Tehran University Medical Journal

Background: Tetralogy of Fallot (TOF) refers to a condition in which left ventricular volume is normal or slightly less than normal. Given the differences observed in some Asian patients with TOF, the present study was conducted to investigate left heart by determining Z-scores for the mitral valve in Iranian patients with TOF.
Methods: Eligible subjects in this prospective descriptive study comprised all patients with TOF presenting to Shahid Modarres Hospital in Tehran from March 2012 to March 2015 and diagnosed as the candidates for surgery. After determining the need for surgery and the therapeutic method required, the mitral valve size and Z-scores were calculated. We analyzed sex, age, body surface area (BSA), mitral size (in 2-chamber and 4-chamber view), mitral Z-score, other cardiac anomalies, number of surgery and previous surgery.
Results: Of a total of 80 patients included in the study over 3 years, 29 (36.3%) were male and 51 (63.8%) were female. The mean age of the patients was 7.15±3.37 years and their mitral size was found to be 10-27 mm (16.2±5.99 mm) using echocardiography. Z-scores of the mitral valve were also obtained as -3.09±2.11, ranging between -7.1 SD and +1.3 SD. 58 (72.5%) patients have only TOF and 22 (27.5%) with other cardiac anomalies. 45 patients were for first time underwent surgery and 22 patients for second time, 12 patients for three time and 1 for forth. Of a total of 35 patients had previous surgery, the most common were shunt 15 (42.9%) and then tetralogy of Fallot total correction (TFTC) in 12 (34.3%). Of a total of 80 patients, 59 (73.8%) underwent TFTC, 17 (21.3%) under pulmonary valve replacement and 4 (5%) shunt.
Conclusion: Z-scores of the mitral valve were found to be significantly below the normal value, (i.e. 0±2 SD), in the study patients, suggesting the risk of hypoplastic left heart syndrome in Iranian patients with TOF, nevertheless, the type of TOF examined in these patients might have been different from those observed in other races and regions.
 

Background: Systemic sclerosis (SSc) is an autoimmune connective tissue disease characterized by vasculopathy and excessive collagen deposition in the skin and internal organs. Based on the skin damage we divide the patients into two groups: limited and diffuse SSc. In restricted type, the thickness of the skin is limited in the face and distal parts of the elbows and knees, with less involvement of internal organs, whereas in diffuse type, facial skin, organs, and trunk generally increase in thickness and internal visceral involvement is noticeable as renal failure, pulmonary artery pressure, and interstitial lung fibrosis. According to the prevalence studies, the prevalence of systemic sclerosis is estimated to be 15 cases per 100,000, of which the prevalence in women is 3 times more than men. Based on clinical evidence the prevalence of SSc is high in Khuzestan province. The aim of this article was to evaluate the demographic features of SSc in Khuzestan province, Iran.
Methods: This cross-sectional study conducted on two hundred SSc patients referred to Rheumatology Clinic of the Golestan University Hospital in Iran, from 2001 to 2015. Patients were selected based on the American College of Rheumatology classification criteria for SSc and were divided into diffuse and restricted types based on the site of skin involvement. Individual characteristics and clinical symptoms were extracted from the information in the patient records which were carefully compiled by physicians. Data on age, sex, race, duration of illness, and family history of SSc were collected orally.
Results: 91.5% of the enrolled patients were female. The mean age was 44 years and the most common race in our study was Lor. The prevalence of the diffuse form of SSc was 68% and the limited form was 32%. The Raynaud's phenomenon was detected in 100% of patients. Sclerodactyly and interstitial lung disease were found in 88.5% and 54.5% of patients respectively. Laboratory features such as ANA (93%), Anti-Scl-70 (77.5%) and anti-centromere antibody (ACA) (70%) of SSc patients were reported.
Conclusion: According to the results of this article, the most systemic sclerosis patients in Khuzestan province were middle-aged Lor race females and the most common type was diffuse systemic sclerosis.

Background: Osteonecrosis of the jaw has recently been reported in patients receiving denosumab for cancer treatment. Accordingly, the present study aimed to determine the frequency of osteonecrosis of the jaw in cancer patients receiving denosumab.
Methods: In the present descriptive-analytical study, 62 cancer patients receiving denosumab who referred to the oncology clinic of Golestan and Shafa Hospitals in Ahvaz in 1403 were studied. The prevalence of osteonecrosis of the jaw among the studied patients was investigated and its relationship with predisposing factors, including gender, type of cancer, comorbidity, and dental caries status, was recorded and analyzed in a checklist.
Results: The prevalence of osteonecrosis of the jaw was 1.6%. There was no significant association between the incidence of osteonecrosis of the jaw and gender and comorbidities (P<0.05), but females showed a 38% higher probability of developing osteonecrosis of the jaw (95% confidence interval; 1.62-1.18, r=1.386). Breast cancer was the most common type of cancer among the study participants (61.3%), but no significant association was found between the incidence of osteonecrosis of the jaw and the incidence of the cancers studied (P-value=0.986). No significant association was found between the incidence of osteonecrosis of the jaw and dental caries (P-value=0.741). The odds of developing osteonecrosis of the jaw in patients with or without dental caries risk were reported to be 1.1 (95% confidence interval; 1.205-1.021, r=1.109).
Conclusion: Despite the lack of a significant association between the incidence of osteonecrosis of the jaw and various factors such as gender, type of cancer, comorbidities, and dental caries, there was evidence of a relative increase in the risk of osteonecrosis of the jaw in women with cancer treated with denosumab, which highlights the need for further investigation.