فهرست مطالب

Medical Sciences - Volume:43 Issue: 6, 2018
  • Volume:43 Issue: 6, 2018
  • تاریخ انتشار: 1397/08/30
  • تعداد عناوین: 14
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  • Azad Khaledi, Afsane Bahrami, Edris Nabizadeh, Yousef Amini, Davoud Esmaeili * Pages 571-580
    Background
    Legionella species are ubiquitous and naturally found in lakes, rivers, streams and hot springs, and other water resources. The present study aimed to investigate the prevalence of Legionella species in water resources of Iran by a systematic review and meta-analysis.
    Methods
    In search of papers relevant to the prevalence of Legionella in water resources of Iran, the scientific information database in both English and Persian languages was used. The search was limited to studies between the year 2000 and end of July 2016. Each cohort and cross-sectional study that reported the contamination of water with Legionella was included in the present study. For data analysis, comprehensive meta-analysis software with Cochran’s Q and I2 tests were used. P values less than 0.05 were considered statistically significant.
    Results
    The prevalence of Legionella species in water resources of Iran was 27.3% (95% CI: 25.3-29.3). The prevalence of Legionella spp. in hospital water, dental settings water, and other water resources were 28.8% (95% CI: 26.4-31.2), 23.6% (95% CI: 16.1-33.2), and 29.6% (95% CI: 25.6-33.8), respectively. The most common Legionella species was L. pneumophila with a prevalence of 60.5% (95% CI: 53.3-67.2) and the prevalence of all other species was 52.5% (95% CI: 44.7-60.2). The highest prevalence was reported in Isfahan with 55.7% (95% CI: 48.0-63.0).
    Conclusion
    Based on the results, the prevalence rate of Legionella species in water resources of Iran was high and the most common Legionella species was L. pneumophila.
    Keywords: Legionella, Water Resources, Iran
  • Seyed Vahid Hosseini, Hajar Khazraei, Alimohammad Bananzadeh, Fahimeh Hajihosseini, Seyedeh Saeedeh Shahidinia, Mehdi Tahamtan * Pages 581-586
    Background
    Stapled hemorrhoidopexy is a safe and acceptable alternative to traditional hemorrhoidectomy with shorter hospital stay, better satisfaction, and less postoperative pain. There have, however, been reports on early and late complications. Therefore, the present study was designed to assess the impact of stapled hemorrhoidopexy on anorectal function and continence.
    Methods
    Sixty-one patients with rectal prolapse and/or symptomatic circumferential hemorrhoidal disease, as validated by the Wexner incontinence score, were included. Anal manometric indices were measured. The Wexner scores and anal manometric measures were compared pre- and postoperatively using the Mann–Whitney U test. (A P<0.05 was considered significant.)
    Results
    Mean age was 46.8 years (range=18–80 y), with a mean follow-up time of 3 months. Fifty-one patients completed their follow-ups. For 45 patients with a Wexner score of 0 and no history of incontinence, the anal maximum squeezing pressure (AMD) was 125.3±43.1 mm Hg, the anal resting pressure (ARD) was 27.8±12.8 mm Hg, and the mean pressure was 40.0±16.8 mm Hg. The changes in the anorectal manometric indices before and 3 months after the operation were not statistically significant (P=0.99, P=0.55, and P=0.32, respectively). In 6 patients with Wexner scores of 1 or higher, the mean values of the AMD, ARD, and mean pressure not only decreased but also increased postoperatively, but the changes were not statistically significant (P=0.32, P=0.42, and P=0.45, correspondingly).
    Conclusion
    These data represent a series of patients with 3 months’ follow-up after stapled hemorrhoidopexy and suggest that this technique is safe in experienced hands. It may have protective effects on anorectal function in patients with imperfect continent scores.
    Trial Registration Number: IRCT2015101324504N1
    Keywords: Anorectal, Hemorrhoids, Continent score, Rectal Prolapse, Recovery of Function
  • Sina Bagheri, Masih Shafa, Afshin Borhani, Haghighi, Mahsa Kiani, Mohammad Mahdi Sagheb , Shahrbanoo Shahbazi * Pages 587-595
    Background
    Remote ischemic preconditioning (RIPC) protects other organs from subsequent lethal ischemic injury, but uncertainty remains. We investigated if RIPC could prevent acute kidney injury (AKI) in patients undergoing coronary artery bypass graft (CABG) surgery.
