manizheh sayyah-melli

This study aimed to investigate the association between pubic and external genitalia hair removal by laser devices and human papillomavirus (HPV) infection.

In this study, a total of 809 women were examined. To this end, 250 women with HPV-positive and 500 ones with HPV-negative/normal cytology were assigned to two groups. Then these women were demographically matched, and the two groups were compared regarding the prevalence of laser device usage for external genital hair removal. Finally, the statistical analysis was performed using unpaired student t-test and Kolmogorov-Smirnov test.

The prevalence of laser hair removal were 59% and 25% in HPV-positive and HPV-negative/regular cytology groups, respectively. It was found that the history of laser hair removal was positively associated with positive HPV results (OR: 4.353, CI: 95%, 3.157 to 5.989).

Laser hair removal was positively associated with positive HPV transmission. However, it was recommended that further studies with greater sample sizes should be carried out to determine if the pubic hair removal by laser devices increased the HPV transmission risk.

Ovarian granulosa cell tumors (GCT) are rare tumors with a late recurrence and a good prognosis. The current study investigated the fertility and obstetrics situation, survival, and the factors influencing the mortality of patients with these uncommon ovarian neoplasms.

This is a retrospective study on ovarian GCT patients admitted to the Al-Zahra hospital oncology department, the tertiary referral hospital in Tabriz, between 2009 and 2022. Data were collected from medical records. Chi-square/Fisher exact tests and t tests were used to compare categorical and quantitative variables between the alive and dead patients, respectively. The Kaplan-Meier curve was used to present patients’ survival.

The study involved 65 patients with ovarian GCT. The presence of ovarian cysts statistically increased the survival of GCT patients (P=0.028). The advanced tumor stage (P=0.023), fast tumor growth (P=0.001), and tumor relapse (P=0.001) are significantly correlated with mortality in the affected patients. However, age and adjuvant chemotherapy were not associated with survival.

There was no evidence of increased survival with the use of adjuvant chemotherapy. Tumor staging is an important prognostic factor. Advanced stages were associated with inferior survival, and only prospective studies can ascertain their definite role.

Women with endometriosis have a high risk of developing ovarian carcinoma that may occur due to endometriosis lesions. There is few research have so far focused on the clinical factors in patients with endometriosis-associated ovarian cancer (EAOC). Accordingly, this study aimed at comparing the demographic and obstetric characteristics between ovarian cancer with and without endometriosis

This cross-sectional study was conducted on 20 EAOC patients and 140 non-EAOC individuals who had gone under surgery from 2011-17 at Al-Zahra hospital. Clinico-pathological characteristics of the two groups including first group only had malignant epithelial ovarian tumor (non-EAOC) and second group had both malignant epithelial ovarian tumor and endometriosis (EAOC). P value less than 0.05 was considered statistically significant.

EAOC cases were significantly younger (P=0.002) and had lower number of pregnancy (P=0.002), parity (P=0.004), and term pregnancy (P=0.005) than non-EAOC patients. A large proportion of EAOC cases had clear cell and endometrioid histopathology in comparison to non-EAOC individuals (P<0.001) and most of the tumors in these cases were unilateral (P=0.01).

We found that age, parity, gravidity, and term pregnancy as well as laterality and histopathologic type of epithelial ovarian cancers vary in EAOC and non-EAOC individuals. Further research is required to identify these differences.

Concurrent bleeding or existing clots usually obscure the vision field and decrease the hysteroscopy success rate. Therefore, any efforts made to have a clear view during the hysteroscopy will improve the diagnostic or treatment outcomes. We examined the effect of preoperative clot evacuation on hysteroscopy related outcomes.

In this parallel-group randomized clinical trial conducted in Al-Zahra hospital, Tabriz, Iran, 114 women with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or after that from December 2018 to September 2019. The study outcomes were the clarity of vision, amount of bleeding, the volume of required distension media, duration of the procedure, and postoperative complications.

There were statistically significant differences in the frequency of the clear vision (P<0.001), the severity of bleeding, mean procedure time (P<0.001), mean used distension media and the mean postoperative hematocrit levels in favour of women with pre-hysteroscopy intrauterine evacuation. There was no difference in in-hospital stay and anaesthetic complications among the two groups. The procedure was successfully performed on all participants of both groups with no post-operative complications.

