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Sabeti M, Naser Moghadasi A, Aloosh M, Paknejad Sm, Toghae M,
Volume 70, Issue 7 (6 2012)
Volume 70, Issue 7 (6 2012)
Abstract
Background: Finding an acute brain lesion by diffusion-weighted (DW) MRI upon an episode of transient ischemic attack (TIA) is a predictor of imminent stroke in the near future. Therefore, exploring risk factors associated with lesions in DW-MRI of the brain is important in adopting an approach to TIA management. In the current study, we tried to determine the risk factors associated with lesions in DW-MRI of the brain in patients experiencing TIA episodes.
Methods: Fifty patients with TIA were recruited consecutively in Sina Hospital, Tehran, Iran, over a 6-month period between July 2008 and January 2009. All of the patients underwent a complete neurological examination and laboratory tests. Brain DW-MRIs were performed for all the patients within 72 hours of a TIA episode.
Results: DW-MRI revealed an acute lesion in 16% of the participants. There was a significant correlation between presence of an acute lesion in DW-MRI and TIA duration, history of diabetes mellitus and presence of unilateral facial palsy (P=0.0003, P=0.02 and P=0.008, respectively). Other variables such as age, hypertension, hyperlipidemia, past history of TIA, headache, vertigo, and sensory or visual disturbances had no significant relation with the presence of an acute lesion in DW-MRI.
Conclusion: Duration of TIA, presence of diabetes mellitus and unilateral facial palsy are risk factors for an acute lesion in DW-MRI, meaning that patients with such risk factors are at risk for stroke in the near future.
Mina Mirnezami , Behfar Pakbaz , Zeinab Saidinejad ,
Volume 71, Issue 10 (January 2014)
Volume 71, Issue 10 (January 2014)
Abstract
Background: Dyskeratosis Congenita (DC) is a rare inherited disease with an incidence of approximately one case per million population. The disease is characterized by a classic triad: nail changes, color reticulated skin and oral leukoplakia. In these patients, premature death is often associated with bone marrow failure, infections, pulmonary complications, or malignancy. Three patterns of inheritance for dyskeratosis congenita have been reports, X-linked recessive trait, autosomal dominant and recessive trait. The present study is a case report of an adoloscent patient with dyskeratosis congenita. Case presentation: The patient is a 16 year old boy living in Arak without history of any illness was referred with fever, chills, malaise and admitted to Vali-e-Asr Hospital with initial diagnosis of sepsis. The patient was treated with broad-spectrum antibiotics. In tests, showed pancytopenia. Bone marrow biopsy was performed. Blood and urine culture were negative, rheumatologic lab test and other tests were normal. Ultrsonography of abdomen and pelvis showed splenomegaly. In physical examination, diffuse hypopigmented lesions on the trunk and extermities, nails dystrophy and oral mucosal leukoplakia were observed. Skin biopsy was consistent with DC. Conclusion: The skin and oral mucosal lesions have an impact role in the diagnosis of systemic disease. Early diagnosis and treatment of patients with DC are important in improving clinical outcomes.
Mansoureh Toghae , Mohammad Reza Ghini , Seyed Mohammad Hassan Pak-Nejad, Elahe Taghvaii Zahmat Kesh , Tayeb Ramim ,
Volume 71, Issue 12 (March 2014)
Volume 71, Issue 12 (March 2014)
Abstract
Background: Many drugs have been abused by patients for headache management. Celecoxib has not been abuse widely as a pain relief drug for headache. The aim of this study was comparison between celecoxib and prednisolone in bridge stage therapy following medication overuse headache. Methods: A double-blind randomized clinical trial was done in patients admitted to a private headache clinic in Tehran, Iran at 2012. Patients were selected with 18- 65 years old and 15 days headache per month at least. Prednisone was administered as a 75 mg/day, 50 mg/day, 30 mg/day, 25 mg/day and 10 mg/day dose, in 3 days interval. Celecoxib was administered as a 100mg dose three times per day (first 5 days), twice per day (second 5 days) and one time per day (third 5 days). Headache time, headache intensity, headache duration, analgesic consumption due to severe headache and drug side effects was assessed. We used the visual analog scale to determine the severity of the pain. Results: One hundred and three patients were enrolled in two groups: celecoxib (53 cases) and prednisolone (50 cases). Twenty and one men and eighty and one women with a mean age of 33.62±9.65 years participated in the study. The maximum fre-quency for headache time in the celecoxib group was 1-4 hours (19 cases) and more than four hours (19 cases). In the prednisolone group the maximum frequency for headache time was more than 4 hours (28 cases) (P=0.149). The frequency of side effects of prednisolone and celecoxib groups were 42% and 18.9%, respectively (Relative Risk=2.2, P=0.011). The most common side effects in both groups were weakness and lethargy. Conclusion: Considering the positive effect of both drugs in reducing patients' head-ache during withdrawal, celecoxib compared with prednisolone has better efficacy and fewer side effects.
Mohammad Javad Fatemi , Farzin Pakfetrat , Mohammad Reza Akhoondinasab Akhoondinasab , Kourosh Mansouri , Seyed Jaber Moosavi , Seyed Aboozar Hosseini , Mitra Niazi ,
Volume 73, Issue 10 (January 2016)
Volume 73, Issue 10 (January 2016)
Abstract
Background: Peripheral nerve injury is one of the most challenging of modern surgical problem. Recent advances in understanding the physiological and molecular pathways demonstrated the important role of growth factors in peripheral nerve regeneration. Platelet-rich plasma (PRP) is a biological product that has many growth factors. The aim of this study was to investigate the effect of PRP in the regeneration of sciatic nerve crush in the rat model.
