Batool Hossein Rashidi, M.D.
The Journal of Family & Reproductive Health (JFRH) is the quarterly official journal of Vali–e–Asr Reproductive Health Research Center. This journal features fulllength, peerreviewed papers reporting original research, clinical case histories, review articles, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology including genetics, endocrinology, andrology, embryology, gynecologic urology, fetomaternal medicine, oncology, infectious disease, public health, nutrition, surgery, menopause, family planning, infertility, psychiatry–psychology, demographic modeling, perinatalogy–neonatolgy ethics and social issues, and pharmacotherapy. A high scientific and editorial standard is maintained throughout the journal along with a regular rate of publication.
Risk of Bias Assessment in Non-Randomized Studies of Interventions for Premenstrual Syndrome: A Systematic Review
Objective: Premenstrual syndrome (PMS) is a very prevalent condition that affects premenopausal women and can result in monthly debilitating emotional and physical symptoms. The objective of this systematic review was to determine which predictive factors were associated with an increased amount of bias in non-randomized studies (NRSs) of PMS.
Materials and methods: A search of the EMBASE and Medline electronic databases was completed from January 1, 2010 to December 2021. The methodological quality of the included studies was independently evaluated and critically appraised using the Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-1) tool. Associations of different factors with the risk of bias levels were assessed using a univariate logistic regression. Odds ratio and 95% confidence interval (CI) were reported.
Results: Of the 1668 studies, 38 were determined to be eligible for inclusion. The ROBINS-1 tool identified that 12 studies were of low/moderate risk of bias (31.6%) and 26 were of serious/critical risk (68.4%). Evidence of relationships between the ROBINS-1 score and impact factor (OR=0.20; 95% CI, 0.07 to 0.57; p= 0.003) and number of authors (OR=0.65; 95% CI, 0.43 to 0.99; p= 0.046) were identified, whereas no relationships were found with the number of citations, the sample size, the funding type, or the conflict-of-interest statement.
Conclusion: The systematic review concludes that the methodological rigor of non-randomized studies of PMS can vary, with fewer authors and a lower impact factor showing evidence of association with a decreased quality of evidence.
In women’s health, clinicians are often faced with diagnosing and administering treatment to patients who present with an increased vaginal discharge without much other information to work with. It’s only once a patient’s background is reviewed and lab work is completed that two common reasons behind vaginal discharge with similar symptoms, Lactobacillosis and Cytolytic Vaginitis, can be differentiated and a proper diagnosis can be reached.
Now, we understand that Lactobacillosis and Cytolytic Vaginitis are symptomatically confused by patients as well as inexperienced clinicians. Lactobacillosis involves the presence of abnormal, extremely long Lactobacilli, a keystone species for vaginal health, while Cytolytic Vaginitis mainly involves, increased Lactobacilli, pH between 3.5 and 4.5, presence of cytolysis, and a lowered white blood cell count.
Both present with similar discharge, leading to their conflation. A microscopic examination of the discharge using a wet mount with normal saline can provide 80% diagnostic sensitivity until further testing can be completed.
Psychological Perceptions of Women With Sexual Arousal Disorder: A Qualitative Study in Iranian Culture
Objective: Psychological perceptions are concerned with how a person perceives and psychologically frames life with an illness. The current study sought to examine the psychological perceptions of women suffering from Female Sexual Interest/Arousal Disorder in the setting of Isfahan, Iran.
Materials and methods: The study was done according a qualitative design, and it was conducted in Isfahan, Iran, from July 2018 to February 2019. Twenty in-depth interviews were performed with 20 patients who were recruited on the purposeful method. The thematic analysis approach was used to analyze the data. The data were organized using MAXQDA software (version 12).
