مجله زنان مامائی و نازائی ایران
سال بیست و سوم شماره 11 (بهمن 1399)

Benign breast diseases are one of the most common diseases in the females of any society. This study was performed with aim to determine demographic characteristics, history of disease and body mass index in women with benign breast masses and compare it with healthy women referred to Khatam-Al-Anbia Clinic in Jahrom.

This descriptive cross-sectional study was performed in 2019 with participation of 610 women referred to Khatam-Al-Anbia Clinic in Jahrom. 148 women had fibroadenoma and 467 didn’t have fibroadenoma. Data related to the patients were collected using a questionnaire including individual demographic characteristics and medical records of the referred women. Data were analyzed using the SPSS software (version 21) and descriptive and inferential statistical tests. P<0.05 was considered statistically significant.

Results

The history of hyperlipidemia was highest in the women with fibroadenoma and without fibroadenoma. In the fibroadenoma group, 29 (29.9%) of women were overweight and 10 (10.3%) were obese, while in the group without fibroadenoma, 125 (43.3%) of women were overweight and 72 (24.9%) were obese. Overweight reduces the chance of developing benign breast masses by 22.2% (95% CI: 0.057-0.836) and obesity reduces the chance of developing benign breast masses by 15.8% (95% CI: 0.036-0.693) and it had a protective effect.

Overweight and obesity reduce the incidence of benign breast diseases. Therefore, it is suggested that the study be performed by adjusting other confounding factors in more extensive level.

The prevalence of infertility in the world is increasing and treatment of infertility is one of the important issues. This study was performed with aim to investigate the relationship between IgG and IgA titers of Chlamydia Trachomatis and tubal obstruction in infertile and fertile women referred to Ali ibn-e Abitaleb hospital of Zahedan.

This case-control study was performed in 2019 on 203 women referred to infertility clinic of Ali ibn-e Abitaleb Hospital of Zahedan. The healthy fertile women were considered as the control group. IgG and IgA antibody titers of Chlamydia trachomatis were measured in both groups. For infertile patients with positive IgG and IgA, laparoscopy was performed and tubal occlusion was evaluated. For patients with negative IgG and IgA, hysterosalpingography were done for more evaluation. Data were analyzed by SPSS software (version 21) and t-test and Chi-square test. P<0.05 was considered statistically significant.

In this study, 203 women were studied. In quantitative comparison, mean IgG and IgA titers were significantly higher in infertile women than fertile women (P=0.039) and (P=0.02), respectively, but in qualitative comparison, the frequency of positive Chlamydia antibody was not significantly different between the two groups (P=0.951). IgG and IgA titer was significantly higher in infertile women with tubal obstruction than infertile women without tubal obstruction (P<0.001).

Although the mean IgG and IgA titers were significantly higher in infertile women than fertile women, but the frequency of chlamydia positive antibodies did not differ significantly between the two groups. Also, the titer of antibodies was significantly higher in infertile women with tubal obstruction.

Due to the fact that medical errors leading to mortality have been associated with low levels of professional ethics in physicians, this study was performed with aim to determine and compare the level of professional ethics of medical students in externships and internships at Mashhad University of Medical Sciences.

This cross-sectional study was conducted in 2018 as a census on 307 students of Mashhad Medical School. In order to collect information, the professionalism level questionnaire including 5 dimensions (duty / responsibility, superiority / independence - dignity / honesty, altruism, respect) was used. Data were analyzed using SPSS software (version 16) and ANOVA, Chi-square and Kruskal-Wallis tests. P<0.05 was considered statistically significant.

Mean age of the subjects was 23.67±1.5 years. In the three dimensions of responsibility, respect and honesty, trainees of the first year (students in the first year of the externship) had completely opposite views, while most trainees of the second year (students in the second year of the externship) and internship students agreed (p<0.01). In the "independence" dimension, all three groups were relatively agreed (p>0.087). In the "altruism" dimension, trainees of the first-year opinion were relatively agreed, but trainees of the second year and internship students disagreed with this dimension (p<0.01).

In terms of responsibility, honesty and respect, the mean scores of interns and second year stagers were significantly higher than the one year stagers; the mean score of altruism in the one year stagers was higher than the other two groups. Therefore, we must take steps to improve the level of professional ethics of students through the empowerment of professors, appropriate training of professional ethics in the form of theoretical and practical courses.

