فهرست مطالب

Journal of Research in Medical Sciences
Volume:20 Issue: 3, 2015 Mar

  • تاریخ انتشار: 1394/01/20
  • تعداد عناوین: 20
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  • Comparison of the effect of topical versus systemic L-arginine on wound healing in acute incisional diabetic rat model
    Alireza Zandifar, Sima Seifabadi, Ehsan Zandifar, Sajedeh Sohrabi Beheshti, Abolfazl Aslani, Shaghayegh Haghjooy Javanmard Page 5
    Background
    Diabetes is associated with endothelial dysfunction and impaired wound healing. The amino acid L-arginine is the only substrate for nitric oxide (NO) synthesis. The purpose of this study was to compare the topical versus systemic L-arginine treatment on total nitrite (NOx) and vascular endothelial growth factor (VEGF) concentrations in wound fluid and rate of wound healing in an acute incisional diabetic wound model.
    Materials And Methods
    A total of 56 Sprague-Dawley rats were used of which 32 were rendered diabetic. Animals underwent a dorsal skin incision. Dm-sys-arg group (N = 8, diabetic) and Norm-sys-arg group (N = 8, normoglycemic) were gavaged with L-arginine. Dm-sys-control group (N = 8, diabetic) and Norm-sys-control group (N = 8, normoglycemic) were gavaged with water. Dm-top-arg group (N = 8, diabetic) and norm-top-arg group (N = 8, normoglycemic) received topical L-arginine gel. Dm-top-control group (N = 8, diabetic) received gel vehicle. On the day 5 the amount of NOx in wound fluid was measured by Griess reaction. VEGF/total protein in wound fluids was also measured on day 5 using enzyme-linked immunosorbent assay. All wound tissue specimens were fi xed and stained to be evaluated for rate of healing. Data were analyzed using SPSS software (version 18.0, Chicago, IL, USA) through One-way analysis of variance test and Tukey’s post-hoc.
    Results
    In dm-sys-arg group, the level of NOx on day 5 was signifi cantly more than dm-top-arg group (P < 0.05). VEGF content in L-arginine treated groups were significantly more than controls (P < 0.05). Rate of diabetic wound healing in dm-sys-arg group was significantly more than dm-top-arg group.
    Conclusion
    Systemic L-arginine is more efficient than topical L-arginine in wound healing. This process is mediated at least in part, by increasing VEGF and NO in the wound fluid.
    Keywords: L, arginine, nitric oxide, streptozotocin, vascular endothelial growth factor, wound healing
  • BRCA1 and BRCA2 mutations in Iranian breast cancer patients: A systematic review
    Hossein Neamatzadeh, Seyed Mostafa Shiryazdi, Seyed Mahdi Kalantar Page 14
    Background
    BRCA1/2 genes mutation prevalence varies among ethnic groups and may be influenced by founder mutations.Understanding BRCA1/2 genes mutations is important for reducing breast cancer (BC) incidence, accurate risk assessment and counseling. This systematic review of the literature was conducted to addressing BRCA1/2 mutations in Iranian BC patients.
    Materials And Methods
    A search for relevant articles was run on before January 2014 using MedLine, PubMed, Science Iranian Database, Google, and Web sites related to the study topic. The key words included: BC and Iran with Genes, BRCA Genes, BRCA1 and BRCA2; “Cancer Genes,” and “Iran.”
    Results
    Thirteen articles retrieved from this search strategy were eligible for this review. The overall BRCA1 mutation rate for Iranian female BC patients was detected 31.8% (377/1183). Although this gene mutation rate for male patients is <0.01%. Eight BRCA1 mutations (c. 4837A > G, c. 3419G > A, c. 3119G > A, c. 2612C > T, c. 3113A > G,c. 2311T > C, c. 4301T > C and c. 4308T > C in BRCA1, and one BRCA2 mutation (c. 6494G > C) were found in multiple case subjects and represent candidate founder mutations.
