A Review of Pharmacological Treatments for Vaginal Atrophy in Postmenopausal Women in Iran

Vaginal atrophy is one of the most common menopausal complications and is often overlooked. There are various pharmacological and non-pharmacological treatment approaches to reduce vaginal atrophy; however, no comprehensive study on a convenient, affordable, inexpensive, and noninvasive treatment with fewer complications has been conducted so far. Thus, the current study aimed to provide a systematic review of pharmacological treatment for vaginal atrophy in postmenopausal women in Iran. In this systematic review, all Iranian articles published in Persian or English during 2009 to 2019 were collected and analyzed by searching the Scopus, PubMed, Web of Science, Magiran, Iranian Registry of Clinical Trials (IRCT), and Cochrane Library databases. The inclusion criteria were clinical trials for vaginal atrophy and menopause. Based on the selection criteria, articles with a Jadad scale score of 3 and above were included in the study and qualitatively analyzed. Overall, 15 clinical trials met the inclusion criteria. In total, 12 articles examined the efficacy of pharmacological treatments (including three herbal medicines, three vitamins and dietary supplements, and two chemical drugs) in treating vaginal atrophy in postmenopausal women. Various types of medication have been used to improve vaginal atrophy, and effective treatments include licorice, chamomile, royal jelly, vitamin E, vitamin D, hyaluronic acid, and Vagifem; however, the results of studies on fennel have been inconsistent. However, considering the small number of studies reviewed, further studies with a stronger methodology are needed to confirm the efficacy of these medications.

Effects of web-based training and educational simulation on midwifery students' self-confidence in postpartum hemorrhage management

Self-confidence, as one of the key elements of clinical competence, plays an important role in one's actions and behaviours. Selection of proper instructional methods influences students' self-confidence. Therefore, this study aimed to compare the effects of web-based training and educational simulation on midwifery students' self-confidence in postpartum hemorrhage management. This experimental study was conducted on 44 midwifery students of Mashhad School of Nursing and Midwifery, Mashhad, Iran, in 2013. The subjects were selected via convenience sampling. The web-based group was trained at the clinical skill laboratory of School of Nursing and Midwifery; both groups were taught the same educational content. Data were collected using a demographic questionnaire, visual analogue scale to evaluate students' self-assessment of their ability to manage postpartum hemorrhage and C-scale to measure students' self-confidence Descriptive analysis, independent t-test, paired t-test, and two-way ANOVA were performed, using SPSS version 11.5. Both groups showed a significant increase in self-confidence in postpartum hemorrhage management one month after the training [P=0.003 and P=0.030 in web-based and simulation groups, respectively]. No significant difference was found between the two groups in terms of self-confidence in postpartum hemorrhage management. Since the two groups showed no significance difference in self-confidence, web-based education, which is a more accessible method, could be applied as an alternative to the conventional method of simulation

Metastatic choriocarcinoma in the small bowel: a case report

Choriocarcinoma is a highly malignant form of gestational trophoblastic disease. It is characterized by metastatic potential, rapid growth and deeply invasion into blood vessel and then widespread dissemination metastasis. However, the most common sites of metastatic choriocarcinoma are lung, vagina, liver, and brain. But, metastatic choriocarcinomas rarely is extended to gastrointestinal system. It is important to keep in mind that despite extensive metastasis, choriocarcinoma is very curable disease. Due to high responsibility of this disease, early diagnosis of choriocarcinoma and treatment with chemotherapy can prevent mortality and morbidity of these patients. In this case report, we present a rare case of metastatic choriocarcinoma in the small bowel after normal term pregnancy. A 34-years-old woman G4, P4, L4 presented with abnormal postpartum vaginal bleeding [45 days] and unresponsive to usual medical and surgical therapy [oxytocine, methergine, antibiotic, and double curettage]. The patient was admitted in the Ghaem Hospital, Mashhad University of Medical Sciences in April 2013. She suffered from rectal hemorrhage and severe weakness. Because of unsuitable condition and shock, laparotomy was performed and small bowel involvement was observed. Segmental resection of small bowel detected metastatic choriocarcinoma of the lesion. We couldn't rescue our patient due to unresponsive to combination chemotherapy [actino-mycine, methotrexate, cyclophosfamide, vincrystine, etoposide]. In abnormal postpartum hemorrhage, we should consider the possibility of choriocarcinoma. Although, it is important to note rare manifestations of metastatic choriocarcinoma of small bowel in massive gastrointestinal hemorrhage