One of the complaints of menopausal period is sexual problems and dyspareunia. According to Persian Medicine, Alcea has a moisturizing and softening effect. This study was performed with aim to determine the effect of Alcea herbal product on sexual function in postmenopausal women.

This double-blind clinical trial was performed in 2019 on 60 postmenopausal women with sexual dysfunction referred to Omolbanin Hospital in Mashhad. The subjects were randomly divided into two groups of treatment and placebo (n=30 in each group). Alcea vaginal suppository 5% or placebo was administered every night for 2 weeks and then every other night for 6 weeks. The FSFI (Female Sexual Function Index) questionnaire was completed at the beginning and end of the intervention. Data were analyzed by SPSS software (version 18) and Independent T-test, Man Whitney, Chi-square and Wilcoxon. P<0.05 was considered statistically significant.

Mean score of all domains of sexual function increased after 8 weeks of intervention in the treatment group, which was significantly higher than placebo group. The mean total score of the questionnaire before the intervention in the treatment group reached from 17.45±5.25 to 26.21±4.01 (P=0.0001) and in the placebo group from 21.93±5.65 to 23.89±5.06 (P =0.001).

Alcea herbal product has a beneficial effect on sexual function in postmenopausal women, so it can be suggested as an alternative treatment.

Genital wart is a common sexually transmitted infection which impairs the patient's quality of life. One of the plants which is mentioned in traditional medicine for the treatment of genital warts is green tea extract. Considering the need for new and improved treatments for external anogenital warts, as well as the emphasis on the use of home and herbal medicines and its prevalence in families and its use by the patient and saving the health costs due to the lack of need to refer to physician, this study was performed with aim to compare the effect of green tea extract cream with pedophylline solution on the reduction of genital wart lesions.

This clinical trial study was performed in 2018-2019 on 76 women with genital warts. The subjects were randomly divided into the intervention and control groups. In the intervention group, green tea extract cream was used 3 times a day and in the control group, pedophiline solution was used once a week. The patients in both groups referred every two weeks until 12 weeks or complete recovery of lesions and the number of dimensions and percentage of reduction of lesions were recorded in the lesion assessment form. The validity and reliability of the tool were confirmed by the views of the experts and Cronbach's alpha coefficient r=89%. Data were analyzed by SPSS software (version 22). P

The number and dimensions of lesions were significant between the two groups of green tea extract and pedophylline in weeks 4, 6 and 8 after the intervention compared with before the intervention (p <0.001) and showed better results in the pedophylline group. But, according to the results of Mann-Whitney test, no statistically significant difference was found between the two groups in the number and size of lesions during the 10 weeks after treatment (p <0.001). The number and dimensions of lesions were significant between the two groups during 10 weeks of intervention compared to before the intervention (p <0.001).

The rate of healing of lesions after the end of treatment in the green tea group was the same as pedophylline, so considering the success of the results of the present study, it is recommended to use this product as a suitable alternative to pedophylline in the treatment of genital warts

Striae Gravidarum is a skin physiological change in purple that many women experience during pregnancy and due to the accompanying problems, they suffer from stress and worries about beauty, low self-esteem and psychological problems. This study was performed with aim to determine the effect of aloe vera gel on prevention of striae gravidarum in nulliparous pregnant women.

This triple-blind randomized clinical trial study with a control group was performed in 2019 on 90 nulliparous women with gestational age of 18-20 weeks referring to the selected centers affiliated to Shahid Beheshti University of Medical Sciences in Tehran. The subjects were randomly assigned to one of the three groups of aloe vera gel or placebo. The participants receiving aloe vera gel and placebo group daily massaged 3 cm of the gel for 2 minutes on the entire abdomen for 8 weeks, and the control group did not use any substances on the skin of the abdomen. After 8 weeks, the severity of striae was assessed by the Davy method, the severity of pruritus by the Kamini method, and the severity of the erythema by the Atwal method. Data were analyzed by SPSS software (version 20) and Kruskal-Wallis statistical test. P <0.05) was considered statistically significant.  

