Journal of Analytical Research in Clinical Medicine
Volume:2 Issue: 2, Spring 2014

Almost 1 in 8 women will have breast cancer during their lifetime. Several risk factors were identified; however, 70% of females with breast cancer have no risk factors.Many risk factors are associated with sex steroid hormones. Some studies have been focusedon identification of the indices of cumulative exposures to estrogen during the patients’ life.One of these indicators is bone mineral density (BMD). Our aim was the comparison of BMDin young patients with and without breast cancer, and finding a relationship between breastcancer and bone density.
In this case-control study, 120 people were enrolled; 40 patients with breast cancerand 80 normal healthy persons as control group. Measurement of BMD was performed in both groups and compared.
Both groups were matched in age, weight, age at menarche, age at first marriage andfirst pregnancy, number of pregnancies over 32 weeks and lactation period, and taking supplemental calcium and vitamin D. However, there was a significant difference between thetwo groups in terms of estrogen intake, family history of breast cancer, and history of breastmasses (P = 0.03, P = 0.03, P ≤ 0.01, respectively). A significant difference was foundbetween BMD, bone mineral content (BMC), and t-scores of lumbar spine of the two groups;they were higher in the control group (P = 0.08, P ≤ 0.01, P = 0.06, respectively).
This study shows that BMD of young patients with breast cancer is not higherthan normal similar age females; thus, BMD is not directly a risk factor for breast cancer .

Brain-death is the end stage of most illnesses that cause brain injury and decrease oxygenation and circulation of brain tissues. Early determination of brain-death isessential to the prevention of expensive modeling in the pediatric intensive care unit (PICU)and reserving facilities for patients with good prognosis. Apnea test is one of the importantbrain-death determining methods in clinical evaluation that can be performed easier and fasterthan other methods.
In a cross-sectional study, 75 patients with brain-death criteria were evaluated from2003-2011. Apnea testing was fulfilled through standard methods. Patients who did not develop spontaneous respiration at PaCo level of 60 mmHg or more were confirmed as brain-dead.
Mean age of patients was 40 months. All patients were comatose, without brainstemreflexes. Cause of coma was status epilepticus in most patients. All patients that had a positive apnea test died after a mean duration of 8 days.
All other confirmative methods, irrespective of their accuracy, need complexinstruments and experienced manpower, and are expensive which makes their preparation impossible in most ICU centers. However, apnea test is a simple prognostic method in braindeathconfirmationwith100%accuracy.​

The objective of this study was to evaluate the safety of liver transaminases monitoring every 12 weeks in patients with inflammatory connective tissue disorders who aretreated with methotrexate (MTX).
In a retrospective study, the data from the rheumatic patients receiving MTX wereanalyzed. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were measured at baseline and every 12 weeks. The patients were classified according to their ALTand AST levels as no change, 1-2 times increase, 2-3 times increase, and more than 3 timesincrease in their ALT or AST levels. Based on the physician’s decision on the dose of MTX,the patients were classified into no change in MTX dose, decrease in MTX dose, anddiscontinuation of MTX. Based on the physician’s final decision about the continuation ofMTX, the patients were classified into one of the following groups: continuation of MTXwithout MTX dose reduction; MTX dose reduction; MTX discontinuation due to livercomplication; and MTX discontinuation due to other reasons.
A total of 809 patients who were on MTX were included in the study. The meanfollow-up duration and the mean duration of treatment with MTX were 31.22 and 19.76 months, respectively. The mean accumulation dose of MTX was 865.85 mg. Due to theincrease in the level of transaminases in 26 (3.2%) of the patients the dose of MTX wasreduced, and in 9 (1.1%) cases it was temporarily discontinued. During the follow-up of thepatients with elevated transaminases levels, they returned to normal limits in 90 (99.5%) of thepatients; however, in 4 of the cases (0.5%) they remained elevated and MTX wasdiscontinued. The probability of the patients remaining on MTX for 5 years withoutdiscontinuation for liver complications was 98.5%.
Liver transaminases monitoring every 12 weeks for MTX treated patients is safe.

The aim of this study was to compare emotional and behavioral difficulties of students with Attention deficit hyperactivity disorder (ADHD) from the perspectives ofparents and teachers.
In the present study, 55 children, who were 7-12 years of age, were diagnosed asADHD by qualified psychiatrists, and were receiving medication, were selected using convenient sampling method. Their fathers, mothers, and teachers filled out Conner’s TeacherRating Scale (39 items) and Conner’s Parent Rating Scale (48 items). To analyze data,Kolmogorov-Smirnov test and analysis of variance with repeated measures were used.
The results indicated that conduct disorder symptoms are underestimated by parentsand symptoms of anxiety disorder are overestimated by teachers (α ≤ 0.05).
Based on the findings, it is concluded that using different sources for recognizingADHD and co-occurring disorders is necessary and prevents the labeling of children, overlooking the disorder, and enhances the accuracy of diagnosis.

