مجله زنان مامائی و نازائی ایران
سال بیست و دوم شماره 12 (اسفند 1398)

Cervical cancer is the second most common cancer in less developed countries. Chemoradiation is the standard treatment for advanced cervical cancer, but there is a lack of radiotherapy equipment in developing country. Therefore, this study was performed with aim to evaluate the pathologic response, treatment complication and survival rate of patients with locally advanced squamous cell carcinoma (SCC) of cervix who were not candidate for chemoradiation with use of chemotherapy before surgery.

In this single group, before-after randomized clinical trial, 24 patients with FIGO stages IB2, IIA2, and IIB squamous cell carcinoma (SCC), who were not candidate for standard chemoradiation due to different causes, received 3 courses of neoadjuvant paclitaxel (135mg/m2)+ Cisplatin (75mg/m2) chemotherapy regimen. Then, surgery was performed. Clinical response to neoadjuvant chemotherapy and treatment side effects were assessed after each course. Wertheim hysterectomy was done 4 to 6 weeks later in those with favorable response. In the absence of major risk factors in the surgical pathology, patients received 3 additional cycles of adjuvant chemotherapy. In high risk patients, adjuvant chemoradiotherapy was performed. Data was analyzed by SPSS software (version 21) and Chi-square, and Kaplan Mayer tests. P

Among 24 patients, 13 cases (54.2%) and 17 (73.9%) had FIGO stageIIB and gradeII tumors, respectively. Parametrial involvement was presented in 13 patients (54.2%). Seven patients were excluded. 17 patients underwent surgical resection. Four high risk patients and were candidate for chemoradiation. Clinical and complete pathological response rate were 17 cases (70.8%) and 8 cases (47.1%), respectively. With a median follow up of 18.5 months, mean of overall survival and disease free survival of patients treated with the study protocol were 24.51 and 25.71 month, respectively. The mean of overall survival of whole patients (24 cases) was 30.8 month (CI: 95%, 29/38-32/26).  

Neoadjuvant chemotherapy in patients with locally advanced cervical cancer despite acceptable pathologic response is not associated with survival advantage.

Gynecologic cancers are the important cause of women's mortality in the world. Considering the importance of epidemiological recognition of gynecologic cancers in regional form for planning the preventive measures, this study was performed with aim to assess the epidemiologic characteristics of patients with gynecologic cancers referring to Mashhad oncologic centers in 1982-2016.

In this cross-sectional study, after evaluation of all patients’ files recorded in the last 35 years, the required data were extracted and recorded. The study period was categorized into 4 intervals: before 1990, 1991-2000, 2001-2010, and 2011-2016. The relative frequency, mean age at the time of diagnosis, and the 35-year trend were then assessed. Data were analyzed by SPSS software (version 16) and Chi-Square, Anova, and Scheffe tests. P 

Among 2953 studied patients, mean age was (49.32 ± 13.69 years. The highest mean age was observed among the patients with uterine body neoplasms (52.21±12.49) and the lowest mean age in those with ovarian cancer (46.09±16.09). The mean age at the time of diagnosis of ovarian cancer has significantly increased in the last decades (p<0.001) while decreased in those with cervical cancer (p=0.017). Cervical and ovarian cancers had the highest relative frequency during the entire study period (39.3% (1161 cases) and 36.6% (1080 cases), respectively). There was also a significant difference in the frequency of various cancers across different decades (p<0.001).

Cervical cancer was the most frequent neoplasm in this study. The mean age of diagnosis had increased in patients with ovarian cancer and decreased in cervical cancer. Since cervical cancer can be controlled by preventive measures, more attention to screening of this cancer is recommended.

Infertility is defined as not getting pregnant after 1 year of unprotected intercourse. Given the large area and high population of Sistan & Baluchestan province and many patients referring to the infertility center of Ali-ibn-e Abitaleb Hospital, this study was performed with aim to compare two methods of ovulation triggers for treatment of infertility in women with no ovulation.

This clinical trial was conducted on 100 infertile women (50 in each group) with infertility referring to gynecology clinic of Ali ibn-e Abitaleb Hospital of Zahedan  in 2017-2018. Patients were randomly assigned into two groups of HCG or HCG plus Oxytocin groups. The rate of pregnancy was evaluated. Data were analyzed by SPSS software (version 22) and Chi-square, independent t and Mann-Whitney test. P

According to the results of Chi-square test, frequency of pregnancy was significantly higher in HCG plus oxytocin group than HCG alone group (p=0.016).

HCG plus oxytocin significantly increases pregnancy rate in infertile women.

