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Article
Effect of metformin on pregnancy outcomes in women with PCOS

Authors: Asma A. Swadi اسماء عبد الجليل سوادي --- Saba M.Swadi صبا مطشر سوادي
Journal: Al-Qadisiyah Medical Journal مجلة القادسية الطبية ISSN: 18170153 Year: 2014 Volume: 10 Issue: 17 Pages: 187-195
Publisher: Al-Qadisiyah University جامعة القادسية

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Abstract

Background: Recurrent pregnancy loss (RPL) classically refers to the occurrence of three or more consecutive losses of clinically recognized pregnancies prior to the 20th week of gestation (ectopic, molar, and biochemical pregnancies are not included). we hypothesized that metformin owing to its metabolic, endocrine effect may reduce the incidence of first trimester miscarriage in PCOS women.Materials and Methods: We examined the records of all 82 nondiabetic women with the polycystic ovary syndrome who became pregnant while being seen in the out patients Clinic of the maternity teaching hospital and private clinic in AL-Qadisyiah city between January 2011 and march 2014, and who did receive metformin 3 months pre-conception (group1; n = 37) in contrast to second group who became pregnant while taking metformin and continued taking metformin at a dose of 1000–2000 mg daily throughout the first 20 weeks of gestation(group2; n = 45). Results: both groups were similar with respect to all background characteristics (age, BMI, parity, RBS, blood urea and serum creatinin).rates of early pregnancy loss in group1(82.5%) compared with (79.7%) in group2.after administration of metformin; pregnancy loss was( 83.7%,15.5%) in group1 and group2 respectively (P value = 0.001).Conclusion: administration of metformin in the first 20 weeks of pregnancy to women with PCOS was associated with a marked and significant reduction in the rate of early pregnancy loss.

أجريت هذه الدراسة على مجموعه من النساء المصابات بمتلازمة تكيس المبايض واللاتي تعرضن الى حالة فقدان حمل متكرر(اجهاض متكرر).82 امراه مصابه بمتلازمة تكيس المبايض وغير مصابات بداء السكري تم تقسيمهم الى مجموعتين (المجموعه1)وعددها 38 اعطيت عقار الميتفورمين لمدة 3 اشهر قبل الحمل وتم ايقافه عند حدوث الحمل مباشرة. اما (المجموعه2) وعددها 45 اعطيت عقار الميتفورمين لمدة 3 اشهر قبل الحمل واستمرت باخد العقار 4 اشهر بعد حدوث الحمل.النتائج:الجموعه الاولى كانت نسبة الاجهاض المتكرر فيها = 83.78% مقارنة بالمجموعه الثانيه التي استمرت باخد العقار 4 اشهر بعد حدوث الحمل حيث اصبحت نسبة الاجهاض= 15.5% . نستنتج بان استمرار استخدام عقار الميتفورمين لمدة 4 اشهر بعد الحمل يقلل من نسبة الاجهاض المتكرر وبشكل ملحوظ (p=0.001)

Keywords

PCOS --- BMI


Article
CORRELATION OF OVARIAN VOLUME IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) WITH CLINICAL AND HORMONAL FINDINGS

Author: Haifa Al-Shaheen
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2006 Volume: 12 Issue: 2 Pages: 71-82
Publisher: Basrah University جامعة البصرة