Methods: In this experimental study that established in the animal lab of the Hazrat Fatemeh Hospital in Tehran from September to October 2013, Twenty-four healthy male Sprague-Dawley rats (200-250 g) were randomly divided into two groups. In all rats the sciatic nerve was cut and then carefully repaired by the tension free method under a light microscope. In group 1, after the repair, 0.05 µL of PRP was injected below the epineurium to the proximal and distal parts of the repaired area. In group 2 the same amount of normal saline was injected to the proximal and distal of the repaired area. After six weeks footprint analysis, neurophysiologic and histopathology evaluations were performed.
Results: Significant differences existed between the two groups footprint analysis (P= 0.001). Also the nerve conduction latency test was significantly shorter in PRP group. (1.0233 ms in PRP group and 1.7375 ms in control) (P< 0.001). The average amplitude in the first group and the second group was 7.6250 mv (control) 6.3667 mv that does not show a statistically significant difference (P= 0.093). Significant differences between the two groups in the number of axons of the proximal portion of the study was not seen (P= 0.29). The parameters included number of axons of the proximal and the distal part of axons, the diameter of the distal and proximal axons in the two groups were compared. In the two groups there was statistically significant difference between the above parameters. (P= 0.298).
Conclusion: It seems that PRP may have an important role in peripheral nerve regeneration and functional recovery after nerve laceration and repair. Further clinical evaluation recommended.
Jalal Moludi , Seyedali Keshavarz , Reza Pakzad , Naser Sedghi , Taraneh Sadeghi , Foad Alimoradi,
Volume 73, Issue 11 (February 2016)
Volume 73, Issue 11 (February 2016)
Abstract
Background: Recently, the role of inflammation and oxidative stress in the pathophysiology of atrial fibrillation (AF) after cardiac surgery has been emphasized. Vitamin C as an antioxidant important role in reducing the incidence of postoperative atrial fibrillation. This study aimed to investigate, administration of vitamin C, as a way to reduce the incidence of atrial fibrillation after coronary bypass surgery.
Methods: In this double-blind clinical study, 290 patients in Rajaee Heart Center, from March 2013 to December 2014 who underwent coronary artery bypass surgery were randomly divided into intervention and control groups to receive vitamin C and placebo. The intervention group before the surgery in the operating room received 2 grams of vitamin C intravenously then one gram per day for four days prior to surgery. After the operation, the two groups were compared in terms of the following: Atrial and ventricular arrhythmias after surgery, ICU stay and hospital stay and duration of intubation.
Results: 113 cases and 177 controls (191 men and 99 women) with a mean age of 55.40±14.40 years in both groups (vitamin C and placebo) were enrolled. The incidence of postoperative atrial fibrillation was 55% in the placebo group to 35% in the vitamin C group decreased (P= 0.001). Duration of intubation in the intervention group 11.8 and the control group was 14.14 hours (P= 0.004). The amount of drainage was lower in vitamin C group (P= 0.003). Vitamin C had no effect on the rates of hospital and ICU stay (P= 0.075). There was no significant reduction in threatening arrhythmia (VT) and VF in this period (P= 0.159).
Conclusion: Vitamin C supplements may reduce atrial fibrillation after coronary artery bypass surgery also can improve conditions such as reducing the duration of intubation. With regard to the safety, these supplements can be recommended for the prevention of atrial fibrillation before coronary artery bypass surgery.
Hamid Kazemian , Zahra Pakbaz , Seyed Mostafa Hosseini , Mohammad Reza Pourmand ,
Volume 74, Issue 3 (June 2016)
Volume 74, Issue 3 (June 2016)
Abstract
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Background: The genome of the bacteria has considerable diversity in terms of sequence of nucleotide bases and change over the time. With the advancement of bioinformatics science possibility of the vast comparison to living organisms has risen. During the last two decades many information about genome sequencing of pathogenic and non-pathogenic bacteria have been published. Using this information and to find connections between them and many phenotypic characteristics and behavior of bacteria could be used in many studies. In this study we compared some of the genetic, phenotypic and behavioral properties of archaebacteria and eubacteria. Methods: In this analytical study, genomic Information of 286 species of archaebacteria and 122 species of eubacteria were collected from the NCBI (National Center for Biotechnology Information) site which was conducted in April to June 2015. Mean of gene size, gene number, protein number and C+G content compared in the two groups of archaebacteria and eubacteria. Association of genomic characterization of bacteria with several other characteristics were analyzed using SPSS statistical software version 19 (Chicago, IL, USA). For this purpose, the Pearson correlation coefficient (Pearson), Student’s t-test and ANOVA test (One-way analysis of variance) was used. The P values less than 0.05 was considered as significant level. Results: There was significant association between means discrepancy in two group (P= 0.01). The genome size of eubacteria and archaebacteria have significant association with some of the characteristics of bacteria, such as the C+G content, the number of proteins, genes and habitats of the bacteria (P= 0.01). As well as there was significant association between genome size and features such as number of pseudogene, mobility and type of breathing in eubacteria (P= 0.01) but not in archaebacterial (P˃ 0.05). |
Conclusion: Many characteristics of eubacteria and archaebacteria are significantly associated with genomic properties. Comparison genomics of bacteria will help in identification of evolutionary origins as well as differences between different categories of bacterial.
Fatemeh Roudbari, Behzad Poopak, Fatemeh Sheikhsofla, Mojtaba Ghadiani,
Volume 74, Issue 6 (September 2016)
Volume 74, Issue 6 (September 2016)
Abstract
Background: Kirsten rat sarcoma (KRAS) gene is a target of genetic alterations which are diagnostic and prognostic biomarkers in patients with metastatic colorectal cancer who are treated with monoclonal anti-EGFR antibodies such as cetuximab and panitumumab. KRAS mutations are seen in 35-42% of patients with colorectal cancer. The high frequency of these mutations in colorectal cancer represents their high potential as a biomarker in early diagnosis of cancer. This study was done to evaluate the frequency of KRAS gene mutations in a small population of Iranian patients suffering from colorectal cancer.
