فصلنامه آزمایشگاه و تشخیص
پیاپی 70 (زمستان 1404)

Microangiopathic hemolytic anemias fall under the category of life-threatening anemias. Early diagnosis of these anemias, which present with fragmented red blood cells such as helmet shapes, triangular forms, microspherocytes, and keratocytes on peripheral blood smears, provides a critical opportunity for the timely treatment of diseases such as disseminated intravascular coagulation (DIC), HELLP syndrome, thrombotic thrombocytopenic purpura (TTP), and hemolytic uremic syndrome (HUS). Schistocytes are so significant that a finding of more than 2 percent is classified as a high grade.
It is important to note that reporting schistocytes in a normochromic and normocytic morphology is crucial, as it indicates damage to the capillaries due to fibrin deposition or white platelet clots and von Willebrand factor.

Menopause, particularly in its abnormal forms such as premature menopause and premature ovarian insufficiency (POI), represents a multidimensional challenge in women’s health. Beyond marking the end of fertility, it increases the risk of physical complications (e.g., osteoporosis and cardiovascular diseases), psychological issues (such as depression and anxiety), and social consequences. In recent years, a declining trend in the age of menopause onset in developing countries—including Iran—has raised serious public health concerns. This review article aims to conduct a comparative analysis of diagnostic and management approaches to menopause in Iran versus developed countries. Findings indicate that while Western nations follow evidence-based guidelines (e.g., NICE and ESHRE/IMS), stratifying diagnosis by age and utilizing hormonal tests in a targeted manner, Iran faces significant diagnostic inconsistencies and delays in preventive interventions due to the absence of a comprehensive national guideline, lack of standardization in laboratory methodologies, and overreliance on isolated follicle-stimulating hormone (FSH) measurements. Additional structural barriers include limited access to advanced assays (such as LC-MS/MS and reliable anti-Müllerian hormone [AMH] testing), scarcity of specialized menopause clinics, and the absence of data-driven health information systems. To bridge these gaps, we propose the development of an evidence-based national guideline, implementation of updated clinical education programs, establishment of a nationwide network of specialized menopause clinics, and expansion of digital health infrastructures. These measures could not only enhance the quality of care for women but also substantially reduce the long-term burden of menopause-related complications in the Iranian population.

Elite migration from developing countries to developed countries is a common phenomenon. However, the migration of elites, employees, students, and specialists causes significant damage to the health systems of the countries of origin. It provides a basis for the unfair exploitation of the social capital of these countries by the destination countries. Therefore, the present study aims to identify and determine the causes and factors contributing to the tendency to migrate, as well as strategies to mitigate it, among employees, students, specialists in laboratory sciences, and other related and affiliated fields.

This study was conducted in a quantitative and cross-sectional manner from 1403 to 1404, utilizing the brainstorming method to determine the causes of migration and strategies for reducing it among specialists, staff, and students of laboratory sciences and related and affiliated fields at Tehran University of Medical Sciences. The research population included staff as well as specialists in laboratory sciences with a Ph.D. and general clinical laboratories of 5 large and medium-sized general hospitals based on the number of beds, including Imam Khomeini (RA), Shariati, Sina, Baharlou and Amiralam, as well as students in laboratory sciences and other related and affiliated fields at the bachelor's, master's and doctorate (Ph.D) levels, a total of 710 people. Using the Krejcie and Morgan table, a sample size of 248 people was determined, proportional to the number of staff and specialists in each hospital, as well as students by field and level of education. A researcher-made questionnaire consisting of 28 questions was used to collect data, and its validity and reliability were confirmed. To present the results, the SPSS software was used, and descriptive results were expressed as means and standard deviations. Analytical results were presented using non-parametric tests, including the Mann-Whitney, Spearman, and Kruskal-Wallis tests.

The study's results showed that contextual factors related to work, the health system, individual characteristics, and destination countries were the primary causes of the desire to migrate, as well as strategies to mitigate it. Initially, individual-related factors and those less closely tied to work were prioritized. Additionally, the professional background of specialists and employees, as well as the educational level of the participants in the study, showed a significant relationship with factors related to work, destination countries, and the health system, as reasons for the desire to migrate and its prevention and reduction.

