فهرست مطالب
Archives of Iranian Medicine
Volume:20 Issue: 6, Jun 2017
- تاریخ انتشار: 1396/04/27
- تعداد عناوین: 11
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Page 332IntroductionLynch Syndrome (LS) is a genetically inherited autosomal disorder that increases the risk of many types of cancer, especially colorectal cancer (CRC). Identifying these subjects improves morbidity and mortality. We aimed to assess the prevalence of LS with both clinical criteria and universal strategy in Mashhad, Iran.MethodsIn this retrospective study, we screened 322 patients with CRC between 2013 and 2016 in Mashhad, Iran. CRCs were screened based on Amsterdam II criteria, revised Bethesda guideline, and universal strategy. Information regarding the clinical criteria was obtained by interviewing the patients or, their families. Tumors were screened by pathologists with IHC staining of four Mismatch repair (MMR) proteins (MLH1, MSH2, MSH6, and PMS2). Tumors with absent IHC staining of MLH1 were tested for BRAF mutations to exclude sporadic CRCs.ResultsOf 322 CRCs, 33 cases were found to be deficient-MMR; 22 of these had concurrent loss of MLH1 and PMS2, followed by concurrent loss of MSH2 and MSH6 in 8 CRCs. Twenty-two cases with a loss of MLH1 underwent testing for the BRAF mutation, 4 of which were recognized as a positive BRAF mutation. Finally, 29 CRCs were found as being positive screen for LS. Poor sensitivity (21.74%) was found for the Amsterdam II criteria and a poor positive predictive value (15.39%) for the revised Bethesda.ConclusionApplication of clinical criteria may not be effective enough to identify LS and at least 2-antibody panel (PMS2, MSH6) should be conducted for newly diagnosed CRCs.Keywords: Cancer screening, colorectal carcinoma, immunohistochemistry, Lynch syndrome, mismatch repair
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Page 338BackgroundThis study aims to evaluate the effect of extracorporeal shock wave therapy (ESWT) on lower limb spasticity in stroke patients.MethodsTwenty-eight eligible patients with ankle plantar flexor spasticity were randomly assigned to two groups. ESWT group received 1 session per week for 3 weeks of ESWT along with oral anti-spastic medications and stretching exercises. The control group received only oral anti-spastic medications and stretching exercises similar to ESWT group. At baseline, weeks 1, 3 and 12, spasticity was assessed and compared between the two groups using Modified Ashworth Scale (MAS), clonus score, passive range of motion (ROM) of joint, pain score, 3-m walk duration and lower extremity functional score (LEFS). Three patients were lost during follow-up; 25 patients completed the study and were analyzed.ResultsAfter one session of ESWT treatment, MAS, pain, ROM and LEFS improved significantly compared to baseline. After three weeks of ESWT treatment, MAS, pain and 3-m walk duration improved significantly compared to week 1. At week 12, MAS, pain, ROM, 3-m walk duration and LEFS improved significantly compared to the control group after controlling baseline values. The trend of decrease in pain score and MAS was significantly different between the groups. The trend of increase in ROM and LEFS was significantly different between the groups.ConclusionESWT significantly improved lower limb spasticity, pain, passive ROM, 3-m walk duration and LEFS immediately and 12 weeks after treatment. So, ESWT in combination with oral anti-spastic medications and stretching exercises could be useful for improvement of spasticity in stroke patients.Keywords: Anti-spastic, extracorporeal shock wave therapy, spasticity, stroke
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Page 344BackgroundA diet rich in fruits and vegetables is of a great importance, especially to adolescents due to their need for nutrients and their rapid growth. The aim of this study was to investigate the relationship between decisional balance and self-efficacy with stages of change for fruit and vegetable consumption in high school students in Bandar Abbas, Iran.MethodsIn this descriptive-analytical study, data were collected from 345 students studying in eight high schools of Bandar Abbas who were selected through multistage sampling. To collect data, separate questionnaires were designed for evaluating each of the variables, including the stages of change, perceived benefits, perceived barriers, and self-efficacy of fruit and vegetable consumption. Decisional balance was estimated by subtracting the perceived benefits and barriers. The data were analyzed with one-way ANOVA using SPSS 19.ResultsThe results of this study indicated that the individuals progress along the stages of change from pre-contemplation to maintenance level was associated with a significant increase in their decisional balance and self-efficacy for fruit and vegetable consumption (PConclusionDecisional balance and self-efficacy should be considered in designing interventions to increase consumption of fruits and vegetables. There needs to be more emphasis on educational programs based on the Trans-theoretical Model (TTM) for the enhancement of perceived benefits and elimination of perceived barriers regarding consumption of fruits and vegetables.Keywords: Fruit, Vegetables, Decision making, Self-Efficacy, Theoretical Model
