فهرست مطالب

Red Crescent Medical Journal - Volume:19 Issue: 10, Oct 2017

Iranian Red Crescent Medical Journal
Volume:19 Issue: 10, Oct 2017

  • تاریخ انتشار: 1396/08/30
  • تعداد عناوین: 21
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  • Jin Zheng, Hong Chen, Ying Pan, Xin Yue Page 1
    Background
    Breast cancer (BC) is one of the leading causes of cancer-related mortality among females worldwide. There is no effective 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 revealing the molecular mechanisms underlying BC.
    Methods
    The current case-control bioinformatics analysis used the already published microarray data of BC. The current foundation-application study was performed in Moffitt cancer center, USA, in 2010. To begin with, the gene expression profile of BC (access number E-GEOD-10780), which included 185 samples (143 normal controls and 42 BC samples), was recruited from ArrayExpress 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 cancer PCN (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, the degree of original pathways in BPCN was greater than that of the majority of AOPs in CPCN. Based on the threshold of RankProd 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 BC therapy.
    Keywords: Breast Cancer, Network, Pathways, Biomarkers
  • Zeinab Jalambadani, Gholamreza Garmarodi, Mehdi Yaseri, Mahmood Tavousi, Korush Jafarian Page 2
    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 the theory of planned behaviour (subjective norm and perceived behavioural control), on reducing fast food consumption in obese Iranian female adolescents.
    Methods
    In this quasi-experimental study, data were collected through a survey. This study included 420 obese Iranian female adolescents, 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, and perceived 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). Also, no statistically meaningful difference 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 behavioural control, and subjective norms can be used in educational interventions and have useful results.
    Keywords: Obesity, Adolescents, Education, Consumption
  • Shahrbanoo Abdolhosseini, Fataneh Hashem-Dabaghian, Roshanak Mokaberinejad, Omid Sadeghpour, Mitra Mehrabani Page 3
    Background
    Nausea and vomiting during pregnancy (NVP) affects approximately 50% - 80% of expecting mothers. NVP can impose negative 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 randomization method. A total of 24 and 31 patients were analyzed in the syrup and vitamin B6 groups, respectively. The 24-hour pregnancy-unique quantification of emesis (PUQE-24) scale was used to examine the severity of NVP. The intervention included the use of pomegranate 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 square test 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 mean PUQE-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
    Conclusions
    The effectiveness of pomegranate and spearmint syrup in reducing NVP was confirmed in the syrup group versus the control group with significant differences.
    Keywords: Pomegranate, Spearmint, Nausea, Vomiting, Pregnancy, Iranian Traditional Medicine
  • Hedayatollah Vakili, Hasan Enayati, Alireza Dashipour Page 4
    Background
    Neuraxial anesthesia is an acceptable technique in pregnant females for cesarean section and up to 71% of pregnant patients have hemodynamic complications, especially hypotension.
    Objectives
    This study aimed at comparing the effectiveness of phenylephrine versus ephedrine in treatment of maternal hypotension due 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 in Zahedan, Iran, between 2015 and 2016, for elective cesarean section, were selected by the Block randomization sampling method. The samples were divided to 4 groups: Group I received 5 mg ephedrine bolus, Group II was administered 10 mg bolus ephedrine, Group III were delivered phenylephrine bolus of 50 mcg, and Group IV 100 mcg phenylephrine bolus in case of hypotension. Neonatal outcome 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 significant difference between the groups (P
    Conclusions
    Control of blood pressure during spinal 50-mcg phenylephrine is recommended.
    Keywords: Phenylephrine, Ephedrine, Spinal Anesthesia, Cesarean Section, Hypotension
  • Seyed Vahid Ahmadi Tabatabaei, Hassan Eftekhar Ardabili, Ali Akbar Haghdoost, Maryam Dastoorpoor, Nouzar Nakhaee, Mohsen Shams Page 5
    Background
    Theory of planned behavior (TPB) has not been adequately addressed in the field of physical activity among Iranian women.
    Objectives
    This study aimed to determine factors affecting physical activity behavior among women based on the theory of planned behavior.
    Methods
