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Intruduction: Testicular feminization syndrome is a disorder with the prevalence of 1 in 20000 to 64000 male births. It,s characteristics are female phenotype, male caryotype (64XY) and normal to increased testosterone and LH levels. In this article a case of testicular feminization is reported. Case: The patient was a 16 years-old woman with primary amenorrhea and without secondary sexual characteristics. The patient had normal female external genitalia, absent axillary and pubic hair, immature breast, and repaired bilateral inguinal hernia with pathology report of immature testicular tissue. FSH and LH levels were elevated. Testosteroe level was normal. Sonography and CT scan of pelvis did not show uterus and adnex. Karyotype was 46XY. Conclusion: It is recommended that due to the risk of neoplasia, the existing testes must be removed. Also hormone therapy must be done for the patient.

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Introduction: An association between depression and altered immunity has been suggested by a number of studies but has not been consistently demonstrated .The effect of maternal depression response on fetal immune system have not been investigated. Thus in this study we evaluated the effects of depression on some parameters of innate and humoral immune system of pregnant women and their infants. Materials and Methods: 62 pregnant women (including 32 depressed and 30 healthy) and their infants in Taleghani hospital of Arak in 2004 were included in this study. All depressed mothers had a diagnosis of depression by Beck Depression Inventory (BDI) and clinical interview based on DSM-IV system. The level of immunoglobulins and components were evaluated by single radial immunosdiffusion (SRID) method of Mancini. Leukocyte and lymphocyte counts were determined by Hycel (an automated cell counter) and for more accurancy were also evaluated by manual method. Statistical analysis was performed using K-S, Mann-Withney, One way ANOVA, Kruskal-Wallis and Pearson tests. P<0/05 was considered significant. Results: Serum IgM level and serum C4 level of infants of mothers with depression were significantly lower than infants of healthy mothers. Lymphocyte number and percentage in infants of depressed mothers was also significantly higher than infants of healthy mothers. The mean cord/maternal blood ratio of IgG in infants of depressed mothers was also significantly lower than infants of healthy mothers. Serum IgG level of depressed mother was significantly higher than other mothers. Conclusion: Fetal impact of stress and depression during pregnancy is just beginning to be understood and research in this area is developing. Our results indicated that maternal depression adversely affects the development and function of fetal immune system. These results are in agreement with the immunological findings of preterm and LBW infants.

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Introduction: Pain relief has been received the highest level of medical attempts continuously but still many patients suffer from it. Narcotics' side-effects have led investigators to apply other techniques for controling acute postoperative pain to reduce narcotics requirements. Recently, some concepts have been presented implying that Metoclopramide does have analgesic effects and this led us to conduct the present study in order to determine Metoclopramide's effect on alleviating pain after cesarean section. Materials and Methods: In this clinical trial, 80 patients who were candidates of elective cesarean section were studied in two groups. 10 minutes before the cesarean section's ending time, the control group was given 25 mg Pethidine accompanied by 10 mg Metoclopramide and control group 25 mg Pethidine and distilled water. Then when patients were conscious after cesarean section, for a period of 6 hours received after-care for their vital signs and side-effects of prescribed drugs. Their pain score (VAS) and nausea rate was measured and if necessary, Pethidine was injected with certain dose. Injection time for first dose of Pethidine and its required amount were recorded in a checklist within first 6 hours after cesarean section. Data was analyzed using ANOVA and T tests. Results: Prescription of Metoclopramide inhaunced analgesic effect of narcotics and a meaningful decrease was found in pain score (p=0.002) and nausea rate (p<0.005). Injection time for the first dose of Pethidine was also prolonged in the group who received Metoclopramide compared to control group (p=0.019) and an obvious decrease was occurred in received Pethidine's amount within the first hours after cesarean section (p<0.005). Drugs side-effects were not found in patients. Conclusion: The results indicate that use of Metoclopramide accompanied by Pethidine in ending time of cesarean section, does have considerable effects in controlling acute pain after surgery and increasing analgesic effect of narcotic drugs. Therefore, use of Metoclopramide as a proper supplement drug with low side-effects is recommended.

