مجله تعالی بالینی
سال هشتم شماره 1 (پیاپی 18، تابستان 1397)

HPVs are common cause of infections and diseases in human worldwide. Most infections are asymptomatic and benign. The importance of HPV infections lies in their ability to cause malignant transformation of Squamous epithelia of mucosal surfaces and significant cancer morbidity and mortality. During recent years HPV vaccines made important avenue toward preventing HPV-associated neoplasia and malignancies.
HPVs are nonenveloped DNA viruses with more than 200 genotypes round the world. Viruses have high degree of specificity to infect human, tissues and cells. Are classified as cutaneous and mucosal. Some mucosal viruses have oncogenic potential that infect anogenital and oropharyngeal mucosa. HPVs are the most common cause of sexually transmitted infections in the world that infect both genders. Most infections are asymptomatic and a minority come to medical attention. Viruses are transmitted horizontally by close skin to skin contact and in some vertically. Most infections cleared uneventfully within 8-24 months.
In the US, at any time more than 20 million US population are infected. Yearly ~6.000.000 new cases occur and the same numbers cleared their infection. CDC estimated that more than 30.000 cases of HPV- related cancer occur in the US that 2/3 are female. Cervical cancer is the most common HPV-associated cancer and oropharyngeal cancer is the 2nd.
Treatment of HPV infections is offered if lesions are large, multiple, recurrent, and life-threatening. Other indications are pain, discomfort or cosmetic problems. A variety of modality for treatment are available, but they are not universally effective or permanent curable. Two main methods for preventing HPV-related malignancies exist: Regular cytologic screening and vaccination. Regular cytologic screening beginning from 21 years of age of female remains as the essential component of cancer preventing programs focused on cervical cytology (Pap smear) and close follow-up of annormal findings. Anal cancer prevention share many similarities with cervical cancer. In June 2006, FDA approved first HPV vaccine to prevent HPV-associated dysplasia and malignancies contain four genotypes (6, 11, 16 and 18) viruses. Vaccine stimulate CMI and humoral immunity scheduled as 3 doses 0, 2, 4 months apart beginning at age 4-11 years of age before any sexual activity. Vaccine resulted in humoral responses in more than 98% of vaccine recipients. After vaccination, the incidence of anogenital wart decreased substantially. Recently, 9-valent vaccine developed and make broader coverage of vaccines.

Paternal depression during pregnancy causes increased incidence of psychiatric disorders, anxiety disorders, and impaired development of the child. Thus, considering the importance of psychological health of fathers in the psychological health of children, this study was conducted with the aim of examining the effect of paternal depression during pregnancy on the couple’s relationships and children’s health.
In this narrative review, firstly, the related keywords was identified with using mesh (medical subject headings) and then search was carried out in electronic databases including google scholar and the more specifically in Magiran, SID, Pubmed, Web of Science, Scopus, Ovid, Science Direct And ProQuest. The keywords: depression, depression in pregnancy, father, child, mental health. The published related articles were extracted from 1983 till 2018. Overall 95 articles have been searched. Researchers reviewed the title and abstracts of all articles searched, 25 articles are excluded due to non-relevance and ultimately they applied 70 studies to compile this review.
The results of our study culminated in organization of findings into two classes: class I: the effect of paternal depression on couple’s relationships including anger and interpersonal conflicts of couples, increased risk of maladaptation and negative feelings in marital relationships, the couple’s over-criticism of each other, emotional-psychological disorders of couples, and risk of infanticide; class II: the effect of paternal depression on children’s health including increased stress and anxiety in the child, mood problems in the child, behavioral problems especially in boys, antisocial behaviors of the child, restlessness and hyperactivity, and emotional-psychological disorders of the child.
Given the negative effects of paternal depression during pregnancy, necessary trainings should be presented to families about identification of depressed fathers during pregnancy by healthcare staff, so that with timely diagnosis and treatment, one can mitigate the consequences of this disorder on the family and child, thereby improving the couple’s relationships and quality of life.

