Experiences of teachers, educators, and school counselors about the sexual and reproductive health of educable intellectually disabled adolescent girls: a qualitative study.

BACKGROUND: Adolescents with intellectual disabilities are probably twice as many people without intellectual disabilities to be sexually abused by family members, caregivers, close relatives, and others in the community. Sex education and training are essential components of children's and teenagers' education and human rights, as well as a source of worry for parents and society. While the parents are thought to be the most accessible choice as sexual educators, they often do not fulfill this role. Therefore, professional teachers and trainers who have undergone sex education courses for mentally retarded adolescents are more reliable sources to provide the sexual information in terms of their educational role. This study aimed to determine the experiences of teachers, educators, and school counselor parents regarding the sexual and reproductive health of educable intellectually disabled adolescent girls. METHODS: This was a qualitative content analysis study. 35 participants were selected via purposive sampling with maximum variation, and data were collected through in-depth individual interviews, focus group discussions and field notes, and analyzed using the conventional qualitative content analysis method simultaneously. RESULTS: Three subcategories have emerged: "knowledge and professional experience of teachers, educators, and school counselors with how to educate and care for adolescent sexual health", "proficiency of teachers, educators, and school counselors in guiding families in solving their child's sexual problems", "attitude of teachers, educators, and school counselors towards sexual behaviors and sexual education of adolescents" which formed the main category of "teachers, educators, and school counselors' inefficiency in maintaining ID adolescent girls' sexual and reproductive health". CONCLUSIONS: Teachers, educators, and school counselors encounter a variety of issues related to the sexual and reproductive health of intellectually impaired teenage females, as a consequence of the findings. As a result, efforts should be made to enhance knowledge and skill development, as well as the evolution of negative attitudes. Therefore, the teaching of sexual guidelines for teenagers with mental impairments should be included in the agenda of the country's educational policies. Teachers and educators should be taught by health experts via the holding of in-service training courses.

Achieving sexual health is a key task to develop health for all people including adolescents. Adolescents with intellectual disabilities are probably twice as many as people without intellectual disabilities to be sexually abused by family members, caregivers, close relatives, and others in the community. The role of schools and educators to manage children's sexual behaviors and provide appropriate training in this field was accepted by most societies. This research aimed to ascertain instructors', educators', and school counselors' perceptions on teenage females with educable ID's sexual health. Participants in the present study were mothers, teachers, educators, and school counselors who were selected via purposive sampling in Isfahan from July 2017 to April 2018. Data were collected from via semi­structured interviews, focus group discussions, and field notes, and analyzed using conventional content analysis. The results showed that teachers, educators, and school counselors face different challenges about the sexual and reproductive health of intellectually disabled adolescent girls. Therefore, it should be attempted to promote knowledge and skill and eliminate negative attitudes and make them aware of the sexual rights of intellectually disabled adolescent girls to protect themselves in different situations.

Comparison of the efficacy of microneedling versus CO2 fractional laser to treat striae alba: A randomized clinical trial.

Striae distensae (SD) are common skin conditions that have posed a significant challenge regarding their assessment and treatment. The present study aimed to evaluate the efficacy of microneedling in comparison to fractional CO2 laser therapy. Similar striae were selected and photographed. Each side was randomly assigned to be treated with CO2 fractional laser or microneedling four times at monthly intervals and followed up for 10 months. Outcome measures including the length and width of the largest striae, dermatologist assessed improvement, patients' satisfaction, and visual analog scale (VAS) were assessed. Wilcoxon signed-rank test and Mann-Whitney U test were used to assess the efficacy of treatments. Forty patients with a mean age of 28.1 years were included. The median cross-section of the largest striae decreased significantly in both groups (P-value <0.001), without statistically significant differences between the two groups before and 6 months after treatment. VAS also improved significantly in both groups, and there were no statistically significant differences between the two treatments in all visits. No clinically significant adverse effects were observed. Fractional CO2 laser and microneedling are both efficient treatments to resolve SD. A new light should be shed on the microneedling modality as it is more economical than the other treatment options.

The effect of educational classes during pregnancy on the level of sexual satisfaction after delivery in nulliparous women.

