Consumption of dairy products in adolescents in Tehran

  Background: Dairy products are required for bone metabolism; however, the majority of adolescent do not consume the products adequately. This study was performed to assess the prevalence of dairy products consumption, daily calcium, vitamin D intake, and vitamin D deficiency.   Methods: In this cross-sectional study, 444 females and males’ students in middle and secondary school were recruited by using mixed sampling method. Food Frequency Questionnaire (FFQ) was used to estimate dietary calcium and vitamin D consumption. Serum calcium, and 25 (OH) vitamin D were measured. The data was analyzed by IBM SPSS Statistics for Windows, Version 19.0. Armonk, NY: IBM Corp. T-test, Chi2 and Spearman correlations tests were used as well.     Results: Out of all participants, 214 (48.2%) were females. The average age of the participants was 14.34 years and 206 (46.6%) of the students were in middle and 238 (53.6%) were in high school. 409 (92.1%) of the students consumed at least one glass of milk per week. Calcium intake from milk and yoghurt was more than calcium intake from other dairy products. The amount of calcium lower than 700 mg/day was consumed in 176 (39.6%) of adolescents. There was a significant positive correlation between weekly calcium intake and serum vitamin D level (P=0.001). The prevalence of vitamin D deficiency was higher in females rather than males (151 (71.2%) vs. 40 (17.5 %)).    Conclusion: Adolescents in Tehran do not consume dairy products enough. Indeed, encouraging teenagers to consume dairy products and alter in dietary patterns that improve calcium intake, should be taken in to consideration

Application of Uterus Manipulator in Total Abdominal Hysterectomy for Benign Diseases

Objective: Pelvic access is a challenging matter in abdominal hysterectomy especially in obese patients and presence of pelvic adhesions. Uterus manipulators (UM) have been used in a number of studies on laparoscopic approach to improve surgical performance. This study aimed to assess the impact of UM application on the operation time and blood loss in total abdominal hysterectomy (TAH) for benign diseases. Materials and methods: Forty-one patients aged 34 to 56 years were enrolled for abdominal hysterectomy – 20 as the case group (hysterectomy with UM application) and 21 as the control group (conventional hysterectomy). In the case group, UM was used after uterus artery ligation during TAH. The control group underwent traditional TAH. Results: The mean operation time was significantly less in TAH with UM compared to traditional TAH (90.23 ± 10.54 minutes vs. 140.5 ± 16.61 minutes; p-value<0.001). The mean decline between preoperative and 12-hour postoperative hemoglobin was 0.74 ± 0.23 mg/dL in the TAH with UM group and 1.65± 1.02 mg/dL in the traditional TAH group (p-value<0.001). Also, no difference was detected in intra- and post-operative complications. Conclusion: The current study showed that, using UM is beneficial in total abdominal hysterectomy by decreasing the operative time and blood loss

Maternal mortality following thromboembolism; incidences and prophylaxis strategies.

BACKGROUND: Thromboembolism is one of the main causes of maternal mortality, which can be prevented in many cases. The present study was designed to investigate the incidence and prophylaxis strategies for maternal mortality following thromboembolism in postnatal. METHODS: In this case series study, the data of the mortality cases were extracted according to the ethical and security standards of the Ministry of Health of the country and compared with a healthy control group. The thromboembolism risk factors measured and scored using a questionnaire entitled the evaluation of risk factors for maternal mortality following thromboembolism during pregnancy, labor, or post-partum . RESULTS: The maternal mortality rate was 16 per 100,000 live births. Among 297 mortality cases, 27 (9%) death were due to thromboembolism. The mean gestational age was 32.5 weeks. Dyspnea (88.8%) and tachycardia (18.5%) were found as common clinical manifestations in these patients. Sixteen cases (59.3%) did not get heparin, 6 (22.2%) received single dose and 5 (18.5%) received two doses and more. In these 11 cases, 5 (45%) patients received heparin before surgery, 1 after surgery, and 5 before and after surgery. Twenty cases deceased in the first hours after delivery and the rest after 2 to 12 days. The average score of risk for thromboembolism based on Royal College of Obstetricians & Gynecologist (RCOG) guideline was 4.6. CONCLUSION: It seems that one of the most important cause of maternal mortality in this study was the lack of recognition of high-risk patients and the lack of prescription for prophylaxis with heparin and this clearly explains the need for accurate screening of high-risk mothers, designing a standard form and the care and treatment of these patients

