SAREM JOURNAL OF MEDICAL RESEARCH (SAREM JOURNAL OF REPRODUCTIVE MEDICINE)
Year:2018 | Volume:3 | Issue:2|Papers Count:8

Screening, in the medical field is defined as a program or strategy to survey population about a risk of health-threats by identifying at risk persons. Its goal is early detection for intervention and management and prevention of a disease and its complications. Therefore, a test or method of screening is necessary to have some certain characteristics as its sensitivity, specificity, repeatability, social acceptance by the people as well as feasibility, availability, case of interpretation and cost-effectiveness. It is evident that the illness or the problem for which a continuous screening program is compiled, must be clinically significant, intervenable, preventable and treatable and its early detection must be possible. According to the citeria mentioned above, the screening program for assessing the fetal malformations and trisomic syndromes including trisomy of chromosome 21 (Down syndrome), trisomy of chromosome 18 (Edwards) syndrome, trisomy of chromosome 13 (Patu) syndrome, has been compiled and executed. Therefore, some opportunities, challenges, and common mistakes about the subject are considered in this article. In the population screening programs, massive policy-making and cost-effectiveness calculations are critical issues. Without the accurate cost-effectiveness, cost-benefitness and cost utility analysis, health resources will be wasted and the health outcomes will not be achived. The sources are so important that the general policy program has also undergone changes. Giving an example in this case can be useful. After adding the fetal screening program for Down syndrome to the UK National Health Programs, the research indicated that a balance between the chromosomal abnormalities associated with maternal age and the established resources should exist. Hence, policymakers believed that the funds can cover pregnancies occuring over maternal age of 35 years and all pregnant mothers are not included. Therefore the age of 35 years old was selected as a borderline to perform the fetal screening thus the cut off for moms older than 35 years. Interestingly, the majority of screening consultants in Iran without the sufficient knowledge about the process, over emphasize on the age of older than 35 years. They unwantedly cause fear and presentiment and exert psychological pressure on mothers older than 35 years and their families. They even introduce the mothers with just a few days older than 35 years wih a high risk for fetal malformations. Another mistake is related to the using novel technologies with very sensitive and expensive methods such as cell-free DNA(known as NIPT or NIFTY). Since Iranian people are welcoming to many modern methods, the health service provider centers and laboratories make advertisements encouraging people to use these methods without adequate explanations. Considering public benefit, most of them believe that cell-free DNA method must replace common biochemical marker screening methods for all pregnant women in the country, but this is not cost-benefit at the present time. On the other hand it should be mentioned that although cf DNA method have extremely high sensitivity, they are not diagnostic and have false positives for various reasons such as confined placental mosaicism (CPM) and so on. Therefore the right application and the proper on time use of the facilities with appropriate informed decision making besides, respecting people and providing new opportunities to health services for the Iranians especially in the tertiary centers, must be created. The other notable points in this category are reporting some cases of diseases or syndromes brought up in different studies as an association with the results of screening tests (with lower sensitivity and specificity). However, they haven't been approved in international and national guidelines. It is necessary to know such reports which are not beneficiary for the patients. They also cause trouble for both physician and patient and cause anxiety, bewilderment imposing unnecessary expenses. This can also be problematic from the legal aspect. So the risk of overdiagnosis like misdiagnosis threatens screening methods and even diagnostic methods and both of them can cause harm. The final point on this subject is the importance of the enrichment of the native data bank especially in population-based statistical methods. The accuracy of threshold and mean of median (MOM) defined in these methods whether for sonographic or laboratory (biochemical markers or cell-free DNA) work have high importance. Hence, without having correct threshold amounts ( both are based on population and innate accuracy of the test), the accuracy of the results with acceptable false positive and false negative rates can not be certain.

