فهرست مطالب

  • Volume:15 Issue: 6, 2013
  • تاریخ انتشار: 1392/05/05
  • تعداد عناوین: 20
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  • Azra Ahmadi, Ali Asghar Arastoo, Masoud Nikbakht, Shahla Zahednejad, Mojtaba Rajabpour Page 449
    Background
    Multiple Sclerosis (MS) is a disease of the central nervous system that results in many symptoms including mobility limitation and fatigue..Patients and
    Methods
    Thirty-one MS patients, all female with mean of age of 36.75 years and Expanded Disability Status Scale scores (EDSS) of 1.0 to 4.0 were recruited. Subjects were randomly assigned to one of the three groups: treadmill training, yoga or control groups. Treadmill training and yoga practice consisted of 8 weeks (24 sessions, thrice weekly). The control group followed their own routine treatment program. Balance, speed and endurance of walking, fatigue, depression and anxiety were measured by Berg Balance scores, time for 10m walk and distance for a two minute walk, Fatigue Severity Scale (FFS), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively..
    Results
    Comparison of results have shown that pre- and post-interventions produced significant improvements in the balance score, walking endurance, FFS score, BDI score and BAI score in the treadmill training group and yoga group. However, 10m walk time decreased in the treadmill training group but did not show any clear change in the yoga group. Moreover, the analysis showed significant differences between the treadmill training group and yoga group for BAI score..
    Conclusions
    These results suggest that treadmill training and yoga practice improved ambulatory function, fatigue and mood status in the individuals with mild to moderate MS..
    Keywords: Multiple Sclerosis, Rehabilitation, Exercise, Fatigue
  • Mohammad J. Ashraf, Leila Beigomi, Negar Azarpira, Bita Geramizadeh, Bijan Khademi, Afsoon Hakimzadeh, Elham Abedi Page 455
    Background
    Primary Small round blue cell tumors (SRBCT) in sinonasal comprise histogenetically diverse entities with overlapping morphologic features. Because of the limited initial biopsy tissue materials, differential diagnostic difficulties may arise, and as they have different management, exact diagnosis and classification are very important..
    Objectives
    In this study, we analyzed the immunohistochemical expression of a panel of markers in the classification and diagnosis of sinonasal SRBCTs..
    Material And Methods
    This cross sectional study was performed on 36 paraffin embedded tissue samples. Histologic and immunohistochemical slides from 36 patients with SRBCT were analyzed retrospectively. The patients were admitted in Khalili hospital, Shiraz from 1383 to 1388..
    Results
    There were 13 women and 23 men with the mean age of 53 ±12.1. There were 9 malignant melanoma, seven poorly differentiated SCC; six lymphoma (DLBL); 4 SCNEC; three SNUC; two ON; two Ewing/PNET; two embryonal rhabdomyosarcoma, and one plasmacytoma. Pan-cytokeratin was strongly expressed poorly differentiated SCC and all cases of SNUC. Coexpression of desmin and nuclear myoD1 was only detected in rhabdomyosarcoma. HMB45 was only expressed in sinonasal melanoma. CD99 expression was identified only in Ewing/PNET. FLI-1 was detected in 50% of PNET. P63 was expressed in poorly differentiated SCC (2/7) and SNUC (1/3)..
    Conclusions
    The results of our study indicate that the integration of histopathologic findings with application of limited but highly specific markers led to the separation of carcinomas, lymphoma and melanomas from other small cell tumors. Using a panel of keratin, LCA, desmin, and HMB45 is the most practical and economic approach to accurately classify these tumors..
    Keywords: Carcinoid Tumor, IHC64, Histological Techniques
  • Amir Hamta, Ali Reza Khalilian, Roya Farhadi, Hossein Ranjbaran Page 462
    Background
    LBW rate is one of the most important health indices in every society. It reveals mothers and their new-born infants'' health..
    Objectives
    Our aim, in the present paper, was to present a new statistical framework for analysis based on path analysis techniques..Patients and
    Methods
    A prospective study was conducted in two maternity wards, (privet & governmental hospital) in Sari, Iran. In this research a check-list containing 25 questions about mother’s demographic information and her new-born infant was prepared. Every new born infant who was born weighing less than 2500 g was entered in our study and just next the newborn infant who was normal all of his/her information use to be taken too, (n = 190). Path analysis, an extension of the regression model, was used in this study..
