فهرست مطالب

Journal of Research in Medical Sciences
Volume:16 Issue: 5, May 2011

  • تاریخ انتشار: 1390/03/20
  • تعداد عناوین: 20
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  • Minoo Mohammad Shirazi, Fourugh-Azam Taleban, Ali-Reza Abadi, Masoumeh Sabetkasaei Page 583
    Background
    It is known that fish oil consumption decreases incidence of cardiovascular disease. However, some studies showed that it increases atherosclerosis as it doesn’t get completely metabolized by the liver. The aim of the present study was to investigate the effects of fish oil on aortic atherosclerosis, hepatic steatosis and serum lipids in rats.
    Methods
    Twenty pregnant Wistar rats were fed with a fish oil-containing diet or standard diet (containing soy bean oil) during pregnancy and lactation and the pups were weaned onto the same diet. Fasting blood samples, hepatic and aortic specimens were taken from pups on day 70 postnatal. Data were analyzed with SPSS software, using t-test, Mann-Whitney test and Spearman correlation coefficient. Values of P<0.05 were considered significant.
    Results
    Medians for fatty streak in aorta of fish oil fed and soy bean oil fed pups were 1.00 and 0.00, respectively, and P value was 0.042. Also, medians for ductular cell hyperplasia of liver in fish oil fed and soy bean oil fed pups were 1.00 and 0.00, respectively, and P value was 0.014. Total cholesterol in pups fed with fish oil was 52.20 mg/dl and in pups fed with soy bean oil was 83.90 mg/dl (p < 0.00) and for low density lipoprotein cholesterol (LDL-C) values were 8.79 mg/dl and 13.16 mg/dl, respectively (p = 0.031).
    Conclusion
    According to the results of the present study, a diet which provided 15.9% of energy from fish oil as the only source of dietary fat, induced aortic atherosclerosis as well as hepatic steatosis in Wistar rat, although it decreased total cholesterol and LDL-C.
  • Mojtaba Rostami, Abbas-Ali Javadi, Farzin Khorvash, Kamyar Mostafavizadeh, Atoosa Adibi, Anahita Babak, Behrooz Ataei, Mohsen Meidani, Hasan Salehi, Majid Avijgan, Mohammad Reza Yazdani, Farshid Rezaei Page 591
    Background
    Pandemic 2009 H1N1 influenza A virus arrived to Isfahan in August, 2009. The virus is still circulating in the world. The abnormal thoracic computerized tomographic (CT) scan findings vary widely among the studies of 2009 H1N1 influenza. We evaluated the thoracic CT findings in patients with 2009 H1N1 virus infection to describe findings compared to previously reported findings, and to suggest patterns that may be suggestive of 2009 influenza A (H1N1) in the appropriate clinical setting.
    Methods
    We retrospectively reviewed the archive of all patients with the diagnosis of 2009 H1N1 influenza A, in Alzahra hospital in Isfahan, central Iran, between September 23, 2009 to February 20, 2010. From 216 patients with confirmed 2009 influenza A (H1N1), 26 cases with abnormal CT scan were enrolled the study. Radiologic findings were characterized by type and pattern of opacities and zonal distribution.
    Results
    Patchy infiltration (34.6%), lobar consolidation (30.8%), and interstitial infiltration (26.9%) with airbronchogram (38.5%) were the predominant findings in our patients. Bilateral distribution was seen in 80.8% of patients. Only one patient (3.8%) showed ground-glass opacity, the predominant radiographic finding in the previous reports, and severe acute respiratory syndrome (SARS).
    Conclusion
    The most common thoracic CT findings in pandemic H1N1 were Patchy infiltration, lobar consolidation, and interstitial infiltration with airbronchogram and bilateral distribution. While these findings can be associated with other infections, they may be suggestive of 2009 influenza A (H1N1) in the appropriate clinical setting. Various radiographic patterns can be seen in thoracic CT scans of the influenza patients. Imaging findings are nonspecific.
  • Shahrzad Shahidi, Nasrin Namdari Ghareghani, Mojgan Mortazavi Najafabadi, Somaye Sadeghi Hadad Zavare, Reza Adeli Page 598
    Background
    The Hepatitis B (HB) vaccine response in hemodialysis patients is less than healthy individuals. Different strategies have been taken into account to improve the response rate. This study aimed to evaluate the effect of tetanus and diphtheria (Td) vaccine as an adjuvant therapy to HB vaccination.