Palpable thyroid nodules are very common in the general population. Most of these nodules are benign and only about 5% of cases are malignant. Ultrasound elastographyis a newly developed technique that uses ultrasound to provide an estimation of tissuestiffness. The aim of this study was to assess the diagnostic value of elastography in theevaluation of thyroid nodules supplementary to other ultrasonographic criteria.
In a descriptive cross-sectional study, thyroid nodules in 60 patients, who werecandidates for fine needle aspiration biopsy (FNAB), were examined with conventional ultrasonography and elastography. The number and size of nodules, echogenicity, andpresence of microcalcification, circumferential halo, and internal structure, margin of nodules,vascularity, and elasticity were determined. Pathologic evaluation of nodules was performedusing FNAB. Imaging findings were compared with FNAB results.
In the present study, 54 (90%) nodules were reported as soft and 6 (10%) as hard byultrasound elastography. According to the results of FNAB, 9.5% were considered as non-benign nodules requiring surgery; all of these nodules were reported as soft in elastographicevaluation.
Routine elastography for all of the patients with thyroid nodule may not help theprocess of diagnosis. Further studies are recommended on its application in the management of thyroid nodules.

Visceral leishmaniasis (VL) is an infectious disease that it has spread in more than 60 countries, in Iran it is caused by Leishmania infantum. The infection is transmitted bysand flies, often affects children under 10 years of age, and it can be fatal if no treatment isundertaken. The progression of leishmaniasis infection in the host depends on cellularimmunity. Studies have associated immune responses against leishmaniasis to host genotype,resistance due to Th1 and T CD8 cells, and responses leading to macrophage activation andparasite killing. The parasite can stimulate the production of interleukin 17A (IL-17A) byTh17. It was shown that IL-17A is strongly and independently associated with protectionagainst VL. Moreover, it seems that IL-17A has a complementary role in human protectionagainst VL.
Blood samples were collected from 259 people among whom 88 were patients withhistory and clinical symptoms of leishmaniasis and 171 were healthy controls with no signs of infection. All participants were residents in an endemic area of VL in east Azerbaijanprovince, Iran. DNA extraction was performed using salting out method. Then, the controlgroup was divided into two groups of seropositive and seronegative by IFA (indirectfluorescent antibody) test, and for detecting polymorphism of IL-17A (197A\G) ARMS-PCR(Amplification refractory mutation system-Polymerase chain reaction) was used.
The result showed that the G allele was more frequent than the A allele among thegroups, but this difference was not statistically significant (P = 0.8). In addition, the GG genotype was more frequent than genotype A/G and A/A among the groups, but thisdifference was not statistically significant (P = 0.7).
On the basis of the results, there was no significant association between VL andpolymorphism of IL-17A (197A\G).

Granulomatous lobular mastitis (GLM) is an inflammatory disease of the breast, which can mimic breast cancer in clinical and radiological findings. We conducted the present study in order to determine the diagnostic and other important aspects of this disease.

In this study, we reviewed the records of 38 patients with granulomatous lobular mastitis in order to describe the clinical, imaging, laboratory, pathologic, and treatment aspects of this disease.

All of the patients’ ages were in the range of 22-62 years (mean age: 42 years). All of them had children, history of oral contraceptive pill (OCP) usage, antibiotic therapy and mammoplasty. In physical examination, dimpling, edema, inflammation, ulcer, abscess, and firm mass were detected. Size of masses was in the range of 2 × 2 to 8 × 6 cm and their location, in most cases, was in the superior lateral quadrant or central region. In Ultrasonography, a hypoechoic fibroglandular mass and collection, and in pathologic findings, granulomatous reaction was reported. These patients were treated by antibiotics, corticosteroids, and surgery.

GLM is a chronic inflammatory lesion of the breast which can mimic breast cancer. A history of child bearing, lactation, and OCP drug usage have suspicious roles in the formation of GLM. The most common clinical sign in these patients is a painful mass in the breast. We uncovered that clinical and radiological findings are not specific and sufficient for diagnosis of GLM. Therefore, for better diagnosis of this disease, usage of core, incisional, or excisional biopsy are recommended.