Diabetic neuropathy is one of the most common and severe complications of diabetes. Very few studies have investigated the effects of resistance-aerobic training on diabetic-peripheral neuropathy. This study was performed with aim to investigate the effect of combined exercise (Resistance - Aerobic ) on neurotrophic changes, neuropathic pain, aerobic endurance and lower body strength in postmenopausal women with diabetic peripheral neuropathy

This practical and semi experimental study was performed on 21 patients with diabetic peripheral neuropathy in Sabzevar in 2017. The subjects were assigned into experimental and control groups. The experimental group performed resistance-aerobic exercises for four months. In fast condition, serum level of Brain-derived neurotrophic factor were taken before the start of the study and after the first, second, third and fourth months after the study. The neuropathic pain was measured with visual analog scale. Six-minute walking test (Rickly Jones) and sitting and standing test were used to estimate aerobic endurance and lower trunk performance, respectively. Data were analyzed by SPSS software (version 16) and Repeated Measure variance analysis and one-way ANOVA. P

Serum neurotrophin levels were not significantly increased in the experimental group compared to the control group (P> 0.05). Pain index significantly decreased compared to the control group (P< 0.05). Aerobic endurance and lower trunk functional strength significantly increased compared to the control group (P< 0.05).

two months of combined exercise (Resistance - Aerobic ) reduces pain index and strengthens aerobic endurance and lower trunk functional strength. Probably, to increase serum neurotrophin levels, the training period should be longer than four months.

Transabdominal ultrasound (TAU) is a non-invasive and easy method that can directly evaluate the function of pelvic floor muscles (PFM) through observation of the bladder base movement. Although, studies have investigated the reliability of this technique during PFM contraction, but there is little evidence of reliability during Valsalva maneuver and abdominal curl. This study was performed with aim to assess the reliability, standard error of measurement and minimal detectable change of TAU of PFM activity during contraction, Valsalva maneuver and abdominal curl in healthy women.

This methodological study was performed on 15 volunteer’s women (20-45 years) who had no symptoms of urinary incontinence in Kashani hospital of Isfahan in 2018. 15 participated in this study. The bladder base displacement (as an indicator of PFM activity), in millimeters, was assessed by TAU during PFM contraction, Valsalva maneuver, and abdominal curl in two sessions at intervals of a week. Interclass Correlation Coefficient (ICC) and standard error of measurement tests were used to evaluate the reliability, standard error of measurement, and minimal detectable change (significance level=0.05).

Reliability of TAU for evaluating the bladder base displacement during PFM contraction was 0.88, during Valsalva maneuver 0.95, and during abdominal curl 0.83. The minimal detectable change during PFM contraction was 2.27 mm, during Valsalva maneuvering 7.94 mm, and during abdominal curl 5.65 mm.

Reliability of transabdominal ultrasound in PFM activity assessment during contraction, Valsalva maneuver, and abdominal curl is good to excellent.

Sexual function is a part of human behavior and life that the rate of sexual dysfunction disorder in post-menopausal period is 72%. Saffron has sexual stimulation effect due to its ingredients such as Crocin and Safranal. This study was performed with aim to evaluate the effect of oral saffron on sexual function of postmenopausal women.

This double-blind clinical trial was performed on 67 postmenopausal women in Bojnourd in 2016-2017. Eligible postmenopausal women daily received one saffron capsule or placebo for 28 days. Female Sexual Function Index was completed before using capsule and 4 consecutive weeks after the intervention. Data were analyzed by SPSS software (version 16) and paired t-test and independent t-test. P<0.05 was considered statistically significant.

The mean sexual function scores in saffron group before and after using saffron were 13.5 ± 8.7 and 18.8 ± 7.6, respectively. The results of paired t-test showed that sexual function was improved (p< 0.001). But, in the control group, no change in sexual function was observed before and after the intervention (p= 0.563). There were no side effects about use of saffron in any of the research subjects

Due to the significant improvement in sexual function with the use of saffron capsules, it is recommended to use saffron as an oral supplement in post-menopausal period.

Tramadol is a synthetic opiate analgesic which is weaker than morphine and stronger than brofen and acetaminophen. This study aimed to evaluate the impact of tramadol on testicular tissue in normal and streptozotocin-diabetic rats.