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CORRELATION OF OVARIAN VOLUME IN WOMEN WITH POLYCYSTIC OVARY SYNDROME (PCOS) WITH CLINICAL AND HORMONAL FINDINGSHayfa Al- ShaheenMB,ChB, DGO, CABGO, Department of Obstetrics & Gynecology, Basrah Maternity and Child HospitalAbstractThe aim of this study is to evaluate the ovarian morphological findings in infertile women given the diagnosis of polycystic ovarian syndrome (PCOS) based on chronic anovulation (menstrual disorders) and evidence of hyperandrogenism (hirsutism & acne), and whether clinical and selected hormonal findings correlate with ovarian volume.Over 12 months period (from 1st of Jan 2005 till the 1st of Jan 2006), the ovarian morphology were determined by transabdominal ultrasound in107 patients included in this prospective study in infertility clinic in Basrah Maternity and Child Hospital. Clinical and endocrinological state was evaluated by history, physical examination and measurements of serum testosterone, Luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactine and progesterone levels. Their ages ranged (18-40 years), mean (27.28 ± 4.4) and their mean body mass index (BMI) was (29.77± 4.0 kg/m2). Ultrasound studies showed all women studied (100%) had altered ovarian morphology (both ovaries had multiple small cyst of (2-9mm), mean total follicular number (12.3±1.7) & thick capsule. Bilaterally enlarged ovaries were found in 84 (78.5%), mean (15.6± 2.04 cm3) and normal ovarian size were found in 23(21.5%) mean (6.6± 1.1 cm3). All patients who had enlarged ovaries were compared with those who had normal ovarian size regarding clinical and hormonal findings in order to determine a possible association between these findings and ovarian volume. Hirsutism was present in (78.5%), acne in (68.2%), Obesity (BMI>25 kg/m2) in (87.8%), menstrual disorders in (100%), manifested as oligomenorrhoea in (77.6%) and secondary amenorrhea in (22.4%). Comparing these clinical findings between patient who had enlarged ovaries and those who had normal ovarian size, this study has confirmed that hirsutism, acne and obesity were significantly higher in women who had enlarged ovaries the values were: (84.5% versus 56.5%), (73.8 %versus 47.8%) and( 92.9% versus 69.6%) respectively, whereas oligomenorrhoea occurred more frequently in women with normal ovarian size (82.6% vs. 76.2%), the difference was statistically non significant p.value>0.05. No significant relationship was found between ovarian volume and amenorrhea. Analysis of biochemical data showed that women with PCOS were found to have elevated Serum testosterone levels (1.3±0.74ng/ml ), elevated LH (11.80 ± 4.2 miu/ml ) and elevated LH/FSH ratio (1.90 ± 1.03) whereas all women were found to have normal prolactin levels (10.8 ± 4.0ng/ml). Comparing these hormonal levels between women who had enlarged ovaries and those who had normal- sized ovaries we found that serum testosterone, LH & LH/FSH ratio were significantly higher in women who had enlarged ovaries. Subtle differences existed between ovarian volume in hypretestosteonemic & hyperluteinizenemic subgroups of polycystic ovarian syndrome compared to normotestosteronemic & normoluteinizenemic ones. With significant relationship was found between the ovarian size and testosterone & LH levels p. value< 0.05. A significant differences also existed between ovarian volume in elevated LH/FSH ratio subgroup of polycystic ovarian syndrome compared to normal LH/FSH ratio ones. P. value 0.001. Whereas no statistical significant difference was found between ovarian volume and FSH levels. Hirsutism, acne and obesity correlated positively with total ovarian volume (r=0.282, p- value 0.002), (r=0.229, p- value 0.009) (r=0.372, p. value 0.0001) respectively. While Oligomenorrhoea and amenorrhea showed negative correlations with total ovarian volume. Total ovarian volume correlated positively with Serum testosterone levels, LH and LH/FSH>2, (r=0.518, p- value 0.0001), (r=0.563, p- value 0.0001), (r=0.266, p- value 0.01) respectively. It can be concluded from the present study that ultrasound scanning provide a non- invasive and accurate procedure for the assessment of ovarian morphology (specifically ovarian volume).Correlation of ovarian volume in women with polycystic ovary Hayfa Al- ShaheenBas J Surg, September, 12, 2006And when clinical diagnosis of PCOS was made, virtually all women were found to have characteristic ovarian morphology that extending from apparently normal to markedly enlarged cystic ovaries. Hirsutism acne, obesity, serum testosterone levels, LH and LH/FSH ratio correlated sssstrongly with increased ovarian size. These results allow us to suggest that ovarian size > 10 cm3 in women with PCOS with hyperandrogenism & menstrual disorders might be predictive of endocrine profiles, and emphasized the importance of careful assessment of ovarian volume by Ultrasound.

