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The purpose of the present study was to study the efficacy of cognitive rehabilitation in enhancing the numerical calculations, comprehension, and production abilities of students with special learning disabilities in the subject of mathematics. The current study employs a quasi-experimental design. Students who were referred to the four centers for learning disabilities in Rasht in 2019 (Dehkhoda 1 and 2, Shahid Yaghoubi, and Shahid Eskandari) comprised the statistical population of the study. A sampling method that was readily accessible was utilized, with a sample size of 30 males. The participants were divided into two groups of 15 (experimental and control) at random. To this end, the group “Experiment” underwent a 12-session cognitive rehabilitation intervention of memory and attention utilizing software (ARAM).Data for the pre-test and post-test phases were collected using the Key Math Scale (KMDT), RAVEN intelligence test (RCPM), Academic Achievement and Mathematical Diagnosis Test (SATDMA), and Mathematical Reinforcement Training Program Based on Intervention Response Model (MRTPBIRP).Multivariate covariance and SPSS-22 software were utilized to analyze the data. Students with special learning disabilities have demonstrated an increase in the utilization of numerical comprehension, numerical production, and numerical calculation as components of their cognitive rehabilitation in mathematics, according to the findings. Based on the findings, it can be concluded that cognitive rehabilitation programs have been effective in improving comprehension, production and numerical calculations and can be used as part of empowerment programs in the field of education.

The evaluation of saturated hydraulic conductivity (Ks) constitutes an invaluable tool for the management and protection of groundwater resources. This study attempted to estimate Ks in the shallow aquifer of Kabul City, Afghanistan, in response to the occurring groundwater crisis caused by overexploitation and a lack of an appropriate monitoring system on pumping wells, based on datasets from well drilling logs, various analytical methods for pumping test analyses, and laboratory-based methodologies. The selection of Ks estimation methods was influenced by data availability and various established equations, including Theis, developed by Cooper–Jacob, Kruger, Zamarin, Zunker, Sauerbrei, and Chapuis, and pre-determined Ks values dedicated to well log segments exhibited the highest correlation coefficients, ranging between 60% and 75%, with the real conditions of the phreatic aquifer system with respect to the drawdown rate map. The results successfully obtained local-specific quantitative Ks value ranges for gravel, sand, silt, clay, and conglomerate. The obtained results fall within the high range of Ks classification, ranging from 30.0 to 139.8 m per day (m/d) on average across various calculation methods. This study proved that the combination of pumping test results, predetermined values derived from empirical and laboratory approaches, geological description, and classified soil materials and analyses constitutes reliable Ks values through cost-effective and accessible results compared with conducting expensive tests in arid and semi-arid areas.

Study region: Zohreh River Basin, Southwest Iran Study focus: The salinity of Zohreh River sharply increases in three salinity zones (SZs) along the river named SZ1, SZ2 (the focus of this study), and SZ3. Determining the salinity sources and salinization mechanism using an integrated approach including geological, hydrochemical, isotopic, geophysical, river sinuosity and hydrocarbon analysis are the main objectives of this study. The study focuses on the combination of evidence of regional-scale (i.e., river sinuosity and seismic data) and small-scale (i.e., drilling core analysis). New hydrologic insights for the region: Among several known sources of river salinity, it was found that the water quality of the Zohreh River is mainly threatened by the salt-bearing Gachsaran Formation and oil-field brine. It is concluded that halite brine and oil-field brine simultaneously cause the salinization in SZ2, and their contributions were delineated to be 95% and 5%, respectively. The lack of reliable geological evidence to support halite dissolution in surficial layers by circulating waters suggests the possibility of a deep source of halite brine in SZ2. The results revealed that deep halite brine of the salt layers of Gachsaran Formation is mainly responsible for the salinization of SZ2. The mechanism of deep brine penetration to the river through the hidden fault failures detected by the combination of river sinuosity analysis and geophysical data for the first time.