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Introduction: Candidiasis is the second common cause of vulvovaginitis. We evaluate the frequency of species of Candida in vaginal candidiasis. Materials and Methods: In this cross-sectional anaiythical study, 220 patients with typic and nontypic signs and symptoms of vaginal Candidiasis were studied. Smear and culture were done. For positive culture, evaluation of germ tube, clamidospor production and carbohydrate assimilation and fermentation was done. Data was presented by descriptive statistics and analyzed using Chi square, Man-Whitney and Kolmogrov tests. Results: 40% of patients showed positive culture and smear. Frequancy of Candida Albicanse (42.03%), Dublininsis (29.5%), Glaberata (14.75%), Gilermondy (6.81%), Norvejensis (2.27%), Tropicalis (2.27%), and Kefayer (2.27%) were determined. There was no significant relationship between antibiotic and OCP consumption and type of identified Candida. Conclusion: Frequency of non Albicanse species is increasing. We suggest treatment based on culture and smear, because non Albicanse vaginitis usually is resistant to Azols.

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Introduction: Menopause is a natural period of life. It means the permanent cessation of menstruation and the end of reproductive period which occurs between 45-52 years old. It also serves as an indicator of population health as the occurrence of menopause indicates the increased risk for the onset of several chronic diseases. In this study, the mean age of natural menopause among women in Arak (Central Iran) was investigated, considering their reproductive and socio-economic-demographic factors and their health behaviors. Materials and Methods: This study was an observational cross-sectional study on a population base, carried out in 2007 year. Interviews and questionnaires were used for gathering data from 458 women resident in Arak city, who had undergone a natural menopause. Sampling was multistaged using postal zones and selecting samples in each zone. Data was analyzed using variance analysis, multiple regression, T and correlation coefficient tests. Results: Findings showed that the mean age of menopause in our sample was 48.2±2.34 years (95% CI: 47.98- 48.41) and its median was 49 years. The mean age of menopause in women who were never married was less than married women (P= 0.015). Low income level (P= 0.003), having physical activity (P= 0.004), number of pregnancies (P<0.001), age of last pregnancy (P=0.026) and place of birth (P=0.003) were meaningfull factors in age of menopause. Conclusion: This phenomenon must be documented in Iran because of its strong link with mortality and morbidity of the growing number of women who are reaching advanced ages whose one forth of life is after menopause. Therefore health education as the best way for changing their lifestyle is suggested.

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Background: Major depression is one of the most prevalent psychiatric diseases, whereas schizophrenia is one of the worst human diseases. Therefore, finding low-cost treatment methods with few side effects can be of great help to patients. The present study was done to compare the serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous in individuals with major depression and schizophrenics with healthy subjects. Materials and Methods: In this cross-sectional study, serum levels of vitamin D, parathyroid hormone, calcium, and phosphorous were assessed in 100 major depressive, 100 schizophrenic, and 100 healthy subjects. Subjects with a history of renal failure, hepatic failure, parathyroid disease, and consumption of vitamin D, parathyroid hormone, calcium, and phosphorous supplements were excluded from the study. SPSS software version 15 was used for data analysis. Results: Depression was accompanied with decreased serum levels of vitamin D and increased serum levels of parathyroid hormone (p>0.001, p=0.01), but there was not a significant difference between depression and healthy subjects in calcium and phosphorous serum levels (p=0.69, p=0.15). Schizophrenia presented a significant correlation with decreased serum levels of vitamin D and phosphorous (p>0.001, p=0.01), but there was not a significant difference between schizophrenic and healthy subjects in calcium and parathyroid hormone serum levels (p=0.47, p=0.67). Conclusion: Since depression and schizophrenia are accompanied by decreased serum level of vitamin D, consumption of supplementary vitamin D can be helpful in the treatment of these patients.

