Knowledge, Attitude, and Practice (KAP) Status toward Clinical Reasoning and Evidence-Based Medicine among the Medical Interns and Gynecology Residents of Iran University of Medical Sciences.

Background: Clinical reasoning and evidence-based medicine (EBM) are important concepts in modern medicine. Objective: We performed this study to investigate the knowledge, attitude, and practice (KAP) status toward clinical reasoning and EBM among the medical interns and gynecology resident physicians of Iran University of Medical Sciences and related factors. Methods: A cross-sectional study (Tehran, Iran, first half of 2022) was conducted based on two researcher-made questionnaires consisting of three components for each including clinical reasoning attitude (CR-A), clinical reasoning knowledge (CR-K), clinical reasoning practice (CR-P), EBM attitude (EBM-A), EBM knowledge (EBM-K), and EBM practice (EBM-P). The related factors were age, gender, educational level, score of general practice education, having research experience, and general practice experience. Results: A total of 60 individuals participated. The mean score was good for CR-A, moderate for CR-K, moderate for CR-P, good for EBM-A, moderate for EBM-K, and moderate for EBM-P. The total score was moderate in both clinical reasoning and EBM. Among the related factors, CR-P was associated with higher educational levels and having experience in general practice (P < 0.05). Research experience was associated with better CR-K and all KAP components for EBM (P < 0.05). Conclusion: The total score and many of the KAP components had moderate status for clinical reasoning and EBM. Planning on the associated factors should be regarded in the future. Such questionnaires are suggested to be validated for use in quasi-experimental studies.

Effectiveness of a mixed lifestyle program in couples undergoing assisted reproductive technology: a study protocol.

BACKGROUND: The desire for fertility is the manifestation of yearning for immortality. Infertility and assisted reproductive technology (ART) expose couples to great affective, anxiety, stress, and financial burden. Increasing evidence emphasize the impact of lifestyle on infertility. One of the most crucial factors affecting the fertility process is the nutrition patterns, the amount and quality of physical activities, emotional problems management; modulate stressors, relief from anxiety, and the living conditions of couples. Most ART treatment interventions in Iran are not integrated into lifestyle programs. Therefore, this research will investigate the impact of mixed fertility health-promoting programs in couples who use ARTs. METHODOLOGY/DESIGN: This study entails three steps. The first step includes the systematic review of literature on a health-promoting lifestyle in infertile couples undergoing ARTs, a systematic review of observational studies and interventions in couple's lifestyle, then, a systematic review of qualitative studies on infertility in couples and their lifestyle, and in the final step couple's life style literature systematically will evaluate in Iran. In case of failure to obtain the required results from systematic reviews, cross-sectional studies will be carried out to determine the lifestyle of infertile couples receiving ARTs. In the second stage, by holding a panel of experts, an intervention is planned based on the results of the previous stages in order to improve the lifestyle of couples. In the final step, the designed intervention will be administered as a random clinical trial-on ART candidates, in intervention or control groups in one of Iran University of Medical Sciences hospitals. Afterward, the data's will be evaluated by using standard questionnaires, that include health-promoting lifestyle questionnaire (HPLII), Beck's depression inventory (BDI), international physical activity questionnaire-short form (IPAQ-SF), and food frequency questionnaire (FFQ). The statistical analysis will be carried out in SPSS software. During the study, subjects meeting the inclusion criteria were randomly selected and randomized into the intervention and control groups. The health-promoting lifestyle training program will be executed for the intervention group while the standard care program is administered to the control group. The content of this program will be obtained from the consensus opinions of the expert panel. The program includes diet recommendations, physical activity, and stress management. Appropriate time, frequency, duration and number of activities will be considered. Communication with subjects will be possible through private meeting special comfort room. Support to the participants will also be through clinical visits social media, SMS and phone calls. Nutritional changes, physical activity amount, anxiety and stress level, abdominal circumference (AC), and body mass index (BMI) will be measured after the completion of the specified time interval. The initial outcome includes examining chemical pregnancy (2 weeks after the transmission) and clinical pregnancy by ultrasound (6 weeks after). The secondary outcome will be live birth rate. Retrieved oocyte and embryo numbers will also be reported. DISCUSSION: Health-promoting lifestyle programs are essential in assisted reproductive technologies to improve pregnancy results and live birth. These programs in association with in-vitro fertilization (IVF) influence the outcome of fertilization. In addition, enhancing parental health leads to healthy pregnancy outcome. Despite the frequency of lifestyle risk factors, employing proper methods helps reduce anxiety and stress, modify dietary patterns, and perform qualitatively and quantitatively balanced physical activities. In addition, having coping skills and mental health management methods, in nowadays modern world challenges seems crucial and effective in solving fertility problems and reducing them before pregnancy.

