Prevalence of Burnout in residents of obstetrics and gynecology : A systematic review and meta-analysis

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The effect of misoprostol on intraoperative blood loss after myomectomy

Background: Uterine myomas are common benign tumors in the reproductive period. Bleeding during myomectomy is one of the major complications. We designed a randomized clinical trial to investigate the effectiveness of misoprostol on reducing Intraoperative Blood Loss (IBL) after myomectomy.Methods: Sixty four patients undergoing abdominal myomectomy were randomized into misoprostol group (n=32) that were given 200 micrograms sublingual misoprostol 0.5 hour before the operation and control group (n=32) that were given placebo. Hemoglobin (Hb) was recorded preoperative, 6 h and 24 h after surgery. Data were analyzed by SPSS software (V.20).Results: Mean of age, body mass index and baseline Hb were not statistically significant between the groups however Hb in 6h after operation were significantly higher in misoprostol group but not significant after 24 h (Hb 6h: 9.8 ±0.8 vs. 9.1 ± 0.9, P=0.003 and Hb 24 h: 10.50 ± 0.56 vs. 10.24 ± 0.58, P=0.066). No difference was observed in terms of anemia and need for blood transfusion after operation among the groups.  Conclusions: Preoperative use of sublingual misoprostol is effective in reducing IBL for women undergoing myomectomies in short time (after 6 h). Further studies should be performed to investigate the effectiveness of preoperative misoprostol with various routes and doses in other post-operative time on reducing IBL in abdominal myomectomy.

Experience of Healthcare Providers to Deal with Victims of Sexual Assault: A Qualitative Research

Introduction: Victims of sexual assault require comprehensive, gender-sensitive health services in order to cope with the physical and mental health consequences of their experience. In most countries, however, there is a gap between the healthcare needs of victims of sexual violence and the existing level of health services provided in such cases. Experiences of the service providers help to deepen the understanding of this phenomenon so, this study aimed to understand the perceptions and experiences of clinical health care providers to victims of sexual assault. Method: This was a qualitative study with content analysis approach. 23 healthcare providers working in private and public hospitals in Ahvaz and Tehran, Iran were selected with purposive sampling method. Data were collected using interviews, observations and recording field notes. All the interviews were recorded and transcribed verbatim. Data were analyzed using descriptive content analysis and the Granheim and Lundman method. Results: Five categories including 255 primary codes were emerged. The derived codes were as follows: 1) focus on the history and physical examination 2) legal considerations 3) diagnostic and para-clinical services4) ostensible prevention and treatment of complications and 5) consult and referral request. The main code included in all derived codes was "routine and task-orientation". Conclusion: The findings showed that clinical healthcare providers provided health care to the victims of sexual violence regardless of their care needs, based on their routine administrative procedures. Therefore, the staff should concerns about the respond to the needs of females who have been sexually assaulted. Keywords: Clinical service, Sexual assault, Qualitative study, Content analysi

A Comparison of the Effect of Ajwain (Trachyspermum ammi (L.) Sprague) and Mefenamic Acid for Alleviating the Symptoms of Primary Dysmenorrhea: An Open-Label Randomized Controlled Trial

Trachyspermum ammi (L.) Sprague (commonly known as ajwain) contains ingredients that attenuate menstrual problems, especially cramping. In this study, we evaluated the impact of ajwain on the pain intensity in a sample of Iranian female college students with primary dysmenorrhea (PD) in comparison to mefenamic acid (MFA). This study was an open-label, randomized, parallel-group clinical trial conducted in the university dormitories in Tehran, Iran, from September 2018 to May 2019. Seventy patients were randomly assigned to two groups of ajwain and MFA. The participants in the ajwain group were treated with a 500 mg ajwain capsule three times a day for seven days, from the 26th cycle day to the 3rd day of the menstrual cycle, for three consecutive cycle periods. The other group received MFA capsules with the first dose of 500 mg and then 250 mg every eight hours, if necessary, from the first day of the menstrual cycle. The two groups were compared in terms of the pain intensity by the visual analog scale (VAS) in pre-intervention cycle and three consecutive cycles during the study. Maximum pain intensity, mean pain, and duration of pain after the intervention were significantly reduced in both groups. The mean VAS score significantly decreased in the ajwain group compared to the MFA group post-intervention (p < 0.02). Moreover, passing blood clots was significantly reduced in the ajwain group (p < 0.03). The findings of this study suggest that ajwain may be effective in pain relief in PD without adverse effects