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Background: Noticing the significant role of fertility in Iranian families, the incidence of infertility and its social and cultural dimensions, this study was carried out to compare general health status of infertile women with fertile women. Materials and Methods: This observational case-control study was done on 147 women as the control group and 147 infertile patients as the case group who were matched in terms of influential variables. Data collection was done through demographic questionnaire and general health questionnaire (GHQ) which were completed by both groups. The results were analyzed by logistic regression analysis, t test, and chi-square using STATA 10 software. Results: Means of general health score in fertile and infertile women were 19.249.72 and 28.06 10, respectively. Here the mean score of the infertile women was significantly higher in comparison with the fertile women (p<0.001). Physical symptoms, anxiety, social interaction, and depression scores of infertile women were significantly higher in comparison with the fertile women (p<0.001). There were no significant differences in the means of age and duration of marriage between the two groups and the distribution of educational level, occupation, and income levels were the same in the two groups. Conclusion: Average scores of general health and physical complaints, anxiety, impaired social interaction, and depression in infertile women were higher than those in fertile women. This indicates their involvement with some degrees of public health diseases.

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Background: Primary dysmenorrheal is one of the most common gynecologic diseases. This study was carried out to compare the effects of omega-3 and vitamin E on the treatment of primary dysmenorrheal. Materials and Methods: In a randomized double-blind clinical trial, 80 female students from high schools in Arak, Iran, were selected by simple sampling and randomly divided into two identical groups in 2010. Omega-3 group received one omega-3 capsule (500 mg) per day while the vitamin E group received one vitamin E capsule (400IU) every other day for 60 days. Intensity of pain, duration of pain, and the number of painkillers taken before and after intervention were measured in both groups. Intensity of pain was assessed by VAS scale of pain. Data were analyzed by SPSS software. Results: After intervention, the mean of pain intensity in the omega-3 group decreased to 3.5 which indicated a significant difference in comparison with the corresponding values before intervention (7.40) (p<0.05) and the values in the vitamin E group (5.25) (p<0.05). After intervention, the mean duration of pain in the omega-3 group reached 11.04 hours which showed a significant difference compared with the corresponding values before intervention (31.74) (p<0.05) and the values in the vitamin E group (34.81) (p<0.05). Conclusion: Omega-3 is more effective than vitamin E in the treatment of primary dysmenorrheal and its application as a new therapeutic method to the treatment of primary dysmenorrheal requires further studies.

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Background: Caesarean section is one of the most common gynecologic surgeries. Nausea and vomiting after pain is the most common side effect of surgeries, today, we most widely use of serotonin receptor antagonists, that are most effective antiemetic and have less side effect rather than other drug. Ondansetron is typical serotonin antagonists.

Materials and Methods: This is a randomized, double-blind clinical trial on 162 women undergoing cesarean section. 4mg intravenous ondansetron was given to first group and 8mg oral ondansetron was given to second group and thired group recived placebo. Blood pressure and heart rate were measured before and immediately after performing spinal and every 5 minute until 20 minute. Post operative nausea and vomiting and APGAR score were recorded after operation in recovery and 2, 4, and 6 houres after surgery.

Results: There was no significant difference among 3 groups according to age, gravidity, mean atrial pressure and heart rate before and during surgery. Nausea and vomiting in oral and intravenous groups at recovery, 2 and 4 hours after surgery were significantly less nausea and vomiting than placebo group (p<0.05). Whereas there was no significant difference between oral and intravenous groups.

Conclusion: It was concluded that using oral ondansetron with the same antiemetic effect is more convience to women undergoing cesarean section with spinal anesthesia.

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Background: Depression is one of the common psychiatric disorders which are more common in women in the reproductive ages. So this study is to investigate the effect of Depo-Provera on depression.

Materials and Methods: This cross-sectional study was performed on 70 women who had chosen Depo-Provera as contraception. Beck test was done at arrival and repeated 3 months later, and the scores obtained were compared by paired t test.