    Methods
    This parallel-group, double-blind, randomized, controlled trial was done on adults undergoing elective or urgent on-pump CABG surgery from 2013 to 2017 in Shiraz, Iran. Patients were allocated to RIPC or control groups through permuted blocking. The patients in the RIPC group received three cycles of 5 min ischemia and 5 min reperfusion in the upper arm after induction of anesthesia. We placed an uninflated cuff on the arm for 30 min in the control group. The study primary endpoint was an incidence of AKI. Secondary endpoints included short-term clinical outcomes. We compared categorical and continuous variables using Pearson χ2 and unpaired t tests, respectively. P<0.05 was considered significant.
    Results
    Of the 180 patients randomized to RIPC (n=90) and control (n=90) groups, 87 patients in the RIPC and 90 patients in the control group were included in the analysis. There was no significant difference in the incidence of AKI between the groups (38 patients [43.7%] in the RIPC group and 41 patients [45.6%] in the control group; relative risk, 0.96; 95% confidence interval, 0.69 to 1.33; P=0.80). No significant differences were seen regarding secondary endpoints such as postoperative liver function, atrial fibrillation, and inpatient mortality.
    Conclusion
    RIPC did not reduce the incidence of AKI, neither did it improve short-term clinical outcomes in patients undergoing on-pump CABG surgery.
    Keywords: schemic preconditioning, Reperfusion injury, Acute kidney injury, Coronary artery bypass
  • Mahdiyeh Behbahani, Fatemeh Zargar *, Fatemeh Assarian, Hosein Akbari Pages 596-604
    Background
    Children with attention deficit hyperactivity disorder (ADHD) are at risk of impairment in multiple domains. This study aimed to investigate the effectiveness of mindful parenting training in reducing clinical symptoms in children with ADHD and parenting stress of their parents.
    Methods
    This randomized clinical trial was conducted on 2 groups (experimental and control) in 3 phases (pretest, posttest, and 8 weeks’ follow-up). Sixty children with ADHD, who had been referred by the child psychiatrist in the Iranian city of Kashan in the second half of the year 2016, were selected along with their mothers. The mothers were assigned to one of the 2 groups via permuted blocked randomization. The mothers completed the parenting stress index–short form (PSI–SF 36) and the Swanson, Nolan, and Pelham Parent and Teacher rating scale (SNAP-IV). All the children in both groups received pharmacotherapy with either risperidone or Ritalin. The intervention group received 8 sessions (1 session each week, each session lasting 90 minutes) of mindful parenting training based on the Kabat-Zinn protocol. The data were analyzed using SPSS, version 20, via the t test, χ2 test, repeated measures analysis of variance, and nonparametric Friedman test.
    Results
    This study showed a reduction in parenting stress, negative parent-child interactions, and children’s problematic characteristics in the mindful parenting training group compared with the control group in the posttest and follow-up. Our results also demonstrated a significant improvement in ADHD symptoms in the experimental group by comparison with the control group in the posttest and follow-up.
    Conclusion
    Mindful parenting training was effective in reducing parenting stress and ADHD symptoms in our intervention group.
    Keywords: Parenting, Stress, Physiological, Attention deficit disorder with hyperactivity, Mindfulness
  • Fatemeh Paknazar, Mahmood Mahmoudi *, Kazem Mohammad, Hojjat Zeraati, Mohammad Ali Mansournia, Mahdi Yaseri Pages 605-611
    Background
    Iran is an Eastern Mediterranean region country with the highest rate of gastric cancer. The present study aimed to evaluate the 5-year net survival of patients with gastric cancer in Iran using a relative survival framework.
    Methods
    In a cross-sectional study, using life-table estimation of relative survival, we reported 1- to 5-year relative survival regarding age, sex, disease stage, pathology, and adjuvant therapies via modeling excess mortality. All the analyses were done applying Stata 11.2 with a confidence level of 95%.
