مجله زنان مامائی و نازائی ایران
سال بیست و سوم شماره 6 (شهریور 1399)

Pain and problems of the upper limb musculoskeletal system in women after mastectomy are unpleasant and common complications that preventing it can affect the surgical outcomes. This study was performed with aim to evaluate the effect ofmassage therapy with and without bandaging on pain, edema and problems of upper extremity musculoskeletal system after modified radical mastectomy.

This clinical trial study was performed over 18 months (2018-2019) in Tabriz Imam Reza Hospital with participation of 90 women. The subjects were randomly divided into three groups of manual lymph drainage massage group, manual lymph drainage massage group + low pressure bandage and control group. Then, the intervention was trained to the patient and the intervention started the day after the surgery (doing daily at home). Demographic information, upper extremity physical tests and edema checklist were recorded before and after the intervention. Data were analyzed by SPSS software (version 19) and One-way ANOVA and X2tests. P<0.05 was considered statistically significant.

None of the variables were statistically significant before the intervention (p>0.05), whereas evaluation of the variables after the end of the intervention indicated that in variables such as edema (p=0.009), pain severity (p=0.003), Hawkins Kennedy (p=0.005), Jergason (p=0.003), Crossover (p=0.001), Falun (p=0.019), protonator (p=0.002) and isometric resistance (p=0.006), a statistically significant difference was observed between the groups. Also, the use of bandages after massage therapy has the best effect.

Rehabilitation measures such as massage therapy and bandaging immediately after massage therapy reduced the amount of lymph nodes edema, pain, and function of the musculoskeletal system of the hand after mastectomy.

Recently, the effect of serotonin receptor blocking drugs such as Ondansetron to prevent hypotension due to spinal anesthesia, especially in pregnant women has been considered. Therefore, this study was performed with aim to compare intravenous ondansetron versus ephedrine in prevention of hypertension after spinal anesthesia in elective cesarean section.

This randomized clinical trial was performed with participation of 100 women who were candidate for elective cesarean section in Tabriz Alzahra Hospital in 2018-2019. After random assigning of the subjects to two groups of Ondansetron and Ephedrine, immediately after anesthesia injection, 4 mg of Ondansetron (intervention group) and 10 mg of ephedrine (control group) were injected into each group. Blood pressure status during surgery for each group was recorded in the tool of each subject in the form of data collection. Data were analyzed by SPSS software (version 22) and T-test, Mann-Whitney U and Chi-square tests. P<0.05 was considered statistically significant.

The mean total dose of ephedrine for Ondansetron group was 12.33 ± 2.20 mg and for ephedrine group was 19.41 ± 3.29 mg (p= 0.003).After anesthesia, statistically significant difference was found between the two groups in terms of heart rate (p=0.002), systolic blood pressure (p=0.03), diastolic blood pressure (p=0.04), nausea and vomiting (p=0.009) and restlessness (p=0.019).

Prophylactic administration of Ondansetron in pregnant women with elective cesarean section reduced the need for ephedrine and also decreased the complications.

Busulfan drug for cancer treatment, due to the oxidation properties and free radicals production, causes disturbance on male fertility parameters, and leaves water spinach plant have antioxidant features. The current study was aimed to evaluate the effect of water spinach leaf on recovery of male genital injuries caused by Busulfan.

This randomized controlled clinical trial was performed on 48 male rats of Wistar race in 2019. The specimens were divided into 8 groups including; normal saline, Busulfan, water spinach leaf extract with doses of 250, 500, and 1000 mg/kg, extract + Busulfan. Daily treatment for 2 months was administered intraperitoneally. Sperm parameters by colorimetric techniques and light microscopy, level of testis malondialdehyde by spectrophotometry, total antioxidant capacity and testosterone by ELISA method, and height of germinal layer through optical microscopy and Motic software were evaluated. Data analysis was applied by SPSS software (version 20) and Tukey post-hoc test. P< 0.05 were considered statistically significant.

The values of sperm parameters, testosterone hormone, and total antioxidant capacity were significantly decreased in negative control group than positive control (P < 0.01). Treatment by extract and extract + Busulfan in all doses significantly increased whole mentioned parameters compared to the negative control group (P < 0.01). In evaluated parameters in extract group alone, no significant changes were observed compared to the positive control group (P > 0.05).

