life, SARS-CoV 2

Saeedeh Foroughinia,1 Kamran Hessami,2,3 Nasrin Asadi,3 Leila Foroughinia,4 Mohammadjavad Hadianfard,5 Azadeh Hajihosseini,5 Najmeh Pirasteh,5 Mehrdad Vossoughi,6 Homeira Vafaei,3 Azam Faraji,3 Maryam Kasraeian,3 Mehrnoosh Doroudchi,7 Mohammad Rafiee Monjezi,8 Shohreh Roozmeh,3 Khadije Bazrafshan3 1Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran; 2Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; 3Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 4Box Hill Hospital, FRANZCOG, Eastern Health, Victoria, Australia; 5Physical Medicine and Rehabilitation Department, Shiraz University of Medical Sciences, Shiraz, Iran; 6Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran; 7Department of Immunology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; 8Shiraz Institute for Cancer Research, Shiraz University of Medical Sciences, Shiraz, IranCorrespondence: Nasrin AsadiMaternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, IranTel +98-71-36128257Fax +98-71-362128257Email nasadi2012@yahoo.caObjective: The aim of the current study is to evaluate the efficacy and safety of acupuncture on sleep quality and overnight melatonin secretion, measured as urinary 6-sulfatoxymelatonin, in pregnant women.Patients and Methods: This randomized, parallel, single-blinded (participant), controlled trial was conducted on 72 pregnant women with insomnia. Study participants were randomly assigned to either the intervention, 10 sessions of acupuncture treatment over a 3-week period, or control group by block randomization (1:1). Patients in both groups were evaluated at baseline and post-treatment (third week) using the Pittsburgh Sleep Quality Index (PSQI) score (as the primary outcome) and urinary 6-sulfatoxymelatonin.Results: Fifty-five of 72 participants completed the study. There was no statistically significant difference regarding PSQI score and 6-sulfatoxymelatonin level between intervention and control groups at the baseline (P=0.169 and P=0.496). At the end of the study period, treatment with acupuncture significantly improved the PSQI score (P< 0.001) with a large effect size of 3.7, as well as 6-sulfatoxymelatonin level (P=0.020) with a medium effect size of 0.6 as compared to the control group. No adverse effects were noted during acupuncture sessions and follow-up visits.Conclusion: Acupuncture was shown to significantly improve the sleep quality in pregnant women, possibly through increasing melatonin secretion, and could be recommended as a low-cost and low-risk alternative treatment to pharmacological therapies.Keywords: acupuncture, pregnancy, insomnia, melatonin

This article, titled "EP07.08: Underdeveloped nasal alae, prenatal ultrasonographic findings and its importance: case report," discusses a case of Johanson Blizzard syndrome (JBS) in a fetus. During a routine anomaly scan, the fetus was found to have nasal alar hypoplasia, along with total anomalous pulmonary venous connection. The parents were informed about the possibility of genetic disorders and pregnancy termination, but they chose to continue the pregnancy. The fetus later developed additional abnormalities and was delivered via Caesarean section. The newborn was diagnosed with JBS, a rare autosomal recessive disorder characterized by various symptoms. The article emphasizes the importance of sonographers being familiar with the sonographic features of nasal alar hypoplasia and including the visualization of nostrils as part of routine anomaly scans. [Extracted from the article]

A recent study published in the journal Ultrasound in Obstetrics & Gynecology examined the effectiveness of pentoxifylline in treating severe early-onset fetal growth restriction (FGR). The study involved 40 pregnant women with early-onset growth-restricted fetuses who were given either pentoxifylline or a placebo until delivery. The results showed that the group treated with pentoxifylline had significantly higher fetal weight gain, increased serum antioxidant capacity, higher 5-minute Apgar scores, and a lower percentage of babies admitted to the neonatal intensive care unit (NICU). The study suggests that pentoxifylline may have promising effects in improving neonatal outcomes and reducing neonatal mortality in pregnancies affected by FGR. [Extracted from the article]