    Results
    Obviously exactly half of the infants were LBW, and the remainder were normal. There were 97 boys and 93 girls. The percentage of IUGR among mothers who had preterm delivery was 19, while this percentage for mothers who had term delivery was 11.5 (P value = 0.167). LBW infants were 36.7% unexpected, while this percent for normal infants was 15.5 (P value < 0.001). Preterm delivery has a significant and direct effect on LBW (p value < 0.001), and its positive sign of path coefficient shows that if it occurs, the probability of LBW will increase, the second important was IUGR, the results showed unexpected pregnancy had direct effect on LBW but this wasn’t significant (P value = 0.292)..
    Conclusions
    By preventing unnecessary termination of pregnancy and keeping fit, the chances of LBW can be reduced..
    Keywords: Path Analysis, LBW, Multipara
  • Seyed Kianoosh Hosseini, Maryam Tahvildari, Mohammad Javad Alemzadeh Ansari, Manouchehr Nakhjavani, Alireza Esteghamati, Masoumeh Lotfi Tokaldany Page 467
    Background
    High cholesterol levels have long been considered an independent risk factor for cardiovascular disease (CVD)..
    Objective
    Controlling risk factors such as dyslipidemia in patients with coronary artery disease is necessary. We aimed to evaluate the success rate of lipid control, during 9 months follow-up after percutaneous coronary intervention (PCI)..Patients and
    Methods
    A total of 195 patients (67.7% men, mean age = 57.8 ± 9.4 years) who underwent PCI in Tehran Heart Center were included. Serum lipid profiles were measured in all the patients before PCI and at 9-month follow-up. Dyslipidemia was defined as serum levels of LDL-C ≥ 100 or TG ≥ 150 or TC ≥ 200 or HDL-C ≤ 40 mg/dl in the men and ≤ 50 mg/dl or less in the women, or non-HDL-C ≥ 130 mg/dl with or without the consumption of lipid-lowering agents. During follow up, all patients were given atorvastatin 20-40 mg/day..
    Results
    Overall, 26.2% had diabetes mellitus, 42.6% had hypertension, and 34.9% were smokers. Dyslipidemia was more common in the women. At 9-month follow-up, there was no significant changes in terms of the prevalence of high HDL-C or low TG in patients; however, a significant increase was seen in the prevalence low TC in patients (63.6% vs. 80.5%; p value < 0.001), LDL-C (47.2% vs. 65.6%; p value < 0.001), and non-HDL-C (40.0% vs. 63.1%; p value < 0.001)..
    Conclusions
    Although by current treatments, the prevalence of patients with low TC, LDL-C and non-HDL-C has significantly increased; dyslipidemia persisted in a considerable proportion of patients. These results necessitate further investigations into the relationship between high serum lipids and long-term outcome of patients after PCI as well as further evaluations of the dyslipidemia treatment strategies..
    Keywords: Dyslipidemia, Lipid Control, Percutaneous Coronary Intervention
  • Farzaneh Golfam, Parisa Golfam, Zeinab Neghabi Page 473
    Background
    Colorectal cancer (CRC) is one of the most common cancers worldwide which is not extensively researched in Iran..
    Objectives
    The present study aims to investigate the epidemiologic characteristics of CRC in patients referred to selected hospitals of Tehran University of Medical Sciences..Patients and
    Methods
    In this descriptive-analytic study 218 patients with colorectal cancer were investigated. Data were collected via reviewing recorded pathologic results of patients of these hospitals which then were analyzed by univariant methods..
    Results
    Among 218 patients, 140 (64.2%) were male and 78 (35.8%) were female. Of all patients, 132 (60.0%) suffered from tumors in rectum; 38 (17.4%) in sigmoid; 12 (5.5%) in descending colon; 10 (4.6%) in transverse colon and 26 (11.9%) in ascending colon and cecum. Tumors were well differentiated in 134 patients (61.5%), moderately in 62 cases (28.4%) and poorly differentiated in 22 patients (10.1%). There was no significant difference between males and females regarding the location and degree of tumor differentiation..