Removal of clots and other uterine contents before the insertion of the hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities. This additional surgical step could significantly impact surgical and clinical outcomes.

In this study, radical hysterectomy, followed by neoadjuvant chemotherapy (NACT) in patients with locally advanced cervical cancer (LACC) was compared with radical hysterectomy in patients with early-stage cervical cancer.

This retrospective comparative observational study was performed on 13 patients with LACC International Federation of Gynecology and Obstetrics (FIGO) stage IB2-IIB who underwent a radical hysterectomy after NACT between March 2014 and November 2018. This group was compared with 18 patients undergoing radical hysterectomy with cervical cancer FIGO stage IIA-IB1 in the same period of time.

In the NACT group, 8 (61.5%) and 5 (38.4%) patients were in stages IIB and IB2, respectively, and 13 (72.2%) cases were in the IB1 stage in the non-NACT group. Post-operative blood transfusion in the NACT group was significantly higher compared to the non-NACT group [5 (38.4%) patients versus 0, P = 0.008]. The estimated blood loss (EBL) and operative time were similar between the groups. Finally, there were no significant differences in terms of intra-operative and other post-operative complications.

Radical hysterectomy after NACT in women with LACC seems to be safe and reduces the need for radiation in patients with NACT who are at stage IIB. These results need to be confirmed in studies with a larger patient sample.

Using hair dye has spread globally in recent years. Concerns have arisen about the safety of hair dyes during pregnancy. The primary goal of this study was to examine the association between hair coloring and pregnancy outcomes.

This cross-sectional study was conducted on 2040 pregnant women aged 14 to 48 years, in Talegani teaching hospital of Tabriz University of Medical Sciences from January 2017 to December 2019. Three trained midwives collected relevant information from the women on the admission to the labor room and recorded pregnancy outcomes. Chi-square test of independence with post hoc tests and logistic regression analysis were used for data analysis. Odds ratios with a 95% confidence interval and contributing effect sizes were reported. The significance level was set at P ≤ 0.05.

The majority of participants (62.67%) colored their hair in the third trimester. There was no statistically significant association between hair coloring and neonate 1-minute (P=0.23) and 5-minute Apgar scores (P=0.99). The logistic regression model did not confirm a rise in overall neonatal complications (NCs) associated with hair coloring at any time during the pregnancy (odds ratio [OR]: 0.027, P<0.001). Higher rates of low birth weight (LBW) were seen among those who dyed their hair in the preconception period and third trimester compared to the woman who colored their hair in the first and second trimesters (P<0.001).

We observed associations between hair coloring and LBW, however there were no increased odds for NC. The evidence for the safety of hair dye during pregnancy is still limited.

Polycystic ovary syndrome is a common endocrine disorder in women of reproductive age. This syndrome may affect cognitive function and impair spatial memory. Therefore, this study was performed with aim to evaluate spatial memory in women with polycystic ovary syndrome.

This correlation descriptive study was performed in 2013 on 50 women with polycystic syndrome and 50 women without polycystic syndrome who were selected among those referring to specialized obstetrics and gynecology clinics. PCO criterion was used to diagnose polycystic ovary syndrome and Computer Spatial Working Memory Test was used to assess spatial memory. Then the score of spatial memory of the two groups were analyzed by SPSS software (version 21) and independent t-test, Chi-square and Pearson correlation test. p < 0.05 was considered statistically significant.

Mean scores of spatial memory test in case and control groups were 0.52±0.88± 0.39±06 and, respectively. The difference in cognitive performance between the case and control groups was statistically significant (P <0.0001) and women with this syndrome had better performance than the control group. Also, spatial memory scores were significantly correlated with age (p = 0.002), but not significantly correlated with education level (p = 0.99) and body mass index (p = 0.38).

Patients with polycystic ovary syndrome had better spatial memory, but since this capability originates from a pathological process, it does not imply an overall improvement in cognitive function, so, comprehensive follow up of these patients and possible complications of the disease may be necessary.

