Introduction: Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic disease (GTD) that is usually associated with high mortality compared to the other subtypes because of its unpredictable biological behavior, less responsiveness to chemotherapy, and poor prognosis. Case Presentation: We present a 27year old nulliparous lady referred to our centre for recurrent vaginal bleeding following two evacuations for an incomplete spontaneous miscarriage after eight weeks of amenorrhea. Her assessment revealed low serum beta-human chorionic gonadotropin (βhCG) and high human placental lactogen (hPL) levels. Ultrasound scan and Doppler study showed a highly vascular tumor infiltrating the myometrium. She strongly desired to preserve her fertility and was initially commenced on low dose Methotrexate with marginal reduction in tumor volume and resistance on higher dose. She responded well to combination chemotherapy and the tumor disappeared after the second course. She received three additional courses and was followed up with serial ultrasonography for one year. She subsequently conceived spontaneously, with vaginal delivery of a live, normal female baby at term. Conclusion: Though hysterectomy combined with chemotherapy is the recommended management for PSTT and serum hPL is the usual tumor marker for follow-up, we present a case of successful treatment with combination chemotherapy alone and follow-up with subsequent cure, spontaneous conception, and delivery of a live baby.
According to the literature, COVID-19 vaccines reduce long COVID-19 symptoms such as cognitive dysfunction, kidney diseases, myalgia, and sleeping disorders (5-7). Therefore, the results of the meta-analysis support the clinical safety and efficacy of SARS-CoV-2 vaccines against long COVID-19. However, the available studies have several limitations: 1) there were individuals that exhibited natural improvement of long COVID-19 symptoms which may have been underestimated as vaccination in clinical setting; 2) studies used wide range of COVID-19 vaccines including both inactivated vaccines and mRNA COVID-19 vaccines. Thus, findings should be interpreted with caution. Since booster vaccines show great promise in both prevention of infection and progression, further research on boosters and omicron-specific vaccination is needed to be performed. Consequently, the current comprehensive literature recommends SARS-CoV-2 vaccine to reduce the risk of long COVID-19 in cases of progression. There are no findings of a negative effect of COVID-19 vaccination on worsening symptoms of COVID-19. Therefore, SARS-CoV-2 vaccination should be improved as soon as possible, especially offering a full course of vaccination. More research is needed to discover the mechanism of action of the COVID-19 vaccines on long COVID-19 in the future.
Background: Effective trauma management requires specialized skills, and advanced technologies such as Virtual Reality (VR) can enhance medical education. This study aimed to evaluate the effectiveness of VR-based educational content in training emergency medicine students on managing multiple trauma victims. Materials and Methods: This educational study involved 40 emergency medicine students who were randomly assigned to two groups. The first group underwent VR-based training in pairs (two students per team) over four sessions, focusing on multiple trauma scenarios. The second group practiced scenario simulations using moulages. Both groups received feedback after each session and had the opportunity to repeat the scenarios. Results: In this study, the performance of 40 emergency medicine students was evaluated using pre- and post-tests. The results demonstrated that both educational methods—Virtual Reality and live simulation—significantly enhanced student performance. A comparison between the two approaches revealed no significant difference in effectiveness, as both methods led to comparable improvements. Conclusion: Virtual Reality was recognized as an effective tool for teaching trauma management and could be widely used in clinical education. However, further studies are necessary for a more comprehensive evaluation and to establish the effectiveness of this technology in educational settings.
Introduction: Polycystic ovarian syndrome (PCOS) is one of the most common hormonal disorders affecting women of reproductive age. Numerous studies have suggested the involvement of inflammation in the pathogenesis of PCOS. As a result, drugs with anti-inflammatory effects may offer therapeutic benefits for this condition. The standard medications used in treating PCOS include cyproterone compound (cyproterone acetate + ethinyl estradiol) combined with spironolactone, metformin, and pioglitazone. This study aimed to compare the effects of these drugs on the serum levels of inflammatory markers, including hs-CRP, C3, and C4, in women with PCOS.Materials and methodsNinety women with PCOS were randomly assigned to three treatment groups for 90 days as follows: Group CC-SP received cyproterone compound (cyproterone acetate 2 mg + ethinyl estradiol 35 µg) daily, along with 100 mg/day spironolactone; Group M received metformin (1500 mg/day); and Group P received pioglitazone (30 mg/day). Serum levels of hs-CRP, C3, and C4 were measured before and after treatment.Comparisons of changes in variables between groups were performed using the ANOVA test. Additionally, covariance (ANCOVA) analysis was used to examine differences between groups, adjusting for confounding variables. Probability values of ≤ 0.05 were considered statistically significant.ResultsThe C3, C4, and hs-CRP levels were increased in the CC-SP group while significantly decreased in the pioglitazone group (p<0.05). These changes were not statistically significant in the metformin group.ConclusionsPioglitazone reduces the serum levels of inflammatory markers and may be effectively combined with cyproterone and spironolactone in the treatment of PCOS.
This article systematically reviews the psychological and professional injuries psychotherapists experience during therapy sessions. A comprehensive search was conducted across databases such as PubMed, PsycINFO, Scopus, and Noormags to identify relevant studies. The findings revealed that psychotherapists are exposed to significant risks, including burnout, occupational stress, secondary trauma, and empathy fatigue, all of which can severely impact their mental health, job satisfaction, and professional performance. These risks are influenced by various factors, such as the type of clients they work with, the severity of mental health issues presented by clients, and the duration of therapy sessions. Effective mitigation strategies, such as developing structured self-care programs, promoting psychological exercises, and fostering a supportive organizational culture, were highlighted as essential. Additionally, providing professional counseling, reducing workloads, and enhancing work-life balance are key measures to address these challenges. Further research is crucial to explore innovative and effective strategies for reducing these occupational hazards and improving psychotherapists' well-being.
