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Background: Most of abortions occur before the 13th week of pregnancy. Nowadays, non-surgical approaches for evacuation of uterine have been replaced with surgical ones due to the reduction in bleeding, fewer complications, ease of management, and cost-effectiveness. Misoprostol is a prostaglandin E1 analog that is used for labor induction. It is known as a safe drug with very few side effects. Case Presentation: A 29-year-old woman with the gestational age of 11 weeks and 6 days with a diagnosis of cystic hygroma introduced herself to the labor ward. At the time of hospitalization, the patient was conscious. The heart sounds were normal. A vaginal exam indicated no pathological findings. Totally, she received 1000 mg of Misoprostol. Approximately, 2 hours after the last placement of Misoprostol, the patient developed bending and mild cyanosis of fingers and showed tachycardia with a pulse rate of 140 beats/min. Her O 2 saturation decreased to 78%. At this time, the patient had a successful miscarriage. Echocardiography showed an ejection fraction of 55% and normal right ventricular size. The electrocardiogram showed sinus tachycardia. Therefore, she was sent to CCU with a possible diagnosis of embolism. The cardiologist administered a heparin drip of 5000-unit IV stat, and 1000 unit/h heparin and asked for a D-Dimer test. However, the laboratory reported that the patient’s blood sample was hemolyzed and they could only check her hemoglobin which was 4 g/dl. Immediately, the heparin drip was held and the patient received 3 packed cells. Her Hb was 6.5 g/dl. 12 hours later she showed tachycardia, and her O 2 saturation reduced to 70%. She lost her consciousness. Nearly 40 minutes later, she had cardiorespiratory arrest and CPR wasn’t successful and she died. Conclusions: In Conclusion, even a frequently used drug such as Misoprostol can cause life-threatening side effects, leading to emergent situations.

Background: There are various approaches in primary health care regarding the key role of nurses. This systematic review investigates the roles of nurses, as part of the family medicine team. Materials and Methods: All published articles related to the role of nurses in the family medicine team from January 2000 to March 2022 were the subjects of this study. The eligibility criteria included original articles published in English or Persian in the last two decades. International credible scholarly databases (PubMed, Scopus, Magiran, IranMedex, and SID) were searched using keywords and syntax. Some of the keywords included “Family Health Nurse,” “Nurses in Primary Care,” “Family Medicine,” “Family Physician Care Program,” “General Physician Program,” “Role,” and “Nurse.” Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) technique and reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: Of 147 identified publications by the search strategy, eight eligible empirical studies were included. The results showed that besides providing nursing care, nurses play vital roles in communication and teamwork, assessment, securing health services relevant to communities' needs, education, empowerment, clinical practice, health promotion, prevention, reflective research practice, and counseling. Conclusions: This study identified different roles nurses could play in providing primary health care. These findings are helpful for the replanning or reform of primary health care in countries, which aimed to expand the Family Physician Program (FPP) in their countries, including Iran.

Background: General anesthesia (GA) for caesarean section (CS) has distinctive characteristics that may increase the risk of awareness during GA (AGA). Objectives: The aim of this study was to investigate the incidence of unintended awareness during GA (AGA) in CS. Materials & Methods: This cross-sectional descriptive study was performed in Alzahra Hospital in Rasht City, Iran. Eligible women with term pregnancy candidates for CS under GA were enrolled in this survey from May 2018 to August 2021. After delivery, a questionnaire including demographic data and questions related to different stages of anesthesia was completed via a faceto- face interview. The collected data were analyzed using repeated measurement, the Chi-square, Fisher exact, and t-test in SPSS v. 21. Results: The data from 174 women were analyzed, and 12 (6.9%) experienced AGA. Among them, dreaming and feeling the manipulation of the surgical area (27.8%) were the most common reported awareness states. Body mass index had a significant (P=0.034) relationship with AGA, but age (P=0.843), the level of education (P=0.714), history of anesthesia (P=0.552), 5-minute Apgar score (P=0.49), and surgery time (P=0.686) had no significant relationship with AGA. Conclusion: The incidence of AGA during CS was almost close to the high limit established by the credible evidence, and a significant number of the women were not in completely acceptable conditions. Therefore, the management of GA for CS should be revised in this academic hospital.