Leaf extract of water spinach plant increases the sperm quality and improves the Busulfan-induced adverse effects on male reproductive parameters.

Nowadays, selection of a contraceptive with most anti-androgenic effects is an important challenge in treatment of patients with polycystic ovary syndrome (PCOS). This study was performed with aim to compare the effects of Etisterone and Contrasmine pills on PCOS outcomes.

This randomized clinical trial was conducted between 2016 and 2018, and enrolled 108 patients with PCOS referred to Research institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The patients were randomly assigned to one of the intervention groups with Etisterone or Contrasmine pills. The studied outcomes included androgenic, clinical and metabolic parameters at baseline, third and sixth months of treatment. Data collection tools included standard questionnaires, bio-physiologic instruments, and laboratory diagnostic kits. To investigate the differences between the two treatment groups, the statistical model of generalized estimating equations was used. P-value less than 0.05 was considered significant.

After 3 months of treatment, the androgens levels was not significantly different between the two treatment groups (p>0.05), while after 6 months of treatment, the patients treated with Etisterone had lower testosterone levels, compared to those treated with Contrasmine (p=0.029). After 3 months of treatment, the metabolic parameters was not significantly different between the two groups (p>0.05), whereas in 6th month of treatment, patients treated with Etisterone had higher triglyceride levels than those taking Contrasmine (p=0.049). At the end of 3rd and 6th months of treatment, diastolic blood pressure was significantly higher in patients treated with Etisterone, compared to those treated with Contrasmine (p < 0.05).

Use of contraceptives containing cyproterone acetate (CPA) is associated with greater improvement in biochemical hyperandrogenism compared to drospirenone containing products (DRSP), while these compounds can induce hypertriglyceridemia and hypertension in patients with PCOS.

Due to the fact that breast cancer has a high prevalence in the society and in a significant number of patients, its initial manifestation is only in the form of microcalcification on mammography, this study was performed with aim to  evaluate the pathologic results of stereotactic core needle  biopsy to determine the prevalence of malignant and benign lesion and subtype in each group in patients with  suspicious microcalcifications on mammography based on BIRADS classification.

In this descriptive study, 59 patients referred to mammographic clinic in Mashhad city between April2017-September2019, and underwent sterotactic core biopsy because of the presence of suspicious microcalcifications (including morphology and distribution) without mass or focal asymmetry on mammography. In all patients, calcification was identified in at least one core needle specimen after performing specimen mammography. The specimens were submitted and referred to pathologic laboratory and analyzed by two pathologists. The total prevalence of benign and malignant lesions and also the prevalence of subtype lesions in each group were evaluated. The results of different mammographic appearance of suspicious microcalcifications were also compared with pathologic diagnosis. Data were analyzed using SPSS statistical software (version 16) and descriptive statistics methods and frequency distribution of variables in the form of tables. P<0.05 was considered statistically significant.

Benign lesions were seen in 42 patients (71%) and malignant lesions in 17 patients (29%) in histopathologic examination. Total prevalence of benign lesions was more than malignant lesions and the prevalence of non-proliferative lesions more than proliferative lesions. Fibrocystic change was the most common lesion in non-proliferative group (54%). In malignant group, prevalence of Dcis Carcinoma and invasive ductal carcinoma was 74% and 26%, respectively. Prevalence of malignancy was more in pleomorphic type of microcalcifications than amorphous and coarse heterogeneous types.

According to the significant prevalence of malignancy especially the prevalence of DCIS, sterotactic biopsy can be used as a noninvasive biopsy method for Microcalcifications which have a suspicious morphology and distribution to detect early breast cancer.

Sleep disorders are one of the most common problems during pregnancy and the presence of Restless legs syndrome in pregnancy can further impair sleep quality The purpose of this study was to compare the effect of two methods of cold and warm water immersion on sleep quality of pregnant women with restless legs syndrome.