For most people, children are the meaning of life. In some cultures, children are regarded as a family function and thus infertility is displeasing problem. In public believes, children are divine blessings. Not having children signifies a sick body and incomplete identity, which give rise to psychological and socio-economic consequences. Studies show that fertility and childbearing are biomarkers of survival and affect infertile men and women subconsciously. Since childbearing is one of the most crucial pillars of human marital life, an increase in infertile cases and use of ARTs by infertile couples, the lack of physical activity, sedentary lifestyle, unhealthy diet, stress, anxiety, and psychological problems caused by infertility problems, and the side effects of using ARTs preoccupy couples and distract their attention from healthy lifestyle and well-being issues. Despite the crucial importance of prevention in the modern world and the cost-effectiveness of prevention till treatment, numerous research findings expressing the importance of health education and disease ameliorates. These dimensions are still overlooked. Considering the importance of the issue, to the reduction of damages caused by chronic diseases, such as preventable NCDs problems including infertility, to promote fertility results, improving before conception. Oocyte retrieving time and in window period could improve embryo-maternal outcomes. Ensures couples' health, increases individuals' life satisfaction, and promotes health and lifespan of individuals, which is the ultimate goal of the healthcare system are the other purpose of health promoting process. It seems that health promotion lifestyle programs in Iran for infertile couples have not yet been integrated. Therefore, the combination of these programs with ART can be effective in achieving the goals of improving reproductive health. This research seeks to promote programs based on improving the health of infertile couples, increasing childbearing and increasing live births in people who are candidates for ART. A mixed study in the first step will be carried out by a systematic review of studies on ART candidate couples 'lifestyles. If the desired results are not achieved, a cross-sectional study will be conducted. In the second step, an intervention will be designed and developed to execute the lifestyle program following the specialists' opinions concerning nutrition, physical activity, and stress management. The next step will be carried out by implementing RCT. This intervention will be executed and evaluated at the end.

The Effect of Uterine Contractions on Fertility Outcomes in Frozen Embryo Transfer Cycles: A Cohort Study.

Background: The relationship between uterine peristalsis before embryo transfer and the success of assisted reproductive techniques (ARTs) has not been properly investigated. In this study, the effect of uterine contractions on embryo implantation in frozen embryo transfer (FET) cycles was investigated to determine whether the frequency of uterine contractions can be used as a quantitative marker to assess endometrial receptivity. Methods: In this cohort study of 68 eligible FET candidates, one hour before embryo transfer (ET), frequency of uterine contractions was assessed with transvaginal ultrasonography. Patients were followed up for 20 weeks. The association between FET outcomes including clinical pregnancy, abortion, and ectopic pregnancy with uterine contractions was evaluated. Binary logistic regression was conducted to test the association between clinical pregnancy outcomes in different groups. The p<0.05 were considered statistically significant. Results: Of 68 patients, 25 (36.8%) experienced clinical pregnancy. Multiple logistic regression for omitted confounders (age, BMI, duration, type and cause of infertility) revealed that patients with uterine peristaltic wave frequency less than 2≤ wave/min had higher chance of successful pregnancy compared to those with ≥4 wave/min (odds ratio: 10.8; 95% confidence interval: 1.5-79.4, p=0.019). The Pearson's correlation showed a statistically significant relationship between the frequency of uterine contraction and endometrial thickness (r= 0.42, p=0.002). Conclusion: Patients with uterine peristalsis of <4.0 wave/min before embryo transfer had a higher chance of successful implantation and pregnancy compared with those with higher contraction frequencies. It seems that measuring uterine contraction frequency before embryo transfer might help to predict pregnancy outcomes.

