Iranian Red Crescent Medical Journal Iranian Red Crescent Medical Journal Iran Red Crescent Med J http://www.ircmj.com 2074-1804 2074-1812 10.5812/ircmj en jalali 2017 6 28 gregorian 2017 6 28 16 12
en 25763241 10.5812/ircmj.18852 Coenzyme Q10 Administration in Community-Acquired Pneumonia in the Elderly Coenzyme Q<sub>10</sub> Administration in Community-Acquired Pneumonia in the Elderly research-article research-article Background

Community-acquired pneumonia (CAP) is generally considered a major cause of morbidity and mortality in the elderly.

Objectives

This study aimed to assess the efficacy of adjunctive coenzyme Q10 (CoQ10) in the treatment of elderly CAP.

Conclusions

CoQ10 administration has no serious side effects and can improve outcome in hospitalized elderly CAP; therefore, we recommend it as an adjunctive treatment in elderly patients.

Results

We enrolled 150 patients for this research. Then, 141 patients, including 70 patients in the trial group and 71 patients in the control group were analyzed. Mean age of the trial and control groups were 67.6 ± 7.2 years and 68.7 ± 7.9 years, respectively. Clinical cure at days 3 and 7 were 24 (34.3%) and 62 (88.6%) in the trial group (P value = 0.6745) and 22 (31%) and 52 (73.2%) in the placebo group (P value = 0.0209). Patients on CoQ10 had faster defervescence (P value = 0.0206) and shorter hospital stay (P value = 0.0144) compared with the placebo group. The subgroup analysis of the patients with severe pneumonia showed differences in clinical cure at day 14. Treatment failure was less in CoQ10 group than in the placebo group (10% versus 22.5% and P value = 0.0440). Adverse events in two groups were few and similar.

Patients and Methods

Hospitalized elderly patients with CAP (diagnosed by using defined clinical and radiological criteria) were randomized to receive oral CoQ10 (200 mg/d) or placebo for 14 days, along with antibiotics. Primary and secondary outcomes on days 3, 7, and 14 were measured. Disease severity was scored using CURB-65 index. Statistical analysis was performed using SPSS and P value < 0.05 was considered significant.

Background

Community-acquired pneumonia (CAP) is generally considered a major cause of morbidity and mortality in the elderly.

Objectives

This study aimed to assess the efficacy of adjunctive coenzyme Q10 (CoQ10) in the treatment of elderly CAP.

Conclusions

CoQ10 administration has no serious side effects and can improve outcome in hospitalized elderly CAP; therefore, we recommend it as an adjunctive treatment in elderly patients.

Results

We enrolled 150 patients for this research. Then, 141 patients, including 70 patients in the trial group and 71 patients in the control group were analyzed. Mean age of the trial and control groups were 67.6 ± 7.2 years and 68.7 ± 7.9 years, respectively. Clinical cure at days 3 and 7 were 24 (34.3%) and 62 (88.6%) in the trial group (P value = 0.6745) and 22 (31%) and 52 (73.2%) in the placebo group (P value = 0.0209). Patients on CoQ10 had faster defervescence (P value = 0.0206) and shorter hospital stay (P value = 0.0144) compared with the placebo group. The subgroup analysis of the patients with severe pneumonia showed differences in clinical cure at day 14. Treatment failure was less in CoQ10 group than in the placebo group (10% versus 22.5% and P value = 0.0440). Adverse events in two groups were few and similar.

Patients and Methods

Hospitalized elderly patients with CAP (diagnosed by using defined clinical and radiological criteria) were randomized to receive oral CoQ10 (200 mg/d) or placebo for 14 days, along with antibiotics. Primary and secondary outcomes on days 3, 7, and 14 were measured. Disease severity was scored using CURB-65 index. Statistical analysis was performed using SPSS and P value < 0.05 was considered significant.

Coenzyme Q10;Elderly;Pneumonia Coenzyme Q10;Elderly;Pneumonia http://www.ircmj.com/index.php?page=article&article_id=18852 Aliasghar Farazi Aliasghar Farazi Tuberculosis and Pediatric Infectious Research Center, Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran; Tuberculosis and Pediatric Infectious Research Center, Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran. Tel/Fax: +98-8632241411 Tuberculosis and Pediatric Infectious Research Center, Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran; Tuberculosis and Pediatric Infectious Research Center, Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran. Tel/Fax: +98-8632241411 Masoomeh Sofian Masoomeh Sofian Tuberculosis and Pediatric Infectious Research Center, Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran Tuberculosis and Pediatric Infectious Research Center, Department of Infectious Disease, School of Medicine, Arak University of Medical Sciences, Arak, IR Iran Mansoureh Jabbariasl Mansoureh Jabbariasl Department of Disease Control and Prevention, Health Center of Markazi Province, Arak, IR Iran Department of Disease Control and Prevention, Health Center of Markazi Province, Arak, IR Iran Banafshe Nayebzadeh Banafshe Nayebzadeh School of Medicine, Arak University of Medical Sciences, Arak, IR Iran School of Medicine, Arak University of Medical Sciences, Arak, IR Iran
en 25763230 10.5812/ircmj.14612 The Attitude-Behavior Discrepancy in Medical Decision Making The Attitude-Behavior Discrepancy in Medical Decision Making research-article research-article Background

In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions.

Objectives

This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description.

Patients and Methods

A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behaviorattitude to risky planattitude to conservative plan (3).

Results

A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P < 0.01) yet if the survival rate was described, there was no such preference (t = -1.48, P > 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P < .05). Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P < 0.01;t attitude to surgery = 4.08,P < 0.01;t attitude to radiation = -2.15,P < 0.05).

Conclusions

A discrepancy of attitude-behavior does exist in medical situations. The framing of a description has an impact on medical decision-making.

Background

In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions.

Objectives

This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description.

Patients and Methods

A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behaviorattitude to risky planattitude to conservative plan (3).

Results

A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P < 0.01) yet if the survival rate was described, there was no such preference (t = -1.48, P > 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P < .05). Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P < 0.01;t attitude to surgery = 4.08,P < 0.01;t attitude to radiation = -2.15,P < 0.05).

Conclusions

A discrepancy of attitude-behavior does exist in medical situations. The framing of a description has an impact on medical decision-making.

Attitude;Behavior;Patient Attitude;Behavior;Patient http://www.ircmj.com/index.php?page=article&article_id=14612 Fei He Fei He School of Public Management, Northwest University, Xian, China; School of Public Management, Northwest University, Xian, China. Tel: +86-2976397654, Fax: +86-2984664724 School of Public Management, Northwest University, Xian, China; School of Public Management, Northwest University, Xian, China. Tel: +86-2976397654, Fax: +86-2984664724 Dongdong Li Dongdong Li Brigade of Cadets, Fourth Military Medical University, Xian, China Brigade of Cadets, Fourth Military Medical University, Xian, China Rong Cao Rong Cao School of Public Management, Northwest University, Xian, China School of Public Management, Northwest University, Xian, China Juli Zeng Juli Zeng Department of Psychology, Officer’s College of the Chinese People's Armed Police Force, Langfang, China Department of Psychology, Officer’s College of the Chinese People's Armed Police Force, Langfang, China Hao Guan Hao Guan Department of Burns and Cutaneous Surgery, Xijing Hospital, Forth Military Medical University, Xian, China Department of Burns and Cutaneous Surgery, Xijing Hospital, Forth Military Medical University, Xian, China
en 25763249 10.5812/ircmj.6577 The Association Between Hyperlipidemia and Periodontal Infection The Association Between Hyperlipidemia and Periodontal Infection research-article research-article Background

Periodontitis is a local chronic inflammatory condition of the supporting structures of the teeth resulting from a dental plaque biofilm attached to teeth surfaces. Recent studies have indicated that this oral disease may have effects on systemic health.

Objectives

The aim of the present study was to evaluate the association between periodontitis and hyperlipidemia.

Patients and Methods

This case-control study was conducted in Iran during March 2011. In this case-control study, levels of serum lipids in 45 subjects with periodontitis were measured and compared with 45 age, gender and body mass index (BMI) matched controls. Data were analyzed using student t-test and chi-square test with P < 0.05 as the limit of significance.

Results

Mean values of total cholesterol (CHL) (periodontitis group = 218.11 ± 29.77, control group = 162.31 ± 48.24) and triglycerides (TG) (periodontitis group = 209.77 ± 44.30, control group = 125.60 ± 44.16) were significantly higher in the periodontitis group (P < 0.001). High-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels were higher in the case group, but this difference was not statistically significant. Frequency of pathological values of CHL and TG were significantly higher in cases compared with the controls (P = 0.002 and P = 0.015, respectively).

Conclusions

This study indicates that hyperlipidemia may be associated with periodontal disease in healthy individuals; yet whether periodontitis causes an increase in levels of plasma lipids or whether hyperlipidemia is a risk factor for periodontal infection and cardiovascular disease, it needs further investigations.

Background

Periodontitis is a local chronic inflammatory condition of the supporting structures of the teeth resulting from a dental plaque biofilm attached to teeth surfaces. Recent studies have indicated that this oral disease may have effects on systemic health.

Objectives

The aim of the present study was to evaluate the association between periodontitis and hyperlipidemia.

Patients and Methods

This case-control study was conducted in Iran during March 2011. In this case-control study, levels of serum lipids in 45 subjects with periodontitis were measured and compared with 45 age, gender and body mass index (BMI) matched controls. Data were analyzed using student t-test and chi-square test with P < 0.05 as the limit of significance.

Results

Mean values of total cholesterol (CHL) (periodontitis group = 218.11 ± 29.77, control group = 162.31 ± 48.24) and triglycerides (TG) (periodontitis group = 209.77 ± 44.30, control group = 125.60 ± 44.16) were significantly higher in the periodontitis group (P < 0.001). High-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol levels were higher in the case group, but this difference was not statistically significant. Frequency of pathological values of CHL and TG were significantly higher in cases compared with the controls (P = 0.002 and P = 0.015, respectively).

Conclusions

This study indicates that hyperlipidemia may be associated with periodontal disease in healthy individuals; yet whether periodontitis causes an increase in levels of plasma lipids or whether hyperlipidemia is a risk factor for periodontal infection and cardiovascular disease, it needs further investigations.

Chronic Periodontitis;Hyperlipidemia;Cholesterol;Triglycerides Chronic Periodontitis;Hyperlipidemia;Cholesterol;Triglycerides http://www.ircmj.com/index.php?page=article&article_id=6577 Leila Golpasand Hagh Leila Golpasand Hagh Department of Periodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Department of Periodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Faramarz Zakavi Faramarz Zakavi Department of Operative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Department of Operative Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran Fatemeh Hajizadeh Fatemeh Hajizadeh Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran; Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Golestan St., 6135715775, Ahvaz, IR Iran. Tel: +98-9166317753, Fax: +98-6133730142 Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR Iran; Department of Orthodontics, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Golestan St., 6135715775, Ahvaz, IR Iran. Tel: +98-9166317753, Fax: +98-6133730142 Morteza Saleki Morteza Saleki Department of Pediatric Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Arvand Branch, Ahvaz, IR Iran Department of Pediatric Dentistry, School of Dentistry, Ahvaz Jundishapur University of Medical Sciences, Arvand Branch, Ahvaz, IR Iran
en 25763243 10.5812/ircmj.21484 Association Between Upstream Purine Complexes of Human Caveolin-1 Gene and Schizophrenia in Qazvin Province of Iran Association Between Upstream Purine Complexes of Human Caveolin-1 Gene and Schizophrenia in Qazvin Province of Iran research-article research-article Results

We detected nine homozygotes in patients and 15 in control subjects. Homozygosity was 7.08% and 11.8% in cases and control, respectively. Nine types homozygote haplotype were detected in upper region of the CAV1 gene in cases and controls. Three haplotypes were common in cases and controls; four haplotypes were seen in controls only and two in cases.

