existing therapeutic interventions for orgasmic disorders: recommendations for culturally competent services, narrative review

In recent years, a growing number of interventions for treatment of female orgasmic problems [FODs] have emerged. Whereas orgasm is a extra biologically and learnable experience, there is a need for practitioners that to be able to select which therapy is the most appropriate to their context. In this critical literature review, we aimed to assess areas of controversy in the existing therapeutic interventions in FOD with taking into accounted the Iranian cultural models. For the present study, we conducted an extensive search of electronic databases using a comprehensive search strategy from 1970 till 2014. This strategy was using Google Scholar search, "pearl-growing" techniques and by hand-searching key guidelines, to identify distinct interventions to women's orgasmic problem therapy. We utilized various key combinations of words such as:[orgasm] OR [orgasmic],[female orgasmic dysfunction] OR Female anorgasmia OR Female Orgasmic Disorder, orgasmic dysfunction AND treatment, [orgasm AND intervention]. Selection criteria in order to be included in this review, studies were required to: 1 employ clinical-based interventions, 2 focus on FOD. The majority of interventions [90%] related to non-pharmacological and other were about pharmacological interventions. Self-direct masturbation is suggested as the most privilege treatment in FOD. Reviewing all therapies indicates couple therapy, sexual skill training and sex therapy seem to be more appropriate to be applied in Iranian clinical settings. Since many therapeutic interventions are introduced to inform sexually-related practices, it is important to select an intervention that will be culturally appropriate and sensitive to norms and values. Professionals working in the fields of health and sexuality need to be sensitive and apply culturally appropriate therapies for Iranian population. We further suggest community well defined protocols to screen, assessment and management of women' sexual problems such as FOD in the Iranian settings

Relationship between blood transfusion and increased risk of atrial fibrillation after coronary artery bypass graft surgery

New-onset atrial fibrillation [AF] after cardiac surgery contributes to increased morbidity, hospital length of stay, and resource utilization. Although many aspects of AF after cardiac surgery have already been elucidated, the mechanism by which cardiac surgery predisposes patients to AF has hitherto remained unknown. Recent evidence supports the notion that blood transfusion enhances the inflammatory response, thereby increasing the incidence of post-operative AF. This retrospective study was conducted on 2095 patients who underwent coronary artery bypass grafting [CABG] alone or accompanied by valve surgery between January 2005 and July 2007. Variables associated with the development of new-onset AF were identified using logistic regression. Intensive care unit blood transfusion increased the risk of AF [odds ratio per unit transfused, 1.16; 95% confidence limits, 1.14, 1.24; P<0.001]. Blood transfusion was performed in 487 patients and was associated with a significant increase in new-onset of AF [45.9% vs. 37.9%; P < 0.01]. Homologous blood transfusion can increase the incidence of new-onset AF after CABG. This factor should be considered in identifying patients who might benefit from prophylaxis in order to prevent this common post-operative complication and the adverse consequences thereof

Postoperative mortality and morbidity in elderly patients undergoing coronary artery bypass graft surgery

Elderly patients [>75 years] have constituted the fastest growing portion of the coronary artery bypass grafting [CABG] patient population over the last two decades. Of the goals that surgical care for the elderly pursues, cure may be an unfeasible one; nevertheless, palliation and comfort warrant sufficient importance. The present study sought to examine the postoperative course and events in elderly patients undergoing CABG with or without other procedures and to compare the results with those in younger patients. Demographic, mortality, morbidity, and resource utilization data were collected from the records of the patients undergoing CABG between January 2005 and July 2007 in Imam Khomeini Medical Center, Tehran, Iran. The mean time to extubation was 9.3 and 6.3 hours in the elderly and non-elderly patients, respectively [p < 0.01]. Blood transfusion was required in 87.8% of the elderly compared to 58.5% of the non-elderly subjects [p < 0.01]. The mean Intensive Care Unit stay was 2.1 days for the elderly and 1.4 days for the non-elderly patients [p < 0.001]. In-hospital mortality was 9% for the elderly patients vs. 2.8% for the younger group [p < 0.001]. The elderly patients undergoing CABG had a significantly higher morbidity rate, with an increased incidence of postoperative renal failure, neurological complications, and in-hospital mortality

Personality disorders in treatment - seeking substance dependent patients

Co-morbidity of personality disorders with illicit drug abuse has a deleterious effect on the management outcome of both conditions. This study was conducted to assess the prevalence of different personality disorders among substance dependent patients in an Iranian city [Isfahan] with a view to have a better understanding of various management strategies. A total of 368 different patients with substance dependency [363 men, 5 women; mean age 29 +/- 9 years] were selected for the study. Using a Persian translation of DSM-IV, information was collected on [i] demographic data; and [ii] personality disorders criteria. A total of 299 clients [81.3%] had at least one personality disorder. Lower level of education, younger age and being married were significantly associated with a higher prevalence of personality disorders. Our findings indicate the importance of assessment of personality disorder for all patients with substance abuse/dependency in order to draw up a more effective management strategy