The Effect of Rheum ribes Root (Rhubarb) on Menopausal Hot Flashes: a Randomized Double-Blind, Placebo-Controlled Trial

Background and objectives: Hot flashes are one of the most predominant complaints of menopause among women. The main treatment is hormone replacement therapy, which has side effects. Therefore, the use of plants with phytoestrogen has been suggested as an adjunctive treatment.  This study aimed to estimate the efficacy of processed rhubarb (Rheum ribes L.) on hot flashes in postmenopausal women. Methods: This double-blind placebo-controlled trial was performed on postmenopausal women who were referred to public health centers at Iran University of Medical Sciences. Ninety postmenopausal women aged over 45 years with menopausal hot flashes were randomly assigned to two groups. The treatment group received 500 mg of encapsulated processed R. ribes twice a day for eight weeks, and the control group received placebo (starch powder) in the same manner. Data were collected using Blatt–Kupperman index at the start of the study, fourth and eighth weeks after the intervention. Descriptive and analytic statistics were used to analyze the data. Results: A total of 74 patients completed the study (39 participants in the intervention group and 35 in the control group). The results showed that R. ribes significantly decreased the mean of flashing in Blatt–Kupperman index four and eight weeks post-intervention (p<0.001). Rheum ribes showed no serious adverse effects. Conclusion: The findings of this study propose that treatment with R. ribes may be considered an adjunctive treatment for hot flashes in postmenopausal women

Efficacy comparison of titrated oral solution of misoprostol and intravenous oxytocin on labour induction in women with full-term pregnancy

A double-blind randomised trial was conducted on women with gestational age of 40–42 weeks of pregnancy and Bishop score of more than 5. The first group received oxytocin infusion and the second group received a titrated oral solution of misoprostol. Then, the two groups were compared by the primary outcome (the number of deliveries in the first 24 hours of intervention). The two groups did not have any significant difference in maternal and gestational age at the time of intervention, primary Bishop score, parity and neonatal weight. The number of deliveries in the first 24 hours was greater in the misoprostol group. Duration of onset of intervention to proper contractions was longer in the misoprostol group. However, the number of deliveries between 6–12 hours, 12–18 hours and 18–24 hours after induction was greater in the misoprostol group. The incidence of tachysystole and meconium was greater in the misoprostol group.Impact statement What is already known on this subject? Labour induction is widely used where the continuation of pregnancy might be dangerous for the mother or the baby. Of the various methods used for induction, misoprostol which is a prostaglandin E1 analogue has been reviewed more in recent years. Misoprostol has various routes of administration but in most studies only vaginal administration has been evaluated, leaving us with limited data about oral administration. What do the results of this study add? Oral misoprostol is a suitable method for labour induction and can be used as an alternative to oxytocin. What are the implications of these findings for clinical practice and/or further research? Misoprostol is not expensive, has a long shelf life, accessible in underdeveloped countries and rural areas and has several routes of administrations such as oral, sublingual and vaginal. Despite the fact that the oral route of misoprostol has a fast absorption and easier administration, there are relatively few studies assessing the the use of the oral route of misoprostol. Misoprostol is a suitable method for Labour induction and it has the potentials of being used as an alternative for oxytocin, however, the optimum dosages, the preferred route of administration, the maximum dose, the maximum time for administration, and maternal and neonatal safety should be studied more

DNA Interaction and DNA Cleavage Studies of a New Platinum(II) Complex Containing Aliphatic and Aromatic Dinitrogen Ligands

A new Pt(II) complex, [Pt(DIP)(LL)](NO3)2 (in which DIP is 4,7-diphenyl-1,10-phenanthroline and LL is the aliphatic dinitrogen ligand, N,N-dimethyl-trimethylenediamine), was synthesized and characterized using different physico-chemical methods. The interaction of this complex with calf thymus DNA (CT-DNA) was investigated by absorption, emission, circular dichroism (CD), and viscosity measurements. The complex binds to CT-DNA in an intercalative mode. The calculated binding constant, Kb, was 6.6×104 M−1. The enthalpy and entropy changes of the reaction between the complex and CT-DNA showed that the van der Waals interactions and hydrogen bonds are the main forces in the interaction with CT-DNA. In addition, CD study showed that phenanthroline ligand insert between the base pair stack of double helical structure of DNA. It is remarkable that this complex has the ability to cleave the supercoiled plasmid