Conclusions

Our findings implied a significant correlation between some haplotypes of upper region of CAV1 gene and schizophrenia. Existence of some haplotypes and lack of another in CAV1 upstream can suggest a significant correlation between schizophrenia and some haplotypes.

Patients and Methods

In a case-control study, 254 blood samples were obtained from 127 patients with schizophrenia and 127 well matched controls referred to 22 Bahman Hospital of Qazvin University of Medical Sciences (QUMS) in Qazvin province, Iran, using simple random sampling method. After extracting DNA, the upper region of the human CAV1- gene was amplified by PCR in all collected samples. The products were visualized by silver staining in 10% polyacrylamide gel and then sequenced.

Background

Caveolin is a multifunctional and scaffolding membrane protein, which involves cholesterol trafficking to plasma lipid microdomain. It organizes and targets synaptic parts of the neurotransmitter and neurotrophic receptor signaling pathways. Caveolins are encoded by CAV-1, 2 and 3 genes. Disruption of the CAV1 would likely ruin the neuronal signaling, which leads to symptoms of schizophrenia in predisposed individuals.

Objectives

The upper area of CAV-1 gene is highly conserved and can have a regulatory role in neurodegenerative diseases. This study was designed to find out the possible association of polymorphisms of this area and schizophrenia.

Results

We detected nine homozygotes in patients and 15 in control subjects. Homozygosity was 7.08% and 11.8% in cases and control, respectively. Nine types homozygote haplotype were detected in upper region of the CAV1 gene in cases and controls. Three haplotypes were common in cases and controls; four haplotypes were seen in controls only and two in cases.

Conclusions

Our findings implied a significant correlation between some haplotypes of upper region of CAV1 gene and schizophrenia. Existence of some haplotypes and lack of another in CAV1 upstream can suggest a significant correlation between schizophrenia and some haplotypes.

Patients and Methods

In a case-control study, 254 blood samples were obtained from 127 patients with schizophrenia and 127 well matched controls referred to 22 Bahman Hospital of Qazvin University of Medical Sciences (QUMS) in Qazvin province, Iran, using simple random sampling method. After extracting DNA, the upper region of the human CAV1- gene was amplified by PCR in all collected samples. The products were visualized by silver staining in 10% polyacrylamide gel and then sequenced.

Background

Caveolin is a multifunctional and scaffolding membrane protein, which involves cholesterol trafficking to plasma lipid microdomain. It organizes and targets synaptic parts of the neurotransmitter and neurotrophic receptor signaling pathways. Caveolins are encoded by CAV-1, 2 and 3 genes. Disruption of the CAV1 would likely ruin the neuronal signaling, which leads to symptoms of schizophrenia in predisposed individuals.

Objectives

The upper area of CAV-1 gene is highly conserved and can have a regulatory role in neurodegenerative diseases. This study was designed to find out the possible association of polymorphisms of this area and schizophrenia.

Caveolin-1;Schizophrenia;Iran Caveolin-1;Schizophrenia;Iran http://www.ircmj.com/index.php?page=article&article_id=21484 Reza Najafipour Reza Najafipour Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Abolfazl Heidari Abolfazl Heidari Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Safar Ali Alizadeh Safar Ali Alizadeh Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Hannaneh Ghafelebashi Hannaneh Ghafelebashi Tarbiat Modarres University, Tehran, IR Iran Tarbiat Modarres University, Tehran, IR Iran Zahra Rashvand Zahra Rashvand Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Cellular and Molecular Research Center, Qazvin University of Medical Sciences, Qazvin, IR Iran Amir Javadi Amir Javadi School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, IR Iran School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, IR Iran Mohammad Moradi Mohammad Moradi Qazvin University of Medical Sciences, Qazvin, IR Iran Qazvin University of Medical Sciences, Qazvin, IR Iran Hosein Afshar Hosein Afshar Qazvin University of Medical Sciences, Qazvin, IR Iran; Qazvin University of Medical Sciences, Qazvin, IR Iran. Tel: +98-2833362959, +98-9121812000, Fax: +98-2833362960 Qazvin University of Medical Sciences, Qazvin, IR Iran; Qazvin University of Medical Sciences, Qazvin, IR Iran. Tel: +98-2833362959, +98-9121812000, Fax: +98-2833362960
en 25763242 10.5812/ircmj.19500 New Therapy Using Omega-3-Acid Ethyl Esters for Decubitus Ulcers and Stasis Dermatitis: A Case Report New Therapy Using Omega-3-Acid Ethyl Esters for Decubitus Ulcers and Stasis Dermatitis: A Case Report case-report case-report Conclusions

This report is the first to document other treatment possibilities for pressure ulcer and/or stasis dermatitis in cases where the use of topical applied ointments and medications is difficult. This new therapy may therefore help physicians to treat pressure ulcers and stasis dermatitis.

Case Presentation

Case 1: A 21-year-old Japanese female with lower-body paralysis. Pressure ulcers appeared on the heel and first toe of her left lower extremity. Although the patient had been treated with various ointments such as dimethyl isopropylazulene and 0.9% iodine-containing ointment, the course showed no improvement, so omega-3-acid ethyl esters was administered orally, completely healing the ulcer of the first toe in 10 weeks. Case 2: A 76-year-old Japanese male. The patient had been treated on an outpatient basis for 15 years due to hypertension, heart failure, type 2 diabetes mellitus, and hyperlipidemia. Two years prior to this presentation, stasis dermatitis occurred in the lower limbs and at the end of last year, erosive ulcers appeared on the front part of the lower-right thigh and shin. Although treatment with various topical ointment and dressings was performed, the course showed no improvement. Oral administration of omega-3-acid ethyl esters was initiated. At 12 weeks, his condition entered the white phase and healed almost completely.

Introduction

In daily practice, it is common to experience difficulty in treating decubitus ulcers (pressure ulcers, also known as decubitus ulcers) and stasis dermatitis of the lower limbs. We hereby report that omega-3-acid ethyl esters were remarkably effective when administered to cases of refractory pressure ulcers and stasis dermatitis for the purpose of improving the blood flow and promoting blood circulation.

Conclusions

This report is the first to document other treatment possibilities for pressure ulcer and/or stasis dermatitis in cases where the use of topical applied ointments and medications is difficult. This new therapy may therefore help physicians to treat pressure ulcers and stasis dermatitis.

Case Presentation

Case 1: A 21-year-old Japanese female with lower-body paralysis. Pressure ulcers appeared on the heel and first toe of her left lower extremity. Although the patient had been treated with various ointments such as dimethyl isopropylazulene and 0.9% iodine-containing ointment, the course showed no improvement, so omega-3-acid ethyl esters was administered orally, completely healing the ulcer of the first toe in 10 weeks. Case 2: A 76-year-old Japanese male. The patient had been treated on an outpatient basis for 15 years due to hypertension, heart failure, type 2 diabetes mellitus, and hyperlipidemia. Two years prior to this presentation, stasis dermatitis occurred in the lower limbs and at the end of last year, erosive ulcers appeared on the front part of the lower-right thigh and shin. Although treatment with various topical ointment and dressings was performed, the course showed no improvement. Oral administration of omega-3-acid ethyl esters was initiated. At 12 weeks, his condition entered the white phase and healed almost completely.

Introduction

In daily practice, it is common to experience difficulty in treating decubitus ulcers (pressure ulcers, also known as decubitus ulcers) and stasis dermatitis of the lower limbs. We hereby report that omega-3-acid ethyl esters were remarkably effective when administered to cases of refractory pressure ulcers and stasis dermatitis for the purpose of improving the blood flow and promoting blood circulation.

Omega-3 Fatty Acids;Ethyl-Eicosapentaenoic Acid;Docosahexaenoic Acid Ethyl Ester;Pressure Ulcers Omega-3 Fatty Acids;Ethyl-Eicosapentaenoic Acid;Docosahexaenoic Acid Ethyl Ester;Pressure Ulcers http://www.ircmj.com/index.php?page=article&article_id=19500 Kazuki Nagai Kazuki Nagai Department of Internal Medicine, Nagai Clinic, Yokohama, Japan; Department of Internal Medicine, Nagai Clinic, P. O. Box: 2350045, Yokohama, Japan. Tel/Fax: +81-458325830 Department of Internal Medicine, Nagai Clinic, Yokohama, Japan; Department of Internal Medicine, Nagai Clinic, P. O. Box: 2350045, Yokohama, Japan. Tel/Fax: +81-458325830 Katsuhiko Matsumaru Katsuhiko Matsumaru Department of Internal Medicine, Nagai Clinic, Yokohama, Japan Department of Internal Medicine, Nagai Clinic, Yokohama, Japan Ikuko Hirai Ikuko Hirai Department of Dermatology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan Department of Dermatology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan Yujiro Takae Yujiro Takae Department of Dermatology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan Department of Dermatology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan Kazuo Andoh Kazuo Andoh Department of Radiology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan Department of Radiology, Saiseikai Yokohama-shi Nanbu Hospital, Yokohama, Japan
en 25763244 10.5812/ircmj.22489 Longstanding Hypoparathyroidism in a Fifty-Two-Year-Old Woman Misdiagnosed as Spondyloarthropathy Longstanding Hypoparathyroidism in a Fifty-Two-Year-Old Woman Misdiagnosed as Spondyloarthropathy case-report case-report Introduction

Hypoparathyroidism might cause various musculoskeletal findings, resembling Spondyloarthropathies.

Case Presentation

We described a 52-year-old woman, diagnosed as a case of undifferentiated spondyloarthropathy for ten years, who was unresponsive to classic anti-inflammatory therapies. She developed anterior ischemic optic neuropathy and had elevated muscle enzymes during the course of disease. On a routine checkup, marked hypocalcemia and suppressed parathyroid hormone levels were found. Calcium and calcitriol therapy led to clinical and laboratory improvement.

Conclusions

This case emphasizes the importance of recognizing rheumatic manifestations of hypoparathyroidism to preclude unnecessary treatments. Serum calcium should be included in the diagnostic workup of these patients.

Introduction

Hypoparathyroidism might cause various musculoskeletal findings, resembling Spondyloarthropathies.

Case Presentation

We described a 52-year-old woman, diagnosed as a case of undifferentiated spondyloarthropathy for ten years, who was unresponsive to classic anti-inflammatory therapies. She developed anterior ischemic optic neuropathy and had elevated muscle enzymes during the course of disease. On a routine checkup, marked hypocalcemia and suppressed parathyroid hormone levels were found. Calcium and calcitriol therapy led to clinical and laboratory improvement.

Conclusions

This case emphasizes the importance of recognizing rheumatic manifestations of hypoparathyroidism to preclude unnecessary treatments. Serum calcium should be included in the diagnostic workup of these patients.

