چاقي مركزي در زنان و ارتباط آن با غلظت تستوسترون و استراديول سرم Central obesity in women and its association with serum level of testosterone and estradiol 2 1 چاقي بالا تنه در ايجاد بيماريهاي متابوليك نظير افزايش چربي خون، پرفشار خوني، ديابت و بيماري عروق كرونر اهميت زيادي دارد. ارتباط هورمون‏هاي جنسي، خصوصاً آندروژن‏ها با توزيع چربي بدن در زنان به خوبي روشن نيست و نتايج حاصل از مطالعات مختلف متناقص مي‏باشد. در اين مطالعه مقطعي ارتباط هورمونهاي جنسي شامل تستــوسـتـرون تام، دهيـدرواپي آندرسـترون سولفات DHEA–S)) ،LH ،FSH، استـراديول و انسولين سرم با شاخص‏هاي تن‏سنجي شامل نمايه توده بدن (BMI) و نسبت محيط كمر به باسن (WHR) در 176 زن در فاصله سني 43-18 (6±8/25) و با نمايه توده بدن 2kg/m 51-17 (4/4±5/27) بررسي شد. در نتايج حاصل، نسبت محيط كمر به باسن با غلظت تستوسترون سرم ارتباط مثبت (05/0=P، 15/0=r) و با غلظت سرمي استراديول ارتباط منفي(05/0=P، 1/0-=r) داشت. سطح سرمي هورمون‏هاي جنسي در زنان چاق و زنان با وزن طبيعي تفاوت معني‏داري نشان نداد، در حاليكه زنان با چاقي بالا تنه (نسبت محيط كمر به باسن بيشتر از 85/0) در مقايسه با زنان طبيعي داراي سطح بالاتري تستوسترون(nmol/L 7/0±4/2 در مقابل7/0±1/2، 01/0=P) و سطح پايين‏تري استراديول سرم (pmol/L 7/8±1/24 در مقابل 5/14±6/57، 009/0=P) بودند. اين نتايج مؤيد آن است كه تعادل بين تستوسترون و استراديول عامل مهمي در تنظيم توزيع چربي در بدن است؛ بطوريكه بالا بودن ميزان تستوسترون و پايين‏بودن استراديول احتمالاً خطر تجمع چربي در بالا تنة زنان را افزايش مي‏دهد. 2 Central obesity is an important cause of hyperlipidemia, hypertension, diabetes mellitus and coronary heart disease. The relationship between sex hormones, especially androgens, and body fat distribution in women is controversial. This study investigated the relationship between sex hormones, such as total testosterone DHEA-S, LH, FSH, esteradiol and insulin, with Body Mass Index (BMI) and Waist to Hip Ratio (WHR) in 176 women with age: 25.8±6.0 years (18-43) and BMI: 27.3±4.4 (17-51 kg/m2). Serum level of sex hormones including total testosterone, estradiol, FSH, LH, Dehydroepiandrosterone Sulfate (DHEA-S) were measured by radio immuno assay. Our findings showed that WHR was positively correlated with serum level of testosterone (r=0.15, P=0.05) and it was negatively related to serum level of estradiol (r=-0.1, P=0.05). Sex hormone concentrations were not different in obese and normal weight women, but women with central obesity (WHR>0.85) had significantly higher levels of testosterone (2.4±0.7 vs 2.1±0.7 nmol/L, P=0.001) and lower levels of serum estradiol (24.1±8.7 vs 57.6±14.5 pmol/L, P=0.009) than women with low WHR (WHR<0.85). In conclusion, these data showed that high serum testosterone and low serum estradiol levels were associated with upper body fat distribution in women. Serum level of estradiol versus testosterone possibly affects body fat distribution in women. 14 21 Mohsen M Maddah محسن مداح Nutrition Department, Faculty of Public Health, Guilan University of Medical Sciences Nutrition Department, Faculty of Public Health, Guilan University of Medical Sciences Iran maddahm@yahoo.com Abolghasem A Jazayery ابوالقاسم جزایری Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Human Nutrition and Biochemistry Department, Faculty of Public Health, Tehran Medical Sciences University Iran Reyhan R Mirdamadi ریحان میردامادی Department of Obstetric and Midwifery, Faculty of Medical Sciences, Tarbyat Modarress University Department of Obstetric and Midwifery, Faculty of Medical Sciences, Tarbyat Modarress University Iran Mohammad Reza MR Eshraghiyan محمدرضا اشراقیان Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Epidemiology Department, Faculty of Publi Health, Tehran Medical Sciences University Iran BMITestosteroneEstradiolCentral ObesitySex hormoneWaist to Hip Ratio 98.pdf Chumlea W.C., Guo S.S. Assessment and prevalence of obesity. Endocrine. 2000;13:135- 42.##Bjorntorp P. Portal tissue as a generator of cardiovascular disease and diabetes. Arteriosclerosis. 1990;10:493-6.##Hubert H.B., Feinleib M., McNamar P.M., Smith A. Obesity as an independent risk factor for cardiovascular disease: A 26-year follow-up of participants in the Framinghan Heart Study. Circulation. 1983;67:986-77.##Kissebah A.H., Krakowar G.R. Regional adiposity and mortality. Physiol Rev. 1994; 74:781-811.##Haffner S.M. Sex hormones, obesity, fat distribution, type2 diabetes and insulinresistance:Epidemiological and clinical corrlation. Int J Obs. 2000;24:56-8.##Armellini F., Zamboni M., Castelli S., Robbi R., Mino A., Todesco T., Bergamo-Andreis I.A., Bosello O.Interrelationship between intraabdominal fat and total serum testosterone levels in obese women. Metab. 1994;43:390-5.##Kirschner M.A., Samojlik E., Drejka M., Fachensik J. Androgen-estrogen metabolism in women with upper body fat versus lower body fat obesity. J Clin Endocrinol Metab. 1990;70:##Hauner H., Ditschuneit H.H., Pal S.B., Moncayo R., Pfeiffer E.F. Fat distribution, endocrine and metabolic profile in obese women with and without hirsutism. Metab. 1988;37:281-6.##World Health Organization (WHO) Expert Committee. Physical Status: The use and interpretation of anthropometry. Technical Report Series no. 854. WHO: Geneva, 1995.##Xu X., De Pergola G., Bjorntorp P. The effect of androgens on the regulation of lipolysis in adipose precursor cells. Epidemiol. 1990; 126:1229-34.##Rebuffe-Scrive M., Lonnroth P., Marin P. Regional adipose tissue metabolism in men and post-menopausal women. Int J Obs. 1987;11:347-55.##Ivandic A., Prepic-Krizevac I., Sucic M., Juric M. Hyperinsulinemia and sex hormones in healthy premenopausal women: Relative contribution of obesity, obesity type and duration of obesity.Metab. 1988;47:13-9.##Evans D.J., Hoffman R.G., Kalkhoff R.K., Strain B. Relationship of androgenic activity to body fat topography, fat cell morphology, and metabolic aberration in premenopausal women. J Clin Endocrinol.Metab. 1983;57:304-10.##Ivandic A., Prpic-Krizevac I, Bozic D., Barbir A., Peljhan V., Balag A., Glanovic M. Insulin resistance and androgens in healthy women with different body fat distribution. Wien Klin Wochenschr. 2002;114(8-9):321-6.##Goodman-Gruen D., Barrett-Connor E. Total but not bioavailable testosterone is a predictor of central adiposity in postmenopausal women. Int J Obs. 1995;19:293-8.##Garaulel M., Perex-Liamas F., Funete T., Zamora S., Tebar F.J. Anthropometric, computed tomography and fat cell data in an obese population: relationship with insulin, leptin, tumor necrosis factor, sex hormone-binding globulin and sex hormones. Eur J Endocrinol. 2002;5:657-66.