Results: The following four themes were extracted: (i) Dysfunctional cognition, which includes five
sub-themes: attention bias, belief bias, memory bias, perceptual bias, and cognitive distortion; and (ii) Relationship and partner factors, which include four sub-themes: psychological maltreatment, aggression, deception, and betrayal.; (iii) lack of life skills, which includes four sub-themes: poor problem-solving, poor sexual knowledge, poor understanding and intimate relationships, and immature defense mechanisms; and (iv) lack of motivation and genuine interest, which includes two sub-themes: forced marriage and lack of initial affection and attraction to the husband.
Conclusion: Internal and interpersonal factors were shown to have a role in the creation of sexual arousal disorder in Iranian women, according to the study. As a result, designing scenarios for cognitive bias modification and educational programs for improving interpersonal skills would be beneficial.
Attitudes and Knowledge of Infertile Iranian Couples Among Treatment With Assisted Reproductive Technologies During COVID-19 Pandemics
Objective: The coronavirus disease 2019 (COVID-19) pandemic affected the continuation of all non-emergency medical treatment and patients potentially suffer from restrictions including patients under infertility treatment. This study aimed to evaluate the knowledge and attitudes of infertile couples about continuing assisted reproductive technologies (ARTs) therapy during the COVID-19 outbreak, in Sari, Iran.
Materials and methods: We conducted a prospective longitudinal investigation on potential infertile couples for treatment with ARTs referred to our infertility clinic from March 2020 to June 2020. Ninety-two patients were studied voluntarily and anonymously in this study. A self-developed structured questionnaire was used to assess the attitude towards continuing infertility treatment. A P-value of less than 0.05 was considered statistically significant.
Results: Thirty-two patients (33.33%) had decreased motivation to continue treatment during the COVID-19 pandemic. Fear of transmission to the fetus (28.13%) had the highest frequency among the causes of decreased motivation to continue treatment (P-value = 0.011). Trust on the support of the treatment team (56.67%) was the most common reason for not reducing motivation in patients without decreased motivation (P <0.001).
Conclusion: Despite the COVID-19 pandemy, in Iran most infertile patients tended to continue ARTs. Although many patients had passable knowledge on COVID-19, the stress of infertility and the high desire of infertile couples to have children did not deter them from continuing their therapy.
The Effect of Sildenafil on Pregnancy Outcomes in Pregnant Women With Idiopathic Borderline Oligohydramnios: A Randomized Controlled Trial
Objective: Borderline oligohydramnios always produces a dilemma of management and counseling among obstetricians. This study was designed to compare the effect of sildenafil plus fluid therapy versus fluid therapy alone on pregnancy outcomes and AFI improvement in pregnant women complicated by idiopathic borderline oligohydramnios.
Materials and methods: This randomized clinical trial was conducted in Arash Women’s Hospital, Tehran, Iran from 2017 to 2020. Fifty-one pregnant women with idiopathic borderline oligohydramnios were allocated to two groups. Group 1 received fluid therapy and Group 2 received fluid therapy and Sildenafil 25 mg three times daily for six weeks. AFI was measured at the time of randomization, 24 h after treatment and then weekly for six weeks. The changes in AFI, type of delivery, gestational age at delivery, and neonatal outcomes were compared between the two groups.
Results: After the intervention, the change in AFI between two groups was not statistically significant. Maternal and fetal outcomes are compared between two groups and there was no significant difference between them. The median (Inter-quartile range) AFI after intervention, in Sildenafil group compared with hydration group, were in 24 hours (8.5 vs. 8, p=0.27), first (9.5 vs. 9.1, p=0.74), second (9 vs 10, p=0.12) third (10.4 vs. 9.4, p=0.33), fourth (10.8 vs 9.1, p=0.1) and Fifth week (10 vs 9.3, p=0.5) of follow-up respectively, but none of them were statistically significant.
Conclusion: The findings showed that sildenafil plus fluid therapy do not improve the pregnancy outcomes in women with isolated borderline oligohydramnios compared to fluid therapy alone.
Objective: Environmental stressors such as physical and chemical factors can have a destructive testicular function. The present study aimed to determine the effect of concomitant exposure to lead and noise on testicular tissue in male rats.