Hypoparathyroidism;Anterior Ischemic Optic Neuropathy;Spondyloarthropathy Hypoparathyroidism;Anterior Ischemic Optic Neuropathy;Spondyloarthropathy http://www.ircmj.com/index.php?page=article&article_id=22489 Mozhdeh Zabihiyeganeh Mozhdeh Zabihiyeganeh Firouzgar General Hospital, Iran University of Medical Sciences, Tehran, IR Iran Firouzgar General Hospital, Iran University of Medical Sciences, Tehran, IR Iran Seyed Adel Jahed Seyed Adel Jahed Booali General Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran; Booali General Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran. Tel: +98-2122770651, Fax: +98-2122770699 Booali General Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran; Booali General Hospital, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, IR Iran. Tel: +98-2122770651, Fax: +98-2122770699 Hounaz Akbari Hounaz Akbari Firouzgar General Hospital, Iran University of Medical Sciences, Tehran, IR Iran Firouzgar General Hospital, Iran University of Medical Sciences, Tehran, IR Iran
en 25763245 10.5812/ircmj.24551 Comparison of Bypassing Agents in Bleeding Reduction in Treatment of Bleeding Episodes in Patients With Haemophilia and Inhibitors Comparison of Bypassing Agents in Bleeding Reduction in Treatment of Bleeding Episodes in Patients With Haemophilia and Inhibitors review-article review-article Conclusions

Although differences between the two products were very close to each other, they reported similar effects on joint bleeds. Further clinical studies should be performed by incorporating a standardized measurement in comparative efficacy of aPCC and rFVIIa.

Results

The mean of bleeding reduction in aPCC and rFVIIa were 71.2% with CI 95% (lower limit 86.8% and upper limit 82%) and 72.3% with CI 95% (lower limit 57.6% and upper limit 83.4%), respectively.

Context

Mild-to-moderate bleeding disorders in haemophilia are primarily treated via recombinant activated factor VII a (rFVIIa) or activated prothrombin complex concentrate (aPCC). However, the efficacy of each bypassing agents may vary and none of them is universally effective.

Evidence Acquisition

After reviewing the databases of PubMed, Scopus, MD Consult, Ovid, Trip database, Google Scholar, ProQuest and the Cochrane Library, finally, 17 papers published from 2000 to 2013 were extracted. We used as a random effect model in meta-analysis. Comprehensive meta-analysis (CMA) software was used for calculating and estimating the mean of bleeding reduction and performing meta-analysis.

Conclusions

Although differences between the two products were very close to each other, they reported similar effects on joint bleeds. Further clinical studies should be performed by incorporating a standardized measurement in comparative efficacy of aPCC and rFVIIa.

Results

The mean of bleeding reduction in aPCC and rFVIIa were 71.2% with CI 95% (lower limit 86.8% and upper limit 82%) and 72.3% with CI 95% (lower limit 57.6% and upper limit 83.4%), respectively.

Context

Mild-to-moderate bleeding disorders in haemophilia are primarily treated via recombinant activated factor VII a (rFVIIa) or activated prothrombin complex concentrate (aPCC). However, the efficacy of each bypassing agents may vary and none of them is universally effective.

Evidence Acquisition

After reviewing the databases of PubMed, Scopus, MD Consult, Ovid, Trip database, Google Scholar, ProQuest and the Cochrane Library, finally, 17 papers published from 2000 to 2013 were extracted. We used as a random effect model in meta-analysis. Comprehensive meta-analysis (CMA) software was used for calculating and estimating the mean of bleeding reduction and performing meta-analysis.

Haemophilia;Meta-Analysis;Bleeding Haemophilia;Meta-Analysis;Bleeding http://www.ircmj.com/index.php?page=article&article_id=24551 Mina Golestani Mina Golestani School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125160488, Fax: +98-4133351048 School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran; School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-9125160488, Fax: +98-4133351048 Peyman Eshghi Peyman Eshghi Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Pediatric Congenital Hematologic Disorders Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Hamid Reza Rasekh Hamid Reza Rasekh School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Abdol Majid Cheraghali Abdol Majid Cheraghali School of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, IR Iran School of Pharmacy, Baqiyatallah University of Medical Sciences, Tehran, IR Iran Jamshid Salamzadeh Jamshid Salamzadeh School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran Ali Imani Ali Imani Iranian Center of Excellence in Health Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IR Iran Iranian Center of Excellence in Health Management, Faculty of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IR Iran
en 25763252 10.5812/ircmj.9507 Malignant Priapism Due to Renal Cancer: A Case Report of First Manifestation of Systemic Spread Malignant Priapism Due to Renal Cancer: A Case Report of First Manifestation of Systemic Spread case-report case-report Introduction

Malignant priapism due to cancers is a rare condition that only 30 cases of kidney cancers were reported.

Case Presentation

We report on the first case of simultaneous penile, renal vein, vena cava, liver and ipslateral adrenal gland metastases from primary renal cancer in a 56-year-old man. The only complain of the patient was a history of painful priapism for one month. Corporoglanular shunt surgery was useless. Postoperative imaging showed extensive regional and distal metastases and tumor embolus in vena cava as well as renal and hepatic vein.

Conclusions

Review of literature showed priapism being the first presentation in 20% to 50% of cases, almost all cases have shown very poor prognosis. This case report underscored the importance of investigation of primary tumors for patients with malignant priapism.

Introduction

Malignant priapism due to cancers is a rare condition that only 30 cases of kidney cancers were reported.

Case Presentation

We report on the first case of simultaneous penile, renal vein, vena cava, liver and ipslateral adrenal gland metastases from primary renal cancer in a 56-year-old man. The only complain of the patient was a history of painful priapism for one month. Corporoglanular shunt surgery was useless. Postoperative imaging showed extensive regional and distal metastases and tumor embolus in vena cava as well as renal and hepatic vein.

Conclusions

Review of literature showed priapism being the first presentation in 20% to 50% of cases, almost all cases have shown very poor prognosis. This case report underscored the importance of investigation of primary tumors for patients with malignant priapism.

Priapism;Metastasis;Renal Cancer Priapism;Metastasis;Renal Cancer http://www.ircmj.com/index.php?page=article&article_id=9507 Jin Zhu Jin Zhu Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Boxin Xue Boxin Xue Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Dongrong Yang Dongrong Yang Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Yachen Zang Yachen Zang Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China Yuxi Shan Yuxi Shan Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China; Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China. Tel: +86-51267784136, Fax: +86-51267784136 Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China; Department of Urology, the Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China. Tel: +86-51267784136, Fax: +86-51267784136
en 25763227 10.5812/ircmj.10477 Initial Presentation of HIV Infection With Two Successive Acute Arterial Thromboses: A Case Report Initial Presentation of HIV Infection With Two Successive Acute Arterial Thromboses: A Case Report case-report case-report Conclusions

This case inspires consideration of HIV infection as a leading cause of thromboembolic event in individuals affected by the first episode of unprovoked one in whom diagnosis of HIV infection has not been established yet.

Case Presentation

A 27-year-old heterosexual smoker man was referred to our center due to a sudden-onset severe left lower extremity pain and claudication since three days prior to admission. In physical examination, end extremity coldness and discoloration as well as left lower extremity pulselessness were found. Color-Doppler sonography revealed a large thrombus in the left common iliac artery and two thrombi in the distal halves of both anterior and posterior tibialis arteries, so the patient was transferred to the operating room for proximal thrombectomy where the blood flow was reestablished and all pulses were then detectable. Two days later, the patient developed another similar episode from knee down and underwent the second thrombectomy. In evaluation, HIV Ab had positive result by ELISA.

Introduction

One of the complications of HIV infection is greater risk of thromboembolic events. A variety of mechanisms has been found to be responsible for prothrombotic tendency in patients with HIV infection.

Conclusions

This case inspires consideration of HIV infection as a leading cause of thromboembolic event in individuals affected by the first episode of unprovoked one in whom diagnosis of HIV infection has not been established yet.

Case Presentation

A 27-year-old heterosexual smoker man was referred to our center due to a sudden-onset severe left lower extremity pain and claudication since three days prior to admission. In physical examination, end extremity coldness and discoloration as well as left lower extremity pulselessness were found. Color-Doppler sonography revealed a large thrombus in the left common iliac artery and two thrombi in the distal halves of both anterior and posterior tibialis arteries, so the patient was transferred to the operating room for proximal thrombectomy where the blood flow was reestablished and all pulses were then detectable. Two days later, the patient developed another similar episode from knee down and underwent the second thrombectomy. In evaluation, HIV Ab had positive result by ELISA.

Introduction

One of the complications of HIV infection is greater risk of thromboembolic events. A variety of mechanisms has been found to be responsible for prothrombotic tendency in patients with HIV infection.

Thrombosis;HIV Infections;Initial Presentation Thrombosis;HIV Infections;Initial Presentation http://www.ircmj.com/index.php?page=article&article_id=10477 Bzhan Ziaian Bzhan Ziaian Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran Sam Moslemi Sam Moslemi Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132306972 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran; Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7132306972 Maryam Tahamtan Maryam Tahamtan Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, IR Iran Department of Cardiology, Shiraz University of Medical Sciences, Shiraz, IR Iran
en 25763228 10.5812/ircmj.12858 Chief Complaints and Diagnosis of Patients Visited by Caravan Physicians During Hajj 2010 Chief Complaints and Diagnosis of Patients Visited by Caravan Physicians During Hajj 2010 research-article research-article Conclusions

Respiratory disease, musculoskeletal pain, headache, and digestion problems were among the most important reasons of patients' referral to physicians in times of Hajj. The mentioned complications could be prevented through correct trainings and conforming to health recommendations in times of Hajj.

Results

In general, medical data of 107074 cases had been registered in this software. Cough with the frequency of 24083 (22.45%) was the most frequent complaints of the patients. Respiratory tract infections diseases with 66197 persons (61.82%) were the most frequently diagnosed diseases in times of annual Hajj of 2010.

Objectives

The objective of this study was to review the frequency of patients’ chief complaints in Hajj to plan and develop medical protocols for expected problems in Hajj.

Patients and Methods

In this short-term past-oriented study, all medical files of the Hajj pilgrims were reviewed and all data regarding the diagnoses were extracted.

Background

The primary data on the patient’s status are articulated by the patient and consist of conditions that force the patient to seek treatment. Such data helps the physician effectively to make an appropriate list of differential diagnoses to establish a treatment protocol.

Conclusions

Respiratory disease, musculoskeletal pain, headache, and digestion problems were among the most important reasons of patients' referral to physicians in times of Hajj. The mentioned complications could be prevented through correct trainings and conforming to health recommendations in times of Hajj.

Results

In general, medical data of 107074 cases had been registered in this software. Cough with the frequency of 24083 (22.45%) was the most frequent complaints of the patients. Respiratory tract infections diseases with 66197 persons (61.82%) were the most frequently diagnosed diseases in times of annual Hajj of 2010.

Objectives

The objective of this study was to review the frequency of patients’ chief complaints in Hajj to plan and develop medical protocols for expected problems in Hajj.

Patients and Methods

In this short-term past-oriented study, all medical files of the Hajj pilgrims were reviewed and all data regarding the diagnoses were extracted.

Background

The primary data on the patient’s status are articulated by the patient and consist of conditions that force the patient to seek treatment. Such data helps the physician effectively to make an appropriate list of differential diagnoses to establish a treatment protocol.

