Factors affecting the choice of treatment center by infertile couples: A cross-sectional study in Yazd Reproductive Sciences Institute.

Background: Infertility is one of the critical health issues in Iran. There are more than 70 specialized infertility treatment centers in Iran, of which the Yazd Reproductive Sciences Institute, is one of the most important ones. Objective: This study aimed to determine the factors influencing infertile couples' choice of Yazd Reproductive Sciences Institute. Materials and Methods: This cross-sectional study was conducted on 275 infertile couples aged 18 and older, referring to Yazd Reproductive Sciences Institute, Yazd, Iran from September 2021 to March 2022. Data were gathered using a 2-part questionnaire. Data analysis was done through SPSS software. We used descriptive statistics, Kruskal-Wallis, Mann-Whitney, and t test for data analysis. Results: Most participants were individuals who came from other provinces of Iran (74.9%) and were referred to the Yazd Reproductive Sciences Institute. Among the 4 categories that influenced couples' decision to choose this center, factors related to the personnel and treatment staff received the highest score (75.83), while personal factors received the lowest score (65.76). The average score for factors related to doctors was 72.90, and for factors related to the center, it was 73.65. The satisfaction with personnel and treatment staff varied based on participants' education levels, with those who had lower levels of education reporting higher levels of satisfaction (p < 0.001). Conclusion: The primary factors contributing to the success of the Yazd Reproductive Sciences Institute in attracting clients were the dedication and expertise of the staff, as well as the esteemed reputation of the doctors at the center.

Comparison of clinical outcome of lumbar spinal stenosis surgery in patients with and without osteoporosis: a prospective cohort study.

BACKGROUND: Osteoporosis is one of the most important risk factors for failure of the spine instrumentation. Management of patients with osteoporosis who requires spinal surgery because of the difficulty in instrument placement and the potential complications is still a challenge. This study was designed to evaluate the clinical outcome of lumbar spinal canal stenosis after instrumentation in patients with and without osteoporosis. METHODS: This prospective cohort study was performed from June 2018 to December 2020, in Be'sat Hospital, Hamadan, Iran. The sample consisted of patients over 50 years old referred to Be'sat Hospital with a diagnosis of lumbar spinal canal stenosis who underwent instrumental surgery (n = 107). Based on bone densitometry, the sample was divided into two groups with osteoporosis (n = 34) and without osteoporosis (n = 73). To collect data, we used a three-part researcher-made questionnaire (demographic information, medical records information, and paraclinical parameters). Statistical analyzes were performed by the Fisher Exact, chi-square, independent t-test, Multiple ANCOVA, Mann-Whitney and the Rank Wilcoxson tests using Stata version 17 software. RESULTS: The mean age (SD) of patients in the two groups with and without osteoporosis was 67.9 (7.0) and 59.1 (5.1) years, respectively (p = 0.001). The results indicated that a significant difference was observed between the two groups in sex (p = 0.032), educational status (p = 0.001), marital status (p = 0.023), employment status (p = 0.004), menopausal status (p = 0.018), taking corticosteroids (p = 0.028), and body mass index (p = 0.015). Also, there was a significant difference between two groups in the loosening of instrument (p = 0.039), the postoperative pain intensity (p = 0.007), fusion (p = 0.047), and neurogenic claudication (p = 0.003). Based on multiple ANCOVA test, there was not a significant difference between two groups in the clinical and paraclinical charatecristics (p > 0.05). The mean (SD) of T-Score in the osteoporosis group was 3.06 (0.37). CONCLUSION: This study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.

Investigating medical tourism development indicators in Yazd Reproductive Sciences Institute: A cross-sectional study.

