فهرست مطالب

Acta Medica Iranica - Volume:55 Issue: 4, 2017
  • Volume:55 Issue: 4, 2017
  • تاریخ انتشار: 1396/02/15
  • تعداد عناوین: 12
  • Alipasha Meysamie, Saeed Ghodsi, Reza Ghalehtaki, Alireza Esteghamati, Fereshteh Asgari, Mohammad Mehdi Gouya Page 218
    The present study aimed to evaluate the distributions of High-Sensitivity C-reactive protein, TCHDL ratio and 10-year risk of cardiovascular diseases among Iranian adult population. We conducted a crosssectional study on a total of 2125 adults aged 25 to 65. Data of the Third National Surveillance of Risk Factors of Non-Communicable Diseases (SuRFNCD-2007) was used. Anthropometric indices, blood pressure and biochemical measurements had been obtained. Ten-year risk of cardiovascular events was also calculated using different models. Median (interquartile range) and geometric means (95% CI) of hs-CRP were 5.1(3.9) and 4.1(4.38-4.85), respectively. Mean TC-HDL ratio±(SD) was 5.94±2.84 in men and 5.37±1.97 in women (P
    Keywords: C, reactive protein, Distribution, Cardiovascular risk scores, FRS, SCORE, TC, HDL
  • Fezzeh Elyasinia, Mohammad Reza Keramati, Farham Ahmadi, Susan Rezaei, Mohammad Ashouri, Reza Parsaei, Maryam Yaghoubi, Fahimeh Elyasinia, Armita Aboutorabi, Ahmad Kaviani Page 228
    Despite many advances in the treatment of breast cancer, it is still the second most common cause of death in women in the United States. It has been shown that inflammation plays a major role in the treatment of these cancers and inflammatory factors enhance tumor growth, invasion, metastasis, and vascularization. In this study, we would like to analyze peripheral blood neutrophil-lymphocyte ratio (NLR) in breast cancer patients and its correlation with disease staging. This cross-sectional analytic study was conducted in Imam Hospital, affiliated with Tehran University of Medical Sciences; a total of 195 female patients with breast cancer met the inclusion criteria. All of the patients had a complete blood count with leukocyte differential performed before chemotherapy. Medical records including pathology reports were also available. Data for all patients were collected prior to any surgical intervention. Exclusion criteria included clinical evidence of active infection, presence of hematological disorders, acute as well as chronic inflammatory or autoimmune diseases, or prior steroid therapy. Higher platelet count was significantly associated with the higher stage. The stage was not associated with the hemoglobin level. There was no association between the tumor size and age of patients with NLR. There was a significant relationship between NLR and IDC. There was a significant relationship between IDC and NLRs of less than 8.1 and greater than 3.3. There was a significant relationship between NLR and vascular invasion. There was no association between NLR and estrogen receptor and HER2. There was no significant relationship between the PLR and the cancer stage. In this study, NLR showed a significant relation with the disease staging. As the NLR increases the stage increases as well. Therefore, this ratio may be helpful in the preoperative evaluation of patients with breast cancer.
    Keywords: Breast cancer, Neutrophil, Lymphocyte, Stage
  • Mehrnaz Rasooli-Nejad, Maryam Khazaee-Pool, Ladan Abbasian, Zahra Bayat Jozani, Sara Ahsani-Nasab, Banafsheh Moradmand Badie, Afsaneh Pargar, Gholamreza Esmaeeli Djavid Page 233
    There are limited documents about HIV patients switched to second-line antiretroviral therapy (ART) in resource-limited countries. We aimed to assess the efficacy of second-line ART for HIV patients following first-line ART failure. This was a cohort study of HIV/AIDS patients with first-line ART treatment failure switched to second-line ART between January 2004 and March 2014, who followed for at least 12 months after switching. Fifty of studied patients (85%) were treated with regimens containing lopinavir/ritonavir (Kaletra) and nine of them (15%) treated with other regimes. Seven patients were experienced opportunistic infections in accordance with stage III and IV WHO classification. In this way, 11.8% of patients had aclinicalfailure, and 37 of them (62%) had immunological responses. Weight gain was evident in these patients, and there was a significant correlation between theincrease in CD4 and weight gain (P=0.007). Only 13 patients achieved HIV viral load testing that 6 of them had avirological response after 12 months on second-line ART. No significant associations were found between virological or immunological response and gender, age, and lopinavir/ritonavir regimens (P>0.05).With counselling and supporting in those failing first-line ART, inessential switching to more costly second-line ART can be prevented in the majority of patients. However, patients'' need to second-line ART drugs has increased, for which national ART programmes and regular follow-up should be organized. The high cost of these drugs and limited access to viral load testing are main barriers to proper management of patients switched to second-line ART regimens.
