Iranian Red Crescent Medical Journal
Year:2017 | Volume:19 | Issue:10|Papers Count:21

Background: The change and trend in serum albumin levels after initiation of peritoneal dialysis may be a crucial determinant forclinical outcomes. Objectives: The current study aimed at determining the association between the trajectory of serum albumin and the 3-year clinicaloutcomes using a novel approach joint modeling longitudinal and survival data. Furthermore, the current study was performed tocompare the impact of baseline and trajectory serum albumin on predictability of 3-year outcomes. Methods: The current retrospective longitudinal study reviewed all of the available files of the patients undergoing continuous ambulatoryperitoneal dialysis (CAPD) in Al-Zahra hospital, Isfahan, Iran, from May 2005 to March 2015. A total of 183 patients with atleast 3 years follow-up were selected for the study. The independent variables of interest were baseline and the trajectories of serumalbumin, age, gender, history of previous hemodialysis (HD), body mass index (BMI), baseline serum creatinine, and comorbidityincluding cardiovascular disease and diabetes. The outcomes of interest were death from all causes, transfer to HD and transplantationduring the first 3 years of CAPD. Results: The patient and technique survival rates at 36 months were 71% and 77%, respectively. C-indexes (prediction errors) of mortality, transfer to HD, and transplantation for joint modeling with trajectories of serum albumin were higher (lower) than those ofthe Cox regression with baseline albumin. Hazard ratios of mortality, transfer to HD, and transplantation for trajectories of serumalbumin were 0. 409, 0. 273, and 3. 394, respectively. Conclusions: The current study indicated that the predictability of 3-year clinical outcomes using trajectories of serum albuminwas higher than those of the baseline. According to the findings of the current study, it seems that controlling serum albumin overtime in patients undergoing CAPD, particularly the ones with the history of diabetes and HD, can help to prevent or modify theclinical outcomes during the PD period.

Background: Early childhood caries (ECC) is one of the most frequent chronic diseases among infants and preschool-aged children. Objectives: Our objective was to determine an association between umbilical cord blood 25(OH)D level and early childhood caries. Methods: This prospective cohort study was conducted at Near East University (NEU) Medical hospital in Cyprus during 2013-2016. All pregnant women followed by NEUgynecology and obstetrics clinic were invited to participate in the study. Cord blood serum samples were collected after birth and analyzed for 25(OH)D levels. Infantsunderwent dental examinations, and questionnaire information was gathered from parents of infants between 1 and 2 years of age. Results: Among 120 deliveries, 90 mothers accepted to participate and supply cord blood. 40 of them were excluded; therefore, 50 toddlers were recruited to participate(mean age 20. 2 3. 1 months, male/female: 23/27) and all of them attended the dental and questionnaire evaluations related to participants aged 1-2 years. Cord blood25(OH)D level (mean: 25. 6 11. 6 ng/mL) was found to be seriously low in 12%, low in 20%, deficient in 28%, and optimal in 40%. 34% of the infants had ECC. Oral hygienehabits and low cord blood level of 25(OH)D were significantly associated with the development of ECC (P = 0. 039 and P = 0. 002, respectively). Logistic regression analysisrevealed that lower cord blood 25(OH)D level was significantly associated with ECC (P = 0. 007). Discussion: This study demonstrated the impact of low neonatal 25(OH)D level on the development of ECC. Based on these results, it can be suggested that measuring25(OH)D levels of mothers during pregnancy can help maintain an optimal maternal and offspring vitamin D level, thereby protecting the infant’ s dental health.

Introduction: Septorhinoplasty is one of the most common cosmetic procedures in Iran. Intracranial complications such asmeningitis, cerebrospinal fluid (CSF) rhinorrhea, pneumocephalus, and damage to the skull’ s base are rare, but potential lifethreateningcomplications are associated with such procedures, though very few cases of intracranial complications after septorhinoplastyhave been reported. Case Presentation: A 29-year-old woman was admitted to a limited surgery clinic in Tehran, Iran in 2015 for septorhinoplasty, and4 days post-operation she complained of headache, drowsiness, and CSF rhinorrhea. The patient’ s surgical complications includeda skull base fracture, pneumocephalus, and an epidural hematoma. Conclusions: Prevention of life-threatening complications following septorhinoplasty is important. Prevention, early detection, and appropriate treatment of intracranial complications will result in fewer catastrophic outcomes. To prevent damage to the skullbase and other cerebral complications, it is necessary that surgeons use a suitable technique, understand appropriate anatomicalinformation, maintain awareness of possible anatomic variations, and practice gentle manipulation of the ethmoid roof.