Common Cold;Respiratory Disease;Training;Outbreak Common Cold;Respiratory Disease;Training;Outbreak http://www.ircmj.com/index.php?page=article&article_id=12858 Sayyed Ali Marashi Sayyed Ali Marashi Hajj and Pilgrimage Medical Center, Tehran, IR Iran Hajj and Pilgrimage Medical Center, Tehran, IR Iran Hojjatollah Rusta Hojjatollah Rusta Department of Cardiology, Shiraz University of Medical Sciences, Shiraz IR Iran Department of Cardiology, Shiraz University of Medical Sciences, Shiraz IR Iran Aminreza Tabatabaei Aminreza Tabatabaei Department of Education and Research, Hajj and Pilgrimage Medical Center, Tehran, IR Iran; Department of Education and Research, Hajj and Pilgrimage Medical Center, Tehran, IR Iran. Tel: +98-2186744114 Department of Education and Research, Hajj and Pilgrimage Medical Center, Tehran, IR Iran; Department of Education and Research, Hajj and Pilgrimage Medical Center, Tehran, IR Iran. Tel: +98-2186744114
en 25763250 10.5812/ircmj.7887 Ramadan Fast in Patients With Coronary Artery Disease Ramadan Fast in Patients With Coronary Artery Disease research-article research-article Conclusions

In the present study, the patients with CAD were able to observe Ramadan fast safely and their combined endpoint of chest pain and dyspnea was not significantly different from that of the non-fasting ones. We would suggest that patients with CAD and normal left ventricular function could fast during Ramadan.

Background

Fasting during the month of Ramadan is of vital significance amongst Muslims; however, little is known about the effects of this kind of fasting on patients with coronary artery disease (CAD).

Objectives

This nonrandomized prospective observational pilot study was designed to investigate the effects of Ramadan fast on the symptoms of CAD.

Patients and Methods

Patients with documented CAD were consecutively (nonrandomized) included in the study, and those with heart failure (ejection fraction < 50%), renal failure, gout, and insulin-treated diabetes were excluded. Patients had the choice of fasting during Ramadan if they so wished and to break their fast as soon as symptoms such as dyspnea and chest pain occurred (fasting group) or not fasting (control group).

Results

A total of 148 patients completed the study. Mean (mean ± SD) age of the patients was 61.5 ± 11.7 years and 50% were male. Finally, 66 patients (44.6%) accomplished Ramadan fast with an average of 22.27 ± 10.46 days of fasting. Occurrence of chest pain was not significantly different between the fasting and non-fasting groups (4 out of 66 [6.1%] vs. 8 out of 82 [9.8%] respectively; P = 0.42). In addition, patients who fasted during Ramadan did not experience a higher frequency of a combined endpoint of chest pain and dyspnea (4 out of 66 cases in the fasting group [6.1%] vs. 11 out of 82 in non-fasting group [13.4%]; P = 0.14).

Conclusions

In the present study, the patients with CAD were able to observe Ramadan fast safely and their combined endpoint of chest pain and dyspnea was not significantly different from that of the non-fasting ones. We would suggest that patients with CAD and normal left ventricular function could fast during Ramadan.

Background

Fasting during the month of Ramadan is of vital significance amongst Muslims; however, little is known about the effects of this kind of fasting on patients with coronary artery disease (CAD).

Objectives

This nonrandomized prospective observational pilot study was designed to investigate the effects of Ramadan fast on the symptoms of CAD.

Patients and Methods

Patients with documented CAD were consecutively (nonrandomized) included in the study, and those with heart failure (ejection fraction < 50%), renal failure, gout, and insulin-treated diabetes were excluded. Patients had the choice of fasting during Ramadan if they so wished and to break their fast as soon as symptoms such as dyspnea and chest pain occurred (fasting group) or not fasting (control group).

Results

A total of 148 patients completed the study. Mean (mean ± SD) age of the patients was 61.5 ± 11.7 years and 50% were male. Finally, 66 patients (44.6%) accomplished Ramadan fast with an average of 22.27 ± 10.46 days of fasting. Occurrence of chest pain was not significantly different between the fasting and non-fasting groups (4 out of 66 [6.1%] vs. 8 out of 82 [9.8%] respectively; P = 0.42). In addition, patients who fasted during Ramadan did not experience a higher frequency of a combined endpoint of chest pain and dyspnea (4 out of 66 cases in the fasting group [6.1%] vs. 11 out of 82 in non-fasting group [13.4%]; P = 0.14).

Fasting;Coronary Artery Disease;Ramadan;Chest Pain;Dyspnea Fasting;Coronary Artery Disease;Ramadan;Chest Pain;Dyspnea http://www.ircmj.com/index.php?page=article&article_id=7887 Mehdi Mousavi Mehdi Mousavi Shahid Bahonar Hospital, Alborz University of Medical Sciences, Karaj, IR Iran; Shahid Bahonar Hospital, Alborz University of Medical Sciences, Karaj, IR Iran. Tel: +98-2632527575, Fax: +98-2632546374 Shahid Bahonar Hospital, Alborz University of Medical Sciences, Karaj, IR Iran; Shahid Bahonar Hospital, Alborz University of Medical Sciences, Karaj, IR Iran. Tel: +98-2632527575, Fax: +98-2632546374 SadafSadat Mirkarimi SadafSadat Mirkarimi Khatam Al-Anbia Hospital, Islamic Azad University, Shahroud, IR Iran Khatam Al-Anbia Hospital, Islamic Azad University, Shahroud, IR Iran Gita Rahmani Gita Rahmani Private Clinic, Karaj, IR Iran Private Clinic, Karaj, IR Iran Ehsan Hosseinzadeh Ehsan Hosseinzadeh Khatam Al-Anbia Hospital, Islamic Azad University, Shahroud, IR Iran Khatam Al-Anbia Hospital, Islamic Azad University, Shahroud, IR Iran Navid Salahi Navid Salahi Khatam Al-Anbia Hospital, Islamic Azad University, Shahroud, IR Iran Khatam Al-Anbia Hospital, Islamic Azad University, Shahroud, IR Iran
en 25763231 10.5812/ircmj.15832 An Epidemiological Study of Gastroesophageal Reflux Disease and Related Risk Factors in Urban Population of Mashhad, Iran An Epidemiological Study of Gastroesophageal Reflux Disease and Related Risk Factors in Urban Population of Mashhad, Iran research-article research-article Results

In total, 420 participants (25.7%) had GERD symptoms. Risk factors with significant effects consisted of smoking, consumption of non-steroidal anti-inflammatory drugs (NASIDs), overeating, chronic diseases, tea and coffee consumption and GERD in spouse.

Conclusions

The prevalence of GERD among people living in Mashhad was above the average prevalence in other cities of Iran. However, risk factors seemed to be similar to those reported by other studies.

Objectives

To evaluate the epidemiology of GERD based on a population study in Mashhad.

Patients and Methods

This was a cross sectional descriptive study conducted in 2010. In total, 2500 participants were selected based on cluster sampling. Modified and validated Mayo Clinic questionnaire for GERD was used for data collection. Overall, 1685 questionnaires were retrieved. Fifty-one participants were excluded because of pregnancies, history of abdominal surgery and being less than 18 years old. We analyzed data using the SPSS software version 16. Prevalence of GERD and significant risk factors (P value < 0.05) were determined.

Background

Gastroesophageal Reflux Disease (GERD) is a chronic and common disease, which is characterized by heartburn and regurgitation. In the last couple of decades, GERD has received much attention and studies have shown an increase in its prevalence. Although there have been a few studies on the prevalence of GERD in Iran, no study has yet been done in the northeastern part of the country. The aim of our study was to evaluate the prevalence of GERD and its risk factors in a population from Mashhad.

Results

In total, 420 participants (25.7%) had GERD symptoms. Risk factors with significant effects consisted of smoking, consumption of non-steroidal anti-inflammatory drugs (NASIDs), overeating, chronic diseases, tea and coffee consumption and GERD in spouse.

Conclusions

The prevalence of GERD among people living in Mashhad was above the average prevalence in other cities of Iran. However, risk factors seemed to be similar to those reported by other studies.

Objectives

To evaluate the epidemiology of GERD based on a population study in Mashhad.

Patients and Methods

This was a cross sectional descriptive study conducted in 2010. In total, 2500 participants were selected based on cluster sampling. Modified and validated Mayo Clinic questionnaire for GERD was used for data collection. Overall, 1685 questionnaires were retrieved. Fifty-one participants were excluded because of pregnancies, history of abdominal surgery and being less than 18 years old. We analyzed data using the SPSS software version 16. Prevalence of GERD and significant risk factors (P value < 0.05) were determined.

Background

Gastroesophageal Reflux Disease (GERD) is a chronic and common disease, which is characterized by heartburn and regurgitation. In the last couple of decades, GERD has received much attention and studies have shown an increase in its prevalence. Although there have been a few studies on the prevalence of GERD in Iran, no study has yet been done in the northeastern part of the country. The aim of our study was to evaluate the prevalence of GERD and its risk factors in a population from Mashhad.

Gastroesophageal Reflux;Risk Factors;Gastroesophageal Reflux Disease;Iran Gastroesophageal Reflux;Risk Factors;Gastroesophageal Reflux Disease;Iran http://www.ircmj.com/index.php?page=article&article_id=15832 Hassan Vossoughinia Hassan Vossoughinia Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Masoumeh Salari Masoumeh Salari Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Elham Mokhtari Amirmajdi Elham Mokhtari Amirmajdi Faculty of Medical Sciences, Nayshabur University of Medical Sciences, Nayshabur, IR Iran Faculty of Medical Sciences, Nayshabur University of Medical Sciences, Nayshabur, IR Iran Hassan Saadatnia Hassan Saadatnia Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Siavash Abedini Siavash Abedini Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Alireza Shariati Alireza Shariati Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Mohammadjavad Shariati Mohammadjavad Shariati Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran Ahmad Khosravi Khorashad Ahmad Khosravi Khorashad Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran; Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel:+98-5138012742, Fax: +98-5138453239 Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran; Department of Internal Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel:+98-5138012742, Fax: +98-5138453239
en 25763234 10.5812/ircmj.16729 Penile Length and Anogenital Distance in Male Newborns From Different Iranian Ethnicities in Golestan Province Penile Length and Anogenital Distance in Male Newborns From Different Iranian Ethnicities in Golestan Province research-article research-article Conclusions

Using -2.5 standard deviations as the cutoff for micropenis, a newborn infant in Golestan Province with a PL of < 23.3 mm had micropenis; however, more investigations are needed to clarify this issue.

Results

Means of PL and AGD of 427 healthy term newborns were 32.1 ± 3.5 and 24.5 ± 2.5 mm, respectively. There was a positive correlation between PL and AGD (r = 0.097, P = 0.046). According to their ethnicity, there were 166 Fars (38.9%), 129 Turkmen (30.2%), and 132 Sistani (30.9%) infants with mean PL of respectively 31.8 ± 3.9, 32.3 ± 3.3, and 32.4 ± 3.3 mm and mean AGD of respectively 25 ± 2.5, 24.3 ± 2.5, and 24 ± 2.5 mm. One Fars neonate (0.23%) had micropenis (PL = 21.3 mm).

Objectives

Since there is no report on penile length (PL) and AGD in our region, we investigated these parameters in male newborns in Golestan Province, Iran.

Patients and Methods

In this cross-sectional study, we measured stretched PL and AGD in term newborns from different races in Dezyani Gynecologic Hospital of Gorgan, Iran. We also recorded the anthropometric parameters and maternal age. The data was analyzed using the SPSS 14.

Background

Anogenital distance (AGD) is a feasible and accepted parameter of exogenous or endogenous androgens effects on development of reproductive system.

Conclusions

Using -2.5 standard deviations as the cutoff for micropenis, a newborn infant in Golestan Province with a PL of < 23.3 mm had micropenis; however, more investigations are needed to clarify this issue.

Results

Means of PL and AGD of 427 healthy term newborns were 32.1 ± 3.5 and 24.5 ± 2.5 mm, respectively. There was a positive correlation between PL and AGD (r = 0.097, P = 0.046). According to their ethnicity, there were 166 Fars (38.9%), 129 Turkmen (30.2%), and 132 Sistani (30.9%) infants with mean PL of respectively 31.8 ± 3.9, 32.3 ± 3.3, and 32.4 ± 3.3 mm and mean AGD of respectively 25 ± 2.5, 24.3 ± 2.5, and 24 ± 2.5 mm. One Fars neonate (0.23%) had micropenis (PL = 21.3 mm).

