ELECTRONIC PHYSICIAN
Year:2015 | Volume:7 | Issue:6|Papers Count:19

Background: Preterm birth is a worldwide health concern due to its various negative consequences. Therefore, the prevention of preterm birth is a top priority for healthcare systems in all countries.Objective: To compare the effectiveness of vaginal versus intramuscular progesterone in the prevention of preterm delivery.Methods: This randomized clinical trial was conducted at Shahid Sadoughi Hospital in Yazd, Iran, from November 21, 2012 to January 20, 2015. Seventy-eight pregnant women with singleton pregnancy and one risk factor of preterm delivery were included in the study. The subjects were assigned randomly to two groups, with group one receiving Cyclogest and group two receiving 17-α hydroxyprogesterone caproate. Subsequently, we analyzed drug complications during pregnancy, delivery time, neonatal outcomes, and patients' satisfaction among the two groups. The data were analyzed using SPSS version 16. We used descriptive statistics, chisquared, t-test, and ANOVA for the analyses of primary and secondary outcomes.Results: Among the 39 births in group one, 33.3% occurred preterm, and, among the 39 births in group two, 30.7% occurred preterm (< 37 weeks). The mean gestational ages at delivery in groups 1 and 2 were 37.07 ± 2.23 and 36.81 ± 2.77 weeks, respectively (p = 0.765). Other variables were not significantly different between the two groups, including birth weight (p = 0.745), Apgar scores for the first and fifth minutes (p = 0.574, 0.630), length of stay in the neonatal intensive care unit (NICU) when the newborns needed hospitalization (p = 0.358), and the patients' satisfaction with the drugs that were used (p = 0.615).Conclusions: In this study, vaginal progesterone and intramuscular progesterone had the same levels of effectiveness, safety and acceptance by patients in the prevention of preterm delivery. Therefore, both can be used for this purpose in clinical practices, but more studies are needed. Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2015040921670N1.Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Background: N-acetylcysteine (NAC) has been used as a classic treatment for hepatotoxicity induced by Nacetyl- p-benzoquinone imine (NAPQI) as a metabolite of acetaminophen. However, cimetidine theoretically can reduce the production of toxic metabolites through the inhibition of cytochrome p450, and it recently was proposed as a complementary treatment for acetaminophen toxicity.Objective: The aim of this study was to compare the effects of treating acute acetaminophen toxicity with NAC alone and with a combination of NAC and cimetidine.Methods: From October 2013 to March 2014, 105 patients suspected of acetaminophen toxicity who had paraclinical confirmation of toxicity requiring medical treatment (based on the risk assessment nomogram of acetaminophen serum level) were enrolled in this double-blind, randomized, controlled trial at Imam Reza Hospital in Mashhad, Iran. The patients were divided into two groups, i.e., 1) patients who were treated with NAC alone (group A) and 2) patients who were treated with a combination of NAC and cimetidine (group B). The primary outcomes were 1) the serum level of acetaminophen and 2) the serum level of aminotransferases at the time of admission and 4, 12, 24, and 48 hours after admission. Exclusion criteria included multiple toxicities, concurrent diseases that could affect liver enzymes, the use of other drugs, and dissatisfaction with the project. For measuring quantitative data, SPSS version 16 was used for t-test analysis and for analyzing the qualitative data with chi-squared analysis.Results: Sixty patients (32 females and 28 males) with a mean age of 25.2 ± 7.3 years were classified in two groups of 30.. There was no difference between the groups in terms of their admission information. The average levels of acetaminophen in both groups at admission, 12, 24, and 48 hours after hospitalization were not significantly different from each other. Twelve hours after hospitalization, the aspartate aminotransferase (AST) level in the group treated with NAC was significantly higher than in the group treated with the combination of NAC and cimetidine (IU/L30.1 ± 110.0 versus IU/L26.38 ± 94.93, p = 0.044). At the other times that the level of liver enzymes was assessed, the serum levels of urea and creatinine were not significantly different in the two groups (p > 0.05)Conclusion: The intravenous administration of 300 mg of cimetidine every six hours with NAC did not improve the level of hepatoprotective action significantly compared with the NAC treatment protocol alone. Trial registration: The trial was registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2013102915204N1.Funding: This research was supported financially by the Research Council of Mashhad University of Medical Sciences (Grant Number: 920427).