    Methods
    Sixty three end-stage renal disease patients were recruited on dialysis that were older than 18 years and had passed at least 3 doses of HB vaccination schedule, and had HBS antibody (Ab) with titer less than 10 IU/L. The patients were divided into two groups; A (30 patients) and B (33 patients). Both of the groups received a 3-dose HB vaccination schedule of 40 µg intramuscularly in the left deltoid muscle at 0, 1 and 6 months. Group A also received Td vaccine intramuscularly simultaneous with the first dose of HB vaccine. HBS Ab was measured in periods of 1 and 6 months after completion of the vaccination.
    Results
    One month after completion of the vaccination, group A had better but not significant response rate than group B (96% vs. 83.9%) (p > 0.05); in addition, after 6 month there was no difference between the two groups (87.5% vs. 83.3%) (p > 0.05). Patients with HCV infection had lower response rate than patients who did not have HCV infection (33.3% vs. 92.5%) (p < 0.05). Age had negative effect on immune response to HB vaccination (r = -0.339 and p = 0.005).
    Conclusion
    The use of Td vaccine concurrent with HB vaccination may increase the response rate in non-responder individuals; however, it seems it does not have any role in the persistence of immune response. Age and HCV infection negatively affected the response to HB vaccination in dialysis patients.
  • Seyed Mohammad Hashemi Jazi, Saeed Shafiei, Seyed Hamid Zarkesh-Esfahani, Saman Maleki Vareki, Shaghayegh Haghjooy Javanmard Page 605
    Background
    The purpose of this study was to compare the effects of bare metal stents (BMS) and drug-eluting stents (DES) implantation on circulating endothelial cells (CECs) which have been proposed as cellular markers of endothelial dysfunction following percutaneous coronary intervention (PCI). Recently, it has been established that DES further reduce restenosis and revascularization rate compared to bare metal stents in elective procedures. However, its benefits are compromised by the stent-related thrombosis events.
    Methods
    22 patients who were candidate of PCI were included in this study. The patients underwent DES implantation (n = 11) or BMS implantation (n = 11). In all patients the numbers of CECs were determined before and a week after stent implantation using flow cytometry and the obtained data were compared within and between groups by paired and unpaired Student's t-test, respectively. CECs were defined as cells negative for CD45 (FITC) and highly double positive for CD146 (PE) and CD34 (PE-Cy5) expression.
    Results
    There were no significant differences in the baseline levels of CECs between two groups (p = 0.96). Stent implantation led to a significant increase in CECs compared with the preprocedural levels in the BMS group (p = 0.005) whereas there was a significant decrease in CEC numbers in DES group (p = 0.00). One week after stent implantation CECs count in BMS group was significantly higher compared to DES group (p = 0.000).
    Conclusions
    The results indicate that patients undergoing DES implantation were subjected to less endothelial injury than patients receiving BMS as indicated by CEC enumeration.
  • Ahmet Mahli, Demet Coskun, Gozde Karaca Inan, Didem Tuba Akcali, Lale Karabiyik, Yener Karadenizli Page 611
    Background
    Our objective was to examine the clinical properties of two anesthetic regimens, propofol target-controlled infusion (TCI) or desflurane using remifentanil TCI under bispectral index (BIS) guidance during ear, nose, and throat (ENT) procedures.
    Methods
    Forty consenting patients who scheduled for ENT procedures were prospectively studied and were included in one of the two groups: TCI group or desflurane (DES) group. General anesthesia was induced with 3 ng mL-1 and 4 µg mL-1 effect site concentrations (Ce) of remifentanil and propofol, respectively, with TCI system. After intubation, while propofol infusion was continued in the TCI group, it was ceased in the DES group and desflurane with an initial delivered fraction of 6% was administered. The Ce of propofol infusion and inspired fraction of desflurane was adjusted in order to keep BIS as 50 ± 10.
    Results
    General mean values of mean arterial pressure (MAP) and heart rate (HR) for the TCI group was significantly higher than DES group (89.3 mmHg and 72.4 bpm vs. 77.1 mmHg and 69.5 bpm). Early emergence from anesthesia did not significantly differ between the groups. The rate of patients’ Aldrete score (ARS) to reach 10 was found to be 100% at the 15th min in both groups.