Three groups were not significantly different in terms of background and interventional variables at the beginning of the study (p >0.05). Kruskal-Wallis statistical tests showed that the incidence of striae (p = 0.001), the severity of pruritus and erythema (p = 0.001) at 28th weeks of pregnancy was significantly lower in the Aloe Vera gel group than the other two groups. Also, the chance of increasing the severity of striae in the placebo group and the aloe vera gel group were 75% and 95% lower than the control group, respectively.

Aloe vera gel has an effect on preventing striae gravidarum and reducing itching and erythema. Aloe vera gel can be recommended to pregnant women as a low-cost method for preventing striae gravidarum.

Paying attention to the needs of infertile couples and involving them in the treatment program allows them to deal with this problem more effectively. The patient-centered care is based on the principle that all resources and activities of the organization should be organized around the patient. This study was performed with aim to evaluate the quality of patient-centered care from the viewpoints of infertile clients.

This descriptive study was performed in 2019 on 200 infertile clients referring to the assisted reproductive centers of Shahid Beheshti selected hospitals. Data were collected using a patient-centered questionnaire in infertile clients. This questionnaire consists of 50 questions in 8 areas including: access, information, communication, patient participation, respect for patient values, patient's continuity and support, staff's competence and care organization area; the minimum score in each area is zero and maximum is 3. Data were analyzed using SPSS software (version 18) and descriptive and regression tests.

According to the results, the most infertility factor was related to female factor with 132 cases (66.0%) and then the common factor of male and female with 62 cases (31.0%). The mean duration of infertility was 5.35±3.67 years. The results of this study showed that in the score range between 0 and 3, the mean focus of patients in infertility treatment was 1.50. The lowest patient-centered score was related to access area (0.37 from 3) and the highest was related to care organization area (2.40 from 3).

According to the results of the study, the quality of patient-centered care has been obtained moderate-level (1.5) from the desired level (3). It is necessary to reform the infrastructure of the country's health system and the patient-centered approach be widely trained and implemented in the country. In order to make this important, we should identify the influencing factors on patient-centered care.

Candida vulvovaginitis is one of the most common vaginal infections in women and in women with diabetes. Although C. albicans has been reported to be the most common cause of this infection, but there have been recent changes in the pattern of Candida causing Candida vulvovaginitis. This study was performed with aim to investigate the frequency of dominant Candida isolates in patients with Candida vulvovaginitis in Torbat-e Jam and its relationship with diabetes.

In this cross-sectional study, 428 women with suspected Candida vulvovaginitis referred to Torbat-e-Jam medical centers were assessed in 2019. Two specimens of vaginal secretions were taken from each patient. The first specimen was cultured on sabouraud dextrose agar (SDA) medium, and the second one was directly examined using wet mount microscopy. The Candida colonies were passaged on CHROMagar Candida medium to identify the species. Demographic and diabetes characteristics of the patients were evaluated. Data were analyzed by SPSS software (version 16) and Chi-square test. p<0.05 was considered statistically significant.

309 positive yeast cultures were obtained from the patients with Candida vulvovaginitis. Identified Candida species included: 145 (46.9%) C. albicans, 53 (17.2%) C. glabrata, 45 (14.5%) C. parapsilosis, 33 (10.7%) C. krusei, and 33 (10.7%) C. tropicalis. Forty-one specimens (13.3%) also had two types of Candida species. Forty-one patients (13.3%) affected to Candida vulvovaginitis also had diabetes that no significant relationship was observed.

The frequency of non-albicans Candida is relatively higher than C. albicans in patients with Candida vulvovaginitis in Torbat-e Jam, and C. glabrata is the most common among non-albicans species. The incidence of Candida vulvovaginitis was not significant in patients with diabetes. C. parapsilosis was most common among non-albicans species in diabetics patients.

Postoperative pain including cesarean section is a source of concern for many pregnant women, as it can cause adverse effects on the wound healing process, especially in mothers prone to infection who require special care for better wound repair. Therefore, this study was performed with aim to investigate the effect of Recove ointment on pain in mothers with cesarean section who are susceptible to infection.

This two-group triple-blind controlled randomized trial was performed on 80 women with cesarean section who were eligible to participate in the study in Mashhad Omolbanin hospital in 2019. The subjects were placed in two groups of intervention and placebo. They used the ointment for 10 consecutive days. The pain intensity was assessed on the basis of visual analogue scale (VAS) in the days before intervention and 3, 5, and 10 days after cesarean section. Statistical analysis was performed using SPSS statistical software (version 21). Independent T-test, Mann-whitney u test, K-squared test and variance analysis were utilized for repeated data. A p-value of <0.05 was taken as significant.