Background: The prevalence of smoking is much higher in prisoners than it is in the general population. Prisoners who smoke cause many health problems for themselves and other prisoners. Therefore, we should help them stop smoking.Objective: To compare the effects of motivational interviewing-based (MI-based) treatment and its combination with nicotine replacement therapy (NRT) on smoking cessation in prisoners at Mashhad Central Prison.Methods: The study was designed as a double-blind, randomized, controlled clinical trial, and it began in February 2013 and ended in February 2014. Two hundred and thirteen prisoners met the inclusion criteria and were enrolled in the study. They were divided randomly into three groups, i.e., MI-based treatment, MI with NRT, and the control group, which didn’t receive any therapy. The outcome measures were reported after intervention and at a 90-day follow-up, and changes in the CO levels in expired air and nicotine dependency were measured.Results: The average age of the subjects was 37.59 ± 8.76, and their mean duration of imprisonment was 3.3 ± 1.90 years. They smoked an average of 21.84 ± 8.72 cigarettes per day. Analysis of the concentration of CO in expired air in the pre-test, post-test, and at the follow-up for the three groups showed that the variations in the mean CO concentrations in the MI group and the MI with NRT group at the pre-test and at the post-test were statistically significant (p < 0.001), but no significant changes occurred between the post-test and the follow-up (p > 0.050). In addition, the results indicated that CO concentration in expired air in the MI with NRT group was statistically significant, with better efficacy of smoking cessation, compared with control group and the MI group after the follow-up (p = 0.02).Conclusions: Motivational interviewing combined with NRT for smoking cessation is more effective than MI alone, and it resulted in a significant decrease in the CO concentration in expired air at the 90-day follow-up.Trial registration: The trial is registered at the Thai Clinical Trial Registry with the TCR identification number TCTR20150724001Funding: This research was supported by the Educational and Research Centre, District XI of State Prisons, Mashhad, Iran.

Background: Patellofemoral pain syndrome (PFPS) is one of the most common disorders of the knee. Conservative approaches, as well as surgery, can decrease pain and the syndrome’s progress effectively.Objective: The aim of this study was to determine the effectiveness of neoprene palumbo orthosis (NPO) and Genu direxa stable orthosis (GDSO) on pain and the activities of daily living (ADL).Methods: Thirty patients (males, ages 18 to 40) participated in this randomized blinded clinical trial. All of them were diagnosed with patella femoral pain syndrome. The participants were divided randomly into two groups of 15, with one group using neoprene palumbo (intervention group) and the other group using Genu direxa stable orthoses (control group). Using the Visual Analogue Scale (VAS) and the Knee injury and Osteoarthritis Outcome Score (KOOS), pain intensity and activities of daily living (ADL) and joint stiffness were analyzed before treatment and after three weeks of treatment. Data were analyzed using paired samples t-test and independent samples t-test.Results: Both orthoses reduced the patients’ pain. Both group showed meaningful improvement in pain reduction and ADL increase after using orthosis in each group. In comparing the variables, no significant differences were found between pain severity and ADL (p = 0.592, p = 0.887). In both groups, the mean of pain severity was different before, during, and after using orthosis (p < 0.05).Conclusion: The results of this study indicated that Neoprene palumbo and genudirexa stable orthoses improved the signs of patello femoral pain syndrome, including pain intensity and ADL.Trial registration: The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) and Current Controlled Trials IRCT138810112946N1.Fund: Funding for the research was provided by the Iran University of Medical and Health Services (NO: 89325- 34).