    Conclusions
    Bispectral index guided combinations of remifentanil TCI either with propofol TCI or desflurane anesthetic regimens are both suitable for patients undergoing ENT surgery. The lower blood pressure in the remifentanil TCI with desflurane anesthetic regimens may be a significant advantage.
  • Saeid Abrishamkar, Ahmad Reza Rafiei, Masih Sabouri, Siamak Moradi, Homayoun Tabesh, Payman Rahmani, Ali Hekmatnia, Mostafa Torkashvand, Noorolah Eshraghi, Ghasem Baghershahi Page 621
    Background
    Low Back Pain (LBP) and radicular leg pain (RLP) after lumbar disc surgery are great challenges that prevent patients and neurosurgeons in making a surgical decision. By spinal anesthesia, LBP and RLP diminish up to 2 to 3 hours postoperatively. The aim of this study was to determine the effect of impregnated epidural adipose tissue (EAT) with acetate on reduction of late postoperative pain after spinal anesthesia.
    Methods
    This study was performed on lumbar disc surgery under spinal anesthesia. Sixty six patients entered our study who were divided into three groups, EAT impregnated with bupivacaine (group1), methylprednisolone acetate (group2) and normal saline (control group). The LBP and RLP were evaluated during the first 24 hours postoperatively and 14 days later by visual analogue scale (VAS).
    Results
    Of 66 patients, 53% were female and 47% male. The average (SE) LBP in the first 6 hours after surgery based on VAS were 1.59 ± 0.90 in group one, 2.36 ± 2.38 in group 2 and 3.09 ± 1.41 in control group but the VAS for RLP in this period were 1.95 ± 1.13, 1.31 ± 1.39 and 2.40 ± 1.09, respectively. The average LBP and RLP did not show any differences after 14 days postoperatively.
    Conclusion
    According to our data bupivacaine was effective on LBP relief and steroid was effective on RLP relief during the first 12 hours after surgery.
  • Reza Bagherian Sararoudi, Hamid Sanei, Ali Baghbanian Page 627
    Background
    Type D personality is based on two global and stable personality traits, including negative affectivity (NA) and social inhibition (SI). The aim of this study was to examine the relationship between type D personality and perceived social support in post myocardial infarction (MI) patients.
    Methods
    One hundred seventy six consecutive patients following MI admitted to the cardiac care unit (CCU) of nine hospitals in Isfahan, IRAN from April to September 2006 were selected based on the inclusive and exclusive criteria. The patients completed the Persian version of type D personality scale and the Persian version of multidimensional scale of perceived social support (MSPSS). Also, demographic and medical questionnaire was completed for each patient. Chi-squared test, t-test and MANOVA were used to analyze the data.
    Results
    The findings indicated that 35.8% patients (35.8 %) were classified as type D. The results of MANOVA showed that type D patients were significantly different from non-type D patients (F = 8.72, p = 0.0001) on MSPSS scores and on all dimensions including family subscale (F = 11.52, p = 0.001), friends subscale (F= 16.16, p = 0.0001) and significant others subscale (F = 5.04, p = 0.026).
    Conclusion
    Type D personality substantially affects the way MI patients perceive availability of social support from different sources including family, friends, and significant others. One implication of this finding may be to develop tailor-made interventions for MI patients with type D.
  • Satish Basanagouda Biradar, Gurupadappa Shantappa Kallaganad, Manjula Rangappa, Sangappa Virupaxappa Kashinakunti, Revathy Retnakaran Page 634
    Background
    Diabetic nephropathy is the major cause for chronic renal failure (CRF) and proteinuria is an independent risk factor for end stage renal disease. Hence, early identification and quantification of proteinuria is of prime importance in the diagnosis and management.
    Methods
    This study was conducted amongst 42 diabetic subjects from HSK hospital, Bagalkot. Twenty four-hour urine protein and random urine protein to creatinine ratio (P:C) was determined. Pearson’s correlation, sensitivity, specificity, positive and negative predictive values were determined using 24-hour urinary protein as a gold standard for spot urine P:C ratio. ROC curve and area under curve was also determined using SPSS (11.5) software. All the results were expressed in mean±SD.
