Ovarian Yolk Sac Tumors: Is Fertility Preservation Possible?

Yolk sac tumors make up 14% to 20% of all malignant ovarian germ cell tumors. Serum alpha-fetoprotein (AFP) levels are elevated in a significant number of patients and are useful for monitoring the response to treatment and for post-treatment surveillance. Surgery is required for diagnosis, staging, and treatment. The first case is a 12-year-old girl presented with abdominal pain. The ultrasonography (US) showed a huge pelvic tumor. AFP level was high (1000 mg/ml). Right salpingo-oophorectomy and pelvic lymphadenectomy were done. Histopathology reported yolk sac tumor of ovary. She received 3 courses of bleomycin, etoposide, cisplatin (BEP). The second case is a 25-year-old G1AB1 presented with pelvic pain and distension. The US showed a huge pelvic tumor in the right abdominopelvic region. AFP level was high (1000 mg/ml). Right salpingo-oophorectomy, omentectomy, and appendectomy were done. Histopathology reported yolk sac tumor of ovary. The patient received four cycles of BEP protocol; AFP level decreased to 10 mg/ml after the four cycles of chemotherapy. The third case is a 21-year-old girl presented with abdominal pain. The US showed a huge pelvic tumor in the right adnexa. AFP level was high (8700 mg/ml). Right salpingo-oophorectomy and pelvic lymphadenectomy were done. Yolk sac tumor is rare in children and it could be cured usually. In this study, we described three patients with ovarian yolk sac tumors and their fertility preservation treatments.These cases has reminded that in young age with high AFP levels and rapidly growing ovarian mass, diagnosis of the yolk sac tumor has to be kept in mind.

Tele-mental health during the COVID-19 pandemic: A systematic review of the literature focused on technical aspects and challenges.

Introduction: Mental disorders are the leading cause of disability and the second leading cause of death worldwide, which leads to the death of more than 9 million people annually. The global impact of the Coronavirus epidemic on mental health includes insomnia, anxiety, and depression. Therefore, given the current situation, innovations such as telemedicine to provide prevention and treatment services for people with mental disorders seem necessary. Methods: A literature review was performed according to the preferred items to report in systematic reviews and meta-analyses (PRISMA). Covering a period from January 2020 to July 2023, we conducted a systematic literature search on five electronic databases (PubMed-Mesh, Scopus, Web of Science, Science direct, and PsycInfo). The search strategy included three categories of keywords: Mental health, Tele, COVID-19. Results: A total of 112 articles were identified by searching the databases of published articles, 13 articles met our inclusion criteria. A total of 76.2% of them were related to patients with stress, anxiety, and depression issues. We found that the real-time method has been the most common method used to communicate between the physician and the patient (92.3%). The communication technologies used also included telephone, video call, video conference, and E-mail. During these communications, data was exchanged in text, voice, and video formats. In three studies (27%), interoperability with other systems was mentioned. In addition, 69.2% of the studies reported challenges, the most important of which were access to electronic and communication devices, network connection problems, audio and video problems, and privacy issues. Conclusions: Considering the many advantages of telemedicine technology in the field of mental health, the need to use this technology in developing countries, including our country, is obvious. But the application of these technologies requires the investigation of technical aspects and challenges related to them as much as possible, which have been seen in few studies.

Evaluation of Efficacy of Transvaginal Sonography with Hysteroscopy for Assessment of Tubal Patency in Infertile Women Regarding Diagnostic Laparoscopy.