Introduction: Prostate cancer is now the third most frequent noncutaneous malignancy in Iranian men and the fifth most common cancer worldwide. Measurement of total serum prostate specific antigens (PSAs) has been one of the strongest predictors of biochemical progression and overall survival in determining the efficacy of definitive external beam radiation therapy in patients with localized prostate cancer. The aim of this research was to identify the 5-year biochemical progression-free survival (BFS) and related prognostic and predictive factors of localized prostate cancer patients who were treated with definitive external beam radiotherapy.Methods: This study analyzed 192 localized prostate cancer patients from stage T1aN0M0 to stage T3N0M0; they were treated with definitive radiation therapy and followed up in the radiation-oncology ward of Shohada-e- Tajrish Hospital in Tehran (Iran) between 2006 and 2013. The 5-year BFS was analyzed using the Kaplan-Meier estimate. For multivariate analysis, the Cox proportional hazards model was used to assess the strengths of various factors for 5-year BFS.Results: The follow-up period was between 14-81 months, with a median of 31 months. The median cumulative prostate dose in our series was 64 Gray (Gy) (range 62 to 78 Gy). The 5-year BFS for all patients was 65.1%, and 5-year BFS in low-risk, intermediate-risk and high-risk groups were 100%, 86.5%, and 54.9% respectively. Multivariate analysis found statistically significant relation between 5-year BFS and initial PSA>20, Gleason score 8-10, high risk group, TNM stage≥T2cN0M0, radiotherapy dose<70 Gy, radiotherapy with 2D technique and hormonal therapy in high-risk group (p=0.003, p=0.032, p=0.014, p=0.001, p=0.035, p=0.035, p=0.022 respectively).Conclusion: Our seven years’ experience of follow-up with PSA showed that PSA was the strongest predictor of biochemical progression survival in patients with prostate cancer who were treated with definitive external beam radiation therapy.

Introduction: Detection of hepatocellular carcinoma (HCC) in cirrhotic patients remains a serious, unsolved problem, and the risk factors for acute variceal bleeding (AVB) in HCC patients remain unclear. This study aimed to determine the in-hospital mortality (IHM) and factors influencing the clinical outcomes of AVB in patients with liver cirrhosis and HCC.Methods: This was a retrospective, non-randomized, clinical study that was conducted in 2014. The study was conducted on 70 patients with liver cirrhosis and HCC presenting by acute upper gastrointestinal bleeding (AUGIH). All patients were examined endoscopically within 24 hours from presentation and bleeding varices accounted for AUGIH. Full medical history, clinical examination, and laboratory and radiologic data were collected from admission charts, and hospital medical records were statistically analyzed with SSPS version 22.Results: Thirty-two patients (45.7%) survived and 38 died (54.3%). Survivors are more likely to be Child-Pugh class A or B, and the non-survivors were class C. The Model for End-Stage Liver Disease (MELD) was highly predictive of IHM at an optimized cut-off value of ≥ 12.9. Higher esophageal varices grades and presence of active bleeding on index endoscopy were significant (p < 0.01) in the non-survivors compared to survivors. Complications of liver cirrhosis and associated major comorbidity were significantly higher (p < 0.01) in the nonsurvivors than the survivors. Univariate logistic regression analysis identified higher Grade Esophageal Varices and number of transfused packed red blood cells units as two independent predictors of IHM.Conclusions: IHM was particularly high (54.3%) among HCC patients with AVB who had MELD score > 12.9, higher grade Esophageal Varices, active bleeding on index endoscopy, more increased needs for blood transfusion, longer hospital stay, decompensated liver disease with major comorbidity.