Keywords

OVARIAN --- POLYCYSTIC --- PCOS --- HORMONAL


Article
Effect of Metformin Therapy on Reducing Leptin

Author: Wafaa Issa Tuama*
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 2 Pages: 65-68
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: The relation between insulin resistance ,leptin levels and other hormones in women with polycystic ovary syndrome(PCOS) is still controversial.Metformin therapy is proved effective in reducing insulin resistance and also in some studies it was seen to be effective in reducing leptin levels.Al- Kindy Col Med J 2012 ; Vol .8 No. (2) p: 65Objective: to study the effect of metformin on reducing leptin levels and enhancing ovulation in PCOS women.Methods:metformin 500mg 3 times daily for 3 months was was given to 36 womenwith proved PCOS, in addition to that, other parameters were included.Results:28 women out of 36(77.78%) showed an evidence of ovulation ovulation after 3 months of metformin therapy(p<0.01) with significant ◌ٌreduction in leptin levels(p<0.001).Conclusion: it can be concluded that metformin can reduce leptin resistance and enhance ovulation in PCOS women.Keywords: leptin, PCOS, metformin.

Keywords

Keywords: leptin --- PCOS --- metformin


Article
RELATIONSHIP BETWEEN INSULIN RESISTANCE AND SERUM CONCENTRATIONS OF RESISTIN AND INSULIN-LIKE GROWTH FACTOR-I(IGF-I) ASSOCIATED WITH INDUCED POLYCYSTIC OVARY SYNDROME IN FEMALE RATS
العلا قه بين مقاومة الأنسولين وتركيز الرزستين وعامل الىمو الشبيه بالأنسولين المصاحب لمتلازمة تكيس المبايض المتعدد - المستحذث في إناث الجرذان

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The present study was carried out to determine the relationship between resistin , Insulin-Like Growth- I (IGF-I) and insulin resistance (IR) in female rats with induced polycystic ovary syndrome( PCOS) model and assess their association. Twenty virgin rats were divided into two equal groups: Control group: included 10 rats were given only single intramuscular injection (i.m) of 0.2 ml pure corn oil for each rat. The second PCOS group: included 10 rats given single i.m of 4 mg estradiol valerate dissolved into 0.2 ml pure corn oil for each rat. After 63 days all rats were sacrificed and blood samples were collected from inferior vena cava to obtain the serum for resistin, insulin, IGF-I, SHBG, FSH, LH and FT concentrations. The results revealed a significant increase in serum resistin, IGF-I, insulin, LH and FT concentrations in PCOS group in comparison with control group (P≤0.05),also a significant(P≤0.05) decrease in sex hormone binding globulin (SHBG) concentration in PCOS group compared with control, while, no significant difference was found in FSH concentration. The presence of insulin resistance may play an important role in the pathogenesis of increase of resistin and IGF-I in rats with induce PCOS

Keywords

Ovary --- Insulin --- PCOS


Article
Micronuclei Formation and Comet Assay in Women with Polycystic Ovarian Syndrome (PCOS)
تكوين النويات الصغيرة وفحص المذنب في النساء التي تعاني من اعراض تكيس المبايض المتعدد

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Abstract

Recently the polycystic ovary syndrome (PCOS) has been linked with DNA damage and genomic instability. Amis of this study to evaluated some parameters of genetic instability such as micronuclei and comet assay score in women with PCOS. Genotoxicity and cytotoxicity of DNA damage were evaluated by measured of micronuclei and comet assay in 25 patients with PCOS and 15 normal menstrual women as control group. The results showed higher significant differences in the level of micronuclei and comet score in patients with PCOS compared with normal women. We concluded that, the genetic instability more occurred in patients with PCOS when compared with control group.

