Iranian Red Crescent Medical Journal
Year:2013 | Volume:15 | Issue:4|Papers Count:20

Prostate cancer is one of the life threatening disorders of male. Although, over the last two decades, a high rate of overdiagnosis, and overtreatment has lowered the incidence rate of prostate cancer, the treatment or prevention strategies are not enough to control the high rate of disease related mortality. Current medical treatment approaches include surgery, radiation therapy, chemotherapy, hormonal therapy, cryosurgery and other methods. These approaches are more or less effective either as monotherapy or in multimodal approach. However, many adverse or side effects exist with these strategies. Researches are ongoing to find out the way or better strategies to eliminate the adverse effects. Dietary modifications may also contribute to decrease prostate cancer risk. Several nutraceuticals against prostate cancer have also been identified. This review article summarizes some of the current treatment, and prevention strategies with the protection of prostate cancer, which may be helpful to control and prevent this highly frequent life threatening disease.

Dear Editor, Hyperbilirubinemia is a common problem in Iranian newborns and constitutes approximately one third of admissions to our neonatal ward.

Background: Hypercholesterolemia is one of the risk factors of cardiovascular diseases. Increased blood cholesterol affects general health and increases mortality due to cardiovascular disease. Poor nutrition increases LDL cholesterol and decreases LDL receptor activities in the liver. Scientists have shown that consumption of antioxidants can reduce hypercholesterolemia and proved benefits of fruit and vegetables. Tomato reduces oxidative stress by increasing serum total antioxidant level.Objectives: This study compared the tomato and tomato paste supplementation on the level of serum lipids and lipoproteins in rats fed with high cholesterol.Materials and Methods: In this study, four male rat groups (10 rats per group) were used. Control group received basal diet, second group received basal diet and 2% cholesterol (Chol), third and fourth groups received basal diet, 2% cholesterol tomato and tomato paste respectively (20 percent of the diet) for a month. Then serum TC, LDL, HDL and TG were measured.Results: Results showed that in Chol group, all lipids increased significantly (P<0.05) except HDL compared to the control group. Tomato and tomato paste supplementation decreased TC, LDL and TG concentration significantly (P<0.05) compared to Chol group. Tomato paste had the higher effect on lipids decreasing than tomato.Conclusions: Decreases of TC, LDL and TG may be related to tomato antioxidant effect. This course in human required more investigations.

Background: The thin and pliable skin of the neck is a region with multidirectional activity, and postburn scar contractures tend to form there easily. The supraclavicular flap is used to correct neck scar contractures. Its main vascular supply is the supraclavicular artery, and it can be harvested as either a skin pedicle flap or an island flap (vascular pedicle flap).Objective: In this article, a total of 41 flaps are studied retrospectively and their efficacy in reconstruction of post-burn neck scar contractures is discussed. Also donor-site morbidity, patient satisfaction, and complications were evaluated.Patients and Methods: Between November of 2004 and January of 2009, 41 supraclavicular flaps were used for reconstructions in 32 patients at the authors’ hospital. Twenty-four of these flaps were skin pedicle flaps, and 17 were island flaps. The range of flap size was 18±6 cm in length, and 9±3 cm in width. Pre-expansion was performed in 14 flaps. Primary closure of donor site was performed in 35 flaps.Results: Thirty-seven of the 41 flaps survived completely, but there were three cases of distal necrosis (10-30%), and one case of complete flap necrosis. Twenty-nine of the 32 patients were satisfied with both the functional and aesthetic results.Conclusions: Scarring of the neck produces problems with function, and appearance. In our view, the supraclavicular flap, a thin flap of good texture, is an excellent and highly reliable flap for covering defects of the anterior neck. This flap is easy to harvest, with good functional and aesthetic results.

Background: Hemodynamic changes and respiratory tract complications are often followed by tracheal extubation. These events may be dangerous in neurosurgical patients and those with cardiovascular disease or at an old age.Objectives: The aim of this study is to investigate the attenuation of cardiovascular responses and upper airway events resulting from tracheal extubation by low dose propofol.Materials and Methods: 80 patients with ASA physical status I, undergoing an elective surgery in a double blind manner received 0.5mg/ kg propofol or normal saline 2 minutes before extubation. Heart rate and blood pressure and quality of tracheal extubation were recorded.Results: Heart rate and blood pressure in patients receiving propofol were less than the control group (P<0.05) at the time of injection of propofol, but there were no differences between the two groups at the time of extubation.Conclusions: We concluded that propofol can reduce SBP, DBP, MAP, HR & cough production at the time of injection but there were no significant changes in these parameters after extubation.