When a flow of electrons passes through a paramagnetic layer with strong spin-orbit-coupling such as platinum (Pt), a net spin current is produced via the spin Hall effect (SHE). This spin current can exert a torque on the magnetization of an adjacent ferromagnetic layer which can be probed via magnetization dynamic responses, e.g., spin-torque ferromagnetic resonance. Nevertheless, that effect in the lower frequency magnetization dynamic regime where the skin effect occurs in high permeability ferromagnetic conductors, namely, the magneto-impedance (MI) effect, can be fundamentally important, and has not been studied so far. Here, by utilizing the MI effect in the magnetic-ribbon/Pt heterostructure with high transvers magnetic permeability that allows the ac current effectively confined at the skin depth of ~100 nm thickness, the effect of spin-orbit-torque (SOT) induced by the SHE probed via the MI measurement is investigated. We observed a systematic MI frequency shift that increases by increasing the applied current amplitude and thickness of the Pt layer (varying from 0 nm to 20 nm). In addition, the role of the Pt layer in the ribbon/Pt heterostructure is evaluated with the ferromagnetic resonance effect representing a standard Gilbert damping increase as a result of the presence of the SHE. Our results unveil the role of SOT in dynamic control of the transverse magnetic permeability probed by impedance spectroscopy as a useful and valuable technique for detection of future SHE devices. [ABSTRACT FROM AUTHOR]

Although this is a very rare congenital anomaly, all sonographer should be familiar with prenatal ultrasound feature and associated anomalies. Most of the cases of diphallia reported postnatally however today with providing of high resolution ultrasound device in-utero diagnosis of many congenital anomalies are possible. Penile duplication or diphallia is a rare congenital anomaly with unclear exact pathophysiological cause. [Extracted from the article]

We study the ac current-driven domain wall motion in bilayer ferromagnetic metal (FM)/nonmagnetic metal (NM) nanowires. The solution of the modified Landau-Lifshitz-Gilbert equation including all the spin transfer torques is used to describe motion of the domain wall in the presence of the spin Hall effect. We show that the domain wall center has a second-harmonic frequency response in addition to the known first-harmonic excitation. In contrast to the experimentally observed second-harmonic response in harmonic Hall measurements of spin-orbit torque in magnetic thin films, this second-harmonic response directly originates from spin-orbit torque driven domain wall dynamics. Based on the spin current generated by domain wall dynamics, the longitudinal spin motive force generated voltage across the length of the nanowire is determined. The second-harmonic response introduces additionally a practical field-free and all-electrical method to probe the effective spin Hall angle for FM/NM bilayer structures that could be applied in experiments. Our results also demonstrate the capability of utilizing FM/NM bilayer structures in domain wall based spin-torque signal generators and resonators. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) against pregnant women can cause several complications for the mother and her baby, which are life-threatening. Thus, we aimed to find the prevalence of IPV and its associated factors in pregnant women in Shiraz, Iran., Methods: This cross-sectional study was conducted among pregnant mothers in Shiraz between July 2020 and January 2021. The questionnaire consisted of four parts: demographic data, socio-economic status (SES), obstetric and medical history, and questions about IPV. Univariate analysis was performed using Chi-square, McNemar, or Fisher's exact test, and variables with p-value < 0.20 were included in Logistic regression. The odds ratio and CI 95% for variables with p-value < 0.05 were considered statistically significant., Results: The overall prevalence of IPV was 93.1% among 830 pregnant women in Shiraz. Psychological violence was the most prevalent type (92.9%), followed by sexual (11%) and physical (7.7%) violence. High SES (OR = 3.21, (CI:1.61-6.41)) was the only risk factor for overall violence, and the age group, 30-34, was a risk factor for physical violence. Mother-desired pregnancy (OR = 26 (Cl:0.09-0.79)) and father-desired pregnancy (OR = 0.91, (CI:0.22-3.80)) were protective factors against physical and sexual violence, respectively. Furthermore, Psychological violence and sexual violence increased during COVID-19 Pandemic (P.value < 0.05)., Conclusion: According to the obtained results, the prevalence of IPV during pregnancy in Shiraz was very concerning, especially psychological violence. Improving conflict-solving skills among family members and addressing economic problems could be considered by health policymakers when designing interventional programs and policies to reduce IPV during pregnancy., (© 2023. The Author(s).)

