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Background Establishing local trimester-specific reference intervals for gestational TSH and free T4 (FT4) is often not feasible, necessitating alternative strategies. We aimed to systematically quantify the diagnostic performance of standardized modifications of center-specific nonpregnancy reference intervals as compared to trimester-specific reference intervals. Methods We included prospective cohorts participating in the Consortium on Thyroid and Pregnancy. After relevant exclusions, reference intervals were calculated per cohort in thyroperoxidase antibody-negative women. Modifications to the nonpregnancy reference intervals included an absolute modification (per.1 mU/L TSH or 1 pmol/L free T4), relative modification (in steps of 5%) and fixed limits (upper TSH limit between 3.0 and 4.5 mU/L and lower FT4 limit 5-15 pmol/L). We compared (sub)clinical hypothyroidism prevalence, sensitivity, and positive predictive value (PPV) of these methodologies with population-based trimester-specific reference intervals. Results The final study population comprised 52 496 participants in 18 cohorts. Optimal modifications of standard reference intervals to diagnose gestational overt hypothyroidism were −5% for the upper limit of TSH and +5% for the lower limit of FT4 (sensitivity,.70, CI, 0.47-0.86; PPV, 0.64, CI, 0.54-0.74). For subclinical hypothyroidism, these were −20% for the upper limit of TSH and −15% for the lower limit of FT4 (sensitivity, 0.91; CI, 0.67-0.98; PPV, 0.71, CI, 0.58-0.80). Absolute and fixed modifications yielded similar results. CIs were wide, limiting generalizability. Conclusion We could not identify modifications of nonpregnancy TSH and FT4 reference intervals that would enable centers to adequately approximate trimester-specific reference intervals. Future efforts should be turned toward studying the meaningfulness of trimester-specific reference intervals and risk-based decision limits. [ABSTRACT FROM AUTHOR]

Objective: In vitro and in vivo researches have shown that silver nanoparticles have more antimicrobial properties with a lower concentration than antifungal agents against candida vaginitis. Therefore, this study evaluated the therapeutic effect of silver nanoparticles (Nivasha spray15ppm) compared to clotrimazole 1% vaginal cream on candida vaginitis. Materials and methods: In this clinical trial study, 110 women with confirmed candida vaginitis randomly were divided into test (n=58) and control (n=52) groups. Silver nanoparticles spray with an applicator (Nivasha 15 ppm), and clotrimazole 1% were administered to test and control groups, respectively. Then, within ten days, post-intervention checkup and patient self-reported for treatment results were recorded in checklists and the data were analyzed statistically. Results: The improvement rate in test group (98.0%) was 1.44 times higher than in control (67.9%). Moreover, disease symptoms after the intervention (including unusual secretions, itching and burning, redness) in test group were significantly less than in the control, but there was no significant difference in the ratio of edema in two groups )p=0.071(. Furthermore, the average recovery time (days) of all symptoms in test group was lower than control (p<0.05). Finally, the rate of patients' satisfaction with the treatment process in the test group (76.9%) was more than control (46.6%) (p=0.004). Conclusion: Nivasha spray had more effectiveness compared to the clotrimazole 1%. Therefore, it can be used as an alternative drug in the treatment of Candida vaginitis. [ABSTRACT FROM AUTHOR]