##Barbieri R.L., Makris A., Randall R.W. Insulin stimulates androgen accumulation in incubations of ovarian stroma obtained from women with hyperandrogenism. J Clin Endocrinol Metab 1986;62:904-10.##Zumoff B. Hormonal abnormalities in obesity. Acta Med Scan. 1988;723:153-60.##Bjorntorp P. Hyperandrogenicity in women- a prediabetic condition? J Intern Med. 1993; 234: 579-83.##Leenen R., Kooy K.V., Seidell J.C., Deurenberg P., Koppeschaar H.P.E. Visceral fat accumulation in relation to sex hormones in obese men and women undergoing weight loss therapy. J Clin Endocrinol Metab. 1994;78:1551-20.##Pasqualli R., Antenucci D., Casimiri F., Rissanen C. Clinical and hormonal characteristics of obese amenhorric hyperandrogenic women before and after weight loss. J Clin Endocrinol Metab. 1989;68:173-8.##Turcato E., Zamboni M., De Pergola G., Armellini F., Zivelonghi A., Bergamo-Andreis I.A., Giorgino R., Bosello O. Interrelationship between weight loss, body fat distribution and sex hormones in pre and postmenopausal obese women. Int J Obs. 1997;241:363-72.##Bates G.W., Whitworth N.S. Effect of body weight reduction on plasma androgen in obese, infertile women. Fertil Steril. 1988;38:406-9.##

ارتباط اورتريت‏هاي بدون علامت با باكتريواسپرمي در مايع سمينال مردان بارور و نابارور Correlation between asymptomatic urethritis with bacteriospermia in seminal plasma of fertile and infertile men 2 1 عفونت دستگاه ادراري تناسلي قادر است قدرت باروري اسپرماتوزوئيد را تحت تأثير قرار دهد و ممكن است منجر به ناباروري مردان دچار عفونت شود. اورتريت‏هاي علامت‎دار مي‏توانند با گذشت زمان پارامترهاي مايع مني را تغيير دهند؛ اما نقش اورتريت‎هاي بدون علامت هنوز مورد شك و ترديد است. در مطالعه توصيفي حاضر، 148 نمونه از مجرا و مايع انزال مردان بارور (شاهد) و 146 نمونه از مجرا و مني مردان نابارور (مورد) به منظور تشخيص پنچ گونه باكتريايي عامل اورتريت شامل استرپتوكوك گروه A (پيوژن)، آنتروكوك، اشرشياكلي، استافيلوكوك كوآگولاز مثبت و منفي مورد بررسي قرار گرفت. ميزان آلودگي مجرا و مني مردان بارور به ترتيب 32/49% و 05/29% و مردان نابارور 90/34% و 27/60% بود. با استفاده از تست آماري Chi-square مشخص شد كه مقايسه ميزان آلودگي مايع مني در بين هر دو گروه معني‎دار مي‏باشد (01/0P<). بيشترين عامل آلودگي مايع مني در هر دو گروه شاهد (14 نفرـ 60/32%) و مورد (37 نفرـ 42%) آنتروكوك بود. 90 نمونه از جمع 131 نمونه آلوده به باكتري در هر دو گروه داراي لكوسيت (پيواسپرمي) و مابقي نمونه‎هاي آلوده(41 نمونه)، فاقد لكوسيت در مايع مني بودند و يا كمتر از مقدار استاندارد لكوسيت داشتند. نتايج فوق نشان مي‏دهد كه باكتريواسپرمي در بين نمونه‏هاي مردان نابارور بطور معني‏داري از مردان بارور بيشتر بوده است. بنابراين گونه‏هاي عامل اورتريت ممكن است در ناباروري مردان نيز دخيل باشند. بعلاوه براي تشخيص باكتريواسپرمي در مردان، انجام كشت و تشخيص باكتري لازم مي‏باشد و تنها وجود يا عدم وجود لكوسيت در مايع مني نمايانگر عفونت فعال سيستم تناسلي نمي‏باشد. 2 Urogenital infection can influence the fertilization potential of the spermatozoa, which may lead to male infertility. The symptomatic urethiritis can change the semen parameters, however the role of asymptomatic urethirtis in fertility is still obscure. In this descriptive investigation, a total of 148 samples from urethra and semen of fertile as well as 146 samples from urethra and semen of infertiles men were examined for the presence of 5 bacterial species including streptococcus group A., Entercoccus, E.coli, coagulase positive and negative Staphylococcus. The rate of infection of urethra and semen of fertile men were 49.22% and 29.05%, respectively. The aforementioned rates were 34.9% and 60.27% for infertile men. The seminal infection was significantly different between two groups of fertile and infertile (p<0.01). The results showed that the most common pathogen in semen of fertile and infertile men was Entrococcus with prevalence of 32.60% (14 cases), and 42% (37 cases), respectively. A total of 90 out of 131 samples contaminated with bacteria showed high rate of Leuckocytes (pyospermia). The remaining 41 infected samples lacked or had low number of leuckocytes. In conclusion, bacteriospermia is significantly higher in seminal samples of infertile than fertile men (p<0.01). Therefore, the pathogens involved in urethritis may be involved in male infertility. In addition, seminal culture is necessary for detection of bacteria presence in the semen, and thus it is important to note that presence or absence of Leukocyte in semen may not represent the urogenital infection. 21 29 Mohammad Bagher MB Khalili محمدباقر خلیلی Microbiology Department, Shahid Sadoughi University of Medical Sciences Microbiology Department, Shahid Sadoughi University of Medical Sciences Iran khalili81@yahoo.com Mohammad Ali MA Khalili محمد علی خلیلی Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences Iran UrethritisBacteriospermiaPyospermySemenMale infertilityUrogenital infection 99.pdf Berger R.E., Karp L.E., Williamson R.A., Koehler J., Moore D.E., Holmes K. The relationship of pyospermia and seminal fluid bacteriology to sperm function as reflected in the sperm penetration assay. Fertil Steril 1982;37:557-64.##Khalili M.A., Pourshafie M.R., et al. Bacterial infection of the reproductive tract of infertile men in Iran. Mid East Fertil Soc J. 2000;5(2):126-31.##Khalili M.B., Sharifi M.K. The effect of bacterial infection on the quality of human’s spermatozoa. Iranian J pub Health 2001;35:62-7.##Shalika S., Dugan K., Smith R.D., Padilla S.L. The effect of positive semen bacterial and ureaplasma cultures on in-vitro fertilization success. Hum Reprod. 1996;11(12):2789-92.##McGowan M.P., Burgher H.G., Baker H.W.G. The incidence of non-specific infection in semen in fertile and sub-fertile men. Int J Androl. 1982;4:657-62.##Bukharin O.V., kuzmin M.D., Ivanov I.U.B. The role of the microbial factor in the pathogenesis of male infertility. Zh Mikrobiol Epidemiol Immunobiol. 2000;2:106-10.##Naessens A., Foulon W., Debruckre P., Devroey P., Lauwers S. Recovery of microorganisms in semen and relationship to smen evaluation. Fertil Steril 1980;45:101-5.##Keck C., Gerber S.C., Clod A., Wilhelm C., Breckwoldt M. Seminal tract infection; impact on male fertility and treatment options. Hum Repord update. 1998;4(6):891-903.##Bussen S., zimmermann M., schleyer M., Steck T. Relationship of bacteriological characteristics to semen indices and its influence on fertilization and pregnancy rates after IVF. Acta obs Gyn Scand. 1997;76(10):964-68.##Ohl D.A., Denil L., Fitzgerald-Shelton K., Mccabe M., et al. Fertility of spinal cord injured males: effect of UTI and bladder management on results of elect ejaculation. J Am Paraplegia Soc. 1992;15(2):53-9.##Toth A., Lesser M.L. A., Lesser M.L. Asymptomatic bacterio-spermia in fertile and infertile men. Fertil Steril. 