Objective: Management of pregnancy complicated by severe early-onset fetal growth restriction (FGR) is one of the most challenging obstetrical issues. So far, there has not been a proven option for the treatment or improvement of this condition. Improper immune response during placentation leads to inadequate trophoblast invasion and impaired utero-placental perfusion. Pentoxifylline improves the endothelial function and induces vasodilation by reducing the inflammatory-mediated cytokines. We have evaluated the effect of Pentoxifylline on fetal-placental perfusion, neonatal outcome, and the level of oxidative stress markers before and after the intervention in the setting of severe early-onset FGR., Materials and Methods: This study is a pilot randomized clinical trial on 40 pregnant women who had developed early-onset growth restricted fetus. Pentoxifylline and placebo were given with a dose of 400 mg per os two times daily until delivery. Serial ultrasound examination regarding fetal weight, amniotic fluid and also utero-placenta-fetal Doppler's were done. For the assessment of serum Antioxidant level, blood sampling was done once at the beginning of the study and again, at least, three weeks after the investigation. After delivery, umbilical-cord blood gas analysis, APGAR score at 1 and 5 min, NICU admission, and neonatal death were recorded and compared between the two groups., Results: Utero-placenta-fetal Doppler's in the Pentoxifylline group did not significantly change compared to the control group. Fetal weight gain was significantly higher in the Pentoxifylline group before (996.33 ± 317.41) and after (1616.89 ± 527.90) treatment (P = 0.002). Total serum antioxidant capacity significantly increased in the Pentoxifylline group (p < 0.036). Average 5 min Apgar score was significantly higher (P < 0.036) and the percentage of babies admitted to NICU was significantly lower (P < 0.030) in the treated group., Conclusion: Using Pentoxifylline in pregnancy affected by FGR might show promising effects. In this study, Pentoxifylline improved the neonatal outcome, increased fetal weight gain, and reduced neonatal mortality by decreasing the level of oxidative stress markers and cutting down the inflammatory cascade., Competing Interests: Declaration of competing interest There is no conflict of interest to be declared regarding the manuscript., (Copyright © 2022. Published by Elsevier B.V.)

Background: Penile duplication or diphallia is a rare congenital anomaly with unclear pathophysiological cause. Most cases of diphallia are reported postnatally; however, today with the use of a high-resolution ultrasound device, in-uterine diagnosis of many congenital anomalies is possible., Case Presentation: Herein we report a multiparous mother at 25 weeks of gestation who referred due to an abnormal cystic structure protruding from a large abdominal wall defect located below the umbilicus that was noted during a routine exam. Target scan revealed two penile-like protrusions with an empty scrotal sac and double bladder in an otherwise normal fetus, which was confirmed postnatally. Neonatal microarray study and karyotype were normal., Conclusion: Diphallia could be detected prenatally as an isolated anomaly, associated with caudal duplication syndrome, or as an exstrophy-epispadias complex. As this is a rare congenital anomaly, all sonographers should be familiar with prenatal ultrasound features and associated anomalies, an important issue in prenatal counseling with parents, delivery planning, psychological support of the family, and postnatal management., (© 2022. The Author(s).)

Background: The new SARS-CoV-2 originated from Wuhan, China is spreading rapidly worldwide. A number of SARS-CoV-2 positive pregnant women have been reported. However, more information is still needed on the pregnancy outcome and the neonates regarding COVID-19 pneumonia., Material and Methods: A systematic search was done and nine articles on COVID-19 pneumonia and SARS-CoV-2 positive pregnant women were extracted. Some maternal-fetal characteristics were extracted to be included in the meta-analysis ., Results: The present meta-analysis was conducted on 87 SARS-CoV-2 positive pregnant women. Almost 65% of the patients reported a history of exposure to an infected person, 78% suffered from mild or moderate COVID-19, 99.9% had successful termination, 86% had cough, and 68% had fever ( p  = .022 and p  < .001). The overall proportions of vertical transmission, still birth, and neonatal death were zero, 0.002, and, 0.002, respectively ( p  = 1, p  = .86, and p  = .89, respectively). The means of the first- and fifth-minute Apgar scores were 8.86 and 9, respectively ( p  < .001 for both). The confounding role of history of underlying diseases with an estimated overall proportion of 33% ( p  = .03) resulted in further investigations due to sample size limitation. A natural history of COVID-19 pneumonia in the adult population was presented, as well., Conclusion: Currently, no evidence of vertical transmission has been suggested at least in late pregnancy. No hazards have been detected for fetuses or neonates. Although pregnant women are at an immunosuppressive state due to the physiological changes during pregnancy, most patients suffered from mild or moderate COVID-19 pneumonia with no pregnancy loss, proposing a similar pattern of the clinical characteristics of COVID-19 pneumonia to that of other adult populations.

