دکتر مینو یغمایی

Although the safety of cesarean sections has increased, there are still considerations, especially for women with a history of repeated cesarean sections. This study was conducted with the aim of investigating maternal and neonatal outcomes in candidates for cesarean sections due to repeat cesarean sections according to the number of previous cesarean sections.

This prospective descriptive study was conducted from April 2020 to June 2022 at Taleghani Hospital. All candidates for cesarean sections due to repeated cesarean sections were included in the study. According to the number of previous cesarean sections, they were divided into three groups. Statistical analysis was performed with Kruskal-Wallis, Chi-squared and Fisher’s exact tests. A P value < 0.05 indicated statistical significance.

 A total of 345 women were included in the study. The results of this study showed that these three groups were significantly different in terms of duration of surgery (P<0.001), abnormal placental adhesion (0.012), and the presence of intraperitoneal adhesions (P<0.001), but there was not a significant difference in terms of other maternal and neonatal outcomes (P<0.05).

The results of this study showed that an increase in the number of previous cesarean sections does not increase most maternal and neonatal complications during a current cesarean section. Of course, it should be noted that the number of women with a history of three or more previous cesarean sections was small in this study, and for this reason, more studies are needed.

Intraabdominal adhesions are associated with an increase in complications during cesarean section because of recurrent cesarean sections. This is why the possibility of predicting adhesions is important. In this study, the diagnostic value of depressed scar, severe striae gravidarum, and negative sliding sign, and their combinations were evaluated for predicting intraabdominal adhesions of cesarean candidates.  

This prospective descriptive study was performed during 2019-2020 on 123 pregnant women referred to Ayatollah Taleghani university hospital with a gestational age of ≥36 weeks 0 days who were candidates for cesarean section because of a previous cesarean section. In each patient, the presence of a depressed scar, a severe striae gravidarum, the absence of a sliding sign, and the presence and severity of adhesions during the operation were examined. Sensitivity and specificity, and positive and negative predictive values of each of the 3 indicators and their combinations were calculated.  

The frequency distribution of severe adhesion in these individuals was 16.27%. The highest sensitivity was related to depressed scar and negative sliding sign (65%). The highest specificity was related to the negative sliding sign and its combinations (97%-99%). The highest positive predictive value was related to negative sign sliding and its combinations (81%-92%). The negative predictive values of depressed scar, negative sliding sign, and severe striae gravidarum, and even their combinations were almost the same and approximately between 89% and 93%.  

To predict the presence of adhesions in a cesarean candidate because of a previous cesarean section, you should first examine the striae gravidarum and scar. In the absence of a depressed scar and severe striae gravidarum, there is a 90% chance of no adhesions. According to this study, if both signs are present, it is recommended to check the sliding sign to obtain a more accurate estimate.

 The COVID-19 infection remains a major pandemic threatening global health. Studies revealed that pregnant women are more prone to develop severe illness, with an increased risk of morbidity and mortality. So the objective of this study is to report the clinical presentation and perinatal outcomes after COVID-19 infection during pregnancy or the puerperium.

 In this case series study, since February 2020, 25 pregnant women with a definitive diagnosis of the COVID-19 infection were registered. Their clinical signs and symptoms, laboratory findings, CT manifestations, pregnancy status, were recorded at the first visit, and they were followed six months after diagnosis.

 The most common symptoms were cough, feeling feverish, and dyspnea. Twenty mothers required hospitalization, 5 out of 20 monitored in COVID-ICU. The chest CT scan demonstrated a grand glass appearance in 77% of cases among admitted patients. The total mortality rate in C-ICU (COVID-19 ICU) admitted patients were 80%.

 In this case series, among 25 pregnant women with confirmed COVID-19, the most vulnerable patients were in the early third trimester and twin pregnancy.

Although theory explains the development of illness script, it does not provide answers how medical students develop scripts in their learning. To fill the knowledge gap of developing illness script in medical students and interns, this study aimed to investigate the impact of educational strategies inspired by theory in the development of illness scripts.