في الاونه الاخيره ارتبطت اعراض مرض تكيس المبايض المتعدد مع الضرر الحاصل في الماده الوراثيه وعدم استقرارها ,اذ تهدف الدراسه الى تقييم بعض المؤشرات المرتبطه بعدم استقرار الماده الوراثيه مثل تكوين النوى الصغيره وفحص المذنب اذ قيمت السميه الوراثيه والسميه الخلويه للماده الوراثيه المتضرره عن طريق قياس تكوين النوى الصغيره وفحص الكومت ل25 مريضه مصابه بتكيس المبايض المتعدد و15 امراءه ذات دوره شهريه طبيعيه كمجموعه سيطره. اظهرت النتائج ارتفاعاً معنوياً في معدل تكون النوى الصغيره والمذنب للمريضات المصابات بمرض تكيس المبايض المتعدد مقارنه بالنساء الطبيعيات ومن خلال النتائج المذكوره تم الاستنتاج بان عدم استقرار الماده الوراثيه يحدث بصوره اكبر في حاله تكيس المبايض المتعدد مقارنه مع مجموعه السيطره.

Keywords

MN --- comet assay --- PCOS


Article
Effect of simvastatin and combined oral contraceptive pills in the treatment of polycystic ovary syndrome

Author: Asmaa abdul Razak hassan al-sanjary
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2016 Volume: 2 Issue: 2 Pages: 90-100
Publisher: Tikrit University جامعة تكريت

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Abstract

Keywords

PCOS --- hirsutism --- simvastatin --- COCP


Article
THE ROLE OF ESTROGEN AND PROGESTERONE ON VAGINAL CYTOLOGY DURING PROLIFERATIVE AND SECRETARY PHASES OF MENSTRUAL CYCLE IN WOMEN WITH POLYCYSTIC OVARIAN SYNDROME

Authors: Huda R. Kareem هدى رشيد كريم --- Haider A. Jaafer حيدر عبدالرسول جعفر --- Zainab H. Hashim زينب حسن هاشم
Journal: IRAQI JOURNAL OF MEDICAL SCIENCES المجلة العراقية للعلوم الطبية ISSN: P16816579,E22244719 Year: 2017 Volume: 15 Issue: 1 Pages: 78-87
Publisher: Al-Nahrain University جامعة النهرين

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Abstract

Background:In the course of cyclic hormonal fluctuation, cytological changes in the vaginal epithelium can be correlated with the phases of the menstrual cycle, this can be utilized in diagnosis of hormonal status in women with pathological cycles as in polycystic ovarian syndrome (PCOS). Objective:To evaluate the effects of estrogen (E2) and progesterone hormones in PCOS on the vaginal cytology in different phases of menstrual cycle, and its relation to ovulation period.Methods:A non-random sample of one hundred women were enrolled in this study, divided into two groups; 50 women free from PCOS, and 50 were PCOS according to the criteria of Rotterdam 2003. All were underwent hormonal assay including estrogen and progesterone on 2nd and 21st day of the cycle respectively, vaginal smears cytology on the 2nd day, 14th and 21st day of the cycle, stained with H&E, the (parabasal, squamous, leukocytes) were identified and counted, ultrasound examination was done on 14th day of the cycle, that divide the sample into ovulatory and an ovulatory subgroups accordingly.Results:At the 2nd day of the cycle, there was a significant reduction in squamous cell count, highly significant increase in leukocyte, E2 hormone level increased markedly, with a significant negative correlation to leukocytes cells in patients' groups at P≤0.05. Squamous cells of vaginal smear attained more acidophilic cytoplasm and increase in nuclear pyknosis. At the 14th day of the cycle, a significant increase in squamous cells count at P≤0.05, cornified squamous cells predominantly seen associated with low ovulation rates of 44%. Ovulation showed significant reduction in parabasal cells count in patients group at P≤0.05. At 21st day of the cycle, progesterone level was reduced with a significant reduction in squamous cells, parabasal cells and leukocytes counts in patients, with no significant correlation between progesterone and vaginal cytology cells, squamous cells consisted of mature cornified cells that seen predominantly in vaginal smear.Conclusion:Hormonal changes in PCOS presented mainly by the effect of elevated E2 hormone, that associated with increase in squamous cells count and cornification, with reduction in leukocytes and parabasal cells toward mid cycle. Progesterone hormone exert no significant effect on vaginal cytology in PCOS.Keywords: PCOS, vaginal cytology, ovulation