Cranial nerve involvement among COVID-19 survivors

IntroductionCOVID-19 was first reported in November 2019 in China and rapidly spread across the globe. COVID-19 causes neurologic symptoms and complications, which may persist even after recovery in patients. The objective of this research was to determine the involvement of cranial nerves in COVID-19 survivors.MethodThis was a retrospective study. The study was conducted between March and July of 2022. The analysis included 98 patients with a certain positive polymerase chain reaction. SPSS software version 19 was utilized for data analysis.ResultsThe average age of the participants was 40.47 years (8.81). The olfactory nerve was found to be the most frequently involved cranial nerve (36.7%). Over 20% of participants had a taste disorder. The findings from the regression analysis indicated that lung involvement and age have a direct and significant relationship with cranial nerve involvement and can serve as its predictors (p = 0.001).ConclusionIt seems that cranial nerve involvement was sustained in COVID-19 patients who survived. In addition, elderly patients and patients with severe illnesses were more likely to show cranial symptoms. It is necessary to monitor COVID-19 survivors for neurological symptoms

The maternal and neonatal outcomes of pregnant women with definite COVID-19

Background: This study aimed to assess the symptoms and clinical laboratory data of pregnant women with COVID-19 in their second or third trimester of pregnancy as well as their maternal and neonatal outcomes. Methods: This retrospective observational study was conducted on 177 pregnant women with COVID-19 who were admitted to Yas hospital (affiliated with Tehran University of Medical Sciences), and Ali-ibn-Abi-Talib hospital (affiliated with Zahedan University of Medical Sciences). Results: There was significant higher complaints including fever (p-value=0.015), cough (p-value=0.028), fatigue (p-value=0.002), dyspnea (p-value=0.022), and lower hemoglobin level (p-value=0.009) in patients who were in their third trimester compared to those who were in their second trimester. 9.6% (n=17) of the patients had severe disease and needed ICU admission. There was a significant variation regarding gestational age (p-value=0.022) in pregnant women admitted to ICU compared to the other ones. During the study, delivery happened in 108 (61%) pregnant women. Fetal distress following meconium deification (p-value=0.041), need to MGSO4 (p-value=0.001), IUFD (p-value=0.006), need for blood transfusion (p-value=0.004), and neonatal death (p-value<0.001) were significantly higher in patients who needed ICU admission. Conclusion: Higher gestational weeks are the main risk factor for severe COVID-19 disease. Although vertical transmission is rare; due to the higher risk of perinatal outcomes, the delivery should be done in a center with a NICU department

Co-treatment of gonadotropin and letrozole in infertile women with endometriosis: A doubleblind randomized clinical trial

Background: The common causes of infertility in women with endometriosis are folliculogenesis alternation, steroidogenesis and fertilization impairment, oocyte and embryo quality reduction, and implantation defect. Objective: To compare in vitro fertilization (IVF) cycle success rates of women with endometriosis who were treated with letrozole + gonadotropin (LA) vs. placebo + gonadotropin (PA). Materials and Methods: This double-blind, randomized clinical trial study was conducted with 94 infertile women with endometriosis (47 in the LA group and 47 in the PA group) who were candidates for IVF, from April-June 2021. For all participants, the long agonist protocol was applied. In both groups, gonadotropin-releasing hormone agonist was prescribed in the mid-luteal stage and from the third day of the cycle, and gonadotropin was started and its doses were regulated based on the patient’s age, serum anti-Mullerian hormone and follicle-stimulating hormone. From the third day of the menstrual cycle, 5 mg of letrozole daily for 5 days was prescribed for the LA group, while the placebo was prescribed for the PA group on the identical days and duration. After embryo transfer, biochemical and clinical pregnancy were measured in the 2 groups. Results: The gonadotropin dosage (p &lt; 0.01) and estradiol level (p = 0.02) on the human chorionic gonadotropin administration day were significantly lower in the LA group compared with in the PA group. Fetus transfer was done for 32 women. No significant differences were detected between the study groups regarding biochemical or clinical pregnancy (p = 0.72 for both). Conclusion: Letrozole as a co-treatment drug in the IVF cycle of women with endometriosis can significantly reduce the gonadotropin dosage and estradiol level with the same pregnancy rates. Key words: Gonadotropin-releasing hormone, Fertilization in vitro, Letrozole, Endometriosis

Investigating the Medical Complaints Related to Normal Vaginal and Caesarean Section Delivery