Background: Exclusive breastfeeding is one of the most important essential components of Kangaroo Mother Care.Objective: This study was performed to evaluate the effects of KMC on exclusive breastfeeding just at the time of discharge.Patients and Methods: In this cross sectional study, 251 consecutive premature newborns admitted to neonatal intensive care unit (NICU) between May 2008 and May 2009 in Alzahra University Hospital in Tabriz were evaluated. All of candidate mothers were educated for KMC method by scheduled program. Standard questionnaire was prepared by focus group discussion, and mothers filled it prior to infant hospital discharge.Results: In this study 157 (62.5%) mothers performed kangaroo mother care (KMC group) versus 94 (37.5%) in conventional method care (CMC group). In KMC group exclusive breast feeding was 98 (62.5%) vs.34 (37.5%), and P=.00 in CMC group, at the time of hospital discharge. Receiving KMC, and gestational age were the only effective factors predicting exclusive breastfeeding. Our result indicated that there was a 4.1 time increase in exclusive breastfeeding by KMC, and also weekly increase in gestational age increased it 1.2 times, but maternal age, birth weight, mode of delivery, and 5 minute Apgar score had no influence on it.Conclusions: KMC is more effective, and increases exclusive breast feeding successfully. It can be a good substitution for CMC (conventional methods of care). It is a safe, effective, and feasible method of care for LBWI even in the NICU settings.

Background: Improving the organization of pre-hospital emergency to provide emergency medical services (EMS), as a part of health system, plays an important role in timely and properly response to incidents, as well as, reducing mortalities and disabilities.Objective: This study was conducted to determine the organizational determinants of emergency medical services in Iran and analyze their relationship and prioritize them.Materials and Methods: The present study is kind of descriptive and cross-sectional study that has been conducted on the first half of 2010 using DEMATEL method (a group decision-making technique). Required data were collected using a questionnaire from a sample of 30 Iranian experts in pre-hospital emergency, who were selected using available sampling method.Results: The determinants of establishing an independent EMS organization as a policy maker and observer organization, providing services through public organizations such as Emergency 115, private organizations partnership in pre-hospital emergency system, and integrating pre-hospital and hospital emergency under single supervision and management were determined as organizational determinants. Also, establishing an independent EMS organization and integrating pre-hospital and hospital emergency under single supervision and management were determined as the most affecting and affected organizational determinants, respectively, with the coordinates (1.01 and 1.01) and (0.85 and - 0.85) in the pre-hospital emergency organizational determinants graph.Conclusions: Emergency medical services should be considered as a system with its independent components. Establishing an independent EMS organization, integrating pre-hospital and hospital emergency under single supervision and management, as well as, extending the possibility of providing EMS through private sector are essential in order to make fundamental reforms in providing emergency medical services in Iran.

Background: Treatment of patients with acute myocardial infarction (AMI) is time related, so delay in treatment could affect prognosis. Recognizing pre-hospital or in-hospital delays in initiating treatment and reducing these factors is very efficacious in treatment of these patients.Objectives: The aim of this study is evaluate the causes of pre-hospital delay just as other studies on effect of different variables such as socioeconomic and personal factors on pre-hospital delay in with patients with AMI.Materials and Methods: A cross sectional study was carried out on 227 patients with acute myocardial infarction and demographic data, educational level, marital status, type of transfer to hospital and delay in arrival to hospital were recorded.Results: 35.7% patients arrived during one hour of symptom onset, and 7.9% arrived after 24 hours. Patients having high level education (P=0.0492) and with a family history of coronary artery disease (P=0.01) had significantly less delay in arriving to hospital. Age, marital status, gender, and route of transfer to hospital were not related with pre-hospital delay (P>0.05). Patients thought most common cause of delay in arrival was unawareness of coronary artery disease (38.8%) and self-medication (34.3%).Conclusions: Increasing awareness of patients about cardiovascular symptoms and their risk factors could be helpful in patient's decision in seeking medical help. So general education via media and primary and middle schools could be helpful.

Background: Cervical cancer is the main cause of malignancy-related death among women living in developing countries.Objective: The aim of this study is to evaluate the quality of life (QOL) among Iranian cervical cancer survivors and its relationships with demographic and disease related factors.Patients and Methods: A descriptive correlational study was carried out on 65 consecutive cervical cancer survivors in three different oncology centers related to Shahid Beheshti University of Medical Sciences, Tehran. The QOL was evaluated using three different standard questionnaires: 1) EORTC QLQ-C30 for patients with malignant tumors; 2) EORTC QLQ-CX24 for cervical cancer patients; and 3) SSQ for assessing the social support. The data was obtained by telephone interviews. The test-retest reliability and internal consistency of the scales were examined. Cronbach's alpha was calculated to assess internal consistency among items. Content validity was assessed to review the scales.Results: Cervical cancer survivors stated a good QOL. However, its score was negatively associated with symptoms including short breathing, lack of appetite, nausea and vomiting, sleep disorders, peripheral neuropathy, and menopausal symptoms. Also, there was a positive association between QOL and economic conditions as well as QOL and social functioning.Conclusions: Although, the QOL in cervical cancer survivors was good, treatment of related symptoms can influence the QOL and improve the care of these patients.