Methods: 50 formalin-fixed paraffin-embedded tissue blocks with colorectal cancer (CRC), already confirmed by histopathology and immunohistochemistry testing, were received to Payvand Clinical and Specialty Laboratory, Tehran, from across the country in 2015. DNA was extracted from the tissue blocks and its quality was then evaluated. The reverse dot blotting method was used to evaluate KRAS gene mutations.
Results: KRAS mutations were found in 42% of the study patients. 30% and 12% of the mutations were found in codon 12 and codon 13, respectively. Moreover, no mutation was found in codon 61. Results also showed that the most frequency of samples examined belonged to male with 68% (average age of 56 years old) and then to female with 32% (median age of 54.8 years old).
Conclusion: This study was performed to evaluate the frequency of KRAS gene mutations in Iranian colorectal cancer patients. According to the study results, the frequency of KRAS mutations was consistent with that of other countries, reported in previous studies. The high prevalence of these mutations in patients with colorectal cancer indicates the important role of these genes in this group of patients. Thus, the presence of these mutations can be used as a suitable biomarker for evaluation of response to targeted therapies in patients suffering from colorectal cancer.
Hassan Babamohamadi , Abbasali Ebrahimian , Fateme Paknazar , Hojat Torkamandi ,
Volume 74, Issue 7 (October 2016)
Volume 74, Issue 7 (October 2016)
Abstract
Background: The ability to recognize the severity of the disease in those who their survival depend entirely on admission to the intensive care unit, is very valuable clinically. This study aimed to evaluate the clinical effectiveness of modified sequential organ failure assessment (MSOFA) scale to predict mortality and length of stay in intensive care unit patients respectively.
Methods: This was a retrospective cross-sectional study conducted on hospital records of patients admitted to the intensive care unit. All patients’ records who admitted to the intensive care unit of Kowsar Hospital, Semnan city (the capital of the province), Iran, in 2015 considered as the sample. Collecting data were done during 4 weeks in April and May 2016. The data collection tool was a demographic questionnaire and modified sequential organ failure assessment scale. Exclusion criteria included discharge in the first 24 hours after admission, the patient died a few hours after admission and incomplete information to complete the modified sequential organ failure assessment form.
Results: The study of 105 patients' records of the intensive care unit showed that 45.7% of patients were died, 15.2% and 39% were discharged and moved to other wards respectively. The results of logistic regression analysis and receiver operating characteristic (ROC) curve showed that this criterion had moderate sensitivity and specificity for prediction of mortality and length of stay in ICU patients (Area=0.635, CI= 0.527-0.743) and each unit increase in modified sequential organ failure assessment score is accompanied by increasing 32 percent chance of death (OR=1.325; 95% CI:1.129,1.555; P= 0.001(. Also each unit increase in modified sequential organ failure assessment (MSOFA) score accompanied by increasing 19% length of stay in ICU (OR=1.191; 95% CI: 1.034, 1.371; P= 0.015(.
Conclusion: The results of this study showed that the modified sequential organ failure assessment scale is not useful tool to predict the length of stay and mortality of patients admitted to the intensive care unit.
Amir Hossein Pakravan, Atena Shiva,
Volume 75, Issue 2 (May 2017)
Volume 75, Issue 2 (May 2017)
Abstract
Background: Osteoblastoma is one of the rarest primary benign bone tumors which accounts for 1% of all bone neoplasms and 3.5% of benign bone tumors, with the potential for local invasion and recurrence. Osteoblastoma is not homogeneous. Differences in histological details have led to the division of these lesions into subtypes. The histologic features in most cases are distinctive, there are various changes that make the diagnosis challenging. Although involvement of this disease is more in the spines or small long bones, but it has been reported involvement of jaws in this disease. Correct diagnosis is very important because it may be misdiagnosed osteosarcoma with hypercellular cases.
Case presentation: In this case report, it is described patient a 7-year-old girl with a lesion in the posterior maxilla and bone resorption in May 2016, Sari, Mazandaran province, Iran. Differential diagnosis of the radiological and clinical findings suggested an osteosarcoma. In terms of pathology, osteoblastoma was included a well-vascularized connective stroma tissue with plenty of veins which osteoid and primitive woven bone can be seen actively. In microscopy diagnosis, samples were shown cortical bone with a natural appearance, prominent osteoblasts and surrounding granulation tissue containing blood vessels that confirmed maxilla osteoblastoma. The lesion was examined by histopathology method for final recognition and the results revealed osteoblastoma.
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Conclusion: Although jaw osteoblastoma is a rare tumor and presents with microscopic features that can mimic a variety of other types of malignant entities. It is important to avoid of other non-specific clinical and radiographic protests that led to the recognition problems. The importance of interdisciplinary cooperation between the surgeon, radiologist and pathologist must be pressured. |
Zahra Kamali Sarwestani , Alireza Dasdar , Setareh Agha Kuchak Afshari , Mohsen Gerami Shoar , Seyyed Jamal Hashemi , Reza Pakzad , Pegah Ardi , Alireza Abdollahi , Mohammad-Taghi Haghi-Ashtiani, Shahram Mahmoudi ,
Volume 75, Issue 4 (July 2017)
Volume 75, Issue 4 (July 2017)
Abstract
Background: Fungi have a worldwide distribution which can cause a broad spectrum of disease ranging from allergic to systemic infections, particularly in immuno-compromised individuals. Fungal spores are an important group of bioaerosols in hospital environment which are an emerging cause of hospital-acquired infection. Nosocomial infections cause significant morbidity and mortality as well as large financial burden on the healthcare system. This study aimed to evaluate the frequency and species distribution of airborne fungi in selected wards of two tertiary hospitals in Tehran, Iran.
