Iranian Red Crescent Medical Journal
Volume:13 Issue: 7, Jul 2011

Retinoblastoma (RB) is the most common primary intraocular cancer of childhood. There is no published report on this affliction at our center as a referral center in southern Iran. This study aimed to perform a 15 years epidemiological assessment of RB, in Fars Province, Southern Iran. We retrospectively analyzed medical records of all patients with RB diagnosed in Khalili Hospital affiliated to Shiraz University of Medical Sciences in Shiraz, Southern Iran. All available pathologic slides were reviewed and staging of tumors were revised using the TNM classification of 2008. Sixty-seven patients were enrolled in this study (46.3% females and 53.7% males). Among the cases, 71.6% had unilateral and 28.8% bilateral RB. The mean age of symptom presentation and diagnosis were 20.5±16.5 and 26.3±20.1 months, respectively, which were significantly lower in bilateral cases. Leukocoria wasthe most common presenting symptom (56.7%), followed by strabismus (10.4%). The result of histopathological review showed that RB in 70% of patients was at T1, T2 and T3 stage, but 30% were at T4 stage. Demographic and clinical variables of RB under the present study are comparable with published reports but our patients were diagnosed at the later stage, leading to poorer prognosis. It is necessary to expand the existing organizations into a comprehensive population-based registry system to obtain a clearer picture of the epidemiology of RB in our region.

Proton pump inhibitors (PPIs) decrease the rate of rebleeding following endoscopic hemostatic therapy in patients with bleeding peptic ulcers. This study compares the efficacy of oral omeprazole vs intravenous pantoprazole in decrease of rebleeding of peptic ulcer patients. One hundred and six patients with high risk peptic ulcer were randomized to receive either oral omeprazole (80 mg BID for 3 days) or IV pantoprazole (80 mg bolus and 8 mg/hour infusion for 3 days) followed by omeprazole (20 mg each day for 30 days). All patients underwent upper endoscopy and endoscopic therapy within 24 hours. Seventeen patients were excluded from the study. Forty four patients were randomly allocated into omeprazole group and 41 patients to IV pantoprazole group. Both groups were similar for factors affecting the outcome. Bleeding reoccurred in five patients of omeprazole group and four patients in pantoprazole group (11.4% vs 9.8 %). The mean hospital stay and blood transfusion were not different in both groups. Oral omeprazole and IV pantoprazole had equal effects on prevention of rebleeding after endoscopic therapy in patients with high risk bleeding peptic ulcers.

Drug abuse is one of the most important public health problems worldwide as in Iran. The aim of present study was to determine whether opium addiction can affect bone mineral density or not. Fifty opium addicted and 50 non-addicted volunteer men aged between 25-45 were enrolled. The subjects with positive history of other osteoporosis risk factors were excluded. The vertebral bone density and potential confounders (age, cigarette smoking and body mass index) were measured in all subjects. Twenty six percent of non-addicted vs. 56% of addicted subjects had vertebral osteopenia. According to adjusted ORs, addiction to opium (OR: 3.08, CI95% 1.20-7.92) and age (OR: 1.11 CI95% 1.03-1.20) were significantly related to vertebral bone loss. Opium addicted patients were more susceptible to bone loss than non-addicted individuals. So, early screening and conducting prevention programs should be taken into consideration for this high risk group.

In order to achieve maximum client satisfaction, family planning must incorporate the client's views and perception; this in turn depends heavily on the cultural and religious context. This qualitative study was performed with the aim of assessing the need for family planning services in various client groups. Focus Group Discussions (FGD) were conducted with four different categories of clients attending primary health care centers in Southern Tehran, Iran. The study also involved group interviews with Liaison Health Workers. Clients generally complained of problems such as the crowding of people inside health centers, inconvenient working hours, disrespectful staff members, poor client education, counseling, and contraceptive complications. Most clients expressed the need for higher education and quality services. Liaison workers listed their main problems as inadequate staffing, limited attendance time, client overload, the community's negative attitude towards state-run health facilities, and common misperceptions regarding various contraceptive modalities. Suggestions for improving quality of services included identification of common goals for staff and clients, providing adequate consultation courses for client and staff members, improving the general atmosphere of the clinic, reducing waiting time, and improving clinic access.

Reflexology is an ancient, mild and non-invasive technique, used widely as one of the non-pharmacological methods for pain relief. The aim of this research was to determine the effect of reflexology on pain intensity as well as to determine the duration of labor in primiparas. In 2008, a randomized clinical trial study was conducted randomly enrolling 120 parturient women with low risk pregnancy into three groups in Shahid Akbarabadi Hospital, Tehran, Iran. The first group received 40 minutes of reflexology at the beginning of active phase (4-5 cm cervical dilatation). Emotional support was offered for the second group in the same stage of pregnancy and with the same duration. The third group received only routine care during labor. Pain severity was evaluated with visual analogue scale (0 to 10 cm). In all groups, pregnant women were asked to evaluate the severity of pain experienced before and after intervention and also at cervical dilatations of 6-7 cm and 8-10 cm respectively. Data were collected through the numerical pain scale. Pain intensity at all the three stages of cervical dilatation was significantly lower in the reflexology group. During the 4-5 cm dilatation stage, women in the supported group reported less severe pain compared to those receiving routine care, but no significant differences at the later stages of labor. This indicates that reflexology could decrease the duration of first, second and third stages of labor. Our findings showed that reflexology can be useful to decrease the pain intensity as well as duration of labor.