    Results
    Data on 330 patients (aged 32–96 y), who were comprised of 228 (69.1%) men and 102 (30.1%) women with gastric cancer and were followed up for 10 years, were analyzed. Adenocarcinoma was the most common malignancy (281 [85.2%] patients), and 248 (75.1%) patients were at stage 3 or stage 4. The 1- and 5-year net survival rates after surgery were 67.96 (95% CI: 62.35–72.98) and 23.35 (95% CI: 17.94–29.28), respectively. Higher stages (P=0.001), older ages (P=0.007), and less use of adjuvant therapies (P<0.001) were independently associated with excess mortality.
    Conclusion
    It is recommended to use the relative survival framework to analyze the survival of cancer patients as an alternative approach not only to eliminate biases due to competing risks and their dependencies but also to estimate the cure at the population level concerning the most important individual characteristics. Our findings showed that the survival rate of gastric cancer in Iran is lower than that in most developed countries in terms of net survival.
    Keywords: Survival analysis, Epidemiology, Stomach Neoplasms
  • Ali Reza Malekzadeh, Hamid Reza Pakshir *, Shabnam Ajami, Fatemeh Pakshir Pages 612-622
    Background
    Palatal rugae have been shown to be associated with racial and geographical variations and are known to be useful in sex identification. The present study aimed to assess palatal rugae patterns in a sample Iranian population and to compare the results with those from other studied populations.
    Methods
    During summer 2017, 130 pre-orthodontic plaster casts from patients aged 17-25 years (65 males and 65 females) were obtained from the Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. The castes were evaluated using the classification given by Thomas and Kotze followed by recording the rugae lengths and shapes. The data were analyzed with the SPSS statistical software package (version 15.0) using the unpaired t test and Chi-square test. P<0.05 were considered statistically significant. Additionally, discriminant function analysis was applied to determine the applicability of palatal rugae patterns as a tool to aid sex identification.
    Results
    The rugae count showed an insignificant difference between the Iranian males and females. The primary rugae were most common in both sexes followed by the secondary and fragmentary. Significant differences were observed between the sexes and the number of primary rugae in males (P=0.03) and fragmentary rugae in females (P=0.04) on the left side of the palate. A significant difference in the straight and diverging unification types was observed, which was highest in males (P=0.01) and females (P=0.03), respectively. Discriminant function analysis enabled sex identification with an accuracy of 70%.
    Conclusion
    Palatal rugae is shown to be an appropriate tool for sex identification in an Iranian population. Further studies with a larger sample size are required for a comprehensive outcome.
    Keywords: Forensic medicine, Palatal rugae, Sex identification, Iranian population
  • Salimeh Diyanat, Mousa Salehi, Omid Koohi, Hosseinabadi, Nader Tanideh *, Farzaneh Dehghani, Farhad Koohpeyma, Sajad Daneshi Pages 623-632
    Background
    Several plants have been shown to possess antioxidant and estrogenic properties that can be useful in postmenopausal bone-loss prevention. The present study aimed to investigate the anti-osteoporotic effects of the hydroalcoholic extract of the Psidium guajava (PG) fruit in ovariectomized (OVX) rats.
    Methods
    Sixty female Sprague–Dawley rats were randomly divided into 6 groups: a control positive group, a sham-operated group, an OVX group given normal saline (OVX-only group), and 3 treatment groups comprising 2 OVX groups treated orally with 500 and 1000 mg/kg/d of the hydroalcoholic extract of the PG fruit respectively and an OVX group treated with an injection of 0.15 mg/kg of estradiol. The study was conducted over a 12-week period. Samples from the animals’ blood, femoral bones, and uteri were collected for stereological and biochemical analyses. The data were analyzed using SPSS, version 19. A P value equal to or less than 0.05 was considered statistically significant.
    Results
    The results revealed a significant decrease in the levels of calcium, total antioxidant capacity, and phosphorus as well as uterus weight, femoral ash density, femoral volume and weight, and numbers of osteocytes and osteoblasts. Moreover, there was an increase in the levels of alkaline phosphatase and urine deoxypyridinoline together with a rise in the number of osteoclasts in the OVX-only group compared to the control and treatment groups (P≤0.05). The hydroalcoholic extract of the PG fruit increased femoral weight and volume, femoral ash density, numbers of osteocytes and osteoblasts, and trabecular volume of the bones in comparison with the OVX-only group in a dose-dependent manner. No significant difference was observed between the groups in the levels of malondialdehyde and interleukin-6.