Background: Mesenchymal stromal cells (MSCs) as multipotent cells with the capacity to be differentiated into several cell lineages are promising sources for cell therapy and tissue engineering nowadays. Today most of culturing media are supplemented with fetal bovine serum (FBS). But FBS containing culturing media may raise the possibility of zoonotic infections and immunological reactions in cell therapy conditions. Numerous investigations have been performed to assess the use of FBS-free culturing systems for bone marrow derived mesenchymal stromal cell isolation.Objectives: The present investigation aimed to assess the effect of serum-free media on growth and differentiating capacity of adipose tissuederived MSCs.Materials and Methods: Approximately, 1cm3 surgically waste sterile adipose tissue was digested with collagenase-I leading to a single cell suspension. The isolated cells were cultured in Ultra Culture media supplemented with 2% Ultroser G. MSC’s isolation was confirmed with respect to morphology, flowcytometry, adipogenic and osteogenic differentiation potentials.Results: The isolated cells showed adherent spindle shaped morphology, expanded rapidly and revealed expected MSC flowcytometric characteristics; they were positive for CD73, CD90, CD105, CD44, CD166, CD44 and negative for hematopoietic antigen such as CD45, CD34 and CD14. They could also be differentiated successfully into osteoblast and adipocyte, being confirmed by using Alizarin Red and Oil red O staining, respectively.Conclusions: According to the results of the present study, it can be concluded that adipose derived MSCs can be cultured in serum-free media with no change in their differentiating capacity. This finding gives us a hope for future cell therapy studies and trials with little concern about zoonotic infections or immunological reaction.

Background: Angular deformities about the knee are one of the common disorders. High Tibial osteotomy is a way of correcting the deformity. Although the general agreement is focused toward the open wedge technique, discussion about the type of device is a subject to debate.Objectives: This current study has attempted to evaluate the results of Orthopedic Dual Sliding Compression Plate (ODSCP) in high medial open wedge osteotomies of the tibia.Patients and Methods: In this cross-sectional study, 16 patients with genuvarum undergone high medial tibial open wedge osteotomy and fixed by Orthopedic Dual Sliding Compression Plate. At the time of the last follow up visit, Lysholm score was gathered.Results: The mean follow-up time was 9.33±1.87 month. The average age was 45.13±7.25 years. Three patients were male and 13 patients were female. The lysholm score showed a significant difference before and after surgery.Conclusions: The ODSCP has many advantages over the other type of plates. It can help the surgeon to operate with a relaxed mind and it is advisable for high tibial medial open wedge osteotomies.

Background: Chlamydia trachomatis and Mycoplasma genitalium infections are the most prevalent sexually transmitted bacterial infections in the world that cause urogenital infections in both men and women. It appears that infertility is a complication of these infections.Objective: This study was designed to estimate the prevalence of Chlamydia trachomatis and Mycoplasma genitalium in symptomatic and asymptomatic men and to assess risk factors associated with infection.Patients and Methods: Urine specimens were collected from 200 men; 100 of them were symptomatic and 100 asymptomatic. Samples were examined by PCR to detect the infections.Results: C. trachomatis was detected in 20% of symptomatic and in 4% of asymptomatic men (P<0.001). The prevalence of M. genitalium was revealed to be 12% and 2% in symptomatic and asymptomatic men, respectively (P<0.01). Four of 100 men in the symptomatic group were infected with both organisms. C. trachomatis infection was associated with dysuria, urethral discharge, testicular swelling, and genital ulcer (P<0.05). M. genitalium infection was related with dysuria, testis inflammation, pelvic pain and low educational level (P<0.05). Furthermore, the prevalence of infections at ages 30-39 years was more than other ages.Conclusions: Considering the role of these bacteria in urogenital infections, a screening test is recommended. Since the PCR assay is a highly sensitive and specific assay for the detection of these bacteria in male urine specimens, it provides a noninvasive technique for routine screening.

Background: Recognizing mortality pattern and observing its trend will help us in determining health priorities, allocating health resources and priorities in health section, eliminating main factors of premature deaths and carrying out epidemiological research.Objective: The aim of this research was to determine avoidable mortality in Kerman province.Materials and Methods: The present study was carried out longitudinal. A checklist was applied for data collection. Avoidable mortalities were examined in Kerman province between 2004 and 2010. Statistical universe of this research was all deaths registered in statistical unit of health deputy of Kerman University of Medical Sciences; they were all studied through a census method. Data analysis was carried out using descriptive and analytical test by SPSS18.0.Results: Two thousand and one hundred-ninety seven deaths were examined. Of them, 210 deaths were unavoidable and 19987 were avoidable. In this study, most unavoidable deaths were due to pancreases cancer and ovary cancer.Conclusions: Relative high number of avoidable deaths indicates that performance of health system was not desirable in Kerman during the studied years. Examining trend of avoidable deaths showed that these mortalities are increasing although it is not significant nowadays. However, if this trend continues, it will be very alarming for health care authorities in this region.

