Milad Hospital Research Articles

Implementation of Intrahospital Transfer Strategy During COVID-19 and Identify Success Factors Based on DEMATEL Technique.

The COVID-19 pandemic caused a significant strain on world health care systems. The lack of trained and experienced staff was a complicated issue during the pandemic. To overcome insufficient staffing problems, the intrahospital transfer (IHT) strategy was implemented at Milad Hospital in Tehran during COVID-19. We evaluated the effectiveness of the IHT strategy in order to determine whether the strategy should be continued post-COVID. Six supervisors with experience in COVID-19 wards and the IHT strategy were consulted to identify the advantages of continuing the IHT strategy and to evaluate the success and continuation of IHT factors. Then, the decision-making trial and evaluation laboratory (DEMATEL) method was used to establish a network of influence relationships among IHT strategy factors' success. The result showed that all criteria except increasing patient satisfaction (C1) and reducing waste of time (C8) are cause-and-effect criteria that affected other criteria. The research findings have implications for improving the day-to-day experience of staff navigating transfers of patients between wards and paraclinic units. This study also highlights the theoretical value of the cross-disciplinary integration of medical decision issues and multiple-attribute decision-making methodologies.

Live Birth after Cleavage-Stage versus Blastocyst-Stage Embryo Transfer in Assisted Reproductive Technology: A Randomised Controlled Study.

Blastocyst stage transfer appears to improve pregnancy outcomes. The aim of this study is to evaluate the pregnancy results between fresh cycle blastocyst stage embryo transfer and cleavage stage embryo transfer in patients who undergo intracytoplasmic sperm injection (ICSI). This randomised clinical trial study was conducted at the Infertility Research Centre of Milad Hospital in Mashhad, Iran from 2018 to 2020 on 240 infertile women who presented for their first ICSI procedure. These patients were assigned to receive either cleavage embryo transfer (n=112) or blastocyst stage transfer (n=107). Pregnancy outcomes were measured in both groups. There were no differences regarding age, body mass index (BMI), serum follicle-stimulating hormone (FSH), duration of infertility, and aetiology of infertility between the groups (P>0.05). There were more follicles, total oocytes, and metaphase II (M2) oocytes in the blastocyst stage group. Considerably more cleavage stage embryos were transferred compared to the number of transferred blastocysts (P=0.001). The blastocyst group had more vitrified embryos than the cleavage group (P=0.000). The rates of implantation (P=0.332), chemical pregnancy (P=0.165), clinical pregnancy (P=0.694), and live births (P=0.727) were higher in the blastocyst group, but they were not significantly different. The rate of abortion was also not significantly higher in the blastocyst group (P=0.296). Blastocysts transferred in the fresh cycle of an ICSI procedure may be more advantageous compared to cleavage stage embryo transfer (registration number: IRCT20181030041503N1).

Molecular characterization and epidemiological investigation of colistin resistance in carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Tehran, Iran

BackgroundCarbapenemase-producing Klebsiella pneumoniae (CRKP) presents a significant challenge to antimicrobial therapy, especially when compounded by resistance to colistin. The objective of this study was to explore molecular epidemiological insights into strains of clinical K. pneumoniae that produce carbapenemases and exhibit resistance to colistin. Eighty clinical isolates of CRKP were obtained from Milad Hospital in Tehran, Iran. Antimicrobial susceptibility and colistin broth disk elution were determined. PCR assays were conducted to examine the prevalence of resistance-associated genes, including blaKPC, blaIMP, blaVIM, blaOXA−48, blaNDM and mcr-1 to -10. Molecular typing (PFGE) was used to assess their spread.ResultsColistin resistance was observed in 27 isolates (33.7%) using the Broth Disk Elution method. Among positive isolates for carbapenemase genes, the most frequent gene was blaOXA−48, identified in 36 strains (45%). The mcr-1 gene was detected in 3.7% of the obtained isolates, with none of the other of the other mcr genes detected in the studied isolates.ConclusionTo stop the spread of resistant K. pneumoniae and prevent the evolution of mcr genes, it is imperative to enhance surveillance, adhere rigorously to infection prevention protocols, and implement antibiotic stewardship practices.

