nasim shokouhi

 Coronavirus disease 2019 (COVID-19) manifestations are highly diverse, potentially affecting nearly all organ systems during or after infection. Given the importance of a thorough assessment of COVID-19.

 Our study aimed to investigate any new onset or worsening lower urinary tract symptoms (LUTS) in patients infected with COVID-19.

 In this cross-sectional study, 88 COVID-19 patients completed the International Consultation on Incontinence Questionnaire-Overactive Bladder and the Overactive Bladder Symptom Score Questionnaires (OABSS). The patients assessed stress urinary incontinence (SUI) and difficulty voiding.

 Our study revealed that urinary symptoms were the only initial symptom for 28 (31.8%) of the patients or part of the initial symptoms. Furthermore, new onset of OAB symptoms was noted in 35 (39.8%) patients; worsening of pre-diagnosed OAB symptoms was noted in 4 (4.5%) patients; new onset SUI was reported in 17 (32.7%) women, and voiding dysfunction was reported in one woman and two men. There was no significant difference in demographic characteristics, laboratory tests, and lung involvement between patients with and without LUTS (P > 0.05). However, new onset or worsening LUTS significantly (P < 0.001) affected the quality of life.

 This study demonstrated that LUTS could be the only symptom or one of the initial symptoms of COVID-19. Therefore, physicians should consider COVID-19 as a differential diagnosis in patients presenting with these symptoms.

The use of transcutaneous electrical nerve stimulation (TENS) to relieve labor pain remains controversial and existing evidence is neither strong nor consistent. This research was designed to compare TENS' effect with the injection of pethidine and promethazine in labor pain reduction.

In this trial, for 45 pregnant women in the active phase of labor, TENS electrodes were placed (two on both arms, and two over the participants’ low back) continuously for 120 minutes; and for another group 45 pregnant women, 100 milligrams of pethidine and 250 micrograms of promethazine were injected intramuscularly which could be repeated once at least one hour later. Labor pain and duration, need for labor induction/augmentation/other pain control methods/ instrumental delivery, delivery type, and maternal and newborn complications were measured in both groups.

The baseline mean visual analog scale (VAS) score, in the TENS group was 8.51±0.62 and in the pethidine and promethazine groups was 8.37±0.61 (P=0.31). While in a 120min post-intervention, it was 6.29±1.50 and 5.73±1.46 in the TENS group and the pethidine and promethazine group, respectively with no statistically significant difference (P=0.07). The labor duration in the TENS group was 6.61±1.71 hours and in the pethidine and promethazine group was 6.17±2.07 hours, with no statistically significant difference (P=0.33). In addition, no complication was recorded neither in the mothers nor newborns.

This study showed that applying TENS in the active labor phase can reduce at least two scores in patient labor pain with no significant complications.

Cervical elongation (CE) can occur in company with pelvic organ prolapse (POP). Preoperative cervical length assessment is imperative before decision-making for pelvic organ prolapse surgical repair. POP-Q is not effective at recognizing supra-vaginal elongation. In this case study, we are reporting a 70-year-old woman, a case of recurrent POP after sacrospinous hysteropexy, that POP-Q failed in diagnosing supra-vaginal elongation preoperatively. POP-Q is not effective at recognizing supra-vaginal elongation.

 Cervical insufficiency occurs in the second trimester. Herein, we report a successful term pregnancy in a woman with glucose intolerance and a history of cervical insufficiency after two consecutive preterm deliveries in the second trimester.

 We present a 35-year-old woman, G3P2L0, with a history of two preterm deliveries in the second trimester. In the second pregnancy, vaginal cerclage at the 18th gestational week did not prevent premature delivery. Following two pregnancies with borderline fasting blood sugar (FBS) results, we decided to further evaluate the gestational diabetes mellitus (GDM) state with a two-hour postprandial (2 hpp) glucose test and glucose tolerance test (GTT). By impaired 2 hpp and GTT results, an insulin regimen was started with subsequent vaginal cerclage in the third pregnancy. She delivered a healthy 2,750-g girl at 38 weeks of gestation by tight blood sugar control.

