MEDICAL JOURNAL OF MASHHAD UNIVERSITY OF MEDICAL SCIENCES
Year:2014 | Volume:57 | Issue:2|Papers Count:12

Introduction: Breast cancer is the most common malignancy in Iranian women. Several factors such as estrogen and progesterone receptors and P53 mutation can influence the prognosis in these patients. In the present study, the frequency of these prognostic factors and their correlation with patient age, tumor size and lymph nodes involvement were evaluated.Methods: In this retrospective cohort study, over a 8-year period, 1022 cases of female breast cancer, referred to Mashhad Omid Hospital, entered for analysis.Result: Frequency of estrogen receptor (ER), progesterone receptor (PR) and P53 mutation were 45.5%, 43.1%, and 18.7%, respectively. There was a significant negative correlation between PR and lymph node involvement (P= 0.006) and more axillary involvement was seen in PR negative patients.Metastasis had significant correlation with P53 mutation (P=0.005). Patients age significantly associated with ER, PR (P=0.00 and 0.01 respectively), such that the presence of ER, PR increased with age, but, P53 mutation had no significant correlation with age. There was a direct correlation between ER and PR (P=0.000) and also a reverse correlation between hormonal receptors and P53 (P=0.001).Conclusion: P53 mutation was correlated with further metastasis and poor prognosis. Hormonal receptors could also predict axillary involvement.Evaluation of such biomarkers aided in estimation of disease prognosis.

Introduction: This research aimed to assess the efficacy of Topiramate in reduction of opioid withdrawal symptoms in opioiddependent patients.Methods: In this double-blind clinical trial in Mashhad (2012-13) the efficacy of added topiramate in patient undergoing methadone detoxification treatment for opiate withdrawal compared to placebo in duration of 2 weeks. The statistical community of addicted men addicts who referred to Addiction Unit of Ibn-e-Sina hospital. Forty two in-patients (20-61 years), who met DSM-IV criteria for opiate dependence selected randomly, then they divided in to two groups randomly (topiramate 100 mg/day and placebo, during two weeks) under double-blind conditions. Measurement instrument of severity of subjective withdrawal symptoms was the Subjective Opiate Withdrawal Scale that conducted at five stages (1st, 3rd, 5th, 7th and 14th days). The collected data analyzed by descriptive and analytical statistic test such as ANOVA and SPSS version 16.Result: In both groups the severity of withdrawal symptoms decreased significantly but there was no significant difference in topiramate group compare to placebo (P>0.05).Conclusion: Added Topiramate (100 mg/day for two weeks) compare to placebo did not lead to significant decrease in acute subjective withdrawal symptoms in opioid addicts.

Introduction: Human T Lymphocytic Virus-type 1, in 3% of carriers causes HTLV-1 Associated Myelopathy /Tropical Spastic Paraparesis. Detrusor overactivity is the most common urodynamic finding. In this study the use of botulinum-A toxin injections into the detrusor, as an alternative approach in patients with HTLV1 related detrusor overactivity who are resistant to anticholinergic therapy or with side effects of the medication, was introduced.Methods: A total of 25 patients with HTLV1 infection and suffering from severe signs of overactive bladder who were resistant to conservative and medical treatment, had been included in this study. Urodynamic study were done, then 300 IU of botulinum toxin type A was injected into the detrusor.The reassessment and follow up were performed with urodynamic study 3 months later.Result: Overall 20 patients (80%) had high Maximum Detrusor pressure, higher than normal and after the injection reduced to 4 patients (16%) (p<0.001). From them, 2 patients had urinary leakage during cystometry, 19 patients (76%) had Uninhibited bladder contractions and after the intervention decreased to 5 patients (20%) (p<0.001) and from them, 2 patients had urinary leakage during cystometry.Conclusion: Injection of botulinum neurotoxin type A showed to be effective in patients with HTLV-1 related bladder overactivity, according to the improvement of urodynamic study parametres. This treatment can have a major impact on future management of patients with resistance to anticholinergic therapy or with side effects of this medication.

Introduction: There is strong clinical and experimental data that testosterone stimulates erythropoiesis. Inflammation, on the other hand, significantly impacts on haemopoiesis, partly through its suppression of erythropoietin and partly through its direct action on erythropoiesis. Therefore, in this study we evaluated correlation of serum testosterone levels with hemoglobin (Hb) and high sensitive CRP (hs-CRP) in patients with Chronic Kidney Disease (CK) in third and fourth stages and hemodialysis patients.Methods: A total of 29 patients with CKD in third and fourth stages (group1) and 29 hemodialysis patients (group 2) were included in this study. Serum hs- CRP, Hb, total and free testosterone, LH, FSH and erythropoietin levels were measured. Pearson’s correlation analysis was used for determining correlation between variables.Result: The mean of serum hs-CRP level was significantly lower in group1 than group 2, while serum FSH was significantly higher in group1. Pearson’s correlation analysis showed a significant positive correlation between hs-CRP and LH in total patients in two groups and patients in group 2. In comparison among 4 groups including group 1 and 2 with (Hgb<11 gr/dl) and without anemia (Hgb≥11 gr/dl), there was a significant positive correlation between hs-CRP and LH and an inverse correlation between hs-CRP and total testosterone only in anemic patients in group1.Conclusion: The significant inverse correlation between hs-CRP and total testosterone in hemodialysis patients with Hb lower than 11gr/dl suggested that this association may also partly contribute to anemia in hemodialysis patients compared with CKD patients in third and fourth stages.