Results: The participants BDI scores at baseline were equal to 7.89±3.85 while 3 months after treatment with the scores were equal to 7.09±3.63 which were significantly decreased.

Conclusion: Since Depo-Provera reduces depressive symptoms in women who take it and does not increase these symptoms in women with a history of depression, it seems that Depo-Provera is an appropriate choice as contraception.

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Background: Today, ultrasonography has become the main tool used for the evaluation of fetal anomalies. The aim of this study was to evaluate fetal heart rate changes immediately after combined two- and 4-dimensional ultrasound.

Materials and Methods: This study was performed on 191 pregnant women aged 15 to 45 years old who were referred for 4-dimensional ultrasonography in summer 2013. Before the onset of 2-dimensional ultrasonography, baseline fetal heart rate was measured by ultrasound. At the same time, the maternal heart rate was recorded during one minute. Then, combined ultrasonography was performed and same parameters were recorded at the end.

Results: Maternal heart rate significantly decreased after combined ultrasonography (p=0.0001). Fetal heart rate did not differ before and after ultrasonography (p=0.693).

Conclusion: Four-dimensional ultrasonography has no effect on fetal heart as an indicator for evaluating the fetus temperature.

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Background: Polycystic ovary syndrome (PCOS) is a complex hormonal disorder affecting the reproductive and metabolic systems. The aim of this study was to investigate the effect of 8-week pilates training on anti-mullerian hormone level and cardiometabolic parameters in women with polycystic ovary syndrome.

Materials and Methods: In this semi-experimental study with pretest–posttest design, twenty PCOS patients (aged 28.16±4.29 y) were randomly assigned to pilates training or non-exercising control groups. The training group took part in an eight-week progressive pilates exercise program, three times weekly while the control group were instructed to maintain their normal daily activities throughout the eight-week experimental period. Serum levels of anti-mullerian hormone, body composition and metabolic parameters were assessed before and after the training period.

Results: After an 8 week pilates training, insulin resistance index, total cholesterol, LDL- cholesterol, triglycerides and abdominal fat were significantly decreased (p<0.05). Furthermore, anti-mullerian hormone concentrations decreased significantly in response to pilates training (p<0.05).

Conclusion: These results suggest that pilates training can have beneficial effects on metabolic indices and ovarian reserve in women with polycystic ovary syndrome over a two-month period.

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Background: Impulsivity is a core social pathology. Therefore, the purpose of this study was to Effectiveness of group dialectical behavior therapy based on core distress tolerance and emotion regulation components on Expulsive Anger and Impulsive Behaviors.

Materials and Methods: Research method is a semi experimental socio-statistic approach consisting of experimental group (dialectical behavior therapy) and control group. Participants were patients referred to Amir Kabir Hospital in Arak. and who were Expulsive Anger and Impulsive Behaviors. Based on stratified random sampling, 16 patients (women) were placed in each group. Research tools included the structured diagnosis interview according to DSM-IV-TR (2000), Barrat impulsivity scale (1994) Distress Tolerance Scale (2005) Difficulties of Emotion Regulation Scale (2004) and dialectical behavior therapy were done for two months, 8 groups Sessions.

Results: The results of this study showed that there was significant difference between control and experimental groups after implementation of dialectical behavior therapy relying on component tolerance and regulation of emotional distress variables impulsive behavior and explosion furies (p<0.01).

Conclusion: Distress tolerance and emotion regulation components effective on Expulsive Anger and Impulsive Behaviors.

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Background: Allergic rhinitis is a common disease which is present in 20% of general population. Major symptoms include sneezing, rhinorrhea, nasal congestion, and nasal pruritus. It seems that tricyclic antidepressants blocking histamine receptors may be used as an effective treatment in allergic rhinitis.

Materials and Methods: In this clinical trial study, 84 patients with allergic rhinitis entered the study and randomly divided into two groups. Patients of 1st group received cetirizine and 2nd group received doxepin for 2 weeks. After 2 weeks patients were evaluated about sneezing, rhinorrhea, nasal congestion, and nasal pruritus.

