The aim of this narrative review is to investigate the reciprocal correlation between melatonin through the brain's central clock management on sleep-wake behavior in women with polycystic ovary syndrome (PCOS). Biological clocks are genetically programmed physiological systems that permit organisms to live in harmony with natural rhythms. The most important function of a biological clock is to regulate overt circadian biological rhythms. Circadian rhythms orchestrate the body's rhythmic physiologic functions like sleep-wake and menstruation cycle. Stress hormones, beta-endorphins, and melatonin which can easily affect the woman's reproductive system. For example, amplitude changes in the luteal phase are one of the results of menstrual-related disorders that occur through this circadian fluctuation. Many reports indicate that levels of melatonin and stress hormones are altered in women with PCOS. The melatonin metabolites are significantly raised in the level of night-time urinary in women with PCOS, which is associated with a significant reduction of sleep quality compared to normal women. The result of this narrative review showed the circadian rhythm as a normal coordinated function is a regulator of the natural structure of sleep-wake architecture. Disruption of this natural pattern can lead to phasic activation of the HPA axis, which increases the continuation of circadian activation; which there is in women with PCOS.

Objective: This study aimed to determine the prevalence of PPPD in Anuradhapura district, its association with maternal PPD, and relevant risk factors.
Materials and methods: Cross sectional study was conducted among fathers in Anuradhapura district having infants 1-5 months by giving questionnaire specifically developed for the study with Edinburgh postnatal depression scale (EPDS) and self-constructed questions. Out of 6324 fathers, 435 fathers and their partners were randomly selected and proportionately allocated to 5 Medical Officer of Health (MOH) areas. R Program and SPSS have used for the data analysis.
Results: Our results revealed that the PPPD prevalence is approximately 11% (95%CI: 8.08-14.67) based on cut off score of 7 points in the EPDS. PPPD was correlated with maternal PPD (OR 19.16, 95%CI 5.0473-85.1203), income decrement (OR 8.1571, 95%CI 2.4621-32.6289), increased time stayed at home in postpartum period (OR 3.7775, 95%CI 1.2365–13.8175).  But other parameters such as infant`s age, work time and number of children were not significantly influenced risk factors for PPPD.
Conclusion: PPPD is prevalent in the Anuradhapura district and maternal postpartum depression has positively influenced. But currently, screening programmes for PPPD is lacking in Sri Lanka. Thus, these deficiencies urgently need to be addressed and should provide information and instructions to fathers regarding this new transition. However, these results need replication in more expanded case control study. Since the prevailing covid-19 pandemic at the time of data collection may have impacted the mental health of the fathers specially in countries like Sri Lanka, where mental health support is limited.

Objective: This study aims to assess the knowledge, attitude, and practices regarding menstrual cups use and the factors associated with it among females of the reproductive age group in an urban setting of South Kerala.
Materials and methods: We conducted a cross-sectional study from December 2021 to January 2022 among females of the reproductive age group. Data was entered in MS Excel and was analyzed using Statistical Package for Social Sciences version 26.0. The significance of association was tested using the Chi-square test. Binary logistic regression was done to predict the factors associated with knowledge levels regarding menstrual cup.
Results: The mean age of study participants was 25.68(SD 6.64) years. Lack of knowledge (22.6%) and fear of insertion (56.2%) were the major reasons for not trying a menstrual cup.  Out of the 350 study participants, 258(73.7%) had good knowledge scores and 92(26.3%) had poor knowledge scores. Discomfort and leakage were the most important problems reported by participants.  A statistically significant association was found between younger age, educational status, socioeconomic, status, marital status of females in the reproductive age group, and knowledge about the menstrual cup.
Conclusion: Most of the participants (93.4%) were aware of menstrual cups. Even though two third of the participants had good knowledge regarding menstrual cups, only 15.1% have tried to use a menstrual cup. Fear of insertion was the most common concern for not trying a menstrual cup. Discomfort and leakage were the most important problems reported by participants. Younger age and higher educational qualifications were found to be independently associated with knowledge levels regarding menstrual cups.