1981;36:88-91.##Arid I.A., Vince G.S. Bates M.D., Johnson P.M., lewis-Jones J.D. Leukocytes in semen from men with spinal cord injuries. Fertil Steril. 1999;72(1):97-103.##Fowler J.E., Kessler R. Genital tract infections. In: Lipshultz L.I., Howards S.S., eds. Infertility in the male. NY.Churchill Livingstone. 1993.PP:283-98.##World Health Organization. Laboratory Manual for the Examination of Human Semen and Semen-Cervical mucus interaction. Press concern, singapore. 1992. PP:1-30.##Revelli A., Bergandi L., massobrlo M. The concentration of nitrite in seminal plasma does not correlate with sperm concentration, sperm motility, leukocytospermia, or sperm culture. Fertil Steril. 2001;76:496-500.##Baron E.J., and Finegold S.M. Diagnostic Microbiology. 8th Edition, Mosby Co, 1990; pp:323-408.##Eggert-Kruse W., Probst S., Roher G., Aufenanger J. Screening for subclinical inflammation in ejaculates. Fertil Steril. 1995;64: 1012-23.##Cottle E., Mcmorrow J,. Lennon B,. Fawsy M. Microbial contamination in an IVF-embryo transfer system. Fertil Steril. 1996;66:776-80.##Holmes K.K., Berger R.E., Alexander E.R. Acute epididymitis: etiology and therapy. Arch Androl. 1979;3:309-16.##Terry P.M., Hoand S., et al. Diagnosis of non gonococcal urethritis; The Gram stained urethral smear in prospective. Int J STD AIDS. 1991;2: 272-5.##Weidner W., Schiefer H.G., Garbe C.H. Acute nongonococcal epididimytis, etiologlcal and therapeutic aspects.Drugs. 1987;34:111-17.##Gregorious O., Botsis D., papadias D., Kassanos D., Liapis A., Zourlas P.A. Culture of seminal fluid in infertile men and relationship to semen evaluation. Int J Obs & Gyn. 1989;28:##Deresinski S.C., and Perkash. Urinary tract infection in male spinal cord injured patrents. J Am Paraplegia Soc. 1985;8(1):7-10.##Micic S., Petrovic S., Dotlic R. Seminal antisperm antibodies and GTI. Urol. 1990;35:54-6.##Fowler I.E., Mariano M. Bactcrial infcction and male infevtility. J Urol. 1983;130:171-174.##Mosli H.A., Gazzaz F.S., Farsi H.M., Abdul- Jabar Hso. Genital infection in males with idiopathic infertility. Ann Suidi Med. 1996;16:42-6.##

مقايسه هيستروسونوگرافي و هيستروسالپنگوگرافي در تشخيص اختلالات داخل رحمي در زنان نابارور Comparison of hysterosonography and hysterosalpangiography in the diagnosis of intrauterine abnormalities in infertile women 2 1 اختلالات رحمي تقريباً در 62-34% زنان نابارور ديده مي‏شود. به علت شيوع بالاي ناهنجاريهاي رحمي، در ارزيابي اوليه علت ناباروري، بررسي حفره رحمي انجام مي‏شود. هدف از انجام اين مطالعه ارزيابي و مقايسه قدرت تشخيصي روش هيستروسونوگرافي با هيستروسالپنگوگرافي در تعيين بيماريهاي داخل رحمي زنان نابارور مي‏باشد. به جهت ارزيابي، هيستروسالپنگوگرافي و هيستروسونوگرافي بطور آينده‏نگر براي 66 خانم نابارور انجام گرفت. نتايج حاصل با يافته‏هاي هيستروسكوپي به عنوان استاندارد طلايي مقايسه شد. نتايج هيستروسونوگرافي در 5/95% (86/0=K) و هيستروسالپنگوگرافي در 9/87% (64/0=K) موارد با هيستروسكوپي همخواني داشت. حساسيت و ويژگي هيستروسالپنگوگرافي به ترتيب 4/71% و 3/92% بدست آمد. هيستروسونوگرافي براي تشخيص ضايعات داخل رحمي از قدرت تشخيص بالايي برخوردار است و مي‏تواند براي ارزيابي اوليه ساختمان داخل رحمي قابل قبول باشد. لذا بعنوان يك روش تشخيصي غيرتهاجمي، آسان، ارزان و مؤثر كه به خوبي نيز توسط بيماران تحمل مي‏شود، براي ارزيابي حفره رحمي در زنان نابارور توصيه مي‏گردد. همچنين در اين مورد مي‏توان آن را به جاي هيستروسالپنگوگرافي به كار برد. 2 Uterine abnormalities are found in approximately 34-62% of infertile women. Because of this relatively high prevalence of uterine abnormalities, evaluation of uterine cavity is performed in the primary evaluation of infertility. The purpose of this study was to compare the diagnostic accuracy of hysterosonography with that of hysterosalpangiography for the evaluation of abnormalities of uterine cavity of infertile women. Sixty six infertile women were prospectively evaluated with hysterosalpangiogram (HSG) and hysterosonogram (H/S) as a part of their infertility workup. The result of each examination was compared with what was obtained by hysteroscopy as a golden standard. The results of H/S agreed with hysteroscopy in 95.5% (K=0.86) while HSG agreed with hysteroscopy in 87.9% (K=0.64) of cases. Sensitivity of H/S was 85.7% and its specificity 98.1%, while sensitivity of HSG was 71.4% and its specificity 92.3%. Hysterosonography was in general more accurate test and appeared to be an acceptable first-line evaluation for intrauterine structure. We recommend use of hysterosonography as a noninvasive, easy, inexpensive, effective and well-tolerated method of investigating the intrauterine cavity in infertile women instead of hysterosalpangiography. 29 36 Mahtab M Zeinalzadeh مهتاب زینال زاده Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Iran zeinalmahtab@yahoo.com Tahereh T Nazari طاهره نظری Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Department of Obstet . and Gynecol Fateme Zahra Infertility Center, Shahid Yahyanejad Hospital, Babol University of Medical Science Iran Mehrangiz M Baleggi مهرانگیز بالغی Babol University of Medical Sciences Babol University of Medical Sciences Iran InfertilityHysterosalpangiographyHysterosonographyHystroscopyIntrauterine abnormally 100.pdf Wallah E.E. The uterine factor in infertility. Fertil Steril. 1972;23:138-58.##Lindeman H., Mohr J. Co2 hysteroscopy diagnosis and treatment. Am J Obs Gyn. 1976;124:129-33.##Ryan K.J., Berkowitz R.S., Barbieri R.L. Kistner’s gynecology principals and practice. 7th Edition,Philadelphia, WB Sunders. 1999;PP741-805.##Donnez J., Nisolle M. An atlas of operative laparoscopy and hysteroscopy. 2th Edition, New York, The Pathenon publishing group. 2001; PP395-7.##Speroff L., Galass R.H. Clinical gynecologic endocrinology and infertility. 6th Edition, Philadelphia,Lippincott Williams. 1999;PP321-79.##Hamilton J.A., Larson A.J., Lower A.M. Routine use of saline hesterosonography in 500 consecutive, unselected, infertilities women. Hum Reprod. 1998;13(9):2463-73.##Soares S.R., Camargos A.F. Diagnostic accuracy of by sonohysterography, trans-vaginal sonography and hysterosalpangiography in patients with uterine cavity diseases. Fertil Steril. 2000;73(2):406-11.##Brawn S.E., Coddington C.C., Schnorr J. Evaluation of outpatient hysteroscopy, salin infusion hysterosonography, hysterosalpangiography in infertile women: a prospective, randomized study. Fertil Steril. 2000;74(5):1029-34.##Darwish A.M., Youssef A.A. Screening sonohysterography in infertility. Gyn Obs Invest. 1999;48(1):43-7.##Hamilton B., Gaucherand P. Transvaginal sonohysterography evaluation of intrauterine adhesions. BMJ Reprod Med. 1998;31(1):101-4.