Results: The results of our study showed that clinical score of patients after 2 weeks was not different in both groups (p=0.261). The only symptom that was affected by the kind of treatment and was significantly different between groups was sneezing (p=0.005).

Conclusion: It seems that there is not much difference in using cetirizine and doxepin in treatment of seasonal allergic rhinitis sympotoms. It is recommended that future studies use TCAs with more potent blocking anti-histamine receptors feature and on more samples.

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Background: About 40% of postmenopausal women experience sleep disruption which can affect their quality of life. Various medications were used for managing the sleep disruption. There are some studies on the effectiveness of gabapentin in the management of post menopausal vasomotor symptoms and sleep disruption. The aim of present study was to assess the effect of gabapentin on improving quality of life and sleep of post menopausal women .

Materials and Methods: In this double blind clinical trial, 90 post menopausal women with sleep disruption were selected and randomly divided into two groups for 12 weeks intervention (300 mg gabapentin, twice daily) and control groups. SF36 questionnaire of quality of life and PSQI questionnaire of sleep quality were surveyed and compared before and after the intervention in patients.

Results: The mean age of participants were 52.7 ± 3.14 and 53.4±3.68 years in intervention and placebo groups respectively. There was no significant difference in demographic information and the mean score of SF36 and PSQI questionnaires between groups before the intervention (p>0.05). Significant improvement was seen in score of SF36 and PSQI in gabapentin group after the intervention and in comparison with placebo group (p=0.0001).

Conclusion: According to the results of present study, it seems that gabapentin 300 mg/twice daily for 12 weeks can improve quality of life and sleep of post menopausal women.

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Background: Episiotomy is one of the most common gynecologic surgery that was done in the second stage of labor, in order to facilitate the delivery. Cutting this area is associated with pain and discomfort. Healing causes pain relief and returning to daily activities became faster. Considering that the high rates of episiotomy infection, we decided to examine the effect of topical cream, saffron 20%, on women who had undergone episiotomy.

Materials and Methods: This randomized, double-blind clinical trial study was performed on 60 primiparous women in 2013-2014 who underwent vaginal delivery and episiotomy at in Taleghani Hospital of Arak. Intervention group recieved 20% topical cream containing saffron extract three times daily for 2 weeks and the control group received a placebo cream. Wound status and its healing were investigated in the first, seventh and fourteenth postpartum.

Results: There was a significant difference between both groups with healing of episiotomy location in seventh(p=0.54) and fourteenth(p=0.003) days and the continuity process of the wound edges in the first (p=0.015), seventh(p=0.013) and fourteenth(p=0.001) days. there was no statistically significant difference about the opening the wound in the first day(p=0.492), There was a statistically significant difference between the two groups in seventh(p=0.001) and fourteenth(p=0.026) days.

Conclusion: This study showed that saffron extract cream 20% can be effective for episiotomy wound healing and wound edges continuity.

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Background: The purpose of this study was to determine the effectiveness of dialectical behavior therapy in reducinng expulsive anger.

Materials and Methods: This is a pre-test and post-test semi-experimental study with control group. The study population included 32 patients with expulsive anger that reffered to Amir kabir remedial education center based on psychiatrist diagnosis and were randomely divided into case (dialectical behavior therapy) and control group. The case group was educated the dialectical behavior therapy skills for 16 sessions from 2 until 2.5 hours at teamly. To collect data, the patients filled Eysenk expulsive questionnaire before and after intervention. Considering no necessary assumptions were fulfilled to conduct the multivariate analysis of covariance and variance, so, the univariate analysis of variance was used.

Results: The results of variance analysis proved that dialectical behavior therapy significantly reduced expulsive angers.

Conclusion: With due attention to the results, it can be said that dialectical behavior therapy leads to reducing expulsive angers in treated patients, thus, this method can be included in interventional programs for target groups in psychotherapy centers. Aslo, it helps to improve the life of patients by reducing expulsive angers.

