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Objective: This study aimed to measure the correlation of sperm DNA fragmentation with semen parameters, lifestyle, and fertility outcomes after intracytoplasmic injection (ICSI). Materials and methods: The partners who were candidates for ICSI with a history of one In vitro fertilization (IVF) failure or male factor were recruited in the study. Semen parameters including sperm count, motility, and morphology as well as DNA fragmentation index (DFI) (that were divided into 2 groups as high (>15%), and low (=15%) fragmentation scales) were evaluated either. The correlation of DFI with semen parameters, lifestyle, and clinical pregnancy after ICSI were compared between groups. Results: In 120 included couples, 59 men (49.2%) had DFIs = 15% and 61 (50.8%) cases had DFIs >15%. In the group with higher DFI, abnormal morphology (p=0.010) was higher whereas, progressive motility (p=0.001), total motility (p<0.001), and total count (p<0.001) of sperm were significantly lower. In addition, the DFI was significantly higher in the subgroup of male infertility (0.012). Logistic regression showed that a lower risk of DFI>15% was associated with higher values of progressive motility (OR=0.97, p=0.001), total motility (OR=0.96, p=<0.001), count (OR=0.96, p=<0.001) and even clinical pregnancy (OR=0.27, p=0.011). However, a history of testicular surgery was associated with a higher risk of DFI>15% (OR=3.37, p=0.046). Although no correlation was found between male age and lifestyle components with DFI, the number of embryos was lower in DFI=15% (p<0.001). Conclusion: DFI provide a clinically important measurement of sperm quality and have an impact on IVF outcomes; however, lifestyle components may not correlate with DFI. [ABSTRACT FROM AUTHOR]

Background & Objective: Preterm birth is the most important cause of neonatal mortality and morbidity. Finding the best treatment regimen, of antenatal corticosteroids, has been under serious concern. To compare the efficacy of intravascular versus intramuscular betamethasone phosphate on neonatal outcomes in the cases of imminent preterm. Materials & Methods: A double-blind randomized clinical trial was performed on 136 eligible pregnant women with gestational age of 26-34 weeks and imminent preterm birth (delivery within 24 hours). They were randomly assigned into two groups. Group A received intramuscular betamethasone phosphate, and group B received a similar dose of betamethasone phosphate intravenously. Women were followed up to delivery, and their neonatal outcomes were compared. Results: Women of the two groups (68 women in each group), did not show a significant difference in maternal age, BMI, gravidity and parity, gestational age at the time of admission and delivery, history of miscarriage and assisted reproductive techniques, delivery route, sex and weight of newborns, and Apgar score in minutes 1 and 5. The need for NICU admission, duration of hospitalization, neonatal respiratory distress syndrome, surfactant requirement, and intubation were lower in the IV betamethasone group. There were no significant differences between the two groups according to necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Conclusion: Using IV betamethasone, in cases where there is no enough time to complete the 24-hour betamethasone course due to the possibility of impending delivery, may reduce neonatal complications due to quicker onset of action. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the maternal and umbilical cord blood antibody levels, after COVID vaccination during pregnancy. Method: The women who received the COVID‐19 vaccine (Sinopharm) during pregnancy were included. Maternal and cord blood samples were tested to detect the severe acute respiratory syndrome coronavirus 2 receptor binding domain (RBD) specific antibodies. In addition, obstetric information and side effects after vaccination were gathered. Result: A total of 23 women were included. Eleven pregnant women took two doses and 12 cases received a single dose of the vaccine. No IgM antibody was detected in any maternal blood or cord blood samples. The RBD‐specific Immunoglobulin G (IgG) antibody was positive in mothers receiving 2 doses of the vaccine and their infants. But the antibody titers were under the positive cut‐off threshold for the other 12 women who were vaccinated with a single dose. Women who received both doses of vaccine had significantly higher IgG levels than a single dose of Sinopharm (p =.025). The same result was demonstrated in infants born to these mothers (p =.019). Conclusion: There was a significant correlation between maternal and neonatal IgG concentrations. Although, receiving both doses of the BBIBP‐CorV vaccine (not 1 dose) during pregnancy is highly beneficial for increasing humoral immunity for the mother and fetus. [ABSTRACT FROM AUTHOR]

