مجله زنان مامائی و نازائی ایران
سال بیست و پنجم شماره 11 (بهمن 1401)

Breast cancer is the leading cause of malignancy related deaths in women worldwide. In 20%-30% of breast cancers, HER2 gene amplification or overexpression is observed. Determination of HER2 amplification is performed mainly by IHC technique to measure its protein expression on the cell surface and by FISH to check gene amplification. This study was aimed to compare the sensitivity and specificity of IHC in comparison to the FISH method for detection of HER2 gene amplification.

In this study which was performed in 2020, 44 paraffin embedded breast carcinoma tissues belonging to women with breast cancer which have been already examined with IHC technique have been analyzed using FISH technique to determine HER2+ overexpression. Data were analyzed using GraphPad (Anova ver8) software. P<0.05 was considered statistically significant.

Comparison of IHC results with FISH represented 16% false positive and 9% false negative, therefore the sensitivity of IHC for identifying of HER2+ the meaning of true positive was equal to 66.6% and the specificity of IHC in determining true negatives was equal to 78.1%. The results showed that IHC has many errors.

The confidence level of positive results and negative results was equal to 53.3% and 86.2%, respectively. Therefore, FISH method should be used as an alternative method in conjunction with IHC.

The pharmacological approach of abortion is a safe and effective alternative to surgical procedures that is associated with a high level of patient's satisfaction. The present study was performed with aim to evaluate the effect of misoprostol with and without letrozole in the treatment of successful medical abortion and its relationship with BHCG titration level and cervical length.

This two-group randomized clinical trial study was performed in 2021 on 168 pregnant women under 18 weeks of gestation who were candidates for termination of pregnancy. The patients were randomly divided into two groups: A (misoprostol and letrozole) and B (misoprostol and placebo). Initial tests, βHCG titration, ultrasound and cervical length were performed for all patients on the first day of hospitalization. After receiving the drug, all patients underwent ultrasound on the fifth day to evaluate complete abortion and removal of pregnancy residues. Data were analyzed by SPSS software (version 22) and Chi-square, independent t and logistic regression tests. P<0.05 was considered statistically significant.

The results showed that misoprostol + letrozole had a more successful abortion rate than misoprostol + placebo (88.1% vs. 59.5%). Increased cervical length was associated with a higher probability of miscarriage (P <0.001), while BHCG titration did not show a predictive role in induction of abortion (p>0.05).

Adding letrozole to misoprostol for inducing abortion leads to an increase in the percentage of successful abortion and a reduction in the use of curettage.

Considering that fertility has a high value in most cultures, if attempt to get pregnant fails, it may lead to the mental health dysfunction of the person. Therefore, the present study was conducted with the aim to compare the postpartum fear of childbirth, postpartum symptoms of depression and postpartum PTSD in women with miscarriage, vaginal delivery and cesarean section.

The present study was a causal-comparative description research which was conducted from February 2021 to June 2021 on 300 women who had just given birth and referred to health centers in Mashhad. The tools used in this study were Wijma Delivery Experience Questionnaire, Beck Depression Inventory and Perinatal PTSD Questionnaire. Fear of childbirth, depression symptoms and postpartum PTSD were measured. Data were analyzed by SPSS (version 22.0) and multivariate analysis of variance test. P<0.05 was considered statistically significant.

Postpartum fear of childbirth, symptoms of depression and PTSD in women with miscarriage was significantly higher than women with vaginal delivery and cesarean section (p<0.001). There was no significant difference between the vaginal delivery and cesarean delivery groups in terms of postpartum fear of childbirth and postpartum depression (p>0.05). Symptoms of postpartum PTSD was significantly higher in the vaginal delivery group than cesarean group (p<0.05).

Postpartum fear of childbirth, depression and PTSD was higher in women with miscarriage than women with delivery.

Endometrial cancer is one of the common diseases among women, which causes the death of many women in the world every year. The survival of patients and their response to treatment is determined based on clinical conditions and the stage of the disease. It has been determined that patients who are in the advanced stage (stage III and IV) have a shorter survival. The present study was conducted with aim to evaluate the survival of patients based on OS and PFS (overall survival and progression-free survival).

Methods :

In this retrospective cohort study, all patients with advanced endometrial cancer who were treated in Firouzgar and Rasoul Akram hospitals during the last 8 years from 2010 to 2018 were compared in two groups with different treatment methods (first neoadjuvant therapy and then surgery compared to first surgery and then adjuvant therapy). Data were analyzed by Stata software (version 14.1). The survival rate of patients was evaluated using the Kaplan-Meier approach. Factors affecting the survival rate were also analyzed using a Cox regression model. The investigation of factors affecting the response to treatment was also done in a multiple logistic regression model. P< 0.05 was considered statistically significant.

