Teaching reproductive endocrinology in Iran: Pilot assessment of hospital-based clinical modules for medical students at Tehran University of Medical Sciences

This pilot study evaluated effectiveness and acceptance of a new hospital-based reproductive endocrinology curriculum among Iranian medical students. A voluntary, anonymous questionnaire was used to compare two teaching methods as applied to junior medical students at Tehran University of Medical Sciences. Students were randomly assigned to one of two clinical teaching settings;no student experienced both modules. Coursework for the pilot (experimental) group (n = 19) utilized a teaching approach comprising lectures, genetics laboratory, pelvic ultrasound, small group sessions, and opportunities to observe advanced reproductive technologies such as in vitro fertilization, ICSI, and embryo transfer. A control group (n = 34) received reproductive endocrinology instruction by the ‘traditional curriculum’, consisting mainly of lectures. Students were sampled at baseline and again atthe conclusion of their reproductive endocrinology session. Pre- and post-test data were analyzed for both groups;post-test differences between groups were also compared. No significant differences in mean age or gender mix were identified between the two study groups. Overall, the ques- tionnaire did not identify any significant intergroup differences for any parameter investigated. Although student acceptance rate appeared similar for both educational modules, the ratio of students having a “favorable regard” for reproductive medicine declined only among students randomized to the control group (41.2% vs. 32.3%). This report offers the first data on teaching reproductive endocrinology to medical students in Iran. Both traditional and innovative approaches to teaching reproductive endocrinology were well-accepted by students, although negative post-test responses were more common among students in the control group. While periodic quality assessments for existing clinical teaching methods are necessary, introduction of alternative teaching approaches is also important. Additional studies are planned to evaluate the impact this initiative may have on results on standardized tests measuring reproductive endocrinology knowledge, as well as election of further specialization in training.

Non-medical factors on choice of delivery (CS/NVD) in hospitals of Tehran University of Medical Sciences

Background: Kind of delivery affect many aspects of individuals, families and health systems situations. The aim of this study was to identify the Role of non-medical factors on choice of delivery (CS/NVD) in hospitals affiliated to Tehran University of Medical Sciences. Materials and Method: This cross-sectional study was performed to identify the factors involved in the choice of delivery (CS/NVD) among women attending hospitals affiliated to Tehran University of Medical Sciences. Data was derived from the medical records of women who gave birth in the hospitals. Results: A significant statistical relationship was found between factors such as age of mother, level of education, occupational status, type of previous delivery, person supervising the pregnancy and dissatisfaction about delivery were more frequent in women who underwent CS than those who gave birth by NVD. Conclusion: The highly increasing rise in the rate of unnecessary CS during throughout the world, and its adverse effect on maternal and child health, the financial burden imposed on families and health systems, has highlighted the importance of studies to identify the non-medical factors that affect decision-making concerning type of delivery as well as to determine the appropriate medical indications of CS.

维生素C和E对早产胎膜早破孕妇潜伏期的影响

Objective: To determine whether supplementation with vitamins C and E after preterm premature rupture of membranes (PPROM) is associated with an increased latency period. Methods: In this double-blind, randomized, controlled trial, 60 women with singleton pregnancies of 26 to 34 weeks’ duration and PPROM were randomly assigned to vitamin C (500 mg/day) and vitamin E (400 IU/day) or placebo until delivery. All women received 2 doses of betamethasone in the first 24 h after admission as well as broad-spectrum antibiotic prophylaxis. Results: Important demographic, as well as clinical characteristics such as number of cases of chorioamnionitis, early neonatal sepsis, and respiratory distress syndrome, were similar in the 2 groups. A statically significant difference in the mean ± S.D. number of days of latency was found between the groups (10.5 ± .5.2 days vs. 3.5 ± .4.0 days (P = 0.03). Conclusion: Vitamins C and E supplementation of after PPROM is associated with a longer latency before delivery.

不育夫妇中男方性欲和性满足的改变

Objective: To clarify the state of sexual desire and satisfaction, with relevant parameters in men, of couples with infertility. Design: Cross-sectional study. Setting: University outpatient clinic. Patient(s): Two hundred infertile couples referred to a reproductive health research clinic. Intervention(s): Patients were investigated by a self-administered structured questionnaire about demographic data, infertility history, and several relevant psychological variables. In addition, clinical and andrological examinations were completed to find predictors for sexual state. Main Outcome Measurement(s): Sexual desire and satisfaction status were scaled, and the relative factors were analyzed statistically. Result(s): Subjects reported a reduction in sexual desire in 41.5%of cases and reduction of satisfaction in 52.5%compared with recalled sexual satisfaction before diagnosis of infertility. No relationship was found between andrological findings and the present status of sexual desire (P > .05). Education level, mutual understanding between couples, and recalled state of sexual satisfaction had a direct influence, but the duration of infertility and duration of desire for a child showed a significant inverse impact on sexual satisfaction (P < .05). Conclusion(s): Less than 50.0%of patients mentioned a reduction in sexual desire and satisfaction after infertility diagnosis, and the frequency of coitus could be regarded as an acceptable indicator of sexual satisfaction in male partners of infertile couples.

甲氨蝶呤在治疗异位妊娠中单剂量与多剂量给药成功率的比较:一项前瞻性随机临床试验

Objective: To assess whether success rate differs in single-dose versus multiple-dose administration of methotrexate(MTX)-in medical management of unruptured ectopic pregnancies. Design: Prospective randomized clinical trial. Setting: Tertiary university hospital. Patient(s): The study population included 108 patients presenting with unruptured ectopic pregnancies who fulfilled the criteria for medical management. Intervention(s): A single dose(study group) or multiple doses(control group) of MTX were administered IM. Main Outcome Measure(s): Success rate of medical management in each group. Result(s): Of the 54 patients on the single-dose protocol, treatment was considered successful in 48 patients(88.9%). Of the 54 patients on the multiple-dose protocol, 50 participants responded to the treatment(92.6%). The diffe- rence between success rates in the two groups was not statistically significant(P=.7; odds ratio 0.64; 95%confidence interval 0.17-2.4). In the single-dose and multiple-dose groups, 15(27.8%) and 20(37%) patients, respectively, had complications(P=.3). Conclusion(s): The results of our study showed that single-dose treatment with MTX could be as successful as multiple doses. The incidence of complications did not differ between the two groups. It appears that single-dose treatment could be the first line of treatment in selected patients.