    Conclusions
    Regarding high prevalence of colorectal cancer in Iran and potential environmental and genetic factors, surveillance must be considered for this disease. Its risk factors such as diet, life style and low physical activity should be evaluated and screening should start at younger ages
    Keywords: Colorectal Cancer, Adenocarcinoma, Colon
  • Mohammad Taheri, Hamid Bazrafkan, Mojtaba Habibagahi Page 477
    Background
    Classical screening methods are incapable to properly detect LTBI (Latent TB Infection) and HCWs (Healthcare Workers) are at the high risk of exposure. Only few reports estimated the prevalence of LTBI among Iranian HCWs and they mostly used the TST (Tuberculin Skin Test), rather than assessing the response against TB-specific antigens..
    Objectives
    The current study aimed to determine the frequency of IFN - γ producing blood cells of microbiology and radiology ward technicians by an in-house IFN - γ ELISPOT assay in the University hospitals of Shiraz University of Medical Sciences (SUMS) against recombinant ESAT - 6 and PPD antigens..
    Materials And Methods
    89 HCWs from medical laboratory and radiology departments of Shiraz University of Medical Sciences’ hospitals, South of Iran, were screened for LTBI. To achieve the goal, an in-house IFN - γ (Interferon - gamma) ELISPOT (Enzyme Linked ImmunoSpot) assay was used to detect the reactivity against ESAT - 6 (Early Secreted Antigen Target protein - 6) and the PPD (Purified Protein Derivate)..
    Results
    Almost 8% of the personnel showed positive TST (over 10 mm) reaction while 29% of them had considerable T - cell reactivity against PPD in ELISPOT assays. However, the ESAT - 6 reactivity was found only in one case of HCWs. No correlation was found between the patterns of the reactions and the age or the duration of the employment or previous vaccination history of the participants. The ELISPOT results were not correlated with the TST results..
    Conclusions
    Considering the hindrance of TST, the IFN - γ ESAT - 6 ELISPOT assay, even in forms of in-house tests, could replace traditional methods to properly spot the LTBI among the high risk groups from Iran’s health system..
    Keywords: Latent tuberculosis, Tuberculin test, Interferon, gamma, Enzyme, Linked Immunospot Assay, Iran
  • Ghasem Soltani, Mohammad Abbasi Tashnizi, Ali Asghar Moeinipour, Mahmoud Ganjifard, Jamil Esfahanizadeh, Alireza Sepehri Shamloo, Seyed Javad Purafzali Firuzabadi, Nahid Zirak Page 483
    Background
    Cardiac surgery under Cardiopulmonary bypass causes a systemic inflammatory response with a multifactorial etiology including direct tissue damage, ischemia and stimulation of immune system induced by cardiopulmonary bypass. This study was designed due to the high prevalence and complications of this stimulated immune system in mortality, morbidity, length of ICU stay, and mechanical ventilation..
    Objectives
    This study was aimed to compare preoperative and intraoperative methylprednisolone (MP) to intraoperative MP alone with respect to postbypass inflammation and clinical outcome..Patients and
    Methods
    Sixty pediatric patients (age < 5years) undergoing cardiopulmonary bypass surgery between September 2011-2012 at Imam Reza hospital-Mashhad were randomly assigned to receive preoperative and intraoperative MP (group 1: 30 mg/kg, 4 hours before bypass and in bypass prime, n = 30) or intraoperative MP only (group 2: 30 mg/kg, n = 30). Postoperative temperature (peak temperature and average temperature during the first 24 hours), amount of inotropic, duration of mechanical ventilation, ICU stay, WBC, BUN, creatinine, and CRP were recorded and compared in both groups. Data were analyzed with SPSS version 13 by T-test, Mann-Whitney test if necessary, and Chi-squared distribution..
    Results
    Patient characteristics including age, weight, gender, and duration of bypass were almost similar in both groups (P > 0.05). No significant difference in amount of inotropic medications used for hemodynamic supports, duration of mechanical ventilation, peak and average temperature and length of ICU stay was observed. Among the laboratory tests (WBC, BUN, creatinine, CRP) only WBC counts raised more in group 2 when compared to group 1(P < 0.05)..
    Conclusions
    There was no difference in clinical outcome after cardiac surgery when we administered an additional dose of methylprednisolone compared to a single dose of methylprednisolone..