BACKGROUND: In the postpartum period, changes in sexual desire and marital satisfaction can be seen. Learning and giving enough information on changes in pregnancy and postpartum can help to increase marital satisfaction. The purpose of this study was to determine the effect of prenatal training on the level of postpartum marital satisfaction in nulliparous women. METHODS: This study is a semi-experimental two-group study in which 150 nulliparous women were divided into two groups: control and intervention groups. The samples into intervention group received routine prenatal care and eight sessions of prenatal education with a training package (educational pamphlet on sexual health and sexual issues and an educational CD on pregnancy and pelvic exercises), and the control group received only routine prenatal care along with a pregnancy education pamphlet. Marital satisfaction was measured before intervention during pregnancy and 3 months after delivery (after intervention) using the ENRICH Marital Satisfaction Scale. Data were analyzed using t-test, paired t-test, Mann-Whitney, and Chi-square test. RESULTS: There was no significant difference in demographic and obstetric variables and pregnancy status between the two intervention and control groups (P > 0.05). There was no significant difference in marital satisfaction during pregnancy between the two groups (before intervention) (P > 0.05). However, there was a significant difference in the level of postpartum marital satisfaction in the intervention group (P < 0/05). So that, the average marital satisfaction is increased from 52.2 to 64.6. CONCLUSION: The results of this study show that eight sessions of prenatal education class with a training package (educational pamphlet on sexual health and sexuality and training CD of prenatal and pelvic floor exercise) can improve postpartum marital satisfaction in women.

Overexpression of receptor for advanced glycation end products (RAGE) in ovarian cancer.

BACKGROUND: Ovarian cancer is one of the important challenges in the field of gynecologic oncology because of some problems in understanding its etiology and pathogenesis. Receptor for advanced glycation end products (RAGE) is a multiligand trans-membranous receptor which is upregulated in some human cancers. Mechanisms of RAGE involvement in carcinogenesis of ovarian cancer are unknown. OBJECTIVE: This study aimed to investigate the expression of RAGE in ovarian cancers and its association with clinicopathological characteristics. METHODS: The RAGE expression level in ovarian cancer and corresponding noncancerous tissues were analyzed by real time quantitative RT-PCR and immunohistochemistry techniques. RESULTS: Results indicated that RAGE gene was overexpressed in ovarian cancer tissue compared with adjacent noncancerous tissue (p < 0.001). A significant association between RAGE expression and tumor size (p = 0.04), depth of stromal invasion (p = 0.031), lymphovascular invasion (p = 0.041) and stage of cancer (p = 0.041) was observed. The receiver operating characteristic (ROC) analyses yielded the area under the curve (AUC) values of 0.86 for RAGE in discriminating ovarian cancer samples from non-cancer controls. CONCLUSIONS: In conclusion overexpression of RAGE in ovarian cancer may be a useful biomarker to predict tumor progression.

Increased Expression of the Receptor for Advanced Glycation End-Products (RAGE) Is Associated with Advanced Breast Cancer Stage.

BACKGROUND: The receptor for advanced glycation end-products (RAGE) is a multiligand transmembrane receptor that is overexpressed in various pathological conditions including cancers. However, the expression pattern of RAGE in breast cancer tumors is still not completely clear. METHODS: In this study, we investigated the expression levels of RAGE in 25 fresh-frozen breast cancer samples and corresponding noncancerous tissue samples collected from breast cancer patients, by real-time polymerase chain reaction (PCR). Additionally, we performed immunohistochemistry on breast cancer specimens. RESULTS: The results indicate a high expression of the RAGE-encoding gene in the cancerous tissues. RAGE expression at the mRNA and protein levels was statistically significantly up-regulated in advanced-stage and triple-negative breast tumors and node-positive tissues compared with other tissues (p < 0.001). A significant association between RAGE expression and tumor size was observed (p = 0.029). CONCLUSIONS: Overexpression of RAGE in advanced-stage tumors may be a useful biomarker for diagnosis and the prediction of breast cancer progression.

Functioning adrenocortical tumors in children-secretory behavior.

OBJECTIVE: Adrenocortical tumors are rare childhood neoplasms. More than 95% are functional and present with virilization, Cushing's syndrome, hypertension, or hyperestrogenism. The objective of this paper is to present the clinical, laboratory and pathological findings of this rare disease and to highlight the secretory behavior of these tumors. METHODS: Clinical and laboratory data of seven Iranian children and adolescents aged between 2 and 16 years with functioning adrenocortical tumors are presented. Five patients had virilization and two had Cushing's syndrome at the time of diagnosis. In all subjects, the tumors were removed successfully by open surgery, during which a blood sample was drawn from the corresponding adrenal vein for hormonal evaluation. RESULTS: Peripheral blood evaluation revealed that in addition to the dominant hormone (testosterone in the cases presenting with virilization and cortisol in those with Cushing's syndrome), significant amounts of other hormones were secreted from these tumors. Adrenal vein evaluation revealed that testosterone, dehydroepiandrosterone sulfate, estradiol, 17(OH) progesterone, and cortisol were directly released from the tumor. The tumors weighed between 36-103 grams. The patients have since been followed for 5 to 20 years, and there have been no signs or symptoms of relapse in any of the patients. CONCLUSIONS: The study shows that functioning adrenocortical tumors should be considered in children and adolescents presenting with hyperandrogenism, Cushing's syndrome, or hyperestrogenism. A diagnosis of a functioning adrenocortical tumor requires surgical removal as early as possible to prevent the untoward effects of virilization or corticosteroid excess. Evaluation of adrenal vein hormones showed that the steroids are secreted directly from the tumor and peripheral conversion has little contribution to the serum levels.