Background: Migraine headache is a prevalent periodical and neurological impairment that is associated with functional disorders. Regarding the side effects of available medications, research is continuing in an effort to identify new, effective pharmaceutical regimens with limited side effects.Objective: The aim of this study was to compare the effectiveness of vitamin B2 versus sodium valproate in migraine prophylaxis.Methods: This was a single-blind clinical trial conducted on 90 migraine patients in two parallel groups. The first group underwent vitamin B2 treatment (400 mg/day) for three months, and the second group was treated with sodium valproate (500 mg/day). The patients were examined at the beginning of the study and 4, 8, and 12 weeks later. After the administration of the drugs in both groups, we recorded the duration of migraine pain, the frequency of migraine episodes, and the severity of the headaches. Potential complications of this study that were measured were weight gain, dizziness, and gastrointestinal problems.Results: The findings showed that the frequency, median duration per month, and severity of the headaches decreased in both groups, but the difference between them was not significant (p > 0.05). However, there were significantly fewer side effects in vitamin B2 group (p = 0.005).Conclusion: Sodium valproate and vitamin B2 have similar effects on the reduction of migraine attacks, but vitamin B2 had fewer complications and fewer adverse effects; therefore, vitamin B2 can be administered to patients who are prohibited from taking sodium valproate or who have adverse side effects when they take it.Trial registration: The trial is registered at the Thailand Clinical Trial Registry (http://www.clinicaltrials.in.th) with the TCTR identification number TCTR20150924001.Funding: This study received no funding from external sources.

Introduction: Hyponatremia is common in cirrhosis. The relationship between hyponatremia and severity of cirrhosis is evidenced by its close association with the occurrence of complications, the prevalence of hepatic encephalopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, refectory ascites, and hepatic hydrothorax. The aim of this study was assess the impact of hyponatremia on the occurrence of both liver-related complications and the hemodynamic cardiovascular dysfunction.Methods: This prospective study was conducted in 2015 on 74 patients with liver cirrhosis. The patients were from the Gastroenterology and Hepatology Department of Theodor Bilharz Research Institute in Giza, Egypt. The patients were divided into three groups according to their serum level of sodium. Group 1 included 30 patients with serum sodium >135 meq/L, group 2 included 24 patients with serum sodium between135 and 125 meq/L, and group 3 included 20 patients with serum sodium <125 meq/L. For each of the patients, we conducted aclinical examination, laboratory investigations, chest X-ray, ECG, abdominal sonar, and echocardiography.Results: Hyponatremia was found in 59.46% of our cirrhotic patients, and they showed significantly increased Model for End-Stage Liver Disease (MELD) score, MELD-Na score, QTc interval, Pulmonary vascular resistance (PVR) and inferior vena cava (IVC) collapsibility, and decreased SVR and IVC diameter. Also hepatic encephalopathy, ascites, renal failure, infectious complications, and pleural effusion were significantly more common in hyponatremic cirrhotic patients.Conclusion: In cirrhosis, hyponatremia is more common in severe cardiovascular dysfunction and associated with increased risk of hepatic encephalopathy, ascites, illness severity scores, renal failure, infectious complications, and pleural effusion. We recommend selective oral administration of vasopressin V2-receptor antagonist, tolvaptan, which acts to increase the excretion of free water, thereby resolving hypervolemic hyponatremia and may have the potential to improve outcomes in these patients.

Introduction: Health literacy is one of the main determinants of health promotion. Regarding the influential role of the women in a society, enhancing their critical health literacy would be a prerequisite for the promotion of public health. The aims of this study were to determine the level of health literacy among fertile Iranian women with breast cancer and to determine the relationship between the health literacy level and socio demographic factors, such as age, educational level, occupation, age of marriage, duration of marriage, and several clinical factors, including taking psychiatric medication and the type of breast surgery among breast cancer patients.Methods: This cross-sectional study was conducted on 260 fertile patients with breast cancer from screening and monitoring centers and breast cancer clinics in Tehran from August 2014 to August 2015. Data were collected using socio demographic and clinical questionnaires developed by the researchers and the questionnaire for health literacy for Iranian adults (HELIA).The results were analyzed using SPSS-IBM version 20 and the Pearson product-moment correlation coefficient, along with Kido’s correlation test.Results: The mean age of the participants was 43.32. Most of the participants (68.5%) had high school diplomas or lower school degrees (based on educational system in Iran). The mean score of health literacy was 75.73. The levels of health literacy among the different groups of participants were as follows: insufficient health literacy (6.9% of patients), barely enough health literacy (18.8% of patients), enough health literacy (38.8% of patients) and excellent health literacy (35.1% of patients). Also, significant relationships were found between the level of health literacy and the participants’ age of marriage, duration of marriage, educational level, and occupation (p < 0.05).Conclusion: This study showed that the level of health literacy was high among women with breast cancer. This indicates that their high level of health literacy might be used as a contributor to the promotion of the public health in terms of awareness about breast cancer.