    Results
    Forty two diabetes mellitus patients participated in this study. The average of 24 hour urinary protein was 1.6 ± 1.7 gm/day. The spot urine P:C ratio was 1.27 ± 1.55. There was a positive correlation between 24 hours urinary protein and spot urine P:C ratio (r = 0.925, p < 0.0001). The area under the ROC curve for urine P:C ratio at various cutoff was 0.947 (95% confidence interval: 0.831-0.992, p < 0.0001). The sensitivity and specificity was 80.65% and 100% respectively at P:C ratio cutoff of 0.3.
    Conclusion
    The random urine P:C ratio predicts the amount of 24-hour urinary protein excretion with high accuracy. Hence it can be used as a faster diagnostic substitute for 24-hour urinary protein estimation.
  • Ali Reza Khosravi, Masoud Pourmoqhadas, Mohammad Ostovan, Gilda Kiani Mehr, Mojgan Gharipour, Habib Zakeri, Bahram Soleimani, Mehrdad Namdari, Mehdi Hassanzadeh, Ali Akbar Tavasolli, Samad Ghaffari, Arsalan Khaledifar, Farshad Roghani, Mohammad Reza Khosravi, Shahrooz Sarami Page 640
    Background
    To compare the early and late cardiovascular events as well as side effects of Osvix, a generic form of Clopidogrel versus Plavix regimens in patients with chronic stable angina, undergoing bare metal stent (BMS) or drug eluting stent (DES) placement, this study was carried out.
    Methods
    A total of 442 patients with chronic stable angina who were scheduled for elective percutaneous coronary intervention (PCI) were included in a randomized, double blind, multi-centric clinical trial being performed in 6 distinct university hospitals in 5 cities of Iran from March 2007 to November 2009. Baseline, demographic and history of risk factors were recorded using the patients’ medical charts. Stenting procedure was performed via approach using low contrast agents. Patients underwent BMS or DES placements based on the physician selection and were randomly assigned to Osvix or Plavix groups. Patients were followed by telephone in 0 and 6 months intervals regarding the major adverse cardiovascular events (MACE) including death, myocardial infarction, in-stent thrombosis, stroke, target lesion revascularization, and target vascular revascularization. Angina episodes, bleeding, liver enzymes, neutrophils and platelets count were also assessed in these intervals.
    Results
    There was not any significant difference between these two groups regarding the baseline characteristics. In the DES group, the 6-month mortality rate and the incidence of MACE in Osvix and Plavix groups were 0.9% and 1.9% (p = 0.61) and 1.8% and 4.9% (p = 0.26), respectively. During the follow up period after DES or BMS placement, there wasn’t any significant difference regarding neutrophil and platelet counts or liver enzymes between study groups.
    Conclusion
    Using Osvix and Plavix are followed by similar major cardiovascular events and side-effect profile in patients undergoing PCI.
  • Mojtaba Rahimi Varposhti, Saied Morteza Heidari, Azim Honarmand, Mohammadreza Safavi, Shahnam Raeesi Page 651
    Background
    Residual neuromuscular blockade continues to be a clinical problem after surgical procedures. The purpose of this study was to determine the incidence of residual paralysis in the postanesthesia care unit (PACU) after a single intubating dose of twice of the 95% estimated dose (ED95) of a nondepolarizing muscle relaxant with an intermediate duration of action.
    Methods
    Two hundred and sixteen patients scheduled for elective surgery under general anaesthesia requiring tracheal intubation were included in the study. They received a single intubating dose of intravenous atracurium (0.5 mg/kg) to facilitate tracheal intubation. At the end of surgery, if train of four (TOF)-ratio was ≤ 0.9, neostigmine 40 µg/kg intravenously was given. If TOF-ratio was ≥ 0.9, no neostigmine was given. Also, in awake patients with TOF > 0.9, residual neuromuscular paralysis was evaluated by using clinical tests such as head lift test and tongue depressor test.
    Results
    TOF was less than 0.9 in 48 (22.2%) patients while after 120 minutes, no patients had TOF less than 0.9. Of 33 patients whose operation lasted less than 120 minutes, 4 patients had TOF less than 0.9 at the end of surgery. There was no case of hypoventilation or hypoxia at PACU. The incidence of negative value in clinical tests was high.