Objectives

Since there is no report on penile length (PL) and AGD in our region, we investigated these parameters in male newborns in Golestan Province, Iran.

Patients and Methods

In this cross-sectional study, we measured stretched PL and AGD in term newborns from different races in Dezyani Gynecologic Hospital of Gorgan, Iran. We also recorded the anthropometric parameters and maternal age. The data was analyzed using the SPSS 14.

Background

Anogenital distance (AGD) is a feasible and accepted parameter of exogenous or endogenous androgens effects on development of reproductive system.

Ethnic Groups;Anthropometry;Male;Iran Ethnic Groups;Anthropometry;Male;Iran http://www.ircmj.com/index.php?page=article&article_id=16729 Ehsan Alaee Ehsan Alaee Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran Mohammad Javad Gharib Mohammad Javad Gharib Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran Department of Pediatrics, Tehran University of Medical Sciences, Tehran, IR Iran Mahnaz Fouladinejad Mahnaz Fouladinejad Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran; Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-1715547680 Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran; Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, IR Iran. Tel: +98-1715547680
en 25763232 10.5812/ircmj.16638 Double Uvula in a Fifty-Six-Year-Old Woman Double Uvula in a Fifty-Six-Year-Old Woman case-report case-report Introduction

Deformities of the uvula are considered as the dark area of otorhinolaryngology practice. This little and plain part of the human organism has various functions and its abnormalities might cause serious disabilities.

Case Presentation

In our case report, we present a unique deformity of the uvula in a 56-year-old woman.

Discussion

The aim of this report was to present a very rare condition, unique case “polyuvula”, and to review the literature regarding other uvula abnormalities.

Introduction

Deformities of the uvula are considered as the dark area of otorhinolaryngology practice. This little and plain part of the human organism has various functions and its abnormalities might cause serious disabilities.

Case Presentation

In our case report, we present a unique deformity of the uvula in a 56-year-old woman.

Discussion

The aim of this report was to present a very rare condition, unique case “polyuvula”, and to review the literature regarding other uvula abnormalities.

Uvula;Case Reports [Publication Type];Otolaryngology Uvula;Case Reports [Publication Type];Otolaryngology http://www.ircmj.com/index.php?page=article&article_id=16638 Tolgahan Catli Tolgahan Catli Bozyaka Teaching and Research Hospital, Izmir, Turkey; Bozyaka Teaching and Research Hospital, Izmir, Turkey. Tel: +90-2322505050, Fax: +90-2322505051 Bozyaka Teaching and Research Hospital, Izmir, Turkey; Bozyaka Teaching and Research Hospital, Izmir, Turkey. Tel: +90-2322505050, Fax: +90-2322505051
en 25763229 10.5812/ircmj.14490 Stage at Diagnosis and Delay in Seeking Medical Care Among Women With Breast Cancer, Delhi, India Stage at Diagnosis and Delay in Seeking Medical Care Among Women With Breast Cancer, Delhi, India research-article research-article Conclusions

A significant association was found between ages of women with their delays in consultation. Delay is still prevalent amongst women with breast cancer. It seems necessary to design educating programs for women in both clinical and community settings, about breast cancer and early detection practices.

Results

the mean age of women was 46.99 years. 38.4% of women were ≤ 40 years. 61% of women were in stage IV of cancer at the time of diagnosis. The mean duration of gap between knowing the problem and consulting a physician (patients delay) was 10.90 months. There was no significant association between stage of cancer and consultation gap. A significant association was found between the stage of breast cancer and income; women with lower income had a higher stage of breast cancer (P < 005).

Background

Patients with cancer often delay seeking medical advice in developing countries. It can adversely influence the outcome of disease.

Objectives

The present study was performed to determine the stage at diagnosis and delay in seeking medical care among women with breast cancer in Delhi, India.

Patients and Methods

This was a cross-sectional study based on a census (case series) approach to reach all women (172) diagnosed with primary breast cancer “detected in surgery Out Patient Department (OPD) from January 2007 to December 2009” at Lok Nayak Hospital, Delhi, India. Patients were interviewed using a self-structure questionnaire. Seeking behavior variables were awareness of problem, first consultation, followed physician's advice, detection of problem, system of medicine and gap between knowing the problem and consultation (patient delay). Statistical Analysis was performed using the Microsoft SPSS-pc version 14.0 statistical program. The analytic methods were used (mean, standard deviation, X2, Fisher's Exact Test, K-S, Kruskal-Wallis) for variables. All statistical tests were performed at a significance level of 5% (P < 0.05).

Conclusions

A significant association was found between ages of women with their delays in consultation. Delay is still prevalent amongst women with breast cancer. It seems necessary to design educating programs for women in both clinical and community settings, about breast cancer and early detection practices.

Results

the mean age of women was 46.99 years. 38.4% of women were ≤ 40 years. 61% of women were in stage IV of cancer at the time of diagnosis. The mean duration of gap between knowing the problem and consulting a physician (patients delay) was 10.90 months. There was no significant association between stage of cancer and consultation gap. A significant association was found between the stage of breast cancer and income; women with lower income had a higher stage of breast cancer (P < 005).

Background

Patients with cancer often delay seeking medical advice in developing countries. It can adversely influence the outcome of disease.

Objectives

The present study was performed to determine the stage at diagnosis and delay in seeking medical care among women with breast cancer in Delhi, India.

Patients and Methods

This was a cross-sectional study based on a census (case series) approach to reach all women (172) diagnosed with primary breast cancer “detected in surgery Out Patient Department (OPD) from January 2007 to December 2009” at Lok Nayak Hospital, Delhi, India. Patients were interviewed using a self-structure questionnaire. Seeking behavior variables were awareness of problem, first consultation, followed physician's advice, detection of problem, system of medicine and gap between knowing the problem and consultation (patient delay). Statistical Analysis was performed using the Microsoft SPSS-pc version 14.0 statistical program. The analytic methods were used (mean, standard deviation, X2, Fisher's Exact Test, K-S, Kruskal-Wallis) for variables. All statistical tests were performed at a significance level of 5% (P < 0.05).

Breast Neoplasm;Patient Acceptance of Health Care;Women Breast Neoplasm;Patient Acceptance of Health Care;Women http://www.ircmj.com/index.php?page=article&article_id=14490 Sedigheh Pakseresht Sedigheh Pakseresht Reproductive Health Research Center, Department of Obstetrics, Guilan University of Medical Sciences, Rasht, IR Iran Reproductive Health Research Center, Department of Obstetrics, Guilan University of Medical Sciences, Rasht, IR Iran Gopal Krishna Ingle Gopal Krishna Ingle Department of Community Medicine, Maulana Azad Medical College, New Delhi, India Department of Community Medicine, Maulana Azad Medical College, New Delhi, India Suneela Garg Suneela Garg Department of Community Medicine, Maulana Azad Medical College, New Delhi, India Department of Community Medicine, Maulana Azad Medical College, New Delhi, India Nahid Sarafraz Nahid Sarafraz Department of Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9132614866, Fax: +98-3615556633 Department of Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran; Department of Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-9132614866, Fax: +98-3615556633
en 25763240 10.5812/ircmj.17785 Factors Affecting the Prevalence of Obesity Among Primary School Students in Turkey Factors Affecting the Prevalence of Obesity Among Primary School Students in Turkey research-article research-article Conclusions

The study concluded that there were certain criteria related to development of obesity during a specific period of childhood and taking certain precautions could be effective in preventing it.

Results

The median age was 10.3 ± 2.1; 47.6% of the children were female and 52.4% of them were male. About 70.2% of the students consumed fast food. It was identified that 67.1% of the students in the 6-10-year age group and 32.9% in 11-15-year age group were obese (P = 0.000). The obesity prevalence of children with one or two siblings was higher than the ones with more than two siblings (P = 0.001).

Background

Obesity is an energy metabolism disorder which results in the excessive storage of fat and may also lead to physical and psychological problems. Since the 1980s, obesity has drastically increased across all age and socio-economic groups around the world.

Objectives

The purpose of the study was to investigate the risk factors affecting obesity in students in the age group of 6-15 years.

Patients and Methods

This was a population-based cross-sectional study on 868 students in Bahçelievler elementary school in Zonguldak, Turkey from March to April in 2010. Data was collected using demographic questionary forms and weight-length measurements.

Conclusions

The study concluded that there were certain criteria related to development of obesity during a specific period of childhood and taking certain precautions could be effective in preventing it.

Results

The median age was 10.3 ± 2.1; 47.6% of the children were female and 52.4% of them were male. About 70.2% of the students consumed fast food. It was identified that 67.1% of the students in the 6-10-year age group and 32.9% in 11-15-year age group were obese (P = 0.000). The obesity prevalence of children with one or two siblings was higher than the ones with more than two siblings (P = 0.001).

Background

Obesity is an energy metabolism disorder which results in the excessive storage of fat and may also lead to physical and psychological problems. Since the 1980s, obesity has drastically increased across all age and socio-economic groups around the world.

Objectives

The purpose of the study was to investigate the risk factors affecting obesity in students in the age group of 6-15 years.

Patients and Methods

This was a population-based cross-sectional study on 868 students in Bahçelievler elementary school in Zonguldak, Turkey from March to April in 2010. Data was collected using demographic questionary forms and weight-length measurements.

Body Mass Index;Children;Obesity;Health Behavior Body Mass Index;Children;Obesity;Health Behavior http://www.ircmj.com/index.php?page=article&article_id=17785 Tulay Kuzlu Ayyildiz Tulay Kuzlu Ayyildiz Department of Pediatric Nursing, Bulent Ecevit University, Zonguldak, Turkey Department of Pediatric Nursing, Bulent Ecevit University, Zonguldak, Turkey Meltem Kurtuncu Meltem Kurtuncu Department of Pediatric Nursing, Bulent Ecevit University, Zonguldak, Turkey; Department of Pediatric Nursing, Bulent Ecevit University, Zonguldak, Turkey. Tel: +90-3722613394, Fax: +90-3722613399 Department of Pediatric Nursing, Bulent Ecevit University, Zonguldak, Turkey; Department of Pediatric Nursing, Bulent Ecevit University, Zonguldak, Turkey. Tel: +90-3722613394, Fax: +90-3722613399 Hulya Kulakci Hulya Kulakci Department of Nursing, Bulent Ecevit University, Zonguldak, Turkey Department of Nursing, Bulent Ecevit University, Zonguldak, Turkey Sevim Celik Sevim Celik Department of Nursing, Bulent Ecevit University, Zonguldak, Turkey Department of Nursing, Bulent Ecevit University, Zonguldak, Turkey
en 25763235 10.5812/ircmj.16786 Barberry Administration and Pro-Oxidant–Antioxidant Balance in Patients With Metabolic Syndrome Barberry Administration and Pro-Oxidant–Antioxidant Balance in Patients With Metabolic Syndrome research-article research-article Conclusions

Barberry supplementation reduces oxidative burden in patients with metabolic syndrome.

Results

There was no significant difference between the groups regarding their baseline PAB values (P = 0.32). A significant decrease in PAB was observed in the barberry group (P = 0.022), whilst there was no significant change in the control group (P = 0.18). The magnitude of change in PAB during the study was significantly greater in the case group compared to the control group (P = 0.01).