Background: Payingspecial attention to the development indicators of medical tourism (MT) can lead to the further development of this industry and tourists' satisfaction. Objective: This study aimed to investigate MT development indicators in Yazd Reproductive Sciences Research Institute, Yazd, Iran in 2021. Materials and Methods: In this cross-sectional study, 430 medical tourists referred to the Yazd Reproductive Sciences Institute, Yazd, Iran in 2021 were studied. A researcher-made questionnaire with 46 questions and 10 dimensions was used in both internal and external environments to collect data. The Spearman correlation coefficient was also used to assess the correlation between the quantitative factors. Results: The reliability and validity of the scale were confirmed. The mean ± SD of the advertising and marketing index scored was lower than the other internal environmental indices (15.05 ± 2.16). Also, the economic factors and tourism infrastructure were lower than the other external environmental factors (9.8 ± 1.99, 8.53 ± 2.11, respectively). Conclusion: Given the importance of MT, top managers and relevant authorities should pay close attention to the criteria of advertising, marketing, and tourism infrastructure. MT demand can be improved by increasing the importance of advertising, implementing realistic advertising strategies, and developing adequate urban infrastructure and services.

Self-compassion training and psychological well-being of infertile female.

BACKGROUND: The empowerment of psychological well-being is an important and fundamental issue among infertile females. OBJECTIVE: The present study investigates the effect of teaching self-compassion on the psychological well-being of initial infertile women. MATERIALS AND METHODS: In this cross-sectional, quasi-experimental study with pre-test and post-test, 32 infertile women who were referred to the Yazd Reproductive Sciences Institute during 2016-2017 were enrolled. The participants were randomly divided in two groups as control and experiment (n = 16/each). The participants only in the experimental group received 8 sessions of 90 min training (Self-Compassion Training). Ryff's psychological well-being questionnaire was applied (reliability coefficient = 0.82) and covariance analysis statistical test was used to test the research hypothesis. RESULTS: There was a significant difference between the estimated mean scores for improving the psychological well-being of the participants in the experiment and control groups (p = 0.007), and the difference indicates that 72.7% of the covariance of the post-test scores is due to self-compassion intervention. Therefore, the intervention of self-compassion training affects the improvement of psychological well-being among infertile women. Also, the pre-test variable is significant with the effect of 94.2% (p = 0.006). CONCLUSION: The findings showed that teaching self-compassion to initial infertile women has an effect on their psychological well-being.

Cortical Auditory Evoked Potentials in Children with Auditory Neuropathy/Dys-Synchrony.

Auditory neuropathy/spectrum disorder (ANSD), also referred to as auditory neuropathy/dys-synchrony (AN/AD) is a recently described form of hearing impairment. Many studies have shown that changing the pattern of afferent input to the cortex significantly affects cortical organization and there is little studies about cortical neuromaturation and plasticity in children with ANSD. Study of P1 component of cortical auditory evoked potentials (CAEPs) in children with ANSD. This survey was descriptive cross-sectional. During that 97 hearing impairment children were under hearing screening tests. Of these, 14 selected subjects (ear = 28) diagnosed with ANSD (an average age of 8.5 years) and evaluated by P1 component of CAEPs. Based on latency results of p1 wave, the ears of the subjects fell into two seperate groups: Control (normal: n = 10) and case {total: n = 18 (delayed: n = 12) + (absent: n = 6)}. The averages of mean latency of P1 components of the case group in the right and the left ears compared to the control group had significant differences (p < 0.05). Abnormal latency of p1 component in ANSD children shows the possibility of different scales of disturbances in cortical auditory maturation and grow.

Efficacy of Simultaneous Administration of Nimodipine, Progesterone, and Magnesium Sulfate in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial.

OBJECTIVE: To investigate the safety and efficacy of simultaneous administration of nimodipine, progesterone, magnesium sulfate in patients suffering from severe traumatic brain injury (TBI). METHODS: Overall, 90 patients with blunt head trauma who were admitted to the Besat hospital, Hamadan University of Medical Sciences, Iran through the Emergency Department in 2017 to 2018 were randomly assigned to the study or control groups each containing 45 patients. In the study group, intravenous nimodipine 60 mg every 12 hours for 5 days, intramuscular progesterone 1 mg/kg daily for 5 days, and magnesium sulfate 5 grams stat followed by 2.5 grams every 4 hours for 21 days were administered. Daily GCS and jugular venous oxygen saturation (SjvO2) of the patients were measured on admission day (day 0) through hospitalization day 4 at the intensive care unit. Then, all patients were visited at three months after discharge. RESULTS: The mean age of the patients was 31.4 ± 12.8 years including 59 (65.6%) men with no significant difference between the groups. The baseline GCS and SjvO2 of the patients were comparable in both groups, however, GCS of the patients in the study group were significantly higher in the next 4 hospitalization days compared to the controls. Whereas, the SjvO2 of the patients were not significantly different between the groups during these days. Three-month mortality rate of the patients in the study group was significantly lower than the three-month mortality rate of the patients in the control groups (22.2% vs. 42.2%, p=0.042). CONCLUSION: Administration of combined protocol of magnesium sulfide, progesterone and nimodipine may be safe and effective in patients suffering from severe TBI. CLINICAL TRIAL REGISTRY: IRCT201210229534N2.