    Conclusion
    According to these studies, there is heterogeneity in BRCA mutations in Iranian BC patients.
    Keywords: BRCA1, BRCA2, breast cancer, familial, Iran
  • Mehdi Karami, Meisam Rabiei, Maryam Riahinezhad Page 209
    Background
    Legal age estimations of living individuals are gaining increasing importance for radiologists involved in delivering expert opinions. The present study aimed to assess the correlation between chronological age and apophyseal centers distance from pelvic bone.
    Materials And Methods
    This was a cross-sectional study carried out on 2013. Subjects were chosen from 15 to 25 years old people who had previous pelvic multi-detector computed tomography for any reason. The distance of iliac crest apophysis to iliac bone, and pubic apophysis to pubic bone were assessed.
    Results
    There was a reverse linear correlation between chronological age and distance of iliac crest apophysis (P < 0.001, r = 0.899) and pubic apophysis to pelvic bone (P < 0.001, r = 0.898). Pubic apophysis was not appeared in subjects before 16 years old and it was appeared in all of the subjects with 18 years old and more. Subjects with age of 21 had near ossification of iliac or pubic apophysis and subjects with age of 24 had full ossification of iliac or pubic apophysis.
    Conclusion
    skeletal age can be estimated by assessing the apophyseal centers distance from the pelvic bone in adolescents 15-25 years old.
    Keywords: Age estimation, iliac crest apophysis, multi, detector computed tomography, pubic apophysis
  • Hamid Reza Marateb, Sobhan Goudarzi Page 214
    Background
    Coronary heart diseases/coronary artery diseases (CHDs/CAD), the most common form of cardiovascular disease (CVD), are a major cause for death and disability in developing/developed countries. CAD risk factors could be detected by physicians to prevent the CAD occurrence in the near future. Invasive coronary angiography, a current diagnosis method, is costly and associated with morbidity and mortality in CAD patients. The aim of this study was to design a computer-based noninvasive CAD diagnosis system with clinically interpretable rules.
    Materials And Methods
    In this study, the Cleveland CAD dataset from the University of California UCI (Irvine) was used. The interval-scale variables were discretized, with cut points taken from the literature. A fuzzy rule-based system was then formulated based on a neuro-fuzzy classifier (NFC) whose learning procedure was speeded up by the scaled conjugate gradient algorithm. Two feature selection (FS) methods, multiple logistic regression (MLR) and sequential FS, were used to reduce the required attributes. The performance of the NFC (without/with FS) was then assessed in a hold-out validation framework. Further cross-validation was performed on the best classifier.
    Results
    In this dataset, 16 complete attributes along with the binary CHD diagnosis (gold standard) for 272 subjects (68% male) were analyzed. MLR + NFC showed the best performance. Its overall sensitivity, specificity, accuracy, type I error (?) and statistical power were 79%, 89%, 84%, 0.1 and 79%, respectively. The selected features were “age and ST/heart rate slope categories,” “exercise-induced angina status,” fluoroscopy, and thallium-201 stress scintigraphy results.
    Conclusion
    The proposed method showed “substantial agreement” with the gold standard. This algorithm is thus, a promising tool for screening CAD patients.
    Keywords: Classifi cation, clinical prediction rule, coronary artery disease, data mining, fuzzy logic
  • Kiana Shirani, Zahra Talaei, Majid Yaran, Behrooz Ataei, Ali Mehrabi, Koushki, Farzin Khorvash Page 224
    Background
    Tuberculosis (TB) remains one of the leading infectious diseases throughout the world. Among various forms of extrapulmonary TB, tuberculous meningitis (TBM) is the most severe form and remains a major global health problem with a high mortality rate. Our study was designed to evaluate tuberculous polymerase chain reaction (PCR) positive rate in patients who present with fairly long symptoms of meningitis.