##Lee A., Ying Y.K., Novy M.J. Hysteroscopy, hysterosalpingography and tubal ostial polyps in infertility patients. J Reprod Med. 1997;42(6):337-41.##Schwarzler P., Concin H., Bosch H., et al. An evaluation of sonohysterography and diagnostic hysteroscopy for assessment of intrauterine pathology. Ultrasound Obs Gyn. 1998;11:337-42.##Van den Brule F.A., Wery O. Comparison of contrast hysterosonography and transvaginal ultrasonography for uterus imaging. J Gyn Obs Biol Reprod. 1999;28(2):131-6.##Goldberg J.M., Falcon T., Attaran M. Sonohysterography to evaluate uterine defects on hysterosalpangiography and its correlation with hysteroscopy. J Am Assoc Gyn Laparoscopy. 1996;3(4 Suppl):S16.##Lindheim S.R., Morales A.J. Comparison of sonohysterography and hysteroscopy: lessons learned and avoiding pitfalls. J Am Gyn Laparoscopy. 2002;9(2):223-31.##Bacci P., Wanden B.J., Bernard J.P. Evaluation of transvaginal sonography with salin contrast. J Gyn Obs. 1997;11(2):121-4.##Larson A.J., Lower A.M. Hysterosonography in infertile women. Hum Reprod. 1998;13(9):63-73.##Dinaro E., Brata F. Diagnosis of benign uterine pathology by hesterosonography. Clin Exp Obs Gyn. 1997;23(2):103-7.##Wang C.W., Lee C., Lai Y. Comparison of hysterosalpangiography and hysteroscopy in female infertility. J Am Assoc Gyn Laparoscopy. 1996;3(4):58-4.##Rudigoz R., Sale B. Hysterosonographic study of the uterine cavity. J Gyn Obs Reprod Paris.1997;24(7):697-704.##Ayida G., Chamberlain P., Barlow D. Uterine cavity assessment prior to in vitro fertilization: Comparison of transvaginal, saline contrast hysterosonography and hysteroscopy. Ultrasound Obs Gyn. 1997;10(1):59-62.##Lindheim S.R., Sauer M. Upper genital tract screening with hysterosonography. Int J Gyn. 1999;60(1):47-50.##Alatas C., Aksoy E., Akarsu C., et al. Evaluation of intrauterine abnormalies in infertile patients by sonohysterography. Hum Reprod. 1997;12(3):487-90.##Alatas C., Aksoy E., Akarsu C., et al. Evaluation of intrauterine abnormalies in infertile patients by sonohysterography. Hum Reprod. 1997;12(3):487-90.##

مقايسه PCT پس از استفاده از بروموكريپتين واژينال و خوراكي در خانمهاي مبتلا به هيپرپرولاكتينمي و ناباروري Comparison of PCT after vaginal and oral bromocriptine use in women with hyperprolactinemia and infertility 2 1 هيپرپرولاكتينمي از دلائل شايع آمنوره و ناباروري مي‏باشد. استفاده از بروموكريپتين واژينال در اين بيماران مؤثر بوده و عوارض مصرف خوراكي را نشان نمي‏دهد. با توجه به محدوديت مطالعات موجود در اين زمينه و احتمال اثر موضعي بروموكريپتين روي عملكرد اسپرم، در اين آزمون باليني و مقطعي، تعداد اسپرم متحرك، مندرج در نتايجPCT پس از مصرف بروموكريپتين واژينال در گروه مطالعه (11نفر)، با نتايج PCT پس از مصرف بروموكريپتين خوراكي در گروه كنترل (15 نفر)، پس از برقراري سيكلهاي قاعدگي مرتب و اطمينان از تخمك‎گذاري، بررسي و مقايسه شد. 26 نفر از خانمهاي مبتلا به هيپرپرولاكتينمي مراجعه‏كننده به درمانگاه با شكايت گالاكتوره، اختلال قاعدگي و ناباروري در طول 6 ماه انتخاب و پس از حذف عوامل مخدوش‏كننده به طور تصادفي در دو گروه تقسيم شدند. مدت زمان لازم براي كاهش واضح پرولاكتين و برقراري سيكلهاي اوولاتوري در دو گروه بررسي و پس از برقراري سيكلهاي اوولاتوري، PCT در روزهاي 14-13 سيكل و در حضور موكوس سرويكس مناسب، 12-8 ساعت پس ازنزديكي انجام گرديد. نتايج در دو گروه با استفاده از تستMann-Whitney U مقايسه و مورد تجزيه و تحليل آماري قرار گرفت. ميانگين زمان لازم براي برقراري سيكلهاي اوولاتوري در گروه مورد مطالعه، 5/5 هفته و در گروه كنترل، 8/5 هفته بود كه از نظر آماري تفاوت آماري معني‏دار را نشان نداد (05/0P>). در گروه مورد مطالعه، پس از مصرف روزانه mg5/2 بروموكريپتين واژينال بين 11 تا 20 (7/2±3/15) اسپرم متحرك در هر HPF در PCT مشاهده شد. همچنين در گروه كنترل بررسي نتايج PCT پس از مصرف روزانه mg5-5/2 بروموكريپتين خوراكي، بين 10 تا 23 (8/2±2/14) اسپرم متحرك در هر HPF مشاهده گرديد. در مقايسه آماري گروه مطالعه با گروه كنترل تفاوت معني‏داري از نظر تعداد اسپرم متحرك و تحرك اسپرم در دو گروه مشاهده نگرديد (05/0P>). مطالعة حاضر اين فرضيه را پيشنهاد مي‏كند كه استفاده از بروموكريپتين واژينال، روي بقا و تعداد اسپرم متحرك و نتايجPCT اثر محسوسي نداشته و مي‏تواند در موارد هيپرپرولاكتينمي و ناباروري، بدون اختلال در عملكرد اسپرم و باروري بكار برده شود. به نظر مي‏رسد انجام مطالعات وسيعتري براي اثبات اين فرضيه و نهايتاً اثر استفاده از بروموكريپتين واژينال روي نتايج حاملگي در دو گروه ضروري است. 2 Hyperprolactinemia is the most common cause of amenorrhea and infertility. Oral bromocriptine is the drug of choice for the treatment of hyperprolactinemia. Due to complications of its oral use, vaginal bromocriptine has been introduced as an effective and safe method. There is limited information regarding possible side effects of vaginal bromocriptine on motile sperm count in PCT results. Thus, in this clinical cross-sectional study, we sought to determine possible effects of vaginal bromocriptine on motile sperm count in PCT after resumption of ovulatory cycle in outpatients in reproductive age with hyperprolactinemia and complaints such as galactorrhea, menstrual irregularity and infertility. After exclusion of all confounding factors, the patients were divided in two groups. The study group (n=11) was treated with vaginal bromocriptine 2.5mg daily, and the control group (n=15) was treated with oral bromocriptine 2.5-5mg daily. Treatment duration needed for marked reduction in prolactine and also initiation of menses and ovulatory cycles were evaluated in both groups. After restoration of ovulation, PCT was done on 13-14th day of cycle in the presence of good cervical mucus, 8-12 hours after coitus. The numbers of motile sperm count atozoa/HPF in both groups were recorded and statistically compared with Mann Whitney U test. Treatment durations needed for initiation of ovulatory cycles in study group and the control group were 4-8 (mean5.5) weeks and 4-7 (mean 5.8) weeks, respectively with no statistical difference (p>0.05). PCT results showed 11-20 (mean15.3) motile sperm/HPF with progressive forward movement in study group, who were treated with vaginal bromocriptine. By using oral bromocriptine, PCT showed 10-23 (mean 14.4) motile sperm/HPF with progressive forward movement in the control group. There were no statistical difference in PCT results between these two groups (p>0.05). These results suggests the hypothesis, that vaginal bromocriptine has no adverse effects on motile sperm count in PCT, and vaginal bromocriptine can be used safely without possible adverse effect on sperm function in women with hyperprolactinemia and infertility. However, larger studies with more cases are necessary to confirm this hypothesis and to determine if vaginal bromocriptine has any effect on fertility in both groups. 