There was no significant difference in terms of mean survival in patients who were treated with chemotherapy surgery and surgical chemotherapy (p>0.05). Total survival rate was higher in patients treated with standard method compared to patients who received chemotherapy first and then surgery.

There was no significant difference in the survival of patients in terms of treatment with chemotherapy surgery and surgical chemotherapy. However, the variable of surgery had the highest correlation in the recurrence of the disease and also the survival of the patients.

Thalassemia is a genetic disease with an autosomal recessive pattern. Prenatal diagnosis (PND) and termination of pregnancy in the case of fetus infection is the best way to prevent this disease. This study was performed with aim to evaluate the incidence rate and causes of new cases of major β-thalassemia (MBT) after implementing the national prevention program in Kerman University of Medical Sciences.

This was descriptive and analytical study on health system research. Information of patients (Date of birth, status of other siblings) and carrier couples (year of marriage, kinship relationship, performing screening at the time of marriage, history of surveillance, and causes of the birth of beta-thalassemia patient) was obtained from the data available in the Health Department of Kerman Universities of Medical Sciences from 2011 to 2019. Data were analyzed by SPSS (Version 24) using Fisher's exact test. 

The 9-year incidence rate in the whole region was 0.55 per 10,000 live births. The success rate of the program in the whole region was 84.37%. Fifteen patients were born between 2011 and 2019. The most important cause of MBT incidence was the lack of identification of thalassemia couples and their lack of awareness about their condition (46.6%). Nine (60%) of the patients' parents had consanguineous marriages. There was no statistically significant relationship between causes of new cases of MBT and the level of education and occupation of the patients' parents (P>0.05).

Although the implementation of the prevention program has significantly reduced the number of new cases of MBT, appropriate planning to improve the quality of counseling services and carrier couples care and increase the level of awareness and change the attitude of target groups to eliminate the incidence of the disease is necessary.

Cesarean section is one of the most common surgeries and is usually followed by pain. According to some studies, flaxseed oil may reduce pain. The present study was performed with aim to evaluate the effect of flaxseed oil ointment on the severity of cesarean section wound pain.

This triple-blind randomized clinical trial study was performed in 2018 with participation of 120 women who had cesarean section in Imam Reza and Shahid Hasheminejad hospitals in Mashhad. Individuals were randomly assigned into to three groups (flaxseed ointment, placebo, control). In two groups of flaxseed ointment and placebo, the ointment was applied on cesarean section wound. The intensity of wound pain was measured 24 hours after surgery, 4th and 8th day after cesarean section by pain intensity Scale. Data were analyzed using SPSS software (version 25), and Chi-Square and Kruskal-Wallis tests. P <0.05 was considered statistically significant.

According to the results of statistical tests, there was statistically significant difference between flaxseed group with control and placebo groups in terms of cesarean section wound pain intensity on days 4 and 8 after the intervention (P <0.001). In addition, in the intergroup comparison, Friedman test showed that in all three groups, the variation of pain intensity scale was significantly different in different days (P <0.001).

Regarding the reduction of pain intensity cesarean wound score after the intervention, flaxseed oil due to its effective ingredients can greatly reduce the severity of cesarean section wound pain.

The lack of information about the impact of Covid-19 on pregnancy and the increased side-effects of the disease for pregnant mothers and fetuses showed the importance of investigating its impact on pregnancy and neonate. The present study was performed with aim to investigate the impact of positive test result of PCR on the weight and Apgar scores of infants.

In this analytical study (retrospective cohort), sampling was conducted by examining the files of 98 pregnant women who gave birth between April 2020 and September 2021 using the apple system which were covered by health care centers located in Isfahan province. The information obtained from the comparison of two groups of mothers based on the results of the PCR test was analyzed by SPSS software (version 18) and Independent t-test. P<0.05 was considered statistically significant.

Among the examined files, 50 cases (51%) had a positive PCR test and 48 cases (49%) had a negative PCR test. 99% of the infants had an Apgar score of ≥7. According to the results of Independent t-test, no significant difference was found between the Apgar score at minute 1 (p=0.714) and minute 5 (p=0.580) of the infants of PCR+ and PCR- mothers. Also, According to the results of Independent t-test, no significant difference was found between the weight of newborns in mothers of two groups (p=0.112).

The positive PCR test result has no significant relationship with the weight and the Apgar-score of the 1st and 5th minute of the newborn. Research on the effects of COVID-19 infection during pregnancy continues to be completed and updated. Further research with more samples can better show the possible complications of this disease.

Abnormal uterine bleeding occurs as a disturbance in the quantity, duration, regularity and schedule of menstruation, which has been a significant problem. The present study was performed with aim to summarize the recommendations of Persian medicine in the treatment and management of abnormal uterine bleeding.