    Materials And Methods
    The 162 Patients with an indolent onset of symptoms compatible with central nervous system infection were admitted. Sample of cerebrospinal fluid (CSF) was evaluated for biochemistry and tuberculous real-time PCR. Data analyzed by Student’s t-test and Fisher’s test.
    Results
    Patients were mostly male (69.8%), with a median age of 43.69 ± 22.67 years. CSF real-time PCR results in 6 patients (3.7%) were positive for tuberculous DNA. Of these 6 patients, 4 of whom were men and two of whom were women. In other words, the frequency of positive tuberculous DNA was in male 5.3% and female 1.4%, respectively.
    Conclusion
    Given that we live in Iran and in the vicinity of the tuberculous endemic countries, if we face a meningitis case with lasting symptoms and tendency to be chronic, TBM should be considered.
    Keywords: Meningitis, real, time polymerase chain reaction, tuberculosis
  • Atoosa Adibi, Maryam Golshahi, Mehri Sirus, Kimia Kazemi Page 228
    Background
    Patients with the previous history of breast cancer are in risk of contralateral breast cancer. On the other hand, increased breast density is a risk factor for breast cancer and the sensitivity of detecting nonpalpable cancers in screening mammography in radiographically dense breasts is low. The use of ultrasonography in dense breast remains a controversial topic. The purpose of this study was to assess the usefulness of routine ultrasonography in follow-up of women with the previous history of breast cancer and negative mammography but dense breasts.
    Materials And Methods
    In a cross-sectional study, a total of 267 individuals with unilateral postmastectomy mammogram screened and 153 subjects assigned to study. Th ere were 28 subjects with American College of Radiology (ACR) breast density 2 and 125 with ACR breast density 3-4, which there was no new finding in their mammogram in comparison to previous studies. We assumed subjects with ACR breast density 3-4 as mammographic Breast Imaging Reporting and Data System (BI-RADS) category 0 for malignancy. Standard two-view mammogram was performed for all participants, and breast ultrasound (US) examinations were performed by an expert radiologist in radial and anti-radial planes. The data were analyzed using SPSS version 20.0 (SPSS Inc., Chicago, Illinois, USA).
    Results
    The results showed that in subjects with ACR breast density 3-4, when there was no new density in two consecutive mammograms in comparison to previous studies, US also showed no possibility for malignancy (BI-RADS 1-2). And also in subjects with ACR breast density 2, when the mammographic results were BI-RADS 1-2, the US results was the same.
    Conclusion
    Our data indicate that for the detection of breast cancer, sensitivity of US was not greater than mammography in patients with postmastectomy unilateral dense breast if there is not any new density.
    Keywords: Breast cancer, breast density, breast imaging reporting, data system, mammography, ultrasound
  • Mahmood Sadeghi, Reza Afshari, Maryam Vahabzadeh, Adeleh Mahdizadeh, Mansooreh Vafaee, Mahdi Balali, Mood, Seyed Reza Mousavi Page 239
    Background
    Rhabdomyolysis is a clinical and biochemical syndrome, which is observed in some patients with acute chemical and/or pharmaceutical poisonings. We aimed to investigate rhabdomyolysis in patients with acute poisonings due to different chemicals, natural toxins or drug overdose.
    Materials And Methods
    Following approval of the University medical research committee and obtaining informed consents from the patients or their relatives, all patients with acute poisonings who were treated between March 2009 and February 2010 in the Toxicologic Ward of Imam Reza Hospital and had serum creatine phosphokinase (CPK) above 975 IU/L (as a definition for rhabdomyolysis) were studied.
    Results
    Of 3555 hospitalized poisoned patients, 114 patients had rhabdomyolysis with CPK of 5996 ± 892 IU/L (mean ± standard error). The most common intoxication to induce the rhabdomyolysis was opioid overdose (28%). Acute renal failure (ARF) was diagnosed in 11 (8.7%) patients. There was a linear correlation between CPK and creatinine (P < 0.001), which in turn had a significant correlation with death (P < 0.05).
