Iranian Red Crescent Medical Journal
Year:2014 | Volume:16 | Issue:12|Papers Count:20

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).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).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.

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

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.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.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.

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.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.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).Conclusions: Barberry supplementation reduces oxidative burden in patients with metabolic syndrome.

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 Bahcelievler elementary school in Zonguldak, Turkey from March to April in 2010. Data was collected using demographic questionary forms and weight-length measurements.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).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.

Background: Insomnia is the most common sleep disorder that reduces quality of life.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.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.Conclusions: VO can be presented as a safe, well-tolerated, and effective herbal preparation in patients with chronic insomnia.

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.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.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.

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.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.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.

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: 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.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.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.

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 behavior\attitude to risky plan\attitude 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: 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.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.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.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.

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.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.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.

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.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.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.

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.

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: 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.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.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.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.

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: 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.