Introduction: In spite of the widespread use of automation in industry, manual material handling (MMH) is still performed in many occupational settings. The emphasis on ergonomics in MMH tasks is due to the potential risks of workplace accidents and injuries. This study aimed to assess the effect of box size, frequency of lift, and height of lift on maximum acceptable weight of lift (MAWL) on the heart rates of male university students in Iran.Methods: This experimental study was conducted in 2015 with 15 male students recruited from Tehran University of Medical Sciences. Each participant performed 18 different lifting tasks that involved three lifting frequencies (1lift/min, 4.3 lifts/min and 6.67 lifts/min), three lifting heights (floor to knuckle, knuckle to shoulder, and shoulder to arm reach), and two box sizes. Each set of experiments was conducted during the 20 min work period using the free-style lifting technique. The working heart rates (WHR) were recorded for the entire duration. In this study, we used SPSS version 18 software and descriptive statistical methods, analysis of variance (ANOVA), and the t-test for data analysis.Results: The results of the ANOVA showed that there was a significant difference between the mean of MAWL in terms of frequencies of lifts (p = 0.02). Tukey's post hoc test indicated that there was a significant difference between the frequencies of 1 lift/minute and 6.67 lifts/minute (p = 0. 01). There was a significant difference between the mean heart rates in terms of frequencies of lifts (p = 0.006), and Tukey's post hoc test indicated a significant difference between the frequencies of 1 lift/minute and 6.67 lifts/minute (p = 0.004). But, there was no significant difference between the mean of MAWL and the mean heart rate in terms of lifting heights (p > 0.05). The results of the t-test showed that there was a significant difference between the mean of MAWL and the mean heart rate in terms of the sizes of the two boxes (p = 0.000).Conclusion: Based on the results of this study, it was concluded that MAWL and heart rate are influenced by the variables of lifting frequency and the size of the boxes.

Background: Fibroma, the most common benign pelvic tumor in women, affects 25 to 30% of women of reproductive age. Primary treatment for patients with symptomatic or large fibroma is surgery.Objective: The purpose of this study was to investigate the effect of a single rectal dose of Misoprostol on bleeding during abdominal hysterectomy.Methods: This double blind randomized clinical trial was conducted with 80 candidates for abdominal hysterectomy, due to uterine myoma, in the Shahid Sadoughi hospital of Yazd in 2012. The aim of this study was to assess the effect of single rectal dose of Misoprostol on peri-operational abdominal hysterectomy bleeding. Following administration of 400 micrograms of Misoprostol in the case group (n=40), predetermined criteria were compared with control group (n=40).Results: Volume of bleeding during the operation was significantly lower in cases where Misoprostol was used. (268.71 ± 156.85 vs. 350.38 ± 152.61 cc in the case and control groups, respectively). Our findings also showed that Hemoglobin (Hb) levels before, 8, and 30 hours following the operation differed significantly (p=0.001), but these changes were similar in both groups. Pre-operative Hb levels were 11.90 ± 1.7 and 11.90 ± 2.0 in the case and control groups, respectively.Conclusion: A single rectal dose of Misoprostol has positive effect on reducing peri-operational bleeding in women undergoing abdominal hysterectomy due to symptomatic leiomyoma. Trial registration: The trial is registered at the Thailand Clinical Trial Registry (http://www.clinicaltrials.in.th) with the TCTR identification number TCTR20151011001.Funding: this study funded by Shahid Sadoughi University of Medical Sciences