    Conclusion
    Patients with acute poisoning were at risk of rhabdomyolysis. Acute opioid poisoning was the most common cause of toxic rhabdomyolysis in the intoxicated patients, and ARF was the main complication.
    Keywords: Acute poisoning, acute renal failure, creatine kinase, creatinine, intoxication, rhabdomyolysis
  • Sima Ajami, Mahdi Askarianzadeh, Mojgan Mortazavi Page 244
    Background
    Disease registry is a database that includes information about people suffering a special kind of disease. The aim of this study was to first identify and compare the National Renal Disease Registry (NRDR) characteristics in some countries with Iran; and second, develop a provisional and NRDR for Iran.
    Materials And Methods
    Retrieval of data of the NRDR was performed by scholars responsible in related agencies, including the Ministry of Health and Medical Education, Renal Disease charity, and data registries in the United States, United Kingdom, Malaysia, and Iran. This research was applied, and the study was descriptive-comparative. The study population consisted of the NRDR in selected countries in which data were collected by forms that were designed according to the study objectives. Sources of data were researchers, articles, books, journals, databases, websites, related documents, and people who are active in this regard, and related agencies, including the Ministry of Health and Medical Education, and patient support charity. The researchers collected data for each country based on the study objectives and then put them in comparative tables. Data were analyzed by descriptive, comparative, and theoretical methods.
    Results
    Most of the renal transplant teams report their own results as a single center experiences. America and Britain have a preeminent national registry of renal disease compared to other countries.
    Conclusion
    Given that control, prevention, and treatment of chronic renal diseases incur high expenses and the disease is one of leading mortality factors in Iran and across the world and since national registry system for chronic renal diseases can provide better tools and strategies to manage and evaluate patients’ characteristics as well as risk factors which eventually leads to making better decisions.
    Keywords: National, registry, renal disease
  • Assel K. Izekenova, Ainur B. Kumar, Akmaral K. Abikulova, Aigulsum K. Izekenova Page 250
    Background
    During the 20th century, the share of elderly in the total population of the Earth has increased steadily. It is expected that this trend will continue in the 21st century. In 1950, the elderly (persons aged 60 years and older) were 8% of the world population; in 2000, is already 10%; and in 2050, according to United Nations projections, the proportion will reach 21%. This research on Kazakhstan provides demographic analysis from 1989 to 2012 and presents the main features of population’ ageing through comparative analysis.
    Materials And Methods
    We used information-analytical, content-analysis, mathematical treatment and comparative analysis of statistical data on demographic status in Kazakhstan and some other countries of the world (UK, USA, Turkey, Russia) over the 1989-2012.
    Results
    Age dependency ratio of the Russian federation - >1.7 times, in the USA-up to 1.9 times and the UK has dependency ratio higher than 2.5 times of similar indicators in Kazakhstan in 2010.
    Conclusion
    Life expectancy of the elderly population KZ after 65 years in 2010 was only 13.8 years, which is 6-9 years inferior to European and U.S. indices. Thus, increasing the retirement age is inappropriate for the current period.
    Keywords: Comparative study, demographic status, public health, retirement age
  • Niloofar Peykari, Shirin Djalalinia, Amir Kasaeian, Shohreh Naderimagham, Tahereh Hasannia, Bagher Larijani, Farshad Farzadfar Page 253
    Background
    Diabetes burden is a serious warning for urgent action plan across the world. Knowledge production in this context could provide evidences for more efficient interventions. Aimed to that, we quantify the trend of diabetes research outputs of Middle East countries focusing on the scientific publication numbers, citations, and international collaboration.
    Materials And Methods
    This scientometrics study was performed based on the systematic analysis through three international databases; ISI, PubMed, and Scopus from 1990 to 2012. International collaboration of Middle East countries and citations was analyzed based on Scopus. Diabetes’ publications in Iran specifically were assessed, and frequent used terms were mapped by VOSviewer software.