Objectives

This study aimed to explore the impact of supplementation with barberry, a fruit rich in antioxidants, on PAB in patients with metabolic syndrome.

Patients and Methods

A total of 106 patients diagnosed with metabolic syndrome were randomized in two groups: case and control. The case group received three capsules of barberry and the control group received three capsules of placebo for 6 weeks. Serum PAB was measured in all patients before and after the intervention.

Background

Metabolic syndrome is the constellation of several cardiometabolic risk factors, and is associated with a heightened risk of coronary heart disease (CHD). The pro-oxidant–antioxidant balance (PAB) is a measure of factors that promote and control oxidative stress. PAB may also be associated with the risk factors of CHD.

Conclusions

Barberry supplementation reduces oxidative burden in patients with metabolic syndrome.

Results

There was no significant difference between the groups regarding their baseline PAB values (P = 0.32). A significant decrease in PAB was observed in the barberry group (P = 0.022), whilst there was no significant change in the control group (P = 0.18). The magnitude of change in PAB during the study was significantly greater in the case group compared to the control group (P = 0.01).

Objectives

This study aimed to explore the impact of supplementation with barberry, a fruit rich in antioxidants, on PAB in patients with metabolic syndrome.

Patients and Methods

A total of 106 patients diagnosed with metabolic syndrome were randomized in two groups: case and control. The case group received three capsules of barberry and the control group received three capsules of placebo for 6 weeks. Serum PAB was measured in all patients before and after the intervention.

Background

Metabolic syndrome is the constellation of several cardiometabolic risk factors, and is associated with a heightened risk of coronary heart disease (CHD). The pro-oxidant–antioxidant balance (PAB) is a measure of factors that promote and control oxidative stress. PAB may also be associated with the risk factors of CHD.

Metabolic Cardiovascular Syndrome;Berberidaceae;Randomized Controlled Trial Metabolic Cardiovascular Syndrome;Berberidaceae;Randomized Controlled Trial http://www.ircmj.com/index.php?page=article&article_id=16786 Akram Mohammadi Akram Mohammadi Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Amirhossein Sahebkar Amirhossein Sahebkar Neurogenic Inflammation Research center, Mashhad University of Medical Sciences, Mashhad, Iran; Biotechnology Research center, Mashhad University of Medical Sciences, Mashhad, Iran Neurogenic Inflammation Research center, Mashhad University of Medical Sciences, Mashhad, Iran; Biotechnology Research center, Mashhad University of Medical Sciences, Mashhad, Iran Tayyebeh Kermani Tayyebeh Kermani Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Marzieh Zhilaee Marzieh Zhilaee Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Shima Tavallaie Shima Tavallaie Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Biochemistry of Nutrition Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Majid Ghayour Mobarhan Majid Ghayour Mobarhan Cardiovascular Research center, Mashhad University of Medical Sciences, Mashhad, Iran; Cardiovascular Research center, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +98-5138421190, Fax: +98-5138823251 Cardiovascular Research center, Mashhad University of Medical Sciences, Mashhad, Iran; Cardiovascular Research center, Mashhad University of Medical Sciences, Mashhad, Iran. Tel: +98-5138421190, Fax: +98-5138823251
en 25763239 10.5812/ircmj.17511 Efficacy of Viola odorata in Treatment of Chronic Insomnia Efficacy of <italic>Viola odorata</italic> in Treatment of Chronic Insomnia research-article research-article Conclusions

VO can be presented as a safe, well-tolerated, and effective herbal preparation in patients with chronic insomnia.

Results

Improvements in sleep and ISI scores were significantly greater in patients after a month receiving VO drop in comparison with before starting treatment (P < 0.05). A few patients reported some complications about VO consumption, most of which were mild and no serious adverse event was encountered.

Objectives

Due to side effects of hypnotic drug and the increasing demand for alternative medicine substitutes, violet oil (VO) was used in this study. VO is a known medication in Iranian traditional medicine that induces sleep in insomniac patients.

Patients and Methods

This study was conducted as an experimental pretest-posttest evaluation on VO efficacy in 50 patients with chronic insomnia in Iranian Traditional Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran. Treatment consisted of intranasal drop of VO, two drops containing 66 mg of VO in each nostril nightly before sleeping for one month. All patients were asked to complete an Insomnia Severity Index (ISI) questionnaire before the start of the trial and after one month of treatment.

Background

Insomnia is the most common sleep disorder that reduces quality of life.

Conclusions

VO can be presented as a safe, well-tolerated, and effective herbal preparation in patients with chronic insomnia.

Results

Improvements in sleep and ISI scores were significantly greater in patients after a month receiving VO drop in comparison with before starting treatment (P < 0.05). A few patients reported some complications about VO consumption, most of which were mild and no serious adverse event was encountered.

Objectives

Due to side effects of hypnotic drug and the increasing demand for alternative medicine substitutes, violet oil (VO) was used in this study. VO is a known medication in Iranian traditional medicine that induces sleep in insomniac patients.

Patients and Methods

This study was conducted as an experimental pretest-posttest evaluation on VO efficacy in 50 patients with chronic insomnia in Iranian Traditional Medicine Clinic of Mashhad University of Medical Sciences, Mashhad, Iran. Treatment consisted of intranasal drop of VO, two drops containing 66 mg of VO in each nostril nightly before sleeping for one month. All patients were asked to complete an Insomnia Severity Index (ISI) questionnaire before the start of the trial and after one month of treatment.

Background

Insomnia is the most common sleep disorder that reduces quality of life.

Violet Oil;Viola Odorata L;Chronic Insomnia;Iranian Traditional Medicine Violet Oil;Viola Odorata L;Chronic Insomnia;Iranian Traditional Medicine http://www.ircmj.com/index.php?page=article&article_id=17511 Zohre Feyzabadi Zohre Feyzabadi Department of Iranian Traditional Medicine, Shahed University, Tehran, Iran Department of Iranian Traditional Medicine, Shahed University, Tehran, Iran Farhad Jafari Farhad Jafari Department of Health and Social Medicine, Shahed University, Tehran, Iran; Department of Health and Social Medicine, Shahed University, P. O. Box: 141563111, Tehran, Iran. Tel: +98-2188963849, Fax: +98-21-88946253 Department of Health and Social Medicine, Shahed University, Tehran, Iran; Department of Health and Social Medicine, Shahed University, P. O. Box: 141563111, Tehran, Iran. Tel: +98-2188963849, Fax: +98-21-88946253 Seyed Hamid Kamali Seyed Hamid Kamali The School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran The School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran Hassan Ashayeri Hassan Ashayeri Department of Neurosciences, Iran University of Medical Sciences, Tehran, Iran Department of Neurosciences, Iran University of Medical Sciences, Tehran, Iran Shapour Badiee Aval Shapour Badiee Aval Complementary and Traditional Medicine Faculty, Mashhad University of Medical sciences, Mashhad, Iran Complementary and Traditional Medicine Faculty, Mashhad University of Medical sciences, Mashhad, Iran Mohammad Mahdi Esfahani Mohammad Mahdi Esfahani Quran, Hadith and Medicine Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran Quran, Hadith and Medicine Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran Omid Sadeghpour Omid Sadeghpour Department of Herbal and Traditional Medicine, Research Institute of Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran Department of Herbal and Traditional Medicine, Research Institute of Islamic and Complementary Medicine, Iran University of Medical Sciences, Tehran, Iran
en 25763237 10.5812/ircmj.17066 Iatrogenic Aspiration of Custom-Made Keel: A Case Report Iatrogenic Aspiration of Custom-Made Keel: A Case Report case-report case-report Conclusions

Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger’s needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.

Case Presentation

We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later.

Introduction

Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics.

Conclusions

Endoscopic keel placement should be done with heavy suture through cricothyroid and thyrohyoid membranes. Surgeons should suture the keel to the anterior laryngeal wall with specially designed Lichtenberger’s needle-carriers to prevent complications such as keel aspiration, adhesion formation and imposing a second trip under general anesthetics, which put the patient at increased risk. The false vocal cord microflaps, as biological keels and a relatively new method may replace silastic keel placement in the future.

Case Presentation

We report on a case of anterior glottis stenosis with keel aspiration for two weeks, after endoscopic CO2 laser resection of the stenotic section and keel placement. The patient was admitted to our center, where bronchoscopy was performed and the keel was removed. A new custom-made silastic keel was properly placed in raw areas and fixed to the skin with suture through the cricothyroid and thyrohyoid membranes. The keel was removed three weeks later.

Introduction

Laryngeal stenosis has various causes and treatment options. Endoscopic resection of the stenotic part with CO2 laser is one of the treatment options of laryngotracheal stenosis. Keels are useful for preventing adhesion formation, restenosis and web formation, which may happen during the later stage. They can be put in place either via the endoscopic approach or through a micro thyroidotomy and are held in place with a heavy suture through cricothyroid and thyrohyoid membranes. They are left in place for two to four weeks, and then removed through the endoscopic approach under general anesthetics.

Laryngostenosis;Prosthesis Implantation;Laryngeal Diseases;Stents Laryngostenosis;Prosthesis Implantation;Laryngeal Diseases;Stents http://www.ircmj.com/index.php?page=article&article_id=17066 Hadi Sharouny Hadi Sharouny Department of Otorhinolaryngology Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Otorhinolaryngology Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7116291478, Fax: +98-7116291478 Department of Otorhinolaryngology Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran; Department of Otorhinolaryngology Head and Neck Surgery, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98-7116291478, Fax: +98-7116291478 Rahmat Bin Omar Rahmat Bin Omar Department of Otorhionlaryngology Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia Department of Otorhionlaryngology Head and Neck Surgery, University of Malaya, Kuala Lumpur, Malaysia
en 25763236 10.5812/ircmj.16837 An Unusual Mesenteric Tumor ‘Paraganglioma’: A Case Report An Unusual Mesenteric Tumor ‘Paraganglioma’: A Case Report case-report case-report Introduction

Paragangliomas are mostly localized in the adrenal medulla and they are usually pheochromocytomas, derived from the neural crest, but otherwise mesenteric paragangliomas are extremely rare tumors.

Case Presentation

In this article we represent a 59-year-old female with an abdominal mass and pain due to mesenteric paraganglioma.

Conclusions

Paragangliomas can occur as mesenteric tumors; usually, preoperative accurate diagnosis is not possible with imaging methods and precise diagnosis is possible after histological evaluation.

Introduction

Paragangliomas are mostly localized in the adrenal medulla and they are usually pheochromocytomas, derived from the neural crest, but otherwise mesenteric paragangliomas are extremely rare tumors.

Case Presentation

In this article we represent a 59-year-old female with an abdominal mass and pain due to mesenteric paraganglioma.

Conclusions

Paragangliomas can occur as mesenteric tumors; usually, preoperative accurate diagnosis is not possible with imaging methods and precise diagnosis is possible after histological evaluation.