36 42 Soheila S Arefi سهیلا عارفی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran soheilaarefi@yahoo.com Nader N Fallah نادر فلاح Biostatistics Department, Faculty of Medicine, Shahed University of Medical Sciences Biostatistics Department, Faculty of Medicine, Shahed University of Medical Sciences Iran HyperprolactinemiaBromocriptinePCTMotile spermOvulatory cycles 101.pdf Sclechte J., Sherman B., Halmi N.,Van Bilder J., Chapler F.K., Dolan K., Granner D., Dueo T., Harris C. Prolactine secreting tumors. Endocrin Rev. 1980;1:295.##Matzuaki, Azuma K., Irabara M., Yasui T., Aono T. Mechanisms of anovulation in hype prolactinemic amenorrheadetermined by pusatile gonadotropin releasing hormoninjection combined with human chorionic gonadotropin .Fertil Steril. 1994;62:2254.##Blackwell R.E. Diagnosis and treatment of hyper prolactinemic syndromes. Fertil Steril. 1985;43:5.##Keye W.R., Chang J.R., Wilson C.B., Jaffe R.B. Prolactine secreting pituitary adenoma 3. Frequency and diagnosis of amenorrhea galactorehea. JAMA. 1980;244;1329.##Pepperel R.J. Prolatine and reproduction. Fertil Steril. 1981;35:267.##Ginsburg J., Hardiman P., Thomas M. Vaginal bromocriptine clinical biochemical effects. Gynecol Endocrinol. 1992;6(2):119-26.##Katz E., Weiss B.E., Hassell A., Schran H.F.,Adashi E.Y. Increased circulating levels of bromocriptine after vaginal compared with oral administration. Fertil Steril. 1991;55:882.##Fletes Rabago V.M., Torres Farias S., Dominguez Jimenez A., Padilla Ruiz R. Alternative to bromocriptine (BEC) management in patients with prolactinoma and intolerance to oral (BEC). Fertil Steril. 1996;65(2):440-2.##Motta T., de Vincentiis S., Marchini M., Colombo N., D’Alberton A. Vaginal cabergoline in the treatment of hyperprolactinemic patients intolerant to oral dopaminergics. Gyn Obs Mex. 1991;59:283-8.##Rojas F.J., Djannati E., Rojas I.M. The effect of bromocriptine on the motility of human sprmatozoa and its capacity to penetrate the cervical mucus. Fertil Steril. 1991;55:48.##Chenette P.E., Siegle M.S., Vermesh M., Kletzky O.A. Effect of bromocriptine on sperm function invitro and invivo. Obs Gyn. 1991; 77:935.##Stanislarov R., Nalbanski B., Purevska M. The post coital test: Clinico-laboratory observation Akush Ginekol (Sofiia). 1999;38(4)30-2.##Cuellar F.G. Bromocriptine mesylate (Parlodel) in the management of amenorrhea/ galactorrhea associated with hyper prolactinemia. Obs Gyn. 1980;55:278.##لیون اسپیروف. رابرت اچ گلس. ناثان جی‏کیس. آندوکرینولوژی زنان و ناباروری اسپیروف. ترجمه قاضی جهانی بهرام، مهاجرانی سمیرا، فدایی اکبر. گلبان، تهران، 1380.##Ricci G., Giolo E., Nucera G., Pozzobon C., De Seta F., Guaschino S. Pregnancy in hyperprolactinemic infertile women treated with vaginal bromocriptine: report of two cases and review of the literature. Gyn Obs Invest. 2001;51(4):266-70.##Scommegna A., Ye S.H., Prins G.S. Bromocriptine reverses the inhibitory effect of macrophages on human sperm motility. Fertil Steril. 1994;61(2):331-5.##

تأثير روش ارزيابي حياتي اسپرم انساني توسط MTT بر نتايج حاصله از تزريق مستقيم اسپرم به داخل سيتوپلاسم تخمك Effect of human sperm MTT viability assay on outcome of intraycytoplasmic sperm injection 2 1 تحقيقات قبلي نشان داده است كه روش ارزيابي حياتي اسپرم توسط MTT، روشي مناسب براي تشخيص اسپرم‏هاي زنده از غيرزنده مي‏باشد. در اين روش نمونة اسپرمي در مجاورت MTT قرار گرفته و MTT توسط آنزيم دهيدروژناز ميتوكندري اسپرم‏هاي زنده در ناحيه قطعه مياني به رنگدانه بنفشMTT Formazan تبديل مي‏شود. با توجه به مشاهده مستقيم دانه‏هاي تشكيل شده، مي‏توان از اين روش در تفكيك اسپرم‏هاي زنده توسط سوزن ميكرواينجكشن و تزريق آنها به داخل تخمك استفاده كرد. هدف از اين مطالعه بررسي تأثير روش ارزيابي حياتي اسپرم توسط MTT برروي لقاح، تسهيم و تشكيل بلاستوسيست مي‏باشد. لذا تعداد 109 عدد تخمك‏هاي انساني كه در متافاز II قرار داشتند به دو گروه تقسيم شد. يك گروه توسط اسپرم‎هاي MTT مثبت و يك گروه هم توسط بخش ديگري از همان نمونه اسپرمي بدون مجاورت با MTT تزريق شدند. مقايسة نتايج بين دو گروه مورد (آزمون) و گروه كنترل نشان داد كه تفاوت معني‏داري بين درصد لقاح، تسهيم و بلاستوسيست، در هر دو گروه وجود ندارد. لذا در صورتي كه بتوان ثابت كرد كه روش ارزيابي حياتي اسپرم توسط MTT تأثيرات ميتوژنيك يا تراتوژنيك ندارد، مي‏توان از اين روش براي درمان به روش ICSI بخصوص در بيماران آستنواسپرمي داراي اختلالات ناحيه دم اسپرم سود جست. 2 Sperm MTT Viability Assay has been shown to be a suitable test for differentiation of viable from non-viable sperms. In this procedure MTT is converted to observable purple MTT Formazan by mitochondrial dehydrogenase in the midpiece region and therefore viable sperms can be distinguished which makes this test suitable for ICSI. Therefore, in order to study the effect of MTT positive sperms on fertilization, cleavage and blastocyst formation, 109 fresh human oocytes (metaphase II) were divided in to two groups; one group was injected with MTT positive sperms and the other one was taken as control. The results of study showed that there is not significant difference with respect to fertilization, cleavege and blastocyst formation between these two groups. Therefore, if MTT proves to be nether mitogenic nor teratogenic, sperm MTT viability assay might be useful for ICSI in patients with absolute or severe asthenospermia, especially in cases with tail abnormality. 4 14 Mohammad Hossein MH Nasr-Esfahani Embryology Department, Royan Institute, Iranian Academic Center for Education, Culture & Research (ACECR) Embryology Department, Royan Institute, Iranian Academic Center for Education, Culture & Research (ACECR) Iran nasrmhn@yahoo.com Roshanak R Aboutorabi روشنک ابوترابی Anatomy Department, Faculty of Medicine, Isfahan Medical Sciences University Anatomy Department, Faculty of Medicine, Isfahan Medical Sciences University Iran Ebrahim E Esfandiary ابراهیم اسفندیاری Anatomy Department, Faculty of Medicine, Isfahan Medical Sciences University Anatomy Department, Faculty of Medicine, Isfahan Medical Sciences University Iran Human spermMTTViability assayICSI 97.pdf Eliasson R., Mossberg B., Camner P., Afzelius BA. The immntile-cilia syndrom. A congenital ciliary abnormality as an etiologic factor in chronic airway infections and male sterility. N Engl J Med. 1977;297:1-6.##Yieh-Loong T., Jiaen L., Jairo E., Garcia E., Eugene K., Campton G., Baramki T.A. Establishment of an optimal hypo-osmotic swelling test by examining single spermatozoa in four different htpo-osmotic solutions. Hum Reprod. 1997;12(5):1111-3.##WHO laboratory manual for the examination of human semen sperm-cervical mucus interaction. 3th Edition, Cambridge University Press. 1992; PP52.