Objectives: To compare the effects of mefenamic acid versus quince on menorrhagia and quality of life. Methods: This randomized controlled trial was conducted on women with menorrhagia. The participants were allocated into 2groups through block randomization. The first group (n, 72) received quince pills, while the second group (n, 74) used mefenamicacid pills for 3 consecutive cycles. The participants completed the pictorial blood loss assessment chart (PBAC) before and duringthe intervention. Moreover, the short-form health survey (SF-36) was completed before and 3 months after the intervention. Results: The mean PBAC scores decreased significantly in both groups. The mean PBAC score in the quince group decreased from173. 6 (SD, 53. 8) before the intervention to 116. 7 (51. 7), 86. 4 (43. 1), and 68. 9 (36. 4), respectively in the first, second, and third monthsafter the intervention. The mean PBAC scores in the mefenamic acid group was 176. 8 (54. 3) at baseline and 106. 6 (50. 40), 81. 6 (38. 7), and 63. 8 (33. 8), respectively in the first, second, and third months after the intervention. There was no significant difference betweenthe groups in terms of the mean PBAC score (P = 0. 183). Similarly, after the intervention, there was no significant difference betweenthe groups in terms of physical health (P = 0. 476) and mental health (P = 0. 572) components of quality of life. Conclusions: Quince pills were as effective as mefenamic acid pills in reducing the intensity of menstrual bleeding. Therefore, theyseem to be a proper alternative for mefenamic acid.

Background: The number of reported food illnesses in Iran has increased over the past 10 years. Objectives: The present study aimed at investigating the effect of education, based on the transtheoretical model (TTM) and thetheory of planned behaviour (subjective norm and perceived behavioural control), on reducing fast food consumption in obeseIranian female adolescents. Methods: In this quasi-experimental study, data were collected through a survey. This study included 420 obese Iranian femaleadolescents, aged 15 to 18 years, who were gathered from 12 schools in city of Sabzevar in Iran during 2014 tand 2016. Using a questionnaire, the demographic and anthropometric characteristics, transtheoretical model (TTM) constructs, subjective norm, andperceived behavioural control were measured and analysed. Results: The average rates of perceived behavioral control (11. 949 2. 876), subjective norms (16. 515 4. 877), stages of change (6. 355 1. 342), processes of change (8. 614 3. 406), and self-efficacy (22. 447 6. 783) in the education group were meaningfully increased(P value < 0. 05); however, these changes were not meaningful in the control group (P value > 0. 05). Also, no statistically meaningfuldifference was obtained in decisional balance between the 2 groups after the intervention (P = 0/924). Conclusions: The results of this study suggest that the use of TTM (except with decisional balance) focuses on the perceived behaviouralcontrol, and subjective norms can be used in educational interventions and have useful results.

Background: Breast cancer (BC) is one of the leading causes of cancer-related mortality among females worldwide. There is noeffective treatment for it, since the molecular mechanism underlying BC still remains unclear. Objectives: The current study aimed at identifying the hub pathways for BC based on pathway crosstalk networks (PCNs), and revealingthe molecular mechanisms underlying BC. Methods: The current case-control bioinformatics analysis used the already published microarray data of BC. The currentfoundation-application study was performed in Moffitt cancer center, USA, in 2010. To begin with, the gene expression profile ofBC (access number E-GEOD-10780), which included 185 samples (143 normal controls and 42 BC samples), was recruited from Array-Express database. Then, data pretreatment method was used. Next, the original pathways (OPs), original protein-protein interaction(PPI) network (OPPIN), and attract OPs (AOPs) were obtained. Then, the construction of background PCN (BPCN) and cancerPCN (CPCN) was performed, following by the degree analysis of pathways in the BPCN and CPCN to further identify hub pathways. Moreover, the cross-talks for hub pathways were extracted and termed as hub cross-talks. Results: There were 300 nodes and 42, 293 edges in BPCN, and 283 nodes and 25, 750 edges in CPCN. According to the degree results, it was found that the degree distribution of pathways for BPCN was concentrated, while that of CPCN was dispersed. Moreover, thedegree of original pathways in BPCN was greater than that of the majority of AOPs in CPCN. Based on the threshold of RankProd <0. 01 and false discovery rate of AOP < 0. 01, thirteen significant pathways were detected. Using the threshold of impact factor > 240, a total of 4 hub pathways including glycolysis/gluconeogenesis, Alzheimer disease, carbon metabolism, and hepatitis C virus (HCV)infection were identified. Conclusions: Hub pathways such as glycolysis/gluconeogenesis and Alzheimer disease might be the potential signatures for BCtherapy.

