Acta Medica Iranica
Volume:51 Issue: 9, Sep 2013

Breast cancer is the most commonly diagnosed invasive malignancy and first leading cause of cancer-related deaths in Iranian women. Based on silymarin’s unique characteristics, its application in chemotherapy combined with doxorubicin can be effective to enhance the efficacy together with a reduced toxicity on normal tissues. The present study focus on evaluate the efficacy of silymarin in combination with doxorubicin, on viability and apoptosis of estrogen-dependent breast carcinoma cell line (MCF-7). After being cultured, MCF-7 cells were divided into 8 groups and treated as follows: 1st group received 75 μg silymarin, groups 2, 3, and 4 were treated with 10, 25, and 50 nM doxorubicin, respectively, and groups 5, 6, and 7 respectively received 10, 25, and 50 nM doxorubicin as well as 75 μg silymarin. Viability percentage and apoptosis of the cells were assessed with Trypan Blue staining after 16, 24, and 48 hours. Silymarin has a synergistic effect on the therapeutic potential of doxorubicin. Use of silymarin in combination with doxorubicin can be more effective on the therapeutic potential of doxorubicin and decreases its dose-limiting side effects.

In a good deal of studies cholesterol distribution, as a risk factor, demonstrates a special treatment towards age so that it shows an upward trend up to an age group and exhibits a downward trend for older age brackets thereafter. To investigate this phenomenon, two general points of view are presented. First, this issue may occur naturally for many subjects and it may be due to natural treatment of cholesterol variable with age. Second, it could be related to differential mortality, i.e. mortality changes in different age groups. In other words, it can be said that higher levels of cholesterol are relevant to younger-age mortality rate. Constructing a parametric model based on Weibull distribution, the association of this phenomenon with differential mortality was investigated. This study revealed that the effect of differential mortality on cholesterol distribution in the age groups younger than 65 were insignificant and it could partly be justifiable just in older age groups because it involves 35% changes in the 85-95 age groups. Thus, the differential mortality justifies just a part of cholesterol changes and other parts are due to intrinsic changes of cholesterol variable with time.

QT dispersion is an indicator of lack of ventricular repolarization homogeneity and an independent predictor for ventricular arrhythmia and sudden cardiac death. In this study, we evaluated the effect of inpatient cardiac rehabilitation on QT dispersion in patients admitted to Afshar hospital CCU with diagnosis of acute myocardial infarction (AMI), including ST elevation or non-ST elevation MI. Sixty patients with diagnosis of AMI were randomly divided into two 30-subject groups. The subjects in the first group were undergone inpatient cardiac rehabilitation, and the subjects in the control group received only conventional treatments. QT interval dispersion was measured in two occasions: once in the first day of admission and once before discharge from hospital. In this study there was a significant reduction in QT dispersion in patients undergoing inpatient cardiac rehabilitation (48.4 vs. 42.4 ms, P<0.001), but in the control group, QT dispersion was not significantly reduced (49.2 vs. 46.2 ms, P>0.05). The reduction was not significantly different regarding gender. The effectiveness of the rehabilitation on the reduction of QT dispersion was not affected by such variables as age, gender, hypertension, positive family history, hyperlipidemia, type of AMI (with ST-elevation or non-ST-elevation) and left ventricular ejection fraction. Diabetes caused a resistance to the beneficial effects of inpatient cardiac rehabilitation, so as non-diabetic patients showed more reduction in QT dispersionin response to inpatient cardiac rehabilitation comparing non-diabetic patients and the difference was statistically significant.

As a significant number of patients diagnosed with transient ischemic attack (TIA) at emergency department are at risk to develop TIA or cerebral vascular accident (CVA), several attempts have been made to figure out a predictive method to detect those at higher risk of such attacks. We aimed to evaluate the role of ABCD2 scoring which includes age, blood pressure, clinical symptoms, diabetes mellitus, and duration of symptoms in predicting short term outcome of the patients presenting with TIA. One hundred consecutive patients visited between 2009 and 2010 in Hazrat Rasoul Akram Hospital and diagnosed with TIA were enrolled and their ABCD2 scores were registered. The incidence of death, CVA, or TIA during the first week after the attack was recorded. Eleven patients suffered new TIA/CVA after 1 week. Sensitivity and specificity of ABCD2 score for predicting CVA/TIA at cut-off point of 4 were 72.7% and 52.8%, respectively. At the same cut-off point for ABCD2, positive and negative predictive values were 16% and 94 %, respectively. Our results show that although patients with ABCD2 score greater than 4 were more likely to develop recurrent TIA/CVA in short term, those with lesser score still harbour a considerable risk for TIA/CVA. Though ABCD2 as an easily applicable tool is very helpful in management of TIA patients at emergency department, but it should not be the only measure to rely on in our decision making.

