Fatemeh Davari Tanha, M.D.
The Journal of Family and Reproductive Health (JFRH) is the quarterly official journal of Reproductive Health Research Center, Tehran University pf Medical Sciences. This journal features fulllength, peer reviewed 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, related 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.
Objective: The incidence and prevalence of postpartum depression is increasing due to multiple factors. Aromatherapy is a widely used complementary and alternative (CAM) therapy in the management of depression. This systematic review and meta-analysis was done to find the effect of aromatherapy on postpartum depression.
Materials and methods: Electronic databases like PubMed, Scopus, Cochrane Library and Science Direct since inception till February 2021 were searched using related keywords to obtain eligible studies. Randomised controlled trial studies (RCTs) reporting the effects of aromatherapy therapy in women with postpartum depression were included. Aromatherapy studies conducted on population other than postpartum women were excluded. The primary outcome was depression scores obtained by using valid depression scales. Meta-analysis was performed using the random-effects model of Der Simonian and Laird to produce summary treatment effects in terms of Hedges' g effect sizes with 95% confidence interval (CI).
Results: A total of 4 RCTs (n=303) were included. The results indicate that aromatherapy (Hedges'
g =-0.94, 95 CI= -2.55, 0.61, I2=88%, p<0.01) reduces depression levels among postpartum women without statistical significance.
Conclusion: The available evidences suggest aromatherapy may be effective in reducing post-partum depression. The number of scientific evidences currently available are very limited and more studies with robust study designs are required to strongly recommend aromatherapy in the management of post-partum depressions. However, being a safer intervention with no adverse effects being reported in previous studies, aromatherapy could definitely be added as an effective complementary therapy in the management of post-partum depression along with conventional medicine.
Objective: A common genito-urinary infection known as Balanoposthitis presents with mild symptoms like itching or severe complications such as phimosis, ulceration of glans, and foreskin. It can result in four types of sexual dysfunction including Disorder of sexual desire, Disorder of erectile dysfunction, Disorder of satisfaction/premature ejaculation, and Disorder of orgasm.
Materials and methods: An observational clinic study including 50 patients diagnosed with Candidal Balanoposthitis based on KOH and clinical findings were recruited and evaluated for sexual function using a standardised questionnaire.
Results: The results demonstrated that sexual dysfunction in patients with Candidal Balanoposthitis is a common entity encountered in STI clinics and should be addressed properly as any deficiency in any aspect of sexual health of a patient can lead to emotional and psychological disability impacting the overall quality of the life. The factors like advanced age, Diabetes Mellitus, and poor hygiene measures of genitalia can increase the incidence of candidal Balanoposthitis as well as sexual dysfunction.
Conclusion: Candidal Balanoposthitis, a common cause of sexual dysfunction in elderly population takes a toll on emotional and psychological health and certain modifiable factors like diabetic control and hygiene can prevent recurrent fungal infections.
Objective: Advances in technology and treatments have improved the survival rate of small for gestational age (SGA) infants that need more concern for their neurodevelopmental outcomes. In the present study, we hypothesized that a history of SGA may affect verbal and non-verbal intelligence indices among pre-school children.
Materials and methods: A case-control study was conducted at the Tehran University of Medical Sciences (Tehran-Iran, 2020). Totally 232 children entered the study. An expert pediatrician examined all included subjects. Based on birth weight (extracted from medical records), participants were divided into the case (born SGA) and control (born Appropriate for gestational age (AGA)) groups. Wechsler Intelligence Scale (WISC) and Conners tests were implemented to assess intelligence quotient (IQ), verbal, attention, development, and executive functions. Finally, total scores were compared between groups.
Results: Totally, 232 preschool children were included in the study. Of all, 114 (49.1%) and 118 (50.9%) subjects had the history of born SGA and AGA, respectively. The results related to WISC scores showed that the mean WISC-verbal score among children born SGA was significantly higher than children born AGA; (114.288±18.130 vs. 108.898±20.145; P=0.024). This significant difference was associated with Vocabulary (13.531±2.843 vs. 12.745±3.242; p=0.046) and Similarities (14.054±3.630 vs. 13.279±4.898; p=0.048) domains between the groups. The results related to different domains of the Conners test also showed that the mean scores of Inattention (B) and attention deficit hyperactive disorder score (D) in the case group were higher than these scores in the control group; however, these differences were not significant (4.929±3.511 vs. 4.906±4.300; p=0.495 &10.371±5.867 vs. 10.093±7.588; p=0.211).