Background: Pathway analysis is the first choice for gaining insight into the underlying biology of disease, as it reducescomplexityand increases explanatory power. Objectives: The purpose of our paper was to investigate dysregulated pathways between ankylosing spondylitis (AS) patients aswell as normal controls based on the pathway interaction network (PIN) related analysis. Methods: This is a case-control bioinformatics analysis using already published microarray data of AS. It was conducted in Kunming, China from October 2015 to June 2016. We recruited the gene expression profile of AS from the ArrayExpress database(http: //www. ebi. ac. uk/arrayexpress/) with the accessing number of E-GEOD-25101. E-GEOD-25101 existed on A-MEXP-1171-IlluminaHumanHT-12 v3. 0 Expression BeadChip Platform and was comprised of 32 samples (16 AS samples and 16 normal samples). Meanwhile, the protein-protein interaction (PPI) data and pathway data were retrieved from Search Tool for the retrieval of interactinggenes/proteins (STRING, http: //string-db. org/) as well as Reactome databases, respectively. Furthermore, according to the principalcomponent analysis (PCA) method, the seed pathway was selected by computing the activity score for each pathway. A PIN was constructeddependent on the data and Pearson correlation coefficient (PCC). Dysregulated pathways were captured from the PIN byutilizing the seed pathway and the area under the receiver operating characteristics curve (AUROC) index. Results: The PIN consisted of 1022 pathways and 7314 interactions, of which, 3’-UTR-mediated translational regulation was the seedpathway (absolute change of activity score = 10. 962). Starting from the seed pathway, a minimum set of pathways with AUROC =0. 902 was extracted from the PIN. Consequently, a total of 11 dysregulated pathways were identified for AS compared with normalcontrols, such as L13a-mediated translational silencing of Ceruloplasmin expression, GTP hydrolysis, as well as joining of the 60Sribosomal subunit. Conclusions: These results might be available to provide potential biomarkers to diagnose AS as well as give a hand to reveal pathologicalmechanism of this disease.

Background: Studies show that infertility can result in body image changes, which can majorly affect personality. Objectives: The current study aimed to determine the effects of cognitive behavioral therapy (CBT) on body image in infertilewomen. Methods: This clinical trial was performed on 24 infertile women, admitted to the Infertility Research and Treatment Center ofAhvaz, Iran in 2016-2017. In the first stage, convenience sampling was applied, and the participants were allocated to 2 groups (12patients per group), using a table of random numbers. The experimental group participated in 10 sessions of CBT weekly, basedon the 8-step program by Cash. body-self relations questionnaire and Beck Self-Concept inventory were completed in each groupbefore, immediately after, and 1 month after the intervention. Results: After the intervention, the mean scores of body image were 156. 9  3. 4 and 148. 7  4. 8 in the experimental and controlgroups, respectively; the difference was significant (P = 0. 025), and the effects persisted until the follow-up. Conclusions: CBT based on the 8-step program by Cash can improve the body image of infertile women through challenging andimproving their irrational beliefs about their bodies.