Introduction Labor induction is an important issue in modern obstetrics. One of the important factors for the success of induction of labor is the Bishop score of cervix. Objective The purpose of the present study was to evaluate and compare the efficacy of dilapan with extra-amniotic saline infusion and oral misoprostol for cervical ripening in term pregnancies. Methods This clinical trial study was performed on 120 nulliparous pregnant women with the Bishop score of less than 5. Group one, group two and group three received dilapan, extra amniotic saline infusion (EASI) and misoprostol respectively. All three groups were compared for duration from beginning of the intervention up to cervical ripening and Bishop Score of ≥7, duration of active phase and the second stage of labor, number of deliveries in the first 24 h, duration from beginning of the intervention up to delivery, rout of delivery as well as neonatal weight, neonatal Apgar score; hyper- stimulation, and need for oxytocin and oxytocin doses administered after 12 h of intervention. Results The number of deliveries in the first 24 h after intervention were not significantly different between the three groups. There was no significant difference between the three groups according to duration from beginning of the intervention up to cervical ripening and Bishop Score of ≥7, duration of active phase and the second stage of labor, duration from beginning of the intervention up to delivery, rout of delivery as well as neonatal weight, neonatal Apgar score; and hyperstimulation. The Bishop Score was higher in the misoprostol group 6 h after intervention [dilapan: 4.32 ± 1.38, EASI: 5.47 ± 1.28, and misoprostol: 6.72 ± 1.61 (p = .000)], Oxytocin requirement [dilapan: 38 (95%) women, EASI: 37 (92.50%) and misoprostol: 30 (75%) women, p = .013], and required dose [dilapan: 7543 ± 2465 miu/ml, EASI: 5758 ± 1615miu/ml and misoprostol: 4930 ± 2589miu/ml, p = .000] were lower in misoprostol group. Conclusion Dilapan is an effective and safe method for cervical ripening in full term gestations. In cases where misoprostol and EASI cannot be used or are not desirable, dilapan can be used as an alternative. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the role of cerebroplacental ratio (CPR) in term pregnancies with reduced fetal movements (RFM) and appropriate for gestational age (AGA)fetuses to predict poor neonatal outcomes. A prospective cohort study was performed on 150 singleton pregnancies with gestational age of 37–41 weeks and multiple episodes of RFM (case group) and 150 pregnancies within the same criteria only without RFM (control group). Both groups had appropriate for gestational age (AGA)fetuses. Umbilical artery (UA) and middle cerebral artery (MCA) pulsatility indices (PI) were measured, and MCA to UA ratio (CPR) was calculated. Doppler indices and neonatal outcomes were compared between the two groups. Independent prediction role of CPR MoM was evaluated through a binary logistic regression method. The RFM group had significantly higher UA- PI MoM (1.01 ± 0.19 versus 0.86 ± 0.05, p <.001), lower MCA MoM (1.28 ± 0.20 versus 1.40 ± 0.13, (p <.001)) and lower CPR MoM (0.98 ± 0.24 versus 1.23 ± 0.12, (p <.001)) compared to the control group. Mean umbilical artery pH was lower in the RFM group and the frequency of neonatal UA cord pH <7.2 was higher in the RFM group. In RFM group, CPR MoM showed a significant linear correlation with birth weight centiles (r = 0.244, p =.003), umbilical artery pH (r = 0.319, p <.001) and Apgar score at minute 1 (r = 0.332, p <.001). CPR MoM exhibited negative correlation with duration of NICU stay (r= −0.187, p =.022). No similar correlation was observed in the control group. In binary logistic regression analysis, CPR MoM was adjusted for the results of NST; and it was concluded that CPR MoM was the only significant predictor of Apgar score minute 1 = <7 (OR: 0.004; 95% CI: 0.0002–0.0673, p <.001), umbilical artery ph <7.2 (OR: 0.019; 95% CI: 0.00005–0.0423, p <.001) and NICU admission (OR: 0.116; 95% CI: 0.018–0.744, p =.023). In multivariate binary logistic regression analysis included parity, history of abortion and ART, AFI, BPP and CPR MoM; the AFI (OR: 0.976; 95% CI: 0.957–0.995, p =.014), BPP (OR: 0.306; 95% CI: 0.172–0.545, p <.001) and CPR MoM (OR: 0.00005 95% CI: 0.000003–0.00061, p <.001) were the significant predictor of RFM. Area under the curve in receiver operating characteristics (ROC) curve was calculated as 0.828 for CPR MoM as a predictor of RFM (SE: 0.024, p <.001), yielding sensitivity and specificity estimates of 80.0% and 65.0%, respectively, using an optimal cutoff level of = < 1.19. This study concluded that reduced fetal movement was significantly related to low CPR MOM. Also, it showed the independent role of CPR MoM for prediction of lower neonatal umbilical artery pH, lower Apgar score minute 1 and higher rate of NICU admission in AGA term fetuses without considering NST results. Also, AFI, BPP and CPR MoM are significant predictors of RFM. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence This study aims to evaluate and compare patients' joint perception (PJP) with other commonly employed patient‐reported outcome measures (PROMs) in a cohort of patients following anterior cruciate ligament reconstruction (ACLR).A retrospective study was conducted on 108 patients who underwent ACLR between 2017 and 2021, with complete data available for visual analogue scale (VAS) pain, PJP, Forgotten Joint Score (FJS), Tegner Activity Scale, Lysholm Knee Scoring Scale, Anterior Cruciate Ligament Return to Sport After Injury (ACL‐RSI), Single Assessment Numeric Evaluation (SANE), Cincinnati Knee Rating System (CKRS) and The Hospital for Special Surgery Anterior Cruciate Ligament Satisfaction Survey (HSS ACL‐SS) at a mean follow‐up of 3 years. Spearman's rank‐order correlation was used to determine the correlations between clinical scores. A receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory power of the chosen PROMs in detecting natural joint perception. Natural joint perception was defined as patients responding ‘like a native or natural joint’ or PJP = 1. This study hypothesized that PJP would demonstrate significant correlations with established PROMs, indicating its reliability and validity as a tool for assessing outcomes following ACLR.PJP showed significant correlations with all the reported PROMs, suggesting its potential as a valid and reliable assessment tool for evaluating ACLR outcomes. The ROC curve analysis indicated a good area under the curve for identifying natural joint perception using various PROMs. According to the PJP, nearly 20% of patients reported natural joint perception.This study evaluates PJP as a reliable tool for assessing patient outcomes following ACLR. Its significant correlation with other established PROMs underscores its potential as a valuable addition to the existing array of PROMs in ACLR.Level III. [ABSTRACT FROM AUTHOR]