Uterine leiomyoma (ULM) is one of the most common medical conditions where the molecular pathogenesis in women in still unknown. The aim of the present investigation was to demonstrate the association between catechol-methyltransferase (COMT) (rs4680 G>A) gene polymorphism with the risk of ULM. In the present case-control study we included 200 peripheral blood samples of women, which consisted of 100 women with ULM and 100 women who were healthy. The genotype frequencies were assessed using polymerase chain reaction - restriction fragment length polymorphism (PCR-RFLP) method. The genotype frequencies of COMT (rs4680) gene polymorphism AA + GG vs. GA revealed a significant association with the risk of ULM (OR = 2.453; CI = 1.274 - 4.723, P = 0.006). The findings suggested that the COMT (rs4680) gene polymorphism may be contributed as a predisposing risk factor to ULM.

Endometrial hyperplasia has an affinity for progression toward endometrial carcinoma. This study was conducted to compare the effect of metformin plus megestrol acetate with megestrol acetate alone on endometrial histology in the patients with endometrial proliferative and hyperplastic disorders.
In a single-blind clinical trial, 96 patients with abnormal uterine bleeding and endometrium with irregular or hyperplastic glands with or without atypical foundations were divided randomly into 2 equal groups. Group1 received metformin 500 mg twice a day plus megestrol acetate 40 mg daily for 3 months and group 2 received megestrol acetate 40 mg/d for 3 months. The treatment response was evaluated using pathologic samples of endometrial biopsies 2 weeks after completing the treatment.
In both groups, endometrial hyperplasia was resolved in most cases. Significant decrease was observed within groups in the endometrial thickness before and after the intervention. Comparison of thickness between 2 groups showed that in the megestrol acetate group, after intervention, significant decrease in the endometrial thickness was revealed (12.73 ± 6.04 mm [group 1], versus 8.55 ± 3.43 mm [group 2], P Both treatment modalities were effective in treating proliferative and hyperplastic disorders. However, the response to treatment in the megestrol group was greater than that in the megestrol plus metformin group.

The ovarian mucinous tumors include 10%–15% of ovarian tumors. These tumors are either having ovarian origin or they are metastatic from other organs, particularly from gastrointestinal tract. According to ancient studies, routine appendectomy for tumours was determined based on differentiation of primary appendix carcinoma from ovarian tumors. However, recent investigations showed that appendectomy was performed only in cases with abnormal macroscopic appearance of appendix and in advanced stages of ovarian cancer. The aim of the present study is to investigate the correlation between macroscopic appearance of appendix and histopathology results of ovarian mucinous tumors as well as determining the stage of ovarian cancer appendices.
This descriptive and cross-sectional study was conducted for inquiring about patients with pathologic diagnosis of ovarian and appendix mucinous tumors who had a surgery from 2010 to 2016 in Alzahra teaching hospital, Tabriz-Iran. The presented data were collected through a printed questionnaire followed by analysis.
This study was done on 257 patients with definite diagnosis of ovarian and appendix mucinous tumors. Total number of 121 patients had undergone appendectomy and 110 cases of them had normal macroscopic appearance of appendix. Furthermore, 98.2% of patients with grossly normal looking appendix had normal pathology results and 63.6% of patients with abnormal looking appendix had abnormal pathology results. Totally 5.9% of patients with borderline and 30% of invasive ovarian mucinous tumors had affected appendix. A number of 4 patients were at stage III and 2 of the cases were at stage IV.
According to our investigation and previously published studies, appendectomy during ovarian tumor surgery is the only recommended option in cases with abnormal macroscopic appearance of appendix and advanced stages of ovarian mucinous cancer.

This study intended to explore whether letrozole and metformin can change endometrial histology in the patients diagnosed with disordered proliferative endometrium.
In a pre- and post-interventional study, 31 patients with abnormal uterine bleeding (AUB) were participated to receive 5 mg letrozole and 500 mg metformin daily for 3 months after pathology report of disordered proliferative endometrium. The effect of this combination therapy on endometrial histology was evaluated through comparing the endometrial histology results before and after the intervention.
After treatment with letrozole and metformin, 77.4% of patients showed significant response to therapy in the form of inactive and atrophic endometrium (P Based on the results of this study, letrozole and metformin can be successfully used for treatment of disordered proliferative endometrium. Hence, the effects of these medications deserve to be noticed for careful treatment of the patients with AUB.