Background: Noinformation has been published on the effectiveness of digital non-diagnostic opportunistic screeningmammographyin Iran that is measured by recall rate as one of its indices. Objectives: In this longitudinal study, we measured recall rate of non-diagnostic mammography at a tertiary referral universityhospital and made a comparison with reported international data. Methods: We examined 9395 digital mammograms performed in 2014-2015 from which, 2930 were the first-time and 6465 weresubsequent mammography. The patients were referred to the university hospital by their clinicians during annual check-ups whilenone of them had any chief complaint. The mean age was 49 years. We calculated recall rate, sensitivity, specificity, and cancerdetection rate. Results: Breast cancer was diagnosed in 80 patients. Recall rateswere 29% for the first-time and 22% for subsequentmammography, and the overall rate of cancer incidence was 8. 5 per 1000 mammograms (80/9395) with specificity of 75. 9%, sensitivity of 97. 5%, PPVof 3. 4%, and NPV of 99%. Conclusions: The recall rate was much higher in this setting than the acceptable range reported in literature. However, the sensitivityand detection rate were higher; thus, the higher recall rate could be due to some differences in the patient population such asbeing at younger ages and higher risks.

Introduction: Mucormycosis of the gastrointestinal tract is a rare invasive fungal infectionanddue to late diagnosis, it is associatedwith a high mortality rate. Case Presentation: The studied patient was a 20-year-old woman, known case of Ulcerative colitis, admitted to emergency unit ofAlzahra hospital of Isfahan University Of Medical Sciences, Iran, in May of 2013 by abdominal pain, fever, and leucopenia. With possiblediagnosis of typhlitis, she underwent laparotomy. Gangrene, inflammation, and obstruction of 30 centimeter of jejunum andmomentum were detected. Pathology reported neutropenic enteritis due to zygomatic infection consist with intestinal mucormycosis. Conclusions: In patients with high clinical suspicion of gastrointestinal tract mucormycosis, the emergence of early diagnosis, correction of underlying risk factors, and treatment are of great importance.

Background: Current evidence on the effect of pelvic floor muscle (PFM) training for promoting sexual function is limited. Recentreviews indicate need for high quality trials in this area. Objectives: To examine the effect of PFM training on sexual function (primary outcome), sexual quality of life, and PFM strength(secondary outcomes) in pregnant and postpartum women. Methods: This was an assessor-blind two parallel arm superiority trial. A total of 84 nulliparous women with a singleton pregnancyat 17-20 weeks, aged 18-35 years, were recruited using purposive sampling among clients of five public health centers or two governmentalmaternity clinics in Sari-Iran. The recruitment was done from May to November 2014 and follow up ended on July 2015. Participants were equally allocated into either PFM training or routine care groups using block randomization. Women allocated tothe PFM group received 4 sessions of supervised training, with practical, oral, and written instructions on how to continue performingregular PFM exercises at home. Female sexual function index, sexual quality of life questionnaire-female, and Oxford scoringwere used to assess the outcomes at 28-30 weeks gestation and 80-90 days following birth. Results: Therewasoneloss to follow-upfromeach group. Atotal of 6womenhadnot exercised regularly. Comparedwith the controlgroup, the mean total sexual function score was significantly greater in the PFM training group during both pregnancy (29. 3 vs 21. 1; adjusted difference 9. 4, 95%CI 7. 7 to 11. 0, P < 0. 001) and postpartum (28. 7 vs 16. 0; adjusted difference 13. 0, 95%CI 12. 1 to 13. 9, P < 0. 001). Also, almost all domains of sexual function, sexual quality of life, and PFM strength during both periods improved significantly inwomen who received the PFM training compared with the controls. Conclusions: Based on the results, PFM training during pregnancy and postpartum could improve sexual function in nulliparouswomen. Therefore, it should be recommended to all of the women.

Dear Editor, In Iran, nurses do not have the authority to prescribemedications and only physicians have such an authority. However, due to the development of societies andenrichment of knowledge, other health groups such asnurses can also prescribe medications consistent withtheir knowledge and acquired experiences. In the developedcountries such as America and Australia, prescribingmedications by nurses is permitted, but because of somereasons, it has not been permitted in Iran yet.