The authors comment on the high suicide rate among medical residents which is said to be exacerbated by the challenging conditions faced by residents in Iran. They discuss the period of the academic year when a higher percentage of suicide deaths occurred, the prevalence of burnout and depression among medical residents, and the situation of suicide among Iranian medical residents.

Purpose: The purpose of this study is to analyze the short anterior cruciate ligament return to sport after injury (ACL-RSI) (Persian) version's cultural adaption and validity., Methods: To assess test-retest reliability, 102 participants were filled out the short ACL-RSI(Per) scale 6 months or more after ACLR surgery. Internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficients), construct validity (Pearson's r ) and sensitivity (floor/ceiling effect) were determined. In addition, patient completed other relevant measures such as Lysholm scores, the hospital for special surgery ACL satisfaction survey (HSS ACL-SS), the visual analogue scale (VAS) of pain and patient's satisfaction, the Tegner activity score (TAS), the single assessment numeric evaluation (SANE) and the Cincinnati Knee Rating System (CKRS)., Results: The short ACL-RSI(Per) scale showed high internal consistency (Cronbach's alpha = 0.91) and test-retest reliability (ICC = 0.923). Significant correlations between short ACL-RSI(Per) and other scales supported validity. There was a statistically significant connection between the short ACL-RSI(Per) and the following outcomes: HSS ACL-SS ( r  = 0.698, p  < 0.001), VAS pain ( r  = 0.356, p  < 0.001), CKRS ( r  = 0.644, p  < 0.001), TAS ( r  = 0414, p  < 0.001), Lysholm score ( r  = 0.467, p  < 0.001) and SANE score ( r  = 0.536; p  < 0.001). In addition to a satisfactory ceiling impact (15%), a sizeable floor effect (16.7%) was also seen., Conclusion: The short ACL-RSI(Per) scale is a reliable and valid tool for assessing psychological readiness for return to sport after ACL reconstruction in Persian., Level of Evidence: III., Competing Interests: The authors declare no conflict of interest., (© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Background: Common postoperative complications following surgery, particularly acute appendicitis surgery, include postoperative pain and vomiting, which can cause discomfort and delay recovery time., Methods: A randomized double-blinded placebo-controlled clinical trial was conducted with 80 cases of acute appendicitis of American Society of Anesthesiologists (ASA) physical status I or II and aged 18-60 y/o scheduled for appendectomy under general anesthesia. Patients were randomly divided into two equal groups: group A received 4 mg of ondansetron IV (2 ml) and group B received 2 ml of normal slain IV (placebo). Pain according to VAS, nausea and vomiting according to clinical symptoms, shivering and sedation according to the Bedside Shivering Assessment Scale (BSAS), and the Ramsay Sedation Scale (RSS) at 2, 6, 12, and 24 hours after surgery were evaluated and compared between the groups., Results: There was a significant decline in the severity of pain only at 2 hours after surgery between the ondansetron and control groups (5.3 ± 1.0 vs. 6.0 ± 1.0; p =0.01), not showing a difference between the groups at 6, 12, and 24 hours after appendectomy. Postoperative nausea and vomiting at 2 (5% vs. 25%; p =0.03) and 6 (7.5% vs. 27.5%; p =0.04) hours after appendectomy in the ondansetron group. At different times, the ondansetron and control groups did not differ in terms of pethidine consumption or sedation., Conclusions: In conclusion, our study found that ondansetron was effective in reducing postoperative vomiting after acute appendicitis surgery. However, it did not show a clinically significant effect on postoperative pain. This trial is registered with IRCT20230722058883N1., Competing Interests: The authors have no relevant financial or nonfinancial interests to disclose., (Copyright © 2024 Moein Khoori et al.)