Children's Sexual Health means providing possibility of natural sexual development and prevent sexual abuse. The education and awareness of children is necessary, and play a decisive role in the development and general, sexual and reproductive health of children. Therefore, this study was conducted to review factors influencing children's sexual health education.
For conducting this narrative literature review electronic databases, including Google Scholar, Web of Science, Science Direct, Scopus, and PubMed, including Medline, as well as Persian databases like Scientific Information Database and Iran Medex were searched to retrieve articles published from 2001 to 2018 by using the keywords Sexuality Education, Sexual Health, Children and Sex Education, a total of 87 studies that was related to the topic were extracted. After title and abstract screening, 52 articles and then in full text screening, 18 articles were excluded. Finally, 17 articles were used for writing this review. Factors influencing children's sexual health education were classified in 3 categories: 1- Parents-related factors: gender, poor awareness, insufficient insight, high concern, doubt and wandering, shame and veil, uncertainty, lack of education, knowledge from ineffective sources, perception of the child and her/his role as a parent, and the perception of sexual education. 2- Teacher- related factors: gender, age, teaching experiences, academic qualifications, area of residence, area of work, marital status, to have children, religious practice, participation in educational training, inadequate knowledge, uncertainty in the provision of education, lack of comfort, shame, concerned about parents' attitudes and lack of access to educational resources. 3- Culture and society- related Factors: sexuality taboo, policies, culture of family, social and cultural acceptance, and limited educational resources.
Results show that several factors affect the education of children's sexual health. In order to achieve the sexual health of children, it is necessary to identify these factors and plan to reduce negative factors and strengthen positive factors.

Neisseria meningitidis has 13 clinically significant serogroups, classified according to the antigenic structure of their polysaccharide capsule. Six serogroups, A, B, C, Y, W-135, and X, are responsible for virtually all cases of the disease in humans.
Quadrivalent (Serogroups A, C, W-135, and Y) There are currently three vaccines available in the US to prevent meningococcal disease, all quadrivalent in nature, targeting serogroups A, C, W-135, and Y:Two conjugate vaccines (MCV-4), Menactra and Menveo, and One polysaccharide vaccine (MPSV-4), Menomune, produced by Sanofi Pasteur.
Bivalent (Serogroups C and Y): On 2012, the FDA approved a new combination vaccine against two types of meningococcal disease and Hib disease for infants and children 6 weeks to 18 months old. The vaccine, Menhibrix, will prevent disease caused byNeisseria meningitidis serogroups C and Y and Haemophilus influenzae type b. This is the first meningococcal vaccine that can be given to infants as young as six weeks old.
Serogroup A: A vaccine called MenAfriVac has been developed through a program called the Meningitis Vaccine Project and has the potential to prevent outbreaks of group A meningitis.
Serogroup B: Vaccines against serotype B meningococcal disease have proved difficult to produce, and require a different approach from vaccines against other serotypes.
Serogroup X: The occurrence of serogroup X has been reported in North America, Europe, Australia, and West Africa. Current meningoccocal meningitis vaccines are not known to protect against serogroup X N. meningitidis disease.
Side effects of the vaccine include: Common side effects include pain and redness around the site of injection (up to 50% of recipients). A small percentage of people develop a mild fever. As with any medication, a small proportion of people develop a severe allergic reaction. The highest risk was when individuals received a dose of Soliris within 2 weeks after being vaccinated with Bexsero.

Behaviorists believe that the need for attachment is a prerequisite need and many aspects related to it are innate. Therefore, mother and child attachment is more than nutritional needs during infancy. Early interactions between parents and infants seem to be the basis for future interactions and other behaviors in childhood, adolescence and even adulthood. Therefore, the purpose of this study is to review the implications of secure and insecure attachment of mother and child.
This study is a review which to compile it, search was conducted in database such as Google scholar and more specially databases such as MEDLINE, SID (Scientific Information Database), Magiran, PubMed, SCOPUS, Science Direct and Cochrane with using the keywords such as secure attachment, insecure attachment, mother and child and attachment implications. First, 78 articles were searched, after abstracts screening stage, 44 articles were excluded from the research due to lack of their relevance or repetition. Finally, 34 articles were used to write this review article.
The findings of this study lead to the classification of the contents in four main categories as follows: 1-Short-term implications of mother and child secure attachment (feeling security, preparing for social challenges, creating positive relationships with peers, facilitating learning of social interactions and emotional adjustment skills, self-efficacy, collaboration with adults, improvement memory performance, academic achievement, problem solving skills and stress reduction), 2-Long-term implications of mother and child secure attachment (performing more aerobic exercise, less smoking, narcotics or alcohol, more healthy eating habits, better sleep habits, using more safety belts, less indecency and immorality in sex), 3-Short term implications of mother and child insecure attachment (anxiety, fear and panic, negative social-emotional growth such as rape, hostility, social retardation, physical health side effects such as growth disorder, eating disorder), 4. Long-term implications of mother and child insecure attachment (kleptomania, lying, sexual obsessions, sadism, negative perception to parental support).
Considering the short-term and long-term effects of attachment, it can be stated that by identifying the factors of maternal behavior which affecting the attachment and training of mothers and providing opportunities for attachment of children, we can help to increase the growth of the secure attachment.