Introduction: Recently, acute training and exercises have been recommended as a non-pharmacological and less expensive treatment of hypertension. For this reason, the aim of this study was to investigate the effects of rest interval (RI) between circuit resistance exercises (CRE) on post-exercise blood pressure reduction.Methods: Eleven normotensive females (aged 21.3±1.3 yrs, height 163.5±5.9 cm and weight 57.5±8.9 kg) performed two CRE with RI of 30 (RI30s) and 40 (RI40s) seconds between the exercises randomly. In the exercise sessions, subjects performed 3 circuits of 6 exercises with 10 repetition maximum (10RM) and 2 minutes rest between circuits. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured before exercise and at intervals of 10 min for 60 min after exercise.Result: In comparison of rest values, reduction of SBP observed after CRE with RI30s (at R20, R30, R40, R50 and R60) and RI40s (at R30, R40, R50 and R60), whereas reduction of DBP observed only after CRE with RI30s at R60 (p≤0.05). Also, there was no significant difference between exercise trials in pre and post-exercise levels of SBP and DBP.Conclusion: It can be concluded that CRE with different rest intervals between the exercises may have beneficial effects on health and can lead to occurrence of blood pressure reduction similarly in magnitude and duration.

Introduction: Acute Myocardial Infarction is one of the most common diseases all over the world and the first cause of death in Iran. Reperfusion therapy is the cornerstone of the effective treatment in these patients. Early thrombolytic therapy leads to better coronary reperfusion, and a greater reduction in mortality and reinfarction rates. The main purpose of this study, was to evaluate the effect of ESI triage, in improving the time of fibrinolytic therapy, in patients with STelevation MI, in emergency department of Imam Reza Hospital (from December 2009 to june 2012).Methods: This was an observational prospective study - before and after the implementation of ESI triage- Carried out, in 210 patients with STE- MI, referred to Imam Reza Hospital Emergency department. We compared door-to- ECG and door-to-needle times, between the two groups; spot check triage and ESI triage.Result: Overall 210 patients were included in this study, 105 patients were triaged through spot check method and 105 patients triaged through ESI triage.The mean age of the patients, was 55.56±1.36 years The door-to-ECG time was significantly lower in the ESI triage group than spot check triage ones (35±10.38 v.s.15.02±10.33 mins) (p<0.001). The door-to-needle time was also, significantly lower in the ESI- triaged patients (50.23±11.10 v.s.30.56±6.03 mins) (p<0.001).Conclusion: Implementation of ESI triage, can Significantly lower the door-toneedle time in the patients with STEMI, and hence, decrease the morbidity and mortality in these Patients.

Introduction: Asthma is a chronic inflammatory disorder in children.Intelligence quotient is an indicator of one's efficacy. This study aimed to compare the IQ of children diagnosed with moderate asthma compared to IQ of healthy children.Methods: This comparative study was conducted in 2011. Wechsler intelligence scale for children was used by split half method to calculate the overall IQ (0.97), verbal IQ (0.97) and practical IQ (0.93). The t-test and Chi square test were used to analyze quantitative variables and qualitative variables; respectively. P-value was significant when less than 0.05.Result: Out of 204 children, 114 (56%) in the case group and 90 children (44%) in the control group participated in comparing their IQs. One hundred and fifteen (56%) were males and 89 (44%) were females. The overall IQs of asthmatic patients and healthy patients were 109 and 108, respectively; the difference was not significant (p=0.905). Furthermore, there was no significant difference in the IQ scores between males and females.Conclusion: Asthma is a chronic disease that has no negative impact on IQ.

Introduction: The reduction of melatonin is associated with the increase in vasoconstriction and blood pressure (BP).The purpose of this study was to investigate the effect of short-term melatonin consumption (MC) on some cardiac parameters of young women during rest, immediately after exercise and during recovery.Methods: This semi-experimental study was done in Mashhad. Active young women (24people) voluntarily participated in the study, and were randomly divided into two groups of MC and placebo groups. During rest condition, BP and body temperature were measured and heart contractility and hemodynamic parameters were measured using the cardio screen system. Then Bruce protocol was conducted on the treadmill until exhaustion phase. In the recovery, the subjects walked on the treadmill and at the fifth minute cardioscreen indicators and blood pressure were recorded. For one week, experimental group took 3milligram melatonin tablets and placebo group took 3milligram of placebo tablets every night. On the ninth day of luteinizing, the tests were repeated again and by using paired t-test and ANOVA test the following findings were obtained (p<0.05).Result: There were a significant difference (SiDi) between two groups in BP changes in the "recovery" and Heart Rate (HR) and Systemic Vascular Resistance index (SVRI) changes in all the three phases. There was a SiDi in the Acceleration Index (ACI) and Velocity Index (VI) changes in the "right after exercise" and "recovery", so that the increase in VI and ACI in MC group was more than the increase in placebo group. There was no SiDi in the amount of Left Ventricular Ejection Time (LVET) changes in three conditions.Conclusion: According to the results, MC reduces the pressure on cardiovascular system during the activity and increases the efficiency of recovery.

Introduction: Cecal volvulus is an uncommon cause of large bowel obstruction in developed countries. Cecal vovulus is the second most common type of colonic volvulus, accounting for 10-40 % of colonic volvulus and 2% of all cases of adult intestinal obstraction.Case Report: We presented a case of cecal vovulus in 52 years old man. In this case Cecum was twisted axialy and severely distended with patchy gangrenous areas, but there was no perforation.Conclusion: In most cases of Cecal vovulus resection by hemicolectomy is favoured, except in patients with a viable cecum and high degrees of comorbidity. In these cases cecopexy may be considered.