Conclusion: Our results indicated that the development of non-verbal intelligence in children born with SGA had been delayed. This finding shows that these children may need more consideration during the preschool period and after that.
Objective: This study aimed to compare the effects of clomiphene citrate (CC) combined with metformin or placebo on infertile patients with poly cystic ovary syndrome (PCOS) and insulin resistance (IR).
Materials and methods: We included 151 infertile women with PCOS and IR in a university hospital from November 2015 to April 2022 in this prospective, double-blind, randomized, placebo-controlled trial. Patients were randomized into two groups; group A: received CC plus metformin (n = 76) and group
B: received CC plus placebo (n = 75). The ovulation rate was the main outcome measure. Clinical pregnancy, ongoing pregnancy, live birth and abortion rates were secondary outcome measures.
Results: There was no remarkable difference in ovulation rate in two groups. Moreover, no significant changes were observed in clinical pregnancy, ongoing pregnancy, live birth and abortion rates between two groups. A larger proportion of women in group A suffered from side effects of metformin
(9.3% versus 1.4%; p=0.064), although this was not significant.
Conclusion: In IR infertile women with PCOS, metformin pre-treatment did not increase the ovulation, clinical pregnancy and live birth rates in patients on clomiphene citrate.
Objective: Women's quality of life is essential both for women’s and their family’s health. The aim of this study was to examine the quality of life status and interaction of subjective socioeconomic status and violence, on quality of life of married women in west of Iran.
Materials and methods: This was a cross-sectional study that recruited 1533 married women using multi-stages sampling method. Multiple linear regression was employed for estimating adjusted association and 95% confidence intervals.
Results: The mean (SD) age of the participants was 33.67(11). The majority of participants (92%) experienced some degree of domestic violence. Less than half of women (46.70%) perceived medium socioeconomic status. Mean (SD) score of quality of life was 3.57 (0.94). There was a significant statistical interaction between socioeconomic status and domestic violence on quality of life.
Conclusion: These findings suggest that considering the interaction of subjective socioeconomic status with domestic violence in prevention program, especially in poor categories of family, appears to be one of the important ways in improving married-females’ quality of life.
Objective: Genital warts are a highly contagious sexually transmitted disease. It is caused by the human papillomavirus (HPV), which is transmitted through sexual contact. HPV is the most important cause of cervical cancer. This study aimed to evaluate the health belief model (HBM) constructs in adopting HPV preventive behavior in women referred to comprehensive health centers in Southwestern Iran.
Materials and methods: This descriptive-analytical study was performed on 1000 women referring to health centers in Ahvaz during 2019-2020 who were selected via a two-stage stratified random sampling technique. Data were collected using a valid and reliable researcher-made questionnaire based on the HBM. The data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficient, and regression analysis in SPSS v.18, at a significance level lower than 0.05.
Results: Total scale reliability of the tool was very good (α=0.828), as the Intra-cluster correlation coefficient (ICC) was to be 0.86. The mean of preventive behavior using an ANOVA test was significantly different at different levels of education (P <0.05). The mean and standard deviation of knowledge about HPV and preventive behavior was moderate (11.45±3.4). Pearson correlation coefficient showed a significant direct relationship between preventive behavior with awareness, perceived sensitivity, and self-efficacy and inversely related to perceived barriers. Perceived sensitivity (0.01) and self-efficacy (<0.001) were identified as the final predictors of behavior in regression analysis.
Conclusion: As the results showed, designing programs to prevent HPV, considering the perceived role of perceived sensitivity and self-efficacy, increases the likelihood of effective interventions.
Objective: Achieving pregnancy in poor ovarian response patients is a challenge. Failed fertilization after ICSI, despite normal semen parameters is due to defects in oocyte activation. In-vitro activation of oocytes using Ca+2 agents can be useful in increasing the fertilization rates in these patients. This study aimed to evaluate the efficacy of artificial oocyte activation by calcium ionophores in poor responders in improving fertilization, cleavage, implantation and clinical pregnancy rates.