Myocardial Infarction in Patients with and without COVID-19: Comparisons of Characteristics, Clinical Courses, and Outcomes.

Background: COVID-19 has rapidly become a global health emergency. This infection can cause damage to various organs. Injury to myocardial cells is one of the salient manifestations of COVID-19. The clinical course and outcome of acute coronary syndrome (ACS) are influenced by various factors, including comorbidities and concomitant diseases. One of these acute concomitant diseases is COVID-19, which can affect the clinical course and outcome of acute myocardial infarction (MI). Methods: The present cross-sectional study compared the clinical course and outcome of MI and some of its practical factors between patients with and without COVID-19. The study population consisted of 180 patients (129 males and 51 females) diagnosed with acute MI. Eighty patients had COVID-19 infection concurrently. Results: The mean age of the patients was 65.62 years. The frequencies of non-ST-elevation MI (vs ST-elevation MI), lower ejection fractions (<30), and arrhythmias were significantly higher in the COVID-19 group than in the non-COVID-19 group (P=0.006, 0.003, and P<0.001, respectively). The single-vessel disease was the most frequent angiographic result in the COVID-19 group, while the double-vessel disease was the most frequent angiographic result in the non-COVID-19 group (P<0.001). Conclusion: It appears that patients with ACS who are co-infected with COVID-19 infection need essential care.

Conservative Management of Cervical Pregnancy with the Administration of Methotrexate and Potassium Chloride: A Case Report.

Background. Cervical pregnancy is a rare form of ectopic pregnancy in which the fetus implants and grows inside the endocervical canal. This report aims at introducing a case of successful conservative management of cervical ectopic pregnancy. Case presentation. The patient was a 35-year-old woman, who had received treatment for primary infertility for 5 years. She complained of painless bleeding on day 37 of gestational age with a start point from 10 days before. The patient had stable vital signs and was referred to Shahid Akbar Abadi Hospital in Tehran affiliated with the Iran University of Medical Sciences. In the ultrasonography, the pregnancy sac and the yolk sac with the embryonic pole with a positive fetal heart rate were presented and located near the internal os, so the cervical pregnancy was diagnosed, and after treatment with intramuscular methotrexate and intra-amniotic administration of potassium chloride, a gradual decrease in ß-HCG levels was observed without the need for additional interventional treatment. Conclusion. The primary takeaway of our report is that the conservative treatment, including intramuscular methotrexate and intrauterine potassium chloride administration, may be effective in treating cervical pregnancy that can be detected early without the use of curettage.

Anti-mullerian hormone levels before and after ovarian drilling in polycystic ovary syndrome: has this an effect on fertility?

BACKGROUND: Polycystic ovary syndrome (PCOS) is the most common endocrine, metabolic, and multi-causal disorder in the reproductive period with a possible genetic origin. Women with PCOS are characterized by oligo-ovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries. Women with PCOS have an increased number of antral follicles. Anti-Mullerian hormone (AMH), a dimeric glycoprotein produced from the granulosa cells of the pre-antral and antral follicles, is elevated in PCOS. AMH has been implicated in two stages of follicle dysfunction that lead to the development of PCOS. The level of AMH decreases following ovarian drilling in patients with PCOS. The present study compared the level of AMH before and after Laparoscopic ovarian drilling (LOD) in patients with PCOS and its effect on fertility. MATERIALS AND METHODS: This cohort study was carried out on 84 women with PCOS who underwent LOD in Akbarabadi Hospital in Tehran in 2020. Demographic characteristics, AMH, and estradiol levels were determined before surgery and compared with the amount one week after surgery. The effect of AMH level on pregnancy rate was also evaluated. RESULTS: The mean age of the patients was 29.01 ± 4.01 years. The mean Body Mass Index (BMI) of the patients was 26.33 ± 4.14 kg/m2. The results showed that the mean AMH level decreased significantly after ovarian drilling (P-value < 0.001). Menstrual cycle distribution was significantly different before and after LOD (P < 0.001). None of the variables had an effect on the pregnancy (P-value > 0.05). Oligomenorrhea in the previous menstrual period might cause AMH levels to increase by 3.826 units after LOD (P-value < 0.001). CONCLUSION: Measuring serum AMH concentration before treatment can be a useful tool to predict LOD outcomes. This can help in selecting the patient for treatment. TRIAL REGISTRATION: The project was found to be under the ethical principles and the national norms and standards for conducting research in Iran with the approval ID and issue date of IR.IUMS.FMD.REC.1397.206 and 2018.08.26 respectively, which has been registered with the research project number 2766 in the Vice-Chancellor for Research and Technology Development of Iran University of Medical Sciences, School of Medicine, Tehran, Iran. URL: https://ethics. RESEARCH: ac.ir/EthicsProposalView.php?id=34791 .