Abdominal Neoplasms;Paraganglioma;Tumor Abdominal Neoplasms;Paraganglioma;Tumor http://www.ircmj.com/index.php?page=article&article_id=16837 Zeynep Ozkan Zeynep Ozkan Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey; Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey. Tel: +90-4242341450, Fax: +90-4242121461 Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey; Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey. Tel: +90-4242341450, Fax: +90-4242121461 Cengizhan San Ozdemir Cengizhan San Ozdemir Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey Gunay Yasar Gunay Yasar Department of Patology, Elazig Training and Research Hospital, Elazig, Turkey Department of Patology, Elazig Training and Research Hospital, Elazig, Turkey Onder Altas Onder Altas Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey Department of General Surgery, Elazig Training and Research Hospital, Elazig, Turkey Mustafa Koc Mustafa Koc Department of Radiology, Elazig Medical Park Hospital, Elazig, Turkey Department of Radiology, Elazig Medical Park Hospital, Elazig, Turkey Yeliz Gul Yeliz Gul Department of Radiology, Elazig Training and Research Hospital, Elazig, Turkey Department of Radiology, Elazig Training and Research Hospital, Elazig, Turkey Emre Durdag Emre Durdag Department of Neurosurgery, Elazig Training and Research Hospital, Elazig, Turkey Department of Neurosurgery, Elazig Training and Research Hospital, Elazig, Turkey
en 25763233 10.5812/ircmj.16711 Prevalence of Motor Developmental Disorders in Children in Alborz Province, Iran in 2010 Prevalence of Motor Developmental Disorders in Children in Alborz Province, Iran in 2010 research-article research-article Background

Unlike developed countries, data from the developing world regarding motor developmental disorders is scarce.

Objectives

In the present study, we used the Infant Neurological International Battery (Infanib) test to determine the prevalence of motor impairment in 4-18 month-old infants in Alborz province, Iran, in 2010.

Patients and Methods

This study was a descriptive-analytic study performed on 6150 infants in Iran. The sample was recruited by convenience sampling from all 4-18 month-old children attended healthcare centers in different districts of Alborz province. Sampling was continued until reaching the desired sample size.

Results

The sample included 3129 boys and 3021 girls. There was no significant difference between the scores of girls and boys (P = 0.403). The number of children with motor developmental abnormality varied depending on the considered cut-off points. In normative cut-off points, 3.7% had motor disorder, whereas based on the Iranian cut-off points, it was 6.5%.

Conclusions

Providing an early detection and intervention system is an urgent public health problem due to the prevalence of motor developmental delay in infants living in Alborz province, because it indicates that most infants had been previously undiagnosed and untreated.

Background

Unlike developed countries, data from the developing world regarding motor developmental disorders is scarce.

Objectives

In the present study, we used the Infant Neurological International Battery (Infanib) test to determine the prevalence of motor impairment in 4-18 month-old infants in Alborz province, Iran, in 2010.

Patients and Methods

This study was a descriptive-analytic study performed on 6150 infants in Iran. The sample was recruited by convenience sampling from all 4-18 month-old children attended healthcare centers in different districts of Alborz province. Sampling was continued until reaching the desired sample size.

Results

The sample included 3129 boys and 3021 girls. There was no significant difference between the scores of girls and boys (P = 0.403). The number of children with motor developmental abnormality varied depending on the considered cut-off points. In normative cut-off points, 3.7% had motor disorder, whereas based on the Iranian cut-off points, it was 6.5%.

Conclusions

Providing an early detection and intervention system is an urgent public health problem due to the prevalence of motor developmental delay in infants living in Alborz province, because it indicates that most infants had been previously undiagnosed and untreated.

Prevalence;Infant;Child Development Prevalence;Infant;Child Development http://www.ircmj.com/index.php?page=article&article_id=16711 Farin Soleimani Farin Soleimani Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran Roshanak Vameghi Roshanak Vameghi Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran; Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel: +98-2122180099, Fax: +98-2122180140 Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran; Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran. Tel: +98-2122180099, Fax: +98-2122180140 Akbar Biglarian Akbar Biglarian Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran Mehdi Rahgozar Mehdi Rahgozar Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, IR Iran
en 25763238 10.5812/ircmj.17492 Exploring Correlation Between Perceived Parenting Styles, Early Maladaptive Schemas, and Depression Among Women With Depressive Symptoms in Iran and India- Role of Early Maladaptive Schemas as Mediators and Moderatos Exploring Correlation Between Perceived Parenting Styles, Early Maladaptive Schemas, and Depression Among Women With Depressive Symptoms in Iran and India- Role of Early Maladaptive Schemas as Mediators and Moderatos research-article research-article Patients and Methods

The study sample was selected randomly and consisted of 200 (age group 16-60 y) depressed females (mild to moderate); 100 from Tehran (Iran) and another 100 from Pune (India). The type of the research was causal-comparative. The data collection took place in hospitals and clinics in the targeted cities. Descriptive statistic tests and hierarchical multiple regression were executed (for the purpose of analyzing data) by SPSS 17.

Conclusions

These findings suggest that the correlation between childhood experiences and depression in adulthood are mediated by dysfunctional schemas.

Results

It was demonstrated that the association between parenting and depression was not moderated by early maladaptive schemas. On the contrary, the results supported meditational models in which parenting styles are associated with the cognitive schemas, and these in turn are related to depressive symptoms. It was also found that abandonment mediates the impacts of maternal style on depression in Iran. On the other hand, abandonment and punitiveness schemas mediated the relation between paternal style and depression in India.

Background

Many studies have reported that inadequate parental styles can contribute to depressive symptoms through dysfunctional cognitive styles.

Objectives

This study aimed to investigate the association of dysfunctional schemas and parenting style with depression, as well as the role of maladaptive schemas such as moderators and mediators in Iran and India.

Patients and Methods

The study sample was selected randomly and consisted of 200 (age group 16-60 y) depressed females (mild to moderate); 100 from Tehran (Iran) and another 100 from Pune (India). The type of the research was causal-comparative. The data collection took place in hospitals and clinics in the targeted cities. Descriptive statistic tests and hierarchical multiple regression were executed (for the purpose of analyzing data) by SPSS 17.

Conclusions

These findings suggest that the correlation between childhood experiences and depression in adulthood are mediated by dysfunctional schemas.

Results

It was demonstrated that the association between parenting and depression was not moderated by early maladaptive schemas. On the contrary, the results supported meditational models in which parenting styles are associated with the cognitive schemas, and these in turn are related to depressive symptoms. It was also found that abandonment mediates the impacts of maternal style on depression in Iran. On the other hand, abandonment and punitiveness schemas mediated the relation between paternal style and depression in India.

Background

Many studies have reported that inadequate parental styles can contribute to depressive symptoms through dysfunctional cognitive styles.

Objectives

This study aimed to investigate the association of dysfunctional schemas and parenting style with depression, as well as the role of maladaptive schemas such as moderators and mediators in Iran and India.

Schemas;Depression;Women;Parenting;Iran;India Schemas;Depression;Women;Parenting;Iran;India http://www.ircmj.com/index.php?page=article&article_id=17492 Maryam Khajouei Nia Maryam Khajouei Nia Department of Psychology, Payam Noor University of Jiroft, Kerman, IR iran; Department of Psychology, Payam Noor University of Jiroft, Kerman, IR iran. Tel: +98-9134489200 Department of Psychology, Payam Noor University of Jiroft, Kerman, IR iran; Department of Psychology, Payam Noor University of Jiroft, Kerman, IR iran. Tel: +98-9134489200 Anuradha Sovani Anuradha Sovani Department of Applied Psychology, University of Mumbai, Mumbai, India Department of Applied Psychology, University of Mumbai, Mumbai, India Gholam Reza Sarami Forooshani Gholam Reza Sarami Forooshani Department of Psychology, University of Kharazmi, Tehran, IR Iran Department of Psychology, University of Kharazmi, Tehran, IR Iran
en 25763251 10.5812/ircmj.8311 Effective Intervention of Self-Care on Glycaemia Control in Patients With Type 2 Diabetes Effective Intervention of Self-Care on Glycaemia Control in Patients With Type 2 Diabetes research-article research-article Conclusions

Self-care training instructions led to improve knowledge, attitude, and performance of the subjects under study and also the average HbA1c. Therefore, the nurses and health care staff should be educated accordingly.

Results

The mean scores of awareness, beliefs, Self-care behaviors of the educational group, were 46.6 ± 8.57, 46.5 ± 0.86 and 29.06 ± 10.02, respectively; and it was found that after the education, knowledge, attitude, and self-care scores increased significantly (P < 0.001 Before the training, the scores of self-care, beliefs, and awareness were less than average in the intervention and control groups. In addition, the levels of HbA1c in the patients were higher than the normal levels. Following the intervention, the mean of self-care and HbA1c of the intervention group significantly reduced as compared with those of the control group (P < 0.001).

Patients and Methods

The current experimental study was conducted on 138 female patients with type 2 diabetes in Zahedan city, Iran. The data were collected by a self-administered questionnaire which included items on demographics, awareness, beliefs, Self-care behaviors. Before the educational intervention, the (HbA1c) test check list was completed for the patients in both groups. Then the training was applied for the intervention group in five 60-minute educational sessions within one month. Three months following the training, the data collection based on the check list was repeated for both groups. Data were analyzed using SPSS software.

Background

Diabetes is one of the most common diseases, which requires lifelong self-care to improve the quality of life.

Objectives

The current study aimed to determine the impact of self-care education programs on reducing HbA1c in patients with type 2 diabetes.

Conclusions

Self-care training instructions led to improve knowledge, attitude, and performance of the subjects under study and also the average HbA1c. Therefore, the nurses and health care staff should be educated accordingly.

Results

The mean scores of awareness, beliefs, Self-care behaviors of the educational group, were 46.6 ± 8.57, 46.5 ± 0.86 and 29.06 ± 10.02, respectively; and it was found that after the education, knowledge, attitude, and self-care scores increased significantly (P < 0.001 Before the training, the scores of self-care, beliefs, and awareness were less than average in the intervention and control groups. In addition, the levels of HbA1c in the patients were higher than the normal levels. Following the intervention, the mean of self-care and HbA1c of the intervention group significantly reduced as compared with those of the control group (P < 0.001).

Patients and Methods

The current experimental study was conducted on 138 female patients with type 2 diabetes in Zahedan city, Iran. The data were collected by a self-administered questionnaire which included items on demographics, awareness, beliefs, Self-care behaviors. Before the educational intervention, the (HbA1c) test check list was completed for the patients in both groups. Then the training was applied for the intervention group in five 60-minute educational sessions within one month. Three months following the training, the data collection based on the check list was repeated for both groups. Data were analyzed using SPSS software.

Background

Diabetes is one of the most common diseases, which requires lifelong self-care to improve the quality of life.

Objectives

The current study aimed to determine the impact of self-care education programs on reducing HbA1c in patients with type 2 diabetes.

Diabetes Mellitus;Self-Care;Health Education;HbA1 Diabetes Mellitus;Self-Care;Health Education;HbA1 http://www.ircmj.com/index.php?page=article&article_id=8311 Iraj Zareban Iraj Zareban Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Shamsodina Niknami Shamsodina Niknami Department of Health Education, Tarbiat Modares University, Tehran, IR Iran; Department of Health Education, Tarbiat Modares University, Tehran, IR Iran. Tel: +98-05442515493, Fax: +98-05442425375 Department of Health Education, Tarbiat Modares University, Tehran, IR Iran; Department of Health Education, Tarbiat Modares University, Tehran, IR Iran. Tel: +98-05442515493, Fax: +98-05442425375 Alireza Hidarnia Alireza Hidarnia Department of Health Education, Tarbiat Modares University, Tehran, IR Iran Department of Health Education, Tarbiat Modares University, Tehran, IR Iran Fatemeh Rakhshani Fatemeh Rakhshani Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Mohsen Shamsi Mohsen Shamsi Department of Public Health, Arak University of Medical Sciences, Arak, IR Iran Department of Public Health, Arak University of Medical Sciences, Arak, IR Iran Mahmood Karimy Mahmood Karimy Department of Public Health, Saveh University of Medical Sciences, Saveh, IR Iran Department of Public Health, Saveh University of Medical Sciences, Saveh, IR Iran
en 25763247 10.5812/ircmj.26033 Gadolinium Enhanced MR-angiography Results in Patients With Peripheral Arterial Disease: Positive Predictive Value Compared to Surgery Gadolinium Enhanced MR-angiography Results in Patients With Peripheral Arterial Disease: Positive Predictive Value Compared to Surgery research-article research-article Results

22 patients were male (73.3%) and the mean age was 60.3 ± 10.6 years in our study group. The most common artery for cut off and run off was superior femoral artery in both assessments. Proximal section of each artery was the most common anatomical section for cut off and run off. There was a same report of cut off artery by MR-Angiography and surgery (kappa coefficient of agreement was 0.96, P value < 0.001) and positive predictive value was 0.97 (95% CI: 0.83-0.99).

