Journal of Research in Medical Sciences
Volume:25 Issue: 10, Oct 2020

Oral aphthosis is a painful ulceration of mucus membranes characterized by round or oval lesions with central necrosis and erythematous haloes. Due to unknown etiology, treatment is highly controversial and based mainly on individual experience. The aim of this study was to investigate the safety and efficacy of topical penicillin 6.3.3 for the treatment of recurrent aphthous stomatitis.

This randomized, double‑blind, controlled clinical trial was done in Shahid Sadoughi Hospital Clinic in Yazd (2011–2012). Fifty patients aged 15–45 with recurrent oral aphthosis were randomly divided into two groups. After obtaining informed consents, patients in the case and control groups were treated (four times/day for a week), respectively, by topical penicillin 6.3.3 powder and placebo in similar vial. The patients who had acute‑onset oral aphthae (≤48 h of appearance) with diameter ≥5 mm were included. History of sensitivity to β‑lactam antibiotics and cephalosporin; spontaneous recovery during <5 days in previous episodes; concurrent systemic, infectious, or any autoimmune disorders; history of taking drugs (local or systemic) from 2 weeks prior to presentation; alcohol or drug abuse; smoking cigarette or tobacco; and poor compliance were exclusion criteria. Patients were examined in days 0, 3, 6, and 8. The main outcome measure was reduction in the median pain. Burning, pain, erythema, and inflammation were recorded as complications.

Of 25 patients receiving penicillin, 13 were female and 12 were male. Regarding the pain score (mean difference = 1.6 vs. 0.88, P = 0.012) and size of aphthus (mean difference = 9.43 vs. 1.24, P = 0.008), patients who received penicillin had significantly better results than the placebo group on day 8 after the treatment. The mean duration to healing was 3 days for penicillin group and 6 days for placebo group (P = 0.016). No topical or systemic adverse effects were observed.

Our study showed a dramatic response to topical penicillin with respect to placebo. Hence, it seems that penicillin could be a safe and effective option in managing oral aphthosis.

The aim of this study was to optimize computed tomography pulmonary angiography (CTPA) protocols with regard to improve vascular attenuation without increasing contrast media (CM) volumes. Therefore, we compared the standard CTPA protocol to an individualized contrast media injection protocols adjusted for the patient’s body mass index (BMI).

Two groups of 295 patients with suspected pulmonary embolism (PE) have been receiving CTPA. Group 1 received a standard protocol without taking patient’s BMI into account. Group 2 received a CTPA scan, where dose and flow rate of CM injections were adjusted for the patient’s BMI. Images were retrospectively analyzed by drawing regions of interests in defined positions in the superior vena cava, descending aorta, the pulmonary main trunk as well as the left and right lower lobe arteries. Intravascular attenuation, contrast volumes, and flow rates were compared using unpaired t‑tests. Furthermore, a qualitative image analysis was performed by two experienced readers blinded for the protocol used for image acquisition to evaluate the image quality and arterial attenuation.

Patient’s BMI was similar in both the groups (27.5 ± 1.5 kg/m2 vs. 28.4 ± 2.1 kg/m2 ; P = 0.67). Contrast volumes were lower (54.2 ± 4.8 ml vs. 55 ml; P < 0.05), and flow rates (4.1 ± 0.3 ml/s vs. 3.5 ml/s; P < 0.05) were significantly higher in the individualized protocol. The qualitative image analysis yielded an agreement on diagnostic interpretability in the individualized and standard group of 49% and 51% (95% Wilson confidence interval for mean), respectively.

An individualized CTPA protocol based on the patient’s BMI reduced the contrast media volume and led to an increased pulmonary artery enhancement improving image quality, particularly in the evaluation of the peripheral pulmonary arteries. Thus, contrast media volumes in CTPA should be adjusted for the patient’s BMI.

Screening for personality disorders through reliable instruments is of high importance for clinical and preventive purposes. Examining the psychometric properties of measures in societies with diverse cultures can improve their external validity. This research is specifically aimed to studying psychometric properties of the McLean Screening Instrument for Borderline Personality Disorder (MSI‑BPD) in a sample of Iranian men serving military service.

The Persian version of the MSI‑BPD was prepared through forwarding translation, reconciliation, and back‑translation. A sample of 254 soldiers was selected through the convenience sampling method in Tehran and completed a set of questionnaires, including the MSI‑BPD, The Deliberate Self‑harm Inventory (DSHI), Borderline Personality Scale (STB), Cognitive Flexibility Inventory (CFI), and Self‑Compassion Scale (SCS) Short‑Form. The construct validity of the MSI‑BPD was assessed using confirmatory factor analysis and divergent and convergent validity. Internal Consistency and test‑retest reliability (2 weeks’interval) were used to evaluate the reliability. Data analysis was conducted using LISREL (version 8.8) and SSPS (version 22) software.

MSI‑BPD and its subscales were found to be valid and reliable measures, with good internal consistency and good test‑retest reliability among soldiers. In terms of convergent validity, MSI‑BPD and subscales showed a significant positive correlation with self‑report measures of DSHI and STB. MSI‑BPD and subscales showed negative correlation with SCS Short‑Form and CFI, thus demonstrated a good divergent validity. The results of this study also provide support for both one‑factor and two‑factor models of the MSI‑BPD.

The MSI‑BPD showed good validity and reliability, making it a useful measure to Screening borderline personality disorder in the Iranian population. Screening offers a means of identifying persons for more detailed evaluation for early intervention and for research. The MSI‑BPD is an efficient instrument suitable for screening purposes among soldiers.

Parathyroidectomy, the standard treatment of primary hyperparathyroidism (PHP) due to parathyroid adenoma, is not suitable for all patients. We evaluated the efficacy of ultrasound‑guided ethanol ablation of parathyroid adenoma in a group of patients with PHP.