It is widely accepted that spring hydrographs are an effective tool for evaluating the internal structure of karst aquifers because they depict the response of the whole aquifer to recharge events. The spring hydrograph is affected by various factors such as flow regime, geometry, type of recharge, and hydraulic properties of conduit. However, the effect of conduit network geometry received less attention and required more comprehensive research studies. The present study attempted to highlight the impact of the two most frequent patterns of karst conduits (i.e., branchwork and network maze) on the characteristic of the spring hydrograph. Therefore, two conduit patterns, branchwork and network maze, were randomly generated with MATLAB codes. Then, MODFLOW-CFP was used to quantify the effect of conduit pattern, conduit density, and diffuse or concentrated recharge on the spring hydrograph. Results reveal that peak discharge, fast-flow recession coefficient, and the return time to baseflow are mainly affected by conduit network pattern, conduit network density, and recharge, respectively. In contrast, the time to reach peak flow only reacts to recharge conditions. Large variations in conduit density produce tangible changes in the baseflow recession coefficient.

Purpose: Traditionally, an omental flap is employed to reduce the risk of recurrence of vesicovaginal fistula (VVF) repair. In this study, we employed a modified surgical technique wherein the vaginal defect was closed using Connell sutures, without incorporation of an omental flap, aiming to mitigate potential complications., Material and Method: Between 2010 to 2018, the current randomized clinical trial was conducted on 52 women who were candidates for open fistula repair. The patients were randomly allocated into two groups. In one group, the conventional method of fistula repair was performed involving an omental flap, while in the other group, we used a modified approach with a variation in the vaginal wall closure technique. In-hospital variables, including the length of surgery, hospital stay, and occurrences of ileus, were recorded. Patient follow-up extended for one year, with assessments conducted one, six, and twelve months postoperatively. These evaluations encompassed pad test to ascertain success rates and identify any potential complications., Results: The final analysis comprised 49 patients, with an average age of 46.5 years. Baseline characteristics were comparable between the two groups (P-values > 0.05). The modified technique was associated with significantly reduced surgical duration (P = ˂ 0.001), and shorter hospital stays (P < 0.001). Ileus occurrence was reduced, but it was not significant(P = 0.856). However, the success rate showed no significant difference between the groups, with a success rate of 100% for the modified technique compared to 91.6% for the classic O'Conner method (P = 0.288)., Conclusion: Based on the findings of this study, vaginal wall closure using Connell sutures during VVF repair demonstrates a success rate equivalent to the classic approach involving an omental flap. Moreover, this technique presents a reduced incidence of adverse effects, along with decreased surgical duration, hospital stay, and postoperative ileus.

Introduction and Hypothesis: Genitourinary fistula is a devastating ailment that has an impact on women's physical health, mental health, emotional health, and financial security. The management of genitourinary fistula depends on the type, size, and duration of fistula formation. The purpose of this study is to report the features of genitourinary fistula in Iranian women and our experience in the management of fistula., Methods: Retrospective chart reviews of 283 patients were performed to determine the cause of the fistula, prior repairs, tissue interposition, and the success rate. The operation was considered successful if the patient did not have any urine leakage during the observation time., Results: The mean (SD) age of women was 49.51 (19.39; range: 21-70) years, Of these, 137 (52.9%) had a history of previous genitourinary fistula surgery. The average fistula was 1.53 (0.041) cm in size. The median (interquartile range) operation lasted 70 (15) min. The success rate after fistula repair was 91.5%. The typical follow-up period lasted 13.26 (range: 1-88) months. Forty-three (15.2%) patients had a big fistula (>2.5 cm) and 4 patients (1.4%) had a history of pelvic radiation therapy, among other reasons for failure. After a second repair, all patients' initial failures were resolved. There were no significant complications, as classified by Clavien-Dindo class 2 or greater. Additionally, there were no bowel, ureteral, or nerve injuries., Conclusions: Our patients with genitourinary fistula had a successful outcome following repair techniques, without any significant morbidity or mortality., (© 2024. The International Urogynecological Association.)