Phenotypic and Genotypic Antibiotic Resistance Patterns of Clinical Shigella Isolates from Tehran, Iran

Background: The emergence of multidrug-resistant (MDR) Shigella is a health concern in both developed and developing countries. The indiscriminate use of antibiotics without considering resistance patterns has led to the emergence of resistant strains. Objectives: This study aimed to investigate the phenotypic and genotypic patterns of antibiotic resistance and virulence gene distribution in Shigella isolates from patients in Tehran, Iran. Methods: In this cross-sectional study, 60 Shigella isolates were collected from patients referred to Milad Hospital and Pasargad Laboratory in Tehran. The isolates were gathered over four months, from February 2023 to June 2023. After biochemical and genetic confirmation of the isolates, the disk diffusion method was employed to determine antibiotic resistance patterns. The distribution of beta-lactamase genes (blaCTX-M1, blaCTX-M2, blaCTX-M8, blaSHV, blaTEM, and blaOXA) and virulence genes (ial, virF, invE, sigA, and pic) was investigated in Shigella isolates using the multiplex PCR method. SPSS statistical software version 22 was used for data analysis. Results: Thirty-six percent of isolates were found to be MDR. The highest rate of resistance was against tetracycline (90%) and ampicillin (80%). The lowest resistance rate was against azithromycin (1.9%) and amikacin (7.1%). The blaCTX-M1 and blaCTX-M8 genes were more prevalent, detected in 38.3% and 50% of the isolates, respectively. However, the blaSHV and blaCTX-M2 genes were not detected in any of the isolates. Additionally, 32% of the MDR isolates harbored both the blaCTX-M1 and blaCTX-M8 genes simultaneously. The distribution of virulence genes ial, virF, invE, sigA, and pic in the studied isolates was 28.3%, 85%, 68.3%, 81.7%, and 15%, respectively. Conclusions: The present study emphasizes the increasing trend of MDR Shigella isolates. Therefore, serious measures are needed to prevent the spread of resistant genes. Furthermore, the detection of virulence factors could help in controlling shigellosis, which is a significant global health issue.

The effects of ANRIL polymorphisms on colorectal cancer, tumor stage, and tumor grade among Iranian population.

Colorectal cancer (CRC) is a type of neoplasm, developing in the colon or rectum. The exact etiology of CRC is not well known, but the role of genetic, epigenetic, and environmental factors are established in its pathogenesis. Therefore, the aim of this research was to explore the effects of ANRIL polymorphisms on the CRC and its clinical findings. The peripheral blood specimens were collected from 142 CRC patients and 225 controls referred to Milad Hospital, Tehran, Iran. PCR- RFLP method was used to analyze ANRIL rs1333040, rs10757274 rs4977574, and rs1333048 polymorphisms. The ANRIL rs1333040 polymorphism was related to a higher risk of CRC in the co-dominant, dominant, and log-additive models. ANRIL rs10757274, rs4977574, and rs1333048 polymorphisms showed no effect on CRC susceptibility. The CGAA and TGGA haplotypes of ANRIL rs1333040/ rs10757274/ rs4977574/rs1333048 polymorphisms were associated with the higher and the lower risk of CRC respectively. The rs1333040 polymorphism was associated with higher TNM stages (III and IV). The frequency of ANRIL rs10757274 polymorphism was lower in CRC patients over 50 years of age only in the dominant model. In addition, the rs10757274 was associated with well differentiation in CRC patients. The ANRIL rs1333040 polymorphism was associated with a higher risk of CRC and higher TNM stages. ANRIL rs10757274 polymorphism was associated with the well-differentiated tumor in CRC.

The elderly wayfinding performance in an informative healthcare design indoors

This study examines the influence of architectural design elements and age on the wayfinding performance (WP) of older adults in healthcare circulation patterns. The study was conducted at Milad Hospital in Tehran, Iran, and included the Emergency, Outpatient, Clinics, and Inpatient wards. The study used a quantitative research method to investigate and virtual reality (VR) to simulate. Wayfinders were shown the circulation patterns of five types of healthcare circulations in virtual reality (VR) using two design approaches: high indicative features (the most guiding design aids) and a neutral environment (the fewest design aids). The study revealed that architectural design elements and age influence users' WP. Initially, it is worth noting that the mental-perceptual conditions of users in both groups were almost indistinguishable. However, the records of the elderly group (from 66 to 82 years) indicated a lower frequency of environmental design aid scenes (base design), which enabled them to more effectively identify and focus on locating the destination points. Nevertheless, the control group, consisting of younger individuals (from 18 to 39 years), exhibited superior and more efficient performance than their senior counterparts. When the users of both groups perceived the route to be challenging to traverse, their performance dropped, and they felt disoriented and anxious. Also, the Corridor circulation pattern exhibited a relatively low level of navigational complexity. Overall, the results suggest that architects should prioritize the design of circulation routes that are easily recognizable and highlight prominent features while considering the cognitive and perceptual needs of the elderly population.