The principal treatment of ovarian cancer is surgery with or without chemotherapy. The chemotherapy, however, might be ineffective and long with serious side-effects. To obviate these shortcomings, more efficient and safer medications are required, among which ginger has recently gained popularity because of its anti-cancer properties. This study aims to compare outcomes and side-effects of adjuvant chemotherapy with and without ginger in ovarian cancer patients.
A total of 49 patients (20 patients in case group and 29 patients in control group) with stage I to III, histopathologically proved ovarian cancer underwent cytoreductive surgery followed by platinum-based adjuvant chemotherapy with and without investigator-prepared oral ginger capsules (2 g per day for 6 cycles). Potential side-effects, poor 12-month outcome (serum CA125 levels >35U, radiologic evidence of metastasis and recurrence, or death), and 12-month disease-free survival were documented and compared between the 2 groups.
Poor outcome including serum CA125>35, metastasis, recurrence or death was documented more common in control group (69% versus 40%). metastasis frequency confirmed by computerized tomography (CT) scan 6 month after treatment was significantly lower in case group (P = 0.04). There was no significant difference regarding mortality and disease free survival during one year follow-up after treatment between 2 groups (P = 0.55). Chemotherapy complications such as nausea, vomiting, weight loss, and peripheral neuropathy were detected in case group less than control group but the difference was not significant.
Oral administration of ginger is along with a significantly better 12-month outcome in patients on chemotherapy because of ovarian cancer, and accordingly, considering its safety, its administration is recommended.

This study aimed to compare the effectiveness of a single preoperative dose of misoprostol with intraoperative oxytocin infusion in abdominal myomectomies.
Patients undergoing abdominal myomectomies were divided into 2 groups. An hour before the operation, women in the misoprostol group (n = 35) received a single dose of vaginal misoprostol (400 μg); those in the oxytocin group (n = 35) received oxytocin (intravenous infusion of normal saline solution [30 units in 1000 mL] during myomectomy).
Blood loss, operation time, and need for blood transfusion were significantly reduced in the group administered with vaginal misoprostol. No difference was observed between patients in term of the period of hospitalization and complications. The results of oxytocin in abdominal myomectomy showed no significant difference.
Administration of a single preoperative dose of misoprostol could be a simple and reliable method for reducing intraoperative blood loss and need for postoperative blood transfusion in abdominal myomectomies.

Medical records contain valuable information about a patient's medical history and treatment. Patient safety is one of the most important dimensions of health care quality assurance and performance improvement. Completing the process of documentation is necessary to continue patient care and continuous quality improvement of basic services. The aim of the present study was to evaluate the effect of medical recording education on the quantity and quality of recording in gynecology residents of Tabriz University of Medical Sciences.
This study is a quasi-experimental study and was conducted at Al-Zahra Teaching Hospital, Tabriz, Iran, in 2016. Thirty-two second through fourth year gynecologic residents of Tabriz University of Medical Sciences who were willing to participate in the study were included by census sampling and participated in training workshop. Three evaluators reviewed the residents’ records before and after training course by a checklist. Statistical analyses were performed using SPSS 13 software. P-values less than 0.05 were considered statistically significant.
The results showed that before the intervention, there were significant differences in the quantity of information status among the evaluators and no significant difference was observed in the recording of qualitative status. After the workshop, among the 3 evaluators, there were also significant differences in the quantity of data recording status; however, no significant change was observed in recording of qualitative status.
The study findings revealed that a sectional training course of correct and standardized medical records has no effect on reforming the process of recording.

Pregnancy Associated Osteoporosis (PAO) can lead to serious difficulties such as fragility fractures, elongated back pain and height loss in affected women. Soluble Receptor Activator of Nuclear Factor-Kappa B ligand (sRANKL) to Osteoprotegerin (OPG) ratio is chosen as a bone metabolism equation in many bone diseases characterized by bone resorption, such as post-menopausal osteoporosis and would be modified with folic acid supplementation. This study was done to compare the effects of high dose (5mg/day) and low dose (0.5 mg/day) folic acid in the RANKL/OPG ratio and Tumor Necrosis Factorα (TNFα) concentration during pregnancy.
Forty-five pregnant women who visited the AL-Zahra Hospital, Tabriz Iran, from September 2013 to November 2014 were assigned into two groups in this randomized, double-blind, clinical trial, included women who took 5 mg/day (group1) and who took 0.5 mg/day (Group 2) folic acid supplementation before pregnancy until 36th pregnancy. The biochemical variables in serum of pregnant women were measured before and at the end of the study. The study was registered in the Iranian Registry of Clinical Trials (IRCT) as ID, IRCT2013122315903N1.
OPG levels were significantly higher compared with the baseline value (P=0.008), although sRANKL (P High dose of folic acid supplementation could decrease bone resorptive biomarkers and may prevent PAO in pregnant women by increasing OPG and decreasing sRANKL and TNFα.