    This cross-sectional study was conducted on 398 women in Kerman, Iran. The women were selected through the multi-stage random sampling method. Data were collected using the international physical activity questionnaire (IPAQ) and a researcher-made questionnaire 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 (β = 0. 16, P = 0. 013) and behavioral intention (β = 0.16, P = 0.005) had a significant positive direct effect on physical activity behavior. Moreover, instrumental attitude (β = 0.04, P = 0.003), subjective norms (β = 0.04, P = 0.003) and perceived behavioral control (β = 0.03, P = 0.002) had a significant positive indirect effect on physical activity behavior. Behavioral intention and perceived behavioral control constructs predicted 6% of variance of physical 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 activity in women.
    Keywords: Physical Activity, Behavior, Theory of Planned Behavior, Women
  • Zhi-Hua Wang, Dong Xiang, Jun-Jie Dong, Shao-Xuan He, Li-Min Guo, Jia Lv, Wei Wei, Nan-Nan Kou, Jun Shu Page 6
    Background
    Pathway analysis is the first choice for gaining insight into the underlying biology of disease, as it reduces complexity and increases explanatory power.
    Objectives
    The purpose of our paper was to investigate dysregulated pathways between ankylosing spondylitis (AS) patients as well 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 - Illumina HumanHT-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 interacting genes/proteins (STRING, http://string-db.org/) as well as Reactome databases, respectively. Furthermore, according to the principal component analysis (PCA) method, the seed pathway was selected by computing the activity score for each pathway. A PIN was constructed dependent on the data and Pearson correlation coefficient (PCC). Dysregulated pathways were captured from the PIN by utilizing 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 seed pathway (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 normal controls, such as L13a-mediated translational silencing of Ceruloplasmin expression, GTP hydrolysis, as well as joining of the 60S ribosomal subunit.
    Conclusions
    These results might be available to provide potential biomarkers to diagnose AS as well as give a hand to reveal pathological mechanism of this disease.
    Keywords: Ankylosing, Spondylitis, Pathway, Interaction, Network
  • Zohreh Ahmadi, Zahra Abbaspoor, Naser Behroozy, Amal Saki Malehi Page 7
    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 infertile women.
    Methods
    This clinical trial was performed on 24 infertile women, admitted to the Infertility Research and Treatment Center of Ahvaz, Iran in 2016-2017. In the first stage, convenience sampling was applied, and the participants were allocated to 2 groups (12 patients per group), using a table of random numbers. The experimental group participated in 10 sessions of CBT weekly, based on the 8-step program by Cash. body-self relations questionnaire and Beck Self-Concept inventory were completed in each group before, 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 control groups, 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 and improving their irrational beliefs about their bodies.
    Keywords: Body Image, Cognitive Behavioral Therapy, Infertility
  • Pari Rahi, Mojgan Mirghafourvand, Sakineh Mohammad-Alizadeh-Charandabi, Yousef Javadzadeh Page 8
    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 2 groups through block randomization. The first group (n, 72) received quince pills, while the second group (n, 74) used mefenamic acid pills for 3 consecutive cycles. The participants completed the pictorial blood loss assessment chart (PBAC) before and during the 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 from 173.6 (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 months after 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 between the groups in terms of the mean PBAC score (P = 0.183). Similarly, after the intervention, there was no significant difference between the 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, they seem to be a proper alternative for mefenamic acid.
    Keywords: Mefenamic Acid, Quince, Menorrhagia, Quality of Life
  • Sila Korun, Nerin Nadir Bahceciler, Mustafa Murat Uncu, Nilufer Galip, Ceyhun Dalkan, Serap Cetiner Page 9
    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 NEU gynecology 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. Infants underwent 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 blood 25(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 hygiene habits 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 analysis revealed 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 measuring 25(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.
    Keywords: Dental Caries, Vitamin D, Chronic Disease, Oral Health
  • Maryam Moradinasab, Afshin Ostovar, Iraj Nabipour, Seyed Sajjad Eghbali, Katayoun Vahdat, Abbas Ghaderi, Mohammad Reza Farzaneh, Mohammad Reza Ravanbod Page 10
    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 function of 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 risk in southern Iranian women from Bushehr.
    Methods