Pericarditis as a trigger for Prinzmetal angina - a case report.

Prinzmetal angina is one of the causes of acute coronary syndromes, the exact etiology of which is still unknown. Here we introduce a 27-year-old man with no history of cardiovascular disease, with a history of hospitalization due to acute pericarditis in the previous month, who was discharged with a good response to ibuprofen treatment but had clinical and electrocardiographically recurrence of pericarditis with compressive retrosternal chest pain and electrocardiogram (ECG) changes in favor of acute infero-postero-right ventricular (RV) myocardial infarction (MI). Treatment with vasodilator improved compressive retrosternal chest pain and reversed acute myocardial infarction changes completely and left pleuritic chest pain and pericarditis changes in the ECG. Due to the typical chest pain, he was admitted to the emergency room; ECG revealed generalized ST-segment elevation with acute pericarditis pattern again. Acute infero-posterior and right ventricular acute myocardial infarction pattern was also evident. After treatment with nitroglycerin in the Critical Cardiac Unit (CCU), all ECG ischemic changes returned to baseline, and pericarditis remained in all leads. The patient was discharged with non-steroidal anti-inflammatory drugs (NSAIDs), calcium channel blockers, and a good general condition.

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and urinary tract infections in pregnant/postpartum women: A systematic review and meta-analysis.

BACKGROUND: Urinary tract infections (UTI) and asymptomatic bacteriuria (AB) during pregnancy can result in considerable maternal and foetal adverse outcomes. Production of extended-spectrum beta-lactamase (ESBL) is a major antibiotic resistance mechanism by Enterobacteriaceae. OBJECTIVES: To determine the global prevalence of ESBL-producing (ESBL-P) Enterobacteriaceae in symptomatic UTI/AB among pregnant/postpartum females. DATA SOURCES: A systematic review of the PubMed, Embase, Scopus, WOS (Web of Science), ProQuest and the grey literature was conducted. STUDY SELECTION AND DATA EXTRACTION: Studies that reported the frequency of ESBL-P Enterobacteriaceae in pregnant/postpartum women with UTI and/or AB were eligible. First, the titles and abstracts of the retrieved articles were reviewed. Then, the full texts of the remained articles were reviewed. SYNTHESIS: In order to estimate the pooled prevalence and the 95% confidence interval (95% CI), meta-analysis was performed using the random-effects model. RESULTS: Twenty-three studies (six from Africa, two from North America, one from South America, 12 from Asia and two European studies) that reported data on 20 033 Enterobacteriaceae strains were included. The pooled prevalence of ESBL-P Enterobacteriaceae was 25% (95% CI 18%, 32%); I2  = 98.8%. The estimated prevalence (95% CI) rates were 45% (22, 67%) in Africa, 33% (22, 44%) in India, 15% (6, 24%) in other Asian countries, 5% (2, 8%) in Europe, 4% (1, 11%) in South America and 3% (1, 5%) in North America (P < .001). This estimate was 21% (95% CI 11, 31%) in patients with symptomatic UTI and it was 28% (95% CI 15, 41%) in patients with AB (P = .40). CONCLUSIONS: The prevalence of ESBL-P Enterobacteriaceae among pregnant women with UTI/AB was significant and geographic region was a major source for heterogeneity. The findings could be taken into account by healthcare providers and programmers in the management and antibiotic selection of UTI/AB during pregnancy, especially in high prevalence areas.