Introduction: One of the goals of the health reform program (HRP) which was started in 2014, was normal vaginal delivery (NVD) promotion. Although, HRP has been successful in increasing NVD, it seems medical complaints related to the delivery have been rising during this program. Therefore, this study examined the complaints related to the NVD and cesarean section in 2011 to 2017. Materials and Methods: In this retrospective study, the complaints registered in the field of obstetrics and gynecology surgery in the sub-branch of midwifery, in the Forensic Medicine Organization and the Police Department of Tehran were investigated (before and after the HRP) randomly. Results: The results of this study showed that in 18 cases (16.3%) of the investigated medical complaints, malpractice occurred, 14 cases of which (77.8%) related to before and 4 cases (22.2%) related to after the implementation of the HRP. Conclusion: The results of this study showed that some medical malpractices are avoidable. Health system managers should pay more attention to avoidable malpractice to improve the quality of the services. The results of this study showed that the implementation of the HRP did not cause an increase in the number of registered complaints related to the delivery

The satisfaction of infertile patients with the quality of medical services in Tehran university of medical sciences hospitals during the year 2020-2021

Background: Patient satisfaction is considered as one of the most important elements of the evaluation of healthcare centers. In this research, the level of satisfaction of infertile patients was evaluated. Methods: This study is a cross-sectional descriptive study. The research population is infertile patients who referred to the infertility clinic (at least 4 visits) and hospitalized in four hospitals affiliated with the Tehran University of Medical Sciences. The satisfaction questionnaire was valid researcher-made which included 56 questions in 9 areas, and were collected from May 2021 to September 2022. In order to comply with the ethical principles in research, hospitals were named 1-4.The results were analyzed using the chi-square test or Fisher's exact test for qualitative variables and analysis of variance for quantitative variables in SPSS software, version 24 (SPSS Inc., Chicago, IL, US). Results Three hundred–four infertile women in four hospitals were studied. The mean age of the participants was 33.8 years, with a standard deviation of 5.8 years. The average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in the number-1 Hospital had the highest score, and the average satisfaction with nursing or midwifery services, diagnostic and therapeutic services (radiology/laboratory), hospital services, charter patient rights, management services, paid expenses in Hospital 4 received the most points. The mean score of satisfaction was the highest among those who visited the infertility clinic of Hospital 3 (161.54±21.41). Average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in Hospital No. 1 had the highest score, and average satisfaction with nursing or midwifery services, medical diagnostic services (radiology/laboratory), hospital services, respecting the patient's rights, management services, paid expenses in hospital number 4 got the most points. The average of nursing or midwifery services, respecting the patient's rights, and hotelling in all hospitals received the highest score, respectively, and nutrition services and paid expenses received the lowest points (most dissatisfaction) (P<0.05). Conclusion: The level of satisfaction of women referring to the infertility clinic in 35.9% of cases was considered to be at an appropriate and exceptional level, in 49.3% of cases it was at a partially appropriate level, and in 14.8% at an inappropriate level

Uterine involvement in epithelial ovarian cancer and its risk factors

Abstract Background Epithelial ovarian cancer (EOC) is an extremely aggressive and lethal carcinoma. Specific data that identify high-risk groups with uterine involvement are not available. Thus, this study aimed to evaluate a gross number of women with EOC to obtain the frequency of uterine involvement and its risk factors. Methods This retrospective observational study was conducted on 1900 histologically confirmed EOC women, diagnosed and treated in our tertiary hospital from March 2009 to September 2020. Data including their demographic, medical and pathological findings were collected. Results From 1900 histologically confirmed EOC women, 347 patients were eligible for participations. The mean age of study patients was 51.31 ± 11.37 years with the age range of 25 to 87 years. Uterine involvement was detected in 49.6% (173) of the patients either macroscopic (47.4%) or microscopic (52.6%) types. Uterine involvement was significantly associated with having AUB (P-value = 0.002), histological type of ovary tumor (P-value < 0.001), ovarian cancer stage (P-value < 0.001), and abnormal CA-125 concentration (P-value = 0.004). Compared to the other study patient, the patients with metastatic uterine involvement had significantly higher stage (p-value< 0.001), higher grade of ovary tumor (p-value = 0.008), serous histological type (p-value< 0.001), and a higher level of CA-125 concentration (p-value< 0.001). on the other hand, the patients with synchronous uterine cancer were significantly younger (p-value = 0.013), nulliparous (p-value< 0.001), suffered from AUB symptoms (p-value< 0.001) and had endometroid histological type (p-value = 0.010) of ovary cancer in comparison to other study patients. Conclusion Considering the high prevalence of uterine involvement in EOC patients, ultrasound evaluation and/or endometrium biopsy assessment should be done before planning any treatment