Association of Food Insecurity With Malnutrition and Cognitive Status in Elderly Referred to Outpatient Clinics of Milad Hospital in Tehran

Food insecurity can cause adverse effects on the physical and mental health of the elderly. This study aimed to investigate the association among food insecurity, malnutrition, and cognitive impairment in elderly. To assess malnutrition, cognitive status, and food insecurity, the questionnaires Mini Nutritional Assessment, Mini-Mental State Examination, and the Household Food Insecurity Access Scale were used. There was a significant association between food insecurity and malnutrition (odds ratio [OR] = 5.36; 95% confidence interval [CI], 2.18-13.17; P < .001). The odds of cognitive impairment in the elderly with food insecurity were also more than 4 times higher than those with food security (OR = 4.35; CI, 1.78-10.59; P = .01). Because of the association between food insecurity, malnutrition, and cognitive impairment, food security in the elderly should be considered.

Investigation effectiveness of the integrated educational approach on obsessive-compulsive disorder

Obsessive-Compulsive Disorder (OCD) is one of the most common and debilitating psychological disorders. This quasi-experimental study aimed to investigate the effect of three psychological interventions, including cognitive-behavioral therapy (CBT), existential therapy (ET), and transactional analysis (TA), which have been performed simultaneously on Obsessive-Compulsive Disorder (OCD) patients in Milad Hospital. In this study, 60 patients were randomly assigned to experimental and control groups. The measures used included the Yale-Brown Obsessive-Compulsive Scale. The intervention program of cognitive-behavioral therapy, existentialism, and interaction behavior analysis consisted of eight 60-minute sessions performed only on the experimental group. The results of covariance analysis showed that the combined program of CBT, ET, and TA is effective in the obsessive-compulsive beliefs of patients with OCD (P <0.01). According to the results of the present study on the effectiveness of the intervention program, training can be combined with CBT, ET, and TA as suitable option in designing psychological treatment plans for patients with OCD.

Comparison of Psychometric Properties of the Original and Brief Version of the Tampa Scale for Kinesiophobia

Introduction: Some accurate tools exist to assess fear-avoidance behavior, such as the Tampa scale for kinesiophobia (TSK) in individuals with musculoskeletal problems. The current research aims to compare the psychometric characteristics of the original Persian 17-items TSK questionnaire and its 11-item brief version in chronic non-specific low-back pain (CNSLBP).
 Materials and Methods: In this test development study, 295 patients with CNSLBP referred to the physiotherapy clinic of Milad Hospital in Tehran city, Iran were evaluated. Confirmatory factor analysis (CFA) and α Cronbach was conducted to assess the validity and reliability of the original and brief Persian version of the TSK, respectively. For goodness-of-fit, the Χ2/df, root mean square error of approximation (RMSEA), goodness-of-fit index (GFI), and comparative fit index (CFI) indices were used.
 Results: Internal consistency specified by Cronbach’s α was 0.949 for the original version of the questionnaire and 0.927 for the brief one. Based on the CFA findings, the goodness-of-fit indices for the brief version were GFI=0.921, RMSEA=0.078 (90% confidence interval (CI), 0.062%-0.094%), comparative fit index (CFI)=0.981, and Χ2/df=2.791. These indices for the original one were 0.882, 0.066 (90% CI, 0.055%-0.076%), 0.983, and 2.270, respectively. A significant correlation was found between these two versions (P<0.001). These findings confirm the adequacy of the brief version of the TSK.
 Conclusion: The brief Persian version of TSK can be considered a reliable and valid tool to evaluate somatic focus and activity avoidance in patients with CNSLBP.