Aims Unexplained recurrent spontaneous abortion (URSA) might be caused by an immunological rejection of fetus due to the immune dysregulation during pregnancy. It is supposed that the balance between Th17 and regulatory T cells (Treg) is one of the immune system regulatory mechanisms for pregnancy. The objective of the present study was to evaluate the Treg and Th17 cytokines in the women with URSA compared to healthy women. Materials & Methods This case-control study was carried out on 30 women with a history of three or more URSA (case group) and 28 normal healthy women with at least one successful delivery (control group) in Sarem women hospital (Tehran, Iran). The levels of IL-17, IL-21, IL-10 and TGF-β were measured in the serum samples by ELISA method and compared between two groups. The data were analyzed by Mann-Whitney U test and Spearman’ s rank correlation coefficient using SPSS 22 software. Findings The level of IL-17 in the case group was significantly higher than the control group (p<0. 001). Also, the level of TGF-β in the control group was significantly higher than URSA patients (p=0. 001). The serum level of IL-17 showed a positive correlation with TGF-β in URSA group (r=0. 554; p=0. 002). There were no significant differences in IL-21 and IL-10 levels between two groups (p>0. 05). Conclusion The level of IL-17 in patients with URSA is higher than normal healthy women, however, the concentration of TGF-β in women with URSA is lower than healthy women; these findings show that Th17 immunity and regulatory T cell-mediated immune regulation are involved in the pathogenesis of URSA.

Aims Spontaneous abortion is one of the most common complications of pregnancy. Human leukocyte antigen G (HLA-G) is thought to have a mediating role in mother and fetus interactions. The aim of this study was to investigate the association of the +14bp/-14bp polymorphism of HLA-G gene with recurrent spontaneous abortion (RSA) among Iranian women. Materials & Methods This case-control study was conducted on 50 patients with RSA and 50 normal women referred to Sarem women hospital (Tehran, Iran) during a six-month period from October 2012 to March 2013. After preparation of the blood samples and extraction of DNA, the exon 8 of HLA-G gene was amplified by polymerase chain reaction (PCR) and observed by polyacrylamide gel electrophoresis. Statistical analysis of data was done by Chi-square test using SPSS software. Findings There was a significant difference in the frequency of homozygous genotypes between patient and control groups (p=0. 034). The homozygous genotypes of +14bp or-14bp were found more frequently in patients with RSA (60%) than the control group (34%). The odds ratio (OR) for homozygous genotypes relative to heterozygote genotype was found as 2. 91. Conclusion The frequencies of heterozygous and homozygous genotypes of the polymorphism, +14bp/-14bp of the HLA-G gene, differ between Iranian women with a history of RSA and healthy women.

Aims Job satisfaction among staffs has considerable effects on personnel functions in any organization, overall organizational performance, satisfaction of clients, and improving the quality of organizational processes. The objective of this study was to investigate the effects of socio-cultural status, demographics, economical-livelihood and quality of life of staffs on their job satisfaction in Sarem women’ s hospital, Tehran, Iran. Materials & Methods This descriptive-analytical study was conducted on staffs from Sarem women’ s hospital in 2014. The information of the staffs (n=200) was obtained by census method and reviewing their documents. A standard job satisfaction questionnaire was used to collect the information. Data were analyzed using SPSS 22 software by Pearson correlation coefficient. Findings There were no significant correlations between age, the level of education, academic major, family guardianship, number of employed persons, residential status and monthly income with overall satisfaction (p>0. 05); however, significant correlations were found between marital status and number of supported persons with overall satisfaction (p<0. 05). There were significant correlations between the overall scores of the socio-cultural factors and demographics with job satisfaction (p<0. 05), while no significant correlations were found between the overall score of the economic-livelihood status and quality of life of the personnel with their job satisfaction (p>0. 05). Conclusion The socio-cultural status and demographics have the greatest effects on the overall satisfaction of the staffs in Sarem women’ s hospital, while the economic-livelihood status and quality of life have no effects on their overall satisfaction.