Introduction and Hypothesis: Abdominal Sacral Colpopexy (ASC) is one of the best surgical methods to repair apical or uterine prolapse. We aimed to evaluate the short-term results of a triple-compartment open ASC strategy using polyvinylidene fluoride (PVDF) mesh in the treatment of patients with severe apical or uterine prolapse., Methods: Women with high-grade uterine or apical prolapse with or without cysto-rectocele were prospectively enrolled in the study from April 2015 to June 2021. We performed all-compartment repair using a tailored PVDF mesh for ASC. We assessed the severity of pelvic organ prolapse (POP) using the Pelvic Organ Prolapse Quantification (POP-Q) system at baseline and 12 months after the operation. The patients completed the International Continence Society Questionnaire Vaginal Symptom (ICIQ-VS) questionnaire at baseline, 3, 6, and 12 months postoperatively., Results: Thirty-five women with a mean age of 59.8±10.0 years were included in the final analysis. Stage III and stage IV prolapse was evident in 12 and 25 patients, respectively. After 12 months, the median POP-Q stage was significantly lower compared to the baseline (4 vs 0, p=<0.0001). Vaginal symptoms score was also reduced significantly at 3-month (7.5±3.5), 6-month (7.3±3.6), and 12-month (7.2±3.1) compared to the baseline (39.5±6.7) (p values < 0.0001). We did not observe any mesh extrusion or high-grade complications. Six (16.7%) patients had cystocele recurrence during the 12-month follow-up, and two of them needed reoperation., Conclusions: Our short-term follow-up showed that using an open ASC technique with PVDF mesh in treating high-grade apical or uterine prolapse is associated with a high rate of procedural success and low rates of complication., (© 2023. The International Urogynecological Association.)

Purpose:  The urodynamic study is an invasive test, and causes pain and stress in the patient. We have investigated the effect of rectal midazolam sedation on the pain, stress, and cooperation of women performing urodynamic study.  Materials and Methods: At the present randomized clinical trial (RCT) from January to July of 2021 a total of 84 women were prospectively randomized to undergo urodynamic study with or without sedation. The primary outcome of interest was experienced pain during urodynamic study. In the intervention group, after monitoring baseline vital signs (heart rate, blood pressure, O2 saturation), sedation was done with rectal midazolam at a dose of 0.3 mg/kg (maximum 15 mg). Completing the procedure, after recovery from sedation patients were asked to fill a self-assessed visual analog pain scale (VAS, 0-10), 5-point visual stress scale (1-5) and, patient collaboration level during urodynamic study was evaluated by nurse with a researcher-made tool (0-3). In the control group test was performed in routine practice with no sedation. Baseline vital signs measured pre and intra-procedural time, as well as their experienced pain, stress, and cooperation levels were recorded.  Results: 84 female cases were evaluated. In terms of comparison of changes in pre and intra-test physiologic parameters, results showed that there were no significant differences between the two groups for all physiologic parameters: SBP, DBP, PR, SpO2. Analysis of the pain score showed that it was lower in the intervention group, and there was a significant difference in pain score between the two groups (P =.024). While the stress and corporation scores were not reported statistically significant (P=.388 and P=.955, respectively)., Conclusion:   Sedation with rectal midazolam in adult women before UDS is safe and effective in reducing pain but is not effective in reducing stress and increasing cooperation. The amount of pain based on the visual analog pain scale is mild and although this method is safe, its use routinely is not recommended.

