فهرست مطالب

Journal of Research in Medical Sciences
Volume:24 Issue: 2, Feb 2019

  • تاریخ انتشار: 1397/11/06
  • تعداد عناوین: 9
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  • Mostafa Qorbani, Habibollah Mahmoodzadeh, Alireza Shirzadi* Page 1
    Background

    Neoadjuvant chemotherapy (NAC) is increasingly used to treat patients with breast cancer, but the reliability of sentinel lymph node biopsy (SLNB) following chemotherapy is in doubt. In this meta‑analysis, we aimed to evaluate studies that examine the results of SLNB after NAC to assess identification rate (IR) and false‑negative rate (FNR).

    Materials and Methods

    Systemic searches were performed in the PubMed, ISI Web of Sciences, Scopus, and Cochrane databases from January 1, 2000, to November 30, 2016, for studies of SLNB after NAC for breast cancer and followed by axillary lymph node (LN) dissection in two subgroups: initially node negative and node positive converted to node negative. Two reviewers independently review quality of included studies. A random‑effects model was used to pool IR and FNR with 95% confidence intervals (CI), and heterogeneity among studies was assessed by I2 and Q‑test.

    Results

    A total of 23 studies with 1521 patients in the initially node‑negative subgroup and 13 studies with 1088 patients in the node‑positive converted to node‑negative subgroup, were included in this meta-analysis with IR and FNR of 94% (95% CI: 92–96) and 7% (95% CI: 5–9) in the initially node‑negative subgroup and 89% (95% CI: 85–94) and 13% (95% CI: 7–18) in the node‑positive converted to node‑negative subgroup, respectively.

    Conclusion

    Our meta‑analysis showed acceptable IR and FNR in initially node‑negative group and it seems feasible in these patients, but these parameters did not reach to predefined value in node‑positive converted to node‑negative group, and thus, it is not recommended in these patients.