 More attention should be paid to evaluating glucose intolerance in pregnancy, especially in patients with cervical insufficiency. Blood glucose control in these patients can probably improve pregnancy outcomes.

This study aimed to evaluate the ABO blood group characteristics in women with Gestational Diabetes Mellitus (GDM).

This cross-sectional research was conducted on pregnant women with GDM in Yas Hospital, Tehran, Iran, from April 2018 to March 2019. 

Totally, 449 pregnant women enrolled in the study. The average age of the participants was 32.26±5.08 years with a range between 18 and 45 years. 46% of the participants were treated with insulin. In this study, 35% were typed as group O, 34.3% as group A, 24.3% as group B, and 6.5% as group AB. The Rh+ blood antigen was present in 92% of the pregnant women. Blood group A (35.7%) was the highest in pregnant women with insulin therapy and the frequency of blood group O was the highest in pregnant women with diet (39.5%) and metformin therapy (35.7%). 

In pregnant women with insulin therapy, the most prevalent blood group was A. This was different from those that are frequent in the Iranian normal population and pregnant women with GDM who underwent diet therapy. It seems that blood group A, as a probable associated factor for GDM, can be beneficial in high-risk pregnancy detection for GDM in the Iranian population.

Background and Aims :

Urinary incontinence (UI) has been known as one of the clinical manifestations of pelvic floor muscle (PFM) instability; however, limited research has been published on PFM function in patients with different types of UI. This study aimed to compare the PFM function of the continent women and women with Stress urinary incontinence (SUI) and overactive bladder (OAB).

Methods :

This cross-sectional comparative study was performed on 30 women, 10 continents, 10 SUI, and 10 OAB, with a mean age of 42.67±4.77 years. PFM function was assessed using manual muscle testing, a perimeter, and surface electromyography. Data analysis was performed using SPSS software and the level of significance was considered as P≥0. 05.

Results :

There was no significant difference in the PFM function, strength, and electromyographic activity between SUI and OAB patients.  However, it decreased in both groups compared to the healthy group (P=0.001). Also, a strong correlation was found between clinical examination, a perimeter, and electromyography (r=0.82, P=0.0001).

Conclusion:

 This study revealed that the PFM function was impaired in both groups of women with SUI and OAB. Also, both manual examination and the perimeter can be used as clinical methods in evaluating PFM function.

Since the COVID-19 pandemic initiation, more than 28 million elective surgeries were postponed with a cancellation rate of 72.3%. However, studies suggested that the patient treatment should be conducted within 12 weeks of diagnosis because delay in treatment might have had adverse impacts on patients' health status, prognosis, and pathologic stage. Hence, the current study aimed to assess the importance of a pre-operative COVID-19 screening test for the patients were candidates for elective surgery.

This cross-sectional study was conducted on 141 patients who were candidates for any type of elective surgeries or cesarean section at a tertiary university-based hospital, between June 2020, and September 2020.

The mean age of participants was 41.38 ± 11.66 years. Of them, 91.5% were women and 8.5% were men. The COVID-19 polymerase chain reaction (PCR) screening tests were positive in 12 (8.5%) patients. From whose PCR tests were positive, only five people (less than half) had symptoms of COVID-19 such as fever (three patients), a distinctive smell (two patients), and cough (one patient). Suspected exposure to COVID-19 was reported in four of them.

In this study, we found that more than half of PCR positive COVID-19 patients were asymptomatic. Therefore, to have a safe hospital environment, and improve patient health outcomes, the COVID-19 screening test should be applied before any interventions.

There is a growing need for information regarding the recent coronavirus disease of 2019 (COVID‑19). We present a comprehensive report of COVID‑19 patients in Iran.