Keywords

PCOS --- vaginal cytology --- ovulation


Article
COMPARISON OF ANTIMULLERIAN HORMONE LEVEL BETWEEN WOMEN WITH POLYCYSTIC OVARY SYNDROME AND NORMAL OVULATORY INFERTILE WOMEN OF REPRODUCTIVE AGE

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Background: Polycystic ovary syndrome (PCOS) is the most common cause of chronic anovulation and hyperandrogenism in young women. This syndrome is characterized by an increase in the number of small antral follicles that are between 5-8 mm in size. Antemüllerian hormone (AMH) is secreted mostly by this type of follicle and when it is much too high, the production of a healthy egg every cycle can be halted as it works by reducing the receptors of the ovary to follicle stimulating hormone (FSH).Objective: To compare the AMH level between women presented with PCOS with its level in normal ovulatory infertile women and to determine its correlation with the clinical, hormonal and ultrasonographic parameters in both groups.Methods: This is a prospective cross-sectional study done at Um-Albaneen Infertility Center in Al-Imamein Al-Kadhimein Medical City from march 2015 to January 2016. One hundred infertile women were recruited in this study, 50 women with PCOS and 50 women have other factors of infertility apart from PCOS and ovulatory dysfunction. Sera were taken from all the participants at day (2-3) of menstrual cycle and were investigated for AMH, FSH, luteinizing hormone (LH), androstenedione, testosterone and estradiol (E2) levels. The number of early antral follicles (2-9 mm in diameter) was estimated by transvaginal ultrasound scanning.Results: Level was significantly higher in PCOS women (42.6±23.8) compared to the normal ovulatory infertile women (16±7.5), P-value <0.001. There was positive correlation between AMH and LH, testosterone, androstenedione, number of antral follicles (antral follicle count) and ovarian volume. However, the correlation was negative with age, body mass index, estradiol, and FSH.Conclusion: AMH strongly correlated with testosterone level and the number of small antral follicles in PCOS women, so it can be considered as a good diagnostic marker for PCOS.Keywords: Antimullerian hormone, PCOS. Citation: Almoayad HA, Abdulrasul EA. Jumaa NA. Comparison of antimullerian hormone level between women with polycystic ovary syndrome and normal ovulatory infertile women of reproductive age. Iraqi JMS. 2017; Vol. 15(3): 234-241. doi: 10.22578/IJMS.15.3.4


Article
Correlation between vitamin D receptor gene polymorphisms and levels of some hormones in Iraqi infertile women with polycystic ovary syndrome

Author: Sanaa Jasim Kadhim , Ismail A. Abdul-hassan
Journal: Iraqi Journal of Biotechnology المجلة العراقية للتقانات الحياتية ISSN: 18154794 Year: 2017 Volume: 16 Issue: 4 Pages: 104-113
Publisher: Baghdad University جامعة بغداد

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Abstract

The polycystic ovary syndrome (PCOS) is a disorder that characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovarian morphologic features. As defined by the diagnostic criteria of the National Institutes of Health (i.e., hyperandrogenism plus ovulatory dysfunction). The purpose of this study was to investigate the correlation between VDR gene polymorphisms and level of LH, FSH, TSH and Prolactin hormones .This study was carried out in the Institute of Genetic Engineering and Biotechnology for Postgraduate Studies - University of Baghdad through the period from November 2016 - August 2017, The PCOS patients were taken from the Kamal Al-Samarraee Infertility Treatment Hospital in Baghdad.Women with PCOS (n=50) and apparently healthy control group (n=50) , were enrolled . Genotyping of VDR gene (rs2228570) (rs7975232) , as well as (rs731236) SNPS between groups were determined by using Taqman genotyping assay . Hormonal analysis for LH, FSH, TSH and Prolactin was performed by using Automated Immune Assay (AIA). the results of the present study indicate that serum LH , FSH and TSH concentrations were unaffected by the studied SNPs of VDR gene within carriers of genotypes of rs2228570 , rs7975232 and rs731236 SNPs in VDR gene, while serum prolactin levels were significantly (p<0.05) higher in PCOS patients versus controls.