Background: Neuraxial anesthesia is an acceptable technique in pregnant females for cesarean section and up to 71% of pregnantpatients have hemodynamic complications, especially hypotension. Objectives: This study aimed at comparing the effectiveness of phenylephrine versus ephedrine in treatment of maternal hypotensiondue to spinal anesthesia for elective cesarean section to determine drug efficacy and fewer side effects. Methods: In this randomized double blind clinical study, 124 pregnant females, who were admitted to Ali ibn Abi Talib hospital inZahedan, Iran, between 2015and2016, for elective cesarean section, were selected by the Block randomization sampling method. Thesamples were divided to 4 groups: Group I received 5mgephedrine bolus, Group II was administered 10mgbolus ephedrine, GroupIII were delivered phenylephrine bolus of 50 mcg, and Group IV 100 mcg phenylephrine bolus in case of hypotension. Neonataloutcome and maternal side effects, hemodynamics changes, and Apgar score were controlled and recorded. Results: In terms of hemodynamic parameters (systolic blood pressure, diastolic blood pressure, and pulse rate), there was a significantdifference between the groups (P < 0. 0001). The umbilical arterial pH value and base excess between ephedrine and phenylephrinegroups were significantly different (P < 0. 0001), and fetal acidosis in the ephedrine group was found. Nausea and vomitingwas significant between the 2 groups (P = 0. 03), while the incidence of nausea and vomiting in the ephedrine group was higher thanthe other groups. There was no difference between the 2 groups in the first-and fifth-minute Apgar (P = 1). Conclusions: Control of blood pressure during spinal 50-mcg phenylephrine is recommended.

Introduction: Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing andcompensatory behaviors such as self-induced vomiting to undo or compensate for the effects of binge eating. Case Presentation: We present a 24-year-old female patient with severe abdominal pain and distension after binge eating. Thispatient was admitted to the Chosun University hospital in Gwangju, Republic of Korea, on January 2017. In spite of conservativetreatment, the symptoms were more aggravated. Therefore, we decided to conduct operative intervention. After gastrotomy, massivebleeding showed on nasogastric tube and drain site, then disseminated intravascular coagulopathy was developed. On thethird postoperative day, the patient died despite of resuscitation. Conclusions: We should pay attention to gastric atony in bulimia nervosa. Therefore, we must prevent massive gastric dilation, constant gastrointestinal bleeding, and disseminated intravascular coagulopathy.

Background: TP53 tumor suppressor gene participates in several pathways involving in carcinogenesis such as cell cycle control, DNA repair, and apoptosis. A common TP53 SNP (guanine/cytosine nucleotide substitution at codon 72), rs1042522, affects the functionof p53 protein and may influence tumor behavior in response to environmental carcinogens. Objectives: This study investigates the association between TP53 codon 72 polymorphisms, tobacco smoking, and breast cancer riskin southern Iranian women from Bushehr. Methods: A case-control study was conducted on 144 cases with histologically confirmed invasive breast carcinoma and 162 randomlyselected healthy controls with no previous cancer history in their family. TP53 codon 72 genotype was determined by usingrestriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) technique. Results: Analysis revealed that smoking frequency was significantly higher in cases compared to controls (OR = 2. 31, 95%CI = 1. 33-3. 99, P = 0. 003) and the association between smoking and breast cancer was only significant for individuals with Arg/Pro genotype (OR =3. 23, 95% CI = 1. 47-7. 06, P = 0. 003). On the other hand, there was no statistically considerable difference in the allele and genotypedistribution between cases and controls. Conclusions: These results should be confirmed in larger studies, but suggest that TP53 Arg/Pro genotype modifies the risk of breastcancer in tobacco smokers and causes significantly more susceptibility to breast cancer due to smoking.