##Ahmadi A., Soon-Chye N.G. The single sperm curling test, a modified hypo-osmotic swelling test, as a potential technique for selection of viable sperm for intracytoplasmic sperm injection. Fertil Steril. 1997;68(2):346-50.##Hossein A.M., Rizk B, Bairk S., Huff C., Thorneycroft I.H. Time course of hypo-osmotic swelling test of human spermatozoa; evidence of ordered transition between swelling subtypes. Hum Reprod.1998;13(6):1578-83.##ابوترابی ر، اسفندیاری ا، نصراصفهانی م ح، مردانی م. یک روش نوین جهت بررسی حیات اسپرم با استفاده از MTT. نشریه پزشکی یاخته، سال 3، شماره 9، 1380، ص 6-1.##Knars-Esfahani M.H., Aboutorabi R., Esfandiari E., Mardani M. Sperm MTT viability assay: a new method for evaluation of human sperm viability. J Assist Reprod Genet. 2002;19(10):475-80.##Mosmann T. Rapid colorimetric assay for cellular growth and survival, Application to proliferation and cytotoxisity assay. J Immunol Method. 1983;65:55-63.##Hansen M.B., Nielsen S.E., and Berg K. Re-examination and further development of a precise and rapid dye method for measuring cell growth/cell kill. J Immunol Methods. 1989; 119: 203-10.##El-Nour A.M., Al Mayman H.A., Jaroudi K.A., Coskun S. Effects of the hypo-osmotic sweelling test on the outcome of intracytoplasmic sperm injection for patients with only nonmotile spermatozoa available for injection; a prospective randomized trial. Fertil Steril. 2001;75(3):480-4.##Tasdemir I., Tasdemir M., Tavukculoglu S. Effect of pentoxifylline on immotile testicular spermatozoa. J Assist Reprod Genet. 1998;15:90-2.##Ramirez J.P., Carreras A., Mendoza C Sperm plasma membrane integrity in fertile and infertile men.Andrologia. 1992;24:141-4.##

تأثير ماساژ بر ميزان درد و اضطراب در طول دوره زايمان Effect of massage on reducing pain and anxiety during labour 2 1 درد زايمان يكي از شديدترين دردهايي است كه زنان تجربه مي‏كنند. درد شديد پايدار باعث ايجاد استرس مي‏شود، كه اثرات مضري بر مادر، جنين و نوزاد دارد. بديهي است كه اين درد بايد تسكين يابد. با توجه به اثرات سوءدرد، اين مطالعه به منظور تاثير ماساژ بر ميزان درد و اضطراب در طول دوره زايمان انجام شد. اين مطالعه تجربي در نيمه دوم سال 1380 بر روي 60 زن حامله نخست زا كه به صورت تصادفي آسان انتخاب شده بودند و انتظار مي‏رفت زايمان طبيعي داشته باشند، در بيمارستان آيت الله كاشاني شهر جيرفت انجام شد. نمونه‏ها به دو گروه آزمون (30=n) و كنترل (30=n) تقسيم شدند. براي گروه آزمون از ماساژ استفاده شد. از مقياس پاسخ بيمار به شدت درد(PBI) براي سنجش ميزان درد و از مقياس بصري ـ عددي (VASA) براي سنجش اضطراب استفاده گرديد. شدت درد و اضطراب در بين دو گروه در فاز نهفته (باز شدن گردن رحم 4-3 سانتي متر)، فاز فعال (باز شدن گردن رحم7- 5 سانتي متر) و فاز زايماني (باز شدن گردن رحم10- 8 سانتي متر) مقايسه شد. نتايج حاصل از پژوهش نشان داد كه با پيشرفت زايمان، ميزان درد و اضطراب افزايش مي‏يابد. آزمون آماري تي‏زوج نشان داد كه در گروه آزمون ميزان درد در اين سه فاز زايماني بطور معني‏داري پايين‏تر است (فاز اول 0/0=P، فاز دوم 002/0=P و در فاز سوم 00/0=P) و اضطراب بين دو گروه فقط در فاز نهفته اختلاف معني‏دار داشت(04/0=P). 87% (26=n) از افراد گروه آزمون بيان نمودند كه ماساژ مؤثر بوده، در طول زايمان درد را برطرف و حمايت رواني ايجاد مي‏كند. يافته‏هاي حاصل از پژوهش نشان داد كه ماساژ يك مداخله پرستاري مؤثر و ارزان است كه مي‏تواند باعث كاهش درد و اضطراب در طول زايمان شود و مداخله پرستاران در انجام‏دادن ماساژ مي‏تواند بر تجربه زايماني تأثير مثبتي داشته باشد. پيشنهاد مي‏شود از ماساژ در طي دوره زايمان به عنوان يك كاهندة درد و اضطراب استفاده شود. 2 Labour pain is one of the most severe forms of pain that each women may experience during her life. Severe pain makes stress response with harmful effects on both mother, and her fetus. This study was carried out to evaluate the effect of massage therapy on relieving pain and its harmful sequel such as anxiety during labour. This clinical trial was performed on sixty nulliparous women selected randomly who were expected to have a normal childbirth in the Jiroft city hospital. Cases were randomly assigned to experimental (n=30) and control (n=30) groups. The experimental group received massage intervention. The nurse-rated Present Behavioral Intensity (PBI) was used as a measure of labour pain. Anxiety was measured by the Visual Analogue Scale for Anxiety (VASA). The intensity of pain and anxiety between these two groups were compared in the latent phase (cervix dilated 3-4cm), active phase (cervix dilated 5-7cm) and transitional phase (cervix dilated 8-10cm) of labour. In both groups, there was an increase in pain intensity and anxiety level as labor progressed. Results of T-test analysis demonstrated that the experiment group had significantly lower pain reaction in all three phases (Phase1 P=0.000, Phase2 P=0.002, Phase3 P=0.000) and anxiety levels were significantly different between two groups only in latent phase (P=0.00). Eighty seven percent (n=26) of cases in experimental group expressed that massage was helpful, provided pain relief and psychological support during labour (P<0.40). Our findings suggest that massage is a cost effective nursing intervention that can decrease pain and anxiety during labour and nurses intervention to perform massage could have positive effect on delivery experience. It is suggested that massage be used for decreasing pain and anxiety during labour. 42 47 Motahareh M Pilevarzadeh مطهره پیله ور زاده Jiroft Faculty of Nursing, Kerman University of Medical Sciences Jiroft Faculty of Nursing, Kerman University of Medical Sciences Iran Saadat S Salari سعادت سالاری Jiroft Faculty of Nursing, Kerman University of Medical Sciences Jiroft Faculty of Nursing, Kerman University of Medical Sciences Iran Nematollah N Shafiei نعمت الله شفیعی Jiroft Faculty of Nursing, Kerman University of Medical Sciences Jiroft Faculty of Nursing, Kerman University of Medical Sciences Iran MassageAnxietyNursing interventionChildbirthLabor pain 102.pdf Carol C., Hayes J. Physiologic and psychodynamic response to the administration of therapeutic touch in critical care. Intensive crit care Nurs. 1999;15:363-8.##Fraser J., Rose K.J. Psychological effects of back massage in elderly institionalised patients. J Adv Nurs. 1995;18(2):238-45.##Hill C. Is massage beneficial to critically ill patients in intensive care units. Intensive crit care Nurs.1999;9:116-21.##Melsak R., Schaffebery D. Low back pain during labour. Am J Obs & Gyn. 1987;156:901-5.##Field T.M. Massage therapy effects. Am Psychol. 1997;53:1270-81.##Hayes J., Carol C. Immediate effect of a five minutes foot massage of patients in critical care. Intensive crit care Nurs. 1999;15:77-82.##Waston S. The effects of massage: a holistic approach to care. Nurs stand. 1997;11(46):45.##Denis T. Complementary therapy. 3th Edition, Baltimore, Bailliertinall. 2000;pp38-41.##Chand., Chen. Effects of massage on pain and anxiety during labour. Am J Nurs. 2001;pp##Field T., Tailors. labour pain in reduced by massage therapy. J Psychosomatic Obs & Gyn. 1997;18:286-91.##Bonnel A.M., Bourcuf. Labour pain assessment. Measurement validity of behavioral. Index: pain. 1985;22:81-95.##Gift A.G. Visual analogue scales: Measurment of subjective phenomena. Nursing Res. 1998; 38:286-8##Holroyd E., yin king L. Hang Kong chine’s women’s perception of support from midwives during labour. Midwifery. 1997;13:66-72.##Mccafery Mand Beebe. Pain. Clinical manual for nursing practice Co. Mosby. 1989.##