This randomized clinical trial study was performed on 80 pregnant women with restless legs syndrome referred to Arak Taleghani hospital in 2019. The samples were selected by convenience method and were randomly divided into two groups: hot water (group 1) and cold (group 2). Group 1 was asked to soak their feet in cold water 20 to 25°c every night for 10 minutes and for 2 weeks. Group 2 was asked to soak their feet in warm water 40 to 45°c every night for 10 minutes and for 2 weeks. Sleep quality was measured between the two groups and at the beginning and end of the study by Pittzburgh Sleep Quality Questionnaire. Data were analyzed by SPSS software (version 23) and Chi-square, independent t-test and paired t-test. p < 0.05 was considered statistically significant.

Sleep quality in hot water group before and after the intervention was 7.42 ± 2.46 and 4.91± 2.17, respectively (P = 0.001); in cold water before and after the intervention was 6.50 ± 2.56 and 4.47 ±1.86, respectively. There was no statistically significant difference between the sleep quality scores of the two groups after the study (p = 0.329).

Intervention with hot water and cold water reduced the quality of sleep score in pregnant women. As a result, the mentioned interventions can be used to improve the sleep quality of pregnant women who are not able to use medical interventions due to their side effects

Episiotomy is the most common surgery in obstetrics that like any other wound can cause infection or delay in wound healing. Hypericum perforatum has antimicrobial and anti-inflammatory and wound healing properties. Therefore, this study was performed with aim to determine the effects of Hypericum perforatum on episiotomy wound healing in primiparous women.
This double blind randomized clinical trial was performed on 100 eligible women referred to Shahid Noorani hospital of Talesh in 2014. The subjects were randomly allocated into two groups of Hypericum cream (group A) and placebo (group B). After delivery, two groups used 2 cm Hypericum or placebo cream at scar site twice a day for 10 days. Wound healing was measured before the intervention, first 12 hours and 5 and 10 days after delivery by RIDDA scale. Data were analyzed by SPSS software (version 19) and Mann-Whitney and independent t test. P<0.05 was considered statistically significant
The mean of wound healing score before the intervention was not significant in two groups (p>0.05). The mean of RIDDA score significantly decreased at 12 hours and 5 days and 10 days after delivery in hypericum perforatum cream group (p<0.05).
Hypericum perforatum cream is effective on perineal wound healing.

Infertility is one of the most important health-treatment problems in many societies. Recently, much attention has been paid to the role of miRNA in the pathway of spermatogenesis. miR-378 plays an important role in regulating proliferation and differentiation in the spermatogenesis pathway. Q10 is also an antioxidant that plays a role in protecting cells from oxygen free radicals.  Insufficient amounts of coenzyme Q10 can be a major factor in failed spermatogenesis. This study was performed with aim to evaluate the plasma level of coenzyme Q10 and its association with expression of miR-378 gene in infertile men with normal spermatogenesis pattern.     

This case-control study was performed on 45 infertile and 45 healthy individuals as controls. Expression of miR-378 was determined by qRT-PCR and enzyme level was measured by ELISA method. Data was analyzed by SPSS software (version 20) and t-test. P<0.05 was considered statistically significant.

The results of this study indicated that the titres of coenzyme Q10 were significantly lower in the infertility group than the healthy subjects. Also, in infertile individuals, the expression of the miR-378 gene was averagely 1.196 ± 0.020 times of healthy individuals; this increase was not statistically significant (p = 0.45).

In general, the change in coenzyme Q10 significantly reduced in the serum of patients compared to controls. Also, in infertile individuals, the expression of miR-378 increased compared to healthy ones, which was not statistically significant. These findings can be effective in spermatogenesis of male infertility. However, perhaps better results may be achieved by increasing the number of samples.

Since attitudes and beliefs can predict behavior, policy, and performance of an individual, so the midwives' attitudes and beliefs toward labor and delivery can also affect their caring behavior and performance, and the prenatal consequences of the mother and neonate. And the baby is effective. There was no suitable Persian tool to measure the attitude and belief of midwives toward physiological delivery, so this present study was performed with aim of translating and psychometric evaluation of the Persian version of the questionnaire of attitude and belief of midwives toward physiological delivery.

This methodological study was performed on 200 midwives working in the selected hospitals of Tehran University of Medical Sciences in 2018. The midwives were asked to complete a demographic questionnaire and midwives' attitudes and beliefs questionnaire toward physiological childbirth. At first, the face and content validity of the questionnaire was performed qualitatively. Then, construct validity was performed by confirmatory factor analysis. The reliability of the questionnaire was confirmed by stability reliability method and internal consistency.