As the technique of choice, hysteroscopy can be used in visualizing and treating intrauterine pathologies such as polyps, septa, fibroids and endometrial hyperplasia. The best visualization, however, is attained when the endometrium is flat or atrophic; or a pre-existing active bleeding is minimal or suspended during hysteroscopy. Both epsilon-aminocaproic acid (EACA) and oxytocin have been found effective against active bleeding. The present work aimed to compare the efficacy and safety of intrauterine EACA and intravenous oxytocin in the management of intractable uterine bleeding in candidates of operative hysteroscopy.
In this single-center, observer-blinded clinical trial, 144 candidates of operative hysteroscopy with intractable moderate uterine bleeding were randomized in two groups, receiving either intrauterine instillation of EACA (2 g in 1 L of 5% dextrose serum, n = 72) or intravenous oxytocin (10 IU/L, n = 72). The operator graded the severity of intraoperational bleeding (I = no to V = most severe). Serum hematocrit and hemoglobin changes, intra- and post-operational complications, the mean operative time, and the mean volume of the employed media were also recorded and compared between the two groups.
The two groups were comparable in terms of age, gravidity and parity. Grades I, II and III of intraoperational bleeding were reported in 79.2%, 18.1% and 2.8% of cases in the EACA group, and 18.2%, 65.3% and 16.7% of the cases in the oxytocin group, respectively (P Owing to less severe intraoperative hemorrhage and shorter duration of operation in the group who received intrauterine instillation of EACA than those with intravenous injection of oxytocin, we recommend the intrauterine EACA in managing intractable uterine bleeding in candidates of hysteroscopy.

There are many ideas concerning the etiology and pathogenesis of preeclampsia including endothelial dysfunction, inflammation and angiogenesis. Elevated levels of total homocysteine (Hcy) and lipoprotein (a) [Lp(a)] are risk factors for endothelial dysfunction. This study aimed to evaluate the effect of high dose folic acid (FA) on serum Hcy and Lp(a) concentrations with respect to methylenetetrahydrofolate reductase (MTHFR) polymorphisms 677C→T during pregnancy.
In a prospective uncontrolled intervention, 90 pregnant women received 5 mg FA supplementation before pregnancy till 36th week of pregnancy. The MTHFR polymorphisms 677C→T, serum lactate dehydrogenase activity, urine protein and creatinine concentrations were measured before starting folic acid administration. Serum levels of Hcy and Lp(a) were determined before and after completion of folic acid supplementation period.
Supplementation of the patients with FA for 36 week decreased the median (minimum– maximum) levels of serum Hcy from 11.40 μmol/L (4.40-28.70) to 9.70 (1.60-20.80) μmol/L (p=0.001). There was no significant change in serum Lp(a) after FA supplementation (p=0.17). The overall prevalence of genotypes in pregnant women that were under study for MTHFR C677T polymorphism was 53.3% CC, 26.7% CT and 20.0% TT. There was no correlation between decreasing level of serum Hcy in the patients receiving FA and MTHFR polymorphisms.
Although FA supplementation decreased serum levels of Hcy in different MTHFR genotypes, serum Lp(a) was not changed by FA supplements. Our data suggests that FA supplementation effects on serum Hcy is MTHFR genotype independent in pregnant women.