Background: In the absence of acute coronary syndrome (ACS), various conditions may increase the level of cardiac troponins. Objectives: We aimed to determine the absolute and relative changes of high-sensitive cardiac troponin T (hs-cTnT) in 2 groups ofpatients: non-ST-segment-elevation myocardial infarction (NSTEMI) and non-ACS patients. Methods: In this longitudinal study, performed between December 2011 and July 2012, we calculated the absolute and relativechanges of hs-cTnT and troponin velocity in consecutive patients, admitted to the emergency department of Tehran Heart Center. The patients had symptoms of acute MI with elevated baseline hs-cTnT levels. Blood sampling was performed 3 times followingadmission. The hs-cTnT changes were evaluated and compared between the 2 groups of NSTEMI and non-ACS patients. Results: After exclusion, the second and third samples (taken 12 and 36 hours after admission on average, respectively) were availablein 889 and 641 patients, respectively. Cardiovascular risk factors, including hyperlipidemia, diabetes mellitus, smoking, andhistory of coronary events or intervention, were significantly more frequent in the NSTEMI group, compared to the non-ACS group. The hs-cTnT level at baseline and in the subsequent samples was significantly higher in the NSTEMI group, compared to the non-ACSgroup. Also, the absolute and relative changes in hs-cTnT were more significant in the NSTEMI group. Moreover, hs-cTnT velocitywithin the first 12 hours was significantly higher in the NSTEMI group, compared to the non-ACS group (18. 85 84. 89 ng/L/h vs. 4. 96 14. 58 ng/L/h; P < 0. 001). Conclusions: The changes in hs-cTnT (ie, absolute, relative, and velocity changes) were more significant in the NSTEMI group incomparison with non-ACS patients.

Background: Nausea and vomiting during pregnancy (NVP) affects approximately 50%-80% of expecting mothers. NVPcan imposenegative effects on the quality of life; therefore, more attention should be paid to improve patients’ health outcomes. Objectives: The purpose of this trial was to evaluate the efficacy of pomegranate and spearmint syrup on NVP. Methods: In this randomized clinical trial, 74 pregnant women with moderate NVP were divided into 2 groups via block randomizationmethod. A total of 24 and 31 patients were analyzed in the syrup and vitamin B6 groups, respectively. The 24-hour pregnancyuniquequantification of emesis (PUQE-24) scale was used to examine the severity of NVP. The intervention included the use ofpomegranate syrup (5 cc/TDS) plus vitamin B6 in the syrup group; on the other hand, the control group only received B6 tablets(20 mg/TDS) for 1 week. The subjects were followed-up for 1 week without any interventions. Data were analyzed, using Chi squaretest for qualitative variables, t test and Mann-Whitney U test for quantitative variables, and Friedman test for repeated measures. Results: There was no significant difference between the groups in terms of demographic and pregnancy characteristics. The meanPUQE-24 score in the syrup group was 9. 4 1. 8 at baseline, 4. 6 1. 5 on day 7, and 4. 8 2. 6 on day 14 (P < 0. 001). The mean PUQE-24score in the control group was 8. 5  1. 5 at baseline, 6  2. 3 on day 7, and 6. 2  2. 6 on day 14 (P < 0. 001). Although a major declinein PUQE-24 scores was observed in both groups, it was more significant in the syrup group (P = 0. 001). Also, the PUQE-24 score wassignificantly lower in the syrup group, compared to the control group on days 7 and 14 (P = 0. 02). The visual analog scale scoresalso showed a greater reduction in the syrup group, compared to the control group (4. 7 2. 8 vs. 1. 6 3; P = 0. 001). No significantdifference was observed between the groups regarding the duration of nausea, frequency of vomiting, and frequency of retching; also, no complications were reported. Conclusions: The effectiveness of pomegranate and spearmint syrup in reducing NVP was confirmed in the syrup group versus thecontrol group with significant differences.

Background: The relationship between the oral care and ventilator-associated pneumonia (VAP) was confirmed in patients undergoingventilation. Objectives: The current study aimed at investigating the effects of chlorhexidine gluconate (CHX) and ozonated water on the preventionof VAP. Methods: The current double-blind, randomized, clinical trial with the experimental and control groups was conducted in Iranin 2014. In the current study, 75 inpatients undergoing ventilation were grouped through the convenience sampling method andrandomly allocated into 2 groups based on the inclusion criteria. In the experimental group (39 patients), oral care provided byozonated water, while in the control group (35 patients), oral care was provided via CHX. Clinical pulmonary infection score (CPIS)was used to examine the rate of VAP infection. Results: According to the results of the current study, the occurrence rate of VAP in the experimental and control groups were 2. 4%and 8. 3%, respectively that was equal until the 3rd day (P value = 0. 339). However, on the 4th day, the VAP occurrence rate in theexperimental group (14. 6%) was significantly lower than that of the control group (30. 6%) (P value = 0. 02). Conclusions: Basedonthe results, ozonated waterwasmoreeffective to preventVAPthanCHX. Ozonewater canbeused as a suitablealternative mouthwash in patients undergoing mechanical ventilation.