Aim: To compare the success rate of vaginal misoprostol versus intravenous (IV) oxytocin in termination of pregnancy in the second trimester intrauterine fetal death (IUFD)., Methods: This was an open-label randomized controlled study for 106 women with second trimester IUFD. Patients were randomly divided into two groups: women given vaginal misoprostol (400 mcg every 6 h up to 48 h) versus those given IV oxytocin (starting with 50 units up to a maximum of 300 units). When the first-line treatment (as mentioned above) failed, treatment methods were replaced with each other. When the second-line treatment failed, the patients underwent dilation and evacuation., Results: The first-line treatment yielded the successful rate of 88.7% versus 73.7% for misoprostol versus oxytocin, respectively (p = 0.047). Among those with first-line treatment failure, the second-line treatment yielded success rate of 85.7% versus 83.3% for misoprostol versus oxytocin (p = 0.891). The mean duration of induction to delivery in women with successful response to first-line treatment was 28.72 and 20.55 h after initially receiving misoprostol versus oxytocin, respectively (p < 0.001). While during second-line treatment, this mean interval was not significantly different among those with misoprostol versus oxytocin (p = 0.128). No severe adverse events were observed., Conclusion: Vaginal misoprostol was associated with higher termination rate than oxytocin without adverse events when used as the first-line treatment. Both methods yielded the same success rate when used as the second-line treatment., (© 2022 Japan Society of Obstetrics and Gynecology.)

Background: Prenatal corticosteroid administration is known to be an effective strategy in improving fetal pulmonary maturity. This study aimed to evaluate the impact of maternal betamethasone administration on fetal pulmonary and other arteries Doppler velocity and the correlation between RDS development and Doppler indices results., Methods: Fifty one singleton pregnancies between 26 and 34 gestational weeks with a diagnosis of preterm labor were included in the exposed group and received betamethasone. Fifty one uncomplicated pregnancies were included in the non-exposed group. Fetal pulmonary, umbilical and middle cerebral arteries Doppler parameters were evaluated before and 24 to 48 h after steroid administration in the exposed group and two times at same intervals in the non-exposed group. Maternal records were matched to neonatal charts if delivery happened, and demographic and outcome data were abstracted., Results: When compared with the nonexposed group, fetuses treated with corticosteroids demonstrated significantly decreased umbilical artery Pulsatility index (PI) and significantly increased the middle cerebral artery PI, pulmonary artery Acceleration time (AT) and pulmonary artery AT/ET (Ejection time), while all other indices remained similar. We found significantly decreased pulmonary artery AT in the fetuses with respiratory distress syndrome (RDS) compared to those that did not., Conclusions: The results of our study showed that maternal antenatal betamethasone administration caused significant changes in the fetus blood velocity waveforms and also affected the blood flow in the pulmonary artery which led to an increase in the pulmonary artery AT and AT/ET. Among those fetuses with RDS, we found a significant decrease in the pulmonary artery AT, but we did not observe any pulmonary artery AT/ET differences.