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Background: Missed abortion refers to pregnancy products remain dead with age less than 20 weeks in the womb for several weeks. This study was designed to evaluate the efficacy of castor oil on cervical ripening in the treatment of abortion.

Materials and Methods: This triple blind clinical trial was done on 72 women with missed abortion who were divided into two groups of 36 patients based on odd or even numberd of cases. The case groups received 800 mg vaginal misoprostol and 60 ml castor oil mixed with fruit juice and control groups received 800 mg vaginal misoprostol and 60 ml placebo with fruit juice, respectively. In both groups, if needed, 3 doses of vaginal suppository 800 mg were repeated with at least 24 hours. After the disposal of pregnancy products, sonography and curettage were performed if necessary.

Results: During the intervening period, the time of the opening of the cervix in the intervention group was shorter than control group and there was a statistically significant difference (p=0.032). Also, the control group required a higher frequency of administration of misoprostol than intervention group and the difference was statistically significant (p = 0.037).

Conclusion: It seems that the castor oil can be effective on cervical ripening for treatment of abortion.

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Background: Adoption has a significant role for strengthening families without children and also resolution of psychological confilicts of unsupervised children. The goal of this study is to assess the psychological status of adoption applicant couples.

Materials and Methods: This is a descriptive- analytic study that is done with cooperation of welfare organization and Arak University of Medical Sciences in 2014. All adoption applicant couples referred to welfare organization for 1 year participated in the study. Data were gathered by using demographic questionnaire and MMPI-II. Data were showed by descriptive statistic and were analyzed by using mean, average and covariance analysis indices.

Results: Mean and standard deviation of all clinical scales and reliability of MMPI-II in all samples and also different subgroups of statistical population were under 65. All applicants had good mental health and psychologically were eligible for adoption. A group of applicants have pretended themselves better than what they are because of the fear of rejection that led to significant difference in k scale(p=0.019).

Conclusion: According to the findings of this study, applicants had good mental health and didn’t have any psychopathologic damage, but sometimes they have pretended themselves better than what they are. Investigation of other diagnostic tools in future studies is recommended.

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Background: Few studies have examined the effects of calcium plus vitamin D supplementation on metabolic profiles in overweight women with polycystic ovary syndrome (PCOS).This study was conducted to determine the effects of calcium plus vitamin D supplementation on metabolic profiles among overweight women with PCOS.

Materials and Methods: This randomized double-blind placebo-controlled clinical trial was conducted among 104 overweight and obess women with PCOS. Participants were randomly assigned into four groups to receive: 1) 1000 mg/d calcium+ vitamin D placebo; 2) 50000 IU/weeks vitamin D; 3) 1000 mg calcium/d and 4) calcium placebo + vitamin D placebo for 8 weeks. Fasting blood samples were taken at baseline and after 8 weeks intervention to measure metabolic profiles.

Results: After administrating calcium plus vitamin D supplementation, a significant decrease was observed in serum insulin (-3.3±11.4 vs.-1.1±8.5, -1.4±3.0 and +3.1±6.1 µIU/ml, p=0.03), insulin resistance (-0.7±2.4 vs.-0.3±2.5, -0.2±0.6 and +0.8±1.9, p=0.04), malondialdehyde (-0.6±0.3 vs.-0.1±0.2, -0.5±0.2 and +0.6±0.4 µmol/L, p=0.009) and a significant rise was seen in total antioxidant capacity (+35.2±21.7 vs.+22.5±37.7, +21.1±34.1 and -153.8±65.2 mmol/L, p=0.006) and glutathione (+216.0±79.3 vs.-47.5±60.2, +3.9±31.3 and -160.8±82.9 µmol/L, p=0.001) compared with vitamin D, calcium and placebo groups.

Conclusion: In conclusion, calcium plus vitamin D supplementation for eight weeks among women with PCOS had beneficial effects on metabolic profiles.