Background: Blood loss of postoperative after prostate surgery could be related with an increase in urinary fibrinolytic activity. Tranexamic acid (TXA) is both a potent inhibitor of plasminogen and urokinase activators and a low molecular weight substance that is excreted unchanged in the urinary tract and can be administered both orally and intravenously. This study aimed to evaluate the effectiveness TXA administration in reducing bleeding in benign prostatic hyperplasia (BPH) patients who underwent open prostatectomy., Materials and Methods: This double-blind randomized clinical trial was conducted on patients with BPH who underwent open prostatectomy. The first group received TXA (1 gr IV from during surgery to 48 h after surgery, 3 times/day). Twenty-four hours after surgery, the two groups were compared in terms of bleeding rate. Hemoglobin (Hb), hematocrit (HCT), and platelet (Plt) counts were also assessed before and after the intervention., Results: Intervention and control groups were comparable in terms of basic and baseline values of variables at the beginning of the study ( P > 0.05). The mean bleeding volume in TXA group was significantly lower than the control group 112.11 ± 53.5 and 190.00 ± 97.5 CC; P ≤ 0.001). Mean hospitalization (3.28±0.46 vs. 4.38 ± 0.95 days P < 0.001) and surgery duration (98.11 ± 37.11 vs. 128.00 ± 39.12 h; P = 0.001) were significantly lower in TXA group compared to control intervention., Conclusion: According to the findings of the current study, the administration of TXA led to reduce bleeding in BPH patients who underwent open prostatectomy. Furthermore, the mean Hb, HCT, levels were significantly affected by TXA. TXA treatment approach also can reduce the surgery and hospitalization time effectively. TXA approach is recommended as effective procedure in BPH patients who underwent open prostatectomy., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Research in Medical Sciences.)

Introduction and Hypothesis: To study the mid-term safety and functional outcomes of transvaginal anterior vaginal wall prolapse repair using polyvinylidene fluoride (PVDF) mesh (DynaMesh®-PR4) by the double trans-obturator technique (TOT)., Methods: Between 2015 and 2020, we prospectively included women with symptomatic high-stage anterior vaginal wall prolapse with or without uterine prolapse or stress urinary incontinence (SUI) in the study. The patients underwent transvaginal repair of the prolapse using PVDF mesh in two medical centers. We followed all patients for at least 12 months. We recorded the characteristics of vaginal and sexual symptoms, urinary incontinence, and prolapse stage pre- and postoperatively using International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Urinary Incontinence-Short Form (ICIQ-UI-SF), and Pelvic Organ Prolapse Quantification (POP-Q) system, respectively., Results: One hundred eight women were included in the final analysis with a mean follow-up time of 34.5 ± 18.6 months. The anatomical success was achieved in 103 (95.4%) patients. There was a significant improvement in patients' vaginal symptoms, urinary incontinence, and quality of life scores postoperatively (p < 0.0001). Only six patients (5.5%) had mesh extrusion, five of whom were managed successfully. The total rates of complications and de novo urinary symptoms were 21.3% and 7.4%, respectively. Significant pain was reported in 17 cases (15.7%)., Conclusion: Our findings show that using PVDF mesh in the double TOT technique for anterior vaginal wall prolapse repair is a safe procedure with high anatomic and functional success rates and acceptable complication rates in mid-term follow-up., (© 2021. The International Urogynecological Association.)

Objective: To define the prevalence of hypothyroidism in women with chronic lower urinary tract symptoms (LUTS) and to compare the severity of each symptom between patients with hypothyroidism and controls., Subjects and Methods: In this prospective observational study, we screened all adult women who came to the urology clinic between March 2017 and September 2020, and enrolled patients with chronic LUTS in the study. We assessed thyroid function. We evaluated the severity of voiding and storage urinary symptoms by the International Prostate Symptom Score. We also assessed the severity of urge urinary incontinence (UUI) and stress urinary incontinence (SUI). For between-group analysis, we selected age-matched cases and controls and compared them regarding the distribution and severity of urinary symptoms., Results: Seven hundred and twenty-five women with a mean age of 51.7 ± 14.0 years were included in the final analysis. Two hundred fifty-eight patients (35.6%) had hypothyroidism. Age-matched case and control groups consisting of 210 patients each were selected. There was no significant difference in the severity and distribution of voiding LUTS and UUI between the study groups (P values >0.05). The severity of storage symptoms was lower in patients with hypothyroidism (P = 0.04). Sixty-seven patients with hypothyroidism (31.9%) had SUI, which was significantly higher than controls (23.3%) (P = 0.03)., Conclusion: More than one-third of women with chronic LUTS have hypothyroidism which is much more frequent than in the general population. We also suggest a possible relationship between hypothyroidism and the severity of SUI and an inverse relationship between hypothyroidism and storage symptoms., (© 2022 John Wiley & Sons Australia, Ltd.)

