Evaluation of Emotional Divorce in Male Patients with Urethral Distraction Defect in a Referral Center

Background: Emotional divorce is the first stage of divorce in which the marital relationship deteriorates and the couple's relationship lacks love and affection. Given that the family is one of the foundations of the society, emotional divorce can have devastating effects on society and negative effects on family members. Therefore, it is essential to study this issue. Methods: Patients with Pelvic Fracture Urethral Distraction Defect (PFUDD) admitted consecutively to Shohada-e-Tajrish Hospital (Tehran, Iran) from May 2020 to May 2021 were enrolled in the study. In this study all patients were evaluated by two questionnaires: Gottman emotional divorce questionnaire to assess the patient's marital status, and the International Index of Erectile Function (IIEF-5) questionnaire to assess the patient's sexual situation.  Results: The mean score for the IIEF-5 scores in the case and control groups were 18.32 and 21.04, respectively. The mean Gottman Scores in the case and control groups were 3.84 and 2.12, respectively. There was no significant difference between IIEF-5 and Gottman Scores between the two groups. Conclusions: Considering the lack of differences between the two groups, it can be inferred that the effect of the spiritual and emotional dimension in strengthening marriage was more than the physical dimension. When a man encounters a physical problem, his wife will play a supportive role and seek to strengthen relationship and solve problems

Effect of Magnesium Sulfate Added to Tincture of Opium and Buprenorphine on Pain and Quality of Life in Women with Dysmenorrhea: A Prospective, Randomized, Double-blind, Placebo-controlled Trial

Background: Adding magnesium sulfate (MgSO4) to opioid receptor agonists increases the opioid analgesiceffects via blocking this receptor. The current study aimed to evaluate the effectiveness of adding MgSO4 totincture of opium (TOP) and buprenorphine (BUP) on pain and quality of life (QOL).Methods: In prospective, randomized, double-blind, placebo-controlled clinical trial, one hundred andsixty-three women with secondary dysmenorrhea caused by endometriosis were selected using a respondentdriven sampling (RDS) and assigned into six groups using block randomization. Patients received 50 mg/kgMgSO4 in 100 ml saline by micro set in six monthly menstrual periods and completed the visual analoguescale (VAS) and QOL Questionnaire (QOLQ). Data were analyzed by repeated measures analysis of variance(ANOVA) and hierarchical regression.Findings: The primary outcomes showed that pain scores in magnesium (MAG) + opium tincture (OT)[F = 5.7(1,162), P = 0.004] and MAG+ BUP [F = 4.5(1,162), P = 0.006] groups showed a significant decreasecompared with control group. Also, QOL scores in MAG + OT [F = 4.8(1,162), P = 0.005] and MAG + BUP[F = 5.9(1,162), P = 0.003] showed a significant increase. However, there was no significant differencebetween the two groups (P = 0.140) and the changes did not persist until follow-up (P = 0.810). Secondaryoutcomes indicated that the low scores of the two components of QOL including physical and psychologicalcomponents were predictors of pain (P = 0.011, Beta > 3.09).Conclusion: Simultaneous use of MAG with opioids is associated with pain reduction and the improvement ofQOL. However, this hypothesis requires careful handling in a randomized controlled tria

Which method is best for the induction of labour?: A systematic review, network meta-analysis and cost-effectiveness analysis

Background: More than 150,000 pregnant women in England and Wales have their labour induced each year. Multiple pharmacological, mechanical and complementary methods are available to induce labour. Objective: To assess the relative effectiveness, safety and cost-effectiveness of labour induction methods and, data permitting, effects in different clinical subgroups. Methods: We carried out a systematic review using Cochrane methods. The Cochrane Pregnancy and Childbirth Group’s Trials Register was searched (March 2014). This contains over 22,000 reports of controlled trials (published from 1923 onwards) retrieved from weekly searches of OVID MEDLINE (1966 to current); Cochrane Central Register of Controlled Trials (The Cochrane Library); EMBASE (1982 to current); Cumulative Index to Nursing and Allied Health Literature (1984 to current); ClinicalTrials.gov; the World Health Organization International Clinical Trials Registry Portal; and hand-searching of relevant conference proceedings and journals. We included randomised controlled trials examining interventions to induce labour compared with placebo, no treatment or other interventions in women eligible for third-trimester induction. We included outcomes relating to efficacy, safety and acceptability to women. In addition, for the economic analysis we searched the Database of Abstracts of Reviews of Effects, and Economic Evaluations Databases, NHS Economic Evaluation Database and the Health Technology Assessment database. We carried out a network meta-analysis (NMA) using all of the available evidence, both direct and indirect, to produce estimates of the relative effects of each treatment compared with others in a network. We developed a de novo decision tree model to estimate the cost-effectiveness of various methods. The costs included were the intervention and other hospital costs incurred (price year 2012–13). We reviewed the literature to identify preference-based utilities for the health-related outcomes in the model. We calculated incremental cost-effectiveness ratios, expected costs, utilities and net benefit. We represent uncertainty in the optimal intervention using cost-effectiveness acceptability curves. Results: We identified 1190 studies; 611 were eligible for inclusion. The interventions most likely to achieve vaginal delivery (VD) within 24 hours were intravenous oxytocin with amniotomy [posterior rank 2; 95% credible intervals (CrIs) 1 to 9] and higher-dose (≥ 50 μg) vaginal misoprostol (rank 3; 95% CrI 1 to 6). Compared with placebo, several treatments reduced the odds of caesarean section, but we observed considerable uncertainty in treatment rankings. For uterine hyperstimulation, double-balloon catheter had the highest probability of being among the best three treatments, whereas vaginal misoprostol (≥ 50 μg) was most likely to increase the odds of excessive uterine activity. For other safety outcomes there were insufficient data or there was too much uncertainty to identify which treatments performed ‘best’. Few studies collected information on women’s views. Owing to incomplete reporting of the VD within 24 hours outcome, the cost-effectiveness analysis could compare only 20 interventions. The analysis suggested that most interventions have similar utility and differ mainly in cost. With a caveat of considerable uncertainty, titrated (low-dose) misoprostol solution and buccal/sublingual misoprostol had the highest likelihood of being cost-effective. Limitations: There was considerable uncertainty in findings and there were insufficient data for some planned subgroup analyses. Conclusions: Overall, misoprostol and oxytocin with amniotomy (for women with favourable cervix) is more successful than other agents in achieving VD within 24 hours. The ranking according to safety of different methods was less clear. The cost-effectiveness analysis suggested that titrated (low-dose) oral misoprostol solution resulted in the highest utility, whereas buccal/sublingual misoprostol had the lowest cost. There was a high degree of uncertainty as to the most cost-effective intervention