Ethnopharmacological Relevance: Traditional manuscripts refer to plants such as Apium graveolens L. Fruit (celery seed), which could be used to improve sexual function among women. Since that time, local herbal shops in Iran continue to provide this herb as a natural aphrodisiac product., Aim of the Study: This study aimed to evaluate the efficacy and safety of celery seed for the treatment of female sexual dysfunction., Methods and Materials: In this parallel, randomized, double-blinded clinical trial, 80 women were assigned to receive either 500 mg of celery seed or placebo 3 times a day for a period of 6 weeks (n = 40 per group). The female sexual function index (FSFI) questionnaire was used to evaluate women's sexual function before and after treatment., Results: At the end of the sixth week, an improvement in the total FSFI score was significantly greater in celery seed-treated women than those receiving the placebo (P < 0.001). Increased total FSFI score is mainly contributed by improvement in the sexual desire (p < 0.001), arousal (p < 0.001), lubrication (p < 0.001), and pain (p = 0.033) domains at the endpoint of study. No serious side effects were noticed in both groups during the study period., Conclusion: It seems that celery seed improved sexual function in women and could be used as a safe, well-tolerated, and effective herbal medicine in women with sexual dysfunction., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Ethnopharmacological Relevance: Traditional Persian medicine manuscripts refer to plants such as Commiphora myrrha (Nees) Engl. (myrrh) and Boswellia carteri Birdw. (frankincense), which could be used to improve wound healing process. Since that time, local midwives in Iran continue to provide these herbs to precipitate episiotomy wound healing., Aim of the Study: To investigate the efficacy and safety of myrrh- and frankincense-based sitz-baths on episiotomy wound healing in primiparous women., Materials and Methods: This randomized controlled trial was conducted on 90 primiparous women with singleton pregnancies after normal vaginal delivery at Hafez hospital affiliated to Shiraz University of Medical Sciences from July to October 2019. Study participants were randomly allocated in three groups (2 intervention groups and 1 control group). Women in intervention groups were assigned to receive either 10-min sitz-bath of myrrh extract or frankincense extract twice a day for 1 week. While the women in control group received the betadine sitz-bath for the same period of time. The main outcome was the episiotomy wound healing, which was measured using the REEDA scale before intervention, on 2nd and 7th postpartum days., Results: An improvement in the episiotomy wound healing was significantly greater in patients receiving myrrh than those receiving the frankincense or betadine on 2nd (p = 0.003 and p < 0.001) and 7th (p = 0.043 and p = 0.015) postpartum days. However, the total REEDA score was not statistically different between the frankincense and betadine groups on 2nd and 7th postpartum days (p > 0.05)., Conclusion: The present results suggest that myrrh was more efficient than frankincense and betadine in healing of the episiotomy wound and could be recommended as a safe natural therapy., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Both knowledge and attitude can play key roles in the prevention of novel COVID-19. This cross-sectional study was conducted on a statistical sample of pregnant women in southwestern Iran between March and April 2020 to evaluate their knowledge and attitude toward this condition. So, pregnant mothers registered in antenatal clinics affiliated to Shiraz University of Medical Sciences were called and asked to fill in a three-part online questionnaire including sociodemographic characteristics, obstetric/medical history, and knowledge/attitude toward COVID-19. P -values < 0.05 were considered statistically significant. The mean score of knowledge among 540 respondents was 34 (±4.1) out of 43. Also, 44.3% answered more than 80% of the items correctly. Higher knowledge scores were accordingly associated with marriage duration, area of residence, health insurance coverage, socioeconomic status (SES), and self-rated health status. However, a strong relationship was found between knowledge, SES, and health insurance coverage with reference to multivariate analysis results. Moreover, majority of the pregnant women and their households expressed their concern about using preventive measures against COVID-19. Although most respondents were moderately worried about becoming infected with COVID-19, 264 (48.9%) cases reported that they were very much anxious about their newborns being infected with COVID-19 and 388 (71.9%) individuals asserted that they were worried about their mortality due to this infection. Besides, most mothers maintained that they had some degrees of rumination, which could interfere with their routine daily chores. Hence, health policy-makers should pay much focus on educating pregnant mothers to help them prevent mental exhaustion.