During the ten days of follow-up, the intervention and placebo groups were not homogenous in terms of the variables of duration of walking (p= 0.002), sitting position (p= 0.03), and carbohydrate share (p= 0.04). In general, the pain scale was significantly different in the intervention and placebo groups which showed reduction of pain in the intervention group (p <0.001).

Due to the presence of effective compounds, Recove ointment can significantly reduce the pain severity of the cesarean scare in mothers who are susceptible to infection.

Uterus transplantation, as a treatment method for absolute uterine infertility, is still in the experimental stage. It is necessary to determine the ethical feasibility of uterus transplantation before using it as a standard treatment for absolute uterine infertility. Therefore, this study was conducted with aim to review uterus transplantation from the perspective of bioethical principles.

In this review study, to find the related articles, the databases of SID, MagIran, Irandoc, PubMed and Iran Medical Articles Bank were searched. The search was conducted without any limitation in Persian databases until June 20, 2020 and in English databases until March 20, 2020. After acquiring the relevant articles, the ethical issues mentioned in them regarding uterus transplantation were identified and classified in principles of bioethics.

From 92 identified articles, 48 papers were entered the study for qualitative review. Based on the results, from the perspective of the principle of autonomy, uterus transplantation is a step towards achieving the reproductive autonomy. From the perspective of the principle of beneficence, in addition to the possibility of giving birth to a healthy baby by the recipient, treating infertility through transplantation has many benefits for the recipient and donor.
From the perspective of the principle of non-maleficence, extensive efforts have been made to identify, reduce and eliminate transplantation risks; however, a proper balance of benefit and loss is essential to perform the transplantation. From the perspective of the principle of justice, some criteria have been considered for the fair allocation of transplant uterus, but funding of the transplant is still debated.

From the perspective of the principles of autonomy, beneficence and non-maleficence, ethically performing of uterine transplantation is possible. Currently, the most ethical discussion in the field of uterus transplantation is related to the principle of justice.

Epithelioid trophoblastic tumor (ETT) is a kind of trophoblastic tumors that is arising from placenta. Since it is extremely rare, estimation of its prevalence is difficult. Involvement of lower uterine segment and cervix in this tumor is unique when compared with other types of trophoblastic tumors. ETT is similar to placental site trophoblastic tumors (PSTTs), in terms of growing slowly, producing low levels of HCG and resistance to chemotherapy. Optimal surgery is always the first and the best approach. In this article, an extremely rare case of metastatic ETTs in the lymph nodes is reported.

A 49 year old women G3L3 presented with menorrhagia in recent 4 months and being severe, she underwent emergency curettage. Pathology report was pregnancy products. Because of exaggerated vaginal bleeding and plateaued hcg levels (40MIU/MIL), hysterectomy was performed. Pathology report was ETT.

Abnormal vaginal bleeding can be the signs of normal or abnormal pregnancy and it is necessary to check hcg level. ETT is usually associated with misdiagnosis or delay in diagnosis which leads to mismanagement of the disease and reducing its survival. Therefore, in diagnosis of molar diseases, regarding to resistance to chemotherapy, the best surgical approach should be performed for the patient.

The most common signs and symptoms of the novel coronavirus disease which causes severe acute respiratory syndrome include: fever, dry cough, dyspnea and myalgia. But the remarkable point is that half of the patients with this infection have digestive symptoms. In this study, a case of covid-19 with atypical symptoms is reported.

A 24-year-old pregnant woman with generalized abdominal pain, bloat and losing appetite without respiratory signs referred to Akbarabadi hospital. Regarding to the epidemic of covid-19 and febrile of the mother after 20 hours, PCR test was done and the result was positive. Emergency appendectomy was done obliquely through a McBurneys point. Pathological results confirmed perforated appendicitis.

Since now coronavirus infection is a pandemic, PCR test should be considered for patients with no typical symptoms, but they have acute digestive symptoms; because in the present case with covid-19, appendicitis progressed rapidly and increased maternal morbidity and complications.