آگاهي، نگرش و رفتار زنان مهاجر افغاني ساكن شهر زاهدان در مورد تنظيم خانواده Knowledge, attitude and practice of Afghan refugee women residing in Zahedan about family planning 2 1 به دليل اهميت حضور مهاجرين افغاني و چگونگي روش زندگي آنان، پژوهش حاضر آگاهي، نگرش و رفتار زنان افغاني ساكن زاهدان را در زمينه برنامه‏هاي تنظيم خانواده مورد بررسي قرار داد. بدين منظور از يك نمونه 397 نفري از زنان متأهل افغاني در منازل مسكوني‏شان مصاحبه بعمل آمد. داده‏ها پس از جمع‏آوري با استفاده از آزمونهاي آماري Chi-square, t-student وKruskal-Wallis با استفاده از SPSS مورد تجزيه و تحليل قرار گرفت. يافته‏هاي پژوهش پايين‏بودن سن اولين ازدواج و بارداري و بالابودن ميزان باروري و بيسوادي را در جمعيت مورد مطالعه نشان داد. بيشترين آگاهي در زنان مهاجر افغاني در مورد استفاده از كنتراسپتيوهاي خوراكي وجود داشت و شايعترين وسايل مورد استفاده آنها قرص‏هاي خوراكي و آمپول بود. 6/48 درصد از هيچ روشي استفاده نمي‏كردند، كه تمايل به داشتن فرزند بيشتر، حامله‏بودن يا مخالفت شوهر را به عنوان مهمترين دلايل بيان نمودند. 4/20 درصد تا كنون دچار حاملگي ناخواسته شده بودند كه عدم استفاده صحيح بعنوان شايعترين علت ذكر شد. 8/51 درصد با لزوم داشتن فرزند پسر در خانواده و 3/57 درصد با اين نگرش كه دختر هر چه زودتر به خانه بخت برود موافق بودند. آگاهي، نگرش و رفتار اين زنان با متغيرهاي سواد، سواد همسر، قوميت و مذهب آنها ارتباط معني‏داري نشان داد(001/0P<). سيستم بهداشتي ايران خدمات مشابه با ايرانيان به مهاجرين افغاني ارائه مي‏نمايد كه لازم است ضمن تداوم آن نسبت به ارائه آموزشهاي مؤثر بر اساس نيازهاي در حال تغيير تلاش شود. 2 Considering the high number of Afghan refugees in Zahedan and the important issue of their life style, the present study was carried out to determine knowledge, attitude and practice of Afghan Refugee women residing in Zahedan about family planning. A sample of 397 married women was interviewed at their homes. Statistical analysis was performed using Chi-square, t-student and Kruskal Wallis tests by SPSS. Our findings indicated that there existed low marriage and pregnancy age and high rate of pregnancy and illiteracy among them. Most Afghan refugee women had knowledge about oral contraceptives and the most common contraception used by them was oral and injectable contraception. Forty eight and sixth percent were using no contraception, for which, intention to have more children, being pregnant and husband’s disagreement were mentioned as main reasons. Unwanted pregnancy was reported by 20.4% with improper use of contraception as its main reason. They believed that having son in the family (51.8%) and early marriage of daughters (57.8%) are necessary. There was a significant relationship between knowledge, attitude, practice with literacy, husband’s literacy, ethnicity, and their religion (P<0.001). Iranian health system presents health services to refugee Afghan women similar to Iranian women. It is necessary to continue those services and to provide effective training based on their changing needs. 47 55 Fatemeh F Rakhshani فاطمه رخشانی Public Health Department, Faculty of Health, Zahedan Medical Sciences University Public Health Department, Faculty of Health, Zahedan Medical Sciences University Iran rakhshanif@yahoo.com Alireza A Ansari Moghaddam علیرضا انصاری مقدم Public Health Department, Faculty of Health, Zahedan Medical Sciences University Public Health Department, Faculty of Health, Zahedan Medical Sciences University Iran Abdolfahim A Hor عبدالفهیم حر Faculty of Medicine, Zahedan University of Medical Sciences Faculty of Medicine, Zahedan University of Medical Sciences Iran KnowledgeAttitudePracticeFamily planningAfghan refugee women 103.pdf شجاعی تهرانی، حسین. جمعیت و بهداشت باروری. انتشارات جهاد دانشگاهی، تهران، سال 1377، ص 36-35.##Yurdakul M., Vural G. Reasons for using traditional methods and role of nurses in family planning.Contraception. 2002;65:347-50.##Donati S., Hamam R., Medda E. Family planning KAP survey in Gaze. Soc Sci Med. 2000;50(6):841-9.##Popou A.A., Visser A.P., Ketting E. Contraceptive knowledge, attitude and practice in Rossia during the 1980s. Stud Fam Plan. 1993; 24(4):227-35.##Gelennon M.J., Fagan D.J. Attitude towards family planning in Dharan, East Nepal: implications for the family planning programme. Trans R Soc Trop Med Hyg. 1993;87(6):612-4.##Adinna J.I., Nwosu B.O. Family planning knowledge and practice among Nigerian woman attending an antenatal clinic. Adv Contracpt. 1995;11(4):335-44.##کیخائی نسرین. مطالعه سطح آگاهی، رفتار و نگرش زنان بارور زاهدانی. پایان نامه برای اخذ درجه دکتری پزشکی. دانشگاه علوم پزشکی و خدمات بهداشتی درمانی زاهدان. سال 1375.##بولتن خبری اداره کل اتباع سیستان و بلوچستان ، سال 1377، ص 8 و 7.##Kapoor L. Unmet need in family planning in South Asia region. Int J Gyn Obs. 1995;(2):s19-s26.##Rama Rao G., Moulasha K., Sureender S. Knowledge, attitude and practice of family planning among fisherman in Tamil Nadu. J Fam Welfare. 1993;39(3):50-4.##Myntti C., Ballan A., Dewachi O., El-kak F., Deeb M.E. Challenging the stereotypes: men, withdrawal, and reproductive health in Lebanon. Contraception. 2002;65:165-70.##Johnson T., Macke B. Estimating contraceptive needs from trends in method mix in developing countries. Int Fam Plan Perspec.1995;22:392-6.##جهانفر، محمد. جمعیت و تنظیم خانواده. انتشارات اورنج، تهران، سال 1379، ص 172-170.##