Methods: In this cross-sectional study, samples were collected during six months from July 2016 to December 2016 by using of settle plate method. Samples were collected from selected wards of Imam Khomeini Hospital and Children's Medical Center and then incubated at 28 °C for 8-10 days. Fungal isolates were identified using the macroscopic features of colony and microscopic characteristics in slide cultures. Yeast isolates were identified by CHROMagar candida medium. PCR-sequencing of ITS1-5.8 S-ITS2 region of ribosomal DNA was used for identification of unknown isolates.
Results: A total of 202 colonies including 133 colonies from the Imam Khomeini Hospital and 69 colonies from the Children's Medical Center were isolated. Cladosporium spp. were the most common obtained fungi accounted for 30.1% and 47.8% of all isolates in the Imam Khomeini Hospital and the Children's Medical Center, respectively. Penicillium spp. and Aspergillus spp. were other frequent species in two hospitals. Infectious diseases ward in Imam Khomeini hospital and emergency and urology wards in Children's Medical Center had the highest rate of contamination.
Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.
Methods: In this cross-sectional study, samples were collected during six months from July 2016 to December 2016 by using of settle plate method. Samples were collected from selected wards of Imam Khomeini Hospital and Children's Medical Center and then incubated at 28 °C for 8-10 days. Fungal isolates were identified using the macroscopic features of colony and microscopic characteristics in slide cultures. Yeast isolates were identified by CHROMagar candida medium. PCR-sequencing of ITS1-5.8 S-ITS2 region of ribosomal DNA was used for identification of unknown isolates.
Results: A total of 202 colonies including 133 colonies from the Imam Khomeini Hospital and 69 colonies from the Children's Medical Center were isolated. Cladosporium spp. were the most common obtained fungi accounted for 30.1% and 47.8% of all isolates in the Imam Khomeini Hospital and the Children's Medical Center, respectively. Penicillium spp. and Aspergillus spp. were other frequent species in two hospitals. Infectious diseases ward in Imam Khomeini hospital and emergency and urology wards in Children's Medical Center had the highest rate of contamination.
Conclusion: According to the results of this study, the frequency and diversity of fungal spores in hospital wards were different. In addition, since the fungal contamination in the hospital environment are affected by various environmental factors and the efficiency of ventilation systems, some of these wards require better ventilation system as well as regular monitoring to remove these fungal bioaerosols in order to maintain the health of patients and health care workers.
Hamideh Pakniat , Razieh Akbari ,
Volume 76, Issue 7 (October 2018)
Volume 76, Issue 7 (October 2018)
Abstract
Background: A significant increase in cesarean section in worldwide is known as one of the health system problems. The WHO has estimated that cesarean section in recent years has been 10% in all countries. Despite the increasing popularity of cesarean section, the literature lacks insights about factors affecting the selection of this delivery method. In this vein, this study investigates the factors affecting the choice of cesarean-section from the perspective of pregnant women.
Methods: The sample of this descriptive and analytical study is 200 pregnant women selected using simple random sampling method in Kosar Hospital in Qazvin Province, Iran. The survey questionnaire was used for data collection from March to September of 2017. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure effective factor. Statistical package for social science software (SPSS) version 22 (SPSS Inc., Chicago, IL, USA) were used to analyses the data. T-test and ANOVA were used to compare groups.
Results: The results of prioritizing the items in terms of psychological factors showed that the statements “I am afraid of the pain of normal labor” and “I feel higher stress and anxiety with natural labor were the first priorities”. There was no significant difference between pregnant women who had previous experience and those who did not have a delivery experience. The results of the mean comparison test showed no significant difference between the attitudes of women with previous delivery experience and women who did not have a delivery experience. There were only differences between socio-cultural factors (P= 0.004), factors related to delivery conditions (P= 0.001), consequences of delivery (P= 0.017) among pregnant women with different levels of training.
Conclusion: The results of this study revealed that there is a difference between the attitudes of pregnant women and different levels of education, so pre-pregnancy training should be provided to pregnant women.
Methods: The sample of this descriptive and analytical study is 200 pregnant women selected using simple random sampling method in Kosar Hospital in Qazvin Province, Iran. The survey questionnaire was used for data collection from March to September of 2017. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure effective factor. Statistical package for social science software (SPSS) version 22 (SPSS Inc., Chicago, IL, USA) were used to analyses the data. T-test and ANOVA were used to compare groups.
Results: The results of prioritizing the items in terms of psychological factors showed that the statements “I am afraid of the pain of normal labor” and “I feel higher stress and anxiety with natural labor were the first priorities”. There was no significant difference between pregnant women who had previous experience and those who did not have a delivery experience. The results of the mean comparison test showed no significant difference between the attitudes of women with previous delivery experience and women who did not have a delivery experience. There were only differences between socio-cultural factors (P= 0.004), factors related to delivery conditions (P= 0.001), consequences of delivery (P= 0.017) among pregnant women with different levels of training.
Conclusion: The results of this study revealed that there is a difference between the attitudes of pregnant women and different levels of education, so pre-pregnancy training should be provided to pregnant women.
Mohsen Sheykhhasan, Hossein Bakhtiari Pak , Mohammad Bakhtiari Pak , Naser Kalhor ,
Volume 77, Issue 12 (March 2020)
Volume 77, Issue 12 (March 2020)
Abstract
Background: One of the most significant factors in the success of dental implant procedures, can be mentioned by the quality and quantity of jaw bone. The occurrence of some problems such as trauma, infection, pathological lesions and the long-term absence of teeth in patients, it causes irregularities in the jaw bone and can get bone resorption. Sever defects after trauma or tumor resection needs bone reconstruction. Sticky bone is a new biological agent that provides stabilization of bone graft in the defect, and therefore, ameliorates tissue repairing and decreases bone loss during healing period. In this study, the evaluation of sticky bone performance to reconstruction of defects in two patients jaw's bone was considered.