Estradiol attenuates spinal cord injury-induced pain by suppressing microglial activation in thalamic VPL nuclei of rats.

In our previous study we showed that central pain syndrome (CPS) induced by electrolytic injury caused in the unilateral spinothalamic tract (STT) is a concomitant of glial alteration at the site of injury. Here, we investigated the activity of glial cells in thalamic ventral posterolateral nuclei (VPL) and their contribution to CPS. We also examined whether post-injury administration of a pharmacological dose of estradiol can attenuate CPS and associated molecular changes. Based on the results,in the ipsilateral VPL the microglial phenotype switched o hyperactive mode and Iba1 expression was increased significantly on days 21 and 28 post-injury. The same feature was observed in contralateral VPL on day 28 (P<.05). These changes were strongly correlated with the onset of CPS (r(2)=0.670). STT injury did not induce significant astroglial response in both ipsilateral and contralateral VPL. Estradiol attenuated bilateral mechanical hypersensitivity 14 days after STT lesion (P<.05). Estradiol also suppressed microglial activation in the VPL. Taken together, these findings indicate that selective STT lesion induces bilateral microglia activation in VPL which might contribute to mechanical hypersensitivity. Furthermore, a pharmacological dose of estradiol reduces central pain possibly via suppression of glial activity in VPL region.

Hypermethylation of p16 tumor-suppressor gene in ameloblastic carcinoma, ameloblastoma, and dental follicles.

PURPOSE: The high rate of p16 gene alterations in malignant neoplasms suggests the important effect of this tumor-suppressor gene mutation on the malignant behavior of tumoral lesions. The present study investigated the possible methylation of the p16 tumor in ameloblastic carcinoma, ameloblastoma, and dental follicles. MATERIALS AND METHODS: Eighteen samples of ameloblastic carcinoma, ameloblastoma, and dental follicles of mandibular impacted third molar were selected from available documents in the archives of the Department of Oral and Maxillofacial Pathology, Taleghani Hospital and the Department of Oral and Maxillofacial Pathology, Shahid Beheshti University of Medical Sciences, Tehran, Iran. After confirming the initial diagnosis, 6-µm sections were used for DNA extraction. A CpG island methylation of p16 was identified by polymerase chain reaction. RESULTS: Although CpG methylation of p16 was observed in all ameloblastic carcinoma samples, only 1 ameloblastoma specimen exhibited the mutation. The mutation was not detected in other ameloblastoma specimens or in any dental follicle sample. CONCLUSIONS: The p16 alteration might play a role in the malignant progression of ameloblastic carcinoma. It is worth mentioning that ameloblastoma can be further differentiated from ameloblastic carcinoma based on molecular observations.

Role of microglia and astrocyte in central pain syndrome following electrolytic lesion at the spinothalamic tract in rats.

Central pain syndrome (CPS) is a debilitating state and one of the consequences of spinal cord injury in patients. Many pathophysiological aspects of CPS are not well documented. Spinal glia activation has been identified as a key factor in the sensory component of chronic pain. In this study, the role of glial subtypes in the process of CPS induced by unilateral electrolytic lesion of spinothalamic tract (STT) is investigated. Male rats received a laminectomy at T8-T9 and then unilateral electrolytic lesion centered on the STT. Thermal and mechanical thresholds as well as locomotor function were measured on days 0, 3, 7, 14, 21, and 28 post-injuries by tail flick, von Frey filament, and open field tests, respectively. To investigate the spinal glial activation following denervation in STT-lesioned groups, Iba1 and GFAP were detected by immunohistochemistry and Western blotting at the same time points. Data showed that STT lesion significantly decreased thermal pain at day 3 in comparison with sham groups. Significant bilateral allodynia appeared in hind paws at day 14 after spinal cord injury and continued to day 28 (P < 0.05). Additionally, electrolytic spinal lesion attenuated locomotor function of injured animals after 7 days (P < 0.05). In both histological assessments and Western blotting, Iba1 increased at days 3 and 7 while increased GFAP occurred from day 14 to 28 after lesion. It appears that microglial activation is important in the early stages of pain development and astrocytic activation occurs later. These events may lead to behavioral outcomes especially central neuropathic pain.