Materials and methods: Twenty male Wistar rats (250-300 g, 12-13wk) were divided into four groups (n=5/each): 1) Control group, 2) Lead group treated with 4 mg/kg lead acetate by gavage for 30 days,
3) Noise group exposed to 4 kHz octave band at 105 dBA for eight hrs./ day for 30 days, and 4) the exposed group to lead plus noise concurrently. The testes' weight was measured, and testes abnormalities were assessed after staining with Hematoxylin and Eosin.
Results: The results showed that the weight of testes in experimental groups was significantly decreased compared with the control group (p<0.0001). Also indicated edema, degeneration and necrotic cell debris in the lumen, congestion and atrophy of seminiferous tubule in rat testes tissue due to sub-acute exposure to lead and noise.
Conclusion: Exposure to 105 dB and lead can cause damage to the seminiferous tubules, intubation edema, and testicular weight loss compared to control. We also found that simultaneous exposure to noise and lead could have more detrimental effects on testicular histology and weight than others.
The Effect of Couple's Motivational Interviewing on Exposure to Secondhand Smoke Among Pregnant Women at Home
Objective: Secondhand smoke (SHS) during pregnancy is associated with many maternal-fetal complications. Iran has a high male smoking prevalence rate. This study aimed to determine the effect of motivational interviewing with couples on exposure to SHS at home in pregnant women referring to health centers in Urmia in 2019.
Materials and methods: A randomized control trial was performed on 112 non-smoking pregnant women with smoking husbands, randomly allocated into two groups (each with 56 members). The participants were asked to specify the daily average times and duration of exposure during the last week. Five motivational interviewing sessions were held for the members of the intervention group. Each session lasted90 minutes and two sessions were held per week. The data were collected before and four weeks after the intervention. The data were analyzed using the repeated-measures analysis of variance (ANOVA) by SPSS-20 at a significance level of 0.05.
Results: Of 112 couples who were randomized, 102 (91.07%) completed the trial. There was a significant reduction in terms of the daily frequency and duration of SHS exposure of the husband one week and one month after the intervention in the intervention group. The daily frequency and duration of SHS exposure of people other than the spouse at home did not decrease over time.
Conclusion: Following the results of the study, the couple-based motivational interviewing approach can be used to reduce SHS exposure in women at home.
Effects of Aromatherapy With Citrus Aurantium Lavender on Sexual Function of Postmenopausal Women: A Randomized Controlled Trial
Objective: The purpose of this study was to explore the effectiveness of aromatherapy with Citrus aurantium Lavender on the sexual function of postmenopausal women.
Materials and methods: A randomized controlled trial with single-blind design was conducted on eighty postmenopausal women in Ahvaz, Iran from January to December 2019. The women were randomly assigned to the Citrus aurantium group (n=40) and placebo group (n=40). The intervention group received two drops of Citrus aurantium essential oil twice a day, for four consecutive days a week, for four weeks as inhalation. Similarly, placebo was received by the control group.
Results: The results of this study revealed that in the intervention group, the FSFI total score and all of its dimensions were significantly improved compared to the control group.
Conclusion: Aromatherapy using Citrus aurantium can be used as an alternative or complementary method for improvement of sexual function in postmenopausal women. It is recommended that the postmenopausal women suffering from sexual dysfunction be informed on the aromatherapy by Citrus aurantium essential oil.
Objective: Surgical site infections (SSIs) owing to nontuberculous Mycobacteria (NTM) have emerged as an important cause of hospital-acquired SSI leading to great morbidity and mortality. Among NTM, Mycobacterium abscessus is reported in these sites. Epidemiology and transmission of M. abscessus in humans is noticing crux changes.
Case report: We hereby describe a case of SSI after lower segment cesarean section (LSCS), presenting as a skin and soft tissue infection (SSTI) owing to a NTM.
Conclusion: Clinicians should be aware of the possibility of infections caused by M. abscessus in patients who develop SSIs, particularly if they do not respond to conventional first-line antimicrobial therapy.
Letters to the Editor
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