Relationship Between Coping Strategies and Outcome of Bariatric Surgery in Patients With Morbid Obesity

Background and Objective Bariatric surgery is one of methods for treatment of morbid obesity. Psychological factors can affect its outcome. This study aims to investigate the relationship between coping strategies and the outcome of bariatric surgery in patients with morbid obesity. Materials & Methods This prospective observational study was conducted on 85 patients who underwent bariatric surgery in the obesity clinic of Hazrat-e Rasul Akram and Milad Hospitals in Tehran, Iran. Subjects were evaluated before and two years after surgery using Folkman & Lazarus’ ways of coping questionnaire and the Bariatric Analysis and Reporting Outcome System (BAROS). Results During the follow-up, 9 patients left the study. The mean age of participants was 38.11±11.5 years (ranged 17-65 years). Problem-focused coping strategies and their components had a significant positive relationship with the surgery outcome (P<0.05), but emotion-focused coping strategies had no significant relationship with the surgery outcome (P>0.05). Conclusion Problem-focused coping strategies can predict the outcome of bariatric surgery.

Effectiveness of Virtual and In-person Methods of Education on Pregnant Women’s Satisfaction With Childbirth Preparation Classes: A Pilot Study

Background: Childbirth preparation classes are among the most important components of pregnancy education. This pilot study was conducted to compare the level of satisfaction of pregnant women from holding childbirth preparation classes using two methods of virtual and in-person training. Methods: This is a quasi-experimental post-test pilot study that was performed on 30 nulliparous women in Milad Hospital affiliated with Iran’s Social Security Organization, Tehran, Iran from September 2019 to June 2020. The subjects were recruited by convenience sampling and then were assigned voluntarily to two groups of virtual (n=15) and in-person (n=15) training. Both groups received the same educational content on childbirth preparation at 20 to 37 weeks of pregnancy. The virtual educational content was designed based on Mayer’s multimedia principles and shared through the Telegram application. The courses were held in eight 2-hour sessions. The satisfaction questionnaire was completed by the participants at 36-38 weeks of pregnancy. The significance level was set at P≤0.05. Results: There was a significant difference between the total score of satisfaction with childbirth preparation courses between the virtual group compared to the in-person training group (P=0.028). Also, the results showed that the virtual group was able to significantly attract the spouse’s participation in accepting the role of parent compared to the in-person group (P=0.05). Also, 100% and 46.7% of the virtual and in-person groups, respectively, were completely satisfied with the way the educational content was presented (P<0.01). Conclusion: Considering the greater satisfaction of pregnant women with virtual training compared to in-person training and its important role in attracting the participation of the spouse and considering that in-person classes are held as a national routine, virtual classes are recommended to be held alongside in-person classes. It is also recommended to use a larger sample size and random allocation in future studies.

Prevalence of Plasmid-Mediated Quinolone Resistance Genes and Molecular Typing of Klebsiella pneumoniae Isolates from Blood Cultures in Milad Hospital, Tehran, Iran, Within 2018 - 2019

Background: Plasmid-mediated quinolone resistance (PMQR) determinants are commonly characterized in Klebsiella pneumoniae isolates worldwide and complicate the treatment of infections caused by this bacterium. Objectives: This study aimed to investigate the prevalence of PMQR determinants and molecular typing of blood isolates of K. pneumoniae in Milad hospital in Tehran, Iran, within 2018 - 2019. Methods: A total of 100 K. pneumoniae isolates were tested for susceptibility to quinolones using the disk diffusion method. The minimum inhibitory concentrations (MICs) of ciprofloxacin (CIP) and levofloxacin (LEV) were determined using the microdilution broth method. The PMQR determinants were detected by polymerase chain reaction (PCR) assay, and the genetic relationship between the isolates was assessed using enterobacterial repetitive intergenic consensus (ERIC)-PCR. Results: The resistance rates of the isolates to LEV, CIP, nalidixic acid, and norfloxacin were determined to be 62, 46, 29, and 23%, respectively. Eighty-one isolates were resistant to at least one tested quinolone. A high-level CIP and LEV resistance (MIC > 32 mg/L) was observed in 15 (18.51%) and 36 (44.44%) isolates, respectively. The PMQR genes were detected in 71 (87.65%) isolates. The oqxAB, qnrS, qnrD, qnrB, aac(6')-Ib-cr, qnrA, qepA, and qnrC genes were detected in 71 (87.65%), 30 (37%), 25 (30.8%), 24 (29.6%), 18 (22.2%), 17 (21%), 17 (21%), and 8 (9.9%) isolates, respectively. The ERIC-PCR revealed 64 genotypes among quinolone-resistant isolates. Conclusions: The high prevalence of PMQR genes observed in this study is a significant concern for public health since they can contribute to the spread of fluoroquinolone resistance among clinical isolates. The ERIC-PCR revealed high heterogeneity among the studied isolates, indicating that they emerged from different sources.