Glutathione S-transferase mu gene variants and colorectal cancer development--use of sequence-specific probes for an Iranian population.

BACKGROUND: Enzymes of the glutathione S-transferase (GST) family are encoded by a set of polymorphic genes as an important part of cellular chemical defense. The aim of this study was to investigate the possible effect of GSTM1 deletion on susceptibility to developing clinical outcome of colorectal cancer in a group of CRC patients from Isfahan province, Iran, in comparison to age and gender matched control group. METHODS: DNA was extracted from blood of 140 CRC patients and 90 healthy individuals and a set of sequence specific hybridization probes was used for GSTM1 genotyping by real-time PCR in Light-Cycler instrument. Chi-squared test was used to assess the statistical significance of observed differences between the patient and control subjects of different genders and ages. To estimate the risk for overall and stratified analyses, odds ratios (OR) with 95% confidence intervals (CI) computed with logistic regression. RESULTS: No difference in GSTM1 null genotype frequency was found in CRC patients and controls stratified by gender (p value=0.14). The data were suggested a trend of increasing risk for GSTM1 null genotype in patients over 60 years old compared with controls (p value=0.05). GSTM1 null genotype carried an increase of the odds of developing CRC in patients over 60 years old (OR=2.7; 95% CI: 1.03-7.05). No significant association was found (P>0.05) between the GSTM1 null genotype with tumor site (right, left, rectum) or tumor differentiation (well, moderately). CONCLUSION: Our findings suggest that the GSTM1 null genotype may contribute to colorectal cancer development in people over 60 years old.

Primitive neuroectodermal tumor of the cervix: a case report.

INTRODUCTION: Peripheral primitive neuroectodermal tumor of the cervix uteri is extremely rare. Between 1987 and 2010, there were only nine cases reported in the English literature, with considerably different management policies. CASE PRESENTATION: A 45-year-old Iranian woman presented to our facility with a primitive neuroectodermal tumor of the cervix uteri. Her clinical stage IB2 tumor was treated successfully with chemotherapy. Our patient underwent radical hysterectomy. There was no trace of the tumor after four years of follow-up. CONCLUSIONS: According to current knowledge, primitive neuroectodermal tumors belong to the Ewing's sarcoma family, and the improvement of treatment outcome in our patient was due to dose-intensive neoadjuvant chemotherapy, surgery and consolidation chemotherapy in accordance with the protocol for bony Ewing's sarcoma.

Extrahepatic bile duct neurilemmoma mimicking Klatskin tumor.

Neurilemmoma rarely develops in the biliary tree. Here, we report a 39-year-old Iranian woman with neurilemmoma in the extrahepatic bile duct presenting with progressively deepening jaundice. On the basis of clinical and radiological features, this tumor was initially suspected as Klatskin tumor. Histologically, the tumor was a typical neurilemmoma. Immunostaining showed that tumor cells were strongly and diffusely positive for S-100 protein, which supported the diagnosis of neurilemmoma. Neurilemmoma should be considered in the differential diagnosis of obstructive jaundice.

Prognostic values of proliferative markers ki-67 and repp86 in breast cancer.

BACKGROUND: Breast cancer is the leading cause of carcinoma death in women. Proper treatment depends on the consideration of molecular biology status of tumor cells, which may determine the patient's treatment and prognosis. To determine the prognostic models for this disease, we evaluated the role of cell proliferation-related antigens including ki-67 (a nuclear antigen, expressed in G1, G2, and M phases of cell cycle) and repp86 (an 86-kDa nuclear protein expressed in S, G2, and M phases of cell cycle) for detection of biologic behavior of breast cancer. METHODS: We studied 60 women with grade I and II lymph node-negative and 27 with grade III lymph node-positive breast cancers. The mean follow-up periods for these two groups were 60 and 72 months, respectively. Tumor cell proliferation was measured by immunohistochemical methods with monoclonal antibodies directed against the nuclear antigens ki-67 and repp86. RESULTS: The ki-67, repp86 labeling indices (percentage of antibody-stained tumor cell nuclei) were not statistically different between the cases and controls of lymph node-negative patients (ki-67 with P = 0.33; repp86 with P = 0.40). The odds ratio (the mean chance of ki-67 labeling index > 10%, repp86 labeling index >10%) in patients with recurrence was 4 (CI = 0.2 - 76.5) for ki-67 and 3.6 (CI = 0.4 - 32.5) for repp86. Both indices were statistically different in lymph node-positive cases and controls (P < 0.0001). The odds ratio in patients with recurrence was 87 (CI = 4 - 18.71) for ki-67 and 71.5 (CI = 5.7 - 899.2) for repp86. CONCLUSION: The present study confirms the importance of cell proliferation as a determinant of biologic behavior of breast cancer. Measurement of ki-67 and repp86 labeling indices may be very helpful for physicians to detect high-risk patients and to adopt appropriate procedure such as adjuvant therapy.