Conclusions

According to our findings MR-angiography is an appropriate alternative imaging modality for patients suspected to have peripheral arterial disease and it facilitates the early diagnosis proposed by the clinical findings. Also beneficial characteristics of this method such as low exposure to ionizing radiation, repeatability, and low risk of contrast agent-induced nephropathy make it a modality of choice in patients with renal impairment.

Objectives

To compare the results of Gadolinium enhanced MR-Angiography and surgery in patients suspected to have peripheral arterial disease.

Materials and Methods

In this prospective cohort study, 30 consecutive patients matching the inclusion criteria were enrolled and MR-Angiography was performed prior to surgery for each one.

Background

Peripheral arterial disease (PAD) represents systematic atherosclerosis of great vessels. PAD affects approximately 10-20 % of patients older than 60 years and is associated with high mortality and morbidity rate debilitating individuals’ life.

Results

22 patients were male (73.3%) and the mean age was 60.3 ± 10.6 years in our study group. The most common artery for cut off and run off was superior femoral artery in both assessments. Proximal section of each artery was the most common anatomical section for cut off and run off. There was a same report of cut off artery by MR-Angiography and surgery (kappa coefficient of agreement was 0.96, P value < 0.001) and positive predictive value was 0.97 (95% CI: 0.83-0.99).

Conclusions

According to our findings MR-angiography is an appropriate alternative imaging modality for patients suspected to have peripheral arterial disease and it facilitates the early diagnosis proposed by the clinical findings. Also beneficial characteristics of this method such as low exposure to ionizing radiation, repeatability, and low risk of contrast agent-induced nephropathy make it a modality of choice in patients with renal impairment.

Objectives

To compare the results of Gadolinium enhanced MR-Angiography and surgery in patients suspected to have peripheral arterial disease.

Materials and Methods

In this prospective cohort study, 30 consecutive patients matching the inclusion criteria were enrolled and MR-Angiography was performed prior to surgery for each one.

Background

Peripheral arterial disease (PAD) represents systematic atherosclerosis of great vessels. PAD affects approximately 10-20 % of patients older than 60 years and is associated with high mortality and morbidity rate debilitating individuals’ life.

Angiography;Peripheral Vascular Disease;Surgery Angiography;Peripheral Vascular Disease;Surgery http://www.ircmj.com/index.php?page=article&article_id=26033 Seyed Rasool Mirsharifi Seyed Rasool Mirsharifi Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Morteza Noaparast Morteza Noaparast Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran; Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166581657, Fax: +98-2161191609 Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran; Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166581657, Fax: +98-2161191609 Mona Khazravi Mona Khazravi Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Department of General Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Hossein Ghanaati Hossein Ghanaati Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Madjid Shakiba Madjid Shakiba Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Amirsina Sharifi Amirsina Sharifi Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
en 25763246 10.5812/ircmj.26010 Diagnostic Efficacy of Vessel Specific Coronary Calcium Score in Detection of Coronary Artery Stenosis Diagnostic Efficacy of Vessel Specific Coronary Calcium Score in Detection of Coronary Artery Stenosis research-article research-article Objectives

To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease.

Patients and Methods

In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70.

Results

Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict existence of stenosis in LM. However none of the vessel specific CAC can reach to 100% sensitivity and specificity of CCTA method.

Conclusions

CCTA is highly superior than vessel specific CAC score thus to minimize patients radiation does maybe we can eliminate CAC scan as a routinely perform procedure at the beginning of the CCTA.

Background

Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population.

Objectives

To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease.

Patients and Methods

In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70.

Results

Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict existence of stenosis in LM. However none of the vessel specific CAC can reach to 100% sensitivity and specificity of CCTA method.

Conclusions

CCTA is highly superior than vessel specific CAC score thus to minimize patients radiation does maybe we can eliminate CAC scan as a routinely perform procedure at the beginning of the CCTA.

Background

Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population.

Computed Tomography;Coronary Angiography;Coronary Artery Disease Computed Tomography;Coronary Angiography;Coronary Artery Disease http://www.ircmj.com/index.php?page=article&article_id=26010 Marzieh Motevalli Marzieh Motevalli Department of Radiology, Shahid Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Department of Radiology, Shahid Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran Hossein Ghanaati Hossein Ghanaati Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Kavous Firouznia Kavous Firouznia Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Jalal Kargar Jalal Kargar Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Department of Radiology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran Mounes Aliyari Ghasabeh Mounes Aliyari Ghasabeh Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), edical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, IR Iran. Tel: +98-2166581579, Fax: +98-2166581578 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran; Advanced Diagnostic and Interventional Radiology Research Center (ADIR), edical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, IR Iran. Tel: +98-2166581579, Fax: +98-2166581578 Mona Shahriari Mona Shahriari Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Amir Hosein Jalali Amir Hosein Jalali Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Madjid Shakiba Madjid Shakiba Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran
en 25763248 10.5812/ircmj.26040 Association of Different MRI BIRADS Descriptors With Malignancy in Non Mass-Like Breast Lesions Association of Different MRI BIRADS Descriptors With Malignancy in Non Mass-Like Breast Lesions research-article research-article Conclusions

Although in our study washout pattern was the most powerful indicator for malignant pathology in non mass like enhancing lesions, more studies with larger sample size needs in this regard.

Background

Several studies on the diagnostic efficacy of MRI has not real consensus for the accuracy of MRI characteristics in non mass like breast lesions, and the number of malignant lesions in different studies is insufficient.

Objectives

In this study we aimed to analyze the diagnostic role of MRI BIRADS features for diagnosis of malignancy in non mass like breast lesions.

Patients and Methods

All patients with positive findings (BIRADS 3, 4, 5), which had either biopsy proved pathology or follow-up MRI data at least for 12 months were included in the study. Finally, 213 breasts MRI that showed non mass like enhancing lesions among our patients were assessed in study. One experienced breast radiologist who was unaware of any clinical information or the histopathologic diagnosis evaluated all images retrospectively. The morphologic parameters evaluated consisted of distribution modifiers and pattern of internal enhancement. The kinetic enhancement parameters were assessed as showing washout, plateau, or persistent patterns. In the enhancement kinetic analysis, the most worrisome curve type in each lesion was considered for interpretation, if it was more than 2% enhancement. We have evaluated the visual findings by comparison of the signal intensity on the first and third dynamic series. Data for the study were extracted from the breast MRI database and analyzed using SPSS version 16 statistical software.

Results

Totally 188 patients had 213 non mass like lesions. Mean age of the patients was 44.9±8.3 years (24-63). Totally 46 of lesions were malignant (21.6%). The most common BIRADS score was 4 (116; 54.5%). The most prevalent feature of distribution, internal enhancement and curve type were focal (59.2%), clumped (27.2%) and washout (34.3%). Distribution of different subgroups of MR BIRADS features was different among benign and malignant lesions (All Pvalues < 0.05). Regarding association with malignancy, odds ratio of lesions with segmental or ductal linear distribution was 3.4 (95% CI=1.7-6.8), Clumped, Reticular and Dendritic internal enhancement was 2.5 (95% CI=1.3-5) and wash out curve type was 5.4 (95% CI=2.7-10.9). Sensitivity of higher MR BIRADS (4,5) for diagnosis of malignancy was 100%. Specificity of segmental or ductal linear distribution in diagnosis of malignancy was 81%. Specificity of BIRADS 5 for diagnosis of malignancy was 98%. In a multivariate logistic regression analysis for diagnosis of malignancy in which distribution, internal enhancement and curve type were considered as independent variables, distribution and curve type remained significant in the model while the internal enhancement showed a borderline P-value.

Conclusions

Although in our study washout pattern was the most powerful indicator for malignant pathology in non mass like enhancing lesions, more studies with larger sample size needs in this regard.

Background

Several studies on the diagnostic efficacy of MRI has not real consensus for the accuracy of MRI characteristics in non mass like breast lesions, and the number of malignant lesions in different studies is insufficient.

Objectives

In this study we aimed to analyze the diagnostic role of MRI BIRADS features for diagnosis of malignancy in non mass like breast lesions.

Patients and Methods

All patients with positive findings (BIRADS 3, 4, 5), which had either biopsy proved pathology or follow-up MRI data at least for 12 months were included in the study. Finally, 213 breasts MRI that showed non mass like enhancing lesions among our patients were assessed in study. One experienced breast radiologist who was unaware of any clinical information or the histopathologic diagnosis evaluated all images retrospectively. The morphologic parameters evaluated consisted of distribution modifiers and pattern of internal enhancement. The kinetic enhancement parameters were assessed as showing washout, plateau, or persistent patterns. In the enhancement kinetic analysis, the most worrisome curve type in each lesion was considered for interpretation, if it was more than 2% enhancement. We have evaluated the visual findings by comparison of the signal intensity on the first and third dynamic series. Data for the study were extracted from the breast MRI database and analyzed using SPSS version 16 statistical software.

Results

Totally 188 patients had 213 non mass like lesions. Mean age of the patients was 44.9±8.3 years (24-63). Totally 46 of lesions were malignant (21.6%). The most common BIRADS score was 4 (116; 54.5%). The most prevalent feature of distribution, internal enhancement and curve type were focal (59.2%), clumped (27.2%) and washout (34.3%). Distribution of different subgroups of MR BIRADS features was different among benign and malignant lesions (All Pvalues < 0.05). Regarding association with malignancy, odds ratio of lesions with segmental or ductal linear distribution was 3.4 (95% CI=1.7-6.8), Clumped, Reticular and Dendritic internal enhancement was 2.5 (95% CI=1.3-5) and wash out curve type was 5.4 (95% CI=2.7-10.9). Sensitivity of higher MR BIRADS (4,5) for diagnosis of malignancy was 100%. Specificity of segmental or ductal linear distribution in diagnosis of malignancy was 81%. Specificity of BIRADS 5 for diagnosis of malignancy was 98%. In a multivariate logistic regression analysis for diagnosis of malignancy in which distribution, internal enhancement and curve type were considered as independent variables, distribution and curve type remained significant in the model while the internal enhancement showed a borderline P-value.

Breast; Magnetic Resonance Imaging; Neoplasms Breast; Magnetic Resonance Imaging; Neoplasms http://www.ircmj.com/index.php?page=article&article_id=26040 Masoumeh Gity Masoumeh Gity Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran; Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, IR Iran. Tel: +98-2166581579, Fax: +98-2166581578 Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran; Advanced Diagnostic and Interventional Radiology Research Center, Medical Imaging Center, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, IR Iran. Tel: +98-2166581579, Fax: +98-2166581578 Koosha Ghazi Moghadam Koosha Ghazi Moghadam Clinic of Solingen, Medical University of Cologne, Cologne, Germany Clinic of Solingen, Medical University of Cologne, Cologne, Germany Amir Hossein Jalali Amir Hossein Jalali Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Madjid Shakiba Madjid Shakiba Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, IR Iran