This experimental study was conducted in Islamic Azad University, Damghan Branch in 2018. In this study, 60 male Wistar rats were divided into 6 groups (case, control, experimental 1 and 2 and 3 and 4). Simultaneous with other groups becoming diabetic, the control group received intraperitoneal citrate buffer by body weight in order to maintain stability of the body. The diabetic (case) group received intraperitoneal streptozotocin at a dose of 55 mg/kg, experimental group 1 (normal rats + 50 mg/kg tramadol), experimental group 2 (normal rats + 100 mg/kg tramadol), experimental group 3 (diabetic + 50 mg/kg tramadol) and experimental group 4 (diabetic + 100 mg / kg tramadol), received tramadol via gavage for five weeks after being diabetic for two months. At the end of week 5, blood samples were drawn from samples, and biochemical and hormonal factors as well as macroscopic and histological testicular sections were evaluated. Data were analyzed in SPSS 21 using one-way ANOVA and Tukey's post-test. P<0.05 was considered statistically significant.
 

In the case (diabetic) group, a significant decrease was observed in spermatogonia (p=0.03), Sertoli (p=0.032) and spermatid cells (p=0.022) compared to the control and experimental groups 1 and 2. In experimental groups 1 and 2, a significant decrease was observed in spermatid cells (p=0.051) compared to the control group. In experimental groups 3 and 4, a significant decrease was observed in Sertoli cells compared to other groups (p=0.02). In the case group, there was a significant decrease in insulin (p=0.001) and testosterone levels (p=0.001) compared to other groups. In experimental groups 1 and 2, due to tramadol administration, testosterone levels showed a significant decrease compared to the control group (p=0.041). In experimental groups 3 and 4, a significant decrease was observed in testosterone levels (p=0.01) compared to the case group, and no significant change was observed in insulin levels in the experimental groups.

Oral administration of tramadol daily for 35 days with specified doses in normal and diabetic rats disrupted blood testosterone balance and reduced spermatogenesis process, such that the more the dose of the drug was, the higher the tissue and hormonal damage was.

Lymphedema due to breast cancer treatment has a wide range of complications, including carpal tunnel syndrome (CTS). This syndrome causes disability for breast cancer survivors, so knowing its prevalence is essential for future action. This study was performed with aim to evaluate the frequency ratio of carpal tunnel syndrome in women with breast cancer treated with lymphedema.

This descriptive cross-sectional study was performed on 160 breast cancer survivors with lymphedema in Tabriz city health centers in 2018-2019. Demographic data and Boston CTS Questionnaire (CTS) were used for the purposes of the study. Data were analyzed by SPSS software (version 20) and Regression and Spearman Correlation tests. P<0.05 was considered statistically significant.

Thirty-three (20.62%) patients had carpal tunnel syndrome. The results of Chi-square test indicated that there was a significant association between carpal tunnel syndrome and age (p= 0.009), lymphedema (p= 0.001), history of radiotherapy (p= 0.001), history of surgery (0.019), history of lymph node removal (p= 0.03) and history of diabetes mellitus (p= 0.04).

The incidence of carpal tunnel syndrome in the present study was 20.62% in women with breast cancer treated with lymphedema. Identifying the risk factors for this syndrome may be the basis for preventive and controlling measures in these patients.

Controlling postpartum pain affects maternal care of baby and mother's return to normal life. Studies have shown the effect of pressure on the 3- liver point in reducing uterine-induced pain, such as menstrual pain. Therefore, this study was performed with aim to evaluate the effect of 3-liver pressure point on postpartum severity of pain.

This controlled randomized clinical trial study was performed on 150 mothers who had normal delivery and complained of postpartum pain in the postpartum ward of Shahid Sadoughi Hospital in Yazd in 2017-2018. Mothers were randomly divided into three groups of 3-liver pressure point (n=50), Sham group (n=50) and Ibuprofen group (n=50). All three groups received oral Ibuprofen 400 mg every 6 hours up to 24 hours if they had moderate or severe pain. In the 3-liver pressure point group (intervention group), the pressure was applied to the 3-liver point for 10 minutes on each foot, and in the Sham group, the same pressure was applied to the ectopic point. The Control group received medication only (routine care). Pain was measured every 6 hours before, 30 and 120 minutes after each intervention. Data analysis was performed using SPSS software (version 16) and tests of Chi-square, Friedman, Kruskal Wallis, Wilcoxon, and GEE)Generalized Estimation Equations (. P<0.05 was considered statistically significant.

The postpartum pain severity after the intervention were statistically significantly different in each group (p <0.001). The mean of postpartum pain severity decreased as 0.34 over time. The mean pain score in the 3-liver point group was 0.8±0.23 lower than the control group (p=0.001). The mean pain score in the 3-liver point group was 0.0±64.3 lower than the sham group (p = 0.035). But there was no significant difference between the sham and control groups (p = 0.468).

Acupressure at 3-liver point is effective in relieving postpartum pain and it can be used like other pressure points affecting postpartum pain.