Evaluating the efficacy of outpatient use of isosorbide mononitrate on cervical ripening in pregnant women with unfavourable cervix

The aim of the present study was to evaluate the efficacy of outpatient administration of nitric oxide donor isosorbide mononitrate for cervical ripening. A randomised clinical trial was performed on term pregnant women with Bishop Score < 6. In the case group, Isosorbide-5-mononitrate capsule and in the control group, placebo was inserted in the posterior vaginal fornix for two consecutive days. The main outcomes were increases in Bishop Score after 48 hours of intervention, number of vaginal deliveries and interval from intervention to delivery. There was a significant increase of the mean Bishop score in the isosorbide group [3.57 ± 1.12 VS 1.54 ± 1.42 respectively (p = .001)]. The other outcome variables did not show a significant difference between the two groups except for headache which was significantly more in the case group. No cases of tachysystole were observed in the two groups. Additionally, haemoglobin levels after delivery did not show a significant difference between the two groups.Impact statement: What is already known on this subject? Cervical ripening in women with an unfavourable cervix and having an indication for induction of labour is an important issue in modern obstetrics. Different methods have been used for cervical ripening and induction of labour including mechanical (i.e. laminaria tents, Dilapan-S, foley catheter), medical (i.e. PGs) and supportive methods. There is no consensus on the best option for cervical ripening What will the results of this study add to the current knowledge of this subject? Outpatient administration of nitric oxide could affect cervical ripening without a significant improvement in the duration of different stages of labour, intervention to delivery interval and number of vaginal deliveries. What are the implications of these findings for clinical practice and/or further research? Due to the contradictory results of various studies, more studies should be performed with greater sample size to evaluate nitric oxide donor isosorbide mononitrate effect on labour duration and reducing caesarean deliveries. Additional data is needed to assess the real impact of NO donors on different stages of labour and its implications

A Comparative Study of Whole Body Vibration Training and Pelvic Floor Muscle Training on Women's Stress Urinary Incontinence: Three- Month Follow- Up

Objective: To determine whether Whole Body Vibration Training (WBVT) is effective at improving pelvic floor muscles strength in women with Stress Urinary Incontinence (SUI). Materials and methods: The study was designed as a randomized clinical trial. 43 women with SUI were randomly assigned in two groups; WBVT and Pelvic Floor Muscle Training (PFMT) and received interventions for four weeks. Pelvic floor muscle (PFM) strength, quality of life and incontinence intensity were evaluated. All measurements were conducted pre and post intervention and also after 3 months in all participants. The ANOVA and the independent sample t test were applied respectively to determine the differences in each group and between the groups. Results: This study showed the WBVT protocol in this study was effective in pelvic floor muscles strength similar to PFMT, and also in reducing the severity of incontinence and increasing I-QOL questionnaire score. We found significant differences in each group pre and post intervention (p = 0.0001); but no significant difference in comparison of two groups' outcomes. Also after three-month follow up, there was no significant difference between groups. Conclusion: The findings of this study showed the beneficial effects of WBVT in improving pelvic floor muscles strength and quality of life in patients with urinary incontinence in four-week treatment period and after three months follow up

Effects of pelvic floor muscle exercises on quality of life outcomes in women with stress urinary incontinence

Introduction Stress urinary incontinence (SUI) is the involuntary loss of urine that occurs with physical exertion and a rise in abdominal pressure Original Research Effects of pelvic floor muscle exercises on quality of life outcomes in women with stress urinary incontinence Absract Background: Stress urinary incontinence is a common problem in the middleaged women and can affect their quality of life. This study evaluated the effects of pelvic floor muscle exercise on quality of life outcomes in women with stress urinary incontinence. Methods: After baseline evaluation, 50 women were assigned for this clinical trial. Participants were instructed to do pelvic floor muscle exercises for 3 months and their quality of life measured before and 3 months after intervention. Results: forty-six women completed the trial. Significant difference in the quality of life scores (P&lt;0.0001) were noted in women with stress urinary incontinence, after 12 weeks. Conclusion: 12 weeks of pelvic floor muscle exercises significantly improved quality of life outcomes in women with stress urinary incontinence