Diagnostic value of silver nitrate staining for nucleolar organizer regions in selected head and neck tumors.

BACKGROUND: The present study is aimed to assess the usefulness of silver nitrate staining of nucleolar organizer regions (NORs) as a quantitative criterion for the diagnosis of selected head and neck tumors. MATERIALS AND METHODS: The silver nitrate staining technique was used on 195 paraffin blocks collected from 85 patients. The samples consisted of 21 squamous cell carcinoma (SCC) of larynx, 28 SCC of oral mucosa and 36 samples of most common salivary gland tumors. Mann-Whitney U-Test was used for data analysis. RESULTS: A significant difference was seen in the number of AgNOR dots between oral and laryngeal SCC with surrounding dysplastic and normal tissues (P < 0.001) and also between mucoepidermoid carcinoma and adenoid cystic carcinoma with pleomorphic adenoma and normal salivary gland tissue (P < 0.001). CONCLUSION: The silver nitrate staining for NORs is a useful method for aiding the diagnosis of malignant and dysplastic mucosal lesions and also malignant and benign salivary gland tumors.

Insulin resistance in chronic hepatitis B and C.

AIM: To determine whether insulin resistance occurs in patients with chronic hepatitis B (CHB) and chronic hepatitis C (CHC) and its relationship with the presence of liver fibrosis and steatosis. METHODS: Untreated patients with CHC (n=60) or CHB (n=40), similar in age, gender, body mass index and waist-hip ratio, were studied. Relationship between anthropometric, biochemical (fasting serum insulin, C-peptide, ferritin, iron, TNF-alpha, cholesterol, triglyceride, bilirubin, hemoglobin and platelet concentrations) and liver biopsy (43 CHC and 20 CHB patients) findings was investigated by insulin resistance determined via the homeostasis model assessment (HOMA-IR). RESULTS: The mean fasting serum insulin was 14.9 (11.9) mU/mL in CHC and 21.4 (17.4) in the CHB group (normal range 0.7-9; p=0.049) and mean HOMA-IR was 3.1 (2.6) in CHC versus 4.7 (4.1) in the CHB group (normal range 0.12-4.61; p=0.036). HOMA-IR was significantly associated with fibrosis stage in the CHC group (p=0.015), but not in the CHB group. CONCLUSION: Hyperinsulinemia occurs in chronic viral hepatitis B and hepatitis C; insulin resistance is associated with stage of fibrosis in hepatitis C.

Cortisol and estradiol secretion by a benign virilizing adrenocortical tumor in a prepubertal girl.

We report a 5.5 year-old girl with a benign adrenocortical adenoma who presented with virilization and rapid growth. She did not have any clinical features of isosexual precocity or, except for hypertension, Cushing's syndrome. Measurement of hormones in adrenal vein blood obtained at surgery showed high concentrations of testosterone, cortisol, estradiol and intermediary substrates. Elevated levels of hormones detected in the peripheral blood were released directly from the tumor and were not the result of peripheral interconversion. Hyperandrogenism can obscure the clinical features of Cushing's syndrome and estrogen hypersecretion in patients with functional adrenal tumors.

Investigation of acute lead poisoning on apoptosis in rat hippocampus in vivo.

Despite decades of study, the exact mechanism of action of lead, a potent neurotoxic agent, have not been fully elucidated. One of the suggested mechanism of lead neurotoxicity is apoptotic cell death. The present study sought to examine the effect of acute lead poisoning on apoptosis in rat hippocampus. Two to four and 12-14 week old rats were treated for 7 days with 15 mg/kg daily dose of lead acetate intraperitoneally. Control animals received distilled water. In treated groups, the blood lead levels was increased by about 17-19-folds. Histological study of hippocampus revealed apoptotic cells, using light and electron microscopy. In Western blot analysis, the ratio of Bax/Bcl-2 protein expression in hippocampus was significantly increased compared to controls. In conclusion, the lead induced cell death in hippocampus in vivo may partly be due to apoptosis.