Investigation of OXA-23, OXA-24, OXA-40, OXA-51, and OXA-58 Genes in Carbapenem-Resistant Escherichia coli and Klebsiella pneumoniae Isolates from Patients with Urinary Tract Infections

Background: Escherichia coli and Klebsiella pneumoniae are frequently responsible for urinary tract infections (UTIs). The high rate of carbapenem resistance in Enterobacteriaceae has become a global therapeutic concern. Objectives: The study investigated OXA-23, OXA-24, OXA-40, OXA-51, and OXA-58 genes in uropathogenic E. coli and K. pneumoniae isolates. Methods: We isolated 500 uropathogenic isolates of E. coli and K. pneumoniae from patients at Milad Hospital, Tehran, Iran. Antibiotic susceptibility testing was performed using a strip-test method, and the carbapenem-nonsusceptoble isolates were confirmed with an automated antibiotic sensitivity testing system. The OXA genes were determined by multiplex PCR. Molecular typing was performed by multilocus variable-number tandem repeat (VNTR) analysis (MLVA). Results: Out of 500 isolates, 40 (8%) were detected as carbapenem-resistant, including 13 E. coli and 27 K. pneumoniae. All carbapenem-resistant isolates were ESBL-producing and resistant to ceftriaxone, ciprofloxacin, meropenem, ceftazidime, and amoxicillin-clavulanate. Moreover, 46.1% and 26% of carbapenem-insensitive E. coli and K. pneumoniae isolates carried a beta-lactamase-producing gene associated with the OXA-23-like group. Finally, E. coli and K. pneumoniae isolates were divided into two and three MLVA patterns, respectively. Conclusions: This is the first report of OXA-51, 58, and 24 carbapenemases in clinical isolates of E. coli and K. pneumoniae from UTI patients in Iran. Significant differences were seen in OXA-51, 58, and 24 genes between carbapenem-insensitive and carbapenem-sensitive E. coli and K. pneumoniae isolates. Molecular typing suggested the vertical transmission of resistance genes.

Evaluation of Service-Oriented Nursing Supervisor Strategy Based on Data Envelopment Analysis (DEA)

Background: This study introduced a service-oriented nursing supervisor strategy to increase the performance efficiency of different hospital wards. The efficiency of this strategy in 12 wards under the supervision of 12 supervisors was evaluated using Data Envelopment Analysis (DEA). Materials and Methods: The efficiency of the service-oriented nursing supervisor strategy was evaluated using DEA. This study aims to evaluate the relative efficiency of hospital wards before and after implementing the service-oriented nursing supervisor strategy at Milad hospital. Data were evaluated using two basic models of data envelopment analysis technique, i.e., CCR and BCC output-oriented methods. Then, the relative performance efficiencies of 12 wards in 2 periods, including the first half of 2020 (before service-oriented nursing supervisor strategy) and the second half of 2020 (after service-oriented nursing supervisor strategy) were analyzed. Finally, efficient wards were ranked using the Anderson-Peterson method based on the results. Results: According to the CCR output-oriented method, after implementing service-oriented nursing supervisor strategy, Urology, Gastroenterology, and Neurosurgery wards, as well as ENT, had the highest and lowest efficiency rates, respectively. Based on the BCC output-oriented method, Urology, Renal Transplant, Neurosurgery, and Gynecology wards had the highest efficiency in performance, while ENT had the lowest efficiency. Conclusion: In conclusion, the findings of this study offer a service-oriented nursing supervisor strategy that improves the efficiency of different wards of the hospital.

Expression of LasR and LasI genes in quorum sensing system under the influence of iron oxide nanoparticles modified with silver surface structure in the clinical strain of Pseudomonas aeruginosa