Childhood asthma and obesity are significant public health problems. Most prospective studies suggest that obesity increases the risk of asthma. But, some authors did not found this association. In this study the association between asthma and body mass index (BMI) was investigated. This case-control study was conducted on 200 asthmatic children aged 6-15 years and 200 children without asthma. The criteria for asthma diagnosis and its classification were on the basis of National Asthma Education and Prevention Program (NAEPP). BMI of patients and controls were also measured and BMI grater than 85% and 95% were defined as overweight and obese respectively. The data was analyzed by SPSS software. The BMI among the asthmatic children (17.9 kg/m2) was higher than the BMI among the non-asthmatics (16.5 kg/m2), P=0.0001. This relationship was significant in both males and females. 18% of asthmatic children were classified as overweight and 13.5% of them were obese versus 7.5% and 6% respectively in non asthmatics (P=0.0001). However, there was no significant relationship between severity, duration of asthma, kind of medication and BMI in children with asthma (P>0.05). Result of this study showed that there is an association between asthma symptoms and obesity in children. Therefore, any attempts for weight control in asthmatic children might be beneficial.

To assess the one year results of Artiflex Phakic intraocular lens (IOL) implantation in the treatment of high myopia. In this non-random interventional study, myopic patients with spherical equivalent worse than -5.0 diopters (D) who were not eligible for laser surgery were assessed. All patients had refraction, uncorrected and best corrected visual acuity tests (UCVA and BCVA), endothelial cell count (ECC), and measurement of the anterior chamber depth and intraocular pressure before surgery and at 1, 3, 6, and 12 months after surgery. Main outcome measures of this study were refractive stability, refractive predictability, safety, and efficacy after implanting Artiflex IOLs. We studied 53 eyes of 20 female and 8 male patients. The mean preoperative spherical equivalent was -10.22±3.02 D which reached -0.69±1.08 D one year after surgery (P<0.001). On the last follow-up visit, 75% of the eyes were within +0.5 D of emmetropia, 2 eyes had lost one line of BCVA, 18.75% had gained one line and 31.25% had gained 2 or more lines of BCVA. Others showed no change in BCVA. At one year after surgery, 72.2% of the eyes had 20/25 vision or better. The safety and efficacy indices were 1.16 and 1.05, respectively. ECC showed 3.04% decrease (P=0.176). In cases where laser surgery is not an option for myopic patients, use of Artiflex IOLs can have good results with acceptable safety and efficacy.

Skin cancer is the most prevalent type of cancer in most of the countries and more than 90% of cancer cases are related to ultra violet rays of the sun. Therefore protective behaviors against sunlight are considered the most essential measures for skin cancer prevention. This study has been conducted to determine the frequency of protective behavior against sunlight among female students of Tehran city high schools. The Health Belief Model has been used for this cross-sectional study to analyze the factors related to protective behaviors. A multi-phase sampling method was used. 941 female student of Tehran city high schools were studied using a probed question form. The data were then analyzed using SPSS software. During the study of protective behaviors against the sunlight, 24.7% of participants mentioned that they always use sunscreen. The behavior of using sunscreen is related to perceived sensitivity, severity and benefit amongst the students (P<0.05). Also 3.8% of the students who participated in our study were always using gloves in summer to protect against sunlight. The behavior of using gloves in summer was also related to perceived sensitivity, severity and benefit (P<0.05). Physicians were the most effective influencing people with 84.9% influence on the appropriate decision making by these students. There is a low frequency of protective behavior against sunlight among the female students of Tehran city high schools. These findings show the necessity of training the students in this regard and promote the protective behaviors amongst them.

Despite the increased emphasis on chronic non-communicable diseases, there are notable deficits about nutrition education in many medicine training programs particularly gastroenterology fellowship programs. In the present cross-sectional study, we examined the nutritional knowledge related to clinical nutrition among Iranian gastroenterology fellows. Thirty-six gastroenterology fellows currently enrolled in a gastroenterology fellowship program completed a questionnaire, including two sections. The first of which assessed the gastroenterology fellows experience about nutrition training, nutrition management of patients with gastrointestinal (GI) disorders and evaluating perceived nutrition education needs. The second section consisted of multiple choice questions that assessed nutritional knowledge. A total of 32 gastroenterology fellows completed the first section. The majority of gastroenterology fellows failed to partake in any nutrition education during their fellowship training particularly for inpatients despite the availability to participate in the nutrition training especially for the purpose of nutrition support. Mean correct response rates for the second section was 38%. The highest mean score was seen in nutrition assessment (48.1%), followed by scores of 40.5% in nutrition support, 37.0% nutrition in GI disease, and 25.0% in micro and macronutrients. Iranian gastroenterology fellows have serious deficits in their nutrition knowledge. This study paves the way for the development of an education program to improve nutritional knowledge of gastroenterology fellows.