    Keywords: Breast cancer, meta‑analysis, neoadjuvant systemic therapy, sentinel lymph node biopsy
  • Nasrin Zare, Nahid Eskandari, Valiollah Mehrzad, Shaghayegh Haghjooy Javanmard* Page 2
    Background
    The standard treatment for patients with diffuse large B‑cell lymphoma (DLBCL) had been rituximab‑based
    immunochemotherapy. However, the biological and clinical heterogeneity within DLBCL seems to affect treatment outcome. Therefore,
    the evaluation of miRNA levels might be useful in predicting treatment response and relapse risk. miR‑146a is a modulator of innate and acquired immunity and may play an important role in predicting treatment response. The aim of the present study was to compare the expression level of miR‑146a in plasma‑derived exosomes of responsive DLBCL patients (response to R‑CHOP (Rituximab, and Cyclophosphamide, Hydroxydaunorubicin, Oncovine and Prednisone)), refractory DLBCL patients (resistant to R‑CHOP), patients receiving R‑CHOP, and healthy donors.
    Materials and Methods
    After the preparation of plasma and isolation of exosomes, the presence of plasma‑derived exosome was confirmed by Zetaseizer, electron microscope, and Western blot. The patients’ medical records were collected and analyzed. The expression level of exosomal miR‑146a was evaluated in DLBCL patients and healthy donors using real‑time polymerase chain reaction (PCR). The −ΔCt values of miR‑146a were compared among responsive patients (n = 17),refractory patients (n = 16), patients receiving R‑CHOP therapy (n = 15), and healthy donors (n = 6).
    Results
    The presence and size of plasma‑derived exosomes were confirmed. Our findings did not show any significant difference in the expression level of exosomal miR‑146a between DLBCL patients and healthy donors (P = 0.48). As well, the clinical and histopathological parameters were not correlated with the expression level of exosomal miR‑146a or plasma miR‑146a. The expression level of plasma miR‑146 was lower than the expression level of exosomal miR‑146 (P = 0.01).
    Conclusion
    Exosomal miR‑146a might be useful as a promising “liquid biopsy” biomarker in predicting treatment response and relapse risk; however, we could not find significant differences due to small sample size.
    Keywords: Diffuse large B‑cell lymphoma, exosomes, miR‑146a
  • Mohammad Reza Sabri, Mojtaba Montaseri, Amir Mohammad Armanian, Mehdi Ghaderian* Page 3
    Background
    Patent ductus arteriosus (PDA) is a common disease in premature neonates, which could occur in up to 50% of the neonates weighting <1000 g. PDA might induce hemodynamic and respiratory disorders and increase mortality and morbidity. This study aimed to compare the effectiveness of oral ibuprofen and a low dose of intravenous acetaminophen in the management of PDA.
    Materials and Methods
    This randomized double‑blind clinical trial was conducted on the preterm neonates with an equal gestational age of <34 weeks and weight of >1000 g with symptomatic PDA, who were admitted in Shahid Beheshti and Al‑Zahra Hospitals Affiliated to Isfahan University of Medical Sciences, Iran. In total, 40 preterm neonates were examined, 20 of whom received 15 mg/ kg/6 h of intravenous acetaminophen for 2 days and 20 infants received 10 mg/kg of intravenous ibuprofen on the 1st day and 5 mg/kg for the next 2 days, and the results include vital signs and echocardiography findings were compared.
    Results
    In the acetaminophen and ibuprofen groups, 16 (80%) and 17 neonates (85%) responded (PDA closure rate) to the treatment, respectively (P = 0.68). Furthermore, acetaminophen and ibuprofen have a similar effect on vital signs. Both drugs did not change in blood pressure, but they reduced the respiratory rate and heart rate after treatment.
    Conclusion
    Low‑dose acetaminophen compared to ibuprofen has an equal effectiveness in the closure of PDA.
    Keywords: Acetaminophen, ductus arteriosus, ibuprofen, preterm
  • Seyed Badredin Najmi, Assiyeh Jamshidibeyk, Mohammad Reza Maracy*, Silva Hovsepian, Leila Nasiripour Page 4
    Background
    We aimed to investigate the association between demographic and familial characteristics and psychological
    properties of adolescents including identity style, spiritual intelligence (SI), perceived parenting style (PPS), family functioning, and mental health.
    Materials and Methods
    In this cross‑sectional study, high school students aged 15–18 years were enrolled. Demographic characteristics of each student and their parents were recorded. Psychological properties of the students including PPS questionnaire, family assessment device, identity status, mental health status, and SI were assessed. The association between demographic and familial characteristics and psychological properties of adolescents was determined using Multiple Indicators and Multiple Causes (MIMIC) model.
    Results
    In this study, 279 high school students (140 boys and 139 girls) were enrolled. The most common forms of identity style were diffusion and foreclosure with a prevalence rate of 49.1% and 39.5%, respectively. Results of MIMIC model showed acceptable fit with comparative fit index = 0.91, Tucker‑Lewis index = 0.87, and root‑mean‑square error of approximation = 0.05 (0.04–0.06). There was a significant positive association between age and family functioning (P = 0.001).There was a significant positive association between age and mental health (P = 0.003). There was a significant negative association between gender and PPS (P < 0.001). The most common forms of PPS in females and males were authoritative form and uninvolved parenting, respectively. There was a significant positive association between father education and PPS (P = 0.001).
    Conclusion
    Our findings indicated that there is an association between families’ demographic characteristics and identity style, perceived parental style, family functioning, and SI of adolescence. The association of some factors with mentioned psychological variables is more prominent such as age, gender, and father age.
    Keywords: Adolescent psychology, demographic factors, family conflict, identity, intelligence, mental health, perception, spiritual
  • Hae Jin Kim*_So‑Yeon An_Seung Jin Han_Dae Jung Kim_Chang Hyung Hong_Yong Hyun Kim_Dong Hyun Shin_Nan Hee Kim_Ji A Seo_Yu‑Bae Ahn_Seung‑Hyun Ko_Yong Wook Cho_Seok Won Park_Soo Kyung Kim_Kyung Wook Kim_Chul Sik Kim_Kwan‑Woo Lee Page 5
    Background