Trichomoniasis vaginalis is now an important worldwide health problem. Metronidazole has so far been used in treatment, but the metronidazole-resistant strains and unpleasant adverse effects have been developed. Myrrh is one of the oldest known medicinal plants used by the ancient Egyptians for medical purposes and for mummification. Commiphora molmol (Myrrh) proved safe for male reproductive organ which is the main habitat of T. vaginalis and this study aims to evaluate the efficacy of the herbal against T. vaginalis in females. In the present study, 33 metronidazole-resistant T. vaginalis females were treated with a combined course of metronidazole and tinidazole. Those still resistant to the combined treatment were given C. molmol. Also, natural plant extract purified from pomegranate (Punica granatum, Roman) was in-vitro investigated for its efficacy against T. vaginalis on Diamond media. The anti-T. vaginalis activity of both P. granatum (in-vitro) and C. molmol (in-vivo) extracts gave promising results. The anti-T. vaginalis activity of P. granatum and C. molmol showed promising results indicating to sources of new anti-Ttrichomonas agents.

Polycystic ovary syndrome (PCOS) is one of the most common diseases among women associated with various inflammatory reactants such as C-reactive protein (CRP) and ferritin. This study aimed to investigate the effect of metformin on probable reduction of serum ferritin in patients with PCOS. This study was conducted on 45 patients with PCOS who had not other systemic diseases and did not take any medications. Weight, waist and hip circumstances (WHR), body mass index (BMI), metabolic indexes, CRP, ferritin and “Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) ˝ were measured before the study. Metformin (500 mg/tid) tablets were prescribed for three months and then same above parameters were re-measured. Of 45 patients, 19 (42.2%) were overweight and 14 (31.1%) were obese. After drug therapy, there was a significant reduction in waist circumstance and serum ferritin. This reduction was significant only in the lean and overweight groups but not in the obese group. There was not significant association between serum ferritin and CRP, HOMA-IR, BMI and WHR. There was not significant correlation between CRP and HOMA-IR and also BMI. The effect of metformin on reduction of serum ferritin was not significant just in obese group and was not associated with metabolic and anthropometric indexes.

Hemoglobin-D (Hb D) is an uncommon structural hemoglobin variant, which is reported to be prevalent in north western India. There are only a few small series, of this entity in the literature. We report the largest single center experience on this entity from Iran. Between November 2002 and December 2010 as a result of screening premaritally for beta-thalassemia in Shiraz, Fars Province, Southern Iran, column chromatography, Hb electrophoresis, solubility test, and/or high performance liquid chromatography (HPLC), direct sequencing and restriction analysis were used for hemoglobinopathies and structural Hb variants. The data of 220 subjects with Hb D variants are analyzed in this report. These comprised of 180 carries of Hb D; 92 cases of Hb D Punjab/Los Angeles (b121Glutamic acid®Glutamine) and 88 subjects with Hb D Iran (b 22 Glu®Gln), 3 homozygous cases for Hb D, 17 subjects with beta- thalassemia- Hb D, 12 with Hb D- alpha- thalassemia- 1, 3 homozygous Hb D- alpha thalassemia- 1 trait, one with Hb D Punjab - sickle cell anemia, and two with Hb D Iran/sickle cell anemia. The carriers of Hb D and homozygous cases for Hb D were not anemic and had normal red blood cell morphology, as they are not usually detected. If Hb D was inherited in combination with thalassemia, the subjects had mild anemia and in some of them, the spleen was palpable (1-2 cm). Co-inheritance of alpha thalassemia and Hb D resulted in the slightly higher Hb level and lower Hb D level as compared to Hb D/ beta- thalassemia cases (Hb D 24-37% vs 57-88%). Co inheritance of Hb D and sickle cell results was moderate to severe hemolytic anemia.

Actinomycosis of the tonsils has been reported in a variable percentage of tonsil specimens by other authors. This study determines the incidence of actinomyces in the palatine tonsil and evaluates the clinical diagnoses and histopathological features of tonsillectomy specimens. In a retrospective study, 204 patients who had undergone tonsillectomy for recurrent tonsillitis (group A) and for sleep apnea without a history of recurrent tonsillitis (group B) were enrolled. The prevalence rate was significantly higher in the adult compared with the pediatric population. The prevalence of tonsillar actinomycetes colonization was higher in patients who had undergone tonsillectomy for recurrent tonsillitis (43.9%) than in patients who had undergone tonsillectomy for obstructive sleep apnea (26.3%). The prevalence did not differ by sex of patient. Histopathological analysis of resected tonsils did not show active tissue infection. There was a statistically significant relationship between the presence of actinomycosis and age, with a greater occurrence of actinomycosis in adult patients. Although actinomyces colonization is more prevalent in patients with recurrent tonsillitis than sleep-disordered breathing, but the presence of actinomyces does not indicate any active disease.

Diabetes mellitus (DM) is one of the most common disorders of endocrine glands which has a worldwide distribution and is a risk factor for oral pathology so; the purpose of the present study was to investigate the association between median rhomboid glossitis (MRG) and DM. We examined 202 Iranian patients with DM aged 10-86 years and 261 healthy subjects aged 10-28 years and the diagnosis of MRG was made based on clinical features. The examination indicated that 13 (6.43%) diabetic patients and 4 (1.53%) of control group had MRG. There was a significant difference in the prevalence of MRG, between patients and control group. MRG showed no association with other variables (age, sex, duration of DM, drugs, FBS, A). In the present study the prevalence of MRG in diabetics was much higher than that of controls.

Simultaneous squamous cell carcinoma (SCC) of esophagus and gastroesophageal adenocarcinoma has rarely been reported. It is often difficult to diagnose this coexistence preoperatively due to the presence of esophageal stenosis. Herein, we report a patient with esophageal SCC whose gastroesophageal adenocarcinoma was also detected after pathologic examination of the resected specimen.