    Keywords: Antiretroviral therapy, HIV, Cohort studies, Iran
  • Fatemeh Pouya, Seyed Hassan Eftekhar-Vaghefi, Parvin Salehinejad Page 241
    The human body dimensions are affected by ecological, biological, geographical, racial, sex, and age factors. Craniofacial measurements can be considered to be one of the important tools for determination of the morphological characteristics of the head and face. In this study, which was conducted on Persian adolescents living in Kerman/Iran, different forms of head and face were determined for using in various aspects of medicine. The study was conducted on 732 participants including 366 males and 366 females in the age of 18-20-year-old. In addition to the height and weight of the participants, cephalofacial sizes of them were measured and then cephalic, facial, and brain indices were calculated. Among the cephalofacial sizes, cranial length and breadth, cranial circumference, prosopic length and prosopic breadth were significantly greater in males compared to females (P
    Keywords: Anthropometric analysis, Cephalofacial, Chephalometric
  • Gholamreza Pourmand, Shahram Gooran, Seyed Reza Hossieni, Fateme Guitynavard, Majid Safavi, Amirsina Sharifi, Ehsan Mokhtari Page 249
    Preoperative Gleason score (GS) obtained from Trans Rectal Ultra Sonography (TRUS) is the most common grading system to evaluate the appropriate treatment for patients with clinically localized prostate cancer. But this method showed upgraded and downgraded results in comparison to Gleason score obtained from radical prostatectomy. The current study aimed to determine clinical or pathological variables to reduce the differences between biopsy and radical prostatectomy Gleason scores.Through retrospective review of 52 patients with radical prostatectomy, this study examined the correlations of preoperative Gleason score with age, prostate volume, PSA level, PSA density, digital rectal exam findings and percentage of positive core needle biopsies across two groups, including patients with preoperative GS≤6 (i.e. group one) and patients with preoperative GS≥7 (group two). The discordance between biopsy GS and radical prostatectomy GS was observed to be 52% in the current study. Among patients with preoperative GS≤6, prostate volume (P=0.026), PSA density (P=0.032) and percentage of positive core needle biopsies (P=0.042) were found to be significant predictors for upgrade. There was no significant predictor for downgrade in patients with preoperative GS≥7. Findings of this study revealed that in patients with preoperative GS≤6, smaller prostate volume, higher prostate density and higher positive results of core needle biopsies were associated with theupgrade of GS. Therefore, it should be considered when selecting treatment modalities among these patients.
    Keywords: Grade change, Prostate adenocarcinoma, Radical prostatectomy, Gleason score
  • Khatereh Isazadehfar, Masoud Entezariasl, Bita Shahbazzadegan, Zahra Nourani, Yousef Shafaee Page 254
    Postoperative nausea and vomiting (PONV) are one of the most common complications of anesthesia and without prophylactic intervention occurs by about one-third of patients under general anesthesia. The aim of this study was to compare the efficacy of ondansetron and metoclopramide in reducing PONV after laparoscopic cholecystectomy. In this study, 60 patients undergoing laparoscopic cholecystectomy were randomly allocated into two equal groups (n=30), and in the first group 10 mg metoclopramide and in the second group 4 mg ondansetron preoperatively were injected. Nausea and vomiting and the need for rescue antiemetic treatment in recovery and 6 hr. and 6-24 hrs. After surgery were evaluated. Data were analyzed by SPSS software with chi-square test and analysis of variance (ANOVA). The incidence of nausea in metoclopramide was 43.3 % and in ondansetron was 33.3 %. The difference between two groups was not significant (P=0.6). The incidence of vomiting in metoclopramide was 20% and in ondansetron was 26.7%, and there was not any significant difference between intervention groups (P=0.12). For prevention of PONV after laparoscopic cholecystectomy, both metoclopramide and ondansetron are effective, and in preventing of nausea, ondansetron is more effective than metoclopramide, whereas there was not any significant difference between two drugs in preventing of vomiting.