    Keywords: Cardiopulmonary Bypass, Heart Defects, Inflammation, Congenital
  • Kemal Peker, Abdullah İ., Nal, Huriye GÜllÜ, DÜriye GÜl, Murat Ş, Ahin, Ayca Dumanli Ozcan, Kemal Ki, Li, Ç Page 488
    Background
    Haemorrhoids are cushions of submucosal vascular tissue located in the anal canal starting just distal to the dentate line. Haemorrhoidal disease is a common anorectal disorder which has symptoms of bleeding, prolapse, pain, thrombosis, mucus discharge, and pruritus. Haemorrhoidectomy is one of most frequently performed anorectal operation worldwide..
    Objectives
    The aim of this study was to compare the effectiveness of the LigaSure tissue sealing device, Harmonic Scalpel and conventional MM open haemorrhoidectomy..
    Materials And Methods
    Sixty-nine patients with newly diagnosed symptomatic grade three or grade four haemorrhoidal disease, from July 2011 to December 2011 were recruited for the study. Patients were prospectively randomized to LigaSure, Harmonic Scalpel and conventional haemorrhoidectomy. Patients were evaluated on the basis of the mean operative time, postoperative pain, day of discharge, early and late complications..
    Results
    Each group has twenty-three patients. Ten (14.5 %) were female and fifty-nine (85.5 %) were male. Mean age were 44.5 ± 10.8 for LigaSure group, 39.5±14.4 for Harmonic Scalpel group and 39.8 ± 13.6 for conventional haemorrhoidectomy group. Mean operative time was 12.6 ± 2.9 for LigaSure group, 12.6 ± 2.5 for Harmonic Scalpel group and 22.3 ± 4.5 for conventional haemorrhoidectomy group. Postoperative pain and required analgesic dose were significantly lower for conventional haemorrhoidectomy. Wound healing was also more rapid in conventional haemorrhoidectomy than both LigaSure and Harmonic Scalpel..
    Conclusions
    Lateral heat dissipation of energy based cautery such as Harmonel Scalpel and LigaSure is considerably high when compared with conventional methods. More thermal damage which is generated on tissue seems to be the reason for increased degree of postoperative pain and delay in wound healing..
    Keywords: Haemorrhoidectomy, LigaSure, Harmonic Scalpel
  • Mohammad Jahangiri, Mehrdad Hosseionpour, Hoda Jazayeri, Mahdi Mohammadzadeh, Davood Motaharizad, Azadeh Sadat Page 497
    Acute appendicitis is a common occurrence in childhood, but this diagnosis is considered rarely in differential diagnosis of acute abdomen in the neonatal period because its occurrence is very rare in neonates. We report a 20-day- old afghan female baby that was admitted to neonatal intensive care unit, because of irritability and abdominal distension. Complete ultrasound of abdomen and pelvis was normal. In plain Radiographs of chest and abdomen with the exception of Air-filled stomach and intestine, there was no abnormality. Due to the lack of improvement and severe abdominal distension, she was transmitted to the operating room and Surgical exploration revealed perforated appendix. Appendicitis should be considered in the differential diagnosis for a neonate with abdominal distension and bilious vomiting and needs strong clinical suspicion..
    Keywords: Infant, Newborn, Appendicitis, Peritonitis
  • Ali Akbar Haghdoost, Mohammad Reza Baneshi, Sana Eybpoosh, Razieh Khajehkazemi Page 500
    Background
    To get more precise responses when gathering information about sensitive topics such as drug use, it is important to use the most optimal method..
    Objectives
    This study was carried out to address the impact of three interview methods (street-based, household, and telephone interviews) on response pattern to sensitive and non-sensitive questions in terms of participation, disclosure and discontinuing rates..Patients and
    Methods
    We selected three culturally diverse major cities of Iran. Then, we randomly selected 300 subjects, 100 for each type of interview, from each major city (899 in total). For street-based interviews only pedestrians who were walking alone were recruited, for household interviews only one individual from each house participated (3-4 houses in each alley were selected), and for telephone interviews we selected phone numbers using a random number list. We asked five non-sensitive and five sensitive (related to drug use and sexual contact among their personal network) questions..