The Effect of Soft and Rigid Cervical Collars on Head and Neck Immobilization in Healthy Subjects.

STUDY DESIGN: Whiplash injury is a prevalent and often destructive injury of the cervical column, which can lead to serious neck pain. Many approaches have been suggested for the treatment of whiplash injury, including anti-inflammatory drugs, manipulation, supervised exercise, and cervical collars. Cervical collars are generally divided into two groups: soft and rigid collars. PURPOSE: The present study aimed to compare the effect of soft and rigid cervical collars on immobilizing head and neck motion. OVERVIEW OF LITERATURE: Many studies have investigated the effect of collars on neck motion. Rigid collars have been shown to provide more immobilization in the sagittal and transverse planes compared with soft collars. However, according to some studies, soft and rigid collars provide the same range of motion in the frontal plane. METHODS: Twenty-nine healthy subjects aged 18-26 participated in this study. Data were collected using a three-dimensional motion analysis system and six infrared cameras. Eight markers, weighing 4.4 g and thickened 2 cm2 were used to record kinematic data. According to the normality of the data, a paired t-test was used for statistical analyses. The level of significance was set at α=0.01. RESULTS: All motion significantly decreased when subjects used soft collars (p<0.01). According to the obtained data, flexion and lateral rotation experienced the maximum (39%) and minimum (11%) immobilization in all six motions using soft collars. Rigid collars caused maximum immobilization in flexion (59%) and minimum immobilization in the lateral rotation (18%) and limited all motion much more than the soft collar. CONCLUSIONS: This study showed that different cervical collars have different effects on neck motion. Rigid and soft cervical collars used in the present study limited the neck motion in both directions. Rigid collars contributed to significantly more immobilization in all directions.

Lack of Association between Cu T-380A Intrauterine Device and Secondary Infertility in Iran.

BACKGROUND: The appropriate choice of a contraceptive method has been a major issue in reproductive health research. Cu T intrauterine device (Cu T IUD) has been introduced as one of the most effective contraceptive methods in the world, however, the relationship between prior use of Cu T IUD and secondary infertility has not been evaluated in Iran. To examine the association of Cu T-380A IUD and secondary infertility in Iran. MATERIALS AND METHODS: A retrospective cohort study was conducted from December 2010 to September 2011 in the Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. A total of 750 married women (15-49 years old) with at least one parity, whom were referred to four educational healthcare centers of Shahid Sadoughi University of Medical Sciences, were selected as participants. They were divided into two groups (case and control) based on previous history of using Cu T-380A IUD. Data were gathered using a standard reliable questionnaire along with a face-to-face interview and were analyzed with descriptive and analytical (χ²) tests. RESULTS: Mean period of Cu T-380A IUD usage in the case group was 57.46 ± 47.74 months and mean time length from Cu T-380A IUD removal to pregnancy was 14.87 ± 5.18 months in this group. We observed no relationship between the use of Cu T-380A IUD and frequency of secondary infertility (3.5% in the case group versus 2.7% in the control group, P=0.52). CONCLUSION: Given the relatively large sample size studied here, it is unlikely that Cu T-380A IUD results in secondary infertility and may be used by Iranian women as a safe contraceptive method.

The Influence of Rocker Bar Ankle Foot Orthosis on Gait in Patients with Chronic Hemiplegia.