    A case-control study was conducted on 144 cases with histologically confirmed invasive breast carcinoma and 162 randomly selected healthy controls with no previous cancer history in their family. TP53 codon 72 genotype was determined by using restriction 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 genotype distribution between cases and controls.
    Conclusions
    These results should be confirmed in larger studies, but suggest that TP53 Arg/Pro genotype modifies the risk of breast cancer in tobacco smokers and causes significantly more susceptibility to breast cancer due to smoking.
    Keywords: P53, Breast Neoplasms, Polymorphism, Smoking
  • Afsaneh Alikhassi, Maryam Rahmani, Nasrin Ahmadinejad, Sona Akbari, Farzin Roozafzai, Zahra Alikhassy Habibabadi Page 11
    Background
    No information has been published on the effectiveness of digital non-diagnostic opportunistic screening mammography in 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 university hospital 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 were subsequent mammography. The patients were referred to the university hospital by their clinicians during annual check-ups while none of them had any chief complaint. The mean age was 49 years. We calculated recall rate, sensitivity, specificity, and cancer detection rate.
    Results
    Breast cancer was diagnosed in 80 patients. Recall rates were 29% for the first-time and 22% for subsequent mammography, and the overall rate of cancer incidence was 8.5 per 1000 mammograms (80/9395) with specificity of 75.9%, sensitivity of 97.5%, PPV of 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 sensitivity and detection rate were higher; thus, the higher recall rate could be due to some differences in the patient population such as being at younger ages and higher risks.
    Keywords: Recall Rate, Mammography, Breast Cancer, Screening, Detection Rate
  • Mehri Khoshhali, Iraj Kazemi, Sayed Mohsen Hosseini, Shiva Seirafian Page 12
    Background
    The change and trend in serum albumin levels after initiation of peritoneal dialysis may be a crucial determinant for clinical outcomes.
    Objectives
    The current study aimed at determining the association between the trajectory of serum albumin and the 3-year clinical outcomes using a novel approach joint modeling longitudinal and survival data. Furthermore, the current study was performed to compare 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 ambulatory peritoneal dialysis (CAPD) in Al-Zahra hospital, Isfahan, Iran, from May 2005 to March 2015. A total of 183 patients with at least 3 years follow-up were selected for the study. The independent variables of interest were baseline and the trajectories of serum albumin, age, gender, history of previous hemodialysis (HD), body mass index (BMI), baseline serum creatinine, and comorbidity including cardiovascular disease and diabetes. The outcomes of interest were death from all causes, transfer to HD and transplantation during 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 of the Cox regression with baseline albumin. Hazard ratios of mortality, transfer to HD, and transplantation for trajectories of serum albumin 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 albumin was higher than those of the baseline. According to the findings of the current study, it seems that controlling serum albumin over time in patients undergoing CAPD, particularly the ones with the history of diabetes and HD, can help to prevent or modify the clinical outcomes during the PD period.
    Keywords: Longitudinal Studies, Iran, Serum Albumin, Survival Analysis, Peritoneal Dialysis
  • Nasrin Hanifi, Masomeh Masoumi, Mohammad Reza Jamshidi, Soghrat Faghihzadeh Page 13
    Background
    The relationship between the oral care and ventilator-associated pneumonia (VAP) was confirmed in patients undergoing ventilation.
    Objectives
    The current study aimed at investigating the effects of chlorhexidine gluconate (CHX) and ozonated water on the prevention of VAP.
    Methods
    The current double-blind, randomized, clinical trial with the experimental and control groups was conducted in Iran in 2014. In the current study, 75 inpatients undergoing ventilation were grouped through the convenience sampling method and randomly allocated into 2 groups based on the inclusion criteria. In the experimental group (39 patients), oral care provided by ozonated 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 the experimental group (14.6%) was significantly lower than that of the control group (30.6%) (P value = 0.02).
    Conclusions
    Based on the results, ozonated water was more effective to prevent VAP than CHX. Ozone water can be used as a suitable alternative mouthwash in patients undergoing mechanical ventilation.
    Keywords: Oral Hygiene, Chlorhexidine Gluconate, Ozone, Ventilator, associated Pneumonia, Mechanical Ventilation
  • Zahra Pourkhiz, Sakineh Mohammad Alizadeh Charandabi, Mojgan Mirghafourvand, Sakineh Haj Ebrahimi, Fariba Ghaderi Page 14
    Background