    Results
    For telephone and household interviews, relative to street-based interviews, participants were less likely to disclose alcohol and drug-related behaviors (Adjusted OR = 0.76; 95% CI: 0.60- 0.97) and sexual behaviors among their network (Adjusted OR telephone/street-based = 0.64; 95% CI: 0.39- 1.07 and Adjusted OR household/ street-based = 0.56; 95% CI: 0.33- 0.95). We found that participants who were interviewed via the telephone were more likely (Adjusted OR = 1.24) and those who were interviewed at home were less likely (Adjusted OR = 0.86) to report non-sensitive information compared to participants who were interviewed on the street; however, these findings were not statistically significant. The largest participation rate and the least discontinuation rate were observed for household interviews..
    Conclusions
    It seems that the methods of interview effect response to both sensitive and non-sensitive questions. We believe that for street-based interviews, respondents may disclose more sensitive information than telephone and household interviews..
    Keywords: Sexual Behavior, Alcohols, Drug Users, Population
  • Arash Mirabzadeh, Mahrokh Dolatian, Ameneh Setare Forouzan, Homeira Sajjadi, Hamid Alavi Majd, Zohreh Mahmoodi Page 507
    Background
    Although several socio-medical risk factors have been identified for preterm labor, there is a gap in understanding the underlying etiology of preterm labor..
    Objectives
    The current study aimed to analyze the relationship pathway of perceived social support, stressful life events, and other psychosocial risk factors during pregnancy with incidence of preterm labor..
    Materials And Methods
    In a prospective cohort study in four hospitals in Tehran, 500 pregnant women in their 24th to 28th gestational weeks were studied. They filled out a self-report questionnaire on perceived social support, depression, anxiety, stress and stressful life events. Sociodemographic characteristics were also assessed. The participants were followed up until labor, and the data about mother and the newborn were collected after labor. The data were analyzed by SPSS 16 and Lisrel 8.8 software programs using pathway analysis..
    Results
    The final path model fit well (CFI = 0.96; RMSEA =. 064). The results showed that depression, anxiety, and stress (β = -0.18) directly, and stressful life events indirectly (β= -0.0396) had the most predict on gestational age at labor. Perceived social support, directly through socioeconomic status (β=0.25), and indirectly through stress, depression and anxiety (β= -0.26) affected the gestational age at birth (β= 0.0468)..
    Conclusions
    The current study showed that supporting pregnant mother moderates psychological problems such as stress, anxiety, and depression, and hence reduces preterm labor..
    Keywords: Social Support, Depression, Anxiety, Stressful Life Events, Path Analysis, Stress
  • Ramesh Omranipour, Sadaf Alipour, Maryam Hadji, Forouzandeh Fereidooni, Issa Jahanzad, Khojasteh Bagheri Page 515
    Background
    Diagnosis of breast cancer is completed through core needle biopsy (CNB) of the tumors but there is controversy on the accuracy of hormone receptor results on CNB specimens..
    Objectives
    We undertook this study to compare the results of hormone receptor assessment in CNB and surgical samples on our patients..Patients and
    Methods
    Hormone receptor status was determined in CNB and surgical samples in breast cancer patients whose CNB and operation had been performed in this institute from 2009 to 2011 and had not undergone neoadjuvant chemotherapy..
    Results
    About 350 patients, 60 cases met all the criteria for entering the study. The mean age was 49.8 years. Considering a confidence interval (CI) of 95%, the sensitivity of ER and PR assessment in CNB was 92.9% and 81%, respectively and the specificity of both was 100%. The Accuracy of CNB was 98% for ER and 93% for PR..
    Conclusions
    Our results confirm the acceptable accuracy of ER assessment on CNB. The subject needs further investigation in developing countries where omission of the test in surgical samples can be cost and time-saving..
    Keywords: Breast, Neoplasm, Carcinoma, Estrogen, Progesterone
  • Mohammad Amiri, Reza Chaman, Mehdi Raei, Seiyed Davoud Nasrollahpour Shirvani, Abolhasan Afkar Page 519
    Introduction
    Preparedness of hospital has a major impact on their optimal and satisfactory performance. This study aimed to investigate the preparedness of the hospitals to deal with disasters..
    Case Presentation
    This cross-sectional study was carried in 2011 and all of the hospitals which were located in the northern areas of Iran were investigated through the census method. The data collection instruments were self-administered Managers’ Awareness Questionnaire (40 items) and a 141-item checklist. The mean percentage score of hospitals in management of the unanticipated disasters program in the hospital was good. The mean score of managers’ awareness of the hospital status was moderate. With the increase in managers’ awareness, the preparedness of the hospitals significantly increased (r = 0.73, P < 0.001)..