Introduction: Peppermint is an efficient medicinal plant for the treatment of diseases, and it also can be used to produce raw materials in the pharmaceutical industry. The purpose of the current study was to evaluate the effects of various levels of peppermint alcoholic extract on body-weight gain and blood biochemical parameters in adult male Wistar rats.Methods: This experiment was conducted using a completely randomized design (CRD). Fifty adult, healthy, male Wistar rats (ages of 2.5-3 months; weights of 190-210 g) were allocated randomly into five groups. T1 was the control group in which the rats received 0.3 ml of distilled water). Groups T2, T3, T4, and T5 received 75, 150, 300, and 600 mg/kg of peppermint extract, respectively. The rats received daily pretreatment by oral gavages for 21 days. We recorded body weights at the beginning and at the end of the study to determine the changes in the body weights. Blood samples were collected for the measurement of glucose, cholesterol, triglycerides, HDL, LDL, albumin, globulin, and total protein. Statistical analysis of the data was done by SAS software. The data statistically analyzed using one-way analysis of variance (ANOVA), which was conducted through Dennett’s multiple comparison post-test.Results: The results indicated that the rats treated with peppermint gained more weight (p < 0.05) and also decreased the serum concentrations of triglycerides, total cholesterol, LDL, and glucose in T3, T4 and T5 than the other groups (p < 0.05).Conclusion: Peppermint extract had a positive effect on body-weight gain and some blood parameters in adult male Wistar rats. The findings showed that peppermint is a crucial substance at high temperature, and future research should be focused on determining the details of the mechanisms involved in producing the observed effects of peppermint extract.

Introduction: Brucella spp. are gram-negative, facultative intracellular bacteria pathogens responsible for brucellosis, a zoonotic disease that can cause abortion, fetal death, and genital infections in animals and undulant fever in humans. Lipopolysaccharide (LPS) is known as a major virulence factor of Brucella spp. The wboA gene is capable of encoding a glycosyltransferase that appears to play a major role in LPS biosynthesis. Hence, the characterization of this gene can help in the clarification of the pathogenicity of Brucella spp.Methods: This study was carried out at Razi Vaccine and Serum Research Institute in 2011. Briefly, the wboA gene in B. abortus biovar 3 and B. melitensis biovar 1, the predominant biovars in Iran, were amplified by using two pairs of specific primers. Polymerase chain reaction (PCR) products were cloned into a thymine–adenine (TA) cloning vector and transformed into an E. coli DH5α before being sequenced. Multiple alignments of identified sequences were performed, with all wboA sequences deposited in the GenBank sequence database.Results: This study showed that a mismatch has occurred in B. melitensis biovar 1; this biovar is predominant in Iran. In contrast, the wboA gene from B. abortus biovar 3 was similar to that of other B. abortus variations.Conclusion: The comparison and alignment of the wboA gene of native Brucella strains in Iran to all wboA sequences deposited in GenBank revealed that the wboA gene has changed in the long term; hence, because of its unique nucleotide pattern, the gene can be used for specific diagnosis of B. abortus and B. canis.