    Results
    Over 23-year period, the number of diabetes publications and related citations in Middle East countries had increasing trend. The number of articles on diabetes in ISI, PubMed, and Scopus were respectively; 13,994,11,336, and 20,707. Turkey, Israel, Iran, Saudi Arabia, and Egypt have devoted the five top competition positions. In addition, Israel, Turkey, and Iran were leading countries in citation analysis. The most collaborative country with Middle East countries was USA and within the region, the most collaborative country was Saudi Arabia. Iran in all databases stands on third position and produced 12.7% of diabetes publications within region. Regarding diabetes researches, the frequent used terms in Iranian articles were “effect,” “woman,” and “metabolic syndrome.”
    Conclusion
    Ascending trend of diabetes research outputs in Middle East countries is appreciated but encouraging to strategic planning for maintaining this trend, and more collaboration between researchers is needed to regional health promotion.
    Keywords: Diabetes, Middle East, scientometrics
  • Shou, Wu Lee, Han, Chung Lien, Chi, Sen Chang, Hong, Zen Yeh, Teng, Yu Lee, Chun, Fang Tung Page 263
    Background
    A high prevalence of gastroesophageal reflux disease symptoms has observed among chronic obstructive pulmonary disease (COPD) patients, and proton-pump inhibitors (PPIs) are the main medication in clinical practices. The aim of this study is to analyze the impact of PPIs to the risk of pneumonia in the cases with COPD.
    Materials And Methods
    This was a nationwide, population-based, cohort study using National Health Insurance Program in Taiwan. The enrolled cases were newly-diagnosed COPD, older than 30 years, between 2001 and 2005. Patients’ prescriptions with PPIs and histamine receptor 2 antagonists (HR2As),>2 months, were identified. The appearance of pneumonia and mortality of these enrolled patients was recorded. Multivariate Cox’s regression was used to examine the influence of acid-suppressing drugs to pneumonia on individuals with COPD.
    Results
    A total of 17,498 patients were included, of whom 109 (0.6%) and 526 (3%) cases had used PPIs and HR2As respectively. The risk of pneumonia existed when patients had used concurrent PPIs (adjusted hazard ratio [HR] = 1.76; 95% confidence interval [CI] = 1.33-2.34) or HR2As (adjusted HR = 1.25; 95% CI = 1.07-1.47). The positive association was lost in the cases over 70 years. The ratio of mortality also increased in those with PPIs or HR2As.
    Conclusion
    Acid-suppressing drugs, especially PPIs, are attributed to more pneumonia happening in COPD patients compare with nonusers. The association was lost in elderly cases. Use acid-suppressing drugs should be careful about a higher possibility of pneumonia in younger individuals with COPD.
    Keywords: Chronic obstructive pulmonary disease_histamine receptor 2 antagonists_pneumonia_proton_pump inhibitors
  • Xianping Huang, Weihe Zhou, Yuefeng Zhang Page 268
    Background
    The objective of this study was to investigate the fatigue status and related factors in patients with early-stage non-small cell lung cancer (NSCLC) 1-5 years after surgery.
    Materials And Methods
    This cross-sectional study included 254 patients with stage IA or IB NSCLC, who had undergone surgery. They completed several surveys, including the Brief Fatigue Inventory, Karnofsky Performance Scale, Physical Activity Questionnaire, Baseline Dyspnea Index, Hospital Anxiety and Depression Scale. The association between fatigue and functional status was assessed using Chi-square analysis. Spearman rank correlation and multivariate logistic regression analysis were used to assess the correlation between fatigue and various other factors.