Keywords

PCOS --- VDR --- Polymorphism --- Infertile.


Article
Plymorphism of CYP17 for Polycystic Ovarian Syndrome in Women of Salah Al-Din Provence/ Iraq
ارتباط تعدد اشكال الجينCYP17 مع متلازمة تكيس المبايض PCOS لدى نساء محافظة صلاح الدين/ العراق

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CYP17 gene is the key in the metabolic pathway of sexual steroids, it codes for two enzymes 17–alpha hydroxylase and 17, 20 lyase who play an important role in the production of sex steroid hormones. The current study included study of the relationship of this gene with PCOS women in reproductive age. Blood samples were collected from two groups of women: first group consists of 98 women infected with polycystic ovaries syndrome, the second consists of 25 healthy women to detect the presence of mutation within the gene, then calculate allele frequency of mutant and wild allele for this gene, then repeat genotypes in infected women and compared with healthy once, were calculated body mass index BMI of two groups and measure the level of sex hormones (LH, FSH, Prolactin, Testosterone) in both groups, were the results showed significant differences between patients and healthy women in BMI and the level of hormones (LH, Prolactine) while there is no significant differences in the (FSH, Testosterone) hormone. Three pattern of genotype were obtained: TT, homozygous wild, (TC) much lower than the frequency in the healthy 0.82 while the frequency of allele C among patients 0.44, which is more than double than in healthy 0.18. The current results showed absence CC genotype in healthy women and appeared only in women with PCOS. This monitor the presence of link between this gene and PCOS as may be considered the mutation -34 (T C) in the promoter of gene CYP17 marker of the disease.

يعتبر جين CYP17 المفتاح في المسار الايضي للستيرويدات الجنسية اذ يشفر للانزيميين 17-الفا هيدروكسليز و17،20 لاييز واللذين يلعبان دوراً مهماً في انتاج الهرمونات الستيرويدية الجنسية . تضمنت الدراسة الحالية معرفة علاقة هذا الجين مع متلازمة تكيس المبايض PCOS للنساء في سن الانجاب والناتج من خلل هرموني. تم جمع عينات الدم من مجموعتين من النساء المجموعة الاولى تتكون من 98 إمرأة مصابة بمتلازمة تكيس المبايض والمجموعة الثانية تتكون من 25 إمرأة سليمة للكشف عن وجود الطفرة ضمن هذا الجين و من ثم حساب التكرار الاليلي للاليل الطافر والبري لهذا الجين و تكرار الانماط الوراثية لدى المصابات ومقارنتها مع السليمات، كما تم حساب معامل كتلة الجسم BMI للمجوعتين و قياس مستوى الهرمونات الجنسية (LH, FSH, Prolactin, Testosterone) لدى المجموعتين وقد اظهرت النتائج وجود فروق معنوية بين المريضات والسليمات في BMI ومستوى هرموني (LH, Prolactine) عند مستوى معنوية 0.05 بينما لم تظهر اي فروق معنوية لهرموني (FSH, Testostern) بين المجوعتين عند نفس المستوى . كما تم الحصول على ثلاثة انماط وراثية هي متماثل الزيجة بري TT، مختلف الزيجة TC و متماثل الزيجة الطافر CC وقد بلغ التكرار الاليلي للاليل T لدى النساء المريضات o.55 وهو اقل بكثير من التكرار لنفس الاليل لدى النساء السليمات 0.82 في حين كان التكرار الاليلي C لدى النساء المريضات 0.44 وهو اكثر من ضعف ما في النساء السليمات 0.18 . كما اشارت النتائج الحالية الى عدم ظهور النمط الوراثي CC عند النساء السليمات وظهوره فقط عند النساء المصابات هذا يدل على وجود ارتباط واضح بين هذا الجين ومتلازمة تكيس المبايض اذ يمكن اعتبار الطفرة(T C) فيه كمؤشر للمرض .

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