    Conclusion
    The hydroalcoholic extract of the PG fruit prevented OVX-induced bone loss in the rats, with no proliferative effect on atrophic uteri; it should, therefore, be considered for treatment purposes.
    Keywords: AMP1 protein, Psidium guajava, Ovariectomy, Osteoporosis, Rat
  • Sheila Shahsavari, Pour, Ehsan Aliabadi, Mona Latifi, Nehle Zareifard, Mohammad Reza Namavar, Tahereh Talaei, Khozani * Pages 633-644
    Background
    Platelet-rich plasma (PRP) and bioceramics such as hydroxyapatite (HA) and zirconium oxide (ZrO2) are used to reconstruct mandibular defects. We sought to determine the synergistic effects of HA/ZrO2 and PRP and compare their osteogenic activity.
    Methods
    ZrO2 scaffolds were constructed by the slurry method and were then coated with HA and impregnated by PRP/heparan sulfate (HS). Bilateral mandibular defects were created in 26 male rabbits. In 20 rabbits, the left defects were treated with HA/ZrO2/PRP (Group 1) and the corresponding right defects were filled with HA/ZrO2 (Group 2). The 6 remaining models were treated with PRP gels at both sides (Group 3). The osteoconductivity of HA/ZrO2/PRP was compared with that of HA/ZrO2 or PRP by radiological and histological methods after the follow-up period, at weeks 6, 8, and 12. The statistical analyses were performed by ANOVA and LSD using SPSS, version 16.0, for Windows (P<0.05).
    Results
    After 2 weeks, the percentage of the surface occupied by bone was significantly higher in the HA/ZrO2/PRP-treated defects than in the PRP-treated defects (P=0.007). Osteoblast and osteocyte counts were higher significantly in the PRP-treated group (P=0.032); however, the cells had not started matrix formation on a large scale and just small islands of osteoid with trapped osteocytes were observed. In the long term, the regenerative potential of all the scaffolds was the same.
    Conclusion
    HA/ZrO2 showed a superior osteoconductive capacity over PRP in the short term; however, they showed no long-term synergic effects.
    Keywords: Durapatite, Hydroxyapatite, Zirconium oxide, Platelet-Rich plasma, Heparan sulfate proteoglycans, Osteogenesis
  • Hamed Bagheri, Saeed Rezapour, Masoud Najafi, Elahe Motevaseli, Babak Shekarchi, Mohsen Cheki, Hossein Mozdarani * Pages 645-652
    Background
    The search for potent radioprotective agents for the amelioration of radiation side effect is an important aim in radiobiology. The present study aimed to evaluate the effects of curcumin and seleno-L-methionine against radiation-induced micronucleus formation in rat bone marrow.
    Methods
    In total, 40 male rats were divided into 8 groups (n=5 each), including control, curcumin or seleno-L-methionine treated alone or in combination, 2 Gy irradiation, irradiation of treated groups with curcumin or seleno-L-methionine or their combination. Curcumin was administrated orally and seleno-L-methionine was injected intraperitoneally 24 hours before irradiation. The frequency of micronucleated normochromatic erythrocytes (MnNCEs) and micronucleated polychromatic erythrocytes (MnPCEs) was scored in 5,000 polychromatic erythrocytes (PCEs) and the cell proliferation ratio [(PCE/(PCE+NCE); NCE=normochromatic erythrocytes] was calculated for each treatment group. Data were analyzed by the SPSS software version 16.0 and P<0.05 was considered as statistically significant differences.
    Results
    Pretreatment with curcumin and seleno-L-methionine before irradiation reduced the frequency of MnPCEs and MnNCEs (P=0.01) and increased the cell proliferation ratio. Moreover, the results showed that this pretreatment reduced the frequency of MnPCEs with a protection factor (PF) of 1.2 and 1.6, respectively. The combination of curcumin and seleno-L-methionine in reducing MnPCEs and MnNCEs was not more effective than each agent alone, while improved cell proliferation ratio.
    Conclusion
    Both curcumin and seleno-L-methionine showed potent protection against radiation induced MN in bone marrow cells. The combination of the two agents further ameliorates this activity, thus leading to improve bone marrow protection.