Background: Several studies have been published to present normal values of female genitalia in different age and racial groups., Aim: The primary objective of our study was to measure the parameters of the external genitalia in adult Iranian women, record the data using the Labiagram system (the first national Labiagram design in Iran), and establish a preliminary database., Methods: A descriptive study was conducted from March 2022 to December 2022, involving 220 nonpregnant adult women who presented to the gynecology clinic. Women who met the inclusion criteria for the study underwent a comprehensive examination of the external genitalia. The data collected during the examinations were recorded in electronic files and the Labiagram system., Outcomes: The data showed the diversity of external genital parameters of nonpregnant adult Iranian women., Results: In this descriptive study, the mean ± SD age of the participants was 51.5 ± 13.44 years, ranging from 15 to 84 years. A total of 192 women (87.3%) had a history of vaginal delivery. There was no statistically significant difference observed in the average measurements of the vulva among the 4 age groups ( P  < .05). The Pearson correlation coefficient test indicated a statistically weak correlation between body mass index and perineum length ( r  = 0.174, P  = .010). Additionally, a weak correlation was found between body mass index and the width of the labia minora at the left-lower point ( r  = 0.143, P  = .030) and the right-middle point ( r  = 0.146, P  = .031). Furthermore, the results demonstrated that women with a history of vaginal delivery had a significantly longer introitus (49.3 vs 44.3 mm, P  = .037), longer labia majora (91.3 vs 87.3 mm, P  = .046), and longer labia minora (56.8 vs 50.9 mm, P  = .008) when compared with women without prior labor experience., Clinical Implications: The data will be used as a basis for future studies., Strengths and Limitations: The use of simple tools for the measuring, data recording, and digital drawing of female external genital anatomy, along with privacy protection, is one of the strengths of this research. The weakness is the small sample size, which is the reason for piloting the Labiagram chart for more extensive studies., Conclusion: Increasing age and the number of births had no statistically significant effect on the size of external genital parameters among Iranian women. Despite the considerable diversity in these parameters, it has not resulted in a significant demand among Iranian women for female cosmetic surgery., Competing Interests: No financial aid was received from any institution, organization, or person to conduct this study., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.)

Introduction: This study aimed to evaluate the effectiveness of selective laser photocoagulation of communicating vessels (SLPCV) on cardiac function in twins with twin-to-twin transfusion syndrome (TTTS). Methods: This retrospective cohort study evaluated 178 women with twin pregnancies complicated with TTTS and scheduled for SLPCV between 16 and 26 weeks of gestation. The severity of TTTS was determined by Quintero staging and the severity of cardiovascular disorders by the CHOP (Children's Hospital of Philadelphia) score. Patient survival was evaluated through a one-month-after-birth follow-up of fetuses. Results: The study revealed significant improvements in Doppler indices in both donors and recipients after SLPCV. The CHOP score also significantly decreased after the intervention. One-month-after-birth survival rates were 55.1% in donors and 56.7% in recipients. Some Doppler indexes of fetuses before SLPCV could predict survival until one month after birth. Conclusion: The study suggests that SLPCV can improve cardiac function in fetuses with TTTS and that some Doppler indexes can predict survival outcomes. Additionally, the severity of TTTS can be a powerful indicator of the severity of cardiovascular complications., Competing Interests: None declared., (Copyright © 2023 J Lasers Med Sci.)

Objective: The current study aims to evaluate the correlation between oxytocin augmentation and postpartum hemorrhage., Method: PubMed, Web of Science, and Scopus has been searched for studies assessing the correlation between oxytocin augmentation and postpartum hemorrhage up to January 24, 2024. The search strategy included relevant keywords related to PPH and oxytocin augmentation. The risk of bias assessment was conducted by two reviewers using the Newcastle-Ottawa Scale (NOS). To pool the effects sized of included studies odds ratios (OR) of interest outcome with their 95% confidence interval (CI) were used., Results: Eight studies were included in this meta-analysis. The pooled analysis of the included studies showed a statistically significant association between oxytocin augmentation and increased odds of PPH (pooled odds ratio [OR] = 1.27, 95% confidence interval [CI]: 1.05-1.53; I2 = 84.94%; p  = 0.01). Publication bias was assessed using funnel plots, which appeared relatively asymmetrical, indicating significant publication bias. Galbraith plot and trim and fill plot were used for publication bias. Sensitivity analyses were performed by leave one out method., Conclusion: This meta-analysis suggests that using oxytocin for labor augmentation is linked to a significant increase in the risk of PPH. It highlights the need for careful monitoring and consideration when using oxytocin, especially in low and middle-income countries where guidelines and supervision are crucial.