Objective: Metabolic syndrome is a risk factor affecting reproductive health and pregnant outcomes. So far, the effect of this syndrome on the success rate of assisted reproduction techniques (ART) has not been investigated. The aim of this study was to investigate the relationship between metabolic syndrome and the success rate of ART in infertile women in Isfahan. Materials and methods: A prospective cohort study performed on 147 women candidates using in-vitro fertilization/intra cytoplasmic sperm injection (IVF/ICSI) and/or ICSI methods referred to Isfahan Infertility Center in two groups with metabolic syndrome(n=49) without metabolic syndrome(n=98), by convenience sampling methods in Isfahan, Iran in 2018. Body mass index (BMI) and waist, abdominal circumference, Serum triglyceride (TG), cholesterol and FBS were measured. If ßHCG test was positive (day 15-16 after ART), transvaginal sonography (TVS) was done 15 days later. Pregnant women were followed up to the 20th week of pregnancy. To analyze, t-test, chi-square and logistic regression tests were used. Results: The frequency of metabolic syndrome was 33.4% (n=49). The frequency of ART was not significantly different between women with and without metabolic syndrome (p=0.321). The relative frequency of pregnancy (p=0.907) and abortion (p=0.896) did not show a significant difference between the two groups. Independent t-test showed that the mean FBS, HDL, TG, systolic and diastolic BP, abdominal circumference and BMI in the studied units did not differ significantly based on the occurrence of pregnancy and abortion. Conclusion: According to the results of this study, there was no significant difference between the indicators of metabolic syndrome and the success rate of ART in achieving, pregnancy and pregnant outcomes in the first twenty weeks of pregnancy. [ABSTRACT FROM AUTHOR]

Using a parallel design, this interventional study explored the effectiveness of robot-enhanced LMOOCs in learning Persian for nursing purposes skills education among 229 non-Iranian students at the Medical University of Isfahan. After conducting a Persian proficiency test, the participants were randomly divided into three groups, namely, CLMOOC, XLMOOC and blended LMOOC to interact with telepresence robots; this way, the arrangement was made for conducting 16 sessions for practicing Persian for nursing purposes through the robot-enhanced LMOOCs. In parallel, the participants' receptive and productive skills were assessed in the healthcare field. The study was completed through a focus-group interview. While the quantitative data were analyzed through the Repeated Measures ANOVA procedure, the qualitative data were analyzed through thematic analysis. The findings revealed the functionality of the robot-enhanced LMOOCs in Persian for nursing purposes skills education. The CLMOOC appeared as a highly efficient course for boosting the functionality of the robot-enhanced LMOOCs in Persian for nursing purposes skills education. The participants believed that playing an active role in developing the scenes of LMOOCs can help boost the functionality of LMOOCs in Persian for nursing purposes skills education. The findings could be useful for the medical college authorities who are interested in using new LMOOCs in higher education. [ABSTRACT FROM AUTHOR]

Background: Since endothelial dysfunction is related to atherosclerosis, this study was planned to determine the effect of type of delivery on Nitric Oxide (NO) metabolites and endothelial function. Materials and Methods: This Cohort study was conducted in 2015 in selected hospitals of Isfahan. 88 nulliparous women with gestational age of 39 weeks and above were enrolled in this study using convenience sampling method and finally, after giving birth, 51 mothers with vaginal delivery, 21 with urgent C-section and 13 with elective C section were considered for data analysis. The serum levels of NO metabolites were measured in the laboratory with standard kits and data was analyzed using student and paired t-test, one-way ANOVA, and Chi-square test. The significance level was considered less than 0.05 for all tests. Results: The NO metabolites levels in mothers who had vaginal delivery or urgent C section showed a significant difference before and after delivery (normal vaginal delivery (NVD): t50 = 5.61, p < 0.001, Urgent C section: t23 = 5.38, p < 0.001). But those with elective C-section showed no significant difference in the nitrate and total nitrite levels before and after delivery (p > 0.05). Conclusions: Since reduction in serum levels of NO metabolites may possibly indicate endothelial dysfunction and predict cardiovascular disease, especially atherosclerosis in the future, it could be concluded that, childbirth, regardless of the type of delivery, could damage the endothelial cells but C-section (urgent or elective) could cause more disruption than vaginal delivery. [ABSTRACT FROM AUTHOR]