Objective: Polycystic ovarian syndrome is the most common cause of infertility and endocrine disorder among women due to anovulation. The aim of the present study is to investigate the effect of chamomile on oligomenorrhea and hirsutism symptoms as well as hormonal parameters among patients suffering from polycystic ovarian syndrome.
Materials and methods: The present study is a randomized clinical trial performed on 70 patients with diagnosis of polycystic ovarian syndrome according to Rotterdam criteria referring to the infertility clinic of a university hospital. The patients were randomly assigned into intervention and control groups, with the former receiving two chamomile capsules 500 mg for three months, and the latter receiving two placebo capsules for 3 months. Both groups were evaluated in terms of laboratory parameters (FBS, LDL, and testosterone) on the third day of first and third cycles. The collected data were analyzed by SPSS 20.
Results: The mean age, body mass index, marital status, history of infertility, and pregnancy rate showed no significant difference between the two groups. In the chamomile group, clinical symptoms of hirsutism (p<0.001) and oligomenorrhea (p=0.048) decreased following the treatment, but significant difference was found between the two groups only in hirsutism symptoms (p=0.028). Regarding the parameters of FBS (p=0.06), HDL (p=0.224), cholesterol (p=0.99), triglyceride (p=0.106), testosterone (p=0.894), and LDL (p=0.61), no significant difference was observed between the two groups. Nevertheless, following the treatment, testosterone decreased in both placebo (p=0.005) and chamomile (p=0.001) groups.
Conclusion: overall, the chamomile therapeutic regimen has relatively been able to mitigate the clinical symptoms and testosterone levels in patients suffering from polycystic ovarian syndrome. Use of chamomile plant as a simple, inexpensive, and effective measure can be suggested for improving and treating patients with PCOS after confirmation by further studies.

Objective: Our aim was to evaluate the trend of effect of prior caesarean delivery (CD) on obstetric outcomes; and to investigate the existence of a threshold for order of CD associated with geometrical increase in complications.
Materials and methods: We performed a retrospective cohort study of 942 parturients who undergone CD between June 2012 and May 2015 in a teaching hospital in Nigeria. The participants were stratified by the order of caesarean deliveries. We used linear-to-linear association to assess presence of a trend between the order of CD and categorical variables while Jonckheere-Terpstra was used to investigate whether a trend exist between order of CD and continuous variables. We also used multivariate logistic regression to evaluate the relative risk ratio of the outcome variables for each order of CD.
Results: Composite adverse maternal outcome depicted a significant increasing trend from 1^st CD (5.2%) to the 5^thCD (50%). The relative risk ratio for composite adverse maternal outcome increased arithmetically from 1^st CD to 3^rd CD: RRR2.21, 95%CI 1.2-3.98 for 2^ndCD; RRR3.39, 95%CI 1.60-9.27 for 3^rdCD; followed by a geometric increase between 3^rdCD and 4^thCD (RRR11.64, 95%CI 3.20-18.86). In contrast, composite adverse fetal outcome did not depict a significant trend. However, perinatal death increased significantly from primary CD (4.6%) to 5^thCD (33.3%).
Conclusion: Maternal and fetal complications of repeat CD increase with increasing order of CD; and this trend became astronomical after the third CD. Couples should be counselled that both maternal and fetal complications increase with each additional CD and advised strongly to forgo future pregnancies after the 3^rd CD.

Objective: Studies on the sexual consequences of female genital mutilation is mostly related to sexual function, while sexual quality of life is a more objective criterion for studying the effects of genital mutilation on the women's sexual life. The purpose of this study was to compare the sexual quality of life and marital relationship in the mutilated women with other women living in the Kurd region of Mahabad (Iran).
Materials and methods: In a case-control study, 600 married women (300 mutilated and 300
non- mutilated women) who referred to the health centers completed the sexual quality of life questionnaire (SQOL-F) as well as demographic questionnaires. Data analyzed using chi-square, independent t-test, and linear regression model with stepwise method at 95% confidence level.
Results: The mean total score of sexual quality of life in the mutilated group (40.28±16.76) was significantly lower than the control group (45.29±19.16). The chance of having a higher score of sexual quality of life in the mutilated group was 0.13 times lower than the control group. This value was
0.16 times for self-worthlessness area, 0.10 for sexual repression, 0.12 for psycho-sexual feeling, and 0.32 for sexual and marital satisfaction areas (p <0.05). In the mutilated group, the total score of sexual quality of life was significantly correlated with age, income, spouse's violence, spouse's infidelity, intercourse frequency, and residence status (P <0.05).
Conclusion: Female genital mutilation can decrease the sexual quality of life and increase the chance of negative consequences such as spouse violence, infidelity, and intercourse reduction.

