Objective Despite premarital screening, prenatal diagnosis and the option for voluntary termination of pregnancy, some Iranian couples continue a pregnancy with a fetus affected with beta-thalassaemia major (b-TM). We examined the reasons for this decision, to evaluate the sociocultural challenges these couples face. Methods A retrospective evaluation of medical records of all fetuses aborted was conducted to identify those with b-TM, to determine the frequency of b-TM births and to establish the number of couples with b-thalassaemia who declined prenatal diagnosis or a termination of pregnancy in this period. We investigated the reasons for declining these options. Results The birth prevalence of b-TM decreased from 39.38 to 2.68 in 100,000 live births from 2005 to 2010. Terminations of pregnancy for affected fetuses increased from 67 in 2005 to 135 in 2010. We identified eight couples as b-thalassaemia carriers who declined prenatal diagnosis or a termination of pregnancy. All but one couple already had a child with b-TM. The reasons for declining prenatal diagnosis were strong religious beliefs, superstition and faith in a supernatural solution in six couples. Economic and cultural factors, and previous termination of pregnancy were also mentioned as reasons by the other two couples. Conclusion Although most of the couples had a b-TM child and related socioeconomic problems, their reasons for refusing prenatal diagnosis or termination remain a challenge for the healthcare system in Iran. Couple screening and educational programmes have effectively decreased the rates of refusal in at-risk couples in recent years.
The marginal zones of the Caspian Sea and the Persian Gulf have a higher prevalence of thalassemia compared to other regions of Iran. This disease has disabled many people and resulted in increasing health care costs. The aim of this study was to assess the incidence of β-thalassemia (β-thal) and to evaluate the outcome of applied preventive strategies over a 14-year period in Fars Province, Southern Iran. This cross-sectional study comprised all new cases of β-thal recorded during 1997-2011. The data were obtained from the Non-Communicable Diseases Surveillance Department of Shiraz University of Medical Sciences, Shiraz, Iran, and are presented as mean ± standard deviation (SD). The Fars Health Network System screened 840 686 males and females applying for marriage certificates. Among the carriers, 50.5% cancelled their marriages, 42.5% married, and 7.0% did not show up at the clinics. The rate of cancelled marriages has reduced since 2000, when marriage candidates were given the option of prenatal diagnosis. From 2000 to 2011, a total of 3539 married couples were referred for prenatal diagnosis. Of these, 806 fetuses were found to carry thalassemia and 800 aborted. It is impressive to note that while 101 cases of thalassemia were recorded in 1997, this figure was reduced to two cases by 2011. This study has established that an integrated primary health care approach, with good infrastructure for implementing successful strategies, can significantly reduce the incidence of β-thal.
Introduction There is no data on the number as well as the prevalence of congenital hypothyroidism (CH) in the Fars province. Hence, we designed this study to analyze the latest data and the possible predictive factors on transient and permanent CH in this province. Method This cross sectional study is based on the Fars province screening data from 2013 to 2016. A total of 294,214 newborns were screened with 938 confirmed cases of CH, which were included in this study. After recall and completion of the missing data, follow-up data for 642 CH cases with thyroid stimulating hormone (TSH) concentrations and levothyroxine doses for ten outpatient visits and final transient vs. permanent CH diagnosis were included. Results The incidence rate was 1:313.66, and out of the 642 CH cases, 66.04 % had permanent CH, while 33.96 % had transient CH. TSH level trend during the outpatient visits were not statistically different between the two groups (P = 0.312). A cutoff point of > 2.25 levothyroxine µg/kg (sensitivity: 76.11 %, specificity: 58.52 %) at the third year and a TSH concentration of > 43.35 mIU/L at the venous sampling (initial TSH) (sensitivity: 31.66 %, specificity: 90.32 %) were the predictive factors for permanent CH. Conclusion Fars province has one of the highest incidence rate of CH in Iran. Levothyroxine dose at the 3rd year and the 1st venous TSH sample are the predictive factors for permanent CH in the Iranian population; however, TSH concentrations during follow ups are unreliable predictors.
Introduction: There is no data on the number as well as the prevalence of congenital hypothyroidism (CH) in the Fars province. Hence, we designed this study to analyze the latest data and the possible predictive factors on transient and permanent CH in this province.Method: This cross sectional study is based on the Fars province screening data from 2013 till 2016. A total of 294,214 newborns were screened with 938 confirmed cases of CH, which were included in this study. After recall and completion of the missing data, follow-up data for 642 CH cases with thyroid stimulating hormone (TSH) concentrations and levothyroxine doses for ten outpatient visits and final transient vs. permanent CH diagnosis were included.Results: The incidence rate was 1:313.66, and out of the 642 CH cases, 66.04% had permanent CH, while 33.96% had transient CH. TSH level trend during the outpatient visits were not statistically different between the two groups (P=0.312). A cutoff point of >2.25 levothyroxine µg/kg (sensitivity: 76.11%, specificity: 58.52%) at the third year and a TSH concentration of >43.35 mIU/L at the venous sampling (initial TSH) (sensitivity: 31.66%, specificity: 90.32%) were the predictive factors for permanent CH.Conclusion: Fars province has one of the highest incidence rate of CH in Iran. Levothyroxine dose at the 3rd year and the 1st venous TSH sample are the predictive factors for permanent CH in the Iranian population; however, TSH concentrations during follow ups are unreliable predictors.
Background: In this survey we studied the incidence and clinical presentations of galactosemia in Fars province, in south west of Iran. Galactosemia is a rare genetic metabolic disorder ofgalactose. Its metabolism can be performed through 3 pathways. Although enzymes deficiencyof each of them can lead to galactose accumulation in plasma, the term galactosemia is specifically used for UDP-galactose uridyl transferase (GALT) deficiency. Classical galactosemia (G/G) is mostly manifested by poor growth, irritability, lethargy, vomiting, poor feeding, and jaundice.Material and method: 337000 newborns were screened for galactosemia by measuring total galactose level. Blood samples were collected from the heel on the Gauthriepaper, and thencalorimetric test with enzyme was performed to determine total galactose level. Blood galactoselevel below 4mg/dl was considered as normal and it was repeated if it was more than 4mg/dl in the first stage. The test was considered as abnormal if it was more than 5mg/dl, then blood samples were collected on filter paper and dried for 3-4 hours at room temperature and shipped frozen to laboratory for detection of GALT activity and galactose and galactose-1-phosphate.Results: From those who were gone for screening, 105 newborns had total galactose level more than 5mg/dl, among them, 37 patients had galactose level more than 15 mg/dl. Overall 12 cases were considered as classic galactosemia with an incidence rate of 1/28000, in Fars province.Conclusion: Although all of our patients were symptomatic and were admitted byhyperbilirubinemia before receiving the results, neonatal screening had an important role in the early diagnosis and management of this disease.
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