Introduction: Hyperbilirubinemia is one of the most common problems in newborns, and it is reported in about 60% of infants. Phototherapy is used extensively to treat these patients, and hypocalcemia is one important side effect of the phototherapy. The aim of this study was to determine the prevalence of hypocalcemia after phototherapy in full-term newborns that underwent phototherapy in Koodakan Hospital in Bandar Abbas in 2013.Methods: This cross-sectional study was conducted on 100 neonates admitted to Koodakan Hospital in Bandar Abbas. All of the newborns were full-term, healthy, weighed more than 2,500 g, and were candidates for phototherapy. The newborns were divided into two groups, i.e., 1) those who were more than three days old and 2) those who were less than three days old. Serum bilirubin and calcium levels were measured for each newborn before phototherapy and 48 hours after phototherapy, and the before and after levels were compared. The data were analyzed using IBM SPSS 21.0 statistical software. The Fisher Exact test, the independent samples t-test, and the paired t-test were used to test the research hypothesis.Results: Among the 100 newborns studied, 54% had decreased calcium levels after phototherapy. The prevalence of hypocalcemia was 9% in this study, and the prevalence was not significantly different in the two age groups (P = 0.217).Conclusion: Phototherapy does not increase the risk of hypocalcemia in healthy, full-term neonates. Therefore, prophylactic calcium is not recommended for healthy, full-term neonates who have undergone phototherapy.

Cutis laxa is a connective tissue disorder caused by deficiency of fibro elastic plexus, which can involve multiple organs. It is inherited in autosomal dominant, autosomal recessive, and X-linked. Autosomal recessive cutis laxa type 2, which appears to compromise a spectrum of disorders, starts with severe wrinkly skin syndrome and leads to more severe diseases related to growth and developmental delays and skeletal anomalies. The clinical manifestations in some of cases of Cutis laxa consist of redundant loose skin, pre-and post-natal growth deficiency, mental retardation, large fontanels, and dislocation of the hips. The authors present the case of a female patient with involved internal organ disorder and delay in growth in addition to skin laxity in which gene sequence analysis of PYCR1 indicated C.797G>A mutation.

Introduction: Apical protrusion in the central 4-mm ring in the Scheimflug imaging (Pentacam), both for the anterior and posterior floats as well as Corneal Hysteresis and Corneal Resistance Factor by Ocular Response Analyzer (ORA), generally are considered important predictors for post-Lasik ectasia. The aim of this work was to find out if there is a statistically significant correlation between these different predictors and their correlation with the central corneal thickness for refractive non-keratoconic Egyptian patients trying to achieve a better decision and avoiding ectasia.Methods: This case-control study involved 142 eyes (of 77 patients with various refractive errors) arriving at the refractive surgery unit in the Research Institute of Ophthalmology in Giza (Egypt) in 2014-2015 seeking excimer laser ablation. The flattest, steepest keratometry readings, central corneal thickness as well as the apical protrusion in the central 4-mm ring, both for the anterior and posterior floats, in microns were measured by Scheimflug imaging. The Corneal Hysteresis and Corneal Resistance Factor were measured by the ocular response analyzer. Statistical analysis was performed by SPSS, using the Pearson correlation test.Results: The spherical refractive error ranged from +7.00 to -13.00 diopters (-3.80 ± 2.89). The central pachymetry ranged from 494 to 634 m m (550.35 ± 32.13). For the central 4-mm ring, the apical protrusion ranged from 0 to +15 m (6.93 ± 2.99) for the anterior float and from -3 to +20 m (9.33 ± 4.55) for the posterior float. The Corneal Hysterisis (CH) ranged from 7 to 14.8 mmHg (10.18±1.44), while the Corneal Resistance Factor (CRF) ranged from 7.5 to 14.9 mmHg (10.58 ± 1.67). There was a strong positive correlation between the central corneal thickness and both Corneal Hysteresis (CH: r = 0.56, P ≤ 0.01) and Corneal Resistance Factor (r = 0.46, P ≤ 0.01). A significant correlation (P < 0.05, r = 0.15) existed between apical protrusion in the posterior float and the central corneal thickness. Also, significant negative correlation (P < 0.05, r = -0.12) existed between apical protrusion in the anterior float by pentacam and the Corneal Resistance Factor by ocular response analyzer.Conclusions: Our finding of a strong positive correlation between both Corneal Hysteresis and Corneal Resistance Factor and the Central corneal thickness being important for biomechanical corneal stability. The findings of this study also support using both machines preoperatively to decrease the risk of post-Lasik ectasia.