A total of 15 medical students and 12 interns participated in an educational intervention that included theory-driven strategies. To evaluate the impact of this intervention, clinical reasoning problem (CRP) and key features (KF) tests were used for before and after the intervention. In addition to descriptive statistics, the differences in participants’ pretest and posttest variables were tested using Wilcoxon. Significance level was set at p≤0.05 for all tests.

Interns significantly recognized more KF in the posttest. However, no significant difference was found between the pretest and posttest scores in total diagnostic accuracy (5.41±1.16 vs 4.91±1.44; p=0.111) and total correct discriminating score (0.41±0.66 vs 1.41±2.06; p=0.146). Medical students produced less total key features in the posttest, indicating that they became less elaborate in their case processing. However, no significant difference was observed in common KF score (0.4 [0.25-0.78] vs 0.9 [0.6-1]; p=0.791) and discriminative key features score (0.33 [0.16-0.33] vs 0.22 [0.11-0.44]; p=0.972) in the posttest compared to the pretest.

This study showed that theory-driven educational strategies have an impact on illness script development specifically in interns. It is recommended that this intervention would be tested on those in higher levels of expertise (ie, residents).

Preeclampsia (PE) is one of the main causes of maternal and perinatal mortality and morbidity. Evidence shows that oxidative stress plays an important role in the pathophysiology of the PE. As catalase is a key enzyme in antioxidant enzymatic defense which protects cell from oxidative damage, in this study, we aimed to investigate the relationship between CAT‑21A/T (rs7943316) polymorphism and PE susceptibility.

This case–control study was conducted on 155 PE women and 159 normotensive pregnant women. Polymerase chain reaction‑restriction fragment length polymorphism method was used for genotyping.

There was no association between CAT‑21AT and TT genotypes and PE susceptibility. However, the CAT‑21A/T polymorphism was associated with 1.6‑fold higher risk of PE in dominant model (AA vs. AT + TT) (odds ratio [OR] 1.6 [95% confidence interval [CI]: 0.9–2.9]; P = 0.04). However, the CAT‑21A/T polymorphism was not associated with PE in recessive model (TT vs. AA + AT) (OR 1.3 [95% CI: 0.8–2.1]; P = 0.4).

The CAT‑21A/T polymorphism could be a risk factor for PE susceptibility in dominant model.

Empathy is a cognitive characteristic defined as the ability to understand people’s experiences, interests, and viewpoints and the capacity to share this understanding. Empathy constitutes the foundation for the patientphysician relationship, leading to both the patients’ and physicians’ satisfaction, and is effective on the patients’ cooperation and clinical outcomes. Many studies have shown that the level of empathy decreases in students during their clinical course. Learning literature and art is theoretically one of the methods to increase empathy in clinical environments. We aimed to assess the efficacy of storytelling on medical students’ empathy toward patients.

This quasi-experimental study with a nonequivalent group pretest-posttest design was performed during 2010-2011 in Zahedan, southeast Iran. We initially invited all fourth and fifth-year medical students studying at Zahedan University of Medical Sciences to participate in our study. The volunteers were asked to complete the Persian version of the Jefferson Scale of Physician Empathy-students version (JSPE-S) plus questions regarding their demographic data and the field in which they would like to continue their education. The case group was enrolled in 10 sessions of storytelling, each lasting for 2 hours. Part of a book was initially selected by the researcher and the students were unaware of the story. The participants then discussed the story recited by the researcher.

After the intervention, a decrease was observed in the mean of JSPE-S score of the control group, and an increase in the mean score of the case group. The participants did not differ significantly in terms of sex, age, duration of training course, and intended field of study. We found that the empathy score was not significantly related to the participants’ sex (p = 0.086), duration of training course (p = 0.210), age (p = 0.902), and tendency to study in different fields (p = 0.815).

Storytelling courses are possibly effective both in maintaining the level of medical students' empathy toward patients and in preventing the reduction of empathy during their education.