Physiological changes in pregnancy can affect the tissues of the mouth and gums and can increase the severity of problems such as inflammation, bleeding and swelling of the gum. Periodontal diseases can play a role as a focal point Infections in the body. According to the above, the purpose of this study is to investigate the effects of maternal periodontal disease on pregnancy outcomes.
In this review article, articles related to the key words (periodontal disease, pregnancy outcomes, preterm delivery, premature infants) from prestigious internal databases (SID, Irandoc, Iranmedex) and With keywords (Periodontal disease, Consequences of Pregnancy, Preterm Delivery, Premature infants) (Confirmed in Mesh) from foreign authoritative databases (Google Scholar, Scopus, Pubmed, Medline) were found between 2008 and 2017 and Articles published in this field were reviewed.
In this study, 48 papers were collected, of which 30 papers were analyzed. 18 other articles were omitted due to repeatability, non-relevance to the title and keywords from the review process. The results of the research showed that periodontal diseases are infections that can affect cytokines production, causing early birth pain, tearing of fetal screens and early delivery. Preterm infant births also increase infant mortality. Studies have shown that periodontal disease of pregnant mothers is associated with the birth of a low birth weight baby. Also, periodontal disease is associated with an increase in inflammatory factors as a risk factor for gestational diabetes mellitus.
The findings indicated that periodontal disease was associated with gestational diabetes, and pregnant women with periodontal disease were 5/7 times more likely to have gestational diabetes than non-periodontal patients.
Regarding the role of periodontal condition of pregnant mothers in the health of their future children, the need for an appropriate planning to increase the awareness of women and improve their oral health is becoming more and more evident. With the prevention and treatment of periodontal diseases in pregnant women, these complications can be decreased. Confirmation of periodontal health of women by the dentist can be very effective before going to pregnancy in this direction.

In spite of the primary and secondary preventions from infections, the load of infectious diseases still accounts for a major part of children diseases. Irrational use of antibiotics has led to the emergence and spread of antibiotic-resistant bacteria all over the world. With the development of antibiotic-resistant bacteria, despite the development in the production of new antimicrobial compounds, the imminent return of a pre-antibiotic period is happening. Phage therapy is proposed as a preventive and therapeutic option for some infections in children. This study aimed at integrating and combining the results of phage therapy studies in children using the review method. This study was carried out based on the authenticated electronic databases of Web of Science, Google Scholar, Pubmed, and Scopus in 1990-2018. Eighteen articles out of 8140 articles in Google Scholar, 1 article out of 4 articles in Scopus, 1 article out of 4 articles in Web Science, and 1 article out of 5 articles in Pubmed were included in the study through selecting phage studies on prevention of infections in children in 1990-2018. Results proved that 5 studies on children used polyvalent phage to prevent diarrhea, shigellosis, and gastrointestinal infections and 1 study employed phage spray to prevent gastrointestinal infection in children. Phage therapy results indicated that 7 studies used the oral use of phages for diarrhea and salmonellosis, 3 studies used the subcutaneous and topical use of phages for osteomyelitis, skin diseases, and abscess, 1 study used phage intramuscular injection for urinary tract infection, 1 study used intramuscular injection for the infection of upper respiratory tract, 1 study used it for meningitis, and 3 studies used it for septicemia treatment.

The use of oral cocktail bacteriophages prevents from the gastrointestinal infections caused by Enterobacteriaceae bacteria. Phages are effective for oral treatment for gastrointestinal infections, local infections for skin infections, injections for sepsis, urinary tract infections, and respiratory tract infections.