    Conclusion
    Our study gave the impression that more than two hours between the administration of a single intubating dose of an intermediate-acting nondepolarizing muscle relaxant (atracurium) and arrival to the PACU can probably guarantee the lack of a residual paralysis.
  • Afsaneh Malekpour Tehrani, Ziba Farajzadegan, Fariborz Mokarian, Ahmad Reza Zamani Page 658
    Background
    Breast cancer is the most common cancer in women. It seems that breast cancer patients benefit from meeting someone who had a similar experience. This study evaluated the effect of two kinds of interventions (peer support and educational program) on quality of life in breast cancer patients.
    Methods
    This study was a controlled clinical trial on women with non-metastatic breast cancer. The patients studied in two experimental and control groups. Experimental group took part in peer support program and control group passed a routine educational program during 3 months. The authors administered SF-36 for evaluating the quality of life pre-and post intervention. Also, patient’s adherence was assessed by means of a simple checklist.
    Results
    Two groups were similar with respect of age, age of onset of the disease, duration of having breast cancer, marital status, type of the treatment receiving now, and type of the received surgery. In the control group, there were statistically significant improvements in body pain, role-physical, role-emotional and social functioning. In experimental group, role-physical, vitality, social functioning, role-emotional and mental health showed significant improvement. Vitality score and mental health score in experimental group was significantly higher than that of the control group, both with p < 0.001. Also, it was shown that adherence was in high levels in both groups and no significant difference was seen after the study was done.
    Conclusion
    According to the results of this study, supporting the patients with breast cancer by forming peer groups or by means of educational sessions could improve their life qualities.
  • Ayfer Tezel, Elanur Yi, Lmaz Karabulutlu, Ouml, Zlem Ş, Ahin Page 666
    Background
    Dialysis patients experience psychosocial problems, such as anxiety, depression, social isolation, loneliness, helplessness, and hopelessness. All of these psychosocial problems can increase patient's need for holistic care, including attention to the person's environment and receiving support from family. If dialysis patients are better supported and cared for, these negative consequences might be prevented or at least decreased. This study was performed to determine the perceived social support from family and depression level of hemodialysis patients.
    Methods
    In this study, descriptive design was used. Data were collected during structured interviews in an outpatient clinic using a questionnaire. The questionnaire aimed to determine the patients’ descriptive characters and the scores of Beck Depression Inventory and Perceived Social Support from Family Scales. In data evaluation, descriptive statistics, Student's t tests, Kruskal Wallis tests, Mann-Whitney U tests and Pearson product moment correlations were used.
    Results
    The mean depression score was very high (23.2 ± 10.5). Significant differences were found between employment status and level of depressive symptoms. The mean level of perceived social support from family was 15.23 ± 5.37. There were no statistically significant differences between all the variables for the level of perceived social support from family. Perceived social support from family was negatively correlated with depression.
    Conclusions
    The results of this study indicate that Turkish hemodialysis patients experience depression. However, patients who were dissatisfied with their social relationships had higher depression scores.
  • Saedziaaldin Samsamshariat, Gholam Basati, Ahmad Movahedian, Morteza Pourfarzam, Nizal Sarrafzadegan Page 674
    Background
    Platelet-activating factor acetylhydrolase (PAF-AH) is a circulating enzyme that has an important role in the development of coronary artery disease (CAD). The correlations between PAF-AH and CAD are controversial. Furthermore, the differences of the enzyme levels between patients with stable and unstable CAD are not fully determined. The purpose of this study was to evaluate plasma PAF-AH levels and its association with the presence of CAD and some clinical risk factors in the patients.
    Methods
    This case-control study included 50 control subjects without CAD, 50 stable CAD patients and 50 unstable CAD patients with angiographically documented CAD. Plasma PAF-AH activity was determined by a commercial kit. The inflammatory markers, high sensitivity C-reactive protein (hsCRP) and oxidized low density lipoprotein (ox-LDL), and lipid profile were also measured. Comparisons of biochemical risk factors among all groups were performed by one way ANOVA. The association of PAF-AH activity with the presence of CAD was analyzed by multiple logistic regression.
    Results
    Plasma PAF-AH activity levels were higher in unstable CAD patients (0.040 ± 0.012 μmol/min/mL) than in stable CAD patients (0.032 ± 0.010 μmol/min/mL) and control subjects (0.026 ± 0.009 μmol/min/mL) (p < 0.01). Plasma PAF-AH activity was also independently associated with the presence of CAD (p < 0.01).