Jurisprudential and Legal Study of Organ Donation by Anencephalic Neonates : organ donation

زمینه و هدف: پیوند اعضاء یکی از دستاوردهای علم پزشکی است که پس از فتح قله‌های آن نوبت به بررسی چالش‌های جدید، نظیر دستیابی به منابع جدید برای رفع کمبود اعضا بالاخص برای کودکان رسید. پس از به اجماع رسیدن دانشمندان در مورد پیوند اعضای غیر حیاتی و پیوند اعضای مبتلایان به مرگ مغزی، پیشنهاد جدیدی در دنیای پزشکی مبنی بر استفاده از نوزادان آنانسفال به عنوان منبع جدیدی برای پیوند ارائه گردید. آنانسفالی یکی از ناهنجاری‌های جنینی است که بر اثر نقص بسته شدن لولة عصبی در ناحیة سر جنین ایجاد می‌شود. مبتلایان به این اختلال اغلب قبل از تولد می‌میرند و نوزادانی هم که زنده متولد می‌شوند فاقد هوشیاری هستند و در چند ساعت اول پس از تولد، می‌میرند. در این پژوهش به دنبال پاسخ به این سؤال هستیم که آیا اهدای اعضای چنین نوزادانی با مبانی فقهی و حقوقی جامعه ما سازگار است یا خیر. مواد و روش‌ها: در نگارش مقاله حاضر، با استفاده از روش توصیفی - تحلیلی، پس از بیان ادله موافقین این نظریه، به واکاوی آن بر اساس متون فقهی - حقوقی پرداخته می‌شود. یافته‌ها: هرچند برخی از اندیشمندان غربی، از طریق استدلال به ادله‌ای نظیر شباهت این بیماران به مرگ مغزی و وجود اعلام رضایت والدین، موافق این نظریه هستند، لیکن به هریک از این دلایل ایراداتی وارد است که منجر به رد نظریه فوق می‌شود. پس از تبیین دلایل موافقین و نقد آن، به ارائه پیشنهادی جایگزین که موافق با مبانی فقهی و اخلاقی جامعه باشد، پرداخته می‌شود. مطابق این پیشنهاد، با وجود اذن والدین، نباید درخصوص اهدای اعضای غیر رئیسه نوزادان مبتلا به آنانسفالی محدودیتی وجود داشته باشد.Background and Aim: Organ transplantation is one of the achievements of medical science that today faces new challenges, such as access to new resources to address the shortage of organs, especially for children. Following the scientists' consensus on non-vital organs transplantation and patients with brain death transplantation, a new proposal was provided in the medical community to use anencephalic newborns as a new source for transplantation.Anencephaly is a fetal abnormality caused by a defect in the neural tube closure in the fetal head. Babies with this defect often die before birth, and who born alive are unconscious and die within the first few hours after birth. In this study, we seek to answer the question of whether donating organs of such infants is compatible with the jurisprudential and legal principles of our society or not. Materials and Methods: In descriptive-analytical article after arguments in favor of this theory, it is analyzed based on jurisprudential-legal texts. Findings: Although some Western thinkers agree with this theory by reasons such as the similarity of these patients to brain death and parental consent, there are objections to each of these reasons that lead to the rejection of the above theory. After explaining the reasons of the proponents and criticizing it, an alternative proposal is presented that agrees with the jurisprudential and moral principles of the society. According to this proposal, there should be no restrictions on non-vital organ donation by anencephalic neonates with parental consent

Characterization of Elastic Properties of Porous Graphene Using an Ab Initio Study

Importance of covalent bonded two-dimensional monolayer nanostructures and also hydrocarbons is undeniably responsible for creation of new fascinating materials like polyphenylene polymer, a hydrocarbon super honeycomb network, so-called porous graphene. The mechanical properties of porous graphene such as its Young’s modulus, Poisson’s ratio and the bulk modulus as the determinative properties are calculated in this paper using ab initio calculations. To accomplish this aim, the density functional theory on the basis of generalized gradient approximation and the Perdew–Burke–Ernzerhof exchange correlation is employed. Density functional theory calculations are used to calculate strain energy of porous graphene with respect to applied strain. Selected numerical results are then presented to study the properties of porous graphene. Comparisons are made between the properties of porous graphene and those of other analogous nanostructures. The results demonstrated lower stiffness of porous graphene than those of graphene and graphyne, and higher stiffness than that of graphdyine and other graphyne families. Unlikely, Poisson’s ratio is observed to be more than that of graphene and also less than that of graphyne. It is further observed that the presence of porosity and also formation of C-H bond in the pore sites is responsible for these discrepancies. Porous graphene is found to behave as the isotropic material