Ovarian cancer is one of the most common causes of cancer related death in women. Diagnostic techniques to detect ovarian cancer in the earlier stages are likely to improve prognosis. The aim of this study is to evaluate a novel serum tumor marker HE4 in comparison with CA125 and the risk of ovarian malignancy algorithm (ROMA) in patient with ovarian malignancy and benign tumors. CA125, HE4, ROMA were determined in 33 patients with ovarian cancer and in 67 patients with benign tumors. CA125, HE4 cut offs were 35 U/ml and 70 pM, respectively. ROMA algorithm cut off was 13.1% and 27.7% for pre-menopausal or post-menopausal women, respectively. Data were analyzed by SPSS19 software; and P < 0.05 was considered significant. In this study, serum level of CA125, HE4 and ROMA were higher in patients with ovarian cancer than benign tumors (P <. 001). Area under the ROC curve for CA125, HE4 and ROMA were 82.4%, 84.01% and 82.4%, respectively. The differences were not significant. The median CA125, HE4 and ROMA serum levels differed significantly between benign and malignant cases. Although the initial reports were promising, measurement of HE4 and ROMA did not increase the detection of malignant diseases compared with CA125 alone.

Polycystic ovary syndrome (PCOS) is a disorder in women of reproductive age. Psychosocial factors can play a role in PCOS. To determine the psychosocial factors associated with PCOS in a case control study, 742 PCOS cases were compared to 798 women without PCOS for psychiatric disorders and social conditions. The data were collected using a validated questionnaire of the Minnesota Multiphasic Personality Inventory (MMPI). The Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire (DSM-IV) was used to diagnose major psychopathological disorders and other depressive and anxiety syndromes. The suspected psychopathology was evaluated by a clinical psychiatrist. There was a significant difference between cases and controls in education level (71.8% vs. 80.4%; (P<0.001), and employment status (60% vs. 53%; P=0.01) (respectively). Chronic anxiety (35.7% vs. 26.8%; P<0.001), depression (18.9% vs. 7.9 %; P<0.001), anxiety disorders (7.7% vs. 3.3%; P<0.001), and personality disorders (2.9% vs. 1.7%; P=0.01), were higher in the PCOS patients compared controls, respectively. The results showed that chronic anxiety and depression were the most pscycologic pattern in PCO patients. Lower educational level and unemployment were higher in the cases than controls.

The multiple-choice questions (MCQs) are the most commonly used type of test items in medical education examinations. This method could be reliable tool for guarantee of education quality if develop carefully and according to standard test preparation criteria. This study aimed to compare some quality indicators of multiple-choice questions of pediatric, general surgery, internal medicine and genecology and obstetrics residency in pediatric residency promotion examinations (2010 and 2011) held at the Tabriz university medical science (TUMS), with board certification questions in these disciplines during the above years, and special consideration for improved quality management and monitoring of university internal examinations. Methods and Materials: In this cross-sectional study, we evaluated 2400 MCQs format of preboard examination of (TUMS) and national board examination in these disciplines. Individual MCQs evaluated for taxonomy levels (Bloom levels I, II and III) and following structural principles (based on Millman check list). Data analyzed by SPSS (version 18) software. Quality of MCQs in preboard examination of (TUMS) and national board examination in these disciplines was different and this difference was significance in some discipline. We find more perfect quality in national board MCQs examinations in general surgery and in preboard examination of (TUMS) in internal medicine. Pediatric and general surgery residency preboard MCQs examinations of (TUMS) were significantly low level of learning in comparing to national board MCQs examinations,and had more structural problems. To prevent descending quality of national and internal university examinations, management and monitoring of these exams is recommended.

The objective of this study was to compare Multiple-Choice Questions (MCQs) quality parameters of pediatric residency tests between the pre-board examinations of Tabriz University of Medical Science (TUMS), Tabriz, Iran and the national board examination in 2007 and 2011. In this cross-sectional study, we evaluated the format of 300 MCQs in the pre-board examination of TUMS and the format of 300 MCQs of the national board examination in pediatric residency. Individual MCQs were evaluated for content budgeting according to the Nelson pediatric residency reference textbook, taxonomy levels (Bloom’s levels I, II and III) and following structural principles (based on Millman checklist). Data were analyzed by SPSS (version 18) software. We find more consistent content budgeting in the national board MCQ examinations. Forty one percent of pre-board MCQ examinations and 72% of national board MCQ examinations were Bloom’s taxonomy levels II -III (P=0.000). We found correct structural principles in 69.2% and 76.2% of pre-board and national board MCQs examinations, respectively (P=0.05). 30.7% and 22.5% of pre-board and national board MCQs examinations were negative stem, respectively (P=0.025). Most of the negative stem MCQs were Bloom’s taxonomy level I questions. Pediatric residency pre-board MCQ examinations of TUMS were of a significantly lower level of learning (taxonomy level I) compared to the national board MCQ examinations. To prevent low quality development of internal university examinations, monitoring of these exams is recommended.