    Results
    The overall incidence of postoperative fatigue was 59.8%. Among patients with moderate to severe fatigue,21.1% had obvious dysfunction, whereas only 9.6% of patients with mild or no fatigue (?2 = 5.369; P = 0.02) showed obvious dysfunction. Multivariate logistic regression analysis showed that functional status (odds ratio [OR]: 3.57; 95% confidence interval [CI]: 1.17-6.19), concurrent lung disease (OR: 2.34; 95% CI: 1.08-4.99), depression (OR: 6.39; 95% CI: 2.42-17.35), and anxiety (OR: 2.45; 95% CI: 1.13-4.87) were independent risk factors for fatigue, whereas physical activity (OR: 0.27; 95% CI: 0.11-0.73) could prevent fatigue.
    Conclusion
    More than half of the patients with early-stage NSCLC experienced fatigue 1-5 years after surgery, and moderate to severe fatigue was often associated with obvious dysfunction. The strong association of fatigue with anxiety, depression, and lung complications suggests that fatigue and other symptoms constitute a symptom cluster. Therefore, comprehensive treatment methods may achieve better therapeutic results.
    Keywords: Early, stage, fatigue, non, small cell lung cancer
  • Kamran Soltani Arabshahi, Fariba Haghani, Shoaleh Bigdeli, Athar Omid, Peyman Adibi Page 273
    Background
    Holding educational sessions in a clinical environment is a major concern for faculty members because of its special difficulties and restrictions. This study attempts to recognize the challenges of the ward round teaching through investigating the experiences of clinical teachers in 2011.
    Materials And Methods
    This qualitative research is carried out through purposive sampling with maximum variation from among the clinical teachers of major departments in Isfahan University of Medical Sciences (9 persons). The sampling continued until data saturation. Data were collected through semi-structured interview and analyzed through Collaizzi method. Data reliability and validity was confirmed through the four aspects of Lincoln and Guba method (credibility, conformability, transferability, and dependability).
    Results
    Three major themes and their related sub-themes (minor themes) were found out including the factors related to the triad of clinical teaching (patient, learner, and clinical teacher) (concern about patient’s welfare, poor preparation, lack of motivation, ethical problems),factors related to the educational environment (stressful environment, humiliating environment and poor communication) and the factors related to the educational system of the clinical environment (poor organizing and arrangement of resources, poor system’s monitoring, bad planning and inadequate resource).
    Conclusion
    Ward round teaching has many concerns for teachers, and this should be recognized and resolved by authorities and teachers. If these problems are not resolved, it would affect the quality of clinical teaching.
    Keywords: Challenge, clinical teacher, clinical teaching, qualitative study, ward round teaching
  • Elham Behrangi, Shooka Esmaeeli, Farzaneh Baniasadi, Kosar Hedayat, Azade Goodarzi, Zahra Azizian Page 281
    Background
    Melasma is a common acquired disorder characterized by symmetric, hyperpigmented patches with an irregular outline, occurring most commonly on the face. It is most prevalent among young to middle-aged women. Although iron overload affects skin pigmentation, effect of iron deficiency on skin is not clear. So, we evaluated serum iron level, ferritin and total iron binding capacity (TIBC) level among nonpregnant women with and without melasma.
    Materials And Methods
    A cross-sectional case study was conducted in 2012 at university dermatologic department on 33 nonpregnant women with melasma (case) and 33 nonpregnant women without melasma (control). Serum iron level, TIBC and ferritin in the two groups was measured and compared.
    Results
    Serum iron level was lower in the case group (85 ± 11) in comparison with control group (102 ± 9), but the difference was not significant (P: 0.9). Mean TIBC and Ferritin were higher in the case group (TIBC: 329.4 ± 29, ferritin: 6 ± 18) than the control group (TIBC: 329.3 ± 29, ferritin: 33 ± 6) without significant difference.
    Conclusion
    Although the serum iron level was lower in nonpregnant women with mealsma, it was not signifi cant compared with those without melasma.