Introduction: Ovarian cancer is the second most common malignancy in women, the most common cause of gynecologic cancer deaths, and most patients have advanced stage disease at the time of diagnosis. The purpose of this study was to estimate the 5-year survival of patients with epithelial ovarian cancer based on age, tumor histology, stage of disease, and type of treatment.Methods: This study was conducted on 120 patients with epithelial ovarian cancer referred to Shahid Sadoughi hospital and Shah Vali oncology clinic of Yazd from 2006 to 2012. Demographic data and patient records were studied to evaluate the treatment outcome, pathology of the tumor, and stage of disease. Finally, the overall survival rate and tumor-free survival of patients was assessed.Results: The mean patient age was 53.87± 14.11 years. Most participants had stage I (36.7%) or stage II (35%) disease. Serous adenocarcinoma (57.6%) was the most common pathology found in patients with epithelial ovarian cancer. The overall survival of patients in this study was significantly associated with the histological tumor type (p = 0.000) and disease stage (p = 0.0377). Stage I (84.18%) and serous adenocarcinoma (72.81%) demonstrated the best survival. The tumor-free survival rates were not associated with histology types (p = 0.079), surgical procedure (p = 0.18), or chemotherapy (p = 0.18).Conclusion: The survival of patients with epithelial ovarian cancer was significantly associated with disease stage. Serous adenocarcinoma also had the best prognosis among the pathologies studied. Therefore, early detection of ovarian cancer can substantially increase the survival rate.

Introduction: In recent years, the World Health Organization (WHO) has emphasized the importance of determining the equality of the distribution of healthcare resources. Inequalities in the healthcare system are one of the world’s most important developmental challenges, and the inefficiencies that exist in healthcare systems are the most important reason for these challenges. Thermal burns are one of the common injuries worldwide, and their effects are a significant reason for the mortality and morbidity rates throughout the world. Considering the importance of burns as one of the 30 leading causes of death in Iran, this study was aimed to compare the distribution of burn beds with its disability-adjusted life years (DALY) in Iran.Methods: This applied analytic-descriptive study was conducted in order to determine the distribution of burn beds in Iran using the Lorenz curve. In this way, the distribution of burn beds was analyzed in relation to the population of each province and lost DALY caused by burns in Iran. For each province, the number of burn beds in 2012 was collected from credible and authoritative sources at the Ministry of Health, and the population of each province was obtained using data from the National Center of Statistics. The data were analyzed and presented using Microsoft Office Excel.Results: Isfahan and Khorasan Razavi Provinces had approximately 11 and 10.4% of the country’s burn beds, respectively. The Provinces that had the most DALY were Sistan Baluchestan, Fars, and Kerman with 10.75%, 10.34%, and 9.54%, respectively. The Gini coefficients of burn beds in relation to population and DALY were calculated as 0.09 and 0.16, respectively.Conclusion: The Gini coefficients in relation to population and DALY were less than 0.2. Although the Gini coefficient of the burn beds in relation to DALY was more than that for the population, the difference was not significant, and the distributions of beds regarding the two calculated coefficients were equal. It is recommended that healthcare policymakers distribute burn beds in proportion to the populations of the provinces.

The aim of this study is to report a case of a nonvital, discolored, maxillary central incisor bleached by 35% hydrogen peroxide gel with the use of glass ionomer cement as a mechanical barrier in an attempt to minimize the undesirable side effects of intracoronal bleaching. The patient was a 13-year-old boy complaining of a discolored nonvital upper-right central incisor and was selected for this study from the pedodontic clinic in the Shibin Elkom teaching hospital in June 2013. After successful endodontic treatment, the tooth was bleached by 35% hydrogen peroxide gel (Opalescence Xtra), activated by a standard curing light unit, and evaluated for any periapical changes by a periapical radiograph for a nine-months follow-up period. Radiographically, there was no evidence of cervical or apical resorption during the study period.