    Keywords: Ondansetron, Metoclopramide, Laparoscopic cholecystectomy, PONV
  • Soheil Peiman, Azim Mirzazadeh, Maryam Alizadeh, Sara Mortaz Hejri, Mohammad-Taghi Najafi, Abbas Tafakhori, Farnoosh Larti, Besharat Rahimi, Babak Geraiely, Parichehr Pasbakhsh, Gholamreza Hassanzadeh, Fatemeh Nabavizadeh Rafsanjani, Mohammad Ansari, Seyed Farshad Allameh Page 259
    To present a multiple-instructor, active-learning strategy in the undergraduate medical curriculum. This educational research is a descriptive one. Shared teaching sessions, were designed for undergraduate medical students in six organ-system based courses. Sessions that involved in-class discussions of integrated clinical cases were designed implemented and moderated by at least 3 faculties (clinicians and basic scientists). The participants in this study include the basic sciences medical students of The Tehran University of Medical Sciences. Students’ reactions were assessed using an immediate post-session evaluation form on a 5-point Likert scale. Six two-hour sessions for 2 cohorts of students, 2013 and 2014 medical students during their two first years of study were implemented from April 2014 to March 2015. 17 faculty members participated in the program, 21 cases were designed, and participation average was 60 % at 6 sessions. Students were highly appreciative of this strategy. The majority of students in each course strongly agreed that this learning practice positively contributed to their learning (78%) and provided better understanding and application of the material learned in an integrated classroom course (74%). They believed that the sessions affected their view about medicine (73%), and should be continued in future courses (80%). The percentage demonstrates the average of all courses. The program helped the students learn how to apply basic sciences concepts to clinical medicine. Evaluation of the program indicated that students found the sessions beneficial to their learning.
    Keywords: Active learning, Problem based learning, Medical students
  • Farzaneh Motamed, Rita Bagherian, Gholamhossin Adalat, Mohammad Hassan Moradinejad, Nilofar Hajizadeh, Mohammad Vasei, Mehrzad Mehdizadeh, Nima Rezaei Page 265
    Systemic amyloidosis is a very rare complication of inflammatory bowel disease (IBD). The reported cases of secondary amyloidosis in children with IBD are much fewer than those reported in adults. Herein, a teenage boy with Crohn’s disease is presented who developed nephrotic syndrome due to renal involvement secondary to amyloidosis, whereas the patient was under treatment with corticosteroid and 6mercaptopurine. To our best knowledge, this is the first reported case of secondary amyloidosis in a teenage Iranian boy with Crohn’s disease.
    Keywords: Systemic amyloidosis, Inflammatory bowel disease, Children
  • Mehri Najafi Sani, Mitra Ahmadi, Pejman Roohani, Nima Rezaei Page 268
    Zellweger syndrome (ZS) is a peroxisomal disorder with a multiple congenital anomalies, characterized by stereotypical facies, profound hypotonia, organ involvement including cerebral, retinal, hepatic, and renal. Herein, a 3-month-old female with ZS is presented who was referred because of increased liver enzymes (subclinical hepatitis), which was detected in work-up of her neck cyst, severe hypotonia, and abnormal facies. An increased concentration of very long chain fatty acid in lipid profile was detected. ZS should be considered in the list of differential diagnosis in infants with stereotypical phenotype, neurodevelopmental delay, and severe hypotonia in association with liver and other organs involvement.
    Keywords: Zellweger syndrome, Peroxisomal disorder, Micorcluplication
  • Anju Bansal, Manveen Kaur, Varsha Dalal Page 271
    Sarcomas account for less than 1% of all primary breast malignancies, pleomorphic sarcoma of the breast being even rarer. We present two cases of pleomorphic sarcoma of the breast in a 35-year-old and a 43-year-old female. An extensive review of the available literature with evaluation of the etiology, changing terminologies and histopathologic features of pleomorphic sarcoma of the breast are discussed. The prognostic factors and treatment modalities have also been reviewed.
    Keywords: Pleomorphic, Sarcoma, Breast
  • Mohammad Ali Mohagheghi, Ramesh Omranipur, Fereshteh Ensani, Alireza Ghannadan, Shahriar Shahriaran, Farhad Samiee, Zahra Sedighi Page 276
    We present here a 32-year-old male with advanced lately diagnosed, right sided retroperitoneal mass, which had been already treated due to progressive muco- cutaneous lesions clinically consistent with psoriasis, during recent four years. The advanced retroperitoneal mass resected surgically and reported as hyaline-vascular castleman disease with a dense focus of coarse calcification, on histopathology. Association of psoriasis and castlman disease is discussed in this case report. © 2017 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2017;55(4):276-278.
    Keywords: Castleman's disease, Lymphoproliferative disorders, Psoriasis, Retroperitoneal neoplasm
  • Fateme Sepehri, Mostafa Langarizadeh, Laleh Sharifi, Gholamreza Azizi, Reza Safdari, Asghar Aghamohammadi Page 279