The face validity and qualitative content of the questionnaire of midwives' attitudes and beliefs toward physiological childbirth were confirmed. Also, confirmatory factor analysis by estimating weight Partial Least Squares showed that the Persian version of this questionnaire has a suitable structure. In order to determine the reliability, the Cronbach's alpha coefficient was estimated as 0.68 to 0.733 for domains of the tools and the Intra-class correlation coefficient was 0.78; both of which indicated good reliability of the Persian version of the questionnaire.

Persian version of the questionnaire of midwives' attitude and belief toward physiological childbirth is valid and reliable and can be used as an appropriate instrument for assessing the attitude and belief of midwives toward physiological childbirth in Iran.

Breast cancer is one of the most common cancers and the second leading cause of cancer deaths among women worldwide. There is direct relationship between hypertension and the risk of blood cancer. Since the studies have showed that renin-Angiotensin pathway can be involved in cancer progression, therefore, this study was performed with aim to investigate the effect of angiotensin-converting enzyme inhibitors (ACEI) on survival of breast cancer patients by meta-analysis method.

In this systematic review and meta-analysis, the databases of pubmed, scopus, and web of science were systematically searched with the keywords of Breast cancer, neoplasm, tumor, Angiotensin receptor blockers, Angiotensin converting enzyme inhibitors and survival using OR and AND without a time limit until February 19, 2020. I2 index was used to assess the heterogeneity between the studies. Egger's test was used for assessment of publication bias. Data were analyzed by meta-analysis method using random effects model.

In this study, a total of 57708 papers were reviewed and 13 studies were included in this meta-analysis. The results of meta-Analysis showed that based on the random effects model, ACEI had no effect on the survival of patients with breast cancer (HR = 0.1; 95% CI: 12.1 to 0.89; p = 0.99).

The results of the studies show that using angiotensin receptor blocker and renin-angiotensin system inhibitors had no effect on survival of patients with breast cancer.

The effect of environment on reproductive health and pregnancy outcomes has been expressed in some epidemiological studies. Exposure to green space has been shown to improve health as well as improve fetal growth and reduce the risk of pregnancy complications. This systematic review study was performed with aim to determine the relationship between green space and preterm birth.

In this review study, to obtain relevant studies, we searched the English databases of Pubmed, Scopus, Web of science and Persian databases of Iran Medex, SID and Magiran published until 8 April 2020, with the English and Persian keywords of green space and preterm birth and all possible combinations.

From 6964 articles, 18 (12 cross-sectional studies and 6 cohort studies) which met the inclusion criteria were included in the study. Most studies evaluated green space using the normalized Index of Vegetation Difference (NDVI), proximity to green space, and distance to the park. The results of 9 studies showed no relationship between green space and preterm birth, and other studies reported conflicting results on protective effect of green space on preterm birth.

The results of most studies showed no association between green space and preterm birth and gestational age at delivery time. While some studies reported conflicting results on protective effect of green space on preterm birth. Therefore, it is suggested that further studies be conducted in this area.

Didelphys uterus is found in 0.1% to 0.5% of women in reproductive age. Imaging plays an important role in the diagnosis of this anomaly. This study was parformed with aim to train the stages for diagnosing of a rare case of didelphys uterus accompany with obstruction of the cervix due to transverse vaginal septum.

A 25 - years - old woman with infertility, history of irregular menstruation, dysmenorrhea, prolanged bleeding and spotting was admited in the infertility ward of the Royan Institute. Vaginal examination revealed a 3 cm mass in the right part of the vagina. The uterus was observed as didelphys along with a 43 mm hypo-echo mass in the right and lower part of the uterus. In hysterosalpingography, the uterus has a unicorn view. According to this result and sonography findings, didelphys uterus with right obstruction of cervix was reported. MRI also confirmed these findings. A connection was made between two uterine cavities with Strasman surgery, but the patient's symptoms persisted and cysts containing secretions and blood clots were still seen on ultrasound. Due to the persistence of hematocolposus, septum of the vagin was removed and obstruction was eliminated and all clinical symptoms of the patient were removed.

Two and Three Dimensional Ultrasound, hysterosalpingography and MRI play an important role in the diagnosis of uterine anomalies, including didelphys uterus.