This study was an attempt to examine expression of LasR and LasI genes in quorum sensing system under the influence of iron oxide nanoparticles modified with silver surface structure in the clinical strain of Pseudomonas aeruginosa. The participants of this study 51 samples of Pseudomonas aeruginosa bacteria (samples from different sources) such as Wounds, blood, urine and sputum (from Milad Hospital) in January 2019 to May 2020. The steady development of antibiotic resistance in various bacteria poses a high-risk threat to the health of the global community. Activation of quorum sensing signaling and biofilm formation leads to antimicrobial resistance of pathogens, thus increasing the difficulty in treating bacterial diseases. In this study, 50 clinical samples of patients were prepared in Milad Hospital, Tehran. By confirmatory and differential tests, these samples were confirmed as strains of Pseudomonas aeruginosa. After obtaining the MIC of iron oxide nanoparticles, this concentration (MIC = 0.512) of the nanoparticles was applied to the bacteria. The effect of iron-oxide surface nanoparticles on bacterial pathogens and genes affecting it (LasI and LasR) was investigated. Therefore, in this study, the expression of LasR and LasI genes in quorum sensing system under the influence of iron oxide nanoparticles modified surface structure with silver was investigated in the clinical strain of Pseudomonas aeruginosa.The analysis of data revealed that In microbiological (phenotypic) studies, the effect of iron oxide nanoparticles on surface structure modified with silver led to the lack of growth of Pseudomonas aeruginosa. The expression of LasR and LasI genes was significantly reduced under the influence of iron oxide nanoparticles modified surface structure with silver.In this study, the fidings that iron oxide nanoparticles modified by surface structure can be effective on preventing pathogens by Pseudomonas aeruginosa. Also, surface iron oxide modified silver nanoparticles have antimicrobial properties in inhibiting bacterial growth there are various that are applied through different mechanisms. Decreased expression of LasR and LasI genes causes our nanoparticles to inhibit the quorum sensing system. Therefore, this study proposes to investigate the synergistic effect of iron oxide nanoparticles with antibiotics and other genes from the quorum sensing system.

A Structural Model of Depression Based on Early Maladaptive Schemas, Resilience and Perceived Social Support with the Mediating Role of Self-Compassion and Hope in men and women with cancer

Aim: The aim of the present study was to investigate the depression prediction model based on early maladaptive schemas, resilience and perceived social support by considering the mediating role of self-compassion and hope in men and women with cancer. Methods: The research method was descriptive correlation. The statistical population in this study included all cancer patients referred to Imam Khomeini and Milad hospitals in Tehran. The sample size was 300 patients were selected based on inclusion and exclusion criteria. Research instruments included the Nef Self-Sufficiency Questionnaire (2003), Young's Early maladaptive Schemas Questionnaire (1998), Connor-Davidson Resilience Questionnaire (2005), Zimet et al.'s Perceived Social Support Questionnaire (1988), Beck depression Scale (1961) And Snyder (1991) Hope Questionnaire. The collected data were analyzed by structural equation modeling. Results: The finding of data analysis showed that the depression prediction model based on initial maladaptive schemas, resilience and perceived social support, considering the mediating role of self-compassion and hope based on experimental data, has a good fit. Also, the direct and indirect effects of early maladaptive schemas, perceived resilience and social support were considered (p <0.05) regarding the mediating role of self-care and hope on the depression of cancer patients. Self-compassion directly affects the depression of cancer patients (p <0.05). Hope also directly affects the depression in cancer patients (p <0.05). Conclusion: According to the research results, in order for cancer patients to function properly, on the one hand, it is necessary to have modified maladaptive schemas, on the other hand, their treatment t should be based on improving resilience and perceived social support.

Comparison of tamoxifen and hormone replacement cycle (HRT) in frozen embryo transfer. A randomized controlled trial.

The use of frozen embryos in the treatment of infertility with assisted reproductive techniques has been increased. Different methods are used to prepare the endometrium for frozen embryo transfer (FET). The aim of this study was to compare pregnancy outcomes after treatment with tamoxifen and hormonal replacement therapy (HRT) in FET. This randomized clinical trial was carried out with 214 infertile women in the infertility research center of Milad Hospital in Mashhad during 2018-2020. We had 84 patients receiving tamoxifen and 92 took HRT. Endometrial thickness (ET) and pregnancy outcome were measured in both groups. Mean infertility duration (p=0.328), number of embryos (p=0.649), FSH (p=0.390), LH (p=0.051) and LH/FSH ratio (p=0.287) as well as type of infertility (primary or secondary) (p=0.295), causes of infertility (p=0.750) and pattern of menstruation (p=0.676) were not significantly different in the two groups. Mean ET in the TMX and HRT groups were 8.72±1.45mm and 9.00±1.69mm, respectively (p=0.423). There was no statistically significant difference between chemical pregnancy (p=0.663), clinical pregnancy (p=0.994) and ongoing pregnancy (p≥0.999) in the TMX and HRT groups. Treatment with tamoxifen can be as effective as GnRH agonist for endometrial preparation in FET.