بيوتكنولوژي در آيينه فلسفه اخلاق Biotechnology in the mirror of ethics 2 1 امروزه مباحث بيوتكنولوژي از مباحث مهم حوزة اخلاق كاربردي است كه توجه فيلسوفان اخلاق را به خود جلب كرده است. اين موضوعات از يك سو پيوند با نظريات اخلاقي دارد، از سوي ديگر بخش هنجارهاي اخلاقي را با مباحث حوزة بيوتكنولوژي درگير نموده است. مسائلي چون: مراقبتهاي بهداشتي، توليد مثل و تكنيكهاي جديد مربوط به آن، مرگ و زندگي، خودكشي، سقط جنين، پيوند اعضاء،‌ دست آوردهاي علم ژنتيك، كنترل جمعيت و رفتار با حيوانات نمونه‏هايي از مسائل اين حوزه از اخلاق كاربردي است. پاسخ به مسائل حوزة بيوتكنولوژي با توجه به حساسيت‏هاي خاص آن افزون بر معيارهاي هفت گانة كارآيي، معيار ديگري را مي‏طلبد كه نگارنده آن را قدرت الزام دروني ناميده است. اين مقاله، نخست به بررسي اجمالي نظريه‏هاي مهم اخلاقي مانند: اخلاق سود انگار، اخلاق كانتي و اخلاق فضيلت مدار مي‏پردازد، آن گاه ضمن اشاره به رويكرد مذهبي در اين حوزه، به بيان پيامدهاي پايبندي به هر يك از اين نظريه‏ها در حوزة مباحث بيوتكنولوژي مي‏پردازد. سپس با الهام از اصول راهنما در اين حوزه، دو مسألة محوري حوزة بيوتكنولوژي مطرح مي‏شود؛ مسأله نخست بررسي اخلاقي بودن يا غير اخلاقي بودن تصرف‏هاي زيست شناختي در سه حوزة گياهي، حيواني و انساني است؛ و مسأله دوم تعيين تكليف مالكيت حاصل از دست‌آوردهاي حوزة بيوتكنولوژي است. در پايان توجه به «پژوهشگر» و «موضوع پژوهش» به عنوان دغدغه‏هاي اخلاقي در مطالعات بيوتكنولوژيك مطرح مي‏شود. 2 Bioethics seems to be the most important branch of applied ethics. It concerns both philosophers and scientists. Such crucial questions as health care, ART, genetic engineering, abortion, euthanasia, suicide, trasplanation, population issues, animal rights and the like are just examples of questions are being dealt with in this decipline. Due to special nature of these questions, to offer a sufficient moral theory, in addition to seven criteria of applicability i.e., clarity, completeness, comprehensiveness, practicability as well as justificatory, output and explanatory powers, an internal urging power is needed. And that may be achieved by divine persuasion to follow rational moral principles which are comprehensible by human faculty. Accordingly, in the level of content moral principles are rational norms, but in the level of implementation divine command is an urging motivation to persuade human agents to act morally. And by this, we would have a non-divine command moral theory which gives considerable role to religious beliefs. Also in this article in addition to dealing with main moral theories, Kantian, utilitarianism, virtue ethics and religious approach to biotechnological issues and their implications in this field, I have offered certain moral principles which can be applied as guiding principles biotechnological questions. 55 68 Seyyed Mohammad SM Seyed Fatemi سید محمد سید فاطمی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran m-fatemi@cc.sbu.ac.ir BioethicsEthical principlesDivin command theoryKantian theoryUtilitarianismVirtue Ethics 104.pdf Shiner, R. Law and Morality, in ed. Patterson, D. A companion to philosophy of law and legal theory.Blackwell Publishers. 1999;PP436-449.##Lafollette, H. ed. Ethical theory. Blackwell Publishers. 1999.##کمسیون اخلاقیات در علم و تکنولوژی یونسکو. اسناد شماره، /13 March 2002×165/E .##Singer, P., Kuhse H. "What is bioethics? a historical introduction". in a Companion to Bioethics. Blackwell Publishers. 2001;PP3-15.##Harris J. The value of life. Routledge, London. 1985;P87##Mary Anne Warren. Sex selection: Individual choice or cultural coertion, in ed. Kuse, H, Singer P.Bioethics, and Anthology. Blackwell publisher. 1999;PP137-142.##قاری سید فاطمی، سید محمد. حق حیات. مجله تحقیقات حقوقی دانشگاه شهید بهشتی، شماره 32-31، پاییز و زمستان 1380-1379.##قاری سید فاطمی، سید محمد. سقط جنین حق یا جرم. بولتن تولید مثل و نازایی پژوهشکده ابن سینا، شماره 51، آذر ماه 1381.##Rhodes R. Organ transplantation, in ed. Kuhse, H., Singer p. A companion to Biothics Blackmen Publisher. 2001;PP329-340.##Cloning Human Beings, Reports and Recommendations of the National Bioethics Advisory Commission, 1997.##Harris J. Goodbye Dolly? The ethics of human cloning. Journal of Medical Ethics. 1997;23,PP 353-60.##Battin, M.P. Population issues, in ed. Kuhse H., Singer P. A Companion to Bioethics. Blackwell Publishers. 2001;PP149-163.##Kant I. Duties towards animals, in Lectures on Ethics, translated by Louis Infield. New York, Harpter and Row, 1963;PP239-41.##Beauchamp T., Childress P. Principles of Biomedical Ethics. Oxford University press, Oxford.1994;PP:47##Quinn P.H., Divine command theory, in ed. Hugh Lafollette. Ethical theory. 2001;PP53-74.##قاری سید فاطمی، سید محمد. نظریات اخلاقی در آئینه حقوق، نامه مفید شماره 29، بهار 1381.##Hare R.M. A utilitarian Approach, in ed. Kuhse, H., Singer P. A Companion to Bioethics. Blackwell Publishers. 2000;PP:80-86.##Boyle J. An absolute Rule Approach, in ibid. 2001;PP72-79.##Slote M., in ed. Lofollette H. Virtue Ethic. 2000;PP325.##Macintyre A. After Virtue, University of Dame Press, V.S.A. 1981##Brody B. Religion and Bioethics, in ed. Kuhse, H., Singger P. Blackwell Publishers. 2001; PP##Beauchamp T., Childress T. 1994;PP120-96.##Frankena W. Ethics, Englewood Cliffs N.J., Prentice-Hall. 1973;PP47.##

استيگما و ناباروري در ايران ـ راهكارهايي براي مقابله Stigma and infertility in Iran - coping skills 2 1 حدود چهل سال پيش, گافمن (1963) در كتاب خود, به موضوع استيگما به عنوان شرايط آزار دهنده توجه كرد كه باعث رنج بعضي از افراد در زندگي آنها مي‏شود. او استيگما را به عنوان علامت بدني توصيف كرد كه نشان از چيزي غيرمعمول دارد و همچنين به عنوان وضعيت بد اخلاقي (ارزشي) و يا اجتماعي دانست كه فرد داراي استيگما با آن مواجه است. اين لغت به جاي توجه به وضعيت بدني خاص بيشتر به انگشت‏نما بودن اشاره دارد و طيفي وسيع از خصوصياتي را شامل مي‏شود كه يك شخص بر اساس آنها ممكن است ناجور و خارج از هنجار نشان داده شود. مردان و زنان نابارور به خاطر عدم توانايي در داشتن فرزند حاصل از باروري خود با نوعي حالت استيگما مواجه هستند. در اين مقاله عوامل ايجادكننده استيگما براي اشخاص نابارور به تفصيل توضيح داده شده است. مشاهدات باليني نشان مي‏دهد كه تحريفات شناختي داراي تاثير غيرقابل‏ انكاري در ايجاد شرايط استيگما براي ناباروري مي‎باشند. همچنين در اين مقاله نقش اصلاحات شناختي در كاهش استيگما براي افراد نابارور توضيح داده شده است. يك مورد باليني كه از شرايط استيگما در رنج بود، بهمراه تكنيك‏هاي شناختي ـ‌ رفتاري براي درمان وي تشريح شده و همچنين چند روش براي توقف فشارهاي اجتماعي بر روي افراد نابارور توصيه شده است. 2 About fourty years ago Goffman (1963) in his book pointed at stigmatizing as distressing condition which harm some people in their life. He described stigma as bodily signs designed to expose something unusual and bad about the moral status of signifier. This term is used more to mean disgrace than any bodily feature, it can include the wide range of characteristics which make a person odd or seen deviant. Men or women with infertility face stigma because of unability to have their own children. In this article some factors which involve to make stigmatized situations for infertile persons have been described. Clinical observations shows that cognitive distortions has eminent effect in creating stigmatized situation for infertility. The role of cognitive modification in decreasing stigma for these persons are explained. A single case who suffered from stigmatized situation is described here and some CBT techniques for her treatment have been introduced. 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