Introduction: Primary and secondary angiosarcomas of the breast are rare neoplasms. Radiologically, magnetic resonance imaging, mammography, and ultrasound (US) findings of angiosarcomas have been reported previously. However, ultrasound (US) elastographyfindings of angiosarcoma have not been reported yet. Currently, US elastography should be used commonly to decidebiopsy or short-term follow-up of breast lesions. Case Presentation: A 39-year-old female from Adana, Turkey, was admitted to Dr. Turgut Noyan Adana Teaching and Medical ResearchCenter at the breast center of Baskent University, with a palpable right breast mass, which had been enlarging for one year in2015. Our breast center is a tertiary referral center. B-mode US and US elastography findings suggested that the lesion was benign; however, magnetic resonance imaging showed a mass enhancing intensely at early phases with rapid wash out. The final diagnosisof the mastectomy specimen confirmed low-grade angiosarcoma. If the recommendation would have been based on the elastographyfindings, it would have been catastrophic because angiosarcomas tend to rapidly increase in size. Conclusions: B-mode US and elastography findings of breast angiosarcoma may mimic benign lesions.

Background: Hypertension is a risk factor that may lead to development of Atherosclerosis (ATS). Recent studies have emphasizedon the importance of high blood pressure and cholesterol on cardiovascular diseases. Objectives: This study aimed to simultaneously examine factors that affect total cholesterol (TC), systolic blood pressure (SBP) anddiastolic blood pressure (DBP) using the mixed response model. Methods: This cross-sectional study comprised of 245 participants, hospitalized at Shahid Madani state hospital, Khorramabad-Irandiagnosed with ATS in fall and winter 2014. The method of sampling was convenience sampling and the participants were selectedthrough census of all the patients hospitalized in different cardiac wards, except for angiography. Results: Systolic blood pressure was significantly associated with fasting blood glucose (FBG) (P = 0. 001), C-reactive protein (CRP)(P = 0. 021), erythrocyte sedimentation rate (ESR) (P = 0. 004), and low density lipoprotein-cholesterol (LDL-C) (P = 0. 002). In addition, FBG (P=0. 002), CRP (P = 0. 011) and LDL-C (P = 0. 027) levels were significantly associated with DBP. It was revealed that age (P = 0. 016), smoking (P = 0. 010), triglyceride (TG) (P = 0. 001) and FBG (P = 0. 021) were significantly associated with TC. Conclusions: Cardiovascular diseases are highly prevalent and there are many risk factors. Therefore, it is necessary to provideproper education on changing life style and preventing the disease.

Background: Theory of planned behavior (TPB) has not been adequately addressed in the field of physical activity among Iranianwomen. Objectives: This study aimed to determine factors affecting physical activity behavior among women based on the theory ofplanned behavior. Methods: This cross-sectional study was conducted on 398 women in Kerman, Iran. The women were selected through the multistagerandomsamplingmethod. Data were collected using the international physical activity questionnaire (IPAQ)anda researchermadequestionnaire based on the constructs of the theory of planned behavior and analyzed using structural equation modeling(SEM). Results: The mean age (SD) of participants was 36. 9 (9. 9). Perceived behavioral control ( = 0. 16, P = 0. 013) and behavioral intention( =0. 16, P=0. 005)hada significant positive direct effectonphysical activitybehavior. Moreover, instrumental attitude ( =0. 04, P=0. 003), subjectivenorms( =0. 04, P=0. 003)andperceived behavioral control ( =0. 03, P=0. 002)hada significant positive indirecteffect on physical activity behavior. Behavioral intention and perceived behavioral control constructs predicted 6% of variance ofphysical activity behavior. Conclusions: Given that the constructs of behavioral intention and perceived behavioral control could predict physical activity behavior, health promotion interventions should be designed with an emphasis on these factors in order to promote physical activityin women.