    Conclusions
    Plasma PAF-AH activity levels were highly increased in unstable and stable CAD patients as compared to control subjects and may be a useful biomarker for CAD prediction.
  • Daniel Olusola Ojurongbe, Adebola M. Adegbayi, Oloyede S. Bolaji, Akeem A. Akindele, Olugbenga A. Adefioye, Oluseyi A. Adeyeba Page 680
    Background
    Malaria and intestinal helminths are parasitic diseases causing high morbidity and mortality in most tropical parts of the world, where climatic conditions and sanitation practices favor their prevalence. The aim of this study was to determine the prevalence and possible impact of falciparum malaria and intestinal helminths co-infection among school children in Kajola, Osun state Nigeria.
    Methods
    Fresh stool and blood samples were collected from 117 primary school children age range 4-15 years. The stool samples were processed using both Kato-Katz and formol-ether concentration techniques and microscopically examined for intestinal parasitic infections. Blood was collected by finger prick to determine malaria parasitemia using thick film method; and packed cell volume (PCV) was determined by hematocrit. Univariate analysis and chi-square statistical tests were used to analyze the data.
    Results
    The prevalence of Plasmodium falciparum, intestinal helminth infections, and co-infection of malaria and helminth in the study were 25.6%, 40.2% and 4.3%, respectively. Five species of intestinal helminths were recovered from the stool samples and these were Ascaris lumbricoides (34.2%), hookworm (5.1%), Trichuris trichiura (2.6%), Diphyllobothrium latum (0.9%) and Trichostrongylus species (0.9%). For the co-infection of both malaria and intestinal helminths, females (5.9%) were more infected than males (2.0%) but the difference was not statistically significant (p = 0.3978). Children who were infected with helminths were equally likely to be infected with malaria as children without intestinal helminths [Risk Ratio (RR) = 0.7295]. Children with A. lumbricoides (RR = 1.359) were also likely to be infected with P. falciparum as compared with uninfected children.
    Conclusion
    Asymptomatic falciparum malaria and intestinal helminth infections do co-exist without clinical symptoms in school children in Nigeria.
  • Ali Reza Moghtaderi, Neda Moghtaderi, Amir Loghmani Page 687
    Background
    Most medical treatments for carpal tunnel syndrome (CTS) have focused on suppressing the inflammatory process. Injection of dexamethasone acetate might provide the necessary cellular and humoral mediators to induce a healing cascade. Dexamethasone is a water-soluble steroid that is safe to be used in the third trimester, especially as a local treatment. The aim of this study was to evaluate the effectiveness of 4 mg dexamethasone acetate injection for treatment of carpal tunnel syndrome in pregnancy period.
    Methods
    Twenty pregnant patients with carpal tunnel syndrome were recruited using strict inclusion and exclusion criteria. All patients were injected with 4 mg of Dexamethasone acetate and 0.5 ml lidocaeine 1% under the carpal tunnel. Pain intensity [based on visual analog scale (VAS)] and electrophysiologic parameters of median nerve (transcarpal median sensory nerve conduction velocity (SNCV), distal motor latency (DML), and distal sensory latency (DSL) were recorded before and 3 weeks after injection.
    Results
    The average pain scores before and 3 weeks after Dexamethasone acetate injection was 8.70 ± 0.92 and 4.30 ± 0.76 respectively (p < 0.005). Also transcarpal sensory nerve conduction velocity of median nerve was 33.7 ± 6.3 m/s and 24.5 ± 6.8 m/s (p = 0.001); distal motor latency of median nerve was 5.16 ± 1.04 ms and 4.70 ± 0.53 ms (p = 0.001) and distal sensory latency of median nerve was 4.84 ± 0.77 ms and 4.2 ± 0.6 ms (p = 0.001), respectively.
    Conclusions
    After Dexamethasone acetate injection, pain intensity and electerophysiologic parameters were significantly improved. This study offers encouraging results for an alternative minimally invasive treatment for CTS in pregnant women.
  • Parviz Owlia, Monir Baradaran Eftekhari, Ameneh Setareh Forouzan, Farahossadat Bahreini, Mostafa Ghanei, Mahdi Farahani Page 691
    Background
    Priority setting is one of the major issues in the health research system and no health system can afford to pay for every research they want to do, particularly in developing countries, so we decided to set the national main areas of the health research priorities.