One hundred hospitalized patients with COVID‑19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and postdischarge follow‑up were analyzed.

The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C‑reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), and lymphocytopenia (74.2%) on admission. Lower lobes of the lung were most commonly involved, and ground‑glass opacity (81.8%) was the most frequent finding in computed tomography scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom aggravation, 8.6% were readmitted to the hospital, and three patients (4.3%) died.

This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with COVID19. The most common presenting symptoms are nonspecific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom aggravation.

Overactive bladder (OAB) syndrome, a condition with urgency, is often characterized by increased daytime frequency and nocturia. Overactive bladder is a highly prevalent condition that drastically impacts the quality of patients’ life.

This study was conducted to investigate sleep disturbance and fatigue in women with OAB by reliance on two validated questionnaires.

This case-control study was performed among 70 patients recognized with OAB and 70 women in a control group. We employed validated questionnaires, namely PSQI and FSS, to comparatively assess sleep disturbance and fatigue symptoms, respectively.

The participants’ mean age was 44.50±12.64 years old. The mean PSQI score was 13.24±3.67 (range: 6 to 22), and the mean FSS score was 39.05 ± 15.12 (range: 9 to 63). Furthermore, the mean scores of PSQI (P < 0.001) and FSS (P < 0.001) were significantly higher in OAB women compared to the control group. In women with OAB, there was a significant positive correlation (P = 0.007) between PSQI and FSS scores. Furthermore, this correlation was observed between urgency urinary incontinence at night and PSQI (P = 0.047) and sleep disturbance (P = 0.023) and between nocturia and sleep efficiency (P = 0.012), sleep disturbance (P = 0.001), sleep latency (P = 0.007), and FSS score (P = 0.032). In addition, a significant direct correlation (P = 0.022) was found between urgency urinary incontinence during the day and daytime dysfunction.

The study shows that sleep disorder is common in patients with OAB, and it seems that urinary problem assessment is a prerequisite for any sleep medication prescription.

Primary carcinoma of the fallopian tube is a rare, but fatal gynecologic cancer. The preoperative diagnosis of this carcinoma is challenging due to the absence of specific symptoms and signs, and in most patients, it is an intraoperative finding. A 55-year-old patient (G3Ab1P2) was referred to the urogynecology clinic of our hospital with the chief complaints of heavy, prolonged menstrual bleeding and a persistently abnormal yellow discharge, which could not be distinguished by the patient from urinary leaks. After a complete diagnostic work-up, the patient was identified as a candidate for hysterectomy due to abnormal vaginal bleeding resistant to megestrol acetate, family history of malignancy, and abnormal vaginal discharge. Laparotomy revealed unusual left fallopian tube features (large, bulky, and vegetative), suggesting malignancy. The intraoperative frozen-section analysis of the left fallopian tube and the ovarian specimens indicated the mass as a high-grade serous carcinoma of the fallopian tube. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy were performed for the patient. The definitive histopathological diagnosis was high-grade serous carcinoma of the left fallopian tube (stage 2b) with omental involvement, without any evidence of lymphovascular invasion. High-grade serous carcinoma of the fallopian tube is likely to have non-specific symptoms, causing a significant delay in diagnosis and treatment, which negatively affects the prognosis and survival of these patients.

Pelvic Organ Prolapse (POP) is one of the dysfunctions of the Pelvic Floor Muscles (PFM), with descending of pelvic viscera, vaginal wall, uterus, bladder and rectum. Regarding the role of PFM as part of the core muscles in body balance, it has been suggested that women with PFM dysfunctions may have a lower level of balance. Therefore, this study was performed with aim to compare the level of dynamic balance in non-postmenopausal women with and without POP in two positions of full and empty bladder.