Case Presentation: Two patients (1 male, 1 female) with an average age of 50 years underwent surgery, due to the history of tooth extraction. They had resorption of jaw bone for implant surgery. The teeth were 11 and 37. This study was performed in Al-Mortaza's Clinic, Qom province, Iran, from May 2016 to January 2017. 10 ml of blood were taken individually and centrifuged at 1300 revolutions per minute (rpm) for 8 minutes to separate the platelet-rich fibrin. Then, platelet-rich fibrin was combined with allogeneic bone to form sticky bone. Sticky bone prepared during implant surgery, with implant inside the patient's jaw bone was used.
Conclusion: The use of sticky bone to stimulate and induce bone resorption in toothless area was associated with increased implant's success. Sticky bone due to multiple growth factors, such as TGF-β1 and VEGF, usability is an appropriate and efficiency method for stimulation of bone resorption.
Case Presentation: Two patients (1 male, 1 female) with an average age of 50 years underwent surgery, due to the history of tooth extraction. They had resorption of jaw bone for implant surgery. The teeth were 11 and 37. This study was performed in Al-Mortaza's Clinic, Qom province, Iran, from May 2016 to January 2017. 10 ml of blood were taken individually and centrifuged at 1300 revolutions per minute (rpm) for 8 minutes to separate the platelet-rich fibrin. Then, platelet-rich fibrin was combined with allogeneic bone to form sticky bone. Sticky bone prepared during implant surgery, with implant inside the patient's jaw bone was used.
Conclusion: The use of sticky bone to stimulate and induce bone resorption in toothless area was associated with increased implant's success. Sticky bone due to multiple growth factors, such as TGF-β1 and VEGF, usability is an appropriate and efficiency method for stimulation of bone resorption.
Neda Pak , Fateme Zamani, Sara Naybandi Atashi, Anese Saleh Nia,
Volume 78, Issue 6 (September 2020)
Volume 78, Issue 6 (September 2020)
Abstract
Background: Central venous catheterization is a procedure that is being performed frequently especially in critical clinical settings. In such conditions, good knowledge of the surface anatomy of venous structures is vital to avoid possible complications which could result in life-threatening situations such as bleeding and pneumothorax. Considering the difference between venous anatomy of children and adults and even among different age groups of children, and the fact that our recent knowledge of anatomy is based on studies performed on non-Iranian population, we decided to evaluate the anatomy of the intrathoracic systemic venous system in adults and children and assess the rate of catheter malposition in children.
Methods: This was a retrospective cross-sectional study performed in Dr. Shariati Hospital and Children Medical Center of Excellence, Tehran, Iran, from April 2016 to August 2019. In our study, the surface location of brachiocephalic vein (BCV) formation, the junction of superior vena cava (SVC) to right atrium and, formation of SVC were examined in 150 contrast-enhanced chest computed tomography (CT) scans in children. They were classified into three groups based on their age (neonates to three years, three to seven years, and seven to ten years). Also, 100 similar CT scans in adults were being studied. The other category which has been evaluated through 130 pediatric X-rays, was the location of the tip of the central venous catheter.
Methods: This was a retrospective cross-sectional study performed in Dr. Shariati Hospital and Children Medical Center of Excellence, Tehran, Iran, from April 2016 to August 2019. In our study, the surface location of brachiocephalic vein (BCV) formation, the junction of superior vena cava (SVC) to right atrium and, formation of SVC were examined in 150 contrast-enhanced chest computed tomography (CT) scans in children. They were classified into three groups based on their age (neonates to three years, three to seven years, and seven to ten years). Also, 100 similar CT scans in adults were being studied. The other category which has been evaluated through 130 pediatric X-rays, was the location of the tip of the central venous catheter.
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Results: The formation of BCV was mostly depicted posterior to the sternoclavicular joint in adults while in children it’s located posterior to the medial aspect of the head of clavicle. In adults, the SVC formation was at first intercostal space (ICS) in 52% and second ICS in 29%. In first group of children, SVC was commonly at the level of 2nd costal cartilage (CC), but changed to the first ICS or first CC by increasing age. In adults, junction of right atrium to SVC was at the 3rd CC then 4th CC but in the first group of children was located at the 4th CC that changed to 3rd ICS /3rd CC by increasing age. Also, the tip of central venous catheters was located in the proper position in 74.7% of cases.
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Conclusion: This study indicated the different anatomy of central veins in children and adults which could be a cause for malposed central catheter, so knowing this difference and controlling the tip of the catheter by ultrasound during catheterization could help in avoiding this malpositioning.
Hossein Khodadadi, Mohammad Taghizadeh, Firozeh Shabankareh, Keyvan Pakshir ,
Volume 78, Issue 10 (January 2021)
Volume 78, Issue 10 (January 2021)
Abstract
Background: Candida auris is a globally emerging yeast pathogen that has shown not only resistance to most anti-fungal drugs but also thermo-tolerance to temperatures higher than the mammalian’s body temperature. Although it has been only a decade since the fungus was identified, its spread of infections has been rapid and quasi-epidemics have been reported. Co-occurrences of the fungus infections in all five continents are one of the strangest aspects of this fungus. All isolates, despite slight genetic differences, belong to a common genetic ancestor. However, different clades appear to have independent evolutionary paths. We have discussed the relationship between the acquired thermal tolerance of C. auris and the environmental temperature changes with the genetic affinities of the isolates.
Methods: This basic science survey was carried out at the Shiraz University of medical sciences from July to December 2019. Phylogenetic analysis was used to compare the temperature sensitivity of C. auris and the species with which it is genetically related. The sequences of Internal transcribed spacer (ITS) region and the growth temperature ranges for C. auris and yeasts belonging to the Candida haemulonis complex as well as other environmental yeasts isolated from different geographical areas of the world were randomly selected and evaluated. Their phylogenetic relationship was investigated with the mapping of the phylogenetic tree based on ITS sequences.