    Conclusions
    The findings showed the moderate preparedness of the hospitals in the Northern provinces to deal with disasters..
    Keywords: Iran, Disasters, Hospital Preparedness
  • Parisa Azimi, Hassan Reza Mohammadi Page 522
    Initial presentation of diastematomyelia is rarely seen in adults. The purpose of this case report is to present a case of clinically silent diastematomyelia unrecognized into adulthood and review of the literature. A 53-year-old Persian man was admitted to our hospital with gait disturbance, weakness of the right lower extremity, sensory loss of the left and right lower extremity of two weeks’ duration, with no pain or sphincter dysfunction. The patient underwent radiological examinations, and diastematomyelia was diagnosed. The deteriorating condition of our patient led to the decision to perform a surgery. A laminectomy was performed from L-3 to L-5 with resection of the soft-tissue mass and excision of the bony spur, and the patient was followed for 6 months. Postoperatively, the patient did not show new neurologic deficit and he returned to work 4 months after surgery. Our case was unique because of the absence of any pain, neurologic signs, and precipitating acute event leading to diagnosis, until 53 years of age. Surgical decompression of bony spur provided relative improvement of his symptoms..
    Keywords: Diastematomyelia, Pain, Spinal Cord
  • Bita Dadpour, Omid Mehrpour, Leila Etemad, Mohammad Moshiri Page 526
    Introduction
    Chronic lead exposure is known to be a risk factor for hypertension (HTN). No specific medication is recommended for the treatment of lead-induced hypertension (LIHTN)..
    Case Presentation
    Our patient was a male admitted with the chief complaint of chronic abdominal pain. His whole blood lead level was reported to be 1961 µg/L. He also mentioned a previous history of HTN managed by propranolol (10 mg, TDS). He discharged himself by giving written consent and 19 days later, he was re-admitted due to high blood pressure of 220/140 mmHg. His Blood pressure (BP) was decreased to 180/110 mmHg with sublingual captopril; but, in maintenance therapy, higher doses of captopril could not further decrease BP. Amlodipine was tried which was discontinued due to the patient intolerance. Prazosin was then administered in gradual increasing doses up to 1 mg twice a day and captopril was tapered..
    Conclusions
    We would like to suggest that LIHTN may better be managed by alpha blockers compared with converting enzyme inhibitors.
    Keywords: Lead, Hypertension, Prazosin
  • Arife Zeybek, Abdullah ErdoĞ, An, Ş, Irin Akdenizg., Ouml, KÇen Kenar, Levent Dertsiz, Abid Demircan Page 529
    Hydatid cyst is a zoonotic disease that is common in the Mediterranean region. Thoracic wall, rib or extrapulmonary intrathoracic localization of the cysts is very rare. Giant extrapulmonary intrathoracic hydatid cysts can lead to both diagnostic and treatment difficulties and can be confused with tumor. We present a case of a hydatid cyst with thoracic wall involvement mimicking tumor. We confirmed diagnosis only by surgical exploration and histopathological examination because radiology is not conclusive. Surgical treatment involved the total extirpation of cyst together wide debridement and resection of affected tissue. Primary thoracic wall closures were performed. In thoracic wall localization of cyst, post-operative course of albendazole for 6 weeks associated with surgery can help in sterilizing the cyst and reduce the recurrence rate. In this article, we presented a thoracic wall hydatidosis which is very uncommon asymptomatic presentation of hydatid cyst disease with its surgical management..
    Keywords: Echinococcosis, Atypical, Thoracic Wall
  • Mohammad Taghi Peivandi, Hami Ashraf, Omid Shahpari, Zahra Mostafavian, Mehran Azami, Masoud Mirkazemi, Amirreza Fatehi, Nastur Bekhradianpour Page 534
  • Hossein Hooshyar, Bahram Hosseinbigi, Mehrzad Saraei, Safarali Alizadeh, Mohammad Eftakhar, Sima Rasti, Nader Khosro, Shahi Page 536
  • Mohammad Taghi Karimi, Amir Esrafilian Page 539