Aim: This study focused on women with chronic lower urinary tract symptoms (LUTS) who simultaneously suffered from obsessive-compulsive disorder (OCD) to evaluate the association between micturition abnormality and OCD., Methods: A cohort case study was conducted on 128 women with chronic LUTS who visited the academic clinic from 2012 to 2018. The participants with a history of OCD were grouped together, whereas the other group consisted of those with no psychiatric issues. Data were analyzed using the Kolmogorov-Smirnov test and also the nonparametric Kruskal-Wallis and χ 2 tests., Results: The participants with OCD had a lower mean age (41.7 vs. 48.8 years) and longer symptom duration than the control group. Moreover, voiding phase problems were more prevalent among OCD patients (mean voiding score: 9.3 vs. 6.9). Urge urinary incontinence (UUI) was the most common type of urinary incontinence in OCD patients, and the most important urodynamic study finding was bladder outlet obstruction (45% and 17% in the OCD and control groups, respectively). Voiding disorders resulted in chronic renal failure in two patients (3.12%). It was shown that bladder outlet obstruction (odds ratio (OR) 4.43, 95% confidence interval [CI] 1.53-12.78, p = 0.006] was the strongest predictor of OCD and stress urinary incontinence (OR 0.20, 95% CI 0.07-0.53, p < 0.001) was the best protector against OCD., Conclusion: The findings revealed that chronic LUTS was related to voiding dysfunction and urodynamic abnormality in OCD patients. These disorders may be categorized as somatoform disorder that requires appropriate treatments., (© 2021 Wiley Periodicals LLC.)

Background: The combination of MRI-guided targeted biopsy (MRGB) with systematic biopsy (SB) provides the highest accuracy in detecting prostate cancer. There is a controversy over the superiority of fusion targeted biopsy (fus-MRGB) over cognitive targeted biopsy (cog-MRGB). The present head-to-head randomized controlled trial was performed to compare diagnostic yield of fus-MRGB in combination with SB with cog-MRGB in combination with SB., Methods: Biopsy-naive patients with a prostate-specific antigen level between 2 and 10 ng/dL who were candidates for prostate biopsy were included in the study. Multiparametric MRI was performed on all patients and patients with suspicious lesions with Prostate Imaging Reporting and Data System score of 3 or more were randomized into two groups. In the cog-MRGB group, a targeted cognitive biopsy was performed followed by a 12-core SB. Similarly, in the fus-MRGB group, first targeted fusion biopsy and then SBs were performed. The overall and clinically significant prostate cancer detection rates between the two study groups were compared by the Pearson χ 2 test. McNemar test was used to compare detection rates yielded by SB and targeted biopsy in each study group., Results: One-hundred men in the cog-MRGB group and 99 men in the fus-MRGB group were compared. The baseline characteristics of patients including age, PSA level, prostate volume, PSA density, and clinical stage were similar in the two groups (p > 0.05). Both the overall and clinically significant prostate cancer detection rates in the fus-MRGB group (44.4% and 33.3%, respectively) were significantly higher than cog-MRGB group (31.0% and 19.0%, respectively) (p = 0.035 and p = 0.016, respectively)., Conclusion: The accuracy of identifying overall and clinically significant prostate cancer by fus-MRGB in biopsy-naive patients with PSA levels between 2 and 10 ng/dL is significantly higher than cog-MRGB and if available, we recommend using fus-MRGB over cog-MRGB in these patients., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)