Methods: This basic science survey was carried out at the Shiraz University of medical sciences from July to December 2019. Phylogenetic analysis was used to compare the temperature sensitivity of C. auris and the species with which it is genetically related. The sequences of Internal transcribed spacer (ITS) region and the growth temperature ranges for C. auris and yeasts belonging to the Candida haemulonis complex as well as other environmental yeasts isolated from different geographical areas of the world were randomly selected and evaluated. Their phylogenetic relationship was investigated with the mapping of the phylogenetic tree based on ITS sequences.
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Results: Study of temperature ranges which the fungi are capable of growing clearly shows that all species of C. auris can tolerate temperatures higher than the mammalian body temperature. Genetic distances, as well as geographic distances between species of C. auris are visible during phylogenetic studies. These results illustrate the possibility that, despite these distances, the temperature tolerance attribute for each C. auris clade was independently and under a common external pressure such as global warming.
Conclusion: The results of this study have discussed the increased incidence of emerging fungal infections due to climate changes; however the role of other contributing factors in the spread of these infections needs further investigation. |
Zohreh Dalirsani, Atessa Pakfetrat, Nasrollah Saghravanian, Negin Samiee, Samaneh Salari ,
Volume 79, Issue 1 (April 2021)
Volume 79, Issue 1 (April 2021)
Abstract
Background: Lymphoma is a malignant proliferation of lymphoid cells. External T-cell lymphoma is very rare. Lymphomas are neoplastic growth of lymphocytes caused by organisms like EBV, HIV, etc. This malignancy is classified as Hodgkin’s lymphoma and non-Hodgkin’s lymphoma. Oral lymphomas account for a small percentage of head and neck malignancies, and intraoral lymphoma is rare and mostly seen in Waldeyer's ring of immunocompromised patients.
Case presentation: A 67-year-old female was referred with a palatal wound that developed within two months. In medical history, she had a peptic ulcer since last year, and intestine lymphoma was diagnosed 4 months later. After that, her gastrointestinal lymphoma was treated with surgery and chemotherapy for 6 sessions. The oral examination revealed an endophytic ulcer with a granular surface in the left posterior part of the hard and soft palate and maxillary alveolar ridge. The lesion was under biopsy with clinical differential diagnosis of squamous cell carcinoma or metastatic lymphoma or deep fungal infection. Microscopic examination with hematoxylin and eosin (H&E) staining revealed malignant mononucleated lymphocytes and hyperchromatic, polymorphic, dysplastic cells. Also, acinic cells and muscular cells were destructed. Moreover, immunohistochemistry (IHC) analysis was positive for CD3, showing the presence of T lymphocytes. Therefore, diagnosis of metastasis of intestinal T-cell lymphoma to oral cavity was established. Because the patient had a history of intestinal lymphoma, she was referred to the oncologist for treatment. In further examinations, lung and liver metastasis were detected and the patient died on the second session of chemotherapy.
Conclusion: Malignant metastases to the oral cavity can occur in various forms, including swelling and ulcer, periodontal lesion and tooth luxation. Since, metastatic lesions in the oral cavity, could imitate the feature of inflammatory lesions, a thorough examination and taking history can be helpful in the early diagnosis and appropriate treatment planning to increase patients’ survival.
Case presentation: A 67-year-old female was referred with a palatal wound that developed within two months. In medical history, she had a peptic ulcer since last year, and intestine lymphoma was diagnosed 4 months later. After that, her gastrointestinal lymphoma was treated with surgery and chemotherapy for 6 sessions. The oral examination revealed an endophytic ulcer with a granular surface in the left posterior part of the hard and soft palate and maxillary alveolar ridge. The lesion was under biopsy with clinical differential diagnosis of squamous cell carcinoma or metastatic lymphoma or deep fungal infection. Microscopic examination with hematoxylin and eosin (H&E) staining revealed malignant mononucleated lymphocytes and hyperchromatic, polymorphic, dysplastic cells. Also, acinic cells and muscular cells were destructed. Moreover, immunohistochemistry (IHC) analysis was positive for CD3, showing the presence of T lymphocytes. Therefore, diagnosis of metastasis of intestinal T-cell lymphoma to oral cavity was established. Because the patient had a history of intestinal lymphoma, she was referred to the oncologist for treatment. In further examinations, lung and liver metastasis were detected and the patient died on the second session of chemotherapy.
Conclusion: Malignant metastases to the oral cavity can occur in various forms, including swelling and ulcer, periodontal lesion and tooth luxation. Since, metastatic lesions in the oral cavity, could imitate the feature of inflammatory lesions, a thorough examination and taking history can be helpful in the early diagnosis and appropriate treatment planning to increase patients’ survival.
Safura Pakizehkar, Samaneh Hosseinzadeh, Majid Valizadeh, Mahdi Hedayati,
Volume 79, Issue 3 (june 2021)
Volume 79, Issue 3 (june 2021)
Abstract
The presence of the antibodies against the main thyroid antigens, which include thyroid peroxidase (TPO) or microsomal antigen, thyroglobulin (Tg) as well as thyrotropin receptor or Thyroid Stimulating Hormone Receptor (TSH-R), is a hallmark and symbol of the autoimmune thyroid diseases (AITDs) as one of the most common autoimmune diseases (AD) around the world. The prevalence of the thyroid peroxidase antibodies (anti-TPO antibody) and the thyroglobulin antibodies (anti-Tg antibody) is considerably higher in patients suffering from Graves’ disease (GD) and Hashimoto's thyroiditis (HT, chronic autoimmune thyroiditis, autoimmune hypothyroidism). While the TSH receptor antibodies (TRAbs) are common in the patients suffering from GD, they are relatively rare and infrequent in HT patients. This fact may indicate that TRAbs are more specific than other antibodies. In fact, TRAbs as one of the most important autoantibodies against the different thyroid antigens, are a set of the heterogeneous group of antibodies that based on the function, fall into three categories, including TSHR-stimulating antibodies (TSAbs), TSHR-blocking antibodies (TBAbs), and the neutral antibodies (no effect on receptor). TSAbs and TBAbs result in overproduction and reduction of intracellular cAMP respectively. Therefore the induction of the relevant signaling pathways can be the cause of different clinical symptoms in the form of hyperthyroidism or hypothyroidism consecutively. The extra-thyroidal effects of TRAbs as the extra-thyroid GD manifestations, such as ophthalmopathy and dermopathy, often have an effect on the eyes as well as the skin with the relatively well-known immunological mechanisms of the antibodies functions. Hashimoto encephalopathy is an extra-thyroidal effects of anti-TPO that provokes the central nervous system. On the other hand, anti-TPO like anti-Tg can affect the reproductive organs of women and lead to infertility by an unknown mechanism. Moreover, the circulating antibodies against the thyroid antigens can also be detected in other autoimmune diseases such as rheumatoid arthritis (RA), type I diabetes (T1DM) and celiac disease (CD). In this review article, the most important types of thyroid autoantibodies, their essential immunological processes in AITD as well as the main and important clinical extra-thyroidal manifestations of them have been discussed and reviewed.
