Journal of Clinical Medicine

Background/Objective: Women after cesarean delivery (CD) may feel discomfort and pain until the gastrointestinal (GI) activation. Standard care approaches following an elective cesarean delivery often fail to address the needs of patients. Nurses care for women after CD, managing their symptoms and promoting GI activity to prevent ileus. Randomized controlled trials (RCTs) have shown that gum chewing is an effective method compared to standard care. Additionally, pilot RCTs have found Paula method exercises to be beneficial in comparison to standard care. This study aims to compare the time of first flatus and first defecation between the Paula method group and the gum-chewing group in women after an elective CD. Methods: A randomized controlled trial was conducted with 90 women; forty-four women were randomized to the Paula method exercises, and forty-six to gum chewing. Both groups received standard care. The primary outcomes were the time to the passage of the first flatus and the time to the first defecation from the delivery. Results: There was no significant difference between groups in time to flatus or time to defecation, yet there was a median 8.2 h shortening of time to flatus in the Paula group (19.7 h [IQR 15.7–28.3] in the Paula group versus 27.9 h [IQR 17.6–38.2] in the gum-chewing group). In an exploratory analysis of the first 16 h post-cesarean delivery, the gum-chewing group showed a shorter time to passage of the first flatus compared to the Paula group. Conclusions: Gum chewing is recommended as part of the current guidelines to enhance recovery after surgery, yet it is not suitable for all. While the Paula method appears safe and demonstrates promise, definitive conclusions require validation from larger, adequately powered trials.

Background: Inflammatory bowel disease (IBD) is associated with chronic pain and reduced quality of life, even in the absence of active intestinal inflammation. International studies suggest that fibromyalgia (FM), a chronic pain disorder characterized by widespread musculoskeletal pain, fatigue, sleep disturbance, and multiple somatic symptoms, is more prevalent among patients with IBD than among the general population. However, data from Saudi Arabia are limited. Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, during July and August of 2024. Patients with biopsy-confirmed IBD were identified from hospital records and contacted by phone to screen for FM using a validated Arabic version of the Fibromyalgia Rapid Screening Tool. Demographic data, comorbidities, medication exposure, IBD characteristics, disease activity, and laboratory parameters were extracted from the medical records and compared between patients with and without FM. Results: Of 274 patients with IBD (mean age 30.9 ± 9.2 years; 56.9% male), 51 (18.6%; 95% CI 14.2–23.7) met criteria for FM. Patients with FM tended to be older than those without and were more likely to have comorbidities, particularly thyroid disorders, as well as low Vitamin D levels. Prior 5-aminosalicylic acid use was also more common among patients with FM. Inflammatory markers, hematological indices, IBD phenotypes, and disease activity were similar between the groups. Conclusions: Saudi patients with IBD often have comorbid FM. Routine FM screening in IBD clinics may help avoid misattributing central pain to active inflammation and unnecessary treatment escalation.

Background/Objectives: Hypogonadotropic hypogonadism (HH) is an uncommon but treatable cause of non-obstructive azoospermia (NOA). Fertility can often be restored with gonadotropin therapy. This study evaluated spermatogenic and reproductive outcomes in men with HH-related NOA managed by stepwise gonadotropin therapy, microdissection testicular sperm extraction (microTESE) for persistent azoospermia, and assisted reproduction when indicated. Methods: A retrospective cohort study included 35 men treated between 2010 and 2022. Human chorionic gonadotropin (hCG), with or without follicle-stimulating hormone (FSH), was administered to induce spermatogenesis. Outcomes included sperm appearance in the ejaculate, microTESE sperm retrieval rate in persistent azoospermia, and pregnancy and live birth outcomes after natural conception or in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) when required. Results: Mean gonadotropin therapy duration was 12.0 months (range 6–24). Sperm appeared in the ejaculate in 27/35 men (77%). The remaining 8/35 (23%) underwent microTESE, with sperm retrieved in 7/8 (88%). Seven couples proceeded to IVF-ICSI, undergoing 11 cycles that yielded 6 clinical pregnancies (55% per cycle) and 5 live birth deliveries, including 2 twin pregnancies. Among responders, 13 natural pregnancies occurred, resulting in 13 live birth deliveries, including 2 twin pregnancies. Overall, 18/35 men (51%) achieved biological fatherhood, corresponding to 18 live birth delivery events (4 twin and 14 singleton deliveries) and 22 newborns. Conclusions: In men with HH-related NOA, exogenous gonadotropin therapy is expected to induce spermatogenesis in most patients. MicroTESE provides high sperm retrieval rates for those without ejaculatory sperm. Through an integrated approach of hormonal induction, microsurgical sperm retrieval, and assisted reproduction, approximately half of patients may ultimately achieve biological fatherhood in longer-term follow-up, depending on baseline severity and partner factors.