Tuberculosis is a major health problem in Iran and its laryngeal involvement is not uncommon. Laryngeal tuberculosis is so infectious and delay in diagnosis and treatment could result spread of disease and causes divesting complications. We reviewed clinical and para-clinical characteristics of patients with laryngeal tuberculosis in Iran. In a cross sectional study, patients with laryngeal tuberculosis were studied and followed. All patients admitted from May 2000 to Dec 2011 in Amir-Alam hospital, a referral center for laryngeal diseases in Tehran. We studied 19 cases of laryngeal tuberculosis with typical histopathology (chronic granulomatous inflammation with caseous necrosis and langhans-type giant cells) and 6 cases of laryngeal tuberculosis with atypical histopathology (chronic granulomatous inflammation or chronic inflammation without necrosis). They had laryngeal symptoms and signs from 2 to12 months before definitive diagnosis. Macroscopic appearances of laryngeal lesions were exophytic in 11 cases and ulcerative in 14 cases. True vocal cords were involved in 22 cases. The primary clinical diagnosis was malignancy in 17 cases, tuberculosis in 5 cases, and nonspecific inflammation in 3 cases. The chest x-ray findings were compatible with tuberculosis in 14 patients. The response to anti-tuberculosis therapy was desirable in all patients. In endemic area, tuberculosis should be considered as an important diagnosis in patients with laryngeal lesions even when histopathology of laryngeal lesions is not typical. Association with pulmonary tuberculosis helps for diagnosis.

Trends in cholesterol level of different populations have been investigated in several studies. This study is conducted to determine the trend of cholesterol level of Iranian adults from 1990 to 2007. Data on cholesterol measurements of four national health surveys that have been carried out in Iran used in this study. Cholesterol level of 12728 adults aged 25-64 were measured in 1990-1 survey. Also in 1999, 2005, and 2007 surveys, blood cholesterol level of 18398, 52344 and 19630 have been sampled, respectively. The median of cholesterol were modeled with age for men and women separately for the four surveys using fractional polynomials. Then, trends in the median of cholesterol across these four surveys were studied. The analysis of cholesterol data over four national health surveys showed that the change in males'' cholesterol level had a decreasing trend. This decreasing trend was more pronounced in ages younger than 45 years. However, the medians of cholesterol of females during 16 years of four national surveys had a varying trend. It was decreasing in ages younger than 45; but increasing in ages over 45 years. The median of the cholesterol level of males and females in 2005 survey was on average about 10 mg/dl higher in comparison with the other surveys. Our findings showed that the pattern of trend in cholesterol level of Iranian men and women adults have a considerable difference with those of the other developing and developed countries.

Endometrial cancer generally carries a good prognosis. Endometrial carcinoma more frequently metastasizes to the pelvic and para-aortic nodes. Visceral metastases usually occur in the vagina and ovaries. Distant metastases involve lungs and occur as a terminal event. This case report describes vulvalar metastasis of endometrial cancer to the clitoris. Metastatic tumors of the vulva are rare. Moreover, in the presence of metastatic endometrial carcinoma to the vulva, it is necessary to verify if other visceral metastases are present. Endometrial cancer can extend through direct dermatogens and lymphatic spread. We report a clitoral metastasis of an endometrial carcinoma and discuss whether the possible mechanism is vascular spreading or direct seeding.

Congenital hepatic fibrosis (CHF) is a developmental disorder of the biliary system, characterized by defective remodeling of the ductal plate. Herein a family of three children, from consanguineous parents, with minor thalassemia is presented who suffered from congenital hepatic fibrosis (CHF). Prompt diagnosis and appropriate treatment are necessary to avoid further complications in the affected patients.

Uncontrolled hypertension is well- known to give rise to systemic complications involving multiple central organs. Artherosclerosis leads to damage of the retinal vessels wall, contributing to venous stasis, thrombosis and finally, occlusion. Retinal vein occlusions compromise vision through development of ischaemic maculopathy, macular oedema, and rubeotic glaucoma. Laser photocoagulation remains the definitive treatment for ischameic vein occlusion with secondary neovascularization. Timely treatment with anti- vascular endothelial growth factor prevents development of rubeotic glaucoma. We hereby report an unusual case of bilateral retinal vein occlusion complicated by rubeosis irides, which was successfully managed to improve vision and prevent rubeotic glaucoma.