Zohreh Dalirsani, Atessa Pakfetrat, Nasrollah Saghravanian, Negin Samiee, Elahe Vazavandi,
Volume 79, Issue 8 (November 2021)
Volume 79, Issue 8 (November 2021)
Abstract
Background: Primary intraosseous squamous cell carcinoma (PIOC) of the mouth is a very rare but well-known carcinoma. It is locally invasive and its prognosis is quite poor. It may originate from the walls of an odontogenic cyst or de novo from the remnant epithelium at this region. Because the early symptoms of such malignancies are sometimes similar to those of inflammatory or periodontal diseases, early diagnosis is the most important step toward appropriate treatment.
Case Presentation: The case was a 46-year-old female with a sudden luxation of two posterior mandibular molars referred to a general dentist in May 2019. With diagnosis of periodontitis, the teeth were extracted without finding the cause of the tooth luxation. After four months, because of pain, swelling and non-healing socket of extracted teeth she referred to the department of Oral medicine in Mashhad Faculty of Dentistry. The patient was healthy with no systemic disease, drug history or familial history of cancer and no history of trauma, habits, tobacco, alcohol, and smoking. ln clinical examination, a nodular swelling with extensive ulcer and rolled borders along with hyperkeratosis and erythema on the posterior part of the right mandibular ridge was observed. The Extraoral examination revealed a tender mobile lymph node in the right submandibular region. After radiographic evaluation, with an initial diagnosis of SCC originated from the socket of extracted mandibular molars, incisional biopsy was performed, and histopathological analysis of the specimen revealed a primary intraosseous squamous cell carcinoma (grade II) and then necessary treatments (surgery, radiotherapy, chemotherapy) were performed.
Case Presentation: The case was a 46-year-old female with a sudden luxation of two posterior mandibular molars referred to a general dentist in May 2019. With diagnosis of periodontitis, the teeth were extracted without finding the cause of the tooth luxation. After four months, because of pain, swelling and non-healing socket of extracted teeth she referred to the department of Oral medicine in Mashhad Faculty of Dentistry. The patient was healthy with no systemic disease, drug history or familial history of cancer and no history of trauma, habits, tobacco, alcohol, and smoking. ln clinical examination, a nodular swelling with extensive ulcer and rolled borders along with hyperkeratosis and erythema on the posterior part of the right mandibular ridge was observed. The Extraoral examination revealed a tender mobile lymph node in the right submandibular region. After radiographic evaluation, with an initial diagnosis of SCC originated from the socket of extracted mandibular molars, incisional biopsy was performed, and histopathological analysis of the specimen revealed a primary intraosseous squamous cell carcinoma (grade II) and then necessary treatments (surgery, radiotherapy, chemotherapy) were performed.
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Conclusion: Dentists should know that any sudden changes in the mouth or teeth such as tooth luxation should be considered as a possible sign of malignancy. With proper diagnosis and early initiation of treatment, the prognosis of the disease can be improved and the patient can be treated with minimal complications of necessary treatments of surgery, radiotherapy, or chemotherapy.
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Samaneh Hosseinzadeh, Safura Pakizehkar,
Volume 79, Issue 11 (February 2022)
Volume 79, Issue 11 (February 2022)
Abstract
Medullary thyroid cancer accounts for 5-10% of thyroid carcinomas. RET proto-oncogene mutations occur in all of the hereditary MTCs and about 66% of the sporadic MTCs. So, the detection of the RET mutations is necessary for rapid and proper diagnosis and treatment. This systematic review seeks to find a comprehensive list of RET gene mutations in the diagnosis of medullary thyroid cancer.
The previous studies on RET proto-oncogene mutations in the diagnosis of medullary thyroid cancer were searched in the major databases including PubMed, Scopus, Medline, Embase and NCBI between 2010 and 2021.
Missense mutations in exons 10, 11, 13, 14, 15, and 16 of the RET proto-oncogene have the highest frequency in MTCs. The most common mutations in FMTC, are in codons 609, 611, 618, and 620 in exon 10, codon 768 in exon 13, codon 804 in exon 14, and codon 634 in exon 11. In the case of MEN2A, RET gene mutations have been observed in exons 5, 8, 10, 11, with the highest mutations in exons 10 (codons 609, 611, 618, and 620) and exon 11 (codons 630 and 634). Moreover, M918T mutation in exon 16 and A883F mutation in exon 15 have been detected in 95% and 5% of the patients with MEN2B respectively. In the case of MTC, the M918T mutation in exon 16 is the most common mutation, which is associated with a poor prognosis. RET genetic screening is crucial for an exact approach to the diagnosis and treatment of MTC. Anyone with MTC, even without a family history of MEN2, should be genetically tested for the RET mutations to confirm or rule out the inherited disease and, if necessary, preventive thyroidectomy. This systematic review provided a comprehensive list of the reported mutations in the RET gene for the diagnosis of medullary thyroid cancer.