Objective: This study aimed to investigate and identify the psychosocial factors that are associated with paternal postpartum depression.
Materials and methods: A longitudinal correlation study with 150 fathers was performed with three time frames (late pregnancy, postpartum, and four weeks postpartum). The Edinburgh Postnatal Depression Scale assessed those with depression (38.7%; n=58) and those without depressive symptoms (61.3%; n=92). Psychological variables related to paternal depression were also assessed through questionnaires.
Results: Psychological variables such as marital adjustment and stress had a significant relationship with paternal depression. In addition, depressed fathers experienced less marital compatibility and more tension than non-depressed fathers.
Conclusion: These findings emphasize the importance of considering the psychosocial variables that affect paternal psychological health. Mental health professionals may be able to reduce mental disorders, stress, psychological distress, and marital maladjustment in fathers with appropriate psychological interventions.

Objective: Breaking bad news to the patient is challenging, especially for the physicians and the residents, due to the lack of structured and practical training. This study aimed to design and evaluate a novel virtual instructional design for improving obstetrics and gynecology (Ob/Gyn) residents breaking bad news skills.
Materials and methods: Virtual instructional design was performed based on the ADDIE model (Analysis, Design, Development, Implementation and Evaluation) from September 2020 to July 2021 at the Department of Ob/Gyn, a referral hospital affiliated with Tehran University of Medical Sciences, Tehran. Iran. The five steps of ADDIE virtual instructional design were applied sequentially.
Results: Totally 33 of the Ob/Gyn residents included in the study that 77% needed specific training. The awareness of the performance of the residents in seven areas including interview context, strategy, planning, professionalism, empathy, knowledge, and receiving information needed to be trained for breaking bad news. The content of the virtual training package was designed based on the prior assessment needs in four multimedia lectures of professors, one short educational video, a 65-page file that combines text and images in 4 parts. The pre-test and post-test mean scores (SD) were 9.45 (2.0) and 10.67 (1.7), respectively (p-value≤0.001) in the cognitive and attitudinal domain. In the final step, the final corrections were made in the virtual training package. Interestingly, the satisfaction of residents' attitudes was 96.5%.
Conclusion: Most Ob/Gyn residents do not have the necessary perception and skills to deliver bad news to the patients. Designing an appropriate virtual training package for improving communication skills is associated with satisfaction. Thus, the efficacy of the training program should be implemented for all Ob/Gyn residents.

Objective: This descriptive-analytic cross-sectional study aimed to figure out whether maternal serum vitamin D concentration correlates with cervical length measurement in mid-gestation or not.
Materials and methods: During Jun-Jan 2021, 213 pregnant women at 18-22 weeks of gestation were investigated. First, demographic features were obtained then, maternal serum vitamin D concentration was measured by enzyme-linked immunoassay and cervical length was measured via transvaginal sonography according to fetal maternal foundation guideline and appropriate statistical test was used to analyze the correlation between maternal vitamin D level and cervical length in mid-pregnancy.
Results: It was shown that 29.6% and 25.4% of participants had vitamin D deficiency and insufficiency, respectively. Spearman’s test found no significant correlation between maternal vitamin D level and cervical length in mid-pregnancy. Moreover, cervical length and maternal vitamin D level had no association with maternal BMI.
Conclusion: Although maternal vitamin D level and its sufficiency status was not associated with cervical length in mid- pregnancy, as a trend toward decreased maternal serum vitamin D level by advancing gestational age was observed. It may be concluded that it is prolonged vitamin D deficiency during gestation that may lead to cervical length shortening and subsequent preterm delivery later in gestation.

Objective: During the COVID-19 pandemic, burnout of healthcare workers, including anesthetists, has become a critical issue. This study aimed to provide a practical framework for decreasing and preventing burnout among anesthesiology residents through preserving their good mental health.
Materials and methods: Since the onset of the COVID-19 outbreak, anesthesiology residents have been members of medical teams with the attending staff, senior residents, and partner residents. Besides, the following measures were taken to reduce burnout: providing financial support for the attending staff to procure personal protective equipment (PPE), rearrangement of work schedules to reduce the workload, holding training sessions in virtual meetings, and improving the social network system for reducing burnout.
Results: The interventional program could help anesthesiology residents to adapt to or cope with the healthcare system status and also prevent burnout. Moreover, development of empathy, integrity, and cohesion in the healthcare system motivated the staff to comply with the principles of medical professionalism.
Conclusion: During the current health crisis due to COVID-19, it is essential to implement specific interventional and training programs for decreasing or preventing burnout among healthcare workers.