The reasons for the migration of paramedics to destination countries are a multifaceted combination of economic and personal problems, structural inefficiencies in the health system, and a sense of discrimination in the selection and employment of specialists, as well as mental despair regarding the country's future. Although the attractiveness of destination countries as strong pull factors is involved in the emergence of the migration phenomenon. Preparing and formulating fundamental strategies to improve the economic situation, reforming the educational and research structure, and strengthening the culture of professionalism, along with strengthening national pride and dignity among the younger generation, can prevent the migration phenomenon to a large extent.

The Doctor of Clinical Laboratory Sciences (DCLS) degree was implemented at the University of Texas Medical Branch in 2016 with the goal of training laboratory professionals who can improve patient outcomes by participating as part of the healthcare team, providing input regarding the use of laboratory testing in clinical decision-making, and optimizing the utilization of laboratory tests. The University of Texas Medical Branch (UTMB)-DCLS program presented data regarding the implementation of the program from 2016 to 2021. This follow-up study presents the DCLS program outcomes to date. A DCLS alumni, clinical supervisor, and employer surveys were distributed to evaluate the effectiveness of the program and explore the role and patient-care impact of DCLS graduates. The majority of UTMB DCLS alumni secured employment before graduation or shortly thereafter and currently work in academic medical centers and reference laboratories as medical or laboratory directors. Clinicians rate the perceived contribution of DCLS graduates to clinical practice to be highly beneficial, and employers indicate a significant impact of DCLS graduates on patient outcomes. The results presented in this study demonstrate the active participation of DCLS in the healthcare team, thus supporting the need to invest in academic DCLS programs to further the growth of this advanced practice degree.

Cancer is one of the leading causes of mortality worldwide, and the incidence of new cases continues to rise. This disease results from uncontrolled cellular proliferation, a process rooted in stable genomic alterations. Such mutations can drive extensive and impactful changes across multiple levels, including proteins, metabolites, transcripts, and signaling pathways. Since multiple factors contribute to the onset of cancer, the disease manifests in diverse forms. In other words, cancer is not a single disease, and therefore a uniform therapeutic approach cannot be applied to all types. In this context, personalized medicine has emerged as a novel strategy. Within this approach, each tumor mass is regarded as a unique entity, and by analyzing the molecular profile of tumor cells, a specific and tailored treatment is designed for that tumor. According to evolutionary theory, tumor cells are constantly competing and even cooperating with other cellular groups within a tumor mass. Consequently, their molecular markers are continuously changing. Thus, effective targeted therapy requires precise knowledge of the molecular mechanisms involved in the initiation and progression of the disease. Thanks to advances in modern technologies such as next-generation sequencing, mass spectrometry, artificial intelligence, and mathematical modeling for predicting drug effects, achieving a complete cure for cancer may not be out of reach. Nevertheless, serious challenges remain, including limitations in monitoring molecular changes during the evolutionary process of tumor masses. In this article, we first examine cancer within the framework of systems biology. We then highlight Darwin’s evolutionary theory and its role in the dynamics of tumor masses, emphasizing the necessity of adopting a dynamic monitoring approach based on molecular markers in personalized cancer therapy.

Some viruses, such as those that cause colds, disappear after a short period of time, for example, after a season, and are defeated by the immune system, but there are viruses (retroviruses) or microbes (microbiome) that can remain in the body for a long time, being our influential guests for generations. From ancient times to the present day, humans have suffered from diseases that can be caused by the acceptance of microbes due to physical weakness caused by the activity of ancient infections or by the infection of a virus hidden in the DNA. In this article, we will examine the viruses and microbes left over from ancient times in the human body; we will also examine the extent of the disadvantages and advantages of the activity of this group in the body of human evolution. In fact, when viruses completely disappear, they only leave genetic material in the environment, only to reappear later. Microbes play different roles at different times. The activity of some microbes and viruses, both old and new, is sometimes beneficial and even accelerates human evolution and reproduction (Syncytin), but some groups also cause physical disabilities and hold a person back from the rest of society, and sometimes cause HIV, COVID, HERV, and modern-day cancers.