Samaneh Salari, Atessa Pakfetrat, Nooshin Mohtasham, Farzaneh Khosravi, Mahdi Saeedi ,
Volume 81, Issue 2 (May 2023)
Volume 81, Issue 2 (May 2023)
Abstract
Background: Jawbone involvement and destructive bone lesions in the mandible and maxilla are reported in 30% of patients with multiple myeloma. In general, plasma cell neoplasia rarely occurs in the maxillofacial area, and an incidence of 2.6-3.3 per 100,000 people is reported for solitary plasmacytoma in jawbones. This study aims to present and evaluate a patient with multiple myeloma and the first symptoms in the maxillofacial area.
Case Presentation: The patient was a 52 years old woman complaining of painful swelling in the left area of the face that had enlarged during the last month. She was referred to the maxillofacial disease department of the Dental School of Mashhad, Iran in Feb 2022. The patient has had paresthesia in the left area of the face since 6 months ago. In the extra-oral examination, a 4×10 cm mass was observed in the left mandibular angle extending anteriorly toward the sublingual area. The oral mucosa was normal. According to the clinical profile, malignancy was considered a differential diagnosis. Incisional biopsy of the lesion revealed the proliferation of neoplastic plasma cells. The positive result of immunohistochemistry (IHC) staining for CD138, performed on the specimen to confirm plasmacytoma and detection of small primary lytic lesions in the skull and spine confirmed multiple myeloma. The usual symptoms of multiple myeloma, including low back pain, were not observed. The patient underwent chemotherapy under the supervision of a hematologist.
Case Presentation: The patient was a 52 years old woman complaining of painful swelling in the left area of the face that had enlarged during the last month. She was referred to the maxillofacial disease department of the Dental School of Mashhad, Iran in Feb 2022. The patient has had paresthesia in the left area of the face since 6 months ago. In the extra-oral examination, a 4×10 cm mass was observed in the left mandibular angle extending anteriorly toward the sublingual area. The oral mucosa was normal. According to the clinical profile, malignancy was considered a differential diagnosis. Incisional biopsy of the lesion revealed the proliferation of neoplastic plasma cells. The positive result of immunohistochemistry (IHC) staining for CD138, performed on the specimen to confirm plasmacytoma and detection of small primary lytic lesions in the skull and spine confirmed multiple myeloma. The usual symptoms of multiple myeloma, including low back pain, were not observed. The patient underwent chemotherapy under the supervision of a hematologist.
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Conclusion: Jawbone involvement is often less mentioned as the first symptom of multiple myeloma; however, compared to the vertebral column or skull lesions, these areas are easily biopsied, providing the possibility of early detection and treatment of multiple myeloma, hence a promising disease prognosis. The concurrence of destructive bone lesions and sensory changes in the maxillofacial area is a red flag. Precise radiographic evaluation and blood tests can help early detect multiple myeloma. Awareness of general dentists about the possibility of blood dyscrasia such as multiple myeloma with such early symptoms in patients can lead to early diagnosis of patients. This report reminds inexperienced clinicians of the special importance of sensory changes in the head and neck.
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Seyedeh Fatemeh Hosseini Nejad , Mahshid Vaziri, Ahmad Reza Mohtadi, Elham Kargar Zadeh , Mohammad Pakzadi,
Volume 82, Issue 3 (June 2024)
Volume 82, Issue 3 (June 2024)
Abstract
Background: Postoperative nausea and vomiting (PONV) is a common challenge in cesarean surgeries, on the other hand, the use of dexamethasone has been proposed as an effective prophylaxis in the management of these complications. This study evaluated the effect of dexamethasone in reducing PONV.
Methods: This study was conducted as a randomized and double-blind clinical trial from April 2022 to September 2023 at Razi Hospital of Jundishapur University of Medical Sciences, Ahvaz. Elective cesarean section patients under spinal anesthesia were divided into two groups of 30 people. In this research, there were two groups: a group that received 0.1 mg/kg dexamethasone (Iran company) and a placebo group that received normal saline. The injections were done before the start of anesthesia, and both groups had received 500 cc of normal saline serum before drug injection. During the surgery and after that at specific time intervals, parameters such as blood pressure, heart rate, and the occurrence of nausea and vomiting were recorded through the V&N scoring table and shivering through the shivering scoring table. Recorded 1/2/4/6/12 after surgery.
Methods: This study was conducted as a randomized and double-blind clinical trial from April 2022 to September 2023 at Razi Hospital of Jundishapur University of Medical Sciences, Ahvaz. Elective cesarean section patients under spinal anesthesia were divided into two groups of 30 people. In this research, there were two groups: a group that received 0.1 mg/kg dexamethasone (Iran company) and a placebo group that received normal saline. The injections were done before the start of anesthesia, and both groups had received 500 cc of normal saline serum before drug injection. During the surgery and after that at specific time intervals, parameters such as blood pressure, heart rate, and the occurrence of nausea and vomiting were recorded through the V&N scoring table and shivering through the shivering scoring table. Recorded 1/2/4/6/12 after surgery.
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Results: In this study the investigated variable is postoperative nausea and vomiting (PONV), since the investigated variable is a qualitative/nominal variable, to calculate the sample size from the formula P1- P2 ∕√P(1-P) used. The significance level of the tests is considered to be less than 0.05 and data analysis was done with SPSS type 23 software. Although no significant difference was observed between dexamethasone and placebo in the first hour after the operation, in the following hours, dexamethasone significantly reduced nausea and vomiting, on the other hand, heart rate and blood pressure decreased faster in the groups receiving dexamethasone.
Conclusion: Dexamethasone is significantly effective in reducing nausea and vomiting after cesarean surgery. It also has a positive role in reducing the heart rate and blood pressure and This drug is particularly effective in controlling complications after spinal anesthesia after the operation. |
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