Fetal abnormality screening counseling is one of the duties of midwives according to fetal abnormality screening guidelines. Since promotion of midwives' clinical competence through efficient training system with modern educational methods is very important and necessary, therefore, this study was performed with aim to compare the effect of standardized patient-based training and feedback lecture on midwives' clinical competence in counseling of fetal abnormality screening.

This interventional randomized clinical trial was conducted on 67 licensed midwives in Mashhad in 2018. The subjects were divided into two groups of standardized patient-based training groups and feedback lecture. After doing the pre-test, a 4-hour training program was conducted for each group, and midwives' clinical competence was assessed two weeks after training, using a questionnaire and a researcher-made questionnaire of clinical competency assessment. Data were analyzed by SPSS software (version 16) and using independent t-test, paired t-test, Mann-Whitney and Chi-square tests. P<0.05 was considered statistically significant.

Changes in mean score of clinical competency 2 weeks after the intervention were significant in both groups (p <0.001).There was no significant difference between the two groups in the mean score of clinical competence before the intervention (p = 0.711) and 2 weeks after the intervention (p = 0.412).  

Both methods of standardized patient-based teaching and feedback lecture is effective on promotion of midwives' clinical competence in fetal abnormality screening counseling.

Hemorrhoid is one of the most common problems in pregnancy, especially in the second and third trimesters. In the absence of timely treatment and proper follow-up, the problem leads to a chronic disease that can impose harmful effects on the individual, the family and the society. Considering the high prevalence of this problem among pregnant women and failure to review the new advocacy, especially pharmacological and aggressive methods over the past 12 years, this study was performed with to review a variety of non-pharmacological and pharmacological treatments of hemorrhoids in pregnancy and their effectiveness.

To achieve the aim of the study, databases of PubMed, Scopus, ProQuest, Google Scholar, Science Direct, SID and Magiran were searched using English keywords of Hemorrhoid, Haemorrhoid, pregnancy, Pregnant, Medical Treatment, Conservative, Life style, Diet, Nutrition, Surgery, Hemorrhoidectomy and their Persian keywords were searched individually and in combination, from the timeframe covered until October 2019.

There are several methods to treat hemorrhoids during pregnancy, but many of these methods are based on the results of clinical trials on the general population of patients with this condition, so, due to the lack of sufficient and powerful clinical studies on the application of some methods and the prohibition or caution of using some other methods during pregnancy, deciding about the choice of treatment depends on the condition of each patient and considering the criteria such as: gestational age, the severity and degree of sustainability of symptoms as well observing the hierarchy of treatment from conservative and non-invasive approach toward aggressive methods.

There are various methods for the treatment of hemorrhoids, but sufficient and robust studies to confirm the efficacy and safety of these methods to the specific population of pregnant women are limited.

Herpes encephalitis is a neurological emergency disorder. In this paper, a case of sporadic herpes encephalitis in a pregnant woman at 26 weeks of gestation was reported.

The patient was a 30-year-old pregnant woman with gestational age of 26 weeks that due to decreased consciousness, confusion, failure to answer questions, disorientation, nausea and vomiting, headache on both sides of the temporal region and Dysphoria was admitted in gynecology ward of Bojnourd Bentolhoda Hospital. On admission, vital signs and oxygen saturation were normal. Magnesium sulfate was administered because of suspected neurological symptoms of eclampsia and proteinuria. Brain MRI was performed after 8 hours due to fever, continued disturbance of consciousness and generalized tonic-clonic seizure that bilateral involvement of the temporal and left frontal areas was evident. Electroencephalogram (EEG) showed Sharps waves in the left frontal, which was consistent with seizure disorder. Intravenous acyclovir was administered after convulsions and exacerbation of neurological symptoms. Polymerase chain reaction (PCR) for detection of Mycobacterium tuberculosis complex, Herpes simplex virus 1 and Brucella in Cerebrospinal Fluid was negative. Level of Protein, leukocytes and RBC was increased in CSF analysis. Blood cultures and serum tests for brucellosis (2-mercaptomethanol and Wright's agglutination test) were negative.  PCR was not repeated because of the patient's dissatisfaction. According to the results of laboratory tests, brain MRI and EEG, diagnosis of herpes simplex encephalitis was suggested. The patient improved and was discharged after 14 days of hospitalization. Healthy baby was born by vaginal delivery at 39 weeks of gestation.

In the event of neurological symptoms in pregnant women (headache, dizziness, and altered consciousness), an urgent consultation with a neurologist is required to rule out other differential life-threatening diagnoses other than eclampsia such as herpes simplex encephalitis. Since there is no specific guideline for management of viral encephalitis in pregnancy, guidelines designed for non-pregnant women are recommended in these cases.