Introduction Before foundation of the midwifery school, there was no classical education on midwifery and only traditional midwives undertook this responsibility. The lack of knowledge in this field led to the high rate of maternal and neonatal mortality. The aim of this study was to explore a historical period of midwifery education, in which the maternal and neonatal mortality rate decreased. Lack of exploration on the history of midwifery education in Iran and lack of information about its process are the deficits of Iranian medical history. In order to achieve the historical evidence on the midwifery history in Iran, the documents of formal midwifery education available at the National Library and Archives Organization of Iran were reviewed. Conclusion Midwifery in Iran was performed traditionally and based on the personal experiences of people up to 1919. In this year, Mirza Ahmad Khan Nassiroddowleh, the Minister of Education, ordered that the French high school for girls called “ Franco-Prussian” be changed to “ Dar-Al-Moallemat” and 10 students of the high school go to the women’ s hospital 3 days a week to study midwifery and gynecological diseases. Dr. Mathilde Dremps was recruited as a gynecologist to teach them; thus, the midwifery school was founded. After that, even the traditional midwives were requested to pass the exams.

Introduction Recurrent Spontaneous Abortion (RSA) is one of the most common complications in reproductive ages. Several factors such as genetic, anatomical, and endocrine disorders, infection, and environmental and immunological factors have been involved in RSA. In cases of abortions, whose reasons are known, the chance of success in pregnancy can be increased after the elimination of the defective factors; but, in women with a history RSA with an unknown reason, there is an imbalance in the regulatory mechanisms of immune cells, and even the pattern of immunological cells changes in these women. Actually, an inappropriate immune response is often associated with pregnancy loss. Immunologic factors involved in patients with RSA have gradually been identified, using diagnostic methods and several studies. The present study was conducted with the aim of reviewing RSA immunology and new findings in this field. In this study, more than 40 articles on immunologic factors involved in RSA were reviewed. Conclusion Based on the current findings related to the immunology of pregnancy, due to the extensive role of the immunologic factors in this disorder, more accurate identification of the functional role of each immunologic factor becomes more important. Also, new therapeutic approaches will be addressed to the researchers in this field based on the changes in the function of immune system.

Patient Information Spontaneous splenic transplantation and implant in in abdominal and pelvic regions is splenosis, which occurs after splenectomy followed by trauma and surgery. The clinical significance of splenic implant and the requirement for its removal are debatable. The cases of splenic implants in the pelvic zone have rarely been reported. Generally, these patients have no clinical features and are usually discovered by chance. In this report, a 36-year-old woman with the history of splenectomy after an accident at the age of 4 was introduced with Dysmenorrhea and infertility; the primary diagnosis was endometriosis, but pathology results reported the splenosis. Whole tissues and implants of spleen around the ovary and choledosac were removed; following this, the patient’ s pain was reduced and the overall health improved. Conclusion Splenosis can emerge as a benign condition in the abdomen and pelvis, and can show itself as a spread of tissue implants in the pelvic cavity. It can, however, easily be mistaken for endometriosis in imaging.

Patients Information Farber’ s lipogranulomatosis or ceramidosis is a rare lysosomal storage disease with autosomal recessive transmission. This disease is caused by the ceramidase acid deficiency, which leads to the accumulation of ceramides in the tissues. Children with a clear neuropathy die early in infancy, and those with no or negligible neurologic symptoms develop malignant deformation due to the appearance of granuloma in the joints, subcutaneous nodules, acoustic harshness and respiratory failure, and, ultimately, interstitial pneumonia; they die in the third and fourth decades. In this study, 6 patients with Farber disease (5 females and 1 male) were examined in the last 7 years. In most patients, clinical symptoms included stiffness of joints and pain, weak cry, and granules around the joints. Three patients had large liver and spleen. All patients were genetically evaluated. Conclusion We analyzed acid ceramidase gene and detected 4 novel mutations on them. Currently, 3 patients are alive.