BACKGROUND: This study aimed to evaluate the effect of rocker bar ankle foot orthosis (RAFO) on the spatiotemporal characteristics of gait in chronic hemiplegic patients compared with the effect of solid ankle foot orthosis (SAFO). METHODS: Following ethical approval, 18 patients with chronic hemiplegia, at least 6 months post stroke, were investigated in barefoot condition, with SAFO and RAFO in random sequences. Their spatiotemporal characteristics were examined by 2 force platforms and a Vicon motion analysis system. RESULTS: There were significant changes in spatiotemporal outcome measures between barefoot condition and using SAFO and RAFO (P < .05). Compared with SAFO, RAFO resulted in significantly more step length, faster gait velocity, and less preswing time (P < .05), although no significant differences were seen regarding step width and cadence (P > .05). Furthermore, RAFO led to significant increases in hip extension and knee flexion at toe-off, whereas SAFO did not change these parameters (P < .05). CONCLUSION: Findings of the present study showed that RAFO further improves gait abilities in chronic hemiplegic patients compared with SAFO, which could be due to the positive effect of added rocker bar on push-off function during the late stance phase of gait.

The attitudes of infertile couples towards assisted reproductive techniques in Yazd, Iran: A cross sectional study in 2014.

BACKGROUND: Knowledge about assisted reproductive techniques (ART) and its procedures affect the attitude of infertile people. Making decisions about the use of ART is affected by one's perception and attitude. OBJECTIVE: The aim of this cross-sectional study was to determine the attitude of infertile couples toward applying ART, and to investigate its related factors. MATERIALS AND METHODS: A randomized cross-sectional study was conducted on 184 infertile couples who had referred to the Research and Clinical Center of Infertility, Yazd, Iran for diagnosis and treatment in June 2014. The data was collected using a two-part questionnaire containing demographic and attitudinal statements. For data analysis, SPSS statistical software and statistical tests of mean differences (t-test), Pearson correlation and analysis of variance were used. RESULTS: A significant relationship between spouse's attitude (p<0.01), relative's attitude (p<0.01), the applied knowledge of ART (p<0.01), and attitude of infertile couples toward applying the ART was observed; however, there was not any significant relationship between gender and socioeconomic status toward applying ART (p>0.05). CONCLUSION: In conclusion, making a decision and accepting ART can be influenced by couple's attitude, their family's attitude and applied knowledge of ART.

Factor structure of the General Health Questionnaire-28 (GHQ-28) from infertile women attending the Yazd Research and Clinical Center for Infertility.

BACKGROUND: Nowadays, infertility problems have become a social concern, and are associated with multiple psychological and social problems. Also, it affects the interpersonal communication between the individual, familial, and social characteristics. Since women are exposed to stressors of physical, mental, social factors, and treatment of infertility, providing a psychometric screening tool is necessary for disorders of this group. OBJECTIVE: The aim of this study was to determine the factor structure of the general health questionnaire-28 to discover mental disorders in infertile women. MATERIALS AND METHODS: In this study, 220 infertile women undergoing treatment of infertility were selected from the Yazd Research and Clinical Center for Infertility with convenience sampling in 2011. After completing the general health questionnaire by the project manager, validity and, reliability of the questionnaire were calculated by confirmatory factor structure and Cronbach's alpha, respectively. RESULTS: Four factors, including anxiety and insomnia, social dysfunction, depression, and physical symptoms were extracted from the factor structure. 50.12% of the total variance was explained by four factors. The reliability coefficient of the questionnaire was obtained 0.90. CONCLUSION: Analysis of the factor structure and reliability of General Health Questionnaire-28 showed that it is suitable as a screening instrument for assessing general health of infertile women.

Mental health status of infertile couples based on treatment outcome.

BACKGROUND: Infertility is accompanied by numerous psychological and social problems. Infertile couples are more anxious and emotionally distressed than other fertile people. Previous studies suggested that infertility is more stressful for women than men. OBJECTIVE: The purpose of this study was to determine the status of general health of infertile couples. MATERIALS AND METHODS: This cross-sectional study evaluated general health of 150 infertile couples attending to Yazd Research and Clinical Center for Infertility that were selected consequently. The data were gathered by the researchers, based on face to face interview before and after three months of treatment by two questionnaires. The first questionnaire had questions on demographic information and the second one was the General Health Questionnaire-28 (GHQ-28). This questionnaire has four sub- scales areas. All data were transferred directly to SPSS 15 and analyzed. RESULTS: The mean age of women was 28.3 and men were 32.4 years. The scores for all sub- scales of GHQ in women were more than men. There was significant difference between age and general health at physical symptoms scales (p=0.002), anxiety and sleep disorders (p=0.003). The age group 25-29 years had higher scores (more than 7) than other age groups. There was significant difference between the scale of social dysfunction and results of treatment. CONCLUSION: Our results, similar to the previous studies have revealed negetive social and mental effects of infertility on women is more than men, so there is need that they be educated specially.