    Keywords: Radiation protection, Curcumin, Seleno-L-methionine selenoxide, Micronuclei, Gamma rays
  • Adesina Oluwafemi Adewale *, Opaleye Taofiq Olamide, Salmai Ajibola Yussuf, Idowu Omobolaji Stephen Pages 653-658
    Necrotizing fasciitis of the head and neck is a rare but rapidly progressive infection involving the skin, subcutaneous tissue, and fascia. We report 4 cases of cervicofacial necrotizing fasciitis with similar patterns of presentation. All the 4 cases presented with an odontogenic source and no underlying medical condition. All the patients had tooth extraction and serial wound debridement. Three of these patients recovered well, and healing of the wound occurred by secondary intention. One patient had a resultant neck defect, which was repaired with a supraclavicular island flap after the infection had subsided. We advocate the importance of early detection of necrotizing fasciitis with or without an underlying medical condition and an aggressive medical and surgical intervention. Additionally, eradication of the source of infection is highly indicated to reduce the mortality of this disease.
    Keywords: Neck, Fasciitis, necrotizing, Infection, Tooth
  • Mehdi Dehghani, Saranaz Jangjoo, Ahmad Monabati, Dena Masoomi Bandari, Nasrin Namdari * Pages 659-663
    The standard therapy for thyroid cancer is total or near total thyroidectomy, followed by the administration of radioactive iodine for remnant ablation or residual disease. Patients with radioiodine therapy are predisposed to second malignant neoplasms in organs such as central nervous system (CNS), breast, prostate, kidney, bone marrow, salivary gland, and digestive tract. Exposure to carcinogen including occupational and therapy related hazard, aging and genetic susceptibility are other causes of second primary cancers. The second primary malignancies are not uncommon and, nowadays, the prevalence of it is mildly increasing due to the increasing survival of cancer patients and advances in early diagnosis and therapeutic modalities. Here, we present a fifty-one-year-old man with papillary thyroid carcinoma (PTC), who developed chronic lymphocytic leukemia (CLL), renal cell carcinoma (RCC), and basal cell carcinoma (BCC) in 15-20 years after radioactive iodine therapy. Second primary tumors are increasing and environmental, genetic susceptibility and increase in survival of cancer patients are the major risk factors.
    Keywords: Second primary cancer, Thyroid cancer, Renal cell carcinoma, Chronic lymphocytic leukemia, Basal cell carcinoma
  • Farnoosh Mohammadi, Pouyan Aminishakib, Mahdi Niknami, Abolfazl Razi Avarzamani, Samira Derakhshan * Pages 664-667
    Cementoblastomas are rare benign odontogenic tumors. Diagnosis of these lesions must be made by an association of clinical, radiographic, and histopathological findings. Cementoblastomas rarely occur in both primary and permanent dentitions. We describe the sixth case of cementoblastoma in the literature with the involvement of both deciduous and permanent teeth. The aim of this case report is to present the clinicoradiopathologic features of a cementoblastoma in a 4.5-year-old boy with an unusual recurrence. The first clinical and radiographic features appeared on the deciduous mandibular second molar. The second lesion occurred 1 year after treatment at 5.5 years old, involving the permanent mandibular first molar, and a subsequent lesion was seen at age 8 years in the edentulous region of the extracted mandibular first molar. After the last surgery, there was no recurrence of the lesion at 6 months’ follow-up. Follow-ups of patients with cementoblastomas are highly recommended for an early detection of recurrences
    Keywords: Cementoma, Dentition, Mandible, Odontogenic tumors
  • Sunitha Carnelio, Mathangi Chandramouli, Gabriel Rodrigues * Pages 668-670
    Benign lymphoepithelial cysts of the parotid are common in retropositive patients, but extremely rare in HIV-negative individuals. We present a 28-year-old man who presented with a painless, gradually increasing swelling in the left parotid region and was clinically diagnosed to have a pleomorphic adenoma of the left parotid gland. Preoperative blood investigations revealed that the patient was seronegative. He underwent a left superficial parotidectomy and the histopathology report indicated a benign lymphoepithelial cyst. The rarity of this lesion in a seronegative patient is the main reason for reporting this case.
    Keywords: Parotid gland, Adenoma, pleomorphic, Epidermal cyst, HIV infections
  • Selahattin Cal??kan *, Musa Türkmen, Mustafa Sungur Pages 671-672