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Page 350BackgroundHealth-related quality of life (HRQOL) is associated with household food insecurity (HFI). However, the studies examining the relationship between HFI and HRQOL in patients with type 2 diabetes are scarce. Thus, this study was designed to examine the relationship between HFI and HRQOL in rural type 2 diabetic patients.MethodsIn this cross-sectional study, we included 1847 rural patients with type 2 diabetes in Neyshabur from April to July 2012. HRQOL and HFI were measured with 36-item HRQOL (SF-36) and 6-item version of Household Food Security questionnaires, respectively. HRQOL was divided into eight dimensions and two summary components. We categorized households as high food secure (HFS), low food secure (LFS), and very low food secure (VLFS). Multiple linear regression model was applied to assess the independent effect of food insecurity on HRQOL.ResultsThe mean age of participants was 59.65 ± 12.3 years (range: 3097) with 69.8% women. The overall prevalence of HFI was 46.1%, and the total mean score of HRQOL was 51.11. Multiple linear regression model showed that HFI was significantly associated with the total mean score of HRQOL and its eight dimensions. One-way ANOVA test also showed that HRQOL (in all dimensions) was significantly different between 3 groups of household food security status (HFS, LFS, and VLFS) (PConclusionsThe results of this study showed that HFI was associated with all dimensions of HRQOL and it is one of the strongest variables, in association with HRQOL among rural patients with type 2 diabetes.Keywords: Diabetes, Household Food Insecurity, Quality of life, SF-36
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Page 356BackgroundThis is a cross-sectional survey conducted on 6900 male prisoners in Great Tehran Prison from October 2013 to May 2014.MethodsIn order to find HIV positive prisoners in the prison's quarantine and two housing units, we used HIV active case finding (ACF) strategies by rapid screening test. In ACF, healthcare staff and trained prisoners asked inmates to answer relevant questions about history of risky behaviors related to HIV as well as to be tested voluntarily by HIV rapid test. A positive result was confirmed by ELISA screening and Western blot tests. Furthermore, to find HIV risk factors in the prison, the prevalence of specific HIV risk factors among prisoners were assessed using a questionnaire, and the results were analyzed by STATA software, providing univariate and multivariate modeling.ResultsThere were 85 HIV positive patients. The prevalence of HIV was 1.23%. The risk factors independently associated with HIV infection were age (adjusted odds ratio of 3.46 for 3544 yrs., 95% CI:1.0111.92), duration of imprisonment (adjusted odds ratio of 4.22 for ≥10 yr., 95% CI: 1.92-9.24 ), history of injection drug use (adjusted odds ratio of 5.01, 95% CI: 2.2411.18), history of needle sharing (adjusted odds ratio of 2.28, 95% CI: 1.254.16) and tattooing (adjusted odds ratio of 1.84, 95% CI: 1.053.24).ConclusionsThe prevalence and risk factors of HIV infection should be recognized by policy makers for planning harm reduction programs and reforming the HIV guidelines in prisons.Keywords: HIV, Prevalence, Prison, Risk factors
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Page 361BackgroundIt is reported that women in developing countries reach menopause earlier compared to developed countries. This seems to be due to underestimation of age at menopause as pre-menopause women who will reach menopause at older ages are commonly excluded in cross-sectional settings. In this study, we propose an estimation method which can deal with this bias. We also assessed major determinants of menopause.MethodsThe second national integrated micronutrient survey in Iran completed in 2015 is a population-based study with a nationally representative sample of 4,898 Iranian women aged 50 to 60 years. We used data on menopause status and menopausal age (asked retrospectively) to estimate the median survival time. We also