    Keywords: Ferritin, melasma, serum iron level, total iron binding capacity
  • Roya Kelishadi, Parisa Mirmoghtadaee, Hananeh Najafi, Mojtaba Keikha Page 294
    Background
    The adverse health effects of abdominal obesity are well documented in adults, but such association remains to be determined in the pediatric age group. This study aims to perform a systematic review on the association between abdominal obesity and cardio-metabolic factors such as dyslipidemia, hypertension, and hyperglycemia among children and adolescents.
    Materials And Methods
    A systematic literature search was conducted using PubMed, Scopus and Google Scholar databases to May 2014. Two independent reviewers identified relevant papers in several steps. After studying the titles and texts of documents, repeated and irrelevant ones were excluded. The search was refined to the English language. We did not consider any time limitation. Studies with different measuring methods of abdominal obesity were included. Studies with abdominal obese patients secondary to other disease were excluded from the study. In final, the data of association of cardio-metabolic risk factors and abdominal obesity extracted from studies.
    Results
    Overall, 3966 articles were reviewed, and 67 of them were studied according to the inclusion and exclusion criteria. Waist circumference (WC), waist-to-height ratio, and waist-to-hip ratio were the most common indexes used for defining abdominal obesity. The association of high blood pressure with increasing WC was seen in several studies. The association of other cardio-metabolic risk factors was seen in some studies.
    Conclusion
    Whatever the definition used for abdominal obesity and whatever the methods used for anthropometric measurements, central body fat deposition in children and adolescents increases the risk of cardio-metabolic risk factors. Therefore, more attention should be paid to abdominal obesity of children and adolescents both in clinical practice and in epidemiological studies.
    Keywords: Cardio, metabolic risk factors, central fat deposition, obesity, pediatric age group
  • Ezzat Khodashenas, Mohammadhassan Aelami, Mahdi Balali, Mood Page 308
    Mercury (Hg) is a toxic agent that evaporates in room temperature and its inhalation may cause poisoning. Due to the nonspecific symptoms, diagnosis is difficult in special circumstances with no initial history of Hg exposure. We report two such cases of Hg poisoning. The patients were two sisters, presenting with pain in extremities, itchy rashes, sweating, salivation, weakness, and mood changes. They have used a compound that contains mercury, for treatment of pedicullosis three months before admission. This compound was purchased from a herbal shop and was applied locally on the scalps for 2 days. Their urinary mercury concentrations were 50 and 70? g/L. They were successfully treated by D-penicillamine and gabapentin. In a patient with any kind of bone and joint pain, skin rash erythema and peripheral neuropathy, mercury poisoning should be considered as a diff erential diagnosis.
    Keywords: Acrodynia, mercury poisoning, pediculosis, twins
  • Serena Corioni, Federica Perelli, Claudia Bianchi, Mauro Cozzolino, Luana Maggio, Giulia Masini, Maria Elisabetta Coccia Page 312
    Interstitial pregnancy is an ectopic pregnancy at high hemorrhagic risk. It often poses a diagnostic and therapeutic challenge to the clinician, with a significant risk of morbidity and mortality. It presents a difficult management problem with no absolute standard of care; the most appropriate treatment technique for these pregnancies remains controversial. We describe a case of unruptured interstitial pregnancy successfully treated with a single-dose of systemic methotrexate with subsequent ultrasound and serum beta human chorionic gonadotropin monitoring. Medical management can be a safe and successful option in selected cases that satisfy specific criteria and in women who are able to be monitored after treatment.
    Keywords: Ectopic pregnancy, human chorionic gonadotropin monitoring, interstitial pregnancy, medical management, medical treatment, methotrexate, noninvasive treatment, ultrasound monitoring
  • Tirado, SÁ, Nchez AndrÉs, Bonifaz Alexandro, Montes De Oca, SÁ, Nchez Griselda, Ponce, Olivera Rosa MarÍ, A Page 317
  • Saurabh R. Shrivastava, Prateek S. Shrivastava, Jegadeesh Ramasamy Page 318