Background: Currently, it is shown that pregnancy may have an impact on the thyroid that can be leading to pregnancy complications such as abortion, preeclampsia, and preterm delivery. The objective was to compare the thyroid volume, number and characteristics of thyroid nodules, and prevalence of diffuse thyroid diseases in a sample of Iranian pregnant women in the first trimester to nonpregnant women. Materials and Methods: This case-control study was conducted on 298 pregnant and 290 nonpregnant women. Thyroid volume, maximum diameter of thyroid nodules and prevalence of moderate to highly suspicious thyroid nodules, Hashimoto's appearance and goiter were assessed using thyroid ultrasonography. Antithyroperoxidase (TPO) antibodies were measured if the sonographic features were highly suggested for Hashimoto's thyroiditis. Results: The mean of total thyroid volume in pregnant and nonpregnant women was 6 and 6.5 ml, respectively (P = 0.053), and the median (interquartile range) was 6.2 and 5.5, respectively. Nodules were observed in 16.4% of pregnant and 16.6% of nonpregnant women (P = 0.845). Hashimoto's thyroiditis was detected in 6.7% of pregnant and 12.4% of nonpregnant women (P = 0.013). Anti-TPO antibodies were detected in 5% of pregnant and 9.3% of nonpregnant women (P = 0.034). Conclusion: The thyroid volume and nodule characteristics in the first trimester of pregnancy were similar to nonpregnant women. Hashimoto's thyroiditis and anti-TPO antibodies in pregnant women were significantly lower than in nonpregnant women. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes is the second common disorder in pregnancy period, which is detected in 24-28 weeks of gestational age through screening tests. Low-grade systematic inflammation is associated with an increased risk of type 2 diabetes. C-Reactive Protein (CRP), an acute phase protein produced by hepatocytes, may be associated with diabetes. This study aimed to investigate serum levels of CRP in women with Gestational Diabetes Mellitus (GDM) and impaired glucose tolerance test compared with control subjects. Materials and Methods: This observational longitudinal study was conducted on 176 pregnant women in Isfahan. After administration of a CRP test in these women in the first trimester, a screening test of Glucose Challenge Test (GCT) with 50-g oral glucose was conducted in 24-28 weeks of gestational age. Then, CRP levels and GCT were compared. Results: Serum CRP levels were not significantly correlated with positive GCT among the women. In GDM patients, there was not a significant correlation between CRP and BMI. Conclusions: There was no significant correlation between maternal serum CRP level and gestational diabetes. Maternal serum CRP level in the first trimester cannot predict Intolerance Glucose Test (IGT) in 26-30 weeks of gestational age. [ABSTRACT FROM AUTHOR]

Background: This paper presents the protocol and primary findings of pregnancy cohort population-based study in Isfahan, Iran. Materials and Methods: In this cohort, 418 pregnant and 438 nonpregnant women were enrolled. In the first phase, serum concentrations of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), thyroid peroxidase antibody, and urinary iodine concentration (UIC) were measured. Furthermore, the thyroid ultrasound was also performed. According to the results of thyroid function tests in the first phase, local reference range for TSH, FT4, and FT3 in pregnant and nonpregnant women are determined. The 2.5th and 97.5th percentiles are determined as limits of the reference ranges. In the second phase, all pregnant women underwent prenatal care visits in each trimester and they followed for 7 days after delivery and the pregnancy outcomes data are reported. Results: The mean ± standard deviation for TSH, FT4, FT3, and UIC in the first trimester of gestation was 1.84 ± 1.32 mIU/L, 1.01 ± 0.15 ng/dL, 4.50 ± 0.64 pmol/L, and 172.0 ± 90.29 µg/L, respectively. In nonpregnant women, these values for TSH, FT4, FT3, and UIC were 2.58 ± 1.77 mIU/L, 1.10 ± 0.21 ng/dL, 4.49 ± 0.57 pmol/L, and 190.0 ± 109.6 µg/L, respectively. Conclusion: The results of the present study could contribute to establish a local thyroid function tests reference ranges in the first trimester of pregnancy. It could possibly be effective on making a local reference value to prevent of thyroid disease misdiagnosis during pregnancy and adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]