Abstract Background and Aims In anesthesia practice, aminophylline is clinically used to treat bronchospasm. However, due to its antagonistic effect on adenosine, studies have recently focused on the drug's ability to enhance the recovery profile. The aim of this study was to investigate the hypothesis that the administration of aminophylline leads to better recovery after general anesthesia in hysterectomy. Methods This randomized controlled double‐blinded study, was conducted at Alzahra academic hospital in Guilan, Iran. During December 2022 to March 2023, 70 eligible women scheduled for elective abdominal hysterectomy were divided into two groups. Group A: received 3 mg/kg IV aminophylline diluted in 100 mL of normal saline and Group C: received 100 mL IV normal saline. The time to recovery of consciousness, tracheal extubation and discharge from post anesthesia care unit were recorded. In addition, heart rate, and mean arterial blood pressure were measured at 10 point times including; baseline (T0), immediately before the administration of aminophylline (T1), every 5 min until the end of the surgery(T2,T3,T4,T5,T6), and every 15 min in PACU(T7,T8,T9). Results There was no significant difference in terms of demographic data between the study groups. Comparing the two groups, the time of ROC was shorter in Group A than group C; 5.95 ± 1.12 and 8.5 ± 1.77 for Groups A and C, respectively (p

The family physician program (FPP) is one of the most significant health care reforms in Iran; however, many studies showed that this program has not been able to achieve its intended objectives because of a variety of challenges. This program, despite the existing challenges, is going to be expanded across the country. To improve the likelihood of its success, identification of the structural and infrastructural challenges is necessary. This systematic review was conducted to assess the structural and infrastructural challenges of FPP in Iran. This systematic review of the literature was conducted in order to investigate the infrastructure and structure needs of the current program in Iran. All published articles related to the FPP in Iran were the subject of this study. The eligibility criteria included original articles, reviews, or case studies published in English or Persian during 2011–2021 related to the challenges in the referral system of FPP in Iran. Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type technique and were reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. International credible scholarly databases were searched. The search strategy was defined based on keywords and the search syntax. This study identified different challenges of the referral system in the areas associated with legal structure, administration, and social structure. The identified challenges in this program should be addressed in order to ensure that this program will lead to improved quality of care and equity in Iran health care system.

Background and purpose: Female sexual dysfunction (FSD) is a high-frequent multifactorial problem and may have a major effect on the quality of life. This study was conducted to investigate frequency of female sexual dysfunction and its correlated factors in women attending outpatient gynecological clinics. Methods: A total of 300 married women attending four gynecological outpatient clinics in Rasht, Iran were assessed. Sexual function was evaluated through Female Sexual Function Index (FSFI) questionnaire. Demographic characteristics, obstetric and surgical history, some medical conditions and body mass index (BMI), life style variants, knowledge about sexuality, and help-seeking behavior were assessed by a self-created questionnaire. Statistical analysis included Fisher exact test Chi-square and Spearman’s correlation coefficients. Results: 76.67% of all women in this study reported sexual dysfunction in at least one domain. The total frequency of FSD according to the low total FSFI score was 18.3%. The most frequent dysfunction was desire disorders (63.7%). The frequencies of other sexual disorders were as follows: pain disorders (35.7%), arousal disorders (34.7%), orgasmic disorders (16%), lubrication disorders (10.7%), and satisfaction disorders (10.7%). Age, number of deliveries, number of children, number of abortions, menopause, mode of delivery, episiotomy, anemia, psychiatric disease, psychotropic medication use, poor sexual knowledge, and husband’s age showed a significant statistical correlation with low total FSFI score. Women who thought they had a sexual problem involved 15.3% of all subjects, of which 67.4% have had no professional consultation about it. Conclusion: FSD is highly frequent in women referred to gynecological clinics. Thus, more attention to the state of women’s sexual health is recommended.