Vulvovaginal Candidiasis (VC) is a common mucosal infection in women caused by the opportunistic yeast-like fungus Candida albicans. A significant percentage of these patients (5%) subsequently experience recurrent candida infections. The diagnosis of vulvovaginits is based on the patient’s presenting symptoms and the clinical laboratory methods. The aim of this study was to characterize the Candida species isolated from patients with vulvovaginitis. All patients with the VC symptoms who were referred to the gynecologist’s clinic of Alzahra and Taleghani hospital were investigated. After sampling from vagina and cervix discharge، two direct slides were perpared and then stained with gram stain method. The vaginal discharges were cultured on suitable media for isolation and characterization of Candida species by related laboratory methods. 120 samples obtained from patients. 77 patients (65%) were infected with Candida species. The frequency of the Candida albicans، Candida glabrata، Candida parapsilosis and the Candida tropicalis were 63 (81. 8%)، 9 (11. 7%)، 4 (5. 2%)، and 1 (1. 3%)، respectively. Candida albicans was the most common species leading to the Vulvovaginitis in patients with VC while other species were at the secondary importance stages.

One of the most common complications of intrauterine device (IUD) users is bleeding. These symptoms are varied in different type of IUD. The aim of this study was to compare bleeding in two types of intrauterine device (Multiload 375 and Copper T 380A).

A randomized double- blinded controlled clinical trial was carried out on 48 women who were referred to a public health center of Tabriz، Iran، from 2011 September to 2012 October. Participants allocated randomly into two equal groups with random block-size of 4 and 6. Group 1 received Multiload 375 IUD and group 2 received the Copper T 380A IUD. Amount of bleeding was measured with Higham chart during menstruation، one cycle before IUD insertion and four cycles after. Data were analyzed using SPSS software version 13، chi square، independent t-test، analysis of covariance and ANOVA with repeated measures tests. P value less than 0. 05 was considered significant.

No significant differences were found between two groups in terms of demographic and pregnancy characteristics (Except for drug consumption during the study and the interval of last delivery with IUD insertion) (p>0. 05). The mean of bleeding was statistically significant in the first 4 months after IUD insertion in two groups (p<0. 001) as the bleeding in Multiload 375 group was decreased and in Copper T 380A group was increased.

The Multiload IUD resulted in considerable reduction in amount of bleeding. Therefore، counseling about each type of intrauterine device (Multi load and Copper T) in family planning service providers seems to be necessary.

There are many non-pharmacological methods for relieving labor pain. The preferable method is certainly the one that is effective and harmless. Therefore, we decided to compare the efficacy of massage therapy and breathing techniques on pain intensity, physiological responses to labor pain, labor type and the outcomes. A quasi-experimental study was conducted in Alzahra Hospital in Tabriz. At first, 4o primigravidas, satisfying the inclusion criteria, were selected and randomly divided into two groups of massage 1 (M1) and breathing 1 (B1). Then, another 42 mothers were selected based on the same criteria and randomly divided into two groups of massage 2 (M2) and breathing 2 (B2). An educated researcher assistant (ERA) provided practical training to (B1 and B2 groups) by holding one educational session. As the labor process started, the ERA, who was present at the labor room, repeated the breathing technique for B1 and B2 groups. The breathing groups employed the techniques during the first or second stage of labor at 4, 6, 8 and 10 centimeter of dilatation for 30 minutes. The intensity of pain was measured by a numerical rating scale (NRS) 30 minutes after determining dilatation. The physiological responses were evaluated at the same time intervals. The ERA performed massaging at the same dilatations for M1 and M2 groups. The data was collected similarly. Labor progression was evaluated by the partograph. Massage at 4 and 6 cm dilatations and breathing at most dilatations decreased pain scores significantly. The mean difference of pain intensity and physiological responses to pain was not significant between the massaging and breathing groups at most dilatations. Based on the findings of this research, providing the possibility of choosing one or both methods for labor pain relief and decreasing cesarean section rate is suggested.