In this narrative review article, the key words related to abnormal uterine bleeding (AUB) in the sources of Persian medicine, which is called "Efrate tams", were reviewed and the items related to nutritional measures and treatment of this disease were extracted. Keywords "Menorrhagia" or "Menometrorrhagia" or "Abnormal uterine bleeding-AUB" or "Poly-menorrhea" or "Herbal medicine" or "Nutritional treatment" and "Efrate tams" were searched in SID, PubMed, Scopus, Web of science, Science direct and Google Scholar databases, and finally the cases which had scientific evidence were presented in the form of nutritional measures and treatment.

A significant part of the recommendations of Persian medicine for the treatment of abnormal uterine bleeding has practical clinical evidence. These include the use of foods which reduce bleeding and fast digestion, avoiding the consumption of heavy foods, lifestyle modification, the use of herbal medicines, and also the prescription of appropriate medical treatments according to the patients' conditions.

Based on the results of this study, the use of simple solutions of Persian medicine in the treatment of abnormal uterine bleeding along with common medicine protocols can help in controlling this disease and contribute to the health of women as much as possible.

In recent years, the role of inflammation and oxidative stress in the etiology of polycystic ovary syndrome has received more attention. Evaluation of the existing studies regarding the effects of inflammatory mediators and oxidative stress on ovarian function in patients with polycystic ovary syndrome (PCOS) indicates the key role of these factors in the progress and development of disease complications. The current review study was conducted with aim to summarize the presence and role of the aforementioned inflammatory mediators as well as the effect of recent treatment approaches including the use of antioxidant supplements and anti-inflammatory agents in improving the results of infertility treatment cycles in these patients.

In the present review article, to find the related articles, databases of PubMed, Science Direct, Scopus, and Google Scholar databases were searched with the keywords of polycystic ovary syndrome, inflammation, oxidative stress, oxygen-free radicals, antioxidant supplementation, infertility treatment, androgens, cytokines, and insulin resistance using the "AND" and "OR" operators from January 1991 to December 2020.

After reviewing all the articles in this field, it was found that PCOS, as a genetic and autoimmune disease, is associated with low degrees of inflammation, which plays an important role in the etiology, progression and occurrence of the disease. Moreover, ovulatory dysfunction, increased concentrations of oxygen free radicals in granulosa cells, as well as the follicular fluid of infertile PCOS patients under ART treatment, have been reported.

It seems that the coordination between three main factors, namely high dietary carbohydrate intake, insulin resistance, and hyperandrogenism, can be considered as the initiator for inflammation induction and oxidative stress in PCOS patients. The antioxidant supplements and anti-inflammatory agents can be useful to improve the results of infertility treatment cycles in these patients; however, concluding the results still requires further studies.

The elderly more than others in the society were affected by the corona epidemic. Social isolation as one of the important consequences of corona pandemic, affected the elderly. This review study was performed with aim to investigate studies related to social isolation of the elderly during the corona virus epidemic.

In this systematic review, to find the article entitled elderly social isolation and Covid-19, the articles published in English from the beginning of the Corona virus pandemic to 2021 were searched in databases of Scopus, ISI (web of science), PubMed (Medline), Cochrane Library, and Science direct using MeSH and the keywords of "social isolation", "elderly", "loneliness", "coronavirus", "COVID -19", "SARS COVID -2", "pandemic", "elderly", alone and in combination using the operators AND and OR.

A total of 11 studies related to Covid-19 and social isolation were included in the study. The findings showed that the COVID-19 pandemic and health policies have exacerbated feelings of loneliness and isolation in the elderly. Loneliness and social isolation in the elderly have increased due to the implementation of preventive protocols such as social distance and quarantine.

Attention to approaches which reduce social isolation in the elderly during the COVID-19 pandemic is one of the important interventions that should be considered by government and policy makers to reduce the rate of harm in the elderly and consequently reduce health costs to compensate its side-affects.

Uterine anomalies have been caused by impairment in the formation, evolution, or defect in the connection of Mullerian bud during the embryonic period. In this study, a case of unicornuate uterus with cervical agenesis is presented.

The patient was a 14-year female with symptoms of backache, pain in the left thigh, nausea, vomiting, and chill, which were started six months ago (no complain of abdominal pain). Sonography was performed and a cystic appendage with a thick wall containing internal eco and somewhat septa solid components appeared in the sinistral pelvis, indicating the sinistral rudimentary horn of the uterus with hematometra (secondary to cervical agenesis). Sonography showed a 32×92 mm twist tubular cystic appendage having an internal eco in left lower quadrant, indicating hydrosalpinx. No left ovary tissue was observed. Hymen was checked and it was imperforate. Due to cervical agenesis, blind vagina and hydrosalpanx, hysterectomy and left salpingectomy surgeries were performed. The pathological answer showed cervical  agenesis and  a unicornuate uterus containing hematometra and hematosalpinx in the left fallopian tube and endometrioma cyst.

Gynecologic problems should be considered in adolescents with initial amenorrhea and abdominal pain.