Cervical cancer is among the most common causes of cancer-related deaths in low- and middle-income countries (LMICs). Despite the strong evidence regarding cervical cancer screening cost-effectiveness, its utilization remains low especially in high risk populations such as HIV-positive women. The aim of this review was to provide an overview on the patient-reported factors influencing cervical cancer screening uptake among HIV-positive women living in LMICs. We systematically searched EMBASE, PUBMED/MEDLINE and Web of Science databases to identify all quantitative and qualitative studies investigating the patient-reported barriers or facilitators to cervical cancer screening uptake among HIV-positive population from LMICs. A total of 32 studies met the inclusion criteria. A large number of barriers/facilitators were identified and then grouped into three categories of personal, social and structural variables. However, the most common influential factors include knowledge and attitude toward cervical cancer or its screening, embarrassment, fear of cervical cancer screening and test results, patient-healthcare provider relationship, social support, screening costs and time constraints. This review's findings highlighted the need for multi-level participation of policy makers, health professionals, patients and their families in order to overcome the barriers to uptake of cervical cancer screening among HIV-positive women, who are of special concern in LMICs., Competing Interests: The authors declare no conflicts of interest., (© 2020 The Authors. Published by Elsevier Inc.)

Background: Myrrh (Commiphora myrrha (Nees) Engl.) has a long history of traditional use as a herbal medicine for different purposes. In ancient traditional Persian manuscripts, it has been noted that myrrh may act as uterine stimulant and probably cause complete abortion. However, there is no evidence to verify this comment. Therefore, the current study was carried out to evaluate the efficacy and safety of Myrrh in the treatment of incomplete abortion., Materials and Methods: In a randomized double-blinded placebo controlled clinical trial, 80 patients with ultrasound-documented retained products of conception (RPOC) were assigned to receive capsules containing 500 mg of Myrrh oleo-gum-resin or a placebo three times a day for 2 weeks. The existence of the retained tissue and its size were evaluated by ultrasound examination at the beginning and end of the study., Results: After 2 weeks, the mean diameter of the RPOC in the Myrrh group was significantly reduced compared with the placebo group (P < 0.001). Meanwhile, the rate of successful complete abortion was 82.9% in the intervention group and 54.3% in the placebo group (P = 0.01). The patients in both groups reported no serious drug-related adverse effects., Conclusion: This study shows that Myrrh is effective and safe in the resolution of the RPOC and may be considered as an alternative option for treatment of patients with incomplete abortion. However, further studies on active compounds isolated from myrrh and their uterine stimulant effects are needed., Trial Registration: This study was retrospectively registered at Iranian Registry of Clinical Trials (www.irct.ir) IRCT code: IRCT20140317017034N7.

Background: Myocardial infarction is the combined result of environmental factors and personal predispositions. Prothrombotic factors might play an important role in this phenomenon. Annexin V (ANV) is a calcium-dependent glycoprotein widely present in various tissues exerting a potent anticoagulant effect in vitro by reducing plaque adhesion and aggregation. Anti-annexin V antibodies (aANVAs) are detected in various diseases like rheumatoid arthritis, systemic lupus erythematosus and anti-phospholipid antibody syndrome. The study of ANV in Acute Myocardial Infarction (AMI) might shed light on hypercoagulability mechanisms in the pathogenesis of acute coronary syndromes. This study was conducted to investigate the association of plasma ANV, aANVAs and anti-cardiolipin antibodies (aCLAs) with AMI., Methods: This study recruited 45 patients with the diagnosis of AMI according to WHO criteria in their first 24 hours of admission. 36 matched individuals were studied as the control group with normal coronary artery angiography. Plasma levels of ANV, aANVAs and aCLAs were determined by enzyme-linked immunosorbent assay and the results were compared., Results: Plasma ANV levels in the patients with AMI on admission were significantly lower than those in the control group (p = 0.002). Positive test for aANVAs were found to be present in a significant number of our patients (p = 0.004). The studied groups were similar in their rate of patients with positive aCLAs tests. ANV, aANVAs and aCLAs were not correlated with hypertension, diabetes mellitus, hyperlipidemia, sex, age and smoking., Conclusion: Our findings suggest that low plasma ANV levels along with positive aANVAs tests in patients with AMI are indicative of hypercoagulable state that is not related to the traditional cardiovascular risk factors.