Background: Endometrial receptivity is required for successful implantation and pregnancy. Despite the remaining controversy, many studies have shown that ultrasonographic endometrial thickness can be considered as an indicator of endometrial receptivity.Objective: The study objective was to investigate the effect of dilatation and curettage on the endometrial thickness.Materials and Methods: Enrolled in the study were 444 patients visited in Obstetrics & Gynecology clinic of Shahid Sadoughi hospital between Jan.2011 to Sep.2012. Only patients whose menstrual cycle was regular were included in study. Patients with myoma, adenomyosis, endometrial polyps or other uterine anomaly, those who smoked, whose BMI was greater than 30 and who were taking medications that could affect endometrial thickness were excluded. Endometrial thickness was measured one day before evolution (n=444) and 5-7 days after it (n=444) using transvaginal ultrasonography. The endometrial thicknesses were correlated to the patients’ history of dilatation and curettage. Data analysis was done through SPSS software version 16 and using descriptive statistics, independent T-test and Anova.Results: Endometrial thickness in patients who had 0, 1, 2, 3 and 4 D&C were 10.00±0.58, 9.83±0.47, 8.90±0.92, 7.42±0.18 and 7.40±0.07, respectively one day before ovulation (spearman’s correlation coefficient=-0.33) and 10.62±0.68, 9.64±0.49, 8.48±0.96, 6.32±0.15 and 6.90±0.04, respectively, 5-7 days after ovulation (spearman’s correlation coefficient=-0.66) estradiol and progesterone levels, measured in the day of 2nd ultrasonography had not statistic relation with endometrial thickness (P=0.27 and 0.31). The relation of endometrial thickness and age was not significant (P=0.54 and 0.06).Conclusions: Dilatation and curettage has a significant effect on the endometrial thinning.

Extramedullary plasmacytoma is a rare neoplasm characterized by monoclonal proliferation of plasma cells. Most lesions occur in the head and neck, primarily in the upper aerodigestive tract. The nasal cavity and nasal septum are the most common sites of occurrence. In this report, three patients admitted in our clinic with history of nasal obstruction and/or epistaxis. Patients were diagnosed with extramedullary plasmacytoma and mass were completely excised. This entity usually occurred in 5th-6th decade of life. One of our patients, a young man, was completely asymptomatic and following a paroxysm of coughing, a polypoid mass was expectorated. The clinical and histopathologic findings of plasmacytoma are discussed. In order to exclude systemic involvement, systematic approach using clinical, laboratory, and radiologic investigations was performed. Extramedullary plasmacytoma of the nasal cavity is rare and should be considered in the differential diagnosis of nasal cavity masses especially in young age group.

The treatment of carbuncles is early administration of antibiotics and surgery. The commonest surgical approaches are saucerization, and incision and drainage (I&D). Although these two techniques are vastly different, there is a lack of evidence to determine which one produces a better outcome. Three cases of carbuncles are presented to illustrate the contrasting surgical techniques and their results. Three consecutive patients who presented to this hospital with carbuncles were treated with either saucerization or I&D. They were followed up for 8 weeks to assess their outcome. One patient had saucerization while two other patients underwent I& D of their carbuncles. Saucerization produced the shortest length of hospital stay. I& D resulted in earlier wound healing. A randomized controlled is needed to determine the best surgical approach for the treatment of carbuncles.

Dear Editor, People with serious mental illness experience an erosion of functioning in day-to-day life over a protracted period of time. There is also evidence to suggest that people with serious mental illness have a greater risk of experiencing oral disease and have greater oral treatment needs than the general population.

Dear Editor, Patients with mediastinal masses, particularly masses in the anterior or superior mediastinum present unique problems for the anesthesiologists which are during general anesthesia, which are usually the consequence of extrinsic compression of the airway, obstruction of the venous return or obstruction to the output of the heart (1-4).

Dear Editor,Water taking diseases are frequent in psychiatric patient. Approximately 3-6% of psychiatric patient water intoxication is seen. Although water intoxication is defined well, the metabolism of this is not understood. In psychiatric patients, headache, ataxia, confusion, urinary incontinence and electrolyte imbalance is reported. If not treated, confusion, acute delirium, coma and death is seen.

Dear Editor, Human immunodeficiency Virus (HIV) and hepatitis B are prevalent and important viral infectious throughout the world and are considered as an important problem (1) HIV related immunosuppressive increases significantly the risk of acquiring opportunistic infections due to hepatitis B.