    Methods
    In this study, according to Essential National Health Research (ENHR) strategy and with cooperation of all the Iranian universities of medical sciences and other stakeholders, the national health research priorities were extracted.
    Results
    The number of research priorities collected from the universities of medical sciences was 6723. Seventeen percent of the research priorities were related to basic science, 78 percent applied science and 5 percent were related to developmental type. According to epidemiological classification, 50% of the research priorities were in descriptive form. In this process, 9 main extracted areas consist of communicable diseases, non-communicable disease, Health System Research, pharmaceutical sciences and Industry, basic science, traditional medicine and herbal medicine, nutrition, environmental health, and dentistry. And then for each area, five main projects were defined.
    Conclusion
    In the Health Research System, the participatory priority setting is the main function based on needs assessment.
  • Tuba Cimilli Ozturk, Serpil Yaylaci, Onur Yesil, Sebnem Eren Cevik, Ozlem Guneysel Page 699
    Dyspepsia with mild, stabbing epigastric discomfort without history of trauma is a very common symptom that emergency physicians see in their daily practice. Vascular emergencies, mostly the aortic dissection and aneurysm, are always described in the differential diagnosis with persistent symptoms. Isolated celiac artery dissection occurring spontaneously is a very rare diagnosis. The involvement of branch vessels is generally observed and patients show various clinical signs and symptoms according to the involved branch vessel. Here we are presenting a case with spontaneous isolated celiac artery dissection, without any branch vessel involvement or visceral damage, detected by computed tomography scans taken on admission.
  • Mansour Salesi, Peyman Mottaghi Page 703
    Pamidronate is a bisphosphonate derivative that can inhibit bone resorption by actions on osteoclasts and increase bone density in spite of treatment with steroids. This drug has the anti-inflammatory effect by increase apoptosis of monocytes. 5-10 percent of rheumatoid arthritis patients is seronegative and may be resistant to conventional disease modifying anti rheumatic drugs (DMARDs). Intravenous (IV) pamidronate can be effective in disease control in seronegative rheumatoid arthritis. We report two cases of seronegative and drug resistant rheumatoid arthritis that favorably responds to pamidronate.
  • Simin Hemati, Omid Esnaashari, Mohammad Reza Mohajeri, Mostafa Sarvizadeh, Mehri Sirous Page 707
    Choriocarcinoma is an extremely rare pathology among breast malignancies. It is introduced by two distinct terms in the literatures: breast cancer with choriocarcinomatous features and metastatic choriocarcinoma to the breast. In this case report, the history, physical examination, laboratory findings, imaging studies, and pathological findings of breast choriocarcinoma in a 41-year-old woman are described and previous literatures about choriocarcinoma in the breast are reviewed.
  • Siddhartha Sharma, Bias Dev, Mohammad Farooq Butt Page 712
    Dear Editor,We would like to commend Attari et al on their excellent study entitled ‘Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: A randomized clinical trial’.1 The authors’ findings are consistent with those of Jellish et al2 and Rung et al3 who recommend spinal anaesthesia over general anaesthesia for operative procedures on the lumbar spine lasting less than two hours. However, we would like to discuss an important aspect of this study, namely deterioration in neurological status after administration of spinal anesthesia. Hebl et al reported a higher incidence of post-operative neurological complications after central neuraxial blockade in patients with underlying spinal canal pathology. However, in absence of a control group, the authors could not determine whether such complications were because of the anesthetic technique, surgical procedure or natural history of the disease.4 It has been proposed that spinal anesthesia may increase the intra-canal pressure in patients with lumbar canal stenosis and result in ischaemic damage to the spinal cord or nerve roots.5 The authors were careful to exclude patients with severe lumbar canal stenosis and arachnoiditis and none of the patients had arachnoid cysts or ankylosing spondylitis. This could probably account for the fact that no patient had post-operative worsening of neurological status. In view of these findings, we would like to emphasize the need for proper patient selection in order to minimise neurological complications. Also, there is need for a multicenter collaborative study to evaluate whether or not neurological complications in patients with pre-existing spinal pathologies could be attributed to spinal anaesthesia before this modality can be declared as a safe alternative to general anaesthesia.