BACKGROUND: Infertility, as one of the most common gynecological disorders, affects many people worldwide. To choose the clinical treatment, correct assessment of tubal patency can provide an important clue; therefore, it is considered as one of the major steps in workup examinations of infertile women. In this study, we aimed to compare the results of transvaginal ultrasonography (TVS) after hysteroscopy (HSC) with laparoscopy, as a gold standard, for assessing the fallopian tubal patency in infertile women. MATERIALS AND METHODS: This is a cross-sectional study which included 49 infertile women referred to Shahid Beheshti Hospital affiliated with Isfahan University of Medical Sciences during the years 2015 and 2016. At first, patients who met the inclusion criteria were examined through HSC in by a specialist in gynecology and obstetrics in operating room because laparoscopy was performed after TVS with HSC, but HSC was performed without anesthesia. TVS was performed before and after of HSC to observe fluid in the pouch of Douglas. The findings of TVS with HSC and laparoscopy were compared. RESULTS: There was a strong agreement between TVS after HSC and laparoscopy (kappa coefficient = 0.935, 95% confidence interval [CI]: 0.81, 1.00). The sensitivity of TVS after HSC was 100% (95% CI: 66.37, 100) and specificity was 97.50% (95% CI: 86.84, 99.94) with a positive predictive value of 90% (95% CI: 55.50, 99.75) and negative predictive value of 100% (95% CI: 90.97, 100). CONCLUSION: TVS after HSC is an accurate diagnostic tool for examination of fallopian tubal patency in infertile women.

Fatigue and Depression in Iranian Amyotrophic Lateral Sclerosis Patients in Tehran in 2012.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease with a progressive and rapid course. Fatigue and depression are common among ALS patients. The aim of this study was to determine the relationship between depression and fatigue in Iranian ALS patients. METHODS: In this 2012 cross-sectional study, 40 ALS patients, including 22 females and 18 males, were selected through consecutive relapsing-remitting, and 40 age- and gender-matched health controls (HCs) were recruited from Loghman Hakim Hospital in Tehran, Iran. The Persian version of the Fatigue Severity Scale (FSS-Per) questionnaire and depression substance of Hospital Anxiety and Depression Scale (HADS) were used to assess fatigue and depression. Data were analyzed using the Kolmogorov-Sminov Test, Levene's test, Independent Samples t-test, and Pearson product-moment correlation coefficient. RESULTS: We identified a significant and positive relationship between fatigue and depression in patients with ALS (p=0.000). Furthermore, the scores of fatigue and depression in ALS patients were higher than in non-ALS patients. CONCLUSION: The results indicated that there was a relationship between fatigue and depression in ALS patients and that early intervention services can improve these symptoms. Further studies are suggested to investigate the direction of such relationship.

The relationship between family planning methods, individual hygiene, and fertility with vaginal infections among the women referring to selected health centers in Isfahan city.

BACKGROUND: With regard to the high commonality of vaginal infections among pregnancy-age women, especially gardnerella, candidiasis vaginitis, trichomonal vaginitis and chlamydia and by attending to this fact that these infections have a high cost, including the medical expenses and other services like missing working hours and bear a negative effect on the life quality of women as influential individuals in family and society, we decided to examine the commonality of some of these infections and their related factors among women referring to selected health centers in Isfahan City. METHODS: This research was of an analytical-descriptive type conducted on 266 samples referred to the midwifery unit of selected health centers in Isfahan City due to one of the common vaginal infections (gardnerella, candidiasis vaginitis, trichomonal vaginitis and chlamydia). The collection of data was carried out via conducting interview with women and filling out the researcher-made questionnaire with close-ended answers (38 questions) and open-ended answers (25 questions). Data analysis was done by descriptive and analytical statistics (variance analysis and chi-square test). RESULTS: The findings of the study showed a significant relationship (p = 0.04) between suffering from different kinds of vaginal infection and fertility factors (the treatment record of the spouse). But, there was no significant statistical relationship between suffering from these infections and delivery type, period regulation, seeing stains and the pregnancy prevention type. Meanwhile, a significant relationship was found between suffering from vaginitis and demographic and individual factors like women's job (p=0.001), their educational level (p = 0.006), body mass index (p = 0.01) and their weight (p = 0.02). However, no significant relationship was found between suffering from common vaginal infections and individual health factors. CONCLUSIONS: With regard to the research findings, knowledge of the factors related to vaginal infection, including the fertility factors, can be instrumental in preventing and reducing the suffering from these infections. Therefore, training related to mothers' educational level and consulting with women for knowing the susceptibility factors like the effect of weight, attending to mothers' professional issues and prevention methods by following individual and sexual health-related issues by men and women can reduce the rate of suffering from these infections and promote the health level of mothers and hence, the society's health status.