    The prevalence of depression and type 2 diabetes mellitus (T2DM) are increasing in the elderly and are reportedly related to each other. We evaluated the relationship between T2DM‑related factors and the degree of depression in elderly patients with T2DM based on gender.
    Materials and Methods
    A total of 155 patients with T2DM (56 males and 99 females aged ≥ 65 years) from seven hospitals were included in the study. To assess the status of depressive symptoms, the short form of the Geriatric Depression Scale‑Korean version (SGDS‑K) was used. We evaluated DM‑related factors, such as T2DM duration, hemoglobin A1c (HbA1c) levels, and T2DM complications, as well as other possible factors that could affect depression, such as cognitive function, physical function, education level, and other personal factors.
    Results
    Mean age of the participants was 71.3 years with a mean HbA1c level of 7.6%. Males in the good glycemic control group (HbA1c <7%) showed lower SGDS‑K scores compared to those in the poor glycemic control group, and the mean SGDS‑K score was higher in the group with a longer duration of DM (M10 years); however, no difference was observed in females. Males and females with microvascular and macrovascular complications tended to have higher SGDS‑K scores than participants with no microvascular or macrovascular complications. A multiple linear regression analysis revealed that DM duration and HbA1c level were independently associated with SGDS‑K scores in males.
    Conclusion
    Greater depression was associated with poorer glycemic control and a longer duration of DM in elderly males with T2DM.
    Keywords: Depressive symptoms, diabetes mellitus, elderly, type 2
  • Syed Azhar Syed Sulaiman, Dzul Azri Mohamed Noor, Nor Azizah Aziz, Mohamed Anwar Hammad* Page 6
    Background
    Statins are recommended for cardiovascular protection for people with diabetes (high‑risk groups). This study aimed to evaluate the gap between the guidelines of statin utilization and clinical practice among outpatients with type 2 diabetes regarding the patient’s age and gender, to assess if this preventive drug is being satisfactorily utilized or not.
    Materials and Methods
    In this cross‑sectional study, patients aged <40 or >75 years, pregnant patients, and patients with type 1 diabetes, human immunodeficiency virus, or liver cirrhosis were excluded. Demographics, laboratory parameters, and prevalence of exposure to statin therapy were evaluated. This study was guided by the 2013 American College of Cardiology/American Heart Association cholesterol guidelines. IBM SPSS software was used for data management.
    Results
    The study cohort involved 576 patients, with age being 58.3 ± 8.9 years. There were 50.5% of females and 49.5% of males. Overall 81.1% of patients aged 58.8 ± 8.8 years were statin users and 18.9% of patients aged 56.2 ± 9 years were statin nonusers. About 83.2% of females and 78.9% of males were prescribed statins. Statin medications included simvastatin 79.2%, atorvastatin 11.6%, lovastatin 5.8%, rosuvastatin 2.1%, and pravastatin 1.3%. Statin users’ and nonusers’ adherence was 56.5%, and 41.3% (P = 0.004), respectively. The adherence to medication plan of females and males was 55.7% and 51.6%, respectively (P = 0.004).
    Conclusion
    Patients with diabetes who are at high risk of cardiovascular events, xposure to statin treatment is significantly less than perfect position both in females and males. Nearly one‑fifth of the patients with type 2 diabetes are not using statins despite therapeutic necessities.
    Keywords: Age_clinical gap_gender_Malaysia_practice guidelines_statin medication_type 2 diabetes
  • Farzin Ghiasi, Keivan Gohari Moghadam, Babak Alikiaii, Ziba Farajzadegan, Sara Sadrzadeh* Page 7
    Background
    Mechanical ventilation (MV) is a life‑saving intervention that should be considered for patients with respiratory failure. This study was conducted to evaluate the predictive value of physiologic dead space for weaning success and compare it with rapid shallow breathing index (RSBI).
    Materials and Methods
    This cross‑sectional study was conducted on 80 intensive care unit (ICU) patients who were under MV and candidate for weaning; among them, 68 patients experienced weaning success. RSBI was measured by dividing the respiratory rate by tidal volume. End‑tidal CO2 (PETCO2) was obtained using caponometry, then dead‑space was calculated as (VD/VT = (PaCO2 − PETCO2)/PaCO2). PaCO2 was also obtained from arterial blood gas recorded chart.
    Results
    Age, PaCO2, PETCO2, and RSBI were significantly different between those patients with and without weaning success (P < 0.05). RSBI ≤ 98 could predict the success of weaning with sensitivity 91.7%; specificity 76.5% and (AUC) area under the ROC curve (AUC = 0.87; 95% confidence interval [CI]: 0.78–0.94; P < 0.001). Dead space was not statistically significant prognostic index (AUC = 0.50; 95% CI: 0.31–0.69; P = 0.09).
    Conclusion
    In our study, RSBI was an effective predictive index for weaning success in ICU patients under MV, but dead space did not show significant predictive value. Further studies with larger sample sizes for providing more evidence are recommended.
    Keywords: Intensive care unit, mechanical ventilation, physiologic dead‑space, rapid shallow breathing index, weaning
  • Bahram Bagherpour, Tahmine Tavakoli, Mahsa Khodadoostan, Seyed Mehdi Hejazi, Alireza Saadatmand*, Hamid Kalantari Page 8
    Background
    The present study aimed to determine the frequency of the IL28B polymorphism rs8099917 in patients with genotype 1
    hepatitis C virus (HCV) infection treated with pegylated‑interferon‑α2b (PEG‑IFN‑α2b) and ribavirin (RBV) and its treatment outcome.
    Materials and Methods
    The IL28B rs8099917 genotypes were determined among 100 HCV‑infected patients and the viral load was also estimated. PEG‑IFN‑α2b and RBV combination were administrated to the patients for 48 weeks and the treatment outcome was defined.
    Results
    Sixty‑seven (67%), 27 (27%), and 6 (6%) of 100 patients were determined as TT, GT, and GG genotype, respectively. The response rate to treatment was significantly higher in patients with TT genotype.
    Conclusion
    According to the results of the present study, patients with IL28B rs8099917 TT genotype achieve higher sustained virological response than the GT and GG genotypes. Thus, when there are no alternatives, treatment with PEG‑IFN‑α2b and RBV combination can be suggested in patients with IL28B TT genotype.
    Keywords: Chronic hepatitis C, interleukin 28B, pegylated interferon, ribavirin
  • Parvaneh Sadeghi Moghadam, Mohsen Pourazizi, Shamim Shafeyoon Page 9