Evaluation of the general health of the infertile couples.

BACKGROUND: The prevalence of infertility is variable between 5-30% around the world. In Iran, more than 2 million couples suffer from infertility. Infertility causes depression, anxiety, social isolation and sexual dysfunction. OBJECTIVE: This descriptive study was undertaken to determine general health in infertile couples. MATERIALS AND METHODS: One hundred and fifty infertile couples attending Yazd Research and Clinical Center for Infertility were randomly selected during March till September 2009. The GHQ-28 questionnaires were completed by researchers, based on face to face interview. It contains 28 items, which have been divided to four sub- items. The results come out by scoring the patients answer from 0 to 84. All data were analyzed by Chi-square and t-test in SPSS software. RESULTS: GHQ scores of all sub-scales and total in women were more than men, which shows general health condition in women is worse than men. There was no relation between the duration of infertility and general health scores. CONCLUSION: This study suggests that the infertility has significant effect (p=0.001) on health situation of infertile couples, especially infertile women. They are at risk of somatic symptoms (p=0.0001), social dysfunction (p=0.0001) and severe depression (p=0.0001). GHQ could provided help and support in order to improve the health situation of infertile couples.

Osteoid osteoma of the first 2 cervical vertebrae. Report of 4 cases.

Osteoid osteoma affects the spine in only 10% of cases. More than 50% of the spinal cases involve the lumbar and cervical vertebrae. Involvement of C-1 and C-2 vertebrae has previously been reported only very rarely in the published literature. The authors report 4 cases of upper cervical osteoid osteoma, 1 involving C-1 and the other 3 C-2, and they discuss different aspects of management in similar cases. The patients were 14, 17, 35, and 46 years old, and all presented with neck pain and various degrees of painful limitation of head rotation not ameliorated by ordinary analgesics. Radionuclide isotope bone scans, CT scanning, and MR imaging were helpful preoperative diagnostic modalities. The first attempt at eradication of the lesions failed in 2 cases and the lesions could be excised totally at a second approach. Postoperatively, the patients all became pain free and gained full range of neck motion. There has been no tumor recurrence and no sign of instability in short- to medium-term follow-up. Among the several etiologies mentioned for neck pain and torticollis, osteoid osteoma of the first 2 cervical vertebrae should be considered as a possible but rare cause. Even though different kinds of management have been mentioned for osteoid osteoma, resection of the lesion remains the best option for achieving a cure.

Extracranial aneurysm of the distal PICA presenting as isolated fourth ventricular hemorrhage: case report and literature review.

BACKGROUND: Posterior inferior cerebellar artery (PICA) aneurysms are relatively uncommon, comprising only 0.5-3% of all intracranial aneurysms. Distal PICA aneurysms are much more uncommon, with more than 200 cases being reported in the literature. The finding of an extracranially located aneurysm of distal PICA is considered a true rarity. METHODS AND DISCUSSION: A rare case of extracranially located PICA aneurysm presenting with isolated fourth ventricular hemorrhage is presented and the diagnostic and therapeutic challenges discussed.

Work-related penetrating head trauma caused by industrial grinder tool.

Nonmissile low-velocity penetrating brain injuries are unusual among civilian population. Work-related penetrating head wounds are rarer among this group. Here, we report two rare cases of penetrating head wounds caused by industrial grinder tool. The patients (both men) were struck to the head by detached blades of the grinder tool. Depressed fractures, penetrated bone fragments, and dural lacerations were all treated by the routine fashion. Paranasal sinus damage and further cerebrospinal fluid leakage were also treated conservatively. The reported cases are unexpected variants of injuries that neurosurgeons may come across and their management is still beyond the scope of textbooks. Skill and experience of the general neurosurgeons can handle the cases properly but prevention of such incidents using safer and guarded instruments should be stressed to manufacturers.