used Logistic regression to model menopausal status on the current age and to estimate the median age, at which 50% of women will experience menopause. Demographic, lifestyle, and anthropometric determinants were also examined.ResultsThe estimated age at menopause was 51.2 (51.051.3) years in the logistic model and 50.5 (48.1, 53.7) years in survival analysis. In both models, the age at menopause was significantly lower among rural and underweight women. In addition, survival analysis showed that smokers and women with smaller family size had significantly lower age at menopause.ConclusionWhile many studies stress a gap in age at menopause between developed and developing countries, this study with a reliable estimation method showed that such a gap might originate from an underestimation of age at menopause in developing countries rather than a real difference.Keywords: Age at menopause, Determinants, Bias estimate, Developing countries, Iran
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Page 368BackgroundHuman respiratory syncytial virus (HRSV) is an important cause of acute respiratory infection (ARI) and mortality in ≥60 years old population around the world. The aim of this study was to determine the frequency and circulating genotypes of HRSV in Iranian patients ≥ 60 years old.MethodsIn this cross-sectional molecular epidemiology study, we examined the C-terminal located hypervariable domain of G glycoprotein of HRSV in throat swabs from Tehran, Hormozgan, Boushehr, West Azarbayjan, Ghom and Alborz provinces of Iran which were addressed to national influenza center between October 2013 and March 2015. During these two consecutive years, a total of 225 samples collected from patients older than 60 years were tested using RT hemi-nested PCR and sequencing and the acquired sequences were phylogenetically analyzed.ResultsSixteen out of 225 samples (7.1%) yielded a positive result. Among the positive samples, 13 cases (81%) pertained to antigenic group A and the remaining 3 cases (19%) belonged to group B. Three genotypes including GA1, GA2 and BA9 were identified in the first year of survey whereas during the second year, only GA1 and GA2 genotypes were detected.ConclusionOur study indicates that HRSV genotypes from both A and B antigenic groups which were discovered in pediatric population previously, are circulating among Iranian ≥60 years old population.Keywords: Frequency, genotype, ≥60 years old, Iran, human respiratory syncytial virus
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Page 376IntroductionBirth defects are a series of disorders that occur during embryonic life. In Iran, no national situation analysis is available to show the rate of congenital disorders. We aimed to estimate the prevalence of structural birth defects in Iran.MethodsWe searched for English studies on PubMed, Scopus and Google Scholar from January 1990 to July 2016. The search for Persian articles was performed in Scientific Information Database and Magiran. Two reviewers assessed the identified articles independently. The relevant studies were selected based on predefined criteria. Data were analyzed using the Comprehensive Meta-Analysis software. Random effect method was used for meta-analysis.ResultsIn total, 42 studies were included. The prevalence of congenital anomalies was as follows: orofacial clefts, 1.4 per 1,000 births (95% confidence interval [CI]: 1.21.6); neural tube defects, 3.2 per 1,000 births (95% CI: 2.54.3); urogenital anomalies, 3.9 per 1,000 births (95% CI: 1.212.9); musculoskeletal malformations, 3.3 per 1,000 births (95% CI: 2.34.9); cardiovascular anomalies, 3.3 per 1,000 births (95% CI: 2.25.1); Down syndrome, 0.9 per 1,000 births (95% CI: 0.71.2); gastrointestinal disorders, 1.4 per 1,000 births (95% CI: 0.92.1).ConclusionOur results show that urogenital disorders are the most prevalent births defects in Iran, followed by musculoskeletal and cardiovascular malformations.Keywords: Congenital anomalies, Iran, newborns, prevalence
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Page 386Ibn Sina is regarded as one of the greatest physicians, thinkers and medical scholars in the history of medicine. Ibn Sina, a Persian scholar in the medieval era, wrote a famous book of medicine, the Canon of Medicine. The book was adopted as the main textbook of medicine in most Western and Persian universities. In the present critique, we analyzed the functional and anatomic descriptions of the heart, airways and the lungs as viewed by Ibn Sina in volume three of the Canon of Medicine textbook, and compared them to modern anatomy texts.Keywords: Anatomy, Avicenna, Cardiorespiratory system, Heart, Ibn Sina, Lungs, Trachea