In a prospective self‑controlled trial, 39 patients with parathyroid adenoma, who were not candidates for surgery, were enrolled. Ethanol injections were performed by two experienced interventional radiologists under the guidance of real‑time ultrasonography. Adenoma size changes were assessed at about 1 month later. Serum levels of parathyroid hormone, calcium, phosphate, 25‑OH Vitamin D, and alkaline phosphatase were evaluated at the baseline, 1, 3, 6, and 12 months after the injections. The treatment effects on outcome variables were assessed by repeated measures analysis.

Volume of the adenomas decreased during the study period from 1.87±6.45 cm3 to 0.38± 0.48cm3 (P < 0.001). Corrected serum calcium levels decreased from 10.40 ± 0.96 mg/dl to 8.82 ± 0.58 mg/dl (P < 0.001), and remained stable during one year follow‑up. Serum levels of parathyroid hormone decreased gradually from 129.85 ± 63.37 to 72.58 ± 53.86 pg/mL after 3 months and to 44.78 ± 28.04 pg/mL after 1 year (P < 0.001). Overall, 46% of the patients improved after 1 month of ethanol ablation therapy which increased to 84.5% during 1‑year follow‑up. No major complications were observed.

The current study showed the efficacy of ultrasound‑guided ethanol injection in PHP and may be considered as a suitable alternative treatment in patients who are not candidates for the surgery. It has also a good safety profile without major complications if performed by experienced hands.

The hepatitis C virus (HCV) outbreak in Iran is increasing. This study investigated the dissemination and transmission routes of HCV genotypes in different regions of Iran. The relationship between serum biochemical markers and viral genotypes was also assessed to find whether liver enzymes level can be considered as the markers for HCV genotypes.

HCV‑infected patients from different provinces of Iran (from August 2017 to March 2019) were enrolled. Nested reverse transcriptase polymerase chain reaction (PCR)‑restriction fragment length polymorphism and real‑time PCR were used to discover the genotypes. The infection transmission routes in the study population were investigated and recorded. Serum samples with equal viral loud from the patients without other liver disorders were recruited to explore the association between the genotypes and the liver biochemical markers.

One thousand serum samples positive for the HCV genome were recruited. Genotype 3a was the most prevalent in the north, while genotype 1a was dominant at the center. In total, genotype 3a was the dominant genotype closely followed by 1a. Needle sharing by addicts was the most common transmission way of infection in Iran. This way was also the most for genotype 3a dissemination, and genotype 1a was transmitted mostly between family members. No significant association (P > 0.05) was observed between biochemical marker titers and HCV genotypes.

A shift in the distribution profile of HCV genotypes, related to the transmission routes, has happened over time. Public awareness of the main routes of HCV transmission can break the cycle of transmission. Liver enzyme values in HCV‑infected patients showed no relation with genotypes and only represented hepatocellular dysfunction.

Survival rates for breast cancer (BC) are often based on the outcomes of this disease. The aim of this study was to compare the performance of three survival models, namely Cox regression, Aalen’s, and Lin and Ying’s additive hazards (AH) models for identifying the prognostic factors regarding the survival time of BC patients.

This study was a historical cohort study which used 1025 females’ medical records that underwent modified radical mastectomy or breast saving. These patients were admitted to Besat and Chamran Hospitals, Tehran, Iran, during 2010–2015 and followed until 2017. The Aalen’s and Lin and Ying’s AH models and also traditional Cox model were applied for analysis of time to death of BC patients using R 3.5.1 software.

In Aalen’s and also Lin and Ying’s AH models, age at diagnosis, history of disease, number of lymph nodes, metastasis, hormonal therapy, and evacuation lymph nodes were prognostic factors for the survival of BC patients (P < 0.05). In addition, in the Lin and Ying’s AH model tumor size (P = 0.048) was also identified as a significant factor. According to Aalen’s plot, metastasis, age at diagnosis, and number of lymph nodes had a time‑varying effect on survival time. These variables had a different slope as the times go on.

AH model may yield new insights in prognostic studies of survival time of patients with BC over time. Because of the positive slope of estimated cumulative regression function in Aalen’s plot, metastasis, higher age at diagnosis, and high number of lymph nodes are important factors in reducing the survival BC, and then based on these factors, the therapists should consider a special therapeutic protocol for BC patients.

Breast cancer is the most common cancer accounting for about one‑fourth of total cancer cases and 15% of all cancer deaths among women worldwide. It is important to determine its trend across the regions in the world to find the high‑focus regions. Hence, the current study was done to assess the global trends and deviations in the incidence of breast cancer.

A descriptive trend analysis was done using the data on breast cancer incidence from the WHO Cancer Incidence Data of Five Continents plus database. Joinpoint regression was performed to determine the average annual percent change (AAPC), and age‑period‑cohort analysis was done to obtain age‑, period‑, and cohort‑specific deviations and rate ratio.

All the regions showed an increasing trend in breast cancer incidence, with an exception of America. Maximum increase was observed in Asia (AAPC = 2.6%; 95% confidence interval [CI]: 2.4%–2.9%) followed by Europe (AAPC = 0.7%; 95% CI: 0.5%–1%). There was consistent rise in the breast cancer incidence across the age groups in all the four continents with maximum burden in elderly (P < 0.001). Except in America, all other regions showed consistent rise in the incidence of breast cancer through the periods 1998–2002 to 2007–2012 (P < 0.001). There was consistent increase across the cohorts from 1923–1927 to 1978–1982 in continents such as Asia and Oceania (P < 0.001).

To summarize, the incidence of breast cancer shows an increasing trend globally with a maximum increase in the Asian region. This makes a strong need for newer strategies irrespective of current prevention and control interventions.