This cross-sectional comparative study was performed in 2018 on 30 non-pregnant married women in the Rehabilitation School of Shahid Beheshti University of Medical Sciences. The subjects were divided in to three groups (n=10 in each group): with symptomatic POP, asymptomatic POP and without POP. After collecting demographic information, the pelvic inclination angle, and the dynamic balance in Antero-Posterior, Medio-Lateral planes as well as total balance index were assessed. Data were analyzed using SPSS statistical software (version 22) and Kolmogorov-Smirnov, one-way ANCOVA and Fisher's exact test. P<0.05 was considered statistically significant.

No significant differences were not found among three groups in terms of dynamic balance index with both full and empty bladder (p<0.05). Moreover, there were no significant differences among three groups regarding the pelvic inclination angle (p<0.05).

The association of POP as one of the dysfunctions of pelvic floor muscle is not confirmed by postural stability. Further studies using the motion analysis system and simultaneous recording of electrical muscle activity are recommended.

Uterine prolapse and cervical elongation are rare conditions that can complicate pregnancy, labor, and its management. To minimize complications, proper management of this condition is necessary. A 26-year-old woman referred to our outpatient clinic with a lump protruding from her vagina. She was 16 weeks pregnant. Physical examination revealed uterine prolapse and cervical elongation, so to prevent the complications of the protruded cervix, a pessary was inserted. She had the pessary during the first stage of labor until the rupture of membranes (at 6 cm cervical dilatation). After removal of the pessary, although the cervix was out of introitus, the active phase of labor initiated and a normal vaginal delivery was done. New- onset prolapse during pregnancy with more probability is due to cervical elongation. During labor and delivery, this condition could be managed with conservative methods, including pessary placement. and this condition could be managed with conservative methods including pessary placement during pregnancy and labor.

  Pregnancy is a known risk factor for urinary incontinence (UI) due to physiological and anatomical changes, especially in the third trimester of pregnancy. This study aimed to determine the prevalence of UI in the third trimester of pregnancy and its related factors in pregnant women.

  This cross-sectional study was conducted on 330 pregnant women in the third trimester of pregnancy, referred to the perinatal care clinic of Yas Hospital in 2016-2017. The sampling method was convenience sampling. Then, the prevalence of UI and its related factors were investigated in these participants.

  The mean age of the subjects was 30±5 years old. Totally, 98 pregnant women (29.7%) had UI. The rate of urine leakage was mild at 26.4% and moderate or severe at 3.3%. The time of urine leakage in 6.4% of women with UI was before reaching the toilet, 1.2% was permanent, 19.4% was related to cough and sneezing, and 2.7% of women did not indicate a specific time. In evaluating the relationship between each of the variables and UI, three factors were identified to be completely related to UI, i.e., morbid obesity (P=0.038), gestational age between 32 to 37 weeks (P=0.012), and age ≥ 35 years old (P=0.009).

  It seems that one-third of pregnant women in the third trimester of pregnancy have UI, which is a multifactorial issue and therefore requires multidisciplinary programs to prevent it.

Pelvic floor disorders are a common disease which, with varying degrees of severity, disrupts daily life and also decreases the quality of life of the individual. This disease can be cured by lifestyle modifications and self-care education; on the other hand, smartphones have become a good platform for health services and therapeutic interventions. The aim of this study was to identify information and educational components for the self-care application of women with pelvic floor disorders.

This descriptive study was performed in Yas Hospital affiliated to Tehran University of Medical Sciences. According to Morgan table, 30 gynecologists who were randomly selected were included in the study. The data gathering tool was a researcher-made questionnaire which its validity and reliability were confirmed (α=0.85) and its content was provided by reviewing the scientific sources.

The results of the analyzes showed that from the experts’ point of view the interventional section including reminders, daily activities diaries and targeting with an average score of 4.14 has been of great importance. Since then, the applied and self-care section with an average score of 4.364is ranked second in priority.

According to a survey by experts who play a major role in the management of the disease. The essential components of this application were identified in three main sections consist of: electronic records, the interventional section and the practical and self-care and their subsections.