    Current evidence on the effect of pelvic floor muscle (PFM) training for promoting sexual function is limited. Recent reviews 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 pregnancy at 17 - 20 weeks, aged 18 - 35 years, were recruited using purposive sampling among clients of five public health centers or two governmental maternity 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 to the PFM group received 4 sessions of supervised training, with practical, oral, and written instructions on how to continue performing regular PFM exercises at home. Female sexual function index, sexual quality of life questionnaire-female, and Oxford scoring were used to assess the outcomes at 28 - 30 weeks gestation and 80 - 90 days following birth.

    Results

    There was one loss to follow-up from each group. A total of 6 women had not exercised regularly. Compared with the control group, 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

    Conclusions

    Based on the results, PFM training during pregnancy and postpartum could improve sexual function in nulliparous women. Therefore, it should be recommended to all of the women.

    Keywords: Pelvic Floor, Quality of life, Exercise, Sexual function, Pregnancy, Postpartum
  • Sahar Dalvand, Zahra Salehi, Masoud Taheri Asl, Hossein Zahednezhad, Nazli Ebrahimi, Mahboubeh Nazari, Vahid Rahmani, Reza Ghanei Gheshlagh, Fereshteh Mazhariazad Page 15
    Background
    Hypertension is a risk factor that may lead to development of Atherosclerosis (ATS). Recent studies have emphasized on 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) and diastolic blood pressure (DBP) using the mixed response model.
    Methods
    This cross-sectional study comprised of 245 participants, hospitalized at Shahid Madani state hospital, Khorramabad-Iran diagnosed with ATS in fall and winter 2014. The method of sampling was convenience sampling and the participants were selected through 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 provide proper education on changing life style and preventing the disease.
    Keywords: Atherosclerosis, Systolic Pressure, Diastolic Pressure, Cholesterol, Multivariate Analysis
  • Ali Akbar Ahmadi, Mohammad Javad Alemzadeh-Ansari, Yaser Jenab, Neda Ghaffari-Marandi Page 16
    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 of patients: 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 relative changes 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 following admission. 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 available in 889 and 641 patients, respectively. Cardiovascular risk factors, including hyperlipidemia, diabetes mellitus, smoking, and history 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-ACS group. Also, the absolute and relative changes in hs-cTnT were more significant in the NSTEMI group. Moreover, hs-cTnT velocity within 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
    Conclusions
    The changes in hs-cTnT (ie, absolute, relative, and velocity changes) were more significant in the NSTEMI group in comparison with non-ACS patients.
    Keywords: Acute Coronary Syndrome, Myocardial Infarction, Troponin T
  • Sun Pyo Kim, Seong Jung Kim, Kyung Hoon Sun, Yongjin Park Page 17
    Introduction
    Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory 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. This patient was admitted to the Chosun University hospital in Gwangju, Republic of Korea, on January 2017. In spite of conservative treatment, the symptoms were more aggravated. Therefore, we decided to conduct operative intervention. After gastrotomy, massive bleeding showed on nasogastric tube and drain site, then disseminated intravascular coagulopathy was developed. On the third 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.
    Keywords: Bulimia Nervosa, Gastric Atony, Disseminated Intravascular Coagulopathy
  • Fares Najari, Masoud Ghadipasha, Ali Alimohammadi, Ideh Baradaran Kayal, Khadijeh Saravani Page 18
    Introduction
    Septorhinoplasty is one of the most common cosmetic procedures in Iran. Intracranial complications such as meningitis, cerebrospinal fluid (CSF) rhinorrhea, pneumocephalus, and damage to the skull’s base are rare, but potential life-threatening complications are associated with such procedures, though very few cases of intracranial complications after septorhinoplasty have been reported.
    Case Presentation
    A 29-year-old woman was admitted to a limited surgery clinic in Tehran, Iran in 2015 for septorhinoplasty, and 4 days post-operation she complained of headache, drowsiness, and CSF rhinorrhea. The patient’s surgical complications included a 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 skull base and other cerebral complications, it is necessary that surgeons use a suitable technique, understand appropriate anatomical information, maintain awareness of possible anatomic variations, and practice gentle manipulation of the ethmoid roof.
    Keywords: Rhinoplasty, Cerebrospinal Fluid Rhinorrhea, Pneumocephalus, Postoperative Complications
  • Tahmine Tavakoli, Peyman Adibi, Mohammad Hossein Sanei, Kiyan Heshmat-Ghahdarijani Page 19
    Introduction
    Mucormycosis of the gastrointestinal tract is a rare invasive fungal infection and due to late diagnosis, it is associated with a high mortality rate.
    Case Presentation
    The studied patient was a 20-year-old woman, known case of Ulcerative colitis, admitted to emergency unit of Alzahra hospital of Isfahan University Of Medical Sciences, Iran, in May of 2013 by abdominal pain, fever, and leucopenia. With possible diagnosis of typhlitis, she underwent laparotomy. Gangrene, inflammation, and obstruction of 30 centimeter of jejunum and momentum 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.
    Keywords: Mucormycosis, Inflammatory, Bowel, Disease
  • Hulya Aslan, Aysin Pourbagher, Ali Ezer, Filiz Aka Bolat, Hakan Yabanoglu Page 20
    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) elastography findings of angiosarcoma have not been reported yet. Currently, US elastography should be used commonly to decide biopsy 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 Research Center at the breast center of Baskent University, with a palpable right breast mass, which had been enlarging for one year in 2015. 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 diagnosis of the mastectomy specimen confirmed low-grade angiosarcoma. If the recommendation would have been based on the elastography findings, 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.
    Keywords: Breast, Magnetic Resonance Imaging, Angiosarcoma, Ultrasound, Elastography
  • Hamid Taghinejad, Gholamreza Noori, Elham Mohammadyari, Hamed Tavan Page 21