Materials and methods: This is a prospective, cohort study conducted on 120 patients having poor ovarian response, (POSEIDON criteria) undergoing in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment at Southend Fertility and IVF, New Delhi from 1st August 2019 to 31st March 2020. Exclusion criterion was patients with partners with abnormal semen parameters. After OPU patients were randomized into two groups, study group (n=50) underwent ICSI-AOA (ICSI followed by artificial oocyte activation) using calcium ionophore- GM508 Cult-Active Solution) while the controls (n=57) were subjected to ICSI only.
Results: Comparison of ICSI-AOA and ICSI groups showed: (i) number of fertilized oocytes - 2.42 vs. 2.16, p = 0.049 (ii) No. of cleavage stage embryos 2.32 vs. 1.96, p = 0.008 (iii) No. of grade A embryos 1.52 vs. 1.04, p = 0.009 (iv) fertilization rate - 89.00% vs. 83.04%, p = 0.093 (v) cleavage rate - 96.33% vs. 92.55%, p = 0.165 (vi) implantation rate - 27.14% vs. 11.74%, p = 0.098 (vii) clinical pregnancy rate - 34.3% vs. 20.5%, p = 0.167.
Conclusion: The number of fertilized oocytes, grade A embryos and cleavage stage embryos formed after ICSI-AOA were statistically significantly more than ICSI. ICSI-AOA has not shown improvement in fertilization, cleavage, implantation and clinical pregnancy rate. From the present study the conclusive evidence cannot be drawn due to small sample size hence further studies are needed on a larger population.
Objective: Vaginal agenesis or atresia in females suffering from MRKH syndrome is more common and management involves both surgical and non-surgical approaches. Use of prefabricated stents to maintain the patency of the canal may not fit appropriately during the initial surgical phase and are not economical. This case report discusses a series of modifications in a custom-made vaginal dilator to improve the retention for expansion after surgical management of MRKH syndrome.
Case report: A 28-year-old female diagnosed with MRKH syndrome with characteristic Mullerian agenesis was referred for customised vaginal stent. Customised surgical stent was fabricated with loops for orientation and retention, which was later modified into interim expansion and passive stent.
Conclusion: The customisation of the vaginal stent, provision of a retentive loop that positioned the stent in the proper orientation, and gradual increase in the size of the stent, ensured dilatation in a patient with vaginal agenesis.
Objective: In fertile women, hysterocele is a rare condition. Genital prolapse can be treated conservatively with laparoscopic hysterosacropexy. It is objected to present a successful case series of laparoscopic hysteropexy for patients with hysterocele after vaginal delivery.
Case report: We presented a successful case series of three patients with III or IV degrees of hysterocele who were treated conservatively with an uncomplicated laparoscopic hysteropexy within a year of delivery. Given our patients' young ages and the fact that they all have infant children at home, we chose a conservative surgery performed laparoscopically due to the lower surgical impact and quicker return to normal life. All surgical procedures were successfully performed, without complications, with a prompt recovery of all women and with a regular subsequent follow-up, without recurrence nowadays.
Conclusion: For young women who have not terminated their desire to bear children, laparoscopic hysterepexy may be a safe and effective surgical option.
Objective: Folliculitis is a skin infection and inflammation that develops in the hair follicles. While most cases of folliculitis are caused by bacterial infections, here is a case of folliculitis caused by the Candida fungi in an immunocompetent host.
Case report: A 23-year-old non-diabetic immunocompetent female with recurrent vaginal candidiasis developed clusters of erythematous, pruritic papules in the pubic area. Upon evaluation, the clusters were determined to be folliculitis. Risk factors for folliculitis included shaving of the pubic area, hot tub use, and wearing of tight, restrictive clothing. Cultures and skin samples of the folliculitis demonstrated Candida albicans. The patient was subsequently and successfully treated with clotrimazole solution and cream. There was no recurrence of the folliculitis upon her 3-month follow-up appointment.
Conclusion: Candida folliculitis is a rare condition in non-diabetic patients. The patient’s history, risk factors and immune status assessment, and physical examination with proper diagnostic testing, are crucial steps in attaining the correct diagnosis.
Fatemeh Davari Tanha, M.D.
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