The effect of phytoestrogens (Cimicifuga racemosa) in combination with clomiphene in ovulation induction in women with polycystic ovarian syndrome: A clinical trial study.

Objective:Phytoestrogens can be used as an alternative to clomiphene for ovulation induction in patients with polycystic ovarian (PCO). In this study, we evaluated the impact of phytoestrogens (Cimicifuga racimosa) in combination with clomiphene on the endometrium thickness and follicle number in women with PCO.Materials and Methods:This study was a prospective clinical trial conducted in the infertility research center of Milad Hospital in Mashhad, Iran, during 2016 and 2017 on 100 women with PCO syndrome. The patients were randomly divided into two equal groups. The patients in both groups were treated by clomiphene citrate 50 mg, twice a day for 5 days, from the second day of the menstrual cycle and for three consecutive cycle periods. The intervention group received Cimicifuga racemosa tablets 10 mg twice a day for 10 days from the second day of the menstrual cycle, in addition to the mentioned standard treatment. The two groups were compared in terms of the number and size of follicles and endometrial thickness on the ultrasound.Results:There was no significant differences between the number of medium (p=0.288), large (p=0.086), and total (p=0.288) follicles between the two groups. Also, no significant difference was observed in endometrial thickness between the two groups (p=0.227).Conclusion:As a result, adding Cimicifuga racemosa to clomiphene could not increase the endometrial thickness and the number of follicles in PCO patients.

Comparing the effect of in-person and virtual childbirth preparation trainings on the fear of childbirth (FOC) and pregnancy experience of pregnant women: protocol for a quasi-experimental feasibility study

BackgroundChildbirth preparation trainings are an important component of prenatal education, and pregnant women are increasingly interested in seeking information from online sources. The aim of this study is to compare the feasibility and the effects of in-person and virtual childbirth preparation training courses on the pregnancy experience, fear of childbirth (FOC), birth preference, and type of delivery among pregnant women.MethodsIn total, 165 primiparous women referring to a prenatal clinic at Milad Hospital in Tehran, will be included in this study. The subjects will be selected using the convenience sampling method and will be divided into three groups of study A, study B, and control. The study groups A and B will receive virtual and in-person childbirth training with similar content, respectively. The control group will receive only routine prenatal care. In the 18th and 20th weeks of pregnancy, the demographic information, pregnancy experience scale (PES), and version A of the Wijma delivery expectancy/experience questionnaire (WDEQ-A) will be completed, and in the 36th and 38th weeks of pregnancy, the PES and WDEQ-A questionnaires, as well as birth preference form will be completed. The type of delivery will be recorded in the first few days of postpartum.ConclusionThis quasi-experimental clinical trial will investigate the effect of virtual childbirth preparation training on primiparous women. The expected outcomes will include the difference in pregnancy experience measured by the brief version of PES, the difference in FOC measured by WDEQ-A, the birth preference, and the type of delivery.Trial registrationIRCT.ir: IRCT20180427039436N2;

Comparison of the Effectiveness of Emotion-Focused Therapy and Cognitive Behavioral Therapy on Sexual Self-Efficacy in Women with Breast Cancer

Background: Breast cancer is a disease that women with it are at risk of experiencing disease-related turmoil and pressures.Objective: This study aimed to compare the effectiveness of emotion-focused therapy and cognitive behavioral therapy on sexual self-efficacy in women with breast cancer. Methods: The present study was semi-experimental with pre-test, post-test, and follow-up with a control group. The statistical population of this study was all married women with breast cancer referred to Milad hospital in 2020. Forty-five patients who met the criteria for entering the study were selected as the final sample size by sampling method in non-random and available sampling and were placed in two experimental groups of one control group (each group 15 people). At this stage, all three groups responded to the sexual self-efficacy questionnaire as a pre-test, then the two experimental groups received cognitive-behavioral and emotion-focused therapy sessions and the control group waited. After completing the course, all three groups responded to the questionnaire listed as a post-test. After 4 months, the follow-up test was performed again. Data were analyzed by covariance analysis test and paired comparison of measurement stages by SPSS.22.Results: The results showed that both emotion-focused therapy and cognitive behavioral therapy were effective on sexual self-efficacy (p <0.001), but there was no difference between the two treatments on sexual self-efficacy. Conclusion: The results of this study showed the effect of emotion-focused approach therapy and cognitive behavioral therapy as supportive methods in increasing sexual self-efficacy in women with breast cancer.